Injectable fillers have come a long way since the approval of the first non-collagen based product in 2002. While once conceived as only a way to make lips bigger and nasolabial folds less deep, injectable fillers have evolved into a popular aesthetic technology that has a wide number of facial uses.
Injectable fillers are used for two aesthetic facial applications, spot filling and volumetric enhancement. It is the latter that is often coined as ‘non-surgical facial sculpting’. That term is probably more accurate than not as it definitely takes skill and a good eye to get pleasing facial results with fillers. There is more art to it than science.
When it comes to facial volumetric enhancement with fillers, they are often compared to and even viewed as a substitute for surgical solutions to the same problems. Some injectors view synthetic fillers as a better treatment choice as they are easier to do and have less risk of complications than surgery. While that is partially true, they rarely give better results than surgery or offer the best value for the money invested to do them. Fillers can be a quick non-surgical fix but the benefits will ultimately fade away.
For skeletal augmentation of the three facial highlights, chin, cheek and jaw angles, injectable fillers can be used to create a visible external effect. When placed down at the bone level, I prefer Radiesse. Its calcium hydroxyapatite composition makes it the most viscous filler which provides a better push of the overlying soft tissues per cc of volume. But when comparing it to synthetic facial implants that have been used for decades, it has several disadvantages. It takes a fair amount of syringe volume to get a visible effect, often at least two or three syringes depending upon the area. The effect will never be as significant as a surgical implant and the filler material will go away by about one year after injection. This makes using an injectable filler for bony augmentation very patient selective. Filler are best used when one is uncertain about how a surgical implant may look (trial ‘implant’) or if the effect is time dependent based on an upcoming event and one doesn’t have the time to recover from surgery.
The face is also made up areas whose shape is not dependent on the underlying bone. These include two large areas in the lateral face and the temples. In the triangular area between the cheeks, chin and jaw angles, lies the lateral facial region. This area has garnered a lot of attention in facial aging as it becomes more concave in some people as they age due to fat atrophy. Plumping it up with fillers has become popular as a rejuvenative manuever. I prefer Sculptra for the lateral facial triangle because of the volume of material needed. Using an 8cc reconsitution of Sculptra in an almost pure watery form, it is easy to get a good amount of material over this large area. Sculptra does not work immediately and it takes time and three total injection sessions to get a result. But its effect may last for up to two years.
The concept of facelifting has evolved considerably in the past fifteen years. Not only has the techniques of facelift surgery changed, but how it has become markerted and advertised has changed as well. When you throw in the media coverage of celebrities and some of their results, understanding facelift surgery becomes even more muddled.
The options in facelift surgery are, however, far simpler than it appears. Facelift surgery traditionally speaks to correction of aging of the lower face only, the neck and jowls. As we age, jowling develops first which then leads to neck sagging and eventually the dreaded neck wattle. At its most simplist form, facelifts can either correct the jowls only, the neck only or both.. Thus facelifts can be done either as a partial (aka mini-facelift) or a full version.
The partial facelift is done when jowling is the main problem and any neck issues are either non-existant or minor. A full facelift is needed when the neck problem is the main issue or just as prominent a concern as that of the jowls. Thus, partial or limited facelifts are usually done on younger patients (less than age 55 or so) who have yet to develop significant neck sagging. The recovery from mini-facelifts is quicker because the operation is shorter and less technical manevers and tissue manipulations are done.. These are also the type of facelifts that have become very popular, largely driven by people in the workface trying to look younger and refreshed to remain competitive. They have been given a lot of different marketing names that imply less surgery and faster surgery and recovery, all of which is true. But don’t let the names fool you, they are all very much the same surgery.
A full facelift is usually needed in patients 55 to 60 years and older when the neck is a noticeable aging feature and either flaps or gets in the way of shirts and neck wear. In these more complete facelift patients, other procedures may be beneficial and are combined with it such as eyelid tucks and browlift surgeries. It is these combination procedures that give the impression that a facelift is a very extensive operation from which it takes a month to recover.
In between the mini- and full facelift patients lies an almost third category. This is where a partial facelift is not enough and a full facelift maybe more than what is needed. This may be perceived as a 3/4 facelift whose level of invasiveness and recovery is somewhere between a partial and full facelift.
Dr. Barry Eppley
There are many options to tighten loose skin in the neck and jowls, the most common aging problem in the bottom half of the face. One of the most significant developments in the past decade has been to limit the scarring that goes with the more traditional forms of facelifting. These procedures have become known by a lot of names including short scar facelift, S- lift, MACS lift and dozens of other catchy marketing names. But in the end, there are all ‘Mini-Facelifts’.
These smaller facelifts tighten up sagging jowls and droopy neck skin and do so with less scar. The scarring that is eliminated is in two specific hairline places, in the temples above the ear and in the crease behind the ear. Why is it important, if possible, to eliminate such scarring? The issue is one of scar widening and hairline displacement. When a facelift scar runs up into the temple hair, it will always move one’s sideburn hair up. (not important for men who can just grow new sideburns) When scars are placed back into the hairline behind the ear, they will become noticeable if one has very short hair or wears a pony tail that may expose the scars.
The incisions for a mini-facelift starts at the top of ear, goes inside it behind the tragus (bump of cartilage in front of the ear), and then tucks around the earlobe. It stops in the crease of the ear just above the earlobe. This incision pattern (and ultimately the scars) prevents loss of the tuft of sideburn hair and eliminates scarring behind the ears. This allows one to wear their hair any way they want without being ‘discovered’.
While less scarring would be an important part of looking better, these mini-facelifts are not for everyone. The vast majority of patients that benefit by them are under the age of 60. Today many people seek neck and jowl improvement by age 45 or 50. These short scar procedures are designed to smooth out the jawline, soften the nasolabial folds and restore a more sinuous and curved facial shape. As one ages, sagging of facial skin and jowls create a more square or ‘bulldog’ look for some. A mini facelift reverses this facial shape change into a more triangular shape which is more synonyous with youth.
The one disadvantage to a shorter scar facelift is it is not as good as improving the significantly droopy neck as that of a traditional lift. This is why older patients with more advanced neck problems have to accept the trade-off of greater scars from more extensive facelifts.
Many mini-facelifts are done with other facial aging procedures as well to get the maximal benefit. When potentially combined with such procedures as liposuction of neck fat, removal of excess eyelid skin and chemical or laser skin resurfacing, that tired aging look can be completely wiped away in a few short hours.
Today’s patients are more concerned about treating the early signs of aging and unwanted fat than ever before. Women and men alike are looking for faster, less invasive procedures with little if any downtime that can reduce their wrinkles and improve their figure. While many devices have been touted over the years, most have failed to produce satisfactory results for many patients. But a new technology is now available that offers the latest advancement in nonsurgical, pain free therapy for the reduction of targeted fatty deposits, skin tightening, and sun damaged and/or wrinkles skin anywhere on the face and body.
Exilis is an FDA approved device that offers a non-surgical solution using radio frequency (RF) energy for fat reduction and tissue tightening anywhere on the body. The procedure uses safe radio waves to heat your skin and targeted fat cells. This thermal energy speeds up the metabolic activity of the fat cells causing them to shrink. At the same time it stimulates and strengthens the collagen network which improves skin texture.
Exilis is one of the first systems that produces actual circumferential reduction. By combining RF energy with cooling, all areas of the body where stubborn fatty deposits persist or tighter, firmer skin is desired can be treated. While Exilis is heating the tissues, patients remain relaxed and comfortable. Having no pain alone is a real advancement in non-surgical device treatments.
The most frequent areas treated with Exilis Therapy in men are the love handles, chest, abdomen, face, jowls, and neck. In women they include the face, jowls, neck, decolletage, arms, bra fat, thighs, hips, breasts, buttocks, stomach, and knees. Exilis requires a series of treatments, usually four, to get the best results. The results from Exilis Therapy are gradual and may take from two to four months to see the maximal effects of the treatments.
During the procedure the Exilis computer-controlled delivery device is guided over the treatment area. One feels a deep heating sensation as the Exilis RF energy is delivered to the deeper layers of the skin. The therapy causes the collagen support tissues to remodel and tighten. The applicator provides cooling to the skin’s surface as the energy is delivered, keeping one comfortable during the treatment. Many patients report the treatment similar to a ‘hot stone massage’. Exilis therapy is performed in the office and takes from 15-30 minutes depending upon the size of the treated area.
The highlights of this new Exilis therapy is NO downtime and NO pain, NO anesthesia, NO numbing creams and NO after care, reasonably quick treatment sessions, progressive results that last, able to treat all areas of the face and body and is scientifically proven and FDA-approved.
Exilis offers a revolutionary non-invasive form of treatment for the reduction of wrinkles and for the reshaping of unwanted fat deposits. Exilis also provides a method of after surgery smoothing and skin tightening from invasive liposuction procedures. Exilis treatments can postpone or eliminate the need for invasive surgery particularly for patients with mild to moderate fat deposits and who may not want liposuction surgery. As the only provider of Exilis therapy in Indianapolis and the state of Indiana, I am very excited to offer my patients a real alternative to fat reduction and skin tightening surgery.
Dr. Barry Eppley
Cosmetic plastic surgery is now more than a $10 billion a year industry in the United States that has seen increases in number of procedures across all age groups. The largest growing population of patients, however, are those in their later years. Due to Americans being healthier, living longer and being more active later in life, millions of them want their looks to keep pace with how they feel. As a result, many are turning to cosmetic surgery to help them look younger and feel better about themselves.
In 2010, over 600,000 Americans age 65 or older choose to undergo some form of cosmetic surgery. Compared to ten years ago, that is a five times increase in number of procedures done. However a significant of these procedures, and a big reason for the large surge in numbers being done, is not actual surgery. In the interest of of wanting to look younger and fresher, many are going the injectable route choosing such popular products as Botox and Juvederm. While not as effective as surgery, they do help give one an extra edge in their appearance by decreasing frowning and plumping up certain wrinkles and folds.
Such injectable procedures involve only a minimal amount of discomfort by being placed right under the skin. Between wrinkle reduction and tissue plumping, these injections help give the face a smoother more youthful appearance. These are all procedures that can be done fairly quickly with a limited recovery time and are more economical options compared to surgery. When combined with a variety of available skin refreshening procedures such as chemical peels and light laser resurfacing, one can really take off a few years with next to no recovery or downtime.
While injectable treatments have lead the way in number of procedures for older Americans, ironically they are not the most effective given the amount of aging changes that are usually present. Injectables are more effective in younger patients simply because they have less wrinkles, lines and sagging skin. This is why surgery is also growing in numbers for the Baby Boomer generation with popular procedures being eyelid tucks, browlifts, and face and neck lifts. These anti-aging facial plastic surgery procedures can be done alone or, ideally in combination with surgery, to remove loose and sagging skin that creeps its way across our faces as we age.
We all look for that extra something to look and feel better as we age. My older and more mature patients clients are traveling, playing sports, exercising and doing all of the right things in life to look, feel and stay young. But, unfortunately as we age, all of the activity and exercise won’t make your face look any better. Looking better requires a effort, just of a different kind than that of feeling better.
Dr. Barry Eppley
The pursuit of the perfect or idealized female appearance is not a realistic goal for any woman, regardless of what plastic surgery has to offer. Improving your own body through diet and exercise, and perhaps a little plastic surgery if desired, is a more common sense approach. Women should only want to have a pleasing face and good body proportions that fall within what their natural genetics will allow.
The Barbie doll, introduced in 1959 and celebrating her 50th birthday in 2009, has always been a controversial figure when it comes to body image. One of the most common criticisms of the doll is that it promotes an unrealistic or unattainable body image for young women to try and emulate. Based on her 1/6 scale at a height of just under 12 inches, she would be the equivalent of 5’ 9” with a weight of 110 lbs with measurements of 36-18-33. Technically at these dimensions she would have a body mass index of around 16 which would classify her as anorexic.
While the Barbie look is not one young women should really admire, it is perhaps interesting to know what plastic surgery procedures one would have to go through to achieve it. In the October issue of O magazine, former model Katie Halchishick served herself up as a example of what she would have to do to achieve Barbie proportions. Posing for a photographer, she used her body to diagram out what she would surgically have to do to change her features to achieve the equivalent of Barbie’s proportions and shape.
Based on this photographic diagraming, it was shown that she would need facial plastic surgery consisting of a browlift, jawline reduction and thinning, nose reshaping, neck contouring and a chin augmentation. For her body she would need a breast lift, upper arm thinning by liposuction and a tummy tuck…and that is for just above the waist. And it was not like this former model didn’t have an attractive face and body to start with.
While this is an entertaining and even humorous bit of photographic morphing, it does actually have a serious message. Trying to have so called ideal body proportions, or even an unrealistic body shape like that of Barbie, is not a healthy pursuit…even if plastic surgery could make it possible. On a more common request, trying to look like a certain model or entertainer is equally unrealistic. Plastic surgery should be used to enhance the face and body shape that women already have rather than pursuing excessive surgery to try and achieve what one isn’t meant to be. This is a healthy and psychologically balanced approach to plastic surgery that many teenage and younger women would be advised to follow.
Dr. Barry Eppley
The thought of eating turkey at the upcoming Thanksgiving holiday brings together two inseparable images. While history does not show that turkey was ever actually served at the first pilgrim’s festival, it has become the featured culinary dish since. While many will enjoy the tasteful bites from a turkey leg, breast or stuffing, few will aspire to have the turkey neck.
While few want to eat a turkey’s neck, even fewer want to have one on of their own. The turkey neck or neck wattle is that well known fleshy fold of hanging skin that is unavoidable for many as we age. The loss of a once smooth jaw line and a shapely neck shows the persistent effects of gravity and time.
While creams and other potions promise much, the turkey neck needs a surgical fix. Forget about non-surgical options and other ‘lunchtime’ type procedures. They simply do not work no matter how hopeful one is. For the fuller neck in a young person, fat removal by liposuction alone may be enough. But when the neck skin is loose and floppy, and you can pinch a wad of skin and fat between your fingers, some method of actual removal is needed.
The removal of a turkeyneck requires some form of a facelift. While often misunderstood, a facelift is really a neck and jowl operation and does not change the face much above the level of one’s mouth. It is a poorly named procedure and the term necklift would more accurately describe it. It is really less extensive and easier to go through than most people think.
When it comes to necklifts, there are numerous options.Which one is best for any particular person is determined by how much loose neck skin one has. Some jowling and a little loose neck skin may only need a limited facelift. If there is a lot of loose neck skin, then a fuller form of a facelift is really needed. This is a powerful neck changer and can produce some really dramatic results. For those that want the least invasive amount of surgery but with a dramatic change, the turkeyneck can also be directly cut out in a procedure appropriately called the direct necklift.
The turkeyneck is not a desired culinary item on the bird and many people don’t like it on themselves either. While year round turtlenecks are always an option, a little skillful carving may be a better solution.
Dr. Barry Eppley
Shopping for discounts as an innately human characteristic. Most people like to negotiate or are attracted to sales as the need to feel like one has gotten the best deal is sometimes as important as the item of interest. At no time is this more evident than in economic downturns. While I think the Groupon concept may have been successful at any time in history, it has really taken off since our recent recession started.
While Groupon had its origin in retail items such as restaurants, spa services, and clothes, it has more recently spread to medical procedures such as cosmetic surgery. Groupon discounts now exist on a wide range of cosmetic procedures from Botox to breast implants. These elective medical procedures for some appear to fall into the mindset of any other retail purchase.
While cosmetic surgery today is commonplace, it begs the question why anyone would be willing to buy cosmetic surgery based on a doctor who only offers the lowest price. Choosing cosmetic surgery on price seems to be a poor health decision. Almost all of these cosmetic procedures can cause serious problems if done improperly…and may cause injuries that are hard to correct later.
But beyond this concern, there are other issues that underpin serious problems with the Groupon cosmetic surgery concept. One of these is that not every patient who buys such a discount may be a good candidate for surgery. While Groupon does make a footnote that services are dependent on being qualified, making an online purchase creates a level of provider obligation that may be difficult to reverse. In this discount coupon approach, eligibility is not done before one purchases the procedure. This is the exact opposite of what occurs in common medical practice.
Unlike a meal which you don’t like or a purse whose clasp falls off weeks after you have purchased it, what happens when you don’t like your cosmetic surgery result that requires a revision or a complication that requires further surgery or medical care? Who is going to pay for it? Who is financially responsible? I can assure you that it isn’t Groupon even though they took a hefty profit on the transaction. Having cosmetic surgery because you could afford it due to the discount unintentionally exposes the enthusiastic shopper to a financial risk that they are completely overlooking.
Equally relevant, why would any cosmetic surgery provider offer an expensive surgery at half price? Would a well qualified plastic surgeon with lots of experience offer cheap cosmetic surgery? More times than not such, cosmetic surgery Groupon offers come from doctors of dubious backgrounds and training for the procedures that are touting. The Groupon concept makes it easy for such providers to find new patients who don’t look past the dollar signs.
Cheap cosmetic surgery may sound attractive…but the consequences later may be anything but cheap.
Dr. Barry Eppley
Botox remains a popular and effective method of reducing unwanted facial expressions and wrinkles. While it is a highly desired anti-aging facial treatment, it must be introduced by a needle and preferably in a doctor’s office or a medical facility. While the injections are not terribly uncomfortable, if there was a way to avoid having needles put into one’s face these anti-wrinkle treatments would likely become even more popular.
The quest to find a ‘topical Botox’ or cream that would penetrate through the skin to reduce the source of facial wrinkles has been much like the search for the Holy Grail. There is a strong belief that such a cream exists but it has remained elusive. Many topical creams and serums claiming to have a Botox-like effect have been touted, but the real beneficiary of those products has always been the manufacturer .
At this year’s annual American Society of Plastic Surgeons meeting in Denver, a new botulinum toxin-based gel was presented that showed promise. Reporting results from a recent prospective double-blind clinical trial of nearly 100 patients, near 90% of those that had the active gel had observable reduction in crow’s feet wrinkles. This compared, interestingly, to just under 30% in those patients that have been treated by a non-active or placebo gel. In a second study that involved nearly 200 patients about 40% of those treated with the botulinum toxin gel had good results. In either study, the effects of the gel lasted around four months which was comparable to that of injectable Botox.
These study results are the first to show that dynamic facial wrinkle reduction is possible through topical application or a cream. It is no surprise that the studies have been done for wrinkles in the crow’s feet region to the side of the eye. This skin is very thin and the most easily penetrated down to the orbicularis muscle underneath. This is unlikely in the substantially thicker forehead tissues where an effective topical cream would be much more challenged to penetrate deep enough.
While it is encouraging that a botulinum toxin gel has been shown to noticeably soften crow’s feet wrinkles without needles, it remains to be seen how practical it will be. Does the gel work better than injectable Botox? Would it’s cost be similar, less or even more? This information awaits further clinical study which undoubtably is ongoing. Getting rid of some wrinkles may truly be just a dab away in the near future.
Dr. Barry Eppley
Being overweight is a well known health risk. Accumulations of fat, particularly around one’s midsection, contribute to the risk of heart attacks, stroke, and diabetes. Losing this weight through a sustained diet and exercise program is the best way to improve one’s health. There is a large number of medical studies that would support the health benefit’s of overall body fat reduction.
It has long been theorized that the surgical removal of body fat rolls through liposuction may offer some similar albeit less significant health benefits. To date, there has been no medical evidence that would support this belief. It was presumed that the amount of fat removed in most liposuction procedures was simply too small to make a difference. In addition, it has always been believed that the fat that really matters, from a health standpoint, was visceral or intra-abdominal fat. Subcutaneous fat or that which lies right under the skin only mattered because it made up those unflattering outer body rolls.
A recent study given at the 2011 annual American Society of Plastic Surgeons meeting in Denver presented some interesting findings on potential health benefits from liposuction surgery. In over 300 hundred patients who had either liposuction, a tummy tuck or both combined, blood levels of triglycerides, cholesterol and white blood cells were studied both before and after surgery. Triglyceride levels in patients with normal levels before surgery were unchanged. However, in patients with elevated triglyceride levels before surgery (defined as greater than 150 mg/dl), they showed a triglyceride level reduction of over 40 percent. Such significant level reductions are usually associated with drug therapies which often are even this effective. White blood cell counts, viewed as an indicator of chronic inflammation and disease inducer, dropped an average of 10 percent.
Does this mean that liposuction is good for your overall health? That is a stretch at this point but this study clearly shows that liposuction causes blood chemistry changes that reduce certain disease risk factors. Much more work needs to be done but it does provide some proof that subcutaneous fat may have a greater metabolic role to play than previously thought. It is not just an idle depot of excess fat whose only relevance is as the creator of undesired body rolls and bulges. At the least it may be comforting to know there may be some benefit, small as it may turn out to be, that liposuction removal of abdominal and waistline fat may also be good for more than just how you look.
Dr. Barry Eppley
Breast augmentation remains a popular body contouring procedure for women. In as little as one hour, a woman can dramatically change her body shape in a very favorable way. Only breast implants can produce such a significant body change in such a short period of time. When it comes to breast implants there are two types currently available, saline -filled and silicone filled. Since 2006, silicone breast implants have returned which are filled with a new cohesive gel formulation that is much better than that used in the past.
Given these two choices, how does one decide which type of breast implant is better for them?
In reality, neither saline or silicone breast implants are perfect. If one was truly better than the other, there would be only one choice not the two that we have. Each type of breast implant is safe (FDA-approved) and has its own unique set of advantages and disadvantages. Both of them will do the job and do what they are intended to do… make the breasts bigger. But there are some differences between them and understanding these differences helps you make the best implant.
Saline breast implants have the advantages of a lower cost and can be placed through a small incision high up in the armpit that is not on the breast. That incision location may be an advantage in the Hispanic woman who may be concerned about any scarring around the breasts. Saline implant disadvantages are that there may be some implant rippling that can be felt on the bottom or sides of the breast and the risk of immediate deflation of the breast should the implant rupture.
Silicone breast implants have the benefits of a slightly more natural feel (no rippling) and the breast will not go flat should the implant rupture. However, they do require an incision in the lower breast crease and have higher implant costs.
Other than these implant differences, everything else about the breast augmentation procedure is the same including recovery time (one week or less) and how long the breasts will be swollen. (two to three weeks)
What is the best type of breast implant for you? I tell patients to make their choice based on which of their disadvantages you can live with the best. Both saline and silicone implants work for breast augmentation…which of their disadvantages is more acceptable to you?
Dr. Barry Eppley
Inadequate training and poor judgment account for a disproportionate number of complications and unsatisfactory results that occur from cosmetic surgery procedures. With so many different types of doctors doing cosmetic surgery, how can one make a safe choice? Historically, the use of the terms ‘board-certified’ and ‘specializing in’ were enough to demonstrate a doctor’s expertise, but today that is not enough.
Are they board-certified in plastic surgery or another specialty? Many new cosmetic surgeons are board-certified but not in plastic surgery. Their board certification may be in General Surgery, Dermatology, Oral Surgery or Ob-Gyn to name a few. Some may even have an additional board-certification in cosmetic surgery. But this self-created board should not be assumed to be equivalent to those certified by the American Board of Plastic Surgery. There is a significant difference between board-certified plastic surgeons and board-certified cosmetic surgeons that makes them not equivalent at all.
How experienced in doing your procedures of interest is the doctor? This can be a hard piece of information that is not easy to ascertain. Certainly asking the doctor is an obvious way to learn how many the doctor does, but that is not the exclusive source I would use. Look at their websites and see how many before and afters of the procedure are posted. Ask for before and after photographic results and to talk to some more recent patients. (done in the past 3 to 6 months) Word of mouth still remains as a good method of recommendation. Willingness to easily and quickly divulge this information is a good sign. Hesitancy or avoidance of doing so would be of concern.
Hospitals are obviously certified and have to meet highs standards of care and comply with stringent regulations. Surgery centers can be quite different and you want to have your surgery in one that has been accredited by either the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), the Accreditation Association for Ambulatory Health Care (AAAHC) or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). This accreditation and a state license to operate means the facility adheres to safe operating conditions. Doctor’s office are fine for minor surgery but most are not accredited for more significant surgeries and any anesthesia that may be needed.
The cost of cosmetic surgery is always of concern and no one wants to overpay for their procedure(s). But the cost of cosmetic surgeries is influenced by market factors just like any other retail business. This makes a fairly consistent price range for procedures in any given geographic region. If after getting several consultations one price is considerably lower than another, the question should be why. Where are the costs being reduced to offer such a lower price? This is what makes the whole concept of Groupon and other discount programs for cosmetic surgery so unnerving.
Dr. Barry Eppley
Aging is inevitable and it begins to appear first around the eyes. While eyelid and brow lifts provide immediate and significant improvements, many would prefer to lessen these eye flaws without the costs and recovery of an operation.
There are a variety of non-surgical eye treatments combining neurotoxins, fillers, lasers devices and topical products. Which ones are used often follows the age of the person. Those in their 30s and 40s usually just need Botox to control their frowning and squinting wrinkles. Fillers and light and laser treatments are added for those in their 40s and 50s. At age 50 and beyond, surgery is needed to remove extra upper eyelid skin and lower eyelid bags. But these non-surgical treatments are still needed to preserve one’s surgical investment.
Botox is the most known name when it comes to facial wrinkle reduction by injection. But it is not alone as two other injection drugs, Dysport and Xeomin, are also available. While there are some that believe one is better than the other, they all are really comparable. They all take a few days to a week to start working and their effects will last from three to four months. One is not more powerful than the other nor does one cost less. These injections are given by the unit and the cost per unit varies for each one but so does how they are prepared. As such their treatment costs are all about the same.
While Botox is the most common non-surgical eye treatments, injectable fillers can also play a role. Many people will develop shadowing and tear troughs under the lower eyelid, sometimes as early as the late 30s. This can be treated with fillers to plump the area out. While they are over a dozen types of injectable fillers, the hyaluronic acid-based fillers (e.g., Restylane and Juvederm) are preferred. They can be delivered under the thin tissues of the lower eyelids with a low risk of lumps and irregularities.
While eye wrinkles can be held in check with Botox and fillers, they can not reverse certain skin problems. Blood vessels and brown spots can be removed with pulsed light treatments. These are often confused with lasers which they are not. When it comes to improving skin texture and reducing fine lines and wrinkles, laser resurfacing can provide improvements beyond what an eyelid lift can do.
Topical skin care products complement eye the benefits of injectable and energy treatments. The skin around the eyes is so thin that it responds well to many Vitamin C, retinoid and antioxidant-containing products. A new topical product, Latisse, is great for thinning eyelashes and eyebrows and it works like nothing else. Eyelashes and eyebrows can become one-third longer and thicker in a few months.
While surgery may be needed or inevitable for some, younger and less tired looking eyes may be just a few injections or the wave of a laser wand away.
Dr. Barry Eppley
Without explanation, everyone seems to know what a neck wattle is. While not seen as an endearing neck ornament as one gets older, this sagging piece of skin and fat is often a source of considerable anguish of one’s appearance.
The good news is that neck wattles can be successfully eliminated and usually much easier than one thinks. The trick is matching the proper solution for the size of the neck wattle. Some wattles are small, others are quite large. Different wattles need different approaches.
The two things that we know about neck contouring is what doesn’t work. There has yet to be a cream that has a real ‘neck rejuvenation’ effect. The winner in that transaction is always the seller of the magical potion. If there was a cream that could really change your neck, we would all know about it and it would cost thousands of dollars per jar. The other scam is that of neck exercises. If a neck wattle was really due to loose muscles, this approach might have some benefit. But it is loose skin and fat for which the ‘neck gym’ remains no better than those creams in a jar.
Getting rid of that neck wattle requires a necklift, also known as a facelift. There are different varieties of these lower facial lifting procedures depending upon how the size of the wattle. Smaller or more limited versions are popularly known as Lifestyle Lifts. They are great for jowling but not for the bigger neck wattle. For a neck that hangs more, a full facelift is what is needed. It has a powerful change effect on making that neck more shapely and tucked up again.The difference between the two is the location and extent of the incisions around the ears and the time of recovery.
To really change the neck in more significant wattles and sagging, the facelift must have an incision that goes up behind the ear and back into the scalp. It is the pull from behind the ear that draws up and tightens the loose skin in the middle of the neck. When needed, the extra recovery is worth the investment.
The other neck wattle surgery that few people have ever heard of is the direct necklift. It is the real wattle reducer and is the simplest of procedures to go through with but a few days of recovery. By cutting out the wattle directly, it is gone forever and creates a neck shape that will last for decades. The tradeoff for this simple wattle eliminator men is a fine line scar down the center of the neck. For men who have beard skin, this scar heals beautifully and may be the procedure of choice in the older male. For women, this potential scar must be considered very carefully.
Have you ever looked in the mirror and seen that tired look and wondered why? If you are over forty, this might be a near daily occurrence. Fullness or extra skin of the upper eyelid is one of the most common causes of tired looking eyes. You may be wondering what’s the best way for me to remove this fullness and restore the youthful, attractive look to my eyes. Is it an eyelid lift (blepharoplasty), a browlift or some combination that is right for me?
Fullness and heaviness of the upper eyelids occurs for two reasons. The most common reason is too much skin and fat. Due to the constant stretching of opening and closing your eyes (the upper eyelid accounts for most of eyelid closing) extra skin is created over time. Eventually this can become so significant that it hangs down onto your eyelashes, known as hooding. The other contributing reason can be the position of the eyebrows. If the eyebrows have dropped down and are too low (gravity does usually win) this can also add fullness to the upper eyelids as it pushes the eyelid skin down.
To really know whether it is the eyelid skin, the eyebrows or a combination of both that is causing those full and tired looking upper eyelids, you must do an eyebrow placement test. By putting your eyebrows in the proper aesthetic position (by pulling up on the forehead skin until you have the desired eyebrow position) and then opening and closing your eyes, one can see the true amount of upper eyelid fullness remaining. By so doing, there are three possibilities for correction which will be revealed.
When the eyebrows are lifted to a better position, all the upper eyelid fullness is gone. This means the fullness is due to low eyebrows and the solution is some form of a Brow Lift. In this situation if only an eyelid lift was done, it would actually cause your eyebrows to become lower.
When the eyebrows are lifted, some but not all of the upper eyelid fullness gone. This means a combined browlift and eyelid lifts are ideally needed. It would also be perfectly appropriate to just do an eyelid lift and accept the lower eyebrow position. For men this is usually more common than in women as most men have naturally lower eyebrows.
If the eyebrow is already in a good position on the lower end of the forehead and all of the eyelid fullness remains, than only eyelid lifts are needed. This is , by far, the most common tired eye scenario particularly if one is under the age of 55 or so.
Plastic surgery correction of aging of the upper eyelids must consider its upstairs eyebrow neighbor to determine the best solution to a less tired and rejuvenated look.
Dr. Barry Eppley
While the neck is technically not part of the face, it does makes a very important contribution to one’s appearance. A sharp neckline helps highlight the jawline and makes a clear transition between the two. When the neck is too full or hangs downward, it may be the result of too much fat, loose or saggy skin or a combination of both.
How to reshape the unsightly neck requires an understanding of why it is that way. As a general rule, a younger patient’s neck has more fat than skin. Conversely, older patients usually have more loose skin than fat…and skin that may have lost much of its elasticity.
Many neck contouring treatments are touted that range from non-surgical energy therapies to actual surgery such as liposuction and necklifts. The degree of effectiveness of any of these neck procedures depends on how well the treatment changes the amount of fat in the neck, tightens the skin or preferably does some of both. When the patient’s problem matches what the treatment does best, an improved neck shape will occur. If not, results will be poor.
One effective neck contouring treatment is liposuction. As the only known treatment method that can remove fat, it is no surprise that it is a part of almost any surgical neck procedure. A basic principle of liposuction is that the skin must contract afterwards. Part of its reshaping effects relies on the skin shrinking down to the slimmed down neck. What is unique in neck liposuction is that the skin must actually shrink upward.
While traditional liposuction does not have any direct effects on creating skin tightening, that has changed with the use of Smartlipo or laser liposuction. The heat created by the melting of fat and the ability to directly treat the underside of the skin with the laser energy creates better skin retraction and some degree of actual skin tightening.
Smartlipo has been and remains my preferred technique when liposuction of the neck is done as a stand alone procedure. When used in younger patients with fuller fatty necks, good skin retraction and reshaping can be seen. It is very common for the neck to feel very firm for weeks afterwards. This is a temporary skin effect that takes a month or two to soften and go away.
In older patients with significant skin sagging, the tightening effects of Smartlipo are limited due to the amount and quality of the skin. When requested to do it in a few patients who refused any other form of surgery, I have seen a few impressive neck reshaping results. But I do not consider it the treatment of choice in the older neck and patients should temper their expectations accordingly. Its benefits are also obviated when liposuction is done as part of a face or necklift where skin undermining and flap repositioning are far more effective methods for neck reshaping.
Dr. Barry Eppley
When the subject of breast implants or breast enlargement surgery comes up, many people immediately think about size. Large breasts that create eye-catching cleavage are what comes to many minds, a concept that has not been helped over the past two decades from celebrities ranging from Pamela Anderson to Heidi Montag of more recent note.
The reality of breast implant surgery, however, is far from this image. There are certainly a minority of women who do want this look. But the vast majority of women who choose to have breast implants are much more interested in finding the right size for their body and not to have overpowering breasts that become the focal point of their appearance.
Most breast augmentation patients are average women who simply want to look good in clothes and sport attire. I have seen many women who have told me that they are embarrassed to wear a bathing and won’t go to the pool or beach with their family. While breast underdevelopment is the most common motivation for getting implants, there are numerous other reasons. These include such breast conditions as postpregnancy sagging, asymmetrical breasts, body proportioning, breast asymmetry and reconstruction after mastectomies.
Pregnancy and nursing can have an adverse effect on a woman’s breast shape and size causing sagging and, almost always, a change in the amount of breast tissue. Many women are unaware that it is completely normal to lose breast tissue after pregnancy, a phenomenon known as involution. For some women who have had multiple pregnancies, they lose all of the breast tissue they originally had. When combined with stretched out skin, the change in a woman’s breasts can be deflating for their self-image as well. These are women who simply want to return to their pre-baby size and shape.
There are many women who have breast asymmetry where one breast is larger or different in shape than the other. In some cases the breast size difference can be as much as a cup size, sometimes even more. For women so afflicted, finding a bra to fit comfortably and properly is not as easy as going to Victoria Secret’s and pulling a good fit off the rack. Often they are forced to add padding to create a more even look in their clothing.
One of the most recognized and easily understandable reasons for implants is in breast reconstruction. The physical and emotional devastation of going through any form of a lumpectomy or mastectomy procedure can be softened knowing that an immediate or even a delayed reconstruction can be done. While numerous forms of breast reconstruction exist, including flaps that form the breast mound out of your tissues, implants remain the backbone of how most breasts are recreated.
Dr. Barry Eppley
Rhinoplasty surgery can make many changes to the nose, from taking down a bump on the bridge to narrowing the tip. But in the end, the result that will be seen depends how the skin of the nose redrapes and adapts to the new changes that have occurred in the supporting framework underneath it. Given that removing skin from the nose or tightening it through incisions and creating external scars would be unacceptable, the wildcard in any rhinoplasty outcome is ultimately the patient’s nasal skin.
Thus, unlike any other piece of nasal anatomy, the skin is really a fixed and not a variable component of rhinoplasty. It is the one piece of nasal anatomy in which its surface area can not be reduced. It is a common principle in rhinoplasty teaching that the skin will shrink down and adapt to show the changes that have occurred in the bone and cartilage framework. But this is not always so and is not necessarily even always predictable.
How well the skin of the nose can shrink down is influenced by many variables. The two most important are the thickness of the skin and where on the nose it is located. Skin in the upper half of the nose seems to be better at adapting than the lower half of the skin. But that may be just a reflection of the complexity of the anatomy underneath it. The upper nose is like a saddle while the lower nose has a much more complex shape and is more similar to wrapping paper around one side of a ball. Thin skin is believed to shrink better than thick skin and probably reflects that it has less overall mass. In theory, thick skin should shrink more than thin skin due to a higher number of elastic fibers. But its thickness provides 50% more mass given any surface area so significant skin contraction does not occur.
When one has thick skin on the nose and is undergoing a rhinoplasty, it is important to temper one’s expectations and to have extreme patience in awaiting the final result. This is particularly relevant to many ethnic rhinoplasties including Africa-American, Hispanic, and Middle Eastern. Since one of the main objectives of these rhinoplasties is to have a more slim and refined nose, thick skin will have an influence on how achieveable that goal is. It is also important when performing these rhinoplasties to not attempt to slim the nose by removing too much underlying structure. That will cause the skin to ‘ball up’ particularly in the tip area since the now ‘excessive’ skin has nowhere to go but to contract onto itself.
Dr. Barry Eppley
The stomach area is the number one region that almost all women, and some men, would like to improve. Many have discovered, however, that improving that body area is not as easy as one would like. Many people work hard at it but eventually ‘hit the wall’, get frustrated and may even quit their diet and exercise routinue with no more changes are seen. But the fault may not be your own. Loose stomach skin and fatty bulges at the waistline from pregnancy or significant weight loss are not amenable to internal calorie or fat burning. This brings some to the conclusion that the only way to a more shapely torso is a surgical one.
Everyone knows that a tummy tuck is the removal of skin and fat with muscle tightening to get a flatter stomach and better waistline. While it is almost always a very satisfying procedure, and many patients say afterwards they wish they had done it sooner, it is major surgery and is not just a weekend recovery. When considering a tummy tuck, be aware of the following considerations.
There are two basic types of tummy tucks. If your excess skin and fat is mostly located below the belly button, you may do just fine with a mini tummy tuck. Because the skin and fat removal is done below the belly button, there is a shorter incision that can be placed very low and the belly button is not moved. There is also a slightly shorter recovery with emphasis on the word ‘slightly’. If the loose skin and stretch marks are above the belly button, only a full tummy tuck will do. With that comes a longer scar, a bellybutton scar and a longer recovery.
I have seen recent treatment approaches, particularly online, that tout a ‘scar-free tummy tuck’. There is no such thing and this is just marketing spin to say they are offering stomach liposuction. That raises a question that many people would like to pursue…liposuction instead of a tummy tuck for their flabby and sagging stomachs. That has become a popular request, particularly since Smartlipo (laser liposuction) technology has become available. While it is true that Smartlipo does have some skin tightening ability, it is quantitatively different than what many people need. Smartlipo tightens skin as measured in millimeters, most people need stomach skin tightening as measured in centimeters. With this understanding, it is easy to see that liposuction is not a substitute for a tummy tuck.
Liposuction, however, is very often a part of a tummy tuck. But it isn’t necessarily used to make the tummy part looking better. It is used to shape the areas outside of where the effects of the tummy tuck occur…the outer waistline and back. (i.e. muffin tops) A tummy tuck alone is a 180 degree or frontal torso change. By adding waistline and back contouring with liposuction, the results becomes more of a 270 degree torso change.
Dr. Barry Eppley
Botox is commonly recognized as an injection treatment to either turn back or slow down the hands of time. By reducing the wrinkle lines of the forehead and around the eyes, a more relaxed and often a less scowling appearance is achieved. But the use of Botox continues to find new medical problems for which it is effective. Allergan, Botox’a manufacturer, is already a multibillion company which continues to experience record revenue and earnings growth.
The newest FDA-approved indication is in the treatment of migraines. Approved last year it works for migraines just like it does for wrinkles, by relaxing muscles. But it is injected around those nerves in the head which are being squeezed by muscles and thus serve as the trigger for the migraine headache. These are commonly in the eyebrow, temple and at the base of the skull in the back of the head. For some patients the temporary relief is a near-miracle which will last about four months. Botox in migraines is also a test which proves that doing surgery by removing this muscle around the nerve can have a more permanent effect.
Botox has long been approved for halting severe underarm sweating, an embarrassing condition known as hyperhidrosis. This disorder causes so much perspiration that some sufferers are forced to carry several changes of clothing to make it through the day. The excessive sweating is caused by over stimulation of the sweat glands by the nerves of the autonomic system. Botox interferes with the nerves responsible for this drenching. It has a similar benefit to those who also suffer excessive sweating in the palm of their hands. (palmar hidrosis)
Botox is effective for cervical dystonia, a condition that causes the neck to twitch, twist, and go though repetitive movements and carry the head in abnormal postures. This happens because of involuntary muscle contractions which the injections directly weaken. It is similarly effective in cerebral palsy in which patients have stiff spastic arms and legs caused by abnormal signals from the brain to the muscles. Botox interrupts this communication between the nerves and the spinal cord which then causes the muscles to relax.
Overactive bladders are also benefiting by these injections. Caused by muscle spasms of the bladder muscles, urinary incontinence can make it difficult for some patients to undergo even short car trips. Some patients end up wearing adult diapers. Botox overcomes bladder incontinence by weakening or paralyzing those muscles which contract inappropriately and squeeze out the urine involuntarily.
Botox can also stop chronic pelvic pain which can make it difficult to have sexual intercourse or undergo an examination or a pap smear test. This type of pelvic pain is caused by tight over-contracted pelvic muscles.
While often perceived as a drug of beauty, the many medical benefits of Botox makes its few precious drops life-changing for more just a better look in the mirror.
Dr. Barry Eppley
When a product or manufacturer calls itself ‘smart’, there should be a good reason. Such is the case with the plastic surgery method known as Smartlipo. Highly touted as a better and more efficient method of liposuction, its name clearly suggests that it is better than traditional or ‘dumb’ liposuction. Grandiose claims are made all over the internet, most of which by doctors who use this liposuction technique. The manufacturer of the liposuction device, Cynosure, focuses on the established science behind it.
Smartlipo is a laser technique for melting fat to make it easier to extract. By first heating up the fat to a specific temperature, like oil in a cooking pan, it is turned from a solid into a liquid. This is done by using a laser probe that is passed through the fat area until the right temperature is reached. Then a liposuction cannula is used to remove by vacuum the oily liquid and any other fatty chunks in the area.
But what makes this liposuction so smart and why is it better? First, what it isn’t. Because a laser is involved, many potential patients think it is not invasive surgery. It is just as invasive as traditional liposuction which means there will be a recovery. This is not some magical approach that works from outside the body. Just because it is a laser, it doesn’t really zap the fat like a video game. It is about raising the temperature of the fatty zone until the fat begins to melt. The laser is just a way to heat the fat like the burner on the stove.
What makes Smartlipo better is that it creates a global melting effect which removes more fat than suction alone. Because of the heat damage, more fat is lost later than just what comes out at the time of surgery. Fat continues to die days to weeks later, thus the full effect of the fat removed is not really seen for months even though the early results are apparent within weeks after the procedure. This heating effect also accounts for its skin tightening capability. Such an effect, however, is almost always overstated and over expected. Do not expect Smartlipo to replace what a tummy tuck or armlift can do.
While many doctors tout Smartlipo as being done under local anesthesia with little recovery, this is often not so. Because there is considerable heat generated during the procedure, it is not hard to see that local anesthesia is often not enough for a comfortable operative experience. One can only remove enough fat if the patient is comfortable and will allow it. It is not a test to see who is the toughest. This is why I recommend a general anesthetic. The best result in the shortest period of time can be done when the maximal amount of fat can be comfortably removed.
Recovery from Smartlipo is not much different than traditional liposuction. While the amount of fat removed can be better, this does not mean there is less recovery. The laser does result in less pain and bruising but the amount of swelling is about the same, requiring months to eventually see the final body contouring effect.
Dr. Barry Eppley
The concept of non-surgical fat reduction has been around for over a century. From belt machine devices in the early 1900s to the infomercial weight loss supplements of today, hope is eternal when it comes to getting rid of unwanted fat. Without question, the definitive way to lose spot areas of fat is liposuction. Liposuction is a proven surgical method to trim down specific body areas, but it is an operation and involves recovery.
Non-surgical fat removal, no matter what the method, will never be as effective as surgery for spot reduction. However, newer non-surgical methods of fat melting have appeared in the past few years. One of these is Zerona, or specifically the Zerona laser treatment program. It is touted as a painless body slimming method that is proven to remove fat and inches without surgery with zero pain and downtime. Does it really work? Is it hype or hope?
Zerona works by using a low frequency ‘cold’ laser that passes through the skin without injury and targets the fat cells. The laser energy targets the fat cells through a photochemical process. Not to be confused with a photothermal (heat) or photoacoustic (vibration) method, this non-heat generating process makes the fat cells ‘leaky’. The fat cells shed their liquid fat content, now known as free-fatty acids, which is then absorbed through your lymphatic system. The lymphatic system transports it to the liver where it is processed and broken down, and most importantly, not re-circulated and stored again as fat.
Zerona is more than just a machine, it is a process. Treatment sessions number six to nine and have been shown to be able to take off three to five inches in the hips, waist and thigh in two to three weeks. But to aid the lymphatic clearing process, one must significantly increase their water intake and take a twice-daily niacin supplement (Curva) or HCG (human chorionic gonadotropin) during the treatment process. The treatment sessions require a commitment and must be done every two to three days to really be effective. Once the fat cells get leaky, you can’t let them heal themselves by missing treatments or having them too far apart. Each treatment session takes just under an hour and is painless. You literally get up and go afterwards. Daily exercise (such as brisk walking, light running, or other cardio training) can increase the final results by aiding in lymphatic clearance and an increased metabolism.
Is Zerona fat reduction too good to be true? It depends on your expectations and how much fat you have from the beginning. We do screen our patients and select those that we think, based on our experience, have the best chance for success. That has resulted in about a 70% satisfaction rating from our treated patients. This means that those patients saw enough of a difference, both visually and by measurements, that they rated the treatment a worthwhile investment. Thus, as part of a jumpstart on the front end of some body slimming or as part of an overall weight loss program, Zerona can make for very visible body changs.
Dr. Barry Eppley
Catching a glance in the mirror or looking at a picture and seeing those sagging jowls and a droopy neck can be a troubling finding. It often seems like it came out of nowhere. I have yet to see a person find this discovery charming. While hope lies in that some magic cream or laser treatment will make it all go away, deep down inside we all know it isn’t true. (but we can dream can’t we?)
When it comes to that loose jowl and neck skin, everyone wants to avoid the dreaded word…facelift. While most people are unaware that a facelift is really just a necklift, everyone would agree that they would like as little surgery as possible. While the fears and recovery surrounding a necklift are largely overstated, one really hopes that they can get by with a ‘minimal’ procedure. This understandable apprehension has led to the nationwide branded selling of facelift surgery.
The best example is that of the Lifestyle Lift. Through their national magazine and television ads, this is a franchise approach to getting a facelift…or some version of it. I have seen many patients who know the name, but don’t really know what it is. Promising to turn the clock back at least ten years and look recovered in just a few days, its catchy name seeks to assure patients that it will fit into their ‘lifestyle’. Interestingly, and perhaps not an oversight, nowhere in their advertising does it even suggest that it is real surgery. Many prospective patients only become aware that it is surgery when they actually visit a company facility.
What is a Lifestyle Lift? While sounding new, it is really quite old and has been practiced by plastic surgeons for decades. It is a scaled-down version of a facelift, a ‘mini-facelift’ if you will. Sometimes called a tuck-up facelift, a secondary facelift, or a jowl lift, it is a limited operation that best improves those sagging jowls with a little tightening of the neck. The operative word here is a ‘little tightening of the neck’. If you have a neck wattle or turkey neck, this is not the right procedure for you.
Because it has an appealing name, the Lifestyle Lift has created a number of name knock-offs, including the Swiftlift and even the Lunchtime Lift to name just a few. Most of these are surgeons who have jumped on the naming and marketing bandwagon and have given their version of a limited facelift its own name. There is no real difference in the procedure or in whom it is or is not most beneficial.
Because it is heavily marketed and the internet exists, the Lifestyle Lift has its share of critics. Much of this has to do with trying to make an individualized custom operation into a factory line retail product. As an operation, however, limited types of facelifts do have a valuable role in facial rejuvenation. Not every patient needs or wants a full facelift.
Facelifting is not an operation that should performed the same on everyone. Nor does having a catchy name mean it leads to better results or a quicker recovery. Many plastic surgeons offer similar limited types of facelifts that just don’t have a branded name, but that doesn’t make them any less effective or useful.
Dr. Barry Eppley
Liposuction is a very effective procedure for removing unwanted fat. It is a well known procedure that many people want and some have concerns about its safety. There are stories every year around the U.S. about serious complications arising from liposuction so it is no wonder it can give one pause. If you dissect behind these stories, however, there is almost always a reason these liposuction complications have occurred. This recent story caught my attention…I will get into the reason after the story.
‘Earlier this month, an Arizona doctor was charged with murder after three patients died in 2006 and 2007 during liposuction procedures performed at his clinic. According to the prosecution, the doctor did not kill these patients with a gun, rather the murder weapon was arrogance and the motive was greed. Two of the patients overdosed on anesthesia during routine liposuction procedures and the third died of a fat embolism after undergoing buttock augmentation with fat injections. All three were improperly intubated during resuscitation, making it impossible to save them.
The doctor, who was trained in Internal Medicine and Dermatology, opened a cosmetic clinic in 2005. Initially he offered Botox, hair restoration and laser procedures before moving ‘up’ to do liposuction and breast augmentation. He employed medical assistants with little or no medical training. According to the Arizona Medical Board Review, his medical staff included a massage therapist, a former restaurant owner, two former pre-school teachers and his mother. And when he had to surrender his medical license after the first two deaths, he hired a homeopathic doctor to perform surgery that soon killed a third patient.’
While on the surface of the story liposuction receives the blame for these complications, even the medically uneducated would perceive that the real problem was not the procedure but the doctor. The average person reading this story would say…how could this happen? Aren’t there rules and regulations that govern what doctors are allowed to do?
The simple answer is…no. Once a doctor has a medical license, they can perform anything they want…in their office or their own clinic. The only regulations are when they try to perform procedures in a hospital where medical oversight exists. This has become a significant issue in cosmetic surgery where much can be done under local and IV sedation anesthesia. An office setting without general anesthesia is very appealing to many patients, particularly when it comes to liposuction, as they perceive a limited or virtually no recovery scenario. As this story illustrates, the office setting under local anesthesia may not be safer than an operating room under general anesthesia. Not to mention that the results between the two locations may not be remotely similar.
How could someone with no real training be allowed to perform these procedures you ask? Because in the office setting the only ‘regulations’ a doctor has is their own conscience. In today’s medical climate, whether it be for economics or ego, the appeal of an upfront fee as opposed to an insurance billable procedure is an invitation for doctors to step beyond what they are actually formally trained to do.
Prospective cosmetic surgery patients need to do their homework and look out for their own health and safety. That attractive low fee and the ‘simple’ office procedure can be a recipe for problems. Bargains are for the retail mall, not for medical procedures.
Dr. Barry Eppley
If you ever consider having plastic surgery, qualifying the doctor is an important first step. Are they the right doctor for you and what you need? Many magazine articles and other sources will give you a list of good questions to ask when you have an in-office consultation such as (1) are they board-certified, (2) how many years have them been in practice, and (3) how many procedures of your interest have they done?
While these are certainly good questions and the answers are extremely relevant, such questions today can be answered long before you ever pull into the parking lot of the doctor’s office. If you walk in with these types of questions for your consultation, you must not have a computer in your house or have never done a Google search. It is hard to imagine that such a person exists today, except maybe my 95 year-old grandmother.
While these were once good questions for prospective patients to ask during an office visit, they have gone the way of the bag phone. Such answers are relatively easy to find at the click of a mouse from home. Whether we as plastic surgeon’s like it or not, our websites and the information that they provide is a lot more relevant to patients than any number of diplomas hanging on the wall. If a plastic surgeon doesn’t have an up-to-date website that easily provides this basic information, patients will quickly move on to another surgeon that does. Today’s internet-based society makes it essential that these once basic qualifying questions are easily answered with minimal research effort.
With today’s electronic informational access, photo and video acquisition, and numerous locations for postings, contemporary plastic surgery qualifiers are different and more meaningful. Today, the more relevant checklist in finding the right plastic surgeon for your needs is procedure education, photographic examples and patient testimonials.
Traditional office print pieces, such as brochures and flyers, are historic methods of education in every plastic surgery practice. While they are still useful, so many are tempate-derived that they provide generic and virtually useless information…other than to say this service is provided. You want to know what this specific plastic surgeon does, not what most plastic surgeons do. This has spilled over now into websites as well. They all look pretty but what about their content? Is it meaningly and relevant to your needs? Look for brochure and website information that provides current and updated procedure information. This also suggests an interest in ongoing patient education which is most manifest in some type of website blog.
We have image overload everyday. Whether it is on Facebook or on your cell phone, we are surrounded by pictures. Plastic surgeons are without question the most advanced and proficient of all medical specialities in taking pictures. Therefore, patients should expect a good demonstration of a plastic surgeon’s most valued asset, their before and after patient photographs. While it is true that the best results will be posted, at the least you need to see a handful of actual patient before and after photographs. The more, the better.
Patient testimonials carry a lot of weight. Who doesn’t want to hear about a happy patient when you are considering going to that plastic surgery practice. But don’t just rely on what is posted, ask to talk to at least one patient who has had your similar procedure. But a patient who had surgery a long time ago is not as useful as one who has had surgery in the past weeks to months. Fresh experiences are what you need as these patients have the best recall of what it was like right after surgery.. Having a recent patient also suggests that the procedure is performed more than just a few times a year.
Dr. Barry Eppley
Liposuction is a very popular body contouring surgery largely because it works. It is an immediate method to remove certain areas of unwanted fat that you just haven’t been able to budge by your best efforts. With this fat removal method, may people expect to lose weight as well. It is no wonder many people think this when you see such advertisements such as ‘Lose 10 lbs In A Few Hours’ or ‘Get The Body You Always Wanted’. I have seen many such liposuction promotions in magazines and on the internet and it begs the question of aggressive advertising vs . medical fact.
Can you lose weight by liposuction? The simple answer is yes…in the short term. When advertisements promote how much weight is removed with liposuction, they are referring to what is suctioned out at the time of surgery. This is known as the fat aspirate and and is collected in a canister. It can be both measured in cubic centimeters or millimeters (always is) and weighed. (sometimes is) The weight of the aspirate can be closely approximated by its measured volume. Since a gallon of water weights 8 lbs and a gallon contains 2.2 liters (2200cc), then a liter (1000cc) of fat will approximately weigh 3 1/2lbs. Therefore if you have had liposuction surgery and had 2000ccs removed, for example, then you would have had a surgical weight loss of about 7lbs.
While this seems impressive, and one did have this 7lb weight loss in a hour or two, it is actually a bit misleading. The reason is that prior to the actual liposuction being done, a large amount of fluid is first put into the fat known as tumescent fluid. This is essential to liposuction to not only lessen the pain after surgery but, of equal importance, to reduce any bleeding that the procedure will cause. This fluid has both volume and weight and the actual fat aspirate will contain up to 1/3 of this by content. So the actual amount of fat removed and weight that has come off has to be toned down a bit. When you see large weight loss claims from liposuction, it is because large amounts of tumescent fluid have been initially placed….and then removed as well.
While liposuction may cause some weight loss immediately (surgical weight loss), a more significant drop may actually occur afterwards. In the healing phase for several weeks after surgery, most people are not motivated to eat normally. When combined with the increased caloric demands of healing, a metabolic weight loss often happens. This will usually equal the surgical weight loss by four to six weeks after surgery. So if 5lbs of fat aspirate has been removed during surgery, one can usually expect to be down 10lbs in another month or so. Whether one sustain this weight loss over time is affected by many factors, not the least of which is one’s lifestyle habits.
While liposuction and weight loss will be forever linked, one should view the association as incidental and a side benefit. Weight loss is not the reason to have liposuction…spot body contouring is. Some weight loss will happen for almost all patients. The amount varies on one’s body and how much fat was removed. Some view liposuction as a jump start method for their weight loss approach and, in the short term, that is what will happen.
Dr. Barry Eppley
While women have always made up the majority of plastic surgery patients, the percentage of men is steadily increasing. More men today acknowledge what women have known all along…appearance does matter regardless of age.
While the goals are always the same, to look as good as one can, a man’s age influences why it matters. Younger men are motivated by optimal attractiveness or to correct features that they consider embarrassing. Older men are motivated by divorce, job competitiveness and countering the effects of time. The common procedures that men choose, not surprisingly, are also influenced by age. Droopy eyelid skin and neck wattles are the concerns of older men while the removal of excessive body fat and reshaping noses, ears and chins captivate younger men.
While age may make a difference in what plastic surgery procedures men desire, there is one characteristic that they all share. Men are less patient than women, particularly when it comes to appearance issues. This means that cosmetic treatments that require regular maintenance, like Botox and injectable fillers, are not that appealing. Men prefer more of an immediate fix like what surgery does. And men do not want a lot of recovery or downtime after surgery if possible. Discretion is paramount in male cosmetic surgery. While everyone knows that men having plastic surgery is not rare, the male patient does not really want to broadcast it.
One observation that has reverberated amongst plastic surgeons for decades is that men can be difficult to please and are less satisfied than women after surgery. They also are more prone to want revisional surgery. That has not been my experience…with the exception of the younger male patient. Facelifts and eyelid surgery in the middle to older-aged male gets good results and satisfaction is just as good as women. When it comes to structural changes in the face or body contouring surgery in the younger male patient, there is some definite truth to that belief. Younger men today grow up today playing with action figures, looking at men’s magazines and seeing great emphasis placed on exercise and sports which exposes them to more pressure to have a very masculine face and body. This makes managing the expectations from surgery in younger men extremely important.
One male quality that seems to be true…and most women will probably second it as well… is that many men are not very tolerant of pain. They are less comfortable with after surgery discomfort and that is to be expected as men have never endured pregnancy and child delivery. That gives women a decisive advantage in the early after effects of many plastic surgery procedures. This is not to say that men are not tough, just not as tough as women when it comes to appearance alteration.
Last year over one million men underwent some form of cosmetic alteration in the U.S. The stigma of men paying more attention to their appearance and grooming habits has changed alot in the past ten years. The beauty gap between men and women is closing to some degree as an increase in the desire of men to use their improved looks to remain competitive professionally and personally is on the rise.
Dr. Barry Eppley
A common question that some women face today is…are they for real? With more women than ever undergoing breast augmentation, this is not a far-fetched question. It may be inappropriate to ask but the statistical reality is one may be more right than wrong many of the times. According to statistics from the American Society of Plastic Surgeons, the number of women who have had breast augmentation had risen nearly 40% over the past decade. In 2010, nearly 300,000 American women received cosmetic breast enhancement.
One other trend in breast augmentation is a noticeable size difference. Many plastic surgeons have commented that women are asking for bigger breasts than they were a decade ago. Historically women would usually ask to go a cup size bigger. Today it is not uncommon for a women to want two or three cups bigger, particularly the younger they are. Women state they want to get a good value for their investment and they want to make a noticeable difference in their clothed appearance.
What accounts for these trends in breast augmentation? By far I would say that it is simply more accepted than ever before. As we enter the upcoming decade of 2010 to 2020, this is the beginning of the third generation of women who have had access to breast implants for cosmetic enlargement. It is a normal part of society now and younger women’s mothers and soon grandmothers will have had the procedure.
Breast augmentation has a track history of safety as well as effectiveness. Despite the hullaboo of what transpired in the early 1990s, the procedure has been proven to cause no medical problems or makes people systemically sick.. While it is far from a perfect procedure, because after all it is an implant in the body, its complications are local in nature and often aesthetic in significance.
The social trends of today play a major role in its popularity as well. Just go through the checkout counter at the local grocery store and the magazines are full of articles about celebrities who have had or are assumed to have had some form of plastic surgery. Many of these are women actors and performers who have enhanced their top half. The influence of these magazine, TV shows and now the internet have made it seem that having breast enhancement is now the new norm.
There are more choices in breast implants today than ever before. Since 2006, both saline and silicone implants are available in not only differing sizes but projection and styles as well. With the potential for gummy bear breast implants to be available perhaps later this year, increasing implant options appeal to an even broader spectrum of women. Just like the many aisles in a drugstore, multiple options for a single product line result in more sales.
The rise in breast augmentation is a result of greater societal acceptance, safety of the devices, influence of famous people, and a wide variety of implant options. I suspect the upcoming decade will see the number of implanted women continue to rise.
Dr. Barry Eppley
Liposuction remains the most rapid way to lose unwanted fat albeit a surgical one. While it is ideally for those people who have made every effort to lose fat areas on their own through diet and exercise, not every fat area responds the same. Some fat areas are more difficult to lose than others and certain fat areas can not be reduced at all except in the face of extreme weight loss. It is these non-metabolically responsive fat areas that justify liposuction intervention.
One of the very good questions any prospective patient should ask about liposuction is will my fat return? Will I keep this fat off years from now or is this just a short-term fix? Economically does this procedure have a good ROI? (return on investment) There are many urban myths about whether fat can or can not return after liposuction. Where some of these purported claims come from I do not know, but science and a lot of patient experience provides the following insights.
Fat will not return after liposuction. This is patently false and perhaps was started and propogated by what one would hope will happen. The reality is fat can return. The results from liposuction are closely aligned with your weight. If your weight stays the same years from now then so should the result. Fat after liposuction can return just as easily as after weight loss…and then weight gain. Some body areas are more resistant to fat return than others (knees or arms vs stomach and waistline), but no body area or fat cell is completely immune to the allure of extra calories.
If fat comes back after liposuction it will go to other body areas. This is sort of true but not to the extent of what was originally removed. A recent published study showed that fat suctioned from the stomach and thighs from women had some slight increase in measurements in the arms and upper back a year after surgery. But not to the extent that the women noticed or was bothered by it…or that they regretted having the procedure. If fat returns it must go somewhere and it is logical that it may have more trouble going back to a treated area that is now embedded with scar tissue.
Fat cells are permanently destroyed by liposuction. This is not true. Those fat cells that have been suctioned out are permanently removed. But there are always lots of fat cells left behind as you can not or would you want to remove them all. (otherwise your skin would be stuck down to your muscles and wouldn’t move) While the fat cells that are left behind may be damaged, they have a great ability to heal and regrow. Since it has been discovered that fat sites have the highest amounts of stem cells in the body, and stem cells can be easily stimulated to grow and transform into fat cells, liposuctioned fat sites are not immune to recur. This may be different with the current use of Smartlipo (laser liposuction) where the heat from the laser energy can cause more fat and stem cell damage.
Despite the effectiveness of liposuction to reduce unwanted fat, the long-term success of the procedure is highly dependent on the lifestyle habits on whom it is performed.
Dr. Barry Eppley
If a picture is worth a thousand words, then a story is worth at least five hundred words. Many mothers may find this story of interest.
‘When 34 year-old Kathy opted to get breast implants and a lift one year after having her third child, she didn’t really think of herself as having any type of makeover. She just wanted back what she had before children and to regain the confidence and clothing options that she once had. Before three pregnancies, she was a nice full C cup. But between breastfeeding and the repeated stretching and shrinking that occurs from the pregnancy process, she was now done to nearly an A cup. She knew it was bad when her sister said she really need some plastic surgery.
Two years later, she returned for a tummy tuck. She wouldn’t be seen in a swimsuit or any tightly fitting clothes, lest her stomach bulge be seen complete with all of its stretch marks and an unusually-shaped belllybutton. Despite of years of steady dieting and numerous weekly workouts, no stomach cure had been achieved. She wasn’t fat but had a lot of loose skin of which no amount of exercise is magically going to burn off. She finally realized that she was trying to get rid of something over which she had no control. ‘
Between the two plastic surgery procedures she had undergone a Mommy Makeover, a popular term used for multiple plastic surgery procedures that restore, or improve, one’s post-pregnancy bodies. Unlike the extreme plastic surgery makeovers seen on TV, mommy makeovers are extremely common and the breast and stomach procedures are both done at the same time. Unlike the previous generation, mothers of today want to return to their old body and, in many cases, even have a better one than before the pregnancies.
One interesting thing about Mommy Makeovers is some psychology behind them. Many women feel guilty and little selfish about such ‘self-indulgence’. They may also be worried about taking time away from their children’s and husband’s hectic schedules to undergo surgery. Some may argue that how you feel as a mom is important to one’s family as well. It is not really all that self-centered to feel youthful and more confident. Having an improved body image may also improve one’s interactions with their own family. I am not a women nor have ever been pregnant so I can’t speak for whether this is psychological double talk or fact. But I do know what many women have told me… they may be a mommy but they are still their own person as well.
One very common Mommy Makeover questions I get asked is, how soon after my last pregnancy can I have surgery? How long to wait differs on whether it is the breasts or the stomach that is being addressed. Breast augmentation and/or lifts can be done as soon as six months afterwards as time never improves breast shape. One only awaits the completion of breast feeding or the maximal amount of breast deflation. Liposuction and/or tummy tucks should wait until you have put forth your best effort at diet and exercise or have come to the realization that the loose skin is the main problem. This may be six months for some and for other women it may be years later.