I was honored and excited to be invited to speak at the Facial Aesthetics Conference and Exhibit (FACE) in London last month. I was looking forward to exposure to a different, “European” take on aesthetics and I was not disappointed. The first thing that struck me was that most of the physicians and their staffs, as well as the speakers, looked normal to me. They were not over done with gigantic fish lips and cheeks and breasts that defied gravity and stuck straight out. OK, there were a few but they were the exception and not the norm. The aesthetic conferences here in the states seem to always be held in Las Vegas, and “normal” is the exception there among the attendees. The Aesthetic Show, or TAS, is one the premier aesthetic shows in the US. Compared to FACE it is simply a marketing tool for aesthetic devices and not a true sharing of evidence-based best medical practices like most other U.S. medical conferences. In other words—lots of flash and not much substance—which, to be fair, is how most people view aesthetic medicine in the first place. It was the opposite at FACE. I was in hog heaven! Speakers from all over the world shared their experiences and their experimental study results. Information, it seemed to me, appeared to flow more freely. I think part of the problem in the states is the lack of communication between the various medical specialties and competition between these specialties. That, however, is another topic for another day. Lets just say it was refreshing to teach and learn new things without everybody’s ego (and boobs) getting in the way!

The first thing I learned was something that I had suspected was true but I had no way of proving. Over the years it has seemed to me that my patients who had repeated filler injections, in other words, ‘kept up’ with their filler, seemed to get a little better result each time. Despite the fact that time was passing and the aging process was marching on, their results continued to improve. Most other things in medicine are the opposite, like cortisone injections of a joint or face lifts, the first time is usually the best with diminishing returns on repeated treatments. One of the FACE speakers spoke of the Velcro effect of repeated filler treatments. He discussed repeated filler to the angle of jaw acting as Velcro fasteners and lifting the skin to improve jowling. That was an ah-ha moment for me. It is truly as if we are creating a “Velcro lift” with repeated fillers injections over time. Amazing! I suspect surgical face lifting procedures will decrease in numbers in the future.

The next thing I want to discuss is a new procedure I learned. I’m simply going to call it the “London Neck” since I learned the technicalities of the treatment in London. I actually had read a paper by a Russian physician on a similar treatment about 6 months ago, which peaked my interest. This paper did not get into the nitty-gritty of “how to” so I filed it under “Need to Learn More About This” before taking it any further.

The London Neck is a treatment to the dermis of the skin of the neck with diluted calcium hydroxyapatite (Radiesse). This type of calcium molecule, which is the same type that is in our bones, has been shown to stimulate osteoblasts, or bone making cells, when placed next to bone. This same calcium molecule will stimulate fibroblast cells (collagen making cells) when placed next to fibroblasts in the dermis of the skin. The skin of the neck is naturally thinner than most areas of the body and as collagen and elastin fibers break down and sun damage sets in, it tends to get that crepey look, like crumpled tissue paper. By fanning dilute Radiesse (undiluted would be too thick and could possibly cause lumpiness) to the dermis you not only get an immediate fill, you stimulate native collagen production to tighten and smooth the neck skin. The more times the treatment is repeated the better results you get. Consensus seemed to be 3 or 4 treatments over 6 to 9 months, though different doctors had slightly varying protocols, with yearly or biannual upkeep treatments. We’ll announce in the newsletter when the “London Neck” treatment will be available at St. Louis Skin Solutions.

Did you know that probiotics aren’t just for yogurt any more? They are popping up everywhere as science begins to understand the importance of maintaining our individual ecosystems of bacteria. For years in medicine, essentially since the discovery of penicillin, bacteria have been something to eradicate and keep off and out of the human body. As our understanding of gut bacteria evolved and we came to understand the protective, symbiotic relationship the human body has with its gut bacteria, we realized maybe this is true outside the gut as well. So, where am I going with all this?
Well, we may be welcoming probiotics to our skin care products soon. Topical probiotics have been shown to help improve eczema and acne, among other things. The trouble is keeping them alive. When packaged in a cream or lotion form they tend to die quickly and who wants to be spreading bacteria carcasses all over their face? To do all their good stuff, like warding off acne causing bacteria, they have to be alive. This hasn’t quite been perfected yet so don’t be fooled by products that say something like they have “10 million colony forming units”. That may be true but they could all be dead. I’m going to give it a year or two and see how technology has progressed because probiotics could be a wonderful tool in our battle against acne.

The forth thing on my list is the amazing stuff you can do with filler for a nonsurgical nose job. I usually use filler in the nose to smooth out humps and straighten the profile of the nose. Well, in Europe and Mexico, that’s just baby stuff. A plastic surgeon from Mexico City, Dr. Frank Rosengaus, gave a lecture on how he recreates the nasal implants he uses in surgery with dermal fillers and creates a nose job result without surgery. He performed a live procedure on a patient and the before and after pictures were amazing. She looked like she was 6 months post a rhinoplasty (nose job) immediately after the treatment. I felt like I was watching the master at work (which really I was) and I vowed then and there to get really good at injecting noses and help some patients avoid surgery in the future.

Okay, so the next item on the list is something I’m really excited about. It is not yet FDA approved and the president of the company says he expects it will take about one year for approval. Once it is OK’ed I hope to be one of the first practices in the U.S. to offer this technology because it is AWESOME! It’s already taking the UK and Europe by storm and yielding impressive results. What is this amazing new technology you ask? Well, it’s called the Tixel; feel free to google it. It is a non-laser that works like a laser to tighten the skin. Since it does not use laser energy it is safe for use on the eyelids (no worries about the laser light burning a retina). This is huge, I have several lasers that tighten facial skin but I cannot use them inside the orbital rim (eye socket) because it is too dangerous. (I do have one that I can use, but metal contacts have to be placed in the eyes, and that still does not reduce the risk to zero). Eyelid skin is the first to go and the thing I get questions on the most. Imagine if you could tighten and smooth out the eyelid skin without surgery. It is possible; we just got to get the technology across the pond. When I get my hands on this technology we will announce it not only in the newsletter but an e-blast too.

Another thing I leaned in London is not to expect ice in your ice water, iced tea or soda. You get rationed one ice cube, if you are lucky. If you ask for more, the waiter or waitress will disappear, never to reappear. Oh, and mushy peas are quite tasty, and spotted dick is a desert. Plus, they have ‘TK Maxx” over there instead of TJ Maxx. The Supreme Court is open to the public, air conditioned and never crowded. It is right across from the insanely crowded, non air conditioned Westminster Abbey. Inside the Supreme Court are gifts given to the UK from other nations to celebrate solidarity. Things like beautiful china and ornate statues. We (the US) gave them a brick from our Supreme Court building. A brick!

Well that completes part 1 of Things I Learned in London. Part 2 coming soon.