Total Body Surgical Blog

Let's have some fun today.  It's been a little while since we had a little audience participation and I think it is time to change that.  Sooo, it's test time again!! 

Here are the rules:

1.  Look at the picture and see what you think would help.  (those of you who come here often will find it easy...you are educated!!).

2.  The choices will be between using Botox, a Filler of some sort, laser, or a surgical procedure.

You may elect to combine the use of these tools and that is OK.  I do it all the time.  Today though, let's not get too complicated.  In my analysis of the patient I will give you some ideas on what other things would be good for the patient.  I need to feel useful in some way!!

Always remember, there is no right answer, because, in Cosmetic surgery everything is elective.  You can always choose to do nothing.  However, there are wrong answers.  Wrong answers are when you plan to do more than the patient needs or wants.  My job is to steer people away from unecessary procedures and only do what's needed or desired...today, that's your job.  Good luck!!

Example #1: 

Here we have a 40'ish female with no other medical problems.  She complains that she looks "old" and wants a face lift or something to help her look the way she feels.  Look at her closely.  What do you think??

What would you recommend:

1.  Botox  2.  some type of filler  3.  laser  4.  a surgical procedure

Example #2:

40'ish young lady who complains about the lower part of her face sagging.  Her friends have told her that you have helped them and she should come talk to you about what could be done.  You would recommend???

  Your recommendation??

1.  Botox  2.  a filler of some type  3.  laser  4.  a surgical procedure

Example #3:

A 54 year old lady who is disgusted with her neck and just thinks she looks OLD!!  She says that cost is no obstacle and wants it all fixed, or injected, or something! 

 And the winner is....

1.  Botox  2.  some type of filler 3.  laser  4.  a surgical procedure

Example #4:

28 year old female who states her boyfriend says she has "wrinkles around her mouth".  She is concearned about this and wants to know what you think....

  Here she is...

1.  Botox  2.  Some type of filler  3.  laser  4.  surgical procedure  5.  get a new boyfriend!

Example 5:

A 65 year old widow comes to you and says she has finished mourning the loss of her husband and wants to look younger so she can "get out there".

  Very nice lady....funny too....what would you recommend??

1.  Botox  2.  some type of filler  3. laser  4. Surgical procedure  5.  Birth control

Well, let's see how you did.  On number one if you said Botox, that would be a great start.  Most people want to start small.  Botox would get rid of the lines around the eyes and in the upper face.  She will eventually probably want a brow lift to eliminate the lines and the cause of them but Botox is fairly cheap and less invasive.

On number two, I would say Botox and some type of filler.  This combination is great for softening wrinkles in the upper face and getting rid of nasolabial folds as this lady has.  She has good facial structure and her skin is in good shape.  This will make her very happy and not cost a fortune.

On number three, I would recommend a surgical procedure or two.  Looking at the "hooding" over her eyes, she would benefit greatly from a brow lift.  It will take years off of her appearance.  She also has the "turkey gobbler" neck and jowling but her neck is not heavy.  I would recommend a mini lower face and neck lift as well.  She will be very happy!

On number four....get a new boyfriend of course.  We see people like this sometimes and my job is to DO NOTHING.  She needs to be told how beautiful she is and just how silly it would be to do anything to change that.  Unfortunately, in many cases, these people will find someone to mess things up.  It's sad.

Number five would need a brow lift, upper eyelids, face lift, and I would also recommend full face laser to treat the discolorations and fine lines on the rest of the face.

I hope you did well on the quiz today, and enjoyed using your own evaluation skills.  If you like, let me know how you scored and if you have anything you would like addressed, send that too.

Call us at 918-786-7780 or 1-877-weight-0 to make an appointment.

  Do you ever feel like this?  What is a brow lift and when do I need one?  How do you know if it's the eyelid or the brow?  This week I hope to give you the information you need if you have these questions, or know someone who does.

  Many people show up to the office wanting their eyelids done.  The eyelids droop, look bad, and sometimes even effect their vision.  The question is..this, is it the brow, the lids, or a combination of the two?

If you look closely at this picture, what do you see?  First, it looks like her lids are drooping.  On closer inspection, the problem is a little more subtle.  If you look at the brow position, it is very low.  There is a hood over the outside of the eyelid and out over the outside of the eye.  This is a tell-tale sign....lateral hooding.  The second thing you notice is how low the eyebrow is in relation to the eye.  In females, the normal position should be above the boney rim of the upper eye and should have an arch to it that is highest at about the outer iris (colored part of the eye).  Her brow is far from being in the proper position...it is very low.  She may come asking to have her eyelids fixed, and without further examination, she may be right, but the primary problem is her brow.

Brow ptosis, or droop, is a problem that can be multi-factorial.  It is partially hereditary and is added to, as a problem, by facial fat loss.  It can cause cosmetic issues, making you look older, tired all the time, and causes wrinkles in the forehead due to over-use of the muscles in the area so you can see.  Brow ptosis can also cause visual field problems.  Our peripheral vision is dependant on a clear field of vision, up, down, medial and lateral.  What the droop can cause is an occlusion to the vision.  Once the brow falls significantly, it is like having blinders on a horse, you can only see straight ahead!

In many cases, the brow droop is accompanied by upper lid laxity (blepharachalasia) as well.  When this happens, we try to address both problems at once.  For older patients with visual problems, we establish the problem exists first by doing a "visual field" test.  This establishes if your vision is actually effected by the extra or low tissue.  Then the lid or brow is taped out of the way and the test repeated.  This allows us to tell if removing eyelid tissue or elevating the brow is indicated, or if both are indicated.(Visual field testing.)

 This is a great example of an eyelid problem only.  If you look closely you see that the brow position is exactly as we discussed.  The brow is in a good position as far as it relates to the boney part of the eye socket, and it is arched nicely.  Also note that there is no lateral hooding present as we saw in the previous picture.  It is the eyelids that are the problem and a simple blepharoplasty is sufficient to fix this.  This is a great result by the way, off of google images.

 A blepharoplasty means removing skin from the upper eyelids and often a small amount of fat.  This gives you back the lid platform for eye make-up, makes you look less tired, and is very rejuvenating, knocking several years off of your appearance.  I usually do these in the office, mostly under local.  It takes about 45 minutes or so, you go home after, there usually is no more than minor bruising, and after healing several months, you can't even see the scar.  It is a great procedure.

When a brow lift is done for cosmetic purposes.  I do them using a scope and a camera.  Some people still make a large incision on the scalp but I think the scope gives great results without significantly moving the hair line and without a big scar.

This picture depicts where the small incisions are placed for a brow lift.  We shave no hair, the hair line stays the same, and the results are just as good as the old big incision.

This shows a nice result from a brow lift.  She looks much younger and the hoods that she had before are now gone.  The brow position is arched and good...no surprised look.

If you are dealing with these problems, come see us today at Total Body Surgical.  We can help...call 918-786-7780 or 1-877-weight-0.

Why Botox???  Well, look at my picture...see any lines??  Do I look fake or funny to you??  I don't feel funny!!  The best way to summarize the answer to the Botox question is...it makes you look younger.

If that's what you want, Botox is the medication for you.  As we age, the muscles of facial expression work day after day.  Our surprised look, our concearned look, our mad look, and squinting from the sun or when trying to read all lead to eventual wrinkles in the skin.  We get crows feet, lines in our forehead, elevens between the eyes and so on.  This happens to everyone whether we like it or not.  As these lines appear, sometimes as early as the 3rd decade of life, they start to show our age with only a glance.  These lines are difficult to hide with cosmetics and may not only show your actual age but may make you look older than you really are.
  Don't be depressed, have a low self esteem, and lose your confidence, DO something about it!!

What we have today is a whole armamentarium of therapy to make you look your best every day.  Botox is the product I want to talk about a little.  First of all it is very safe.  It is next to impossible to have a severe complication from Botox.  The safety profile is excellent.  It has become very affordable as well.  Usually the cost for treatment of the upper face is around $300.00.  This will generally get the forehead, the elevens between the eyes and the crows feet.  It is very quick and simple to do.  We use the smallest needle we can find and use the highest concentration so that bumps after injection are usually non-existent.  There is very little discomfort and it takes about five minutes.  About the worst that can happen is a small bruise which is rare unless you are taking aspirin or ibuprofen.

  After injection we have you briefly hold pressure on the areas and exercise the muscles we have treated.  In 3-5 days or less the wrinkles will soften and many will disappear.  The effect usually lasts for 3-6 months and for this time, the muscles are weakened and cannot crease the skin as badly.  It does not paralyze the face or make you look "funny" if done properly.  You will look refreshed and younger as the wrinkles fade.  When the strength in the muscles creating your wrinkles starts to return, you will notice the change in the skin and then return for re-treatment.  Most people have 2-3 treatments per year.  After you quit paying for wrinkle creams that do not work and cosmetics to hide the wrinkles that are marginally effective, it is a good investment.  If kept up with, you can go wrinkle free for years and if you keep up with good skin care as well, you will be miles ahead of the game.

Come see us today at Total Body Surgical, we are specialists at Botox and all other aspects of Cosmetic Surgery.  Also Click on any of the flags to see specials.  Mention this blog and get Botox for $9.00/unit.  Call 918-786-7780 for a visit today!!

New blogs starting after the new year.

Let's hope 2012 will be a great one and that things actually do "change".

Look for some of the same offers this year AND some new ones.

Thank you all for making our year a very good start here in Grove.

Last week we discussed (and hopefully dispelled) many of the myths about the use of Botox.  The FDA  has approved the cosmetic use of Botox in the  Glabellar region or the area between the eyes and forehead.

However, off label uses for the medicine have become common place.  I like to use it around the eyes to elevate the brow, treat crows feet, and to open the eye to show more of the iris or colored part of the eye.  Botox is VERY effective in these areas and due to the small size of the muscles, it requires only a very small amount.

  Notice the "crows feet" around the outer aspect of the eye and the hypertrophy or enlargement of the muscle below the eye.  Botox works extremely well to smooth these areas creating a more youthful look.

Another area that can be improved is the neck.  Many men and women develop banding of the muscles that lead to wrinkling of the skin.  Botox relaxes the muscles that cause the banding and the skin smooths very well.

A third area is around the mouth.

Many people start to form lines around the mouth due to the pursing motion of the muscles around the lips and loss of volume.  Smoking, using a straw, pursing the lips all create the lines.  When used carefully, Botox can help smooth these areas.  Add some volume and the mouth appears much younger.  Be warned that it may create some temporary weakness and this should be expected.  The chin area can also be smoothed with botox.

Another off label use is for Masseter muscle enlargement.

This can occur due to genetics or teeth clenching.  Botox can weaken the muscle and allow it to shrink giving the face a less angular look.

Botox can also be used to treat hyperhydrosis or excessive sweating.  The best area to treat is the under arm but it is also effective on the palms and feet.  Many people have this problem that cannot be resolved with anti-perspirants.  A simple test done at the time of treatment shows where the sweating is most profuse and small amounts of botox are injected.  It is very effective and seems to have good longevity....6 months to a year.

These are just a few of the off label uses for Botox.  There are many others and more are tried all of the time. 

Next week I will discuss volume replacement with dermal fillers and other things such as fat or implants.

Be sure to check our liposuction, nail fungus, and lap band offers.  Many are taking advantage of them, saving significant money, and getting GREAT results!!

Cosmetic consultations are complimentary so call today 918-786-7780 or fill out our contact form!