A good faith exam is a brief meeting wherein the physician (or an advanced practice practitioner such as a Nurse Practitioner or Physician Assistant) assesses the patient, makes note of their history, and explains the procedure prior to the first treatment at that particular facility BEFORE a Botox, Restylane, etc. injection is undertaken.  Thereafter, no further exams are required and those that are properly licensed medical professionals may then administer all future treatments.  This exam is part of the intake and medical history required to provide a prescription for the patient (Botox, Restylane, etc. are all prescription pharmaceutical products).

Each state dictates its own legislation through their State Medical Board and/or Board of Registered Nursing to determine the scope of practice for those performing medical procedures.  Currently, California has determined that the administration of Botox Cosmetic must be carried out only by a Registered Nurse (RN), Physician Assistant (PA), Nurse Practitioner (NP), or Physician (MD).  In addition, if the physician is not the practitioner performing the first Botox, Restylane, etc. procedure, it is mandated that a “Good Faith Exam” must be performed by the physician overseeing the practice or by an individual with an advanced practice degree (Nurse Practitioner or Physician Assistant) before the first Botox, Restylane, etc. injection may take place.  For example, if the nurse is going to perform the injections, it is required that the good faith exam be completed by the advanced practitioner - MD, PA or NP - before the injections may commence.

Read About All Celibre's Facial Shaping Techniques

Celibre's Botox and Restylane Los Angeles injections program, www.celibre.com/wrinkles.aspx. 

Schedule a FREE Botox Los Angeles consultation, www.celibre.com/contactlist.aspx.

More Botox and Restylane Los Angeles before and after pictures at www.celibre.com/botoxba.aspx.

Although this requirement may seem uneventful and more of an inconvenience for patients and practitioners alike, we believe that it is a very necessary step in ensuring that current California legislation is respected and carried out as mandated.  For those practitioners who knowingly disregard current state requirements or plead ignorance, we would call into question their ethics and also mention that they are breaking the law. 

Patients, consumers, and all practitioners should be concerned with this "good faith exam" issue for Botox, Restylane and other injectables as state requirements continue to evolve to keep pace with this growing practice of medicine.

The answer may seem quite obvious – permanent fillers such as Radiesse and Sculptra, have more longevity than non-permanent fillers such as Restylane, Juvederm and Perlane.  "Permanent" injectable fillers typically last a period of years (depending on the one used) whereas "non-permanent" fillers last up to 18 months (Restylane and Juvederm) after repeated injections at 4-6 months apart.

Some patients believe they receive more value for their money and time by using permanent fillers - which can be used less often.  On the upside, if the treatments do last a lot longer and if they are not priced disproportionately higher, there can be value in using a longer term injectable filler.  On the downside, once the permanent filler product is injected, there is no way to remedy the situation if the patient is dissatisfied with the outcome or if there is a complication.  Permanent injectable treatments also have a higher risk of granulomas (lumps) that may or may not be treatable once they are discovered.  For these reasons, the risk of using the permanent fillers is higher because the procedures cannot be reversed.

Read About All Celibre's Facial Shaping Techniques

For more information on all of Celibre's Los Angeles injection treatments visit www.celibre.com/wrinkles.aspx.

Schedule a FREE Los Angeles Restylane, Juvederm or Perlane consultation with Celibre Medical, www.celibre.com/contactlist.aspx.

Los Angeles Restylane Injections by Celibre Medical.  More Los Angeles Restylane before and after pictures at www.celibre.com/restylaneba.aspx.

Non-permanent injectable fillers are called hyaulronic acid cosmetic dermal fillers.  The primary benefit of using non-permanent fillers over longer term ones is that when a situation arises wherein the treatment needs to be reversed, it's possible to do so.  There is a remedy that dissolves these hyaluronic acid products within a few minutes to several hours.  Also, these types of products can offer improved facial sculpting because of the smaller particles used in the products.  For this reason, shorter term non-permanent fillers like Restylane, Juvederm and Perlane offer lower risks.

There are pros and cons for almost every product.  Only you and your practitioner can decide what's best for your goals.  Regardless of what you choose, be certain that your injection practitioner is trained to use the product and has been doing so for some time.  When choosing to use these products, make certain that you have reviewed the risks and benefits with your practitioner.

Take a look a tthe photo below.  This well known actress appears to have had some injection work done, most likely Botox and fillers which have created some unintended consequences. 

First the Botox.  On the side fo the nose, she has what is commonly referred to in the industry as "bunny lines".  Bunny lines appear on the side of the nose most often in response to utilizing too much Botox Cosmetic to the forehead and brow area.  You're probably saying to yourself, How does Botox injected in the forehead cause lines around the nose?  Well, Botox relaxes the muscles it is injected into so that wrinkles smooth out and disappear.  But when the muscles injected are relaxed too much, it can cause other muscles to work harder to animate the face (smile, frown, etc.).  As these "unopposed muscles" strengthen in response to the overuse of Botox in other areas, they can create unintended consequences, such as the bunny lines. This wrinkling of the sides of the nose looks unnatural.

Read About All Celibre's Facial Shaping Techniques

Los Angeles Botox injections by Celibre Medical, learn more at www.celibre.com/botox.aspx.  

Schedule a free consultation for Botox Los Angeles - www.celibre.com/contactlist.aspx.

Los Angeles Botox Injections for frown lines around the mouth. 

Botox Los Angeles before and after photos, www.celibre.com/botoxba.aspx. 

Los Angeles Restylane Injections Before and After Photos, www.celibre.com/restylaneba.aspx.

Now bring your attention to her mouth. It would appear that her injector augmented (filled) the pink part of the mouth without also addressing the vermillion border which is the area wherein the pink of the lip is outlined by the white part of the mouth..  When the lips are injected in the body rather than the border, they tend to "roll" over the teeth, giving the appearance of a swollen or fattened lip.  This is what makes them look unnatural.

Whether injecting Botox Cosmetic or cosmetic dermal fillers, the concept is to enhance the appearance of the face and to bring interest to an area using the natural form and contour of the patient's face.  In this case, that concept has been ignored resulting in an overdone appearance that invites negative attention.  To the untrained eye, most will only notice that something isn't quite right.  To an experienced practitioner, we think of all that should have been done differently.       

Lori Haney, RN, MEP-C

Certified Medical Laser Safety Officer 

As we age, our facial structure changes.  Sometimes we know what's changed, aren’t certain how or why this is occurring or, more importantly, what may be done to address the concerns.  One of the main issues for our patients is a loss of facial volume due to thinning of the skin.  When this happens, not only do we lose volume, but the skin we do have shifts which then affects the structure and shape of the face.  We also lose muscle and skeletal mass as bone gets reabsorbed by the body.  The face becomes elongated and the heart shape or upside down triangular shape of a more youthful face becomes the opposite.  We often hear that the eyes are the windows to the soul, and women often complain that their eyes are testimony to the aging process.  We’d like to suggest that it isn’t the windows that have necessarily changed but the frame of the windows.  The “frame” being the midface. A young face appears rounded with soft contours.  Whereas, the aging face displays a more angular appearance where there is more defined borders and hollow areas.

Read About All Celibre's Facial Shaping Techniques

Los Angeles Restylane injections, Perlane, Botox and Juvederm, www.celibre.com/wrinkles.aspx. 

Schedule a FREE consultation for Los Angeles Restylane injections as well as Juvederm, Perlane and Botox, www.celibre.com/contactlist.aspx.

Los Angeles Restylane Injections before and after photos for mid face filling.  

More Celibre Medical Restylane Los Angeles Before and after photos, www.celibre.com/restylaneba.aspx.

Because of gravity and age facial muscles begin to contract which leads to a downward and inward pull.  This is represented by drooping of the eyelids combined with a constant contraction of the frown lines (between eyes) and crow's feet (sides of the eyes).  The mouth begins to contract in a purse string effect.  This then leads to the fine lines so annoyingly known as “smoker’s lines.”

As the volume of tissue in our faces change, jowls along the jaw line appear and pockets of volume loss below the corners of the mouth also known as marionette lines show.  The mouth may become thin with a loss of definition and fullness.  We begin to see a flattening and enlarging the surface area between the bottom of the nose and the upper lip. In contrast, consider the youthful mouth that has a defined border and full body to the lips.

What are the options for those interested in slowing down the aging process with Botox and injectable fillers?  Or, more importantly, how can we look like we used to without an unnatural appearance?  The traditional face lift may not be the most appropriate solution because of the loss of volume.  If we understand that the factors involved in aging are volume loss as much as gravity, the ideal treatment is to restore the volume before deciding if surgical intervention will be beneficial.  This is where Botox cosmetic and cosmetic dermal fillers such as Restylane, Juvederm and Perlane play a valuable role. 

By relaxing hyperactive facial muscles with FDA-approved Botox Cosmetic and adding volume with FDA-approved cosmetic fillers (Restylane, Juvederm, Perlane), we can restore a more refreshed appearance - a natural, more youthful and appealing look.  The many techniques and products offered in accomplishing this goal is considered “shaping” of the face, and there is an artistry involved in these injectable treatments.  Be certain to choose a practitioner that has an aesthetic eye and appreciates the individual canvas that they see before them.

Many don’t realize that the shape and size of a woman’s mouth and lips may dramatically change her appearance (in a positive or negative way).  For instance, augmenting the volume too much with fillers (hyaluronic acid:  Juvederm, Restylane) may give a very unnatural look and draw too much attention to this area of the face.  On the other hand, as we age, the area between  the base of the nose and the top of the lip becomes flatter and longer as the muscle around the mouth contracts inward and downward.  This is what causes fine lines (smoker’s lines) and thinner lips.

Read About All Celibre's Facial Shaping Techniques

Learn more about Los Angeles Restylane and Juvederm injections by Celibre Medical, www.celibre.com/wrinkles.aspx. 

Schedule a free Los Angeles Restylane or Juvederm consultation with Celibre Medical, www.celibre.com/contactlist.aspx.

By using a small amount of Botox Cosmetic to the muscle that encircles the mouth, it is possible to soften any lines and create a natural, subtle eversion (upward or downward rolling) of the upper lip.  This technique is not creating an unnatural look but rather providing an appearance of how this area used to be before the aging process became visible.  Using hyaluronic acid fillers such as Juvederm and Restylane helps to restore volume and shape to the lips and mouth.  This can be done to the vermillion border which is the outline of the mouth and also enhances the corners of the mouth that tend to dimple in or pull down with age.    These fillers also help to restore volume to the body of the mouth or the in pink part of the lips also known as the mucosa.

Using all or a combination of the above mentioned techniques is an excellent way to enhance the lips and mouth with Botox, Juvederm and Restylane.  At Celibre, we believe that a natural, subtle technique is an appealing, aesthetic look.  Always make certain that your injector/practitioner understands your goals and individualizes your treatments.

Restylane, Juvederm, and Perlane are names of cosmetic injectable fillers.  These products are also known as hyaluronic acid fillers or HA for Hyaluronic Acid, which is a natural substance found in all of our bodies and is responsible for lubricating joints.  These products are manufactured in a synthetic form for the use of facial cosmetic enhancement.  These fillers work by filling lines, wrinkles, and restoring volume in areas such as the tear trough (the hollows of the eyes), lips, laugh lines, hollows of the cheeks, the chin and jawline, and much more.  Restylane, Juvederm and Perlane not only fill areas immediately, but they also attract water to the area over the several weeks after injection.

For more information on all of Celibre's Orange County and Los Angeles wrinkle treatment programs visit www.celibre.com/wrinkles.aspx.

These products are extremely safe and are used not only by millions in the United States but in other countries as well.  They also have a proven safety record with very little risk for allergic reaction which makes HA's much safer than collagen and silicone.

Read About All Celibre's Facial Shaping Techniques

Schedule a FREE Los Angeles Restylane consultation with Celibre Medical, www.celibre.com/contactlist.aspx.

Los Angeles Restylane Injections by Celibre Medical.  More before and after pictures at www.celibre.com/restylaneba.aspx.

At Celibre, we offer Restylane, Juvederm, and Perlane.  Restylane & Juvederm are produced by two different manufacturers but have very similar benefits.  Both are considered non-permanent and generally last approximately 3-4 months.  Although the manufacturer of Juvederm (Allergan) has received FDA approval to state that Juvederm may last up to one full year, most practitioners will tell you that this is not typical.  We are pleased with the ease of the product when shaping the face.  Perlane is similar to Restylane & Juvederm but is a longer lasting filler.  Because Perlane uses larger particles in its product, it is designed for deeper folds and is placed at a different depth within the tissue for optimal results and a natural filling effect.   

The use of Restylane, Juvederm and Perlane has increased dramatically over the past several years as consumers discover the value of shaping the face to achieve dramatic improvement in the appearance of folds and wrinkles.  When considering treatments, be certain to choose a practitioner that listens to your goals and involves you in the educational process and treatment plan.

To learn more about Celibre injection treatments visit www.celibre.com/wrinkles.aspx or call or e-mail at www.celibre.com/contactlist.aspx.

The term "facial rejuvenation" is becoming more popular because there are so many treatments being offered that claim to offer this.  Rejuvenation of the face invovles texture improvement, resolution of facial discoloration (brown/red), pore size reduction, skin tightening, and improvement of fine lines and wrinkles.  The practice of aesthetics allows for all of these concerns to be addressed without undergoing a traditional surgical procedure.  There is the concept of the Three R's that capture the goals of rejuvenation:  Relaxing, Refilling, and Resurfacing. 

The Celibre Medical Orange County Laser Resurfacing Program, www.celibre.com/micropeel.aspx.

Relaxing hyperactive muscles with the use of Botox Cosmetic will soften fine lines/wrinkles if not resolving them completely.   It is the repetitive contraction of facial muscles that create wrinkles to the eye area, around the mouth, the forehead, and between the eyebrows (frown lines).  Botox Cosmetic is also used to soften a "pebble chin" or to correct a mouth frown wherein the corners of the mouth are turned down.  Undergoing rejuvenation with other modalities is a step forward but unless the underlying problem that is leading to wrinkles is corrected (ex: muscle activity) one may not see long-term results.

Read About All Celibre's Facial Shaping Techniques

Contact celibre Medical in Los Angeles and Orange County for a free consultation regarding laser resurfacing procedures, www.celibre.com/contactlist.aspx.

Facial rejuvenation using laser and injection treatments.  Los Angeles Laser Resurfacing for facial rejuvenation.

Refilling deep wrinkles and folds of the face using hyaluronic acid fillers (ex: Juvederm, Restylane, Perlane) is an excellent way to resolve the deeper lines that cannot be resolved with Botox.  The most common area wherein fillers are used is the nasolabial folds which are referred to as laugh or smile lines.  Fillers work by adding volume in a very natural, appealing way.  Fillers are used to augment and define the mouth area, add support and smoothing to the lower mouth and chin area (marionette lines), and to add volume to the hallow areas of the cheeks.  The concept with fillers is to focus on shaping the face rather than just filling lines and wrinkles.  Oftentimes as we age, we see the mid-face area change.  The common complaint is "my face is falling!"   By restoring volume to the upper cheeks and filling the tear trough area (area below lower lid and orbital rim), the shape of the mid-face is improved to a more youthful appearance.  The outcome is subtle yet appealing.

More before and after photos of Los Angeles laser Resurfacing Patients, www.celibre.com/micropeelba.aspx.

Laser Resurfacing and facial rejuvenation refers to improving the texture and pigmentation (color) of the skin by using lasers, chemical peels, appropriate skin care products, etc.  In our practice, we utilize the Erbium MicroLaserPeel which works by removing the outermost layer of the skin while stimulating collagen remodeling in the dermis below the surface of the skin.   Although there are many, many modalities that are being offered that claim to achieve these goals, we have found that the Erbium MicroLaserPeel is "tried and true" with consistent, predictable outcomes.  We also utilize non-ablative lasers (no downtime involved) that are efficient in addressing pigmentation concerns as well as stimulating collagen remodeling.

There is no one particular treatment plan that is appropriate for all.  We believe that the best treatment plan is one that sets realistic expectations, attempts to over-deliver on those expectations, is mindful of the patient's goals, concerns, and lifestyle.  Not all patients are candidates for a traditional face lift when the issue is restoring volume.  For the same reason, the above modalities may not be effective if the patient presents with much laxity (sagging) of the skin and would be best served with surgical intervention.  However, it is always in one's best interest to know what their options are while doing their research.  http://www.celibre.com/wrinkles.aspx or http://www.celibre.com/sunspots.aspx.