Author: Morgan Cosmetic Surgery

Botox is expensive. When you get cosmetic Botox for facial lines, you do not want to overspend and you want value for money. How do you know what that is?

There are two ways to charge for Botox, by the area injected or by the units used. When you pay by the area, you are likely to pay too much because the price is the highest price that area could require. Many patients need much less and everyone’s facial muscles are different. If you pay by the unit, you get exactly the amount an area needs to treat the wrinkles.

It is best to go somewhere you are charged by the unit.

The average wholesale cost of Botox is $6 per unit. The wholesale cost is lowered for very large orders on a regular basis from Allergan. The average retail cost of Botox per unit in Atlanta is $13. In many medical practices injecting Botox is done by RN injectors for the average retail price. If the doctor injects the Botox there is sometimes extra cost involved.

Dr. Morgan does all her own injecting, there is no wait and she charges $12-$13 per unit, depending on any specials that we have throughout the year. She is a Board Certified Plastic Surgeon and has been injecting Botox for 20 years.

You will see Botox advertised on Groupon, Medispas and even hair salons. The price can be as low as $7. If you are thinking this is too good to be true, you may be right. If you get 40 units for $7 per unit that comes to $280 and Groupon takes ½ of that so it is being injected for less than cost. What is going on?

Some things to consider:

• The Botox is extremely diluted so it may not last very long
• The Botox is counterfeit or bought from the “black market”
• Botox is not what is being injected

For your best results when getting Botox, go to a Board Certified Plastic Surgeon or Dermatologist who does their own injecting. A physician who is Board Certified is less likely to risk their reputation and purchase a “fake” product. If a doctor is caught injecting fake Botox they may have to pay high fines and even possibly do jail time. In other words you must trust who is injecting it and know there credentials.

One other tip if you are on a budget for Botox. Allergan, who is the manufacturer of Botox, has an amazing savings program for members who purchase their line of products. It is free to join and many physicians offer this program. Every time you get a treatment you earn points which can be converted into rewards toward your next Botox treatment. For more information go to BrilliantDistinctionProgram.com.

Some people notice darker skin after surgery or an office treatment. This is called post-inflammatory hyperpigmentation (PIH). It is more common in darker skins but it can occur in anyone.

PIH is caused by the skin over-reacting to mild injury with a sun protective response. The skin has cells called melanocytes that make melanin which gives skin its color. All skin irritation including surgery and injections may cause mild, temporary inflammation. In some skins, this inflammation activates melanocytes which rapidly darken the skin. Once activated, the cells may keep the skin too dark for months, or permanently.

It is hard to predict if you will get post-inflammatory pigmentation. Two things usually seen in patient’s that develop PIH are a surgical scar which is white or a natural color or has skin that burns or at most gets a very light tan. If you get burned or cut and your skin appears darker after you have healed, this is usually PIH.

The best way to prevent post-inflammatory hyperpigmentation is use a physical sunblock containing zinc oxide and titanium dioxide every morning applied to the affected area. If you know you get PIH and you having a procedure or treatment, you can apply 4% hydroquinone to the area being treated twice a day for 6 weeks prior to your procedure and 6 weeks after. Also applying tretinoin 0.1% (Retin-A) cream to the area once a day for the same time period can help. Both of these creams must be obtained by prescription.

If it is too late and you already have post-inflammatory hyperpigmentation start the hydroquinone and tretinoin treatment as soon as possible. If is an old scar or injury applying 10 % shea or cocoa butter twice a day for one year can be effective.

 

 

Men are increasingly interested in cosmetic plastic surgery and treatments. There are differences between how these work for men compared to women. Here are some procedures popular with our male patients and what makes them different.

• Botox – Very popular and effective in softening deep facial grooves that men’s strong muscles etch in their faces. Because muscles are stronger, more Botox is needed but with the right Botox dose, results are excellent.
• Filler –Done to create facial definition and fill in lines. Wider jaws, stronger chins and higher cheek bones are popular male looks. Men are more precise in the placement of their filler and don’t want to look over-filled. Often my male patients will watch in a mirror while I inject their filler so we can work together to get it exactly as they want it. .
• Body implants- Implants to enlarge the calves and chest are popular with men who have muscles here that won’t enlarge with exercise. Here men’s strong muscles help conceal the implants better and make healing very fast.
• Liposuction- Men often have fat on the flanks (sides) even when the rest of the torso is slim. And some men have deposits on the chest (gynecomastia). Liposuction here is very effective and results excellent. But on the abdomen, men often have less fat under the skin than they think. Liposuction here can be disappointing.
• Body lifting after major weight loss- Because they have less fat under the torso skin, when men lose a lot of weight, they usually lose it evenly, so body lifts restore their shape with better definition than is possible for many women.
• Face lifts- Men are more likely to bleed after a face lift because of their larger blood vessels. But this also has the benefit of making men heal very quickly with fewer irregularities from swelling than women.

Men want to look their best, just as women do.

 

Subcision can be one of the best treatments for rolling acne scars and chicken pox scars. A rolling scar is a shallow, indented scar with no sharp edges. They primarily occur on the cheeks. Other treatments for rolling scars are microneedling and injectable fillers. Subcision is the least expensive. Twelve treatments of microneedling may be needed to treat rolling scars at a cost of $3600. Injectable fillers range in price from $665-$680 but may need repeating every 9-12 months. Not all rolling scars can be treated with filler. Subcision is $400 per treatment. The treatment number is variable, but is done every 3 weeks to 3 months. So, if you have 4 per year it is $1600, making it the least expensive and more permanent solution.

Subcision is done in the office. The scars are numbed with lidocaine and nitrous oxide (laughing gas) can be administered to make this more comfortable. Then a special needle is inserted into the skin at an angle, targeting the scar bands. This breaks up the fibrotic strands that are tethering the scar to the underlying tissue. This causes bleeding , which forms a clot. The clot plus the release of the bands raises up the scar. As the clot is absorbed it leaves scar tissue that continues to support the skin.

Subcision causes bleeding, swelling, pain and bruising. Occasionally, the patient may experience nodules under the skin while the area is healing. All these things will begin to subside in 5 days. Several subcision treatments may be needed. It works for 60% of patients. Improvement can be seen over 6 months but sometimes it takes longer. It is not 100% predictable.

CoolSculpting has become the #1 non-invasive fat reduction procedure. It is popular because it can be done in the office and promises easy recovery. It can be as expensive as liposuction surgery but usually only gets rid of 10-20% of the fat calls. Unless you experience what a patient of mine experienced. A condition called paradoxical adipose hyperplasia which means “reverse effect of fat growth”.

The Patient’s Story:

“I had three CoolSculpting treatments at my dermatologist’s office. My upper abdomen got fatter and fatter. It affected my breathing and my clothes became too tight. I looked deformed and I thought I was going crazy. I asked the CoolSculpting technician what happened. She told me she did not know and she never offered for me to see the doctor. I decided to get a second opinion which led me to Dr. Morgan. She explained the problem and recommended that I have liposuction of the entire area.”

“I had the liposuction surgery and I am so pleased. I can wear a smaller size in clothes and I can breathe again!”

What Happened?:

The idea behind CoolSculpting is that extreme cooling of the skin and fat makes fat dissolve. Paradoxical adipose hyperplasia has the exact opposite effect. The fat cells grow and grow with each CoolSculpting treatment. You need liposuction to get rid of this hyperplastic fat. No one is sure why the condition occurs but the theory is that some people have fat cells that have evolved to hold more fat when it gets cold as a winter survival mechanism.

Paradoxical adipose hyperplasia was thought to be rare but it is clear that it is much more common than is reported. This is because it is not documented in the published studies. Published studies are usually done at academic hospitals or related facilities. CoolSculpting is usually done at a private medical office or medi-spa. The procedure is commonly not performed by a physician. The condition is also not life-threatening. Therefore, these factors can lead to the condition not being diagnosed and the patient not being aware that it is a possibility

A Few More Things:

Paradoxical adipose hyperplasia is more common than reported, more common in men and more likely to occur in people who are overweight. Liposuction is the “gold standard” for major fat reduction. CoolSculpting is FDA approved and very popular but my impression it is better for very small areas of fat.

 

 

It is tempting to have a cosmetic procedure that gives us minimal scars and cost less especially if it will replace a more expensive operation of higher risk with a longer scar. The problem is that if a less expensive, smaller scar operation does not fix the problem, you may not get the result you want and then it was not worth it.

Three Examples When This May Happen:

1. Having liposuction when the problem is loose skin and muscle.

The Problem-You have had children or you have gained and lost a substantial amount of weight, you have a bulge in your abdomen and you want it to be flat. You get liposuction and it looks worse. Loose skin looks even worse when fat is gone, it makes the bulge more obvious.

The Solution-You needed a tummy tuck which removes the excess skin and repairs the muscle.

2. Having a thread lift or getting fillers when you need a face and neck lift.

The Problem-You have jowls and loose neck skin so you decide to get a thread lift and fillers. The thread lift last 6 months and you have gotten minimal correction of the jowls and saggy skin. The fillers replaced volume loss but the saggy skin still remains.

The Solution-If you need a face lift but cannot afford one, do not waste your money on a temporary, poor substitute. Save your money for a face lift or evaluate how you can make yourself look better with a less expensive procedure. Two less expensive procedures that freshen the face are CO2 fractionated laser to tighten and resurface the skin or an upper eyelid lift to open up hooded eyes.

3. Having a fat transfer to the breast instead of breast implants.

The Problem-You have fat transferred to your breast instead of breast implants. A third of the fat does not survive and much of the result vanishes once your swelling goes away. You only get a half a cup larger with one session and need 2 or more procedures to achieve the size breasts you want. You could have had breast implants which involves one surgery and less cost.

The Solution-If you want larger breasts and can have breast implants, this is the way to go. Fat transfer is very unpredictable and gets expensive if you need multiple procedures.

When doing less surgery is the right approach. Here are a few examples:

1. A lip lift is a minor surgery done in the office under local anesthetic . It increases the prominence of the vermilion border giving you a fuller upper lip. You do not need a face lift to lift the upper lift.
2. Injectable fillers are good for increasing lost volume in the face, not a face lift. A face lift restores structure and gets rid of excess skin it does not replace fat loss due to aging. In many cases, after a face lift you will need filler or a fat transfer to replace lost volume.
3. A face lift will tighten the face and get rid of excess skin but it does not repair sun damaged skin. For sun damaged skin you need to have use medical grade skin care, have a chemical peel or laser resurfacing.

Cosmetic plastic surgery has so many options. To choose the right procedure see a Board Certified Plastic Surgeon. A well trained plastic surgeon should explain all your options and help you choose the right one for you.

Many women have breasts that sag or get smaller, perhaps from pregnancy, breast feeding, weight loss or time. Saggy breasts need a breast lift. Smaller breasts need a breast implant. Small saggy breasts need both.

At times you can see yourself that you need a breast lift, e.g. if your breasts are sitting on your tummy. For breasts like these, you must have a lift and implants. Otherwise your breasts stay on the abdomen, the implants sit on the chest and your result looks very odd.

At other times it is obvious that you do not need a lift because your breasts are high on the chest and the nipple is a bit above the natural breast crease.  All you need are breast implants.

Sometimes you cannot tell and you need your plastic surgeon to measure you and advise you. About a third of the time the conclusion is that you are “borderline for a lift.”  You have to make the decision to have a lift or not and here is how.

• If you really do not want a breast lift because of the cost or the scars, just have your breast implants. You may later change your mind. Fine! Have the breast lift then.
• If you feel sure that you will look better with a lift and can afford it and do not mind the scars, then definitely have the breast lift done with the implants.
• If you don’t want a lift but do not want to have to get a lift later for a good result and really want to get this right – here is what to do. Before the day of surgery and the day of surgery, ask your surgeon to put the breast implants in first and then sit you up on the OR table to see how they look. If your breast do not sag with the implants in, you do not need a lift. It is very important to ask because most surgeons perform the breast lift first.

 

Most plastic surgeons cannot agree on what a mini face lift is. For one plastic surgeon it may be a face lift done as an outpatient procedure while to another it may be a face lift done in that office. Others consider a mini face lift a short scar face lift or a thread lift.

My definition of a mini face lift is the outpatient minimally invasive composite face lift or MICFL for short. It specifically and scientifically tightens the jowls and sagging around the mouth and loose tissues up to the cheek bone. It will also tighten the neck. It usually involves little bruising and a short recovery time.

This procedure can be done in the office if you do not have high blood pressure. General anesthesia is not used in the office. Instead we use Pronox (nitrous oxide also known as laughing gas) as well as local anesthetic. The MICFL is a very precise face lift and is done under magnification. The procedure takes about 4 hours. So, if you are not one to be able to lie still that long, it is probably best if you have it done at the outpatient surgery center under general anesthesia.

If you are considering a thread lift because it can be done in the office, please know they do not last and can be asymmetrical. You may also think laser is an option but it does not tighten deep loose tissue, it only tightens the skin.

Swelling will always occur after cosmetic surgery. Swelling is a normal part of the healing process. It takes time and it will take at least six months to see the final result. It is tiresome but true; however sometimes your swelling could be abnormal, here are the ways you can tell.

The three common causes of abnormal swelling after cosmetic surgery are

1. Seroma (Most Common) – A fluid collection
2. Hematoma (Rare) – A blood collection
3. Infection (Uncommon) – Ranges from minor to severe

All three problems need prompt treatment. You may ask, when should you call your plastic surgeon if you are worried that your swelling is abnormal? I tell my patients, “Don’t try to figure it out. Just call me!” But more information always helps. So here’s what to look for.

1. Seroma is a firm bulge visible seen through the surgical swelling. It may have an audible ‘slosh’, looks bruised and is usually seen the first week after surgery.

Treatment– It is usually simple – drawing out the fluid 3 – 4 times over the span of a few weeks. Untreated, a seroma doesn’t go away and will eventually need to be removed surgically.

2. Hematoma is usually seen soon after surgery but can occur suddenly weeks later. Steady or sudden swelling, tight skin, often painful. Bruising is usually severe.

Treatment– Complete prompt surgical drainage is essential – otherwise the hematoma ruins your result.

3. Infection usually noted two weeks after surgery. The early sign – instead of feeling better with less swelling two weeks after surgery, you feel worse and swell more.

Treatment – Call immediately if you experience a fever, pain, chills and redness don’t wait for them to develop and become more severe.

Your questions after surgery are never foolish. It is perfectly fine to call about something that proves insignificant. It means all is well. But it makes no sense to have a problem and delay calling for days because if you have a problem, the longer you wait, the harder it is to treat.