Over half of the US population is overweight. Most of us
are considering again our old resolution for the New Year - losing weight. Fad
diets that require severe calorie restriction have historically failed us
long-term. Many of us lose weight with these diets temporarily, but then
the weight comes on again, and is usually much more difficult to take off. The
body goes into survival mode with severe calorie and fat restriction. When this
happens, the body holds onto fat and burns muscle tissue, reducing the body's
ability to burn fuel in the future.
vicious cycle of calorie restriction has allowed many to give up. Patients need more
structured guidance on what types of food to consume, how much to eat for their
size and how often. We need to think of food as medicine or poison to our
system. What we put in our mouths triggers certain responses.
most successful programs recommend the following:
meals (typically five throughout the day)
healthy fats such as nuts and avocados
Unlimited leafy greens
simple carbohydrates - sugars and high glycemic foods
amount of protein and fat
in moderate exercise that is enjoyable
hormone imbalances in conjunction to diet and exercise is critical to improving
the body's metabolism. Hormones that play a role in weight control include:
healthcare provider you may not have time to address this in detail with your
patients but you can have resources available. You can still play a part
in the success for a healthier year.
The art of tattooing has been performed since ancient times
and will continue to be performed for years to come all over the world. People
get tattoos for a variety of reasons. Tattoos may be a loved-one's name,
identify an individual belonging to a group, a symbol of a significant event in
someone's life or something that seemed like a good idea during a rebellious
time in someone's life.
Laser technology for tattoo removal has advanced over the
last decade, however many of the latest lasers continue to have a challenge
with removing certain colors like aqua green or blue. Some tattoos can be
significantly reduced in one to three treatments. However, multiple treatments
are usually required.
Toxic acids have been used as an alternative to lasers for
removing tattoos, and unfortunately tattoos had been replaced with scars. Some
permanent makeup artists have been successful with removal of unwanted cosmetic
tattooing with some acid solutions without scarring, however this is dangerous
practice. Fortunately, the face is very vascular and allows for faster healing.
When toxic acids are used for tattoo removal from the neck down, the risk of
A safe all-natural non-acid saline solution can now be used
as an alternative to laser tattoo removal. After a specific technique is used,
using a tattoo machine with a specific needle configuration, the solution is applied
directly over the area. Over time a scab forms.
Patients have to take extreme care during the healing
process. The longer the scab stays on, the better the results. Once the scab
falls off the process is interrupted. The scab must be kept dry. Patients experience
more pain at the site of tattoo removal after 4-5 days. An average of 3-5
treatments are required, spaced 6-8 weeks apart. The biggest advantage to this
procedure is that all tattoo colors can be removed.
Non-laser, all natural solution tattoo removal has risks
just like laser tattoo removal. Pain,
swelling, infection, scarring and skin discoloration can occur. There is a
higher risk of hypo and hyperpigmentation with darker skin types.
A technician performing non-laser, all natural solution
tattoo removal must not only be trained in proper techniques of performing the
procedure, but must know how to minimize risk of complications as well as know
how to treat complications from the procedure.
A common concern among patients is treating and improving
skin tone and brown spots on the skin, particularly the face. These changes can
often be reflections of long term sun exposure or hormonal changes. We have
many options for treating such conditions; however, our go-to treatment remains
topical creams because of their effectiveness, low cost and low risk nature.
I often wonder how many times a patient has gone to a
dermatology office and been offered a "bleaching" cream. I am guilty of using
the word frequently myself. We have been using the term for years. More
recently, though, I am trying to avoid the term. My reasoning? When people hear
the term bleach thoughts of Clorox come to mind. We are not treating skin like
a soiled garment of clothing. I believe we must be more creative with our
It is almost 2014, people. Let's move beyond the term
bleaching and use words such as "brighten" or "lighten" or "remove excess
pigment." Just as we don't use straight bleach in laundry as much these days,
we don't need patients envisioning themselves leaving white spots on the skin.
I can't tell you how many patients have been given an unknown
"bleaching" cream in which they did not know the ingredients or what
mechanisms were at play to help their condition.
By simply educating and being careful with our use of the
word bleaching, we can remove a lot of the misconception that can go along with
the age old term. I do not feel that the word is the most appropriate term in
treatment of hyperpigmented skin conditions. Use it how you wish, but I urge
you to be creative and detailed in your discussion with patients for their skin
care treatment. And remember, with all the great treatments out there please
don't just throw another "bleaching" cream at them!
Liquid facelifts using products like Restylane, Perlane,
Juvederm and Radiesse as well Sculptra have become extremely popular during the
last few years. Using a blunt cannula has increased the safety of these
injections tremendously. Blunt cannulas minimize the risk of intravascular
The use of blunt cannulas various widely from practitioner
to practitioner even in the same office. The gauge range I have used is as fine
as a 30 gauge to 22 gauge. The length I now prefer is one inch, however, for
several months I preferred 2 inches.
I still find myself having a new favorite as I try various
sizes. I feel I have more control with the more rigid the cannula is, so I know
exactly where I am. I do not use a blunt cannula for Sculptra, because I had
issues with the cannula getting clogged.
The safety of using cannulas has given me more confidence of
injecting various areas of the face; however, it is not without challenges or complications.
The following are a few challenges:
More time is generally required when using the
Some areas of the face, especially lateral to
the mid pupillary line, are more painful when using cannulas
Extra care needs to be taken to maintain
sterility of the needle if you set the needle and syringe down on your tray
Patients experience more swelling after
injections under the eyes
I use more product when using the cannula
Bruising can still occur, so patients should be
aware that the cannula does not guarantee that they will not bruise
In areas like the marionette lines, I almost
always now use the needle to do fine tuning
I find myself varying my technique depending on the
patient's condition, their expectations, the area I am treating, the amount I
have to use and social downtime factors.
When attending a skin care seminar, learning about a
company's product line and how you could potentially incorporate certain items
into your practice is the intended purpose. However, one of the greatest
things you can take from such an experience is far more than just information
from a PowerPoint slide or an ingredients list. For me, it is the
experiences discussed "between slides" from other providers and lecturers that
is invaluable. Their lessons, if you will, can impact your practice in a
very positive way.
I recently attended a national product seminar for a
well-known cosmetics company. While at times "salesy," I left with
knowledge about new products, backed by clinical data and lots of pretty before
and after pictures. The lecturer also brought up a few points that had my
mind thinking and wanting to share with you.
I was taking notes on a product when someone asked about
pricing. The lecturer said the price but didn't stop there. She also
mentioned that many people enjoy a cup of coffee on their way to work in the
morning. Now, a cup of coffee can run say $5 or so. Over the course
of one month that is approximately $150. In a year, that coffee a day
could total almost $2,000.
How is this useful in clinical practice? Well, for
starters it can open patients' eyes to their priorities. The price point
for some physician dispensed products can be higher than OTCs, although in many
cases the difference is not much.
As a provider, think of all the money wasted on failed
attempts to improve a skin condition with over-the-counter products. This skin
care over coffee idea just helps to show patients that if skin care falls in
the category of important to them then it is not a leap at all to purchase a
high quality product. Especially patients who really want to see results
and come to us for our expertise. Sometimes we need to break it down and
give them that push to get them closer to better skin.
I find this simple concept such an excellent example when
it comes to patients questioning the price of products. Sometimes
inexpensive OTCs are great options (see my previous post "When
to Skimp, When to Splurge") but often the old saying is true: "You get what
you pay for." Of course great skin care can come at a price and it must be
one a patient is comfortable with.
But when we look at the big picture, I feel this is a
great way to help patients feel "ok" with making a skin care purchase outside
their comfort zone when it comes to pricing. This doesn't mean pushing
someone to purchase something they can't afford. This is just a means of
comparison where money can go on a daily basis.
The cost of products can certainly deter patients from
purchasing them. We all want to be the provider that changes our patients'
skin for the better. Having great products at our disposal that a patient
can use and improve with is a must. Being able to have the patient leave
with that product is essential in helping them.
Lesson learned - sometimes a little education, story,
comparison or just simply time can go a long way. In my eyes, the health
of my skin is far more valuable than a Starbucks, not to mention a few less
For many years I felt that home care cleansing brushes like
the Clarisonic Brush was a gimmick and really did do much. Over time as I
inquired patients about their skincare regimen, I found that a good percentage
of patients used the Clarisonic Brush and were happy with their skin when they
remembered to use it regularly. It's
difficult to recommend something that I did not have experience with or have
not seen any clinical studies.
When Clarisonic developed the Clarisonic Pro to be available
only in medical clinics, I reviewed the clinical studies that had been
performed. Although the samples sizes were small, the study results that
Clarisonic reported were similar to the positive feedback that I received from
The following is a list of benefits patients have reported and
have been studied using the Clarisonic Brush:
- Cleaner skin: Image analysis software was used
to show that six times more makeup was removed using the Clarisonic brush
versus washing makeup manually.
- Improves absorption of skincare products:
Spectrometric chemical analysis showed up to 61% greater absorption of Vitamin
C after using Clarisonic sonic cleansing compared to manual cleansing.
- Improves photo-aging, fine lines, wrinkles and
fewer dry patches
- Improves skin texture, tone and firmness
- Safe and gentle treatment even for rosacea and
- Improves skin color and brightness
- Men reported softer, smoother skin, less
irritation and experience a closer shave
I routinely do a skin analysis imaging using the VISIA skin analysis
program in our clinic. Although I have not done a formal study, I often notice
that my patients who do use the Clarisonic Brush generally have better skin
analysis profiles than those who don't.
I recently attended a National Product Seminar hosted by
SkinMedica in Miami. Did I mention I love my job? One of the products
highlighted was Lytera. This product is being marketed as effective in
reducing the appearance of dark spots to create a more even skin tone. Results,
they say, are seen in as early as 4 weeks with continued improvement over
Lytera has been shown to be effective enough to use as a
mainstay treatment for hyperpigmentation or melasma but also safe enough to use
as a maintenance therapy. Lytera is non-hydroquinone based, composed of
items such as licorice root extract, retinol and niacinamide, and can be used
on all skin types. It is not indicated for pregnant patients as it
contains a very small percentage of retinol.
As opposed to a hydroquinone product which is going to
treat existing pigment only, this product can be thought of as an inhibitor of
injury to the skin. This means more preventative treatment over just
treating hyperpigmentation as it comes. For those of us familiar with
hydroquinone, the stuff works well (for many patients) but typically the
My best advice with any pigment treatment is to always
combine it with a sunblock (like zinc oxide or titanium dioxide). I like
the idea of Lytera (even in combination of hydroquinone products) to help
combat common skin conditions involving hyperpigmentation and to possibly help
prevent new skin pigmentation.
SkinMedica put the product in my hands and here are my
thoughts: Lytera has a soft, elegant feel and pleasant scent. To me
this is important because patients are much more likely to use something that
they will like to wear and feel on their skin. The price point is feasible
at $125 for 60 ml (approximately 3 month supply, used twice daily) The
company also packages it as a four step system (with a cleanser, SPF and
retinol) which retails for around $250.
I love options for patients and I feel this product is a
great option for patients who have already tried and failed many topical
modalities, those who cannot use hydroquinone, or want to take care of their
skin and help avoid new pigmentation. I don't believe it to be a
replacement for hydroquinone. I think there are some patients who truly
need hydroquinone and do remarkably well with it. I find this to be a
product with much potential especially with retinol and of course sun
Most of us have been told
that we need more sleep. "If you don't sleep, you are not going to grow," is
something that many of us heard as children and have repeated to our children. We
have been aware that lack of sleep is not good for our health, but may not have
understood what overall negative effects it can have on us, including our skin
health and beauty.
Our bodies go through a
repair and rejuvenation mode when we sleep. When we are sleep-deprived,
hormonal and metabolic changes are disrupted.
Chronic sleep deprivation has been linked to increased stress, oxidative
stress and inflammation, which results in conditions such as obesity, diabetes,
cancer and a host of conditions related to immune deficiency.
Sleep deprivation interferes with skin cell
regeneration. Skin cell regeneration usually doubles during sleep. A small
study at University Hospitals Case Medical Center in Cleveland, Ohio showed
that women with sleep deprivation had a disruption in skin-barrier function,
greater water loss from the skin and higher levels of inflammatory chemicals in
the circulation that, over time, resulted in adverse changes in the epidermal
and dermal of the skin.
The researchers found that the sleep-deprived subjects
showed increased signs of skin-aging with more fine lines, uneven pigmentation
and reduced elasticity while the subjects that had quality sleep recovered from
environmental stressors like sunburn from UV radiation more rapidly. An
additional finding showed those who slept well perceived themselves to be more
attractive than the sleep-deprived subjects.
So, don't compromise your beauty and health by depriving
your body of sleep. Get a good night's sleep. Give our body time to repair and
rejuvenate to maintain your skin's health and beauty. Sleep well at night, enjoy beautiful skin and
feel more attractive during the day.
Peels are a great pick me up for the skin. Think: minimal
downtime. Think: glow and go. Combined with the use of great products, peels
are the type of treatment that I cannot recommend enough.
I personally love superficial peels. I've always been a fan
of Glycolic acid, whether in washes, creams or peels and this peel is a staple
in any derm or aesthetics office. Glycolic acid is derived from sugar cane. This
is a great option before an event or for oily or acne prone skin, and great for
darker skin types with conditions such as hyperpigmentation (acne marks, scars,
etc.). This peel tingles and can slightly burn but is generally very well
Combination peels work very well and are probably the most
trending peels. We offer a great peel that utilizes salicylic acid, lactic acid
and glycolic acid. There are also a number of superficial peels that combine
agents such as alpha hydroxyl acids, lactic, salicylic and retinoic acid. Look
into SkinMedica's Vitalize Peel and Precision MD's Milk and Spot Peel.
These peels promote collagen production, improve
pigmentation, acne and melasma. After one treatment, skin will appear healthier
and more youthful. These also offer minimal downtime, with excellent results
and little to no peeling. Who could refuse?
More recently, I've become a fan of Mandelic acid. Mandelic
acid is derived from bitter almonds and has antibacterial and anti-aging
properties. This is a great peel for acne patients, rosacea patients or
patients looking for minimal downtime.
I performed a Mandelic acid peel on my face, neck and chest
and received so many compliments afterwards on my "glow." I did not peel but I
certainly got a bit pink and some scaling occurred by the next week (note: my skin is very sensitive - many patients do
not experience any redness). I recommend a facial two weeks later (you could
also do it prior) to really hydrate the skin and pack it with antioxidants. I
love the look and feel of my skin after that combination of treatments.
Quite possibly my favorite, Malic acid, derived from apples
and cherries, is full of antioxidant properties. It helps fight free radicals
that contribute to skin damage and aging and increases oxygen supply to the
skin. Yes, please! As a natural
humectant, Malic acid hydrates the skin without contributing to oiliness.
Trichloroacetic acid (or TCA) peels are more aggressive and
can yield very good results. However, not everyone is a candidate for this type
of a peel. Depending on the strength and contact time, you will pretty much be
guaranteed to peel after this treatment. Patients will likely see areas that
form crusts (or superficial scabs) and whole regions of skin that slough off.
These peels also present with more discomfort, although most
patients tolerate them well with a hand held fan. This peel is great for fine
lines, hyperpigmentation and overall rejuvenation. Careful application in the
under eye region can help with the common complaint of darkness and hollowing
under eyes. I'm a big fan of this peel and still remember my first patient
frosting with this technique! Time flies when you are having fun.
Talk with your skincare professional before doing any home
peels or if you are not sure what is best for you. As one of my favorite
professors in grad school told us, "start low and go slow." Spot testing
(particularly off the face!) is a great idea if you want to see if a higher concentration
can be tolerated. If you have any doubts, be conservative. For best results, a
series of peels is recommended. Skincare professionals - what are your favorite
peels and combination of treatments?
NPs and PAs often times feel
awkward retailing skin care products to patients in a medical spa setting. Various
factors contribute to lack of sales and patient guidance on skin care products
appropriate to their skin condition. The following are just a few:
feelings of violating medical ethics
- Lack of knowledge
of skin care products
- Fear of coming
across as "too salesy"
- Lack of
confidence in the products sold in the clinic.
- Fear of the
patient rejecting the product.
Surveys of patients visiting
a spa or medical spa revealed 90% of patients purchased an over-the-counter
skin care product when skincare products were not recommended by the clinic.
Clinics who perform a range of skin rejuvenation procedures from
microdermabrasion to CO2 laser resurfacing should have a plan to provide or
have specific recommendations for patients to use after the procedure.
It's not unusual for patients
to report that they purchased several items over-the-counter but found them to
be too irritating or were afraid to break out. In my experience, there are
quite a few patients who developed allergic contact dermatitis using
over-the-counter antibiotic ointments after chemical peels, permanent makeup or
Patients go to professional
skin care clinics to get the advice of experts. The following have been very
helpful in educating our patients on skin care:
- Computer analysis
of the patient's skin care condition: UV damage, brown spots, redness, texture,
pore size and porphyrins.
- Educate yourself
and staff on effective skin care products for the skin conditions that you see
in your clinic.
- If you choose not
to sell skin care products, have a list of your recommendations for your
patients to take home including guidance on sunscreen/block for protection.
appointments after skin care products sold or recommended and make adjustments
- Provide retail
sales product education as well as education on techniques of retailing.
- Keep patients'
expectations realistic. Explain that skin quality improvement with skin care is
usually not visible for 2-3 months.
- Have confidence
in your approach in "prescribing" skin care for your patients.
Patients seek your advice. Educate
and recommend products appropriate for their skin type and condition, and they
will respect your professionalism and guidance especially when they start to
Frequently Asked Aesthetics Question: I didn't peel after a
chemical peel. Is this normal?
A common misconception in aesthetics is that you must peel after a "chemical peel." I hear
this all the time and this is just not so. There are many types and strengths
of chemical peels. The term "peel" actually refers to a multitude of products
that are available to qualified providers at a medical grade concentration. The
term "peel" does not imply that you will
peel, should peel or need to peel.
Superficial peels, such as glycolic acids and salicylic
acids, may induce little to no peeling. This does not mean that the peel was
not performed properly. This means that the peeling agent is superficial (think
little down time, less pain, etc.) and working microscopically to induce
positive changes in the skin.
These peels are excellent before an event when a patient wants
a glow and little down time. Especially when performed in a series (every 2 to
4 weeks depending on the type), these peels can achieve great results.
Deeper peels, such as TCA (Trichloroacetic Acid) peels, are
much more likely to cause peeling or significant sloughing of the skin.
Depending on the percentage and the contact time, skin after this peel tends to
darken or crust before the skin is fully exfoliated off.
Not all skin types are a candidate for this depth of a peel
because of potential adverse reactions (hypo or hyper pigmentation, etc). This
depth of a peel also comes with more discomfort (think "burning sensation");
however, most patients tolerate these peels well with the use of a hand held
While the name may imply otherwise, a chemical peel may or
may not cause physical peeling of the skin to occur. If the proper peel and
technique are used on an individual patient, the results should be noticeable
regardless of any actual "peeling." The most important things to consider are
what agent is going on your skin and what it will do for your skin.
What are your favorite peels? Did you peel after the
treatment? In my next post, I will discuss some of my Go-To Peeling Agents.
Most patients prefer simplicity in their skin care routine.
Unless the benefits of toners are explained to the patient, toners are usually
the first product in a skin care system to be cut out.
Patients new to skin care associate toners with over-the-counter
acne astringents that are stripping and drying. Various ingredients are used
for specific skin conditions. The following are just of the few benefits of
using a toner.
cleansing: Soap or certain cleansers as well as the water used to rinse
after cleansing can leave a residue on the face. This residue can clog pores
and cause breakouts.
surface oil or shine: Toners are formulated for different skin types. Acne
prone patients or those with oily skin can benefit from a toner containing
salicylic acid. Some patients feel their pores seem tighter using this type of
properties: Some products have various ingredients that are known to reduce
bacteria on the surface of the skin.
- Hydrating properties: Humectants can add hydration
and suppleness to the skin. Some hydrating ingredients can be found in acne
toners as well.
protection: Vitamin C and E are ingredients that help reduce unwanted skin
pigmentation and damage related to sun exposure.
properties: Products such as Retinol Palmitate (a form of Vitamin A) can be
converted to retinoic acid, can be found in some toners and can stimulate new
cell tissue and can be moisturizing.
Vitamin C, Ginseng Root and Chamomile Extract are just a few ingredients
found in some toners that have anti-inflammatory properties.
Once patients experience the benefits of a toner suited to
their skin condition, the toner is usually the product they miss the most when
they run out.
As part of the body's capacity to heal itself, platelets and
other components in human blood migrate to a site of injury. Platelets are
known to release a variety of factors that respond to tissue injury, where they
initiate and promote healing. By concentrating platelets at the site of injury,
the body's own natural capacity for healing can be stimulated.
Selphyl is a unique system that taps into this capacity. The
Selphyl system contains a fibrin matrix to effectively capture the body's own platelets.
Through this process platelets are stabilized and protected, allowing the
sustained release of growth factors to promote growth of new tissue, blood
vessels, and collagen.
The treatment takes place in a single office visit. A small
amount of a patient's own blood is drawn into a vacuum collection tube containing
a cell separator gel. We typically collect two vials of blood. The tubes are
then placed into a centrifuge and spun for six minutes to separate the blood. The
platelets and plasma are then transferred in a closed system to a second vacuum
tube containing a small amount of calcium chloride solution. The material is then
injected, serving as a three dimensional scaffold to maintain the platelets at
the site of injection.
There is virtually no risk of allergic reaction since
Selphyl does not contain any synthetic or animal products. The procedure takes
place in about thirty minutes. Immediate results can be noted, however true
results are seen in around two to three weeks and as collagen is stimulated
thereafter, around 8 weeks or so. The results are long lasting, with claims of
up to 2 years.
Do you have experience with this system or one similar? I'd
love to hear your thoughts. From my experience, I find it to be a great option
for those hesitant in having synthetic fillers or neurotoxins. Not only will
patients see results, but they may feel more comfortable in choosing a more
"natural" treatment. For patients new to aesthetics, this could be a great
gateway treatment that leads them to consider more aesthetic options.
Although the percentage of total aesthetic procedures performed on men is still under 10%, it has increased more than 100% since 1997.
The most common surgical procedures sought by men include liposuction, rhinoplasty and eyelid surgery. Laser hair removal, noninvasive body sculpting, neurotoxins and dermal fillers are the preferred nonsurgical options.
Male-centric aesthetics is becoming more socially acceptable not only in the gay population, but also the younger population with more interest in fitness, staying in shape and looking good. Most of our male patients are younger than 50, with many starting in their teens for acne treatment. Men in their 20s or 30s usually seek treatment for acne scars, hair or tattoo removal.
The baby boomers are slower to seek aesthetic procedures. They are usually encouraged or dragged in by partners who seek to embrace the concept of aging well and looking youthful. If they are in a competitive job market, they tend to be more accepting and desire to look less tired and want to refresh their appearance.
Advances in laser technology in body sculpting, hair removal, hair restoration and implantation, acne and acne scar as well as general laser skin rejuvenation have driven the interest among men. The vast Internet resources have allowed men, who tend to be more private about their aesthetic interests, do their research on procedures that appeal to them.
It takes a little more effort to get men in the door, but once they start to experience the benefits of the various aesthetic treatments, they tend to be more regular at scheduling their appointments than women are.
One morning one of my co-workers walked past me and
smiled. Something about her looked different. It was something
subtle. I couldn't put my figure on it, but her smile was brighter than
Well, it turns out that the previous week my co-worker
had Botox injections for a television segment my supervising physician had an
appearance on. The topic was "correcting a gummy smile."
A "gummy" or "gingival" smile is a term used to describe
a smile in which there is a show of the anterior gingiva above the teeth when
smiling. A smile tends to be more "gummy" for many reasons, such as the
size and shape of our lips, gums and teeth, as well as the muscles that are
involved in raising the upper lip when smiling.
As in her case, a gummy smile can be successfully
treated with a low dose of a neuromodulator, such as Botox or Dysport. Placed
in the proper muscle(s), the injection will help to reduce the gums from
The three lip elevator muscles converge on the area
lateral to the nasal ala, so this location tends to be the most common injection
site for this purpose. In the case of my co-worker, and many other patients,
the results were incredible. All of this was achieved with a very small
amount of Botox (5 units total).
The effect of Botox/Dysport can take several days, or
even up to a week or two, for full results. Once the full results are evident,
the upper lip will not rise as high when smiling and will reduce the amount of
the gum that is visible.
Keep in mind, injecting the lower face in this region
could affect your singing or playing of a wind instrument, using a straw or
spoon, etc., so this treatment is not for everyone. The treatment should
also be performed very conservative for this reason. Such injections
should only be performed by an experienced provider.
Neuromodulators, such as Botox and Dysport, are not
permanent solutions and typically last between 3-4 months. Surgical
correction would be a more permanent treatment, however may seem quite drastic
to patients who only have a mild condition.
I'm still in awe of how much this simple technique changed
the smile of my co-worker. We have always thought she was a beauty, but
she had always disliked the look of her smile and now is happy to smile with
Sometimes the most subtle aesthetic touches are the ones
that get noticed the most. Having someone say "you look great- what did
you do?" is truly one of the greatest compliments we can strive for in
If you truly have a gummy smile, Botox
is not the definitive
treatment for you. Although it may be temporary, it could distort your smile
slightly and create some asymmetry while you are at rest.