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Terry L. Hand, M.D.
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| Prevelle Silk is Here!
The above photos are of patients that had correction of the nasolabial lines between the nose and the corners of the mouth.
JANUARY SPECIAL
Save $75 per syringe, instant rebate!
Net cost at the time of your appointment is $500.00 per syringe.
Offer expires 1/31/10
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Ask The Doctor
We talked about facial lasers awhile ago. I am confused about which one I need because I have freckles (lots of freckles!) but would like skin tightening too. Would one session fix both problems? S.C.
The 2 procedures that we discussed were Matrix RF and SRA with intense pulsed light. Both procedures address different aspects of skin concerns and thankfully they can be combined in a customized course of treatment for individual patients.
When I see a patient that has minimal to moderate face or neck laxity with very little sun damage, I find the Matrix RF to be the best procedure. Usually 2-3 treatments are necessary with gradual improvement after each procedure. If minor skin discoloration is also an issue, I will incorporate 2 to 3 SRA with IPL treatments as well to the treatment regime.
A patient that has mostly sun damage with freckling and redness will usually respond well to SRA with IPL, possibly adding in a treatment or 2 of Matrix RF at some point.
There is almost no downtime with the Matrix RF as far as altered appearance. Most patients will see a great deal of redness the first day after treatment followed by minimal redness that can be easily covered in following days.
The SRA treatment creates redness the first day of treatment. Areas of redness and freckling will progressively darken over the next week and flake off. With each consecutive treatment, the areas of darkening become progressively lessened after each treatment.
The beauty of both of these procedures is that the downtime is minimal and the results are subtle and amazing. They can be done on an individual basis or package pricing is available depending on my recommendations.
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| New And Fun Procedure: Earlobe Rejuvenation!
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Yet another great use for hyaluronic acid fillers! One of the many facial problems that occur with aging is the thinning and wrinkling of earlobes. Years of wearing heavy earrings take their toll on the earlobe as well as the natural aging process. With this procedure, the earlobe is plumped for an immediate youthful result and may be done for pierced or nonpierced ears.
Another procedure that may be done prior to plumping the earlobes is a repair of piercing holes that have elongated or split. After 6 weeks the earlobe can be repierced and/or injected with the hyaluronic acid product (Restylane, Juvaderm or Prevelle Silk).
Please take a moment to review the video below that was aired on "The Doctors"
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| Latisse Timeline
If you haven't tried Latisse yet, what are you waiting for?? Most of my patients that have finished the initial 4 month period of daily use, are now applying Latisse only 2 to 3 times a week and maintaining their results.
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| Patient Financing Plans |
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Recently our practice has had inquiries about what financing plans are available for the beginning of 2010, at what rates and what is it going to cost per month?
Care credit is a well established financing agency establishes a line of credit that is accepted by most plastic surgeons, dentists and veterinarians. Different offices participate with various plans offered by this lender. Our office offers 3 month, same as cash financing for all procedures over $300.00.
Because of our relationship with Allergan, the manufacturer of Naturelle implants, there are a variety of plans from 36 to 48 months that offer an extended payment program at 13.9% interest for breast augmentation procedures.
Credit lines from $300 to $25,000 are available with instant qualification and credit availability.
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Send A Question Or Procedure That You Would Like To Hear More About!
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Click the link below to send a question you have been wondering about and would like to see discussed in this letter. If I haven't heard of it, I will get the scoop and report back.
Dr. Hand, comment on this please! |
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Happy New Year!
Happily, the "cosmetic surgery tax" was removed from the copy of the health care bill signed on Christmas Eve. As I stated before, I was greatly opposed to this "sin tax". Thank you for your positive responses to several of the websites dedicated to letting our representatives know your thoughts about this tax. The plastic surgery societies were blindsided when it appeared on the medical reform bill since they had been told it would not. Even though it is gone for now, it may reoccur as the lawmakers grasp for ways to pay for this massive healthcare overhaul.
I love the chance to predict the "future" in plastic surgery every year. I believe that techniques will continue to improve for many procedures, particularly body lifting. New ideas and products will continue to abound in the coming year. There will be a resurgence of many old techniques, relabeled as new and a proliferation of new clinic type plastic surgery facilities making big promises. All will not actually be what is promised. Take it from this wizard, do your homework and check out the actual results of the surgeon you employ.
A new product that I am adding to my practice for the New Year would be Prevelle Silk. Why do I like it? It is a product manufactured by Mentor, the chief rival of Allergan. It is a clear hyaluronic acid with similar properties to Restylane except for it also includes lidocaine. Immediate injection discomfort is minimized and there is a residual numbness that calms any discomfort. Also, the post injection swelling seems to be minimized in many patients.
Our featured procedure is eyelid lift this month. In evaluating all of the different cosmetic procedures that I perform, I still believe that rejuvenating tired eyes is the single procedure that makes the most dramatic difference in facial appearance.
This month I am adding a "New and Fun" procedure category. Sometimes as I have done this month, the procedure will be a wonderful new addition and sometimes it will just be a procedure that is in the news. I will brand the procedure with a "thumbs up" or a "thumbs down" recommendation. This month I have added a short note on earlobe rejuvenation . I have also included a very good video that was previously aired on "The Doctors" where hyaluronic acid fillers were used to rejuvenate earlobes!
Latisse continues to be the "fun" product of my practice. One of my patients commented that "the gig is up", now women ask her if she uses Latisse because her eyelashes are so unbelievably long. Her husband still thankfully believes that she was just born with good genes!
Our featured article relates to a subject my female patients have complained about for years, women seem to wrinkle easier than men. Finally, a group of doctors from the Netherlands did a study of perioral wrinkles (the wrinkles around the mouth) and the difference between the genders. This study reports on why the wrinkles are accelerated in women. The full synopsis of this study is reviewed later in this newsletter.
All the best,
Terry Hand, M.D.
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| What Do I Predict The Trends Will Be For 2010? |
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More dermal fillers and wrinkle relaxers will be developed
In the past year, I have seen many come and some go. Some are trying to tread water to stay alive but the competition has become fierce. Last year, Elevess became the first product to market hyaluronic acid with Lidocaine. It's parent company also marketed Artefill (a permanent filler). When the company declared bankruptcy, both products were bought by other companies and repackaged. Now Mentor, the main competitor of Allergan, is marketing it's own version of a very similar hyaluronic acid filler called Prevelle Silk. I predict the competition will mandate price advantages for consumers via rebates and specials. Most physicians will probably pick the top 3 fillers that they prefer and offer them to their patients. I will continue to use Botox at this time since I have had great success with excellent cosmetic results.
More doctors will relabel old procedures as the newest miracle surgery
Over the past year, I cannot remember how many stories have been told to me by patients about a new procedure they saw on TV that only one doctor is the best at. My response to that is to acknowledge that reputable plastic surgeons study and report on their techniques. The majority of board certified doctors read incessantly and attend our professional meeting where these techniques are presented. Some of the "new" ones that I hear about are actually old techniques repackaged. They weren't the strongest procedure years ago and still aren't. My recommendation is buyer beware if a doctor tells you that only he has the technical knowledge to obtain a great result. I do believe that long term experience in performing a procedure is the greatest indicator of a successful surgical outcome.
Advertising will become slicker blurring reality
I have been in practice for many years and can honestly say that most of my patients are referrals from other patients. I understand the need to have a website that is a source of information and the advantage to publishing a newsletter like the one that you are reading to remind my patients of current events. However, I am alarmed by much of the marketing that is happening in this industry. Slick TV advertisements are seen by many. Fluffy newspaper ads labeling certain doctors as "the best in Marin" are a daily event. Some patients do minimal investigation and are bulldozed into signing up for procedures without even seeing the actual results of the surgeon doing the surgery. I can truthfully say that I have never seen a good "Lifestyle Lift". A thoroughly trained cosmetic surgeon would never simply do a straight slash in front of the ear or create "Pixie ears". Remember, an ad is just an ad. Being your own advocate and investigating all of the questions you need answered will be of great benefit.
The economy will improve and patients will reconsider surgical procedures
This past year, many patients have slowed the aging process with fillers, Botox, skin resurfacing and fun products such as "Latisse". All of these procedures have stayed strong over the past year but there will be many people that will reconsider a surgical procedure as a better solution in many cases. Sometimes when a surgical procedure is the best choice, the maintenance procedures should be considered as a means to further refine the results.
Body reconstruction procedures will continue to evolve
As a society, obesity has continued to advance and the medical community has responded with better bariatric procedures. The end result is more patients with excess skin and muscle that needs to be contoured. The plastic surgery community has been reporting on new techniques to address redundant skin of not only the lower abdomen but also the thighs, buttocks and upper back. The laser manufacturers are developing many techniques that are supposed to tighten relaxed body skin efficiently. Although I believe the face can be improved significantly with some of the new laser techniques, I have not seen any discernable difference with most of the body tightening versions.
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Featured Procedure: Eyelid Lift
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Blepharoplasty, commonly referred to as an eyelid lift, is a plastic surgery procedure designed to rejuvenate the aging eye and to create a more youthful appearance. The eyes truly are the feature that most people notice first as tired and sad or refreshed and animated. Candidates for this procedure have noticed excess skin on the upper and/or lower eyelids, often with areas of puffiness that never seem to go away. Normally, everyone has a small amount of fat surrounding the eyeball. If the quantity of fat increases or the local tissues stretch and weaken, the fat begins to bulge producing "bags". Occasionally, surgical correction is recommended when this bulging is seen in young patients because of a familial tendency.
The expectation of the surgical outcome for blepharoplasty should be of a more youthful and rested appearance of the eyes. Visual fields may be widened if excessive upper skin has blocked vision.
Procedure Description
Dr. Hand performs the eyelid lift procedure in our accredited Marin County outpatient surgical facility. Depending on the extent of the procedure, the eyelid lift will be performed under local anesthesia with sedation or general anesthesia.
Blepharoplasty is a procedure that removes sagging skin and muscle from the eyelids, and removes "bags" by trimming away excess fat bulges. In some cases, the upper or lower lids can be treated alone. If indicated, all four lids may be treated at the same time. Excess drooping of the eyebrows and of the corners of the eyelids may also require a forehead lift to achieve the best correction. During lower eyelid blepharoplasty, Dr. Hand also performs a mid-facelift to lift and reposition the fat of the cheek area and to minimize the nasolabial folds (the folds between the nose and mouth).
The incision on the upper eyelid is placed in the lid crease. The lower eyelid incision lies just along the lash line. Both incisions may extend for a short distance slightly beyond the edge of the eyelid, in a natural smile crease. The excess fat, muscle and skin are removed and/or repositioned. Excellent healing is characteristic of the eyelid skin, and once the wounds are mature they usually become quite inconspicuous. The repetitive motion wrinkle lines will be softened, not completely erased. Most procedures are completed in one to two hours.
Recuperation and Healing
Immediately after surgery and for the rest of the day, cold saline compresses will be applied to the eyelids along with bed rest and head elevation to achieve the best result. Normal swelling and bruising will occur. Discomfort is easily controlled with oral pain medication. The following day, Dr. Hand will clean and examine the eyelids. At 4 days following surgery, all sutures will be removed. Contact lens should not be worn for 1 week but eyeglasses and sunglasses may be worn the day following surgery. Swelling and bruising usually begin to diminish 48 hours after the procedure. Normal activity or work may be resumed in 3 to 4 days using dark glasses and cover-up makeup to camouflage any swelling or discoloration. The patient will usually be presentable without dark glasses in 7 to 10 days and may resume regular exercise in 10 days.
Other Options
Blepharoplasty is a procedure that is often performed alone but just as often combined with other complimentary procedures with the goal of achieving the best aesthetic outcome. During consultation, Dr. Hand will make recommendations for areas of treatment based on the appearance of the eyes exclusively and the surrounding areas that may benefit from surgical correction. Very often the best result is seen when a blepharoplasty is combined with a brow lift. The eye then has a refreshed appearance and the brows have returned to a natural, youthful position. Facelift is sometimes also done with the eyelid procedures or may be done at a later time. Often, dermal fillers are injected into the nasolabial lines at the completion of the blepharoplasty to further compliment the mid-facelift that occurs during the lower lid blepharoplasty.
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Study Shows Women Are More Prone to Facial Wrinkles Than Men
New York, NY (December 14, 2009) - Findings from a new study published in the November/December issue of Aesthetic Surgery Journal (ASJ) suggest that gender-specific differences in the perioral skin (skin surrounding the mouth) account for more and deeper skin wrinkling in women than in men. The study, conducted by a team of plastic surgeons from the Netherlands, was presented at the annual meeting of the European Association of Plastic Surgeons last May in Barcelona, Spain.
"The aim of this study is to obtain new insight into the perception that women wrinkle earlier and more severely than men," said the study's lead author, Emma C. Paes, M.D., from the Department of Plastic, Reconstructive and Hand Surgery at the University Medical Center in Utrecht, Netherlands. "If we understood the reasons for differences in wrinkling between women and men, then we might be able to develop better strategies for the treatment of perioral wrinkles."
Skin surface replicas of the upper lip region in 10 male and 10 female cadavers (age range 75-93) were used to define the amount and depth of perioral wrinkling. To provide additional data, 3 full-thickness lip resections were taken from each of 15 male and 15 female fresh cadavers and were investigated in a blinded fashion.
The study found that all of the following could be contributing factors to the presence of more and deeper perioral wrinkles in women:
- Women's perioral skin contains fewer sweat glands and sebaceous glands (microscopic glands in the skin that secrete an oily/waxy matter, called sebum, to lubricate skin and hair), which could influence the natural filling of the dermis (skin).
- Women's perioral skin contains fewer blood vessels and, therefore, is less vascularized compared to men, which could accelerate the development of wrinkles.
- In women, the closer attachment of the muscular fibers surrounding the orifice of the mouth to the dermis may cause an inward traction, thereby creating deeper wrinkles.
Current treatments for perioral wrinkles include the use of lasers, botulinum toxin injections, and injectable or implantable wrinkle fillers as well as older methods such as dermabrasion and chemical peels. Despite these many options, the effective treatment of wrinkles in the perioral region still remains a challenging problem.
"We think it's important to consider the reasons why a particular treatment may or may not be effective," said Dr. Paes. "Sometimes one has to go back to the basics instead of just moving forward. In the end, having more basic knowledge about a problem can speed up the process of finding the right solution." |
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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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