Today's cosmetic patient expects the highest level of care and treatment outcomes. Rightfully, people want results that are both natural and enhancing. We have dedicated ourselves to meeting this demand by not only providing excellent care but also leading the way with innovative applications and teaching others in our specialty- with the ultimate goal of advancing the entire field.
The key to a natural and effective treatment outcome is based on experience, judgment, and a thorough understanding of the injectable product that is being used. Dr. Karam has extensive experience in advanced and innovative non-surgical facial rejuvenation techniques.
He is frequently invited to lecture at national training courses on the latest uses on injectable products and is a speaker and national trainer for Allergan the makers of Botox, Latisse, and Juvederm. He frequently trains physicians and other allied health professionals around the country on the safe and effect use of non-surgical injectable approaches to facial rejuvenation. He has become the trusted source for excellent and consistent outcomes, with patients consisting of other cosmetic professionals, physicians and industry leaders. His patients travel from throughout the country for their treatments. Carmel Valley Facial Plastic Surgery, is among the highest volume providers of cosmetic injectable treatments, earning the Platinum Provider status, by Allergan.
Botox®
The American Society for Aesthetic Plastic Surgery ranked BOTOX® Cosmetic
as the most popular physician-administered aesthetic procedure in the United States for the
fourth year in a row.
Botox® is used to treat unwanted wrinkles on the face and neck. Botox is
used to treat dynamic wrinkles (motion wrinkles). These wrinkles are caused by contraction of
the facial muscles. After time, this repeated muscle contractions results in permanent wrinkles
(static wrinkles). Static wrinkles are defined as lines and creases that remain on the skin even
when the face is not moving. Botox has revolutionized our ability to treat dynamic wrinkles of
the face. Botox works by decreasing the activity of muscles which produce these wrinkles.
Perhaps, one of the most important benefits of repeated long-term treatment is prevention of
wrinkle formation. By preventing the dynamic wrinkles from forming, they can not lead to static
wrinkles and creases, which are much more difficult to treat once they have occurred. The
preventive age-preserving value of Botox was shown in a comparative study of identical twins
( ref: Long-term effects of botulinum toxin type A (Botox) on facial lines: a comparison in
identical twins. Arch Facial Plast Surg. 2006 Nov-Dec;8(6):426-31)
Botox has been approved by the FDA for treatment of glabellar rhytides (the
vertical lines between the brows that appear when you frown), and is used safely to treat
horizontal forehead lines as well as the "crow's feet" around the eyes.
In our San Diego , Carmel Valley / Del Mar office more advanced techniques
are preformed in order to treat:
neck bands
downward turning corners of the mouth
facial asymmetries
non-surgical eyebrow lifting
treatment of migraines
Patients often comment on how painless and comfortable our techniques are.
The effects of botox generally appear in 1-3 days and are fully evident within 1-2 weeks.
Effects generally last 3-4 months. Published literature now shows that patients who maintain
a schedule of treatments over time may permanently reduce the severity and onset of facial
wrinkles.
At Carmel Valley Facial Plastic Surgery, we maintain the highest quality control
with regards to storage and dilution of Botox. By minimizing dilution and disposing of unused
material after several days, we are able to provide our patients with consistent, long lasting
results. All botox injections at Carmel Valley Facial Plastic Surgery are administered by our
facial plastic surgeon, Dr. Karam or a skilled, highly - trained nurse.
How Botox Works:
Botox Cosmetic is a purified protein produced by the Clostridium Botulinum bacteria
that decreases the activity of wrinkle-forming muscles. This botulinum protein was initially used
successfully by Neurologists to treat muscle spasm in the face and neck, and the cosmetic effect of
diminishing wrinkles was noticed as a side effect.
Acetylcholine is the neurotransmitter responsible for making muscles contract. The
botulinum protein, following injection into the skin and muscle, is absorbed by nerve endings (nerve
terminals), where it blocks the release of the neurotransmitter acetylcholine by those nerve endings.
After several months, the nerve terminals recover and begin releasing acetylcholine again, and muscle
function recovers.
Picture Yourself with BOTOX® Cosmetic
Side effects of Botox:
Patients often question whether Botox will prevent them from making or conveying facial
expressions. The reality is, in well-trained hands, treatment results in creating a more pleasant
relaxed expression, while allowing you make natural expressions. The difference is the expression will
not result in deep wrinkling and facial lines. This type of result is dependent on the skill, artistry
and experience of the individual injecting.
Side effects of the injection are relatively rare in skilled in hands, but may include
bruising at the injection site, or temporary eyelid drooping. Patients who are pregnant or breast feeding
should avoid treatment, as should patients with any active infection around the injection site. Botox
is contraindicated in patients with underlying muscle weakness diseases such as myasthenia gravis.
Hyaluranic Acids
(Restylane® /Perlane® and Juvederm®)
This class of cosmetic fillers are made from hyaluronic acid, a naturally-occuring
substance that provides fullness and volume to our skin. Restylane and Juvederm, are made in the
laboratory and therefore has little or no risk of transmitting animal-based disease or allergy. They
typically last from six to nine months depending on the site of treatment. Typical applications
include:
Wrinkles/Folds
Nasolabial Folds
Lip Augmentation
Corners of the Mouth
More advanced applications include:
Treatment of hollows around the upper and lower eyelid region (see Non-Surgical
Eye Lift section in Periorbital Rejuvenation Section)
Sculptra®
Facial volume loss occurs as a result of loss of fat beneath the skin, thinning
of facial muscles, and loss of bone density. These age related changes can lead to sunken cheeks,
hollows beneath the eyes, and other depressions, which contribute significantly to an aged and
tired appearance.
Sculptra is an exciting new FDA-approved product designed for correcting facial
volume loss (facial lipoatrophy) throughout the face. Sculptra® is a synthetic biocompatible
and biodegradable injectable material known as "poly-L-lactic acid." Poly-L-lactic acid has been
widely and safely used for many years in dissolvable stitches and soft tissue implants. It is not
a true filler. It works by stimulating production of collagen within the skin. Though Sculptra
injection produces an immediate fullness, this fullness disappears over several days. However,
the body reacts to its presence by gradually depositing new collagen, leading to thicker,
healthier-looking skin. These "final results" take about 4-6 weeks and can be very dramatic. At
that point, the patient is reassessed and a second treatment may be given. For anti-aging treatments,
typically 2-3 treatments may be required. This "liquid facelift" is performed in the office with
local anesthesia and no downtime. Results typically last 2 years and longer!
Radiesse™
Radiesse is an injectable filler that is used for correction of deeper wrinkles
and skin defects and may last up to one year. More advanced applications, allow this product
to be used to augment the cheeks, giving results that are similar to a cheek implant without
the downtime!
Radiesse is made of smooth calcium hydroxylapatite (CaHA) microspheres. The
microspheres (particles) form a scaffold through which your body's own collagen grows, and this
produces the long-term effect. Radiesse is especially effective for improving the nasolabial
folds and depressions around the mouth and jawline. This products is often used during our "liquid
facelift" procedure. Radiesse in injected with local anesthesia in the office, and produces
immediate results. There is no significant patient downtime.
Dr. Karam, who is board certified by the American Board of Facial Plastic and Reconstructive Surgery and American Board of Otolaryngology, offers services in San Diego County including San Diego, Del Mar, Carlsbad, Carmel Valley,
Encinitas, Rancho Bernardo and La Jolla in Southern California. If you are ready to schedule an appointment with Dr. Karam contact us today. 858-259-3223
Dr. Karam voted
"2010 Best Cosmetic Surgeon"
Ranch and Coast Magazine
Readers Choice Award
Contact Dr. Karam
