Non-surgical Methods for Prevention and Treatment of Wrinkles
There are excellent non-surgical steps that can be taken to prevent facial aging. Good skin care includes daily cleansing and non-comedogenic moisturization. Frequent deep exfoliation is important. Microdermabrasion and Micro peel with dermaplaning are excellent methods.
All of my patients are on some form of topical therapy. Retin A and Vitamin C Serum can help prevent wrinkles and other signs of sun damage and facial aging.
Photo facials with IPL or Intense Pulsed Light can remove fine blood vessels and brown spots which are signs of skin inflammation and skin aging.
Botox relaxes the facial muscles that cause frown lines, crows feet, worry lines, lip lines and other lines that occur when our face is dynamically moving. Botox is very effective and safe for most people. I believe it is especially important for people to have Botox to prevent lines from returning after the laser has been used to remove them.
Soft tissue fillers like Hyaluronic Acid can help deep facial lines like the nasal labial fold and Marionette lines, but fillers do not work well on the dynamic lines such as frown lines, crows feet and worry lines.
Fillers can be used effectively to rejuvenate the lips.
In summary the best non-surgical treatments are:
• Daily skin care
• Frequent deep exfoliation
• Topical Retin A or Vitamin C Serum
• IPL-Photo facial
• Botox
• Soft Tissue Fillers-Hyaluronic Acid
I do recommend that you seek these treatments by a qualified professional office such as a dermatologist or plastic surgery office.

Before and after Botox injection to remove crow’s feet.

Laser Wrinkle Treatment
The most effective wrinkle removal treatment for facial skin rejuvenation is laser resurfacing. In the past, stronger CO2 lasers were used and while facial lines were removed and skin tightened, often the skin lost color. The recovery from CO2 laser resurfacing was very difficult, with wounds and redness lasting several weeks.
In the past two years exciting new laser resurfacing technology called ablative fractional laser resurfacing has been developed which is both effective and safe. Fractional ablative laser is very different from non-ablative fractional lasers which have been around for 4-5 years. Ablation is required for effective wrinkle removal. I use the fractional 2940 Erbium laser because the 2940 Erbium is effective and has a much quicker recovery than CO2 fractional laser in my experience. Results like those in the photo below can be achieved with only 4-5 days of redness or pinkness, compared to a three week recovery with traditional CO 2 resurfacing.

Even lip lines and crows feet can be improved dramatically with the new fractional ablative 2940 Erbium laser-see photo below:

Remember, prevention is always the best cure. However if you see signs of aging starting in your face, start prevention and treatment now, the earlier you take action the better. The exciting new fractional ablative erbium lasers are the wave of the future for facial laser treatments that actually work, with minimal down time

For more information on how to remove wrinkles and prevent facial aging read my book or call 978-369-4499 or contact me by email.

Dr Seckel
Boston, Massachusetts
Concord, Massachusetts

Soft tissue fillers like Juvederm® and Restylane® have been used and can produce a beautiful plumping effect on the lip and camouflage lipstick lines and lip wrinkles (See Photo Below).

Juvederm® and Restylane® however are not permanent and need to be repeated. Fat injections last longer but require surgery with a long recovery period due to over correction and fat eventually, in many people dissolves.

More importantly, in my opinion, the plumping effect of fillers like Juvederm®, Restylane®, and fat do not correct the actual wrinkle or crease in the skin which is the cause of the lipstick line or lip line. The lipstick line or lip wrinkle is a permanent crease or depression in the skin of the lip caused by years of the pursing action of the lip muscle and aging changes in the skin. Lipstick lines are much more common and pronounced in smokers.

In the past, CO2 laser resurfacing was the most effective method for erasing lipstick lines and lip wrinkles. However the difficult recovery and long term whitening or hypo pigmentation (loss of color) on the lip caused by the CO2 laser made CO2 laser resurfacing unacceptable for many people.

We have recently introduced the new Lux2940 Fractional Erbium Laser Resurfacing technique which removes lipstick lines and lip wrinkles with fractional laser resurfacing. There is minimal down time, 4-6 days as compared to 3-4 weeks with the older CO2 laser resurfacing. Furthermore, the treatment is much less painful and can be done with only a topical anesthetic cream. Because the Lux2940 is a much gentler laser, an Erbium Fractional Resurfacing Laser which causes less skin damage than the CO2 laser resurfacing, the risk of whitening or hypo pigmentation of the lip is greatly reduced.

The Lux2940 fractional laser lip resurfacing is done in my office with numbing cream and takes about 5 minutes. Your lip will be red for 2-3 days and you can wear make up by day 4 although you may not need make up.

Fractional laser lip resurfacing is a procedure for removal of lip lines, lipstick lines and lip wrinkles that you can do on Friday and return to work on Monday or Tuesday.

The Lux2940 Fractional Erbium Laser Resurfacing lip rejuvenation is truly a revolutionary new development in non surgical facial rejuvenation and medical aesthetics. The Lux2940 Fractional Resurfacing Laser can also be used to remove the crow’s feet around the eyes (see photo below). Full face Lux2940 Fractional Laser Resurfacing treatments for wrinkle removal and removal of face lines, smile lines and cheek lines can also be done in the office with only 4-5 days of down time.

For more information on facial rejuvenation, laser skin care and plastic surgery read Save Your Face or contact me.

Be sure to sign up for my free email newsletter published monthly.

Dr. Seckel

978-369-4499

Concord, Massachusetts

Boston, Massachusetts

Soft tissue fillers like Juvederm® and Restylane® have been used and can produce a beautiful plumping effect on the lip and camouflage lipstick lines and lip wrinkles (See Photo Below).

Juvederm® and Restylane® however are not permanent and need to be repeated. Fat injections last longer but require surgery with a long recovery period due to over correction and fat eventually, in many people dissolves.

More importantly, in my opinion, the plumping effect of fillers like Juvederm®, Restylane®, and fat do not correct the actual wrinkle or crease in the skin which is the cause of the lipstick line or lip line. The lipstick line or lip wrinkle is a permanent crease or depression in the skin of the lip caused by years of the pursing action of the lip muscle and aging changes in the skin. Lipstick lines are much more common and pronounced in smokers.

In the past, CO2 laser resurfacing was the most effective method for erasing lipstick lines and lip wrinkles. However the difficult recovery and long term whitening or hypo pigmentation (loss of color) on the lip caused by the CO2 laser made CO2 laser resurfacing unacceptable for many people.

We have recently introduced the new Lux2940 Fractional Laser which removes lipstick lines and lip wrinkles with minimal down time, 4-6 days as compared to 3-4 weeks with the older CO2 laser (see photo below). Furthermore, the treatment is much less painful and can be done with only a topical anesthetic cream. Because the Lux2940 is a much gentler laser, an Erbium Laser which causes less skin damage than the CO2, the risk of whitening or hypo pigmentation of the lip is greatly reduced.

The Lux2940 laser lip rejuvenation is done in my office with numbing cream and takes about 5 minutes. Your lip will be red for 2-3 days and you can wear make up by day 4 although you may not need make up.

This is a procedure you can do on Friday and return to work on Monday or Tuesday.

The Lux2940 Fractional Laser Lip rejuvenation is truly a revolutionary new development in non surgical facial rejuvenation and medical aesthetics. The Lux2940 Fractional Laser can also be used to remove the crow’s feet around the eyes (see photo above). Full face Lux2940 Fractional Laser treatments for wrinkle removal can also be done in the office with only 4-5 days of down time.

For more information on facial rejuvenation, laser skin care and plastic surgery read Save Your Face or contact me.

Be sure to sign up for my free email newsletter published monthly.

Dr. Seckel

978-369-4499

Concord, Massachusetts

Boston, Massachusetts

The effective skin health promoting and skin rejuvenation effects of the retinoids has been known for over 20 years, RetinA is the only topical cream approved by the FDA for reversing aging skin changes, yet few doctors prescribe Retin A for its anti aging effects. My feeling is that if your skin cream does not require a prescription then it is unlikely that it is scientifically proven to work. You would not take a non prescription drug for an infection, high blood pressure, or other medical condition, why is your skin health any less important?

I encourage all of my patients to use Retin A because I have seen dramatic and wonderful skin rejuvenation results in my patients. Patients who have very sensitive skin and cannot tolerate Retin A can usually use Vitamin C Serum instead of Retin A.

Over 20 Billion Dollars are spent each year on skin rejuvenation face creams to prevent facial aging yet most of them are not scientifically proven to work. As Dr. Klingman, the pioneer who developed Retin A, put it, “We have a marketplace that is absolutely crazy and the consumer is left to do her own personal clinical trial to see what works”. The most important thing I want you to remember is that there are only two treatments that have been approved by the FDA as effective for reversing facial aging changes– Retin A and laser resurfacing, the latter, of course is a surgical procedure.

Cheryl, my medical aesthetician, and I will perform a careful medical evaluation of your facial skin and recommend the products that are most effective and safe for you.

My current recommendations for various skin skin rejuvenation and treatment of other skin conditions are:

1. Fine wrinkle removal, exfoliation, new collagen production and improved skin texture: Retin A or Vitamin C serum for those who cannot tolerate Retin A. Obagi Nu Derm system is an excellent Retin A based skin care program which includes 6 products-3 at night, 3 in the morning. The results of the Obagi System are dramatic and reverse many of the superficial aging changes in the skin. There is pinkness and mild peeling for the first two weeks, but after that you will see incredible improvement in your skin

2. Pigment Control-removal of sun damage: Retin A combined with 4 % Hydroquinone. The Obagi Nu Derm System works very well for pigment control.

3. Acne and break outs: Retin A and Pro Heal Serum by Innovative Skin Care are excellent products for controlling the occasional break out. Patients with more severe flare ups and chronic recurring breakouts need the addition of Brevoxyl Washes and occasionally Differin and Clindamycin topical antibiotics. Severe Cystic Acne usually requires Accutane which I prefer to be prescribed by your dermatologist. The Obagi Nu Derm System, a combination of 6 products including Retin A produces phenomenal results for acne control once acute episodes are under control and is dispensed in our office.

4. Rosacea and facial red spots, blood vessels and telangiectasia- blood vessels on the face are a sign of inflammation most commonly secondary to years of sun exposure. Pro Heal Serum is an excellent product for patients with sensitive blotchy skin and Rosacea

Topical prescription strength skin rejuvenation creams are a very important part of your program for optimal skin health. However, good diet, hydration, exercise, and stress management will also contribute to your skin health.

One major benefit of having your skin care supervised in my office is that there are many additional treatments that will improve or enhance the results of your skin care program that can only be safely and effectively done in the office of a physician experienced in these new techniques. I have made a major commitment to effective safe skin care techniques for the past 12 years and you will not find the same level of care, experience, and dedication to your health and happiness in any other practice.

For many of you topical creams alone are not enough, and if that is the case we can provide you with the safe, effective leading edge non surgical technologies necessary to help you. These methods include:

Microdermabrasion: Microdermabrasion removes dead skin and superficial pigment and improves the penetration and thus effectiveness of Retin A, Hydroquinone and the other topical products

IPL: IPL (intense pulsed light) also called photo-facial, is the newest and most widely accepted method for removal of pigment and blood vessels from the face and Declote. IPL treatments give a wonderful head start to the Obagi New Derm System.

Non ablative “skin plumping” with the Lux1540 fractional laser: It has been 3 years since non-ablative fractional laser  skin resurfacing was introduced with Fraxel, and although I was skeptical in the beginning I am seeing results that show definite improvement is skin texture. The new Lux1540 stimulates new collagen formation in the deeper skin layers and actually plumps wrinkles and acne scars. The exciting thing is that this is a non ablative procedure which means minimal down time. You are pink for a day but no open wounds or oozing. With deeper treatments there is some “bronzing” of the skin the next day but this is easily covered by make up. While your topical skin creams stimulate new collagen in the upper skin layers, skin creams cannot reach the deeper skin layers where significant wrinkle causing collagen loss has occurred. The 1540 allows us to treat the deeper layers where significant new collagen production can be stimulated.

If you would like to come in for a professional skin evaluation please call the office at 978-369-4499. Cheryl and I will give you our recommendations based on sound scientific principles and 25 years of experience. I will also give you a complimentary copy of my book Save Your Face so you can learn the basics of modern medical skin care and anti aging.

Be sure to subscribe to my email newsletter to keep up to date with new developments.

I hope to see you soon.

Dr Seckel

Concord, Massachusetts

2/01/08

Botox® is the most revolutionary and effective facial anti-aging treatment since the advent of laser resurfacing. Unlike laser resurfacing, there is no down time with the procedure, which, along with the effectiveness of Botox® accounts for its incredible popularity. Yes, the name Botox® is short for botulinum toxin, a toxin produced by the bacteria Clostridium botulinum. It was discovered in 1895 and purified as botulinum toxin A (the type we use today) in 1946. It was first used in the late 1970’s to treat torticollis and other severe forms of muscle spasm and was found to be very safe and effective.

In the 1980’s, doctors Jean and Alastair Carruthers noticed that when they used Botox® to treat patients with ocular spasm (spasm of the eyelid) the wrinkles or crow’s feet around the treated eye disappeared (4). These results encouraged doctors to use Botox® to treat the lines of facial expression, frown lines, worry lines, and crow’s feet. The cosmetic use of Botox® was approved by the FDA in April 2002.

Botox® works by weakening the muscles of facial expression. When you contract or tighten one of the muscles of facial expression, the nerve which connects with the muscle releases a chemical called acetylcholine. The acetylcholine then stimulates the muscle to contract or tighten. Botox® works by blocking the effect of acetylcholine on the muscle, and causes the muscle to relax and quit pulling on the skin. When the muscle stops pulling on the skin, the wrinkle caused by the muscle pull goes away. Importantly, the muscles of facial expression function to produce an expression on your face.

The muscles of facial expression are not involved in chewing or other important functional tasks. If they were, we would not use Botox® on them. Botox® also works well on the bunny lines, those little lines at the base of your nose when you squint or wrinkle your nose. The part of your eyelid muscle that is important for eye closure is not treated with Botox®, we treat only the outer part of that muscle which causes the crow’s feet. [Figure 7].

Botox injections are quick and relatively painless, especially when the area to be injected is iced first and a small 32 gauge needle is used.

Figure 7. Before (left) and 3 weeks (right) after Botox injection for “crows feet” (patient is actively smiling in both photographs.)

Doctors who are expert at the use of Botox® can also use Botox® to lessen lipstick lines and some of the deep furrows below the lip on the chin. Only small amounts, two or three IU’s (International Units ) are used in these areas.

Correction of the lines of facial expression is not permanent, so Botox® injections must be repeated. The initial injection last three to six months, but the second injection often lasts six to nine months. The effect of Botox on the muscle seems to be cumulative in my experience, raising the possibility that after two to three years of use, the muscles will have atrophied and will be weak enough that repeat injections may not be necessary. At the present time, however, you should assume that you will continue to need Botox® injections every 6 to 9 months for as long as you want the lines to be gone.

It is essential that the physician who injects Botox® be experienced in the injection techniques for this drug. Botox® must be accurately placed within the muscle for it to work. The muscular anatomy of the face is very complex and injections can easily be placed too deep (below the muscle), or too superficially (in the dermis.) In either case, the injection will not work as well and you will be unhappy with the result. This is not something that a nurse or anyone other than a physician should be doing. It looks so simple, but technique is very important.

If Botox® is placed into the wrong muscle, your eyelid can droop or your smile can become crooked. Ask the right questions when you seek this treatment. Adverse reactions that have been reported are headaches (13%), nausea (3%), and flu-like syndrome (2%), but whether they are related to the Botox® is unknown. Three percent of patients in initial studies had temporary eyelid droop lasting three to six weeks, but in my opinion, eyelid droop can be avoided by proper injection technique.

Botox® injections sting, but the discomfort can be significantly reduced by icing the area prior to injection and diluting the Botox® with a preservative containing saline. Botox® is expensive. Botox® comes from the manufacturer as a powder which must be refrigerated. It must be mixed and diluted with saline (salt water) prior to injection and after it is diluted, it must be kept refrigerated. The company that makes Botox® recommends that the diluted, refrigerated Botox® be used within two weeks, or it loses much of its effectiveness.

Treatments are charged by the unit of Botox®, usually around $20 per unit. A typical initial treatment uses 25 units, which costs $500. Fifty units is usually the maximum treatment recommended for one session. In my practice, 50 units could easily treat frown lines, worry lines, crow’s feet and bunny lines. Very small amounts (1-3 units) are used around the mouth for lipstick lines, carefully placed to avoid the corner of the mouth where smile muscles and the muscles used for chewing are present.

We still don’t know the long term effects of Botox® treatment on the muscles, but it has been in clinical use since 1978 and no adverse long-term effects have been reported in the past 26 years. Recent widely-publicized stories of complications in Florida were misleading. The individuals involved did not use Botox but rather an unapproved solution, ordered from a lab which was unsafe. Please re-read the first section of this chapter and Chapter 10 about the importance of finding a board-certified, ethical doctor for your facial rejuvenation treatments.

For more information on Botox, soft tissue fillers and other non surgical facial rejuvenation options read Save Your Face or contact me.

 Be sure to sign up for my free email newsletter.

 Dr Seckel

Boston, Massachusetts

Concord, Massachusetts