Archive for the ‘Procedures’ Category

what to do about sebaceous hyperplasia which are single to multiple 1-3mm yellow umbilicated little pimple formation lesions.

Friday, July 10th, 2009

You can excise it or use cold therapy to take the lesion away with potential for scars. Also you can use oral isotretinoin with many risks including harm to the unborn fetus, dry skin, increase cholesterol, liver abnormalities, etc. Topical retin a has been shown to help as well. Laser Resurfacing are an option including pulse dye laser, 1450 laser and traditional erbium yag and co2 lasers work.

One thing to rule out is basal cell carcinoma which can be mistaken for sebaceous hyperplasia.

Dr Young is located in Bellevue near Seattle, Washington

Does a procedure that works on the corrugators help with bunny lines?

Friday, July 10th, 2009

Your bunny lines are created by the levator labii superioris and transverse portion of the nasalis muscle.  Botox is probrably the best thing for this.  Other surgery to affect the muscles here would likely change your smile too much and might be possibly disfiguring.  The corrugators run from the middle part of the your eye bone and insert into the middle part of your eyebrow.  Manipulating the corrugators improves the wrinkles between your eyes.  Surgery to improve this done and has been done quite a bit.  The corrugators can be manipulated from an eyelid crease incision or through forehead incisions when you do a Brow Lift.

Dr Young is located in Bellevue near Seattle, Washington

When should I have the anchor sutures taken out after a facelift and chin lift?

Friday, July 10th, 2009

It really depends on the doctor after your facelift and chin implant. I would go by what he is used and find works for him.  I usually take out anchor sutures one month later.  Not every doctor has anchor sutures placed and will just have you come back 7 days later approximately to have the sutures removed.  Anchor sutures are placed to help with the healing and are usually few in number. Basically, the longer you have the sutures in the greater the chance for scarring and train tracking.  Train tracking is essentially the appearance of train tracks due to the sutures leaving marks where they were.

Dr Young is located in Bellevue near Seattle, Washington

difference between ablative and non ablative laser skin resurfacing and treatments.

Friday, July 10th, 2009

A better question and the one you might have wanted to ask is what is the difference between non ablative and ablative Laser Resurfacing for the skin.  Nonablative is usually done through radiofrequency, or other wavelengths that go deeper in the skin to stimulate the deeper tissues to tighten up the skin.  Wavelengths from 1300-1600 achieve this non ablative skin tightening.  Radiofrequency is another way of doing this via thermage, etc. These devices although not removing the layers of the skin, can cause significant swelling and redness and this can lasts a couple of days to more time.  The ablative lasers such as co2 (Active fx, etc), and erbium yag lasers remove the top layers of the skin (ablate) and allow stem skin cells from within the hair follicles to resurface the treated areas to rejuvenate skin by decreasing wrinkles, tightening skin, decreasing pore size, removing unwanted pigmentation and removing precancerous skin cells. The strength of ablative or non ablative lasers really depend on what energy use and can be set by your doctor.

Here is a live demonstration of my use of a co2 laser and laser resurfacing.

Dr Young is located in Bellevue near Seattle, Washington

Will Juvederm totally take away the smile lines and nasolabial folds?

Thursday, July 9th, 2009

This a question someone asked me on line about whether Facial Fillers completely removed the nasolabial folds because she hoped that some of it remains so that she can still smile:

With augmentation with Juverderm, the nasolabial folds will be reduced but they will not completely go away.  When you smile the nasolabial folds will deepen with the action of the muscles but will not be totally gone with juvederm injections.  Also juverderm will only last around a year or less.  This is a temporary treatment.  Also if you don’t like the augmentation or what was done there is an enzyme injection that can be administered that will take away some of the juvederm if you desire.  Experience is important to make sure that too little or too much is given with these injections.

I refined an amazing volumizing procedure called “the YoungLift”.  This is an innovative technique that volumizes your face to bring out the younger and natural you without looking like you had something done.  This is not a facelift and requires no incisions.  Only pinpoint puncture sites are used and these heal imperceptibly.  The YoungLift can be done without general anesthesia and without drains, and large bandages.  You also have a lot less downtime and discomfort compared with traditional facelift procedures.  I employ the very best techniques from around the world into one volumizing procedure and he uses his internationally acclaimed understanding of facial beauty to create the youthful volume you once had. The YoungLift techniques can help with filling up the lips as well.  You can great results with fat injections in the lips.

Dr Young is located in Bellevue near Seattle, Washington

Making your skin look great without surgery and the options

Wednesday, July 8th, 2009

All of these options can help you maintain your skin without surgery.

Fillers: when you age you lose volume and replacing this volume can do wonders to fill in the facial contours.  This can get rid of general wrinkles and highlight the face in ways to bring youth to the face.  Restylane, Juvederm, Perlane are hyaluronic acids and last from 6 months to a year or more.  Radiesse is made out of bone and is very compatible and will last about a year.  Artefiill is polymethametacrylate microspheres and is a permanent filler that is FDA approved for the nasolabial folds and can basically last permanently.

Resurfacing: is a way to remove wrinkles, make pores smaller, take away unwanted pigmentation and tighten the skin.  Chemical Peels, co2 laser resurfacing, dermabrasion, aggressive microdermabrasion, fractionated lasers can all do this to some degree.  They can be tailored to fit your lifestyle and schedule.  This is the only way to really improve the etched in wrinkles on the surface aspect while fillers can help do this from a deeper level.  Fillers however will not change the surface charateristics as much as resurfacing modes can.

Retin A: can reverse skin damage, decrease your chances of skin cancer, improve fine wrinkles, decrease unwanted pigmentation in mild to moderate degrees.  This is a topical medication and is available through prescription only.  Retin A can also help with Acne as well.  It is also used to prepare the skin for laser resurfacing.

IPL: Intense Pulse Light is light that is concentrated and filtered to allow a selected range of light to target pigements, brown spots, and vessels and the red spots they create.  There is essentially no downtime with this treatment.  It can also tighten your skin to a small degree.  The reduction of the spots can really make your skin look clear and younger

Botox/Dysport: makes the muscles in your face weak whereever its injected. When the muscles are weak they can’t make wrinkles with the expressions.  Botox can be injected in a directed manner to reduce the appearance of wrinkles!

Skin care is vital. Your skin protects your face and allows it to look the way it does.  When you wash your face with harsh chemicals or expose it to the environment in a extreme way it will react with redness and hyperpigmentation.  Washing with a gentle cleanser and only once a day max will help.  Tanning is a no no and you should always wear sunscreen and apply it all the time.  Staying out of the sun is also important.

Dr Young is located in Bellevue near Seattle, Washington

Approach to small pox scars through excision, resurfacing and hair transplantation?

Wednesday, July 8th, 2009

Small pox scars are a lot like Acne Scars. The pox scars can appear very differently in people.  Depressed scars can be excised or they can be elevated and then resurfacing can then be done.  Excision of the scars will likely need two stages.  You would need to excise them at the first stage and then allow them to heal. At 6-8 weeks or later, we can then do the resurfacing procedure to smooth over the incision from the excision.  If you want to do it in one stage, you can elevate the scars through punch excisional techniques where the depressed scar is incised completely around it and then elevated so that the skin is at the same level.  Once this is done with all of the depressed scars you can then resurface the face or area at the same time.  Results can be as good as the two stage approach.  When the scars are raised, you can use resurfacing techniques to lower the raised portion and then the area can be healed over by the migrating cells.  Hair transplantation can help but they can be placed in areas that you might not want hair located at.  You have to make sure you don’t mind hair in the area that you transplant hair.  With the above techniques you may not need hair transplantation given the excellent results that you can attain. Here is a live demonstration of my use of a co2 laser and laser resurfacing.

Dr Young is located in Bellevue near Seattle, Washington

What to do about a bad result after a rhinoplasty?

Wednesday, July 8th, 2009

This is a question that I answered for someone who had aRhinoplasty done by another surgeon:

A bad nose job really depends on how long ago it was done.  Right after surgery, your nose usually doesn’t look very good. The swelling and the bruising usually distorts the area so that it really won’t look like it should for weeks to months.  This especially occurs in the tip area. Sometimes, after your rhinoplasty, results that are not going to turn out as promising can be determined.  Usually they are very obvious things like a deviated nose still appearing deviated after the procedure.  Or the bump over your nasal bridge is obviously still apparent.  One thing to know is that the tip area takes the most time to refine itself.  The swelling in this area takes patience for it to go down.  Your doctor will consider steroid injections and oral steroids to help this in some cases but using steroids can be a risky thing to do especially if it is not injected deep enough.

Don’t worry though. There are a lot of great surgeons out there that can improve almost any situation in the nose from a prior rhinoplasty.  It might take some work but there are options to improve the situation.

Dr Young is located in Bellevue near Seattle, Washington

What is Intense Pulse Light Treatment?

Wednesday, July 8th, 2009

Intense Pulse Light can treat sun spots, small veins, rosacea, and other forms of skin discoloration.  This machine uses light to target your pigment and blood within your skin while sparing the other structures of the skin for less down time. You usually need 3-4 treatments to be fully effective often times but because of the essentially no downtime, this form of treatment is very popular.  Intense Pulse Light can also be used to reduce unwanted hair as well.

Here is what I usually tell people during a consultation: Intense Pulse Light treatments are indicated for cosmetic and reconstructive applications requiring selective photo thermolysis of soft tissue in the medical specialties of plastic surgery and dermatology. The wavelengths used in intense pulse light are between 515 and 1200 nm for the treatment:

• Benign pigmented epidermal and skin lesions including dyschromia, hyperpigmentation, melasma, scars, striae
• Benign skin vascular lesions, including port wine stains, hemangiomas, facial and truncal telangiectasias, rosacea, erythema of rosacea, angiomas, spider angiomas, poikiloderma of Civatte, leg veins, and venous malformations
• In other words, Intense Pulse Light can be used to treat red and dark spots that are at risk for cancer.

Contraindications for Intense Pulse Light include but are not limited to:

• Current or history of cancer, especially malignant melanoma, or recurrent non-melanoma skin cancer, or pre-cancerous lesions such as multiple dysplastic nevi.
• Any active infection.
• Disease which may be stimulated by light at 560nm to 1200nm, such as history of recurrent Herpes simplex, systemic lupus erythematosus, or porphyria.
• Use of photosensitive medication and / or herbs that may cause sensitivity to 560-1200m light exposure such as isotretinoin, tetracycline, or St John’s Wort (Best Avoided for at least one year before your resurfacing).
• Immunosuppressive disease, including AIDS and HIV infection, or use of immunosuprressive medications.
• Patient history of Hormonal or endocrine disorders, such as polycystic ovary syndrome or diabetes, unless under control.
• History of bleeding coagulopathies, or use of anticoagulants.
• History of keloid or hypertrophic scarring.
• Very dry skin.
• Exposure to sun or artificial tanning during the 3-4 weeks prior to treatment. Sunblock should be applied 2 weeks or more before your procedure using a product that is sensitive for the skin and contains titanium dioxide or zinc oxide-containing sunblock.
• Skin type V1 or very dark, black skin types
• Pregnancy and nursing.
• Ectropion, outward turning of the lower eyelid and excessively dry eyes, previous lower blepharoplasty.
• koebnerizing diseases, prior radiation therapy leading to a loss of adnexal structures, extensive fibrosis resulting from prior cosmetic treatments (e.g., dermabrasion, deep chemical peels, silicone injections).

Intense Pulse Light is not intended to substitute for a surgical facelift, ablative skin resurfacing, or procedures that treat deep wrinkles and saggin skin. It is inended for patients desiring eveness of color in their complexions, or those showing signs of sun damage and photoaging. Intense Pulse Light skin treatments have a great appeal to individuals with active lifestyles who cannot set aside healing time, as required with ablative procedures or surgery. The procedure requires not “downtime”, ie, patients can resume all activities immediately after treatment, except sun exposure.

What can you expect:

• There may be some discomfort or pain associated with treatment
• Transient erythema/edema may appear immediately following treatment
• Pigmented lesions may become darker for up to fourteen days following treatment
• Acceptable results will likely take a number of treatments, usually four to six. The entire program should be planned at the outset so that you can have a set schedule to come in and to help you to have realistic expectations.
• There is a very small risk of adverse reactions such as changes in the testure and pigmentation of the skin. These are usually transient and rare.

Possible side effects of treatment:

Intense Pulse Light are typically administered in a series of four to six treatments, performed at intervals of a minimum of three weeks. A Three week interval has proven optimal. However larger intervals do not appear to adversely influence treatment results. Spreading the treatment over this period provides a gradual improvement of the skin, a minimal risk of adverse effects, and preserves the importrant “no downtime” feature of the program. In rare cases where side effects do occur, postpone further treatments until after complete healing. The most common side effects are:

Discomfort: When a pulse is triggered, it may cause a various degrees of discomfort. Some describe the sensation as stinging, while others liken it to a rubber band snap. A burning sensation may last up to an hour after treatment.

Damage to natural skin texture: A crust or blister may form, which may take from five to ten days to heal

Change of Pigmentation: There may be a change of pigmentation in the treated area. Most cases of hypo- or hyper-pigmentation occur in people with darker skin, or when the treated area has been exposed to sunlight before or after treatment. In some patients, hyper-pigmentation occurs despite protection from the sun. This discoloration usually fades in three to six months, but in rare cases, mainly hypopigmentation, the change of pigment may last longer or be permanent.

Scarring: There is a very small chance of scarring, such as enlarged hypertrophic scars. In very rare cases, abnormal, large, raised keloid scars may appear. To reduce the chance of scarring, it is important to carefully follow all post-treatment instructions and exclude patients that have a genetic tendency for scarring.

Excessive Swelling: Immediately after treatment, especially around the nose and eyes the skin may swell temporarily. Swelling usually subsides within hours to as much as seven days.

Fragile skin: The skin at or near the treatment site may become fragile. If this happens, avoid makeup and do not rub the area, as this might tear the skin.

Bruising: Very rarely, a blue-purple bruise may appear on the treated area. It may last from five to fifteen days. As the bruise fades, there may be rust-brown discoloration of this skin, which fades in one to three months.

Burns: There is a small chance of burns occurring on the skin. To reduce the possibility of burns from occurring, it is important to carefully follow all treatment instructions, and in particular performing test patches can be an option.

Post Treatment:

General: cold packs should be applied immediately after treatment, to cool the treatment site, reduce swelling and ease discomfort. Chemical cold packs are not recommended, if their temperature is below 4 degrees celcius. Alternatively, frozen 4 x 4 gauze, previously moistened with water and inserted into small plastic bags or in plastic wrap, could be used after treatment..

In most cases, the low energy, low risk nature of IPL skin treatments make is safe to resume vitually all activities except excessive sun exposure.

Exposure to Sunlight: Patients should use high factor (30-35spf) sunblock and protect the treated area from exposure to sunlight for at least one month following treatment. Tanning after treatment sessions may enhance melanin regeneration, which may result in hyper-pigmentation.

Makeup: You can use makeup immediately but if there is any reaction you should notify us as soon as possible.

Follow-up: We will have you return every three weeks until your program is completed

Adverse effects: If there is any adverse effects, treatment should be discontinued until the treatment site has healed and the reason for the adverse reactions are understood.

Concluding treatment:
Determining when treatment should be concluded will be discussed with you and we will do everything to make sure that you are happy!

Dr Young is located in Bellevue near Seattle, Washington

Can laser resurfacing remove sun damage that is not yet apparent?

Wednesday, July 8th, 2009

Absolutely! Laser Resurfacingalong with chemical peels, dermabrasion, dermasanding, can all remove cells that have accumulated sun damage over the years. The removed cells are then replaced with cells that are new from deep within the hair follicle which “resurfaces” the skin that has been treated. There are many scientific studies out there and most of them are related to chemical peels which show the benefits of removing precancerous cells in the skin.  Many of these studies have shown that the progression to precancerous lesions such as actinic keratoses are significantly reduced when some deeper form of resurfacing is done.  These resurfacing procedures have been shown to be as effective as topical chemotherapy such as 5-fluorouracil. Here is a live demonstration of my use of a co2 laser and laser resurfacing.

Thanks for reading,

Dr Young

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