Author: Morgan Cosmetic Surgery

Cosmetic Question: I have heavy arms but is arm liposuction a good idea? I am told it will leave loose, irregular skin.

Cosmetic Answer: You are right to be concerned. The skin on the under surface of the arm is thin. Excessive liposuction here can leave sagging skin. Also, the thin skin in this area may not hide the track marks of the liposuction cannulas.

This does not mean arm liposuction is not right for you, because using small cannulas and going all the way around the arm can often reduce a bulky arm without sagging or visible marks.

This information will help you decide if arm liposuction may be right for you:

• Are there stretch marks on the skin of your arms? If so, you have a high risk of sagging skin after arm liposuction. Stretch marks mean that the skin that has lost its strength and elasticity.
• Have you lost weight in your arms? Liposuction may actually make things worse, removing more fat will make arms even looser.
• Is the problem your shoulder area? Some women cannot fit into jackets and blouses with sleeves because of arm fat in this area. This is a great area for liposuction. The skin is thick and results are almost always good to excellent.
• Are your arms chubby and you want skinny arms? Not a good idea, removing enough fat to make a chubby arm skinny will definitely leave loose skin.
• Is your skin good, no stretch marks, no weight loss and you just want them appropriately smaller? A small cannula liposuction done all around the arm may be exactly right for you.
• Word of warning: arm liposuction should be conservative. It is disappointing if you don’t see all the result you want, but removing too much is worse. Once too much fat is removed or visible track marks have appeared, correction is difficult or even impossible.

Can local anesthesia be used for arm liposuction? Yes.

If it is just your arms, I can do this with local anesthesia and sedation by mouth in our office.

If you want several areas of liposuction done at the same time and the arms are just one of these areas, I do the surgery in an accredited out-patient surgery center. If done at the surgery center, you can usually choose local anesthesia or general anesthesia for liposuction of multiple areas.

Just give us a call (404.941-3200) and let us help you!

Cosmetic Question: Is it okay to have a breast reduction or a tummy tuck before I have children?

 

Cosmetic Question: Yes, it is okay to have any breast surgery before or after having your family. The only time not to have breast surgery is when you are pregnant and for six months after delivery or 3 months after you stop breast feeding.

The cosmetic operation that you should not have before having your children is a tummy tuck. The physical growth of the baby predictably stretches the skin and muscle of the abdomen, reversing the tummy tuck surgery repair every time. So, wait until having your family for a tummy tuck.

It is hormones, not growth of the baby that affect our breasts during pregnancy and these effects are totally unpredictable. Breasts may be larger, smaller or the same after pregnancy. Therefore, it does not undo the effects of breast surgery. If you have had a previous breast reduction, your breasts remain proportionally smaller afterwards.

If your breasts are too large and are causing you a lack of confidence, embarrassment or back and neck pain, then breast reduction surgery is the best treatment, before or after pregnancy.

A breast reduction is an out-patient surgical procedure with a two week recovery. It is done with general anesthesia. You can get back to full activity (running, kick boxing, etc) after six weeks. Recovery is not painful.

Can you breast feed after a breast reduction? Of course lots of women are not able to breast feed anyway. However, for those who can, any breast surgery can affect breast feeding.  Modern breast reduction surgery keeps the breast-nipple attachments unchanged and breast feeding is definitely possible.

So if your large breasts are a concern , please call us and let us help you!

 

 

Cosmetic Question:  I know it’s expensive so before I try it, I’d like to know how Vitamin C serum improves aging skin?

Cosmetic Answer:

Great question. Vitamin C used in a serum on the skin has been shown to have a range of beneficial effects. It reduces fine lines. It improves the skin’s texture and strength. It evens the skin tone and decreases brown spots. It does this because it is an anti-oxidant that prevents skin damage. Vitamin C is a tyrosinase inhibitor. Tyrosinase is involved in producing color on the skin, contributing to hyperpigmentation. Therefore, if you block tyrosinase, you prevent hyperpigmentation from forming.

Vitamin C is expensive because it rapidly deteriorates. A glass of fresh orange juice loses half its vitamin C just sitting overnight. So, this means manufacturing of stable vitamin C skin serum products is expensive. It also means that inexpensive versions are unlikely to have much effect on your skin. We carry the Obagi Professional-C Serum 15% because of its proven Vitamin C activity.

The advantages of using Vitamin C serum on the skin are:

• It is easy to use and usually well-tolerated, except for some skin dryness. In comparison, topical Vitamin A which is the active ingredient in Retin- A or its generic formulation, tretinoin, is harsher and harder to use. Although, if tolerated, Retin-A’s effects can be dramatic.
• It is excellent for women with early changes who don’t want or need an aggressive skin regimen.
• It is less likely to trigger cold sore outbreaks, a common problem with Retin-A.
• It can be used with other products without blocking their benefits.
• It improves the results of skin treatments, such as microneedling.
• It protects the skin to some extent from sun damage.

If you want to protect your skin from the signs of aging or help reverse damage that has already occurred. Vitamin C is an excellent start.

Please give us a call if you are considering improving your skin and want to try Vitamin C.

 

Cosmetic Question:  What is the lunch-time face lift?

Cosmetic Answer:

The lunch-time face lift describes any office treatment that rejuvenates your face with the idea being that it can be done in the lunch hour and you can go back to work right after. You can definitely get improvement with some “lunch time face lifts” but nothing like the results of a standard surgical face lift, if that is what you need.

The “lunch time face lift” usually means one of these techniques:

1. A mini-face lift: This is a surgical procedure done in the office and it is like a standard face lift, but more limited. Local anesthesia is injected into the face. An incision is made in front of the ear, lifting the skin so the deep tissue (SMAS) can be tightened. It takes longer than a lunch hour and you will not be going back to the office, but you can work the next day. That is if you do not mind some swelling and bruising. For women under 40 with early jowls, results are pleasing, healing is fast and it does delay the need for a major face lift.

Do we offer this treatment? Yes we do!

2. A filler (or liquid) face-lift: One sign of aging is a thinner face, as our natural fat is absorbed. Face lift surgery tightens tissues but does not add volume to the face. Fillers add the volume. They temporarily plump up your face just like fat. The result is that we look younger. A syringe or two of filler usually takes an hour. Therefore, you can be back to work afterwards, if having some swelling and even a little bruising is acceptable. The amount of filler used for the liquid face lift is very important to understand. Fabulous results used to advertise liquid” lunch time face lifts” is usually the results of $5000 – $10,000 of filler. However, even two syringes can make a significant difference and cost in the range of $1300 – $1800, making this reasonable for many people.

                   Do we offer this treatment? Yes, we do!

3. Threading Face Lifts: This face lift is done in the office and uses a technique that weaves thick, thread-like sutures, under the skin and ties them tight, lifting the face. It is expensive and the results may look great at first but are typically gone in a few months. It is a “new” technique now – just as it was “new” in the late 1990’s. It is rediscovered periodically and discarded because results are poor for the cost.

Do we offer this treatment? Yes, we do. I will do a thread lift if a patient insist on it, but first I like to discuss other options that will give you better results for the money.

  

 

Cosmetic Question: I have heard of a new cosmetic treatment called Neubelle for frown lines. Is it still ok to get Botox?

Cosmetic Answer: Absolutely, you can still get Botox, unless you are one of the few people who do not get a response from Botox.

Neubelle is bi-polar radiofrequency nerve ablation, recently FDA approved for treatment of glabellar frown lines (the ‘elevens’ in between the eyes). It is not new, it was earlier sold as Relaxed Expressions by Merz Esthetics.

What is radiofrequency? It is a heat-creating energy wave. The heat from radio frequency can slightly tighten the skin, reduce fat and treat chronic pain.

Neubelle involves a minor office procedure requiring local anesthetic. A needle probe goes through the numbed skin and then a nerve stimulator is used to identify the nerves to the glabella. The nerve is then heated at various points to the temperature of 185 degrees, usually for 14 seconds. This causes a temporary nerve injury and the muscle stops working temporarily.

In the past eight years it is said that approximately 500 patients have had Neubelle to treat their glabellar lines. However, I can only find the PubMed reports for 51 patients:  In a study of 29 patients, a third had significant bruising. In a study of 27 patients, one had a second degree burn of the skin and two had abnormal sensations for several weeks.  In both groups, results lasted a little longer than Botox: four months in 30%, six months in 60% and a year or more in 10%.  But in 2016, a report was published on one patient treated for 70 seconds and it seems to have created a permanent result.

Permanent results sound great but they may not be if you get an unwanted effect. One advantage of Botox is that it wears off. It is usually gone in 3 months and certainly within a year. This is an advantage because balancing facial muscles to get a natural result is not easy. Treating the glabellar muscles (‘elevens’) can make the forehead muscles pull more. Treating the forehead muscles can make the outer brow droop. What if this happens after a permanent Neubelle glabellar treatment? Either you have to live with the look or get Botox to improve it. You may even have to have another Neubelle treatment, which may leave you with a frozen look.

Neubelle , like other radio frequency devices, is going to be useful, but there are problems with all new advances. These problems usually get worked out. At this time it seems useful chiefly for people who do not respond to Botox. Exciting as Neubelle is, Botox remains the safe, predictable, effective treatment for facial lines caused by our over-active muscles.
 

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!

Cosmetic Question: A friend warned me that during menopause, my skin would develop whiteheads. It did. What can I do?

Cosmetic Answer:

Developing acne breakouts during menopause is common. It seems to come from a change in hormone ratios, which changes oil production in our sebaceous glands. The oil thickens, easily blocking tiny pores on the face.  Pores are the openings of oil glands that sit at the bottom of the tiny hairs that cover our facial skin

This is what I recommend:

• Check the labels of your skin care products. Throw away anything that is too old. Make sure the products are oil free.
• Use oil-free or non-comedogenic skin care products, especially moisturizers, sunscreens and even make-up.
• You could use tretinoin cream or gel 2-3 times a week. This is a prescription topical medication that helps keep pores from getting clogged. You could use over-the -counter Retinol but it is not as effective.
• Then see your Plastic Surgeon or other physician specializing in cosmetic treatments and start a series of light, no-down-time peels. I find glycolic peels work well for most women.

Some women actually get acne after menopause. A combination of tretinoin, benzoyl peroxide and topical prescription antibiotics will control it. Your insurance will require pre-authorization for these prescriptions because according to insurance companies, no one over 30 gets acne.

 

Cosmetic  Question:  I had Juvederm in my lips two weeks ago. They still look swollen and feel very chapped. Am I allergic to Juvederm?

Cosmetic  Answer:

No, you probably have an outbreak of cold sores. Cold sores are caused by a virus called HSV-1. So common that it is present in more than half the people in the USA today. Typically lying dormant in the tissues around their lips and mouth.  However, these outbreaks can occur anywhere on the skin.

It is easily transmitted and the HSV-1 virus does not go away when cold sores subside. Instead it rests happily inside the nucleus of the infected cell, causing no problems. Once thought to settle only in nerve cells, it now appears to settle in the cells of our lips as well. If something irritates that cell, the virus is re-awakened, leaves the nucleus and causes another bout of symptoms.

Filler injections are a common way to re-activate HSV-1 infection. Usually you see no sores , just uncomfortable, swollen lips that feel chapped, but the chapping may last for a long period of time and does not improve with lip balm.

The treatment is the anti-viral drug, Valtrex and it needs to be taken for about 5 days. The anti-viral is needed to suppress the infection.  Topical anti-viral creams such as Zovirax, Denavir and Zerese are also used for these outbreaks, but not on the lips because they can cause even more irritation.

So, you probably are not allergic to Juvederm. Especially if five days of Valtrex makes you better, it was a cold sore outbreak.

Cosmetic Question:

The backs of my hands look old with bulging veins. Can fillers be used to make my hands look younger? What is the best filler to use? What is the best way to have it done and does it work?

Cosmetic Answer:

Yes, fillers can be used to hide the visible veins and tendons that appear in time on the backs of our hands. These veins and tendons and sometimes even bone becomes visible as fat is absorbed from the hands. Hand fillers are injected in the office. The filler, Radiesse is usually used.  Radiesse is calcium hydroxylapatite and is FDA approved for use in the hand.  It cannot be dissolved like the fillers made from hyaluronic acid.

Hyaluronic acid fillers (Juvederm, Restylane) can be used but light reflects differently from these fillers. This means they may be visible under the skin. So, Radiesse is preferable.

How is the injection done?

The Radiesse is pre-mixed with local anesthetic. Under sterile conditions, an injection numbs the skin and then a long cannula (blunt needle) is placed just under the skin between two knuckles. The skin is tented up and tiny amounts of Radiesse are placed directly under the skin along the edges of veins and tendons. The Radiesse is massaged into position with each droplet placed. Some doctors use sharp needles and go deeper, but recent anatomical studies show that directly under the skin is probably the ideal place.

How much is needed?

Between 2 – 4 syringes of 1.5 cc of Radiesse or between $1250 – $2500 worth of filler.  How much you need depends on how visible your veins and tendons are and the more they stand out, the more filler is needed. Many people like to start with 2 syringes, one for each hand and if you like the result, you can always have more.

How long does Radiesse last?

It’s visible effects last about 9 months but there is almost always some remaining Radiesse which is usually made of filler and collagen. As time goes by and you have your hands re-done each year, you may find that you need Radiesse less often to maintain your result.

What are the risks of Radiesse hand injections?

These injections will often cause swelling, redness, tenderness and bruising of the back of the hand.  This is usually gone in 3 weeks or sometimes less. In contrast, fat injections to the back of the hands can cause swelling that lasts for many months.

What are the post injection instructions?

You will want to avoid exercise that uses your hands such as horseback riding, hand ball or tennis for 7 to 14 days. The bruising can lead to comments so plan to have Radiesse at least 3 weeks before extremely important social occasions, such as a wedding or a Gala Charity ball unless you are planning to wear gloves.

Radiesse vs. Fat

Although fat can be used instead of Radiesse, it costs more, it causes much more swelling that lasts much longer, it tends to look lumpy and the result depends on whether your tissues can keep the fat alive. It does not make fat a bad choice but Radiesse is a better one.

Cosmetic  Question:  Is there such a thing as a calf lift? I have loose calf skin but I cannot find calf lifts anywhere.

Cosmetic  Answer :  Yes, there are calf lifts. They are not often needed since the skin is thick and the calf muscle bulky.

Common reasons for needing a calf lift are:

• Massive weight loss.
• Calf injury causing the calf muscle to permanently shrink.
• Liposuction of the calf that left the skin permanently loose.

There are two common procedures to ‘lift’ the calf and which procedure is done depends on the extent of loose skin. The 2 procedures are:

1. The small scar calf lift is used if there is excess skin in the upper calf which can be lifted and removed which leaves a scar in the crease at the back of the leg. This is a good approach for moderate amounts of looseness.
2. The long scar calf lift is needed when the skin is very loose and extends down most of the leg. A vertical scar is left after the surgery and goes down the back of the leg. This allows much more skin to be removed. The long and short scar calf lifts are similar in concept to the long and short scar arm and thigh lifts.

Although, everyone would prefer a short scar lift because the amount of skin removed is modest, this will not work for everyone. When there is a lot of loose skin you must do the long scar lift.

Long scar calf lifts take time to heal. In most cases your legs will ache for months. You need to wear knee high compression stockings for at least 6 weeks or more to control swelling. You cannot exercise vigorously for at least 8 weeks. Finally, because of the network of fine nerves that run down the leg, dysesthesias (nerve pain) can last for six months or more.

All that said, for people who need these operations, results are worth the effort because there is no other way to fix the problem.

Cosmetic Question:  What is the best way to care for my incisions after surgery?

Cosmetic Answer:

Most people who have surgery are anxious about how to take care of their incisions. Our bodies know how to heal, so it is simpler than you think. Our job is to not disturb the healing process by doing too much. Here are some common do’s and don’ts.

Things you should do:

• Keep the bandage in place.
• If the bandage becomes wet, stained or loose, ask your surgeon if it can be removed.
• Do not remove any bandages or tapes from your incisions without permission.
• If your skin is irritated or itching in any way (tape and garments can cause allergic reactions) call your surgeon to find out what to do.
• If your sutures are not bandaged, this is often the case for eyelid, nose and lip incisions, a gel or ointment keeps them comfortably moist. For the eyelids, I recommend Lacrilube. For the nose and mouth, I recommend Aquaphor. Both are sold in pharmacies over the counter.
• Most incisions don’t need cleaning. However, crusts of blood or serum may form, this usually occurs in nose surgeries. Very gentle cleaning with a tiny amount of hydrogen peroxide diluted with water may help. Aquaphor and Lacrilube will help the crusts loosen and fall off.
• If your incision becomes red, swollen or extremely painful, call your surgeon.

Things you should not do:

• Do not keep removing the bandage to look at the incision. Incisions need to rest. In fact, research shows that leaving bandages alone for several days causes less infection
• Do not apply any products to the incision such as arnica, scar tape or gel, medicated ointments or vitamin E. These can be irritating to a healing wound and do help healing. They can be helpful 6 weeks after surgery but wait until your surgeon advises you what to use.
• Do not pop a blister. A blister has powerful healing agent. If you form a blister, cover it with Aquaphor and a bandage. Let your surgeon know about it.
• Do not scrub, soak or wash incisions with soap. It is unnecessary and may irritate them.

           If you aren’t clear on what to do, just call your surgeon!