Workshop in Paris – Thanks
Dear Hervé, Koen and Mauricio

Thanks for giving so generously of your time and expertise last Sunday in Paris. Besides the inspiration of your insights and discussion, it is most impressive to see your cohesivity and smooth flow as a team… no rheologic pun intended!

I look forward to seeing you again at the Genève AMWC and/or American Society of Aesthetic Plastic Surgery (ASAPS) congresses.

With kind regards

Hema

—
*Hema Sundaram, M.D.*

Dermatology, Cosmetic & Laser Surgery

11119 Rockville Pike, Ste 205, Rockville, MD 20852.
Tel. 301-984-3376

8316 Arlington Blvd, Ste 401, Fairfax, VA 22031.
Tel. 703-641-9666

Thanks to several standardized, advanced techniques like ©ChicLift, the signs of aging are no longer inevitable.

Everyone wants to have this 20years old fresh look in their eyes, so it seems logical that many patients consult us with this idea in mind : getting a rejuvenated look of the eyes area.

Even more so since the eyes are a mirror of the soul…

New techniques and injectables have led to a holistic approach when it comes to treatingsigns of aging. However, the procedures involved in this approach are very little documented and there are no approvedrecommendations yet.

This is whyI wanted to provide a detailed and practical guide to restoring volume in the midface  and rejuvenating the eyes area, based on expert consensus recommendations,at a time where cosmetic surgery is losing ground to non-invasive procedures like injections.

The conclusion ?

Combining treatments like botulinum towin injections, Hyaluronic Acid injections and volumizing products undeniably provide an embellishment and rejuvenation effect inthis area.

Botulinum toxin injections have been used for 35 years nowand, when performed by experienced practitioners, they are completelysafe. Relaxingthe eyesmuscles with low doses oftoxin,will notchange the eyes’ expression but simply prevent, foras long as possible, the contractions that cause wrinkles.

Remember that each look has its own morphology and characteristics, which make a person’s unique charm and personality.

One last thing: did you know that researchers statedthat the eye structure and thepersonality could be related ? The genesequences involved in developing the iris also contribute to the development of the brain’s frontal lobe, which could be seen as the ”motherboard”of our personality. But this is a differentstory …

Turkish national congress for Plastic Reconstructive and Aesthetic Surgery.

From the 11th to the 14th of October was held the 39th Turkish National Congress ofPlastic and Aesthetic Surgeons, and I had the pleasure to participate to it.I received a very touching thank you letter that I share with you below. I’m taking this opportunity tothank Dr. ÖZMEN for his testimony and for attending this congress.

Training et Learning à Singapore : anatomy of the face and neck, Asian beauty, Botox and hyaluronic acidinjections. We provided excellence training for practitionerscoming from Dubai, Turkey, Lebanon, Kuwait, Taiwan, and Thailand…

I was very touched by the comment of one of these surgeons, Dr. Alice LIUI, from Taiwan:

Une séquence amusante publiée par une consœur d’Istanbul !

There is one procedure that is very popular among patients seeking to erase fine linesor spots and to restore the skin’s radiance: it’s calledpeeling.

It can be performed at different intensities, using always the same principle: a more or less deep exfoliation of the skin’s upper layers.

We use more or less concentrated acids,according to the type of treatment, and they all aim to refresh the complexion, to blur the spots and toerase certain scars.

This goes from a simple radiance boost to a complete lines and fine lines treatment.

You are wondering what the treated areas are? Actually, all of them. The uppereyelids, the fine lines around the eyes, the forehead, the cheeks, the “barcode” wrinkles around the mouth, the cleavage and even the hands!

The first step – preparing the skin: the patient must put on a special cream during 3 weeks before the procedure.

The second step – the peeling session in our clinic. After cleaning and degreasing the skin withspecific lotions, weapply the acid product for a few minutes, using cotton swabs. Then, the acid solution is rapidly neutralized with an alkaline lotion and rinsed with water. The procedure ends with a softening and hydrating cream.

No recovery time is needed, you can go back to your activity immediately. This peeling procedure can be performed at any time of the year, on all skin types.

For me, it all started with a focus on the human and culturaldiversity, during the30 years spent at the University Hospital of Nice where I treated patients with diseases or trauma of the face and neck. At many points ofmy career,I had to deal with difficult cases. I had to repair or restore the functions and then the naturallook, even when it seemed almost impossible.

Besides, I have always hada passion for getting to know different cultures around the world. It allowed me to train in treating all types of face,of any ethnic group from any continent.

This approach must be supported by high qualifications, as well researchwork like scientific articles and films published for highly rated medical journals (Plastic Reconstructive Surgery Journal / PRS Global open access, Dermatologic surgery …).

This passion forunderstanding and learning has given me the joy of creating the EIFFEL TOWER Nose Lift concept,which isa particularly effective and natural method for reshaping the nose, but also the HEART OF FACE conceptin 2006, which is the first rejuvenation concept emphasizing the beauty of the heart-shaped face, successfully adopted by fellow practitionersand by cosmetic firmsin Asia. We should alsomention the FACESCULPTURE, a global,anatomical and soft remodeling concept, using injections and a 3D technology; or the CHIC-LIFT (eye rejuvenation procedure usingsurgery or injections) in 2016 to name justa few…

The medical Botulinum toxin is manufactured industrially and it’s used as a treatment for strictly local purposes; it has been used for 25 years in neurology, ophthalmology and pediatrics in order to relax muscles that causeabnormal or painful conditions.

The Botulinum toxin blocks the muscle by inhibiting the release of a neurotransmitter responsible for transmitting information between the nerve and the muscle. The acetylcholine causes the muscular contraction; when blocked, the muscle can no longer contract. The botulinum toxin action does not alter the muscle or the nerve, and is fully reversible when the toxin is eliminated. This is the action and the product I use in our clinic for the Botox procedures.

I use it mainly fortreating expression wrinkles inthe upper face (upper third of the face). In this area, the skin and the muscle join, forming a tightcouple that results in theso-called “expression” wrinkles. The muscular relaxation becomes visiblea few days after the injections and it’sreversible; it lasts only 4 to 6 months, so the procedure will have to be repeated if the patientwants to obtain the same result.

Let’s not forget one essential thing: we must conduct an accurate analysis of the entire aging process of the face, because sometimes I might recommend the combined use of different products and techniquesin orderto achieve a more global action.

Thank you for botulinum toxin !
Date: 28 août 2014 20:13:47 UTC+2
Destinataire: doctor@raspaldo.fr
Objet: Thank you for BOTULINUM TOXIN

Hi Dr Raspaldo!

Thank you so very much for seeing me today and being so generous! Im very lucky! It was great to see you, and Im glad you are so well.

I hope you had a Cannes afternoon and got to see your daughters.

When you have a spare moment will you send me my images you took of my nose. I want to show mum.

Thank you very much again and see you soon!!

G

The skin around the eyeshas a very atypical structure that makes it particularly fragile. It’s aphysiological fact, and everyoneis concerned. The skin is twenty times thinner than the rest of the face. It is also less rich in collagenand elastic fibers, and has very little subcutaneous fat, which are the two elements that providedistension and relaxation.

Unfortunately,that’s not all: the blood and lymphatic circulation is lazier in this area.  The 22 musclesare constantly at work, 14 of themare activated every 10 seconds, not to mention the 28,000 daily blinks. The expressiveness of our face clearly influencesthe intensity and precocity of expression lines, but our life style also has an impact. The outline of the eye suffers heavily fromtobacco, pollution, intensive screen use and unhealthy eating.

Toomuch salt causes eye bags, whereasa lazy or excessively solicited liver is a source of bluish darkrings. The factis that as early as age 25, our eyes can start losing their fresh look.

Besides, the skull changessignificantly between 20 and 60 years. The lower areaof the orbits become larger, the boneslose density, the musclesweakendue to the billions of repeated contractions.

The eye becomes rounder,because the opening of the upper eyelids changes. The lower eyelid retracts, due to the receding tissues. At the same time, the fat in the orbital area moves towards the cheekbone. This is what makes us looktired and sad.

According to a study conducted on women, theirmain concern is dark circles (37%), wrinkles (34%), eyebags(15%) and drooping eyelids (9%). But all of these conditions have solutions that can be combined.

Six out of ten cosmetic medicine procedures in France are injections of Botulinum toxin. With a steady growth of 10% per year, thistechnique attracts more and more women, at a younger age.

Women under35 are twice as many receiving Botulinum toxin injections than womenover 55. For women who are determined to delay signs of aging, as for all those who are definitely fans, Botox remains a magical and safe product for smoothing wrinkles.

The technique is safe,since it has been used from 1977 for medical purposes, to correct the strabismus of the newborn. The danger lies not in the product, but in the hand of the practitioner. The right doseof Botulinum toxin is effective for diminishing muscle contractions. But poorly dosed or injected in the wrong place, it canbe responsible for a closed eye, an asymmetrical smile or a frozen-lookingforehead.

The effects of Botulinum toxin settle in slowly, they become visible afterthree to fifteen days, and last three to six months, according to the quantity injected.

But the crucial questionis: what is the best age to start?

The answer is basically when you feel the need to. But in order to prevent wrinkles, some patients prefer to start veryearly. The goal is not to correct wrinkles, but to prevent them from showing up.

How many times in a lifetime do you need Botulinum toxin? If you startearly enough and you care for your skin, there is no actual limit. You can get Botulinum toxin injections all life long, witha minimum of three months timebetween two sessions, otherwise you could develop a resistance to the toxin, which would then become ineffective.

For those who don’t necessarily want to chase downwrinkles but simply seek for a freshlookingface, Botox is a standard,self-sufficienttreatment.

Regenerate the skin during sleep and wake up to a fresh complexion.

This is the number one concern of 60% of women, even before wrinkles; it almost turns to obsession and makes the number of aesthetic procedures go up.

This is to say how fatigue ruins the lives of many people. Twenty years ago, women searched the advice of a practitionerhoping for arejuvenating action. Today, they ask us to make them look more radiant and well-rested. By the age of 30, almost a third of our patients complain about their sad and tired-lookingfaces. Surprisingly, their complexion looks dull even after a good night’s sleep.

The problem is that they often live a hectic life, and when the body has drawn too much energy, it causes several visible symptoms: dull complexion, deep dark circles, sagging skin around theeyes, sagging tissues, contracted muscles – like the lion’wrinkles onthe forehead, the mouth folds– and all this makes a person look ten years older.

There’s a real change in the metabolism hiding behind these external signs of skin fatigue.

An exhausted body generates a large amount of ”waste”that prevents the skin from recovering. When the body is overworked or stressed, not only does the melatoninlevel (powerful antioxidant and universal cell repairer) drop, but thecortisol level (which is a collagendestroyer) goes up. And that’s not all. Glycation, which is responsible for the stiffening of the skinfibers, causing wrinkles,  accelerates. At the same time, the proteasome, the cell scavenger responsible for cleaning the damaged proteins, is overwhelmed.

It’s a very complex process. This is why acting on the skin brightness is not enough, we have to act on all the signs of fatigue and strengthen the cellular regeneration mechanisms that are at work at night.

This is the aim that we will be discussing asa “regeneration” protocol when you come visit us in our clinic.

The cosmetic surgery has made tremendous progresses. I am delighted to see what we can achieve today thanks to the enthusiasm and the energy in the world of surgery.

The technologies are improvingand we have many resources available while we try to offer personalized solutions to our patients, going from medical procedure tocosmetic surgery procedures.

Our standards are more preciseand reliable. We have also been able to reduce the procedures time,  making them safer for patients.

The improvement of medical devicesis another important evolution, and they are used in both medicine and cosmetic surgery. These are engineering products backed up by many years of researchand development.

Let’s not forget that the products continue to improve, reducing the painand the recovery time while improving the immediate results and making them last longer. For example the quality of injectables gotbetter: they last longer, their “feel” or texture are more natural and the side effects very much reduced. We contributed to this evolution with countless trainings that we provided for the last 25 years all overthe world.

The two major evolution incosmetic surgery are: the improvement of non-invasive procedures and the natural-looking results.

I would like to thank the scientists who help us improve our procedures, as well as my colleagues, many of whom work relentlessly to achieve progresses for our patients’benefit.

We should also mention the introduction of the recent ISO “IMAL” certification, which makes it easier for patients to have quality procedures using adapted and sophisticated tools.