Beverly Hills Rhinoplasty Surgery Blog

Seeing red? Feeling blue? Now that the election is over, let’s all come together and reunite! Whatever your politics, the one thing we can all agree on is beauty…and if it’s affordable, even better!

So, just because the economy is on a roller-coaster doesn’t mean your skin should suffer. Between now and January 1st, we’re offering our friends the revolutionary skin smoothing Vi Peel for 50% off…a $300 value for only $150.

To see before and after photos, check out our own Nadine’s blog. She swears by the results and is finally able to go without makeup!

http://jolienadine.com/blog/2008/07/22/vi-peel-before-and-after-photosand-videos/#comment-7927

We love how the Vi Peel gets rid of pigmentation, acne marks and fine lines, and it’s the first peel that works on *any* skintone, even African-American complexions. Give us a call at 310-276-6800 to set up your appointment.

– Profiles Beverly Hills

Source: jolienadine.com
Et voila! You asked for my Vi Peel photos, and here they are. On the left is the “before” photo, taken six weeks ago. On the right is the “after” photo, taken this afternoon. …

Now that the hangover from the election is finally over, we wanted to announce the introduction of our two new dedicated websites. As you know our main site facial plastic surgery site is www.beverlyhillsprofiles.com. Here you can read about all the details of the gamut of procedures that we perform, read about us, as well as contact us regarding consults and questions.

Since you are reading this, you are aware that as rhinoplasty and revision rhinoplasty experts, we frequently blog at www.rhinoplastyinbeverlyhills.com. However, as facial plastic surgeons we like to cover the range of issues and questions that our patients ask us about regarding facial rejuvenation- face lifts, brow lifts, eyelid lifts, fillers- juvederm, restylane, Elevess, as well as peels like the blue peel and Vi peels, etc.

Because so many patients look to us as the Los Angeles rhinoplasty experts as well as the originators of the new Hybrid Facelift procedure we have now developed two more dedicated sites that will focus on these two focuses. The first is

www.beverlyhills-rhinoplasty.net

Here we focus on the major niche of our practice and our passion- rhinoplasty and revision rhinoplasty, including all the various things that you should know before you undergo rhinoplasty as well as all the things we can correct for those who are looking for BeverlyHills expert revision rhinoplasty surgeons.

The next site is our dedicated facelift site which focuses on our innovative trademarked procedure the Hybrid Facelift. Since our development of this procedure and our appearance on the Insider, we have had an enormous turnout of people wanting to know what the Hybrid Lift is exactly, how it differs from the traditional facelift, and if it is better for them than the so- called mini lifts.  We developed the site to clearly delineate for you why the Hybrid Lift is the final evolution  of facial rejuvenation and why we perform it is more cost effective than having repeated filler procedures. This information as well as continual updates of patient’s before and after photographs can all be found here:

www.beverlyhills-facelift.net

We thank all of you for your support and welcome suggestions regarding what you want to see and hear about.

This morning as we were reading through some new editorials, we came across this article from today’s Washington Post which addressed what we blogged about yesterday, namely how fillers are used and whether they increase collagen production.

The paper’s dermatologist, Dr. Herschenfeld says “that Sculptra and Radiesse, which stimulate the body’s natural ability to form collagen, can be used to fill hollows under the eyes, to rebuild cheekbones, fill in sunken temples and even smooth the jawline. ‘Although they cannot tighten skin the way surgery can, they can produce striking improvements in appearance without cutting, stitching, scarring and all the down time that comes with a facelift.’”

We agree that volume enhancement is an essential part of facial rejuvenation, and it is one of the main reasons we have developed the Hybrid Facelift (more on HybridLift here). However, we found two things compelling about the article:

1. It is interesting to note that major newspapers report the utilization of fillers for off- label uses like filling in the hollows under the eyes without any disclaimers, and
2.  Perhaps more interestingly, a new study in the Archives of Facial Plastic Surgery looking at Radiesse concluded “We found no evidence of new collagen formation 1, 6, or 18 months after injection.”

Granted the study numbers in both papers are small. However, the utilization of the Radiesse in this more recent study was much more in line with how most practitioners use fillers. As we blogged yesterday, the study most people site in speaking about new collagen production (Archives of Dermatology) utilized an entire syringe of Restylane per area of the forearm injected. We suspect, as the original authors concluded, that when this much filler is injected into one small area of forearm skin, the skin is put under tremendous stretch, much like the case of tissue expanders, and responds by producing new collagen. Perhaps this accounts for the discrepancy between the two papers. We think the second paper is more accurate because it reflects how fillers are generally utilized in the face.

In early 2007, the Archives of Dermatology published a report saying that injection of cross- linked hyaluronic acid fillers, like Restylane and Juvederm, stimulated new collagen production. Since that time many dermatologists and others who work primarily with fillers have used this report to increasingly tout their philosophies. They claim that lifting procedures may not be necessary because fillers can increase collagen production and tighten skin. This contention has always been dubious at best since the amount of collagen production necessary to lift sagging facial skin would have to be a lot.

However, the study findings need to be re- examined in more depth because a new study looking at injection of Radiesse (calcium hydroxylapatite) found no increase in collagen production.

We decided to review both papers to see if we could find the source of the discrepancy, and we think we may have. It seems that those who cite the original Restylane paper may not have noticed that, in the study, volunteers had an entire syringe of Restylane injected in one small area identified on the forearm. One to three separate sites were injected this way and then samples were taken that showed increased collagen production. Why is this important?

Simply put, this study does not make a lot of sense for at least 2 reasons. First, and most important, no one injects an entire syringe of Restylane into one designated area. It is generally used in the face to fill in wrinkles distributed over some distance. Since the doctors propose that mechanical stretch is the reason they think new collagen production is induced, we now can discern that it would take a whole lot of Restylane to be injected into any one area of the face to allow for collagen production. Not only would this likely be cost prohibitive, but it would also counter normal aesthetics. Second, the study used the forearm of participants to examine the effects, and we know that skin from different areas of the body respond differently to injection of these fillers.

This also explains why, in the more recent finding, new collagen production did not occur when Radiesse was injected. One would suspect that if the mechanism was simply mechanical stretch that it would not matter which of the fillers was injected, but the study found no new collagen on examination. Why is the second study likely more reliable?

1. They used a crease behind the ear as the site of injection. One would reason that this skin is more like the rest of the skin in the face than is forearm skin.
2. They injected only 0.1 ml into the area. This is closer to the amount that is normally injected into any one wrinkle area.

So, while fillers work well for temporary improvement of wrinkles, the evidence that they have any real effects on collagen production is lacking.

Since we last wrote, there has been a firestorm of political activity in Sacramento regarding cosmetic surgery. The Bill AB2968, otherwise known as the ‘Donda West Bill’, was vetoed recently by the Governor reportedly because it did not represent high enough priority legislation given the backlog he was dealing with.

The Bill was proposed after the untimely death last year of Dr. Donda West, mother of Kanye West, one day following a cosmetic surgical procedure. She was found to have preexisting high blood pressure and heart disease, though the contribution of these to her death is unknown. These unfortunate events prompted California legislators to try to find an answer to prevent this kind of tragedy in the future. The resulting bill that was overwhelmingly supported by lawmakers would have required all patients seeking cosmetic surgery to have a physical exam and medical clearance for surgery.

We are fully in support of doing whatever is possible to ensure the safety of patients. That is our oath, to first do no harm. That burden is especially high for elective cosmetic surgery where most of the patients we take care of do not ‘need’ our services. This takes nothing away from the fact that cosmetic surgery can have huge far-ranging benefits. Still, we need to take a zero tolerance policy for surgical complications if we are to do our very best for the patients in our care.

The problem is that legislators generally make bad decision makers when it comes to medicine. More and more medical practice guidelines today are based on evidence from clinical trials. The American Society of Anesthesiologists (ASA) has appointed a task force just for this purpose.

Their last report found surprisingly little evidence that routine preoperative testing does anyone any good. A good history and physical is a good idea for every surgical patient and this should be done by the surgeon and anesthesiologist anyway. For more invasive procedures and higher risk patients, the exam should be done before the day of surgery so that their general health can be optimized ahead of time. Tests, if done, should be targeted to the patient individually.

A routine across-the-board medical clearance is not supported by the findings of the ASA. It sounds pretty harmless, right? Forget about the added time and costs to the system. When we do tests without thinking and without looking for something specific, we often act on findings without thinking too, and this can lead us down the road to more unjustified tests and procedures that may do more harm than good.

Apparently, for some there is. At least that’s what 20/20 says. According to a recent spot on the show a couple of nights ago, a plastic surgeon in New York is offering unlimited plastic surgery to the ultra-rich for the summer while they recover in the lap of luxury in a fully-stocked Hamptons mansion, and all for the low, low price of half a million dollars. Yes…you read that right…we said unlimited plastic surgery.

Well, what do you get for someone who has everything? It seems you get one of every type of cosmetic procedure available. Does anyone else see any problem with this? For one, with that price tag, we think you should be entitled to cosmetic surgery for life! But, seriously, should cosmetic surgery really be reduced to a buffet? It is perhaps not the best idea to cram as many surgical procedures as possible into a two-month period. When we brush off the fact that these are real medical procedures, we slip into dangerous waters.

Not to mention the fact that most people don’t actually need every cosmetic procedure under the sun. This is not a pick-what-you-want-off-the-shelf type of service. Our whole philosophy of plastic surgery is that the relationship relies completely on an involved discussion so that the surgeon can recommend the procedure most appropriate to achieve your goals in a reliable and safe manner. That way, you should come out feeling like a more pleasing version of yourself…not a completely different person.

Cosmetic surgery may be elective, but it is not like a salad bar or a box of chocolates. The all-you-can-eat offer can leave you with so much more than just an upset stomach.

Sorry we haven’t blogged in a while. We have just finished a tour of Las Vegas and New Mexico including a conference and consultations with patients. What was interesting to us was the similarities we see among patients’ desires and fears related to surgery. We have both practiced in big cities on both coasts but we have never had the pleasure of consulting with patients in the smaller cities of this beautiful desert country.

We talked to people who were generally well-informed and who had a great deal of interest in the latest and greatest in plastic surgery. Like our patients here in LA, they have justifiable doubts about some of the less invasive procedures that make over-the-top claims in the media. Some have had a Lifestyle Lift elsewhere and have been sorely disappointed. Most all spoke of wanting to look natural and of fearing an overdone appearance. All of them were very willing to consider surgical procedures to achieve their goals. Mostly, they were in need of doctors who would tell the truth about what they could expect from today’s surgical anti-aging procedures.

What we did not expect was the level of sun damage that a majority of patients exhibited. We probably shouldn’t have been surprised since many people in these areas spend much of their work and leisure time in the great outdoors. But, most also confessed that they did not use sunscreen at all, let alone effectively. As a result, we saw a lot of premature skin aging and most patients had had early precancerous lesions scraped or burned off. Many of these sun-related changes such as fine wrinkling, brown spots, and thickening can be treated really well with a series of peels, such as the ViPeel or Blue Peel, along with lifting and volume enhancing procedures such as our new Hybrid Lift to treat sagging skin.

But, the most important thing you can do is to protect your skin from the sun in the first place. We’re good about sun protection, yet UV-filtered photos of ourselves still show a fair bit of accumulated sun damage. So, we spent a lot of our time lecturing about sun protection. Avoidance of sun in the mid-day hours, wearing protective layers, and using a SPF 30 or greater sunscreen liberally and often (especially after water exposure) are all sensible things everyone should do, regardless of skin type. If you want to take skin anti-aging to the next level, then use of a good skin care regimen that incorporates antioxidants and bleaching agents can give your skin a healthy glow that you haven’t seen since grade school. Check out our website for more details.

Welcome to the no spin zone: no, you have not found your way to the O’Reilly blog, however when we read a recent article in the Daily Mail-UK we couldn’t help but wonder why these things would be reported in a newspaper. Do they actually research or do they decide a story they want and then find a number of people who will agree with them?

The story begins by telling us that the popularity of facelifts and anti-aging/ facial rejuvenation surgery is growing year after year, but then takes an abrupt turn by quoting a number of “cosmetic doctors,” who happen to have non surgical cosmetic practices (comprised of fillers- juvederm, restylane, perlane- and botox) who believe that surgery is bad.  What a surprise.

If you have been reading our blogs, especially those regarding the Hybrid Lift, you know by now that our Beverly Hills facial plastic surgery practice is dedicated to bringing natural looking results, and this means that we are strong advocates of a balanced approach utilizing volume enhancement, i.e. fillers, and lifting procedures in concert.

We recognize that potential patients are constantly bombarded by spin and hype from competing physicians and corporations [Allergan- Botox, Juvederm; McKesson- Restylane, Perlane, Myobloc; Artes- Artefill; Bioform- Radiesse, to name a few] and it is important for doctors to be advocates for their patients (not the corporation), so they can honestly explain all the risks and benefits of every available procedure. This is perhaps most important in plastic surgery and cosmetic surgery where we are talking about elective procedures.

The truth is that surgery works brilliantly when done correctly and for the right reasons. Let’s face it, if you have sagging skin and jowling, fillers are not the answer, though they may play a part. On the other hand, if you have hollowing in the cheeks or under the eyes, volume enhancement with a skin pinch may very well be better than traditional blepharoplasty (eyelid surgery). The key is understanding the difference between what a mini lift (lunch time lift) can do and how long it lasts as opposed to a lift that involves the deeper tissues.

Does anyone really believe you can correct these wrinkles by just filling under the skin without making this face look completely different?

We believe that for facial rejuvenation to work that lifting and volume must be coupled. Volume enhancement, for us, has come to mean fat, because some of it will last permanently and, perhaps more importantly, it is natural and safe. We remind you that none of the fillers to date have FDA approval outside the scope of the nasolabial folds (and perhaps lips but we have to check on that). As far as surgery, mini lifts occasionally are indicated, but we have found that patient satisfaction and long term results really depend on addressing the underlying, descending tissue (the SMAS).

The point of all this is that the story begins by telling us how the number of women and men having anti-aging surgery is growing rapidly. There is a reason for that: when it’s done correctly, it works.

Reading the New York Magazine we came across an interesting article that goes over a “new” phenomenon among New York’s higher echelons that involves volume enhancement using fillers and occasionally fat to restore the lost volume that many patients experience as they grow older. The article goes on to highlight a number of dermatologists and facial plastic surgeons in New York that are on the forefront of the phenomenon there.

Composite picture of Demi Moore, Angelina Jolie, Madonna, and Michelle Pfeiffer courtesy of the New York Magazine showing the natural aesthetics which are ideal when volume enhancement and facelifts are combined such as in the HYBRID LIFT

As we read the very well-written article trace the history of facial aesthetics and volume enhancement, we could not help but notice that many of the doctors and quotes noted that as patients age there is a descent of tissue, sagging of skin, wrinkles and jowling, but then they glossed over the fact that volume enhancement alone fails to correct all of these issues. The idea that adding fillers or fat can correct jowling and redundant skin is simply not true.

We don’t normally like to brag here on the post, but in this one instance we hope you permit us a minute to gloat over our HYBRID LIFT.  What we do for our own patients is a minimal incision deep facelift—this is tailored individually depending on how much skin descent and jowling there is—and then add the patient’s own fat back (as in the “new new face”) to recreate the volume so many patients lose as they age. The aesthetic results have been fantastic and our patients love that they can be up and around after only a few days.

While we respect the claims in the article and are proponents of volume enhancement, we find it disingenuous to claim that by replacing volume you can somehow correct the tissue and skin which descends with time. The  problem is that too many people with hammers begin to see everything as nails.

The key points of our HYBRID LIFT are:

1. By doing a deep lift we are able to first replace the patients’ own fallen deep tissue (the SMAS) back into its proper position

2. By using a minimal incision, we never get into the hairlines, move hair tufts, or get a windswept appearance

3. Unlike mini lifts, because we do the work in the deep layers; the results last

4. By then adding fat and restoring volume, we fill out the concavities that lead to an aged appearance and we restore the youthful heart-shaped face that people are drawn to

5. By using your own fat, we are confident that the results last and are natural. Temporary fillers unfortunately are just that: temporary. Permanent fillers are all too often not tested for safety in these other areas, are not approved for these uses by the FDA, and are used in “off- label” procedures whose safety is unclear.

For us, the HYBRID LIFT represents the culminant evolution of facial rejuvenation.  Stay tuned for the HYBRID LOWER EYELID LIFT…

Here’s a typical scenario. You’re considering facial plastic surgery to take care of a bump on your nose, a droopy tip, or a sagging jaw line. The feature may be subtle, but it’s definitely there. And you’ve been thinking of doing something about it for so long.

You’ve finally worked up the courage to tell your husband/mother/sister/brother/best friend (insert loved one here) about it and, instead of unwavering support, you hear something like “Your nose is fine. Why would you mess with it?”. Other reactions are “Whatever makes you happy, honey” or, “I was wondering when you were gonna take care of that honker”. But, the overwhelming #1 reaction is the first one.

You’re crestfallen. You start to second guess yourself. You think “I’m not imagining this. There is a noticeable bump on my nose. Why doesn’t anyone else see it?” Well, the answer is, they do and they don’t. They can see the feature you’re pointing to just as well as you can. The human eye is capable of incredible feats. Our eyes can discriminate between two objects down to 1/25th of an inch or about 1 mm. So, if we show you a photo of your nose and another photo with your bump shaved down just one millimeter, you’ll be able to see the difference every time. And, we all also have a built-in, hard-wired aesthetic sense of proportion, symmetry and ‘belonging’ness when we compare one feature to the rest of the whole. So, they know deep down that the bump is there.

But, your family or friends may not “see” what you’re talking about because they don’t wish to and they don’t attach the same level of importance to it as you do. They care for you as you are, as they should. And, they’re afraid for you. Afraid of the risk, even if it’s very small. And, afraid that you’ll change too much. After all, you may want a subtle change or a dramatic change, but they don’t necessarily see what you see.

Some of our patients who are REALLY close to family and friends and look to them for advice are really freaked out by this. We’ve even had a few patients recently who’ve nearly psyched themselves out of their decision. The important thing here is not to try to force your loved one to feel about your proposed surgery the way you do. Family are never quite as enthusiastic as you may be. Instead, you should let them know how important this decision is to you, and how much better you’ll feel if you have a positive outcome. That will often turn them around because what’s important to you is often what’s important to them. The decision to have surgery is a very personal one and is ultimately yours. You can reassure them that, if you’ve chosen the right surgeon, your results will look natural and won’t remove your identity.

What’s interesting is that the most resistant family member or friend is usually your most astonished and glowing supporter after the surgery once they see how happy you are with the change. This is just something to consider when you sit down to have “the talk”.