What are the options for sunken cheeks besides temporary dermal fillers?

August 5th, 2009

This is a questions I answered for someone that was wondering what option there were for sunken cheeks besides temporary Facial Fillers. Fat Transfer or Facial Implants can give you the long term volume you desire in the cheek.

Sunken cheeks is a natural aging process.  When you age you lose fat in your cheeks and this can lead to your tissues descending, wrinkles developing, folds developing, lower eyelid fat protruding, eyelid bags, etc.  Dermal fillers like restylane, juvederm, radiesse, perlane, are temporary and last from 6 months to a year or more.  Of these fillers radiesse is a bone product made up of calcium hydroxyapatite while the others are made up of hyuloronic acid.  There are more permanent fillers like silicone injections, and artefill.  The problem with permanent fillers is that they have the potential to cause infections, scarring and granulomas (balls of chronic infection) that can present years later after you think everything is okay.

Other more permanent options for sunken cheeks include fat injections and silicone implants.  Silicone is very compatible to place in the cheeks.  The silicone atom is one step below carbon on the atomic chart and hence makes it really compatible.  The infection rate with silicone is very low and its use has a long history of safety.  Silicone implants can be placed within the cheek to give a person a more permanent volumizing and lift up sunken cheeks.

Fat injections are another way of volumizing the cheek. Perrmanency depends on whether the fat survives.  This depends on many factors: technique, health of the patient, care of the patient after the procedure, etc.  If fat lasts for more than 6 months to a year, it will likely survive for many years sometimes 10-15 years or longer.

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 I use my internationally acclaimed understanding of facial beauty to create the youthful volume you once had.

Dr Young is located in Bellevue near Seattle, Washington

Posted in Cheek Augmentation, Facial Implants, Fillers / Facial Fillers, Juvederm, Perlane, Radiesse, Restylane, YoungVolumizer | Comments Off on What are the options for sunken cheeks besides temporary dermal fillers?

Can a forehead augmentation be done after a brow lift?

August 5th, 2009

Forehead augmentation can be done but can affect the results of previous browlifts. You can augment the forehead with silicone after a browlift.  One of the issues is that the augmentation will affect what was done with the previous browlift and you will sometimes need to refix the brows and allow them to fixate in the newer position.  Browlifts depend on the fixation of the bone to the bone covering and the soft tissue that covers the forehead.  When you dissect to implant something into the forehead it will break that bond.  Also with the implant fixating the brows to a new position will present some challenges as well depending on where the implant is placed.  Implants placed in the forehead can establish needed volume that is lossed with aging.  Most of the time, however, forehead augmentation is used to fill in defects from trauma and for reconstructive purposes. Also depending on what implant is used and the size you may need longer incisions such as a variation of the coronal incision that goes from ear to ear.  Not all of this incision is needed most of the time.  In terms of augmentation, you can use silicone sheets / blocks, Facial Fillers or fat augmentation.  Silicone and fat are the options that offer more of a longer lasting results with silicone being more permanent than fat.  Fat injections, however, can be done with no incisions most of the time with less downtime associated with long incisions. Augmenting the forehead can potentially help with wrinkles in the forehead, eyebrow drooping, extra eyelid skin and temple hollowing depending on how and where the augmentation is done.

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.  Dr Young employs 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.

Dr Young is located in Bellevue near Seattle, Washington

Posted in Browlift / Eyebrow Lift / Brow Lift, Fat Transfer / Fat Injections, Fillers / Facial Fillers, Juvederm, Perlane, Radiesse, Restylane, YoungVolumizer | Comments Off on Can a forehead augmentation be done after a brow lift?

How to avoid problems with Botox, such as eyelid drooping.

August 5th, 2009

This a questions someone asked me regarding botox:

Botox / Dysport can help with wrinkles in between your eyes or glabella, forehead wrinkles, crows feet, eye wrinkles, bunny lines, chin dimpling, lip lines, lower eyelid wrinkles, gummy smile, neck banding, etc.  In terms of safety, there are a lot of ways to make botox safe and avoid complications. Botox can be done in a safe way to avoid problems.  First off, diluting the botox with less solution can go a long way.  I typically use only 2cc of botox where some other physicians use up to 4 cc of saline.  When you use more saline, you end up needing more volume for the same number of units.  What this means is that the more volume you use the more the botox will be spread out.  When the botox is spread out, it can affect other muscles around the area and cause unwanted effects.  In your specific question, having droopy eyelids can occure when the botox reaches the muscle that lifts up your eyelid.  With a smaller volume with the same amount of botox, the botox is less likely to reach that muscle.  Also to avoid reaching that muscle its important to stay away from the eye or the orbital part of the eye.  As you inject botox as it approaches the middle part of the eyebrow you need to move the injections further away from the eye.  Knowing where to inject makes a big difference as well.  For the forehead, you don’t want to inject the botox too low.  When you inject too low it can lead to your eyebrows descending as well.  I usually try to stay at least superior to the halfway point in terms of the height of the forehead.  Consulting a person specializing in the face is always an important thing to consider.

Dr Young is located in Bellevue near Seattle, Washington

Posted in Botox, Dysport, Botulinum | Comments Off on How to avoid problems with Botox, such as eyelid drooping.

How long does Alar base reduction results take to appear

August 5th, 2009

This was a question that I answered for a person who had a procedure done somewhere else by another physician:

Rhinoplasty during a rhinoplasty / nose shaping / nose reshaping / nose job procedure are done for big nostrils, wide nose near the nostrils, or big noses in general.  The area around the nostrils are called the alae and alar reduction or augmentation is used to change the shape of the alae. Alar reduction results should be earlier than later compared to other results with rhinoplasty / nasal reshaping / nose job  such as tip reshaping / tip rhinoplasty or modifications for a bulbous, big nasal tip. Alar base reduction swelling and the results should be faster when compared to work done on the tip area.  Generally, healing takes place on a logarithmic scale. Simply put, 60% of your healing should take place the first 6 weeks, 80% at 6 months and 89% at 2 years.  You will never have 100% of the strength that your tissues had before the procedure.  So in general, by 6 months 80% of the results should be present.  This is a generality and this is important to understand though. The above percentages are based on wound breakage strength and many surgeons and physicians use this to assess how healing in general takes place.  Usually results with procedures that are done in the tip take a while to be realized while other areas are a little faster like your nasal bridge and work done around the alae.  Your physician should best direct you.  But a second opinion never hurts in my opinion.

Dr Young is located in Bellevue near Seattle, Washington

Posted in Rhinoplasty / Nose Surgery / Nose job / Nose Reshaping / Nasal Reshaping | Comments Off on How long does Alar base reduction results take to appear

Asian double eyelid surgery and maintaining the Asian appearance as opposed to westernizing the Asian Eyelid

August 4th, 2009

When considering surgery for the Asian Plastic Surgery, there is a significant difference between an eyelift that maintains a person’s Asian appearance and one that changes the eyelid to look like a westerner or caucasian eyelid.  For an null you want to make the double eyelid crease no more than 3mm high when the eyes are open (The crease is surgically set from 6-10mm), you want to keep the mild puffiness that characterizes this ethnicity, you want to avoid taking out too much fat in the Asian eye.  For a westernized eye, the crease is surgically set higher (set at 8-10mm), more fat is removed, and there is a lesser degree of an epicanthal fold (the extra skin that covers the middle part of the eye).  Knowing where to place the crease, how much skin to remove, how much fat to remove, how to design the incision, making sure things are symmetric, how to place the crease forming sutures, etc all play a vital part.  Finding a surgeon that pays attention to all of these details is very important for an excellent result.

Dr Young is located in Bellevue near Seattle, Washington

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Asian Double Eyelid Surgery

August 4th, 2009

lowerlid-profile-preop

I have a lot of patients that come in to have “double eyelids”.  Many patients ask me what the difference is between a regular eyelift and an null that entails creating the double eyelid.  There are significant differences and going to someone that specializes in these type of procedures can mean the world of difference.  Creating the double eyelid requires a more thorough knowledge of the eyelid anatomy.  You have to understand all of the layers of the eyelid in order to find the muscle that elevates the eyelid called the levator aponeurosis (colored purple) in the picture.  This is the muscle that helps pull up the eyelid margin and create a tight layer of skin that folds under the more superior areas of skin.  The superior areas of the skin then hang over to be the crease part of the eyelid.  Prior to doing the procedure, it is important to relay to your doctor some of the important things you would like accomlished during the procedure.  Questions regarding whether you would like an inside or outside fold, how high you would like the crease, whether you would like the crease to follow the eyelid margin or flare upward as the crease approaches outside the eye or that lateral parts of the eyelid near the lateral part of your eyebrow, etc.  When people come in for an Asian Eye lid fold procedure, I sit down with them and recreate the crease while the patient looks in the mirror to determine exactly what they want.  This is a really important part of the consultation.  Going to a facial plastic surgeon that understands the Asian patient and how Asian eyelid surgery works for this particular patient is important as well.  Many surgeons attempt to make Asian patients look more caucasian and this can be a mistake. In fact, when an Asian Plastic Surgery requests this change I really talk to them about this and what this westernization type of eye lift / blepharoplasty can do to change their appearance.  I often get many Asian patients asking me to change their westernized eyelid back so they look more Asian.  Many times these patients had their surgery done in Asia, which is puzzling to me.

Dr Young is located in Bellevue near Seattle, Washington

Posted in Asian Cosmetic Surgery, Asian Double Eyelid Surgery / Asian Eyelid Surgery | Comments Off on Asian Double Eyelid Surgery

Stephanie Pratt and her rhinoplasty/ nose job?

July 21st, 2009

stephanie pratt

From the looks of the picture, it appears that Stephanie Pratt has some changes to her nose which could very well be from a Rhinoplasty.  From my eye, her nasal tip looks significantly different.  The tip is rotated higher and it is smaller in size. Also the upper portions of the nasal tip has been made smaller as well. Her bulbous tip has been refined so that is is closer to the size of her iris.  It is a really good job done by her plastic surgeon.   She does have a narrowing in the area above her nasal tip that could have been improved to a little larger width like the rest of her nose and hence have more harmony for the entire nasal bridge.  Based on my theory on facial beauty called the Facial Beautyher tip is near ideal size and shape!

Dr Young is located in Bellevue near Seattle, Washington

Posted in Hollywood Plastic Surgery / Hollywood Stars, Rhinoplasty / Nose Surgery / Nose job / Nose Reshaping / Nasal Reshaping, Stephanie Pratt | Comments Off on Stephanie Pratt and her rhinoplasty/ nose job?

Heidi Montag Nose Job, did she have one and how are the results

July 21st, 2009

heidi-montag-breast-implants This is a picture of Heidi Montag. Because I specialize in the face and neck plastic surgery and not the rest of the body. I will comment only on what I see in her face.  From the look of these pictures, it appears that Heidi has a change in her appearance from the left to the right.  Her nasal tip looks to be more refined with less of a bulbous appearance.  This is a common maneuver in Rhinoplasty.  The ideal size of the nasal tip should be about one iris width in dimension.  Anything bigger will attract more negative attention because it draws more attention to it than the iris.  When it is the same size as the iris, the nasal tip harmonizes with the iris and there is a connection between the nose and the eye.  When the nasal tip is smaller than an iris width, it attracts less attention and is less of a distraction but it harmonizes less with the iris and hence will be considered less beautiful.  Based on these photos, if she where to have had a rhinoplasty, I think the results have definitely improved her Facial Beauty!

Dr Young is located in Bellevue near Seattle, Washington

Posted in Heidi Montag, Hollywood Plastic Surgery / Hollywood Stars, Rhinoplasty / Nose Surgery / Nose job / Nose Reshaping / Nasal Reshaping | 2 Comments »

Non Surgical Face Lift

July 19th, 2009

There are many questions out there regarding an alternative for a non surgical facelift.  There are ways to tighten up your face without making incisions.  One way to do this is to undergo a laser resurfacing. We have the lumenis Laser Resurfacing unit and this is proven to be the best one out there on the market. It is the safest and most versatile of all co2 laser units and this can improve your skin by decreasing the wrinkles, improving skin texture, decreasing pore size, tightening the skin and creating collagen under the skin surface to create some more youthful volume.  Co2 laser resurfacing can tighten your neck skin and laxity as well. One thing to remember is that the tightening from a non-surgical face lift with co2 resurfacing will be subtle as compared to a facelift but you can get some results from this.

The other options include using Botox , fillers, and fat injections that don’t require incisions.  Botox / Dysport is a neuromuscular agent that can make certain muscles weaker that helps decrease wrinkles that are from muscular contraction. I have a youtube video to show where you can have botox and how it can help.

When you age you tend to lose volume and this can be replaced with fillers that require injections as an option for a non surgical face lift. Facial Fillers are usually temporary, at least the safer ones and last from 6months to a year or more.  Restylane, Juvederm, Radiesse, Perlane are some options. These modes can be used for the wrinkles between the eyes called the Glabellar region, for the dark circles under the eyes, forLip Augmentation, and many other issues in the face.

Fat injection are another option for a non-surgical facelift and related to this is the YoungLift which I have refined.

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.  Dr Young employs 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.

Dr Young is located in Bellevue near Seattle, Washington

Posted in Botox, Dysport, Botulinum, Facelift / Face Lift / S lift / Mini Lift / Weekend Face Lift / Quick Lift / Image Lift, Fat Transfer / Fat Injections, Fillers / Facial Fillers, Lip Augmentation / Lip Fillers / Lip Injections / Lip Reduction / Lip Grafts / Lip Advancements / Fat Injections of the Lip, Wrinkle Treatment, YoungVolumizer | Comments Off on Non Surgical Face Lift

After rhinoplasty from another surgeon my nostrils are bigger after nose picking and is this possible.

July 17th, 2009

This is unlikely unless your nostrils were made to be smaller with suture techniques during Rhinoplasty.  If this were the case, your nose picking could have dislodged or broken some key sutures that were keeping your nose a certain shape. Also if your nostrils were made smaller from the surgery, your nose picking could have stretched out the reshapened nostrils and made them smaller.  Making your nostrils bigger is actually less of a concern than if you were to tell me that your nose is smaller after picking your nose. Contractures can happen that can make your nostril smaller and the correction of this is much more involved requiring grafts to enlarge the nostril and sometimes the need for multiple revisions to enlarge the nostril.

Dr Young is located in Bellevue near Seattle, Washington

Posted in Rhinoplasty / Nose Surgery / Nose job / Nose Reshaping / Nasal Reshaping, Uncategorized | Comments Off on After rhinoplasty from another surgeon my nostrils are bigger after nose picking and is this possible.

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