Dr. Robert F. Gray, MD, FACS – Presentation on Advances in Facial Rejuvenation Non-Surgical Fillers – MD Laser Spa

Video Transcript

Dr. Robert F. Gray, MD, FACS – Presentation on Advances in Facial Rejuvenation Non-Surgical Fillers – MD Laser Spa

I’m Dr. Robert Gray. I specialize in facial plastic and reconstructive surgery. And I have offices here at Antica and, and also in Pleasanton. So as mentioned, I’m dual-board certified in … surgery and facial plastic and reconstructive surgery. And the topics that we will review will be the non-surgical services, which include Botox, Restylane, fillers Perlane, Laser treatments called IPL photofacials, there’s a skin tightening device called Thermage, laser hair and spider vein removal, facial resurfacing and overall just good skin care.

Surgical Services

And as mentioned I do surgeries. So of course that encompasses everything from eyelid surgery to nose surgery, facelifts, liposuction, ear surgery, scar revision, mid-facelifts, endoscopic brow lifts, facial implants. So, hopefully my background and training will tell you what works and what doesn’t work. You know, there’s a saying that if all you have is a hammer, everything in the world looks like a nail. Well, I feel like I’ve got a full toolbox of choices and hopefully I can impart some of that to you guys.

So as was mentioned in the introduction, it’s on the news, it’s on the media and everything that you read, it can be very confusing. When I go to meetings and there are a thousand ?lasers? out there and you don’t even know where to start, but I have a lot of experience on all of this and I can kind of determine what’s good and what’s bad, and hopefully I can help you decide that as well.

So it’s pretty straightforward how the aging process starts. Basically in summary, it kind of just starts in the eyes. And then it goes to other parts of the face, but the eyes are some of the first areas to start with drooping and some little crow’s feet lines on the sides and that little “11” line that we develop between our eyebrows. And then it can advance and extend to, in our forties our brows start to get a little bit heavy. We’re not really seeing much to the nasal labial folds but we can just a little bit here, with the jowl formation. And then in the fifties the eyes, and the other parts of the skin are starting to notice some changes with deeper creases in the face and skin. And the jowls start getting a little lacity in the lower neck area. And the sixties just increases with that. So basically think of gravity and think of everything kind of heading south.

We’ll talk and review a little bit of the surgical services that we offer and then non-surgical, and then hopefully I’ll be able to differentiate the two. 

So obviously rhinoplasty is something that I do all the time. You only got one nose, it sits right in the middle of your face just right in your face. You can’t cover it up with the shirt. You can’t cover it up in the glasses. It’s right there for everyone to know. So that can attract a lot of attention if it’s too big, too small, things like that. So that’s a common procedure that I do. And so I’m showing you some examples of that. My goal anytime I make a conversation about rejuvenation surgery is so no one will really notice. It all looks very natural, you just look refreshed. And so many people that come back after their procedure would say, no one noticed but everyone complimented me on how well-rested I looked. Or, what did I do to lose 15 pounds, did I start to work out, you know, and it’s just like a little secret, it’s kind of a fun little secret. And, I have examples on my website at mdlaserspa.com.

And here is a gentleman that came. He had a pretty prominent tip and edge of the nose called the nasal dorsum. He just wanted it to look a little bit more natural and that’s exactly what we did. It’s a very natural looking nose. It still has a masculine look to him.

Chins. We don’t really usually think about our chins, but our chins actually have a lot to do with the way our profile looks and our neck line. Some people with no chin, the chin blends in with the neck, and helps to draw attention to the neck when really the problem may very well be the chin. And here are examples where you might be thinking, “oh look at the differences in noses.” No, really those noses are all the same.  There’s just differences in the chin and from very recessed on the right to less recessed on the left. 

And here’s an example of a gentleman, who… here’s a secret, a lot of the guys who wear goatees have small chins, except for me, but they’re just trying to hide it to make it look a little bit more balanced.

Facelifts. There are a whole different kinds of facelifts out there these days. There’s short scar facelifts. A whole bunch of different names, which is basically, if you think of it, forget about the name, there’s just like mini lift and then there’s a full facelift, and that really answers everything that you might want. A full facelift obviously it takes a little bit longer and it’s for people that might be, you know, late fifties, sixties, having a lot of things in the neck and upper face. And there’s the mini lift which is very simple to do, takes an hour and a half to do. And it’s for someone where the neckline is fine just starting to get a little bit of laxity here in the mid face. Okay. All these people came up with all these little fancy names but there’ really are only two kinds of facelifts. Mini lift and Full facelift. But it can be very dramatic. And I’m kind of partial to surgery. I like surgery and think it works great but there’s a lot of people who, that’s a four letter word to them, and they don’t even want to consider it. So we’ve developed all these other options for people to consider.

So here’s an example of a lady. Look at that neckline. That’s greatly improved. She was in her mid fifties. Here’s a lady, this one is dramatic. This is dramatic changes. You cannot get that with any laser. That’s the same person. Left is before and the right is after. She was actually a grandmother in her sixties and she acted like a 25 year old. She had so much energy it was amazing. And just wasn’t showing it on the outside. So she wanted the outside to match the inside, and now it is and she’s very pleased. 

Or, if that doesn’t fit your budget. You can certainly … [laughter] … I’m sure it’s out there. 

And for the guys. I was in the newspaper a few years ago about senior citizens. What kind of procedures they’re having out there? And this guy really care about his neck. He couldn’t button his shirt. And I kind of refer to that as a term, called a little “turkey gobbler neck.” So that took one hour to do and he is very delighted with the procedure.

Next we’re going to talk a little bit about liposuction. Sometimes it’s not just skin, but skin and fat, and you got to get rid of that fat. That’s 20 minutes in the OR for that and she had a little chin implant and look at the big difference. Talk about that chin that blends into the neck. Now she’s going to have a neckline that is going to be much better for her her whole life.

Eyelid surgery, as I mentioned earlier, that’s one of the early changes that we have with aging. And your eyes tell a lot about you. You’re looking at people and if they have the dark circles under them or they look a little bit tired, or people think you might be angry and you’re not angry. You’re asking me, “are you tired?” “No, I slept fine.” I’m sure we get that. I’m 45. I definitely get that stuff. And here’s examples of people that had procedures to correct that. An hour-and-a-half to go from the left to the right. She just looks so much more alert. She was in her late forties when she had this. And she’s delighted. It just looks so much more rested for her. Next example, a lady in her early fifties, much more alert.

Non-Surgical Services

So that was kind of a quick rundown of surgical services. Now let’s talk a little bit about non-surgical. This is all the stuff that’s in the news. The surgery stuff doesn’t have as much glamor to it. All this non-surgery stuff does. And, really, that’s where the confusion lies under for the public. 

So let’s start, first of all, with fillers. What are fillers? Fillers are natural substances that come in a syringe and you can place them underneath the skin in any line or wrinkle that you do not like. Collagen was one of the early ones. Now they’ve come up with longer-lasting fillers but they’re all natural fillers. So these are made from components found in the cartilage. components found in bone. And those are, and I do, I’m actually one of the busiest surgeons in all of Northern California doing the fillers. So I have a tremendous amount of experience with that. And some fillers are for different parts of the face and do on. The common place for people to consider getting a filler is in these nasal labial folds here, right in there. That’s one of the early signs of aging and that takes 15 minutes. There’s another filler called Radiesse and it will last up to a year. I really loved doing that and I did a lot, a lot of fillers. So that’s one area that you can apply fillers to.

Another is if your lips [have] some lip lines around here, or if you’re just thinning and fine, that it is really shrinking with age. The lip, upper lip, tends to thin as we get older as we are adding a little bit of volume to that really looks great. I’m not really talking about the jumbo Angelina Jolie lips, okay. People say, no, I don’t want those lips and I say okay, alright, we can do any kind of lips you want. Most people just want a natural-looking lip, something they may have had a few years earlier.

Now, the hands are a very popular area also. You can do everything to your face, but when you reach out with your hands, they really can show your age. And it’s the veins and the tendons that can really be noticeable here and the texture and the wrinkly skin and things like that. Put a little filler in there. It stretches it out and gets rid of the blue veins and the tendons and the aging and it looks great. People love hand rejuvenations done. And the skin is so smooth when you, when you just add some volume to it, it’s really nice.

Another popular are, ah, I gave that secret, are eyes. Here’s an example of a lady that had one eye with, one eye without.She’s mid fifties. Very typical to get this little bulging of fat there then a little bit of an indentation there. There’s still that indentation with Restylane. That is immediate. I took that picture 5 seconds after I was finished. It took 15 minutes to go from there to there. I liked it so much that I did it on myself. So that’s me. That’s what my natural eye looks like without any filler. Look at that. Boy, he’s a good looking guy with that. So those are my eyes and I still have it that way right now just so I can show patients one eye with, one eye without. It’s a very popular thing. It takes 15 minutes and that can last for up to a year. [laughter]

So our next slide. Botox. Botox has been around for 18 years or so. Botox is a medicine that we put in the muscle to relax the muscle. Well, why is that important? Well, there are certain muscles that when we use them, it causes lines to form on our skin. When you scowl at somebody, it leaves that ‘11’. When you raise your eyebrows, it leaves those marks on the forehead. When you squint and smile a lot, it leaves these things called crow’s feet. So Botox is a medicine that works actually really wonderfully well. It takes five minutes to do and lasts about three or four months. And there’s nothing, nothing, that can work like what Botox does. It is a great, great invention. And here are some examples just between the two eyebrows of this lady here. From there to there. She doesn’t have that mean scowl look. It really just makes the whole upper face near the eyes look fabulous.


Another nonsurgical option that I wanted to discuss is something called Thermage. Thermage is a machine that I use that has probably been around for about eight years, really the first one in skin tightening. So it’s a machine that binds to the, the skin contracts. It’s good for different parts of the face and the body. It works nice. It’s not a facelift, but it’s 25% of the facelift. So it’s pretty easy to do, takes about an hour. Here’s an example of a lady that just had her neck and lower face done. So this is the before and that’s after. Not as dramatic as the surgery pictures that I showed, but also she can go back to work that day. She just pops in the office for two hours, gets this done, and this will continue to improve over a period of several months. It’s a great option for people who are looking for non-surgical choices to help rejuvenate their skin.

Another area that works really nicely is around the eyes. So this lady has […] Thermage treatments done around the upper eyelid. And look, it raised the eyelid crease. A lot of that heaviness that she had around the eyes is improved. It takes about an hour or  hour and a half. It’s a non surgical option. I think it would be a great thing for someone who’s not quite ready for eyelid surgery, but has a little extra skin around their eyes and they don’t like it. So, easy to do, takes a little over an hour. And this will last you a couple years.

I see this often. After delivery, the skin didn’t quite shrink down 100%. And you get a little bit of laxity around the abdomen and the belly button. So she had this tightening procedure done and now her six pack abs came back and she looks a lot better. That can actually last two to three years. And the only other option,years ago, was surgery and this is not a surgery.

Laser Treatments

In practice. I have a whole bunch of lasers and we do hair removal, spider vein, photofacials, which I’ll get into, microlaser peel. We have a brand new laser that we just got yesterday, called a pro fractional laser, it’s really revolutionary, and a whole bunch of anti-aging treatments. So nothing glamorous about hair removal but for people that have had it really appreciate not having to deal with the shaving aspects.

And for those little teeny spider veins, those are easily treated, takes about 15 to 30 minutes. Zap, zap, zap, and the blood vessels are gone. So that’s a pretty remarkable improvement from the upper here to the lower. Okay. Spider veins. For people that stand on their feet a lot they tend to get those.

And one thing that I agree with everybody, whether they’re coming in for a surgical or non-surgical consultation is sunscreen and skincare. The sun is your enemy. You may have worshipped it in your twenties and now you’re hating it in your forties. I get that all the time. And a lot of the things that we did when we were younger, you know, slathering on the baby oil, the sun tan oil, laying on the backyard, just cooking, have caught up to us. Okay. And we have treatments now to reverse those changes, but also getting you into it a very good skin care program for the rest of your life. Sunscreen is something that a person should wear every single day, even when it’s raining outside. And just get into the good habit of that will protect against the sun’s damaging rays for the rest of your life.

Then, in mentioning, so that skincare is always a big part of whatever I do. And then talking a little bit about lasers. I have several lasers that can help just kind of get rid of the dead skin layer. You’ve heard of the term exfoliation, well, lasers take exfoliations and the nth degree  and we can adjust it to however much time and whatever you need. So if the person says, “Hey, I’ve got one week to recover, make my skin look as good as it possibly can look in one week.” And you know no bottle of lotion can do that, right? So I can adjust the laser to give them one week of recovery with a very, very significantly noticeable improvement in their complexion. Brown spots, age spots, dull complexion, fine lines and wrinkles. This laser stipends for that. Here’s an example, this lady just had a laser treatment around her eyes.

We’ve introduced a new laser called the pro fractional laser, which is even an advance on the existing lasers. And it’s probably in between this pro fractional laser and the one that I showed you before. Absolutely the most cutting edge laser available ever for skin rejuvenation. This can actually go 10 times deeper than the laser before, but actually have a shorter recovery period. So it’s profound in advancement in laser technology. This has been on the news just last week on the Today Show this type of laser was featured. It’s a revolutionary laser for facial rejuvenation. This lady had lots of lines around her lips she didn’t like, and one or two treatments to go from there to there. And that’s not to say that you can’t have it on your whole face, but if you have target areas,  around the eyes or lips, from all of the sun damage. This lady had a lot of pigmentation on her skin and one treatment. And that probably took her five days to recover. She had some pinkness on her skin afterwards but clearly could wear makeup. So the lasers that are available today are wonderful. This gentleman, terrible sun damage from there to there. When people would meet him, I’m sure they were looking at all those spots. That’s not terribly attractive and he’s so much happier. So that’s an example of the pro fractional laser as one that can go 10 times deeper. So from there to there in one week. Pretty profound. 

There are other lasers called photofacials or IPL or intense pulse light treatments, which are no downtime. It does three things. Number one, it gets rid of the Brown spots. Number two, it helps shrink pore size and number three, it gets rid of red broken capillaries. IPL photofacial treatments are usually done in the series and somewhere between three and five. Walk out the door 20 minutes after having you’re right back to work. It’s pretty amazing stuff and we do an awful lot of that.

On the decollete area, as the spring and summer are approaching and those strapless dresses are coming out to help get rid of some of that sun damage. And this is also really  great on the backs of hands, because as I mentioned, you can’t hide your hands unless you’re going to wear gloves outside. Those are just some of the age spots a filler can help rejuvenate out of the […]

So it’s pretty confusing. It’s kinda like when you walk up to a makeup counter or skincare counter at Macy’s. There’s just so many to choose from. I sympathize with you and hopefully this talk was a little preview of what’s out there for you, but I don’t really expect you guys to become experts in this 30 minute discussion. And that’s really why I feel a consultation. Let’s sit down and talk about it. Or any surgeon or a provider that you’ve discussed with will be able to help say, “Aw, this isn’t gonna work for you”, or “This is great for you,” those kinds of things. So Anyhow. I want to let you know that we do have a booth outside here on the left for my laser spa. We’re giving a raffle here of some great skincare products, a chemical peel for your skin and a customized skincare evaluation. And for people here’s one of the benefits of attending today is that you can get $75 off at our office here in Antica or in Pleasanton, of either Botox or a filler, and then I’d be happy to meet with you and kind of customize a skincare plan.

I just want to summarize and say, “Remember, you never get a second chance at a first impression.” And thank you very much for your time today and I appreciate the organizers of today’s event. You can refer to my website. And so we may have a few minutes here. If there are any questions possibly from the audience or I’ll be available throughout the day.

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