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Non-Invasive Cosmetic Surgery

Dr. Riyaz Hassanali

Looking your best with Dr. Riyaz Hassanali

Judy Sperry, host of, visited the offices of Dr. Riyaz Hassanali to find out the latest developments in non-invasive comsetic surgery. Dr. Hassanali, a recognized expert in his field with offices in Rochester and Williamsville, also has patients worldwide, from Dubai to London.

AV: Dr. Hassanali, we know you are an advocate of non-invasive surgical techniques, such as Botox, and facial fillers. Can you tell us what’s very new on the market?

RH: Well, the latest addition to Botox type treatments is a new product called Dysport. It works in the same way as Botox, which is primarily for relaxing the lines in the forehead, around the eyes, and smooths crows feet. But as you know, Botox has additional applications to reduce sweating, muscle relaxation, and so forth.

Dysport came out about a year ago and it’s slowly gaining acceptance in the medical community. About 10 percent of our patients now are using Dysport. The main difference between Dysport and Botox is that it has a quicker onset of action. Where typically Botox takes about three days before you start noticing an improvement, with Dysport, studies have shown that it probably reduces that time by half.

The cost of the two products is almost identical, and in terms of longevity, both treatments are about the same, which is about four to five months after a treatment. Of course, that also depends on frequency of use and the age of the person and degree of muscle that needs to be atrophied over time.

AV: At what phase of life would someone start using products like Dysport or Botox?

RH: The answer to that would be based on need. I have had young patients in their early 20s who come in and could actually benefit from Botox simply because they’ve been overusing expressive muscles and as a result they’re causing hypertrophy of the muscle. Their foreheads appear severely and prematurely wrinkled. And then I have patients who are in their 60s who have perfectly smooth facial muscles. Perhaps, it all comes down to how old were you when your mother started telling you not to frown?

AV: What is Dysport extracted from?

RH: Both products, Dysport and Botox, are derived from a bacteria, it is a toxin. But it’s a well-controlled purified protein and we know exactly how much to inject for a therapeutic level. To the best of my knowledge there haven’t been any long-term side effects associated with either product.

AV: Would you say this is a way of preserving your skin and reducing wrinkles?

RH: Well, I think the first step is to avoid sun, okay? So I think that that’s a take-home message that I would like to impart to your audience. There’s no doubt that the best way to reduce sun damage, and reduce aging of the skin, is to actually stop exposing yourself to UV rays, that includes tanning beds. It’s sad for me that I’m seeing younger and younger patients coming in with not only wrinkling but early onset of skin cancer, and I think that there is a direct relationship between tanning beds and the introduction of tanning beds and skin cancer. You need to stop smoking, as well, if you’re a smoker. That not only increases wrinkling of your skin but it also increases the risk of cancer.

AV: Does treatment Dysport or Botox replace someone having a face lift?

RH: No, not necessarily. It might replace surgery someone may have had to address lines in the forehead or wrinkles around the eyes, but it wouldn’t address something like drooping jowls or a sagging neck. A facelift is primarily needed for those people who have had laxity of the skin where the skin has become kind of droopy. Botox is just one measure of trying to offset some of more of the invasive procedures primarily in the forehead. So yes, in terms of forehead treatment, Botox has certainly become more popular than a forehead lift, rather than a total facelift.

In the facial region, newer products now available have reduced the number of facelifts that are being conducted nationally. And those products, which are called fillers, are designed to add volume your face. I’ll use the analogy of a balloon. If you take a balloon and you blow it up, and you let it sit there for a while, over time the balloon loses its air and the latex looks very wrinkly. Re-inflate the balloon, and it looks taut and new again. The same thing is happening to your face. Over time, with natural aging, your face loses its natural volume. And by losing its volume, the skin, because of aging, does not have a way to adjust so it forms creases. What we’re doing today is we’re actually re-augmenting the face by filling out the face with a variety of fillers. In this way we are able to make the face look more youthful. Look, for example, at the big, robust cheeks of a baby and compare that with very old man or woman.

AV: They usually look gaunt.

RH: Gaunt, exactly. So I think that these products are a perfect way to get a procedure done that’s minimally invasive and have a quick recovery, and they give a more youthful looking, without having to endure more invasive procedures such as a facelift.

AV: A quick recovery? How quick?

RH: Some of these procedures are done during the lunchtime, for example, where women come in during their lunch-break; they get the filler done, and return to work the same day. Let me just say that there are more invasive filler procedures that we also recommend, such as fat transplant. This is a procedure where we actually remove fat from one area of the body under local anesthesia in the office, and then re-inject it back into the face. And recent studies have shown that the transplanted fat, first of all not only lasts several years, but it also has stem cells, a concentration of stem cells, these stem cells migrate to the surface of the skin and make the skin look more youthful. So this is all new stuff that I think you’re going to hear about in the coming years.

AV: Why is the forehead so prone to getting wrinkled before the other parts of your face?

RH: That is probably habitual. We have a person who has an expressive face and so they will express surprise, annoyance, anger, joy, all these are muscle movements used to express a certain feeling. But the skin is attached to the muscle. So as you’re contracting the muscle you’re sharing the skin with it. And over time the collagen under the skin gets stretched out and contracted so much that it forms natural creases resulting in wrinkles.

AV: Okay, so the key factors in avoiding wrinkles so that someone doesn’t have to visit a cosmetic surgeon would be what?

RH: Stay out of the sun, avoid stress, and watch your diet. I’m an ardent believer of proper nutrition as part of your total package. So use sunscreens, or sun avoidance ideally, no smoking, healthy nutrition, plenty of hydration, and of course appropriate skin care.

—AV Interview by J.M.

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