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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

closed-rhinoplasty

Dr William Portuese
1101 Madison St #1280,
Seattle, WA 98104
206-624-6200

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.

Gary E. Alhadef, DDS
8226 Douglas Avenue #753 Dallas TX 75225
(214) 368-2434

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.

Dr. Jay H. Lucas, Board Certified Plastic Surgeon
The Lucas Center Plastic Surgery
280 Fort Sanders West Boulevard Building 4 #112 Knoxville TN 37922 - View Map
Phone: (865) 218-6210

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.

Image By Design Plastic Surgery
29167 Jefferson Ave
St Clair Shores, Michigan 48081
Phone: (586) 776-3223

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

Athena Clinic – Robert Peterson, MD Robert Peterson, MD
1319 Punahou Street, # 1070 Honolulu, Hawaii 96826 Phone: (808) 944-8551

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.

Melek Kayser MD - Image By Design Plastic Surgery
29167 Jefferson Ave
St Clair Shores, Michigan 48081
Phone: (586) 776-3223

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.

Twins-Rhinoplasty
Rhinoplasty-Twins

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.
Twins-and-Rhinoplasty

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.

Peter B Fodor MD, FACS
2080 Century Park East
Suite 1511
Los Angeles, 90067
(310) 203-9818

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.

Peter Fodor MD
711 East Valley Rd. Suite 202C Basalt, CO 81621
Phone: (970) 925-4900

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.

A Comprehensive Three-Dimensional Rejuvenation Center
Dr. Jay H. Lucas, Board Certified Plastic Surgeon
The Lucas Center Plastic Surgery
280 Fort Sanders West Boulevard Building 4 #112 Knoxville TN 37922 - View Map
Phone: (865) 218-6210

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

Dr. Jay H. Lucas, Board Certified Plastic Surgeon
The Lucas Center Plastic Surgery
280 Fort Sanders West Boulevard Building 4 #112 Knoxville TN 37922 - View Map
Phone: (865) 218-6210

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

Stephen M. Miller, MD, PC, FACS
8435 S Eastern Ave
Las Vegas NV 89123
Phone: (702) 369-1001

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.

Atlantic Center for Plastic and Cosmetic Surgery
3855 Pleasant Hill Rd
Suite 300
Duluth, Georgia 30096

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.

Ernesto J Ruas MD FACS
603 S Boulevard
Tampa, FL 33606
Telephone: (813) 259-1550

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.

tammy

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.

Dr. Jay H. Lucas, Board Certified Plastic Surgeon
The Lucas Center Plastic Surgery
280 Fort Sanders West Boulevard Building 4 #112 Knoxville TN 37922 - View Map
Phone: (865) 218-6210

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.

Dr. Jay H. Lucas, Board Certified Plastic Surgeon
The Lucas Center Plastic Surgery
280 Fort Sanders West Boulevard Building 4 #112 Knoxville TN 37922 - View Map
Phone: (865) 218-6210

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.

rhinoplasty-portland-oregon

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 Portland Center for Facial Plastic Surgery
18650 NW Cornell Rd, #324
Hillsboro, Oregon 97124
Phone: 503-899-0006

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.

Dr. Jay H. Lucas, Board Certified Plastic Surgeon
The Lucas Center Plastic Surgery
280 Fort Sanders West Boulevard Building 4 #112 Knoxville TN 37922 - View Map
Phone: (865) 218-6210

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.

Learn more at Millennium Dental and Wohlers Family Dentistry

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

 

Dr William Portuese
1101 Madison St #1280,
Seattle, WA 98104
206-624-6200

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.

Dr. Jay H. Lucas, Board Certified Plastic Surgeon
The Lucas Center Plastic Surgery
280 Fort Sanders West Boulevard Building 4 #112 Knoxville TN 37922 - View Map
Phone: (865) 218-6210

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.

Reza Nabavian MD
2001 Santa Monica Blvd #1180
Santa Monica, California 90404
Phone: 310-829-5550

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 .

Dr William Portuese
1101 Madison St #1280,
Seattle, WA 98104
206-624-6200

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.

Dell P Smith, M.D.
1880 Fillmore Avenue North
Twin Falls, Idaho 83301
Phone: (208) 735-8386

I recently attended the preeminent breast surgery meeting of the year, sponsored by the Southeastern Society of Plastic and Reconstructive Surgeons (SESPRS). This was the 32nd annual gathering of international thought leaders in plastic surgery. Many new topics have been introduced at this symposium over the years and discussed at length prior to other meetings or journal articles making this a cutting-edge event. I always make time to attend this meeting to ensure that I am offering the most current surgical services for my patients.

Here’s what I gleaned from this year’s symposium:

Fat Grafting – Around a decade ago at this symposium a panel was organized with plastic surgeons, ethicists, lawyers, bio-engineers, oncologists, radiologists and general surgeons to contemplate the concept of moving forward with fat grafting to the breast to override the ban that the American Society of Plastic Surgeons had placed on this technique many years ago. Fortunately, this sparked the movement of our society and our best researchers to invest time and money into the field of plastic surgery. Certainly the clinical experience of utilizing fat grafting to provide shape and improve contours of the breast has been well documented at this meeting before. This year, additional data added further proof that this technique is here to stay.

Dr. Steve Kronowitz, from MD Anderson Cancer Center, presented data that fat grafting does not disrupt the diagnostics of mammography nor does it promote cancer growth in the breast that has been fat grafted. Furthermore, fat grafting maturity in the new recipient tissues stabilizes by four months. Dr. Kronowitz and others have demonstrated that injecting fat cells under badly damaged radiated skin can greatly improve and heal these tissues, although the actual mechanisms have not been fully elicited.

Dr. Louis Bucky, a noted fat-grafting expert from Philadelphia, has demonstrated that large volume fat grafting into areas which have experienced significant neurologic pain from either breast cancer surgery or multiple operations resulting in scaring can provide predictable relief from this pain. The pain relief is the result of delaminating scar tissue and providing fat in its place to avoid further scaring around nerves.

The takeaway from the symposium is that fat grafting in plastic surgery continues to grow in scope and popularity among surgeons and their patients.

New concept for breast reconstruction – Patients who elect to undergo breast reconstruction with implants historically have the devices placed under the pectoralis muscle with or without the use of an Acellular Dermal Matrix (ADM) extending the coverage of the device down to the fold. The muscle provides additional soft tissue coverage of the implant, blending its presence with the surrounding tissues. This approach also has demonstrated benefit in preventing capsular contracture.

The downside of this procedure is animation deformity, meaning that when the muscle is activated during exercise, it will contract and may greatly distort the breast. Also some women will be numb on the skin surface but will have sensation around the muscle and feel the implant movement at times, which can be bothersome. Lastly, during the early postoperative period, placing an implant under the muscle causes a significant amount of muscle spasm pain for a few weeks.

A new interesting concept is removing the muscle from the reconstruction equation by wrapping an ADM graft around the implant then suturing the ADM to the chest wall to stabilize the orientation of either the expander or a final implant without elevating the muscle. This approach mandates having reliable thick mastectomy skin flaps to cover the device with ADM.

A secondary procedure utilizing large-volume fat grafting to provide additional thickness of skin flaps and correct contour deformities is also required three months later. The advantage is quicker surgery time, less pain, no muscle animation issues and no abnormal feelings with the muscle. I plan to offer this to selected patients shortly.

Sugar Land Plastic Surgery
16614 Creek Bend Drive #100 Sugar Land, TX 77478

Phone: 281-980-8000
Review Us On Google - Dr. John T. Nguyen, MD
Serving Sugar Land and Houston Texas Areas.

It’s winter in East Tennessee, but I’m already looking forward to sunny blue skies with spring blossoms floating through warm breezes. Gone will be the heavy coats and long sleeves, replaced by sleeveless clothes and bare arms. If you’re self-conscious about your upper-arm contour, then spring might not be your favorite season. No worries. Board-certified plastic surgeons like me are at your disposal to give you the confidence to be comfortable in your own skin and bare it all. No more hiding your arms when the temperature rises.

A successful arm-contouring plan depends your specific anatomy. What’s your skin quality and quantity? Is there excess flesh with thin deflated tissue and inelastic skin? Or do you have reasonable skin quality with some increased adipose tissue and a thicker arm contour? Your personal medical history is important as well. Have you gained and lost significant weight or undergone bariatric weight-loss surgery? Do you have a history of large amounts of sun exposure with subsequent sun damage leading to a crepe paper-like skin tone?

The algorithm for management of the unacceptable upper-arm appearance starts with the question of excess skin. Particularly if there is thin deflated skin that is present the full length of the upper arm, a vertical brachioplasty is required. The advantage of this procedure is the ability to remove a great deal of excess skin along with aggressive liposuction to create a wonderful tight contour. The disadvantage is the vertical scar that runs in the posterior medial aspect of the upper arm. Generally speaking, the scar is not visible when someone is facing you or behind you with your arms in repose. The scar can be exposed when the upper arm is extended away from the center of the body.

I can say with great certainty that patients who have undergone massive weight loss, with or without bariatric surgery, would choose the scar over the skin excess any day. Of course, there can be shades of grey in terms of skin excess and laxity. Milder forms may be treated with judicious VASER-assisted lipectomy followed by a modified horizontal brachioplasty, in which the excess tissue is resected and advanced within the axilla (arm pit). Scars are only visible when the arms are elevated with a sleeveless shirt.

If there’s no skin excess and the overlying skin is of good quality and there is contour excess related to an increased volume of fat in the upper arm, the VASER-assisted suction lipectomy is an excellent choice for sculpting the arms to a new contour. The manipulation of the dermis with the cannulas used to remove the fat via small openings in the skin placed in hidden areas of the arm leads to skin re-draping and shrinking. This redistribution creates firmer skin coverage of the arm leading to a nicer sculpted appearance.

What about Cool Sculpting (Cryolipolysis)? My answer is if there is only a very limited amount of excess fat and already tight skin it may work.

However, there is no mechanism with cryolipolysis to induce inflammatory reactions leading to collagen production within the dermis, which causes skin tightening unlike liposuction or micro-needling. My advice is to save your money for the real deal. Radio frequency may have a role in skin tightening, but the results don’t warrant the investment in the expensive equipment, which certainly is passed down to the consumer.

The key to a good result or the avoidance of a disappointing outcome is good clinical experience by a knowledgeable board-certified plastic surgeon with the correct judgment to know which technique to employ to maximize results. Buyer beware when entering the multitude of medispas that exist today without competent medical supervision. Recently in the Atlanta area, an emergency room physician untrained in plastic surgery was performing liposuction in an office without hospital credentials and created injuries to the diaphragm and liver leading to the deaths of two patients. Vetting your physician before undergoing surgery can prevent tragedies like this.

Blue Water Spa Aesthetic Laser Center

10931 RAVEN RIDGE ROAD, SUITE 201 | RALEIGH, NORTH CAROLINA 27614 | 919-870-6066

Fraxel repair is a revolutionary laser treatment to correct deeper wrinkles, tighten skin and remove years from your appearance. It is a safer, more effective and more comfortable alternative to surgical procedures.

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Botox has certainly become part of our lexicon since the new millennium. When I was in medical school at Penn in the early 1990s, botulinum toxin was only something to be memorized in pathophysiology class as the virulence factor for the Clostridium bacterium that caused botulism. Later on, in residency at the Hospital of the University of Pennsylvania, it was used in the treatment of involuntary muscle contractions and eyelid spasms. At the beginning of my plastic surgery fellowship in 1998, Botox was just beginning to be explored as a novel approach to facial wrinkles. The literature and the applications were still in the infancy when I started practice in 2001.

Fast-forwarding to the present, what would women and yes, men, do without this little protein for facial rejuvenation and the prevention of early aging? What started out as a means to control our “elevens” or “mommy frowns” has now blossomed into a method to actually sculpt the face by applying the knowledge of muscle anatomy to deploy Botox in the right areas to balance opposing muscles of the forehead, mouth, jaw and neck, creating pleasing facial postures.

Having been part of the rise and current use of Botox, I can testify that using this neuromuscular-blocking agent can improve your current appearance with regular use and also prevent or postpone the aging process of your face. Today many clients, particularly women, look at it as yet another maintenance activity like getting your hair and nails done.

Botox can be used to selectively weaken the central brow area to reduce horizontal lines in the forehead. It can also be used on the circular superficial muscle surrounding the eyelids to minimize lateral fine lines around the eyes. Applied properly, Botox can preferentially reduce the lateral eyebrow depressor muscles to allow unopposed lift of the lateral brow by the forehead muscle, weakening the fine lines around the mouth, correcting asymmetries of the mouth, and reducing the banding appearance of a thin neck.

While the results are limited to around three months without reapplication, nothing else can achieve these desired effects as well as prevent the future etching of these lines deeper into your skin.

However, when something becomes commonplace, people begin to feel comfortable with the product to the point that they may oversimplify the treatment process. This comfort level can lead to the misconception that anyone can deliver Botox safely and reliably. For optimal safety and efficacy, Botox should only be purchased from Allergan, the owner and developer of the product. The company will only ship to licensed physician offices.

Some people try to purchase Botox online from out of the country in order to save money, which may or may not be safe or effective. The FDA recently reported that fraudulent Botox packaging was being sold on the Internet. There have been deaths or seriously neurologically impaired events when patients got a different kind of botulinum toxin which was a much stronger concentration and resulted in overdoses.

It’s my professional opinion that no one should receive Botox from an establishment that does not have a medical director who is intricately involved in the day-to-day practice of the office and has a firm command of the anatomy of the face and neck. I am baffled by the concept that dentists are now offering this service to patients as well. Having graduated magna cum laude from dental school prior to going on to medical school, I can emphatically state that dentists are not qualified to participate in these services. Botox Injections are not inexpensive — why purchase it somewhere that might result in substandard results, not to mention nerve damage or death? The quality of the result is directly related to the skill level and knowledge of anatomy of the injector. Be good consumers and check the credentials of your provider. Caveat emptor.

Sugar Land Plastic Surgery
16614 Creek Bend Drive #100 Sugar Land, TX 77478

Phone: 281-980-8000

Review Us On Google - Dr. John T. Nguyen, MD
Serving Sugar Land and Houston Texas Areas.

mother

As we age, the volume in our faces diminishes over time. However, in the right hands you can age gracefully and look as good as you feel for a long time, which is the goal I have for all my patients. Volume restoration of the face, as a part of an overall comprehensive facial rejuvenation algorithm, combined with skin resurfacing and tissue repositioning, can yield beautiful results.

The aging process causes fat volume reduction in the face. The fat in our faces is organized into discrete packages and, predictably, the fat found just below our cheekbone is one package which reduces in volume first. The combination of gravity and volume loss in cheek fat results in our faces changing shape. Our cheeks appear to decrease, and our skin drops. Cheek folds become more pronounced, creating the inevitable downward-turning at the corners of the mouth and contributing to the jowling effect in the lower jaw line.

Another area that can experience volume loss is the lateral forehead in the temple region, which results in the brows re-draping downward, causing a hooding effect and obscuring the upper eyelids. Still another indication important to women is the loss of volume of the lips and the relative loss of the three-dimensional appearance of the upper lip with increased vertical lines emanating from the red border.

The tear trough region around the lower eyelid can lose volume, regardless of your age, particularly if the eyelid fat pads are prominent with a relatively soft mid face projection.

All the above areas can be treated nicely with filler agents. The advantages of out-of-the-box filler agents is they can be used quite nicely with topical anesthetic agents in the office. There’s relatively little to no bruising and no downtime. Many filler agents contain hyaluronic acid, which is a naturally occurring agent in our skin that acts like glue to hold components of our dermis together. Denser material with lots of cross-linking can have a better effect of lifting tissue. Because of its dense properties, Voluma can last up to two years and is routinely placed in the area where the cheek fat packet decreases. This filler is used to lift the cheek back to a normal position, thus improving the cheek fold and the corners of the mouth.

Lips can be enhanced to normal volumes (not the duck lips that I see coming from various spas) to create a natural red lip border with the adjacent skin helping to eliminate the vertical lines. I also enhance the vertical pillars that span between the base of the nose and the cupids bow high points, which returns a three-dimensional appearance to the upper lip. I mostly utilize Juvederm for this area.

The tear trough deformity can be handled nicely with Restalyn or Juvederm to blend the eyelid cheek junction and smooth the appearance of the lower eyelid.

Volume restoration of the temples to return the brow to a more normal position can be best handled using a step-wise approach with Sculptra, which is an injectable form of a polymer of lactic acid. When introduced to the tissue, the lactic acid induces an inflammatory response leading to the formation of new collagen. The advantage of this material is that it can restore large areas of volume loss, which would be difficult with traditional filler agents. It also slowly builds up collagen and restores volume over a six-week period making your transformation less obvious to your friends and family.

Without question, the concept of volume restoration of the face as a part of an overall comprehensive facial rejuvenation algorithm has led to superior results compared to plans that did not include volume replacement. As with Botox, the overall value of the injection material is greatly dependent on who is administering the filler agent.

Poor technique can result in poor outcomes. I liken filler agents to sculpting materials for the face. You can put clay in front of a true artist who can transform this simple material into a work of art. An untrained eye with no sense of perspective or artistic skill will create very little value out of the raw materials. The same goes for these injectable products in the Wild Wild West of aesthetic services here in American and abroad.

Michael Law MD Aesthetic Plastic Surgery

10941 RAVEN RIDGE RD #103 RALEIGH, NORTH CAROLINA 27614 | 919-256-0900

Board certified plastic surgeons have a very diverse training experience because we do not own a particular body part such as an Orthopedic or an ENT surgeon and we must be prepared to reconstruct or rejuvenate all parts of the body when the demand arises. Those who felt the calling to become plastic surgeons out of medical school realized their gifts and talents that could be offered to patients pertain to their unique skills of three dimensional thinking and artistic perspective to be able to see the problem and formulate a solution no matter how complicated the deformity exists.

I am troubled by the notion that patients think that facial filler agents, neurotoxins, LASERS, non-invasive contouring machines and other technologies or even surgery will work the exact same way no matter who is providing the services. I feel that Madison Avenue and corporate greed is mostly to blame because all aesthetic companies want to sell the product and place it in as many provider hands as possible to deliver their product to the masses. Many products can provide safe, and reproducible results in the right hands but in the untrained provider can result in injuries, poor outcomes and unhappy patients. None of these products are dirt cheap so why go to a clinician who is unable to critically analyze the face or body because of the lack of years of extended training. Remember if you can’t see the problem correctly then you can’t formulate a proper solution. My analogy for this situation is you can give a novice and a true artist the exact same canvas, paint and palate and ask each to create their masterpiece I hazard to guess there will be a distinct difference in outcome and quality. Why risk your face and body or your wallet to chance go to a true trained professional in aesthetic procedures. All providers are not created equal. Plastic surgeon have a unique training and perspective which I can assure you results in better outcomes.

As an example of why I feel uniquely qualified to analyze faces and what can be provided to achieve your aesthetic goals look to my experience as a craniofacial plastic surgeon who spent years mastering the art and science of the rehabilitation of the child with cleft lip and palate. It requires great understanding of the biology of the facial structures of bone, teeth, muscle, skin, fat, and cartilage and how growth and wound healing affects theses structure over time. Typically the child undergoes a lip and initial nose repair at three months of age with or without pre-surgical orthopedic repositioning of the bony segments. Followed by cleft palate repair at age six months to reposition the muscles that move the palate and close the hole between the nose and mouth. The third surgery to repair the cleft of the bone which house the teeth utilizing bone from the hip is performed somewhere around five to six years of age. After a period of six months then the cleft nasal repair is performed to balance the nasal tip with cartilage taken from the back of an ear. Additional surgeries may be required to improve speech function or revise the lip scar. We work closely with ENT’s, speech therapist, orthodontist and pediatric dentist to achieve excellent results.

Dr. Marcel F. Daniels
1760 Termino Avenue Long Beach , CA 90804 - View Map
Phone: (562) 597-4575

Have you ever been required to take an antibiotic before your dental appointment?  That may have changed recently.  Based on an extensive review of scientific evidence, new guidelines are in place.  For many years antibiotic prophylaxis has been recommended for two groups of patients.

The first group is those patients with a heart condition that may predispose them to infective endocarditis, which is an inflammation of the valves of your heart.  If you have an artificial heart valve, a history of infective endocarditis, a heart transplant or certain congenital heart defects, you may be required to take an antibiotic before most dental procedures.  This is because bacteria from your mouth may be introduced into the blood stream during many routine dental procedures including cleanings.  This bacterium has the potential to cause a heart valve infection.  For these conditions, your Amarillo cosmetic dentist like Dr Ormson will normally recommend an antibiotic and a dose.  It is usually required that you take the antibiotic at least an hour before your appointment so that adequate levels of the antibiotic can reach the blood stream before any bacteria can.  For these patients, we will work with your cardiologist and our office can keep you supplied with the prescriptions needed for your dental visits.

It is important to know that if you are on an antibiotic for any other reason, the type of antibiotic required for you dental visit may change.  Please contact our office before your appointment if you are currently taking an antibiotic for another condition.  Studies into infective endocarditis are on-going.  These current recommendations may be changed in the near future.  We will keep you informed.

The second group of patients who have been required to take antibiotics before their dental visits are patients with a prosthetic joint.  This was due to the perceived risk for developing infections at the site of the prosthetic.  Last year the American Dental Association assembled an expert panel to update and clarify the clinical recommendations for patients with artificial joints.  This panel has concluded that, in general, for patients with prosthetic joint implants, prophylactic antibiotics are NOT recommended prior to dental procedures. No evidence could be found linking dental procedures to prosthetic joint infections.  In addition, the risk of developing antibiotic resistance and opportunistic infections were greater than the possible benefit of the antibiotic regiment.

For our patients with artificial joints, we will be happy to work with your osteopathic doctors if they feel an antibiotic is still necessary in your case.  However, we will not be requiring antibiotics before your dental appointment nor we will be re-filling any antibiotic prescriptions without first consulting with your doctor.

Miami Smile Dental
9350 S Dixie Hwy #920, Miami, FL 33156
(305) 670-5100

1. Will a lower body lift fix all my problems that concern me after massive weight loss?
The surgery of the lower body lift is a constellation of several procedures rolled into a single anesthesia event. It amalgamates an abdominoplasty with a lateral thigh lift, a lower flank-plasty, and buttock augmentation with the patient’s tissue derived from the flanks to give a shapelier appearance that is not flat and amorphous. Many people who have experienced the loss of over one hundred pounds have many areas troubling to the patient beyond the mid and lower torso. These individuals have redundant hanging skin of the arms and medial thighs, significant aesthetic deformities of the breast, and often premature aging of the neck and face. These above mentioned areas are addressed with additional procedures performed separately such as a breast lift with or without a brachioplasty (arm lift), medial thigh lifts, and face- neck lifts. Patients also typically inquire about the order of the procedures and I often state I prefer to perform the lower body lift first to establish the “Keystone “ area of the torso and then I can better make aesthetic judgements about the breasts and thighs with respect to the shapelier proportion of the new torso.

2. Will I spend the night in the hospital after the lower body lift?
Although the lower body lift with all its components takes about 7.5 hours of anesthesia time, The Lucas Center of Plastic Surgery’s protocol is for an outpatient surgery status. People seem amazed at this concept. My explanation is a hospital is for sick patients who require monitoring of unstable vital signs, severe pain requiring IV pain management, the inability to take oral consumption of fluids and nutrients, or the requirement of IV antibiotics. After this very significant surgery we have done very thorough evaluation of what is required to make a patient comfortable, safe and recover in an expedited manner. First of all the surgery utilizes a technique supplemented with tumescent anesthesia which provides local anesthesia with a blood vessel constrictor (epinephrine) which results in a very limited amount of blood loss eliminating any risk of unstable vital signs postoperatively. We also ensure adequate pain management with the combination of a long acting local anesthesia pump to control pain along with narcotic analgesia. There are no limitations on what you can or can’t eat afterwards. At home pain medications can be dispensed as needed, as compared to a busy hospital when your pain control may be limited by the availability of the nursing staff. Home limits the risk of hospital acquired infections which can occur on the nursing floors. Lastly one of the biggest safety measures is the prevention of deep venous thrombosis and pulmonary emboli. Early ambulation even the night of surgery is one of the most important factors along with chemo-prophylaxsiswith Lovenox which can be easily administered at home. In the hospital ambulation is once again limited by the nursing staff availability and can result in almost no mobilization the night of surgery or beyond. In conclusion home is the best place to be after this operation.

3. What are the things patients will be responsible for after surgery?
A patient will wake up in a compression garment that helps to limit swelling and support the abdomen. Four drains will be placed during surgery to reduce fluid collections on the abdomen, flanks and lateral thighs. This will require some care to encourage fluid drainage and the patient or the care giver must measure the output to determine when the drains can be removed. All incisions are closed deeply with resorb able sutures with a layer of a glue –like substance over top so no incisional care is required for two weeks. The patient may shower the first post-operative day. The most comfortable position to rest is in a reclined position to reduce the tension on the abdominal closure.

4. When can I resume normal activities and exercise?
This is a very significant operation which can result in a whole new lease on life by liberating the patient of the imprisonment of the excess hanging skin of the torso. However this comes at a cost of being quite sore and requires subsistence living for about two weeks. After this time many of the inflammatory chemical released by the body as a result of surgical trauma have cleared and most people begin to feel significantly better and are able to resume a more normal life. To feel completely normal it takes around six weeks which is also the time frame to return to regular exercise.

5. What are lifestyle loans? Can they be utilized to finance these procedures?
Lifestyle loans are now becoming more popular and several institutions such as Credit Unions and banks in Knoxville, Tennessee offer loans for cosmetic surgery procedures up to $10,000 with rates as low as 9.20% APR for up to forty eight months. This is substantially more attractive than other popular finance plans to help finance larger procedures such as body contouring after bariatric surgery. Please contact your local bank or credit union for more details.

Turkle & Associates
11455 N Meridian St #150, Carmel, IN 46032
(317) 848-0001

In my practice the majority of my consultations and surgeries are on women. But over the past few years I have seen an increased demand of men requesting surgeries as well. Some of this may be related to baby boomers who have taken good care of themselves and desire to look as good as they feel. Other men don’t want their wives to look better than they do after they have been undergoing facial rejuvenation procedures so they request surgery as well.

1. Blepharoplasty: Eyelid rejuvenation

Just as women often show signs of aging around the eyes so do men. The phrase “the eyes are the window to the soul” may well be a true but I would also add the statement the “eyelids are the window treatments through which you see the soul.” Loose hanging furrowed skin, lateral brows that hang over the upper eyelids, and bulging fat pads below the eyelids with accentuated tear troughs put forth the image of fatigue and loss of vitality often resulting in friends and colleges asking if you are tired and are you getting enough sleep. Fortunately surgery to restore the upper eyelids to a crisp appearance with correction of any eyelid droop can be a game changer. The lower lids can be rejuvenated by removing excess fat with reposition this tissue over the cheek to eliminate the tear trough combined with skin and muscle tightening provide a fresh and vibrant appearance. This can be an important not only in social situations but also how a person is viewed in the workplace.

2. Neck lifts

Do you look in the mirror and say to yourself I hate this turkey neck? Is buying dress shirts getting more difficult to find that are comfortable with ties? Despite not gaining weight do you look heavier in the face? If the answer to all these questions is yes a consultation for a neck lift may well be a beneficial idea that is not just for vanity. Ideally a man should have a strong jaw line and a crisp chin neck junction. Having hanging skin with or without fat excess that obscures the jaw line certainly can put forth the image of premature aging of the individual beyond his chronologic age. A neck lift can be a valuable tool to restore your appearance and convey youth and energy without changing your overall appearance or giving an odd appearance. The surgery is very predictable in the hands of a board certified plastic surgeon and is an outpatient procedure with very little pain. Most people can be comfortable in social situation in two weeks.

3. Rhinoplasty (Nose surgery to reshape the appearance)

Proportionality is everything. If you are unhappy with the shape of the nose or how it blends with the rest of the face then request a plastic surgeon to perform a facial analysis of you. If the nose seems big maybe the lower face is out of place such as a small lower jaw or chin. Often times I will perform a chin augmentation with a rhinoplasty to provide a harmonious facial appearance. Nose surgery requires finesse and a keen understanding of the anatomy of the many subunits of the nose. The key is to provide shape without feminizing the male nose. This is also a rather easy surgery to recover from and the patient can return to work within a week usually.

4. Chin augmentation with or without an implant.

As mentioned above the facial subunits should all be proportionate to each other. If the lower jaw projection is limited by lack of growth it can portray a weaker jaw with less of a masculine appearance. By using the correct judgement a plastic surgeon can provide an enhanced projection with the combination of either an implant or repositioning of the bone in combination with liposuction of the jaw line to create a sculpted jaw which projects strength.

5. Liposuction of the abdomen and flanks

If you look in the mirror and the phrase “dad bod “screams out… liposuction maybe something to entertain. An important fact to remember is liposuction with its many variations is a contouring tool not a weight loss technique. I strongly encourage anyone who is considering body contouring should first consider diet and exercise first. If after some toning in the gym and normalized weight you are still unhappy with the shape of your body then liposuction may be a reasonable adjunct to improve the appearance. The abdominal area can be shaped as well as the flanks reduced to provide a sleeker frame. It’s a safe surgery that is easily recovered from and normally patients can return to work in a day or two. Final results take between six weeks and two months to observe the full effect of the reshaping.

6. Gynecomastia repair (Man boobs correction)

If you have excess fat and skin of the breast which can also affect the size and shape of the nipple-areolar complex this can project a very feminizing effect of the male chest. In my experience I have been very happy with the results of the combination of VASER liposuction (ultrasound assisted liposuction) with direct excision of any sub-areolar glandular elements with or without areolar reduction to achieve a masculine chest. This can be a very disturbing condition for a man of any age particularly in the teenage years. We see a bimodal distribution of people seeking treatment; those of the teenage years and men in their late forties and fifties who are seeking help to restore the loss of tone of the chest area.

Plastic surgery has continued to evolve in its perception ever since its creation after World War I. Aesthetic surgery was once viewed as taboo or something to hide because it was perceived to be too self-indulgent, now has become more common place and in the minds of many its presence is look upon as main stream. I think this evolution of societie’s views is related to the strong work of The American Society of Plastic Surgery, and the American Society of Aesthetic Plastic Surgery to ensure that board certified plastic surgeon are well trained and perform safe and predictable surgeries that patients seek and desire with excellent outcomes. Also our population is living longer with better quality of life and people are remaining active and engaged and wish to look as good as they feel and are no longer shy about requesting procedure to keep them looking their best.

Plastic Surgery Associates LLP
515 Valley View Dr #201
Moline, IL 61265-6175
Phone: 309-764-4600

hi I'm Austin hey I'm a plastic surgeon

and portland oregon and seattle

washington and today I'm going to talk

about recovery after breast augmentation

a lot of women are interested in her

breast augmentation that they have

questions about the recovery

some of them may have had friends who

have a documentation and found that they

had a lot of pain and swelling and that

they were taking strong pain medicine

and that demanded motivation use that

arm for a couple of weeks

well thankfully breast augmentation

niques have changed and now the recovery

is much shorter and women can get behind

their day-to-day activities typically

within hours

here's an example of this young woman

who underwent an augmentation surgery

where she is immediately before

procedure

gender when a breast augmentation with

round silicone implants for implants

were placed under the muscle using

precise dissection techniques

prospective hemostasis dividing her

muscle carefully we were able to

decrease swelling and decrease pain for

only dressing after the surgery is a

bandaid that covers your inch incision

that's hidden in the crease of her

breasts no special process required in

this young woman who are banned broad

because she found it most comfortable

immediately after the surgery she goes

home fix the two-hour nap and then wakes

up and gets into a warm shower arm

raises start immediately after the

surgery and she does the arm raises five

times per hour which helps relax your

chest muscles and actually makes

everything feel we send less tight

I see all my patients the first day

after surgery and this gives me an

opportunity to check and make sure that

everything looks ok miss Eyre no fluid

collections around the implant

as you can tell her implants look hi

this is completely normal and they will

settle over the course of the next

several months here she is one week

after surgery as you can tell her

implants are already starting to settle

and it's at this one week visit that I

give her a fresh set of band-aids you

can see this that incision is hidden

nicely in the crease again it's only

about two inches long at this one week

is it you talk about implant massage

where she pushes the implant in

different directions and massages the

breast to help keep them soft while she

heals here she is at her six weeks

visiting our implants have continued to

settle the lower part of her breast is

looking more round and more natural

appearance and the upper part of the

dress is looking less full for incision

has healed nicely i use four layers of

sutures that are all buried underneath

the skin as you can tell she has a nice

an incision is still red and this is

completely normal but this will fade to

a light color over the coming year

on the left this is the first day after

surgery in the middle mrs. one week and

on the right is that we visit this is

an example of what's called the drop and

plus this is the implant settling and

you can tell most noticeably at the top

of her breasts that on the left it

appears quite full

and as you move to the right the top of

the breast appears less full as the

implant settles the bottom of the breath

starts to look around and this process

will continue over the next several

months at the end of six weeks she's had

her final visit and we have a happy

patient who had a great recovery after

breast augmentation surgery

thank you

Austin Hayes MD
Tanasbourne Plastic Surgery
18650 NW Cornell Rd #324
Hillsboro, OR 97124
(503) 297-9340

Plastic Surgery Cost Michigan

I would like to address a question that is commonly asked in our practice that relates to pricing. We often have patients who call asking for a specific price for a procedure or service that we provide – and although we would like to provide this information in most circumstances its very difficult to do. There are so many variables involved in pricing such as length of surgery, anesthesia costs, facility costs, and even variables among patients. In some cases such as breast augmentation we can provide a range for which a patient can be given information about the general costs. However, in other situations such as fat grafting to the breast or butt for example this can be more challenging. Each patient is different. So depending on the areas that we might transfer fat for example or the amount that we use or any other variables that can impact the length of surgery – these can have an impact on how long the surgery will take and reflect upon the final cost. This can be challenging of course and we want you to call the office to ask specific questions and ultimately we invite you to come in to a full consultation and evaluation whereby we can fine tune each procedure that meets your specific needs and therefore give you a more accurate pricing in the end.

Melek Kayser MD - Image By Design Plastic Surgery
29167 Jefferson Ave
St Clair Shores, Michigan 48081
Phone: (586) 776-3223

tammyinjecting

For many years, facial rejuvenation was limited to skin resurfacing with lasers and peels, and various surgical soft tissue repositioning procedures. However, our options have expanded with the understanding of muscle relaxation via neurotoxins such as Botox, and the evolution of our knowledge of how fat atrophy in the face leads to stereotypical architectural changes with aging. Plastic surgeons can now add volume to refresh the face. In order to achieve a youthful but natural appearance for my patients, I use a combination of muscle balancing, skin resurfacing and tightening as well as volume restoration. Ultimately, when the battle of gravity versus skin plays out over time, surgical repositioning is required.

Let’s examine the question of how best to restore volume in the face.

One option for facial volume restoration is off-the-shelf materials such as hyaluronic acid, in various structural manifestations, as a direct filler. Another option is a polymer of lactic acid (Sculptra), which acts as an inflammatory material inducing collagen synthesis to create a guided tissue volume additive over time. Both are easily administered in the office without any donor site pain or bruising. While these procedures are easy and safe, it takes experienced hands, eyes and judgement to achieve the best outcomes. Results can be expected to last up to two years.

Fat grafting is another source of filler material to restore volume to the face. Fat is easily harvested from the abdomen or the thighs to use in the face. The technique is a gentle form of liposuctioning which then requires a minimal amount of processing followed by reinjection into the desired locations. In the office setting under local anesthesia, patients may not enjoy some of the pressure sensations required to obtain the fat. In an effort not to injure the fat and to prevent fat from being injected into vessels, blunt cannulas are utilized to place the cells into the tissues. This technique causes some degree of pressure sensation as oppposed to a sharp small needle, which can inject off-the-shelf fillers. The advantage of fat is that it is cheaper to obtain than manufactured materials. In most cases, there is a relatively unlimited supply. Furthermore, peripheral stem cells may direct cellular differentiation leading to improved tissue quality.

Fat versus fillers

Fat is certainly more technically demanding and unforgiving. For injections around the eyes to smooth the eyelid cheek junction, I prefer hyaluronic acid. When injected smoothly with appropriate application, no lumps or bumps should occur. In the lips, when I am working to recreate vertical ridges of the phyltral columns of the upper lip and “Cupid’s bow” points as well as a nice rolled margin of the lip, I prefer hyaluronic acid, because it is the consistency of caulking material and can provide shape. Fat is soft, and does not exert force on the skin in the same way as fillers. However, recent research from the University of Texas Southwestern Medical Center demonstrates excellent results of restoring large volume loss of the upper lip beyond the vermillion by placing fat cells in a broad area making the loose skin less apparent.

With regard to the common area of deflation of the sub-malar fat pad in a non-surgical case, I prefer the highly crosslinked stiff material of Voluma which does an excellent job of re-supporting the facial structures to a more youthful position. If I am already performing a surgical case of a face or neck lift, I always add volume to the face prior to elevating the tissue; this is when I choose fat, because of the ease of harvest and injection under anesthesia. Some thin women may show very demarcated loss of volume in the temple area giving the face a skeletonized appearance around the eyes and making the brows seem to sag. This is an excellent indication for Sculptra. If the volume loss exceeds several vials worth of Voluma in the sub-malar fat pad per side, I also prefer to use Sculptra.

Fat grafting is an evolving technique in plastic surgery. Every industry conference has a significant discussion about the techniques and the science behind the results with just about every region of the body applicable to its uses, including face, breast, hand, buttock and other contour deformities. For the early stages of facial rejuvenation, which can occur in the third decade of life and beyond, much of the volume restoration is performed with off-the-shelf filler agents in an office setting due to ease and convenience.

It’s a case-by-case decision.

So when do you use fat versus fillers? It depends. It’s a case-by-case decision to determine the best protocol for each patient. I take a customized approach from the consult to the procedure, based on my unique skill set and my years of experience and training. My goal is to provide the absolute optimal results for each of my patients and to cultivate a lifetime relationship.

Washington Plastic Surgery
12800 BOTHELL-EVERETT HWY, SUITE 260 EVERETT, WA 98208
425-316-5080

Plastic surgery for males is a relatively new phenomenon. Historically, men have viewed this venue of services as mostly for women. My father’s generation was not working out in gyms and drinking protein shakes to stay healthy and active in middle age and beyond. Undeniably, the aging baby boomer population refuses to be defined by chronologic age and embraces the concept of wanting to look as good as you feel. With this is mind, why let women have all the resources to age gracefully and look young and vibrant? Men can now maintain a youthful appearance proportionate to our level of health and to our significant others.

What services are available to men?

Skin care: The concept may seem too metrosexual at first glance, but there is a health benefit as well. Sun exposure has a cumulative effect, which damages the outer skin, and dermis making the skin look dry and leathery. Loose, inelastic skin coupled with blotches of dark pigmentation makes the skin appear older than chronologic age would suggest. This is also a set up for skin cancers. Skin care may include skin resurfacing with peels to remove the damaged skin along with micro-needling to induce collagen production and improve skin tightening to provide a much-improved appearance and reduce the potential risks of skin cancers.

The use of Botox, which will weaken the overactive muscles between the brows and around the eyes, can prevent the deep furrows of the skin thus smoothing the appearance. This agent can be employed to hide some of the muscle bands in the neck as well.

Filler agents, such as Voluma, can be easily injected into areas of programed fat atrophy which occurs in aging and results in the cheek falling causing accentuation of the cheek folds and may produce hanging on the jaw line. Voluma, which is a highly crosslinked stiff hyaluronic acid filler, can manage to lift the cheek without making the face look fat.

Rhinoplasty: This is the art and science of the interactions of skin, bone and cartilage of the nose to provide an aesthetically appealing appearance with normal function. Rhinoplasty is a very meticulous surgery with the goal of providing a balanced appearance between the various components of the nose as well as creating harmony with the rest of the face. This surgery can provide a real boost to someone’s appearance and self-esteem.

Gynecomastia: This is a condition in which the male breast increases in size with fibro-glandular tissue mixed with added volume of fat giving it a feminized appearance. Gynecomastia can occur at any age creating self-conscious situations both with and without clothing. Fortunately the correction is very straightforward and very predictable. We recommend the use of ultrasonic energy mixed with traditional liposuction to facilitate fat and fibro-glandular removal of tissue to sculpt the breast back to a masculine appearance. There are occasions when direct excision of tissue directly under the nipple-areolar complex is necessary in addition to the liposuction to achieve the desired results, but the scaring in minimal. Without question a very power surgery that gives wonderful results.

Lipo-sculpturing: Unfortunately diet and exercise can’t cure all problems with the contour of the abdomen and posterior flanks. With metabolism changes, even a meticulous healthy eater with an active lifestyle can still experience abdominal bulges and flank adiposity. For patients with good skin quality without a great deal of skin excess, liposuction can provide a means of sculpting the torso to give a more pleasing shape and enhance confidence with and without clothes. The surgery is generally not that difficult to recover from, and results can be effective.

Eyelid rejuvenation: Do people say you look tired? Do your lids hang over your eyes giving the appearance of sleepiness? Do you have puffy lower eyelids giving you a less vibrant persona? Then you may want to consider eyelid surgery to give you a refreshed look. It’s been said that the eyes are the windows into the soul; so don’t have outdated window treatments. The surgery is mildly uncomfortable with swelling being the biggest issue related to return of feeling comfortable in social situations. Careful consultation with your surgeon is required to avoid complications depending on the anatomy of your eyelids. People will notice the refreshed look after the recovery has taken place.

Neck rejuvenation: A hanging neck with loose skin and excess fat can give the appearance of an aged and out-of-shape individual. It may also project being overweight. Depending on the degree of tissue excess and skin quality, this may be correctable with liposuction alone. However if the skin quality is poor and there is the presence of muscle bands in the neck, a true neck lift will be required. This surgery can take an old-looking neck and transform it to a smooth crisp neckline with well-defined jaw contours. Neck rejuvenation can take years and pounds away from how you look.

In summary, plastic surgery offers men many options to consider feeling good about the skin you’re in. It’s not just for women anymore.

Dr. Kent W. Gabriel, MD
704 W. Nye Lane, Suite 102, Carson City, NV 89703
Telephone: (775) 885-8890

So you work out, eat smartly and watch your calorie consumption but your face looks tired, and you look older than you feel. Trust me, you’re not alone. The good news is something can be done that is predictable and sustainable to make you look and feel better about your face.

The key to success is a thoughtful facial analysis, which evaluates your bone structure, muscle activity, soft tissue volume, skin quality and the position of your forehead, brows, eyelids, cheeks and neck. I approach a patient’s face much like an engineer with a sculptor’s artistic eye. I create a problem set followed by a detailed treatment plan, tailored to each of my patient’s wishes and financial parameters.

Treatment plans often include skin quality improvement with techniques such as serial chemical peels and micro-needling. Please see previous blogs on these therapies on my website. If excessive muscle activity leads to a harsh appearing forehead and brows, muscle modulation with Botox can be an excellent approach.

Looking at the upper third of the face, I evaluate brow position with respect to the bony orbital rim and its relationship with the upper and lower eyelids. On women you want the brow to be above the orbital rim with the outer third being elevated compared to the inner 2/3 of the brow. Heavy hanging brows make the eye aperture appear small and tired.

Another important factor in evaluating the upper eyelids is eyelid ptosis (the muscle mechanism which elevates and maintains resting tone of the upper lids). Eyelid ptosis must be addressed with the blepharoplasty to prevent a tired sleepy appearance despite correcting the fat pads and excess skin.

The lower eyelids must be evaluated carefully in comparison to the bony anatomy surrounding the eye and the supporting structure of the lateral canthus, which anchors the eyelids to the lateral bony orbit. Great care must be taken if you have a prominent eye compared to your cheeks and have deficient lower eyelid vertical skin coverage. Weak lateral canthi can result in disastrous results with excessive eye exposure leading to pain and visual disturbance.

Finally, the lower eyelid cheek junction must be inspected. A large tear trough and bulging fat pads can detract from a youthful appearance. Taking out too much fat can result in a hollow eyelid, which can actually create an even older appearance. Current techniques include judicious removal of some of the fat and then actually transposing the fat pad down onto the cheek mass obscuring the demarcation and giving volume to the cheek and avoiding a hollow look.

The midface is all about volume. As we age, the cheek fat pad shrinks in size leading to the face falling with accentuation of the nasolabial folds. In most cases midface restoration can be corrected with volume-added techniques of either fat or filler agents making tissue repositioning in this area less important. A non-invasive injection of Voluma can be a great treatment option.

The lower facial third and neck are evaluated with regard to the jaw line, chin neck angle, and the draping of the soft tissues including the skin and neck muscles. Younger people with good skin quality may well be treated with liposuction alone to achieve a pleasing neck line. If the lower jaw is small with respect to the rest of the face, a chin implant or chin repositioning may help your neck appearance, in addition to liposuction to improve results and create harmony with the lower facial third compared to the rest of the face.

Older skin, with bands of the platysma muscle showing through, is less compliant and is best treated with a neck lift procedure. This surgery includes fat equilibration, neck muscle tightening and soft tissue repositioning and stabilization around the ears.

Facial rejuvenation is not painful, although swelling and bruising will occur. After the dust settles, results can be natural and youthful in appearance with long-lasting results that will boost your confidence beyond any wardrobe or hair makeover.

Look as good as you feel in 2016. Happy New Year!

Farahmand Plastic Surgery
12411 Brantley Commons Court
Fort Myers, Florida FL 33907
Phone: (239) 332-2388

Do you want to change your smile? You’re not alone and we can help you! There are many cosmetic dentistry procedures including the most popular, bonding and porcelain veneers. Both bonding and porcelain veneers have similarities. They both are used to correct dental imperfections. However, the procedures are quite different.

What is the difference between the two?

Porcelain Veneers:

Porcelain veneers are fabricated from a solid piece of porcelain. They fit over the front and underside of your tooth covering the entire surface of visible tooth. Veneers can be fitted to lengthen or widen teeth to close gaps or fill in chips. Porcelain veneers according to Alpine Meadows Family Dental  are generally used for patients who have several cosmetic problems or want their entire set of front facing teeth made over. Modern porcelain veneers tend to last many years, are easy to care for (normal brushing and flossing is fine, no special care is required), provide a very natural appearance, and offer a stronger alternative to other cosmetic options.

Dental Bonding:

Dental bonding uses a smooth tooth colored solution which is applied to teeth. It covers stains, and fills in small chips and gaps. After the dental bonding solution has been applied and shaped a specialized dental light is used to harden the bonding material. Once the bonding solution is dried and cured additional layers may be applied depending on your situation. When the process is complete the tooth is then polished. Bonding is used on patients who need one or two teeth corrected.

While veneers and bonding are cosmetic procedures used to treat similar problems, veneers may be a better alternative in cases where the patient wants to adjust the size or shape of the tooth. Contact Alpine Meadows Family Dental located in Lehi Utah for more information.

Daniel Baird DDS
Alpine Meadows Family Dental
1020 S 1100 W, Ste A
Lehi, UT 84043
Phone: (801) 492-9207
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Mommy Needs a Lift

Women who have had children know what a blessing they are. They also know that the fluctuation in weight during pregnancy, and nursing can lead to many changes in a woman’s breast causing them to sag. A Mastopexy or Breast Lift to raise and reshape sagging breasts would be a great procedure to correct this condition.

Breast lift surgery is a common cosmetic surgery procedure which women use to regain that youthful appearance they had before childbirth. Also, to restore breasts to a more lifted position while improving their shape and firmness. Please note that a Mastopexy alone does not significantly alter breast size. If you have lost a considerable amount of volume in your breast after pregnancy you might want to consider a Breast Augmentation in addition to your breast lift.

Once you’ve decided you are done having children, as any pregnancies following this surgery can reverse the results of this procedure. Consult with a highly experienced, board certified plastic surgeon. He will evaluate your eligibility and determine if a breast lift is needed or if another breast surgery might be a better fit for your needs.

Kevin Dieffenbach, M.D.
98-1247 Kaahumanu Street #109,
Aiea Hawaii 96701
(808) 678-1955

Residents of Las Vegas know all too well the meaning of extreme weather. With thechanging seasons comes dry winter skin, and now that the holidays fast approachingit is time to focus on your skin care regime. Dry climates equal dry skin. Not to mention, dry skin is uncomfortable. It draws out the moisture from your skin leaving you with a less youthful glow, andcan lead you looking older than you really are. It’s easy to ignore daily skin care but when you live in a dry state like Nevada, understanding your skin first is the basis of a good skin care program.

An important part of our mission is sharing our expertise with you. Using the latest VISIA technology, a Skin Spa specialist will take ultra-violet and digital photographs to assist in evaluating your skin. Your face will then be thoroughly cleansed and analyzed for type and condition. To round out your consultation, we will formulate a customized program, and skin care treatments.The medical-grade products we use are available in our retail boutique by prescription so you can maintain the restorative effects at home between treatments.

We carry the following lines:

Obagi® Medical -offers an extensive line of clinically-proven, by-prescription-only skin care systems and products designed to help revitalize, enhance and maintain beautiful skin for life. The following sampling of systems meet the needs of all ages, all skin types.

Éminence Organic Skin Care – body and facial products are a natural approach to skin care. Produced using sustainable farming and green practices in Hungary, Eminence products only use ingredients without harmful chemicals or additives to allow premium results for all skin types. These products are made-up of essential oils and coloring and scents from fruits, vegetables, herbs and teas.

Jane Iredale Mineral Makeup -This is THE Skin Care makeup. Jane was the first to introduce mineral makeup. It is made with minerals and pigments that allow the skin to breathe. Her products provide anti-inflammatory, weight-less coverage, it’s a foundation, powder and concealer all in one. The products will not clog pores, carry a lowallergy risk, contain no talc or parabens or synthetic ingredients and provide sun protection.

Corrective Skin Therapies – Our medically-advanced peels are custom-designed just for you. Using clinically-proven, professional products by BioMedic® and SkinMedica®, we deliver great results when our peels are routinely combined with a prescribed, at-home skin care regime.

In addition to the above, remember to always wear sunscreen. The number one case of premature aging and wrinkles is sun damage. Make better food choices reduce your intake of junk food, Watch foods high in fat and sugars. Hydrate drink up to 8 glasses of water a day.Moisturize its one of the most important things to prevent sagging and dull aging skin. Use oil-based products that retain water on the outer layers of the skin.

Stephen M. Miller, MD, PC, FACS
8435 S Eastern Ave
Las Vegas NV 89123
Phone: (702) 369-1001

BRA Day USA– Closing the loop on Breast Cancer

By now most of us know that the month of October is dedicated to Breast Cancer Awareness, we wear our pink in support, walk in memory of to honor the brave who have fought this disease, but today specifically is for Breast Reconstruction Awareness known as BRA Day. The goal is to educate, inform and provide access for breast cancer survivors of their breast reconstruction options. In America, 7 out of 10 women diagnosed with breast cancer needing a mastectomy are not aware of their breast reconstruction options. As a result, less than 1 in 5 women who choose to undergo a mastectomy will go on to have breast reconstruction.

Breast cancer is the most common cancer in women after skin cancer in the United States, according to the American Cancer Society. Most of us have been touched by cancer or know someone who has. How can you help?

Make a donation that will benefit the Breast Reconstruction Awareness fund of the Plastic Surgery Foundation: http://www.bradayusa.org/donate.html. No gift is too small, and your generosity will help tremendously.

Each and every woman battling breast cancer deserves to know her options.

The Rosato Plastic Surgery Center
Dr. Ralph M. Rosato, MD
3790 7th Terrace Vero Beach FL 32960
(772) 562-5859