Repairing a bad steroid injection with Perlane

At Celibre, we see all types of injuries and unique concerns.  This was a new one for us.  

A female patient came to us after having had a steroid injected into her cheek for the removal of Juvederm.  While steroids are not normally used for the removal of a Hyaluronic acid based filler, this patient claimed that the physician she went to injected steroids to remove the Juvederm.   In the process, the patients cheek was atrophied and this resulted in a sunken area.  

To remedy this issue, we used Perlane injections to smooth the surface of the skin.   Results can be seen below.  For more information about Perlane injections in Los Angeles, contact us for a free consultation.  

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Posted by administrator on Monday, January 26, 2015 3:36 PM
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How to Treat Eye Bags?

Los Angeles Restylane for Eye Bags

Under Eye bags are a big concern for many of our patients.  And while surgery is always an option, many fo the patients we see are not ready for the knife.  In situations where eye bags are a concern and surgery is not an option, we offer Restylane injections.

Restylane is a Hyaluronic acid product that is designed to add volume under the eyes where it has been lost.  Adding volume can help to fill the hollow area under the eyes or to smooth our bumpy fat pads that look like bags.  

The severity of the eye bags will determine if a patient is a suitable candidate for injection procedures.  Two examples are below.  The first is a female patient that was an excellent candidate and got very nice results for smoothing the loose skin below the eyes.  The second candidate (male) was a good surgical candidate with much loose skin under the eye, although he was not prepared for a surgical procedure.  

To learn more about call the office now.  

 

  

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Posted by administrator on Wednesday, January 21, 2015 1:25 PM
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Injections for Dark Circles Under the Eyes

One of the most common questions we get from our patients is what they can do to help with the tired appearance caused by dark circles under the eyes.  Many of these same patients are not ready for a surgical procedure, which is a good option, but more invasive than the injections provided at Celibre Medical.

For patients that are concerned with dark circles under the eyes, we use Restylane injections.  Restylane is made of Hyaluronic acid and is a water absorbing gel used to add volume under the eyes where it has been lost because of age.   By injecting deep under the muscle that surrounds the eye, Restylane lifts the plane forward so that the deep recess under the eye is no longer present.  

 This technique improves the appearance of dark circles for two reasons.  The first is that light from above no longer creates shadows under the eyes.  The second is that the small blood vessel and natural color of medium skin tones can be camouflaged by the additional "padding" that the Restylane offers.  

To see an example of before and after pictures of Restylane for dark circles under the eyes in Los Angeles, see below. 

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Posted by administrator on Monday, January 19, 2015 5:14 PM
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Injections for Dark Circles Under the Eyes

One of the most common questions we get from our patients is what they can do to help with the tired appearance caused by dark circles under the eyes.  Many of these same patients are not ready for a surgical procedure, which is a good option, but more invasive than the injections provided at Celibre Medical.

For patients that are concerned with dark circles under the eyes, we use Restylane injections.  Restylane is made of Hyaluronic acid and is a water absorbing gel used to add volume under the eyes where it has been lost because of age.   By injecting deep under the muscle that surrounds the eye, Restylane lifts the plane forward so that the deep recess under the eye is no longer present.  

 This technique improves the appearance of dark circles for two reasons.  The first is that light from above no longer creates shadows under the eyes.  The second is that the small blood vessel and natural color of medium skin tones can be camouflaged by the additional "padding" that the Restylane offers.  

To see an example of before and after pictures of Restylane for dark circles under the eyes in Los Angeles, see below.  

To find out more about how Restylane can help with your dark circles, call the office today for a free consultation.   

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Posted by administrator on Monday, January 19, 2015 5:14 PM
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Am I allergic to Hydroquinone?

Many hydroquinone formulations contain three ingredients - hydroquinone, Retin A and steroids.  Hydroquinone works to bleach out brown spots or dark marks such as melasma, brown acne scars and brown scars - post inflammatory hyperpigmentation (PIH).  While this formulation can be very effective for getting rid of these cosmetic concerns, there are side effects.  

Many patients that use this triple formula are too sensistive to the retin A in the product.  Retin A is designed to exfoliate the skin and it can cause redness, peeling and irritation.  Depending on the strength of the retin A, how often it is used and also the patient sensitivity, the irritation it creates may make it too difficult to use.  In this situation, our hydroquinone offering that does not contain Retin A is an excellent option.  In addition, because our liquid gel formulation can be compunded at 4%, 6% or 8%, we are able to help Melasma patients that have not achieved good outcomes with traditional forumlations to succeed with ours (an example is below).

To learn more about our non-Retin A hydroquinone formulation, call the office today.  

 

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Posted by administrator on Thursday, January 15, 2015 4:31 PM
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What is Hyaluronidase?

We get asked this question often by patients who have been injected at other practices and are unhappy with their results.  They are looking for solutions for how to reverse Restylane or Juvederm injections and they find us their answer.

Hyaluronidase is an enzyme that is designed to break down the Hyaluronic acid gels that comprise dermal fillers such as Restylane, Perlane, Juvederm, Voluma, Belotero and others.  When injected, Hyaluronidase immediately goes to work breaking down the injection product so that the patient looks the same as prior to the dermal filler injections.  The procedure is has little discomfort and is quick.   The results are seen between an hour and 1-2 days.  Multiple injections can sometimes be required but in many cases, the first injection of Hyaluronidase dissolves the dermal filler completely.

Hyaluronidase is not effective for products such as Radiesse, Sculptra and Artefil that do not use Hyaluronic acid as a base for the product.  These longer lasting fillers are not reversible with Hyaluronidase.  Tade names for Hyaluronidase include Vitrase, Wydase, Amphadase and Hylenex.  While we have not tried all of these products, we have found Vitrase to work very well.  

To see an example of a Vitrase Hyaluronic acid based reversal of Juvederm, check the photos below.  If you need to reverse a dermal filler injection, contact us today for more information.

 

  

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Posted by administrator on Thursday, January 15, 2015 4:04 PM
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Los Angeles Fractional Laser Resurfacing for the Eyes

Fractional Laser Resurfacing has been around for since 2005/2006.  Since that time, there have been many improvements to the technology including changing the wavelength of the laser light to achieve better tissue absorption.  This means that skin concerns like wrinkles and acne scars are more easily improved with newer fractional technologies.  it also means that we can easily treat those with darker skin types, like the African American patient below that had scar revision.  

 In addition, newer technologies added the ability to use a function commonly referred to as "coagulation", which is a method for heating and contracting deeper dermal tissue during the resurfacing process.  Using coagulation in the laser resurfacing process helps to produce the amazing eye rejuvenation results seen below.  Finally, deeper penetration of newer technologies and larger sized fractional perforations allow for more significant improvements and few treatments.

To find out more about Sciton Profractional laser resurfacing in Los Angeles, contact us for a free consultation.  

 

 
 

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Posted by administrator on Thursday, January 15, 2015 10:45 AM
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Laser Resurfacing for Black Skin

Dark skinned patients often ask us if laser treatments are right for them.  The answer to their question is a resounding yes...if you have the right technology.   Along the way, they have been told or read online that - because they are black - laser treatments are not appropriate for their skin type.   This is simply not true.  Dark skin types can undergo laser treatments, but additional laser technologies are necessary to offer safe and effective treatments to darker skin types.

This point is the key difference between Celibre Medical and most other cosmetic dermatology and medical spa offices.  We have 10 different lasers in each of our offices and the breadth of technology allows us to offer a variety of treatments to all skin types.  

If you are in Los Angeles or Orange County and are interested in laser treatments for African American skin, call the office today to schedule a free consultation.  

Below find an example of a patient that underwent fractional laser resurfacing for lacerations in the forehead as a result of a car accident.  This is before and after 3 Sciton Profractional laser resurfacing procedures.

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Posted by administrator on Monday, January 05, 2015 2:32 PM
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Recovery for Deep Profractional Laser Resurfacing Los Angeles

We speak to patients every month that have been disappointed with the results of their laser resurfacing procedures, specifically Fraxel laser resurfacing Los Angeles. 

When asked about the details of the procedure, it's very common to have the patient describe only being numbed with topical numbing cream and having little to no bleeding.  These two details - the type of anesthesia and the amount of bleeding - are key to determining what kind of procedure was done and also why it may have been disappointing.  

If the only anesthetic offered is a topical numbing cream, then we know that the resurfacing procedure is a very superficial one.  The reason is that deep resurfacing cannot be offered without other forms of anesthetic such as valium, vicodin, dental blocks (mouth) and direct inject lidocaine (other areas) because it would be too painful.  So, if you've had laser resurfacing with only a topical numbing cream, then you've had a very superficial resurfacing with limited potential benefits.  The depth of the resurfacing will affect how well the acne scars are revised.  If the procedure is too superficial, no bleeding will occur and results will be limited.  On the other hand if significant bleeding does occur, then the procedure was deeper and results will be better.  

Below is an example of what the 7 day recovery process looks like for a deep resurfacing for acne scars.  If yours did not look anything like this, then it's likely you had a very superficial resurfacing procedure.   

 

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Posted by administrator on Monday, December 29, 2014 1:06 PM
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How to Get Rid of Hemosiderin Staining?

The reason our organization is so different is that we commonly offer solutions to skin issues that other facilities like ours cannot.  One of the reasons is experience and the other is technology.  

Hemosiderin staining is a perfect example.  Recently a patient came to us after having been badly bruised from under eye injections many months prior.  She could not find anyone in Los Angeles to help...until she found Celibre Medical.  

Look what just a couple gentle q-switched Nd:Yg laser treatments can do to remove long term hemosiderin staining that has been left as a byproduct of injection treatments.  Needless to say, our patient was thrilled to put this issue behind her.  If you've got a hard to treat cosmetic skin issue, call the laser experts at Celibre Medical today.  

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Posted by administrator on Tuesday, December 23, 2014 10:46 AM
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Want Great Lips? Choose a Great Injector

One of the biggest fears of our patients when they consider lip injections is that they will look like they have ducklips.  While this is a legitimate concern, the way to look natural when you have dermal filler injections like Restylane, Juvederm, Perlane, Radiesse and Sculptra is to find a great injector.  

Injecting dermal fillers really in an artistic pursuit and it takes a keen eye and a good bit of experience to help our patients look younger and also look natural.  Lori Haney, RN has been injecting at Celibre Medical since 2006.  She has a sharp aesthtic eye and a soft touch.  

So, if you don't want ducklips, come see an expert.  Call today for an appointment with Lori Haney, RN, our lead injector.  

 

    

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Posted by administrator on Tuesday, December 16, 2014 2:34 PM
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Why Cheap Botox is Not Necessarily Good Botox

We get calls every day from patients asking about the price of Botox.  Because we are a cosmetic dermatology facility and all of our services are paid for directly by our patients, we understand how important the price of the service can be. 

But one consideration that some consumers overlook when they are searching for a service like Botox Injections in Los Angeles is that they are paying as much for the expertise of their injector as they are for the product itself.  As with any service, more skilled providers usually have higher prices.  

  

  Cheap Botox Injections (top) and after we fixed them (bottom). 

To highlight this issue, we have included a case study above with a patient that came to our practice after having bad (and cheap) Botox injections for years.  She had a very unnatural looking browline with accentuated arches at the outer brow.  It was almost witchlike in it's appearance and was not flattering for her.  To correct the situation we smooted the forehead and frown lines, but at the same time relaxed the arch of the brow so that it settled down and became more natual looking.  Her forehead looked smooth and relaxed after the treatment, but without the accentuated brow arch that made her look unnatural previously.

If you are interested in balancing the cost of your Botox injections with the skill of a master injector, then you've found the right place.  Call today fro a free consultation.   

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Posted by administrator on Thursday, December 11, 2014 10:07 AM
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Avoiding Bruises Associated with Injection Procedures

Injection procedures such as Restylane, Juvederm, Perlane, Radiesse and Sculptra can have marvelous benefits in helping us look our best.  But they can sometimes have side effects as well.  

Bruising is a primary side effect of dermal filler injections.  Whether you will bruise or not during dermal filler injections depends on several factors.  Your age and health, how prone to bruising you are, what product is injected, where it's injected and how it's injected all factor into whether you may bruise.  

Finally, there are several ways to avoid bruises by following our pre-treatment suggestions.  First, do not drink alcohol within 24 hours of your procedure.  Alcohol thins the blood and contributes to bruising.  Fish oil and Vitamin E also thin the blood and our recommendation is to stop taking them approximately 7 days before your treatment.  Finally, many patients use baby aspirin on a daily basis and this should also be stopped a week ahead of your injection procedure. 

In spite of taking these precautions some patients still bruise.  But fear not.  At our practice we are able to remove or reverse the effects of bruisnig within 2-3 days.   We use a long pulsed yag laser to heat and disperse the blood particles below the surface of the skin.  An example of bruise reversal over a 2 day period is below.  

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Posted by administrator on Thursday, November 20, 2014 2:43 PM
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What is Coolbeam Laser Los Angeles?

We are often asked by patients and potential patients about the Coolbeam laser (also called the Cool Laser) and how it compares to the lasers we use at our office. 

We have asked the office that uses the Coolbeam laser what kind of technology it is and they let us know it is a fractionated Erbium laser.   Fractionated erbium laser technology is similar regardless of the brand of the laser.  The Sciton profile fractionated laser that we use at Celibre Medical uses the same type of laser light and fractionated pattern that is used in the Coolbeam laser.  The office that uses the Coolbeam laser uses it for rejuvenation, stretch mark removal, scars and other services.   While it is certainly a useful laser for these applications, the Coolbeam is not fundamentally different from the Sciton Profractional or other fractionated erbium lasers.

For an example of fractionated erbium treatments with the Sciton profile for acne scar patients in Los Angeles, view the photos below.

 

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Posted by administrator on Thursday, November 13, 2014 10:41 AM
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Eye Rejuvenation with Laser Resurfacing and Restylane

Aging around the eyes is one fo the biggest concerns for our patients.  It's also one of the most difficult areas to treat.  For this reason, we often use combination treatments to achieve the desired results.

In the case below, we offered three options.  The first is Dysport fo rthe outer eye (crow's feet).  These are the small wincing lines to the sides of the eyes, that are especially present in photos when we smile.

The second phase of the treatment plan was laser resuerfacing.  We resurfacing the sides of the eyes and the undereye area to soften the fine lines.

Finally, we added dermal fillers below the eyes (Restylane) to add volume back that has been lost to the aging process.  

This multi-treatment approach yields nice results for softening and diminishing the fine lines and wrinkles around the eyes.  

  

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Posted by administrator on Tuesday, November 11, 2014 11:01 AM
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Los Angeles Ulthera Review

At Celibre, we think results trump marketing.  We believe in long term patient relationships, not short term scores.  For this reason, we are averse to recommending (or purchasing) radio frequency devices that are marketed to "tighten" and "lift".  Examples of these devices include Ulthera, Titan and Thermage.  Show us tissue tightening before and after pictures and we will point out the same two issues.  They are almost never past the six month mark and they are almost always with the patients head tilting down before the photo and titling up in the after photo (for neck tightening).

The problem for us is that they never live up to the expectations created when using the words "tighten " and "lift".  As an alternative, we recommend cosidering surgery or even long term injections like Radiesse or Sculptra.



If Thermage was such a great product (like Radiesse), then why did it completely disappear from the landscape of cosmetic treatments.  The Lumenis Lightsheer laser for hair removal has been around for 15 years and patients still request it because it delivers PERMANENT results.  And that's where radio frequency has it's problems.  It delivers limited, short term results at a high price point.  We don't think there is value in the service (compared to a facelift) and so we do not buy or use the equipment and we do not recommend it.  Ulthera is just the latest craze, but it's sure to be replaced by another in the none to distant future :(.  That new one will certainly show up on Dr. Oz, The Doctors, KCAL 9 and everywhere else that wants to do a little sensational marketing.  The problem is that's all it will be....marketing.

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Posted by administrator on Friday, November 07, 2014 7:59 AM
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Syringoma Removal with Cauterization

We get contacted fairly regularly in regard to the removal of syringoma.  Syringoma are troubling, persistent, fleshy bumps that occur most often below the eye.  The condition is very common in Asian patients.  

Many of these patients ask about CO2 (or other forms) of ablative laser resurfacing.  Laser resurfacing is certainly an option for syringoma, but to use an old adage, we feel that is't analogous to pounding a nail with a sledgehammer.  Although we offer laser resurfacing, it's difficult to resurface just the bumps themselves and it's a lot more time consuming and costly than a good old fashioned hyfrecator.

Hyfrecation is the process of using heated probe to cauterize the syringoma and an example of a recent case of before and after pictures for a Los Angeles patient is below. To leanr more, contact the office today.

  

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Posted by administrator on Wednesday, October 22, 2014 3:13 PM
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Why we're not currently using Voluma by Allergan 10/20/14

We've had many requests for Voluma over the past few months in response to the launch Allergan's newest dermal filler product.  The strategy of our organization has always been to let new products earn their place in our practice by proving, over a year or two in the market, that they are worth the hype.

And that's what product launches are - hype.  The manufacturers of lasers and injection products have to hype their products with huge PR campaigns to try and make a name for their brand in an already cluttered cosmetic dermatology marketplace.   They get consumers really excited when appearing on shows like "The Doctors" and "Dr. Oz".  The problem is that the reality of the product is usually quite far off from the hype and Voluma is a perfect example.  

In the FDA study used for the approval of Voluma in the cheeks, the AVERAGE patient used 6.5 CC's of product in the cheeks.  Now, if you know anything about injection product, you know it's very unusual to use this much product.  In fact, most patients at our practice get a maximum of 3-4 CC's in the cheeks.  To give you an idea of how much this would cost in today's market, Voluma is selling for between $750 and $1000 per CC.  So that 6.5 CC average patient from Allergan's study would have paid between $4,875 and $6,500 for their injections.  We don't know many consumers willing to pay that for their injections.

On top of this fact, if you inject 6.5 CC's of ANY dermal filler, you are going to get a lot of duration, just because there is so much product in the cheeks.  Voluma claims a 2 year duration, but Juvederm XC also claimed 18 months when they originally came out and if you know Juvederm, you also know it doesn't last for 18 months.   We believe that it's very realistic for Voluma to achieve 12 months of duration, but beyond that we are skeptical and will let consumers weight in over the next year as to whether the premium cost of Voluma is worth it.

 


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Posted by administrator on Monday, October 20, 2014 2:21 PM
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Why All Fractional Resurfacing is Not the Same

We get calls regularly from patients that are frustrated with the results of their fractional laser resurfacing treatment at another office.  In over 90% of the cases, we can trace the reason for their disappointment back to the depth of the resurfacing treatment.

Fractional laser resurfacing is not the same everywhere.  The depth of the resurfacing matters, coagulation matters (heating of the tissue) and how large the fractional holes are matters.  There are a lot of determinants to set when performing a fractional laser treatment and how well your practitioner knows these determinants and how they will affect your case will determine your results.

Most patients are not told (nor do they ask) how deep their resurfacing will be.  This is important because for acne scars, fine lines and sun damage, the deeper the resurfacing, the easier it is to resolve the concern.  But with deeper resurfacing, patients feel more pain and thus need more comfort measures.  We always know when a patient has had a very simple fractional resurfacing because they tell us that all they had for numbing is the triple numbing cream that is placed directly on the face.  Using this method alone ensures that the resurfacing must be very superficial, otherwise it would be too painful.  

 
 At our practice, we resurface down to 1000 microns (1 millimeter).  In most practices, they limit the depth to 200 microns.  We know this because when we askpatients that have come from other practices whether they experienced heavy bleening or not, the answer is almost always no.  Once you get past 150-200 microns the bleeding becomes more profound, but so do the results.  To resurface deep acne scars, the treatment needs to go much deeper than 200 microns.  
 
Take a look at the picture below of a typical 7 day recovery process.  You will note that there is much bleeding right after the procedure ends (first photo) and this is indicative of a good, deep, fractional resurfacing procedure.  A procedure that's a little more difficult to recover from, but one that delivers much better outcomes.
 
 

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Posted by administrator on Tuesday, October 14, 2014 4:05 PM
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What's the Best Treatment for Wrinkles Around the Eyes?

We get asked this question all the time and there is no one single answer.  One of the follow up questions we ask is "Which wrinkles?  Is it the crow's feet on the sides of the eyes that wrinkle up during the smile?  Is it the frown lines between the eyes that appear when frowning or is it fine lines and/or loose skin below the eyes.  We have options for all of these, but they vary depending on the area.  

Frown Lines:

Your best bet for frown lines is always going to be Dysport or Botox.  Botulinum Toxin Type A relaxes the muscles that cause the frown lines.   The area smoothes out nicely for 3-4 months after a proper dosage, leaving you looking very relaxed.  In rare instances where the frown lines are very deep, we will use a small amount of Hyaluronic acid based filler such as Restylane to improve the area.  We do not recommend laser resurfacing in this area because it does not generally help.  See photos below.

 

 
Crow's Feet (smile lines):
 
For the crow's feet lines on the sides of the eyes, Dysport or Botox are also our go to treatments.  Laser resurfacing has more benefit in this area than between the eyes, but the fundamental cause of the wrinkles, (muscle contraction) is not changed by laser resurfacing so the lines usually return fairly soon after the resurfacing.  We love Dysport and the duration would be in the same 3-4 month range.  See photos below.
 
 
Tired Eyes and Dark Circles (Tear trough):
 
Finally, the area under the eyes (the tear trough) represents the most difficult area to treat.  In this area, for patients without too much excess skin, we normally opt for a dermal filler such as Restylane.  Often the issue in this area is hollow eyes or dark circles in addition to fine lines.  Restylane can help with all three.  And when the skin is a little loose and the texture needs improvement, we reach for the Sciton Profractional for fractional laser resurfacing. See photos below.
 
 

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Posted by administrator on Thursday, September 25, 2014 5:33 PM
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Contact us today to schedule a FREE consultation!