Recently I was asked about the treatment of nasolabial folds. As we age, the region of the nasolabial creases is often a region that patients complain about. This situation is consistent with the unfortunate aging process. As we grow older, the soft tissue of the cheek sags downward with the force of gravity. Because of tethering of the skin to the deep structures of the face at the nasolabial area, the drooping tissue forms a fold and shadow at the nasolabial crease.

Increasing volume in the cheek area with an implant can help this a bit, and alternatively fillers placed to the crease can bulk it up and reduce shadowing. Unfortunately, while both of these procedures improve the symptom of the shadows at the nasolabial fold, neither looks natural or mimics the look of youth.

Literally yesterday I saw two sisters who both came in for Restylane in their nasolabial creases. Both had previously had this procedure performed by another surgeon, and complained of a firm ridge at their nasolabial area. I explained that further injection of filler to this area is certainly possible and popular these days, but it does not tend to look youthful or natural. I can spot a woman who has had soft tissue fillers from across the room- it rarely makes a woman look more like she did at a younger age.

For these women, I instead showed them the effects of a cheek lift on the mid-face and nasolabial folds. When a lifting of the soft tissue of the cheek back to its proper position over the natural cheekbone is performed, the entire mid-face is rejuvenated, and the shadows of the nasolabial fold are improved in a natural appearing manner. Instead of placing bulk into the crease (where it does not belong in the first place), the shadow is eliminated by rejuvenating the entire cheek structure. This can be mimicked by gentle traction on the cheek area in the direction of the temple- the fold is greatly improved, and the volume of the full and youthful cheek is restored. Both women decided against further injectables and are planning on getting this more natural appearing, more permanent solution.

My reputation for natural appearing plastic surgery in Santa Barbara depends on my honest assessment and recommendation for my patients. While many women come to the office for fillers and it remains a large part of my practice, I recommend injection of the nasolabial folds in only a limited fashion. When limited to the upper fold and a subtle injection of the lower aspects of the nasolabial crease, soft tissue fillers such as Restylane and Juvederm can be great. For women who have significant shadows in this region, however, I routinely discuss the more permanent option of the cheek lift- I have never had a patient undergo this procedure who was disappointed with the outcome.

Just wanted to say thanks to everyone for coming out to Float Spa last night- we had a great crowd despite the crazy weather, and a lot of great questions following my talk on minimally invasive plastic surgery in Santa Barbara.  Best of all, it was a great even for Girls Inc.!

Thanks again!!

As many of you know, following Dr. Sheffield’s retirement at the end of last year, some gentle transformations have kept us busy at Montecito Plastic Surgery. New paint adorns the walls, and new furniture can be found throughout the office. This week, the finishing touches will be placed with new flooring in two exam rooms. Several new pieces of art will be received from the framers, and will be heading for our newly painted walls.

The hardest part, and yet the best part, has been that throughout this transition, we have remained clinically as busy as ever. Two and often three operating days per week have been filled through much of February by the ongoing interest in having plastic surgery in Santa Barbara by some old, but many new patients. I will be performing several face lift operations, rhinoplasty operations, liposuction, and breast augmentations in the coming weeks on both men and women from Santa Barbara and beyond.

We are thrilled at the response that patients have given on the new look to the office. It appears lighter, larger, and more aesthetic. Additionally, computers placed in each room allow increased access to the new electronic medial record, as well as plastic surgery imaging programs that aid in patient education. We couldn’t be more pleased with the enhancements to Montecito Plastic Surgery, and we invite you to stop by and see what all of the excitement is about.

“Tanning beds have been ranked alongside cigarettes, arsenic and asbestos as posing the greatest threat of cancer to humans by an international cancer research group.”- from a Reuter’s news article last week.

Skin cancer is finally being recognized as the significant cancer that has significant morbidity and even mortality.  The chief culprit to cause this problem is radiation from the sun, but for those that just can’t get enough sun in the outdoors, the tanning booth has been the go-to option.  Finally reports are surfacing that have tagged the dangers of this increased radiation exposure.

Many plastic surgery patients, particularly here in California, and PARTICULARLY here in Santa Barbara, are sun worshippers. No doubt that the sun in moderation is a good thing- even psychiatrists have reported that the sun is the general basis for light therapy and is good for both the mood, as well as converting precursors to Vitamin D which helps your bones with calcium.   BUT, too much of a good thing is a bad thing, and excessive exposure to the radiation of the sun, which is really what a tanning bed emulates, provides a high risk for skin cancer.

Such radiation can be a causal factor in basal cell cancer, as well as squamous cell cancer, and additionally the more deadly melanoma.  But for those more aesthetically inclined, I remind them that even the conditions that are pre-cancerous, such as actinic keratosis, are sun related, and these spots need to be treated too.  The treatment for the minor cancers, as well as many of the pre-cancers, may be invasive enough to cause permanent scarring, and nobody wants extra scars on their face.  Since the face is one of the most exposed areas on the body- this is often where the lesions manifest themselves.

The take home message- we are gifted in Santa Barbara and most of the rest of California to see the sun in the sky so much of the year, but SUN SCREEN IS A MUST!!!! and….. TANNING BOOTHS ARE A MUST NOT!!!!!

JUST SAY NO TO SKIN CANCER!

With hopes of the economic recovery on the horizon, more and more people are once again considering plastic surgery as a means of self-improvement. From breast augmentation to facial rejuvenation, patients are looking to their plastic surgeon for the means to make a change. Not all patients seem to be looking locally, however.

Santa Barbara plastic surgeon Dr. Adam Lowenstein reports that increasing numbers of patients are traveling from their distant homes to have plastic surgery in Santa Barbara. “I’m seeing more and more people who are interested in traveling to Santa Barbara for their plastic surgery. This week alone we’ve made arrangements to see women from Alaska and Colorado. Last week I saw a woman from New York. We’ve dealt with patients from Europe recently as well.�

Dr. Lowenstein is insisting on proper postoperative planning when seeing patients traveling from far away, and has specific thoughts on what he terms “destination plastic surgeryâ€�. Dr. Lowenstein comments, “Patients traveling to Santa Barbara for their plastic surgery must understand (more…)

Today I had a call from the concierge at the Four Seasons Resort here in Santa Barbara.  One of their guests wanted a Botox® treatment and was curious if we were available today, Sunday.  I spoke with the concierge and explained that I would of course love to provide services to their guests.  This woman decided that she wanted to have her injection later in the week, and so I’ll look forward to seeing her then.  It did get me thinking, however, about who, what, and where patients are getting their Botox® done. (more…)

Yesterday I did another rhinoplasty- this patient is from Scandinavia and came to see me in Santa Barbara for her plastic surgery. At her preoperative consultation, I asked her who she was planning on having help her following surgery, and how she was going to get back to her hotel. She had planned to take a taxi to and from the surgery, and was going to stay alone overnight until she could come back and see me the following day.
Well, this was not going to fly with me. (more…)

Plastic surgery in Santa Barbara- what’s in a name?

The term plastic surgeon is getting more confusing to understand, every day.  Cosmetic surgery, cosmetic medicine, plastic surgery, cosmetic surgery, facial plastic surgery- many patients, and unfortunately some physicians, are using these terms interchangeably.

This is largely because any physician with a medical license can call themselves anything they want.  A general surgeon can advertise themselves as a plastic surgeon.  So can a physician who is trained in obstetrics and gynecology.  A family medicine physician, who has a very limited training or experience in invasive medicine, nonetheless surgery, can even advertise under a variety of self-deemed terms from cosmetic surgeon to plastic surgeon.  And in fact, it’s hard to blame them. (more…)