1) Botox at a glance

What is it ?
 Apart from being a mega hit, Botox is a drug made from a neurotoxin produced by the bacterium Clostridium botulinum called botulinum toxin. It is used medically to treat certain muscular conditions and cosmetically remove wrinkles by temporarily paralyzing muscles. Botulinum toxin is sold commercially under the names:§ Botox, Vistabel, Botox cosmetic (OnabotulinumtoxinA or botulinum toxin type A)§ Dysport (AbobotulinumtoxinA or botulinum toxin type A)§ Bocouture, Xeomin(IncobotulinumtoxinA or botulinum toxin type A)§ Myobloc (RimabotulinumtoxinB or botulinum toxin type B).OriginsDid you know that the  inactive instance of botulinum toxin, Clostridium botulinum organism and its spores, are located in nature worldwide in forest and cultivated soils, sediments of lakes, streams, coastal and untreated waters . The bacterium can also be found in the intestinal tracts of mammals and fish and in the gills and viscera of crabs and other shellfish. In nature these bacteria are relatively harmless. Issues occur when the spores transform into vegetive or actively growing cells.Neurotoxins are toxins that target the nervous system and disrupt the signaling that allows neurons to communicate effectively.
How it works…?
Botulinum toxin has proven to be a successful and valuable therapeutic protein when dosage, frequency of treatment and variety of treated clinical conditions are considered.Botulinum toxin can be injected into humans in extremely small concentrations and works by preventing signals from the nerve cells reaching muscles, effectively leaving the muscles without instructions to contract, therefore paralyzing them.The effect of botulinum toxin causes a reduction in abnormal muscle contraction allowing the muscles to become less stiff.Medical and cosmetic useBotulinum toxin's main claim to fame is that it will appear to iron out wrinkles and lines in aging faces. More than just a vanity product, it can be useful for treating a variety of medical conditions ranging from eye squints to migraines, excess sweating to leaky bladders. There are currently over 20 different medical conditions that botulinum toxin is being used to treat with more being discovered regularly.
Approved therapeutic uses for botulinum toxin:§ Blepharospasm (spasm of the eyelids)¹§ Idiopathic Rotational Cervical Dystonia (severe neck and shoulder muscle spasms) ¹§ Chronic Migraine³§ Severe Primary Axillary Hyperhidrosis (excessive seating)¹§ Strabismus (crossed eyes)¹§ Post-Stroke Upper Limb Spasticity⁴§ Detrusor Overactivity Urinary Incontinence⁶§ Overactive Bladder⁵§ Hemifacial Spasm¹§ Glabellar Lines (frown lines between the eyebrows)²§ Canthal Lines⁷§ Crow's Feet Lines.⁷Off-label uses:§ Achalasia⁸§ Anal Fissure and Anismus⁸§ Sialorrhea⁹§ Allergic Rhinitis¹⁰§ Sphincter of Oddi Dysfunction¹¹§ Cerebral Palsy¹§ Oromandibular Dystonias¹²§ Laryngeal Dystonia¹³
How is it performed?
Botuilinum toxin takes up to 72 hours to take effect and make a noticeable difference.The botulinum toxin is administered by diluting the powder in saline (sodium chloride) and injecting directly into neuromuscular tissue, The toxin requires 24-72 hours to take effect, reflecting the time necessary to disrupt the synaptosomal process. In very rare circumstances, some individuals may require as many as five days for the full effect to be observed.
Who should not have botox?Botulinum toxin should not be used in pregnant or lactating women, as well as people who have had a previous allergic reaction to the drug or any of its ingredients.What are the risks and side effects of botox?Injections with botulinum toxin are generally well tolerated and side effects are few. Uncommon responses to a drug because of a genetic predisposition are uncommon, generally mild, and transient.
A universal advice though….Botox should be performed only by a certified plastic surgeon a dermatologist or a medical doctor that knows how to use it.____________________________________________________________________________________
2) SKIN NEEDLING

Enhancing your appearance with skin rejuvenation and resurfacing
If you want to improve the appearance of your skin why don’t you try it with the help of yourself… You ask for something minimally invasive… Skin needling is the answer. Using a derma-roller we perform pinches on the surface of the skin (depth between 0,3- 3,5 mm).

 The result is a smoother, clearer and more youthful appearance to your skin.

What can skin rejuvenation treat?

Skin rejuvenation is a treatment to resurface your skin, or to improve the texture, clarity and overall appearance of your skin.

Conditions that can be treated include:

• Static wrinkles: These wrinkles are visible at all times and do not change in appearance with facial movements.
• Dynamic wrinkles: These are expression lines that may appear as folds when the skin is not moving, and deepen  with facial movements or expressions.
• Improves freckles, sun spots, melasma, or other darkened patches of skin result mainly from sun exposure.
• Smoothes cars as the result of acne or injury to the skin, scars may be rolling (a wavy appearance to the  skin),  pitted, discolored, or have raised borders.
• Improves the loss of skin tone weakening of the supportive skin structure (collagen and elastin fibers) that results in a loss of skin firmness, or the development of cellulite.
• Beautify the skin quality
  
• Improves acne dips
• Improves the appearance of stretch marks

My recovery

When your procedure is completed, you will be instructed on how to care for the treated skin. When carrying out the process of skin needling on the healthy outer layer of the epidermis, the goal is to launch small-scale induction of new collagen beneath the skin (in order to 'awaken' the endogenous production of new collagen). The small "needles" retain almost intact skin and this means that healing is almost immediate lasting up to 3 days. On the 4th  day the skin is ready to accept make-up and on the 7th  everything is back to normal. Something that makes the process extremely popular is the quick rehabilitation. Reintegration is a matter of "Weekend", and the return to normal activities and work is complete after 4 days.

After the entire epidermis remains intact, the healing process and recovery is much shorter. There is no risk of permanent structural damage to tissue, photosensitivity, loss of skin tone and hyper-pigmentation. The skin needling is effective for treating sensitive skin, for which no other methods suitable grinding. This includes the area around the eyes, especially the area beneath them, the area of the neck and back of hands.

Results and outlook

Very often patients see improvement almost immediately and others see a slow, more gradual improvement. The last ones feel satisfied after 8 - 12 weeks but there is no specific time at which we expect improvement as the rate of healing varies from person to person, and the refresh rate of each is unique. We believe that the use of renewable products such as vitamins A & C and enzymes such as collagenase help maintain the collagen in the area. After following some treatments and achieving the desired effect, the revitalized face skin can be maintained for many years

Combinations

The skin needling can and usually is associated with: renewal facial surgery, face lift, neck lift, restoring facial deformities and aesthetic plastic surgery of the body to induce relaxation interventions such  as lipoplasty buttocks, waist, abdomen, arm, thigh, knee , rachis. It is an ideal method to improve the image of orange peel that occurs in many women's bodies, the famous 'cellulite' and also for the areas between the sternum and cervical (neck), known as "neckline" important for many women exposed to the sun.
The skin needling technique when repeated many times has more favorable cumulative effect.
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3) FILLERS
Wrinkle fillers at a glanceThere is nothing more gratifying for cosmetic patients than having an immediate wrinkles correction  or scars as a result of the injection of a dermal filler.

The early steps...Yes, blame it on the ‘80’s, yes it when everything started! Approval took place as early as 1981, it was bovine collagen that had been the only US Food and Drug Administration (FDA)–approved dermal filler more than a decade. Quickly, this dermal filler gained popularity and was marketed under the name Zyderm I. This dermal filler was found to be extremely effective for the correction of fine lines and shallow scars, with results lasting up to 3 months.

Back then, moderate wrinkles, deeper nasolabial folds, and marionette lines could be treated using Zyderm I, with fair results, but results often did not last more than 2 months. What became clear is that Zyderm I had 3 major shortcomings: (1) the potential for allergy to the bovine collagen, which required skin testing prior to the first treatment; (2) results generally lasted 3 months or less; and (3) disappointing results if used to fill moderate wrinkles, skin folds, or scars.

Two years later, Zyderm II and Zyplast were FDA approved and introduced into the market, to address the latter 2 shortcomings of Zyderm I. These newer dermal fillers, Zyplast in particular, significantly improved overall results for deeper rhytides and folds and these dermal fillers, for more than a decade, remained the only dermal fillers that were FDA approved for use in the United States. Despite this, the need for most patients to have frequent treatments, the need for new patients to undergo skin allergy testing prior to treatment, and the limitations of the treatment of deeper rhytides and folds, the full potential for dermal fillers was not seen until the recently with the addition of newer dermal fillers to the armamentarium.

The perfect dermal filler would be inexpensive, safe, painless to inject, hypoallergenic, and long lasting.

In addition, it should have consistent and predictable results, feel natural under the skin, take little time to inject, be ready-to-use, exert no downtime on the patient, and have a low risk of complications. With the increasing desire for people to achieve a more youthful appearance and the increased demand for "lunch-time procedures," the pharmaceutical industry responded by providing cosmetic surgeons with an increasing number of options to meet the demands of the cosmetic patient. Thus, this segment of cosmetic surgery has been the fastest growing ( at an accelerating pace) for the past decade.

By definition, a dermal filler is a product that is injected or placed into the skin. Patients are instructed to not manipulate the treated areas, because the product may shift. The best way to reduce inflammation is to immediately apply a cool pack to the areas that were treated ( strongly adviced). In current practice, several dermal fillers are available for use, in addition to subdermal fillers, or those that are placed underneath the dermis in the subcutis.

So....all you should know about wrinkle fillers is

 Injectable wrinkle fillers can give an impressively  youthful look for a fraction of what a traditional face lift costs. Most will fill lines and wrinkles in less than 30 minutes with results that can last about a year ( all last generation fillers are meant to last more and provide a natural look).Injectable wrinkle fillers, unlike Botox injections that relax the muscle under a wrinkle, fill the line or crease with one of several different substances. As a result, the line or crease seems to have nearly disappeared.Wrinkle fillers can also be used as "volumizers," plumping and lifting cheeks ( a youthful natural result that last really long, but, do not over do it!), filling out thin lips, and plumping sagging hands.

 The treatment >>>>>Fast and easy, yet, wrinkle fillers have a slightly flip side, including the risk of allergic reaction ( if you suffer from allergies you should have a good talk with your plastic surgeon) and the formation ( though, really rare) of tiny bumps under the skin. In extremely few cases, those bumps may be permanent. A bluish skin discoloration known as the Tyndall effect might be possible. The color change can last for several months, however, for that there are several treatments available.In exceptionally rare cases, skin cells may die if the wrinkle fillers are not used properly. Typically, the wrinkle fillers with longer-lasting effects are the ones more likely to cause side effects.Not every wrinkle is right for every type of wrinkle filler. The least risks and best results come from using the right wrinkle filler correctly (try to remember that). That's one reason why you should only have wrinkle fillers injected by a certified plastic surgeon.To help you discuss your options with your doctor, here is a breakdown of the wrinkle fillers currently available. It includes their basic ingredients, how they work, risks and benefits, and the best areas for treatment. Your doctor can help you choose the right one for you.

 Hyaluronic Acid>>>The most popular wrinkle fillers is hyaluronic acid, an ongoing mega-dimension success story! Each type of hyaluronic acid wrinkle filler works in a slightly different way with varying results.Side effects are extremely rare, but they can include redness, swelling, and bruising at the injection site. The filler may also be seen beneath the skin as tiny bumps. This is a problem that often improves over time.How long the results last varies from several months to over a year. Some research shows that repeated injections may help stimulate the body's own natural production of collagen. That will help reduce the number of lines and wrinkles. There is also some evidence that less filler is needed over time to achieve the same look.

Ingredients of hyalouronic acide fillers: gel or particles in a soluble liquid for injection.

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