Important Information Every Patient Should Know

images-4.jpgMore than 13 million cosmetic procedures were performed on patients looking to rejuvenate or enhance their natural appearance through plastic surgery in 2010. The choice of the right surgeon is the single most important decision you will make. Be sure you have all the facts to make an informed choice.

In the state of California, any physician who holds a medical license can call himself any kind of specialist he/she wishes to, whether trained in that specialty or not. There is no law to prohibit this. This is why your choice of a plastic surgeon is so important. Here are guidelines to assist you in selecting a qualified surgeon:

1. Be certain the physician is a real plastic surgeon certified by the American Board of Plastic Surgery.

2. Check into the qualifications of the surgeon you are considering. Ask about his or her credentials and study them carefully. A qualified plastic surgeon will welcome your questions about his/her background and be pleased that you are concerned enough to ask.

3. If you are in doubt about a surgeon ‘s qualifications, it may be wise to seek consultation with more than one surgeon.

4. If there is confusion about a physician’s board certification, consult the current ABMS Compendium of Medical Specialist of the Directory of Medical Specialists available in most libraries. These directories list the training and background of all surgeons certified by the American Board of Plastic Surgery.

As a public service for those contemplating plastic surgery, the California Society of Plastic Surgeons maintains a consumer information service. For a board certified plastic surgeon near you, call 1-800-722-2777. The service is available from Monday-Friday, 9AM to 5:30PM

The Art of Rhinoplasty & Revision Nose Surgery Using the Closed Technique

Open Vs. Closed

The art of revision rhinoplasty surgery has been developed over 35 years fixing or altering previously operated on structures of the nose practicing and perfecting the “closed” surgical technique.  The “open” surgical technique for nasal surgeries limited the surgeon in many significant ways.  Open technique does not allow certain degrees of finesse in placing cartilage grafts in exacting locations in order to correct deformities that are commonly found in revision rhinoplasties.  In my experience with the closed technique, making small incisions and taking cartilage from the nasal septum or the ear, I can accurately place small millimeter-sized grafts into various locations throughout the nasal tip, the dorsum, and sides of the nose sparing the patient extensive and invasive surgical intervention.   Open nose surgery requires a much greater disturbance of the nasal structures.  A surgeon cuts the skin under the tip of the nose and literally removes the soft tissue back from the cartilage and bridge giving the doctor a completely open visual field and access to deep parts of the nose.  This technique is used to teach plastic surgeons how to manipulate the nose and remove unwanted sections to shape and reduce areas in size, so it is a far easier method.  The problem is, it completely exposes the most vulnerable part of a patient’s face and is far more abrasive in terms of the invasiveness of the procedure.  This technique also distorts the normal anatomical attachments of the skin to the nasal bones and nasal cartilages, further complicating the surgeon’s ability to perform a natural revision rhinoplasty.  Infection risk and scar tissue formation both increase dramatically with the open technique.  One of the most important factors to consider is the result in shape and size is often much harder to determine with this method, often resulting in undesired results.

Closed: How It Works

The patient is seen in the treatment room preoperatively and in the upright position.  The surgeon has direct communication with the patient prior to surgery, and exact locations for cartilage grafts are discussed and agreed upon by both the patient and the surgeon.  Once the various ink marks are made on the outside of the nose, the patient is then taken to the operating room and given intravenous sedation—a voiding all narcotics and anesthesia gases.  This type of anesthesia virtually eliminates nausea and drowsiness which are the most common negative side effects of anesthesia.  After harvesting cartilage from the nasal septum or the ear (and occasionally the rib), small incisions are made inside the nose in order to accomplish the reconstructive portion of this rhinoplasty procedure.  The anesthetic used is local in the entire area of the nose in addition to intravenous sedation.  Intubation and deep general anesthesia is avoided to ensure much less nose bleeding encountered during the procedure, allowing for even further improvement in technique because of the limited amount of blood loss.  The small cartilage grafts are placed where the surgeon marks the external aspect of the nose with ink in order to map out the correct placement of the grafts.  There is very little discomfort to the patient postoperatively because packing is never used and because of the less invasive nature of the closed technique.  Also during recovery pain and swelling are absolutely minimal because the open technique has been avoided preventing unnecessary incisions and unnecessary dissection throughout the nose area.  The exact appearance of the nose can be noted right after the surgery, and considering the minimal swelling the long two to three-month delay in seeing the final result is avoided when the open technique is used.

The closed nose surgery technique is used by the most skilled plastic surgeons with results far surpassing those of the open nose surgery technique.  The procedure results in extremely high patient satisfaction with minimal discomfort and quick recovery time.  Choose this method for rhinoplasty and revision nose surgeries every time!

Fat Transfer to the Breasts: A Revolution in Breast Augmentation

Fat injections have worked beautifully for filling the lips, laugh lines, frown lines, and defects throughout the body (including indentations from injections, trauma, or irregularities from liposuction).  Finally, with the blessing of research as well as the American Society of Plastic Surgeons, fat grafting is growing in popularity for augmenting breasts for reconstructive purposes such as in irradiated breasts to help in skin tone and begin to soften scar tissue around the breasts.  Fat transfer to the breasts is nothing new.  It was done almost 30 years ago but was not encouraged, as it was felt that it might perhaps hide early detection of breast cancer using mammography.  However, more recent studies and information coming from multiple credible sources have shown that this may not be a worry as it has been in the past.  In fact there has been tremendous interest in transferring one’s own body fat from perhaps the hip or abdominal area to the breasts.  There are studies encouraged by the American Society of Plastic Surgeons to further evaluate fat grafting to the breasts both using direct fat from another region of the body of that same individual to the breasts and now even fat stem cells to the breast area.

Early preliminary studies with plastic surgeons performing the fat transfer to the breast procedure have been nothing less than encouraging.  There have been positive results in loosened skin and improvement in skin texture and tone when putting fat under mastectomy scars or under irradiated tissue.  In addition, promising results are shown when augmenting breasts either primarily or after removal of breast implants with fat.  Candidates have to be chosen carefully and thoroughly understand the procedure involved. Usually, it is done over a 3-12 month period in multiple sessions.  The patient has to have good donor sites to take the fat from the abdomen or thigh area.  The harvested fat will then be transferred throughout the number of sessions to the breast area allowing for adequate blood supply to surround all the fat cells and allow viability and growth.  Fat grafting is usually done over sittings spaced three months apart. The three months allows the newly transferred fat cells to obtain and maintain that necessary blood supply.  The subsequent sessions then deposit more fat cells on top of the older fat cells that are in place.  If a person is a good candidate after a thorough physical examination and informed consent, a qualified surgeon can start the process.

Fat transfer to the breasts can be done just for routine augmentation and/or for a patient who desires to have their breast implants removed and replaced with fat.  It also, as mentioned above, is excellent for breast reconstruction or scarring throughout the breast area and for patients who have had radiation following a mastectomy.  Smaller volumes of fat in the range of 50-100 cc at each sitting is preferable spaced three months apart to slowly build up the breast with that amount of fat.  If too much fat is placed at one time, not enough blood supply gets to the fat cells and, the viability of the fat cells is jeopardized.  It is much better to use smaller volumes of fat over the designated period of time for the most desirable result.  More and more research is published showing this procedure is a very viable alternative to traditional breast augmentation and reconstruction without the risks and concerns that have been voiced in the past about potential masking or difficulty in detecting early breast cancer.   The positive feedback that we have received from patients has been truly fantastic, and the results give encouragement to continue cautious and careful ongoing fat grafting sessions to the breasts.  Remember, these should always be done in an accredited operating room facility with an anesthesiologist present and under very controlled circumstances. Discomfort for the patient and recovery time are both minimal.  If you are considering breast augmentation or need breast reconstruction, you should absolutely call the Clavin Center (or a trusted plastic surgery practice near you) and schedule a consultation for even more information and a complete examination for candidacy.  We are here to help you live the life you’ve always dreamed.

Combining Juvederm and Rhinoplasty for Best Results

The combination of surgical Rhinoplasty, either primary or secondary, combined with injecting Juvederm into the nose has gotten superior results and excellent patient satisfaction.  Juvederm is a hyaluronic acid which can last up to a year and sometimes longer when injected into various facial irregularities, defects, or deep facial lines (such as laugh lines, crease lines, or chin lines).  Juvederm has also been known to be used to inject around the mouth area  (vertical lip lines) or into the lips themselves.  This smooth cosmetic filler is also highly successful when injected into a variety of nasal defects.

Juvederm can be used in both primary and secondary rhinoplasties to help improve the aesthetic result of cosmetic nose surgery without actually doing further invasive surgical procedures to the nose.  Some irregularities throughout the nose and tip area, especially those in patients who have had several rhinoplasty operations, can often be readily improved in an office setting without surgical intervention using approximately 1 cc of Juvederm or less with a small gauge needle that causes extremely minimal patient discomfort.

The nose, nasal dorsum, or tip can be revised substantially and improved tremendously, by injecting these cosmetic fillers.  A recommended combined approach for rhinoplasty or revision rhinoplasty using Juvederm is to use this filler as an ancillary procedure during the rhinoplasty rather than operate on a certain part of the nose, which can be difficult and not as predictable. The cosmetic filler is then injected into the nasal tip, the dorsum, or the sides of the nose resulting in an improved surgical result with virtually no downtime to the patient and an extremely fast recovery.

Basically, the nose is the most difficult part of the face to operate on and certainly to perfect.  Surgical intervention is often necessary but simply cannot create the exact look a patient is looking for without a little help from fillers.  I take something away when I make a nose smaller and contour the details of that nose to fit the face of each patient.  Every single nasal structure is different on every single face, so often in that process of removing the unwanted features Juvederm is the amazing tool to take advantage of to add structure and fullness to areas of that nose to ultimately sculpt a natural-looking, gorgeous nose.  Patients often have several rhinoplasties, determined to fix features on their noses that they aren’t satisfied with, and this practice often ruins nasal structures completely and causes undesirable indentations and even collapse.  If done properly by a highly trained and skilled plastic surgeon, a first time rhinoplasty will give a patient the look they have always wanted.  Cosmetic filler used to achieve that end result is such a more favorable route to take than operating multiple times on the same nose.  Juvederm lasts up to a year and often longer, and can give you the perfect nose for your face.  It is definitely worth the fast, affordable, and almost painless “up keep” that this process requires.

In one of my extremely thorough consultations, you could even discover that no surgical intervention is necessary.  I can perform a “liquid nose job” using Juvederm to change the shape of the nose entirely.  Few people are aware that this practice exists, and even fewer surgeons will suggest this option and skip the surgery.  For the right candidate, filler instead of a rhinoplasty can save that patient a tremendous amount of money and eliminate recovery time that the surgery requires.  At the Clavin Center, you are in highly trained and skilled hands.  I, Dr. Clavin, perform all the cosmetic procedures and surgeries, and my favorite of all of these is rhinoplasties.  I have developed some of the best techniques and certainly can give patients optimal, natural-looking results that will improve the look of the entire face.  And, I will always recommend what is best for the patient and his or her individual circumstance.

Combined Use of Botox and Juvederm

Botox and Juvederm have become exceptionally popular with patients in the last several years.  The success rate of both of these products has proven to be excellent with minimal risk and very, very high patient satisfaction.  The combination of the two products achieves outstanding results, turning back the clock years without going under the knife.  Administering the injectables is quick, effective, and as close to painless as possible.

Botox and Juvederm work in two different ways.  Botox weakens the muscle action in specific areas of the face and, therefore, leads to vast improvements in the smoothness of those areas, particularly in the forehead, frown lines, and crow’s feet region.   It prevents the skin from creasing and wrinkling where lines naturally appear and deepen over time.  For places on the skin that already have lines, Botox can even reverse the signs of aging and certainly prevent further damage.  Juvederm is a soft tissue filler and has proven very successful at filling in indentations throughout the face areas such as the frown lines, laugh lines, cheeks, lips, and any other area where augmentation of the soft tissues is beneficial.  Patients love the youthful smoothness and fullness that Juvederm brings back to the face!  Botox should be repeated at three-month intervals to get optimal results and to maintain a consistent anti-aging effect.  Juvederm has been clinically proven to have the longest lasting results of any synthetic filler, proven to last in some patients up to a year.

The most outstanding results are achieved by using both of these products together.  In particular the following areas can be treated with the powerhouse duo, and the final ultimate result increases an additional 50% beyond the improvement of the use of just Botox or Juvederm alone:

1. Frown Lines
2. Crow’s Feet Regions
3. Lip and Laugh Line Areas

The combined effects of using Juvederm and Botox have almost eliminated the need for more invasive or surgical procedures, yet can give superb results that in many cases mimic the results of the more extensive and involved surgical procedures.  The advents of these formulas are the closest steps to the fountain of youth that medicine has taken us.

I personally choose to take more time than a lot of trained professionals to examine all aspects of a patient’s face and really sculpt the features with Botox and Juvederm.  I have found that taking this extra time and energy to very thoughtfully and carefully administer the products always results in the most optimal yet natural-looking outcome with the highest rate of patient satisfaction.  Everyone wants to look younger, but no one wants to look “done” or “plastic.”  At the Clavin Center, I can provide you with the rejuvenation you desire without anyone ever knowing what has made you look so healthy and beautiful.