Dr. Katie Beleznay

Vancouver Skin Care Specialist

Dr. Katie Beleznay is a leading medical and cosmetic dermatologist specializing in the latest treatments to repair and rejuvenate the skin

Filtering by Tag: vancouver cosmetic dermatology

Say Cheese: The Power of a Smile

There has been a great deal written about the benefits, from happiness to health, of smiling. Studies have shown that forcing ourselves to smile tricks our brain into thinking we are happy. The simple act of smiling spurs a chemical reaction in the brain, releasing dopamine and serotonin. Dopamine increases our feelings of happiness while serotonin is associated with reduced stress. So a forced smile is certainly better than no smile at all.

Research has also been done that demonstrates the power of a genuine smile. This genuine smile is referred to as a Duchenne smile, named after French physician Guillaume Duchenne who studied the physiology of facial expressions in the nineteenth century. In one long-term study,  photos of young women were reviewed and those with a Duchenne smile were significantly more likely to report higher marriage satisfaction and overall well-being up to 30 years later. One could conclude that those who smile regularly and sincerely are more likely to lead happy lives.

Can you tell the difference between a genuine smile and a fake one? Studies have shown that even at young ages children can tell insincerity with facial expressions. When you look at the two images below, the smile on the right portrays two hallmarks of a Duchenne smile: contraction of the zygomatic major, raising the corners of the mouth, and the orbicularis oculi, raising the cheeks and producing crow's feet around the eyes. Since contraction of the orbicularis oculi happens naturally when we smile but cannot easily be faked, the absence of crow’s feet can signal an insincere smile (or the result of being “over frozen”).

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For patients undergoing treatment with neuromodulators (Botox, Dysport, Xeomin), preserving the natural smile is essential. Patients who receive too large a dose of a Botox in the crow’s feet may appear to have a fake or insincere smile even when they are genuinely happy. Don’t get me wrong, I think a small amount of neuromodulator for crow’s feet is a wonderful option to soften lines and prevent wrinkles. Also receiving cosmetic treatments can help patients to feel better about their appearance overall, increasing confidence and happiness (resulting in more smiles!). Choosing the right injector will make sure that your emotions continue to show and your face doesn’t appear “frozen.” One of my guiding principles as an injector is to make sure patients achieve natural looking outcomes. Understanding the facial anatomy and ensuring that injections to lessen the appearance of crow’s feet do not eliminate the appearance of that natural, genuine Duchenne smile is very important!

Boardroom Botox: Can Cosmetic Procedures Boost Your Career?

The following Q&A was conducted with The Kit for an article that was published in October 2018.

1. When did you first notice an increase in patients electing to have procedures done because of their careers? Were you surprised at first? And how common is it now?

Looking younger and feeling better about their appearance are common reasons patients give as to why they are choosing to have cosmetic procedures and these directly or indirectly impact both their personal and professional lives. So I don't think having procedures done for career benefits is a wholly new phenomenon but rather it is becoming more top of mind for patients when they discuss their motivations. I don't see that many patients that I would say are doing cosmetic treatments solely for career reasons, but for some it may be the impetus ie. applying for a new job or wanting to look and feel on top of their game. Feeling and looking good can of course impact confidence and studies have shown that both appearance and confidence can impact job opportunity, promotion etc.

2. What are some of the things patients routinely say to you about why they’re having something done/why it’s so important?  Has anyone told you they actually felt pressure or faced comments at work that made them worry about looking older?

I have had patients who have shared personal experiences where they felt that appearing younger provided them an advantage in a business setting. And even if it is simply a matter of feeling more confident, that alone can be a major career benefit. I had one patient where in her company the people all being hired around her were younger and she felt some pressure to fit in.  For others it’s more about maintenance and prevention, so not so much about wanting to look younger, but rather wanting to work on steps to maintain healthy skin. Sometimes there is a driving force like they got their passport photo after 10 years and were surprised at the changes since their last photo or they have an upcoming high school reunion or wedding.

3. What is driving this phenomenon? Are people under more pressure to look younger in general, but especially in the context of work/career?

I think that some people express a desire (or feel pressure) to look younger, but it has also become more acceptable to talk about that and to act on it. Coupled with that is the fact that cosmetic procedures have become more mainstream thanks in large part to the many non-invasive options that require very little down time (away from work) and the open discussion and wealth of information about options on social media. People are constantly seeing before and after photos of people after various treatments and all the information about the different options is quite accessible.  I had one patient say … she invests in nice clothes and purses, she dyes her hair every 6 weeks, and she started to realize that if she’s spending so much on that, she wanted to also invest in her face to make sure she is doing what she can to keep things looking healthy and vibrant. Even though there is often a request to “look younger” I try not to focus on “anti-aging”, but rather review specific personal goals to help people feel great and look and feel rejuvenated whatever their age. 

4. Around what age do people tend to start coming to you with career-related concerns? Does it differ for men and women? What’s the youngest you’ve seen people start worrying about looking older on the job?

It varies quite a bit and really depends on the industry. For example those in the entertainment industry may start earlier. I do have patients in their 20s who see me for small treatments simply to maintain their appearance and slow down signs of aging. In fact, starting small doses of "preventative" botox early can save you from needing more significant treatments down the road.

5. What do women and men typically have done? And how does this tend to evolve over the years (for example, might someone start with Botox in their 40s, then begin adding treatments as they age?)

When people start out they may focus on their skin and developing a personalized skin care plan that is preventative and can help give the skin a little glow. Those with concerns like sun spots or redness may consider a laser or light based treatment to help. Botox and filler have become increasingly popular. They are non-invasive and there is increasing evidence on their ability to not only improve appearance, but also prevent signs of aging over time, and there has been a renewed focus on natural looking outcomes.

In terms of what options are best at which age, it has less to do with age and really is patient-specific i.e. some people in their 20s may have deep frown line and conversely someone in their 60s may not and may focus on other things such as skin tightening or body sculpting. Similarly some patients genetically may be prone to a double chin (at any age) and they may consider an injectable like Belkyra to help reduce that.

6. What are some of the most popular options out there now?

The popular options vary depending on individual patient needs. Complexion enhancing treatments are always popular, so for example IPL to help remove brown spots and reduce redness or microneedling that can stimulate collagen production and help smooth out skin and minimize the appearance of pore size and acne scars. Neuromodulators such as botox are extremely popular and can help soften lines and wrinkles in different areas of the face. Fillers can provide a little lift to help with sagging skin and can be done conservatively for a natural looking outcome. CoolSculpting is quite popular as an option to permanently reduce pockets of fat. There are many other treatments available and I like to review the patient’s main goals for treatment.

There are always new treatments in this field.  Belkrya, which we have been using to reduce the fat in the double chin area, is now commonly being used in other areas. One area we are more frequently treating is the jowls to help contour along the jawline. 

We are also more frequently seeing people for treatment of their necks. One common concern is necklace lines, so called “tech neck”. These lines may be increasingly seen from looking down at computers or phone. SkinBoosters or Volite (both a hyaluronic acid solution) can help to soften those lines. Volite is new to the market in North America, but has been available in Europe and popular there. It is an innovative injectable designed to improve skin quality and help with hydration and elasticity and is commonly used on the face and décolletage. 

If you’re interested to learn more about cosmetic treatments, contact us to book a consultation.

Botox Basics

Some of the most frequent questions I get asked are about Botox and how it works, so I wanted to share some basic information for anyone thinking about getting botox treatment. Botox can be used for many things, including treatment of migraines and excessive sweating, but this post will focus on cosmetic Botox treatments for reducing wrinkles.

Botox is a brand name for botulinum toxin A, a neurotoxin that causes the condition known as botulism. The type of botulism most people have heard about is food borne and can be very serious if not treated as it can spread through the blood stream. In the use of injectable Botox, botulism occurs in a contained location, specifically where it is injected in the face. Here the botulinum toxin attaches to nerve endings. Once attached to the nerve endings it inhibits the release of the neurotransmitter responsible for triggering muscle contractions. 

Essentially Botox “freezes” the muscle, thereby reducing the appearance of wrinkles as muscles remain relaxed. The effects of Botox will last for 3-6 months.

One of the most common uses for cosmetic Botox is to treat the hyperdynamic lines, often called “worry lines” or "frown lines" found in the upper third of the face. These lines are formed due to repetitive muscle action in specific areas. A specific area of use is the glabella, where Botox is used to treat the “11s” (the lines made when you furrow your eyebrows). Botox can be used to treat horizontal forehead lines, “crow’s feet” and "bunny lines." We also use Botox to provide a lateral eyebrow raise, to help with dimpling of the chin, and to minimize large masseters (the muscle on the lateral face that we use to chew). There is a large list of areas that can be treated with Botox but these are the most common.  

Many people think of wrinkles and assume Botox is the best treatment. However, it’s important to understand that Botox works to treat dynamic wrinkles, not static wrinkles.  Dynamic wrinkles only appear when you make facial expressions, for example when you furrow your brow, frown, or smile, so you don't see them when your face is still. Static wrinkles, on the other hand, are wrinkles you have even when your face is at rest. For example, if you have 11s in between your brows without moving your face, those are static wrinkles. 

If Botox were to freeze the muscles around a static wrinkle, it wouldn't make that much of a difference in the appearance since the wrinkle would still be there with or without any muscle contraction. However, with long term use, Botox can help prevent shallow static wrinkles from growing deeper. 

The bottom line is that Botox can help reduce wrinkles in motion, not wrinkles at rest. Botox will not help for lines that are deeply etched in your skin. For these static wrinkles we often need to consider soft-tissue fillers.

Obviously the decision of whether or not Botox (or any other cosmetic treatment) is right for you is one that deserves careful consideration and should include consultation with a dermatologist trained in the use of injectables. My hope with this post was simply to provide a better understanding of how Botox works. For additional information, there is a good post on Real Self that addresses some common myths about Botox.

2015 ASDS Survey on Cosmetic Dermatology

This week new survey data was released by the American Society for Dermatologic Surgery. The 2015 ASDS Consumer Survey on Cosmetic Dermatologic Procedures reflects overall consumer views on cosmetic medical treatments.

According to the results, half of consumers are considering a cosmetic medical procedure and the specialty in which the physician is board-certified is the single most important factor when selecting a practitioner for a cosmetic procedure.

The top cosmetic concerns for consumers are:

  • Excess weight, 88 percent
  • Skin texture and/or discoloration, 72 percent
  • Lines and wrinkles around and under the eyes, 69 percent
  • Excess fat under the chin/neck, 67 percent
  • Sagging facial skin, 67 percent

Highlights of the survey are summarized in the infographic below.