Vaping And Cosmetic Plastic Surgery | E-Cigarettes | SF Bay Area

Posted January 15, 2017 in Breast Augmentation, Breast Reduction, Facelift (Rhytidectomy), Home, Smoking and Plastic Surgery, Tummy Tuck (Abdominoplasty)

Smoking around the time of surgery can lead to increased complications.

Smoking leads to more complications after surgery.

There is ample evidence proving that smoking tobacco cigarettes increases the risk of complications after plastic surgery. Most plastic surgeons recommend that smoking be stopped four weeks before and four weeks after cosmetic surgery to reduce complications and improve healing. If you are a smoker, this may seem excessive, but even four weeks is a compromise. For example, it takes eight weeks for the immunosuppression that accompanies smoking to substantially resolve.

Since patients and doctors alike want the best results with the lowest risk of complications, stopping smoking before plastic surgery is aligned with the patients’ ultimate goal of being better, faster. In fact, even if you are not considering plastic surgery, not smoking significantly improves your health and decreases the outward signs of aging.

Smoking And General Surgery

Smoking doubles the risks associated with general surgery (operations like hernia repair, appendectomy and gall bladder removal). The glass-half-full way to look at this is that if you smoke, you can cut the risks of surgery in half by stopping smoking four to eight weeks before surgery.

General Surgery Vs. Plastic Surgery

General surgery procedures and plastic surgery procedures are different. Many general surgery procedures are emergencies, so there is little chance to stop smoking before surgery. Additionally, most general surgery operations are performed on internal organs, rather than the skin. Since general surgeons are not usually rearranging the skin, the circulation to the skin is less likely to be disturbed with general surgery procedures. The mastectomy is the most obvious exception to this rule.

Smoking And Plastic Surgery

Smoking increases the complications of plastic surgery by 600%. Plastic Surgery is Skin Surgery, so most procedures involve rearranging skin, tightening skin, stretching skin or removing excess skin. The sentinel procedures for smoking studies in plastic surgery have been Face Lifts, Breast Reductions and Tummy Tucks.

How long does it take for your body to recover from smoking? The above timeline gives just a few examples and includes the average time it takes for the health benefits to be seen.

How long does it take for your body to recover from smoking? The above timeline gives just a few examples and includes the average time it takes for the health benefits to be seen.

Face Lifts, Breast Reductions and Tummy Tucks

Face Lifts, Breast Reductions and Tummy Tucks require the formation of skin flaps. Skin flaps are sections of skin that are moved based solely on the blood supply within the skin. These vessels are extremely sensitive to smoking. When smoking, the blood vessels in the skin contract, reducing the blood flow, and the ability of the incision to heal. For these procedures, the risk of wound healing problems is not doubled like in general surgery procedure. It is increased by factor of six. Wound healing problems and skin loss are six times more likely for smokers than for non-smokers.

Is Marijuana Safer Than Tobacco?

The banner on the left was meant to convince voters that marijuana should be legalized. The banner on the right is a joke. Any questions?

The banner on the left was meant to convince voters that marijuana should be legalized. The banner on the right is a joke. Any questions?

No. In many ways, smoking a weed is smoking a weed. Both lead to increased coughing, and for most facial plastic surgery and body work, this causes real problems like bleeding and torn sutures. It is believed that the high from marijuana is directly related to the damage done to the alveoli. Just like smoking, this leads to an increased heart rate to compensate for the decreased oxygen delivery and lower than normal oxygen concentrations in the blood. Since normal oxygen delivery is better for wound healing, smoking makes healing worse. Marijuana may decrease nausea, and so does tobacco, but there are better and safer meds for the nausea associated with anesthesia. Marijuana also has psychological effects not present with tobacco, which can further interfere with the medications given around the time of surgery.

Is Vaping Safer Than Tobacco?

An actual Lucky Strike advertisement, trying to make is seem like doctors recommend them. Granted, less information about the long term effects of smoking was known then. The message of the ad is that their cigarettes are less irritating than other cigarettes; however, they still make you cough, and coughing leads to additional surgical complications. Less terrible seems to be a redundant theme in smoking advertising, begging the question that it is still terrible.

An actual Lucky Strike advertisement, trying to make is seem like doctors recommend them. Granted, less information about the long term effects of smoking was known then. The message of the ad is that their cigarettes are less irritating than other cigarettes; however, they still make you cough, and coughing leads to additional surgical complications. Less terrible seems to be a redundant theme in smoking advertising, begging the question that it is still terrible.

The long-term effects of inhaling nicotine vapor are unclear. It may be less likely to cause cancer and heart disease, but research is still early. Early in smoking’s history, it was touted as the new health craze. It is good to know the history, so that we don’t repeat it.

While there seem to be fewer noxious chemicals with e-cigarettes, questions remain about exactly what all the substances in e-cigarettes are, and what they do. The American Society of Plastic Surgery has recommended to all its members that e-cigarettes be treated the same as cigarettes until they have been proven safe. Definitive research on the effects of vaporized nicotine on the survival of skin and soft tissue flaps is not currently available. Nicotine is vasoactive, and inhaling nicotine vapor may have similar effects on skin circulation as inhaling the nicotine in cigarettes. When it comes to your appearance and your health, why take unnecessary risks?

What Do Most Plastic Surgeons Recommend?

It may seem like I am being hard on smokers, but these are not theoretical risks. I have seen Tummy Tucks go from perfect to purple after half a cigarette. I have replanted fingers successfully, only to have a patient go home, weeks later, smoke and have his finger turn black and fall off. Smoking caused the blood vessels in the skin to contract to the point of not working. These are preventable injuries, and there is no better medicine than prevention.

Most plastic surgeons recommend stopping smoking four weeks before and after any procedure that involves skin flaps. The most common cosmetic skin flap procedures are Face Lifts, Breast Reductions and Tummy Tucks. The risks of wound healing problems is six times higher in smokers when compared to non-smokers having these types of procedures.

When the incision used is only an access point, i.e. no skin flaps, like Breast Augmentation, your risks are only doubled from smoking. Only doubled. Think about that.

While most plastic surgeons will operate on smokers for non-skin-flap type cosmetic procedures, it is still better to stop at least four weeks before surgery. And if you can stop for four weeks, there is no reason to restart. Only 15% of Californians currently smoke cigarettes. This is an all-time low, but with the recent passage of Proposition 64, we will have to see if the decline in smoking will continue.

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Chin and Neck Enhancement | Facial Plastic Surgery | San Francisco Bay Area

Posted January 09, 2017 in Chin Implants/Augmentation, Facelift (Rhytidectomy), Facial Augmentation, Home, Liposuction, Neck Lift (Rhytidectomy)

The Chin and the Neck are neighbors, so it makes sense that when Plastic Surgery is being considered to enhance one, the other should also be evaluated. This San Francisco Plastic Surgery Blog post considers three patients who presented to my Walnut Creek Plastic Surgery Clinic. Each of them had different problems, but all of them wanted something to improve the profile of their necks.

Neck Liposuction Before and After Pictures

The full neck responds well to Neck Liposuction, as long as the skin tone is good. This is demonstrated by the Neck Liposuction Before and After Pictures shown above.

The “full” neck responds well to Neck Liposuction, as long as the skin tone is good. This is demonstrated by the Neck Liposuction Before and After Pictures shown above.

The Full Neck

The ideal Neck Liposuction patient is someone who has disproportionate fat under their chin and good skin tone. The excess fat can be safely and predictably removed with Liposuction, and elastic skin will easily shrink-wrap to the new, tighter profile.

The first patient, whose neck profile is shown in the above Neck Liposuction Before and After Photos, is a good candidate for the procedure. There is excess fat and the skin tone is good enough to show-off the new and improved contour. The definition between the face and neck is enhanced, and the angle of the neck is better defined. What happens when there is not a lot of excess fat, or when there is just too much skin? Read on; the next two examples explain.

Neck Liposuction With A Chin Implant Before and After Pictures

A weak chin can affect the neck profile. When the chin is small, it decreases the definition between the chin and the neck. In the case above, Neck Liposuction was combined with a Chin Implant to maximize the definition and the results.

A weak chin can affect the neck profile. When the chin is small, it decreases the definition between the chin and the neck. In the case above, Neck Liposuction was combined with a Chin Implant to maximize the definition and the results.

The Small Chin and the Full Neck

Sometimes, the appearance of the full neck is compounded by a weak chin. With less area, it takes less fat to fill the neck. Liposuction alone would provide some improvement, but would be less effective than it is for someone with a proportionate chin. The Neck Liposuction With Chin Augmentation Before and After Pictures above show what the combination can accomplish.

In the above example, the excess fullness of the neck is removed with Liposuction. The profile is further improved by increasing the projection of the chin with a well proportioned Chin Implant. The “ideal” position of the chin on profile is equal to the projection the lower lip.

Neck Liposuction With A Neck Lift Before and After Pictures

Sometimes there is too much skin for Liposuction to be successful. In the Neck Liposuction with Neck Lift Before and After Pictures shown above, a Neck Lift was used to remove the excess skin, and to reveal the contour created by removing the excess neck fat with neck liposuction.

Sometimes there is too much skin for Liposuction to be successful. In the Neck Liposuction with Neck Lift Before and After Pictures shown above, a Neck Lift was used to remove the excess skin, and to reveal the contour created by removing the excess neck fat with neck liposuction.

Neck Liposuction With A Neck Lift

In cases when disproportionate neck fat is combined with excess neck skin, a Neck Lift or Face Lift is used with Neck Liposuction to give the best results. Liposuction alone would leave the neck skin deflated, like a loose sail of skin. By adding a skin lift, the excess is removed, and the skin that remains is tight to the newly sculpted neck profile.

Neck Enhancement Consultations

The secret to excellent Neck Contouring results is a combination of good technique and selecting the procedure that is right for your neck. There are many procedures which can be used to improve the profile of the neck, and searching them all on the Internet can be confusing. Let a qualified and experienced Board Certified Plastic Surgeon be your guide.

If you would like to learn more about what Plastic Surgery can offer you, call (925) 943-6353 today, and schedule a private, personalized consultation appointment in my San Francisco Bay Area Plastic Surgery Clinic.

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What To Do Before Cosmetic Plastic Surgery

Posted November 13, 2016 in Home, Patient Safety, Smoking and Plastic Surgery

Last week, I blogged about What to Expect After Breast Augmentation Surgery. Well, several of my proactive patients wanted to know what they could do before surgery to help their recovery. Great question, so today we are talking about how to plan for your Cosmetic Plastic Surgery.

How To Prepare For Cosmetic Plastic Surgery

First and foremost, Cosmetic Surgery is elective. Since you are making the choice to proceed, you should also plan to succeed with a quick and safe recovery. Making a few arrangements and taking a few precautions can really boost the safety and predictability of your procedure.

Timing Is Everything

timing

Very few of us have a plethora of free time. Recovery takes time, and giving yourself adequate time for recovery is very important. For some procedures, doing too much activity will increase swelling and discomfort, for others, it can reverse the progress made with your procedures. Be sure to ask your Board Certified Plastic Surgeon about how much time you will need and what precautions to take, specific to your body and your procedure.

Plan Ahead

You want to arrange your schedule so that you have the time necessary to take care of yourself. So get your resources organized early, and have your recovery tools ready. Ice packs, prescriptions and a little help from your friends should all be arranged before surgery. With the crack-down on the abuse of prescription drugs, it can take more than one visit to the pharmacy to get pain pills. If you have small children, additional child-care may be very helpful during the days after surgery. Preparing a few days of meals that can be easily warmed up can also help.

Eat A Healthy Diet

dieting

Eating healthy is always a good idea, but it is especially important to consume the building blocks your body needs to heal. Balance is important, and more is not better. Supplementing in situations were vital elements of nutrition are lacking can be important, but filling these needs through a healthy diet is always the first choice. In certain situations, like after Bariatric Surgery, certain nutrients may need to be supplemented to make up for the malabsorption these procedures are designed to produce.

Hydration is equally as important. Dehydration contributes to increased nausea after surgery, so stay hydrated before and after surgery. Dehydration after surgery leads to lower blood pressure, decreased circulation and slower healing.

Stop Smoking

In case you haven’t heard this yet, smoking is bad for you. If you’re a smoker, smoking cessation will improve your results, your recovery and your health in general. For some operations, smoking increases your risk of wound healing problems by 600%, and most Plastic Surgeons will ask you to stop at least four weeks before and after them.

no_smoking

Operations that have a problem with smoking include:

Smoking tobacco is bad, but smoking marijuana may be worse, because unlike cigarettes, pot often it is inhaled completely unfiltered. Even casual pot smoking, now legal in California, will restrict the blood flow to the surgical site, leading to decreased healing, prolonged inflammation and swelling and a reduced result. Marijuana is not the only herb you should avoid before surgery.

Avoid Things That Will Make You Bleed

Certain medications, supplements and herbal remedies are known to increase bleeding. You should review your diet, and everything thing else you take before your surgery. Many herbal remedies seem harmless, but those derived from root and bark often contain salicylates, which will make you bleed just like aspirin can. You can find lists of supplements to avoid on the Internet, like this short List from the Otolaryngologist at Stanford, but the best thing to do it to bring all your medications, herbs and supplements to your pre-op visit for your surgeon to review.

It’s Harder To Hit A Moving Object

potatoes

Keep moving. The better shape you are in before surgery, the easier it will be to get up and move after surgery, too. Be certain to follow your surgeon’s limitation for activity, but do not become a “couch potato”. Early ambulation has been shown to decrease the risk of problems like pneumonia and blood clots, but it will also make you feel better faster. Humans were not designed to sit around.

Ask Your Surgeon

Be certain to ask your surgeon what you can do to speed your recovery. They can tailor their recommendations to you and your surgery, and help you feel better faster. If you are considering Cosmetic Plastic Surgery in the San Francisco Bay Area, give me a call at (925) 943-6353, and we can go over all the details, together.

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The Neck Lift – Opened Or Closed? – SF Bay Area

Posted May 01, 2016 in Facelift (Rhytidectomy), Home, Liposuction, Neck Lift (Rhytidectomy)

Natural Facial Rejuvenation  depends on selecting the best techniques to correct the natural signs of aging. The Neck Lift is usually combined with the Face Lift to maintain facial harmony, as is shown in the before and after pictures shown above..

Natural Facial Rejuvenation depends on selecting the best techniques to correct the natural signs of aging. The Neck Lift is usually combined with the Face Lift to maintain facial harmony, as is shown in the before and after pictures shown above.

Plastic Surgeons and Facial Plastic Surgeons alike have for decades debated the benefits of opened and closed approaches for Facial Rejuvenation. Most often, open vs. closed is debated for Rhinoplasty (Cosmetic Nasal Surgery), but at the most recent American Society for Aesthetic Plastic Surgery meeting in Las Vegas, the open vs. closed debate centered around Neck Lifts.

The Annual Aesthetic Meeting attracts thousands of Cosmetic Plastic Surgeons from around the world.

The Annual Aesthetic Meeting attracts thousands of Cosmetic Plastic Surgeons from around the world.

The American Society for Aesthetic Plastic Surgery

The American Society for Aesthetic Plastic Surgery (ASAPS) is over 2600 Plastic Surgeons strong. Most members are from the United States and Canada, but many countries are represented. Only about one-quarter of all American Board of Plastic Surgery certified surgeons have been accepted as ASAPS members. The ASAPS is the largest plastic surgery society dedicated exclusively to the Cosmetic side of Plastic Surgery. Most members, like myself, are also members of the American Society of Plastic Surgeons (ASPS). The ASPS represents both cosmetic and reconstructive plastic surgeons and has over 8000 members. The ASPS represents about 94% of all Board Certified Plastic Surgeons in the United States.

The Las Vegas Plastic Surgery Debates

The nice thing about a society dedicated to just the aesthetic aspects of plastic surgery is that we can focus on Cosmetic Surgery. There are many scientific sessions, expert panels and instructional courses offered over the week long meeting, each dedicated to a specific aspect of what Plastic Surgeons do. Every procedure is covered, often with multiple sessions exploring every aspect of every technique. Since there is often more than one way to do each procedure, lively debates are common, and some of these debates have been going on since long before I started my San Francisco Bay Area Plastic Surgery practice.

The Neck Debate – Open Vs. Closed

One such on going debate explores the various approaches to Neck Rejuvenation. Neck Lifts seem easy enough, but they are one of the more challenging areas to correct. Just about everyone over 40 has tried lifting their neck at least once or twice in the mirror, but making the change long lasting, without distortion, is the challenge. Several Neck Lift techniques exists, but they are usually divided into two main groupings – Closed Neck Lifts and Open Neck Lifts.

Closed Neck Lifts

There is a tremendous amount of crossover between Neck Lifts and Face Lifts, and since the face and neck age together, the Neck Lift and Face Lift are usually combined to maintain facial proportions and harmony. The term Rhytidectomy (literally wrinkle removal) is used for Neck Lifts, Face Lifts and even Brow Lifts.

When the neck has loose skin without platysmal bands, a Closed Neck Lift may be the best option. If disproportionate fat is present, Liposuction can be used to sculpt an even smoother contour.

When the neck has loose skin without platysmal bands, a Closed Neck Lift may be the best option. If disproportionate fat is present, Liposuction can be used to sculpt an even smoother contour.

Closed Neck Lifts are similar to what we do in the mirror. The skin is tightened in the direction of the jaw line, and the excess is removed to hold the smoothed skin in place. This reduces the loose skin under the chin (the waddle or turkey gobbler), reduces jowls and better defines the junction between the face and neck. For closed neck lifts, the skin is opened around the ears like for a Facelift, but the neck is left closed.

Open Neck Lifts

The platysma is a flat muscle that supports the neck skin.  Often it is separated in the midline. As we age, we see this separation as Platysmal Bands, the two cords running down the front of the neck. One goal of the Neck Lift is to diminish to appearance of these bands.

The platysma is a flat muscle that supports the neck skin. Often it is separated in the midline. As we age, we see this separation as Platysmal Bands, the two cords running down the front of the neck. One goal of the Neck Lift is to diminish to appearance of these bands.

Open Neck Lifts do everything a closed neck lift does, but also include an incision under the chin. The opening allows for direct adjustment of the superficial fat and muscles under the chin and down the front of the neck. When platysmal bands are present, the two cords of skin that run from under the chin down the front of the neck, they can be “repaired” through an open technique. Excess fat can also be removed, and we Plastic Surgeons debate how much and from which levels fat removal is most effective, yet still safe and predictable.

Minimally Open Neck Lifts

I add a third class of Neck Lift to my treatment algorithm: the Open-But-Just-A-Little-Bit Neck Lift. This is a combination of a Closed Neck Lift with Liposuction of the neck. It can accomplish much of the fat removal of the open technique through a much smaller incision. When disproportionate fat is present beneath the chin, Liposuction can be a useful adjunct to tightening up the skin. In this case a small incision is made under the chin to allow the fat to be suctioned, but not big enough to look through or repair the platysma muscle.

Most Plastic Surgeons Use Multiple Approaches

In our yearly ASAPS debates, Plastic Surgeons choose techniques and debate the pros and cons, but in reality most of us use multiple techniques. The choice depends on what our patients need. This month I have used techniques from all three categories of Neck Lifts listed above. I choose different techniques for different patients depending on what is broken, and what I have to fix.

How To Choose The Best Neck Lift For Your Neck

If you are considering a Neck Lift, it is helpful to have an idea of what your options are. Some problems respond better to specific techniques. If loose skin is the main problem, a closed technique may be the best. Platysmal bands may respond better to an open technique, while disproportionate fat may respond to liposuction.

The Internet provides lots of information, but trying to choose your own technique is a bit like trying to pick the wrench your plumber is going to use. Get a working knowledge of what is possible and get the help of a professional. Choosing the best Board Certified Plastic Surgeon is much more important than choosing the best technique. Getting multiple opinions can help, but you will likely learn that multiple approaches are possible. Having multiple choices can be a source of confusion, and this is why you need the best Plastic Surgeon.

Neck Lift Consultation

If you are in the greater San Francisco Bay Area, and would like to come into my Walnut Creek, CA, office for a Neck Lift evaluation, give me a call at (925) 943-6353. During your private consultation we will review your expectations and explore your options, so that the best Neck Lift for you can be selected.

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2015 Plastic Surgery Statistics

Posted March 20, 2016 in Breast Augmentation, Breast Lift (Mastopexy), Breast Reduction (Men), Eyelid Lift (Blepharoplasty), Facelift (Rhytidectomy), Home, Liposuction, Plastic Surgery Societies, Rhinoplasty (Nasal Surgery), Tummy Tuck (Abdominoplasty)

The numbers are in and America, you like Plastic Surgery. The American Society for Aesthetic Plastic Surgery has released the data collected for Cosmetic Plastic Surgery performed in 2015.

Plastic Surgery 1997 – 2015

When I started my San Francisco Bay Area Plastic Surgery practice in 1997, cosmetic procedures were performed one eighth as often as they are today.

When I started my San Francisco Bay Area Plastic Surgery practice in 1997, cosmetic procedures were performed one eighth as often as they are today.

In 1997, over 1.6 million cosmetic plastic surgery procedures were performed, and most of them were surgical. The breakdown was 55% (900,933) surgical and 45% (740,751) non-surgical.

In 2015, almost 13 million cosmetic plastic surgery procedures were performed. The number of surgical procedure performed more than doubled, from 900,933 to 1,912,468. Percentage-wise, however, surgery slipped to only 15% of all cosmetic procedures. There was a tremendous surge in the number of non-surgical procedures performed driven by new technology and expanded FDA approval. In 2015 10,879,909 non-surgical procedures were performed, a 1400% increase.

Non-surgical Plastic Surgery Procedures Then and Now

The nonsurgical procedures of 1997 were not the same as today’s. The sole filler was collagen, which only lasted a few weeks, sometimes months. Botox was available, but the use of Botox for wrinkles was not FDA approved. In 1997, using Botox for frown lines and wrinkles was strictly an off label, use confined to selective Dermatology and Plastic Surgery practices (like mine).

In 2016, there are a variety of FDA approved fillers are available, each lasting months, sometimes years. The most commonly used dermal fillers are Hyaluronic Acid based including: Restylane, Juvederm, Restylane Lift (Perlane), but Radiesse (Calcium Hydroxyapatite spheres) has also emerged for boney augmentation (Cheeks and Chins) and the nasolabial folds. Botox is FDA approved for wrinkles, and is now found in just about every spa in the San Francisco Bay Area.

Surgical Plastic Surgery Procedures Then and Now

Unlike their non-surgical counterparts, the majority of the surgical procedures performed today are largely the same. New techniques and material (sutures and implants), have developed, but the most popular procedures of 1997 are the most popular procedure of 2015 too. To date, they have not been replaced by non-invasive procedures because non-invasive procedures cannot accomplish the same results. Women continue to dominate men in numbers, so let’s break down the procedures desired by each sex.

Plastic Surgery for Women

The headlines read that Buttocks Augmentation is the fastest growing cosmetic surgery. The 30% increase is statistically true, but is magnified by the fact that not as many Buttocks Augmentation are done as Breast Augmentation. Looking at the number of cases performed in 2015 reveals the popularity of the procedures:

  • Buttocks Implants – 5678
  • Buttocks Lifts – 5008
  • Brazilian Butt Lifts (Fat Grafting to the Buttocks) – 15,705
  • Breast Implants – 305,856

Comparing Buttocks to Breast Augmentation, if 3000 more Brazilian Butt Lifts are performed this year, that will almost be a 20% increase. On the other hand, if 3000 more Breast Augmentations are performed, that will be an increase of less than 1%. It’s all relative to how many procedures are performed.

The most popular Cosmetic Plastic Surgeries for women  are Liposuction (Suction Assisted Lipectomy), Breast Augmentation (Augmentation Mammoplasty), Tummy Tuck (Abdominoplasty), Breast Lift (Mastopexy) and Eyelid Lift (Blepharoplasty).

The most popular Cosmetic Plastic Surgeries for women are Liposuction, Breast Augmentation, Tummy Tuck, Breast Lift and Eyelid Lift.

The most popular Cosmetic Plastic Surgery procedures from women have been pretty consistent over the last 18 years:

When the men are added, these five procedures account for 1.2 million of the 1.9 million cosmetic surgeries performed in 2015.

Plastic Surgery for Men

Men account for about 10% of all the cosmetic plastic surgeries performed in the United States.

The most popular Cosmetic Plastic Surgeries for men are Liposuction (Suction Assisted Lipectomy), Nose Surgery (Rhinoplasty), Eyelid Lifts (Blepharoplasty), Male Breast Reduction (Gynecomastia Reduction) and Facelifts (Rhytidectomy).

The most popular Cosmetic Plastic Surgeries for men are Liposuction, Nose Surgery, Eyelid Lifts, Male Breast Reduction and Facelifts.

The most popular Cosmetic Plastic Surgery procedures from men are also pretty consistent over the last 18 years, but there has been a proportionately larger increase in Gynecomastia Reduction:

Since men do not get pregnant, procedures like Breast Augmentations, Breast Lifts, Tummy Tucks and other Mommy Makeovers are not as often needed.

Comparing the male and female procedures, Rhinoplasty, Facelifts and Breast Reduction are pushed out of the top five by Mommy Makeovers; however, they are next. Cosmetic nasal surgery was number 6; Facelifts was number 7, and breast reduction was number 8 for women. When it comes to Cosmetic Plastic Surgery, men and women seem to want the same things.

Cosmetic Plastic Surgery Consultation

If you are considering Cosmetic Plastic Surgery in the San Francisco Bay Area, call (925) 943-6353 today, and schedule a private consultation appointment. Every consultation is tailored to your specific needs. The decision to proceed, or even to explore, cosmetic surgery is personal. My goal is to provide you the information you need to make your own informed decision.

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How to Help Your Face – San Francisco Bay Area

Posted January 24, 2016 in Botulinum Toxin (Botox Dysport Xeomin), Chemical Peels, Eyelid Lift (Blepharoplasty), Facelift (Rhytidectomy), Fillers (Restylane Juvederm Perlane Radiesse), Home, Rhinoplasty (Nasal Surgery), Smoking and Plastic Surgery, Wrinkle Reduction (Non-surgical)

If we are lucky, Facial Aging is something we all experience. It can present as changes in skin tone or coloration, fine lines or deeper wrinkles, and even loose or saggy skin. It happens, if we stick around long enough. While Facial Aging cannot be altogether prevented, how you look is influenced by how you treat your skin. Some of our normal daily activities help, while others hinder the effects of time.

Good Genes and Bad Habits

We all know someone who never wears sunscreen, drinks, smokes and whose skin looks great. It’s hard to beat youth and good genes, but you can if you try hard enough. Skin likes Protection, Hydration and Circulation, so here’s how to earn your PhC in beautiful skin:

  • Protect your skin. It protects you.Protection – Prevention is the best medicine, and this is true for your skin, too. While we need a small amount of sunlight to activate vitamin D, the amount we subject our skin to, especially when we are young, is excessive. The high-energy ultra-violet light in the sun’s rays breaks the DNA inside the skin cells. At a minimum, sunshine dehydrates the skin, but it also damages the elastic fibers that keep skin supple, reduces the skin’s ability to heal itself and if too much damage is done, leads to the development of skin cancer. We would all treat cancer after it’s found, but why not treat it before it starts, by protecting your skin?

    Skin cancer can occur even where the sun does not shine, but it is most commonly found in areas exposed to the sun. Moreover, the risk of Skin Cancer increases with the amount of sun exposure. Today, sunscreen is incorporated into many moisturizers, cosmetics and even fabrics. Hats and long sleeves help, but sunscreen is a must. Personally, I could not survive a trip to Hawaii without sunscreen, a hat and a swim shirt. When I was young, it may not have made me look cool, but it did allow me to have fun with my friends without a week of recovering from sunburns. Now, if you go to the beach, sunscreen and sun shirts are common, and using them shows that you care about your body.

  • Your skin likes being hydrated.Hydration – Our skin keeps us from drying out, but it is not impermeable. I remember a junior high school science project during which we placed a plastic bag over one hand. The water that is normally lost through the skin was trapped in the bag. It made it quite clear that we are constantly dehydrating.

    If you’ve ever watched Naked and Afraid, or any of the other survivor “reality” shows, you know that water is more important than food. Keeping hydrated keeps us healthy. It improves circulation and allows the body to rid itself of toxins. Alcohol, on the other hand, tends to dehydrate us, so all things in moderation.

    You can help your skin by using a moisturizer. Moisturizers do not supply moisture to the skin, but trap the normal water that is lost through the skin. Petroleum Jelly (Vaseline) is very effective. It certainly helps injured skin heal with better scars, but its sheen is a bit obvious and it greasiness makes using vaseline quite messy. Most moisturizers are not as good as Vaseline, but are easier to live with. It’s a compromise.

  • Good circulation makes for healthy skin.Circulation – Good hydration promotes good circulation. The blood is mostly water, and when we are dehydrated the skin suffers more than another other organ. Circulation is also effected by our habits. Good habits, like daily exercise, promotes increased circulation and may improve the look of our skin, too. Bad habits, like smoking, decreases circulation, and the skin is especially hard hit.

    As a Cosmetic Plastic Surgeon, I am operating on the skin, and I need healthy skin and circulation to get the best results. Several cosmetic operations are known to have increased risk in people who smoke. For procedures like Face Lifts, Breast Reduction and Tummy Tucks, smoking increases the risk of wound healing problems by six-fold. Because of this, Plastic Surgeons recommend smoking stop at least four weeks before and after any elective surgery. If you can quit smoking for surgery, you can quit for life, literally your life.

Good Genes and Good Sense

There are many simple actions we can take to keep our face and skin happy, and earn our skin a PhC. You have probably heard many of them before, like eating right and sleeping, but good advice only works if you act on it. I will share additional pearls in additional posts.

With the title How to Help Your Face, you might have thought I was going to review all the plastic surgery options for Facial Rejuvenation. That information is certainly available here on the the San Francisco Plastic Surgery Blog. The most common, Eyelid Surgery (Blepharoplasty), Face Lifts (Rhytidectomy), Nasal Surgery (Rhinoplasty), Chemical Peels, Fillers and even Botox, all work better with skin that is cared for.

If you would like to learn more about Facial Plastic Surgery procedures, feel free to follow the links in this post article to access more information, or give me a call at (925) 943-6353, to schedule a personal consultation appointment at our San Francisco Bay Area Plastic Surgery office in Walnut Creek, CA.

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Counterfeit Botox is Back Bay Area

Posted April 25, 2015 in Botulinum Toxin (Botox Dysport Xeomin), Chemical Peels, Facelift (Rhytidectomy), Fillers (Restylane Juvederm Perlane Radiesse), Home, Patient Safety, Wrinkle Reduction (Non-surgical)

The real Botox bottle and box have many security features to prevent counterfeiting.

The real Botox bottle and box have many security features to prevent counterfeiting.

Botulinum Toxin remains the number one non-surgical cosmetic treatment year after year. In 2014, 3,588,218 neuromodulating wrinkle treatments were reported by the American Society for Aesthetic Plastic Surgery alone. Botulinum Toxin Treatments were more popular than the next four nonsurgical beauty treatments combined:

The Top Five Nonsurgical Cosmetic Procedures

  1. Botulinum Toxin (Botox, Dysport, Xeomin, Myobloc) – 3,588,218
  2. Hyaluronic Acid (Restylane, Juvederm, Perlane, etc…) – 1,696,621
  3. Hair Removal (Laser or Pulsed Light) – 828,480
  4. Chemical Peel (TCA, Phenol) – 484,053
  5. Microdermabrasion – 417,034

Counterfeit Botox

The latest counterfeit Botox bottles look a lot like the old Botox bottles. They are taller, thinner, lack holograms, lack unique lot numbers, lot numbers on bottle and box may not match and they have "Botulinum Toxin Type A" instead of "Botox Cosmetic OnabotulinumtoxinA."

The latest counterfeit Botox bottles look a lot like the old Botox bottles. They are taller, thinner, lack holograms, lack unique lot numbers, lot numbers on bottle and box may not match and they have “Botulinum Toxin Type A” instead of “Botox Cosmetic OnabotulinumtoxinA.”

When I say, “Counterfeit Botox,” I am not talking about competitive brands of FDA approved Botulinum Toxin. Botox was the first to market in the US, while Dysport was the first to market in Europe. Both are FDA approved, as are two others:

  • Botox® (onabotulinumtoxinA)
  • Dysport® (abobotulinumtoxinA
  • Xeomin® (incobotulinumtoxinA)
  • Myobloc® (rimabotulinumtoxinB)

FDA Approved Botulinum Toxin – What’s The Difference?

Dysport was the first to market in Europe, second in the US and is also FDA approved.

Dysport was the first to market in Europe, second in the US and is also FDA approved.

There is a big difference between FDA approved Botulinum Toxin and everything else fraudulently making the claim. The approved drugs are deemed safe and effective when administered in the prescribed fashion by a qualified and experienced injector. These drugs have been tested, and are manufactured under the supervision of the FDA. Their factories are open to surprise inspection at any time, and the distribution can be stopped when problems are found.

Counterfeit Botulinum Toxin on the other hand, is not manufactured with the same quality controls. It may not contain any Botulinum Toxin, and when it does, the dosing can range from ineffective to lethal.

How to Avoid Counterfeit Botox

You get what you pay for, and beauty is not cheap. If an offer seems too good to be true, it’s most likely false. It takes experience to become a good injector, so look for an established practice with experienced injectors. Ask questions:

  • How many Botox injections do you do a month?
  • How long have you been performing Botox injections?
  • What is your training?
  • Can I see the bottle? (for Botox look for the Allergan hologram)
  • How long between mixing the Botox and Administration?

Reputable doctors will be happy to explain. Grumpy or evasive responses are a red flag.

Wrinkle Ridding Consultations

As a Board Certified Plastic Surgeon, I perform everything from Botox to Facelifts. Botox is usually performed in the office on the third Wednesday of each month. It’s a busy day, but it allows me to use Botox or Dysport within a few hours of mixing, so nothing gets stale. If you are interested in Botox, Fillers or Surgical Correction of Facial Wrinkles, give me call at (925) 943-6353. More Plastic Surgery Information is available on our newly revamped and mobile friendly web site: DrMele.com.

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Face Lifts & Neck Lifts on SF Bay Area’s KRON 4 Body Beautiful

Posted January 31, 2015 in Chemical Peels, Facelift (Rhytidectomy), Facial Augmentation, Fat Grafting, Fillers (Restylane Juvederm Perlane Radiesse), Home, Mini Facelift (Mini Rhytidectomy), Videos, Wrinkle Reduction (Non-surgical)

The Face Lift is the apex of Facial Plastic Surgery. Like many Plastic Surgery procedures, the more it does and the less it’s noticed, the better we like the results.

Face Lifts Neck Lifts and More on Body Beautiful

I had the opportunity to talk about Facial Rejuvenation on The San Francisco Bay Area’s News Station KRON 4’s Body Beautiful, host Janelle Marie and I discussed:

  • Face Lifts
  • Neck Lifts
  • Dermal Grafts
  • Facial Fillers
  • Chemical Peels
  • Laser Resurfacing

Unfortunately, we had technical issues with the Face Lift Before and After Pictures. You can see some of my work by clicking the link above, or visiting the Cosmetic Plastic Surgery Before and After Gallery on DrMele.com.

Face and Neck Lift Video Presentation

What Can A Face Lift / Neck Lift Do?

It’s easy to see what a facelift can do, try a “six finger face lift”. You can do it right now. All you need is a mirror and two hands. Place the tip of your index finger on the angle of your jaw, the tip of the thumb under the the jaw and the middle finger on the cheek. Gently, push your facial skin up and back to tighten the neck, smooth out the jowls and lift the cheek.

How Is The Rhytidectomy (Face Lift / Neck Lift) Performed?

There are almost as many methods of Face Lifts and Neck Lifts as there are Plastic Surgeons performing them. Most of them are variations on two basic methods, lifting just the skin or incorporating the deeper layers. There are pluses and minuses to each method, which need to be discussed in detail tailored specifically to your face. However, no matter which technique is selected, even the Mini Face Lift takes longer then the “six finger face lift” described above.

Rhytidectomy (Facelift and Necklift) Consultations

There are many methods of lifting the face. My goal is to provide the best results in the safest and most predictable way possible. I prefer to use the simplest method that will work. For the best results, there needs to be the proper balance between the problem and the solution. A big lift for a small problem can lead to a tight or “over done” appearance. On the other hand, sometimes less is just too little.

Call (925) 943-6353 to schedule a private consultation at my San Francisco Bay Area Plastic Surgery office in Walnut Creek, CA. You can also send your questions via the contact form in the column.

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FaceTime and Face Lifts (Rhytidectomies) | SF Bay Area

Posted December 27, 2014 in Facelift (Rhytidectomy), Home, Mini Facelift (Mini Rhytidectomy)

Media is buzzing about the Selfie leading to more Plastic Surgery. It is no secret that Selfies and FaceTime allow us to view ourselves and our faces in a new way. Perhaps we are seeing ourselves a little more often because of video chat services like FaceTime, Skype and Google Hangouts. On the other hand, mirrors, photographs and video have been around much longer. The ability to compare past and present in visual form has often provided the motivation for self improvement, and portable video chat technology is yet another way for us to see how we look to others.

Are Selfies and FaceTime driving a surge in Facelifts?

Are Selfies and FaceTime driving a surge in Facelifts?

Physiognomy

Physiognomy (from the Gk. physis meaning “nature” and gnomon meaning “judge” or “interpreter”) is the assessment of a person’s character or personality from his or her outer appearance, especially the face. Physiognomy is a double edged sword. It is part of forming a first impression when we meet someone new. It is a starting point that helps us to interpret whether someone is friend or foe. Study after study shows that initially we prefer attractive faces. This is not a learned behavior and can be demonstrated in infants as young as 6 months of age. While Physiognomy becomes less important for relationships after we get to know someone, it is an initial metric that is undeniably inherent in being human.

Facelifts and Job Opportunities

Studies of job interviews show that all other variables being equal, attractive people are more likely to get the job and to get the promotion. Attractive sales people are more likely to make the sale. Many of my San Francisco Bay Area Plastic Surgery patients mention the desire to maintain a successful career as part of the reason for getting Plastic Surgery. One of the more popular procedures as we get older is the Facelift or Rhytidectomy.

What Does the Face Lift Do?

Facelifts can reverse signs of aging and remove lines associated with worry, fatigue and even anger.

Facelifts can reverse signs of aging and remove lines associated with worry, fatigue and even anger.

The Facelift is unique in that it can reverse signs associated with aging and diminish facial animation lines associated with fatigue, disinterest, anger or worry.

Face Lift or Neck Lift?

Neck Lifts and Face Lifts both treat the neck. The procedures are very similar, and they are usually performed together, so really you don’t have to choose between the two. The difference in the names is more an indication of where the emphasis is placed, rather than a difference in techniques. Below is a view of the face not usually seen on FaceTime or in a Selfie, but is often seen in the photographs patients bring in as an illustration of what they want fixed. Often, pre-Facelift and pre-Rhinoplasty patients will purposefully avoid profile pictures until after their procedures.

Before and After Neck Lift as seen from the side. Loose skin under the chin is removed and the angle between the neck and chin is improved. Facelifts also improve jowls, clean-up the jawline and reduce the loose skin that accumulates around the mouth and sides of the nose as we age.

Before and After Neck Lift as seen from the side. Loose skin under the chin is removed and the angle between the neck and chin is improved. Facelifts also improve jowls, clean-up the jawline and reduce the loose skin that accumulates around the mouth and sides of the nose as we age.

Facial Rejuvenation Consultation

When considering a Face Lift, Neck Lift, Mini Facelift or any other Facial Plastic Surgery, be certain to get the advice of an experienced and Board Certified Plastic Surgeon. We Board Certified Plastic Surgeons dedicate our professional lives to learning and refining the techniques specific to Facial Rejuvenation and applying these techniques uniquely for each of our patients, and it’s a great job to have.

During your personal Face Lift Consultation, you can expect a frank discussion of not just the risks and benefits of the procedure, but more importantly the options available to correct the aspects of your appearance that you would like to see improved.

To schedule your private consultation, call (925) 943-6353, or use the contact form in the margin.

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Can Old People Have Plastic Surgery?

Posted November 08, 2014 in Breast Augmentation, Facelift (Rhytidectomy), Home, Tummy Tuck (Abdominoplasty)

Many people have Plastic Surgery, but is it safe for “old” people? Should there be an age limit on Cosmetic Surgery? Recent research shines a spotlight on the question, and what is reveals is very encouraging.

How Old is Too Old for Plastic Surgery?

The woman above is a patient of Dr. Suzanne Noel, a French Plastic Surgeon who was doing "lunchtime facelifts" in her apartment one-hundred years ago.

The woman above is a patient of Dr. Suzanne Noel, a French Plastic Surgeon who was doing “lunchtime facelifts” in her apartment one-hundred years ago.

How old is too old for Plastic Surgery? is a question I hear every week in my San Francisco Bay Area Plastic Surgery Office. My standard answer has always been that your health is more important than your age, and research presented at this year’s American Society of Plastic Surgeons meeting in Chicago backs that up.

Dr. Suzanne Noel, pictured above, was a gifted Plastic Surgeon and one of the first to perform outpatient surgery. Thankfully, today we use gloves. In 1924 she founded Soroptimist International Paris, the first Soroptimist club in Europe. The very first Soroptimist club was founded in 1921, in nearby Oakland, California.

Dr. Suzanne Noel, pictured above, was a gifted Plastic Surgeon and one of the first to perform outpatient surgery. Thankfully, today we use gloves. In 1924 she founded Soroptimist International Paris, the first Soroptimist club in Europe. The first Soroptimist club was founded in 1921, in nearby Oakland, California.

How Old is Old?

For me, the age at which someone is “old” gets a little higher every year. Perhaps, it is because my reference changes with my age. For the paper, Safety of Cosmetic Procedures in Elderly and Octogenarians Patients, the young group had an average age of 39 (+/- 12.5 years), and the elderly group had an average range of 69 (+/- 4.1 years). Investigators reviewed the outcomes of 183,914 people who underwent cosmetic surgery.

Differences Between the Young and Elderly Groups

There were some interesting differences between the young and elderly groups besides their age. There were more men in the older group (11.3% vs 6.2%), and the older group was a little heavier (average BMI 25.4 vs 24.2). There were more diabetics in the older group (5.7% vs 1.6%) and fewer smokers (3.4% vs 8.5%).

Different Folks Different Strokes

The Mommy Makeover, in this case Breast Augmentation plus a Tummy Tuck, is more often performed for younger women who are finished having children.

The Mommy Makeover, in this case Breast Augmentation plus a Tummy Tuck, is more often performed for younger women who are finished having children.

The two age groups also had different types of procedures. Younger women for example have more Tummy Tucks and Breast Augmentations and don’t need many Face Lifts. As expected, the elderly group had more Facial Plastic Surgery (69.2%) than their younger peers (12.0%).

Facelifts are more common performed after age 50, to reverse the sequela of aging: jowls, deep naso-labial folds and sagging neck skin.

Facelifts are more common performed after age 50, to reverse the sequela of aging: jowls, deep naso-labial folds and sagging neck skin.

And the Complication Rate is…

The most common complications with any surgery are bleeding (hematoma), infection and wound healing problems. The study revealed there was no difference in complications between the two groups. The complication rate for the younger group was 1.94%, while the complication rate for the elderly group was 1.84%. Even when selecting only the octogenarians, the complication rate was 2.2%, and still not statistically different from the younger group’s results. Each procedure was examined independently, and only the Abdominoplasty had a higher incidence of complications in the older group (5.4% vs 3.9%), so get your Tummy Tucks early.

Board Certified Plastic Surgeons

This study was for a group of patients operated on by Board Certified Plastic Surgeons. The selection of patients who are good candidates for Plastic Surgery includes more than the fact that someone wants surgery. It includes objective and subjective evaluations about safety and predictability. The was no data available for the number of patients who were declined Cosmetic Surgery because of health concerns. This study looked only at a group of patients who Plastic Surgeons felt were safe to have their selected procedures. It is not clear if the outcomes would be the same if another group of providers were making the selection.

If you are considering Plastic Surgery, select a Board Certified Plastic Surgeon with experience performing your desired Cosmetic Surgery. If you are seeking a Plastic Surgeon in the San Francisco Bay Area who specializes in Cosmetic Plastic Surgery, give me a call at (925) 943-6353, or contact me through the contact form in the margin.

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