Gone (mostly) are the days of the post-injection frozen face, the seemingly emotionless Botox-bot shopping its way down Madison Avenue. As highly trained plastic surgeons in Manhattan’s upper east side beauty mecca, our needlework is getting much more subtle, “smarter”, and more customizable! Over the past year, I have seen a huge increase in younger patients, hoping to incorporate a little Botox into their regular beauty regimen to help prevent the development of fine lines and wrinkles, and to set the stage for lovely, natural, beautiful wizening (I don’t like to say “aging”). My patients, both men and women, want to look natural, just a little more refreshed and less stressed. They want to be able to express themselves with their faces- to laugh, get mad and even cry.

Introducing Protox

Often, as part of their jobs, they must be able to express themselves with their faces to be effective and successful. Lucky for us all, with some experience and knowledge, Botox is highly customizable! Introducing what I’ve dubbed “Protox” – custom Botox designed with your professional goals in mind. A personal brand identity is key to one’s career and the face often says it all.

The Case of The Lawyer

Attorneys must have the ability to look disapproving. This patient always needs to maintain a little corrugator movement (this is the muscle group that give you the vertical “11 lines” between the eyebrows, and furrows the brow) in order to successfully argue a case or negotiate a mediation.

When The Psychiatrist is the Patient

A Psychiatrist needs to maintain a sympathetic demeanor without displaying a disapproving, “frozen” look. In contrast to the lawyer, this patient needs to seriously weaken movement in the corrugators so they can relax and listen to what their patients are saying without looking judgy, but keep a little movement in the frontalis muscle (the muscle that raises the eyebrows) so they can still look like they care about what they’re hearing.

Let The Teacher Teach

He needs to maintain the ability to look surprised and to be sympathetic. This patient needs to retain almost all movement of the frontalis muscle that raises the eyebrows, but can often benefit greatly from Botox used to soften the crow’s feet and raise up the arch of the eyebrow.

The Poker Player

This patient needs Botox to retain her poker face and help eliminate the look of surprise (frontalis muscle) and some of the most common facial “tells” such as clenching the jaw and flexing the masseter muscle at the angle of the jaw. (masseter muscle Botox) It’s important for poker players to be able to keep all emotion under wraps.

The Actor Needs to Emote

Performers need to be able to express all emotions, but must also look permanently airbrushed with subtle touches of Botox in a number of areas.

No matter your personal or professional goals, subtle, natural, customized Botox is possible in the hands of an experienced injector!

Every holiday season, I’m asked about non-surgical options for quick, no downtime pre-party rejuvenation. Everyone knows about using Botox for forehead frown lines and Juvederm to camouflage nasolabial folds and plump the lips, but there are dozens of other, lesser known uses of these products that produce incredible results! Here are just some of those options, including how much they cost, and how long results will last.

Botox Brow Lift

A few units of Botox placed judiciously just above the natural arch of the eyebrows can help to relax the muscles that pull down the eyebrow. This allows the eyebrows to drift slightly higher, producing a Botox Brow Lift that really opens up the eyes. When your Botox kicks in at 4 – 7 days, you can expect to look more wide-eyed and fresh-faced. This treatment usually requires 6 units of Botox (3 units per side). The cost is $120 and results last up to 4 months.

Earlobe Rejuvenation

Let your lovely, festive holiday earrings sit pretty once again! A very small amount of Juvedem injected around the earring hole can rejuvenate the earlobes, so you can say goodbye to sagging, thin, pulled earlobes. An amazing result can be achieved with as little as 0.2cc of Juvederm, and results last over a year. One syringe of Juvederm contains 1cc, or 1mL, of filler and is $750. Bonus: Since this treatment uses only 0.2cc of filler, you will have plenty leftover Juvederm to use elsewhere on the face, and an excuse to use it. We can decide optimal placement together.

Non-surgical Rhinoplasty

Not all nose concerns are amenable to liquid, non-surgical Rhinoplasty using a combination of Botox and facial filler, like Juvederm, but if you are among the lucky (or unlucky, depending upon how you look at it) ones whose nose can be improved with non-surgical treatment, the results are dramatic, and so are the savings! The cost of the procedure is around $750-$1,000 and results last up to 2 years. Compare this with the total cost of surgical rhinoplasty, around $12,000 inclusive of operating room and anesthesia fees, not to mention the pain and downtime of surgery.

Cheek Augmentation

As we age, we lose volume in our lips and our cheeks. Well-done injectable cheek augmentation can take years off of your appearance. With Juvederm VOLUMA, you can now get injectable cheek augmentation that lasts 2 years! The volume required varies between 1 – 4 syringes.  Juvederm Ultra Plus lasts for one year and costs $750 per syringe. Juvederm VOLUMA lasts 2 years and costs $1000 per syringe.

Botox Neck Lift

Stop feeling bad about your neck! The Botox Neck Lift, also called the “Nefertiti Neck Lift”, uses Botox to relax the Platysma muscle, which creates the horizontal banding in the neck. Results can be dramatic – in a good way. Cost ranges from $400 – $600 and lasts 4 – 5 months.

Please feel free to contact me to book your appointment for consultation and treatment, and as always, feel free to email me with questions!

Basically, anything non-surgical, or liquid is exploding in popularity in my office right now. The most popular of the popular is the liquid rhinoplasty. Liquid rhinoplasty is a procedure that uses Botox and facial filler injections to change the shape of the nose. At this time last year, I was performing about one liquid rhinoplasty per month. Now, it’s more like two or three per week!

In this liquid, non-surgical procedure, a combination of Botox and facial fillers are injected to achieve the desired result without a scalpel. In the right candidate, a liquid rhinoplasty can even out irregularities along the bridge of the nose, make the nose appear straighter, raise the nasal bridge, or camouflage a dorsal hump on the profile view. Although you are technically adding volume with filler, the end result is often a nose that appears smaller and more refined. The idea is to change the way light hits your nose, creating a kind of semi-permanent contour makeup on your nose. During a liquid procedure, ice is used to numb the skin, and small needles are used to inject filler and/or Botox.

Not all nose concerns are amenable to liquid, non-surgical, rhinoplasty, but if you’re among the lucky (or unlucky, depending upon how you look at it) for whom this procedure can work, you can skip the pain and recovery of surgery. Results are dramatic and instant, and so are the savings! As compared to surgery, non-surgical rhinoplasty saves time, money, and pain. For most patients, there is essentially no downtime. The major downside is that the procedure is not permanent – depending on the filler selected, the results generally last from 1-2 years. Sounds like a good deal, no?

It is important to note, however, as we become more accepting of the idea of being poked and prodded with needles as a part of our routine beauty upkeep, that all of these injections, while effective, and amazing when done properly and subtly, are not without risk.

Vascular compromise leading to skin necrosis (actual death of skin because of decreased blood flow to the area) is the dreaded risk of non-surgical rhinoplasty. It can either occur from filler material actually getting into blood vessels, or from filler material pushing on blood vessels under the skin. While appropriate training and experience can help to minimize the risk of this occurring, the risk is never zero.

Studies have shown a rate of vascular compromise after filler injection of approximately 0.05% even in the hands of highly trained physician injectors. That equates to approximately 1 in 2000 times that facial filler injections are performed in the nose. Thankfully, vascular compromise is exceedingly rare, and when treated promptly and correctly, will resolve without long-term consequences. But that is the key – it must be attended to swiftly and expertly. If not treated appropriately, long-term consequences can be serious.

This is the reason that you should always ALWAYS be sure that your injector is properly trained, and knows how to handle vascular compromise after filler injection, whether they have personally experienced it first hand or not. All physicians who inject hyaluronic acid fillers like Juvederm, Restylane, Perlane and Belatero, should be stocking hyaluronidase in their office (this is the enzyme that breaks down the hyaluronic acid fillers used for liquid rhinoplasty).

Bottom line: While non-surgical rhinoplasty can be amazing, and is often quick, easy, and effective 1,999 out of 2,000 times, it is not without risks. Choose a plastic surgeon or dermatologist who is well trained, competent, approachable and responsive to you and your concerns.

The “face” of the plastic surgery conversation is changing. Slowly, cosmetic surgery discussions are becoming more frank, and the details of Botox, filler, and cosmetic surgery – which used to be the secret of the Manhattan and Los Angeles elite – are becoming less secret. In his recent TIME Magazine article entitled, “Nip. Tuck. Or Else.”, Joel Stein comments that, “cosmetic surgery has become the new makeup”.  While I think this is a bit of an overstatement, there is a kernel of truth in it. Little tweaks of Botox and filler, even rhinoplasty, and facelift surgery, are becoming more talked about, thus losing their stigma. Celebrities and civilians alike are speaking more openly about the procedures they’ve had done. We can thank Betty Ford (facelift and blepharoplasty), Joan Rivers (lots!), Ashlee Simpson (rhinoplasty), Renee Zelwiger (blepharoplasty), and most recently, Caitlyn Jenner (facial feminization and breast implants) for speaking frankly about cosmetic surgery.  We can thank sites like RealSelf for helping demystify the logistics of cosmetic procedures, as well as helping people become more educated cosmetic consumers.

Have No Doubt:

Cosmetic surgery is happening all around you. According to the International Society of Aesthetic Plastic Surgery (ISAPS), more than 20 million cosmetic surgical and nonsurgical procedures were performed worldwide in 2014, with the United States ranking number one for most cosmetic surgical and non-surgical procedures performed in 2014 (Brazil was briefly number one in 2013, but Brazilian Butt Lift be damned, we managed to regain the number one spot this past year). Cosmetic surgery technology is advancing, and procedures are becoming more minimally-invasive, with short, or no, recovery time required. As the technology advances, procedures become more common, and the cost is coming down, making procedures affordable to more people. Surgeons are also becoming more skilled, and more subtle, making results more predictable and less scary.

Along The Beauty Continuum

More and more in my practice, I see cosmetic procedures, particularly Botox and filler, regarded as regular maintenance rather than narcissistic indulgences. I even have many patients that come in for treatments with friends and make a day of it. I’ve seen that, with time, the idea of beauty and personal upkeep is becoming a continuum, with haircuts and shopping on one end and facelifts on the other. There are no longer any hard stops. If you have no reservations about coloring your hair with chemical dyes when it turns gray, why shouldn’t you take advantage of anti-aging treatments for your face? If you buy clothing and accessories in order to convey your personal style – to portray to others the way that you see yourself – why not take advantage of available procedures to do the same for your face and body?

The Shame Of Beauty Routines Is Long Gone

As Stein points out, in the 19th century, makeup was often sold under the counter because it was considered a tool of prostitution. In the 1930s, when hair dyeing was new, women got their color done in the basements of beauty parlors so no one would see them and continued to do so for decades. The shame of these beauty routines is long gone, and I hope that in the same way, we can soon say that the days of plastic surgery shaming are over.

Getting married this spring or summer? Believe it or not, NOW is the time to start thinking about your skin. This will likely be the most photographed and filmed day of your life, with lots of close-ups.  If you’re wondering how to get that effortless, fresh-scrubbed look that will carry you through your honeymoon, I’m about to tell you: It takes effort!

Make a Plan

Since you’re working up to your wedding day, and you may have photo shoots or events leading up to the big day, in my opinion, it’s best to have a series of less aggressive treatments that require little or no downtime rather than harsh ones (like deep chemical or deep laser peels) that require significant healing time, and may cause pigment irregularities, or excessive dryness or redness during the healing period. The cost is comparable, and this type of “stacked” plan is less risky, allowing you to achieve the same, or superior results, gradually by stacking the right treatments at the appropriate intervals.

 Start Early

Starting your skin boot camp 3-6 months prior to your wedding also gives you plenty of time to see how your skin reacts to each treatment so that the intensity can be either ramped up or down to produce maximally effective, and perfectly predictable, results for you on your wedding day.  The three basic steps are:

• Target the imperfections beneath the skin: banish brown spots and shrink capillaries with medical IPL (intense pulsed light) treatments that use special filters to erase imperfections below the surface of the skin. Adding a SkinTyte treatment at the end of each session is helpful for those prone to acne, and for shrinking pores. These sessions should be spaced about a month apart.
• Replace dry, damaged skin cells at the skin surface: Encourage cell turnover on the surface of the skin, and allow your face to make brand new, perfect, skin on its surface with a series of treatments (options include superficial laser peels, topical ViPeel treatments, or MyBody Probiotic Youthboost treatments, depending upon your skin and your particular concerns). We can discuss which of these treatments is right for you, your schedule, and your skin, during consultation. These sessions should also be about a month apart, and staggered with the IPL treatments.
• Maximize and maintain your results: Perfect skin care and eye care products between treatments are essential. Starting 3-6 months before your wedding means that you have some time to get the absolutely best product regimen in place for your skin, so that you will have predictably gorgeous skin from now until go time. And sunscreen is a MUST. ALWAYS.

On a side note, if you’re thinking about Botox or facial fillers, like Juvederm, Juvederm Voluma, or Belotero, before your big day, definitely do not wait until the last minute.  I recommend these treatments between 4 and 5 weeks before the wedding.

Bridal Skin Boot Camp Regimen

Here’s a sample Bridal Skin Boot camp regimen for a May 30 Wedding for someone with absolutely no downtime for healing between treatments:

• February 21: First IPL treatment with SkinTyte
• March 14: First Probiotic Youthboost treatment
• April 4: 2^nd IPL treatment with SkinTyte
• April 18: 2^nd Probiotic Youthboost treatment
• May 2: Final IPL treatment with SkinTyte
• May 16: final Probiotic Youthboost treatment
• May 30: Wedding Day!

To schedule an appointment with Dr. Liotta, please visit: www.FacialPlasticsNYC.com or call 212-288-2222.