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2011-03-07T07:52:00.000-08:00

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2010-07-03T09:36:00.000-07:00

Asian Eyelid Surgery

2010-06-26T05:57:00.000-07:00

Asian Eyelid Surgery

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Dr. Edward S. Kwak is a New York City board certified surgeon specializing in facial plastic surgery. His focus is cosmetic surgical procedures strictly limited to the face and neck region.

Dr. Kwak graduated cum laude from Tufts University. His medical education began at Indiana University School of Medicine where he garnered several academic awards including induction to the Alpha Omega Alpha medical honor society and the Eli Lilly/K.K. Chen Pharmacology Award. After medical school, Dr. Kwak moved to New York City for his post graduate medical training. He studied one-year of general surgery at Saint Vincent's Hospital in Manhattan. After this year he went on to one of the country's most prestigious residencies in Otolaryngology-Head and Neck Surgery at The New York Eye and Ear Infirmary. As a resident, he earned the J. Swift Hanley award for his research in Head and Neck Surgery. Upon completion of residency, Dr. Kwak was chosen to one of the elite fellowships in facial plastic surgery at the University of Texas-Texas Medical Center in Houston, Texas, under the preceptorship of Dr. Russell Kridel and sponsorship of the American Academy of Facial Plastic and Reconstructive Surgery. Upon completion of his fellowship, Dr. Kwak traveled to Seoul, Korea where he served as a visiting surgeon to some of the country's most famous plastic surgery clinics.

Dr. Kwak has written several scientific articles and book chapters on numerous topics in facial plastic surgery. He continues to give national lectures on advanced Rhinoplasty techniques. Dr. Kwak is a Clinical Assistant Professor in Head & Neck Surgery at The New York Medical College and is also responsible for teaching in-training surgeons facial plastic surgery at Saint Vincent's Hospital and The New York Eye and Ear Infirmary.
In your experience, what's the most effective surgical technique for an Asian DES?
Asian double eyelid surgery is one of the most common cosmetic procedures performed on patients of East Asian decent. This procedure is done to create an upper eyelid crease. Approximately 50% of East Asians are born without a supratarsal fold (aka double eyelid crease).

This procedure can be performed using several techniques. But the major difference in techniques is whether the surgeon approaches this surgery using an incision or a suture technique (non-incision) to create a double eyelid fold.

Incisional technique
This is when an incision is made in the upper eyelid which is placed within the desired crease to be formed. The approach allows the best exposure to the upper eyelid anatomic structures and the surgeon can directly visualize specific changes made. There are some variations in this approach, such as limiting the size of the incision, or partial incision double eyelid surgery. This approach requires skin closure with sutures (stitches) to re-approximate the cut edges of the skin.

Pros: more predictable long-term outcomes, more control to create precise placement of the desired fold, able to address other anatomic factors to the eyelid (such as addressing upper eyelid fat deposits, excess muscle, and redundant upper eyelid skin).

Cons: increased healing time, increased potential for a conspicuous scar, and irreversible

Non-incision-suture technique
This technique involves the use of a suture to create the desired changes. The suture is passed through the upper eyelid structures in such a way, so as to create an upper eyelid crease, while positioning the suture to be concealed deep the upper eyelid skin. Typically this is performed without making an incision in the upper eyelid skin.

Pros: relative ease of performing the procedure, quick recovery time, reversible

Cons: Unable to address other structures in the eye (redundant skin, fat, or muscle), increased potential for loss of crease over time, increased potential for asymmetry, and higher rates of relapse (loss of fold).

While I perform both techniques, the approach I recommend is customized to each individual's concern. Factors, including your desired changes, your eyelid anatomy, and your lifestyle are all important consideration when determining which technique best suits you.

What is the healing time for this surgery?
Almost every perspective patient inquiring about Asian eyelid surgery, or double eyelid surgery, has concerns regarding healing time. Appropriately so, since many of my patients have highly demanding professions in the New York City metropolitan area.

For the incisional double eyelid technique, the typical postoperative healing time is as follows:

The first day after surgery, we have all patients return to our office to monitor their healing. At this time you can expect to have some swelling and potentially some bruising to the upper eyelid. Your eyelid crease height will be also exaggeratedly high, because of this swelling. On day 3-5, you will make a second post-operative visit to our office. On this visit, some or all of the skin sutures will be removed. On day 7, you will make a third post-operative visit to have any remaining skin sutures removed. At this time, most of the bruising has resolved and swelling to the eyelid has come down so that most patients feel very comfortable to return back to work. Week by week, the swelling in your eyelid will subside for up to 3-6 months after surgery, however most of the swelling will have resolved by one month after surgery.

The amount of bruising and swelling varies person to person, however to help minimize swelling after surgery, I recommend using ice packs to the eyes for the first 48 hours after surgery.

What are the various shapes that I can expect after a DES?
The most common cosmetic concern patients discuss with double eyelid surgery is the height of the crease/fold, which is the distance from your upper eyelid margin and the eyelid crease. I typically recommend a crease height of 2-3mm for most patients. In the central part of the upper eyelid the eyelid crease can take on two shapes: tapered or parallel. For the tapered shape the eyelid crease gradually tapers down to fuse with the upper eyelid margin. As for the parallel shape, the upper eyelid crease extends parallel to the upper eyelid margin maintaining a distinct crease shape.

One additional area of the eyelid which influences the shape of the upper eyelid and width of the eye appearance is the epicanthal fold. The epicanthal fold is present during early infancy in all ethnic groups. However in most ethnic groups as the face grows this fold becomes less apparent. In adulthood, the epicanthal fold is a unique feature to the Asian eye. The epicanthal fold is located on the middle portion of the Asian eyelid and is essentially redundant skin overlying the lacrimal lake (the pink portion of the central eyelid). The shape of the epicanthal fold can vary considerably, with a prominent fold creating a smaller appearance to the eye. An epicanthoplasty is a surgical procedure performed to change the shape of the epicanthal fold, typically to reduce this skin fold and to have more of the lacrimal lake showing, thereby increasing the overall width of the eye.

Edward S. Kwak MD
ESK Facial Plastic Surgery
170 West 12th Street
Spellman 5
New York, NY 10011
(212)-229-1100
(212)-229-1105 (fax)
www.eskfps.com

gummy bear breast implants

2010-06-19T13:17:00.000-07:00

Gummy Bear Breast Implants
Breast Augmentation - Gummy Bear Breast Implants

gummy bear breast implantsA woman’s breasts have become a symbol for her sexuality, and it is considered by most as the part of the body that needs to be kept in the best shape. Women enhance their physical beauty to fulfill their need to radiate their youthfulness and womanhood. Willing to go as far as cosmetic surgery to improve their appearance, one of the female testimonies to artificial beauty is breast augmentation.

There are a variety of ways to augment one’s breast. Saline and silicone implants have been the most popular methods. Recently, however, a new silicone method made its debut after getting FDA Approval in 2006. Commonly called gummy bear breast implants, the cohesive gel breast implants have by far, been the biggest buzz in breast augmentation.
Gummy Bear Feel vs. its Predecessors

Gummy bear breast implants are implants that come in the form of implant products that use a firmer and solidified silicone gel as its base. The reason why it has been given the gummy bear pseudonym is because of how it reacts when you cut it. When you slice into it,, you will feel a sensation not unlike how gummy bear candies feel like: a soft solid that does not spill when its outer shell is ruptured.

Before the gummy bear breast implants were introduced, the most popular methods were the saline and the silicon implants. Saline implants are silicone rubber shells filled with saline solution, and formed to the desired shape of the patient. Silicone implants, on the other hand, are implants pre-filled with a fat-like silicone substance. It is fluid and sticky.

For a long time, the use of these implants were all the rage, until certain drawbacks started becoming apparent. Problems arise when the implant shells are ruptured. Saline implants deflate when ruptured, and the liquid that spills out will eventually be absorbed by the body. You can just insert another implant afterward, however.

Silicone implant rupture, on the other hand, may cause breast pain or deformity to a patient’s breast, and needs surgery to be removed from the body.

Compared to its two predecessors, gummy bear breast implants will hold together when ruptured. This is because it is solidified, and comes with a thicker outer shell. Moreover, this implant feels more natural to the touch than the other two, and there is the apparent lack of a watery sound when the breasts move around (unlike saline solution implants).

Appearance-wise, the gummy bear implants are like nothing you’ve ever seen. The solidified gel’s consistency makes your breast look more natural. They hold their form, and will not likely wither, ripple or lose their shape over time. With these new breast implants, sagging risks are also lessened.

Gummy bear implants actually have almost the same composition as that of silicone breast implants. The only difference is that they have stabilized the bonds using cross-linkers, helping the molecules better bond to each other, thereby creating a more stable shape.
How will you know if Gummy Bear Breast Implants are for You?

These implants are open to first timers in breast augmentation, patients who wish to undergo breast augmentation revision, or to those who underwent mastectomy and need breast reconstruction. However, patients with specific medical problems need to reconsider. To be able to get the implant, a willing participant will undergo ten years of follow-up check up, and should live within the area of the surgeon.

asians and breast augmentation surgery !

2010-06-11T10:18:00.000-07:00

Breast implants for Asian women is a particular subspecialty of the breast augmentation procedure. Asian women are statistically smaller framed and smaller breasted than many other ethnicities. In today’s multicultural society, many Asian women find they would like to have a fuller bust line, yet do not want to look disproportionate or obviously enhanced.

Breast Implants for Asian Women
Breast Implants for Asian Women / Society
Many Asian countries glamorize pop stars and actors who have been surgically enhanced. This has created a rather sudden surge of women who would also like to increase their breast size and fullness. Fashion has also greatly contributed to this demand, since many styles are tailored to fit more curvaceous figures and have a tendency to hang on the smaller breasted build common to many Asian women. Finally, the world is an ever shrinking place and many women have been blessed with larger breasts on a small frame, due to a mixed heritage of Asian combined with another ethnicity. These women are often envied for their exotic looks and dramatic builds. It is no surprise that cosmetic surgery is on the rise all across Asia.
Asian Breast Implant Considerations
The typical Asian build is smaller and lighter than White, Black or Hispanic women. Obviously, this does not apply in every case, but is often a very true stereotype. Petite women have special needs when it comes to breast augmentation surgery since they must chose their doctor and breast implant size very carefully. Learning to proportion implants on a smaller framed woman is a specialized art which must be perfected through years of practice. Concealing the implant behind what might be a very small amount of natural tissue is also a practiced science. These are important qualifications to look for during the process of choosing your surgeon. Experience working with many other Asian clients is a good indicator of a doctor who is likely to understand your individual needs and expectations.
Breast Implants for Asian Women Advice
Finding a compromise between enhancement and an organic appearance is the most important factor in Asian plastic surgery. Smaller implants and the correct procedure are often the biggest differences between natural looking results and breasts which resemble swollen shiny circles. As some darker Asian skin might be more prone to scarring and even possible keloid formation, be especially careful that your surgeon has experience dealing with these issues. Talk to your doctor about achieving the look you desire and maintaining that unique beauty which blesses Asian women of all backgrounds.

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2009-11-23T18:46:00.000-08:00

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The New Silicone Breast Implant News

2009-06-09T12:56:00.000-07:00

The New Silicone Breast Implant News

After the moratorium in 1992 only patients who met the FDA’s criteria were candidates for Silicone Breast Implants. Some of these patients included women with chest or breast deformities, women undergoing breast lifts, women who already had silicone or saline implants and were having a problem and women who were undergoing reconstructive surgery after breast cancer.

Breast implants are the most studied medical device in the history of medicine. On April 14, 2005, Mentor Corporation, a leading supplier of medical products in the United States and internationally, announced that an advisory panel to the U.S. Food and Drug Administration (FDA) determined that the Company's silicone gel-filled breast implants are safe and effective for use in breast reconstruction and breast augmentation patients. This 7-2 recommendation for approval, with a series of conditions stipulated by the FDA's General and Plastic Surgery Advisory Panel, represented a significant step towards the current FDA’s approval of Mentor's silicone gel-filled breast implants in the United States. Silicone implants are preferred and used regularly in other countries but were under major scrutiny in the USA.

Limited right to choose
On November 17, 2006 the FDA agency announced that Silicone Breast Implants are once again available for cosmetic use in women over the age of 22 in the USA. After years of studies including information from doctors and patients using Silicone breast implants submitted to the IRB (Institutional Review Board) some women now have the right to chose what type of breast implant they feel comfortable putting in their bodies.

However not everyone will have the right to choose between silicone or saline. The FDA still does not allow patients less than 22 years of age to get silicone breast implants for cosmetic enhancement only. The same women are old enough to vote, drive cars, drink alcohol or smoke cigarettes that are proven to cause cancer, but they cannot chose between a saline or silicone breast implants.

Silicone
Saline Breast Implants are encased in a silicone shell. Almost all forms of implants or prosthesis are made of silicone and approved by the FDA. For example, cheek implants, chin implants, calf implants, nasal implants, knee prosthesis, hip prosthesis and testicular implants are all made of Silicone.

Why did it take the FDA 14 years to lift the moratorium on silicone breast implants? When men’s silicone testicular implants went up for the FDA’s OK they were approved in approximately 6 months with no age or physical restrictions qualifying patients.

Men now qualify for silicone breast implants
In the past men could use silicone testicular implants, but they did not meet the FDA’s approval list for silicone breast implants. After November 17th if a patient is a male/transgender patient who is seeking breast enhancement they now can qualify for silicone breast implants. Under the current FDA’s guidelines men now have the option for silicone breast implants if they are over the age of 22.

Some Grey Areas?
There still seems to be some grey areas in the category of who does and who doesn’t qualify under the FDA’s guidelines for silicone breast implants. What if a surgeon has a patient under the age of 22 who has a breast deformity with only one breast and wants both breasts enhanced? Is the surgeon only supposed to put the silicone implant in on the deformed side and a saline implant on the normal side? The rules are not always black or white.

Even surgeons with years of experience are calling the FDA and implant manufactures to ask about the guidelines in some gray areas of who qualifies for silicone breast implants and who does not.

Known for his expertise in breast surgery, Dr. Corbin’s practice also runs the full gamut of plastic and reconstructive surgery, and is not limited to cosmetic surgery. Regarding breast implant procedures, Dr. Corbin does approximately 450 implants per year, of which approximately only 20% involve the use of Silicone Gel implants. The latter category of implants was in the past reserved for patients who met the Adjunct Study Protocol established in l992, which included patients with reconstructive needs, included, without limitation, drooping breasts (ptosis), asymmetry, and patients that require replacement or revision and for whom saline implants were unsuitable (e.g., skin too thin, etc.).

Corbin says if he is in doubt he has called the implant manufacturers experts to advise him if a patient qualifies for silicone or not.

The right to choose
A Stage III invasive Breast cancer patient Lisa, chose silicone breast implants for her breast reconstruction with Dr. Corbin recently. She had the option of silicone or saline implants because she was a reconstructive patient. “I had a mastectomy on my left breast and went through 3 months of Chemotherapy. My hair was gone. My sense of self was forever altered. I was bald. My breast was gone. The loss of a breast is an extremely difficult experience for a woman to go through. Mind, body and spirit do not go unscathed. ” Lisa finds it interesting that a cancer patient whose immune system may be compromised or weaken by cancer can put silicone in her body and a healthy young woman may not qualify for silicone breast implants. “If silicone implants are safe for breast cancer patients why don’t all women have the right to choose them? I absolutely love mine. The new breast Dr. Corbin created for me looks and feels totally natural. I am so glad I had the choice to choose the silicone breast implants.’’

Ruptures
In its Nov. 17 announcement, the FDA recommends that women using silicone implants have their breasts checked by MRI (magnetic resonance imaging) three years after breast augmentation surgery and every two years thereafter for the course of their lifetime. The MRI is recommended to check for any ruptures of the implants. If a leak or break is detected in the prosthesis "the implant should be removed and replaced, if needed," according to the FDA.

With Saline implants ruptures may be more easily detected. Usually if a saline implant has a rupture it goes flat immediately like a tire would if it had a leak. In some cases however, a saline implant can have a slow leak and a deflation can occur over time.

The newer Silicone breast implants are manufactured differently today than they were in 1992. According to Fred Corbin M.D. he along with other experts toured the Mentor manufacturing plant in Texas recently. He saw first hand the care and precision it takes to make a silicone breast implant. According to Dr. Corbin, “The outer case of the silicone breast implants is thicker and provides a protective barrier also the gel substance inside the breast implants is “cohesive”. The new gel is like one solid unit unlike some of the older silicone gel breast implants where the silicone was more like a liquid. If you cut a new silicone breast implant in half it would not drip out of its case. The breast implant would remain as a cohesive unit. Some experts compare to the new silicone gel’s consistency to Jelly candy like a gummy bear. If you cut a gummy bear in half you have 2 separate cohesive pieces like the new silicone breast implants. If a silicone breast implant or saline breast implant ruptures there is no medical science that concludes a ruptured breast implant a danger to a woman’s health.

Safety
The prosthetic devices were pulled from the general marketplace in 1992 because of some concerns that they could rupture and endanger patients and possibly contribute to autoimmune diseases. After 14 years and many studies, no link to health problems was ever proven. According to Carla Peppler a Research Nurse with the Cross Cancer Institute in Canada she was apart of a clinical trial who researched the causes and treatments for breast cancer for over 20 years.” In the data we obtained and studied from my patients and NSABP there was no correlation between breast cancer and silicone breast implants.” In fact, when my daughter came to me before she had a breast augmentation with silicone implants and asked me if I thought they were a health risk I told her not based on any medical evidence I’ve ever seen.”

Beverly Hills plastic surgeon Dr. Corbin says,” I would feel totally comfortable putting silicone breast implants in my wife or daughters. In fact my wife has the new cohesive silicone implants” True to the Hippocratic Oath he took when he became a doctor, Corbin, also states , “I feel silicone breast implants are safe or I would never perform a single surgery using them on any patient knowing that it could harm them.”

Corbin educates his patients on all the risks and the benefits of breast surgery and according to him,” It doesn’t matter to me one way or the other if a patient who is a candidate for silicone chooses saline over silicone. I get beautiful surgery results with both types of breast implants. I inform my patients as much as I can and the ultimate decision I believe should be theirs.”
After the breast implant surgery is over it’s the patient who has to be happy with the implants they chose to live with and enhance their breasts with and not the plastic surgeons, politicians, lawyers, implant manufacturers or the FDA. Women rights have come a long way and all women and men should have the right to choose saline or silicone. The FDA’s recent ruling on silicone breast implants is a step in the right direction.

Los Angeles Asian Plastic Surgery

2009-06-09T12:50:00.001-07:00

Los Angeles Asian Plastic Surgery

At Enhance® Medical Center, Inc., Charles S. Lee, M.D. is a Los Angeles Asian plastic surgery specialist who aims to provide you with beautiful results and the care you deserve.

Meet Our Doctor

Our Los Angeles Asian cosmetic surgery specialist, Dr. Lee, is board certified by the American Board of Plastic Surgery (ABPS) and the American Board of Otolaryngology (ABOto). He has both the surgical knowledge and skills to provide you with a rewarding surgical experience.

Dr. Lee has taught many Asian cosmetic surgery courses for the American Society of Aesthetic Plastic Surgeons (ASAPS); his attendants are all board certified surgeons.

Procedures

Our physician specializes in a number of aesthetic procedures that can yield an impressive degree of facial rejuvenation:

Rhinoplasty:
In Los Angeles, Asian nose surgery specialist Dr. Lee performs a unique method of rhinoplasty that aims at making the nose larger as opposed to smaller. This has proven to be most effective amongst Asian patients.
Blepharoplasty:
Our Los Angeles Asian eyelid surgery expert has assisted many patients in achieving their goal of improved facial aesthetic quality. During this procedure, Dr. Lee will create more natural-looking creases in the eyelids of the patient.
Cheek Surgery:
With the aid of our Los Angeles cheek surgery professional, Dr. Lee, you can enjoy a refreshing facial image. Our physician understands that by reducing prominent cheekbones or evening out the cheeks, Asian patients will receive beautiful results.
Please contact our office at (310) 271-5954 to schedule a consultation with Dr. Lee today! You may also fill out our online contact form where you can ask a question or share a concern regarding Asian plastic surgery in Los Angeles. Be sure to view our before and after plastic surgery photos and our patient testimonialsto gain further insight into the cosmetic talent of our physician.

Asian Blepharoplasty (Double Eyelid Surgery)

2009-05-24T12:57:00.000-07:00

We offer various cosmetic surgery procedures to meet
the unique needs of Asian ethnic groups.
Asian Blepharoplasty (Double Eyelid Surgery)
Although about half of the Asian population does have a fold in the area above the eyelashes, the other 50% of the population does not. For those without a fold, a blepharoplasty procedure known as Asian double eyelid surgery can create a natural-looking crease. Dr. Charles Lee skillfully performs Asian double eyelid surgery in Los Angeles, California.

Asian vs. Caucasian Eyelids
The difference between Asian and Caucasian eyelids is in the position of the eyelid fold. Asians who do have a crease above their eye have very different looking eyelids than Caucasians. The Asian eyelid typically starts at the crease very close to the eyelashes. As the crease gets further away from the nose, it gets larger and larger until the midpoint of the pupil, at which point the fold runs parallel to the eyelash origin.

A Caucasian lid crease is slightly different in both shape and size. It typically tapers closer to the eyelashes as the fold goes out laterally so that it is more of an upside-down "U" shape, rather than a parallel shape to the eyelash lid. The Caucasian lid crease is also about 20% larger than an Asian eyelid crease. When considering the blepharoplasty techniques that will be used to place a crease, it is important for both the patient and the surgeon to understand that the goal of double eyelid surgery is not to westernize an Asian face, but to create a crease that looks natural.
Asian Double Eyelid Surgery Methods

DST Double sutures and twisting method (DST) technique is the most sophisticated of the suture (non-incision) methods of double eyelid surgery. The traditional suture method has been criticized for its relatively high breakage rate and indistinct folds, which fade over time. The DST technique addresses these disadvantages while maintaining the benefits of a suture technique, such as the virtually scarless fold, a supreme naturalness to the crease, the potential reversibility and the quick recovery, which takes just a few days instead of weeks. In a suture method eyelid procedure, a crease is created by burying permanent non-reactive sutures (prolene, used in heart valve surgery) pinching a bit of the undersurface of the eyelid skin to the deep soft tissue of the eyelid.

An analysis of fold failure in such cases reveals that sutures do not usually break, but rather the sutures cheesewire through the soft tissue of the upper eyelid. The DST technique rectifies this problem by securing the sutures to firmer structures less likely to allow the sutures to tear through. This is accomplished by first securing one end of the sutures to the firmest structure of the upper lid, the tarsal plate, which is made of strong cartilage.

The other end of the suture is interlinked to an adjacent suture, much like two links on a chain. A bit of the underbelly of the eyelid skin is pinched into the suture before tying the knot. This results in a firm interlocked fold which is tremendously resistant to tearing through or breaking.

The published report for breakage or loss of fold is approximately one percent per year (ten year follow up).

This statement is remarkable for two reasons. One is that a claim of superior results has been supported by scientific data, a rare accomplishment in and of itself in aesthetic surgery. Secondly, an extraordinarily low failure rate has been established, comparable to an incision method. We hope to dispel some common misconceptions. First and foremost is the notion that the DST technique frequently fails or disappears over time. This has been repudiated by published study, our extensive personal experience with hundreds if not thousands of cases, and a reasoned explanation of why this procedure works. In anecdotal comments we have received, the most common source of misinformation has been in confusing the DST technique with traditional suture techniques that are unreliable.

Another misconception is that the DST technique results in more scarring than an open procedure. Because no significant incisions are made, there is virtually no scarring. This lack of scarring allows the procedure to be reversed by simple removal the sutures. In addition, we have confirmed during the occasional re-surgery that DST patients have much less scarring than those that have had prior incisional surgery. The ease with which re-surgery can be performed is reflected by the fact that we have always been able to revise DST procedures without difficulty.

As a practical matter the DST procedure continues to have tremendous appeal and secure reputation in the Beverly Hills and other Southern Californian communities. The majority of patients have referred themselves to our office after their friends have had the procedure done and have witnessed.

Fold failure after prior incisional surgery elsewhere (left) corrected with DST suture technique (right)

We consider the DST technique the procedure of choice for the ideal candidate, as described below. The best candidates for the DST technique have: A) thin skin that is not excessive and do not have a lot of upper lid fat, have not had prior eyelid surgery; B) whose brows are not low or heavy; C) who do not have complex eyelid problems such as ptosis ("sleepy eye") or retraction (overly pulled upper lid). Other candidates for the procedure include A) men, who generally cannot conceal the incisions with makeup, B) smokers (more than ten cigarettes per day), who are at higher risk of prominent scar. C) Patients with a fear of incisional surgery. D) Those in need of quick recovery period, who have a few days, not weeks.

Risks of surgery Debate continues regarding the preference of incisional vs. suture method crease formation. Although suture techniques are sometimes disparaged as inferior surgery, patients resistant to the incision technique know something on an instinctive level - that the risks of an incisional surgery are more significant. The main risk of suture technique is fold failure. This is an annoying, embarrassing, but ultimately a readily correctable problem. The significant major risk of incisional surgery, on the other hand, is damage to the levator mechanism, which can result in ptosis (sleepy eye) or retraction (lid stare). Inexperienced surgeons can also create havoc by over removing fat and/or skin, resulting in an uncorrectable, permanent deformity. Finally there is on occasion the poor scarring and permanent puffiness of the upper lid, overwhelmingly which occur in smokers, cigarettes or otherwise.

Incisional technique The ideal candidate for Incisional technique include patients who are A) older than the latter 20's, B) have excess skin or fat, C) desire a larger, dramatic fold who have a preference for an Incisional technique. Some of the less ideal candidates for this technique include: A) Smokers (more than ten cigarettes daily), B) who will scar more prominently C) Excessively saggy brows or deep forehead wrinkles, whose correction would lead to too much removal of upper lid skin. D) Multiple prior upper lid surgeries, whose scarring results in limited eyelid function, and who probably should limit themselves to correcting eye problems related to function, not appearance enhancement.

Surgeons differ in two major areas: the crease markings which will determine the shape and size of the fold, and technique of surgery, namely which deep eyelid structure will the skin be secured to. Although many types of folds have been described, the most natural (hence, ideal) shape of the fold is a tapered fold and the parallel fold, referring to the shape in relation to the margin of the inner half of the eyelid. The ideal size of the fold allows 2 - 3mm of skin above the eyelashes to show on direct frontal view with the eyes open. This also usually corresponds to a crease set at 10mm from the lash line when the eyes are closed (with the skin on light tension). This height is modified based on whether the eyeball is slightly deep set (larger crease) or overly shallow (smaller crease). This height also corresponds to the size of the tarsal plate, the cartilaginous skeleton of the eyelid. Skin excision is usually needed, determined by the sagginess of the brow - more skin removal being required for saggier brows. Skin excision is limited to 3 or 4mm in order to maintain the naturalness of the eye area and prevent risk of dry eyes. Patients over age 40 and those who require more correction than this are strongly encouraged to consider a brow lift. An advantage of undergoing an evaluation from a plastic surgeon certified by the American Board of Plastic Surgery is that such surgeons are trained to evaluate and treat not only your eyelids but your face in its entirety, whether it is the eyebrows or the midface.

More dramatic folds result from an incisional “anchor” blepharoplasty with a brow lift.

Technical differences between surgeons involve the structure to which the eyelid skin-muscle is secured. One structure preferred by some surgeons is the septum, lying deep to the skin-muscle. The advantage of securing the fold to this structure is that there is minimal swelling due to the limited dissection. The disadvantage is that any excess fat, which lies just deep to the septum is not addressed. Also the limited dissection leads to a higher rate of crease failure. Perhaps the most popular technique today is securing the skin to the levator aponeurosis, the structure just deep to the fat and which is responsible for pulling the eyelid open. This technique, developed in the 1960's by plastic surgeon Leabert Fernandez, is considered the first modern technique for double eyelid surgery. Although probably used by more surgeons than any other, a drawback is the not-insignificant rate of fold failure and imprecision in the crease. This phenomenon is due to the fact that the levator aponeurosis is a structure with a glossy, teflon-like surface, necessary for gliding motion as the levator aponeurosis lifts and lowers the eyelid. This slippery surface, unfortunately, also can resist attempts to attach the skin-muscle to it when creating a surgical fold. This can result in imprecise folds that "slide" around. This also accounts for the occasional fold loss.

Prior incisional surgery with skin fixation to levator aponeurosis performed elsewhere resulting in multiple creases, indistinct fold, and left eyelid ptosis (droopage) (left photo).

Correction using anchor technique with fixation of skin to tarsal plate and correction of detached levator aponeurosis (right photo).

The most precise, permanent folds result from securing the skin-muscle to the tarsal plate, lying beneath the levator aponeurosis. Fat and other slippery soft tissues are removed to allow the muscle and skin to attach to the rough raw surface of the tarsus. The result is a secure permanent crease. This technique is known as an "anchor blepharoplasty". One drawback of this technique is the complexity of the operation which has limited the number of surgeons who feel comfortable with this technique. Performed properly, however, the procedure results in a highly stylized precise, permanent crease.

S = Skin
F = Fat
LA = Levator aponeurosis
TP = Tarsal Plate

In the “anchor” technique, the crease is secured to the Tarsal Plate rather than the Levator Aponeurosis resulting in a more secure fold. The levator aponeurosis has a slippery, shiny surface which is a less secure structure than the tarsal plate for suturing.
Medial epicanthoplasty The medial epicanthus (ME), or Mongolian fold, covers the inner corner of the eyelid. The degree of severity can be categorized as non existent or mild, moderate and severe, depending on how much of the caruncle (the pink "bump" inside the eye corner) is exposed. The severe cases should be corrected; for moderate folds, correction is optional. One popular technique for correction is to remove a crescent of skin along the ME. The location of the incision is parallel to the edge of the fold, in an attempt to hide it. Our observation is that this frequently leads to a widening of the scars due to the stretching forces resisting against the incision. In addition. the crescent removals are frequently performed as one long incision connected to the double-eyelid incision. We find that the continuous incision contributes to an undesirable appearance of the scar. Instead, our preference is what is called a "v-w plasty" in which incisions are placed not parallel but perpendicular to the edge of the ME. 7 sutures carefully placed with the aid of magnifying loupes usually results in barely detectable scars. However, we limit this procedure to non smokers.

Double sutures and Twisting (DST) method Asian eyelid surgery with v-w medial epicanthoplasty (ME)

For a technical description of the procedures described above geared to physicians, please go to: http://www.emedicine.com/plastic/topic425.htm

View Locations
BEVERLY HILLS CENTER
436 N. Roxbury Drive, Suite 207 Beverly Hills, California 90210
Tel: 310.271.5954
Fax: 310-271-0539

asian rhinoplasty

2009-05-24T12:38:00.000-07:00

asian rhinoplasty (asian nose job)

The same goal exists for rhinoplasty performed on Asians as for rhinoplasty performed on Caucasians, which is to build a natural-appearing structure that blends harmoniously with the face. As a group, Asians require augmentation of the nose to achieve this result, in contrast to Caucasians who usually require reduction. As with other types of surgery performed on Asians, successful surgery results in a feature consistent with the patient's ethnic identity. Thus, the goal of surgery should be an attractive Asian nose, not the creation of an attractive Caucasian nose on an Asian face. For more information on aesthetic medicine, including news and CME activities, visit Medscape’s Aesthetic Medicine Resource Center.

History of the Procedure

Previously, surgery has focused primarily on dorsal augmentation. Although still performed (especially by nonphysicians or those with limited training), injection of paraffin or liquid silicone has been replaced by alloplastic augmentation, most commonly silastic. Historically, the surgeon addressed the tip by augmenting it together with the dorsum in a one-piece, L-shaped implant with the bend of the L forming the new tip. Because extrusion at the tip remains an ongoing concern with implants of this type, the surgeon frequently protects the tip with cartilage from the ear, septum, or lower lateral cartilage.

The nasal tip and especially nasal tip lengthening vis-à-vis facial thirds remains the primary challenge of Asian rhinoplasty. The popularity of open rhinoplasty in the United States has led to an increased interest in applying this method to Asian rhinoplasty.

Nevertheless, due to the poorer healing characteristics of Asian skin, currently the author prefers the endonasal approach to Asian rhinoplasty.

Problem

Address the problem as isolated to the dorsum, tip, alar base, vertical dimension, or all of the above. The Asian nose shares similar ideal dimensions with the Caucasian nose but with emphasis on subtleness: the dorsum requires less height, the tip less definition, the alar base less narrowness. As in Caucasians, ideally the radix begins at or slightly below the lash line. The length, measured from the idealized radix to the base of the columella (subnasale), occupies the central third of the face. The tilt of the columella measures 90-115° from the vertical plane, with higher angulation preferred for smaller women.

Southeast Asians (Malay, Filipino, southern Chinese) typically require the most dorsal augmentation (4 mm or more), while northeast Asians (Korean, Japanese, northern Chinese) require less (1.5-2.5 mm) or none. It may be necessary to better define the tip and increase its projection. A deficient premaxilla may need augmentation, as evidenced by a retracted columella with deficient columellar show from lateral view. The nose may require lengthening as measured from the radix to the tip or from the radix to the base of the columella.

The need for alar reduction is frequent in southeast Asians but much less so in northeast Asians. In most cases, both the flare and width need to be corrected; this necessitates an incision into the alar groove.

Pathophysiology

Skin

Nasal skin's thickness better conceals the anatomic detail of the underlying nasal skeleton. This allows better blending of alloplastic or autogenous augmentation with native tissues. Nevertheless, do not use this as an opportunity for sloppiness in surgical technique, because in this patient population, expectations are exceedingly high.

Cartilage

The more delicate cartilaginous tissues of the lower lateral cartilage generally require reinforcement with autogenous cartilage from the ear or septum to obtain a desired result. Affecting a result with pure cartilage reshaping techniques is difficult and usually inadequate. Septal cartilage frequently requires two-layered reinforcement because of its thinness. When harvesting septal cartilage, preserve 1.5 cm of caudal and dorsal septum to prevent nasal dorsal collapse. In about 20% of cases, the septal cartilage is inadequate and additional cartilage from the ear is necessary.

Generally, the lower lateral cartilage is too soft and pliable to adequately support the tip. Such softness precludes the successful use of onlay grafts to the tip, except for the rare patient who has sufficiently strong cartilage (about 10% of patients). Currently, when the author performs an open rhinoplasty, preference is given to creating an anterior strut graft with ear cartilage. In the author's experience, even 2 layers of cartilage appear inadequate to maintain the projection beyond 2 years. While septal cartilage appears adequate for tip projection in closed rhinoplasty, the compromise of circulation at the tip when using the open rhinoplasty approach may contribute to long-term weakness, absorption of the septal cartilage, or both. Conchal cartilage grafts placed as a strut appear to have a more durable outcome.

When an endonasal approach is used, a 1-layered graft appears adequate to maintain durable tip projection.

When tip grafting, defatting should be limited in order to decrease the likelihood of graft visibility. This is particularly true in the open approach, as the 2-layered graft combined with a columella incision can lead to compromised circulation at the tip area and more significant scarring.

Nasal bones

The shorter and more delicate nasal bones place the patient at higher risk for internal valve collapse; consider spreader grafts in the rare patient requiring isolated dorsal reduction. Fortunately, alloplastic dorsal augmentation functions as a spreader graft, precluding the need for this as a separate maneuver in many cases.

Because of the shorter height of the nasal bones, the author finds that a curved osteotome provides a more consistent result than the percutaneous approach.

Indications

The indication for Asian augmentation nasal surgery is a patient with realistic expectations and mental stability. Asian male rhinoplasty patients appear to have a higher rate of dissatisfaction from nasal surgery. Careful screening is recommended, especially with regard to outcome and the likely shortfalls of the operation.

Relevant Anatomy

First analyze the nasal dorsum, which begins at or slightly below the eyelash line. A straight line drawn from this point to the supratip area determines the appropriate dimensions of the nasal implant. Because of the high visibility of implants ending in the mid dorsum, it may be necessary to lower the height of the dorsum to accommodate a longer implant, even if the dorsal deficiency appears isolated to the radix.

Next, assess the nasal tip for three characteristics: the need for increased projection, tip definition, and/or length from radix to tip. Because of their interrelationship, the need for improvement in any one of these aspects impacts the other two.

The resilience of the lower lateral cartilage determines the approach used to correct the deficiency. According to Millard-Sheen, a well-developed firm nasal tip may require nothing more than a suture-reshaping technique or a graft isolated to the nasal tip identical to a Caucasian rhinoplasty. More typically, a tip grafting technique is required. As the tip becomes increasingly delicate, construct increasingly substantial tip cartilage.

As the nasal tip projection is increased with a graft, the nose rotates cephalically, shortening the radix-tip length. One way to offset this involves suturing the lower lateral cartilages to each other to prevent rotation; bolster this effect with ear cartilage two layers thick, or use a modification of Robert Flowers' toboggan-graft technique (a modified Millard anterior nasal strut). Secure a septal cartilage graft, two layers thick, to the base of the columella, with a buttress behind the graft at the tip if necessary to further offset the tip rotation.

As mentioned above, when using an open approach, the author prefers conchal cartilage, made 2 layers thick, to serve as an anterior strut graft. Perhaps owing to circulatory disruption, septal cartilage appears to weaken or resorb over time, resulting in the loss of tip projection. The endonasal approach preserves better circulation to the tip area, and this may explain the better survivability of cartilage tip grafts. Currently the author prefers an endonasal approach using a 1-layered conchal (cavum) cartilage anterior strut graft with minimal defatting to the tip.

Next, look for maxillary spine deficiency, as evidenced by a retracted columellar base and an acute nasolabial angle. The degree of deficiency may require a plumping graft of cartilaginous tissue. Finally, determine whether the alar base requires correction of width or flare. Increasing the projection of the nasal tip usually obviates the need for this in the northeast Asian population (Koreans, Japanese). More frequently, this procedure is performed on Southeast Asians such as Filipinos and Malay. When correcting the flare, the surgeon should avoid a pasted-on appearance of the nostril at all costs. This is done by preserving a slight curvature to the nostril when making the lateral incision.

Contraindications

Prior injections of liquid silicone or paraffin to the nasal dorsum predispose patients to infections when the nose is augmented with alloplastic material. The patient should accept the risk of infection rates, which border on 40% or more.

Rhinoplasty, Asian

Overview: Rhinoplasty, Asian
Treatment: Rhinoplasty, Asian
Follow-up: Rhinoplasty, Asian
Multimedia: Rhinoplasty, Asian

asian breast augmentation surgery

2009-05-07T21:33:00.000-07:00

Home
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Featured Asian Beauty

Dr. Corbin's patient Grace Kim
Playboy Playmate November 2008
Asian Beauty Gallery
Breast Augmentation Patient Melanie

Name: Llorena
Bust: 34 C
Waist: 24
Hips: 34
Height: 4'11 1/2
Weight: 95

Personal Goals: To own and manage my own dance studio. To have a successful and fulfilled life. And to have a strong, loving, healthy marriage.
Pet Peeves: Dishonest people and people who are always late
Personal Style: Fun and sassy.
Hobbies: Dancing, shopping, traveling, spending time with my family and friends.
Three Most Important Things to Me:
Honesty,
Loyalty,
Respect.
Also My independence, my family, friends and happiness.

Testimonial: I was referred to Dr. Corbin by friends who are his patients. For years I went back and forth on whether I should have surgery or not. Finally, after a lot of thought, I decided it was a decision I knew I wanted to do for only myself. The experience, so far has been wonderful. It was not painful at all, in fact, within a day or two I felt ready to take on the world! I was always secure and confident, but surgery enhanced these qualities even more. I love how clothes fit and look on me more now than ever. The staff was wonderful and Dr. Corbin was amazing! Like anyone considering surgery, I was nervous and scared, but I knew Dr. Corbin and his professional staff would take care of me therefore, I was more excited than afraid. I would do it all over again in a heartbeat. My breast augmentation was one of the best decisions I have made.
Thank you, L.

Schedule your complimentary cosmetic consultation today! click here
Dr. Frederic Corbin
Beverly Hills Office
436 N. Bedford Drive, Suite 202
Beverly Hills, CA 90210
Phone: (310) 284-8384
Dr. Frederic Corbin
Orange County Office
400 West Central Avenue, Suite 101
Brea, CA 92821
Phone: (714) 671-3033
Fax: (714) 671-1231
Asian Breast Augmentation
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boobie's video,are they real or fake titties?

2009-04-26T10:25:00.000-07:00

Boobies - Watch more Funny Videos

silicone or saline breast implants,whats better?

2009-04-26T10:10:00.000-07:00

april 25 2009
Is Silicone or Saline Better?
Posted by Dr Asher Malderan under beauty
by Dr Asher Malderan
Each breast augmentation surgeon has his or her preference. Some prefer silicone implants purely for aesthetic reasons. Silicon breast implants tend to have a more natural texture and over all natural look to them. Others are leery of the risks associated with silicone (see below)

Saline Implants:

Breast implants filled with a saline solution are a newer form of implant and come with some advantages over their silicone counterparts, like the ability to inflate or deflate the implant while in the breast without the need for revision surgery, allowing for complete client satisfaction before after breast implants.

Two types of saline breast implants are currently available at cosmetic breast clinics. The first and classic version is prefilled to a specific volume and size. The second and latest model is constructed with a valve and is filled before the patients eyes for the perfect size and shape, this also allows for future adjustments to be made. The breast surgery cost is the same for both.

There are very few risks evolved when dealing with saline breast implants, they are less likely to rupture and leak. Some studies have shown that bacteria can grow inside the implant and if it leaks or breaks it can cause infection and possible repertory issues. On the up side a break in a saline implant is simple to detect and can be addressed quickly.

Implants made from Silicone

Outer shells of implants made from silicone and are reported to be strong and hold up to a great deal or wear and tear. Unlike saline these implants are made in a particular size and shape. There are every size, shape (tear, round or oval), textures and the shells can be thicker or thinner.

Silicone implants were banned by the FDA in the 90s but have reapproved despite little advancement. Breast surgeons using implants should make the client aware of the risks when going with this type if implant. Studies have concluded that not only can silicone implants lead to cancer (if ruptured) but because of high amounts of platinum and other toxic materials found in the implant, it can lead to diminished motor functions and problems concerning memory.

Ruptures in silicon implants are harder to detect and involve and extra cost each year to check them (they are checked using and MRI which can cost several hundred to thousands every year)

When a silicone implants ruptures there may be no physical signs as the silicon leaks into the surrounding breast tissue.

Added risks include: After having silicone breast implants it has been shown that if the women has children and implant has leaked, the child may be severely affected by the toxins in the implant. Unfortunately a child may still be adversely affect even after the breast plastic implants surgeon removes the implants prior to conception as platinum and other toxins are not expelled from the body.

For cosmetic reason reasons silicone implants are popular because they lend themselves to a more natural look and feel. They do however have a worse rate of rupture and capsular contraction (that is when the tissue surrounding the breast implant hardens up and it can be painful).

For more information on breast implants and breast surgery see the breast foundation.

About the Author:
Dr. Asher Malderan is one of the contributing authors for the Breast Foundation online resource site, giving the latest news and advancements on what you need to know about plastic surgery& prices/fees, listings of the top cosmetic surgeons and the latest for breast surgery implant . For any questions regarding breasts surgery feel free to consult our site via the links.

asian breast augmentation

2009-04-11T07:13:00.000-07:00

creating the perfect asian girl just ad breast implants!

new plastic and reconstructive surgery

2009-04-11T06:58:00.000-07:00

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New & Cheaper Injectable Reloxin May Become Competitor To Botox
Posted on April 7th, 2009 in Facial Plastic Surgery, Plastic Surgeon Interviews & Articles, Procedures & Breakthroughs by MakeMeHeal.com
By Patty Kovacs, Editor-at-Large, Makemeheal.com

As the number of plastic surgery procedures in the United States decline with the tightening economy, a new secret weapon in the war on wrinkles may soon become the hottest age-defying injectable treatment. Called Reloxin, this new injectable may just be the affordable version of Botox to help bailout people who cannot afford the original. Can Reloxin be as effective as Botox? Possibly. Will it be cheaper than Botox? Likely.

Presently awaiting U.S. Food and Drug Administration (FDA) approval, Reloxin is suggested by many as the up-and-coming rival to Botox Cosmetic to become the newest wrinkle fighting injectable to work magic on lines and furrows of the face, particularly the forehead area.

Like Botox, Reloxin (Clostridium botulinum toxin type A-hemagglutinin complex) is an injectable form of botulinum toxin Type A. Also like Botox, small doses of the Reloxin are injected into targeted wrinkle-causing muscles, preventing the muscle from contracting and effectively reducing appearance of wrinkles. But with Reloxin, there is a greater diffusion of the toxin from pontiff injection, quite desirable in certain areas like the forehead.

Reloxin is now approved in 23 countries outside the United States to smooth wrinkles and has also been used outside the United States for more than 15 years to under the trade name Dysport to treat neurological disorders.

Reloxin is currently sold outside the U.S. by Ipsen SA, based in Boulogne-Billancourt, France, outside Paris. In 2006, Ipsen granted Medicis the rights to develop, distribute and commercialize Reloxin as a wrinkle treatment in the U.S., Canada and Japan. Medicis is also the company behind the popular hyaluronic acid injectable Restylane.

“Reloxin is as safe and it works as well as Botox,” says Dr. Ronald Moy from the Moy-Fincher Medical Group for cosmetic and skin surgery in Los Angeles and esteemed professor at University of California, Los Angeles medical school. Having served as lead researcher in a Reloxin study funded by Medicis, Dr. Moy was impressed with the results of the objective study.

Dr. Moy spoke with Makemeheal.com recently as he shared that he’s quite in favor of Reloxin’s potential to serve the cosmetic injectables market. “Many of our patients were happier and got a more natural look with the use of Reloxin. I think it will be a serious competitor to Botox,” Moy added.

A team from the Moy-Fincher Medical Group researchers in Los Angeles conducted the study treating 1,200 patients with injections of Reloxin in sites of the forehead area of the face. As many as five treatments were given during the study. Patients were asked to record the effects of the treatment in diaries and were interviewed 7-10 days after treatment. In addition, patients were reexamined two weeks, then 30 days later, and then again each month after treatment. Many patients reported that the drug started working within days after treatment. After a week, up to 95 percent said they had responded to the medication. The study also found that in many cases Reloxin lasted remarkably long term.

Among the 1,052 patients who completed the 13-month study there were 2,838 adverse events among 880 patients. Of these, 28 percent were probably related to the treatment. These included problems at the injection site, nervous system disorders such as headache and eye problems including ptosis, a drooping of the eyelid or brow. Only one patient withdrew from study due to the side effects of the drug, the researchers say.

Another possible benefit of this new wrinkle relaxer is cost. Reloxin may turn out to be more cost effective than Botox Cosmetic. Medicis has made no decisions on pricing but sources say Reloxin may possibly be priced as much as 15% lower than Botox which will allow it to take a significant share of the billion dollar wrinkle relaxer market. At a recent conference of the American Academy of Dermatology, Reloxin had almost all participants abuzz with anticipation and excitement. Word in plastic surgery circles is that it will at the very least drive down the cost of Botox because of the competition. I’m one for a little ‘healthy’ competition in this market.

For years, Allergan has monopolized the cosmetic and therapeutic market of botulinum toxin type A, taking full advantage of their 83% worldwide monopoly by raising the price of Botox almost biannually. Botox sales for 2009 are expected to be between $1.15 billion and $1.19 billion. Last year’s revenue was $1.3 billion, about half from cosmetic sales. Botox has long been such a U.S. mainstay of cosmetic medicine to reduce forehead wrinkles and frown lines that consumers’ conversational use of the word “Botox” is both a noun and a verb by regular ‘Botox-ers’.

The arrival of a less costly injectable such as Reloxin during the worse recession in decades is timely, as some price-conscious Botoxers will likely shift to using Reloxin if the results are comparable.

Approval for Reloxin is still hush-hush, but its corporate sponsors, Medicis Pharmaceutical of Scottsdale, Ariz., and Ipsen of Paris, have refiled their application for Food and Drug Administration approval to market this new wrinkle-fighting injectable drug in the United States.

Since less quantity is required of Reloxin, the conversion rate of units will initially be sort of like learning a new language. Don’t look to convert units to units, rather work with a trusted physician to learn the required units of Reloxin for your body.

Remember, always carefully research and check the medical credentials and Board Certification of any physician or surgeon you select for cosmetic aesthetic enhancement.

Patty Kovacs, Editor-At-Large at Makemeheal.com, is a published author and beauty expert. Patty is the Executive Producer/Host of The Health and Beauty Revolution Show on wsRadio. Her 800+ interviews include over 450 New York Times best-selling authors.

See Patty’s Websites: www.pattykovacevich.com

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Want a Facelift? Call this Dentist
Posted on March 20th, 2009 in Facial Plastic Surgery, Plastic Surgeon Interviews & Articles, Procedures & Breakthroughs by Patty Kovacs
By Patty Kovacs, Editor-at-Large, Makemeheal.com

Back in the 1980’s Sam Muslin, DDS, MAGD, a practicing Santa Monica dentist, was testing a then unknown product called veneers to enhance the smile of a select group of his patients. What is today known as cosmetic dentistry began with pioneering expert dentist like Dr. Muslin.

Dr. Muslin’s continued application of veneers and his meticulous assessment and rebuilding of teeth to achieve a more aesthetically pleasing smile led him to perfect his art of beautiful dentistry. Developing his own signature style, he began to notice that specific applications produced distinguished, improved facial dimension. His dental work was transforming receding chins, sunken jaws, and thinning lips into stronger chins, sculpted jaws, and fuller lips. With his unique methods and dental expertise, he was creating gorgeous smiles and turning back the clock on otherwise sagging, aging faces.

He called the procedure Face Lift Dentistry as word got out and patient after patient came to him from around the country for state-of-the-art cosmetic dentistry and facial rejuvenation without plastic surgery.

Face Lift Dentistry is a unique, patient-centered, restorative, and bite-reconstructive treatment that requires only dental restorations, no actual facial surgery, yet utterly remarkable facial rejuvenation is naturally achieved. No stitches, no cosmetic injectables, and minimal to zero grinding down of the patient’s natural teeth. The procedure can be completed in as little as two office visits. Face Lift Dentistry is a level of care that exceeds all previous levels, the highest, most complex level of dental care made possible by improvements in advanced technology using Dr. Muslin’s refined techniques. This super specialty procedure is highly concentrated, utilizing and coordinating the most advanced dental technologies available to achieve the ultimate level of individualized dental care while also achieving astonishing facial rejuvenation.

“What are my goals of Face Lift Dentistry?” asks Dr. Muslin. “To achieve the absolute best jaw position and comfort, tooth angle, dental health level, clear speech, ideal facial support and optimal facial length possible. The result? A weak chin appears stronger, a short, round face is elongated, a collapsed bite is restored, and a remarkably improved facial profile results. That’s why I call it Face Lift Dentistry.”

I met Dr. Sam Muslin at a medical luncheon at the Regent Beverly Hills, sure that I would discern his technique to be somewhat questionable. He quickly proved me wrong and now I’m a fan. His results are astonishing. Facial wrinkles and weaknesses become more obvious with age. When you think about it, it just makes good sense to incorporate enhancing one’s smile and facial dimensions simultaneously. Big plus? No surgery. Dr. Muslin is going far beyond conventional dentistry and his before-and-after patient photos and testimonials tell the story.

“The Dental Face Lift technique plumps the appearance of thinning lips, adds volume to sunken cheeks, elongates an otherwise weak jaw and chin, and makes taut that ugly, loose turkey neck. The technique naturally enhances the patient’s unique soft facial tissue with restructure of the hard tissue: the teeth. In other words, it’s much more than a ‘dental smile makeover,’” he explains.

A careful, three-dimensional analysis of the patient’s entire face geometry begins the initial procedure. A highly customized course is determined to reconstruct the patient’s bite as well as to enhance the patient’s entire facial structure. No surgery is required on the face or any soft tissues. Only the teeth are treated.

“The development Face Lift Dentistry actually allows a patient to change what nature created and turn back the hands of time. Instead of being satisfied with the length of our face and the position of our jaw that we grew into randomly at a young age, we can now utilize this dental technology to achieve the best possible face, lips and jaw position possible while restoring youthfulness to the entire face,” says Dr. Muslin.

The procedure restructures the face, the bite, even the health of the entire body by maximizing the potential of the teeth to support the overall facial structure, lips and cheeks. It removes years off the facial appearance, vertically lengthening the face, actually smoothing out wrinkles, giving a naturally thicker appearance to the lips. Not only is the smile vastly improved, but the entire face is transformed to a far more aesthetically pleasing and youthful appearance by reconstruction the teeth. The teeth are lengthened to achieve a longer face and this lengthening process is harmonized with the specific requirements of the patient’s jaw-joint or TMJ. According to Dr. Muslin, in most instances the jaw-joint will move itself to the best position naturally if given the opportunity during the course of dental care.

“Wearing down of the teeth because of bruxism (grinding) is a normal process of aging. The gradual loss of vertical dimension in a patient’s face is an added result of getting older; in other words, our faces get shorter as we age because of tooth wear,” explains Dr. Muslin. “Over time, the bite is flattened and depressed facial structure follows. A face looks older due greatly to loss of tooth support and flattening of the bite. Mine is the only procedure that actually lengthens the face permanently and creates a lasting, vertically enhanced, youthful looking face.”

Dr. Muslin’s patients aren’t just aging baby boomers. A 30-year-old patient can actually have a 50-year-old looking face due to a deep over-bite and years of grinding. Short, dark yellow teeth from smoking, partying, poor eating habits, or childhood antibiotics combined with old fillings and crowns that don’t match can make a thirty-something look, well, old.

“Some of us never had a good bite to begin with. Our bite is formed in early adolescence once all of the adult teeth erupt. It’s our teeth that determine facial length and jaw position for the rest of our lives. Our faces can be short and round if the teeth don’t provide adequate support. Many of my patients experience enormous relief from migraine headaches due to teeth misalignment and grinding” continues Dr. Muslin.

As soon as mismatched crowns and fillings are replaced, the patient is made healthier. Decay is removed for maximum health and the bite is rebuilt. Conflicting metals and decaying tooth structures are replaced with biologically compatible porcelain materials.

Worn down cusps are rebuilt and restored for better chewing, adding subtle, three-dimensional vertical facial height, creating astonishing youthful restoration of the patient’s entire facial appearance. No surgery, no stitches, and most patients go back to work the very next day.

Dr. Muslin’s years of knowledge and expertise are critical in in Face Lift Dentistry. His advanced training and artistic ability are vital components for the biological harmony of this highly advanced procedure.

Dr. Sam Muslin is a Master of the Academy of General Dentistry and has been awarded by the International College of Dentists. He has been practicing cosmetic dentistry in Santa Monica for almost 30 years. Dental Face Lift and Face Lift Dentistry are registered trademarks of Dr. Sam Muslin. www.faceliftdentistry.com.

Patty Kovacs, Editor-At-Large at Makemeheal.com, is a published author and beauty expert. Patty is the Executive Producer/Host of The Health and Beauty Revolution Show on wsRadio. Her 800+ interviews include over 450 New York Times best-selling authors.

See Patty’s Websites: www.pattykovacevich.com

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Over 50 Plastic Surgeons Answer Consumer Questions on Makemeheal.com’s Ask-An-Expert Tool
Posted on February 6th, 2009 in Body Procedures, Breast Augmentation, Implants, Reduction, Facial Plastic Surgery, Liposuction, Plastic Surgery Recovery & Preparation, Procedures & Breakthroughs, Skin Care, Tummy Tuck, Abdominoplasty, Uncategorized by MakeMeHeal.com
February 6, 2009 - Los Angeles, CA

Make Me Heal (www.makemeheal.com), the world’s largest website for all things plastic surgery, cosmetic treatments, and anti-aging, has announced that over fifty top plastic surgeons have joined Makemeheal.com to answer questions live that are posted by consumers on the website’s Ask-An-Expert area. Launched in November of 2008, Ask-an-Expert is a free service that allows consumers to ask a question and get key answers from top doctors and experts about any procedure or topic within the fields of plastic surgery, dermatology, and skin care. Moreover, regular people from the Makemeheal.com community can also post responses to questions.

“Ask-an-Expert is rapidly becoming one of Makemeheal.com’s most popular areas of our portal, as it allows consumers to ask important questions and get answers from different leading doctors and experts at a click of a button — and for free,” says Ariel Perets, Founder & CEO of Makemeheal.com.

Aside from asking questions, users can simply use this incredible resource to do research numerous types of procedures, treatments, and products using sophisticated search functions on Ask-an-Expert.

Among the physicians answering questions on the Makemeheal.com site include Dr. Marcel Daniels, Dr. Brent Moelleken, Dr. Shervin Naderi, Dr. Alexander Rivkin, and other top plastic surgeons.

Check out Ask-An-Expert.

About Make Me Heal

Make Me Heal (www.makemeheal.com) is the world’s largest website for all things plastic surgery, beauty enhancement, and anti-aging. With 1 million members and over 300,000 unique visitors per month, Make Me Heal is a one-stop portal for all the products, services, and information resources needed by the consumer.

Discover The Make Me Heal World…

Find a great plastic surgeon on Makemeheal.com’s Plastic Surgeons Directory, check credentials, and read patient reviews of doctors.
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Visit the website: Make Me Heal

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Overview Of Non-Surgical Cosmetic Procedures Part One: Non-Surgical Nose Job
Posted on February 2nd, 2009 in Facial Plastic Surgery, Plastic Surgeon Interviews & Articles, Procedures & Breakthroughs by MakeMeHeal.com
By Alexander Rivkin, M.D.

Traditional cosmetic procedures such as rhinoplasty, blepharoplasty, facelifts, and chin augmentations are no longer the only option for individuals who wish to enhance their outward appearance. These surgical procedures are now in competition with the latest innovations in injectable filler techniques. Products such as Radiesse, Artefill, Juvederm, and Sculptra allow a skilled physician to gently mold and sculpt the face. Facial fat disappears as we age, changing our appearance from full and youthful to gaunt and fatigued looking. Fillers will replace that fat, giving us back the youthful fullness that is lost over time. In addition, fillers can easily soften and camouflage aesthetic irregularities of the face, such as a nasal bump or an asymmetric chin. With so many new choices in aesthetic medicine available, why endure painful, invasive surgery that requires anesthesia and an overnight hospital stay? In this article I would like to specifically focus on Non-Surgical Rhinoplasty, also known as the Non-Surgical Nose Job, and discuss some of the procedure’s advantages relative to surgical rhinoplasty techniques.

As a surgically trained otolaryngologist/facial plastic surgeon I understand my patients fears and anxieties associated with “going under the knife.” I have devoted my career to developing cosmetic surgery alternatives in order to reduce recovery time, discomfort, and financial cost to patients seeking cosmetic improvements. Recent developments in aesthetic medicine have allowed me to focus on minimally invasive facial sculpting as new varieties of injectable fillers are becoming more readily available in the US market. Four years ago, I was the first in the United States to offer Non-Surgical Rhinoplasty using injections of Radiesse to raise the bridge of the nose and camouflage bumps. Since then, I have performed about 1000 successful procedures and have trained physicians across the country and abroad.

The idea of correcting nasal abnormalities with the use of injections is actually not new. In the mid 1800’s doctors attempted to perform this procedure with substances like paraffin, silicone, and goose grease. These techniques did not last because the substances used caused long-term side effects and turned out to be inappropriate for injection. However, the idea of performing rhinoplasty with injections remained a possibility and modern cosmetic surgeons continued to experiment with the idea of minimally invasive facial sculpting.

When I started using Radiesse to fill in lines and wrinkles, I was impressed with the longevity and smoothness of the results. I had heard rumors that Asian plastic surgeons were using fillers to contour the nose non-surgically and I recognized the possibility that American patients could obtain results similar to traditional rhinoplasty without surgery. I questioned why US surgeons were only offering fillers as a post-rhinoplasty corrective procedure. There was (and still is for the most part) a perception that an operation is the only way to correct cosmetic nasal irregularities, even the most minor bumps or asymmetries. After using injectable fillers as an alternative to rhinoplasty for four years, I am convinced that the Non-Surgical Nose Job is a procedure that is safe and effective with significantly less discomfort and risk than traditional rhinoplasty.

With proper administration from a trained specialist, Non-Surgical Rhinoplasty can effectively correct a mild to moderate bump on the bridge of the nose, a mild to moderate drooping of the nasal tip (nasal tip ptosis), mild to moderate post-rhinoplasty asymmetry, and mild to moderate deformities such as “boxer’s nose” or an upward scooping of the nasal tip (also known as saddle nose deformity). Skill and experience are required if a physician wishes to correct more difficult situations such as asymmetric nostril shape, or poor definition at the point between the face and nostril wing.

(Left: Before, Right: After)

Cosmetic concerns often vary between ethnic groups and the Non-Surgical Rhinoplasty procedure can present the best solution across cultural lines. For example, Asians often desire a heightened bridge of the nose and want better nasal definition. African Americans, like Asians, often request bridge augmentation while Hispanic Americans frequently ask for correction of a droopy nasal tip or irregular bump. Caucasians most commonly request camouflage for an obvious hump or unbalanced appearance of the nasal bridge.

(Left: Before, Right: After)

Individuals who have already received a traditional rhinoplasty procedure commonly ask for minor corrections of asymmetry, augmentation for an upward slope of the nose, and, occasionally, a desire for augmentation and camouflage in the of the nose bridge due to a post procedure cartilage collapse.

There are several injectable fillers available on the US market today that are safe, effective and relatively long lasting. I have mostly used Radiesse and am very comfortable with this filler. Radiesse is composed of calcium hydroxyapatite microspheres in a polysaccharide gel carrier. Since there is no way to dissolve the material, it must be injected with great care. I routinely under-correct because over correction is quite difficult to resolve. Immediately after injection, Radiesse is malleable and I will contour and shape it according to the needs of the individual patient. Generally I see patients one to two weeks after the initial procedure so that I can administer touch ups if necessary. Radiesse is a semi-permanent filler and generally lasts between 10 and 12 months. Because Radiesse is not animal based, no allergy testing is required.

Some patients choose to start with more temporary hyaluronic acid fillers such as Restalyne or Juvederm in order to experiment with the outcome of their cosmetic makeover. The advantage to the hyaluronic acids is that they can be easily reversed with an enzyme in the rare event that results are dissatisfactory. After trying out their new look with temporary fillers, patients can then choose to go with a permanent filler if they decide a re-contoured nose suits their expectations (which is the case with most people). Restalyne and Juvederm last between six to nine months and are non-animal based so skin testing is not necessary and allergic reactions are unheard of.

Although the Non -Surgical alternative to rhinoplasty is an excellent option for many, it is not the best solution for all patients. Patients with a severely crooked nose may not be good candidates for an injection rhinoplasty because the augmentation needed to give a straighter appearance to the nose may make the nose too wide. Patients with a nose that is disproportionately large may need to opt for a traditional reduction surgery. The procedure will not correct breathing problems.

As with any medical procedure, selecting the right physician to perform your Non-Surgical Rhinoplasty is critical. Injecting filler into the nose must be done with care and a thorough understanding of both nasal anatomy and the properties of the filler being used. A patient contemplating this procedure should make sure his or her physician has had specific training and experience in cosmetic injection techniques, especially if the doctor is not a formally trained aesthetic surgeon. Precise knowledge about the injection spots, depth, and amount of filler needed is very important for the success of the procedure.

Non-Surgical Rhinoplasty is a relatively painless procedure that requires minimal downtime and post-procedure care. In fact many of my patients have resumed normal activities immediately after their Non-Surgical Nose Job, returning to work or a busy social calendar on the same day as the appointment. Slight bruising or swelling may occur at the site of injection, however the severity of the inflammation pales in comparison to the aftermath of traditional rhinoplasty. If discoloration or tenderness does occur, it usually disappears within a few days.

Topical anesthesia is adequate for pain control and icing the nasal area just before injection reduces the chances of bruising. I suggest patients take Arnica Montana orally after their injection – it works well for reducing any swelling or bruising that may follow. Patients can use Tylenol, but should not use non-steroidal anti inflammatory medications (Advil, Alleve, etc) for 3 days or wear sunglasses for 2 weeks after the procedure. No other limitations are required. The Non-Surgical Nose Job usually takes between 10-15 minutes to perform. Patients are usually in the office for about an hour, however, when we figure in the time needed for topical numbing cream.

Non-Surgical Rhinoplasty costs a fraction of the price of the surgical procedure. Depending the on the filler being used - temporary, semi-permanent, or permanent - a Non-Surgical Nose Job costs between $1,000 - $2,000.

Minimally invasive procedures like Non-Surgical Rhinoplasty are quickly gaining popularity because they offer patients exactly what they want cosmetically, but with much less pain, downtime, and cost. The Non-Surgical Nose Job is currently performed throughout much of the world and will only increase in popularity as the possibility of non-surgical aesthetic corrections continue to be publicized.

About the Author

Alexander Rivkin M.D. is a Yale trained facial cosmetic surgeon and UCLA faculty member who focuses exclusively on providing his patients with the latest in non-invasive, non-ablative cosmetic treatments. As an international authority on non-surgical cosmetic treatments, he divides his time between patient care, clinical research, educating other physicians, media appearances, and lecturing at scientific conferences throughout the world. Dr. Rivkin was the first physician in the country to offer the Non-Surgical Nose Job, his signature method for non-invasive correction of cosmetic nasal irregularities. He has been featured throughout the national and international media on shows such as the TODAY show, the Tyra Banks Show and EXTRA for the innovative procedures he has invented. Dr. Rivkin is a member of the teaching faculty of the American Academy of Facial Plastic Surgery. He is also a prominent member of the national teaching faculties for Allergan, Contura, Johnson and Johnson, Medicis and Bioform. Click here to learn more about Dr. Alexander Rivkin.

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Top 9 Plastic Surgery Predictions For 2009
Posted on January 7th, 2009 in Plastic Surgeon Interviews & Articles, Procedures & Breakthroughs by MakeMeHeal.com
By Anthony Youn, MD

As a cosmetic plastic surgeon, I often have patients ask me what’s the latest on the horizon in the field of plastic surgery. Are there procedures that they should save for? In the near future will there be cheaper and easier ways to change their look than what we are currently doing now?

Here are my Top 9 Plastic Surgery Predictions for 2009:

#9. Plastic Surgery Vacations will become more and more popular. As our country falls into recession, greater and greater numbers of people will save money by combining plastic surgery and vacations. Americans will travel to Mexico, Brazil, and even India in an attempt to save money and look better. I predict that this trend will unfortunately bring about an unprecedented number of disturbing complications, as people bring their botched results back to the U.S. for American plastic surgeons to treat. The lucky ones, however, will come back looking both rested AND younger.

#8. Fat, from both from animals and people, will become a new Green resource. There are reports that a renegade Beverly Hills radiologist used liposuction fat to power his SUV to work each day. While this is an extreme example, I do believe that the work on Biofuels will continue, with liposuction fat on the periphery of this trend. No, I don’t plan on ever doing this.

#7. Sculptra will gain FDA approval as a liquid facelift for the general population. With the realization that facial volume loss is an integral component of the aging process, Sculptra treatments may take center stage in the fight against facial gauntness. Sculptra is currently only FDA-approved for treatment of HIV-associated facial wasting, but has been used in Europe for many years under the name Newfill. It is currently the only injectable filler that can produce generalized volume replacement in the face without excessive cost.

#6. 2009 will bring with it a plethora of new extreme, bizarre, and unusual plastic surgeries. 2008 brought us such plastic surgery oddities as cosmetic leg lengthening, the G Shot, the Boob Jab, and the Acupuncture Facelift. I expect fringe medical practitioners to do the same in 2009. Can we expect to see actual rib removal to thin the body, removal of the omentum (fat around the intestines) to decrease a protuberant tummy, or tummy tucks performed at the time of C-sections? Not by me!

#5. Will Gummy Bear Implants Boost Busts in 2009? In November 2006 the FDA lifted the ban on silicone gel implants. Since then plastic surgeons and patients in the know have been waiting for FDA approval of the form-stable, “gummy bear” breast implants, the only silicone breast implants that did not receive approval two years ago. These firm, textured, tear-drop shaped implants are made to retain their shape and not conform to the shape of surrounding tissues. They are already in widespread use throughout many other countries in the world. Will the FDA approve these implants for general cosmetic use in 2009? Thousands of plastic surgeons and patients hope so.

#4: Nonsurgical Liposuction Techniques Run Rampant… As Do Disappointing Results. One of the hottest procedures today is nonsurgical liposuction. Cosmetic practices throughout the country are advertising fat reduction via injections, external lasers, external ultrasound, and even by freezing the fat (called cryolipolysis). While these techniques sound intriguing, none have actually been proven to safely work…yet. The American Society of Plastic Surgeons (ASPS) is currently conducting an FDA-approved study on Lipodissolve, with the initial results due in the near future. While the only proven way to safely and effectively remove fat is via liposuction, 2009 may bring considerable advances to some of these, so far, unproven modalities. I expect that most will fall by the wayside, although a few may be proven to safely work.

#3: Eyelash Enhancing Medication “Latisse” Hits Big in a Blink. Recently an FDA advisory panel recommended approval for this eyelash stimulating medication from Allergan, the makers of Botox. Peak sales are estimated to reach $500 million, as this treatment will be a one of a kind. I expect Allergan will see huge profits from this topical medication, as will the physicians that dispense it. And people will walk around with Tammy Faye Baker eyes…

#2: Stem Cells are the Future in the U.S., but the Present in Other Countries. Stem cells are currently all the rage in potentially curing cancers, developmental abnormalities, and other medical problems… but are they the future for plastic surgery as well? Actually, stem cells are currently being used by some pioneering (and possibly reckless) surgeons outside the U.S. Dr. Vincent Giampapa introduced a stem cell facelift in France back in October and a handful of surgeons are performing breast enhancement with stem cells in Japan and Europe. So will we see stem cells being used by plastic surgeons in the U.S. in 2009? Not likely. The FDA is cautious with allowing procedures like these to be performed here in the States, and with good reason. Scientists need to prove that the use of stem cells for indications like these is safe and effective before allowing patients to undergo it. Until then, Americans will need to travel abroad for these extremely controversial treatments.

#1: Botox-Competitor Reloxin will act as an Economic Bailout for Millions of Botox Users in 2009. FDA approval for Medicis’s cosmetic botulinum toxin Reloxin is expected sometime in the new year. This may prove to be a relief to patients and plastic surgeons who have been forced to buy Botox at increasing prices each year. I currently charge my patients $650 for Botox injections to three areas, and the price of the Botox product itself accounts for at least half of that charge. Reloxin will be the first legitimate Botox competitor to challenge Allergan’s monopoly on this market, and hopefully bring prices down for the most popular cosmetic treatment in the U.S. It can end up being an economic bailout for the millions of people who undergo cosmetic botulinum toxin treatments several times a year.

About the Author

Dr. Anthony Youn is a Michigan-based board-certified plastic surgeon, and a member of the American Society of Plastic Surgeons. He has been featured on E! Television’s Dr. 90210 and Celebrity Plastic Surgery, The Montel Williams Show, Fox News Channel, The O’Reilly Factor and quoted in US Weekly, In Touch, Life & Style Weekly, RADAR magazine, MSNBC, OK! Weekly, and Star Magazine discussing a wide range of plastic surgery issues. His blog Celebrity Cosmetic Surgery is the most read blog by a plastic surgeon in the country and has received nearly 6 million hits. Learn more about Dr. Anthony Youn.

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Laser Hair Removal Home Devices Set To Become Hottest Holiday Gift
Posted on November 25th, 2008 in Procedures & Breakthroughs, Skin Care by Lisa Stanfield

Does anyone know a woman who wouldn’t want to trade shaving and waxing regularly for a few painless treatments that will leave her hairless with silky skin? Because the answer for most women is a resounding no, the hottest present for this holiday season may just be a home laser hair removal device that keeps you hairless in unwanted areas for the long-term. Until now, laser hair removal has been a luxury treatment offered by doctors, aestheticians, and spas for anywhere from $400 to $900 per treatment area and on average for $3000 per year if you were treating legs, bikini line, and underarms. Now, the same laser technology is finally available to use at home safely and the FDA has approved two home-use laser devices that deliver professional-level hair removal results in the privacy of your own home with minimal discomfort.

The two FDA-cleared devices have just been launched and are Silk’n Hair Removal Device ($800) and the TRIA ($995). Besides the convenience of being able to forego the endless waxing and shaving routine and the cost savings relative to standard hair removal methods (see comparison table below), these devices have actually been proven to deliver excellent results in clinical studies.

(Left: Before Silk’n treatments, Right: 3.5 months after Silk’n treatments)

With Silk’n, women who participated in clinical trials achieved an average hair reduction of 50% following three months of bi-monthly treatment sessions. Using these devices is a relatively painless ritual, with most people reporting a slight sensation of heat, itch, or minor sting that goes away immediately after treatment. That may just be a small price to pay compared to painful waxing, continuous shaving routines, side effects like razor bumps and ingrown hairs, and expensive in-office treatments. The FDA cleared these devices for home-use, which means that when used as directed Silk’n or TRIA have been tested to have no side effects or risks. However, just like with professional spa hair removal devices, these home-devices should not be used on deep brown and black skin tones and they are not effective on blond, red, gray, or white body hair. The user satisfaction rate speaks for itself, as nearly 90% of women said they would recommend Silk’n to a friend or family member, and close to 90% described Silk’n as convenient, easy, useful and innovative.

For optimal results, the manufacturers of the devices recommend spacing treatments every two weeks during the first few months and then gradually reducing the number of treatments and using the devices again only when hair re-appears. The results are not immediate due to the nature of hair growing in cycles. During any cycle, some hair follicles will be dormant and will not be visible and then grow and become visible during the growth phase. Laser hair removal is only effective when the hair is in the growth cycle, which is why the treatments need to be repeated for some time.

The technology underlying Silk’n and TRIA is the very same technology behind professional machines found in spas and aesthetician offices. Light-based hair removal is based on the theory of selective photothermolysis in which optical energy is used to disable hair growth. To achieve this effect, the hair shaft needs to selectively absorb light energy and transform it into heat. This selectivity is achieved when high optical energy that is delivered to the tissue is mostly absorbed by hair shaft pigment, while the epidermis and the surrounding tissue is actively cooled (by a cooling mechanism). Melanin is the pigment in the hair shaft that is responsible for the absorption of the light, which generates the heat that eventually disables hair growth. When hair growth is disabled, long-term hair removal is achieved.

(Left: Before treatment, Middle: During laser hair removal; Right: After treatment)

Both Silk’n and TRIA have safety features to make the user experience as safe as possible. Silk’n comes equipped with an applicator tip that has been designed so that a light pulse can only be emitted when the applicator is in contact with the skin. This eliminates the possibility of an accidental flash of light directly towards a user’s eyes. Silk’n also uses a very low but effective level of energy, up to 5 joules per square centimeter. The TRIA includes a neat, proprietary skin sensor that enables the user to test their skin prior to each treatment to ensure that the user’s skin tone is compatible with TRIA.

With a price tag of less than $1,000, Silk’n and TRIA can save you more than just the hassle and pain of shaving and waxing — but money as well. The average cost of alternative hair removal over a period of 10 years is estimated to run anywhere from $3,400 to over $7,000, whereas Silk’n and TRIA can be used again and again, reducing the overall cost* of lasting hair removal.

Service
Cost
Silk’n $800
TRIA $995
Waxing Services $5,250
Waxing at Home $3,440
Mechanical Devices $4,530
Shaving $7,050
Professional Hair Removal $4,980
*cost included time spent at $20 per hour

So which device works better?

In November this year, Good Morning America’s Becky Worley put the two devices to the test and used Silk’n on one leg and TRIA on the other for two and a half months. The results showed that Silk’n worked remarkably better than TRIA, which takes longer to deliver results.

“If I had to qualify the differences in hair growth for me, I’d say that after two weeks of not shaving either leg I have 70 percent less hair on the Silk’n leg and about 30 percent less hair on the Tria leg,” said Worley. “I haven’t counted the hairs, but I have twice as much hair on the Tria side as I do on the Silk’n side.”

Featuring a patented Home Pulsed Light (”HPL”) technology, Silk’n has a spot treatment size of 2cm by 6 cm, compared to the smaller spot size of 1 cm diameter of the TRIA, a diode laser. This means that Silk’n covers more area with less time than the TRIA. On average, the underarms can be treated in as little as 5 minutes by Silk’n and two lower legs can be treated in less than 30 minutes.

Dr. R. Stephen Mullholland, a cosmetic plastic surgeon in practice in Los Angeles, California and Toronto, Canada believes that compared to TRIA, Silk’n is “not as painful and the effective treatment size [with Silk’n] is probably about 300% larger, so it is much faster.” Dr. Mullholland, who has tested the two systems, also points to the advantage of Silk’n running on regular household current with unlimited power, unlike the battery-operated Tria which provides power “for only a limited number of pulses, so you cannot treat an entire lower leg on one charge.”

While the devices are both being marketed to women, that is not to say that men have not rushed to try the devices either. With men accounting for 13% of the laser hair removal market, it is not surprising to find men buying Silk’n and TRIA.

So if you’re still undecided what to get your significant other, friend, relative, or for yourself, you may just want to consider Silk’n or TRIA, which is certainly heating up to be one of the most sought after gifts during this holiday season.

Where can I find Silk’n & TRIA?

Shop for Silk’n here
TRIA is sold exclusively through physicians’ offices
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The Past, Present & Future of Breast Implants
Posted on October 24th, 2008 in Breast Augmentation, Implants, Reduction, Plastic Surgeon Interviews & Articles by Makemeheal.com Staff
By Dr. Jennifer Walden, MD, FACS

The History. The enhancement of the female breast has been a source of attention for centuries. In 1889, one of the first recorded breast augmentation procedures was performed by the Austrian surgeon Gersuny, who injected liquid paraffin directly into the breasts to enhance their shape and fullness. Since then numerous attempts including the placement of foam, sponge, and liquid silicone have been performed to surgically enlarge the breasts, often with devastating results.

In 1962, Houston plastic surgeons Cronin and Gerow began the clinical trials which led to the first silicone gel-filled implants by the manufacturer Dow Corning in 1963. Although various modifications have and continue to be made on the original prototype design, it was the silicone breast implant that was greatly responsible for reducing the serious problems associated with earlier injection techniques. In an ironic twist, public concerns regarding a possible link between silicone implants and autoimmune disease, as well as other health issues sparked a media frenzy which resulted in a moratorium on silicone gel-filled implants by the FDA in 1992. This ban left saline implants as the only option in the U.S. for surgical augmentation until 1998, when silicone was reintroduced in restricted clinical trials. By 2006, however, there had been no conclusive scientific data to support a correlation between silicone breast implants and any systemic disease. Silicone gel implants once again have become available for primary augmentation procedures and remain the prosthesis of choice worldwide with a well-established safety profile.

What Now? Problems with the earlier generation silicone gel implants were that they had a thick, unnaturally stiff shell, a high rate of gel bleed, and an unacceptably high incidence of capsular contracture (up to 70%). Third generation implants, from the mid-1980s forward until today, utilize a multi-layer barrier shell to decrease gel bleed and are filled with a thicker, more cohesive gel to reduce potential leakage. These implants, termed “responsive gels,” have proven high rates of safety and efficacy, and were re-approved for general use with conditions by the United States FDA in November 2006. Currently, third generation silicone gel-filled breast implants are approved for: (1) reconstruction in women of any age and (2) augmentation in women 22 years or older. In contrast, saline-filled breast implants are approved for women 18 years or older. The two main implant manufacturers which provide plastic surgeons and patients with well-studied, safe FDA-approved breast implants for their patients in the United States are Mentor (Santa Barbara, CA) and Allergan Corporation (Irvine, CA).

As a female plastic surgeon, breast augmentation is my most requested and performed procedure. In New York, my average patient is in her 20s or 30s, wants to do it for herself to improve the appearance of her breasts, may have one or two children, and has arrived at the decision to have it done independently and privately after conducting her own research. Besides me doing this procedure multiple times every week, breast augmentation has also been the most commonly performed cosmetic surgical procedure for women in the United States the past two years! I am using silicone implants about 85% of the time and saline implants about 15% of the time. I find that silicone implants more closely resemble the consistency and texture of normal breast tissue, and that the tactile and visual aesthetics are more pleasing. That being said, saline implants are still a nice option in women under 22 years of age for primary breast augmentation or when dealing with an asymmetry where it will be helpful to fill the implants different volumes intraoperatively. One of the benefits of saline filled implants is that they can be adjusted in the operating room, as opposed to pre-filled silicone implants which often require the use of sizers intraoperatively for cases of different sized breasts.

In the following preop and postop example, the patient is 5′4″ and 115 pounds. I used 300cc smooth round moderate plus profile under the muscle saline filled implants.

(Left: Before, Right: After)

The breast pocket may be created in either the subglandular (under the gland) or subpectoral (under the pectoralis major muscle) space. The subglandular technique is usually reserved for patients who have substantial breast tissue or a mild degree of ptosis, or breast droop, since greater projection may be obtained. Also, women who are avid bodybuilders may prefer subglandular implants for the reason that placing them under the muscle in some instances may produce breast animation and distortions when the pectoral muscles are flexed. Increased risks of capsular contracture, rippling and implant palpability are typically issues discouraging the routine use of subglandular placement.

In the vast majority of patients, I believe the under the muscle technique produces optimum results. The pectoralis major drapes the top 3/4 of the implant, softening the transition, and therefore creating a more anatomically shaped breast mound. This method also achieves a natural feel, which is especially desirable when using saline implants. In addition to improved aesthetic outcomes, there are advantages in regard to breast-feeding as well as cancer screening.

The proper selection if breast implant size is extremely important for minimizing complications and optimizing patient satisfaction. I consider the base diameter of the chest, along with tissue laxity and the amount of breast tissue a patient is starting with, as the most important factors in choosing implant size. Implants come in three types of profiles: moderate, moderate plus or midrange depending upon the implant manufacturer, or high profile. For a given width, or base diameter, of an implant the implant project lower or higher on the chest. So, for a base diameter of 12 centimeters (a measurement the surgeon takes across the width of your breast), a moderate profile implant will have less volume and projection than a moderate plus or high profile implant does for the same base diameter. I generally use moderate plus or midrange profile implants because the average base diameter I see is around 11.5 to 12.5 cm. This gives around 300 to 325 cc of volume (a very common size of implant—around a C cup if you were starting as an A cup, or with little breast tissue).

I tend to reserve moderate profile implants for women with very broad chests who don’t particularly want to look top-heavy, and I use high profile implants in women who are petite with a smaller base diameters (say 10.5 cm) who say they want to be a C cup or bigger…. I need the increased volume built into the higher projection of the implant to get them to the volume they want without the implant borders extending outside of the natural confines of their breasts. Ultra high profile implants are available and more popular in Europe and other countries due to the increased demand for greater projection and size. Implants that are too big for a woman’s individual chest dimensions lead to a higher likelihood of irreparable tissue stretch, bottoming out, and complications that may lead to reoperation.

In the following preop and postop example, the patient is 5′4″ and 115 pounds. I used 350cc smooth round high profile under the muscle silicone gel implants.

(Left: Before, Right: After)

What’s New? Evaluation of the highly-cohesive, form-stable fourth generation implants is well underway by the FDA in the United States, but these implants have been widely used since the mid-1990s in many other countries and are very popular in Europe. These teardrop-shaped (often called anatomic or “gummy bear”) implants are textured and contain a highly cross-linked form of silicone gel to minimize the possibility of silicone migration, as well as upper pole collapse and folds in the implant shell. Studies of these devices have shown significant promise in clinical trials with low rates of capsular contracture and rupture, and high rates of patient satisfaction. Both Mentor and Allergan Corporation have shaped anatomic gel implants that are being reviewed by the FDA but are available in Europe and other countries around the world. There are a matrix of different implants to chose from in these lines, with varying width, height, and projection for different body and breast types.

Allergan’s highly cohesive, shaped implant is called the Style 410, and the company is currently in discussions with the FDA and look forward to a decision regarding its approval, but cannot speculate on timing. A very similar situation exists with Mentor Corporation as well for their form stable shaped implant called Contour Profile Gel (CPG). The shaped cohesive gel implant represents a new option in the United States for women considering breast surgery for reconstruction and augmentation. In my opinion, the potential drawbacks are that they do feel a little firmer than the smooth round responsive gels, and the possibility exists that they could shift or turn in the pocket and not look or feel right if that were to happen (called malrotation). For this reason, very precise breast pocket dissection is needed for this type of implant. These implants do cost significantly more than saline, and likely will cost several hundred dollars more per pair than responsive silicone gel implants if and when they are approved by the FDA.

Since highly cohesive gel implants are not deformable, they cannot be squeezed through little incisions. Depending upon the size of the implant, incision length must be between 4.5-5.5 cm. It also can make insertion from around the areola difficult. Armpit, or transaxillary incision is possible, but exceedingly difficult. The reason at this point in time that I actually prefer smooth round gels is that they act and feel very much like normal breast tissue — when you lay down, normal breast tissue flattens and lateralizes, and so do the smooth round responsive gels. When you stand up, gravity takes effect and the gel situates within the implant at the base of the breast to give fullness in the lower pole and a smooth slope at the top. This can be illustrated in Figure 1a (Style 410) and Figure 1b (Smooth round responsive gel) with my nurse, Sarah, and the two types of implants in the photos. I also am able to fit smooth round silicone gel implants through relatively small incisions at the inframammery crease, areolar border (periareolar), or armpit.

(Left: Figure 1a, Right: Figure 1b)

In summary, pending FDA approval Mentor’s Contour Profile Gel and Allergan’s Style 410 will be the latest additions to the already wide selection of available implants; there are hundreds of breast implant combinations from type of filler, volume, base width and profile—all to help women and their surgeon find the fit that is appropriate for them.

The Future. Breast enhancement using fat grafts (lipoaugmentation) rather than silicone or saline implants employs fat suctioned from the patient’s buttocks, thighs or other fatty areas. This type of breast surgery can be used to increase the size of the breast or to fill in defects or abnormalities in existing breasts, including enhancing the appearance after breast reconstruction and softening the look of existing implants. Fat injections of the breasts may offer patients augmentation with a natural look and feel and the benefit of body contouring through liposuction—without the requirement for incisions or implants.

However, long-term safety and efficacy data as well as the effect of the procedure on breast cancer screening using mammography is still being evaluated in clinical studies. Concerns about fat grafting for breast enhancement include unpredictable or low survival rates of the transferred cells (which are frequently absorbed by the body), development of cysts, calcification and tissue scarring. Another major concern is long-term problems with breast cancer detection due to difficulties in telling the difference on mammograms between calcifications associated with breast cancer and calcifications associated with fat transfer.

This procedure does offer a modest opportunity for enhancement— specifically, about one cup size increase and the degree of enlargement will depend on the amount of spare fat that the patient has. But, numerous questions remain about this new technique: How much of the fat survives? Does the procedure have to be repeated? Are the breasts hard and uncomfortable for long periods after the procedure? And most importantly, what are the cancer implications of this technique? Research projects, funded by the Aesthetic Surgery Education and Research Foundation (ASERF) of the American Society for Aesthetic Plastic Surgery are being conducted to determine the safety and efficacy of breast enhancement with fat.

In the meantime, plastic surgeons will continue to study the intricate details of the procedure for the safety of our patients– namely, the techniques of harvesting, preparation, and placement of the fat tissue, who should receive fat transfer, when it is appropriate, and whether it is safe for the long term. Results of clinical studies this far seem promising—so maybe going up a cup size with the benefit of a little liposuction elsewhere will be common practice in 5 or 10 years! Anyone reading this should be aware that this procedure is very technique dependant and to avoid complications it must to be done correctly by a properly trained, board-certified plastic surgeon.

Let the Buyer Beware. Have you heard of dermal fillers? These materials are gel-like compounds that can be injected into the body and have been traditionally used in facial rejuvenation. They increase the volume of the area injected, and are either classified as permanent or semi-permanent. Restylane, Hylaform, and Juvederm are types of hyaluronic acid dermal fillers that are currently FDA approved for injection into the nasolabial folds, or laugh lines, of the face.

Swedish scientists have developed a dermal filler called Macrolane (made by Q-Med in Sweden) which is being marketed in Europe and is not approved by the FDA for use in the United States. Macrolane is composed of hyaluronic acid but in larger particles than those found in Restylane. This makes it more suitable for treatment of larger areas, and the body may absorb it more slowly given the larger particle size. Known on the internet and in the media as a “Boob Jab,” Macrolane is being touted for breast augmentation and shaping of the décolletage, as well as an adjunct after breast implant procedures and liposuction when there may be contour problems. Compared with treatment with Restylane, much greater volumes are used in an average treatment with Macrolane and the gel is injected deeper in the skin layer to add larger volumes.

But be aware that this procedure is not permanent - all dermal fillers are eventually absorbed and metabolized by the body! One round of Macrolane breast augmentation may last 1-2 years, but could resorb in less time than that. Controversy exists around this procedure as we don’t know exactly how this material will look on mammogram, if it will eventually cause permanent lumps and bumps, or if it could even obscure of confuse the diagnosis of a future breast cancer.

My associate recently met a woman from London who consulted with him about getting silicone breast implants. The patient reported that she had undergone breast injections with Macrolane for enhancement. The procedure was done by injecting the material through a cannula, or hollow tube, with incisions of 6-7mm on either sides of her breasts. The patient stated that the material was injected under the pectoralis major muscle and was indeed painful even though some local anesthesia was used. She went from a full A cup to a B cup…but all of the material was gone in 2 ½ to 3 months, and then she was right back down to an A-cup! Hence the consultation for real breast implants.

Other drawbacks of the “Boob Jab” procedure include that Macrolane is only available in the UK and Europe, costs an average $4,000 - $7,000 (similar to the cost of breast implants, which is a much longer lasting form of enhancement!), and we don’t know its long term effects on breast tissue and the overlying skin. Yes, this means the procedure and payment needs to be repeated every 1-2 years if you decide to enter into such a treatment plan; I would argue to save your money and think about augmentation with FDA approved breast implants if you are this serious about going forward with augmenting your breasts.

Can breast pumps be used for breast enlargement and how do they work? Breast pumps basically work through the physiological process known as tissue expansion. If you apply a gentle pressure to stretch skin or other soft tissues, they slowly stretch. If you’ve ever seen a person with oversized ear plugs or a native tribesman with a large ornament in his lip, you’ve seen tissue expansion at work. By applying relatively gentle vacuum (negative) pressure to the breasts, breast pumps encourage the process of tissue expansion. Over time this leads to a modest increase in breast size, but temporary breast pumps in my opinion are really not a viable permanent breast enlargement solution. In fact, overuse of this type of breast pump may cause broken blood vessels, skin irritation, and discomfort. The Brava system (Brava, LLC, Coconut Grove, FL) is one of the more popular branded devices for external breast enlargement by this method that has been studied in a well-controlled fashion. The Brava system has been shown to increase breast size after prolonged use, but there are some significant drawbacks including the following:

Cost - the Brava device runs about $2500
Time - the device must be worn 10 hours a day for 10 weeks, or 700 hours
Discomfort - the device applies a rather strong suction to the chest, which many women find uncomfortable
Amount of growth - on average, after 10 weeks, a woman may gain about 100 cc of breast volume, and that’s only about ½ of a cup size.
Embarrassment - you don’t want to be seen outside the house in this contraption, and most women that I know (including myself) would not be game for wearing this apparatus on their breasts for 10 hours a day… it’s simply not feasible.
Cleavage enhancers like Rodial Boob Job (Rodial, UK) are creams that tout enlargement of the breasts as an end effect. Although these creams may tighten, soften and enhance the appearance of the skin of the breasts, there is no way that a topically applied cream can block internal fat deposition elsewhere in the body and focus it to the breasts, which is what the company’s website claims.

Mama Mio Boob Tube (Mama Mio, Huntington Beach, CA) is a nice product that has active ingredients including CoQ10 which is important for skin strength and elasticity, Shea Butter and Dandelion Root for restoring skin tone, Evening Primrose Oil, Avocado oil, and a rich blend of omega 3, 6, and 9. I have used this product before and has a very rich moisturizing quality, lovely scent…and the company sells a complement of products for the tummy, buttocks, breasts, etc, including “Bootcamp for Butts” and “Bootcamp for Boobs” creams! (LOL).

In summary, breast augmentation technology is changing fast, and but I seriously doubt implants themselves will ever become a thing of the past! Newer techniques involving the injection of substances into the breasts should be considered judiciously after doing proper research and consulting with a qualified plastic surgeon.

About Dr. Walden

Jennifer L. Walden, MD, FACS is a Plastic and Reconstructive Surgeon who is fellowship-trained in aesthetic surgery and board certified by the American Board of Plastic Surgery. She currently is an associate attending in Plastic Surgery at Manhattan Eye, Ear and Throat Hospital and Lenox Hill Hospital. She is also a member of the American Society of Plastic Surgeons and is a Fellow of the American College of Surgeons. Her office is located at in Manhattan at 50 East 71st Street (on the corner of Park Avenue and 71st Street).

Dr. Walden, a native Texan, received her undergraduate education at the University of Texas at Austin, graduating with Honors with a Bachelor of Arts in Biology. She continued her education at the University of Texas Medical Branch in Galveston where she received her Medical Doctorate with Highest Honors and numerous academic awards including graduating as the salutatorian of her medical school class. Dr. Walden received her formal training in plastic and reconstructive surgery at the University of Texas Medical Branch and completed an externship at the prestigious Plastic Surgery Associates in Miami under the direction of Dr’s. Baker and Stuzin. After completing her residency training, she moved from Texas to New York to pursue her special interest in aesthetic surgery during her fellowship at Manhattan Eye, Ear and Throat Hospital under the direction of Sherrell J. Aston, MD. During her fellowship, she benefited from the knowledge and expertise of many internationally known leaders in the field of aesthetic plastic surgery. Dr. Walden is currently the Program Director of the Manhattan Eye, Ear and Throat Hospital Aesthetic Surgery Fellowship, one of the foremost organized training programs of cosmetic surgery in the nation.

Dr. Walden has presented multiple research papers, published articles, and has enjoyed involvement in organized medicine and plastic surgery on both local and national levels. Learn More About Dr. Walden

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Sharon is Confident After Rhinoplasty
Posted on October 20th, 2008 in Facial Plastic Surgery, Personal Interviews by Makemeheal.com Staff

See Sharon’s Before & After Plastic Surgery Pictures Album.

Ohio native Sharon (username: goldilox1975) was teased about her nose ever since she was young, but mostly by her brother. She never seriously considered a rhinoplasty until a few years ago she saw a picture of a girl she went to high school with. She knew this girl had gotten a nose job, and Sharon realized she still looked like herself, only better. After several consultations with various surgeons, she finally settled on Dr. Frank Barone, based on personal reviews, reputation, and her consultations with him. She used the Make Me Heal message boards and her own blog to gain knowledge about what to expect from surgery and recovery, as well as support from others. She had her procedure on August 5th, 2008 and though she had a stressful night before surgery and hated the packing in her nostrils for a week after, she experienced little serious pain and was very well prepared for a smooth recovery. She was out on the town only 11 days after surgery and is now pleased that she has a more refined version of her own nose, and feels more confident in herself.

Sharon’s advice for anyone having plastic surgery is:

“If you have wanted it for a while, don’t wait any longer. Do it!!! It’s not that bad and 9 out of 10 times the results are incredible! Research as many doctors as possible and don’t let cost be the deciding factor. Get the best possible doctor no matter the cost.“

Please join us below with an interview with the lovely Sharon:

Make Me Heal: When did you first have the idea to have your procedure(s)?

Sharon: In high school a few friends got nose jobs. Part of me was jealous, but the other side of me looked down on them for being so vain. Honestly I didn’t think any of them needed it and was somewhat sad to know that their unique looks would be diminished. Recently I was flipping through a book of wedding photos by a local photographer in my city. He had wedding pictures of one of those girls. She looked stunning! That was the day I decided I was really ready to take this idea to the next level. I thought that she still looks like herself, just better, and I could too.

Make Me Heal: What were your motivations (physical, emotional, social, etc.) behind your decision to have the procedure(s)?

Sharon: I thought I would be more confident, outgoing, and happier. I had seen some of my friends who had it done and they looked amazing, and I thought…’why not me’ I always thought my nose was too big, too long, and didn’t fit my face.

Make Me Heal: How long did it take you to make a decision and was it an easy or difficult one to make?

Sharon: It took one year. I began thinking about it and even made an appointment 1 year ago. I chickened out, but still wanted to do it. Recently I had a bad breakup, and was feeling down about myself in general. I came into some extra money, and thought, ‘I wish I had done it last year’. I decided I didn’t want to be saying that in another year so I decided to do it. I was a little difficult because I was very nervous that I wouldn’t like it and I would regret doing it. I was scared it would end up looking worse. Also I was afraid of the pain and the recovery.

Make Me Heal: Did your family, friends, and any other people in your close circle give you support, opposition, or did you make this decision without considering them?

Sharon: Everyone was very supportive. My friends and I had a ‘Going away Party’ for my nose. We had Goucho Marx glasses, fake animal noses, and even a theme song…Nobody Nose the Trouble I’ve seen! (pic on my blog) My Dad was the only one who was uneasy because my sister had the procedure and had major complications leaving her with visible scar after 2 revisions.

Make Me Heal: How did you research the procedure and come to decide on this particular procedure?

Sharon: I knew what I wanted, a nose job, simple as that. The doctors recommended the specific procedures as far as nostril reduction and grafts. My doctor ended up not doing a graft.

Make Me Heal: Please discuss if you used any of Make Me Heal’s resources such as the message boards, pictures library, doctor directory and doctor reviews, and any recovery and preparation products that you used.

Sharon: Make Me Heal was the ONLY resource I found online that was helpful. The before and after pictures were a HUGE help I looked for girls who looked like me, and saw the incredible differences and decided if they can do it so can I. The message boards are great. I used them a lot, posting my own concerns, questions, and fears and got wonderful responses. Everyone was very supportive.

Make Me Heal: How did you come to choose your doctor?

Sharon: I made consultations appointments with 3 major plastic surgeons in my area. I listened to each one taking notes and had a barrage of questions (in a notebook) for each. I made my decision based on what they thought my nose should look like, their willingness to answer my questions, how comfortable I felt with them, their before and after books of prior patients, and the look and feel of the office. Price was not my main concern and I ended up going with the most expensive doctor. Also I had 3 relatives who had used him for different things and they all recommended him highly. We had one initial consultation, another one to answer questions, and another to take pictures right before the surgery. After the surgery I had 3 appointments where they massaged my face to help with draining. This was very comforting and did help a lot. Of course I also had a post op appointment to remove the packing, and the stitches. I had to go back 3 more times for stitch removal (they would not come out on there own and I just kept finding more and more). I have my final appointment in 3 weeks for post pictures which will be at the 3 month mark.

Make Me Heal: Please discuss if you have any role in deciding the type of technique used for your surgery by the doctor, incision placements, implant brand, anesthesia type, etc.

Sharon: I put my trust fully in my Doctor, an let him do what he thought was right for me. I didn’t make outside suggestions. When he told me he wanted to do a graft, he said it was because not only was my bump big, but the area between my eyes was deep which made the hump appear bigger. While in surgery he opted not to do the graft, because he liked the way it looked after he did the hump reduction.

Make Me Heal: How did you prepare for the surgery?

Sharon: Arnica for bruising, Vitamedica (3 am and 3 pm) for 2 weeks before and after the surgery, Bromelain for swelling. Cleaned my house, bought tons of soups, juices, ice cream, puddings etc. I assigned my friends days and times to help me. Laid out all my meds and made a chart of when to take each, with or without food, and lined them all up in Dixie cups. I had my friends dole them out to me so that I didn’t get confused. I washed my sheets, cleaned and prepared my humidifier, made tons of ice, bought about 50 magazines, rented movies. I bought Q tips, bandages, AYR spray to lubricate, Benadryl for congestion, picked up my Rx’s (Valium, Percoset, Vicodin, Nausea Meds), and Chapstick (which didn’t work well and I switched to Blistex Medicated which kept my lips from drying out). I didn’t know it at the time, but I also needed lighted tweezers, bendy straws, hard candy, and mashed potatoes with gravy (lots of it!!).

Make Me Heal: How were you feeling the night before the surgery and on the moments before the surgery itself?

Sharon: I was a basket case the day and night before my surgery. I was very nervous, and scared. Part of me wanted to back out. I was mostly nervous about what it would be like to have packing in for a week. I tried plugging my nose for 1 minute and just that one minute was awful, so I knew it would be bad. That night I called my doctor and he said to take 1-2 Valium to calm me down and help me sleep. I’m so glad he did because it really helped. Before that I was freaking out and crying over the tiniest things. My cousin spent the night which helped and she drove me to the surgery center in the morning.

Make Me Heal: How was the recovery process? Please discuss what side effects you experienced? What were the worse parts of the recovery? Did anyone help you during the recovery?

Sharon: The worst part was the packing. It was extremely uncomfortable and made it hard to eat or drink. Also the dry mouth was unbearable. The 2nd night I got up to pee 10 times because I was drinking so much water. I had many friends and family bringing me food, giving me my medication, changing my bandages, cleaning my wounds, and keeping me company.

Make Me Heal: Please discuss the pain or discomfort you experienced during the recovery?

Sharon: The pain was minimal, especially since I had the Vicodin and Percoset. It was more like the pain you have when you get hit real hard on the nose, a dull pain that wouldn’t go away. The discomfort was due to the packing the first week. After that it was just very sore for about another week. The following 2 weeks it just felt strange because I had very little feeling in my nose, it was numb from the nerve damage that is caused during the operation. Any slight bumps to my nose were very painful as well. Even now 2 months later the tip is still a little numb. I predict another 3 months until I regain full 100% feeling again. Still now, picking my nose is hard, and I still use Q tip to help me do this. There is still scar tissue inside my nostrils which makes cleaning it out hard.

Make Me Heal: How well prepared were you for the recovery from physical, emotional, and mental respects?

Sharon: Most of my research was done on Make Me Heal.com. I also consulted with my sister who had the surgery, and my cousin and a couple friends who had it as well. I was as prepared as anyone could have been which made it much easier.

Make Me Heal: What are your top recovery tips to other patients?

Sharon: I have a long detailed list of recovery tips on my blog at: http://anewnose.blogspot.com/ (in which I recommend Make Me Heal.com) I will list the main points here:
• Q-tips
• Blistex Medicated (in the jar)
• Lighted tweezers
• Ice chips
• Mashed potatoes
• Arnica
• Humidifier
• Hard Candy
• Marked Dixie Cups for medications (to pre dispense)
• Bendy Straws
• Magazine
• Movies
• A schedule of help (friends, family who are willing to drive to the store to get you what you need)
• Soups (especially Chicken with Stars because you can drink the whole thing with a bendy straw)
• Valium, Vicodin, Percoset
Also I would schedule the surgery in the winter months when you wont be so sad to miss out on warm days, also make sure you have at least 1.5 months for the swelling to go down enough if you are preparing for reunions, weddings etc.

Make Me Heal: How long did you take off from work? What did you tell your co-workers about taking this time off? Did anyone notice your cosmetic procedures at work and what did you tell them if they asked about it?

Sharon: I took off 2 weeks and needed it all. I told my close friends at work. If anyone else noticed the change no one said anything. One friend’s husband knew about my surgery but when he saw me he forgot I had it done. When I asked him why he hadn’t said anything about my new nose, he said, “Wow the doctor must have done a great job because you look great but I didn’t really notice the change.”

Make Me Heal: How happy are you with the results?

Sharon: I am very happy. I don’t ever feel like people are looking at my nose anymore and I feel VERY confident about my profile!!!

Make Me Heal: How has your makeover impacted your life from personal, social, career, and other respects?

Sharon: Like I said before, I feel much more confident, and I don’t feel like people are only seeing my nose. I love showing it off, and now would like to improve other parts of myself to go with my new look like weight loss, and better clothes!

Make Me Heal: Would you have done anything differently if you had the chance?

Sharon: The only thing is that I would have waited until the dreary winter months so that I didn’t have to miss out on the beautiful and seldom sunny days of Ohio summers.

Make Me Heal: Was Make Me Heal beneficial to you along your journey?

Sharon: Yes…HUGE!!!!!!!

See Sharon’s Before & After Plastic Surgery Pictures Album.

See Before & After Rhinoplasty Photos

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Liz Throws Away Her Padded Bras for a Breast Augmentation
Posted on October 10th, 2008 in Breast Augmentation, Implants, Reduction, Personal Interviews by MakeMeHeal.com

See Liz’s Before & After Plastic Surgery Pictures Album.

Since she was a teenager, 26-year-old Liz (friendname: lizNher2sisters) knew she would eventually get breast augmentation, but it wasn’t until 2 years ago that she started saving and researching for the procedure. After having trouble choosing her implant size, she finally chose 400cc Mentor silicone implants for her June 19th surgery with Dr. Mark Zilmer in Washington. Additionally, she used the Make Me Heal Message Boards to connect with others having the same procedure for support and advice. Though she experienced a lot of pain right after the procedure, she was back to work after only 5 days. Now, at 4 months post op, she loves her new womanly figure but is experiencing a bit of “boob greed” and wishes she would have gone a bit bigger.

Liz’s advice for anyone contemplating plastic surgery is:

“Do what makes YOU happy and don’t listen to others. If you do it to give you self esteem, you won’t find it. Do it to help bring out what you know is inside of you. It is an enhancement of the beautiful person you already are.”

Please join us for an interview with Liz:

Make Me Heal: When did you first have the idea to have your procedure(s)?

Liz: In my teenage years I knew I would eventually do it, but seriously began the research and saving about 2 years prior.

Make Me Heal: What were your motivations (physical, emotional, social, etc.) behind your decision to have the procedure(s)?

Liz: Physically I felt inadequate and wanted to fill out a pretty lacy bra or bathing suit WITHOUT using inserts or push ups! Wanted my tall athletic frame to be more proportional.

Make Me Heal: How long did it take you to make a decision and was it an easy or difficult one to make?

Liz: Having the surgery was an easy choice. However, choosing the size was extremely stressful. I feared going too big for what was recommended but I wanted bigger than suggested by my first pre op PS. So I looked at many pictures and debated for over a month. Even still I wish I would’ve had more time and made a better decision as I would have chosen 450-475cc’s.

Make Me Heal: Did your family, friends, and any other people in your close circle give you support, opposition, or did you make this decision without considering them?

Liz: This decision was for ME 100%. My mother opposed it, my significant other supported me. However, I told them plain and simple that I was going to do it no matter what. At that point, the support was there from all areas.

Make Me Heal: How did you research the procedure and come to decide on this particular procedure?

Liz: I went on line and read a lot of facts and myths and looked at pictures constantly. I asked those I knew who had done it and posted on MMH for a month beforehand. I still wish i would’ve taken a little more time on MMH before the surgery but I was too excited that I didn’t plan it accordingly. Still no regrets on the surgery itself. Just size.

Make Me Heal: Please discuss if you used any of Make Me Heal’s resources such as the message boards, pictures library, doctor directory and doctor reviews, and any recovery and preparation products that you used.

Liz: I took full advantage of the message boards and pictures to help make my decisions and help me in my recovery. It was an extreme help.

Make Me Heal: How did you come to choose your doctor?

Liz: My doctor was the 2nd PS I met. The practice I chose was recommended by a friend. I was comfortable with my PS’s support and ease. He made me feel like this surgery was natural and normal, and whatever I wanted within reason he could make happen. That helped me push the CC’s slightly larger than recommended size my first consult PS recommended for my BWD. Glad I did.

Make Me Heal: Please discuss if you have any role in deciding the type of technique used for your surgery by the doctor, incision placements, implant brand, anesthesia type, etc.

Liz: No my practice typically does one certain types of incisions and anesthesia. However due to my lack of tissue, the placement was recommended and I agreed.

Make Me Heal: How did you prepare for the surgery?

Liz: I purchased comfortable clothing for the first post op days. Easy to eat foods. The prescribed meds and vitamins to help for a speedy recovery. Took them for 2 weeks prior and a few weeks after to help with healing. Did not engage in any alcoholic beverages or blood thinning agents listed in the paperwork provided by my Ps. Took 5 days off from work and prepared my team for my return and inability to lift or do excess activity. Purchased button front sports bras. Had plans for where my 4 year old would be taken care of in order for optimal outcomes for all involved.

Make Me Heal: How were you feeling the night before the surgery and on the moments before the surgery itself?

Liz: I experienced doubts and fear and insecurities of my decision. Did I go too big, will it look too small? Will I still feel my nipples? Will the scars be too big with silicone…should I change to saline? How will people react to them, will they even notice? Will I just look fat? Will they feel real or fake? Will they ripple because I have little tissue, or will I get CC? All these thoughts ran through my mind plus many more. I was VERY nervous the morning of. It was surreal and was excited to wake up and feel like a woman!

Make Me Heal: How was the recovery process? Please discuss what side effects you experienced? What were the worse parts of the recovery? Did anyone help you during the recovery?

Liz: Morning boob was HORRIBLE. I honestly felt it was worse than childbirth. I expected it to be much easier, but I was wrong. I have a high tolerance for pain but my pain meds seemed to simply put me to sleep rather then kill any pain. My boyfriend helped me for 3 days non stop. It was a nice help, but still very stressful as we both did not know what to expect.

Make Me Heal: Please discuss the pain or discomfort you experienced during the recovery?

Liz: Very painful to move. Painful To get up or down from the 45 degree angle in bed. I feared moving and it took much courage and determination to do it on my own. Even with help I cried in pain.

Make Me Heal: How well prepared were you for the recovery from physical, emotional, and mental respects? Did you do any research (i.e. online, books, message boards, etc.) to make your recovery smoother?

Liz: I relied mostly on the MMH boards. They were VERY helpful with all the weird feelings or sounds my new implants made or caused. However I was not prepared enough for the pain or decision of what size I should go.

Make Me Heal: What are your top recovery tips to other patients?

Liz: Stay on top of your pain meds!! Give it time before you start to worry! Two different breasts, two different recoveries.

Make Me Heal: How long did you take off from work? What did you tell your co-workers about taking this time off? Did anyone notice your cosmetic procedures at work and what did you tell them if they asked about it?

Liz: 5 days off from work and all of my employees knew what I was doing for the most part and I would be limited on my activity when returning. They hardly noticed since I wore a lot of padded push ups prior.

Make Me Heal: How happy are you with the results?

Liz: 1 to 5 … I would say I am a 4. Wish they were a tad larger, otherwise they look amazingly perfect!

Make Me Heal: How has your makeover impacted your life from personal, social, career, and other respects?

Liz: My personal life is much better as I more comfortable in the nude and confident showing myself. Socially I carry myself with my chin a little higher as i am proud that its ALL ME and no longer just a great bra. Career has not changed and I didn’t expect it to.

Make Me Heal: Would you have done anything differently if you had the chance?

Liz: Gone with more CC’s. More research would have gotten me to where I needed to be to be happier.

Make Me Heal: Was Make Me Heal beneficial to you along your journey?

Liz: It has been a tremendous help. I can share my crazy thoughts and worries that everyone else wouldn’t even begin to understand. I can see others progress and know it is different with everyone and I am NOT alone.

See Liz’s Before & After Plastic Surgery Pictures Album.

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Plastic Surgery After Massive Weight Loss
Posted on October 6th, 2008 in Body Procedures, Breast Augmentation, Implants, Reduction, Plastic Surgeon Interviews & Articles, Tummy Tuck, Abdominoplasty by MakeMeHeal.com
By Andrew Wolfe, MD

Obesity and the constellation of diseases which result from obesity are among the most significant health problems in the United States today. In an effort to combat this epidemic, patients are increasingly turning to Bariatric Surgeons for massive weight loss surgery. Last year 200,000 Bariatric procedures were performed, representing a 10-fold increase over the previous decade. The benefits of the weight loss are profound and far-reaching. Physiologically, there are improvements in many weight-related conditions, such as diabetes, cardiovascular disease, and skeletal disorders. The psychological benefits include marked improvements in body image and social acceptance as well as decreases in depression and anxiety.

Although the weight loss is truly a life saving process, it is not without its negative side effects. Psychological challenges can include stressful changes in relationships with the patient’s spouse, friends, and the opposite sex. These changes can be so pronounced that patients may experience an identity crisis after weight loss, and psychological counseling and support groups are integral to the successful transition from obese to non-obese. Physically, the loss of fat results in disproportionately loose skin and underlying soft tissue, which can lead to both aesthetic and functional concerns.

For many massive weight loss (MWL) patients, Plastic Surgery is a vital step in their journey, and improves their physical and psychological well-being. More than 100,000 contouring procedures have been performed on MWL patients, and that number is growing exponentially. The goals of surgery are straightforward – improved function, hygiene and appearance, achieved through safe, predictable procedures. As straightforward as these goals may be, post-MWL Plastic Surgery is a rapidly-evolving specialty, and procedures are constantly evolving to offer patients better, safer results.

Prior to any elective surgery after MWL, preoperative considerations which must be taken into account include nutrition, weight stability, and smoking habits. Nutritional deficiencies are common after weight reduction surgery, although newer Bariatric procedures are less likely to affect patients adversely than were older techniques. Vitamin and protein levels are generally checked before surgery, and supplemented if necessary, in an effort to maximize the efficiency of wound healing. Weight stability prior to contouring procedures is beneficial, and most patients undergo Plastic Surgery 12 to 18 months after their Bariatric procedure. A minimum of 3 months at a stable weight is a typical benchmark, although 6 months of stability is preferred. Of note, some patients do find that contouring procedures lead to further weight reduction through increased activity levels postoperatively. All nicotine-containing products must be avoided around the time of surgery, as they significantly increase the risk of wound healing complications.

The types of procedures performed on MWL patients are different than those on non-weight-loss patients. Given the profound laxity that most patients exhibit, extensive excisional procedures are usually necessary, resulting in larger scars, longer recovery times, and greater risks. In addition to the increased amount of skin, the quality of the skin that remains after contouring procedures tends to be of poor quality – stretch marks, loss of elasticity, and atrophy of the skin are all to be expected. Because of this, secondary touch-ups and revisions are not unusual in this population, and should not be seen as failures of the original surgery. Fortunately, MWL patients tend to be very tolerant of scars, very motivated, and extremely satisfied with the dramatic improvements that these procedures can produce.

Procedure types are generally broken up into the lower body (abdomen, buttocks, and thighs), and the upper body (breast, back, and arms). MWL patients present with a wide variety of deformities, priorities, and expectations, and individualization of treatment is crucial to success. Many patients require more surgery than can safely be performed in one session, and a staged approach is usually necessary. The lower body is generally addressed first, as the abdomen is almost universally a priority for MWL patients. Second stage procedures address the upper body, while a third stage may be useful for thigh tightening and/or touch-ups. Facial procedures may also be performed.

Laxity of the skin and soft tissues of the abdomen can be pronounced after MWL, and virtually all patients require some type of abdominal tightening. An abdominoplasty, or “tummy tuck” corrects this laxity with a multi-layered approach that tightens skin and muscle while removing excess fat in the lower abdomen.

This diagrams illustrates the key steps of an abdominoplasty. The initial incisions are made around the umbilicus and in the lower abdomen, and the skin is lifted off of the underlying muscles up to the rib cage. The rectus muscles are then tightened. As shown, this tightening is generally done in a vertical fashion, although additional vectors of tightening may be added if significant laxity exists. The patient is flexed on the table, and excess skin is advanced down towards the pubis and excised. Finally, the umbilicus is brought up through the abdominoplasty flap and sculpted into position.

Photos of a 35-year-old woman who had lost 90 lbs, before and after an abdominoplasty.

Photos of a 44-year-old woman who lost 120 lbs after an open gastric bypass before and after an abdominoplasty. (She previously underwent an augmentation/mastopexy.)

Photos of 38-year-old woman who lost 180 lbs after a laparoscopic gastric bypass, before and after lower body lift with augmentation/mastopexy.

Surgical correction of the upper body includes the female breast, male chest, arms, and back. Female breast surgery is commonly performed after MWL with the goals of improving the breast shape, volume, and skin envelope. Given the loss of soft tissue integrity of the breast that comes with MWL, most patients will need some type of skin tightening, be it with a mastopexy, augmentation/mastopexy, or reduction. In some patients, this can be achieved with a vertical scar pattern, while others with more profound ptosis may need a Wise-pattern or “anchor” scar.

The preoperative breast volume may be ideal, in which case a mastopexy alone can be performed. In this operation, the breast gland is reshaped, and excess skin is removed. Although no volume is removed, the breast tends to appear smaller due to its more compact shape. Many patients present with breasts that remain too large even after weight loss, and a breast reduction is performed. Finally, patients may desire a breast that is larger and perkier than their current breast. A breast augmentation in conjunction with a mastopexy is then performed.

Photo of a 45-year-old patient before and after an augmentation/vertical mastopexy.

Arm laxity is an issue for many patients after MWL, and is corrected with an arm lift, or brachioplasty. A brachioplasty tightens loose arm skin, improves the contour of the axilla, and can be combined with liposuction of the arm if residual fullness exists. The degree of laxity often seen after MWL often requires a full brachioplasty as opposed to a more limited technique, and results in scars which extend to the inner elbow. These scars often heal very well but take years to fully mature, and are visible in a short-sleeved shirt.

MWL patients often experience premature aging of the facial soft issues in addition to those changes seen in other parts of the body. Loss of volume and elasticity in the face can be corrected with procedures that resuspend soft tissues and tighten the skin while maintaining or augmenting facial volume. Newer facelift techniques may afford patients shorter scars, a quicker recovery, and fewer complications. A popular technique is the “Short-scar Lateral SMAS-ectomy” facelift, developed by Dr. Daniel Baker. Also known as a “Mini-facelift”, this procedure offers significant improvement in facial shape with a surgery less aggressive than that commonly performed. Many patients choose to add other procedures such as eyelid surgery (”blepharoplasty”) or brow lift at the same time for a more complete facial rejuvenation.

The risks associated with these procedures vary widely. For many body contouring procedures, the scars are long and heal to varying degrees of fineness. Wound healing complications are more likely in smokers and those with poor nutrition. Secondary relaxation of tissues is certainly possible, even after an aggressive procedure, and revisions are common in this patient population. As previously stated, a revision should be seen as a fine-tuning or enhancement of a previous operation. Deep venous thrombosis, or DVT, is one of the most dreaded complications seen with this type of surgery. During surgery, or in the postoperative period, these clots can form in the deep veins of the legs and have the potential to migrate to the lungs as a pulmonary embolism, a potentially fatal complication. A key intraoperative step to prevent DVT’s is the use of pneumatic compression devices that are applied to the legs. Early ambulation after surgery is also important. The risk of DVT is increased in the obese, older patients, smokers, and patients taking birth control pills. If multiple risk factors are present, short-term treatment with an injectable anticoagulant such as Fragmin or Lovenox may be used.

The postoperative recovery after surgery can range from less than a week for some breast procedures to three weeks for a lower body lift. Most breast procedures require a week off from work, and result in postoperative discomfort that requires prescription pain medication for three or four days. Lighter exercise may be resumed in two weeks, while more vigorous activities such as yoga or Pilates should be avoided for three or four weeks. In contrast, abdominoplasties and body lifts often require two tow three weeks off of work, with lighter exercise resuming at three weeks. Strenuous activities should be avoided for six weeks to allow adequate healing of the lifted tissues. Facial procedures tend to result in relatively mild discomfort, but patient appearance may dictate a two-week avoidance of social activities.

In summary, the field of Plastic Surgery after MWL is rapidly advancing. For these patients, safety is first and foremost, and a systematic approach to presurgical, intraoperative, and postoperative care can reduce complications. Communication, patient education, and informed consent are crucial, and patients must have realistic expectations. Finally, individualization and timing of procedures should be based on patient anatomy and patient priorities. Despite the challenges MWL patients present, the rewards for both surgeon and patient can be great.

About the Author

Born and raised in New York, Dr. Andrew Wolfe operates his practice, “The Center for Cosmetic Surgery,” in Denver, Colorado. Dr. Wolfe is passionate about his work, and thoroughly enjoys both the personal and technical aspects of the specialty. He believes that the physician-patient relationship is truly a partnership. “I have to understand a patient’s history, desires, and physical status before I can recommend a course of action. At the same time,” Dr. Wolfe says, “the patient has to learn about the various options available for any given procedure before they can make an informed decision.” Patient education is a high priority at the Center for Cosmetic Surgery, and Dr. Wolfe spends a great deal of time with his patients, both before and after surgery, making sure that they understand their surgical options. At the Center for Cosmetic Surgery, Dr. Wolfe has created a blend of state-of-the-art techniques and more traditional approaches. “I’m not shy about adopting new techniques or procedures”, he says, “but I need to be sure that they are safe and effective first.” Above all, Dr. Wolfe feels privileged to be able to be able to perform the work he does. “Virtually everything I do is elective, and I consider it an honor to be chosen by a patient to perform their surgery.” Learn more about Dr. Wolfe.

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