INFORMATION BOOKLET LOOK as YOUNG as you feel Treatments for WOMEN & MEN Discover the many options to help you put your best face forward. Beat the AGING process TABLE OF CONTENTS 2 About Refresh MD Providing safe and affordable medical aesthetic treatments since 2013. 3 Beat the Aging Process 23 Refresh LiftTM 27 Eyelash Growth Treatments Get fuller, longer, and darker eyelashes. Learn how skin ages and what you can do to turn back time. 11 Gentlemen, Your Skin Ages Too! Discover our solutions to keep you looking timeless. 12 16 30 Underarm Muscle Relaxants Reduce excessive sweating. 33 Facial Muscle Relaxants Soften frown lines, relax crow’s feet and smooth forehead wrinkles. Discover our signature treatment. The Refresh MD Maintenance Plan Look your best for less. 34 Why Refresh MD? Because you’re in good hands. Dermal Fillers Reduce lines and wrinkles, enhance your cheeks, plump your lips and better define your chin and jawline. Welcome to Refresh MD, an Affiliate of LASIK MD Thank you for choosing Refresh MD to help you achieve the refreshed, rejuvenated and natural look you deserve. We understand how excited you must feel about your decision to begin medical aesthetic treatments. You will be even more pleasantly surprised with the results: Looking as YOUNG as you feel will improve your confidence and change your life. This document’s aim is to address your concerns about our treatments and provide up-to-date information about the benefits, potential risks and processes involved so you can make an informed decision about medical aesthetics. ABOUT REFRESH MD Refresh MD is the leader in affordable, high-quality medical aesthetics. We offer a wide range of non-invasive cosmetic treatments that can help you enhance your features and achieve a soft, youthful look. Launched in 2013 with the help of its affiliate company, LASIK MD, Refresh MD was founded on a simple and straightforward principle: To deliver the best experience to patients with safe and effective treatments, knowledgeable staff and personalized service. Our medical team has performed thousands of treatments on satisfied patients, and understand the importance of achieving radiant, natural-looking results. Whether you’ve had cosmetic treatments done in the past—or are thinking about getting something done for the first time, we’re confident that Refresh MD will deliver the results you’re looking for. 2 BEAT THE AGING PROCESS S kin does a tremendous amount of work for us. All day. Every day. And all without so much as even a thank you. As the body’s largest organ, it shields us from the sun’s most harmful rays and protects us from viruses and bacteria. It keeps us warm when it’s too cold out and keeps us cool when it’s too warm. The epidermis And if that wasn’t enough, our skin needs to look clear, healthy and glowing, too. So why not give it some recognition? The dermis Get to know your skin It contains collagen and elastin, which are two proteins that give skin its shape and elasticity. Collagen and elastin are constantly renewed in young, healthy skin. Older skin tends to sag and wrinkle because the collagen and elastin levels are reduced. The dermis is also full of nerves, blood vessels, hair follicles and sweat and oil glands. The top layer, or epidermis, is where essential cell renewal takes place. In younger skin, cells are replaced roughly every 15–30 days. As we get older, the process can sometimes take twice as long. The dermis, or the middle layer of the skin, is where most of the wrinkle-causing changes are taking place. The skin is an ever-changing organ made up of three primary layers. Each plays a specific role in keeping you healthy and beautiful. The epidermis, or outer layer, acts as a protective shield for the body while the dermis below provides structure and support. The inner layer, called the hypodermis, functions as insulation and padding for the body. Hypodermis Aging impacts all three of these layers differently. The hypodermis is a layer of fat and connective tissue that houses larger blood vessels and nerves. This layer provides padding to give the face and body the bulk of its physical structure. With time, the distribution of fat in the hypodermis changes and volume decreases. This will result in the “shallow” look commonly associated with old age: Prominent facial folds, sunken eyes and hollow cheeks. STRATUM CORNEUM LAYER EPIDERMIS GRANULAR LAYER CONNECTIVE TISSUES ADIPOSE TISSUES 3 DERMIS HYPODERMIS BEAT THE AGING PROCESS That’s not all: Introducing collagen, elastin and hyaluronic acid Your body produces important components to keep your skin young and healthy. The most important of these are collagen, elastin, and hyaluronic acid. • Collagen represents around 70% of the proteins found in the dermis. It gives the dermis its resistance to strain and traction. Since it forms a network of fibres, it acts as the skin’s support structure and framework. As we age, collagen begins to deteriorate and causes the skin to thin out. • Hyaluronic acid (HA) is a natural complex sugar that gives the skin its volume. It retains over a thousand times its weight in water within the skin’s cells, hydrating our skin and increasing its volume. HA stimulates the production of collagen in skin and works as an antioxidant and free radical scavenger. It also maintains skin elasticity and cushions joints and nerve tissue. As we age, cells lose the ability to produce hyaluronic acid and our skin becomes dehydrated, causing folds and wrinkles. • Elastin is a protein that gives the skin its resilience and bounce. Damage to elastin fibres, from sun exposure or disease, can lead to a loss of elasticity. Over time, elastin breaks down and causes wrinkles. Anti-aging creams are just as effective. MYTH FACT: Creams can’t stop the aging process once it has begun. Injectables correct the signs of aging from within for a total refresh, unlike skin creams, which mostly work on the surface. MYTH Treatments are risky. FACT: Products we use are safe and FDA-approved. Your safety is our top priority. The products we use have undergone rigorous testing to ensure their safety before they officially entered the market. Additionally, many of our products contain hyaluronic acid; a component the body naturally produces, meaning they are made up of organic substances safe for absorption. 4 BEAT THE AGING PROCESS Intrinsic and extrinsic aging: What can and cannot be prevented Research shows that there are two distinct types of aging: One is mostly preventable while the other one is much less so. Intrinsic or “natural” aging is caused by the genes we inherit. As aging occurs, a person’s skin cells divide more slowly and the inner layer of the skin, or dermis, starts to thin. By age 40, our regenerative processes represent about half of what they were in our 20s. Since intrinsic aging depends on our individual genetics, there aren’t too many preventive measures that can be taken. Aging caused by environmental factors is extrinsic or “avoidable” aging. It includes exposure to the sun’s rays, repetitive facial expressions, gravity, hot or cold extremes as well as smoking. In order to prevent the onset of extrinsic aging, it is crucial to have a good skincare regimen to preserve your youthful glow. Signs of aging Given all the day-to-day abuse your face skin endures, it’s no wonder that it can start to look tired with age. As we grow older, our skin regenerates more slowly, meaning less collagen, elastin and hyaluronic acid, no matter what we do or what products we use. • Dryness: Skin becomes drier • Deflation: We lose volume in our face and lips; skin gets thinner • Descent: Some features begin to sag or droop The loss of these vital building blocks of beauty is particularly apparent on the face, where we can easily see the “four Ds” of aging: • Deterioration: Fine lines and wrinkles form; skin texture changes; eyelashes thin 5 BEAT THE AGING PROCESS Facial wrinkles, lines and folds With time, our skin has difficulty snapping back due to a loss of elastin. Small creases become lines which eventually stay and create wrinkles. The first signs of aging often appear as crow’s feet, smile lines and forehead wrinkles. “Crow’s feet” are wrinkles that begin to form at the outside corners of our eyes when we hit our mid‑twenties. Forehead wrinkles Smile lines (“nasolabial folds”) are the large wrinkles that run vertically from the bottom of the nose to the corners of the mouth. These are called smile lines because they’re most prominent when we smile or laugh. Crow’s feet Forehead lines are wrinkles that run horizontally across the forehead and are most visible when frowning or raising eyebrows. Smile lines Some wrinkles are associated with our repeated smiles, frowns, and squinting. Because of this they are called dynamic wrinkles. The best solution for preventing dynamic wrinkles is a facial muscle relaxant treatment. When wrinkles and lines are not linked to our facial expressions, they are simply known as “static wrinkles”. Deeper wrinkles and folds, like smile lines, can be treated with dermal fillers such as Juvéderm®, Restylane®, Teosyal® and Radiesse®. These fillers help to restore the skin’s volume, better define the jawline and smooth away static wrinkles. Fine lines and dull complexions Teosyal® Redensity I is a rejuvenation product. It restores hydration, luminosity and tone while serving a different purpose than most dermal fillers; it is not meant to fill in deep wrinkles or restore volume. Redensity I contains hyaluronic acid like other dermal fillers, but it also includes eight amino acids, three antioxidants, two minerals and one vitamin. This light filling innovation targets dull complexions, fine lines and dehydrated skin on your face, neck, décolleté and hands. It guarantees a completely natural and uniform result due to the combination of injectable mesotherapy techniques. 6 BEAT THE AGING PROCESS Facial volume loss Some people may begin to feel the gradual loss of the facial fat layer under the epidermis earlier than others. Pre‑existing health conditions and the use of specific medications (such as corticosteroids) can accelerate the process. Our face loses fat as we age. And that isn’t necessarily a good thing. Voluminous, youthful-looking skin is one of the many benefits of estrogen and good genes. The loss of that precious layer under the epidermis causes our faces to lose volume as we grow older, revealing more blood vessels and other internal structures hidden by younger and thicker skin. Thinner skin tends to break and bruise more easily. Too much unprotected sun exposure can also lead to the breaking down of collagen and elastin (the protein that lets your skin “snap back” after you make a facial expression). Smoking is also an important factor: Nicotine is just one chemical found in cigarettes that can cause premature aging and further degrade the collagen in the skin. Delicate lip tissue is also affected by facial fat loss: Lips get smaller and thinner; wrinkles deepen. As we age, the attractive poutiness of lips is progressively replaced by a more stern and worn appearance. The loss of volume can also lead to deeper wrinkles and a constricted appearance in the lips. In some people, the changing balance of lips can even create a “toothless” look as the lower lips get thinner and the upper lips begin to sag. You can reduce some effects of aging by using sunscreen with an SPF rating of at least 15. But loss of volume is inevitable as we grow older. Your medical aesthetic professional can recommend the treatment that best suits your concerns—such as Juvéderm®, Restylane® or Teosyal®—to help you get smooth, wrinkle-free skin with a natural glow. Volume loss Volume loss 7 BEAT THE AGING PROCESS Sagging skin Dry skin Starting in our 20s, the skin’s natural supports begins to break down, producing a gradual loss of definition in the cheeks, eye sockets, temples, lips, jawline, and forehead. With time, gravity takes its toll causing jowls and droopy eyelids. As we age, our bodies produce less estrogen, a hormone that promotes skin thickness and moisture. As estrogen production slows down, skin gets noticeably drier. Estrogen increases hyaluronic acid and collagen production in the skin. Those two building blocks help maintain epidermal thickness and allow your face to remain youthful, hydrated and wrinkle-free. The waning of estrogen in your 40s also leads to oilier skin and, in some cases, acne. Age can be partly blamed for the deterioration of the face’s bone infrastructure and decreasing levels of facial fat, collagen and elastin; Lifestyle factors such as weight changes and smoking also play a role. Your medical aesthetic professional can recommend some non-surgical options such as fillers to restore your features. Those treatments must be started early to prevent excessive sagging as you age, which would require more invasive corrective procedures such as plastic surgery. Targeted dry skin products, like serums and masques, can deliver even more moisture to dry skin, as well as hydrating topical antioxidants and sunscreens that soothe symptoms of dryness while shielding the skin from free radical and UV damage. To counter moisture loss, improve elasticity, and rejuvenate dull skin or for more information, please consult your medical aesthetic professional. Sagging skin 8 BEAT THE AGING PROCESS Thinning eyelashes Our treatments Wrinkles aren’t the only skin surface problem we encounter with age. Whether you are looking to reduce the visibility of wrinkles and fine lines, provide a better contour to your face, or restore fullness to your lips and eyelashes, Refresh MD has the solution for you. Medical aesthetic treatments offer an effective, cost-conscious and safe alternative to plastic surgery. New scientific data suggests that there may be a link between aging and the loss or thinning of eyelashes. Eyelashes also suffer from the reduced production of estrogen. Refresh MD provides safe and proven treatments to get you looking your very best: Research shows that length and thickness start to decrease in our 20s and 30s. Our lash colour also begins to fade. By the time we reach our 60s, our lashes are considerably thinner, shorter and lighter in colour. • Facial muscle relaxants soften wrinkles and fine lines for a younger and fresher look without the inconvenience of recovery time. There are many causes behind thinning eyelashes, including too much scrubbing and rubbing, which can damage the skin and cause delicate eyelashes to fall out. Some medical conditions and heredity may also play a part in eyelash loss. • Dermal fillers, such as Juvéderm®, add volume to your lips and cheeks and better define your jawline for smooth, natural-looking results while Redensity I, a light filling innovation, targets dull complexions, fine lines and dehydrated skin on your face, neck, décolleté and hands. Your medical aesthetic professional can prescribe a clinically-proven treatment to help you grow back fuller, longer, and darker lashes in about 16 weeks, with noticeable results after 8 weeks. • Volumizing fillers, such as Radiesse®, diminish the appearance of wrinkles, add volume and structure to your face and increase the production of collagen. • Refresh LiftTM, our signature treatment, combines facial muscle relaxants and dermal fillers for a non‑surgical facelift, resulting in balanced and natural, youthful glow. • Eyelash treatments prolong the eyelash growth cycle, resulting in longer, thicker and darker lashes. Once I start, monthly visits will be required. FACT: Results can last for months. MYTH The results of dermal filler treatments start to show immediately. Optimal results, achieved in two weeks, can last roughly six months to a year. The effects of facial muscle relaxants appear in 14 days and can last for up to four months. 9 After the age of 30, both men and women lose about one per cent of their collagen each year. Medical aesthetic injections are a great option for men who want to improve the look of their skin, redefine the contours of their face and boost their confidence. GENTLEMEN, YOUR SKIN AGES TOO! M en may forego the daily use of moisturizers more often than women, but that doesn’t mean they don’t want smooth, attractive-looking skin. In fact, more men than you think are seeking to recapture their youth with anti-wrinkle injections. Men’s Skin vs. Women’s Skin Moisture There are three main differences between the skin of a man and a woman. By taking a closer look at the differences, we can begin to see how they impact the signs of aging. Men naturally sweat more and produce more lactic acid in their sweat than women. While this might initially seem like a bad thing, it’s actually good for the skin—especially since men are less likely to use daily moisturizers. It’s also worth noting that lactic acid acts as a moisture absorber for the skin. Skin Thickness A man’s skin is approximately 25% thicker than that of a woman. This is largely due to the fact that testosterone causes an increase in skin thickness. A man’s skin also thins gradually with age, while a woman’s skin thins gradually until she reaches menopause, at which point the rate at which her skin thins increases significantly. Refresh MD has solutions for men too, including: • Facial muscle relaxants subtly smooth your forehead lines, soften your frown lines and relax your crow’s feet; Collagen • Dermal fillers such as Restylane®, Juvéderm® and Teosyal® lift your cheeks, soften your smile lines and better define your chin and jawline; It’s a well-known fact that collagen helps keep the skin looking youthful. Men have a higher collagen density than women. Because of this, men’s skin appears to age slower than women’s. Of course, external factors like sun damage play a role, and the fact that women tend to use sunscreen more often than men helps balance the scales. our signature treatment • Refresh LiftTM, combines facial muscle relaxants and dermal fillers for a non-surgical facelift, resulting in youthful, balanced and natural looking look. After the age of 30, men and women both lose about one per cent of their collagen per year. However, when women reach menopause, the rate at which they lose collagen increases dramatically for about five years then slows to a loss of about two per cent per year. MYTH Treatments are just for women. FACT: Use in men has increased by 100% since 1997!* Millions of men worldwide are turning to medical aesthetic treatments to help them look their best and restore their confidence. Just last year, men in the United States received over 1.2 million treatments, a number expected to climb as treatments continue to soar in popularity. *According to the American Society of Aesthetic Plastic Surgeons 11 FACIAL MUSCLE RELAXANTS F acial muscle relaxant injections are used to soften frown lines, crow’s feet and forehead wrinkles. They are also great at preventing the appearance of dynamic wrinkles. Am I a good candidate? They contain a purified protein used to relax the muscles under the skin that cause wrinkles. Facial muscle relaxants are safe, clinically-proven and designed to treat various issues that cause us to appear older than we feel. They may not be for you if you meet any of the following criteria: Most men and women are excellent candidates for facial muscle relaxants. How do they work? As their name suggests, facial muscle relaxants target the small facial muscles that cause wrinkles around the eyes, between eyebrows, and across the forehead. • You are undergoing treatment for a chronic or severe illness. • You had a prior allergic reaction to facial muscle relaxants. The injection relaxes specific facial muscles, thus immobilizing the underlying cause of unwanted lines and wrinkles. • You are pregnant or nursing. • You have an underlying neurological disorder. • You suffer or have suffered from dysphagia (problems or difficulty swallowing). Risks and potential complications • You have muscle disorders in other parts of your body (myasthenia gravis, Lambert-Eaton syndrome, amyotrophic lateral sclerosis). Due to the non-invasive nature of the treatment, side effects from facial muscle relaxants are rare, mild and treatable. They include mild discomfort, tenderness and/or bruising (which can be covered up with makeup) at the site of injection. • You have an infection at the proposed injection site. • You have received or will receive a laser skin treatment or chemical skin peel within a month of your treatment. If you develop a droopy eyebrow or eyelid, don’t be alarmed. This rare side effect is not serious. Eye drops can be prescribed which will alleviate this problem. • You are under 18 years of age. MYTH My face will look expressionless. FACT: Our team strives for natural-looking results. Rest assured: We don’t want to freeze your face (or your emotions). You will receive a customized treatment plan during your first appointment, and we will administer the appropriate amount of product to help reverse the signs of aging while leaving you with a radiant, glowing look. 12 FACIAL MUSCLE RELAXANTS Treatment instructions To minimize possible bruising, you should avoid any blood thinning, over-the-counter medication (such as Aspirin® or Motrin®) and herbal supplements for at least seven days before treatment. You should also refrain from drinking any alcoholic beverages for at least 24 hours before treatment. The treatment is quick and easy and usually lasts between ten to 30 minutes, depending on the number of areas treated. It is recommended that you actively contract and use the muscles in the treated area for a few hours after the injection by smiling and frowning. This helps accelerate the absorption of the muscle relaxants. For the first four hours after your treatment, you should avoid makeup. You should not touch, rub, apply pressure, or massage the treated areas in any way for the first six hours following your treatment. You should also not bend at the waist, lie down, or adopt a position in which you could fall asleep. Plucking your eyebrows is also not recommended. You should avoid strenuous exercise, extreme sports, and consumption of alcohol for a day or so after your treatment. Do not rub vigorously or apply pressure to the injection site for at least two weeks after your treatment. Be mindful not to wear constrictive eye masks or swimming goggles for at least 24 hours after your treatment. In order to minimize redness and bruising, avoid anything that will make your face or body flush such as direct sunlight, exercise, alcohol, hot showers, or spicy foods for 24 hours. If bruising does occur, it will go away in several days. You may apply cold water compresses to the treated sites if they are uncomfortable or red. If you develop a headache, Tylenol®/acetaminophen is allowed. Do not take Aspirin® or ibuprofen as these agents may increase the risk of bruising. 13 FACIAL MUSCLE RELAXANTS Results Results begin to appear approximately two to five days after treatment, but optimal results are usually achieved two weeks after the injection. Here are some untouched pictures from actual Refresh MD patients. The patients are making the same facial expressions in both the before and after photos. Please note that specific results may vary for each patient. The Refresh MD team is confident that you can achieve similar results as we use the latest techniques and proven treatments. Forehead wrinkles Before After Before After Before After Frown lines Crow’s feet 14 FACIAL MUSCLE RELAXANTS FAQ How long is recovery? Will I lose the ability to make facial expressions? There is no downtime with facial muscle relaxant treatments. Patients can return to work immediately after treatment and can resume daily activities as usual after roughly four hours. Unfortunately, some celebrities have given facial muscle relaxant injections an undeserved reputation. As with many things in life, too much of a good thing doesn’t always make for the best results. The frozen, expressionless look worn by some stars comes as the result of too many units of facial muscle relaxants and too many treatments in general. How long do facial muscle relaxant injections results last? Results will vary from patient to patient but most authorities state that the average treatment’s effects last three to four months. In some exceptional cases, patients may still see effects up to six months after their treatment. A follow-up appointment is typically scheduled every three to four months. In the hands of our experienced medical aesthetic professionals, your anti-wrinkle treatment will only enhance the way you look, giving you a soft, natural and refreshed-looking appearance. What happens if I choose not to continue treatments? Is the treatment painful? If you stop getting facial muscle relaxant treatments, your wrinkles and lines will gradually return to the way they looked prior to treatments. The pain associated with the injection is minimal. The needles used are very small and the injection is quick. Some patients compare the feeling to that of receiving a mosquito bite. Your aesthetic professional may also choose to use a numbing medication and ice to help numb the skin and the layers below the skin. Facial muscle relaxants can be preventative, however. They are made with formulas that encourage the body to produce new collagen thus halting the skin from aging. Your anti-wrinkle treatment will only enhance the way you look, giving you a soft, natural and refreshed‑looking appearance. ” 15 DERMAL FILLERS D scars. Am I a good candidate? ermal fillers consist of a soft gel injected under the skin’s surface to add volume, reduce wrinkles and lines, enhance cheeks, plump lips, and smooth Most men and women are good candidates for fillers. Dermal fillers are safe and designed to treat various issues that cause us to appear older than we feel. Dermal fillers may not be for you if you meet any of the following conditions: Most fillers use a hyaluronic acid (HA) base. HA forms an elastoviscous matrix in which the other skin support structures are embedded, so its presence is absolutely critical in supporting the structure and volume of the skin. Since HA is a substance naturally produced by your body, it gives a smoother, more natural appearance. Fillers can last from six to 18 months, depending on the type used. • You are undergoing treatment for a chronic or severe illness. • You are pregnant or nursing. • You have an infection at the proposed injection site. • You have recently received a laser skin treatment or chemical skin peel (or are planning on it). Refresh MD offers three of the most popular clinically‑proven dermal fillers on the market: Restylane®, Juvéderm® and Teosyal®. • You are under 18 years of age. How do they work? Risks and potential complications Dermal fillers are injected under the skin where they restore lost volume to the aging skin, thus reducing the appearance of wrinkles, fine lines, and deep creases. They can even improve the appearance of scars, frown lines, dimples, and thin or wrinkled lips. Dermal fillers are also used to improve the contours of your face. They’re excellent at giving the appearance of a stronger jawline in men or more pronounced cheekbones in women. Some common side effects of dermal filler injections include swelling, redness, bruising and mild asymmetry as the inflammation settles down. Complications are reversible and generally minimal. Please note that side effects may vary as some people swell more than others. Treatments take too long. So does recovery. FACT: Treatments take under an hour & downtime is minimal! MYTH In reality, many patients treat themselves to lunchtime lifts and return to their daily activities quickly so no one will be the wiser. Generally, treatments are short: facial muscle relaxants take roughly 15 minutes to administer while dermal filler treatments take up to 30 minutes and a Refresh Lift® can take up to one hour. Following treatments, swelling or bruising is usually quite minimal and disappear within 24 hours. Remember: Every patient is unique and results may vary. 16 DERMAL FILLERS Treatment instructions To minimize possible bruising, you should avoid any blood thinning, over-the-counter medication (such as Aspirin® or Motrin®) at least a week before treatment. The treatment is quick and easy, lasting anywhere from 15 to 60 minutes, depending on the number of areas being treated. Your medical aesthetic professional will use a fine needle to insert the injectable gel directly under your skin. You may experience some temporary redness, tenderness, or swelling at the injection site following the treatment. To minimize these possible effects, apply a cool compress to the treated area but avoid applying pressure. This will help reduce swelling and the potential for bruising. For the first four hours after your treatment, you should avoid makeup. You should not touch, rub, apply pressure, or massage the treated areas in any way for the first six hours following your treatment. You should also not bend at the waist, lie down, or assume a position in which you could fall asleep in that same time period. You should avoid strenuous exercise, extreme sports and consumption of alcohol a day or so after treatment. For the first week after your treatment, you should not sleep on the site of your injection. Facial expressions should be kept relaxed and natural. Exposure to the sun and UV lamps (tanning booths) must be kept to a minimum for 1-2 weeks after treatments. Cosmetic treatments, such as facials and massages, that require pressure to the treated area should be avoided as well. Finally, laser skin treatment and chemical peeling treatments should not be undertaken in the first month following your treatment. MYTH Treatments are painful. FACT: Most patients say injections feel like a mosquito bite. Many of our patients are surprised to discover that our treatments hardly hurt. Many of our dermal fillers are prepared with Lidocaine to reduce pain and an anesthetizing cream can be applied to the treatment zone upon request. 17 DERMAL FILLERS Results You’ll see noticeable results roughly three days after your dermal filler injections. Final results will be achieved in about two weeks. Here are some untouched pictures from actual Refresh MD patients. The patients are making the same facial expressions in both the before and after photos. Please note that specific results may vary for each patient. The Refresh MD team is confident that you can achieve similar results as we use the latest techniques and proven treatments. Lips Before After Before After Before After Smile lines Marionnette lines 18 DERMAL FILLERS Jowls Before After Before After Chin 19 DERMAL FILLERS FAQ Why should I use dermal fillers? Where can dermal fillers be used? • The treatment is a non-invasive and non-surgical solution; Dermal fillers have many applications. They can be used to smooth away facial lines, such as smile lines and wrinkles. They can also be used to plump and define lips, shape facial contours such as the cheeks and chin, and fill hollow areas in the face. Finally, they can be used to revitalise the skin and change the way the skin reflects light to give a healthy glow. Restylane®, Juvéderm® and Teosyal® dermal fillers can be used on the following areas: • Fillers allow you to treat precise areas; • The treatment can be given gradually, resulting in a more natural look; • They can reliably treat wrinkles at depths that other methods cannot; • They will rarely cause a reaction since they are naturally occuring in the human body. • Lines from nose to the mouth (nasolabial folds or smile lines) Are dermal fillers safe? What are the possible side effects? • Lines from mouth to chin (melomental folds or marionette lines) It is estimated that millions of Americans receive dermal filler treatments every year. Restylane®, Juvéderm® and Teosyal® dermal fillers have a long track record of providing safe and effective results. Restylane® has been delivering proven results to patients since it was approved in Canada in 1998, while Juvéderm® has been offering Canadians great results since 2004. Teosyal®— produced by Teoxane Laboratories in Geneva, Switzerland—is newer to the market, but it has shown extremely low incidents of complications since its introduction to the Canadian market in the late 2000s. • Lines between eyebrows (frown lines) • Small vertical lines above and below the lips • In the lips for volume and definition • To restore volume in cheekbones or cheeks • To add volume and better define your jawline and chin • Under the eyes to reduce dark circles Additionally, Redensity I can be used on the face, neck, décolleté and hands to restore hydration, luminosity and tone. MYTH Dermal fillers & facial muscle relaxants serve the same purpose. FACT: Each treatment addresses different concerns! Facial muscle relaxants smooth dynamic wrinkles caused by smiles, frowns and squinting, whereas fillers on top of smoothing static wrinkles replace lost volume in cheeks, and lips and redefine the jawline and contours of your face. Plus, these customizable treatments can also act as a preventative measure against future signs of aging. 20 DERMAL FILLERS Is the treatment painful? As is the case with any injection, patients report a feeling of slight discomfort at the injection site. A fine gauge needle is used to help reduce the pain. Restylane®, Juvéderm® and Teosyal® dermal fillers are available with local anaesthetic to help reduce the pain during the treatment. Your aesthetic professional may also choose to use a numbing medication and ice to help numb the skin and the layers below the skin. How long is recovery? Dermal filler treatments require very little downtime. Most activities can resume immediately following treatment. Some patients even opt for a “lunchtime lift” – getting a dermal filler treatment during their lunch hour. Treatment side effects are usually mild to moderate, lasting seven days or less, and include temporary injection-site reactions such as redness, pain, firmness, swelling, and bumps. Dermal fillers are not recommended for people with severe allergies. How long do dermal filler injection results last? Depending on the area treated, the skin type, and the injection technique, treatment typically lasts around six months. In some cases, the results can last for as long 18 months. The thicker versions of Restylane®, Juvéderm® and Teosyal® dermal fillers tend to last longer, usually around nine to twelve months. MYTH Treatments can’t be combined. FACT: Get to know Refresh Lift®, our signature 2-in-1 treatment! Thanks to this combination of dermal fillers and facial muscle relaxants, you’ll get optimal and rejuvenated results in under an hour. Your aesthetic professional will determine the safest and most effective course of treatment for you. 21 My friends say ‘WOW, you look great’, but can’t figure out why. Ana Maria Martins REFRESH LIFT TM O ur signature treatment, Refresh Lift™, is a non‑surgical facelift. It will help shed years from your appearance by reducing wrinkles and giving your skin a smoother and younger look. Refresh Lift™ can improve the look of the following areas: This complete treatment can help you look up to 10 years younger by combining facial muscle relaxants and dermal fillers. Refresh Lift™ is a proven non-invasive solution with very little downtime that restores a youthful glow in a balanced, subtle, and natural way. • Crow’s feet • Forehead lines • Frown lines • Smile lines • Vertical lines around the mouth • Lips The Refresh Lift™ treatment can be customized by your medical aesthetic injector to precisely target your individual needs. • Cheeks • Jawline How does it work? • Neck This unique combination of facial muscles relaxants and dermal fillers provides a safe and cost-effective alternative to surgical facelifts. • Décolleté Am I a good candidate? The facial muscle relaxant portion of Refresh Lift™ is used to treat wrinkles and fine lines around the eyes and forehead. The dermal fillers help soften deeper wrinkles between the nose and mouth, and can also be used to plump the lips and restore lost volume around the contours of the face. The combination of the two products gives patients a noticeably refreshed look, while maintaining a natural and balanced appearance. Most men and women are good candidates for a Refresh Lift™. The treatment might not be right for you if you meet any of the following criteria: • You are undergoing treatment for a chronic or severe illness. • You are pregnant or nursing. • You have an infection at the proposed injection site. • You have received or will receive a laser skin treatment or chemical skin peel within a month of your treatment. Risks and potential complications Some common side effects of the dermal filler injections portion of the treatment include swelling, redness, bruising and mild asymmetry as the inflammation settles. This side effects are generally minimal and completely reversible. Possible side effects from facial muscle relaxants are rare, mild and treatable. They may include mild discomfort, tenderness and/or bruising (which can be covered up with makeup) at the injection site. 23 REFRESH LIFT TM Treatment instructions Refresh Lift™ normally takes longer to administer than a facial muscle relaxant or dermal filler treatment and can take up to an hour. It can take more or less time, depending on the number of areas being treated. To minimize possible bruising, you should avoid any blood-thinning, over-the-counter medication (such as Aspirin® or Motrin®) at least three days before treatment. You should also refrain from drinking alcoholic beverages for at least 24 hours before treatment. Your medical aesthetic injector will then use a fine needle to place the injectable gel directly under your skin. The treatment is quick and easy, lasting anywhere from 15 to 60 minutes depending on the number of areas being treated. Patients are fit to return to work immediately following a Refresh Lift™ treatment and can resume most daily activities as usual. Some patients may experience mild bruising. You may experience some temporary redness, tenderness, or swelling at the injection site following treatment. To minimize these possible effects, apply a cold compress to the area treated and avoid applying pressure. This will help reduce swelling and the potential for bruising. For the first four hours after your treatment, you should avoid wearing makeup. You should not touch, rub, apply pressure, or massage the treated areas in any way for the first six hours following your treatment. You should also not bend at the waist, lie down, or assume a position in which you could fall asleep in that same time frame. Plucking your eyebrows is also not recommended during this time. It is recommended that you avoid strenuous exercise, extreme sports, and alcohol consumption for a day or two after your treatment. Do not rub vigorously or apply pressure to the injection site for at least two weeks after your treatment. Be mindful not to wear a constrictive eye mask or swimming goggles for at least 24 hours after your treatment. For the first week after your treatment you should not sleep on your injection site. Facial expressions should be kept relaxed and natural. Finally, laser skin treatment and chemical peeling treatments should not be undertaken in the first month following your treatment. 24 REFRESH LIFT TM Results Patients notice softened lines and wrinkles as well as better defined facial contours immediately following the treatment, which represents the immediate results from the dermal filler portion of the treatment. It takes roughly two to five days for the facial muscle relaxant portion to start showing results. Here are some untouched pictures of an actual Refresh MD patient. The patient is making the same facial expressions in both the before and after photos. Please note that specific results may vary for each patient. The Refresh MD team is confident that you can achieve similar results as we use the latest techniques and proven treatments. 30+ Before After Before After 40+ 25 REFRESH LIFT TM 50+ Before After Before After 60+ FAQ Why should I get a Refresh Lift™? How long is the recovery? The Refresh Lift™ treatment is a non-surgical facelift that helps shed years from your appearance and make your skin look smoother and younger. Unlike surgical facelifts, there is no downtime for Refresh Lift™. After the one-hour treatment, most patients can return to work. After a few hours, the majority of day-to-day activities can be resumed. It combines both facial muscle relaxants, to correct wrinkles and fine lines caused by facial movements, and dermal fillers to restore facial volume loss. How much does Refresh Lift™ cost? The total cost of your Refresh Lift™ treatment will vary based on the number of facial muscle relaxant units and dermal filler syringes required per area, and the number of areas treated. Refresh Lift™ is a proven non-invasive solution with little downtime that restores youthful glow in a balanced, subtle, and natural way. 26 EYELASH GROWTH TREATMENTS D * Am I a good candidate for eyelash growth treatments? esigned to prolong the eyelash growth cycle, our treatment results in thicker, longer and darker lashes. Most men and women qualify as good candidates for eyelash growth treatments. The treatment is based on the active medical ingredient bimatoprost, an ingredient originally found in a prescription eye drop used to control the progression of glaucoma, a common eye disease. The ability of bimatoprost to help improve the look of eyelashes was discovered when glaucoma patients who took the drops began noticing thicker, longer and darker eyelashes. Successful clinical trials ensued, and bimatoprost was eventually bottled into this topical solution. The treatment is safe and clinically-proven. However, it must be prescribed by a doctor before it can be used at home. Conditions that may keep you from benefitting from this treatment include the following: • Glaucoma • An active eye infection How does the treatment work? • An intraocular pressure diagnosis The treatment is a solution applied once daily directly to the eyelid, right along the lashline. • Broken or irritated skin on eyelids • Shingles/zoster around the eyes This regular application increases the number of lashes that are actively growing at any given time. This safe and simple-to-use treatment has already helped thousands of women grow longer, thicker, and darker eyelashes. • Prior discolouration on the eyelids You will likely start to see longer lashes at eight weeks, with full growth at 16 weeks. The growth is gradual. Risks and potential complications An itching sensation and/or redness has been reported in about 4% of patients. The eyelash growth treatment may cause other less common side effects such as skin darkening, eye irritation, eye dryness and eyelid redness. The treatment’s clinical study showed no reports of eye colour change. There may be some potential for increased brown iris pigmentation which is likely to be permanent. This is very rare, but increased iris pigmentation has been associated when bimatoprost is instilled directly into the eye. *Due to new policy changes in the province of Quebec, the eyelash growth treatment is only available through a pharmacy with a prescription. Affordable prescriptions are available at Refresh MD. More details in clinic. 27 EYELASH GROWTH TREATMENTS Pre- and post-application instructions The treatment needs to be applied once a day, ideally before going to bed at night. The first step is to remove your makeup by washing your face and contact lenses. Place one drop of the solution close to the tip, but not right on the tip, of the supplied applicator. Just as you’d apply eyeliner, carefully “draw” the solution along the skin of the upper eyelid, beginning near the nose and working towards the outer edge. Blot any excess solution. If you get some solution in your eye, it shouldn’t cause any harm, so there’s no need to rinse your eye. Dispose of the applicator after one use and repeat the steps for your other eye. Some important DOs and DON’Ts: Do not apply to the lower lid or in the eye. Blot excess solution with a tissue. Only use the supplied sterile applicators to apply the product. Don’t allow the tip of the bottle or applicator to touch fingers or any other unintended surface, as contamination by common bacteria is known to cause infections. If you forget to apply the treatment one night, do not double the dosage the following night. Contact lenses may be reinserted 15 minutes after application. 28 EYELASH GROWTH TREATMENTS Results Results appear within two months of regular daily use. By the end of four months, lashes will be noticeably thicker, darker and longer. Here are some real results of what can be achieved with Refresh MD’s eyelash growth treatment. Before (week 0) After (week 16) Photo credit: Allergan, Inc. FAQ What if the solution gets in my eyes? Can I still wear mascara if I use the treatment? Getting the occasional drop of the solution in your eyes should not be a cause for concern. The treatment is first and foremost a glaucoma medication, which is intended for eye health. If you get a drop in your eye, do not try to rinse it. Proper application should not cause any problem with accidentally getting the product in your eyes. The treatment does not prevent you from wearing mascara. However, it is best to wait until the treatment has dried before applying mascara. What happens if I stop using the treatment? If you stop applying the eyelash growth treatment, your lashes will slowly go back to the way they were before the treatment. 29 UNDERARM MUSCLE RELAXANTS T * Treating hyperhidrosis he same way our bodies shiver when we’re cold, we sweat when we’re warm. These two essential bodily functions are designed to help regulate our body temperature. Unfortunately, roughly 3% of the population suffers from excessive sweating, also known by its medical term hyperhidrosis. This dermatological condition—which is characterized by abnormal amounts of sweating in the underarms, palms, feet or face—can have a profound effect on various aspects of people’s lives. At Refresh MD, we can treat axillary hyperhidrosis (excessive underarm sweating). Treatment of hyperhidrosis is challenging. Prescription or specialty antiperspirants are considered the first line of treatment for those suffering from hyperhidrosis. If antiperspirants don’t work, an effective treatment for axillary hyperhidrosis is underarm muscle relaxant injections. Treating excessive underarm sweating effectively with muscle relaxant injections can be life-changing. If left untreated, this medical condition can have a negative impact on numerous aspects of a person’s life. Dr. David Pariser, the International Hyperhidrosis Society Cofounder, said “treating hyperhidrosis leads to a greater improvement of a patient’s quality of life than treatment of any other dermatologic condition.” The impact of hyperhidrosis Hyperhidrosis can have a serious psychological effect on people. A U.S. national survey found that over half of the people affected by axillary hyperhidrosis feel less confident, and one in five feel depressed. The emotional toll that hyperhidrosis has on people largely stems from the daily embarrassment associated with sweat stains on clothes. They often feel anxious at work or in social settings because they’re constantly worried about needing to change their clothes due to sweat stains. In fact, over 70% of patients with axillary hyperhidrosis report that they are forced to change their shirt two or more times a day due to the sweat stains. Research has shown that underarm muscle relaxant injections for excessive sweating are safe and effective. Clinical research shows that over 80% of patients with severe underarm sweating achieved a greater than 50% reduction in sweating following muscle relaxant treatments. Hyperhidrosis can also cause serious discomfort because of skin maceration, which is an excess of moisture in the skin. This is something we’ve all experienced when we stay in a bathtub for too long and get raisin-like skin wrinkles on our fingers and toes. But for people who suffer from hyperhidrosis, the long periods of moisture on the skin can lead to fungal or bacterial infection. This can cause itching or foul odours. *This treatment is only available in select Refresh MD clinics. 30 UNDERARM MUSCLE RELAXANTS How do they work? Treatment instructions Muscle relaxants are approved by the FDA to treat the symptoms of severe underarm sweating when topical treatments or medicines are insufficient. • Do not touch, rub or apply pressure to the treated area for the first six hours following your treatment. Refresh MD’s medical aesthetic injectors will use a fine needle to inject small amounts of muscle relaxant beneath the underarm skin. This helps control the condition by temporarily blocking the chemical signals from the nerves that stimulate the sweat glands. When the sweat glands don’t receive chemical signals, the severe sweating is reduced, often by half. The procedure only takes a few minutes and involves only minor discomfort. • Do not use deodorant or anti-perspirant for the first two days following your treatment. • Be mindful during that first two weeks following the treatment to not rub vigorously or apply pressure for extended periods of time to the treated area. • Avoid laser hair removal to the treated area for two weeks following your treatment. Am I a good candidate? Most men and women who have been diagnosed with axillary hyperhidrosis are good candidates for underarm muscle relaxant injections. • Please be advised that consumption of acetaminophen, ibuprofen or other, non-steroidal, anti-inflammatory drugs may result in a temporary increase in bruising and bleeding. The treatment might not be right for you if you meet any of the following criteria: Results • You are undergoing treatment for a chronic or severe illness. In general, underarm muscle relaxant injections take full effect approximately one week after treatment. You should notice a significant reduction in underarm sweating within four weeks of your first treatment. • You are pregnant or nursing. Your symptoms will gradually reappear. You will need follow-up treatments every six to seven months to prevent excessive sweating from returning. • You have an infection at the proposed injection site. • You have received or will receive a laser hair removal treatment within a month of your treatment. • You are under 18 years of age. Risks and potential complications Possible side effects from underarm muscle relaxants are rare, mild and treatable. They may include mild discomfort, tenderness and/or bruising at the injection site. 31 UNDERARM MUSCLE RELAXANTS FAQ Will I sweat more in other areas after the procedure? What causes hyperhidrosis? There is no specific cause, but the following factors play a role: No. The underarm sweat glands, which only contain 2% of your body’s sweat glands, do very little to cool the body down. This way, your body doesn’t have to sweat more in other areas. • Genetics • Overactive nervous system (nervous system working overtime without reason to do so) Will my body still be able to cool down? • Dysregulated nervous system (nervous system which cannot discharge energy in a timely manner) Yes, sweating is very important because it helps regulate body temperature. However, the underarms have less than 2% of the body’s sweat glands. For this reason, blocking the sweat glands in your underarms is not a concern as it has no effect on your body’s ability to regulate its temperature. • Hypothalamic dysfunction (section of the brain which helps regulate body temperature) How many people have axillary hyperhidrosis? At least 3% of the global population is affected by hyperhidrosis. Furthermore, 66% of people with severe axillary hyperhidrosis haven’t discussed it with a medical professional. How long do treatments last? In clinical studies, effects from the treatment last 201 days (roughly 6–7 months). Your medical aesthetic professional will provide you with a personalized treatment schedule to allow you to maintain the benefits of the treatment. Is the treatment painful? Discomfort after a treatment will vary from patient to patient. Many patients describe a mild sensation of pain at the treatment site. After the first few hours, these uncomfortable feelings usually subside. Does Refresh MD treat hyperhidrosis in the hands, feet or head (scalp)? For the time being, we only offer treatment for the symptoms of axillary hyperhidrosis. Is there a recovery period following muscle relaxant injections for axillary hyperhidrosis? If you are experiencing symptoms of hyperhidrosis in another area, we recommend contacting a dermatologist for treatment. Clients are asked to avoid axillary laser hair removal, strenuous exercise and the use of a sauna on the day of the injections. Other than that, there are no limitations on what you can do following your treatment. 32 REFRESH MD MAINTENANCE PLAN W hile we may not like it, wrinkles are a natural part of aging. Over time, our skin produces less elastin, collagen and hyaluronic acid. This results in thinner skin with less elasticity. Facial muscle relaxants and dermal fillers each help you in their own way: The first softens your wrinkles while the second restores volume and contour to your face. The Refresh MD Maintenance Plan has been designed to maximize and preserve your youthful appearance for years to come. Facial Muscle Relaxants Day 1: Full treatment Week 2: Follow-up for any necessary touch-ups Continue every 4 months with a full treatment Dermal Fillers (full treatment) Look your best for less Day 1: Full treatment The Refresh MD Maintenance Plan can help you achieve beautiful, long-lasting results at a reasonable price. Week 2: Follow-up for any necessary touch-ups 1 Month 6: Maintenance treatment 2 Month 12: Maintenance treatment 2 This unique plan features a suggested schedule for treatments of facial muscle relaxants (every four months) and dermal fillers injections (every six to 12 months). This combination provides the best possible long-term solution to preserve and enhance your youthful and radiant glow through the years. 1 Following years: Maintenance treatment 2 Dermal Fillers (partial treatment) Day 1: Partial treatment Week 2 to Month 4: Follow-up for any necessary touch-ups and/or completion of full treatment Month 6: Maintenance treatment 2 following last treatment Month 12: Maintenance treatment 2 following last treatment Following years: Maintenance treatment 2 1 Will be determined by your registered nurse during your follow-up treatment. 2A maintenance treatment is approximately 50% of your treatment for a full area. Dosage may vary depending on the patient’s metabolism, skin type and lifestyle. Amount to be used will be determined by your registered nurse to ensure you receive the treatment best-suited to your needs. Refer to your preferred Refresh MD clinic for more details. WHY REFRESH MD? S Medical Aesthetic Team electing a medical aesthetic clinic should not be a spur-of-the-moment decision. Your choice should be based on specific criteria, such as: Refresh MD’s medical team is made up of specialists at the forefront of medical aesthetics. Their experience with the safest, latest and most effective techniques can help you achieve your objectives. • A combination of extensive and up-to-date knowledge, clinical experience, and training you can trust; • Clinically-proven techniques and treatments to turn back the clock and bring back the refreshed, revitalized, younger you; Certified Registered Nurses Refresh MD’s registered nurses are among the most experienced aesthetic professionals in Canada, having collectively performed thousands of treatments. • Treatment plans best suited to your needs; • Affordable prices to ensure that money won’t be Our registered nurses have held a variety of positions which have helped them gain valuable medical aesthetic experience. Our team members have owned their own clinics, worked with prominent plastic surgeons, are trainers on various products for other practitioners, and many have travelled the globe for specialized training. an obstacle towards getting the look you want and deserve; • Multiple locations, so you have the flexibility to get treatments and attend follow-ups where it’s most convenient for you. From facial muscle relaxants to dermal fillers, our registered nurses know which products to use, and how much to use, based on your specific skin type, age, desired result and treatment area. They also stay up‑to‑date on the latest injection techniques by attending regular training seminars. The Refresh MD Team Your face deserves the best. That’s why treatments at Refresh MD are only performed by trained, professional medical injectors, physicians or registered nurses. Our injector team has in-depth knowledge of facial anatomy, injection techniques and the chemical composition of the products they use. Aesthetic Consultants Our aesthetic consultants are here to listen to your expectations and needs and to guide you towards a refreshed and younger you. They will provide tips and techniques to make you more radiant and confident. MYTH Treatments are too pricey. FACT: They’re more affordable than you think. We believe that cost should not get in the way of looking your best and we are proud to offer the lowest prices guaranteed* on all of our treatments. This commitment, combined with our flexible financing options**, make our treatments even more accessible than you’d expect. *Full details and conditions available at refreshmd.ca. **Subject to Desjardins Card Services credit approval. Offer subject to change or termination without prior notice. Minimum purchase of $500. Available to citizens and permanent residents of Canada only. 34 WHY REFRESH MD? Variety of treatment options for customized results Flexible financing options and affordable prices Providing a wide variety of products and aesthetic treatment options ensures that our medical professionals can work out the best combination to help you attain your beauty goals. Can we put a price on your beauty? Yes. The most affordable price with flexible financing options, that is. Refresh MD believes that everyone should enjoy the benefits of looking young and healthy, not just celebrities. That’s why we strive to offer the highest quality treatments at the lowest price. We believe that you will be surprised by how affordable treatments at Refresh MD are. Multiple locations to serve you better Refresh MD has several clinics and authorized service points in Quebec and Ontario. This vast network ensures that we can offer the following to our patients: We also offer financing plans which can help you spread out the cost of your treatment. • Greater economies of scale, which translate into access to high-quality care at an affordable cost; Clinically-proven, safe and effective treatments • Better results generated by a collaboration between our experienced professionals who share treatment results and best practices; Refresh MD offers clinically-proven, leading-edge techniques and treatments to turn back the clock and bring back the refreshed, revitalized, younger YOU. • A wider range of services and products than a standalone clinic; All Refresh MD products have been approved for use in Canada by qualified medical professionals. These medical products have undergone extensive clinical trials and researches that back their claims, safety, and effectiveness. • The ability to begin treatments at one location and get follow-ups at another. The Refresh MD team has designed and implemented a standardized clinical method to ensure your complete satisfaction and safety. Should any complications arise, our medical aesthetic professionals are readily available and well-versed in possible treatment options. Refresh MD offers techniques and treatments to turn back the clock and bring back the refreshed, revitalized, younger YOU. ” 35 LOOK as YOUNG as you feel! BOOK YOUR APPOINTMENT TODAY To help you make an informed decision, we offer free consultations. These consultations will allow you to decide which treatments are best suited for you to refresh your look. Our friendly and knowledgeable staff will gladly set up a free, no-obligation consultation to answer all of your questions. Call us today at 1-855-319-6864 or visit refreshmd.ca Juvéderm is a ®/TM trademark of Allergan, Inc. 36 refreshmd.ca
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