Reverse the Age of Your Skin? Really??

Okay, so I realize I talk about our Sciton laser a lot in these posts.  But I have to admit I absolutely love using that thing.  Where I trained for residency, we didn’t actually own any lasers, so having a fully loaded Sciton at my disposal is like getting to drive an Aston-Martin (the Bond car, for those of you who don’t have a father-in-law as car-obsessed as mine!) every day.  And if you wonder why my residency program didn’t own a laser… it’s because it costs about the same as a new Aston-Martin.  So when we did absolutely need one, we rented it.

Right, I was making some sort of point here, which I think was why I love, and talk about, our laser so much.  Anyway, today I wanted to share something particularly fantastic- with regular BBL treatments (which I’ll explain in a sec), you can actually reverse aging.  Please note, that’s not “reverse the signs of aging”– that’s actually reverse aging in the skin.  I first heard about this during an excellent laser training course, but I really hate sharing things with the public without some sort of proven study in an actual scientific journal.  Well, Stanford has published a study which demonstrates changes in gene expression after BBL treatments which make aged skin resemble the gene expression seen in younger skin.  The other study available on that page shows some of the cosmetic results of patients that have received regular (i.e. yearly) treatments with the BBL over 5-10 years, and patients look significantly younger.

And now you’re wondering- what the heck is a BBL?  Excellent question, and I’m going to avoid getting too technical here.  BBL stands for broad-band light.  This is also known as IPL (intense-pulsed light).  It’s similar to a laser, with one important difference- a laser produces light in only one wavelength.  Whereas a BBL produces all wavelengths of light, and we filter out those we don’t want.  The difference is important for two reasons:

  1. BBL doesn’t behave quite like a laser, so we have to be a bit more careful on whom we use it.  This means (for you), no tanning, no fake tanner (it reacts with the BBL), and if you have darker skin, we use more conservative settings.
  2. Because we apply different filters for different treatments, we can do many different treatments with one machine.  This means we can treat acne, brown spots, little capillaries around the nose, rosacea, and even do hair removal.

So what is a BBL treatment like?  I’ve done a couple on my own forearms, and it feels a little bit like a rubber-band snap.  Afterward, there is some discomfort similar to a sunburn, but this is usually gone after 30-60 minutes.  So we’re talking really minimal downtime.  Below you can see my before and after pictures after two treatments on my arms.  I had a fair amount of sun-damage for my age from summers full of horse-back riding, and you can see how much more even my skin tone is.

Do you have any questions about BBL?Before (left) and after (right) two BBL treatments

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Joseph Murray (1919-2012)

Dr. Joseph Murray (1919-2012)

Dr. Joseph Murray died this yesterday at Brigham and Women’s Hospital in Boston.  For those of you who don’t know who he is, he performed the first kidney transplant in 1954.  He was also a Plastic Surgeon.  Why would a plastic surgeon perform a kidney transplant?  Excellent question- the way the story has been told to me, is that Dr. Murray had the technical expertise and surgical skills necessary to perform such a technically demanding operation.  When I did my Transplant Surgery rotation, I always listened with pride when my attending surgeons recounted the story of the first kidney transplant (done on identical twins), and then asked the other residents, most of them training in general surgery, if they knew what type of surgeon Dr. Murray was.

The truth is, Plastic Surgeons have always been pioneers.  The rabbit experiments of Dr. Harry Bunke, another Plastic Surgeon, helped create the field of microsurgery.  It is this ability to repair tiny nerves and blood vessels that now allows us to reattach a severed finger, or perform a face transplant.  Of course, Dr. Bunke’s son Greg had many one-eared pet rabbits while his father was still learning!

Plastic surgeons are also the “surgeon’s surgeon”.  When other physicians have wounds they can’t close, they call us.  And much of this knowledge came from surgeons who treated soldiers injured in World Wars I and II (Dr. Murray himself was an Army doctor).  Being a Plastic Surgeon is a huge honor, and a big responsibility.  So when you’re watching Dr. Paul Nassif on The Real Housewives of Beverly Hills (who was originally trained as an Otolaryngologist, by the way), or reading another article about celebrity cosmetic surgery, remember that most Plastic Surgeons still perform more reconstructive surgery than cosmetic.  And think of the more than 600,000 individuals who have received an organ transplant since that first kidney transplant back in 1954.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

It’s All in the Eyes… Part 2

In a previous post I talked about how aging of the forehead and cheeks can make your eyes look older.  Today I’m going to talk about the eyelids themselves, and how we can reverse the effects of aging.

courtesy of office.com

First, let’s talk about the upper eyelids.  Young eyes have a smooth upper lid, with a well-defined crease and no excess skin.  Older eyes have excess skin, and may have some bulging medially (meaning near the midline).  This bulging is actually fat inside the orbit.  The orbital septum is a layer of connective tissue that keeps the fat inside the orbital cavity from bulging out.  As we age, this layer of connective tissue weakens, allowing the fat to bulge out.  In addition, our skin stretches and droops as we age.

So how do we fix this?  It’s actually a relatively simple procedure:

  1. Take off the excess skin.  The resulting scar is well-hidden in the crease of the upper eyelid.
  2. Remove the bulging fat.  Removing just a pinch or two of fat smooths the contour of the upper eyelid.

One common question I am asked- are upper eye lifts (blepharoplasty) covered by insurance?  The answer, as always, is that it depends.  For the procedure to be covered, the upper eyelid skin has to be drooping so much that it actually obstructs your vision.  If you have so much excess skin that it’s difficult to see your eyelashes, it very well may be covered by your insurance.  In order to find out for sure, you will need to see your opthalmologist for a visual fields exam, which is basically a test to determine if your excess eyelid skin is blocking your vision.

Now what about the lower eyelids?  Lower eyelids age in a similar way to the upper eyelids.  Excess skin develops, and the fat in the orbit begins to push on the orbital septum (the connective tissue holding it back), causing bulging and bags under the eyes.  The major difference between the upper and lower eyelids is that the lower eyelid can also develop laxity, meaning it becomes slack.

Lifting the lower eyelids is similar to to lifting the upper eyelids with one major difference:

  1. The excess skin is taken off
  2. The bulging fat is removed
  3. Here’s the difference– the lower eyelid is tightened.  The canthal ligament, which is the tough connective tissue that supports the lower eyelid, is suspended higher into the outer corner of the bones that make up the orbit.  Not every patient needs this, but it is commonly done to help provide support to the lower eyelid.

Do you have any experience with eyelifts you would like to share?  Or any questions you would like to ask?

 

 

 

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Abdominoplasty, Mini-Abdominoplasty- What’s the Difference?

Today I’m going to try to explain another confusing issue- what exactly happens during a mini-abdominoplasty (tummy tuck) vs. in a full abdominoplasty.  This will also give you an idea of which procedure might be appropriate for you.

There are two concepts to grasp:

  1. How much skin is taken off.
  2. What is done to the abdominal muscles.

Let’s look at the first concept to start.  In a full-abdominoplasty, patients generally have a significant amount of excess skin.  To get a nice, tight result, all the skin from just above the belly-button (umbilicus) down to the level of the bikini line is removed.  The belly-button is left in place, and a new hole is made for it in the skin that is pulled down. (see the drawing below).  In a mini-abdominoplasty, only the excess skin below the umbilicus is removed.  The umbilicus itself isn’t moved.  The resulting scar is pretty similar, except that in a mini-abdominoplasty, there is no scar around the belly-button.

Now let’s talk about the second factor- what is done to the abdominal muscles.  When there is pressure inside the abdomen, usually from a baby, the rectus muscles (the ones that give you a six-pack) stretch out.  Here’s another great diagram:

 

 

 

 

 

 

 

 

You can see how the fascia -the tough connective tissue between the muscles- has stretched out.  When this happens, no amount of crunches are going to give you a flat stomach.  Instead, the space is pulled tight together using sutures.  This is most commonly done during a full abdominoplasty.  Sometimes if just the lower part of the belly has stretched out, a mini-abdominoplasty gives enough access to tighten up what has stretched out.

So- why the big difference in recovery and cost between the two?  First, the full-abdominoplasty takes more time in the operating room, which means it costs more.  In addition, because more skin is taken off, there is a slightly increased risk for problems healing.  Drains are left in place to prevent fluid collections under the skin, and these stay in for 1-2 weeks.  The part that really makes a difference, however, is the muscle tightening.  This leaves patients feeling very tight, and very sore.  Most patients can expect to be off work for at least a couple of weeks.  And it will be at least six weeks before you’re cleared to start exercising again.  A mini-abdominoplasty has a similar recovery, but you may not have drains in place, and you are often a little less sore.

Which one is right for you?  The only real way to tell is to be examined by a surgeon with experience performing abdominoplasty.

Do you have any questions about abdominoplasty?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

4 Facts You Didn’t Know About Liposuction

Liposuction is one of the most casually referred to, and possibly most misunderstood, surgical procedures out there.  Even Plastic Surgeons make comments such as, “Oooh.. I ate way too many cookies.  Gonna need some liposuction for that!”  But the average consumer knows very little about liposuction- how it works, and what it can, and can’t do.  Today I’m going to clear up some of the misconceptions.

1. Liposuction can’t help you lose weight. I think people sort of know this one, but they don’t realize how limited lipo really is.  “Large-volume” liposuction is defined as lipo that removes more than 5L of fat.  This results in major fluid shifts in patients, increasing the risk of pulmonary edema.  Patients who have this much fat removed have to be admitted to the hospital overnight for observation, so it’s a pretty big deal.  5L sounds like a lot, but it’s only 11 pounds.  Not gonna do the job if you need to lose 20 or 30 pounds.

2. Liposuction is not a fast fix.  It’s true that most patients go home the same day.  But most patients also have significant brusing and swelling that takes weeks to go down.  They also have to wear compression garments postoperatively for 6 weeks,  So if you’re thinking of getting liposuction for a special event, you should plan several months ahead of time.

3.  Liposuction is best for spot reducing problem areas.  That little belly you still have when you’re at your goal weight?  That’s what lipo is perfect for.  Those saddle bags over your hips?  Also good.  Making your thighs thinner- not as good.

4.  You don’t have to be a size 6 to benefit from liposuction.  But you should be at a stable weight, and relatively close to your goal weight.  It doesn’t make sense to spend money and time recovering if you’re planning to lose another 20lbs, some of which may come off those problem areas.  But if you’re happy with the weight you’re at and you just have a problem area or two, lipo can help, even if you’re a size 16.

Do you have any questions about liposuction?  Have you had any experience with liposuction?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.