Celebrity Plastic Surgery, News, Gossip

By, David Shafer, MD

Liposuction is a general term used to describe removal of fat using a suction machine. Tumescent liposuction is the most popular method. In this technique, tumescent solution is injected into the area of fat to be removed. The tumescent solution typically contains lidocaine (to reduce pain) and epinephrine (to minimize bruising). After the solution is injected, liposuction is performed using cannulas (long, thin tubes) to suck out the fat. Fat can be removed from almost anywhere on the body. The most popular areas are the abdomen, waist, back, bra rolls, thighs, buttocks, and chest. Liposuction is usually performed under anesthesia to help minimize any discomfort and to monitor your body during the procedure. Awake liposuction is also possible, but it takes a motivated patient and surgeon since the tumescent solutions must be injected very slowly and the suction performed very meticulously. The volume removed during awake liposuction is also much less than can be removed under general anesthesia in a hospital or surgical center. All types of liposuction are based on variants of the tumescent technique. Liposuction is only for healthy patients.

Recently, laser liposuction (particularly Smartlipo) has received considerable attention and popularity. Smartlipo involves an extra step after the injection of tumescent fluid and before sucking out the fat. During the Smartlipo procedure, a small fiberoptic cable is inserted under the skin and uses a laser to destroy or melt the fat cells. The laser can be set to different modes with different wavelengths to focus more on destroying fat and/or heating up the skin. It is thought that heating the skin leads collagen production and a slight tightening of the skin. After the laser treatment with Smartlipo, the surgeon then performs traditional liposuction with smaller cannulas to remove the melted fat. In most cases, Smartlipo can be performed while you are awake. The advantages are potentially a quicker recovery, slightly smaller incisions, focused treatment and potential for slight skin tightening. Disadvantages, however, are less aggressive treatment since you are awake and can feel the movement of the cannula, smaller volumes of fat removed, inadequate skin tightening and potential for skin burns if you are being treated by an inexperienced surgeon. Also, you should keep in mind that the Smartlipo machine is also sold to doctors who are not plastic surgeons and they perform the procedure with little or no training in liposuction.

In my Manhattan plastic surgery practice, I use both Smartlipo MPX and Power-Assisted Liposuction. I use the Smartlipo MPX, a dual-wavelength laser lipolysis machine, for patients who have small or focused areas requiring liposuction such as love handles, abdomen, arms and neck. I perform these procedures in an accredited, office-based operating room while my patients are awake. In most cases, we perform the procedure on a Friday and patients are ready to go back to work on Monday. For patients requiring larger volume liposuction on multiple areas of their body, I perform Power-Assisted Liposuction in a hospital or surgical center while the patient is under general anesthesia. The Power-Assisted Liposuction (PAL) machine uses a vibrating cannula to quickly breakup the fat and easily such it out. This is a great device for larger volumes of fat to be removed. This can still be performed as an outpatient procedure. However, in the hospital setting, the patient has specialized monitoring. Our priority is patient safety and every precaution is taken to ensure that the procedure is safe and effective.

Whether Traditional or Smartlipo is best for you should be determined in consultation with your plastic surgeon. In either case, liposuction should not be viewed as a weight-loss procedure. Rather, it should be considered a body contouring procedure. Liposuction is not going to prevent you from gaining weight. It will, however, remove fat from specific areas and make drastic changes to your body shape. I like to tell patients that liposuction is a “second chance” to have a nice body. For one reason or another, you let your body get out of control and need fat removed. After liposuction, the patient needs to maintain a healthy lifestyle, eat a balanced diet, and exercise regularly to maintain the results.

Dr. David Shafer completed his plastic surgery residency at the world famous Mayo Clinic. He was then selected to continue his education at the prestigious Manhattan Eye, Ear & Throat Hospital. While most plastic surgeons go directly into practice after residency, Dr. Shafer had the honor to operate with many of the world’s most distinguished plastic surgeons. This unique experience allowed Dr. Shafer to advance his skills to a level that most surgeons take a lifetime to develop. Dr. Shafer continues to operate at MEETH and now teaches the next generation of plastic surgeons from NYU, Columbia and Cornell.

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Visit us at www.ShaferPlasticSurgery.com.

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By John Di Saia, MD

When a reality show contestant ruptured her breast implants after jumping 20 feet off a rope swing, I felt compelled to address the concern that some breast augmentation patients have about this problem.

Bursting a breast implant is not usually so dramatic as what the reality show girl experienced.  Then again, it is uncommon for a patient to know when the break occurred. Breast implant rupture is usually a low key event. Maybe in this case the lady did do some soft tissue damage as well as the break seems to have occurred with a fall from some height. It is conceivable to cause a muscle tear although I have only seen small ones. Torn muscle can hurt.

Usually the implant ruptures quietly and slowly over a few days the breast gets smaller (with a saline implant). If the implant is a silicone gel type, the rupture may not be noticed for quite a while. This is one of the reasons the new FDA recommendations are for breast MRIs periodically after silicone gel breast implant surgery.

The “fix” involves removal of the broken implant and frequently the capsule of scar tissue around it. Silicone gel implants generally have a larger amount of this scar reaction and in removing this scar the healthy tissue available to cover the implants gets thinner. This can be a problem if done repeatedly or if the reaction is long standing or extensive as the breast can be left looking more foreign. The newer generation silicone gel implants will hopefully have less of this reaction than their predecessors, but the truth is we don’t have enough information yet to really say that. The answer to how surgeons minimize this potential problem is a matter of opinion.

John Di Saia MD (www.ocbody.com) is a board certified Plastic and Reconstructive Surgeon. He has been board certified by both the American Board of Surgery and the American Board of Plastic Surgery. He reviews cases for the California Medical Board in their expert reviewer program and contributes to a number of medical journals and internet forums. His practice is founded on the concept of a Higher Level of Care.

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By Dr. David Shafer

Dysport is often called the “New Botox.” However, Dypsort has actually been available in Europe for therapeutic indications since 1991 and for cosmetic applications since 2001. In April 2009, Dysport (officially known as BoNT-A/D) was approved in the United States for the “temporary improvement in the appearance of moderate to severe glabellar lines.” These are the lines between your eyebrows. However, just like Botox Cosmetic, Dysport can be used “off-lable” for treatment of crow’s feet (squinting lines around your eyes), forehead wrinkles, chemical brow lifts, platysmal bands (neck bands) and sweaty palms and armpits.

The molecule in Dysport is exactly like Botox Cosmetic but is covered by a different coating, which dissociates (dissolves) at a different rate. That is why the onset of action of Dysport is thought to be faster than Botox Cosmetic since the coating comes off faster. In Botox Cosmetic Treatment the usual onset of action is 3 to 7 days where the Dysport onset of action seems to be a few days faster. The dosing is different with Dysport, so there may be some confusion when translating Botox “units” with Dysport “units.” This is why you need to see an injector who has experience specifically in Dysport injections. Also, there is a learning curve with Dysport injections, so you may not initially achieve the same results as you are used to receiving with Botox Cosmetic.

There is also some confusion about the pricing of Dysport with many reports on the Internet and advertising claiming that it is cheaper than Botox Cosmetic. There is a discrepancy in the potency of units. A “unit” of Botox is not equivalent to a “unit” of Dysport, so unit pricing is not comparable. There is a slight savings with Dysport, but it is about 5% - nothing substantial. So, do not expect to go to your plastic surgeon to achieve the same results as Botox Cosmetic for half the price. However, with competition, hopefully prices will come down. Allergan (Botox Cosmetic) is currently offering a $50 mail-in rebate for Botox Cosmetic customers and Medicis Aesthetics (Dysport) is offering a $75 mail-in rebate. With these rebates and introductory pricing, you may be able to get a better deal than your last injection.

In the end, it is great to have another minimally invasive product approved on the market which can give consistent and noticeable results with virtually no downtime and minimal risks.

Dr. David Shafer completed his plastic surgery residency at the world famous Mayo Clinic. He was then selected to continue his education at the prestigious Manhattan Eye, Ear & Throat Hospital. While most plastic surgeons go directly into practice after residency, Dr. Shafer had the honor to operate with many of the world’s most distinguished plastic surgeons. This unique experience allowed Dr. Shafer to advance his skills to a level that most surgeons take a lifetime to develop. Dr. Shafer continues to operate at MEETH and now teaches the next generation of plastic surgeons from NYU, Columbia and Cornell.

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By Lois W. Stern, Editor-at-Large, Makemeheal.com

Two simple words hold the keys to understanding the concept of skin renewal: wound and heal. The skill of the practitioner – be s/he dermatologist, esthetician or plastic surgeon – makes all the difference in whether that wound ultimately stimulates the production of healthier, younger looking skin, has little impact or, worst scenario, scars the patient.

That youthful glow you see in a child’s face is the result of constant skin renewal, the shedding of old skin cells continually being replenished with new cells. A baby’s skin is in a constant state of renewal, shedding old cells while growing new ones. Alas, as we enter our teen years and beyond, skin renewal already begins to slow.

Research has shown that by the time we reach our forties and fifties, skin sheds approximately once every fifty-three days. As old, unshed cells build up on the skin’s surface, they become dual culprits to our skin’s dull, aging appearance. This is where the skill and experience of a knowledgeable practitioner who understands both theory and technique behind the wound-heal concept can come to the rescue, helping us kick the skin out of its old habits and coaxing it along into some new ones. Today one popular method for accomplishing this goal is found in a variety of laser treatments. A second, lesser known method for achieving similar goals is through dermal roller treatments.

Let’s begin with a basic understanding or the anatomy of our skin.

Stratum Corneum (the outermost surface of the Epidermis)

The outer layer of our skin is called the epidermis, with the stratum corneum its outermost surface. Beneath the epidermis lies the dermis. When we talk about resurfacing the skin, we are targeting treatment within the epidermis. When we speak of remodeling for wrinkle treatments, we are targeting treatment within the mid-dermis.

The basic concept behind both laser and dermal roller technologies is the same: wound and heal. One must wound the skin to remove old surface tissue, which in turn stimulates the growth of new collagen.

Let’s first take a look at the newer breed of lasers, known as nonablative fractional lasers, claiming to produce the results of older ablative “field” lasers, but with minimal downtime. Fraxel is one fine example of these newer lasers.

To best understand how fractional lasers work, you need to think of your skin as a digital photograph in need of restoration or touch up. Just as you can alter a photographic image pixel by pixel, fractional lasers treat your skin with thousands of tiny microscopic laser spots. During treatment, these thousands of columns penetrate deeply into the dermis. What distinguishes fractional lasers is their ability to leave untouched specific skin areas while treating others. By creating microscopic treatment zones, the laser affects only a fraction of your skin at a time.

During treatment, the fractional laser penetrates the non-living protective barrier of the skin, the stratum corneum, as if it were a window, leaving it completely intact. It then creates microscopic “wounds” within the targeted areas well beneath the outermost epidermal layer of skin. Both epidermal and dermal tissue are removed. In so doing, it triggers the body’s natural healing process to accelerate the production of collagen and new, healthier skin cells.

Below you can see some befre/after photos of one patient treated with a Fraxel laser.

Now let’s take a look at the dermal roller technology, of which the Microneedle Roller is one fine example

The Microneedle Roller uses its 200 extremely fine needles to penetrate the skin. During treatment the Roller leaves the epidermal barrier fully intact, while creating micro-channel wounds with its 200 fine needles. An effective optional compliment to this treatment is the simultaneously infusion of therapeutic serums, which penetrate more deeply while the skin is in its wounded state. These channel wounds fully close within just a few hours after initial application, providing enough time for new collagen structures to form within the skin’s lower layers, but short enough recovery time to ensure the patient nearly immediate resumption of normal schedules.

Photos First Printed in Chapter 3 of Tick Tock, Stop the Clock

During treatment

Immediately following treatment and saline rinse

Clinically-conducted studies in South Korea, Europe, and U.S. have shown that the Roller can increase serum absorption by as much as 1,000 percent. Moreover, the Microneedle Roller is “skin friendly,” in that it leaves the epidermal barrier fully intact, and the micro-channels created by the 200 fine needles fully close within just a few hours after initial application. This provides just enough time for new collagen structures to form within the skin’s lower layers, while ensuring the patient of rapid recovery with the ability to almost immediately resume one’s normal schedule.

For every microscopic zone the Fractional laser or Roller targets and treats intensively, it leaves the surrounding tissue unaffected and intact, allowing the skin to heal much faster than if the entire area were treated at once. Both treatments wound the skin and then use the body’s natural healing process to create new, healthier, tighter tissue to replace the imperfections of the older skin.

Both the Microneedle Skin Roller and the non-ablative Fraxel laser are two viable non-surgical treatments for stimulating elastin and collagen production, thereby thickening the skin, smoothing away fine lines and wrinkles and ridding the skin of hyperpigmentations. Because these treatments spare healthy tissue, they are effective even on delicate skin areas such as the neck, chest and hands. But for more dramatic results, with the downside of more visible wounds and longer downtime, the ablative laser might be a better option for you.

Lois W. Stern, Editor-At-Large at Makemeheal.com, is the published author of two books: Sex, Lies and Cosmetic Surgery www.sexliesandcosmeticsurgery.com and Tick Tock, Stop the Clock www.ticktockstoptheclock.com/ as well as a number of magazine articles. Her Professional Edition DVD is a popular aid to office staff while interacting with their patients. She and Patty Kovacs are the co-founders of http://coast2coastbeauty.com/CURRENT_NEWS.html. Check it out!

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By Shervin Naderi, MD

Although Collagen based fillers such as Zyplast and Cosmoderm had initially dominated the market, they fell out of favor due to their short lasting results and the potential for allergic reactions.

Over the last five to ten years, we have seen the Hyaluronic Acid dermal fillers become the predominant work horse for most Plastic Surgeons and Dermatologists. These are used for reduction of nasolabial folds (smile lines), Marionette lines as well as other wrinkles on the face. They are used for cheek enhancement as well as lip plumbing. Tear troughs under the eyes can often be reduced using these fillers. As with any filler, a properly trained and licensed injector with good judgment and technique is the key in success and avoiding complications.

Restylane gained FDA approval first in the United States followed by Juvederm. These two Hyaluronic Acid (HA) fillers have been the most versatile synthetic dermal fillers in the United States. Other HA fillers such as Hylaform, Captique and Prevelle never became as popular. Allergan plans on introducing a Juvederm with Lidocaine (numbing medicine) pre-mixed, in the near future.

However Hydrelle by Coapt is already here! This is an FDA approved HA filler with a higher concentration of HA molecule and Lidocaine added. The higher concentration of HA molecules mean that 1cc of Hydrelle will give you more HA and volume and wrinkle correction than 1cc of Restylane or Juvederm. The added numbing medicine means that patients who require several shots in the same area for fine contouring will have less pain and more comfort during the procedure.

There is no one great filler. Each patient needs a unique assessment and approach. For those who are happy with Restylane or Juvederm then I would recommend sticking to what you like and what works best for you. But for those who want to try something new, then Hydrelle may be worth a shot!

You can find out more here:

http://www.hydrelle.us/patients/patients_landing.html

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A Q & A with Jason N. Pozner, M.D., F.A.C.S.

What are the main reasons patients seek revision breast augmentation procedures?

Previously, capsular contracture, implant rupture, and size were the reasons most women sought revision breast augmentation. However, today many patients tend to complain about shape and skin texture abnormalities following subglandular saline augmentation.

What are the primary benefits of submuscular conversion?

Conversion to submuscular implant placement provides four main benefits:

A well vascularized cover

Separation from the breast parenchyma

“Padding” that prevents implant palpability

Framework that prevents excessive inferior descent of the implant

More specifically, what type of patients typically seek submuscular revision augmentation?

Patient seeking reaugmentation following subglandular augmentation falls into four broad categories that have considerable overlap.

Caegory 1- Size Change

Patient with adequate tissue coverage seeking size change often request submuscular conversion. Although there are no studies to verify it, in my experience there is considerable evidence that submuscular placement decreases capsule rate and implant palpability.

Category 2- Palpability and Ripping

Palpability and rippling are usually due to inadequate tissue coverage and can be compounded by type of implant used (i.e., textured saline). Submuscular conversion will improve upper pole and medical rippling but will not usually correct lateral rippling. Submuscular conversion with smooth silicone implants may be needed if lateral rippling is extreme.

Fig 1 Preoperative Preoperative Postoperative

Subglandular saline implant with superior After conversion with mentor

Pole and lateral rippling smooth silicone 800 cc high

Profile implants

Category 3- Ptosis, Shape, and Position Changes (Fig 2)

Breast Malposition-patient with subglandular implants, especially after multiple pregnancies, often present with grade three pstosis and the “rock in sock” phenomena. Submuscular conversion with mastopexy offers some advantage for long-term support.

Implant Malposition- patients may have misplaced subglandular implants. During consultation a “tilt test” is performed by having patients sit in a power chair. The chair is then lowered to assess the degree of lateral implant movement. Submuscular conversion in itself will improve superiorly and medially displaced implants, but capsulorrhaphy is needed in addition for lateral or inferiorly displaced implants.

Fig 2 Preoperative Postoperative

Subglandular 275 cc with dropped left and failed previous repair. Exchanged with conversion for 400cc smooth moderate profile silicone with capsule repair.

Category 4-Cacpsular Contracture (Fig 3)

In my experience, submuscular conversion with capsulectomy appears to improve recurrent contracture. It is important to consider nipple areolar viability in extremely thin-skinned women in which Capslectomy and mastopexy is performed simultaneously.

Fig 3 Preoperative Postoperative

Subglandular saline with Baker 3 contracture. Exchanged the conversion or 425 cc smooth saline with Benelli.

What’s involved in your patient evaluation process?

During patient evaluation, a determination is made regarding the breast pocket dimensions and position, implant size, skin dimensions and nipple position. Both the patient’s and surgeon’s input is important to determine the best surgical plan. For example, a patient with capsular contracture may need a larger implant or mastopexy with a smaller implant after capsulectomy.

What surgical technique do you prefer?

Ideally, an aereolar approach is used, although an existing inframammary incision may be used if mastopexy or full caspsulectomy is not needed. If capsular contracture is present, full capsulectomy is performed. With no siginifigant capsular contracture, the subglandular pocket is opened and the implant is removed. If the fold is to be lowered or remain constant, the capsule is removed from the pectoralis major muscle. The anterior capsule is scored and brushed with a electrocautery device. Partial capsulectomy (at least) is always performed to allow the tissue to heal without serroma or excessive scarring (Fig 4). The pectoralis major muscle is elevated and divided. The muscle is then plicated to the anterior tissues, usually at the level of the superior areola with several 2-0 Vicryl sutures. Sizers are placed to determine size and pocket shape. Drains are placed in all Submuscular conversions. After the implants are placed, the patient is brought to a seated position and symmetry is assessed and corrected. If no mastopexy is indicated, the wounds are closed.

Are the special considerations that must be considered during surgery?

Implant Descent

If the inframammary fold needs to be elevated, a capsule flap is elevated from the pectoralis major muscle prior to elevation. The inferior capsule is excised and the tissues closed. The capsule flap is then sutured to the anterior tissues to reinforce the inferior tissue placation.

Symmastia

Overdissection of the medical pocket may create symmastia or excessive cleavage. IN such cases, medial capsulectomy with closure of the overdissected pocket and creation of a submuscular pocket is performed. Postoperative taping and support are essential.

Lateralized Implants

For lateralized subglandular implants, the lateral pectoral attachments are preserved if possible, and the overdissected tissue is corrected with partial capsulectomy and suture of the cut capsule ends.

Ptosis

After submuscular conversion is complete, the skin is tailor tacked with silk sutures to gauge areolar position and the degree and/or necessity of skin excision. Saline implant fill tubes are then removed at the end of the mastopexy.

What breast implant do you prefer for this procedure?

I prefer smooth round implants. A revision augmentation qualifies the patient for silicone gel implants; however, saline implants can be used if the patient prefers. Postoperatively adjustable implants are useful when there is significant asymmetry or insufficient skin.

Fig 4

Previous conversion with failure to remove subglandular capsule. Note the muscle below and the thickened capsule above.

About Jason Pozner, MD

Jason Pozner, M.D., F.A.C.S., can truly claim aesthetic surgery and skin care as his life’s work. The son of a successful health spa and diet center physician in New York, Dr. Pozner is certified by both the American Board of Plastic Surgery and American Board of Surgery, and is a member of the American Society of Plastic Surgeons, the largest and most prestigious organization of board-certified plastic surgeons in the world.

Learn more about Jason Pozner, MD

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By Anthony Youn, MD

With the recession as bad as it is (I’m hearing that some plastic surgery practices are down 80%!), I thought I’d think up some ways people may still want to get their plastic surgery… but on a budget.

Here are my Seven Plastic Surgery Tips to Survive the Recession:

7. Try Saline Implants Instead of Silicone Gel - Although not as natural-looking or feeling, saline breast implants are still nice implants, and may have a lower complication rate. They can also save you a cool grand in implant costs.

6. One Cream to Rule Them All - If you could only use one anti-aging cream for your face, it should be Retin-A. Not only does it improve acne, but it also smooths wrinkles, exfoliates, thickens collagen, and clears blemishes. And it costs less than a hundred bucks for a big tube. Do not use if you’re pregnant, though.

5. Try Sculptra instead of conventional fillers - Although not FDA-approved for general cosmetic use yet, many surgeons are using Sculptra off-label to fill in hollowness under the eyes and overall gauntness. Unlike traditional fillers which last only 6-12 months, it can last 3-5 years. Some are predicting FDA approval for general cosmetic use sometime this year.

4. Opt for Regular Lipo Over Ultrasonic or Laser Lipo - I recently returned my VASER machine since I didn’t see a significant improvement over traditional liposuction in my patients, therefore not justifying the higher price tag. I have the same opinion of laser liposuction, with which some unscrupulous practitioners claim is comparable to a facelift.

3. Try Chemical Peels Instead of Lasers - A good TCA peel (like the Blue Peel) is comparable to laser treatments, but carries a much smaller pricetag. Whereas a laser can cost $150,000 to purchase, what are the costs for the supplies of a generic TCA peel? A couple bucks.

2. A Little Botox Goes a Long Way - Many patients are saving money on Botox by using a smaller amount and spreading it out over multiple areas. Instead of injecting 20 units in the forehead, they may have 10 units in the forehead and 10 units in the frown lines. The actress Jenny McCarthy recently admitted to People Magazine that she prefers frequent injections of smaller amounts of Botox.

1. Let Your Insurance Pay For It - Do not take this wrong. Health insurance will not pay for your breast augmentation, tummy tuck, or facelift, BUT it might pay for your upper eyelid lift if you can prove the excess skin of your eyelids severely disturbs your vision. It may also pay for your breast reduction, if your breasts are massive and create severe pain. If you are unsure whether your surgery will be covered by insurance, ask yourself if you want it truly for cosmetic reasons or to treat a medical condition. If it is the latter, then call your insurance company and see if they may pay for it.

About the Author

Dr. Anthony Youn is a Michigan-based board-certified plastic surgeon, and a member of the American Society of Plastic Surgeons. He has been featured on E! Television’s Dr. 90210 and Celebrity Plastic Surgery, The Montel Williams Show, Fox News Channel, The O’Reilly Factor and quoted in US Weekly, In Touch, Life & Style Weekly, RADAR magazine, MSNBC, OK! Weekly, and Star Magazine discussing a wide range of plastic surgery issues. His blog Celebrity Cosmetic Surgery is the most read blog by a plastic surgeon in the country and has received nearly 6 million hits. Learn more about Dr. Anthony Youn.

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By Patty Kovacs, Editor-at-Large, Makemeheal.com

Back in the 1980’s Sam Muslin, DDS, MAGD, a practicing Santa Monica dentist, was testing a then unknown product called veneers to enhance the smile of a select group of his patients. What is today known as cosmetic dentistry began with pioneering expert dentist like Dr. Muslin.

Dr. Muslin’s continued application of veneers and his meticulous assessment and rebuilding of teeth to achieve a more aesthetically pleasing smile led him to perfect his art of beautiful dentistry. Developing his own signature style, he began to notice that specific applications produced distinguished, improved facial dimension. His dental work was transforming receding chins, sunken jaws, and thinning lips into stronger chins, sculpted jaws, and fuller lips. With his unique methods and dental expertise, he was creating gorgeous smiles and turning back the clock on otherwise sagging, aging faces.

He called the procedure Face Lift Dentistry as word got out and patient after patient came to him from around the country for state-of-the-art cosmetic dentistry and facial rejuvenation without plastic surgery.

Face Lift Dentistry is a unique, patient-centered, restorative, and bite-reconstructive treatment that requires only dental restorations, no actual facial surgery, yet utterly remarkable facial rejuvenation is naturally achieved. No stitches, no cosmetic injectables, and minimal to zero grinding down of the patient’s natural teeth. The procedure can be completed in as little as two office visits. Face Lift Dentistry is a level of care that exceeds all previous levels, the highest, most complex level of dental care made possible by improvements in advanced technology using Dr. Muslin’s refined techniques. This super specialty procedure is highly concentrated, utilizing and coordinating the most advanced dental technologies available to achieve the ultimate level of individualized dental care while also achieving astonishing facial rejuvenation.

“What are my goals of Face Lift Dentistry?” asks Dr. Muslin. “To achieve the absolute best jaw position and comfort, tooth angle, dental health level, clear speech, ideal facial support and optimal facial length possible. The result? A weak chin appears stronger, a short, round face is elongated, a collapsed bite is restored, and a remarkably improved facial profile results. That’s why I call it Face Lift Dentistry.”

I met Dr. Sam Muslin at a medical luncheon at the Regent Beverly Hills, sure that I would discern his technique to be somewhat questionable. He quickly proved me wrong and now I’m a fan. His results are astonishing. Facial wrinkles and weaknesses become more obvious with age. When you think about it, it just makes good sense to incorporate enhancing one’s smile and facial dimensions simultaneously. Big plus? No surgery. Dr. Muslin is going far beyond conventional dentistry and his before-and-after patient photos and testimonials tell the story.

“The Dental Face Lift technique plumps the appearance of thinning lips, adds volume to sunken cheeks, elongates an otherwise weak jaw and chin, and makes taut that ugly, loose turkey neck. The technique naturally enhances the patient’s unique soft facial tissue with restructure of the hard tissue: the teeth. In other words, it’s much more than a ‘dental smile makeover,’” he explains.

A careful, three-dimensional analysis of the patient’s entire face geometry begins the initial procedure. A highly customized course is determined to reconstruct the patient’s bite as well as to enhance the patient’s entire facial structure. No surgery is required on the face or any soft tissues. Only the teeth are treated.

“The development Face Lift Dentistry actually allows a patient to change what nature created and turn back the hands of time. Instead of being satisfied with the length of our face and the position of our jaw that we grew into randomly at a young age, we can now utilize this dental technology to achieve the best possible face, lips and jaw position possible while restoring youthfulness to the entire face,” says Dr. Muslin.

The procedure restructures the face, the bite, even the health of the entire body by maximizing the potential of the teeth to support the overall facial structure, lips and cheeks. It removes years off the facial appearance, vertically lengthening the face, actually smoothing out wrinkles, giving a naturally thicker appearance to the lips. Not only is the smile vastly improved, but the entire face is transformed to a far more aesthetically pleasing and youthful appearance by reconstruction the teeth. The teeth are lengthened to achieve a longer face and this lengthening process is harmonized with the specific requirements of the patient’s jaw-joint or TMJ. According to Dr. Muslin, in most instances the jaw-joint will move itself to the best position naturally if given the opportunity during the course of dental care.

“Wearing down of the teeth because of bruxism (grinding) is a normal process of aging. The gradual loss of vertical dimension in a patient’s face is an added result of getting older; in other words, our faces get shorter as we age because of tooth wear,” explains Dr. Muslin. “Over time, the bite is flattened and depressed facial structure follows. A face looks older due greatly to loss of tooth support and flattening of the bite. Mine is the only procedure that actually lengthens the face permanently and creates a lasting, vertically enhanced, youthful looking face.”

Dr. Muslin’s patients aren’t just aging baby boomers. A 30-year-old patient can actually have a 50-year-old looking face due to a deep over-bite and years of grinding. Short, dark yellow teeth from smoking, partying, poor eating habits, or childhood antibiotics combined with old fillings and crowns that don’t match can make a thirty-something look, well, old.

“Some of us never had a good bite to begin with. Our bite is formed in early adolescence once all of the adult teeth erupt. It’s our teeth that determine facial length and jaw position for the rest of our lives. Our faces can be short and round if the teeth don’t provide adequate support. Many of my patients experience enormous relief from migraine headaches due to teeth misalignment and grinding” continues Dr. Muslin.

As soon as mismatched crowns and fillings are replaced, the patient is made healthier. Decay is removed for maximum health and the bite is rebuilt. Conflicting metals and decaying tooth structures are replaced with biologically compatible porcelain materials.

Worn down cusps are rebuilt and restored for better chewing, adding subtle, three-dimensional vertical facial height, creating astonishing youthful restoration of the patient’s entire facial appearance. No surgery, no stitches, and most patients go back to work the very next day.

Dr. Muslin’s years of knowledge and expertise are critical in in Face Lift Dentistry. His advanced training and artistic ability are vital components for the biological harmony of this highly advanced procedure.

Dr. Sam Muslin is a Master of the Academy of General Dentistry and has been awarded by the International College of Dentists. He has been practicing cosmetic dentistry in Santa Monica for almost 30 years. Dental Face Lift and Face Lift Dentistry are registered trademarks of Dr. Sam Muslin. www.faceliftdentistry.com.

Patty Kovacs, Editor-At-Large at Makemeheal.com, is a published author and beauty expert. Patty is the Executive Producer/Host of The Health and Beauty Revolution Show on wsRadio. Her 800+ interviews include over 450 New York Times best-selling authors.

See Patty’s Websites: www.pattykovacevich.com

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By Alexander Rivkin, M.D.

Traditional cosmetic procedures such as rhinoplasty, blepharoplasty, facelifts, and chin augmentations are no longer the only option for individuals who wish to enhance their outward appearance. These surgical procedures are now in competition with the latest innovations in injectable filler techniques. Products such as Radiesse, Artefill, Juvederm, and Sculptra allow a skilled physician to gently mold and sculpt the face. Facial fat disappears as we age, changing our appearance from full and youthful to gaunt and fatigued looking. Fillers will replace that fat, giving us back the youthful fullness that is lost over time. In addition, fillers can easily soften and camouflage aesthetic irregularities of the face, such as a nasal bump or an asymmetric chin. With so many new choices in aesthetic medicine available, why endure painful, invasive surgery that requires anesthesia and an overnight hospital stay? In this article I would like to specifically focus on Non-Surgical Rhinoplasty, also known as the Non-Surgical Nose Job, and discuss some of the procedure’s advantages relative to surgical rhinoplasty techniques.

As a surgically trained otolaryngologist/facial plastic surgeon I understand my patients fears and anxieties associated with “going under the knife.” I have devoted my career to developing cosmetic surgery alternatives in order to reduce recovery time, discomfort, and financial cost to patients seeking cosmetic improvements. Recent developments in aesthetic medicine have allowed me to focus on minimally invasive facial sculpting as new varieties of injectable fillers are becoming more readily available in the US market. Four years ago, I was the first in the United States to offer Non-Surgical Rhinoplasty using injections of Radiesse to raise the bridge of the nose and camouflage bumps. Since then, I have performed about 1000 successful procedures and have trained physicians across the country and abroad.

The idea of correcting nasal abnormalities with the use of injections is actually not new. In the mid 1800’s doctors attempted to perform this procedure with substances like paraffin, silicone, and goose grease. These techniques did not last because the substances used caused long-term side effects and turned out to be inappropriate for injection. However, the idea of performing rhinoplasty with injections remained a possibility and modern cosmetic surgeons continued to experiment with the idea of minimally invasive facial sculpting.

When I started using Radiesse to fill in lines and wrinkles, I was impressed with the longevity and smoothness of the results. I had heard rumors that Asian plastic surgeons were using fillers to contour the nose non-surgically and I recognized the possibility that American patients could obtain results similar to traditional rhinoplasty without surgery. I questioned why US surgeons were only offering fillers as a post-rhinoplasty corrective procedure. There was (and still is for the most part) a perception that an operation is the only way to correct cosmetic nasal irregularities, even the most minor bumps or asymmetries. After using injectable fillers as an alternative to rhinoplasty for four years, I am convinced that the Non-Surgical Nose Job is a procedure that is safe and effective with significantly less discomfort and risk than traditional rhinoplasty.

With proper administration from a trained specialist, Non-Surgical Rhinoplasty can effectively correct a mild to moderate bump on the bridge of the nose, a mild to moderate drooping of the nasal tip (nasal tip ptosis), mild to moderate post-rhinoplasty asymmetry, and mild to moderate deformities such as “boxer’s nose” or an upward scooping of the nasal tip (also known as saddle nose deformity). Skill and experience are required if a physician wishes to correct more difficult situations such as asymmetric nostril shape, or poor definition at the point between the face and nostril wing.

(Left: Before, Right: After)

Cosmetic concerns often vary between ethnic groups and the Non-Surgical Rhinoplasty procedure can present the best solution across cultural lines. For example, Asians often desire a heightened bridge of the nose and want better nasal definition. African Americans, like Asians, often request bridge augmentation while Hispanic Americans frequently ask for correction of a droopy nasal tip or irregular bump. Caucasians most commonly request camouflage for an obvious hump or unbalanced appearance of the nasal bridge.

(Left: Before, Right: After)

Individuals who have already received a traditional rhinoplasty procedure commonly ask for minor corrections of asymmetry, augmentation for an upward slope of the nose, and, occasionally, a desire for augmentation and camouflage in the of the nose bridge due to a post procedure cartilage collapse.

There are several injectable fillers available on the US market today that are safe, effective and relatively long lasting. I have mostly used Radiesse and am very comfortable with this filler. Radiesse is composed of calcium hydroxyapatite microspheres in a polysaccharide gel carrier. Since there is no way to dissolve the material, it must be injected with great care. I routinely under-correct because over correction is quite difficult to resolve. Immediately after injection, Radiesse is malleable and I will contour and shape it according to the needs of the individual patient. Generally I see patients one to two weeks after the initial procedure so that I can administer touch ups if necessary. Radiesse is a semi-permanent filler and generally lasts between 10 and 12 months. Because Radiesse is not animal based, no allergy testing is required.

Some patients choose to start with more temporary hyaluronic acid fillers such as Restalyne or Juvederm in order to experiment with the outcome of their cosmetic makeover. The advantage to the hyaluronic acids is that they can be easily reversed with an enzyme in the rare event that results are dissatisfactory. After trying out their new look with temporary fillers, patients can then choose to go with a permanent filler if they decide a re-contoured nose suits their expectations (which is the case with most people). Restalyne and Juvederm last between six to nine months and are non-animal based so skin testing is not necessary and allergic reactions are unheard of.

Although the Non -Surgical alternative to rhinoplasty is an excellent option for many, it is not the best solution for all patients. Patients with a severely crooked nose may not be good candidates for an injection rhinoplasty because the augmentation needed to give a straighter appearance to the nose may make the nose too wide. Patients with a nose that is disproportionately large may need to opt for a traditional reduction surgery. The procedure will not correct breathing problems.

As with any medical procedure, selecting the right physician to perform your Non-Surgical Rhinoplasty is critical. Injecting filler into the nose must be done with care and a thorough understanding of both nasal anatomy and the properties of the filler being used. A patient contemplating this procedure should make sure his or her physician has had specific training and experience in cosmetic injection techniques, especially if the doctor is not a formally trained aesthetic surgeon. Precise knowledge about the injection spots, depth, and amount of filler needed is very important for the success of the procedure.

Non-Surgical Rhinoplasty is a relatively painless procedure that requires minimal downtime and post-procedure care. In fact many of my patients have resumed normal activities immediately after their Non-Surgical Nose Job, returning to work or a busy social calendar on the same day as the appointment. Slight bruising or swelling may occur at the site of injection, however the severity of the inflammation pales in comparison to the aftermath of traditional rhinoplasty. If discoloration or tenderness does occur, it usually disappears within a few days.

Topical anesthesia is adequate for pain control and icing the nasal area just before injection reduces the chances of bruising. I suggest patients take Arnica Montana orally after their injection – it works well for reducing any swelling or bruising that may follow. Patients can use Tylenol, but should not use non-steroidal anti inflammatory medications (Advil, Alleve, etc) for 3 days or wear sunglasses for 2 weeks after the procedure. No other limitations are required. The Non-Surgical Nose Job usually takes between 10-15 minutes to perform. Patients are usually in the office for about an hour, however, when we figure in the time needed for topical numbing cream.

Non-Surgical Rhinoplasty costs a fraction of the price of the surgical procedure. Depending the on the filler being used - temporary, semi-permanent, or permanent - a Non-Surgical Nose Job costs between $1,000 - $2,000.

Minimally invasive procedures like Non-Surgical Rhinoplasty are quickly gaining popularity because they offer patients exactly what they want cosmetically, but with much less pain, downtime, and cost. The Non-Surgical Nose Job is currently performed throughout much of the world and will only increase in popularity as the possibility of non-surgical aesthetic corrections continue to be publicized.

About the Author

Alexander Rivkin M.D. is a Yale trained facial cosmetic surgeon and UCLA faculty member who focuses exclusively on providing his patients with the latest in non-invasive, non-ablative cosmetic treatments. As an international authority on non-surgical cosmetic treatments, he divides his time between patient care, clinical research, educating other physicians, media appearances, and lecturing at scientific conferences throughout the world. Dr. Rivkin was the first physician in the country to offer the Non-Surgical Nose Job, his signature method for non-invasive correction of cosmetic nasal irregularities. He has been featured throughout the national and international media on shows such as the TODAY show, the Tyra Banks Show and EXTRA for the innovative procedures he has invented. Dr. Rivkin is a member of the teaching faculty of the American Academy of Facial Plastic Surgery. He is also a prominent member of the national teaching faculties for Allergan, Contura, Johnson and Johnson, Medicis and Bioform. Click here to learn more about Dr. Alexander Rivkin.

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By Anthony Youn, MD

As a cosmetic plastic surgeon, I often have patients ask me what’s the latest on the horizon in the field of plastic surgery. Are there procedures that they should save for? In the near future will there be cheaper and easier ways to change their look than what we are currently doing now?

Here are my Top 9 Plastic Surgery Predictions for 2009:

#9. Plastic Surgery Vacations will become more and more popular. As our country falls into recession, greater and greater numbers of people will save money by combining plastic surgery and vacations. Americans will travel to Mexico, Brazil, and even India in an attempt to save money and look better. I predict that this trend will unfortunately bring about an unprecedented number of disturbing complications, as people bring their botched results back to the U.S. for American plastic surgeons to treat. The lucky ones, however, will come back looking both rested AND younger.

#8. Fat, from both from animals and people, will become a new Green resource. There are reports that a renegade Beverly Hills radiologist used liposuction fat to power his SUV to work each day. While this is an extreme example, I do believe that the work on Biofuels will continue, with liposuction fat on the periphery of this trend. No, I don’t plan on ever doing this.

#7. Sculptra will gain FDA approval as a liquid facelift for the general population. With the realization that facial volume loss is an integral component of the aging process, Sculptra treatments may take center stage in the fight against facial gauntness. Sculptra is currently only FDA-approved for treatment of HIV-associated facial wasting, but has been used in Europe for many years under the name Newfill. It is currently the only injectable filler that can produce generalized volume replacement in the face without excessive cost.

#6. 2009 will bring with it a plethora of new extreme, bizarre, and unusual plastic surgeries. 2008 brought us such plastic surgery oddities as cosmetic leg lengthening, the G Shot, the Boob Jab, and the Acupuncture Facelift. I expect fringe medical practitioners to do the same in 2009. Can we expect to see actual rib removal to thin the body, removal of the omentum (fat around the intestines) to decrease a protuberant tummy, or tummy tucks performed at the time of C-sections? Not by me!

#5. Will Gummy Bear Implants Boost Busts in 2009? In November 2006 the FDA lifted the ban on silicone gel implants. Since then plastic surgeons and patients in the know have been waiting for FDA approval of the form-stable, “gummy bear” breast implants, the only silicone breast implants that did not receive approval two years ago. These firm, textured, tear-drop shaped implants are made to retain their shape and not conform to the shape of surrounding tissues. They are already in widespread use throughout many other countries in the world. Will the FDA approve these implants for general cosmetic use in 2009? Thousands of plastic surgeons and patients hope so.

#4: Nonsurgical Liposuction Techniques Run Rampant… As Do Disappointing Results. One of the hottest procedures today is nonsurgical liposuction. Cosmetic practices throughout the country are advertising fat reduction via injections, external lasers, external ultrasound, and even by freezing the fat (called cryolipolysis). While these techniques sound intriguing, none have actually been proven to safely work…yet. The American Society of Plastic Surgeons (ASPS) is currently conducting an FDA-approved study on Lipodissolve, with the initial results due in the near future. While the only proven way to safely and effectively remove fat is via liposuction, 2009 may bring considerable advances to some of these, so far, unproven modalities. I expect that most will fall by the wayside, although a few may be proven to safely work.

#3: Eyelash Enhancing Medication “Latisse” Hits Big in a Blink. Recently an FDA advisory panel recommended approval for this eyelash stimulating medication from Allergan, the makers of Botox. Peak sales are estimated to reach $500 million, as this treatment will be a one of a kind. I expect Allergan will see huge profits from this topical medication, as will the physicians that dispense it. And people will walk around with Tammy Faye Baker eyes…

#2: Stem Cells are the Future in the U.S., but the Present in Other Countries. Stem cells are currently all the rage in potentially curing cancers, developmental abnormalities, and other medical problems… but are they the future for plastic surgery as well? Actually, stem cells are currently being used by some pioneering (and possibly reckless) surgeons outside the U.S. Dr. Vincent Giampapa introduced a stem cell facelift in France back in October and a handful of surgeons are performing breast enhancement with stem cells in Japan and Europe. So will we see stem cells being used by plastic surgeons in the U.S. in 2009? Not likely. The FDA is cautious with allowing procedures like these to be performed here in the States, and with good reason. Scientists need to prove that the use of stem cells for indications like these is safe and effective before allowing patients to undergo it. Until then, Americans will need to travel abroad for these extremely controversial treatments.

#1: Botox-Competitor Reloxin will act as an Economic Bailout for Millions of Botox Users in 2009. FDA approval for Medicis’s cosmetic botulinum toxin Reloxin is expected sometime in the new year. This may prove to be a relief to patients and plastic surgeons who have been forced to buy Botox at increasing prices each year. I currently charge my patients $650 for Botox injections to three areas, and the price of the Botox product itself accounts for at least half of that charge. Reloxin will be the first legitimate Botox competitor to challenge Allergan’s monopoly on this market, and hopefully bring prices down for the most popular cosmetic treatment in the U.S. It can end up being an economic bailout for the millions of people who undergo cosmetic botulinum toxin treatments several times a year.

About the Author

Dr. Anthony Youn is a Michigan-based board-certified plastic surgeon, and a member of the American Society of Plastic Surgeons. He has been featured on E! Television’s Dr. 90210 and Celebrity Plastic Surgery, The Montel Williams Show, Fox News Channel, The O’Reilly Factor and quoted in US Weekly, In Touch, Life & Style Weekly, RADAR magazine, MSNBC, OK! Weekly, and Star Magazine discussing a wide range of plastic surgery issues. His blog Celebrity Cosmetic Surgery is the most read blog by a plastic surgeon in the country and has received nearly 6 million hits. Learn more about Dr. Anthony Youn.

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