Michael Law, M.D.
I seldom, if ever, see any information about arm surgery. I know the most common surgery that reduces the overall size of the upper arm leaves some undesirable scarring. However, what can be done to tighten just the inside skin of the upper arm?
In some cases, when the skin excess exists primarily in the upper half of the upper arm, the skin excision can be performed in the underarm area only, avoiding the scar along the inner aspect of the upper arm. Underarm incision brachioplasty can often be combined with liposuction to produce a very favorable upper arm contour. This can be a good option for some younger patients and for those with more deeply pigmented skin. In some patients with an 'in between' amount of skin laxity, the underarm incision may be combined with an incision that extends only halfway down the arm, thereby avoiding the 'armpit to elbow' scar
I am considering having the hoods over my eyelids removed. Can you tell me the best procedure for this type of operation and what the recuperation time might be? Also, when I interview the surgeon, what are some pertinent questions to ask?
Excessive or 'redundant' upper eyelid skin is a very typical aging change that leads people to seek eyelid surgery. In many patients, this surgery can be performed under light sedation with local anesthesia as an outpatient office procedure. In a few cases, protruding fat behind the eyelids is also removed. As with most facial aging changes, no two people present with exactly the same eyelid concerns. Surgical treatment is therefore individualized to the needs of each individual patient.
My approach to upper eyelid surgery is to be conservative with skin excision, and to reserve excision of fat for patients with significant fat excess. In my opinion, aggressive removal of upper eyelid skin and fat is a 'skeletonizing' procedure which risks making eyes appear more deep-set and aged, rather than younger. In fact, in many patients I perform structural fat grafting (using the patient's own fat, from the abdomen or hips) to help restore soft tissue volume around the eyes.
The next time you flip through Vogue or Allure (guys, just grab one at the checkout stand) take a close look at the eyes of the models. In most of them, women in their teens and twenties, you will see only a sliver of the upper eyelid, if it is visible at all. In many, the upper lid is completely obscured by soft tissue fullness between the brow and eyelashes, which I sometimes refer to as the 'brow roll'. Perusing the fashion magazines provides quick confirmation that the youthful upper lid is not a skeletonized upper lid.
Structural fat grafting provides a mean for restoring or enhancing this 'brow roll' area. In patients that have always had, or who with age have developed a deep recess between the upper lid and brow, the addition of soft tissue volume candramatically rejuvenate the appearance of the eyes. This novel aesthetic enhancement of the upper lids does not look like eyelid surgery – it just looks youthful.
When you interview a surgeon be sure they are certified by the American Board of Plastic Surgery. Look at many, many photos that are appealing to you and speak to former patients.
I would like to know if they can use the laser hair removal treatment on black skin. I'm black but I have light skin and I wanted the hair removed from below my belly button on up to my breasts. It is so unattractive to have hair in those places.
Dark or tanned skin requires a laser with a long pulse. A longer pulse means that more of the laser energy is delivered to the root of the hair rather than to the surface of the skin where pigmentation problems might occur with lasers designed to treat light skin.
In my Raleigh, NC medical spa we use the GentleYag by Candela lasers. We have had great success treating afrian-americians with this laser.
I have been to two different plastic surgeons for a consultation on a brow lift. They agree on the fact that I need a brow lift but they disagree on the procedure. One has suggested an endoscopic brow lift and the other a coronal brow lift. I am 46 and have low eyebrows but not a significant amount of loose skin on my forehead. The coronal lift seems very invasive but I have heard that the endoscopic lift doesn't work as well. What are the statistics?
I rarely see a patient that has such significant brow descent that I recommend elevation of the entire brow. However, I frequently see browlift patients for whom conservative elevation of the lateral brow produces a more rested, bright, and even elegant appearance. This is very easily simulated with gentle upward traction on the skin of the lateral forehead – if you feel that this may apply to you then try it in the mirror and the improvement will be quite obvious.
In years past, a browlift surgery required an incision across the top of the head, from ear to ear. This was replaced in the 1990's, for most surgeons, by the endoscopic browlift, which allowed the same procedure to be performed through small incisions just behind the hairline.
While I used endoscopic browlift techniques for several years to treat brow descent, more recently I have transitioned to performing a limited incision lateral browlift that does not require the use of an endoscope. The relatively short incision is hidden behind the temporal hairline, and no incisions are required in the scalp directly above the eyes. The advantage is as follows: this approach allows me to not only redrape the lateral brow (conservatively!) in a higher position, but it also allows me to reposition the skin and soft tissues of the lateral periorbital area in an upward direction, producing a more complete rejuvenation of the periorbital area. Additionally, through this same incision I can perform suspension of the midface (cheek) if that is part of the surgical plan.
I have read and heard conflicting information on facial implants. I would like to consider including a chin implant with a facelift, but I am concerned about infection/rejection of the implant. Statistically, how common is infection? What are the best implants made of? Do they last indefinitely?
A wide variety of facial implants are currently available for the enhancement of the skeletal elements of facial aesthetics. The most commonly used facial implants are used to enhance the profile of the chin and the cheeks. Facial implants very widely not only in shape and style, but also in terms of the materials from which they are fabricated.
My preference is to use structural fat grafting, as much as possible, to enhance facial features. In many cases, the need for a solid implant can be eliminated by the careful and meticulous grafting of a patient's own fat. While the incidence of complications with facial implants is not high, certain problems may develop which require implant removal including infection and implant migration. Bone resorption (bone loss) has also been reported below solid facial implants. Neither of these problems are an issue with structural fat grafting.
The only setting in which I currently use a solid facial implant is for chin implant augmentation. Some patients with a 'weak' chin profile can be adequately improved by structural fat grafting alone. However, when the chin protrusion needs to be enhanced by a half centimeter or more, a chin implant is absolutely required. I prefer to use a soft, flexible, anatomic chin implant that conservatively enhances the anterior projection of the chin in profile. The chin implant is placed through an incision hidden underneath the chin, an area where many people already have a scar from a fall in childhood.