The buzz in plastic surgery over the past couple of months has been the recent findings of the Aesthetic Surgery Education and Research Foundation’s (ASERF) Gluteal Fat Grafting Task Force. This task force had been formed to investigate risks associated with high volume fat grafting to the buttocks, specifically the risk of fat embolism, which has been the cause of many high profile BBL-related deaths in the media. Fat embolism can be fatal if fat inadvertently enters bloodstream and travel to the lungs, shutting down vital portions of this organ and leading to sudden death during the procedure. The task force did show an increased risk of sudden death secondary to fat embolism after Brazilian Butt Lift compared to other plastic surgery procedures.
In my mind, the vital questions are these: Can Brazilian Butt Lift be performed safely and how can you, the patient, optimize your safety during the procedure?
One of the key limitations of the task force’s findings was failure to disclose the specific techniques utilized during cases which led to fatality or was the relative experience of the surgeons performing the procedures. Knowledge and experience matters when performing Brazilian Butt Lift.
Plastic surgeons need to be vigilant that they are not inadvertently injecting fat into the gluteal blood vessels while performing Brazilian Butt Lift. Certain anatomic planes are richer in large blood vessels and inadvertent fat injection could be more likely to happen in these locations without close attention to buttock anatomy. Specifically, deeper anatomic planes (i.e. deep to the gluteus maximus muscle and along the deeper aspect of these muscles) contain the inferior and superior gluteal vessels, the major blood vessels of the buttock, as well as a rick plexus of veins around the lower spine. That being said, in many cases, if I do not inject fat in deeper anatomic planes, I cannot achieve the same cosmetic results. In these cases, strict adherence to safe technique is essential. These vital techniques using blunt cannulas to inject fat to avoid accidental puncture of large veins, performing all injections under low pressure, and avoiding the regions of the buttock that are rich in blood vessels; for this last part, knowledge of anatomy is obviously essential.
Low pressure injection is particularly important and, to that end, I have switched to an automated injection system with a built in pressure gauze. With this pressure monitor, I can ensure that all fat is introduced at a pressure less than that in our veins, preventing fat from entering the vessels. For those surgeons utilizing older technology (syringes and cannulas), the surgeon needs to utilize slow injections without significant resistance; experience is vital in these cases to ensure that a safe technique is being utilized. For surgeons who use an automated system, having a built-in pressure monitor will insure that only low pressure injections occur, thereby preventing inadvertent injection of fat into blood vessels.
Do your research before having a Brazilian Butt Lift. To avoid unnecessary fear and anxiety, seek out a highly trained and highly experienced plastic surgeon to perform your surgeryJuly 24, 2016
Scars are a necessary evil with cosmetic surgery. Nobody wants scars, but if you want surgery to achieve the breasts, body or face of your dreams, surgical incisions are a necessary byproduct. Realizing that scars are inevitable, our goal must be to create cosmetically beautiful scars. Obviously, a precise surgical closure with attention to detail is essential for achieving this. That being said, patients play a huge role in the final appearance of their scars. Following a few rules is essential to obtaining beautiful scars.
Rule #1 – Protect your scars from the sun
The sun emits UV rays, which can cause permanent damage and discoloration of scars. Most clothing still allows a small fraction of UV light to penetrate it and reach your skin. This small amount of UV light is enough to harm your scars. If you can’t stay inside, sun protection is a must! When going outside for even a few minutes, cover the scars with a bandage or silicone strip or use sunscreen with an SPF of at least 30.
Rule #2 – Be judicious with what you put on your scar
A lot of commonly used products for lacerations can be harmful for the final appearance of scars. Hydrogen peroxide is an example of this. Not only does it destroy bacteria; it also destroys and inactivates proteins and cells necessary for scar healing, maturation and contraction. Because of this, prolonged use of hydrogen peroxide can lead to ugly scars.
Most commonly used antibiotic ointments, when used in excess, can also have negative effects on the appearance of your scars. Most patients tend to develop allergic contact dermatitis after several weeks of topical antibiotic treatment. This prolonged inflammatory response can lead to scars that are darker than desired.
Finally, a long perpetuated myth is that Vitamin E is beneficial for scars. Many studies have found that Vitamin E has no effect on scar appearance, and one actually found that Vitamin E is harmful. Bottom line – avoid Vitamin E creams.
Rule #3 – Silicone strips are the gold standard in scar care
Silicone strips put pressure on your incision, helping your incision mature faster. Silicone strips also work an effective barrier against UV rays, preventing long term darkening. Silicone strips affect fibroblasts within your scar, which are the cells responsible for reorienting and remodeling collagen. As fibroblasts work, scars become thinner and less red. Of all the available topical treatments for scars, silicone strips has the longest and most reliable track record in producing thin, pale scars.
Rule 4 – Talk to us if you have questions
If your scars don’t look, bring this us to your surgeon. Additional treatments are available, including corticosteroid injections, bleaching creams, and fractional laser treatments. In worst case scenarios, scar revisions are available and can often lead to better results.May 22, 2016
Although breast augmentation is one of the most commonly performed operations in the United States, many patients still have misperceptions about the surgery. It’s important that all patients know exactly what to expect from breast augmentation and for that reason, we decided to write this blog post.
First myth – breast implants are an appropriate solution for severely drooping breasts, either after massive weight-loss or pregnancy.
Breast implants can make your breasts look fuller and larger, but they do not raise the position of the nipple and areola (pigmented skin surrounding the nipple). If you have severely drooping breasts, you likely need a breast lift, either in addition to breast augmentation or instead of it. Overly large implants result in overly large breasts; they do not adequately lift the breasts.
Second myth – different women with different body shapes and sizes, should expect similar results with the same breast implant.
Every woman has a differently shaped body, and, as a result, differently shaped breasts with different properties of their skin and soft tissue envelope (elasticity, skin thickness, etc.). Specific anatomic characteristics directly contribute to the final results after breast augmentation. Thus, even though you may love your friends results after breast augmentation, choosing the exact same implants as her does not guarantee the same results.
Third myth – breast implants always have to look fake.
Most of the time, when you see a patient who has an overly round and fake look after breast augmentation, it is because that is what that particular patient chose to have. The majority of women choose sensibly sized implants that allow them to have a natural look after their surgery. In many cases, you may not even be aware that they’ve had surgery.
Fourth myth – the scars after surgery are obvious and look bad.
The most common incisions utilized for breast augmentation are in the natural skin crease underneath the breast, at the junction of the pigmented areola and the surrounding skin, or in the arm pit. In the vast majority of cases, the scars are small and barely perceptible.
Fifth myth – breast implants must be replaced every 10 years.
Although relatively old data suggests that one out of four women gets revision surgery within 10 years of their breast augmentation, newer implants have less association with capsular contracture than previous generations of silicone implants. Although implants do not last forever, breast implants only need to be replaced if a patient has a problem. These problems may include droopiness, a size larger than desired, or capsular contracture (painful and hard breasts).
Do you have more questions? If so, please do not hesitate to contact our office at 214-827-2814.March 27, 2016
As we get older, our face tends to lose the brightness of youth. Since facial skin gets more sun damage than other parts of our body, it requires more care. It’s amazing how many patients come to the office looking for an aggressive laser or chemical peel treatment who do not have a daily skin care regimen. A daily skin care regimen is essential to restore healthy and youthful appearance .
Daily skin care generally includes the following:
- Although seemingly intuitive, the best cleansers rid your skin of unwanted impurities without irritating or drying it
- Toners are a confusing category of skincare products. Toners are meant to be used after cleansing, as a step to restore the body’s natural pH balance. Because of the great cleansers that are now available, the need for a product to restore the body’s pH balance has generally disappeared.
- That being said, for patients with oily or combination skin, use of an astringent may be essential to clean and tighten your pores.
- For patients with dry or sensitive skin, toners that are water-based and have ingredients like rosewater or chamomile extract will help lock in moisture and help makeup apply more evenly.
- Facial exfoliants
- Exfoliating removes dead and dry skin cells from the surface of your skin, which is essential for achieving a smooth and bright face. Not only does it improve the texture of your face, but it helps prevent breakouts, evens out your skin tone, and helps other skin care products penetrate more deeply.
- Exfoliation increases the circulation of blood to your skin, which, over time, leads to thicker skin and a vibrant appearance.
- Facial scrubs, many home chemical peels, and a variety of mechanical products (Clarisonic, microdermabrasion, etc.) all promote this.
- Facial moisturizers
- Moisturizing the skin is essential for keeping your skin hydrated and for achieving softer, more elastic skin.
- Many facial moisturizers have sunscreen incorporated, which can eliminate a step in your daily routine.
- Products with hyaluronic acid can promote soft, velvety skin.
- Anti-aging creams
- An important step is your face is beginning to show signs of age, including fine wrinkles and pigment changes
- High concentration of hyaluronic acid can penetrate your skin to help combat fine wrinkles
- Antioxidants work by limiting the production of free radicals in your skin, which in turn damage skin cells. Antioxidants can calm inflamed skin, firm up your skin, reduce the appearance of wrinkles and repair sun damage. Commonly found antioxidants in skin care products include alpha lipoic acid, Vitamins C&E, and Coenzyme Q-10.
Confused? Contact Dr. Jejurikar’s office at 214-827-2814 to set up a consultation. Not only can we help you establish a regimen, but we can see if you’re a candidate for a procedure to jump start the process!February 29, 2016
Our skin is often the first determining factor of how old we look. The bad news is, we are all aging, all the time. The good news is, there is an amazing skin care line made by Teoxane Laboratories that repairs the outward signs of aging, and replenishes that youthful glow we all covet. They have done this by creating products with high concentrations of the naturally occurring substance known as Hyaluronic acid, the key to youthful skin.
Hyaluronic acid is an essential skin component. It acts like a sponge that retains water and keeps the skin moisturized, plump, and healthy. We lose approximately fifty percent of our hyaluronic acid between the ages and of forty and fifty. Our skin, in turn, becomes very dry, thin, and fragile.
Various external factors damage and affect our skin in addition to the loss of hyaluronic acid. These include: sun exposure, pollution, unhealthy food, lack of proper sleep, and smoking. The damaging factors create “free radicals” which attack the skin, decreasing its elasticity and tonicity; thus you are left with the loss of brightness of your skin and premature aging. Shriveled and dehydrated skin alters the way the light strikes the skin, leaving shadows which make you appear older.
Teoxane Laboratories’ skincare line has uses a highly innovative formula of crossed-linked hyaluronic acid. More than the recognized properties of traditional Hyaluronic Acid, their patented RHA Resilient Hyaluronic Acid® forms a mesh on the application zone that permits active ingredients to gradually be released. This premium skin care line offers multiple products targeting the very causes of aging. Our favorite products are listed below, and we use them with our injectable procedures.
Teoxane RHA Prime Solution Prep Cleansing Solution
Allows you to purify your skin with a unique facial cleansing water. Like all other Teoxane Products, this cleansing water contains Resilient Hyaluronic Acid, the richest concentration of hyaluronic acid available on the market. It soothes and comforts the complexion with rose water is alcohol free, allowing removal of makeup and skin impurities without drying the skin.
The high-dose RHA® helps to reactivate skin’s natural mechanisms of deep regeneration: cell renewal and tissue restructuring. These actions combined with enhanced antioxidant protection offer improved skin texture with high hydration power and an instant tightening effect. After 14 days, signs of skin fatigue disappear, skin looks smoother, and regains its ability to reflect light offering a brightened complexion. The skin also becomes plumper and more toned.
Perfect Skin Refiner
The exclusive combination of RHA and highly concentrated resurfacing ingredients is visibly effective in rapidly increasing the quality of your skin. In 15 days, the effects are visible on the markers of “perfect skin”: the complexion becomes more uniform and radiant, pores are refined and pigmented spots are corrected.
Deep Repair Balm
The moisturizing and filmogen action of deep repair balm helps restoring the altered skin protection function. This is indicated for: The care of irritated, sensitized or dry skin caused by external factors (wind, cold, sun…), accompanying professional aesthetic procedures (injections, laser treatment, peeling…), soothing, moisturizing and reducing skin redness that is characteristic of localized skin disorders.
Advanced Filler Dry Skin
The exclusive combination of RHA and Restructuring Complex boosts the synthesis of hyaluronic acid and collagen deep inside the skin to recreate its tissue from inside and fill wrinkles in. Its unique soft and enveloping texture is specially adapted to comfort dry skin. After several applications the skin appears more plump, wrinkles reduced, and lines are diminished.
To learn more about the complete product line from Teoxane Laboratories go to their website and then visit our office!
Our staff loves these products and will be able to help you choose which products will be right for you!February 9, 2016
America has been struggling with the obesity epidemic for many years. In fact, according to the CDC, more than one-third (34.9% or 78.6 million) of U.S. adults are obese. While the rate of obesity has been stabilizing over the last few years, the average American today is twenty-four pounds heavier than in 1960.
Since the obesity epidemic was brought to the forefront, many Americans are making more conscientious choices when it comes to their health and fitness. Many people have turned to the help of surgical weight loss (Gastric Sleeve, Gastric Bypass, etc.) to make reaching their weight loss goals attainable. Celebrities including Sharon Osbourne from “The Talk”, Al Roker from the “Today Show”, Rosie O’Donnell from “The View”, and even Governor Chris Christie of New Jersey, to name a few, have all had surgical weight loss procedures.
But, often what you don’t hear about are the changes to your appearance that occur after dramatic weight loss. The major unwanted side effect of massive weight loss is loose skin. Even though the weight is gone, pounds of excess skin remain on your frame and only serve as a reminder of just how far you had once let yourself go.
The good news? Plastic surgery can help uncover the figure underneath the layers of loose, redundant skin and give you the body you have worked so diligently to regain.
The most common surgery to begin with would be a circumferential body lift which concentrates on contouring the truncal region. Reason being, this area is often the most troublesome area for patients and often inhibits activities such as working out or even playing with their children. This surgery entails both the typical “tummy tuck” which removes skin and fat from the abdomen and diastasis repair (muscle tightening of your “six-pack” muscles), followed by removal of redundant skin and fat of the back. This allows the surgeon to sculpt a new, shapelier silhouette.
Brachioplasty is the surgery of choice to correct and contour the arms. Its sole aim is to remove the loose skin of the arms, tightening and shaping them. The same can be done for the thighs with a medial thigh lift. This requires an incision from the groin to just above the knee on the inner surface of the thighs to allow the scar to be disguised.
Often times these surgeries can be done in combination or separately. It is important to determine your surgical planning with your surgeon as well as have a physical with your primary physician to determine if you are healthy enough for a lengthier combination surgery. It more than likely will require more than one surgery to get you back to your best possible self. With the help of plastic surgery, you can say goodbye to compression garments and Spanx, and hello to sleeveless tops and designer jeans.January 29, 2016
Plastic surgery continues to become more acceptable and less taboo with each new year, and 2016 is sure to not disappoint. More celebrities like Iggy Azalea and Lisa Kudrow are diminishing the stigma that once plagued plastic surgery by being completely forthcoming with cosmetic procedures they have done in the past and how it changed their lives for the better. It’s no surprise that we saw a record increase in the number of procedures last year alone, but it wasn’t just the ladies who were taking note. That’s right; more men are electing to have cosmetic procedures as well. Here are the top procedures men seek when visiting the plastic surgeon.
Liposuction – As men age they begin to deposit unwanted fat in the abdomen, love handles, and chest. Even healthy men who work out and lead a healthy lifestyle can be subject to the unwanted fatty buildup. And despite their best efforts, these problem areas often become impossible for them to get rid of without surgery.
Liposuction is performed by inserting a cannula just below the skin in the fatty layer, which breaks up the fat, and is removed by utilizing high pressured vacuum to suction out the fat. It is the most common cosmetic procedure in the United States with over 400,000 procedures occurring every year. It is important to remember that liposuction is not meant to be used as a weight lost tool, rather to sculpt and refine. The most successful results are seen in patients who are at a steady weight with “problem areas” prior to the procedure.
Gynecomastia correction – Many men suffer from an embarrassing condition called gynecomastia, which is often the result of hormonal imbalance. It is related more to the overgrowth of the glandular breast tissue rather than excess fat, although the two often come in combination. It can truly be an emotionally difficult challenge for men and may cause them to alternate their lifestyle to avoid situations where it may become the focus of attention.
Correction of this involves cutting out the excess glandular tissue and can be coupled with liposuction to help sculpt and perfect the shape of the chest.
Blehparoplasty – If you look in the mirror and find yourself looking tired, then this just might be the surgery for you. Eyelid drooping occurs as an individual ages and the eyelids stretch, while at the same time the muscles supporting them weaken. This provides an environment for excessive fat to build up under the eyelids and above the eye, giving you that tired look no matter how many hours of sleep you had the night before.
Blepharoplasty is often an outpatient procedure that consists of removing excess skin of the upper and lower lids, as well as fatty deposits that cause “bags”. The incision is well hidden in the creases of your eyelids, so once the welling and bruising subsides, the incisions are virtually imperceptible. All you will be left with is a more freshened, bright, well rested appearance.
There are several more cosmetic procedures being done on a daily basis, however, we have only focused on those that have burst in popularity. If you have questions regarding any cosmetic procedure, be sure to schedule your consultation with us today!January 24, 2016
2015 was an extraordinary year in plastic surgery. With the overexposure of celebrities on the internet and social media driving the desire to look youthful, both women and men alike are seeking cosmetic treatments to help them achieve the best version of themselves. Many of the trends we saw last year will carry over into this new year. But still, there is one trend we expect to see in 2016 that is a shift from that of the past.
Lip Augmentation — Call it the Kylie Jenner effect. Bigger, fuller lips are definitely higher on the list of “must have’s” than ever before. Thirty percent of dermatologists and forty-three percent of plastic surgeons revealed that they had more requests about lip enhancement procedures in 2015 than the previous year. Plastic surgeons around the country fully expect this trend to become more popular in 2016. It is a simple, in office procedure that usually takes less than thirty minutes to perform. The most common fillers on the market today are Juvederm and Restylane Silk. Results are immediate and typically last for one year.
Buttocks Augmentation – What Kylie Jenner has done for the lip boom, we can thank her sister Kim Kardashian for the even more popular and continually growing trend of bootylicious backsides. The Brazilian Butt Lift procedure combines the removal of fat via liposuction, sculpting of the waist and midsection, and transfer of the collected fat cells to the buttocks. Together, this procedure accentuates the female figure by creating a small waist with a fuller backside. About forty-seven percent of plastic surgeons said they received a higher number of buttock related procedure requests from women in 2015 when compared to 2014. We expect this trend to only increase in the new year.
Breast Augmentation — Back in the early 1990’s, when Baywatch was all the rage (and Pamela Anderson was the spokesmodel for all things perfect), women were lining up to get breast enhancements. At the time the motto was, “the bigger, the better.” This was also during a period of time when silicone implants were off the shelves and your only device choice was a saline implant. Saline implants have the unique ability to be overfilled to a desirable size, and most women chose to have them filled to their full capacity. However, times they are a-changing. In recent national surveys, plastic surgeons are reporting that women are opting for a more “natural” look to their enhancement. This is usually achieved by using smaller sized silicone implants (the national average is 234cc!). With the vast improvement in silicone technology, women have more choices when it comes to implant devices. The newest generation of silicone implants offers a more natural breast shape and appearance as well as natural feel.
Most likely, we will see more trends emerge as 2016 unfolds, but we won’t be surprised if these three are the mainstay in cosmetic medicine for the foreseeable future. Stay tuned for part 2 of this blog for more trends in 2016!January 20, 2016
If you’re a fan of reality television, you have likely heard a recent story surrounding Real Housewives of Beverly Hills star Yolanda Foster, her battle with Lyme disease, and her unrelenting search to find a cure to what ails her. Not only has she had all of her metal fillings removed from her teeth because she fears they are toxic, the most recently aired episode chronicles her journey to Cincinnati where she undergoes breast explantation. She wrote in an Instagram post, “We might have hit the jackpot by finding all this silicone from a 20 year old implant rupture through ultrasound mapping…” It can’t help but raise the question, just how safe are silicone implants?
You may also recall the “implant scare” in the early 1990’s during which women were concerned that ruptured silicone implants were causing connective tissues disorders such as lupus and rheumatoid arthritis. The implants in question at the time were what we describe as ‘second generation’ silicone implants, which were liquid in consistency, had thin shells, and did have the potential to leak free silicone. Despite widespread use of silicone implants in breast reconstruction, and no data to support the claims, silicone implants for cosmetic use were removed from the market and wouldn’t be brought back until 2006!
It has taken several years to prove the safety of silicone gel, making silicone breast implants the single most studied medical device in the history of medicine. Beginning in the mid 1980s, “good manufacturing practices” were applied to breast-implant production, including standardization of materials (stronger shells and improved gels), and other strict safety protocols. Each generation of devices was better and stronger than their predecessors.
The silicone gel breast implants most recently approved by the FDA are fifth-generation implants, much different than the implants that were removed from the market in 1992. This generation is made of a solid silicone that does not leak and has the consistency of a gummy bear. If you cut it in half, it keeps its form. It has the lowest recorded risk of capsular contracture rates in the history of implants. Not only are these implants safer – proven over and again by undeniable data generated by multiple significant scientific studies – they are also stronger. Not to mention they have been quickly accepted by Board Certified Plastic Surgeons nationwide.
Suffice it to say, if Yolanda had an earlier generation implant, there is a possibility she had free silicone in her body. The likelihood that it was contributing to her illness is considerably small, but none the less, we hope she is feeling more like herself since her recent surgery. The lesson here is that if you are considering breast surgery, you can rest assured that the implant technology we have today far exceeds that of years past, and implants are far safer today than they once were.
It is no secret that the average woman looks in the mirror a minimum of eight times per day. Whether it be to check her hair, check her makeup, or even to evaluate that new spot that was not there this morning, she relies on that reflective reassurance. But, as sure as time goes by, that reflection changes from the woman she once was to the woman she sees now. The beauty of good cosmetic surgery is that you don’t have to choose between a less rejuvenated you and a fake, “plastic-y” you. That is the point of good cosmetic work: not to make someone look radically different, but to make us look the way we feel we ought to look.
There are a variety of procedures, some more invasive than others, that you can do to help improve your looks without drastically changing them. So what are they?
Botox is the most common procedure for beginners. It is quick, effective, and offers results in a matter of a few days. Typical areas for Botox include the forehead, “11” lines (frown lines) between your eyebrows, and your crow’s feet. It works by paralyzing your muscles that create deep expression lines on your face, softening your appearance and making you look more refreshed and vibrant. Botox usually lasts 3 months on average before treatment should be repeated.
Juvederm is next in line for common treatments for beginners. It is just as easy as Botox and offers instant results. Juvederm is a filler product made of a naturally occurring substance in our bodies known as hyaluronic acid which plumps up areas where we lack the fullness we had in our youth. The most common area of treatment are the nasolabial folds, also called your smile lines. You can also decrease the wrinkles around the mouth, plump your lips, as well as the lines that extend from the corner of your moth to your chin (we call these marionette lines). Treatments typically last up to 1 year.
Another form of Juvederm is called Voluma. Voluma is made specifically instantly to add volume to your cheek area to correct age-related volume loss. It can give you contour and a subtle lift for up to two years with optimal treatment.
Kybella is the newest product on the market and is very unique coomplared to the rest of the non-invasive treatments. It is specifically designed to improve the appearance and profile of moderate to severe fat below the chin (submental fat), also called “double chin.” The best part is, results are likely permanent.
One area that many patients are concerned about is the eyes. Volume loss below the eyes causes discoloration and bags, where excess skin above the eyes makes them look tired. Blepharoplasty is often the best treatment to correct these issues. It results leave you looking more rested and rejuvenated with very little down time.
Cosmetic surgery doesn’t have to mean completely changing the way you look. If you have the right procedures, the right products, and the right practitioner, you can discover the best version of yourself.← Older posts