DermLife

What is the difference between Botox® and fillers?

Both of these products can effectively soften lines and rejuvenate or enhance your look. They are complementary to each other but work in different ways.

Botox® is a neuromodulator, of which there are several different brands with slightly unique properties- Botox® (Allergan), Dysport® (Galderma), and Xeomin® (Merz). Neuromodulators temporarily relax the muscles of facial expression to soften dynamic lines- lines that appear when we are expressive, such as frown lines. Depending on the product and location, they take a few days to take effect. When done well, results look natural. You should expect people to tell you “you’re looking good”, or “you look rested”. Neuromodulators for cosmetic purposes last, on average, 3-4 months before their effects gradually and completely wear off. There is evidence, however, that repeated use of neuromodulators leads to increased collagen production, so in addition to preventing dynamic lines from becoming static lines (more on that below), there are benefits to regular use.

Fillers are injectable products that add volume, or “fill”. These target mainly static lines (lines that are present at rest) and volume loss. As we age, we lose volume in certain fat compartments in our faces, and our bone structure changes. As we age, we lose that volume, and filler is a way to restore it. Fillers can also enhance your look- give you slightly more volume in your cheekbones or lips, for example. Again, the goal here is a natural, better-rested appearance- you on your best day.

There are multiple different classes of filler, but the most commonly used fillers today are the hyaluronic acid fillers. Hyaluronic acid, “HA”, is a naturally occuring molecule in the layer of skin called the dermis. It has numerours appealing properties, including the fact that it can be dissolved- so we have on hand an “eraser” if we need it. Some other types of filler are semipermanent and these cannot be disolved.

How do Fillers and Neuromodulators work together?

As discussed above, neuromodulators like Botox® relax muscles of facial expression to soften dynamic lines and prevent static lines like the “11s” between the eyebrows from forming. Fillers restore volume and enhance facial proportions. Furthermore, when used together, they can help each other to last longer.

How do I know what is right for me?

This is where you need an expert opinion. When coming in for a cosmetic consultation, it is helpful if you can identify one or a few areas that bother you. Now, get ready for the tricky part- we rarely start by treating right where you are pointing! This may seem counterintuitive, but to get the best and the most natural-looking results, the face must be treated as a whole. Volume loss in the cheekbones affects the nasolabial folds, the “red show” of the lips, and loss of elasticity in the lower face. A well-trained injector can tell you what is needed and in what sequence, and explain why. An experienced injector can also tell you what you don’t need.

The array of products available, and new products that will be arriving soon to the market make this a very exciting time in cosmetic dermatology. I look forward to keeping you up to date on these developments.

This article is intended to provide general information and is not intended as a substitute for assessment and care from your doctor. 

Even wonder about the risks of popular nail treatments?

Just last week I was invited to speak with Sonia Sunger on Global BC’s morning news about this issue. Here are a few of the tips we discussed:

Nail polish:

• Toxic trio: formaldehyde, toluene, dibutyl phthalate- some products have moved away from containing these ingredients
• Look for a well-ventilated salon, and consider seeking out nail products that don’t contain these ingredients. If you own or work in a salon, make sure it is properly ventilated.

UVA and LED lights

• These are necessary to set shellac nails and gel nails
• Both UVA and LED lights give off UVA radiation, which is a class I carcinogen (cancer causing agent) as defined by the World Health Organisation
• Protect your hands: apply a broad spectrum sunscreen containing a good UVA blocking ingredient (zinc oxide, titanium dioxide, and Mexoryl XL ®)
• Better yet: cut the finger tips off an old pair of gloves that don’t let any light through and protect your skin

Cleanliness and Sterility

• Reusable manicure instruments should be sterlilized in an autoclave to prevent the spread of infection
• For pedicures: look for foot basins without jets- it is very difficult to perform a high-grade clean on jets between customers

Risks of Gel and Acrylic Nails

• Gel nails, and shellac nail treatments all use acrylates.
• As discussed above, this requires UVA light for curing/ hardening.
• If improperly cured, these acrylates are highly allergenic. Signs can include eyelid  redness, swelling, scaling and itch- not necessarily a rash on the hands, where the skin is thicker and less sensitive.
• This can have serious implications: this type of contact allergy, once acquired, lasts for life, and can affect other procedures that use acrylates, such as cosmetic dental work.

Protect your cuticles

A popular part of a manicure is to push back and trim the cuticle. Unfortunately, this can lead to all kinds of nail problems. The cuticle is a very important part of the nail- think of it as the glue that attaches the skin to the nail, and prevents water, irritants, and infection from getting in to attack the nail at it’s growth plate- the nail matrix. Once cuticles are damaged or gone, it is very difficult to promote healthy re-growth. Personally, if I get a manicure, I ask them to leave my cuticles alone- the less we mess with them the safer!

This article is intended to provide general information and is not intended as a substitute for assessment and care from your doctor. 

Even wonder if you should be checking your moles? Or your childrens’ moles? Or what to look for?

Worrisome features in children’s moles are different from those in adults. Read on  for a set of guidelines for skin self-checks.

A set of rules to assess moles for melanoma risk in adults and older children (older than 10) is the “ABCDE” rule. Not every mole that meets one or more of these criteria is worrisome, but moles that meet the ABCDE criteria deserve to be checked:

• A: Asymmetry– this describes moles that don’t look the same on both sides if you imagine dividing them in half
• B: Border irregularity– a border with notches or an irregular outline
• C: Colour variation- moles with more than one colour
• D: Diameter– greater than 6mm; the size of a pink eraser on the tip of a pencil
• E: Evolution– a mole that is changing rapidly, for example from one month to the next, or changing differently or faster than other moles.

A modified ABCD rule was developed for pre-pubertal children (10 and younger) in 2013, as melanoma can present differently in this age group and can be missed by the traditional ABCDE above:

• A: Amelanotic– the bump is not pigmented (i.e. not brown or black), but is skin-coloured, pink or red
• B: Bleeding, Bump– a new, non-resolving bump or bleeding skin lesion
• C: Colour uniformity– while in adults and older children multiple colours are a warning sign, early childhood melanomas can be a single colour
• D: De novo, any Diameter– a new lesion, not necessarily larger than 6mm

Evolution remains an important feature- most childhood melanomas present as rapidly growing.

Some helpful hints for managing your moles:

1. Avoid sun exposure- ultraviolet (UV) exposure, both with and without sunburn, is linked with the development of more moles in children. We also know that the sun can cause changes in moles that can lead to melanoma.
2. Know your moles. If you have moles on your back, take a picture that you can compare to when checking.
3. Watch for change: moles do change throughout life- they can grow, and sometimes become more bumpy. These changes usually happen slowly over the course of years, and happen similarly in multiple moles.
4. A mole that is changing faster than others, or meets any of the ABCDE criteria, should be checked by your doctor.

This article is intended to provide general information and is not intended as a substitute for assessment and care from your doctor.