The Role of Beauty in Our Day to Day

As we enter 2014 it is my pleasure to wish all my patients a Happy New Year and best wishes for a peaceful and prosperous 2014.

Each New Year brings the possibility of life changes large and small – some we can control and some we cannot. I have always viewed my role as a physician-surgeon as that of helping my patients achieve their best aesthetic and functional outcomes. Most times this results in a small life change; sometimes the change is profound.

In the past I have discussed the “Neuroscience of Beauty” – the primal reason why we want to be attractive. In the Globe and Mail Saturday January 11, 2014, Leah Eichler, in her excellent column Women at Work, gives a more objective assessment of the “Beauty Premium” both in the workplace and life in general. In a nutshell, society rightly or wrongly places a premium on and rewards beauty. To quote Ms. Eichler “beauty pays off” and a “beauty premium” exists in the workplace. Ms. Eichler emphasizes that the total package – hairstyling, fashion sense and intellectual value- is of paramount importance to achieve success in life and the workplace. However, enhancing your basic attractiveness with cosmetic dentistry, a new hairstyle or tweaking those wrinkles and frown lines with Botox, Juvederm or perhaps a forehead lift may also be beneficial. The good news is that while it may be difficult to get a job promotion, it’s relatively easy to erase forehead wrinkles with Botox or plump up those thin lips with Volbella.

On that note, I am pleased to be attending “Rejuvenation of the Aging Face” a four day, world class Masters of Facial Rejuvenation program in San Diego. This annual event sponsored by the American Academy of Facial Plastic and Reconstructive Surgery will highlight new advances in the surgical and non-surgical treatment of facial cosmetic concerns. As always I am sure I will benefit from the expertise of the wide range of international speakers present.

Be sure to stay warm and safe – remember spring is only two months away.

Dr. Keohane

Natural Fuller Lips

I trust you have had a great, sun and fun-filled spring and summer. Fall is definitely upon us – funny how that happens every year.

I was able to attend a couple of great conferences this year on rhinoplasty and facial cosmetic surgery in Chicago and Banff.  I also presented a paper on “Complex Reconstruction Rhinoplasties Utilizing Ear Cartilage and PDS Sheeting,” an exciting breakthrough in revision rhinoplasties. To date, I believe I have one of the largest series of this type of surgeries in Canada and perhaps North America.

I also attended my thirtieth medical school reunion.  That officially makes me either an old or experienced physician – you can decide which. It was wonderful to see my classmates and realize how lucky we have been, in both life and career pathways. Enough about the “old stuff," here is something new.

Allergan has released a new dermal filler called, Volbella – a cousin to Juvederm Ultra Plus and Voluma. It is specifically indicated for lip augmentation and will help to diminish vertical lip lines (often called “smoker lines”) and naturally accentuate the vermillion border and Cupid ’s bow. If you have always wanted to have you lips enhanced with filler, but were afraid of over-filled, artificial appearing lips, then this could be the product for you to try. It is an exceptional product that is easy to use with long lasting results. Initial patient feedback has been very positive and it will probably become the product of choice for lip augmentation.

Every year as we move towards the holiday season, Botox and Juvederm appointments become oversubscribed. We never want to turn anyone away and do our best to accommodate everyone’s schedules. If you are planning a “touch up” with Botox, Juvederm, or both, the earlier you book your appointment, the more likely we are able to facilitate your appointment request.

The same thought process applies to surgical procedures – each year we add additional surgical days in our Non Hospital Surgical Facility suite to accommodate the seasonal rushes. However, the more lead time we get the better.

Have a great fall and Halloweeen. Remember that winter is just around the corner.

Dr. Keohane

A Touch of Hollywood

As I watched the Academy Awards last week, I noticed that there is certainly no shortage of beautiful men and women in Hollywood. The truly distinguished, however, are the actors and actresses who have managed to maintain successful careers, and a refined appearance and persona over several decades.

These are not the stars that we see in the tabloid magazines. These are the beautiful, iconic faces that typically grace the covers of Vanity Fair, GQ, or Vogue. These are the type of good looks that we try to emulate with cosmetic surgery, fillers or Botox. While we can’t make our patients look like celebrities, we can accentuate positive features such as cheek bones, lips, eyelids, and noses with nonsurgical and surgical interventions. Small amounts of Botox and Juvederm in the right places frequently result in a recognizable improvement in overall aesthetics.

Dr. Theda C. Kontis, M.D. from John Hopkins Medical Institute recently published an excellent scholarly review of injectable facial fillers. In the February 2013 issue of JAMA Facial Plastic Surgery, Dr. Kontis reviews the history and safety record of Hyaluronic acid, the main component of Juvederm, which has now been used for over seven years. Safety data has been recorded from over 400,000 patients with an adverse reaction rate of 0.06%. Most commonly used medications have an adverse reaction rate between 2-10%. In 2011, 1.2 million patients were injected with Hyaluronic acid in the United States. Based on those numbers, we can extrapolate that approximately 100,000 patients received Hyaluronic acid injections in Canada. This confirms what I tell my patients: Hyaluronic acid fillers such as Juvederm are very safe and effective. The best news in all of this is that you do not need to reside in Beverly Hills or make twenty million dollars a movie to enhance your true beauty.

Have a great March. Spring is just around the corner.

Dr. Keohane

Dermal Fillers — Where Bioscience Meets Biochemistry

As a surgeon, my number one goal for my patients is that any procedure I do will be safe, predictable, and based in science and physiology. Many things in life are predictable – sunrise – sunset – freezing weather in Edmonton in January. Unfortunately, many treatments in the field of cosmetic medicine and surgery are not. Fads come and go, sometimes with dire results for the patient. However, if we stick with well-researched and developed products and strategies, and use them in a thoughtful, conservative fashion, we should achieve aesthetically pleasing, long lasting results.

Juvederm Voluma is an example of bioscience meeting biochemistry. Juvederm Voluma is a highly concentrated crossed-linked hyaluronic acid, perfectly suited for volume replacement in deep cheek and nasolabial folds. Its effects are immediate and long lasting – up to a year- and if used properly, very safe. Juvederm has an excellent safety record. FDA approved in 2006, it has been used in thousands of patients, with no significant toxicity. However, if injected too superficially or on areas of very thin skin, i.e. “tear trough” below the eye, it may result in a visible bluish-grey discoloration due to the “Tyndall effect” - the scattering of light through the Juvederm. The lower eyelid is anatomically complex. Very thin skin fuses with a dynamic and well-vascularised muscle. Thus, injecting in this area can be extremely problematic. I am usually reluctant to inject this area and in the rare instance I do, I inject very conservatively – small amounts, slowly. Because of its cross linking, Juvederm Voluma is not suitable for this anatomic area. Lips are another area that can be augmented with Juvederm; however, we need to again be conservative and use the correct product and amount. I have found Juvederm Ultra plus XC to be excellent filler for the lips.

As many women age, the muscle of the lip – the obicularis oris- undergoes atrophy. This leads to a thinning or reduction of vertical height of the lip and a loss of lip definition with an increase in vertical wrinkles or fissures. Proper use of fillers in this area will correct this problem. Usually 0.4cc into the red lip – white lip junction with attention to creating a well-defined “cupids bow” for the upper lip with 0.2 – 0.4 cc’s for the lower lip will create a well-defined lip without the over-filled, pouty appearance many women fear.

In summary, if we choose the right therapeutic solution for the defined cosmetic problem, a solution that is well researched, tested and safe – and use it appropriately, the end result should be an aesthetically pleasing, natural cosmetic appearance.

Spring will be here shortly; stay warm!

Dr. Keohane