Tag Archives: plasticsurgery

Ulthera or Thermage?

Which is better Ulthera or Thermage….I have followed both technologies since their inception, Thermage for about the last 10 to 12 years, and Ultherapy by Ulthera for the past 4 years.  Based on the science behind them and the patient satisfaction results, Ultherapy by Ulthera is a superior treatment.

Ultherapy by Ulthera is the only FDA approved device for both tightening and lifting of the muscles and skin of the face and neck, including the eye brows.  Ultherapy is the only technology available that uses ultrasound to heat the muscles and skin to create both deep and superficial collagen production.  The level of the treatment is visualized on an ultrasound screen to insure that the energy is being delivered to the proper level.

The muscle fascia or SMAS is targeted in the neck and face.  This is the same layer that s surgeons tighten when they perform surgical face lifts.  Ulthera energy goes deeper than any other energy device, 4.5 mm for the SMAS, and 3.5 mm for the deep skin collagen production.  The patient satisfaction rate with Ulthera is about 90% in the clinical studies.

Thermage is a radio frequency technology device that heats the skin and subcutaneous tissue superficially.  Although Thermage has been improved over the years, it’s main problems have been a very high patient dissatisfaction rate (up to 66%), and a very painful patient experience.  Ulthera can cause discomfort as well, but if patients are enduring pain, they appreciate a result that they can notice.

Ultherapy, featured in Vogue, is a safe and effective non-invasive ultrasound (US) treatment that can lift and tighten facial skin and muscle without downtime.  According to Catherine Piercy, author of the well written Vogue article, “Ulthera…is making it much easier to imagine a world in which hooded lids, falling cheeks, and lazy jaw lines can be treated without a single incision”.

Originally FDA approved for lifting eyebrows non-surgically,Ulthera’s unique state of the art technology is now used to lift and tighten the face, neck, and other areas of the body.  It has successfully treated the lines along the upper lip that are most difficult to treat with injectables.

Ultherapy is performed in the office with only ultrasound gel applied to the skin.   An ultrasound screen image allows the technician  to visualize the level of treatment before US energy is applied to the targeted tissue.  The treatment takes from 45 to 90 minutes depending on the area(s) treated.  Cost also depends on the areas treated.

What about the discomfort level?  Again from Ms. Piercy in Vogue, “If anything, Ultherapy’s greatest drawback may be the pain factor, which ranges from a hot prickling sensation to short but intense bursts of discomfort”.  Patients can be given oral medications or local anesthetic nerve block injections if needed, but the majority of Ulthera patients are able to tolerate a properly performed treatment with a topical numbing cream.

Although many patients see immediate lifting results, the ultimate results do not happen overnight, but gradually over time.  It can take up to 2-3 months for optimal rejuvenation.   Ulthera has been used for close to 2 years.  Some patients treated 1 1/2  to 2 years ago are now returning for second treatments.  Though they still appear improved from their pre-treatment “before” photos, most desire further improvement, further turning back the hands of time.  Patients feel and notice the tightening to the point of being satisfied. After two years of personal research and due diligence about the clinical benefits of Ulthera, as well as being impressed by the findings and experience of worldwide  respected cosmetic physicians, I  decided to add Ulthera to our practice 2 years ago.  We have been overwhelmingly pleased with the results as have our patients.  As with all cosmetic treatments, results will vary depending on the skill,experience, and aesthetic sense of the treating physician, physician’s assistant, nurse, or staff member.  Results will also depend on proper diagnosis and patient selection.  Side effects may include some bruising, swelling, and a feeling of tightness in the days after the procedure.

Ultherapy by Ulthera has been recently featured  on Dr. Oz, The Doctors,as well as on Real Self reviews, links which you may access for further information about this amazing state of the art technology.

 

Smart Lipo – Yay or Nay?

LASER LIPOSUCTION
Using a Smart laser to enhance traditional liposuction may sound like a scientific advance, but many doctors have their doubts. Six years ago, doctors began promoting the device as an efficient way to melt fat with high heat before removing it from the body. In reality, so-called SmartLipo and similar procedures add both time and money to the typical technique. First, a laser wand is inserted under the skin, then another tube vacuums out the fat. The benefit of the heat is better skin tightening, with more elasticity and less bruising, says Barry DiBernardo, a plastic surgeon in Montclair, New Jersey. The downside? “There is the added risk of burns, large scars, tissue hardening, and prolonged pain,” said Steven Teitelbaum, a plastic surgeon in Santa Monica, in a debate with DiBernardo at last year’s meeting of the American Society for Aesthetic Plastic Surgery. Studies show that most women spend more time shopping for shoes than chosen their surgeon.  Make sure he is board certified with the American Board of Plastic Surgery.  A certification as a “Cosmetic Surgeon” can mean they attended a 3 hour class.

Plastic surgery involves many choices. The first and most important is selecting a surgeon you can trust.  Choosing an ASPS Member Surgeon ensures that you have selected a physician who:

  • Has completed at least five years of surgical training with a minimum of two years in plastic surgery.
  • Is trained and experienced in all plastic surgery procedures, including breast, body, face and reconstruction.
  • Operates only in accredited medical facilities
  • Adheres to a strict code of ethics.
  • Fulfills continuing medical education requirements, including standards and innovations in patient safety.
  • Is board certified by The American Board of Plastic Surgery.

ASPS Member Surgeons are your partners in cosmetic and reconstructive plastic surgery. Look for the ASPS Member Surgeon logo.

Be careful of a “special” or a “great deal”, there should never be “blue light specials” in plastic surgery.  Also remember that a great surgeon doesn’t need to spend a lot of money advertising, if he has weekly or monthly ads in magazines you should think twice.  If they got “Top Doc” it means they paid for that position.  You only get the opportunity for great plastic surgery once- everything after that is trying to correct someone else’s mistake.  Often times it can never be successfully repaired.

Don’t be fooled by his charming personality or his claim to be “an artist”.  You aren’t going to date him so his personality doesn’t really play into it.  Sometimes the most brilliant surgeons have very average or below average people skills.  Even if they give you patients to call for referrals it could be their family or friends.  Do most of your research on his work outside of his office.  Read the reviews online, call the Medical Board, check the public records for law suites and funny enough reporters for small newspapers such as the Dallas Observer usually have all the dirt lol

7 Mistakes That Are Making You Break Out

1.SMART PHONES, HATS/CAPS, EYEWEAR

There’s a lot of gunk lurking on smartphone screens, eyeglasses, and the lining of your favorite hat: oil, makeup, and the residue of old hair products. All of that dirt and bacteria can quickly break you out,”

2.While the urge to go to town on a zit (especially when it appears many times its actual size in a magnifying mirror) can seem overwhelming, popping pimples only pushes bacteria further into the pore. So muster the strength to turn away—

3. There’s a difference between twice-weekly skin-brightening exfoliation (good), and daily obsessive overscrubbing (bad). That’s because the layers of our skin near the surface form a protective matrix of proteins and lipids that keep moisture in and acne-causing bacteria out. Aggressive scrubbing can impair the skin-barrier function and lead to inflammation. So think of that eager-beaver scouring as a means of exposing your skin to the very things that make it break out—and just don’t.

4. Splashing water on your face in the morning might seem like an adequate start to the day, since all that’s transpired since your last cleansing was a night of restful sleep on clean Egyptian cotton pillowcases. But you’d be surprised by how much settles on the face at night: Waste left from nighttime products and, if you had a glass of wine with dinner, the metabolized remains of alcohol. Wash your face before bed, at all costs, and repeat the process after you get up, since breakouts erupt when old makeup and your face’s natural oils meet pollutants and dirt during the day.

5. We all know that snack foods eventually end up on our hips and thighs. But tell a true beauty junkie that she’s also doing damage to her skin, and that should be enough to make her swear off sugar, white rice, and, well, everything nice. New evidence suggests that eating foods that cause blood sugar to spike—pizza, bagels, and cookies are all culprits—can trigger an avalanche of acne-generating hormones. Treat your skin to foods rich in vitamins A and E, like leafy greens, grapefruit, nuts, and avocado, which can help clear the complexion, and fiber, which slows the absorption of sugar into your system and reduces the risk of acne.

6. Indulging in alcohol doesn’t directly cause acne, although it has been blamed for turning skin blotchy, dry, and dull. It’s what accompanies alcohol in the glass that really brings on the breakouts. Ingredients like tonic water, fruit juice, syrups, and other sugary mixers are all offenders. (Remember what we said about sugary junk foods?) Stick with the basics at the bar (no sweetened mixed drinks ending in “toni”), match each round of booze with a glass of water (to combat dehydration), and consider a two-drink maximum as a worthy personal goal if you’re prone to pimples.

7. Skipping a shower after a workout may prolong the exercise induced euphoria, but wearing a damp sports bra or t shirt against your skin will form the perfect breeding ground for body acne, since the moist material pushes bacteria into sebum glands, producing zits. So wash your face and then change into clean, dry clothes. Also, if you’re still rocking your middle-school T-shirts and faded black stretch pants (the ones with the totally shot elastic waistband), consider a wardrobe overhaul: Invest in breathable designs made from moisture-wicking, fast-drying fabrics.

Ulthera vs Botox

According to the BotoxCosmetic® website, close to 12 million people have had Botox® treatments since its release in the United States in 2002. Botox® has become standard treatment for forehead wrinkles and is the centerpiece of virtually every aesthetic practice’s cosmetic offering.
An interesting phenomenon accompanies aging where Botox® alone becomes less effective in reducing wrinkles and lines and frequently leads to a lowered brow position. Many feel they have become “immune” to Botox. ® They attribute brow lowering to their body “fighting” the cumulative effects of Botox® as it tries to elevate the brows.
Atrophy of facial bones and fat typically begins at age thirty. As the aging process progresses, atrophy of the frontal (forehead) bone is evident as there is less antigravity support for the forehead. The body responds with more forehead muscle activity to lift the falling forehead. This, along with thinning of the skin, results in more visible forehead wrinkles. Using more Botox® initially may be effective; however, wrinkles caused by increased muscle activity are critical to maintaining brow position. Therefore Botox® actually leads to a lowered or aged brow position.
The correct way of treating the aging process and forehead wrinkles is to treat the cause—forehead atrophy. Fillers work well but do not slow the aging process and can be expensive due to the large area of the forehead. Fat grafting works; the stems cells in body fat slow the aging process, but the procedure is quite technique dependent. Today, another alternative is available.
Ulthera ®has been used successfully to elevate the brow position by tightening the forehead skin and muscle. It also increases the collagen content of the skin improving elasticity and reducing wrinkles during animation. Using Botox® between the eyebrows and for crow’s feet releases these muscles resulting in additional brow elevation.
This combination approach has given patients a dynamic duo that treats both the symptom and the cause of aging in the upper third of the face, cost effectively and with no downtime.

Anatomy of the skin around the eyes

The anatomy of the skin around the eyes, also referred to as the adnexa is unique to the face and body. In order to properly care for the skin around the eyes, it is important to understand not only the anatomy of this area, but also the process of skin cell renewal.

Eyelid skin is composed of several layers. The deepest, the subcutaneous layer contains a thin layer of fascia which lies on top of the orbicularis muscle, a muscle that allows the eyelid to move. Next, the dermis, which forms the support layer of the skin, is made up of threadlike proteins including bundles of elastin and collagen, fibroblasts, nerves and vessels. The top layer, the epidermis, is made up of basal cells, melanocytes, Langerhans cells, keratinocytes and on top, the dead cell layer (also known as the stratum corneum) made up of corneocytes. The epidermal layer gives the skin its appearance, color, suppleness, texture, and health.
Basal cells reproduce new cells every few days. As these cells migrate upward, they become drier and flatter.  Once they reach the surface of the skin, they are no longer alive, and are referred to as corneocytes. This process of migration from basal cell to corneocytes is what gives the epidermis the ability to regenerate itself. This skin renewal process is known as desquamation. Desquamation is an ongoing process that takes about two seeks in a young person, and significantly longer – about 37 days for individuals over 50. The build up of corneocytes gives skin a callous or dry, aged and thickened look. The skin feels and looks rough and its ability to retain water becomes impaired.

Sexy lips

lip print

Augmentation of the lips should be subtle.  A small increase goes a long way and gives a natural, sexy fullness to the lips. Your lips should not arrive in a room before you.

You should discuss what you’d like your lips to look like. Do you want more body in your lips, more definition of the edges of the lips, or both? Your upper lip should be smaller than your lower lip (70% the size of the lower lip). The lower lip should not be filled all the way to the corner (oral commissure) to avoid a “sausage” appearance.

Juvederm® is an excellent material for lip augmentation. It is made out of hyaluronic acid, a substance that is found naturally in the intra- and extracellular matrices of our bodies. Juvederm® is derived through a synthetic process by Allergan, the maker of Botox®. Juvederm® provides and even volumetric enhancement (plumping) of the lips because it is hydrophilic (attracts water), which helps with the lines around the lips as well.