In all other branches of medicine, a treating doctor assumes that the patient has some kind of medical problem that the doctor has to fix or make better. If the patient experiences some pain, gets a big scar, or has some side effects, it’s an acceptable trade off because it’s for the patient’s benefit to attain…
The Liquid facelift. I first heard about it from Heidi Rebuck, a Juvederm and Botox rep from Allergan. “The Liquid facelift” is basically what I did with my male patient, using a filler with Botox, but I think these pictures of “The Liquid facelift” are worth a thousand words. Basically, the patient in the photo (courtesy of Allergan) had Botox to forehead and “crow’s feet” wrinkles around the eyes, with tissue fillers to the lips, nasolabial folds (folds that go from side of nostrils towards the corners of the mouth), and possibly under the eyes. The change is dramatic and substantial.
Many young women come to my office when they start noticing a little bit of ‘extra skin’ on their eyelids, or sagging upper eyelids. They have heard about Eye lifts (blepharoplasty), and how easily it can be performed- under local anesthesia. Naturally, they are very interested because the procedure is performed in the office and takes only 1-2 hours. However, the Upper eye lift is not an ideal procedure. I don’t think the results are as good as a brow lift. Furthermore, if too much skin is taken off, the eye lids will have a had time closing and the patient can suffer with dry eye syndrome. In fact, I usually prefer to perform a Brow Lift instead of an Eyelift in order to achieve a better result. The Brow Lift will elevate the brow to it’s youthful position, and in the process it will lift the upper eyelids. The result is a refreshed natural appearance.
I went to see Dr. Rodriguez on Sept 25th for Lip Advanta Implants and Sculptra. I was greeted by the nicest staff and made to feel very comfortable. I was more than briefed on every option that I asked about to ensure a confident choice in procedure. After my procedure, I was a bit terrified by the immediate effects of surgery (swelling), but the entire staff assured me that the swelling was completely normal.
For forehead wrinkles, a cosmetic dermatologist will tend to recommend “therapy”, or facial fillers such as Restylane, or BOTOX. All of these injectables have to be repeated over time, with the full knowledge that if therapy is stopped, the wrinkles will come back. The plastic surgeon, on the other hand, will think of a more permanent solution, such as lifting the muscles that cause those wrinkles in the first place. Thus he may recommend an endoscopic forehead lift.
Several people have asked me if fat grafts are permanent. They keep reading from other sources that fat grafts are not permanent or that they may need another procedure. In my experience, when done correctly, fat grafts are permanent, and I have yet to do a second procedure to add more fat in any of my patients. This is because of the way fat is harvested and the choice of sites for harvesting fat are crucial to the success of the Brazilian butt lift or any other fat injection procedure. In this blog entry I will detail how I harvest fat, process it, inject it, and care for the graft after surgery. In a subsequent entry I will describe how choice of harvest site matters.
Patients are asking for specific procedures because they have been reached by the marketing efforts of Plastic Surgeons. Since surgeons are trained to do procedures, they market procedures as their product. In order to differentiate themselves in the marketplace, they come up with these catchy names to create a “unique” presence for themselves in the marketplace. Alternately, if there is a particular buzzword or catchphrase that is getting media attention, the surgeon will use it in his marketing pitch, to benefit from the attention generated by that particular “product-lift”.
Yesterday I did a Lip lift. My patient was a young woman, which is unusual for this procedure. Most women that need a Lip lift are older, and they have noticed the upper lip getting “thinner” as they age. Since the “red” part of the lip is getting thinner, they assume this is the part that needs to be augmented. So when a woman comes to me for lip enhancement, most of the time she is thinking…
Since the advent of thread lifts over the last couple of years, I keep hearing from patients wanting to know if they need a Thread lift or a face lift. A few years ago the question used to be whether they needed a laser treatment or a Facelift. The answer to either question is: It depends on what your goal is.
A British study was quoted in the news with the following teaser, “Is Botox addictive”? Here’s the short answer: no, breathe easy, it’s OK. The actual data quoted is that “up to 40% of patients feel a compulsion to have additional treatments”. Well, of course!! What else can, at such a low relative price point, for such little inconvenience, wipe years off your face? So you have it once. Hmm, that was easy! You become used to your new face because in three days, those wrinkles are g-o-n-e. Life is great, nobody is telling you you look tired, and when you look in the mirror, that’s what you’re supposed to look like!
Collagen, fascian, Restylane, etc., are wonderful options for tissue fillers, but their effect seems to be measured in months. If a patient repeats the procedure enough, the costs soon approach those of surgery. I found myself suggesting to more and more patients that they should just have surgery and make the result more permanent. Fat injections in the facial area do provide a longer lasting result than most fillers. However, fat injections are more of a surgical procedure rather than a quick injection. With fat injections, I use the patient’s own fat as a filler. The results can be dramatic and long lasting. Fat injections can be used in areas besides the face. I use a special type of fat injection is to fill out areas we never thought could benefit from large volume injections, such as the butt. I love doing fat injections, but there are a certain amount of pre and post op issues associated with it. So I look upon fat injections as a surgical procedure with a recovery time.
Most patients who come to my office don’t come in asking for a full facelift. Most come asking for a specific face procedure to “make them look younger”. If they are relatively young, they focus on the nasolabial folds the lines that go from the side of the nose to the corners of the lips). Or they may mention the lips, how they are getting thinner. If they are somewhat older, they will focus on the jawline and neck. I listen to them, because that is what they are concerned about, but then I have to ask: Do you want to look better to yourself or to others?
Last weekend (10 days ago) I went to my medical school 25th year class reunion at the University of Wisconsin Medical School in Madison, Wisconsin. I had been so driven in my surgical residency, then marriage, then being on the faculty at Yale, that wonderful memories had been buried deep. This was the first time I set foot in Madison in over 25 years!
Today I got a very nice letter from a patient who had consulted with me about Eyelid surgery. I had recommended a Brow lift with a mid Facelift. She thanked me for a very thorough and knowledgeable consult, but decided to go ahead and get just her eyelids done by an ophthalmologist who does Plastic surgery. This is an issue I encounter often, and I thought I would write my thoughts down in case anybody can benefit from this. First of all…
A lot of my patients have been asking about Thread lifts. The Thread lift is a mini-facelift which can be done under local anesthesia in the physicians office. At our last national meeting in Chicago (American Society of Plastic Surgeons), the opinions seemed to be split into two camps. The first proponents were easily visible because the “threads” are a product to be sold and the companies want to create a buzz. The detractors were in the multiple closed door meetings, po-pooing both the medico-industrial complex and the myriad “me-too!!!” early adopters.