Fillers: Sculpt the face

drvandykeAs I continue on my journey to the big “6-0”, I have taken a good hard look at the shape of my face. Aging declares itself with subtle changes starting with a decrease in volume of the upper face followed by an increase in width of the lower face. The overall effect is a loss of the youthful oval replaced with the more masculine square. No one wants to be a square. If you want to see your future face there is a fascinating website, aprilage.com, that lets you age yourself (or have fun with it – age someone else!)

Everything descends, darn that gravity! Folds form from excess skin folding on itself. Lines and wrinkles form when facial movements are repeated countless times over a lifetime. Very much like flexing a piece of leather, over time wrinkles set in. My dad used to say, “don’t give me that look, your face will freeze like that”, and he was right!

Solutions? Well one would be to grow out your hair and wear it a la Goldie Hawn. Has anyone seen her face? Most photos I find feature large sunglasses and the “face frame” do. Don’t get me wrong though, hair styling can enhance and hide all kinds of features and I support that! But for a little longer lasting solution, and one that looks good rolling out of bed in the morning, we can do wonders with fillers. Fillers are like Jell-O, they work by filling a space. They are great for replacing volume in the upper face, for that we use Voluma. It is made by Allergan, the Botox people, and lasts as long as 2 years! It is injected with a tiny needle and gives instant gratification. I had my first taste of Voluma recently and voilà! Cheeks were lifted.

For the wrinkle side of things the more traditional fillers (Restylane and Juvederm) and a newer option (Belotero) serve as the spackle once the volume is enhanced. Even the finest lines can be improved with very small amounts of filler. I had Belotero for my lip lines after some well-meaning (?!) doctor asked me why I didn’t treat my “smokers lines”….I don’t smoke!

What is the difference between the popular fillers? Well they are all basically the same: hyaluronic acid, which is composed of strings of sugar molecules. Each company has a proprietary method of making their fillers which can influence how thick they are and how long they last. Generally the thicker the filler is, the more lift and the greater longevity. For fine lines we need a very thin product which correlates with less longevity.

We need all our fillers to undo what nature is doing to us. And a new hairdo doesn’t hurt, either! Check out our events page and RSVP to our next patient seminar where we will discuss sculpting and framing your face with injectables and the perfect do!

Turning 60 Is No Sweat!

drvandykeThis month is something different: I am doing something BRAND NEW and I am not sweating it one bit. My new toy, gadget, highly technical piece of equipment is miraDry. MiraDry gives you practically sweat free armpits after one or two treatments.

I had my first treatment yesterday. No, I do not have a serious sweating problem. I have a serious wardrobe problem, namely: I can’t keep a white shirt for more than a half dozen wearings! Icky, yellowish marks come from nowhere and increase progressively until my only option is to donate to Goodwill (they probably don’t want them either) or walk around with my arms plastered to my sides hoping no one notices the tell-tale sign that, yes, I do indeed sweat. Light colored silk can be an issue too with small dark crescents forming under my arms just when I want to look fabulous. Again, the solution: keep my arms by my side.

So I have decided to sweat like a lady!

MiraDry is an FDA cleared noninvasive procedure that provides long lasting results by destroying sweat glands under the surface of the skin. Kind of like laser hair removal where hair follicles are targeted and destroyed. Sweat glands don’t regrow (and by the way, only 2% of your sweat glands live in your armpits so you will never miss them). More than 90% of people treated had dramatic decreases in sweating immediately after one or two treatments, and miraDry has an incredible 95% satisfaction rating on RealSelf.com.

Of course Botox is also approved to treat underarm sweating and I have treated many patients with Botox injections with great results. Unfortunately Botox has to be repeated at least once a year. From a cost and time commitment point of view, miraDry is a much better value!

If you are a really heavy sweater (change your shirt multiple times a day) this treatment is life changing. This condition is referred to as hyperhidrosis and can be devastating to one’s social and professional life.

If you are like me and are simply bothered by sweat you will get great benefits, too. You can be pretty confident that you will never have to check for sweat stains again (and save tons on deodorants, dry cleaning and new white shirts). Did I mention two of the side effects are actually benefits: odor is reduced and so is under arm hair!

Back to me: I had miraDry last night. My nurse numbed my armpits with a local anesthetic (I felt a few pinches). The applicator was placed on my skin and a warm pulse of energy was delivered. This was repeated multiple times. I felt no pain during the treatment and it took about 20 minutes for each side.   After treatment I applied ice to each side to reduce the swelling and soreness that are expected when the anesthesia wears off. When I woke up this morning I honestly had forgotten that I had had anything done. I had no pain at all. I did see some local swelling under each arm (about golf ball size) and have had some mild soreness and tenderness which should disappear in a couple of days.

So far I haven’t sweated a drop. If in 3 months there is still some sweat I can have miraDry done again for even better result. In the meantime, I think I will go buy a new white blouse!

Mommy Makeovers The Easy Way

Yes I am a mommy, and yes I had a mommy makeover back in the day. My four boys (all with birth weights over 9 lbs., by the way!) now range in age from 25 to 31 years old, so “the day” was quite a while ago. That meant my options were pretty much limited to a tummy tuck, the most invasive, painful and slow recovering plastic surgery there is. That’s not my opinion, that’s what the surgeon told me at my consult 20 years ago … and he was right.

The subject of this month’s blog is: what would my mommy makeover consist of today? Don’t get me wrong, I don’t regret the surgery and some women still truly benefit from it even today, but let’s discuss the latest alternatives.

Post baby we can be left with sagging, stretch marks (which are like thin scars in the skin) and some excess “baby fat”. As hard as we try, we may not be able to overcome this even with the perfect diet and a million sit-ups. Your mom may tell you: “Face it. You had a baby and your body will never be the same”. While this is true, it doesn’t mean you can’t make some positive improvements.

Skin sagging: Radiofrequency has long been used to tighten and firm the skin. Thermage was the first, and I still believe is the best at triggering your body to make new collagen, increasing elastin that helps to restore skin turgor. Best of all, Thermage is a non-invasive procedure so there is no downtime and the results after a single treatment can be very impressive as they continue to evolve, improving over several months.

Stretch marks (also known as stria): Not all of us suffer from this, but if you do you hate them. Fraxel Dual is a resurfacing laser that we use on the face, but can also use on other parts of the body to reduce the appearance of stretch marks. In recent years, much research has been done on the treatment of atrophic scars (thin white scars similar to stria) with great success. We have seen nice improvements with one to three Fraxel treatments, and treatments may be done as close together as 4 weeks. Expect to see redness and mild irritation to the stretch marks for a few days, and avoid the sun for a couple of weeks after each treatment.

Baby fat: If you have that little roll below the belly button or need the entire abdomen and love handles reduced, but don’t want liposuction surgery – you are in luck! Thanks to treatments such as CoolSculpting (fat freezing) and Liposonix (ultrasound fat melting), the era of effective, non-invasive fat reduction is here. Each procedure is equally effective after one treatment, and you can always repeat either if you wish. We can also combine the two treatments or customize the treatment to best fit you.

There you have it, saggy skin, stretch marks, and unwanted fat can all be treated at the same time. It just depends on what works best for you. For example, I did two separate treatments, Thermage and Liposonix, to treat my cellulite a couple of months ago. Customizing a treatment plan that fits your comfort level and target your trouble areas is key to a successful modern day mommy makeover.

Van Dyke Laser & Skin is holding free seminars on Wednesday, May 21st if you want to learn more. Join us for either lunch or happy hour, enjoy some refreshment and get your questions answered. RSVP please.

Getting Great Legs Without Surgery

drvandykeI hate my saggy thighs. Despite that I am a fairly fit runner and my BMI is within normal, the lumps of fat always seem to migrate to my thighs in the form of dreaded cellulite. It’s especially obvious when performing a “downward dog,” the semi-inverted yoga pose that leaves you no choice but to stare at your imperfect thighs.

So my latest move in “the year of turning 60” project – where I share my experiences as I personally try out the latest cosmetic procedures offered here at Van Dyke Laser & Skin – is to tackle the impossible: great legs without surgery, starvation diets or 8 hours a day at the gym. I know some people feel that diet and exercise are the only acceptable ways to improve your appearance, but I beg to differ. I think non-surgical cosmetic procedures can be a great complement to any fitness routine.

One of my favorite combination treatments is Liposonix & Thermage. Liposonix is a fat reduction treatment and Thermage a skin tightening treatment, a winning combo. While I was focused on my thighs, this same procedure can also be used on the tummy, bra fat and flanks. Learn more about Liposonix, Thermage and Fraxel (a skin resurfacing treatment) at our upcoming Non-Invasive Mommy Makeover event. Join us on Wednesday, May 21 for either a Lunch & Learn Seminar: (1 – 2:30 PM) or a Happy Hour Seminar: (5:30 – 7 PM) and find out how Liposonix, Thermage, and Fraxel can work together to restore your natural pre-pregnancy body shape, while reducing the appearance of stretch marks at the same time. But in the meantime, back to my experience with both Liposonix & Thermage.

Because my nearly 60-year-old legs show some laxity and sagging as well as extra fat, I opted to combine my Liposonix with a Thermage treatment. While you can see firming and lifting with Liposinix fat reduction I wanted to specifically target skin laxity which is where Thermage shines. Thermage uses radiofrequency energy to generate heat deep within the skin itself triggering collagen tightening, stimulating new fibroblasts and resulting in new collagen formation. Collagen is the magic material that makes younger skin smoother, firmer and less crepe-like.

Day of: To be honest, Liposonix is an uncomfortable, even painful procedure for some. Most patients chose a pain pill such as Percocet or Vicodan combined with a mild sedative like valium for the treatment, about 5% go for twilight sleep. Various other options include prescription and over the counter anti inflammatories. Comfort management is entirely customizable to the procedure that the patient. Notably, discomfort following the procedure is minimal and does not require pain medications. Because I have decided to have several treatments done at the same time (I will review Ultherapy for facial laxity in a future blog but this was also done at the same sitting) I chose to have twilight sleep. My favorite anesthesiologist (board certified of course and his nurse) arrived at the office to do a quick medical check in, start an IV and I drifted into a lovely slumber.

The Procedure: I was photographed, measured and weighed for base line. Then the areas to be treated were meticulously marked off according to the plan developed at my consultation. We discussed again what areas were of concern. The front of the thighs, inner thighs and the area under the buttock were “grided” (a blueprint for the treatment). Liposonix would be applied precisely to the areas of need. Since I also chose to do Thermage over the same areas on the same day this area was also marked off and included the cellulite/laxity zones of my anterior thighs.

Liposonix was done first and with 40 sites treated took just about 1.5 hours. Immediately after Liposonix was completed the fronts of my thighs were treated with Thermage (about 45 minutes) to further firm and tighten.

After the procedure I felt pretty sore, like I had run a marathon (which I am proud to say I have actually done). I slid into some long leg SPANX for the comfort and compression that reduces soreness, bruising and swelling. And yes I did bruise, Arnica was applied to hasten the resolution and reduce soreness. I must say it did not slow me down one bit. We treat with a high-energy protocol when patients are sedated and the result can be bruising. When patients (95% patients) do not have twilight sleep we use a lower energy protocol that is more comfortable and causes less soreness and bruising but delivers the same results although the treatment time is about 75% longer.

I am now excited to see my results but as I tell my patients: patience! It takes weeks to months for the ultimate result.

Voluma: the greatest thing since the Fountain of Youth!

Doc’s Journey continues this month as she takes the patient’s seat and shares her experience as she receives the latest in cosmetic dermatology treatments. This month features the hottest treatment currently at Van Dyke Laser & Skin – Voluma!

Of course we all know the Fountain of Youth is not real. But, Voluma is and I must say I’m truly wowed by this new filler. Not only does it last twice as long as its’ cousins (Juvederm, Restylane, Radiesse, Perlane) but it can do something that we haven’t been able to do before: LIFT!!

This March I’m continuing on my mission to improve myself in the year that I turn 60. In previous months I’ve written about my Ulthera and Thermage experience (and the results are starting to really show!) My latest adventure is with Voluma.

The goal: to “lift the face” without the “facelift”. Have you ever stood in front of the mirror and pulled up on the skin of your face? The results are great, right? The cheeks elevate, the folds from the corners of the mouth to the nose smooth out, along with positive improvement in the marionette lines from the corners to the chin (together known as parentheses). Even the crinkles, bags and dark circles under the eyes look better!! So you ask the plastic surgeon “can’t you just do a little tuck…like this (as you pull upward on your cheeks)?” His/her response, “well, little lady, that is a facelift, general anesthesia, incisions up and down your face, weeks of recovery and months of swelling and oh by the way, well into 5 figures financially.” So you get a face-lift or go home dejected.

Enter: Voluma, FDA approved in November 2013, and widely used in Canada and around the world for years. Voluma’s magic is in its ability to restore facial volume in the cheeks to better support sagging skin of middle age and later. Instant gratification, no down time, a fraction of the cost of surgery (and no surgery) and a natural, not surgical look that lasts for 2 years. PS: you don’t have to be middle aged to benefit; we are now able to enhance cheeks and deliver high cheekbones that maybe you did not get from mom.

Voluma: 2 to 4 syringes (I had 2), a few practically painless injections to the cheekbone area (don’t worry, you won’t get swollen or fat cheeks) and my face is more lifted and youthful. Seriously, it is the easiest thing I have done so far. You should try it.

Note: Dr. Van Dyke is a national trainer and lecturer for Allergan, makers of Voluma, Botox and Juvederm. She has trained hundreds of medical providers and physicians in the use of Voluma and was the first in Arizona to use the product upon FDA approval.

Treatment #1 for the New Year and my renewal

After years of assessing, advising and treating patients I am taking my own advice! Why wait until it has gotten to the point that you “just have to do something!” My advice is to embrace the low risk, non-invasive, treatments that really work; FDA approved for safety and efficacy. Look at this way, we are preserving youth, not just recapturing it. Now at 59, going on 60, I can’t pretend to be preserving youth; but I can look as good as I can by recapturing “youthful,” if not outright young. So here we go…Ways to firm and tighten sagging skin on the face and neck!

Thermage and Ultherapy are two phenomenal non-invasive (read: no down time, minimal risks) procedures for “shrink wrapping” your skin. Thermage has been around for more than a decade and we have done thousands of procedures on the face, neck and eyes to firm and tighten (What’s better, it’s good for other areas of the body, but that’s for another blog!). Ultherapy is a bit newer and penetrates deeper into the skin with Ultrasound generated pinpoints of heat. It precisely targets the SMAS layer below the skin of the face and triggers the generation of new, younger, tighter tissue to actually lift the brow, the cheeks, the jawline and the neck. SMAS is that sheet of connective tissue that fights gravity to keep the face from sagging; it gets lax as aging occurs. Not just a lifting procedure, Ultherapy also firms and tightens the skin itself.

The procedure I had was a combination of Ultherapy for the face and neck and Thermage for the eyelids – kind of a non-surgical eye job! Immediately after I felt some mild soreness and my face was a little pink but looked great, maybe a little early tightening. I wasn’t expecting much since I know it takes at least 1 month for new collagen to form and as long as 3 or 4 months for true results. The morning after, I was one of the few who get some swelling. I noticed it (I am pretty self-critical) but unless you know me you wouldn’t think anything was amiss. After a couple of days a subtle yellowish bruise appeared on my jawline, easily covered with makeup. Now, 3 weeks later, my jawline and neck feel delightfully tighter and people are telling me I don’t look my age. I love that! But this is still very early. I will post some photos in a blog after a little more time passes.

I am so excited to see my results!

Happy New Year,

Susan Van Dyke, MD

A Year of Treatments with Susan Van Dyke, MD

drvandykeThis year I turn 60. There, I said it. Don’t ask me how it happened, because truth be told, the time has literally flown by. Sixty is the age your grandmother is. Well, I became a grandmother three months ago. Time is a funny thing; it gets away from you.

Being the “queen of cosmetic dermatology,” I preach prejuvenation; don’t wait until you need major work done, do subtle, moderate things along the way so that you look your best at any age. But, like the shoemaker’s child, I have gone without shoes for far too long…

Turning 60 has me motivated, and I’m going to do some catching up. I would like to journal with you as I embark on my own personal adventures in cosmetic dermatology because after all, I’m not just a doctor, I’m a patient too! Each month throughout 2014 I will have a procedure done and share with you my experience, my feelings and my results. In December 2013, I had both the Liposonix & Ultherapy procedures completed, so be on the lookout for my next blog where I will share my experience with you!

I invite you, take the journey with me! In the end we will both be a year older, hopefully wiser and more comfortable in our own skin.

Happy New Year!

Susan Van Dyke, MD

Wishing You A Happy Holiday
- Susan Van Dyke, MD

Whether you celebrate Christmas, Chanukah, or are simply caught up in the excitement of the season, it seems fitting to pause and reflect on the year that is quickly coming to a close. I would like to take a minute to give thanks for all of the friends, new and old, who have walked through the doors of Van Dyke Laser & Skin throughout 2013. Some I have known for nearly 30 years, and many have just found us and we hope to know for the next 30!

Of course this practice would not be what it is without the providers and support staff here at Van Dyke Laser & Skin. I am grateful for Marie and Carrie, our awesome RN’s DeAnn and Grace, our amazing laser tech/aestheticians Ronalda (head MA) and Kelly (MA/laser tech), as well as Kay and Amanda at our front desk and Kara, our Practice Administrator. Without this truly gifted team of talented women we would not be able to live up to our mission of:

  • Van Dyke Laser & Skin is dedicated to delivering the absolute best in cosmetic dermatology procedures and products in a professional and elegant environment.
  • We assure superiority through the utilization of cutting edge technology in equipment, materials and products.
  • We assure a superb patient experience through a qualified, caring, compassionate and knowledgeable staff.

Happy Holidays to all and see you next year!!

November Notes

This past month was a whirlwind here at Van Dyke Laser & Skin, and there is no signs of stopping as we move into the prime months of the year! Thank you to everyone who came out to our annual Open House; it was one of the most energetic, engaging and informative events to date. October also marked a huge personal milestone for me…, which some of you may already know. I welcomed the next generation into my world: Penelope Price Hays, my very first grandchild. She was born October 3rd and weighed in at 8lbs, 15 ozs, 21.5 inches and we love her in every way! Happily I had returned from my lecture tour of Japan and Korea just in time to hold her.

Looking ahead, November is already packed full of fun and exciting events. We will be the first to introduce Juvederm Voluma (a huge advance in facial fillers), we will be making a big donation to the Juvenile Diabetes Research Foundation and I will be returning to Asia for a week to continue to teach physicians about current trends in Cosmetic Dermatology and Lasers. Phew! Last but not least, I’d like to wish you and your families a very happy Thanksgiving.

Susan Van Dyke, MD

Don’t put your neck on the line- Treatments that Rejuvenate it!

Have you noticed how the focus is shifting off of the face and on to the neck when it comes to rejuvenation? Actually this is not new. For decades, (yes, I have been around for that long) women and men have been coming to me and to plastic surgeons wanting to make their face more youthful; and we have been doing just that. But the most youthful face plopped onto a saggy, wrinkly spotty neck does not get the desired result. Now we have a disconnect; the face is 40, the neck is 50! How did this happen? Well, frankly, there was not a lot we could do for necks 10 years ago. Necks are delicate creatures, they need gentle nudging. Strong lasers are too much, surgery certainly can do the trick; but who wants their throat cut?

So we have established the problem. Now for the solution, or rather solutions! So much has evolved in even the last year for the “forgotten neck.” Such as Ulthera; which received the first, and only, FDA approval to LIFT the neck, in October of 2012. It is a non-invasive procedure (this means no downtime, no surgery) that utilizes high intensity focused ultrasound to generate heat very precisely into the underpinnings of the neck, face and brow triggering a nice tightening and lifting effect that will last. New collagen is produced and improvements continue for months. Because it is non-invasive you can repeat this procedure in 3 months for even more results or every year, or two, to maintain.

The new Thermage also has the neck in mind. Thermage technology (also non-invasive) has been around for a decade. The new part has to do with comfort and results. We have been using the new Total Tip for Thermage to target the deeper structures of the skin where the collagen lives. The result: beautiful overall firming and tightening including the neck. After 10 years of treating patients with the ever improving and upgraded technology of Thermage, I am impressed! You see results immediately that keep on improving over time.

Let’s not forget the spotty, dull and crepey neck skin that has previously been neglected, let’s talk resurfacing. In a nut shell, resurfacing promotes the emergence of new healthy, evenly pigmented skin after a treatment or series of treatments. We now have 3 options: mild for the 30 and 40 somethings, medium for 40 and 50 somethings and deep for all who have just seen too much sun. The lighter treatment, Clear & Brilliant, is accomplished in less than half an hour, with some pinkness that is gone in hours. The medium treatment, Fraxel Dual, gives more result in fewer treatments and will cause a few days of redness.

Most important is your skin care. Growth factors, antioxidants, retinoids and SPF (and, as needed special products for pigment or redness) are your key to improved skin beauty now and into the future. Investing in your skin includes taking care of it between treatments. Kind of like your teeth, we get them cleaned every 6 months at the dentist, but if you don’t brush and floss on a daily basis you will be sorry!

So, next time you feel like grabbing a turtleneck or wrapping a scarf around your neck to cover it up, remember there are many great options to rejuvenate the long neglected neck!

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