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.

Cosmetic Trends: Fads vs. Truths

There are articles and advertisements online, in print and on television every day talking about the latest device, product or technique that will get you fast results for cheap. This extends from the more extensive surgeries, like a facelift to smaller treatments like a facial or noninvasive laser. Most of the claims should be taken with at least a grain of salt, but some shortcuts and claims could lead to more serious complications like scars and the need for corrective surgery. If it sounds too good to be true, it probably is not true – exercise caution.

Beware of “New” Facials, creams and potions

Snails, bird poop, and gold are just a few things that have made headlines on ingredients for anti-aging treatments that focus on good skin care recently. Does any of that make sense to you?

Lunchtime Facelifts?

There are many ways to lift a face and some patients do well with a mini-lift with shorter incisions and a quick recovery, but most of this cannot be achieved over an hour lunch. Injectables and skin resurfacing treatments are more appropriate for that time frame.

Illegal injections!

Perhaps the most alarming trend is the increase in illegal injections of potentially toxic and unverified products from unlicensed individuals due to the popularity of buttock augmentations and Botox. It seems like there’s a news story every week about the arrests of these unscrupulous criminals who prey on vulnerable patients who do not have the resources and information to make better decisions. Make sure you see a surgeon that is certified by the American Board of Plastic Surgery.

I’ve Got To Do Something About My Face, But What?

Years ago, it was easy. You chose from a menu of forehead lift, eyelift, midface lift, cheek implants, rhinoplasty, facelift, chin implants and liposuction, which might be coupled with a skin resurfacing treatment. But now, almost each surgical procedure has a noninvasive counterpart to treat the same problem.

The marriage of technology and imagination has spawned a supermarket of noninvasive procedures that claim to iron out wrinkles, lift, chisel, plump and remodel. With a less expensive price tag and less downtime, the issues related to noninvasive procedures boil down to: “What results and how much longevity can I get from noninvasive treatments?”

Though the surgical options are more expensive, the nonsurgical treatments will need to be repeated, so it is up to you to do the math. Here is a sampling of some of the surgical facial procedures and their noninvasive counterparts that are currently available:

Brow Lift or Botox?

Surgical. A brow lift, also called a forehead lift, corrects skin wrinkling and drooping that causes your eyebrows to sag and excess skin to hood your upper eyelids. It can soften the deep creases across your forehead and reduce the horizontal frown lines at the top of your nose and the vertical lines between your brows.

Nonsurgical. Botox and Dysport are neurotoxins that relax the muscles underneath the skin to prevent wrinkle formation. They are FDA-approved to treat the “elevens,” – those lines that form between your brows. They have also been successfully used to treat horizontal forehead lines, crow’s feet, tiny bunny lines on the side of the nose and can give your eyebrows a gentle lift.

Eyelift, Soft Tissue Fillers or Your Own Fat?

Surgical. Upper eyelid blepharoplasty removes the excess fat and sagging skin of the upper eyelids that can make you look tired or sad and corrects a puffy upper eyelid appearance.

Lower eyelid blepharoplasty eliminates under eye bags, excess lower eyelid skin and fine crepe-paper type wrinkles, dark under eye circles and lower eyelid droopiness. The result is a more alert and rested appearance.

Nonsurgical. Injections of Botox, Dysport or Xeomin can minimize Crow’s feet. When injected above the eyebrows, Botox or Dysport can also provide a ten-degree lift to the arch and a slight lift to the tail. To get rid of under eye depressions (bags), your plastic surgeon can inject your own fat or a hyaluronic acid, such as Restylane, into the area. An autologous fat injection (your own fat) usually lasts longer than hyaluronic acid, which will last up to a year.

Cheek Implants, Fillers, or Your Own Fat?

Surgical. Cheek implant surgery can make your cheekbones more pronounced and attractive, replace lost cheek volume (due to aging and weight loss) and fill in hollowed-out cheeks. Cheek implants vary widely in material, size, and shape and can be custom made to suit you.

Nonsurgical. Autologous fat is commonly used to build-up the cheeks. Your plastic surgeon can take fat from areas such as the belly or thighs and meticulously inject it into the cheek area. This is commonly used as an adjunct to facelift. Filler injections (Restylane, Perlane or Juvederm), or a collagen stimulator (Sculptra or Radiesse) are also great cheek enhancement options. In addition to balancing your face, injectable facial fillers will lift your cheeks to create a youthful appearance.

Rhinoplasty or Injectables?

Surgical. Rhinoplasty can reshape your nose to remove a nasal hump and reduce an enlarged tip. It can also improve the angle between your nose and upper lip. If your nose has drooped with age, rhinoplasty can lift it.

Nonsurgical. A Botox or Dysport injection in the divider between the nostrils can also lift the tip of your nose. Bumps on the nose can be minimized with injections of soft tissue fillers. In some patients, tissue fillers are added to increase nasal volume where desired.

Facelift or Injectables?

Surgical. A facelift can reverse the effects of gravity, tightening deeper tissues, firming up excess loose skin and addressing the volume changes that occur with aging. Liposuction can remove excess fat under the neck.

Nonsurgical. Injectable soft tissue fillers can be used to lift and diminish jowls, lift corners of the mouth, and minimize wrinkles, folds, and lines. Injections of Botox or Dysport can be used to make neck cords recede. Necklines can be softened with mini doses of hyaluronic acid fillers in combination with Botox or Dysport.

It is important to know what’s available so you can get more out of your plastic surgery consultation. Call 212-249-6000 for a consultation with Dr. Aston to discuss your options.

Why People Put Themselves Under The Knife: Psychologists Confirm Long-Term Positive Effects of Plastic Surgery

Psychology & Psychiatry In a long-term study, Prof. Dr. Jürgen Margraf, Alexander von Humboldt Professor for Clinical Psychology and Psychotherapy at the RUB, investigated the psychological effects of plastic surgery on approximately 550 patients in cooperation with colleagues from the University of Basel. Patients demonstrated more enjoyment of life; satisfaction and self-esteem after their physical appearance had been surgically altered.

The results of the worlds largest ever study on this issue are reported by the researchers in the journal Clinical Psychological Science. The aim of the research The researchers examined whether patients who undergo plastic surgery are systematically different from other people, what goals they set themselves before the surgery, and whether they achieve these afterwards. The researchers compared 544 first-time surgery patients with two other groups: on the one hand with 264 people who had previously wanted plastic surgery and then decided against it, and on the other hand, with around 1000 people from the general population who have never been interested in such operations. The desire for a better appearance for aesthetic reasons usually occurs in younger people with slightly above-average incomes.

Women represent 87 % of all patients who opt for cosmetic surgery. Overall, there were no significant differences among the three groups studied in terms of psychological and health variables, such as mental health, life satisfaction, and depressiveness. Most patients do not expect the impossible from surgery using a psychological instrument, the so-called Goal Attainment Scaling, the researchers examined what goals the patients wanted to achieve with cosmetic surgery. Alongside open questions, ten standard goals were offered, also including two, which were clearly unrealistic: All my problems will be solved and I’ll be a completely new person. Only 12 % of the respondents specified these unrealistic standard goals. In the open questions, the patients answered on the whole more realistically, expressing wishes such as to feel better, eliminate blemishes and develop more self-confidence.

Long-term improvements in psychological variables after surgery the psychologists tested the patients before surgery, as well as three, six and twelve months afterwards. On average, the participants claimed to have achieved their desired goal, and to be satisfied with the results in the long-term. Compared to those who had chosen not to have plastic surgery, the patients felt healthier, were less anxious, had developed more self-esteem and found the operated body feature in particular, but also their body as a whole, more attractive. No adverse effects were observed. Thus, the researchers were able to establish a high level for the average treatment success of the cosmetic surgery, also in terms of psychological characteristics.