Archive for November, 2009
The lips are the most sensual feature of the face. They are also one of the most common areas of the face to augment with facial filler material, particularly in younger patients. Lip enhancement can make the individual feel more sensual and desirable adding to ones self confidence. Many practitioners do not have a comfort level with surgery of the lip to offer permanent surgical lip enhancement procedures. Often, the rest have a single noninvasive technique to offer, most commonly a Gortex implant. These carry the same inherent risk of any foreign material implanted in the body with little ability to customize the results.
Gortex implants use tunnels created under the surface of each lip from corner to corner to create a precise pocket to receive the implant. Two procedures employ a similar technique, but use the body’s natural tissues to achieve the augmentation: dermal fat grafts and SMAS grafts. The dermal fat grafts can be performed in just about any patient and requires the grafts to be taken from the bikini line resulting in a small imperceptible incision. Often this can be camouflaged with a pre-existing c-section scar. SMAS lip grafts can only be performed at the same time as face lift surgery. It involves taking part of the layer tightened during a face lift and places it in the lips to achieve a more permanent lip augmentation. In general, when considering augmentation procedures in the face, it is better to use the body’s natural materials than a foreign substance to reduce the risk of infection and eliminate the risk of rejection.
Some practitioners advocate fat transfers or injections to the lips. The lips are one of the most dynamic areas of the face undergoing the forces associated with motion. It is commonly understood that the success of fat transfers to the face is dependent on the harvest technique as well as the degree of movement that particular area of the face is subject to. The success of fat transfers or injections to the lips is uniformly less successful than other areas of the face commonly injected, as such it runs a higher risk of failure than other lip augmentation methods. Additionally, the feel of the lip can be less natural with fat injections or transfers because of the inherent differences in the augmentation materials used.
The V to Y lip augmentation procedure is a customizable, surgical enhancement procedure that allows for permanent lip augmentation whith the ability to emphasize certain subunits of the lip. Very few practitioners have experience or training in the technique and finding ones that offer it can be difficult. The incisions are on the inside of the mouth resulting in no external incisions and the lip is rolled forward to give a fuller, sensual lip. Within reason, the surgeon and the patient can choose to emphasize certain subunits of the lip, customizing results. When performed properly the V to Y lip augmentation can provide amazing, permanent results.
Two additional lip enhancement procedures that do not augment the size of the lip are the lip lift and lip reduction procedure. The lip lift uses an imperceptible incision placed under the base of the nose to shorten the white lip resulting in 2 to 3 mm of natural tooth show. Some patients have long lips naturally or as the result of aging. In either case the procedure can result in a small amount of attractive tooth show with mild improvement in the amount of red lip show. Lip reductions are for patients who have excessively large lips and involves a reduction in the overall size. Patients should not take the procedure lightly, as excessive reduction can preclude effective reconstruction augmentation procedures and result in dissatisfied patients.
When choosing to undergo surgical lip enhancement procedures patients, must understand the options available to them. There are certain indications for each procedure outlined above, and a certain amount of training required to deliver excellent results. The best practitioners have an understanding of all of the risks and benefits of the procedures and work collaboratively with the patient to develop a plan to reach the patient’s goals. Lip enhancement surgery is certainly not easy and requires the knowledge and intricacy of many techniques to deliver optimal outcomes.
Post provided by: Surgical Lip Enhancement Atlanta GA | Benjamin C. Stong MD
Since the advent of facelift surgery, the pursuit for optimal outcomes has been balanced by safety for the patient, the comfort level of the surgeon, and healing time. Today, marketing strategies are directed towards advertising minimally invasive, short scar procedures with minimal down time. Even more confusing to the body of information are terms such as the “nonsurgical face lift” and “liquid face lift.” “Nonsurgical” and “Liquid Facelift” procedures involve laser procedures and facial fillers respectively, tightening the skin or filling in the normal loss of facial volume that occurs with age. In no way do they involve tightening the deeper support structures of the face, a critical element to true facelift surgery. Many people seeking facial rejuvenation believe that aggressive skin rejuvenation procedures can provide comparable results to facelift surgery and are often dissatisfied with the final outcomes.
Minimally invasive and short scar facelifts are synonymous with the “s-lift” procedure. In these procedures an abbreviated skin incision is used, compared to traditional facelift incisions, but they have nothing to do with how the support tissues in the face are released and suspended, the technical sophistication or longevity of the procedure, or the degree of lift achieved. Facelifts are performed primarily to treat the jowls in the cheek and the vertical bands of the neck while removing excess skin from the face and neck. The procedure can be modified based on the patient’s specific concerns and issues pertinent to their case.
Commercialized, assembly line facelift procedures that promise minimal healing time often fail to deliver satisfactory results to patients because they either ignore tightening the deeper support structures of the face or do not adequately release and suspend these structures to gain an effective lift. As such, there are diverging thoughts on the correct procedure to achieve an excellent long lasting outcome, with experienced surgeons falling on either side of the argument. The most effective way to adequately achieve long lasting optimal results is to release the deeper support mechanisms of the face from the facial skeleton and suspend them with an abbreviated, camouflaged skin incision that does not effect the position of the sideburn or temporal hair tuft.
To date, the two most universally effective ways to release the support structures of the facial soft tissue are the deep plane facelift and the extended subSMAS facelift. Although these techniques have gone through an evolution and have been modified over time, they effectively release the retaining structures of the cheek and neck allowing for greater elevation and suspension and a youthful more natural look that can last 10-12 years. These procedures can be performed with the shorter skin incision techniques in order to have a well camouflaged incision that does not alter normal facial structures. A common concern among patients considering facelift surgery is avoiding a wind swept or pulled look. Contrary to popular belief, the technique used to tighten the deeper facial support structures has nothing to do with avoiding the “pulled look.” The most important element is the direction of pull on the skin when closing the skin incision, so even “minimally invasive” surgeries can result in this problem depending on the direction of pull during closure.
Healing after surgery is an important concept when considering the procedure. After excluding obvious medical conditions, there are several routine medications recommended that have questionable benefit to affect a more rapid recovery. Two herbal remedies that are routinely prescribed with facelift surgery include Arnica Montana and Bromelain for bruising and swelling, respectively. There is no conclusive data to support the benefits of Arnica Montana and Bromelain, but there is also no significant risk of adding the medications to the operative regimen.
Comfort with your surgeon is of primary importance when considering facelift surgery. Being an informed consumer is essential in order to avoid disappointing results and negative outcomes. Knowledge about all the techniques relevant to performing facelift surgery is a very important characteristic when choosing a surgeon in order to achieve optimal outcomes and avoid complications. There is no short cut to achieving good results in facelift surgery; in most cases patients are interested in one effective procedure during their lifetime, and as such it is necessary to understand the myths and truths behind the term “facelift.”
Post provided by: Facelift Surgery Atlanta GA | Benjamin C. Stong MD
Loss of facial fat volume and skin elasticity is a natural part of aging. There are many different ways to address these problems keeping in mind the patients goals and concerns as well as the capability and versatility of the practitioner. Today there is a minimally invasive, no downtime revolution. Many patients do not have the time or patience to undergo more invasive, technically challenging, effective procedures. This phenomenon coupled with more and more practitioners with little to no surgical training and effective marketing strategies, has led to a boom in the facial filler industry. The primary purpose of facial filler therapy is repletion of lost volume in the face or to augment naturally thin or small structures. The allure for injectable facial filler therapy to both practitioners and patients is the temporary nature of the treatment. Initially patients seeking facial rejuvenation procedures typically like to “test the waters” and take comfort in the knowledge that the procedure is temporary. Similarly, practitioners with less advanced training take comfort in the idea that the changes they effect are not permanent.
Collagen was the initial, biocompatible, completely absorbable facial filler introduced to the cosmetic industry. It has since fallen out of favor due to the 100% biocompatibility and more natural feel of haluronic acid fillers. The two most common haluronic acid fillers on the market are Restylane and Juvederm. Juvederm has significantly increased its market share in recent years due to studies that claim a longer duration of action (approximately 6 to 9 months), due to slower absorption and a more natural feel, because of a less granular texture. Radiesse uses calcium hydroxyapatite, a component of bone, that has a significantly longer absorption rate compared to haluronic acid fillers, but is not as smooth after injection. Consequently, Radiesse is generally injected deeper under the skin, in larger folds, and in patients with thicker skin to avoid feeling the substance after injection. Sometimes it is layered deep to haluronic acid fillers to provide longer lasting, more natural feeling results. It is reported to last approximately 1 year following injection. Sculptra is an additional injectable facial filler that is composed of small fragments of a suture material called vicryl. It is reported to have a more permanent effect because it uses inflammation to stimulate collagen deposition. It is still not widely used by many practitioners because it is less precise and predictable than other facial fillers.
The “Liquid or Lunchtime Facelift” has become a popular marketing technique in many practices promising superior results with no down time. Anytime a patient is going to have a facial filler procedure the amount of skin laxity must be taken into account. To use a common analogy, not only does the face deflate like a balloon as we age, but the skin is permanently stretched, as such with more advanced aging, filling the face with various substances without tightening the skin or facial structures can result in an over-inflated look. When used earlier on in the aging process, facial fillers can camouflage the effects of aging temporarily resulting in a more youthful appearance. As the process advances additional procedures such as skin rejuvenation and face lift procedures become necessary to achieve a more natural, youthful look. The most common areas treated in the aging face are the nasolabial folds, the tear troughs under the eyes, and wrinkles around the mouth. Augmenting facial structures in both younger and older patients is a very useful procedure to accentuate attractive features. The most common area augmented with facial fillers is the lips to improve an individuals feeling of sensuality and gain an idea of the outcome from a permanent lip augmentation procedures. Additionally, adding volume over the cheek bones is common to sculpt the face into an attractive, youthful heart shape. Most recently the term ”nonsurgical rhinoplasty,” has come in vogue and uses various combinations of the facial fillers to sculpt the shape of the nose. Although commonly marketed as a surgical procedure, in no way are the above facial shaping/augmentation procedures considered permanent or a surgical procedure.
Facial fillers offer a minimally invasive, temporary solution to reverse the effects of aging. Proper selection of the injection material and the areas to be injected is critical to good outcomes and satisfied patients. Many practitioners offer facial fillers when skin rejuvenation and face lift procedures may be indicated for optimal outcomes. Some patients may be adverse to additional, more invasive, permanent procedures electing to undergo facial fillers to gain an understanding of the possible outcomes from surgery. Also, some patients may never choose to undergo additional surgical procedures, instead choosing to continue facial filler treatments. When beginning facial fillers it is necessary for the patient to understand what is and is not possible and determine their goals collaboratively with their facial plastic surgeon.
Post provided by: Facial Fillers Atlanta GA | Benjamin C. Stong MD
Botulinum toxin is a derivative of the toxin produced by the bacteria, Clostridium Botulinum. Immunization against the bacteria is customary with childhood vaccinations, and as such it is no longer relevant as an infectious disease risk. When injected locally the toxin weakens muscles allowing precise control of the effect. Initially the toxin from C. Botulinum was used to treat neuromuscular movement disorders. In the head and neck it was used to treat Blepharospasm (uncontrolled spasm of the eyelid muscles) and an uncommon voice disorder, Spasmodic Dysphonia. From there, the medical industry recognized its benefits and expanded its role into what is now the single most common cosmetic procedure in the United States. Until recently, Botox has been the exclusive producer and distributor of the medication within the U.S. In 2009, Dysport gained FDA approval with a reported quicker upstroke during the onset period of the medication. In the cosmetic industry they are both used to relax facial muscle groups softening existing wrinkles and delaying the onset of new ones. Additionally, advanced injection techniques, can lift the eyebrow and the corners of the mouth reversing some of the effects of aging. In no way can Botox be considered a substitute for the long-term, more dramatic effects of surgical procedures.
One of the most common areas treated on the face is the Glabella, the area between the eyebrows. This area is commonly used during facial expressions exhibiting anger and is also referred to as the furrow or the 11’s. As time marches on the vertical folds and wrinkles developing in the area deepen and increase in number resulting in an angry look. The Crows feet, or smile lines, is another commonly treated area. The degree of wrinkling in this area is a result of smiling, squinting, and sun exposure. Another very common area treated is the forehead, or worry lines, with wrinkle reduction balanced by maintaining the brow position. Other less common areas treated in descending order, are the perioral wrinkles around the mouth (smokers lines), the bunny lines over the upper bridge of the nose, the vertical bands that form in the neck, and less frequently, the chin for puckering that occurs with facial expression.
Botox can be used to provide a mild to moderate lift to the arch of the eyebrows and corners of the mouth. These two procedures are commonly referred to as a chemical brow and lip lift, respectively, and can restore the youthful arch to the brow and gentle curve to the corners of the mouth. Patients should be aware that this is a temporary effect and will not offer the degree of improvement that surgical brow lifts and lip augmentation procedures do.
Once wrinkles are well formed, muscle weakening therapies offer less dramatic results than when used as maintenance or preventative therapy. As a result many people initiate therapy in their late 20’s and early 30’s. Botox therapy can be combined with skin rejuvenation or surgical procedures for additional wrinkle reduction and more global skin rejuvenation. Following skin rejuvenation procedures, Botox therapy can delay the onset and formation of future wrinkles. Botulinum therapies, such as Botox and Dysport, offer a versatile noninvasive procedure to treat and prevent the onset and effects of aging. Optimally, Botox therapy should be initiated as a preventative and maintenance therapy and combined with future skin rejuvenation and surgical lifting procedures to deliver the best results and maintain a youthful appearance.
Post provided by: Botox Therapy Atlanta GA | Benjamin C. Stong MD