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Terry L. Hand, M.D.
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The Rachael Ray Show Discusses Matrix RF Sublative Skin Resurfacing
As most of you know, our practice added Matrix RF for skin tightening to our arsenal of low downtime tools last August. This month's interactive tool is a video clip aired on the Rachael Ray show on 9/25/2009.
See video clip of Matrix RF on the Rachael Ray Show
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ASK THE DOCTOR
I cannot afford the facial surgery I planned to do for several years. I have seen fat grafting done on TV to fill out the face. Will that procedure fill out the wrinkles until my planned surgery? E.F.
Facial fat grafting is not a new procedure although many of the plastic surgery shows represent it as such. I have done this procedure for many years and believe that it has several applications where it is a great solution. That said, the concept of "filling in the face with fat" can be overused. The areas I am most opposed to ares under the eye to fill in hollows and to extremes in the cheek area.
I use fat very often to fill in nasolabial creases (the lines between the nose and the mouth), marionette lines (the downward lines in the corner of the mouth) , malar prominences (the cheekbones) and the lips. Why? I find that approximately 30% of the fat survives on most people. Also, when harvesting the fat, the charge is the same for multiple cc's. If there are several areas to inject, it is often more cost efficient to do a fat graft to multiple areas rather than dermal fillers purchased by the cc. The downside with fat is that often there is more bruising and swelling than with hyaluronic acid (dermal) fillers immediately post injection. I leave the choice of fat grafting vs. hyaluronic acid fillers purely to the patient.
However, I am definately not an advocate of overdoing this procedure. A small amount in the cheekbone region softens a females look beneficially. Large amounts of fat grafting in that area lends to a puffy, unnatural look.
The solution for redundant, sagging skin is almost always surgical. We can soften the aging appearance with fillers, fat and botox and refine the skins appearance with Matrix RF and the IPL RF resurfacing but moderately to severe facial laxity requires a surgical solution. |
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Maybe it's the new competition (Dysport) or maybe the economy. Either way, you win! |
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$70 Off! |
Come into the office for Botox and either try for the first time or refill your Latisse precription at the same time. You'll save $70 OFF ($50 mail-in rebate and a $20 instant rebate).
Promotion ends on 10/31/2009, Boo! |
"If my eyes are the windows to my soul, I want long, luxurious window treatments!"
--Lisa's favorite quote
Lisa has recently been certified as an eyelash expert. Bring on the questions! |
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Why Choose A Plastic Surgeon With An Accredited Surgical Facility?
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For the past 6 months, our office has been preparing for the facility inspection that is performed every three years. Very recently, we were recertified to continue the standard of care we strive to deliver always. We welcome this opportunity for several reasons:
1) Patient safety is first in priority in the mission of our practice. The opportunity to be certified for our outstanding efforts confirms our commitment to excellence in patient care.
2) The practice of medicine is an ever changing science. We welcome all comments and suggestions regarding how we can better our facility.
3) The recognition given that we are certified nationally as a safe alternative to hospital based procedures, brings peace of mind to our patients. A surgeon should always be certified to perform any procedure that is done in the office at a local hospital as well.
4) This certification recognizes the ability of our facility to facilitate patient comfort and safety with general or local anesthesia capabilites. "Cosmetic" surgery providers that will state that they do not offer general anesthesia for "safety reasons", most likely do not have a certified surgical facility since it is not required for the performance of "local anesthesia only" procedures. |
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Halloween will soon be upon us! October is a terrific time to consider cosmetic surgery and/or more minimal rejuvenation procedures. This month we are highlighting yet another use for Botox, the added benefit of reduction of migraine headaches. The photo I have utilized to illustate migraine pain seems to capture the aggravation of a migraine and the Halloween spirit! All kidding aside, procedures completed in October are generally healed and looking great for the holidays.
This month's featured procedure is forehead lift. I have chosen this procedure because often after it's completion, the patient not only has an improved cosmetic appearance but also a cessation or reduction of migraine headaches. It's greatest cosmetic benefit however is when the patient's eyebrows are repositioned back to their youthful position. I perform this procedure often as an adjunct procedure to blepharoplasty (eyelid lift).
I am frequently asked questions concerning the training and qualifications of a board certified plastic and reconstructive surgeon compared to a self described "cosmetic surgeon". Who is better trained and why does it matter? Later on in this newsletter is a letter written by one of my colleagues, Dr. Mark A. Brzezienski, that is so well done, I can only applaud his explanation and pass on his well done effort.
Our new Matrix RFsubablative resurfacing procedure and intense pulsed light option with radiofrequency is now making the news. It has been a perfect combination of technologies for our office. We have been able to target red and brown areas of pigment on the arms, chest and face with our new intense pulsed light technology with radio frequency. The real stunner in this technology though has been the Matrix RF. We have not only seen immediate tightening after the procedure on the face, neck and chest but also continuing improvement as collagen stimulation and remodeling continues to occur for months after treatment. My "always eager to try the next big thing" nurse Lisa has significantly noticed a tightening of her neck and crows feet lines. Being that she has the most sensitive skin of almost any of my patients, she was thrilled that she was able to cover any redness with mineral makeup the day after her Matrix RF. In following months, she will chronicle her experience with both technologies.
All the best,
Terry Hand, M.D.
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| Featured Procedure: Forehead Lift |
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Forehead lift, commonly referred to as brow lift, is a procedure designed to restore a more youthful, refreshed appearance to the forehead and brows. With aging, often the brows will begin to droop and horizontal lines and furrows between the eyebrows will begin to develop. Most patients seeking forehead lift report that friends ask them if they are angry, sad or tired. Good candidates for forehead lift are seeking improvement in softening the lines in the forehead and the frown lines above and between the eyes. "Drooping" eyebrows that cause minor hooding of the upper eyelids and laxity in the corners of the eyes will also be improved. Often, an upper lid blepharoplasty or "eyelid lift" will be performed at the same time to address eyelid puffiness and redundant skin.
Procedure Description
Dr. Hand performs forehead lift in our accredited Marin County outpatient surgical facility under general anesthesia. Several variations of the procedure are available dependent on the degree of correction required, the age of the patient and the anatomy of the forehead and upper eyelids.
The classic forehead lift, often referred to as the coronal lift, is a procedure where the incision line runs from the top of the ear, across the top of the forehead to the other ear. The incision is made well behind the hairline so that the scar is not visible. On a patient with a high forehead, the incision is placed at the hairline. This incision avoids the look of a hairline that starts too far back. Hair usually grows into the scar site and incision lines gradually fade. A concealing hairstyle may be advised for a few months after surgery. During the surgical procedure, the brow is carefully lifted and repositioned so that extra skin can be trimmed and redraped. The muscles of the forehead between the eyebrows can be modified to smooth the forehead, raise the eyebrows and minimize frown lines. The eyebrows are elevated to the natural position at the supraorbital rim. This procedure generally offers the best correction for most candidates.
The endoscopic forehead lift is usually reserved for the younger patient with minimal sag and furrows. The procedure is performed using an endoscope, a lighted viewing instrument attached to a video camera makes visualization of internal structures of the forehead possible. Several small incisions are placed in the hairline. In most instances, no skin is removed. The eyebrow is elevated and held in place with fixation to the underlying bone.
Recuperation and Healing
A dressing will be applied to the forehead that will be removed by Dr. Hand after the 1st or 2nd day at the office. After the removal, it is OK to gently wash the hair taking care not to disturb the wound, letting the hair air dry. The stitches and clips will be removed at or before 10 days following surgery. Initial discomfort is easily controlled by oral pain medication. Smoking must be avoided for at least 2 weeks prior to surgery and afterwards. Regular exercise may be resumed at 10-14 days after the procedure. Most swelling and bruising is gone within 7 to 10 days.
Other Options
Additional procedures that may enhance the result include upper and/or lower eyelid lift or facelift. Dr. Hand will carefully evaluate the brow position and the aging changes of the eyelids when making a recommendation regarding browlift. See more photos of forehead lift |
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GOT MIGRAINES?
New Study Proves Forehead Lifts Can Erase Years and Headaches! |
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ARLINGTON HEIGHTS, Ill. - Migraine headaches are a drain - not only on the estimated 30 million Americans who suffer from them, but on the economy, too. Because pain and other symptoms caused by migraine headaches can be quite severe, it is projected that nearly $13 billion is spent every year in headache treatment and loss of time from work, which no one can afford these days. But according to a new study in Plastic and Reconstructive SurgeryŽ, the official medical journal of the American Society of Plastic Surgeons (ASPS), there is hope for severe and frequent migraine sufferers who can't find relief in conventional remedies.
"Nearly one out of four households, including 18 percent of women, suffer from migraines and many patients are not only eager, but desperate to stop the pain," said ASPS Member Surgeon and study author Bahman Guyuron, MD, professor and chairman, department of plastic surgery, University Hospitals Case Medical Center. "In this study, we've shown that surgical treatment of migraine headaches is safe, effective, and that this reasonably short operation can have a colossal impact on the patients' quality of life - all while eliminating signs of aging for some patients, too."
For nearly a decade, researchers have been testing the concept that migraines are caused when a person's trigeminal nerve branches are irritated. When the muscles around these branches are incapacitated, the headaches stop, which is why some patients have found relief from the 'freezing' effect of Botox treatments. However, according to this study, removal of these muscles or 'triggers,' offers an easily attainable and permanent fix.
In this double-blind, placebo controlled clinical trial, researchers (including a plastic surgeon and two neurologists) from Case Western Reserve University and University Hospitals Case Medical Center in Cleveland, identified the three most common trigger sites and then randomly assigned 75 patients to either the actual (49 patients) or sham-surgery groups (26 patients). Patients then completed questionnaires and underwent either a real or perceived deactivation operation on their predominant migraine trigger site, which for most patients, was similar to that of a traditional forehead lift.
One year later, 57 percent of the patients in the actual surgery group reported complete elimination of migraine headaches, compared with only 4 percent in the sham surgery group. Furthermore, 83 percent of the actual surgery group observed at least a 50 percent reduction in migraines. And while there was a high (57 percent) incidence of symptom improvement in the sham surgery group, which has been similarly reported in other studies and could be attributed to the placebo effect, among other things - researchers point out that the difference in migraine improvement and elimination reported by the two groups was statistically significant.
"Though one might not think to look to plastic surgeons to treat migraines, we are commonly involved in peripheral nerve surgery and treat nerve- related pain, so this is a meaningful addition to the field of reconstructive plastic surgery," said Dr. Guyuron. "And I can say that these procedures are the most rewarding for me, because these are the patients that come back and report that their lives have been changed."
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| Turf War: "Cosmetic Surgeons" Vs. "Real Plastic Surgeons
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This response to a recent article in the Chattanooga Times Free Press was posted in my PSP journal this month. It is one of the best descriptions of plastic surgery training that I have seen. I would like to credit Dr. Mark Brzezienski for this very clear and appropriate description of the qualifications and challenges involved in becoming a "real" plastic surgeon.
The Chattanooga Times Free Press featured a front-page article about cosmetic surgery in Chattanooga. The "Turf War" is not, as Dr. Carey Nease points out, about business or finances. It is about providing the highest quality of care for the people of our region. As the article notes, we have had "cosmetic surgeons" in Chattanooga before Dr. Nease began practice in Calhoun.
When I was interviewed by Emily Bregel for her proposed article, I wanted to be certain that Truth (that is truth with a capital "T") in medical advertising was part of the thrust of her piece. I think that she did a fine job. As an academic plastic surgeon, I am intimately involved with the education of plastic surgeons at the UT College of Medicine Erlanger Campus.
The training of "real" plastic surgeons is as rigorous as surgical residency gets. The public should understand the oversight that is involved in the making of a real plastic surgeon. After three to five years in an accredited surgical residency program (see ACGME's website), the qualifications of these talented young people are scrutinized before they can begin their two to three year long plastic surgery training. We typically interview about 30 surgeons for two slots.
All plastic surgery residencies are continually reviewed by the Residency Review Committee (RRC) of the ACGME to be certain that training in all disciplines of our field is standardized across the United States. Upon completion of an approved residency, a surgeon can take his boards in plastic surgery. The American Board of Plastic Surgery (see the ABPS website) is the only Board recognized by the American Board of Medical Specialties (see ABMS website). A written and then oral examination are performed by the board officers. If the candidate passes, then they are certified by the ABPS. Incidentally, ABPS certification testing must be repeated every ten years. This is to insure that real plastic surgeons stay up to date on current treatment. To quote the ABMS website, "Certification is not a hurdle; it is a commitment and an opportunity."
All of these organizations, (the ABMS, the ABPS, the ACGME, the RRC) were established to standardize education and provide the best patient care possible for the people of the United States. The American Board of Cosmetic Surgery is not recognized by any of these regulating bodies. The fellowship training of "cosmetic surgeons" has no recognized institutional oversight. It is of a mentorship style. The type that was abandoned by plastic surgery training programs years ago for its haphazard nature. There is no university in the United States that has a Division or Department of Cosmetic Surgery. Real plastic surgeons dominate the scientific literature. The levels of training between plastic surgery and cosmetic surgery are simply not worthy of comparison. It is utter hubris to argue the opposite. To illustrate the point, I believe I recall former Defense Secretary Rumsfeld's comment on a battlefield situation's potential danger. He said that the most concerning element was that "You don't know what you don't know." I think that applies well here, too.
An aesthetic breast surgery consultation, for example, should include a thorough review of breast cancer potential, family and personal history, examination, and appropriate breast imaging. What experience does an ear, nose, and throat surgeon have in managing diseases of the breast? Are they confident that they can identify a potential problem? Aesthetic /Cosmetic surgery requires a mastery of patient care that goes beyond the technical ability to correct physical flaws.
Ear, nose, and throat residency training and subsequent board certification permits one to refer to themselves as a "facial plastic surgeon." Marvelously orchestrated websites and advertising spin does not change reality. Does a year of cosmetic surgery fellowship equate to the training of a Plastic Surgeon? That is a decision that our community will need to make. However, they should make it with facts in hand.
Mark A. Brzezienski, MD, MS, FACS
Diplomate, ABPS - (ASPS, ASAPS, AAHS)
Asst. Professor Plastic Surgery
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| Thank you for taking your valuable time to once again read our newsletter. As always, our office would like to extend the offer of a no cost consultation for our loyal clients that subscribe to this newsletter. Please do not
hesitate to let Cheri or Lisa know if you have further questions about
any of our procedures or financing.
Sincerely,
Terry L. Hand, M.D. |
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