A Board Certified Plastic Surgeon in Scottsdale
Reviews
Restylane-L™ and Perlane-L™ now available with lidocaine for patient comfort.
01 year ago
Patient receives a full correction with Restylane™ in the
nasolabial folds. Photos courtesy of Medicis.
Restylane™ injections in Scottsdale, Arizona.
Scottsdale – Our patients have responded positevely towards the Restylane-L™ and Perlane-L™ treatment regiments for reducing the wrinkles around the mouth. These new products contain lidocaine which helps reduce the pain before and after the injection. Joni Roney has been injecting dermal fillers for patients by themselves or with Botox® or Dysport™ on her Scottsdale Botox® Days. Check out Joni’s event schedule for Scottsdale Restylane™ injections.
Restylane-L™ and Perlane-L™ data shows improvements in patient comfort.
- 72% of patients treated with Restylane-L™ reported at least a 10 mm reduction in pain score vs Restylane™ at injection.
- 95% of patients treated with Perlane-L™ reported at least a 10mm reduction in pain score vs Perlane™ at injection.
- Pain assessment showed a statistically significant improvement with Restylane-L™ and Perlane-L™ vs Restylane™ and Perlane™, respectiveley, at all time points.
Learn more about Restylane-L™ or Perlane-L™
Restylane™ Regimen chart showing wrinkles
around the mouth area (laugh lines) improvements up to 18 months.
Restylane™ Regiment can last up to 18 months.
In the latest clinical study the Restylane™ Regimen for at least 95% of patients saw results for up to 18 months. Learn more about the Restylane™ Regimen.
Smoking doesn't Mix with Plastic Surgery.
1Scottsdale – What does smoking actually due to you during plastic surgery? Well, here’s a not-so-easy answer.
Cigarettes have nicotine. Nicotine closes the blood vessels responsible for bringing oxygen and nutrition your tissues. Cigarettes have cyanide and that is toxic to your tissues. Cigarettes have arsenic, and that is another poison. Cigarettes also have cadmium, formaldehyde, pesticides and benzene. All of these substances are very bad for your body.
Oxygen is really good for you! In addition to blocking oxygen, cigarettes, reduce your body’s healing power. Oxygen also fights infection and keeps tissue alive. When the blood vessels are open, important medications like antibiotics are more easily delivered. Smoking before and after anesthesia can increase the risk of pulmonary infection such as pneumonia. Smoking during cosmetic surgery can also increase the risks of clots in the lungs.
This is why patients who smoke, have higher risks when they have plastic surgery.
Plastic surgery always entails some level of risk to your health. Smoking greatly increases those risks. Non-smokers enjoy better and longer lasting results, quicker recovery, and less risk.
Plastic Surgery 101.
0Scottsdale – In our continuing efforts to educate patients, we are beginning Plastic Surgery 101 on our blog. Were going to deal with terms in plastic surgery. Here are 10 important terms to learn:
Abdominoplasty: A surgical procedure performed to flatten your abdomen by removing extra skin, fat, and tightening the muscles in your abdominal wall. This procedure is commonly referred to as a tummy tuck.
Acne: A skin condition characterized by the excess production of oil from sebaceous glands which become plugged.
Acne scar: This is a skin condition in which scars occur due to severe acne. Deep pits to scars that are angular or wavelike can occur.
Age spots: These are small flat pigmented spots that are most often seen on areas of the body that have been exposed to the sun over a period of years. Age spots usually occur in the hands and face, especially after the age of 40.
Albinism: An inherited disorder in which there is no pigmentation in skin, hair or eyes. This is due to the absence of melanin, the substance that gives your skin its color.
Alopecia: The partial or complete loss of hair.
Azelaic acid: A naturally occurring substance that can be used in skin care products.
Benzoyl peroxide: An antibacterial medication used to treat the bacteria which aggravate acne.
Blepharoplasty: A plastic surgery procedure that reduces bagginess from lower eyelids and raises drooping upper eyelids. Also known as an eyelid lift, the procedure involves removal of excess skin, muscle and underlying fatty tissue.
Breast augmentation: A plastic surgery operation designed to enhance the shape and size of the breasts.
3 Plastic Surgery New Year's Resolutions….
02 years ago
1. Consumer plastic surgery book review: There are many good plastic surgery books created for consumers. Which are the good ones? Well, we plan to review the lot of consumer plastic surgery books. We will write our reviews on the blog as the year progresses.
2. Introduction of the Video Blogs: We are working hard to bring video to the blog. Stay tuned to hear about new ideas in all aspects of plastic surgery.
3. More information: Based on our experience, we find that consumers still are not getting the information they need. Many new ideas have crossed my desk. All of the ideas being considered are designed to educate the public on plastic surgery and all the options available. Our resolution is to bring these ideas to fruition.
Plastic Surgery after Major Weight Loss: Dermal Suspension Breast Lift.
02 years ago
Getting your new body after major weight loss.
Scottsdale – The popularity of gastric bypass and lap band surgery continue to rise. As a result, patients continue to seek plastic surgery after major weight loss. The breasts are one part of the anatomy which requires special attention in women after the weight comes off. Several techniques have been developed to deal with the breasts in these situations. However, very little has been published on the safety and efficacy of these techniques. For the blog, I am discussing an article which uses a innovative technique with very good results and low complications.
Breast deformities after weight loss vary significantly, but many patients report the classic changes with deflation of the breasts, medial localization of the nipple-areola complex and lateralization of the breast roll. The article published in Plastic and Reconstructive Surgery, reviews how the technique is performed, including the key steps, while summarizing the experience with this technique in 91 patients over the follow up period.
The technique is different from other breast lift techniques in that it uses several dermal flaps to raise the position of the entire breast gland and nipple complex. In fact, the central gland is elevated first and sutured higher via the dermal flap to the lining of the 2nd rib in the center. Then a medial and lateral flap is elevated and used to give the breast a round shape. Extensive dermal suturing is performed to reshape the gland even more to establish the desired shape. The standard anchor pattern is used for the surgery.
I have used this technique since it was originally published in a previous article, but was glad to see a well performed review. The breast related complications were only eight and included seroma (3), wound separation (3) and skin flap necrosis (2) of the T junction. In this series, most of the breast patients had other procedures performed including body lift, thigh lifts and arm tucks.
The before and after photos in the article are impressive and demonstrate that the upper pole can be maintained over the length of the follow up period. The authors concluded that implants are not necessary to achieve a good breast shape and nice upper pole volume in patients after major weight loss. On the other hand, 17 additional patients had breast lift with implant placement. This second group of patients had a statistically lower body mass index at the time of surgery. This suggests that, in this second group, the breast were more emptied out and required volume addition via the placement of the implant.
In my opinion, dermal suspension is a useful technique that is ideal for treating major weight loss patients which can be carried out safely with low complication rates.
For more information on Scottsdale breast augmentation surgery and breast lift in Phoenix go to www.bellabreast.com
Caution: Fat Grafting to Lower Eyelids, why I don't do it.
02 years ago
Scottsdale – Fat grafting is a popular procedure for rejuvenation of the face and contour improvement in the face and body. I have used fat grafting for the past 8 years to compliment my facelift technique and for body contour improvement. I recommend fat grafting for many conditions except in breast augmentation and eyelid rejuvenation.
A recent article in Aesthetic Plastic Surgery reviews the potential complications which can result from fat grafting to the lower eyelids. The study presents a single case where a patient received fat grafting to the lower eyelids 5 years before consulting with the senior author of the article. The patient had the initial procedure in Germany and experienced a deformity of the eyelids at the time. According to the patient, she had a second fat graft procedure in an attempt to correct the deformity created by the first procedure. The result was worse and as time passed the patient became increasingly dissatisfied with the appearance of her eyelids.
The patient presented for correction and a surgical lower blepharoplasty approach was used. The fat graft was viable after 5 years and was located in a non-anatomical location between the skin and the orbicular muscle. Interestingly, there was no need to remove any orbicular fat. All the fat graft was successfully removed. The total volume of fat graft removed was 1.2 cc from the right and 1.8 cc from the left eyelid.
This case illustrates a couple of important facts about fat grafting. First, fat grafting like all other plastic surgery procedures can be associated with complications and may even require re-operation to obtain a better outcome. Second, fat grafts are more likely to be problematic when the fat is placed superficially where it is more likely to create contour deformity as shown in this case. In the eyelid, because it is so anatomically thin, the margin for error is very low, as there is a good chance some of the fat graft could end up in a shallow location. There are very good surgeons who can avoid this complication, but I have seen this exact complication in many patients even in the hands of experienced clinicians. For eyelids, I believe that standard blepharoplasty techniques are more predictable than fat grafting.
I am a proponent of fat grafting when I can place it deeply. Fat grafting can be performed safely and can be successful in achieving aesthetic goals. When I perform fat grafting to the face, for instance, I use a low pressure injection technique with very small volume placed per injection. The article points out that inappropriate injection technique has likely contributed to the very serious complications of fat grafting previously reported by other authors.
A Comparison of popular Short Scar Facelift Techniques.
02 years ago
Facelift Surgery
Scottsdale – Short scar facelift is very popular among younger women seeking facial rejuvenation. The procedure has several advantages including reducing the length of the scar. With this procedure, the scar is limited to an area front of the ear and patients avoid an extensive scar in the hairline behind the ear. Additionally, short scar facelift is performed with less surgical dissection and is noteworthy because patients experience less pain and swelling and a faster recovery with minimal bruising.
Several short scar techniques have been developed. The two most popular include the Minimal Access Cranial Suspension (MACS-Lift) and the Lateral SMASectomy techniques. An article has been published in the journal Plastic and Reconstructive Surgery, which examines these two surgical options and gauges the outcome at 1 month and 24 months after surgery. The researchers enrolled 97 patients who had short scar facelift using either of the techniques mentioned earlier that were followed for a total of 24 months.
The results of the study demonstrated that MACS-Lift takes significantly less time to perform when compared to Lateral SMASectomy. Patients after Lateral SMASectomy experience significantly less pain than those having MACS-lift. There was no statistical difference in the aesthetic outcome of the operations at 1 and 24 months after surgery between the two techniques. At 24 months some patients had recurrence of the jowling and did not appear as improved in the neck area.
It is not unexpected to see some laxity in the neck after short scar facelift. This area does not respond particularly well to the short scar techniques which are designed to treat early aging signs in the face, but generally do not treat serious laxity in the neck. When a patient requires more lift in the neck I prefer to use a full facelift technique which addresses the neck issues better. The results of the study are impressive, however, and the before and after photos in the article show some very nice results of the surgery.
The article is important as it attempts to identify how long the results of short scar facelift results actually last. More research will be needed to see the actual time the results will last, but given the findings it is likely that short scar results do not last as long as results from full facelift techniques. What is important to note from this article is that the techniques are comparable with regards to the results and low level complications.
I have used both of these techniques and have been happy with the results. I find that patients do well regardless of technique and have a nice aesthetic improvement (model used in illustration).
Plastic Surgery after Major Weight Loss: The Extended Abdominoplasty.
12 years ago
Plastic Surgery after Weight Loss.
Scottsdale, AZ – Many patients with major weight loss request body contouring to improve the shape of their body. The most accepted procedure for contouring in these patients is the body lift. However, many patients shy away from body lift because they believe the procedure is too aggressive, carries higher risk, and is too expensive. Other options exist that patients should know about.
The extended abdominoplasty or tummy tuck procedure is one alternative that we are discussing on the blog. Traditionally, this procedure has been performed as an inpatient, hospital-based procedure that can be associated with higher expenses. A recent medical article published in the Aesthetic Surgery Journal, discusses extended tummy tuck safely performed as an outpatient. The authors began performing outpatient extended tummy tuck in 2004. A total of 19 patients were included in the study, with an average age of 43 years, and an average weight loss of 142 pounds.
All the patients had successful surgery. No blood transfusion was required with an average blood loss of 130 ml. All patients went home the same day, with a pain pump and prescriptions to control their discomfort. The rate of complications was 26%, with superficial wound separation being the most common complication. Other complications included were infection, bleeding, umbilical necrosis and seroma formation. One patient required seroma sclerosis. No patient required re-admission to the hospital.
This is an important article because it is the first study to address extended abdominoplasty in major weight loss patients performed strictly as an outpatient. The article demonstrates the safety and efficacy of the technique. The complication rate is acceptable and we see that most complications were relatively minor and responded quickly to treatment. This experience supports that extended tummy tuck in patients with major weight loss can be performed safely as an outpatient. The authors emphasize that a high degree of patient education is required to minimize complications and increase the success rate.
I advise patients undergoing extended abdominoplasty to walk immediately after surgery and several times on the first day to reduce the risks of deep vein thrombosis. I have been using extended tummy tuck in major weight loss patients since 2003 and prefer to have patients stay in the facility for 23 hours, which is considered outpatient surgery. The surgery is safe, but requires a lot of work from the patient to ensure they are doing all they can to heal as best as possible.
For more information on plastic surgery after major weight loss, body lift or extended tummy tuck check out our website at www.MyFaceAndBody.com.
Plastic Surgery after Major Weight Loss: The Modified Vertical Abdominoplasty.
22 years ago
Plastic surgery after major weight loss.
Scottsdale – After major weight loss many people experience notable skin excess in almost all the areas of the body. For many, the anterior abdominal wall becomes a priority. For most, a comprehensive circumferential body contouring procedure, such as, a body lift offers the best overall improvement. However, many patients believe the bodylift is too aggressive or they do not want an incision that goes all the way around their body for other reasons. Those patients may present themselves requesting a traditional tummy tuck. Unfortunately, the standard tummy tuck does not address all the excess skin that is usually present after major weight loss.
A Modified Vertical Abdominoplasty, on the other hand, has been shown to compensate for most of the excess skin and can help patients achieve a better result. Other options might include an extended tummy tuck (will be covered in a forthcoming issue of the blog). While for others the only option may still be the bodylift. An exam by a plastic surgeon will be necessary to see which procedure might ultimately be better for you.
The modified vertical abdominoplasty has been around for a long time. It was, however, seldom used until the popularity of weight loss surgery exploded a few years back. An article published in Plastic and Reconstructive Surgery, presents a significant experience using this technique out of Harvard Medical School. The authors present a 2 year experience, in 64 consecutive patients and noted the outcome and complications. The average patient in the series was 44 years old, had lost 59 kilograms, and had surgery done 22 months after bariatric surgery. Some of the patients had hernia repair performed at the same time as modified vertical abdominoplasty. Seven other patients had brachioplasty (arm tuck) or breast surgery.
The procedure involves creating a horizontal abdominoplasty excision combined with vertical triangular excision of the tissues above the belly button. It is an ideal design for patients that already have an open bariatric surgery scar. The design of the skin excision compensates better than the traditional tummy tuck for the amount of excess skin seen in major weight loss patients. Final closure of the incision leaves an upside-down T design on the abdomen.
The results of the study demonstrate that the procedure can be carried out efficiently, with an average time of 2.5 hours by itself and 3.6 hours with hernia repair. The weight of the tissue removed, on average, was 3.8 kilograms. The most common complication was wound breakdown at the T junction, experienced in 17 patients, seroma formation (trapped fluid) in 3 patients, hernia recurrence, and minor wound separation.
Importantly, the authors only identify one potential risk factor for wound healing complications at the T junction- and that was a Body Mass Index (BMI) of 35 and above. In fact, they no longer offer the procedure to patients with a BMI greater than 35, instead they encourage those patients to loose weight until they can have surgery. Abdominal scars, diabetes and smoking were not independent risk factors for wound healing complications.
Patients should realize that Modified Vertical Abdominoplasty is an option after weight loss surgery that “partially compensates” for all the excess skin. Bodylift is still considered the best operation. However, the MV Abdominoplasty may be associated with less risk than body lift. Wound healing complications at the T junction are common as this article shows, but most wounds healed efficiently with treatment. The authors of the article stated that all wounds healed by an average of 4 months. This is not unusual since bariatric patients suffer from profound malnutrition and it takes a long time for most wounds to heal completely (model used in illustration).
Review: Assessment of Gluteal Fat Grafts with MRI.
02 years ago
Scottsdale – Many people desire fuller round buttocks. One popular procedure that has a high success rate involves the use of lipoinjection technique, sometimes referred to as the Brazilian Buttock Lift. With this surgery, fat tissue is removed from the body using a specialized technique to preserve the fat cells. Because of their low metabolism, fat cells can survive outside of the body for a short period of time. Meanwhile, the fat cells are prepared for re-injection. I have used this technique since 2002 with excellent success.
I advocate fat grafting over implants for several reasons. First, it is your own tissue and it is more natural looking and feeling than implants. Second, there is the additional benefit of loosing fat from other parts of the body and donate your fat; you get thin in heavy areas and gain volume into a flat buttock. Third, implants are not life-time devices and have unique complications. Patients can avoid implant related complications using fat grafts and have a better opportunity to achieve long-lasting results. An article from the journal Aesthetic Plastic Surgery, discusses an objective method to assess fat cell survival after lipoinjection using MRI.
The article has some problems. First, it only includes 10 patients with MRI examinations. This number of patients is usually too small for us to use this data and apply it across a larger number of patients. Second, the follow up period is too short, only 3 months. A longer follow-up period would have been better to assess longevity of the results. Third, the average injection volume is relatively small amount, 350 mililiters per buttock. On the positive, we clearly see evidence of viable fat grafts within the gluteal muscle and an increase in the size of gluteal circumference. The authors noted some significant findings that validate what patients and surgeon see clinically. For instance, at 2 weeks after surgery, the circumference of the buttocks was increased about 1 to 3 centimeters and greater than the circumference seen at 3 months after the procedure. This likely represents the phenomenom of fat reabsorption and resolution of post-operative swelling.
The most valuable information in the article has to do with the relation of gluteal volume seen on MRI before and after surgery. The average volume increase from before to 3 months after was from 687 ml to 765 ml. The increase in circumference, on average, was from 94.7 before to 95.5 centimeters after gluteal lipoinjection. Importantly, the researchers estimated that an average of 28 percent of the injected fat volume is reabsorbed at 3 months.
It is important for patients contemplating this surgery to know that swelling and recent surgery will make your buttock look bigger in the first few weeks when compared to 3 months later. The research estimates that about 30% of the fat will go away by 3 months from surgery. I recommend an over-correction for that reason on all my patients. Basically, if the patient’s ideal volume increase is 700 ml, then I inject 1000 ml knowing that approximately 30% of the volume will go away due to reabsorption. As long as the patient has the fat to donate, we can use as much of it to counteract the effects of reabsorption. If you examine the volumes used in patients on my photo gallery at www.myfaceandbody.com you will notice the range is between 600 to 1000 ml. In some cases I have injected as much as 1400 ml in a single operation.
