Facial Plastic Surgery
Have you ever felt like you were in a revolving door at your doctor’s office? I can recall appointments when a doctor doesn’t even look me in the face because they’re in such a hurry. It’s unfortunate when doctors feel the need to rush because they need to see more cases to get more money, or perhaps they’ve just become complacent. Maybe a sore throat doesn’t require a lot of personal attention, but when deciding to undergo a facial surgical procedure, trust in your doctor is of utmost importance.
It is my personal goal to educate patients first and foremost of the reasons why I practice medicine. I believe that patients have the right to the truth and be educated about surgical and medical procedures they are about to undergo as well as access to the most innovative and creative solutions to their problems. Medical and surgical procedures should be delivered with patient safety, long lasting excellent outcomes and customer service as the top priorities. These tenants can be applied to just about any medical or surgical practice. My practice just happens to be facial plastic and reconstructive surgery, but no matter what field of medicine I had chosen, I would have still held these core values. I want to develop trust with my patients so that they can effectively discuss their issues with me without having questions or being embarrassed. When trust is established between a doctor and patient, treatment flows smoothly. When communication is open and all questions are answered, expectations and goals are in line.
There are many other attributes to look for when forming a trusting relationship with your facial plastic surgeon.
1. Make sure your doctor is properly trained and experienced in facial plastic surgery.
2. Find a doctor who is dual board certified to ensure the highest level of education.
3. Make sure your doctor operates only in accredited medical facilities.
4. Be sure that your doctor is dedicated 100% to your goals and results.
5. Look at before and after pictures and pay attention to patient reviews.
I list these points often because of the many doctors who are performing surgical procedures under false pretenses. Treating facial cosmetic issues ranging from the aging face, aging eyelids, sagging necks, nose reshaping, and also facial trauma and skin cancer reconstruction should all be provided by a double board certified facial plastic surgeon. Facial plastic surgeons are also well versed in non-surgical procedures such as injectables like Botox and fillers like Juvederm to help improve aging skin.
Post provided by Benjamin C. Stong, MD
We’re all aware of the over exaggerated marketing efforts to brainwash consumers into believing they “need” items or services. There’s always a newer, better, more effective, healthier, promise attached. We often forget there’s a billion dollar industry behind this marketing dedicated to selling whatever the advertiser pays them to sell. There’s no difference in the plastic surgery industry. Many surgeons like me have dedicated their lives to facial plastic surgery because they love helping people. Whether it’s a skin cancer reconstruction or a facelift, I receive equal gratification. Although surgeons are highly educated and skilled at their profession, they’re still in a business that requires making money to pay their bills.
At this day and age with increasing competition, doctors are forced to perform surgeries at lower costs and possibly with increased risk to patients. To the unsuspecting shopper, these quick fixes or “assembly line facelifts” such as the Lifestyle Lift or Quick Lift, seem like a viable option to get a faster, safer facelift at a fraction of the cost. The truth is, doctors are taking techniques that have existed for years and packaging them into a so-called “revolutionary procedure.” Some doctors who offer these types of surgeries even pride themselves on the short amount of time it takes to complete the procedure. Surgery should be measured in quality, not in terms of speed.
Many of these assembly line facelift practices have been under investigation for false advertising and using high-pressure sales tactics on patients who don’t need surgery. I have seen countless patients who settled for these heavily marketed procedures that are shocked when their faces begin to sag again after a year. Perhaps results last longer in some cases, but a proper facelift should last 8-10 years. The techniques most commonly used by these practices are similar to what you might find with any facial plastic surgeon. The “S-lift” facelift yields a shorter healing period, less scarring, and smaller incision lines. Although patients may see the same named procedure, there is still a big difference in how the surgery is executed.
The assembly line facelifts most commonly only lift the skin and are sometimes accompanied by limited SMAS techniques, which will quickly fall back down with gravity. When I perform a facelift, I comprehensively lift the layer of tissue beneath the skin and subcutaneous fat in the face is known as the SMAS (superficial musculo-aponeurotic system). By fully releasing and moving this layer upward it allows the skin and fat in the face to move up as well, lifting the cheeks, jowls and neck tissues. This technique produces the most effective and longest lasting results in restoring a younger appearance.
The most important factor as a patient is to be properly educated and informed of expectations. Choosing a dual board certified facial plastic surgeon is of upmost importance to insure optimal results.
Post provided by Benjamin C. Stong MD
There are an overwhelming amount of facial beauty options on the market. Many of them promise their product will diminish your lines and wrinkles, restore a youthful appearance, and perfect your skin in ways you could never imagine. The truth is these are merely claims that are driven by persuasive advertising and most often create false expectations. This is not to say there are not remarkable products that can deliver noticeable results; there is simply an exaggeration that leads consumers to believe they can turn back the hands of time and achieve flawless complexions with a single product. Over the counter products are largely a waste of time and money. There is no miracle cure in a bottle. Only Medical grade skin care products, injectables including fillers, lasers, and facelift surgery can truly take years off an appearance. The best results are obtained with combinations of all of these products and services
I have numerous patients who come in with the same aging problems; wrinkles, sagging skin, dull complexions, age spots, and so forth. Their medicine cabinets are spilling over with every cleanser, serum, and creams over the counter on the market that guarantee results. Unfortunately, there is a common misconception that the pricier the product, the better it works. It’s important to consult with a skin expert to find out what your skin condition is first, and then we can help guide you on products or procedures that will be most helpful for you.
I often suggest Neocutis products to patients because of its unique formula of PSP (Processed Skin Proteins) that is a patented cosmetic ingredient essential in wound healing and skin rejuvenation that uses stem cell technology. Aside from nourishing delicate skin after laser procedures or surgery, the products deliver vital nutrients to skin that restore moisture and help reduce the appearance of wrinkles. I also suggest Obaji products for patients that want medical grade skin rejuvenation. Combined with a tretinoin and hydroquinone treatment, this treatment can build collagen, even skin tone, lighten dark spots, and improve superficial wrinkles. The sun is the skin’s worst enemy, so I always recommend a broad spectrum sunscreen with at least 30 SPF, uva/uvb, and zinc oxide blocker for maximum protection. As stated previously, there are no miracles for perfecting your skin and facial appearance, but drastic improvements can be made with the correct approach. During a consultation, a patient’s skin can be assessed and various options can be offered to achieve the desired results and set patient goals and expectations.
Post provided by Benjamin C. Stong MD
There always seems to be a newer and better anti-aging, skin resurfacing laser on the market. The options are almost overwhelming and the expectations can be very high. Laser resurfacing is a relatively new procedure with ablative and non-ablative options for treating common skin issues like wrinkles, acne, sun spots, and scars. Certain techniques deliver pulsating beams of light to problems areas stimulating collagen production, cell regeneration, and reduce brown spots. It can be confusing for patients to decipher which laser is the best fit for correcting their skin problems.
When I was researching lasers for my practice, I searched for a state of the art solution that could correct a wide range of skin issues. The Cutera Xeo laser is a multiplatform system that contains an intensive pulse light, a YAG, and an ablative YSGG full surface ablative and fractionated deep dermal laser. YAG is used to treat spider veins and vascular lesions (CoolGlide) as well as build collagen and treat rosacea (Laser Genesis), and an intense pulse light system (Limelight) to treat brown and red spots. A series of about six treatments can produce remarkable results and have no downtime. We often call these procedures “lunchtime fixes.”
YSGG can be utilized in two ways: traditional full skin ablative resurfacing (Pearl) and fractionated resurfacing (Pearl Fractional). The Pearl treatment can renew skin’s surface, minimize wrinkles, uneven texture and discoloration in only one or two treatments, depending on the severity of the issues. There is about 3-4 days of downtime associated with the Pearl as it will cause skin to peel and redden. The Pearl Fractional is the most effective solution for photodamaged skin in just one treatment. Patients see an improvement in skin tone, texture, sun damage, and have a noticeably brighter complexion. There is a little more downtime of about 5-7 days after the Pearl Fractional treatment.
Choosing a double board certified facial plastic surgeon who is experienced in both surgical and laser skin rejuvenation is important when considering any procedure. We provide free consultations to determine which laser works best for patients specific skin goals.
Post provided by Benjamin C. Stong MD
Most of us have moles on our bodies with the average being about 25 per person. A mole is simply a small, often slightly raised blemish on the skin made dark by a high concentration of melanin. The more moles you have, the more likely you are to develop a type of skin cancer called melanoma, which can be deadly. If your mole is larger than the eraser on a pencil, has changed colors, has irregular borders, itches, or bleeds, it should be tested to make sure it is not cancerous. The earlier melanoma is detected the outcome is drastically improved.
Sometimes moles can be precancerous and need to be removed in order to prevent them from progressing to melanoma in the future with no additional treatment other than a simple excisional biopsy procedure. If cancer is found in your mole, it is medically necessary to have a trained cancer surgeon perform a surgery to remove the cancer and possibly test lymph nodes for metastasis. When patients have this type of surgery on the face, scalp, or neck, they may frequently request a facial plastic and reconstructive surgeon to perform the reconstruction. Choosing a board certified facial plastic and reconstructive surgeon is important to ensure the patient receives the best outcome in regards to scarring. As long as the facial plastic surgeon accepts your insurance, the mole removal, cancer treatment, and reconstruction are covered under insurance.
Even If a mole does not appear suspicious, but has an unsightly appearance, patients often opt to have it cosmetically removed. This just means that health insurance will not cover the procedure because it is elective and patients are responsible for the cost. Mole removal can be performed in our office under local anesthesia in under an hour. During the mole removal process, an anesthetic is injected to numb the area so that no pain or discomfort will be felt. Using a scalpel, the mole and a minimal amount of surrounding tissue is removed in an elliptical fashion. Two layers of stitches are then carefully placed to ensure the best result for healing and scarring. An antibiotic is normally prescribed to avoid infection, and if needed, a pain medication. Most patients only need an over the counter pain reliever. After about five days, the stitches will be removed and instructions are provided on how to best care for the wound.
In addition to keeping your scar out of the sun, I suggest Biocorneum, an advanced silicone treatment with SPF 30 for minimizing the appearance of scars. If a patient is interested in having a mole removed for either cosmetic or medical reasons they may set up a consultation with a facial plastic surgeon to go over in detail what the procedure may entail prior to having the procedure performed.
Post provided by Benjamin C. Stong MD
It’s always nice to be recognized for working hard and going the extra mile. I was very pleased to learn that the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS) recently released a patented logo for use by its members. The logo signifies the highest level of education, specialization, and certification in Facial Plastic and Reconstructive Surgery. It also distinguishes which facial plastic surgeons are board certified, and most commonly double board certified, in Facial Plastic and Reconstructive Surgery and Otolaryngology Head and Neck Surgery.
Patient education is always of upmost importance when choosing to undergo a surgical procedure. It’s sometimes difficult for individuals seeking a facial plastic surgeon to differentiate which doctors are specialists in a specific area, their credentialing, or certifications. Choosing a doctor who is double board certified ensures that you will work with an extensively trained and experienced surgeon. The ABFPRS developed particular qualifications, exams, reviews, and standards in order for a surgeon to become a diplomate of the organization. Now that the logo has been unveiled, it will be easier for patients to determine which doctors are qualified and experienced to give them the best possible results.
Deciding on a doctor to perform facial plastic surgery can be a scary process. In addition to informing patients about my certifications, I always feel that it is necessary to make sure they are well-informed about my background and my experience with facial plastic and reconstructive surgery. During consultations, I take ample time to ensure the patient and I are on the same page of what expect when it comes to healing and final results. Some cosmetic surgeries, like rhinoplasty take longer to heal than a blepharoplsty. Often, I see patients who aren’t even sure what type of surgery they want. Aging cosmetic patients don’t want to look pulled and pinched, just younger and refreshed.
Medically necessary reconstructive procedures, such as trauma or skin cancer are also carefully evaluated in order to produce the least amount of scarring. I enjoy talking to patients about their expectations and tailoring options for every person. At Kalos Facial Plastic and Reconstructive Surgery, we are committed to making sure every patient receives the highest quality of care with the best result possible.
Posted provided by Benjamin C. Stong, MD
Have you ever seen someone who looks naturally unhappy or sad when they’re not smiling? It may not be what you think. Youthful, attractive lips have a full and voluptuous red lip with upturned corners of the mouth and one to two millimeters of central tooth show. As we age, our skin and soft tissues of the face lose elasticity and along with gravity, cause the upper white lip to elongate, reducing the attractive tooth show. Additionally the red lip turns inward, thinning our red lip, and the corners of our mouth to turn downward. As with other drooping soft tissues of the face, these age related changes of the lip can be addressed surgically with several different procedures.
A drooping corner of the mouth, can give a look of a permanent frown, signaling unhappiness or sadness to others, in even the happiest of people. This droop often extends to a fold at the junction of the cheeks and the lips, creating a “marionette” appearance. In extreme cases, such as seen with facial paralysis, the droop can be extreme enough to cause lateral oral commissure drooling and angular cheilitis (an inflammatory condition at the corner of the mouth due to chronic irritation).
Many patients who are bothered by this cosmetic issue are offered hyaluronic acid injectable fillers such as Juvederm, Restylane, or Belotero to push the corners of the mouth upward in addition to filling the red lip. Although fillers may be partially effective for correcting the issue, they are not permanent solutions and only last, at most, 6-9 months. A more effective resolution for a longer lasting result is a surgical Oral Commissure Rejuvenation, or as more commonly referred to, a corner of the mouth lip lift. This surgery can be done in the office, under local anesthesia in under one hour.
During the surgery, a sliver of skin is removed at both corners of the mouth and the corners of the mouth are lifted upward with a small, resultant incision. Two layers of stitches are applied with a subsequent nearly invisible incision line located inconspicuously along the outer corner of the mouth and the junction of the red and white upper lip. Stitches are removed after four or five days and makeup can usually be applied at seven to ten days. There is minimal recovery and downtime associated with the surgery and an instantaneous result. Most patients only need an over the counter pain reliever. Always be sure to choose a double board certified facial plastic surgeon with experience in lip rejuvenation and enhancement procedures when making decisions about surgery on the face and lips in order to insure the best outcomes.
Post provided by Benjamin C. Stong MD
Although we are inundated with facts and fears about skin cancer, the number of cases continues to rise every year. Because 80% of skin cancers occur on the scalp, face, and neck, I unfortunately see the damage that skin cancer causes on a daily basis. There are two main categories of skin cancers, melanoma and non-melanoma. Melanoma is the deadliest form of skin cancer. Melanomas are derived from melanocytes that create the pigment that color the skin and are most prevalent on the face where sun exposure is the greatest. Melanomas are treated best when detected early, but is also one of the deadliest cancers once they metastasize, or spread, to other organs in the body. Squamous cell and basal cell cancers are the most common non-melanoma skin cancers with basal cell being the most common. They are not as aggressive as melanoma, but can cause significant local tissue damage because as the spread through the skin, and sometimes invading important structures when left untreated.
I routinely perform Mohs reconstructive surgery when there are larger defects and for lesions that may affect areas of cosmetic significance such as the eyelids, lips, ears, and nose. The chief purpose of the reconstructive surgery for skin cancer is to repair affected areas effectively and safely, and re-establish form and function to delicate areas of the face. An experienced facial plastic surgeon is often requested by patients because it ensures that they will have the best outcome in regards to cosmesis, scarring and healing. We work very closely with the Mohs surgeons to offer patients same day service, and virtually all procedures are performed in the office under local anesthesia, avoiding a trip to the hospital and operating room.
While skin cancer is one of the most commonly diagnosed forms of cancer, it also falls amongst the most preventable cancer types. Although we have heard them all before, here are a few reminders to prevent skin cancer:
1. Forego tanning by all means. Tanning beds are actually more dangerous than going outdoors to catch some sun. The high-pressure sunlamps found in new tanning bed units release as much as 12 times more than natural UV ray exposure from sun. Many states have even banned tanning for minors.
2. Lather on as much sunscreen as you can, regardless of age. While most of those who develop skin cancer are between 45 and 55 years old, be consistent with your sunscreen no matter your age. It is always best to go for a broad-spectrum sunscreen with at least a 30 spf, uva/uvb and zinc oxide blocker.
3. Regularly check your skin for unusual growths or any change in size, shape and appearance in moles. You should schedule an appointment with a dermatologist at least once a year for check up’s.
Finding a double board certified facial plastic surgeon is always suggested when dealing with any type of sophisticated skin cancer reconstruction on the face. Visit our website to see before and after pictures of skin cancer surgeries.
Post provided by Benjamin C. Stong MD
Full, plump lips are considered a sign of beauty and sensuality. Some of us were born with thin lips or lose our original fullness with age. Most patients seek lip enhancement because they feel their lips are too thin, they are drooping, or they are wrinkled. Whatever the reason, lip enhancement is a commonly desired procedure in our office. There are a number of lip enhancing products and surgery techniques, but cosmetic lip augmentation generally refers to adding materials to the lips either surgically or with the use of hyaluronic acid injectable fillers.
The most requested and least expensive option, in the short term, for enhancing lips is injectable hyaluronic acid fillers, such as Juvederm, Restylane, or Boletero. These fillers create a fuller appearance without undergoing surgery. I use an advanced injection procedure called the Cannula Technique. This method avoids trauma to the facial soft tissues, therefore making is less painful and virtually bruise-free. The advantage of this technique is that it typically requires a single injection port. Instead of using a sharp needle to puncture the lip over and over, I make a small entrance point at the corner of the lip. Then a special blunt tip cannula is inserted into the lip and then the product is injected for an immediate fuller, natural look with no downtime. This technique is more effective in attaining a smoother fill with minimal time commitment by the patient. Although they provide excellent results, fillers only last six to nine months.
Surgical lip augmentation is for anyone who desires to have permanently fuller and more appealing lips. A person with extremely thin lips or a long upper lip may desire to have a more balanced facial appearance. I generally suggest the V -Y lip augmentation in younger patients who want to avoid repeated filler treatments or older patients who desire to plump up aged, thin lips. This procedure is performed by making incisions on the inside of the lip, with no external incisions or scars in the shape of a V and advancing them into a Y shape, rolling the red lip out for a naturally fuller lip. A V-Y does not utilize an implant, but pushes out the patient’s own lip, thus, increasing the amount of external lip show. This can be performed on the upper and lower lips. This procedure does require downtime, but ultimately creates a more natural look and feel compared to implants and fat transfers. Other good surgical options for surgical lip augmentation include SMAS lip grafting, performed as part of a facelift, and dermal fat grafting. An additional surgical lip enhancement surgery usually performed in older patients is a sub nasal lip lift, to shorten the upper white lip giving a couple of millimeters of tooth show that is lost as we age.
Since every person has different goals and expectations, I always suggest consulting with a double board certified facial plastic surgeon with experience with lip enhancement procedures and surgery prior to making the choice that is right for you.
Post provided by Benjamin Stong MD
I see patients weekly with very similar issues; Sagging skin with loss of elasticity and volume, fine lines and wrinkles. After a certain point in age, fillers and injectables can only do so much. Sometimes surgery is the only option to achieve exactly what the patient is seeking; a younger appearance. The word “facelift” can be a scary word. People can be adverse to undergoing surgery in order to look ten years younger. Often times, it is associated with looking overly pulled, windblown, and unnatural. Many people have been exposed to high profile celebrities in the media who have had countless cosmetic surgeries and ended up looking, well… scary.
Facelifts have evolved over the last several decades. Various approaches have been used to refine our techniques to produce a natural look. As we age, our skin loses elasticity and the tissues in our faces relax. Factors such as sun damage, smoking, and stress can also accelerate the aging process. These issues combined result in deepening of the facial folds, heavy cheeks or jowls, and a sagging turkey neck.
Previous facelift techniques included simply lifting or moving the skin around, which could result in an unnatural or distorted look. The layer of tissue beneath the skin and subcutaneous fat in the face is known as the SMAS (superficial musculo-aponeurotic system). When you release and move this layer vertically upward, the skin and fat in the face moves up as well, lifting the cheeks/jowls and neck tissues restoring a younger appearance. Most of the advances in facelifts have been the refinement of SMAS lifting techniques. When you move the SMAS upward in a vertical direction, you are undoing what aging and gravity have done, by putting things back in a natural and more youthful place. This innovative advancement in the procedure provided dramatic results, and when coupled with the most contemporary smaller s-lift incisions, also less scarring and downtime. Patients are often surprised to learn the facelift has a virtually painless recovery. Patients often tell me that they either took only a couple of pain pills or Tylenol only. Additionally, when performed correctly, a patient can have more than one facelift during their lifetime while still maintain a natural look. I often tell patients that you don’t recognize patients who have had natural looking facelift surgery, well, because it looks natural……or “they live among us” so to speak.
Facelifts are becoming a much more common procedure that when performed by experienced and knowledgeable surgeons can lead to extremely gratifying results. Finding a Double Board Certified Facial Plastic and Reconstructive Surgeon is important when selecting the doctor to perform such an intimate and personal operation. Visit our website to see before and after photos of our happy patients!
Post provided by Benjamin Stong MD