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Welcome To Dr. Aston’s Blog

Within this regularly updated feature of my website, I will provide visitors with practice news and specials, as well as information regarding the most recent technological advances and new treatments in plastic surgery.

I believe that patient education and open communication with your doctor are the keys to achieving healthy, aesthetically-pleasing results and patient satisfaction, which is why I strive to provide the highest quality of care for patients of all ages. This is done by combining technical skill and broad experience with cutting-edge technology for impeccable medical and cosmetic results.

I sincerely appreciate you taking the time to visit my new blog. Please check back often to learn about the latest news, updates, and additions to the practice and within the field of plastic surgery, and feel free to post comments and/or suggestions on any posts that you find of interest.

 

More QA From The Doctor Radio Show!

I am posting some questions from my SiriusXM Channel 81 Doctor Radio Show from August 12, 2014. There were great questions that were called in from our listeners all over North America. The questions have a broad appeal, as I hear many of these questions on a daily basis in my practice. Therefore, I thought it would be good to share some of the Q&A with you! My next show is Tuesday, September 23rd from 6-8PM. Please tune in!

Q: What is the most popular non-surgical procedure for the face?

A: Botox injections are the most popular non-surgical procedure for the face. It is primarily used to reduce frowning and crows feet. When properly administered it does an excellent job in both of those areas.

 

Q: How do the eyebrows become too low in patients who have had Botox?

A: There is only one muscle that raises the eyebrows. It’s called the frontalis muscle. It is the muscle that causes the creases across the forehead. If that muscle is completely paralyzed with Botox injections the eyebrows don’t have a muscle to hold them up and therefore they become too low. In my opinion, eyebrows that are too low are just as much, if not more, of a distraction from a good aesthetic appearance as creases on the forehead. The creases on the forehead can be reduced with the proper amount of Botox, but the forehead should not be completely paralyzed.

 

Q: Is Vanquish a safe procedure, what are its costs, and does the fat return?

A: Vanquish is a device that uses radiofrequency to target fat cells. It is especially good for the abdomen and love handles. It is a non-surgical procedure that is usually conducted in four 30-45 minute sessions 1 week apart. It is possible to do 2 sessions in 1 week. Most patients report a decrease in the thickness of their fat, which tends to be noticeable by the third treatment. The final result is seen 3 to 4 weeks following the 4th treatment. The result with Vanquish is not comparable to liposuction, but it is a non-surgical option for fat reduction.

 

Q: Does Botox help to eliminate the deepness of 11 lines, or is filler necessary to eliminate the grooves?

A: Most people can be significantly improved with Botox injections to treat the depressed lines that occur from frequent frowning. Most people are not even aware that they are frowning and not only when they are unhappy but in routine daily activities and normal conversation. When the corrugator muscles and the procerus muscles are blocked with Botox injections the depressed lines become less deep and over time they improve even more. When the creases have become very deep then a small amount of a filler substance, most often Juvederm or Restalyne, will help bring the depression up to a level with the skin. Occasionally it’s necessary to put a small amount of filler in the creases again many months later. The most important injection is the Botox to stop the movement of the muscles.

 

Q: Is an internist an appropriate person to go to for Botox?

A: There are no State or Federal regulations that limit the medical procedures that an individual with a medical degree can perform. In other words, a doctor who has been trained in any specialty is permitted by law to perform Botox and filler injections. In general, one would anticipate a better result when procedures are performed by someone who has had training and extensive experience.

 

Q: Do injections (Botox, Juvederm) hurt?

A: Both Botox and Juvederm are injected using a small needle. They do hurt to the extent that a small needle puncture is uncomfortable. Some patients like to have a topical anesthetic put on the skin prior to the injections. This will reduce the small amount of discomfort. The vast majority of my patients are busy and want to have their injections and go. The number of sites of injection will play a role in the amount of discomfort one will have. Botox injections for the 11 lines between the eyebrows and crows feet take approximately 4 minutes. Filler injections are slightly more uncomfortable, but only approximately 25% of patients want numbing cream.

 

Q: The skin under the eyes is very thin, and was injected with a hyaluronic acid. (Restylane, Juvederm, Belotero) One eye was fine; the other eye had migration and lumpiness. What can prevent this? And what can fix it?

A: Hyaluronic acid is injected into a larger volume or close to the surface under the skin. It can cause puffiness and a swollen look to the lower eyelids. Most often this goes away. It’s important that the injector knows exactly where to put the fillers. When this occurs it can be eliminated by injection of hyaluronidase, which will break down the hyaluronic acid, and almost an immediate improvement is seen.

Doctor Radio Show On SIRIUSXM Channel 81 QA

We had a number of great questions that were asked on The Doctor Radio Show, SiriusXM Channel 81 last Tuesday, July 15th. I have decided to share some Q&A from the show on my blog.

Q: WHAT IS THE BEST COURSE OF ACTION FOR STUBBORN FAT DEPOSITS THAT DO NOT DECREASE WITH DIET AND EXERCISE?

A: Liposuction is generally considered the number one treatment for fat deposits that do not respond to diet and exercise. The goal of liposuction is to remove isolated accumulations of fat. Liposuction is not a treatment for generalized obesity. Vanquish, a non-invasive procedure which uses radiofrequency reduction of fat & Cool Sculpt, which is an actual freezing of the fat cells are two alternatives to removing areas of fat. Approximately 20% of the amount of fat one would remove with traditional liposuction.

Q: WHICH HAS LESS RECOVERY TIME? TRADITIONAL OR SMART LIPOSUCTION?

A: The recovery time from traditional liposuction vs. smart liposuction is essentially the same. Recovery time depends on how much fat needs to be removed. It is usually not a long drawn out recovery, even when large amounts of fat are removed.

Q: WHEN IS THE BEST TIME TO HAVE A BREAST AUGMENTATION AFTER BREAST FEEDING?

A: It is important to wait 6 to 12 months following breastfeeding before breast augmentation. This permits the breast tissue to get over the stretching of the tissues that incurred during the breastfeeding process. In addition, there is frequently atrophy of the breast tissue following breastfeeding and the true size of the breast will not be seen until 6 to 12 months following breastfeeding.

Q: ARE THE RESULTS OF FAT AUGMENTATIONS COMPARABLE TO TRADITIONAL BREAST AUGMENTATION?

A: The short answer is, no. There are some very good results seen without augmentation of the breast, but the long-term effects of fat injections are yet to be determined. In addition, a certain amount of the fat will disappear over a period of 6 to 12 months following augmentation. Frequently patients requesting breast augmentation do not have a significant amount of fat on other areas of the body that can be used to augment the breast to the desired size. Traditional breast augmentation gives an excellent result with only an hour and a half of surgery. There is a great choice in breast size and contour that can be established.

Q: AT WHAT AGE IS APPROPRIATE FOR A TEENAGER TO HAVE A RHINOPLASTY?

A: A large number of teenagers have rhinoplasty between 15 and 18 years of age. Females usually develop earlier than males and it is safe to perform a rhinoplasty once a female is having regular menses. Males develop slightly slower and a large number of rhinoplasty procedures in males are performed between 17 and 19 years old.

Q: WHAT DO YOU LOOK FOR WHEN RESEARCHING A SURGEON TO PERFORM A RHINOPLASTY? SHOULD I LOOK FOR A SURGEON THAT HAS DONE A LOT OF NOSES?

A: All cosmetic surgery is a combination of art, science, and surgery. An experienced surgeon counts a great deal in the aesthetic decision-making process and judgment required for aesthetic surgery procedures. Rhinoplasty is one of the most complicated procedures performed. You want to look for a surgeon that has a great deal of experience with rhinoplasty.

Check back soon! We will be answering more questions shortly as a continuation of our Doctor Radio blog series! Don’t forget to tune in LIVE for the next show on Tuesday, August 12th from 6-8PM EST. Feel free to call in: 877.698.3627 or email: docs@siriusxm.com

American Society For Aesthetic Plastic Surgery (ASAPS) Releases Its 2013 Plastic Surgery Statistics Check Out The Highlights Below!

* There were over 11 million surgical and nonsurgical cosmetic procedures performed in the United States in 2013.

* From 2012 to 2013, there was a 6.5% increase in the total number of cosmetic surgical procedures, with almost 1.9 million surgical procedures performed this past year.

* The most popular surgical procedure in 2013 was liposuction with 363,912 procedures performed; a 16% increase compared to 2012. Breast augmentation was the second most popular procedure with 313,327 procedures performed, down 5.2% from 2012.

* Buttock augmentation and labiaplasty, which have not previously been considered popular took the top spots for the most significant increases in the number of procedures performed over the course of a one-year period with buttock augmentations in the lead at 58% and labiaplasty coming in second at 44%.

* Top 5 Procedures of 2013:
1. Liposuction
2. Breast augmentation
3. Blepharoplasty
4. Abdominoplasty
5. Rhinoplasty

* Top 5 Nonsurgical procedures of 2013:
1. Botox
2. Hyaluronic Acid
3. Hair removal
4. Microdermabrasion
5. Photorejuvenation

* Women had more than 10.3 million cosmetic procedures, 90.6% of the total.

* Men had more than 1 million cosmetic procedures, 9.4% of the total.

* Americans spent more than $12 billion on cosmetic procedures.

* People age 35-50 had the most procedures in 2013 over 4.7 million and 42% of the total.

* The most common surgical procedure for people age 35-50 was liposuction.

The data listed above is a portion of the statistics reported by ASAPS. This report gives an overall view of cosmetic procedures in the United States.

Doctor Radio QA: Are Brazilian Butt Lifts Safe and Do They Last? What Are The Consequences?

Brazilian butt lifts are safe and they do last. However, the complication rate with butt lifts is higher than with other cosmetic procedures. Brazilian butt lifts are performed using Autologous fat injections, where the fat has been harvested or removed from another part of the body. Silicone buttocks implants can be used when the individual does not have an adequate amount of fat to use for the augmentation. Some patients receive a combination of the silicone implants and Autologous fat to give the best contour and fullness. As with all aesthetic surgery procedures, it needs to be performed by someone with a great deal of experience.

More QA From Doctor Radio!

What are the consequences and changes on the breast after breast augmentation: Following breast augmentation, the breast will continue to age just as they would normally age. There is no evidence of breast implants that cause cancer or any other breast disease. One can breast feed following most breast augmentations if one is in the breastfeeding age range. Mammograms require special x-ray views in order for the radiologist to get the maximum visualization of the breast tissue. This is a normal process for most radiologists performing mammograms, as there are millions of women with breast implants. Fibrous capsular contracture is a possibility following breast augmentation, although the incidence is very low with the silicone gel implants and saline breast implants that are used today. It’s appropriate that the breast implants be an appropriate size for the individual’s body frame and their breast tissue. Excessively large implants can cause thinning and distortion of the breast tissue.

More QA From Doctor Radio: What Is A Forehead/Brow Lift? Is It A Seperate Procedure From A Facelift?

A forehead /brow lift is not part of a facelift procedure. A facelift procedure essentially lifts from the collarbone to the corner of the eyes. A forehead /brow lift is a separate procedure.

There are different ways to perform a forehead/brow lift:
1.) Endoscopic Brow Lift: Several small incisions are used and the work is done under the skin with an endoscope.

2.) Coronal Brow Lift: Requires an incision across the top of the scalp.

3.) Anterior Hairline Incision: Which is useful when lowering of the hairline is indicated.

The surgeon evaluates each patient and determines which technique will give the best result for the individual. With the variations in technique that are available, it’s not necessary to have a major distortion of a hairline. Most people who have a forehead/brow lift that is performed correctly do not show obvious signs of having had the procedure.

SIRIUSXM 81 Radio Show QA From The February 11th Show

A number of topics were discussed on my SiriusXM Doctor Radio Show on Tuesday, February 11th, which I think making interesting content for this blog. The show started with an article from The London Observer, by writer Eva Wiseman on February 8, 2014, addressing the question, “IS COSMETIC SURGERY NOW A NORMAL PART OF MODERN LIFE”? Cosmetic surgery has become a part of everyday life for a huge number of people around the world. Cosmetic procedures are no longer just limited to celebrities and those who are finically well off. Lasers, fillers, neuromodulators and other non-invasive procedures help people long before they need a surgical treatment. The age range of people undergoing cosmetic procedures has dropped significantly with more individuals interested in maintenance of their appearance and prevention of the more obvious signs of the aging process. For many seeking help, a surgical procedure is the only way to get a significant improvement. Many surgical procedures today are minimally invasive with faster recovery times.

The following slightly paraphrased questions are from callers listening to the show:
Question: I HAVE SOME FAT UNDER MY CHIN AND LOOSE SKIN HANGING BUT I DON’T WANT A FACELIFT. CAN THIS BE CORRECTED WITHOUT A FACELIFT? Answer: If there is a significant amount of loose skin under the skin it will require a facelift for a great result. Some males who have a large, turkey gobbler neck will benefit from local excision of skin and fat on the front of the neck, but this will leave a vertical scar that is visible on close observation. Some men are only concerned about the heaviness of the front of their neck and are willing to have an incision if the excess fat and skin is eliminated. This is usually not a good procedure for a female.

Question: DO YOU NEED AN INCISION UNDER THE CHIN WITH A FACELIFT?
Answer: If a patient has large muscle bands on the front of the neck an incision is necessary under the chin in the transverse skin crease in order to work directly on the muscle bands. With the direct approach to the muscle bands (very large cords on the front of the neck) can be eliminated. Individuals without muscle cords on the front of the neck do not need an incision under the chin. When an incision is made under the chin, it is made in the skin crease in such a way that is usually not visible.

Question: WHEN CAN I HAVE PLASTIC SURGERY AFTER BARIATRIC SURGERY? IS THERE A TIME THAT ONE NEEDS TO WAIT?
Answer: Patients having bariatric surgery should lose all of the weight that is indicated in their particular case and be stable in that weight for approximately six months prior to having surgery to eliminate loose and hanging skin. The sequence of body contouring procedures to remove loose and hanging skin following massive weight loss will depend on the needs and desires of the patient and the order in which the plastic surgeon thinks its best for the individual.

Question: WILL A BREAST REDUCTION REDUCE PAIN IN THE UPPER BACK AND GROOVES ON THE SHOULDERS?
Answer: Patients with large pendulous breasts often receive significant improvement in pain and discomfort in the upper back. The pressure from heavy breasts on bra straps can be significantly reduced. Of course, not all back pain is caused by heavy breasts, but it’s a frequent symptom and complaint of those requesting breast reduction surgery.

Question: I HAVE A STENT IN MY RIGHT CORONARY ARTERY DUE TO A CONGENITAL NARROWING OF THE VESSEL. I WANT TO HAVE A BREAST REDUCTION, BUT I NEED TO KNOW IT’S SAFE TO UNDERGO A PROCEDURE.
Answer: A single isolated stent in a coronary artery is not a contraindication to elective surgery. However, a complete workup and evaluation is mandatory in order to determine there is no underlying cardiac disease and there is no further coronary artery narrowing. The person needs to be evaluated and cleared by their cardiologist. The overall lifestyle and activity level of the individual, as well as a number of other factors, are important in the final decision-making process. Essentially a single coronary artery stent with no indication of any further heart disease, in my opinion, is not a contraindication to an elective surgical procedure.

Question: MY WIFE IS 55 AND WANTS TO HAVE A BREAST LIFT AND ABDOMINOPLASTY. SHE IS HEALTHY AND EXERCISES A GREAT DEAL. IS 55 YEARS OF AGE A GOOD TIME TO HAVE THESE TWO SURGICAL PROCEDURES AND CAN THEY BE DONE TOGETHER?
Answer: Breast lift and abdominoplasty is part of the combination of procedures that plastic surgeons call the, “mommy-makeover.” 55 years of age or earlier is an excellent time to these procedures for the motivated individual. Sagging breasts can be lifted and shaped to a much more youthful appearance. Elimination of hanging abdominal skin and repairing bulging abdominal muscles can significantly change the clothes an individual wears and elevate their self-esteem.

Question: IF YOU HAVE LIPOSUCTION WITH REMOVAL OF FAT FROM ONE AREA OF YOUR BODY, DOES IT COME BACK IN ANOTHER AREA?
Answer: No. It’s impossible to gain weight if one burns up as many calories as consumed. Following liposuction, it is possible to gain weight if one is eating too much. A significant number of fat cells are removed from an area undergoing liposuction. If one is gaining weight and there are a large number of fat cells in other areas than those fat cells can expand in size. It is possible to enlarge an area that has undergone liposuction if one eats too much. Liposuction is not a weight reduction procedure; it is a body contouring procedure. It is excellent at getting rid of genetically determined fat pockets. It’s also useful for removing fat in areas where an individual has gained weight due to an increase in calorie consumption. It is important that a person undergoing liposuction maintain a diet where the calorie load taken equals that burned.

Question: IS IT POSSIBLE TO CREATE DIMPLES IN THE CHEEKS?
Answer: In general it is not a good idea to create dimples in the cheeks. Unfavorable healing or scarring or changes with animation can result in a contour that can be unattractive and not considered an appropriate aesthetic result.