Modesto Doctors

Plump Lips Without the Duck Bill Look

on CBS today was a dermatologist Dr. Colbert who created his own lip plumping technique he called Colbert Lips. Colbert outlines the vermillion border with hyaluronic acid injections of Restylane or Juvaderm. What technique do you think gives the most natural looking lips that don't get the duck bill appearance -- like you see all over the Housewives of Orange County!

Filling in the lips with fillers can be challenging. There are several parts to the lips, and there is the upper lip and lower lip. The are two main challenges -- figuring out how much to inject and in what proportion (ratio). Besides these two challenges, injectors have to figure out what our patients want. Thus, communication with your doctor is very important. It may be helpful to bring in pictures of lips that you like and pictures of lips that you do not like.

Keep in mind that it is nearly impossible to replicate the lips of the pictures that you bring. Everyone has a different starting point. To answer your question regarding how to avoid the "duck bill" look, the greatest way to reduce that chance is to communicate your desires -- spend the time to explain what you want and consider using some pictures as examples.

Also, you can have the injector hand you the mirror so you can monitor the progress but keep in mind that you will have swelling during the procedure. Leaving the office with a "duck bill" would look less plump a week or two later -- this may be what you want.

Good luck, please see your doctor in person to get his or her own opinions on filling the lips.

Tammy Wu, MD

Modesto Plastic Surgeon

Obagi Nuderm Vs. Clenziderm - Which is Better?

I have used the Obagi Nuderm for six months and ran out. Since then my face has began to break out again. I can't really afford to used the Obagi again and was considerning trying the Clenziderm. I wasn't sure how much of a difference there is between the two. Which is better?

Both systems will help address acne, but they are different systems. With the Nu-Derm system you get the added benefits of hyperpigmentation reduction and anti-aging effects. Clenziderm will mainly just treat acne. The Clenziderm system does not contain hydroquinone products.

Background info about CLENZIderm from OBAGI

Obagi CLENZIderm is a prescription strength acne treatment that has a patented, solubilized 5% benzyol peroxide which penetrates deep in to the follicle to treat acne at its origin. There's a Oily and Dry skin version of this product (just as with Nu-derm). The manufacturer says that their benzyol peroxide has better penetration therapeutics than others because of CLENZIderm's much smaller size.

Background info about Benzoyl Peroxide

• Works by killing bacteria and reducing inflammation in the follicle
• Higher strengths doesn't necessary improve therapeutic benefit. Better penetration may be the key (as in the Clenziderm system)
• Use once or twice per day
• May cause skin irritation
• May bleach hair or fabrics (ie. your pillow)
• Shouldn't be used at the same time with Retin-A / tretinoin because benzoyl peroxide inactivates it.

Regarding Cost of OBAGI Nu-derm and Clenziderm

If you are out of a few products in the Nu-derm system, you can buy the products individually to replenish your system. This might cost less than buying the whole Clenziderm set - which is a new system.

The pricing (as of this posting) of a Nu-derm starter set costs about $394, and the pricing of a Clenziderm Starter Set is $130. Tretinoin costs $73-83 depending on the strength.

To continue on the thought from one of the paragraphs above on replacing a Nu-derm product: One of the most important products in the Nu-Derm system that is frequently used up/replaced is the Nu-Derm Clear which costs $91 for a new replacement bottle.

Combo possibility

It is also possible that for certain patients, one can combine these two systems for desired effects (using mainly Clenziderm in the morning and nu-derm at night -- not at the same time due to degradation of Tretinoin). Please see your doctor in person to see what is best for you.

Tammy Wu, MD

Modesto Plastic Surgeon

What is Diamond Microdermabrasion?

i assume diamond particles are used in the microdermabrasion, right?

Where are the diamonds in diamond microdermabrasion?

These diamonds aren't "spitted out" or in the "dust". The diamonds are embedded (glued) in the tip of the wands used for this form of microdermabrasion.

How is this different?

This form of microdermabrasion is cleaner and less risk of leaving crystals in the skin. It is less messy and the operator doesn't have to wear a mask.

Hope this answer helps!

Tammy Wu, MD

Modesto Plastic Surgeon