Tag Archives: facelift


Permalink to Plastic Surgery Timeline – When Will I Heal By?

Plastic Surgery Timeline – When Will I Heal By?

In plastic surgery, often one of the biggest questions patients will ask me is,”how long will I be down after this procedure?” Of course, this depends on the surgery and partially on an individual basis although for the most part, it is pretty predictable.

I recently found a little straight-forward article by a husband and wife plastic surgery team out in Columbus Ohio who summed it all up very nicely. Drs. Christine and Michael Sullivan of The Sullivan Centre are certified plastic surgeons and this is what they wrote:

Breast Augmentation or Liposuction (Including SmartLipo TriPlex)
To be ready by New Year’s, have surgery by December 1.To be ready by Valentine’s Day, have surgery by January 14.To be ready for Graduation, have surgery by April 20.To be ready by Independence Day, have surgery by June 4.To be ready by Labor Day, have surgery by August 1.To be ready by Thanksgiving, have surgery by October 22.To be ready by Christmas, have surgery by November 25.
Facelift or Rhinoplasty
To be ready by New Year’s, have surgery by September 1.To be ready by Valentine’s Day, have surgery by October 14.To be ready for Graduation, have surgery by January 20.To be ready by Independence Day, have surgery by March 4.To be ready by Labor Day, have surgery by May 1.To be ready by Thanksgiving, have surgery by July 22.To be ready by Christmas, have surgery by August 25.
Tummy Tuck or Breast Lift
To be ready by New Year’s, have surgery by November 15.To be ready by Valentine’s Day, have surgery by December 31.To be ready for Graduation, have surgery by March 5.To be ready by Independence Day, have surgery by May 15.To be ready by Labor Day, have surgery by July 15.To be ready by Thanksgiving, have surgery by October 7.To be ready by Christmas, have surgery by November 10.
I found this to be very accurate and helpful! Good job, Drs. Sullivan!

About The Sullivan Centre: The Sullivan Centre, co-founded by Drs. Christine and Michael Sullivan, is the first free-standing ambulatory surgical center dedicated to cosmetic surgery in central Ohio. It is located at 97706 Olentangy River Road in Columbus, Ohio 43235. Reach them at sullivancentre.com or by phone at 614-436-8888.


Permalink to Celebrity Plastic Surgery – The Collective Obsession With Youthful Perfection

Celebrity Plastic Surgery – The Collective Obsession With Youthful Perfection

Lisa Rinna Lips

Lisa Rinna Recently Had Her Lip Augmentation Reduced.

Plastic surgery is a part of celebrity culture today. From reality stars like Heidi Montag, Kim Kardashian, Pamela Anderson, and “The Real Housewives of…” to comedians like Joan Rivers and Kathy Griffin, to actors like Lisa Rinna, Nicole Kidman, Meg Ryan, Micky Rourke and of course stage performers like Cher and Kenny Rogers. All of these celebrities and hundreds more like them appear to have had cosmetic work done, and most, save Kim Kardashian and Cher, seem to have gone too far and pushed the limits of what plastic surgery is capable of.

The force behind this Hollywood celebrity trend to use plastic surgery beyond what is rational is a collective obsession with youthful perfection. That is, in American culture, youth is romanticized and physical perfection is idealized. The problem is that we are only young for a brief time in reality. Indeed, this evanescent quality is probably an ingredient of the fuel feeding this obsession. Combine this with the fact that very few, if any of us, are genetically perfect and you end up with a majority of the country somewhat unsatisfied with their appearance. Add to the fire, the pressure celebrities are under to be examples of perfection to those who consume their movies, TV shows, and music videos and you can imagine the desperate feelings these people have to hold on to this image of perfection or lose their celebrity status.

Further complicating the mix is that the personalities who go into that line of work tend to already enjoy some degree of narcissism with their coffee and you have a perfect storm. Nowhere do we see example after example of drastic measures taken by desperate souls to enhance or hold onto any shred of perfect youth that medical science might be able to offer. Likewise, nowhere else do we see so many sad cases of the fuel of this collective obsession with youthful perfection igniting the fire that ends in plastic surgery disasters.

As a plastic surgeon who believes very much that plastic surgery, and other cosmetic procedures such as Botox and facial fillers, can improve a person’s appearance and make them feel more confident, I cringe when I see the next star to step onto the red carpet with lips the size of sausages or faces pulled so tight they look like, as a friend of mine recently described, “a screaming skull.” Likewise, it sickens me to see a breast augmentation disaster such as putting 700cc breast implants in a petite woman of 5 foot 2 inches as was done to Heidi Montag, so she ends up making Barbie look comparatively proportional! These cases are not medical science being used to improve lives, they are a shameful mockery of the fine art of plastic surgery.

The most difficult thing for me to get my head around is the process by which a trained doctor goes through with these surgeries. If he or she is even remotely educated in plastic surgery, or even the pretend plastic surgeons who call themselves, “cosmetic surgeons,” these doctors have to know how awful these results are going to be before they even put the patient to sleep. As a plastic surgeon, my job is to improve on nature while balancing these improvements with aesthetic principles of balance, physical limits, and genetic realities. And a reality of being a plastic surgeon is knowing that some patients will come in with unrealistic expectations. I regularly have to sit down and explain in no uncertain terms, that there is such a thing as “too big” when it comes to breast implant size. It is very common for small framed women who have A-cup breasts to request breast implants that are simply going to make her look very top-heavy, cause stress damage to the skin, and create discomfort to the point that she will need to have them removed. When I explain the physical limits and the reality, most women normally understand and opt for smaller implants. In cases where they are still unconvinced and determined to have the larger implants, I apologize and tell them that as an ethical plastic surgeon, I cannot perform the surgery with the implants requested and we go our separate ways. And yes, occasionally they come back to me to have their “too large” implants removed.

I can feel for these plastic surgeons who have celebrities for patients. I can imagine they hear a lot of desperate stories about needing “that edge” in order to stay relevant in the fast paced world that is Hollywood, where one day you may be the toast of the town and the next you are wondering why you can’t even get an infomercial job. I realize there is tremendous pressure to push the limits because if you don’t someone else will. At the same time, we are doctors first and we have to do what is right by the patient, even if the patient is demanding what is wrong. We know that lips that look like two sausages painted red will look like hell, we know that 700cc implants can not be sustained in a petite woman of 5 foot 2 inches, we know that if you stretch the face back too far you will create a lizard mouth. We know this because it is what we do. Just as an engineer knows what you can and can’t do if you want a bridge to stay standing, a plane to stay in the sky or a computer to crunch ones and zeros and end up with me being able to type this article.

One thing I always stress with my patients is that when all is said and done, a stranger should never be able to look at you and “know” you’ve had plastic surgery. Whether it is breast augmentation, lip augmentation, a tummy tuck or a facelift, all should be subtle enough to look perfectly natural. Sure, if you go from an A-cup to a C-cup overnight, your friends might notice, but to the world, you should just look shapely, balanced and aesthetically pleasing to the eye, not like a freak of nature. Similarly, a facelift should simply take 10 to 15 years off your face, not make you look like a new person. You should look like pictures of yourself from the past. If you look at Joan Rivers now and Joan Rivers from 15 years ago, it is like they are two different people. On the other hand, if you look at Cher now and Cher 15 years ago, she looks the same! That’s plastic surgery done right!

The collective obsession with youthful perfection will probably be a part of the American cultural reality for the foreseeable future. Perhaps, just being a little more aware of it and reminding ourselves and our children to actively work toward being less influenced by it and more happy with our own realities is the answer. Sure, a good plastic surgeon can improve on nature a bit, fix some of the effects of time and make your day-to-day life a little happier because you smile more when you look in the mirror. But youthful perfection is not something we are capable of producing and someone needs to see that Hollywood gets the memo.


Permalink to Cher – Plastic Surgery & The VMA’s

Cher – Plastic Surgery & The VMA’s

CHER- Video Music Awards 2010 - VMAs with Lady Gaga

CHER at the 2010 Video Music Awards "VMA's"

Cher presented Lady Gaga with the Video Music Award for Video of the Year Award last night at the 2010 MTV Video Music Awards. When Cher first walked out wearing a similar or the same outfit she wore for her 1980′s video, “If I Could Turn Back Time,” you could almost hear a collective, “wow,” as the entire country watching realized she is now in her 60′s! Indeed, Cher is 64 years old and looks, even on my high definition T.V., like she’s in her early 40′s. Is plastic surgery the secret? Actually, no… as in, “no, it isn’t a secret.” Cher takes care of herself, but she also has been very open about her use of plastic surgery to maintain her looks.  Make Me Heal reports, “Cher has had a breast augmentation, rhinoplasty (nose job), blepharoplasty (eyelid surgery), and possibly many others including enhancing the appearance of her teeth, liposuction, and a facelift. Although speculation revolved around Cher getting cheek implants, a tummy tuck, and a rib removed, she has completely denied the truth in those rumors. However, Cher openly admits she has become “the plastic surgery poster girl”.

The great thing about Cher is that she doesn’t expect anyone to not realize how old she is, she’s been a celebrity since the mid 1960s! Instead, she’s realistic about her age and the fact that time and gravity tend to be harsh on us all. But this is where great plastic surgery can work. Of course, when we look at Cher we think, “wow, she must have had a lot of work done.” But we don’t think, “YIKES!” like we do with some of the really bad celebrity plastic surgery we are all familiar with. To me, She looks great. She looks like she’s had very talented plastic surgeons and beyond that, she also obviously listened to their recommendations. I’m sure a lot of those scary celebrity plastic surgery cases are more a result of the celebrity insisting on procedures than doctors may have recommended against. At 64, Cher is an example of plastic surgery as an art.

What did/do you think of Cher’s plastic surgery and her overall look? Please weigh in below!


Permalink to Heidi Montag Lessons

Heidi Montag Lessons

Heidi Montag Breast Augmentation

Heidi Montag's Breasts Are Too Big!

Some stories just won’t go away. The Heidi Montag saga seemed like just another fifteen minutes of fame for a desperate starlet. And it makes for a great story: D-list celebrity trying to get an edge with an extreme makeover that will catapult her to stardom… or not.

But now, after the initial stories cataloging her surgeries mini brow lift, nose revision, facial and buttock fat grafts, breast implant revision, ear pinning, neck liposuction, the stories continue. She’s in pain. She’s happy. She’s not happy. She wants bigger implants. She’s going outside the U.S. for implants she can’t buy in the U.S., and the stories just continue on and on, probably fed by her publicist.

Since Heidi Montag and her drama are not going away anytime soon, what can we all learn from this modern-day tale of transformation that will help us in our thinking about plastic surgery?

If you are considering plastic surgery, it is important to be realistic about what you are considering and why.  Number one, if you don’t want to set yourself up for disappointment the only reason you should have plastic surgery is for yourself.  No one should be considering plastic surgery because someone else is telling you to.  Plastic surgery should not be undertaken to get or keep a husband or boyfriend, nor to get a specific job. The procedure, and your new image, should be its own reward. It should give you a positive self-image and give you more confidence. To expect secondary gain is setting yourself up for disappointment. The exception to this rule may be a situation where someone is looking prematurely old and seeks facial surgery for better competitiveness in the job market. Heidi Montag is not prematurely old.

Less is more–rule one: I don’t know exactly how long Heidi’s ten procedures took, but I try to limit my procedures to less than six hours. The medical standard for safe elective surgery is less than six hours. This means that after six hours the risk of medical complications rises. It is also more difficult to recover when you can’t get in a comfortable position because of the pain resulting from your multiple procedures. Performing fewer procedures in two operations makes for two shorter, safer operations with quicker recovery time, as opposed to one long one with a much longer and more uncomfortable recovery.

Less is more–rule two: As you age you should only have the minimum amount of work done to correct the problems. There is no such thing as prophylactic facelifts, although some people claim to do them. I’m okay with the chin and nose changes. But the brow lift and fat grafts actually made her look older boring here and harsher. Nothing can replace the freshness of youth and once it’s gone it’s gone.

Less is more—rule three: And important thing to remember about breast augmentation is that breasts can be too big! The only kind of movie Heidi Montag’s new breasts will get her into is the kind with three X’s, rather than snagging Meghan Fox’s roll in Transformers 3! I’ve put in large implants, even the maximum size, 800cc, but these are cases where the woman could handle them because of her height and the size of her chest. If Heidi wants to go bigger than her current 700cc implants, in order to really see a difference she would need to go to 1000cc which is way too much for anyone, much less a thin woman who is 5’2.

The downside of really big implants: Bigger scars to put them in for silicone implants. Putting in 1000cc  saline implants would be a nightmare. They would come down to her knees in no time.

What goes up must come down. Implants that large would have minimal muscle support. There is no breast lift that would lift them up for any significant length of time. She will have to downsize in order to have a successful breast lift.

Implants that big would make her skin tissues paper thin over time. Wrinkles and ripples would be visible.

Implants that large would actually pull down on her shoulders and neck. They would likely cause severe back pain. Most women who naturally have breasts that size eventually come in for breast reduction.

Just because a surgery can be done, doesn’t necessarily mean it should be done. She’s not yet in the ranks of plastic surgery monsters but if she keeps this up, there is little doubt she will be listed on one of many scary plastic surgery Websites.  Good plastic surgery is designed to makes people look like themselves and doesn’t make you look like a different species. Is she on her way? Only time will tell.


Permalink to Facelift By OBGYN?

Facelift By OBGYN?

With the current wave of “Alice in Wonderland” mania, a recent email from a friend reminded me of a scene in that classic book.  In that scene, Alice is talking to the caterpillar and he keeps asking her, “who are you?” This reminder, in my mind, led to my impressions of a current phenomenon I’ve been seeing and reading about lately regarding the business of plastic surgery. It occurred to me that it seemed apropos to ask any doctor, offering plastic surgery, that very same question. This is because the answer to that question can be very vague.

There is a disturbing trend in medicine where internists, family doctors, gynecologists and other specialists are offering to do plastic surgery procedures as a way of making a little cash, “on the side.”  Dermatologists and E.N.T. (ear, nose & throat) doctors are expanding into areas where they have little or no training.  Because of this, complications are escalating like never before.

I know someone who went in for a yearly checkup and found her internists now owned a roomful of lasers next-door and was promoting their use.  The largest liposuction clinic in my community is run by an internists and an emergency room doctor.  Family practice doctors are opening, “med spas.”   Some E.N.T. doctors are beginning to perform breast augmentation surgery and gynecologists are doing face-lifts. What’s going on?

A recent article in Plastic and Reconstructive Surgery by Matthew Camp, titled Who is Providing Aesthetic Surgery? A detailed examination of the geographic distribution and training backgrounds of cosmetic practitioners in Southern California put some insight into this question.

So what is going on?

Medicine is hard-pressed for fair reimbursement by health insurance companies.  Despite any statements to the contrary, it is likely going to get worse in the future.  More and more doctors will be attempting to supplement their income by offering plastic surgery procedures in which they have little or no training.

Plastic surgery is literally the only cash business left in medicine, especially if you include hair transplants, laser hair removal, varicose veins, and all noninvasive treatments under that umbrella.

Individual magazines devoted to different specialties routinely promote, “boosting your income by adding cosmetic services.”  Medical meetings also promote one-day workshops in different procedures and technologies.

Makers of cosmetic products and devices are actively promoting their goods to non-plastic surgeons as a way of expanding their markets.  Moreover, those that are not intentionally marketing to these doctors are none-the-less bound by law to sell to these doctors if the doctor orders from them.  This is because in California, a medical doctor has a license that entitles him or her to do anything they see medically fit in the office.  He can do brain surgery, heart surgery, or sex changes.  If something goes wrong, let the lawyers sort it out after the fact.  There is no restraint of trade for physicians.  Hospitals monitor doctors and only allow them to have privileges for those procedures in which they have actual training and/or certification.  This is why most of these practitioners who are expanding their offerings work only in their offices where they are completely unsupervised and unregulated.

The economic situation that is leading gynecologists to start offering facelifts is also placing very young plastic surgeons, just out of school, in a difficult situation.  Therefore, they are vulnerable to being scooped up by franchise corporations that have catchy names and usually offer one specialty procedure at what they suggest is a discount price that an established and experienced plastic surgeon cannot compete with. The reality is that in most cases they are at or very near regular market prices for these procedures.  These “McFacelift” shops or “LipoKing” franchises perform procedures with pressure on the doctors and staff to do as many per day and as fast as they possibly can.  To quote from the Camp article, “the development of aesthetic practices with individual providers are considered to be interchangeable and replaceable is becoming ever more prominent.”  This is particularly the case among the “medispas.” The practices are often named after a geographic location with the cachet of affluence such as Rodeo Drive, Beverly Hills or La Jolla.  In these practices, or perhaps better described as “mills,” the practitioners are employees of the corporate owner of the clinical facility and are pushed to produce revenue.  The divorce of the practice from the name of a responsible physician has the potential to have a profound impact on the doctor-patient relationship and how patients select a provider.

Therefore, as the Romans said, “caveat emptor;” Let the buyer beware. This is especially true in California since there is essentially no enforcement by the medical board, which has recently been stripped of most of its funding.  Many complaints and many bodies must pile up before anything will be done.  Any doctor can do virtually anything in his office and will not be stopped until there are large numbers of complaints or he kills or maims a patient.  It is amazing that we require such tight restrictions on many other fields such as airline pilots.  What is happening is the equivalent of allowing someone who knows how to fly a single engine plane to go ahead and sit at the controls of 747, bringing it down for a landing into a major metropolitan area without any training.  Do you want the professional airline pilot with a complete education or someone who had a one-day course in the 747 before he takes your life into his hands? On the flip side, I am a trained plastic surgeon who has had thousands of hours of training and experience in plastic surgery but I have also had some training in many other aspects of medicine.  Legally, I can perform brain surgery and heart transplants in my own operating room, but would I be your best choice if you needed these procedures?  What if I were to offer to do the surgery at a discount?  …Yeah, I didn’t think so.

If you’re considering a plastic surgeon, do what the caterpillar did.  Ask, “who are you?”  “Are you board-certified?”  “Are you board-certified in plastic surgery?”  “How many of these procedures have you done?”  “How long have you been providing this procedure?”  “Do you have hospital privileges?  Or is plastic surgery just another way to boost your income.”  Or, “are you a cosmetic surgeon” which is essentially a meaningless term since there is no recognized Board of cosmetic surgery.

Caveat emptor. Do your homework and trust your gut feelings.  If you feel unsure or apprehensive, regardless of whom the person is, move on.  Plastic surgery is not like having your hair done.  Some people spend more time researching a vacation then researching a plastic surgeon, don’t be one of them.


Permalink to Local Anesthesia, General or Sedation for Plastic Surgery?

Local Anesthesia, General or Sedation for Plastic Surgery?

There seems to be a trend of late, judging by what is out on the Web and in advertising, to promote plastic surgery procedures under local anesthesia…  only… nothing else… stone cold sober.  Nothing to make you feel relaxed, to take the edge off, nothing to soften or eliminate the sights, the sounds,  and other physical and emotional reactions to having a plastic surgery procedure performed on your body.

Now, I do perform some plastic surgery procedures using local anesthesia pretty much every week.  A little scar revision, a facial contour in a small area, or a micro-liposuction on the face.  But most of the plastic surgery I perform at Advanced Concepts in Plastic Surgery in Sacramento are performed with sedation or with a general anesthetic.

First of all what is sedation? Sedation is when the patient has an IV and receives sedation medication through it but remains conscious.  There are several different kinds of drugs that put the patient in a particularly happy place.  This means you’re not completely asleep but you are also not aware of what’s going on, you are very comfortable and breathing without the help of a breathing machine.

So why would you not want to be aware of what is being done to you?  I’ll use myself as an example.  Several years ago I had a wisdom tooth erupt.  I guess I’m a late bloomer. I had it removed under local anesthesia only.  The dentist did a great job as I did not feel any pain.  But it was a very unpleasant experience with all the rasping, grinding and pulling.  In addition to that, my mouth and jaw was very sore from staying open.  So, how do you think I would have felt after two or three more just like that?  So let me state the case.  If I have to do that again, I just don’t want to know about it, and I assume my patients would rather not experience that kind of discomfort during their plastic surgery procedure either.

Where does strict local anesthesia work best?  Local anesthesia works in small areas and in a very limited short plastic surgery procedure.  When do you want sedation?  When doing a longer procedure with larger areas where they may still have feeling in spite of the local anesthesia, like scar tissue or when working under the muscle.  When you have a longer procedure it’s difficult to lay in one position for hours.  The local anesthesia may wear off and need to be freshened or it will become uncomfortable.  My goal for all my patients is to have everything as painless as possible on all levels.  When you do it under strict local anesthesia, there is always some amount of pain involved.

Another issue has to do with the regulations of surgery centers.  In California, if you do plastic surgery with sedation or general anesthetic, the facility has to be licensed by an agency that licenses surgery centers.  Currently there are two main ones AAAHC and AAAASF.  I actually do inspections for the latter.  When you pass inspection for unique standards of organization, cleanliness, accountability, and safety that means that your physical plant has been approved, it also means that you have hospital privileges for the procedure being done.  However if the procedures are under straight local anesthesia, you do not need to meet the strict standards of the physical plant or hygiene and safety accountability.

That certainly doesn’t mean that everyone promoting, “local anesthesia only procedures,” is doing it to avoid regulation of shoddy or dangerous conditions, but… let the buyer beware.

What about general anesthesia for plastic surgery procedures?  Even when using lots of local anesthesia some surgeries are very stimulating to the nervous system.  This is because local anesthesia blocks the pain stimulus but not necessarily pressure, pulling or heat.  One of the worst horror stories I’ve heard about local anesthesia revolve around a patient that had a breast augmentation under local anesthesia, with some sedation, and “woke up” in the middle of the procedure and was told to be still,” because we have to finish.”  They felt and  experienced much more than they wanted to.  Sometimes you need what is called muscle relaxation sedation to do what you need to do, i.e., put in a breast implant or suture up the abdominal muscles.  A light general anesthetic is perfect for a breast augmentation, mommy makeover or total facial rejuvenation such as a facelift because it keeps you perfectly comfortable for those longer procedures and often times actually requires less total medication and sedation.

In summary: straight local anesthesia is great for very small procedures. But IV sedation or   general anesthesia are better solutions for making the patient comfortable for many plastic surgery procedures.  My goal for the patients is a painless plastic surgery, and local anesthesia is not the best way to achieve  that in every case.


Permalink to Plastic Surgery with Low Level Laser

Plastic Surgery with Low Level Laser

Low level laser, or cool laser, is one of the new high-tech devices we use at Advanced Concepts in Plastic Surgery in Sacramento.  Although it has been used for years in chiropractic to decrease pain and inflammation, this laser is relatively new to plastic surgery.

How can something that looks like a Star Trek Tricorder, and shines a flashing red light that you can’t feel, actually do anything?  Well it does, and surprisingly well!  Scientists have known for a long time that light is biologically active.  Look at photosynthesis, how light creates energy in plants.  In a similar way, light creates energy in all of us in the cellular energy cycle.

The cool laser has a wavelength of 635 nanometers.  Don’t worry; you’re not supposed to know what that means.  This is a wavelength that is biologically active, that it influences the energy in our bodies.  It penetrates the cells and activates enzymes that increase something called ATP which is the energy currency of our body.  This also increases circulation decreases pain and suppresses inflammation.

On a practical level, every one of my patients is treated post-operative with the cool laser.  It works dramatically to decrease swelling, discomfort, and pain.  The healing time has been cut down in most procedures as well as the amount of pain medicines taken.  It is used for facial surgery, breast enhancement surgery, body contouring, and VASER Hi Def liposuction.


Permalink to Brow Lift Choices, Which One is Right for You?

Brow Lift Choices, Which One is Right for You?

Many times patients come to see me at Advanced Concepts in Plastic Surgery in Sacramento and they don’t like the way their eyes look.  They know that they look heavy, tired, full, squinty, and request eyelid surgery and sometimes even think they need a full facelift.   In reality, what they need is a brow lift.

In some people the brow skin stays tight for a lifetime.  In others it starts dissent and stretches as early as their twenties.  As the brow drops the upper eyelids also drop and make the eyelids look full or droopy.  The best way to check this is to put a finger on the brow and lift directly upward to see how much the brow contributes to the look of the eyelid.  If the brow is the main factor in the appearance of the lids, eyelid surgery alone is never enough for good results, therefore, a brow lift is needed.  In fact aggressive eyelid surgery when a brow lift is needed can make a future brow lift impossible because the eyes may not close.

So if a brow lift is needed, which one will work the best?  Like most things in plastic surgery there are many choices.  The best choice for most people is the endoscopic brow lift: five small incisions behind the hairline.  A TV camera is put in the incisions to help separate the skin from the bone, the skin is pulled up just the right amount and reattached at a higher spot.  There is no skin removed and a tiny amount of hair is cut to close the incisions of the brow lift.

However if the patient has a high hairline you don’t want to pull that even higher.  Therefore, for these brow lifts, the incisions are made right at the hairline so the scar is hidden by the growing hair.  Therefore the skin is lifted, pulled, and just the right amount is removed.  What this does is lift the brow and make the high forehead a normal size at the same time.

A brow lift surgery is just like all plastic surgery procedures, anatomy dictates everything.  The right procedure for the right anatomy gives the right results.


Permalink to Free Facelift Preview

Free Facelift Preview

Considering a Facelift? Here at Advanced Concepts in Plastic Surgery, we like to give things away free if at all possible.  Since we almost never get that chance, after all, body sculpting tends to have many fixed costs associated with it, I thought I’d let everyone in on a little secret.

Everyone considering facelift surgery wants to know what he or she will look like after the facelift surgery is performed.  It is only human nature that if we are going to pay for something, we want some idea what we will be getting!

Of course as a plastic surgeon in Sacramento, I’ve performed thousands of face-lifts over the last 25 years but as hard as I may try to describe what I will be doing, words can only go so far.  You will look more rested, this or that will be lifted, skin will be smoother and more relaxed. The mental picture a patient will get will likely be somewhat accurate but they may still have a hard time picturing.

Over the years a lot of software has been developed to duplicate what the result of facelift surgery will be.  However the facelift preview software still relies on the surgeon’s ability to manipulate the software and may exaggerate or understate what the final result may be. It also only shows a two-dimensional image.

What if there was a way to preview the result of a facelift in a simple, cost-efficient way?  In fact, what if it were free and you didn’t even have to visit a plastic surgeon for a consultation? Well there is.  In plastic surgery, this method has been known for years.  In fact, I learned about it in my residency years ago.  Another plastic surgeon recently published and article about it although the idea has been around for decades.

And the fancy, high tech method to previewing what your facelift surgery will end up looking like? –Lie down.  That’s it.  Lie down on your back with a mirror and look at your face.   Most of the sagging effects are due to gravity and lying down takes some of that out of play.  Pictures taken of this position nicely preview a future facelift.    Now if you’re a real stickler for accuracy you could say lying down only accounts for some of the effects of gravity and ideally you would actually do well to stand on your head.  This is true and some doctors have actually written about this as well.  Dr. PatrickTonnard, when talking about the MACS facelift, one of the best facelift innovations of the last 10 years, has a picture showing this in his book.  However, from a practical standpoint not many people can stand on their heads for very long, or want to.


Permalink to Plastic Surgery Best of 2009 – Advanced Concepts in Plastic Surgery

Plastic Surgery Best of 2009 – Advanced Concepts in Plastic Surgery

This is a belated summary of the big ideas and new procedures in the field of plastic surgery that were important in 2009.  2010 is in and who knows what it will bring in terms of plastic surgery innovation advances and controversy.  Everywhere you look there are best of lists: movies and music books television you name it.  I thought I would take a little time to go over my best in plastic surgery of 2009 list.  These are the ideas that have come to the forefront in my practice and from what I have seen at meetings and in the medical literature.  It’s a very subjective list.  But what list isn’t when it comes to best of ?

#1. The BoTax.  The “BoTax” as it was referred to by the media was almost a part of the healthcare bill the Democrats hope to pass this year.  Basically it was going to be a 5% tax on all cosmetic surgeries: Botox, fillers and plastic surgery procedures   The  fact it was defeated is huge for the plastic surgery industry and patients.  It was wrong on so many levels.  It was the entry into the luxury/sin tax model regardless of the fact that most people using cosmetic services make less than $90,000 per year.  Privacy concerns would have been a huge issue and it would have been a logistical nightmare.  Doctors as tax collectors?  It also would have opened the door to other specific luxury taxes.  Why not Harley-Davidsons, golf clubs, massages, facials, etc.?  The possibilities are endless.  In addition the one place this actually was tried was in New Jersey and the plan just plain didn’t work and brought in nowhere near the projected income.  The only thing it really accomplished was increasing the numbers of surgeries performed in the state next door, New York.  I was very happy to see cooler heads prevail and the BoTax dropped from the healthcare legislation.

#2.  Fat is back.  Fat grafting has been around for over 20 years but was always treated as the poor stepchild of liposuction.  Because, in the beginning the results were variable so it was concluded that fat grafting was not scientifically consistent.  Over the years since there have been many more studies successfully supporting the science.  In addition, now there have been several reports that show that what is being transferred are actual stem cells in addition to the fat.  In fact, the stem cells may be the main source of what remains six months to a year later.  There is now more attention being paid since stem cells are the current darlings of scientific research.  There are even efforts being made to purify the stem cells out of the fat to increase survival of the fat cells.  In addition breast augmentation by fat grafting has become an accepted procedure and several investigators showed impressive results.  It’s not going to replace silicone breast augmentation nor is it for everyone.  This is because it is time consuming more expensive and may even require several procedures to get the final result.  Nevertheless there are a number of people who are candidates and would benefit from this procedure which would basically be permanent as opposed implants which have a limited longevity.  I have used fat grafting in Sacramento both for covering small defects and for breast augmentation at Advanced Concepts in Plastic Surgery with wonderful results.

#3. Vaser Hi Def liposuction.  I’ve been doing liposuction in Sacramento for over 20 years, Vaser liposuction for five and Vaser Hi Def liposuction for 1 ½ years.  There is a very confusing array of new technology, six different laser light machines a brand-new water jets Liposuction system and most recently radiofrequency.  However after reading the information and same salinity systems in action as well as speaking to my colleagues in the field of plastic surgery I’ve come several conclusions.

First of all, for multiple area liposuction skin shrinkage and maintaining viability of fat cells transferred Vaser Hi Def liposuction is the most advanced solution.

Second, laser liposuction works for small areas but is too time-consuming for larger areas.  It’s still unclear which wavelengths of light works the best despite all the claims.  There appears to be a lot at heat damage from the laser.  This does not allow viable cells for transfer.

Third, waterjet liposuction seems promising but it’s still really too new to say much about.

#4.  Thermage has had major technological advancements that have changed the game.  The new Thermage is not the same as the old Thermage.  Thermage has been around for years.  It is now in its third generation.  The first generation was effective but quite painful and needed considerable sedation.  Second generation was uncomfortable but manageable with a little sedation.  The new generation is not painful due to vibration of the tip which confuses the nerves in the skin and also has a cooling apparatus.  I’ve had this tested on myself and it is comfortable.  It is an ideal skin tightening: noninvasive, no downtime, procedure.  With the new changes it is now very patient and doctor friendly.  I recommend Thermage in Sacramento at Advanced Concepts in Plastic Surgery for my patients who need a little skin tightening but are not requiring the more dramatic results that can be a result of a tummy tuck, a face lift, arm lift or thigh lift.

#5. The Mini Lift, they’re back with a vengeance.  To paraphrase Shakespeare, ‘a rose as a rose is a rose.’  Mini face lifts have been around forever.  Actually, it can be argued that the mini face lift have been around since the beginning of the last century.  When I was at UCLA as a medical student, the chief made a lot of Hollywood happy by doing mini lifts every few years because they were small surgeries with minimal downtime.  Now there is a   huge move: for mini lifts, cheek lift, S lift or any other letter.  There have been some changes recently such as using deep purse string sutures that considerably improved the result.  Do they work?  For the most part they do.  However if all you have is a hammer everything in the world is a nail.  In other words, one must be prudent in determining whether a mini lift will work based on advice from a knowledgeable plastic surgeon who can offer other solutions if a mini lift will not achieve the desired results such as a regular face lift. Do I perform mini lifts on my patients in Sacramento?  Yes, I have been performing mini face lifts in Sacramento for about the last 25 years.  Now there are some newer features to a mini lift such as vertical vectors, barbed deep sutures and Vaser liposuction   Would they work for everyone?  No, that’s where the judgment comes in.

#6.  Acellular Dermis.  Acellular dermis is a manufactured product, most commonly made of porcine skin which has been treated to remove any chance of reacting with the immune system  This is then placed underneath the skin in breast augmentation revisions for cases of wrinkling or rippling.  It is also used for breast reconstruction to prevent those same problems.  Patients with thin-skin and implant problems have always been difficult because there was so little to work with.  With the acellular dermis there is now a solution that can solve these problems.  It also seems to prevent capsular contracture recurrence after breast augmentation surgery.  The times I have used acellular dermis on my plastic surgery patients in Sacramento in the last year I have been quite pleased with the results.

So there it is.  Some new ideas, some old ideas, and some ideas that have simply come back with a new angle.  It was a very interesting year with the common denominator being progress for plastic surgery patients, better plastic surgery results and safer and easier surgeries.

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