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By admin on January 31, 2010
Artefill is an injectable product used as a wrinkle reducer. It is FDA approved for injecting into the smile lines between the nose and the corner of the mouth. Basically, it simply fills the wrinkles like Restylane, Juvederm and other fillers. The difference is that Artefill lasts much longer, probably five years or more. About 20% of the product is the actual Artefill, which is PMMA microspheres, and 80% is collagen. So it is the 20% that is considered permanent. However, because of the collagen, a skin test must be performed prior to its use. Typically, a small amount of the collagen is injected just under the skin, and then we wait 30 days to see if there is an allergic reaction such as redness, itching, or irritation. I have been injecting the product for several years and have not seen an allergic reaction yet.
I believe its best used in places of maximum activity, such as the smile lines or the marionette lines that go down from the corners of the mouth. Another excellent place for Artefill is in the chin. Many people have small chins which do not protrude enough for the rest of the face. Usually, a silicone chin implant is used for correction. This is a minor surgical procedure with some recovery time required. Artefill can be injected in a few minutes and there is essentially no recover period needed.
Since only 20% of the product is actually the PMMA microspheres, an injection will probably be under corrected. An additional injection or more can be expected for complete correction.
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 19, 2010
Hormone deficiency: menopause, andropause, somatopause and Bio-Identical Hormones
In women menopause is the cessation of hormone production (estrogen, progesterone and even testosterone) that occurs at about age 45 to 50 years old. In men, it is called andropause and is a cessation of testosterone production. It occurs at a much wider range between 40 and 60 years old. Somatopause relates to decrease production of growth hormone, which starts at about 30 years old and continues throughout life. It occurs in females and males.
The most common symptoms of menopause are night sweats, depression, and hot flashes. Additional signs are weight gain, earlier death and dementia. Andropause results in loss of muscle mass, weight gain, loss of the youthful shape of mass in the shoulders, larger abdomen and trunk size, moodiness, depression, loss of energy and sex drive. Both andropause and menopause contribute to mental decline, increased body fat, cardiovascular disease and cancer mortality.
A well documented study was the WHI, Woman’s Health Initiative published in April, 2004 in the Journal of American Medical Association. The problem with the study was they only used synthetic hormones, and not bio-identical hormones. This resulted in increase in breast cancer and cardiovascular disease. Numerous studies show just the opposite using bio-identical hormones, namely decreased cardiovascular disease, breast cancer and dementia.
Bio-identical hormones are plant derived but the chemical compounds are identical to those of humans. An example of synthetic hormone is Premarin, which is derived from pregnant mare urine, thus pre-mar-in. There are about 30 compounds that are unnatural to the human being. Provera is a synthetic progesterone and has been linked to increased cardiovascular disease and breast cancer. Unfortunately, many doctors stopped prescribing HRT (hormone replacement therapy) because of this study.
The hormones we are concerned with in women are estrogen, progesterone, and testosterone and in men only testosterone. While we find more estrogen in women and more testosterone in men, the difference is the amounts. Women have more estrogen and men more testosterone. However, at age 50, men may have more estrogen than women. Women have a reduction in estrogen production and in men, testosterone is converted into estrogen. Both sexes have a decline in testosterone.
These problems of hormone deficiency can be treated with HRT, hormone replacement therapy, and only bio-identical hormones should be used. For women estrogen and testosterone can be replaced with compounded creams, tailoring the doses individually to the patient. An even better solution is the estrogen/testosterone pellets. These are inserted into the lower abdomen or upper buttocks through a very small incision and will last 4-5 months in the female. Women also need bio-identical progesterone replacement, which is given by oral capsule. In the male, only testosterone is replaced, and it lasts 5-6 months.
Testosterone creams are not advocated for the male because of the increase in DHT (dihydrotestosterone), which causes prostate enlargement and hair loss. If this occurs, it can be treated with Avodart, if necessary. Oral testosterone may cause liver damage. The pellets do not have these problems.
Prior to treatment, lab tests must be done to determine the patient’s hormone levels. Additionally, men must have a PSA drawn to determine prostate health. These lab tests will be repeated prior to the next treatment, then thereafter about once a year.
Hormonal balance is one of the primary factors in age control, and it is impossible to feel or look as good following menopause or andropause unless HRT with bio-identical hormones is used.
E. Ronald Finger, MD, FACS
Finger and Associates Plastic Surgery Center
Savannah, GA
800-868-9301
912-354-4411
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 January 8, 2010
Generally, the eyelids are the first areas of the face that show one’s age. The problem can be with the upper lids or the lower lids, but it is usually both upper and lower lids. The upper lids accumulate excess skin, which eventually can cover the actual upper lids and sometimes even the lashes. If this is seen in young people, it is hereditary, such as in the Asian population or people with distant Asian heritage. Whether it is from aging or congenital, it can still be corrected with eyelid surgery, the eyelid lift. An added benefit is often a better visual field, which means that your peripheral vision is better. Sometimes upper eyelid lifts may be covered by your insurance policy, but the problem must be severe. The youngest patient I have performed this procedure on is 22, and now 30 years later her eyes still looks beautiful. Eyelid lifts can be done under local or general anesthesia. My preference is local anesthesia with some mild sedation.
With the lower eyelids, the problem in the younger patients is “bags” under the eyes. These bags are actually fat pads protruding through the skin. Often these patients have an under-developed bony rim under the eye, which makes the fat protrude even more, but it can still be corrected. In the older patients, there is an accumulation of skin also causing wrinkling, especially when smiling, and usually this is in addition to the “bags.”
If the problem is just the protruding fat, the incision can be inside the eyelid, leaving no scar. This is called a transconjunctival incision. If skin must be removed also, the incision and scar are in the skin just below the eyelashes extending outward beyond the eyelids for about ½ inch. Extending the incisions laterally helps remove the “crow’s feet” which are the smile wrinkles lateral to the eyes. The anesthesia is the same as with the upper lids.
During the recovery period, ice packs are placed on the eyes for two days to minimize swelling, but there will still be some swelling and bruising. The sutures come out in five days, and most of the bruising and swelling has subsided enough for one to return to their daily routine in 7 days.
In my opinions, eyelids lifts rejuvenate the face more than anything else in most cases. People talk to your eyes, and beautiful eyes are wonderful to look at.