Cosmetic Surgery « LidLift Blog – Cosmetic, Facial & Eyelid Plastic Surgery

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: beverly hills, cosmetic liposuction, cosmetic surgery under local anesthesia, is botox dangerous, los angeles cosmetic surgeon, safe cosmetic surgery — 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.

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January 19, 2010

Should I have an open or endoscopic forehead lift?

Filed under: Cosmetic Surgery, Dr. Steinsapir, brow lift, forehead surgery — Tags: endoscopic forehead lift, forehead lift, forehead lift in los angeles, open forehead lift, open forehead lift risks — admin @ 10:22 am

It’s astounding that some surgeons insist on performing the open forehead lift after it was essentially replaced by the endoscopic forehead lift in the early 1990s. The closed forehead lift, or endoscopic forehead lift, is just as effective if not more so than the traditional yet outdated open forehead lift, with added benefits: faster healing time, no long term numbness of the scalp, no hair loss, and no scar arching over the head from one ear to another. The open forehead lift, also known as the coronal forehead lift, is undoubtedly oversurgical – the effects can be unnaturally excessive and it leaves a long, unsightly scar often accompanied by permanent numbness.

Before and After: Forehead Lift by Dr. Steinsapir

Endoscopic Forehead Lift Before and After

Some excuse this scar because it can be “hidden” under the hair, but the problem here is that the human eye and brain are amazingly capable of discerning the unnatural patterns of hair growth that result from this surgery. Even with a carefully designed, beveled incision through the hairline’s edge that allows hair to grow through the scar, the eye perceives something amiss. The hair is not as dense here, and for those opting for micrografted hair in this area, be warned that the uncontrolled compression and lack of random placement is easy for the eye to notice. Lacking the relevant technical experience, others may not be able to describe what they are seeing, but they will think to themselves that something isn’t quite right about your hairline. Those in favor of open forehead surgery argue that it is superior because it doesn’t push back the hairline. However, it is nearly always better to push the hairline back a tiny five milimeters than to have an altered hairline and huge scar that even the best of surgeons cannot render natural in appearance.

The results of an endoscopic forehead lift last just as long as the open forehead lift, with the added advantages of faster healing, no hair lass, an extremely low risk of numbness, and no visible scarring.

What’s the difference between an open and closed forehead lift?

In short, the open forehead lift places the hairline slightly lower but creates an unnatural-looking hairline. The endoscopic or closed forehead lift places the hairline subtlely higher while retaining a natural pattern in the hairline. The endoscopic forehead lift offers faster healing time and far fewer complications because it is a minimally invasive technique, whereas the open forehead lift can be categorized as oversurgical. Recovery from the endoscopic forehead lift is 5 times faster than the open forehead lift. The endoscopic forehead lift presents a larger learning curve for surgeons and takes longer to perform until mastered, so some have been resistant to transitioning to this superior method.

How long does a forehead lift last?

As with any cosmetic surgery, an endoscopic forehead lift will set back your aging clock, restoring and extending a youthful appearance, but it cannot completely stop the clock, and gravity and sun exposure will continue to affect you. You can expect your results to be long lasting and benefit you for five to ten years after surgery. Even when the effects start to diminish, you can be guaranteed that you’d look much worse had you never undergone this procedure. Thus an endoscopic forehead lift can be seen as twofold in purpose: it immediately improves the aesthetic appearance of your face, and it prevents you from looking excessively aged in the future.

Am I a candidate for an endoscopic forehead lift?

As we always say, only a personal consultation can tell you for sure, but some good indications of requiring a forehead lift are heavy brows, deep-set or hidden eyes, and wrinkled or sagging forehead skin. In some cases Microdroplet™ BOTOX® treatment or eyelid surgery may be more appropriate, as each of these procedures can affect similar areas. This really depends on the severity of your issue and other individual circumstances. The only way to know for sure is to obtain an individualized consultation from a highly qualified cosmetic surgeon who will examine you and then talk with you about your goals and concerns.

If you had a forehead lift years ago and the effects have worn off, you can receive another if a consultation with a qualified doctor demonstrates that one is necessary. Even if your last forehead lift was coronal, you may still benefit from a closed forehead lift today.

We cannot overemphasize the fact that what is best for one person may not be best for you. While reading reliable information is certainly beneficial, it can never replace the advice obtained from a face-to-face appointment with an actual doctor.

How can I find a doctor who performs endoscopic forehead lifts?

You must directly ask potential surgeons if they perform endoscopic forehead lifts. Also be sure to inquire as to which they perform – open or closed forehead lifts. If they routinely administer the open forehead lift, you should be suspicious. There are a very few exceptional situations for which the open procedure is most appropriate, but the best surgeon will tell you that these cases are rare and that he or she provides many more closed than open forehead lifts. Find a surgeon who recognizes the superiority of the effective, minimally invasive closed forehead lift.

Dr. Steinsapir is such a doctor who understands the importance of administering an endoscopic forehead lift instead of a coronal one. He constantly seeks solutions that involve minimal down time, maximum comfort, and the most natural results for his patients. Dr. Steinsapir’s forward-thinking leadership is not new – in fact, he has been a lead performer of the small incision endoscopic forehead lift since 1990. People from Beverly Hills, Los Angeles, and all over the world routinely travel to his practice to receive the best cosmetic eyelid and forehead treatments available. Contact us today to schedule a consultation and have your questions and concerns addressed with honesty, care, and expertise.

Should I have an open or endoscopic forehead lift?

The results of an endoscopic forehead lift last just as long as the open forhead lift, with the added advantages of faster healing, no hair lass, an extremely low risk of numbness, and no visible scarring.

What’s the difference between an open and closed forhead lift?

How long does a forehead lift last?

Am I a candidate for an endoscopic forehead lift?

As we always say, only a personal consultation can tell you for sure, but some good indications of requiring a forehead lift are heavy brows, deepset or hidden eyes, and wrinkled or sagging forehead skin. In some cases Microdroplet™ BOTOX® treatment or eyelid surgery may be more appropriate, as each of these prodedures can affect similar areas. This really depends on the severity of your issue and other individual circumstances. The only way to know for sure is to obtain an individualized consultation from a highly qualified cosmetic surgeon who will examine you and then talk with you about your goals and concerns.

How can I find a doctor who performs endoscopic forehead lifts?

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January 11, 2010

“I’ve had eyelid surgery and I need help ASAP!”

Filed under: Cosmetic Surgery, Dr. Steinsapir, Eyelid Surgery, Uncategorized — Tags: bad eyelid surgery, eyelid surgery corrections, fixing eyelid surgery — admin @ 10:42 am

If you’ve done your research and chosen a reputable doctor who specializes in oculofacial plastic surgery, chances are you will achieve satisfying results. While it is accurate that you needn’t fear surgery performed by a top-rated practitioner, it is also true that sometimes there are complications, and if you are the unlucky one experiencing complications, you need help soon.

The best doctors know not only how to give you great surgery results – they also know how to correct complications should they arise. Occasionally complications may arise from surgery, which require correction beyond the skill of the original surgeon, or the doctor-patient relationship may break down, and this is when you need to seek a second opinion. Fortunately, these circumstances are unusual.

What are the signs of needing immediate help?

Many people are naturally worried about how their surgery will heal when in reality things will be just fine. This is the case with most anxious patients, as we discussed in a recent post. However, everyone must admit that sometimes something can go wrong, as with any medical procedure and even in any professional field. It is important to understand that these are the times when you need your surgeon the most. Do not wait for your next appointment. Call your surgeon. If you feel you are having a true emergency, go to an emergency room or call 911. Someone can call your surgeon later to let he/she know what is going on. It is far better to be seen for something that turns out not to be serious than to miss something important. An expert physician must understand how to respond in such unusual situations, and fortunately such doctors are available. The key is handling the situation gracefully, swiftly, and effectively.

The following conditions after eyelid surgery are not normal:

1. Bleeding. Generally any bleeding should cause concern. While it does not take much blood to look like a lot, it is not normal to have any visible bleeding after surgery. It can be caused by a number of reasons, most commonly activity after surgery. If you are experiencing this, call your surgeon, discuss the situation and follow their directions.
2. An expanding bruise in the eyelids. This is generally a sign that you are bleeding inside the eyelid where surgery was performed. Again this is rare but needs prompt attention. Call your surgeon immediately. If you have any trouble reaching the surgeon, go to an emergency room especially if there is pain and changes in vision.
3. Pain that is not relived by the pain medications prescribed for use after surgery. The most common reason this might happen is deciding that you really don’t need to take the pain medicine after surgery. Then hours later, everything wears off and not surprisingly you hurt. At this point, it can literally take two hours for oral pain medicine to return you to a pain free state. While the truth is that many patients truly are comfortable after surgery without medications but not ever one. This is perhaps one of the more common reasons for patients to call after surgery. However, there are situations after surgery where pain breaks through even on the prescribed medications or days after surgery when there should not be any pain. Pain is a very important sign. It might represent a lack of pain medicine right after surgery, an expanding bruise, or days later, the earliest symptoms of an infection. Share your concerns with your surgeon and pick up the phone.
4. Loss of vision. Bleeding behind the eyes can cause permanent loss of vision. This is uncommon, estimated to occur 1 in 300,000 eyelid cases. Prompt steps can save the vision. But immediate attention in necessary. Call your surgeon immediately or 911.
5. New onset pain, swelling, and redness in the area of surgery two or more days after surgery. These can be signs of an early infection. Again, don’t wait for your next visit. Call your surgeon to discuss the situation.

Important but less urgent concerns

It’s normal to experience some bruising and swelling during the healing process, but in rare instances this can be severe to affect the outcome. Severe bruising can lead to excessive swelling, which can stretch the eyelid as it heals and alter the final results. Your doctor can help you understand what sort of bruising is expected and what is excessive.

If your eyes look droopy or heavy after surgery, you are experiencing one of the more common complications of surgery called ptosis or blepharoptosis that occurs when the upper eyelid tendon slips. This can happen if it is cut during surgery, but can sometimes happen on its own, and the effect is intensified by severe swelling. It is very common for the upper eyelids to be heavy after surgery due to swelling. This does not mean that your surgery is a failure. Most commonly this heaviness does resolve over a several week period allowing the lid to return to its proper height with no intervention. In some cases, it may take quite a while for the swelling to resolve. For this reason it is generally a good idea to simply give the eyelid time to heal. Should the heaviness fail to resolve in a 6 to 12 months time frame, corrective surgery is appropriate. Although you may only notice heaviness in one eye, reconstructive surgery on both eyes may be necessary. The eye plastic surgeon will closely evaluate you for a subtle ptosis of the other eye to determine the best method of correcting the eyelids.

Some cosmetic surgery textbooks instruct students of medicine to place the upper eyelid crease too high, and through no fault of their own some new professionals may erroneously follow this advice that they only could have known to avoid through increased experience. It is generally easy to raise a crease, but one made too high can be difficult to lower, and requires the most careful and most experienced of care to resolve through further surgery. It’s best to avoid this situation by finding a doctor who understands that the crease is commonly placed to high, but if you’re reading this now because it’s already too late and you’re unhappy with your surgery, then it’s a good idea to seek the opinion of another doctor who can discuss with you the best action to take next.

Other complications that may arise are having loose skin that does not hold makeup, or having eyelashes that droop downward. These issues can be resolved by properly tensioning the skin and adjusting how much skin is present. This procedure is called anchor blepharoplasty and can be performed under local anesthesia in the office setting. Sometimes, the eyebrows seem to fall after upper eyelid surgery. When you are told about the possibility before surgery, this is an expected effect. The result may be satisfactory or a forehead lift may be needed to reposition the eyebrows. It is post-operative surprises that can erode confidence in your surgeon. An experienced surgery anticipates these types of issues and informs you about them ahead of time. He or she can help you decide if a forehead treatment instead of or in conjunction with additional eyelid surgery is necessary.

It is far easier to correct an underdone cosmetic surgery than undo an overaggressive surgery. One does not need to be made drum tight to have a great surgical result. Think about it, when was the last time you saw a model look like they had stuck their head in a wind tunnel? By optimizing the surgical plan it is possible to have extremely natural results that give no indication that they were achieved by cosmetic surgery.

If your friends and loved ones think you look worse, or you just aren’t happy with your results, or you lack confidence in your current physician, you should seek a second opinion from someone who specializes in correcting previous surgeries. At best the doctor can assure you that things are going fine or repair your relationship with your former surgeon. If early action must be taken to correct a problem, a consultation with another doctor can help you decide what to do. You will get a better feel for what you need when you find a concerned, caring doctor who really makes sense and has demonstrated exceptional ability at resolving issues similar to yours like leading oculofacial plastic surgeon, Dr. Kenneth Steinsapir.

You need a second opinion

Dr. Steinsapir regularly consults with individuals who have experienced unsatisfactory surgery nationwide and from around the world. He can help. In some cases, he can help restore communication with the previous physician. In other cases, you may find you need to move on to an oculofacial plastic surgery skilled in correcting your problem. Dr. Steinsapir specializes in fixing eyelid surgery. Lidlift.com contains a wealth of information about correcting eyelid surgery with before and after photos to demonstrate his skills. Eyelid surgery should be a great experience. If it hasn’t been one for you, we are sorry. The good news is, there is help available from a compassionate, respected, and highly qualified surgeon. Take action today to obtain the help you need. Contact us now for more information.

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January 3, 2010

I’m Dissatisfied With my Blepharoplasty Results. What Should I Do?

Filed under: Cosmetic Surgery, Eyelid Surgery — Tags: beverly hills, blepharoplasty surgery, eyelid surgery concerns, los angeles — admin @ 8:11 pm

The first thing you should do if you’re worrying about the results of a blepharoplasty is take a deep breath and ask yourself if you’ve had enough time to heal. It is common for people to feel anxious for the first few weeks after surgery and wonder if they made the right decision. This can lead to excessive worrying which is often unnecessary.

If performed by a skilled and experienced surgeon, eyelid surgery almost always leads to satisfactory results, but it does take several weeks to heal and for the swelling to go away. Most people who worry that their blepharoplasty was a mistake do so before their eyes have had time to heal and before the final results can be seen.

Your surgery should be socially passable after about two weeks, while you may personally be aware of some swelling for two or even three months. After this, you are in the advanced stages of healing, and final results can be seen after six to twelve months.

Three Reasons to Express Concern

There are three general answers to this question. First, your surgeon will be happy to address all your concerns as they arise and will urge you to keep communication open. Usually your concerns can be eased by an explanation of the normal, natural healing process. Before and after surgery, you should openly and honestly discuss your questions with your surgeon to get a good idea of what to expect from the surgery. In this regard, it is appropriate to bring up all your concerns with your surgeon as they arise, noting that it’s important to trust his or her explanations about the healing process, especially if your experiences align with what you’re told to expect. You need time for the tissues to heal and swelling to go down before you can see the full benefits of your blepharoplasty. In the meantime, keep communication open. First and foremost, do not be afraid to tell your doctor what’s on your mind, even if your concern is nothing to worry about, which is most likely. Remember that you have a responsibility to educate yourself and keep your doctor informed about your condition. If you hide the truth from a doctor, how can you expect to be helped? We always encourage you to talk about your experiences and ask questions, even if you suspect your concerns are unwarranted.

These next two instances reflect time when there may be some cause for concern. The second time you should express concern is if you are experiencing excessively dry eyes or trouble closing your eyes, which may not be cause for alarm, but it’s important to tell your doctor about these symptoms. It’s common after any eye surgery, including cataract surgery, to experience dry eyes, which usually return to normal within six weeks. If your eyes are uncomfortably dry, you can treat them with artificial tear drops available at the pharmacy. Talk to your doctor about this to keep the both of you informed. In extremely rare cases, over-aggressive surgery may make it difficult to completely open or close the eye if too much tissue has been removed, in which case revisional surgery may be needed soon.

You can see the final results of your blepharoplasty after six to twelve months. After this time is the third instance when it is appropriate to express concern. Now that you have finished or almost finished healing, you can reasonably think about the outcome of your surgery. Do you like it? Is it what you’d hoped for? What do your closest friends think of the outcome? If you are dissatisfied with the results or hope for more improvement, it is now appropriate to bring these concerns to your doctor.

I’m considering reconstructive surgery. What now?

It’s not obvious to everyone, but the first thing you should do is contact the surgeon who performed the original surgery. A lack of 100% satisfaction does not mean that your doctor can’t address your needs or isn’t skilled enough to solve your problem. There may have been a miscommunication, a rare outcome, or you may be misinterpreting your results. There is probably no one more invested in ensuring that you’re happy with the outcome than the surgeon who originally performed the procedure. Your operative surgeon will be highly motivated to improve your results. This is a mutually beneficial option.

Occasionally, eyelid surgery patients experience a breakdown in the doctor-patient relationship. This can happen in any relationship and, like in any other kind of relationship, the degradation may not always be resolvable or one you are willing to repair. If this is the case, it’s entirely reasonable to seek a second opinion. He or she will be able to continue your follow-up care, monitor your progress, and perform reconstructive surgery if necessary. When appropriate, this new doctor may also facilitate communication with your original surgeon, in some cases restoring a diminished professional relationship back to one of mutual confidence and functionality.

When you are not confident returning to your formal surgeon for whatever reason, seek a fellowship-trained oculoplastic surgeon and member of the American Society for Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). These doctors have the most comprehensive training in eyelid surgery and complication management.

The Difference of a Second Opinion

A second opinion can work wonders in resolving problems with an old surgeon or establishing confidence in a new surgeon who can completely resolve the issues lingering from prior surgery. It’s important to recognize that doctor-patient relationship breakdowns are rare and can usually be resolved. However, if you are experiencing a lack of confidence, a second opinion consultation is appropriate. Dr. Steinsapir is happy to provide second opinion consultations. Dr. Steinsapir’s philosophy is to keep communication clear and ongoing while providing close follow-up post surgery to monitor the healing progress. Occasionally, individuals wish to transfer care and not communicate with their original surgeon. This of course is your right. Simply communicate your desire at the time of your consultation with Dr. Steinsapir. Contact us today to find out how Dr. Steinsapir can address your concerns and improve your blepharoplasty experience.

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December 15, 2009

Should I Get Perlane® or Restylane®?

Filed under: Cosmetic Surgery, Eyelid Surgery, Restylane Injections, Under Eye Restylane — Tags: hyaluronic acid fillers, Perlane, Restylane, restylane or perlane — admin @ 3:37 pm

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

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.

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November 24, 2009

How Can Fat Transfers Correct My Undereye Circles, Hollow Cheeks, and Sunken Features?

Filed under: Cosmetic Surgery, Dr. Steinsapir — Tags: beverly hills, fat transfer risks, fat transfer side effects, fat transfers, los angeles — admin @ 10:09 pm

Some people are born with naturally full faces, while others may have a sunken face, particularly around the eyes and cheekbones. For many people, what was once a youthful, full face develops volume deficiencies due to aging and gravity. The cheeks may begin to droop, creating circles under the eyes and hollowness in the midface. Fat transfers are an excellent solution for correcting volume and contour issues, as they are completely natural and come from your own body, making them biologically safe. Fat transfers are often complimented by other procedures, such as eyelid surgery and lower face and neck lifting.

fat transfer before and after picture

How Do Fat Transfers Work?

Fat transfers, also called fat grafting and fat injections, soften facial features by correcting facial deficiencies. Fat is harvested from another part of the body, such as the abdomen, buttocks, or thighs – the harvest site depends on the recipient’s individual needs. Harvesting can be done through local anesthesia and may improve the shape of the harvest area. This is done with remarkable comfort. The harvested fat, which may be called fat pearls, are living grafts from your own body. These are transferred into regions of the face through very small cannulas and a tiny poke in the skin. These sites heal without a scar. Approximately 70% of the transferred fat survives creating long-term benefits. The fat is delivered very precisely using as series of specially shaped microcannulas designed specifically for this purpose. The amount of fat injected depends on the shape of your face and the volume of the deficiencies. The fat is usually placed under the subcutaneous fat already present just under the surface of your skin or adjacent to the facial musculature according to the FAMI technique based on the surgeon’s artistic judgment, so the ultimate results appear completely natural.

Fat injections are safe because your body cannot reject the transfers or have an allergic reaction to them. Since this procedure uses your own fat cells, the body accepts these transfers as a biological match.

When Do I Need Fat Transfers?

There is no universal answer to this question. You will need an individual consultation to find out which filling method(s) are most appropriate. Juvederm and Restylane injections may be appropriate, but if they don’t get the job done or are inappropriate to your needs, then fat injections may be an alternative. Fat grafting is an excellent choice when the face needs more volume than can be practically done with the other facial fillers. Fat grafting can be particularly helpful in areas like the midface, cheek, jawline and brows. If you have areas of hollowness in the cheek and bags, circles, or sunken areas around the eyes, you may be an excellent candidate for fat transfers. If your face looks hard and aged rather than soft and full, fat transfers may benefit you. The required procedure depends on many factors, such as the natural shape of your face, the thickness of each region of your skin, how much soft tissue is present, what kind of deficit you have, and of course the unique needs of your face. In some cases more than one filling method may be appropriate. Only an experienced surgeon who specializes in improving facial aesthetics will be able to tell you for sure. Ultimately, there is no substitute for a personal consultation.

The Healing Process

People receiving facial fat transfers see results right away but it is important to remember that swelling and bruising after treatment is normal. Typically the bruising lasts about 10 days and most feel ready to return to work at that point. Swelling of some degree may persist for several weeks. A key to peace of mind after your procedure is to allow yourself time to heal. Fat pearls and fat transfers naturally heal with a somewhat lumpy firmness. You will notice this when you feel the treated locations with your hands but it is unusual to see the processes at the skin surface. This is most noticeable at weeks 4 to 6 and then gradually resolves. Typically by four months this firmness as completely resolved.

Your doctor will go over the healing process with you and help you understand what to expect. Although you are bruised after surgery, you will find that you are remarkably comfortable. Downtime is usually about 10 days, although certain activities, such as intense contact sports should be avoided to 2 weeks.

Since fat pearls and fat transfers are 100% natural and come directly from your own body, the transfer region will accept the new cells with results that typically last longer than other filling methods.

There Is No Substitute for Experience

Fat transfer can be a fantastic procedure and with the right surgeon there is no reason it shouldn’t be. Facial fat transfers require precision, insight, and attention to detail. Benefit form Dr. Steinsapir’s exceptional experience and skills. Call for a consultation today and find out how you can rejuvenate your appearance.

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November 22, 2009

BOTOX® Is the Answer to Smoothing Facial Lines Without Surgery

Filed under: Botox Los Angeles, Cosmetic Surgery, Dr. Steinsapir — Tags: Botox Los Angeles, facial line fillers, is botox safe, reduce facial lines, wrinkles on forehead — admin @ 10:05 am

For those seeking a rejuvenated, youthful appearance of the eyes and forehead without undergoing surgery, Dr. Steinsapir’s minimally-invasive Microdroplet™ BOTOX® technique is perhaps the best solution to date.

How BOTOX Helps

We use our faces every day to communicate with others. If you laugh, frown, or make an angry face in front of a mirror, you will probably see lines appear on your face. Dynamic lines – those that appear when we smile, laugh, become angry, and so on – are very important to nonverbal communication and these natural lines are vital to self-expression. However, you may still see some lines present when you relax your face. This is because years of making facial expressions and environmental stressors can cause lingering imbalances in our skin. We may end up with unwanted worry lines, forehead wrinkles, or frowns etched into our faces, known as static lines, which cannot be remedied through use of over-the-counter “miracle” products and creams. Fortunately for those who don’t want surgery, BOTOX® is a natural protein treatment that relaxes the muscles responsible for the static lines on the face and improves aesthetics by helping the face return to its softer, relaxed, youthful look.

BOTOX® can also be used as a preventative measure for younger individuals who wish to retain a youthful appearance, reduce facial lines and prevent forehead wrinkles and frown lines from occurring before their first signs. No matter how well we take care of ourselves, even the healthiest, most care-free individuals can end up with these lines. It may be beneficial to think about how BOTOX® can prevent the signs of aging so that you don’t have to worry about them later in life.

Is BOTOX a Safe Treatment?

Many potential candidates wonder about the side effects of BOTOX®, but it is a safe procedure that involves injecting drops of highly purified protein into areas of the face. A skilled physician can use BOTOX® to relax the muscles that create unwanted static lines and often improve or eliminate them while still allowing you to retain your ability to make a range of expressions, including the Duchenne smile, which occurs naturally when we are genuinely happy. The stereotype that BOTOX® commonly causes the face to “freeze” is inaccurate and originates from misuse of the procedure. BOTOX® is in fact completely customizable to the needs of your particular appearance. Because BOTOX® works on individual muscles, an experienced physician administers the correct amounts of BOTOX® to the appropriate muscles and the results are entirely predictable.

Most people notice that their face appears more youthful, relaxed, and natural after BOTOX® treatments. They see a younger version of themselves looking back in the mirror. In smoothing facial lines caused by stress, BOTOX® patients no longer look perpetually worried and are still able to nonverbally communicate what they truly feel.

An Innovative, Tested Approach

Dr. Steinsapir has invented Microdroplet™ BOTOX® to address the need to retain authentic facial expression and natural eyebrow placement. Where standard BOTOX® procedures work great, Microdroplet™ BOTOX® works even better. If you have had BOTOX® treatments in the past but were not satisfied, Microdroplet™ BOTOX® can give you the results you need by working with greater precision with your facial muscles. The care and interest Dr. Steinsapir has shown in inventing this treatment demonstrates his dedication to achieving a beautiful, youthful appearance without impeding the ability to express emotion.

Don’t Wait to Improve Your Facial Lines

Simply stated, BOTOX® improves facial lines. To find out how BOTOX® can improve yours, contact Dr. Steinsapir today to personally ask questions and discuss your particular needs and concerns. At an individualized consultation, you can find out how Dr. Steinsapir caters his expertise and experience to the needs of each individual and he can tell you more about how lines affect your unique face.

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November 8, 2009

Why Do We Seek Cosmetic Surgery?

Filed under: Cosmetic Surgery, Dr. Steinsapir, Psychology of Cosmetic Surgery — Tags: aging and cosmetic surgery, beverly hills cosmetic surgery, celebrity cosmetic surgery, childhood cosmetic surgery, Cosmetic Surgery, cosmetic surgery addiction, Dr. Steinsapir, New New Face, Psychology of Cosmetic Surgery, surgical disfigurement — admin @ 11:24 pm

As a cosmetic surgeon devoted to aesthetic and aesthetic reconstructive surgery, I often find myself analyzing what motivates my patients to desire and ultimately have cosmetic surgery. In this “Makeover” world we now inhabit, it is easy to suggest that the reason men and women get cosmetic surgery is to increase self-esteem. This fits the American story line of hard work and self-improvement. However, accepting this explanation pushes aside important questions that commonly get overlooked – Why is it that the overwhelming majority of people having cosmetic surgery are women? Do surgeons really understand why people seek cosmetic surgery? How do surgical paradigms affect the outcome of a surgery? How do neuroeconomics play a role in influencing decisions to have cosmetic surgery? In the following article, I present some important psychological and cultural aspects related to why we seek cosmetic surgery.

FLESH WOUNDS

According to the American Society of Plastic Surgeons (ASPS), over 12 million cosmetic procedures were performed in the United States last year. This represents an increase of 40% over the number of procedures done in 2000, despite the economic recession. One of the reasons why cosmetic surgery has become so popular is in part because it provides an accessible if not always affordable mean to reinvent one’s self. To use the term coined by author Virginia Blum (Flesh Wounds: The Culture of Cosmetic Surgery), we are all “surgical”-potential consumers of cosmetic surgery. Blum suggests that all features become categorized into those that need and don’t need surgical work.

One important fact to note from the ASPS statistics is that 91% of the total cosmetic surgeries in 2008 were performed on women. It is interesting to know that there exists a reverse gender imbalance in the world of cosmetic surgery, where men make up for 91% of the cosmetic surgeons and women make up 91% of patients undergoing cosmetic surgery.

GIRL POWER

The feminist drive for equality and empowerment has somehow gotten translated into “girl power” where equality is transformed into sexual aggressiveness in the media. It is difficult to argue that shaving one’s genitals, having breast implants, and pole dancing represents equality and empowerment. Yet for girls and young women this is the message from mainstream media. Female agency is co-opted by commercial representations where sex is used to power consumer demand. Consider the 145 million Bratz dolls that have been sold to preteen girls. These skanky dolls are marketed to six year olds and the junior version, Bratz babyz, to 3 year olds. They make Barbie with her anorectic proportions look down right wholesome. This isn’t just a method of imposing heternormativity on our children. No, this “sexualized too soon” message, what Sociologist Brian McNair describes as the “pornographication” of everyday life sells.

Kids in the United States are exposed to 8 hours of media each day. It is no wonder that girls as young as 6 ask their parents if they are too fat and complain that they are not sexy enough. This demonstrates how this phenomena compresses into childhood. Teachers report an increasing intensity of gender separation between young boys and girls with girls focused on princess culture and femininity and boy on fighting and violence.

Rosalind Gill, a lecturer in gender and media studies at the London School of Economics, has analyzed the way a woman’s sexuality is manipulated in contemporary advertising. Advertisements today represent the empowerment of women by showcasing assertive women who make a statement with their sexual power. Gill argues that we are witnessing a shift from sexual objectification to sexual subjectification, where women today are being presented as knowing and active sexual subjects. To deal with the fierce feminist attitude observed in young women who oppose being portrayed as sexual objects, the advertising world has stealthily constructed a new femininity, which is built around sexual confidence and autonomy. This new construct “girl power” lures those same young women to accept themselves as sexual subjects. The contemporary sexualized representations of women in media and popular culture, unlike in the past, does not depict women as passive objects but as desiring and glorified sexual subjects, so that that activities such as cleaning a toilet with a disposable brush, buying yogurt, and wearing stiletto heels are portrayed by media as self-actualizing personal choices. So instead of the lean, well dressed, apron clad homemaker greeting her suburban husband at the door with a home cooked dinner on the table, advertisements are now assembling the young, narcissistic, sexually assertive, “always up for it”, lean, tattooed, pierced woman who plays with her sexual power. Gill suggests that these images represent a shift from the objectification of women by the male gaze to the subjectification of women.

UNTOUCHABLE

Sandra Bartky, Professor of Philosophy and Gender Studies at the University of Illinois at Chicago has said “Feminine bodily discipline has this dual character: on the one hand, no one is marched off for electrolysis at the end of a rifle, nor can we fail to appreciate the initiative and ingenuity displayed by countless women in an attempt to master the rituals of beauty.” However, the standards for feminine appearance are becoming increasingly unattainable. For example the singers Christina Aguilera and Britney Spears during their pregnancies were featured on the covers of Marie Claire and Harper’s Bazaar respectively -literally and figuratively as new Madonnas. No woman could hope to emulate the perfection Photoshopped into these magazine covers.

Please watch the movie at: http://www.youtube.com/watch?v=hibyAJOSW8U

In return for access to celebrities, fashion magazines now routinely turn over complete control of the photography to the celebrity who employs design staff for the purpose of adjusting the images to their liking in the photographic manipulation program Photoshop as illustrated in this Dove Self-Esteem Campaign movie. Not only are the celebrities and models attractive in their own right, their photographs are retouched and their features enhanced. Yet their published images define sociocultural standards for appearance that many women feel they need to attain. This is also occurring with male models and celebrities but the social pressure is less intense for men.

This is what Naomi Wolf described as the “beauty system.” Second wave feminists have referred to women who attempt to discipline themselves to comply with the social norms of femininity portrayed in the media as “cultural dopes.” While it seems innocuous when a mother takes her daughter to have an ethnic nose refined by rhinoplasty at age 16, it is much more troubling when a mother takes her daughter of the same age to the plastic surgeon for breast augmentation or female genital cosmetic surgery. The American Society for Plastic Surgery reported that 18 and 19 year olds made up 3 % of all breast augmentation surgeries last year. Cosmetic surgery on children under 18 years of age constituted 5% of all cosmetic procedures in 2008.

EXTREME MAKEOVER

Wheeler Dixion writing last year in the Quarterly Review of Film and Video argues that the perfect body and face “is becoming the ultimate status acquisition of the 21st century.” One might ask if shows like I Want a Famous Face, The Swan, and Extreme Makerover have increased consumer demand for cosmetic surgery. Anecdotally, surgeons feel that they have. However, objective studies are harder to come by. Robin Nabi reported her study this year in the journal, Human Communication Research, that these shows, with the exception of I Want a Famous Face, are associated with a small increased interest in cosmetic surgery. I Want a Famous Face highlighted the risks associated with cosmetic surgery and viewing this show was associated in this study with an increased perceived risk of having surgery. Meredith Jones observes that these shows pull back the curtain on the “during” that is normally removed from before and after pictures.

Feminists have increasingly accepted that cosmetic surgery is not going away. Quoting Kathy Davis, a medical sociologist, who studies cosmetic surgery: “It opens the possibilities for biographical reconstruction and opportunities for women to redefine their sense of self.” Susan Paulson and Carla Willig writing last year in the Journal of Health Psychology found that the concerns of women ages 58 to 80 regarding their appearance are related to loss of social relevance and fears of disappearing. In contrast men of a similar age are more concerned with how they function. These women operate with a frame of mind that the aging body represents a mask over the inner younger identity. Some older women reject cosmetic surgery as too radical or dangerous. Screenwriter Nora Ephron in her collection of essays “I feel bad about my neck,” summarizes her concern about being overdone by plastic surgery writing: “ I learned the hard way that just because a doctor was a famous surgeon didn’t mean he had any gift for sewing people up.”

THE NEW NEW FACE

As boomers age, marketers have found glamorous aging celebrities to take up the cause of maintaining appearance. Actresses such as Diane Keton and Susan Sarandon were chosen for the L’Oreal Age Perfect campaign because it could be plausibly implied that they have maintained their appearance without cosmetic surgery. Whether they have or have not had surgery is irrelevant. Who needs surgery when a little Photoshop magic can make you look thirty year younger as can be seen when comparing magazine cover images of Sarandon with images taken at the same time without the benefit of Photoshop.

Meredith Jones in her article “Mutton cut up as lamb” notes that the emphasis on youth culture means a decline in the value of the elderly. In this formula, youth equates to beauty and aging to ugliness. She describes cosmetic surgery as an increasingly essential “toolkit” to maintain a stretched middle age or “agelessness.” This is what I call designer aging, a process eloquently described by Jonathan Van Meter in his August 2008 New York Magazine article where he define the “New New Face.”

Jones contends that women have only two choices: actual youthful beauty or youthful verisimilitude. Trying to appear youthful is almost as important as being youthful perhaps justifying surgical and non-surgical treatment effects that generously are idiosyncratic in their results or less generously hideously unnatural. Jocelyn Wildenstein, the socialite, or Orlan, the body artist, come to mind. Jocelyn is reported to have spent 4 million dollars on cosmetic surgery. Her late husband Alex was quoted as saying: “She seems to think that you fix a face the same way you fix a house.”

Please watch the movie at: http://www.youtube.com/watch?v=ri61lBfMBu0&feature=related

Some of our most notable celebrities appear engaged in this exercise. This perhaps helps us understand why individuals with surgically disfigured looks defend and appear to love their faces. I would suggest that for some individuals, the extreme alteration in appearance actually meets a narcissistic need for attention. We look at these individual with disgust, but instead of experiencing shame and humiliation, they experience attention and interest, which serves to confirm that they are objects of adoration. In the case of Michael Jackson, it now appears that his addiction to cosmetic surgery was also reinforced by the exposure to drugs administered for his anesthesia, contributing to his premature death.

COSMETIC SURGERY JUNKIES

This raises one final issue I would like to discuss with you. In considering my more demanding poly-surgery patients, I would like to suggest that there is a difference between body dysmorphic disorder and what Pitts-Taylor has described as “the surgery junkie.” The line between normal enthusiasm for the benefits of cosmetic surgery and cosmetic surgery addiction is not well defined. Body dysmorphic disorder is defined in the revised DSM IV as excessive preoccupation with a specific body part that causes significant impairment in functioning.

The cosmetic surgery addicts do not restrict themselves to a particular body part. Instead, they have a global appetite for cosmetic surgery. Like the painters of the Golden Gate Bridge who begin repainting the bridge immediately upon completing the last job, cosmetic surgery addicts are never satisfied and are only constrained financially in their quest for ever more enhancement. These individuals have surgery with many doctors and may not be forthright in disclosing recent procedures. I believe that this type of individual is more a victim of the neuroeconomics of appearance rather than some deep-seated psychological problem. Unattainable standards of beauty, the fear of loss of status, and the ready availability of cosmetic surgery all contribute to the problem. As such, cosmetic surgery addiction has more in common with drug addiction and pathological gambling than with body dysmorphic disorder. Unfortunately we are all familiar with the horrible disfigurement that seems to be the final common pathway for these individuals.

When does cosmetic surgery become too much? This is a question that we currently wrestle with as individual surgeons. However, I suggest that this is a public health issue. I ask you to consider that we may already be experiencing an epidemic of adverse cosmetic surgery outcomes. If surgeons can’t address this growing problem, we can look forward to solutions by angry legislators prompted by what will be the inevitable consumer backlash.

CONCLUSION

Socio-cultural pressures have elevated the standards of appearance predominantly for women. The difference between these standards and what people see daily in the mirror creates various levels of chronic shame. More than narcissism it is low self-esteem that drives the demand for cosmetic surgery. Cosmetic surgery is used as a survival kit to mitigate these negative emotions and personal insecurities. In the future, I hope to share my insights on shame mechanisms, attachment and terror management theory, mortality salience and the role of neuroeconomics in the cosmetic surgery, which ascertain the cultural concerns discussed in this article.

This article was given as a lecture before the 40th Anniversary Fall Scientific Symposium for the American Society for Ophthalmic Plastic and Reconstructive Surgery in San Francisco, California on October 21, 2009.

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October 26, 2009

Lip Filling – Important Facts To Consider Before You Decide To Have Fuller Lips

Filed under: Cosmetic Surgery, Restylane Injections — Tags: beverly hills, injectable lip fillers, lip augmentation, lip filling, lip implants, los angeles — admin @ 9:47 pm

Lips are one of the most important features that characterize your face. Lips should be in harmony with other features of your face such as nose, cheeks, eyes, eyebrows, chin and teeth. Plump and youthful lips are the symbol of beauty and a window to a tantalizing smile. As we age, movement of the mouth causes softness, loss of lip volume, and vertical lines can develop. These changes you look less attractive and aged. Lip Filling or Lip Augmentation can help you in attaining fuller lips that will add a sensuous appeal to your face.

lip filling before and after pictures

Even for men, these subtle lip edge changes can take away what makes a masculine youthful appearance. Appropriate lip edge treatment restores these changes. However, it is important to educate yourself about the precautions to be taken and risks involved in a lip filling procedure before taking the plunge. Let’s talk about some important facts related to lip filling:

Who Is Eligible For Lip Filling?
Adults who are in good health and have naturally thin lips, a decrease in lip volume due to age, and those interested in fuller lips. Prior scaring or lip procedures can be improved with lip filling.

The Most Common Lip Filling Techniques
The widely accepted techniques for lip filling are:

• Injectable Lip Fillers
• Fat Transfer
• Lip Implants

Injectable Lip Fillers
The safest technique for lip augmentation is injecting hyaluronic acid or collagen based fillers, which provide pleasing results that last for four to 12 months. The results achieved by injectable lip fillers are temporary because the body eventually absorbs the filler. Some of the reliable fillers for temporary lip augmentation are Restylane®, Perlane®, Hylaform®‚ and Juvederm®. Lip augmentation with injectable fillers that result in temporary lip augmentation is a less time consuming procedure that is carried out under local anesthesia and delivers immediate results. Although longer lasting lip edge treatment is desirable, permanent fillers are generally not recommended in the lip because of the risk of nodularity along the lip edge. So fillers like Bio-Alcamid ®, or Artefill® which are designed to last a very long time in the tissues or be permanent, are generally not recommended in the lip.

Even though this is a low risk procedure, your reaction to treatment will depend on the type of filler and your ability to heal. Mild side effects related to lip fillers include redness, bruising, swelling, minor discomfort, tenderness, and much less commonly, infection. With proper precautions and care, these side effects can be minimized, and will fade within a few days. Allergies to these products can occur even if you have been successful treated with a particular product in the past. Unwanted fullness following a treatment can easily be adjusted with any of the hyaluronic acid fillers, which is why these have rapidly become the number one choice for lip augmentation.

Fat Transfer
Lip augmentation with fat transfer involves removing fat from one area of the body, usually the abdomen or the thighs with the help of liposuction. This fat is subsequently injected it into the lips with the help of a syringe. As only the body’s natural tissue is used, rejection or allergic reaction does not occur. The results are longer lasting with 50 to 60% of the transferred fat surviving to provide permanent augmentation. Depending on surgeon’s and patient’s preferences lip filling with fat transfer is performed under local anesthesia or a general anesthesia. Fat does need to be harvested from another site on the body, often the abdomen or flanks and healing is also needed at this site.

The side effects may include infection, bruising, swelling, and minor discomfort. Bruising typically is present for 2 weeks. This procedure, like all lip services requires a high degree of expertise and finesse because the fat needs to be injected to shape the lip. Care also needs to be taken that the fat cells do not die during the fat transfer. Lip fat transfer can be very helpful in establishing basic lip volume. However, lip fat transfer lacks the level of precision that can be achieved with the lip filler products like Restylane®. Once the transferred fat has achieved a blood supply, the volume is retained on a long term basis. Some offices freeze fat for later use. Evidence suggests that the freezing process damages the fat cells and volume persists after the use of frozen fat cell long as long as it takes the body to reabsorb these cells.

Lip Implants
Lip implants provide permanent lip augmentation. In the lip implantation technique the surgeon makes small incisions on the lips to accommodate the implant. To ensure that the lip implant is placed correctly for an even and natural result, the surgeon creates a fine tunnel through the lips. After inserting the implant in the lips, it is trimmed according to the length of the lips and the incisions are sealed. SoftForm, e-PTFE (generic replacement for Gore-Tex® which is no longer made for the lips) and AlloDerm® are the three popular types of implants used for permanent lip augmentation. It is important to consult an expert cosmetic surgeon to understand which lip implant is right for you.

Some of the risks associated with permanent lip augmentation include implant rejection, infection, implant migration, scarring, and stiffness of the lips. The main benefit of permanent lip augmentation is that it provides longer-lasting results than temporary fillers, which are eventually absorbed into the body. Although the effect of fuller lips is permanent with lip implants than with injections, lip implants carry a higher risk of scarring or lumping of the lips. Also lip implants lack the level of precision that can be achieved with the use of lip fillers. These risks can occur with highly qualified surgeons. It is important to discuss with your surgeon the best choices that are right for you. Many find that filling the lips to be an excellent alternative to surgical lip augmentation with and implant or even fat transfer.

How Do You Prepare Yourself for Lip Filling?
There is a possibility of an allergic reaction to any of the fillers that are used for lip filling. However, the risk is the lowest with the hyaluronic acid fillers. It is your responsibility to report to your surgeon, any pre-existing allergies or respiratory problems which could be compounded due to anesthesia. It is crucial to choose a professional facial plastic surgeon that uses only FDA approved lip augmentation products and guides you in choosing the right cosmetic procedure that is ideal and safe for you.

How Do I Choose The Right Cosmetic Surgeon For Lip Filling?
The most important step to take before undergoing a lip filling treatment is to choose the right cosmetic surgeon. Extensive research performed to identify your potential cosmetic surgeon is very helpful. Is your surgeon board certified in one of the core aesthetic specialities: Dermatology, Oculoplastic Surgery, Facial Plastic surgery, or General plastic surgery? Does you surgeon have hospital privileges at a University based hospital? There is a big difference between surgeons who operate at Major University centers and those who confine themselves to community hospitals. Does you surgeon publish scientific papers, teach other surgeons, and lecture? Does your doctor have medical malpractice insurance to cover the procedures you are considering? These are helpful clues to assist you in identifying a cosmetic surgeon of the highest caliber to assist you in achieving your goals.

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October 20, 2009

Facial Fillers: A Solution to Non-Surgical Cosmetic Treatment

Filed under: Cosmetic Surgery, Restylane Injections, Under Eye Restylane — Tags: ArteFill, Botox, facial fillers, Juvederm, los angeles, Perlane, Radiesse, Restylane, Silicone oil, Zyderm, Zyplast — admin @ 8:45 pm

Twenty years ago, the only solution for removing the classic signs of aging like wrinkles, sagging skin, under eye hollows, and thin lips was going under the knife or hardcore chemical peels and laser. But today, a range of facial fillers can be injected to smooth out those facial lines, enhance lips, treat nasolabial folds, and remove furrows between the brows, taking years off the face to bring back that youthful look. What makes injecting facial fillers so attractive? Facial Fillers also known as “dermal fillers” or “injectables” offer a cosmetic treatment that is minimally invasive with little or no recovery time. Injecting fillers has become the most popular way to solve anti-aging problems in a non-surgical manner. With so many types of dermal fillers available today, choosing the right one can be overwhelming. The following sections provide useful information about some of the most widely used fillers.

What are the Main Ingredients That Constitute These Facial Fillers?
Most of the commonly used fillers are derived from Collagen or Hyaluronic acid. Collagen is a naturally occurring protein in mammals that is used to create injectable fillers that are either bovine-derived, porcine or human-derived. Bovine-derived collagen is extracted from the tissue of cows that have been raised in consistently monitored, disease-free environment. The Allergan, Inc. Zyderm® and Zyplast® product is produced from highly purified collagen collected from a closed herd of cattle. As there is a 3-8 percent chance of an allergic reaction to bovine collagen, an allergy test is required prior to undergoing treatment with this filler. The source of human-derived collagen products varies. However, the most popular of these products, Cosmoplast® and Cosmoderm® from Allergan, Inc., is sources from cultured human fibroblast cells that have been maintain in tissue culture for 10 years. These cells are the source of other human derived products used to treated burn victims and have an excellent safety record. A pre-treatment allergy test is not necessary with the human derived collagen products. Evolence® is the latest collagen product produced from porcine collagen with a useful life in the face of about a year. The longevity of collagen injections depend on patient’s lifestyle, physical characteristics, and the part of the body treated. Collagen is observed to disappear faster in areas that are directly affected by muscle movement. Only a professional doctor can help you to determine the right period required for retreatment to maintain the results.

Hyaluronic acid is a type of polysaccharide called a glycosaminoglycan. Also known as hyaluronan or hyaluronate, hyaluronic acid occurs naturally in the human body and is central to regulating cell growth and renewal. Hyaluronic acid is non-immunogenic, which means the body doesn’t consider it as a foreign substance, thus minimizing the chance of an allergic reaction. While allergies to these products do occur, allergy testing is not recommended do the low incidence of allergies to these products. Dermal fillers that contain hyaluronic acid offer a soft natural look and also have great longevity. Hyaluronic acid fillers have an added advantage in that they can be manipulated even long after a treatment using the enzyme hyaluronidase. The results are like have surgery but the magic wand was an office procedure and a treatment comfortably placed with tiny injections.

The Most Popular Facial Fillers
Restylane ®
Known as one of the most effective and popular fillers, Restylane dermal gel composed of hyaluronic acid. The non-animal biodegradable filler adds volume to the skin treating under eye hollow and dark circles. It smooths facial folds and wrinkles in areas surrounding the eyes and mouth. The effects of this filler easily last for a year or more depending on factors like age and skin type, and the initial treatment volume.

Juvederm ™
This injectable gel is the first FDA-approved hyaluronic acid dermal filler which restores your skin’s volume and addresses moderate to severe the facial folds, like “smile lines” or nasolabial folds. This filler is made up of cross-linked hyaluronic acid and effects last for an average of 6 months. Other hyaluronic acid fillers are granular in nature, but the smooth consistency of Juvederm ™ allows the injection to be administered with relative ease. Due to the enhanced ability of this product to flow in the face, it is best to discuss with your treating physician where this product will work best.

Perlane®
Another hyaluronic acid based filler – Perlane, with larger molecules and large concentration of hyaluronic acid, making it more effective to treat deeper wrinkles and larger folds. Though it is only FDA approved to last up to 12 months, it has found to be longer-lasting than Restylane ®. This product is the best of the hyaluronic volumizers for deeper lines or more active points of facial movement.

Botox ®
This facial injectable is made from Botulinum Toxin Type A and designed to eliminate facial wrinkles. It commonly treats areas like frown lines between the eyebrows, “crow’s feet,” and creases on the forehead. It primarily addresses the periocular region and its effects last up to 6 months. While Botox is not a filler, it is often used in combination with fillers to achieve results that previously could only be accomplished with surgery.

Zyplast® and Zyderm®
The first collagen based fillers approved by the FDA are made of purified bovine-derived collagen and are used to enhance facial contour and reduce fine lines and deep wrinkles. Zyderm® subtly smooths crow’s feet or fine lines around the lips. Zyplast® is used to treat deeper folds such as brow wrinkles or frown lines, and provides volume and contouring to your face. The longevity of this product is limited compared to the new hyaluronic acid fillers. The product contains local anesthetic making quite comfortable for lip edge treatment. Prior testing is needed to screen for potential allergies before actual treatment.

Radiesse ®
Formerly known as Radiance, Radiesse is made of calcium-based microspheres, the same component of bones and teeth. The filler stimulates the body to produce new collagen around the microspheres, which makes it last longer. It is utilized to correct moderate to severe wrinkles and contour the facial features. Radiesse® filler is the first FDA-approved one-year dermal filler that restores and corrects the signs of facial lipoatrophy in patients with HIV. Initially the manufacture claimed longevity of 5 to 8 years, however, clinical experience suggests that this product lasts 12-18 months when used as a facial filler.

ArteFill®
ArteFill® which is known as Artecoll® outside of United States is a dermal filler that offers longer lasting results than other cosmetic filler injections. It is made of polymethylmethacrylate (PMMA) microspheres that are suspended in bovine collagen and is mainly used to treat static facial lines, enlarge lips, fill in facial imperfections, and diminish nasolabial folds. It not only acts as a dermal filler, but its microspheres also stimulate the body to produce its own collagen. As the injected collagen slowly degrades naturally, the newly produced collagen replaces it. This leads to long-lasting, almost permanent results. Due to a tendency to form lumps, the product is not recommended for lip or lower eyelid treatment.

Silicone oil
Silicone oil has only one FDA approved indication for use in the repair of complex retinal detachments. This material finds its way into off label use as a medical grade facial filler. However, silicone oil has a number of side effects. Consequently it is not advisable to use liquid silicone for facial filler. Silicone oil is occasionally used by non-medical injectors for illegally black market treatment. Often the silicone oil used is not medical grade but rather industrial silicone oil, which was never intended for the human body. There have been deaths from these types of illegal treatments.

Benefits and Risks Involved in Injecting Facial Fillers
The biggest advantage of these fillers is that they do not require any invasive surgery and require little recovery time. While the results of fillers do not last forever, their longevity is sufficient to offer a practical alternative to surgery. In many case, the result of filler service can be better than what can be accomplished with actual surgery. Periodic top off allows the effects of service to be maintained. Side effects like bruising, swelling, lumpy firmness, and tenderness are seen in 5% of treatments. The incidence of allergic reaction varies with the products used and should be discussed with the treating physician.
Before undergoing an anti-aging treatment, it is important to consult a well-qualified and a board certified cosmetic surgeon, to help you to understand which FDA-approved filler is the best for you.

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