Author: Morgan Cosmetic Surgery

Question:  How soon will I heal after a lip lift?

Answer:

This is an excellent question because some people heal very easily and quickly. For other people, it may take a bit longer.

Everyone who has a lip lift will have at least a week of uncomfortable lip swelling. It is a strange feeling – the lip feels stiff and unnatural. Smiling feels odd, and your lip isn’t as flexible when you talk. You need to eat soft food and you feel self-conscious. There may be some bruising.

Sutures come out after 5-7 days. If you can’t return to your surgeon to have the sutures removed, you need to find someone else to remove them. Why can’t absorbing sutures be used on the skin? When the white lip is sutured with absorbing sutures, healing is slower and the scar stays red for much longer.

For many people, after a week, things have settled down, although there is still some swelling.
For other people, the lip may feel tight and uncomfortable and look noticeably swollen for another week or so.

During the first 6 weeks after a lip lift, you need to conceal the incision with make-up. The incision will be firm, pink or red, and often looks quite irregular. Things improve a lot after 6 weeks. By six months for almost everyone, the scar is a faint line at the base of the nose and sometimes is invisible.

I have had a few recent lip lift patients who didn’t heal as expected – their bodies rejected the internal support sutures I have always used for lip lifts. This delayed their healing for weeks. Yet these internal sutures are the latest, most expensive sutures, designed to dissolve at exactly 6 weeks when the scar has its maximum strength. They are excellent sutures and I have not seen similar reactions in other areas of the face. So it is a reaction that I cannot explain but it has convinced me that for easy healing after a lip lift, be sure that your surgeon does not use internal support sutures.

This is truly a lovely little operation that can make a big difference.  Watch in this video as Dr. Morgan explains lip lifts and all you need to know about the procedure.

https://vimeo.com/145666873

Question:  I don’t understand what a capsular contracture actually is. Can you explain?

Answer:
With pleasure. Whenever you have an implant in your body, your tissues set down a thin layer of tissue between the implant and your living tissues. This is called a capsule.

If the implant irritates your tissues in some way, your body reacts by thickening the capsule.  Often it is something called a biofilm, where bacteria live the capsule, but don’t create an active infection.  There are, however, many other causes of irritation.  A body cell, called the fibroblast, does the thickening by laying down more and more healing protein. The fibroblast can then become a myofibroblast – this means it becomes like muscle and starts to pull on the scar. (It is the body’s natural way of making scars as small as possible.)

When the scar is inside your body, the effect is to shrink and thicken the capsule until the implant is too big for it. This causes you pain and makes the implant look abnormal, and the capsule needs to be removed.  Of course, capsular contractures can have many different appearances and can be many different thicknesses and sizes.  Smaller thinner ones need only to be released, and not removed.

 

 

Question:  I am very pain sensitive – the regular topical anesthetic isn’t strong enough for me when I get Botox.  Is there anything stronger?

Answer:
Yes, there are much stronger compounded topical anesthetics, but they are used with caution.  Here’s why.
Lidocaine 4% is the standard topical anesthetic – and it works for most people if left on for 20 minutes.  Lidocaine is an amide form of topical anesthetic.
The stronger topical anesthetics are mostly esters – you may know them as tetracaine and benzocaine.  They are stronger, but more likely to cause a rare but severe reaction called methemoglobinema.  What happens?  The compound attaches to your blood so you cannot absorb oxygen.  It is estimated to happen once in every thousand people – rare, but enough to be riskier than amide topical anesthetics.
Because the risks are higher in children, these topical creams should never ever be used in children.
Ask your plastic surgeon if s/he has or can order for you an extra-strong topical anesthetic – these are usual available through compounding pharmacies.  However, if you have any history of allergic reactions or if methemoglobinema runs in your family – please don’t try it!

Question:  What is skin needling?  Does it really work?

Answer:
Great question.  Skin needling is a skin repair and rejuvenation treatment that punctures the outer skin with tiny needles.  This makes the skin create new collagen (the essential skin and healing protein).  In turn, this can help to fill indented scars and rejuvenate the skin – making it thicker, smoother and more youthful.

When did it start?  It is a 600-year-old time-tested Japanese esthetic technique that began as an off-shoot of acupuncture.  Japanese microneedling uses a smaller needle and more superficial skin penetration than Chinese approaches.  The development, in the USA, of machines to do skin needling has made it popular.
Is there any scientific evidence that it works?  Yes – unlike many new and widely promoted office skin treatments, medical-grade skin needling has been studied for more than a decade.  There have been studies comparing microneedling with spot TCA and they appear to work equally well.  Studies have also been done with PRP (platelet rich plasma) and microneedling with or without PRP.  So far, PRP doesn’t seem to improve the results.

What is involved?  Dr. Morgan tries out new treatments whenever possible, before recommending them to patients.  She selected the SkinPen – because it is a medical grade machine and comes with a sterile needle kit, so needles are never reused, unlike with other brands.  It is battery operated so it is flexible and can treat any area of the face.  This includes the eye lids.  It has a skin-depth gauge that can be adjusted to different areas of facial skin.  It also has 12 very small (32 g) needle points – other machines have 9 or fewer needles and larger needles.  The smaller the needle, the less the risk of the tiny, superficial punctures leaving scars.

Dr. Morgan tried it with no topical numbing and a deeper than normal depth to see the treatment at its most aggressive.  She chose her forehead, a sensitive area.  She had the standard 2 skin passes plus a third pass over specific areas.  Did it hurt?  Yes, a little, but not enough for Dr. Morgan to want numbing cream.  (We do recommend numbing cream for most people and it is included in the treatment kit, so there is no extra charge.).  The treated area was red, particularly in the areas treated with 3 passes.  The healing skin was covered with the healing serum.  It made a difference, healing quickly and comfortably.  After 3 days, she was completely healed with photos to prove it.  Most people would be healed in a little less time.

How many treatments are needed?  You need to plan on 3 treatments, usually 1 month apart.  A yearly maintenance is probably a good idea. Some people have monthly skin needling because it makes a significant difference in maintaining their skin.

Do you have to buy special care products as well?  No – the healing serum in included in the price.  You do need to avoid certain skin care products, (those with sodium laurylate, parabens and others) but there are no additional ones you must purchase.  There is an optional mild skin rejuvenation kit which you can purchase if you are looking for a very gentle skin care program.  Again, it is gentle and designed for sensitive skins.

Who should and should not have skin needling?  It works well for superficial acne scarring, and it may help with some “ice pick” acne scarring.  It definitely stimulates collagen production in the aging skin.  It appears to be safely used on all skin types – although a test treatment is reasonable for anyone with a dark skin (there is an additional cost because it involves an additional sterile needle).
Dr. Morgan has noticed that her microneedled skin is smoother and brighter than the untreated skin and of even more interest, her standard Obagi skin care products are more effective on the microneedled skin.  It has been proposed that microneedling allow skin products to be better absorbed and thus more effective.  At least for Dr. Morgan this seems to be the case.

Can PRP (platelet rich plasma) be used with microneedling for a patient who wants that done?  Yes, but it adds considerably to the cost, because the PRP has to be prepared before the microneedling.

For very damaged skin, the microneedling might not be aggressive enough because improvement is subtle.  But for a minimal recovery, scientifically proven skin treatment for superficial scars and aging, it truly does appear to be a significant advance.  This is the reason that Dr. Morgan decided to introduce it into her practice and to provide her patients with the best designed and most advanced machine available.  To learn more about microneedling and to see Dr. Morgan get a Skin Pen treatment, watch these videos:

https://vimeo.com/151687918

1. With the growing range of dermal fillers now available, how often are you performing cheek, chin and/or temporal implants vs. filler injections?

Filler injections at the moment are much more common, because they are less expensive at first and done in the office.  However implants are, over time, less expensive and permanent.  Now that people are learning the limitations of fillers, there is an increasing demand for implants, which are a permanent solution.  Surgeons have learned an enormous amount about implants and the technology of implant manufacture has made huge advances.  These implants are in many ways, the ideal fillers for changing the shape and volume of the face.

2. Are there specific patient groups or concerns that would lead you to select an implant rather than a filler or fat grafting to replace volume in the mid face or temples?

Yes.  The issues are – risk, how much volume is needed, and whether or not filler has been disappointing.

Risk – we know the mid and upper face are a high risk area for fillers, fat injections especially.  So for the temple and areas under the eye, I recommend implants at the start and off-the-shelf, absorbing fillers as a second option.

Volume – young people with slight changes may do well with fillers.  However, with age or significant volume loss, I recommend implants.

Disappointing filler results – if fillers cost too much (meaning over time, since fillers are not permanent, the cost adds up), results are disappointing or the person is allergic to them, implants are needed.  The manufacturers of fillers show amazing results in their before/after photos – and these results are real. But you may need 7 – 10 syringes of filler for these results, which is $5000 – $10,000 for filler lasting 9 – 24 months. So naturally for this kind of result, a permanent implant makes good sense.

3. How do you secure the implant to ensure it stays in place? Are there any specific recovery instructions provided to patients to optimize outcomes?

Securing the implant depends on where it is placed.  Temporal implants and most chin implants do not need fixation – the bone contour holds the implant in place.  Cheek, jaw and mid-face implants usually need a tiny metal screw to keep them in place. After having implants, you are sore and swollen noticeably for about 5 days – and may be bruised.

4. Are there specific materials (i.e., smooth v. textured or silicone v. Gortex) that you prefer for your facial implants?

We have a number of excellent implant manufacturers in the USA, but I prefer the smooth, soft silicone Implantech Contour implants.  These implants can be lined with Gortex, but the main implant material is soft solid silicone.

5. Are there any areas that you feel would benefit from a new facial implant or any implants on the horizon you are interested in learning more about?

We have an excellent range of facial implants today – and for unusual situations, custom implants are available.  Custom implants are expensive but are computer-created using your own CT scan, making them very precise. So almost any problem can be addressed with our technology today.

In the video below, Dr. Morgan talks about facial implants and how they can help you.

https://vimeo.com/141420760

Question:  Fat injections to my buttocks didn’t last so now I want buttock implants.  Is it better to go in the muscle or over it?

Answer:
Buttock implants look better and stay in position better if they go inside the muscle because –
• The muscle supports the implant, so it doesn’t droop and
• The muscle fights off infection so you are likely to heal better.

Large implants won’t fit in the muscle, so implants need to be 350 cc or smaller.  Therefore, larger implants need to go over the muscle, but there are two problems with this approach –
• You are more likely to get an infection and
• Your implants are more likely to droop or move to the side.

Usually it is better to have a smaller implant that doesn’t cause problems than a large one that does!

Putting implants in the muscle takes time during surgery. Unlike other areas where we put implants, the buttock muscle has no natural space for the implant.  Your surgeon has to carefully cut through the muscle fibers themselves to make space.

You will hurt a lot after surgery.  Exparel, a long lasting local anesthetic, can be injected directly into the muscles at surgery to reduce the pain.  It is expensive, usually adding about $1000 to your cost.

Your buttock implant incision, whether over or under the muscle, is the same.  One incision is used for each implant.  These incisions are hidden on the side of each buttock.

Remember to allow enough time for recovery.  You will need to set aside at least 3 weeks because –
• No sitting is permitted at all for 3 weeks – this means no driving, no work at a desk, nothing.
• No housework for 4 weeks.
• No exercise for 8 – 10 weeks.
• And lots of rest during the first 3 weeks, with frequent showers and careful attention to hygiene to reduce your risk of infection.

Buttock implants have advanced a lot in recent years.
Give us a call if we can help you decide if they are right for you.

Question:  My saline implants deflated three months ago.  How easy is it to have them replaced?

Answer:
If your saline implants truly just deflated, it may be possible to remove and replace them in the office.  However, it may not be ideal if they deflated more than a few weeks ago.  You will need surgery in the OR to remove and replace them.  Why?  Your body naturally shrinks around a deflated implant, therefore, the pocket won’t be large enough to replace your implant.

But wait – there’s more!
Although saline implants have a valve that in time, tends to malfunction causing the implant to deflate – your deflation may be caused by a capsular contracture.

What difference does this make?  A lot!  A capsular contracture happens when the implant irritates your tissues – irritation starts a process of scar thickening and shrinking, making your implant pocket smaller.  This shrinkage puts pressure on the implant and can force the valve open so your implant deflates.  This shrinkage continues – so if you have a capsular contracture, your new saline implant will be too large for the shrunken pocket.

If during an exchange of saline implants in the office, your surgeon finds a capsule around your deflated implants, you have a choice –
• Remove the old implant and stop – scheduling an operating room capsulectomy and pocket revision with new implants or
• Put in new implants and partially inflate them – scheduling an operating room capsulectomy and pocket revision with the same implants, if possible.

Some women don’t have the time or money to go through this – if you are in this position and your implants deflate, it is wiser to have the implants removed completely.  Later you can have new implants, pocket revision and capsulectomy, when time and money allow.

Question:  I have a deep vertical up-and-down line in my cheek.  I have tried filler.  It just made a ridge.  Is there anything I can do about this?

Answer:
Yes, filler tends to be disappointing for this area.  The lines are usually caused by muscle so filling the skin is not typically effective.  This leaves you with two options – the easy office option and two surgical options.
The office easy option is to have a little Botox injected in a few places along the line.  This will not make it go away completely, but it will usually improve a lot.  If you also have tretinoin-based skin care, it should help by improving and thickening the skin.  Botox needs to be done every 3 months at first, and then after 2 years, maybe only twice a year.  Skin care is important to maintain – it’s a little like brushing our teeth.  Skin, like teeth, needs maintenance.
The surgical option is a face lift.  If you need a face lift, during the surgery your surgeon can lift the facial skin far across the cheek, lifting the deep line off the muscle below.  Since these lines tend to be half-way across the cheek, this may leave more bruising than usual but should correct the line.
If you have a lot of deep, facial lines or if you don’t need a face lift, a full face CO2 resurfacing laser or Hester phenol-croton oil peel – also done in the operating room, may be a better option.
Just give us a call is we can help.

Question:  I am told I have tuberous breasts. They certainly are misshapen. How hard is this to correct?

Answer:
It totally depends on the severity of your breasts’ shapes.

Tuberous breasts are a totally normal breast variant – only the breast shape is unusual. There is nothing wrong with the breast function or breast tissue. However, the shape can be odd enough to make any woman self-conscious about her appearance.

Changes seen with tuberous breasts include –
• Very wide areolae
• Puffy nipples (because the breast pushes out into the wide areolae
• A tight or short lower breast – this gives the breast a tubular or torpedo shape.
• One or both breasts smaller than normal.
• Asymmetric breasts – with one much larger than the other.
• Drooping of one or both breasts.

In some women, the changes may be very subtle. For instance a woman may have slightly wide areolae which don’t bother her and a slight tightness in the lower breast. She may only want (and need) breast implants with release of the tight breast tissue from inside during surgery.

In other women, all six shape changes may be present and severe. Surgery must be carefully planned to correct each change to produce the prettiest possible result.
This might include –
• Reducing the areolae (this reduces the puffiness under the nipple),
• A vertical lift of the droopy breast,
• Reducing the size of the droopy breast,
• Releasing the tight breast tissue in both breasts and
• Placing breast implants in both breasts for better size and more natural shape.

When the two breasts look totally different, surgery can be challenging – so careful analysis of the differences and planning of their correction is very important.

Be sure to sit down with your surgeon, look at photos of your breasts and discuss what steps are needed for you to get the prettiest possible result and as close to your “wish look” as possible.

Question:  I had Voluma injected six months ago.  I got the flu – now I have a lump over the Voluma injection.  Can this be treated?

Answer:

Yes, this is rare, but it can happen.  How rare?  One study estimates it as once in every 500 injections.
What happens?  The tissue around a filler becomes inflamed, usually because you develop an inflammatory condition such as flu or some other infection.  The swelling is usually temporary, and subsides in 6 weeks.  If the swelling is severe or it does not subside, it can be treated.

What are the treatments used to fix this?  Either an injection of hyaluronidase to dissolve the filler or an injection of steroid to stop the inflammation are the usual treatments.  Steroid pills are also effective, they have significant risks and side effects – including making some people feel paranoid and intensely anxious.  In our opinion, steroid pill treatment is best only for truly extreme reactions.

If you have a post-injection inflammation after Voluma or another filler and you want to be checked or think you need treatment, just give us a call.  We’d be happy to help you.