News Articles from Dr. Berger

Preemptive BOTOX® Strike

by Eric Berger MD on September 25, 2008

... and I overheard her say to the lovely, 30-something femme fatale, “You’re so young and beautiful! Why do you need BOTOX®?”
I’m certain she thought that to be a rhetorical question… but she was wrong. The correct answer, however, becomes self-evident if you’re armed with a basic understanding of skin structure and a little information about how BOTOX® actually works its magic.

First a bit of important anatomy: The muscles of facial expression lie directly over the facial bones. Next there’s a layer of fat which varies in thickness and in some places, for example around the eyes and in the forehead, can be insignificantly thin. Above this fatty layer lies the deepest layer of skin, the Dermis.

The Dermis is a dense web of woven collagen fibers not unlike a thick, flexible cloth. Collagen fibers provide strength and elasticity to the skin, so we constantly produce new collagen to replace old collagen, reinforcing and repairing the Dermis.

As we age, the rate of collagen production slows dramatically, and the formerly thick, flexible collagen becomes thinner and more brittle.
The outermost layer is the Epidermis. It’s composed of four distinct layers. Soft new cells are created at the deepest layer, the Basal Layer, and rise through the more superficial layers, changing and hardening as they rise.

By the time they reach the surface, the epidermal cells become dead, dry, crusty flakes which slough off in order to make way for the next rising layer.

The cycle is endless but, as we age, cell replacement slows to a crawl. Babies create a new layer of epidermis every 7-10 days. At age 40, we require about 45 days to complete the process.

Now, let’s talk about wrinkles.
There are two types of wrinkles, active wrinkles and passive wrinkles. Active wrinkles occur only when you are actually moving muscles to make a facial expression. Passive wrinkles, or furrows, are visible even at rest... even while asleep!

The “woven cloth” of the Dermis becomes more brittle as we age… as if cashmere were becoming burlap… and our facial muscles are actively wrinkling that fragile cloth over and over, thousands of times a day. Regrettably, the most susceptible areas are also the most active and, to make matters worse, have the least amount of cushioning fatty tissue.

Despite skin’s natural elasticity, the formation of permanent, passive furrows are the inevitable result of a million active ‘scrunchings’ of the forehead, between the eyebrows and at the Crow’s Feet. Furthermore, as I mentioned before, adult skin cells shed more slowly leaving a dryer, duller, more brittle surface layer which only serves to accentuate the deepening furrows… visual Black Hole.

Dry, deep furrows covered in dull dead skin cells! What’s a girl to do?!BOTOX®, properly applied, weakens the facial muscles. That’s right, weakens, not paralyses. The worst enemy of “good” is “better”, less is more, etc., etc., etc.

Over-application of BOTOX®, paralyzing your face into an expressionless mask, is singularly unattractive. Really. However, weakening the muscles while preserving the attractive and (in my opinion) essential quality of facial expression, is a terrific way to extend your youthfully smooth appearance and possibly completely avoid ever forming passive wrinkles and deep furrows.

Of course, the process of permanent furrowing accelerates due to thinning and decreased resiliency of the skin as we age… but starting BOTOX® in our 30s, preemptively striking at active wrinkles, is a lot more effective than trying to play “catch up” with our passive wrinkles when we’re approaching 50.
So, the question should have been, “Why not start BOTOX® in your 30s, before permanent, deep wrinkles form?”

And that, indeed, is rhetorical!


Skin Care to Beat the Bitter Cold
by Eric Berger MD on December 1, 2007

My specialty training at Albert Einstein Hospital and Cosmetic Surgery Fellowship prepared me for every surgical eventuality, but I have come to believe that cosmetic lasers, BOTOX® and a regular program of daily care are the future of anti-aging skin care.

If we begin proper care young enough, we may never need cosmetic surgery. These are promising times!

But right now the vicious bite of New York winter is close at hand and we’ll all be tightly clamped in its frigid jaws when this column appears in print. Icy wind will whip particles of dirt and soot into our pores like microscopic bullets and rip soothing moisture from our skin.
Not a pretty picture, but it begs the question, "How can I protect my skin against the cold?"

First, Exfoliate every month. Removing dead skin and awakening fresh new surface cells will maximize the effectiveness of any other skin treatment. There are more ‘exfoliants’ at the cosmetics counter than anyone can count, but real exfoliation is accomplished by trained aestheticians using a Vibraderm™ system or specially compounded facial masks. Vibradermabrasion™ is truly unique. Traditional crystal dermabrasion is very much like using a sand-blaster to remove dead cells… a harsh and irritating process. But Vibradermabrasion infuses healing compounds such as Copper Peptides into freshly exfoliated skin, the gently vibrating paddles stimulate collagen production and Vibraderm feels absolutely wonderful on your face or entire body!

Secondly, Cleanse and Moisturize twice a day and never, ever, go to sleep wearing makeup. When do you expect your skin to breathe? No matter how late you arrive home from holiday reverie, and how warm and inviting your bed appears, deep clean and moisturize your face before it touches the pillow… especially if other party guests were smoking? Do you really want to spend the night with cigarette smoke trapped in your pores by accumulated oils and old makeup?
Whatever your skin type, your physician or his aesthetician can help you select the best cleansing and moisturizing options. Avoid whatever is sold as the "magic ingredient du jour." These heavily advertised products are terribly expensive and usually not as effective as doctor-recommended products which cost about 1/2 the price of commercial products… the ones that are modeled by lovely young women barely past puberty who have never actually experienced either a wrinkle or a blemish.
And don’t just moisturize the surface of your skin. Winter air is much dryer than summer air and heated indoor air is even dryer than that. During the winter, moisturize your entire body by drinking two extra glasses of water a day and use a cool-mist humidifier in the bedroom at night.
Did we forget your lips? It takes only a moment to stay kissable with Chapstick™, but it can take weeks to heal cracked, bleeding painful lips.

Finally, Protect your skin.
Winter may seem less sunny, but until they rebuild the ozone layer or build a dome over Manhattan, winter sunscreen is absolutely essential. Use SPF 30-45 every day. Sun damage is cumulative. “I’m only in the sun ten minutes between the apartment and the taxi,” is not an excuse. Ten minutes a day is 50 minutes a week… 3 hours a month… not counting weekends. “Cumulative” is the operative word.

Exfoliate, cleanse and moisturize your skin, apply sunscreen generously, drink lots of water and Santa will bring you a great complexion for the New Year.
© 2007 Eric Berger MD

Please send questions and suggestions for future articles to:
Dr. Eric Berger
Berger Medical Aesthetics PC
333 East 49th Street, Suite LD
New York, NY 10017
(212) 838-6900
www.bergermedical.com


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