The Face Experts Blog

Acne Scarring

Posted on May 7, 2013 by Mike

When the skin is injured, the body mounts a significant response to try and get it healed as quickly as possible. When it comes to an incision, for instance, the body sends everything it has to get the cut closed. Once the incision has closed, it’s almost as if the body says “hey, I really overdid that”, and then spends the next year remodeling the scar until it looks good.

The same kind of thing happens with acne. As the body senses that the skin has been injured, it tries to “fix” it in several different ways. Which way it responds, and how aggressively it responds, depends in part on how much damage the body senses has occurred. If there is a small amount of irritation caused by the initial acne injury, it will heal without any scarring or discoloration. If the damage is more severe (i.e. if the injury goes deeper into the skin), it goes beyond the ability of the skin to heal without scarring and you can get anything from discoloration to scars. The scars can be deep, narrow scars (ice pick), wider round scars (boxcar), or in the worst case, there can be significant damage to the subcutaneous tissue which causes loss of thickness of the skin in a random uneven pattern causing the entire surface of the skin to roll up and down (rolling hill scar).

 

The scar tissue that forms at the bottom of the scar contracts as it heals, which tends to pull the bottom of the scar downward, causing the depressed appearance that we  associate with acne scars. The treatment for these scars then  depends on the appearance of the scar. The narrow, deep ice pick scars are usually treated with a punch excision. The punch is a small round cookie cutter type instrument that pushes through the skin around the scar, removing a narrow tube of skin that includes the scar. The edges of the skin left behind will heal together giving a better overall appearance. If the scar is a bit too wide to heal well, a small skin graft (a similar sized punch is taken from an area of normal skin where the scar will not be noticeable- behind the ear, for example) can be placed into the hole for a better result. If the scar is wider (boxcar), a punch elevation may work better. In this case the punch is used to cut around the edges of the scar and instead of removing the tube of skin in the middle, the tube is simply elevated upwards until it sits level with the surrounding skin. The scar is still there, but it is no longer depressed. Since it now sits flush with the surrounding skin, it is much less noticeable. Subcision is a technique where you are not removing or moving the skin at all. A needle is placed underneath a depressed area (usually coming in at an angle) and the sharp end of the  needle is used to cut the fibers that are pulling the skin downward. As these fibers are released, the skin floats back upwards, giving a smoother appearance to the surface of the skin. This works best for areas that are depressed with relatively normal looking skin over the top. Fillers can be used for a variety of scars. They are injected underneath the scar, lifting it upwards. Fillers work best for scars that don’t have a lot of subcutaneous fibers tethering it downwards. Sometimes the combination of filler and subcision works well. Hyaluronic acid fillers work best for this (Restylane® probably works best because it doesn’t continue to draw water to it like Juvederm® does), although Radiesse® can be used if the scar is really stuck down.   Micro injections of  Botox® have recently been shown to smooth large pores on the skin and may be an option for some of the smallest acne scars. IPL is a great option for the discoloration associated with acne scars. IPL will remove the color from the scar, as well as   decreasing the surrounding vascularity, making the scar the same color as the surrounding skin, and making it less noticeable. Finally, fractional lasers, both ablative and non ablative, have a role in the treatment of acne scars. Until recently, the ablative lasers were the most commonly used. They did 2 things. They removed the top layer of skin so that shallow scars were completely removed and deeper scars were made shallower. Second, they tightened the skin overall, which narrowed the diameter of the remaining scars. Non-ablative fractional lasers more recently have been shown to help reorganize the scrambled collagen in scars, making them smoother and  softer. Last year, SkinMedica™ released a product called Scar Recovery Gel, that has some promise. Recognizing that early scar formation is characterized by too much type 3 collagen and not enough type 1 collagen (which is partly why early scars don’t look good), and mature scars (which look better) are composed of more type1 collagen and less type 3 collagen, Scar Recovery Gel pushes the skin to make more type 1 and less type 3 collagen, making scars look better sooner. If applied early (within the first few weeks) the overall appearance of the scars seems to be much improved and is an exciting new possibility that may turn out to be very helpful.

 

Posted in Acne, Beauty, Botox, Fillers, Injectables, Lasers, Scar, Skin Care | Tagged , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Chemical Brow Lift with Botox- Why does this work?

Posted on April 17, 2013 by Mike

It’s nice to always have options. In respect to what we do, having options whether it includes surgical procedures or less invasive procedures is something all of our patients can appreciate. Of course, your results will always vary depending on what route you decide on. In other words, a more extreme procedure typically provides you with results that will last longer and achieve more of a dramatic end result versus the alternative of something less extreme, but may still offer a nice but more subtle change.

Take a Brow Lift for example. I’ll start by saying that the brow lift procedure has come a long way. Everyone’s fears of ending up with a surprised, “deer in the headlights” look, are for the most part, something of the past (that is if the surgeon knows what they’re doing of course). If the procedure is done correctly and by the right surgeon, the patient can expect a very natural looking and long lasting result with their brows softly resting along their brow ridge, lines smoother across the forehead and smoother in between their eyes. Of course, a patient’s expectation of their end result will and should far exceed that of what we term a “chemical browlift”.

A chemical brow lift is more or less, a small lift created by injecting a neuromodulator, such as Botox®, Dysport®, or Xeomin®, into specific muscles that work to raise and lower our eyebrows. Although the term is not necessarily a common household name out there in the world of common cosmetic procedures (or really even one of the “highest ranked” Google keyword searched terms), but it is, however, something that we’ve been doing for quite some time now. I’ve demonstrated exactly how this makes sense and why it works in the diagram below.

As I have demonstrated in the diagram (and now with a little more technical verbiage), lateral brow position is determined by the upwards pull of the Frontalis Muscle against the downward pull of the lateral Orbicularis Muscle. Injection of a small amount of neuromodulator underneath the lateral brow is meant to selectively relax the Orbicularis muscle only. This gives the Frontalis a competitive advantage (it is now pulling up against a weakened Orbicularis), causing the lateral brow to lift upwards.

I will say that this works and actually works pretty well for as little Botox® is needed to achieve a slight lift. It is, however, imperative that this particular method for injecting is performed properly, as the opposite effect of not lifting can occur. And what I mean by this is, if the neoromodulator is injected into the Obicularis, as well as the Frontalis- then there is no opposing pull. Both muscles are then weakened and then this negates the lift.

Posted in Beauty, Botox, Browlift, Dr. Menachof, Facial Plastic Surgery, Injectables | Tagged , , , , , , , , , , , , , , , | Leave a comment

Filler:Part Three

Posted on April 4, 2013 by Mike

Last time we figured out where attractive young people have their volume. If all we were doing with filler was injecting thin-faced young people, we could stop here (good news- If you are a thin faced young person you only need to find an injector who has thought it through this far). But young people with thin faces are generally not the people who are calling our office asking about fillers (which is really too bad- it would make my job alot easier). Unfortunately for most of us, it’s those of us that have started aging who are interested in fillers. So how do we make these people look young and attractive? We need to answer that pesky third question in order to figure this out (for those of you not paying attention the pesky third question was “what is it that happens to volume as we age that causes us to look older”). Now, I’m still patiently waiting for my invitation to join Mensa, I am definitely not in Albert Einstein’s IQ league, and I am not really sure why calculus is called math- but it seems to me if we’re going to add volume to people who are losing volume and want them to look younger and more attractive, we have to figure out why the loss of volume is causing them to look older and less attractive. You may not know this, but I spend a lot of time looking at faces. While this may come as a surprise to you, I have spent a lot of this time trying to figure out what is it that is happening to volume as we age that makes us look older and less attractive (see pesky question #3- amazing coincidence, I know). After looking at many thousands of faces, here is what I see with regards to aging, volume, and filler (we will start from the top and work down because that’s how my brain works best):

Area above eyelids and below browbone

Forehead- Young people have volume over their brow bone, just underneath their eyebrows and just above their upper eyelids. Light hitting the face causes this area of volume to shine. This light reflex just beneath the eyebrow gives this area a very young and attractive appearance (you probably already know this- many of the women reading this apply a light colored makeup to this area to try and create this same effect). One of the earliest signs of aging is that the eyebrows start to fall while the volume beneath it goes away. When this happens, the eyebrows now sit over the top of the brow bone, causing this light reflex to disappear. The result? You look older and less attractive.

Volume in the temples and space below the eyes

Temples- As we age, we lose volume over the temples. This happens especially in thin people. This loss of volume causes an older, slightly unhealthy appearance.

Lower Eyelids- As we age, the upper part of the lower eyelids has too much volume (the “bag”) while the lower part has too little (the groove). This also causes the lower eyelid to lengthen, making us look older and less attractive.

Volume in the cheeks and middle portion of the face

Cheeks- As we age, the tissue in the cheeks fall. This changes the face from an oval shape to more of a square shape (oval= young and attractive, square= old and unattractive).

Nasolabial Folds (often referred to as the “smile lines” around the mouth)- As we age, the falling cheek tissue builds up along these folds, causing the creases to become deeper. The problem here is not a lack of volume in the crease, but the fact that there is too much volume pushing up against the fold (this is where we have injected most of our filler over the years and what do you know, it’s really not where we want it).

Volume in the lower part of the face, volume in the lips, and the smooth smile lines, or nasolabial folds around the mouth

Lower Face- As we age, the falling cheek tissue adds too much volume to the lower part of the face, making the overall contour of the face bottom heavy, causes jowls to appear, makes the jaw-line indistinct, and blends the face and the neck into one structure (ughhhh). Once again, this is not where we want to be injecting our filler (and where we have injected gallons of the stuff over the years).

Lips- As we age, the lips start to thin (making them almost disappear when we smile), the edges of the lips flatten and lose definition (we lose the “pucker”), and the philtrum (the 2 pillars going from the nose to the middle of the upper lip) disappears (making the area between the nose and lip look long, flat, and you guessed it- old). Also, the loss of volume underneath the corners of the mouth causes the corners to fall, creating a somewhat sad appearance.

Neck- As we age, our neck seems to take on more fat, extra skin and wrinkles. Oh, and by the way, volume in our neck does not make us look young or attractive.

And there you have it.  We need to add back volume. We need to add the volume to the places that make young people look attractive. Finally, we need to add the volume back to those places we have lost it as we have aged.  Put all of this together and we really can use fillers to make those of us that are aging (meaning anyone over the age of 30) look younger and more attractive. And (ready for it) here is how we do it. Before we spell it out, remember that these are just guidelines. Every person is unique. If there is something that really, really bothers you that doesn’t follow the rules I am about to lay out, you can break these rules if that is what it will take to make you happy. As a general rule though, if we inject outside of these recommendations, it should be a small injection that is done in addition to injections that are following the rules.

Guess what?! We are finally spelling it out now.  This is how we should be thinking about the use of fillers.

  • Don’t fill wrinkles (young, attractive people have wrinkles).
  • Don’t fill the nasolabial folds, commonly referred to as the smile lines around the mouth (it’s a cheek problem).
  • Don’t fill the bottom part of the face (you guessed it- it’s a cheek problem).
  • Fill the cheeks. It will make the nasolabial folds and the bottom part of the face look better. If you are on a limited budget, the cheeks are likely where you will get the biggest bang for your buck.
  • Don’t forget about the lower eyelids. Filling the groove connects the “bag” to the cheek, making the cheek look higher, and therefore making the lower eyelid look shorter.
  • A small amount of filler in the lips makes a big difference (not talking about big, overblown, sausage-like, Goldie Hawn in The First Wives Club lips, but well defined, appropriately full lips with the corners of the mouth no longer turned down).
  • In really thin faces (in case you’re wondering I am primarily talking to my really fit women runners) filling the temples makes a really big difference.
  • A very small amount of filler just beneath the eyebrows opens the eyes and makes them “pop”.

This is how we do it. It’s our magic potion. It’s our secret sauce. It’s not the way everyone does it. In fact it’s not the way most others do it. But it works really well. And because of that, we’ll keep doing it this way. What I mean to say is that we’ll keep doing it that way until we find another way that works better.  I can’t tell you when that will happen, but I can promise you that in the meantime we’ll keep looking at faces… and we’ll keep thinking.

Posted in Beauty, Botox, Dr. Menachof, Fillers, Injectables, Liquid Facelift | Tagged , , , , , , , , , , , , , , , , , , | Leave a comment

Filler: Part Two

Posted on March 27, 2013 by Mike

My high school English teachers always told me that in order to write successfully, you need to make your point early in order to grab the reader’s attention. So here goes.

  • Not all young faces look young.
  • Young people with chubby cheeks look young. 
  • Young people with thin faces usually look older than they are.
  • People with fat faces of any age tend to look younger than they are.
  • Really old people (and by that I of course mean anyone older than me- just kidding, really old means anyone older than any of my friends) look old because they tend to have almost no fat in their face at all. 

Put all of this together and it seems that the more volume you have in your face, the younger you look. I spend a lot of time looking at faces (it is my job after all) and can tell you that by and large this is a true statement. So the first piece to the puzzle is that for almost all of us, the more volume we have in our face the younger we look (important point- remember this last sentence. If we were going to have a test, this would be one of the answers).

Once I figured out that volume in our face makes us look young, I must admit I felt like Indiana Jones when he found The Ark of the Covenant. Unfortunately, my excitement was short-lived. 2 days later I was stuck in the house on a snowy Saturday afternoon and ended up watching a Chris Farley film festival (it’s a long story- don’t ask). Halfway through Tommy Boy (which I think was the 4th of the Farley movies that day), I made 3 important observations.

  • Chris Farley has a lot of fat in his face.
  • Chris Farley looks young.
  • Chris Farley is not attractive.

This means that while volume is a part of the answer, it is not the entire answer. Volume makes us look younger, but as the Chris Farley example points out, looking younger by itself is not enough. There has to be an attractive component as well. When we are injecting filler, our goal is not that you simply look young, but that you look young and attractive (which should have been obvious- I’m pretty sure that if our injections were making my patients look young and ugly I would be writing about some other topic right now -like how to tune up a carburetor in a ‘66 Mustang or the proper way to get a soufflé to rise). Since we know that volume is one of the keys, but not the only key, we next need to figure out how volume makes us look attractive. As I mentioned earlier, I spend a lot of time looking at faces. I’ve also spend quite a bit of time trying to figure out how volume (and aging) relates to attractiveness (not sure that is a word, but given that the purpose of language is communication, I do think it communicates well -so I’ll leave it in even though I can almost hear my high school English teacher cringing or crying, or maybe even wailing). Here are my observations.

  • Volume in our cheeks makes us look attractive.
  • Volume in our lips makes us look attractive.
  • Volume in the bottom part of our face (along our jaw line) makes us look less attractive (and definitely older).
  • Volume in the middle part of our face (against the nasolabial folds) also makes us look less attractive (and older).
  • Wrinkles by themselves do not make us unattractive.
  • Longer lower eyelids make us look older and less attractive  (or if it makes more sense to your brain said the other way- Shorter lower eyelids make us look younger and more attractive).

I also read a recent study that showed the more symmetric your face is, the more attractive you tend to be. This surprised me, so I went back and looked and found that if you look at the first 10 people on People Magazine’s “50 Most Beautiful People” list (I honestly think this is the first time I have used the word “people” 3 times in one sentence), they almost always have very symmetric faces. Interesting.

Putting this all together, here is what we know so far.

  • We want volume in our cheeks.
  • We want volume in our lips.
  • We want volume in the very top of our cheeks so that our lower eyelids appear shorter.
  • In a very thin face we may want volume everywhere, but we have to make sure that even if we are adding it everywhere we still have to highlight the 3 areas mentioned above.
  • We do not want volume in the middle or lower parts of our face.
  • When it comes to fillers we don’t really care about wrinkles.
  • We want to create as much symmetry as possible.

Guess what? I’m pretty sure we have now answered the first 2 questions of the 3 we listed earlier; “how does volume make young people look young”, and “how does volume make us look attractive”. Not a bad start. Now if we can just figure out the answer to the last question- “what is it that happens to volume as we age that causes us to look older”, and we may be able to finally figure out how to inject filler properly. It seems like we are almost there.

 

…even more to Come…

 

 

Posted in Beauty, Dr. Menachof, Fillers, Injectables, Liquid Facelift | Tagged , , , , , , , , , , , , , , , , , , , | Leave a comment

All about filler: Part One

Posted on March 20, 2013 by Mike

I’ve wanted to write about fillers for some time now. The problem is that things seem to change so much in the “filler world” (air quotes would have actually been much more effective in letting you know that when I use the term “filler world” I am actually letting you in on a big secret- that most people talking about fillers are simply reciting what the filler companies have told them to say, as opposed to what I am about to tell you which of course is the honest to god truth- but I have yet to figure out how to indicate air quotes when my computer keyboard has actual quotation marks as one of its keys) that I keep putting it off, waiting for a time when things seemed to have settled out a bit. Great news. March 2013 seems to be the time. Now I think I know what information you want. Keep it simple. Tell me what filler to use, what area to use it in, and how much I need to use at a time. Sorry. Anyone that has talked to me about things that truly interest me (and lately filler has really interested me) knows that I don’t do simple very well. But I will be thoughtful, and careful, and cautious. And I also don’t think it makes sense for you to do filler unless the results bring a smile to your face every time you look in the mirror. Given that I am using my brain (as opposed to someone else’s) as I type this, I need to begin my thoughts on filler at the beginning, which is where my brain always needs to start.

Filler is volume…

There- I said it (for those of you with a short attention span you can quit reading now). It really is as simple as that. It isn’t a “line lifter” (real quotes this time) or a hole filler. It’s definitely not the skin’s version of the bondo that the discount auto shops use to make your car’s dents look better. It is volume. Inject it under the skin and it will lift the skin. Inject it under muscle and it will lift the muscle. Inject it under fat, and (I think you get it now) it lifts the fat. And for many years this is exactly what we did. We injected it under lines around the mouth, under deep nasolabial folds (the lines from the nose to the corner of mouth), and into very thin lips. We did this for years, used a lot of filler, and made a lot of money. But guess what? People looked smoother, but they didn’t look better, and they definitely didn’t look younger. And almost no one (and I really do mean no one) looked in the mirror on a regular basis after their injections and smiled. For many years injectors (myself included) fooled ourselves about this. We would look at the before and after photos, compared the depth of the lines in the after photos to the before photos, all agreeing that the lines were now less noticeable, and patted ourselves on the back. But in all honesty, after the patient would leave the room I would often continue to look at the photos, this time looking not at the lines, but at the overall appearance of the face, and was usually disappointed. The person’s lines looked better, but the person did not.

Here is what I knew at this point in time.

  • I like it when my patients look in the mirror and smile.
  • The way we were using filler wasn’t causing that to happen.
  • The way everyone was using filler wasn’t causing that to happen.
  • The filler companies not only assured me that I was doing my injections correctly but that everyone else was doing them the same way I was (no kidding- we were all getting the same crummy results).
  • This bothered me.
  • I like to solve puzzles.
  • This seemed like a good puzzle to solve.
  • In order for me to solve a puzzle, the entire process, beginning to end, has to make sense to me.
  • In order for this to happen my brain has to start at the beginning.

So that’s what I did. I started at the beginning. Since filler is volume (I tend to repeat things that are important) how can we use volume to make us look better? I came up with 3 questions as a starting point.

  1. How does volume make us look attractive?
  2. How does volume make young people look young?
  3. What is it that happens to volume as we age that causes us to look older?

Little did I know that the answers to these 3 questions would ultimately solve the puzzle.

…More to Come…

Posted in Beauty, Botox, Fillers, Injectables, Liquid Facelift, Uncategorized | Tagged , , , , , , , , , , , , , , , , , , , | Leave a comment

Balancing the nose with the face

Posted on March 4, 2013 by Mike

What makes a great rhinoplasty? It’s really quite simple… Often times, a patient will come to me saying “my nose is too big” or “my nose is too long”. Really what we’re seeing, is that the nose is actually out of balance with the structure of the person’s face.  Symmetry is the largest component in achieving a result that looks natural. If a nose is too big, small, pointed or crooked, then these aspects of the nose are out of proportion with their other facial features. A really great nose is one that disappears on the face and allows the other features of your face, such as your eyes and lips, to be the first thing someone notices.

Posted in Dr. Menachof, Rhinoplasty | Tagged , , , , , , , , , , , , , , | Leave a comment

Finding my niche…

Posted on January 30, 2013 by Mike

Here is why I do what I do…

When you’re in medical school, each day is broken up into four parts. You are in the classroom listening to lectures about six hours a day. You are in the lab an additional six hours of each day and in order to keep up with the lectures and lab work you need to be studying at least six more hours every day. This leaves the last six hours to eat and sleep.  Understandably, by the end of my second year in medical school I had learned a lot but had no idea what I wanted to do with this knowledge.  The last two years of medical school you are exposed to all the different medical specialties. During this time I learned some important things about myself.

First, I quickly realized that I liked spending time with patients. I enjoyed the process of sitting down with people, talking to them and getting to know who they are. This pushed me towards medical fields with lots of patient interaction.

Second, I reminded myself of all the time I had spent as a teenager, building things in my garage. I rebuilt the engine in my ’66 Volkswagen Beetle by using a how-to manual and common sense. I built furniture with scraps of wood and reclaimed parts. I even repaired transistor radios and old television sets that I found in a nearby barn. I believe these experiences gave me an aptitude for surgery. I not only love working with my hands but I thrive on the unique challenge that every surgery brings.

Third, I found that while I liked both the medical and surgical aspects of medicine, I wasn’t willing to give up either of these completely in order to do one of them exclusively. Variety was important to me. With this in mind, I began to carefully evaluate all of the specialties and ultimately my journey led me to Head and Neck Surgery.  As opposed to traditional ENT docs that primarily treat ear, nose and throat infections and do a small amount of surgery, this new specialty has grown to encompass all of the medical problems of the head and neck. It includes allergies, sinusitis, ear infections, hearing loss, dizziness, balance problems, hoarseness, care of the professional voice and swallowing difficulties. This specialty also includes all head and neck surgeries such as cancer surgery, microscopic ear surgery, laser throat and vocal cord surgery, endoscopic sinus surgery and facial plastic surgery. It allows me to treat both children and adults, and spend time in the office as well as in the operating room. I utilize a variety of operative techniques such as microscopic, endoscopic and laser. I treat everything from life threatening cancers to cosmetic facial plastic surgery.  I have found my niche.

Posted in Dr. Menachof, ENT, Facial Plastic Surgery | Tagged , , , , , , , , , , , , , , , , , | Leave a comment

Great Cheeks 101: Adding volume and shape to the cheeks and the middle portion of the face.

Posted on January 3, 2013 by Mike

Cheek Implants and a high volume filler like, Perlane, are both great options for changing the shape of the cheeks and the volume in the middle portion of the face. We find that they both have their advantages and disadvantages. Ultimately, a consultation that involves computer imaging is a great way to better understand what the end result of the procedure might be like for you; and how much of a difference our patients would personally like to see. Below we’ve listed just a few general differences between the two procedures.

What is the best option?

 

Cheek Implants-

The main advantage to cheek implants is that they are permanent. They work best in people who have a congenitally flat mid-face, but give improvement in anyone who has lost volume in the mid portion of their face. Cheek implants come in a variety of shapes and sizes, allowing your surgeon to customize the implant to fit your specific needs. We find that some of our patients are better candidates for cheek implants that add more volume closer to the middle of their face (closer to the nose) vs. those that are perhaps too “cheeky”, and it may be an improvement to see the volume extended along the cheek bone (out toward the ear). Once again, with digital computer imaging we are able to give our patients a realistic understanding as to what the end result may be for them, and perhaps even a couple of different degrees of volume to choose from.

 

Dermal filler-

Prior to the introduction of deep tissue fillers, such as Perlane, fillers were often not a great option for flat cheek bones simply because most people who need volume, need so much volume, that it simply took too much of the “softer tissue” hyaluronic acid fillers to be practical. Perlane, however, adds a great deal of volume per syringe and is typically injected deeper into the tissues. On average, 2 full size syringes are typically enough for most people. The other advantage to something like a deep filler such as Perlane, is that the injector is essentially acting as a sculptor when they put it in, allowing them to get the amount of fullness in the areas they want very precisely. Since the results are immediate, and because you are wide awake while it is being injected (a topical anesthetic cream is all that is needed), you can be a part of the process. I often give the patient a mirror part way through so that they can tell me where they feel they need more volume in order to get the results they desire.

Posted in Beauty, Cheek Implant, Computer Imaging, Dr. Menachof, Fillers, Implants, Injectables | Tagged , , , , , , , , , , , , , , , , , | Leave a comment

Driving under the influence of eyelid surgery

Posted on December 18, 2012 by Mike

My statement/title of this blog seems obvious enough, right? I have to say, it would be pretty disturbing to see this picture in your rear-view mirror as you’re driving home from your surgeon’s office after a recent eyelid surgery.  Well this was an actual Realself question that had myself and my staff cracking up about with visions of someone being pulled over with bandages around their eyes after receiving eyelid surgery:

 

 I Had my Lower Eyelids Done Without Any Anesthesia (just Numbing Shots) and They Let Me Drive Myself Home?

Although they didn’t give me a sedative, they had me take a pill before the surgery to either lower my blood pressure or my heart rate or both ( I don’t have high blood pressure to begin with). They said it would help control the bleeding during the surgery. Does anybody know what this pill was, I cannot remember the name. Is it safe to take a pill like that and let the patient drive themselves home afterwards? I felt very sleepy and plus had a hard time seeing since my eyes had just been operated on.

 

My answer: We perform many of our blepharoplasty procedures using a local anesthetic. We will offer a Valium or pain pill to these people to be taken about an hour prior to the procedure so that the local anesthetic injection is not as bothersome. This usually makes for a comfortable, successful, and most importantly, safe experience. When they are done with the procedure they are driven home by the person who will be keeping an eye on them for the rest of the day. In all honesty, it is hard for me to imagine in this day and age, that you were allowed to drive home after having surgery around your eyes. The pill you received may or may not have been a sedative (there are medicines that will lower your blood pressure to decrease the chance of bleeding that will not cause sedation), but it really doesn’t matter. Everyone’s vision is a bit “off” for a period of time after a blepharoplasty, even if they were wide awake during the procedure. Because of this, you were in no shape to be driving home after your procedure. I’m glad you made it home safely.

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What is a Liquid Facelift?

Posted on November 21, 2012 by Mike

The term “Liquid Facelift” refers to treatments that can be performed using injectable therapies that require little or no downtime. Often times, products like Botox®, Dysport® and Xeomin® are used to soften wrinkles and relax strong  expression lines; while other injectables add volume back into areas where it has begun to dissipate over time. The combination of these therapies gives the appearance of a kind of “lift” in certain areas of the face, for which we like to refer to as “The Liquid Facelift”.

The goal of volume replacement is to help patients appear more youthful and refreshed, perhaps as we did in our younger years… The most commonly used dermal fillers are Restylane®, Perlane®, Juvederm® and Radiesse®. Not all products can be used just anywhere on the face. Depending on the patient’s appearance and the location, one or a combination of these products can be used to reduce the appearance of wrinkles and provide plumping of various facial structures. Hollowing under the eyes, middle portion of the face, temples and chin can dramatically improve with just a little volume. Cheeks can be enhanced to return that heart-shaped face, while also addressing unwanted sagging tissues.  The lines around your nose and mouth can be treated with these various dermal fillers, as well as the jawline and hollowing of the cheeks. Treatment of the eyebrows with a neuromodulator, such as Botox®, Dysport® or Xeomin®, can lift the eyelids and even enhance eyebrow shape.

Facial balance and a more youthful appearance is something we try to offer our patients on a daily basis. A Liquid Facelift provides an option for those patients who are not quite ready to embark on cosmetic surgery, and prefer procedures of a less invasive nature. This combination of injectables requires just a short visit for treatment with little to no downtime after the procedure has been completed. Our approach remains on a more conservative side, as it’s a common desire of our patients not to appear as if they have had “work done”, but rather, look “refreshed and rested”. A Liquid Facelift may be the fountain-of-youth secret for women and men who want to keep everyone else guessing!

Posted in Beauty, Botox, Chemical Browlift, Dr. Menachof, Fillers, Injectables, Liquid Facelift | Tagged , , , , , , , , , , , , , , , , , , , , | Leave a comment

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7400 E. Crestline Circle, Suite 100
Greenwood Village, CO 80111
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At Dr. Menachof's practice in Colorado, face lift, Signature Lift™, brow lift and upper eyelid surgery are performed using the latest techniques and medical spa services such as BOTOX® Cosmetic help Denver area residents from Greenwood Village, Englewood, Littleton, Aurora, Cherry Creek and beyond to look their best.