This morning I had the pleasure of listening to two lectures by Fred Menick, MD, from Tuscon, AZ. Fred is one of the true masters of plastic surgery of the nose, and I’m feeling very fortunate that he and I were visiting my alma matter, the University of North Carolina Medical school, on the same weekend. Some of my best friends run the outstanding residency here, and I was so pleased that they invited me to their residents’ conference.
Fred gave two outstanding discussions about total nasal reconstruction, as well as partial nasal reconstruction. Of course, references to cosmetic nose surgery and rhinoplasty were multiple- the best of the aesthetic surgeons are well versed in reconstructive plastic surgery.
I was very happy to hear him discuss some of the principles that I have been following for years. His examples of complex nasal wounds following MOHS surgery were terrific, and his multi-staged approach to reconstruction yielded fantastic results. My own passion for plastic surgery of the nose and rhinoplasty allowed me to really enjoy his presentation, and I hope that the residents came away from our subsequent discussion with some great “pearls” on plastic surgery of the nose- both reconstructive nose surgery and cosmetic plastic surgery of these areas.
“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. Â 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. Â 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. Â 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. Â 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. Â 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. Â 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!!!!!
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 surgery”.Dr. Lowenstein comments, “Patients traveling to Santa Barbara for their plastic surgery must understand Read the rest of this entry »
Evolence, the soft tissue collagen filler that everyone is talking about, just got FDA approval for labelling thier product as lasting 12 months! This means that long term results have held up to the rigorous standards of the FDA. I love using this product because of its lack of swelling, ease of precise placement, and long term results! Because this is not the run-of-the-mill soft tissue filler, only trained, endorsed physicians have access to this product. It’s use in treatment of lines and wrinkles such as the nasolabial fold area is outstanding- see the Evolence website for details, or call Dr. Lowenstein to find out more information about Evolence!
With every breast augmentation patient in Santa Barbara, I go over the various types of breast implants, the various pockets that breast implants can be placed in, and additionally the different incisions that can be used to place the breast implant into the breast pocket. With respect to this last issue, I think there is some helpful information that has recently been published. Read the rest of this entry »
We are seeing more and more women come from Beverly Hills and Hollywood to have their plastic surgery in Santa Barbara. I find this a very interesting phenomenon. I’ve never been one to gawk at celebrities- I see them as people just like you and I, with very interesting careers. (I have some friends, whoever, that I’m convinced only visit me both here in Santa Barbara and also at my home in Aspen because they like to see and be seen with the rich and famous.) Personally, I feel that privacy issues are of ultimate importance, and as I refuse to divulge anything about my patients Read the rest of this entry »
I’ve finally been persuaded to put up a Facebook page for our office, which you can find HERE. I’m seeing more and more questionable information out there, and so I think that the tools of social networking may be an excellent way for patients to have access to us, and additionally allow patients to be made aware of things going on in the world of plastic surgery in Santa Barbara and Montecito. Through Facebook, I’m hoping to be able to make people aware of things going on at the office, and special situations such as our “Fillers for Firefighters” event which you can read about below. So visit our Facebook page, become a fan, and keep up to date!!!!
Recently, our entire Santa Barbara community was affected by the Jesusita fire, from Goleta to Montecito. Personally, my wife and I hosted evacuees from the foothills, and my wife additionally volunteered at the call center to help provide information regarding the Jesusita Fire. Only by the outstanding work of the firefighters was the home of our nurse, Suzanne, spared. Homes all around hers were unfortunately destroyed, and despite the fire burning down the tool shed in the back yard, and even charring the house itself, the firefighters were able to save her home and we are all so very grateful to them.
Although I’ve been buying dinners for firefighters at any restaurant that I see them at, I’m hoping to do more for the brave men and women that fought the Jesusita fire here in Santa Barbara. I am going to be donating 100% of our profit from all injectables- fillers and additionally BOTOX® as well, from now to the end of June, to the Santa Barbara Fire Department. I’m calling the event, “FILLERS FOR FIREFIGHTING”.
Soft tissue fillers including Retylane®, Juviderm™, and Evolence™ will be available, as well as BOTOX® used to treat dynamic wrinkles. I hope that our patients will enjoy not only the outstanding results obtained from getting their fillers and BOTOX® performed by a plastic surgeon himself, but also receive a sense of pride that the means to enhance their beauty will additionally be going to a good cause. We are expecting to raise several thousands of dollars to donate to the Santa Barbara Fire Department as a thank you for their skill and valor fighting the Jesusita Fire.
I’m posting this on our “What’s New” page of this website as well, and I hope you will tell your friends and spread the word as much as possible. I’m hoping to raise as much as possible by donating the entire profit from our medical injectables for the next 6 weeks.
A friend showed me an article in a recent edition of Forbes Magazine about a New York plastic surgeon that is performing something he calls a Y-lift. This is apparently an outpatient procedure with minimal recovery and patients “look amazing immediately afterward, and in a day or two they look even better.”
After I read the article, I was very excited to learn more about this technique, and in order to see the results, I checked out his website.
While this procedure does have very nice results in some patients, it has significant limitations and is a poor substitute for a true facelift to which the article seems to claim comparison.
While I have not actually seen Dr. Yan Trokel’s procedure personally, the description sounds like a particular application of soft tissue injectables to sculpt the face and re-create the fullness of a youthful appearance. This concept is not new – dramatic effects have been accomplished in patients with “wasting” syndromes such as AIDS in which excessive hollowing in the face have been treated with soft tissue fillers. Dr. Trokel seems to be utilizing similar concepts in different planes of the face – closer to the bones – in order to provide plumping. His argument for this is a very valid one: “As people age, they don’t grow extra skin…”
In fact, the concept that I believe he is getting at is that as patients age, there is a loss of apparent volume in the face – some of this is perceived, and some of this is real. As the natural fat in the face atrophies with age, some volume is actually lost. Additionally, the ligaments that hold the youthful volume in place over the cheekbones and jaw line atrophy with age as well. Sagging below the cheekbone causes these areas of youthful definition to diminish. Sagging below the jaw line causes jowls. Re-filling these areas with soft tissue filler should then provide volume in the areas where there is loss, and the skin, which appears wrinkled and deflated over the lost volume, should again appear rejuvenated as it re-drapes over the new volume. Liken this to a balloon where the rubber that appears dull and wrinkled when deflated appears smooth and shiny once volume (air) is used to inflate it.
And all of this is true. Unfortunately, fillers alone have limitations to a very specific group of patients. The Y-lift (and many other uses of soft tissue fillers) addresses volume loss without necessarily addressing volume droop. If you examine the before and after photos closely, you will see that the best results are seen in women who are actually rather young. These women are beginning to experience some volume loss, and have not yet had significant atrophy of their facial ligaments. All of the women who have after photos of their full face (not profile) are marginal candidates for facelifts in the first place, and have great results from this application of filler. In several of the older women you can see the persistent aging in the neck, and the uneven contour of the remaining facial skin outside of the injected areas. The droop has not been addressed.
Please do not take this as a criticism of Dr. Trokel – I think his technique is a good one and I would like to hear more about it. In properly selected patients, I think the Y-lift concepts are sound, and I think Dr. Trokel deserves praise for his work there. I think that the Forbes article paints his procedure as a substitute for a face lift, which I do not believe it is.
In Dr. Trokel’s own words, “You can’t just throw on the duvet. You have to do all the layers to make it look really nice.” He also says, “So we really don’t need to be cutting the excess skin, because there is no such thing.” Both statements are (almost) completely true, and to a point, I agree. The misunderstanding is that a facelift is not about cutting off excess skin. That would be a face-tightening, not a face “lift”.
When I do a face lift, the majority of the work is addressing the layers of the face- particularly the youthful volume and connective tissue that has dropped because of the aging ligaments. This is addressed in the LIFTING of the SMAS layer underneath the skin, and you can read about that here. Often, minimal amounts of skin are actually cut off. The SMAS layer is elevated and replaced into a more youthful position, and often it can be sculpted in the area of the cheekbone to produce enhanced volume here as well. The skin is re-draped over the newly lifted underlying soft tissue, and if any excess is apparent (usually because of laxity and stretching as aging skin looses youthful elasticity as it ages), this is removed to allow a natural closure to the skin incision.
In addition, the platysma layer of the neck is addressed in most facelift procedures. Here again, the skin is not the focus – the banding and blunting of the angle between the jawline and neck are addressed by sculpting the aging layers lying underneath the skin. The aging muscle here is tightened and shaped in order to re-create the youthful shape of a more defined angle here. Again Dr. Trokel is right: “You can’t just throw on the duvet.”
An alternative to a full face lift in some patients who have only early volume sagging is a cheek lift. In this procedure, the layers under the skin are lifted back over the cheek bone, called the malar eminence, through a lower eyelid incision. This smaller procedure, like the Y-lift, gives great results in properly selected, usually younger patients. In combination with a lower facelift, many patients can get outstanding outcomes. Unlike the Y-lift, however, the results are much longer lasting and use only your own tissues and dissolvable sutures.
So again, kudos to Dr. Trokel for his fine work with soft tissue fillers. I will look forward to continuing my use of these tools in patients who benefit from them. In the right patient, I think this is a commendable short-term solution for early volume loss. A face-lift, as I’m sure Dr. Trokel will agree, it is not.
One last comment- as always, it is important to be comfortable with your surgeon’s training and credentials before undergoing any plastic surgery procedure. In accordance with the American Society of Plastic Surgery, we suggest that patients find a plastic surgeon that is certified by the American Board of Plastic Surgery. Remember that any physician can call himself or herself a cosmetic surgeon. It is up to the patient to ensure that their plastic surgeon is well trained and certified in his or her field of practice.
