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Permalip Implants are another option for permanent lip augmentation

Tuesday, February 16th, 2010

Permalip (Dr Young uses this Lip Implant at his office in Bellevue Washington) is a relative new silicone lip implant that can permanently augment the lips.  There are 3 sizes for the permalip (silicone lip implant, silicone lip enhancement, silicone lip augmentation, silicone lip enhancement) small, medium and large and which very in width from 3, 4, and 5mm.  They are used to essentially give the lip more volume.  They are placed in incision in the red part of your lip and these can be varied and discussed with Dr Young during a consultation.  The great thing about these implants is that they last essentially permanently.  Silicone is very capatible with our tissues.  Silicone is located just under carbon on the atomic chart of all the atoms on earth.  So its elemental structure is very similar to carbon which is what humans are predominately made of.  Of all implants it is the most compatible.  Hundreds of thousands of people have had silicone implants and it is proven to be very safe, non carcinogenic, non toxic, etc meeting many of the characteristics of an ideal implant.  Bottom line is that there is no ideal implant but silicone possesses many of those characteristics.  If silicone implants are not something that you are totally comfortable with, other tissue can be substituted including different areas of your body like muscle covering, SMAS, and free fat grafts.  Other options include micro fat injections to the lip, VY advancements, and other lip lifts.  More temporary lip implants include restylane, juvederm, perlane, and the new juvederm xc which has lidocaine and has received some recent attention.

Here is a video showing a live demonstration of a Permalip Lip Augmentation Procedure.

Thanks for reading, Dr Young

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

Posted in Lip Augmentation / Lip Fillers / Lip Injections / Lip Reduction / Lip Grafts / Lip Advancements / Fat Injections of the Lip | Comments Off on Permalip Implants are another option for permanent lip augmentation

Rejuvenating the Mouth Area through Fat grafting by Dr. Philip Young of Bellevue | Seattle

Saturday, February 13th, 2010

Rejuvenating the Mouth Area through Fat grafting by Dr. Philip Young of Bellevue | Seattle:

YoungVitalizer Before After Pictures

YoungVitalizer Before After Pictures

The mouth area undergoes a lot of changes that can contribute to nasolabial folds, marionette lines, smoker lip lines and a downturned mouth.  Volume loss plays a major role in these changes.  Replacing this volume can have a profound impact in rejuvenating the aging mouth and the YoungVitalizer is our approach to improving this area.  Fat injections are a great way to do this and other fillers can help as well.  Sculptra can help if fat is not available.  Fat and Sculptra are good options for permanent or semi-permanent effects.  By this, I mean results that last more than 1 year. The picture below shows the locations of the nasolabial folds, marionette lines, and prejowl volume loss.  All of these issues can find their origination from volume loss to a large degree.  For the nasolabial folds, there are studies that show specific fat pockets that when re volumized can play a major role in eliminating nasolabial folds.  Specifically the area lateral to the nose and immediately deep to the most medial and superior area of the nasolabial folds is the area where re volumizing can play a big role in reversing nasolabial folds.  Furthermore volumizing in the whole area inside the nasolabial folds and marionette lines can rejuvenate the peri oral and mouth area.  Volumizing in the area immediately medial to the marionette lines can diminish these lines.  Volume in the prejowl area will blend this area in a more pleasing way with the jowls and in turn make them seem less apparent.  This is in line with the whole idea of doing prejowl implants with facelifts to improve the jawline.  Also volumizing the chin can restore this whole area as well and give support for the other areas that are volumizing.  One important thing that I have learned is that volumizing other adjacent areas can help support other areas by aiding in the volume expansion.   An example is if you place on stake in the ground and place a very heavy tarp over this stake.  It is more likely that you will form a nice area under that tarp the more stakes you put under the tarp.  It is also more helpful the more stakes you spread out in the area to give the original stake support.  Volumizing the chin is analogous to this idea.  When you volumize the chin it supports the volume you put in the prejowl area as well.  More likely than not your chin has lost volume as well and volumizing deep to the chin will rejuvenate your lower third or lower mouth area.  Also people are likely to develop deep wrinkles in the labio mental sulcus which is the crease that is under the lower lip.  Volumizing deep in the chin just inferior to this crease will help to eliminate this crease.

Thanks for reading, Dr Young

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

Perioral Diagram

Posted in Chin Surgery, Fat Transfer / Fat Injections, Fillers / Facial Fillers, Lip Augmentation / Lip Fillers / Lip Injections / Lip Reduction / Lip Grafts / Lip Advancements / Fat Injections of the Lip, Mouth Shaping / Perioral Enhancement / Marionette lines, Sculptra, YoungVolumizer | Comments Off on Rejuvenating the Mouth Area through Fat grafting by Dr. Philip Young of Bellevue | Seattle

Why are my face and neck lifts different? by Dr. Philip Young Seattle | Bellevue Washington

Saturday, February 13th, 2010

Why are my face and neck lifts different? by Dr. Philip Young Seattle | Bellevue Washington: First. I have a lot of experience doing facelifts (Shows Dr Young’s Actual Patients).  I’ve done over 1200 and I’ve done almost every imaginable approach to facelifting.  Here is a video of me discussing the differences between a deep plane facelift and mini face lift:

What I’ve learned is that there are several ways to do this procedure and it really depends on the person and what he or she wants.  I do think that minilifts are not long lasting but could be good for the person who doesn’t want a big difference in the face and neck.  As I mentioned in another blog where I show the difference between the many variations of face and neck lifts, the minilift really just pulls up on the facial muscles with sutures. So you are depending a lot on the sutures and subsequent scarring that will hold the lift up.  This works for some people but not everybody. I think this lift works best in a patient that has lost a lot of weight and has a lot of skin and loose structures.  Also, I find that older patients typically haven loosen their anatomy enough to respond to a minilift more than other types of faces. I find that people that have a little bigger face tend to have stronger tissues that resist the minilift’s forces of pulling with just the sutures.  Younger patients also have tighter tissue that respond less to a minilift. If in doubt I think that more traditional approaches get way better release of the structures.  The reason for this is that there are many retaining ligaments in the face, see the picture below.  The zygomatic cutaneous ligaments are tough fibers that hold the cheek to the bone inferior and lateral to the eye.  The parotid masseteric ligaments hold the tissue in front of the parotid to the skin with a long row of fibers from the zygomatic arch to the jawline.  The mandibular ligaments hold the skin to the jawline.  All of the ligaments prevent the skin from going upward when you do a facelift and if you don’t break them up properly they resist most facelifting attempts and forces.  When you do a minilift, there are many times when you do lift the skin up far enough to break up these parotid and zygomatic ligaments.  And even if you do, the sutures that you use to pick up the tissues anterior to those ligaments are loose enough to come up and require a lot of force.  This is why many minilifts are more painful in actuality than traditional full facelifts.  In my experience doing more than 1200 facelifts I have definitely found that to be the case.  Most of the time, you really need to do traditional maneuvers to break up those ligaments and this is usually done through working under the facial muscles or the SMAS.  Also, knowing how to extend these sub SMAS facelifts over the smiling muscles is a vital technique that most surgeons don’t know how to do.  When these zygomatic ligaments are released you can lift up the middle part of the face, the area above the mouth folds (nasolabial folds), much easier.  When the parotid masseteric ligaments are properly released you can pull up the jowls and folds around the mouth much easier as well.  This more complicated facelift is typically called variations of the deep plane lift, composite lift and zygo-orbicularis lift.

One thing to realize is that not all neck lifts are done equally. Take it from me.  I have done hundreds of minilifts with mini neck lifts and there are more definitive ways to pull up the neck.  Find out more about necklifts here. There are many shortcuts that you can do that help but really don’t make a huge difference.  When I do a neck lift, I remove all of the fatty tissue in the neck by actually cauterizing it away.  On top of this, I also take the fat away underneath the chin in a deeper plane.  All of this takes time, and shortcuts don’t get to these areas and you are always left with neck laxity and loose skin and fat in the neck.  There are also other techniques I do to address the deeper muscles underneath the chin that most surgeons do not know how to do.  I have learned over doing so many neck lifts, that cutting the Platysma is not as beneficial as leaving it intact.  When you leave it intact you are able to tighten the neck better and I do a corset type of sewing to really tighten up all the neck muscles for a tighter neck.  This takes a lot of experience to do.

Thanks for reading, Dr Young

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

Come visit our website: Aesthetic Facial Plastic Surgery

Retaining Ligaments

Posted in Facelift / Face Lift / S lift / Mini Lift / Weekend Face Lift / Quick Lift / Image Lift, Necklift / Neck Lift / Platysmaplasty / Turkey Gobblers / Neck Bands | Comments Off on Why are my face and neck lifts different? by Dr. Philip Young Seattle | Bellevue Washington

I was invisible and now I feel people notice me – presented by Dr. Philip Young of Bellevue | Seattle

Friday, February 12th, 2010

I was invisible and now I feel people notice me – presented by Dr. Philip Young of Bellevue | Seattle:

That was what a women told me one day about her experience with aging.  My patient once told me that she used to be pretty.  When she was young people would look at her.  As she aged, she noticed that people began to not notice her as much.  The more she aged, the more and more she began to feel invisible.  Invisible, wow, what a word to describe how you used to feel.  I was moved by this comment.  I thought, how lonely would that feel if you were actually invisible to the world.  Aging really affected her.  She wanted to feel like someone special once more.  I  performed her facelift a couple of years ago and she said that this little transformation made her feel much less invisible and she told me that was a great feeling.  Although, facial rejuvenation may not be the one thing that can change you life in a little way. For her it did.  That made me feel really special, that I could somehow contribute to someone feeling less invisible.  That really made an impression on me.  Stories like this keep me going.  They keep me searching for better ways to improve my patients lives.  Stories like this push me to find how to attain beauty for people in a natural way. I love what I do! Here is a video on facelifts and how they help crowsfeet.

Thanks for reading, Dr Young

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

Posted in Facelift / Face Lift / S lift / Mini Lift / Weekend Face Lift / Quick Lift / Image Lift, My Journey to Find and Attain Beauty | Comments Off on I was invisible and now I feel people notice me – presented by Dr. Philip Young of Bellevue | Seattle

Glabellar frown lines – The lines between the eyebrows can be improved by these Options by Dr. Philip Young of Bellevue | Seattle

Thursday, February 11th, 2010

Glabellar frown lines – The lines between the eyebrows can be improved by these Options by Dr. Philip Young of Bellevue | Seattle:

Youngvitalizer incision less browlift

Youngvitalizer incision less browlift

What are the options to improve those angry lines in between the eyebrows. Well I will talk about the lease invasive type to the most invasive types.  To begin with skin care is a good place to start.  I would always start with a good skin care line. I would suggest a alpha hydroxy toner, gentle cleanser, alpha and beta hydroxy acid lotion, a retinoid and regular superficial peels.  The goal is to decrease the number of days the skin takes to turnover from the usual 28 days to 10-12 days.  This will help to freshen the skin, lighten brown spots, and decrease fine wrinkles.

The next progression is botox. This neuromuscular agent will keep the muscles from working in between the eyebrows and decrease the dynamic wrinkles.  Over time as your skin remodels, your static wrinkles can improve with continual use of botox on a regular basis. The drawback is the repeated treatments that are neccessary. The positives is the low invasive nature.

The next level is fillers. Restylane, Juvederm, Perlane, Radiesse, can decrease the wrinkles by volumizing the glabella and the area in between the eyebrows.  Volume loss plays a large part in this area.  As this area deflates, more skin in relation to the area leads to more wrinkling.  Also, the decrease in volume places the skin closer to the muscles in this area and allows the muscle to place more influence on the skin and hence more dynamic wrinkling.

Fat injections  is the next level in volumizing this area.  This increases the invasiveness but fat injections can be a more permanent option to filling this area and rejuvenating the glabellar area.
 
Our more permanent solution is called the YoungVitalizer the breakthrough incision less facelift alternative.

A browlift can also help  by elevating the eyebrows and increasing the distance between the eyebrows.  Also during a browlift the muscles that make the wrinkles in this area can also be resected and taken away from the area.  This debulking of the glabellar muscles can also be done from the eyelid incisions.  Another way of decreasing the action from these muscles is to cut the nerve to them through an eyelid incision.

One issue when taking the muscles from the glabellar area is that it can increase the volume loss to this area and lead to more relative extra skin.  This can lead to more static wrinkling to this area and when the muscles come back more dynamic wrinkling that can occur.

In my opinion fat injections to the whole forehead, and in between the eyebrows is the most natural way of rejuvenating this whole region. Also the fat injections with their stem cells can lead to skin rejuvenation.  The other effect of the fat is to increase the distance of the muscles from the skin which can decrease the influence of the muscles on the skin which can allow the skin to remodel on its own and improve static wrinkles.  This occurs because the skin has little cells in the skin layers that always remodel skin on a minute by minute, daily basis.

To change the surface of the skin, a chemical peel, dermabrasion, dermasanding, and laser resurfacing can decrease the wrinkles in the glabellar area.  I always suggest volumizing before resurfacing and reshaping through reductive type of procedures like browlifts, eyelifts, and facelifts.

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, Wrinkle Treatment | Comments Off on Glabellar frown lines – The lines between the eyebrows can be improved by these Options by Dr. Philip Young of Bellevue | Seattle

Why was the answer to facial beauty so hard to find?

Thursday, February 11th, 2010

Why have we taken so long to figure out what makes us beautiful.  Even today’s most up to date theories on beauty are based on Leonardo Da Vinci’s Neoclassical Canons.  One rule is the rule of thirds where the distance from the hairline to the area in between the eyes is equal to the distance from there to the bottom of the nose, which is in turn equal to the distance from the bottom of the nose to the bottom of the chin.  His rules go on and on with different measurements.  It has been shown by many researchers that these measurements and rules really don’t define beauty let alone a major percentage of the population (ie Farkas and colleagues). Others have attempted to answer this question by using the greek number phi.  Some have taken great lengths to prove this like Dr Marquadt.  But all this number is, I’m sorry fellow researchers, is really just the proportion of 2/3’s and 1/3’s which many things in nature can be explained by.  Furthermore all of these theories are based on landmarks on the face that are easily identifiable (such as the hairline, inside and outside of the eyes) but really don’t grasp our attention when we view a face.  As I explained earlier, the iris grasps most of our attention and because of this, it dictates almost everything on our face and the basics of beauty are derived from its shape and width.  But these theories did dominate our thinking because essentially it was easier to form a theory based on these easily identified landmarks.  It is much harder to define beauty based on shades of light which the Circles of Prominence is based on.  But these shades of light are what our brains use to determine much of the beauty in our faces.

The other reason beauty was hard to find was due to the many beautiful faces out there that were very close to the ideal but varied from it by very small increments.  Because of all of these beautiful people, easily identifiable elements were hard to pin down.  Furthermore, because beauty is determined largely by these subtleties of light the ideal was harder to find.

The way we sense beauty itself probably has played a huge factor in keeping us from the secrets.  First of all we sense beauty from the right brain.  But, we think concretely and mathematically about our world form the left brain.  In essence, there was a continental divide.  Why is this important? Well our brains are separated from each side based on simple anatomy. The right and left brains are connected by the corpus collusum which is much smaller than the right and left brains.  Hence we communicate with the right and left brains through this smaller conduit and hence a lot of information is lost. The side of the brain that we appreciate beauty is separated by the side of our brain that is trying to identify those elements that we find beautiful.

To further expound on this thought, many parts of our brain sense beauty.  When we see someones lips, the parts of the brain that senses the touch from our own lips is in another part of the brain separated from our right part that senses beauty mostly.  Also the part of our brain that interprets and makes us sense emotions also plays an important part in our interpretation of beauty.  When we see a beautiful person, our hearts beat stronger and our blood pressure rises and this is located in the deep parts of our brain called the autonomic system at the base of the brain.  This part of the brain which senses beauty is even more further from the left concrete and mathematical part of our brain.

More to come…

Thanks for reading, Dr Young

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

Posted in My Journey to Find and Attain Beauty | Comments Off on Why was the answer to facial beauty so hard to find?

Other corner of the lip lifts are options to consider

Thursday, February 11th, 2010

There are other options for the corner of the lip lifts (Lip Augmentation, Dr Young Seattle).  The two major designs are shown below in the diagram that is included.  The original one is on the left and a modified one is on the right.  These lifts can elevate the corners of the mouth significantly but do not address the marionette lines and extra fold inferior to the corner of the lips.  In my experience, and in the hands of others, there can be a tendency with these more traditional corner of the lip lifts to elevate the corners too much.  That is why other’s have adopted excisions more like the ones drawn in my other blog and shown in the cartoon picture that I included as well.  All options can be used to improve the downturned mouth like many women and men wish to improve. Notice how the older lip lifts are bowl and heart shaped and the newer designs in the cartoon drawing are reversed bowl shaped which seem to avoid excessive elevation.  The other shapes in the cartoon are for direct excision of the nasolabial folds and an extension of the corner of the lip lift that includes the marionette folds, or puppet mouth line folds.

Thanks for reading, Dr Young

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

Lip Lift Diagram

Frowning Mouth Drawing

Posted in Lip Augmentation / Lip Fillers / Lip Injections / Lip Reduction / Lip Grafts / Lip Advancements / Fat Injections of the Lip | Comments Off on Other corner of the lip lifts are options to consider

I’m Asian and was wondering how can I make my eyes bigger if I already have a double eyelid crease?

Wednesday, February 10th, 2010

I answered this question for a patient that already had double eyelid crease but wanted her eyes to look bigger.  I noticed in her that she had significant epicanthal folds and this is how I answered her:

An epicanthal fold is the extra fold that you have in the middle part of the eyelid. There are four types of epicanthal folds. Type one is when there is no encroachment on the lacrimal lake (the fleshy part of the eye in the middle of the eye). Type 2 is when there is partial coverage of the lacrimal lake. Type 3 is when there is essentially complete coverage. Type 4 is when the epicanthal fold originates from the lower eyelid which is mostly found in the congenital type of epicanthal fold and in some genetic diseases.  Type 2 to 4 can be treated with medial epicanthoplasty type of procedures.  There are many different types of procedures that address this.  Older types included incisions that crossed the nasal skin which is more likely to scar.  Newer procedures keep the incisions in the eyelid skin which is thinner and less likely to scar.  You can read my blog regarding the type of epicanthoplasty that I prefer.  What this procedure will do is to rearrange the extra skin so that your lacimal lake will be more visible and this will essential open up your eyes.  The other way to make your eyes bigger is to do a lateral epicanthoplasty where the eye is open wider in the lateral part of the eye which is done less frequently.  Botox to the lower eyelid can lead to widening of the eye a little bit as well. Here is video on Asian Blepharoplasty and Medial epicanthoplasty.

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 | Comments Off on I’m Asian and was wondering how can I make my eyes bigger if I already have a double eyelid crease?

How soon can I fly after a blepharoplasty procedure?

Wednesday, February 10th, 2010

After Blepharoplasty and other significant facial surgery, staying near your doctor for the first weeks is important.  The most important periods when bleeding can occur is usually the first 24 hours where most events (greater than90%) occur.  The second point is 6-7 days later when the clots start to dissolve and there is a period when the blood vessels are unstable.  Sudden bleeding can lead to significant pressure on the eye that might need to be addressed immediately.  Sometimes this pressure can put your vision at risk.  I usually suggest not flying for at least 2 weeks from the 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 Blepharoplasty / Eyelift / Eye Lift / Dark Circles / Eye Bags, Uncategorized | Comments Off on How soon can I fly after a blepharoplasty procedure?

Is Acne surgery a good choice for severe acne? What options do I have to severe acne?

Tuesday, February 9th, 2010

Acne surgery (Dr Young of Bellevue, Washington) typically means when a physician or assitant opens up an active flare of acne to express inflammatory fluid to prevent further infection and damage.  This is used to when the acne has already reached the infective stage.  The key is preventing this progression.

A couple ideas could help.  You can take a food diary and find out what foods are causing the outbreak.  The way to do this is to try to eliminate all of your foods for a week or so by just consuming protein non allergenic drinks.  Then once all of the food allergens are out of your system you can introduce one food at a time that you normally eat and then record sensations like tingling to your face or more breakouts that seem to correlate.  I have found many foods to correlate with acne.  Then avoidance is the next step.

You should definitely be on a cleaning regime with salicylic acid cleansers and toners.  Also at home glycolic peels could help as well with this.  A retinoid is always recommended and a 3rd generation retinoid like adapalene could be less irritating, can decrease the inflammation, is keratolytic and has some mild antimicrobial activity.  When you want more antimicrobial activity, topical and oral antibiotics can really help.  And for the other category of sebosuppressive you will need to add an oral retinoid, accutane, or oral contraceptives.

I usually always suggest a salicylic acid cleanser and toner, I add a retinoid and usually adapalene.  If they are resistant to this then I consider topical antibiotics like clindagel for breakouts. For more severe breakouts I will do oral clindamycin, or one of the tetracyclines.  If after three months of not responding to also oral and topical antibiotics I then consider oral accutane.

Other choices include oral contraceptives, and testosterone binding medications like spironolactone, flutamide, cyproterone and testosterone enzyme blockers like 5 alpha reductase.

From a procedural standpoint, serial chemical peels can help but it could also worsen the acne.  The only way to determine whether they will work is to see how they individual affect your acne.  Choices include tricholoroacetic acid, jessner’s, and glycolic peels.

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 | Comments Off on Is Acne surgery a good choice for severe acne? What options do I have to severe acne?

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