Archive for the ‘Procedures’ Category

Lip Advancements for Permanent Lip Augmentation

Sunday, December 20th, 2009

Although during these present times, people are opting for fillers and more temporary correction of thin lips and for lip augmentation, there are permanent options for lip augmentation.  Most of the time these permanent options have a longer recovery time.  But, in the long run you will save money and not have to undergo repeat injections that could happen twice a year depending on the filler that you choose.  Lip advancements are one way to increase the pout of your lips while adding some volume.  Most of the time these lip advancements are done in a V-Y fashion.  What that means is that the inside of the mouth begins in a V shape and drawing.  With the wide part of the V representing how wide you want the lip augmentation to be.  The pointy V part usually starts way inside your mouth inferior to your teeth in the gutter part of your mouth.  When the V is incised it is pushed forward to increase the pout of the lip.  When the V is advanced, the part that is inferior to the pointy part of the V can be

closed in a straight line creating the vertical portion of the letter Y.  Here are some pictures explaining it and also some before and afters from this procedure.  Importantly, I incorporated my theory on facial beauty to get these optimal results.  This result is 2 weeks after the procedure and will get better and better. One thing to notice is that the lower lip is much bigger than the upper lip.  This maintains the correct balance of the lips.  In fact, the lower lip should be twice the size as the upper lip to maintain the optimal aesthetics for this area. The center puckering of the lower lip should also emulate the eye and the pucker should create a highlight approximately 3 iris widths in length, essentially the size of the width of the eye.  The height of the lower lip should be one iris width for optimal aesthetics. Below the dash lines represent the right orientation but they are located inside the mouth. This patient had 3 of these V’s on the bottom and top lips for a total of 6 V-Y advancements.

Hope that helps!

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

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Picture3AC 03 beforeAC 04 after

I have a Polly Beak and how do I correct it? Also I still have a crooked nose after 2 rhinoplasties.

Monday, December 14th, 2009

This is a question that I answered for a patient who had the issues above and this is my answer:

Your polly beak is very small and should be easily corrected. The polly beak looks higher than one that would be due to scarring. I would venture to say that the polly beak that you have is probably due to cartilage being left in and this can be easily reduced.

The crooked bone and septum can also be fixed.  I usually only need one procedure to correct a crooked nose.  A crooked nose requires the most extensive knowledge regarding Rhinoplasty(nose job, rinoplasty, nose plastic surgery, nose cosmetic surgery, nose shaping, nose reshaping) so its not surprising that you might still have that after having undergone two rhinoplasties.  Also one thing to realize is that rhinoplasties are the hardest surgery that a facial plastic surgeon can do.  There are many variables that can contribute to a less than perfect result.  Many times a crooked nose entails some complicated maneuvers along the key areas of cartilage that hold your nose up which many surgeons are not comfortable venturing into.  If you are not careful your whole nose could collapse if not done well.  Many times the cartilage is what is holding your nose in a crooked nature and it requires releasing cuts into the cartilage itself to release the crooked forces that hold your nose in that state.  Then the cartilage needs to be reconstituted and strengthened with other cartilage to solidify the new form.

Hope that helps!

Thanks for reading, Dr Young

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

What can be done for protruding lips?

Monday, December 14th, 2009

A lip reduction procedure will help you tremendously. A lip reduction procedure entails incisions inside your mouth and lips and resecting a portion of the lips to reduce the overall size.  This procedure can be done in an outpatient setting and should take about 1 hour or so.  It is relatively a low risk procedure and it can be done under just local anesthesia or with iv sedation.  General anesthesia is not necessary and actually makes is harder in some ways.

Hope that helps!

Thanks for reading, Dr Young

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

Revising the earlobe due to a delay from a keloid in the area after an otoplasty procedure.

Tuesday, December 8th, 2009

Setting back the earlobe is not a difficult thing to do during otoplasty (ear shaping, ear pinning, ear reshaping, ear plastic surgery, ear cosmetic surgery, earplasty). You can cut the cartilage that holds the earlobe out (called cauda helicis). You can also adjust the skin to pull back the earlobes the right amount.  This can be done really anytime unless there are some things that were done near the area that might require healing before the earlobe revision.  The length of time to wait can be from 3 months more or less.

The biggest confounding issue is the Keloid.  The keloids can come back over and over again.  Steroids and excisions are the most common way to remove keloids. Sometimes, local flaps and recruitment of extra tissue and skin can be needed to remove keloids.  You should be prepared to have more than one revision to take care of the keloid.

Hope that helps!

Thanks for reading, Dr Young

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

Trauma to the nasal tip causing a broken nasal tip and whether changes to it can be made to look better.

Tuesday, December 8th, 2009

This is a question someone had asked regarding whether a broken nasal tip could be fixed. He had mentioned that the tip is now more droopy, bulbous and has irregularities on the surface above and on the nasal tip.

Rhinoplasty can fix your broken nasal tip. When you say broken, it might be good to mention that there are actually no bones in the nasal tip.  The nasal tip is made up of cartilages and your trauma to the nose could have caused the cartilages to be damaged. The drooping may have been caused by some of the cartilage losing its connections from elements that are higher up on the nose.  The bulbous change could be from scar tissue. All of these changes though require quite a lot of force, so you must have hit your nose pretty hard.  These changes can all be improved for you through rhinoplasty (nose job, rinoplasty, nose plastic surgery, nose cosmetic surgery, nose shaping, nose reshaping) and it will essentially require tip work and very likely no treatment to your nasal bones.  One question is whether you have closely looked at the pictures of yourself long before.  Sometimes people notice things more after an event and attribute it to the event when it was really has been happening for a long time.  This is just a thought though and all this could be from the trauma.

Hope that helps!

Thanks for reading, Dr Young

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

Difference between co2 laser resurfacing with Lumenis and their active fx / deep fx / total fx / max fx technical advances explained

Monday, December 7th, 2009

active_deep_totalfx

skin anatomy

skin anatomy

A knowledge of skin anatomy can help with understanding resurfacing (laser peel, laser skin rejuvenation) of all types including laser, chemical, dermabrasion.  Taking a look at the cross sectional area of the skin, you can see that the skin is broken up into basically two areas, the epidermis and dermis. All resurfacing progressively take away layers of skin and by doing so remove skin lesions, unwanted pigmentation, wrinkles etc.  What happens is that the deeper skin cells located in the depth of the hair follicle eventually resurface and repopulate the skin.  during this process a layer of scar tissue and collagen is formed under the new basement membrane.  This new layer of collagen is thought to be responsible for some of the benefits of resurfacing including tightening of the skin and maintaining the decrease state of wrinkles.  The basement membrane is the connective tissue floor that the stem cells rest on where they reside and repopulate the more superficial layer of skin cells.  Active Fx essentially takes away more superficial layers confined to just above or just below the basement membrane depending on how many passes are done, what power and what density is chosen.  The basic principle of active fx is the use of a fraction of the spot size.  When you look at the picture above you can see that active fx has some wide dots, wider that the deep fx.  But the key are the areas in between the dots that represent untreated skin.  This untreated skin allows a faster recovery and less down time.  The goal is to get some of the effects of resurfacing without the downtime.  To help with the results of active fx, deep fx was added to create more tissue tightening to a deeper level.  Notice in the picture that with deep fx the dots are thinner.  Deep fx is thinner but it reaches to a deeper level heating up deeper layers and leading to more tissue tightening to a thicker amount of skin.  When deep fx is combined with active fx you can get better results than when each are used alone and this is done with less downtime than traditional resurfacing.  Total fx is when active fx is combined with deep fx.  Traditional resurfacing can be explained by active fx and that approach.  The difference is that the dots are much closer together and depending on whether you increase the density of the dots the dots may overlap to a varying degree.  When the dots start to overlap at a density of 4-5 you start to get into more traditional type of resurfacing where all parts of the skin are taken away or ablated per spot.  This approach does not leave healthy skin in between the treated dots, so the downtime is like older approaches. This use of active fx with dots touching or overlapping is more appropriately called max fx, or traditional co2 resurfacing. One thing to remember is that the more aggressive you are the more results but also the more risks are involved.  Total fx tries to get more results than you would normally get with a certain amount of risk. 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

How much reduction can a bulbous tip actually receive and will it look much differently?

Monday, December 7th, 2009

Reducing the Bulbous tip can be done but the results often depend on what the tip is made of during Rhinoplasty (nose job, rinoplasty, nose plastic surgery, nose cosmetic surgery, nose shaping, nose reshaping). If the bulbous tip is made up of thick skin this presents a dilemna.  A surgeon can defat the tip but this can increase irregularities to the skin and also can cause skin to possibly be devascularized and worst case scenario die partially.  If the tip is made up of cartilages mostly creating the bulbous tip, you can be more certain that the tip can be reduced significantly.  This is done through non destructive reversible suture techniques.  You can make a nose look quite a bit different. Because the nose is in the center of the face, the appearance of the face can be markedly altered.

Thanks for reading, Dr Young

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

Acne Scar Treatment Options

Monday, December 7th, 2009

There are many options for treating your scars from Acne Scar Treatment (Acne scar treatment, acne scar reduction, acne scar removal, acne scar revision, scar revision).  A lot of the techniques used are based on what they look like.  Acne scars can be 1. elevated 2. depressed 3. come in different shapes 4. different colors 5. different locations 6. different sizes.  Elevated scars can be excised then followed up with excision 6-8 weeks after the excision. Depressed scars can also go through that same process.  In addition, you can carry subcision for depressed scars instead of completely cutting out the scars.  This entails cutting around the circumference of the scar and elevating it to the rest of the level of the skin. This usually requires suturing the newly elevated skin.  Linear scars that are longer than 7mm may need to be broken up into different directions or shapes to camouflage the straight line better. People tend to see lines that are greater than 7mm in length. Scars can be excised or resurfaced if they are different colors. Resurfacing entails taking away the top layers of the skin to allow deeper skin cells (that reside in the hair follicles that are a lot deeper) to resurface the layers of skin that were taken away by laser, chemical peels, or dermabrasion.  Depending on the location, there are different issues to think of in order to allow the scar to heal in the best possible way.  Depending on the size, other techniques could be considered. Recruitment of tissue is sometimes necessary to get the best possible result.  Local tissue that is next to the scar can be used. Regional tissue that can be rotated in based on definitive blood flow and  sources.  Free tissue that is totally removed from the source and reimplanted into the scarred area by connecting blood vessels is needed on the more extreme end of cases.  Here is a live demonstration video of an Acne Treatment Procedure.

An example here shows elevated scars that were excised at the first stage, closed in different patterns for camouflage, and then resurfaced with a co2 laser(total/max/active/deep fx).

Thanks for reading, Dr Young

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

Before Acne Scar Treatment

Before Acne Scar Treatment

After Acne Scar Excision / Camouflage Techniques

After Acne Scar Excision / Camouflage Techniques

After Acne Scar co2 Laser Treatment

After Acne Scar co2 Laser Treatment

What is a non surgical nose job and do the results last if I can’t afford a rhinoplasty.

Monday, December 7th, 2009

Fillers can be an option for a non surgical Rhinoplasty (rhinoplasty, rinoplasty, nose plastic surgery, nose cosmetic surgery, nasal hump removal, non surgical rhinoplasty) and can be less expensive.  The results though are temporary.  It can be used to fill in volume to augment and make things bigger.  But fillers have a harder time to make things smaller especially the tip area.  A nose hump can be made to look smaller through filling above and below the hump.  Again the results are temporary.  Through my experience, I have noticed that rarely fillers can last for years.  The cause of this is through scar tissue surrounding the filler protecting it from getting dissolved by the body.  Most permanent changes are effected through some surgical type of procedure. Permanent fillers are an option but inferior to surgical means and can have significant complications.

Thanks for reading, Dr Young

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

Shortening the long nose and whether you should bring in pictures of people that you would like to look like.

Monday, December 7th, 2009

Shortening the long nose is a fairly common thing in Rhinoplasty (rinoplasty, nose job, nose plastic surgery, nose cosmetic surgery, nose augmentation, nose enhancement).  It involves shortening the cartilage that is holding the nose in a long position. Bringing in pictures helps the surgeon know what you are talking about. This can be a vital factor in getting what you want out of Rhinoplasty.  One thing to realize is that you should be realistic about what can be achieved. A rhinoplasty will improve your look, but you may still look like you just better. To totally change your look, a lot usually needs to be done.

Thanks for reading, Dr Young

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