Author Archive
Thursday, July 1st, 2010
This is something that a person asked me to correct for her. She has a right eyelid that was larger than the left to a minimal degree. It appeared that the lower eyelid of the right eye was lower in position making the right eye appear larger in general.
This was my answer:
This would be difficult to correct the asymmetry in your eyelids through blepharoplasty. It seems that your lower eyelid in the right eyelid is lower than the left. It would be possible to take some skin from the left eye to lower that and this would have to done very carefully. The risks that this could not be exactly what you are looking for is relatively high. As most of the experts have mentioned, most surgeons would likely stay away from this situation. You would have to accept the risk that it might not be completely what you are looking for. Given that your eyes are already pretty, a surgeon would less likely want to do anything. One thing to remember is that surgery is never as natural as what God created for you. At least this is not the case at this time.
Thanks for reading, Dr Young
Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington
Posted in Blepharoplasty / Eyelift / Eye Lift / Dark Circles / Eye Bags | Comments Off on My right eye is larger than my left. The lower eyelid is lower on the right which makes it look larger than the left eye.
Wednesday, June 30th, 2010
Botox or Dysport both work equally well in decreasing the muscle mass of the jaw muscle called the masseter. This procedure is very safe. I have never had any serious issues with this use. The amount of botox or dysport to use is dependent on the person because everybody has different responses and different volume of muscle. I usually tell this to people and then explain that I recommend starting at a lower dose like 15-25 units of botox for each side. Dysport requires 2.5 to 3.0 times the units of botox for equivalent dosing. Then I tell them that they can see if this adequate muscle relaxation in 2 weeks for botox and 1 week for dysport. If there is still significant muscle movement of the masseter you can elect to do more. One important point is that the muscle mass reduction lags behind the muscle movement. It takes from 3-5 months to see the maximum volume changes in the masseter muscle and then it slowly increases the mass to normal by one year. So, in short, there are some doctors that are seeing results from botox to the jaws for one year. In my experience, the mass usually comes back earlier than this but the results are more longer lasting than what can be expected with other facial muscles.
Thanks for reading, Dr Young
Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington
Posted in Botox, Dysport, Botulinum, Jaw reshaping / Jaw Implants / Jaw Augmentation | Comments Off on Botox or Dysport both work equally well in decreasing the muscle mass of the jaw muscle called the masseter.
Wednesday, June 30th, 2010
Restylane has not shown to produce collagen in studies. But in my experience, I have seen persistent correction of people for longer than what is advertised. The thought of what process is going on is that there seems to be scar tissue that is forming around the restylane that prevents is degradation. This is not an uncommon thing that I have noticed in my practice. I would say that I have seen this in about 5 % of my patient population where they get much longer acting results from restylane injections. With the manipulation of the needle and the subsequent bruising, I believe that some collagen production is possible but not consistent in my experience.
Thanks for reading, Dr Young
Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington
Posted in Fillers / Facial Fillers | Comments Off on Does Restylane lead to collagen production?
Friday, June 18th, 2010
There are many times when I get people that come to my office wondering about changing the appearance of a chin implant that they had before. I have this case of a woman who had a chin implant by another surgeon and she felt that the chin implant was riding too high. She felt that the chin implant was also too large and it made her look a little masculine. When it comes to revisions, you should not ever just take an implant out unless it is a really small implant. What happens is that the soft tissue can ball up and contract and create an unfavorable appearance. What is typically the better thing to do is to replace the large implant with a smaller one. If the implant is already smaller, then you could make a case to not put any implant in and this is an option only for a small implant. Generally small implants are the ones that people have an issue with. Also when you put an implant in, they implant should alwaws ride on the inferior border of the mandible where the bone is hard and less likely to undergo resorption. I prefer medpor implants for many reasons. They can get incorporated and vascularized to act like your own tissue much more so than silicone implants. Silicone implants tend to have a capsule form around it and will not get incorporated. Hence, when you hit your silicone implant there is more likely the chance for complications years after the procedure as opposed to medpor where once it gets incoporated past 12 weeks, it will be more resistant to infection and rejection. Here is a video showing and demonstrating what we are talking about.
Thanks for reading, Dr Young
Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington
Posted in Chin Surgery, Facial Implants | Comments Off on Chin Implant Revision for misplacement and for aesthetic reasons (when the implant is too large)
Friday, June 18th, 2010
I have many people that come to me to inquire about mole removal. There are many ways to do this. The most common ways are to excise (cut them out) or use the co2 laser to vaporize them. Which do you choose? That is a great question that many people ask me all the time. Both have some positives and negatives. With excision, you have to incise around and take out the mole. With this approach you can take a margin of tissue and you can go deep enough so you know that it will not come back as readily. You also have a little faster healing and less need to care for the wound. The healing is a little more predictable. The drawback with excision is that you need to take more tissue to make sure the closure is flat. This usually requires a wedge of tissue that needs to be taken out. This can make the excision and resulting scar a lot larger than the mole itself. Also you need sutures and you need to take them out 6-7 days later. With the co2 laser you can vaporize the mole and just a little around it. You avoid the larger excision of tissue, or the need to take out more than just the mole. You avoid an incision and sutures. But the area of that is vaporized will need to heal over and this can take up to a week or more with the wound being raw and oozing a bit. You also need to care for the area that is vaporized with cleaning 2-4 times a day and constantly have vaseline over the area vaporized. Also with the vaporization you have more of a potential for less of pigmentation that can be permanent. Although if this happens you can always have the area excised to remove the pigmentation and this would be like what you would need if you were to excise it in the first place. But you don’t always have hypopigmentation and thus could have everything work out perfectly with the co2 laser. I think recurrence of the mole is more common with the co2 laser than when you excise it out. Here are some videos to explain this during a live demonstration.
Thanks for reading, Dr Young
Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington
Posted in Laser Resurfacing, Mole / Skin Lesions / Cyst Removal | Comments Off on Mole Removal by Excision or Laser Removal
Thursday, June 17th, 2010
Neck lift versus Liposuction for Neck Laxity and Double Chin by Dr. Young of Bellevue | Seattle: When a patient comes in for neck laxity and a double chin, the exam to figure out what options are best is vital. Typically what I do is to assess the neck for how much fat the neck has, how much laxity there is in the neck muscle (platysma), how the skin is, etc. The most important thing I ask patients to do is to show their lower teeth to assess the platysma. What this allows me to do is assess how lax the platysma is and if the laxity and double chin situations is due to the platysma being lax and is coming away from the deep neck structures. When someone shows their lower teeth and the platysma is tensing and showing through the skin and appears to be causing the neck laxity, a neck lift would seem to be the best option to improve the overall neck laxity. If the movement of showing the lower teeth does not show that the platysma showing through the skin of the neck and being the cause of the neck laxity and the fat could be responsible for the neck laxity, then liposuction could be the best option. My approach to neck laxity is based on over 1200 neck and facelifts. I tend to keep the platysma muscle intact without cutting it and I use sutures to tighten the platysma from under the chin to the bottom of the neck just like a corset and this technique is called the corset platysmaplasty. I think that working under this muscle is important as well include more defatting and more sculpting of the muscles deep to the platysma to further contour the neck and just under the chin. I further use sutures to further tighten the neck muscle laterally and not just in the midline. Laterally, I continual the tightening in a corset manner to improve the contour and also to shape the submandibular gland and its position. Here is a video to explain:
Thanks for reading, Dr Young
Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington
Posted in Liposuction, Necklift / Neck Lift / Platysmaplasty / Turkey Gobblers / Neck Bands | Comments Off on Neck lift versus Liposuction for Neck Laxity and Double Chin by Dr. Young of Bellevue | Seattle:
Friday, June 11th, 2010
This eyelid weakness after Asian Double Eyelid Surgery is a very common occurance and will get better or at least should get better. Your doctor would know best what was the status during your procedure. This weakness is due to the fact that your eye muscle that opens up your eye is the same muscle that you use to create the eyelid crease. So you need sutures that are attached to this muscle. These sutures can place the muscle under tension and make them temporarily weak. This is really common. The other scenario is less than desirable and can occur if there is any damage to the muscle that opens up your eye. If this is the case you could need a more formal repair to repair that muscle. This would require a more complicated surgery. This is much less likely. The other situation is when the levator or eye muscle that opens up the eye is placed under too much tension when creating the eyelid crease. This can occur when the crease is set too high on the levator. You can go on my blog to read about more of this and this is found on my website. When this is the case it will take longer for the muscle to recover. Sometimes it won’t recover and the levator needs to be released from the fixation and refixed. This situation is more rare fortunately. The hard lump will get better with time. Sometimes steroid injections can help this get resolved more quickly. Your physician can determine this as well. Here is a video of an asian eyelid surgery.
Thanks for reading, Dr Young
Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington
Posted in Asian Cosmetic Surgery, Asian Double Eyelid Surgery / Asian Eyelid Surgery, Blepharoplasty / Eyelift / Eye Lift / Dark Circles / Eye Bags | Comments Off on Eyelid weakness after Double Eyelid Surgery and a hard lump after this surgery?
Friday, June 11th, 2010
Some doctors feel that you should repair the ptosis and then do the double eyelid surgery 6 months later. Ptosis Correction with Asian or Double Eyelid Creation can be done in stages but also all at once in my hands. This has not been a problem for me. After reattaching the levator to the tarsus in the best position, I then attach the levator muscle to the orbicularis muscle or skin or whatever technique you use for the double eyelid crease. This has been okay to do for me in my hands. I think some people stage this procedure because they feel that they will have some better control of the results. But I think if you can do it in one procedure why not. You can always stage a revision if the results are not as desirable. But usually one surgery is possible to correct them both with out needing more surgery in my experience. Here is a video of an asian eyelid surgery.
Thanks for reading,
Dr Young
Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington
Posted in Asian Cosmetic Surgery, Asian Double Eyelid Surgery / Asian Eyelid Surgery, Blepharoplasty / Eyelift / Eye Lift / Dark Circles / Eye Bags | Comments Off on Does ptosis repair (for a droopy eyelid) and Asian Double Eyelid Surgery need to be done in a staged fashion?
Friday, June 11th, 2010
Visible scars are unavoidable whenvery you do a procedure that requires an incision. But with upper blepharoplasty / eyelid surgery the incision is usually placed in your crease so they are not visible when you eyes are open. With the eyes closed the incision is usually very minimal to imperceptible. Here is a video of an eyelid surgery.
Thanks for reading,
Dr Young
Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington
Posted in Blepharoplasty / Eyelift / Eye Lift / Dark Circles / Eye Bags | Comments Off on Do you have visible scars with eyelid / blepharoplasty surgery?