Caracas Masque (before - After) Pt. 3

Caracas Masque Procedure. Before (Above) and After (Below)


Douglas Hamilton M.D. & Babak Azizzadeh M.D.

Caracas Masque (before - After)

Caracas Masque Before (Below) - After (Above)

Caracas Masque - Before and After.

The Facelift Alternatives: Tightening Devices and Volume Restoration

Part II


The Facelift Alternatives: Tightening Devices and Volume Restoration

How much laxity and volume loss you have on a varying scale – mild to moderate; moderate to severe – can help your doctor determine whether or not you need a facelift. But it’s vital that you know, beforehand, so that you come to your doctor as prepared as you can possibly be.
Chapters 7 and 8 are designed to help you discover what non-surgical procedures are right for you and, if necessary, what non-surgical procedures might be complementary to various surgical procedures your physician might recommend. That’s right; gone are the days of one-procedure-fits-all – for everybody.

Today most doctors customize a diagnosis based not just on the degree of laxity and volume loss but that patient’s specific personality, pain and recovery threshold and a variety of other factors. But to perfectly tailor your procedure, or combination of procedures, you and your doctor need to work together as two equal parts of your own personal doctor-patient team.
That is why it is so important for you to be educated before you speak with your physician; being intimidated by all those degrees and pedigrees on the whole behind his or her head is no way to feel like you’re on equal footing with your doctor. However, that is exactly where you need to be; eye to eye, not sitting at his or her feet and lapping up those pearls of wisdom.
You want to discuss your options, openly and honestly; without fear that you are asking “dumb” questions and with the knowledge that your physician is interested in the unique and personal you. A generic diagnosis won’t do here; it has to be personal and unique to you and your specific needs if you are to get the results you desire.

A lot of what we do with our patients is actually “undoing” what the popular media and decades of hearing “facelift” have already done to them. Many people think that a facelift is the ultimate in plastic surgery or the gold standard of surgical procedures; others think that all the creams and lotions and skincare is something you do until the inevitable aging process makes a facelift equally inevitable.
Not true; as we always say in our offices the best procedure is the one you avoid by taking care of your skin in the first place. Just as importantly, through a complement of various surgical and non-surgical procedures, you can avoid the severity and invasiveness of a facelift altogether.
Then again, perhaps the years have been unkind to you and that, combined with genetics has increased the need for a facelift; so be it. Chapter 8 will cover all that – and then some. But for our purposes in this chapter we are gearing the information toward people with early laxity and volume loss that a typical facelift isn’t going to deal with.

After all, a facelift too soon is only going to make matters worse in later years just as waiting too long is going to make the need for a facelift later just that much more imperative. The key is to know what to do and when; we’re here to help you do just that.
The two issues we’ll be talking about in this chapter are:

To be Continued...

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Facelift Alternatives: Tightening Devices & Volume Restoration

The Facelift Alternatives: Tightening Devices and Volume Restoration




“I don’t plan to grow old gracefully. I plan to have face-lifts until my ears meet.”
~ Rita Rudner



Before Botox®, before Restalyne® and Thermage® and all the other lotions, potions, lasers, products and procedures we’ve catalogued throughout this book, the default term for any surgical cosmetic procedure for the last few decades was pretty much this: facelift. “Tight was right” and less wasn’t even an issue; more was better and, quite often, not quite good enough.
“When are you getting a facelift?”
“Did you see Maryanne’s new facelift?”
“The plastic surgeon said I needed a facelift.”
“Do you think I need a facelift?”
“How soon before I can get another facelift?”

Questions like these and so many more were popular fare at water coolers, gyms and PTA luncheons throughout the land and, without any other clear options, facelifts became the end-all and be-all of plastic surgery.

How times have changed. Today there are so many other non-surgical options and so much patient- and doctor-driven education to inform the various surgical procedures that now exist that most of us realize there are many steps on the way to a facelift; that having a facelift is not the inevitable costly, surgical and intensive procedure we all must “face” one day down the road. This chapter is designed to help you discover what those alternatives are and, more importantly, where you fit on the “do I need a facelift?” scale. In other words, we will teach you a new scale to use that doesn’t necessarily involve how old you are or what you think you need.

WARNING: Age is NOT the determining factor in whether or not you need a facelift. In our practices we’ve both learned that age is not necessarily an indicator along the “who does and who doesn’t need a facelift” spectrum. Both of us know dozens of individuals in their fifties who don’t need a facelift – and just as many in their forties who do.

Where do you fall on this scale? To determine the answer we must consider the two mitigating factors that we will be discussing in this chapter:

1.) Laxity: As we have discussed, laxity is our term for “looseness and sagginess,” otherwise known as drooping.
2.) Volume loss: As your skin ages it loses volume and becomes more brittle and less supple, creating a more severe look to the face.

To be Continued...

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Dr. Hamilton in Telemundo

Neck Lift in Beverly Hills by Dr. Azizzadeh

HOW DOES COLLAGEN WORK?

How does Collagen work?

Collagen is a natural fibrous protein that is already naturally found in your own bones, skin, and cartilage. As we age, collagen levels in the skin begin to decrease, leading to loss of elasticity and fullness, particularly in the face.

How Many Times Must I Be Treated?

Treatment with bovine Collagen (Zyplast®/Zyderm®) requires a test to determine if you are allergic (3-5% of people are). A wait of 1 month is required; many physicians perform a second test and wait 2 weeks since very rarely the first test is falsely negative. Newer collagen products (Cosmpolast®/Cosmoderm® and Evolence® family) do not require allergy testing. The number of individual collagen injections will vary depending on what we are treating you for. Most individuals will need to repeat injections every three months.

Are there side effects with collagen products?

Collagen is an extremely safe product with excellent track record when used in the midface, laugh lines and lips. As with all fillers, collagen can have some adverse events such as: bruising, irregularity, over/under correction and nodularity. However, compared to hyaluronic acids which will be discussed below, collagen products cause less immediate swelling. Injection is not recommended for areas under or around the eyes.

How Long Will It Last?

Injectable collagen treatments will fill in depressions or lines and augment soft tissue features, to give you a fresh, glowing, youthful look. Bovine and human-derived collagen are the shortest lasting fillers, with the duration of three months. Evolence® has been reported to last six months or longer.

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Long Term Vs. Short Term Facial Beauty treatments

Long Term Vs. Short Term Facial Beauty treatments

In general we can classify such treatments as either shorter (3-6 months) or longer (from 6-24 months) or even permanent. Which is which? In this chapter we take a look at two ways to approach facial procedures:

1. Short & Sweet – or Short-term – (3 to 12 months): Many of the treatments we offer fall into the “short and sweet” category, meaning they last for about three to six months and do require minimal upkeep to maintain their effectiveness.
2. A (Slightly) Longer Story – or Long-term – (over 12 months): Other procedures last longer and don’t require quite so many office visits to perfect.

Why two options? There are a few reasons. In the case of fillers, it may be a matter of cost (the shorter the duration, the lower the cost) or that certain fillers are not appropriate for certain areas of the face. Additionally, certain aging issues may only be addressed by certain technologies which have a specific duration of effect (e.g., loose skin treated by ThermaCool®). Another factor influencing choice is downtime (e.g., CO2 laser resurfacing vs. fractionated laser resurfacing).

Short & Sweet: 3-12 Months

In this section of Chapter 6 we discuss those facial treatments that we refer to as “short and sweet,” meaning just like your dentist or other doctors you only have to come into the office every three to six months to help maintain the youthful effect of these mostly temporary, but quite effective, treatments.
These short-term (3 to 12 month duration) treatments include:

• Botox®
• Hyaluronic Acids (Restylane®, Perlane®, Juvederm™)
• Collagen

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Injectables: How Long Will They Last?

The images above are from actual clients. Pre Artefill and Post Artefill.

Injectables: How Long Will They Last?
The Simple Answers


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“More than anything else, I’d like to be an old man with a good face, like Hitchcock or Picasso.”
~ Sean Connery

Duration of Injectable Products

This handy chart will help you determine how long a particular injectable lasts:

Short Term (3 – 12 months):

• BOTOX® (3 months)
• Collagen products
o Bovine collagen: Zyderm®, Zyplast® (3 months)
o Human-based collagen: Cosmoderm®, Cosmoplast® (3 months)
o Porcine collagen: Evolence®, Evolence® Breeze (6 months)
• Juvederm™ (6-12 months)
• Restylane® (6-12 months)
• Perlane® (6-12 months)
• Fascian™ (Extremely variable; increasing duration with repeat treatments)

Long Term (over 12 months):

• Radiesse® (1-2 years)
• Sculptra® (2-3 years)
• Artefill® (Permanent)
• Silikon® 1000 (Permanent)

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Typical Costs of Facial Rejuvenation

Typical Costs of Facial Rejuvenation


• Skin care products: $75 - $200 per month
• Botox®: $250 - $800 per treatment (depends on the area; typically $16 - $20/unit, 15 - 20 units for crow’s feet, 15 - 20 units for frown lines, 10 - 20 units for forehead lines, men need more units than women)
• Restylane®, Juvederm™, Perlane®: $550 - $650 per syringe (typically need 2 - 3 syringes face, 1 - 2 syringes for lips)
• Radiesse®: $800 - $900 per syringe (typically need 2-3 syringes)
• Sculptra®: $1,250 - $1,500 per vial (3 - 4 vials average per person)
• Rhinoplasty: $9,000 - $20,000 (depending on complexity)
• Forehead lift: $7,500 - $12,000
• Blepharoplasty: $3,500 - $8,000
• Fat grafting: $6,500 - $9,000
• Facelift: $12,000 - $25,000
• Fractional laser: $1,000/treatment (3 - 4 treatments typically required)
• CO2 laser: $4,000



The Consultation: Expectations, Questions, and Answers

We are not in a cookie-cutter business. The beauty of faces is that no two are exactly alike. Even identical twins – who may start out with startlingly similar features – will develop unique and personal differences over time. A beard, a way of applying makeup, five or ten additional or fewer pounds – each of these variables can affect one’s appearance.
Likewise, the aging process affects every individual differently. Genetic, environmental and gravitational forces have significant impact on the facial appearance. A comprehensive facial rejuvenation consultation should discuss skin, non-invasive and surgical management tailored to each specific patient. A systematic approach must be undertaken to address the face, eyes, nose and neck in its entirety in order to obtain a balanced, natural and un-operated appearance. We recommend a four-part consultation for maximum benefits.

1. Preventive Measures.
2. Non-Invasie Procedure.
3. Surgery Specifics.
4. AfterCare.

This steps in more detail later. Contact us for questions, suggestions, and advice.


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Let’s Talk About Lip Augmentation

Let’s Talk About Lip Augmentation

Improvement and enlargement of lip contour is commonly desired. There are multiple ways to approach this goal. The treatment options include:

1. Hyaluronic acids: Juvederm™, Restylane®
2. Collagen: Cosmoplast®, Cosmoderm®, Evolence® Breeze
3. Lip implants: Gore-tex® (soft-form), Vera-fil* (new) AlloDerm
4. Fat grafting
5. Silicone*
6. Cymetra

Although collagen is the most commonly used method for lip augmentation, no single approach has become standard. Each option has its advantages and disadvantages.

Skin Care Regime - Change is Coming

A Change is Gonna Come: Maybe?

Only halfway through this chapter we’ve talked a lot about skin care products; the good, the bad and the ugly. And yet, chances are, you’re still confused. That is because there is so much new technology out there, making so many new products, discoveries and even delivery systems – serums, potions, lotions, capsules, oils, etc. – that it’s hard to keep up. Well, in this chapter we can’t promise to categorize every skincare product – or even list every skincare product – but we can at least simplify the search by classifying these products into one of only two categories.
When it comes to skin care products, believe it or not, change will come. We are all looking for change; better skin tone, more radiance, fewer lines, less wrinkles – changes all.

The two categories of skin products are:

1. A rejuvenating change – Reparative skin care products: Some skincare products attack symptoms, i.e. fine lines, sagging skin, discoloration, spots, wrinkles, laxity, etc. So when you’re shopping for these lotions and potions, you’re actively looking for something to change.

2. Postponing aging change – Preventative skin care products: A second aspect of skincare is keeping what you’ve got; the luster of youth. Skin care systems that prevent wrinkles from becoming prominent and provide proper support for clean, healthy skin. Some skincare products are designed not so much to change your face for the better, but to prevent changes from happening for the worse.


Reparative Skin Care Regimen

The glow of youth is lost over the years as the outer layer of the epidermis becomes thick and opaque. Some skincare products actually do create change. For instance, they can help restore the luster of skin on the outside and create better skin health from the inside. These include:

• Neo Strata: Hydroxy acids are one example of skincare products that actually produce a direct, measurable change; in this case, younger, glowing skin. The purpose of hydroxy acid products is twofold: 1.) Produce a smoother texture and even color and 2.) Help in acne-prone skin. While there are many hydroxy acid companies, we use NeoStrata (glycolic based) because it was founded and managed by Drs. Eugene Van Scott and Ruey Yu, who are the world recognized experts in glycolic acid research.

• RevaléSkin ™ cream: Brought to market in 2007, RevaleSkin ™ cream is a relatively new product on the market is utilizing the benefits of caffeine to, as the company’s slogan says, “Wake up your skin.” RevaléSkin ™ cream, an anti-oxidant derived from coffee berry, provides the promise of reducing lines as a result of moderate sun damage. RevaleSkin™ is the first professional line of anti-aging skincare that the authors are aware of that contains Coffeeberry, a powerful natural antioxidant. And as an aside, recent studies have shown that coffee drinkers seem to have a lower instance of internal diseases.

• Triluma®: Triluma® is the most widely used prescription bleaching agent in the United States. It contains three prime ingredients – 4% hydroquinone, Tretinoin, and a topical steroid. This product is excellent for color irregularities seen in photodamaged skin especially in darker skin types.

• 302™ Protein Drops: A new topical technology began in the laboratories of pharmaceutical giant, Eli Lilly, in the early 1990s. The fruits of this research of more than a decade yielded a spin-off company of former Lilly scientists in 2004. 302™ Protein Drops are avocado derived and have the unique ability to thicken skin: both the dermis and the epidermis. We prescribe it to help reverse the skin thinning effects of age.

Preventative Aging Change

When it comes to skincare, our first hope is to make one’s skin look better. But just as important is our other wish: to postpone or at least delay the aging process. In this instance, we want to maintain our youthful appearance and prevent the aging process. The prevention of wrinkles is typically focused on the abnormalities occurring in the collagen component of the dermis (deeper layer of the skin). Other elements of the dermis include elastic fibers, Hyaluronic acids and blood vessels. These last three are targets of some products as well. Yet it is the collagen stimulation factors of cosmeceutical creams and lotions that have received the attention of skin care professional and the public.
Retin-A, an acne preparation developed in the late 1960’s, was shown to stimulate collagen to the point that biopsy studies showed youthful collagen being generously deposited over a period of months. Tretinoin, Retin-A’s active ingredient (also found in Renova) quickly became the gold standard for “collagen creams.” It held its throne until the early 1990’s, when several competitors arrived. Currently we recommend the following powerful preventative skin care lines that have been proven by outstanding clinical research.

• Neova® (Copper peptide): Since 1999, copper peptide creams have been considered undoubtedly the most effective wrinkle prevention creams available, having been shown in several independent medical school studies to stimulate collagen at almost twice the rate as Retin-A and Renova®.

• NIA 24™: Niacinamide based NIA 24™ which was tested at the National Cancer Institute may be able to reverse DNA damage. This product is very important for people with fair skin who have had sun damage – even severe damage. We have noticed with numerous individuals a softening of color irregularity and reduction in scaling, precancerous growths. Therefore, this product serves a unique purpose by perhaps reducing the prevalence of skin cancer in people who use it and at the same time reducing the effect of the sun, wrinkles.

• Antioxidants: One of the leading theories for preventing skin aging is based upon the concept that cells are attacked by harmful elements called free radicals; aging can be prevented by preventing free radical formation with antioxidants. Antioxidant (“free radical scavengers”) skin care products have increasingly assumed center stage. There are numerous antioxidants used in skin care products including vitamins (C & E), herbal and green tea extracts (polyphenols) and others. This list is likely to expand rapidly and may even have value in preventing skin cancer.

1. Replenix™: Replenix™ is our most commonly recommended antioxidant preventative skin care product. It contains green tea derived polyphenols, which are known to be strong anti-oxidants.

2. Citrix® - Vitamin C: Vitamin C is the most plentiful antioxidant in human skin and a potent anti-inflammatory agent. Our recommended Vitamin C based antioxidant skin care system is Citrix®. Citrix® is used more commonly in acne-prone and oily skin because it functions as an astringent in these skin types.

3. Persimmon leaf: Persimmon leaf, a naturally occurring plant, contains tannins (as found in wine) and has skin-lightening and collagen-stimulating capacities. We are looking at new and recent skincare developments in this area.

• Broad-spectrum sunscreens: Sunscreen application is perhaps the most important preventative measure for sun damage and aging. Please see the section below for a detailed discussion

[START BOX]
Some skincare products are designed not so much to change your face for the better, but to prevent changes from happening for the worse.
[END BOX]

Ladies!!!....Stretch Marks in Cougar Town

Ladies!!!....Stretch Marks in Cougar Town

These days, it is not uncommon to see a fit and fab 40 year old woman with her beau of 26 or 27. Thanks Demi Moore!!

But, in your quest to work your body into better shape than it was in your 20’s, you may be faced with an undesirable side effect…..stretch marks! Did I say it?—YES, I did!! Stretch marks!! Stretch Marks!! Stretch Marks!!—Almost as disturbing as it’s three syllable sister..Cell-u-lite! And just as unpleasant aesthetically.

Celebrities like Jennifer Aniston and Courtney Cox rely on talented make-up artists and skillful retouchers to wipe away stretch marks. But what can you do?

Technology has heard your cries and answered with the FRAXEL LASER. A laser initially designed to treat acne scars, fine lines and texture issues…new studies have found that it can do wonders on stretch marks!

Procedure usually takes 3-5 treatments and can be done 3 to 4 weeks apart. There is NO down time and that means no need to skip the sun this summer. Appearance of stretch marks improves with each treatment. Cost can range from $600-$1200 per treatment depending on the size of the area.

So, rejoice!—Have that baby, tone up those hips, get rid of those implants and ask out that hot neighbor…after all, he is getting his Master‘s degree!

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Our Goal, Our Book...

The Best Source for Your Information

Traditionally, the physicians such as plastic surgeons and dermatologists were the experts that clarified the appropriate intervention to address an individual’s concerns. Today, however, the Internet as well as print and television media have become an important source of information for people when seeking the appropriate procedure and available intervention.

Advertisements by physicians and cosmetic products and procedures are abundant. Multiple books have also been published about beauty and health. Most of the advice provided in these books is limited by the experience and specialty of the physicians. Regardless of the significant amount of available information, in our practices we have learned that people are more confused than ever and most do not feel that they have a source that would serve as an unbiased source for facial enhancement and preservation.

Until now. We are Douglas Hamilton, MD and Babak Azizzadeh, MD and our new book is called Beverly Hills Celebrity Beauty Secrets: The Secrets Celebrities Don’t Want You to Know – From Two Doctors Who Work On Them Every Day (?). To our knowledge, this is the first book written by both a facial plastic surgeon and a dermatologist with expertise in facial rejuvenation. This groundbreaking dual format allows for a broad-based – and unbiased – approach to facial rejuvenation.

It is a mixture of excitement and concern that has energized us to write this book. With the proper application of technological and surgical approaches now available, many elements of facial aging can be addressed today in ways that were not imaginable even five years ago. Yet, with this advancing tide of technology and surgery comes some muddying of the waters.

The promises provided by these advancements can be nullified by their inappropriate application in unqualified hands. This may range from doctors far removed from their specialties, with backgrounds as thin as a weekend course certificate, to non-physicians employed in a business model where medical professionalism has been suffocated by the drive to profit.

For individuals seeking to enhance and preserve their facial appearance, our goal in writing this book is to give “insider trading” that most cosmetic health care providers are aware of. These include:

1. Providing the guidelines for understanding the aging changes specific to their face so that they can be educated about alternative treatments

2. Clarifying the available surgical and non-surgical treatments

3. Providing the all-important criteria for choosing the physician specialist who would understand the appropriate procedure

Together, we have over four decades of experience in facial plastic surgery and dermatology, all of which is poured into Face It. Through a combination of sound advice, quantifiable research, unvarnished truth and actual case studies from both our practices, the reader will experience a life-enhancing result with money well spent – and hopes well placed. That is our sincere wish.

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Our Book as Text Book

We are proud to announce that our book will be the sole text of a freshman business beauty course at the University of California at Irvine.

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My Nose Job In Beverly Hills

"Three 3 Tips for an Age-Proof Face"

Less Sun - More Sunscreen.
Stop worshiping the sun and start caring for your skin instead. We can't say this enough. We all enjoy a day at the beach and the fresh, attractive feeling we have when our faces are suntanned - or sunburned. However spending too much time in the sun is like squandering your savings account in your youth only to regret it in your golden years - you will pay for it later. We have seen how the sun damages the skin; avoid harmful UltraViolet (UV) rays when you can and protect yourself when you cant. It's simple as that. Use a total (UVB and UVA) sunblock.


Quit Smoking.
If you are still smoking, quit. If you are thinking about starting to smoke, dont. If your co-workers smoke, avoid them - or get them to quit. The chemicals and heat from a burning cigarette wreak obvious havoc on your face, and it isn't always easy to remove. If you want to start achieving a more youthful appearance by tomorrow, quit smoking today. Nicotine has shown in numerous laboratory experiments to harm the varous components of the dermis (a deeper layer of the skin).


Stop Worrying.
What is done is done; you cant go back in time. If you were a sun worshiper in your youth or smoked until just yesterday, quit crying over spilled milk; it wont do any good. All you can do is move from today and look forward to tomorow. You can quit adding to the lines that are already etched into your face by worrying less from this day forward. Revel in the knowledge that modern techniques can delay or reverse the effects of aging.

At what age should I start worrying about facial aging?

Start early with prevention by using sunscreens. Most extrinsic aging is due to sun damage.

In your 20's, skin care home products such as anti-oxidants and collagen stimulating creams become important along with mild collagen stimulation from microdermabrasions.

In your 30's, lip enhancement (enlargement) and filling of forehead and smile lines (nose to mouth corners) can be treated with botox and fillers, respectively.

The 40's are a perfect age for Thermage to tighten some early skin sagging and removal of fine lines and color irregularity with lasers like the IPL and Fraxel.

From the 50's on, the above can maintain youthful appearance for a long time but invasive tightening (facelift or blepharoplasties (eyelids) ) may be needed. Remember for some people, you may be 55 and look 35 or the reverse. These are general guidelines.

Summer Skin Care

Summer is MOSTLY about the sun & facial skin aging is MOSTLY about sun damage.Prevention is about sunscreens but their efficacy is not just about the (SPF )numbers. SPF measures only protection from a small part of the sun’s harmful spectrum. For full protection:

#1 The right ingredients are needed- high % of Zinc; mexoryl; or helioplex.

#2 Apply thickly- only a minority of individuals apply sunscreens as thickly as in the SPF studies &

#3 Re-apply once or more if you perspire heavily. Additionally, studies suggest that antioxidants such as Vitamin C applied before sun exposure may offset much of the free radical damage elicited by UV exposure.

Dr Azizzadeh: Facelift & blepharoplasty on Discovery Health

Dr Babak Azizzadeh: Facelift and blepharoplasty on Discovery

Dr Azizzadeh: Revision Rhinoplasty on Discovery Health Chan

Dr. Babak Azizzadeh's discussing Facial Rejuvination

Mary Jo buttafuoco's plastic surgery by Dr. Azizzadeh

Dr Babak Azizzadeh - Facial Paralysis Reconstruction

Dr Babak Azizzadeh: Medical Mission for Children

Noninvasive facial rejuvenation: botox and fillers

Dr Azizzadeh: Bell's palsy & Facial Paralysis Reconstruction

Medical Missions For Children in Quito, Ecuador

NBC 2 - Beauty Secrets

Telemundo - BH Beauty Secrets

ABC GMA - BH Beauty Secrets

Extra - BH Beauty Secrets

Extra 2 - BH Beauty Secrets

NBC - BH beauty Secrets

Excerpts From "Beverly Hills Beauty Secrets"

Introduction
Forget Wall Street - Our Insider
Trading Secrets Come Straight
from Rodeo Drive!

The boomers are aging - and don't want to look it. Women are looking to nonsurgical procedures - and loving it.

Men are using beauty products - and not afraid to admit it.

We are a nation obsessed with appearance - and the statistics prove it.

According to the American Society for Aesthetic Plastic Surgery (ASAPS), Americans spent approximately $12.4 billion on cosmetic procedures in 2007. This means that more doctors than ever before are performing more procedures on more people, creating and inherent confusion about not only which procedures are the most appropriate but also which doctor is the most qualified to perform them.

It doesn't help to clarify matters that in the past decade, techniques to enhance the appearance of the face have grown exponentially. New products mean new brand names, and new brand names mean new buzzwords, which cause even more confusion. (Can you say "Radiesse, Restylane, and Thermage, with a side of Artefill for good measure"?)

Many of the latest techniques in cosmetic advancement involve nonsurgical procedures. In fact, recent statistics reveal a widening gap in the surgical versus nonsurgical conundrum: of the nearly 11.5 million surgical and nonsurgical procedures performed in the United States in 2007, surgical procedures accounted for only 19 percent of the total procedures, and nonsurgical procedures made up the other 81 percent.

The top five nonsurgical cosmetic procedures in 2005 were as follows:

1. Botox injections
2. Laser hair removal
3. Hyaluronic acids (Hylaform, Restylane)
4. Microdermabrasion
5. Chemical peels

Simultaneously, the demand for facial rejuvenation and beauty preservation has increased at an unprecedented rate because of increasing societal acceptance of cosmetic procedures. Popular magazines continue to tout the "youth is power" message through glossy photographs of young, unblemished, wrinkle-free models. Television has also had a huge impact: Extreme Makeover and Dr. 90210 and their countless spin-offs made cosmetic surgery fodder for :reality TV" shows, and Queer Eye for the Straight Guy turned beauty products for men into a fad that became a trend that continues as a habit today.

As a result, a significant amount of confusion has surfaced about the cornucopia of procedures, physician board certification, cost, and the validity of "lunchtime makeovers." The trends are actually as surprising to physicians as they have been to patients. For decades surgery was performed in a medical center and nonsurgical procedures were performed at clinics, but recent statistics reveal newly emerging trends: of all the cosmetic procedures performed in 2005, 48.3 percent were performed in office-based facilities, 27.9 percent were performed in freestanding ambulatory surgical centers, and 23.8 percent were performed in hospitals.

The Best Source for Your Information

Traditionally, plastic surgeons and dermatologists were the experts who clarified the appropriate intervention to address an individual's concerns. Today, however, the Internet as well as the print media and television have become important sources of information for people who are seeking the appropriate procedure and available intervention.

Advertisements by physicians and the makers of cosmetic products and procedures are abundant. Numerous books have also been published about beauty and health, but most of the advice in these books is limited by the experience and specialty of the physicians. Despite the significant amount of available information, people seem to be more confused than ever, and most do not think that they have an unbiased source for information on facial enhancement and preservation.

That's about to change with the publication of this book. To our knowledge, this is the first book written by both a facial plastic surgeon and a dermatologist with expertise allows for a broad-based - and unbiased - approach to facial rejuvenation.

A mixture of excitement and concern has energized us to write this book. With the proper application of the technological and surgical approaches that are now available, many elements of facial aging can be addressed today in ways that were not imaginable even just five years ago. Nevertheless, with this advancing tide of technology and surgery comes some muddying of the waters.

The promises provided by these advances can be nullified by their inappropriate application in unqualified hands. This can range from doctors who are far removed from their specialties, with background as slight as a weekend course certificate, to nonphysicians who are employed in a business model in which medical professionalism has been suffocated by the drive to profit.

For individuals who seek to enhance and preserve their facial appearance, our goal in writing this book is to give "insider trading" tips of which most cosmetic health care providers are aware. These include the following:

• Providing the guidelines for understanding the aging changes that are specific to the face so that individuals can be educated about alternative treatments
• Clarifying the available surgical and nonsurgical treatments
• Providing the all-important criteria for choosing the physician specialist who would understand the appropriate procedure

Together, we have more than four decades of experience in facial plastic surgery and dermatology, all of which is poured into this book. Through a combination of sound advice, quantifiable research, unvarnished truth, and actual case studies from our two practices, we want to enable the reader to choose a life-enhancing result with money well spent - and hope and trust well placed. That is our sincere wish.

BABAK AZIZZADEH, M.D. - Book Co-Author

BABAK AZIZZADEH, M.D., is the director of the Center for Facial and Nasal Plastic Surgery and an assistant clinical professor of surgery at UCLA's David Geffen School of Medicine. Dr. Azizzadeh has been actively involved with nonprofit organizations including Operation of Hope, and has recently started the Facial Paralysis and Bell's Palsy Foundation. He has been featured on ABC News, Oprah, and Discovery Health, and in the New York Times, the Los Angeles Times, and People magazine.

DOUGLAS HAMILTON, M.D.

DOUGLAS HAMILTON, M.D., is the director of the Laser Rejuvenation Institute and an assistant clinical professor of dermatology at UCLA's David Geffen School of Medicine. Dr. Hamilton specializes in a full range of noninvasive cosmetic procedures designed to rejuvenate and enhance appearance. He has been featured on Good Morning America, CNN, ABC News, CBS News, Extra, and Access Hollywood, and in the Washington Post and the Los Angeles Times.