What to Expect at a Cosmetic Consultation

I often get questions from prospective patients about treating their skin and when I suggest they book a cosmetic consultation they want to know what to expect. During an initial consultation it is important for me to find out about the patients’ concerns and wishes. Some patients want to address concerns about looking tired or sad, for others it’s dealing with frown lines or sagging skin. I explore these concerns and review different treatment options to help each patient achieve their goals.

I often start by discussing skin care and long term strategies which may include ways to help prevent and treat photodamage, such as brown spots and fine lines. Depending on the patient though the concern could be redness or acne prone skin. A skin care discussion is very much tailored to each patient’s skin type.  Lasers that help with discolouration, pore size, and texture may be a useful adjunct for complexion as well. I then move on from the skin to talk about the underlying muscle, bone and fat support and this is where botox, fillers, or deeper skin tightening devices play a role in an overall treatment plan.

While the face is often the focus, I also take time to review other areas such as the neck and chest since focusing on prevention in these areas is critical as well.  Sometimes people treat their face, but forget their neck, chest and hands and these areas can really show someone’s age. Some patients have specific body sculpting concerns and may want to reduce fat or tighten skin in other areas of their body like their abdomen or arms for example. 

I see patients across all age groups and often we need to prioritize what areas we want to focus on initially and things we may want to plan for down the road. I like to think of everything globally as well and project out where people might start to age in 10-20 years, so we can plan for treatment and think about prevention strategies as well. 

The needs for each patient are unique and as such the treatments are customized. So for example, someone may come in looking for treatments for under eye hollows that they have had since they were young. They want to address this as more of a longstanding anatomic concern. Another patient may come in with the start of a jowl and say that they see it in their mom or dad and want to work on strategies to treat and prevent this. A different but common concern would be someone with sun spots and lots of textural skin changes from too many years of sunbathing. After consultation and reviewing the options we can make an individualized treatment plan for you.  

If you are interested in booking a cosmetic consultation contact our team.

Shaping the Perfect Profile

Was Marilyn Monroe onto something? In the cosmetic world there has been a big focus on the lower face and jawline, emphasizing the importance of the chin for balance and symmetry. In this age of selfies, there has even been a term coined: “profiloplasty,” which refers to aesthetic treatments used to improve a patient’s profile.

At a recent meeting we discussed that injectors shouldn’t just be giving our patients mirrors, but showing them photographs, so they can see their face in 3 dimensions rather than just the frontal view.  It impresses me how many millennial patients seem to know their proportions; they often ask about the chin and jawline and want to improve the profile of their nose. How do people know what their nose looks like in side profile or that their chin is slightly retruded? They know because they take selfies from all angles!  As cosmetic physicians it’s important that we think of the face from all angles. Yes we can fill a cheek or soften a fold, but we need balance, symmetry, and harmony between the different facial features. A full cheek may look imbalanced if present with a weak chin and lower face. 

This brings me back to Marilyn Monroe. In the US, a person’s right to medical privacy ends 50 years after their death and in 2013 Marilyn Monroe’s medical records were auctioned off.  These records seemed to indicate that Marilyn Monroe had chin augmentation in the 1950s. Could this have contributed to her iconic beauty? Most would agree that she is one of the timeless beauties. So perhaps Marilyn was indeed onto something with the focus on her chin and in photographs she really worked those angles to emphasize her stunning chin and jawline!

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”).

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!

Trends in Dermatology for 2018

As we start off the New Year I wanted to share a few emerging trends in dermatology. In my practice I treat patients for both medical and cosmetic concerns so I will highlight some developments in both areas.

On the medical side there are a number of exciting new treatments emerging for the treatment of psoriasis, eczema and acne just to name a few!

Eczema – This chronic condition can be challenging to treat, particularly since, to date, we have had limited effective systemic medications. Dupilumab is a new biologic that was approved by the FDA in 2017 and has been approved by Health Canada for roll out in 2018. Dupilumab is a human monoclonal antibody that is designed to inhibit overactive signaling of two key proteins (IL-4 and IL-13) that are believed to be major drivers of the underlying inflammation in atopic dermatitis (eczema). We dermatologists (and our patients) have all been awaiting the approval of this new medication as the data suggests it is quite effective and safe. A number of other biologics and topicals (including non-steroid options) are also in the pipeline, promising even more options to treat this condition.

Psoriasis – There are a number of new biologics being introduced for the treatment of psoriasis as well. New IL-17 inhibitors and IL-23 inhibitors, including risankizumab, guselkumab, tildrakizumab, ixekizumab and brodalumab (all a bit of a mouthful to say J), are either recently approved or in the final stages of gaining approval to be marketed in the US and Canada. If you suffer from psoriasis you can ask your dermatologist whether any of these new medications may be right for you. Topicals in newer formulations, such as spray foam (enstilar), also continue to gain popularity for treating mild to moderate psoriasis where a high-powered biologic medicine is not called for.

Acne – In terms of acne treatments there is new evidence that certain combination treatments, such as adapalene and benzoyl peroxide (TactuPump Forte) can help treat acne, including more severe acne, and can also prevent and treat acne scarring. There are number of new topicals in the pipeline for acne treatment as well, including topical sebum inhibitors that could act to reduce “oily skin” that may drive acne in some patients.

Moving on to cosmetic treatments, there are a number of themes influencing the way we treat patients.  

Body Sculpting - Each year the American Society for Dermatologic Surgery (ASDS) surveys consumers to understand their views on cosmetic treatments. For the fourth consecutive year the treatment of excess fat ranked as the #1 thing that bothered people about their appearance. This has given rise to the popularity of treatments such as CoolSculpting. A number of new and faster CoolSculpting applicators have recently become available and I believe this treatment will continue to increase in popularity. In addition, Belkyra (Kybella in the US), which was originally approved as a treatment for double chins, is now being used (off-label) on different body sites as well to help treat stubborn fat.

Combination treatments – Increasingly you will find different cosmetic treatments, such as neuromodulators like botox, being used in combination with fillers, and lasers, for more effective results. We have moved away from simply treating a line or wrinkle to thinking of the face in 3-dimensions and focusing not only on the skin, but thinking about the underlying structures as well. The aging process is complex and while a patient may be bothered by one thing, we may approach this concern with a combination of treatments to address related concerns. Often a combination approach may provide the most effective and longest lasting improvement. 

Natural looking outcomes – While this is not a new theme, it is definitely one that continues to be important. The desire to ensure a natural look has led to the rise in treatments like microneedling and thermage, skinboosters, and the use of more frequent, but smaller treatments with filler and neuromodulators such as botox. This also aligns with the goal of prevention and using cosmetic treatments to help preserve skin elasticity and collagen, so that your skin can stay looking healthy and vibrant longer.

Focus on men - Men have always represented a smaller proportion of the cosmetic patient population but they continue to grow each year. While men make up only about 10% of the total patient population for popular procedures like botox, the number of men seeking cosmetic treatments has increased dramatically over that past several years. Understanding the unique needs of men and developing customized treatment plans to emphasize masculine features continues to be a focus.

These trends will continue to play a big role in my practice in 2018 and beyond. I will continue to keep up-to-date on the latest in both cosmetic and medical dermatology. If you have any questions or want to book a consultation, please feel free to contact us.