Most people considering a “nose job” (technically known as rhinoplasty) want to reduce, not increase, the size of their nose. But there are some patients who ask me how I can help them make their nose look “longer” or “thinner.” Each nose job in Houston is an extremely individualized procedure, so what works for any one patient may not be best for another, but here are the 3 basic ways I usually recommend to make the nose look longer:

• Augmenting the bridge: This option can be one of the quickest and least invasive ways to get a slimmer nose, and it works mainly by an optical illusion – when your bridge extends even a little bit farther from your face, it gives a clearer vertical line to the nasal dorsum. This visually narrows the entire nose and helps de-emphasize the width of the nose tip. Depending on the patient, I can sometimes perform this enhancement using just injectables (though of course, that approach is not permanent).
• Narrowing the nose: Rarely, I will come across a patient whose nasal bridge is wide but not prominent – usually because their facial structure is wider or more squareish in general. In these cases I can adjust the structure of the bridge to reduce the extra bone and cartilage just enough to give the nose a narrower, longer look.
• Refining the tip: In general I try to avoid performing extensive changes to the nose tip since I think that “overdoing” this area is a mistake a lot of surgeons make. Even so, a few very small adjustments can sometimes give much better definition to a wide nose tip. This visibly “narrows” the nose, which indirectly helps it look longer.

Of course, some patients will need a combination of these approaches or the addition of another technique entirely, so be sure to speak with a highly trained and experienced surgeon in detail before you get “set” on any one option.

Lately many patients are considering facelifts much earlier in their lives, but I’m a bit surprised when I see a surgeon pushing full-scale, traditional facelifts as the norm for patients in their early 40s – or even their 30s.

Facial aging varies greatly depending on factors like whether you smoke, but in general there are good reasons most surgeons aren’t performing the traditional, full face lift for Houston patients younger than their late 40s / early 50s. For me, the biggest reason is the fact that at this point you’re only beginning to see the “big” signs of aging that a facelift treats – nasolabial folds (also known as “parentheses”), muscle laxity, and drooping of facial fat and skin.

Better Options for Patients Before 50

In a few cases, I have seen a patient with abnormal premature aging that merits an intensive approach, but by and large I will tell younger patients they are better off with one of these options for the time being:

• BOTOX® Cosmetic / DYSPORT® injections (to smooth dynamic wrinkles)
• Injectable fillers (to fill out facial hollows and improve fine lines)
• Laser treatments (to improve skin texture, reducing both dynamic and static wrinkles)
• Mini facelift (to tighten skin and muscle enough, but not too much)

In general, if you feel that your surgeon is pushing for “too much too soon,” follow your instinct and ask “why.” I mentioned that there are times when a younger patient does merit full surgery, but a good surgeon should be upfront and give you clear answers explaining how and why that’s the case. If you feel at all confused or pressured, look for another surgeon.

This year, the oldest of the Baby Boomer generation will be turning 64 years old according to the U.S. Census Bureau. We’ve all heard of this generation of Americans born after World War II between 1946 and 1964, and now some people are talking about what they’re calling a “Baby Boomer Face Lift.” What is this procedure all about?

Otherwise known as a short-scar or mini-face lift, the “Baby Boomer” face lift is a quicker, less invasive, and more affordable alternative to a traditional face lift, and can be appropriate for certain patients in their 40s and 50s in particular who do not need as extensive surgical correction as a traditional face lift provides.

This type of face lift in Dallas uses significantly smaller incisions, ending at the earlobe so that scarring behind the earis largely or completely eliminated.

Even if they don’t have a “Baby Boomer” procedure, more and more people in the 40-65 age bracket are considering facial rejuvenation. That’s not just what I’m seeing, but also a national trend, at least according to researchers from Boston University School of Medicine and the Laser and Skin Cancer Center of Indiana. They found a dramatic increase in procedures performed and patient demand for dermatologic health care since 2000, and I expect the same holds true for facial cosmetic surgery.

What do you think? Will Boomers continue to take advantage of cosmetic surgery in the years to come?

There is a large market for plastic surgery in Dallas relative to its population, so a new company choosing the Dallas-Fort Worth area to launch its in-home BOTOX® injections service by nurses as part of “BOTOX parties” isn’t all that surprising (read more here). BOTOX has been the most popular cosmetic procedure since 2000 and these parties have been around for awhile, though this company plans to offer additional enhancements such as lip augmentation, scar treatments and non-surgical face lifts.

While it may be fun to have your treatment during a gathering with friends, you might want to think twice about trading your visit to the doctor’s office for a house call with a nurse.

7 Things to Think About

1. Medical History: You should be fully comfortable to disclose any medical conditions you have, including medications you’re taking (even vitamins) with the person performing the injection in order to minimize risk of side effects, and be aware that anyone in the vicinity may hear this private information.
2. Consultation: A thorough evaluation of a patient helps to determine candidacy and assess alternatives. Doctors use the consult time to provide education, and you may not get a full explanation of your options from a nurse injector.
3. Consent: Before you agree to a BOTOX treatment, be sure you fully understand the benefits and risks, and have time to ask questions.
4. Experience: Even quick and straightforward procedures like BOTOX injections carry a potential for complications, and having an experienced clinician administering a procedure or treatment will improve the results, based on their knowledge and technique.
5. Environment: Cosmetic procedures are safest when performed by a qualified clinician in a medical setting. The physical setting should be suitable for treatment and equipped for emergency situations.
6. Post-Procedure: You need to take care and precautions after an injection for the best results. A party environment where alcohol is served, for example, can cause people to fail to follow post-treatment instructions, which can lead to complications.
7. Follow-Up Care: Even with cosmetic skin treatments, pre- and post-procedure care is an important part of any doctor-patient relationship and shouldn’t be forgotten. It’s comforting to know that you have a doctor to turn to in case any concerns arise.

When you think over these factors, how do BOTOX parties compare to treatment in a medical office? Where would you choose to have your treatment, and why?

Despite the argument that comes up from time to time (and currently is being forwarded by some professionals in the tanning industry), it’s not just wealthy Americans who benefit from cosmetic surgery. In fact, the majority of people choosing cosmetic surgery fall squarely in the middle class.

Many in the tanning industry are upset now that a tax in the health care legislation making its way through Congress has been changed from a tax on cosmetic procedures to a tax on tanning bed sessions. Instead of fighting the tax on its merits (or lack thereof), some are pointing the finger back at cosmetic plastic surgery. In the Dallas market where I see patients, people come from all walks of life, making the stereotype of the wealthy housewife that much more offensive and out of touch with reality.

Just One Example

As women age, despite social status or tax bracket, their bodies change. For most women, this becomes evident with drooping or sagging breasts. As with many signs of aging, there’s a cosmetic surgery procedure to combat this change: a breast lift. My breast lift patients – who, by the way, represent a broad socioeconomic range – discover a whole new confidence once they have their youthful breasts back. It’s a change that enriches the rest of their lives and is as meaningful for women without a lot of money as it is for very wealthy women.

The so-called “Bo-tax” didn’t make it into the healthcare reform legislation because enough people all across the country recognized its fundamental unfairness. Congress made the right call, keeping cosmetic surgery procedures affordable for the broad range of women and men choosing them.

We’ve recently celebrated National Breast Cancer Awareness Month and, if you’re like me, you’ve spent some time reflecting on the ways that breast cancer has affected your life and the lives of those you love. Here’s something new to reflect upon, something just as troubling as the many lives lost to the disease: news of a woman in Texas who claimed to have breast cancer even though she did not, raised money through donations, and then used the money to pay for breast enhancement surgery. As a Tampa, Florida plastic surgeon, I see many women who would like to improve their appearance with breast enhancement, but would certainly never commit fraud to make that goal a reality.

Why She Did It

According to an article from MSNBC, 24-year-old Trista Joy Lathern cited some disturbing motivations for her actions. Apparently, she was having marital problems and thought that a breast cancer diagnosis could improve her relationship with her husband. Moreover, she believed that larger breasts would go even further toward strengthening their marriage and decided to use the fraudulently-raised money for implants.

What We Can Learn

This story provides an opportunity for plastic surgeons performing breast augmentation in Tampa and across the country to discuss what breast surgery can and cannot do. While it can improve your appearance and, for many women, improve self-confidence, breast augmentation is never going to fix a broken marriage.

I see how happy my breast enhancement patients feel when they speak with me after their surgery and I’ve heard the way that they describe their new sense of confidence. So, even though I cannot deny the power of physical improvement for emotional wellbeing, I want to emphasize that plastic surgery is not a Band-Aid and cannot fill the void of an unhappy life or unhappy marriage.

Now, at the same time, don’t be discouraged! I can vouch for the fact that most of the women I meet are pursuing cosmetic enhancement for all the right reasons. When this is the case, plastic surgery can be a positive and empowering experience.

By: Daniel P. Slaughter, MD

The field of Facial Cosmetic Surgery is undergoing a tremendous change. A much greater understanding of the aging process has led to the development of many non-surgical techniques that can remove years of aging with minimal downtime.

Let’s look at three of the largest components of early facial aging.

1. Facial Fat Loss

As we age we loose the youthful fullness of our face. This is literally from a loss of the normal subcutaneous fat throughout the face. The loss of this fat causes a deflation of the skin much like taking air out of a balloon. This deflation results in sagging skin, thickening facial folds, and a hollowing appearance.

2. Dynamic Wrinkles

At the same time as our facial volume is deflating we begin to show the deep lines of facial muscular expression. These result from strong muscles in the forehead, around the eyes, and around the mouth. Vertical lines between the eyebrows, horizontal lines in the forehead, crow’s feet at the side of the eyes and upper cheek, and vertical lines around the mouth become increasingly visible.

3. Skin Texture and Pigmentation Changes

The facial deflation and lines of facial expression are then accentuated by fine wrinkling, pigmentation changes, and fine dilated vascular spots throughout the skin that occur secondary to sun exposure. This is associated with mild laxity secondary to solar weakening of the skin’s collagen.

Solutions

Instead of addressing these three areas surgically we can now offer specific non-surgical techniques to reverse these signs of aging.

• The loss of facial fat is naturally reversed by transplanting some of the patient’s unwanted fat that has accumulated in their thighs, bottom, or low back. Tiny cannulas are used to remove the fat and transplant the fat back to the areas where the facial volume has been lost. This restores the youthful fullness, lifts the sagging skin, and flattens the facial folds.
• BOTOX® Cosmetic can be used to weaken the strong muscles of facial expression and erase the associated frown lines, forehead wrinkles, crows feet, and smile lines. This is done with a deep understanding of the facial musculature resulting in a very natural appearance.
• Fraxel® re:pair CO2 laser resurfacing can be done to erase years of sun related aging. The fine wrinkles, pigmentation spots, and vascular spots are remarkably reduced and the face obtains a general lift and tightening. Unlike other laser techniques, the results are present with only one treatment and there is just a few days downtime.

Can a patient really restore their natural youthful appearance with minimal downtime and discomfort? Absolutely.  While surgical results continue to offer a greater degree of improvement, these non-surgical techniques can provide excellent results with minimal downtime.   The modern understanding of facial aging is providing this generation the opportunity to stay naturally youthful without the artificial appearing results or all of the downtime experienced by patients in the past.

By: Camille Cash, MD

Another surgeon on this site recently posted an article outlining the significant risks that smoking poses to facial surgery patients. As a Houston plastic surgeon who focuses on breast enlargement and body contouring, I would like to outline a few additional facts about the negative effects smoking has on breast aesthetics and breast surgery, generally:

How Smoking Negatively Affects Breast Appearance

Because smoking inhibits healthy circulation and starves tissues (especially skin) of nutrients, it can affect delicate breast tissues dramatically. Often, I will meet with women who used to smoke and are now interested in breast enlargement in Houston, when in reality their breast volume may be fine – their damaged skin is simply failing to hold their breasts in an attractive position.

Smokers, much earlier than most women, will start to develop a “flat,” droopy look that is nothing like the perky shape they used to enjoy. As a plastic surgeon, I help many of these women restore their shape very effectively (and attractively) through procedures like breast lift. For most plastic surgery procedures, patients generally need to stop smoking completely several months before and after their surgery.

Why? Smoking delays wound healing, poses extra risks of capsular contracture, and tends to prevent scars from healing in attractive ways. As a Houston plastic surgeon, I value the ways patients’ lives and lifestyles change, and I am sensitive to the effort it takes to make this kind of alteration to your habits. If you are a smoker who is worried that her breasts are starting to look less attractive, though, I would strongly recommend quitting as the first step toward improving your health and getting the shape you want.

By: Camille Cash, MD

Healthy liposuction should enhance – not “erase” your shape.

When I meet with Houston liposuction patients to discuss their goals for their procedure, most of them are concerned with “getting rid of” certain problem areas. Realistically, this is the starting point for most plastic surgery patients, but while a good plastic surgeon will identify problems compassionately and honestly, the main focus always needs to be on enhancing the patient’s naturally positive features.

Know Which Curves Work for You – and Which Don’t

For a patient to be happy with her results, both she and her Houston plastic surgeon need to have a clear idea of which aspects of her shape are most appealing and which ones could use some work.

For example: A woman whose family and culture tends to see curvier shapes as more attractive might want to focus her liposuction procedure more on smoothing out “lumpy” areas and emphasizing firmer, clean-lined curves rather than on creating a very “slim” look.

Unfortunately, surgeons and plastic surgery patients who do not take some time to touch base on this area tend to find that their procedures fall short of the ideal both were aiming for.

What to do: Take the time before your consultation to figure out in specific terms what you do and don’t like about your appearance, and what you feel characterizes your form uniquely.

Choose Minimal Approaches that Complement a Healthy Lifestyle

Body shapes can sometimes create the illusion that a certain area is very large, heavy, lumpy, or imbalanced, when in reality small adjustments to another area may be all that is necessary to present that “problem spot” in a more positive way.

A good liposuction surgeon will have the experience and sensitivity to assess your shape accurately and recommend only what is necessary and appropriate for you to achieve the balance you want.

For example: Small fat pockets above the buttocks can make even “perky,” well-shaped buttocks look flat and saggy, and in some cases I can correct this problem using a lipousuction alternative – Lipo-dissolve.

What to do: Find a surgeon who focuses on means to enhance your appearance in ways that emphasize your best features – rather than simply substituting your best characteristics for a “one size fits all” ideal.

By: Michael Bogdan, MD, FACS

Reality TV shows focusing on cosmetic surgery procedures like liposuction and breast enlargement are extremely popular, but how do they influence the ways real women and men approach cosmetic surgery in Dallas?

Last week, we looked at some of the ways these shows might negatively affect how patients see themselves and their surgery, but this week I want to touch on some of the potentially positive ways shows like The Swan and Extreme Makeover might actually help some people considering procedures like liposuction or breast enlargement in Dallas.

Cosmetic Surgery Reality Shows – A Potential Positive Influence:

Feeling more comfortable and understanding which approaches make sense for you are both important, but in the end it is still important to be cautious of the ways these shows often portray cosmetic surgery. While your results may be just as dramatic and wonderful, they will not happen instantly. A good plastic surgeon will help you develop expectations that match up with what you can realistically achieve.

Interact with this topic:

• Read Post 1 – “Cosmetic Surgery Reality Shows: Good or Bad?” (part 1)
• Share your thoughts – Do cosmetic surgery reality shows help or harm accurate perceptions of plastic surgery?