Great doctor, I am super satisfied with my cosmetic surgical results, I would recommend to anyone.

The doctor performed a non invasive manhattan lift on me and i love it. everyone asks me if i went on vacation or if i lost weight! he was very professional and his assistant is the best. i highly recommend dr. dagan to everyone seeking cosmetic help.

Dr Dagan was my third nose job surgeon. Out of all three I was most pleased and satisfied with Dr. Dagan’s patience, knowledge and work. He takes him time to make sure I understood what can be done realistically and what can not. He is far from greedy like some other plastic surgeons. His staff is also very caring and you never have to wait to see him. Dr. Dagan thanks for the nice nose!

I had nasolabial folds and acne scarring. Previous fillers had left my right side less full than my left. I had 4 syringes, more in the right side than left. I am very happy with the results. I noticed immediate improvement, with more over the time. I have not had any adverse reactions. It’s been 2 years and I don’t need a touch up. It hurt more than other fillers but was worth it. I noticed many of the unhappy users had injections around the eyes, which isn’t suggested for Artefill. The skin is too thin. Side effects are possible and likely.

Dr. Dagan is very honest about the services that are needed. He likes to keep you looking natural, but beautiful.

Loved it! Really clear breakdown of expectations and everyone is super friendly.

As we age, our skin droops and develops wrinkles, lines and furrows (also called rhytids). The number of wrinkles and how deep they are depends on a variety of factors ranging from our genetic makeup, the type of skin color, its characteristics and how sensitive it is to the effect of the ultraviolet rays coming from sun exposure and exposure to environmental factors like smoke and air pollutants.
The severity of these changes in an individual depends on genetic tendency, skin phototype and exposure to environmental factors.
An often used method to grade skin aging is called the Glogau’s classification which rates the skin as follows:
Mild – Few wrinkles, requires little or no make-up for coverage
Moderate – Early wrinkling, sallow complexion, requires little makeup
Advanced – Persistent wrinkling, skin discolouration with broken blood vessels and actinic keratoses, often wears make-up
Severe – Severe wrinkling and furrows, actinic keratoses, often wears make-up but it may not hide the ageing changes
Another classification commonly used to describe the degree of skin wrinkling, the Fitzpatrick classification refers to the lines around the mouth and eyes
Class I: Fine wrinkles
Class II: Fine-to-moderately deep wrinkles and moderate number of lines
Class III: Fine-to-deep wrinkles, numerous lines, and possibly redundant folds

How do facial lines and wrinkles form?
Facial lines and wrinkles (rhytides) form because of the following factors:

  • Degenerative changes in the skin makeup that naturally occurs as we age
  • Ultraviolet damage from sun exposure
  • Overuse of the muscles of facial expression or hands
  • Gravity
  • Scars, wounds and injury
  • Results of surgery
  • Acne and acne scars
  • Skin diseases that have a tendency to scar like Lupus.
  • Smoking and even second hand smoke exposure.

There is often a degree of asymmetry to the lines, as people tend to smile or frown more on one side than the other, or consistently sleep on the right or the left cheek.

FROWN LINES

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After

PARENTHESES (NASOLABIAL FOLDS)

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After

CROW’S FEET

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After

FOREHEAD LINES

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After

DIMPLED OR CLEFT CHIN

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After

DIMPLED OR CLEFT CHIN

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After

Facial lines and wrinklesFacial lines and wrinkles — codes and concepts

Ageing skin droops and develops wrinkles, lines and furrows. The severity of these changes in an individual depends on genetic tendency, skin phototype and exposure to environmental factors.

Dermatologists and cosmetic surgeons often use Glogau’s classification when describing these ageing changes.

Mild – Few wrinkles, requires little or no make-up for coverage 
Moderate – Early wrinkling, sallow complexion, requires little makeup
 
Advanced – Persistent wrinkling, skin discolouration with broken
 blood vessels and actinic keratoses, often wears make-up 
Severe – Severe wrinkling and furrows, actinic keratoses, often wears make-up but it may not hide the ageing changes

The Fitzpatrick classification of facial lines refers to the degree of wrinkling around the mouth and eyes:

Class   I: Fine wrinkles 
Class
 II: Fine-to-moderately deep wrinkles and moderate number of lines 
Class III: Fine-to-deep wrinkles, numerous lines, and possibly redundant folds

How do facial lines and wrinkles form?

Facial lines and wrinkles (rhytides) form because of the following factors:

  • Ageing processes
  • Sun damage
  • Muscle movement
  • Gravity
  • Injury
  • Surgery
  • Acne
  • Other skin diseases with a tendency to scar (e.g. discoid lupus)
  • Smoking

There is often a degree of asymmetry to the lines, as people tend to smile or frown more on one side than the other, or consistently sleep on the right or the left cheek.

Fine lines
Fine lines and wrinkles arise because of irregular thickening of the dermis and because of a decrease in the amount of water held by the epidermis. This is mainly caused by sun damage and exposure to environmental toxins particularly tobacco smoke.

Furrows
Deeper lines or furrows are classified as dynamic or static. Dynamic lines appear with movement i.e. the activity of facial muscles. Static lines are unchanged with muscle movement. Eventually dynamic lines become static.

  • Crow’s feet around the eyes are due to smiling and activity of the eyelid muscles (orbicularis oculi).
  • Worry lines on the forehead are due to contraction of the frontalis muscle when raising the eyebrows
  • Frown lines between the eyebrows are due to contraction of corrugator supercilii muscles and procerus muscle when concentrating or angry
Facial lines and wrinkles

 

Sags and bags

Skin laxity or drooping is caused by several factors:

  • A reduction of the fat cells under the skin (subcutaneous tissue)
  • Loss of collagen and elastin fibres in the dermis reducing cutaneous strength and elasticity
  • Gravity, which allows the lax tissue to sag

The result is:

  • Brow ptosis (the forehead sags so the eyebrows drop over the eyelids, which then feel heavy)
  • Eyelid ptosis (the upper eyelid drops, sometimes obscuring the pupil)
  • Baggy upper and lower eyelids
  • Sagging lower eyelids, revealing the reddened mucosal surface (ectropion)
  • Hollow look to the eyes
  • Tired-looking eyes with a prominent groove beside the nose (tear-trough deformity)
  • Jowls (loss of jaw line)
  • Loss of neckline
  • Elongated earlobes
  • Dropping of the tip of the nose
  • Thinning of the upper lip

What treatment is available?

Remarkable changes in facial appearance can be obtained, giving a younger appearance and improving complexion. Often combinations of different cosmetic procedures are required for the best results.

It is most important to protect the skin from the sun life-long using sunscreens on exposed areas daily, and to avoid smoking and exposure to second-hand smoke or other pollutants.

Moisturisers
Ageing skin feels and looks better when moisturisers are applied regularly. These improve the water-holding capacity of the skin. Choose one that feels nice to apply, doesn’t sting or burn or provoke acne.

  • Use tepid or warm tap water and a non-soap cleanser to wash your face twice daily.
  • If you will be outdoors even briefly, include UV-protection as part of your morning regime.

Anti-ageing formulas
Many face creams may include so-called anti-ageing ingredients. These may include anti-oxidants and/or exfoliants including:

  • Topical retinoids
  • Vitamin c
  • Alpha hydroxy acids
  • Polypeptides
  • Various plant extracts

With the exception of the topical retinoids, the effectiveness of many of these anti-ageing ingedients is unproven.

Resurfacing
Resurfacing refers to various techniques in which the top layers of the epidermis are peeled off using chemical or mechanical means. Peels may even out pigmentation and improve skin texture. They can improve fine lines and static furrows but have no effect on dynamic lines.

  • Superficial and medium-depth chemical peels
  • Dermabrasion and microdermabrasion
  • Neodynium:YAG or carbon dioxide laser resurfacing
  • Non-ablative laser, intense pulsed light or thermal resurfacing including thermage

Implantation
Individual lines and furrows can be lifted up with implants, i.e. temporary or permanent fillers or grafts. They can also be used to improve the appearance of a thinning lip.

Botulinum toxin
Botulinum toxin is most useful for dynamic lines. It can be used to paralyse the muscles that are responsible for frown lines, crow’s feet and forehead lines. It can also be used to change the shape of the eyebrows and to soften so-called smoker’s lines around the lips, among other uses.

Cosmetic surgery
Cosmetic facial surgery involves repositioning facial tissues (rhytidectomy) and altering the structure of the sagging tissues.

  • A facelift or mid-face lift remove excessive skin and tighten underlying muscles of the lower two thirds of the face (cheek and neck).
  • A forehead or brow lift, and mid-temporal lift reduce static lines and lift up drooping eyebrows.
  • Rhinoplasty may lift up the tip of the nose, reshape it or thin out excessive tissue due to rhinophyma
  • Upper and/or lower blepharoplasty removes redundant skin and fat pads from the eyelids.
  • Correction of platysmal bands in the neck by an open plication technique improve the appearance of a sagging neck.