Advances in Skin Care - Spider Veins

Spider Veins – two dreaded words that are the plague of millions of men and women. These unsightly thread-like veins develop as we age on the face and body. They are typically caused by abnormal blood flow and weakening of the blood vessel wall. Unfortunately once developed they generally get worse and do not resolve on their own. Spider veins are universal. They affect all ethnic groups and gender. These veins are often harmless and not associated with any symptoms, the exception being cosmetic concerns. They can be unsightly and cause embarrassment when they begin to appear on the face and the legs.

Spider Veins can often be managed with conservative approaches such as, maintaining a healthy weight, wearing support hose, exercising (especially walking) and avoiding prolonged sitting or standing. However once they begin to appear a more aggressive treatment is needed to resolve the problem. The gold standard treatment for spider veins is laser. Laser vein removal is an effective way to treat superficial veins. Advances in laser technology have developed many different lasers, but the most common laser used to treat spider veins is the Nd:YAG 1064 laser. This laser uses a focused beam of light that targets the pigment in the blood. The laser heats up the small vein and collapses it. The vein is then reabsorbed by the body. The laser has a cooling device on the tip that minimizes discomfort during treatment. Because the laser light is so focused, it does not damage the nearby skin tissue. Smaller veins up to about 3mm may respond well to laser therapy.

It is important that you are evaluated prior to laser vein treatment. For patients with darker skin you need to be treated with a longer pulse width and lower energies. Seeking treatment at a center that has physician direction and supervision will often ensure that you will not develop complications from improper treatment. The procedure often takes 10-20 minutes and will need to be repeated from 2 to 6 times for clearing of the vessels. Treatments are usually spaced 4-6 weeks apart. After treatment, the skin above the vein will have a reddish, “cat-scratch” appearance that will resolve in a few days. The most common side effect is bruising. Patients are encouraged to resume normal activities. Pain following treatment is mild and can be managed with an ice pack and Tylenol.

Laser Vein Treatment can be combined with Sclerotherapy. This treatment requires a series of injections of a sclerosing agent into the vein. Laser vein treatment has fewer side effects than sclerotherapy and is less traumatic to the surrounding skin. Again each individual needs evaluation of their condition to implement the best treatment plan. Larger, deeper veins will require treatment from a physician that specializes in vein therapy. Often these veins will require a surgical intervention such as ambulatory phlebectomy. Proper pre-treatment evaluation will determine if laser treatment is the right treatment for you or if referral is needed.

There is a revolutionary new procedure called Veinwave for the treatment of spider veins. It is unique in its use of microwaves to heat the vessels, utilizing high frequency energy. This results in the instant disappearance of spider veins in a process called thermo-coagulation. The Veinwave system has a pen-like shape and a single use micro-needle probe at the end. It barely punctures the skin over the vessel and the high energy results in the thermo-coagulation, leading to the collapse and instant disappearance of the unsightly spider vein. It can be used on any size vessel in the face and on .3mm or smaller vessels in the leg. You can treat the clear thread like veins on the nose, cheeks, and chin in one 10 – 20 minute session. The procedure is comfortable and is often described as a slight pin prick. Following treatment you are left with minimal redness and occasional crusting that clears in a few days. This procedure is not suitable for anyone with a pacemaker, who is pregnant, or an epileptic. The Veinwave has been used in Europe since 2001 and is just coming into the U.S. this fall. EpiCentre Park Lane in Dallas, Tx has the Veinwave and is offering this revolutionary new treatment to help clear spider veins on the face. You can expect good clearance in one to possibly two treatments with results lasting for one year or more. A touch –up treatment might be needed as with any spider vein treatment. Spider veins are recurrent and often need ongoing maintenance.

Practicing good skin care can not be stressed enough.- I feel very strongly that one can only look great if you also use great sunscreen , great skincare along with excellent cosmetic surgery. Everyone should include using a UVA/UVB Sunscreen, Antioxidant and Retinol crème. Providing sun protection, exfoliation, moisturizing and antioxidant protection are crucial to healthy skin. There are many excellent prescription strength skin care lines available and we use only those skin care lines with scientific proven ingredients with proven clinical results .

EpiCentre Park Lane is our world class laser and skin care center is under the medical direction of the Plastic Surgeons of Dallas Plastic Surgery Institute. It is managed by a Registered Nurse with 17 years of plastic surgery experience. They provide a full range of laser vein, hair removal, tattoo removal, skin resurfacing, peels, facials and medical skin care. Skin Care lines offered are Skin Medica, Obagi, Skinceuticals, Vivite, MD Forte and BioMedic. Consultations are complimentary and taking the time to come in for a skin care evaluation is well worth your time. Our tremendously experienced staff at EpiCentre can assist you in preparing a skin care routine to fit your needs and lifestyle.

EpiCentre Park Lane is located at 9101 N. Central Expy. Suite 500 Dallas, TX 75231 and can be reached at 214-887-1577.

Statement by Dr. Rod Rohrich, professor and chairman of plastic surgery at UT Southwestern, on ASPS survey of Dallas plastic surgery trends

Media Contact: Russell Rian
214-648-3404
russell.rian@utsouthwestern.edu

Statement by Dr. Rod Rohrich, professor and chairman of plastic surgery at UT Southwestern, on ASPS survey of Dallas plastic surgery trends

DALLAS – Dec. 17, 2007 – Following are comments by Dr. Rod Rohrich, professor and chairman of plastic surgery at UT Southwestern Medical Center in Dallas and a past president of the national American Society of Plastic Surgeons, regarding the society’s survey on Dallas plastic surgery trends.

“Dallas has always been one of the leading areas for cosmetic surgeries.
“The national and local priorities reflected in the survey suggest people want to invest in themselves and in their appearance. It also suggests many people feel they need help getting to their final goals beyond the routines of nutrition and exercise.

“We experienced many of the same local trends – increases in requests for breast augmentation for women, breast reductions among men, tummy tucks, liposuction, nose reconstructions and eyelid surgeries.
“We also have many patients tell us they want less invasive procedures, mostly due to less down time, recovery time and less cost.
“The less invasive procedures also may be serving as an introduction, of sorts, to cosmetic surgery. Once they see some favorable changes in their appearance with these, they may be more willing to consider other image-enhancing procedures that further their goals to look and feel better.”

“The increase in body contouring procedures, such as Mommy makeovers, reflects a popular sentiment among today’s more active mothers. They want to get back to their pre-birth look and shape as quickly as possible with procedures such as liposuction or tummy tucks.
“The boom in weight-loss surgeries also is creating an echo boom in surgeries to help remove excess skin and some cosmetic and body contouring procedures to help complete their new look.

“Dallas’ uptick in skin cancer tumor removals, which more than 70 percent of surgeons surveyed reported on the rise, is disconcerting, particularly since nationally such procedures are on the decline.

“That could be because of our longer sunny season and the value we place on having a “good tan” in Texas. Sadly, that tan can also translate to skin cancer and wrinkles in the long run.

“Fortunately, people are also becoming smarter about recognizing the signs of potential skin damage and acting on it by seeing a doctor to minimize further damage. If you notice unusual skin discolorations, spots or lumps in the skin that don’t go away, that’s a signal it’s time to see a physician.
But it’s best to avoid sun-related skin damage in the first place by limiting sun exposure and always wearing a sunscreen with UV protection. Those who aren’t willing to give up the tanned look should consider tanning creams.


Dr. Rohrich is an internationally recognized plastic surgeon whose research covers safety outcomes in cosmetic surgeries, age management, evaluation of new laser and surgical products, nutritional supplements to enhance wound healing and anatomic studies of face and nose.

Dr. Rohrich is past president of the ASPS, a past president of the Dallas Society of Plastic Surgeons and Texas Society of Plastic Surgeons and a past director of the American Board of Plastic Surgeons. He is also editor in chief of Plastic and Reconstructive Surgery, the leading journal for plastic surgeons.
He holds the Crystal Charity Ball Distinguished Chair in Plastic Surgery and the Betty and Warren Woodward Chair in Plastic and Reconstructive Surgery at UT Southwestern.

UT Southwestern’s Plastic Surgery Clinic is located in the Outpatient Building at 1801 Inwood Road. Contact the clinic at (214) 645-2353 or learn more at www.drrohrich.com.

Is There Really a Lunch Time Facelift? What Works and What Doesn’t?

Is There Really a Lunch Time Facelift?
What Works and What Doesn’t?

GET REAL
There has been much media hype about the so called “lunch time facelifts”, facelifts touting minimal recovery time with results similar to well established traditional facelift techniques. These “lunch time” facelifts range from procedures that place barbed sutures in the face, supposedly to suspend and lift the cheek skin, to “franchise-type mini face lift” procedures done in a dental chair without anesthesia and performed by practitioners with little to no credentials in surgery let alone in cosmetic surgery!

Cutting corners in cost and downtime by having “lunch time” facelifts can be unsafe and short-lasting. Bottom line is THEY DON’T WORK.

Patients may be left with residual long-term widen scars and asymmetries because these “lunch time” facelift procedures are frequently unsafe and not properly monitored. Patients’ expectations may also be unsatisfactory because of the 3-6 month short-term results of these procedures in comparison to traditional facelifts which may last up to 7-10 years. Another disadvantage of the “lunch time” facelift procedures are that revisions may be more difficult to correct if an unsatisfactory outcome occurs.

MY PHILOSOPHY
My philosophy is that anything in medicine, as in life, that is too good to be true usually is. Your face ages over years and years and the concept to restoring it superficially and fast is ill-conceived. I believe that beauty is not the immediate product of a result, but rather the result of nurturing yourself and feeling good both inside and out. Beauty is a way of life. It doesn’t have a time limit on it, a day, a week, a month: being beautiful is an ongoing process that not only incorporates procedures and products, but also healthy lifestyle. These include exercise, healthy eating, avoiding tobacco, and using sunscreen to avoid ultraviolet light exposure. (These will be a subject of an upcoming segment on how you can slow down and control the aging process.)

WHAT WORKS
Along with these healthy lifestyle choices, there are many non-surgical and non-invasive effective and safe ways to improve your appearance as well. Using appropriate fillers for your skin type and facial features is key.

There are also minimally-invasive solutions that have been safe and really work. I will discuss briefly the use and indications for Botox as well as modern Soft Tissue Fillers that actually provide a variety of reliable and safe treatments that last for several months to over a year. They definitely improve the shape and appearance of lines and creases, plump thin lips, and improve cheek contour and soften wrinkles around the eyes and lips.

Botox is safe and useful to shape the eyebrows, soften the wrinkles around the eyes (crows feet), and also improve the lower face especially the wrinkles in the lip as well as helping to turn the corner of the mouth upwards. These all need to be done by someone who is skilled in these techniques and insight in facial aesthetics.

Likewise, the simultaneous use of several Soft Tissue Fillers has also been very useful in plumping the lips, softening the nasolabial folds, hollows on the sides of the chin, and bumping up the cheek, as well as, correcting and improving the cheek. These fillers include Restylane, Juvederm, and Radiesse, which are all excellent fillers that last from 6 months (for Juvederm and Restylane) to 1-1/2 years (such as Radiesse).

This series is designed to help you understand what is safe, what works, and how it can potentially help you “look as good as you feel” at every stage in your life as it relates to cosmetic surgery.

Botulinum Toxin
First used to treat eye disorders, botulinum toxins have been used for neck spasms, cranial nerve disorders and eye spasms. For cosmetic purposes, the product is used for the temporary improvement of moderate to severe wrinkles in the glabellar region. When injected into facial muscles, botulinum toxin blocks nerve impulses, temporarily weakening muscles which smoothes wrinkles. Currently BOTOX® Cosmetic is the only form of botulinum toxin approved by the FDA for cosmetic purposes. It usually last about 3-4 months.
More than 4 million BOTOX® Cosmetic injections were performed in 2006 and remains the most popular minimally-invasive cosmetic procedure. Sixty-five percent of all BOTOX® Cosmetic procedures were performed on people between the ages of 30 – 55.

Injectable
Description
Purpose
Possible Side Effects / Risks
Results
Regulatory Status
BOTOX Cosmetic

Allergan
Botulinum toxin type A
Smoothes wrinkles, reduces hyperhydrosis
Bruising, numbness, droopy eyelids (rare)
Can begin to take effect 5-7 days, maximum effect in two weeks, last 3-4 months
FDA approved for use in the glabellar region.All other use considered off label but used in crows feet, laugh lines and lip areas.

COLLAGEN FILLERS – SHORTER LASTING FILLERS (<3 MONTHS)
Injectable collagen (CosmoPlast) is a good short-term dermal filler. Collagen is a naturally occurring protein that supports various parts of the body including skin, tendons and ligaments.
In 2003, the first human-based collagen was FDA approved. The primary disadvantage to injectable collagen is its short duration, typically averaging about 3 months. The tissue, harvested using sterile techniques from donors or grown in a laboratory, are processed to form an injectable human collagen matrix. It is excellent to use for fine lines around the lip and corner of the mouth. It causes minimal to no bruising.

Injectable/
Company
Description
Purpose
Possible Side Effects/Risks
Results
Regulatory Status
CosmoPlast

Derived from human tissue that has been purified and grown in a laboratory, contains lidocaine.
Cosmoderm is used for superficial lines, while Cosmoplast is used for more pronounced wrinkles.

Bruising
Immediate,lasting up to 3-4 months depending on the area treated
FDA Approved

No skin test required
Photos on the left show patient prior to treatment. Right photo shows 3 months after botox to brow, eyes and lips as well as post facial fillers to smile lines and lips.

HYALURONIC ACID FILLERS – LONGER LASTING FILLERS (4-6 MONTHS)
Hyaluronic acid exists naturally in all living organisms and is a natural component of connective tissues, including the skin. As a natural substance, allergic reactions are rare. Restylane®, the first FDA approved hyaluronic acid dermal filler, is manufactured by recombinant technology which adds volume to minimize wrinkles and lines. It is excellent for lip plumbing as well as correction of nasolabial fold fullness, the depression (tear trough) below the lower eyelids. Juvenderm is optimal for lip plumbing and correcting wrinkles around the lips.

Injectable
Description
Purpose
Possible Side Effects/ Risks
Results
Regulatory Status
Juvéderm
Non-animal hyaluronic acid gel
Temporarily corrects moderate to severe facial wrinkles and folds
Redness, pain/tenderness, firmness, swelling, and bruising at injection site
Immediate; corrects up to six months
FDA approved 2006:
For injection into the mid to deep dermis for the correction of moderate to severe facial wrinkles and folds (such as the nasolabial folds)

Restylane
Non-animal hyaluronic acid
Temporarily corrects moderate to severe facial wrinkles and folds
Redness, bruising, tenderness, swelling, pain, itching
Immediate, lasts six months

FDA approved 2003:
For mid to deep dermal implantation for the correction of moderate to severe facial wrinkles and folds such as nasolabial folds

Perlane
Non-animal hyaluronic acid
Temporarily corrects moderate to severe facial wrinkles and folds
Pain, redness, swelling, itching, discoloration, and tenderness at the point of injection
Immediate; lasts six months to one year
FDA approved 2007:
For injection into the deep dermis or superficial subcutis for the correction of moderate to severe facial wrinkles and folds, such as the nasolabial folds
SEMI-PERMANENT FILLERS – LONGER LASTING FILLERS (>12 MONTHS)
Two semi-permanentt soft-tissue fillers being used for their wrinkle reducing and volume-adding qualities are Sculptra® and Radiesse® (formerly RadianceTM). Radiesse® received FDA approval for cosmetic applications in December 2006, and is composed of calcium hydroxylapatite, which has been used in the body for multiple applications including cheek and chin implants. Radiesse® is injected into the face adding volume through microspheres that are suspended in polysaccharide carriers until encapsulation occurs. Sculptra®, which is made of synthetic poly-L-lactic acid contained in microspheres, is approved by the FDA for restoration and/or correction of the signs of facial fat loss (lipoatrophy) in people with human immunodeficiency virus.
Injectable
Description
Purpose
Possible Side Effects/ Risks
Results
Regulatory Status

Radiesse
Microspheres of calcium hydro-xylapatite suspended in an aqueous gel carrier.
Reported to last 1-2 years. The body forms collagen around the micro-spheres that adds bulk.
According to manu-facturer, clumping, lumping, and nodules can appear when injected into the lips. Little risk of allergic reaction.
Immediate, according to the manu-facturer.
FDA approved for subdermal implantation for the correction of moderate to severe facial wrinkles and folds such as the nasolabial folds and it is also intended for restoration and/or correction of the signs of facial fat loss (lipoatrophy)

Sculptra
Synthetic polylactic acid contained in micro-spheres.
Restores lost facial volume in people with HIV. The body forms collagen around the micro-spheres.
Redness, bruising, lumping and granulomas
Immediate, and typically last two years according to manu-facturer.
Approved by FDA for restoration and/or correction of the signs of facial fat loss (lipoatrophy)

SUMMARY
These injectables and fillers all have a common thread – they are safe! They last longer than collagen but are temporary safe fillers. If properly placed by a skilled practitioner, the fillers will look natural and youthful until one desires and would benefit from surgical procedures such as eyelid surgery or facelift surgery. None of these are substitutes for a facelift but they are actually great options to use as alternatives from 30 to the early 50’s.

You can see more by going to my website (http://drrohrich.com) for updates on these areas.

Today's Facelifts

Hi Dr. Rohrich
I have heard about different kinds of face-lift. I read about SMAS, Deep Plane and FAME. I am still confused because there are too many medical expressions used to explain these three types. I visited ASPS and ASAPS and found your e-mail address. I thought by asking the most prominent surgeon I can get the best answer.

Can you please in simple words, tell me about the differences of these three types. And could you please let me know which one you use?
Thank you,

Laura



Dear Laura,

There are many thing happening in how we perform facelift surgery today- the entire way we look at each patients face which is so unique with each persons face having some asymmetries- therefore the facelift is now customized to the individuals face and not the other way ,which has been the way it has been done for decades- thus creating this wind-swept "hollywood" appearance which is very unattacrtive and unnatural .

The facelift I perform is based on the preop analysis of the persons face and use both the superficial - skin layer for redraping only and the deep layer- the SMAS layer for RESHAPING the fat compartments of the face along with REFILLING THESE FAT COMPARTMENTS with the persons own fat -THIS IS A NEW CONCEPT WHICH ALLOWS FOR A NATURAL UNOPERATED LOOK AND OFFERS THE BEST WAY TO OBTAIN A YOUTHFUL APPEARANCE WITH OPTIMAL LONGEVITY . Most real facelifts have a life span of 7-10 years.

The answer to your question about the different types of facelifts is simple -
there is a Skin only lift which has a brief longevity and can cause facial distortion when used alone the SMAS lifts is optimal when used as described above as it is a carrier of the deep and superficial fat compartments DEEP plane lifts add another level of complexity, prolonged post op swelling and recovery and increased risk of facial nerve damage while the results are no better than the SMAS- type lifts FAME is a version of the SMAS lift
I hope this helps

Good luck to you

Sincerely,

Dr Rohrich

REVOLUTION IN FACIAL AGING WILL CHANGE HOW WE DO FACELIFTS

The goal in face-lifting today is to achieve a natural inoperative look. A recent discovery shows that facial aging is not only gravitational pull and skin descent, but also a gradual deflation of the entire face filling. A recent article by Rohrich and Pessa, published in the Journal of Plastic and Reconstructive Surgery (The Fat Compartments of the Face: Anatomy and Clinical Implications for Cosmetic Surgery. Plastic & Reconstructive Surgery. 119(7):2219-2227, June 2007. Rohrich, Rod J. M.D.; Pessa, Joel E. M.D.) has shown conclusively that facial aging is different in different areas of the face. How do we apply this to our patients to improve our result? In most patients, the traditional facial technique pulls or LIFTS one way only WITHOUT FILLING and then often resulting in an unattractive “windswept” operative look. The procedure for modern facelifts includes deep lifting and filling in multiple planes. Without this understanding, the patient will have a much higher chance of having the "windswept Hollywood" appearance. THE GOAL OF MODERN FACELIFT IS TO RESHAPE, REFILL, AND RESTORE A NORMAL YOUTHFUL NONOPERATIVE LOOK.

WHY SALINE IMPLANTS ARE THE OPTIMAL CHOICE FOR BREAST AUGMENTATION

In 1992, American Plastic Surgeons were forced into a noble experiment when the FDA halted the routine use of silicone gel implants for cosmetic breast augmentation. Now 15 years later, the data revealed from this noble experiment and after placing hundreds and thousands of implants in American women for breast augmentation, many pleasant surprises. SPECIFICALLY SALINE IMPLANTS ARE INDEED AN EXCELLENT CHOICE IN MOST CASES. SALINE IMPLANTS REMAIN AN OPTIMAL CHOICE FOR COSMETIC BREAST AUGMENTATION FOR THE FOLLOWING REASONS.

They are safe, they have a much lower capsular contracture (hardness rate) than silicone gel, less then half the incidence, the incision size for silicone implant is less than half, and the cost is less than half of a breast silicone gel implant. Perhaps most important is that when implants need to be replaced, and all breast implants need to be replaced between 10 and 15 years, saline implants are much easier to remove and replace than silicone gel implants, they usually require no drains, and can be done as a simple outpatient procedure.

All silicone gel implants require removal of the capsule and potentially some breast tissue and require drains and have more post operative morbidity. These facts are not well known or distributed for various reasons.

Saline implants are an excellent method for breast augmentation in patients because they are safe, simple, have a high patient satisfaction rate greater than 95%, and low complication rate. They remain an excellent and premier choice for breast augmentation today and continue to do so. The United States market for breast augmentation now offers the potential patient a choice between saline and silicone gel implants. When my patients ask me what would I prefer if my wife, significant other, or a family member wanted to have cosmetic breast augmentation, I would unequivocally tell them that it would be a saline breast augmentation.

NOT ALL FACELIFTS ARE CREATED EQUAL

The goal of cosmetic facial surgery today has changed. TODAY OUR PATIENTS WANT MAXIMAL RESULTS AND SIMPLE TO MINIMAL RECOVERY. However, true facial rejuvenation and facelifts is real surgery that is performed by real surgeons in real operating rooms.

THERE ARE MANY NEW PROCEDURES THAT ARE TOUTED AS BEING FACELIFTS OR REPLACEMENT FOR FACELIFTS THAT ARE NOT FACELIFTS AT ALL. Specifically, they do not have the longevity of a true facelift which is between 7 and 10 years. Many facelifts today are skin lifts only while it is well known that deeper layer lifting and repositioning of the deep layers and filling gives you the longevity that is desired. Facelifts that promise a short recovery (2-3 days) will also have a very short lifespan (3-6 months). This is true of many different franchise type facelifts that are being marketed all around the United States. These minimally invasive lifts are in essence a skin pull and often lead to a distorted facial appearance. THE OPTIMAL FACELIFT PROCEDURE IS ONE THAT INCORPORATES LIFTING BOTH SUPERFICIAL AND DEEP LAYERS AND FILLING TO REPLACE LOSS FACIAL VOLUME TO REJUVENATE THE FACE. These techniques give the patient a more natural, youthful appearance.