aesthetic plastic surgery procedures

Julene’s Top 10 Tip #2

Posted on June 13th, 2014
Posted by Julene



Since wrinkles are formed at least in part by crinkling of the skin in the same places over and over due to the activity of the muscles under the skin, it makes sense that we can delay the onset of wrinkles by weakening the muscles themselves.  The skin wrinkling process begins even with just “resting muscle tone” actually.  Over time, unopposed resting muscle tone and muscle activity cause the thin skin of the eyelids to become “crepy” and allow wrinkles to deepen.  In my opinion, even though Botox and Dysport are not permanent in their effects, this does not diminish their overall value as maintenance skin therapy because these agents keep deep wrinkles from forming and have great preventive benefit.

We don’t have to completely paralyze the muscles to relax them, and we can still look normal in animation as a result.  It is an absolute myth that Botox or Dysport used correctly “freezes” the face.  The goal is to soften the wrinkles at rest, so some wrinkles will actually still appear when squinting or smiling or when elevating the brows or frowning, because again, the muscles are “weakened”, not “paralyzed”.  But if you consider how thin the skin is in the face, especially the lower eyelid and crow’s feet area, it is quite easy to understand how the skin begins to look a little crepy in most 30 year-olds.  I like my patients to begin to think in a preventive fashion in their early 30’s, or when they begin to see lines around the eyes or on the forehead, and to use Botox or Dysport at that time.

There really aren’t too many side effects of Botox or Dysport.  Slight bruising occasionally at the injection site, change of brow position, sagging eyelids are all reported, but fortunately are pretty rare.  We do expect to change brow position when we inject the forehead however, so we discuss this with our patients and try to change it in a positive fashion…elevate the outer brow or treat asymmetric eyebrow positions…a “chemical browlift” can be performed.

The cost for Botox or Dysport is about $12 to $14 per unit, and most patients will see effects that last up to 3 or 4 months on average.  If a patient keeps up with their injections when they wear off, the results can start to stretch to 4 to 6 months duration.  Typical dosage amounts are frown…24 units; crows’ feet…22 to 32 units; forehead…22 to 24 units.


Stay tuned for Tip #3 soon…


Non-Surgical Top 10 Tip #1: Sculptra

Posted on June 6th, 2014
Posted by Julene

Thanks for visiting my Blog Sculpt.  Happy to have you.  We will be researching how each of the non-surgical tips ended up on my personal Top 10 list.  We keep no secrets from our patients in terms of how they can best spend their time and money when it comes to looking your best, and many times we end up saving you from having to have that surgery!  I love to operate because it gives a quick result and answers many of my patients’ needs, but all good surgeons know that surgery has its limitations, and even the best surgical techniques benefit from smart non-surgical adjuncts to both “finish” and maintain the best looking result.

So let’s get started with Tip #1, Sculptra, and check in here each couple of days for information on the other tips that made the list…

The facial aging process is manifested by 3 main changes over time…

1) Laxity due to gravity’s effects causing sagging

2) surface skin textural change from muscle animation, environmental damage, sun exposure, and smoking, causing fine lines and wrinkles

3) volume loss due to fat atrophy causing hollows and folds

For sagging and laxity, lifts are great…facelifts, necklifts, browlifts and blepharoplasties.  For skin textural change, skin care, chemical peels and laser smoothing and tightening treatments are best.  For volume loss, we turn to fillers, fat injections, and/or collagen stimulating injectables like Sculptra.

What makes Sculptra a good choice is that the collagen stimulation you create wherever the product is injected (since the collagen that results is your body’s own tissue), the results look very natural and are longer lasting than a typical filler off the shelf.  Most fillers can only be placed in focal spots or smaller areas, whereas Sculptra can be placed anywhere in the face (except lips where the filler Juvederm or Restylane is still the best option).  Sculptra collagen stimulation tends to restore volume (when used correctly) in a way that makes the cheeks, jowls, temples, and outer brows look “lifted” rather than fatter or fuller…hence the nickname “Liquid Facelift”.  It takes usually a series of injections (typically 2 to 3) to create enough collagen deposition to achieve as much change as most patients want, but then less maintenance is usually required than with the traditional filler.  The results are very pretty yet subtle enough to not totally change a patient’s look…it’s you but younger!

Since it takes a while to “build” a Sculptra result, many of our patients will continue to use a hyaluronic acid filler as a “quick fix”, for an upcoming event, or in the lips.  Maintenance Sculptra injections frequently require the use of less product over time per injection, further decreasing costs over time compared to the costs of restoring volume with fillers alone.  For many patients, restoring volume and working on skin tone and texture can allow patients to “put off” having a facelift, cheeklift or browlift until the neck laxity worsens significantly.  Even after choosing to undergo a facelift, Sculptra can maintain the look of a facelift longer leading to fewer facelift revisions over time, since facelifts do not restore lost volume.

Our office has the most experience with the use of Sculptra in our area, and any of my staff would love to share this rich experience with you if you care to give us a call to set up a consultation about the product, obtain an informational DVD or come to one of our Sculptra open houses.  Additionally, you may want to visit my website to see before and after photo’s of how can work in the facial rejuvenation treatment plan.

Tune in for Tip #2 soon…





Imitation is…

Posted on October 2nd, 2012
Posted by Julene

How does the saying go…Imitation is the greatest form of flattery.  Well, I guess so.

My office is proud to have been the first in Louisville to introduce lots of things.  Here’s a partial list:

Plastic Surgery office-based prescription skin care
Computer Imaging
Sciton Contour Profile Laser for facial rejuvenation
Shaped, anatomical tear-drop saline breast implants
“Quick Recovery” Breast Augmentation technique
VASER ultrasonic liposuction
VASER 2.0 High-Definition Liposuction with Fat Transfer
High-Lateral Tension Abdominoplasty with Circumferential Liposuction
Style 410 form-stable, fully cohesive silicone gel breast implants (Gummi Bear implants)
Sculptra Aesthetic
Extended Deep-plane SMAS facelift

It’s a great list, and it speaks to the breadth and scope of practice that my office strives to offer cosmetically inclined patients in our community.  I am pleased that as leaders in the field, other offices have watched what we do, and have decided to add many of these facets to their cosmetic practices as well.

When it comes to being the first to offer something meaningful in clinical practice, nothing takes the place of having a thorough understanding of the patients we serve and for truly understanding their needs… for that is what really allows visionaries to provide the products and services of tomorrow that will have lasting relevance in plastic surgery.  It’s also just as important to be able to weed out the new techniques and technology that just don’t stack up, and to vow to offer only new technology – or to stick to the tried and true over what may be newer –  because it’s the best option for patients.

You can follow trends…or you can set them.  I’ll bet you can guess which I prefer.


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