Comprehensive aesthetic rejuvenation : a regional approach

188 Pages·2011·5.85 MB·English

by  Jenny Kim

EDITED BY
JENNY KIM
GARY LASK
ANDREW NELSON
Comprehensive Aesthetic Rejuvenation
Series in Cosmetic and Laser Therapy
Series Editors
David J. Goldberg, Nicholas J. Lowe, and Gary P. Lask
Published in association with the Journal of Cosmetic and Laser Therapy
1. David J. Goldberg
Fillers in Cosmetic Dermatology, ISBN 9781841845098
2. Philippe Deprez
Textbook of Chemical Peels, ISBN 9781841842954
3. C. William Hanke, Gerhard Sattler, Boris Sommer
Textbook of Liposuction, ISBN 9781841845326
4. Paul J. Carniol, Neil S. Sadick
Clinical Procedures in Laser Skin Rejuvenation, ISBN 9780415414135
5. David J. Goldberg
Laser Hair Removal, Second Edition, ISBN 9780415414128
6. Benjamin Ascher, Marina Landau, Bernard Rossi
Injection Treatments in Cosmetic Surgery, ISBN 9780415386517
7. Avi Shai, Robert Baran, Howard I. Maibach
Handbook of Cosmetic Skin Care, Second Edition, ISBN 9780415467186
8. Jenny Kim, Gary Lask, Andrew Nelson
Comprehensive Aesthetic Rejuvenation: A Regional Approach, ISBN 9780415458948
9. Paul Carniol, Gary Monheit
Aesthetic Rejuvenation Challenges and Solutions: A Global Perspective, ISBN 9780415475600
10. Neil Sadick, Diane Berson, Mary P. Lupo, Zoe Diana Draelos
Cosmeceutical Science in Clinical Practice, ISBN 9780415471145
11. Anthony Benedetto
Botulinum Toxins in Clinical Aesthetic Practice, Second Edition, ISBN 9780415476362
12. Robert Baran, Howard I. Maibach
Textbook of Cosmetic Dermatology, Fourth Edition, ISBN 9781841847009
13. David J. Goldberg, Alexander L. Berlin
Disorders of Fat and Cellulite: Advances in Diagnosis and Treatment, ISBN 9780415477000
14. Kenneth Beer, Mary P. Lupo, Vic A. Narurkar
Cosmetic Bootcamp Primer: Comprehensive Aesthetic Management, ISBN 9781841846989
15. Neil S. Sadick, Paul J. Carniol, Deborshi Roy, Luitgard Wiest
Illustrated Manual of Injectable Fillers: A Technical Guide to the Volumetric Approach to Whole Body Rejuvenation,
ISBN 9780415476447
Comprehensive Aesthetic Rejuvenation
A Regional Approach
Edited by
Jenny Kim,
MD PhD
Associate Clinical Professor of Medicine, Division of Dermatology, David Geffen School of Medicine,
University of California, Los Angeles, and Department of Dermatology,
Veteran Affairs Greater Los Angeles Healthcare System,
Los Angeles, California, USA
Gary Lask,
MD
Clinical Professor and Director of Dermatologic Surgery and the Dermatology Laser Center,
David Geffen School of Medicine, University of California, Los Angeles, California, USA
Andrew Nelson,
MD
Assistant Clinical Professor, Department of Dermatology, Tufts University School of Medicine,
Boston, Massachusetts, USA
First published in 2012 by Informa Healthcare, Telephone House, 69-77 Paul Street, London EC2A 4LQ, UK.
Simultaneously published in the USA by Informa Healthcare, 52 Vanderbilt Avenue, 7th Floor, New York, NY 10017, USA.
Informa Healthcare is a trading division of Informa UK Ltd. Registered Office: 37–41 Mortimer Street, London W1T 3JH, UK. Registered in
England and Wales number 1072954.
©2012 Informa Healthcare, except as otherwise indicated
No claim to original U.S. Government works
Reprinted material is quoted with permission. Although every effort has been made to ensure that all owners of copyright material have been
acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention.
Cover and section heading photographs © Nicole Maloney. Nicole Maloney is a fine art photographer based in Los Angeles.
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contained herein. The publisher wishes to make it clear that any views or opinions expressed in this book by individual authors or contributors
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in this book is intended for use solely by medical professionals strictly as a supplement to the medical professional’s own judgement, knowledge
of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances
in medical science, any information or advice on dosages, procedures, or diagnoses should be independently verified. This book does not indicate
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ISBN-13: 9780415458948
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Library of Congress Cataloging-in-Publication Data
Comprehensive aesthetic rejuvenation : a regional approach / edited by Jenny Kim, Gary Lask, Andrew Nelson.
p. ; cm. -- (Series in cosmetic and laser therapy)
Includes bibliographical references and index.
ISBN 978-0-415-45894-8 (hardback : alk. paper)
I. Kim, Jenny (Jenny Jiyon) II. Lask, Gary P. (Gary Philip) III. Nelson, Andrew, 1979- IV. Series: Series in cosmetic and laser therapy.
[DNLM: 1. Reconstructive Surgical Procedures--methods. 2. Aging--physiology. 3. Esthetics. 4. Rejuvenation. 5. Surgical Procedures, Minimally
Invasive--methods. WO 600]
617.9’52–dc23
2011033579
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Typeset by Exeter Premedia Services Private Ltd., Chennai, India
Printed and bound in the United Kingdom
Contents
Contributors vi 3.2 Structure and function of hair 101
An approach to the aging process and rejuvenation vii Gurpreet Ahluwalia
Andrew Nelson, Gary Lask, and Jenny Kim
3.3 What factors play a role in unhealthy hair? 107
Jamie Zussman
1 Introduction
3.4 Aesthetic hair care 111
1.1 Skin aging and function 1
Corey Powell
Howard Murad
3.5 Excess hair 115
1.2 Cosmeceuticals 10
David Beynet
Gurpreet Ahluwalia
3.6 Hair loss and hair transplantation 121
1.3 Achieving healthy skin through
Paul J. McAndrews
a multimodality approach 17
Howard Murad 4 Body Rejuvenation
4.1 Introduction to fat and body rejuvenation 131
2 Facial rejuvenation
Andrew L. DaLio
2.1 Introduction to facial rejuvenation 27
4.2 The impact of obesity 133
Andrew L. DaLio
Andrew L. DaLio
2.2 The aging process on the face 28
4.3 Approach to cellulite and fat 136
Andrew L. DaLio
4.3.1 Lasers and noninvasive body
2.3 Laser rejuvenation 30
contouring treatments 136
H. Ray Jalian and Andrew Nelson
Daniel I. Wasserman, Mathew Avram,
2.4 Eyes, lashes, and brows! Approaches and Andrew Nelson
to periorbital rejuvenation 43
4.3.2 Liposuction 145
Joseph F. Greco, Anastasia Soare,
Andrew L. DaLio
Frederick Beddingfield, and Jenny Kim
4.4 Body contouring surgery 148
2.5 Midface rejuvenation: Fillers for
Andrew L. DaLio
augmentation of the cheeks and
nasolabial folds 60 4.5 Breast contouring surgery 152
Derek Jones and James C. Collyer Andrew L. DaLio
2.6 Perioral rejuvenation 71 5 Beauty and aging in ethnic skin
Frederick Beddingfield, Diane Murphy,
5.1 The aging process in ethnic skin 161
Cherilyn Sheets, Andrew Nelson, and Jenny Kim
Quyn S. Rahman and Stefani Takahashi
2.7 Surgical interventions for the aging
5.2 Hyperpigmentation and skin-lightening agents 165
face: Rhytidectomy (facelift) 91
Quyn S. Rahman and Stefani Takahashi
Tom S. Liu and Andrew L. DaLio
5.3 Aesthetic treatments 169
3 Hair
Quyn S. Rahman and Stefani Takahashi
3.1 Introduction to hair 99
Jamie Zussman Index 175
v
Contributors
Gurpreet Ahluwalia Gary Lask
Dermatology Clinical R&D, Allergan, Inc., Irvine, California, USA Division of Dermatology, David Geffen School of Medicine, University
of California, Los Angeles, California, USA
Mathew Avram
Tom S. Liu
Wellman Center for Photomedicine, Department of Dermatology,
Liu Plastic Surgery, Los Altos, California, USA
Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
Paul J. McAndrews
Paul J. McAndrews, MD, Inc., Pasadena, California, USA
Frederick Beddingfield
Division of Dermatology, David Geffen School of Medicine, Howard Murad
University of California, Los Angeles, and Dermatology Clinical R&D, Division of Dermatology, David Geffen School of Medicine,
Allergan, Inc., Irvine, California, USA University of California, Los Angeles, and Murad, Inc.,
El Segundo, California, USA
David Beynet
Division of Dermatology, David Geffen School of Medicine, University Diane Murphy
of California, Los Angeles, California, USA Global Medical Writing, Allergan Inc., Irvine, California, USA
Andrew Nelson
James C. Collyer
Department of Dermatology, Tufts University School of Medicine,
Division of Dermatology, University of Washington and Westside
Boston, Massachusetts, USA
Dermatology, Seattle, Washington, USA
Corey Powell
Andrew L. DaLio
Sally Hershberger Salon, Los Angeles, California, USA
Department of Microsurgery, Division of Plastic and Reconstructive
Surgery, David Geffen School of Medicine, University of California, Quyn S. Rahman
Los Angeles, California, USA Atlanta Dermatopathology and Pathology Associates, P.C., Atlanta,
Georgia, USA
Joseph F. Greco
Cherilyn Sheets
Division of Dermatology, David Geffen School of Medicine,
Newport Coast Oral Facial Institute, Newport Beach, California, USA
University of California, Los Angeles, California, USA
Anastasia Soare
H. Ray Jalian
Anastasia Beverly Hills Salon, Beverly Hills, California, USA
Wellman Center for Photomedicine, Department of Dermatology,
Massachusetts General Hospital, Boston, Massachusetts, USA Stefani Takahashi
Department of Dermatology, Keck School of Medicine, University of
Derek Jones Southern California, Los Angeles, California, USA
Skin Care and Laser Physicians of Beverly Hills, and Division of
Dermatology, David Geffen School of Medicine, University of Daniel I. Wasserman
California, Los Angeles, California, USA Riverchase Dermatology and Cosmetic Surgery, Naples, Florida, USA
Jamie Zussman
Jenny Kim
Division of Dermatology, David Geffen School of Medicine, University
Division of Dermatology, David Geffen School of Medicine, University
of California, Los Angeles, California, USA
of California, Los Angeles, California, USA
vi
An approach to the aging process and rejuvenation
Andrew Nelson, Gary Lask, and Jenny Kim
key points
● The goals of rejuvenation are to soften the signs of aging by minimizing and reversing
the natural changes that are responsible for the aging process
● Aging occurs due to a complex interplay between intrinsic (natural) changes and
extrinsic (external) damage
● In order to achieve the ideals of beauty, a multimodality approach combining many
different techniques is necessary to address all of the changes
● It is our goal to describe these different techniques, as well as how they can be com-
bined synergistically, to help your patients achieve a rested, rejuvenated appearance
Aging is a natural process of life. As we grow older, our features When patients present for cosmetic consultations, they typi-
and appearance change. Some of these changes can be won- cally do not ask for a specific procedure. Rather, most patients
derful, while there are others that we wish we could avoid. For describe the areas of their face or body that have aged and
thousands of years, people have been trying to change their changed; it is then up to the proceduralist to help the patient
appearance in order to accentuate their desirable features understand their options and make an informed decision
while minimizing others; there are reports of cosmetics being regarding which therapeutic options will help to best achieve
used as far back as ancient Egypt. More recently, there has been their goals. Throughout the remainder of this book, we will
an explosion in the number of minimally invasive procedures therefore approach rejuvenation from a regional body area
to help reduce the signs of aging. As a result, more patients are perspective. Rather than discussing each therapy on its own,
seeking out these minimal downtime procedures, and more we will instead focus on how to rejuvenate an area of the body.
physicians are offering these services. This approach allows us to discuss all the therapeutic options
In order to offer patients the ideal rejuvenation treatment for rejuvenating that body area, as well as discuss how to com-
option, it is necessary to understand the aging process and the bine the therapies together to achieve the best outcome. This
underlying mechanism for these changes. For instance, it is approach allows the proceduralist to offer the most compre-
important to understand the mechanistic difference between hensive approach to rejuvenation to their patients, and to help
dynamic rhytides due to muscular activity versus static rhytides the patients achieve their best cosmetic outcome.
due to an overall loss of facial volume and hyaluronic acid.
the four rs of rejuvenation
Dynamic rhytides are best addressed through the administra-
tion of botulinum toxins, while a loss of facial volume requires
The four Rs represent an easy and effective way to approach
restoration with a dermal filler product. Throughout this book,
rejuvenation. These four aspects: relax, refill, resurface, and
we will discuss the aging process from a basic science perspec-
redrape, attempt to address the different aspects of the aging
tive, as well as provide a strong clinical perspective, in order to
process.
understand the reasoning behind the different treatment
options. With a thorough understanding of how the aging pro-
Relax
cess results in undesired changes, it is then possible to under-
stand the best options to reverse or minimize these effects. Dynamic rhytides often represent one of the most visible
It is also necessary to keep in mind that the best cosmetic aspects of the aging process. These lines develop from overac-
outcomes will typically result from a multimodality approach. tivity of the underlying muscles. While smiling and laughing
There is no single magic bullet that can address all of the dif- are a part of life, the wrinkles that they cause no longer need to
ferent changes associated with aging. Instead, different options be. Botulinum toxins, including Botox® and Dysport®, can
will address differing aspects of the aging process. By combin- safely and effectively be used to temporarily reduce the
ing different approaches, it is possible to offer your patients the appearance of these lines. Due to their effectiveness and posi-
best opportunity to achieve their ideal goals of rejuvenation. tive outcomes, they are now the most common cosmetic pro-
The best results will typically occur from combining a holistic cedure performed in the United States. Botulinum toxins are
approach, beginning with good nutrition, including essential extremely effective in relaxing dynamic rhytides on the upper
vitamins and minerals for healthy skin, topical medical thera- and lower face, including the neck. Rather than discussing
pies, injectable products, minimally invasive laser and light botulinum toxins in a single section, we will focus on how to
source therapies, and even invasive surgical procedures. incorporate botulinum toxins into an approach to rejuvenation.
vii
viii
AN APPROACH TO THE AGING PROCESS AND REJUVENATION
Throughout the rest of this book, we will discuss the potential combining the technologies with botulinum toxins and/or
uses of botulinum toxins in the rejuvenation of different dermal filler products. We will discuss each of these technolo-
regions of the body, particularly showing how to incorporate gies, their application to regional body rejuvenation, and how
botulinum toxins into a multimodality treatment approach. to incorporate them into a multimodality approach to achieve
the best cosmetic outcomes.
Refill
Redrape
As we age, our body’s natural stores of collagen, hyaluronic
acid, fat, and bone slowly redistribute and decrease. These Our initial goal for cosmetic patients is to achieve their rejuve-
changes alter the shape of our face and body. Historically, few nation goals with the safest, most effective, least downtime,
products were available to restore this lost volume, and these minimally invasive procedures possible. There are, however,
original products often had risks such as hypersensitivity aller- many cases where the cosmetic goals of the patient can be best
gic reactions or long-term granulomatous reactions. Fortu- addressed through surgical procedures. It is important for all
nately, there are now products such as hyaluronic acids proceduralists to be familiar with these procedures, their out-
(Restylane®, Juvederm®), calcium hydroxylapatite (Radiesse®) comes, and limitations. These surgical procedures may result
and collagens that can safely and effectively replace our lost in some of the most dramatic cosmetic improvements for your
volume and restore the natural shape to our patients’ faces. patients, but may also have associated downtime.
These filler products can be used in many areas, including the We discuss the incorporation of surgical procedures into the
upper face, lower face, neckline, ears, and hands to replace lost rejuvenation of the body. While the exact details of the surgical
volume. Throughout the book, we will discuss the safe and technique may be beyond the scope of this book, it is nonethe-
effective incorporation of these products into a regional reju- less important for physicians to understand and be aware of
venation approach. the benefits and limitations of these procedures. Physicians
Unfortunately, the aging process can also redistribute excess can then properly counsel patients on their cosmetic options,
adipose tissue to areas we would prefer to avoid, such as the as well as help the patient to make an informed choice regard-
love handle and flank areas. While liposuction remains the ing the approach to cosmetic rejuvenation.
gold standard for removing excess adipose tissue, there are
conclusions
now laser, radiofrequency, cryolipolysis, and other technolo-
gies to treat these changes through non-invasive means. An
The field of cosmetic rejuvenation has undergone a dramatic
understanding of the uses of all of these technologies, as well
transformation in the last two decades. The incorporation of
as their limitations, is necessary to achieve complete rejuvena-
botulinum toxins, dermal filler products, laser technologies,
tion for our patients.
and minimally invasive surgeries allow nearly all patients to
achieve their goals of cosmetic rejuvenation simply, safely,
Resurface
and effectively. The four Rs of rejuvenation are a simple and
Extrinsic components of the aging process, particularly ultra- effective method to describe rejuvenation techniques. How-
violet light, ultimately result in mottled discoloration, textural ever, it is not possible to achieve the best outcome by only
changes, and other undesired effects. These changes can often using one of these techniques. While we often talk about new
be some of the most visible effects of the aging process. Resur- technologies and techniques as being independent, the reality
facing the skin attempts to treat and remove these damaged is that each has its benefits and limitations. Rather than focus-
superficial layers of the skin, in order to expose the healthy, less ing on each of the single techniques on their own, it is better
damaged skin below. There are many different approaches to to learn how to incorporate them together to achieve the best
resurfacing the skin, including medical therapies and chemical cosmetic outcome.
peels. More recently, many different laser technologies have Many textbooks have been devoted to cosmetic rejuvena-
been developed to achieve similar goals. These laser technolo- tion. This textbook is unique in that we approach rejuvenation
gies range from non-ablative visible and infrared lasers to from a body region, multimodality approach. When your cos-
ablative CO and erbium lasers. More recently, fractional metic patient presents and tells you that they want their eyes to
2
devices have been developed, which attempt to achieve similar look younger, your goal should be to think about how to
outcomes as fully ablative devices while minimizing the side incorporate botulinum toxins, dermal fillers, lasers, cosmetic
effects associated. peels, and surgery to achieve the best outcome. With that in
Given the rapid development of novel technologies to resur- mind, this textbook is organized into different sections and
face the skin, it is important for the physician to understand chapters, each focusing on a specific body region or patient
the mechanisms and theories behind these devices. With this type. The techniques relevant to that body region are then dis-
background, it is possible for the physician to apply this knowl- cussed together, focusing on all the options for rejuvenation
edge and continue to evolve their practice as new devices are and how to use them synergistically. With this approach in
developed. While laser devices result in wonderful improve- mind, proceduralists will be able to help their patients achieve
ments for patients, the best outcomes typically occur when their ideals of beauty and rejuvenation.
1.1
Skin aging and function
Howard Murad
1