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By admin on May 31, 2010
Dark circles make a person look older, stressed and tired (no matter how you feel). There are three causes of dark circles. The most common cause in my experience is what we call “shadowing.” Most light comes from above, so any protuberance above the “dark circle” will cause a shadow and thus the complaint of dark circles. Most often the offending protuberances causing the shadow are “bags” under the eyes. These are actually fat pads which have herniated forward into the overlying muscle and skin. The treatment can actually be non-surgical or surgical. The surgical treatment is to remove the fat through a small incision either in the skin or on the inside of the lid. The latter leaves no scar, but excess skin cannot be removed by that approach. Your plastic surgeon will decide which is indicated. The non-surgical method is to inject and fill the dark depression under the fat pad with a filler, such as Restylane, Sculptra, or another indicated filler. With this depression filled, there is no shadow from the fat pad.
The second cause is from the dark blood pigment, known as hemoglobin that has leaked out of the red blood cells in the capillaries and into the very thin skin. The hemoglobin turns into hemosiderin which oxidizes when exposed to ultraviolet light, and this turns a bluish red color. This is more difficult to treat and is unaffected by topical creams that reduce melanin, such as hydroquinone. Peels, such as 35% TCA (trichorolacetic acid) can be helpful, but are usually disappointing. We are now trying Croton oil peels and the IPL laser and are hopeful that results will be more satisfying. Topical creams or serums such as New Youth Fade should also be used to reduce any excess melanin present that could add to the darkness.
The third cause of dark circles is excess pigmentation, or more specifically, melanin which is produced by our cells called melanocytes. This can be reduced by both peels and topical creams or serums with hydroquinone or other ingredients such as Kojic acid. However, both retinol, retin A, and vitamin C do have some lightening properties. Chemical peels are also effective in lightening excess melanin in the tissues. Peels do just as the name says—peel the top layer from the skin. Also think of it as removing the protective layer. So, when a peel is performed, it should be accompanied with a good professional skin care program that offers skin protection, or the excess pigment will return. Our choice is New Youth Skin Treatment System.
To treat dark circles, your plastic surgeon must be prepared to evaluate all the various causes and treat it accordingly.
E. Ronald Finger, M.D., FACS
Finger and Associates Plastic Surgery Center, PC
912-354-4411/ 800-868-9301
By admin on January 30, 2010
Doctor what can I do about my double chin?
First your doctor must analyze why you have a double chin You may classify double chins into those that have a normal placed chin (when looking from the side) and those who have a small chin, meaning the chin is set back from the rest of the face when looking at your profile.
Patients with small chins, called microgenia, will need a silicone chin implant or injections with a product like Sculptra, Artefill, Juvederm, etc. to bring the chin out appropriately. A chin implant is inserted through an incision just under the chin, and this procedure can be performed under local anesthesia or IV sedation. The resulting scars should be imperceptible. Chin implants are permanent, and the injections are temporary, with the exception of Artefill, which is also permanent.
Once this is done and the patient’s profile is symmetrical, the neck fat and skin must be evaluated. If neck fat is excessive, but the skin is good without much sun damage or loss of elasticity, the neck can be liposuctioned. Liposuction of the fat in these instances is very gratifying, and it makes the person look thinner. This can be performed satisfactorily even with mild excess of skin. The liposuction takes about thirty minutes to perform and is usually done under local anesthesia.
When the skin is wrinkled and loose, this will require either a face lift or a direct excision which leaves a scar down the front of the neck. Usually these scars are minimally noticeable, but we prefer the face lift when possible so that there is no scar on the front of the neck. Liposuction of the neck is often performed even when the skin is removed by either of the above methods.
By admin on January 17, 2010
Doctor what can be done about torn ear lobes?
Tears in the ear lobe occur from using very heavy earrings. Also those shaped like rings lend themselves to be caught in something, tearing the lobe. Sometimes the ear piecing hole is so large that it must be repaired, although there has not been an actual tear.
The ear lobe repair requires a minor surgery procedure, which is performed under local anesthesia. Basically, the scarred in tear must be trimmed to remove all of the scar tissue. This leaves the edges of the tear raw, and only then can it be re-sutured, sewing together the two edges. The sutures are removed in about five days. Re-piercing can be done in a month. The scar is almost imperceptible and there is virtually no recovery needed from the procedure.
How do you reduce ear lobe wrinkles?
Wrinkles are a different problem. Unfortunately, ears continue to grow throughout our lives, and the ear lobes thin and becomes larger. If the lobe is not too large and wrinkly, it can be inflated appropriately with one of the fillers, such as Restylane, Juvederm or Sculptra. These are temporary fixes, but correction can last for years. And it only takes a few minutes for correction. This fills out the ear lobe thereby reducing the wrinkles. The last effort, if the former solution does not work, is a surgery procedure in which a part of the lobe is excised or trimmed, a minor surgery procedure. This procedure is done under local anesthesia, requiring minimal recovery. Sutures are usually removed in 5 days.
By admin on January 16, 2010
Chin implants can offer the most dramatic improvement in one’s face, if it is needed. A small chin, called microgenia, makes a face, and particularly the profile, asymmetrical. Generally, plastic surgeons divide faces into equal thirds. The upper third is from the eyebrow to the hair line, and the middle third from the brow to the upper lip, and from there downward is the lower third. If either of the thirds is excessively small or large, the face looks disproportionate and less attractive. The lower thirds, which includes the chin is the most common problem of them all and fortunately the easiest to correct.
Once I was giving a lecture to some students and gave them a side photo of a lady with a large nose and small chin. I asked them what they would do to improve the patient’s appearance. One student said to remove some of her nose and put it on her chin. His answer was close and perceptive. For years, I repaired such chins with chin implants. The implant is made of silicone and measured specifically for the degree of correction needed. The procedure can be done under local or light general anesthesia and as said, it makes a dramatic difference in one’s appearance.
With the new injectable products, such as Restylane, Juvederm , Sculptra, Artefill, etc. the correction can be much simpler. We simply inject one of the products into the deficient chin, and make it instantly larger. All injectable products are temporary,with the exception of Artefill. Of the others, Sculptra lasts the longest, about 2 years. However, if the patient likes the result, we can then inject Artefill which is permanent. Some patients want to go directly to Artefill. A small amount can be injected initially, and more injected in 2 months or so. Non-surgical chin implants have been satisfactory in all of my patients so far, and all have been elated with what the improved symmetry can do for one’s appearance.
By admin on October 30, 2009
We have many requests for chin augmentation for those with “weak” or small or retrusive chins. When looking at a profile of a person, the chin should protrude to about the vertical level of the lower lip, or slightly behind. When the chin is set back from that position, it is hereditary and the result is an improper jaw/neck ratio. This often makes the neck look fatty or droopy and the lower lip protrude too much. The symmetry of the face and neck is off balance. Oddly, many of these patients also have a large nose, and reducing the size of the nose while augmenting the chin makes a remarkable improvement.
Chin implants are usually made of silicone and are inserted through an incision just under the chin. They must be sized before hand so they protrude in relation to the defect. Many times the implant must be longer than usual, extending much further to the sides. This is why the planning stage must be carefully performed. The procedure can be done under local anesthesia or a light general anesthesia. Recovery requires a light dressing and one can expect significant swelling for two to three weeks. Because of the swelling, the final appearance will not be seen for at least 3-4 months, although at one month the appearance will be much better than prior to surgery.
An easier, faster, but temporary alternative is injection with a product like Sculptra, Juvederm, or other injectables. Sculptra will last about two years and the others about a year, and injections require no anesthesia. The injections also give you an idea of whether you like the new appearance. If you want something permanent at a later date the implant can be inserted.
By admin on August 31, 2009
How does Sculptra work?
Sculptra is the latest of a multitude of injectable fillers to be approved for aesthetic facial anti-aging treatment. While it enters a milieu of other injectable products that are commercially available, Sculptra has the unique distinction in that it lasts the longest, about 2 years and often longer. Duration of action is usually the one injectable filler feature that is most desirable.
But before you run out to get your Sculptra injections, it is extremely important for you to realize that the mechanism of action s different than with other fillers. Strictly speaking, Sculptra is not a filler, but is more like a volumizer. The face will de-volumize or deflate with age. A analogy would be an inner tube that is filled with air. Hold the inner tube up with one hand and deflate it 10-20% and it will sag, but reflate it and the sagging is corrected. The same correction occurs when the face is “re-inflated,” although it is not as simple. So Sculptra is not an instant filler of wrinkles, but more like a volumizer. It changes the face back into a more youthful shape, which in itself reduces many of the wrinkles.
Sculptra uses a completely different approach to achieving soft tissue augmentation. Rather than merely being a filling material which breaks down and goes away in a set period of time, Sculptra does not fill, it stimulates your own tissues to produce collagen, which creates volume. The tiny Sculptra particles (poly L-lactic acid) are basically a powder, which is mixed (suspended) with water and then injected into the desired tissue. The body reacts to these particles over time by laying down collagen around the polymer seeds, a perfectly normal response. The particles are not big enough nor are there enough of them placed to result in a significant foreign-body reaction. (known as inflammation and swelling).
This approach leads to two fundamental concepts of how the biology of Sculptra works. First, water is used to carry the particles into place. This gives a very satisfying immediate effect and allows the patient to view the ultimate goal of the treatments, but it will subside within a few days to a week. The correction at this time will only be about 20%. Then the tissues will start to thicken up again due to the stimulation of new collagen in the tissues from the product, and the face will re-volumize, filling some of the depressions of the aging process. Secondly, it requires more than one injection session to build up enough collagen to create the optimal effect. Two or often three injection sessions, spaced four to six weeks apart, are needed to create an effect that will last two years or longer. Because of its mechanism of action, Sculptra can also be used to create the “cheek bone” or weak chin that have been deficient since birth
By virtue of the build up of the facial area over time, Sculptra is not best used as a simple wrinkle filler for an immediate result. Rather it is intended to be for volume restoration due to fat atrophy and aging. This requires much more of an artistic sense and truly represents a form of facial sculpting…as the name implies. In our Savannah, GA and Bluffton, S. C. plastic surgery practices, Sculptra can be very useful for after facelift touch-ups, reversing volume loss from early signs of facial aging, and, when combined with other facial treatments such as Botox, the Fraxel laser, New Youth Skin Treatment System, one can have dramatic facial rejuvenation without a surgery.
By admin on July 30, 2009
Sculptra, the re-volumizer for the face, has finally been approved by the FDA for cosmetic use. For the past five years I have been injecting it “off label,” which means it is approved for another use. Botox and most other injectable have limited approval by the FDA and are injected off label as well, but this
has been a tremendous handicap for Sculptra because it was only approved for cosmetic use in an HIV patient. We have been very impressed with Sculptra in the past as it is the longest acting injectable. It is often called the “liquid face-lift” or “face lift in a bottle.”
By admin on April 26, 2009
Various injection products are used for different problems. The appearance of age occurs from loss of elasticity as you know, but just as important is the loss of volume. You have heard the comment, “You’ve lost your baby fat” before, usually made to someone in their twenties. Well, you never stop losing it. Your face literally deflates and support is lost causing sagging. The wrinkles are from sun exposure, smoking, and lots of animation.
Injectables such as Restylane, Juvederm, and Perlane are hyaluronic acid products and used mostly for wrinkles such as the nasolabial wrinkles between the corners of the mouth and the side of the nose. Or the marionette lines dropping down from the corners of the mouth. Radiesse, a different compound, is also used for that and into deeper tissues for re-volumizing.
The most common product used in my practice for re-volumizing (inflating) the face is Sculptra. Sculptra is a powder that must be mixed with water for injection. It can be used in almost any part of the face and lasts for about 2 years. Typically, it takes about three injection sessions for maximum benefit, but some amazing results can be achieved with lots of lift. Only topical anesthesia cream is used prior to the injections.
Botox, the most common injectable product causes local paralyzing of the muscles, such as the corrugators muscles, causing the frown lines. Other areas are the “crow’s feet” just outside of the eyes and the forehead furrows.
Often combinations of injections are used if the patient has many different problems, such as deep frown lines and lots of deflation in the cheek area. This may require inflation with Sculptra or another product plus Botox.
For loss of elasticity, if one does not want surgery, a laser such as the Fraxel is best non-surgical opinion. Combining of injections with a Fraxel can reverse the appearance of age from 10-15 years.
By admin on September 30, 2008
Q: How long does a face lift last?
A: Actually, it lasts forever, but it doesn’t stop the clock. For instance, if you have a face lift at age sixty and it makes you look fifty, when you get ninety you will look eighty.
Q: Is there a way to reverse signs of aging of the face without surgery?
A: Sagging of the face comes from both loss of elasticity of the skin and loss of volume. Have you ever heard someone say, “You’ve lost your baby fat.” The problem is that we continue losing fat in our faces and thus support is lost resulting in sagging of the skin. With this in mind, correction would require a skin tightening procedure like the Fraxel laser combined with one or more of the many injectable products, such as Sculptra, Restylane, Perlane, or Juvederm which help revolumize the face. These can all be done without significant recovery. A serious skin care system would offer additional benefit