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Ask the Plastic Surgeon

Ask the Plastic Surgeon:

  1. I have read that Botox is botulism and is only a temporary treatment therefore I would need to get subsequent treatments every 4-6 months.  What are the long term effects of botox. The good news is that Botox now has some help in the wrinkly relaxing department. Dysport is another wrinkle softener with a proven track record of safety in Europe. It has been recently FDA approve for use in the US. Like Botox it is a botulinum toxin and requires injections. When it is placed in select frown muscles it can help soften those tired, mean expressions which make us look older than we are 
  2. I am thinking of getting botox for my forehead wrinkles but I am concerned about the frequency of treatments.  Will I always have to get botox as frequent as when I started? . Botox  and Dysport act to selectively relax those muscles that are treated, thus softening the overlying wrinkles. If used consistently these treatments can be a prevention tool to avoid permanent creasing or wrinkling of the skin. People who have used Botox  or Dysport consistently may only need touch up treatments every 9 – 12 months. Remember an once of prevention is worth a pound of cure.
  3. I would really like to get some of the fillers done in my lips or around the mouth. Once I start getting this type of treatment am I committed for ever to continue? I am worried that my lines will be worse if I stop getting the treatments. Fillers are one of the areas in plastic surgery in which you get to cut the cake and eat it too, in that the very act of getting fillers stimulates your body to generate more of its own collagen in those areas. Newer fillers allow for resculpting of areas like your cheeks and chin which before could only be done by surgical implants. Fillers in these areas are long lasting. Sometimes chemical peels and plasma peels can be used to soften those fines lines around the lips so that filler can be used more efficiently for volume. 
  4. I have deep wrinkles and loose skin around my jaw and mouth. Is a facelift the best treatment for the mouth and jaw area? . Some issues like very droopy eyelids and turkey gobbler necks may require a surgical approach to get the most dramatic results.  In the past the only tool a plastic surgeon had for the face, was a facelift. New techniques and technologies like fillers, Botox, Dysport  and plasma peels supplemented by a rigorous home skin care regimen can allow people to experience facial rejuvenation with out major surgery 
  5. My lower eyelids have excess skin and the bags under my eyes are unsightly. My friends say this ages my looks. I have purchased every eye cream on the market to get rid of this problem but I have not seen any improvement. Is there anything else I can do to help my eyelids? Baggy lower eyelids can be very aging. If a person also has very prominent fat pads, surgery may best way to manage those issues. Before having surgery it would be important to make sure that you were using quality skin care products. As a board certified plastic surgeon, I am able to carry skin care products which generally are more potent than those available at the local drug store. Sometimes a series of chemical peels or a plasma peel allow for enough toning of that loose skin, so that surgery can be delayed. 
  6. I have excessive eyelids and  I get headaches by the end of the workday cause it seems like I have to use  my forehead muscles to keep my eyes open to see. Is the surgery to correct this issue costly and  what is the “down time”? Some people not only have excess skin on their eyelids, but their eyebrow has dropped down much like a loose roman shade resulting in a very heavy sensation. Often people unknowingly try to compensate for this drooping by raising their eyebrows arched high and look they are perpetually surprised. Many times these people have a significant reduction in their peripheral vision which can lead to them hitting their head or worse yet not being able to see their side car mirrors.  In this situation, the problem becomes a matter of poor function and is covered by insurance. The way to test if you are having functional issues is to get a Visual field test – taped and untapped. Depending on which surgery needs to be done on the eyelids and brows, a person should expect to be back to most usual activities within a week especially if they are willing to wear some tinted glasses to further camouflage the bruising.
  7. I am a man and  I want to start going to the gym to get into shape because I have what my friends call “man boobs”. The problem is that I am self conscious since I cant wear more fitted T-shirts. Why cant I seem to lose the fat in this area and  what options do I have? The official medical term for “man boobs” is gynecomastia.  You are not alone. It occurs in about half of males going through puberty. Almost 18,000  surgeries where done in 2008 to treat this condition. A majority of the times it is related to your inherited physique. Occasionally it can be related to abnormal hormones or male breast cancer. Men who use steroids to aid in bulking up may develop gynecomastia as a side effect. Any medicine that disturbs the normal hormonal balance may lead to gynecomastia.  Also gynecomastia is associated with marihuana and alcohol use. So make sure that you are not using any drugs that result in gynecomastia, have your physician examine and test you for tumors or masses and if all that is normal and usually it is, then it can be resolved with surgery. This surgery is not covered by insurance. Most men can resume working out their lower body within a week. It is important to allow for complete healing 4-6 weeks before resuming vigorous upper body toning. 
  8. I have “male pattern” baldness and  I have tried the OTC shampoos to regrow my hair without success. I have looked into hair transplant procedures. Is everyone a candidate for this type of procedure. Male pattern baldness occurs in 70% of men by the time they are 80 years old. Hair loss in these men is progressive over a lifetime.  It is important to plan ahead when considering hair restoration surgery. As long as a man has retained an area of normal density along the back of his head then he would be a candidate for hair restoration surgery which may consist of several procedures over time. Modern hair restoration is about transplanting follicular units or normal family units of 1,2 or 3 hairs to the area of hair loss. This avoids the old fashion “corn row” look. As a man is completing his hair restoration surgeries, it is important for him to use hair maintenance products like Rogain or medicines like Propecia to maintain the result