Total Body Surgical Blog

A good friend asked me to talk about fillers this week and I promised I would, so here goes.

First of all, what is a filler and why would someone want to use one??  Fillers are just what the name sounds like.  As we age, we lose volume in our face.  We lose it around the eyes, in the cheek area, and in the folds around the mouth and lips.  This is caused by hormonal changes and in many cases, genetics plays a significant role.

  As you can see in this graffic, as volume is lost, the skin begins to respond to gravity and "folds" in typical spots start to form.  Nasolabial folds are the most common, forming around the base of the nose to the corners of the mouth.  Secondly, "bags" begin to form under the eyes.  This is due to shrinkage of the fat pads in the cheek area that, in younger people, "windowshade" the fat pad under the eye.  This creates the dark circle under the eye which is really shadowing, as light is blocked by the overhanging fat pad.  The other commonly effected areas are the "marionette lines" at the lower corners of the mouth and vertical lip lines.  One other common complaint is thinning of the lips and loss of the youthful shape of the lip.

This picture depicts the "cone of youth" and how aging turns it into a box.  Again, most of this is due to loss of volume and loss of skin elasticity.

Now that we have covered what happens, what can be done about it?  There are a few ways we can correct or reverse the aging process.  The first thing I recommend is good skin care.  It wouldn't be right to fix up a vintage car and not re-paint the thing would it?  You want your skin to look as youthful as possible and I think Obagi is as good as it gets for that.

Second, we have to increase volume.  Even when we do face lifts to remove excess skin, most of us will add volume to fill up the upper part of the face...this is youthful.

The first and best way to increase volume is with facial implants.  They are solid silicone and never go away....one time and that's it.  The second best way is with fat grafting.  We use your fat, process it, and place it back in the face.  This is good because it can last a pretty long time...5-7 years.  The third way is with fillers.

Fillers have been around quite a long time.  First came collagen fillers that only lasted about 3-4 months and required skin testing.  We now have them that last a year or more and can be used in anyone.  The most commonly recognized one is Juvederm.  It is made of cross-linked Hyaluronic acid (HA).  HA is a substance that is present between our cells naturally.  Juvederm is clear and almost jelly like.

  It can be used literally anywhere in the face.  We use it to fill the cheek area, the nasolabial folds, marrionette lines, and lips.  It can also be used to correct nasal deformities or acne scars.  Think of it as putting dirt in a hole in your yard without disturbing the grass.  It is used to fill deformities or add volume to the cheek area, the nasolabial folds or marrionette lines.  It can be used to make lips larger or reshape them.    The second type of filler non-occuring in the body and made of a calcium compound mixed with a sugar based carrier.  This filler is good for volumizing but can only be used in deeper tissues. 

Radiesse is great for liquid face lifts where we place volume into the cheek area, lifting the face and restoring volume.  It can be used in nasolabial folds and carefully in marrionette lines.  It cannot be used in lips or in the dermis (skin).  Most other fillers on the market are made of HA, regardless of the name, except Artefill (made of collagen and spheres of solid material) and Sculptra (made of a powder material that causes collagen to form).  These two materials are made to inject deeply and last 5+ years.  All fillers have advantages and disadvantages.  You must consult with your injector to know which one is best to get the result you want.

My preferences are for Juvederm and Radiesse, for shorter term fillers.  I use silikon 1000 for my long term filler as it never goes away.  I use it to make great looking lips that stay.  I do small injections a month or so apart to get the right amount of correction.  Hope this helps everyone.  We love fillers and do them very well.  Call today and come see me at 918-786-7780.  All cosmetic consultations are complimentary.

Last week we discussed how Botox can be used to prevent some wrinkles and soften others.  It is a great product and is now more affordable than ever.  Today I would like to briefly discuss what to do about those wrinkles that won't go away with Botox or those that Botox is not appropriate for....what can we do with them??

The most common complaints I see about facial appearance AFTER Botox have to do with residual wrinkles or sunken spots around the mouth.  Here is a common picture that shows and labels the areas we are discussing.  As we age, the face loses volume..ie fat.  We get it where we don't want it and lose it where we'd like to keep it....go figure!

When the volume is lost, of course the skin falls a little creating a hollow area.  When not too severe, these areas can be helped tremendously by replacing the volume with either harvested fat or some other material.This picture demonstrates a before and after of a nasolabial fold filled with Radiesse....Nice result I think.  The area is softened quite nicely.  This is done in the office with very little discomfort and an immediate result.  We could also use Juvederm in this area.  Both fillers last a year or more and there are few problems with them.

Another area commonly complained about is the Marrionette line area.

  Here we see in the before picture how the nasolabial folds are prominent and the marrionette lines are too.  These lines are present at the corners of the mouth and cause the lip corners to turn down.  When filled, the result is pretty amazing.  You get a much more youthful appearance with no surgery and no recovery time.

  A third area complained about is the glabellar area.  Botox works to soften this area but when the lines persist, it is a great place to fill.

These three areas are the most commonly treated spots that we use fillers on.  At Total Body Surgical I use Juvederm and Radiesse.  I think they both work very well.  As I said, they both work for about a year.  We do injections in the office and it takes very little time.  There is no recovery time and the worst problem that can arise is a bruise. 

At Total Body Surgical we have a great deal of experience with many fillers.  For the remainder of the summer we will offer a special on fillers.  If you pay full price for one syringe you get the second one at half price.  That means you get two syringes for $775 and Botox for $9 per unit if you mention this blog.  I use Botox with fillers as it helps them last longer.

We look forward to seeing you soon.  Call 918-786-7780 to set up your time!!

Click on one of the buttons to see other specials currently running.

Last week we talked about eyes, the window to the soul.  Today we are going to discuss another part of the anatomy that can instantly tell your age.

Youthful lips are generally very full and inviting.  They are made of the white line where the skin and the pink mucosa of the lip join and the fullness of the lip takes off.  The cupids bow is in the center of the upper lip giving definition and contrast that the lower lip is missing.  Usually the lower lip is slightly larger than the upper.  Youthful lips are smooth and surrounded by skin that is also smooth with uniform color and texture.

  So what happened??  A number of things.  Skin aging, sun damage, volume loss, i.e. fat, around and in the lip, smoking, using straws, smiling, frowning, kissing and just time.  All of these things age our entire face but since the mouth is one of the centers of motion and expression in the face, like the eyes, it shows the use as we age.  The lips become thin and surrounded by vertical lines, nasolabial folds, marrionette lines.  The "white line" becomes less visible and the "cupids bow" becomes a straight line.

How can we repair the damage??  We can lift the tissue around the lips, correcting the cheeks and neck.  We can correct the nasolabial folds by adding volume in the form of a filler (Juvederm, Radiesse, fat grafting).  We can do dental correction to improve the underlying structure if needed.  To correct the skin damage, it is important to improve the skin.  We can do this in a few steps.  First, good skin care is critical.  As stated here before, we recommend Obagi products that combine Tretinoin and hydroquinone to correct color changes and improve the texture of the skin.  We then can augment the lips using temporary fillers like Juvederm or more permanent fillers like Silikon 1000.  This replaces the volume that has been lost.  Lastly, after pre-treating the skin with Obagi and repairing sun damage, the deeper wrinkles and vertical lines remain.  What to do about them?  They can be filled if extremely deep, again, with a temporary filler.  The best way to treat the area is with laser.  Resurfacing the area promotes new collagen production, softens the wrinkled areas, and removes the sallow color of the skin.  I usually recommend doing the entire face along with the area around the mouth.  This removes transition zones and looks more uniform.  We use the Pearl laser which is great for this.  It has a faster recovery time than similar lasers, can be spread over multiple treatments, and gives great results.  The price for the first treatment is only $1000 and repeat treatments are $500.  Most require 2 or 3 treatments for a great outcome.  The order should be, skin care, laser, then filler as some laser treatments can degrade the filler material.

Come see us for lip rejuvenation.  We carry a complete line of Obaji products and fillers.  Also Botox that can help prevent some of these changes.

Don't forget our other specials too....summer is approaching rapidly!!  Breast augmentation starting at $3799.00!

Sorry about the late post this week!  Spent the weekend in Oxford, MS at the Ole Miss, Arkansas game.  Oxford is a great place to visit and I recommend it to all.  The game was fun.  One of my daughters went to Ole Miss and the other is currently a Hog!!!

This week we are going to discuss the unusual uses of fillers.  Last week I talked about the normal uses around the mouth and in the nasolabial folds.  I hope you all got to read it. 

There are a number of uses for fillers that are a little out of the main stream.  The first is in the nose.  There are a number of people that present with complaints of imperfections in the shape of their nose and they are not ready for rhinoplasty, OR, they have had a less than perfect rhinoplasty and have persistant defects.  In these cases I will use Radiesse or Silikon 1000 to help re-shape the bridge of the nose or fill defects.  With Silikon 1000 the fix is permanent and therefore I like to correct in stages so as not to overcorrect.  Fillers are a great way to a non surgical rhinoplasty.

A second out of the mainstream use of fillers is for cheek augmentation and filling the nasojugal fold....the line we get below the eye from the corner of the eye onto the cheek.  This is done in those that do not want an implant or fat grafting.  The filler is essentially placed where an implant would sit over the cheek bone.  It is a great way to rejuvenate the mid face without surgery.  It is done in the office and usually requires several syringes of product.  I usually use Radiesse as it offers more volume per syringe for the same price.  I like to call this the liquid face lift.  It is not perfect but does do a good job.

The third use is in rejuvenating the hands.  As we age, we not only lose fat in the face, we also lose it in our hands.  Many times we work on our face and body then forget the hands. Hands age quickly due to sun exposure.  Fillers or fat can do a great deal to make the hands look much younger.

The fourth place is for acne scarring.  Laser resurfacing can do a great deal to smooth out scarring that occurs from acne.  When they become too deep for the laser....fillers can help.  I usually use Juvederm or Silikon 1000 in very small amounts to help level these areas.  In some cases subcision or release of the scar must be done first and this is done in the office with some local anesthetic.

The last place I will talk about for fillers is the lips.  Believe it or not....they get smaller too!!  Adding volume to the lips is a great way to rejuvenate.  Voluptuous lips are what all the girls want!!  I like to use Juvederm, and for those who want a permanent fix...Silikon 1000 in a gradual fill.  Both are great and can make you look outstanding....

Enough about fillers I think.

Remember our special offers on fillers, liposuction, lap bands and treatment of toe nail fungus!!

918-786-7780...and like us on Facebook Please!

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!