January 31, 2010

What is the Best Chemical Peel?

There are a number of effective, safe chemical peels available that can do wonders in restoring your face to a healthier, more youthful appearance.  These peels can be applied in a variety of strengths, concentrations, and combinations depending on your skin type and the extent of damage your skin has incurred over the years.  Your cosmetic surgeon can determine the best one for you by examining your skin type, condition, and goals.  This way you can agree on the best chemical peel that will rejuvenate your skin without damaging it.

Chemical Peel Before and After Photo

Chemical Peel Before and After Photo

When Do I Need a Chemical Peel?

Your doctor will go over this with you at your consultation.  Some general indications are:

•    acne with or without scaring
•    dark spots that have developed over time
•    aging skin from sun exposure
•    intrinsic skin aging
•    fine lines
•    creases and deep furrows
•    loss of skin elasticity
•    scaly dry skin with irregular brown spots
•    premalignant lesions
•    an overall yellowish hue to the skin due to chronic sun damage

Some patients may benefit from other procedures, like a facelift or facial filler, which can only be determined by an experienced surgeon at an individual consultation.

Which Chemical Peel Should I Get?

This depends on factors like the condition of your skin and what kinds of problems it has, your treatment goals, your skin color as classified by the clinical Fitzpatrick scale (which factors in how easily you sunburn), and other individual conditions.  To give you an idea of available chemical peels, here are some that are effective depending on the personal circumstances:

Alpha Hydroxy Agents

This peel is usually delivered in a series of treatments to improve mild brown spots and freshen the skin tone.  We derive alpha hydroxy acids (AHA) from fruit and dairy products, most commonly using glycolic acid to smooth the skin.  If your skin is suffering from discoloration and darkening from damage, skin bleachers combine synergistically with AHA to lighten the skin nicely.  Repeated treatments yield new collagen and elastin, which is thought to reduce skin sagging.  AHA can be used in an acne facial peel to improve your complexion, too.  Very low concentrations of about 2-15% are available over-the-counter, which generally are not concentrated enough to cause dramatic improvement on their own, but can be used as an effective at-home treatment in conjunction with stronger treatments from a cosmetic physician.

Jessner’s Solution

This balance of resorcinol, salicylic acid, and lactic acid is a mild treatment that can be combined with TCA to treat the skin more deeply.  When combined with TCA, which by itself is a mild to moderate peeling agent, Jessner’s Solution is a mild peel with increased skin effects.  Generally, those being treated with Jessner’s peel alone need frequent treatments (perhaps monthly) and would likely benefit from a stronger peel performed two or three times per year, which would create similar or better results.

Trichloroacetic Acid

Depending on your needs, your doctor can apply trichloroacetic acid (TCA) in any number of strengths to achieve your desired results.  Depending on the concentration strength, your doctor may administer a regional anesthesia and oral or intravenous sedation to ensure your complete comfort.  After TCA treatment, your skin will be fresher and smoother.  Generally the maximum concentration of TCA used is 35%.   TCA solutions of 50% are less predictable and can sometimes result in scaring.  The better option is to opt for an effective but less concentrated treatment that will provide predictable benefits without unwanted scars or use phenol which will safely peel deeper into the skin.  The exception to this is the so-called Cross method using 95% TCA for acne scar pits.

Phenol

This peel, when made into an 89% solution, creates a medium-deep chemical peel used to peel the face.  Phenol formula is remarkably effective at addressing problem lines, improving all but the deepest ones.  The tightening of the facial skin achieved with this treatment can, in some cases, rival facelift results without the need for surgery.  This peel can address sun damage, sun-spots, pre-malignant actinic keratosis, which left untreated can progress to in-situ squamous cell carcinomas. Since this agent is both strong and effective, your doctor must be cautious in its application.  Conservative applications are best because, when overdone, phenol can contribute to scaring, but in lower quantities it is a reliable, powerful treatment.  Very few patients require treatment of this depth on their whole face.  Instead, your doctor should use phenol to treat only small areas of the face where problems are most severe.  It may take 10 to 12 days to heal from a phenol peel while your skin rejuvenates.  Because the skin can stay red up to four to six months, some patients wear coverup and love their results, while many men find that this subtle hue readily blends into their complexion without concern.

Are Fruit Peels Safer Than Chemical Peels?

It’s important to understand that fruit peels are chemical peels, but milder and usually less effective than the chemical peels outlined above.  The word “chemical” scares a lot of people, but it’s important to understand that everything is a chemical, scientifically speaking, and chemical peels have a safe track record.  Fruit peels are generally made of mild alpha hydroxy acids and citric acids extracted from fruits.  Some may think it’s better simply because they hear the word “fruit” instead of “chemical,” but this peel is superficial with minimal benefits.

Should I Get the New Melange Peel?

This peel, which you receive at an office and then leave on for several hours at home, does receive a lot of internet hype.  There have been fantastic claims made about the Melange Peel. It is important to separate marketing hyperbole from reality: while you can expect mild improvement in skin tone, the real issue is do you get real value for what you have been asked to pay?

Expert Treatment

Chemical peels are not something a doctor can learn in a weekend seminar, but something a doctor must perfect by treating hundreds of faces.  The peel is an art form and your physician will assess the best peel or combination of peels for your unique situation.  Find a board certified surgeon with actual fellowship training in cosmetic surgery who has a long history performing facial peels for satisfied patients.

Dr. Steinsapir demonstrates his face peel expertise through years of experience, and his chemical peel before and after photos demonstrate his skill as both a cosmetic surgeon and an artist.  Call us today to schedule your consultation and find out which peel is most suitable to your needs.

January 27, 2010

Can I have cosmetic surgery under local anesthesia?

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 17, 2010

Anchor Blepharoplasty: Is It for Me?

Anchor blepharoplasty addresses, loose, crepey skin on the upper eyelid platform by tightening the skin between the upper lashes and upper eyelid crease.  This platform may become loose and sag, giving an unsightly appearance of tired eyes with sagging eyelashes, a form of ptosis.  For women, having skin in this condition makes it very difficult for the eyelid to hold makeup, creating a problem that is difficult to artificially enhance. For both women and men, it can make the eyes look dull.  The discreet nature of the incisions used in an anchor blepharoplasty means that this procedure will not contribute to visible external scarring, nor will it impede your healing process. This safe treatment should be part of every upper blepharoplasty to ensure that the lashes are properly supported.

Cosmetic Anchor Blepharoplasty and Ptosis Repair

Cosmetic Anchor Blepharoplasty and Ptosis Repair

Whether anchor blepharoplasty is for you depends on your candidacy for upper eyelid surgery, as we previously discussed – for example, if you have puffy, sunken, asymmetrical, or tired eyes then you may benefit from an upper blepharoplasty and thus an anchor blepharoplasty.  This is an essential part of correcting upper eyelid problems.

Is this a separate procedure from blepharoplasty?

Ideally, no.  Your surgeon should perform the anchor blepharoplasty as part of your regular upper blepharoplasty to correct tension problems along the eyelash line and ensure that your eyes look bright and lively.  However, performing an anchor blepharoplasty is a highly specialized, technical skill, and it takes the most experienced surgeons to execute this procedure.  If you go to a doctor who does not offer this procedure in conjunction with your blepharoplasty, then you may be setting yourself up for disappointment and possible revisional surgeries.  If your eyes have already healed with droopy lashes and loose skin, then it’s time for a consultation.  It’s always a good idea to find out if your original surgeon can help you resolve this issue.  However, the most common reason it was not performed at the time of the original surgery is that the surgeon lacked the skills necessary to incorporate structurally important element into the eyelid surgery.  If he or she can’t, or you lack confidence in their ability, then seek a second opinion.

The right doctor can easily correct problems with a properly designed anchor blepharoplasty.  Since precision is key to obtaining a great outcome, you should find a surgeon who has performed this procedure numerous times and recognizes its importance.

How long should I wait after surgery to receive a corrective anchor blepharoplasty?

Allow yourself several months to heal before seeking revisional surgery, assuming you’ll still want it when you are close to your final results.  Certainly keep communication open with your doctor so he or she can address your concerns and keep a close eye on your recovery, and it is also fine to seek a second opinion to decide on the best time for another eyelid procedure.  Unless it’s an emergency as we discussed in our last post, you should finish healing before undergoing more procedures in the same area.  This will enable your doctor to correct your eyelid tension with the fewest possible variables that may affect the outcome of your surgery.

I’m ready to talk to a professional about my concerns.

Consulting with an oculoplastic surgeon is the single most helpful action you can take when deciding whether anchor blepharoplasty is right for you.  You’ve done a bit of research, and now you need an examination by an experienced doctor who can accurately diagnose your problem and recommend the best treatment course, or no treatment when none is necessary.  If you haven’t yet had a blepharoplasty, be sure to ask your potential doctor about an anchor blepharoplasty so you love your results the first time.  If you need revision, a consultation will help you determine if an anchor blepharoplasty is ideal for your individual needs.

Dr. Steinsapir considers anchor blepharoplasty a normal part of upper eyelid surgery.  For evidence of his skill and attention to detail, we welcome you to browse his before and after blepharoplasty photos, where you will notice the alert position of the eyelishes and properly tensioned eyelid platform skin.  Dr. Steinsapir is a top eye plastic surgeon in Los Angeles who holds an impressive list of publications, qualifications, trainings, and certifications, including the multiple fellowships he has completed and his professorship at UCLA.  Contact us today to schedule your personal, individualized consultation with Dr. Steinsapir and learn how he can resolve your upper eyelid concerns.

January 4, 2010

What’s the Difference between Dysport and BOTOX?

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.

January 3, 2010

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

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.

November 24, 2009

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

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.

November 18, 2009

Can I Get a Fotofacial If I Have Asian Skin or Olive Skin?

Fotofacials, also known as IPL (intense pulsed light) Photofacials, are great for correcting sun damage and uneven skin tones. If you have unwanted reds and browns in the skin, a fotofacial can create an even tone and revitalized complexion. Fotofacials also diminish small wrinkles and the appearance of pores. Although fotofacials are said to work best for those with light complexions, do not rule out fotofacials if you have a darker complexion.

Skin Pigmentation

Melanin is the component that primarily determines our skin color. The genes we inherit from both of our parents determine how much melanin and what type of melanin we have in our skin. Depending on this genetic makeup, our skin may be anywhere from very light to very dark, and it may have different shades of browns, reds, and olives present. Melanin is responsible for the diversity in human skin colors, and is something to celebrate. Individuals with Asian skin or olive skin can take pride in their heritage and natural beauty. Higher concentrations of melanin in the skin protects the skin from the damaging effects of the Sun’s rays and can delay aging changes in the skin compared to relatively lightly pigmented skin. Sun damage, aging, acne scars, and prominent blood vessels also affect our skin’s appearance. Fotofacials target this damage in the skin, renewing your natural, healthy complexion.

Melanin and Fotofacials

The goal of a Fotofacial is usually not to lighten the skin overall, but to give it a more youthful and healthy appearance by gently correcting sun damage, color spots, blood vessels, and inconsistencies in skin tone. A Fotofacial is not about becoming whiter or lighter. Instead, Fotofacials improve damaged skin, close small capillaries and red spots, and stimulate collagen production. The diminished appearance of wrinkles and pores further improves the complexion.

The Intense Pulsed Light administered during a Fotofacial targets melanin, but it is important to understand what this means. Instead of whitening or lightening the skin overall, Fotofacials target selected areas where melanin is most concentrated. Because sun damage can increase the amount of melanin in the skin, and damage can occur unevenly, a properly tuned Fotofacial targets the areas with the highest melanin concentrations. This allows the excessive melanin from sun damage, freckles, and Sunspots to be separated from the intrinsic skin melanin. Sun damage can be improved without harming the natural tone. As the natural skin tone increases, less energy is used for each Fotofacial treatment. Provided the spots on your skin darker than the surrounding skin, you may be a good candidate for a Fotofacial. To get the most from your Fotofacial, it is important to choose an experienced physician with broad experience treating a wide variety of skin types.

Risks

If your problem areas are not significantly darker than your natural skin tone, a successful Fotofacial may be more difficult to achieve. With Asian skin, it is easy to underestimate the amount of pigment present, resulting in burns, blisters, and even skin discoloration. This happens when the IPL treatment power setting is too high. If the power setting is too low, however, you will have no benefit from the treatment.

The best way to avoid this is to have an experienced doctor administer the Fotofacial, rather than have a nurse, technician, or medical assistant administer the procedure. Many practices routinely turn over Fotofacial treatments to nurses and technicians, who do not have the expertise of a fully qualified doctor. Nurses and technicians rely on standard recommendations for power settings, rather than observing how your unique face is reacting to the treatment and adjusting the power settings accordingly. This is why the immediate presence of a physician is highly beneficial to get the greatest benefit from your treatment.

Individualized Treatment Plans

When you are seeking a doctor, ask as many questions as you have. Press the doctor to find out if he or she has experience with your skin type. Ask the doctor how he or she makes treatment decisions to get a feel for how insightful the doctor is. The doctor most likely to achieve great results will be one who has worked with a variety of skin types, including yours. A doctor who has worked with your skin type has first-hand experience necessary to achieve the best treatment results. A doctor who has a history of treating diverse skin types can distinguish differences in treatment, both subtle and large, that each skin type requires. If your skin differs somewhat from similar skin types, the doctor’s range of abilities will help him or her figure out how to adjust your treatment accordingly.

When questioning doctors to find the one right for you, ask who is and isn’t a suitable candidate for a Fotofacial. A good doctor will be happy to answer your questions without making you feel stupid or like you are wasting his or her time. A competent, honest, and ethical doctor will admit that certain complexions may not benefit from this treatment. An ethical practitioner will also be honest if this treatment is not suitable for your complexion.

Fotofacials often benefit people with Asian or olive skin. Depending on the individual nature of your skin, a Fotofacial may help you. However, because your skin type presents certain challenges, you may be better off without a Fotofacial. The only way to know for sure is to consult a doctor who specializes in Fotofacials and has treated a wide range of skin types.

What to Expect at a Consultation

Call Dr. Steinsapir today for a consultation. He will assess you personally to determine if Fotofacial will be beneficial for you. If a Fotofacial is not right for you, Dr. Steinsapir will tell you about more suitable options. If you are a candidate for Fotofacial, he will personally perform your Fotofacial to maximize the benefits according to your needs and the needs of your complexion.

October 26, 2009

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

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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