The Aging Face and Volume Loss

There are a number of factors that combine to make our faces look older with time, but the two most important factors are changes in the quality of the skin and the loss of volume. The skin quality changes, that are markedly worsened by factors such as sun exposure and smoking, have long been recognized, but the changes due to volume loss have come to be appreciated only recently.

 

Physicians used to believe that loose skin was due to the gradual stretching effect of gravity, but now we understand that much of this is due to the loss of deeper tissues. As we age we loose facial fat and connective tissue. Our facial bones get thinner and our teeth get ground down. All of these factors combine to produce a hollow appearance where the skin that was once supported by these deeper tissues now sags and droops. There have been examples where patients have had large volumes of filler injected, and have had tightening of the loose skin on the lower face and jowls, comparable to that produced by a surgical procedure. Unfortunately the amount of filler required currently makes this approach not economically feasible for the vast majority of people.

One area where filling is a very practical solution is restoring the mid-face, the youthful contour of the cheeks, and improving the appearance of the bags under the eyes. We now understand that, in many cases, bags under the eyes are not the result of excess or protruding tissue, but are due to the loss of the deeper tissue in the upper cheek, which makes the normal tissue around the eye visible as a bag. Surgically removing this normal tissue results in what has been called "hollow eye" while replacement of the tissue lost with filler results in a more youthful and attractive appearance. 

 

If you’re interested in restoring a more youthful look with a filler, call us at Mangat-Kuy-Holzapfel Plastic Surgery for a consultation at (513) 984-FACE in Cincinnati, (859) 331-9600 in Northern Kentucky, or (970) 766-FACE in the Vail Valley of Colorado. 

Plastic Surgery for Men - A Growing Trend

Today’s modern man, often known as the ‘metrosexual’ man, no longer needs to hide the fact that he cares about his appearance. Where, once upon a time, cosmetic surgery only ever applied to women, an increasing number of men are now going under the knife in order to achieve the perfect look. In fact according to the results of a recent study undertaken by the American Society of Plastic Surgeons (ASPS) 15% of its patients are now male and around 20% of clients requesting Botox injections are men.

 

So why is it all of a sudden acceptable for men to enter what was previously only thought of as a woman’s world? Maybe it has something to do with celebrities such as David Beckham, Ashton Kutcher, Zac Efron and many, many more making it not only acceptable, but incredibly cool to be a modern metrosexual man who cares about his appearance. Or could it be more to do with the increasing number of women voicing their admiration for a man who likes to take care of himself and his appearance? Slobs are most definitely not on the dating agenda where today’s women are concerned.

 

But exactly how far are men prepared to go? Some further than others, that’s for sure. For, despite what current trends might suggest, some men will still look upon cosmetic procedures as vain, stupid, not for real men and embarrassing. However, for those who can afford it and are not afraid to go for what they want, cosmetic treatments are definitely on the rise. So, what are the options? What is becoming not only acceptable, but popular and what do these procedures cost?

 

Nose Reshaping

Nose reshaping (rhinoplasty) was one of the first cosmetic procedures to become widely accepted among the male population and continues to be one of the most popular procedures to date. No longer do men need to go through life lacking in confidence and being ridiculed for an “imperfect” nose . 

 

Chin Implants

Chin implants are becoming increasingly popular as men seeking that chiseled, masculine look will undoubtedly be seeking a strong, manly chin. Chin implants can make your chin larger or just improve the shape to suit the type of face you have, allowing your features to appear more proportionate and balanced. Chin implants can change your entire look and are often combined with other procedures in order to achieve good facial symmetry. 

 

Eye Bag Removal or Eye Lift Surgery

Another popular procedure for men wishing to appear younger than their years is the eye bag removal or eye lift. The stresses of everyday life, hard work, lack of sleep, too much sun, smoking or even some hereditary factors can all contribute to the eyes sagging, resulting in premature ageing. 

 

Chest/Breast Reduction 

Men have often said that one of the most embarrassing body defects to be cursed with is a large chest – i.e. man boobs, or moobs as they’re often referred to. These fatty deposits can develop around the chest during puberty and often disappears with age however unfortunately for some, it can also remain into adulthood.

 

Weight loss and aging can also cause the chest to look large and saggy and an increasing number of men are looking towards male breast reduction surgery in order to address this problem. A chest reduction involves liposuction to remove excess fat and sometimes the removal of glandular tissue or loose skin is also required. This surgery can greatly improve self esteem, and provide men with a new lease of life and level of confidence that can far outweigh the cost of surgery.

 

This noticeable shift in social acceptance of men going to such lengths to enhance what nature gave them bundled with the decreasing cost of these procedures as the demand soars and competition starts to squeeze clinics’ margins seems to highlight a cosmetic trend that is only going to grow. 

 

It should be advised that whatever type of surgery you are considering please be sure to get grounded and impartial advice from your physician. If you or someone you love are considering male cosmetic surgery, call us at Mangat-Kuy-Holzapfel Plastic Surgery for a consultation at (513) 984-FACE in Cincinnati, (859) 331-9600 in Northern Kentucky, or (970) 766-FACE in the Vail Valley of Colorado. 

FDA AFFIRMS SAFETY OF BREAST IMPLANTS

By Daniel Kuy, MD, FACS

On Sept 8th, 2011 the Food and Drug Administration and the Medical Device Advisory Committee conducted a panel hearing over two days on silicone gel filled breast implants. Dr. William Maisel, chief scientist for the Food and Drug Administration Center for Devices said, “we believe the benefits and risks of the silicone implants are sufficiently well understood.” After two days of discussion testimony, the agency officials said silicone breast implants were safe and studies would continue.

Dr. Maisel said, “We felt before the meeting that silicone breast implants were safe and we continue to feel that way after the presentations and discussion over the past two days.” There are risks to the implants, however, Dr. Maisel said, including ruptures, a hardening of the area around the implant, the need to remove the implants, scarring, pain, infection, and asymmetry. “Women should feel assured that the FDA continues to believe that currently marketed silicone breast implants are safe and the current post approval studies will continue to better understand these potential risks.”

The committee also agreed that the patient should no longer be told that their breast need to be screened with an MRI three years after getting the implants or every two years following. Most patients have ignored the requirement because MRIs are expensive and it is still not clear what should be done when unforeseen ruptures are discovered. The risk associated with leaking implants may not be greater than the risk of the operation needed to take them out. The FDA continues to believe, as does the pane members that the MRI is the goal standard for evaluating breast implants for silent rupture.

US surgeons performed nearly 400,000 breast implant procedures last year, more than half the operations used silicone gel filled breast implants. Unfortunately, many study participants have been lost to follow up. One frequently mentioned reason for the low followup rates in the post market studies was that augmentation patients see no reason to return for checkups if they have no problems. Dr. Maisel said that the decision to keep the implants on the market is not just based on the companies’ market studies. The FDA has looked already that the studies conducted prior, which have longer and better followup than the ones launched after the approval of the silicone filled breast implants.

Towards the end of the final days of the hearings, the panel commented that they were impressed by the two plastic surgery societies, efforts to generate data and address important issues such as international registries, labeling compliance, patient confidentiality and informed consent.

Everybody seems committed to see the ongoing studies to be completed and also remain committed to see the follow up rates improved.

Dr. Mangat and Dr. Holzapfel attend surgical mission to Belize

Dr. Devinder Mangat and Dr. Allison Holzapfel recently returned from a week long surgical mission trip to Orange Walk, Belize.  This area of Central America lacks sufficient surgical services in the fields of plastic surgery and otolaryngology-head and neck surgery.  During their week in Belize, over 250 people showed up for the screening day and the surgeons performed over 100 surgeries! 

In 2004, Horizon Community Church set up a mission trip and traveled there to help build houses, install screens and run a vacation Bible school.  A small surgical team provided medical help.  Since that trip, the team has grown to having more than 50 volunteers.  Dr. Mangat joined the trip six years ago and recruited Dr. Holzapfel to join for the first time this year.

 

The trip is quite busy with all the physicians and support personnel working long hours.  The most rewarding part is seeing the patients after surgery with huge smiles on their faces.

Dr. Allison Holzapfel discusses Cincinnati Plastic Surgery

The Liquid Facelift

Over the years, the face begins to lose volume and elasticity leading to the formation of wrinkles, creases and folds. This loss of collagen and elastin contributes to sagging facial features causing many of us to think we need surgery. With the development of many of the new FDA-approved dermal fillers, Botox®, and Dysport®; physicians have been able to "lift" the face without having to resort to surgery.

Many of the techniques now used focus on lifting and contouring the face, with the added benefit of wrinkle reduction. This differing approach to the treatment of sagging facial features has been called a Liquid Face Lift, a non-surgical face lift alternative.

A Liquid Face Lift can accomplish any of the following:

• Gentle lift of individual or overall facial features
• Reduced wrinkles, creases or folds
• Restoration of natural, curved facial contours
• A more rested, energetic look
• A friendlier smile

For example, bags can be masked under the eyes by using Liquid Facelift techniques; eyes can be opened up and lids lifted; jowls can be lifted and diminished; natural shape can be restored to flattened cheeks or temple areas; corners of the mouth can be lifted; as well as several other facial feature benefits.

A Liquid Face Lift involves the use of dermal fillers in combination with Botox® or Dysport®. The fillers include Juvederm™ Ultra, Juvederm™ Ultra Plus, Radiesse®, Restylane® and Sculptra.

Not only is product choice important, but it is fundamental that the physician take into account a patient's unique facial characteristics and goals when performing a Liquid Face Lift procedure. Each person has unique facial features and individual skin types, as well as varying degrees of skin damage, collagen depletion and skin laxity. Goals and desires also vary from patient to patient.

Results from these procedures are usually gradual and can range from subtle to astonishing. It is common for patients who have had these procedures to say that they receive compliments on their appearance without others knowing that they have done anything. As with any cosmetic medical procedure, results vary from patient to patient.

Interested in trying a Liquid Face Lift? We're taking 20% OFF Juvederm™ Ultra, Juvederm™ Ultra Plus, Radiesse®, Restylane® and Sculptra® for our May special.

Find a coupon at http://www.renewyourlooks.com/asp/coupons.asp.

(expires June 30,2010)

Call and schedule your appointment today! 513-984-FACE (3223)

The Full Face Chemical Peel

THE PROCEDURE OF THE MONTH
Each month, we will feature one procedure performed at our center to educate our clients. The series will begin with the Chemical Peel.

Chemical peels come in many varieties. The light, or superficial, peels are performed by aestheticians or skin care specialists. The chemicals may include glycolic, salicylic, lactic or other fruit acids. These peels cause little or no downtime and are excellent for skin care maintenance and rejuvenation.

Medium depth chemical peels are usually performed by physicians. The peels used most often are the 30% to 35% TCA (trichloroacetic acid) peels and the straight 89% phenol peel. This peel is used to treat brown spots, uneven pigmentation, mild wrinkles and mild acne scars. Healing times is less than 7 days and mild redness fades in 4 to 6 weeks.

The workhorse of skin resurfacing is the Deep chemical peel. We use the Hetter Peel for deep skin resurfacing. The solution is a unique combination of Phenol and Croton Oil that can be applied in different strengths based on the individual patient's skin type and amount of skin rejuvenation needed. The peel is used to treat patients who have coarse facial wrinkles, severe sun damage, or pre-cancerous growths on their face. The dramatic results from this type of peel produce smoother, tighter, younger-looking skin.

Make an appointment to see which peel is right for you and save $500 if you schedule your medium or deep chemical peel before 2-15-10.

(859)331-9600

www.renewyourlooks.com

Plastic Surgery May Also Ease Migraines

MANY of the nearly 30 million Americans who suffer from migraines end up feeling like guinea pigs. Chronic patients — those who are laid low 15 or more days a month — often cycle through drug after drug in search of relief. They also contend with side effects like mental sluggishness and stomach upset. Treatment involves guesswork because doctors have not pinpointed what causes migraines, nor do they know which drugs will best help which patients.

“It can be a merry-go-round going from medication to medication in pursuit of control,” said Dr. Roger K. Cady, the vice president of the board for the National Headache Foundation, a nonprofit organization devoted to patient education.

No wonder that last month, news of a surgical “cure” that touts a high success rate ricocheted worldwide. The double-blind study, published in the journal Plastic and Reconstructive Surgery, found that more than 80 percent of patients who underwent surgery in one of three “trigger sites” significantly reduced their number of headaches compared with more than 55 percent of the group who had sham surgery. More than half of the patients with the real surgery reported a “complete elimination” of headaches compared with about 4 percent of the placebo group.

Forehead lifts are cosmetic procedures that plastic surgeons typically perform to smooth furrowed brows. But a decade ago, after some of his patients reported that their migraines improved post-operation, Dr. Bahman Guyuron, a plastic surgeon and the lead author of the study, began to search for a surgical solution that could address migraine trigger points — which he defines as where the headache begins and settles — in the forehead, temples and the back of the head

Headache specialists tend to be neurologists or internists, so Dr. Guyuron’s work has not always been taken seriously. “If I had a neurologist tell me there’s a new way of doing a facelift, I would have been very skeptical about it also,” said Dr. Guyuron, the chairman of the plastic surgery department at University Hospitals Case Medical Center in Cleveland. “But honestly I would have had an open mind.

”In the last month, the press has made much of the fact that a single operation could relieve migraines and turn back the clock in one fell swoop. But it is the potential that surgery for migraines may offer a viable alternative to drugs that has migraine specialists intrigued. “A very large subset became headache-free and remained headache-free for a year — that is a fantastic result,” said Dr. Richard B. Lipton, the director of the Montefiore Headache Center in the Bronx.

Especially considering that in the field of migraines, success is defined “as a reduction of 50 percent of attacks,” Dr. Cady said. Going from 10 episodes monthly to 5 is a welcome change, he added, but “it’s still a lot of migraines.”

The theory behind the surgery is that because some migraines are caused when sensitive nerve branches are squeezed and irritated by muscles, deactivating those muscles could bring prolonged relief. In the off-label use of Botox for migraines, those same muscles — when paralyzed with Botox injections — have eased headaches in some patients for roughly three months. Forehead lifts, Dr. Guyuron reasoned, might result in a longer-lasting, perhaps permanent, alleviation of pain. Only study participants who responded positively to Botox were offered the surgery.

(Dr. Cady cautioned that the research on Botox as a treatment for chronic headaches is not yet ironclad. Allergan, Botox’s maker, is pursuing the approval of Botox as a treatment for chronic migraines by the Food and Drug Administration.)

Many headache specialists, Dr. Lipton and Dr. Cady included, emphasize that this migraine surgery isn’t applicable to most sufferers. “Folks who are appropriate for this procedure — they are the tip of the iceberg, not the vast majority,” said Dr. Jennifer S. Kriegler, a neurologist who is one of the study’s authors and who works at the Cleveland Clinic’s headache center.

At this stage, suitable candidates are those who endure frequent migraines and have failed more tried-and-true methods of controlling their headaches, several doctors said. The bottom line, Dr. Lipton explained, is if you can’t identify a point of irritation and “if you don’t respond to Botox, we don’t know if this treatment works for you.

”Some doctors fear that the surgery may be offered to inappropriate patients before further research confirms its efficacy for a broader group of patients. “I don’t want us to overshoot and start doing widespread surgeries in not very well selected patients until we are convinced this is broadly effective,” said Dr. F. Michael Cutrer, the chief of the headache division in the neurology department at the Mayo Clinic in Rochester, Minn. “You can always stop a medication but you can’t reverse a surgery.”

As word of the surgery spreads, Dr. Cutrer said that he anticipated pleas for referrals to the few plastic surgeons nationwide who offer the operations, but that “until we maybe have studies that are a bit larger, and some longer follow-up I’m going to be very cautious.”

So far, Dr. Guyuron has trained roughly 150 doctors, and other plastic surgeons are refining their own migraine operations, even though they barely advertise.

Two years ago, an aunt told Shannon Byrne, from Mayfield Heights, Ohio, about Dr. Guyuron’s migraine surgery. Ms. Byrne said that she had already spent a decade on “every single medication you can think of.” Still, pain hammered her head more days than not. “You’re willing to try anything,” she said. Dr. Guyuron’s surgery, which she had 18 months ago, was a godsend. The migraines that led to her dropping out of college and to a stroke at 20 are gone. “My dad told me not to worry about the money,” Ms. Byrne, now 22, said of the thousands paid out of pocket.

A classic forehead lift for cosmetic effect differs significantly from surgery for migraine sufferers. The latter removes frown muscles more thoroughly and entails padding nerves with fatty tissue, said Dr. David A. Branch, a plastic surgeon in Bangor, Me., who performs migraine operations.

Sometimes, migraine surgery doesn’t involve the forehead at all. It varies according to where the patient’s trigger sites are: forehead, temples or back of the head. If Dr. Guyuron operates on the temples, the eyebrows are rejuvenated, he said. It is only the surgery at the back of the head that has no added perk, he said.

It’s unclear whether or not the migraine sufferers whose pain had disappeared a year post-operation will remain headache-free for life.

“My goal is zero headaches,” said Dr. Jeffrey E. Janis, a plastic surgeon in Dallas, who has performed roughly 100 operations in the last five years after training with Dr. Guyuron. “I might be able to achieve that in some, not in all.”

Complete elimination is “a pretty strong claim after one year of follow-up,” Dr. Cutrer said.

As a way of dampening expectations, Dr. Kriegler, who has referred patients to Dr. Guyuron, frequently tells them: “Once a migraineur, always a migraineur.”

The Importance of Nutrition & Surgery

Surgical outcome tends to improve when the patient is in good physical health. Optimizing a patient’s nutritional status is an important part of this process and is essential for proper wound healing.

Wound healing sets off a complex chain of events that involved increased cellular activity and an intensified metabolic demand for nutrients. This activity requires a number of vitamins and other chemical cofactors to complete its job. Without these building blocks, wound healing takes longer and may be compromised. Patients who don’t meet their nutritional needs may be at risk for increased bruising and swelling, delayed wound healing, and other wound-related complications.

To augment their health, many Americans are taking nutritional supplements on a routine basis. While generally beneficial and safe, the uses of several popular supplements, around the time of surgery, are not recommended. Certain nutritional supplements may cause adverse reactions during or after surgery, including prolonged bleeding.

We offer our surgery patients a line of vitamins and healing supplements that are formulated with essential nutrients to support wound healing, enhance tissue repair, support the immune system, prevent infection, minimize inflammation and reduce bruising. At the same time, the products have selectively excluded any nutrients that can cause problems during peri-operative period.

Guidelines to Healing (Post Surgery)

1. Schedule elective surgery when you're healthy. This will optimize your immune system and improve your chances for a speedy recovery.
   
2. Consume sufficient calories and protein. Two of the most important elements for healing are calories and protein. Extra protein is needed to build new tissue and blood vessels, repair injured tissue and increase production of cells to repair the wound.
   
3. Stay well hydrated by drinking water. It is important to drink at least 6-8 glasses of water each day and especially the day prior to surgery to help cleanse and hydrate the body. Water is especially important prior to surgery as fluid intake is reduced the day of surgery.
   
4. Do not take aspirin or aspirin-containing products for ten days prior to surgery. Aspirin is not recommended prior to surgery because it is an anti-coagulant (blood thinner) and can promote bleeding during surgery.
   
5. Do not drink alcohol one week prior to surgery. Alcohol suppresses the immune system and should be avoid around the time of surgery.
   
6. Do not smoke one month prior/after your surgery. Smoke inhibits wound healing because less oxygen is supplied to the operative site. In addition, smoking increases the risk of various complications during surgery. If you smoke, use your surgical procedure as an opportunity to quit.

Smart Sun Habits

Cincinnati summers are full of outdoor activities – golf, swimming, tennis, biking, hiking, kayaking. You name it, we’ve got it! Though each outdoor activity requires its own special equipment, one item is common to them all – sunscreen. Most people remember to apply sunscreen for a day at the beach or the pool, but participants in outdoor sports and other activities are much more likely to forget to apply sunscreen and run the risk of being burned. Did you know that even one blistering sunburn in childhood doubles the risk of getting melanoma later in life?
People most at risk for developing skin cancer are those that burn easily in the sun, have fair skin, light-colored hair, green or blue eyes and freckle easily. BUT, skin cancer can occur in people with darker skin tones including those of Hispanic and African American backgrounds. More teenagers and young adults are being diagnosed with skin cancer than ever before. This includes a rise in the deadliest form of skin cancer - melanoma.

Yearly skin examinations are recommended to identify precancerous and cancerous lesions prior to significant growth. So what do we look for? The most common precancerous skin lesion is an actinic keratosis, which usually appears as a red, scaly patch of skin. The most common locations for actinic keratoses are the face, ears, scalp, arms, hands, upper back, and upper chest. These lesions are usually treated with various topical therapies.

Basal cell carcinoma is the most common form of skin cancer. 800,000 Americans are diagnosed each year. Basal cell carcinomas most commonly present as pearly, raised papules with a central ulceration. Treatment of these cancers is usually complete surgical excision.
Approximately 250,000 new cases of squamous cell carcinoma, the second most common skin cancer, are diagnosed in the US each year. These cancers usually present as crusted, scaly patches with a red, inflamed base. Treatment is usually surgical excision. If left untreated, these lesions can spread throughout the body.

The most deadly form of skin cancer is melanoma. Melanoma is diagnosed in approximately 53,000 people in the US each year. Melanoma usually arises from an existing mole. To identify melanomas use the ABCD’s. A stands for asymmetry, B stands for border irregularity, C for color variegation and D for diameter greater than 6mm. Asymmetry, border irregularity, and color variegation are all associated with melanoma lesions whose diameter are more than 6 mm. If you discover an abnormal mole, be sure to show your doctor.

Even if you have tanned or been burned before, it’s never too late to protect your skin. Sunscreens protect your skin from UV rays and are classified according to the Sun Protection Factor (SPF). The higher the SPF number the greater the protection level. Specifically, an SPF sunscreen rating of 30 means if you use the sunscreen properly you can stay in the sun 30 times longer than without the sunscreen and get the same level of sunburn. Unfortunately, most people don't put on the right thickness of sunscreen and they don't reapply it frequently enough. As a result, many people who use sunscreen actually end up with sunburn. One ounce, enough to fill a shot glass, is considered the amount needed to cover the exposed areas of the body properly.

What else can we do?

• Apply sunscreen with an SPF of 30 or greater.• Apply sunscreen every day, all year long, for maximum protection and to prevent sun-related aging.
• Apply sunscreen 60 minutes before going outside to allow time to bond with your skin.
• When possible, avoid outdoor activities between 10 AM and 4 PM, when the sun’s rays are the strongest.
• Be sure to reapply sunscreen frequently, every two hours, and after swimming, perspiring heavily or drying off with a towel.
• Wear a hat with a 4-inch brim all around to protects areas often exposed to the sun, such as the neck, ears, eyes, forehead, nose and scalp.
• Wear clothing to protect as much skin as possible. A tightly woven fabric provides greater protection than loosely woven fabric.
• To protect your eyes from sun damage, wear sunglasses that block 99 to 100 percent of UVA and UVB radiation.
• Swimmers should remember to regularly reapply sunscreen. UV rays reflect off water and sand, increasing the intensity of UV radiation and making sun protection especially important.

Allison M. Holzapfel, MD, FACSFacial Plastic and Reconstructive SurgeonMangat-Kuy-Holzapfel Plastic SurgeryBoard Certified, Facial Plastic and Reconstructive SurgeryBoard Certified, Otolaryngology – Head and Neck SurgerySpecializes in cosmetic and reconstructive surgery of the face and neck. She specifically performs multiple skin cancer reconstructions on the face and neck each week.