Archive for the ‘Uncategorized’ Category

Orbicularis to Levator Fixation can lead to longer lasting results and more definitive crease formation with Asian Double Eyelid Blepharoplasty.

Tuesday, February 9th, 2010

There are many options with Asian Double Eyelid Crease Formation (Dr Young Seattle) including whether to use incisions or not, how to fixate the crease, how high the incision should be, whether an inside the fold or outside the fold crease is desired, if an epicanthoplasty should be done.  This particular blog will focus on how we do the internal fixation.  Most surgeons, greater than 90%, use the external fixation sutures to make the crease.  Essentially what we do is first make the incision and then we have to make our way down to the orbital septum.  It is essential to be very careful in doing this because you don’t want to start too low and enter the orbital septum below where the orbital septum and levator come together.  If this is done you could injure the levator and cause ptosis which is when your eyelid is lower in relation to the iris and you essentially look like you aren’t opening your eyes as big as before.    After we reach the orbital septum we then enter into the “post” septal space and elevate the post septal fat and find the levator. Traditionally at this point  the skin is then tacked to the levator with sutures and this is what causes the crease to form.  These sutures are then taken out 7 days later.  Usually this is enough to cause enough scarring to last a long time.  Another way of doing this is to tack the orbicularis muscle as shown in the photo below to the levator with orbicularis-levator fixation sutures.  These are internal fixation sutures that stay in there permanently.  In addition to these sutures, I also do the external sutures for extra assurance that the fold will stay for a very long time if not indefinitely.  The internal sutures have the benefit of acting more like the natural action that the levator has on the skin that is in front of the tarsus.  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

Upper eyelid anatomy

Surgery or volumizing. What should I do? by Dr. Philip Young of Bellevue | Seattle

Thursday, February 4th, 2010

Surgery with a Facelift or volumizing. What should I do? by Dr. Philip Young of Bellevue | Seattle: I think ultimately when you talk about facial rejuvenation, at one point you will face this question of whether to undergo surgery to remove extra skin and lift or the other choice of filling up the space to volumize the extra skin and the space around it.  Take for example the eyes.  Traditionally plastic surgery and its surgeons typically took away skin and fat.  That usually improved the situation but often times, in many cases, the person didn’t look younger necessarily.  Aging is predominately a process of losing volume in the face and around the eys and the way to reverse that is to replace this volume.  Here is a pictures of what improvements you can get after volumizing around the eyes: The YoungVitalizer.  I usually say that aging is a process that is analogous of a grape changing into a raisin.  Traditionally plastic surgery would make that raisin into a smaller raisin and not like the younger grape that it once was.  Volumizing returns the person’s face back into the grape it once was.

YoungVitalizer Before After Image

YoungVitalizer Before After Image

So when do you opt for the traditional reductive type of procedures where things are removed such as when you do an eyelift, browlift, facelift and the like? Well it depends on how you looked like when you were young.  If you thought your face was larger than you liked when you were young then some reduction may be necessary. I have a lot of Asian women who used to have much larger faces which they didn’t like.  They like there shape now that it is smaller but they still look aged.  I think some reductive type of procedures for this particular situation may be more necessary.    Reductive type of surgeries are also more indicated when the person gains a lot of weight and changes the face shape from what it was when that person was younger.  In this case as well, reductive type of surgeries would be more beneficial before volumizing.  Ultimately, whatever the face is looking like right now and what changes it needs to reach the ideal is what you would be most beneficial in doing.  I use my theory to find that ideal for people.

Thanks for reading, Dr Young

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

Earlobe reduction can markedly improve the aging looking earlobes.

Sunday, January 17th, 2010

Otoplasty (ear shaping, ear pinning, ear reshaping, ear plastic surgery, ear cosmetic surgery, earplasty) is the art and surgical procedure of shaping the ears to a desired shape. As one ages, your earlobe can lose volume and also ligaments within the earlobe can be stretched to ultmately give you a larger earlobe, with creases that can make your ears look aged.  Also, the enlarged earlobe can be distracting in and of itself from an aesthetic standpoint. Otoplasty can be done on the enlarged earlobe to acheive a shape and size that is more desirable in appearance.

Thanks for reading, Dr Young

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

My background and how I came to do what I do

Saturday, January 9th, 2010

One moment of my life that made a huge impact was the loss of my mother.  This occured when I was an undergraduate at the University of Washington.  This was obviously the saddest moment of my life.  I think that experience made me really appreciate life.  When I started undergraduate school, I began as premed.  I always wanted to be a doctor. My father was a real estate developer and that began to influence me.  During my first year, I switched majors to start to concentrate in Business.  I was accepted into the School of Business and started going to classes.  After the passing of my mother, I had a rejuvenated desire to return to medicine and did a total switch into that route.  That eventually led me to Tulane medical school in New Orleans, Louisiana.  I choose this school because it was located in a city that was totally different from Seattle, Washington.  It was a complete culture shock there but an amazing experience.  While in medical school, I was fascinated by the anatomy of the Head and Neck region.  This influenced my concentration of my studies toward Otolaryngology, which is the specialty of Head and Neck Surgery, commonly known as ENT, or Ear Nose and Throat.  I was then accepted into the residency program at University of Southern California, which is one of the top schools in the country. During residency, I had a broad range of experience in this field. I originally thought that I would go into the treatment of Head and Neck Cancer.  While learning this particular subspecialty, I was introduced to the reconstructive aspects of this specialized field.  Coupled with the very difficult role of diagnosing and being the bearer of bad news for people with cancer, this interest in the reconstructive aspect motivated me to learn more about the subspecialty of Facial Plastic and Reconstructive Surgery.  As I learned more about the field of Facial Plastics one element of this field began to fascinate me more and more.  One thing I noticed while in Los Angeles were the less than optimal results from plastic surgery that was occurring for many Hollywood stars.  I thought that if the most rich and famous people were getting these results that something must be missing in this field.  This lead me to gradually concentrate my interests into the field of beauty and specifically the ideas of beauty. The question I wanted to answer was ” what makes a face beautiful’?  Surprisingly, I found that no one really knew.  Our ideas of beauty were based on what is known as the neo classical canons.  These are rules of beauty that were brought down through the ages but originated during greek times. The were termed “neo” because they were revised during the renaissance and by Leonardo Da Vinci in the 1400’s.  I was shocked to find out that our rules of beauty had not changed much since the 1400’s.  If you read my paper you can find out about what some of the rules were at http://www.drphilipyoung.com/pdf/circles_of_prominence.pdf.  But essentially they are dogmatic rules based on external landmarks that I found occupied very little time when a viewer looks at a face when it analyzes it.  This question lead me to this journey of finding what beauty is and how to attain it for my patients.  During residency in Head and Neck Surgery, I applied for a Facial Plastics and Reconstructive Fellowship.  I was chosen among many candidates to train at Shreveport, Lousiana under the famous Dr Frederick Stucker, one of the grand masters in this field.

Thanks for reading, Dr Young

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

What are the long term side effects of Sculptra? Is it a smart choice? Who are the best candidates?

Wednesday, December 30th, 2009

Facial Fillers is actually the powder form of a suture, Vicryl, that has been used in surgery for many years without significant problems. The body absorbs the powder and eventually turns it into carbon dioxide and water. The benefit of Sculptra is that during this inflammation to degrade the Sculptra collagen formation is being carried out by the body in a scar like reaction. It is this collagen that creates the new volume.  With this inflammation there is the risk of infection.  However the benefit of having the inflammation to create the collagen in a scar form is paradoxically what can lead to the infection.  If you didn’t have this inflammation you wouldn’t have as much collagen formation.

In my opinion, Sculptra is most beneficial for the person who does not have a lot of fat in the rest of the body to undergo fat injections and would like some more volume in the face.  It is also useful in the person who has only a little fat to offer for fat injections.  In this particular situation I would use sculptra in the areas that can tolerate it more such as the cheeks, mouth area, temples, forehead and jawline areas and reserve fat injections for the areas closer to the lips and around the eyes.  It is also good to use Sculptra for people who don’t want the invasiveness of fat injections where you have the need to harvest the fat from somewhere else. Sculptra, in general, is less of a process than fat injections.  But with the negatives that come with Sculptra, there is a lot of positives for people in these situations above.

From a long term standpoint, once the Sculptra is dissolved there should not be long terms issues. If a person somehow does not degrade the Sculptra effectively there could be infections but there are ways to treat these issues without a lot of problems.  Silicone injections and Artecoll injections present more long term issues in my opinion.

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

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

Picture1

Picture3AC 03 beforeAC 04 after

What results can I expect from scar revision surgery after worsening scars around my ear and face?

Monday, December 7th, 2009

It always depends on what your scars look like.  Options for Scar Revision (scar treatment / scar improvement / scar reduction, scar removal) include:

1. excision and reexcision: straight closure, running w plasty, multiple z plasties, geometric closure.

2. skin resurfacing: including laser, dermabrasion, chemical peels

3. tissue expanders to recruit more skin

4. local flap surgery whereby skin and tissue are recruited to reline the areas of scars

5. free flap surgery where tissue from some other part of the body is transferred to the areas of the scars and connected with blood vessels.

Many scars are excised and reclosed.  There are many options with this approach.  You can cut the scars out and close them as a straight line.  Your eye however usually notices anything that is longer than 7mm.  So many times, it helps to close the new incision not in a straight line but broken up into “w’s”, “z’s”, or multiple patterns (geometric line closures).  This is done in attempts to trick the mind by not having any line longer than 7mm.

Resurfacing is always an option to improve the scar by taking the scars away on the surface and allowing new skin to grow over to improve the appearance.  This can be done with lasers, dermabrasion, chemical peels, and dermasanding.

If there is a big area to improve, sometimes having more normal looking tissue is needed. This is where the concern with bringing in tissue comes into play. Tissue expanders allow you to make more skin. You have to go through expansion of your skin with a balloon under the skin near the area you are wanting to correct.  Expansion occurs every 2-3 weeks.  Once you have enough tissue you can then take the expander out and then the new tissue is used to reline the scarred area.  Local flaps can be rotated into the area.  If this is not enough, you can then take skin and tissue from another area and hook up the vessels to reline the scarred area.

The other option includes fillers that are an adjunctive option.  Fillers essentially fill in the volume deficiency that sometimes is present in the scarred area.  Fat injections, which are a filler that uses your own fat can fill in volume and also regenerate your skin through incorporation of new stem cells in the fat.  These stem cells can have a regenerative property on scar improvement.

From a results standpoint, you shouldn’t expect it to make your scar back to complete normal.  This is impossible.  But through scar revision the scars can be really improved.  That is the key to scar revision the word “improve”.  Here is a video on Scar Revision.

Thanks for reading

Dr Young

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

Will fat grafting make me look fat and can you do fat grafting in the lower eyelid with a lower eyelid blepharoplasty?

Tuesday, November 17th, 2009

Fat injections (fat filler, fat transfer, fat grafting, pearl fat grafting) done right will not make you look fat just younger. Repeating the lower eyelid blepharoplasty and doing fat grafting is not a familiar course for me. I either do one or the other and I tend to do more fat grafting.  I only consider the lower blepharoplasty with fat grafting when there is an extraordinary amount of fat in the lower eyelids and this is not common.  Most of the time when you remove fat and skin from the lower eyelids you tend to look hollow there.  Fat grafting as a whole can really help this area by bringing back the volume to the lower eyelid and upper cheek area.  Also combining the two procedures can have an impact on the fat survival in my experience.  With fat grafting, I always have patients bring in photos of themselves when they were between 10-20 years old.  This helps me to determine where to put the fat.  Fat grafting will not necessarily make you look fat at all. When placed correctly, it can dramatically make you look younger.You just need to put the fat in the right places. Also browlifting is more complicated than most surgeons think.  A little can do a lot to make someone look surprised.  Many times fat grafting around the eyes, temple, and forehead can really make someone look younger in this area while elevating the eyebrows or giving the illusion that it has been elevated. You can see my before and afters at this link: http://www.drphilipyoung.com/procedures/youngvitalizer/

Thanks for reading, Dr Young

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

Fat Grafting to Rejuvenate Aging Hands

Tuesday, November 17th, 2009

Fat grafting into the hands is a great way to rejuvenate the way your hands look in the aging hand.  When you age you tend to lose the thickness of the skin and also the fat tissue within your hands. This eventually exposes the veins and the tendons in your hands.  Many people feel, surgeons and lay people, that the face and the hands are the easiest way to figure out how old a person is.  The options for rejuvenating the hands include fat injections, temporary fillers or other grafts including alloderm, whole fat grafts, special skin grafts, radiesse, restylane, sculptra, etc.  Using implants that are not part of the body can cause problems and sometimes can have an unnatural feel.  Fat grafting is a great option to rejuvenate the aging hands while using your own tissue.  When you come in we try to determine what you are looking for when it comes to rejuvenating your hands.  We then discuss some pictures of hands to get an idea where you would like to be.  Then we discuss where we will place the fat in your hands.  At this point we can determine if we want the fat just between your tendons or also around your knuckle area to disguise these better.  We also discuss where we will take the fat from.  We harvest fat from almost anywhere in your body, including the abdominal area, the hips, butt, flanks, back, inner and outer legs and arms depending on your desires.  This is the same process that we go through when we discuss fat grafting in your facial area.  We also discuss what kind of anesthesia you would like including 1. just local anesthesia, 2. oral sedation with local anethesia, 3. iv sedation with our registered nurse with local anesthesia, and 4. more heavy iv sedation with our certified registered nurse anesthetist.    The process of fat harvesting and implantation I use is termed “Serial Timed Fat Harvesting and Transfer”.  This is a technique that I developed to maximize fat survival incorporating the latest techniques that are found across the world.  I harvest the fat with small cannulas through a very small puncture/incision under low pressure.  Then the fat is then spun in a centrifuge at the lowest speed and for 3-5 minutes.  This separates the fat into 3 layers.  The fat is then refined removing the top and bottom layers which are lysed fat cells in the top and liquid and anesthesia in the bottom layer.  The middle layer which is the most important layer of fat cells is preserved and used for fat transferring.    We then inject the fat through tiny puncture holes that heal like mosquito bites and this is done in a careful layering process to insure survival (Figure 1).  Our “Serial Timed Fat Harvesting and Transfer” is our secret which we have found has markedly increased the survival of our fat and we employ this with our fat grafting to the hands and the YoungLift for the Face.  For each hand we typically harvest 60-80 cc or milliliters and then inject approximately 10-30cc into each hand with the average being around 20 cc. One US Teaspoon is approximately 5 cc’s or milliliters. You can see a video of this on our YouTube account. When you go to our website www.drphilipyoung.com you can click the YouTube icon and it will bring you to all of our videos. Or you can use this link: http://www.youtube.com/watch?v=_Pgs7XGiWWs.

Thanks for reading, Dr Young

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

Figure 1

Figure 1

Can Birthmarks be removed or reduced with microdermabrasion?

Friday, October 16th, 2009

This is a question that I answered recently.

It could work but microdermabrasion is usually a more superficial procedure. Birth marks usually have a deeper component within the skin.  Microdermabrasion is a superficial type of treatment that is not usually done to remove birthmarks, however. If done aggressively with more suction and more passes you can make the microdermabrasion reach deeper.  There are some microdermabrasion machines that are medical profession strength that can be used more aggressively.  Lasers, actual excision of themark, laser resurfacing, dermabrasion are other options.

Thanks for reading, Dr Young

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