Rejuvenation of the Neck and Lower Face

In most cases, expressive lines in the upper face can be effectively treated with Botox.  These include forehead lines, lines between the eyes and Crow’s Feet.  Folds and creases in the lower face can often be effectively treated with fillers.  But what can be done for crepey skin on the face and neck?  One excellent treatment is eMatrix Radio Frequency.

What is eMatrix Radio Frequency? (RF)

eMatrix skin resurfacing is an effective way to reduce fine lines and wrinkles, helping you look years younger.  eMatrix works by heating tissue at a specific depth which stimulates your skin to produce more collagen and better-quality collagen.  The radio waves cause a controlled injury to the skin which stimulates your body to deposit and remodel both elastin and collagen causing the skin to contract and tighten giving you a fresher look.  RF continues to cause tightening for up to 6 weeks after a single treatment.  If a series of 3-5 treatments is performed at 4–6-week intervals, the effects are cumulative.  After your aesthetic goal is reached,  maintenance of the neck or lower face can usually be achieved with periodic single booster treatments, 2-3 times a year.

What does eMatrix treat?

eMatrix RF can be safely used on the neck and face to improve texture, eliminate crepiness, and reduce pore size.  It can be used to treat fine lines that develop around the mouth, and fine lines on the lower cheeks.  On the neck, it can reduce the appearance of horizontal lines and even surgical scars from thyroid or thymus surgery.  eMatrix can also be used to smooth old acne scars, and even stretch marks!

What is the Recovery Time after eMatrix?

eMatrix can be performed in the office in less than 30 minutes after a topical anesthetic is applied, making the procedure relatively pain free.  You can expect redness over the treated area for 1-2 day. A slightly rough texture from the “grid” may be present for 3-4 days.  After a single treatment, eMatrix continues to work for weeks, energizing your body to make new collagen and elastin leading to smoother, tighter skin.  We will send you home with a soothing cream and a cold pack.  Mineral based skin care products such as those by Colorescience™️ can be used to during the early days to cover any discoloration.

Most people want to look the best that they can without trying to look unrealistically young or fake.  With eMatrix RF skin resurfacing, you can look your personal best with a smoother neck and less fine lines and wrinkles on the face while still looking like you!

Have a great day, and I hope you continue to “Look Fresh and Feel Confident”.

The Role Collagen Plays

Collagen is the most abundant protein in the body and is the main component in our skin, bones, and muscles.  It provides the structure and support that holds the body together.  When we are young, our bodies produce all the collagen we need but as we age, collagen production slows down by 1% per year which can be accelerated even more by exposure to uv light and various toxins like tobacco.  A reduction in the collagen content of skin leads to loss of elasticity and firmness which creates fine lines, wrinkles and a sagging appearance.  So, what can be done?

Replacing Collagen

One strategy for improving wrinkles and producing a more youthful look is to supplement your body’s collagen either topically in creams and serums applied to the skin or orally by maintaining a diet rich in amino acids or by adding peptide supplements.  Peptides applied to the skin actually stimulate collagen production. Two peptide containing products you may already be familiar with are ZO®️ Daily Power Defense and Recovery Cream.  In addition, two procedures that can improve absorption of these collagen building blocks are a Hydrafacial which exfoliates the skin and Microneedling which allows for direct penetration of the peptides into the deeper layers of the skin.

Secondly, a diet rich in animal and plant proteins can provide the raw materials necessary for collagen production.  If collagen supplements are desired, these should be in the form of peptides which are smaller than collagen and more easily absorbed.

Collagen Stimulation

Collagen production is also increased with injury or perceived injury.  Both Sublative Radiofrequency and Microneedling are perceived as injuries by the body and can stimulate the body to increase not only the rate of collagen production but improve the quality of the collagen made.  This increased production can continue for weeks to months after a single treatment leading to firmer,  more youthful looking skin.


Collagen is the protein that provides structure to your skin creating a smooth, youthful look.  Applying peptides, the building block of collagen, to the skin’s surface increases collagen production and improves texture and tone.  Both ZO®️ Daily Power Defense and Recovery Cream contain peptides.  In addition, a balanced diet rich in peptides or the use of peptide supplements can be another source of collagen building blocks.  And if you want “a little help from your friends”,  a Hydrafacial, Sublative RF, or Microneedling can give your fibroblasts a little nudge to step-up collagen production in your skin and turn back the clock, just a little bit!

Unique Uses

Botox®️ or Xeomin®️are commonly injected into 3 main sites; the forehead to treat expressive lines, the outer sides of the eyes to treat “Crow’s Feet”, and between the eyebrows to eliminate frown lines sometimes referred to as “11s”.  But did you know that botulinum can also be used to raise the eyebrows, eliminate horizontal “bunny” lines on the nose, turn up the corners of the mouth, reduce lines above the lip, get rid of chin dimpling and smooth out neck bands?  Read the details below.

Eyebrow Lift

When an elevated brow is desired, botulinum injected into the upper lateral aspect of the circular eye muscle named the orbicularis oculi can achieve this.  By slightly weakening this part of the muscle, the opposing muscle of the forehead literally lifts the eyebrow up. Simple!

Bunny Lines

People use their facial muscles differently. Some people develop vertical “11” lines when they frown while others also contract the muscles on the side of the nose creating a horizontal “bunny” line across the bridge of their nose.  This can be easily treated with a single injection of botulinum to each side of the nose.


Mouth Frown

Do people think you look sad when you are not?  Droopy mouth corners can be improved by reducing the activity of a muscle that pulls the corners of the mouth down, the depressor anguli oris.  This allows the smile muscles that pull up on the corners of the mouth to function, unopposed. Easy as that.

Lip Lines & “Lip Flip”

Nothing makes one feel older than the fine lines that develop above the lip.  Often incorrectly referred to as “ Smoker’s Lines”, they can develop in smokers and non-smokers alike.  When low dose botulinum is placed above the lip in the circular muscle that creates puckering, the muscle relaxes, and the lines are reduced creating a more youthful look.  Some people even get the added effect of a slightly wider upper lip leading to its nickname, the “lip-flip”  or the “ lip-pop”.

Dimpled Chin

Chin dimpling can occur with age if the mentalis muscles become overactive. Botulinum can be used to relax these muscles thereby reducing the dimpling, giving you a smoother chin.


Teeth clenching and teeth grinding can cause enlargement of the masseter muscle which adds fullness to the face and angulates the jaw. Botulinum into this muscle not only relieves the symptoms of teeth grinding but can have the added benefit of slimming the face.

Neck Bands

The platysma is a broad superficial muscle that spans the neck from the top of the chest to the jawline.  With age, it can develop bands and cords. Botulinum into these bands relaxes them, making them less visible.  The result is a smoother, more youthful neck.

So next time you are in for your Botox®️ or Xeomin®️appointment, let me know if you are interested in treating one or more of these areas.   I will evaluate your unique, expressive face, and we will decide if adding any of these sites would be a good choice for you.

The HydraFacial™️ system is a patented four-step program that cleanses, extracts, and hydrates the skin using gentle suction, special skin surface tips, and a series of formulated fluids to address your specific skin needs. Many professionals have found it to be more effective than IPL, microdermabrasion, and chemical peels for maintaining healthy skin, while being painless with no downtime

I like to say the HydraFacial is to the standard facial what vacuuming is to sweeping. The HydraFacial employs gentle suction and fluids, rather than abrasive chemicals, and manual extraction to provide you with great results. I chose to offer the patented HydraFacial at my Medispa because I found it to be safe, comfortable, and effective. Generally, clients notice a brightness and youthfulness in their face after one treatment, though monthly sessions are recommended

The standard HydraFacial removes dead skin, painlessly removes debris from pores, nourishes the skin with moisturizers and then saturates the skin’s surface with antioxidants and peptides. Booster serums, red and blue LED lights, and even lymphatic drainage can be added to the standard four-part Signature HydraFacial to personalize and expand treatment results. HydraFacial also partners with Dr. Obagi’s line (which is exclusively sold to physicians) and offers a series of ZO boosters that pair nicely with Dr.Obagi’s ZO home care products. To minimize uneven skin tones and lighten brown spots, a ZO Brightalive booster can be added to the HydraFacial further enhanced by the ZO Brightalive Skin Brightener for daily home use. To address and reduce fine lines and wrinkles, particularly those around the mouth and above the upper lip, a Connective Tissue Growth Factor booster can be added and paired with ZO Growth Factor Serum for daily home treatment.

For oily or acne-prone skin, two treatments with Beta-HD can help reduce congestion, especially when combined with Blue LED lights which kill surface bacteria. The combination, along with a good home care regimen, can treat the acne-prone face, which can, unfortunately, return with adult hormonal shifts. Adding lymphatic drainage to any of the listed protocols turns the HydraFacial into a truly unique, relaxing and rejuvenating experience. Routine, comprehensive skincare and sun protection are vital for graceful, healthy aging.

Use your sunscreen regularly and consider a HydraFacial™️. You WILL see a difference.

Microneedling is a highly effective procedure that works to rejuvenate your skin by stimulating it to make new, collagen-rich tissue.  The procedure itself involves creating pin-holes in the skin using a professional pen that delivers tiny needles to a precise depth.  This controlled, mechanical injury stimulates the body’s natural wound healing process.  The result is increased production of Growth Factors, collagen and elastin resulting in smoother texture, more even pigment and reduced pore size.

Nuts and Bolts

Microneedling can be performed in the office in less than an hour.  A topical numbing cream is first applied to make the procedure pain-free.  The face is then thoroughly cleansed and disinfected.  The microneedling pen is then applied to the skin with depth adjustments made for varying skin thickness.  Peptides are applied to the face during the procedure in the form of a soothing serum and then immediately after, in a cool mask which will be removed before you leave the Medispa.  You will go home with a packet containing a peptide cleanser, peptide serum and peptide lotion which you will use exclusively for at least 48 hours.

What to Expect After

After microneedling, you can expect some redness, some bruising and mild swelling.  In addition to being asked to use your peptide after-care products, you will need to avoid make-up, abrasive cleansers, pool saunas, direct sun exposure and any products containing Retin-A.  Improvement in your skin’s texture and pigmentation will begin almost immediately but the maximum improvement may take a month to be fully expressed. I know that sounds like a long time to wait, but you will be AMAZED at the results.  (See real client picture below, 2 months after ONE microneedling procedure.

Ideal Candidates

An ideal candidate is anyone looking to modify the appearance or texture of her skin.  Microneedling improves skin laxity, reduces lines, acne scars, hyperpigmentation and striae.  The only clear contraindications to the procedure are blood or bone disorders such as anemia, blood or bone cancers, clotting issues or being on blood thinners.  Clients should avoid any medications that reduce the body’s ability to clot such as aspirin or non-steroidal anti-inflammatory drugs for a few days before and a few days after a treatment session.

One Treatment or a Series?

Although a series of 3-4 sessions at least one month apart is generally recommended for the very best results (with epidermis thickening up to 400% at 6 months),  we have seen remarkable result after a single session in patients with skin surface and pigment irregularities.  Deeper acne scars will probably require multiple sessions, but you can decide for yourself based on your results.  In general, clients have been so pleased with the results from the first microneedling, they have often chosen to add a second.


If you want smoother, healthier looking skin and are ready to take the next step, microneedling may be the right choice for you.

I am proud to share that December 20th of this year will mark the three-year anniversary of the opening of my Medispa, Refresh!  As I reflected on the past three years, there are so many people and things for which I am grateful.

Firstly, I am grateful for my loving and supportive family, for my sweet husband, Terry, who insisted on installing a security system in the Medispa and who personally filled the holes and cracks in the old side-walk out front, all for our safety.

I am grateful for my children, John and Dale, who helped me navigate Google and Instagram, and for everyone who advised and encouraged me.  I am grateful for Kate, my first assistant, who cheerfully helped me through the early, slow days, and uncertain COVID months, and my current assistant, Nadya, who skillfully orchestrates hectic weeks.

I am grateful for my neighbors on Mechanic Street: George, owner of Island Silver, and Betsy, owner of Betsy by Design, who create a true sense of community and offer neighborly support through flooded streets, jack-hammered sidewalks and all of the trials of running a small business in downtown Galveston.

And finally,  I am grateful for you, my wonderful clients.  One of my greatest joys since opening Refresh has been the opportunity to get to know each one of you.  Thank you for trusting me with your care and for sharing your pictures, your stories and your lives with me. With all of my heart, I wish you and your families a happy holiday season full of peace, love and joy.

As you age, your skin becomes thinner, especially on the neck.  Concealing your neck with clothing like scarfs or turtlenecks is not a practical solution, particularly in Texas with our hot and humid climate.  Surgical procedures, though effective, come with extended recovery time, expense and risk.  That is why many people are turning to non-surgical procedures that can rejuvenate thin skin and restore a youthful appearance.  We will review a few here.

Botox®️ or Xeomin®️

The platysma is a superficial thin sheet-like muscle that stretches from the jaw-line to the clavicle just below the base of the neck.  With aging, the muscle becomes weaker, separates and forms unwanted platysmal bands.  Injecting these bands with Botox or Xeomin causes the muscle bands to relax and creates a smoother neck.  You can expect results to last 3 months or significantly longer as many of my client’s report.

eMatrix™️ Sublative Rejuvination

In addition to muscle bands, the skin on the neck can get thin and crepey with reduced collagen and elastin content.  Sublative rejuvenation causes selective damage to small areas of skin leaving adjacent skin intact to accelerate the healing process. Sublative therapy stimulates fibroblasts to increase production of elastin and collagen which leads to tighter skin.  Amazingly, you will continue to see improvement in your skin texture for up to 6 weeks after a single treatment!  However, usually a series of 3-4 treatments is performed with an impressive cumulative effect.


Almost 2/3 of adult’s report that they are bothered by fullness under the chin, the so-called ‘double chin’.  In some, the cause is excess fat which can create an unflattering profile.  Treatment for this involves disrupting the membranes of the fat containing cells so that the fat is released and removed from the body.  Kybella is an FDA approved treatment for stubborn fat under the chin.  It is made of deoxycholic acid , a naturally occurring substance in the body.   Kybella is usually administered in a series of 2-3 treatments, scheduled 4 weeks apart.  The total number of treatments can be modified as results are seen.


So, remember to include your neck and décolleté in your skin care regime.  Apply sunscreen and your skin care products to these areas.  If you are not happy with the appearance of your neck, Botox or Xeomin, Kybella or Sublative rejuvenation may be reasonable non-surgical options to consider!

Many of us see our lips getting thinner with age. This is due to a decrease in collagen and elastin formation in our lips just as it decreases in our faces. Many women would like to have fuller lips like they had when they were younger, but most do not want a fake or over-done look. Natural, fuller looking lips can be achieved when the right filler is selected, the right amount is injected and in the right way. Not ready for filler? Sometimes, fuller lips can be achieved with carefully placed, low dose Botox or Xeomin alone!

Volbella™️ vs Juvederm®️ Ultra XC
(Filler Options)

For those wanting a subtle increase in their lip size, Volbella may be the right choice. One of Allergan’s newest fillers, Volbella was specifically formulated to be a softer filler with a more natural look. Alternatively, Juvederm Ultra has been on the market much longer and is the single most popular lip filler. It adds volume. Being careful not to overfill the lips (one syringe is usually enough), a natural look can be achieved with either. Both are FDA approved for lips. Results are immediate and can last up to a year. The most common side effects are swelling and bruising in the first few days.

(Not Ready for Fillers)

Botox and Xeomin, both neuromodulators, are most commonly used in the upper face to reduce wrinkles by relaxing muscles of facial expression in the forehead, between the eyes and at the corners of the eyes. Additionally, they can be used in a low dose to relax or “flip” the upper lip creating a slightly fuller appearance. Also, Botox can be injected into muscles at the corners of the mouth to flip the down-turned corners up. The results of both of these treatments are subtle but can be enough to make a difference in your look. Care must be taken to place the neuromodulator in the right muscles and at the correct dose, so that eating and speaking are not affected.


Most of us do not want exaggerated, over-done lips. Most of us do want the slightly fuller lips of our youth. Whether you are ready to take the leap to filler or would rather try low dose Botox or Xeomin, you have options.

Do you have a special pair of earrings, maybe even a pair of diamond studs, that no longer sit well in your pierced earlobe? There is now a simple outpatient procedure you can do to fix that.

Do Earlobes Age?

Interestingly, just like the face, earlobes lose volume as we get older. The combination of sun damage, wrinkles, loss of collagen and elastic tissue changes the shape of the earlobe, causing the piercing to hang lower. Additionally, years of wearing heavy earrings, age, gravity and genetics can contribute to the development of saggy earlobes.

Can Stretched Earlobes Be Fixed?

Yes! The same hyaluronic acid fillers that are used to restore volume to the face can be used to restore structure, shape and volume to the earlobe. This includes the Allergan line of fillers including Juvéderm®️ Ultra, Juvéderm®️ Ultra Plus, or Vollure™️.

Is Filler in the Earlobe a Long Procedure?

Often referred to as a “lunch time procedure”, filler in the earlobe takes only a few minutes to complete. A single syringe is typically more than enough to fill both earlobes. The use of a topical anesthetic cream can make the brief procedure pain free. Most clients return to their daily activities immediately. There can be some mild swelling and bruising that can last a few days, but when that goes down, you can expect lobes that look and feel great. And now, your earrings will actually sit upright in their piercing!

How Can I Effectively Maintain the Results from my Earlobe Filler?

In order to get the best and longest results from your earlobe filler (which you can expect to last from 12-18 months depending on the filler used), follow these simple suggestions:

  1. Avoid the frequent use of heavy earrings as they drag on the piercing and elongate the hole.
  2. Earring support discs that adhere to the post can help support the earring or earrings relieving some of the pull.
  3. Take your earrings out before you go to bed, and before you hold the phone receiver up to your ear. Better yet, use ear buds or the speaker phone!

Let’s avoid extreme earlobe damage that could require surgical repair. A little filler to the earlobe can help restore volume. Following the three suggestions above can help you maintain the improvement. Get those pretty stud earrings out of the jewelry box and have fun wearing them, once again!


Microneedling is a skin rejuvenating procedure that involves puncturing little holes into the skin with a medical-grade device or ‘pen’ which delivers tiny needles to a precise depth. The microneedle injuries promote collagen production by the skin which is further enhanced by the topical application of either polypeptides (the building blocks for collagen and elastin) or Platelet Rich Plasma (PRP) which is rich in growth factors. The result is smoother, healthier looking skin.

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