Multiple 9 Yearly Facelifts-?Acceptable Contemporary ProceduralAesthetics??

I was surprised today to read about a study extolling the virtues of 2nd & even 3rd facelifts after the first lift being performed in the patients' early 50s. Each facelift lasted some 9 years. In the era of minimally invasive cosmetic procedures it is extraordinary that some plastic surgeons should view this as an acceptable treatment plan . The reality is that patients usually develop an "operated on" appearance even after the initial facelift. Recurrent radical procedures in this way are in my view inconsistent with modern aesthetic principles & expectations. However it should be appreciated that plastic surgeons are unlikely to surrender their scalpels while patients can be convinced that such a radical approach to facial rejuvenation is in their best interests.
In fact we have now followed up patients for up to 10 years who, despite the passage of time, appear more beautiful than they did before using only minimally invasive procedures with natural outcomes.
http://www.medicalnewstoday.com/releases/257036.php

A Smile Is The Shortest Distance Between Two People

A charming observation attributed to the wonderfully talented Danish/American pianist- comedian, the late Victor Borge http://www.youtube.com/watch?v=E3QejAk4exw  "A smile is the shortest distance between two people". This epitomises what we strive to achieve with non or minimally invasive cosmetic procedures. In females a smiling face is more than the warm fulsome lips that we recreate with injectable fillers. Females also smile with their eyes. So ideally we enhance and beautify both the lips and eyes and connect them with curvaceous cheeks.
The outcome is the creation of an engaging femininity as exemplified in the beautiful face of young singer-songwriter Cassandra https://www.facebook.com/Cassandrasingslive
http://www.youtube.com/cassandrasingslive

I am impressed by the confidence so evident in patients returning after such treatments. All are created without scars or artificiality. Always such a pleasure for me as well to see these happy outcomes.

V>W=F (Volume creation more than wrinkle treatment =Femininity)

Attended 2 presentations in Sydney in the last week on injectables

Excellent presenters Dr. Danny Vleggar (Switzerland) http://www.youtube.com/watch?v=ldezLZKQlaM & Dr Glenn Murray (Perth) http://www.youtube.com/watch?v=0z6xA1GCM0A while demonstrating different injectable products both focused on Volumisation in preference to Wrinkle treatments in modern aesthetic facial rejuvenation.
This trend to volumise rather than to "chase" wrinkles is completely correct in my opinion and is certainly  reflected in the wonderful outcomes achieved by informed cosmetic aesthetic practitioners.
In this regard the disappointing outcomes we frequently witness with formal radical face lift outcomes are founded on the erroneous objective of stretching the face (achieving wrinkle reduction) rather than creating aesthetic contours. We frequently see patients who have spent near $20,000 on face lifting with unnatural and rather "de-contoured" faces who require their faces aesthetically "re-contoured" with appropriate fillers. They leave the clinic generally delighted with their feminising outcomes. A few have stated I had the wrong procedure having a face lift?? We try to be diplomatic!
http://www.youtube.com/watch?v=p3hYzRIOJrs
http://www.youtube.com/watch?feature=endscreen&v=yfPO147wxYs&NR=1
http://www.youtube.com/watch?v=g1D666k0nvA

Tweaking Facial Rejuvenation with Muscle Relaxant Injections

Traditionally teaching encouraged cosmetic injectors to over-treat faces with muscle relaxants,  often resulting in cases of stunned and rather expressionless features. Add to that droopy brows, droopy cheeks, asymmetrical smiles diminishing character. Generally the effects are to be endured for some 3-4 months. The following celebrity examples attest to this unfortunate trend.
http://pinterest.com/barbiegurl29/botox-gone-bad-celebs-with-out-make-up/

For some years now many Australian injectors have appreciated that less is more and that subtle treatments should prevail. Judicious tweaking with these injections can enhance other the outcomes of other facial enhancement procedures.  So we are effectively value adding with such injections.

Will expand on this interesting topic in a future blog.

Weird Therapies and Procedures

Fringe if not bizarre cosmetic procedures abound, with questionable professional ethics only matched by gullibility of some patients.

Women considering genital enhancement surgery should first consult the following paper just published online: http://whv.org.au/static/files/assets/ca7e9b2f/Women-and-genital-cosmetic-surgery-issues-paper.pdf
 A short excerpt from this article follows:   Women and Genital Cosmetic Surgery. Women’s Health Issues Paper No. 9, February 2013 Page 1 © Women’s Health Victoria

9.1 Reduced sensation
It is ‘not yet understood exactly how labia minora engorgement during sexual arousal may be involved in sexual pleasure and how labia removal might affect this’4. However, there is evidence to suggest that female genital cosmetic surgery involves removal of tissue that may contribute to sensory sexual arousal28, 66, and is likely to interfere with innervation and sensation in the genital area10, 34, 66, 67. The outcomes of genital surgeries suggest decreased enjoyment of being caressed, impaired arousal and lubrication, and an inability to reach orgasm12, 36.

There is a particular risk of providing female genital cosmetic surgery to younger women who may not fully understand the implications for their future sexual lives
68. Genital surgery during adolescence risks damaging sensitive genital tissue and may require reoperation68 if puberty is incomplete. The risk associated with operating too early in a woman’s development is highlighted in the case of a ten-year-old pre-pubescent girl who underwent one procedure on her left labia minora and, nine months later, had the same operation on her right labia minora. The surgeons themselves reflected that ‘in retrospect we feel that she could have had both operations after puberty’32.

There is no information to demonstrate how female genital cosmetic surgeries will impact on childbirth



http://www.iol.co.za/lifestyle/love-sex/sex/the-disturbing-rise-of-the-g-spot-jab-1.1464150
http://www.dailymail.co.uk/femail/article-2245450/Cosmetic-fillers-destroy-looks-The-truth-botox.html

Non-invasive Body Contouring alternatives to Liposculpture

While patients and cosmetic doctors enthusiastically embrace non-invasive technologies as alternatives to liposculpture, a recent review article seems to suggest that, to date, outcomes from these technologies are either only fair to modest or simply disappointing.  Focused ultrasound and cryolysis seem to hold the most promise thus far but patient expectations should be realistic before committing to rather expensive treatments that may come to little or no improvement. In my view Tumescent Liposculpture remains the gold standard in the quest for a reliable and durable outcome. Additionally there would appear to be very little if any difference in costs. http://www.plasticsurgerypulsenews.com/13/article_dtl.php? QnCategoryID=130&QnArticleID=262 In Summary:

ULTRASOUND CAVITATION aims to induce fatty tissue disruption. However, the frequencies associated with cavitation are difficult to focus with precision. There are several ultrasonic cavitation devices on the market, but there appears to be little evidence that they produce a true cavitation effect resulting in cell lysis with lasting effects. RADIOFREQUENCY The permanence of RF as a body-contouring treatment has not been well proven and newer technology platforms have taken the spotlight. CRYOLIPOLYSIS Treatments are generally well tolerated but are limited to areas that can be lifted into the suction head of the device. Each application takes about 1 hour, and an average of 25% reduction in thickness of the adipose layer has been reported. Each area is treated once, though re-treatment is possible after a period of months if desired. FOCUSED ULTRASOUND Though this may be associated with greater discomfort during these procedures, focusing may be more precise than it is with frequencies used for cavitation however the effects are mostly modest. LASER There is skepticism as to the clinical mechanism of action and long-term results. No histological studies of tissue treated in vivo have been presented despite the marketing claims of efficacy.

Tear Trough Filler Trend Continues

As 2012 draws to a close we continue to observe that "Tear Trough" filler injection continues to emerge as the new go to procedure for facial enhancement:

http://www.nytimes.com/2012/12/13/fashion/tear-trough-fillers-may-help-under-eye-shadows.html?_r=0

These procedures remain complication prone and require an advanced appreciation of the underlying anatomy and technique if unhappy results are to be avoided.

My wonderfully talented colleague Dr Naomi McCullum from Paddington Sydney http://www.drnaomi.com.au/HOME.html  and I will co-present a paper on this tricky subject at the Cosmetex 2013 conference in Melbourne.

http://www.cosmetex.org/melbourne2013/pdf/Cosmetex_2013_Program.pdf
http://www.cosmetex.org/melbourne2013/

Blood Sweat and Tear Troughs' What Is It, Where Is It and How Should We Actually Be Injecting It? Dr. Ronald Feiner, Cosmetica Medical Aesthetic Clinic, Sydney Australia   Dr Naomi McCullum, Dr. Naomi Clinic, Paddington, Sydney Australia