A More Flattering Picture of My Son

So, a few days ago, I published a picture of my son Matthew scowling.  It was a bit of fun at his expense, and it allowed me to make a point about Botox.

But my family does not share my sense of humor.  "He is such a handsome boy.  Why don't you post a more flattering picture?" my mother exclaimed.

"Mom, it's supposed to be a blog about plastic surgery," I retorted.

"I don't care.  Post a good photo."

This one is for you, Mom.  Here's my son, drool and all....

 

"Does My Baby Need Botox?"

my wife asked.

I answered, "Obviously, no."

However, you can already tell that our 9-month-old son Matthew did inherit his father's strong corrugator muscles, which will eventually cause frown lines between his eyebrows (sometimes call 11s).  So, decades from now, he will probably be a good candidate for Botox.

Botox is extremely safe, but it has never been studied in infants.  So, Matthew, no Botox for you.  Just stop scowling.  (By the way, what did I do to p*ss you off so much?)

Best Cosmetic Surgeon in Ventura County!

Dr. Michael Pickart takes great pride in how he cares for his patients.  The citizens of Ventura County have responded, and named him the best cosmetic surgeon in Ventura County!

Published in the V. C. Reporter last week, Dr. Pickart was ranked #1.  He thanks his patients for their support.

Who Gets Botox and Plastic Surgery? Regular People!

My practice is in Ventura, California--70 miles away from Los Angeles.  However, my high school and college buddies always assume that my patients are more Beverly Hills and less Ventura County.

I repeatedly explain how "normal" are my patients, but I'm not sure that my statements ever get through.  However, now I have some research to back myself up.

The Aesthetic Surgery Education and Research Foundation (ASERF) recently reported what I have always known.  Plastic surgery patients are regular people.  Typical plastic surgery patients tend to be...

• women
• between 41 and 55 years old
• usually married
• with 1-3 children
• almost always employed
• with a household income < $100K

Oh, but those ladies must stuck-up, over-sexed, or crazy--just like on Nip/Tuck.  Wrong...

• Philanthropy and charity tend to be high priorities.
• Exercise and healthy eating are part of their routines.
• Most disdain the "unnatural" look of many Beverly Hills matrons.
• Their typical goals are to look "fresh," "less stressed," "more relaxed," and "rejuvenated."

In fact, most of these patients are comfortable enough with their procedures to talk about them freely...

• Nearly 9 out of 10 openly discuss Botox and injectable treatments.
• 7 out of 10 receive support from the people they have told.

So, let's put to rest the myth that Hollywood and corporate wives are the only plastic surgery patients.  Even if you don't believe me, believe the ASERF demographic data.  It is true that plastic surgery has become mainstream and acceptable for regular women (and men!).

Is Artefill Back?

Artefill is the only permanent soft-tissue filler approved by the FDA.  Owing to corporate over-expansion and to the recession, Artefill's parent company, Artes Medical, filed for bankruptcy in December 2008.  So, Artefill has been unavailable for the past 9 months.

I am not a business person, and I certainly don't understand corporate finances and accounting.  Nevertheless, it appears clear that Artes Medical's problems were not a result of a bad product.  On the contrary, Artefill had been safely and effectively used in thousand of patients.

It's therefore exciting that Suneva Medical will soon re-launch Artefill.  Its competition is...

• Juvederm Ultra/Juvederm Ultra Plus:  6-9 month duration
• Restylane/Perlane:  6-9 month duration
• Elevess/Hydrelle:  6-9 month duration
• Prevelle Silk:  3-6 month duration
• Evolence/Evolence Breeze:  6-9 month duration
• Radiesse:  8-16 month duration
• Sculptra Aesthetic:  > 2-3 year duration

All of the above fillers are eventually absorbed.  (Sculptra is the lone exception.  Because the collagen produced by Sculptra is a patient's own, perhaps some of Sculptra's effects will be permanent too.)

Artefill stands out because it will not be degraded.  The FDA will allow it to be marketed as the only permanent device for correction of nasolabial folds--the creases between the nostrils and the corners of the mouth.

Of course, patients will continue to age, so even Artefill's smoothing effects will not truly be permanent.  At least, perhaps, Artefill injections can be limited to once every 5-10 years.

I think that Artefill will have a place in my armamentarium.  There certainly are patients who have "injection fatigue."  While the procedure for Juvederm or Restylane is not painful, the bruising and swelling are never fun.

Cost may be an issue.  An Artefill treatment will likely cost twice as much as the other products' treatments.  Of course, in the long run, Artefill should be cheaper, but it remains to be seen whether patients in our difficult economy will be willing to spend $2000 for a single session of injectables.

Belotero Balance: Another Hyaluronic Acid Filler on the Way?

The FDA will review Merz Pharmaceuticals' premarket approval application for Belotero Balance.

Belotero Balance is another hyaluronic-acid-based dermal filler that will likely be FDA approved for injection into the mid-to-deep dermis for correction of moderate to severe facial wrinkles and folds.

There are already a truckload of popular, non-animal-stabilized hyaluronic acid fillers in the USA:

• Restylane
• Perlane
• Juvederm Ultra
• Juvederm Ultra Plus
• Hydrelle (formerly, Elevess)
• Prevelle Silk
• Captique

How will Belotero be different?

• Restylane, Perlane, and Juvederm last about 6-9 months.  Will Belotero stick around that long?
• (By the way, don't believe the marketing that Restylane, Perlane, and Juvederm last 12 months or longer.  Exaggerations!  These products NEVER last 1 year.)
• Will Belotero be as easy to use as Restylane, Perlane, Juvederm, and Hydrelle?  These are easily administered in the office without the needs for pre-treatment allergy testing and extensive post-treatment care.
• Safety?  I have never had a major complication with Restylane, Perlane, Juvederm, or Hydrelle.  Zero complications is a pretty high standard!
• Price?  Might Merz distinguish Belotero by offering it at a more competitive price point?

I'll keep you informed!

The "No Vertical Scar" Breast Lift

I want a breast lift and breast implants, but I do not want the vertical scar.  I want only the scar under the breast like you get for implants alone.  Is this possible?

-Mary

Maybe.

The vertical portion of the "anchor" breast lift is for...

• lifting the breast mass
• narrowing the breast width
• restoring the breast's conical shape

The "no vertical scar" technique works best, Mary, if...

• your breasts are long
• but not too droopy
• they are already narrow
• you like a rounder (rather than conical) shape

Obviously, these limitations preclude most women from the "no vertical scar" technique.  The majority of breasts benefit from the lifting and narrowing afforded by the vertical incisions.

Nevertheless, it's impossible without photographs to tell whether you would be one of the lucky minority!  Please send photos and then come in for a personalized consultation.

Under Eye Bags Caused by Muscle Hypertrophy

Hi, This has been a problem since I was a little girl.  Now I'm 40 and want to improve the appearance of my under-eye bags, whether it is with surgery or fillers.

I look tired all the time and my bags just keep getting bigger as I age. I went to another consultation for blepharoplasty (eyelid surgery).

The doctor told me there's nothing that can be done, because it's all muscle and not fat. Could I have hypertrophy?  What can I do?  I can't stand to look at myself or have others look at me.  If there is surgery for this, what is it called?

-Shellee

 

Dear Shellee,

Find an experienced Botox injector.  Ask for 1 unit of Botox in the roll under each eyelid.  This might solve your problem without surgery.

(If your plastic surgeon is up on the latest treatments, 2.5 units of Dysport would also work.  Dysport is probably equivalent to Botox.)

Do be aware that this is a tricky use of Botox/Dysport.  There are a few potential (albeit unlikely) risks...

• Lowering the lower eyelid margin (so that you see white beneath your green irises)
• Loosening the tension on the fat beneath the eyes, such that bags really do become apparent (I agree with your current analysis.  You do not have fat bags, just excess muscle.)
• Causing your eyes to become dry and scratchy

I highly doubt that you will have problems, but other plastic surgeons might be hesitant to give my suggestion a try.  This is definitely a Botox/Dysport use for experienced injectors only.

If the Botox/Dysport is unsuccessful, the injector could try more.  Or, a little filler in the upper cheeks (at the infraorbital rims--the bony rim beneath the eyes) can smooth the area out.  My favorite is Sculptra.

(By the way, the world's 2nd most beautiful woman--Angelina Jolie--also has muscular rolls beneath her lower eyelids.  Shellee, you're in good company.)

(Who's the world's most beautiful lady?  My wife, of course!!)

Sincerely,

Mike Pickart

Hydrelle: Elevess Has Been Re-Named

A promising dermal filler has been re-named.  Elevess has been re-christened as Hydrelle.

• Like Restylane and Juvederm, Hydrelle is a hyaluronic acid-based product.  This is a type of dermal filler that has a long track record of safety and success.
• Like Restylane and Juvederm, Hydrelle should last between 6 and 12 months.
• What makes Hydrelle different (and potentially superior) is that it contains a local anesthetic (specifically, lidocaine).  (Restylane and Juvederm do not.)
• Even with numbing creams and dental-type anesthetic shots, injecting certain areas of the face can still be uncomfortable.  With lidocaine, Hydrelle should have even less pain and discomfort at the point of injections.
• Could Hydrelle became the injectable of choice for needle-averse patients?!

Protruding abdomen? Consider a Tummy Tuck

My belly looks like a "prune."  I've had two kids.  I watch my weight.  I exercise daily.  What else can I do?

-Nicole

  

Nicole, you could consider an abdominoplasty.

An abdominoplasty is commonly known as a tummy tuck.  It is a major surgical procedure to improve the appearance of the tummy by...

• removing excess skin (and most of the pregnancy-related stretch marks!) from the lower and middle abdomen
• removing excess fat from the tummy
• tightening the abdominal muscles (whose laxity produces a protrusion of the central belly)
• rejuvenating the bellybutton

The best candidates for a tummy tuck usually...

• are in good shape
• have an abdominal "roll" that won't respond to dieting
• have loose skin that won't tighten with exercise
• have stretched abdominal muscles, due to multiple pregnancies
• have lost significant amounts of weight

An abdominoplasty is NOT...

• a weight loss technique
• for a patient who intends to lose more weight
• for a women who plans more pregnancies (The vertical muscles which are tightened during surgery can separate again after a pregnancy.)
• for patients who scar very poorly

Overall, an abdominoplasty can dramatically improve the appearance of a post-partum abdomen.  However, patients should bear in mind that...

• there will be a permanent scar that extends from hip to hip (about 3 times the length of a C-section)
• the recovery can be prolonged (2-4 weeks is typical.)
• smoking must be stopped for 4 months--2 months before and 2 months after surgery (Tobacco may lead to poor healing.)
• poor healing may necessitate a secondary operation

Our questioner Nicole did great: