aesthetic plastic surgery procedures

FILLERS: Juvederm, Restylane and Perlane

Posted on August 12th, 2014
Posted by Julene

One of my all-time favorite “quick-fixes” has to be a quick injection of Juvederm, Restylane or Perlane. It’s a fast, affordable, no down-time procedure to remove folds, scars, wrinkles, and fine lines…or a quick way to lift the corners of the mouth… or give shape or volume to the lips…or erase lip lines. Fillers are used in localized areas of the face to plump things up a bit. They are naturally-occurring sugars, well-tolerated by the body, because they are normally found in the deep layer of skin known as the dermal layer (or collagen layer).  A natural consequence of the aging process is loss of collagen and fat, and fillers provide a quick way to restore both. The ideal place for a filler is in the nasolabial folds outside the mouth, the prejowl sulcus, the tear trough (although I prefer Sculptra here), and the lips (my favorite!). Because they are made of a material naturally found in the dermis, there is no need for skin testing and few side effects have been reported. It takes about 20 minutes to inject these products, results are seen immediately and last up to 9 to 12 months or more. The only side effects seen include slight bruising at the injection site in about 10% of patients, although if patients consume aspirin or non-steriodal anti-inflammatories on a regular basis, we advise patients to discontinue these medications for several days prior to an injection. For the heavy bruiser, we administer an herbal combination of arnica and bromelaine 2 days before injection. Juvederm and Restylane are similar, with slight differences in the amount of crosslinking of the hyaluronic acid gel, and are also used in the lips, either to smoothe fine lines at the vermilion border, or to give shape and/or fullness to the lips themselves. Beware…fillers to the lips can be addictive if performed correctly (ie, artistically)! My least favorite thing is poorly done lips…and my most favorite thing is well treated lips! Fillers to the lips can smoothe the fine lines as well as give that “Cupid’s Bow” shape back. The goal is not always to enhance volume, although we can certainly shoot for that result in the thin-lipped patient. But too often, I see big lips that have become larger at the expense of shape. In the attempt to add volume, loss of all of the pretty Cupid’s Bow shape might occur…I call these lips “sausage up and sausage down” = UGH. Hence, my affinity for injecting lips…it requires an artist’s eye.

The typical cost of a filler injection is anywhere from $500 to $650 per syringe, and most injections require one to two syringes…occasionally more, depending on the patient. Perlane is a product used for fine lines, but is also a naturally occurring sugar well-tolerated by all patients. Many patients combine these products in a single treatment.

So if you are not quite ready for a facelift…don’t despair! Cheating is always allowed! Call us and see what you might have been missing!


TIP # 5: VASER Shape (with or without HcG)

Posted on July 14th, 2014
Posted by Julene

Are you tired of that bulge here and there? Are you already working out and eating smart and can’t lose that weight? Are you hitting menopause and experiencing that creeping weight gain around the middle? There is an easier way to focus on unwanted fat and an easier way to jump-start your metabolism and achieve quick weight loss with a little effort. Even better…you can use my method (Tip #5) once or twice a year if you are in that menopausal age bracket where there is a natural slowing of metabolism and a natural decrease in hormone levels that help regulate your weight at a stable place.

Enter…the nonsurgical body contouring technology. In the spring of 2010, I decided to incorporate nonsurgical body contouring into my surgical practice which already included liposuction and tummy tucks. This seemed a natural progression to me, because as a plastic surgeon who can perform the ultimate body contouring procedures through surgical means, I felt that we needed to provide a totally nonsurgical method OF VALUE as an option, and who better to research options than the type of physician who can offer BOTH surgery as well as non-surgery? I personally believed that the only way to “keep the industry honest” is for surgeons to remain involved as leaders in the development of nonsurgical technologies, especially since we are the only ones who can also do the surgeries. In other words, a surgeon is not going to be as quick to offer a patient a nonsurgical approach if they know that surgery is really still the best option for a given patient, whereas, if a patient is seeking the advice of a non-surgeon, they will probably not be offered surgery even if it is the best option, and could therefore potentially be sold a procedure that proves to be a waste of time and money. This is not to say that a non-surgeon can’t offer meaningful nonsurgical contouring approaches, but as a consultant to many device manufacturers today, I can tell you that surgeons and non-surgeons definitely approach the technology from different angles, and surgeons tend to not look twice at technology that is too under-aggressive, or too subtle in its results. Quite frankly, I just won’t mess with a treatment, or endorse it for my patients, if it’s results don’t impress me, or if it takes too many treatments to see results, or if it is too painful. After all, I can do surgical liposuction under oral and local sedation IN MY OFFICE without anesthesia, so why would I recommend a nonsurgical body contouring treatment that is so painful that the patients need to be heavily sedated to perform it, or if they achieve only an inch of change after waiting 6 or 8 weeks, and then require re-treatment???  I would just operate on that patient and be done with it in one session!

So what exactly is my current favorite weight loss trick?  I like a quick fix…I am a surgeon after all!  And as a menopausal woman myself (but you can’t tell from my ever-sunny disposition), I like to combat the natural decreased metabolism of menopause with a direct fix…a metabolic boosting agent.  A very safe and quickly effective one is HcG…the pregnancy hormone, human chorionic gonadotropin.  Just as in pregnancy, HcG increases metabolic rate, it decreases appetite, and it helps us burn our “abnormal” fat (belly, flank and thigh fat).  It is very safe and works quickly when used in its injectable form (we use the subcutaneous injection route, like a diabetic shot in the fat), with a low calorie diet we provide to the patients.  There are very few contra-indications to the use of HcG, and I have been prescribing it for my body contouring  patients who are looking to increase their single-step surgical results in a shorter time-frame, as well as now for my nonsurgical patients who are using VASER Shape.   We prescribe a 3 week supply of HcG at a time, and the cycle can be repeated if more than 10 to 15 pounds of weight loss is desired.

Then there is VASER Shape, our favorite nonsurgical body contouring approach.   Most of my patients who desire body contouring want both tighter skin and reduction of unwanted fat.  I have researched all available technologies and now serve as a consultant to several device manufacturers, and by far the best technology out there to accomplish both of these goals at the same time is ultrasound.   There are devices which tighten skin (radiofrequency or Exilis), and devices which freeze fat (Cool Sculpting or Zeltiq), and then there is ultrasound which can affect both fat and skin at the same time.  But there are different kinds of ultrasound technology.  There is focused ultrasound (Liposonix, Ultrashape and Ulthera) and there is nonfocused or lightly focused ultrasound (VASER Shape).  Focused ultrasound is painful as it works via very high temperature or very high negative pressure, and the zone of fat affected is only a thin rim or band of fatty tissue because the ultrasound energy is so focused.   Due to the type of tissue injury induced, patients also have to wait 6 to 8 weeks to see any true volume reduction, less volume of fat is affected overall, and there is virtually no skin tightening seen.  In contrast, VASER Shape is very comfortable to perform, there is ultrasound applied to the skin for the skin tightening effect, and below the skin in the fat, the energy is lightly focused to affect all layers of fat in a single treatment.  Because tissues are affected with a more even distribution of the ultrasound energy, patients see results immediately after each treatment, more fat is lost, and volume reduction is more pronounced overall (more lost inches in fewer treatments).  Zeltic and Cool Sculpting (cryolipolysis or fat freezing) does kill fat cells, but doesn’t tighten skin (only heat can tighten skin), and only small areas can be treated in each session, whereas VASER Shape treatment area size is much more extensive per session (ie, the whole anterior abdomen, the whole flank or waist, the whole arm, etc.)   Liposonix, Exilis  and Cool Sculpting users will tell patients to expect loss of one inch after 6 to 8 weeks…we see loss of 2 to 4 inches or more with VASER Shape beginning immediately after the first treatment.

Then there is the possibility of combining both HcG and VASER Shape to achieve both actual weight loss as well skin tightening and fat melting in desired locations at the same time.  Additionally, VASER Shape can be used pre-operatively to improve liposuction skin tightening and fat loss, or post-operatively after liposuction to do the same.  There is even a portion of each VASER Shape treatment session devoted to manual lymphatic drainage itself, as this phase of the treatment is important in helping the body eliminate the newly released fat cell contents which result from the VASER Shape treatment, and this same lymphatic drainage technique can hasten the normal healing period of liposuction as well as improve the skin result after liposuction or a tummy tuck.

We can put together better discounts for patients when we meet them, and right now are offering special pricing on all my Top 10 Tips items for a limited time, so come see us and look and feel better this summer!




Top 10 Tip #4…Combination Laser Peel plus ProFractional

Posted on June 24th, 2014
Posted by Julene

Our Sciton laser was designed to be able to deliver two of our favorite laser treatments to face and neck in a simultaneous treatment session…the laser peel for smoothing, and the ProFractional for tightening. This is a very popular combination treatment for our patients, and the results from combining skin smoothing with tightening are even better than when each of these treatments is performed alone. There is a little down time with both the peel and the ProFractional, but the down time is not that much longer for the combination (usually 3 to 5 days).

The laser peel is called a “Microlaser Peel” if the depth chosen is less than 40 microns, and the recovery for this depth peel is anywhere from 1 to 3 days. The deeper the peel depth in microns, the longer the recovery, but the more smoothing that can be achieved. For peels over 40 microns (up to 120 microns can be performed awake in our office), one can add 1 to 3 days of downtime. In other words, if a patient tells us they have a certain number of days of down time that can be allowed, we can design a peel that fits that desired recovery period. Since the Sciton laser uses erbium energy, it works more by an evaporative effect than by a heat driven “burning” effect, so there is much less redness in the recovery period, and the recovery period is far shorter, than with traditional CO2 (carbon dioxide) laser devices, which work via a process of coagulation (more heat).  Patients look like they a sunburn and do not peel or scab over as with dermabrasion or CO2 lasering procedures.  Fine lines, large pores, and deep wrinkles can be resurfaced with the peel modality.  Patients are given some relaxing medications, the skin is pre-chilled, treatments take approximately 30 minutes and are performed in sequential passes over the face and neck.  Acne scars can also be resurfaced.

ProFractional is a skin tightening tool designed to deliver vertical micro-columns of energy to a fraction of the skin’s surface.  Since erbium works via ablation rather than coagulation necrosis (as do other technologies, which leave scar tissue in their path), this ensures that the tissue within the micro-column is ablated (gone or evaporated), such that the undisturbed surrounding normal skin can then “fall together” to fill the column resulting in a tighter skin appearance on the surface.  Since only 1 to 2% of the skin’s surface is actually heated, the recovery time is marked more by a little swelling and bruising than by a really red or “burned” appearance.  Again, patients are very comfortably treated awake with a little relaxing medication, and are usually healed within 3 to 5 days or less depending upon the depth of the treatment chosen.

When performed together, peel and ProFractional results really “pop’ in my opinion! Skin smoothing and tightening together may even decrease overall the number of individual treatments it takes for most patients to be happy, and they aren’t much more uncomfortable than each performed alone.  Down time for the combination patient is increased by a couple of days only, and total treatment time is still within an hour. Patients use a little over-the-counter aqhaphor or Catrix (a prescription healing cream) or other post-procedure topical provided by my office for a week, and are usually able to apply make-up within 5 to 7 days…again depending totally on the depth of treatment chosen.

This combination laser treatment is my absolute favorite skin maintenance treatment to be performed on an annual basis after other skin problems are corrected.  We usually do a little bit of prepping of the skin before a combination laser peel and PF and then resume these same  products after healing, both to add to the laser results as well as to maintain them long term.  The best way to prepare the skin for a combination laser treatment is with a cleanser, a toner, a retinol or Retin-A and hydroquinone (or other bleaching agent) to decrease the “blotchies” seen in a typical healing period.  The best laser result can be evaluated approximately 3 months after the treatment and the overall skin care program will be adjusted accordingly.

So you can see that with this approach to the health and rejuvenation of the skin, each patient gets an individualized treatment plan, depth recommendation, and follow-up care tailored to their specific needs by myself and my skin care and laser personnel.  All of the treatments are performed by either me or my nursing staff depending upon the overall depth of the treatment and how invasive it is designed to be.

Tune in soon for Tip #5VASER Shape!

Best regards,



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