Is there a non-surgical lower eyelid lift?

Aging lower eyelids can make you look chronically tired, even if you are well-rested. Several things happen during the aging process:

  • Skin texture changes, becoming more crepey in appearance.
  • Skin elasticity decreases, resulting in excess skin over the lower eyelids.
  • The connective tissue that spans between the cheekbone and lower eyelid, called the orbital septum, stretches out with age. This allows the fat which surrounds the eyeball and protects it to “pooch out”, causing bags under the eyes (see the image below).

    lower blepharoplsaty

    Original photo from emedicine.com

The gold-standard way to fix this is, of course, a lower eyelid lift (blepharoplasty). A blepharoplasty removes a small amount of the fat causing the bags under the eyes, and removes the excess skin as well. But what if you’re not ready to commit to having surgery?

There isn’t a non-surgical way to actually fix bags under the eyes, but we can camoflauge them. Adding filler at the top of the cheekbone to make the cheeks fuller will smooth the transition between the lower eyelid and the cheek. The filler I like for this area is Radisse®. Radiesse® is composed of calcium hydroxylapatite, a mineral found in your bones. It is gradually broken down by the body over 9-12 months, so it gives fairly long-lasting results. The key with filler is to place it over the cheekbone, not the actual lower eyelid. Lower eyelid skin is very thin and delicate, so filler can look unnatural in this area.  The picture below outlines ideal filler placement with the blue dots. lower eyelid filler

Do you have a question about lower eyelid rejuvenation or cheek filler? I would love to address your questions in the comments section!

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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 can I make a scar less noticeable?

Making a scar less noticeable is one of the primary goals of plastic surgery. But to accomplish this goal, we first need to understand what makes a scar more visible in the first place. Let’s break it down:

  • Color: scars optimally fade to slightly lighter than skin tone. But some scars may remain pink or red, or even darker than the surrounding skin (hyperpigmented). It can take 6-12 months for a scar to finish fading, so redness or pinkness is normal during this stage. If the pink color persists beyond this time, or if you’re just a bit impatient, laser treatments can help the pinkness fade. Hyperpigmentation in scars occurs when they are exposed to the sun. To prevent this, I recommend applying sunscreen to the scar daily over the first year. If hyperpigmentation is already present, skin lightening creams can help even out the pigmentation, as can laser treatments.
  • Contour: an ideal scar is narrow and flat. But some scars may become thick and raised during the healing process, as I’ve discussed in a previous post on hypertrophic scars. This commonly occurs in scars on the chest, and some people are also just more prone to forming raised up scars. Silicone scar cream, massaging the scar, and steroid injections can all help flatten out a raised scar.
  • Width: instead of becoming thicker, scars may instead widen during the healing process. This is very common on the arms, legs, and back where the skin is under more tension. I have noticed that scar widening also seems to occur more often in teenagers. Keeping a steri-strip or piece of medical tape on the incision for the first several months can help decrease tension on the incision and lower the risk of the scar widening. But widening cannot always be completely prevented.

    photo credit: emedicine.com

    photo credit: emedicine.com

  • Blending into natural anatomic boundaries: you may have noticed that all of the above factors depend on the healing environment, i.e. how the wound is taken care of, and intrinsic healing factors that vary from person to person. But how the wound is closed also impacts how a scar develops. Wounds under significant tension are more likely to widen or raise up, so minimizing this tension through different closure techniques is an important part of plastic surgery. In addition, a good scar will blend into natural anatomic boundaries. This isn’t always an option in a scar resulting from trauma, e.g. after a dog bite. But if I am taking a skin cancer off the nose, for example, I can design the incision in a way that makes it less noticeable. Facelift incisions are another great example. Even though the incision is right on the face, placing on the natural boundary between the ear and the cheek makes a good facelift scar nearly invisible.

Do you have any questions about scars? I would love to hear them in the comments section.

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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.

Can I have a breast reduction and a tummy tuck at the same time?

I recently had a patient ask me if a breast reduction and a tummy tuck (abdominoplasty) could be done at the same time. I am often asked if two operations can be combined, and the answer isn’t always the same, so in today’s blog post I wanted to give you a peek into my thought process. There are several factors to consider:

  1. Will recovery be more difficult if the two operations are combined? I won’t do a carpal tunnel release on both hands in a single surgery, for example, because during the recovery period the patient is stuck with a splint on each wrist. This makes it fairly difficult to do things like shower, feed yourself, or even use the bathroom. Along the same lines, I usually recommend splitting a brachioplasty (arm lift) and thigh lift into separate operations so that you can use your arms to compensate for the soreness in your legs, e.g. when getting up out of a chair, and vice versa.
  2. How long with the total operation be? Several studies have shown that longer operations increase the risk of forming blood clots in the legs (deep vein thrombosis). There may be an increased risk of infection in longer operations as well, although the data here is not as clear cut. In addition, surgeon fatigue definitely plays a role. Surgeons are human, and we do get tired during long cases. In my own practice, I limit operations to around 8 hours or less when combining elective procedures.
  3. Are the two operations considered cosmetic or covered by insurance? The hospital that I operate at will allow me to combine cosmetic and medically necessary operations. They just separate the billing, so the portion for the non-cosmetic operation goes to the insurance company. Some surgery centers will not allow surgeons to combine a cosmetic operation with one covered by insurance, however, so this may be a factor in your surgeon’s decision making process.
shutterstock.com

shutterstock.com

After reading through the information above, you’ve probably concluded that it is possible to perform a breast reduction and an abdominoplasty at the same time. And in fact, this is a fairly popular combination operation. The advantage is that you can recover from both operations at the same time, rather than having two separate recoveries.

 

Do you have any questions about combining operations? I would love to hear them in the comments section.

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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.

Do I need to lose weight before having breast reduction?

Many of the patients I see coming in for information on breast reduction surgery are overweight. In today’s blog post I am going to discuss how being overweight can affect breast size, and whether or not you should lose weight prior to considering surgery. Let’s break it down into several commonly-asked questions:

  • Will my breasts be smaller if I lose weight?  Maybe, maybe not. Breasts are composed of both fat and glandular tissue. Younger women tend to have more glandular tissue, whereas older women tend to have more fat. If you lose weight, the amount of glandular tissue does not change, so if your breasts are largely glandular tissue, you won’t see a dramatic size decrease. In addition, everybody loses and gains weight differently. I tend to gain weight in my hips and thighs, whereas another person might gain weight in her stomach. So losing weight in and of itself is no guarantee that your breast size will decrease.
  • What if I lose weight after I have breast reduction surgery? The answer to this question is similar to the question above. You may or may not see a decrease in breast size if you lose weight. The more weight you lose, the more likely you are to see a change in your breast size. An if your breasts do decrease in size, they can become droopy (ptotic). I generally recommend to my patients that if they are planning on losing more than 25-30lbs, they should try to do this prior to having breast reduction surgery.
  • What if I’m happy at my current weight, even if I am overweight? We all have dreams, er… goals, of losing that last 10, 15, or 20lbs right? If you are considering breast reduction surgery, ask yourself honestly if you have a plan of losing weight, or if it’s just a dream. It’s okay to be happy at your current weight. But my goal as a surgeon is to perform a safe operation and minimize the risk of complications, and a patient’s weight does affect the risk of complications. A study published in Plastic and Reconstructive Surgery looked at the number of complications after breast reduction in 675 patients. They noted a significant association between body mass index (BMI) and complication rate. This complication rate increased significantly when BMI was 35.6 or larger.

In my own practice, I balance the risks of surgical complications with the benefits a patient is likely to obtain from having a breast reduction. I often ask patients with a BMI>35 to lose weight prior to surgery, especially if they have other risk factors such as diabetes or a history of smoking. There are no hard and fast rules regarding weight, but understanding a patient’s weight loss goals is an important part of the surgical decision-making process.

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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.