Total Body Surgical Blog

  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.

Laser days at Total Body Surgical!!!!  We know have the Cutera laser full time in Grove...VERY exciting.  The Cutera laser is one of the most comprehensive lasers, IPL combinations on the market.  The system can nearly do it all, and do it well.  I have many years of experience using this system and it is great at treating a large number of problems.  Let's itemize them:

1.  Laser hair removal.  With the Cutera system we use the ProWave 770.  It is an IPL (intense pulsed light) that can treat large areas and do it very effectively.  In a pinch for smaller areas that are difficult, we have the 1064 YAG which most of the older systems are based on.  Laser hair removal is very popular and has, in the past, been cost prohibitive.  For a limited time, we are offering an exceptional deal...$50.00 per area per treatment.  This will be good through the summer so don't miss it.  Usually facial hair takes about 9 treatments and body hair 6.  This means you can get your underarms done for $300.00.  Take advantage of a great value!

2.  Facial or body dyschromias.  Age spots and redness become a problem as our skin ages.  The IPL Limelight system is great for treating a variety of discolorations on the face, arms, and hands.  This usually requires a series of 3-5 treatments and we usually like to have you on the Obagi skin care system to prevent further damage or recurrence.

3.  Facial veins.  We use the 1064 YAG to treat small viens that occur at the base of the nose, on the cheeks and chin.  The laser targets the pigment and closes the vein, removing it on a permanent basis. 

4.  Leg veins.  We use the 1064 YAG to treat small areas of leg spider veins as well.  For larger areas we usually inject with a sclerosant.

5.  Laser skin resurfacing.  We have the Pearl laser for resurfacing.  This helps with reducing pore size, improving skin color, fine lines, and wrinkles.  The great thing about the pearl is the short recovery time and similar results to the CO2 laser.  Recovery times are about 4 days with great results.  Some may require a series of 2-3 treatments about 2 months apart.

6.  Laser treatment of Hemangiomas or cherry spots on the body or face.  These require only one treatment in most cases and they are eradicated.

7.  Laser Genesis for treatment of acne, to reduce pore size and improve skin tone and texture.  This works exceptionally well with no down time.

8.  Titan treatments for skin laxity in the neck and face using Radio Frequency with no down time.

We are very proud to have such great technology in Grove.  Our pricing is unbeatable and results are outstanding.  Our nurses, Janet and Trish are very skilled at suggestions and advice and are very good at treatments.  We also have the Zimmer system that provides comfort during treatment sessions.  

Come see us soon to arrange YOUR treatment plan and schedule.  Call 918-786-7780 to arrange today.

This week we are still talking about wrinkles!!  Ya'll will enjoy this one...

http://youtu.be/NCvHgppVey4

To sum things up at this point, young skin, ages up to about 30 just need protection from the sun and some type of vitamin C product to maintain collagen production (Obagi or Skinceuticals make great products).  From ages 30-40 or 50 most can get by with good skin care, and add Botox to slow the musculature down that is causing the typical wrinkles between the eyes, crows feet, and forehead lines.  For stubborn wrinkles that are too deep for Botox, fillers such as Juvederm and Radiesse can be used to soften them.  Laser procedures and peels can help a great deal as well and that is what we will discuss in this installment. 

Lasers have come a long way in the past several years and this is exciting.  Laser technology has come a long way and this seriously benefits our patients. The old complications can still occur but are not as common with fractional techniques.  The most common problems are hyperpigmentation, hypopigmentation, persistant redness, and scarring.  These problems are less likely with the new technologies and pre treatment.

Who needs or wants laser treatment?  There are many indications.  The most prevalent use is for treatment of mild to moderate wrinkling.  It also helps a great deal in rejuvenating the skin and helping remove spots from sun damage.  Lasers stimulate the skin to make more collagen and make it look much healthier by removing damaged stratum corneum (the outer layer) and promoting new skin growth. 

Older "full ablation" laser techniques removed all of the outer layer.  Since the skin heals from either hair follicles or by expanding from undamaged areas, this took awhile.  Newer laser technology allows us to "fractionate" the damage.  This means that we can now regulate the energy put into the skin, the depth of penetration , and the separation of spots that are treated.  In other words, we are treating small areas that are surrounded by normal skin.  This allows the skin to heal much quicker so recovery time is much shorter and complications are less.  The down side is that multiple treatments may be required to get the same result.

At Total Body Surgical, we have the Pearl Laser by Cutera. www.cutera.com  .  We have access to other lasers as well, depending on the need.  This laser is a great tool to treat both younger and older skin.  The recovery time is usually only 4 days.  This means you can begin wearing makeup after four days and look about back to normal in a week or two.

Come see us at Total Body Surgical Cosmetic Surgery for complimentary cosmetic consultations, Obagi Products, or laser therapy.

Don't forget our Breast Augmentation and Laser hair removal specials!!

  Last week on the Total Body Surgical Cosmetic Surgery blog we talked about wrinkles and how good skin care and Botox can make a big difference.  This week we will take a look at the common fillers that can be used.

Below is one of the commonly used scales to measure and quantify the severity of wrinkles and skin damage.

Class II we would usually use Botox or Dysport because slowing the underlying muscles will usually eliminate the wrinkle as long as it is maintained.

Class III wrinkles will usually require "filling" as they are present at rest and are more or less permanent fixtures.  Filling them will not remove the wrinkle 100% but will go a long way toward making them tolerable.

There are many fillers on the market and thank goodness most of them now last a year or more.  This is in contrast to only 5 or 6 years ago when a filler would work for 2-4 months.  Many techniques can be nearly peramanant.

Hyaluronic acid fillers such as Juvederm and Perlane are great all around fillers that can be used nearly anywhere in the body.  This is because it is a naturally occurring substance in the body and is colorless.  They cause very little collagen production and the newer ones contain lidocaine which is a nice plus for the patient and injector.  These are the most widely used products.

Radiesse is another filler that is made of small calcium hydroxyapetite beads in a sugar based carrier.  This filler is limited in its use and should not be used in the lip or superficially anywhere.  It is great for larger volume fills in the cheek and nasolabial fold.  It works by causing your body to form collagen in the treated areas. It should last 12 to 18 months but will need some supplementation in that time.

Other common fillers are Sculptra which is poly L lactic acid can be used to create volume in the cheeks but this is a much slower process than the other two.

More permanent fillers are fat and silicone.  Fat harvesting and grafting has become common all over the body, but is very popular in the face.  Fat is harvested, treated and placed in areas where fat has disappeared over time.  There is some variability in the percentage of the fat that lives and therefore the procedure may need repeating. Lastly, silicone.  Silicone has received a bad name.  There are countless examples of low grade silicone used in too large a quantity to create a terrible result.  At Total Body Surgical, I have a great deal of experience with silicone.  We use only the best quality silikon 1000 that is manufactured by Alcon and made for use in the eye.  It works great for augmenting lips, filling areas of imperfection on the nose, and some acne scarring.

Next week....we'll address pigment issues!!  Come see us at Total Body Surgical.  Mention this blog and get $10.00per unit botox....That's a good price now!!