Potomac Plastic Surgery

Non-surgical Rhinoplasty: Nose Job without Surgery

2011-10-30T20:52:00.000-04:00

Non-surgical rhinoplasty has reemerged over the past few years as a popular option for certain patients. In the past, only silicone was injected into the nose, but now Maryland and northern Virginia rhinoplasty patients can choose from a variety of cosmetic injectable fillers. As the FDA has not yet approved the use of fillers for cosmetic injection into the nose, they are currently being used off-label. Fillers are typically injected into the bridge of the nose to help smooth depressions and irregularities. They may also be used to build the bridge and provide augmentation for flat or wide noses. Injectable fillers which have been used for nonsurgical rhinoplasty include Radiesse and hyaluronic acids, such as Restylane or Juvederm.

However, I'd like to offer a few words of caution for those considering the use of fillers as non-surgical rhinoplasty. Nasal injections can have potentially serious problems. As a result, your cosmetic specialist should be appropriately trained and board-certified. Some potential complications include, but are not limited to lumps, irregularity, color changes, discoloration, swelling, infection, blood flow problems, skin loss, pain, or numbness.

Technically, any physician or nurse can treat a patient with cosmetic Restylane injections into the nose. However, laws vary by state within the US regarding who can treat with fillers. To help minimize potential complications, one should be treated by someone who has extensive training and experience with nasal procedures and rhinoplasty.

Additionally, non-surgical rhinoplasty with fillers is temporary given that fillers eventually dissolve. Fillers in the nose, however, do last much longer than in other areas of the face, such as cheek or lip enhancement. For example, hyaluronic acid fillers (Restylane and Juvderm) can last up to a year or longer in the nose while only 6 months in the lips.

Lastly, non-surgical rhinoplasty cannot achieve all the results that a formal rhinoplasty surgery can provide. Only surgical rhinoplasty can narrow wide nostrils with skin removal or narrow a bulbous tip with cartilage removal. In addition, only surgery can remove a nasal hump with bone and cartilage removal. Non-surgical rhinoplasty may possibly give the illusion of a reduced hump or narrowed bridge, but the non-surgical results are different from what surgery may provide.

Depending on the specific anatomy of your nose and your personal preferences, I suggest first speaking with a rhinoplasty surgeon who can use computer imaging to simulate rhinoplasty. You'll be able to visualize in real time what results are potentially available. Only after a comprehensive in-person evaluation can a facial plastic surgeon help determine the appropriate cosmetic surgery options for your nose.

© Copyright 2008 - 2011 Houtan Chaboki, MD. All Rights Reserved. Board Certified Facial Plastic Surgeon specializing in Cosmetic Surgery of the nose, face, neck, eyelids, and eyebrow in Washington DC, Maryland, and northern Virginia. Privacy Policy and Disclaimer.

Topical Ointment after Facial Surgery - Vitamin E

2011-09-01T23:11:00.000-04:00

I had an interesting conversation with my dermatology colleague in the DC office. The dermatologist recommended Vitamin E ointment to help reduce scarring after surgical procedures, such as excisions, skin biopsy, and mole removal. The dermatologist claimed facial incisions looked better after using topical Vitamin E.

I've already talked a bit about ointments to help prevent facial scars in a previous blog post. So I asked her to review the medical literature again with me. Vitamin E ointment was not found to be any better than plain petrolatum for scar prevention. It did, however, contribute to skin allergy and contact dermatitis after prolonged use.

These educational debates among Maryland and Virginal skin care specialists occur commonly. For my northern Virginia face lift patients, we use an antibiotic ointment and avoid getting the incisions wet for the first two days after the cosmetic surgery. Once initial healing complete, then topical petrolatum jelly or silicone gel (patient's choice) is used on the incision daily for approximately 1-2 months.

What did we learn? Always speak with your Washington DC facial plastic surgeon or dermatologist and follow their advice. You can talk about recent scientific research or journal articles with your specialist. We learn from each other, both from patients and physicians.

© Copyright 2008 - 2011 Houtan Chaboki, MD. All Rights Reserved. Board Certified Facial Plastic Surgeon specializing in Cosmetic Surgery of the nose, face, neck, eyelids, and eyebrow in Washington DC, Maryland, and northern Virginia. Privacy Policy and Disclaimer.

Should Your Parents & Grandparents "Grow Old Gracefully?"

2011-07-21T12:20:00.013-04:00

It doesn’t surprise anyone when friends or family members between the ages of 45 and 60 choose to undergo facial cosmetic surgery. After all, as we age, we’ll all experience sagging, bagging and wrinkling, which is particularly visible on our faces. Although I make every effort to help my Washington, DC patients age gracefully by utilizing Botox and dermal fillers, eventually they’ll need more correction than these non-surgical methods can provide. Ultimately, a facelift is the best choice for those with signs of facial aging. In my Virginia-area facial cosmetic practice, I’d estimate that 55 is the average age of patients seeking facial rejuvenation, with some patients opting for age-related corrections earlier than others due to lifestyle habits and inherited aging patterns.

However, did you know that those over the age of 65 are embracing aesthetic enhancements at a rapid rate? It’s true. The Baby Boomers, the largest cohort group in the US, are increasingly represented in our facial plastic surgery office here in Washington, DC. In fact, procedures that were once deemed for those of “middle-age” are now quite popular for grandmothers and grandfathers, too!

As an indication of this trend, there was a recent story in the London press about a 65-year-old woman, Joan Lloyd, who decided that as a fairly new widow, she needed cosmetic enhancements in order to “help me find love again,” in her words. When asked why she decided to have her breast augmented to an F-cup, she replied, “I decided to get maximum impact.”

Although this charming woman no doubt did create maximum impact, most of the Virginia and Maryland men and women I see for facial cosmetic surgery are more likely to desire a facelift that’s a bit less “maximum” in terms of revealing that they had anything done. A beautiful facelift should suggest rest and relaxation; nothing pulled, nothing jarring, just soft and full, like the face of youth. If there is a lesson to be learned by Mrs. Lloyd, certainly it’s that there is no shame in wanting to look as young as you feel, or even to look younger than you are. As long as a patient is in good health and has realistic expectations, I have no qualms about older patients undergoing cosmetic procedures.

Are Older Americans Getting More Plastic Surgery?

The American Society of Plastic Surgeons reported that in 2010 there was a 2% increase in the number of both male and female patients over 55 that underwent a cosmetic procedure. It could be, at least to an extent, that older celebrities are very open about the work they have had themselves to look younger. Even Betty White has recently admitted to undergoing cosmetic procedures. With so many older celebs praising plastic surgery, it is only natural for the older crowd to accept cosmetic procedures for themselves as well.

I’m interested in hearing what you think! Is cosmetic surgery a good idea for those 65, 70 and older or should they “grow old gracefully?” What would you think if your parents or grandparents chose to undergo a cosmetic procedure?

To your health and beauty,

Dr. Houtan Chaboki

© Copyright 2008 - 2011 Houtan Chaboki, MD. All Rights Reserved. Board Certified Facial Plastic Surgeon specializing in Cosmetic Surgery of the nose, face, neck, eyelids, and eyebrow in Washington DC, Maryland, and northern Virginia. Privacy Policy and Disclaimer

How to Determine if you are a Face Lift candidate

2011-06-15T21:41:00.000-04:00

When you look in the mirror and lift your jawline and cheek skin, do you like what you see? Perhaps it's time to consider facial rejuvenation surgery.

Face lift or neck lift surgery is a purely elective cosmetic procedure to rejuvenate the face for men and women over 40. Both the face lift and neck lift are cosmetic procedures that one chooses to reduce the signs of aging and sun damage of the lower face. Cosmetic surgery is an option, among many other good aesthetic options. Keep in mind that your face continues to age with time, despite any treatment or surgery, but you will continue to look better after cosmetic surgery than if you've never had the initial face lift surgery.

Generally during the consultation, I discuss non-surgical face lift options first, especially for patients who have never tried any procedure and just starting to consider plastic surgery treatments. These patients may be looking for minor changes or minimally invasive treatments to freshen their appearance, or they may not have opportunity to take time off work to recover after a face lift. Non-surgical face lift options for DC area residents may include facial fillers, fat transfer, or Botox Cosmetic. These non-surgical treatments are sometimes referred to as "liquid facelift".

Washington DC face lift candidates may include those who have already tried Juvederm or Restylane but were not completely satisfied with the short term results. Alternatively, some Washington area patients prefer to have natural results without the injection of synthetic materials. Anatomically a face lift might be a better aesthetic option, as compared to laser skin resurfacing, Botox Cosmetic, or injectable fillers (hyaluronic acid, Restylane, etc), for one who has loose, sagging skin especially along the jawline (jowls) and neck (turkey gobbler).

Face lift candidates generally have the following qualities, but circumstances may vary for each person:

over 40 years old
good general health
excess neck skin or fat
jowls or loose skin tissue along jaw line
time for recovery after surgery

As with other face lift surgeons, I will tailor the facelift appropriate for you. The plastic surgery is customized to the degree of facial aging you have, in conjunction with your personal goals. Some patients require a limited or mini lift, while older patients with excess sagging skin would benefit from a full face lift or traditional lift. Only after a comprehensive evaluation can a surgeon help determine appropriate options.

© Copyright 2008 - 2011 Houtan Chaboki, MD. All Rights Reserved. Board Certified Facial Plastic Surgeon specializing in Cosmetic Surgery of the nose, face, neck, eyelids, and eyebrow in Washington DC, Maryland, and northern Virginia. Privacy Policy and Disclaimer.

Botox Injection and Eyebrow Waxing, Plucking, Threading, and Tweezing

2011-05-24T17:07:00.001-04:00

Botox Cosmetic is a great option to help reduce wrinkles and smooth the skin in the forehead and around the eyes. Many DC area women, and some men, frequently have their eyebrows regularly groomed, either at a salon or done by themselves. My Washington DC Botox patients often ask if they can have an eyebrow waxing after Botox injection.

Most DC plastic surgeons and dermatologists suggest avoiding any eyebrow or skin treatment around the eyes and eyebrow for least the first day after Botox Cosmetic injections. This restriction includes similar treatments such as skin care, microdermabrasion, and facial massages. Some DC cosmetic specialists will encourage 1 week for this restriction. After 2 weeks, it should be OK to get eyebrows waxed or tweezed following your Botox Cosmetic treatment. Always check with your Botox injector regarding any concerns you may have.

© Copyright 2008 - 2011 Houtan Chaboki, MD. All Rights Reserved. Board Certified Facial Plastic Surgeon specializing in Cosmetic Surgery of the nose, face, neck, eyelids, and eyebrow in Washington DC, Maryland, and northern Virginia. Privacy Policy and Disclaimer.

Face Lift Anesthesia Options for Maryland & Virginia

2011-05-16T22:43:00.000-04:00

A lower face lift or neck lift can greatly rejuvenate the face and help restore the appearance of youth and beauty. Maryland or Virginia face lift patients are typically active individuals who have sagging skin and jowls and excess neck fat. Face lift patients often ask about the incisions used during the face lift and anesthesia during the cosmetic surgery.

A face lift is not one operation, but rather many potential cosmetic procedures, dependent on the surgeon and patient to improve neck line, jowls, and signs of facial aging. Although there are many different face lift procedure terms, there are really only a few different types. These basic face lift surgery types are the SMAS, deep, or composite. Face lift may be combined with other cosmetic surgery for Maryland or Virginia patients such as a eyelid surgery, fat transfer, or others.

The amount of tissue adjusted or tightened depends on the specific approach & the requirements of a particular patient. The minimal access or minimal incision lift that leaves a short scar is more appropriate for younger patients (less than 60) or patients with little/moderate skin aging. All of these types of face lifts are variations of SMAS lifts. Older Maryland or Virginia patients or patients with severe & excess skin sagging will require a more traditional facelift procedure. By far, a majority of plastic surgeons who perform face lift surgery do a SMAS lift variation. This face lift type generally has the quickest recovery with great results.

Typically most face lift surgery is performed with either IV sedation (twilight anesthesia) or general anesthesia, along with local anesthesia. Either are good, safe options, with their own advantages and disadvantages. IV sedation or general anesthesia may be provided by a board-certified anesthesiologist and/or nurse anesthetist dependent on the surgical facility. It's better to have someone else other than your face lift surgeon monitoring you and your vitals during anesthesia. Let your plastic surgeon concentrate on the cosmetic surgery.

Some cosmetic surgeons perform face lift surgery under local anesthesia only, termed "awake surgery". Read my press release on awake surgery. I advise my Maryland and Virginia face lift patients against performing any extensive plastic surgery via local anesthesia only. While minor procedures can be performed in the office with local anesthesia, patients are more comfortable with IV sedation or general anesthesia for more extensive procedures.

The decision on the type of anesthesia depends on the extent of face lift surgery, combined cosmetic surgery procedures along with the face lift, patient factors/preference, and surgeon factors/preference. After an evaluation by a plastic surgeon, one chooses the appropriate anesthesia type for their plastic surgery.

Facial Plastic Surgery with a Single Injection

2011-05-10T23:26:00.000-04:00

Which single medication has been used for a variety of aesthetic treatments for Washingtonians? Botox Cosmetic.

Botox Cosmetic may be applied in specific ways to achieve certain results for facial rejuvenation. Wrinkle reduction around the eyes and forehead is the most common application, but lifting the eyebrows or slimming the jawline are alternative treatments that have been used by DC area plastic surgeons and dermatologists.

The non-surgical brow lift to raise the eyebrows is achieved by injecting the muscles just below the eyebrow (orbicularis muscle) which pulls down the brow. Results are temporary and subtle with the Botox browlift. This non-surgical brow lift method may not be noticeable if you have severely droopy eyebrows. Cosmetic surgery with an endoscopic brow lift would be more appropriate for severe eyebrow ptosis (droopy).

Speak with a Washington DC Botox specialist to perform a comprehensive evaluation and help determine appropriate options for you.

Plastic Surgery to Augment Sunken Cheeks

2011-05-09T22:33:00.000-04:00

Sunken, flattened cheeks are signs of inadequate facial volume. While this may occur from natural aging in patients I see from northern Virginia, sunken cheeks are also commonly congenital or genetic. These facial features may run in families. Cheek volume loss may also be seen earlier with some medical conditions, severe weight changes, trauma, or medications too.

Several cosmetic options are available to improve volume loss in the cheeks or midface and to sculpt the face. Treatment obviously is to add volume, typically. Injectable fillers with hyaluronic acid (Restylane or Juvederm) may be appropriate in the tear-trough or nasolabial folds, otherwise known as smile lines. Alternatively, longer acting facial fillers such as Radiesse or Sculptra provide longer-term improvement of the cheeks. All these injections are office procedures with temporary results.

Other cheek enhancement options include fat injections, which have been used for decades for facial rejuvenation. Fat injections have the potential for long-term natural cheek enhancement, in addition to a poorly understood possible "stem-cell" effect. Cosmetic surgery with a silicone implant or midface lift may be more appropriate in selected patients. Silicone cheek implants are a good option for permanent cheek enhancement in northern Virginia patients. Cheek implants placed via small intraoral incisions enhance the cheek bones, add volume underneath the cheek bones or midface, or both.

Lastly, the cheeks can be enhanced by removing excess volume, which may appear counterintuitive. However, some patients are born with too much fat and may benefit from buccal fat reduction. Alternatively, large jaw muscles may distract from the cheeks. These patients can enhance the upper face by jaw line reduction with Botox.

There isn't one best treatment for facial plastic surgery procedures. Cosmetic cheek augmentation has several options. Only after a comprehensive evaluation by a specialist can he/she help determine appropriate options for your northern Virginia cheek enhancement.

Face Lift Recovery and Healing

2011-05-07T22:32:00.000-04:00

A very common question for Maryland plastic or cosmetic surgeons is how quickly can one return to normal activities after a face lift. Of course, recovery after face lift surgery varies on the specific type of face lift you had, and your body's natural healing ability.

First, there will be recovery from the anesthesia along with the surgery. Most Maryland patients recover from the anestheisa effects within the first day or two. You should'nt drive or make any major decisions during this early period after anesthesia. You'll feel tired and gradually regain strength once the effects of anesthesia are gone.

The surgical recovery typically is longer. Mini face lifts (short scar or minimal access) or neck lifts have a faster recovery than traditional face lifts or full face lifts, since mini lifts require less surgery and tissue manipulation. Combination facial plastic surgery procedures in Maryland such as eyelid surgery or fat transfer along with the face lift will have a longer healing period. Generally, most swelling and bruising after facial cosmetic surgery resolve within a couple weeks. You may have residual slight bruising or swelling for longer, however, may still be able to go into public without drawing attention. Plan for at least 2 weeks of recovery, especially when combined with other cosmetic surgery. During this early healing period you should avoid any activity that increases your blood pressure or heart rate, such as exercise, bicycling, sex, or yoga, while light-activity like walking is permitted.

To maximize your cosmetic results, follow the face lift care instructions of your facial plastic surgeon. Lastly, speak with your face lift surgeon regarding any concerns you may have.

Cost-Effective Skin Care without Expensive Laser Treatment

2011-01-31T07:56:00.029-05:00

Lasers are everywhere and play an important role for Washington DC area skin rejuvenation patients. However, cosmetic laser treatments aren’t the only or the best answer for every aesthetic patient.

I’ve already spoken a bit about basic skin care and sunblock. Now let’s focus on another great option for DC, Maryland & northern Virginia skin rejuvenation: tretinoin.

Tretinoin has been available for over 20 years in the United States. A couple of brand names include Retin-A ® and Renova ®. Tretinoin is a form of vitamin A that is used as a cream or gel on the skin and has targeted various conditions:
• Acne
• Wrinkles or photo aging
• Sun damage
• Age spots or sun spots
• Stretch marks
• Skin preparation for chemical peel

Many dermatologists and plastic surgeons agree that tretinoin is the best collagen building anti-wrinkle cream available.

Brand names, alphabetical order:

Altinac®
Atralin®
Avit®
Refissa®
Renova®
Retin-A®
Tretin X®

Brand names of combination products, alphabetical order:

Solage® (contains tretinoin and mequinol)
Tri-Luma® (contains tretinoin, fluocinolone, and hydroquinone)
Veltin® (contains clindamycin and tretinoin)
Ziana® (contains clindamycin and tretinoin)

How does tretinoin work on your skin?
Tretinoin increases the rate at which the top layer of your skin (epidermis) sheds and replaces itself with new skin. Young skin sheds and replenishes cells much more frequently than older or sun damaged skin. Tretinoin speeds up the natural skin cycle so that the top layer is fresh and new. In addition, tretinoin thickens collagen and the dermis, or deeper skin layer, so that wrinkles are smoother. Sunlight breaks down tretinoin, so many specialist recommend using the cream nightly

While many patients are very happy with using tretinoin therapy, some are disappointed due to the redness, irritation, and scaling that often accompany the initial treatment. Below are suggested steps to help get through the irritation phase & tolerate tretinoin therapy. Speak with your northern Virginia, Maryland, or DC dermatologist, plastic surgeon, or skin care specialist to help determine the appropriate treatment plan for you.

Do’s
• Apply at night only, right before going to bed, when first starting tretinoin
• Use a mild, non-irritating cleanser to wash your skin and remove any makeup
• Apply tretinoin after washing your skin at night, and wait 15 minutes before applying any other skin care products. Tretinoin may cause more irritation if applied to moist or wet skin.
• Apply a “pearl” sized portion, or size of pinky fingernail. “Less is more” when using tretinoin. Applying a thick layer or dab/spot treatments isn’t appropriate.
• Continue your daily sunblock every morning. Protect your skin from both UVA and UVB

Don’ts
• Apply it during the day (unless advised by your physician)
• Use other skin care products such as glycolic acid or benzoyl peroxide (unless advised by your physician)
• Tan
• Allow excessive sun exposure

If you’re still having difficulty with initial irritation, but still want to use tretinoin for its beneficial cosmetic effect, then you may try the following (after consultation with your doctor):
• Start tretinoin slowly, either at a lower concentration or apply only every 2nd or 3rd night. You may advance to every night or a higher concentration as your skin adjusts to therapy. A little dryness or irritation is normal at first, but if the treated skin becomes really sensitive, take a break. Let the skin recover and then slowly begin treatment again.
• Try an oral antihistamine tablet to help reduce itchiness
• Switch your cleanser to something mild and non-irritating. Many facial cleansers are too irritating for tretinoin sensitive skin.
• Reduce sun exposure since your skin becomes more sun sensitive.

Important things to know about tretinoin treatment
• Epidermis may thin from therapy due to exfoliating effect, therefore no hair removal should be performed over treated areas, including plucking or waxing.
• Tell your doctor or skin care specialist performing a procedure such as a chemical peel, microdermabrasion, or laser treatments that you are on tretinoin. You may need to stop tretinoin for a period of time before and after your treatment.
• Anyone who is or may become pregnant should not use tretinoin.

Tretinoin comes in various concentrations or strengths, for example.

0.025%
0.05%
0.01%

Higher concentrations typically provides greater aesthetic results, but may have more initial skin irritation. Younger patients with mild acne may start with low concentration of 0.025%, while older patients with severe sun damage and wrinkles may start at a higher concentration. Based on your skin condition and personal preference, your plastic surgeon or dermatologist will help choose an appropriate concentration to start therapy. As your skin improves, your skin specialist may modify the concentration and/or frequency as needed.

Why bother with tretinoin treatment?
As a facial plastic surgeon , I'm current on all the latest in cosmetic surgery and skin care treatments. However, in my opinion, no treatment rivals tretinoin for such tested and lasting cosmetic benefits. Several scientific studies and professional experience give me many reasons to recommend tretinoin for appropriate Washington DC area patients:
• Reduces, reverses, and prevents wrinkles. Younger patients usually receive more of a benefit, but patients may start at any time and still experience visible improvement.
• Prevents and lightens age spots and sun spots.
• Thickens collagen & dermis.
• Improves acne.
• Helps decrease the risk skin cancer.
• Improves skin’s general appearance.

Tretinoin has been used for over 20 years, but doesn’t have the same marketing presence compared to other laser and skin care treatments. However, I see the benefits of this product in patients at my Washington DC facial plastic surgery office every day. How about you? Tell me about your experience with tretinoin.

Houtan Chaboki, MD

5 Non-Surgical Face Lift Options

2010-10-14T21:28:00.005-04:00

Northern Virginia & Maryland patients seeking cosmetic options for the face typically are overwhelmed by the many nonsurgical and surgical options. Metropolitan DC area dermatologists, plastic surgeons, and facial plastic surgeons are now able to offer non-surgical options that weren't available years ago, including laser treatments, Botox Cosmetic, fat injections, and facial fillers. Naturally, many would like to avoid plastic surgery on the neck or face and are considering non-surgical facial rejuvenation options. Nonsurgical facial treatments work well in early facial aging only, such as patients in their 30's or 40's. In many ways, facial fillers may give aesthetic results superior to plastic surgery for rejuvenating the face in this age group.

Non-surgical facial procedures are typically performed in the office with local anesthesia. A small needle may be briefly used for anesthesia and treatment. Recovery is faster than traditional plastic surgery, with good aesthetic results. Patients may return to work much faster, possibly within the same day.

Nonsurgical face lift may not be for everyone. Some patients are excellent candidates for face lift surgery and prefer the typical aesthetic results associated with cosmetic surgery. Patients who may be older or have more sun damage generally are not satisfied with nonsurgical treatments alone. Many patients with sun damage require combination, both surgical and nonsurgical, cosmetic treatments to achieve optimal aesthetic results. Lastly, unlike plastic surgery, nonsurgical cosmetic treatments may not be permanent and often require repeated treatments.

Below are some options that rejuvenate the face and reduce the signs of facial aging. Only after a comprehensive evaluation can a aesthetic specialist help provide the appropriate option for you.

Fat injection
Fat injection is the most natural method of facial enhancement without plastic surgery. Fat is taken from the abdomen or similar areas via liposuction. The fat is purified and then injected into the face to add volume and reduce signs of aging. Fat may provide natural, soft enhancement of the cheeks, lips, and under eye areas. Fat can provide permanent facial enhancement and improve skin quality due to the "stem cell effect", which is a poorly understood effect at this time.

Fat injections may result in more facial bruising, as compared to other nonsurgical face lift options. In addition, they have a certain level of unpredictability since less than 100% of the fat survives long-term. Finally, the face continues to age naturally, so touch-ups may be required for some patients.

Hyaluronic acid (HA)
HA is a normal component of human skin. Some companies have purified HA as a bio-compatible soft tissue & skin filler for wrinkles & facial aging. HA bonds with the body's natural moisture to smooth the skin and replenish volume. Restylane, Juvederm, and Perlane are the more common HA products available today. Results are immediate and may last from 3 months to one year.

Sculptra Aesthetic
Sculptra is a relatively new type of facial injectable made from poly-L-lactic acid, which helps gradually replace collagen lost from aging. Sculptra corrects shallow to deep facial folds and wrinkles. The main ingredient is a bio-compatible, bio-degradable synthetic material that has been used by physicians for decades in other areas. Results are not immediate and are visible only after several months. Typically more than one treatment session is required to achieve results, which may last up to 2 years.

The lips and eyes are a few areas that may not be appropriate for Sculptra. Lastly, some patients may develop small nodules in the tissue after treatment.

Radiesse
Radiesse wrinkle filler stimulates collagen production. Results are immediate and potentially can last up to one year in some patients. Radiesse has also been approved to be mixed with lidocaine anesthesia to enhance patient comfort. Similar to Sculptra, Radiesse is not placed in the lip.

Selphyl
Selphyl is the newest nonsurgical option for facial enhancement. A small amount of blood is taken & purified for Platelet-Rich Fibrin Matrix (PRFM), and then reinjected into the face. Selphyl has been termed "vampire face lift" by the media. The purified blood is a natural way to fill skin depressions, acne scars, wrinkles and folds, rather than using synthetic, or animal-derived materials. Results are not immediate, but develop gradually over time.

Plastic Surgery: Numbness or Tightness after a Face Lift?

2010-09-28T23:56:00.000-04:00

Maryland face lift patients may experience of variety of skin sensations immediately following their cosmetic surgery. A face lift procedure involves improving the appearance of the lower face, jaw line, and neck via small incisions around the ears, in order to elevate sagging skin & underlying facial tissue. While many other non-surgical cosmetic options are available to improve the lower facial area, face lift surgery can have dramatic results to greatly restore the appearance of youth.

Regardless of specific facelift surgery technique (s lift, deep plane, smas, thread, short scar, etc), numbness of the skin, cheek, neck, and ear may be seen after face lift surgery. A skin incision must be performed which naturally cuts the very small nerves of the skin. Other larger nerves around the ear may be stretched or bruised too. Numbness is most commonly seen near the ear lobe. Most numbness resolves within a couple weeks, but may take a few months for resolution.

Another sensation felt following cosmetic surgery is tightness or stiffness of the cheeks, jaw line, and neck. This tight sensation is expected, and gradually improves with time. Patients wear a gentle elastic wrap around the head & neck, which will also contributes to a "snug" feeling.

Speak to your Maryland facial plastic surgeon, and ask about numbness & tightness after your facial plastic surgery.

Ear Lobe Repair: Plastic Surgery or Injection?

2010-09-26T20:40:00.000-04:00

Torn Ear Lobe

A very common plastic surgery procedure (perhaps even #1) is ear lobe repair surgery for people who have stretched out, torn, or split their earlobes.

A popular television show in the northern Virginia and Maryland area recently did a segment for those who love to wear big earrings. Big, heavy earrings may stretch out the earlobes gradually over time. The show demonstrated a woman in her 30's who loves to wear jewelry, especially big hoop earrings. Gradually with time, her ear lobe started to split and she was concerned about completely tearing through the ear. Even before splitting, some women have difficult time wearing earrings since the ear piercing hole has become too large.

The dermatologist on the show reported what most plastic surgeons and facial plastic surgeons have been doing to help repair the ear lobe. First, we clean the ear lobe, cut out the scar tissue, and put the skin back together again. Typically performed within 15 minutes by DC cosmetic surgeon Dr. Chaboki, this entire ear lobe procedure is done in the office just with local anesthesia. Next, once the ear is adequately healed, the ear may be re-pierced.

Some dermatologists or plastic surgeons will then plump up the ear lobe, to add volume and strength. Northern Virginia and Maryland fat injections have been the traditional method to rejuvenate or plump the ear lobe. This dermatologist demonstrated Juvederm® injection, which is a newer technique of facial filler injection. Juvederm®, similar to some other Washington DC facial fillers, is made of hyaluronic acid. Facial fillers with hyaluronic acid are commonly used to rejuvenate the face or for lip enhancement.

Ask your local cosmetic specialist if an ear lobe enhancement with dermal fillers is appropriate option for you. What do you think?

Ointment after Surgery to Reduce Scars: Best to Prevent Scarring?

2010-09-01T22:21:00.002-04:00

Many company's ointments and creams claim to reduce scarring after plastic surgery, injury, scratches, or cuts. Unfortunately, there isn't much well-done scientific research to support those claims. So how does one pick the best ointment to prevent scars? First, speak with your Washington DC facial plastic surgeon or dermatologist and follow their advice.

Several studies have suggested that any occlusive dressing on an incision or surgical site will improve the final scar by about 33%. Redness, swelling, and cosmetic appearance of the incision generally looks better by merely covering up the surgical site with something. Years ago, the general idea was to keep the wound open and let wounds scab to help prevent infection. However, plastic surgeons better understand wound healing and no longer recommend letting wound dry out. Covering the wound or incision with ointment may prevent the need for future scar revision procedure.

The occlusive skin dressing should be a bland, non-allergic material such as petrolatum jelly or silicone. Vaseline®, Aquaphor®, and Mederma® are products with varying degrees of petrolatum. Petrolatum jelly, however, should not be used in the following areas:

Recent Burns, including sunburn. Petrolatum traps heat inside tissue, which worsens heat damage. Only once the heat has dissipated, it may used for specific burns.
Nasal congestion or dryness: petrolatum stuns the natural cleaning ability of the nose by immobilizing the cilia (small wipers) in the nose. Also, petrolatum may form deposits in the lungs and lead to pneumonia.

Studies have also shown that some topical ointments may cause a skin allergy or contact dermatitis after prolonged use, such as vitamin E, triple antibiotic, Neosporin^®, or Bacitracin. Other topical antibiotic ointments have much less risk of skin allergy such as polymyxin B or muporicin.

Other methods to help reduce scarring after surgery include:

Avoid direct sunlight on the area
Treat infections immediately
Massage

For my Maryland face lift patients, they use an antibiotic ointment & avoid getting the incisions wet for the first two days after cosmetic surgery. Once the incisions are healed, patients resume using their sunblock. Topical petrolatum jelly or silicone gel (patient's choice) is used on the incision for approximately 2 months daily.

Nasal Care after Rhinoplasty Surgery or Septoplasty

2010-07-21T21:56:00.000-04:00

The nose and septum are understandably sensitive after rhinoplasty surgery. Variable nasal swelling typically occurs both on the outside and inside of the nose, with cosmetic nasal surgery or septoplasty for deviated nasal septum. To help with healing in the recovery period, a post-operative care regimen of nasal cleaning is critical. Nasal care helps keep the nose clean, moist, and reduces rhinoplasty swelling. One is unlikely to disrupt the rhinoplasty surgeon's delicate work on the nose with the cleaning; however, rhinoplasty patients must be gentle!

Maryland rhinoplasty surgeons typically ask their patients to start rinsing the nose with regular saline irrigation, sprays, or neti pot. Nasal salt water rinses should be several times daily, in both nostrils. These saline rinses may be purchased over-the-counter or made at home. (mix 1 liter Distilled water, 1 teaspoon kosher salt, and 1 teaspoon baking soda). After the salt water rinse, then place muporicin ointment via a cotton-tip applicator (or your clean finger) in your nose three times a day. Perform the rinse and ointment 2-3 times daily, or whenever you feel dry in the nasal passages. Washington allergy patients also benefit from a regular neti pot or saline nasal wash.

Read Dr. Chaboki's care instructions following rhinoplasty for his northern Virginia and Maryland patients for further information. Always follow the specific advice and instructions of your plastic surgeon or rhinoplasty specialist.

Finding the Best Plastic Surgeon for Your Cosmetic Surgery

2010-07-19T22:56:00.000-04:00

Good plastic surgeons are not just in Beverly Hills or New York City. The best cosmetic specialists can be found all over the world. Top surgeons performing plastic surgery have a range of training backgrounds and professional interests. Some plastic surgeons specialize in breast augmentation, while others perform exclusively face lift surgery. Maryland patients seeking plastic surgery should do their homework before deciding on cosmetic surgery. For example, Maryland rhinoplasty surgery patients are encouraged to visit at least 2 rhinoplasty surgeons in their area to perform a comprehensive evaluation. The rhinoplasty surgeon will often perform computer simulation surgery to show intended results and to help in the decision making process.

The best plastic surgery is not the result of the procedure alone. Great results do not necessarily mean a satisfied cosmetic patient. Good rapport must be developed between the patient and plastic surgeon. Trust, based on realistic expectations and exacting medical expertise, develops in the consulting stages before cosmetic surgery. Preoperative and postoperative care are essential for outstanding results. Your plastic surgeon should be available to answer all of your questions about your specific needs in a professional manner.

No single factor can guarantee you the best doctor for a specific cosmetic procedure. From brow lift to fat injections, Washington DC area has several great cosmetic surgeons with various professional interests. Each person decides for themselves which surgeon is best for their specific goals and expectations. Only then can you determine the best plastic surgeon for you.

Rhinoplasty Cost: Does Insurance Cover Nasal Surgery?

2010-07-09T07:31:00.000-04:00

The cost of rhinoplasty surgery varies greatly across the United States, including the metropolitan Washington DC area, Maryland, and northern Virginia. Rhinoplasty cost is always one of the first questions asked the plastic surgeon. However, rhinoplasty cost should be taken into consideration with many other factors when choosing your cosmetic nasal surgeon.

Rhinoplasty is not one operation, but rather many potential procedures to improve the appearance and function of the nose. The cost of rhinoplasty varies greatly, but it's usually similar for plastic surgeons in your area. For example, northern Virginia rhinoplasty may range from $2000 to $20,000 as an example.

Rhinoplasty cost is depends on several factors, but largely dependent on the following:

Region - Beverly Hills rhinoplasty more expensive than rural Midwest
Complexity - Full rhinoplasty treating many parts of the nose and requiring anesthesia is more expensive than simple procedures isolated to specific areas which may be performed with local anesthesia
Revision rhinoplasty - Revision surgery more expensive than primary surgery
Surgeon - Some plastic surgeons charge significantly more or less than their peers

In addition, portions of rhinoplasty surgery may also be covered by your insurance provider. The majority of cosmetic surgery is elective, so insurance plans don't usually cover it. However, there are exceptions and some plastic surgeons participate in the major insurance plans. Remember, plastic surgery covers a broad area of medicine which includes both reconstructive procedures and cosmetic procedures. If your procedure is medically indicated, some portion of the cost may be covered. For example, Maryland patients with nasal allergy symptoms or sinus problems may combine their sinus surgery with rhinoplasty. Our office accepts insurance in applicable cases and will, if you wish, contact your insurance company to find out if a portion of your procedure will be covered.

Nasal Splints in Rhinoplasty or Deviated Septum Surgery

2010-06-17T08:44:00.001-04:00

Splints are commonly used in deviated septum or rhinoplasty surgery. Northern Virginia and Maryland patients often ask how long such nasal splints are used.

Nasal splints may be internal or external. The external splint, or nasal cast, is gently removed one week after surgery. This cast helps to decrease nasal swelling after rhinoplasty, and maintain nasal alignment. The cast is tape to the cheek skin & should be kept dry until your followup with your plastic surgeon or rhinoplasty surgeon. Other methods to reduce nasal swelling with rhinoplasty was reviewed earlier.

Internal nasal splints, which may or may not be used, are also typically removed around one week following nasal surgery. These internal splints are made of silicone and help support the septum & to improve healing. Internal splints may be used for northern Virginia and Maryland deviated septum surgery (septoplasty) patients, but may not necessarily be used for rhinoplasty patients.

More Wrinkles with Tanning & Sun Exposure

2010-05-18T07:45:00.001-04:00

Everyone should know sun exposure contributes to facial aging and wrinkles over time. Even worse, sun damage is the leading cause of skin cancer. Tanning from either indoor beds or outside direct sun exposure is the most harmful, especially with sun burns and sensitive skin. Maryland skin care patients are always put on sun blocks routinely, from Botox Cosmetic to face lift surgery. While facial cosmetic treatments such as chemical peel and skin care can help reduce sun damage, prevention by using a sun block and avoiding tanning is a better method to reduce wrinkles in the first place.

Medical research has shown a correlation between those who regularly tan with anxiety or depression. Previously, the risk of skin cancer was used to frighten young men and women from tanning (indoor beds or outside sun exposure). However, a recent study demonstrates that the risk of forming wrinkles was a better method to stop people from tanning. In addition to the poor cosmetic results of sun exposure, treating related anxiety or depression may be a more effective method to reduce tanning & sun damage.

What do you think?

Cosmetic Surgeon Review Sites

2010-05-02T10:10:00.000-04:00

Maryland face lift patients often go to the Internet, in addition to their close friends, to research plastic surgeons for cosmetic surgery. Nothing will ever beat a personal recommendation from a trusted person. However, several physician review sites exist that provide patient reviews for multiple physician specialties. Doctor review sites are just one component of the decision making process cosmetic patients should use to help determine their plastic surgeon for their facial cosmetic surgery.

In Washington DC, successful facial cosmetic surgery is the result of many factors, including the cosmetic procedure itself. Good rapport must be developed between patient and plastic surgeon. Trust, based on realistic expectations and exacting facial expertise, develops in the consulting stages before plastic surgery. Preoperative and postoperative care are essential for outstanding results. The cosmetic surgeon should always available to answer all of your questions about your specific needs.

Swelling & Edema after Cosmetic Surgery of the Face & Neck

2010-05-01T20:15:00.001-04:00

Swelling after cosmetic surgery is expected, even when non-surgical (Botox Cosmetic) office treatments are performed. Plastic surgery swelling usually resolves within a few hours to a few weeks or longer, mostly dependant on the procedure performed.

Cosmetic surgery patients may help reduce post-treatment swelling via a variety of methods. I've already talked about rhinoplasty swelling in a previous post. Many of those guidelines apply to other facial surgery, such as face lift, for my Maryland and northern Virginia patients. Other potential helpful factors which may help with postop cosmetic surgery swelling include the following

reduce salt intake
reduce ingesting processed foods and focus on fresh fruits & vegetables
reduce spicy foods
oral diuretic to help urinate excess salt, only for a brief duration
steroid injection or pills
hyaluronidase
facial massage or gentile compression dressing to the area

Lastly, swelling or edema in the face may be due to allergies, thyroid condition, medication side-effect, or other medical conditions. Speak to your plastic surgeon to help determine methods to help reduce facial swelling that is appropriate for you.

Anesthesia for Injectable Fillers to Reduce Pain

2010-04-20T23:21:00.000-04:00

Injectable fillers such as Restylane (hyaluronic acid), Juvederm, Radiesse, and Sculptra are good options for various cosmetic enhancements for facial aging Washington area residents. Treatment areas vary for each product, including nasolabial / smile lines, marionette lines, cheek or midface augmentation, or lip enhancement.

Some local anesthesia is generally required, since each filler is injected via a small needle. However, cosmetic treatment should not be very painful. Most Maryland facial plastic surgeons or dermatologists use a combination of anesthesia techniques to minimize discomfort.

ice pack prior to procedure
topical anesthesia cream on treated areas
nerve or dental block with injection of anesthesia into skin
mixing anesthesia directly with the filler
oral pain medication prior to procedure
specific technique of administering local anesthesia
facial massage

There are many other techniques I use which may help alleviate any pain with injections.

Saline Neti Pot Rinse for Nasal Congestion

2010-04-15T16:33:00.000-04:00

Great article in CNN today on the benefits of saline nasal rinses.

I tell every patient prior to and after cosmetic nasal surgery (rhinoplasty) to use nasal saline rinses. Saline rinses helps clear dust, pollen, and mucous from the nose and sinuses. Washington DC and northern Virginia patients suffer from terrible allergies. Saline rinses help Maryland deviated nasal septum, seasonal allergies, and hayfever patients. After surgery on the nose or sinuses, saline rinses help to reduce internal swelling and to keep the nasal cavity clean & moist.

Combine Plastic Surgery Procedures?

2010-03-18T08:39:00.000-04:00

Many northern Virginia cosmetic surgery patients ask if they should combine plastic surgery procedures. While each individual has a unique treatment plan, it is usually preferred to combine procedures up to a point. The decision to combine procedures is a balance of many factors, and too many or too extensive procedures may contribute to other issues.

The first advantage of combining surgery is that insurance may cover a portion of the procedure, and one may save money on plastic surgery fees. Secondly, tissue modified from one area of the body may be used for another surgical area, such as liposuction and fat transfer, or cartilage from deviated septum repair and rhinoplasty. Lastly, the recovery process following surgery would only be once, and you minimize downtime by avoiding separate procedures.

Disadvantages of combining surgery would include a prolonged recovery time and longer anesthesia. Some procedures should not be combined until one has healed from the first procedure, such as deeper chemical peels or some laser resurfacing with a face lift.

Facial plastic procedures which are normally combined include the following:

Blepharoplasty and brow lift
Brow lift and face lift
Face lift and fat transfer
Fat transfer and Botox Cosmetic
Chemical peel and Botox Cosmetic
Septoplasty and rhinoplasty
Chin augmentation and rhinoplasty

Botox Cosmetic: Touchup

2010-01-31T21:46:00.002-05:00

Botox Cosmetic is a very popular non-surgical method for reducing facial wrinkles. Most patients have minimal discomfort with treatment. Results are are most evident by 2 weeks after treatment, but may be visible as early as a few days.

Plastic surgeons may provide touch up Botox Cosmetic to their aesthetic patients. Touch ups are provided at 2 weeks or later. Any touch ups cosmetic treatment earlier than 2 weeks is generally inappropriate, as sufficient time has not been given for the first treatment to fully work.

Fat Injection after Facial Injectable Filler

2009-11-10T08:05:00.005-05:00

Can I get fat injection after already having an injectable filler, such as Restylane, Juvederm, or Radiesse?

Yes.

Fat, taken from your own body, is a natural alternative to injectable fillers. It largely depends on where you were treated with the original facial filler, and where you are considering facial enhancement with fat grafting.

Generally, if you are considering adding more volume or filling wrinkles in the same area as a prior injectable filler, it's better to wait until the first treatment if complete. Depending on the original filler, the waiting time may range from several months to over a year. The plastic surgeon will be able to better determine how much fat to transfer, since fat has the potential of permanent facial rejuvenation.

Only after a comprehensive evaluation can a plastic surgeon determine the appropriate treatment options for you.

Deviated Septum Surgery presentation

2009-10-22T10:22:00.003-04:00

I gave a Deviated Septum & Rhinoplasty presentation to the DC, Maryland, and northern Virginia community last night at George Washington University. It was a great turn out with lots of good questions from the audience!

Nasolabial Lines: Plastic Surgery or Filler?

2009-10-16T11:00:00.004-04:00

I'm only in my 20's, but developing signs of aging. Do I need plastic surgery?

No.

Early, subtle signs of aging may become evident in patients who are in there 20's or 30's. The nasolabial lines or Crow's feet may begin to show. The skin become thinner and less uniform in appearance. Volume loss and sagging tissue, which comes primarily from age, sun, and genetics, contribute to the gradual deepening of these facial lines.

Initial treatment of these facial wrinkles is to (1) add volume, and/or (2) lift the cheek or mid face. Adding volume is done with a quick procedure with any of the available injectable fillers (Restylane, Juvederm, collagen, fat). Facial plastic surgery with either a cheek lift or cheek augmentation is appropriate for select patients.

Plastic surgery should not be the first option in younger patients. Many non-surgical choices exist to improve skin quality and decrease the signs of aging.

Speak with a plastic surgeon to help determine the most appropriate treatment for you.

Non-Surgical Rhinoplasty before Traditional Nasal Surgery

2009-10-05T10:51:00.004-04:00

Can I have a non-surgical nose job, if I'm thinking of getting a real rhinoplasty later?

One should avoid any non-surgical rhinoplasty before traditional nasal surgery.

Nasal injections themselves may have complications or side-effects that may interfere with future cosmetic rhinoplasty. Scar tissue may form and nasal cartilage may be altered with any procedure, even non-surgical rhinoplasty. Fat, silicone, or other specific injections should not be injected into the nose. However, certain products such as hyaluronic acid (Restylane and Juvederm) might be used if you wait at least over one year before rhinoplasty. Some residual injected material may still be present in the nasal tissue long after the initial treatment.

Speak with a rhinoplasty surgeon to determine the best option for you, before any non-surgical rhinoplasty.

Rhinoplasty: Augment Bridge of Nose

2009-09-25T08:02:00.004-04:00

What is the best material to build the bridge of the nose?

There isn't a best material. Your own tissue is usually a better material than synthetic implants (silicone, etc). Silicone implants in the nose are more likely to become infected and may extrude. Normally, cartilage such as ear, septal, or rib cartilage is used to augment the nasal bridge for rhinoplasty surgery.

Cartilage is available from many places in your body for nasal surgery. Each tissue has its own strengths and weaknesses. The exact material used is largely based on the plastic surgeon's and the patients preference. Keep in mind that all tissue used in nasal surgery may warp, bend, or reabsorb to some degree.

Most rhinoplasty surgeons prefer to use septal cartilage. In Asian rhinoplasty patients, the septal cartilage may be thin or insufficient for nasal augmentation. As a result, many Asian rhinoplasty surgeries involve ear cartilage.

Only after a comprehensive evaluation can a rhinoplasty surgeon determine the most ideal material for you.

Rhinoplasty: Cosmetic Surgery after a Septoplasty?

2009-09-24T17:33:00.004-04:00

Can one have a cosmetic rhinoplasty after already having a septoplasty?

Yes

One can have cosmetic rhinoplasty to alter the shape of the nose after septoplasty for a deviated septum.

During the septoplasty procedure, deviated portions of bone and cartilage may be removed entirely or they may be readjusted and repositioned. This deviated septum surgery has different techniques and approaches, largely dependent on the anatomy of the nasal septum for each particular person. For a majority of patients, septoplasty surgery does not alter the external shape of the nose, since the deviated portions of cartilage and bone are usually internal.

After a septoplasty, it's best to wait an adequate amount of time for appropriate healing. Most plastic surgeons wait at least 6 months, if not longer, before proceeding with rhinoplasty surgery.

If you are planning to have a septoplasty in the future and considering a possible rhinoplasty, then it would be better to combine both procedures at the same time. Combination nasal surgery is beneficial for several reasons. First, cartilage modified from the nasal septum during the septoplasty may be used for grafts during the rhinoplasty. Second, the recovery and healing following surgery would only be once, and downtime is minimized by avoiding two separate procedures. Lastly, rhinoplasty after having had a septoplasty is a potentially more complicated procedure.

Rhinoplasty: Age for Teen Nasal Surgery?

2009-09-14T10:30:00.004-04:00

What is the right age for Teenage Rhinoplasty?

Rhinoplasty is a common plastic surgery request from teenagers, after otoplasty or scar revision. The teenager's nose is relatively larger than the rest of their face during this time. Due to this facial imbalance or asymmetry, many teenagers pressure their parents for cosmetic surgery. Keep in mind that body parts that might appear too large or too small now can become more proportionate over time.

The nose continues to grow as we age, but the largest rate of nasal growth occurs during teen years. Generally, this growth rate slows greatly at age 16 for most girls, and 17 for most boys. As a result, most plastic surgeons wait until this age before considering rhinoplasty for teenagers.

Botox Cosmetic: Nurse or Physician Inject?

2009-09-11T08:59:00.003-04:00

Should I go to a nurse or doctor for Botox treatment?

Botox Cosmetic is not one treatment, but a collection of potential treatments. Botox Cosmetic may be applied in specific ways to achieve certain results for facial rejuvenation.

Anyone who has received extensive training may inject Botox Cosmetic, physicians or nurses. Plastic surgeons or dermatologists are not the only ones able to provide treatment. Your child's pediatrician could give Botox too. Laws vary by state. Ultimately, it comes down to the injector's experience and training. Even the best injectors may get less than optimal results.

Botox Cosmetic: Weak Smile & Droopy eyes

2009-09-09T09:43:00.004-04:00

Why do I have weakened smile and droopy eyelid after Botox Cosmetic?

Botox Cosmetic may partially migrate & affect other facial muscles which were not originally intended. Normally, small doses of northern Virginia Botox Cosmetic are injected at very specific sites to affect specific muscles to improve facial wrinkles for . Occasionally, Botox Cosmetic moves a bit away from the original injection site and weakens other facial muscles.

Most commonly the upper eyelid becomes droopy after Maryland Botox injections performed in between the eyebrows or Crow's feet. Crow's feet Botox treatment may also affect the smile & upper lip movement too.

Unintended facial weakness from northern Virginia or Maryland Botox treatment will recover. Muscle activity returns once the Botox activity is gone, which is usually 3-4 months. To help prevent such results, it's important not to massage the face immediately after Botox treatment.

Face Lift: Recovery Time?

2009-09-08T10:57:00.004-04:00

How long is recovery after face lift surgery?

No one wants to look as if they have had cosmetic surgery, and no one wants a long recovery period after plastic surgery. Fortunately, modern face lift surgery may get you natural results without the prolonged healing period.

Face lift recovery varies on the specific type of face lift you had and your body's natural healing ability. Minimally invasive face lifts (mini lifts, short scar, or minimal access) usually have a faster recovery time than traditional facelifts or full face lifts. Generally speaking, most swelling and bruising after facial cosmetic surgery (mini face lift) resolve within a couple weeks. One should plan for at least 2 weeks of recovery. You may have residual slight bruising or swelling for longer, however, may still be able to go into public without drawing attention.

Speak to you facial plastic surgeon to learn more about face lift surgery.

Chemical Peel: Spa or Physician Office?

2009-09-04T13:31:00.004-04:00

Where should I get a chemical peel?

Some patients are confused by skin care peels. Salons and medical spas are offering chemical peels, in addition to other non-surgical cosmetic treatments such as Botox Cosmetic or injectable fillers (collagen & hyaluronic acid). Generally, very superficial skin treatments such as fruit peels or microdermabrasion may be performed by anyone (physician, nurse, aesthetician, etc). Some companies sell such peel kits for home use by patients themselves.

Aesthetic results from a chemical peel are primarily dependent on depth of peel, chemical agent & concentration (TCA, Jessner's, glycolic acid, etc), and your skin quality (thick/thin, dry/oily, color, etc). The physical location (physician's office versus a spa or salon) itself should not matter. Patients get better results as the peel goes deeper into the skin; however, the recovery time and potential risks are higher. Regardless, any location where skin care takes place must be clean & sterile.

Generally speaking fruit peels are very superficial and do not go deep into the skin. Consequently, the results are minimal and treatment must be repeated multiple times to appreciate an effect. Recovery is quick though.

Any treatment which goes deeper into the skin must be performed by a physician. Lastly, skin care starts before and continues after the peel, which your physician can help manage. Certain skin care products are only available from a physician, such as retinols & hydroquinone.

Speak to a cosmetic physician performing skin care and chemical peels to determine which treatment is appropriate for you.

Rhinoplasty: Bump on Top

2009-09-04T08:11:00.004-04:00

What is this bump on top of my nose?

Bumps on the top of the nose are a common reason patients seek rhinoplasty. Most nasal bumps are natural and develop as we age, while fewer are do to trauma or injuries. Nasal bumps come in various sizes & shapes. Bumps are commonly made of both bone and cartilage.

Rhinoplasty surgery (nose job) is the best long-term method to reduce or remove a bump. Sometimes, temporary injections of material into the area may help camouflage the bump.

Once you are ready for nasal surgery, speak with a specialist who can perform a comprehensive evaluation and determine if rhinoplasty surgery is appropriate for you. Best of luck.

Face Lift: Turkey Neck treatment

2009-08-28T15:20:00.004-04:00

Treatment options for the turkey neck?

A typical sign of facial aging is the "turkey neck" is . Skin, fat, and neck muscle sag with age contributing to the typical appearance of the neck. The "turkey neck" is a more advanced sign of aging. Early signs of facial aging are chin wrinkles, jowling, and subtle fullness under the chin.

Traditional face lift surgery with liposuction of the neck area is usually a great option. These traditional face lift procedures have many variations and may be called deep plane, extended SMAS, composite face lift, or subperiosteal face lift. However, there is a healing period after surgery approximately a few weeks or longer.

With faster recovery & less downtime, more minimal incision face lifts (mini lifts, minimal access cranial lift, short scar lift, etc) have been developed. Younger patients with earlier signs of facial aging benefit most from these minimal procedures. Older patients with advanced signs of aging may benefit more from the traditional face lift procedures.

Facial plastic surgery is individualized, and there isn't one face lift procedure that is appropriate for all patients. Age, skin quality, degree of fat, bone structure, and muscle tone are only some of the many factors that a plastic surgeon examines to develop a cosmetic surgery plan. We also consider other medication conditions, smoking, and medications, among other factors.

Speak to a plastic surgeon specializing in face lift surgery to help determine which face lift is appropriate for you.

Septoplasty: Perforated Septum Risk?

2009-08-28T14:31:00.004-04:00

Having a perforated septum is relatively rare. It is a low risk after septoplasty surgery, estimated to be less than 1%. There are many factors which increase the risk of developing a hole in the septum:

revision nasal surgery
broken nose, or nasal / facial trauma
nasal piercing
severely deviated septum, usually from trauma
drug or cocaine use
chronic nasal decongestant use
nasal infection
other medical conditions: radiation, cancer, autoimmune disorders, etc

A deviated septum is not the only cause of nasal or sinus symptoms of nasal congestion / obstruction. Only after a comprehensive nasal evaluation can a nasal rhinoplasty surgeon best advise regarding treatment options for a deviated septum. One must carefully follow the facial plastic surgeon's postoperative care instructions too.

Face Lift: Incision & Types

2009-08-24T12:53:00.005-04:00

Which Face Lift is right for me?

Maryland face lift surgery has changed over the years, as we better understand the structures of the face & neck. Facelift surgery refers to cosmetic facial surgery of the jowls (lower face) & neck. Although there are many different face lift procedure terms, there are really only a few different types. Some basic face lift types are the deep, SMAS, or composite lifts. Face lift surgery may be combined with other cosmetic surgery such as a neck lift, fat transfer, liposuction, or other treatments. All of the face lifts types have an incision in front of the ear, with variable extension of the incision up around the temple or behind the ear & upper neck.

The amount of tissue adjusted or tightened depends on the exact surgical approach & the requirements of a particular aesthetic patient. The minimal incision or minimal access lift performed via a short scar is more appropriate for younger patients (less than 60) or patients with little/moderate skin aging. All of these types of face lifts are variations of SMAS lifts. Older patients or patients with excess skin sagging will require a more traditional facelift procedure with SMAS treatment. By far, a majority of plastic surgeons who perform northern Virginia face lift surgery do a SMAS lift variation. This face lift type generally has the quickest recovery with great results.

One face lift type is not appropriate for all patients. Each facial cosmetic surgery is specific for each patient. Keep in mind, many companies or plastic surgeons may market face lifts by different names, which confuses patients. Speak to a plastic surgeon to determine which facelift is right for you.

Eyelid Surgery: Thyroid Affect Bags?

2009-08-12T08:46:00.004-04:00

Can the thyroid gland affect facial appearance?

Yes.

All thyroid conditions may affect one's appearance. Thyroid disorders, either elevated/hyper or low/hypo, changes all tissue: mucous membranes, skin, hair, muscle, and bone. Most patients have under active thyroid gland, which may contribute to increase aged appearance. For some thyroid patients, they may have increased under eye bags with a tired appearance, or eyes which seem to pop out of their head.

Most plastic surgeons performing eyelid surgery will evaluate for thyroid condition, in addition to allergies, prior to any facial cosmetic surgery. It is very difficult to determine, however, how much of one's appearance is specifically due to thyroid condition vs. normal aging, or other factors.

There isn't a best cosmetic treatment for all thyroid patients. Only after a comprehensive evaluation by a cosmetic surgeon, can one determine what cosmetic treatment is appropriate for a particular patient. Aesthetic treatment may be skin care, injectable fillers, or skin resurfacing (laser, chemical, etc). Malar bags are generally more difficult to treat with than pure eyelid bags, with any approach. Alternatively, plastic surgery of the eyelid, midface, or malar bags may be more ideal after evaluation.

Speak with a surgeon performing eyelid surgery to help determine if cosmetic eyelid surgery is appropriate for you.

Rhinoplasty: After Having Septoplasty?

2009-08-03T07:41:00.003-04:00

Is rhinoplasty after already having a septoplasty a more complicated procedure?

Yes, in general, rhinoplasty after a septoplasty is more complicated.

Cosmetic nose job surgery complexity largely depends on exactly what was performed in the original deviated septum surgery, your specific nasal anatomy, and the desired results from cosmetic nasal surgery. Only after a comprehensive examination by a nasal cosmetic surgeon, can he/she be able determine the complexity of rhinoplasty in your particular case.

Both septoplasty and rhinoplasty may be "minor" or "major" procedures. There are many variations is each procedure. Having one performed prior to another may make the second procedure unnecessarily "major".

Ideally, you should heal completely from septoplasty before considering rhinoplasty surgery. Generally, many surgeons prefer to wait at least 6 months, if not longer, before cosmetic surgery.

Rhinoplasty: Plastic Surgeon or Facial Plastic Surgeon?

2009-07-20T07:49:00.003-04:00

Does it make a difference who does my rhinoplasty?

Cosmetic rhinoplasty patients should look at many things when considering elective cosmetic surgery, not just the specific board certification. Both plastic surgeons have training and may perform rhinoplasty. Some surgeons may have a particular interest in rhinoplasty surgery, while other plastic surgeons have other aesthetic interests. Speak with more than one surgeon for consultation. Only after discussing your specific rhinoplasty are you able to make an informed decision.

Rhinoplasty: Allergies affect Results?

2009-07-17T10:25:00.003-04:00

I rub my nose a lot from allergies. Can this affect my rhinoplasty results?

Patients undergoing rhinoplasty surgery (nose job) should not be sneezing, rubbing, or wrinkling their nose after cosmetic surgery. Rhinitis, swelling of the internal nose, may be from allergies or irritants. Patients should have rhinitis controlled as much as possible before the elective, cosmetic rhinoplasty surgery. A combination of once daily nasal saline irrigation and nasal steroid spray should help reduce nasal irritation.

Another option is to have Botox cosmetic injected into the "bunny" lines of the nose. Botox will relax those nasal muscles, and may prevent negative alterations of your rhinoplasty results by rubbing the nose. Botox will not reduce the rhinitis though.

Speak with a cosmetic nasal specialist / otolaryngologist before your cosmetic facial surgery.

Computer Imaging in Plastic Surgery

2009-07-13T17:55:00.002-04:00

Are the pictures on the plastic surgeon's website real???

It depends on the website & the surgeon. Photographs and images on websites should be properly labeled as actual patients or models. Photographs, either online or in-person, may be misleading, due to variations in lighting, patient position, photo angle, camera, makeup, or computer manipulation.

It is relatively easy to simulate plastic surgery on the computer. Simple digital imaging software can provide before and after pictures of plastic surgery. Some surgeons simulate surgery with patients in-person, while some plastic surgeons recommend a followup appointment to review computer imaging.

Anyone considering facial plastic surgery should be doing their homework, and not base the final decision on the surgeon's website pictures alone.

Brow Lift: Augmentation Too?

2009-07-09T11:07:00.002-04:00

Does Brow Lift surgery augment the Eyebrow? No.

Some patients may think brow lift surgery requires placing material into the forehead and brow area to augment or fill the eyebrow. Typical cosmetic brow lift surgery does not need any fillers. Endoscopic brow lift surgery does not augment the forehead, rather this cosmetic surgery lifts and repositions the eyebrow into a more youthful position. Temporary implants or suture material may be used to help hold the forehead and eyebrow in its new position, but these type of implants do not augment.

Forehead augmentation or cranioplasty normally requires more exposure, which is provided via a coronal incision. Patients who have had extensive head trauma, neurosurgery, congenital abnormalities, or cancer surgery may require this reconstructive plastic surgery. None of these patients would benefit from aesthetic endoscopic brow lift, usually.

Med Spa: Permanent Injectable Fillers

2009-07-02T16:15:00.004-04:00

Just say no.

I would not recommend any permanent injectable filler anywhere in the face. Remember, your face and skin continue to change over time, and permanent injectable fillers will become visible over time. These permanent fillers cannot be removed.

Cosmetic injections should be natural. The best natural injectable filler with potential for long-term results is your own fat. Fat injections may be permanent, but can also be modified as needed.

Long term cosmetic results are better achieved with surgery. Facial plastic surgery has become less invasive with faster recovery times. Speak to your cosmetic surgeon for the latest in facial plastic procedures.

Septoplasty: Throat Infection?

2009-07-02T14:09:00.002-04:00

Deviated septum is very common. Estimates of 80% of all adults have a deviated septum. Not everyone with a deviated septum is symptomatic or requires a septoplasty though.

It is unlikely that deviated septum causes persistent throat infections. Deviated septum and nasal congestion may contribute to throat irritation, but it is not a major contributing factor. Usually patients have nasal obstruction from a deviated septum, swollen turbinates, allergies, and sinus problems. These patients are unable to breath through the nose during sleep. The nose should warm and humidify the air we breathe. As a result, the throat may feel dry and irritated when they wake up.

Speak to a head and neck specialist to evaluate your symptoms first.

Chin Implant: Numbness after Surgery?

2009-07-02T11:50:00.003-04:00

Skin and tissues are bruised and stretched during any form of chin surgery, implants, or augmentation. The first week is still very early after facial surgery. It's not uncommon to have numbness and strange sensations in the lower lip and chin area. Some patients complain of "tight" feeling. Numbness continues to improve with time. Fortunately, most of the numbness resolves within a month, but occasionally may take several months to go away.

Speak with your surgeon about your concerns of numbness after chin implant surgery.

Septoplasty: No Nasal Packing?

2009-06-30T13:33:00.002-04:00

Can I have deviated septum surgery without cotton nasal packing?

Yes, one does not absolutely need cotton nasal packing after septoplasty or deviated septum surgery.

Most plastic surgeons and otolaryngologist use cotton packing temporarily to help control natural bloody oozing following nasal surgery. This nasal discharge after surgery is the worst the first day, but often takes several days to resolve. Some surgeons may also use temporary silicone splint to help support the septum during the healing period.

You may have a little extra nasal mucous discharge or nose bleed after surgery, if packing is not used. The amount of discharge or bleeding largely depends on the surgery performed, patient anatomy, and degree of septal deviation.

Ultimately, the decision for nasal packing depends on the surgeon, patient, and extent of nasal or sinus surgery. Speak with your facial plastic surgeon. Let him/her know your concerns about packing.

Rhinoplasty: Nasal Congestion after Surgery?

2009-06-30T13:11:00.003-04:00

Yes, rhinoplasty or cosmetic nasal surgery may contribute to breathing problems with the nose.

Nasal congestion may either be immediate or chronic with rhinoplasty / nose job surgery. Most immediate nasal congestion after rhinoplasty surgery is due to normal postoperative swelling. A majority of this internal, as well as external, swelling resolves within a couple weeks. However, it may take a couple months for the final internal swelling to resolve. Some surgeons use cotton nasal packs or silicone splints after surgery. Normal crusting and scabs inside the nose also keep the breathing down after surgery.

Long-term nasal congestion after nose job / rhinoplasty surgery is more of a concern, and due to many, many conditions, some of which may not be due to the original surgery. Fortunately, it is uncommon to have long-term nasal breathing difficulty after rhinoplasty. Allergies, nasal polyps, dust exposure, and sinus problems all cause nasal congestion. These nasal breathing problems can be evaluated by an otolaryngologist and treated accordingly.

Turbinate hypertrophy and deviated septum are common potential causes. These conditions are also usually easily treatable.

Lastly, scarring or major alteration in the structure of the nose after rhinoplasty surgery can contribute to breathing problems. Fortunately, this is usually the least common cause of breathing issues following surgery.

Speak to a facial plastic surgeon, who specialized in both the inside and outside of the nose, to perform a comprehensive examination and help guide your treatment plan.

Botox: Baldness Cure?

2009-06-30T08:13:00.002-04:00

There have been reports in the media recently that some doctors use Botox Cosmetic for hair loss. Initial reports sound promising.

The truth is Botox is not FDA approved for hair loss, and physicians are using the medication off-label. Unfortunately, there aren't any research articles in the medical literature that supports Botox injections for hair loss. There have not been any well-documented results with this application. Risks and side effects are unknown with this application. Long-term results are also unknown.

Botox Cosmetic may be a potential treatment option for baldness and hair loss. However, plastic surgeons and dermatologists should do well organized medical research to study the possible risks and benefits before offering it to our patients.

Rhinoplasty: Cast & Swelling at 1 week

2009-06-23T21:17:00.002-04:00

Swelling following rhinoplasty surgery occurs both on the outside and inside of the nose. All patients feel congested and have nasal congestion and postnasal drip immediately after rhinoplasty surgery, which is normal. Normally, patients are socially acceptable within 2 weeks. Most nasal swelling after rhinoplasty resolves within one month. The final 20% of rhinoplasty swelling takes a much longer time to resolve, up to a year or longer after surgery. Fortunately, this final swelling is usually only evident to the surgeon and patient.

Patients are anxious at the one week office visit to the plastic surgeon, and they have great expectations when the nasal cast is removed. Keep in mind, the nose may be very swollen and the nasal cast may appear to contribute to an unnatural appearance to the nose. This brief unnatural appearance from casting resolves pretty quickly. Most nasal plastic surgeons keep the the nasal cast for at least one week following surgery.

Rhinoplasty swelling varies greatly and is largely based on the areas of the nose treated, surgical approach to the nose (open or closed/endonasal), skin thickness, postoperative care, and your healing ability. The more extensive the surgery, the more you will swell and the longer the swelling will last. The tip of the nose holds onto swelling longer than the other parts of the nose. Open rhinoplasty, where there is an external incision at the base of the nose, typically swells more and longer than closed/endonasal rhinoplasty. Patients with thicker skin will also have more swelling than thin skin patients.

Keeping your head elevated, maintaining the nasal splint/cast, ice, arnica montana, and following your plastic surgeon's guideline may help reduce rhinoplasty swelling. Persistent swelling may also be reduced by steroid treatment into the nose. Don't hesitate to speak to your plastic surgeon about any swelling.

Rhinoplasty: Non-Surgical with Injectable Filler

2009-06-22T20:21:00.002-04:00

Be very careful with any cosmetic injections into the nose. The nose is very susceptible to discoloration, swelling, ischemia, pain, numbness, and other potential complications with inappropriate injections into the nose.

There isn't an injectable filler on the market currently that is FDA approved for injection into the nose. Everything is being used off-label for non-surgical rhinoplasty. Fillers should never be placed into the tip of the nose. Complications usually occur at the nasal tip. Fillers should only placed in the bridge to help smooth contour irregularities and minor augmentation. Fillers which have been used for nonsurgical rhinoplasty include Radiesse and hyaluronic acids.

Depending on the anatomy of your nose and your aesthetic desires, I suggest first speaking with a rhinoplasty surgeon who can use computer imaging to simulate rhinoplasty. You'll be able to visualize in real time what possibilities are available with rhinoplasty.

Rhinoplasty: Can We Undo the Results?

2009-06-22T20:04:00.003-04:00

Unlikely.

Regardless of the exact rhinoplasty technique used initially, your nose may not look exactly as it did before the original surgery.

First, the nose continues to change naturally over time without any further surgery. Swelling subsides and skin tightens. The nose can loose some of the projection over the course of the year. Rhinoplasty results aren't fully realized until waiting at least one year. If you are still unhappy with your nose after waiting an appropriate amount of time, then you may consider revision rhinoplasty.

There are so many variables for rhinoplasty. How was the rhinoplasty performed? Is there history of trauma or prior nasal or sinus surgery? Cartilage grafts used? Septoplasty done at same time? Thick or thin skin? Only after a comprehensive examination by a rhinoplasty surgeon in DC, can one be appropriately advised whether revision rhinoplasty is helpful.

Fat Transfer, Graft, Injection - What's the Difference?

2009-06-22T19:45:00.002-04:00

Cosmetic procedures for facial rejuvenation with fat use many terms. All plastic surgery with placing fat into the face are essentially the same procedure. Terms which may be used for this aesthetic procedure are fat injection, liposculpture, fat transfer, autologous fat grafting, micro fat graft, fat augmentation, and others.

The procedure takes your own fat via liposuction, usually from around the abdomen, and injects it into areas of the face that require volume. Fat may also be harvested from the hip, legs, and buttocks. Fat should be harvested, processed, and injected with minimal trauma, to allow the fragile fat particles, cells, and living tissue to survive long-term. The fat is injected as tiny particles via a small syringe. Fat is normally injected into the nasolabial folds, tear trough area of the lower eyelid, cheeks, lips, and midface to name a few areas.

Results last several months, and potentially permanently. The procedure may be performed under local anesthesia or IV sedation, depending on patient and surgeon preference.

Speak with your plastic surgeon to determine if a fat graft procedure is appropriate for you.

Chin Implants: Witch's Deformity?

2009-06-18T09:36:00.003-04:00

Witch's chin deformity may occur with any form of dental or plastic surgery around the chin. The mentalis muscle becomes loose from surgery or implants, resulting in a pointier or bulbous chin. The skin and soft tissue of the chin sags or droops.

Witch's deformity may occur spontaneously. More often it's due to dental surgery. Incisions that are intraoral (inside the mouth) or external (under the chin) may cause the deformity. Chin implants and augmentation, or replacing implants are also a risk.

Although relatively uncommon, having a plastic surgeon recognize the risk helps to manage and prevent the chin deformity from occurring, or treating the deformity.

If you feel your chin implant is too big or masculinizes your face, then it should be removed or exchanged. As with any procedure, you must weigh the risks, advantages, and disadvantages.

Speak with a plastic surgeon about chin deformities with chin implants and augmentation.

Blepharoplasty: Scleral Show after Eyelid Surgery?

2009-06-17T22:17:00.005-04:00

Scleral show, otherwise known as excess exposure of the lower whites of the eye, is a somewhat common condition. The lower eyelid may be pulled down, weak, or rotated. There are many causes of the increased exposure of the white eye. The eyelid has several layers and components, any one of which may result in eyelid malposition. Patients may also develop dry eyes from poor tear flow.

Age increases the laxity of the skin and structures of the eyelid, resulting in droopy and weaken eyelids. Some elderly patients need to squeeze their eyes a few times, before they close completely. Facial paralysis is causes scleral show from weakness of the eye muscles. Eyelid surgery is a very common cause of this condition. Surgery on the skin, muscle, fat, and connective tissues may all result in scleral show.

Fortunately, many options exist to help for cosmetic eyelid surgery in DC, northern Virginia, and Maryland. Suturing and pulling up the eyelid is the simplest method. Sometimes it's necessary to tighten the lower lid by shortening it, like tightening a belt buckle. Scleral show from scarring may be managed by cutting the scar and placing soft tissue from the mouth to make the eyelid more mobile. Lastly, lifting the cheek and midface may be necessary to help lift the eyelid and prevent relapse of scleral show. These various surgical methods have advantages and disadvantages.

One eyelid plastic surgery procedure cannot treat all patients. Speak with a plastic surgeon to perform a comprehensive examination and determine which exact procedure may be most appropriate for you.

Blepharoplasty: Reduce Eyelid Swelling

2009-06-16T13:04:00.002-04:00

Ice to eyes after cosmetic eyelid surgery is most useful during the first 48 hours. I advise cosmetic patients to keep fresh, clean ice pack over surgical wounds while they are awake only for the first 2 days. After the first 2 days, ice does help control swelling but is much less effective. I still recommend using ice for the first week, as tolerated. Each DC facial plastic surgeon has a preference based on the procedure and each specific patient.

Keep your head elevated at all times, and avoid bending over. Sleeping on top several pillows or in a chair also helps reduce facial swelling after cosmetic surgery.

I advise patients to strictly avoid lifting, straining, or any strenuous activity (including sex) for at least 2 weeks following facial plastic surgery. This activity restriction helps healing during the recovery period.

Some plastic surgeons also prescribe a steroid pill, such as prednisone, to control post-procedure swelling and help in recovery.

Although, most swelling after eyelid surgery resolves in a couple weeks, it really takes longer for the final swelling to go away. Four days after eyelid surgery is still very early.

Speak with your eyelid surgeon, and ask when you should stop the ice packs.

Brow Lift: What causes Droopy Eyebrows?

2009-06-15T20:52:00.003-04:00

Most eyebrows naturally droop or descend with age. The skin and connective tissue around the eyes and eyebrows weaken, which makes them drop. The side of the eyebrows tend to drop more than the part of the brow near the nose. Age-related eyebrow changes usually become apparent around 40-years old, but sometimes earlier. The modern cosmetic surgery technique of the endoscopic brow lift offers several advantages over the conventional brow lift.

One other common cause of droopy eyebrows is congenital or genetic. Do your siblings, parents, or other family members have droopy eyebrows?

Don't forget than everyone has an asymmetric face to a degree. Sometimes one eye and/or eyebrow may be a little different than the other.

A more concerning cause of droopy eyebrows is weakening of the facial nerve. The facial nerve controls the muscles of the face. When this nerve is weak, the muscles it supplies also become weak. Weak facial muscles result in droopy eyebrows. Other parts of your face may appear droopy too. Sometimes facial nerve weakness (ie. facial paralysis) may be associated with strange sensations of the face or taste. There are numerous causes of facial paralysis.

Speak with your primary care physician to perform a comprehensive examination, who may then refer you to a specialist for further testing if you are concerned or have any of the following:

progressively droopy eyebrows
weakness of the the entire face
weakness of just one half or one quarter of the face
fever
headache
change in vision
numbness or tingling
speech changes
memory changes
pain
drooling

Face Lift Incisions: Which is Best?

2009-06-15T16:38:00.002-04:00

Facelift and neck lift surgery has a long a history, with numerous incisions described in the medical literature for facial rejuvenation. Incisions have been in and around the scalp, neck, jawline, ears, forehead, and chin. Modern face lift surgery primarily focuses the incision around the ear, eventhough the neck and lower neck has the excess skin and fat.

The facelift incision may be anywhere from the temple & side burns, around the ear, and upper neck. The incision varies largely based on the age of the patient and how much lift an individual needs. The plastic surgeon will minimize the incision but maximize the lift, without creating an unnatural appearance. The face lift incision, regardless of exact location and when performed well, blends and hides from view.

Most face lift and neck lift surgeries also have a supplemental incision under the chin. This chin incision is well hidden, and is used largely to access fat in the neck for liposuction, chin augmentation, or muscle tightening.

The cosmetic outcome of directly removing skin from the neck is poor. The aesthetic outcome of neck lifting is significantly better by pulling up and out around the ears. Patients are mostly unhappy tightening muscles of the neck via a chin incision without also performing face lift incisions around the ear.

More important than the specific incision or face lift technique is the rapport and relationship you build with your plastic surgeon. For example, a northern Virginia facial plastic surgeon will be able to fully explain in-person the appropriate surgical option which is right for you, without a sales pitch or pressure.

Consultation with a face lift surgeon will provide you with a personalized face lift. Speak with more than one plastic surgeon regarding face lift surgery in northern Virginia.

Face Lift Surgery: Mini or Short Scar or SMAS?

2009-06-15T11:01:00.003-04:00

A minimal lift for the lower face and neck is a great option with the least downtime for facial rejuvenation. There are many minimally invasive facelift options for the neck and face, which go by several names: s lift, mini lift, short scar lift, macs lift, SMAS, lunchtime lift, etc. These face lift surgery names are confusing. Technically, all these face lift procedures differ a little, but cosmetic results are the same.

Best cosmetic results for face lift surgery in northern Virginia, Maryland, and Washington DC usually combine the facelift with another procedure, such as fat grafting, skin care, skin resurfacing, Botox cosmetic, etc.

More important than the specific technique is the rapport and relationship you build with your plastic surgeon. He/She will be able to fully explain in-person the appropriate surgical option which is right for you, without a sales pitch or pressure.

The name brand choices for face lift surgery may not offer complete care or counseling before/after surgery. In addition, they cannot provide supplemental plastic surgery services that you may want or require for the best results.

Consultation with a face lift surgeon will provide you with a personalized face lift. Speak with more than one plastic surgeon regarding face lift surgery.

Cheeks: What can be done?

2009-06-12T23:20:00.001-04:00

Plastic surgery patients in DC, northern Virginia have many options for sunken, hollow cheeks and the midface area. Although age and sun damage are the biggest contributing factors, many patients on HIV medications have a condition called facial lipodystrophy, which also causes hollow cheeks.

Regardless of the exact method, the aesthetic treatment is for cheek indentations is augmentation. Fortunately, one has many options to add volume to sunken cheeks. More temporary injectable fillers, such as Restylane, Juvederm, and Radiesse, last several months by augmenting the skin. The cosmetic facial treatments must be repeated, but injections are simple office procedures with little downtime. Injectable fillers are more affordable.

Another injectable solution is Sculptra. It's a material which is injected much deeper into the face and stimulates fibrous tissue over time. Results are not immediate, but rather develop months after treatment, but last much longer. Patients usually require more than one treatment for the desired cosmetic effect.

The more popular solution for injection is fat from you own body, performed either under local or general anesthesia. Fat injections have the possibility for long-term natural results. Some touch-up injections may be necessary, but may be performed in the office.

The most permanent solution for the cheek is enhancement with a silicone implant. Cheek augmentation with implants is performed under IV sedation or general anesthesia via a small incision inside the mouth. There is more swelling and bruising as compared to the other techniques, but results last much longer.

Lastly, a combination of various volume enhancement solutions may be performed at the same time. Speak with your northern Virginia facial plastic surgeon to discuss cheek augmentation to find a cosmetic treatment which is appropriate for you.

Insurance vs. Patient Care: When Patients Loose

2009-06-11T22:29:00.003-04:00

I was just sent this article on a patient I had treated. It's a reminder of the poor quality and bureaucracy of health insurance in the United States.

Physicians are fighting everyday to get health care covered for their patients, whether it is tests, medications, specialist referrals, or surgical procedures. My office and I call insurance providers regularly to try to get patients the care they require. This constant struggle is frustrating for patient and physician, and not what I expected when in medical school.

Brow Lift: Need Botox after Cosmetic Surgery?

2009-06-11T16:21:00.003-04:00

Wait a second! I just had an aesthetic brow lift to help rejuvenate my face. Why do I still need Botox Cosmetic injections?

It is not unusual to need Botox Cosmetic after brow lift surgery.

The need for repeat Botox injection is largely based on what was done during the initial plastic brow surgery. Eyebrow lift surgery not only lifts the brow, cosmetic surgery may also modify the forehead muscles. These same muscles are the ones treated with Botox cosmetic. Active muscles of the face create the dynamic wrinkles, which reveal signs of aging. Muscles which are weakened, removed, or cut during surgery will need less Botox, if any at all. Forehead and brow muscles may be modified with almost any surgical approach to the eyebrow: endoscopic, coronal, pretrichial, direct, transblepharoplasty, midforehead, or lateral brow lifts. Some plastic surgeons in DC, northern Virginia, or Maryland will inject Botox at the time of forehead surgery to help keep the eyebrow in good position.

Speak to your facial plastic surgeon to help plan Botox cosmetic injection and your aesthetic Brow Lift.

Blepharoplasty: Suture Breaking in Double eyelid?

2009-06-11T15:25:00.003-04:00

Creating a double-eyelid is a common operation in the upper eyelid of Asian people. The double-eyelid (crease) is considered beautiful, and is not Westernization. The double-crease has been desired for thousands of years.

Most Asian blepharoplasty procedures in the Washington DC and northern Virginia use a suture from the skin to the deeper muscle, which help create the double-eyelid / crease. These sutures may be either absorbable or require removal.

Sutures and stitches for cosmetic eyelid surgery is only realistically important for a few days/weeks. The appearance of your eyes should not return to the way it looked prior to the surgery. After a few days/weeks, these areas fuse with a little scar & fibrous band. At this point the sutures are no longer required to maintain the crease. If the stitches break within the first day or two, then yes the crease can go away. It's a simple revision to put a new stitch back in.

Speak with your plastic surgeon or ophthalmologist, if you have any concerns regarding Asian blepharoplasty stitches.

Rhinoplasty: Does Cosmetic Surgery Affect the Upper Lip?

2009-06-10T14:26:00.005-04:00

Yes.

First, the tip of the nose, septum, and upper lip are connected intimately and affect one another. Modifying and reshaping the columella, nostrils, lower lateral cartilages, vestibule, caudal septum, and nasal muscles all contribute to the appearance of the upper lip. In fact, facial plastic surgeons leave the upper lip exposed during rhinoplasty to evaluate minor changes which may occur during cosmetic nasal surgery. The upper lip may feel tight or stiff after surgery, especially when smiling. The tip of the nose and lip area may feel numb too.

Second, the nose, especially the tip area and skin, continue to change following surgery. Most of the nasal swelling resolves within a month, with the final swelling taking at least 1 year.

Lastly, patients with a deviated nose may also have a deviated lip. Look at the philtrum, the central part of the upper lip, of anyone with a slanted or crooked nose. The philtrum portion of the lip is also deviated in patient with twisted noses.

Speak with your rhinoplasty surgeon to help explain how cosmetic surgery on the nose affects the upper lip.

Update: See how Botox Cosmetic may affect the nose when the upper lip pulls the tip down.

Rhinoplasty: Does Massage Help Swelling or Scar?

2009-06-10T05:28:00.001-04:00

The nose, especially the skin around the tip, normally swells after rhinoplasty. Most swelling resolves in a few weeks, but the last 20% of nasal swelling takes at least 1 year to resolve.

Gently pressure and massage may be appropriate after rhinoplasty. The bridge, middle, or tip of the nose may be massaged. Scar tissue softens and swollen tissue is reduced with any massage of the skin. Pressure that is too forceful may shift and move the nasal bones and cartilage. Steroid injection under the skin may be required to help control swelling, scar, and edema.

Speak to your facial plastic surgeon if nasal massage is appropriate for your particular case.

Rhinoplasty: Treatment for Slanted, Crooked Nose?

2009-06-10T05:18:00.002-04:00

Deviated noses are a common problem. The bridge, middle, and/or tip of the nose may be crooked. Sometime the external nose is straight, but the internal nose and nasal septum is deviated. Twisted noses may be major, or very small & minor.

Slanted noses are usually developmental and congenital. Trauma is another major reason some noses slant.

Many options exist to straighten a nose. Rhinoplasty surgery, deviated septum surgery, septoplasty are the best options. Minor imperfections, asymmetry, and slanting may be treated with small injections, in order to avoid rhinoplasty surgery.

Speak with several plastic surgeons and determine whether treatement is appropriate for you.

Does Insurance cover Cosmetic Surgery?

2009-06-09T20:02:00.003-04:00

Many board certified plastic surgeons provide the finest in aesthetic plastic surgery at affordable prices. Many also participate with most insurance plans within the United States.

Plastic surgery covers a broad area of medicine, which includes both reconstructive procedures and cosmetic procedures. Reconstructive plastic surgery, such as trauma, broken nose, scars, skin cancer, septoplasty, congenital deformity, are typical areas where health insurance applies. Secondary or revision cosmetic surgery may also be covered. If your procedure is medically indicated, some portion of the cost may be covered. Most plastic surgery offices accept insurance in applicable cases and will, if you wish, contact your insurance company to find out if your procedure will be covered. Insurance coverage varies greatly for patients, however, pure cosmetic surgery is usually not covered.

How does one know if plastic surgery is covered? Ask your plastic surgeon. He/she will review with you exactly the proposed procedures and a guideline as to what may be a covered benefit.

Fat Injection: Where can I get Fat Injected?

2009-06-09T15:45:00.004-04:00

Many places in the face.

Fat transfer or fat injections in the face is a popular cosmetic treatment for facial enhancement and rejuvenation. Fat is a natural and soft injectable filler that has potential for long term aesthetic results. Fat transfer is commonly performed under local anesthesia or IV sedation. Most patients have swelling and bruising after the procedure, which lasts a few weeks.

The most common area treated is the cheek and midface areas for volume enhancement. The cheeks droop and become hollow with aging, as our natural fat atrophies and tissue sags. Most patients are happy with fat injections for cheek augmentation.

The upper and lower lips are other facial areas for enhancement. Full, soft natural lips may be achieved with autologous fat injection.

The jaw line and pre-jowl area is another option. This fat injection may be an alternative or supplemental cosmetic treatment for face lift surgery. Patients who would benefit from jaw or jowl fat injection are usually older than 40.

The cheek, lips, and jawline are the most common areas for fat injections. Some patients may also benefit from fat in the temple areas, around the eye, and even earlobe.

Some surgeons save fat to be added later for touch-up or minor injections in the office, without IV sedation. Touch-up injections may occur several weeks after the first injection, once a majority of the swelling and bruising has subsided. Most surgeons wait at least 6-8 weeks before considering repeat injection.

Speak with your plastic surgeon and ask where fat may be injected.

Septoplasty: Is it a Cosmetic Procedure?

2009-06-09T15:26:00.003-04:00

No.

Deviated septum surgery is a very common operation, as more than 80% of people have deviated septums. A deviated septum is a medical condition, which may cause nasal obstruction, congestion, snoring, allergy symptoms, or post nasal drip. Septoplasty, surgery on the septum, is an outpatient procedure that helps corrects the deviation.

Septoplasty is not cosmetic, and is usually covered by insurance plans. For a majority of patients, septoplasty will not alter or change the external appearance of the nose. No nasal cast needs to be applied after routine septal surgery.

Rhinoplasty, surgery on the external nose, will alter the appearance of the nose. Rhinoplasty may be combined with septoplasty during the same operation.

Rhinoplasty: Can I Avoid Surgery with Botox Cosmetic?

2009-06-09T11:33:00.003-04:00

Botox is applied via a small needle to help relax muscles of the face. It is a quick, safe procedure in the office. Cosmetic results are temporary, only lasting a few months.

Big smiles may pull the tip of the nose down, causing a droop. If the tip of your nose bothers you only when you smile, then yes Botox Cosmetic is a possible alternative to rhinoplasty surgery. A single injection of Botox would be given to help relax the nasal muscles which affect the nose appearance.

However, Botox will not help with cartilage or bone reshaping. Excess or deviated cartilage or bone in the nose for from the nasal septum will not change with Botox Cosmetic. Rhinoplasty, with or without a septoplasty, is the only option for reshaping cartilage and bone.

Justifying rhinoplasty surgery is a personal decision, based on an informed decision and counseling from rhinoplasty surgeon. Although Botox Cosmetic has many uses, it is unable to replace cosmetic nose surgery.

Speak with a plastic surgeon for options regarding rhinoplasty.

Face Lift: When is it Too Young for Plastic Surgery?

2009-06-09T11:12:00.003-04:00

Plastic surgery is becoming increasingly popular. No longer hidden from the public, everyone is looking at cosmetic surgery for self-improvement. Patients are also getting younger and younger.

Some young patients are considering face lift surgery. Most patients in their 30's are too young for any face lift surgery, including mini lift, s lift, short scar lift, and thread lift. Plastic surgery is usually reserved for more advanced skin aging, even including these minimally invasive face lift procedures. Most plastic surgeons consider face lift surgery starting in the late 30's or early 40's for both men and women.

More appropriate, if your chin & neck areas bother you, would be liposuction of the neck, chin augmentation or chin implant. A weak chin will make the neck appear full. Appropriate chin enhancement would not make you masculine. Some patients may even need jaw & teeth realignment, for severely small chins.

Jowls may also be treated with injectable fillers, such as collagen, hyaluronic acid, and fat. Jowls contribute to full neck and aged appearance of the lower face.

Consider starting with more minimal cosmetic treatments, including basic skin care. If you are still unsatisfied with the aesthetic results with non-surgical treatments, then you may consider face lift surgery.

Speak with your plastic surgeon about cosmetic options for neck & jowl treatment in young patients.

Fat Transfer: When Can I get more Fat Injected?

2009-06-03T22:05:00.003-04:00

Fat transfer or fat injections in the face is a popular cosmetic treatment for facial enhancement and rejuvenation. Fat is a natural and soft injectable filler that has potential for long term aesthetic results. Fat transfer is commonly performed under local anesthesia or IV sedation. Most patients have swelling and bruising after the procedure, which lasts a few weeks.

One can usually have more fat injected, if you feel more volume is needed. Some patients feel they need more fat injected, even before fully healed from the first treatment. Your plastic surgeon may not have injected specific areas of the face for better overall facial balance and harmony. One may not need more fat transferred at all. It's better to have too little fat than too much injected.

Some surgeons save fat to be added later for touch-up or minor injections in the office. Touch-up injections may occur several weeks after the first injection, once a majority of the swelling and bruising has subsided.

Speak with your plastic surgeon and ask when, if any, more fat may be injected.

Torn Ear Lobe: What can be done?

2009-06-02T10:37:00.002-04:00

A common problem for many women are stretched, damaged, or torn earlobes. Since large earrings are so fashionable, plastic surgeons see many patients requesting aesthetic ear lobe improvement.

Earlobe injuries occur from various types of trauma — most commonly from wearing pierced earrings. In some cases, it's a very elongated hole from the prolonged weight of heavy earrings. In other cases, there is a complete tear through the earlobe.

Cosmetic and reconstructive ear lobe problems can be repaired in a simple office procedure performed under local anesthesia that typically takes a few minutes. The incisions are usually closed with very small sutures and no bandage is needed — so you may return to work the same day. After a healing period of couple months, if you wish, your plastic surgeon may re-pierce your ear.

Various tape and adhesive devices are available that may help. These nonsurgical methods are a temporary solution for a chronic problem. For patients who have saggy, droopy, split, stretched, or torn ear lobes, plastic surgery is a great option. An ear lift surgery may also be performed, in combination with other facial plastic surgery.

Speak to you plastic surgeon on how to rejuvenate your ears with cosmetic surgery.

Rhinoplasty: Bump on Bridge after Cosmetic Surgery?

2009-06-02T08:59:00.001-04:00

Bumps on the bridge of the nose after rhinoplasty is not uncommon. Early bumps, which may last months, is due to swelling of the nasal tissues (skin, muscle, and periosteum). Bumps that persist beyond a year may represent additional bone and/or cartilage that won't go away on its own. Patients with very large bumps usually have the most swelling. Large bumps or individuals with a history of traumatic facial injuries may require more than one operation to create a smooth, straight profile.

Small bumps that develop after cosmetic nasal surgery usually go away. Gently pressure and massage may be appropriate. Pressure that is too forceful may shift and move the nasal bones and cartilage. Steroid injection under the skin may be required to help control swelling and edema.

Much less common causes of bumps on the nose immediately after cosmetic rhinoplastic surgery is a blood clot (hematoma) or infection. These are readily apparent and treated by your surgeon.

Speak to your facial plastic surgeon if you have concerns about swelling after nose job surgery.

Brow Lift: Correcting Asymmetry

2009-06-01T15:08:00.002-04:00

Treatment options are available to treat asymmetric eyebrows.

Botox Cosmetic is a great option to help adjust brow height a little bit, to produce a more symmetric eyebrow. It is better at lowering a brow, than elevating. Results with Botox may vary and last several months.

Endoscopic facial surgery is the next option. Brow asymmetry may be treated by endoscopic approach, or alternatively a traditional open approach. Most surgeons perform endoscopic brow lifts currently, but brow position is better controlled with an open or direct approach.

Lastly, everyone has some degree of asymmetry to the face, especially the eyes and eyebrows. Facial asymmetry is natural. Some degree of asymmetry may have been present before cosmetic surgery. A few patients have eyebrow asymmetry from tweezing or hair removal.

Speak with a plastic surgeon to be able to determine what treatment approach would be appropriate in your case.

Lip Augmentation: Avoiding Big Lips and Trout Pout

2009-06-01T14:45:00.004-04:00

Big lips after cosmetic injections? Try not to panick, and give it time.

Lip augmentation with hyaluronic acid injectable fillers such has Restylane or Juvederm is common today. Fewer cosmetic specialists are using collagen for lip enhancement. The lip naturally swells & bruises from the injection. Most of the swelling, which contributes to the trout pout, goes down within a day or so, but sometimes longer.

Lip exercises and ice packs help reduce the swelling. After several days, if you are still unhappy with the lip size, you have 2 options after hyaluronic acid injection. Either wait it out, as your body naturally absorbs and breaks down the injectable filler over a few months. Another option to consider is using hyaluronidase, a material which accelerates the breakdown of hyaluronic acid. The last option is to have your plastic surgeon make a very small skin incision and squeeze out hyaluronic acid.

Med Spa: Which Lip Augmentation passes the Kiss test?

2009-06-01T07:44:00.004-04:00

Soft, full, natural looking and feeling lips is possible with lip augmentation. Regardless of lip enhancement method, it must pass the Kiss test. Your partner should not notice an unnatural texture to your lips after augmentation.

Both Juvederm and Restylane are clear gels that are given in the office with local anesthesia and last several months. These injectable fillers are made with hyaluronic acid, a natural material found in the dermis.

Both Juvederm and Restylane are soft to touch and pass the Kiss test. You should not look like a porn star, unless you have large volumes injected into the lips. Most plastic surgeons and dermatologist will only inject the appropriate amount.

Your own fat injected into the lips is another alternative. Fat transfer, a natural alternative to other injectables, lasts for several months. Some patients may experience a little lumpiness with this method, although most cosmetic patients are very happy.

Speak to your cosmetic specialist to find which lip augmentation is appropriate for you.

Botox Cosmetic: What about Pregnancy?

2009-05-28T12:40:00.003-04:00

BOTOX® Cosmetic is a very common cosmetic procedure, especially in young woman of child-bearing age. A concern which always comes up is the timing of Botox around pregnancy.

BOTOX® Cosmetic is a category C medicine, based on animal pregnancy studies. There are no adequate and well-controlled studies of BOTOX® Cosmetic in pregnant women.

BOTOX® Cosmetic becomes most active within 2 weeks after injection. Cosmetic results from Botox are typically 4 months, while some patients may have longer aesthetic benefits.

The current recommendation is not to have any elective procedure, including Botox, if you are pregnant or about to become pregnant, or breastfeeding. If a patient becomes pregnant after injection the potential risks, which have only been observed in rabbits, include abortion or fetal malformations.

A safe answer would be

wait at least 4 months after your last injection before trying to become pregnant
absolutely no Botox while pregnant
absolutely no Botox while breast feeding

Speak to your Ob/Gyn about your concerns.

Septoplasty: What is in my nose after surgery?

2009-05-21T16:23:00.002-04:00

Septoplasty, deviated septum surgery, is one of the most common surgeries in the face and nose areas. A deviated septum is present in most patients, although some may not realize it.

Septoplasty is an outpatient and relatively simple procedure. Patients with severely deviated septums, revision septoplasty, prior facial trauma, prior nasal surgery or rhinoplasty, or history of cocaine use may have more complicated surgery and recovery period, as compared to a routine septoplasty.

Almost always there is enough natural internal nasal lining (skin or mucous membrane) that covers the septum. Many surgeons place silicone sheet inside the nose to temporarily support the septum in the healing period. This splint is usually removed within 2 weeks.

Most likely you are feeling normal crust, sutures or stitches, or a silicone splint. It is less likely you have an exposed septum or raw surface, even though it may feel like it. Small areas of exposed septum heal very well normally. Many surgeons ask patients to use ointments and saline nasal rinses during the healing period.

Always follow your postoperative surgery instructions and speak to you plastic surgeon if you have any concerns.

Chin Augmentation: Removing Big Facial Implant?

2009-05-19T23:42:00.003-04:00

Chin implants are usually made from silicone, and may be removed at anytime. If the implant is too big or too small, the implant can be exchanged for a more appropriate size for facial balance. Big chins are more masculine, and inappropriate for a woman. Small chins make the nose appear larger, and also inappropriate for a man.

Removing implants is a relatively simple procedure. Generally, one waits at least 6 weeks following chin augmentation to allow swelling to resolve. Appropriate determination of aesthetic results can only be obtained once chin swelling has subsided. First let all swelling resolve, then reassess your chin in conjunction with the entire facial harmony. If you still feel your chin is unbalanced at that time, then consider exchanging or removing the implant.

Botox Cosmetic: What Concentration?

2009-05-18T13:11:00.006-04:00

Most patients don't know the concentration of Botox Cosmetic they are receiving. Some frequent Botox users may know the total units they receive. Everyone knows the facial areas they wanted rejuvenated!

For the glabella (between the eyebrows), a total 10-25 units of Botox Cosmetic injected via 4-5 injections is appropriate. Most plastic surgeons and dermatologist use concentrations of either 2.5 units or 5 units per 0.1cc. There is no cosmetic difference with the concentration. Patients with thicker skin and more active muscles may require a little more units than someone else.

Botox Cosmetic takes a little bit of time before you see results. Wrinkle improvement starts within a few days, with maximum aesthetic rejuvenation by 2 weeks after injection. Touch up Botox Cosmetic injections are sometimes needed to achieve the best results.

Rhinoplasty for Broken Nose: Septoplasty or Nose Job First?

2009-05-18T11:46:00.004-04:00

Patients frequently have deviated noses, septal deviation, and nasal obstruction following nasal injuries. Trauma may be acute or immediate, but usually the injury occurred years ago. Most patients injure their nose from sports, fist fights, or minor falls.

Broken noses should be evaluated by a facial plastic surgeon soon after the injury. Swelling after injury last several weeks. Swelling occurs both on the outside and inside of the nose. Most swelling resolves within a month, but the last 10-20% of swelling a minimum of one year to resolve.

It may be too early to determine whether additional surgery, such as rhinoplasty is required for deviated nose. Most plastic surgeons fix the broken nose first, then perform a rhinoplasty at a later point. Nasal healing is better, and rhinoplasty results are generally more predictable when rhinoplasty is done separately from the acute trauma. Nasal injuries which involve a fractured septum are more severe than a typical broken nose. Generally, most plastic surgeons wait at minimum 6 months after injuries or surgery before contemplating another surgery.

Treatment varies, so speak with your facial plastic surgeon to evaluate your nasal injury, deviated septum, and broken nose.

Botox Cosmetic: Can it help for Facial Paralysis or Bell's Palsy?

2009-05-04T14:37:00.003-04:00

Idiopathic facial paralysis (ie, Bell's palsy) is a relatively uncommon condition. Most patients recovery completely, but some may continue to have residual facial paralysis. Every patient who has facial paralysis which includes a comprehensive evaluation of possible causes of the paralysis, which includes blood, MRI, and neurology testing. Patient with chronic facial paralysis suffer from facial asymmetry and may have a functional deficit with eye / visual or oral problems.

Botox Cosmetic may be used for either facial spasms on the same side as the prior Bell's. Occasionally, facial muscles spasm or contract uncontrollably following recovery of facial paralysis. Botox on the affected side helps reduce these spasms.

Alternatively, Botox may be used on the other side (unaffected by prior facial paralysis) to help relax the facial muscles to improve overall facial symmetry.

Lastly, there may be facial plastic surgery that could be appropriate for your condition. Speak with your plastic surgeon to help identify how Botox or other plastic surgery may be used for your condition.

Eyebrow: Thread Lift or Endobrow

2009-05-01T08:12:00.003-04:00

Droopy eyebrows is a common sign of aging, with the tail part of the brow descending the most with age. While thread lifts are an option, this minimally invasive method is also minimally effective. Thread lifts are usually performed by nonsurgeons done with local anesthesia, with results being temporary.

The best cosmetic surgery for the eyebrow is plastic surgery with an endoscopic brow lift, or endobrow. Endobrow surgery is also minimally invasive, performed under IV sedation (twilight anesthesia) or general anesthesia. Several small incisions are hidden in the hair. A small camera is used during surgery to help move and reposition the eyebrow to a better position. Then various methods are used to secure the brow in its new position. Results typically lasts for years.

Speak with a plastic surgeon, to help determine if endoscopic brow lift surgery is appropriate for you.

Chemical Peel: When Can I Excercise?

2009-04-30T08:38:00.004-04:00

Each resurfacing procedure and individual patient vary, so there isn't a single answer.

Most resurfacing procedures (laser, CO2, chemical peel) may be superficial to medium depth in the skin. Deeper resurfacing is less commonly used. Depending on the actual depth of peel, healing may be anywhere from a couple days to a week or more. Regardless, I tell all patients who have a superficial peel to avoid anything that raises blood pressure or pulse for 1 week, and medium depth peels 2 weeks at minimum. This activity restriction includes aerobics, yoga, exercise, heavy lifting, and sex. Sweating and body heat from exercise may compromise your results, and may risk skin infection. Light walking may be started earlier, however.

Lastly, all resurfacing patients must follow the guidelines provided by their cosmetic skin care specialist, plastic surgeon, and dermatologist strictly. Speak with your specialists about any concerns you have regarding your peel.

Botox Cosmetic: Visual Complications

2009-04-14T19:42:00.003-04:00

Botox Cosmetic is a great and simple treatment for facial wrinkles, and restoring a youthful appearance in men and women. However, Botox Cosmetic does have potential complications.

Botox Cosmetic migrates a little bit away from the injection site, like a drop of water in the pool. As a result, Botox may affect facial muscles not intended. Injections around the eyes, which are helpful for wrinkle reduction, may spread to a muscle responsible for lifting the upper eyelid, called the levator. This migration occurs with anyone who injects Botox, including dermatologist, facial plastic surgeons, and cosmetic specialists.

Ptosis, otherwise known as a droopy or saggy eyelid, occurs because of a weakened levator muscle of the upper eyelid. Although uncommon, Botox may affect the vision by causing a droopy eyelid obstructing the upper visual field. Ptosis from Botox is temporary and resolves within a few weeks, but may last 3-4 months.

Upper eyelid ptosis from Botox can be temporarily managed by stimulating another muscle that helps lift the upper eyelid, called Muller's muscle. Eye drops, such as apraclonidine 0.5%, are used twice daily in the interval time until the natural muscle movement of the levator returns.
Speak to your plastic surgeon and ask about treatment for eyelid ptosis from Botox Cosmetic.

Upper Blepharoplasty Complications: Swelling and Redness

2009-04-01T08:05:00.005-04:00

Swelling of the upper eyelid incision may likely represent a localized cyst, either from a trapped suture deep in the skin or trapped epithelium under the skin. More concerning causes for this swelling may be infection / abscess or early scarring. Redness and swelling may also occur from topical ointments, either as an allergic reaction or secondary fungal infection. Most expected swelling and redness after blepharoplasty usually only lasts a short period time. Redness and erythema resolves more quickly than swelling.

Treatment of redness and swelling following blepharoplasty is relatively minor which may include a stopping topical ointments, minor revision procedure, stab incision and drainage of fluid, antibiotics, steroid injection, warm compress, and massage. Watchful waiting is another option, depending on complete evaluation.

Speak to your plastic surgeon, and discuss these various options, to help prevent potential complications after blepharoplasty.

Chemical Peel: Does uneven healing suggest uneven results?

2009-03-08T22:54:00.005-04:00

No. But keep a close eye on your skin.

Uneven redness and healing is not uncommon after chemical peels. Different areas of the face and neck heal at varying rates, largely based on the thickness of the skin. Thicker skin of the nose or forehead may recovery much faster than the thin skin of the lower eyelids. In addition, different areas of the face & neck area have received different degrees of sun damage. Areas of more sun damage will appear more red and irritated during the recovery period following a peel.

Although uneven application of a chemical peel might possibly result in an uneven cosmetic outcome, it's unlikely with medium/superficial peels. Lower strength peels makes any uneveness once all healing is complete even more unlikely.

The most important concern with uneven appearance in skin healing is infection. Your skin is extremely vulnerable after any resurfacing procedure, including peels. Viral, bacterial, and fungal infections are potential complications. Inform you physician immediately if any areas appear infected.

Follow your doctor's post peel guidelines, and speak with him/her regarding any concern have.

Rhinoplasty swelling: How long should it last?

2009-03-06T23:27:00.005-05:00

Rhinoplasty swelling occurs both on the outside and inside of the nose. It is normal to feel congested and have nasal obstruction and postnasal drip immediately after rhinoplasty surgery. Patients are generally "restaurant ready" and socially acceptable within 2 weeks. Most swelling after rhinoplasty resolves within a month. The final 20% of swelling takes a much longer time to resolve, up to a year or longer after surgery. Fortunately, this final swelling is usually only evident to the surgeon and patient.

Rhinoplasty swelling varies greatly and is largely based on the areas of the nose treated, surgical approach to the nose (open or closed/endonasal), skin thickness, postoperative care, and your healing ability. The more extensive the surgery, the more you will swell and the longer the swelling will last. The tip of the nose holds onto swelling longer than the other parts of the nose. Open rhinoplasty, where there is an external incision at the base of the nose, swells more and longer than closed/endonasal rhinoplasty. Patients with thicker skin will also have more swelling.

Keeping your head elevated, maintaining the nasal splint/cast, ice, arnica montana, and following your plastic surgeon's guideline may help reduce rhinoplasty swelling. Persistant swelling may also be reduced by steroid treatment into the nose. Don't hesitate to speak to your plastic surgeon about any swelling.

Botox Cosmetic: Long-term benefit?

2009-03-02T13:44:00.004-05:00

No one really knows the long-term cosmetic benefit of continuous Botox use. There have not been any good research studies to show a cumulative benefit. There is some evidence, however, that redosing Botox before it has completely worn off will lead to longer term, more effective wrinkle reduction. But does getting Botox continuously for 20 years make a difference? Again, no one knows.

If you are having financial difficulty acquiring Botox, then don't obtain it. Go back to the basics of good skin care that everyone should follow: Hydration, healthy diet, regular exercise, limit sun exposure, avoid smoking, adequate sleep, stress reduction. These basic guidelines are the fundamentals of good care, and inexpensive too. Your skin will ultimately look better 20 years from now by following these basics, than by regular Botox injections alone.

There is no known harm to long-term use of Botox Cosmetic. Repeated Botox Cosmetic injections every few months may be too expensive for many individuals. How you balance the cosmetic benefit versus the cost will depend on your financial situation, and is a personal decision. Speak to your plastic surgeon or dermatologist about long-term benefit of Botox.

Treatment for Tired, Puffy Eyes?

2009-03-01T23:03:00.009-05:00

Tired, droopy, puffy eyelids are a common complaint of many seeking plastic surgery. However, before proceeding with any cosmetic procedure, a medical evaluation is required.

Puffy eyelids are common with thyroid disorders. It is important that your thyroid hormones are stable before considering any plastic surgery. Allergies are another medical condition which contributes to the appearance of tired/puffy eyelids. Ensure any allergies are controlled as well. Speak to your endocrinologist and allergy specialist before speaking to a plastic surgeon.

Blepharoplasty, cosmetic surgery of the eyelids, is one of the most common plastic surgery procedures in the US and may be the best treatment option. Blepharoplasty surgery deals with the skin, muscle, and fat of the upper and lower eyelids. Botox Cosmetic is an injection which helps more the Crow's feet, or fine wrinkles on the sides of the eye. Botox Cosmetic does not help the puffy or droopy eyelids. Resurfacing, laser or chemical peel, is another good option to consider to help with puffy eyes. Resurfacing removes the top layers of skin, allowing the skin the refresh itself. Resurfacing procedure help to reduce fine wrinkles and tighten the skin.

Speak with you plastic surgeon, who can perform a comprehensive examination, and recommend a cosmetic treatment which is appropriate for you.

Forehead Lifts: Are Endobrows Better?

2009-02-26T22:24:00.002-05:00

A forehead lift, regardless of exact method, elevates the forehead and eyebrows. Each method of surgery requires some form of anesthesia, either general or IV sedation (twilight). Both have similar cosmetic outcomes.

The difference between a traditional forehead lift and an endoscopic brow lift is the approach, or surgical access, to the brow area. Traditional forehead lifts made a long incision either right at the hairline, or just behind the hairline. This approach allows greater degree of control to brow position. Disadvantages are the longer incision, longer operative time, itching, and higher risk of hair loss.

Endoscopic brow lift, or endobrow, is the newer and less invasive approach for cosmetic brow and forehead enhancement. Much smaller incisions are hidden within the hairline. A camera or endoscope is used to visualize the brow area. This technique for brow lifts requires more advanced training. Benefits include shorter operative time, smaller incisions, much less itching, lower risk of hair loss, and faster recovery.

Endobrows are generally the preferred method of cosmetic enhancement of the forehead and brow, and applicable to most patients. However, each patient has specific cosmetic needs and particular anatomy, so endobrows may not be the ideal approach for everyone. Speak to your plastic surgeon to help decide which method is right for you.

Makeup After a Chemical Peel?

2009-02-03T14:30:00.006-05:00

A common question with chemical peels, or any laser resurfacing procedure for wrinkle reduction. The answer largely depends on the depth of the chemical peel and the rate at which your skin heals following the cosmetic procedure. You want to minimize skin irritation after any peel or resurfacing procedure.

Lunchtime peels are generally very superficial peels, such as low strength glycolic acid. One may be able to start wearing makeup the next day. With deeper peels, your cosmetic surgeon will provide and recommend a guideline to help the healing process. Makeup can be usually be worn approximately 7 to 10 days after a deeper peel. Skin is vulnerable after peels and resurfacing, and application of makeup prematurely will delay healing and risk causing infection, pigmentation changes, or scarring.

Each individual recovers at a varying rate. Keep in close communication with your plastic surgeon and dermatologist, who will tell you when you can resume makeup use.

Cosmetic Surgery: How to get rid of bruise?

2008-12-29T13:06:00.011-05:00

Any cosmetic surgery, procedure, or product has the potential to result in bruising, and skin discoloration. Luckily, most of this bruising is temporary and fades away in a few days or weeks. More extensive procedures may take longer to recover. What can one do to proactively minimize the bruising after cosmetic plastic surgery? To help have the best outcomes after plastic surgery, follow the basic guidelines below, whether you're having a lunchtime cosmetic Botox injection, face lift, or a cosmetic rhinoplasty.

Avoid Blood Thinners
Makes sense, correct? But we are sometimes unaware that normal medications or herbs may cause bruising. Stop all aspirin and aspirin-like products such as ibuprofen for at least 2 weeks prior to your procedure. Avoid any herbal teas or medications which have blood thinning qualities such as St. John's wort, ginko, ginger, garlic, ginseng, kava, vitamin C, and vitamin E. Your plastic surgeon will let you know when it's ok to resume taking these products.

Elevate Your Head
Avoid lying flat or prone. Positioning your head on top of a few pillows, or elevated mattress top, will help reduce bruising, swelling, and pooling of blood in the area. Let gravity play a role in the healing process.

Ice, Ice, Baby
Crushed ice or cool compress help constrict the blood vessels and help prevent a bruise from spreading. Ice should not be directly on the skin. Use a soft cloth to help distribute the cooling effects of the ice to the skin. Ice and cool compresses are especially important within the first 2 days after cosmetic surgery.

No Strenuous Activity
Any activity which elevates your blood pressure or causes Valsalva effect may exacerbate and cause bruising, at worst even frank bleeding. Strenuous activities to avoid include, but are not limited to running, exercise, weight lifting, pilates, aerobics, cycling, climbing, and sex. Yoga should be avoided too. Patients should even avoid straining on the toilet! Your plastic surgeon will inform you when you can resume normal activity.

Arnica Montana
A homeopathic or alternative medicine approach to bruising, Arnica is available without prescription. Arnica helps alleviate dark, swollen bruises by apply a gel containing arnica every few hours over the affected area. Arnica has traditionally has been used for muscle aches, sprains, and bruises. Some may have a reaction to arnica. Discontinue use if the treated skin becomes red, itchy, or inflamed. Speak to your plastic surgeon before starting arnica, as it is not allowed at all for some cosmetic procedures.

Skin Care: The Basics

2008-12-22T13:25:00.009-05:00

Skin care product companies generally do not promote the basics of skin care. They want you to purchase their products instead. But what good is their products without the basics in-place first? Don't jump to Botox Cosmetic or a TCA chemical peel before starting with the skin basics. Patients in DC, Maryland, and northern Virginia follow these general guidelines for beautiful, natural skin for a lifetime.

Sun Protection
Skin damage from the sun is due to UV radiation, and occurs so slowly that we don't realize how much damage occurs. Sun burns are extreme damage, and there is no such thing as a good tan. Sun prematurely ages the skin, and may lead to skin cancer. Even the little bits of sun exposure during routine daily activities (ie. walking to your car) add up over a lifetime. Utilize daily sunscreen ,which blocks both UVA and UVB, covering hats, and sunglasses to help protect your skin.

Maintain a Healthy Diet

Your appearance reflects the food you eat. We all know fresh fruits and vegetables are great for muscles, bones, and your vital organs, but the natural vitamins and minerals are also great for your skin. Too many calories end up being converted to fat, usually in your hips, abdomen, legs, neck, and face.

Get Adequate Sleep

Inadequate sleep does more than promote baggy eyelids. Poor sleep also contributes to increase facial wrinkles and skin sallowness. The ideal of at least 8 hours of uninterrupted sleep may be difficult for our busy lives. However, even small cat-naps during the day are beneficial.

Avoid Smoking

One can usually spot a long-time smoker based on a picture alone. Premature skin aging is notorious in this population. Today there are many options to help quit this habit.

Keep Well Hydrated

The entire adult human body is mostly water, including the skin. Water naturally hydrates your body and helps prevent dry skin. Well hydrated skin functions better and can help maintain youthful appearance. Eight glasses of water a day is the recommended minimum amount of water intake. Athletes and active people, more is needed to replace the fluid they excrete through perspiration.

Be Gentle

Wash your face with gentle cleansers. Strong cleansers may be harmful to sensitive skin. Wipe dry with a soft cloth, and don't rub hard. Aggressive manipulation of the skin may irritate the skin and cause redness and swelling.

Other skin care methods such as cleansing, moisturizing, exfoliating, and toning come after these initial basics are implemented. Speak with a physician who specializes in skin care in your area, such as a dermatologist, plastic surgeon, or facial plastic surgeon to learn more about basic skin care.

Rhinoplasty Techniques: Which one is right for me?

2008-12-16T09:20:00.006-05:00

Two primary methods exist for performing cosmetic rhinoplasty: closed or open. Each has its advantages and disadvantages.

Closed rhinoplasty, otherwise known as endonasal, involves incisions confined to the inside of your nose. There are no sutures to remove. The plastic surgeon can modify or alter any part of the nose, including the tip and hump. Swelling improves earlier and recovery is generally faster. However, for patients who have had previous rhinoplasty or congenital cleft lip, your plastic surgeon may be limited to achieve some changes in your nose because of inability to see parts of the inside of the nose.

Open rhinoplasty involves a small incision across the base of the nose, between the nostrils, otherwise known as the columella. Additional incisions are made on the inside of your nose. Open surgery may be preferred in more complicated rhinoplasty surgeries. Some plastic surgeons prefer the open rhinoplasty approach because it allows greater visibility of the nose. Swelling and bruising usually lasts much longer with this rhinoplasty approach.

Lastly, the method of rhinoplasty is based on the plastic surgeon's prior training and expertise. When deciding on open vs. closed rhinoplasty, one should follow the advice of your plastic surgeon, and your specific rhinoplasty needs.

My preference has always been endonasal rhinoplasty, as results are more predictable and postoperative swelling much less, as compared to the open approach. I discuss the options with patients, and based on their specific rhinoplasty desires, help develop a treatment that is appropriate for them.

Rhinoplasty Complications: Sinusitis

2008-12-15T14:29:00.006-05:00

Complications may occur with any procedure, surgical or nonsurgical. Surgery on the nose or septum may result in sinusitis, inflammation of the nasal & sinus cavity. Symptoms may include nasal congestion, nasal obstruction, nasal discharge, post nasal drip, facial pressure, and headaches.

A majority of the time this form of sinusitis is not a complication, but rather a side effect of performing any procedure on the nose. Operating on the nose, both rhinoplasty or septoplasty, will naturally result in inflammation. The typical symptoms of infectious sinusitis are usually indistinguishable from the normal postoperative healing following rhinoplasty. Patients may also have temporary nasal packing following surgery, which contributes to the symptoms of nasal congestion, discharge, and drip.

The solution to these common postoperative symptoms? Nasal saline washes or irrigation. This simple solution helps alleviate many of these symptoms. Saline is a natural method to help wash and clean the nose. Patients may create their own salt solution, or buy one from their local pharmacy.

Discuss the healing period for rhinoplasty with your plastic surgeon, and ask about saline irrigation to help treat the expected sinusitis.