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Now the implant is going to be placed underneath this which is going to make it bigger and its going to do the opposite of reducing the breast so we are kinda using two different approaches here when we combine a breast lift and an implant. A breast lift reduces the skin enveloped an implant expands the skin envelope so there’s a fine balance here. Personally I like to do the breast lift first and then place the implant at the end. I will trim the skin if necessary to achieve my final result.

I am back – I have done a slight reduction on this left side – we’re pretty close – there’s still a little bit of difference and I think it has to do as much with position and the overall difference in the natural breast. Volume wise I think we’re pretty close. I took off about the equivalent of two implants which is a decent amount – she certainly could have elected to just use two different implants and not do this and that is usually the most common approach to doing this.

I’ve done the lift – base width here is a little wider than this one – position wise it will equal out, vertical height on this is longer than here and all these little things add up – her chest is different between one side and the other and these are significant issues that come into play when we perform surgery because most patients don’t even realize that they are different – until we start looking at and evaluating their breasts, so its important that I spend a lot of time discussing all these nuances with patients so there are no surprises.

So we’re here in surgery and both sides are done enough actually in the process of creating a pocket under the muscle – the muscle lays on the chest and I virtually always go under this because it allows a little bit more protection over the implant. So here’s that main muscle to the chest and I’ve actually started to dissect it and when I go underneath here you can actually start to see the ribs and the pocket – so that’s the pocket that I’m going to create and where to put the implant in will be done with them.

Alright we are back. The sizers are placed on both sides, they are temporary implants to allow me to get close. We have got 100 cc’s in this sizer here which I think is a very nice breast – its a full B Cup and obviously she wants to be more of a C Cup so we are going to be put in another 50, that’s 150, here’s 200, heres’s 250, and this is going to be close to 270. So as we increase the volume we round out the breast, we get more fullness up here and actually starts to distort the natural appearance in the breast and bigger is not always better. A lot of women like this look but it clearly is not a natural look. I’ll also is fighting against this portion of the breast and in her particular case Ive had to release down here just to make sure that I can make this fold as low as this one. This is our implant Ive got a 270 here – it’s a silicone implant silicone gel wonderful devices and I think that for her it’s going to be a nice. Its going to match her base width and so we are just going to go ahead and insert this relatively straightforward to put in – good — perfect… Ive got some anesthetic medicine – Ive got the implant over here – the implant over here – you got to see it inserted we’re gonna go ahead and close and then we’ll update you one more time.

Alright so what Ive done here is Ive internally closed everything and the final closure in this we call a circum- vertical breast lift this does not have the upside down T so that’s not what we want but when we do this I can take the sharp needle and go all the way around with this per minute stitch call gore-tex and what that allows me to do is that. And this is beautiful and there is a little bit gathering here this almost always goes away but this permanent stitch tends to keep the areola from widening up again the other thing I’d like to show you is that here’s the areola and nipple you can see this is where skin used to be and I just kind of peeled of the outer layer of skin and kept all this attached this has never been removed nipples nice and pink and there’s nothing about this that is at all concerning and so they keep their sensation and they keep their the whole nipple and we don’t disconnect it and so what this is basically done the lift occurs by removing the excess skin above the level of the nipple and this ends up moving up and so when we do that that’s how that looks and you can see this sides been done over here and that’s the final look at we trim that extra skin and bring it through and we will be done.

Alright welcome back to the end of the case we are done and we all agree she looks really really good Ive used dissolving stitches for everything all the incisions are sealed with a topical adhesive so the patients can take the dressings off the next day – they can shower the next day they wear a support bra – for 5 to 6 weeks – I see them at one week, six weeks, six months a year, I like to follow up with my patients. And everything is healthy. These minor gathers virtually disappear as the months go by. Implant height it looks good. The volume symmetry is I think very good Ive expanded the lower pull of this breast a little bit to match this one. Nipple height looks good. So I think that’s it’ll be exciting to see her back as the weeks and months go by. So thank you for being with us”

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.

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

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

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

Myth #1: A root canal is painful.

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

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

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

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

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

Myth #4: Root canals causes illness

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

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

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

 

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

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

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

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

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

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

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

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

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.

FullSizeRender (005)

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

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

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

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

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

Breast Implant Exchange with Fat Enhancement

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

425cc anatomical saline implants were placed under the muscle

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

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

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

Displacement and flattening of the implants occurred with every muscle contraction

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

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

Rippling was more pronounced with saline implants especially when leaning forward

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

 

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Fighting Fifty

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

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

It Begins with the Skin

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

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

The Aging Eye

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

Injectables for Immediate Results

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

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

Hormones Play a Big Part in the Aging Process

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

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

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

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

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

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

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

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

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

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

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

Stephen M. Miller, MD and Axiom Spa Open House

May 25, 2016 5-7 PM

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

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

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

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

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

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

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

Before and After

Before and After

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

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

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

When is Kybella the right choice?

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

When is Kybella the wrong choice?

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

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

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

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

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

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

Make inquiries and express your concerns.

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

• Consult at least 3 different surgeons before choosing one

• Be sure the cosmetic surgeon you choose is board certified

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

• Request to see before and after photos of previous patients

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

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

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

• Ask about the follow-up procedures

• Request to contact former patients about their own experience

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

The results of rhinoplasty

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

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

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.

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.

Skin

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

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

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

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

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

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

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

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

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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.

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.

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.

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.

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.

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.

Special Price: $4200
Regular Price: $5500
Expires 1/30/16

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.

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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.

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.

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.

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.

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 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.

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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.

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. For more in-depth discussions of procedures and spa services, visit thelucascenter.com or call 865.218.6210 to schedule your personal consultation with me.

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!

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.

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.

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.

BRA Day USA– Closing the loop on Breast Cancer
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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.

Rapid Recovery Breast Augmentation

Yes. You can have a Breast Augmentation and go back to normal activities the VERY SAME DAY.

Breast Augmentation is the most popular and most frequently performed cosmetic surgery procedure in the U.S. It’s ideal for women who wish to enhance, regain or restore volume and balance to their bodies.

At the WG, Rapid Recovery Breast Augmentation is the hottest, new approach and our patients love it. What makes recovery so quick? The secret lies in a gentle surgical approach and having our patients get active immediately after surgery.

During surgery, gently and efficiently dissects tissues while creating the implant pocket. This minimizes trauma to the breast tissues and shortens a patient’s time under anesthesia. Less anesthesia is then absorbed and metabolized within the body. After surgery then, the body has less to release. Also, gentle tissue dissection leads to less bruising and less bruising leads to less post-operative pain. It’s a win-win!

After surgery, patients are encouraged to get back-to-life. Within an hour or two, patients are required to get outside, walk, shop or to do light housework. They are asked to complete a routine series of prescribed over-the-head exercises. To help with the soreness, patients rely solely on Ibuprofen.

With Rapid Recovery, the earlier a patient gets active the less stiffness and pain sets in quickening the recovery process.

This is contrary to the traditional post-operative surgical regimen still prescribed widely by plastic surgeons. The typical post-op plan is to have a patient rest and not raise her arms above her head. This leads to a longer, more painful recovery. Why? Stiffness sets in with less movement. Then the cycle starts – more stiffness, more pain, more recovery time needed.

Our patients have been amazed. They tell us that they have gone to the movies, out to eat and shopping with family and friends the very same day and still feel great afterwards. They often find the initial exercising challenging but say they adapt quickly and actually love getting back into their normal routine. They also tell us that they are amazed at how well and clear thinking they feel so fast.

Rapid Recovery Breast Augmentation is the perfect procedure for patients who are having their first Breast Augmentation. However, a traditional recovery regimen is still recommended for patients requiring breast revisions, lifts or reductions.

How Old is Too Old for Cosmetic Surgery?
Most people believe cosmetic surgery is riskier for senior citizens than younger adults. However, would be wrong according to a recent study by plastic surgeons at Vanderbilt University Medical Center identifying senior citizens are at no higher risk for complications from cosmetic surgery than younger patients that was just released. The doctors analyzed data from more than 129,000 patients during a five-year period and found there was no difference in the number in the rate of complications for individuals older or younger than 65 years old.

“Our study demonstrated that patients over 65 can safely undergo cosmetic procedures with a complications rate similar to younger patients when surgery is performed by a board-certified plastic surgeon,” said Max Yezhelyev, M.D., Ph.D., the author of the study and a plastic surgery resident at Vanderbilt.

There are an increasing number of older patients undergoing cosmetic surgery every year the study also revealed.Senior patients accounted for more than 6,700 of the participants included in the database with an average age of 69. The younger patients in the study age averaged 39.The rate of major postoperative complications after cosmetic procedures among elderly patients was 1.94%, as compared to 1.84%for the younger group. The average age in the study was 69 years old. However, when looking at patients 80 and over with the average age being 82, the rate of complication was only 2.2 percent compared to 1.9 percent for younger patients. As you can see, there’s not much of a difference.

Facial procedures were the most common in patients over 65. Surprisingly, most of the older patients were men, rather than females. The demographics of younger patients included more females.

I wanted to spend just a minute with you and discuss a subject of credentialing as I have been hearing more and more about blunders and problems in the world of plastic and cosmetic surgery. It certainly goes without questions that as the world of medicine is changing and insurance reimbursements are continuing to decline, so are more non-qualified doctors and even NON-physicians getting into this market to cash in. OMG, this has become an epidemic and so many innocent patients are paying the price.

Becoming a plastic surgeon is a life long endeavor that requires, not only years of education and training but, ongoing learning and experience as well. Only after four years of medical school, 5 years of a general surgery residency, 2 years of plastic surgery training and another year of an additional fellowship in a plastic surgical specialty, did I become eligible to qualify for board certification! Then it required passing both a written and subsequent oral examination to finally meet the high standards to become a board certified plastic surgeon. But it wasn’t over as my entire career has required ongoing training, education and examinations to maintain my status.

Unfortunately, many states, including Michigan, do not regulate who does what and where. Your obstetrician or family doctor, for example, can perform procedures in their offices that would scare you if you realized how little training and experience they had! And companies, such as implant or laser manufacturers don’t help as they will sell to anyone who will buy from them. Although most hospitals require only board certified plastic surgeons to have privileges, this does not stop all the others from having their own facilities and operating there. We are then left to pick up the pieces but only after it is often too late:(.

When searching for a surgeon, make sure they are certified by The American Board of Plastic Surgery and that they have full privileges (in this specialty) at a fully credentialed hospital. I would encourage any of you seeking to have any plastic or cosmetic procedures in the future to consider this, and although cost may be a factor to take shortcuts, the price to be paid if disaster strikes will be so much more in the long run.

I wish you all a wonderful day!

Dr. Kayser

Dentists like Gottfred Olsen DDS recommend you brush your teeth twice a day, but as you walk down the toothbrush aisle at your local store, have you ever wondered which toothbrush you SHOULD be using?

When you’re considering which of the dozens – or hundreds – of choices on the shelf you should buy?

Here are some basic guidelines for choosing the right toothbrush:

-Any brush you choose should be certified by the ADA. The presence of the ADA seal indicates that the brush is both safe and effective – brushes not certified by the ADA should be avoided.

- Unless specifically instructed by a dentist, you should probably be using a brush with soft bristles. Brushes with hard bristles are more likely to injure your gums, potentially causing gum recession that is difficult to reverse, and are unlikely to clean teeth any better than soft bristles.

- You should choose a brush that is the right size for your mouth – it should have a large enough handle that you can reach the back of your mouth, but should be small enough (especially the head of the brush) that you can effectively reach the top AND sides of each tooth. If you’re unable to fit the toothbrush between the side of your cheek and your molars, it’s too large – choose a smaller brush. For many adults, a toothbrush where the head is approximately 1” long by ½” wide is usually appropriate.

- Manual brushes and electric brushes can both be effective – choose the one you prefer using. Electric brushes may help patients that brush too hard and cause gum recession, but many patients will find that manual brushing is easier for their daily routine. – Brushes should never be shared, and they should be replaced every 3 to 4 months, or after a cold or strep throat. Disposable brushes are fairly inexpensive, so buying one or two extras will help prevent sharing if unexpected guests arrive, and will help encourage you to swap brushes if you get sick.

Proper brushing is crucial to avoiding tooth decay, and it starts with choosing the right brush. If you have questions about whether or not you’re choosing the right brush, or if you have questions about which brush is right for you, ask your dentist – they’ll be happy to help explain the pros and cons of the various types, and make sure you’re using your brush effectively.

 

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How to choose the right Breast size for you
Once you have decided to have a Breast Augmentation, how do you decide what size implant is best for you?

The goal of Breast Augmentation is to change your breast size proportionally making them larger and fuller in shape. If you’re not sure what breast size you would like to be ask your surgeon a lot questions and look at as many pre- and post-op pictures of patients who are similar in body shape. When it comes to implants, what looks good on one woman may not look good on another.

At your consultation, we will evaluate your chest wall and breasts, including the base and width of your breasts. An implant that fits your width, size and build will create a naturally proportional look. While many women prefer a natural look to make their implants less obvious, others opt for a more dramatic look. Remember…the larger your implant size, the more vulnerable you may be to breast implant complications.

The shape of your body and your lifestyle also should be taken into consideration when choosing your size. For instance, if you are involved in sports, or other physical activities, the size and weight of larger implants will put stress on your breasts and may cause more drooping.

Dr. believes spending time with patient’s pre-operatively leads to happier patient outcomes and dramatically decreases the need for future re-operations. To help make the right choice, he suggests looking through before and after photographs and trying on implants in different sizes at his office to help you visualize your perfect new size.

When is the best age it to get a Facelift?

The primary goal of a Facelift is usually to correct sagging skin around the face, particularly at the jawline and in the cheeks, jowls, and neck areas. Other initial signs of aging typically repaired by a Facelift are the deep creases around the mouth area called the nasolabial folds and marionette lines, displaced facial fat, and creased skin in the neck area.

The most important factorsare having significant facial aging changes that can best be corrected with a Facelift, you want to have the procedure, and if you are healthy enough to have the procedure. Your age is a secondary factor.

Today, those considering a Facelift are often looking to appear more youthful for personal to professional reasons. Many prefer to have the surgery earlier and then maintain a rested, refreshed look with the ongoing help of non-surgical options like Botox, dermal fillers, and medical peels, facials and by-prescription products.

A study published in Plastic and Reconstructive Surgery (Vol 129.no1.p263) looked at the age a patient chooses to have a Facelift and compared it with their long term satisfaction and results. The younger patients had longer lasting effects from their surgery and were more satisfied. Independent surgeon rating of the results also favored the younger patient.The women in the study were grouped by age, under 50, 50-60, and over 60. The over 60 group consistently rated their early and long term satisfaction as lower than those in the two younger groups.

Spring Cleaning! Getting Rid of Your Old Makeup

Most beauty products are designed to stay fresh for a specified period of time then they start to break down. Hanging on to your skincare or makeup past its expiration date, might be causing skin problems. Using a product beyond its expiration date may seem harmless, but expired beauty products can carry a range of bacteria.

In a 2013 study published in the International Journal of Cosmetic Science evaluated the makeup routines and habits of 44 women ranging in ages 18 to 28, and the results showed 70% of women in the study used some type of expired product, mostly eye makeup mascara, eyeliner, and eye shadow.

Products that contain water as one of the first ingredients have the shortest shelf life after opening because water encourages the growth of bacteria and products made up of almost no water (such as powders) last the longest. Also products are susceptible to bacterial contamination and breakdown from exposure to air. If you have a product that is discolored, runny or lumpy, has separated, developed a strange odor, or feels different on the skin than it once did, then by all means throw it away.

Here is what you need to know on the shelf life of your favorite makeup and skincare products, and how to spot those that are past their prime.

Lotions and Perfume
Recommended replacement: 3-4 years
Body lotion and perfumes typically tend to last longer than most. Although, at times it is hard to remember how long you’ve actually had that scented body lotion. So, if it has changed color from a bright white to an unappealing yellow that seems thinner or more watery than when you initially purchased it, replace it.
As for perfume, alcohol is a natural preserver, keep it in a cool, dark place, and it should last for a few of years. When the scent of the perfume smells different, you should toss it.

Skincare Products
Recommended replacement: 1 year
Typically, you shouldn’t hold onto skin-care products for more than. Products that fight wrinkles, or acne are typically only formulated to be active for a year.

Sunscreen
Recommended replacement: 1 year
Sunscreen should be replaced every year, however, if your formula comes out runny or has turned from white to yellow, this could mean the active ingredients might be compromised and most likely will not protect you from the sun’s harmful UV rays. Be sure to always pay attention to the way the products looks.

Makeup
Recommended replacement: Loose compact powder last for about 1 to 2 years
Recommended replacement: Powder blush last for about 1 to 2 years
Recommended replacement: Foundations 6 months to 1 year
Powdered beauty products contain the least amount of water, making it harder for bacteria to grow. However, the brushes you use to apply the powder may carry dangerous bacteria. Invest in a brush sanitizer and clean your brushes regularly to prevent breakouts and bacteria growth. Within just months, foundation can start to grow bacteria that present health risks to your skin. Every time you touch your makeup, you transfer germs to them and ultimately to your face. Try to keep your fingers out of products. As oils rise to the top, and the consistency thickens, the odds of bacterial growth increase. This can lead to breakouts or irritation, even infection.

Mascara
Recommended replacement: 3 months
A mascara tube is a dark, wet environment which is the perfect breeding ground for bacteria. Also, every time you re-insert the brush into the tube you double dip, all of which increases the risk of an eye infection.Pumping the wand pushes air into the tube, causing it to dry out faster. Try slowly draw out and twist the brush instead.

Eyeliner and Eye Shadow
Recommended replacement: Liquid eyeliners, 3 months
Recommended replacement: cream eye shadows, 6 months
Recommended replacement: pencil eyeliners and powder eye shadows, 2 years
Eye makeup is especially vulnerable to bacteria, so start reviewing your makeup collection for expiration dates. Pencil eyeliners can be renewed by sharpening after each use. Expired powdered eye shadows tend to be more flaky and dry.

Lipstick and Lip liner
Recommended replacement: Lipstick and gloss, 2 years
Recommended replacement: Lip liner 2 years or more
The water content in lipstick makes them potential mini reservoirs of bacteria so avoid sharing it with others. Also, if you get a cold sore, throw out all lip products you are using.
Another way to tell that lip gloss has passed its expiration date is if it you notice color changes or you see mold, get rid of them.

Here are some easy tips for prolonging the shelf life of your products:

Things to remember:

Store your products in a cabinet or drawer
Wash your hands before using products
Tighten/secure the cap after each use
Toss out eye/lip products after you’ve had an eye infection or cold sore

Things to avoid:

Storing your products in direct sunlight
Sharing your products with others
Adding water or saliva to thin out or remoisten your products
Pumping your mascara

Cosmetic Surgery Financing in Today’s Market

As the market for cosmetic surgery and non-surgical procedures grows, patients are always searching for new, innovative ways to pay for their treatments.

WHAT THEY FINANCE
You can wrap up all of your surgery-related costs and cover it with your AHCL loan!
American HealthCare Lending finances treatments, procedures, medications, anesthesia, facility fees, recovery care, surgical garments, travel and lodging, etc.

HOW TO OBTAIN AN AHCL LOAN
It’s easy. Go to www.drstephenmiller.com, click on the AHCL logo and get started with your pre-approval process. Enter your information and our provider number. You’ll receive an email decision upon approval and funding within minutes. Then just select one of the loans offered and verify your personal information. Loans are funded directly to the bank account of the individual listed on the loan.

OTHER PAYMENT OPTIONS TODAY
Dr Stephen Miller still offers traditional payment options such as cash, cashier’s checks, Visa, MasterCard, Discover, American Express and lay-a-way plans. In addition, if you’re interested in opening a heath care-related credit card, we also participate with Care Credit which offers 0% interest rate for 6 and 12 months and 14.9% interest on extended payment options for 24 to 60 months.

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A local woman openly takes us through her very personal story of finding and beating breast cancer.
http://www.fox2detroit.com/healthworks-sponsored-by-henry-ford-health-system/30746603-story

fox2detroit

“I was lying in bed reading and, for whatever reason, I felt a twinge and reached over and did a squeeze and felt a really big lump. So, that was three weeks from doing a self-exam and feeling nothing to feeling a really large lump,” she remembers.

That lump would change everything.

Susan was quickly diagnosed with an aggressive form of breast cancer.

“Horrified. I was terrified. It’s a very frightening diagnosis,” she says. Her first instinct is to get rid of the cancer with chemo and then with a double mastectomy.

“Whatever I could do to live was the only thing that was important to me,” she says. But at the same time Susan methodically considered her treatment options.
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“Then you start thinking, ‘Well, why shouldn’t I look as good as I can?'” she says. That’s how she ended up at St. John Hospital with plastic surgeon Dr. Melek Kayser. Susan decided on a lesser known option called fat grafting, or moving the fat from one part of her body to another.

“We create the entire breast mound from a patient’s body fat,” Dr. Kayser explains.

First there’s liposuction, then that fat is processed and injected.

“I was lying in bed reading and, for whatever reason, I felt a twinge and reached over and did a squeeze and felt a really big lump. So, that was three weeks from doing a self-exam and feeling nothing to feeling a really large lump,” she remembers.

That lump would change everything.

Susan was quickly diagnosed with an aggressive form of breast cancer.

“Horrified. I was terrified. It’s a very frightening diagnosis,” she says. Her first instinct is to get rid of the cancer with chemo and then with a double mastectomy.

“Whatever I could do to live was the only thing that was important to me,” she says. But at the same time Susan methodically considered her treatment options.

“Then you start thinking, ‘Well, why shouldn’t I look as good as I can?'” she says. That’s how she ended up at St. John Hospital with plastic surgeon Dr. Melek Kayser. Susan decided on a lesser known option called fat grafting, or moving the fat from one part of her body to another.

“We create the entire breast mound from a patient’s body fat,” Dr. Kayser explains.

First there’s liposuction, then that fat is processed and injected.