Fat Transfer vs. Fillers to the Face for rejuvenating

This is an ongoing debate among plastic surgeons and dermatologists who perform these procedures.  We offer both of these in our office, but in recent years favor hyaluronic acid fillers for facial rejuvenation over fat transfer.  Fat transfer is more surgically invasive with a higher risk of complications including infection and scarring.  In the past with only collagen fillers available fat transfer to the face may have been superior and longer lasting, but now we have HA fillers like Voluma that last 2 years and stimulate new long-lasting collagen.  That being said, sometimes the decision should involve weighing the skill of the physician.  Some physicians are more skilled at fat transfer vs. fillers, so despite the lower long term risks of fillers they may get better results with what they are most skilled at.
 

Under eye dark circles and veins

I get asked a lot by my patients how to improve their under eye circles and veins.

Some of us have dark under our eyes all our lives for hereditary reasons.  I have even seen some teenagers with hereditary prominent and unsightly under eye veins.  Sometimes it can be acquired or exacerbated by allergies, sinus congestion and lack of sleep.  In addition, with age and sun we can get thinning and wrinkling of the skin along with spider veins under the eye.

We used to not have a good, safe treatment for this problem, other than make up concealers and creams that contain vitamin K which never seemed to work very well, except maybe a new one called Teamine cream (Revision SkinCare) - see pic below.  My associate at Gateway Aesthetic Institute in Utah, Dr. Mark Taylor, recently published (now a year ago) one of the first reports of successful treatment of unsightly under eye and around the eye (periorbital) spider veins with the NdYag 1064nm  laser.  I have since been successfully treating this in people of all ages and skin types, but with caution and very good eye protection.  I must emphasize that Dr. Taylor and I are board-certified dermatologists and laser treatment experts and can do this treatment safely.  The NdYag laser can be a tricky laser to use well and safely.

In addition to treatment of the spider veins around the eyes, we also will treat the darkness and/or redness of this under eye area with careful use of our IPL(Intensed Pulsed Light) device.

Both treatments may need to be repeated 2-3 and there can be temporary swelling, redness or bruising.
It is not usually painful because we use numbing cream and ice pops.

 

Safety of UV-light cured nail polishes (gel, shellac)

There was a study recently published by dermatologists at the University of Utah, which measures nail lamp UVA exposure amounts over a year and the significance.  Other than this study, there has been only one other regarding UVA nail lamp exposure, which did not provide the same helpful information.

In this new study, the doctors estimated the amount of time of UV exposure based on the average time needed under the lamp per full set of nails.  They assumed the nail client has their nails done every three weeks for a year.

International experts recommend limiting your UVA exposure to no more than 30Joules/m2 for 8 hours to avoid significant cellular DNA damage.  They calculated that the total cumulative dose of UVA exposure per year in the average gel/shellac nail polish client was 285-386 Joules/m2 which is about ten times the max. limit for 8 hours.

To translate this to a year of gel /shellac UVA-cured polish, one could say each manicure involves four minutes of UVA, and if done every 3 wks, tranlates to 17 nail treatments.    17 treatments at four minutes duration each of UVA, is about 68 minutes or just over an hour of UVA per year.  Phew, I hope that wasn't too confusing.  So what does over an hour of UVA mean as far as hazards?  Well...during that one hour the total dose is 285-386 Joules, but we all know that the one hour of exposure is divided into 17 plus treatments, so it's not one straight hour of exposure.

Bottom line is this study implies that the UVA exposure from a nail lamp COULD BE hazardous over time but it seems we need more studies to clarify if the cumulative dose over a year at 285-386 Joules is really significant when the exposure is in 4-5 minute increments.

The authors of the study I am referring to do advise that if you use a UVA nail lamp, that you put on sunblock a half hour before your treatment.  I would agree that until further study, that is probably a good idea.  Those gloves that have the fingers cutout are pretty good but they don't protect the skin around the nails, so are inadequate.  Try the gloves and then applying sunblock on the remaining exposed skin.

Who is a candidate for Neograft (follicular unit extraction) thinning hair treatment ?

Hair transplants done with the Neograft system are useful for thinning hair, receding hairline, thinning or misshapen eyebrows, or to mask a scalp scar.  A scalp scar can be from a mole or skin cancer removal, an injury or previous hair transplant treatment.  It is best to be properly evaluated by a dermatologist to exclude other causes for hair loss like dermatitis, lupus, thyroid problem, or anemia prior to a transplant.  Dermatologists are experts in evaluating diseases involving the hair and may offer Neograft in their office as I do.

Hair transplants have evolved to allow very natural results.  The days of "tree farm" like plugs and linear scars are over.  The Gold Standard or leading hair transplant treatment procedure is called Follicular Unit Extraction (FUE) is when small clumps of hair - one to four follicles - are taken from an area of the scalp where they are abundant, and transferred to where they are needed like the front or top of the scalp.  Some physicians will use the SAFE system, other the Neograft for FUE which permit more efficient transfer of the hairs.

I happen to use Neograft for FUE at my office.  In the past, traditional hair transplants would leave a linear scar in the back of the scalp which was often visible in a man wearing his hair short.  With the Neograft system we have no linear scar, and men can get a buzz cut post-transplant as desired.

Laser Blepharoplasty vs. Scalpel Blepharoplasty

As we age, some of us, even as early as in our thirties, develop saggy eyelid skin and undereye bags. All of which can give us a tired and aged look.

Traditionally, dermatologic/plastic/ophthalmic surgeons have removed the saggy excess skin or under-eye bags with either a scalpel or a scissors.  While there are many talented surgeons who still prefer this technique, physicians who are skilled at laser surgery have revolutionized blepharoplasty.  With laser, there is significantly less bruising, bleeding, swelling, and recovery time and hence the results are better with less visible scarring.  At my practice, we have many years experience with this technique and have enjoyed the beautiful results in our patients and many of the staff too.  If you have under-eye puffiness or bags, you can have the fat pad that is responsible in most cases gently removed with a small invisible laser incision on the inside of the lower eyelid.  See before/after photos below.

There are human psychology studies that  have shown us that when people are meeting and conversing the primary point of focus on a person's face is our eyes.  With eyes being so important in human communication, it makes sense to consider if eyelid rejuvenation would be helpful.

What is a Vaser? VASERlipo?

I am excited to have a new device in our practice that improves efficiency and speeds healing from our traditional tumescent liposuction.

The Vaserlipo device from Solta Medical co. is an ultrasound-based system for fat removal.  It uses ultrasound energy to gently shake up the subcutaneous fat, so that it can be easily suctioned out with the microcannula.  It also tightens the overlying skin as it treats the fat so you don't have leftover saggy skin. This treatment as well as traditional liposuction are appropriate when you can pinch more that an inch or two of fat in the abdomen, chest, arms, legs, neck, chin.  If you have less than a couple inches thickness of fat to remove, then a body-sculpting device like Liposonix may work fine.  Please see my page on Bodysculpting.

The Vaserlipo treatment is done with local tumescent anesthesia, outpatient. You only rest for 12 hours or so, and then are able to move about.  Strenuous activities need to be avoided for only three weeks.  The final healed result can be seen at 3-4 months.  The treatment can be combined with fat transfer.  For example, if you want to move fat from a place where you have too much like the belly or hips to a place where you need it like a scar, the face or breasts.

Lots of people ask "will the treatment last?".  The answer is yes for some people, and no for others.  If you are planning on losing fat with any of these procedures I have described, you should also commit to maintaining the weight loss with a healthy diet and exercise plan.