Question:

I’ve been told by a doctor that I have thick nasal skin. How will this impact my rhinoplasty surgery?

Answer:

Thick nasal skin can interfere with an ideal result in rhinoplasty for several reasons. First all the fine and intricate cartilage work done under the skin is frequently covered up by the thick skin thus limiting the final result. Think of someone refining the floor under a thick shag carpeting. The other reason is because  thick skin in noses is heavy and surgeons must be careful not to overdo the cartilage work (removal) or the heavy skin can be too much for the cartilage framework. So a middle ground approach will usually limit the degree of improvement that Rhinoplasty can achieve but not eliminate improvement.  Thick skinned noses can improve but patient’s need to be counseled on what to expect and the degree of improvement that is usual in thick skinned patients.

Question:

I am female, 50 years old, and would like laser hair removal of my chin and upper lip. How many times must I undergo the laser treatment before this is a permanent removal of my facial hair?

Answer:

Most studies on the long term results of laser hair removal show that the best long term results on laser hair removal is after 5 treatments.  You can remove as much as 40-60% with a single treatment but to get up to the 80% removal point 5 treatments will be required. In some patients maintenance treatments may be necessary or more than 5 if hair growth is very extensive.

Question:

Which injectable filler would you recommend for crow’s feet? Do patients often get several areas of the face treated at the same time?

Answer:

Actually we prefer to start with botox or dysport to relax the crow’s feet which are caused by the contraction of the orbicularis oculi muscle. When filling the area we need to use a super small needle and not over inject the lines. We will use hyaluronic acid fillers such as Restylane or Juvaderm

Question:

In my line of work, I spend a significant amount of time in the sun. If I were to have a fractional laser treatment, when would I be able to return to work?

Answer:

We utilize three different fractional lasers at the center all of which can be performed under topical anesthesia.  Two are fractional CO2 lasers and one is a fractional Erbium laser.  We also utilize a non ablative fractional laser for very limited down time.  In general the ablative fractionals will require 3-5 days for recovery and slight erythema after that. The condition treated may make the recovery longer or shorter depending on the actual laser treatment time. For example acne scarring typically utilizes higher energies and mild sun damage lower energies.  Come for a consultation to see which is best for you.

Question:

I am a 75- year-old woman interested in a facelift. I am in pretty good health and take care of myself as best as I can.  I stay fit by working out, eating healthy, and not smoking or drinking. Would I be a good candidate for this surgery or am I too old to undergo something so invasive?

Answer:

In our specialty because much of what we do is for aging a larger percentage of our patients are over 70.  There are patients who are 40 or 50 who may be ineligible for surgery because of ill health so chronological age is not as important as one’s physiologic age which is determine by one’s health status.  If medical problems exist you may need to see your Physician prior to surgery and many patients elect to do so for a check up prior to surgery. We do not use general anesthesia for any of our aging face patients which dramatically reduces the incidence of side effects of the anesthetic. Our pre operative teaching addresses many recommendations for a safe recovery from surgery.

Question:

I recently heard of an alternative to Botox. I think it was called Dysport. What is this? Is it as effective as Botox and are there any advantages to using it over Botox?

Answer:

Dysport is a very similar type of botulinum toxin specifically Type A.  They are not identical but are similar in their administration as well as the side effect profile. I think when a new product is introduced it is most important to know how it stacks up to the “gold standard” if one exists.  We find Dysport is not inferior to Botox and some patients prefer it over Botox.  Many of the durations observations need more published data before we can say it works longer or quicker. Dysport can be slightly less expensive than Botox.