A Board Certified Plastic Surgeon in Scottsdale
Posts tagged facial plastic surgery
Fat Grafting in the Face: Processing.
01 year ago
by Dr. Aldo
in Facial Rejuvenation
Fat Processing for Facial Fat Injection.
Scottsdale – After fat harvest the fat must be prepared for fat injection. Plastic surgeons call this series of the steps – fat processing!
The first step in fat processing is the removal of unwanted fluids. This is fluid that is removed when fat is harvested and has stromal components and some blood. Strategies to remove the fluid include systems such as Lipivage® or Viafill®, use of a centrifuge, or gravity separation.
There are advantages and disadvantages to all techniques for this type of cosmetic surgery. The Lipivage® system is a closed filtration system which avoids exposure to excessive forces, provides sterility and lack of exposure to air. I no longer used this system because I have found a better system for facial fat grafting. I do continue to use a similar system to the Lipivage® when I perform large volume fat grafting as in for the Brazilian Butt Lift technique.
I prefer to use the Viafill® kit because it allows the cosmetic surgeon to carry out the harvest to injection steps of fat grafting using a single-use closed system of disposable fat harvesting and fat injection cannulas for facial plastic surgery. This system is advantageous for a variety of reasons, including a reduction of infection risk and the selection of better fat grafting cells. Centrifugation is an important step used with the Viafill® kit.
Use of the centrifuge is preferred by some plastic surgeons. Centrifuged fat cells are believed to be younger and more rich in viable fat cells. The layers of the compact region in the centrifuge will differ with regards to the number of viable fat cells. A study has demonstrated that the bottom portion of the fat layer demonstrates 250 percent more viable cells when compared to the top layer.
Voltaire and Plastic Surgery: Perfect versus Good.
21 year ago
by Dr. Aldo
in Body Plastic Surgery
Perfection: The Enemy of Good.
Scottsdale – There are situations in the plastic surgery arena when obtaining good results from major body contouring operations may not completely satisfy the cosmetic surgery patient.
This scenario is more and more common in today’s medical practices due to a variety of factors. In many cases, a revision plastic surgery operation may indeed be well justified. In others, the search for perfection could lead one into a path of ongoing dissatisfaction because the desired results may not be a realistic possibility.
This scenario always reminds me of Voltaire’s famous quote on the subject. The original quote in French is “Le mieux est l’ennemi du bien.”, from Voltaire’s Dictionnaire Philosophique (1764). This when literally translated means “The best is the enemy of good.” Today, this is more commonly cited as “The perfect is the enemy of the good.”
The message is simple and it can be applied to all the major areas in a plastic surgery practice. Because the risks of cosmetic surgery are the same with revision surgery, pursuing the “best” solution may end up doing less actual good than accepting a solution that, while not perfect, is effective. Worse case scenario, a revision operation could result in a worse result and the loss of all or most of the aesthetic surgery gains obtained during the initial operation.
All plastic surgeons perform revision surgery, on their patients and on patients where surgery was performed elsewhere. I recommend all patients consider whether revision surgery is in their best interest before undergoing the procedure.
Reward for Good Grades: Plastic Surgery?
01 year ago
by Dr. Aldo
in Eyelid Surgery
South Korean Parents Reward Students with Plastic Surgery
Scottsdale – It turns out some parents are offering plastic surgery to students undergoing rigorous college entrance examinations. According to Reuters, a number of plastic surgery hospitals have taken advantage of a recent trend by South Korean parents to reward their children for years of hard study.
Plastic surgeons and hospitals are offering large discounts for cosmetic eyelid surgery and nose operations. Popular surgeries include – westernizing – the nose to give it an upward tilt and double-eyelid surgery to make eyes look bigger.
“We already had a long reservation list with names of students even before they took the test,” the manager of one hospital told the JoongAng Daily.
At that hospital, the two surgeries — one for the eyes and one for the nose — would normally go for 3.7 million won if done separately. The special cosmetic surgery package offers a discount price of 900,000 won for those having both. A second hospital took a different approach by aiming at the students’ long-suffering mothers, who offer support through the hard years of study to their children until the dreaded tests are past.
“If a student has two plastic surgeries for eyes and nose at the same time, we will provide a free Botox shot for the mother’s wrinkles,” it said in an advertisement on its website, the JoongAng Daily said.
Neck Lift or Lipo and the "Turkey Gobbler".
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Plastic Surgery for the Turkey Gobbler.
Scottsdale – Happy Thanksgiving everyone! Now, lets talk about that turkey gobbler. No, not the one on your diningroom table, of course. We want to talk about your turkey gobbler, whether it’s fat or extra skin or both, we are going to list the options…
Plastic Surgery for your Turkey Gobbler.
Many of us develop a little extra under the chin. Many of us could therefore be could candidates for plastic surgery of the neck. When cosmetic surgery patients come to my office complaining of a “turkey gobbler” this typically means large skin folds hanging under the chin.
Neck Lift to Reshape the Neck.
A good treatment for this condition includes the plastic surgery operation known as a neck lift. Neck lift surgery includes incisions hidden around the ear and under the chin, the plastic surgeon then surgically releases the skin and exposes the underlying muscles and uses a suture technique to tighten the muscles. In order to remove the fat more effectively, liposuction might be used to help create a more youthful appearance.
When only Liposuction is needed in the Neck.
What about if you just have some fat and no extra skin? I see this all the time and is more common in today’s society than the classic turkey gobbler neck. In cases where the skin is not excessive and the bulge only involves fat, liposuction is the treatment of choice for the area.
The best way to know what procedure you need is to have a consultation with a board certified plastic surgeon.
The Ear and Facelift Incisions: I.
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The Ear and your Facelift Incisions.
Scottsdale – Understanding the anatomy of the ear is important for anybody considering facelift surgery.
The human ear becomes important in several facial plastic surgery operations because the incisions for facelift, go around the ear. In fact, by using the ear landmarks, a plastic surgeon can effectively camouflage the incisions, so they become hardly noticeable. A facelift is a very special plastic surgery operation, where patients desire natural looking results and hardly noticeable incisions.
Let’s learn about human ear anatomy!
In the Diagram: The Ear and your Facelift Incisions, we see the model’s ear strategically colored to demonstrate the points. The green color is over the Helix of the ear. The pink color is demonstrating the anti helix. Please not that the bottom of the antihelix, is often times referred as the anti tragus.
We also see the lobule colored in yellow. The lobule is very important for facial rejuvenation surgery. We make a very special effort to restore the normal anatomy of the ear lobule, in order to camouflage the fact that a cosmetic surgery patient has had a facelift.
In the top front of the ear (colored in white), we see the root. The root attaches to the face and transitions nicely to become the helix of the ear. The root is another critical portion of the design of any facial plastic surgery.
The concha or bowl of the ear is colored in gray. The concha is variable in size and depth and may be enlarged or prominent in the prominent ear. We also see the tragus colored in blue. When a cosmetic surgeon plans a facelift or neck lift operation, he has to carefully consider the tragus. The incision can go on the tragus itself or in front of the tragus. To learn more about facelift incisions an how a plastic surgeon uses the ear anatomy to make these less noticeable, stay tuned for tomorrow’s blog.
Plastic Surgery Success: First U.S. Face Transplant.
01 year ago
by Dr. Aldo
in Facial Surgery
Scottsdale – It’s really impressive. The results of the first U.S facial transplant really impressed me! The initial operation was carried out by a team of dedicated plastic surgeons from the Cleveland Clinic nearly 2 years ago. The patient, Connie Culp, was disfigured by a shotgun blast 6 years ago. In 2004, her husband shot her in the face, tearing away her nose, upper jaw, teeth and all of her facial nerves and muscles. The injuries left her with the loss of smell and taste, unable to breathe through her nose and mouth, and nearly blind.
Now, the proud grandmother is recovering from her final facial plastic surgery, in which her doctors removed the extra skin around her jaw line. Over the past several months, Culp has regained sensation in her face as her nerves continue to regenerate. She no longer has an airway in her throat, can breathe through her nose, taste food, and importantly, smile and speak more clearly.
“As we planned, we have removed this extra skin, and essentially she received a facelift, and that really changed that extra skin look into a normal looking face,” said Dr. Maria Siemionow, who led the team of board certified plastic surgeons during the 22-hour procedure that replaced 80 percent of her face.
The first face transplant in the world was performed in France in 2005 on a woman mauled by her dog. Since then, a dozen or so more have been performed worldwide. In the U.S., a second face transplant has been performed by doctors at Harvard-affiliated Brigham and Women’s Hospital (Boston, MA) on a man who was disfigured in a freak accident.
“It feels great to go out and not have people gawk at me because I look strange, but it’s OK for people to go out that look different,” Culp said. “Don’t let nobody bring you down because you don’t look the same as somebody else.”
We have covered this story of success with face transplant on the blog previously. However, I continue to be impressed with the outcome and scope of this plastic surgery operation.
Facelift Scottsdale Techniques.
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Facelift Scottsdale Techniques
Scottsdale, AZ – As an individual ages, the tone of the facial muscles decreases and the facial skin elasticity also diminishes. All these changes, allow wrinkles and lines to become more prominent.
Facial Aging and Plastic Surgery.
These age related events can combine to cause a flabby or droopy appearance in the face and neck. Loose skin, jowls, lines, and wrinkles develop as a natural result of the physical aging of the face. The cheeks may also become flabby resulting in the development of deep laugh lines.
Jowls and Facial Plastic Surgery.
The jowls continue to sag, leading to a double chin. The turning down of the corners of the mouth, the formation of deep folds and wrinkles around the mouth coalesce, resulting in an aged facial appearance.
A Natural Facelift result.
Plastic surgery of the face, or facelift, can reverse many of the changes that occur as a result of natural aging. The goal of facelift is to make patients look younger and healthier. The results of facial plastic surgery should appear as natural as possible.
In my practice, the highest priority is given to restoration of the sagging facial tissue into the normal, youthful anatomic position. This means the surgeon has to manipulate the tissue and pull in a superior direction, and not simply backwards.
We must understand that with aging the face falls down due to gravity. Pulling the saggy face in the correct upward direction typically results in a very natural and youthful appearance.
Dermabrasion: Achieving Excellent Results.
11 year ago
by Dr. Aldo
in Facial Surgery
Scottsdale – Last month we introduced a blog post on dermabrasion, a plastic surgery procedure used to improve the appearance of the skin and reduce wrinkles and other signs of aging.
Dermabrasion involves the mechanical removal of the damaged top layer of the facial skin using a high speed rotary wheel. Dermabrasion is performed using a hand-held engine that can reaches a rotation speed of 18,000–35,000 rpm. Rapid planing of the skin is achieved through the combination of this rotation speed, the abrading device, and the pressure applied by the operator. This technique is one of the best wrinkle treatments available. What else do you need to do before having dermabrasion and achieve the best results possible?
Here’s the answer! Pretreat your skin to maximize healing:
- Avoid sun exposure for a minimum of 8 weeks before and after dermabrasion.
- Apply Retin-A 0.05% at night for 2 weeks and then 0.1% for 6 weeks before the procedure. This medication will enhance the ability of the skin to heal – faster and smoother – when compared to no pretreatment.
- Apply Hydroquinone 4%, a skin lightener, for 8 weeks before dermabrasion to avoid blotching after the cosmetic surgery procedure.
- Select a plastic surgeon with significant experience with this procedure.
- Take your medications as prescribed! This will be critical to prevent cold sores or breakouts after the procedure.
- After the procedure, the treated areas are dressed for healing. Be sure you perform your dressing change as instructed.
Spots and wrinkles before Dermabrasion
After Dermabrasion - 3 years
We see in the example above is the results of diamond-fraise dermabrasion with pretreatment of the skin for 8 weeks as prescribed by AB Guerra, MD, a Scottsdale plastic surgeon. There is a drastic reduction in the number of wrinkles around the lips and face. Dermabrasion has a great reputation as a powerful wrinkle treatment. The combination of Hydroquinone and Retin-A has reduced most of the pigments and spots on the patient’s lower face.
Please remember! Throughout the entire process, at our plastic surgery Phoenix office, we will assist you with the most important information about FDA-Approved dermal fillers, Botox, and Dysport, which are also great therapies to reduce wrinkles.
Facial Plastic Surgery: Nose Cartilage.
11 year ago
by Dr. Aldo
in Facial Surgery
Cartilages of the Nose.
Scottsdale – Why discuss the anatomy of the nose? We do this so that plastic surgery patients interested in nose surgery can understand how the anatomy will change with surgery. Changing the anatomy, then changes the way you look.
In other words, the anatomy is the underlying reason why your nose looks a certain way. Accurate assessment of the nose anatomy allows a plastic surgeon to develop a rational and realistic surgical plan. I recommend you understand this plan as best as possible before undergoing rhinoplasty.
Study the nose diagram on the left.
All the blue areas are the cartilages of the nose. Cartilage is a flexible connective tissue found in many areas in the body including the joints between bones, the rib cage, the ears, and the nose.
The orange part of the diagram represents the nasal bones. The nose is made up of bone and cartilage. In the diagram, we see that nasal cartilage has several locations and different shapes. In the tip of the nose, the most important cartilage is the paired lower lateral cartilages. These cartilages give your nose tip most of its shape.
In the middle part of the nose, we have the upper lateral cartilages. These nose cartilage structures give the middle part of the nose its shape. These are also important in the breathing function your nose provides.
The septal cartilage is the largest cartilage structure in the nose. It divides the nose into two halves and helps to keep the airway open. The septal cartilage can contribute to the hump which is often seen on the top of many patient’s noses.
Knowing this anatomy should help you to understand what steps are involved in most nasal surgery operations. We recommend you review these carefully before consulting with a board certified plastic surgeon about nose surgery.
Facial Plastic Surgery: The Nasojugal Groove
01 year ago
Deep nasojugal grooves and fat grafting.
Scottsdale – In reporting this plastic surgery technique, I see a variation on the use fat grafting. As the authors explain, the technique is not truly new, but has been used before using a variety of other materials. In this article, the researchers placed a rolled fat graft into the nasojugal groove, one of the most challenging areas of the anatomy to obtain satisfactory correction.
The plastic surgeons in this study, obtained the fat graft from the fat pad found in the upper eyelid, which is typically removed during an upper eyelid lift or blepharoplasty. They then rolled the fat graft into the best shape to fill in the groove between the cheek and the eyelid, the nasojugal groove. Their technique offers two important advancements: the first is the choice of filler material. The fat of the eyelids is quite unique and many practitioners believe there is an advantage to using orbital fat when the need is in the human orbit. Second, the technique used to place the fat graft. They advocate creating a tunnel under the orbicular muscle. The tunnel is directly created by the surgeon using scissors. It is the combination of material and technique that adds up to establishing very nice results from this cosmetic surgery procedure. The before and after photos are truly impressive.
The article was published in the Aesthetic Surgery Journal in 2009, and was presented at the annual meeting of the American Society for Aesthetic Plastic Surgery in New Orleans, LA in 2005.
The authors make some important distinctions about when this type of plastic surgery should be used. It is indicated in patients in which there is no excessive fat found in the lower eyelids before surgery. The authors advocate a more traditional treatment to the groove and eyelid if the lower eyelid fat pads are present. That second cosmetic surgery procedure is a lower eyelid lift or blepharoplasty. The fat that is found in the orbit is placed into the groove using a sliding fat flap technique. Some plastic surgeons recommend other treatments for the groove including facial silicone implants like the Flowers Tear Trough implant.
My view on Plastic Surgery.
My take on this cosmetic eyelid surgery technique: I found this article and technique very useful. The fact that you can custom design the fat graft to fit the patient’s groove is quite important. This allows the plastic surgeon to treat more variations of the same deformity in more patients. Fat is an ideal material and can be universally applied using this technique. The other useful aspect of the technique offered was the use of the pocket under the orbicualris muscle. This is an important step because grafts placed above the muscle and under the thin eyelid skin can be seen when the swelling dissipates after surgery. By going below the muscle, the cosmetic surgeon can feel more confident about the post-surgery results being smoother and avoiding step-offs and lumpiness in the eyelids.
In fact, I use the same dissection technique, under the orbicularis muscle, and place the fascia of the postauricular muscles in the nasojugal groove.
This is a very effective technique in my practice. I have been using this method since I published the anatomy and harvest techniques for the postauricular fascia in the journal Archives of Facial Plastic Surgery in 2004.
