Have you heard about JUVÉDERM VOLUMA™ XC injectable gel?

JUVÉDERM VOLUMA™ XC injectable gel is the first and only filler FDA-approved for deep injection in the cheek area to correct age-related volume loss. JUVÉDERM VOLUMA™ XC is for patients over the age of 21.
JUVÉDERM VOLUMA™ XC is from the makers of the #1 family of fillers
JUVÉDERM VOLUMA XC injectable gel is the first and only filler FDA-approved to instantly add volume to the cheek area. Juvederm Voluma is the Juvederm specialty product for volumizing. It is designed for injection in the deep dermis to treat age-related facial volume loss. Voluma has the optimal thickness of a volumizer while still retaining the smooth nature of the Juvederm family.
It gives you a subtle lift, helping to restore contour and for a more youthful profile, for up to 2 years, in patients over the age of 21. It’s different than JUVÉDERM® XC and works on a different area of the face. JUVÉDERM® XC smoothes out moderate to severe wrinkles and folds around the nose and mouth, like parentheses. JUVÉDERM VOLUMA XC, however, adds volume to the cheek area.
What else should you know about JUVÉDERM VOLUMA XC?

  • First and only Hyaluronic Acid (HA) filler FDA-approved to instantly add volume to the cheek area, resulting in a subtle lift
  • Clinically proven to last up to 2 years with optimal treatment
  • JUVÉDERM VOLUMA XC is from the makers of the #1 family of fillers
  • After 24 hours, you should be able to resume your normal activities
  • Side effects are moderate and generally last 2 to 4 weeks. Common side effects include temporary reactions at the treatment site such as tenderness, swelling, firmness, lumps/bumps, bruising, pain, redness, discoloration, and itching.

Hyaluronic Acid (HA) is a naturally occurring, hydrating substance found in your skin. As you age, you start to lose HA, which causes the skin to lose structure and volume.
Dr. Mark Bishara offers minimally invasive procedures for patients, that are designed to provide subtle enhancements to improve your targeted problem areas, while allowing you to return to work and your regular activities the very same day. Dr. Bishara is proud to offer a wide range of enhancing, minimally invasive procedures such as Botox, Xeomin, Juvederm Ultra Plus XC and Radiesse.  Juvederm Voluma XC will be available soon. We will keep you updated or call our office for more information at (817) 473-2120.

Rewards Program:
Dr. Bishara and The Paragon Med Spa are proud to offer the Brilliant Distinctions Program for our patients. All you have to do is earn points for your purchase from our participating providers, including Botox and Juvederm.  Then start saving by redeeming points per treatment for instant savings off your next purchase.  Ask us how to set up an account when you visit our office.
For example:  For 1 Botox/Juvederm cosmetic treatment you earn 200 points (a $20 Value).  For more information on participating in this program visit https://www.brilliantdistinctionsprogram.com

Like the rest of our bodies, our hands show signs of aging that may include brown spots, thinning skin, wrinkles, and large veins. I recently had a very happy facelift patient who looked 15 years younger, but suddenly the skin on her hands didn’t match her rejuvenated face. There a few simple procedures that can make your hands match your new youthful appearance. Plastic surgery on the hands can be rather complicated. However, a few minor non-invasive procedures can be done successfully with impressive results.
Brown spots on the hands can be treated topically with a daily application of hydroquinone cream. In addition, fine wrinkles and pigmentation may benefit from a chemical peel. Light TCA-peels are most effective for eliminating uneven pigmentation in the long term and smoothing the skin. Daily use of a good hand cream containing glycolic acid, Vitamin C, Vitamin E and Beta-carotene is recommended. One of the most effective and convenient procedures is the use of Intense Pulse Light (IPL). This form of photo-rejuvenation will smooth color irregularities and evens skin tone.
With age and sun damage, the skin of the hands may also begin to atrophy, leaving hands with a bony appearance. A procedure known as structural fat grafting can soften wrinkles, cover prominent veins and tendons, and disguise enlarged joints on the hands. It restores the soft tissue that is lost with age or disease, and helps fill out grooves between the bones of the hand, as well as help improve the color and texture of the skin.
Structural fat grafting involves removing fat cells from other areas of the body such as the abdomen, back, buttocks, or flanks, purifying them and then transplanting them into the back of the hand through a series of strategically placed injections. When grafted successfully, these fat cells will continue to live there permanently with lasting results.
Dermal fillers are an alternative to fat grafts for adding volume to the back of the hand. These products are commonly used in other parts of the body, especially the face, and can be employed with minimal discomfort and virtually no down time.
To help minimize swelling, the hands are elevated and cold compresses are applied for 48 hours. Under normal conditions, regular activity can be resumed almost immediately thereafter.
During your consultation, ask specific, detailed questions, view several before/after photos of the surgeon’s work, and obtain several referrals from past patients to inquire about their experiences. Good doctors will be happy to provide you with this information.

This information is brought to you courstesy of Dr. Mark Bishara and The Paragon Plastic Surgery & Med Spa


It used to be that one would go to a salon simply to get one’s hair and nails done, but these days salons offer all kinds of beauty treatments including cosmetic injectables and even more invasive procedures. The prices can be very cheap, but the results can be catastrophic.
Why is it crucial for consumers to take a second look and ask more questions? Notably, there were dramatic cases out of Miami last year when reports surfaced about illegal cosmetic injections being performed on several women. “Doctors” were accused of injecting these women with substances like mineral oil, super glue, concrete, and Fix-a-Flat. The women reportedly were getting buttock injections in hopes of attaining a healthy “backside”, but they could have lifetime disfigurement as a result.
Earlier this year, in Tyler, Texas, a salon owner was arrested for injecting clients in the breast and buttocks with an unknown substance (likely automotive grade silicone) and closing it with a superglue-type sealant. Why would someone get this done to their body? Perhaps it is the very low cost and the lack of information about what these victims are being injected with.
Please be educated on the three P’s of getting a cosmetic procedure done as safely as possible: Product, Practitioner, and Place.
1. Product – Make sure the product you are getting injected with is an FDA approved product for the particular area you are wanting injected. The FDA has approved certain products for injection into different regions of the face for cosmetic purposes, like Botox, Juvederm, Restylane, Radiesse, and Sculptra. There is no synthetic material that has been approved by the FDA for injection in the breast so that is a red flag itself. Ask what neurotoxin or filler is being used, and even research the product labeling online. If a provider refuses or is unable to tell you what material you are being injected with, do not let that person treat you.
2. Practitioner – Know what type of practitioner to go to like a physician trained to do cosmetic procedures or his/her designee has cosmetic injection training.
3. Place – Don’t get injected in a place that you feel uncomfortable undergoing a procedure in such as a salon, mall, or private home. These are medical procedures and they should be performed in a medical office or medical facility due to its sanitary environment with resources at hand. Often the price may seem too good to pass up, but if you hear of a Groupon ad that’s too good to be true or a salon owner that is offering rock bottom prices on something that is going to be injected in your face or body, let the buyer beware as it be dangerous or even fatal. Even at a Botox “party” or event, a physician must be supervising anyone who is doing these procedures and they must the appropriate credentials.
In other words, do your research, ask questions, and become informed!

This information is brought to you courtesy of Dr. Mark Bishara and The Paragon Plastic Surgery & Med Spa


Aside from being the largest organ of the human body, skin is also the only organ continually exposed to the surrounding world, interacting with the environment and reflecting the general health condition and age changes.
How Skin Ages
Understanding the mechanisms by which the skin ages has been increasing significantly, along with considerable progress on the way to prevent and reverse the visible signs of aging. However, there are still several mysterious factors concerning aging process and why we all appear to age differently. Aging of the skin is likely caused by both intrinsic (biologic) ‘intrinsic aging’, and extrinsic aging (environmental) factors ‘extrinsic or photoaging‘; these factors are interconnected and may share a final common pathway. The quality of skin features is greatly affected by aging, as skin ages, it tends to become roughened, lax and wrinkled with some pigmentary changes.
The main feature of photodamaged skin is solar elastosis; with accumulation of elastotic material in the dermis. Meanwhile, photoaged skin shows gradual decrease in collagen content. Additionally, collagen becomes disordered with decreased synthesis and enhanced breakdown. These changes contribute to the skin laxity and wrinkling formation.
Skin Rejuvenation
Besides being an art, facial rejuvenation is a developing science. Patients now routinely present to their physician requesting information on improving the signs of facial aging; it is the physician’s responsibility to select the most appropriate intervention(s) based on the patient’s age, physical needs and concerns, extent and location of volume loss and cosmetic goals. Different therapeutic approaches were used throughout the years to give the face a youthful appearance. However, because each person is unique, there is no one modality that is best for everyone. Therefore, to choose the most appropriate therapy, distinctions must be done between rhytides caused by loss of collagen within the dermis, wrinkles due to volumetric loss of fat, redundant folds created by gravitational pull and those caused by hyperfunctional facial muscles.
For ease of patient education, the treatment options for addressing these changes may be simplified into five categories, often referred to as the ‘5 Rs (Redraping, Resurfacing, Retaining, Relaxing and Refilling) of skin rejuvenation: surgically Redraping and lifting redundant tissue; Resurfacing photoaged skin with ablative or non-ablative technologies whether physical, chemical or mechanical; Retaining with skin care; Relaxing dynamic rhytides that are due to hyperfunctional muscles with neurotoxins and Refilling of diminished subcutaneous tissue by restoring 3D volume.
Ablative and Non-Ablative Procedures
Although ablative modalities remain the gold principle for photodamaged skin rejuvenation, its use is associated with risk of side effects as well as a prolonged and an unpleasant post-treatment ‘downtime’ and recovery period. Thus, interest in ablative treatment has waned considerably while non-ablative modalities as well as fractional skin rejuvenation have become appealing alternative treatments.
New perspectives in non-ablative skin rejuvenation treatments have been established with the development of new technologies and techniques, which are used to rejuvenate skin with minimal downtime and complications. Many different terms have been used to describe these procedures including: subsurface resurfacing, laser toning and minimally invasive skin rejuvenation. These modalities are designed to produce many cosmetic benefits, including improvement of wrinkles, skin laxity and texture.
Beside lasers and various in-office procedures, many topical skin care agents were used for prophylaxis as sun screens and for rejuvenation such as retinoic acid and different anti-oxidants including vitamins C and E, co-enzyme Q10 and green tea.
Choosing the appropriate treatment modality which will be the key to success in skin rejuvenation depends on careful evaluation and determining the patient’s needs, skin type and condition, to frame a treatment plan. Good candidates for minimally invasivetechniques tend to have minimal facial sagging. Patients should understand that skin texture will improve and fine lines will be softened but not eradicated. Cumulative aesthetic benefits will occur gradually and will be less dramatic than those seen with ablative resurfacing. Patients with Fitzpatrick skin type III or less are generally best candidates for different procedures with minimal risk of complications.
Goals of Minimally Invasive Treatments
The goal of most minimally invasive treatments is to induce selective dermal injury which results in wound repair response; while keeping the overlying epidermis intact. In response to the induced dermal injury, the healing process begins to stimulate the fibroblast with deposition and reorientation of collagen bundles. Such modalities for skin rejuvenation could be classified into two types, the first relates to treatment of ectatic vessels, pigmentation and pilosebaceous changes, while the second refers to dermal remodeling with wrinkle reduction and/or skin tightening.
Dr. Mark Bishara, whith office in Mansfield and Southlake, TX- provides a wide range of cosmetic procedures to help patients look and feel their best. These procedures are designed to improve the appearance of the face and body through minimally invasive techniques that provide highly effective results. Many of these procedures can be combined in order to achieve your desired appearance. All of our procedures are performed using the most advanced, state-of-the-art equipment.
At our office we offer many treatments that are ablative as well as non-ablative.  Our Pragon Med Spa offers many laser services- skin tightening, skin resurfacing, as well as peels and microdermarbrasion.  Our office also offers Botox, Juvederm and Radiesse.  The new Juvederm Voluma XC will be coming soon.  Please call our office for more information at (817) 473-2120.


According to an opinion piece published in JAMA Dermatology, when considering the appropriate ages for aesthetic procedures, the question isn’t so much “What age is too young” as it is “What age is too old?”

In that edition’s Viewpoint feature, the authors write that deeply-etched facial lines that develop as patients age “are caused by repeated folding of the skin and include lines of facial expression and sleep lines,” and that in young adulthood these lines predict “the unique pattern of facial wrinkling that will be seen without expression years later.”
Regular treatment with a neuromodulator when patients are in their 20s or 30s will minimize etched facial lines by the time they’re in their 40s and 60s. They cite the case of identical 38-year-old twin sisters. One began regular botulinum toxin (Botox) injections in the forehead and glabella when she was 25, while the other got injections in the same areas just twice over seven years. They write that while lines glabella and forehead lines were visible at rest, they were not visible in the regularly treated twin four months after her last treatment.
“This observation suggests that regular treatment with a neurotoxin, beginning in young adulthood, can prevent the development of etched-in lines. So there really is rarely a time that is too early. Perhaps the better question is, ‘When is it too late?’”
CST Trends asked two doctors to give their opinions on the issue concerning when is “too early” to begin aesthetic treatments.
“I basically agree with the opinions of the authors but also understand the biopsychosocial implications that may be argued by those who disagree,” says Joe Niamtu III, D.M.D., a Richmond, Va., specialist in facial cosmetic surgery. “I can guarantee that you will see some negative feedback on this viewpoint article, with the opposition saying that we are creating a society of ‘plastic’ people who can’t deal with the normal process of aging … I can see both sides of the argument.”
Dr. Niamtu says he thinks the real “take-home point” of the article is that while preventive treatment can influence the future appearance of aging, “treating younger patients has positive and negative benefits that reach beyond the needle. There are clearly some patients that would benefit from treatment at a younger age and others who would suffer body-image issues if they did do it or wanted to do it and could not afford it.
“The other very important piece of this discussion is that we could not discuss this topic 20 years ago, as there were basically no fillers, neuromodulators or light- and energy-based therapies,” he adds. “I think that the current discussion will become lost in time because in another 20 years we may have easier and more effective treatments that are more effective and preventive and may be highly used by younger patients.”
Joel Schlessinger, M.D., a dermatologist and cosmetic surgeon in Omaha, Neb., concurs with the viewpoint authors.
“I agree wholeheartedly with the authors,” he says. “Sadly, most people take the opposite viewpoint, waiting until it is too late, as the authors comment, and either missing the opportunity to have a full correction or even any chance to have a significant change. On the other side of the equation, there clearly are individuals with body dysmorphic syndrome, who have no issues at all and undergo multiple surgeries in pursuit of a ‘better’ look. This is something that all dermatologists run into at one point or another.
“Overall, it is best to have a discussion with the individual and prepare a plan of action and an ongoing concept of how to diminish signs of aging over time,” Dr. Schlessinger says. “This approach is highly successful and leads to less intervention in later years and, surprisingly, less expenditure over the years.”