Over 30 million people in the United States have some degree of migraine headaches. While there are drug therapies that are very effective, some patients either get little to no relief or have other problems related to side effects from taking the drugs. For a small number of migraine sufferers it is very disabling and little benefit is obtained despite the best neurologic care.
Plastic surgeons have developed new procedures to “deactivate” migraine headaches…and it was learned from results seen from cosmetic treatments. Usually cosmetic surgery benefits from what is learned in reconstructive surgery but this is one of the rare instances where the reverse has occurred. Based on Botox injections and browlift surgery, both which temporarily paralyze or remove certain brow muscles, significant improvements or actual cures occur in migraines that start in the forehead. This has led to understanding the cause of migraines in some patients known as the peripheral trigger.
The peripheral trigger theory of migraines is based on certain sensory nerves being squeezed or compressed by a surrounding muscle or contact point. Due to the nerve being irritated, this leads to a cascade of events that becomes a migraine. To date, four trigger areas have been identified. Three of these are where a nerve passes through a muscle and many with migraines can actually put their finger on these exact spots; the greater occipital nerve in the back of the head, the zygomaticotemporal nerve in the temple area, and the supraorbital nerve at the inner half of the eyebrows. The fourth trigger point has been identified in the nose where a significant septal deviation makes contact with an enlarged turbinate.
Surgical migraine deactivation is done by removing the source of irritation, the muscle from around the nerves or straightening the nasal septum. This is done through small incisions inside the scalp hair or from inside the nose. Studies have now been reported that such surgery produces good results that last, with nearly 90 percent of patients having at least partial relief at five years after surgery. Migraine attacks were less in number, not as severe, and lasted for a shorter period of time. In about one-third of patients studied their migraine headaches were completely eliminated.
While migraine surgery is for just a minority of sufferers, it is not a procedure that is associated with any significant complications or side effects. The procedures are comparatively minor surgery, have quick recovery, results are immediate and no patient yet has reported that they have gotten worse afterwards.
How does one know they may get improvement in their migraines with surgery? Before surgery, one needs to be tested with Botox injections to confirm the correct trigger site. If Botox works to temporarily improve migraine symptoms, then the peripheral trigger is confirmed and surgery will likely be successful. But before one considers Botox injections and even surgery, they should be initially evaluated and treated by a neurologist. Only after failure of traditional medical treatments should one consider this new plastic surgery treatment.
Dr. Barry Eppley
Breast augmentation continues to be one of the most popular and successful body contouring procedures in plastic surgery. While it may seem hard to make the association of breast enhancement with confections and desserts, they are more closely related than one would think. This is because of two recent technological advances in the type of breast implants that are available and how they are implanted at the time of surgery.
One important, but often overlooked, aspect of the surgical implantation of breast devices is getting them placed into the breast pocket. When only saline implants were available this was never a concern as they were inflated after they were placed. This meant that very small incisions could be used for their introduction that were not even on the breast. Rolled up like a burrito, a saline implant is inserted through a one inch incision and then inflated to the desired size. With the re-introduction of silicone breast implants in 2006, larger incisions are needed as they are pre-filled and must be inserted as such.
This makes the issue of larger scars with silicone breast implants a concern for some patients. Plastic surgeons will frequently push and cram the breast implant through a small incision because of this concern. Needless to say, this technique is not good for the implant and undoubtably weakens its shell and leads to premature rupture and the early need for replacement. That has all changed with the introduction of an improved delivery method.
Known as the funnel, and looking exactly like what is used to decorate a cake, the breast implant is now easily propeled into the implant pocket….all without ever touching the implant or squeezing it too hard in one place. This incredibly simple but highly effective delivery method now makes it possible to use very small incisions again and even do silicone gel breast augmentation from a remote armpit incision.
As silicone gel has returned as an implant option to saline, it has again become a sought after breast implant material. With no risk of ever spontaneously deflating like a saline implant can (and eventually will), its more natural feel makes it a very popular choice. While the health concerns from the early 1990s with silicone has long been dispelled, the concern about rupture and what happens to the material persist. This has lead to the development of advanced silicone materials that hold together more like a solid, resulting in what is known as the gummy bear breast implant.
The gummy bear breast implant is more than just a cute nickname. It is a reflection how the silicone filling looks and feels…soft and spongy. And just like those cute little red, green and yellow bears, you can push and pull on it and even cut the material and it won’t lose its shape. The physical similarity between this new implant and the candy are striking and it is no wonder how it got tagged with this name.
Breast augmentation continues to get better and more safe as the materials and techniques to deliver them improve. This gives women more options to choose what they feel best fits their bodies.
Dr. Barry Eppley
One of the most common reasons men appear for facial plastic surgery revolves around one issue…they are tired of looking tired. Even though they get 7 or 8 hours of sleep, every morning someone eventually asks if they had slept well. Most men over age 50 can relate. They want their face to look as good as they feel and can be frustrating when it is not.
The classic story that I often tell is one of the differences between being younger and older. In college you pull an all-nighter and the next day, looking like you had, proudly proclaim your accomplishment when asked. When you are older you get 8 hours of sleep, go into work and the first thing someone asks is…did you pull an all-nighter?
Eyelid lifts, or blepharoplasties, can clean up that tired look by removing extra skin and fat from around the eyes that has developed over the years. But blepharoplasty is just one of the growing number of cosmetic procedures that more men are having. Facelifts, hair transplants and stomach and love handle liposuction make up most of the age-fighting operations.
While men were once just a minute fraction of any plastic surgeon’s practice, those numbers have grown to represent 15% to 20% today. Men of all ages are growing more comfortable with the idea of getting help for their looks. It is simply more acceptable today, another example of the rapidly changing social attitudes sweeping our society. Most men are interested in improving their appearances but without taking too much time from work. It also doesn’t hurt that plastic surgery reality shows (do men really watch these?) and affordable financing have also promoted interest.
Another galvanizing drive for man having plastic surgery is job insecurity and staying competitive. While looking good and appearing energetic has always been important, in a tough job market it is important to look as best as one can. I just had a man come in last week who was between jobs and wanted to look good for interviews. The competitive nature of men can make them willing to try something they believe will give them an edge in an interview or a potential business transaction. The practical economics of men also has them saying such changes are an investment in their future.
The internet has also fueled this male cosmetic surgery interest, specifically internet dating. I have had more than one man who has told me he can’t post a current picture online of the way he looks now. One patient even told me a woman embarrassed him by commenting in an e-mail exchange about his eye bags. (he reposted his picture after his eyelid lifts)
Men fear more than women that undergoing plastic surgery will make them look too drastically changed or have a ‘surgical look’. While there are certainly some male celebrities and actors that have that look, they are the exception. In reality, getting rid of those sagging jowls and droopy eyelids can definitely make one look less tired and more alert but the change is almost always subtle and natural.
Dr. Barry Eppley
The Book entitled ‘I Feel Bad About My Neck’, that came out a few years ago, bespoke of an inevitable aging problem. Necks unfortunately don’t lie. The folds of skin hanging down from one’s jawline are like rings on a tree. While Botox, injectable fillers and lasers can do a lot for the face above the jawline, the neck has been the poor sister of non-surgical rejuvenation. The neck can even look comparatively worse as the rest of the face above it gets a few less wrinkles and becomes more plumped with these treatments.
While a necklift is the only sure thing for the most ideal and long-lasting improvement, not everyone has a wattle that is so deserving. Less-invasive options have cropped up over the past few years that are promising and have caught a lot of press. One of the more recent ones uses ultrasound waves to help grow collagen under the skin to create a tightening effect. Targeted towards early neck aging patients, usually under the age of 55 years old, it can improve some of that loose skin under the chin. This has led to it being touted on numerous popular TV shows and magazines.
Enigmatic of many new and inadequately studied cosmetic treatments, Dr. Oz (a heart doctor) proclaimed on his show that this was the equivalent of a non-surgical facelift. He spoke how it could get rid of a sagging neck immediately and that it was pain-free. Its discussion on the show also left a distinct impression that such a device was cleared by the FDA for neck treatments… when it is not.
The reality is that ultrasound, and other collagen-stimulating treatments, do have some skin tightening properties but the effects take months to appear…and numerous treatments. Any immediate effects are temporary due to the heat created in the skin but real collagen takes much longer to form. The manufacturer claims that these results can last up to a year or longer but actual clinical trial data has only followed patients up to 3 months after treatment. Costing up to several thousand dollars, most patients won’t be happy with that investment even if the results did last for one year.
While many people think that surgically tightening the neck also requires that the face be lifted as well are not aware of more recent advances…that catch much less press than trendy devices. There are isolated necklift procedures and many more men get isolated necklifts than women. Most women are concerned about the jowls and the neck while most men are actually more focused on just the neck alone. The influence of time on a man’s face, even including baldness, is pretty well tolerated but a neck wattle is usually not viewed as a graceful sign of aging. I have had many men tell me that the only thing that they think makes them look old is their neck.
While creams, exercises and these newer skin tightening devices all have purported neck benefits, most people by the time they notice their neck problem are beyond the help of these approaches. Something less appealing, but infinitely more effective, is the spectrum of necklift surgery options.
Dr. Barry Eppley
The recent tragic events that are ongoing in Libya actually have some plastic surgery implications. It was recently reported that a Brazilian plastic surgeon says he performed cosmetic surgery on Libyan leader Moammar Gadhafi in 1995. This included harvesting fat from Gadhafi’s belly and injecting it into his face to smooth wrinkles as well as giving him hair plugs.
The plastic surgeon stated that while he really needed a facelift, he refused and wanted something that would have a less noticeable change. Gadhafi reportedly told him that he had been in power for 25 years at that time and that he did not want the young people of his nation to see him as an old man. (even dictators can be vain) Interestingly, the Libyan dictator insisted on using local anesthesia and interrupted surgery at one point to eat a hamburger.
While this story may be mildly amusing and seemingly ancient occurring over 15 years ago, it was an early use of a plastic surgery concept that has become very much in vogue today…that of facial fat grafting.
All faces age by loss of fat and the stretching of skin, gravity just compounds the problem by making it look worse in certain positions. By losing fat, the skin gets closer to the underlying bones of the face and sags as well. To ideally restore a more natural and youthful appearance, the skin must be expanded outward by lifting it away from the underlying bone. This is where the role of fat grafting has come into play. By harvesting fat from another part of your body, it can then be artistically injected back into the face to restore some youthful contours. From the method by which liposuctioned fat is processed prior to injection, it contains a good number of stem cells. (fat has been shown to have 300X to 500X more stem cells than bone marrow) This may partly explain why patients tend to notice improvement in their skin as well as more youthful contours with facial fat grafting.
When facial fat grafting alone is not enough to fill out the deflated face (too much sagging skin), lifting procedures can be done as well. Many types of facelift procedures are done today, which can be lumped into the concept of short incision face lifts. These incisions do not disturb the hairline and results in a very fine line scar around the natural curves of the ear, extending slightly behind the ear. These limited types of facelifts result in some small amount of neck and jowl tuck-up. By adding fat grafting to them, a real 3D (three dimensional) face lift can be achieved.
The Libyan leader was way ahead of his time by getting facial fat grafting before the technique was as developed and understood as it is today. You may say that such fat grafting to the face is the ultimate form of recycling or ‘green surgery’.
Dr. Barry Eppley
The eyes are the focal point of the face, at least in everyday conversation, and a more youthful appearance contributes substantially to the impression a person makes. Bags beneath the eyes, wrinkled and drooping layers of skin on the eyelids, and sagging eyebrows give the entire face a perpetually tired and sad expression.
Blepharoplasty (eyelid tuck) for men has become increasingly popular and is the second most frequently performed male cosmetic procedure, surpassed only by liposuction. It can provide tremendous benefit to a man’s appearance as it corrects sagging upper eyelids and puffy bags underneath the eyes. The procedure can also correct vision impairment caused by saggy skin on the upper eyelids.
While the surgical technique for cosmetic eyelid lift surgery on a man is fundamentally the same as that used on a woman, there are several different considerations. It is important that men retain their masculine image rather than the more stereotypical feminine result. A quick search of celebrity photos on the internet or magazines will reveal whom sought out a plastic surgeon than understood this difference. (Kenny Rogers, Bruce Jenner, Gary Busey to name a few) Poorly performed eyelid tucks that give a man a wide-eyed open appearance will quickly find that celebrity’s pictures’s on many websites that portray poor plastic surgery results.
In general, most men are seeking a more conservative (less obvious) change. Like women, men want their results to appear natural. But there is a gender difference in what is considered a natural result. While most women want a very clean eyelid look with smooth skin, such a look in a man will look ‘done.’ Too much eyelid skin removal in a man will create the appearance of having had plastic surgery and, in some cases, can just look plain bizarre. It is quite acceptable for a man to retain a little extra skin and a few wrinkles on the eyelids after surgery.
Patients are always understandable concerned about whether incisions or scars will be visible after surgery. The key to a non-visible male eyelid tuck scar is proper placement. This is especially important given that men can not wear make-up to hide any scars. Knowing that a man’s natural upper eyelid crease is lower than a woman’s helps put it in the best place so no scar can be seen after surgery.
Besides an eyelid tuck to make the eyes look less tired, there is also the consideration of low hanging brows and the potential need for a browlift as well. The classic handsome male brow is full, low and horizontal while a female brow can vary from full to thin but almost always has some degree of an arch to it. In my opinion, few men cosmetically benefit by a browlift, and there are too many browlifts done in men. A browlift in a man, where the brow gets elevated to an unnaturally high position and now has an unnatural arch to it as well, is the main reason men can look peculiar after such surgery. If a browlift is needed or wanted, the approach should be that less is more.
Men should not fear blepharoplasty surgery as it can make a real difference in their appearance. The key to a natural result is that the man’s features should be preserved during eyelid tucks as well as to not over-correct or remove too much skin. As men age, their eyelids will differ from those of their youth and blepharoplasty for men should appreciate this subtle difference.
Dr. Barry Eppley
The Guinness Book of World Records has a lot of peculiar and unusual human achievements. Plastic surgery makes up but a few of them. One such record is that of a 55 year-old woman from Ohio who has had the most number of cosmetic surgeries. With 52 plastic surgery procedures to her credit, she appears to hold this dubious record.
By her own admission she has had five facelifts, two sets of blepharoplasties, liposuction to her stomach and knees as well as regular sessions of Botox and injectable hand rejuvenation. She has spent over $100,000 in fees over the past 25 years. With such a vast personal experience, it is no surprise that she makes a living as a cosmetic surgery consultant and has authored a book on what she calls cosmetic surgery secrets.
While most would understandably view this accomplishment as just another attention-seeking addict heading down the Michael Jackson highway, there is actually a more interesting and relevant side to this story. While few will ever even come close to this number of plastic surgery procedures, there is no denying that for 55 years of age she looks exceptional and not a bit unnatural or having an ‘operated look’. This certainly separates her from many other celebrities who undoubtably have spent a great deal more and do not look nearly as good.
Why she has turned out better, despite a large number of anti-aging endeavors, is a result of two efforts. First, she has stated that her goal in all of this was to look authentic and remain natural looking. She never wanted to look like she had anything done. This seems obvious and I have seen few patients who wanted to look unnatural after surgery. Just wanting to have natural-looking results after surgery, however, is not enough. The key and the contemporary approach to plastic surgery is to do smaller operations earlier in life.
Despite her many plastic surgeries, the vast majority of these were not major surgeries. Most of her surgeries were more ‘nips and tucks’ and many of her procedures were injectable in nature, although counted as if they were operations. In essence, she used more minimally-invasive procedures that were then done on a periodic basis. Like the regular maintenance on an expensive car, she intervened at earlier stages of facial aging and not waited until she had ‘broken down’ and needed a major overhaul. This avoids extensive surgery and the associated drastic change and operated look that can appear afterwards.
This is the contemporary approach to the treatment of aging…intervene early and control its effects by taking advantage of today’s injectable and less invasive plastic surgery procedures. Botox, injectable fillers, laser and light therapies, and more limited operations such as the Lifestyle Lift and numerous other facial tucks have created this new way of thinking. Like in many other areas of life, today’s plastic surgery illustrates that less can truly be more.
Dr. Barry Eppley
When it comes to plastic surgery, women are perceived to make up the vast majority of patients. And for the entire last century as plastic surgery evolved, this was historically true. But a gender shift is occurring in whom now chooses to undergo the altering effects of the knife.
In a recent article entitled, ‘Men Fuel Rebound in Plastic Surgery: Sizeable Increases in Facelifts and Other Surgical Procedures for Men’ that appeared in the Science Daily, more men than ever before are having something ‘done’. Statistics released by the American Society of Plastic Surgeons (ASPS) show that cosmetic plastic surgery procedures were up about 2 percent in 2010 compared to 2009. However, male plastic surgery procedures increased significantly. Facelifts for men were up nearly 15 percent in 2010 while liposuction of the male chest, stomach and love handles increased almost 10 percent.
These same statistics show that men underwent more than 1 million cosmetic procedures last year, close to 20 percent of all plastic surgery that was done. While many of the cosmetic procedures that have accounted for the overall large increases in plastic surgery during the last decade have been non-surgical (e.g., Botox, injectable fillers), men buck this trend. Men actually do very little of these minimally-invasive treatments and choose surgery instead.
By the very nature of most men, they usually wait longer to consider having something done and have more significant age-related and weight issues. Because Botox and injectable fillers only work to a certain point, the more significant effects of age and gravity require surgical procedures that remove and lift skin or actually removes fat to show a significant improvement.
Another trend in male plastic surgery can be seen in whom shows up to request these procedures. While once thought of as just for celebrities and high profile men, the typical male cosmetic surgery patient is just the average guy who wants to look as good as he can. The most common reason I hear is that ‘I want to look as good as I feel’. Other underlying motivations can be a recent divorce or remarriage or is driven by job security or seeking new employment. In any case, looking vigorous, fit and well rested is the new norm for aging gracefully. These leads to the middle-aged or older male seeking procedures such as eyelid tucks (blepharoplasty), necklift, nose reshaping (rhinoplasty) and hair transplantation.
The newest burgeoning area is the young male plastic surgery patient. While not subject to aging concerns, they are interested in changing their facial look albeit to have a more balanced or masculine-looking face. Seeking more of a ‘male model’ look, structural changes of the face such as rhinoplasty and cheek, chin and jaw angle implants have the younger male driven by the desire to become better looking.
While you may never see a male patient on the TV shows, such as ‘Extreme Makeover’ and the new ‘Pretty Hurts’, more men are undergoing physical changes and adjustments than ever before…they just don’t talk about it.
Dr. Barry Eppley
The large number of stem cells in fat has led to a new wave of treatments in plastic surgery that hopes to harness the potential of this ‘wonder’ cell. Since a stem cell can turn into any type of cell if properly stimulated, it is not hard to see why any treatment attached to it is being hyped as a rejuvenative or regenerative therapy. These R words translate to anti-aging or make me look younger.
Given the ease from which fat can be extracted through liposuction, fat is being reprocessed and injected all over the body by plastic surgeons mainly because it is easy to do and perfectly safe. You might say it is the ultimate form of recycling, a green procedure if you will that is most certainly organic. Injected fat can be used from body contouring to facial rejuvenation. For the body, buttock augmentation and breast reconstruction (lumpectomy defects) are being widely done. Breast augmentation using fat instead of implants is being approached more cautiously. The other good body use is in the aging hands, using injected fat to make the hand look more plump and have a less bony appearance.The face, however, is the most common area for fat injections. Research has now shown that we loss fat in our face as we age. This facial deflation is one of the reasons that we look old and contributes to skin sagging. This has led to younger people getting fat injections at an early age and fat injections being used as part of a facelift procedure for more advanced degrees of facial aging. For the aging gaunt-looking face (or even a younger gaunt face), fat injections can be a good complement to traditional skin removal and tightening procedures.
In the most contemporary spin of fat grafting to the face comes the Stem Cell Face Lift. The concept is that stem cell-rich fat grafts combined with skin tightening makes for a better facelift result. Proponents claim that the stem cells provide a regenerative effect that makes the fat take better and helps the quality of the overlying skin as well. By mixing the fat with a little of your own blood, a theoretical youthful elixir is created.
Is the Stem Cell Facelift actual science or more science fiction? Is it hype or hope? At this point I would say a little of science and a lot of hype. The real scientists of stem cells would most certainly tell us that it just isn’t that simple. While stem cells have been extensively studied, how to make them work is far less clear. Conversely, the hopeful part of stem cells in facial rejuvenation is that it exemplifies the concept of ‘heal thyself’. Our tissues have a remarkable ability to heal themselves from injuries throughout our entire lives. It just seems that we should be able to use that to our advantage at some point.
One of the benefits of fat grafting to the face, whether the stem cells really make a contribution or not, is that it adds volume. And with our current appreciation of what happens as most faces age, becoming a little more cheeky might not be a bad thing.
Dr. Barry Eppley
Getting rid of the jelly belly and having a flat stomach is the desire of most women. Many women can remember that belly of their youth with fond nostalgia when they good eat whatever they want and still look good in a swimsuit. However the combination of pregnancy, weight gain and gravity conspires against this goal.
While being bikini clad may not be possible for some as the warm weather approaches, at least looking good in a one-piece without that bulge would be great. This brings many to consider that a tummy tuck would be the answer. There is no question that the fullest version of a tummy tuck can make one the flattest but with that comes a fine line scar from hip to hip as well as a scar around the new belly button. That may be a good trade-off for the bigger hanging midruff but is not for everyone.
An alternative to this scarring is the mini-abdominoplasty, also known as the bikini line tummy tuck. Like the Lifestyle Lift is to the facelift, the bikini line tuck results in less scar (shorter low scar with no belly button scar) and puts it in a better location…as low as possible. I often find that the length of the full tummy tuck scar is not what is usually the most offensive. It is that is very difficult to keep it really low, within the bikini line, due to the amount of skin removed and the tension that is placed upon it when it is closed.
Bikini Tucks are best for women who do not have tons of excess skin and fat. They are most ideal for the average build to more trim individual that just can’t get rid of that small belly issue and is driving them crazy. No amount of diet and exercise can get rid of it and one has reached the wall in terms of effort in trying to do so. This is understandable as loose skin is not a calorie sensitive tissue, it can’t be exercised off no matter how many situps you do or miles that you walk or run.
Some skin will tighten back up after weight loss or pregnancy but if it hasn’t done within 6 months to a year, it is not going to happen. If there are stretch marks over the skin you want to get rid off, forget about any tightening at all. Stretch marks means the skin has been permanently damaged and has little to no elasticity at all left, it has been permanently expanded.
Liposuction can be part of any tummy tuck but it is most extensively used and often needed in the bikini line tummy tuck. Thinning out any fat above the belly button and along the sides of the waistline and hip at the same time adds to whatever skin and fat is removed in the front.
Are you bikini ready? Maybe not and you may not even wanna be. But the Bikini Line tummy tuck can take your stomach and waistline to a place that you can’t get to…without a lot of visible scarring.
Dr. Barry Eppley
One of the most significant changes in plastic surgery in the past decade has been the emergence of non-invasive cosmetic procedures. Led by the well recognized use of treatments such as Botox, injectable fillers and laser skin resurfacing, some youthful changes and anti-aging prevention can be realized. Obtaining such results without surgery represents a paradigm shift from historic invasive treatments.
From treating wrinkles to losing wanted body fat, devices using various forms of energy have become popular. (laser, high intensity light, ultrasound, radiofrequency) Their popularity is not just because they are not surgery but because they do produce visible results for most patients. Such hopes of cosmetic improvements by an external device has also been applied to loose or unwanted skin. The concept of non-surgical skin tightening has tremendous appeal, whether it is those sagging jowls, that unwanted roll of belly skin, or that floppy skin on the back of the arms.
Such devices abound and are all over the internet and popular magazines from Thermage, Ulthera or Smartlipo, to name just the most popular. They claim to produce skin tightening as one of their benefits. I regularly see patients who come in to get rid of their turkey neck, bat wings, sagging breasts or roll of skin that bulges over their beltline…with the hope and belief that such devices will avoid the need for surgery.
In reality all of these devices do produce skin tightening, with an occasional dramatic change in a few patients and more modest changes in most patients. Despite their skin tightening abilities, many patients will never be happy with the outcomes of these treatments alone. This has to do with the differences in how patients perceive skin tightening and in how much skin tightening these devices can do.
My observation is that a patient’s perception of skin tightening can be measured by centimeters and inches. Any device’s skin tightening ability can be measured in millimeters or just small fractions of an inch. It is not that these devices can not tighten skin but that most patient’s loose skin problems far exceed what can be done without surgery. No skin tightening device can replace a facelift, armlift or a tummy tuck when truly sagging skin exists. Non-surgical skin tightening works best for very modest amounts of loose skin…that one wouldn’t consider undergoing surgery to remove.
Like trying to lose fat with only taking a pill, wiping the appearance of cellulite and stretch marks clean by a skin massager, or getting rid of those dark undereye circles by just applying a cream, hope is eternal. Getting rid of loose skin, as most patients define extra skin, will almost always defy any current method of device-based skin tightening. It is not always appealing to realize that surgical removal is still the best way to get rid of unwanted loose areas of skin. Having a ‘nip and tuck’ may not be high-tech, but it continues to provide a level of improvement that will satisfy most patient’s expectations.
Dr. Barry Eppley
Zerona is a relatively new body contouring device that uses cold laser technology to help with spot fat reduction. This can be particularly helpful for those troublesome stomach, waistline and thigh areas. Through its photochemical effect, fat cells in the path of the light energy become temporarily leaky and lose some of their contents. Through a series of painless and comfortable laser sessions over a few weeks, we have seen most patients lose a collective number of inches based on circumferential measurements taken before and after the treatments.
In weight loss management, there are numerous medications and supplements that have variable amounts of effectiveness. Adding a weight loss component to a Zerona treatment series is a logical application of combining light technology and modern pharmacology. Patients should get an enhanced result by attacking the problem simultaneously from different angles.. One of the intriguing hormonal supplements with a long history in weight loss is HCG. Once popular in the 1970s it fell into disuse until recently. It has now resurfaced as a weight loss medication and is gaining renewed use.
HCG or Human Chorionic Gonadotropin is a hormone produced in pregnancy that is made initially by the developing embryo after conception (hence the positive pregnancy test) and later by the placenta. Its primary role in pregnancy is to help nourish the growing fetus by releasing the nutrients in fat from the mother’s body. This hormonal role has lead to a lot of research that has looked at its potential role in adult weight loss and obesity. While its exact role in fat metabolism can be debated, it is currently thought that it likely exerts its effect by stimulating testosterone, an anabolic hormone that causes weight loss in both men and women.
Taking small daily doses of HCG (approx. 125 IU to 200 IU) can help in the weight loss process, particularly when combined with other treatments such as Zerona and a calorie-restricted diet. When accompanied by a low calorie diet of approximately 1500 calories, HCG has emerged as a very useful adjunct. People fear dietary restriction because they know they will feel hungry or deprived. However, on HCG people do not feel the same as with the usual diets. This occurs because the HCG instructs the body to utilize fat reserves through the hypothalamus. Thus the body becomes flooded with 2000 to 3000 calories from these reserves, which along with the calorie intake, is more than sufficient to take care of one’s daily nourishment. As a result, not only do patients not feel as hungry but their energy levels stay high.
The combination of HCG with Zerona treatments creates a combination fat reducing effect. Zerona targets problem areas with its cold laser technology for spot reduction, HCG helps the body with overall fat and weight reduction. The Zerona treatments will last only several weeks but the HCG supplement and keeping your calories low is to be done for 40 days.
While liposuction surgery offers an immediate and sometimes dramatic body change, many people would prefer a less traumatic approach. Zerona HCG offers a less painful and costly approach that some people may find provides enough improvement that the thought of surgery is just that…a thought.
Dr. Barry Eppley
Pregnancy and childbirth can wreck havoc on a woman’s body. Few women would cast doubt on a phenomenon that they have probably seen or experienced. Throw in the strain of a few months of breast feeding and a bunch of sleepless nights and a woman’s body is sure to suffer (not to mention how she may feel). To reverse some of these changes, plastic surgery has come up with a variety of cosmetic procedures to help restore a woman’s body. Dubbed the “Mommy Makeover”, it has become popular as both a marketing concept and a treatment strategy for the post-pregnancy female body.
A Mommy Makeover is a collection of female body reshaping procedures that focus on the breasts and abdomen- the two body areas that are most affected by pregnancy. These can include breast procedures such as a breast lift to perk up sagging breasts after breast feeding, breast implants to bring back a woman’s cup size or even more, and a breast reduction to reduce breasts that may have become enlarged during pregnancy. Abdominal and waistline options include various forms of tummy tucks to tighten stretched stomach muscles and remove loose and sagging skin, and liposuction to eliminate unwanted pockets of fat from the stomach, hips and thighs.
None of these plastic surgery procedures are new, but combining them all at once in a single surgery is. Combining breast and abdominal reshaping can create the most dramatic changes ever seen in a woman between the shoulders and the hips. Some women can never return to exactly the way they looked before children even with the best of plastic surgery, but others can end up looking more shapely than before pregnancy.
While many women get stellar results with a Mommy Makeover, it is not right for everyone. The best candidates are those women who are finished having children and are done with breast feeding. One should have made a good effort with diet and exercise to get the best body possible before surgery, and have sufficient time off and support to allow for an adequate recovery. While some women are anxious to begin the process of a Mommy Makeover shortly after giving birth to their last child, it is often better to wait for at least 6 months to a year.
Most Mommy Makeovers are done on an outpatient basis under general anesthesia. No really significant breast and abdominal changes can be done within the limits of local and sedation anesthesia. Real body changes requires real surgery…and recovery.
While some women bounce back from pregnancy like nothing ever happened, other women struggle with feeling their bodies have been ravaged after pregnancy. Mommy Makeovers can reverse years of damage to a woman’s body in just a few hours.
Dr. Barry Eppley
One of the images highly associated with Valentine’s Day are lips…big, red and full lips. They are as synonymous with this day as much as chocolate and flowers. While big lips may be highly visible on this one day, they are actually sought out every other day of the year as well. Lip enhancement has been one of the popular office procedures in plastic surgery for nearly a decade and there is no sign of the demand slowing down.
Many women want fuller lips, some motivated by the look of Hollywood stars like Angelina Jolie which is more of an extreme look. But women of all ages seek lips that are larger, even if it just a little bit more. They want to add volume to their lips or improve the shape of their lips so that they can have more of an attractive pout. There are numerous injectable fillers that can make an instantaneous change, albeit temporary, and even some more surgical procedures and implants that offer a permanent result.
But plastic surgery technology aside, why is it that women want fuller lips? What is the deep-seated reason for this facial enhancement? Men do not ask for it and I have never had a single male request compared to thousands of female lip enlargements performed.
Some, of course, would say that bigger lips are an enticement to be kissed and therefore makes one more attractive. Kissing in not an exact science, although there is some interesting factoids about it. When you give your loved one a smooch, the majority of people tilt their head to the right. It requires six major muscles around the mouth to pucker up for a kiss. Our pupils dilate while we kiss, which is why we often close our eyes. A good sloppy wet kiss can transfer up to 100 million bacteria (not very romantic, but scientific fact nonetheless).
There is no question that lips are an erogenous zone for women in both appearance and function. Anthropologists tell us that a woman’s lips are a visible expression of her fertility. Studies have shown that a woman’s facial and sexual attractiveness is closely linked to her hormonal makeup during puberty and development. A woman’s estrogen levels helps maintain a youthful facial appearance in which the lips are fuller. Full lips are therefore attractive to men because they serve as marker of a woman’s health and fertility. They certainly seem to make women feel more attractive and sexy.
With this understanding, putting injectable fillers into the lips (or the more common application of lipstick) takes advantage of this innate biology. Bigger lips ‘fool’ men into thinking that a woman has more estrogen than she actually has and thus is more fertile and attractive. I have always said men are easy creatures to motivate…and this is one time again we don’t mind being fooled. Pucker up !
Dr. Barry Eppley
The shape and profile of the neck, even though it is not on the face per se, imparts an impression as to one’s appearance. Whether one is young with a fat neck or older with loose skin or a turkeyneck, a poorly defined neck angle results. While liposuction can remove fat and a necklift can tighten skin, an ideal neck angle is not always achieved.
What is missing from any cosmetic neck operation is a method to tighten the underlying muscles and tissues. By making a more firm ‘hammock’ that extends from ear to ear, the neck angle can be changed significantly. A new device, called the iGuide, has now become available to help create a firmer and more youthful neckline.
The iGuide is an FDA-approved device that is for tightening and lifting of neck tissues. It provides a less invasive technique to improve the neck and jawline with minimal incisions (unlike a traditional facelift) while at the same time shortening recovery time. By not doing wide undermining and elevation of neck skin, the swelling and bruising is much less and one’s recovery is quicker.
The iGuide allows the deeper tissue in the neck to be tightened by essentially creating a ‘neck hammock’ using a permanent suture. Through a series of needle punctures placed along the jawline, a suture is weaved back and forth from side to side to create a trampoline-like structure. This suture weave creates a low-tension support which elevates the tissues below the neck skin, a missing element from current necklifting procedures. This type of suture is not to be confused with the infamous barbed sutures (Threadlift operation) of the past.
From a neck recontouring standpoint, the iGuide has multiple potential uses. For the younger patient with a fuller neck where liposuction alone is not completely satisfactory, a suture weave can provide additional neck angle improvement. For the early signs of neck and jowl aging, a short scar facelift is great for the jowl area but may not always optimally treat the neck angle. The trampoline effect of the suture weave makes for a better neck angle result. Older patients with a turkeyneck may still require a more traditional necklift however.
The iGuide neck contouring system, in some cases, may be able to be done under local anesthesia without going to sleep. If all one’s neck needs is some liposuction and a suture weave, this would certainly be possible. Neither the tiny incisions nor the weaving of the suture requires the use of any sharp needles. But when other facial procedures are being done with it, then more than local anesthesia would be needed.
The iGuide provides a clever minimally invasive approach to redefining one’s neckline and is a great adjunct to liposuction and any form of a necklift. As its tagline states, it is ‘The Neck’s Big Thing‘.
Dr. Barry Eppley
The development of a droopy neck and saggy jowls is loved by few…and is the bane of many women and some older men. Much can be found that promises to improve it from creams, exercises, laser and light therapies, and even the occasional clothespin approach. But we all know deep down inside that such hope only benefits the manufacturers and sellers of these products…and the only lifting that gets done is usually from your wallet.
While surgery is the only effective option for that loose neck and jowl skin, everyone would like to have as little surgery as possible and avoid hearing that dreaded word…facelift. While the fears surrounding a facelift are largely unfounded, people would certainly like to avoid that consideration if possible. This facelift phobia has led to the emergence of the concept of the branded selling of facelift surgery.
The most well-known current 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. Promising to turn the clock back at least ten years and look recovered in just a few days, its snazzy name seeks to assure patients that it will fit into their ‘lifestyle’. Interestingly, nowhere in their advertising does the company suggest it is actual surgery. Somehow the concepts of surgery and lifestyle are incongruous. I have seen numerous patients who have visited their facilities and were surprised to learn that it was actually an operation that requires some recovery and a temporary change in their lifestyle.
In reality, the Lifestyle Lift is an operation that is decades old and is practiced by most plastic surgeons. This ‘mini-facelift’ operation has now cloned many spinoffs including the Swiftlift and Weekend Lift to name just a few. Often touted as being innovative and original by the advertising surgeon, the names suggest that getting a fresh, younger look is really easy…or at least is quick for the surgeon to do.
Like many things that are heavily marketed, the Lifestyle Lift has its share of proponents and critics. An internet search will quickly bare that out. As an operation, however, limited types of facelifts do have a valuable role in facial rejuvenation. Not every patient needs or wants a fuller or more complete type of facelift.
Facelifting is not, nor should be, an operation that is performed the same on everyone. ‘Mini-facelifts’ are best reserved for patients with earlier signs of aging, not advanced problems such as turkey necks. A catchy name does not necessarily make the procedure novel or unique. Many plastic surgeons offer similar type facelift procedures that just don’t have a branded name, but that doesn’t make them any less effective or useful.
Dr. Barry Eppley
There are a lot of patients who are halfway between injectable fillers and a traditional facelift. Their facial contouring concerns are not really adequately addressed with short-acting fillers but they are not yet prepared to go as far as a surgical facelift. Most of these patients are between the ages of 40 to 50 and may already be using or at least have tried Botox and injectable fillers. As they have continued to get older, they have found that new aging problems have developed around the jawline, the neck and the lower face.
The lower part of the face is out of reach for what any injection methods can really improve. Helping to bridge the gap before a facelift is a ‘Smart and Tyte’ approach. To help remove neck and jowl fat and tighten skin, the combination of Smartlipo and Skin Tyte is done. This is a two-pronged approach using laser liposuction for the neck and jowls followed weeks later by a series of SkinTyte office treatments.
For the neck and jowl fat, a laser probe is inserted from a few millimeter incision under the chin. The fat is treated at a depth of immediately subdermal to just above the platysma muscle is a fanning fashion out from under the chin. The entire procedure takes about 30 to 45 minutes and is done under local anesthesia. Downtime is not really an issue as there is only the mildest of discomfort afterwards. Swelling and bruising, however, will take a week or more to completely resolve.
Beginning three weeks after surgery, in-office pulsed light treatments (Skin Tyte) are done to aid the skin tightening process. Between the intial heat of the laser and these treatments, good skin contraction can be obtained. The Skin Tyte process is done every two weeks for a series of four total treatments. I judge the final outcome of this combination approach at six weeks after completion of the final in-office treatment.
For patients with the beginning signs of jowling and neck changes with favorable skin tone, really good contouring of the fat and tightening of the skin can be obtained. Such results can last for years and can turn back the clock five to seven years. Because the laser treatments is done under the skin, it can be performed on patients with any type of skin. Skin Tyte is turned down in power and intensity for darker pigmented patients to avoid any risk of pigmentation changes for the external treatments.
The key to a successful ‘Smart and Tyte’ outcome is patient selection. It is not for every patient that wants to avoid a facelift. In fact, most patients that want to avoid a facelift usually are in need of exactly that. But for those headed in that direction, this may be a smart way to avoid getting there too quickly
Dr. Barry Eppley
Plastic surgery, unlike some medical specialties, seems to always find its way into the news. 2010 was no exception in this regard. As a plastic surgeon, most of the items that become newsworthy were an incredible mix of the freaky, incredulous and even fantastic events.
Breasts always seem to make the news and the more freaky seems to be better. Whether it is basketball-size implants of quadruple FFFF proportions, dancers subject to IRS scrutiny trying to write off their surgery, or breast augmentation as part of a marathon makeover (aka Heidi Montag), women who seek their ten minutes of fame marr the perception of an otherwise highly successful body contouring surgery. While the real breast augmentation news this coming year will be the introduction of a new form-stable (gummy bear) implants, this will likely be overshadowed by the media’s never-ending focus on celebrities, their breasts and Hollywood’s version of silicone valley.
There is always the continued incredulous news of patients suffering complications and even death at the hands of so-called cosmetic surgeons. This seems to be most evidenced with liposuction, largely due to its popularity and the larger body surface areas that it treats. There is an obvious difference in the size of the trauma to the body from abdominal and thigh liposuction from that of a nosejob or eyelid surgery for example. Liposuction attracts a large number of inexperienced and often unscrupulous practitioners because of the relative ‘simplicity’ of the procedure and easy access to new liposuction devices. It only takes a medical license and a credit card to buy the newer laser liposuction machines. Equipment manufacturers are more interested in sales than safety as evidenced by their marketing and selling behavior. Patients died last year from one coast to the other at the hands of doctors with dubious credentials. The public would think that better regulations would exist but they would be wrong. Doing your homework is your best protection.
Botox continues to show its fantastic benefits and those are not only in those worried about their frown lines or crow’s feet. Last year Botox was approved by the FDA for the treatment of migraines. For some migraine sufferers, Botox injections can be a miracle even if its effects are only temporary. The benefits of Botox have translated into an actual migraine surgery procedure developed by plastic surgeons. If Botox injections relieve one’s migraines, a relatively simple muscular decompression around the nerve trigger points can provide a more permanent amelioration of one’s migraine pain and frequency of attacks. It’s a rare example of a cosmetic treatment turning into a really useful medical or reconstructive surgery, usually that works in reverse.
One other piece of fantastic plastic surgery news from last year has been the emergence of face transplants. While once thought impossible and something more akin to a movie or science fiction, more and more partial or complete face transplants are being done around the world. While the patients who need them are last resort problems of massive facial deformities and tissue loss, that is the history also of all organ transplants which are commonplace today. From the extreme technical advances of today come spinoffs that will benefit many more facial reconstruction patients in the future.
No telling what this coming year will bring, but if past history is any predictor of future events, plastic surgery will continue to make the headlines…let us hope it is largely in the fantastic category.
Dr. Barry Eppley
Just when I thought I had seen every conceivable variation of a plastic surgery reality show, a new twisted version appears. If your entertainment schedule has not allowed you to catch E!’s newest reality television disaster, Bridalplasty, consider yourself fortunate. If you haven’t seen it, it a summary is that it is a bride-against-bride elimination-style show where 12 women compete to have various cosmetic plastic surgery prizes- ostensibly to turn them from ducklings to swans just in time for their weddings. Or, as E!’s tagline cleverly states, it’s the only competition show on television where “the winner gets cut.”
If you are thinking- as I was, You have got to be kidding me, seeing it will only make you feel worse. The household of brides-to-be initially compete in difficult wedding challenges that would test the mental limits of the average grade school child. These ‘prize’ for winning each of the competitive challenges is a surgical procedure intended to help transform the prospective bride closer to physical perfection. Each week one of the contestants gets eliminated while the others receive their dream plastic surgery procedures along the way. Eventually one bride-to-be will receive the wedding of her dreams…and will head down the aisle in a designer dress as a transformed woman ready to surprise her soon-to-be husband.
The concept of a show in which women compete for the grand prize of a plastic surgery makeover in order to be the perfect bride for her wedding day would normally be funny… if it weren’t so sad. At its most basic, the show is a societal commentary on our contemporary fairytale wedding culture where so much effort is spent in both time and money for just a few short hours. Maybe its greatest entertainment value is in seeing how the fully complicit contestants are willing to trade any dignity for some free plastic surgery and a little bit of fame. I suspect the show’s creators are well aware of this self-deprecation but the contestants are clearly completely oblivious to it.
While Bridalplasty may be the pinnacle of self-parody for reality TV, the participation of the plastic surgeon in the show violates some of the most stringent ethics of the American Society of Plastic Surgeons. The most egregious ethical violation is the very premise of the show – all ASPS members are prohibited from giving away free plastic surgery as a prize in any contest. To encourage any prospective patient to undergo surgery because it will be free encourages patients to cast aside any consideration of its risks and expectations. Part of what any ethical, well-trained plastic surgeon should do is to educate the patient about both the benefits and the risks of their procedure(s) of interest. Reaching for a little fame here seems to have affected more than just the brides-to-be.
‘Bridalplasty’ is cringe-worthy TV at its finest, and brings the practice of medicine and surgery to a whole new low point. What’s next, ‘Who wants to win a quadruple bypass’?
Dr. Barry Eppley
A bump or hump on the nose is one of the most common reasons someone doesn’t like the way their nose looks. Removing a hump on the nose and having a smoother bridge down its length will make it appear more pleasing. That feeling about a nose hump is universal as people seem to intuitively know when the upper part of the nose is out of balance to the lower part of the nose…humps make the nose look too big and thick and sometimes even ages a face. Large nose humps can make one look older. (just like a downturned tip of the nose)
Hump reduction of the nose is one of the main reasons many people want nose-changing surgery or rhinoplasty. But removing a nasal hump is usually more than just simple shaving of the bone. What makes up most humps is a combination of bone and cartilage as the hump occurs where the bone of the nose stops and the cartilage of the nose begins. This means that both bone and cartilage must be taken down for a successful hump removal.
How big a nose hump is changes how it is done and what the recovery would be. Small hump reductions can be done by shaving or rasping and do not require breaking the bones of the nose, but larger hump reductions almost always do. That is why some patients will get black and blue under the eyes after a rhinoplasty while others do not.
Think of the bridge of the nose like the roof line on your house. Trimming off a little bit of the rooftop will not significantly change the inverted-V shape of the roof. (small hump) But taking more than just the very top of the roof line will leave the sides of the roof standing where they originally were….with an open top. To change that open roof back to an inverted-V shape requires moving the sides of the roof inward. To make them fall back to the middle, the base of the roof must be cut so they will fall back in together. This is what breaking or cutting the nose bones does. It is also the rhinoplasty maneuver that will leave you with black eyes afterward. The nasal bones are cut down low and then pushed in to close the open roof. This will also make the upper part of the nose more narrow and less thick.
Taking off a nasal hump, however, must not be done too far. Taking down the bridge of the nose too much, as was commonly done in the past, results in ‘scooped out’ or ‘ski-jump’ noses and leads to breathing problems. Keep a high but smooth and non-humped bridge of the nose helps to protect from breathing problems after rhinoplasty surgery.
Interestingly, taking down a hump also makes the nose look smaller and less long, an optical illusion that can easily be demonstrated by computer imaging.
The shape of one’s nose is said to reflect on one’s personality. I have no idea whether that is true but a well-shaped nose without a hump can definitely improve one’s facial balance and appearance.
Dr. Barry Eppley
Fat is one of those topics that we hear too much about and want as little to do with as possible. Most people feel like they have a little or maybe a lot too much. For some, fat is a definite the enemy that makes the choice between what tastes good and one’s waistline a difficult one.
When thinking of fat, it is almost always perceived as this blob of yellow jelly-like stuff that just sits there without much purpose. This collection of extraneous lipids and carbohydrates appears as nothing more than a piggybank of kitchen and restaurant memories. The reality is quite the contrary, however, as fat is really a dynamic body tissue that is a lot more active than it looks. And it has different bodily functions than just being an annoyance.
Seeing patients daily who have chosen to finally battle their fat with plastic surgery, I get to hear a lot of personal stories and insights into how fat is perceived and what is believed to get rid of it. Such experiences have prompted me to write a little mini-tutorial on one aspect of the biology of fat and body contouring.While fat may look the same throughout the body, it is actually quite different in structure. The size of fat globules, for instance, is quite different from that of the abdomen (big) versus that of the face or neck. (small) This is clearly evident when performing a tummy tuck versus a facelift. Because structure follows function in nature, it should be not surprise that the role of fat in the two places is different. Fat in the abdomen and waistline (men and women) and in the buttocks and thighs (just women) is depot fat. These are the primary storage areas and they offer a good central location with a lot of storage capacity. Fat in the extremities and the face and neck is largely insulating fat. Yes you can accumulate there but it is harder than storing it in your trunk regions.
This may be interesting biology but how is it relevant? While diet and exercise is a great first line of fat defense, it will not spot reduce any single area. And it does not work well on peripheral insulating fat areas. You can reduce tummy fat but it is virtually impossible to do the same with arm, neck or knee fat for example. And that flank or back fat is just about as stubborn. (it has smaller fat globules as well even though it is a trunk area) You can do all the crunches and twists that you want (and it is worth giving it a try first) but core fat reduction comes from overall weight loss. Spot or resistant fat reduction is most effectively reduced by liposuction, a focused fat removal method.
Will fat return after liposuction? The parallel question is will fat return after weight loss? Yes but the difference lies in what body areas are being treated. Depot fat site removal can return just like that of weight loss. But peripheral or insulating fat site removal is much more difficult (not a primary depot site) and those results are more likely to persist over time.
Dr. Barry Eppley
As we begin a new year, it is time to once again throw out some fearless predictions about what we will see in 2011. There are endless lists of predictions this time of year, so why not one for plastic and cosmetic surgery as well.
1) As the economy improves, albeit slowly, expect to see the number of people undergoing plastic surgery to increase this year. The past two years has seen the numbers of most major cosmetic surgeries decline by anywhere from 10% to 25%. If the economists are right (?), this will be the a turnaround year to reverse this downturn. Nips and tucks that people have put off in the recession will account for this increased demand.
2) The demand for non-surgical procedures will continue to increase. Between the number of new injectable fillers, competitive products to Botox, laser and light therapies for skin tightening, and different methods to zap unwanted fat, science and technology continue to expand the non-surgical market. The irrepressible human hope that one can look five or ten years younger in just one office visit assures a surging public interest.
3) The need for body contouring after massive weight loss will rise this year. As more and more people undergo bariatric surgery with weight losses in excess of 100lbs, the burgeoning amount of flabby skin will parallel that of the national debt. The subspecialty of Bariatric Plastic Surgery grows as fast as the number of contestants lining up to vie for the next The Biggest Loser show.
4) Incredulous cosmetic procedure disaster stories will continue. While the internet can account for anything becoming instant international news, poorly trained and unqualified practitioners will keep the complications coming. From discount injectable products to surgeries performed in a hotel room or people’s homes, those searching to gather quick cash off of naive patients will keep contributing to this type of plastic surgery news.
5) The number of reality plastic surgery TV shows will reach new lows. The list of cringe-inducing reality TV shows continues to grow. Just when I thought it couldn’t possibly get any worse than with the debut of Bridalplasty last fall, next up will be Mistress Makeover… a show for women who have had alleged illicit affairs with celebrities. I think I could have stomached a show on Pet Makeovers better.
6) The hottest body fashion trend this year will be the one you sit on. With the influences of celebrities like Kim Kardashian, Beyonce, and Jennifer Lopez, women are increasingly seeking a more shapely rear-end. Buttock lifts and fat injection buttock augmentations will become more mainstream. This is also influenced by an ever growing and diverse ethnic population that often places as much emphasis on this area as has historically been focused on the breasts.
Dr. Barry Eppley
It has been over a decade since a landmark study was published on identical twins and how their appearance changed as they aged. It showed how you live your life impacts how fast you age, and how old you look, more than the genes that are flowing through your bloodstream or camped out in your skin.
In this plastic surgery research that studied twins, it was observed that often one twin would look considerably older then the other. Since their gene make-up was obviously identical, how does one account for these differences? After studying hundreds of adult identical twins, the researchers discovered that how we nurture our skin has a huge influence on how well or poorly our skin ages. Three lifestyle factors came up consistently as accelerants of wrinkles and droopy skin; sun, smoking and stress.
So for this New Year if you want to slow down the clock on how you look as you age, here is another set of resolutions to consider. Limit the number of S’s in your lifestyle, adopt an S-free lifestyle as possible. Limit sun exposure, quit smoking and reduce the stress in your life as much as possible.
Everyone knows of the damaging effects caused by too much sun exposure on your skin. There are great examples that are not more than a person or two away most of the time. But not getting as burnt as toast at the beach is not what ages most people, it is the daily innocuous exposure that we don’t even feel. Lack of adequate daily UV protection in your moisturizer will add a few years and wrinkles than might otherwise have occurred.
The horrific effect of smoking on our heart and lungs is well chronicled since C Everett Koop was our Surgeon General. And most people recognize that it is not good for the skin either. Its impact is more than just those pesky lip lines from embracing that cylinder (and we have yet in plastic surgery come up with a good way to get rid of them), but it causes more and deeper wrinkles to occur, thins the skin, and creates a lot of dark spots and pigmentation irregularities. By reducing the blood supply to the skin, proper nutrients can not be delivered creating a state of skin malnutrition. A significant smoking habit can easily make a person look five to ten years older.
Stress is the wild card. It is bad for your skin and definitely causes more wrinkles. But treating stress is not as easy as applying a topical cream or not flicking a match or lighter. Maybe don’t sweat the small stuff (and it is all small stuff) approach is one antidote to adopt.
So if you’ve got wrinkled skin, age spots or a turkey neck, don’t blame your family tree. Blame those Ss in your life and make this the year you resolve to reduce them.
Dr. Barry Eppley
Christmas gift ideas can often be brain racking. Gift card, book or that new Wii game? Maybe something homemade like a festive ceramic bowl -or maybe not. In my quest to find self-improvement gifts for the holidays, I searched the internet for what one could give from a health standpoint. (if that is ever a good idea?) To my surprise, I found a wide range of personal improvements that shamelessly used a holiday theme for promotion of their services and products. Here are just of few of the best (or worst?)
“Get the Turkey Out Of Your Neck after the Holidays” While that sagging neck probably has nothing to do with the holidays, who could knock this perfect opportunity to make the association with that tryptophan-loaded bird and a little neck tightening plastic surgery.
“Get Through Christmas without the Stuffing” Many people will gain a little weight over this holiday season, adding to their muffin tops and love handles. Associating fat with stuffing is irresistable although it is really largely tasty carbohydrates. Dale Carnegie will no doubt tell you that there is no better way to make friends than to offer the gift of liposuction.
“Finance your Face” While faded from the retail scene for years, the layaway merchandise purchase has reemerged due to the recent recession. Who would have thought that if you couldn’t afford that face lift or nosejob, you can now get one on layaway. Imagine the surprise of your in-law or boss when they open that gift card with the initial down payment being made by you.
“Get Rid of that Santa Belly” Santa’s job doesn’t require any more of a workout plan than milk and cookies. Most of us aren’t so fortunate. But your spouse will no doubt view you ever more affectionately with Jillian’s newest book or DVD.
“Healthy Fruitcake” Who wouldn’t love this newest twist on an old favorite that everyone recognizes and discards regularly. This healthiest version must be one we are inclined to discard even faster with no chance of ever even tasting it.
“Dental Stocking Stuffers” That lip smacking experience under the mistletoe is reported to potentially exchange up to 500 different types of germs according to one dental study. This is even more for those who suffer from gum disease. Stocking stuffers of toothbrushes and travel-size floss is bound to convey an American Dental Association approved holiday message.
“Bring in the New Year’s with a Bang” The promise of improved and future performance appears to know no limit when it comes to that male who has lost the festive spirit. Imagine the happy look on your husband’s or boyfriend’s face when he unwraps this little bottle of holiday magic. This is one New Year’s resolution that will surely be kept.
Just a few gift giving suggestions that will no doubt make you memorable…but perhaps not conveying the holiday spirit that you might have thought.
Dr. Barry Eppley
Muffins and their tops are very appealing in this colder weather. On a brisk wintry day the thought of warm coffee and a muffin is hard to resist. But indulging in too many will likely give one a permanent addition of their own. While they are cute and crispy on an actual muffin, they are less than flattering on one’s body. Both men and women grapple with the muffin top fat deformity. Most know this name as it provides a clear picture of unsightly rolls of fat that pop out and over one’s waistline. Muffin tops seem to be a feminine description, in men they are better known as love handles.
Why fat deposits want to settle in this area is not known. Certainly genetics plays a major role in where and how the body distributes its fat. While diet and exercise helps control how much fat is deposited, such efforts don’t always prevent it from accumulating on the waistline. I have seen many fit patients, who exercise regularly and are weight conscious, but still developed a bit of a muffin top. This is especially true as one ages where these stubborn pockets of fat develop even if one is fairly weight appropriate for their height. The fashion world has contributed to this problem in women where waistbands are becoming lower and tighter, exposing and emphasizing these fat bulges.
The muffin top has always been an ideal area to treat with liposuction. It is considered ideal because of two important treatment considerations. It can be maximally reduced with liposuction even though it is a curved surface that is being treated. Aggressive liposuction can be safely done because if the area becomes over-resected, no aesthetic harm is done. There is probably no such thing as a waistline that tapers in too much. Fat in the muffin top or love handle comes out very easily with liposuction. Secondly, it is not a big area to treat so fat removal is fairly quick and recovery is relatively easy. One may only need a few days off work and the wearing of a compression garment for a week or two to get back to a normal lifestyle.
As liposuction as evolved, many patients wonder what is the best method and does one work better for the muffin top problem. The technology has evolved in liposuction with different ways to help break and loosen the fat for it then to be suctioned out. My current preference is the use of the laser probe. Known by the brand name of Smartlipo, laser liposuction helps heat and melt the fat. This not only does a better job of destroying the fat in the too fatty araes, but contributes to less pain and bruising afterwards.
While muffin tops can appear in isolation, most of time they are part of a more global waistline problem. Muffin top reduction is often part of abdominal and hip liposuction as well as tummy tuck or abdominoplasty surgery. For most patients, the muffin top is just part of a near 360 degree waistline fullness. But whether they appear alone as side bulges or just part of the ‘spare tire’, today’s liposuction techniques can successfully rid one of these less than flattering protrusions…in just slightly more time than it takes to drink that cup of coffee and finish off that muffin.
Dr. Barry Eppley
The holiday season is full of strenuous activities and one of these is travel. Anyone who has traveled by air in the past year knows that security is getting ever more scrutinizing. But of all the things that could be potentially hazardous to an airplane and its passengers, who knew that breast implants would be one of them?
Recently, a flight attendant’s breast prosthesis (external) became an unfortunate source of controversy that illustrates the growing conflict between one’s privacy and that of air travel security. New TSA screening rules include the use of either full-body scanners or pat-downs for selected passengers, the inclusion criteria of which is not clear. Incredulously, the flight attendant was made to remove her implant as part of the screening process.. This event has understandably raised concerns amongst some plastic surgery patients about their right to having to reveal their most intimate of physical information.
If you are traveling and have any implants, breast or otherwise, do you have to tell screeners that you have implants? According to the TSA website, “It is recommended (but not required) that you advise the Security Officer that you have an implanted medical device, and where that implant is located. If you have an implanted medical device that you would like to remain private and confidential, ask the Security Officer to please be discreet when assisting you through the screening process.”
While having breast implants is a personal matter, stepping onto a public airline mandates that you may be asked to give up all your rights to privacy. This offends all of us but this issue has long had a legal precedent. A similar issue confronted us decades ago in the height of the first wave of terrorist activity in airlines…the introduction of the need to pass through a metal detector. Similar concerns were raised then and the highest court in the land ruled that making you do so was not unconstitutional.
The body scanner has the ability to not only see breast implants but many other types of implants as well. From facial implants, chemotherapy ports, shunts for water on the brain, any artificial orthopedic joint replacements and even testicular implants. No one knows the actual statistics but I would estimate that at least one out of every three people traveling have some indwelling implant. Pat downs, of course, can tell almost none of these internal issues but they are infinitely more offensive.
I am certain that the TSA doesn’t care if you have had breast augmentation. But you can argue that their concern about them has some validity. Intelligence reports have come forth that indicates that terrorists may be having women implanted with breast prostheses filled with explosive material. This would be all too easy to do and is a potential reality. It only requires a method of activation, an indwelling receiver to make it work. And this is exactly what a body scanner can hopefully pick up.
Dr. Barry Eppley
The past few years have been part of an economic recession that we are told is the most serious since the Depression. Economists take a daily pulse on whether we are in some form of a recovery yet. As we enter the Christmas season, this economic ‘dip sticking’ is particularly keen. The flurry of buying, or lack thereof, at this time of year is one gauge of the state of the economy.
But, if you really want to know how the economy is doing this holiday season, don’t bother listening to pundits and endless boring numbers, such as the consumer price index, or even most of the more dry economists that have created them. They are about an accurate as the local football handicapper. I propose focusing on just one indicator and a very simple one at that – one that nearly any consumer can understand. In one word…bras…more specifically that of bra sales.
The sales of this one single clothing item is a lot more tangible for me to grasp than any cadre of numbers, fractions or percentages. If women are buying themselves new lingerie, this surely must be a sign of economic recovery. I would like to hear from Victoria’s Secret how their sales of push-up bras are going this season. According to the expert I consulted on this topic (my wife is a bra connoisseur and can spot a LaPerla knockoff in a room chock full of underwire, lace and padding) bras can sell for up to hundreds of dollars. In my mind, such purchases are a sure sign of consumer confidence. When the largest buying segment of the population is willing to indulge themselves (men may buy underwear but they are not about to splurge on an expensive item that no one ever sees), this suggests they may be willing to spend freely in other ways as well.
Paralleling the bra sales economic indicator is that of cosmetic surgery. Major cosmetic surgeries, such as breast augmentation, tummy tucks and many facial procedures, took a serious nose dive the last two years. Some plastic surgeons reported decreases of 40% or more in numbers of elective cosmetic surgeries performed. The national pulse now indicates that patients are returning for nips and tucks and some remodeling and overhauls. From Botox injections to facelifts, patients are returning to the ‘table’ in substantial numbers and spending on ‘personal image’ is gradually returning to its previous levels. Either consumer confidence is improving or the reflection in the mirror is heading in the wrong direction.
Does this mean the recession is over? No one seems to know for certain, but on a recent trip through the local Victoria’s Secret there were encouraging signs that the economy may be pushing back up.
Dr. Barry Eppley
Our skin is the largest body organ that we have and has more medications and treatments per surface area than any body part. The skin care world is chocked full of thousands of products that claim to either protect it or make it look younger. The sheer cacophany of skin care products clamoring for our attention leaves most women (and a few men) completely confused about what to use.
One newer type of skin care technology is that of antioxidants. Besides the obvious psychological appeal of not wanting to be ‘oxidized’, products containing antioxidant ingredients are popping up everywhere. While the scientific benefits of antioxidants and how they work are better reserved for a classroom or as a replacement for melatonin before retiring, it strikes me that we are seeing what’s old becoming new again…through the wonders of modern chemistry.
Antioxidants in skin care is actually a bit nostalgic and reminds us that our great grandmothers had the right concept all along. Most of today’s antioxidant skin care potions derive their properties from the naturally available fruits, vegetables, and whole grains that were once the main ingredients of age-old facials and historic healing compounds. They may not have known why it worked, and may not have had the right proportions of ingredients, but their organic approach was rooted in science after all.The fruit acid facials of today (also known as alpha hydroxy acids, or AHAs) derive their ingredients from extracts of grapefruit (procyanidin), lemon (vitamin C) or apple cores (vitamin C and phenols), are actually quite old. I have had more than one older patient who has told me they used to rub lemon juice or the cut edge of an orange on their face to reduce wrinkles or on their scars to make them look better. The ancient use of green tea facials (and you thought it was only for drinking) has been found to contain catechin which has potent antioxidant properties.
Old vegetable masks contained tomatoes, which are rich in lycopenes and carotenoids, to help control oily skin and reduce wrinkles. Oatmeal powder and other grains contain ferulic acid which has an antioxidant effect…not to mention the skin calming benefits of the well known oatmeal bath. Curd contains lactic acid which is a chemical peel. Cucumber and pumpkin have high levels of the potent antioxidant vitamin C. (the benefits of reducing eye puffiness from sliced cucumbers is not because they have a magic ingredient, it is that they are cold…a cool washcloth works just as well) Honey and egg yolk have been used in facials dating back to ancient Egypt. Honey contains flavinoids and vitamin C while egg yolks have the antioxidant carotenoid in them.
Before we wax romantically and start rubbing lemons and green teas leaves on our face, it is important to realize that science has several advantages over nature. Through purified and concentrated extracts from these natural sources and using technologically advanced delivery systems, what does come out of that expensive bottle is easier to use and does work better.
Turkey and Thanksgiving go together like no other holiday and food combination. While there is no evidence that it was ever actually served at the first pilgrim’s festival, it became a mainstay shortly thereafter. While many will anxiously await for their share of the turkey this holiday, whether it is a leg, breast or stuffing, no one aspires for the turkey neck.
This fleshy fold of hanging skin, known as the neck wattle in the bird, appears in people as well. While in turkeys it occurs mainly in the male, in humans the turkey neck is not gender specific. As we age, the appearance of one’s neck often becomes a bothersome issue. The loss of a once smooth jaw line and a shapely neck shows the effects of gravity and time. Catching one’s profile in a picture can sometimes be disturbing…who is that older person with such a floppy neck?
While creams and other potions do much to alleviate’s one’s pocketbook, the turkeyneck is otherwise a surgical problem. Forget about non-invasive options or ‘lunchtime’ type procedures. These simply will not work for the dangling neck no matter how they are marketed or hopeful one is. For the full neck with good skin, and if one is young enough, good results can be had with liposuction alone. But when the skin is loose and floppy, fat removal alone with only make the neck skin more loose and floppy.
If you can grab a wad of neck skin and fat between your fingers, then some form of a facelift procedure is what is needed. Using the term facelift can be confusing as this procedure often conjures up images of extensive surgery from the forehead down to the neck. In reality, a facelift is really a neck and jowl operation and does not affect the face above the jaw line. It is a poorly named procedure and the term necklift would more accurately describe it than calling it a facelift. It is really less extensive and easier to go through than most people actually think.
When it comes to facelifts (aka 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. (often called the Lifestyle Lift) If there is a lot of loose neck skin, then the more complete 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 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
The association of turkey and theThanksgiving holiday goes back for over three hundred years. While there is no real evidence that it was ever served at the first pilgrim’s festival, it became a mainstay shortly thereafter. While many people will anxiously await for their share of the turkey this holiday, albeit a leg, breast or otherwise, nobody aspires to have a turkey neck.
This well recognized fleshy fold of hanging skin, known as a wattle in the bird, appears in people as well. While in turkeys it occurs mainly in the male, in humans the turkey neck is not gender specific. For some, the neck is often one of the biggest areas of concern as one ages. The loss of the once smooth jaw line and a more well-defined neck angle are telltale signs of the effects of gravity and time. The turkey neck is just an advanced stage of neck aging as it eventually flops from side to side in the older patient.
While year round turtlenecks are an option, it is otherwise a surgical problem. Forget about non-invasive options or ‘lunchtime’ type procedures. These simply will not work for the turkey neck no matter how they are marketed. If the neck and jowls are made up mainly of fat with good skin, as usually occurs in the younger patient, then good results can be had with liposuction alone. But when the skin is loose and floppy, fat removal alone with only make the neck skin more loose and floppy
If you can grab a wad of neck skin between your fingers, then some form of a facelift procedure is what is needed. Using the term facelift can be confusing as this procedure often conjures up images of extensive facial surgery throughout the whole face. In reality, a facelift only effects the neck and jowl area and will do nothing for the face above the jaw line. It is a poorly named procedure and a facelift should be called a neck-jowl lift. It is really less extensive and easier to go through than most people actually think.
In actuality, there are only two types of facelifts… limited and full. Which one is best for any particular6 person is determined by the amount of loose neck skin that one has. If the loose neck skin is not extensive, a limited facelift may be enough as this lifts the loose jowl skin a lot and the loose neck skin a little. If there is a lot of loose neck skin, then a full facelift is really needed. This is the most powerful neck procedure and can produce some really dramatic results. The differences between the two are how much of an incision is needed around the ear and the number of days of recovery needed. (even though the recovery is really about how you look or a social issue, there is next to pain at all for either)
Dr. Barry Eppley