Beverly Hills Beauty Secrets

Douglas Hamilton, M.D. and Babak Azizzadeh, M.D.

PROCEDURES & GLOSSARY

The following products and procedures are outlined in our new book Beverly Hills Beauty Secrets. Here we provide a brief description of each. They are organized alphabetically for your convenience:

  • 302 protein drops: 302 Drops are derived from avocado and have the unique ability to thicken skin-both the dermis and the epidermis. We prescribe it to help reverse the skin-thinning effects of age.
  • Accent: Accent is a radio-frequency device that is used to tighten the skin and reduce the effects of aging. Accent's radio-frequency treatments can create dramatic change without requiring invasive surgery or even topical anesthetics. Accent is designed to uniformly heat the dermis with radio-frequency energy while protecting the epidermis with built-in contact cooling. The increased temperature in the dermis causes collagen contraction, realignment, and new collagen production, which continues to build over several months. (See also "Thermage")
  • Alpha hydroxy acids (AHAs): AHAs such as glycolic and lactic acids, are fruit acids that are the mildest of the peel formulas and produce light peels. These types of peels can provide smoother, brighter-looking skin for people who can't spare the time to recover from a phenol or a trichloroacetic acid (TCA) peel. AHA peels may be used on areas of dryness, uneven pigmentation, and acne.
  • Antioxidants: Cells are attacked by harmful elements called free radicals. One of the leading theories on skin aging is that it can be prevented by stopping the formation of free radicals with antioxidants (which are considered "free-radical scavengers"). Antioxidant skin-care products have increasingly assumed center stage. There are numerous antioxidants used in skin-care products, including vitamins (C and E) and herbal and green tea extracts (polyphenols). This list is likely to expand rapidly and may even have value in preventing skin cancer.
  • ArteFill: Composed of polymethyl methacrylate (PMMA), lidocaine, and bovine collagen, ArteFill can permanently eliminate expression furrows: "smile lines," "marionette lines," brow and deep forehead lines, and depressed acne scars. The results look and feel extremely natural, since 80 percent of the fill is the patient's own collagen, produced over several months as a stimulation of the PMMA; the other 20 percent of the fill is the permanent PMMA microspheres themselves.
  • Blepharoplasty: Blepharoplasty is eyelid surgery in which excess skin-sometimes in combination with fat and muscle-is removed from either the upper or the lower eyelids. The procedure can be performed simultaneously on the upper and the lower eyelids.
  • BOTOX Cosmetic: BOTOX is a purified version of a natural protein, Clostridium botulinum, that is derived from bacteria. Administered in very small doses, Botox can relax and smooth deep furrows and lines in the face. There's no recovery time, so you can get back to work or participate in other activities immediately. BOTOX Cosmetic works by reducing muscle contractions and elevations in the treated area, causing even deep lines and forehead furrows to become smoother and less prominent. There usually is some reduction in the ability to raise the brows or squint.
  • Bovine (cow) collagen (Zyderm and Zyplast): first became available in 1981, and for more than twenty years virtually stood alone as the only filler substance used in the United States. It truly initiated noninvasive facial rejuvenation, and its short duration of three months was easily tolerated when no competition was available. Bovine collagen treatment requires skin testing (unlike most fillers that have followed), so immediate gratification on the day of your consultation is not possible if you have not had collagen before. Human-derived collagen (Cosmoderm and Cosmoplast), however, does not require skin testing. It also has a duration of three months and is grown from human skin under sterile conditions.
  • Caracas Masque: Cosmelan is an excellent pigment-removing alternative to IPLs (Intense Pulsed Light, see below) and lasers in certain dark skin types (Latin Americans, Asians, and Iranians), for whom laser technology can actually make things worse by darkening the very spots that the individuals are attempting to lighten. Cosmelan is a truly revolutionary system that uses a chemical mask designed especially for these skin types. This process allows us to remove facial and body brown spots in just a few days.
  • Chemical Peels: The standard chemical peel is a treatment that uses a chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers. It is helpful for individuals with facial blemishes, wrinkles, and uneven skin pigmentation. The precise formula that is used can be adjusted to meet each patient's needs. Chemical peels can also remove precancerous skin growths, soften acne facial scars, and even control acne. It is not a treatment that closes up enlarged pores.
  • Chin Implant: These days, chin implants are formed from a safe, solid silicone material. Thanks to modern technology and a skilled plastic surgeon, a silicone chin implant will look and feel just like the real thing. We want you to feel as good as you look, so we work hard to create a natural-looking, balanced effect with all our chin implants.
  • Citrix-Vitamin C: Vitamin C is the most plentiful antioxidant in human skin and a potent anti-inflammatory agent. (Read more about this in Chapter 4 of our book titled, "Lotions and Potions: How to Prevent or Reverse the Aging Process.")
  • CO2: (See "Laser skin resurfacing.")
  • Eyelid surgery: (See "Blepharoplasty")
  • Fascian: Fascian is an injectable human implant material that is made from the fascia, or the body's connective tissue. The active ingredient in Fascian is fascia lata from the covering of the abdominal muscle. Fascian implants have been used less frequently since other fillers have appeared. Their best use is for cheek augmentation.
  • Fat (Multi-level Fat Grafting, or MFG): Fat grafting is an outpatient procedure that removes and refines fat tissues from the lower part of the body with liposuction. This refined fat is then injected into the multiple layers of the face with small needles, to restore facial volume. Live fat cells are transplanted near muscles that provide blood supply to the fat cells, which results in long-term transfer. We refer to it as multi-level fat grafting (MFG) because the fat is injected in multiple layers to improve its viability and increase overall appearance.
  • Fractionated Skin Resurfacing: Fractional lasers have advanced the field of skin resurfacing by producing excellent results with high efficacy and no downtime. Fractional lasers deliver light in an array of high-precision microbeams. These create narrow, deep columns of skin coagulation that penetrate below the epidermis and into the dermis while sparing the tissue surrounding the columns from damage. The beams actually penetrate deeper than the CO2 or erbium lasers. The coagulated tissue within the columns initiates a natural healing process that accelerates the formation of collagen, thereby inducing new healthy tissue.
  • Hyaluronic Acids: Hyaluronic acids are produced in the body and help to maintain not only skin growth but also volume. As the skin ages and is exposed to environmental pollutants and the sun, the cells lose the ability to produce hyaluronic acid. As a result, the skin begins to lose volume which often results in the formation of facial wrinkles. Dermal fillers are used by physicians to help temporarily replace lost hyaluronic acid and to restore skin volume.
  • Intense Pulsed Light (Photo Rejuvenation): Intense pulsed light, or IPL, is a popular skin treatment offered by many dermatologists and plastic surgeons wherein a broad spectrum of light is applied to the skin. IPL is used to reverse signs of aging that are caused by exposure to the sun; it can also improve irregular or uneven skin tone, including red and brown spots.
  • Juvéderm: Juvéderm is another product that, like Restylane and Perlane, is composed of hyaluronic acid; it comes in the form of a gel that is inserted into the skin. Juvéderm is a smooth gel that flows into the skin; it was designed so that the overall effect would be smooth and natural rather than harsh and abrasive.
  • LaRoche-Posay products: In early 2007, this company introduced a similar product (sunscreen) to Neutrogena's. It contains Mexoryl, which appears to be equally effective in blocking UVA and UVB rays. (Read more about this in Chapter 4 of our book titled, "Lotions and Potions: How to Prevent or Reverse the Aging Process.")
  • Laser removal of birthmarks and skin lesions: The abnormal blood vessels that cause port-wine stain birthmarks are reduced in size by a laser, and the treated area lightens. Skin growths, facial spider veins, warts, and some tattoos respond well to the use of the laser. The patient may see results after the first treatment, but typically, more than one laser treatment is required. Minimum laser intensity preserves as much healthy tissue as possible, which results in the need for multiple treatments.
  • Laser skin resurfacing: Reduces wrinkles around the lips, around the eyes, or even on the entire face. Softens fine wrinkles; removes certain blemishes on the face. (See also "Fractionated Skin Resurfacing.")
  • Laser Surgery: There are many benefits to cosmetic skin resurfacing. Lasers are able to change tissue without making an incision. Because of laser technology, for instance, major surgery does not have to be performed to treat birthmarks or damaged blood vessels, remove port-wine stains, or shrink facial spider veins.
  • Lip enlargement: Current aesthetic facial fashions strongly support full luscious sensual lips. Various fullers are used to yield this affect, including Restylane, Juvederm, Evolence Breeze (all temporary) and silicone (permanent).
  • Lip furrows: These are lines above the upper lip that can be treated with either fillers or lasers, depending upon the depth.
  • Lipoatrophy: Loss of cheek volume can be treated with multi-level fat grafting, Radiesse or Sculptra with long duration results.
  • Liposuction: Many people will develop some fatty deposits under the neck during the aging process. This is an excellent area for conservative liposuction during a neck lift. Younger individuals may even be candidates for neck liposuction as a stand-alone procedure to rejuvenate the neck area.
  • Lower-Face Face-Lift: The superficial musculo-aponeurotic system (SMAS) is a layer of tissue just below the skin that serves as the foundation and structural support for the lower face. Subcutaneous face-lifts essentially elevate the skin without touching the SMAS. For the most part, SMAS face-lifts use this layer to fortify the face-lift. Deep-plane face-lifts penetrate the SMAS to lift the lax tissue. Most sophisticated facial plastic surgeons employ either the SMAS or the deep-plane face-lift. Many surgeons have excellent success with subcutaneous face-lifts as well.
  • Microdermabrasion: the process of removing the face's outer layer of dead or damaged skin-is an excellent solution for blemished, wrinkled, rough, or otherwise aged skin. The procedure involves the mechanical removal of the epidermis by air-driven aluminum oxide crystals. Because the epidermis contains no blood vessels, there is generally no bleeding during microdermabrasion. Treatments must be repeated monthly to maintain the benefits.
  • Midface-Lift: The technological advance of the endoscope allows surgeons to reduce deep "laugh lines" and increase fullness in the midface with minimal invasiveness, using specialized tools. When your procedure is performed with an endoscope, the incisions will be smaller and can be camouflaged by natural facial features, such as the hairline or the front of the ear. Depending on the severity of the problem and your desired outcome, an endoscopic midface-lift can take from one to three hours to perform. It is an outpatient procedure.
  • Neck Lift: In some cases, a neck lift is absolutely the only solution to restore and revitalize your appearance. In most cases, face-lifts and neck lifts are performed simultaneously, thereby creating a more natural-looking appearance. Speak with your doctor openly and honestly about your expectations of a neck lift. Your goals will customize the procedure you get.
  • NeoStrata: Hydroxy acids are one example of skin-care products that actually produce a direct, measurable change: younger, glowing skin. The effect of hydroxy acid is twofold: it produces a smoother texture and color, and it helps acne-prone skin. (Read more about this in Chapter 4 of our book titled, "Lotions and Potions: How to Prevent or Reverse the Aging Process.")
  • Neova (copper peptide): Since 1999, copper peptide creams have been considered undoubtedly the most effective wrinkle prevention creams available. They have been shown in several independent medical school studies to stimulate collagen at almost twice the rate as Retin-A and Renova. (Read more about this in Chapter 4 of our book titled, "Lotions and Potions: How to Prevent or Reverse the Aging Process.")
  • Neutrogena products: Neutrogena Ultra Sheer Dry-Touch Sunblock is a dermatologist-tested formula that contains Helioplex technology, the latest breakthrough in UV protection. (Read more about this in Chapter 4 of our book titled, "Lotions and Potions: How to Prevent or Reverse the Aging Process.")
  • NIA 24: Niacinamide-based NIA 24, which was tested at the National Cancer Institute, may be able to reverse DNA damage. This product is very important for people with fair skin who have had sun damage-even severe damage. We have noticed, with numerous individuals, a softening of color irregularity and a reduction in scaling, precancerous growths. Therefore, this product serves a unique purpose by perhaps reducing the prevalence of skin cancer in people who use it while also reducing another major effect of the sun: wrinkles. (Read more about this in Chapter 4 of our book titled, "Lotions and Potions: How to Prevent or Reverse the Aging Process.")
  • Nose job: (See "Rhinoplasty.")
  • Perlane: An injectable filler that is composed of hyaluronic acid in a clear gel form. Hyaluronic acid is a natural substance that has been synthesized to be safe, nonallergenic, and completely degradable, so there's no need for pre-testing. (See also "Restylane.")
  • Persimmon leaf: The leaf of the persimmon plant contains tannins (which are also found in wine) and has skin-lightening and collagen-stimulating capacities. We are looking at new and recent skin-care developments in this area.
  • Phenol: is the strongest of the chemical solutions and produces a deep peel. It is used mainly to treat people with deep facial wrinkles, areas of blotchy or damaged skin caused by sun exposure, or precancerous growths. Since phenol often lightens the treated areas, your skin pigmentation will be a determining factor for whether this is an appropriate treatment for you.
  • Platysmaplasty: A platysmaplasty is a procedure in which the underlying muscles are tightened and the fat is removed. This procedure provides more dramatic results for individuals whose underlying neck tissue is very lax.
  • Radiesse: Radiesse is composed of calcium hydroxylapatite, a naturally occurring component found in the bones and the teeth that appears to have no risk of allergic reaction when used as an implant. Radiesse appears to have some biostimulatory effect that increases collagen production in the body. Radiesse was approved by the FDA for facial use in 2006, but many have been using it off-label for that purpose since 2001.
  • Radio-frequency: (See "Thermage")
  • ReFirme: Another skin-tightening procedure that is very popular on the market today is ReFirme. Like the other tightening procedures, ReFirme addresses the common signs of aging, including sagginess under the eyes, saggy brow lines, jowls and neck laxity, and nasolabial folds. Using a combination of bipolar radio-frequency and light energies, ReFirme heats the dermal tissue to treat the affected area and go deep below the dermal layers to manipulate the collagen beneath the skin.
  • Replenix: Replenix is our most recommended antioxidant preventive skin-care product. It contains green tea-derived polyphenols, which are known to be strong antioxidants.
  • Restylane: An injectable filler that is composed of hyaluronic acid in a clear gel form. Hyaluronic acid is a natural substance that has been synthesized to be safe, nonallergenic, and completely degradable, so there's no need for pre-testing. (See also "Perlane.")
  • Retin-A and Renova: The active ingredient here is tretinoin. These were the gold standards for collagen-stimulating (antiwrinkle) cosmeceuticals for many years. Recently manufactured products appear to be superior, however.
  • RevaléSkin cream: RevaléSkin cream utilizes the benefits of caffeine through an antioxidant derived from the coffee berry (the red fruit of the coffee plant) that reduces the lines that are a result of moderate sun damage. Recent studies have shown that even coffee drinkers-who ingest the bean, not the berry-seem to have a lower instance of internal diseases. (Read more about this in Chapter 4 of our book titled, "Lotions and Potions: How to Prevent or Reverse the Aging Process.")
  • Rhinoplasty: Rhinoplasty is one of the most common yet challenging cosmetic procedures. The key to a successful outcome resides in creating a natural-looking, well-proportioned nose without sacrificing an individual's breathing function. Your desires, ethnicity, and facial proportions are of the utmost importance in determining the proper rhinoplasty procedure. A systematic approach is utilized for the treatment plan, which is almost always unique to each individual. A rhinoplasty begins with the plastic surgeon making incisions inside the nasal cavity. After that, the cartilage and bone of the nose are sculpted, shaped, or in some cases even reconstructed to the desired specifications of the preoperative treatment plan. The skin from the nose is then sutured carefully, and bandages are applied to prevent infection and promote proper healing. Rhinoplasty is usually an outpatient procedure; it can take from one to four hours, depending on the severity of the procedure. In most people, you will see no exterior, noticeable scars.
  • Sculptra: Sculptra (marketed outside the United States as New-Fill) is an injectable compound of poly-L-lactic (PLA) acid gel. A synthetic polymer, Sculptra is designed to restore facial volume to areas of hollowness. Sculptra is currently approved for use in people with lipoatrophy as a secondary aspect of HIV-related treatment. The majority of its use, however, is off-label for aesthetic enhancements. The product works extremely well for individuals with moderate to severe volume loss. It is also extremely useful for areas such as the temples, the cheeks, and around the mouth.
  • Silicone: Lip augmentation appears to be silicone's best and safest use. Indeed, it is felt by many filler experts that silicone is the safest and most natural permanent filler augmentation product worldwide. The use of silicone in other areas of the face appears to yield a much higher risk of allergic reaction (granulomas, or red bumps), which can occur years later. Silicone stimulates the production of your lip collagen to enlarge the lips.
  • Skin care: The glow of youth is lost over the years as the outer layer of the epidermis becomes thick and opaque. This layer can be corrected by the daily application of a hydroxy acid (see "Neostrata.") Also, the preventative theory for skin aging is based upon the concept that cells are attacked by free radicals. Aging can be prevented with antioxidants. Dermal creams that increase collagen production based on medical evidence of skin biopsy studies would consist of copper peptide creams (see "Neova.").
  • Skin and platysma lift: The skin lift consists of lifting and tightening the skin in combination with the platysma muscles along the neck. By removing excess skin, the surgeon can create a more youthful facial appearance. The incisions for an isolated neck lift can be placed behind the ears, thereby avoiding any visible scars.
  • SkinMedica Growth Factor: According to a press release from the American Society for Dermatologic Surgery, "Growth factors refer to a variety of natural protein substances that facilitate the communication between damaged and healthy cells and thus increase the rate of new cell growth. It is a proven treatment for chronic, non-healing skin wounds such as extensive burns and ulcerations caused by diabetes." We have concerns, however, about the theoretical possibility of the stimulation of skin cancers by these growth factors.
  • Thermage: Thermage is the most commonly used safe and effective treatment for moderate laxity (or looseness of facial skin or flesh). Thermage is safe and noninvasive, requires no downtime, and is applied in a single treatment. It works by heating the skin to over 61 degrees C. This induces curling or contraction of collagen which produces a tightening effect over a period of 6 months. Some tightening is noted on the day of the procedure with gradual improvement over the next several months. Additionally, there is new collagen production in the dermis (the thick part of the skin).
  • Titan: In our opinion, Thermage is the gold standard for the tightening devices. Titan purports to have similar features, particularly in its claims of "deep dermal heating with new collagen formation over time." Titan uses infrared light to heat the skin of the face. The depth of skin heating is less than occurs with Thermage and, therefore, the tightening effects are less. Additionally, there have been several reports of skin burns with Titan. Thermal heating that extends deep into the skin is associated with the production of more collagen, which helps to tighten and firm the face.
  • Trichloroacetic acid (TCA): can be used in many concentrations, but it is most commonly used for medium-depth peeling. Fine wrinkles, superficial blemishes, and pigment problems are commonly treated with TCA. The results of a TCA peel are less dramatic and not as long lasting as those of a phenol peel. In fact, more than one TCA peel may be needed to achieve the desired result. The recovery from a TCA peel is shorter than with a phenol peel.
  • Tri-Luma: Tri-Luma is the most widely used prescription bleaching agent in the United States. It contains three prime ingredients: 4 percent hydroquinone, tretinoin, and a topical steroid. This product is excellent for color irregularities in photo-damaged skin, especially for darker skin.
  • Zinc oxide: To equip yourself with the most protection on the market today, we suggest full-blockage, zinc-containing sunscreen. Until 2007, zinc stood alone as the only true broad-spectrum UVA and UVB protection. Z-Silc is our recommended zinc-based sunscreen.

ABOUT THE BOOK

Whether they're on the red carpet or close up on the big screen, Hollywood celebrities know how to keep their faces looking young and flawless. Now you can, too!

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DR'S IN THE MEDIA

Check out Dr. Hamilton's TV appearances and more! Dr. Azizzadeh's coming soon.

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ABOUT THE AUTHORS

  Babak Azizzadeh, MD

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  Douglas Hamilton, MD

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