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. Terry L. Hand, M.D. |
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Less Pain, More Gain
In Dermal Fillers
Skin fillers with lidocaine are among the latest advancements in injectable options in the United States.
The incorporation of lidocaine has surely provided a much higher comfort level for patients.
In previous years, I was forced to inject a dental block prior to injecting fillers to provide for patient comfort. The current generation of fillers that I am currently using,
Juvéderm XC,
Restylane-L
and Prevelle Silk all include lidocaine (the same skin numbing agent I previously used independently.) What does this mean to the patient? When undergoing an injection that includes even a small percentage of lidocaine, the majority of patients say they barely feel the second stick. All of the above products perform
similarly to their lidocaine-free predecessors in terms of efficacy and safety.
FILLER STUDIES: In the 72-patient trial of Juvéderm XC, investigators actually blindfolded patients, all of whom were randomized to treatment in each nasolabial fold with either Juvéderm or Juvéderm XC. Patients assessed pain levels during treatment, then 30 minutes and 24 hours post-treatment. Altogether, 93 reported less pain with the lidocaine formulation versus the original formulation (Weinkle SH, Bank DE, Boyd CM, et al. J Cosmet Dermatol. 2009 Sep;8(3):205-210).
Investigators for Medicis', the makers of Restylane-L injected patients with either Restylane-L or Perlane-L in one cheek and its lidocaine-free counterpart in the other. Subjects evaluated injection-site pain for each side of the face using a straight-line visual analogue scale (VAS). This analysis revealed a within-patient difference of at least 10 mm (a distance that investigators defined as meaningful) in 71.7 percent of Restylane-L patients and 95 percent of Perlane-L patients
I am generallly finding that injection with one of the above products is relatively comfortable for most of my patients. For those that would still like the addition of a dental block, I will happily provide additional local anesthesia.
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Celebrate The Skin You Were Born With!
10% off individual Matrix SRA with RF treatments!
For all of you wannabe Irish lasses that desire a return to a more homogenous skin color that this little Irish rose was born with, this month we are offering a special on Matrix SRA treatments with radiofrequency.
To celebrate flawless Irish skin, we are offering 10% off of the individual price of our Matrix SRA skin treatments or 10% off our already discounted packages.
Matrix SRA with RF is the treatment of choice in refining pigment changes, spots and redness of the face, chest and arms.
This intense pulsed light based technology also has a radiofrequency component to further refine the skin.
Offer expires 3/31/2011
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Schedule your gratis consultation with Dr. Hand by simply sending us
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Ask The Doctor
I have a short list of procedures I would like to do on my face and breasts! My question is how many procedures can I do in one setting? B.G.
When I look at combining procedures, my first concern is surgical time. it is my preference to keep surgical time to 6 hours or under.
I often combine face and breast procedures but will always do the facial portion first. Without knowing the specific procedures you are considering, I can comment on some common combinations.
I often perform upper and lower blepharoplasty combined with breast augmentation and/or breast lift. Smaller procedures such as fat transplant, fillers and Botox can also be added in the time frame allowed. If a patient is considering face, eyes and eyebrows, I encourage the patient to recover from that combination first and then schedule additional body surgeries at a later date.
It is my personal belief that recovery from surgical procedures completed in the 6 hour time frame is easier on most patients.
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"For each petal on the shamrock this brings a wish your way. Good health, good luck, and happiness for today and every day." An Irish Blessing
Happy St. Patrick's Day Month! May a leprechaun wink at your beauty!
This month I have enclosed 2 interesting studies regarding facial aging. One article discusses a study one of my colleagues did on his own roster of patients. Although I found his data interesting, I was not able to discern the level of facelift he did on each patient. Since facelifts can be done in many different ways from minimal to very involved, recovery times and a return to normal daily activities can be varied.
The other study confirms that not only the facial muscular and skin structures change as we age, the bone structure may as well. I personally use facial implants in some patients but do not find that all patients need additional facial augmentation. This reiterated the fact that each patient is an individual, ages differently and requires a surgical plan that is individualized to specific needs. A competent plastic surgeon should never "sell" a one size fits all technique. The individual patient should mandate a specific surgical plan tailored to the individual facial aging issues.
Every year, the different cosmetic surgery societies attempt to predict trends for the coming year. This months newsletter contains the predictions for 2011. In my practice, I am seeing the demand for injectables such as Botox and skin fillers remain strong. I tend to use the hyaluronic fillers (Juvaderm, Prevelle Silk and Restylane) primarily, but have also been using the longterm fillers such as Artefill for patients that are appropriate candidates. This year I am also seeing many patients that have been considering cosmetic surgery, particularly for facial issues, that fillers alone will not correct. I absolutely agree that the coming year will bring many new "miracle" solutions to almost every perceived aging issue. The challenge for the consumer is not to the assume that every claim is valid. I believe that all skin resurfacing lasers will continue to evolve in a very positive manner but have doubts about all of the "non-invasive liposuction" type lasers that at this point are budget busters with very little real benefit.
One of the best advancements to come about last year was the addition of lidocaine to almost every hyaluronic filler on the market. All of your favorites, Restylane, Juvaderm and Prevelle Silk, all contain lidocaine in the product now so that separate pain blocks are often unnecessary. However, my patients have me trained and I absolutely understand that some of you prefer a prior block. Your comfort is my priority so your preference of additional anesthesia or not, will always be honored!
All the best,
Terry Hand, M.D.
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10 Cosmetic Plastic Surgery Predictions for 2011
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These predictions regarding aesthetic surgery are made by the American Society for Aesthetic Plastic Surgery. The topics that are bolded connect directly to procedure descriptions and tools on the ASAPS website.- As the economy continues to improve, demand for facelifts and other facial rejuvenation surgery will increase. Non-surgical facial rejuvenation procedures will also see some growth, but people who have been putting off surgery for the past few years because of the economy will be ready for the gold standard in facial rejuvenation in 2011.
- The growth and popularity of cosmetic injectables (Botox, Dysport, Sculptra, Radiesse, Evolence, Juvederm, Restylane, Perlane etc.) will continue to increase as products continue to evolve and new players enter the market.
- As our population increasingly realizes the dangers and health consequences of obesity, the number of patients seeking plastic surgery procedures for body contouring after dramatic weight loss (abdominoplasty, lower body lift, upper arm lift, etc.) will rise in 2011.
- As the baby boomer generation continues to age, so do their breast implants. This year many baby boomer women who have aging implants and/or breast ptosis will replace their implants and have breast lifts.
- Consumers looking for a bargain on cosmetic procedures will unfortunately lead to an increase in horror stories about "discount injectables" bought offshore and cosmetic medicine and cosmetic surgical procedures performed by untrained or poorly trained practitioners.
- While liposuction (lipoplasty) will continue to be the gold-standard in fat reduction, there will be continued interest in experimental techniques for non-invasive fat removal (freezing, zapping, lasering, etc.) as a future alternative or adjunct to liposuction (lipoplasty) surgery.
- Aesthetic Medicine has seen a dramatic increase in the diversity of the patients treated over the past decade and this trend is expected to continue to grow stronger than ever, with applications that cater to all people. The appeal of both aesthetic surgery and cosmetic medicine will continue to spread across the spectrum of our population, as plastic surgeons further tailor treatments to meet the sometimes unique needs of that expanding population.
- As the popularity of non surgical and minimally invasive procedures continues to grow, surgeons and manufacturers will develop new techniques and products that advance the science, produce even better results and lessen recovery time.
- Celebrities like Kim Kardashian, Beyonce, and Jennifer Lopez have made a shapely derrière a must have accessory. In the coming year patients will be seeking posterior body lifts, buttock lifts, surgical and nonsurgical buttock augmentations to shape and augment their buttocks.
- Following the trend in increased consumer sophistication patients will increasingly want to know if the latest procedure and device being touted on the internet and TV talk show really works and if it is safe. By incorporating evidence-based medicine into the core specialties of plastic surgery, the Aesthetic Society will make it easier for both doctors and patients to determine fact from fiction.
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Facelift Makes You Look 12 Years Younger
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Patients who have undergone a facelift rate themselves as looking an average of 12 years younger after surgery, according to a study in the February issue of Plastic and Reconstructive Surgery
®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
After a "significant" recovery period, the vast majority of patients undergoing facelift surgery are satisfied with their results, according to the study by Dr. Eric Swanson, a plastic surgeon in private practice in Leawood, Kansas. "These findings support the recommendation of surgical facial rejuvenation to patients who wish to look younger," Dr. Swanson writes.
For Most Patients, Facelift Improves Appearance and Quality of Life
The patients were highly satisfied with their results. The "average subjective reduction in apparent age" was 11.9 years, with a range of 0 to 27½ years. Ninety-seven percent of patients said the results met their expectations. Forty percent rated the results even better than expected.
Nearly 90 percent of patients said they had received positive reactions from other people regarding their new appearance, while only seven percent reported negative reactions. More than 80 percent of patients reported improved self-esteem, and 70 percent reported improved quality of life.
Just over one-third of patients reported some type of complication, although these were mainly temporary problems (for example,
dry eyes). Just two percent were unhappy with their scars.
New Insights into Expected Recovery Times
Dr. Swanson also asked in detail about recovery after facelift surgery. On a scale of 1 to 10, the average pain rating was 5. Pain lasted an average of ten days, with six days on prescription pain medications. Most patients felt that pain was about what they expected or less.
Recovery was fairly prolonged, with an average of 24 days off work. Patients resumed driving after about two weeks and were able to sleep comfortably again after about two-and-a-half weeks. Patients said it took about one month before they looked "presentable" in public, and two-and-a-half months before they were "back to normal."
Patient satisfaction and quality of life are key considerations in assessing the results of any type of surgical procedure. Yet few studies have evaluated these outcomes in patients undergoing facelift surgery for facial rejuvenation. "Patients often inquire as to how painful the surgery will be, the length of recovery, and when they can get back to their normal activities, including return to work," Dr. Swanson writes. "These questions merit investigation so that patients can be given reliable advice on what to expect."
The new study provides important data on the expected results and recovery time after facelift surgery. Although results vary, most patients are highly satisfied with their results, reporting a more youthful appearance, improved self-esteem, and better quality of life. The results will be useful in counseling patients on what to expect before facelift surgery. "They may plan appropriately for surgery and avoid unwelcome surprises," Dr. Swanson writes. "Well-informed patients are more likely to be satisfied."
See photos of facelift patients of Dr. Hand
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Study Shows That Facial Bones Show Signs of Aging Too!
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For Optimal Facial Rejuvenation, Plastic Surgeons Should Consider What's Going on Under the Skin
ARLINGTON HEIGHTS, Ill.- What makes us look older? Wrinkles and sagging result not just from changes in the skin, but also from age-related changes in the underlying facial bones, according to a report in the January issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
The researchers, led by Robert Shaw, Jr., MD, at the University of Rochester Medical Center, analyzed computed tomography scans of the facial bones in young (age 20 to 40), middle-aged (41 to 64), and older (65 and up) age groups. All scans were performed for medical reasons-not for planning plastic surgery.
Aging Linked to Changes in Eye Sockets, Jaw Bones, and More
Detailed measurements in three-dimensional reconstructions of the CT scans showed some important differences in the facial bone structure (or facial skeleton) between age groups. "The facial skeleton experiences morphologic change and an overall decrease in volume with increasing age," Dr. Shaw and colleagues write.
One prominent change was an increase in the area of the "orbital aperture" - that is, the eye sockets. In both men and women, the eye sockets became wider and longer with age. Aging also affected the bones of the middle part of the face, including reductions in the glabellar (brow), pyriform (nose), and maxillary (upper jaw) angles. The length and height of the mandible (lower jaw) decreased with age as well. Although these changes occurred in both sexes, many occurred earlier in women - between young and middle age. In men, most of the changes occurred between middle age and old age.
Plastic surgeons are experts at dealing with changes in the skin and underlying soft tissues that contribute to an aged appearance of the face. However, as the new study demonstrates, they must also understand the contribution of changes in the underlying facial bones. "The bony components of the face are important for overall facial three-dimensional contour as they provide the framework on which the soft-tissue envelope drapes," Dr. Shaw and coauthors write. For example, the enlarging eye socket and decreasing brow angle could contribute to frown lines on the forehead, "crow's feet" at the corners of the eyes, and drooping of the lower eyelid.
By using materials and techniques for skeletal augmentation, plastic surgeons can improve the outcomes of facial rejuvenation, Dr. Shaw and colleagues believe. They discuss the "aesthetic implications" of changes in the facial bone structure, and outline some strategies plastic surgeons can follow to optimize the final results for patients who desire a more youthful appearance.
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| 6 Month Interest Free Financing Is Still Available | 
2011 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 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 payment plan that gives you 6 months to pay for your procedure with no interest charges may be selected. A secure CareCredit application may be found on the financing page link below. Click on the blinking "Learn More About CareCredit" button. Most applications are approved in several minutes.
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.
View the CareCredit payment calculator and application |
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THANK YOU!
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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 at 415-461-6742 for any questions or if you would like to meet with Dr. Hand. We will look forward to hearing from you!
Schedule a consultation with Dr. Hand
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