NEW AT BIRKEN

Artefill - Using the Longest Lasting Dermal Filler for a Non-Surgical Facelift in Houston/The Woodlands, Texas

[ No Comments ] Posted on 09.08.10 under Artefill, Dermal fillers, Facial, Facial Collagen, Facial Rejuvenation, Non-Surgical Facelift, Wrinkle reduction

Artefill, the longest lasting dermal filler, can be used to lift sagging facial features as well as adding volume to areas that have lost collagen.

“By finding the weak points on the face, a natural lift and be accomplish that will reduce wrinkles as well as rejuvenate the face,” Dr. Randy Birken said, a board certified physician. “Artefill is easy to insert with minimal discomfort and bruising.

Patients can see a difference before they leave the office; but most importantly, Artefill last from 5-10 years.

Call 281-419-3231 for more information or email at info@birkenmedicalaesthetics.com

Artefill - Using the Longest Lasting Filler for a Non-Surgical Facelift

[ No Comments ] Posted on 09.07.10 under Artefill, Dermal fillers, Facial, Facial Collagen, Facial Rejuvenation, Non-Surgical Facelift, Wrinkle reduction

Not all dermal fillers are the same - Artefill, a combination of bovine and PMMA, lasts for 5-10 years and can be used to lift facial features that have lost support from aging.

“By restoring volume to specific areas on the face, collagen is easily injected to create a lift and reduce wrinkles,” Dr. Randy Birken, a board certified physician, said.  “Patients are delighted and leave the office looking 10-15 years younger.

To find out more information about facial rejuvenation, call 281-419-3231 for more information or email at info@birkenmedicalaesthetics.com

Long Lasting Dermal Fillers - The Non-Surgical Facelift

[ No Comments ] Posted on 09.07.10 under Artefill, Dermal fillers, Facial, Facial Collagen, Facial Rejuvenation, Non-Surgical Facelift, Wrinkle reduction

Artefill, the longest lasting dermal filler, can be used to lift sagging facial features as well as adding volume to areas that have lost collagen.

“By finding the weak points on the face, a natural lift and be accomplish that will reduce wrinkles as well as rejuvenate the face,” Dr. Randy Birken said, a board certified physician. “Artefill is easy to insert with minimal discomfort and bruising.

Patients can see a difference before they leave the office; but most importantly, Artefill last from 5-10 years.

Call 281-419-3231 for more information or email at info@birkenmedicalaesthetics.com

Non-Surgical Face - Using Artefill to Lift and Fill

[ No Comments ] Posted on 09.04.10 under Artefill, Dermal fillers, Facial, Facial Collagen, Facial Rejuvenation, Non-Surgical Facelift, Wrinkle reduction

Is it possible to create a lift to facial features caused by age and gravity?

“The longest lasting dermal fillers can be placed strategically in areas that have lost collagen and volume,” Dr. Randy Birken, a board certified physician said.  “Artefill lasts from 5-10 years and actually stimulates natural collagen production.”

Dr. Birken has trained in the “art” of Artefill can restore facial features to a more natural and youthful appearance.

Call 281-419-3231 for more information or email at info@birkenmedicalaesthetics.com

The Non-Surgical Facelift with Artefill Dermal Filler

[ No Comments ] Posted on 09.01.10 under Artefill, Dermal fillers, Facial, Facial Collagen, Facial Rejuvenation, Non-Surgical Facelift, Wrinkle reduction

Can facial features be lifted, volume restored, and wrinkles reduced without surgery?

“Yes,” says Dr. Randy Birken, a board certified physician and member of the American Academy of Cosmetic Surgeons.  “Artefill is the longest lasting filler on the market, producing results for five to seven years.  But it’s where you inject it in the facial skin that lifts areas loosened by lost of collagen.”

Dr. Birken has trained with other clinicians who utilize a safe and assertive approach with dermal fillers in order to achieve face-lift like results without the risks of surgery, cost, or downtime required by a plastic surgical procedure.

Artefill contains both bovine and PMMA collagen that allows volume enhancement, lift, and overall facial appearance improvement with minimal discomfort and bruising.  PMMA actually stimulate one’s own collagen production, hence the long lasting effect compared to other fillers, such as Restylane and Juvederm that contain hyauronidic acid that breaks down between 6 and 12 months.

For more information about Dr. Birken’s non-surgical face-lift call 281-419-3231 or email at info@birkenmedicalaesthetics.com

Facial Collagen Without Needles in The Woodlands-Houston, Texas

[ No Comments ] Posted on 11.04.09 under Age Management Medicine, Conroe, Cosmetic gynecology, Facial, Facial Collagen, Facial Rejuvenation, Houston, Montgomery County, Texas, The Woodlands, Women's Health, micodermabrasion

Dr. Randy Birken, founder of Birken Medical Aesthetics of The Woodlands, offers needle facial collage for reduction of wrinkles.  The Transermal Ionto uses dermatoelectroporation to delivery the collagen used in Restylane and Juvederm after microdermabrasion.

“The results are excellent,” Dr. Birken said.  “It’s painless, yet we deliver collagen to the face, reducing wrinkles and plumping-up the skin.”

For more information, call Liz at 281-419-3231 or email at

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info@birkenmedicalaesthetics.com

Facial Rejuvenation - Laser and Needle Free Collagen in Houston-The Woodlands, Texas

[ No Comments ] Posted on 09.14.09 under Anti-Aging Medicine, Bio-identical Hormones, Facial, Houston, Texas, The Woodlands, Vitamins for Healthy Aging, Women's Health

No needle, or needle free, collagen combined with laser photo-rejuvenation is a safe and effective way to improve skin texture, fine wrinkles, laxity, sun-damage, and pore size without surgery of down-time.

Dr. Randy Birken, founder of Birken Medical Aesthetics, has created an excitement new development for non-surgical facial rejuvenation.

“It makes sense,” Dr. Birken, Clinical Assistant Professor at Baylor College of Medicine said.  “The laser stimulates natural collagen production while the no-needle technique adds new collage - the best marriage for skin facial improvement.”
For more information, call Liz at 281-419-3231

or email at

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info@birkenmedicalaesthetics.com

Anti-Aging Medicine - Bioidentical Hormones for Weight Loss and Healthy Living in Houston-The Woodlands, Texas

[ No Comments ] Posted on 06.13.09 under Facial, In-Office Liposuction, LVR, Vitamins for Healthy Aging

What is anti-aging medicine?  Sounds a bit mystical and unscientific.  But is it? “Nothing can stop aging, but we can slow it down and improve quality of life as we get older,” said Dr. Randy Birken, founder of Birken Medical Aesthetics of The Woodands. It’s nothing like snake-oil, just good nutrition, healthy life style, and exercise … but testing for hormone deficiences,micronutrient status, and neuro-trasnsmitter status allows the clinician to make proper supplementation recommendations as well as prescribing natural hormones for optimal functioning.” Dr. Birken utilizes hormone, vitamin, mineral, anti-oxidant, fatty acids, lipids, and metabolic metabolites testing along with information about brain hormones, like serotonin, epinephrine, and other chemicals that effect mood, sleep, and focus. “Even the healthiest appearing patient has hormone and nutritional deficiencies.  Without these advanced testing techniques, most patients are at higher risk for chronic diseases, such as heart problems, cancer, and other age related conditions. In addition, treatment for depression, moodiness, anxiety, attention deficti, and poor sleep can be improved with the right supplement recommendations.”

To view a short presentation on Anti-aging/Functional Medicine for Weight Loss and Healthy Living, click this link: http://tiny.cc/IXM36

New Targets of Photorejuvenation

[ No Comments ] Posted on 05.12.08 under Facial

With the dawn of photorejuvenation, clinicians used noninvasive optics to improve skin tone and texture, as well as reduce sun damaged epidermal lesions. Now photorejuvenation has new targets: wrinkles and skin laxity.

Advances in infrared modalities give aesthetic clinicians the ability to decrease rhytids and essentially “tighten” loose skin without pain, downtime or complications. In the past, we had ablative modalities, such as dermabrasion, chemical peels and resurfacing lasers (e.g., carbon dioxide laser and Er:YAG laser) that caused epidermal injury. A new skin matrix was created by the proliferation of fibroblast activity, inflammatory mediators and deposition of new collagen. Unfortunately, these direct physical, chemical or thermal treatments caused significant edema and erythema that lasted for several weeks.

In contrast to ablative rejuvenation procedures, nonablative skin rejuvenation uses dermal heating to stimulate fibroblastic activity and collagen formation without injuring the epidermis. These procedures offer treatments that are safe, virtually painless and without recovery time.¹

History of Infrared Treatment

The ideal rejuvenation treatment creates skin improvement without causing epidermal injury. In the mid- to late-1990s, clinical and histological evidence showed that certain visible light lasers improved hypertrophic scars, stretch marks, dyspigmentation and skin erythema. However, these lasers caused significant bruising and swelling for up to two weeks. Furthermore, these lasers weren’t suited for darker-skinned or tanned patients.

Intense pulsed light sources improved tone and photodamaged skin, but had their downsides. Patients with Fitzpatrick skin typing above III, or those with tanned skin, were subject to postprocedure keloids and hyper- or hypopigmentation. They also had to avoid excessive sun exposure -post-treatment to minimize epidermal injury.

Laser energy in the near- and mid-infrared range changed this. Weakly absorbed by epidermal melanin, this energy provided deeper penetration to the dermis for all skin types. Heat-induced dermal injury generated dermal fibroblastic activation, leading to collagen remodeling and a decrease in facial wrinkling.¹ The technically easy to perform extended pulse 1064-nm Nd:YAG laser, with minimal melanin absorption, improved skin texture in all skin types with little or no patient discomfort.

In 2000, the Thermage ThermaCool System (Thermage Inc: Hayward, CA) used radiofrequency energy instead of laser energy to provide deep dermal -volumetric heating at 60 C by combining epidermal cooling with a cryogen spray to its electrode membrane. This system has a device that employs a proprietary capacitive coupling electrode to disperse radiofrequency energy and create a uniform electric field across the tip’s surface with contact cooling.

With this technology, the depth and degree of heating and thermal injury depend on the size and geometry of the tip, the treatment level setting, and the conductive properties of the tissue being treated. As collagen is heated above 60 C, the mechanism of action is two-fold. First, collagen denatures, and the fibrils immediately contract and thicken. Second, dermal remodeling begins with the wound healing response, producing additional skin tightening over time. This biologic reaction to heat tightens tissue and renews facial contours.²

In 2002, Groot and Smith showed that the CoolGlide Vantage Sub-Millisecond 1064 nm laser (Cutera Inc: Brisbane, CA), with its short duration laser bursts applied in a repetitive fashion and with a relatively small spot size, gradually heated the upper dermis 43 C to 48 C. This stimulated remodeling and new collagen production while maintaining epidermal safety and patient comfort.^3,4

In 2005, Esparza described a new nonablative device using infrared light in the 1100 to 1800 nm wavelength range. The Titan (Cutera) laser energy targeted water as the chromophore while combining pre-, parallel- and postcooling with each exposure.^5,6 Zellickson et al. evaluated the ultrastructural effect of this technology on forehead and abdominal skin. Their study revealed electron microscopy evidence of collagen fibril denaturation, consistent with fibril thermocontraction, immediately after treatment.^7,8

One author reported 95 percent visible results after two treatments for immediate contraction, as well as continuous skin contraction up to seven months. Patient satisfaction and acceptance were high.^9,10

The ReFirme ST Applicator (Syneron Medical Ltd: Yokneam, Israel) was also introduced in 2005, combining broadband infrared light (700-2000 nm) and bipolar radiofrequency electro-optical synergy [ELOS] to nonablatively treat skin laxity with mild to moderate rhytides.

Technically, the device delivers optical energy to preheat the target and radiofrequency energy to heat the target without epidermal injury. The sapphire treatment tip provides chilled contact cooling. This helps direct energy into the dermis and away from the epidermis by using real time temperature feedback with every pulse. Visible improvements in wrinkles were noticed after the first treatment. Firmness persisted and continued to increase at the three-month follow-up visit.11

In 2005, the Fraxel laser treatment (Reliant Technologies: Palo Alto, CA) was introduced, using a 1550 nm wavelength fractional photothermolysis to create a pattern of microscopic zones of tissue coagulation that healed over several weeks while the skin retained its normal appearance. Instead of creating a global tissue effect at the surface of the target tissue or the dermis alone, Fraxel creates injury in a tiny fraction of the treated skin by coagulating multiple columns of tissue from 70 to 100 micrometers in diameter, extending through the epidermis while deeply penetrating the dermis.

The epidermal microthermal zones are coagulated, but remain intact without raw surfacing. The coagulated tissue is extruded over several weeks and replaced with new healing tissue that’s invisible to the naked eye. One study showed an 18 percent reduction in wrinkles by pre- and postphoto comparison, and more than 90 percent of the participants revealed visible improvement.¹²

The Harmony Multi-Application System’s ST module (Fort Lauderdale, FL) uses a near infrared 780 to 1000 nm technology to induce deep dermal heating to treat lax skin on the face, neck and underarms. The handpiece energy output can be set from 5 J/cm2 to 105 J/cm2 based on three time intervals at 5, 10 or 15 seconds with the repetition rate maintained at 3 Hz.

Our Experience

Because every patient’s skin is unique with different degrees of genetic and environmental damage, we use an individual approach toward facial photorejuvenation as outlined by Groot and Johnston.¹³ This incorporates infrared deep dermal heating for skin laxity and wrinkles; 1064 nm sub-millisecond pulsing to improve texture, reduce pore size and create upper dermal collagenesis; and intense pulsed light to treat superficial pigment changes induced by sun damage, producing a uniform skin color.

Because all modalities are easily accessible on one platform, patients can have the treatments in one setting without any increase in epidermal injury. This eliminates the need for frequent return visits. All devices are on one platform with hand pieces that provide contact cooling for epidermal protection.

Our technique is based on the experiences published by Lisa S. Bunin, MD, who recommends covering the entire area of laxity and extending a few centimeters outside the area with pulses adjacent to one another. This produces uniform contraction, allowing the entire area to be pulled as a unit in a spandex-like effect. Second passes cover the same or smaller area than the first pass.

This creates a pulling effect on the treated area, while the third and sometimes fourth pass is placed along lines of “vector forces.” These are determined by gently pulling the skin to visualize the greatest improvement in wrinkle reduction, such as nasolabial folds, marionette lines or jowl contour. The third and possibly fourth passes are concentrated along these determined vectors, creating maximum tightening results.¹⁰

By addressing the three problems of agingskin color, texture and gravity—we can improve tone and tautness with a more homogenous color appearance to the face. Because these modalities work synergistically but with different light properties, all three painless treatments can be done during one session, a significant patient benefit. We recommend starting with the deepest dermal layer first and moving toward the most superficial with two sessions one month apart.¹³

For patients with deep wrinkling, we also use dermal fillers for static wrinkling and Botox for dynamic wrinkling. This provides impressive immediate facial rejuvenation with high patient satisfaction. We encourage our patients to maintain improved skin quality by using prescriptive cosmetics, sun protection and especially antioxidant formulas to reduce future environmental facial damage.

Nonablative infrared laser treatments provide an attractive alternative for patients who can’t afford the downtime of more aggressive procedures, such as ablative dermabrasion, chemical peels, skin resurfacing and plastic surgery. By stimulating dermal collagen without epidermal damage, nonablative infrared laser treatments can restore the skin’s appearance without producing dramatic and sometimes artificial results from surgery.

If you’re interested in providing photo-rejuvenation services to your patients, especially tightening for skin laxity, all the modalities I’ve referred to have shown success. But it’s important to check the scientific data, as well as the clinical parameters, since good results produce high patient satisfaction. Additionally, patients want treatments that fit their busy schedules without downtime.

Before purchasing a unit, research specifics, such as disposables, cooling systems and potential obsolescence, as well as patient tolerability and healing time. A device that requires multiple parts and additional cooling systems may be more expensive in the long run. In addition, make sure the manufacturer can adjust or change your present platform to accommodate for future advances in optic techniques as well as scientific breakthroughs.

When it comes to optical photorejuvenation, one-stop shopping does not fit all types of skin problems, nor does a light-based unit that hurts with minimal outcome. Happy patients, both with results and tolerability, are your best walking billboards.

For a list of references, go to www.advanceweb.com/healthyaging and click on the references toolbar.

Randy A. Birken, MD, is a clinical assistant professor at Baylor College of Medicine and medical director of lan Medspa and Timeless Benefits Medical Spa in Houston.

Disclosure: Dr. Birken indicates that he is a paid consultant for Cutera and has an ongoing relationship with the company.