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Filed under: Chin — Tags: , , , , , — Dr. Andrew Campbell

No, I would highly recommend that you not let anyone place ArteFill in an empty pocket where a chin implant was removed. ArteFill is a methylmethacrylate permanent injectable filler that is designed to be placed in the dermis of the skin and placing large quantities of this substance in a pocket in the chin I think would have a very high risk of some sort of complication. Mainly, I would be concerned that the filler material would not provide adequate support for the chin and you could end up with asymmetries, bumps, nodules, and even infection. Depending on the reason that you required a chin implant removal, I would personally recommend replacement of the chin implant with another more appropriately sized implant. This could be performed at the same setting as the removal of the implant if the only reason for removal was due to malposition, malplacement, or an overly large or small size. If the reason for removal was infection, then you may have to wait until the infection completely subsides before another chin implant can be placed. I would again caution you against placement of any sort of filler in the chin area as I personally feel that you would have a much higher likelihood of a successful result if you opt for revision chin implant surgery.

As far as I know, virtually all photorejuvenation laser systems use some form of intense pulsed light. Intense pulsed light has been around for many years, but they have made some significant improvements in the technology, specifically the BBL System by Sciton, which stands for broadband light, seems to be distinctly superior over our previous technology of intense pulsed light in that it has a significant amount of “punch.” In essence, the broadband light seems to be much more efficient at treating vascular and pigmented lesions and we therefore tend to turn down the power setting quite a bit compared to our prior intense pulsed light technology. This allows us to treat in a much safer and more comfortable manner and yet we end up getting superior results when compared to intense pulsed light. We have had several employees that have extensive experience with intense pulsed light in the past and now have been trained on our new broadband light or BBL technology. These employees have been extremely impressed with the BBL therapy as it seems to provide a more efficacious treatment with less discomfort and less risk of any complications. At Quintessa Medical Spa we will frequently combine BBL technology with other laser systems such as the ProFractional laser and/or micro laser peels to not only rid our patients of unwanted pigment and vascularity, but also to improve their overall skin texture and provide for wrinkle reduction.

Juvéderm can be placed in virtually any fold or line on the face that is deep enough to fit the filler material in. In essence, any fold that can create a shadow can be filled with Juvéderm or Restylane and the fold and shadow then will temporarily be gone. These hyaluronic acid fillers are wonderful treatment options for patients that have some early signs of aging as with one to two syringes, we can virtually rid the patient of any unsightly lines and folds that they have and give them an extremely rejuvenated appearance in as little as 20 minutes. The results are instantaneous. The downtime is absolutely minimal with only a small amount of redness or swelling in the area for a day or two. The results can then last up to 12 months and then the product slowly is resorbed. For certain issues like the smile lines, there really is no adequate substitute for the hyaluronic acid fillers as they work so incredibly well, are so well tolerated, are relatively inexpensive, and last a relatively long period of time. I would recommend anyone interested in considering Juvéderm or Restylane for their smile lines to make a complimentary consultation at Quintessa Medical Spa so that your concerns can be discussed and a customized treatment plan developed.

I would personally have to say that fat injections would indeed improve the skin quality more than the Sculptra injections would simply because fat injections do have this subtle rejuvenating quality to the overlying skin, which is thought to be due to a stem cell type rejuvenation of the skin cells. Sculptra obviously would not have the stem cells that fat injections have and the only improvement in skin quality the Sculptra would perform would be due to the overall volume improvement of the face due to the inflammatory changes that occur with the injection of Sculptra. The improved volume would thus essentially stretch out the skin or fill the face with more volume, so that the overall skin looks better, but the actual quality of the skin really should not have any significant improvement. I have; however, seen significant overall rejuvenation of the skin secondary to fat grafting and this is an interesting and positive side effect of the volumetric enhancement that fat grafting has.

A wide nose for the most part can really only be improved by surgical treatment via a rhinoplasty. I would recommend that if you are interested in treating a wide nose, that you seek out a very experienced rhinoplasty surgeon, especially one that can perform computer generated imaging as I feel this really aids not only the patient in understanding the expected outcome, but also really aids the surgeon in creating an appropriate plan for the patient’s anatomic features. The deep smile lines can be treated in multiple different ways, the easiest of which is through the use of injectable fillers such as Restylane and Juvéderm. These filler materials can be placed in the fold of the smile line and used to fill in the depression and virtually rid the patient of this concerning area. The only downside of these types of fillers is that they are temporary, but they will typically last nine to twelve months and overall are a very good value. A more sophisticated approach toward treatment of the smile lines would be placement of the patient’s natural tissue whether that be by fat grafting or if the patient has significant features of aging, we can harvest portions of the fibrofatty tissue beneath the skin during a facelift and place this under the smile lines for a more permanent improvement of this area. A more sophisticated approach to treatment would be an extended SMAS deep place facelift, which is really the only surgical technique of a facelift that can improve the smile lines long term. I have had many patients with extremely significant improvement in their smile lines after an extended SMAS deep place facelift, but overall I discuss with my patients the fact that they can expect a one out of four improvement in this area in that if they have severe smile lines, they can expect moderate smile lines after the procedure and if they have moderate smile lines, they can expect mild smile lines after the deep plane facelift. I have however seen many patients get a more significant improvement. The only other option that will create significant improvement would be direct excision of these folds where the soft tissue is literally removed and then sutured resulting in a relatively inconspicuous, yet visible scar in this area. For the most part, I tend to condemn this treatment as most patients do not find the scar to be an acceptable alternative to the smile line fold.

Yes, there are certainly options for patients that are not healthy enough to undergo general anesthesia specifically regarding their lower face. Standard facelifts or certainly extended SMAS deep place facelifts are typically performed in the operating room setting under either deep sedation or general anesthesia. Options for patients that are not healthy enough to undergo these types of anesthetic care would be mini facelifts, which can be performed under local anesthesia in the office and I have certainly performed these on patients that are not qualified for procedures performed in an operating room setting. Though this treatment is compromised compared to the more sophisticated and technically demanding extended SMAS deep plane facelift, they nonetheless get a very significant improvement in the lower third of their face and these patients are quite satisfied with the results of this type of surgery. A more advanced and newer technology that is available now for patient that are showing the early signs of aging would be Ultherapy, which is an ultrasound device that can target the deeper layers of the skin and this ultrasound energy is then focused on the deeper layers thus heating up the collagen and causing new collagen deposition, which in turn results in tightening of the deeper tissue and lifting of the facial structures. This can be performed in the area around the eyes to cause a nonsurgical brow lift. This can also be used to treat the midface, jowl, and the area under the chin to create the lift of a miniature facelift. There is no need for any anesthetic and there is absolutely no downtime as this is performed in a medical spa setting and the patient’s own healing creates the lift over a three-month period. This would be an excellent alternative for any patient with early aging that is not a good candidate for a standard facelift.

That really depends on the significance of wrinkles that you have and the area of the face that you are concerned about. Fine lines and wrinkles around the eyes can certainly be improved visually by the use of Retin-A, but overall the result will be rather subtle and patients with fine lines will be able to visually notice this more than patients that have deeper lines. Retin-A in and of itself is a very superficial peeling agent and it also causes a small amount of swelling in the skin that creates the illusion of wrinkle reduction. This effect is only present while the patient is using Retin-A and is really not a long term effect. There are certainly more effective long term treatments for wrinkle reduction of the skin and these include treatments such as Micro Laser peels, ProFractional laser treatments, erbium or CO2 laser resurfacing, as well as the new technology of Ultherapy. I would highly recommend a consultation with our extremely experienced staff at Quintessa Medical Spa to determine which option would be best for your skin type.

Filed under: Uncategorized — Tags: , — Dr. Andrew Campbell

If you have undergone treatment for keloids of the earlobes, I would highly suggest that you do not get your ears pierced in the future. Obviously the reason you had a keloid of the earlobe in the first place is due to earlobe piercing and if after the treatment of the keloid, if you end up with a good result, it would be unwise to then re-pierce the ear due to the extremely high risk of the recurrence of the keloid. Keloids can be exceptionally difficult to completely eradicate and if you are fortunate enough to get an excellent result after treatment of the keloid of the earlobe, I would again highly discourage re-piercing this earlobe. You can obviously wear clip-on earrings as these would pose no risk to recurrence of a keloid and the pressure from these can actually improve your chances of preventing a recurrence of the keloid after removal.

Filed under: Eyes + Eyelids,Restylane — Tags: , , — Dr. Andrew Campbell

No, under eye Restylane really should not be noticeable when smiling if it was performed by an experienced injector. Typically it only takes rather small quantities of Restylane or Juvéderm to improve the trough or groove under the lower eyelid and if it is performed by an experienced injector, this should be a very natural appearing improvement in the lower eyelid area and should not be noticeable when you smile. An added bonus is that the result typically lasts approximately one year in most patients, which is significantly longer than other areas of the face.

Yes, mini facelifts definitely cost less than your standard facelift for several reasons. One reason is that mini facelifts are typically performed in an office setting under local anesthesia and therefore there is no need for the cost of a surgical center, hospital, or anesthesia provider. Secondly, a mini facelift is exactly what it sounds like, which is a miniature version of a standard facelift and as such typically takes much less time, is less technically difficult, and is not nearly as sophisticated as some of the more advanced techniques that I personally can perform in an operative setting. As such, the cost of a mini facelift is approximately half of what I charge for a facelift in the operating room. With that said, I personally feel that the more advanced techniques that I perform in the operating room, specifically the extended SMAS deep place facelift with platysmaplasty not only create a more rejuvenated look, but also last much longer than a mini facelift and as such, overall, is a much better value than a mini facelift. With that said, many patients find it advantageous to undergo a mini facelift due to its lower cost and the fact that they have slightly less downtime and do not have to undergo any sort of anesthesia in an operating room setting and certainly for patients with early signs of aging, I think this is a perfectly appropriate option for them and I personally perform mini facelifts on a very regular basis.

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