Archive for the ‘Procedures’ Category

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Mole Removal by Excision or Laser Removal

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

Neck lift versus Liposuction for Neck Laxity and Double Chin by Dr. Young of Bellevue | Seattle:

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:

Eyelid weakness after Double Eyelid Surgery and a hard lump after this surgery?

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?

What is the relationship of the eyelashes with the eyelid and Asian eyelid?

Friday, June 11th, 2010

Eyelashes can be affected by asian eyelid skin. When you lack a double eyelid crease, the extra skin can lay over the eyelashes and can affect the way they are positioned.  When you do a double eyelid crease procedure, the skin can be positioned higher and this can allow the eyelashes to rise up higher.  Also there are ways to attach the levator muscle to the skin and orbicularis muscle to elevate the eyelashes to a different degree with Asian double eyelid surgery / eyelid crease formation surgery.  Sometimes this relation of the eyelashes with the eyelid is natural depending on the person’s anatomy and what they inherited. 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 What is the relationship of the eyelashes with the eyelid and Asian eyelid?

Does ptosis repair (for a droopy eyelid) and Asian Double Eyelid Surgery need to be done in a staged fashion?

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?

Do you have visible scars with eyelid / blepharoplasty surgery?

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?

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

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