I know that you have heard this before, only to be disappointed with having set your TIVO in vain, but I have been told by pretty high sources that my appearance on EXTRA discussing Fraxel re:pair has been "etched in stone" for Tuesday November 25, 2008 on NBC at 7:00 pm, for what that's worth in "Hollywood". I hope that you and your family have a loving and warm Thanksgiving.

Plastic Surgery Practice (PSP) reports in their current e-report that "Lipotec has introduced a nonsurgical way to give patients full lips, a new method of vehiculizing hyaluronic acid called Hilurlip. The name doesn't exactly roll off the tongue, but the manufacturer is making big claims for its product. Hilurlip is an oil suspension containing particles of sodium hyaluronate, which is processed to the point at which the particle size is reduced and homogenized up to 1µm—the company claims that this enhances the product's penetration and efficacy, and can provide up to an 18% increase in lip volume. These particles expand when they come in contact with skin water, and reportedly provide long-term plumping of the lips. Hilurlip also contains the tripeptide GHK, a well-known RCS scavenger that protects the lips against photodamage and loss of collagen elasticity. The product can be incorporated into water-free lip care formulations, such as glosses and lip balms. The company advises against using the product in lipsticks. Source: Lipotec" I for one will believe it when I see it. I remain skeptical at this time about product claims of penetrating topically through the skin barrier to impose their effect. How many millions of dollars have been wasted on Strivectin anti-wrinkle cream, and its claims that it is "better than Botox"? Please comment if you have had any experience with these products.

Colin Stewart, cosmetic medicine columnist of the Orange County Register asked me to comment on whether my patients still request facial features "like Angelina Jolie's" -- or have other celebrities edged her out? The most common request from my patients regarding a feature of Angelina Jolie's that they would like on them is Brad Pitt! Second to that are lips, most patients would love to have her lips, while others do not want their lips to "be as full as Angelina Jolie's". Angelina possesses the classical features of beauty that were described by Leonardo da Vinci during his anatomy studies and drawings of 1511. His proportions are used by plastic surgeons today. Angelina's face is very symmetric. Her face can be divided into 3 equal thirds horizontally, her forehead, her brows to her upper lip, and her upper lip to chin. Likewise, vertically her face can be divided into equal fifths, each the width of the distance between her eyes. Her forehead is flawless (Botox?). Her nose fits her face and allows us to focus on her beautifully shaped eyes. And then of course those sexy Angelina lips. Are they real or not? I won't tell, but only Angelina and her injector know for sure. Enough on her, Brad, know that you are still the most requested feature of Angelina that my patients request. Check out the Orange County Register later this week for the complete article.

I, like all of you, was and continue to be deeply saddened by the local Metro link train crash in Chatsworth on Friday, September 12, 2008. I know that many survivors suffered facial and other lacerations, some of which may result in permanent scars. I would like to offer those involved in the accident with scars Fraxel re:store laser treatments at no cost. The treatment is relatively painless, quick, and involves anywhere from one to a series of treatments until the scar is maximally improved. The treatment can blend scars so that they are nearly imperceptible. Please call my office to set up an appointment. I hope that everyone heals well and that this service will be not be necessary. Be well.

Lumigan 0.03%, manufactured by Allergan as a glaucoma eye drop is gaining popularity as an eye lash enhancer. As noted below in the "warnings" section, one of the side effects is the growth of eyelashes. Patients are seeing imrpovement as soon as 3 weeks. The product is available from physicians by prescription only. Instructions for use for eyelash growth: Remove Lumigan dropper cap and dip eyeliner brush into bottle. Apply with eyeliner brush as you would eyeliner, once daily until lashes are desired length (it may take 1-3 months to achieve the desired length), then once weekly for maintenance. If irritation occurs, stop for 1 week then start again every other day. Rinse after each use and keep brush in clean baggie or replace cap over brush. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor. Warnings: Lumigan® (bimatoprost ophthalmic solution) 0.03% has been reported to cause changes to pigmented tissues. When used for glaucoma as eye drops on the eye, the most frequently reported changes have been increased pigmentation of the iris (the colored portion of the eye), periorbital tissue (eyelid) and eyelashes, and growth of eyelashes. Pigmentation is expected to increase as long as Lumigan® is administered. After discontinuation of Lumigan® pigmentation of the iris is likely to be permanent while pigmentation of the periorbital tissue and eyelash changes have been reported to be reversible in some patients. Patients who receive treatment should be informed of the possibility of increased pigmentation. The effects of increased pigmentation beyond 5 years are not known. For additional Important Information about Lumigan® call 818 501-face.

CLINTON AND COSMETIC MEDICINE As Hillary Clinton, 60, basks in the spotlight at this week’s Democratic National Convention, doctors say she appears to have used some of the tools of cosmetic medicine to fight against the signs of aging. But Clinton would still benefit from more skin-rejuvenation treatments to further the process, they say. Minimally invasive injections and laser treatments are what the doctors see some evidence of, not nip-and-tuck-style plastic surgery. If Clinton has had Botox injections, though, the photo above is evidence that only a modest amount, at most, was used in her forehead. Otherwise, she wouldn’t be able to make that expression. You might think otherwise if you only looked at her smooth forehead in the photo below. Plastic surgeon Dr. Michael A. Persky of Encino suggests that the skin on Clinton’s face looks as though it was firmed-up with a Fraxel re:store laser. Made by Reliant Technologies of Mountain View, Calif., the re:store device is a non-ablative erbium fractionated aser, which rejuvenates the skin with 1 to 2 days of recovery time. Persky says: Hillary Clinton may have had Fraxel re:store treatments, a series of no-downtime laser treatments that help with skin tone, texture, and color, with minimal tightening of the skin. She also may have had Botox and dermal fillers (Restylane, Juviderm, Preville Silk). Ms. Clinton does not appear to have had any major plastic surgery. That’s the type of treatment that Newport Beach dermatologist Dr. Vince Afsahi recommends for Clinton: Many prominent women we treat in our office prefer a subtle-yet-effective transformation when they embark on a skin rejuvenation program. Because they are in front of the camera on a daily basis, non-surgical modalities for treating the signs of aging are recommended. Fillers such as Juvederm for the laugh lines, lip lines, and cheek augmentation can be used. Botox is wonderful for the crow’s feet, frown lines, and glabella [between the eyebrows]. A favorite of many of patients is laser and light based treatments such as photofacials to freshen up the skin, reduce pore size and sun spots before a big event. Most of these procedures can be done with little downtime and the patient returns to work quickly. Beverly Hills dermatologist Dr. Don Mehrabi proposes a series of anti-wrinkle Botox injections plus skin-rejuvenating laser treatments: Hilary Clinton would easily most benefit from Botox injections to the crow’s feet, forehead, and the area between the eyebrows. Her most significant improvement would be to do a fractional resurfacing procedure to even out her skin texture and get rid of the lines under her eyes. Fillers in her laugh lines and the areas around and below her mouth would be great, but the top two suggestions would be Botox and laser resurfacing. Near the convention site in Denver, Dr. Tahl Humes says that Clinton appears to have benefited from wrinkle-fighters such as Botox. “It appears that she has restored a youthful look with a combination of injectables,” said Humes, a specialist in internal medicine who owns Vitahl Medical Rejuvenation Spa in Denver and conducts training sessions on cosmetic injections and Cutera cosmetic laser systems. The Daily News of New York quoted Humes earlier this month and said, “A source tells us Clinton visited a New York plastic surgeon early this month and received injections of a ‘dermafiller’ in her face.” Persky suggested that Clinton should move on to treatments with a Fraxel re:pair laser, a newer skin-rejuvenation device that has attracted wide praise from dermatologists. For Clinton, that “would result in a healthy and rested natural appearance,” he said. For the full article go to http://inyourface.freedomblogging.com/2008/08/26/doctors-propose-more-work-on-hillary-clintons-60-year-old-face/ Stay tuned next week for equal time for Republicans, Cindy and John McCain. Be well. Copyright © 2008 Orange

The PSP eReport reports that 55,000 bottles of Botox A was confiscated by Chinese police. This is an excerpt from the PSP eReport: The Chinese State Postal Authority is warning Wednesday that terrorists may use mail services to deliver lethal biochemicals. "Beijing police have detained 11 suspects involved in the illegal sales and mailing of Botox bacteria," the report states. "Botox—more commonly known for its use as a cosmetic treatment—is a highly poisonous neurotoxin. Botox A can be mixed with powders, liquids, food or medicine and delivered to people by mail. Recipients could die of respiratory failure," the official warning said. More than 55,000 bottles of a Botox A powder preparation have been seized by police. Police in Xinjiang Uygur Autonomous Region have also investigated a case in which explosives were concealed in ziran, a traditional Xinjiang seasoning. The package was found on July 9 in a taxi along with a letter instructing people to use the explosives in attacks on areas around the upcoming Olympic Games. Source: Xinhua News Agency Let's hope that the only Botox in Beijing is Botox Cosmetic by Allergan, keeping a few frown lines and crow's feet away.

At the recent Facial Cosmetic Surgery 2008 Meeting in Las Vegas, Steve Dayan, MD of Chicago, IL spoke on noninvasive methods of facial rejuvenation. His new book, "Instant Beauty" outlines methods to "look your best in one hour or less". Originally wanting to entitle the book "First Impressions", Dr. Dayan emphasized how we all strive to make an excellent first impression in those precious first seconds. One of Dr. Dayan's quotes is, "It is about making people feel better". By using the noninvasive techniques now available, properly trained physicians can truly improve that first impression.

There were so many television cameras around our office the past two days that I would not have been surprised had Steve Carell, Jenna Fischer, and their Dunder Miffin Corporation pals shown up. Earlier in the week, BBC correspondent Ms. Kate Spicer came in for a consultation and filmed a Fraxel repair treatment for an hour show that will air this summer in Europe. Today, KTLA, Channel 5 in Los Angeles, filmed a full face, eyelid, neck, and décolletage Fraxel re:pair treatment on their health reporter, the lovely Ms. Marta Waller who will be documenting her experience in a daily video blog (http://ktla.trb.com/news/health/). Talk about sticking your neck out for your job. Ms. Waller should look even younger and more beautiful when she accepts her Emmy for this investigative report, above and beyond the call of duty.

I just returned from The Aesthetic Show at the Mandalay Bay Hotel in Las Vegas. Over the next week or so I hope to share with you the highlights of the meeting. The largest buzz of the meeting was non-invasive aesthetic treatments for fat sculpting and facial rejuvenation. Laser and light treatments are definitely in, and the wars on cellulite have officially begun. Fractionated CO2 lasers for facial rejuvenation (Fraxel repair, Deep FX, mixto, smartxide dot, and others) are the wave of the future for non-surgical facial rejuvenation. Fat and cellulite are very popular treatment options. Smartlipo and Vaser high definition body sculpting were featured with impressive results. Alexander Rifkin, MD of the Westside Medspa in Westwood, CA presented the non-surgical rhinoplasty. Stephen Mulholland, MD, (SpaMedica med spa clinics) and Mark Tager, MD presented pearls from their recent book, "The Art of Aesthetic Practice, How to Profit form the Cosmetic Boom". The Silk N home laser hair reduction device was presented. David Matlock, MD presented his Laser Vaginal Rejuvenation techniques, including The G-Spot Shot (TM). Imagine my surprise when I arrived to the meeting on the first day a little late (as a facial plastic surgeon) into the large, darkened convention center general session room with a vagina projected on the screen. After rushing from the airport to the convention center, I thought that I had walked into the wrong medical convention. As I recover from the excitement of the weekend meeting, I hope to expand upon some of the new treatment modalities that were presented. Saturday night I visited the World Series of Poker, and I later was fortunate to see comedian Steven Wright perform. Unknowingly, he summarized what is new in plastic surgery in one of his dry witty jokes, “I just got the most spectacular technology. It is the greatest new, advanced technology. It is incredible. In fact it is so futuristic and advanced that you don't even need it". Be well.

I am excited to be spending this upcoming weekend in Las Vegas at The Aesthetic Show. There will be three days of conferences, exhibits, and candid conversations between cosmetic providers. I find that the personal exchanges outside of the formal lectures and conferences are the most informative aspect of attending these conferences. In an informal setting, experts can exchange new ideas as well as confirming what really works and what doesn’t. I look forward to returning to Los Angeles next week and sharing with my patients and bloggers, "What happened in Vegas". Be well.

Fraxel Re: pair laser, manufactured by Reliant, is at the cutting edge of the future of facial plastic surgery. It is a pre-emptive strike against a facelift, and in those patients who begin their treatment at the early signs of aging in the face and neck (jowling and lax skin with wrinkles), a facelift may never be necessary. Addtionally, ttreatment of the upper and lower eyelids results in youthful eyes. It is safe, effective, and quick with a very short social downtime period. The results are a natural younger version of you, without the "pulled” look of too many unfortunate surgical facelifts. There is no cutting, operating room fees, or anesthesiologist involved. This is truly where the future of facial plastic rejuvenation surgery is heading.

The FDA has approved a new hyaluronic acid facial filler Prevelle Silk. Hyaluronic acid (HA) is the filler material in Restylane, Perlane, and Juviderm. Preville Silk is the first hyaluronic acid product to contain lidocaine, a local anesthetic. In a controlled study, patients reported significantly less pain during injection with Preville Silk as compared to the other HA products that do not contain lidocaine. The new product is manufactured by Mentor Corp. of Santa Barbara, CA. It is still to be seen how long the product will last compared to the other currently available facial soft tissue fillers. I will keep you posted, if you have any questions contact me.

Sagging facial skin results from the loss of volume from the face, and the aging of the superficial skin. Traditionally surgeons correcting the problem pulled the sagging tissue and cut away the excess. You can tell who those patients are when you see them walking down Rodeo Drive in Beverly Hills, Park Ave in Manhattan, and Collins Drive in Miami. Natural results can be obtained today by restoring volume to the face, and then by treating the face and neck with Fraxel repair. In the great majority of my patients, this will restore an amazing youthful, rested appearance to the face. This will not leave a patient as "tight" as they might be after a surgical facelift. In some cases of excessive skin "sag", traditional surgery may still be needed.

Recently a woman under went extensive body plastic surgery. It was the policy of her surgeons to send flowers and a get well card to their post operative patients. They received a phone call from the puzzled woman who asked the doctors why they send her the flowers and a get well card. After investigation, it was discovered that the patient had stolen the woman's identity, and had paid for the surgeries with ATM and credit cards. She was surprised at her post operative appointment when after having her stitches removed; police hand cuffed her and took her off to jail. Just another reason why we like to have a copy of our new patient’s driver's license.