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

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I hope you find my posts both informative and fun to read. I welcome your suggestions for topics and questions and look forward to meeting you in my office!

Breast Augmentation Overview

Cosmetic breast enhancement continues to be one of the most popular procedures requested by patients here in beautiful southern California. The sunny weather and warm breezes lend themselves to people wanting to look and feel their best. The latest statistics gathered by the American Society of Plastic Surgeons ranks breast augmention as the #1 most commonly performed cosmetic surgery in 2010 with nearly 296,000 cases performed nationally, which is up 2% from 2009. With the well-documented safety record of the newer generation of breast implants and the high satisfaction rating among patients, more and more women are looking to breast augmentation to give themselves a nice aesthetic enhancement and to boost their self-confidence.

Breast augmentation has traditionally been performed by placing a prosthetic implant underneath the breast to provide increased projection and improved contour. The implants come in variable sizes to reflect the different desires of their recipients. The implant shells are all made of silicone but they come filled with either saline solution or silicone gel. Although there was a moratorium on silicone implants in the past regarding concerns over a possible link with autoimmune disorders, multiple studies have confirmed that this was never the case and silicone gel implants have now been approved for use since 2006. Not only are they as safe and effective as saline implants, but there are the added benefits of less rippling and a much more natural feel to the breast. Here in Newport Beach, the popularity of silicone implants exceeds that of the saline implants 3 to 1.

The implants are typically placed under general anesthesia at an outpatient surgery center and can be placed either over or under the pectoralis major muscle. The latter method is usually recommended due to the benefits of a more natural appearance, less rippling, and a significantly decreased risk of capsular contracture, ie. scar tissue formation around the implant. Several incisions can be used for access including the inframammary fold, periareolar, and axillary approaches. Occasionally the breast augmentation can be combined with a breast lift or other cosmetic surgeries as indicated. It is essential to note that breast implants, like all prosthetic devices, do not last forever and typically will need to be replaced with new implants every 10-15 years. Interestingly, I have seen patients who have kept their implants for over 30 years, but this is not recommended.

Patients who have undergone breast augmentation are among the happiest of all cosmetic patients. It is important to have a full consultation and candid discussion with a fully-trained and knowledgeable Plastic and Reconstructive Surgeon affiliated with the American Society of Plastic Surgeons (ASPS). There are many self-reported cosmetic surgeons these days with little or no training and unfortunately there are no governmental regulations limiting their practice. 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.

Parviz H. Goshtasby MD

Newport Plastic Surgery, Inc.

www.newportplasticsurgery.com