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. Terry L. Hand, M.D. |
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Fat Transfer To The Hands
|  | I am often asked what options are available for aging hands. Patients complain that their hands have lost fullness under the skin and that they seem "bony". What has actually happened is that with aging the fat volume under the skin naturally begins to diminish. Consequently, the structures under the back of the skin become much more visible.
There are 2 methods to address this problem, fat transfer and using a dermal filler such as Radiesse. I prefer using fat because Radiesse is more expensive (purchased by the cc). I can usually harvest the amount of fat necessary to completely address the aging changes and some of the fat usually survives long term, whereas Radiesse will usually last about a year.
The fat is usually aspirated from wherever a small pocket of nonconspicuous fat exists. Often that site is the thigh, tummy, back of the arm or knee. Such a small amount is taken from the donor area that there is not any sort of irregularity afterwards.
As with any dermal filler or surgical procedure, the patient is asked to refrain from using medications such as fish oil, antiinflammatories or Vitamin E for 2 weeks prior to the procedure. Local anesthesia is injected into the donor area and the hands prior to injecting the fat. I aspirate 10 to 20 cc's of fat from the donor area and inject it into the skin on the back of the hand, carefully molding it.
The hands may be slightly bruised and swollen for several days but no special recovery is necessary after the procedure.
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For readers of our newsletter, schedule your gratis consultation with Dr. Hand by simply sending us
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Ask The Doctor
I am considering having cosmetic surgery on my eyes because I find myself lifting my eyebrows often to see better. Will getting the upper eyelid skin reduced solve the problem?
Without examining your eyelids specifically, it is difficult to comment. I will suggest several scenerios that will probably address your issues. When we are young, our eyebrows naturally drape across the bony prominance above our eyes. In most individuals, as we age, the eyebrows begin to drop lower. At the same time the upper eyelid skin begins to age and sag and fat pads in both the upper and lower eyelids begin to lose position and herniate. Usually, patients that describe your issues have some combination of the above aging changes occurring.
I would evaluate your eyes for the above changes being very careful to observe your brow position. If the position is still good, a blepharoplasty of the upper eyelids would be sufficient to address your issues. If not, a brow lift might be the optimal solution of which there are several types: in front of the hairline, behind the hairline or a temporal lift. Most often, a blepharoplasty is performed concurrently of the upper and/or lower lids.
Following a browlift and blepharoplasy, the brows are returned to their youthful position and the eyelid skin and muscles are trimmed and tailored to return to a bright eyed look.
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'It's a smile, it's a kiss, it's a sip of wine ... it's summertime!"
-Kenny Chesney
June brings several trends in my practice. Weddings, graduations and vacations abound, so looking good quickly seems to be the prevalent desire. Dermal fillers and Botox seem to be the best solution for a quick pick-me-up. As always, I am stressing the importance of sunscreens for several reasons. I recognize that the most sun exposure a person encounters is usually as a child. This month I have included a summary of a recent study that confirms childhood exposures add up to major hyperpigmentation and skin cancers in later years. So mamas, coat those kids with sunscreen this summer! I always encourage adults to remember to apply sunscreens as well. With all of the products and laser type treatments that are now available to decrease pigment and make skin more homogenous, why not protect your beautiful results!
A procedure that seems to be as popular in our practice as dermal fillers and Botox is intense pulsed light (IPL) treatment. We are finding that our patients are really enjoying the options of decreasing redness and age spots to not only their faces and necks but also the chest, arm and hand areas. When we accompany these procedures with fillers or fat transplants to the hands, a much more youthful look ensues. Our special this month, hand fat transplantation, is wonderful in plumping the back of the hands, masking tendons and veins that tend to become more prominent as we age. It is a simple procedure done under local anesthesia in about an hour. Fat is harvested from the hip, thigh or knee and transplanted into the hands. When consulting about fat and skin issues of the torso, I am often asked what the best course of treatment would be, liposuction or tummy tuck and how satisfied patients are after having one or both procedures. The article featured this month regarding a study of this topic confirms my experience with both procedures. However, I would add to the article that there are times I prefer performing the surgeries in stages. An aggressive circumferential liposuction (around the whole midsection, tummy and back) procedure performed prior to a tummy tuck often corrects the problem alone by eliminating fat and stimulating contraction of the skin. If the skin remains loose or the abdominal muscles still need tightening, the fat layer is reduced to a manageable level all around the body. A subsequent tummy tuck that tightens the abdominal skin and muscles will then yield a much nicer result. Please enjoy this beautiful weather and wonderful moments with your family and friends. All the best,
Terry Hand, M.D. |
My Best Tips For Picking Dr. Right! |
I understand, the time has come. You've thought and pondered and the concerns that have been nagging you to investigate cosmetic surgery are real and valid. Now it is time to investigate and pursue a cosmetic procedure. Where do I start and how do I know that I am selecting the right office and surgeon? If I were selecting a surgeon for myself or my family, I would consider the following points salient in my decision making process.
#1 Board Certification and Expertise: Plastic surgery is an art form not hastily learned. First and foremost, I would encourage you to consult with surgeons that are board certified by the American Society of Plastic Surgery (the only cosmetic surgery board that is recognized by the American Board of Medical Specialties). Certification by the ASPS requires the full spectrum of training in plastic surgery of the entire body - the head, neck, trunk and extremities, both reconstructive and cosmetic. Another certification that is grand is recognition by the ASAPS ( the American Society of Aesthetic Plastic Surgery). To be certified by the ASAPS, the surgeon has to have documented multiple successful aesthetic procedures and profiency. Time and experience in actually being a practicing surgeon are crucial. A weekend course on how to do a procedure does not make an expert. A recent residency does not compete with the expertise gained by years of a plastic surgery practice combined with endless continuing education meetings and journals.
It is never a bad idea to confirm professional certifications. Unfortunately, any licensed physician can go out and practice any specialty he or she chooses. Not being board certified nor trained in plastic surgery does not prevent an aspiring "plastic surgeon" from hanging out a shingle. So, you may have an ER doctor performing liposuction. As a patient, perform your due diligence and confirm your surgeons qualifications. Ask your friends and trusted doctors for recommendations. The majority of our patients are acquired as referrals, the very best compliment to any practice.
#2 Do you feel comfortable with the office and surgeon?: Plastic surgery is a business, hopefully performed by a doctor that loves what he does. There is a process in deciding on a procedure that varies for each individual. Some patients decide immediately to pursue a procedure and others investigate, think about it, reinvestigate and think about it again. The decision to respect the patients timeline, fears and or concerns should be paramount in any practice. A followup phone call or email by staff is intended only to be helpful. In my practice, you will never be placed in a glamour room to be "closed". It is my job to give you the information that helps in your decision. I am the fellow performing the surgery. Therefore I should answer your questions the first, second and even third time you consult at our office, not a charming salesperson. My staff is also available for questions regarding financing or procedures they have experienced.
#3 Did the consultation and plan of action address your concerns and vision for your procedure? Schedule yourself for a consultation with the surgeon and ask the tough questions. View photos, lots of photos of patients that actually had surgery performed by the doctor. There is a current trend in cosmetic surgery of "branding" a procedure and distributing photos to any surgeon that has signed up as a representative of the corporate "brand". Enticing as the office may seem, the doctor may not have actually operated on the patients you are viewing. Every patient is unique with individual needs. See photos of patients with similar issues as your own and ask the doctor specifically what his recommendation for treatment would be. Confirm that the photos you are viewing are his results. Take all the time you need in your consultation, you are making a big decision and deciding if this is the doctor that you can make your wishes a reality. Get an absolute cost estimate of all fees associated with your procedure, including anesthesia. Check with your office regarding the followup schedule after your surgery. At my office, every patient is given an appointment for the following day and my cell phone number. I encourage multiple postoperative visits and hope that all my patients will contact me with any concerns. If you need to return for a followup consultation, schedule it. We understand, big decisions often take more time and information to complete.
#4 Beware the hardsell! I love the internet and the information that websites can provide. I have a profound distaste for the current trend in "warm and fuzzy" websites complete with videos set to "mood music". I am practicing a wonderfully creative form of medicine that is of great benefit to many. I also understand that cosmetic surgery is never an emergency and thoughtful budgeting and planning ultimately provide for a better experience. An office that pressures an immediate decision or does not value your time should be avoided. Take your time, evaluate your options and trust your gut. Your instincts will serve you well.
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Cancer-causing Skin Damage Is Done When Young
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ScienceDaily (May 10, 2012) - With high UV levels continuing in Queensland this autumn, young people are at risk of suffering the worst skin damage they will receive during their lifetime, research from Queensland University of Technology (QUT) has found. Researcher Professor Michael Kimlin from QUT's AusSun Research Lab said the study found UV exposure during a person's first 18 years of life was the most critical for cancer-causing skin damage and skin aging.
Professor Kimlin said while people aged over 50 had the slowest rate of skin degradation, results indicated that damage still occurred even at that age, so lifetime sun protection was important. The study used a unique, non-invasive "UV camera," which took images of skin damage and aging invisible to the naked eye, to measure the relationship between lifetime sun exposure and skin cancer risk.
Professor Kimlin said the majority of skin damage occurred in the early years of sun exposure, with a much slower increase in damage in subsequent years over the age of 50. "We looked at how age impacted on the skin damage we saw and found it's not a simple one to one relationship," said Professor Kimlin. "The message from this research is to look after your skin when you are a child and teenager to prevent wrinkles and skin damage. "Sun protection when you are young sets you on a lifetime of good skin health."
One hundred and eighty people aged 18 to 83 years old were imaged with the UV camera and interviewed to determine the level of their sun exposure. The study measured hyperpigmentation of the skin to determine level of damage and wrinkles to indicate skin aging. Professor Kimlin said using the UV camera meant people's skin could be examined for skin cancer risk factors without an invasive biopsy.
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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 |
| ASPS Journal Reports Liposuction and Tummy Tuck Improve Quality of Life |
Study is first of its kind to assess patient-reported outcomes of procedures to reduce abdominal fat
Arlington Heights, Ill.- Patients undergoing cosmetic liposuction and/or abdominoplasty ("tummy tuck") procedures report significant improvements in self-esteem and quality of life, according to a study in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). Outcomes are especially good with liposuction plus "tummy tuck," although they include somewhat higher pain scores and longer recovery times, reports the new study by ASPS Member Surgeon Dr. Eric Swanson, MD, a plastic surgeon in private practice in Leawood, Kan.
Study Shows Improved Quality of Life and Other Benefits
Dr. Swanson formally evaluated quality of life and other outcomes in 360 patients undergoing liposuction and/or abdominoplasty to remove excess abdominal fat. About 60 percent of patients underwent liposuction alone, while 35 percent underwent a combination of liposuction and abdominoplasty. The rest underwent abdominoplasty alone. The patients' average age was 42 years; 85 percent were women. Thirty percent of patients underwent other cosmetic plastic surgery procedures (such as face lift or breast augmentation) at the same time. Outcomes were assessed an average of four months after surgery. Patients undergoing liposuction alone had shorter recovery times: average time off work was about six days, compared to 16 days with abdominoplasty (with or without liposuction). The liposuction-only patients also had less discomfort: average pain score 6 out of 10, compared to 7.5 for those undergoing abdominoplasty. Combined Procedure Yields Best Results
Patients undergoing abdominoplasty rated their cosmetic outcomes higher than others: average score 9 out of 10, compared to 8 out of 10 with liposuction only. Liposuction plus abdominoplasty produced the highest patient satisfaction rate-over 99 percent-with no increase in pain compared to abdominoplasty alone. Ninety-eight percent of patients undergoing liposuction plus abdominoplasty said they would undergo the procedure again and 99 percent that they would recommend it to others. Overall, 86 percent of patients reported an improved sense of self-esteem after surgery. About 70 percent reported improved quality of life, more commonly after liposuction plus abdominoplasty. Quality of life is an increasingly important focus measure of effectiveness for all types of medical and surgical treatments. Even though liposuction and abdominoplasty are among the most frequently performed cosmetic surgery procedures, few studies have formally evaluated their impact on quality of life and other patient-reported outcomes. "Liposuction and abdominoplasty, individually and in combination, produce high rates of patient satisfaction and reliably improve self-esteem," Dr. Swanson writes. By formally assessing these important outcomes in a large number of patients, he hopes his study will provide a clearer picture of the expected results and recovery times associated with these widely performed cosmetic surgery procedures.
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