How Can I Change the Look of My Oral Commissures?

“How can I change my what?” you may be asking. The oral commissure is the term that cosmetic professionals use to describe the area at the corner(s) of your mouth. Yes, it’s that spot where you’ve noticed a line or crease forming under the corners of the mouth! Although it’s a small area, correcting this age-related change with dermal filler injections can make a big change in your appearance.

The oral commissures are an extension of the “laugh lines”. If you aren’t sure what this term refers to, it is the area beside the nose that extends down to the corners of the mouth. As we age, the skin in this area thins and the cheeks droop. Combined with other structural and volume-related changes in the face, a permanent line can form. Don’t worry though, you don’t have to stop having fun—laugh lines can easily be smoothed with dermal filler injections.

We can also develop creases that extend from the corners of the mouth down the sides of the chin. These are the oral commissures. Volume and structural changes in the chin along with thinning skin and repeated motion trigger their formation.  Rest assured, injections of dermal fillers such as Restylane, Restylane Lyft, Radiesse or Juvederm provide natural and soft smoothing to this area.

Changing the look of your oral commissures (the laugh lines) can rejuvenate the appearance of your chin, mouth, and lips. So, go ahead and smile…you’ll look even happier after this treatment!

 

oral commissures chin rejuvenation restylane los angeles before and after pictures oral commissures chin rejuvenation restylane los angeles before and after pictures

Restylane Before and After Pictures


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We’ve had many requests for Voluma over the past few months in response to the launch of Allergan’s newest dermal filler product. The strategy of our organization has always been to let new products earn their place in our practice by proving, over a year or two in the market, that they are worth the hype.

And that’s what product launches are – hype. The manufacturers of lasers and injection products have to hype their products with huge PR campaigns to try and make a name for their brand in an already cluttered cosmetic dermatology marketplace. They get consumers really excited when appearing on shows like “The Doctors” and “Dr. Oz”. The problem is that the reality of the product is usually quite far off from the hype and Voluma is a perfect example.

In the FDA study used for the approval of Voluma in the cheeks, the AVERAGE patient used 6.5 CC’s of product in the cheeks. Now, if you know anything about injection product, you know it’s very unusual to use this much product. In fact, most patients at our practice get a maximum of 3-4 CC’s in the cheeks. To give you an idea of how much this would cost in today’s market, Voluma is selling for between $750 and $1000 per CC. So that 6.5 CC average patients from Allergan’s study would have paid between $4,875 and $6,500 for their injections. We don’t know many consumers willing to pay that for their injections.

On top of this fact, if you inject 6.5 CC’s of ANY dermal filler, you are going to get a lot of duration, just because there is so much product in the cheeks. Voluma claims a 2-year duration, but Juvederm XC also claimed 18 months when they originally came out and if you know Juvederm, you also know it doesn’t last for 18 months. We believe that it’s very realistic for Voluma to achieve 12 months of duration, but beyond that we are skeptical and will let consumers weight in over the next year as to whether the premium cost of Voluma is worth it.


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Your Hands Show Your Age

Most of us are familiar with the saying, “You can tell a woman’s age by her hands.” This is mostly attributed to the fact that women take great measures to care for their faces but often ignore their hands. Many consumers also do not know the options that exist for hand rejuvenation.

Why do My Hands Look Old?

So what makes the hands show their age? Loss of fatty tissue and collagen as we age causes the hands to reveal the bones and veins. Years of sun exposure reveal a roughened texture and brown spots (sun spots, solar lengtigines, seborrheic keratosis) become more numerous.

It is not unusual for these conditions to appear rapidly, and we often hear women say, “Why is this all happening now?” Years of bad skin care habits, genetics, and aging all catch up with us at some point. Hand rejuvenation is the process of reversing the common signs of aging hands.

hand rejuvenation brown spots before and after pictures hand rejuvenation brown spots before and after pictures

Removing Brown Spots

We achieve excellent results using Q-Switched laser technology to remove brown spots from the hands. These powerful lasers work by removing brown pigmentation, and at the same time, they develop heat that promotes collagen stimulation and mild skin tightening. There is no downtime, and the treatments take only a few minutes. This same laser technology also works well for face, chest, and leg spots.

Adding Volume

For the loss of volume in the hands, we use dermal fillers such as Restylane and Radiesse to minimize the “ropey” looked caused by thinning skin. Treating voids between veins and ligaments on the back of the hands is a job well suited for dermal fillers.

Fillers have an immediate impact, making hands look younger by creating a plump and youthful appearance. These injection benefits are immediate and continue to improve over a two-week period after injections. Results typically last for a minimum of six months.

Sclerotherapy Injections

In addition to removing brown spots and adding volume, we have one other tool in our kit for creating more youthful hands. Sclerotherapy injections with Asclera can close some of the more visible blood vessels on the back of the hand without affecting proper circulation. This procedure is used in combination with Radiesse injections to hide bulging, ropey veins.

Multiple Hand Rejuvenation Solutions

Regardless of whether you have brown spots, visible veins, or thin, frail-looking hands, we can help rejuvenate them with lasers and injections.


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In 2009, the FDA issued a “Black Box” warning for Botox that has now carried over to all neuromodulators such as Dysport and Xeomin.

A Black Box warning is the most serious warning that the FDA may issue for drugs/medications that have potentially dangerous side effects. Because of the potential spread to distant areas after injection, Botox (and its sister products) was given this warning on its packaging.

Botox black box warningLet’s consider the following:

  • When Botox/Dysport are received directly from the manufacturer and used responsibly by a trained practitioner, treatments are extremely safe.
  • Botox has a higher safety rating than Aspirin.
  • Botox (neuromodulators) is the #1 cosmetic treatment in the world.
  • Reports of distant spread of Botox were associated with very large doses in patients already with compromised health wherein the risks of treatment were outweighed by potential benefits. (ex: cerebral palsy)
  • Cases wherein patients suffered great harm were associated with “bootleg” Botox that was not received directly from the manufacturer.
  • A more recent case of distant spread was related to the use of high doses in the neck for platysmal bands that resulted in compromised swallowing for more than a couple of months. We do NOT use Botox/Dysport in the neck as we believe this is far left off-label wherein benefits are outweighed by potential risks.
  • Finally, there are many common drugs that carry a Black Box warning such as:

Cipro (a common antibiotic), anti-depressants, anti-coagulants, anti-diabetics

Balanced and responsible information in all things…


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Our skin is our largest organ. Just like our heart, brain and digestive track, it needs certain conditions to function optimally. Skin is unique in this way because we can easily see its response to the things that we put into and on our bodies.  Certain disorders such as acne, eczema and psoriasis trigger distinct and recognizable signs in our skin.

Your skin is your barrier to the outside world. And while it may look simple on the surface, it’s anything but! It is a large and complex organ that has a variety of functions. Just like everything else in our bodies, our skin has a pH. The pH is a measure of how acidic or basic something is. Without going too heavily back into high school chemistry, it’s all related to the balance of hydrogen ions. The more acidic, the lower the pH and the more basic, the higher. Neutral pH is around 7.

The outermost layer of our epidermis is called the stratum corneum. It’s a thin layer, but it has big impact on our skin’s function. The outer surface of the stratum corneum is called the acid mantle. Just like it sounds, it maintains a low pH. The acidity of this layer is the reason why it works so well as our first line of defense from environmental organisms and threats like bacteria, viruses and fungi. A major component of the acid mantle is sebum or oil. It mixes with a variety of other things in to keep a lower pH and effectively do its job.

Now back to an earlier point…what you apply to your skin, including soaps, cleansers, lotions, toners and even medications can all alter and affect the acid mantle and change its pH. So, if you have a skin disorder like acne, the things that you put on your skin play a big role in how it functions.

Many of us have been led to falsely believe that oily skin is bad. Oily skin leads to acne. Oily skin causes clogged pores. Oily skin means dirty skin and on and on and on. Early on, we somewhere learn that if you have oily skin (especially oily skin with acne), you need to scrub it and use products to dry it out. Harsh soaps, astringents and scrubs are marketed to acne sufferers as the magic cure. But if you’ve been reading closely, you understand sebum/oil is an important part of normal, healthy functioning skin. So, when you remove it, especially harshly, you’re forcing your skin to make more to replace it. So, if you’re oily, you’re going to get oilier. And in most cases, your skin is not going to like this. You may see redness, dryness and flaking. This all means that your acid mantle is gone and your skin is in overdrive trying to replace it.

Remember that acne (as with eczema and psoriasis) is an inflammatory skin disorder. If you irritate something that is already inflamed, what do you think will happen. Yep—you’ve just made your acne worse and become your own worst enemy!

At Celibre Medical, we see many patients who’ve fallen into this vicious cycle of trying to dry out the skin. We don’t blame them at all!  It’s advertised and practically preached to us from our teenage years that using these irritating products on our skin will help us. We work with our patients to educate them that nothing could be further from the truth! Proper, gentle skincare goes a long, long way in calming the inflammation of acne and helping it get better.  Not only will this help your skin look better, it will make it feel better too.

acne laser treatments los angeles before phot0acne laser treatments los angeles after photo
* Acne Laser Removal Before and After Pictures


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Do you have hemosiderin staining? Some people who suffer with it may not even realize what it is. Hemosiderin staining is an infrequent, but long-term side effect that’s usually caused by cosmetic procedures such as dermal filler injections, sclerotherapy (for leg veins) and eyelid surgery.

Hemosiderin staining is a brownish discoloration that comes about after bruising when red blood cells die.  Iron is released from the red blood cells is converted into “hemosiderin” and stored in the tissue beneath the skin, causing the darkening.

Hemosiderin staining is more common with in patients who have darker skin types (colors) such as Hispanic, Asian, Middle Eastern and African American.  Here, we’ve included some photos of a patient with hemosiderin staining beneath the eyes. We successfully resolved this for her by using q-switched laser treatments.

Q-switched lasers target pigment in tattoos and birthmarks, but they can also be used to target the darkening from hemosiderin staining and other types of dark, pigmented scarring.  The treatments are relatively quick, easy and painless, and many patients see improvement of the dark discoloration very soon after treatment. A series of treatments may be necessary, and for most patients the pigmentation can be removed.

If you have hemosiderin staining, or a long-term, darkly colored bruise that you’d like to see go away, please consider giving us a call to have a free consultation. It may be easier than you think to get rid of the discoloration and your skin back to looking like it’s old self again.


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Acne can be tough. It’s hard to find someone who hasn’t been affected, either their own personal struggles someone in their lives. For females dealing with acne, one of the options is birth control pills. Many want or need birth control, but others find help with their acne.

Oral contraceptives help some people with acne, but they can also stimulate it in others. Why? Because birth control pills are hormonal replacements for what happens naturally in your body. And there are numerous combinations of birth control pills, so just like the skin care products and medications used to treat acne, there’s no “one size fits all”.

Remember that acne begins with the oil glands. It’s the overproduction of oil that leads to clogged pores, inflammation and sometimes, deep cysts. Your oil glands are stimulated by hormonal changes in your body. This is why some experience “flares” of acne during or immediately after their menstrual cycle. The idea behind using oral contraceptives for acne is that they take over abnormal hormonal fluctuations that are triggering breakouts and make things a bit more stable. However, sometimes, changing things can trigger acne to flare. This explains why some women experience terrible acne that they’ve never had before during a pregnancy. Others become pregnant see their acne calm down as their bodies and skin take a break from the month to month fluctuations of their menstrual cycles.

The answer to the question is that sometimes birth control can help with acne. The FDA has approved three different birth control pills specifically for the treatment of acne. There are potential side effects, some of which can be serious such as blood clots. You need to discuss oral contraceptives in detail with your medical provider before you decide if they are the right choice for you.

oral birth control for acne before and after pictures oral birth control for acne before and after pictures
* Acne Before and After Pictures


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We’ve all seen them—those infomercials for the most amazing eye cream ever.  It erases every line and wrinkle and works better than surgery for your under-eye puffiness and bags!!  If it were that easy, nobody would have crepey skin and puffiness around their eyes, right?!  It’s tempting to want to use an eye cream to fix the crepey skin around your eyes. After all, it’s cheap and easy.  Many of us see the first signs of age around their eyes. As the focal point of your face, it’s easy to understand why you’d want a quick fix.

restylane injections for dark circles under eyes before picturerestylane injections for dark circles under eyes after picture

Restylane Before and After Photos

So, why does the shape of your eyes and the skin around them start to change in your thirties and forties? Because it is the thinnest and most delicate skin pretty on your body!  Think about it: this fragile, delicate skin is exposed to the sun every single day. Because UV damage thins the skin by breaking down collagen and elastin, we often start to see lines, wrinkling and drooping in our eyelids before anywhere else.  When this aging happens, it will take more than a good, hydrating eye cream to save the day and make us look younger.

So, what can fix the crepey skin around your eyes. A combination of things tends to work the best. Yes, good skincare is the foundation, but you may also benefit from laser resurfacing to jump start your skin’s collagen and elastin-making capability. This procedure works the best to tighten, firm and thicken this delicate area, and it may be done without resurfacing or treating the entire face if you so choose.

Botox and Dysport injections are also helpful in reducing some of the muscle contraction around the eyes that trigger lines (frown) and creases (or crow’s feet). These injections are also used to lift and shape the brows. This doesn’t change the skin, but can make your eyes appear more open, awake and refreshed.

Lastly, injections of dermal fillers like Restylane and Juvederm can replace lost volume under the eye in the tear trough area. This helps brighten the appearance of dark circles while providing a stock pile of hyaluronic acid to improve the overall texture of your lower eyelid skin.

If you’re not a candidate for any of these treatments or if your eyelid skin laxity and/or changes around your eyes is advanced, then you may need a surgical procedure known as blepharoplasty to reshape and contour the skin and fat in both your upper and lower eyelids.

When considering these treatments, make sure you consult with an experienced practitioner who is well versed and familiar with each. Again, a combination of treatments is usually the way to go to get your eyes “smiling” again. And always remember to protect the delicate skin around the eyes with the proper medical-grade skin care, sunscreen and sunglasses every day.


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We know that red stretch marks can cause much distress for patients like you. Red stretch marks often occur at the beginning, when new stretch marks are first being formed. They also occur more often in light or medium skin types.

Red stretch marks are caused when new blood vessels are created by the body to heal the area in and around the stretch mark. These small blood vessels are very near the surface and can appear as red streaks on the abdomen, love handles and even legs.

Red Stretch Marks Before PhotoRed Stretch Marks After Photo

Although these marks can be embarrassing and frustrating, they are easily treated with lasers. Pulsed dye laser treatments are the gold standard for the removal of red stretch marks. These lasers are highly absorbed by the blood in the small capillaries in the red stretch marks. When these small blood vessels absorb laser light, heat is generated, thereby closing them and removing the red color.

To learn more about removal of red stretch marks with lasers, give us a call today to schedule a free consultation.


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grinding teether migraines 2When I meet an injection (Dysport, Botox, filler) patient for the first time, I take note of any signs of muscle tension.  We all recognize how this looks on the upper face with a furrowed brow.

grinding teether migrainesHowever, it’s more common to observe chronic stress of the lower face muscles.  This appears as a dimpled chin, downward turn of the corners of the mouth, a puckered look to the sides of the chin, and…the most problematic area – the Masseter (jaw muscle).

The Masseter muscles are the large chewing muscles often referred to as the jaw muscles.  They are located in front of the ear and extend down to the jaw bone.  For people that grind or clench their teeth, they often will exhibit an overly large, bulky, or square jaw line or Masseter muscle.

Masseter Before Dysport Injections Photo 11Masseter After Dysport Photo 11

Besides lower face muscle tension influencing one’s appearance, there are some common complaints that need to be explored.  For example, those that tend to exhibit a large Masseter muscle mass will confirm migraines, tension headaches, or even neck and shoulder pain upon questioning.  They may even describe being under the care of a physician that is providing prescription medications for migraines.  Or, a neurologist that is dosing with Botox to the upper face muscles, scalp, or even the back of the neck for relief.

grinding teether migraines beforegrinding teether migraines after

Oftentimes health professionals are not asking the patient if they grind or clench their teeth.  Better yet, they should be checking the Masseter muscle for evidence of over-use and tension.  The reason being, these muscles that are tight and over-worked may lend to symptoms of migraines with radiating pain along the neck (of the side they are using) and sometimes down the shoulder.

Although our focus is aesthetic outcomes, we have had several patients find relief by simply administering Dysport and/or Botox into their Masseter muscles.  Pain and tension is generally relieved within several days, and the appreciable changes to the appearance are realized in as little as a few weeks for most.

When we are able to help piece the puzzle together, it’s rewarding for both patient and practitioner alike.


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