It’s All About Volume

Isn’t it always about volume?  Full hair… full eyelashes… full lips…

Courtesy of office.com

Courtesy of office.com

Today I’m going to talk more about fillers.  I’ve hit on that topic before, but I’m going to get a little bit more into the nitty-gritty of why I use the fillers I do.

First- Why do so many fillers exist?  Back in the booming days of cosmetic surgery (i.e. the 1980s) we had collagen.  This was largely derived from bovine sources (read- cows), although there were some human options out there.  The biggest problem was that patients had to have an allergy test every time they received filler, a month ahead of time.  Not exactly convenient if you wanted to get rid of a few wrinkles right before your son’s wedding.

Obviously fillers are a lucrative market, and a plethora of new options have developed.  There are more types of filler, and sometimes multiple options within the same type of filler.  So I’ll give you the basic breakdown.

There are three main filler types that I use.

  1. Hylauronic acid fillers contain a slippery, clear substance called hyaluronic acid (HA), which is chemically the same between all animals, and is a major component of the fluid around joints.  Because it is identical between species, no allergy test is needed before treatment.  Juvederm, Restylane and Belotero are all hylauruonic acid based fillers, and essentially vary in the size of the HA particles and how they are linked together.  This basically changes how thick the filler is, and possibly how long it lasts.  The HA fillers are the only ones I use in the lips, and they are also great for fine wrinkles.
  2. Radiesse is made of hydroxylapatite, a mineral found in bone. Because it is a mineral, it is obviously firmer and stiffer than the HA fillers.  For this reason, it does not work for fine wrinkles or in the lips.  I use it for deep wrinkles or to add volume, especially over the cheekbones.
  3. Poly-L-lactic acid is the main component of Sculptra.  Sculptra was initially approved for HIV-associated lipoatrophy- that very thin, wasted-looking appearance that patients who are on antiretroviral medications sometimes have.  It is meant to add overall volume as opposed to treating specific wrinkles, and it works by stimulating collagen production as the product itself is slowly metabolized to lactic acid.  It is now approved for cosmetic use, and oit appears to be semi-permanent; follow-up studies demonstrated results at two years.

If you’re thinking about getting a filler, here are some questions to consider:

  • What are your goals?  Do you want fuller lips, to get rid of wrinkles or to add volume? (Note that sometimes the way to improve wrinkles is by adding volume, so don’t be surprised if your surgeon suggests this.)
  • How long to you want results to last?  The HA fillers and Radiesse last anywhere from 6-12 months (I caution patients to expect results on the lower side of the spectrum, just so they aren’t disappointed if fillers don’t last as long as they expect).
  • What is your budget?

Do you have any questions about fillers?

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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.

Those Flabby Upper Arms…

Yep, we all hate ’em.  Those flabby upper arms.  You wave goodbye to someone, and your arm is still waving five minutes later.  While toning the triceps muscle at the back of the arm can certainly help, it won’t get rid of the extra skin that shows up after weight loss, or with a certain amount of extra years.  So what will?

Office.com

Office.com

As is often the case, there are some non-surgical options.  I’ve talked about SkinTyte in previous posts, as well as VASER Shape.  What I didn’t mention is that they can be used on the upper arms to tighten extra skin.  Do they work?  The short answer is, not as well as surgery.  But most patients can expect to see a modest improvement in skin tightness.  As a brief review, both treatments use heat (SkinTyte derives its heat from a high-energy light source, and VASER from ultrasound) to cause collagen remodeling.  This causes gradual skin tightening over 4-6 months.

If you have significant extra skin, then surgery is probably the better option.  So how is an arm lift (brachioplasty) done?  It’s pretty simple, really- the extra skin is removed, and the incision is closed up.  This leaves a long scar, stretching from the armpit (axilla) to the elbow (nope- no fancy term for elbow.  Sorry!)  And that scar can get ugly- areas like the arms and legs usually heal with wide scars.  It is hidden on the back of the arm, but it’s still not a pretty scar.  The biggest risks of a brachioplasty are problems with healing- it is a long incision, after all- and arm numbness.

Despite the ugly scar, I think that patients who really need a brachioplasty do look better after the surgery.  But if you’re unsure about that scar, it may be better to wait, or try a non-invasive option first.  If you’d like to find out more information, check out the American Society of Plastic Surgery page on brachioplasty.

 

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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.

Why do I know how to pierce ears?

I do know how to pierce ears, and it’s not because I went on a piercing rampage as a teenager.  Nor did I ever work at Claire’s.  Many plastic surgeons occasionally pierce ears, and it’s because we repair torn or stretched earlobes.  After I spend time repairing a torn earlobe, I would much rather pierce that ear myself after it’s healed than send my patient off to the mall.  Plus, that ear piercing gun is pretty fun.

Courtesy of office.com

Courtesy of office.com

So why might a person need an earlobe repaired?  If you’ve ever caught an earring while putting on your sweater, you can easily imagine how that earring can pull right through your earlobe.  This happens during a fight occasionally as well.  Of course, many people intentionally stretch their earlobes out with increasingly larger earrings.  I repair these as well, and the good news is that it is much easier than removing a tattoo.  This can be done in the office, as well.

So how is it done?  For a torn earlobe, these can be repaired anytime after the injury.  The skin around the tear is carefully trimmed away, and the torn part is then sutured back together.  Stretched earlobes are a little more complicated, but essentially the skin around the center hole and part of the stretched earlobe are trimmed away, and the remaining skin is rearranged back to form a normal earlobe.  There is little downtime with either of these procedures, but you cannot pierce your ears again until the incision is fully healed (at least 6-8 weeks).

You can see what a stretched earlobe repair looks like here.  On a final note, these procedures are not covered by insurance, as insurance companies consider them to be cosmetic.  The only exception would be suturing up a traumatic ear injury, i.e. if your earring has just pulled through your ear, fixing the tear with stitches would be considered medically necessary.

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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.

How Long do Breast Implants Last?

photo courtesy of office.com

photo courtesy of office.com

I’m back to conventional plastic surgery topics today, and what’s more “typical” plastic surgery than breast implants?  I covered what having a breast augmentation is like in another post, but today I’m going to talk a little bit more about the implants themselves.  Women may get breast implants for cosmetic reasons, or to reconstruct a breast after cancer, and it’s important to understand the ins and outs of something that is going to be implanted in your body.

The types of implants-

  • Saline vs silicone – are they safe?  I’ve talked about this before in my post on augmentation, but I’ll go into a little more detail here.  First, you should know that both implants are safe.  Silicone implants do not cause autoimmune disease, or arthritis, or any of the plethora of conditions which have been ascribed to them.  The FDA looked very carefully at silicone implants before allowing them to return to the market when these allegations were made, and absolutely no scientific data was found linking silicone breast implants to any of these negative conditions.
  • What about anaplastic large cell lymphoma?  If you’ve been keeping up on the news, you may have heard about lymphoma being associated with silicone breast implants.  This is not an aggressive lymphoma, but more similar to the indolent skin-type lymphomas that do not progress quickly, and are rarely fatal.  More importantly, there are only a handful of cases described (numbering in the double digits), and there is no data to suggest that the breast implants themselves are actually causing this condition. The risk has been estimated at around 0.1 per 100,000 people with implants (literally, 1 in a million), and all of the silicone implant manufacturers are studying this very closely.

So how long do implants actually last?  Most surgeons will tell you to expect a lifespan of 10-20 years.  That’s not to say there is a strict expiration date, after which you must have your implants either removed or replaced.  Rather after that period of time, the risk of needing another operating is much higher.  There are essentially two reasons you might need to remove or replace an implant that was otherwise perfectly fine:

  • Capsular contracture.  This describes a condition in which a tough rind of scar tissue forms around the implant, making it firm, and possibly even painful to the touch.  This isn’t an all or nothing event- there are gradations.  So a person with mild capsular contracture may be happy with the appearance and feel of her implants, and thus not need surgery.  This ultimately happens in anywhere from 15-30% of patients, but again, not all of these patients need their implants replaced.
  • Implant rupture.  When a saline implant ruptures, the saline is reabsorbed by the body, so the implants becomes flat.  So in other words, it’s pretty easy to tell if a saline implant has ruptured.  Silicone is not so easy- silicone itself comes in various consistencies, from a thick gel like honey, right up to something more similar to a gummy bear.  The important thing to know is that this silicone isn’t going to go anywhere; it will stay in the breast implant pocket.  Your implant may change shape, or feel slightly different.  Or you may not even be able to tell (what is called a silent rupture).  For this reason, the FDA recommends an MRI to screen for rupture on all women who have silicone implants: first three years after you get your implants, then every two years after that.  How often do implants rupture?  Around 1% per year, so 10% of patients who have had an implant for 10 years might experience an implant rupture.

Do you have any questions regarding breast implants?

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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.

Happy New Year!

I guess I’m a little late with the first blog post of 2013, but here it is.  And you know what, I’m not even going to talk about plastic surgery today.  I’m going to talk about one of my favorite new moisturizers instead.  I know I’ve gone on and on about how important it is to moisturize your skin- not only is dry skin itchy and uncomfortable, but dry skin can crack, letting bacteria that start an infection brewing.

So what is my favorite new moisturizer?  Well, it smells great, you can use it on your skin and hair, and even eat it.  Did you guess already?  Yep- its coconut oil!  Coconut oil has been in the popular press quite a bit lately for all of these uses.  I have used in in some recipes to replace butter (it’s great in granola, for example).  And since winter started, I’ve also been using as lotion.  It absorbs fast and smells great.

Coconut oil also works well as a hair moisturizer- just rub some on your hands, then rub into your hair.  Let is set for 5 or 10 minutes, then shower as usual.  Now want to hear something a little strange?  I’ve actually been using coconut oil on my dog.  Yeah, I realize that’s um…. thinking outside the box.  But she’s a Maltipoo, and she’s got some long, curly hair.  She also doesn’t shed, which is a set-up for matting.  I don’t like to give her baths in the winter, because she gets cold so quickly, so I tried rubbing a little coconut oil in her fur.  (She smells great, by the way- we call her the coco-mutt.)  I’ve just been rubbing it on my hands, then through her fur, and as long as I don’t use more than a teaspoon, she doesn’t get anything oily when she lays down (e.g. the couch, our bed…)  And she is not only much easier to comb out, but her skin isn’t nearly as dry.  And her hair isn’t full of static when I brush her, which we both appreciate.  Oh, and since it’s totally edible, I don’t worry when she promptly licks it off her fur!

You can see her crazy, curly fur in the pics below.

Thanks for stopping by over the past few months.  If there are any topics you’d like to hear about over the next year, I would love to hear about them!

Maggie Moo, relaxing at home

Maggie Moo, relaxing at home

Look at that Maltipoo move!

Look at that Maltipoo move!

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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.