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Working Toward Painless Treatments with Injectable Fillers – Board Certified Plastic Surgeon Dallas – Sam Jejurikar, MD

Working Toward Painless Treatments with Injectable Fillers – Board Certified Plastic Surgeon Dallas – Sam Jejurikar, MD

Treatments with injectable fillers, such as Juvederm, Restylane, Radiesse, and Evolence, not to mention others, can restore a youthful appearance to the lips, nasolabial folds, marionette lines, midface, jowls and lower eyelids, with minimal to no downtime.  Many patients avoid these treatments, though, because they have heard horror stories from friends or colleagues about the pain associated with these treatments.  Suffice it to say, this needn’t be the case – there are steps your plastic surgeon can take to make these treatments more comfortable.

Recently, BioForm Medical, Inc., makers of Radiesse, received approval from the Food and Drug Administration to mix the filler with lidocaine, an injectable local anesthetic, prior to injection into the skin.  This approval was based on a large study of patients, in which 100% of patients reported feeling less pain when Radiesse was pre-mixed with lidocaine.  Many plastic surgeons, including me, have begun to pre-mix lidocaine with all fillers, including Juvederm, Restylane, and Evolence, not to mention Radiesse, prior to injecting into patients.  The results of treatment are still great, but patients are significantly more comfortable during treatment.

Others things your plastic surgeon can do to make your treatment with injectable fillers more comfortable include:
•    Using topical anesthetic gel for at least 30 minutes prior to commencing any injections.
•    Augmenting treatment with topical anesthetic gel with injections of local anesthetic into nerves above and below the lips.
•    Using small gauge needles and slow injection techniques

Combining all of these treatments can ensure that you’ll not only look fantastic after your treatment with injectable fillers, but you’ll feel pretty good during the treatment too!

Risks of breast augmentation – Dallas Plastic Surgery Institute – Sam Jejurikar, M.D.

Breast augmentation can give women with small or uneven breasts a fuller, better-proportioned look through the placement of saline breast implants or silicone breast implants, dramatically improving self-esteem and confidence. Any operation, though, including breast augmentation, poses some risks that can lead to complications or unfavorable results.

The most common complication is capsular contracture, or hard, firm scar that forms around the implant. Because the breast normally is soft, the development of scar tissue can make the breast feel and look hard, and in severe cases, can cause pain. With older silicone breast implants, capsular contracture was much more common. The frequency of capsular contracture has diminished with currently utilized silicone breast implants, so that the occurrence rate is now similar between silicone and saline breast implants. Mild capsular contracture is hardly perceptible, but severe contractures can be painful and unattractive. Treatment consists of surgery to remove the entire capsule and placement of a new breast implant. Placement of the implant in a pocket below the chest wall muscle results in a lower risk of capsular contracture than placement over the muscle.

Infection, if it occurs, usually does so within a few weeks of surgery. Infection occurs very rarely, but if an infection occurs it often requires antibiotics and the removal of the involved implant for several months.

Some women report that their nipples become oversensitive, undersensitive, or even completely numb. Some women also report small patches of numbness near their incisions. These symptoms usually disappear within time, but may be permanent in up to 15% of patients. If the possibility of having numb nipples is unacceptable to a patient, she should not have breast augmentation, as no plastic surgeon can predict which patients will develop this complication.

There is no evidence to indicate that breast implants will affect fertility, pregnancy, or the ability to breastfeed. If, however, a patient has nursed a baby within a year before breast augmentation, she may produce milk for a few days after surgery. This may cause some discomfort, which usually resolves within a few days. For women who get pregnant after having breast implants placed, in most cases, breast implants will not affect the fate of the breasts. After the breast tissue shrinks after pregnancy and breastfeeding, the breast skin may or may not shrink. If the skin does not shrink, the breasts will likely droop. Whether or not the skin shrinks is controlled by factors other than the presence or absence of breast implants.

Breast implants may break or leak. Most often, breast implant rupture is the result of normal wear and tear on the breast implant shell. If a saline-filled implant breaks, the implant will deflate within a few days and the salt water will be harmlessly absorbed by the body. To restore volume, another implant needs to be placed. If a break occurs in a silicone breast implant, silicone gel may move into surrounding tissue, provoking an inflammatory reaction which can lead to a severe capsular contracture. There may be a change in the shape of the breast, and the breast may become hard and painful. This will require a second operation to remove the breast implant shell and to replace the leaking implant.

No data exists suggesting that breast implants cause breast cancer. Silicone and saline breast implants, however, can alter surveillance for breast cancer. Breast implants can alter the amount of breast tissue visualized on a mammogram. When placed below the chest wall muscle, greater than 90% of breast tissue can be seen well on mammogram. When placed above the muscle, only about 75% can be visualized. Breast implants do not interfere with the ability to detect masses with self breast examination, regardless of position relative to the chest wall muscle. Self exam is the most successful way to discover new breast masses. Implants also do not interfere with ultrasound or MRI scans, which are helpful in the evaluation of breast masses.

Breast implants can move out of position anytime after breast augmentation surgery. If they move a lot, surgery may be needed them back into position. The larger the implant, the more likely it will displace downward.

Rippling or wrinkling of the implant is much more common with saline breast implants compared to silicone breast implants and in thin patients. The visualized wrinkles are the folds of the breast implant shell. Ripples can be particularly disconcerting if they occur on the upper pole of the breasts.

Because breast implants are manmade, mechanical devices, they are prone to problems over time. All women who undergo breast augmentation surgery should assume that, at some point in their lives, they will require a secondary procedure, whether it’s for capsular contracture, rupture, displacement, etc. Some women may never have problems, but it’s impossible to predict which patients will fall into this category.

Silicone and saline breast implants for breast augmentation – Dallas Plastic Surgeon – Dr. Sam Jejurikar

Many patients want to know, “What’s better – silicone or saline?”  The answer is that it depends.  Both silicone and saline implants have pros and cons.  It’s important that the educated patient understands these differences before making an informed decision.  Before delving into these differences, though, it’s important to state unequivocally that currently utilized silicone breast implants are safe.  Over the past 15 years, many large and rigorous studies have been performed investigating whether silicone breast implants are associated with autoimmune diseases or any types of cancer.  All studies performed reached the same conclusion; there is no conclusive data supporting any link between silicone implants and these diseases.  Only after carefully considering these scientific studies did the U.S. Food and Drug Administration approve the use of silicone breast implants in all women for breast reconstruction and in women over the age of 22 years for cosmetic breast augmentation.

Some good things about silicone breast implants; breast implants filled with silicone gel look and feel more like natural breast tissue.  Also, particularly in thin patients, silicone breast implants tend to have fewer problems with visible rippling than saline breast implants.

Some bad things about silicone breast implants; breast implants filled with silicone are more expensive.  Silicone breast implants are approximately twice the cost of saline breast implants, which is factored into the price of surgery.  Also, a breast implant rupture is easy to detect when the implant is filled with saline; the breast tends to deflate rapidly, in the span of a few days.  A silicone breast implant ruptures is much more subtle to detect.  For that reason, the Food and Drug Administration recommends an MRI to monitor for rupture, the first one 3 years after surgery, and then every 2 years thereafter.  This test is expensive and most likely will not be covered by third-party insurers.  Lastly, capsular contracture rates, or pathologic scarring around the implant, traditionally were much higher with the older generation of silicone breast implants.  This does not seem to be the case with the newer generation of silicone breast implants used, which is largely attributable to a thicker implant shell and thicker, more viscous silicone gel within the implant.

So, what’s better?  To repeat, silicone breast implants look and feel much more natural, but it comes at a higher financial cost, the recommendation for MRI monitoring to detect for rupture, and a larger incision.  Despite this, with each passing year, more and more patients are opting for silicone breast implants.

How Do Our Attitudes About Beauty Change As We Age?

This is taken directly from a press release from the American Society for Aesthetic Plastic Surgery

New York, NY and Arlington Heights, IL – What people find beautiful about themselves may be different than what they find appealing in another person. That’s just one finding from a recent consumer survey conducted on the BeautyforLife website (a joint venture of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery.) Visitors were asked “What aspect of physical beauty do you find most appealing in another person?” In their 20s, 30s, and 40s, respondents look for a fit, well proportioned body; youthful skin ranked at the top for respondents in the 50s and 60s. When considering “Which part of your body are you most concerned about?” respondents ranked their abdomen/hips number one in their 30s. But surprisingly, respondents listed the face, not their body, as the most popular choice in the 20s, 40s, 50s and 60s.

“It is always important to understand what our patients are most concerned about at different stages of their lives. We want to be equipped to help our patients make the right decisions to maintain their beauty at every age—no matter which type of cosmetic medical procedure they are interested in.” said ASAPS President Renato Saltz, MD.

Additional results were revealed when answering “Which part of your body are you most concerned about?” While respondents primarily chose their face, significantly more respondents are concerned about their abdomen/hips than their breasts (chest)—with the disparity increasing throughout the decades:

  1. 30s – 37% chose abdomen/hips as their top concern while only 18% chose breasts
  2. 40s – 32% selected abdomen/hips and only 10% breast
  3. 50s – 25% chose abdomen/hips compared to 7% breast
  4. 60s – 23% indicated concern about their abdomen/hips, while only 7% selected breast

Community members were also asked to consider “The most important reason to maintain your physical appearance.” “To boost self-confidence” was the top choice across all decades, with “To attract potential partners” a close second for the 20s. In the 30s and 40s, the second-most popular choice shifted to “To increase professional opportunities,” which remained the number two choice in the 50s, but by a much smaller percentage. In the 60s, increasing professional opportunities fell to third behind “To help make friends.”

“The survey on the BeautyforLife website has provided interesting data about patients’ attitudes, motivation and perception. Our goal is to provide useful tools for prospective patients to help them first decide if a cosmetic medicine procedure is right for them and then to provide information on how to choose an appropriate provider,” said Dr. Richard D’Amico, past president of ASPS.

Another question asked members to contemplate “The most important factor in maintaining beauty.” While adherence to a healthy diet, regular exercise and skin care were popular choices, approximately one in five members felt that a cosmetic medical procedure was most important in the 50s and 60s.

This survey was conducted by The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, via their Beauty for Life program—a series of patient education tools.

About ASPS
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 6,700 physician members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. For more information, please visit the ASPS website at www.plasticsurgery.org.

Evolence® collagen-based filler lasts 12 months!


<!–[endif]–>Evolence®, a collagen-based injectable filler used for the correction of facial wrinkles and folds, has recently been given permission by the FDA to advertise results lasting 12 months. While relatively new to the United States, Evolence® has been available in Canada and Europe for many years.

The filler uses porcine (pig) collagen to restore a more youthful appearance. This new generation collagen filler is injected into the mid-to-deep layers of the skin for the correction of moderate to deep facial wrinkles and folds, such as nasolabial folds. Results are visible immediately after treatment.

The most common side effects include mild swelling, redness, and pain. A skin test is not required because porcine collagen is the most genetically similar to human collagen.

Evolence® is now clinically proven to last for 12 months! Call 214-827-2814 to learn about our special rates!

Branded Surgery Is Not Always the “Quick Fix” it is Advertised To Be

This is a news release directly from the American Society for Aesthetic Plastic Surgery

New York, NY (July 16, 2009) – Have you seen the commercial for in-office procedures that will make your face wrinkle-free or sculpt your stomach, with no downtime and no scars?  Lifestyle Lift, Lunchtime Lift, Thread-Tox, and Smart-Lipo, are just a few of the brand-name surgical procedures being marketed to the public as a cosmetic quick fix with a clever name.Brand name surgical procedures generally fit under two categories; first, those that are legitimately assigned the name of the person that has popularized the technique, for example Saldanha’s lipoabdominoplasty or Furnas’conchal setback technique, (either through the efforts of that same person or others assigning his or her name to it) and second, those that are simply created by someone to market a the procedure to the public.  The first situation is usually a very legitimate situation and is often in the scientific literature, but not in the public domain.  However, the second situation has become very popular for cosmetic surgery procedures.  But are highly marketed procedures really the right choice when deciding on aesthetic surgery?

“In the wrong clinical setting, the results may not come close to the promises made in the advertising,” says J. Peter Rubin, MD, a plastic surgeon in Pittsburgh, PA.  “What is really indispensible for the best results, however, is not a specific procedure but the judgment of a board certified plastic surgeon who can match the right patient with the best procedure for them.”

“These named procedures are used by the marketing entity to popularize the technique so that patients ask for it whether it fits their situation or not.  This is a problem that can be very dangerous,” said Dr. Al Aly, a plastic surgeon from Iowa, and a member of the Aesthetic Society’s Body Contouring Committee.  “A procedure is only as good as the hands that perform it.”

“Patient safety and efficacy need to be the top priorities, not commerce or marketing,” says Robert Singer, MD a plastic surgeon from La Jolla, CA and a past-president of ASAPS.  If you decide a procedure is right for you, make sure you have done your homework, that the procedure has been fully explained, you know exactly who will be performing your procedure and that they are qualified to perform the exact procedure you are undergoing, and that you have thoroughly read and signed informed consent documents.

Facial surgery and body sculpting procedures are often marketed to the public with brand names.   “One does not have to be a plastic surgeon to know intuitively that one facelift technique will not be appropriate for all individuals undergoing a facelift,” says Sherrell Aston, MD, past-president of the ASAPS and member of the Society’s Facial Surgery Committee.  “The human anatomy and the aging process vary significantly from person to person. The so-called minimally invasive surgical procedures have gained popularity in all surgical specialties. For many procedures the work that is performed through the small incisions is rather extensive, and requires significant expertise on the part of the surgeon. A short incision facelift can give an excellent result, when properly performed for the appropriate patient.”

“The issue of untrained or inadequately trained practitioners, some of whom are not medical doctors, performing cosmetic plastic surgery is an extremely serious patient safety concern,” says Salt Lake City, UT plastic surgeon and president of the American Society for Aesthetic Plastic Surgery (ASAPS), Renato Saltz, MD. “For ultimate patient safety it is essential that the media and the general public be better educated about what constitutes appropriate training to perform operations such as facelifts, rhinoplasty, liposuction, abdominoplasty, breast surgery and cosmetic eyelid surgery.”   The demanding residency program that all plastic surgeons must complete before they can be considered for certification by the American Board of Plastic Surgery (ABPS) ensures that they not only acquire general surgical knowledge and experience but, additionally, that they master the principles, ethics and practice of plastic surgery.

Source: The American Society for Aesthetic Plastic Surgery

http://www.surgery.org/press/news-release.php?iid=531

What’s all the fuss about mommy makeovers? Dallas Plastic Surgeon – Dr. Sam Jejurikar

Having a child usually is the one of the most magical and emotionally-fulfilling experiences of a woman’s life.  Unfortunately, the physical toll that pregnancy, childbirth and breastfeeding can have on a woman’s body often is devastating. Even with proper diet and exercise, it usually is nearly impossible to restore a youthful, pre-pregnancy body.

Women come in with a litany of complaints, including loosening and bulging of the abdominal wall muscles, stretching and loosening of the skin of the breasts, thighs, and abdomen, and extra fat of the belly, back and thighs.  For those women out there who want a firmer, tighter body, even after childbirth, there is the Mommy Makeover. This cosmetic procedure is individualized for each patient.  One patient may need a breast lift and a tummy tuck; another may opt for liposuction and breast augmentation.  No two patients are the same, so the mommy makeover combines the best of several popular procedures to restore a youthful, pre-pregnancy body.

Through the end of October 2009, we are offering 10% of all surgeon’s fees on breast and body contouring surgery.  Call today (214-827-2814) to schedule a consultation!

Dysport & Botox – What are the differences? Dallas Cosmetic Surgeon – Sam Jejurikar, M.D.

Dysport is the first competitor to Botox  in the U.S., but has been used in Europe in for several years.  These products seem relatively similar; a great analogy is Coke versus Pepsi. Competition can only be a good thing for pricing, though, and  that should become evident over the next couple of years, as more products are released.

That being said, the major differences between Dysport and Botox seem to be the following:

1) A faster onset of effects is noted with Dysport in some patients.  Whereas Botox may take 3-7 days to take effect, some patients who receive Dysport see results in a day.

2) Some studies indicate a slightly longer duration of effect, but not all of them.  Clinical experience in the U.S. over the next several months will help guide consensus on this.

3) The dosing for Botox and Dysport is different.  A Botox unit is not equivalent to a Dysport unit.  The converision is approximately 2.5 Dysport units to 1 Botox unit, but there is some variation between the upper and lower face, as well as variations based on the patient’s facial muscle mass.

A recently published study showed Dysport is highly effective in women, as well as highly effective and longer lasting in African Americans.  It also demonstrated that Dysport was highly effective in patients who previously had a good response to Botox.Right now is a great time to try Dysport – our office is offering $50 off your initial treatment.  If you’ve had a good response to Botox in the past, or have simply wanted to try it, the time may be right to try Dysport.

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9101 N. Central Expwy.
Suite 600, Dallas, TX 75231
Tel: 214.827.2814
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