Plastic Surgery Blog

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.

Since we have seen an overwhelming inquiry into Dysport, this post is to inform you that it is now available in the 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.

One of the most important concepts in understanding facial aging is the idea of deflation. As we age, unlike in the rest of our bodies, the face loses its fullness/volume.  This exposes the underlying bone, allows the skin to sag, and contributes to an aged appearance.

Facial volume is often overlooked when thinking about rejuvenating an aged appearance. A recent research study examined the appearance of identical twins throughout life. The study revealed that the “heavier” twin appeared more youthful then their “skinnier” counterpart. To reiterate: the identical twin, who had more facial fullness, appeared younger then his or her twin, who had a less full appearing face.

The conclusion from this study is not to go out and gain weight so you can look younger. It simply illustrates the importance of volume in facial rejuvenation. This is something which I have been preaching for years now. We see the loss of facial volume begin in our 20′s and its effects are noticed by a change in our appearance as early as in our 30′s.

When I speak of facial volume in this regard, it is not about filling in lines and wrinkles, it is a matter of restoring lost facial proportions caused by volume loss- filling in the areas that have lost volume. This is an art in and of itself that restores your youthful look in a very natural appearing way.

Visit our fat grafting page for more information on this procedure or our facial filler page.

Every day patients come to my office desiring to look younger. There are so many amazing procedures, non-invasive and surgical that can be performed to make you look younger in the most natural appearing way. However, I want to dedicate this blog to a very important product that everyone in South Florida should be using daily, sunscreen.  Yes…its as simple as that- sunscreen.  There are so many products out there that are sold by the cosmetics industry, generating billions of dollars every year.  Most of them are not proven to help at all (except for a few) and are very expensive. The best thing you can do for yourself to delay the signs of aging is to protect yourself from the sun’s harmful UV rays. Oh yeah, it also prevents skin cancer!

In addition to cosmetic surgery I perform reconstructive surgery for patients who have had skin cancer removed. MOHS surgery is performed by dermatologists specially trained in the procedure.  They remove the cancer and then look under the microscope, at the same time, to make sure all of the cancer was removed. The cure rate is as high as 99%.  After MOHS surgery, a hole (called a defect) is left behind.  I repair MOHS surgery defects every week, big and small.  On a personal note, I had MOHS surgery performed on my cheek 5 years ago.  So I can tell you from personal experience, wear sunscreen! (Click to learn more about MOHS Surgery)

UV rays from the sun speed up the aging process. They caus  damage to the skin’s DNA, leading to abnormal skin pigmentation (sun spots/brown spots), fine lines, and wrinkles. Skin peels are procedures performed to treat this condition called solar aging. You will delay and perhaps avoid the need to have chemical peels or laser peels simply by using sunscreen.

The best type of sun protection you can use is sunscreen that has what is called a physical blocker. Zinc or titanium are physical blocking agents that physically blocks the sun from penetrating your skin.  The other types of sunscreens are chemical blockers, which in my opinion do not work as well.  For this reason, my line of sunscreen has a specially formulated physical blocker that in not  visible. Feel free to call my office if you need more information.

There is a new kid on the block. In the next couple of months, the FDA is likely going to approve Reloxin for a cosmetic indication to treat wrinkles. Botox received its cosmetic indication by the FDA in 2002. For the past 7 year Botox has enjoyed a competition free environment. In this same time it has rapidly grown to become the MOST commonly performed non-surgical cosmetic procedure today.

Botox is a simple and painless in-office procedure that produces remarkable results. Women and men as early as in their 20′s are reaping the benefits of Botox these days. Reloxin works in the same exact fashion.

So how do Reloxin and Botox work? The short answer is that they work by weakening the wrinkle causing muscles of the face. For those of you who love physiology, these products prevent the presynaptic transmission of acetylcholine into the synaptic cleft thus preventing muscle contraction. The results last approximately 4-6 months and the injection needs to be repeated to see continued effect and enjoy the cumulative effects of the product.

So what is the difference?
In order to better understand this we need to break down the potential benefits into several categories.

1) Effect- Which will achieve the best results- Botox or Reloxin? 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 Reloxin 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.

Reloxin 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 Reloxin last? Several studies have compared the two products. One study, which was NOT biased by support from either company, revealed that Reloxin actually lasted longer then Botox. I wouldn’t close the case file on this 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.

In summary, the anticipated release of Reloxin is exciting news in the world of facial cosmetics. Perhaps there will be a role for combining both of these products in order to achieve the best possible results.

please visit the Botox information page in order to obtain more information about Botox Cosmetic

We have added some new features to the website that I believe will enhance your experience and understanding of cosmetic surgery. I have divided the testimonials section into a written and video portion. Video testimonials will give you more insight into understanding the experience of my patients who have had facial plastic surgery. I have just added a facelift and rhinoplasty (nose job) testimonial. Keep posted as additional videos are added. I am grateful to my patients who have eagerly agreed to have their testimonials posted.

The website is updated literally every day. New pages and tools will continue to be added. I would need a team of programmers to keep up with my ideas at this point. Right now I have 2 people who work VERY hard at it. I want to thank Amit Schechter who is one of the most talented computer programmers/designers that I have come across. He never fails to impress me with his ingenuity. Thanks Amit!!