Words of the True Expressions PowerPoint Show

Facial Surgery & Cosmetic Centre of Ottawa, Inc.
Ottawa, Canada

We have changed
Giving true expression to the way we feel inside

• Our skin is the palette – we all want a smooth, glowing foundation.
• Our life paints the picture – it reflects natural cycles and changes.
• Some of those experiences seem etched too deeply - are you looking in the mirror and not seeing who you truly are inside?

Smooth, glowing skin helps you to look and feel good, whatever your age. Your skin has a natural cycle and changes at every phase of your life. Some of these changes you can comfortably live with. But what about the ones that don't express the real you?

Times have changed
New cosmetic rejuvenation techniques
• Mindsets about looking good have changed.
• Technology – developing effective, quick and simple techniques.
• Increasing acceptability and broader usage.
• Adopting these techniques means NOT having to wait until you have to resort to extremes.

Gone are the days when cosmetic rejuvenation techniques were the exclusive domain of celebrities and socialites. Now more and more people, men included, are turning to these techniques to make sure their faces express the way they feel inside.

Better still, you don't have to resort to drastic measures to get the looks you want. Thanks to today's rapidly evolving technologies, some of the most effective procedures are relatively quick and simple with minimum to no recovery times.

Why do we age?
Our skin and how it ages
• Our skin consists of two layers:
• The epidermis – protects and regenerates.
• The dermis – contains blood vessels, nerves, oil and sweat glands. Also contains collagen, elastin and hyaluronic acid which support and maintain your skin's shape.
• Our skin ages over time:
• Causes – the elements, habitual facial expressions, aging and hormones.
• Result – sun damage, fine and deeper lines, age spots, pigment discolorations.

Our skin consists of two layers. The thin outer layer, called the epidermis, is our body's protection from the environment. New epidermal cells are constantly forming to replace dead skin cells that flake off at the surface. The dermis, or inner layer, contains blood vessels, nerves, oil and sweat glands. It also contains, to a large extent, collagen, elastin and hyaluronic acid, substances that support and maintain your skin's shape.

Over time, the effects of sun, wind, facial expressions, aging and hormones can cause changes in your skin. These appear as fine lines, age spots and sun damage.

With early aging of the skin, fine expression lines (like frown lines), may begin to appear on the face. These become etched into our skin from excessive folding of the skin when we frown or otherwise express ourselves. Over time, especially with repeated sun exposure, collagen, elastin, and hyaluronic acid begin to wear out. This leads to the formation of deeper lines, grooves and folds in our brow, next to the nose and down to the corners of our mouths. In addition, facial blood vessels often increase in size and pigment discolourations can occur.

What can we do about skin-aging?
A. Address the causes
1. Sunscreens
2. BOTOX Cosmetic®

B. Soften deep lines
1. BOTOX Cosmetic®
2. Dermal Fillers

C. Improve tone and texture
1. Intense Pulse Light (IPL)
2. Topical Creams

Cosmetic procedures generally help fight skin aging in the following ways:

What follows is a more detailed look at these cosmetic rejuvenation techniques and answers some of the most common questions about them to help prepare you.

Remember - the clearer you are about your needs, the better you can be evaluated on which treatment is right for your type of skin and expectation level. That will bring you one step closer to having the face that expresses the real you!

A. Address the causes:
1. Prevent Skin Aging: Sunscreens
• Prevention is better than cure
• Ultraviolet rays – discoloration, broken blood vessels, wrinkles
• Daily sunscreen usage

As mentioned above, deepening facial expression lines, wrinkles, brown spots and broken blood vessels are all signs of skin aging. To a great extent, many of these cumulative changes can be prevented. The daily use of sunscreens provides protection against harmful ultraviolet rays which can discolour the skin and contribute to the development of wrinkles and broken blood vessels. Many excellent sunscreens are available on the market to suit all skin types. They should be used regularly by anyone interested in preventing the visible signs of skin aging.

A. Address the causes:
2. “Stop the clock”: BOTOX Cosmetic®
• Habitual expressions (e.g. frowning, squinting) leave their marks – these “dynamic wrinkles” make you look tense, angry or tired.
• BOTOX Cosmetic®
• Muscle relaxant (purified protein)
• relaxation of specific muscles that cause dynamic wrinkles
• prevention of further deepening of lines

Habitual frowning can leave its mark on your face, making you look more tense and angry than you actually are. BOTOX Cosmetic®, an intramuscular injection derived from a purified protein, relaxes the underlying muscles that cause wrinkles. Regular use of this simple treatment will soften expression lines and "stop the clock" on the development or further deepening of lines which, once present, may be difficult to do away with.

B. Soften deep lines:
1. Relax your dynamic wrinkles: BOTOX Cosmetic®
• Softening of unwanted expression lines can have a dramatic effect on how others perceive you.
• For example, softening of frown lines makes entire face look more rested and youthful.
• Takes 10 - 15 minutes; lasts 3 - 4 months.
• Long-term benefit of maintenance.

One or two wrinkles in the wrong place can really change how people react to your overall facial appearance. BOTOX Cosmetic®, a quick, almost painless injection between your brows, has the effect of making your whole face look more rested, approachable and youthful looking.
One 10 to 15 minute treatment usually takes effect after several days and keeps your face more relaxed looking for three to four months. If you choose not to have further BOTOX Cosmetic® treatments, your lines will eventually return to pre-treatment levels.

B. Soften deep lines:
2. Dermal Fillers – adding volume where needed
• Creases/deep furrows injected to “fill”, plump up or smooth.
• Collagen – temporary, absorbed, bovine/purified human collagen.
• Hylaform® and Restylane® - replacement of lost hyaluronic acid.
• Artesense® - offering more permanent corrections.

Fillers are similar to BOTOX Cosmetic® in that they can diminish or completely eliminate lines for months. However, rather than relaxing the underlying facial muscles, dermal fillers are substances that are injected beneath your skin to "fill" creases and deep furrows. Areas most commonly treated with dermal fillers include the furrows which run from the sides of the nose down to the corners of our mouth, deep smile lines, frown lines and crow's feet. They can also be used to plump up lips or smooth out uneven lip lines.

Some fillers, such as collagen, are temporary and are gradually absorbed into the body after several months. The older kinds of injectable collagen products are manufactured from purified bovine (cow) collagen, while the new ones contain purified human collagen.

Both Hylaform® and Restylane® are made of hyaluronic acid, a modified form of hyaluronan, a natural compound in the human body that helps keep your skin plump and elastic. As you age, the amount of hyaluronic acid in your skin decreases, resulting in increased lines. When injected into your skin, these products temporarily replace your body's lost hyaluronic acid to create the volume needed to fill out problem areas for a period of several months.

Other products, such as Artesense®, offer more permanent corrections. Artesense® contains tiny acrylic beads suspended in cow collagen. Following collagen removal by your body, the beads remain behind resulting in long-lasting improvement of wrinkles or lines.

BOTOX Cosmetic®
frequently asked questions:
Q. Will BOTOX Cosmetic® give me a fake, frozen look?
A. No.
• An experienced physician will determine the right dose and injection technique to create the results that you are looking for
• Pin-point specific – only has effects on the treated muscle(s)
• No sensory deprivation.

Not if you are treated by an experienced doctor, who will be able to determine the right dose and injection technique for you. BOTOX Cosmetic® works only on the specific area being treated, so that the other elements of your facial expressions remain active. It also has no effect on the sensory nerves, so you will still have normal feeling in the treated areas

BOTOX Cosmetic®
frequently asked questions:
Q. Does BOTOX Cosmetic® have any side effects?
A. Treatment is very safe if administered by experienced physician.
• Small dosage amount injected into specific area = little risk of systemic side effects
• Most common side effects are local and temporary, and are related to the injection rather than the medicine. E.g. bruising, tenderness at the injection sites, which are mild and usually last for a few days only.
• Dropping of eyelid is possible when the wrong muscle is treated. Rare in the hands of experienced physicians.
• Headache has been reported but it’s likely to be related to the injection, not the medicine. In clinical studies, there were more reports of headache by patients treated with saline than those treated with BOTOX Cosmetic®.

In the amounts used for the treatment of frown lines, side effects - if they do occur -- are usually temporary and localized to the area of injection. The most common side effects, such as bruising, are temporary and limited to the area of injection. Side effects may occur within the first week following injection. Localized tenderness, bruising and headache may be associated with the injection procedure. Ptosis, which causes the brow or an eyelid to droop, can occur but it is rare especially in the hands of an experienced doctor.

BOTOX Cosmetic®
frequently asked questions:
Q. What is the history of BOTOX Cosmetic®?
A. Over 20 years of therapeutic use for a variety of conditions: uncontrollable blinking, crossed eyes, muscle spasm, foot deformity associated with cerebral palsy in children as young as 2, excessive sweating
• Approved specifically for cosmetic use in > 20 countries, including the US and Canada, which means that it’s deemed safe and effective by the governments.
• Over a million people have been treated for cosmetic conditions.
• Most popular and fastest growing cosmetic procedure in North America.

In addition to its use for cosmetic purposes, BOTOX® has been used for over ten years at much higher doses to treat patients with a variety of medical conditions including cerebral palsy in children as young as two, adult spasticity, movement disorders and hyperhidrosis (excessive sweating).

As well, more than a million people have used BOTOX Cosmetic®, making it the most popular and fastest growing cosmetic procedure in North America.

BOTOX Cosmetic® is a prescription-only medicine and as such is only available from a doctor. Furthermore, since treatment results depend very much on the administration, it is important to go to doctors who are experienced and well trained with the use of BOTOX Cosmetic®.

Dermal Fillers
frequently asked questions:
Q. How long will the treatments take?
A. 15-30 minutes
• Administration of small amounts for natural volume.
• May require small local anesthetic.
• May require second or several treatment sessions.
• Fillers dissolve over time, requiring on-going treatment.
• Simultaneous BOTOX Cosmetic® treatments address preventative requirements to provide longer lasting effects

Dermal filler treatments take about 15 to 30 minutes, and may require a little local anaesthetic to numb the area. During treatment, the filler material is injected into the skin with a very thin needle to smooth out and give natural volume to the wrinkle, fold, or groove. One treatment may not be enough for particularly deep smile lines, and a second treatment may be required some weeks later. The longer-lasting treatments Artecol®l are usually administered a bit at a time over several treatment sessions. BOTOX Cosmetic® treatments may be provided at the same time as dermal fillers for patients who require both preventative muscle relaxation and volume filling.

For most people receiving temporary dermal fillers, a top-up injection is needed every three to six months to maintain the desired level of correction. Collagen, Hylaform® and Restylane® dissolve over time, and your skin will gradually return to the way it looked before treatment.

Dermal Fillers
frequently asked questions:
Q. Are there side effects?
A. Temporary, may include mild redness, itching, swelling and pain
• Resolve spontaneously – longer for lips.
• Hylaform® and Restylane® - possibility of acne like lesions.
• Hylaform® - rare cases of persistent redness, red spots and bruising.
• Artecol® - long-lasting lumps or bumps on occasion.
• Treatment or direct supervision by experienced physician.

Some side effects, which are temporary, may include mild redness, itching, swelling and pain. These typically resolve spontaneously within one or two days after the injection into the skin and one week after injection into the lips. Acne-like lesions have also been reported at the injection site with Hylaform® and Restylane®. In rare cases, persistent redness, red spots and bruising may occur with Hylaform®. In addition to these side effects, long-lasting lumps or bumps have been reported to occasionally occur with Artecol®.

All of the injectable filler substances listed here are intended for treatment by or under the direct supervision of a physician.,

C. Improve Skin Texture
1. Intense Pulsed Light (IPL)
• New, non-invasive, highly targeted
• Treats wide variety of skin problems (sun damage, broken blood vessels, rosacea, wrinkles).
• Virtually no down time (as with BOTOX Cosmetic®).
• Produce smoother, even-toned, more youthful skin.
• Repeated treatments over a few months to optimal results.

Intense Pulsed Light (IPL) technology is a new, non-invasive, highly targeted therapy that uses pulses of light energy to treat a wide variety of skin problems. As with BOTOX Cosmetic® and fillers, there is virtually no down time, allowing you to return to normal activity immediately following treatment. IPL treatment can produce smoother, even-toned, more youthful skin by simultaneously improving all of the following:

• broken blood vessels on the face, neck and chest
• redness from rosacea and flushing
• brown pigmentation or freckles caused by sun damage
• skin discolouration and mottled pigmentation
• fine facial wrinkling

C. Improve Skin Texture
2. Topical Creams – promote growth or new skin cells growth and removal of dead layer
• History of treatment for acne and other dermatological conditions.
• Benefits on the treatment of sun damage – wrinkles, uneven pigmentation, brown spots, leathery appearance.
• Tazorac® cream – latest “pharmaceutical grade” cream that has been proven to reverse a wide range of sun damage symptoms.
• Tazorac® is approved by Health Canada for the treatment of sun damage, and is available by physician prescription.

Acid-based exfoliating creams have long been used by medical professionals to treat chronic skin problems such as eczema and severe acne. More recently, milder formulations of these creams have been used for cosmetic purposes to remove dead skin cells from the skin's upper layer and reveal the fresher skin beneath.

Today, sun damaged skin is one common concern. Skin characterized by wrinkles, uneven pigmentation, brown spots, and a leathery appearance can be treated with an exfoliating cream. One such product is Tazorac® cream. Clinical research has shown that Tazorac® cream significantly improves sun damaged skin, fine wrinkling, pigmentation problems and enlarged pores. Side effects may include mild to moderate irritation and redness.

Products containing Vitamin A acid (tretinoin) have also been found to be of value in reversing some signs of skin aging, including fine lines, uneven pigmentation and sallow skin colour.

Tazorac® and tretinoin creams are prescription products and, as such, are only available from your doctor. On the other hand, since these products are classified as pharmaceutical products, it means they underwent stringent clinical studies to prove their safety and effectiveness before being approved by Health Canada

Intense Pulsed Light
frequently asked questions:
Q. How does IPL work?
A. Intense bursts of light energy, directed through specific filters, at damaged skin areas.
• Targeted light is absorbed by the skin.
• Damaged area is heated and fragmented.
• Remainder of skin’s pigmentation is unaffected.

IPL delivers intense bursts of light energy (similar to a camera flash) through very specific filters to your skin. When this light energy is applied to a problem such as a brown spot or broken blood vessel, it is absorbed by the skin and heats up that area. This causes the brown spot or broken blood vessel to be fragmented, without affecting the rest of your skin's pigmentation

Intense Pulsed Light
frequently asked questions:
Q. How is the treatment performed?
A. As follows:
• Cold gel application to area being treated.
• Pulses of light directed through IPL hand piece (may alleviated sting with anesthetic cream).
• Full face takes approximately 20 minutes. Flaking occurs after 2-3 weeks.
• Gradual treatments minimize risk and down time, possibly 6 months for completion.

A cold gel is applied to the area that is being treated and the smooth surface of the IPL hand piece is gently applied to your skin. Each pulse of light produces a slight sting. A topical anesthetic cream may be used to reduce discomfort. Further pulses are provided until the entire area has been treated. IPL therapy of the full face may take 20 minutes while larger areas of the chest and neck may take up to 45 minutes. There is usually a bit of redness which may last for a few hours. Slight darkening and flaking off of pigmented spots occurs after about two or three weeks. By dividing the treatment into several sessions, gradual improvement is achieved with low risk and no down time. Typically, four to six treatments are done approximately three to four weeks apart. A full treatment will therefore often take four to six months to complete.
It is important to avoid sun exposure after IPL therapy. You must wear a hat and sunscreen after this treatment.

Topical Creams
frequently asked questions:
Q. Can anybody use exfoliating creams?
A. Exfoliating products can irritate sensitive skins.
• Fair-skinned, freckled, blue-eyed Celtic (i.e. burn easily/tan poorly).
• Skin that stings intensely after using perfumes, sunscreens or astringents.
• Blushers and flushers – noticeable when embarrassed or drinking.

Exfoliating products can irritate sensitive skin. The following skin types have a high sensitivity to exfoliating treatments:

• Fair-skinned, freckled, blue-eyed Celtic (such as Irish or Scottish) people who burn easily and tan poorly.
• People with skin that stings intensely after using perfumes, sunscreens or astringents.
• Blushers and flushers, whose faces turn red and feel hot when they are embarrassed or drinking.

Topical Creams
frequently asked questions:
Q. What are “Cosmeceuticals”?
A. Cosmeceuticals are generally milder products that are not regulated as pharmaceuticals but have some therapeutic effects on dermatological condition.
• Exfoliate, increase cell production, repair sun damage and diminish uneven pigmentation.
• Alpha- and beta-hydroxyl acids – work like chemical peels or dermabrasion (less invasive)
• Stable Vitamin C products – reduce fine lines and repair certain sun damage.
• Cosmeceuticals should not be ‘mixed’ – may cause burning or irritation.
• May take months to produce visible effects.

The innovations that have revolutionized cosmetic rejuvenation techniques are also being seen with creams and lotions. A new breed of facial products called "dermocosmetics" or "cosmeceuticals" combine dermatologic and pharmaceutical properties to offer an alternative way to refresh your look. Many of these products, such as those containing alpha- and beta-hydroxyl acids, work in the same manner as a chemical peel or dermabrasion - but less invasively - to exfoliate, increase cell production, repair sun damage and diminish uneven pigmentation. Others, such as stable Vitamin C products, have been shown to reduce fine lines and repair some aspects of sun damage in the skin.

Which treatment is right for you?
• This wide choice of simple, accessible procedures facilitates informed decisions.
• Make an appointment with our office.
• Treatment options and costs will vary based on individual needs.

BOTOX Cosmetic® and fillers have the ability to instantly and almost entirely erase existing lines for months. "Cosmeceuticals", on the other hand, may take months to diminish even fine lines.
Check with your dermatologist first to make sure a facial product is right for you and that its claims are valid. Also, do not mix different "cosmeceutical" products together as they may burn or irritate your skin.

Having a wide choice of simple and accessible cosmetic procedures means you can make a more informed decision about the face you wish to project to the world. Be sure to make an appointment with a Dermatologist, cosmetic surgeon, or other physician with special knowledge of cosmetic facial treatment to discuss your individual case.

Your regular physician can refer you to the appropriate specialist. Otherwise, you can easily find a physician in your local area by entering your postal code into the Physician Referral Page and clicking "search". He or she will help you make choices based on your age, skin condition, expectation level and overall health. The cost of treatments will vary, depending upon the options most suitable for your situation. You should discuss these with your doctor prior to treatment.

Join the growing number of people who are turning to simple, non-invasive cosmetic rejuvenation techniques to make certain that their faces mirror the way they feel inside!