Many patients ask us if there are any vitamins or supplements we can recommend that will speed up healing after surgery. Arnica and Vitamin E seem to be the current favorites.

A recent study showed 55% of cosmetic surgery patients use herbal medications or supplements compared to 24% of the general population.

The official word is out on many of these remedies because hard science is hard to come by. And there is a tendency to believe that these supplements are gentle and natural when many of them are quiet potent and potentially harmful if taken around the time of surgery. The non- vitamin group including Ginko, Ginseng, Ginger, and Green Tea can increase chances for bleeding after surgery. Others can affect blood pressure or heart rhythm during anesthesia or potentially react with other medications. And, these preparations are not regulated by the FDA, so you can’t be exactly sure what you’re getting. So, you should always inform your doctor of your supplement intake and generally stop these preparations 2 weeks before surgery. This is true of over-the-counter medications as well.

But, there are some recent studies that do suggest that Arnica Montana taken by mouth is effective in reducing postoperative swelling and bruising for a number of procedures including cosmetic facial surgery. This may help speed up recovery in the first week after surgery. And there did not appear to be any unwanted side effects. So, Arnica can be cautiously recommended after facial surgery.

Vitamin E, on the other hand, doesn’t have the same record. Some studies find it helpful while others find it harmful, and about 5% of people can get a nasty rash from Vitamin E cream, especially if taken in its natural form. So, we don’t recommend it.

We’ll give you lots more details about this topic during your consultation. 

About a year ago, the makers of Botox came out with their new filler, Juvederm. And in an interesting marketing ploy, they allowed physicians from around the country to treat 10,000 patients with Juvederm for free who had previously been treated with Restylane. The idea was that it would get their name out there and allow doctors experience with the new product.

In this way, the makers of Juvederm believed that they would by year end probably get 10% of the injectable filler market which was largely dominated by Restylane. The result: by year end it appears that Juvederm had captured some 25% of the patients who were getting injectible fillers.

You might be wondering, so what does this all mean?

If you are one of the one million Americans who used injections to smooth out wrinkles, nasolabial folds, or to plump up lips, you probably have come to realize that there are very few substantive differences between these 2 products. They are both transparent gels made of hyaluronic acid, a complex chain of sugar molecules, which is found naturally throughout the body in skin and joints. Unlike Botox, which works by temporarily paralyzing the muscles underlying wrinkles, these injectables temporarily fill out depleted areas, adding volume to the skin. And whether you got Restylane or Juvederm was probably the result of some preference your physician had.

Of course, this may all change with the introduction into the market in the near future of more permanent fillers like Artefill (keep an eye out for Aquamid).

But it also leaves us wondering if the makers of Restylane will return the favor when they introduce their new Botox- like product- Myobloc- late this year.

Rhinoplasty is different for men and women in almost every respect starting out with facial aesthetics. While there is a lot of individual variation, facial aesthetics differ substantially between the sexes. In general, compared to women, the following features are considered more masculinizing and, therefore, more desirable for most men:

• a more acute nasofrontal angle (the angle between the forehead and the nose seen from the profile)
• a more acute nasolabial angle (the angle between the nose and the upper lip seen from profile - usually about 90-100 degrees)
• a straighter profile
• a higher bridge (even a slight bump)
• a more sharply defined, angular tip
• a longer nose
• more tip projection (the degree to which the tip juts out from the face)

In addition to the above, there are other factors we have to consider when contemplating Rhinoplasty in men vs. women. Men tend to have stronger, heavier cartilages and bone along with thicker skin in many cases. This will influence what needs to be done to create the desired changes and also the expected timeline of healing. We will vary our discussions with men depending on whether they have very strong, angular features or softer, rounder features. After all, the nose must fit the face. In general, though, men can tolerate a slightly high bridge and overprojected tip. By contrast, a male nose that is slightly scooped, too short, or too rounded does not go over well at all. So, we will always err on the side of maintaining a strong, masculine nose for male patients. There are some women who prefer and would benefit from some of these features, albeit to a lesser degree. Very tall women with longer faces, for example, usually look better with a straighter profile while very slight-featured, petite women can better tolerate a petite, softer, ‘cutesy’ nose.

This blog only begins to scratch the surface of the differences between the sexes when it comes to Rhinoplasty. And these only serve as the basis for our assessment in creating a highly individualized surgical plan for you.

Who wouldn’t want a more permanent option for filling deeper facial folds and creases?

 Well that option is finally here. We are now offering Artefill treatments here at Profiles. Artefill is an injectable gel that consists of permanent microspheres of PMMA (polymethylmethacrylate) suspended in dissolvable bovine collagen and a local anesthetic to improve comfort. There is about 20% PMMA to 80% collagen. The collagen allows the microspheres to be injected smoothly. As the collagen slowly dissolves, your body responds by surrounding the microspheres with your own collagen, thus maintaining the beneficial result.

Why haven’t I heard of Artefill before now?

Artefill is relatively new to the United States, having recently been FDA approved in October 2006 for filling of smile lines (nasolabial folds). However, it is by no means untested. It has been used safely for over 10 years in Europe and Canada (and by our doctors) under the trade name Artecoll in the treatment of over 400,000 patients. Studies have followed the results for over 5 years and demonstrated the long-lasting positive changes.

Artefill is an option for most deep lines and creases. Since it is permanent, we generally recommend going slowly over 2-3 treatment sessions to build up to the desired effect. While very safe, it should not be used in areas of thin skin where problems may tend to occur. Also, there is a small risk of collagen allergy, so we skin test you for this about a month before your scheduled Artefill treatment.

For those who like the look of short-acting fillers but would prefer a more permanent solution, Artefill is a welcome addition to the facial filler line-up. Next time you drop in for a visit, ask us if Artefill is a good option for creating your more youthful look now.

The facial filler market is getting very crowded lately. Everyone is searching for the holy grail- the perfect filler. It should be smooth, resilient, reliable, free of side effects - and, oh yeah, PERMANENT. To date, Artefill is the one and only permanent filler FDA-approved for cosmetic facial use. But, there are a number of long-lasting fillers coming down the pike. One of these is liquid silicone.

Liquid silicone has been quietly used for decades by its supporters who claim it provides superior handling and results, especially when used carefully with a microdroplet technique. That may be true in most cases. However, there has been a healthy number of very serious reactions to liquid silicone, resulting in nodules, lumps, and severe inflammation that is near impossible to treat. What’s worse is that a reaction may occur many years after the initial injection and the material may migrate over time to unwanted areas.

When liquid silicone goes wrong, it goes very wrong. It’s true that many of these disasters occurred when non-physicians injected what may have been impure product. But, serious reactions have also happened in expert hands, prompting the FDA, in 1992, to stop a group of prominent physicians from using the product. You can be sure that doesn’t happen often. The reactions have been severe enough to relegate talk of liquid silicone to the backrooms of facial filler discussions and most doctors won’t touch the stuff.

But, all this may be about to change. In 1997, the FDA approved liquid silicone for use in treating detached retinas. Since then, its use as a cosmetic filler is starting to creep up again. And a new breed of the product is in development and under investigational study. The dermatologists who have tried it are using words like “spectactular.” So, whether liquid silicone is the panacea of tomorrow or a “time bomb” is yet to be determined. But, you can be sure that we won’t be the first ones jumping on that boat to who knows where.

For more information about injectable safety, you can check out www.injectablesafety.org 

This is the product of a joint physicians’ coalition from the AAFPRS, the ASAPS, and ASOPRS dedicated to safe injectable practices and information for the public.

Along with all the glitz and glamour that we see and read in the run up to the Oscars, there is always a host of information about all the peels, Botox, injectibles, lasers, and nips and tucks that the stars get done to get ready for the big day. However, what is really interesting is that the truth is that cosmetic surgery is no longer the province of the rich and celebrated. Long gone are the days when in order to have facial plastic surgery you had to pay cash or write a check up front.

Plastic surgery has been redefined as a coveted yet attainable luxury and surgeons around the country are noting a democratization of cosmetic surgery.

Even more interesting, according to a survey conducted in 2004 for the American Society of Plastic Surgeons, about a third of people considering plastic surgery reported average household incomes below $30,000; The poll of 644 people found that only 13% of those seeking information on plastic surgery procedures reported an annual household income of more than $90,000.

Today, we find that everyone including stay at home moms, high school teachers, law enforcement officers, lawyers, etc present to us with an interest in getting something done. And perhaps one of the most welcome illustrations of this economic reality is the rise of finance companies offering middle-income patients easy access to credit to pay for their surgeries.

Patients can now find out about financing options at our office from established financing companies like American Benefit Finance, Reliance, Capital One and CareCredit. Mike Testa, the president of CareCredit, said that Americans spent about $14 billion last year on cosmetic medical procedures, from rhinoplasty to skin peel treatments. Of that, $1 billion is financed by finance companies.

“It is certainly getting more patients to say yes today rather than delaying treatment,” Mr. Testa said. “If you had to pay cash for a car, how many cars would you buy in your lifetime?”

 ”Financing gives the average person like me the opportunity to do this without having to wait,” one patient said. At Profiles, while we strive to offer only the highest quality care in the most, modern ambience with five star service, we are cognizant of the times and always work with our patients to help make their goals attainable.  

How is it that anyone can look in the mirror these days without screaming? I mean, who can stand to look at her naked truth sans the benefits of airbrushing? We have a very high resolution camera in the office that we use for photo imaging and nobody, and I mean nobody, likes it. We are so used to looking at silky smooth computer-aided skin and perfectly sculpted features in ads and billboards that the mere sight of a blemish or, dare we say, imperfection is enough to send everyone running for the hills.

That’s why the recent Dove Real Beauty Campaign is so refreshing for people. You can check out one of their excellent and slightly shocking videos at:

http://www.youtube.com/watch?v=rTb4hur4gYw

Now, coveting Beauty is not a modern pastime. The power of Beauty has frustrated and inspired people for as long as anyone has put pen to paper or paint to cave walls. Makeup, for example, can trace its history as far back as the Egyptian 1^st dynasty (around 3000 B.C.) and it has never looked back. There are many complaints about modern makeup, but these pale in comparison to slightly older remedies that included everything from heavy metals such as lead and mercury, and poisons such as arsenic, nitric acid, coal tar and Belladonna. Our personal favorite was a combination of vinegar and cat dung that, when worn over the forehead, was meant to help reduce a rising hairline. During the Italian Renaissance, Aqua Toffana, created by the Signora of the same name, was a popular face powder to be used only when the husbands were around. Too bad it was made from arsenic. Signora Toffana was promptly dispatched from this Earth when authorities discovered several hundred dead husbands.

The idea that modern media has rewritten Beauty concepts is a bit of a stretch. Influenced? Sure. But, Beauty as a concept has spanned generations and transcends race and culture. Babies prefer to look at a beautiful face, when given a choice. The allure of Beauty, with or without media influence, is undeniable, and that will never change. That’s why restoring beauty, harmony, proportion and with these, confidence and happiness, is so rewarding for us.

Remember the phrase “She’s a rare beauty.” The main difference today compared to ages ago is that Beauty is so much easier to attain. And, if everyone is equally beautiful and Beauty is everywhere, it loses some of its fascination. So, maybe Dove has it right. Maybe our media images of Beauty should be Photoshopped.

There was a nice article a couple of days ago in the LA Times Beauty section about mineral makeup and its overwhelming increase in popularity in recent years. You can read the full article here:

http://www.latimes.com/features/lifestyle/la-ig-minerals17feb17,1,2149221.story?ctrack=1&cset=true

The article points out a few distinct advantages of mineral makeups. They cover up flaws more easily. They don’t get absorbed into the skin, so they are less likely to aggravate your complexion.

But, the biggest point of the article relates to sun protection from makeup. Many, if not most, makeups these days promise sun protection of SPF 15 or sometimes greater. What’s important to understand is that SPF is in part related to how much of the product covers a certain area. The amount of zinc oxide or titanium dioxide in these products is low enough that, to get that level of sun protection, you would have to really cake it on…not something most women want to do. So, you should always consider using a separate sunscreen under your makeup.

Remember, sun protection is probably the single most important thing you can do to help slow down the process of skin aging.

A bump seen in the profile view is one of the most common concerns we see in patients seeking Rhinoplasty. Many wonder about or ask whether they can achieve a perfectly straight-line profile after surgery? You may have seen Rhinoplasty results such as these or those that go one step further and scoop out the nasal bridge.

The fact is that even beautiful unoperated noses are NEVER perfectly straight in profile. You could even say that nature hates a straight line since all of our features are made up of gentle curves and geometric shapes. Our eyes are drawn to straight lines. We recognize them and pick them out easily. So, a scooped out or even straight nasal profile is usually a dead giveaway that someone has had Rhinoplasty surgery. Not only is it unnatural, a ski-slope profile overly softens the nasal appearance, making it appear ‘washed out’ and child-like.

A naturally appealing profile has a very slight fullness or ’strength’ in the area of the bridge and just a hint of a depression or ‘break’ just above the tip. This is the post-operative profile we often recommend and strive for in our practice, though we will work with you during your consultation to see what is optimal for you. So, if you want a great-looking and inconspicuous Rhinoplasty result, ask us about going ‘natural’.

You can read more about this and other topics in our online book about Modern Rhinoplasty.

In general, people have always identified African American noses as ones with a wide, short nasal bridge with wide nostrils. However, in point of fact there is tremendous variability in every parameter of the African American nose: including nostril shape and flare, nasal length, skin thickness, columella length, nasal projection, and bridge height. Unfortunately people continue to try to “pigeon- hole” African Americans into one type.

This African American patient is an example of some of the typical concerns addressed in an Ethnic Rhinoplasty. This young woman was unhappy with her lack of tip projection and definition, and the width and flare of her nostril base. She had a columellar strut, tip graft, and dorsal graft placed and an alar base reduction. In the After photo to the right, you can see that her tip projection and definition are improved and her nostril width and flare are reduced substantially. This reduction can be done naturally with inconspicuous scars and without the tell-tale pinched look that results in a very unnatural-looking nostril base.  

All this being said, what we have found is that if we were to compare our average African American nose to our average Caucasian nose, we find that our African American patients tend to have:

1. Wider nasal bridges
2. Lower nasal bridges
3. Thicker skin
4. Wider, more bulbous nasal tips
5. Thicker soft tissue overlying the nasal tip
6. Softer cartilage
7. Nasal tips that appears to droop
8. Shorter nasal tips
9. Wider variability in nostril shape
10. Greater nostril flare (bigger nostril curvature)

So what does all of this mean to you if you are considering surgery?

It means that it is very important that you find a surgeon who is comfortable operating on people of different ethnicities. It is important for your surgeon to understand how thick skin differs from thin skin when dealing with rhinoplasty. It is also important for your surgeon to be able to individualize your surgery to achieve your goals. And most importantly, it is important for you to know what you want to achieve with the surgery.

We take all these factors into consideration in planning your surgery and in explaining to you, our patient, what can be accomplished with your surgery. We will sit with you in consultation as we work together to define what your goals are using computer imaging. Based on your desires and your individual anatomy, we will then determine a surgical plan which is best suited to achieve your individual goals.

For further info we recommend you go to our Modern Rhinoplasty online book and read further on African American Rhinoplasty.