Plastic Surgery Newsletter
  April 2010

.drhandlabcoat1
Terry L. Hand, M.D.
 
In This Issue
Botox Donation To SaveABunny
Ask The Doctor
Interesting Procedures: DermarRoller vs. Matrix RF
Lisa's Dermal Filler Experiment
CareCredit 6 Months Free Financing Plan
Featured Procedure: Breast Lift
Latisse LashPerks Program
You Are What You Eat!
Brilliant Distinctions Program Information
Quick Links
Join Our List
Join Our Mailing List
 
Forward this issue to a Friend 

2009 image 
"Miss Mercedes La Rue"
A natural beauty!

Do I Need Botox???

$10.00 from each Botox treatment  done in April will be donated to SaveABunny.

April is the month where cute bunny photos are everywhere and thousands are rabbits are purchased and surrendered to shelters after the holiday. This beautiful bunny girl is of one many rabbits that have been adopted to a great home with the help of the non-profit animal shelter, SaveABunny, that I support and adopt from.
  Remember,  Brilliant Distinction reward points will also be given for each treatment. 

Link to  SaveABunny website

Ask The Doctor

 I have noticed that fewer people seem to have large lips now.  What are the current trends in dermal fillers?

In my practice, I am still seeing a large amount of patients for dermal fillers.  Hyaluronic acid products such as Prevelle Silk that contain local anesthesia have made injection much more comfortable for most patients.  Although permanent and semipermanent fillers are available, I am seeing most patients gravitate to the hyaluronic acid fillers because of the comfort level and price point.

  There seems to be a trend towards a less puffy upper lip and a return to a shapely upper lip with a larger amount of fullness in the lower lip.  One method that I use very often to shape the upper lip is to outline the lip edge with filler and add a small amount to the bow of the lip.  This technique does not result in an appreciably  puffy lip, it decreases the wrinkles along the border and redefines the mouth shape.  When most people look at what is considered to be an aesthetically pleasing mouth, the bottom lip has more general fullness and is slightly "pouty".

Another area that I correct often is the downturned corners of the mouth, referred to as "marionette lines".  A small amount of dermal  filler makes a huge difference in the frown lines.  Botox may also be injected directly into the muscle that produces the frown to minimize downturn of the lip.

As always, the most common issue my patients have continued to use dermal fillers for is to minimize the nasolabial lines
(the lines between the nose and the corner of the upper lip).

I am not a big fan of correcting lost facial volume in the cheeks and jowls with filler.  I believe that surgical correction that redefines that youthful facial bone structure  most often provides the best result rather than creating a puffy mid and lower face.


InterestingProcedure:  DermaRoller
dermaroller

The concept of this at home procedure is interesting.  Although this device looks like an instrument of torture, it is actually a microneedling device.  The premise of the alleged benefits of wrinkle reduction is that from rolling this over your skin and causing trauma daily, collagen synthesis will be increased and the skin wrinkling will improve. There may be a small amount of benefit that can be achieved by this procedure but probably is negligible.

I am not convinced that this device has any sginificant benefit other than antedotal stories manufactured by the internet marketing firms.  Also, any instrument that involves even microscopic puncturing of the skin without being a disposable, single use product runs the risk of being a carrier of infectious bacteria or illnesses that may be communicated by skin disruption.   The risk of overzealous "rolling" of the skin may cause at the very least rashes and potentially broken capillaries from skin trauma.

My vote for this procedure:

thumbs down

An extension of the logic of this procedure that is much more beneficial is the Matrix RF radiofrequency device that we are currently using at our office.  With this device fingers of radiofrequency current are pulsed into the skin at several different layers, heating the dermis and increasing true dermal collagen genesis.  The recovery is minimal but the benefit to the general tightening of  the skin and refinement of fine wrinkling is very noticable.

 My vote for this procedure, thumbs up!

thumbs up

prevellesilkand syringe
Lisa's Dermal Filler Experiment

Since I am the eternal gunea pig, willing to try all the new procedures, a few weeks ago I volunteered to try a hyaluronic acid filler with local anesthesia on 1 side of my nasolabial creases and to outline my upper lip and one without the local anesthesia on my other side.

I have always thought that a dental block worked adequately to control discomfort but have never thought that my upper lip was numb enough. I found that the side done with the local anesthesia added to the product was minimally uncomfortable, certainly acceptable.  The side without the local was still tough for me.  Post procedure, the numbing agent wore off quickly and I felt less soreness on the side with the product with local anesthesia added.  My swelling was minimal and I looked fine the following day with all swelling gone by 3 days afterward.

Prevelle Silk will continue at our office to be offered at $500.00 for the 1st syringe and $450.00 for additional syringes.  As always, you should try to avoid aspirin, antiinflammatory type drugs and fish oils for 10 days prior to injection to avoid bruising.
 
6 Months Free Financing!
Carecredit#1
2010 has brought new government rules regarding financing.  CareCredit has refined it's programs and has a new option that will benefit most of our patients.  In the past, our office offered a 3 month same as cash option for payment.  Carecredit has revised the program so that the repayment period is now extended to a 6 months, same as cash! There is no longer a minimum charge amount to qualify for this offer.
 
Credit lines up to $25,000 are available with instant qualification and credit availability. A secure CareCredit application may be found on the financing page link below.

Please let Cheri or Lisa know if you need any further clarification regarding the current financing options with CareCredit.

As always, our office continues to accept Visa, Mastercard and personal checks as well. 
 

 THANK YOU!

Once again, thank you for reading our newsletter!  As always, subscribers to this letter are free to come into the office for a no charge consultation regarding surgical or cosmetic procedures.  Please give Lisa or Cheri a call for any questions or if you would like to meet with Dr. Hand.  We will look forward to hearing from you!

 
I predict the rain is gone!  OK, I'm not sure about that but I do know that this is the month that Marin County wakes up and enjoys the natural beauty of our community.  Along with enjoying the spectacular outdoors, many patients begin to think about body procedures to be completed before the summer months.

As many of you know, my wife and I actively volunteer and support a nonprofit animal rescue here in Marin, SaveABunny.  April is always a huge month for rabbit purchases and conversely abandonment to shelters because of the Easter holiday.  I will be donating $10.00 from every Botox injection to support medical and spay/neuter costs for this organization. The Brilliant Distinctions Consumer Loyalty program is up and running now.   You will also be eligible for registration points ($25.00) and treatment points ($25.00).  I have added more details about the program later on in this letter.  Give Cheri a call if you haven't registered yet.  It costs nothing and rewards you for simply registering and for each treatment of Botox you have afterwards.
 
This month our featured procedure is breast lift.  As a member of the American Society of Plastic Surgery, I am able to access  procedure animations that explain many surgeries quite well.  I am including a link to a tutorial that details most of the methods of breast lift from the minor to the major techniques. 

Lisa gave dermal fillers with and without the local anesthesia added to the product a try this month, at the same time! Her grand experiment illustrated that the new generation of dermal fillers with local anesthesia added are much more comfortable.  She discusses her experience in  this month's issue. 
 
Later in the newsletter is an article synopsis that addresses nutrition for good skin health  and triggers for common skin conditions.  One of the commonalities I have noticed in my years of practice has been that women that are constantly calorie deficiting often have thin skin.  When queried about their nutritional habits, I have found that often  an adequate ingestion of protein is neglected.  Adequate protein is necessary for skin healing and optimal aging.

All the best,

Terry Hand, M.D.
Featured Procedure: Breast Lift (Mastopexy)
 

2009 imageMastopexy, commonly referred to as a breast lift, is a plastic surgery procedure designed to lift and reshape sagging breasts. A woman's breasts will naturally become less firm and sag slightly with aging and gravity. The addition of pregnancy, breast feeding or changes in body weight further undermines the skin's elasticity and will contribute to drooping of the breasts and stretching of the size of the areola. Breast lift is designed to restore breasts to their natural, youthful state while maintaining their current size. The breasts will be lifted higher on the chest wall and the nipple will be restored to its correct position.

The addition of breast augmentation may accompany mastopexy for the woman that would like increased breast volume. During consultation, Dr. Hand will clearly describe the anticipated size and shape of the breast that should result from the breast lift. The addition of breast implants needs to be carefully planned to include the patient's wish for increased size. She should also understand that the base diameter of the implant needs to be appropriate for the size of the chest wall in order to create the most natural appearance.

Procedure Description

Dr. Hand performs the breast lift procedure in our accredited Marin County outpatient surgical faculty. The mastopexy procedure is always performed utilizing general anesthesia.

Mastopexy is performed with several variations on technique depending on the amount of sag and stretching of the areola. The most common procedure addresses the entire breast and involves an incision that runs completely around the nipple and as an inverted T, with an incision from the nipple to the crease of the breast and underneath the breast. This approach is always used on the woman that has a nipple pointed significantly downward with a loose skin capsule. The reason for this approach is that Dr. Hand can restore the areola to a youthful, pre-pregnancy size and extra skin volume can be resected horizontally and vertically creating an optimal contour. The result will be firmer, more youthful breasts.

Another procedure for the patient that has less breast sag is the "lollipop" or "vertical" pattern. This procedure that does not involve the incision under the breast is best for breasts with only a small amount of sag.

Recuperation and Healing

Immediately after the surgery, Dr. Hand will wrap the breasts in a compressive dressing that is to remain undisturbed until the 1st post-operative appointment the following day. The breasts will be rewrapped for another 2 to 5 days for compression. The patient should wear a non-underwire supportive bra for another 4 to 6 weeks most of the day and at night to lend further support to the breasts. The breasts will appear bruised and swollen for the 1st week following surgery. They will continue to "round out" over the next several weeks. Postoperative pain is easily controlled with oral pain medications. The incision sites should gradually fade over 3-12 months.

Other Options

Mastopexy may be combined with other body or facial rejuvenation procedures simultaneously. Dr. Hand can address any other areas of requested improvement at the time of consultation.

See my breast lift photo gallery

The link below may be muted in the right hand corner. 
See procedure animation for breast lift

Latisse LashPerks Program
another eyelash photo 
Want the inside scoop on tips, news and special offers?  Sign up now and you'll get a $20.00 mail-in rebate on your Latisse purchase.  Plus, once you redeem your rebate, Latisse will send you a stylish bag as a special gift! You may also use your Brilliant Distinction Points for your Latisse purchase. Don't forget to continue to use your Latisse every 2 to 3 days after the initial 4 month treatment program to maintain your wonderful results. If you haven't tried Latisse yet or are running low, give us a call!

Sign up for LashPerks
See patients testimonials for Latisse
You Are What You Eat!
apple
This synopsis of an article from Science Daily illustrates the importance of good nutrition for skin health and aging.  It also speaks to different types of skin conditions and the foods that help or aggravate them. The old adage "you are what you eat" not only applies to our overall health and nutrition, but how our skin looks and feels as well.

As the largest organ in the body, our skin can benefit from the same nutrition we get from foods that have a positive effect on our heart and other major organs. In fact, new research suggests that eating foods rich in protein and certain vitamins and minerals might provide valuable anti-aging effects.

Good Food, Good Skin

Perhaps the simplest way to maintain a healthy, balanced diet and ensure the skin is getting optimal nutrition from the foods we eat is to follow the recommendations of the U.S. Department of Agriculture's (USDA) Daily Food Guide, commonly referred to as the food pyramid.

These include:
Choosing and eating at least three ounces of whole grain breads, cereals, rice, crackers or pasta.
Eating a wide variety of fruits and vegetables, including more dark green and orange vegetables.
Consuming calcium-rich foods, such as fat-free or low-fat milk and other dairy products.
Opting for a variety of low-fat or lean meats, poultry and fish.


The foods recommended by the USDA as part of a healthy diet contain valuable vitamins and minerals that have proven health benefits for our bodies. Research has shown that the antioxidants in vitamins C and E can protect the skin from sun damage and help reduce damage in skin cells caused by harmful free radicals, which contribute to aging skin. Similarly, we have long known that the B vitamin biotin is responsible for forming the basis of skin, hair and nail cells, and vitamin A, found in many fruits and vegetables, maintains and repairs skin tissue. Without an adequate supply of these vitamins, you may notice it in the appearance of your skin, hair and nails.

While the direct link between food consumption and skin damage has not been widely studied, one study comparing the correlation between food and nutrient intake with skin wrinkling found a positive relationship. The study, "Skin Wrinkling: Can Food Make a Difference?", published in the February 2001 issue of the Journal of the American College of Nutrition, determined that Swedish subjects aged 70 and older had the least skin wrinkling in a sun-exposed site among the four ethnic groups studied. This cross-sectional study, which analyzed the pooled data using the major food groups, suggests "that subjects with a higher intake of vegetables, olive oil, and monounsaturated fat and legumes, but a lower intake of milk/dairy products, butter, margarine and sugar products had less skin wrinkling in a sun-exposed site."

Foods That Can Worsen Skin Conditions

For the millions of Americans affected by medical skin conditions such as acne, rosacea, eczema or psoriasis, eating certain foods or consuming alcohol could aggravate their symptoms or trigger an unexpected flare-up.

Contrary to popular belief, acne is not caused by the foods we eat. Although numerous studies have not found a link between diet and acne, emerging research now suggests there may be a link between a low glycemic diet and an improvement in acne. The study, "Low Glycemic Load Diet May Improve Acne in Young Men," published in the July 2007 issue of the American Journal of Clinical Nutrition examined whether male acne patients aged 15 to 25 who followed a low glycemic diet (25 percent of energy from protein and 45 percent from low lycemic-index carbohydrates) had a reduction in acne lesions vs. a control group that consumed a diet rich in carbohydrates.

The study found that at 12 weeks, acne lesions had decreased more in the young men in the low glycemic group than their counterparts in the control group whose diet had no consideration for the glycemic index. This suggests that there could be a relationship between limiting carbohydrate-rich foods in acne patients' diets and an improvement in their acne, but more studies need to be done to confirm this finding before we consider any future dietary modifications for our patients.

On the other hand, some acne patients have noticed that certain foods worsen their symptoms - particularly chocolate, greasy foods, soft drinks, peanuts or foods high in fat.

Patients who notice a cause/effect relationship between eating certain foods and acne flare-ups should avoid those foods. However, following a strict diet will not clear acne either. The best advice is to eat a well-balanced diet and follow the treatment plan recommended by your skin care specialist.

Rosacea, characterized by facial redness and swelling, commonly can be triggered by spicy foods or alcohol. In fact, a survey conducted by the National Rosacea Society found that the most common rosacea triggers are alcohol (52 percent), spicy foods (45 percent) and heated beverages (36 percent).

Patients with rosacea should keep a journal to track their food and beverage triggers, so they can record how the experience made them feel and remind themselves to avoid these items in the future. They also should read the labels at the grocery store and proceed with caution when it comes to spices, such as cayenne, red, black and white pepper, curry, chili powder, and even salsa.  In addition, foods such as liver, vinegar, soy sauce, dairy products, certain fruits and vegetables, hot chocolate, cider, tea and coffee have been known to cause flare-ups in some rosacea patients.

Another chronic skin condition that can be aggravated by food is eczema, which is commonly characterized by dry, red and itchy patches on the skin. Foods that have been known to worsen eczema symptoms include eggs, milk, peanuts, soy, wheat and fish, while some patients even report that chocolate, coffee, alcohol, tomatoes and sugar can trigger a flare-up. Juices from meats and fruits can irritate already-sensitive skin when they come in contact with the skin. Eczema patients also should keep a trigger journal as a reference for what foods or drinks may have caused a flare-up.

Research has shown that psoriasis, a serious medical condition affecting the immune system and characterized by patches of raised, reddish skin covered by silvery-white scales, can be triggered by heavy drinking and that alcohol consumption may even inhibit the effectiveness of psoriasis treatment. Psoriasis patients who drink should be cautioned  to do so in moderation and to avoid alcohol if they suspect it is worsening their symptoms. While certain foods also can trigger psoriasis, patients should avoid any radical diets that claim to 'cure' psoriasis. There is not a cure for psoriasis and extreme changes in diet actually can worsen symptoms.
 
BRILLIANT DISTINCTIONS PROGRAM INFORMATION
brilliant distinctions

Our office has  received our  sign up kits.  Please call or send an email at this link to our office. Cheri can give you individual activation code that may be used on the activation site below.  You will instantly be credited with a $25.00 sign-up bonus.  You may begin to use your Botox loyalty program any time after that and choose to redeem points right away or later if you like.

* Sign up now for 200 bonus points (Value $25.00)

* Get your activation code from our office with a simple phone call, then sign up online at www.BotoxCosmetic.com/activate

* Accumulate points with your Botox treatments

* Redeem points to create a coupon and use that coupon for any Allergan treatment or product in our office

* Your first 200 points will be instantly redeemable for a $25 coupon on your next Botox visit to our office.

Brilliant Distinctions Loyalty Program

Brilliant Distinctions is a Consumer Loyalty Program offered by Allergan, the makers of Botox, Juvederm and Latisse. Points are earned for each Botox treatment. These points can then be used to create a coupon that you can apply not only toward your future Botox treatments but also toward Juvederm treatments or to purchase Latisse.Currently the program only allows you to earn points from your Botox treatments. Point accumulation for Juvederm will begin in the early summer. 

Treatment 1 and 2

200 points

Treatment 3, 4,and 5

250 points

Treatment  6,7, and 8

300 points

Treatment 9, 10 and 11

350 points

Treatment 12 and up

400 points

As you continue to receive Botox treatments, you will see a larger savings. Point awards increase as your treatment numbers add up. See Point Redemption Values below. 

200 Points

$ 25.00 coupon

300 points

$ 35.00 coupon

400 points

$ 50.00 coupon

500 points

$ 65.00 coupon

575 points

$ 75.00 coupon

725 points

$100.00 coupon

850 points

$125.00 coupon

950 points

$150.00 coupon

1100 points

$195.00 coupon

1450 points

$320.00 coupon

 Once you have your account created, you will start receiving rewards immediately.

How Do I Get Coupons To Use For My Treatments?

Just prior to coming to the office for a treatment, log onto your account in the Brilliant Distinctions Website and choose "Redeem Points". Brilliant Distinctions Log In Link  The screen will show you how many points you have available to you.  Make your selection as to how many points you would like to use and Click "Create Coupon".  Print this coupon and bring to your treatment.  This amount will then be taken off your treatment charge.

What Happens If I Forget to Print a Coupon?

Since this is not a program created and maintained by our office, we can not honor any discounts offered by the Brilliant Distinctions Program unless a printed coupon is presented at the time of treatment.  We do not have the power to make exceptions since it is not our program.

Do I have to do anything after the treatment?

Yes, Once you have received your treatment our staff will let the program know that you have received a treatment.  The Brilliant Distinctions Program will then email you a voucher with the points earned by having this treatment.  Please note that there is an expiration date on the voucher.  We suggest that you immediately upon receiving the voucher in the email, log onto the website and "bank" the points so that they will be available to you for your treatments.    If the voucher is not redeemed prior to the expiration date, these points will be lost and there is nothing our office can do to get them back for you since this is not our program.

Do the Points Expire?

Yes.  It is important to realize that the points have not been added to your profile until after you redeem the voucher issued from your treatment.  The expiration date of the voucher will be printed on the voucher you receive in the email.  Once the points are "banked" the program states that these points will remain active in your profile as long as you have either deposited or redeemed points within 2 years.  Our office can not make allowances for expired vouchers or points since The Brilliant Distinctions Program is an Allergan Corporation Program.