Archive for the ‘Procedures’ Category

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Laser Resurfacing with Active fx / Deep fx / Max fx to tighten the face for a non surgical face lift

Sunday, January 24th, 2010

As I mentioned in another blog, Active and Deep fx are techniques using technology to decrease the downtime from laser resurfacing while attempting to get better results. One thing that I mentioned in the last blog was that often times the more aggressive you are the more results you can get but also the more risk you take on.  Active Fx and Deep fx attempts to get  better results by having fractionated more superficial ablation and deeper fractionated ablation.  This technique treats the superficial elements like wrinkles, pigmentation and skin textures in a fractionated manner with the Active fx while trying to tighten the skin with the deep columns of ablation with the deep fx.  This can get subtle to moderate results.  If you want more significant results then max fx is an option to consider.  This is like active fx except the ablation is not longer fractionated and essentially is like more traditional resurfacing.  With max fx you are likely to get more tissue tightening.  Scientific research has shown that the amount of skin reduction that can be achieved with max fx is approximately 1cm squared in the cheeks and 0.5cm squared in the forehead and mouth area with less reduction around the eyes.  There is a limit to the amount of wrinkle reduction from laser resurfacing.  There is a point where the amount of water decreases the deeper you go.  This prevents the co2 laser from getting to deep.  This also prevents the co2 laser from creating scarring but also keeps the affects from working at the deeper wrinkles.  The options then include repeating the laser resurfacing in another year to further improve the results.  The other option which I like is the addition of dermasanding to the deeper wrinkles like around the eyes, between the eyes, around the mouth and parts of the cheeks.  I will talk more about dermasanding in another blog… Here is a live demonstration of my use of a co2 laser and laser resurfacing.

Thanks for reading, Dr Young

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

Posted in Laser Resurfacing | Comments Off on Laser Resurfacing with Active fx / Deep fx / Max fx to tighten the face for a non surgical face lift

What is a glycolic peel best for treating?

Sunday, January 24th, 2010

Glycolic acid peels are superficial but can be important for regular skin care. They are superficial peels and the aggressiveness of the peel is dependent on the percentage of the glycolic acid in the preparation.  They are fairly safe and it is very difficult to make them deep and thus complications are much lower as compared to other peels.  One thing to remember is that sometimes the more aggressive you are the more results you will get for the most part.  Glycolic acid peels that are from 0-30% can be done at home with some guidance.  Anything stronger would be wise to be carry out with the guidance of a physician.  At home glycolic peels are a great way to keep up your skin from a maintanence stand point.  I usually start patients on a skin care program with retinols, hydroxy acids, buffing cleansers, gentle cleansers and see how they do and tolerate it.  Once this basic regimen is tolerated for a couple of weeks then I start them on the at home glycolic peels and guide them through this.  With this regimen, you can get your skin to turnover much quicker (from 28 days to 10-14 days or less).  This will help with unwanted pigmentation, decrease the size of pores, improve texture, and decrease fine wrinkles.

Thanks for reading, Dr Young

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

Posted in Chemical Peels, Dermatology, Skin Care / Intense Pulse Light | Comments Off on What is a glycolic peel best for treating?

How often should you do chemical peels to maintain the results.

Sunday, January 24th, 2010

How often you do peels can be subjective and dependent on how you feel your skin is doing and for what condition you are treating.  Chemical peels can be varied in terms of how deep you want the peel and how deep the issues you are trying to treat. Superficial wrinkles and pigmentation issues can be improved by superficial peels.  Deeper wrinkles and pigmentation can be improved by more aggressive and deeper peels.  Deeper peels should not be repeated for several months and even up to a year.  Your physician can monitor how you are healing and determine this.  Superficial peels allow a faster recovery and thus you can do these much more frequently.  Glycolic peels can be done 2-3 times per week depending on how a person is tolerating the treatments.  Your doctor can help you determine this.  To maintain the results you need to determine with your doctor how your results are coming along.

Thanks for reading, Dr Young

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

Posted in Chemical Peels, Dermatology, Skin Care / Intense Pulse Light | Comments Off on How often should you do chemical peels to maintain the results.

Can hair removal work on someone who is on levothyroxine for hypothyroidism?

Sunday, January 24th, 2010

Yes laser hair removal can work on someone with this issue and condition. The question is whether you thyroid state is affecting your hair at all.  If you are well controlled the likelihood that your hair is not growing well is low.  Some patients with hypothyroidism have loss of hair and this could mean that some of the hair that you would like to remove may not have enough activity and pigmentation to be targeted by the laser.  But for the most part, if there are hairs that are showing and are not desired laser hair removal can reduce the amount of unwanted hair.

Thanks for reading, Dr Young

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

Posted in Laser Hair Removal | Comments Off on Can hair removal work on someone who is on levothyroxine for hypothyroidism?

Can corner of the lip lift correct an asymmetric appearing lip?

Sunday, January 24th, 2010

The corner of the lip lift is done on the skin portion next to the corner of the lips.  With this procedure their will be an incision that will be visible at the junction of the white and red portions of the lips.   It can elevate the corner of the lips to make the lips more symmetric. A lip lift under the nose is another way to make the lips more symmetric with a less visible scar as opposed to the corner lip lift.  Also, sometimes the asymmetry can be due to the decreased appearance of the red lip area.  To evert the red lip sometimes mucosal advancements are needed to show more of the red lip and volumizing procedures may be needed as well to create more symmetry.  All of these options are more permanent than the temporary fillers.

Sometimes the lips are asymmetric due to the connection of the lip to the surrounding bone.  More specifically it can be due to the way the lip is attached to the area around the nose and the bone in this area. When the attachment of the lip to the nasal bone area is asymmetric the lips can appear different on each side.  This condition may require attaching the lip and the muscles of the lip higher around the nasal bone area.  This is a more complex situation.

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 Can corner of the lip lift correct an asymmetric appearing lip?

Can chemical peels and photofacials be done every 2 weeks alternating?

Friday, January 22nd, 2010

Yes you can do this but you need to be careful and not be too aggressive. Chemical peels that are combined with photofacials need to be light and superficial. It all depends on what condition you are trying to treat. If it is melasma, being to aggressive can sometimes aggravate the condition. This same principle also applies to hyperpigmentation. It also depends on your skin type too. If you have darker skin, being more cautious is important. chemical peels that are done every month should be more superficial. Deeper chemical peels require a longer interval otherwise scarring could occur.  The benefit of doing chemical peels and photofacials together is that chemical peels work on more superficial elements of the skin while the photofacials can concentrate on deeper structures.  The combination of the two however is rather in its infancy stage and there are not a lot of solid scientific evidence regarding using them. The research however will continue to find new ways to benefit our patients.

Thanks for reading, Dr Young

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

Posted in Chemical Peels, Intense Pulse Light | Comments Off on Can chemical peels and photofacials be done every 2 weeks alternating?

Heidi Montag’s recent 10 procedures in one day topic

Tuesday, January 19th, 2010

Its big news that Heidi Montag had 10 procedures in one day.  In my opinion, that might be a little too much surgery in one day.  Although all of this information may be false. Who really knows but her and her doctor and the people in the room that day how many surgeries she really had.  I think based on looking at her pictures that she did appear to have had chin reduction, a rhinoplasty, possibly a browlift, and cheek enhancement.  Based on the pictures, I think she looks better before all of her procedures.  The chin reduction surgery has made her face actually look more square and more masculine. Although she mentions that she was teased as a child about her chin, I think the chin gave her lower face a pointier appearance which as an overall affect made her face appear more pear shaped.  Now that the chin is reduced, the face has lost the pear appearance and has been squared off like many male faces.  Her changes in her nose, possibly due to a rhinoplasty, has actually lengthed the appearance of the middle part of her face.  With that change, her face looks longer and less proportionate.  the distance between her eyes, nasal tip and lower lip should all be separated by equal distances and ideally 3 iris widths.  Her nose looks longer and I think her face has loss some beauty points. I think she might have also has her cheeks augmented.  This appears to have made her cheeks look wider.  I think that has also masculinized her face.  The cheek augmentation should have been more anteriorly closer to the eye and just outside (or lateral to) the eye.  The browlift, if it was done, is questionably needed at best.

When I see patients that request things that I don’t think needs to be done, I will tell them exactly what I think.  If I feel strongly enough, I refuse service to them.  If the procedure they are requesting is not consistent with my beliefs of what would enhance their aesthetics, it takes a lot of influencing for me to do what they request.  Although, I always have to balance my aesthetic beliefs with the desire of the patients.  Ultimately, what the patients wants is still very important.  But I have a long discussion with them if their desires are quite different then what I think will help them.

Thanks for reading, Dr Young

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

Posted in Cheek Augmentation, Chin Surgery, Fat Transfer / Fat Injections, Heidi Montag, Rhinoplasty / Nose Surgery / Nose job / Nose Reshaping / Nasal Reshaping | Comments Off on Heidi Montag’s recent 10 procedures in one day topic

Asian Double Eyelid Revision Surgery

Monday, January 18th, 2010

This topic is addressing perhaps the most difficult procedure to do. First of all, anything done around the eyes has the smallest margin of error. You can have a tiny variance of less than a millimeter and have it become very noticeable when anything is around the eyes.  That is why, procedures around the eyes have to be done with the utmost accuracy.

This is why Asian Eyelid surgery is so difficult. Some reasons for revision are ptosis.  This is a condition where the eyelid margin is lower than it previously was before.  When you do eyelid surgery for Asians and the goal is to recreate the eyelid crease, you have to work on the muscle that pulls up the eyelid.  It is essential to attach the skin edges, or elements of, to this muscle called the levator aponeurosis.  Sometimes work on this muscle can damage this muscle and lead to different affects on its function.  This can result in differences in movement and thus ultimately the height of the eyelid margin. Very small degrees of ptosis, or eyelid margin being lower than normal, can be noticeable to people  The way to treat ptosis is to expose the aponeurosis and shorten it through sutures.  This is done by grabbing the levator and attaching it to the tarsus which is the cartilage near the eyelid margin.

Other reasons for revisions include asymmetrical eyelid creases / folds, too much fat taken out of the eyelids, discontinuous creases, multiple folds, round eye deformity, etc.

For asymmetrical creases, if it is a lower eyelid crease that is desired, one needs to find what the height is desired and then the new crease is incised and the old crease needs to be released.  To prevent adhesion, you can place a fascia graft (tissue from muscle covering), or fat graft from another source into the area that is released and also to prevent readhesion.  Another way of doing that, is to lower the fat inside the eyelid over the area of adhesion.  But in the case that the eyelid fat is lacking, you need to use fascia grafts or fat from another source as noted above.  The best option is to use the free fat grafts.  Of all of the tissues that helps to prevent adhesion, fat is the best tissue to use.

For multiple creases, this situation is essentially like a crease that you want to remove.  This requires elevation of the crease and prevention of readhesion with the techniques that were just mentioned with tissue grafts as above.

For discontinuous creases, you have to recreate the crease which may entail a new incision and redoing the crease forming sutures that were done before.  Some variations of this can be done to cause longer lasting fixation. Some recreation of the creases can be done with longer lasting sutures that are placed below the skin level and allowed to absorb on their own.  Other techniques can be done to improve the fixation.

Taking too much fat entails adding fat grafts.  This can be done with free fat grafts through an incision technique or through harvesting with a cannula.  Here is video on Asian Blepharoplasty and Medial epicanthoplasty.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic 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 | 3 Comments »

Nasolabial Fold Grafts are another option to improve the Nasolabial folds by Dr. Philip Young of Bellevue | Seattle

Monday, January 18th, 2010

Nasolabial Fold Grafts are another option to improve the Nasolabial folds by Dr. Philip Young of Bellevue | Seattle: Nasolabial folds are a very common structure that develops as one ages and it is one of the most common structures that people want to get rid of.  I’ve learned a lot of things about improving this structure.  Facelifts have been experimented with over the years and most people believe that the deep plane facelift when the SMAS is lifted over the smiling muscles is the best way to improve the nasolabial folds from a facelift prospective.  Others find that a midface lift does this better.  Others find that volumizing the cheek in certain ways improves the fold as well.  Fillers have been used in the nasolabial folds to improve them and this is a very common option that people have chosen. Here is a video explaining the  differences between deep place facelifts and mini facelifts:

My opinion is dependent on the person’s anatomy.  If the person has a lot of tissue and has some extra weight that they have gained.  Volumizing might make the face a little too big.  In this case a facelift can help improve the nasolabial folds.  One thing that can help the folds is too fill the volume up with a nasolabial fold graft.  This graft can be taken from the SMAS (superficial muscular aponeurosis system) which is the layer of tissue that is connected to all of the facial muscles. The SMAS is convenient because this the layer that the facelift uses to pull the face and can be easily taken to use for the nasolabial fold graft.  This graft can be placed in the nasolabial folds through the nose and can help improve their appearance along with the deep plane facelift.

If a person is against such a surgical procedure than I think volumizing might be the best choice for them.  This can be done with essentially no incisions.  The YoungVolumizer is great for this.  If undergoing a procedure like this is too involved for the particular person, then volumizing with fillers such as restylane, radiesse, juvederm, and perlane are options.  Sculptra is another long term permanent filler option that can also be used to improve and volumize the face to improve the nasolabial folds.  In terms of fillers and volumizing, there is a special location, an area that contains a deep fat pocket that really helps to decrease the nasolabial folds when it is volumized.  It takes a lot of experience to learn how to fill up this fat pocket with fillers and other volumizers, like the “The YoungVitalizer” 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 Facelift / Face Lift / S lift / Mini Lift / Weekend Face Lift / Quick Lift / Image Lift, Fat Transfer / Fat Injections, Fillers / Facial Fillers, YoungVolumizer | Comments Off on Nasolabial Fold Grafts are another option to improve the Nasolabial folds by Dr. Philip Young of Bellevue | Seattle

Reducing forehead wrinkles

Monday, January 18th, 2010

The aging that occurs in the forehead entails a volume loss and it also entails some loosening of tissue and ligaments that hold structures in place.  As the eyebrow descends, we tend to elevate them to improve our vision and this can lead to wrinkling in the forehead area. This situation is coupled by our loss of volume (fat, collagen, bone loss).  This loss of volume places the vicinity of our skin closer to our muscles in our face.  Hence when we move our muscles in our face, like our forehead muscles, the muscles exert more action on our skin just by the fact that they are closer to the skin.   Through volume we can create a distance between the muscles and our skin and hence decrease the influence of the muscle on creating wrinkles. The question is then does the volume make us look weird.  The answer is simply “no”. When we were young, we had more volume all throughout our face.  If you take a look at pictures of yourself when you were young, you will notice a lot of loss of volume in your face.  Take a look at your temples, forehead, and your cheeks.  It will take a little time to adjust your thinking but you will see the difference. This loss of volume places your muscles closer to your skin. This is one of the main reason for forming wrinkles.  The amazing thing is that through volume, you can actually affect your skin change it for the better.  With the volume, the skin is allowed to remodel itself.  Your skin is in fact always turning over the cells and tissue within its structure.  With the decreased influence of the facial muscles on the skin, the cells within your skin begin to remodel and decrease the wrinkles that it has created all of those years.  This process of skin rejuvenation after volumizing can take many years and the change will be gradual.  This is a couple of reasons why the YoungVitalizer is my procedure of choice for facial rejuvenation.

In terms of the forehead, the volume can elevate your eyebrows to a state that you were a long time ago.  The volume again will also improve your wrinkles as well.  Volumizing is the most natural way to rejuvenate your forehead.  When I do forehead rejuvenation and rejuvenation of the upper eyes, I place the volume deep below the eyebrows, inferior to the eyebrow and within the upper eyelid, above the eyebrows and also in the temple and forehead areas.  This volume helps lift the eyebrows and can brighten the appearance of the eyes better than any other form of facial rejuvenation.

Browlifting is another way to do so.  You can elevate your brows and this can decrease your need to lift your eyebrows and ultimately your wrinkles can improve.  Also through browlifting some of your muscles can be altered to weaken them.  This is useful in the area in between your eyebrows and eyes.  Browlifting however can lead to less than a natural appearance.  Your eyebrows can be elevated to a point that is higher than they use to be. Also the removal of the muscles in between your eyes, although it will help decrease the movement there, the volume loss can make this area look worse.  If you want your eyebrows higher than they used to be, a browlift might be the better option.  But this is probably the only option that is better than volumizing in my opinion.

Thanks for reading, Dr Young

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

Posted in Browlift / Eyebrow Lift / Brow Lift, Fat Transfer / Fat Injections, YoungVolumizer | Comments Off on Reducing forehead wrinkles

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