2. BEAUTY & COSMETIC TREATMENT PART-I

2.1 BEAUTY

“Beauty is not caused. It is.” (Emily Dickson).

“Beauty is everywhere and welcomes guest” (Johann Wolfgang Von Goethers).

“Beauty is the gift of nature” but it can also be created by a cosmetic surgeon.

“A thing of beauty is a joy for ever, Personal beauty is a greater recommendation than any letter of reference” (Aristotle)

“Beauty is the pilot of young ones” (Ralph Waldo Emerson),

“ Beauty in distress is much the most affecting beauty” (Edmund Burke),

“When beauty fires the blood, how love excites the mind” (John Dryden).

“Beauty is a gift of God.” –Aristotle.

“Beauty is a mystery. You can neither eat it nor make a flannel out of it.” (D.H. Lowrence).

“Beauty intoxicate the holder and beholder” (Zimer mean), “Beauty is a power which charms lover but may terrify husband.” “Beauty is in the eye of beholder.” “Beauty cannot be separated from the eternal” (Dunte Alighievi). “Make all things beautiful to keep beauty in its place” (George Satayana). “As on asylum form the terrors of finite nature, we fly to beauty” (Ralph Emerson). “Beauty makes its way directly to the soul. Do not purchase beauty product in a hardware stores” (Miss Piggs). Simplicity is beautiful. To get simple beauty is like getting best invention.” “Old person remember power of beauty although they are unfit for ladies love.”

Beauty is a complex aspect of human life. There is not single standard of beauty by which everybody can be compared. Racial difference exists. So, skin texture, internal support structures and various body features varies. Skin of Indian people is somewhat thicker as compared to European’s. So, with increase age, wrinkles appear quite late as compared to Western counter parts. Courage is not a gift, it is a decision.

Beauty provides new delight, satisfaction. Beauty improves confidence. Beauty is harmony, perfection, acceptance, good self image. Beauty is in appearance but more so in maintenance. Beauty is never of body but it is more of feeling, more of mental vision, more of confidence, more of patience, more of sacrifice, more of following rules and regulations. Beauty is in the vision of us and also of other people. It is in accepting our self as we are and efforts to compensate for its limitations. Every beauty has its period. It has some expiry period. Beauty is never permanent. Beauty is nature’s gift. It can be prolonged by our external efforts and nature’s co-operation. Human beings can maintain and improve their beauty by following rule of nature. Natural diet, exercise, good habits, enough rest, regular routine life style are important factors which support body. Positive attitude, positive thoughts, positive creative work. Good mental balance, maintaining satisfaction with whatever happens in life and social life (including family), patience, mental perspiration by good handling of emotions and ego. Positive physiological base are important factor. Beauty is not on the skin but it is deeper below the skin upto heart. Beauty is not just in good oration but in good service, beauty is not in rituals but it is in devotion to mankind. Beauty begets beauty. Beauty stimulating lust feeling or sex feeling is superficial beauty. Quality beauty is not in its value of attraction but in the value of realization. Beauty upto skin can take oneself to temporary pleasure which evokes more greed for it. Beauty below the skin upto the heart can take one self to feeling of satisfaction rather than pleasure. There is nothing like temporary happiness in true beauty. Beauty means youthfulness. Every elder person is beautiful because of pleasurable face, active movements and loving language. Old persons are often appear ugly because of sadness in thinking, attitude, behaviour etc. natural beauty has divine proportions. For some people beauty is number like physical proportions of body. For others it is more than physical proportions like mind, social life and philosophy. Beauty is characteristic of our body, mind, social life and soul. If I am beautiful then all other thing appears beautiful. Things appear beautiful if their proportion of breadth to height is 1:67

Beauty is in the eyes of beholder. Mind of youth is beauty. Beautiful mind makes a man more young. Credit may not go to the originator but credit goes to the man who reaps it, grinds it, feeds it to the world.

Beauty is not only skin deep but also bone deep, mind deep & spirit deep.

Shrinkage of facial bone and changes in shape of the face makes the people look older. Effects of aging and gravity leads to reduction of bone volume or change of shape of bone and reduction in tissue volume of face. These changes further create wrinkles. So, bony tissue dissolves, shrink and leave empty space. With increase of age, skin losses its elasticity and so tissue around these spaces cannot be tightened. Women tend to loose facial bone at a younger age. So, as time marches on it often affects across our faces.

Facial flaws affect our mind. Our attitude towards these flaws on the face will affect our personality complex, our confidence and social life. Our way of feeling about our flaws on the face decide extent of these effects. Everybody of us ages slowly everyday. We do not notice such very minor loss of beauty for some years during young age. After some months or years, we incidently & suddenly realize loss of quality of beauty. It is often others who brought to our notice such loss. Tricky comments by others about our beauty often harm our mind or make us extra alert. Instead of approaching systematically to analyse causes in our own case by consulting doctor, we rather tend to find short cuts & use of advertised product which promise guarantee. In beauty care & skin treatment, there is nothing like guarantee but there is hope. Doctors or cosmetologist may not give you guarantee of recoveries of the original beauty because multiple factors affect our beauty. Response to treatment varies according to case and stage of the disease & health status of the patient & habits & life style. So, improvement varies from case to case.

As mentioned above, no beauty in this world is stable. But it can be stabilized by various treatment. It needs co-operation of the individual with himself / herself to make changes in own life style, habits, diet & environment. Instead of doing such change in them, they rather try to depend on external factors & treatment modalities. As beauty is unstable, it needs care to maintain stability.

Beauty is a need of time

For a person who meets many people every day for public relation, marketing, administrating etc. face is his fortune. Take care of beauty in such a way that one can appear beautiful in any setting through healthy approaches. Do you want to improve your appearance? You are on right track!

How does cosmetic treatment help you?

Today, more than ever before more and more people are undergoing facial rejuvenation to fight aging. Many prefer quick turn around so that they can swiftly go back to work. There are many cosmetic procedure options ranging from non surgical methods to surgical methods to change appearance. These procedures build up confidence & increase happiness by changing internal feeling. These procedures also wipe out the lines of time and aging on the face. These help to reduce signs of aging and improve self image. Most of us are eager to look younger and more fit. Now a days many choices are available to treat and prevent aging of face.

These help to reduce signs of aging and improve self image.

Changes in body due to aging:

Shrinkage of facial bone and changes in shape of the face makes the people look older. Effects of aging and gravity leads to reduction of bone volume or change of shape of bone and reduction in tissue volume of face. These changes further create wrinkles. So, bony tissue dissolves, shrink and leave empty space. With increase of age, skin loses its elasticity and so tissue around these spaces cannot be tightened. Women tend to lose facial bone at a younger age. So, as time marches on, it often affects across our faces.

Why one appear older than our actual age?

Wrinkles, puffiness and droopiness of the face make our face look older. Everybody has some natural wrinkles around the eyes, the nasolabial folds (from nose to mouth and other parts of the face). Due to elastic nature of the skin, these natural wrinkles are seen and they help to express our natural expressions of face like smiling natural expressions. In cosmetic surgery, these are not removed as they allow more natural expressions. Other type of wrinkles are fine wrinkles caused by aging and sun exposure and so face feels leathery and rough. These need to be treated by skin tightening procedures in cosmetic treatment centre.

Aging changes of the face can be treated by LASER resurfacing. These can also treated by chemical peeling but less effectively. Milder chemical peel is used to treat around the eyes. Other area of face needs stronger peel.

Various non-surgical cosmetic treatments:

These are non-surgical procedures like unwanted hair removal by laser skin rejuvenation of face & body. Skin tightening, skin bleaching, brown & blackish pigmented spots removal, excision of changes on skin surface, wrinkle eradication or wrinkle reduction, & non-surgical face lift are also done here.

Various cosmetic surgeries:

Facial palsy, face lift, neck lift, double chin, natural and artificial hair transplant, liposuction, liposculptor, lipo injection, lipo grafting, hair removal, mentoplasty, molar elevation, prosoplasty, dermatipectomy, lipoabdominoplasty, non-surgical facial rejuvenation, non-ablative facial rejuvenation, surface rejuvenation, sub surface rejuvenation. Whatever you expect from the treatment, do you have any drug allergy, are you intaking any medicines at present? for what?

Advantages of beauty:

Good look do matter. More doors may open for good looking people than average people. Inclination of being attracted to good looking people is instinctive. Most of us think attractive people are good people. People are smilling to give extra chance to persons who look good. Attractive people earn 10% more than average looking people.

Everybody wants to look good. When given will, even child of 2 years ask for more beautiful clothes.

2:2 TO IMPROVE BEAUTY AND HAPPINESS OF LIFE

1. During free time, engage yourself in hobbies. Keep interest in various types of exercises and games.
2. Establish relationship with people out side your profession.
3. Try to learn new topics, topics of your interest and new things.
4. Try to do new things and do old things in new ways.
5. Play with children for some time and discuss with elders about their interests, experience of opinions.
6. Always think of options and use these options in your routine life and profession.
7. Discuss with others about their interests, experiences and options. Be in company of elders for some time everyday.
8. Talk to unfamiliar person.
9. Wear different types of clothes.
10. Be spontaneous and intuitive.
11. Do not form self limiting assumption about yourself. Sky is also not the limit.
12. Learn from little things. Learn even from children.

2:3 SKIN CARE:

SKIN:

Skin is the largest organ of the body. It is elastic, flexible but tough waterproof cover of the body which protects inside parts of the body from heat, cold, germs and sunlight. So, it is most commonly exposed to wear and tear. Thus, to cover up and renew this cover, skin grows faster in comparison to other parts of the body. On every inch, there are 19 millions cells. Beauty of skin lies in its smoothness, tightness, luster. We are attracted to the beauty of the person means it is often the skin of that person which glows and glares. Good skin boosts self esteem of the individual. Healthy skin is important parameter of good health. Skin is sensitive to touch. We experience much of joy by touch. So, skin plays very important role in emotions like love. By its capacity of providing sensations of pressure, pain and temperature, skin protects us & help to develop our skills.

Various types of the skin in the world:

Know your skin:

Everybody has specific type of skin. Some may have oily skin. Others may have dry skin. The points of care differ according to type of skin. Assess your skin type and skin tendencies from your doctor. Request him to tell precaution to follow in your case & causes of problem in your skin.

Sun and skin:

Superficial layers of skin protects us from sunlight and its various dangerous rays like ultraviolet rays, infrared rays. Melanin pigment is present in basic layer of epidermis which absorbs sunlight and protects deeper part. Those who do not have melanin in their basic layer of epidermis are not protected satisfactorily by sunlight.

Sunlight penetrates clouds, fogs, mist. Generally, most of us are exposed to sun upto 80% before age of 18 years. Sunlight alters cells of the skin. Sometimes even genetical changes develop. Sun damaged skin develops. Damaged skin develops premature sags, wrinkles, darkening of the skin, pigmentation and spots. Skin shows development of spider veins, pigmentation etc. Acne scars become prominent. Skin seems older than actual age. So, one should always try to protect skin by wearing sun glasses, hat, sunscreen over arms and legs.

Most of us have some misconcepts about maintaining skin. so, also we have some ignorancy about maintenance case of the skin. Those who have knowledge of skin care, may not follow all precautions or tend to miss precautions which they think that these are inconvenient to them. Everybody of us want to enjoy life. So, also one try to feel to be relaxed & protected. In an attempt to do so.

We damage our skin in our 20’s and 30’s in an attempt to look younger forever. We need to undo this damage later on. Retinoic acid, vitamin C and glycolic acid are mainly used in anti aging regimen.

At the age of 40, we enter in stage of skin maintenance. Always assess what injustice has been done with skin in last two decades. Earlier you start caring for skin, better will be the results. Everyone’s skin is different and needs of skin are different. Skin responds to medicine differently in different individual. So, same concentration of ointment or formula is not applicable to everybody. Duration, frequency of application & combination of these application vary from person to person depending upon his general health. Health problem, life style, habits, diet, exposure to sunlight & environment factors etc.

If one has acne, rosacea, mottled hyperpigmentation, do not purchase advertised products. These common conditions tend to be chronic because of self treatment and incomplete treatment, in sufficient application, insufficient concentration of medicine etc. These factors rather provoke skin problem or tend to make problem resistant to treatment or maintain tendency of the skin to recur the problem. These conditions should be well treated in consultation with expert. In normal skin and acute acne facial treatment is done every 4-6 weeks. In black heads, deep cleansing and use of comedone extractor is advised. Always do good cleansing and exfoliation as essential step in de-aging program.

Use lighter and sheerer make up. Use a water based foundation or moisturizing formula and blend with the sponge. Use concealer only in the inner corners under the eyes. Apply powder sparingly with brush after the foundation. Eye brows need definition. Use shimmer shadow, use matte-eye shadow, use shimmer shadow only to the browbone and the centre of eye lid. Use natural shades with one item having hint of brightness e.g. lipstick, a lip gloss. Use brighter blush to highlight cheek bones or dust over eye make-up. Gray hair or streaks result appearance of faster aging in women.

Keep the skin clean:

On the surface of the skin, sweat, dead cells, dirt, grease, oil and pollutants are present which make the skin dull and flaky on the need to clean the skin everyday. Hence use simple soaps or cleanser twice in a day. Use enough water to wash away the residual soap solution completely. If the skin is oily, use deodorant soaps with antiseptic agent. For normal skin and dry skin, use super fatted soap or glycerin based soaps. To keep superficial layer of skin healthy and glowing one needs to preserve water content of this uppermost layer. Drink plenty of water. Consequently, use moisturizer twice a day and take plenty of water. If skin is oily, use oil free moisturizer only once a day. If one is exposed to dusty environment or if skin is oily, wash your face in morning & in evening with soap & 2-3 times with simple water.

To maintain good and healthy skin:

1. Take well balanced diet regularly at regular time. Avoid junk food, fried food, processed food like chocolate. To reduce weight do not have too much starvation and take plenty of green leafy vegetables, sprouts, pulses and fruits.

2. Take enough water.

3. Maintain good health by regularity in daily schedule of life & good life style.

4. Take enough sleep and rest. Avoid irregular sleep hours & incomplete rest.

5. Avoid bad habits like tobacco in any form (e.g. Ghutka, Mishri, smoking), alcohol, excess tea. Replace these habits by taking milk, fruits, green tea.

6. Ultraviolet rays increase pigmentation. Avoid direct sun light exposure in between 10 a.m. to 4 p.m. Use sun screen.

7. Exercise regularly. Do 30 minutes aerobics like fast walk, jogging, running etc. at least five minutes in a week. Do relaxation exercises like yogasanas and breathing exercises like pranayam.

8. Do light massage over the face regularly. Avoid massage when acne are in active stage i.e. during pain and discomfort.

9. Try to understand environmental factor which affect beauty of skin & try to avoid them. E.g. dry weather of winter, working in congested & closed room.

2:4 SKIN CLEANSERS

Cleansing means wetting the skin to emulsify and remove the grease. Then, rinse the skin with hot water or mild steam bath to remove deeply ingrained dirt which is present in the pores of the hair follicles and sweat glands. Thus, acidic pH (4.5 to 5.5) of the skin surface changes to alkaline which creates a feeling of freshness. As a result, by using cleanser one removes sebum, sweat, dirt, dead cells, make up and micro-organisms from the skin surface.

Cleanser:

Due to dust, sebum & disposition of environmental pollutants, one needs cleansing. To remove make up, to feel good & fresh, cleansing is done. Cleanser should be emollient, exfolient, surfactant (surface cleaner), moisturizer.
Soap is alkaline solution of fatty acid.

Types:

Baby soap, perfume soap, glycerine soap, liquid soap. Advertise of soap promises & gives hope. While advising about soap, take into consideration, the skin type, age, sex, any skin disorder, life style, occupation, specific need & economic condition of the patient. Patient does not hesitate to spend on good products. Take into consideration, sun sensitive skin, dry skin, elderly / child’s skin, atopic / sensitive skin, industrial exposure. Soap should have near neutral pH.

Types of cleanser:

1. Soaps: Soaps clean the skin, soften the water and gives cold and fresh feeling. Perfume action adds grace Antibacterial or deodorant bars: It is used for oily skin. These soaps have pH between 9 to 10 and act against bacteria.

2. Moisturizing based soap bars: These are used for dry skin. These soaps have pH between 5 to 7 and are non-irritant nature. These soaps contain moisturizing agents like lanolin or glycerin. In tropical climate of India, it helps to maintain more than 10% moisture level of upper most layer of the skin.

3. Lipid free cleaner / face wash: They clean without soap formation and leave thin moisturizing film. Subsequently, it is good for sensitive and photo aged skin. Such cleanser contain glycerin and cetyl alcohol. It does not contain any fat.

4. Cleansing lotions: These lotions are water based and so are used for dry skin and normal skin. As these are water based lotions, can be easily washed. These are sold as pore cleansers.

5. Cleansing cream: These are used for dry skin. It is oil based product which removes grease and cosmetic on the skin. Those who have oily skin should avoid its use.

6. Exfolients: These cosmetics remove dead cells from the skin.

7. Abrasive scrubs: Mechanical exfoliants in the form of granules of aluminium oxide, ground fruit pits remove dead cells. They control excess sebum secretions.

8. Cleansing mask /packs:
a Non-setting mask: Non-setting mask contain cold cream and oil packs. It only cleans the skin.

b. Setting mask: It contains ‘fuller’s earth’ (multani mitti). It cleans exfoliate and tightens the skin. c. Peel off masks: It contains gel and latex. It cleans exfoliates and tightens the skin.

2:5 SHAMPOOS AND CONDITIONERS

Everybody of us wants soft, smooth and lustrous hair. Hairs are cosmetically very important. Shampoos and hair conditioners help to improve appearance of the hair. Types of hairs on the basis of oiliness.

Dry hair:
Due to lack of sebum, hair appears dry. Environmental factors (like wind, sunlight), chlorinated water (in swimming pool), chemicals of hair colouring material and mechanical injuries like straightening, perming make hair dry. Oily and

greasy hair:
These are due to excess secretions of sebum by sebaceous glands of the scalp.

Shampoos: To wash hair properly detergent is used in the form of shampoo. It removes dirt, sebum, sweat and dead cell present on the hair and scalp.

Types of shampoos:

A. Normal hair shampoos: To wash healthy hair properly and for minimum conditioning, normal hair shampoos are used.

B. Dry hair shampoo: To make hairs more manageable and to reduce their static electricity, dry hair shampoos are used. These dry hair shampoos do mild cleaning and good conditioning.

C. Oily hair shampoo: Oily hair shampoos carry out good cleaning and minimum conditioning of hairs.

Damaged hair shampoo: Hairs are damaged by hair colour, straightening agents and bleaching agents. In order to repair these hair temporarily, these shampoos do more conditioning and act as mild detergents for cleaning.

D. Conditioning shampoo: This shampoo remove body’s natural secretion i.e. sebum. Also, it contains artificial conditioners. Thus, it is a combination of shampoo and conditioner.

E. Medicated shampoos:

(i) Antidandruff shampoo: In addition to usual contents, antibacterials are also present. Selenium sulphide, zinc pyrithione are present in this shampoo. Dandruff is caused by fungus Pityrosporum ovale.

(ii) Antilice shampoo: Antilice chemical permethrin or gama benzene hexa chloride is present in this shampoo.

(iii) Baby shampoo: These are mild shampoos. So, even adults who wash their hair everyday can use it. It contains ‘amphoteric surfactants’.

Conditioners:

Everybody’s hairs are damaged and made harsh, brittle and entangled. We damage our hair by hair by combing, bruising, drying, shampooing, dyeing, styling, permanent waving and straightening. It cracks the cuticle and weakens the hair. Hot rollers and blow of dry hair from driers weakens tensile strength of the hairs. Chlorinated and salt water damage hair. Weathering grooming leads to hair damage. Permanent hair colours, bleaching, perming, straightening reduces the strengths of hairs. Conditioners increase the strength of hair shaft. They reduce brittleness of hair shaft.

These conditioners reverse the hair damage and thus hair are made manageable.

Types of conditioners:

1. Deep conditioners:

They are concentrated. After application, one should wait for about 25 minutes and then rinse.

2. Instant conditioners:

These are applied and wait for 7-10 minutes. Then rinse hairs, these are less effective due to less contact time.

3. Sunscreen conditioners:

PABA and benzophenones protects the hairs during sun exposure. Thus, these prevent dryness, roughness of surface and loss of colour. 4. Leave in conditioners: After drying the hair, these conditioners are applied and left on hair till next shampoo. These are available in the form of drying lotion.

Action of conditioner:

Conditioners protect the cover of hairs i.e. cuticle and hair shaft. They seal split ends. Shampoo makes hair alkaline and conditioner restores the acidic pH. Hair become more smooth and manageable. So fly away hair do not cause any disturbance. Conditioners make dry, brittle and lusterless hair, more strong, bouncy, glossy and shiny.

2:6 MOISTURIZERS:

Moisturizers are essential in tropical environment in country like India. These should be used just after the bath on moist skin surface. Moisturizers contain different components.

a) Humectants: They absorb water from the environment and lower layers of skin to maintain water content in superficial layer of the skin.

b) Occlusive oils: These oils retard water loss from the skin into environment.

c) Hydrophilic matrices: These have soothing action and these prevent water loss.

d) Others: They contain water, emulsifying agents, sunscreens, fragrances, colouring agents and preservatives.

e) Special additives: Various types of additives are added. E.g. aloe Vera, vitamins, ceramides, EFA’s, urea, hyaluronic acid, alfa hydroxyl acids, collagen and elastin. Use sunscreen during the day and use moisturizer at bed time. People with normal skin and dry skin should use both creams and lotions which have water in oil emulsions.

Oily skin & acne:

Patient with oily skin should not use creamsDue to occlusive healing ointments and biosynthetic dressing acne may likely to occur in 80% patients. Use short course of oral antibiotics. Apply local antibiotic ointment. Retinoic acid can be topically applied. Milia may be formed in 14 % cases.

2:7 Stress & Beauty

Stress is motivator for work so also stress is motivation for fun. How we manage our stress decides whether stress is fun or strain. As our age increases, our skin ages. Mismanaged stress slowly corrodes our beauty. So, stress aggravates aging process of the body & the skin.

Keep releasing tension at interval through change of work & enough rest. Working with relaxation and seeking experience as rewards reduces stress. Let us make our self beautiful from inside otherwise our outer beauty will not last for long period. Inner changes make real changes and lasting changes.

All of us have within us many gifts and strengths which help us to give specific identity and recognition. Everybody should recognize one’s own qualities and strength and utilize them so that these go on developing & skill continues to improve. It nourishes our spirit. It maintains smile on the face and glow on the skin.

Proper method of relaxation helps to cope up with such damage caused by stress & aging. Use positive, approaches like smiling, self expression, music, devote some time for active exercises, yoga, meditation to keep fit oneself in routine life. During routine work, take exercise break or hobby break instead of tea or oily snacks during break. Take food at regular time. avoid harmful habit. We have many socially accepted habits which corrode our health & beauty. substitute them with good habits. Hear music intermittently. This makes you fresh for more studying or working. One can create better nourishing memories than frustrating memories to relish.

2:8 CAMOUFLAGING COSMETICS:

Three basic approaches are used for camouflage cosmetics.
Concealing: These hide the incision lines and bruises.

Camouflages are more opaque and thicker in comparison to regular foundation of make up. Choose concealer which is water proof, more opaque and creamy. It should be avoided on thin skin, skin around the eyes. On thin skin, thick concealer will collect in creases. So, use colour corrector or eye make up in this area.

2:9 FAT INJECTION AS A FILLER

FAT INJECTION IS SAFEST AND CHEAPER SOURCE OF FILLERS

Wrinkles and fat injection:

Due to aging, contours of body and face change. When elastic and collagen fibers in deeper part of the skin break down with increase in age, wrinkles start developing. Furrows and wrinkles develop on the face and neck. Our frequent negative expressions like frowning, squinting, stressful facial expressions promotes this process of wrinkle development. Positive expressions like smiling do not create much stress on these deeper layers of the skin. Various materials like fat, injectable implant, collagen, hyaluronic acid etc. are used to inject in these wrinkles and frown lines to reduce or to eradicate them. Fat injection is done in persons who have sunken areas on the face, cheeks, thin lips, skin wrinkling area of back side of palm etc. Procedure may need 2-4 hours. Patient feels discomfort, swelling and bruising. He can join his work within 5-10 days. Rarely infection may occur. Side effects are minimum.

Fat injection and Fat transfer for recontouring: Facial fat grafts:

Human fat is delicate and fragile substance. Strips of fat are removed from the donor site and inserted in the hollow part, the nasolabial fold (skin fold raming from the bottom of nose to the corner of the mouth), the marionette line, (that runs from the mouth down the chin), the upper lips, lower lips, cheeks, eye brows and the areas next to the eyes where crow feet appear.

Due to aging, cheek bones and lips become less prominent. Consequently these patients desire to increase prominence of these structures. Microlipo injection or autologous fat transfer is procedure used to recounter the face and to increase prominence of cheeks, chin, lip and lower part below the eyes. Fat injection also helps to improve any contour, depression, fine and deep wrinkle lines, furrows, pits of acne scars. As this is one’s own fat, it is not harmful at all and it does not cause any tissue reaction or allergy. If the area where fat is injected is non movement area, the results are long lasting. e.g. area of grooves under the eyes, sunken cheeks. Lip is highly mobile and so these results are less favourable. Atrophic aging of the hands can also be treated. Fat injection is avoided in breast as it affects mammogram pictures which are taken to diagnose cancer of the breast.

Fat is obtained from another part of the body such as abdomen, thighs etc. Fat is removed under local anaesthesia or sometimes under general anaesthesia and then injected just under the skin beneath the wrinkles. Injection is repeated till desired correction is achieved. After first few months, 60% fat is reabsorbed. Subsequently, three or four reinjections are necessary at a gap of six months. Following fat injection, local swelling and some discomfort may develop which soon disappears.

Fat grafting / microlipoinjection:

Fat grafting gives instant results with almost zero down time. This is not possible in many surgical procedures. Due to aging, hands become bony. These bony hands due to lack of sufficient fat and suppleness look more like gardening tools and mark advancing age. These hands have hollowing, general loss of tissue and fat, wrinkles. These women need hand make over by grafting their own fat. One’s own fat is ideal filler substance. The cells are fragile, small. The fat is extracted with a large syringing from abdominal wall or thighs or buttocks. The blood, liquid are separated from fat. This fat is injected. Usually more than needed volume of fat is injected because it is partly absorbed by the body. No bandage is required. In some patients, revision injection is necessary after 6 months to 1 year to maintain fresh appearance of the area. Thus, ugly part of the body (e.g. hand) becomes more attractive.

Botox:

What you meant by Botox treatment?

Botox blocks impulses from the nerve to contracting muscle and so keeps them relaxed. Botox weakens the contracting muscles and keep them relaxed. Thus, wrinkles disappear & face becomes smoother and softer. It prevents formation of new wrinkles. It is injected in contracting muscle.
Botox is safe and simple way to minimize wrinkles which are caused by contractions of underlying facial muscles. Results last for 3-6 months. Duration of results increases on repetition. Botox is injected by micro needles. It takes few minutes. The injection shows result in 3-5 days. Do not massage after injection. It can also be used in axillary and palmer hyperhydrosis, excess sweating.

Wrinkles on face, before treatment:

Reconstituted botox can be preserved upto 8 weeks. Do not freeze it. Do not use it, if it is thawed. If 5 ml is added, it provides 2 units/ml. In case of Full palmer hyperhydrosis work point at 2 cm x 2 cm square. Inject 2 units per site, 50 to 100 units can be injected at a time. In crow’s feet, injection is given subcutaneously because the muscle is very thin and it is present in subcutaneous layer. Do not inject upto 1cm above internal one-third of eye brow. Mezotak is injected in mesoderm for skin tightening.

After botox treatment:

What is botox?

Botulinum toxin type A is called botox. It is produced from bacterium Clostridium botulinum. This toxin blocks the release of acetyl choline and relaxes the muscle. Very small therapeutic dose is injected every year. About one million patients are using botox. Botox is safe and so it is safe non surgical approach for facial rejuvenation. Safety of botox: Although botox is a toxin, it is very safe. It is used in minute doses. These doses do not spread to other parts of the body. Person can resume his work immediately. Treatment requires about ten minutes. Results are seen in 4 to 5 days. Repetition of botox: Effects of botox lasts for about 6 months. If repetition is done, gradually time interval required increases. So, fewer treatment will be required to obtain same effects. Repetition of botox breaks habit of contracting the muscles and so lines reduce. Botox is not used in pregnant and lactating mothers. Some patients need touch up to improve the results further. It costs ¼ to ½ the cost of initial treatment. Side effects are less common. 10% patient may develop small haematoma which resolves in due course. Drooping of eye lid may develop which reverses after 3 to 5 months. Rarely patient may develop double vision which reverses in three to six months. Avoid aspirin or anti-inflammatory drugs 2 weeks prior to botox treatment. Precautions after the treatment: Do not massage locally after injection. Do not lie down for 4 hours after the treatment. Exercise the muscles for 15 minutes every one hour after the injection for better attachment of botox to muscles.

Botox cosmetics:

Botox is not skin filler but it is relaxant of muscles. Botox can be used with filler. It is used to reduce worry lines (between the eye brows), horizontal lines on fore head, and crows feet. Smoker’s lines (multiple fine lines on the lips) can also be smoothened. It helps to lift turned down corner of the mouth, reducing two prominent vertical neck folds. Excess perspiration of arm pits, palms, soles can also be corrected.

Botox is usually injected in muscle like corrugator, proceras, orbicularis, oculi, frontalis and nasalis muscle. So, know the anatomy of these muscles. In deep crow face injection sites are besides the eyes. Safer zone for botox injection is between the eyes and just above it on the forehead. Point for nasalis muscle i just below it. The mental crease can be treated with botox. Platysma cannot be treated with botox. Botox: results appear after 3 weeks. In crow feet injection, is given just subcutaneously.

Pinch test for lower eye lid to lift the skin by pinching. In ideal patient, after leaving pinching skin. Skin goes to original position immediately. If it takes time then that patient is bad patient for botox. While injecting nasalis muscle inject as medially as possible to protect effects from injection of botox. When you take with patient area and observation muscle when you find dynamic wrinkle. It helps to decide sites to be treated by botox injection.

It is naturally occurring proteins prepared by botulinum toxin bacteria which paralyses motor end plate by reducing secretions of Acetyle choline. Very small amount is used. In neurological cases, about 100 units are required. Man cannot have toxicity upto 3000 units. It can be used to shape mandibular contour to reduce massetor hypertrophy or thickening. To prevent widening of facial scars, if incision is at right angle to langer lines a week prior to surgery. 2 units of botox is given in local area of muscle. In patient having depression, the angle of mouth is depressed to elevate if botox can be given. To treat nasal wrinkles botox can be used. When one wants to use botox on neck & palm dilute it with 2.5 ml. In case of pre-existing asymmetry of face, use unequal amount of dose. Always let the patient know about asymmetry. In boggy eyelid, do not use botox as patient has redundant skin. In lower face one should be conservative. Inject 1-2 units of botox in the belly of the muscle & not in fold in case of nasolabial fold. In marrione line, in prominent upper lip, inject 2 units. To reduce broadening. To reduce mental crease use 1 unit

Injection of Botox in forehead, prevent wrinkling in fore head and worry lines. Patient can raise his eye brow. Thus, forehead and upper eye arc become more youthful. Wrinkles produce worry line, crow’s feet, frown lines.

2:10 OTHER FILLERS Hyaluronic acid (Perlane/Restylane):

Hyaluronic acid is highly stable and very biocompatible. It is available as ‘Perlane’ or ‘Restylane’. After applying topical anaesthesia or local anaesthesia , hyaluronic acid is injected with small needle just like insulin syringe. No skin test is required. The procedure takes fifteen to forty minutes depending on size of area. No dressings are required afterwards. One may need a touch up procedure after about two to four weeks. Results are immediate. Swelling and bruising may be mild or none at all. Pain is absent. No rest is required after the procedure. Result lasts upto six months. Results are appreciated in all cases. Contour and wrinkles improve. It has natural and presentable results.

Looks are impressive in professional, social life.

Collagen injection:

With aging, our laugh lines, smile lines, crow’s feet and facial creases increase in prominence due to underlying muscles breakage. It can be treated by surgery by using fillers. Collagen is used as soft tissue filler.

Injectable implants (Artecoll):

It is used to treat static facial lines, enlarged lips, facial imperfections. About 20 minutes time is required.
Side effects are redness, tenderness, minor swelling, bruising etc. Itching may last for 2-3 days.
Risk- skin may temporarily tighter and harder. Later on it softens.
Results last longer upto 10 years or more.

Hylaform gel: It is like restylane and may cause allergy.

Collagen: it is skin filler which is not preferred nowadays because of better restylane.

For fillers, patient who want, in filler inject, his skin should not be thick and should not be on aspirin. It should not be given too superficial as it causes granuloma.

Filler:
When anesthetic is applied over the skin, it causes some swelling locally so it is avoided when one wants to use filler. In hip, it is injected in philtrum, cupid’s browm vermilion border, projecting bulk of upper and lower lip. Wyclose 15 mg / ml is used to erase effect of unwanted filler.

BEAUTY AND COSMETIC TREATMENT PART- II

2:2 FACIAL REJUVENATION (MAKING THE FACE LOOK YOUNGER)

RENEWAL/RENOVATION OF THE FACE

Face is the most exposed part of the body. Although we look at the face everyday, most of us, look casually and one day we find different face than the one we saw years ago. Aging and wrong habits like smoking, sunlight, stressful life style, negative habits, addictions, wrong diet pattern and various health factors affect the appearance of the face.

Face is the most commonly exposed to trauma of environment, sunlight, accident, infection, side effects of cosmetic & self-treatment. So, everybody of us has certain flaw on the face in the form of scar, pigmentation, dark spots, depressed pits, roughness & dullness, wrinkles, looseness of the skin, excess subcutaneous fat or lack of fat, bone deformity, muscle hypertrophy or atrophy etc. All these problems are treatable partially or fully & face can be improved in its appearance (rejuvenation). Thus, problem of beauty of face can be in the skin, subcutaneous fat, muscle & strength, size, body & shape.

Effects of aging, environment, sunlight & bad life style: Actinic rays, stress and worries contribute in accelerating natural process of aging.

Aging affects body externally and internally.

1) Changes in the quality of skin:

a) With incrase in age, elastic fibers degrade to firm amorphous mass. So luminosity and elasticity of skin is reduced. Collagen fibres decrease around the substances like glycosaminoglycans and proteoglycans increase. So, blood vessels remain dilated, skin pores are enlarged, dark stains develop, uneven pigmentation occurs.
b) Skin wrinkles develop due to decreased turgor of skin.
c) The ptosis of skin and face develops due to loss of tone and action of gravity
d) Reduction and ptosis of fat in subcutaneous area

2) External changes:
Due to sunlight skin damages. This damage leads to reduction in elastic collagen. So tone of skin is reduced. On the skin, one finds heliodermatitis, pigmentation and lentigenesis, actinic keratosis, telengiactasia. Surface of such skin shows dark spots, skin tags, roughness, pigmentation etc. Too cold and too hot climate use of chemicals in make up and use of tobacco (as smoking, tobacco chewing in gum massage etc. hasten process of aging.

Before treatment-------------------After 6 weeks

Variety of procedures to rejuvenation of face:

So, to overcome above changes caused by aging following procedures are used to rejuvenate. But first most important precaution is everyone should take is to avoid sunlight exposure.

1. Non-surgical procedures:

b) Chemical methods:
i) use of chemical peels
ii) use of fillers
iii) use of injection botulinium
iv) mesotherapy

c) Mechanical process:
i) Microdermabrasion and diamond dermabrasion

d) Photorejuvenation of the skin
i) Lasers- Q Switch YAG Laser, LP Nd:YAG Laser
ii) IPL

e) Thread lift

Before ------------After 6 weeks

2. Surgical procedures
i) Surgical lasers like CO2 resurfacing, roller, micro needling, deeper chemical peels, dermabrasion.

various types of face lifts, brow lift, suspension wires, implants, blepharoplasty.

We spend a lot of money on cosmetics, decorating our drawing room, interior of the house etc. during whole life. But we rarely think of expending money on face rejuvenation which improves basic quality of face appearance & reduces our need to use cosmetics & expenses on them. We do not plan our budget for face rejuvenation. Rather we succumb to self-treatment or treatment from non-medical person & make our problem worsen. It becomes resistant to the results of good medical treatment.

Choice of various procedures:

These facial rejuvenation procedures can be simple non-surgical (non-ablative, non-traumatic) like laser peel, skin tightening of the face by laser & by radiofrequency, non ablative chemical peels, non-ablative laser resurfacing, fillers, botox, microdermabrasion. There are surgical procedures like ablative CO2 laser resurfacing, micro needling roller, dermabrasion, face lifts, use of implants etc. each procedure has its limitations of giving benefit. Considering problem of face and its skin, and available instruments like various laser instruments, doctor selects effective procedure for particular case. If multiple laser equipments are avaialable at the centre like ours, laser & cosmetic surgeon has a choice to give effective results. Use of Q-switch Nd:YAG Laser machine is more effective in rejuvenation of skin & this machine also helps to reduce dark spots on the skin, roughness of the skin, dullness of the skin etc.

What you should do if you want to undergo cosmetic procedures?

Before-------------After 6 weeks

After reading about facts of information of these various procedures- individual feels confused. So, he should consult cosmetic surgeon. Let him know what you want and what you expect. Discuss with him about the risk, benefits, costs and suitability of procedure for your individuality. After assessment of problem of your face and health aspect, he can suggest which procedure you should undergo. He also takes into account various aspects of your health & health problems. He also takes into account your capacity to spend. Depending on your financial budget, various procedures can be selected. Procedures of lasers are costly. So, those who cannot spend much cheaper, procedures can be selected. These cheaper procedures have their limitations in comparison to laser techniques.

85 % men are resistant to go to doctor for cosmetic reason as compared to women. Many of them approach for the treatment quite late. Even though they come late, they expect an instant or dramatic improvement. Some of them have a lot of hurry due to marriage problem or residence at distant place.

Surgical face rejuvenation:

On the day of admission: Contact the centre one day earlier to confirm your appointment. Do not eat or drink 6 hours before surgery. Ask about whether to take any medication on this day. Do not take medicine like aspirin, vitamin a week before the surgery. Wear lose clothes. Do not wear contact lenses. Wear glasses. Do not keep valuables and jewellery with you. Avoid make up, nail polish or any cosmetic. Remove all make up. If you have any problem of infection like fever, common cold etc, inform immediately. Take proper bath. Later on do not apply any cream or powder or mascara. It may irritate eyes during surgery (if eyes are taped) or it can get into scar and stain the scar permanently. Keep your all reports with you. Reports like blood test, X-ray, ECG, mammography/ ultrasound of local area. Instructions after surgery: Take enough rest to avoid restlessness for two days. Do not be alone during this period. Doctor may suggest to apply ice pack on the local area for first 48 hours. Take light, simple and natural diet. Drain in wound is removed after twenty four to forty eight hours. One may feel some pain and discomfort. Doctor prescribes pain relieving medicine. If pain does not decreases or persist contact the centre. Also contact if swelling increases or bandages seem too tight. Avoid alcohol, smoking, tobacco. Ask your doctor how to take care of the wounds, when to take bath and when will sutures be removed? For few weeks: With your own hands, do not wash hairs. Do not raise arms above shoulder. Take enough rest. Avoid exercises of shoulder and arms. Avoid exposure to sun. use scarf and sun glasses. Avoid driving for one to two weeks. Wear bra. Where incisions are made? Site of incision is decided after examining and discussing with the patient. Every incisions have its own advantages and disadvantages as mentioned earlier. Every person is different and needs different technique.

Face rejuvenation
Niacinamide 4% as rose water. It decreases pigmentation, reduces sebum & improves collagen.

Before -------4 months after

Pigmentation:
Use Triluma cream which contains hydroquinone 4%, Tretinoine 0.5% & Fluocinolone (steroid).
Vanishing cream: It contains 6% hydroquinone, 0.1% tretinoin & 1% hydrocortisone. 2% Azelaic acid & 2% Kojic acid.

Idebenone:
In morning, use
1. First step, apply 4% niacinamide
2. 2nd step, apply Idebenone
3. 3rd step is anterior helioes SPF 60
4. Heliocare cream

In evening use,
1. Step I- Citrix CRS serum
2. Step II- Apply vanish cream
3. Step III- AHA lotion

Idebenone is easily absorbed in the skin better than L-ascorbic acid.
Antioxidant:- Idebenone 10nm
Ascorbic acid 10 nm
Tocophenol 10nm
Idebenone improves dryness of the skin, glow appearance when used for 8 weeks. It protects from sun damage & depigmentation changes.

Periorbital darkening:
It may be due to atopic dermatitis, allergic contact dermatitis. Family history of autosomal dominance, stress, eye strain, sleepless nights or less sleep, vasculature, increase secretion of ACTH increases melanin formation. Use Vit.E & Aloe vera in a day. Uneven destraction in life may aggravate. Vitamin C, moisturizer, ultrasonic stimulation increases circulation. Moisturizer, tea extract, grape seed extract & titanium dioxide may improve it. Microderma with glycolic acid peel alternately can be done. Iontophoresis with 2% lactic acid can be done. Skin tightening may help. Mesobotox may improve it.

Laser hair removal and photorejuvenation:

1) In light skin and dark coarse hair:

In light or fair skin epidermal protection is not required. The minimum pulse width can be used. Reduce fluence by 10% on bony area. In case of fine hair more fluence is required. In case of coarse hair less fluence is required.

2) In dark skin / coarse hair:

Provide epidermal protection. Use longer pulse width. Take help of precooling and post cooling. First give test dose and look for redness and pain sensitivity of patients. Review patient after 12-24 hour for delayed signs. If there are signs, reduce fluence by 10%. If there are no signs, repeat the same sittings.

3) Post treatment:

Use cold aloe vera gel to prevent burning sensation. In case of burn, use antibiotic cream. Prepare video clip of satisfactory patients.

2:11 SEBORRHEA & SEBORRHOEIC DERMATITIS

In seborrhea, there is excess production of sebum. So, skin, scalp and hairs are seen oily. Most of people dislike oiliness or greasiness of the skin. It seems unattractive. Accumulation or degradation of used cosmetic products or accumulation of byproducts of heavy perspiration produces extra sebum. There is no crusting, inflammation and intense itching.

Due to excess sebum production person may likely to develop acne. Acne is more common in teenage.

Seborrhoeic dermatitis:

Seborrhoeic dermatitis may likely to develop in first three months of life or between the age of 30 to 70 years. It is common disorder. Scalp and hairs have excessive oiliness. So, greasy and yellow scales are formed which cover red inflamed and moist scalp skin and there is intense itching. Itching leads to hard scratching and any infection. It is the most commonly on scalp but it can develop in eye brows, cheeks and fold of the nose. Severe seborrhoeic dermatitis may resemble psoriasis and sebopsoriasis. It is not curable but treatable condition and remain clear with regular use of prescribed treatment.

2:12 COSMETIC ROLLER / MEDICAL NEEDLING

It is done for smoother skin. It is a miniature CIT instrument with much smaller needles. Tiny needles create micro channels in the skin and so product penetrates deeper on the skin. On the skin, vitamin A and C and anti oxidants are applied before procedure. Under anaesthesia, hundreds of pin prick into the out layer of the skin. Collagen tomes up and nourishing formulation dips down. After surgery, skin remains pink for 2-3 weeks. Thus, old collagen strands are broken up without destroying epidermis.