GreatSkin Medispas

Was My Face Red!
My adventures with skin laser resurfacing

In this youth-oriented culture, we all want to stay looking as young as we can for as long as possible. Extreme makeovers dominate our television viewing while the cosmetic industry offers skin-care products that promise eternal youth.

I don’t know when the fine lines crept onto my unsuspecting face and gravity took over. Upon scrutiny I noticed my laugh lines were not funny, my cheeks resembled crinkled tissue paper, and my lipstick bled up toward my nose.

I was not opposed to getting a facelift if I ever needed one, but surely I had not reached that stage yet. Watching a facelift procedure on television cured me of that decision.

Then one day I heard about an easier solution that promised an in-and-out procedure that could be done during one’s lunch break. I located a doctor in my area that offered the service and made an appointment. The first surgery date available was more than a month away and I had to wait three weeks for a consultation.

At the consultation I learned that what I had in mind was something that would not last more than a year or two given my sixty-eight years and my skin’s condition. The doctor’s recommendation was laser resurfacing and blepharoplasty to get rid of the puffiness under my eyes. I viewed before-and-after pictures of patients who’d had the procedure done; I watched videotapes.

Since I had booked a surgery date in advance and felt so comfortable with Dr. Rick Noodleman, I decided to go for it and paid for the procedure. I was required to initial a huge stack of papers outlining the possible dangers involved, ranging from scaring to vision impairment or even death. In this litigious society doctors know to cover all eventualities.

I had to go for a series of health tests and the weeks that followed caused me every discomfort from buyer’s remorse to downright panic. The doctor I had chosen to do this procedure calmed my every fear, even down to calling my cardiologist and primary care physician. I was comforted by his assurances and his willingness to offer me prescriptions for pain, anxiety, and sleeplessness along with the required medications for possible viral or bacterial infections.

Whenever I called him he returned my call immediately, assuring me of the great care he would give me. I do not think I could have gone through with the procedure had he not been so patient, caring, and understanding and so willing to address my every concern.

The day of the surgery I was very nervous. Yet from the moment of my arrival until I left the office six hours later, I could not have been treated with more kindness and compassion by my doctor and his staff. They had soothing music playing and I was given medication to calm my frazzled nerves.

The doctor communicated with me throughout the entire procedure, explaining exactly what to expect. He even kept me amused with jokes, and I was glad that he was a better physician than comedian.

The first step was to numb my entire face and neck with a series of many shots, including the inside of my mouth. The laser made a buzzing sound and the smell of burnt flesh was the only indication that my skin was being removed. He told me when he was ready to do under my eyes, and removed the protective plate that had been in place during the laser process.

Before being discharged my face and neck were encased in a mask that was to stay on for several days. I was given a bag full of products and instructions. I had Angelina Jolie’s lips and my swollen face resembled the hunchback character in Cirque de Soleil. Each day afterward, the mask loosened and slipped due to fluids forming underneath and the swelling diminishing.

Two days after surgery I received a handwritten card from the doctor and his staff wishing me a speedy recovery. The next few days were filled with discomfort, burning, and stinging. Every morning for the next two weeks not a day went by without a call from my doctor inquiring about my progress.

He even called on the weekends and gave me his cell phone number in case I needed to contact him.

By day four it was time to have the mask removed and have the gunk cleaned off my red, raw skin. This was a painful process repeated every other day which, eased by a shot for pain if it became too intense. Once the mask was off I had to apply Vaseline to my face and neck to keep the area moist, and soak my face and neck four times a day before applying a new layer of Vaseline.

The forth to sixth day were the worst, as the old dead skin peeled off and the new started to grow back. I looked and felt like raw meat all greased up waiting to be barbequed.

The eight and ninth days were the itchiest as the healing process began, but I had a supply of ointments to help. Gradually, starting at the forehead, the new skin came in. My face was still scarlet, bloodied, and looked as if I’d been in a horrible accident. The final results and redness would take weeks and perhaps months to get back to normal, but could be covered up with makeup.

The big question: Was it worth the discomfort, pain, expense, and effort? The answer depends on each person’s experience. I know I could not have done so well if I had not had the most considerate doctor ever.

True, the procedure was not a day at the beach but one tends to forget the bad stuff when it’s over, and I kept looking forward to seeing nice new skin without lines and creases. Today, I can honestly say that in spite of the mess, rawness, and discomfort it was worth it.

Even so, I am realistic and know I won’t end up looking like a new me, but hopefully I will not look like an old me either. I was not born a beauty queen and I am not out to prove anything, but I am not too proud to seek a little help to be the best me I can be.

Call it vanity, foolishness, or self indulgence.

I call it striving to put my best face forward and, I hope, to have my exterior reflect some of my inner beauty.

Debby Alden, 69, pre and post C02 laser resurfacing

Read another essay by Debby here.Resource : agedefy

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Botulinum toxin is a neurotoxin protein produced by the bacterium Clostridium botulinum. It is one of the most poisonous naturally occurring substances in the world, and it is the most toxic protein.[1] Though it is highly toxic, it is used in minute doses both to treat painful muscle spasms, and as a cosmetic treatment in some parts of the world. It is sold commercially under the brand names Botox and Dysport for this purpose. The terms Botox and Dysport are trade names and are not used generically to describe the neurotoxins produced by the clostridia species.

History

Between 1817 and 1822 the German physician and poet Justinus Kerner described botulinium toxin, using the terms “sausage poison” and “fatty poison”[2], as this bacterium often causes poisoning by growing in badly handled or prepared meat products. He first conceived a possible therapeutic use of botulinium toxin. In 1870, Muller (another German physician) coined the name botulism, from Latin botulus = “sausage”. In 1895, Emile Van Ermengem first isolated the bacterium Clostridium botulinum. In 1944, Edward Schantz cultured Clostridium botulinum and isolated the toxin, and, in 1949, Burgen’s group discovered that botulinum toxin blocks neuromuscular transmission.

By 1973, Alan B Scott, MD, of Smith-Kettlewell Institute used botulinium toxin type A (BTX-A) in monkey experiments, and, in 1980, he officially used BTX-A for the first time in humans to treat strabismus. In December 1989, BTX-A (BOTOX) was approved by the US Food and Drug Administration (FDA) for the treatment of strabismus, blepharospasm, and hemifacial spasm in patients over 12 years old. The cosmetic effect of BTX-A was initially described by ophthalmologist Jean Carruthers and dermatologist Alastair Carruthers, a husband-and-wife team working in Vancouver, Canada, although the effect had been observed by a number of independent groups. On April 15, 2002, the FDA announced the approval of botulinum toxin type A (BOTOX Cosmetic) to temporarily improve the appearance of moderate-to-severe frown lines between the eyebrows (glabellar lines). BTX-A has also been approved for the treatment of excessive underarm sweating. The acceptance of BTX-A use for the treatment of spasticity and muscle pain disorders is growing, with approvals pending in many European countries and studies on headaches (including migraine), prostatic symptoms, asthma, obesity and many other possible indications are ongoing.

Botox is manufactured by Allergan Inc (U.S.) for both therapeutic as well as cosmetic use. The formulation is best stored at cold temperature of 2-8 degrees Celsius. Dysport is a therapeutic formulation of the type A toxin developed and manufactured in Ireland and which is licenced for the treatment of focal dystonias and certain cosmetic uses in many territories world wide. Neuronox is a new type A toxin manufactured by Medy-Tox Inc (South Korea).

Botulinium Toxin Type B (BTX-B) received FDA approval for treatment of cervical dystonia on December 21, 2000. Trade names for BTX-B are Myobloc in the United States, and Neurobloc® in the European Union.

Medical uses

Researchers discovered in the 1950s that injecting overactive muscles with minute quantities of botulinum toxin type A decreased muscle activity by blocking the release of acetylcholine at the neuromuscular junction, thereby rendering the muscle unable to contract for a period of 4 to 6 months.[citation needed]

Alan Scott, a San Francisco ophthalmologist, first applied tiny doses of the toxin in a medicinal sense to treat ‘crossed eyes’ (strabismus) and ‘uncontrollable blinking’ (blepharospasm), but needed a partner to gain regulatory approval to market his discovery as a drug. Allergan, Inc., a pharmaceutical company that focused on prescription eye therapies and contact lens products, bought the rights to the drug in 1988 and received FDA approval in 1989.[citation needed] Allergan renamed the drug Botox.

Cosmetically desirable effects of Botox were first discovered by Vancouver-based cosmetic surgeons Drs. Alastair and Jean Carruthers.[3] The serendipitous discovery occurred when the husband-and-wife team observed the softening of patients’ frown lines following treatment for eye muscle disorders, leading to clinical trials and subsequent FDA approval for cosmetic use in April 2002.[citation needed] As of 2006, Botox injection is the most common cosmetic operation in the United States.[citation needed]

Besides its cosmetic application, Botox is used in the treatment of

* migraine headaches

* cervical dystonia (spasmodic torticollis) (a neuromuscular disorder involving the head and neck)[4]

* blepharospasm (involuntary blinking)[5]

* severe primary axillary hyperhidrosis (excessive sweating)[6]

* Achalasia(failure of the lower esophageal sphincter to relax)

Other uses of botulinum toxin type A that are widely known but not specifically approved by FDA include treatment of:

* pediatric incontinence[7], incontinence due to overactive bladder,[8] and incontinence due to neurogenic bladder.[9]

* anal fissure[10]

* spastic disorders associated with injury or disease of the central nervous system including trauma, stroke, multiple sclerosis, Parkinson’s disease, or cerebral palsy

* focal dystonias affecting the limbs, face, jaw, or vocal cords

* TMJ pain disorders

* diabetic neuropathy

* wound healing

* excessive salivation

* VCD Vocal Cord Dysfunction a spasming of the vocal cords

* Reduction of the Masseter muscle for decreasing the size of the lower jaw

In the Journal of Dermatologic Surgery, Eric Finzi claims to have treated clinically depressed patients with botox. On Good Morning America, he claimed that by taking away the ability to frown, he was somehow taking away the ability to feel depressed.[11]

Treatment and prevention of chronic headache[12] and chronic musculoskeletal pain[13] are emerging uses for botulinum toxin type A. In addition, there is evidence that Botox may aid in weight loss by increasing the gastric emptying time.[14]

Side effects

Side effects can be predicted from the mode of action (muscle paralysis) and chemical structure (protein) of the molecule, resulting broadly speaking in two major areas of side effects: paralysis of the wrong muscle group and allergic reaction. Bruising at the site of injection is a side effect not of the toxin, but rather the mode of administration. In cosmetic use, this means that the client will complain of inappropriate facial expression such as drooping eyelid, uneven smile, loss of ability to close the eye. This will wear off in around 6 weeks. Bruising is prevented by the clinician applying pressure to the injection site, but may still occur, and will last around 7 - 10 days. When injecting the masseter muscle of the jaw, loss of muscle function will result in a loss or reduction of power to chew solid foods. All cosmetic treatments are of limited duration, and can be as short a period as six weeks, but usually one reckons with an effective period of between 3 and 8 months. At the extremely low doses used medicinally, botulinum toxin has a very low degree of toxicity.

Chemical overview

There are seven serologically distinct toxin types, designated A through G; 3 subtypes of A have been described. The toxin is a two-chain polypeptide with a 100-kDa heavy chain joined by a disulfide bond to a 50-kDa light chain. This light chain is an enzyme (a protease) that attacks one of the fusion proteins (SNAP-25, syntaxin or synaptobrevin) at a neuromuscular junction, preventing vesicles from anchoring to the membrane to release acetylcholine. By inhibiting acetylcholine release, the toxin interferes with nerve impulses and causes flaccid (sagging) paralysis of muscles in botulism as opposite to the spastic paralysis seen in tetanus.

It is possibly the most acutely toxic substance known, with a median lethal dose of about 1 ng/kg[15], meaning that a few hundred grams could theoretically kill every human on earth (for perspective, the rat poison strychnine, often described as highly toxic, has an LD50 of 1,000,000 ng/kg, and it would take four hundred tons to kill every human).

It is also remarkably easy to come by: Clostridium spores are found in soil practically all over the earth.

Food-borne botulism usually results from ingestion of food that has become contaminated with spores (such as a perforated can) in an anaerobic environment, allowing the spores to germinate and grow. The growing (vegetative) bacteria produce toxin. It is the ingestion of preformed toxin that causes botulism, not ingestion of the spores or vegetative organism.

Infant (intestinal) and wound botulism both result from infection with spores which subsequently germinate, resulting in production of toxin and the symptoms of botulism.

The toxin itself is rapidly destroyed by heat, such as in thorough cooking.[16] However, the spores which produce the toxin are heat-tolerant and will survive boiling at 100 degrees Celsius for an extended period of time.

Chemical warfare

Botulin toxin is an inferior agent for chemical warfare since it degrades rapidly on exposure to air. An area attacked with toxic particulate would be safe to enter within about a day. The agent is so unstable that the medicinal form is shipped on dry ice. There are no documented cases of the toxin being used in warfare; however, it has been claimed to have been used in the Operation Anthropoid to kill top Nazi Reinhard Heydrich[17] and in “Operation Mongoose”, where in 1961, the CIA saturated some cigars, of Fidel Castro’s favorite brand, with botulinum toxin for a possible assassination attempt. The cigars were never used, but when tested years later were found still effective.[18] The notorious Japanese biological warfare group Unit 731 fed botulinum to prisoners during Japan’s occupation of Manchuria in the 1930s.[19]

Biochemical mechanism of toxicity
The heavy chain of the toxin is particularly important for targeting the toxin to specific types of axon terminals. The toxin must get inside the axon terminals in order to cause paralysis. Following the attachment of the toxin heavy chain to proteins on the surface of axon terminals, the toxin can be taken into neurons by endocytosis. The light chain is able to leave endocytotic vesicles and reach the cytoplasm. The light chain of the toxin has protease activity. The type A toxin proteolytically degrades the SNAP-25 protein, a type of SNARE protein. The SNAP-25 protein is required for the release of neurotransmitters from the axon endings.[20] Botulinum toxin specifically cleaves these SNAREs, and so prevents neuro-secretory vesicles from docking/fusing with the nerve synapse plasma membrane and releasing their neurotransmitters.

Though it affects the nervous system, common nerve agent treatments (namely the injection of atropine and 2-pam-chloride) will increase mortality by enhancing botulin toxin’s mechanism of toxicity. Attacks involving botulinum toxin are distinguishable from those involving nerve agent in that NBC detection equipment (such as M-8 paper or the ICAM) will not indicate a “positive” when a sample of the agent is tested. Furthermore, botulism symptoms develop relatively slowly, over several days compared to nerve agent effects, which can be instantaneous.

^Outbreaks

^{On July 2, 1971 the FDA released a public warning after learning that a New York man had died and his wife had become seriously ill due to botulism after eating a can of Bon Vivant vichyssoise soup. The company began a recall of the 6,444 cans of vichyssoise soup made in the same batch as the can known to be contaminated. The FDA discovered that the company’s processing practices raised questions not only about these lots of the vichyssoise, but also about all other products packed by the company. The effectiveness check of the recall had revealed a number of swollen or otherwise suspect cans among Bon Vivant’s other products, so FDA extended the recall to include all Bon Vivant products. The FDA shut down the company’s Newark, New Jersey plant on July 7, 1971. Although only five cans of Bon Vivant soup were found to be contaminated with the botulin toxin, all in the initial batch of vichyssoise recalled and part of the first 324 cans tested. The ordeal destroyed public confidence in the company’s products and the Bon Vivant name. Bon Vivant filed for bankruptcy within a month of the announcement of the recall. [21]}
Kaynak: www.Wikipedia.org

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Aramis
1.54µm non ablative remodeling laser

Laser skin remodeling is a new revolutionary treatment of rhytids (wrinkles). This gentle and pain free process involves heating the dermis while cooling the overlying epidermis, thus stimulating the production of collagen. This neo-collagen gradually reduces and softens wrinkles and gives the skin a younger and fresher look.

Non ablative remodeling with Aramis laser

• 1.54µm laser
• Contact cooling in order to protect the epidermis
• Pulse train emission in order to confine the heat in the upper dermis

Advantages of 1.54µm for non ablative remodeling

• Good absorption by dermis ( heat source in the dermis)
• Minimal scattering
• Almost no melanin absorption
  (20 lower at 1.54µm compared to 0.65µm)
  ( 4.8 lower at 1.54µm compared to 0.98µm)
  ( 1.7 lower at 1.54µm compared to 1.32µm)
• Pulse train emission (confinement of heat in the upper dermis)
• Eye safe: for retina, the ED50 threshold value is 70J/cm²(Fletcher -SPIE 2000)

Contact Cooling

• Provides epidermal protection throughout laser shot.
• Gentle cooling at + 5°C eliminates risk of cold sores and post-op erythema
• Well tolerated by patient, with no pain or discomfort

Benefits of Aramis

• Aramis is safe and effective in reducing and softening lines and increasing the elasticity and tonicity of the skin
• The procedure is quick and easy to perform (full face in 20 minutes) \
• Effective contact cooling
  No pain or discomfort
  No side effects (erythema disappears in minutes)
  No downtime (lunchtime procedure)
• Can be performed on all skin types AND on tanned skins
• Remodeling can be combined with peels or Microdermabrasion to have both short term and long term improvement.
• Without cooling, Aramis can also be used to vaporize / coagulate benign lesions
• Rugged, reliable solid state technology

Aramis Benefits

• Clinically proven procedure
• Safe and effective
• Easy and quick to perform
• Painless
• No Side Effects
• Can be performed on all skin types

Laser for wrinkle reduction.
Manufactured by Quantel Medical, the Aramis uses a patented, mid infrared wavelength which is ideally absorbed in the upper layers of the Dermis. A sapphire window at 5ºC is applied to the skin, cooling it constantly while the laser beam is fired through it. Heating the Dermis accelerates the collagen synthesis process induced by the fibroblasts. Keeping the epidermis intact avoids skin barrier disruption. The Aramis benefits include:

• Clinically proven procedure (see Research Information)
• Safe and effective
• Easy and quick to perform
• No down time (“lunch time” procedure)
• Painless
• No side effects (mild erythema disappears in minutes)
• Can be performed on all skin types, tanned skins.

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