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Double Vision should be seen by your doctor after Blepharoplasty as well as by an ophthomologist.

Friday, June 11th, 2010

Double Vision should be seen by your doctor after Blepharoplasty as well as by an ophthomologist.  There could be many reasons for this.  It does depend on the timing after the procedure.  If it is the day of your procedure or the day after, this could be from the swelling and local anesthesia.  Sometimes local anesthesia can have longer affects on the eye muscles. Swelling can also affect the way the eye is positioned so that there is double vision.  The key difference is whether the double vision is from the way both eyes are positioned meaning that when one eye is looking based on one position and the other eye is looking based on another different position.  This can be due to swelling and the eye muscles being temporarily weakened.  Sometimes it is due to muscle damage that can occur with upper and lower eyelid blepharoplasty.  This can resolve on its own over several months.  But could require eye muscle surgery that must be done by a qualified ophthomologist.  If it is double vision only when the one affected eye is open then it could be due to something related to the lens of that one eye.  Sometimes through blepharoplasty the changes brought about changing the eyelid skin leads to differential pressures to the lens that can lead to visual changes that can be interpreted as double vision.  This issue can also be followed by your doctor or ophthomologist as well. Here is a video on lower eyelid blepharoplasty.

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 Double Vision should be seen by your doctor after Blepharoplasty as well as by an ophthomologist.

Cheek implants are another option for volumizing the cheek and middle part of the face

Thursday, June 10th, 2010

Cheek implants (Philip Young MD of Seattle / Bellevue WA) are another option for volumizing the cheek and middle part of the face.  Some plastic surgeons believe that volumizing the face is the most natural way to rejuvenate the face.  Fat injections are very popular and in the right hands can lead to great long term results.  One of the drawbacks with fat injections are the variable results with survival.  It is not reliably known how much fat can survive and this is also dependent on the particular person.  One option to volumize the face is the use of implants.  Silicone and medpor / porous polyethylene are great implants.  Medpor implants are great because they allow vascular in growth and after 12 weeks these implants are very resilient.  Some studies have shown that skin can grow over these implants after the 12 weeks of vascularization.  This is amazing to me.  That is one of the many reasons why I like Medpor / Porous Polyethylene implants.   Many people believe that cheek implants and other facial implants are good to replicate the hard bony contours of the face and that fat can soften the facial features.  People believe that volumizing the face should entail both facial implants and fat injections.  In this video, I demonstrate the use of an inferior orbital rim implant, cheek implant and paranasal implant.  The inferior orbital rim implant is good to improve the hollows of the lower eyelid area.  The cheek implant is good for recreating the volume in the cheeks or creating new volume that a person never had.  Cheek implants help improve nasolabial folds, pull up jowls and the middle part of the face.  Paranasal implants are good to improve the nasolabial folds, and volumize the sunken middle part of the face and make the middle part of the face standout more.  This implant is great for people who have binder’s syndrome, or sunken middle faces as well.

Thanks for reading,

Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Cheek Augmentation | Comments Off on Cheek implants are another option for volumizing the cheek and middle part of the face

Rhinoplasty decreasing the size of the nasal tip and what is usually done

Wednesday, June 9th, 2010

Rhinoplasty (Dr Phil Young MD, Bellevue WA) has gone through some changes during the last 30-40 years.  In the past, surgeons used to do destructive techniques by cutting the cartilage, morselizing, crushing, and placing many tip grafts.  What has been learned over the years is that these techniques tended to lead to unpredictable changes, knuckling, warping of the cartilage, nodule formation and poor results in general.  What is now done today are suturing techniques.  There are basically 5 sutures that surgeons can now do to really change the tip in most any way.  To understand these sutures you should look at the diagram below.  The key structures to know for the nasal tip are the lateral, middle and medial crura.  The lateral and medial crus are show in the diagram. What isn’t show and labeled is the middle crus / crura which is between the lateral and medial crura.  The first stitch that usually is done is the middle crural stitch that brings the middle crus and medial crus together and this is usually placed at the junction between these two crus (green stitch).  The next stitch is the medial crural sutures which brind the medial crura together.  Often times, another cartilage graft is placed in between the medial crura to add strength to the tip and the medial crural sutures incorporate this graft.   If the tip is still too wide and bulbous, you can then narrow the domes by doing the transdomal suture which pinches the lateral crura at the junction between the middle and lateral crura (pink color stitch).  This sutures helps to make the tips smaller.  If the tip is still too wide and the domes are still too far apart you can then do the interdomal sutures that brings the domes closer together on each side (red color stitch).  Sometimes, the lateral crura becomes bowed outwards from the transdomal sutures and then what is then required is the lateral crura stitch that cause the bow to become straighter (green color stitch).  The yellow colored loop in the diagram depicts the part of the lateral crura that is usually taken out or resected.  What should be left is 6-7mm of the lateral crura for adequate support and strength to prevent it from buckling and creating asymmetric tips, knobs, knuckles and buckling.  Part of this is explained in this video.

Thanks for reading,

Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Rhinoplasty / Nose Surgery / Nose job / Nose Reshaping / Nasal Reshaping | Comments Off on Rhinoplasty decreasing the size of the nasal tip and what is usually done

What to do about a hard lump after removing a fat graft by excision

Monday, June 7th, 2010

This person had a fat graft removed through an excision which required cutting.  She had a persistent hard lump 3months after the excision and wanted to know if she should get steroid injections or 5 FU:

The hard lump is not uncommon and can be due to inflammation. Fat is important for many things in the body among them: keeping the body from losing heat, serving as a lubricant of sorts for muscles to move, cushioning the body, etc.  This lump is not out of the ordinary with inflammation that can still be present after 3 months.  Steroids are an option.  But waiting is another option as well. If in doubt do nothing unless it is urgent.  Waiting another 3 months is prudent to see if it is inflammation and maybe it will look and feel better.  If it has not gone down you could consider steroids to soften up the hard feeling of it.  It does help to see the lump as well and hence having your physician examine the lump would be the first thing I would do. I wouldn’t use 5FU before steroids with this medication being a much lesser used drug after oral and injectible steroids.

Thanks for reading,

Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Fat Transfer / Fat Injections, YoungVolumizer | Comments Off on What to do about a hard lump after removing a fat graft by excision

The permanent makeup should not make a huge difference in your eyelids unless there is some type of infection

Monday, June 7th, 2010

The permanent makeup should not make a huge difference in your eyelids unless there is some type of infection after Asian Blepharoplasty (Dr Young Bellevue Wash). An infection would be more likely if there is more tenderness, redness, and swelling than before.  You should get some swelling from eyebrow tatooing and this should be expected.  Nine days is a little early to do something like that in my opinion.  The reason is that after a procedure you will have swelling that is normal. Sometimes the swelling, can break down the skin defenses so it is not a good idea the more closer you do it from your surgery date.  I think waiting at least 2 weeks, and to be conservative at least a month from your procedure is the more prudent thing.  This is what I would have recommended to you. I would have your doctor examine the area to make sure that there is no signs of infection that would need treatment.  Otherwise, I think that you should be okay and that your double eyelid operation should not suffer significant untoward effects. We also have a video demonstrating these procedures for you to see.

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 Double Eyelid Surgery / Asian Eyelid Surgery, Blepharoplasty / Eyelift / Eye Lift / Dark Circles / Eye Bags | Comments Off on The permanent makeup should not make a huge difference in your eyelids unless there is some type of infection

You can increase the height and style of your double eyelid after Non Incision Asian Blepharoplasty

Monday, June 7th, 2010

You can increase the height and style of your double eyelid after Non Incision Asian Blepharoplasty.  In this case you wouldn’t absolutely need to remove the sutures that were there before.  But removing them would not be very difficult and shouldn’t markedly impact your procedure if it were redone in an open fashion.  You can also do the revision with the non incision technique and it should be done just like if your current fold is natural and not from surgery.  I prefer doing Asian Blepharoplasty in an open fashion because I think it is more accurate and leads to more reliable results.  I don’t know how long you had this procedure but it might have lasted longer had your done the double eyelid procedure in an open manner.  To make the crease lower would be much more difficult open and closed.  It is not really possible even to make it lower in a closed non incision technique. We also have a video demonstrating these procedures for you to see.

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 Double Eyelid Surgery / Asian Eyelid Surgery, Blepharoplasty / Eyelift / Eye Lift / Dark Circles / Eye Bags | Comments Off on You can increase the height and style of your double eyelid after Non Incision Asian Blepharoplasty

You can change the way your eye looks after Asian Blepharoplasty Double Eyelid Surgery

Monday, June 7th, 2010

You can change the way your eye looks after Asian Blepharoplasty Double Eyelid Surgery. But it depends on how you want it changed.  Plastic Surgery can only do so much.  There is a point when too much can make you look worse.  This is something to talk to your doctor about.  If you would like your crease higher this is very possible.  It is a little more difficult to make your eyelid crease come down but this is still possible.  If you would like your middle part of your eye so that it is more open, or if you would like your eyelid in the middle part to have less skin then a medial epicanthoplasty would be more ideal for you. The medial epicanthoplasty can really open up your eye by taking away or shifting the skin more medially.  This procedure has a tendency to make your eyes look less Asian so this is something that you should accept.  You can also change the way the eyelid crease tapers medially and laterally.

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, Blepharoplasty / Eyelift / Eye Lift / Dark Circles / Eye Bags | Comments Off on You can change the way your eye looks after Asian Blepharoplasty Double Eyelid Surgery

Is Acne Surgery covered by insurance companies

Monday, June 7th, 2010

For treating acne flares and medical treatment, most insurance companies cover many of these expenses.  When it comes to improving acne scars and the cosmetic portion through Acne Surgery, in my experience, insurance companies generally do not cover these expenses. You should always inquire with the particular insurance companies that you are covered under and their particular policies.  When it comes to active lesions which require some procedures such as incisions and drainages, extractions, and surgically treating active lesions; insurance companies are more likely to treat these.  I usually treat the cosmetic portions that result from Acne which aren’t covered by insurance such as laser treatments, scar excisions, subcision, grafting of skin to scars, etc. Here is a live demonstration video of an Acne Treatment Procedure.

Thanks for reading,

Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Acne Scar Treatment, Scar Removal / scar reduction / scar revision / scar treatment, Uncategorized | Comments Off on Is Acne Surgery covered by insurance companies

There are temporal lifts that can elevate the lateral parts of your eyebrow and eye.

Sunday, June 6th, 2010

This is a question that I answered for a patient that was wondering if there is a skin lift in the temporal areas that could lift the eyes and eyebrows for a more exotic look.  She was able to create this look by pulling her hairback like putting it into a ponytail type fashion:

There are temporal lifts (Philip Young MD, Bellevue near Seattle, Washington) that can elevate the lateral parts of your eyebrow and eye.  These lifts do entail excising, or cutting, skin.  But they also entail lifting the muscle or some form of plicating the muscle like a pleat to lift the muscle.  The elevation of the muscle gives the lift some longevity.  I understand the question that you are asking.  But from the answers of the doctors, I can see that they are interpretating your question literally and that might be limiting their answer.  Yes you can lift the skin, but with the lift in order to ensure that you can create some longevity, you should also work on the muscle.  These lifts can lift your lateral eyebrow and also lift the corner of your eye as well (although this can be more difficult and complicated.  Also there are special lifts that pull up on the muscles on the sides of your eyes that can help with the overall lift.  This procedure is not as well known to plastic surgeons.  This can improve crows feet.

Thanks for reading,

Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Browlift / Eyebrow Lift / Brow Lift | Comments Off on There are temporal lifts that can elevate the lateral parts of your eyebrow and eye.

Chin reshaping by cutting out a wedge of bone or shaving it down, what is the best approach?

Tuesday, June 1st, 2010

This was the question:

I’d like to get some information on chin shaving. Overall, I’d say that I have a chin that is long (in the vertical direction). I would estimate my reduction would be somewhere around 7-8 mm. I read a blog website that chin reduction in the vertical direction is usually done via removing a wedge between the upper and lower portions of the chin, rather than shaving off the bottom – where a witch’s chin deformity may result. Is this the procedure you would recommend, or it is just one Dr’s preference ? Would this procedure be done under general anesthetic ??

That is one way of doing things.  But if you read more articles on chin shaping (Dr Young is in Bellevue, near Seattle WA), the articles reflect the opinion of many people doing this, is that when you cut a wedge of bone there are other risks.  You are more likely to get nerve damage.  After you remove the middle part of the bone, it usually creates a step off on the sides that makes it more difficult to smooth out.  Also after doing the wedge of bone you need to use plates and screws to fix the bone cuts.  The bone that is left also has the potential to become devascularized and lose volume.  Also this method doesn’t allow you as much room for contouring the soft tissue after the reduction. If you try to contour the soft tissue like skin etc you can further devascularize the bone segment. Also this procedure can be done under local and iv sedation.  Also I would approach this from the outside under your chin.  I would not go through your mouth as this leads to more complications. Here is a video on chin reduction for you to see.

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 | Comments Off on Chin reshaping by cutting out a wedge of bone or shaving it down, what is the best approach?

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