We have been testing the fractional carbon dioxide lasers on a few patients in the past weeks with some good results so far. We have found that the results have been excellent for skin texture / wrinkles and pigmentation and the downtime is usually less than one week. Overall, the results achieved with such little downtime is a testament to the new technology.

I have posted a picture of my hand 6 days after a single shot of fractional carbon dioxide laser. You can see the columns of laser treatment within the square treatment zone. The skin in between the columns is the skin that is unaffected by the laser, and this helps the skin to regenerate faster. I would expect even faster recovery times for the face – the hands usually take about twice as long to recover from laser treatments normally.

A patient recently came to me and asked me ‘Doc, just make me look better…’. This patient just wanted to look refreshed and revitalised, but didn’t really exactly what could be done or what they wanted. I started discussing some ideas including the possibility of some dermal fillers when the patient asked me, ‘but how will this make me look better?’

It was the answer to this question that prompted me to write this blog entry…

So, this is what I told the patient;

Basically, there are a few aspects to facial ageing that should be addressed in order to achieve a more refreshed and revitalised appearance.

Firstly, there is the issue of volume. Volume is gradually lost from our faces as we get older (unlike our bodies which tend to get fatter!). Volume loss can occur in any part of the face, and can be due to reduction in fat in the face as well as bone resorption. We usually see it in areas like the cheeks, lips, and brows. Volume can be replaced in the face through many methods. Dermal fillers are one of the most common and simple methods of replacing lost volume in the face, and this can be done as a simple office procedure. Other alternatives include fat transfer from other parts of the body to the face. This is a more involved procedure as it does require the patient to have liposuction first to harvest the fat for injection, but the longevity of this treatment tends to be longer than most dermal fillers.

Secondly, there is the skin. The skin is the drape that covers the face and its appearance is paramount to someone’s perceived age and appearance. UV radiation from sun exposure or solariums increases the rate of skin ageing, pigmentation problems and wrinkles. To improve the skin itself, there are number of things that can be done. Lasers can be used to remove specific problems such as broken capillaries, sun spots / pigmentation, and wrinkles. Also good skin care including a good topical retinoid and sunscreen are important to maintain the skins appearance. Anti-wrinkle injections are also a good method of helping to stop expression lines and creases such as those around the eyes and between the brows.

Thirdly, there is the effect of gravity on the face, which causes the face to sag. This leads to a descent in the cheeks, jowl formation, the formation of folds from the nose to the mouth (nasolabial folds), and a more square appearance to the face. In most cases, a surgical procedure is required to properly correct this descent. Face-lifting and brow lifting are examples of these surgical procedures.

So it is important to address all of the above three aspects of facial ageing when rejuvenating the face. Addressing one of the three issues without the other can sometimes lead to an unusual appearance. We all know of Hollywood stars who still look their age despite having a facelift (or two). The reason for this is that often the issue of volume loss hasn’t been addressed, so they are tight, but not full like a younger person would be. Similarly, addressing facial sag and volume without addressing the skin can also create an appearance that is inconsistent. Ima1gine a person with a youthful shaped face, with lots of sun spots, broken capillaries, and wrinkles!

Usually a specialised cosmetic doctor is the best person to advise you on what you might need. We can tell you where you are doing well and which parts might need to be addressed. Good facial rejuvenation will make you look refreshed and revitalised … naturally!

The carbon dioxide laser skin resurfacing first emerged in the 1990s and was hailed as a revolutionary means to rejuvenate the face. To this day, it remains as the ‘gold standard’ for facial skin resurfacing, but then why is performed so uncommonly by only a few doctors? Although the results from carbon dioxide laser resurfacing are second to none, the recovery period, especially in today’s society, has been deemed to be unpalatable by most people. Recovery periods after carbon dioxide laser resurfacing can range from weeks to months depending on the intensity of the treatment performed. In today’s society, where time becoming increasingly valuable, people are reluctant to undergo such a procedure. Furthermore, risks such as scarring and hypopigmentation (excessive whitening of the skin) were common.

More recently, fractional carbon dioxide lasers have emerged to help strike a favourable compromise between obtaining results and reducing the recovery period required. You may have heard of lasers such as the Fraxel laser which was one of the pioneer lasers to use fractional technology. Fractional lasers are aptly named as they only treat a ‘fraction’ of the skin. They fire small columns of laser energy into the skin and leave the skin adjacent to these columns untouched, and this allows a quicker recovery whilst still producing good results within the skin.

Fractional carbon dioxide lasers are the latest in the generation of fractionated lasers and will possibly be the new way to resurface skin, reduce wrinkles, and acne scarring.

At The Victorian Cosmetic Institute, we are in the process of evaluating the various machines available and will be getting one in the next few months based on our research.

For more information on skin resurfacing, visit our webpage on this topic by clicking on the link below;

http://www.thevictoriancosmeticinstitute.com.au/skin-resurfacing/

The annual Australiasian College of Cosmetic Surgery (ACCS) conference is to be held from May 6 to 9 in Sydney.

It is a great conference that most of the staff at The Victorian Cosmetic Institute will be attending.

Dr. Gavin Chan from The Victorian Cosmetic Institute will be presenting a talk on “Combining multiple wavelengths and mechanisms for the greatest results.

The main categories that will be discussed at the conference are

• Dermal Fillers / Btx
• Laser and Light Technology
• Face and Breast Surgery
• Liposuction
• Highlight: Liposuction interactive plenary session where panellists will be given cases to describe how they would have proceeded to advise patients and respond to questions from the audience on the manner they would handle the procedure

The high profile international speakers include:

• Dr Tony Mangubat (USA) – specialist in cosmetic surgery and hair restoration
• Dr Antonio Campo (Spain) – world renowned dermatologist presenting on his work with Pearl and skin rejuvenation
• Dr. Stephen Mulholland , M.D – Internationally recognized cosmetic plastic surgeon and lecturer, and owner of SpaMedica
• Dr Michael A. Kane (USA) – board-certified plastic surgeon from New York City and author of the Btx book.

The majority of those attending will be cosmetic physicians, cosmetic nurses , dermatologists, and plastic surgeons.

With most of Australia’s cosmetic world attending, if you are in need of urgent cosmetic treatment during this time you might be in dire straits!

However, we do have unlucky doctor and nurse holding the fort , so if you do need some attention we will be around.

We will be reporting on any new innovations, or techniques on our return.

When I heard of the prospect of a drug that could make you tanned and slim without the need for sunlight or dieting, I thought it sounded too good to be true, and maybe I should have trusted my instincts…

Melanotan II was the name of this drug we trialled on 3 of our staff with varying results.

Quoting from melanotan.org: Melanotan and Melanotan II are both synthetic versions of melanocyte stimulating hormone that were created, synthesized and developed at The University of Arizona and the Arizona Cancer Center. Melanotan is a linear, full length peptide (containing all 13 amino acids). Melanotan II is a shortened, circular version of the same peptide. Both Melanotan and Melanotan II have sunless tanning capabilities but because Melanotan II had libido enhancement and spontaneous erections as side effects, To be particularly clear regarding Melanotan (due to previous incorrect news reports) it should be noted that it does not cause sexual arousal nor have erectile effects. These aspects are only found in the drugs Melanotan II and bremelanotide.

So what happened in the end ?

• 3 out of the 3 people in our trial felt severe nausea after their first injection of the recommended dosage (so obviously the increase in sex drive wasn’t apparent)
• All felt irritated and had difficulty sleeping
• 2 out of 3 people stopped after the 1st injection
• 1 out of the 3 people after using the drug experienced some mild sunburn on one of her arms after a brief exposure to sun in her car.
• 1 out of 3 people continued the injection at 1/2 the recommended dosage (to avoid nausea) for 2 weeks

The person who continued Melanotan II ended up getting a mild tan, more so on the face than on the other areas of the body, but also noticed a significant increase in the darkening of moles / naevi on her face, and ceased the treatment as a result.

So in conclusion, Melanotan II wasn’t all it scrubbed up to be, although it did have the desired effect of tanning the skin without sunlight – albeit with many side effects.

On to our second staff trial …

Allergan have recently released a product called Latisse (not yet available in Australia) that is to be used to grow eyelashes. It is essentially an exisiting product of Allergan’s called Lumigan that has been repackaged and FDA approved. Lumigan has the same active ingredient as Latisse (bimatoprost 0.03%), but its intended use is for glaucoma – a condition that causes increased pressure in the eyes. One of the known side effects of Lumigan was that it grew your eyelashes (a side effect that has been exploited by Allergan) and this was our intended use of the drug.

We used Lumigan rather than Latisse, as it has the same active ingredients as Latisse, was available in Australia, and also is significantly cheaper than the proprosed price for Latisse.

We have trialled it on several of our female staff, and after 4 weeks have obtained some preliminary results as shown in these pictures.