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January 27, 2010

Can I have cosmetic surgery under local anesthesia?

Filed under: Cosmetic Facial Fillers, Cosmetic Surgery, Liposuction Beverly Hills, safe cosmetic surgery — Tags: , , , , , — admin @ 12:51 pm

You may be surprised to learn that many procedures like eyelid surgery, liposuction, facelifts, and others can be safely performed under local anesthesia with or without intravenous sedation.  Whenever possible, it’s usually best to choose local anesthesia instead of general anesthesia for several reasons:

1.    Local anesthesia is safer.
While cosmetic procedures today are overall considered extremely safe, it’s noteworthy to point out that in the rare cases of malpractice suits or death, most of these problems involve surgeries performed under general anesthesia.  For example, liposuction’s mortality rate when performed under general anesthesia is estimated to be between one in 40,000 cases to one in 5,000.  The actual figure is probably toward the lower end of that range, which means it’s extremely unlikely that you’ll be so unlucky, especially if you choose an experienced and reputable surgeon.  Then, when we look at the mortality rate for liposuction performed under local anesthesia, we find a mortality rate of only one in 300,000 cases.  The lesson to be gleaned here is that while both methods are very safe, the increased dangers of general anesthesia make safe local anesthesia a better option, so why take a chance?

2.    Local anesthesia enables the doctor and patient to communicate and obtain better results.
When the doctor and patient can communicate during the procedure, there is much to be gained.  If you are having eyelid surgery, for example, your surgeon can have you open and close your eyes so he or she can see exactly how your body is responding to the surgery and you can obtain the most precise results possible.  In cases like liposuction, your doctor will ask you to alert him if you begin to feel any mild discomfort.  This ensures that nearby tissues are not traumatized during the procedure.  If they are, you will be okay, but your recovery time will be longer.  When you are conscious, you can listen to your doctor and tell him or her exactly how you feel, which means your results will be more individualized than they would be if you are “out” under general anesthesia.

3.    Local anesthesia allows for faster recovery.
Fewer drugs means that you are less hung-over after surgery, so you return to normal much faster.  Going back to our liposuction example, the compression garments worn for six weeks after general anesthesia are only needed for five to six days after local anesthesia liposuction.  Since you are able to provide feedback to your doctor during surgery, the liposuction is accomplished with much less trauma which means a much faster recovery.

For these reasons, Dr. Steinsapir performs cosmetic procedures under local anesthesia whenever possible.  Cosmetic surgeries under local anesthesia often cost more than they would under general anesthesia because your doctor needs to spend more time working gently and delicately to ensure your absolute comfort.  The increased doctor-patient time does cost money, but this is also the reason why you heal so quickly and receive detailed treatment, along with fewer complications and health risks.

Which procedures can I have under local anesthesia?

This depends on your unique, individual health status and a personal examination.  Usually, those in good health can safely and comfortably receive most of the treatments we provide under local anesthesia.  Nonsurgical treatments like BOTOX, fillers, the chemical peel, and fotofacial of course are routinely administered under local anesthesia.  Cosmetic surgeries like the endoscopic forehead lift, facelift, midface surgery, liposuction, and eyelid surgeries are best performed under local anesthesia or local with intravenous sedation.  It is especially important to receive eyelid surgery under local anesthesia so your doctor can instruct you to open and close your eyes so that he or she can monitor and adjust the effects of the surgery for optimal results.

When is it best to have surgery under general anesthesia?

Generally procedures that are likely to run more than an hour benefit from sedation.  Body wall surgery including tummy tucks and breast surgery should be performed under general anesthesia.  Procedures that are likely to take more that 4 hours are often best performed under general anesthesia but this is something that should be discussed with the individual surgeon.

How do I find a doctor who will treat me under local anesthesia?

As always, we encourage you to be direct with your doctor.  Simply ask your potential cosmetic surgeon if he or she prefers to work under general or local anesthesia, and what he or she thinks will be best for you.  If your doctor prefers general anesthesia for you, find out why.  Is it because of your unique health situation?  Local anesthesia should be the default answer with general anesthesia functioning as an exception.  Yes, this will require your doctor to spend more time treating you, but in the end you will have peace of mind knowing that you’ll receive the safest care, as well as experience the fastest recovery time and the best results.

Dr. Steinsapir specializes in performing procedures that improve the face and body contours under local anesthesia.  He believes the extra time this requires is well worth the safer, superior results and satisfied recipients.  Dr. Steinsapir emphasizes the importance of minimally-invasive, detail-oriented treatments on a comfortable outpatient basis, while maintaining the expertise and safe resources needed for general anesthesia and inpatient treatment for individuals with unique health needs.  If you have any apprehension about anesthesia, Dr. Steinsapir can answer your questions, offer advice, and create solutions during your individualized consultation.  Contact us today to see how we can help.

January 21, 2010

How often should I get BOTOX and Restylane?

Filed under: Botox Los Angeles, Cosmetic Facial Fillers, Under Eye Restylane — Tags: , , , — admin @ 9:40 am

BOTOX and Restylane are both great solutions for those who wish to improve their facial appearance without undergoing surgery or invasive procedures.  We know them both to be safe,  comfortable procedures that are effective but not permanent.  If you are thinking about receiving treatment, you are probably wondering how often you’ll need it.  This is a great question that we will address in a moment, but first, please slow down and realize that you don’t have to decide right now how often you’d like to be treated or even definitively opt for any follow-up treatments.  We will give you some general guidelines, but exactly how often you’ll need treatment depends on individual circumstances and personal preferences.

Microdroplet Botox and undereye Restylane before and after photo

Microdroplet Botox and undereye Restylane before and after photo

Restylane, the preferred undereye filler for delicate areas like the undereye hollow, is long-lasting and typically retains great results for one to two years. BOTOX results generally last about four months and some benefits are still apparent after five months.  These are guidelines, not rules; results will vary based on your individual anatomy, treatment plan, and your own perception.

Ultimately, it’s up to you.

Dr. Steinsapir recommends a simple mirror test to his patients.  No, we don’t mean the one you may have heard of that instructs you to smile and look for lines (some lines, as previously discussed, are both natural and desirable).  This test is as follows: if you don’t notice anything issues in the mirror, then you don’t need further BOTOX or Restylane treatments at this time.  But if what you see starts to bother you – maybe you’re brushing your teeth and notice that you’re less satisfied with your appearance – then it’s time for retreatment.  This means that some patients come in to receive BOTOX treatment every two and a half months, because they don’t want to see a single effect wear off, while others come in merely once a year because they only just noticed an appearance they would like to treat again. We encourage you to find your comfort level and what makes sense for your personal goals.

I want precise guidance in scheduling my next treatment.

Perhaps you’re an actor, model, or just a busy mom; perhaps there’s another reason why you want objective advice about when to receive your next treatment.  Your doctor can help you decide how often you should receive treatment.  Objectively, it will probably be about once every four months for BOTOX, and once every year for Restylane.  Your doctor is a great resource for objective advice.  Your friends and loved ones may prefer to compliment you rather than give you honest feedback when you ask how your treatment is holding up.  If how others perceive you is a very important part of your treatment, discuss this with your doctor.

You can always modify your treatment plan later.

So relax!  If you are anxious about your first consultation or treatment because you worry that you might be “getting into more than you bargained for,” remember that you don’t have to sign away your life at a consultation, and a reputable, ethical practitioner won’t pressure you into signing up for some “blue plate special.”  BOTOX and Restylane are low-risk cosmetic treatments not only because of how rare complications are, but also because the results aren’t permanent.  Yes, they are effective, but you have no reason to worry that these services will “make you age faster.”  Few drugs are as well studied as BOTOX and the hyaluronic acid fillers like Restylane.  You may want to view your first treatment as a trial; if you like it, as most people do, then you can continue with treatments according to your needs as discussed with your physician.  If you don’t, then leave it at that.

A consultation, not a commitment.

It’s always wise to consult with a trustworthy doctor before committing to any treatment plan.  First, you need to find out if the procedure you have in mind is actually appropriate to your needs.  Then you of course must make sure you feel at ease with your potential cosmetic physician.  The reliable yet flexible nature of BOTOX and Restylane make these ideal products for anyone hesitant to make a permanent change, and they are also great for those seeking long-term treatments they can count on.

Dr. Steinsapir believes in natural Restylane and BOTOX results and in providing caring, honest feedback that is tailored toward your needs.  This means that you will never be pressured into more than you need or want.  At your individualized consultation, Dr. Steinsapir will ask about your goals and other personal circumstances to help you come up with the best course of action.  Remember to keep communication open with whomever you choose as your doctor to ensure that your needs are met at the times that are right for you.  Dr. Steinsapir meets with you personally for your consultation and, when you’re ready, personally performs your service, not a nurse or a technician.

Dr. Steinsapir is a leading practitioner of BOTOX and Restylane treatments.  He trained alongside the inventor of BOTOX and has since been helping Los Angeles BOTOX recipients achieve satisfying results.  He invented Microdroplet BOTOX and Deepfill Restylane methods.  Call us today for a consultation to learn how BOTOX and Restylane treatments can meet your needs through an individualized program.

January 6, 2010

Can I Use Off-Label Silicone Oil As a Facial Filler?

Filed under: Cosmetic Facial Fillers — Tags: , — admin @ 8:24 pm

The more important question is, should you use off-label silicone oil as a facial filler? You can certainly find someone, somewhere, willing to inject you with any substance for pay, but there is only one U.S. FDA-approved use of silicone oil injected into the human body, and that is to repair complex retinal detachments. This is a medically necessary case that prevents the recipient from going blind.

Technically, since physicians may use FDA-approved products for non-approved uses, you can legally receive silicone oil treatments as a facial filler; but that doesn’t make it a good idea. According to the 1997 amendment to the Federal Food, Drug & Cosmetic Act 6, “Nothing in (FD&C Act) shall be construed to limit or interfere with the authority of a health care practitioner to prescribe or administer any legally marketed device to a patient for any condition or disease within a legitimate health care practitioner-patient relationship.” In other words, since silicone oil is legally and rightly marketed to correct retinal detachments, a doctor can apply his or her best professional judgment to use silicone oil along with any other legally marketed product if he or she believes it can help you. This is called off-label use. This important amendment allows doctors the flexibility needed to provide the best care possible, and as such, ethical doctors are extremely careful and thoughtful when using a product for a non-approved purpose.

Injecting silicone oil into the face and other parts of the body like the buttocks is not a case of careful and thoughtful use. Unfortunately a few non-physicians and even physicians continue to use silicone oils this way, and the FDA has aggressively pursued them. There are lay injectors who travel to hair salons and other unsupervised settings to “treat” those who are ignorant of its proper application and associated complications.

But What If Silicone Oil Is the Only Filler I Can Afford?

First, it is a misnomer to call silicone oil a filler because this is not an approved use. It is instead a bogus treatment that gives good fillers an unjustified bad reputation. When it comes to financing cosmetic procedures, here is the bottom line: if you can’t afford safe, quality treatment from an actual physician (not an assistant, technician, traveling person with unspecified qualifications, the black market, or your own hand), then you are better off without any treatment. Silicone oil injections have too many associated complications, including migration and permanent disfigurement, and a number of people have died from these treatments including, recently, a woman in Florida who died from receiving silicone oil injections in her buttocks. Many black market procedures use industrial silicone oil, which is absolutely not intended for the human body in any circumstance. Black market providers are dishonest by definition, so it is foolish to trust them if they assure you their silicone oil is medical grade – of course they will lie to make a sale, especially if they are outside the walls of a licensed medical office.

Instead of automatically assuming you cannot afford legitimate, trustworthy, FDA-approved fillers, consult a bona fide, fellowship trained cosmetic surgeon to learn about the cost and payment options for a safe, dependable filler. Silicone oil injections are cheap for a reason. Anyone who tells you they are a good cosmetic option is misleading you and omitting the facts. Perhaps they actually believe it what they are doing—they are deluding themselves. If they insist that this is an approved treatment, they are again misleading you, as silicone oil injections are only approved for treatment of retinal detachments. The FDA explicitly discourages their use as a cosmetic filler.

If you are certain you cannot afford treatment, then how will you afford to correct complications, should they arise? The complications are very common. You may know someone who is happy with his or her silicone oil treatment, but this doesn’t mean it’s safe or that you will experience your friend’s luck.

Finding a Safe Alternative

The good news is that several other fillers on the market work better than silicone oil anyway, and a cosmetic surgeon in Los Angeles like Dr. Steinsapir who specializes in noninvasive filling techniques can help you find an appropriate solution. As a physician who cares, Dr. Steinsapir does not believe it is ethical to inject silicone oil as a cosmetic filler. Contact us today for a personal consultation during which Dr. Steinsapir can tell you which facial filler or other treatment is best for you. Dr. Steinsapir only uses the highest quality products with proven effectiveness and FDA sanctioning and never treats anyone with an unsafe product and instead uses reliable, safe fillers like Restylane, Perlane and others. The best filler for you depends on your individual concerns. Contact us now if you have additional questions about silicone injections and how to find a more suitable option for your unique needs.

January 4, 2010

What’s the Difference between Dysport and BOTOX?

Filed under: Cosmetic Facial Fillers — Tags: , , , , — admin @ 8:38 pm

Both Dysport® and BOTOX® are botulinum toxin A products that relax overactive muscles to improve facial aesthetics.  But just because these products share a category does not mean they are equivalent.  In fact, it’s important to note that they are not equivalent and the FDA does not consider them to be so.  To be considered a generic drug that is the bioequivalent of a name brand drug, the generic product and name brand must share a dose and therapeutic effect by 90%.  This means that doctors do not have to adjust dose or treatment when switching between the brand name drug and the generic version.  This is not the case with Dysport and BOTOX.

The relative strength of BOTOX to Dysport is thought to be about 2 to 4, so they cannot be used in similar doses.  Further, Dysport diffuses more widely than BOTOX, meaning that treating one section of the face with Dysport will have a wider effect than treating the same portion with BOTOX.  This is not necessarily better or worse – what it means is that BOTOX and Dysport have different applications.  We don’t have meaningful evidence that Dysport lasts longer than BOTOX.  However, Dysport seems to kick in faster and some people really like this difference. These two products share important similarities, but we must be cautious in differentiating them as well.

Is Dysport Better than BOTOX?

It’s too soon to tell because Dysport only just became available in the United States in mid-2009.  So far Dysport and BOTOX seem to be comparable products with important differences outlined above, and Dysport has not demonstrated any clear advantages.   We already know BOTOX to be an extremely beneficial product that is here to stay, and we also know that Medicis (the maker of Dysport, Restylane, and Perlane) has consistently created effective products.  This said, BOTOX is still the market leader and Dysport will need to prove itself and withstand the test of time.

Some people are holding their breath in hopes that BOTOX and Dysport prices will compete until prices drop considerably.  Although there is some competition, we advise you to go ahead and take a deep breath and not expect a drastic change.  Introducing a new drug or product to the market is a costly endeavor that requires extensive research, production, and testing.  Add to this the cost of an experienced doctor who specializes in these procedures, and we see that cosmetic procedures from the better providers are never going to be significantly less expensive.  The advanced and technical nature of the medical field means that good medicine will always come at a premium, if administered safely and as recommended.  Since Dysport and BOTOX are not bioequivalent products, the competition between these products is even less direct than some imagine.  If you have been waiting for the price of BOTOX to drop sharply, you may be disappointed.  BOTOX is still worth as much as it was before, and Medicis still needs to recover the cost of bringing Dysport to the market.  Additionally, it is rumored that the price of BOTOX is scheduled to go up in 2010.

Dysport is turning out to be a great product, just as we expected.  Doctors are now gaining experience with Dysport and perfecting its use. So…

Should I Be Treated with BOTOX Or Dysport?

Your treatment will depend on the results of your private consultation.  Choose a doctor with extensive experience in treating the face with botulinum toxin A products for the best results.  Very subtle differences in treatment make the difference between good and extraordinary results, and experience guides doctors in making treatment decisions.  While any new product has the disadvantage of a short track record, a doctor with a demonstrable high skill level will know how to best apply the new product and when it’s preferable to use the leading brand.

Dr. Steinsapir trained with the inventor of BOTOX and has performed thousands of BOTOX treatments for over two decades.  In this time he has helped BOTOX recipients achieve remarkable results and has pioneered the patent pending MicrodropletTM BOTOX treatment.  As a professional considered among the top BOTOX practitioners, he can help you get the best results from a traditional BOTOX treatment or the new Dysport treatment.  Contact us today for an individualized consultation to find out the most appropriate treatment for your unique concerns.

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