Plastic Surgery
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Patient’s interest in defying facial aging continues to grow. Emphasis on beauty and youth continue to drive patients to seek cosmetic procedures. The area of largest growth has been in the arena of less invasive office based procedures with no down time. They present minimal risk and are highly effective, and can effectively mitigate the undesirable effects of facial aging. Botox has been in the forefront for years as a substance that when used properly can reduce the signs of facial aging especially in the forehead, around the eyes, and around the lips. The most commonly used facial fillers are hyaluronic acid based such as Juvederm, Restylane, and Perlane. Their individual properties differ somewhat as do their duration of action.
What has changed in the past year or two is a multidimensional approach to treating the aging face with a combination of mobility restriction, volumizing and contouring which can lead to very satisfactory mitigation of aging in the face.
When I evaluate a patient I consider the three dimensional changes that have taken place in the aging process and what combination of treatments will make the greatest difference. Sometimes it’s botox or filler alone, but most of the time the combination will give much more satisfying results.
It also goes without saying that the three dimensional sensitivity of the injector will make a big difference in achieving a natural outcome. It is also important to point out to patients where the conservative measures will fall short and surgical procedures such as eyelid surgery, facelit, fat injection or liposuction will be better suited to accomplishing desired goals.
In all aspects of facial rejuvenation an artistic sensitivity will lead to a more natural satisfying result.
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Dr. Elliott - Plastic Surgery
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Botox, Facial Fillers
Recently in my practice I have seen an increase in demand for facial fillers. In our current economic climate patients are postponing surgical procedures because they can’t take time off from work and economic uncertainty has frayed consumer confidence to proceed with luxury expenses.
In spite of current conditions patients still want to do ‘something’ to look better, temporize and feel better about themselves. Fillers have a wonderful role to help achieve these goals.
With aging or just genetic bad luck, smoking or excessive sun exposure there are specific areas in the face that predictably deteriorate. The most common areas I inject are the naso-labial folds the lip lines, the lips, the marionette lines extending down from the corner of the mouth, and the deep lines that can develop between the eyebrows or forehead and the hollows under the eyes.
There are a wide range of products used by physicians to fill these areas. The two broad categories are temporary and permanent. ArteFill and silicone are permanent fillers. Silicone is not FDA approved but is used in an off-label manner. Suffice to say that these fillers can be problematic, with formation of permanent lumps, migration of lumps or granuloma formation. For those reasons I avoid their use in my practice. The semi – permanent fillers, Radiesse and Sculptra have similar issues therefore I prefer to avid them.
In the category of temporary fillers there is collagen and hyaliuronic Acid.. Collagen doesn’t last long enough to make it cost effective. This leaves us with the hyaluronic acid fillers of which there are many; Restylane, Perlane, Juvederm, Hyalaform, Elevess, Puragen, and Prevelle. I have found that for my patients, Juvederm and Restylane have worked the best and have a high level of patient satisfaction. In some areas it is combined with Botox Injection to assist in minimizing lines and creating a more rested, youthful appearance.
Like everything else in plastic surgery, injection of fillers have to be performed with skill and artistic tastefulness. Many offices relegate injection to assistants or nurses. I do it myself, and approach every patient for filler injection individually. We have all seen the “sausage” or “ducks” lips that denote a poor understanding of facial esthetics.
Fillers when performed well can offer great satisfaction both as a stand alone office procedure or as an adjunct to facial surgical procedures. It must be performed skillfully and safely, choosing fillers that are both effective and have minimal potential complications.
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Dr. Elliott - Plastic Surgery
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Facial Fillers, Juvederm, Restylane
 Dr. Eugene Elliott is a California Board Certified Plastic Surgeon extensively trained and experienced in numerous cosmetic surgery procedures. Surgical procedures such as breast implants, tummy tucks, liposuctions and facelifts are performed. Other services include facial cosmetic surgery, body contouring, breast surgery, male cosmetic surgery, cosmetic skin enhancement and laser hair reduction.
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Dr. Elliott - Plastic Surgery
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Breast Augmentation, Breast Implants, Cosmetic Surgery, Facelift, Liposuction, Plastic Surgery, Plastic Surgery for Men, Skin Care, Tummy Tuck
The ideal candidate for liposuction is not overweight but has excess accumulation of fat in certain anatomical locations. The most common locations in women are the abdomen, flanks, and thighs and neck. Other areas include the arms, back, and buttocks. In men the most common area is the lower abdomen and love – handle. It is important that the overlying skin is relatively firm. If the skin is very loose for instance in the abdominal area, that patient may be a better candidate for an abdominoplasty. The method of liposuction involves tumescent infusion followed by fat extraction. I use power – assisted liposuction which gives me greater ability to sculpt the fat. It is important to understand that liposuction is a sculpting procedure requiring experience and three – dimensional skill.
An exciting new technology in liposuction is ultrasonic liposuction. This involves the use of an ultrasonic probe that emulsifies the fat prior to extraction. Ultrasonic liposuction (UAL) is more aggressive. In my practice indications for UAL include men, areas that have had previous liposuction and in patients that have a small amount of lax skin for instance in the arms and abdomen. The UAL energy causes some skin contraction (tightening), which does not occur with conventional liposuction. UAL has become a very rewarding technology for my patients. There are other emerging technologies involving laser probes. At this point they appear to be more expensive, and offer no additional benefit. Before I will offer a new technology to my patients it has to be proven, offer an advantage over existing technology and be safe. Not just a marketable buzzword.
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Dr. Elliott - Plastic Surgery
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Liposuction
When considering breast enhancement the concept seems relatively simple, but there are many options to consider. Most of the options discussed are soft, that is there is rarely an absolute wrong or right way of approaching breast enhancement with a patient. But after 25 years of experience with this operation I will share with you the thoughts that I share with a patient considering augmentation.
The best candidate for breast augmentation is healthy, has no immediate history of breast disease has a good intrinsic shape to her breasts and torso, and has some loose skin. That doesn’t exclude patients with variations but there may depending upon what is observed discussion in addition to augmentation related to lifting or shaping the breasts at the same time as augmentation to enhance the results.
The approach to surgery is most of the time dictated by the patient’s Intrinsic breast shape and contour. Options include infra – mammary, peri-arreolar, trans-axillary, and trans – umbilical. I am in disfavor of the TUBA approach and do not like the trans axillary. With both approaches there is greater morbidity especially concerning implant malposition. I have found no reason to abandon approaches that are for the most part predictable. New developments in procedures sometimes benefit the surgeons marketing program more than patient outcomes.
The most controversial issue is implant type, saline or silicone. It must be disclosed to patients that no implant type is infallible, that there are long term risks associated with both. There are pros and cons to both saline and silicone, Since January of 2007, the majority of my patients have chosen silicone and have been very happy, but this choice is made only after thorough review of the pros and cons of their choice.
The last issue is not new in my practice, but has emerged to the foreground due to some high profile misadventures. Elective cosmetic surgery should be performed by a qualified {board qualified or board certified} plastic surgeon in an accredited facility that ensures a safe environment. Preparation of the patient for surgery should include appropriate medical tests and workup to help lower the intrinsic risks of any surgical procedure.
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Dr. Elliott - Plastic Surgery
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Breast Implants
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