Cosmetic Surgeons Share 10 Popular Procedures
Are any of these on your 2018 beauty wish list?
When it comes to beauty, Father Time is also the mother of invention. New devices and procedures are constantly being introduced into the world of cosmetic medicine. While Botox and fillers have become a popular fountain of youth for many women—and men—doctors have a wide range of rejuvenation tools. But as each of these doctors advise, patients should be savvy consumers. Always go to a board-certified dermatologist or plastic surgeon, and always ask about recovery times and costs before choosing a procedure.
Put a lid on it
BLEPHAROPLASTY EYELID SURGERY
Blepharoplasty delivers a lot of blink for its buck. “It’s a surgery that can result in dramatic results with a relatively short recovery time,” explains Dr. Paul Sabini of Newark. “Little changes around the eyes can make a big difference.” Upper eyelid surgery removes sagging skin that results in heavy, hooded eyes. Lower lid surgery tackles the baggy, saggy eye area. Lid issues affect men and women equally. In Sabini’s practice, men see him for surgery on their eyelids more than any other part of the face. There is a one- to two-week recovery time, which is why Sabini often suggests that people without significant sagging go with the nonsurgical option. Using targeted Botox injections, Sabini can create lift in the upper eyelid area. But Botox doesn’t provide a permanent solution. “The holy grail for every surgeon is to find a tightening procedure that doesn’t have downtime but lasts,” he says. “There are a lot of things out there, but none have surpassed surgery.”
Bumps, humps and bad tips. These are the complaints that many people have about their noses. While surgical nose procedures are common, they do involve recovery time. To get a quicker fix, Dr. Lawrence Chang suggests his so-called five-minute rhinoplasty, which he performs in his Newark and Rehoboth offices. Chang resculpts the nose using Restylane, a hyaluronic filler that’s typically used to target facial wrinkles. This is an off-label use, Chang cautions, but in the hands of a board-certified plastic surgeon, risk of complication is very low. Using a small cannula, Chang injects the filler into certain areas of the nose. There are no incisions or trauma to bones, so the healing time is almost zero. “This is right for the patient who wants a cosmetic change,” Chang says. “It’s not right for someone who has a deviated septum or other issue that needs surgical treatment.” Of course, surgery is permanent. Restylane is not. Noses need touch-ups every six to eight months. “But the good news is that the Restylane lasts longer than in other places because noses don’t move as much,” Chang explains. “The farther you get from the mouth, the longer it lasts.”
Perfect your pout
Full lips are all the rage thanks to the Kardashian-Jenner clan. Sabini explains that, anatomically speaking, there are two ingredients for a youthful-looking mouth. No. 1: volume. “Try filler first so you can see how it looks, and make sure you like it,” Sabini advises. If filler meets with a patient’s approval, she can consider a permanent change via a fat graft. Sabini harvests fat from a patient’s abdomen or hips, then transplants it into her lips. Although not all of the fat survives, patients should see a long-lasting fullness. The second part of lip augmentation is to lift the top lip. “Gravity is relentless and will pull lips down, stretching them out and turning in the upper lip,” Sabini says. Though the surgical correction is fairly straightforward, Sabini cautions that it’s not right for everyone. Patients should get a lip evaluation to see which option is best for their facial structure.
Ask a woman over age 60 to name her least favorite body part and she’s likely to pick her hands. Whereas other areas typically get bigger, hands can lose tissue and become bony, resulting in knotty, skeleton-esque hands. Dr. J. Joseph Danyo of Greenville has an easy fix. During a procedure in his office, Danyo plumps hands’ tissue with filler or patient’s own fat. Filler can be used to see if the look is aesthetically pleasing, but fat grafting is almost permanent. After harvesting fat from the belly or flanks, Danyo uses a syringe to insert it into hands and fingers. The procedure involves two or three injections in each hand. “We create a smooth layer over the entire hand, from knuckles to wrist,” Danyo explains. “There is a little bruising, but no real downtime.”
Gobbler, turkey neck, throat hammock—there are many names for neck’s sagging skin, and none is flattering. Both men and women get gobblers, and cosmetic doctors say they are one of the most complained about areas of the body. In his Newark and Rehoboth offices, Dr. Abdollah Malek uses a neck tightening technique that does not require major surgery or a hospital visit. Malek does the procedure. After a patient is given a mild sedation, Malek makes 3-millimeter incisions under the ears and chin, then inserts a thin probe topped with a laser. Fat is removed with a modified SmartLipo device, then Malek uses PrecisionTX laser on the neck’s skin. “We have learned that if you heat the skin to 45 to 46 degrees centigrade, it will tighten on its own,” Malek says. The procedure lasts 30 to 40 minutes. Stitches aren’t required and bruising is minimal. Recovery takes five to seven days, Malek says.
Sags and bags aren’t the only markers of aging skin. Weathered, dull skin and fine lines are other signs of age-related damage. Acne can also scar facial skin, leaving patients with pock-like marks. Microneedling, properly known as collagen induction therapy, has become a popular remedy. Inserting needles to improve the skin sounds scary and counterintuitive, says Dr. Chris Saunders. “But by damaging the skin ever so slightly, we create an injury that the body heals by producing collagen,” he explains. Microneedling is done with a precise, hand-held device that moves over the face. Patients can opt to get only certain areas done, like the skin above the upper lip, but Saunders warns that can create an imbalance in skin’s appearance. “Treat the face as one aesthetic unit so you can get the best, most even results,” he advises. To avoid discoloration, people with darker complexions should consult with a board-certified cosmetic doctor before undergoing microneedling, Saunders says. Treatments require patients to be in Saunders’ Newark, Wilmington or Chadds Ford office for one hour. While patients see a difference after one session, Saunders recommends a series of three to five spaced over three or four weeks. Downtime is one or two days, he says. “We’re microneedling people of all ages, from 30 to 80,” he says. “It’s a good option for someone who wants enhanced texture and tone and a more youthful-looking complexion.”
SCULPTRA COLLAGEN STIMULATOR
Not ready for a surgical face-lift? Chang uses Sculptra injections to return volume to aging faces and lift sagging, wrinkled skin. Juvederm, Restylane and other fillers are hyaluronic acids. Sculptra is different. It is poly-L-lactic acid, a collagen stimulator. When injected into the skin, Sculptra works inside the dermis to rebuild collagen. “It’s like rebuilding the facial framework,” Chang explains. “When placed in proper areas, Sculptra can lift the cheeks and add firmness, and that decreases nasal labia folds. It’s one of my favorite things for minimally invasive rejuvenation.” There is more bruising with Sculptra than with fillers, and it’s not a quick fix—that collagen takes time to grow. Patients typically see results within four weeks. Tightness and skin texture should continue to improve over several months. The big plus is that Sculptra lasts two years, much longer than fillers.
Plump it up
FACIAL FAT TRANSFERS
No one wants fat in her face—unless it helps her look younger. Several doctors now substitute filler with patient’s own body fat. As Malek explains, fat is an all-natural substance—and it’s free. Here’s how it works. During an in-office procedure, Malek harvests fat from a patient’s tummy, hips or other areas where it’s not wanted. He puts the fat in a centrifuge for a few minutes, then, using a thin cannula, Malek injects the fat, adding volume to the upper face and sculpting the lower face. “We can lift eyebrows, define cheeks and chins, and ease wrinkles in nasolabial folds,” Malek explains. The procedure creates temporary swelling. Recovery is about two weeks. One possible side effect: If patients gain weight, they may gain it in the areas where fat was transferred. On the plus side, more than 40 percent of the fat will survive and last for many years.
FAT TRANSFER WITH PRP
Chang has a way to increase the lifespan of fat transfers. After harvesting the fat, Chang does a simple blood draw. From that, he gets platelet rich plasma, blood’s growth factors. He mixes the PRP into the fat, then injects it into areas of the patient’s face, the same way he would do with filler. Chang can use PRP-enhanced fat to do full facial rejuvenations with long-lasting results. “PRP allows fat to survive better when transferred,” Chang explains. More than 60 percent of it should be in place even after several years. There is more swelling than with basic fillers. Chang says recovery is approximately one week.
Botox, fillers and fat transfers can do a lot to make patients look more youthful. But after a certain age, many opt for surgery. Though it costs more and has a longer recovery time than fillers and Botox, a mid facelift usually provides more comprehensive results. “This is the procedure that turns the clock back,” Sabini says. “We’re lifting the skin and moving it back into place.” As Sabini explains, he raises skin in the cheek areas, tightening there, as well as under the eyes, the nasolabial folds and jaw lines. Bandages come off the next day, but full recovery takes two to three weeks. Patients don’t have to stay home the whole time, but Sabini limits their heavy-duty activities.
Mother’s little helper
Once taboo, vaginal rejuvenation is now one of the most-requested procedures in Delaware. “It took time for women to learn about it, have it done, then tell their friends,” Danyo says. But the grapevine lit up with vaginal rejuvenation’s results, and they aren’t all cosmetic. As Danyo explains, many women in perimenopause and menopause experience dryness, atrophy of vaginal tissue and urinary incontinence. New devices claim they can revitalize that area by boosting collagen in vaginal tissue. No surgery or injections are involved. Instead, cigar-sized devices are inserted, then, during 20- to 30-minutes sessions, the devices release energy into surrounding tissue. Patients get three treatments over a three-week span.
Chang also offers the procedure. He says patients report increased tightness and lubrication. Chang and Danyo emphasize that these procedures are not replacements for treatments that address significant incontinence or other issues for which women should consult other medical professionals, and OB-GYN clearance is needed before women can have the procedure. “But it’s a simple treatment that provides great results for a problem that affects a lot of women,” Chang says.