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”

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

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.

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.

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.

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.


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.

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

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

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

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

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

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

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

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

Fat versus fillers

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

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

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

It’s a case-by-case decision.

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

Washington Plastic Surgery

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.



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.

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.

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.

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

A local woman openly takes us through her very personal story of finding and beating breast cancer.


“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.

“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.

Trend Alert: Patients want to look like they do with Instagram filters

While it’s not uncommon for those seeking cosmetic procedures to request certain celebrities’ features, the latest plastic surgery trend sees women using their own edited snapshots and flawlessly filtered Instagram selfies.

According to a study by the American Academy of Facial Plastic and Reconstructive Surgery, one in three plastic surgeons have seen an uptick in requests for facial plastic surgery procedures due to people wanting to look better in selfies. Many attribute this to the use of filters on Instagram, the social media app. Instagram has a number of filters that allow people to see a better version of themselves with a swipe of their finger. These filters are being used so often, people regularly see the potential for beauty, and come into plastic surgeon’s offices with questions about how to achieve “that look.”

Filters are increasingly popular, with the Willow filter making faces look a little more defined and the Early bird filter giving a warmer, softer glow. According to The Daily News, certain filters, such as Rise and Toaster, can de-emphasize pores and imperfections by highlighting your skin, while others such as black and white filters are eliminating red or ruddy complexions.

Many patients coming into their plastic surgeons’ offices are generally concerned with wrinkles around their mouth, their complexion, and dark spots or red spots. Non-surgical treatments such as Botox, dermal fillers, and chemical peels can take care are many of these issues.

One patient used Instagram filters to disguise her sagging jowl. Realizing that she wanted to look like she did in her edited photos, she opted to have a neck lift after showing her surgeon her Instagram pics and is no longer using filters on her selfies.

The future of social media, is visual content. Everybody has a phone, can take a picture and share it easily. The question becomes what is the image you want to show? And selfie is one way in which you can control that.

Although this new trend may seem odd, it is considered by those in the industry as a step in the right direction. For one, the people who ask for these procedures do not wish to look like another person. They only want to be better or younger-looking versions of themselves. This goes right along with the known positive effects of plastic surgery and an individual’s confidence.

The AAFPRS said this new selfie driven trend shows no sign of declining as there’s been a 33% bump in procedures driven by self-awareness from social media since 2013. After all, selfie sticks were ‘must-have gifts of this past holiday season.’

Steven K Struck MD
3301 El Camino Real #200, Atherton, CA 94027
(650) 562-0587

Dr. Stephen Miller has a keen eye for aesthetic quality. He brings to his Las Vegas plastic surgery practice a unique blend of intense training, surgical excellence, deep compassion, and unparalleled artistic judgment.

Our elegant plastic surgery office in Las Vegas Nevada is the perfect place in which to research your cosmetic surgery procedure. At the office of Dr. Stephen Miller, we have a deep understanding of the important role that physical image plays in life, yet we never lose sight of emotional well being. Our approach to cosmetic surgery integrates both body and mind to promote overall health. Our guiding principle is to treat you with the utmost respect, help you make an educated decision about surgery, and to provide you with the finest medical services in the safest, most professional environment.

Combining artistry with state-of-the-art medical technology, Dr. Stephen Miller offers a comprehensive range of surgical and non-surgical procedures to help you improve your appearance and elevate your self-confidence. Whether you are considering cosmetic or reconstructive surgery at our offices, Dr. Miller and his staff will help you understand your available options. We will work with you personally, to first determine what you wish to achieve cosmetically and then use all of our skills, talents and technological capabilities to help you reach these goals. We will provide unparalleled follow-up services to ensure you realize maximum results as well as peace of mind.

Contact us online or call us at 702-369-1001 to schedule your complimentary consultation.

Stephen M. Miller, MD, PC, FACS

8435 South Eastern Avenue #100 Las Vegas, NV 89123

Phone: (702) 369-1001


It’s that time of year! We have so many delicious treats to indulge in and festivities to attend. Sweets and other goodies are one of the things people look forward to during the holiday season. You may have a family favorite recipe or enjoy the special holiday store baked goods. (See below for a Norman Dental favorite recipe.) Indulging on sugary foods can lead to cavities if you don’t take proper care of your teeth. Be merry this holiday season and enjoy your favorite sweets! Just be sure to take proper care of your teeth. Here are some tips to help you do that.

Use Straws

You can minimize the damage that sugary beverages do to your teeth by using a straw. Straws help reduce the amount of the beverage that comes in contact with your teeth. They also help prevent staining.

Chew Sugar Free Gum

Sugar free gum can actually protect your teeth from cavities. Chewing sugar-free gum can stimulate the production of saliva. Saliva naturally cleans your teeth and mouth. Chewing sugar-free gum can also help prevent the plaque in the mouth from creating extra acid. Furthermore, sugar-free gum can help balance the PH in the mouth.

Eat Your Snacks with a Meal

It is better to eat sugary foods as a part of a meal instead of eating them alone. More saliva is produced when you eat large meals, and this helps prevent food from sticking to your teeth. The saliva also helps neutralize acid. These acids can cause cavities.

Rinse Your Mouth Out

You can protect your teeth by rinsing your mouth out for 15 to 20 seconds after eating something acidic. This helps prevent the acid from attacking your teeth. It also helps stimulate saliva production. Rinsing your mouth out after eating something acidic will help protect your enamel.

Brush Your Teeth

Brushing your teeth is one of the most important things you can do to protect your teeth and prevent cavities. We recommend you brush at least twice a day for two minutes each time. Consider taking a travel toothbrush with you to holiday events so you can brush your teeth shortly after your meal. To give the saliva a chance to neutralize the acid in your mouth, we recommend you wait about 30 minutes after eating before you brush.

Norman Dental Favorite Holiday Recipe

Try this and tag us in your Facebook post when you upload a photo!

Recipe submitted by Vickie

12 oz. macaroni

¼ c. margarine

¼ c. flour

1 tsp. salt

½ tsp. pepper

¾ tsp. dry mustard

3 ½ c. milk

5 c. cheese, grated

Cook macaroni and drain well. Melt butter, stir in flour, salt, mustard and pepper. Stir until smooth; stir in milk and 4 cups cheese. Mix well. Add macaroni. Mix well. Pour in large casserole dish. Bake at 350 degrees for 45 minutes. Sprinkle with remaining cheese and let sit for 5 minutes before serving.

Considering liposuction? Are you a candidate?

In the battle of the bulge, many people are interested in exploring the option of liposuction as a way to get rid of unwanted fat. Liposuction is not a quick fix substitute for exercise or eating a healthy diet. Although the concept of suctioning excess fat may seem simple, liposuction is actually a complex medical procedure. The main challenge is to remove the right amount of fat without upsetting surrounding blood vessels and tissue. Also the surgeon must make sure to maintain the patient’s fluid balance.

Different Liposuction Procedures

In order to suction fat, the tissue must be broken up before it is suctioned through a straw-like tool called a cannula. Liposuction procedures differ in the way they accomplish this. Here are some examples:

1. Suction Assisted Liposuction

In Suction Assisted Liposuction, the physician manually breaks up the fat tissue by moving the cannula back and forth prior to removing it with a vacuum apparatus.

2. Power Assisted Liposuction

Power Assisted Liposuction uses a motor which enables the surgeon to break up the fat mechanically as opposed to moving the cannula back and forth.

3. Ultrasound Assisted Liposuction

With Ultrasound Assisted Liposuction, sound waves are used to emulsify the fat

4. Thermal Lipolysis

Thermal Lipolysis applies laser energy to break up the fat tissue. Although laser is a form of light, it converts into heat energy within the body.

5. Water Assisted Liposuction

Water Assisted liposuction applies a fan shaped water beam to loosen the fat tissue

For more information about liposuction surgery procedures contact Reza Nabavian MD, a board certified plastic surgeon in Santa Monica Ca.