What is a deep-plane facelift? How is it different from a SMAS facelift?

Posted on February 14, 2024 by admin

During a traditional SMAS facelift, the skin and subcutaneous tissue is elevated from an incision designed around the ear in a single layer. The layer deep to the skin and subcutaneous fat is the SMAS, or superficial musculo-aponeurotic system, a term coined by plastic surgeons Mitz and Peyronie in the 1970s to describe the anatomic layer investing the muscles of facials expression. For a traditional facelift, the SMAS layer is either plicated (oversewn) or imbricated (a small portion resected and the ends re-approximated) and the skin pulled along the incision to create a lift. This approach would distribute some of the tension of the lift along the SMAS layer, but a significant portion of this force vector would fall on the skin incision line itself.

During a deep-plane facelift, the skin and subcutaneous fat is elevated in one plane, and then as the dissection proceeds anteriorly towards the midline of the face and neck, the dissection descends under the deep-plane (SMAS layer) to create a thicker, more robust flap consisting of skin, subcutaneous fat and SMAS combined. The SMAS is mobilized and secured to provide the lifting for the facelift, with minimal reliance on the skin itself, thus allowing for a tension-free closure of the incisions. This results in a less “pulled” and more natural appearance, more durable, long-lasting results, and reduces the amount of downtime due to bruising and swelling.

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Where are the scars for a deep-plane facelift? How much downtime is there for a facelift?

Posted on February 13, 2024 by admin

The beauty of a well-designed and well-performed deep-plane facelift is that the result is youthful and natural, and the scar is virtually undetectable. The incision is hidden in the temporal hair tuft, along the back of the tragus, and in the crease behind the ear, outlined in red in the figure above. With meticulous, tension-free closure of the incisions, they become difficult to see by two weeks, and fade with each and every week of healing.

This image has an empty alt attribute; its file name is Skin-Closure-1024x656.png

Sutures remain in place for one week, and patients typically feel “restaurant ready” in two weeks.

Before and After deep-plane facelift with Beverly Hills Plastic Surgeon, Dr. Donald B. Yoo, M.D.

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Does scarless rhinoplasty or closed rhinoplasty have any limitations? Why wouldn’t you want a nose job with no scar?

Posted on February 7, 2024 by admin

Closed rhinoplasty or scarless rhinoplasty is an excellent procedure in the properly selected patient. Scarless rhinoplasty involves making incisions only within the nostrils, so that the scars are hidden and difficult to see from the outside. This does make the surgery faster, and swelling typically will be less than a comparable open rhinoplasty procedure. Scarless rhinoplasty and closed rhinoplasty work best in patients with:

  1. near ideal tip support
  2. near ideal tip aesthetics
  3. adequate dorsal height and projection
  4. thin to moderate thickness skin

Closed rhinoplasty and scarless rhinoplasty faces serious limitations in patients with:

  1. weak nasal tip support
  2. wide, bulbous or ptotic nasal tip
  3. lack of projection
  4. lack of dorsal height
  5. very thin, or thick, sebaceous skin

The best candidates for closed rhinoplasty and scarless rhinoplasty are those patients with near ideal tip aesthetics and seeking only a very mild change to the appearance of their nasal tip, but do want to address contours along the nasal dorsum such as a dorsal hump or wide lateral nasal sidewalls. Anything beyond a minor change to the tip of the nose often will be better served through an open rhinoplasty approach.

This beautiful patients underwent a previous scarless rhinoplasty with another surgeon with overall good results, but with some contour irregularities along the nasal tip and a lack of definition along the tip-alar transition. Using unified tip grafts crafted from her septal cartilage and cartilage from her ear I was able to create a smoother nasal tip contour and redefine the tip, ala and nostrils.

With proper incision design and execution, an open rhinoplasty will also leave a “scarless” appearance, with greater refinement and definition of the nasal tip complex.

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Considerations during Asian Rhinoplasty and Asian Nose Job using your own rib cartilage and DCF (diced cartilage fascia)

Posted on February 7, 2024 by admin

Asian rhinoplasty and Asian nose job surgery has enjoyed a surge in popularity as the interest in rhinoplasty surgery more broadly has also increased due to the wider social acceptance and emergence of techniques and surgeons capable of producing predictably beautiful results. While rhinoplasty as a general concept involves reshaping the nose, it’s far too broad a term to accurately reflect the enormous variation in terms of surgical technique and expertise demanded of rhinoplasty surgeons to modify an individual’s anatomy to create the specific aesthetic desired.

For Asian rhinoplasty more precisely, the challenge of creating definition in a setting where the pre-existing nasal framerwork and innate nasal cartilages are weak relative to the thickness and strength of the overlying skin, the rhinoplasty surgeon has the additional challenge of creating form by supplementing and enhancing the structure and integrity of the nose. The 1970s saw a rapid rise in China, Korea and Japan of using silicone implants to augment the nasal dorsum and bridge, and often project and define the the tip of the nose as well. Silicone provided a quick and easy way to add structure, and some degree of definition, to the nose in a way that was well tolerated for years, and sometimes even decades.

As time went on, however, the effects of having a synthetic implant – silicone, Goretex and Medpor – became clear in that they behaved like foreign bodies in the nose, always facing rejection and sometimes even extrusion or ulceration through the skin. For this reason, surgeons have sought out different sources from your own body to provide building blocks for reshaping the nose, including: septal cartilage, ear cartilage, fascia, rib cartilage, and bone.

For the safest, most permanent results, using 100% your own tissue is the best building block. Whether your surgeon uses ear cartilage, septal cartilage or rib cartilage is only one part of the equation for creating a naturally beautiful nose. While some sculptors may be able to turn a block of marble into a flooring tile, an expert sculptor with superlative aesthetics will be able to create Michelangelo’s David. In the same way, seeking a surgeon who uses your own tissue is the bare minimum, requisite first step to achieving successful results, while the more paramount requirement is having the skill and artistry to create the shape that you desire.

See more at:

https://www.youtube.com/drdonyoo

https://www.instagram.com/asianrhinoplasty/

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Who is the best rhinoplasty surgeon in the world? Best Plastic Surgeon in Beverly Hills?

Posted on February 3, 2024 by admin

Any attempt at definitively and objectively determine who is the single best plastic surgeon, or rhinoplasty surgeon for that matter, is an endeavor fraught with subjectivity and destined for failure. Unlike other surgical specialities where outcomes and quality of treatment may be quantified, at least to a certain extent, with indicators such as rates of cure/survival, complication, infection, patient satisfaction, etc. in plastic surgery, relative success and failure is determined by each individual patient and not the collective of patients undergoing surgery by a particular surgeon. In the case of plastic surgery, simply choosing a surgeon who had success creating a wildly popular and sought after nose on a celebrity’s face such as Song Hye Kyo, Angela Baby, or Scarlett Johansson, is not a gaurantee to yield the same beautiful result. As a patient seeking out plastic surgery or rhinoplasty, be exceptionally wary of any surgeon advertising themself, or even self-describing themself on their website search results as “The Best Rhinoplasty Surgeon in Los Angeles” or “The Best Plastic Surgeon in Beverly Hills” as these are titles bestowed unto themselves.

When choosing a plastic surgeon, or rhinoplasty surgeon, the more important question to ask is: Is this the best plastic surgeon in the world for ME? This means the standard recommendations of vetting the doctor’s credential’s, training, reviews and expertise hold true. However, there is a very important distinction and caveat that can only be gleaned by careful review of this surgeon’s previous work, including before and afters and videos of previous patients. Has she/he operated on patients that have anatomy like mine? Has she/he produced beautiful results on other patients that look like me? HOw often does this surgeon perform this specific procedure? Does my rhinoplasty surgeon or plastic surgeon share my same ideals and biases when it comes to aesthetics and do we align in terms of the facets of my appearance I’d like to enhance and which I’d like to simply preserve? These are simply a few of the questions a potential patient should thoroughly consider before finding the “best” plastic surgeon for any kind of procedure.

In the end, the best plastic surgeon and best rhinoplasty surgeon is the surgeon who delivers the naturally beautiful results you are looking for.

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Time heals all wounds

Posted on September 12, 2022 by admin

When the skin goes through trauma it develops scar tissue to repair and protect the site of injury. There are a few phases to scar tissue formation. First is hemostasis where blood clotting begins and scab formation occurs. Next is the inflammatory phase where there is inflammation and edema. After that is the proliferation phase where collagen, elastin, and other components of granulation tissue are grown. Lastly is the remodeling stage where old cells are destroyed and new cells form. Errors in this stage can lead to excessive growth of tissue leading to hypertrophic scarring or keloids.

Keloids appear as pink, flesh, or red colored raised growths that can continue to grow larger. Growth can occur for months to even years. Hypertrophic scars are thickened scars that are more localized to the area of injury compared to keloids, are easier to treat, and can become less noticeable with time.

Ways to treat hypertrophic scars or keloids include steroid injections, dermabrasion, or lasers. It is important to discuss with your surgeon what options would work best for you!

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Mask of Pregnancy – Melasma!

Posted on July 12, 2022 by admin

Melasma is a condition where gray to brown patches appear on the face. It can occur in all skin types but more commonly on darker skin tones. Melasma occurs in 50-70% of pregnant women hence the nickname “pregnancy mask”. This skin condition is the most common cosmetic problem related to pregnancy. 

Although the exact reason why melasma occurs has not been discovered, there have been various factors that have been thought to contribute to it. Such factors include sun exposure (UV radiation), pregnancy, genetic factors, hormonal treatments and cosmetic products. Pregnant women undergo a variety of changes internally and externally, and it is believed that the main reason melasma occurs is because of hormonal changes.
The most effective way in attempting to prevent melasma is avoiding sun exposure and using sunscreen with high SPF during pregnancy. Hydroquinone is the most popular treatment for melasma after pregnancy. Laser treatments are also effective in treating melasma, specifically Picosure. It is the only laser that is FDA approved to treat melasma. Consult with our medical providers specializing in Picosure to discuss if this is the right treatment option for you.

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Can I wear lash extensions during surgery?

Posted on May 16, 2022 by admin

Got Lashes?

Can I wear lash extensions during surgery?

The short answer is preferably no. We recommend that our patients leave out their extensions mainly because it can interfere with surgery as well as cause an issue with sterility. For some procedures, we tape the eyes with a clear dressing to prevent the eyes from becoming dry and causing any corneal scratching. Lash extensions may be dislodged as we remove the tape. They may also fall off and fall into the eye which can increase your risk for corneal abrasions. 
When can I put lash extensions on again? After surgery, we recommend waiting at least one month! This is to allow all of the incisions to heal correctly and reduce the risk of infection. If you are still unsure about your aftercare instructions or what to prepare for before surgery, contact the office and we can answer those questions for you!

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Palms are sweaty, knees weak, arms are heavy.

Posted on May 9, 2022 by admin

Hyperhidrosis is a condition that involves excessive sweating in the hands, underarms, face, or extremities not necessarily due to exercise or body temperature. Typically, the body’s sweat glands produce enough perspiration during exercise, fever, or under stress to regulate the body’s temperature. In people who have hyperhidrosis, the sweat glands do not shut off and continue production.

Botox is a toxin that is created by the bacteria Clostridium botulinum. It has been used for various conditions such as migraines, hyperhidrosis, muscle spasms, and cosmetic treatments to smooth out wrinkles. Botox works for hyperhidrosis by blocking a neurotransmitter called acetylcholine which binds to the sweat glands and signals the glands to release sweat. Botox injections into the targeted areas can reduce excessive sweating. Botox has been FDA approved to treat underarm sweating. Other “off-label” areas that are done are palms, face, and soles of the feet.

Research shows that Botox can reduce sweating at least by 50% and repeated injections are usually done every 6-9 months. If you are interested in this procedure, book a consultation with our specialist today.

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Trapezius botox!

Posted on May 6, 2022 by admin

The trapezius is a large trapezoid shaped muscle that starts at the neck and extends to the shoulders and back. It is an important muscle that allows you to shrug your shoulders, stand up straight, tilt your head, and control your scapula.

People can develop larger muscles through overuse, increased activities, or lifting weights. This can cause the appearance of broad and masculine shoulders. A way to reduce this is to inject Botox or Dysport into the trapezius.  This procedure will help relax and shrink the muscle allowing a more femine and slim shape to the shoulders. A more defined shoulder line will also elongate the neck giving a more elegant look.

If you are interested in this procedure, book a consultation with our expert to see if this would work for you!

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