| Wrinkles The Generation of Forehead Wrinkles
If the eyebrow is in a normal position treatment options are:-
If the eyebrow is depressed / flattened, with hooding of the upper eyelid, a forehead lift is required for optimum aesthetics. Following this treatment a limited upper blepharolplasty is often required. Forehead Lift Options
Wrinkles Facial Areas Wrinkles in the facial area occur secondary to ageing and :-
Treatment
Nerve Blockade - Botox Some wrinkles are produced by muscle contraction. Patients should not fly for 72 hours following injection
as low cabin pressure may cause spread of the Botox to other muscle groups,
producing unwanted paralysis. Complications include temporary paralysis
of un-intended paralysis of adjacent muscle groups and a subtle loss of
facial expression. With repeated injections some permanent muscle weakness
has been reported.
BIO-ALCAMID™ 
HOW LONG DOES BIO-ALCAMID™ LAST ?
In physiological conditions BIO-ALCAMID™ is a definitive implant like
any other artificial prosthesis (unless it is intentionally removed).
The visible effect created by BIO-ALCAMID™ clearly cannot last forever,
since, with the passage of time, the skin ages and the tissues (especially
muscle tissue) change position and shape creating new imperfections
and anomalies in spite of the “mechanical support” provided by the injected
substance. However, the defect can be corrected even after a period
of time. IS THE IMPLANT PAINFUL? Like any injected substance, BIO-ALCAMID also causes some pain, but
only during the injection. Any type of anaesthetic (even local) can
be used to reduce the pain, depending on the doctor’s opinion. SUNLIGHT AND SKIN PIGMENTATION
It is advisable to avoid exposure to direct sunlight for at least a
month following the implant; this is to prevent possible alteration
of the secondary pigmentation in the temporarily inflamed area caused
by the implant. CAN ANYONE USE BIO-ALCAMID™?
Studies conducted so far have shown that BIO-ALCAMID™ is a safe product;
it does not require any sensitization test as no allergic reaction has
ever been reported. However, it is advisable to inform the doctor regarding
any tendency to allergic reactions (“polyallergic” subjects). WHAT HAPPENS AFTER THE IMPLANT?
I mmediately after the introduction of BIO-ALCAMID™, a thin, natural,
physiological capsule is formed. This encloses the Substance, forming
an actual endoprosthesis that can be easily identified and removed (easy
and painless) at any moment. The oedema that develops immediately after
the implant is minimum in normal conditions and does not last more than
a few hours. IS BIO-ALCAMID™ A SAFE SUBSTANCE?
Years of strict and scrupulous clinical experimentation have allowed
the manufacturers to provide the maximum guarantees as to safety, so
much so that it has been granted the CE mark by official European authorities
for product quality control systems. 
Autologous Cell Therapy Click for movie
After 8-10 weeks period, you receive the first treatment of newly grown myofibroblast cells. These times depend on how the cells are growing as not all patients’ cells grow at the same rate. Following the inital injection treatment this is followed by one more treatment at around a thirty (30) day interval, which takes into account the length of time it takes for your dormant tissue fibroblasts to be activated by the Isolagen process. Following this activation your tissue fibroblasts continue the Isolagen process. 
Early evidence to date indicates that Isolagen is a long-lasting,
safe and effective procedure in clinical trials involving approximately
3,500 injections and 1,200 people. At the National Centre for Aesthetic
Facial and Oral Surgery we have treated over 100 patients (February 2005).
Our cases are audited in great detail, in line with Health Commission
regulations. Stimulation of Natural
Collagen Production Isolagen should not be regarded as a dermal filler -but
a completely new concept - that stimulates collagen production and significantly
increases the number of active skin cells below creases and wrinkles.
How long does Isolagen
take to work ?
 Images courtesy Isolagen In 2004 Isolagen reported that many patients continue to see the improvement for up to 7 years following treatment.
 Images courtesy Isolagen
Why does it take time to see improvement
? Isolagen is a process that assists the body in its own
natural healing. It therefore takes the body’s own timescale to regenerate
collagen with new collagen producing cells and to rejuvenate the skin.
No significant adverse effects have been reported. Facelift Prevention ?
Facial Rejuvenation
 Images courtesy Isolagen
Isolagen cellular therapy may be used to rejuvenate the whole facial
area and not just the grooves and lines around the mouth lips eyes and
forehead. The amount of required rejuvenation depends on :-
As a general rule a minimum of 2 injection sessions are required. Fibroblast Storage  On request, Isolagen laboratories offer a storage service in which cells from the patient’s original biopsy can be stored and kept for future use - years after the original biopsy. This incurs an annual fee, beginning six months after the first biopsy. Contraindications:
Isolagen Research On Februray 18th 2005 Isoalgen announced the 12 month follow-up data from a Phase III Exploratory (double blind placebo control) trial, which was conducted at multiple centres accross 10 sites in the United States. Data from 146 / 158 patients was evaluated, and the therapeutic effect of Isolagen over the Placebo group is shown in the graph below aty 6 months. This therapeutic effect was maintained at 12 months.
We can therefore state that on the evidence of this small sample that the therapeutic effect of isolagen is more than double the effect of placebo. More detailed studies will be forthcoming and this technology looks very promising.
Cell Regeneration Therapy - Future Applications?
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| Skin Resurfacing – Carbon Dioxide and Erbium:
YAG Lasers Laser treatment is the high
tech equivalent of dermabrasion and chemical peels, and is mainly performed
with the carbon dioxide or Erbium YAG lasers. Although carbon dioxide
lasers have been in medical use since the 60's as cutting tools it is
only in the last few years that technological advances in laser design
have allowed the laser beam to hit the skin surface for less than the
“thermal relaxation time of skin” i.e. 695 microseconds allowing controlled
vaporisation of skin with minimal unwanted "collateral" heat damage.
The results of these latter treatments depend on the depth of lesion. Generally deeper respond poorly. The advantage of laser skin resurfacing over dermabrasion and chemical peels, is in more accurate depth control with laser treatment. Distinct colour changes occur as the laser injury becomes deeper. This is a helpful indicator to monitor treatment during surgery and lets the surgeon know when the end point is reached - and treatment is finished. Carbon dioxide lasers vaporise skin in layers of about 65 microns with a zone of "collateral" damage of about 75 microns. Erbium YAG lasers vaporise about 25 microns with a zone of "collateral" damage of about 5 microns i.e. Erbium YAG laser produces less tissue damage and is potentially safer. These figures will vary with different power settings. Less tissue damage occurs with pulsed laser beams, which improves safety margins further.
Many resurfacing procedures require repeat treatments to get the best result and many patients are happy in order to have a shorter period of redness a more shallow treatment is required and accept that they may need an extra treatment to eliminate the cosmetic problem. There has been some adverse publicity related to laser treatment. Whilst this has been the result of inaccurate reporting in some cases suitable patient selection and counselling is vitally important. Treatment in this initial period may either be open, with regular cleansing and the application of Vaseline to keep the wound moist, or alternately, closed with dressings. Infection of the superficial burn - bacterial, viral or fungal - could potentially cause scarring if not promptly treated, although this is rare. Skin erythema (redness) will last for 5 weeks to 6 months depending on:
Skin darkening (Hyperpigmentation) may be a problem
particularly in darker skin types and is related to the post laser inflammation.
It is important that patients with darker skin types are treated with
a test patch in a hidden area to test for hyperpigmentation before treatment
commences on the face. Acne may flare up in susceptible individuals and require
treatment. Acyclovir should certainly be given to patients with
a history of cold sores, as laser treatment may activate the cold sore
virus. If this occurs infection may be severe involving the treated area
of skin. For this reason some surgeons give acyclovir to all patients.
Pre and late postoperative skin care with Retin A or
alpha hydroxy acids may enhance results and can be combined with hydroquinone
in patients at risk of hyperpigmentation. Following a skin resurfacing procedure, using either
a pulsed CO2 or Erbium YAG laser, your skin will appear red and weepy.
It will take between five to seven days before your skin heals and, during
this time, it is very important to remove any crusts that may build up
on your skin. Most patients find Vaseline, applied two hourly during the
day time, to be the most effective and soothing topical medication at
this stage. For the first two or three nights after the skin resurfacing
procedure, you may find that Vaseline gauze applied to the treated skin,
after it has been first liberally covered with Vaseline, would be the
most soothing dressing.
If you have had a General Anaesthetic, it is important
that you do not drive for 24 hours and that, when you go home, there is
someone at home all the time for at least 24 hours to look after you.
Swelling Please note that it is quite usual to get some swelling
around the eyes, particularly if the resurfacing procedure has been carried
out in this area. This may take three or four days to disappear. Infection Infection of the skin following a skin resurfacing procedure
is rare and often antibiotics are not required. It is important to continue
taking Acyclovir for the full five day course if you are prone to cold
sores on the face. Otherwise, this treatment is not necessary, although
a small proportion (about 6%) of treated patients without a history of
cold sores may develop this complication. It is very important to let
your doctor know if you develop any blisters or pustules in the treated
area. Sleeping If you are not a good sleeper, you may find that you
will need to take a sleeping tablet for two or three nights to help you
sleep after an extensive facial resurfacing procedure. Family It is very important that you let your partner or your
family know that you are having a resurfacing procedure carried out; otherwise
your appearance may give your partner quite a shock! Make-Up It is best not to put on any make-up until at least ten
days after your skin has healed. This is because the skin is readily sensitised
following a resurfacing procedure to anything potentially sensitising
such as cosmetics applied to it. Skin Redness
Please note that the redness that follows a skin resurfacing
procedure is entirely normal. This is always much more marked following
the use of the CO2 laser than with the Erbium: YAG laser and persists
much longer. The redness can be very marked, especially in fair skinned
individuals and can persist for up to three or four months following the
procedure. It is nothing to be alarmed about and, in exceptional circumstances,
can be treated using another laser called the Pulsed Dye Laser if individual
patients find it aesthetically displeasing. Retinoic Acid
It is known that the beneficial effects on your skin
of the resurfacing procedure can be augmented and perpetuated by the regular
use of retinoic acid topically. Most patients can begin this treatment
once daily each evening to the facial skin about three weeks after the
skin has healed. Once more however, fair skinned individuals with delicate
white skin may have to wait much longer before they can use retinoic acid.
UV Blocking Creams
It is important to use an Ultraviolet light blocker on
the skin on a regular basis, beginning about ten days after the skin has
healed. This is best applied each morning and should be used regularly
thereafter. Your Consultant will advise you on which strength of ultraviolet
light blocker is required in your individual case. The regular use of
an ultraviolet light blocking cream on the skin minimises the risk of
the development of pigmentary change in the treated area, but the risk
of skin darkening after a resurfacing procedure carried out with the Erbium:YAG
is much less than with the pulsed CO2 laser.
Skin Type
Photorejuvenation
Intense Pulsed Light (IPL) Intense Pulsed LightTM (IPL) skin treatments using the photorejuvenation process represent a breakthrough in skin care. This new technique treats sun damaged skin invasively — there is no disruption of the skin's epidermal surface. IPL treatments address the effects of photoageing and sun damage with low risk of complications and no recovery time. IPL produces dramatic results for a variety of benign conditions, including
:-
Whilst comparatively aggressive Laser resurfacing and deep chemical peels produce excellent long term results, these treatments produce significant redness and swelling which take from 2-6 weeks to subside. Microdermabrasion addresses skin irregularities, but is not effective against all complexion problems including redness, flushing and broken capillaries. IPL is less aggressive in tackling some of these problems and is the fastest growing cosmetic procedure in the U.S. and now Europe. Practitioners determine an IPL treatment plan for each new patient, accounting for the number and severity of skin conditions being treated, as well as skin type. On average, four to six treatments are recommended, scheduled at three-week intervals. Each session usually lasts about 20 minutes, with patients returning to normal activity immediately afterwards. IPL treatments provide gradual, natural improvement with excellent long-term results. What to Expect Before treatment, a cold gel is usually applied to the areas to be treated and patients wear protective eyewear. During treatment, a physician or trained staff member gently applies the smooth, glass surface of the IPL handpiece to the skin. Light is delivered to the skin surface in precise pulses that are typically pain-free. Occasionally some signs of treatment, such as redness, can last for one or two hours. In most cases, the entire face is treated, but the therapy can also work well on the neck, chest and hands. Results from a full series of treatments usually last for a year or more.
IPL Procedure Before treatment, a cold gel is usually applied to the area to be treated, and patients are given protective eyewear. During treatment, the smooth, glass surface of the IPL handpiece is gently applied to the skin, delivering precise pulses of light to the area being treated. IPL treatments are usually pain-free, but an anesthetic cream can be used if the light pulses are uncomfortable. Some patients compare the sensation to a light pinch or the snap of a rubber band. Treatment sessions usually last about 20 minutes, and a complete program usually includes four to six sessions. After treatment, patients can immediately return to normal routines and activities. Occasionally evidence of treatment such as redness or blotchiness may last for an hour or two.
Why are multiple treatments necessary? Several IPL treatments are required to provide gradual, natural-looking improvement with very low risk. Results usually last a year or more.
Complications of IPL The main problem is one of de-pigmentation which may have an adverse effect on patients with a pigmented complexion. This is the main limiting factor of the therapy, and test treatment patches help to identify those patients at risk from this treatment. A possible solution to this problem is ELOS therapy. Electro-Optical Synergy (ELOS) ELOS Technology Syneron's ELOS technology maximizes the synergy of conducted radiofrequency energy (RF) and optical energy. RF energy has limited effectiveness in hair removal and treatment of skin disorders. Combined with optical energy ELOS provides an exceptionally effective, safe and affordable method for a broad range of medical aesthetic treatment applications including
Syneron's Galaxy ELOS Machine
How ELOS works:
Electrical Energy (Conducted RF) - Does not affect
the melanin of the epidermis
ELOS Technology
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