The Critical Importance of Board Certification by the American Board of Plastic Surgery 

Our health and well-being are the most important things we can have.  Many people exercise, eat healthy, and try to maintain a balanced lifestyle in order to preserve and prolong our most precious commodity, our body.  Despite our best intentions, we often cannot remain free of all ailments forever, and when we sometimes fall ill or get injured, we seek the help and expertise of a medical specialist.  These physicians and medical professionals have gone through many years of study and education in order to be fully-trained to manage and treat the wide variety of ailments that can afflict the body, as well as the serious complications that can occasionally occur from them.  Thus, it is natural for people to seek the help of doctors specialized in the area that they are concerned with.  When someone catches a bad cold, they go to see their primary care physician for help.  If someone breaks their leg from a traumatic incident, they typically seek the help of an orthopedic surgeon to fix it.  If someone develops a brain cancer, they go to see a neurosurgeon who is adept in handling and treating these types of tumors.  Therefore, if someone is seeking plastic surgery, would it not make sense to see a plastic surgeon?  All too often, shockingly, that answer is no.
In our fast-paced society where we are constantly bombarded with television and print advertising, as well as the ever-increasing popularity of reality shows that sensationalize cosmetic surgery, often in an unethical fashion, it is no wonder that the public is often confused as to the safety and realistic expectations of these surgical procedures, as well as the actual qualifications of the physicians performing them.  Just because a doctor has a fancy website or their own reality show, do not assume that they are qualified to be performing your procedure!  Unfortunately there are currently no governmental regulations that restrict how doctors can advertise themselves or limit the scope of their practice based on their actual training background.  As a result, with the significantly depressed status of our economy and the upcoming institution of ‘Obamacare’, coupled with the sad reality of dwindling insurance reimbursement for physician services in the setting of ever-increasing office overhead expenses and malpractice insurance, it is no wonder that many discouraged physicians are flocking towards cosmetic surgery as an easy way to make money and bypass the headaches of dealing with insurance claim denials and Medicare reimbursements that have not kept up with the rate of inflation or the astronomical costs of running a medical practice.
Consequently, the cosmetic surgery market has gradually become oversaturated by doctors from every specialty and background claiming to be the world’s expert on a variety of surgical rejuvenation procedures of your choice.  This is especially true in certain geographic locations that are considered plastic surgery meccas, with one of the largest markets being the southern California region.  In particular, Beverly Hills and Newport Beach are major hubs of plastic surgery with the largest concentration of cosmetic physicians in the nation, if not the world.  Unfortunately, many of these doctors are not true plastic surgeons and can be shady, unethical physicians with no medical training or background in cosmetic surgery at all.  Many of the horror stories people hear are often from unqualified doctors performing the surgeries that lead to horrible complications or even death.  Some of the scary practices I have witnessed personally are family practitioners performing facelifts, ENT (ear, nose, and throat) doctors performing breast augmentations and tummy tucks, and dermatologists or gynecologists performing a variety of facial and body cosmetic surgeries with little to no background training.  Many of these doctors take a weekend course or just observe another physician performing these procedures and begin doing these in their practices.  Surprisingly, there is no recourse by state or national regulations against these practices, and consequently the rise of cosmetic surgery practices has grown astronomically.  The lack of regulation also allows them to advertise anything they want, and frequently to further entice the public, they engage in ‘price-wars’ to give significantly reduced rates for cosmetic procedures in this depressed economy where everyone is trying to conserve their money.
Many of these self-proclaimed cosmetic doctors hide behind a variety of bogus certifications and cosmetic society memberships designed to confuse the unsuspecting public as to their validity and trustworthiness.  With the lack of regulations, many times it is up to the patient to do their homework and find a legitimate plastic surgeon who is fully-trained and specialized to perform their surgeries in a safe and ethical manner and provide exceptional results.  The American Board of Medical Specialties, which is the main authoritative organization that provides what is considered the ‘gold standard’ in physician certifications, oversees 24 specialty boards in order to maintain the highest standards of ethics and medical care for its members.  The rigorous board certification process requires extensive education and training, including a minimum of attaining a four-year university degree, an accredited medical school degree, and successful completion of at least three years of prerequisite surgical residency training, followed by three more years of a specialized Plastic and Reconstruction Surgery residency training.  Some physicians, including myself, complete a full five-year general surgery residency and do additional years of surgical fellowship training to further fine-tune their skills.  After completion of this training, candidates must additionally go through grueling written and oral board examinations in order to prove their knowledge, as well as submit cases for peer review by the board members and fellow practicing surgeons.  It is only after successful completion of all of these requirements that a physician can earn the distinction of board certification.
There are 24 exclusive and respected medical boards covered under the umbrella of the American Board of Medical Specialties (ABMS), which runs the gamut of the different medical disciplines, including the American Board of Internal Medicine, American Board of Emergency Medicine, and American Board of Neurological Surgery, just to name a few.  The ONLY board recognized by the ABMS in the discipline of plastic and reconstructive surgery is the American Board of Plastic Surgery (ABPS).  This is a critical fact to know since many cosmetic doctors claim membership and ‘board certification’ in random organizations with impressive names designed to deliberately confuse and mislead the public in order to try to add credibility to their questionable qualifications.  Some of these organizations that are NOT approved for membership into the ABMS include the American Board of Cosmetic Surgery, American Board of Facial Plastic and Reconstructive Surgery, American Society of Ophthalmic Plastic and Reconstructive Surgery, and American Society for Dermatologic Surgery.  Although some of the other surgical specialty training programs may provide limited exposure to the field of plastic surgery during their rotations, none approach the breadth of exposure and complexity of cases offered in a formal plastic and reconstructive surgery residency.
So what does all this mean for you?  If you are not careful, you may find yourself being operated upon by a physician with no formal training in plastic surgery and has not met any requirements to prove their knowledge base or competence in performing your surgery, or dealing with the potential disastrous complications that can occur.  Don’t be misled by dubious certifications or by significantly discounted procedure rates.  If you are interested in undergoing plastic surgery, it is incumbent for you to do your homework and find a qualified plastic surgeon to help you reach your goals.  You can review a doctor’s credentials on their website, research them on the internet, or even ask them if they are board-certified, and if so, by which board?  If you find that they are board-certified by any other organization than the American Board of Plastic Surgery, chances are they may not be qualified to perform your surgery.  You should review where they trained and in what disciplines.  You should also check which hospitals they hold active privileges at, and which medical societies they are members of, such as the Orange County Society of Plastic Surgeons.  It is also helpful to check that they are an active member of the American Society of Plastic Surgeons (ASPS), which is the national plastic surgical society dedicated to promoting higher standards for patient safety, ethical medical practice, and on-going learning through continuing medical education courses and meetings, and whose members are all board-certified by the ABPS.
Not all doctors are created equal.  Although every physician at some point in their career can have a complication, the chances of that happening is significantly reduced when you choose a legitimate plastic surgeon who has accomplished stringent training and examination requirements, undergone a strict peer-review process, and has achieved board-certification by the only board recognized by the American Board of Medical Specialties- The American Board of Plastic Surgery.  Your body is your most precious commodity, so why not maximize your chances for a beautiful aesthetic result and a safe recovery with a Board-certified Plastic Surgeon!

Parviz Hiroshi Goshtasby, M.D., F.A.C.S., a.k.a. “Dr.92660”
Diplomate, American Board of Plastic Surgery
Diplomate, American Board of Surgery
Fellow, American College of Surgeons
Newport Plastic Surgery, Inc.
361 Hospital Road, Suite 527
Newport Beach, CA 92663
(949) 500-5440
Facsimile: 949 548-9664
www.newportplasticsurgery.com

Eyelid Rejuvenation and Asian Eyelid Surgery

Have you ever been told that you look tired, even though you may feel fine?  Often the first area of our bodies people look at to communicate and ascertain our moods is our eyes, and when the usual sequelae of aging occurs, this can be misconstrued as a sign of tiredness and fatigue.  Common aging changes of our eyelids include laxity and hooding of the skin, herniation of the fat pads around our eyes, and weakening of the cartilaginous tarsal sling that supports the eyelid structure and tone.  Sun damage can also lead to many fine lines and wrinkles with contour irregularities around the eyes, as well as lead to pigmentation changes that can further add to a worn-out and exhausted look.  

Thankfully, there are procedures available that can dramatically rejuvenate your eyelids and give you that fresh appearance you had when you were younger!  These procedures range from simple, minimally-invasive office procedures to surgical techniques that address more advanced aging changes.  Everyone’s eyelids are different and each procedure can be tailored to treat unique aspects and concerns for each individual.  Hyperactive orbicularis oculi muscles that lead to the ‘crow’s feet’ appearance upon facial animation can be nicely relaxed using the commonly available neurotoxins, such as Botox or Dysport.  Mild hollowing of the under-eye tear trough region can be augmented in the office using a hyaluronic acid filler product, such as Restylane or Juvederm.  The more static wrinkles and creases that occur from long-term exposure to the harmful ultraviolet rays from the sun can respond well to skin resurfacing procedures, such as microdermabrasion, chemical peels, or lasers.  Although the more aggressive resurfacing procedures can require a few days of downtime, the results can be significant.  Finally, for more advanced eyelid changes, the blepharoplasty/ eyelid lift procedure can dramatically restore the aesthetic contours and tone of your youth.  This office procedure can remove loose skin, excise herniated fat pads, and tighten the weakened tarsal support structure to better define your eyelids.  

Occasionally, the eyelid lift procedure can be used to create a more Westernized look by creating a double-crease of the upper eyelid, which is considered aesthetic in many Asian cultures.  The so-called Asian blepharoplasty addresses the unique anatomy of the Asian upper eyelid which usually has more fullness, as well as a lower insertion point of the orbital septum, leading to the classic ‘oriental’ look.  The creation of the double-crease has become extremely popular in countries such as China, Japan, and Korea.  Being half-Japanese myself and having visited Japan many times, I have seen a significant rise in interest in these cosmetic procedures.  A thorough knowledge of the anatomy and surgical techniques are critical in achieving an excellent result.

If you have concerns over the appearance of your eyelids and want to learn more about what can be done to help rejuvenate them, then I can help you achieve your goals!  Being a double Board-certified Plastic Surgeon who is an active member of the American Society of Plastic Surgeons (ASPS), and who has had extensive experience performing these procedures, I will be able to conduct a thorough examination and discussion in order to recommend a treatment plan that meets your objectives and maximizes your aesthetic results.  You deserve to have bright and revitalized eyes, so what are you waiting for, give my office a call today!

Parviz Hiroshi Goshtasby, M.D., F.A.C.S., a.k.a. “Dr.92660”
Diplomate, American Board of Plastic Surgery
Diplomate, American Board of Surgery
Fellow, American College of Surgeons

Newport Plastic Surgery, Inc.
361 Hospital Road, Suite 527
Newport Beach, CA 92663
(949) 500-5440
Facsimile: 949 548-9664
www.newportplasticsurgery.com

Aesthetic Facial Rejuvenation: Face and Neck Lift Overview

Aesthetic Facial Rejuvenation: Face and Neck Lift Overview

                Greetings and welcome to another installment of my informational blog with full and candid discussions of all things plastic surgery!  Today I would like to discuss a cosmetic surgical procedure that is rising in popularity, especially among the growing number of baby boomers reaching full maturity- face and neck lifts.  There are many reasons people undergo surgery to rejuvenate the face.  Obviously the number one reason people choose to pursue surgery is to look and feel better about themselves.  Leading from this, I frequently hear in my consultations that they feel great and youthful at heart, but their outward appearance does not reflect this due to significant aging changes.  I have also met a number of individuals who have a younger partner and wish to recapture a fresher look to better match their significant other.  Another reason is that these days people live and work longer than ever before, and it is important to maintain a youthful appearance in the workplace to keep that competitive edge, especially in occupations that require frequent public interactions such as sales, marketing, or performing in the entertainment industry.  This has accounted for the growing number of men seeking face and neck lifts in a surgical arena that was previously dominated by women.  I have also noticed that in a society that places heavy emphasis and judgment on women based on their physical attractiveness, aesthetic surgical procedures are linked to power and acts as a status symbol, especially for people who live in affluent locales such as Newport Beach, CA.

                As we get older, there are a series of predictable changes that occur throughout our bodies that lead to an aged appearance, and the face is no exception.  Although babies are born with an abundance of healthy, youthful fat in the face, this fat gradually shrinks and goes away with time leading to a hollowed out and gaunt appearance.  This change, coupled with the effects of gravity and thinning of the dermis with loss of elastin, leads to sagging of the facial skin and the typical ‘aged’ appearance.  Predictable findings we see with time include deepening of the nasolabial folds and Marionette lines (smile lines), as well as jowling and loose, saggy neck tissue (turkey neck deformity).  Weakening and laxity of facial and neck muscles add to contour deformities and neck platysmal banding.  Smoking and sun damage can accelerate and contribute to further aging skin changes such as diffuse fine lines and wrinkles throughout the face as well as sun-damage spots and discolorations, ie. melasma and actinic keratoses.  All these factors also contribute to typical aging changes around the eyes, such as loose hooding of upper eyelid skin with herniation of fat pads around the eyelids leading to puffy lower eyelids with the so-called tear trough deformity and accentuation of the lid-cheek junction along the nasojugal groove.

                The face and neck lift surgery can address and significantly improve many of these changes that occur with aging.  As with all aspects of cosmetic surgery, there are many different techniques and approaches described for face and neck lifts, and if you poll a dozen plastic surgeons on how they perform their lifts, you will most likely hear a dozen different methods.  Some of the methods described include the skin-only short-scar lift, SMAS (superficial musculoaponeurotic system) plication and imbrication lift, SMASectomy lift, deep plane lift, endoscopic lift, and the MACS (minimal access cranial suspension) lift.  There are also hundreds of variations to each ‘traditional’ technique of face and neck lifting that each plastic surgeon has adapted to their practice.  Having performed several hundred face and neck lifts, I prefer using a variant of the SMAS plication technique with liposuction that has produced excellent results with minimal complications.  Certain techniques such as the skin-only lift do tend to have poorer results with limited lifting effect and faster recurrence rate.  However, there have been multiple studies in the literature, including a twin study in the Plastic and Reconstructive Surgery journal comparing different methods of facelifting that ultimately found no long-term differences in results.  The underlying theme of skin elevation, tightening the face and neck muscles separately, then redraping the skin under minimal tension has consistently shown the best results with prevention of the ‘surprised’ and ‘wind-swept’ Joan Rivers or Kenny Rogers look.  A well-executed face and neck lift should improve the sagging facial components, re-elevate the cheek fat, soften the nasolabial folds and Marionette lines, and redefine the neck with a smooth jaw line and youthful neck angle. 

                There are many complimentary procedures that can be done at the same time which can further rejuvenate the face and neck.  Upper and lower eyelid blepharoplasty surgery can remove redundant skin and fat around the eyes to achieve a smooth, rested, and bright eye appearance.  Fat harvesting and injection can help restore lost volume and fill depressions in the face that occur with aging, leading to a fuller, more youthful face.  Common areas of fat augmentation include the cheeks, temples, nasolabial folds, Marionette lines, and lips.  Full face CO2 laser also nicely compliments a facelift by smoothing out fine lines and wrinkles, stimulating collagen growth, and improving dyschromias.  Patients with weak chin projections can benefit from a chin augmentation, usually performed with a silicone implant.  Forehead lifts can also be performed in patients with premature brow descent.  All these procedures work synergistically and can dramatically improve and rejuvenate the face and neck contour and appearance.  Surgeries can be performed under a variety of settings using general anesthesia, IV sedation, or local anesthesia depending on patient comfort level and requests. 

                With our growing aging population, there is no doubt that facelifts and other cosmetic procedures will go into higher demand in the coming years, especially with economic recovery sure to be on its way.  If you are contemplating a facial rejuvenation surgery, as always I recommend you ‘do your homework’ and find an experienced and knowledgeable Plastic and Reconstructive Surgeon in your area affiliated with the American Society of Plastic Surgeons (ASPS).  There are many self-reported cosmetic surgeons with little or no training and I encourage you to explore and evaluate the credentials and training background for every physician you encounter.  Your choice of a well-trained plastic surgeon along with a thorough discussion of your aspirations and goals are important in achieving an optimal outcome.  Please feel free to contact my office for a consultation if you have questions, or to let me know if there are other topics you are curious about for my future blogs.  Until next time, be well and take care of your skin!

Parviz H. Goshtasby MD, aka “Dr.92660”

Newport Plastic Surgery, Inc.

www.newportplasticsurgery.com

949-500-5440

Is aesthetic hand rejuvenation for you?

     Cosmetic surgery has become a very popular and accepted fixture in our society today with a myriad of techniques and products available to help rejuvenate and enhance the face and body.  The face is the #1 most exposed portion of our body that people immediately recognize and observe, and as a result there is a large spectrum of procedures aimed to maximize its aesthetic appeal, from the less invasive neurotoxins, soft tissue fillers, chemical peels, and lasers, all the way up to the more aggressive and effective surgical facelifts.  However, the second most commonly exposed region of our bodies that most people overlook are our hands.  Although patients can spend thousands of dollars trying to rejuvenate their face, I cannot tell you the number of patients who despite having a wonderful facial outcome, their hands give away their age immediately.  Studies have been published in our scientific journal, Plastic and Reconstructive Surgery, concluding that just based on examination of the hand, most people can accurately guesstimate a person’s age.  Therefore, in order to obtain a balanced aesthetic outcome after facial or body rejuvenation, it is recommended to also treat the hands, especially if you have advanced signs of aging that may display your true age.

As a brief overview, there are several well-defined changes that occur to the hands with aging.  If you examine your child’s or grandchild’s hands the next time you see them, you will notice a youthful fullness to the back of their hands with smooth, unblemished, and elastic skin and a lack of prominent veins or wrinkles.  As we age, there is a gradual thinning of the dermal layer of the skin with formation of fine wrinkles, age spots, and even skin cancers.  There is also gradual atrophy of the subcutaneous fat layer and intrinsic muscles with prominence of underlying veins, tendons, and joints.  In addition, you can develop bony deformities from the occurrence of arthritis or other pathologies.  These signs of aging can be exacerbated by factors such as smoking, excessive sun exposure, and lifestyle or occupational insults to the hands.  Our hands are critically important for our daily activities, both functionally and visually.

Treatments are available to address each of these concerns, many of which require minimal downtime.  Dermal thinning and superficial skin dyschromias can be managed with a variety of products.  RetinA, ie. tretinoin, is the only cream proven to thicken the dermis and help exfoliate the outer damaged skin layers.  Glycolic acid, Jessner’s solution, and trichloroacetic acid (TCA) peels are just a few of the chemical peels available to help rejuvenate the hands.  Microdermabrasion performed in the office setting helps smooth the outer skin layer, but will require several treatments for maximal effect.  A number of lasers are also available, the most effective of which is the fractional CO2 laser which can be performed in the office, but does require some post-treatment care and downtime for a few days.  Dorsal hand volume loss can be addressed with volumizing treatments which include augmentation with fat grafting that is typically done in the operating room, or more recently with soft tissue fillers in the office setting.  Prominent veins can also be managed by direct excision (phlebectomy) or by vein coagulation (sclerotherapy).  Finally, any deformities that may be present as a result of trauma, osteoarthritis, ganglion cysts, Dupuytren’s contracture, or any of a number of other pathologies can be improved with hand surgery.

Although many chapters and research articles have been written on the topic, aesthetic hand rejuvenation has not fully caught on yet in our society, whether it is due to a lack of public awareness, or the lack of properly trained physicians offering these procedures.  As the hand is a very intricate and highly technical organ that we use every day to accomplish amazing things, it is important to have a dedicated consultation and candid discussion with a fully-trained and knowledgeable Plastic and Reconstructive Surgeon affiliated with the American Society of Plastic Surgeons (ASPS), and who has completed an additional Hand Surgery Fellowship training to become well-versed on the delicate hand anatomy and physiology.  There are many self-reported cosmetic surgeons these days with little or no training and I encourage you to explore and evaluate the credentials and training background for every physician you encounter.  Your choice of a well-educated plastic surgeon along with a thorough communication of your interests and goals are critical in achieving an exceptional outcome.  If you would like to further discuss your options for acquiring beautiful hands, then give us a call today!

Parviz H. Goshtasby MD

Newport Plastic Surgery, Inc.

www.newportplasticsurgery.com

Want longer lashes? Grow them!

The first moment of engaging someone is with eye contact, and for women in our society, longer eye lashes are a hot commodity in portraying an attractive, aesthetic appearance. For centuries, women have attempted various methods to beautify their eyes and lashes, including hair trimming, eyebrow contouring, fake lash attachment, and use of a variety of cosmetics, including mascara, eyeliners, and creams. There has also been an explosion of products offered by a number of companies over the past few years that can be administered as minimal downtime office procedures aimed to rejuvenate the face. Allergan is one such company that has had a strong presence in the plastic surgery community with its extensive cosmetic line including the well-known Botox neurotoxin; Juvederm, hyaluronic acid soft tissue filler, and the Natrelle line of breast implants. A relatively recent addition to their armamentarium aimed at helping patients with hypotrichosis, or inadequate eye lashes, is Latisse. Currently, Latisse is the only FDA-approved prescription treatment for growing eye lashes thicker, longer, and darker.

Latisse, also known as bimatoprost ophthalmic 0.03% solution, is a medication that has been used for many years by ophthalmologists in the treatment of glaucoma. It is with this experience that doctors began to notice that treated patients’ eye lashes were growing fuller and longer. At this point, Allergan realized its cosmetic potential and formulated Latisse to be specifically aimed for the aesthetic consumer market to help with hypotrichosis. Having treated many patients, I can honestly say that it does work. It does take a certain time commitment and dedication to the regimen in order to achieve maximal effect. Treatment entails a nightly routine of applying 1-2 drops of the solution to the upper lash line with the supplied eye liner. Results become apparent at 6-8 weeks, but maximal effect usually requires a full 12-16 weeks. For the disciplined women who can stay consistent with this nightly regimen, they are rewarded with thicker, darker, and longer lashes that provide a beautiful aesthetic enhancement.

If you think you might be a candidate for Latisse be sure to call to make an appointment for a consultation. The vast majority of women are pleased with the dramatic improvement in their eye lashes with Latisse. If you wish your lashes would be fuller and longer without the hassle of mascara or fake lashes, you can grow them!

Parviz H. Goshtasby MD

Newport Plastic Surgery, Inc.

www.newportplasticsurgery.com

Is a Mommy Makeover for you?

‘Mommy Makeovers’ are popular cosmetic procedures performed today. The term implies aesthetic surgery for improvement of certain changes that mothers endure with pregnancy, but can be applied more broadly to other patients as well, including massive weight loss patients with severe skin excess from dieting or gastric bypass surgery. Essentially, a Mommy Makeover is any combination of cosmetic procedures aimed to rejuvenate various aspects of the body that have undergone the ravages and stresses of pregnancy, aging, and large fluctuations in weight, such as after gastric bypass surgery. It is important to consult with a fully-trained and knowledgeable Plastic and Reconstructive Surgeon to determine which procedures are appropriate to address and improve each problem area.

There are many characteristic changes that occur with each stress that can lead to an unaesthetic appearance and can negatively affect self-esteem. The significant expansion of the abdominal wall with pregnancy often leads to significant skin laxity and spreading of the rectus abdominis muscles with stretch marks that cannot be improved upon with exercise alone. For this problem, an abdominoplasty or “tummy tuck” would best address removal of excess tissue including many of the stretch marks with tightening of the rectus muscles. Engorgement of the breasts with milk followed by its subsequent deflation can lead to sagging, deflated breasts that can respond nicely to a breast lift or augmentation surgery. Persistent fat accumulation after pregnancy, especially in certain problem areas such as the flanks (“love handles”), thighs, and inner arms will respond well to liposuction. These issues are commonly seen with the massive weight loss patient, but usually to a more severe extent that may require a full body lift, brachioplasty/ arm lift, or thigh lift surgery to maximize aesthetic body contouring.

The aging process compounds and exacerbates all of the above changes. With age, our dermis gets thinner, the elasticity of our skin goes down, and there is progressive sagging and deflation of our tissues, which is most notable not only on the body, but on our faces. Deepening of cheek creases (nasolabial folds), tear trough creases (nasojugal folds), and marionette lines can respond to soft tissue fillers, such as Juvederm, Restylane, and Radiesse, which is performed in an office setting. Hyperactive wrinkles of the forehead, glabella (number ‘11’ sign), and crow’s feet can be managed with Botox or Dysport neurotoxin treatment. Facial dyschromias and sun damage spots, which are very common here in sunny Newport Beach, CA, can be managed with CO2 lasering and a good skin care regimen. More severe sagging can be treated with a forehead, face, and neck lift surgeries. Eyelid laxity can also be addressed with a blepharoplasty, ie. eyelid lift surgery.

There are many rejuvenation options available to help mothers deal with the stresses and changes brought about by pregnancy and the aging process. It is important to have a thorough consultation and candid discussion with a reputable and proficient Plastic and Reconstructive Surgeon affiliated with the American Society of Plastic Surgeons (ASPS). There are many practitioners these days who are self-reported cosmetic surgeons with little or no training and I encourage you to explore and evaluate the credentials and training background for every physician you encounter. Your choice of a well-educated plastic surgeon along with a thorough communication of your interests and goals are critical in achieving an excellent outcome. A Mommy Makeover may be just what you need to bring back that youthful aesthetic contour and restore your self-confidence!

Parviz H. Goshtasby MD

Newport Plastic Surgery, Inc.

www.newportplasticsurgery.com

Facial Rejuvenation in an Hour or Less: Fact or Myth?

There are many advertisements and enticements these days in the media and internet touting the latest and greatest cosmetic surgery procedures. Many of these claim fabulous results without pain and no downtime. One such example of the many procedures I have seen is the so-called ‘lunchtime lift’, in which patients are reportedly able to come in during a lunch break, have a minimally invasive procedure performed in less than an hour, and go back to work with no scars or pain and with results comparable to a complete facelift. Having completed a fully accredited Plastic and Reconstructive Surgery Fellowship training, I can report that such extravagant claims are sadly a myth. Numerous variants of these minimally-invasive facelift procedures have been described, whether with limited tissue undermining, skin excision, or with the use of surgical threads to ‘lift’ the face, but most of these techniques have been shown to be ineffective and with limited, temporary results at best. Many of these false campaigns are advertised unfortunately by self-reported cosmetic surgeons with little or no plastic surgery training of any kind. The above-mentioned ‘lunchtime lift’ was advertised by a family practice doctor where I completed my training. As always, I am a big proponent of seeking consultation with a fully-trained Plastic and Reconstructive Surgeon affiliated with the American Society of Plastic Surgeons.

One area of facial rejuvenation that has really exploded in the past few years that can have significant, immediate tangible effects in less than an hour are the injectable agents. Although as a plastic surgeon, I greatly enjoy operating to create aesthetic rejuvenation for my patients, the advent of these injectable agents over the past decade has truly revolutionalized and filled (pun intended!) a niche in the cosmetically-minded consumer market. The patient population that it really appeals to that I personally have seen grow significantly in my private practice in Newport Beach, CA is the mid-thirties to late fifties population who are beginning to see the ravaging effects of aging, sagging facial skin that is exacerbated by the beautiful sunny weather here in southern California. These patients are starting to see wrinkles and creases form in the forehead, glabella (mid-brow), crow’s feet area, cheek folds, and the marionette lines of the lower mouth. Although these early signs of aging progressively give patients a tired appearance, they are not quite candidates yet for a full facelift or other surgical procedure. I have noticed many patients in lovely Orange County, especially women, are vibrant, vital individuals who are very proactive in looking and feeling as good as they can.

Enter the injectable agents, which for all intents and purposes are remarkable in that they can be injected in the office in less than an hour with virtually no downtime, negligible pain, and a minimal complication rate. Too good to be true? I thought so initially when I was first exposed to these products during my Plastic and Reconstructive Surgery training. However, having been injecting for several years now, I have been continually impressed with the results I am able to achieve for my patients with a very high satisfaction rate. Ultimately, a thorough discussion of the concerns and goals of each patient are essential for an excellent outcome. To the patient and public, the large variety of products available can become overwhelming and confusing; a consultation with your plastic surgeon should elucidate which products can be best for you.

As a brief overview, the injectables can be broadly grouped into the neurotoxin category and the soft tissue fillers category. These products do completely different things that target specific problem areas of the face which is important to understand. The neurotoxins, including the well-known Botox and the newer competitor Dysport, are both purified derivatives of Botulinum toxin type A that aim to paralyze hyperactive muscles of the face that lead to the wrinkles and creases that form with aging. Common areas to inject are the glabella to prevent the “number 11” sign between the brows, the crow’s feet area of the outer eyelid creases, and forehead furrows. The paralysis can require up to a week to take full effect, and results typically last for around 3 months. The art of injecting comes with experience with the key being to provide a softened, rejuvenated look without the unaesthetic stigmata of a ‘frozen’ face. Although some practitioners prefer to base their pricing on the number of locations, I think that it is always a good idea to ask exactly how many units are used in each area and base the price per unit to keep it fair, as different dilution methods can be used by various practitioners and the number of units of toxin injected are not always consistent.

The other category of injectable agents is the soft tissue fillers. The most commonly used of these include Juvederm and Restylane which are both hyaluronic acids, Radiesse which is a calcium hydroxyapetite gel, and Sculptra, which is poly-L-lactic acid. There are also other fillers that are not used as often anymore, including Zyderm and Zyplast, which are bovine collagens that require skin testing to rule out allergies before administration, and silicone injections that are not available here in the United States. With time we frequently lose soft tissue fullness from gradual laxity and sagging of our facial skin, giving an aged and weary look. Each variant of filler has a different density and viscosity with its particular range of indications, but they are mainly used to restore lost volume in the face and help smooth out deep creases or wrinkles for aesthetic rejuvenation. Common areas to inject are the tear trough creases (nasojugal folds), depressions around the upper mouth (nasolabial folds) and lower mouth (marionette lines), augmenting the cheek bones and creating fuller, more voluptuous lips. Temporal hollowing or depressed cheek volume can also be restored with the aid of these fillers. The results are immediate and can last 6-9 months, with some effects frequently seen over a year.

Although cosmetic surgery has taken a hit in the past few years, the growth of injectable agents has really taken off in this downturned economy. Experience from prior recessions has typically shown growth in the ‘immediate gratification’ market – items such as lipstick, chocolate and alcohol sales, that can provide a quick boost and pick-me-up to elevate consumer spirits. The injectables are no exception. With the ease of office treatment, minimal pain and downtime, and instant tangible results, treated patients are among the happiest of all cosmetic patients. If you are interested in learning more about these effective facial rejuvenation products, I encourage you to contact my office to further discuss which options may be right for you. Although it seems that everyone and anyone these days is injecting to make a profit, these product injections are real procedures with possible risks and complications requiring a thorough knowledge of the facial anatomy, and I encourage each of you to explore and evaluate the credentials and training background for every physician you encounter. Your choice of a well-educated and experienced plastic surgeon is critical in achieving an outstanding outcome. You deserve a treat, so give us a call today!

Parviz H. Goshtasby MD

Newport Plastic Surgery, Inc.

www.newportplasticsurgery.com

949-500-5440