Dr. Raggio's BOOM! Columns

Dr. Blake Raggio, Facial Plastic & Reconstructive Surgeon

Cosmetic Surgery Amongst Baby Boomers The Cosmetic Plastic Surgery Trend

Self-improvement takes it shape in many forms, whether it be dieting, exercising, meditating, reading, or picking up a new hobby. With that said, there is one self-improvement element that has become more mainstream over the last two decades—Cosmetic Plastic Surgery Procedures.

Whether it be due to a culture where appearance seemingly drives societal norms (e.g., Hollywood), or where “selfies” and virtual meetings (e.g., Zoom) have become more commonplace, one thing is for sure, that is Cosmetic Procedures have become increasingly popular over the last several years, especially for baby boomers.

According to The Aesthetic Society’s National Databank of Statistics, nearly 1.5 million cosmetic surgical procedures were performed in the year of 2019, marking a 6.2% increase as compared to 2015. Similarly, there has been a 13.3% rise in non-surgical cosmetic procedures since 2015, with nearly 3.1 million procedures having been performed in 2019.

Botox, Dysport, Xeomin, Jeuveau) and a wide variety of fillers from reputable companies such as Allergan (Juvederm), Galderma (Restylane, Scuptra), and Merz (Belotero, Radiesse), to name a few.

Why are Cosmetic Procedures so popular amongst older adults?

Cosmetic Surgery has become a widely accepted practice for older adults, including men and women alike, and there are many reasons for this increasing popularity over the last several years.

For one, the social stigma that used to surround the field of aesthetic plastic surgery is nearly gone. This is especially true as more and more people, including older adults, are focusing on their

What about the Baby Boomers?

Older adults (ages 51 and up) represent a large portion of patients undergoing cosmetic procedures, constituting 39% of the aesthetic surgical patient population. In fact, nearly 571,000 cosmetic surgical procedures were performed in this older population, with some of the most popular procedures being Facelift, Eyelid Surgery, and Liposuction, amongst others.

Regarding non-surgical therapy, older adults underwent nearly 1.5 million procedures in 2019, representing roughly 47% of the non-surgical aesthetic patient population. Among these nonsurgical interventions, some of the most common procedures performed included injectables such as botulinum toxin (e.g., The River Region’s 50+ Lifestage Magazine

outward appearance as it relates to their health and self-improvement.

Perhaps the Baby Boomers’ understand what scientists have known for years, in that attractive people tend to be more successful in life.

For instance, data suggests more attractive people tend to be more successful in the workplace. With that said, Baby Boomers often engage in cosmetic procedures to remain competitive in the workplace where younger colleagues tend to dominate.

For other older adults, an improved appearance may restore their confidence and help improve their love-lives.

Another reason for Baby Boomers’ increased participation in Cosmetic Procedures includes the widespread use of social media (e.g., Facebook, Instagram), which has opened the door for easier sharing about one’s Aesthetic Plastic Surgery “experience.”

This added familiarity and comfortability with cosmetic procedures promotes an increased participation by the older adult population.

Whatever the reason, the Baby Boomers represent a large portion of patients who continue to experience all the wonderful benefits associated with undergoing cosmetic procedures to improve or maintain one’s appearance.

What if I am interested in a cosmetic procedure?

Whether you are considering a facelift to look your best for your daughter’s upcoming wedding, or whether you are interested in receiving filler under your eyes to look less tired, you should consult with a physician who has specialty training in the area you are looking to improve. Furthermore, ensure your doctor is well versed in both surgical and non-surgical rejuvenation procedures, so that you are guaranteed a comprehensive evaluation.

Lastly, choose a surgeon whom you trust. There is nothing more important than the relationship you have with your physician. Until Next Time,

Dr. Blake Raggio Facial Plastic & Reconstructive Surgeon Jackson Hospital and Clinics 334-270-2003 RiverRegionFacialPlastics.com drblakeraggio@gmail.com R ive r Re gio n Bo o m . co m

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Dr. Blake Raggio, Facial Plastic & Reconstructive Surgeon

The Anatomy of Facial Aging What’s Happening to My Face?

In November’s article, Cosmetic Surgery Amongst Baby Boomers, we discussed why more and more Baby Boomers are undergoing cosmetic procedures to reverse the signs of aging. This month, I would like to discuss the “Anatomy of Facial Aging” to better elucidate the causes of those bothersome changes we may experience as we get older.

The Certainties of Aging The aging process involves the complex interplay of several key elements including diet, exercise, sleep, genetics, environmental factors (sun exposure, wind damage), and tobacco use, to name a few. Despite our best attempts to alter these variables, the certainty remains— aging will inevitably occur. When it comes to facial aging, there exists several predictable transformations to the tissues of the face, which include the skin, muscle, fat, bone, and retaining ligaments.

Skin Aging skin loses key structural components which contribute to its strength (collagen), elasticity (elastin), and hydration (hyaluronic acid). Aged skin thus becomes dryer, thinner, less elastic, less voluminous, and more likely to wrinkle or sag, such as occurs with excess skin of the upper eyelids or the neck.

Muscle The muscles around the face and eyes may become more hyperactive and contribute to excess wrinkles or puffiness.

Alternatively, the muscles of the face may weaken and atrophy which contributes to a deflated look and decreases support for the rest of the facial soft tissues.

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Retaining Ligaments Facial ligaments provide structural support for the superficial soft tissues of the face. These ligaments, which originate from the bone and attach to the skin and overlying fat pads, weaken over time, and thus contribute (with the help of gravity) to the sagging skin and fat we see with aging.

Fat The most recent and relevant research regarding the anatomy of facial aging pertains to the understanding of the facial fat pads. In short, the facial fat pads are partitioned into separate compartments and exists in two distinct layers (superficial and deep), both of which contribute to the overall balance of the face. In short, some areas lose fat, such as the cheeks and the temples, which creates a hollowed and deflated look. On the other hand, some areas gain fat, such as around the mouth and the jaw, which contribute to the so-called “nasolabial folds” and “jowls”.

Lastly, some fat pads become more visible as they protrude from their intended position due to adjacent structural defects, such as occurs with herniated orbital fat creating lower eyelid bags.

Overall, this errant redistribution of the facial fat pads leads to the creation or worsening of folds, shadows, and other contour irregularities which embody the telltale signs of aging.

Bone We experience significant loss of facial bone with aging. Without the structural support of the bone, the overlying soft

tissues (skin, muscle, fat) also display noticeable changes such as hollowing of the eyes, temporal wasting, cheek deflation, and poor jawline definition.

As one can see, the progressive loss of fat and bone represents a key contributor to the facial aging process.

Therefore, I often recommend revolumizing the face with either dermal fillers or facial fat grafting to anybody contemplating a facelift or other facial rejuvenation procedure. I can’t say it enough, but volume replacement is key!

What can I do to combat the facial aging process?

First, relax. Aging is normal and beautiful, so embrace it for all that it means to you. Second, one must recognize that the changes in balance, proportion, and symmetry associated with the aging face are unique to each patient, and thus a customized treatment plan remains paramount to achieve optimal results.

Next, you should consult with a physician who has specialty training in the area you are looking to improve, who may recommend treatments ranging from non-invasive modalities (e.g., botulinum toxin, fillers, lasers, chemical peels) to more advanced surgical options (e.g., facelift, brow lift, fat grafting, eyelid surgery, lip lift, rhinoplasty). Lastly, choose a surgeon whom you trust. There is nothing more important than the relationship you have with your doctor.

Dr. Blake Raggio Facial Plastic & Reconstructive Surgeon Jackson Hospital and Clinics 334-270-2003 RiverRegionFacialPlastics.com drblakeraggio@gmail.com

The River Region’s 50+ Lifestage Magazine

Dr. Blake Raggio, Facial Plastic & Reconstructive Surgeon

Hair Restoration: What are My Options?

In December’s article, “The Anatomy of Facial Aging,” we discussed the ins and outs of the facial aging process.

This month, I would like to discuss the nuances of Hair Loss and the available treatment options.

Hair Loss Affects Men & Women Let’s face it, hair loss represents a distressing issue that plenty of us are going to experience at some point in our lives. In fact, hair loss affects a large portion of the population, including up to 85% of males and 40% of females, and its incidence increases with age for both sexes. Hair loss can have a devastating effect on your selfconfidence, and it can make you look older than your stated age and leave you looking less youthful.

What Causes Hair Loss?

Though many causes of hair loss exist, by far the most common etiology is androgenic alopecia (AGA), a hormonesensitive pattern of hair loss that affects both men and women. Typical hair loss patterns exist with AGA and include a receding temple hair line (male-pattern hair loss) or a diffusely thin head of hair especially evident at the part (femalepattern hair loss). Another telltale sign of AGA includes the thinning of the hair caliber and lightening of the hair color.

The good news for patients who suffer from AGA is that they represent ideal candidates for hair restoration.

For those patients who may not be sure whether they have AGA, it remains important to rule out other less common etiologies of hair loss including inflammatory or traumatic origins, as

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these conditions may not respond well to current hair restoration modalities.

Signs and symptoms associated with inflammatory or traumatic hair loss would include the following: an unusual hair loss pattern, many broken hairs, excessive shedding, scalp inflammation, unexplained scarring, and scalp pain, burning or itching.

Are There Non-Surgical Treatments for Hair Loss?

Non-surgical modalities exist which may halt the progression of hair loss and even help grow new hairs. These range from over-the-counter products (shampoos and vitamins) to prescription medications (Rogaine and Propecia) to scalp injections using autogenous blood products. Though many options exist, the treatment with the largest body of evidence supporting its use remains Platelet-rich Plasma (PRP). PRP is extracted from the patient’s own blood and processed in a way that collects the growth factors within the blood. PRP scalp injections have been proven to a) decrease hair shedding, b) thicken current hairs, c) and regenerate new hair; and thus, remains the “gold-standard” in non-surgical hair restoration.

What About Hair Transplants?

The stigma previously associated with hair transplants is over. So long are the days of unsightly and unnatural results from outdated techniques such as “hair plugs” and “scalp rotational flaps,” to name a few. Recent advancements in

surgical hair restoration, however, have made hair transplantation an increasingly effective, safe, and reliable way for patients distressed by hair loss to regain a more youthful and natural appearance of their hair.

In short, hair transplantation is a minimally invasive procedure where healthy donor hairs, taken from the back of your scalp, are implanted into thinning or balding areas. The newly transplanted hair follicles then grow to restore thickness and volume to otherwise depleted parts of your scalp.

What Hair Restoration Plan Is Best for Me? First, one must recognize that although certain hair loss patterns exist, hair loss remains unique to each patient. That said, a customized treatment plan, often using a combination approach, remains paramount to achieve optimal results. Next, you should consult with a physician who has specialty training in the various hair restoration techniques mentioned above, as your provider may recommend treatments ranging from non-invasive modalities (e.g., shampoos, supplements, prescription medicines) to procedural interventions (e.g., PRP injections, Hair Transplant).

Lastly, choose a surgeon whom you trust. There is nothing more important than the relationship you have with your doctor.

Until next time.

Dr. Blake Raggio Facial Plastic & Reconstructive Surgeon Jackson Hospital and Clinics 334-270-2003 RiverRegionFacialPlastics.com drblakeraggio@gmail.com

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Dr. Blake Raggio, Facial Plastic & Reconstructive Surgeon

Botox for the Boomer: What You Need to Know In January’s article we discussed the ins and outs of hair loss and the available methods of hair restoration, ranging from in-office stem cell treatments (PRP) to hair transplant surgery. This month, I would like to shift gears and discuss the nuances of perhaps the most popular anti-aging procedure today, botulinum toxin, or more commonly referred to as “botox.”

What exactly is botulinum toxin?

Botulinum toxin, commonly referred to as “botox” or “toxin” for short, represents a powerful neuromodulator derived from a toxin purified from a bacterium, Clostridium botulinum. To add to the confusion, there exists several tradenames of botulinum toxin, four of which are currently available in the United States and FDA-approved for cosmetic use. They include, Allergan’s Botox Cosmetic, Galderma’s Dysport, Merz’s Xeomin, and Evolus’ Jeuveau. For the remainder of the article, we will use the term toxin or neuromodulators to refer to any of the above botulinum toxin preparations.

How does toxin work?

As mentioned above, toxin is a neuromodulator that works by blocking the nerve signals needed for muscles to contract. When injected using precise amounts into targeted muscles of the face, toxin can be safely used to soften wrinkles by relaxing the muscles whose repetitive movement is associated with deep lines or wrinkles (e.g., smiling, frowning, surprised, grimace).

What areas of the face can be treated with toxin?

Botulinum toxin can be used to soften lines and wrinkles on several different areas of the face, including the more commonly addressed forehead, eye area (crow’s feet), and “bunny lines” on the

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nose. A more experienced injector may also discuss the roles of toxin to soften chin dimpling, treat a “gummy smile,” turn up the corners of the mouth, increase lip “pout,” improve the contour of the neck (Nefertiti lift), soften neck-banding (playstma injections), slim the jawline (masseter injections), rotate the tip of the nose, or improve the overall appearance and texture of the skin by injecting hyper-dilute concentrations of toxin (meso-botox). NOTE: some of these treatments may be considered off-label, so please consult with a credentialed and reputable physician when creating a treatment plan.

What does a toxin treatment feel like?

For most people, toxin injections are a very quick in-office procedure with minimal discomfort (often described as a “pinch”). Even better, there is virtually no downtime associated with toxin injections. In fact, many patients come for their treatment during their lunchbreaks and can return to work immediately after their appointment. Also, try to find an injector who offers other ancillary measures to maximize your comfort, which may include vibration devices, ice, or topical anesthesia.

How soon will I see results, and how long does it last?

Generally, it takes 3-7 days to see the full effects of toxin. The results typically last between 3-5 months, depending on a variety of factors including injection technique, dosing concentration, age, metabolism, and physical activity level.

Repeated “maintenance” injections every 3-4 months help patients maintain their results for a longer period, sometimes

requiring less amount of product during subsequent visits as the muscles progressively weaken or atrophy.

Is toxin safe? What are the side effects?

The four FDA-approved botulinum toxin preparations for cosmetic use have an extremely high safety profile with minimal and temporary side effects including bruising, swelling, redness, or tenderness to the injection site. You should know, however, that some contraindications exist, including if you have certain neurological diseases or are taking particular antibiotics. It is also recommended to avoid treatment within 2 weeks of being sick, having dental work, or receiving a vaccine. Overall, neuromodulators such as Botox, Dysport, and Xeomin represent a safe and powerful tool to prevent and treat the signs of aging.

When should I start getting toxin?

What do I need to do?

While some may worry they are “too young” or “too old” to receive toxin, there is no right or wrong age to begin treatments. The first step involves finding a reputable, credentialed, and experienced injector with intimate knowledge of facial anatomy who can offer you a customized treatment plan based on your aesthetic goals. As always, choose a surgeon whom you trust.

There is nothing more important than the relationship you have with your doctor.

Until next time.

Dr. Blake Raggio Facial Plastic & Reconstructive Surgeon Jackson Hospital and Clinics 334-270-2003 RiverRegionFacialPlastics.com drblakeraggio@gmail.com

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Dr. Blake Raggio, Facial Plastic & Reconstructive Surgeon

Facial Filler FAQ’s In February’s article we discussed the nuances of botulinum toxin and its powerful role in facial rejuvenation. This month we will discuss a similarly popular anti-aging procedure, dermal fillers. By the end of this article, I hope you will appreciate why the instant results, quick treatment time, and minimal downtime make fillers so appealing.

What exactly is Facial Filler?

Facial filler, herein referred to as “fillers,” includes a variety of FDA-approved products that can be used to restore a more youthful look to the face. Whilst a multitude of filler options exist, they can most easily be categorized by the substance they are made from, and include the following: Hyaluronic Acid, Calcium Hydroxylapatite, Poly-L-lactic Acid, Polymethylmethacrylate, and fat injections. Nowadays, several reliable filler options exist for the consumer to choose from and include Juvederm, Restylane, Belotero, Radiesse, RHA, Versa, and Sculptra.

How does Filler work?

In short, fillers do just as their name implies—they fill in hollows and depressions associated with age-related volume loss. Fillers also vary in their ability to absorb water, stimulate collagen, and “lift” surrounding tissues, all of which make them more suitable for different areas of the face.

What areas of the face can be treated with Filler?

Fillers can be used to soften folds, hollows, and wrinkles on the face, including these age-related problem areas: depressed forehead, hollowed temples, sunken eyes, deflated midface/cheeks, lines around the nose and mouth, decreased lip plump or pout, recessed chin, poorly defined jawline, jowls, and prominent neck creases.

A more experienced injector may even utilize filler for reshaping the nose, coined “liquid rhinoplasty.” NOTE: Some of these treatments may be considered “off-label,” so please consult with a credentialed

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physician well-versed in facial anatomy and the various filler options available.

What happens during a Filler treatment?

For most people, filler injections are a quick in-office procedure (30 minutes) associated with minimal discomfort. In short, the area is cleansed, marked, and the filler of choice is precisely placed into the target area using a very fine needle or blunttipped cannula. For those concerned about discomfort, you may be relieved to hear that most filler preparations come pre-mixed with lidocaine. It may also help to find an injector who offers ancillary measures to maximize your comfort, which include vibration devices, ice, or topical and/or regional anesthesia.

How soon will I see results, and how long does it last?

The beautiful thing about filler is that results are often immediate! Final results, however, typically take several days to “settle” but can vary depending on the product used, amount injected, and any associated swelling. Results may last anywhere from 6 months to 2 years, but ultimately depend on a variety of factors including the product, the area injected, and the patient.

Repeated “maintenance” injections every 12-18 months will help patients sustain their results for a longer period, sometimes requiring less amount of product during subsequent visits.

Is Filler safe?

Fillers for cosmetic use have an extremely high safety profile with minimal and temporary side effects including bruising, swelling, redness, or tenderness to the injection site. You may be prescribed a medicine, such as a steroid or an

antihistamine, to lessen the chance of such reactions. Rare but serious adverse events have been reported and may include skin necrosis, stroke, and blindness. It is also recommended to avoid treatment within 2 weeks of being sick, having dental work, or receiving a vaccine. Nevertheless, injectable fillers represent a safe and powerful tool for facial rejuvenation when in the hands of an experienced injector.

What is the cost of Filler?

Depending on the type and amount of product used, a 1 mL vial of filler (1/5 teaspoon) may cost anywhere between $400-900, usually enough for 1 treatment area (e.g., lips, chin, cheeks, tear troughs).

You must remember, however, that you are paying for more than just the product, but rather the skill and expertise of the injector as well. Of note, more experienced injectors often require less product to obtain the desired result. In the end, a lower cost does not always equate to a better deal (or result!).

When should I start getting Filler?

There is no right or wrong age to begin filler treatments, though some folks may be better candidates than others.

The first step involves finding a reputable and experienced injector with intimate knowledge of facial anatomy who can offer you a customized treatment plan (surgical and non-surgical) based on your aesthetic goals. As always, choose a surgeon whom you trust. There is nothing more important than the relationship you have with your doctor.

Until Next Time, Dr. Blake Raggio Facial Plastic & Reconstructive Surgeon Jackson Hospital and Clinics 334-270-2003 RiverRegionFacialPlastics.com drblakeraggio@gmail.com

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Dr. Blake Raggio, Facial Plastic & Reconstructive Surgeon

PRF: The New “Gold-Standard” for Hair Restoration You may recall from my January BOOM! article— Hair Restoration: What are my Options? —that we discussed the wonderful benefits of Platelet-rich plasma (PRP) for restoring a more youthful look to the hair. This month, I’d like to revisit the topic of non-surgical hair restoration and introduce you to Platelet-rich Fibrin (PRF), the second generation of PRP which many consider the new “gold-standard” for nonsurgical hair restoration.

How are PRP and PRF Similar?

Both PRP and PRF rely on a blood draw and subsequent centrifugation (spinning) to separate the stem cells and other growth factors from the rest of the blood components. The portion of the blood containing the stem cells and growth factors, or plasma, is collected and injected into areas of thinning hair to decrease hair loss, enhance the consistency of current hair, and promote new hair growth for both Men and Women suffering from thinning hair or hair loss.

What makes PRF Better than PRP? Although there are basic similarities between PRP and PRF, several important differences exist that make PRF the preferred option for non-surgical hair restoration: 1) PRF requires less amount of blood to be drawn.

2) PRF does not require the addition of anticoagulants to "activate" the platelets, whereas PRP does.

3) PRF harvesting utilizes a less traumatic centrifuge protocol compared to PRP, thus producing a higher concentration of platelets, white blood cells, and growth factors that result in more effective hair restoration.

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Who is an Ideal Candidate for PRF? First, it is worth noting that hair loss affects up to 85% of males and 40% of females and incidence increases with age for both sexes. That said, PRF is a great option for both Men and Women looking to counteract the early stages of hair loss. PRF may also benefit those suffering from traction alopecia (thinning secondary to extreme pulling on the hair) and serves as a great alternative for people who are reluctant to regularly take hair restorative medications (e.g., Rogaine, Propecia).

What can I Expect on the Day of my Procedure?

First, a small amount of blood is drawn. The blood is then "spun down" using a custom centrifuge with a specific PRF protocol. The scalp is cleansed and marked for areas to be treated. The PRF is then injected in the areas of thinning hair, typically targeting the hairline, temporal recesses, and/ or crown of the head using very small needles (similar size to Botox needles).

The discomfort is minimal, often described as “ant-bites” or “pinpricks.”

The total procedure time—blood draw, centrifuge, and injection, takes no more than 15-20 minutes and is conveniently done in the office setting.

Is there any Downtime after a PRF Injection?

No. Your only precautions are to keep the scalp clean for the next several hours.

You may experience some slight pinkness or tenderness near the injected area, but this is often temporary and resolves within minutes to hours after the procedure. Some patients take Tylenol if they experience a slight headache, though this often unnecessary. You may return to work immediately and may resume your normal showering or bathing routines immediately as well.

For added safety, it is recommended you refrain from blow drying, coloring, or curling your hair for 3 days after the procedure.

When can I Expect Hair Growth?

You should note a marked decrease in hair thinning and shedding after 3-4 months, but it will take up to 9-12 months to see new hair growth. For optimal hair restoration results, it is recommended to undergo 4 injections separated over 4 months, with "maintenance" injections scheduled every 6-12 months thereafter to maintain results.

How can I Learn More?

If you are interested in learning more about PRF and hair restoration, I suggest consulting with a physician experienced in both surgical and non-surgical hair restoration methods so that you receive a thorough and non-biased evaluation.

As always, choose a surgeon whom you trust. There is nothing more important than the relationship you have with your doctor.

Until Next Time.

Dr. Blake Raggio Facial Plastic & Reconstructive Surgeon Alabama Plastic and Reconstructive Surgery 334-270-2003 Dr.Raggio@ALplasticsurgery.com www.ALplasticsurgery.com The River Region’s 50+ Lifestage Magazine

Dr. Blake Raggio, Facial Plastic & Reconstructive Surgeon

Beauty and the Brows

You may recall from some of my earlier articles, Cosmetic Surgery Amongst Baby Boomers and Anatomy of Facial Aging, where I discussed not only the increasing prevalence of facial cosmetic procedures amongst the aging population, but also the reasoning behind what happens to the face as one gets older. Over the next few months, I’ll be focusing my discussions on certain key areas of the face that can be improved with both surgical and non-surgical options. This month I’d like to discuss the topic of eyebrow rejuvenation by answering some frequently asked questions regarding how to best treat this often-overlooked area of the upper face.

Remind me again, what happens to the brows as we age?

In short, the brows should rest just at or above the bony orbital rim, or what some may call the forehead bone. With age, the brows descend or become ptotic (droopy) due to a combination of factors, namely the weakening of various retaining ligaments of the skin and surrounding structures. This loss of structural support, in association with the downward pull of gravity, are responsible for the sad, tired, or angry look often associated with a descended brow. Furthermore, a droopy brow has more than just cosmetic consequences, as it can exacerbate an already heavy upper eyelid and contribute significantly to both cosmetic and functional changes associated with the upper eyelids.

I am interested in treatment – What are my options?

In the most basic sense, two categories of treatment exist: surgical and nonThe River Region’s 50+ Lifestage Magazine

surgical. In the surgical realm, the procedure is called a brow lift (i.e., forehead lift), which can be accomplished via a variety of surgical techniques ranging from minimally invasive approaches (via endoscopes) to more traditional open techniques. Regarding non-surgical options, a modest lift of the brow can be performed using botulinum toxin (Botox, Xeomin, Dysport) and/or dermal fillers (Juvederm, Restylane, RHA) to help relax muscles pulling down the brow and to provide underlying support, respectively. Recently, there has been a resurgence of thread lifts (i.e., suture lifts) using a variety of absorbable materials to help suspend a droopy brow, though their efficacy and durability remain controversial. Lastly, there exist several energy-based devices (e.g., Ultrasound, Radiofrequency) that tout minor elevation to the brows though evidence to support their claims is weak at best. Overall, more subtle improvements can be achieved with Botox and fillers, whereas more dramatic changes will require a surgical procedure.

At what age is a brow lift usually required?

There is really no age requirement for a brow lift. For instance, some patients in their early 30’s who suffer from a congenitally low-set brow may benefit from a modest lift using non-surgical techniques (Botox, Fillers); On the other hand, patients who acquire a droopy brow secondary to age—typically

noticeable in their 40’s and 50’s—often benefit from a surgical browlift usually performed via a minimally invasive approach or open techniques, depending on the severity of the brow droop.

Is a brow lift covered by insurance?

A non-surgical brow lift is not covered by insurance. However, if you are interested in a surgical brow lift, you might be surprised to hear that your insurance may cover the procedure, but only if the brow descent is caused by a facial paralysis and/or contributing to a problem with your vision. This visual deficit can be easily confirmed via a quick visual field test done by your local ophthalmologist (eye doctor).

How can I learn more about a brow lift?

If you are interested in learning more about brow rejuvenation to correct a tired, sad, or angry appearance to the upper face, I suggest consulting with a physician experienced in both surgical and nonsurgical brow lift techniques so that you receive a thorough and non-biased evaluation.

As always, choose a surgeon whom you trust. There is nothing more important than the relationship you have with your doctor.

Until Next Time.

Dr. Blake Raggio Facial Plastic & Reconstructive Surgeon Alabama Plastic and Reconstructive Surgery 334-270-2003 Dr.Raggio@ALplasticsurgery.com www.ALplasticsurgery.com R ive r Re gio n Bo o m . co m

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Dr. Blake Raggio, Facial Plastic & Reconstructive Surgeon

Is Beauty Only Skin-Deep?

Yes, with Dermal MicroInfusion.

There may be some truth to the ageold adage, “Beauty is only skin-deep,” that is at least when it comes to Dermal MicroInfusion (DMI), a revolutionary new procedure that restores aged, damaged skin. Imagine if you could combine the rejuvenating benefits of traditional microneedling with infusions of reparative growth factors, antioxidants/vitamins, hydrating dermal fillers, and Botox® with none of the downtime associated with traditional microneedling and still achieve similar or superior results?

Interested now? Continue reading to learn more about DMI and how it can help you obtain a more youthful, glowing appearance to your skin.

First remind me, what happens to skin as we age?

Aging skin loses key structural components which contribute to its strength (collagen), elasticity (elastin), and hydration (hyaluronic acid). Aged skin thus becomes dryer, thinner, less elastic, less voluminous, and more likely to wrinkle or sag, such as occurs with excess skin of the upper eyelids or the neck.

So, how does DMI help treat damaged skin?

First, DMI borrows the science behind microneedling by using a device with several tiny needles (thin as hair) to create a series of controlled injuries to the skin which stimulates the natural production of collagen and elastin. Unlike traditional microneedling, however, DMI utilizes hollow-bored needles to deliver specific infusions into the dermis to restore your skin to a smoother, more vibrant complexion.

What are the different serums or infusions used in DMI?

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To reiterate, the uniqueness of DMI relies on its hollow-bore needles used to deliver a variety of substances to the deeper layers of the skin. Available treatments used to restore a glowing, fresh complexion to the skin include the following: • Hyaluronic Acid (HA): available as either a serum or a dermal filler (e.g., Juvederm, Belotero), HA’s moisturizing properties work to create a subtle increase in volume and improve skin hydration, overall decreasing the appearance of fine lines.

• Neuromodulators (Botox® or Xeomin®): used to target acne and improve the overall appearance of the skin by targeting fines lines and wrinkles, enlarged pores, and oily skin.

• Growth Factors: available as either a serum or self-donated Platelet-rich Fibrin, growth factors rejuvenate the skin by assisting with dermal repair.

• Vitamin C and E: powerful antioxidants that protect from damaging oxidative stressors like the sun.

How many treatments do I need?

How much does DMI cost?

Depending on which “cocktail” of skinboosting ingredients you choose, prices vary from $275 to $975 per session.

Although you will see immediate improvement after 1 session, I recommend you complete a series of 4 sessions spaced every 6-8 weeks apart to allow adequate time for “skin turnover” and to achieve optimal results.

What is the downtime and postprocedural care for MicroInfusion?

There exists virtually no downtime

from a DMI treatment, with most patients experiencing slight redness to the treated areas for only a few hours after the treatment. Aside from that, I instruct patients not to wash their face for 4 hours after treatment, nor should they wear makeup for 24 hours as to prevent infection. Also, avoiding retinol, Vit C/E, or other astringents for 48 hrs is recommended to decrease risk of skin irritation. NOTE: both traditional microneedling and DMI treatments carry similar risks, namely pain, bleeding, infection, scarring, motor/ sensory nerve deficits, allergic reaction, cosmetic deformity, and need for repeat treatments. Most of these “risks” are mild and self-limited.

How can I learn more about a Dermal MicroInfusion?

If you are interested in learning more about Dermal MicroInfusion or other skin rejuvenating procedures, I suggest consulting with a physician experienced in both surgical and non-surgical skin-reparative techniques so that you receive a thorough and nonbiased evaluation.

As always, choose a surgeon whom you trust. There is nothing more important than the relationship you have with your doctor.

Until Next Time.

Dr. Blake Raggio Facial Plastic & Reconstructive Surgeon Alabama Plastic and Reconstructive Surgery 334-270-2003 Dr.Raggio@ALplasticsurgery.com www.ALplasticsurgery.com

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