May, 2014


Friday, May 9th, 2014

As a general rule most plastic surgeons agree that starting early is better.  But keep the procedures minimal and more frequent.  This will help to maintain a NATURAL look.  Find a plastic surgeon who will help you keep the procedures reasonable and appropriate.  Use your own good judgement too.  Stay away from “cosmetic or aesthetic” doctors who have little training, experience, or judgement and are not real plastic surgeons.  Stick to board certified plastic surgeons. The best source for fully trained, board certified, ethical plastic surgeons is the American Society of Plastic Surgeons -

Chronological age is not as important as your physiological age.  People develop the stigmata of aging at different times and at different rates.  Fortunately, today, we have many different options to maintain a youthful appearance.   Patients in their 20’s and 30’s should be using sunblock, a good skin care program, and possibly doing laser treatments. Botox and/or fillers may be helpful, but be conservative.

For most people, from 40 years on, the skin begins to sag, sun damage is more apparent, pigmentation irregularities occur, there are volume shifts and volume loss.  When these factors first become apparent it is time consider more aggressive maintenance and correction.  Because botox, fillers, and lasers are simple and quick they are common treatments in my office for patient who are 40+ years old.  Again it is important to avoid being overdone.  In my opinion, fillers do NOT cause significant lifting unless they are overdone leading to a “balloon” look.   For sagging and drooping, lifting procedures are best.  Ultherapy (ultrasound) is a non-surgical office procedure to tighten and lift.  It is great for minimal to moderate sagging.

I am doing many more “mini face lifts”, neck lifts, and fat injections in patients in their 40‘s and 50’s than ever before.  Although I still do “full” face lifts,  this is usually in older patients who have not done any maintenance.  Consider two 45 year old patients- one doing nothing for 15 years and then having a full face lift, the other having 2-3 mini lifts during this same 15 year period. In my opinion it is better to do 2 or 3 mini lifts over 15 years, than wait until everything is severely sagging and be forced to do a full face lift.  Obviously,  if you do multiple mini procedures you will look better during the 15 years. In  addition, at the end of the 15 years,  the patient doing minimal maintenance procedures will have a better and more natural look.

Mini lifts are very simple procedures that involve less surgery and minimal down time (usually 2-3 days).  A mini lift is performed with local anesthesia or sedation.  There are many options regarding the components of the min lift  and possible additional procedures.  I tailor my recommendations to the individual’s particular problems and preferences.  My priorities are safety, keeping a natural look, and maximal improvement, in that order.


New techniques decrease discomfort and bruising from filler injections

Wednesday, May 7th, 2014

For many years fillers have been injected with a syringe and multiple sticks with a small sharp needle.  This was moderately uncomfortable but relatively quick, taking 5-10 minutes. The only way to decrease discomfort was to apply numbing cream or do nerve blocks.  Numbing cream is messy and needs to be applied 30-60 minutes prior to the injection.  The affect is variable and even at its best does not eliminate much pain for most patients.  Nerve blocks, injecting regional nerves with novocaine, need to be performed 5-10 minutes before the filler injection. Most patients find doing the nerve block itself hurts more than the actual injection of filler.  Both of the techniques can distort the tissue, making it more difficult for the physician to determine the amount and location of filler injection.

A number of years ago most filler manufacturers started adding numbing medicine (xylocaine)  to their filler.  This decreases discomfort quite a bit, but the first few needle pricks can still be felt. The numbing medicine definitely helps when the physician has to make 2nd and 3rd injections in the same spot, which is not uncommon.  Patients tell me they greatly prefer the filler with the numbing medicine.

The latest advance for filler injection is the “blunt needle” technique.  There is no question that this technique also significantly decreases discomfort and minimizes the risk of bruising.  Only 2-4 very quick pinches are required.  A tiny blunt tipped needle  is threaded under the skin to deposit the filler. Because the needle is rounded at the end, not sharp, it slides around blood vessels and nerves and causes less tissue trauma than a sharp tipped needle.  Discomfort is minimal and the risk of bruising is decreased. This technique is great for injecting the lip, which is an extremely sensitive area.  It can also be used for cheeks, marionette lines, eyelids, and other areas of the face.  Most fillers can be injected with this method, but blunt injection can not be used when the filler needs to be injected very superficially.

In my office, I use fillers with numbing medicine and the blunt needle technique whenever possible.  Although we have not eliminated discomfort, it is much easier today have fillers with these newer techniques.