Fighting Fifty

Today, women in their 40’s and 50’s are looking younger than ever. We no longer look frumpy or matronly like many of our grandparents did at the same age. These days we have more choices than ever before to turn back the clock. I had an opportunity to sit down with Dr. Peter Fodor, an international expert in aesthetic plastic surgery and ask his thoughts about “Fighting Fifty”. Click To Watch The Video

“The way I would think about fighting fifty, is fighting fifty and WINNING!” ~Peter B. Fodor, MD, FACS

It Begins with the Skin
“They need to exercise, they need to diet, they need to take care of themselves, and they need to use good skin care,” says Fodor. He says good skin care, is critical for this age group. As you reach your 40’s and beyond, you may be seeing dullness, uneven tone, rough texture, fine lines and some sagging in your skin.

Here’s a basic check list of what you need to know about skincare as you reach your forties.
1. Gentle cleansing. Many women will experience drier skin as they age and need to switch to a more gentle cleanser that doesn’t strip the skin. A few to try are Cetaphil and Purpose to be used morning and night.
2. For fine lines and pigment issues, start thinking about skin care with effective Look for a retinoid cream which works to resurface the skin and increase collagen in the dermis. They are best used at night and you may want to start out slow to avoid peeling and redness. Once your skin becomes more accustomed to the cream, you can increase the frequency.
3. Wear sunscreen every day. Your best choice is a broad-spectrum sunscreen which protects skin from UVA (aging rays) and UVB (rays that burn).

The Aging Eye
You may have heard, the eyes are one of the first areas of the face to show the aging process. The skin around the eye is thin and more susceptible to dryness and wrinkling. When the eye starts to sag it can create dark circles, bags and crow’s feet. Dr. Fodor says, “The upper eyelids can really make people look much older than they are at times. It can be genetic; it can come with the family. But a blepharoplasty procedure can make people look fresher and a lot less tired.”

Injectables for Immediate Results
If you really want to turn back the clock, “Botox and facial fillers such as Juvederm and Restylane work well,” states Fodor. Botox, Dysport, and Xeomin are neurotoxins for erasing lines in the upper face and around the crow’s feet.

Facial fillers can replace volume loss in your temples, cheek area and the nasolabial folds. They can also help plump up your lips.

Hormones Play a Big Part in the Aging Process
Fodor explains that as we get closer to menopause our hormones change. When this happens, “certain parts of the body that were once harmonious to the rest of our body, may start to change. It can be in the hips, the knees and the stomach. Liposuction can be a great approach for these patients,” says Fodor.

Fodor is quick to state, that the main message is for patients to take care of themselves. He says going in for an injectable or a surgical procedure that addresses the facial or the body part that you are most concerned about can bring about a rejuvenation that is as much physical as mental.
As with any procedure, make sure you go to a qualified board certified physician who is well-trained in their specialty.

As we age, our skin on the neck start to droop. You will be amazed to know that neck shows you age before your face does. Also, neck drooping as well as the sagging looks pretty odd and can trouble with one’s self esteem. Sadly, there are no exercises to reduce unwanted fat and the sags; however, plastic surgery such as neck lift is a way to get rid of it. If we talk about complications, then we must understand that benefits are more than complications. Let’s talk about the type of surgeries and their complications.

There are a few sorts of neck lift procedures. One sort is “cervicoplasty”, which includes expelling unreasonable skin from the neck. A neck lift of this or any sort might likewise incorporate liposuction (plastic surgery) to uproot a lot of neck fat. Platysmaplasty is a sort of neck lift procedure, which involves re-aiming the neck muscles. Despite the type of plastic surgery a person gets on her neck, problems or complications can happen such as infection. If the person is infected, he or she will suffer from mild fever, sore throat, fatigue, and tender neck. The patient should consult the surgeon for antibiotics.

An unfriendly response to the anesthesia can also be a complication. While the vast majority endures anesthesia pretty well, issues can occur. A person may encounter sickness or vomit sensation in post anesthesia period. There may likewise be an unfavorably susceptible response of sorts. The side effects experienced may be like some other sort of hypersensitive response and may incorporate extreme swelling, tingling or a skin response, for example; hives.

Excessive bleeding is another complication of neck lift plastic surgery. However, a normal amount of bleeding is expected in the process. It is a rare complication and can be controlled by blood transfusion.
Blood clots could also be developed in rare cases; this can be a really intense condition which can cause serious problems. The clot can hurt any part of the body, even heart attack if entered the heart. It can also damage the brain cells. So basically it is the most awful complication which is not only associated with plastic surgery, but also with every type of surgical method.
Before undergoing the neck lift surgery, you should consult your surgeon regarding the complications and problems. Be sure to tell everything about your medical history.

A Closed rhinoplasty procedure can accomplish building up the nasal bridge. In many cases patients are born with a low bridge profile and would simply like to build up the height of the bridge for better facial aesthetics and balance. Other patients, have had an over-resection of the dorsal hump, and are left with a residual ski-slope deformity. In addition, some patients have received a traumatic injury to the nose and are left with a saddle nose deformity. When performing a revision rhinoplasty, it’s important to know how much cartilage as left on the inside of the nose for potential grafting purposes. A cartilage graft is the preferential way to build up patients own bridge line with their own natural tissues. If there is a cartilage-depleted nose, ear cartilage can be considered. In rare cases, rib cartilage may be needed. Once the nasal cartilage or ear cartilages have been harvested for potential grafting, they are then fashioned in the proper shape and inserted through a small incision along the bridge line of the nose. Most of the time the grafts are placed in a precise pocket, but they also can be sewn in place if needed. Alternatively, some patients require a significant amount of augmentation and they have no cartilage left on the inside of the nose and do not wish to have a rib cartilage taken out. For these patients, a Flowers Silastic nasal dorsal implant is used. These are also inserted in a small anatomical pocket along the bridge line. These implants are composed of Silastic, and can be custom carved when necessary. These implants are not the typical L- strut used in Asia. The L- strut implants can cause a lot of problems and many times have to be removed. In addition to building up the bridge of the nose, many patients require osteotomies placed in the nasal bones to narrow a pre-existing wide bridge line in addition to adding height to the bridge. This also helps to give added height to the bridge as well. Both medial and lateral osteotomies of the nasal bones are required to narrow them. It is also important to evaluate the status of the nasal tip to make sure it is in balance with the new and higher bridge line. Some patients require a reduction in the size of the tip with a conservative cartilage removal, while other patients require augmentation of the tip to of balance with the bridge. Tip cartilage grafting techniques are sometimes required to make sure the tip balances with the entire new bridge line. Dr. Portuese performs nasal surgery at The Seattle Facial Plastic Surgery Center, a state-of-the-art licensed and certified outpatient surgery center in Seattle Washington.

Unfortunately gravity is unceasing and combined with age and sun related skin loss of elasticity a woman’s tissues surrounding her breast can lead to the breast mound falling lower on the chest. Additionally, the volume inside the breast can diminish with hormonal changes after pregnancy and menopause and with significant weight loss.  All these factors triumphantly combine to give an aged appearance that can be significantly disproportionate to the otherwise youthful feeling of a women. Sound depressing? Sure it does but the artistry and science behind plastic surgery can offset these changes to a woman’s breasts and make them feel good about the skin they are in.

If someone is unhappy with the appearance of their breasts it is helpful for analysis sake to deconstruct the breast into two separate components: the overlying skin brazier, and the volume and its distribution of the breast mound on the chest wall.

The mound itself may have adequate volume but most of the distribution of the volume is in the lower pole of the breast well below the breast fold requiring a bra to perform a heroic task of keeping the breast on the proper location on the chest wall. This situation can be improved by a mastopexy (lift) with creating a lower pole breast flap of tissue transposed under the rest of the breast mound and fixated to a non-mobile portion of the chest wall to provide upper pole fullness. In this situation the skin brazier is loose and has allowed the breast mound to sink inferiorly and requires and generous amount of skin to be removed and repositioned to be coincident with the newly shaped breast mound. For some women this may produce a nice result but particularly individuals who have a very long trunk with a great distance from the breast fold to the collar bone, creating the appearance of low set breasts, the above technique requires another means of providing upper pole fullness. Some women are comfortable with adding an augmentation with a breast implant to enhance shape and form and creating a nice upper pole roundness. Some surgeons are comfortable offering an augmentation at the same time as the mastopexy. Other surgeons would argue, based on data which has shown a 25% revision rate with the combined procedures, would prefer to stage these techniques. I personally like to perform the augmentation mastopexy in a single stage because I would rather have the implant in place to provide shape and volume to the overlying breast mound prior to tailoring the skin envelope of the lift procedure. I find this saves the patient a second general anesthesia, reduces expenses, and can be performed in the office setting with much less cost. Generally, it is only a minor skin re-tailoring to minimally reposition the nipple-areolar complex vertically on the breast mound.

Implants can provide structural shaping and volume enhancement of the breast mound but there are definitely limitations to their effect. Women who have structural limitations to their chest wall anatomy can have difficulty in achieving satisfactory results with implants alone. Individuals with very wide sternums and rapidly sloping chest walls cannot achieve meaningful cleavage with implants alone because the devise cannot be placed on the sternum. Another anatomic limitation eluded to in the above paragraph is the long chest wall with the accentuated length of the breast fold to collar bone giving the illusion of the low set breast. Even an anatomic shaped breast implant which is taller than it is wide still cannot mask this affect. In both of the above situations in which implants are chosen as the enhancer of choice the addition of fat grafting is necessary to create a much enhanced result. The beauty of fat grafting is that it can be placed in any position on the chest or breast. It can be similar to the concept of photo-shopping an image and allows the surgeon to truly sculpt the breast and chest wall to closer reflect an ideal form and helps to hide these difficult anatomic variants with your very own fat.

Other women may prefer to avoid implants all together and in consultation with their surgeon may choose to enhance the shape and volume of the breast mound and chest wall in conjunction with a mastopexy with just fat grafting lone without implants. Just as implants have limitations so does fat grafting. The current art and science of the techniques of autologous fat grafting has a yield of around seventy percent sustainable take of the viable fat implanted into the tissues. This has been reproducible shown over many series of papers presented in the literature. Since fat is a very soft material that cannot resist significant opposing forces of the skin it is difficult to globally enhance a breast mound much larger than a cup to a cup and a half sizes larger in one session. Therefore a women who has a large skin envelope and very limited breast mound volume and desires to have a very full shape should not consider enhancement solely with fat alone. A combined implant with fat grafting provides a much better and stable result. In my experience fat grafting alone is best to sculpt and shape the cleavage and upper poles of the breast and chest wall interface. It can enhance the overall volume by a cup size as well. The other nice advantage of fat grafting for breasts is it allows the removal of unwanted fat volume from places like the flanks, abdomen, and thighs to achieve improved breast shape and sculpting of the body contour.

If you feel self-conscious about the appearance of your breast and feel it is disproportionate to the rest of the body and how you feel about yourself, consult a board certified plastic surgeon to define your goals and options for rejuvenating your breasts.

Shawn Maguire is a licensed therapist in Oklahoma City, OK.

my name is chris webb been married

years to Angie my wonderful wife we have

four beautiful children

we've been in marriage counseling now for a year

and it had been an eye-opening

experience so it started last year when

my wife really just kind of dropped a

bombshell on me she said we've got to go

to counseling in fact you don't have a

choice

it's serious and I had ignored some

other side's really had avoided and and

resisted life sides

I did it because I was a good guy

I did it because I was a hard worker i'm

in the middle of a career I have plenty

of opportunities to do great things for

my family and and what's wrong with that

so my wife says we have to go to

counseling and I reluctantly agreed i

knew i knew she needed

I knew she needed more than I did right

and we we all kind of think that that

that's the case so I agree didn't want

to but I was going to be there for her

it was an eye-opening experience it was

truly eye-opening what I didn't realize

at the time in fact Sean had recommended

the first day that we read a book called

don't want a divorce and I remember

sitting in the chair next to my wife

saying i don't agree with the premise of

the title what I I started to see was a

tremendous amount of hurt in my wife's

life and an entire story that had been

shaped by pain verbal abuse and every

time she had cried out for help she was

told that it wasn't as bad

and that she needed to go back to the

person that was causing her thing and it

suddenly dawned on me that I was that

person for her that every time she had

come to me for help I told her she

needed to handle it on our own

I told her that she needed to work hard

to try to solve their own problems you

know that's how I was raised and then

the light started to hit maybe I had

some issues that i need to address

I never looked at my my upbringing as

being anything less than perfect you

know it was wonderful yeah my parents

were divorced you know yeah I I guess I

admit later that I had a really unusual

fear of conflict but that was normal

right who wants to have a fight i

thought it was a good thing in marriage

you don't have fights that's that's what

we strive for

I can only remember my parents fighting

once and then they got divorced so why

wouldn't I not want to find and during

the course of the year more and more

starting to build more started to come

out about the health of boundaries the

respect that we need to have for each

other as individuals

Sean many great a great revelation to me

that if to become one

first the to have to behold to begin

with we have to we have to to come into

this union with a wholeness and

completeness in an identity price that I

didn't have and so the transformation

started to take place i started

devouring my time in this these

counseling sessions in fact I would tell

my wife you know what you sit at home on

this one I've got a few things I need to

go over it started to become more and

more about me and now our marriage is

flourishing blossoming and we have a

relationship that I could imagine.
Talk to Shawn Maguire today for more information about how Marriage and Family Therapy can help
11209 N. May Ave., Ste B Oklahoma City, OK 73120 // (405) 921-7776

Cosmetic Veneers

What causes a perfect or confident smile? Do you think those pearly white teeth are by birth? If you think, then you are wrong; the prime reason is Cosmetic dentistry. Cosmetic dentistry has become a truly amazing thing to modify the appearance, especially for the dental area. The most common problem of every human teeth are enamel, which can affect by anything. If you want to enhance your smile or appearance, or to treat the enamel of teeth, then dental veneers or cosmetic veneers can help you.

What are cosmetic veneers?

If your teeth are discolored, then a porcelain coating can cover up the areas, and make your teeth look white and completely undamaged. These coatings are known as veneers. Apart from the discoloration, veneers can also be used to balance the uneven teeth, to fill the gaps every tooth, to give the pearly white appearance, and to hide broken tooth caused by any kind of trauma. If a dentist is advising you veneers, then go ahead as it is the best way to look good and it is also the best way to sparkle your smile.

Why Veneers?

Veneers are recommended by most of the dentists and dental care professionals, due to the fact that these are tested and tried by millions of people around the world. If you think teeth whitening or any other method can get you the missing gloss back, then you are completely wrong. Only Veneers can do this job, that is why they are famous. So why porcelain dental veneers? Due to its popularity, positive results, and no damage to teeth guarantee. What else one can ask for? This cosmetic procedure is the best way to make a perfect smile.

How much time the procedure will take?

It is a kind of swift procedure, but the assessment will take time. The treatment is simple so you just need 3 to 4 dental settings. The procedure time may vary due to the condition, but you don't have to stay longer in a dental clinic.

How long do veneers last?

They last for several years by maintaining good oral hygienes.  They can even last for 25 years or may be more than that; however, it is all depend on your oral hygiene.  So it is a kind of permanent procedure, but you need to consult the dentist regarding every a sect of the procedure.  So do not  ever hold back your happiness, you smile.

Abdominoplasty surgery commonly known as tummy tuck is a surgical procedure to tighten the abdominal wall muscles, and to flatten the abdomen by eliminating excess fat as well as the skin. The operation decreases the extension of mid & the lower areas of the stomach. There are two types of tummy tuck surgical procedures: Complete Abdominoplasty, and Partial or Mini

Abdominoplasty.

Different from other procedures

An abdominoplasty is not to be puzzled with liposuction procedures or gastric bypass surgical treatment. Liposuction is a surgical treatment that eliminates fat deposits; it could be conducted as an aspect of an abdominoplasty. Gastric avoid is a significant surgical treatment that decreases the size of the abdomen and allows food to go through the small intestine.

Tummy Tuck Surgery in Baltimore MD

Weight Reduction

A tummy tuck or abdominoplasty doesn't lead to weight loss. Indeed, it is usually conducted after an individual has lost a lot of body weight and wishes to improve the loose skin. Some females who have experienced several child birth choose to have an abdominoplasty to tense up the ABS muscles and minimize the stretched skin effect which causes during pregnancy. Women who plan to get pregnant or still considering weight reduction should postpone having an abdnominoplasty or a tummy tuck.

Complete tummy tuck: This option is for people who need a lot of modification, the stomach is cut horizontally; the surgeon shapes the skin, muscle, and the tissue. The navel is separated in complete tummy tuck surgery, and the patient will need drainage tubes after the surgery. This type of surgery can last up to six hours.

Partial tummy tuck: Shorter incision is used in this surgery, and the navel will not be separated. Partial tummy tucks performed with an endoscope and it will not take more than 2 hours according to Michele A Shermak MD. Partial and complete tummy tuck, both have risks; however, the serious ones aren't common. The risks include in both surgeries can be an infection, bleeding under the skin, and blood clots. Other potential complications are skinless and suture rupture. Permanent scarring is for sure in both cases.

Tummy tuck is optional in most insurance plans, due to the fact that most of the health insurances do not cover cosmetics. If a person has a hernia, then the insurance company will cover parts of the operation. A Bariatric surgeon always performs these types of surgeries; The cost ranges from $5000 to $10000 for a tummy tuck surgery.

Implant dentistry is a department of dentistry that explains the techniques used to recover smile of people using dental implants. This dentistry comes when a person cannot smile properly due to loss of teeth. To restore the gaps as well as an alternative to natural teeth, dental implants are used according to Bloomington Modern Dentistry.

Who Need Dental Implants

Yes, many people lose teeth when they age, and it is natural as well; at some point; however, living with a gap is not easy for everyone. People who are self conscious cannot live with it. People who love their smile cannot live with a broken or missing teeth. Instead of getting worried about their appearance, they choose implant dentistry to enhance their personalities. Instead of avoiding smile, they choose to get dental implants. Apart from the visual point of view, dental implants allow a person to chew easily; there are tons of advantages of dental implants.

Benefits

One of the significant profits of dental implant is that the inserts have a tendency to fit well in a man's mouth and mix in with the other teeth. They additionally feel natural, so a patient can even forget that he or she has a dental implant. Normally, dental inserts are not noticeable, so a man can smile confidentially without feeling unsure. Since the inserts are immovably planted in a man's jaw bone, the adjoining teeth have bolster and don't move; there are no chances of decay and other teeth problems in near future. Apart from this, you can speak well, eat well, and smile well without giving a second thought.

Dental Surgery

Implant dentistry is all about dental surgery; to fix the dental implants, to place small accessories of titanium, and so on. Dental implants cannot be implanted without surgery. There are a lot of options in implant dentistry for a surgeon to choose from; he or she can use fixtures and implants according to your condition as well as the requirement. Dental implants can likewise replace all teeth; however, it is an expensive option.

It is a myth that you don't need to care about your teeth after having dental implants. Dental hygiene is always important no matter which kind of teeth you have. So if you have dental implants, you should follow all the dental hygiene instruction. Dental implants according to Bloomington  Dentists need same care as the natural teeth need. Brushing, flossing, and mouthwash is important to take care if your teeth. Visit a dentist to know more about implant dentistry.

Yes, a smile dentist can improve your smile; It is a type of dentist who is known as family and cosmetic dentist. This type of dental expert has certification as well as the training in cosmetic dentistry along with general dentistry. Both of these terms are actually dental care branches; A local dentist can acquire the tag of cosmetic dentist by having a special training in this field. Cosmetic dentistry mainly focuses on enhancing the appearance of the teeth, while general dentistry focuses on dental health. Therefore, a family dentist who specializes in cosmetic dentistry can improve your smile and dental health.

General Dentistry

General dentistry is generally centered around precautionary dental care, which includes the gums, as well as the jaw. A standard dental professional can identify and cure many dental illnesses and attacks; take X-rays, and perform minimal regenerative techniques, such as putting caps and dental fillings. They likewise give fluoride medicines and take part in helping patients in oral cleanliness. General dental professionals can treat any kind of patient., Other dental experts choose their area of treatment such as sedation dentistry or cosmetic dentistry.

Family Dentist

A family dentist can undergo any type of dental specialist; ADA certification from the board is required to practice.  In addition to the general dentistry, a family dentist can choose variety of subject in oral treatments. There are tons of dental specialization; however, most of the family doctors choose cosmetic dentistry due to the fact that it is very popular these days. Also, this type of specialization allows a dentist to practice in various subjects and to enhance his or her knowledge.

Combination

Cosmetic and family dentistry combines cosmetic and preventative care. This type of special dental expert or sedation dentist can treat persons of any age, and perform a wide range of treatments and procedures. Repairing broken teeth in kids is the most common procedure for younger kids, which comes under family and cosmetic dentistry. Teeth whitening is most common in adults. Both preventative and cosmetic care can be made through this type of dentist.

You don't need to choose different dentists for your dental issues. A family dentist who is experienced, as well as certified in cosmetic can help you with the treatment. If you are looking for a particular dentist for improving your smile, you should try asking your family dentist about it. Teeth whitening and other enhancement methods are completely safe and successful.

 

When you think of a root canal, does it send chills down your spine? If so, you are not alone. Root canals are considered to be the most feared dental procedure around.

Root canal therapy has received such a bad reputation over the years, but fact is, root canals aren’t quiet as scary or painful as one may think. With all of the technological advances in dentistry, root canal therapy can now be comfortable and quick.

I’m sure you’ve all hear all of the myths about root canals, which have lead you to believe the contrary, but it’s about time that these root canal myths are put to rest. While told being you need a root canal can be frightening, rest assured that most of the things you’ve heard about root canals are likely untrue.

Myth #1: A root canal is painful.

Root canals are done to relieve the pain. A local anesthetic is used to numb the tooth and surround area during the procedure. Root canal therapy is virtually painless. However, the same thing cannot be said for an infected tooth, which is likely what lead you believe that root canals were.

Myth #2: Root canals are only required when you experience tooth pain.

Some teeth that require root canals don’t always cause pain. In some cases, teeth that have already died may need root canals to prevent it from becoming infected. There are many tests that your dentist can run, like percussion testing and temperature testing, which allows them to confirm that a tooth is dead and needs root canal therapy.

Myth #3: A root canal means having the roots of my tooth or my tooth removed.

The entire point of root canal therapy is to save a tooth, not extract it. The canals inside of your tooth are cleaned and scraped. To ensure that all of the bacteria has been removed, your dentist will remove the nerve tissue and pulp along with some of the inside part of your root. Your tooth and tooth roots are not removed.

Myth #4: Root canals causes illness

This common myths indicates that root canals can lead to negative health risks, such as heart disease, kidney disease or arthritis. The myth stems from research done by Dr. Weston Price almost a century ago, and has since been debunked. Not only is root canal therapy safe and effective, it eliminates harmful bacteria from the tooth, improving your oral health and overall health.

Myth #5: Having my tooth removed is a better alternative to root canal therapy.

Having a tooth pulled is traumatic procedure that actually allows harmful bacteria to enter the blood stream. There’s also nothing that can completely replace your natural tooth, and replacement alternatives require elevated costs. Not only is root canal therapy cost effective, it allows you to keep your natural tooth.

 

These root canal myths have mislead several people over the years, don’t let them steer you away from having both good oral health and overall health.

Remodel – Customized Breast Enhancement – Let the Lucas Center, Plastic Surgery offer you a customized approach.

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Are you a breast augmentation patient who either had surgery in the late 1990’s during the silicone false claim crisis or a patient who was misled into thinking that saline is an equivalent to the modern silicone gel implants? Or you were a fan of the 1990’s Bay Watch series and at the time felt that Pamela Anderson’s breast shape and size was the ideal standard. Just like houses with bathrooms and kitchens that seem dated after ten to fifteen years, requiring attention to remodeling to keep the house fresh and modern, so are breast enhancements. Stylistic changes and technology advancement of breast implant materials and fat grafting have come a long way, making your old decisions for your breast enhancement seem out of date and behind the times. Just like clothing styles and cars from the 1990’s seem dated now, so is the oversized sagging breast with saline implants, complete with rippling and pleating requiring an industrial strength bra to keep them in place. Ladies you don’t have to compromise any longer. Does your kitchen and bathroom still have brass fixtures? Then you should not have to put up with these heavy oversized misshapen breasts that are neither comfortable nor stylish. Consult a board certified plastic surgeon to review your options today.

Options not available 10-15 years ago.

First and foremost a modern plastic surgeon who has kept up with the current techniques and evidence based medicine related to breast enhancement will perform a complete tissue based diagnosis of the breast. Gone are the days hopefully of a surgeon standing in front of you without any measurements and eyeballing a one size fits all approach and telling you he or she will make you a “D” cup and you will love it. The facts are the 1990’s approach of shoving in multiple sizers or placing the largest possible smooth round saline implant under the breast without individualizing fit based on the patients breast tissue parameters lead to a revision rate of breast enhancement of 25% which manufacturers submitted to the FDA in the early two thousands. If gallbladders and knee replacements had that high of a revision rate insurance companies and Medicare would have a moratorium on the procedures. Fortunately our though leaders in plastic surgery have evaluated and re-engineered the procedures to minimize complications of capsular contracture, incorrect size placement, and avoidance of soft tissues being permanently thinned and distorted requiring complex revision procedures to correct poor outcomes. Most importantly the surgeon needs to determine the correct diameter of the devise both in width and height. The soft tissue thickness of the upper and lower pole (area above and below the nipple) is important as well as the tissue length from the fold to the nipple-areolar complex. The overall geometry of the chest and breast bone need to be noted requiring modification of procedures. It does not take an engineer to understand a women who is five feet tall and one hundred and ten pounds with a relatively short breast fold to collarbone and narrow chest with minimal breast tissue cannot have the same implant placed as a five feet, nine inch tall female with one hundred and sixty pounds with a wide frame and a large “B” cup breast. Unfortunately some surgeons did feel this way and some still do detracting from a customized approach that minimizes revision rates and unhappy patients.

Three dimensional imaging such as the Vectra has revolutionized my patient education and consultation for breast enhancements.  We can produce a very representative imaging of a women’s breast and torso and with computer simulation can demonstrate how any implant available in the United States can appear with your tissue parameters and allow the patient to see the proposed outcomes before a decision is made. This avoids wrong size surgery and allows patient expectation to be matched thus avoiding revision surgery. However the technology does not exist to provide this information if a breast already has an implant. This simulation also allows patients to see the limitations of an implant alone based on enhancement depending upon the individual’s soft tissue or bony deficiencies. This is where the discussion of fat grafting can be very beneficial to hiding the anatomic variances such as wide sternums that produce wide cleavages to provide an improved outcome and patient satisfaction. We can also demonstrate using a slightly smaller implant which has less weight and drag on poor quality soft tissue and supplementing the overall volume with large volume fat grafting to minimize implant malposition due to failure of soft tissues holding the implant in place.

Breast implants themselves have evolved over the last few decades. Today plastic surgeons can offer patients more options in size, shapes, and types of silicone than ever before also allowing for a more customized approach. I particularly have found the fifth generation silicone gel implants (Gummy Bears) to be particularly useful in petite women and very tall, thin women to exploit the positioning of the implant with differential heights and widths to maximize outcomes. I never use saline implants because they put too much strain on tissues, have excessive rippling, only can function as a round devise and can spontaneously deflate creating emergency surgical situations for patients. Based on clinical evidence, texturing of the implant can reduce capsular contracture, minimizing migration of the devise laterally over time and can maintain pocket size better than a smooth devise. Downsides include late seromas (fluid collections) and possible linkage with a very rare but easily treated form of implant related lymphomas. In my mind the benefits outweigh the small risks with texturing.

Lastly, the techniques of the actual surgery have evolved in the last ten years. These techniques include more precise, less traumatic dissections of the breast pocket, avoiding biofilm (a leading cause of capsular contracture) by minimizing the manipulation of the pockets with implants, and no touch techniques with the surgeon’s hands or patients’ skin on the devises that can minimize revision rates and improve outcomes.

In conclusion if you are a breast enhancement patient and are less than satisfied with your outcome don’t learn to live with compromise explore the modern day breast augmentation procedures available at board certified plastic surgeon’s offices around the country. Remember cell phones, cars, computers and styles have all rapidly evolved for the better compared to the 1990’s refresh yourself you will be glad you did.

For further information into customized breast enhancement procedures please visit www.thelucascenter.com or contact The Lucas Center Plastic Surgery, PLLC in Knoxville, Tennessee 865 218 6210.

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All plastic surgeons undergo rigorous training to perform the core plastic surgery procedures. They attend four years of medical school to earn their M.D. degree and often residency training at a hospital which focuses on surgical training in order to perform certain types of surgery life facelift surgery. Some plastic surgeons continue on with additional residency training in areas that are more specific areas such as ear nose and throat or general surgery which focuses on techniques for a wide range of procedures that are not aesthetic in nature.

Facial plastic surgeons focus their training on the anatomy, physiology, and pathology of the nose, face, head, and neck structures. They are likely to have completed 1-2 years or more of general residency training and 4 years of specialty training in head, neck and facial plastic surgery. Plastic surgeons focus on 3-5 years of general surgery training and 2 or more years of plastic surgery training. Plastic surgeons focus their training on all areas of the body. There are some expectations to this rule as of late because board certification and continuing education has become a hot topic from both consumer and professional prospectives.

Both plastic surgeons and facial plastic surgeons may take continuing education courses to further build on their skills and techniques used in nose surgery. Continuing education is an important factor to explore when considering nose surgery today. Continuing education courses are usually very specific. Such courses may be designed to address wound healing issues. Other courses may be focused on the anatomical dynamics of the nose.

In fact, it is highly advantageous to consumers that surgeons must obtain hospital privileges to perform nose surgery at a hospital. In order to obtain hospital privileges, plastic surgeons must have their skills and educational background reviewed by a panel of peers. So, it's wise to ask your nose surgeon if he or she has hospital privileges to perform nose surgery. Finally, some plastic surgeons that focus on nose surgery demonstrate their expertise in this area by publishing their own papers in trade journals to better educate other surgeons about nose surgery. They may lecture about the various aspects of nose surgery.

Since the nose brings balance and harmony to the face, it is an important feature for plastic surgeons to consider with great care when it comes to nose surgery. It is equally important for people to consider the credentials of the plastic surgeon when deciding onnose surgery.

For more information on facial plastic surgery contact Carmel Valley Facial Plastic Surgery located in San Diego California.

 

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You’ve been dealing with a nasty toothache for a while now. The pain is becoming excruciating so you finally suck it up and make a dental appointment. Sadly, you need to have a root canal. Great. But, what exactly is that going to entail? Do you need a driver? Is it going to be painful? Why did this happen in the first place? Well, a root canal will require one or more office visits, depending on the severity of the case. It will either be performed by a dentist or endodontist. We all know what a dentist is, but an endodontist is a dentist who specializes in the diseases and injuries of the human dental pulp or the nerve of the tooth. The choice of which type of dentist to use depends to some degree on the difficulty of the root canal procedure needed in your particular tooth and the general dentist’s comfort level in working on your tooth. After a brief consultation, your dentist will be better able to tell who might be best suited to perform the work in your particular case.

At your appointment, you will take an X-ray to see the shape of the root canals and determine if there are any signs of infection in a surrounding bone. Once everything is ready for surgery, your dentist or endodontist will then use local anesthesia to numb the area near the tooth. Anesthesia may not be necessary, since the nerve is dead, but most dentists still anesthetize the area to make the patient more relaxed and at ease. The anesthesia used will determine whether or not you will need to bring someone with you to drive you home.

Next, to keep the area dry and free of saliva during treatment, your dentist will place a rubber dam (a sheet of rubber) around the tooth. Once your mouth is prepared, an access hole will then be drilled into the tooth. The pulp along with bacteria, all of the decayed nerve tissue and other debris is then removed from the tooth using root canal files. A series of these files of increasing diameter are each subsequently placed into the access hole and worked the full length of the tooth to scrape and scrub the sides of the root canals. Water or sodium hypochlorite is used periodically to flush away the debris.

Once the tooth is thoroughly cleaned, it is sealed, which may take up to a week, depending on the doctor. If there is an infection, your dentist may put a medication inside the tooth to clear it up. Others may choose to seal the tooth the same day. If the root canal is not completed on the same day, a temporary filling is placed in the exterior hole in the tooth to keep out contaminants like saliva and food between appointments.

At the next appointment, to fill the interior of the tooth, a sealer paste and a rubber compound called gutta percha is placed into the tooth’s root canal. To fill the exterior access hole created at the beginning of treatment, a filling is placed. Once filled, you may have a tooth restoration procedure, but that’s it. You’re done and no more toothache. Because a tooth that needs a root canal often is one that has a large filling or extensive decay or other weakness, a crown, crown and post, or other restoration often needs to be placed on the tooth to protect it, prevent it from breaking, and restore it to full function. Your dentist will discuss the need for any additional dental work with you. Pain will be involved, but you are already in pain. This pain will eventually go away and your tooth will be good as new.

For more information visit http://www.rahillandsimondds.com/  your local dentists in Oklahoma City, OK

Porcelain veneers are a wonderful way to transform your smile from drab to fab! How long your beautiful, flawless restorations last ultimately depend on you and how well you care for them.

As durable as porcelain veneers are, they will not last the 15 to 20 years they are intended to without proper care and maintenance.

The list below includes a few aftercare tips to help ensure that you enjoy your porcelain veneers for years to come:

Take proper care of your veneers. The best way to do this is by practicing good oral hygiene habits. This is extremely important to prolong the life of your porcelain veneers and to maintain good oral health. Be sure to brush for two minutes twice a day, floss once and rinse with mouthwash to increase the lifespan of your porcelain veneers.

 

Use a soft-bristled toothbrush. While porcelain veneers are quite durable, they can be damaged by brushing with a hard-bristled toothbrush. Stay away from hard-bristled toothbrushes and stick to using soft-bristled toothbrushes instead. Also, be sure to use a toothpaste without harsh abrasives. If you need recommendation for a toothpaste without harsh abrasives, be sure to ask your family dentist.

 

Visit your dentist regularly. Visiting your dentist regularly not only helps keep your teeth and gums healthy, but also allows for your dentist to monitor your porcelain veneers and to make repairs to them, if needed.

 

Prevent Gum Disease. Gum disease leads to gum inflammation and may even cause your gums to recede. Gum recession may expose the top of edge of your porcelain veneer, which can result in an unattractive smile. Gum disease can be prevented by practicing good oral hygiene and visiting your dentist for regular checkups and professional cleanings.

Avoid Bad Habits

Properly maintaining and caring for you porcelain veneers also includes avoiding bad habits that can damage your veneers. The following are a few things you should avoid after getting porcelain veneers:

Don’t chew on hard objects. As mentioned earlier, porcelain veneers are durable, however, they aren’t exactly as strong as your natural teeth. Be sure to avoid chewing on hard objects such as ice, pens, and even your nails. Chewing on hard items can cause your veneers to crack or chip. Same goes for clenching and grinding your teeth.

 

Avoid stain causing food and beverages. While porcelain veneers are stain resistant, your teeth and the adhesive used to bond the veneers are not. Be sure to avoid food and beverages that may stain your teeth. If you drink coffee or soda, use a straw to minimize the contact with your teeth.

 

Quit Smoking. The detrimental effects of smoking have long been made known to the public, yet people still smoke. Even big tobacco companies are quick to point out that their products aren’t exactly safe. So if you ever needed another reason to quit, this may be it, smoking is also bad for your veneers. As mentioned earlier, porcelain veneers are rather stain resistant, however, smoking can result in staining and discoloration of your veneers.

Porcelain veneers can give you the smile that you’ve always dreamed of, and as long as you properly care for your veneers they will last for many years to come!

We are now continually learning strategies to strengthen our practice and the things one can offer to you. One important change is in the battle tooth damage. We at this moment see that cavities, can become avoided and even undone if offered the right set of scenarios . Our team has engineered a program that would allow our patients at standard to very high risk for corrosion to benefit from the most recent knowledge that is available . Here Kenneth L Fong DDS - Our Cavity Prevention Program will provide education on what causes you to produce cavities and what you can do to lower your corrosion rate . Some of the things that we are able to evaluate with you will likely be your own saliva flow , saliva pH , sugar intake , snack rate of recurrence and timing , and food consistency . We will be able to supply you with the most effective toothpaste available to re-mineralize teeth , as well as a summary of products that will help cut back on your decay rate . Then we will take the next step with a second appointment to assess how well you are doing with the program . Our main goal is to lessen your decay rate as years pass by following the program, and to help you utilize it for maximum physical health now and in the course of your lifetime .

 

 

Summer is a fun, favorite time of year for all of us. From beach vacations, pool parties, backyard barbecues, and simply having more hours of daylight to enjoy the outdoors are some of the wonderful ways we enjoy summer and make wonderful memories. Try as we might to load up on sunscreen, wear large brimmed hat and sunglasses, our skin can still experience cellular damage. UVA rays can cause damage to the skin membrane, UVB rays damage the DNA of the cells and IR-A damages the mitochondria. Unfortunately, the SPF (sun protection factor) number of a sunscreen indicates only the level of protection from the UVB rays and UVA rays are 50 times more prevalent than UVB rays. They penetrate deeply into the skin cell layers damaging collagen and cells. It is very likely that some of these dangerous rays took a negative toll on our skin over the course of the summer months. Thankfully, there are ways we can correct some of the damage and prevent the unwanted photo-aging. The use of topical cosmeceuticals can rejuvenate the skin, growth factors help support the skin’s natural ability to support itself and anti-oxidants are free radical scavengers and help fight the signs of aging. In-office chemical peels are a must for reversing the damage and photo aging process. I recommend that all of my clients have a single chemical peel or series of peels at this time of year to correct sun damage. Chemical peels come in several different strengths. A treatment plan can be customized for each person based on their skin type, concerns, level of damage and desired outcome. Sometimes results can be achieved with a single peel, other times a series of two to three peels are necessary to work on more stubborn or deeper issues. I would encourage everyone to start planning now for their chemical peels. Minimal downtime can be expected post procedure. The skin will start off pink the day of the peel and will be very tight until peeling starts, generally 48 to 72 hours after the procedure, and can last 2 to 5 days. I would recommend looking ahead at your schedule and setting up a time to accommodate this process since it’s not too early to plan your fall skin rejuvenation. If you are unsure what your skin needs, please call 865-218-6210 to set up a complementary consultation.

Closed Rhinoplasty to widen a narrow nose

Some patients are born with an unnaturally narrow nose and would like to have it cosmetically widened. Other patients are born with an “hourglass deformity” which means they have pinched or very narrowed upper lateral cartilages in the mid-portion of the nose. Typically these patients have wide nasal bones, a dorsal hump, and a wide tip. The inverted upper lateral cartilages appear concave and relatively speaking, can make the tip look more bulbous and the bridge look wider. To widen a narrow nose requires osteotomies placed in the nasal bones, which include both medial and lateral osteotomies. The medial osteotomies are placed at the junction between the upper lateral cartilage and the lower portion of the nasal bones. Instead of narrowing the nasal bones, they’re actually cantilevered out more widely, also known as reverse osteotomies. Cartilaginous spreader grafts are then inserted in the space where the medial osteotomies were placed to hold the nasal bones open in their new wider position. The cartilaginous spreader grafts can be harvested from the dorsal hump that’s been removed or from inside the nose from nasal septal cartilage. The spreader grafts are also placed in a sub-perichondrial and sub- periosteal pocket. It’s also important to make sure the tip of the nose balances with the new bridge line. In some patients the tip may need to be narrowed, and other patients, the tip needs to be widened. A conservative cartilage removal is required to narrow the tip, while cartilage-grafting techniques are required to widen it. Rhinoplasty is a very difficult endeavor, so is very important to choose a rhinoplasty specialist based on extensive experience performing osteotomies, spreader grafts, and advanced bone and cartilage work to create a natural appearance. Dr. Portuese performs all of his nasal surgery procedures at the Seattle Rhinoplasty Center, which is a state-of-the-art Medicare certified outpatient surgery center located in Seattle Washington

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Why would you want to work in peoples’ mouths? That is a question I hear a lot.  But the same type of question could be asked of anyone.  Why do we do what we do?  The answers vary from person to person.  For some, it’s what their dad or mother did.  For others it’s just the best job they could find.  For the lucky few, it is something they are passionate about.

I got very lucky. A family friend was a dentist, and he steered me toward dentistry.  He had good arguments.  You are your own boss, you set your own hours, you make decent money and you get to help people.  All of that sounded great to a teenage kid from a small town.

The next lucky thing happened at college. I became friends with another student who wanted to go to dental school.  Our discussions solidified my desire to become a dentist.  Entering dental school was a little less scary with a friend at my side.

As I began practicing, dentistry went from something I wanted to do to something I love. I embraced continuing education and I love the fact that dentistry is always changing.  I employed coaches to help me be the best dentist in Texas and leader I could be. I hired great people and gave them excellent training.  Being surrounded by awesome people makes every day a good one.

So here I am working good hours, making decent money, in a profession that continues to grow and improve. I have a great team making every day enjoyable and superb coaches keeping us on the right path.  The only boss I answer to is my wife Sara, and I don’t mind that at all.  It’s not a bad gig.

But guess what, none of that is my why. Why do I love Full Mouth Restorations?  Because of the people!  I get to interact with so many people every day.   I get the satisfaction of talking a terrified patient through a procedure and showing them dentistry doesn’t have to be painful or scary.  I get the joy of performing the first filling on a child and having them happy and comfortable the whole time.  This usually astounds mom, which gives me even more happiness.  I love helping people obtain the oral health they want, need and deserve.  Most importantly is the relationships I have formed over the last 30 years.  If I’m having a bad day or things don’t seem to be going right, I spend a few extra minutes chatting, joking and catching up with the patients in the schedule.  This always cheers me up and makes my day better.

When I think back to my first plastic surgery rotation as a medical student in the early 1990’s breast reconstruction was performed much differently then. During this time period the silicone implant crisis was at its peak, women were skeptical of breast implants, and the majority of reconstruction surgeries were with TRAM (Transverse Rectus Abdominus) flaps requiring large skin paddles because the breast surgeons were much more invasive in the way breasts were removed. Today silicone breast implants are safe and available in many sizes and shapes, providing patients and surgeons many more options than ever before. The technique of breast removal (mastectomies) have become much more selective, even being able to spare the nipple-areolar complex in many cases; therefore the need to transport new skin into the area is less often required in primary reconstruction. The advent of soft tissue regeneration with the addition of bio-matrices such as Acellular dermal matrices and guided tissue regeneration materials such as textile silk meshes have revolutionized the outcomes in prosthetic reconstruction. Without question one of the greatest advances in breast reconstruction is the art and science of fat grafting which can augment selected areas of volume deficiencies, improve the overall shape, and restore the health of the overlying tissues which has been previously damaged by radiation therapy.

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Dr. Pat Maxwell coined the term “the bio-engineered breast” which utilizes acellular dermal matrix grafts and fat grafting to rejuvenate the soft tissues surrounding breast implants after mastectomies. I have been modifying these two techniques in my practice since 2004, which has vastly improved outcomes in both primary and revision breast reconstruction. Fat grafting has provided plastic surgeons the ability to selectively sculpt and shape breasts like never before. Implants can only occupy and provide shape and volume in specific locations on the chest and breast. Fat can influence any area desired to be modified similar to photo shopping in pictures. Fat already occupies the majority of a natural breast volume therefore restoring a reconstructed breast to normal form and function with less donor site morbidity is seen with harvesting large flaps from the abdomen and buttock region. This truly is an exciting time in plastic surgery to provide excellent results with less invasive techniques, especially compared to the past.

In addition to the soft tissue restoration procedures the new silicone gel implants have also contributed to better outcomes. The fifth generation silicone gel implants (Gummy Bear Implant) are a very cohesive polymer which maintains three dimensional shape. This for me has two advantages; the first is that we can offer implants which can more easily match a patient’s unique chest wall architecture such as creating an implant narrower in width and taller in height (for a tall thin lady) or shorter and wider for a small wide chested woman combined with a fuller projection in the lower half of the breast mirroring a normal breast shape that will have adequate volume but will not encroach on the arm pit region or have an over expanded upper pole appearance. The second advantage of these implants are the result of a stiffer polymer which resists forces of capsular contracture that have been demonstrated to be a major cause of revision breast implant surgery. With the use of bi-dimensional conceptual planning through meticulous measurements we can offer a more customized approach to reconstruction and we can educate patients on their options with a three dimensional imaging system (Vectra) to demonstrate the effect of different shapes and volumes on their potential outcomes.

Even women who have been diagnosed with breast cancer and elected to undergo “breast conservation techniques” with a lumpectomy and radiation therapy can frequently experience distortions of the breast. The affected breast can shrink in volume and change in shape compared to its baseline and with the opposite breast as a result of surgical removal of tissue coupled with imposed radiation fibrosis changes to the tissues which are permanent and progressive. In my practice I see a number of these women and have been successful in reducing deformities and restoring shape and volume with the use of internal scar release combined with fat grafting. The amount of hard woody scarring of the overlying skin can often be suppler after treatment. Contour deformities which often occur directly in the surgical field where tissue was removed can be restored in shape and volume leaving a softer breast that is more symmetric with the opposing side.

I am very proud of my field of plastic surgery which by its very nature attracts thoughtful and innovating disciples of this surgical specialty leading to a continuous evolution of scientific insights that opens the door for continuous improvements in the care we can provide patients. Breast cancer reconstruction is just one small piece that is being tackled by our field of study.

Being a mom is one of the most challenging, frustrating, yet rewarding experiences a woman can have. You put forth blood sweat and tears, not to mention an untold strain on your whole body during pregnancy. It really boils down to the genetics of your skin and fascia as to how well you can bounce back after the weight gain and abdominal stretching from your baby. Many women lament that despite dieting, exercising and lots and lots of willpower your body is never the same as it was prior to child bearing. Fortunately for the masses of dissatisfied women there are options in Mommy Make-over Surgery to boost your self- confidence and your body image. Here is a list of body corrections (Mommy Make-over) that can be performed in tandem or separately to improve the shape and how you feel about your physique.

Breast Implant Exchange with Fat Enhancement

Amanda’s first implants were placed by another surgeon approximately 15 years earlier

425cc anatomical saline implants were placed under the muscle

She was unhappy with the implant rippling, breast gap and muscle flexion distortion

Even under the muscle, the implants were still very visible as coverage was so thin

Being very lean also made her naturally wide breast gap seem even more prominent

Displacement and flattening of the implants occurred with every muscle contraction

Implants placed above the muscle would have resulted in more visibility due to less coverage

Implant placement under the muscle also created a wider breast gap visible in clothes

Rippling was more pronounced with saline implants especially when leaning forward

Amanda first presented to our practice 10 years earlier for her tummy tuck

Her satisfaction and trust allowed her to feel confident in having breast surgery as well

Correction involved removing the implants and restoring the muscle to its original position

Placing cohesive, gummy bear, anatomical, silicone gel implants in a new pocket above the muscle

Then filling the overlying skin envelope with fat grafts to add cover, volume and cleavage

Amanda is seen at her initial visit (left image) four years earlier with her original saline implants

The center photos show her four years after initial implant exchange to 350cc smooth, round, silicone gel implants (still under the muscle) with 50 cc of fat placed above

There was significant improvement but she still wanted to reduce the gap and muscle animation even more

As she was lean and also very athletic, she wanted complete muscle correction

Mentor MH 440 CC, anatomical, textured cohesive gel implants were placed over the repaired muscle

75 CC of fat was also placed into the overlying breast envelope for coverage, volume and contour

She is now seeing (right images) with her final results 2 months after implant relocation and fat transfer

The fat grafts have completely integrated and have the potential to last a lifetime

There are no visible or palpable irregularities and full natural breasts have been achieved

Amanda went from a C to her desired D cup and… she finally has cleavage

The animation deformity is completely corrected and a soft natural appearance is finally hers

During pregnancy the glandular component of the breast must enlarge to ready for the enhanced production of milk. Additionally weight gain with fat storage all governed by the hormonal changes can increase the breast size immensely. Unfortunately fetal regulation also makes skin “stretchy” to accommodate the increased girth of the breast and abdomen. After the resumption of normal non-pregnant hormones and the lack of need for lactation the breast volume will revert back to baseline and can even reduce in overall size compared to the original baseline. Unfortunately many times the skin does not have the ability to shrink to the original size and will stay expanded resulting in a larger skin brazier with same or even less fill than before resulting in “saggy” breast shape. With increased skin length from the breast fold to the nipple it moves the breast mound lower on the chest with less upper pole fullness. I hear many women call their breasts “sad” in appearance when they come in for consultation. Ok enough depressing thoughts… what can be done? If the skin is not excessively enlarged, the nipple-areolar complex is correct and the fold to nipple distance is not greatly elongated the solution can be to place a silicone gel implant to act as a shaper and a filler of the breast envelope restoring a pleasing breast shape. If the breast has a low positioned nipple-areolar complex, with or without increase skin length from the fold to the nipple-areolar complex, then a mastopexy (breast lift) is required. Often times tissue volume might need to be enhanced to provide better shape and upper pole fullness, thus an implant or fat grafting can be incorporated at the same time. Sometimes upper pole fullness can be accomplished by transposing extra breast tissue in the lower pole and positioning it on the chest wall deep to the rest of the breast to enhance fullness.

Abdomen:
Hormones during pregnancy direct adaptive body changes that allow healthy growth of the baby but unfortunately create lasting changes to a women’s body. The abdominal skin stretches and often can result in stretch marks (tears in the dermis with intact epidermis). Excess skin rarely retracts in these cases leading to hanging skin that drapes over the pelvis. Next the abdominal wall is distorted to accommodate the growing fetus resulting in separation of the paired rectus muscles leading to increased abdominal circumference with permanent bulges in the abdominal wall both above and below the umbilicus. This unfortunately cannot be reduced with abdominal exercise because the stretched fascia between the muscles is not contractile and will not respond to muscle strengthening. Additional weight changes with aging often can be manifested with increased abdominal girth from excess fatty tissue. So what can a Mommy Make-over achieve in the abdomen?

If skin quality is excellent and the abdominal wall is only minimally distorted often liposuction with the addition of additional energy sources such as ultrasonic energy (VASER), oscillating power hand-piece (PAL), or hydraulic power can result in removal of excess fat and create skin retraction/redistribution to improve contour. However, many women will need a full abdominoplasty with correction of excess fat with liposuction, removal of excess lower abdominal skin with tissue resection, and abdominal wall restoration by returning the rectus muscles together with a permanent suturing technique. This can result in excellent contour of the abdomen but you will trade the contour for a scar. I find most people are surprised how long the scar has to be to create the contouring necessary. Once acquainted with the results, most women will gladly trade a scar for the results of a flat smooth abdomen.

Back and Flanks:
Some women can realize their goals by correcting the anterior abdomen by itself. However many women if given the opportunity would love to three dimensionally correct their torso by sculpting their midback (bra line folds) and flanks (muffin tops) at the same time as their abdomens to circumferentially adjust their shape. This can make a tremendous change on how clothing can be worn and how the individual feels about themselves. Liposuction with either PAL or VASER makes a great deal of improvement by releasing all the ligamentous attachments between the back and flanks and the superficial skin (which results in rolls on the back) and allows even removal of fat and the skin to re-drape much smoother.

Legs:
Some women naturally store adipose tissue in their lateral or medial thighs. Depending on the skin quality and the potential for the tissue to re-drape or tighten, fatty tissue can be sculpted just as on the back. Some have significant adipose tissue below the knee down to the ankle. I generally do not add the additional power source with liposuction in this area and have achieved good results.

Buttock:
Popular trends in body shape can change just like in fashion over time. The introduction of the Latin culture into the United States in conjunction with pop culture personalities have made the appearance of a full contour buttock something to aspire to. My preference for buttock augmentation is with fat grafting and not with a prosthesis. Utilizing concepts of tissue equilibration and liposculpturing we can remove unwanted fatty tissue, harvest it as a graft, and utilize the fat as a volumizer of the buttock- while improving the contour of the rest of the body. Women who have gained and lost weight may have loose sagging skin of the buttock and restoring volume can shape and lift the buttock with little or no scarring.

Women who are unhappy with their physical appearance after giving birth to one or multiple children can restore the body to a better place with a Mommy Make-over. To me this represents more than one area of the body to be rejuvenated simultaneously to make the woman feel refreshed and erase some of the “battle scars” of pregnancy so she can feel more confident in her appearance.

Twins

Although the birth rate for twins has risen dramatically since 2009 to about 1 in every 38 births, the birth rate for identical twins is significantly more rare: about 1 in every 285 births. The result of a single egg that splits in two, identical twins share more than just their DNA. Emotionally and physically, identical twins can be so alike that people can’t tell them apart. Which can make the job of a plastic surgeon operating on identical twins extremely challenging. Dr. Peter Fodor, an international leader in the field of aesthetic plastic surgery who has operated on a number of identical twins in his Los Angeles, CA practice, shares some of these challenges.

by Katherine Stuart
and Peter Fodor, MD

Almost a No-Win Situation

While all twins gestate together in the same womb, often speaking without words, identical twins go one step further. They share DNA, making them physically the same. This can create a very interesting, but challenging situation for a plastic surgeon. Emotionally, most identical twins adore each other, in Dr. Fodor’s experience, and want to be the same in every respect from voice to dress to what they eat. There’s even a set of twins in Australia who share the same boyfriend. For twins such as this, if a plastic surgeon doesn’t make them exactly the same then he or she has failed. However, there’s also a smaller sub group of identical twins who are extremely competitive and don’t really like each other at all. But they, too, want to look exactly the same post surgery or else their competitiveness will escalate. This can create a bit of a no-win situation. As Dr. Fodor puts it: “Identical twins whether they love each other or don’t like each other quite as much, you better make them look identical after surgery.”

Two Twins at Once

In order to ensure the most successful outcome possible, Dr. Fodor likes to work on both twins. Ideally, assuming the procedures aren’t too long, on the same day. For example, if he’s performing a rhinoplasty, he will do the first twin’s nose, followed by the second twin’s nose, making sure to go through exactly the same steps in exactly the same order. But some procedures have more predictable results than others. A breast augmentation performed with the same size implant will deliver similar results while a nose job can be more difficult partly due to facial asymmetry.

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Facial Asymmetry is the Norm

Everyone’s face is asymmetrical. If you take a photo of a patient and split it down the middle, the right and left side won’t match up. In fact, Dr. Fodor has a trick mirror in his office that he uses with patients where one side is a regular mirror, and the other is a prism mirror that reverses the right and left sides of the face. Most patients don’t recognize themselves in the prism mirror. “The two sides of the face oftentimes though they look very similar, they’re not identical” says Dr. Fodor. This is true for twins as well.
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One Set of Twins. Two Different Surgeons

Another challenge of working on twins is when you only get to work on one because a different surgeon has already worked on the other. It’s allows for the kind of direct comparison that’s hard to capture elsewhere and can be “kind of an ego builder when the twin that you did looks better” or more natural.

Twins and Facial Aging

Aging identical twins are also fascinating since they often don’t age at the same rate due to lifestyle choices. In fact, a 2009 study used identical twins to determine which outside factors contribute most to facial aging. The main culprits were smoking and sun exposure. This definitely comes into play for Dr. Fodor when he’s performing a facelift on identical twins. For him, the most fascinating thing is following up with these patients years down the road and seeing whether or not changes such as stopping smoking will cause them to age at the same rate again.

Needless to say, working on identical twins may be technically challenging, but it’s also a fascinating learning experience for any plastic surgeon.

 

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Fighting Fifty

Today, women in their 40’s and 50’s are looking younger than ever. We no longer look frumpy or matronly like many of our grandparents did at the same age. These days we have more choices than ever before to turn back the clock. I had an opportunity to sit down with Dr. Peter Fodor, an international expert in aesthetic plastic surgery and ask his thoughts about “Fighting Fifty”. Click To Watch The Video

“The way I would think about fighting fifty, is fighting fifty and WINNING!” ~Peter B. Fodor, MD, FACS

It Begins with the Skin

“They need to exercise, they need to diet, they need to take care of themselves, and they need to use good skin care,” says Fodor. He says good skin care, is critical for this age group. As you reach your 40’s and beyond, you may be seeing dullness, uneven tone, rough texture, fine lines and some sagging in your skin.

Here’s a basic check list of what you need to know about skincare as you reach your forties.
1. Gentle cleansing. Many women will experience drier skin as they age and need to switch to a more gentle cleanser that doesn’t strip the skin. A few to try are Cetaphil and Purpose to be used morning and night.
2. For fine lines and pigment issues, start thinking about skin care with effective Look for a retinoid cream which works to resurface the skin and increase collagen in the dermis. They are best used at night and you may want to start out slow to avoid peeling and redness. Once your skin becomes more accustomed to the cream, you can increase the frequency.
3. Wear sunscreen every day. Your best choice is a broad-spectrum sunscreen which protects skin from UVA (aging rays) and UVB (rays that burn).

The Aging Eye

You may have heard, the eyes are one of the first areas of the face to show the aging process. The skin around the eye is thin and more susceptible to dryness and wrinkling. When the eye starts to sag it can create dark circles, bags and crow’s feet. Dr. Fodor says, “The upper eyelids can really make people look much older than they are at times. It can be genetic; it can come with the family. But a blepharoplasty procedure can make people look fresher and a lot less tired.”

Injectables for Immediate Results

If you really want to turn back the clock, “Botox and facial fillers such as Juvederm and Restylane work well,” states Fodor. Botox, Dysport, and Xeomin are neurotoxins for erasing lines in the upper face and around the crow’s feet.

Facial fillers can replace volume loss in your temples, cheek area and the nasolabial folds. They can also help plump up your lips.

Hormones Play a Big Part in the Aging Process

Fodor explains that as we get closer to menopause our hormones change. When this happens, “certain parts of the body that were once harmonious to the rest of our body, may start to change. It can be in the hips, the knees and the stomach. Liposuction can be a great approach for these patients,” says Fodor.

Fodor is quick to state, that the main message is for patients to take care of themselves. He says going in for an injectable or a surgical procedure that addresses the facial or the body part that you are most concerned about can bring about a rejuvenation that is as much physical as mental.
As with any procedure, make sure you go to a qualified board certified physician who is well-trained in their specialty.

Reshaping the contour of the abdomen is frequently requested in my office consultations. The most common techniques are various forms of liposuction with or without an abdominoplasty. Another tool in our repertoire which can yield effective results is the “Reverse Abdominoplasty.” The classic indications for a regular abdominoplasty is a torso which has loose excess inelastic skin of the lower abdomen, abdominal wall rectus muscle separation (diastasis), and varying degrees of excess fatty tissue. The technique eliminates the excess skin and fatty tissue in the lower abdomen, reconnects the rectus muscle together to tighten the abdominal wall, and excess abdominal fatty tissue can be reshaped with liposuction to provide a pleasing shape. A Reverse Abdominoplasty is chosen for the individual who has loose excess skin in the upper abdomen, who generally does not have a full diastasis which is affecting the lower abdominal contour, and may have excess fatty tissue in the lower abdomen without skin excess. The technique is to start with incisions that follow the lower breast fold then cross the lower sternum to connect both sides of the abdomen. These scars generally hide very well even in two piece bathing suites. The full thickness skin is elevated down the abdomen preserving the vital blood supply on either side of the belly button. If upper rectus muscles need to be tightened this can proceed. Any abdominal fatty excess can also be corrected with liposuction at this time. The elevated released excess abdominal skin can be addressed in several ways depending on the needs of the patient:

1. If a women who has the upper abdominal skin excess and also desires rejuvenation of the breast the excess elevated skin of the abdomen can be utilized as a self-augmentation under the breast to provide added fullness and shape. This is often done in conjunction with a breast lift (Mastopexy) and can avoid the need and expense of an implant. I have even performed this procedure with a woman who many years ago had bilateral mastectomies for breast cancer and we reconstructed her with implants. She had experienced some weight fluctuation and was becoming very active and requested the elimination of her breast implants but still desired a smaller breast to remain. We utilized a reverse abdominoplasty skin excess, removed the outer skin, and placed it in her implant space to fill the void and added tissue volume and shape provided with fat grafting harvested from her back, thighs, and lower abdomen giving her a smaller but still reasonable breast shape.

2. The Reverse Abdominoplasty could be incorporated as part of a treatment plan to tighten the upper abdominal contour. After the incision and elevation of the abdominal excess loose skin, the surgeon can remove the undesirable portion and fixate the remaining tissue to the rib fascia of the lower breast fold to avoid the scars from migrating inferiorly thus preventing the exposure of the scars on the upper abdomen. I have used this as a primary surgical procedure for women with loose skin of the upper abdomen that would not respond favorably to liposuction alone. I have also used this as a secondary procedure on women who have previously had an abdominoplasty with good results but over time the lower abdomen has maintained its results yet the upper abdomen has become loose and has excess as a result of weight changes, sun exposure, and of course gravity. The excess skin can be removed providing a nice tight appearance to the whole abdomen.

3. Another situation for the reverse abdominoplasty is for a women with loose upper abdominal skin combined with previous augmentation mammoplasty in which the implants have become mal-posed and have drifted inferior and lateral to the correct position. In this case the excess elevated tissue can be utilized as a autologous (meaning from your own body) soft tissue sling to help reposition and stabilize the implant similar to an Acellular Dermal Matrix (ADM) graft without the significant added cost of the product to provide long lasting results.

One of the aspects in my profession of plastic surgery I am most proud of is the innovative nature of the field. We take problem sets that patients present to our office and we create unique methods that achieve a sound result with the least amount of surgery and the lowest costs to ensure successful and happy patients. The Reverse abdominoplasty is an example of one of these off shoot procedures which fills a vital niche in my practice.

Jay H. Lucas, MD
Board Certified Plastic Surgery, MOC 2012
The Lucas Center, Plastic Surgery
Knoxville, Tn.
thelucascenter.com

I love experiencing the sun and all the activities surrounding its presence such as boating, swimming, hiking, and cycling. My mood is immediately elevated witnessing its warm glow. Yes there are many benefits to the sun’s rays such as stimulating the production of Vitamin D which is essential in calcium and bone metabolism as well as supporting the immune system. It chases away the blues of seasonal affective disorder and is essential for life. However there is a risk benefit ratio to being exposed to the sun’s ultraviolet rays. Following is a list of downsides to sun exposure. File May 11, 2 23 07 PM

1. The ultraviolet rays of the sun damages the DNA in our skin cells which can result in malignant transformation of cells such as basal, squamous, or melanoma. The latter can be lethal. Therefore minimizing the harmful UVB rays can reduce the risk of developing skin cancer. Sun screen is not a one -time application for a whole day of exposure. It needs to be repeated at least every two hours or more often depending on water or perspiration which can reduce the effectiveness of the prevention. Sun damage is additive over a life time but taking breaks from the harmful rays can allow the tissue to heal and repair some of the mild DNA damage. Therefore year- long tanning such as tanning beds should be discouraged.
2. Exposure of both UVA and UVB rays will damage the elastin fibers in the skin permanently resulting in loose less compliant skin. This will result in the skin of the face, arms, breast, abdomen, thighs, and knees to hang and appear loose. No exercise will tone the damaged skin. Therefore protect your largest organ system, the skin, by shielding the sun with appropriate hats, clothing, and sun screen.
3. Splotchy color changes to the skin. With increased sun exposure the skin will upregulate melanin production resulting in pigmentation changes that are less than attractive and are extremely difficult to reverse.
4. Thinning of the dermis which can result in the appearance of capillaries giving a red appearance around the nose and cheeks.

Everyone wants to have that sun kissed glow to the skin. I wish I had a dollar for every time a women says tan fat looks better than pale fat. Just remember the list above and understand a large sun exposure that creates a nice tan for around a week or so causes a lifetime of damage that can result in potential skin cancer and many vexing maladies of the skin giving a marked aged appearance over time.
Fortunately if you have experienced the above sun damage we can help. A combination of good home skin care with Skin Medica products, chemical peels to remove damaged skin and remove pigmentation changes, and microneedling which can result in collagen induction and improved dermal thickness and skin tone. More educational BLOGS are available on our website. www.thelucascenter.com

Stephen M. Miller, MD and Axiom Spa Open House

May 25, 2016 5-7 PM

Join us for a night of raffles, demonstrations, special promotions and catered refreshments.

Our raffle items include Botox, Juvederm, eyelash extensions and several skincare items from Hydrafacial, Neocutis, Obagi and SkinMedica.

Special promotional prices on Silicone Breast Aug, Fraxel Repair, Thermage, Micro Needling with PRP, Botox, Juvederm, Restylane, Kybella, Voluma, Radiesse, IPL-photo facials and all of the skincare lines listed above.

Representatives of the top anti-aging products will be presenting valuable information about their products.

This is an excellent opportunity to meet Dr. Miller, his staff and Axiom Spa technicians.

Please RSVP at Dr. Stephen M. Miller and Axiom Spa Open House

Non-invasive aesthetic procedures have come a long way in the last ten years. The American Society of Plastic Surgery’s yearly statistics continue to demonstrate strong demand for procedures such as neuromodulators (Botox and Dysport), and hyaluronic acid filler agents (Juvederm, Voluma, Restalyn). Recently, non-invasive contouring systems that perform the techniques of cryolipolysis, such as Cool Sculpting and radiofrequency skin-tightening Ultherapy, have emerged in the marketplace. Now Allergan has added Kybella to the mix as a non-invasive injectable material to dissolve fat under the chin.

Before and After

Before and After

The key to success with these treatments is consulting a comprehensive center that offers a full array of non-invasive and surgical options, and will direct you to the ideal treatment modality for your unique circumstances. Just as with any medical and surgical procedure, there are appropriate candidates and patients with contraindications.

The most important step to avoid dissatisfaction is to be evaluated by a physician who is properly trained to perform comprehensive evaluation and care for all patients with a particular aesthetic concern.

Board-certified plastic surgeons have the most comprehensive education and background experience to correctly evaluate your anatomy and determine which treatments will yield the best outcomes. The statement “if all you have is a hammer the whole world is a nail” rings true for medical spas and dermatologist offices which only have one option, such as Cool Sculpting or Kybella. Just because a treatment option is non-invasive does not mean it is inexpensive. If you factor in the cost of multiple treatments, it may be as expensive as surgery and still fall short of expectations.

When is Kybella the right choice?

With the current status of the injectable form of deoxycholic acid (Kybella) the ideal candidate must have reasonably tight skin with only mild to moderate adipose excess in the submittal and chin neck angle. The patient should not have a significant mandibular jaw discrepancy with the midface or have a particularly steep mandibular plain angle.

When is Kybella the wrong choice?

Any patient with lax skin of the neck or a significant deflation of the neck related to weight loss with demarcated platysmal bands is not a candidate. Taking away fat in this circumstance only worsens the deformity. Any patient with a deep underbite and a small chin with a very oblique chin-neck angle should also avoid Kybella. Deoxycholic acid is mostly created to dissolve fat but does produce some inflammation with the caustic material to encourage collagen production and skin retraction. Skin excess with an oblique chin neck angle and recessed chin will not yield overwhelming positive results.

Instead of Kybella, the better option is placement of a chin implant (genioplasty) with aggressive liposuction to encourage skin retraction. A middle facial third with significant skin excess and deflation combined with loose-hanging skin with platysmal bands is best treated with a corset platysmaplasty in conjunction with a neck/face lift.

Non-invasive aesthetic procedures can be a wonderful adjunct to helping people age gracefully with limited down time. Kybella in the right situation may improve necks and make people happy with the results.

Avoid being pushed into this option without a thorough three-dimensional analysis of your face to determine if it’s right for you. Nothing is more frustrating than spending a great deal of money and not realizing your desired results. Even with surgery, some deformities may not be able to be corrected. Take advice from a board-certified plastic surgeon to maximize your goals and to feel good in your own skin.

Fashion trends change, and so do accepted ideals for body appearance. The influences of Latin culture on American norms have triggered an explosion in the demand for buttock enhancement with fat grafting, which was first popularized in Brazil. Another trend patients are requesting is a more conservative and natural looking breast enhancement. A recent survey in California found that women are not looking for an oversized breast enhancement and desire a more subtle appearance. This is a healthier choice for women to choose.

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Due to the prevalence of evidence-based medicine and FDA demand for data on silicone gel breast implants, findings indicate that revision breast surgeries after a primary augmentation mammoplasty are as high as 25 percent. The main reason for these revisions is capsular contracture, but size change is a factor. Thanks to the work of Dr. John Tebetts, Bill Adams and Dr. Dennis Hammond, the concept of calibrating the correct implant size for a given individual based on breast tissue characteristics allows for customization and has reduced revision rates for surgeons who incorporate these findings into their practices.

The idea of putting the largest possible implant into a women’s breast is fraught with potential complications including excess stretch on the tissues leading to thinning of the breast which may result in increased prominence of rippling of the implant, as well as mal-positioning of the device either laterally or inferiorly. This causes an unsightly aged appearance of the breast. The cost of revision can be high if treatment plans include the need for added soft tissue support utilizing acellular dermal matrices or a silk textile mesh to restore soft tissue support of the implants.

Today is a very exciting time in the field of augmentation mammoplasty, because we surgeons have a wide variety of shapes and sizes and silicone gel consistencies to choose from to provide customized results for our patients.

I strive to deliver a primary augmentation of the breast with a correct implant that is sustainable by the body to provide a long-lasting aesthetic result free of revision until the integrity of the implant has failed.

I think in terms of the height and width and projection of the breast independently and choose styles and shapes to match my patient’s desired outcome. I never want people to say that all my breast augmentations look the same. Just as all faces are unique and different, so are breasts. I want to make an individual’s breast look and feel as attractive as possible with long-lasting results. Proportionate breast enhancement is key to achieving these results.

Furthermore, now fat grafting can be performed simultaneously with implant placement, allowing surgeons to correct volume and shape asymmetries, as well as fill in spaces where an implant cannot be placed, such as the cleavage region and the chest wall/implant interface.

If you’re considering an augmentation mammoplasty, take a look at a three-dimensional analysis imaging of yourself. Then discuss your tissue type and pre-existing breast tissue with your surgeon, who will devise a plan to make a customized result that will look attractive and proportional with your frame. A skilled board-certified plastic surgeon will choose an appropriate implant with or without fat grafting to highlight your own unique figure with long-lasting results.

Rhinoplasty is cosmetic facial surgery that’s ordinarily done to further improve a person’s physical appearance or to reconstruct their nasal area for health related purposes. A rhinoplasty surgery involves adjusting the cartilages and bones of the nostril , or sometimes tissue is added in order to maximize the cosmetic appeal. The surgery is also commonly executed to fix nasal fractures as well. If rhinoplasty is performed to repair someone’s nasal fracture, the surgeon tries to recondition the nostril to its pre-injury condition. A related procedure often known as septorhinoplasty is done on patients that in addition have a nasal obstruction. Septorhinoplasty works to greatly enhance the look of the nasal area , but also stabilizes the overall structure and reduces any internal obstacles that might be blocking the patient’s nasal breathing.

Any aesthetic worries and expectations you have needs to be completely discussed before rhinoplasty surgery treatment . The recommendations of your plastic surgeon along with any special limitations concerning the structure of your nose , skin , or face in general are essential to have thoroughly stated you. Make-up free snap shots are typically taken prior to operation to assist with both the preoperative and post surgery planning stage in order to document the results .

Make inquiries and express your concerns.

Finding a professional , qualified doctor to perform your rhinoplasty surgery should be your main priority when thinking of getting any type of cosmetic operation . ASAPS ( American Society for Aesthetic Plastic Surgery ) has recommended that each patient should ideally consider the following tips for best results :

• Consult at least 3 different surgeons before choosing one

• Be sure the cosmetic surgeon you choose is board certified

• Ask where your surgeon is privileged to legally practice to ensure his credibility

• Request to see before and after photos of previous patients

• Talk in-depth about the surgery as well as the results and recovery and any potential things that may possibly go wrong or happen unexpectedly

• Ask about the surgeon’s rhinoplasty experience . How many has he done ?

• Does the surgeon have malpractice insurance ? If not , get up and leave

• Ask about the follow-up procedures

• Request to contact former patients about their own experience

• How much does the procedure cost ? What about insurance ?

The results of rhinoplasty

Rhinoplasty results could possibly be minor or major , based on the type of modification you want done, but they are however permanent. It’s very important that both you and your cosmetic surgeon are on the same page relating to the goals of your process. If you have realistic expectations and your plastic surgeon like Ernesto J Ruas MD FACS, the outcome will likely be very positive overall.

Spring is here and what a perfect time to refresh your look for graduation, Father’s Day (yes, men do it also!), weddings, or before that fun vacation! It is time to put yourself first, which is hard for so many of us to do. We schedule our physicals and hair appointments. Why not start making appointments to take care of our skin, slow the aging process, and feel more confident? It’s never too early or too late to start. I see patients of all ages, and I will meet with you individually to ensure our goals and expectations are the same. Patients in their early 30’s might want to prevent deeper lines and wrinkles versus the more mature patient that is working to correct volume loss, soften lines, and have a more youthful appearance.

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We have many options to offer depending on your specific goals. I can offer nonsurgical aesthetic treatments, starting with a thorough assessment which includes speaking with you about your concerns, a physical assessment of your face explaining changes I observe from the aging process, and completing a Vectra 3D image. The Vectra 3D imaging is a great tool to assess volume loss in the face, asymmetry and skin quality. We then use this baseline evaluation as a comparison tool during treatments. I also take traditional photos before treatments. It can be overwhelming to take in all this information, so I like to discuss options and come up with a treatment plan to best fit the patient’s desires and budget.

One of our most popular treatments is to use a neuromuscular blocking toxin such as Botox or Dysport to treat frown lines in between the eyebrow, crow’s feet that develop at the corner of the eyes, and forehead creases and wrinkles.

Dermal fillers can address volume loss in the face, reduce lines, wrinkles, and creases on aging skin, create fuller lips, and give the face a more youthful appearance.

My goal is to always keep the patient “natural” looking and make subtle changes to the face. There are multiple dermal filler options. Most are made of hyaluronic acid, which is produced by our own bodies. I select the product based on location and desired effect. Examples are Juvederm, Voluma, Restylane, Lyft, and Silk. I love Sculptra which is an injectable poly-L-lactic acid.  It promotes collagen growth, which improves volume loss, creases, and softens lines. It is an excellent choice for volume loss in the temple area. The key is a good facial assessment and working with my patient to decide on the most beneficial products.

Now a word about microneedling – It is an excellent investment in addition to a neurotoxin and dermal filler to address the aging face. A treatment can be done every four to six weeks promoting collagen growth and improving skin elasticity with minimal down time. Microneedling can improve the appearance of fine lines, acne scars, surgical scars, and stretch marks.

At The Lucas Center we have a dynamic team with over 100 years of combined experience in medical and aesthetics. We are privileged to be led by Dr. Jay Lucas, a board-certified plastic surgeon, who provides medical supervision of the aesthetic team. If your needs can’t be met through aesthetic treatments and filler agents, Dr. Lucas will be glad to meet with you through an individualized consultation appointment to discuss surgical treatments.

Do you look in the mirror and notice subtle changes on your face and frown? The aging process can sneak up on us. The Lucas Center can help you feel more confident about your skin and overall appearance. Get summer ready!

Step Ahead with The Lucas Center! Give us a call today at 865-218-6210 to schedule your free consultation with me.

Rosacea is a fairly common condition that I see in my aesthetics practice. It is a condition which causes redness and in some stages, small pustules on the face. The redness can occur when blood vessels under the skin become enlarged. Though it is a chronic condition, with no known cure, there are several ways it can be controlled with treatment. During a skin assessment I refer to the Kligman acne rosacea classification scale. The stages of rosacea can range from Stage I-Pre- Rosacea, Stage II-Mild Rosacea, Stage III-Moderate Rosacea, to Stage IV-Severe Rosacea. In office facial treatments include a combination enzyme/AHA, mild chemical peels, and microdermabrasion, preformed once a month. In addition to having regular professional skin treatments, I recommend that clients follow an at home regimen to help minimize flare ups. SkinMedica’s Sensitive Skin Cleanser is specially formulated to protect highly sensitive skin. Active ingredients include chamomile flower extract to neutralize irritants, cucumber to calm skin, and marigold which has soothing properties. Follow cleansing with Redness Relief Complex. Redness is reduced with Calmplex (4-Ethoxybenadehyde) and niacinamide to improve barrier function of the skin increasing moisture content by reducing trans epidermal water loss. Please give us a call at The Lucas Center at 865.218.6210 to set up your first facial treatment with skin assessment.

A rhinoplasty procedure can accomplish narrowing wide nasal bones with osteotomies. The osteotomies allow the entire bridge line composed of the wide nasal bones and the corresponding wide upper lateral cartilages to be narrowed from their pre-existing wider position. After performing medial and lateral osteotomies in the nasal bones, a cast is applied across the bridge of the nose and is usually left intact for one week. Anticipate 2 weeks of visible bruising and swelling from the procedure itself. The sutures placed on the inside of the nose with closed rhinoplasty are all dissolvable. It’s also important to make sure the tip of the nose balances with the new bridge line, so in many instances, some type of tip surgery may be required. To narrow the nasal tip requires a conservative cartilage removal or suture techniques called intra-domal or inter-domal sutures, which can narrow the nasal tip. It’s important that all of the components of the nose including the nasal bones, upper lateral cartilages, and the lower lateral cartilages of the nasal tip balance with themselves. To narrow wide nostrils requires an alar-plasty, which can be accomplished with an incision at the base of the nostril sill for very wide nostrils, or an internal incision if the amount of narrowing is minimal. To close the alar-plasty incision usually requires 2 types of sutures to hold the incision together underneath the skin with dissolvable sutures and a meticulous skin layered closure so that the incision heals inconspicuously.

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Many nose job procedures require a dorsal hump reduction. The dorsal hump is composed of cartilage and bone and it must be shaved down in order to remove it successfully. The removing of the dorsal hump creates an open roof, and a flat-top nasal deformity which also has the appearance of a very wide nose. Osteotomies of the nasal bones are definitely required for each time the dorsal hump is removed. Osteotomies performed on the nasal bones allow closure of the open roof deformity to give a very balanced nose. It’s also important that the nose looks balanced from all angles, since it is a three-dimensional structure. Some patients also require small spreader grafts placed underneath a concave upper lateral cartilage once the dorsal hump has been removed. These grafts are placed through a small incision at the septal angle and inserted underneath the perichondrium and periosteum of the nasal septum to bolster and support the upper lateral cartilages and prevent them from falling inwards. Dr. Portuese performs closed rhinoplasty to accomplish narrowing a wide nose under general anesthesia by a board-certified physician anesthesiologist. The procedure is performed in a state of the art in a Medicare Certified, Outpatient Ambulatory Surgery Center. The center is also a licensed by the Department of Health in Washington State

The bottom line on fat grafting for buttock augmentation

 

What is judged to be attractive in women’s body contours changes just like fashion trends in clothing and makeup. The buttock area has reached new levels of interest thanks to the influx of the Latin culture from South America and pop culture’s fixation on the shapely, self-absorbed Kadarshians. Surgeons on the cutting edge of buttock enhancement choose to use fat grafting instead of buttock implants to avoid some very difficult complications.

Thanks in part to Drs. Simeon Wall and Constantino Mendieta’s contributions to the concepts of tissue equilibration and redistribution in body sculpting, fatty tissue can be removed from areas of excess and transposed to areas of deficiency. For example, we can take excess areas like the muffin top and the lateral thigh and place that fat into the under-projected gluteal areas. This creates the idealized hourglass shape of the lower back while framing the buttock from hipbone to the upper lateral thigh and provides volume enhancement to the gluteal region, which also provides a lifting effect. The results can be quite spectacular with limited downtime.

Of course you need to find a plastic surgeon with extensive experience in large volume fat grafting. Often times each cheek of the buttocks will receive as much as a liter of fat per side which is significantly more than what is put into the face, hands, or even breasts. Careful techniques of fat harvesting, fat isolation and reinjection is required to maximize the fat grafting take and the avoidance of nodules and fluid cysts. When performed correctly, the fat retention, which is placed into the buttock, should be around 70% long term. After approximately four months, any fat cell that remains should be a long survivor. Of course smoking can be a cause of less fat retention and should be avoided.

The art of fat grafting and the clinical success of fat transfer for body reshaping have outpaced the basic science of the procedure. Much basic science work needs to be done to better understand the biology of fat and wound healing as well as the actual effects of transference of peripheral stem cells as part of this procedure. However, it has been well documented that fat grafting is safe, has low complication rates in experienced hands, and is highly effective for providing volume and shape to a region of contour deficiency of any part of the body.

Plastic surgeons employ biologic tissue as our medium to create beautiful forms of living art. Fat is a wonderful way to sculpt the human body. It is truly like airbrushing imperfections in three dimensions.

Regardless of the Kardashians over-developed assets, fat grafting is worth the hype. Call 865.218.6210 today or go online to thelucascenter.com to schedule your consultation. I look forward to discussing with you the myriad of options for face, breast and buttock enhancement via fat grafting.

Skin

Many women are uncomfortable wearing form-fitting clothes, because the skin either above or below the bra line creates rolls detracting from the aesthetics of the female back. Unfortunately this can occur at any age. Spanx may hide the problem, but who wants to wear tight undergarments during warm weather months?

Causes: The skin of the back and shoulder must accommodate the wide range of motion of the shoulder girdle. When the arms are raised above the head, the skin in the posterior upper armpit region must stretch to avoid restricting this movement. Over time our skin begins to enlarge and increase in surface area, particularly in the posterior-axillary fold region tapering towards the tip of the shoulder blade. The skin lower in the armpit region and sides along the ribs does not require expansion, but a transitional line or fold can develop and become more pronounced with gravity causing a landslide effect of the skin above. The appearance is made worse with a restrictive band of the bra traversing this region thus forming the dreaded “bra strap fat roll.”

Anatomy varies greatly depending on skin type and quality, body mass index (BMI), and age. In some cases, skin folds are very tight without a great deal of excess fat, but the skin excess is the issue. People with greater BMI scores may have a great deal of fat deposited in this region. The other extreme is the massive weight-loss patient who has very little adiposity but has a great deal of inelastic deflated skin, which hangs over the bra. Each of these types of patients requires different treatments to achieve a pleasing result.

Treatment options: If you have slight increases in fat deposits in your back with deep tight folds, the treatment of choice is suction-assisted lipectomy with the added energy source of either VASER-assisted suction lipectomy (ultrasonic energy), power-assisted suction lipectomy (PAL), which is a mechanical rotating blade effect built into the cannula, or HydraSolve, a heat and water pulsing technique that breaks down interstitial fibers surrounding the fat. All these approaches work by breaking down the ligamentous attachments between the back and the dermis of the skin combined with the inflammatory reaction of the surgical cannulas allowing a re-draping/redistribution of skin to tighten over the back and conform to the new contour.

In my opinion, the results of these techniques are superior to liposuction alone. Non-invasive body-contouring procedures such as cryolipolysis (CoolSculpting) have no mechanism to break down the fibrous insertions to the skin from the deeper fascia, thus no elimination of the tight fold lines will occur.

If you have an elevated BMI and increased adiposity of skin folds, you will also benefit from the above-mentioned techniques of added energy sources with liposuction, but a greater degree of fat removal is necessary. Increased fat volume requires a more cell removal. However, discretion must be utilized to prevent over resection that can result in loose hanging skin on the back.

For the massive weight-loss patient or the person who has a large amount of loose-hanging skin with or without added fat volume, a skin resection technique is often incorporated with a brachioplasty to correct hanging skin of the upper arms as well. My incision choice is a vertical resection of skin along the posterior axillary line angle, which is easily concealed.

If bra line skin or fat excess is detracting from the overall aesthetics of your back, you need a board-certified plastic surgeon to thoroughly evaluate your situation to determine the right treatment option to feel more confident in your own skin.

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There are many issues in the nose that can create an asymmetrical appearance to the nose. A nose job procedure, also known as a rhinoplasty can accomplish making the nose look more symmetrical. There are a variety of techniques available to accomplish making the nose look much more symmetrical than it already is. As a surgeon, it is very important to evaluate what is causing the structural asymmetries underneath the skin soft tissue envelope. A closed or open rhinoplasty procedure can address mild, moderate, or significant asymmetries. With a closed rhinoplasty approach, all incisions are placed on the inside of the nose and dissolvable sutures fall out in about a week. If the nasal bones themselves are asymmetric and crooked, medial and lateral osteotomies of them are required with an osteotome to set them straight and parallel. If the upper lateral cartilages are convex or concave, they need to be adjusted as well. A convex upper lateral cartilage can be shaved down. A concave upper lateral cartilage will make the nose looked twisted in the mid-portion of the nose, and this is corrected with a spreader graft placement. The nasal tip cartilages are often asymmetric and they need to be adjusted as well. The mild asymmetry is adjusted with shaving down a thick lower lateral cartilage of the nasal tip, while a cartilage graft is placed on the thinner nasal tip cartilage on the opposite side. When significant asymmetry exists in the nasal tip cartilages, a full delivery with suture techniques is required to make the lower lateral cartilages of the tip look symmetrical. Asymmetrical nostrils can also be adjusted with an alar-plasty, and a columellar-plasty. A deviated caudal septum can cause the columella to be twisted as well. Dr. William A. Portuese is the medical director and founder of the Seattle Rhinoplasty Center, a Medicare certified, Washington state licensed, outpatient surgery center located in Seattle Washington.

Assymmetrical Nose

By Rebecca Ludwig

Dermaplaning is a client favorite as well as a personal favorite of mine for many reasons.  I call it an instant gratification service, and recommend it before any special event.  The main intention for dermaplaning is to allow better penetration of products, masks, treatments, or peels.  For this reason I perform dermaplaning as part of a full facial treatment.  The technique of dermaplaning involves using a surgical scalpel to ablate the surface layers of dead skin cells and vellus hair. All of the accumulated dry dead flaky skin cells are removed, improving the texture of the skin.  The vellus hair is the peach fuzz that many of us experience in certain areas or all over our faces.  By removing this fuzz the skin looks dramatically brighter.  Dermaplaning is a great option for many clients who are unable to use other methods of hair removal, such as waxing or depilatory creams, due to contraindications from topical cosmeceutical products, such as tretinoin, retinoic acid, retinal, etc. Dermplaning can be performed prior to facial peeling to improve the outcome of the facial peel.  Moisturizes, antioxidants, and humectants are easily absorbed post dermaplaning, leaving the skin feeling baby soft. Treatments are typically repeated every four weeks.  Step it Up with The Lucas Center, give us a call at 865.218.6210 today.

Cosmetic dentistry is enormously trendy the united states , as an increasing number of people-beauty conscious taking advantage of these specific products and services in an effort to enrich their visual appeal . Cosmetic dentists in Huntsville AL have earned a name for themselves across the US the good quality of the services provided . Personalities constitute a majority of individuals cosmetic dentists . These days , however , cosmetic dentistry is gaining popularity among the average individual , which is turning out to be increasingly aware of the importance of a beautiful smile .

The primary objective of cosmetic dentists is to improve the looks of the smile . This improvement can be accomplished by tooth whitening , bonding cosmetic dentistry , porcelain veneers , white fillings natural looking , and porcelain crowns . Gingivectomy aesthetic is also a surgery that should be completed by a cosmetic dentist who is tutored to provide this highly specialist dental service . Other important processes relevant to cosmetic dentistry are gum contour and the contour of the tooth . Using Invisalign braces is the one other really important technique used by cosmetic dentists in their endeavours to establish highly coveted smile .

A cosmetic dentist ought to be able to effectively integrate the various dental techniques to formulate and shape the teeth and gums of an individual in a lovely smile . All details of a patient's face , smile and personality should be incorporated voluntarily for a surprising result . Another significant feature of cosmetic dentistry is the fact that both the patient and the specialist should have an excellent relationship . The most effective way to a client communicates with the cosmetic dentist , the more advantageous the chances of creating the most precious smile .

If you live anywhere in California, you may want to go through the city of Santa Monica to check out its many cosmetic surgeons. Santa Monica has an extensive list of qualified cosmetic surgeons. Each surgeon has his own specialty. Having cosmetic surgery is common nowadays. Aesthetic surgery helps many people feel safer with how your body looks. With the improvements made with skin surgery, facelifts, liposuction and breast augmentation, either with the financial means can be as beautiful as they want.

If you need your excess fat removed or maybe have eyelid surgery, would surely find a skilled board certified plastic surgeon in Santa Monica who can do the job well. Cosmetic surgery is not a profession that suits everyone. To become a plastic surgeon, a good hand and an artistic eye and you need to perform the operation correctly. There are so many cosmetic surgeons in Santa Monica. At first, you may find it daunting and tedious to find the perfect for your needs. But all his time and effort worth it when it is found that qualified surgeon.

If you are considering having cosmetic surgery like breast augmentation, you should start research on exactly what type of surgery you need and what kind of results you want. Cosmetic surgery is extensive, apart from having a good surgeon; you must know what you want to achieve the desired results. Just for the internet alone, you should already find hundreds of plastic surgeon based in Santa Monica California. Prior to optimize your search, make sure you have checked their profiles and credentials. When it comes to cosmetic surgery, you should be as cautious as you possibly can.

Before making the final decision, it is worth making a trip to and visit their surgeons clinics shortlisted. Cosmetic surgery procedures and details are private you need to really have a good conversation with a surgeon. Furthermore, a surgeon and his staff can give you valuable information that can help in choosing a surgeon.

neck-blog

Consider custom solutions for a sagging neckline

Necklines for both men and women can be a focal point of self-consciousness. However, the etiology of an unattractive neckline can be diverse, so treatment options must be tailored to the underlying cause. There is no one solution for everybody. Careful three-dimensional analysis of the soft tissue and underlying bony structure of the midface, lower jaw and neck are imperative to choosing the correct modality to improve your neckline.

Some common underlying causes of poor aesthetic necklines:

Small lower jaw – If you have a deep underbite despite orthodontics and a short chin, this leads to less bone support of the soft tissues of the jawline and submental region. People with this type of lower jaw may have a very obtuse chin-neck angle leading to redundant skin. An ideal treatment for this situation is bony chin advancement (genioplasty).
If your chin is horizontally too short, then an augmentation with a chin implant is an excellent choice. I prefer the Medpore implant, which is carvable, and screw fixated and becomes an extension of the bone.

Both genioplasty and chin implants can easily incorporate the technique of liposuction as a means of sculpting the soft tissues of the neckline by removing unwanted fat. Liposuction induces collagen production and facilities skin shrinkage and redistribution yielding a pleasing result. This combination therapy can produce a wonderful outcome that makes you look more facially balanced. However, if your skin is too loose and hanging, a more formal neck lift may be preferable to liposuction.

Mid face descent of soft tissues – Aging can affect facial fat compartments leading to decreased volume, which results in the midface falling over time. This sagging increases nasolabial folds and causes lower facial soft tissue to drape over the jawline. A crisper jawline can be restored by replacing missing soft tissue volume in the fat compartments of the midface with filler agents like Voluma and Sculptra or via fat grafting. Subtle volume enhancements can create a nice effect on the jawline without looking like you’ve undergone a surgical procedure.

Gravitational changes to the soft tissue of the neck – Gravity affects all of us. The skin and muscles of the anterior neck begin to pull away over time. The appearance of the platysma muscle medial bellies becomes apparent leading to unsightly banding. In the early stages of gravity-induced changes, treatments such as chemical peels, micro-needling and radio frequency can yield improvements and delay the inevitable soft-tissue sagging.
Ultimately the best treatment option is a face/neck lift. A well performed facelift by an experienced board-certified plastic surgeon will yield excellent results with longevity of up to ten years depending on how well you age forward and take care of your skin, avoiding further sun damage.

Obesity: People with elevated body mass indices will accumulate increased fat throughout the body. The neck is no exception. Very mild amounts of fat excess with firm, good quality skin may realize improved contours with Kithera (an injectable product that dissolves fat in the neck). However, in my experience, few patients I evaluate are ideal candidates for this treatment. The injection results in inflammation, which can cause collagen production and skin remodeling, but most people need bigger guns to fight the battle. The price of several rounds of injections is as much as a true liposuction with less effective results.

If you have significant fat in the submental region and reasonable skin quality, liposuction can be a great treatment option to uncover a more normal neckline without a lot of expense or downtime. However, a face/neck lift with a corset platysmaplasty is the tried and true corrective option that works very predictably.

If you’re obese and undergo bariatric surgery or make lifestyle changes to produce massive weight loss, you’ll likely develop excess deflated skin that hangs off your face and neck creating an aesthetic deformity. Modifications of standard face and neck lifts must be incorporated to achieve a pleasing result.

The takeaway is that if you’re unhappy with your jaw and neckline, you can improve your appearance and boost your self-confidence by seeking out proper consultation with an experienced plastic surgeon. During the consult, a detailed facial analysis should be performed. Treatment options can be formulated to yield the best results by addressing your unique issues as presented during the interview. No need to hide your neck behind scarves and turtlenecks any longer.

Rhinoplasty : Cutting edge Techniques and What you really need to Be aware of

Rhinoplasty is cosmetic facial surgery that’s commonly done to beautify a person’s overall look or to reconstruct their nasal area for health related purposes . A rhinoplasty technique involves modifying the cartilages and bones of the nose area , or sometimes tissue is included order to strengthen the aesthetic appeal . The procedure is also commonly performed to fix nasal fractures as well . If rhinoplasty is carried out to repair someone’s nasal fracture , the medical professional tries to recover the nose area to its pre-injury condition . A complementary surgery often known as septorhinoplasty is done on patients that additionally have a nasal obstruction . Septorhinoplasty works to strengthen the look of the nostrils , but also stabilizes the overall structure and eradicates any internal obstacles that might be blocking the patient’s nasal breathing .

Exactly what does a rhinoplasty operation involve ?

Any cosmetic worries and expectations you have needs to be completely discussed before surgery treatment . The recommendations of your cosmetic surgeon along with any special restrictions concerning the structure of your nose , skin , or face in general are crucial to have thoroughly explained you . Make-up free photographs are typically taken prior to surgical procedure to assist with both the preoperative and post surgery planning stage in order to document the results .

Make inquiries and express your concerns .

Finding an experienced , certified doctor to perform your rhinoplasty surgery should be your primary priority when taking into consideration getting any type of cosmetic procedure . ASAPS ( American Society for Aesthetic Plastic Surgery ) suggests that each patient should ideally consider the following tips for best results :

• Consult at least 3 different surgeons before choosing one

• Be sure the cosmetic surgeon you choose is board certified

• Ask where your surgeon is privileged to legally practice to ensure his credibility

• Request to see before and after photos of previous patients

• Talk in-depth about the surgery as well as the results and recovery and any potential things that may possibly go wrong or happen unexpectedly

• Ask about the surgeon’s rhinoplasty experience . How many has he done ?

• Does the surgeon have malpractice insurance ? If not , get up and leave

• Ask about the follow-up procedures

• Request to contact former patients about their own experience

• How much does the procedure cost ? What about insurance ?

The results of rhinoplasty

Rhinoplasty outcomes could be minor or major , based on the type of correction you want done , but they are however permanent . It’s very important that both you and your cosmetic surgeon are on the same page regarding the goals of your surgery . If you have realistic expectations and your plastic surgeon, the outcome will likely be very positive overall .

According to many websites gives an option to standard breast inserts for many women. There are two types of Natural Breast enlargement procedures; Fat transfer breast augmentation and Stem-cell breast augmentation. As the name suggests “fat transfer”, the process involves removing of fat cells from any other part of the body (thighs or buttocks) and transferring it into the breasts. On the other hand, mature stem-cells from excess fat in the client’s own body can be collected, and then injected into the breasts to be augmented, where they can generate more excess fat to enhance the breast naturally. Traditional breast augmentation isn’t completely successful, while natural augmentation has many benefits such as, less complication and threats. Also, the recovery time of naturally augmented breasts will be shorter than standard augmentation.

TRADITIONAL BREAST IMPLANTS
Saline or silicone implants are trending for decades, as they are safe. However, we cannot ignore the drawbacks of traditional breast implants; No natural look, looks lethargic for some women, and non real feel. And, if the body is not responding to the implants, then the healing process will take much longer time. Some women experience deformation due to the implants, as they can slip out of the correct place. Most of the women desire naturally augmented breast; however, due to the unavailability or costlier process, they tends to choose traditional breast implants.

NATURAL BREAST AUGMENTATION
Natural breast augmentation has the least recovery time; Only 2 days, as there are no implants involved in the process. Naturally breast augmentation surgery carries fat or stem cells from the patient’s body. Therefore, there are no risks associated with this type of surgery. This type of surgery is also helps in reducing unwanted fat from the thighs or buttocks, which is directly proportional to losing weight. This methodology doesn’t influence the women’s potential to get mammograms, not at all like traditional breast augmentation

Natural breast augmentation has many benefits but has a major drawback; Limited increase in breast size! Yes, Natural breast augmentation doesn’t support the massive increase in size, so for those women who are looking for massive increase should not go with this type of surgery. However, one cup size can be easily increased with this procedure. This is the ideal surgery for women who are looking to restore their breast dull appearance due to aging, nursing, or pregnancy. The fat transfer process or stem cell augmentation can easily make breasts considerably rounder & firmer. Some women prefer a firmer as well as the rounder breasts instead of the breast size. Cosmetic surgeons like will not reject any type of breast augmentation surgery, so it is up to you; deciding which one is the best for your appearance and desire.