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.

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 (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!

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!!

Last week I began a discussion of common skin care complaints.  Today I will discuss one of the common complaints.....wrinkles...

Now this kid has a cure for everything.  Check out his routine!!

http://youtu.be/X5kFQW7W7_k

What causes wrinkles?  Well, that is a big question but the answer is about the same for everyone.  Time, as in aging, is the primary culprit.  We all make facial expressions that are common.  We all scowel from time to time, we smile, frown, and elevate our brow.  When young, we produce collagen at a rapid rate and elastin that keeps the skin flexible even when the underlying muscles wrinkle the skin.  Skin also produces more oil and moisture when young adding to its pliability.  At around age 30 most of us stop producing collagen at a rapid rate and we gradually develop a net loss of it.  When this happens, the skin, in response to constant pressure from the underlying muscles of expression, begins to gradually show wrinkles.  These wrinkles are seen in nearly everyone starting around age 40 but can occur much later or much earlier.  Genetics takes a part in when the process starts as well.

What can we do about them??  You can start with prevention.  This starts with a good skin care regimen.  The most important part of this regimen is sun screen to protect from UV damage.  For the remainder of the care, at Total Body Surgical Cosmetic Surgery, we recommend the Obagi line of medical skin care.  These products are fantastic at slowing the process of aging, i.e. wrinkles.  When used properly this line stimulates collagen formation and keeps the skin young longer.

When skin care is used properly, wrinkling can and eventually will continue to occur.  When this happens, the best product on the market, hands down, is Botox or Dysport.  These products are time tested, safe, and VERY effective when used properly.  We use Botox by the gallon and everyone loves it.  Wrinkles that are too deep for Botox may need to be Filled.  I will cover these products in my next chapter.

Come see us at INTEGRIS Total Body Surgical for a full line of Obagi products and Botox.  Mention this blog and get Botox for nine dollars per unit (about $300 for the full upper face).  You need to mention this blog though when you book.

Cosmetic consultations and skin care consultations are complimentary!!!

Does this look and sound familiar??????  BE HONEST!

At Integris Total Body Surgical we see the results of sun exposure (over exposure) all of the time.  When we are young, we all perceive ourselves as indestructable and cover ourselves in oil while baking in the sun.  Today, with tanning beds, there is no winter break from exposure and it seems that I see damage at earlier ages than ever before.  Good skin care is the start of the healing process with retinols and or hydroquinone.  To really get a jump start on healing, we recommend laser skin resurfacing.  The machine we recommend is the Pearl 2700nm laser.  This laser treats abnormal pigments in the skin along with fine lines and wrinkles that go along with sun exposure and the normal process of aging.  The procedure is done in the office with minimal discomfort and the recovery time is only 3-4 days.  The skin after is opalescent, very soft, and looks healthier.  Over the next several months your skin will thicken with new collagen.

Treatments can be repeated at intervals and results can be maintained by chemical peels or repeat treatment.

Check out what The Doctors said.....

Everyone knows THESE guys don't lie!!! Our pricing on Pearl treatments and for packages if multiple treatments are needed or desired are VERY competitive. Cosmetic and skin consultations are always Complimentary. SOOOOOO what are you waiting for? Call us today and we will evaluate your skin and come up with a plan! 918-786-7780