What is fractional laser skin resurfacing?

Posted on December 19, 2012 by Donald B. Yoo, M.D.

For years lasers have been used to improve wrinkles, stretch marks, acne, surgical scars, uneven skin tone, and other skin conditions.  Lasers are well-suited to treat specific conditions because of their precision.  In the dark ages of laser resurfacing (1990s) the entire skin surface was ablated (removed) leaving a very large, raw surface area.  Undergoing laser resurfacing was a major ordeal, involving lots of preparation time for adequate pain control, and a prolonged recovery afterwards as the skin healed back over raw areas.

Enter fractional resurfacing technology.  Instead of removing the entire skin surface, columns of laser light in a honeycomb pattern treat 20-30% of the skin surface at a time.  These laser microbeams create areas of treated tissue surrounded by untreated tissue, allowing the skin to recover much more quickly and minimizing the downtime.    Side effects are minimized while healing and aesthetic outcomes are maximized.

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My surgeon recommended “fat grafting” to me. What does it involve and how long does it last?

Posted on December 17, 2012 by Donald B. Yoo, M.D.

Fat grafting or fat transfer has become a very popular stand-alone and adjunctive procedure in aesthetic plastic surgery.  The premise of fat grafting is to use your own body’s tissue as a volumetric filler instead of a synthetic material.  Besides eliminating the chance of any foreign body or allergic reaction, since it is your own tissue, fat has the added advantage of providing a longer-lasting, potentially permanent result.

Fat is first harvested by performing conservative liposuction to the abdomen, or flanks.  The technique used during harvest and fat preparation is critical to ensure the highest concentration of stem cells.  These stem cells are responsible for growing in the grafted areas and maintaining a long-lasting result.  I use the Adivive Lipokit system, which harvests at low pressure so as not to disrupt the fat cells, and filters and prepares fat to achieve high stem cell concentrations.

Once the fat is harvested and prepared, fat grafting and transfer is performed using a cannula.  Fat is commonly grafted to restore volume in the tear troughs, cheeks, smile lines (nasolabial folds), temples, brows, and around the eyes (peri-orbit).  In Asian and Korean plastic surgery patients, a common treatment area is also the forehead, to create a more rounded rather than flat appearance.

Approximately 30-50% of the initial volume remains as a lasting result.  Discomfort after the procedure is minimal, and bruising and swelling typically resolve within a week.

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Why is the revision rate so high for rhinoplasty?

Posted on December 12, 2012 by Donald B. Yoo, M.D.

In a recently published study, rhinoplasty surgeons across the country were surveryed on their rates of revision rhinoplasty.  That number is ~20%, meaning about 1 in 5 patients undergoing a primary rhinoplasty will undergo a revision surgery.  There are a number of possible reasons for revision rhinoplasty surgery.

Rhinoplasty is commonly called the most challenging procedure in all of surgery.  And while it can be a technically demanding procedure at times, the need to balance the forces of healing and the patient’s aesthetic goals with what is surgically achievable increases the difficulty level many-fold.  A fantastic result on the table will not always heal in predictable ways.

Besides unintended results, revision rhinoplasty can occur when there is a disconnect between the patient’s aesthetic and that of the surgeon.  In his/her eye, a surgeon may have performed an impeccable surgery and delivered a nose that is pleasing to him/her, but far from what you consider ideal.  Reviewing photo-imaging and photo-morphing with your surgeon prior to surgery is an excellent way to communicate your goals and to ensure you two are on the same page.  Looking at a surgeon’s before and after pictures is another great way to get a sense of your surgeon’s aesthetic.

Lastly, having realistic goals and expectations about surgery is critical before any procedure and especially for rhinoplasty.  Rhinoplasty is not about perfection, but about improvement.

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What’s the advantage of incisional blepharoplasty versus suture techniques in Asian double eyelid surgery?

Posted on December 10, 2012 by Donald B. Yoo, M.D.

Incision-less suture techniques for Asian blepharoplasty (double eyelid surgery) are popular because they do decrease the downtime and recovery for suitable candidates. In the appropriate patient, suture techniques, such as the double-suture with twist (DST) work extremely well at creating a fairly durable (long lasting) supratarsal crease (double eyelid fold).  Patients with thick upper eyelids, with significant subcutaneous/orbital fat, are poor candidates for suture ligation techniques.  Incision-less techniques also can not address upper eyelid skin asymmetry or ptosis.  Asymmetry of the upper eyelids is commonly encountered, and can only be fully addressed with incisional techniques.

Incisional blepharoplasty (Asian double eyelid surgery) produces the most durable, permanent solution to create an aesthetically pleasing double eyelid crease at a predictable location.  In the Asian eyelid with a natural supratarsal crease (double eyelid), the muscle which opens the eye (called the levator aponeurosis) has small connections with the skin which tether the skin and create the double eyelid crease.  These connections can be re-created during incisional blepharoplasty without relying on a buried suture such as in the suture techniques such as DST.

Suture techniques can provide beautiful results in patients with thin, symmetric upper lids without ptosis.  However, incisional blepharoplasty provides the longest-lasting (permanent), predictable results in all patients.

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Who should be using Retinol or Retinoid creams?

Posted on December 4, 2012 by Donald B. Yoo, M.D.

Retinoid describes a vitamin A derivative that helps unclog pores, boost natural collagen production to reduce fine lines, and speed cell turnover to improve skin tone and texture. There are 3 prescription-strength retinoids available: tretinoin (Retin-A, Retin-A Micro, Atralin, Avita, Renova), tazarotene (Tazorac, Avage), and adapalene ( Differin). As an over-the-counter alternative, retinol is available. Retinol is gradually converted into retinoic acid (the active ingredient in prescription creams), but is less potent.

Starting a retinoid regimen can be irritating at first, and it’s important to keep your skin well moisturized. Applying the cream at night gives your skin a chance to absorb the product without being exposed to sunlight. For the first 2-4 weeks, ease into the regimen by applying every 3rd night while your skin becomes accustomed to the product. Once the skin biology has adapted, apply every other night or even every night if there is no increase in drying or irritation. As always, apply SPF 30 sunscreen whenever exposed to sun.

Anyone who wants smoother, more even, younger looking skin should be on a retinoid. It will soon become your skin’s best friend.

 

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Is there any way to get a browlift without surgery?

Posted on November 30, 2012 by Donald B. Yoo, M.D.

Using Botox or Dysport, it’s possible to modulate the muscles that move the eyebrows to create a temporal browlift. What this means is that the arches of the eyebrows can be raised by selectively treating the forehead and sides of the brows. The frontalis muscle, which is a thin muscle that lies along the forehead, works to raise the eyebrows. The orbicularis muscle closes the eyes and also pulls the lateral brow (sides of the eyebrow) down. By treating the orbicularis and the central frontalis muscle with Botox or Dysport, the muscle can no longer pull the brow down. This results in the arch of the brow becoming lifted and producing a temporal “browlift”.

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What’s a photofacial? Is it a facial or is it a laser?

Posted on November 30, 2012 by Donald B. Yoo, M.D.

A photofacial is another name for an IPL (intense-pulsed light) treatment. It is an FDA-approved treatment that uses rapid flashes of intense light to target problematic areas on the face, neck, chest and hands. It’s a great way to even out your skin tone by eliminating and reducing the appearance of sun-spots, freckles, and hyperpigmentation from years of sun-damage.

An IPL photofacial treatment series typically consists of several sessions spaced 3-4 weeks apart for maximal improvement, although significant improvement is apparent after each treatment. A full-face treatment typically takes 15-20 minutes to perform. The rapid flashes of light are absorbed by the pigment within the skin, and over the course of 1-2 weeks this pigment “lifts” and comes to the skin surface. Once on the surface it will “slough” off with the old skin and disappear, leaving a more even skin tone. The treatments are easily tolerated, and require minimal downtime. Sun exposure should be limited after treatment for best results.

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I’ve been snoring a lot and my ENT said I have a deviated septum. Will straightening my septum get rid of my snoring?

Posted on November 27, 2012 by Donald B. Yoo, M.D.

Snoring is caused by obstruction and turbulent airflow anywhere along the airway. The airway begins at the nostrils and the mouth, and continues through the nasal cavity, oral cavity, oropharynx (back of the throat), larynx (voice box), and trachea (wind pipe), until finally air reaches the lungs. As you can see, there are a lot of different levels at which a potential problem could occur, and result in noisy breathing. The septum is within the nasal cavity, and is only one of the many levels at which airway obstruction can occur. If this is the only cause of airway obstruction, then a septoplasty (surgery to straighten the septum) would potentially eliminate the turbulent breathing causing snoring.

The first step in determining an appropriate treatment plan for snoring is to undergo a test called a polysomnography (PSG) or “sleep study”. During this test the patient presents to a sleep lap at night. Before going off to bed, he or she is connected to multiple monitors including an ECG, EEG, and pulse oximeter. The patient then goes to sleep, and is monitored throughout the night to determine the severity of his/her sleep apnea (snoring). Septoplasty almost always improves breathing and decreases the symptoms of nasal obstruction. However, in cases of severe sleep apnea, may not be sufficient to eliminate snoring.

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Are there any easy things I can do to minimize bruising after surgery?

Posted on November 21, 2012 by Donald B. Yoo, M.D.

Bruising is caused when blood escapes from a broken blood vessel, a common occurrence during facial plastic surgery. Part of minimizing bruising after surgery starts before surgery. It’s important to avoid foods and medications that thin the blood and impair proper platelet function, such as aspirin, gingko, ginseng, garlic and alcohol, to name a few. Taking the right peri-operative supplements, such as Arnica, Bromelain and vitamin K, can help to reduce post-operative bruising.

Immediately following surgery, applying ice to the affected areas, 20 minutes on/20 minutes off, will help to limit the swelling and bruising. The head should be kept elevated, sleeping on 2-3 pillows, to limit excess blood flow to the area. Strenuous activity is to be avoided. Bruising after surgery will usually manifest in 24-48 hours, and once it does the ice packs should be discontinued and warm compresses used instead. The warm compresses help to dilate the blood vessels and help deliver immune cells to the area to speed healing.

With this regimen, most bruising should be significantly improved in the first post-operative week. Residual bruising can be treated with a pulsed-dye laser, which helps promote the clearance of the remaining pigment.

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I want fuller lips, but I don’t want to look ducky. Is this possible?

Posted on November 20, 2012 by Donald B. Yoo, M.D.

Over the years surgeons have tried many different things to increase the volume and fullness of the lips. Not surprisingly, many of the techniques have been abandoned for producing less than stellar results. Fortunately, there is a safe, natural-looking, convenient way to achieve lip augmentation. With hyaluronic acid dermal fillers such as Juvederm and Restylane, lip volume can be restored precisely in the areas that need it. Unlike implants, which do not move with the fluidity that the lip normally moves with, Juvederm and Restylane are soft and pliable, giving you a very natural result. The exact appropriate amount of dermal filler can be titrated by the surgeon during the injection, ensuring precise filling without producing a “ducky” look.

Treatments can be performed in 10-20 minutes with topical anesthesia and/or local nerve blocks. Using a needle-less, blunt cannula technique bruising is rare. Some swelling is expected to occur and resolves over 1-3 days. Patients can resume all of their usual activities immediately after the treatment.

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