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THE COSMETIC SURGERY CONSULTATION – A TWO WAY STREET

Some surgeons offer free consultations, but they most often are quick meetings rather than in-depth and personal discussions. (I went on one of those myself and it was a valuable lesson for me! I quickly determined that he was NOT a surgeon I wanted to work with). The experience helped me hone in on what I was really looking for in a surgeon. So it was time well spent.

What should you expect from an in-depth personal consultation?

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The patient’s Side of the Street: You need to communicate your goals, your wants and want-nots. Many perspective cosmetic surgery patients express a similar thought: “I don’t want to look like I have had surgery. I just want to look refreshed.” Some even bring in photos of themselves at a younger age, to help the surgeon envision the look you would look to recapture. But don’t bring in a photo of Julia Roberts and ask to look just like her! You won’t!

The surgeon’s side of the street: The surgeon will first want to determine if you are a suitable candidate for elective aesthetic surgery, so you will be  asked about your medical history. Be honest. Don’t hold back anything. While the vast majority of people are healthy enough to safely undergo elective surgery, some conditions do advise against it. So tell all. As much as you might have your heart and mind set on having these procedure(s), you don’t want to become a  statistic.

Next step in the consultation is for the doctor to listen to your goals, communicate with you about what outcomes you can reasonably expect, and develop an appropriate surgical plan. You will also have the opportunity to look at a range of before and after photos of patients who have undergone the same procedures. Be sure these are this surgeon’s patients, not photos taken by others.

Before your consultation ends, whip out that list of questions you have prepared in advance. Now is your opportunity to ask the ones still unanswered.

By the time you leave this office, you will have a pretty good idea of whether or not you feel completely comfortable placing your face or body in the hands of this surgeon to perform the procedure you desire.

Want to know the twelve questions women often think about but are too embarrassed to ask their plastic surgeons? Click here.

 

SAFE ANESTHESIA DURING COSMETIC SURGERY

Board certified anesthesiologist, Dr. Barry Friedberg and I have become well acquainted by now. I have been impressed with his innovations to his field, including a brain monitor device that monitors anesthesia levels for each individual to just the right degree. This is a potentially life saving feature – an important feature for those undergoing any surgery – cosmetic or not. 

Click here to watch this video.

It might save your life or that of someone you hold near and dear.

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I have written about this before and in more detail.

Click here for more.

Have a beautiful life!

Lois W. Stern

AGELESS BEAUTY – GETTING A LITTLE WORK DONE . . .

Autumn is just around the corner – the time women begin to seriously consider (or reconsider)  “Getting s little work done”.  With this professional courtesy offer, you can purchase copies @ $8.95 while supplies last – and at this price they are going to go fast!. 

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Your order will include 12 copies of Sex, Lies and Cosmetic Surgery plus a FREE 5.5 X 8 inch laminated sign to post in your office. 

Learn more about this award winning book at: www.sexliesandcosmeticsurgery.com. Read the reviews – even written up in the Style section of the NYTimes.

 Want to offer patients some great encouragement and calming advice coming from over 100 women who have been there, done that? Sex, Lies and Cosmetic Surgery has received glowing reviews from several top board certified plastic surgeons, read and endorsed by three members of the ASPS before being placed in first position on their online bookstore (until their bookstore feature was removed from their website.) 

 

Click here to  place your secure order.

And here is a picture of the laminated sign that will be included with your order.

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Ageless Beauty Through DermaSculpt

After reading a bit about DermaSculpt, but not understanding the difference between dermal filler injections and those administered through a cannula, I watched this video for a little education. I’d love to hear from other plastic surgeons, derms and patients about their experiences with this technique.http://dermasculpt.net/demonstration_videos/Dr_Karimi

From what I gather, DermaSculpt is a new technique for injecting cosmetic facial fillers using a blunt tip rather than hypodermic needles.  According to the surrounding chatter on this technique, it provides excellent results using the same facial fillers and autologous fats through microcannulas of various sizes.

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What are the advantages? Again, I have no first hand experience with dermal fillers, but from what I read, there is less discomfort and bruising than  with needle injections, less risk of trauma to nerves and injury to blood vessels.  You can see in this video how, without removing the cannula, it can be guided quite precisely while under the skin to treat multiple areas of the face. One insertion can treat a much wider area.

I am told that after the procedure, normal activity can be resumed very quickly and that there is virtually no bruising or swelling.

Now I’ll bet my readers would like to hear from other plastic surgeons, dermatologists and patients with personal experience with this procedure.

Which Is Better for Skin Tightening – Ulthera or Thermage?

I recently saw this question posted on Dr. Rod Rohrich’s Facebook page, which in turn linked me to a RealSelf posting of opinions provided by other noted plastic surgeons.

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Although Thermage wins kudos for being on the forefront for non-invasive skin tightening devices, most of the plastic surgeons who weighed in on this topic voted Ulthera as their preferred choice for face and neck skin tightening. Here are a few of their expressed opinions:

Although none of the noninvasive technologies will give the same results as surgery, they do provide a subtle, yet noticeable improvement without much downtime or cost. Ulthera is my choice for skin tightening in the face and neck, since I have seen a definite improvement in the face and neck of the the patients…

Angela Sturm, MD

Houston Facial Plastic Surgeon

 “I have followed both technologies since their inception, Thermage for about the last 10 to 12 years, and Ultherapy by Ulthera for the past 2 years.  Based on the science behind them and the patient satisfaction results, Ultherapy by Ulthera is a superior treatment.”

Rian Maercks, MD

Miami Plastic Surgeon

And finally, the statement that to me is most significant of all.

“Keep in mind these are only tools and by themselves are neither good nor bad.  A scalpel is neither good nor bad but can be used to perform beautiful surgery or make a terrible mess.  That being said, these devices are commonly used by practitioners with no formal training in plastic and reconstructive surgery and thus no understanding of what interventions, forces structures …”

 Michael A. Persky, MD

You’ll find informative articles on most every non-invasive and minimally invasive cosmetic procedure at http://www.ticktockstoptheclock.com.

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WOULD YOU LIE ABOUT YOUR FACELIFT? by Lois W. Stern

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I just read about a woman who has scheduled a facelift, but instead of leveling with her husband, she has told him  that she’s going away on a business trip. Soon she’ll be traveling out of state – off  to her selected plastic surgeon’s office.

Sure her absence is easily explained, but what about the post surgery bruises and swelling? How does she explain all that? “Easy,” says she. “I’ll just tell him I was in a car accident.”

Now  a car accident that causes injury to your face must be more than a simple fender bender. Won’t her husband want more details?  What about damage to the car? Is she going to run it into a brick wall to feign authenticity?  Wouldn’t he ask about those insurance claims that need to be filed? I can see where we are setting up a house of cards here, with one lie pressing against the next until those cards all fall down.

When I was interviewing women for my book, Sex, Lies and Cosmetic Surgery, I spoke to several others who either concealed or minimized the extend of their surgeries. My hair stylist was one. She confided that she told had her significant other that she was having her eyes done, when in fact she went for a full facelift. When he asked her why she had stitches behind her ears, she answered, “I don’t know, I guess that’s the way they do eyes now.” And funny as it sounds, he actually believed her!

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I honestly don’t think we have to share every detail of our beauty routines with our spouses, but where do we draw the line? Would you tell your spouse or significant other? What would you do if you were in those same shoes? I’d love to hear from some of you.

Looking forward to keeping in touch!

Lois W. Stern

 

SMARTPHONE FACE – THE NEWEST COSMETIC SURGERY FIX

‘Smartphone Face’ – Is your cell phone making your face sag?

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How’s this for new math? Smartphone plus gravity equals drooping jowls and double chins.

What exactly is Smartphone face? The term describes a combination of sagging jowls, double chins, and marionette lines (those vertical creases that run from the corners of the mouth towards the chin.) If you sit for hours with your head bent slightly forward, staring at your iPhone or laptop screen, you may shorten the neck muscles and increase the gravitational pull on the jowl area, leading to a drooping jawline. The name also works on another level; face sag becomes especially noticeable when you take photos of yourself or video-chat on your portable device.

According to the American Society for Aesthetic Plastic Surgery, smartphones can make you look prematurely old. There’s no medical name for this condition, at least not yet. Until there is we can just call it “smartphone face.”

According to the ASAPS: “Lines and creases may develop if you spend an excessive amount of time texting and checking your email on your smartphone. The constant downward gaze caused by smartphone use may be causing some individuals to experience more lines and creases on their neck than would appear naturally.” With smartphone use leading people to tilt their head downward all too often, we could see an increase in drooping jawlines, even among the relatively young.

How do you fix smartphone face? 

The battle between smartphone and vanity has begun.

The obvious cure for smartphone face isn’t costly surgery or treatments. It’s giving up your smartphone and all of its apps. While a chin implant is a surgical solution, you can also firm up your jawline with less invasive techniques such as injections of chin fillers, Botox treatments, skin-tightening devices, liposuction/laser facelifts. Or, if you’re looking for a self-help solution, just remember to keep your chin up when you text or stare into your smartphone.

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WHAT’S HAPPENING WITH STEM CELL FACE LIFTS?

Are you beginning to see ads for Stem Cell Facelifts? If so, I’m not surprised!  I too am convinced this is the wave of the not-too-distant future. But many of these Stem Cell Facelifts of today are simply fat removed from one part of the patient’s body and reinjected into other parts, as treatment for aesthetic concerns such as crows feet or mouth to jaw marionette lines. Fat transfer as such is nothing new in cosmetic surgery. It has been used by plastic surgeons since 1983 and is considered extremely safe, but not as long lasting as the fillers of today.

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But stem cell treatments are a bit different from simple fat transfer,  a refinement of the process if you will. In a true stem cell treatment, once the adipose tissue (the fat cells) are removed from the body, the actual fat is separated from the richer stromal vascular fraction (SVF) cells, which are far more potent than the remaining fat cells. Once separated from adipose tissue, they are reinjected  into the patient’s body without further manipulation. The SVF cells are neither cultured, further enriched or changed in any way.

My education on Stem Cells in Plastic Surgery began with noted plastic surgeon, Dr. Alan Kisner, when he wrote a chapter for my book: Tick Tock, Stop the Clock ~ Getting Pretty on Your Lunch Hour. He explained both the huge potential for the use of adult stem cells in medicine, but also the obstacles to its use:

“For the cosmetic surgery patient, fat seems like an ideal material for soft tissue augmentation, but it has been impermanent due to resorption. In order to become permanent, grafted fat must create it’s own blood supply.”

Dr. Kisner went on to explain how fat grafting, one technique being used to circumvent this problem, involves injecting small amounts of fat (less that 0.1 cc at a time) in discrete layers to gradually build new tissue layers. By allowing time and space between these microinjections, new blood vessels are able to grow within the grafted fat, enabling them to establish permanence. Aside from the skill and specialized training of the surgeon, he emphasized that fat grafting is a slow process that requires patience on the part of both patient and surgeon. In this same chapter, Dr. Kisner spoke about pioneering research now underway to separate the fragile stem cells, in order to enable them to more readily produce their own blood supply.

That said, you can see why this emerging technology of  SVF cells holds huge promise not only to the field of cosmetic surgery, but to the pioneering field of regenerative medicine, by enabling the body to repair, replace, and regenerate damaged, aging or diseased cells, tissues and organs.

Funny how things happen through connections over the Internet. I recently posted an article, Stem Cells in the News, where I spoke about a stem cell procedure gone wrong after a surgeon injected both stem cells and derma fillers into a patient’s face, causing a well-meaning but disastrous result. One of my readers, Jonathan Schwartz, commented that this was true stem transfer facelifts have not been FDA approved. We got into further conversations, spoke on the phone, and he subsequently sent me further material to digest. It turns out he is the President and CEO of MedicalMarvels LLC,  a company doing pioneering efforts in regenerative medicine.

A large body of scientific evidence suggests that adipose-SVF may act by replacing lost or damaged cells, reducing inflammation, improving the function of cells at the site, and recruiting cells from other parts of the body to assist in these processes.

There is at present no benefit is payable, either by Medicare or by a health fund for adipose-SVF treatment. You may be able to claim a tax refund of 20% of the cost, if your total health costs are above $2,000 in a year. We recommend seeking independent advice in this area.

Medical Marvels LLC is an emerging leader in regenerative medicine using adipose (fat) derived stromal vascular fraction containing adult stem cells for pioneering regenerative medicine.  Regenerative Medicine is a rapidly expanding set of innovative medical technologies that restore function by enabling the body to repair, replace, and regenerate damaged, aging or diseased cells, tissues and organs.

To date, this company has developed proprietary technology that allows for the efficient and reproducible separation of stromal vascular fraction (branded “Cellication”) containing adipose stem cells and extracellular matrix that can be performed in doctor’s offices, medical facilities and hospitals. This company is also engaging in clinical studies at major medical centers to obtain FDA approval for clinical indications.

Stay tuned folks. We haven’t heard the end of stem cell face lifts yet!

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STEM CELL FACELIFTS IN THE NEWS

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Three years ago a Los Angeles woman had a new cosmetic procedure, a stem-cell face-lift. During this procedure the surgeon liposuctioned adult stem cells from her stomach fat and after isolating them, injected those cells back into her face and around her eyes. In this case the doctors extracted mesenchymal stem cells—which can turn into bone, cartilage or fat, among other tissues—and injected those cells back into her face After some time, the woman was experiencing difficulty opening her right eye, and whenever she tried, she heard a strange sound. Eventually she consulted a second plastic surgeon, complaining of these symptoms. At first the consulting surgeon thought she was exaggerating, but she did indeed have a swollen, drooping eyelid. This was no overactive imagination at play! After more than six hours of surgery, the consulting surgeon and his colleagues had dug out pieces of bone fragments which had been growing in the flesh around the woman’s eye. The strange sound the woman was hearing whenever she tried to open her eye was bone grinding against bone.

Why did this occur? During the patient’s initial aesthete treatment, her surgeon had injected some dermal filler along with the stem cells. Although plastic surgeons have safely used dermal fillers for more than 20 years to plump up the skin and obscure wrinkles, the principal component of such fillers is calcium hydroxylapatite, a mineral which encourages mesenchymal stem cells to turn into bone, the probable explanation for this woman’s unanticipated predicament.

THIS STORY WAS REPORTED IN SCIENTIFIC AMERICA.

Although the consulting surgeon successfully removed the pieces of bone from his patient’s eyelid, no one can say for sure if her saga has ended as some living stem cells possibly have remained, to turn into bone in the future.

We all tend to get excited when we read about the next NEW thing to enhance our beauty. But MORE is not always better and NEW hasn’t yet stood the test of time. Cosmetic surgery is a constantly evolving field, but let’s be cautious and let the science precede the hype.

For more in depth information about Stem Cells, where we are now and where we are headed, read Dr. Alan Kisner’s informative article: STEM CELLS IN THE NEWS.

THE BATTLE OF THE BULGE by Lois W. Stern

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As spring approaches, our thoughts are likely to turn toward refreshing our summer wardrobes. We all want figure enhancing clothes, but if you have fat deposits in unwelcome places, it’s sometimes hard to find clothes designed to conceal those bulges. Despite good health and a reasonable level of fitness, some people may still have a body with disproportionate contours due to localized fat deposits. These areas may be due to family traits rather than a lack of weight control or fitness. What do you do?

What do you do? From least invasive to surgical options, here are some answers.

Diet and Exercise: The first line of defense should always be diet and exercise. It takes some work, but when effective, is so rewarding. However, when an overall slim body is marred by the appearance of selective fat deposits that just won’t disappear, there are several other solutions.

Cellulite treatments as Endermologie and Velosmooth: mechanical systems that use motorized rollers to break down cellulite, slim the body, and firm the skin over areas of stubborn fatty deposits. These treatments, which are said to feel like deep tissue massage, work best for those who are physically fit and only moderately oveweight. A series of treatments is required to obtain results. Candidates are advised to exercise regularly and drink plenty of water to help eliminate fat through their perspiration and urine. Although effective and non-invasive, these are generally not permanent forms of cellulite reduction, as maintenance sessions normally are required. Most recent annual statistics gathered by the American Society of Plastic Surgeons indicate that 37,916 such procedures were performed in the US last year.

Cooling devices: Some of the newer non-invasive systems for body contouring include:
Ultrasound body contouring: based on a mechanical vibration emitted from specialized ultrasound equipment, Ultrasound is designed to permanently destroy fat cells. The objective is to deliver ultrasound energy precisely focused to destroy fat cells, while leaving neighboring tissue unharmed. Treatment is said to be painless for most patients with no downtime or post-treatment restrictions.

CoolSculpting (AKA Zeltiq): based on a cooling process that kills the fat cells underneath the skin, literally freezing them to the point of elimination. Only fat cells are frozen. Healthy skin cells remain intact. Once crystallized, the fat cells die and are naturally eliminated from your body. To learn more about these fat cooling devices,Click here.

Injection Lipolysis: Initial studies by the ASPS concluded as follows: “All patients showed remarkable reductions of fat deposits treated with injection lipolysis. Using the correct technique, injection lipolysis is a safe and efficacious alternative to lipoplasty on smaller areas for patients objecting to, or unable to undergo, surgery. It is not a replacement for a necessary change of lifestyle, nor is it a method of weight reduction or a treatment for obesity. The ideal patient is one with small to medium fat deposits that cannot be reduced by exercise and diet.” Personally, I would like to see studies comparing fat reduction results obtained through cooling devises as opposed to injection methods.

Smart Lipo, approved by the U.S. Food and Drug Administration in November 2006, is a less invasive form of lipoplasty that uses laser technology to sculpt the body. During the Smart Lipo procedure, a tiny tube (a cannula,) about the size of pencil lead is inserted through the skin and into the fat layer. A laser fiber sits inside the cannula, which the doctor moves back and forth in a fanning motion. When inserted under the skin, this laser fiber dissolves fat cells with heat. The melted fat is removed through the cannula, just like during traditional liposuction, but because of the heat, there is less fat to remove and the skin is tighter. Although the laser fiber isn’t hot enough to burn gauze held against it, its heat is sufficient to melt little tunnels through the fat, which can then be drained away. This form of body contouring, best suited to patients within 10 to 15 pounds of their ideal body weight, is ideally used on areas for spot reduction, such as under a chin, upper arms, abdomen, thighs, or knees. Results show loss of inches, though not necessarily a loss of a lot of weight.

Liposuction: Spring is high season for liposuction, a cosmetic procedure described by some as a surgical magic wand. But this magic wand is not recommended for weight loss. It is intended solely to remove excess fat deposits on localized areas of the body, to reshape and to improve body contours and proportion. This surgical procedure removes fat from under the skin with the use of either a cannula, to suctions out the fat, or an ultrasonic probe, to break up the fat into small pieces before removing it.

Advantages of Smart Lipo include its slightly lower cost compared to traditional liposuction and the fact that only a local anesthetic is used and the patient remains awake the entire time. Because Smart Lipo causes less trauma to the body, with less bruising, blood loss, or swelling than in traditional liposuction, there is an overall quicker healing time. However, it is is still a surgical procedure that should be performed only by a surgeon trained and experienced in this technique.

The tumescent or super-wet technique requires an infusion of saline solution with adrenaline and anesthetic prior to removal of excess fat. Ultrasound-assisted lipoplasty uses ultrasonic energy to liquefy excess fat prior to surgical suctioning. According to the American Society for Aesthetic Plastic Surgery (ASAPS), more than 400,000 liposuction procedures were performed on patients in the U.S. in 2007.

For an excellent additional resource for those interested in liposuction procedures, click here.

Reminders:

  • Do not be taken in by media hype.
  • Do not undergo any procedure that has not been FDA approved.
  • Be aware that any licensed physician, regardless of training, legally may perform liposuction.
  • While some physicians’ professional societies may recommend training before performing liposuction surgery, there is no standardized training for physicians performing liposuction.

 

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