Lip reduction surgery is performed to reduce the overall size of the upper and/or lower lips. This is in contrast to Lip Augmentation, which is usually performed to enlarge the lip size. Lip reduction has received a great deal of press lately in light of Lisa Rinna having her lips reduced. Since I have seen all kinds of different reports lately about lip reduction, I wanted to shed some light on the topic.

There are several reasons someone may want to have lip reduction surgery:

1) Silicone Injections: I see this most commonly in practice when someone has had some type of permanent lip injection, such as silicone, and the lips have become too large. This is the case in the lip reduction before and after photo shown above.

2)Congenitally Large Lips: Someone is born with excessively large lips, they are self conscious about this, and they would like their lips reduced.

3) Lip Deformity from Injury Finally, I have seen several cases of people that have had some type of an injury to their lips, and scar tissue has formed on one side more then the other. Lip reduction can be performed in order to help obtain improvement in the appearance of the lips in these cases.

The Surgery:
The procedure is most commonly performed in my office procedure room under local anesthesia. All of the incisions are hidden in the back of the lips, so they are not noticeable, and they heal quite well. Swelling is common and can take weeks or more to subside. There is also minimal pain with the procedure, and my patients rarely even need to take any type of narcotic pain medication (though I prescribe it just in case). This is not as difficult of a surgery to recover from as some of the media has made it out to be.

Overall, lip reduction surgery can be very rewarding for people who are afflicted with some of the issues discussed above. I would recommend you see a board certified surgeon who has experience in lip surgery in order to best evaluate the benefit that can be obtained from the procedure.

Fat grafting is a remarkable procedure performed to rejuvenate the face. As we age, we lose volume in the form of muscle, bone and fat from the face. The distribution of this fat loss will vary from person to person. The art of the facial plastic surgeon comes in when deciding where and how to place the fat.

Without question fat grafting is becoming exceedingly more popular. The effects of fat grafting are seen immediately and for years after the procedure. Since fat has a very abundant supply of stem cells within it, some people are calling the fat grafting procedure a stem cell face lift. This might make sense considering that we are injecting stem cells into the face along with the fat, however until I see definitive evidence that the stem cells play any roll in this, I will not tout it in that fashion. What I will say is that fat grafting works well, very well. As the word is getting out about this no incision procedure, more and more people are turning to it.

That being said, the most common question I get is…”How long does it last?” Fat grafting is a permanent procedure. Live fat cells are removed from the body, purified in my lab, and the transferred to the face (all at the same time). The key is making sure that the fat cells survive the sometimes traumatic process of moving it around. Harvesting, processing, and finally injecting the fat in the proper manner will ensure the longevity of this procedure. So bottom line is that the technique is crucial to the outcome and longevity of the procedure, and you must choose a surgeon very experienced in fat grafting to get the best results.

The photo above is of a patient of mine who is 1 year and 2 months after full face fat grafting. The area I want you to pay attention to is that of her cheeks. Although the entire face was injected, we will use the cheeks to demonstrate that after 14 months the cheeks are still full, and even fuller then they were at 2 months. At this point there is no question that the fat has taken and is now a part of her face.

The advent and popularization of the fractional CO2 laser has been a big step forward in reduced downtime laser peels that actually work. Since purchasing the latest, Premium model of the fractional eCO2 laser, we have amassed a significant clinical experience with the laser.

As with any tool, the CO2 laser can be used in many different ways. This is akin to giving a surgeon a scalpel. A facelift can be performed with this tool, as much as a rhinoplasty or a removal of an appendix. The laser is no different as there are multiple combinations of energy, density, and methods of delievery of the pulses.

This being said, over the past year we have used this laser with remarkable results and only 4-5 days of downtime. However, some of our patients could not even afford that kind of recovery due to there busy schedules. This has led us to develop a protocol for a no downtime fractional CO2 laser peel that works! The laser settings that we have developed allow the procedure to be performed with none of the downtime of the already low down time fractional peel.

The Express CO2 Peel is performed over a course of 3 treatments. These treatments are performed 3 weeks apart. The settings are tweaked with each treatment in order to provide the best results with no downtime. The procedure takes a total of 20 minutes to perform each time. Thus far, every patient that had this peel performed has referred friends in for the remarkable results.

Before undertaking any cosmetic procedure you must first understand what the goals of that procedure are. Since a picture is worth a thousand words, we put together this video of the Deep Plane Facelift complete with before and after photos. It explains the results of the surgery with commentary on the before and after photographs. To see videos about facelift surgery and the recovery involved. Please visit the facelift video page.

It has been said that the eyes are the window to the soul. This speaks loudly, as the goal of any facial rejuvenation procedure is to restore attention back towards the eyes. What happens when that window is missing its drapes!

We often see patients that come in and have had prior blepharoplasty or eyelid surgery, where too much fat or skin has been removed. This defeats the purpose of cosmetic surgery as it does not make you look younger. In fact it makes you look older and un-natural.

A youthful eyelid is almost always associated with fullness around the eyes. Just take a look at any current fashion magazine. Take a look at some of the famous actresses and models today. All of them, almost invariably, have fullness to their eyelids.

That being said, preservation of this fullness must be maintained whenever performing eyelid rejuvenation and blepharoplasty. This means removing just the right amount of skin from the upper eyelid, and in most cases NEVER removing fat from the lower eyelid. For this reason, I perform a fat repositioning lower eyelid blepharoplasty that moves the protruding fat downwards instead of removing it, in order to prevent that hollowed out look. This is a story for another day, but you can read more here.

So what happens if too much skin, fat, etc. has been removed? This can be a difficult problem to treat. It is restorative plastic surgery. The case below is a woman who had no extra skin or fat in her eyelids (from prior surgery), yet she looks older purely because her eyes are too hollow. Since are minds have a harder time thinking in terms of addition (adding volume), I will show you these before and after fat grafting photos to give you a better idea. Take a look at how fat grafting her periorbital region (upper and lower eyes) has given her back years of youth and restored an attractive,youthful eyelid:

The answer to the above question- none of them.

What?! Are you nuts, I can’t believe you just said that! So what do I mean by this?

Simply put, a builder does not build an entire house out of concrete, just as Michaelangelo did not paint the entire Sistine Chapel in brown.

In my opinion, for an injector/physician/surgeon/artist to properly use a facial filler, he/she must have a clear artistic vision and strategy before even beginning to inject. Filling in a deep line is rarely the solution to an overall effective method of making you look younger in the most natural way. A natural looking, youthful appearance comes down to restoring the contour of a youthful face. The proper contour is well balanced and for this reason looks completely natural.

Restylane, Perlane, Juvederm, Radiesse, Evolence, etc. are all great products. I can use these products to contour the cheeks, fill in the tear troughs, enhance the lips, soften the chin and all together improve your appearance. (Notice how I specifically did not mention filling in the nasolabial folds- more on that in a different post) However, they each have VERY unique properties that make them excellent for certain goals, yet terrible for others. Without revelaing the secrets, the best, most natural results are arrived at by combining these products in order to achieve the envisioned end result.

Just as in any surgical procedure, I first envision the appearance that I would like to achieve and then I figure out what tool to use. Facial fillers are the tools that help me achieve these results. They each are unique and have their place in my tool chest.

We are starting to see incredible results from our new Lutronic eCO2 premium laser (Fractionated CO2 Laser).  All of our patients have been thrilled with their treatment and results.  The premium eCO2 laser combines the benefits of CO2 laser technology with the benefits of limited healing time of fractionated technology (such as Fraxel).  In addition, our CO2 laser is very versatile so that I am able to alter the settings (energy forms and patterns)  in order to achieve the most desirable results.

Below is a video of one of our patients who had her Acne scars treated with the fractional CO2 laser. My philosophy on acne scar treatment is based on directing treatment based on the type of acne scar present. Since acne scars come in different varieties (shapes and forms), laser surgery for acne scars works very well on particular types of scarring patterns, but not as well on others. I will often combine modalities at the same time. Treating acne scars in this fashion leads to the best possible results.  

As time goes on, her skin will continue to build new collagen and I am looking forward to the progress.

After a very thorough review process we have introduced the latest addition to our practice, a fractional CO2 laser for skin resurfacing.  Aside from the technical and clinical reasons I chose this particular laser, I want to review why I think this technology is the biggest thing to come out in lasers since the first CO2 laser was introduced for skin resurfacing.

CO2 (Carbon Dioxide) laser skin resurfacing has been around since the 80′s.  The CO2 laser revolutionized skin resurfacing.  There is no question that CO2 laser skin resurfacing is by far and away the best laser method for facial skin rejuvenation and laser skin resurfacing.  ANY laser developed today for purposes of improving skin tone, texture, color, lines, wrinkles, sun damage and uneven skin pigmentation has to be compared to the CO2 laser because it is the GOLD standard.

So why develop new lasers if the CO2 works so well? Quite simply- the downtime and negative effects of the laser .  There is an arduous and involved 10 day healing phase after full face CO2 laser skin resurfacing. During this healing phase, new skin reforms and collagen is produced. The skin stays red for about 1 month and pink for up to 3 months after the procedure.  In addition, this laser should only be used on lighter skinned individuals as the laser itself will cause a permanent lightening of the skin called hypopigmentation.

A huge leap in laser technology came about when the idea of fractionation was introduced. Fractionation refers to the principle of dividing the laser beam into multiple tiny beams that will only treat a set percentage of the skin.  Fractionated lasers only affect a certain percentage of the skin rather then the ENTIRE surface.   1% to 100% of the skin can be treated depending on what settings are used and the laser’s capabilities.  Leaving small bridges of unaffected skin in-between the treated skin allows for a much quicker recovery. Many patients can go back to their full activities the next day and they can start wearing makeup within 4 or 5 days to resume their social activities. In addition, it virtually eliminates the risk of losing skin pigment.  In fact, fractionated technology is safe in darker skinned patients that would normally not be laser candidates.

The latest lasers combine the best of both worlds.  The power of the CO2 laser for skin rejuvenation along with the minimal downtime of the fractionated technology.  Rather then treat 100% of the skin as in with the traditional CO2 laser, a smaller percentage of the skin is treated in a grid-like pattern.

There are several of these lasers on the market including but not limited to the Lumenis Active FX and Deep FX, the MiXto laser, the Lutronic eCO2 laser, etc.  Our evaluation of the fractionated  CO2 laser is complete and we are proud introduce this technology in the platform whch we think is best based on the latest technology.  Fractional laser CO2 is safely performed in tthe comfort of our office.

As many of my patients know, I thoroughly research and investigate any new product on the market in order to provide the best possible cosmetic care to my patients.   I will only introduce something new into my practice if I think it will be better or adjunctive to what is already avaialble.  In addition, safety is a major concern for me. This way my patients know that they are getting both the best possible and safest care around.  I take this trust very seriously and it’s the cornerstone of my practice.

This being said, I am excited to announce the introduction of Dysport when it becomes available in the next couple of weeks.  Just like Botox, Dysport is a simple, in-the-office procedure that can be performed with no downtime. Dysport is a neurotoxin, just like Botox, that improves your appearance by correcting the dynamic wrinkles of your face.

I want to recap some of the potential differences between the two products. In order to best do this, we need to break down the potential benefits into several categories.

1) Effect- Which will achieve the best results- Botox or Dysport? Theoretically they both work in exactly the same fashion, so they should be about the same. Anyway you look at it, Botox is the gold standard and Dysport needs to prove that it is at least as good as Botox. Phase 3 clinical trials usually require that the new product be at least as good as the gold standard. So receiving FDA approval tells us at least that much about Reloxin.

One thing that is important to note is that Dysport has been used in the past on patients who were resistant to Botox. I have seen several patients receive no benefit from a botox injection.  Dysport was effective and beneficial for them.

Dysport is said to spread more easily then Botox. This means that it has an effect farther away from the point of injection. This could be very beneficial in some instances and not so much in others. For example, injecting the crow’s feet or the forehead may require only one injection instead of several. I see this as a moot point since I have never had a patient complain of any pain when I inject their crow’s feet. However, less injection points will lead to less bruising, in the rare instances that bruising can occur. On the other hand, there are areas where you want to minimize the spread of product, Botox may have the upper hand in these regions.

2) Longevity- As Botox lasts 4-6 months, how long will Dysport last? Several research studies have compared the two products. Anytime I look at a study of a commercial product, I pay attention to the influence of the pharmaceutical company on the study.  If the study was funded by one of the copanies, it is an obviosu bias that may impact the results. One study, which was NOT biased by support from either company, revealed that Reloxin actually lasted longer then Botox. I wouldn’t make the final conclusion just yet because other research studies have shown the opposite.

3) Price- Allergan, the makers of Botox Cosmetic, have enjoyed a competition free environment up until now. Perhaps consumers will reap benefits from increased competition in the marketplace. The pricing has come out and Dysport may have a slight advantage over Botox.

We are excited to be one of the first practices in the area to carry this product. Amazingly there is already a waiting list of patients excited about it. Please call us to reserve a spot if you are interested.

 Today Medicis has announced that Dysport has been approved by the FDA for aesthetic and therapeutic indications. Reloxin is the cosmetic name for Dysport, which has been available in Europe for some time.  Reloxin has passed through the US Food and Drug Administration’s stringent policies for use in the US.

Reloxin is the much anticipated alternative to the popular Botox cosmetic injections for treatment of wrinkles.  If you are interested in learning more about the differences, please see my earlier Blog here.