By Carolynn Grimes and Patrick Sullivan MD
ThePlasticSurgeryChannel.com

Upper facial rejuvenation may be something you want to explore if you’re looking older than you feel.

Dr. Patrick Sullivan, a board-certified plastic surgeon and Chair of the Facial Cosmetic Surgery section of the Plastic Surgery Channel says, “whether you’re young or you’re old, you may feel that looking tired or sad is a problem for you at your job, or a problem socially.”

For some people, only Botox is needed to help with lines in the forehead or crow’s feet.  However, Dr. Sullivan says others may need to take a surgical approach.  If you’re bothered by either asymmetrical brows, or the overhang at your brow that crowds in on the eye making someone look tired, you may be a candidate for upper facial rejuvenation. Dr. Sullivan uses endoscopic incisions that are very small and hidden to elevate the upper face.  Sullivan’s main goal is to give the patient a nice shape to their face that looks natural and never surgical or artificial.

After the surgical portion, Sullivan says many patients can really benefit from some of the non-surgical procedures.  “It might be Botox or Dysport for the crows feet, or even Latisse to help enhance their eyelashes. When you put all of these techniques together is has brought about some very happy patients who seem to really love the results,” states Sullivan.

How do I know if I need surgical or non-surgical facial rejuvenation?

According to the American Society of Aesthetic Plastic Surgeons (ASAPS), during your physical examination with your plastic surgeon, your facial bone structure, underlying skin structure, skin thickness, texture, and elasticity as well as the extent of facial wrinkles and folds will be assessed. Your surgeon will use all of this information to formulate a plan to obtain the best outcome for you.

By Carolynn Grimes
ThePlasticSurgeryChannel.com

If you have a drooping jawline or jowls that needs correction, there is a  procedure that uses a patient’s own fat to fill in deflated areas.

They’ll say, “I don’t mind being forty or fifty years old, but I don’t want to be forty or fifty with jowls.” Dr. Patrick Sullivan, a board certified plastic surgeon in Providence, Rhode Island says sometimes this can be a condition that is inherited from your mother or father and there’s very little that can be done about a drooping jawline other than plastic surgery and sometimes weight loss.

Dr. Sullivan is a specialist in facial plastic surgery procedures and says people need to be very careful who they choose as their doctor for plastic surgery. Recently he consulted with a woman in her forties who was left with significant scars along both sides of her face along the jawline. Sullivan says the placement of those scars were not necessary for the result that she was looking for.

Dr. Sullivan uses a lifting procedure that is an extended inner lift with multiple layers, instead of just stretching the skin. He says he also looks at the chin region because often times people will have areas of deflation at the side, in front of the jowl. “These areas start getting more and more deflated causing the chin to look bigger,” says Sullivan, “and filling in this area with fat gives the jawline a smoother appearance.”

Many times he uses a patient’s own fat to fill in behind the jowl to give a better contour to the jawline. This procedure is particularly common in men who want their deflated jawline to look more masculine. For this procedure, Sullivan says, “rather than using a synthetic material that might get infected, if you use your own fat you’re using your own cells, which helps to keep the fat alive.” According to Sullivan, younger patients are the best candidates for this procedure. “We’ve done this in young people who want more of a chin. We put in fat along the chin area and maybe a little liposuction in the neck region to give a more artistic appearance to the lower face so it matches the nice features of their upper face,” says Sullivan. He says, “it’s all about artistic balance.”

Sullivan says the jawline is an area where he can help people of all ages.

“Sometimes it can be a very minimal procedure or it can be a more extensive procedure where we need to remove excess skin.” He says, “we are re-positioning tissue to solve the gravity problem.” Sullivan uses permanent stitches to lift the tissue and reshape the lower face. Using this procedure he brings out the cheekbones which he says “is really their own tissue rather than cheek implants.” Sullivan says “it gives a very nice jaw line with a balanced face that is no longer square but more oval shape, which tends to be much more enhancing in giving them a more natural and youthful look.”

Dr. Sullivan advises patients to bring in photos from their earlier years. “When patients bring in pictures of them in their 20’s, it is so helpful for me to see what they looked like.” He uses the photos as a gauge to help restore what time has slowly changed.

By Carolynn Grimes
ThePlasticSurgeryChannel.com

Plastic Surgery is often needed after massive weight loss

If you’ve been left with sagging skin and tissue due to weight loss, aging, child birth and pregnancy, a lower body lift procedure may be for you. The lower body lift is an operation that combines a tummy tuck with a lifting of the outer thighs and the buttocks.

Dr. Peter Rubin, a board certified plastic surgeon and leader in the the field of body contouring after weight loss says, “This operation is very effective for patients who have lost a lot of weight either after weight loss surgery or just their natural dieting and exercise.” Rubin says, patients can expect a very dramatic change with the lifting of the outer thighs and the buttock combined with a shaping of the tummy or the abdomen. “This combination procedure works very well to shape the whole lower body in one stage. Of course, it’s a bigger operation, the recovery is longer, and there’s always a bit more risk associated,” he says.

Dr. Rubin states because of the higher risks, you want to get properly evaluated by a board certified plastic plastic surgeon who has experience performing lower body lift procedures. He says, “At our center in Pittsburgh, we focus very much on safety as we evaluate our patients to make sure we’re matching the right operation to the right patient.”

Before a lower body lift, patients should be close to their ideal body weight

When is the best time to have the surgery? According to the American Society for Aesthetic Plastic Surgery (ASAPS), “The lower body lift should be performed when the patient is as close to their desired or ideal body weight as possible. If, for example, the patient has tightening of their lower body and then loses weight, the tightened skin will loosen and become saggy.  Conversely, post operative weight gain will either stretch the skin which has been tightened or undo the improvements of the body lift.”

Patients who might be a good candidate for a lower body lift:

1. Patients who have had massive weight loss
2. Loose skin in their buttocks and back of thighs
3. Loose skin in their hips and side of thighs
4. Loose skin in the front of their thighs
5. Loose abdominal skin or in their inner thighs
6. Acceptance of scars around the waist

By Carolynn Grimes
ThePlasticSurgeryChannel.com

It’s a serious question to consider because many women find after having surgery they wished they had gone either a little bigger or smaller.

Dr. John Gross, a board certified plastic surgeon from Pasadena, California, says the size and type of breast implant you choose should be a decision made between you and your surgeon based on the patients size and existing breast tissue.

Fortunately, says Gross, “the options for breast augmentation and the devices (implants) available have markedly improved over the last decade.”  According to Dr. Gross, there are currently two implants approved by the Food and Drug Administration (FDA) which include saline and silicone filled implants both with a silicone outer envelopes.

Gross points out, that there’s a third implant available not yet approved by the FDA, but may be a great option for some patients.

It’s a highly cohesive gel that’s called style 410, referred to as the Gummy Bear implant. “Where it may have particular advantages is with patients who are very thin in their breast tissue, yet want a very natural result,” says Gross.  “Because of its shape and the fact that it tends not to wrinkle or ripple as much as some of the other devices, it may be a great option” says Gross.

Gross says when explaining the decision making process to patients, you’ll hear him frequently use the word, trade-offs.  He says, “all the choices whether they are saline filled, traditional silicone gel filled or the style 410 gummy bear, they each have different benefits.”

According to Gross you should carefully consider your options following a thorough examination and consultation with a board certified surgeon.  Dr. Gross say’s he encourages all his patients to take as much time as they need to think it over.  “When the patient has had time to absorb the information, discuss options with a friend or family member and come to a solid resolution they feel more comfortable moving forward.” He also supplies his patients with detailed information and encourages them to check out his web-site to help answer all their questions.

By Carolynn Grimes and  Peter Rubin MD
ThePlasticsurgeryChannel.com

Sagging skin and plump thighs are among the more common aesthetic concerns for women. Age, gravity and weight loss are the usual culprits according to board certified plastic surgeon, Dr. Peter Rubin. He says, “there are operations that will correct those issues, including thigh lift operations.”

A thigh lift reshapes the thighs by reducing excess skin, and in some cases fat, resulting in smoother skin and better-proportioned contours of the thigh.

Dr. Rubin is director of the Life After Weight Loss program, a clinical center at the University of Pittsburgh dedicated to the care of patients after weight loss. Dr. Rubin says there is usually a lengthy scar involved in this procedure and “the patient needs to realize the scar is in exchange for the removal of excess skin.”  According to Rubin, there are some versions of these operations where the scar can be minimized.  He says, “you may qualify for a minimal incision medial thigh lift which involves an incision only in the groin area.”

The timing and planning for one of these procedures is critical and many patients are excited to have some of their loose skin removed after weight loss.  One of the first questions many patients ask is, “when is the right time for a body contouring procedure?”

Dr. Rubin says a patient should ask themselves the following questions:

Has my weight been stable for the last three months?
Have I reached or am I close to my goal weight?
Am I committed to the lifestyle changes that are going to help me be successful with long-term weight loss success?

Once a patient feels the timing is right for surgery, patients need to know that recovery from a thigh lift can be fairly extensive.

Rubin says, “these are major operations and recovery time has to be accounted for when you’re planning for these procedures.” “Each operation is tailored to an individual’s specific body type,” says Rubin, “and your surgeon will determine what’s appropriate.” Dr. Rubin advises that these operations should be performed by a board certified plastic surgeon with experience in patients who have lost a substantial amount of weight.

By Carolynn Grimes
ThePlasticSurgeryChannel.com

What causes the breast and other areas to sag?

It’s estimated 200,000 people underwent gastric bypasses and gastric bindings in the United States last year. Many of those patients were left to deal with excess skin and tissue following their extreme weight loss.

ThePlasticSurgeryChannel’s Dr. Peter Rubin is the director of the Life After Weight Loss program, a clinical center at the University of Pittsburgh. He is also the lead author of the body contouring medical textbook for plastic surgeons, Aesthetic Surgery After Massive Weight Loss (Elsevier Medical Publishing, 2006). According to Dr. Rubin, plastic surgery after weight loss is the fastest growing area of plastic surgery.

Dr. Rubin and his staff have developed a new procedure in body contouring to help reshape the breast.

According to Dr. Rubin, “We see very dramatic changes in the breast after weight loss, including loss of natural breast volume and a very troubling bra roll that can form.”  Dr. Rubin says “Using the patient’s own tissue we create an internal brassiere that better supports the new shape of the breast.” Additionally, tissue from the side of the chest is used to both increase breast size and eliminate extra skin alongside it.

Rubin says, “This procedure can be very effective in achieving dramatic changes and positive results for our patients. However, it’s more extensive than a traditional breast reshaping procedure and can involve longer scars.” Dr. Rubin says the procedure is a new field in plastic surgery and may not be for everyone. Patients should always discuss their options with a board certified plastic surgeon.

I have done Ulthera for neck 7 month ago and for cheeks – 3 month ago. I really do not see any difference , I have compared the photos before and after. Should I do second treatment for notable result or decide to go for a plastic surgery instead? I am 35, and I have no overweight.

I will be very happy for any answer! Thank you !

By Carolynn Grimes
ThePlasticSurgeryChannel.com

William P. Adams, Jr. MD, a board certified plastic surgeon from Dallas, Texas will conduct what a  refined breast augmentation technique that includes fast-track 24 hour recovery.

The surgery demonstration is taking place in Atlanta, Georgia at the 28th Annual Breast Symposium.  The purpose of the surgery is to teach his colleagues a precise way of doing a breast augmentation that leaves the patient with less trauma, relatively no downtime and a very natural looking result. Adams says, “This teaching demonstration will show how to refine the procedure and improve patient outcomes.”

The patient involved in the surgery is Cari Murray, a 35 year-old Texas mom who says she can’t wait to see her body restored back to the way she used to look before children.

Murray says, “I chose Adams not only because of his fast track 24 hour recovery, but also because of his professional demeanor during our consultation.” Murray says what appealed to her was the open communication and being able to determine exactly what she wanted in her breast surgery. She’s looking for a natural looking breast that fits her frame without being too big or too small.

As she waits for the surgery, Murray seems optimistic and upbeat, eager to see her new self.  It’s typical for Adam’s patients to either go back to work, go shopping, or just go through their normal activities on the same day of the procedure, without narcotics.

Tune in tomorrow to ThePlasticSurgeryChannel.com to see the actual surgery procedure taking place and the outcome for Murray as she goes from surgery to recovery.

Will I have scars after plastic surgery? Scars are a fact of any surgery, but new treatments can be used to minimize their appearance. Some people think twice about plastic surgery when they realize they could be left with permanent scarring.

Patient’s say Don’t Put Off Plastic Surgery For Fear of Scarring

Susie McAuley, a breast reduction patient from Dallas says she put off the decision to have surgery out of her fear of scarring. Susie says, “Making a decision to go in for plastic surgery on my breasts for a reduction was huge for me; very emotional because I knew I had to be cut open to get that done.’” Susie’s fear of scarring isn’t uncommon, in fact some patients delay or put off a surgery altogether due to those fears.

Fortunately surgeons say with new advances in scar therapy, patients have options. Dr. Lee Thornton, a board certified plastic surgeon, says not all patients heal the same way. He says while most people heal just fine over time, other patients can experience problems. Thornton says,
“This happens when scars are under tension or due to genetics. When scars start to have problems there are different options we can use such as silicone topical gels and silicone sheeting.”

Silicone Used to Heal Patients With Severe Burns Scars

Silicone was initially used to heal burn patients and doctors quickly saw the benefits. Dr. Bill Adams, a board certified plastic surgeon with ThePlasticSurgeryChannel.com says silicone based creams and gels are gaining popularity as the single best option for healing most types of scars. Adams says the reason silicone is effective is because it provides the hydration necessary for healing.

Susie says her scars aren’t noticeable anymore at all, and says it’s because of scar therapy prescribed to her by her doctor.  She says, “I should have gone in 10 years earlier.  I think the fear got the best of me because the scars heal; just like everything, life heals, we heal.”

Doctors say silicone treatments combined with time and using a daily sunscreen on scars is the best remedy for healthy, quick healing plastic surgery scars.