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.
Friday, December 14, 2007
Tuesday, December 11, 2007
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.
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.
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