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skin-care-plastic-surgery

Skin Care Advice From A Plastic Surgeon

Acne, lines, wrinkles, discoloration? No worries!

Walk into any store or spa and you are immediately faced with a plethora of facial skin care products to address any concern you may have ever had about your skin. It is understandable to be overwhelmed by all of these lotions, oils and serums and to leave with more questions. What is the best option for my skin? Do I need this to maintain good skin health? Is there any science behind any of these ingredients? Will I see results?

The skin is the largest organ in the human body and is constantly damaged by the effects of sun and smoke. This results in skin that is dull and dry with sun spots or other discoloration. Additionally, aging and the repetitive movements on the face from the underlying muscles can result in lines and wrinkles. How then can we address these changes or, better yet, prevent them? The answer is easy. Two products are an essential part of a healthy skin care regimen: sunscreen and vitamin A (retinol) derivatives.
Broad-spectrum sunscreen can dramatically improve the appearance and health of skin. It is designed to protect your skin from ultraviolet A (UVA) and ultraviolet B (UVB) radiation, which can cause direct and indirect cell and DNA damage. This results in degradation of collagen, an increase in pigment, and a decrease in cell turnover. Ultimately, this results in signs of facial photoaging, lines, pigment changes, and an overall unhealthy appearance to your skin. Daily use of sunscreen can diminish these signs. Additionally, its use can prevent skin cancers. Sunscreen should be used daily and reapplied throughout the day, rain or shine!

Vitamin A (retinol), and its’ derivatives, are powerful anti-aging ingredients. Retinoids, retinoic acid (Retin-A), tretinoins, retinaldehydes, and retinyl esters are all in the vitamin A family. They help increase collagen content in the skin to decrease fine lines and increase cell turnover. Additionally, they can be used to treat acne by decreasing cell debris that can block pores. Retinols can, however, result in skin irritation, peeling or flakiness, and sun sensitivity so it is important to use these products with sunscreen and under the care of your plastic surgeon.
While sunscreen and vitamin A products are the biggest bang for your buck, there are many additional acids and antioxidants on the market which may improve your skin health. It is important to consult with your plastic surgeon to find the right regimen for you. Together, your skin care concerns can effectively be addressed. Please consult with your plastic surgeon’s office prior to starting any pharmacy-grade retinol derivative to verify that it is safe for you and your current health.

Original Article Available at Here

breast-augmentation-five-factors

The Five Factors of Breast Augmentation

Breast augmentation continues to be one of the most popular cosmetic surgery procedures in United States, with 286,254 procedures performed in 2015. That’s an increase of 35% from the year 2000.

When it comes to breast enhancement, patients often feel confused or overwhelmed when selecting an implant or researching different surgical techniques. The final result of any breast augmentation procedure is determined by a series of choices that the patient (with the counsel of their surgeon) will make.

Here are the five main factors to consider regarding breast augmentation:

  1. Size

Breast implant size is one of the most important characteristics that determine the end result of a breast augmentation procedure. Breast implant size is measured in cc’s, typically from 200cc to 600cc. Implant size choices usually come down to a combination of the patient’s anatomy and the degree of naturalness of the desired final result.

Many women want an enhanced appearance without the look of being overly (unnaturally) large. To achieve this result it’s very important for an experienced plastic surgeon to educate the patient on how each implant size will alter their unique physique. One of the best ways to accomplish this is for the patient to try on different implant sizers and see how each size will look. Additionally, patients should ask to view various before and after images of previous augmentation patients with a similar body frame.

  1. Silicone vs. Saline

The second big decision regarding implants is the choice between saline or silicone implants. Saline implants are filled with sterile saline (saltwater) which are filled by the surgeon after placement. This is convenient as it allows your surgeon to set the implants to get the exact desired outcome of the patient. Additionally, the incision necessary for placement is slightly smaller compared to what’s necessary for silicone implants.

Silicone implants are made with a silicone gel that is designed to closely mimic the feel of human fat. Although there is no hard scientific data, silicone is thought to have a more natural appearance and feel. Unlike saline implants, silicone breast implants are placed in the body fully filled. Silicone implants are typically about $1,000 more than saline versions.

More recently, a newer implant option has become available in the United States – the ‘gummy bear’ implant. Gummy bear implants (known medically as form-stable, or cohesive-gel implants) are filled with thicker silicone than traditional silicone implants. They are designed to mimic the natural slope and shape of the breast. The thicker silicone filling, which is similar to that of the popular gummy bear candy, allows the implant to maintain this natural shape. The incisions required for these implants are substantially larger than those required for traditional silicone or saline implants. Additionally, the outcomes can feel more firm than comparable sized smooth round implants.

  1. Surgical Incision

There are four unique types of incisions: trans-axillary, inframammary, areolar and trans-umbilical breast augmentation (otherwise known as TUBA). Periareolar and inframammary are the two most common incisions and most surgeons are well versed in these two types. In the periareolar incision, the surgeon makes an incision near the lower half of the areola, which in turn hides the scar. This type of incision can have an optimal outcome when combined with the breast lift or mastopexy. These are often preferable in patients with poorly defined inframammary folds or in those prone to hypertrophic scarring (thick raised scars).

When performing an inframammary incision, the surgeon creates an incision in the crease under the breast, allowing the surgeon maximum access when placing the implants. This type of incision is ideal for silicone implants as it better exposes the breast tissue-pectoralis muscle interface. It is the most commonly performed approach in the Unites States and is best suited for patients with well-formed inframammary folds who have a history of favorable scarring.

Both the TUBA and trans-axillary incisions are far less common. In the trans-axillary incision, the surgeon creates a small incision in the armpit, also dissecting a tunnel to place the implant in. This kind of technique creates no scar on the breast but it does cause more of a likelihood of inferior asymmetry of the implants. In the TUBA incision the surgeon makes an incision in the naval area, dissecting a tunnel upwards towards the breast area. In these two types of incisions, the empty saline implant is then rolled up much like a cigar and led through the dissected tunnel to be placed within the breast. At that point, the implant is then filled to the pre-determined amount.

If the implant is placed deep to the pectoralis major muscle, the anatomic contour of the “cleavage” tends to be more sloped, or “natural” (again depending on the woman’s anatomy and the size of implant chosen). It is best to discuss with your surgeon, the outcome you are seeking, and inquire whether the implant should be placed on top of or deep to the pectoralis major muscle.

  1. Surface

Women can choose between breast implants with a smooth surface or textured surface:

  • Smooth implants have a higher chance of moving in the pocket (displacement) compared to textured implants.
  • Smooth implants tend to have a slightly lower rupture rate and last longer.
  • Textured implants have a thicker shell than smooth implants, generally making textured implants feel firmer.
  • Textured implants were designed to minimize capsular contracture (however, studies vary on capsular contracture prevention).
  • When the implants are placed in the submuscular space, the rate of capsular contracture tends to be the same with both smooth and textured implants.
  1. Shape

There are two types of shape options for breast implants: round or anatomical.

Round Breast Implants

Round breast implants have a symmetrical round shape. The round shape is beneficial as there is no malformation of breast shape should the implant move within the pocket. Round breast implants come in both textured and smooth surfaces and they tend to be less costly than anatomical implants.

A common misconception about round shaped implants is that they tend to look unnatural once implanted. This is not true: round implants can look just as natural as the anatomical type and vice versa. When a rounded implant is in the vertical position, they take on the same shape as an anatomical implant (which has been proven via radiographic imaging). As always, the final result of your augmentation will be dependent on factors such as your anatomy, the experience level of your plastic surgeon, and the technique used to place the implant.

Anatomical Breast Implants / Contoured Breast Implants

Anatomical breast implants were initially designed for the purpose of breast reconstruction. However, they have begun making their way into the world of cosmetic augmentation. Anatomical breast implants may look oval shaped when viewed from the front. When viewed from the side they appear to have more volume at the bottom, giving the implant a “bottom heavy” appearance since there is more volume at the bottom than the top.

One risk of anatomical shaped implants is that if they shift in position, an asymmetry can occur. To minimize displacement, anatomical implants feature a textured surface which allows for tissue adherence; helping to keep the implant in the proper position. If you are considering an anatomical shape, it is important to choose a plastic surgeon that has experience in anatomical implant placement as the pocket must be precisely created.

Original Article Available Here

Look As Good Pic

Look As Good As You Feel

So you work out, eat smartly and watch your calorie consumption but your face looks tired, and you look older than you feel. Trust me, you’re not alone. The good news is something can be done that is predictable and sustainable to make you look and feel better about your face.

The key to success is a thoughtful facial analysis, which evaluates your bone structure, muscle activity, soft tissue volume, skin quality and the position of your forehead, brows, eyelids, cheeks and neck.

Treatment plans often include skin quality improvement with techniques such as serial chemical peels. If excessive muscle activity leads to a harsh appearing forehead and brows, muscle modulation with Botox can be an excellent approach.

Looking at the upper third of the face, we evaluate brow position with respect to the bony orbital rim and its relationship with the upper and lower eyelids. On women you want the brow to be above the orbital rim with the outer third being elevated compared to the inner 2/3 of the brow. Heavy hanging brows make the eye aperture appear small and tired.

Another important factor in evaluating the upper eyelids is eyelid ptosis (the muscle mechanism which elevates and maintains resting tone of the upper lids). Eyelid ptosis must be addressed with the blepharoplasty to prevent a tired sleepy appearance despite correcting the fat pads and excess skin.

The lower eyelids must be evaluated carefully in comparison to the bony anatomy surrounding the eye and the supporting structure of the lateral canthus, which anchors the eyelids to the lateral bony orbit. Great care must be taken if you have a prominent eye compared to your cheeks and have deficient lower eyelid vertical skin coverage. Weak lateral canthi can result in excessive eye exposure leading to pain and visual disturbance.

Finally, the lower eyelid cheek junction must be inspected. A large tear trough and bulging fat pads can detract from a youthful appearance. Taking out too much fat can result in a hollow eyelid, which can actually create an even older appearance. Current techniques include judicious removal of some of the fat and then actually transposing the fat pad down onto the cheek mass obscuring the demarcation and giving volume to the cheek and avoiding a hollow look.

The midface is all about volume. As we age, the cheek fat pad shrinks in size leading to the face falling with accentuation of the nasolabial folds. In most cases midface restoration can be corrected with volume-added techniques of either fat or filler agents making tissue repositioning in this area less important. A non-invasive injection of Voluma can be a great treatment option.

The lower facial third and neck are evaluated with regard to the jaw line, chin neck angle, and the draping of the soft tissues including the skin and neck muscles. Younger people with good skin quality may well be treated with liposuction alone to achieve a pleasing neck line. If the lower jaw is small with respect to the rest of the face, a chin implant or chin repositioning may help your neck appearance, in addition to liposuction to improve results and create harmony with the lower facial third compared to the rest of the face.

Older skin, with bands of the platysma muscle showing through, is less compliant and is best treated with a neck lift procedure. This surgery includes fat equilibration, neck muscle tightening and soft tissue repositioning and stabilization around the ears.

Facial rejuvenation may initially have some pain, swelling, and bruising, but after the dust settles, results can be natural and youthful in appearance with long-lasting results that will boost your confidence beyond any wardrobe or hair makeover and make you look as good as you feel!

Original Article Available Here

Gynecomastia-1

Gynecomastia After Weight Loss

Gynecomastia-1Gynecomastia after weight loss often requires longer incisions and more contouring due to the presence of redundant skin, tissue, and fat. The goal is to create a masculine, natural-looking chest in which the scars are positioned  discreetly.

Gynecomastia surgery, or also referred to as male breast reduction, comes in different techniques based on the scar appearance. However, massive weight loss patients should accept that they need an extensive amount of work to achieve good results.
Most gynecomasia surgeries use a U-shaped incision within the lower border of the areola (about 4 to 8 o’clock) so the resulting scars blend in with the skin. With this technique, doctors are able to remove the excess glandular tissue.
However, only men with a young, elastic skin can reap the benefits of a U-shaped incision technique. MWL patients, meanwhile, generally have more redundant skin that must be removed to achieve the ideal masculine contour.
In severe cases of gynecomastia, the patient may need an anchor reduction technique in which the incisions go around the areola’s border, vertically down to the inframammary fold, and within the breast crease, leading to an inverted T-shaped scar.
Despite the more visible scar (especially the vertical line between the areola and the submammary fold), MWL patients should accept that it is the only way to achieve the optimal breast shape.
In the first few months, the scars will appear red and will continue to improve within a year. Oftentimes, they heal very nicely that their appearance will not bother most patients.
Original article available here
breast-reconstruction

Why the “One and Done” Approach to Breast Reconstruction Can Be Misleading

breast-reconstructionRecently, a news article circulated with information regarding a new “one and done” approach to breast reconstruction being available and providing promising results. Sounds great right? While the procedure has been available for some time and it can be a great option for some women, calling it “one and done” can be misleading as over 30% of women will need further surgery. For this reason, many surgeons refer to the procedure as “direct-to-implant” instead. Your plastic and reconstructive surgeon can guide you regarding details, and whether you are a candidate for this procedure.

For patients undergoing a mastectomy due to cancer, there are some things to consider before choosing the “one and done” surgery. The final cosmetic results after implant breast reconstruction depend heavily on the thickness of tissue covering the implant. Often after mastectomy, the tissues over the implant aren’t thick enough to camouflage the implant completely, even if the implant is under the pectoralis major muscle. Many patients experience visible implant “rippling” because of this and more surgery is required (usually fat grafting) to add more tissue over the implant(s) to decrease the visible rippling. This is the most common reason for needing further surgery after a “one and done” procedure.

The possibility of post-mastectomy radiation also needs to be considered. Radiation certainly doesn’t preclude breast reconstruction, but it does increase the risk of complications and can impact the final cosmetic results. Radiation can cause damage to the breast skin and soft tissue. If this tissue becomes too thin as a result, problems can result.   Patients undergoing radiation therapy after breast reconstruction often need more surgery for the best results.

One more factor to consider is the impact of nipple-sparing mastectomy (NSM). Preserving the nipple-areola may improve the cosmetic results after breast reconstruction, particularly reconstruction with implants. Talk to your surgeons, whether you may be a candidate.

For patients seeking flap-based reconstruction a single-step approach can be performed, but consistently superior results are achieved with a staged approach. Procedures such as the DIEP flap are often performed at the same time as the mastectomy (“immediate reconstruction”) allowing patients to wake up with breasts and avoiding the trauma of a missing breast. However, the newly reconstructed breast is not considered a finished product.A second surgery—or revision surgery— is typically needed a few months later to “fine tune” the reconstructed breast(s) for the best cosmetic results. This second-stage outpatient surgery often includes further breast shaping, fat grafting, scar revision, and nipple reconstruction. Once again, Radiation Therapy can affect a Flap-based reconstruction, possibly resulting in additional procedures or a misshapen breast reconstruction.

Although the idea of having everything taken care of in one surgery sounds great, unfortunately this will not always be in your best interests. Please discuss your expectations thoroughly with your Board-Certified Plastic and Reconstructive surgeon prior to proceeding with breast reconstruction.

Here Original Article Available at ASPS

 

men-plastic-surgery

What Can Plastic Surgery Offer Men?

What services are available to men?

Skin Care: The concept may seem too metrosexual at first glance, but there is a health benefit as well. Sun exposure has a cumulative effect, which damages the outer skin, and dermis making the skin look dry and leathery. Loose, inelastic skin coupled with blotches of dark pigmentation makes the skin appear older than chronologic age would suggest. This is also a set up for skin cancers. Skin care may include skin resurfacing with peels to remove the damaged skin along with micro-needling to induce collagen production and improve skin tightening to provide a much-improved appearance and reduce the potential risks of skin cancers.

The use of Botox, which will weaken the overactive muscles between the brows and around the eyes, can prevent the deep furrows of the skin thus smoothing the appearance. This agent can be employed to hide some of the muscle bands in the neck as well.

Filler agents, such as Voluma, can be easily injected into areas of programed fat atrophy which occurs in aging and results in the cheek falling, causing accentuation of the cheek folds and may produce hanging on the jaw line. Voluma, which is a highly crosslinked stiff hyaluronic acid filler, can manage to lift the cheek without making the face look fat.

Rhinoplasty: This is the art and science of the interactions of skin, bone and cartilage of the nose to provide an aesthetically appealing appearance with normal function. Rhinoplasty is a very meticulous surgery with the goal of providing a balanced appearance between the various components of the nose as well as creating harmony with the rest of the face. This surgery can provide a real boost to someone’s appearance and self-esteem.

Gynecomastia: This is a condition in which the male breast increases in size with fibro-glandular tissue mixed with added volume of fat giving it a feminized appearance. This can occur at any age, creating self-conscious situations both with and without clothing. Fortunately, the correction is very straightforward and very predictable. We recommend the use of ultrasonic energy mixed with traditional liposuction to facilitate fat and fibro-glandular removal of tissue to sculpt the breast back to a masculine appearance. There are occasions when direct excision of tissue directly under the nipple-areolar complex is necessary in addition to the liposuction to achieve the desired results, but the scaring in minimal. Without question a very power surgery that gives wonderful results.

Lipo-Sculpturing: Unfortunately, diet and exercise can’t cure all problems with the contour of the abdomen and posterior flanks. With metabolism changes, even a meticulous healthy eater with an active lifestyle can still experience abdominal bulges and flank adiposity. For patients with good skin quality without a great deal of skin excess, liposuction can provide a means of sculpting the torso to give a more pleasing shape and enhance confidence with and without clothes. The surgery is generally not that difficult to recover from, and results can be effective.

Eyelid Rejuvenation: Do people say you look tired? Do your lids hang over your eyes giving the appearance of sleepiness? Do you have puffy lower eyelids giving you a less vibrant persona? Then you may want to consider eyelid surgery to give you a refreshed look. It’s been said that the eyes are the windows into the soul; so don’t have outdated window treatments. The surgery is mildly uncomfortable with swelling being the biggest issue related to return of feeling comfortable in social situations. Careful consultation with your surgeon is required to avoid complications depending on the anatomy of your eyelids. People will notice the refreshed look after the recovery has taken place.

In summary, plastic surgery offers men many options to consider. It’s not just for women anymore.

Article originally posted here by By Dr. Jay Lucas, MD.

plasticsurgery

2016 Plastic Surgery Trends Forecast

When asked which body areas they expected to be asked about most in 2016 by female patients, the surgeons responded:

  • Buttocks – 48 percent
  • Vaginal rejuvenation – 39 percent
  • Skin rejuvenation – 30 percent
  • Neck – 29 percent
  • Face – 27 percent

Outlook for 2016 Plastic Surgery Trends

With 2016 in full swing, which procedures and cosmetic enhancements will be in high demand in 2016?

According to the experts, this year will be more focused on neck and jawline procedures, thanks to new injectables like Kybella. In fact, 70 percent of the surgeons polled believe that the chin or neck will be the most popular body part next year.

But 2016 may place emphasis on other areas, including the buttocks and breasts. Here’s a rundown of this coming year’s biggest beauty trends.

2016 cosmetic surgery trend predictions

rihannaIf plastic surgery requests in 2015 forecast anything, it was the demand for a more natural look. The days of super-sized breast implants are long gone says California plastic surgeon Dr. Lavinia K. Chong. When discussing breast augmentation with prospective patients, Chong says that women now look to smaller chested-celebrities like Rihanna, Kate Hudson and Gwen Stefani for inspiration.

Besides the request for smaller, more natural-looking breast implants, more women were also looking to downsize their 34 DD’s. 2016 is likely to see a rise in breast reduction surgeries, thanks to the likes of Modern Family star Ariel Winter, who at just over 5 feet, struggled with a 32F cup size. Winter praised the emotional and physical benefits of the surgery, which she told Glamour finally made her “feel right” in her own body.

One trend that’s probably here to stay is the request for butt augmentation, explains Dr. Sheila S. Nazarian, a Beverly Hills surgeon. Nazarian’s practice has seen a surge in butt lift procedures since last year, but believes women will start asking for a more understated backside, rather than the bodacious curves Kim Kardashian.

The Mommy Makeover has gained widespread traction in recent years, but some doctors believe this post-pregnancy tune-up will shift to a different region of the body. Nearly 40 percent of surgeons expect an increase in requests for vaginal rejuvenation in 2016.

When asked which body areas they expected to be asked about most in 2016 by female patients, the surgeons responded:

  • Buttocks – 48 percent
  • Vaginal rejuvenation – 39 percent
  • Skin rejuvenation – 30 percent
  • Neck – 29 percent
  • Face – 27 percent

In the context of male plastic surgery, doctors say that guys have more awareness about the definition of the jawline and neck. Many are turning to non-invasive treatments like Kybella, which melts under chin fat, and CoolMini, which blasts away stubborn fat pockets with a cooling device. Besides chin and neck enhancements, doctors predict that men will focus on their chest, lower abdomen and eyelids.

Originally posted here December 24, 2015, By: Ava Lawson

blog

Welcome to our new blog!

After a couple of months of planning, we are delighted to announce the launch of our new website!

We hope you like our new look, designed to make your experience user friendly and informative. In particular, we hope you like the feel of the design which is specifically intended to be easy to navigate and to reflect our forward thinking and modern approach. The site is now compatible with modern tablets and smart phones to allow you to keep in touch while on the move.

We will be updating this Blog on a regular basis to keep you in touch with all the new things happening in the field of Plastic Surgery – and there is plenty to tell you about!

If you have any questions about our new site or  any other matter, please get in touch via our Contact Page or email – drherrmann@coalcreekplasticsurgery.com