Category: Skin Care

Botox: Might Be Good for Curing the Blues

40s BotoxDepression may be improved with the use of Botox, according to a report in The New York Times, March 23, 2014 edition. Since Botox can prevent frowning and unhappy facial expression, it was theorized that if you can’t frown it may be harder to be depressed. Researchers wanted to study the idea that facial expressions may feed information back to our brains that influence our mood.

74 patients with major depression received injections in the forehead muscles responsible for frowning. The shots were randomized to either Botox or a salt water solution, placebo. Six weeks later 52% of those who received Botox showed improvement in their depression, as compared to only 15% of those with the salt water injections.

Only half of those in the Botox group were correct in guessing that they had received Botox, which is no better than the toss of the coin. Presumably, knowledge of receiving the Botox could not influence emotional response.

Botox for depression is part of a tradition of “Outside In” therapies that aim to improve the psyche by external manipulations. Acupuncture treatment of anxiety, and exercise for the production of endorphins are other examples of successful use of this methodology. Light therapy sends signals to the brain that can effectively counter Seasonal Affective Disorder. We all recognize that when we look better we have a better sense of self esteem. The concept rings true.

It will take more science to show whether Botox is an effective treatment for depression, and which types of depression it works best for. In the meantime, if you are getting Botox to look a little better, pay attention to whether the absence of frowns puts you in a better frame of mind!

Anti-aging, Beauty, Doctor-Patient Relationship, Facelift, Personal Fitness, Skin Care

JUVEDERM VOLUMA XC: The New Injectable for Improving Cheek and Midface Contour

Juvederm VolumaThe 2013 calendar year saw a whopping increase of 18% in the number of people seeking injectable fillers to smooth wrinkles and enhance contours of the face. There were 1.7 million injection sessions of hyaluronic acid, a naturally occurring substance in all human tissues. The filler contains a numbing agent, lidocaine, so the injection is only a minor discomfort.

Voluma is a  new product developed to be thicker than its cousin Juvederm so it lasts longer.  It is intended to fill in the cheekbones and chin when these start to lose fullness. The FDA approved its availability to Plastic Surgeons in the final quarter of last year and it is becoming readily available.

As the face loses volume and skin begins to lose its elasticity, the cheek bone region flattens and folds of skin develop in the lower cheek from nose to mouth. None of us like it. With Juvederm, the injection is placed into the creases to camouflage the skin relaxing as the volume goes away. With Voluma, the injection is placed in the mid cheek, elevating the nasolabial skin folds to their natural position. With the skilled hands of a Board Certified Plastic Surgeon it can give an immediate improvement in fullness.

Voluma has been used extensively in Europe, Latin America, Canada, the Middle East and Asia since its introduction in 2005. It is finally available here in the US.

Voluma can last up to two years, whereas Juvederm has an average duration of six months. Longer lasting—wouldn’t that be nice? For a low maintenance product and no more upkeep than your skin care routine, you can experience improved facial fullness for up to two years!

Anti-aging, Beauty, Doctor-Patient Relationship, Facelift, Fat Transfer / Fat Grafting, Skin Care

South Korea: The World’s Capital for Plastic Surgery

Korean Plastic Surgery FaceI  just returned from a week in Seoul S. Korea, visiting with a manufacturer of US medical devices. This first time visit to Korea was eye opening. My pre-conceived images of Korea, probably formed by watching re-runs of MASH, were of a struggling people recovering from the ravages of Japanese occupation and the Korean Civil War. They have reversed the sufferings of the last century. Seoul is now a sophisticated metropolis, ringing with commerce and populated with meticulously dressed urbanites, rushing from offices, restaurants, karaoke bars, health clubs and university classrooms. South Korea has made an astonishing move from shanty-town poverty into a modern high rise industrialized economy in a span of 50 years. 

Of particular interest to me was the Korean attention to beauty. They dress stylishly, pay careful attention to grooming and consider looks to be an important element to success. This value allows them to be very open to plastic surgery as a means of achieving their ideals.

South Korea has the world’s highest per capita rate of cosmetic plastic surgery, according to the 2009 and 2011 statistics of the International Society of  Aesthetic Plastic Surgeons. 

For Korean college graduates seeking employment, 27.4% get plastic surgery to fare better in the hyper-competitive job market. Every year 74 out of every 10,000 people undergo cosmetic surgery, a rate 1.8 times the United States. One in five women between the ages of 20 and 45 is reported to have cosmetic surgery. 

Korea is followed by Greece, Italy and the United States in the per capita rate of choosing plastic surgery. The people of Brazil and Taiwan also value and utilize plastic surgery with a high degree of frequency.

The Asian specialized procedures that are performed frequently in Korea include the double eyelid surgery to make the eyes appear larger, cheek implants to create an “apple” shape, jaw contouring to decrease the width of the face and rhinoplasty to raise the height of the nose.  Forehead shaping with fat grafts, liposuction and breast implants are also popular. 

For more information consult:

International Society for Aesthetic Plastic Surgeons,

Anti-aging, Beauty, Blepharoplasty, Doctor-Patient Relationship, Fat Transfer / Fat Grafting, Rhinoplasty, Skin Care

Asian Eyelid Surgery

AsianWomancropSeattle has a large Asian population of varying ethnicities. I find they express different preferences for beauty in the upper eyelid. Those from Chinese, Japanese or Korean heritage more often favor a narrow crease above the eyelashes. Filipinos, Taiwanese, Malaysians and Indonesians prefer a wider fold. Population genetics show that the narrow or no crease peoples were originally from Northern Mongolia in prehistoric times. The Southern Mongolians evolved different facial features including deep set eyes and a wider crease. Most people want to retain a natural look that is true to their familial background.

The “classic” Asian eye

  1. Slants upward on the outer corner
  2. Has an absent lid crease,
  3. Has a fold of skin that lies over the inner corner, referred to as an epicanthal fold

In reality, the Asian eyelid has a large range of individual variation, including the height of the crease, the width of the eyelid opening, the amount of fat around the lids, and the shape of the eye.

It is possible to vary the blepharoplasty procedure according to each person’s preferences, especially when it comes to the desired fold height. You will want to talk about that when you come in for a consultation. You can make aesthetic changes without  erasing your heritage. A “natural” look is better than a “westernized” look. 

Anti-aging, Beauty, Blepharoplasty, Fat Transfer / Fat Grafting, Skin Care, Uncategorized

Planning on Being a Better You in 2013? Get a Plan you Can Stick With

ApplewtapemeasAll of us want to be a better version of our self, so as the calendar turns over another year, it is the occasion to declare a fresh start. Most of us pick goals that have personal meaning, often connected to how our bodies look and feel. My friends are working out more, de-toxing, exercising, eating organic and losing weight. Health clubs get a surge of new member in January and Weight Watcher’s sessions are full.

So why is it that by spring 90% of  New Year’s resolutions have been abandoned? It is human nature to lose our resolve and return to old habits. So how do we convert to that healthy lifestyle and make it stick? Here are a few suggestions:

  1. Start simple and concrete. Resolutions that are too broad, too big, or too drastic are doomed to fail. Think big, but start small.
  2. Write down the change you plan to make and post it several places. The act of writing it makes the commitment more engrained. Posting a reminder in several places re-enforces the plan. 

You may choose to stop drinking soda or other high calorie drinks. Reminders on the refrigerator or near your bathroom scales can keep it fresh in your mind. Outlook or smart phones can be good to keep you on track. Try emailing yourself daily.

  1. Give a commitment of 21 days, rather than forever. It takes 21 days to form a habit and the short time frame will help you avoid discouragement.
  2. Re-evaluate at three weeks. If you could not reach this goal, try to identify the challenges and come up with solutions. Write down your revised strategy to re-new your commitment. If you did succeed, try adding a new habit to change.
  3. Don’t procrastinate. The next time you start you will wish you had done it sooner. No time like the present. Just do it.

Once you change a small habit you can keep it for a lifetime. Being a better version of ourselves is an accessible goal!

Doctor-Patient Relationship, Nutrition, Personal Fitness, Skin Care, Weight loss

What Causes Dark Circles Beneath the Eyes?

Aging is the Most Common Cause

Your eyes are believed to be a window to the soul. They convey a full range of expression and make a difference in how you are perceived in terms of health and beauty. Dark circles beneath the eyes are detractors. They suggest fatigue or sadness or being past your prime. The physical characteristic can suggest troubles even when your emotions do not match. What causes dark circles and what can be done about them? 

Some people have dark eyelid skin that they inherited from their parents. “Hyper pigmentation” is benign, but just as it is impossible to erase a leopard’s spots, it is difficult to change the natural color of your skin if that is your genetic type. 

Illnesses can cause changes in the tissues around the eyes. Lack of sleep, smoking, and excessive alcohol intake are lifestyle choices that negatively impact the appearance of your eyes. Thyroid, kidney and liver disorders can contribute to dark under-eye circles. Allergies, asthma, and circulatory diseases cause swelling that may lead to eyelid changes. 

For those of us in good general health who were not born with dark lower eyelid skin, the most common cause of circles under the eye is simply aging. Eyelid skin is thin and cheek skin is thick. The zone where thin meets thick is called the “lid-cheek junction.” This line begins to drop as we age. The zone between eyelid and cheek becomes more pronounced and the surface irregularity casts a shadow that creates the dark circle. The lower eyelid shape changes and looks like an upside down triangle with its peak pointing away from the middle of the eye. The line from the inner corner of your eye to the peak of the triangle is referred to by plastic surgeons as the “tear trough deformity.”

The problem can be a combination of dark skin pigment, loose skin, fine wrinkling, excess fat, or loss of fat, gravitational forces and irregular contour.

So what choices are there for dark lower eyelids? Treatment begins with identifying the cause.

1. Hyper pigmentation is caused by excess brown pigment (melanin) in the skin. This may be responsive to fade creams, such as hydroquinone, chemical peels, and sun screens. Other skin care products such as Retin A can be useful. 

2. If the cause of the shadow beneath the eye is a contour abnormality, then injectable fillers such as Restylane and Juvederm can be placed in the tear trough deformity for an improvement that lasts 6-9 months.

3. A blepharoplasty is eyelid surgery that gives long lasting improvement for the eyelid changes of aging. It tightens eyelid skin, repositions fat in the orbit, and smoothes the transition from lower lid to cheek. For more on this topic check out Services>Surgical Facial and visit my Facial Procedures gallery.

Anti-aging, Beauty, Blepharoplasty, Nutrition, Skin Care

Why Baby Boomers Are Getting More Plastic Surgery


Madonna brings up the rear of the baby boomer generation.

Here are a few “Baby Boomer” facts:

  • Those born between 1946 and 1964 constitute 28% of the US population.
  • 76 million Boomers will hit 65 over the next two decades, at a rate of 10,000 a day.
  • Boomers account for half of all consumer spending.
  • The typical Boomer feels 9 years younger than their chronological age, according to Pew Research Council data.
  • Elective cosmetic surgery is up 65% in this age group since 2005.
  • Non-invasive plastic surgery procedures are up 87% in the same time period.

So what is contributing to the upsurge in plastic surgery in this demographic? Boomers have chosen to redefine what it means to age. They are re-inventing themselves. Sixty is their new forty. They pay more attention to health, diet, exercise and general sense of well being. They are not afraid to spend money on improving quality of life. They expect the quality of the last third of their life to be high.

 Americans are living longer.  For women, life expectancy has lengthened 34 years over the last fifty years. But the focus for Boomers is not so much on life span as it is getting to the end of their health span in better shape. They are working longer than anticipated. Older workers want to look better to fit in with younger co-workers. Boomers want to stay active, relevant, and engaged with society in important ways. Their outlook on life is to do what they can to enjoy the years they have left.

Pablo Picasso once said, “It takes a long time to become young.” Boomers are taking their time and savoring it.

Beauty, Breast Implants, Facelift, Mommy Makeover, Skin Care

No Down Time Available for Plastic Surgery? Erase a Few Wrinkles First

The VI Peel

Erase WrinklesFor many of us it is hard enough to achieve a work life family balance, much less take time for personal needs. We might enjoy the benefits of plastic surgery but have trouble finding downtime for it. As fewer people have taken time for aesthetic surgery during the recession, there has been a rise in popularity of non invasive cosmetic procedures. Minimally invasive techniques have become a maintenance routine for aging faces.

For those interested in improving skin quality, there is a new product that I like, the VI Peel. I tried it on myself a couple of months ago. This medical grade peel is a light peel that requires minimal downtime and creates little interference with your daily obligations. 

The Vitality Institute Skin Care System has produced the VI Peel to decrease fine lines, fade age spots or sun damage and improve acne scarring. The peel also promotes collagen and elastin growth. This results in better skin clarity and texture and younger looking skin. The procedure takes a few minutes in our office. Your skin turns red like mild sunburn and peels within three to seven days. It can be used on all skin types including Afro Americans and Asian skin. The peel removes the damaged upper layers of skin and repairs from new cells below. 

The peel has a combination of peeling agents that enhance one another. TRICHLOROACETIC Acid (TCA) penetrates the skin. RETIN a causes a rapid turnover of skin cells to reduce wrinkles. SALICYLIC ACID is an exfoliant. PHENOL is antiseptic and helps numb the skin. VITAMIN C is an antioxidant and an exfoliant. 

The peel does not replace a facelift if that is what you need, but it can make a great difference in your skin quality without missing a day of work!

Medical therapy for aging skin can reverse some of the cellular damage that has occurred and create a healthier, younger looking skin.

Anti-aging, Beauty, Skin Care, Uncategorized

Addiction to Tanning Beds: Who Knew This Was Risky?

Addiction to tanning beds by Mary Lee Peters, MDTanning beds are a popular way of keeping that sun kissed look as cold weather sets in. They are particularly welcomed in cloudy Seattle and cold northern climes. It feels good to get warm light exposure, so good in fact that it is addicting. Data shows that the ultra violet light in electric tanning causes release of endorphins. Endorphins stimulate our brain’s pleasure centers. As endorphin levels decrease, the addictive personality looks for ways to increase the pleasurable sensation. Chronic users are drawn in by more than bronzing of the skin. There is also the endorphin release. Tanning beds are used by thirty million people according to the tanning bed industry. That is roughly 10% of the US  population each year.

Not all addictions are bad, but this one is believed to be related to the 30% rise in the rate of melanomas with the biggest increase among women 15-39 years old. Melanoma is a skin cancer that arises in dark colored skin growths. It can be cured if caught early, but results in a devastating course if spread has occurred. The risk of death from advanced disease remains high. Researchers estimate that the increase in incidence of melanoma is related to tanning bed use.

The New England Journal (NEJM 363:10,p901)  has a good description of how the same mechanism that causes your skin to tan is resposible for DNA damage that sets the stage for skin cancer development. It is theorized that tanning may be the body’s attempt to protect itself from the damaging effect of radiation. When DNA is damaged the skin is programed to release melanin, a brown pigment that can help filter the sun’s harmful rays. Tanning cannot occur without DNA damage. If your body does not repair that damage, you may be subjecting yourself to a cancerous change.

There are public health advocates that believe that regulation or even banning of tanning beds might be an opportunity for public safety. Multiple European countries have started to enact restrictions on tanning beds. Whether or not that occurs as a legislative agenda in the US, you can protect yourself by selecting a quality spray tanner and avoiding unnecessary exposure to ultra violet radiation.

So if you like the look of that outdoor ruddy complexion head for the cosmetic counter instead of the tanning parlor and get your endorphins with a brisk work out.

Beauty, Skin Care

Back to top