Question: In what situation would a fat transfer be superior to an injectable filler, and vice versa?
Answer: Fat transfer is superior to injectable fillers in circumstances where you need an extremely large volume for rejuvenation and enhancement. In that situation, fat obviously is something that we can harvest a large quantity from in most people, and fillers would become extremely expensive if literally dozens of cc’s are necessary for volumetric improvement in the face. Injectable fillers are superior simply because they are extremely easy to use since they are literally grab-off-the-shelf items that can then be injected into the face. They are extremely reliable and the complications are extraordinarily low and they are reversible, unlike fat.
Question: My daughter is 20 and had problems with acne that have finally subsided leaving her with scars. Can fat injections help to smooth out the scars from adolescent acne problems?
Answer: Fat injections can definitely improve upon acne scarring but is certainly not going to be 100% effective and requires experienced hands to not only place fat into this area but also to lyse or cut the scar tissue beneath the acne scarring in a very precise and consistent manner. Depending on your daughter’s actual appearance of the acne scarring, I may or may not recommend laser treatments for a better result in my hands.
Question: I am a 25-year-old woman who has had drooping eyelids since I was a child. Would I need a cosmetic or medical blepharoplasty?
Answer: I would have to evaluate your eyes to assess this situation, but it certainly sounds as if you have congenital ptosis, which involves the lack of a levator muscle. This would be considered a medical problem and I personally would recommend seeing an oculoplastic surgeon for correction of this.
Question: Since I have had bad experiences with surgery in the past, I am very interested in the nonsurgical alternative to a facelift. Do they really work as well?
Answer: I will be very honest with you, I do not feel that nonsurgical alternatives work nearly as well as an actual facelift but, considering that they are not a surgical procedure, we have been relatively impressed with what a nonsurgical, noninvasive technique can provide regarding a patient’s rejuvenation.
At Quintessa Medical Spa, we are one of the few facilities in the United States that has the Ultherapy device. Ultherapy uses ultrasound that is targeted to a specific depth beneath the skin, and all of the ultrasound energy heats up the tissue at that specific depth in very small thermal injury zones. This causes denaturization of the collagen, which then sets up the healing process which, in turn, adds new collagen to the tissue and this, in turn, then causes tightening and lifting of the surrounding structures. At this time, Ultherapy is FDA approved for browlifting and is the only nonsurgical, noninvasive device to ever been given a lifting indication by the FDA. We also use it in the mid and lower facial regions to help improve the jowls and submental laxity.
Though I feel it is not nearly as effective as an actual facelift, it is in my opinion one of the best options for nonsurgical rejuvenation regarding facial laxity. We are just starting to evaluate its effectiveness outside of the facial region and are very excited to see if we make some significant improvements in skin and soft tissue laxity of the body.
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, 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.
Yes, a mini facelift at age 41 would be perfectly appropriate assuming that you have the early signs of aging including early jowling and early submental laxity, which is excess skin under the chin. I have performed many minilifts in patients under the age of 40 simply due to the fact that they have early signs of aging including these early jowls and the laxity under the chin and this procedure is excellent in patients in that age group. In fact, patients with early signs of aging are really the best candidates for treatment with a mini facelift as this procedure really does an excellent job in rejuvenating the lower third of the face and I personally feel that the patients in an older age group or with more significant signs of aging are best treated with a more sophisticated extended SMAS deep place facelift, which will restore not only the jowling and laxity under the chin, but also lift the midface and improve the smile lines as well. The bottom line is that I recommend that patients undergo rejuvenation at the earliest signs of facial aging mainly due to the fact that the rejuvenation is more effective, it involves less downtime and less risk, and overall they will have a longer period of time where they can enjoy their rejuvenated appearance.
No, I am not aware of any non-invasive treatment modalities that can remove a lipoma. A lipoma is just a benign overgrowth of fatty tissue and like most benign tumors, slowly grows and enlarges over an extended period of time. Any noninvasive modality really would not affect the lipoma in any significant way and it would continue to grow. The only option for treatment of a lipoma is removal. The only minimally invasive technique that may work would be liposuction through a very small incision. The downside of this technique is that more than likely a small amount of the lipoma would be left behind and over an extended period of time this lipoma would therefore recur. Otherwise, I have removed lipomas from various areas of the face using endoscopic techniques so that no visible scars would be needed. This involves placing the incision up in the hair and then performing the dissection out to the lipoma via endoscopic guidance using small cameras and specialized instruments. The lipoma then can be removed endoscopically and the small incision in the hair closed with dissolvable sutures. This is a more expensive technique of lipoma removal and only occasionally will insurance cover the additional cost for this technique. It is therefore more commonly performed for cosmetic reasons in patients that are very concerned about a more traditional surgical excision.