Author: Morgan Cosmetic Surgery

Fractionated CO2 lasers are an important advance in treating aging and sun damaged skin. It is important to understand how they work and how they are different from the older CO2 lasers.

The First CO2 Lasers

The previous CO2 lasers were total resurfacing lasers. Intense laser heat burned off the outer skin layers. Healing took 1-2 weeks. Skin was permanently lightened, redness lasted at least six weeks and severe scarring was a risk. The skin was permanently thinner. Demarcation lines where the laser treatment ended and the rest of your skin began could be very noticeable.

The Fraxel and The ND Yag Lasers

Next came the Fraxel laser and ND Yag laser skin treatments. These lasers do not penetrate the skin but heat it in tiny columns to induce skin improvement. Four to five treatments are needed to see results. At effective levels of heat, it is quite painful. There is little or no recovery time.

The New Fractionated Lasers

Now we have fractionated CO2 lasers.  These are the first choice for sun damaged and aging skin. We use the Smart Exide Dot laser. These lasers combine the penetration of the original CO2 resurfacing lasers with the tiny treatment columns of the Fraxel. Fewer treatments are needed, sometimes only one. Down time varies from 2 – 10 days but the average is five days.

What to expect from your Smart Exide Dot Laser Treatment

You will see improvement in skin texture and color, softening of lines and wrinkles and fading of skin discoloration. The ideal skin for this treatment is a person with moderate but not severe sun damage as is usually seen in a person from 45 – 55.  It may not be the best treatment for severe sun damage and severe skin damage from smoking.

Done in the Operating Room

•  You are asleep so you feel no pain.
• You wake up with  Aquaphor or other ointment on your skin. This keeps the skin moist and allows rapid, smooth healing. You apply Aquaphor as needed until all crusts are gone and skin is healed.

 

Done in the office

• You come in an hour ahead of treatment for two applications of topical numbing medicine.
• Morgan will also block major nerves with local anesthetic to minimize pain.
• You may want some oral sedation but this is optional.
• Once you are numb and the skin is treated, it takes about 40 minutes for the full face, a bit longer if the neck and decollete are treated too.
• You need a ride home afterwards.
• You rest at home and keep the skin moist with Aquaphor. Average time for healing is five days.

 

Many woman want to know how to get fullness in the upper breast. Is a lift the answer? What about implants? Is it always possible to get that look?

Creating lasting upper breast fullness can be quite a challenge but there is a lot we can do. Read on to see which type of breast you have and your best approach.

Understanding The Problem

• Upper fullness is not a natural breast shape, normal breasts are flatter on top, fuller below.
• Upper fullness is seen in some very full-breasted teenagers and young women. Many women have upper fullness during pregnancy, this fullness is breast swelling from a hormone surge. As the hormones subside, so does the fullness.
• Many women still want this alluring look.

Who is most likely to get that look and have it last, just with implants?

• The smaller the breast, the easier it is. In small breasted women, implants almost always create stable upper fullness and at times it looks unnatural because there is no lower breast tissue to soften the look.
• In normal-breasted women, small to medium implants are likely to create lasting upper fullness.  The implants are not too heavy. The breasts do not sag. The implants that create the upper fullness stay in place.

Who is least likely to get the look just with implants?

• The larger the breasts and the implants, the harder it is.
• Women with large to very large implants face the issue of the weight of the implants making the breast droop, just like naturally heavy breasts. Gradually they slip down the chest and the upper fullness fades away.
• Women who already have very large breasts and have implants placed will have even heavier and droopier breasts. Putting large implants in a large breast can make them sag within months, even if a breast lift has been done.
• Any woman who has a breast lift and large implants already has breast tissue that is stretched, whatever the cause.  These breasts lack holding strength to start and like putting large implants in large breasts, putting large implants in lifted breasts can cause sagging within months after surgery.

But wait! There is hope for women who want large implants.

• The answer is to add internal supporting material called ADM. Acellular Dermal Matrix – a skin-derived material strong enough to support an implant
• ADM is sewn around the implant, like an internal bra. It holds the implant in place, taking the weight off your own tissues so they don’t tend to sag.
• It adds time and cost to your surgery but it is our best way to get lasting upper breast fullness in large breasts.

 

 

After having a Brazilian buttock lift patients always have lots of questions about the recovery, which is perfectly normal.  Below I have addressed the most frequently asked questions. It is important to remember that these are my best estimates. The time for you may be shorter or longer.

When Can I ___?

• Leave the hospital
  • Usually two hours after the end of surgery if you are doing well.
• Get up and walk
  • The day of surgery. Walking around the house, to the bathroom, not staying in bed is important to reduce the risk of blood clots in the legs
• Take off my garment
  • 2-3 days after surgery, to shower and wash the garment.
  • Wear the garment day and night for a full 2 weeks and ideally 6 weeks.
  • Some people wear the garment for months because it feels supportive – that is fine.
• See the swelling go down
  • At two weeks, some swelling goes down but the areas of liposuction still feel ‘fat’
  • At six weeks, a lot of swelling is gone but the lowest areas will still look ‘fat’
  • At six – twelve months you will see your final result with all swelling gone.
  • How to tell when the swelling is gone? As long as skin is numb, it is swollen
• Sit on my bottom
  • About 3 weeks. The fat grafts are usually in the upper buttocks so sitting on a hard chair may be fine but leaning back on the fat grafts should be avoided.
• Lie on my back
  • Three weeks is the earliest.
  • We don’t want pressure on the fat grafts.
• Start to exercise, like a brisk walk
  • 1 -2 weeks. If your energy is 7 out of 10 or more, brisk walking is fine.
• Go back to work
  • 1 – 3 weeks, depending on how much liposuction was done and on your job.
  • For a short commute to a desk job, 1 week is possible.
  • Two weeks is the average.
  • Up to three weeks for a physically demanding job where you can’t take a break.
• Take a 2-6 hour car ride or plane trip
  • 4-6 weeks, with precautions. I recommend an aspirin before the trip and knee high support stockings during the trip. These can be bought in your pharmacy.
• Get back to the gym or other aerobic exercise, like karate
  • Six weeks – you won’t have the energy before them and exercise may be painful.
• Have sex
  • Six weeks – because of energy and the risk of hurting your healing surgery
• See my final result
  • Usually six months although in some people, men especially, it can take longer

Microbotox, also known as airbrushing, is a new term to describe two new ways to use Botox. One done by injecting tiny amounts into many areas of muscle in the usual treatment areas and the other injecting tiny amounts of Botox into skin to reduce crepiness or oiliness.

Multiple small injections in muscles.

Injecting the same amount of Botox in tiny amounts into muscle is claimed to produce a ‘more natural’ effect. It sounds painful because no matter what we do, each injection hurts.  I get natural effects for my patients by discussing the look they want, understanding the muscles and where to inject them and then figuring out which dose of Botox each of the muscle areas need and where to inject it. For instance, the forehead muscle (frontalis) although broad is thin and often needs less than other areas.  I always warn new patients that unless they know the amount of Botox used and where it was injected previously, it may take one or two treatments to get it exactly right because everyone’s muscles work a little differently.  Once we get it right, we should be able to reproduce that effect in each future treatment.

Multiple small injections into oily skin.

This is injection of tiny amounts of Botox into the skin to reduce the activity of the tiny muscles around our oil pores.  The goal is to temporarily decrease pore size and oiliness. (We know Botox reduces sweating from glands under the arms and in the palms. It makes sense to try it in the skin.) The T-zone where skin is oiliest is the usual area that it is treated and for some people this does work. There is the risk that Botox will go deeper and have unwanted muscle effects, like a drooping mouth or changed smile. I suggest to my patients who want to try this to not treat the entire area at first but to start with one safe area, such as an oily mid-forehead.

This has three advantages –

1. It is less painful to inject here than in many other T-zone areas
2. You can tell if the treatment is effective for you before spending a lot of money
3. If the muscles are affected, the result will be a smooth mid-brow, a much better side-effect than a drooping lip or strange smile.

 

Multiple small injections into crepey skin.

Botox is claimed to temporarily smooth crepey skin.  For something unfamiliar like this  I try it on myself before asking my patients to pay. I have areas of crepey skin and I am trying it soon. I’ll report what it does for me – if anything!

 

I love to help my patients get the look they want in the best way possible.

Give us a call so we can help you!

A number of patients have asked me, “Why don’t you recommend a mid-face lift as one of my options when we talk about fillers and face lifts?”  Occasionally I will but I tend to avoid this operation. Here’s why.

We have many different ways of lifting the face –

• Brow lifts
• Upper and lower eye lid lifts
• Mid-face lifts
• Lower face lifts
• Central neck lifts
• Standard neck lifts

All of these have changed over the years and have been improved by various refinements of technique. Many have developed into several different operations. But the new advances of Botox, soft silicone implants and off-the shelf fillers have made the Mid-Face Lift less useful.

 

• Botox corrects the frown lines around the eyes much better than the mid-face lift.
• The mid-face lift can easily exaggerate crows’ feet.
• Fillers give fullness to the mid-face much faster and more safely than mid-face lifts.
• Mid-face implants give support to the mid-face with less risk than the mid-face lift.
• The mid-face lift is notoriously slow to heal and more prone to complications than other facial lifts.

 

The complications caused by Mid-Face Lifts

 

• An incision under the lower lid that extends beyond the eye is usually used.
• This incision takes at least 3 months to fade. The scars of other facial lifting procedures are much less noticeable from the start.
• The pull of the mid-face lift on the lower eyelid can cause ectropion – a pulled down lower lid which is both unsightly and difficult to correct.
• Soft solid silicone mid-face implants have their own risks but will not affect the appearance of the eye while giving lift to the middle of the face.
• Because of gravity and difficulties securing the mid-face lift, results tend to be less durable than other lifts.
• The mid-face can be lifted using an incision in the temple and entering the mid-face from the side. But this is also difficult approach with a significant risk of nerve injury if not done with precise accuracy.

There is always a balance in surgery, especially facial cosmetic surgery, between the safest operation and the most effective one. We want facial operations to be effective but we also want a very low risk of prolonged unsightly recovery, permanent nerve injury and eye disfigurement.  We have a good balance for all other face lifts but not the mid-face lift. So for now, most plastic surgeons feel that for the mid-face, fillers, Botox and mid-face implants offer you a better option – good results and with less risk. But who knows? A year from now we may have something even better to offer you!

I love to help my patients get the look they want in the best way possible.

Give us a call so we can help you!

 

 

Many women and some men have fat deposits above their knees even when their legs are not particularly heavy. This is a difficult area to improve with liposuction but Kybella has been shown to reduce this fat. Treatment is an office procedure and a legal, off-label use of Kybella.

 

Kybella is specifically approved by the FDA to reduce fat under the chin. Almost every approved drug has many more uses than the one or two specifically approved by the FDA. The approval process takes years and is very expensive. So once the FDA approves a drug for one use, we physicians are legally allowed to use the drug as we see fit to help you, our patients. Since Kybella specifically dissolves fat, it is now widely used to dissolve small areas of excess fat in many parts of the body; however it is expensive and does not work well for larger areas of fat.

 

How does Kybella work for the knees?

 

It dissolves the fat lying over the knee, but it will not dissolve other tissues. Sometimes what looks like fat over the knees is actually excess skin – after all, we need to bend the knee so when we stand straight we will always have some extra skin. But if there is a fat deposit under that skin, Kybella can dissolve it. We don’t inject Kybella on the sides of the knees because it can damage nerves in those areas. Nerves have a fatty outer layer called myelin. Presumably Kybella dissolves myelin if it is injected into or near a nerve. Without myelin, a nerve can’t function normally. Even though the nerve damage seems to be temporary, the nerve can take months to recover.

 

The Procedure

 

• First we mark the area of excess fat above the knee
• We lift the tissue and inject multiple small doses of Kybella into the area, (both knees can be treated at the same time).
• You will feel severe pain for 2-3 minutes.
• Then the injected area will be sore and will start to swell.
• You may need a pain pill to sleep the day of your treatment. You may bruised and the knee will be visibly swollen. Visible swelling can last several weeks.
• You wait six weeks to see the final result. Although walking is fine, you probably won’t want to run or bike for the first week or two after the injection.
• You will need at least two treatments – and you may need more if you have a lot of fat over your knees.

 

This is a really nice treatment for those of us with excess fat in this once difficult to treat area.

 

Think this might be for you? Just call us at 404.941-3200 or email us at [email protected]. We would love to help you!

The Brazilian buttock lift or BBL is a procedure that was developed in Brazil that involves transferring fat from other body areas into your buttocks. It has become increasingly popular in the United States. The recovery is much easier than having solid silicone buttock implants.

It consist of the following:

• Fat is removed from other areas of the body by liposuction
• The fat is then put through a purification process
• The purified fat is then injected into the buttocks using a blunt-tipped instrument called a cannula
• To get a good result, the fat must survive. Fat survives best in muscle because of its high oxygen levels. Therefore, carefully injecting the fat under the skin and into the superficial muscles where blood vessels are smaller is the safest.

You must have enough fat to have the procedure done. It takes 500-1000 ccs of fat to inject it into the buttocks. This means a liposuction procedure of 3000-5000 ccs is required.

There were over 15,000 Brazilian buttock lifts performed in the United States last year according to the American Society of Plastic Surgeons. Data now suggests that the risk of sudden death from BBL averages 1 in every 4,000 patients. This makes the BBL THE MOST DANGEROUS PLASTIC SURGERY PROCEDURE. The second being the tummy tuck.  Many plastic surgeons are doing intensive research to find out why the risk is so high and how to make the procedure safer.

The main risk for the BBL is the fat being accidentally injected into the deep muscle of the buttock where the large veins and arteries are located. If the fat is injected here, it can get into a vein and travel to the lung and cause death. This can happen because the fat is injected through tiny incisions and the surgeon can feel but not see where the fat is going.

I take every possible precaution when performing a BBL. I use a 4 mm vibrating cannula or larger with no opening at the tip to inject the fat. This makes plenty of space for the fat. I keep the cannula parallel to the buttock and as I withdraw the cannula, the fat is injected.

If you are considering a BBL, make sure you choose a plastic surgeon that is Board Certified and has experience doing BBLs. Board Certified Plastic Surgeons are constantly doing research on how to keep patients safe as possible during risky procedures. If you do not have enough fat to transfer for a BBL, you may have to consider buttock implants. NEVER get illegal injections of silicone or other materials. This is very dangerous.

I love to help my patients get the look they want in the best way possible and to give you the best possible guidance. Give us a call so I can help you!

 

 

 

Is there really an advantage to using platelet rich plasma with fat injections? We don’t really know but since it uses your own tissues, it should do no harm, although it adds cost to any procedure. We know that platelet rich plasma, also known as PRP, turns out to have many beneficial effects and it may improve the results of fat injections, also called fat transfers or transplants.

The Science Behind These Injections

Fat has stem cells and these are cells that are able to grow into different kinds of tissues. This includes collagen and other body structural tissues.

Platelet rich plasma is rich in growth factors and may increase the survival of injected fat – mostly in small amounts.

Combining the stem cells in fat transplants with the growth factors in PRP will improve the results of transplanted fat.

 

How Does This Procedure Work?

• The area of the body receiving the injection is marked off.
• The area harvesting the fat is also marked.
• Both areas are numbed.
• Ten ccs of your own blood is removed from a vein, just as though it were a routine blood test.
• The blood is put in a centrifuge which separates the plasma from the blood cells.
• After the fat is harvested, it is washed, put in syringes and emulsified – moving it back and forth through a small opening to break up the fat.
• This allows fat to be injected with a small needle.
• The platelet-rich plasma is mixed with the fat.
•  Once both areas are numb, the fat and the PRP are carefully injected into the tissues.
• Results vary because fat is living tissue and has to survive when transplanted. But successful grafts appear to have long-lived and even permanent results.

The Brazilian buttock lift or BBL starts with extensive liposuction, usually of the stomach, flanks (sides) and back. The fat is then washed, purified and injected into the buttocks.

The surgery for placing silicone buttock implants involves making incisions on each side of the buttocks, in the crease. Then an incision is made in the gluteus maximus muscle and the implants are placed.

A big advantage of the BBL is the recovery is easier. Injecting fat does not have the implant’s risk of infection. An infected buttock implant must be removed and it can take weeks for the infection to heal.

The buttocks are largely made of fat, so injected fat feels more natural than even the softest-solid silicone buttock implant. So in general, having a BBL is the first choice unless you are someone with very little body fat or you have had a BBL that failed.

A failed BBL means the fat did not survive. Fat cells removed by liposuction are living tissue. Once injected into your buttocks, the fat cells must survive to keep your improvement. If the fat cells do not survive your body will absorb them and you get no change.

Due to better techniques for fat harvesting and injection, failed BBLs have become less common. A technique called cavitation injections which involves removing toxins in the serum of the fat has made this possible. The process causes less damage to the fat and allows for it to be immediately washed and purified as it is being taken out. The fat is then injected with a vibrating cannula which helps create a space for the fat so it is not under too much pressure. This technique helps the fat cells survive.

Cavitation is also safer because it allows the fat to be injected very slowly as the vibrating cannula is removed. Therefore, the fat is layered under the skin and in the superficial buttock muscles which is thought to prevent inadvertently injecting fat into the deep buttock veins.

BBL safety is a BIG issue. So please also read my BBL Safety Update for 2017. The BBL is increasingly popular among women and men looking to slim their torsos and enhance their bottoms. It is very important that you understand the safety issues before having it done.

 

 

Cosmetic Question:  How often do I need to change my breast implants so they do not leak or deflate?

Cosmetic Answer:  You do not need to have saline or silicone gel implants changed, unless the implant is damaged. The procedure is called Implant Exchange.

Here is what you need to know:

SALINE IMPLANTS

• On average these implants last ten years.
• You will know that they need to be replaced if your breasts seem to be getting smaller or if you notice a significant size difference in one breast and not the other.
• These implants have a one-way valve through which the implants are inflated during surgery. In time, this valve malfunctions, saline leaks out of the implant, which is totally harmless and your breast get smaller and smaller.
• If one implant leaks, usually both are changed at the same time. Especially if the implants are ten years old.
• If your implants are totally soft and the leak has occurred in the past 1-2 weeks, it may be possible to change the implants under local anesthesia in the office.
• Otherwise, the new implants must be put in under general anesthesia in the operating room. This is because if you wait to have them replaced, the tissue around the deflated implant contracts and it will need to be released to make space for the new implant.
• Saline implants do have warranties and if it has not expired, a free replacement pair is provided. The replacement implants must be the same implants that you have already.

GEL IMPLANTS

•  These implants do not leak unless they are ruptured in some way.
• A change in shape or the way the implant feels is the usual indication that one is leaking. You probably will not notice that your breasts are smaller.
• Gel implants are always removed under general anesthesia in the operating room. This is because there may be free floating silicone that needs to be removed. This cannot be done in the office.
• The gel implants also have warranties but the warranty does not cover a rupture caused by outside forces. The warranty only covers the implant if it is proved to be defective.

WHAT CAUSES AN IMPLANT TO RUPTURE?

The most common cause is a mammogram. Always tell the technician that you have implants. And if the mammogram is unusually painful, tell the technician to STOP and have someone else do the study.

DO I NEED AN MRI BEFORE IMPLANT REMOVAL?

The FDA recommends an MRI every 2 years if you have gel implants. There is no scientific basis for this recommendation and these studies are very expensive. Usually an Ultrasound study will give the information needed about a possibly ruptured implant. If the results are confusing or inconclusive, then an MRI may be needed. If you have a clearly deflated saline implant, you may not need any study before your implants are exchanged.

I love to help my patients get the look they want in the best way possible.

Give us a call so we can help you!