Bolitho MD

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9834 Genesee Ave Ste 311 La Jolla San Diego, California
Phone: (858) 458-5100

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23Feb, 2017

The Trend of Modern Aesthetics

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The Trend of Modern Aesthetics

In a world of minimally invasive nonsurgical facial rejuvenation procedures, striking a balance between trend and what’s aesthetically attractive remains the goal. The advent of cosmetic injections such as Botox and fillers has afforded patients with numerous aesthetic possibilities. While this is true, finding the right medical professional such as a board-certified plastic surgeon or their handpicked aesthetic nurse specialist to deliver these injection series is of the utmost importance since their in-depth understanding of the facial anatomy is superb.

Unwavering commitments among these medical professionals, particularly plastic surgeons who are considered excellent by their own peers, have to balance ethics when facial trends emerge. Their Hippocratic Oath bounds them to uphold professional and moral principles which encompass the best care for their patients.

In a patient consultation, doctors will listen to the aesthetic wishes of their patients. If a patient requests a procedure which a doctor believes would not be advantageous to their appearance, a candid discussion will take place on why this is so.

An example of this would be lip augmentation via fillers. Lip enhancement is considered one of the top leading trends. Candidates for lip augmentation may inquire about a treatment for one or more of the following reasons:

  • Naturally thin lips
  • Lips which have lost volume with age
  • Correct the appearance of uneven lips
  • Quick recovery following an injection series

In a consultation, a doctor will determine if enhancing a patient’s lips will help balance one’s facial contours. If a doctor feels as if a patient is a good candidate for the procedure and moves forward with the treatment, a collision between ethics and aesthetics may collide if a patient requests more filler which would outsize their lips following the procedure.

It’s important to note that this just doesn’t pertain to lip enhancement. This applies to “over injecting” other parts of the face, such as augmenting the cheeks or minimizing wrinkles via Botox. It all falls into the same aesthetic category.

The results of cosmetic injections should be subtle and undetectable by others.

While trends do shape culture, it’s ultimately the responsibility of a board-certified plastic surgeon to provide their patients with timeless beauty in a natural looking way.

Even though a patient may have their own particular view on how their nonsurgical facial rejuvenation should look, it’s important to discuss it in detail if a medical professional may not fully agree. If the reasons aren’t totally understood, do ask for more explanation and clarification.

Above all, doctors in this aesthetic field have a distinct vision and don’t want to compromise it based on trend.

17Nov, 2016

Patient gives chemical peel kudos

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Patient gives chemical peel kudos

A month ago our patient visited the office and had a Voluma treatment with our aesthetic nurse specialist, Elizabeth Reed. Two weeks following her injection series, she made plans to return for her Juvederm treatment.

But that didn’t happen.

“I was expecting to get Juvederm, but Elizabeth was so honest with me by saying how I didn’t need it since the Voluma injections I received a couple weeks before to add volume to my cheek area had actually resolved my nasolabial folds,” Christina said. “As I was sitting there, Elizabeth asked when I’d be available to do a chemical peel because she thought I’d benefit from it.”

For Christina G., 50, a TCA peel (trichloroacetic acid) was going to be different than the type she had with Elizabeth months ago during a Break Time Peel. That one was a very light peel and Christina could immediately resume back to her day’s activities, and she didn’t experience any peeling. She didn’t know what to expect from a TCA peel.

“To be honest, I was a bit concerned about how I would look following a chemical peel. I had no idea how much and for how long I’d be peeling,” she said. “That little voice in my head wanted to put it off, but I hadn’t had any special events planned in the next few days so I had no reason to delay it. Besides, this was Elizabeth. She is specially trained as an aesthetic nurse, and I completely trusted her with my skin and cosmetic injections.”

Reed used a medium grade TCA peel. After she prepared Christina’s skin, she applied one layer at a time. Overhead, Reed had a handheld fan to keep Christina comfortable while assessing her skin.

“In typical Elizabeth fashion, her communication skills yet again exceeded my expectations. It was important to her that she knew what ‘tingle level’ I was at,” she said.

Once Reed determined it was time to neutralize the peel, she did so. Reed also instructed Christina to only use her SkinMedica Cleanser and SkinMedica TNS Ceramide Treatment Cream for the next five days. Following that time, she could then go back to her normal skin care routine which included her prescription Retin-A topical at night.

According to Christina, the chemical peel aftermath was completely doable and not at all what she thought it would be like.

“For the first two days, I didn’t have any peeling. On days three, four and five, I had flakiness around my whole face, particularly around my mouth. When the peeling was visible, I just applied my post-treatment cream and that lessened the appearance considerably,” she said.

Two weeks after her first chemical peel, Christina now raves about the results. Her skin is smoother, more even toned, and her brown spots have diminished considerably. And she agrees with Reed that completing a series would be optimal.

“It’s as if the chemical peel boosted my skin to a whole new level. It’s amazing,” Christina said.

 

13Oct, 2016

Facial rejuvenation after weight loss

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Facial rejuvenation after weight loss

As many can attest to, making the decision to lose weight takes patience and dedication. Reaching those weight loss goals is truly a celebratory milestone.

For those who have attained their goal by losing 20 to 25 pounds, while they have redefined their silhouette, they may also notice that their face has lost volume.

“Anytime you lose a significant amount of weight, there is a concern about volume loss and perhaps the change of laxity in your skin,” said Elizabeth Reed, an aesthetic nurse specialist who works with San Diego plastic surgeon Dr. D. Glynn Bolitho. “So what we want to do first is to restore that volume.”

Reed mentioned the optimal products she uses are Juvederm and Voluma.

While Juvederm is used to lessen the appearance of nasolabial folds and marionette lines, Voluma addresses the mid-portion of the face. According to Reed, beginning rejuvenation at the mid-face is a great starting point.

This usually begins with using one syringe of Voluma. Generally, Reed likes to deliver the Voluma first and wait a couple of weeks for the product to settle before addressing nasolabial folds. In some cases, this area may resolve itself due to the Voluma, or a patient may need a lesser amount of Juvederm.

When teaming up with patients for their skin care needs, Reed will also assess whether or not they would like to reverse any premature skin aging caused by sun damage or even brighten their skin tone with a series of chemical peels.

And for those who want to lessen the appearance of wrinkles along their forehead, around their eyes and in between their brows, Botox is the “go-to” cosmetic injection.

“The goal is to tailor a skin care regimen for every person’s specific needs,” Reed said.

Reed wants everyone to know that it’s best to be within five pounds of a weight loss goal before seeking a Juvederm or Voluma treatment. The reason behind this is that when someone is close to their goal weight, a professional such as an aesthetic nurse or plastic surgeon, can glean better insight into a person’s facial structure.

“For me, it’s about a patient investing in something at the right time so they achieve the overall result that they are looking for,” she said. “When you are within five pounds of your goal weight, I think that’s a great time to make an aesthetic care plan.”

24Sep, 2016

Nonsurgical facial contouring choices

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Nonsurgical facial contouring choices
As one reaches their forties and fifties, they may undoubtedly notice their facial contours have altered over time. For example, the fullness in the midportion of their face, particularly in their cheeks, may have lost their youthful volume. As someone looks closely at the lower portion of their face, they may also witness submental fullness, which is more often referred to as a double chin. At different angles, the submental fullness may appear more prominent.

Although these changes don’t occur overnight, many can attest to the fact that it almost appears as if it has. The truth of the matter is that these facial transformations creep up year after year. In addition to maturity, other reasons for these changes may be heredity, weight gain, or weight loss.

Cosmetic injections have made incredible strides in the world of aesthetics. Botox, for example, is one of the leading injections used to diminish lines and wrinkles along the forehead, between the brows, and crow’s feet. While Botox is in the lead, other cosmetic injections have been pioneers in their own aesthetic right. And these injections are top choices for nonsurgical facial contouring.

To address the loss of fullness in the cheek area, a product by the name of Voluma has been considered one which has offered patients with an outstanding outcome. While patient dependent, the effects of Voluma may last up to two years.

During a consultation with a plastic surgeon or their aesthetic nurse specialist, they will determine if a person is a good candidate for Voluma. If it is determined so, photos may be taken prior to the injection so before-and-after pictures will be available.

Prior to the injection, a topical lidocaine cream will be applied to help ensure more comfort for the patient. Methodically, the medical professional will deliver the Voluma slowly. Towards the end of the injection series, a mirror will be on hand so the patient can see the aesthetic transformation. And the results are immediate. There is no downtime with Voluma; however, there may be a bit of bruising which can be easily camouflaged by makeup.

A quickly rising star for addressing submental fullness is another cosmetic injection called Kybella. While the former injection only requires one visit, Kybella is considered more of a treatment plan which may range from two to five series. Kybella’s main ingredient of deoxycholic acid breaks down and destroys fat deposits to help eradicate the appearance of a double chin. Once a person is determined to be a candidate for Kybella, the medical professional will map out the injection area on the underside portion of the chin and numb the region prior to delivering the treatment.

Treatment sessions are generally recommended to be spaced about six weeks apart. Icing is important after treatment to help alleviate any bruising or swelling following the injections.

While these treatments are considered nonsurgical, it’s incredibly important to have them executed by a medical professional who is adept in the facial anatomy.

27Jul, 2016

The Anti-Aging Skin Defense

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The Anti-Aging Skin Defense

For those who want to defy premature skin aging, there is an arsenal of tools which can help make that possible. From those twenty-something years and beyond, there is a youthful pathway for every age group.

Regardless of how ever old one is, there is a tried and true daily routine which consists of sunscreen. Apply a broad spectrum sunscreen of SPF 35 or more every single day and reapply throughout the day if spending time outdoors. Don’t neglect the neck and décolletage area.

And yes, take part in this daily routine even on overcast days.

For those in their late twenties and early thirties, aside from the above solar protection, many are seeking the help of a registered aesthetic nurse who can assist premature skin-aging prevention. While this includes finding the right skin care line, these skilled skin care professionals are also delivering Botox to future areas which could be prone to wrinkles. This type of strategy helps from having these wrinkles develop.

For those in their late thirties to early forties, additional skin changes may occur such as the following:

  • Decrease in elasticity
  • Wrinkles and fine lines
  • Uneven skin tone
  • Age spots
  • Uneven skin texture

While every person is different regarding their skin care type, an aesthetic registered nurse can help remedy these challenges in a variety of ways. As Botox helps smooth out fine lines and wrinkles along the forehead and around the eyes to treat crow’s feet, fillers such as Juvederm can help plump and diminish those marionette lines around the mouth.

When one reaches their mid to late forties and early fifties, they may begin to notice that there is a loss of volume in the cheek area which occurs with the natural aging process. Voluma is an injectable which affords patients with a wonderful option in restoring this volume.

Some nurses will recommend delivering Voluma prior to the Juvederm. The reason behind this is on occasion the Voluma can help remedy or lessen marionette lines by adding more volume and lift to the medial facial region. Again, this is all patient dependent.

While cosmetic injections continue to serve as a great anti-aging defense, there are other treatments that do an extraordinary job such as the following:

  • Dermaplaning as a way to exfoliate and remove vellus facial hair.
  • Chemical peels as a way to diminish fine lines, age spots, and even out skin tone.
  • Micro-Needling as a way to promote collagen and more youthful looking skin.

As one reaches their late forties and early fifties, they may implement the procedures just mentioned as well as a cosmetic injection named Kybella to help submental challenges otherwise known as a “double chin.” Kybella may take two to four sessions to complete, but the treatment destroys fat cells on the underside of the chin.

It’s important to note that while these nonsurgical treatments help a number of individuals, some patients prefer to have plastic surgery procedures such as a neck lift, lower limited facelift, or eyelid surgery for their aesthetic goals.

Despite whatever rejuvenation road one is on, there are a multitude of options to achieve youthful results.

8Jul, 2016

Facial rejuvenation for summer events

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Facial rejuvenation for summer events

Nonsurgical facial rejuvenation treatments provide a boost of youth before special events.

Summer is a popular time of year for hosting special events since the weather is perfect for outdoor venues. Be it a wedding or another type of gathering, many already have their invitations or know they are on the way. Some may wonder what types of nonsurgical facial rejuvenation procedures to consider before their event to provide them with a youthful boost.

And there are some excellent choices on the aesthetic menu.

Non-operative facial rejuvenation treatments can be quite appealing because they are cost effective and there is limited to no downtime. While these treatments are minimally invasive, it’s important to note that they are still considered medical treatments so it’s always recommended to seek these procedures in a medical setting. Many plastic surgery offices have their aesthetic nurses performing these treatments.

Registered nurses who are trained in aesthetics have comprehensive knowledge of the facial anatomy which is vital for optimal outcomes. They are also skilled in an array of areas for nonsurgical facial rejuvenation. It’s important to partner with a medical professional about the treatment(s) one is interested in a few weeks before an event for perfect timing.

Cosmetic Injections

Botox, Voluma, Juvederm, and Kybella have single handedly changed the world of aesthetics. While Botox smooths out fine lines and softens wrinkles, Voluma adds fullness to the cheek area which naturally diminishes with aging. While the effects of Botox last a few months or more, for some patients, Voluma can last up to two years.

For the lower portions of the facial canvas, Juvederm lessens the appearance of marionette lines, also known to many as parenthesis around the mouth. Juvederm can add volume, suppressing these lines for six months to a year.

Kybella addresses submental fullness, destroying fat cells located on the underside of the chin. As long as a patient maintains their weight the visual results are considered permanent.

There is little to no downtime with the above injections.

Chemical Peels 

While cosmetic injections offer excellent results, chemical peels address skin texture. A chemical peel can help with the following skin concerns:

  • Minimize fine lines and wrinkles
  • Lessen the appearance of age spots
  • Even out skin tone
  • Soften skin texture

A series of light chemical peels can provide optimal results.

Dermaplaning

This procedure also enhances the skin and is considered excellent for exfoliating the top layers of dead skin cells and removing vellus hair (peach fuzz). Dermaplaning can be a solo treatment or be done prior to a light chemical peel. If combined, the full treatment takes under an hour. And since there is no downtime, patients can resume their day.

When done in tandem, the chemical peel product will have deeper penetration.

Dermaplaning leaves facial skin baby soft and smooth for excellent makeup application. Dermaplaning has become so popular, patients receive a treatment on a monthly basis.

There are a host of nonsurgical treatments to help prepare individuals for a special occasion. And if there is none on the horizon, invest in oneself for a more youthful and luminous glow.

8Jun, 2016

Kybella® garners attention

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Kybella® garners attention

In the world of aesthetics, science and technology is becoming more refined. When a new non-operative treatment enters the aesthetic market, it takes notice — and Kybella® is an impressive treatment which has come to the forefront.

The manufacturer of Kybella® is Allergan, home to Botox®, Latisse®, Juvederm® and Voluma®.  Since its launch, which was approved this spring by the FDA, many have praised the product for outstanding results.

Registered aesthetic nurse, Elizabeth Reed, who works for San Diego board certified plastic surgeon Dr. Glynn Bolitho is thrilled that their practice is a trained facility which now offers the new Allergan product.

According to Reed, the product is ideal for the right candidate who wants to decrease submental fullness, otherwise known as a double chin, without surgical intervention. Kybella can address this issue with minimal downtime.

“Kybella is an injectable and I consider it as minimally invasive,” said Reed, noting how she has had patients attend special events that very same evening.

While downtime is minimal following an injection series, Reed does recommend some icing afterward.

“Bruising is patient dependent, but typically, I don’t see a lot of that, and a little bit of swelling for a few days is normal,” she said, adding how topical makeup can help camouflage any residual discoloration. “But really, people resume back to their normal day of business.”

When a patient visits Reed, she maps out the underside of the chin, numbs the area with topical lidocaine and gingerly delivers the injections. Reed shared that Kybella destroys the fat cells in this location.

Generally an optimal treatment may consist of two to four visits and is spaced six weeks apart. The decision on the frequency is dependent on the patient’s aesthetic wishes.

“It definitely varies per person,” Reed said.

Follow-up visits will help navigate the next series of injections. And ultimately, the final visit will dictate that the treatment has reached its completion.

As with all non-operative facial rejuvenation treatments, Reed tailors everything to a patient’s needs and wants. It’s her aesthetic philosophy that she abides by each and every day.

Reed added like some other aesthetic journeys, one that undergoes a Kybella treatment should also have some patience. Because the treatment is individually tailored, it may take a couple or more visits.

Oftentimes, Reed is asked about the age range of patients which can benefit most from Kybella. Candidly, she shared that while this is dependent upon the quality of a patient’s skin, the typical age range is thirties to fifties.

The right candidate is one that doesn’t have redundant skin or heavy wrinkles in the area. For those that do, surgery may be a more optimal choice.

Reed is thrilled that Kybella can offer a solution to an area that many women have had challenges with over the years. Sometimes it’s a genetic challenge while other times it may be after one has reached their weight loss goals. For those who reached this weight loss milestone, Reed recommends that their weight remains stable for six months or more before seeking treatment.

“Kybella provides a nonsurgical answer to submental fullness challenges,” Reed said. “Patients can see real and permanent results and that is a wonderful thing.”