December 19, 2009

“Can I order BOTOX® and Restylane® on the internet and treat myself?”

BOTOX® and Restylane® are both excellent and useful products, as we have discussed in previous posts, but they are not over-the-counter products you can buy at a gas station or convenience store.  Like many medical treatments, they require specialized expertise to determine the best treatment and how to apply that treatment safely and effectively.

The reason you can’t buy BOTOX® and Restylane® yourself is not because these are considered dangerous products – by all standards they have proven themselves to be very safe.  But just as you do not draw your own blood at home for a routine medical checkup and instead go to a safe, clean facility to receive help from experts who have many resources at hand, it is a very bad idea to perform such a delicate procedure on yourself, especially without training, education, and years of experience.

Unfortunately, a few poorly-administered BOTOX® cases have undermined many people’s trust in a procedure that can help them cosmetically and medically, and these cases are usually the result of either an unusually inexperienced person like a technician or assistant administering the procedure instead of a doctor or someone shopping around until they find a doctor willing to do whatever they ask even when they want procedures that are not right for them.

But Don’t I Know My Body Best?

You are probably familiar with your own body and its uniqueness in ways no one living outside your body can feel without experiencing it themselves.  You also probably have a vision of what you would like to change.  These are not obstacles and do not contradict the role of your plastic surgeon.  Doctors study the latest technology, research, and treatments for many years in a highly competitive environment and they learn not only about anatomy and healing, but also what to do in rare instances of complications, and how to individually approach each case in ways that may not be obvious to the layperson.  Beyond this they complete residencies, fellowships, research projects, and professorships.  Add to this years of practical experience in the field working with actual patients, and they have now obtained a wide body of knowledge that is impossible to learn by reading an article (or even several articles!) online.

When doctors emphasize the importance of working with a qualified professional instead of relying on self-diagnoses and home remedies, they mean that it’s optimal to bring your concerns to a doctor who will listen to you and consider all that you have to say so that doctor can provide honest feedback about technical and clinical aspects of what you need, sometimes advising a solution that you may not even have been aware of as an option, or sometimes admonishing you against a procedure for health concerns of which you might not have been aware.  There are subtle differences in treatment approaches that require a physical examination along with a consultation, and this kind of insight cannot be gleaned from the internet, a numbered list of instructions, or even by looking in the mirror.

Sometimes one problem can look a lot like another that requires a different treatment – it’s vital that a physician help you distinguish these from one another.  Your doctor is not there to take control of your wishes, but to communicate with you so you both learn from each other in different ways and come to agree on the best course of action.  Your doctor will then act with the precision and knowledge that can only be derived from education, experience, and skill.

How Will My Doctor Understand Exactly What I Want?

By being careful to keep communication open, complete, and honest, you can get exactly what you need.  Keep in mind that it is your responsibility as much as your doctor’s to thoroughly discuss your needs, concerns, and medical history.  He or she will have a variety of approaches ranging from examining you to asking questions to discussing how you feel about different photos.  This way your doctor can get an accurate knowledge of your goals, and you can ask for your doctor’s advice and explain your concerns directly.  Your doctor also has the advantage of being able to spot patient requests that, based on experience, will likely lead to disappointment.  If you insist that an unadvised procedure be performed, you may be able to find someone who will do what you say, but you will likely regret this in the end and are better off talking to the doctor in more detail about your reservations and learning why he thinks one solution will work better than another.

Why Can’t I Create Perfect Results by Myself?

No doctor learns to administer a delicate procedure like BOTOX® and Restylane® injections by reading a simplified list of instructions or watching a five-minute video on a web page.  Bodies are more complex than that, as are the variations between individual bodies.  What lies under the facial skin is more complex than most imagine, with different kinds of tissues and many diverse muscles there, and it’s crucial to have a thorough knowledge of not only where these anatomical parts lie and how to work with or around them, but also how the thousands of components interact with each other.

You cannot simply eye your face and plunge in a syringe here and there until you think it looks good.  This is a great way to set yourself up for asymmetrical results and become one of those rare people who experience complications, like lumping, “frozen” features, or excessive bruising and swelling.  You could even end up giving yourself a complication completely unassociated with these products; for example if you don’t have training about stringent sanitation, you could cause an infection.  Further, it’s important to realize that, even though benefits can be immediate, the final results will not be seen right away because there will always be a certain amount of healing time.  Only a doctor who has closely observed and helped many people heal will understand how the results will change over the next few days and weeks will recognize the face’s optimal response during treatment.

What If I Can’t Afford It?

Usually when something sounds too good to be true it unfortunately is, especially in reference to intricate valuables carrying unbelievably low prices.  BOTOX® and Restylane® treatments are expensive.  The service of an expert cosmetic surgeon is not free and then the products are expensive.  It may be tempting to order Chinese Botulinum toxin or Restylane from a Canadian pharmacy.  The price may be enticing.  However, it is generally illegal to ship these products into the United States.  They may be confiscated and you may be subject to violating Federal import laws.  If your product does not get confiscated you may not get what you paid for.  Many of these products are counterfeit and contain adulterants rather than the medication they claim to be.  This is truly a buyer beware situation.   No ethical doctor will treat you will a syringe of products you bring into the office yourself.  The bottom line is that if you can’t afford treatment, you are better off not doing anything at all.  In fact, you will be much more likely to encounter larger expenses when you need your at-home experiment corrected by a specialized professional.

A Complex Treatment

BOTOX® and Restylane® treatments are not the same as giving oneself a “shot.”  If it were so easy, there would not be entire practices specializing in their optimal administration and so much research devoted to improving every detail of their use.  For example, Dr. Steinsapir invented the Microdroplet™ BOTOX® method which consistently yields remarkable results, and this is not something you can “pick up” online.  This minimally invasive procedure requires specialized skills.  Save yourself a potential disaster by ignoring anyone who claims you can do your own BOTOX® and Restylane® treatments.

Improvement through Individualized, Experienced, Professional Care

Dr. Steinsapir is a world leader in BOTOX® and Restylane® treatments, specializing in procedures that improve the face to restore a rejuvenated, natural look as non-invasively as possible.  He has pioneered inventions like Microdroplet™ BOTOX® and Deepfill™ Restylane®.  Call us today to learn more about Dr. Steinsapir’s Restylane and BOTOX® specializations.

December 15, 2009

Should I Get Perlane® or Restylane®?

Restylane® and Perlane® from Medicis, Inc. are both hyaluronic acid fillers made of sugar gels. It is common to ask which product is better.   The reality is that these are similar products with important differences.  Restylane® is a softer product that provides excellent volume, tends to stay where it is injected, but can be shaped well once placed in the tissue.  Perlane® is also a soft product that provided slight better volumizing, tends to stay where it is injected, and resists shaping more than Restylane®.

Each product has a somewhat different role in facial volumizing.  The right choice for you very much depends on your issues.  This is best determined by an individual consultation with a highly qualified cosmetic surgeon.  Here are some general guidelines and common usages that can give you an idea of when each filler tends to be appropriate, but individualized treatment never takes a one-size-fits-all approach and diagnosis and treatment planning must be done in person.

Before and After: Restylane, Botox and Perlane by Dr. Steinsapir

Before and After: Restylane, Botox and Perlane by Dr. Steinsapir

What’s the Difference between Perlane® and Restylane®?

Both Perlane® and Restylane® are fillers that work especially well when volumizing the face to give it a softer, more youthful look and restore hollow and deflated areas.  Perlane® is a thicker material than Restylane® and it usually lasts a few months longer.  This is an amazing length of time as Restylane can be effective for a year or more.  Restylane® usually works better for the sensitive area under the eye where the skin is thin and there is little fat.  The ability of the Restylane to be readily shaped once it is placed in the tissue means that many potential irregularities can be resolved as the material is placed.  For the same reason, Restylane is also excellent at the lip edge.  Elsewhere in the face, there is much better tissue coverage for the placement of the slightly thicker Perlane®.

Perlane® has a larger molecular structure that Restylane and as a results it is a somewhat better volumizer than Restylane®.  It is preferred in areas like the cheeks, eyebrow, chin, and the tissues around the mouth called the perioral area. Why does it work best in these areas?  Because these areas have more fat to work with than the lower eyelid dark circle.  Perlane®’s thickness necessitates that it be placed deeper than Restylane®, while Restylane® works very well near the surface of the skin and in areas where little fat is present.  Perlane® is wonderful for adding volume to places with more fat under which a doctor can place this filler.  It is less ideal for the lip edge and under eye area where the Restylane serves as a better choice.

Because of both their similarities and differences, Restylane® and Perlane® can be used together to improve the facial aesthetics by eliminating unsightly angles, sunken features, and haggard looks.  For example, Perlane® can be placed in the top of the cheek at the time that Restylane® is used to treat the dark circles in the lower eyelid hollows.  Both of these actions are beneficial in themselves, and when used together they amplify the improvements even more.

What If I’m Unhappy with My Results?

These services are the fastest growing cosmetic services because of how happy people are with the results.  Yet service is not a magic wand and it is sometimes necessary for a treatment to be adjusted.  First make certain that your doctor is aware of your concerns.  If you are having an issue, don’t simply wait until your next visit.  It is a good idea to contact your doctor and let them know what is going on.  There is often a great deal of value in being seen early if there is some issue.  By consulting with your doctor after a procedure, these issues can be readily addressed.

Unlike other fillers, hyaluronic acid fillers like Restylane® and Perlane® can be adjusted after treatment to resolve any surface irregularities that might be present after treatment.   In fact, it is possible to modify these treatments even if it has been quite some time since you were treated.  Over time, these products are absorbed by the body and eventually disappear over a year or two.

Seeking the Right Doctor

Dr. Steinsapir specializes in improving the face in both aesthetic and medically necessary situations.  As a specialist he has some of the highest levels of experience in addressing concerns about the face, including how to best apply fillers like Perlane®.  In fact, Dr. Steinsapir has served as a physician consultant to Medicis, Inc., who distributes both Perlane® and Restylane®, and he is considered among the top 3% users of these products.  He is thought to have the largest under eye filler practice in the World.  Call for a consultation to find out if you are a good candidate for Perlane®, including whether it will improve upon another procedure or could be combined with Restylane® treatment.  Dr. Steinsapir approaches everyone as an individual, customizing treatment to each person’s needs.  Contact us today to find out how he can customize treatment for you.

December 11, 2009

Restylane: The Preferred Minimally-Invasive, Non-Surgical Facial Filler

Dr. Steinsapir regularly uses Restylane in his Los Angeles practice to correct dark circles under the eyes because it has demonstrated time and time again to be more reliable and produce better results than other fillers in most cases.  Restylane is usually a better choice than permanent under-eye filler because the skin and eyelid are very thin in this region.

Under Eye Circles Before and After

Under Eye Circles Before and After

Restylane is easily adjusted after treatment should an adjustment become necessary and it can be done in a non-invasive manner without surgery.  In the rare case that Restylane does not settle right, it can be easily adjusted with just a tiny injection of hyaluronidase, a safe enzyme that breaks down and softens Restylane.

It is unlikely there will be a complication because Restylane’s thickness keeps it from forming lumps the way other fillers sometimes do in the most sensitive areas.  If irregularities do occur, they can be adjusted using the hyaluronidase.  The thickness of Restylane keeps the filler in place in the lower eyelid and upper cheek regions so your results will be long lasting and remain natural looking.  After treatment, Restylane is very effective and usually lasts one to two years.  Because the procedure only requires office based injections and can yields ideal results, many people choose to have periodic Restylane treatments rather than surgery.  What’s best for you will depend on your particular needs based on an evaluation by an experienced doctor.

Bruising

Most people, about 80%, do not experience bruising after a Restylane treatment; the other 20% experience some degree of bruising.  Most of them have mild bruising, but a very few (one or two in a hundred) will form a black eye.  The black eye takes two to three weeks to completely resolve, and this is a cosmetic concern without health dangers.  Considering that Restylane will last over a year, the recovery process is very mild and comfortable even for these few.  The few Restylane recipients who experience bruising usually feel that the short-lived bruise was worth the long-term results.  It’s a good idea to obtain treatment at least three weeks before big events like vacations and weddings just to be completely certain that your pictures will turn out great.

To minimize your risk of bruising, your doctor will ask you to stop taking certain medications that thin the blood, such as aspirin.  If you are taking anything prescribed by a doctor, we strongly advise that you consult with the physician who prescribed it before discontinuing the medication.  If your doctor suggests that you continue the medication, this does not mean that you aren’t a good Restylane candidate.  If you are willing to be at a slightly elevated risk for bruising, Restylane can fill in the hollows under your eyes very effectively.  Your regular doctor and your cosmetic specialist can help you decide the best route to take.

What If I’m Pregnant or Breastfeeding?

There is no foreseeable complication that could be caused by Restylane, a naturally occurring sugar gel.  It has proven itself to be very safe.  The problem with using it to treat pregnant and nursing women is simply that we have no clinical information regarding the safety of this product in pregnancy and during lactation.  Could Restylane cause a problem for your baby?  This is unlikely.  The sugar gel in Restylane occurs naturally in the body.  Many medications and treatments are not advised for pregnant and breastfeeding mothers simply because they have not been tested, and probably will never be – this does not mean that they’re not safe.  It simply means that ethical practitioners recommend that you don’t take any chances when it comes to untested situations.  We recommend you wait until you wean your baby before undergoing cosmetic procedures.   Fortunately, babies do not nurse forever, so you won’t have to wait too long for the long-lasting benefits of Restylane.

My Eyes Are Sensitive.  Can I Still Benefit from Restylane?

This may sound paradoxical, but depending on the sensitivity you may be especially qualified for Restylane.  If you have allergies, the likelihood of a reaction is extremely small but not quite zero (there is always some risk of a reaction to any medical procedure that introduces something new into the body) and can best be assessed by an oculoplastic surgeon.  If your eyes are sensitive to things like hay fever, for example, and they become irritated or red easily, this aggravation may accentuate the hollows under your eyes.  If you know you are prone to this appearance, a filler like Restylane will be very helpful, because during times of sensitivity, your eyes will look much better with treatment than without it.

Recovery Time

Many of Dr. Steinsapir’s patients resume their normal activities just after leaving the office.  If you don’t bruise, there will be about thirty to forty hours during which you experience minimal swelling.  Many patients, both men and women, can hide this swelling right away with a camouflage makeup that matches their skin color.  If your lower eyelid skin quality is poor and you often collect a small bag of puffiness under the eye, the doctor may counsel you regarding the need to consider a procedure like a chemical peel or surgery prior to getting regular filler treatments so that you don’t experience prolonged recovery after each filler service.  This can be discussed when you have your initial consultation.

Can I Combine Restylane with Another Procedure?

Yes.  Restylane can be safely combined with many procedures.  Discuss your concerns with your physician.  He or she will advise you about which procedures compliment Restylane treatments.  Your doctor may advise you to come in on another day for certain procedures that are especially sensitive to changes in the treatment area, but there are many cases when Restylane can be appropriately combined with another procedure at once.  Restylane is a simple outpatient service that can be done while you’re fully awake in the office after numbing cream has been applied to the treatment area.

Consult with a Doctor Who Cares

Dr. Steinsapir invented and published the Deepfill™ method for placing Restylane®. Deepfill™  method is used by thousands of doctors around the world to inject Restylane® safely in the under eye area.  This method adds precision and certainty to the placement filler in this location making this minimally invasive method a true alternative to lower eyelid surgery for many people.  Dr. Steinsapir is one of very few cosmetic surgeons who dedicate a major focus of his practice to treating dark circles and under eye hollows, making him particularly experienced and qualified as a specialist.

Contact us today for a personalized consultation with a caring physician who individualizes each treatment based on your specific concerns.

December 9, 2009

Am I A Candidate For Asian Double Eyelid Surgery?

“Double eyelid” is applied to describe Asian eyelids where there is a defined upper eyelid fold above the eyelashes with and exposed eyelid platform.  There is great variation in eyelids and not every eyelid has a double fold.  The fold is created by a crease at the top of the eyelid platform under the fold.  This crease represents a defined attachment between the eyelid skin and the tendon that raises the upper eyelid.  The Double fold creates definition in the upper eyelid and it is generally considered desirable in both men and women.  For women, the defined platform also creates a protected place to apply make up and further beautify the eyes.

Asian Double Eyelid Surgery Before and After

Asian Double Eyelid Surgery Before and After

Will Asian Double Eyelid Surgery “Westernize” My Eyes?

Double eyelid surgery is not about westernizing the eyes, which is a common mischaracterization.  Both the double eyelid and its absence are common in Asian people.  Some people who don’t have a double eyelid wish to obtain one, but they worry that this means they have to “westernize” their appearance.  This is not an accurate depiction although this was how the surgery was characterized in the past and is sometimes described in articles where the writer does not understand the purpose of the surgery.  Double fold surgery aims to create a natural appearance by creating a well defined upper eyelid fold.  This is accomplished by creating a low crease and removing a small amount of skin, while leaving the rest of the eye’s natural appearance intact.  Unfortunately, there are practioners who make the crease too high and take too much skin and this type of poorly designed surgery can harm the appearance.   The key is to go to an very experienced eyelid surgeon who has thoroughly mastered the procedure and understands what needs to be accomplished.  The goal is the conservation of normal eyelid structure while providing complementary eyelid definition in accordance with what you desire your eyes to look like.

Creating a Double Fold

There are two basic ways to create a double fold.  Suture methods are common in Asian countries and utilize temporary stitches to that make an upper crease.  The threads always eventually fail, which means that they are not the best option for those seeking permanent.
In double eyelid surgery, the doctor removes some tissue to form a defined crease in the eyelid at the top of the eyelid platform.  It is a critical goal of the surgery to maintain the essential Asian character of the upper eyelid while at the same time adding an eyelid crease to form a defined upper eyelid fold.

Many of these surgeries can be performed in the office under local anesthesia.  Recovery is about 10 days before all bruising and most noticeable swelling has resolved.  Most stitches are removed at 1 week for most individuals three tiny stitches are left at the crease for about 3 weeks to help make a permanent crease.  By about 10 days after surgery most people will not be aware that you just had surgery.

What If My Eyes Are Small?

An eye’s size is usually measured by how much of the white area, otherwise known as the sclera, can be seen.  Eyes that appear small may be the result of upper eyelid ptosis, or “droopy” lids, or they may mean you have deep set eyes.  Depending on your condition, the surgical approach will vary.  Often the double eyelid surgery makes the eyes appear larger by adding definition and naturally framing the eye with aesthetic contours.   As always, the best approach is a flexible one that relies on a careful physical examination and weighing the options to choose the best method.  There is no standard surgery or procedure for small eyes – surgery must always be adapted to the individual circumstances.

What about My Other Asian Eyelid Concerns?

If you are worried about other issues including asymmetry or a tired look, these are again best addressed on an individual basis.  All aesthetic reconstructive eyelid surgeries must be tailored and adapted for the unique characteristics of your eyelid.  For this reason, it’s best to find a doctor who specializes in eyelid treatment and who has helped people with widely varying eyelids obtain the best possible results.  There are certainly procedures besides the double eyelid surgery that may be right for you and a doctor who understands the anatomy and variations in Asian eyes will be able to help.

Taking the First Step

Now that you know a bit more about double eyelid surgery and Asian eyelid surgery, call for a consultation rather than try to make sense of all the information and misinformation on the internet.  Remember, a consultation does not obligate you to go through with any procedure, and it will give you an excellent opportunity to seek personalized advice from an experienced professional.  As a specialist, Dr. Steinsapir has extensive experience with oculoplastic surgery and has helped many people obtain their desired results.  Contact us today for an individualized approach that will help you realize your personal goals.

How Can Lower Eyelid Surgery Improve My Puffy Eyelids and Under-Eye Circles?

In our last post, we discussed upper blepharoplasty or upper eyelid cosmetic surgery and its benefits in solving particular cosmetic concerns. Lower blepharoplasty or lower eyelid cosmetic surgery (also known as lower lidlift) has its own set of indications and can vastly improve many lower eyelid or under-eye problems. By removing excess fat, skin, or both on and around the lower eyelid, lower eyelid surgery can eliminate bags under the eyes by correcting problems caused by excess and unsightly skin, muscle, and tissue.

Lower Eyelid Surgery Before and After

Lower Eyelid Surgery Before and After

Transconjunctival blepharoplasty, or tranconjunctival lower eyelid surgery, is the preferred lower eyelid procedure, although what is best for you depends on your particular situation. Transconjunctival blepharoplasty improves the contour of the lower eyelid by correcting herniated orbital fat trapped beneath the eyelid, causing a ‘puffy’ look. This approach uses an incision made behind the eyelid to avoid scaring the eyelid skin or altering the eyelid margin. With an incision from behind the eyelid, unwanted results can be more easily avoided with the utmost precision. Removing this excess fatty tissue will give you a softer, more alert and interested appearance.

Often the puffy lower eyes are confounded by two problems: as previously addressed, excessive herniated orbital fat under the lower eyelid gives this area an inflated look, while the sagging of the cheeks caused from age, stress, or genetics creates a hollow that exaggerates the appearance of swelling or circles under the eyes. Having both these concerns simultaneously means that each problem exacerbates the other; hollow under-eyes make the lower eyelids look even more overly full, while full eyelids makes the under-eye hollows stand out. This compounded problem can be resolved with a procedure called arcus marginalis release, which takes the transconjunctival blepharoplasty one step further. The lower eyelid fat is used to make a living fat graft with its own blood supply. This pedicle of tissue is rotated into the top of the cheek where there is hollowness. This is done through a small incision at a condensation of tissue known as the arcus marginalis. The acrus marginalis release corrects problems of both excessive eyelid fat and the hollow or circle that develops in many of us at the top of the cheek in a single procedure with no skin incision. Like other forms of fat transfers, this procedure is very safe because the body cannot reject its own natural cells. However, unlike other fat transfer procedures that need to develop their own blood supply, the fat from the lower eyelid already has its own blood supply making this transfer of volume highly dependable.

During a lower eyelid procedure, your surgeon’s goal is to correct these problems and aim for a natural, symmetrical look. Your surgeon will take care to remove and/or transfer just the right amount of fat, taking special care to not remove too much, because it is easier to remove more fat later than add it back.

The lateral canthal angle, which is the outer eye corner, may be used as a point of access to perform different procedures. If you are dissatisfied with your lateral canthal angle, this may be a good time for the surgeon to improve it. Dissatisfaction of this anatomic feature is usually caused by prior eyelid surgery. With canthoplasty the surgeon can tighten the lower eyelid and also reconstruct the lateral canthal angle adjusting unsatisfactory issues like a position that is too high or too low. By controlling the shape and position of this corner with precision, an experienced oculoplastic surgeon can attain the desired results.

Improved Methods

Years ago, it was popular to perform related procedures through an incision made just below the lower eyelid lashes. Unfortunately this method sometimes damaged the lower eyelid muscles and created scar tissue. The good news is that the introduction of transconjunctival lower blepharoplasty many changes associated with old style lower blepharoplasty can now be avoided. What does this mean for you? If you are worried about problems you’ve heard are associated with lower eyelid surgery, these are likely the results of older methods that are completely avoidable through more appropriate methods available today. Professionals like Dr. Steinsapir have extensive experience performing transconjunctival lower blepharoplasty, enabling them to obtain the desired eyelid improvement with a significantly reduced risk of complications.

Combined Procedures

Many eyelid procedures can be combine with other facial surgery such as a facelift or forehead lift. Most oculoplastic surgeries can be performed under local anesthesia or local anesthesia augmented with intravenous sedation. Dr. Steinsapir performs many of his surgeries at the UCLA Medical Center Outpatient Surgery Center. Many eyelid procedures can be performed under local anesthesia in the office setting. The doctor will discuss with you the appropriate setting for your surgery. Receiving a chemical peel at the time of lower eyelid surgery is often a fantastic option that will improve your results. Often lower eyelid wrinkles are the result of a combination of fullness and skin laxity. A chemical peel firms the skin and together with fat removal from surgery, the results is improved lower eyelid rejuvenation. A skin pinch is sometimes used as an alternative to the chemical peel in the right circumstance.

Personalizing Your Results

Because no one has eyes quite like your own, a one-size-fits-all approach simply will not do. This is why consulting a doctor who has worked on a diverse range of eyelids will be most informative and yield the best results. Dr. Steinsapir is such a doctor who has improved many combinations of eye concerns. He specializes in minimally invasive techniques and is exceptionally adept at performing corrective procedures. He has developed an number of surgical techniques and treatment methods. His specialization in treating the eyelids is supported by multiple fellowships, residencies, professorial positions, published papers, and of course extensive experience. Dr. Steinsapir never turns over his work to nurses or “physician extenders,” ensuring that you receive the best treatment possible. Contact us today for a consultation to discuss your specific concerns and learn how Dr. Steinsapir can help.

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