Both "artificial fillers" and fat are used in our practice for lip volume enhancement.
Juvederm has proven a popular choice with our patients for plumping and sculpting the lips. It is easy to inject, and after doing a virtually painless nerve block, patients don't feel a thing during the injection. This injectable filler can be put right into the vermillion border (the border between the red and white lip) and also can accentuate the philtrum ( the little vertical lines from the nose to the cupid's bow of the lip). When injected into the lower, deeper portion of the lips, juvederm (or Restylane) add significant volume . It can also be used to correct the corners of the mouth, where creases and lines tend to appear, and can also be injected into the vertical lines around the lips caused by smoking and sun exposure.
Fat grafting is a terrific way to add volume to the face, and is a procedure we add onto many of our facelifts to give a "3 - dimensional rejuvenation." There are two major benefits to fat:
1. It is relatively cheap (volume for volume) compared with fillers: whereas 1-2 cc of filler may cost between $400-$1200, a typical fat grafting session may involve 40- 100 cc of fat and only cost 3-4 times as much.
2. The results you have at 4-6 months are considered permanent.
In most areas of the face the fat is retained very nicely. The cheeks, lower eyes, temple, and jawline all do very well and our patients are very satisfied. The lips and smile lines are a bit less predictable, and occasionally require touchups. These areas of the face are mobile- they move when we smile and talk, and this makes it harder for the transplanted fat to attach and become permanent.
Bottom line is: if you are planning a full face fat grafting session (to correct several areas of volume loss or hollowness), it makes sense to use fat in the lips. If the lips are your only area of concern- consider using an injectable filler like juvederm or restylane. The treatment is quick, easy, and relatively cheap. The only downside- you may have to pop in once a year for a touchup.
Monday, August 24, 2009
Wednesday, August 12, 2009
Mini Lift versus "Full Facelift"
Mini facelifts, and "branded" facelifts (facelifts given the name of their surgeon, or names like "quick lift") have received a lot of attention lately. This is because while there is a huge demand for facial rejuvenation, many potential patients fear long, costly procedures as well as being under anesthesia. One thing branded facelifts may do is help doctors to address these concerns by putting a "friendly face" on the procedure. (This is generally acceptable as long as patients are made aware of any risks- and that a mini lift or branded lift is still surgery!)
While many surgeons have branded their own facelifts, others don't believe in "branded" facelifts stating that "a facelift is a facelift."
I tend to disagree with this, as evidenced by our own "signature mini lift" that we do here at La Jolla Center for Facial Plastic Surgery in San Diego. A proper facelift will always employ some basic principles, regardless of the name or the surgeon-but it is still an expression of the surgeon's esthetic judgement, skill, and experience. Surgical technique and outcome can be quite different in different offices. For example, after performing over 1000 facelifts my own outlook and approach are much different than after my first facelift, or first 50 facelifts.
That said, an experienced surgeon who brands his own "mini" facelift should do so for reasons beyond just marketing a catchy name. The branded procedure should represent something different than a "standard facelift" in that physician's private practice-or be performed in some fundamentally unique way as opposed to other physicians who performs facelifts. A good question to ask the surgeon is: "What is different about this lift from a typical facelift that you or some other surgeon may do?"
Finally, potential patients should not forget that the most important factor in the outcome of any facelift procedure is the quality of the plastic surgeon performing the procedure-not the name of the particular lift.
While many surgeons have branded their own facelifts, others don't believe in "branded" facelifts stating that "a facelift is a facelift."
I tend to disagree with this, as evidenced by our own "signature mini lift" that we do here at La Jolla Center for Facial Plastic Surgery in San Diego. A proper facelift will always employ some basic principles, regardless of the name or the surgeon-but it is still an expression of the surgeon's esthetic judgement, skill, and experience. Surgical technique and outcome can be quite different in different offices. For example, after performing over 1000 facelifts my own outlook and approach are much different than after my first facelift, or first 50 facelifts.
That said, an experienced surgeon who brands his own "mini" facelift should do so for reasons beyond just marketing a catchy name. The branded procedure should represent something different than a "standard facelift" in that physician's private practice-or be performed in some fundamentally unique way as opposed to other physicians who performs facelifts. A good question to ask the surgeon is: "What is different about this lift from a typical facelift that you or some other surgeon may do?"
Finally, potential patients should not forget that the most important factor in the outcome of any facelift procedure is the quality of the plastic surgeon performing the procedure-not the name of the particular lift.
Monday, August 10, 2009
Total FX for Laser Skin Resurfacing and rejuvenation
Our San Diego Plastic Surgery office has performed hundreds of fractionated CO2 laser resurfacing treatments using the Lumenis Ultrapulse laser. Initially, the technology was called "Active FX" and allowed us to achieve dramatic skin tightening, wrinkle reduction and removal, and removal of sun damage- with a quick recovery of 7-10 days and minimal side effects. This has been an excellent adjunct to our practice, with about 75% of our facelift patients also undergoing an Active FX or Total FX treatment to achieve a "3-dimensional" improvement.
The company later introduced "Deep FX" which was an additional treatment head for the laser allowing a smaller spot size with deeper penetration. By combining Active and Deep FX, one achieves a "Total FX" skin resurfacing which allows resolution of deeper lines and scars as well as more superficial brown spots .
Total FX is our treatment of choice for darker skinned patients (Asian, Hispanic) with acne scars, as well as younger patients with moderate sun damage and lines.
Older skin is often best treated with an aggressive Active FX, or combination of Total and Active FX.
The company later introduced "Deep FX" which was an additional treatment head for the laser allowing a smaller spot size with deeper penetration. By combining Active and Deep FX, one achieves a "Total FX" skin resurfacing which allows resolution of deeper lines and scars as well as more superficial brown spots .
Total FX is our treatment of choice for darker skinned patients (Asian, Hispanic) with acne scars, as well as younger patients with moderate sun damage and lines.
Older skin is often best treated with an aggressive Active FX, or combination of Total and Active FX.
Friday, August 7, 2009
Age range for Rhinoplasty
A lot of our rhinoplasty or nose job patients fall between the ages of 25-40, have been thinking about it for years, and have reached a point in life where they are ready to move forward. These patients are generally mature in their thinking, and know what they want. They usually have realistic expecations and goals, and when they see their imaged photos in my office they will often smile and say "Yes- that's exactly what I want." Other patients, however, require more education and guidance as to what the surgery can accomplish, and what may look best for them.
Teenagers are often terrific candidates for nasal surgery. They are young, heal quickly, and a great rhinoplasty result can be a tremendous psychological boost for them. However, these patients may be too young to appreciate the risks of surgery (however minimal they may be), and sometimes are being led into the office by a parent who wants the surgery more than they do. My favorite scenario for teenage patients is when they are accompanied to the consultation by a loving, supportive parent who lets the teen express their own desires, but asks me a lot of questions and wants to be involved. These families are a pleasure to work with, and the patients do very well. What is the minimum age for rhinoplasty? Ideally, when the patient has stopped growing. For girls, this may be as young as 15 or 16, for boys usually 17, 18 and up. A good question to ask oneself is "Has my shoe size changed in the past year?" If that answer is no, then you may be ready to proceed.
Somewhere in between the teen and "adult" years are those patients just out of college and looking to change their image before hitting the workforce. These patients generally also benefit from bringing a parent or spouse to the consultation, but can also be great candidates. I like to see that they have been thinking about surgery on their nose for at least 6 months before coming in for the consultation.
Teenagers are often terrific candidates for nasal surgery. They are young, heal quickly, and a great rhinoplasty result can be a tremendous psychological boost for them. However, these patients may be too young to appreciate the risks of surgery (however minimal they may be), and sometimes are being led into the office by a parent who wants the surgery more than they do. My favorite scenario for teenage patients is when they are accompanied to the consultation by a loving, supportive parent who lets the teen express their own desires, but asks me a lot of questions and wants to be involved. These families are a pleasure to work with, and the patients do very well. What is the minimum age for rhinoplasty? Ideally, when the patient has stopped growing. For girls, this may be as young as 15 or 16, for boys usually 17, 18 and up. A good question to ask oneself is "Has my shoe size changed in the past year?" If that answer is no, then you may be ready to proceed.
Somewhere in between the teen and "adult" years are those patients just out of college and looking to change their image before hitting the workforce. These patients generally also benefit from bringing a parent or spouse to the consultation, but can also be great candidates. I like to see that they have been thinking about surgery on their nose for at least 6 months before coming in for the consultation.
Thursday, August 6, 2009
San Diego Facial Plastic Surgery - Roy Amir
"Very little can compare with the sense of gratification a physician feels when he (or she) knows they have made a positive impact on a patient's life. This knowledge was what led me to medical school following my experiences as a paratrooper and medic. My fascination with the intricacy of facial anatomy and the artistic nature of plastic surgery led me to focus on Head and Neck Surgery and to subspecialize in Facial Plastic and Reconstructive Surgery. I enjoy the artistic nature of facial plastic surgery, and the challenge of continuously striving for improvement and perfection. Whether turning back the clock for a patient who shows signs of premature aging, or giving a rhinoplasty patient the look they have always dreamed of, I truly enjoy my work."
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