aesthetic plastic surgery procedures

So Many Questions – So Many Answers – Q. Which treatments are you most excited about?

Posted on September 21st, 2016
Posted by Julene

I was recently asked quite a few questions about my practice, why I do what I do, what treatments really get me excited and even my predictions for future techniques. Over the next few days I’ll share the questions and my answers.

Which treatments are you most excited about? And why?

I am a surgeon, and while I love the surgical results I can achieve for women, I fully understand the limitations of surgery, as well as the fact that not all women desire surgical intervention. With surgery, I am not directly improving skin quality…I am lifting skin that continually ages, thins, and loses youthful collagen and elasticity. If I can help patients truly improve the quality of their skin, then patients may be able to avoid surgery longer, undergo fewer surgical revisions over their lifetimes, as well as improve the surgical result and its longevity, in those who do choose to add surgery to their intervention program. Part of the way to avoid an over-operated look is to avoid too many operations. With proper surgical techniques and the addition of so many newer and more meaningful nonsurgical interventions, I love the fact that my patients are taking longer to look their age!

I am most excited about:

  • Skin care products that have therapeutic amounts of ingredients that can be combined to target the most common skin aging problems (cleansers, toners, antioxidants, exfoliants, hyaluronic acid replenishment, vitamins and growth factors, collagen stimulators, bleaching agents)
  • Injectables to treat volume loss (loss of fat and collagen) that last longer and can be used in a “panfacial” way, not just in localized areas, for the most natural results
  • Nonsurgical options that now can truly improve the quality of skin by increasing the content of collagen, hyaluronic acid and elastin (the latter being the hardest thing to increase by any modality)
  • New nonsurgical methods of tightening skin, especially in the lower face and NECK.  For so long, the neck has been the “missing piece of the puzzle”…women hate their aging necks…and surgery used to be the ONLY option to really tighten the neck in a meaningful way, since lasers cannot be used as aggressively on the neck as on the face. For skin tightening of the face and neck (and also nonfacial areas), the single greatest new tool in our armamentarium is Microneedling with Radiofrequency. The only one of these devices currently on the market that has been scientifically shown to even remotely approach a surgical facelift or neck lift is Profound, by Syneron-Candela. Scientific studies and clinical trials have proven that the amount of radiofrequency (heat) energy delivered by Profound causes an increase in the amount of collagen, hyaluronic acid, and ELASTIN in the skin. We can see increase in dermal volume (like a filler), skin surface textural improvement (like with a chemical or laser peel), skin tightening of the face and neck (best alternative to a surgical lift…one study compares it to 80% of a facelift result), and the ability to truly contour the face and neck by reducing fat in desired areas (like the fat of the jowls and neck). Some of our Before and Afters almost look like a facelift or neck lift or neck liposuction was done. Profound is a single treatment, in-office procedure with results seen in 1 to 3 months with about a week of downtime (swelling and mild bruising).
  • For the body, there is a brand new FDA approved version of UltraShape (it’s called UltraShape Power) that reduces fat 32% in each treatment area…that’s compared to CoolSculpting’s 18% fat reduction, and Sculpsure’s 13% fat reduction, making UltraShape Power the most effective fat reduction device for nonsurgical body contouring on the market today. UltraShape also allows a larger treatment area per session and more fat lost in fewer treatments sessions than all other modalities. UltraShape Power offers 20% more fat reduction than the current UltraShape device. My office is completing the clinical trial now that led to last week’s FDA approval of UltraShape Power, so this is news hot off the press!!!
  • For vaginal rejuvenation, my office just completed a clinical trial using the CO2RE Intima laser (fractional CO2 laser by Syneron-Candela, that has both facial and vaginal applications) with 2 GYN doctors to treat post-menopausal women suffering from VVA (Vulvovaginal Atrophy) or atrophic vaginal changes of menopause (stress urinary symptoms, dryness, itching, tightness or looseness, painful intercourse, prolapse). CO2RE Intima also benefits postpartum women suffering from VRS (Vaginal Relaxation Syndrome) characterized by looseness, orgasmic dysfunction, stress urinary symptoms and laxity. Some of the improvements seen are of course functional and improved by the internal portion of the laser procedure, but the CO2RE Intima laser also improves the external appearance of the labial tissues during the external portion of the treatments. This is a simple in-office 3-treatment series of the laser requiring no anesthesia or downtime, with results being seen as soon as days after the 1st of 3 monthly treatments. One annual maintenance treatment is recommended to maintain results (to deal with continued aging in both the postpartum and menopausal patient, and loss of estrogen in the menopausal or breast cancer-treated patient).

Hot Summer Trends in Plastic Surgery

Posted on July 6th, 2016
Posted by Julene

There is so much to talk about!  Unless you can come into the office every couple of months to visit with us, it can be really hard to keep up with the treatments and procedures we are loving lately!  Make sure to touch base with Cynthia or Beth and let them know if you need to update your email address on file here in the office, and be sure to “like” our Facebook page, as that does make it easier for us to let you know what you want to know!  I will do my best here to catch you up on some of the newest things we think you should know about…

After great success with UltraShape, we are now offering a spot in a clinical trial to 10 lucky patients to study the effects of a higher powered version called “UltraShape Power”.  Call the office for more details if you are interested or know someone who is.  To review, UltraShape is focused, nonthermal ultrasound permanent fat reduction, and as such is nonpainful and requires no recovery time, with measurement reductions and results seen within 2 weeks of the 1st treatment (a 3 treatment series is recommended).  We can combine UltraShape with VelaShape III for skin tightening and added results in the same treatment session.  There is no (and I repeat no) other fat reduction technology on the market that can permanently reduce as much fat as UltraShape, and all (I repeat all) competitive technology either requires more treatments be done, or smaller areas to be done, and take longer to see lesser (and I repeat lesser) results.  Scientific fact.

Profound continues to please patients who desire facial and neck skin tightening, added dermal volume, surface textural improvement, and the added ability now (with the longer needles available) to truly contour the jowl and neck fat.  All in a single treatment.  In this surgeon’s opinion, there is no better alternative to a surgical lift or lipo of the neck.  Profound can be performed in a segmental fashion (upper face and forehead = “Profound Browlift”), or just the lower face and neck (“Profound Necklift”), or the entire face and neck can be treated (“Injectable Profound Facelift”).  With the availablity of the longer needle cartridge, we can also offer a new cellulite treatment of nonfacial areas (VelaShape III and VaserShape also excel at treating cellulite).  Profound treatments are frequently combined with fractional laser treatments, like the CO2RE.

We are introducing a new skin care line from Biopelle that is best used with medical-grade skin micro-rollers for better absorption and penetration of the growth factors in the Tensage Serum.  This growth factor product is a serum for at-home use but is also applied during the mocroneedling Profound procedure.  Call the office for more information about how to begin this new revolutionary skin care program.  Your skin will thank you for it!

The CO2RE Intima Vaginal Rejuvenation clinical trial has closed, but due to incredible early results for patients suffering from stress urinary symptoms after childbirth or natural aging, another study may ensue to look specifically at the improvement of urinary leakage.  We are currently treating non-study patients and seeing great results in both the post-partum as well as menopausal age group woman.  There is a cosmetic improvement in the appearance of the external genitalia (tightening of lax tissue, treatment of dyschromia, and increased labial symmetry) as well as true functional improvement (improved sexual gratification, correction of dryness through restored lubrication, correction of itching, better vaginal canal elasticity, and either vaginal canal tightening or looseness – whichever is needed).  Call the office for more information on how to restore your sense of feminine well-being.  Results can be experienced within days of the 1st treatment.  An initial 3-treatment series and an annual single maintenance treatment  is recommended for long-lasting results.

Many of the above new procedures constitute the new “Nonsurgical Mommy Makeover”, and we are leading the way.  In fact, I have been invited to Vegas to present our “Nonsurgical Mommy Makeover” Case Study patients at The Aesthetic Show this weekend, because there is much technology that DOESN’T work.  I think it is important to continue to educate other doctors about what DOES work, whether they are plastic surgeons or not, so I remain as active in the multi-specialty arena as I do in my own professional societies of ASAPS and ASPS.  As a surgeon, I always wish to explore the best nonsurgical options for my patients…those who don’t desire surgery as well as those who wish to maintain surgical results nonsurgically.

Who better to sift through the volumes of nonsense research and less worthwhile options than a surgeon?

This is just a brief update, and we love to also use email and social media to keep up with you, so please take a minute to call the office and update your best contact info, “like” us on FB, and check our website for future updates and blog postings.  In fact, give me ideas on topics you would like to see a blog about…I’ll get right to those first!

Happy Summer!







So…what IS the best way to get rid of a double chin?

Posted on February 21st, 2016
Posted by Julene

This is a good question. I just saw a commercial for CoolSculpt’s new transducer that alleges to treat the double chin, and I just have to make some comments. After all, this is my opinion column! It’s not that CoolSculpt DOESN’T work to reduce fat on the face or anywhere else…it does do this…it’s just not the best way to do it. And before the commercial was even finished, I knew what I would see (in what I assume was the best before and after picture they could find), and there it was…a thinner neck, but one that now looked like it needed a neck lift! I mean, is that the desired result? A thinner neck but one that now has a new problem…loose skin? I don’t think so. And even more importantly, it certainly isn’t the only option out there besides surgery. In general, and I don’t care if we are talking about surgery, non-surgery, devices, lasers or injectables – whatever is being offered – I really don’t think it’s fair to create a new problem in the process of trying to reduce another. In a nutshell, while it is wonderful to be able to make a neck thinner, wouldn’t it be even more wonderful to make it look tighter at the same time, so that the patient doesn’t then wish it wasn’t so saggy? Even saggier than when it was fuller?!?

The reason that freezing the neck fat isn’t the best option for the neck is the very same reason it isn’t the best option for non-facial or non-neck areas either…the skin isn’t helped at all by freezing. Only heat can tighten skin, and in the case of CoolSculpting, the skin is actually stretched in order to be fitted between the cooling plates, so it looks worse than it did before the treatment.  In the neck, this just looks like a neck that needs lifting, because it is a small area; but in the body (like tummy or thighs), the skin can look irregular or even create shelving in these larger areas which are also incompletely treated in a single session.

So then you might ask, what IS the best way to treat a double chin? The cheapest thing to do is Profound. This device can be used (via radiofrequency heat that is injected under the skin) to contour out unwanted fat deposits (unlike with CoolSculpt for the neck, the size of the area doesn’t matter with Profound), and the heat under the skin of a Profound patient will AT THE SAME TIME cause skin tightening. About 50% – 75% of what you’d see with a neck lift surgical procedure in fact. Next on the double chin options list would be, VASER liposuction with Profound for larger double chins (still doable in the office), or lastly, the new injectable Kybella with Profound to tighten skin if necessary, however, Kybella is more expensive than in-office lipo, and one might still need the Profound to tighten the skin after it.  And let’s not forget the tried and true face/necklift with direct fat excision!

Hope that helps anyone spending time worrying about a double chin or what to do about it…



Julene :)

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