Sculptra – For Deep Facial Volume Restoration (Liquid Facelift)

One of my favorite fillers is Scultpra (L-Polylactic Acid).  I often tell patients that when they look at photographs from their earlier years, they will notice that their face is fuller.  This fullness is what gives a more youthful appearance to the face.  The key assumption is that the skin overlying that fullness should still have good elasticity.  If this is the case, then deep volume fillers like sculptra can be very effective. 

Sculptra works by inducing collagen production.  The collagen is what does the "filling".  It is a deep injection but is done in the office with only topical numbing medicine applied to the face.  I typically prefer to treat the whole face, but we can also inject specific areas as well.  This is what I discuss with each patient to customize their treatment plan. 

Also, I typically prefer to combine this procedure with re-surfacing of the skin as well.  This may involve an abltative laser or even an IPL(intense pulse light) procedure to give an optimal enhancement of the face.  Below is an example of this treatment.  This patient underwent sculptra injections to the face.  She has a nice result with a rejuvenated appearance.  Notice there is more fullness in her face.  It is just as powerful as fat grafting in my opinion. Her jowls are softened and there is almost a lift, hence the term "liquid facelift".

How do I know if I need a Facelift? What is a facelift?

Patients often ask me "Do I need a facelift ?" This then goes into the second phenomenon that I describe in the aging process, namely the loss of ligamentous support.  As we age, along with losing volume as I have described before, the tissues that "hold up" our face begin to lose strength as well.  Take a look at the image below to understand how the face ages.

This is where you begin to notice deeper lines and wrinkles around the naso-labial folds and jowls.  This is also very evident in the neck region as the tissue gets loose and just cannot « stay up » any longer.  The platysma muscle in the neck, which is contiguous with the SMAS (muscle soft tissue of the face), begins to droop and patients will notice banding of the muscle ( the so-called turkey gobbler neck).  It is at this point that the patient will likely need some surgical intervention to reverse these changes.

Once these changes begin to occur, a patient needs to consider facelift as a solution.  Facelifts have many different connotations for patients.  I think this is because there are so many different techniques and approaches that you all have heard about.  Mini-Facelift, Short scar facelift, LifestyleLifts (strong TV marketing), SMAS facelifts, Twilight lifts, Smartlifts, Deep Plane Facelifts just to name a few and I probably missed a couple in there !  The main goal of any of these procedures should be to restore the laxity that  and ligamentous support.  When I evaluate a patient, I take all these factors into consideration before deciding which technique fits that patient.  It is a mistake to try and fit one technique to all patients that walk in.  I try to be versed in all these techniques to assure natural results and long term results.

Lipoatrophy- What does it mean?

So lets break down our earlier blog and discuss more specifically the changes I talked about.  Lipoatrophy represents, in my opinion, one of the changes that aging brings.  It is a term that we use to describe loss of fat or volume in the face.  When a patient says to me that they "looked so much younger" in old photographs, what they are looking at is volume.  Their face simply has more volume as compared to present.
The simple answer to this problem is to restore lost volume.  We can do this in many ways and with various techniques available to us.  The first "filler" was fat and it still is today.  Sometimes we do fat grafting independently or we can combine it at the time of a facelift.  Other fillers that are available on the market like Restylane, Perlane, Juvederm, and Sculptra also play a significant role in facial volume restoration.  In the last 10 to 12 years, the advent of these fillers has made these procedures very popular.  My goal when I meet a patient for facial aging is to find the right treatment option.  The art, of what I offer, lies in the proper assessment and treatment. The ultimate goal is to achieve the most natural appearance for the patient.

Facial Aging - How does it happen?

Facial aging is one of the most common reasons that patients come to see me.  What I offer to patients is anti-Aging  solutions.  It is entirely possible that this can be gracefully and naturally achieved.  Aging process occurs at various rates and to various extents depending on many factors that I have outlined in previous blogs. 

Patients will often point out to me that someone they know who is the same age looks a lot younger.  This is often a factor of genetics more than anything else.  Why not do something about this now ? What are you waiting for ? 

As a plastic surgeon, it is NOT true that we ONLY recommend surgery for everyone that walks in to the office.  There are so many non-surgical options to consider today that surgery is NOT always the answer.  During the consultation, I first try to explain the aging process, before I recommend any treatment.  In my opinion, if patients understand facial aging, it is easier to understand the treatments that we offer.

So lets review facial aging.  I have tried to condense years of reseach into essentially three basic processes : lipoatrophy, loss of ligamentous support, and skin surface damage .  It is a bit simplistic approach and explanation of what really is a very complex process involving many factors, but keeping things simple is often the best approach in life.  These processes are NOT mutually exclusive, isolated, step-wise events.  They can occur at varying rates, intensity, and duration throughout the lifespan of the patient.  This conept is extremely important as I design a treatment solution.     

Tuberous Breast Deformity - Breast Augmentation is the Solution

Once in a while I will encounter a patient as pictured above, who is seeking breast augmentation.  Often this patient does not realize that the reason she does not like her breasts has to do with not only the small size but also the shape of the breasts.  She has tuberous breasts.  Tuberous breasts have a number of characteristics that make them unique.  It is important to state that there is nothing wrong with these breasts.  This is strictly a cosmetic issue for most women.

Tuberous breasts have a narrow base width and a high constricted infra-mammary fold.  The breasts are  conical in shape and have the appearance of underdeveloped breasts.  In fact they are actually fully developed but lack the proper aesthetics.  In severe cases of tuberous breasts, the nipple areolar complex is often large and misshapen due to breast tissue that herniates behind the areolae.  

Breast augmentation is the best solution to improve the appearance of these breasts.  These cases are challenging.  They require a level of understanding of the proper aesthetic relationship of the breasts.  This again is where the art and science comes together to sculpt beautiful breasts.  These procedures are very satisfying for patients and I love doing them.  

Below is the patient shown about 3 months post surgery using implants.  She is very happy.

South Jersey Magazine Top Physician Award for 2013

Please pick up a copy of August issue of the most popular magazine in South Jersey.  It seems that we have done it again!  Being selected as a Top Physician for South Jersey is a deep honor that I take pride in.  We have received this award consistently since 2007 and I remain proud of this accomplishment.  Thank you to all patients who take the time to vote for us.  We will continue to deliver excellence in plastic and cosmetic surgery to our patients.  For those who are considering plastic surgery, please check us out and let us be part of that transformation for you.   

How young is too young for Cosmetic Rhinoplasty?

Often I am evaluating a young patient for rhinoplasty and this topic needs to be re-visited in my opinion.  Improving the appearance of a nose combines the art with the science of rhinoplasty.  This is where science plays a major role in deciding when to do rhinoplasty.  An aesthetically poor appearance of the nose can have a devastating effect on a young patient from a social standpoint.

We know through our scientific analysis that the nasal anatomy matures during the teen years.  It is generally understood that the female nose matures between the ages of 16 to 18 and the male nose takes a bit longer.  In general the male nose matures closer to 18 to 20 years of age.

Theoretically, we can perform rhinoplasty at the age of 16 in girls, BUT this has to be based on the surgeons assessment of the facial anatomy of that patient.  What I tell patients is that it not just enough to evaluate the nose, my assessment has to include other structures on the face.  How does the nose fit in relationship to other parts of the face for instance, the jaw bone and the orbital bones.  Sometimes, these other structures are lagging behind in terms of growth and waiting is the best option for that patient.  My job is to help patients determine this issue.  In most cases, 16 is the earliest that I would initially consider a female patient for cosmetic rhinoplasty.

Physician Excellence Award

Last week, Virtua Hospital system held their annual Super Star Award ceremony.  At this ceremony, I was recognized by the Board of Directors to receive the Physician Excellence award.  I was extremely touched and grateful for this recognition.  This award has a significance in that it is a recognition of excellence of service by peers.  There is no recognition greater in my humble opinion than that by peers in your profession.  It shows our commitment to excellence at South Shore Plastic Surgery. I would like to thank any and all who were kind enough to nominate me and then to actually award me over so many excellent and amazing doctors in South Jersey.   

Earlobe Reduction

This does not seem like a huge issue, but it can be for some patients.  Earlobes that are too large can have a negative effect on patients.  Patients often complain that they look older just because their earlobes are too large or pendulous.  More often this is an issue that women deal with, especially those who wear heavy earrings.  It can stretch the earlobe and leave them hanging really low.
Another subset of patients are those who are just born with large earlobes.  The earlobes can be thick and pendulous as though they have been wearing large earrings, but in fact it is just their genetics.  This can be corrected with earlobe reduction surgery.
These procedures are done in the office setting with just local anesthesia.  There is often very little down time associated with this procedure.  The results are excellent.  Patients are very happy with the changes that they see.  My goal with this surgery is to make this look natural.  Patients can wear earrings after this procedure, once all the tissues have healed.

Top Physician for Women 2013

I know that choosing the right plastic surgeon is a personal endeavor for all patients.
Once again, I want to extend my deep gratitude to all patients who voted for us.  For a number of years now, we have been voted Top Physician for Women by South Jersey Magazine.  We did it again for 2013!
This represents our hard work, as we strive to provide the best care in plastic surgery to our amazing patients in South Jersey.  We want all of you to know that we will continue to be the best and earn you trust.  If you are thinking about plastic surgery, allow us the privilege of providing that service to you.  Come and meet us and see why we are the Top Physicians for all of South Jersey and dare I say all of New Jersey!

Breast Augmentation and Re-shaping without Implants- Mastopexy or Implants?

Breasts come in all different shapes and sizes.  Breast enhancement surgery is meant to restore volume and projection.  You can sometimes have adequate volume but poor projection and appearance.  This patient seems to have enough volume but poor appearance and even asymmetry of the breasts.
We can improve this situation and it does not always have to involve the use of implants.  Implants are necessary when the patient has lost volume of breast tissue.  This patient underwent a breast lift and re-shaping using her existing volume.  In this case, she also has breasts that look different (asymmetry).
I used mastopexy techniques to re-shape her breasts without the need for implants.  The patient now has a more pleasing shape and contour with an improvement of her symmetry. The scars have healed well and they often do heal well, even in dark skinned patients.

Breast Augmentation- The Most Common Procedure!

In 2009, according to the American Society of Aesthetic Plastic Surgeons, breast augmentation became the single most common cosmetic surgical procedure that we perform in the United States.  This is still true as of 2012.  What is amazing is that it surpassed liposuction.  As a patient, there are a number of things that I think you can glean from this information.

First, it is very common!  Many millions of women get this procedure everyday in this country.  In my practice, this is the most common surgery that I perform.

Second, it is safe.  If this was not safe, we would not be doing as many.  This is true from the standpoint of implant safety concerns (gummy bear implants), anesthesia related problems (virtually none), and post operative pain management concerns.  Patients will tell me that they feels comfortable enough after surgery that they often will go out to dinner with their loved ones the same night of the surgery!

Third, patients love this procedure.  In so many instances, I have seen this procedure positively change a woman's whole personality.  My patients will tell me that it makes them feel confident socially and professionally, and even at home!  This is truly the most amazing and gratifying aspect of this procedure for me as a surgeon.    

The dreaded split ear lobe

This is a common problem that I treat for many patients in our area.  Although this is a common problem, it is a difficult one nonetheless.  The case below demonstrates a patient whose ear lobe not only ripped, but also at some point became infected.  We can correct this in an office setting with just local anesthesia, but the key component is to allow the infectious process to clear up first.  Often, I will re-pierce these earlobes for the patients about 6-8 weeks later.  My general recommendation is to wear only light earrings (studs) after these repairs.  The integrity of the lobe and strength of the tissue is weakened after these types of tears, so heavy earrings can potentially re-create the same problem.

The Importance of Choosing a Board Certifed Plastic Surgeon

As a patient, it is very important to choose the right plastic surgeon.  Recently, we teamed up with one of our breast implant companies, Sientra, to showcase the importance of choosing a board certified plastic surgeon.  Please take a moment to view this video.  There is only one board in the US that certifies us to practice our craft and that is the American Board of Plastic Surgeons.
It is recommended for patients to not only seek out board certified surgeons, but also to actually ask at the time of the consultation if their surgeon is in fact certified by the ABPS.  I want my patients to know that I am certified by the American Board of Plastic Surgeons.

Power of Liposuction

Liposuction is a powerful tool to improve the contour of the abdomen.  It does not have to be some big procedure.  Often it takes only a little bit of vision to make simple improvements.  This patient has a lost some of what makes her sexy after pregnancy.  Her skin is good quality because she is young and the rectus muscle is still in good condition.  Minimal office liposuction can make a subtle, yet powerful change to her abdominal contour.

Mommy Makeover- The Restoration

Often I use the term 'frumpy' to describe the changes that pregnancy brings on both to the breasts and abdomen.  The tissue is loose, hanging, soft and redundant.  Often patients will say "I am not that bad and all I need is liposuction".

This sometimes is true, but in the end the outcome depends on your goal.  Liposuction might be fine if your skin elasticity allows it, but often I look at the patient, who is pictured on the left and describe her as 'frumpy'.

My goal is to contour and sculpt the patient so that they look the opposite of 'frumpy'.  This means restoring their tissue to make them tighter, sculpted and lifted to the original anatomic contour.  Believe it or not, the after photograph on the right is the same patient after her mommy makeover.  This included tummy tuck with lipo-sculpting and breast lift with a gel implant.  This patient has a restored self appearance and can feel confident that she can walk around in a bathing suit without any tell-tale signs of surgery.  This is the power of Mommy Makeover procedures.    

The Great Intersection- Why Plastic Surgery Is Unique

There is no doubt that plastic surgeons are scientists.  We are doing surgical procedures that are based on sound scientific principles of anatomy and re-arrangement of tissues.  However, I am always striving to find that Intersection, where science meets the art of plastic surgery.

Plastic surgery is also just as much an art as it is science.  When I see a patient, I try to examine each patient very carefully and approach each case with an eye to find that balance and intersection of science and art.  I am a sculptor, who is guided by scientific principles to get the most natural result possible for each patient.   

Is it Liposuction or Liposculpting? What am I getting?

Patients often ask me what is the difference between liposuction and liposculpting.  To me they are very different if you look at what we are really doing.

Liposuction is simply the removal of unwanted fat from a particular anatomic region.  Usually, these areas are resistant to diet and exercise.  If your skin elasticity is still well-maintained, then this is a great way to contour your body.  Here we are letting your body re-drape and contour.

Liposculpting is when we use liposuction to actually contour an area to our desired endpoint.  With liposculpting, I might liposuction an area, but not liposuction an area adjacent to that.  This means that the area that I left behind still has fat left.  This often leaves an area that you might call sculpted.  For instance, trying to create a six pack abdomen.  I might liposuction the inscriptions but the area above and below the inscriptions might not be suctioned.  Often I use liposculpting techniques during my tummy tuck procedures.  Some plastic surgeons might refer to this as etching.

In either case, these techniques give me the chance to be a sculptor.  I can carefully and artistically create an area that looks amazing!

When you come for your consult, be sure to ask these questions.

My Life Mission

Once again I personally want to thank all of you in my friend and family circle and among my patient population, who support my mission work.  I am committed to helping those who cannot get the plastic surgery that they desperately need throughout the world.
As most of you know, I have been lucky enough to befriend some of the world's best plastic surgeons and humanitarians to help me achieve this goal.  I never want to pretend that I do this work alone.

Please take a second and check out the video of my most recent mission to Bilaspur, India.  If you are interested to donate and contribute to future missions, please inform my office and they will guide you.

The Human Mission

I started seeing patients the moment we arrived at Apollo Hospital in the small rural town of Bilaspur. There was no time to rest. These patients had been waiting for us for weeks to arrive. It was during this clinic time, on this day, that I realized something that really struck me to the core. I have been to India to do these missions many times. Heck, I have been to the Philippines and other countries, but this was different somehow. Mostly on these missions, I was treating congenital deformities. These are deformities that patients have no control over. This is how they were born. I can deal with congenital deformities. This is what I was trained for, but what I was seeing today was horrific, sad and unimaginable to my Westernized mind. This was the fourth medical mission for the American Society of Indian Plastic Surgeons (ASIPS). I rounded up some of the best plastic surgeons, an all-star cast, from the US for this mission. Dr. Munish Batra (San Diego), Dr. Shashi Kusuma (Ft Lauderdale), Dr. Vineet Mehan (Fairfax), Dr. Satish Vyas (Detroit). Good fortune was smiling on me when my dearest friend Dr. Chanjiv Singh, an amazing plastic surgeon from India agreed to come along and even help set up this mission. We were a team of six dedicated plastic surgeons, dedicated to our craft, dedicated to humanity. Escorted up to the clinic area, I could see the patients lined up waiting for my arrival. Hundreds of people with all sorts of deformities anxiously awaiting my arrival. Just walking to the designated office became an ordeal as the patients wanted me to see them right in the hallway. « Doctor..doctor », they screamed wanting to be heard and seen right there in the hallway. I motioned for them to wait and assured them that we would see all of them, not knowing if I had just made them an empty promise. How could we see all these patients in one day. There were too many. Sitting in an office surrounded by local doctors, nurses and even hospital administrators, who were there to help me translate and communicate with the patients. My Indian heritage is obvious when you see my brown skin, but having spent most of my life in the US, it is just as obvious that I am a foreigner in my own land. I know how to speak Hindi, the main language of India, but I also know my limits. The first patient came in with severe burn contractures to her face and torso. She was an untouchable to the locals, who was about to touch me deep in my own humanity. The local staff practically ordering this woman to sit. Her eyes filled with fear and apprehension. A frozen scarred face. A mind probably filled with complex emotions that I would not even begin to comprehend. To her, I was a strange doctor from a far away land that she could not even imagine. To me, she was a patient that I came to help. Pulling my chair right up to this woman’s side, I wanted to stay eye level with her during my examination. I wanted her to feel comfortable with me. I wanted her to maintain her dignity, if there was any left. I wanted to show her the respect she so deserves and has earned. As she recounts her story, I realized how much pain this woman has endured and will continue to endure. First the fake version of the story, this was an accidental burn. Then the truth, a deliberate act by a cowardly man to disfigure a beautiful woman, a wife for reasons that make no sense to this Westernized brown doctor. Sadly enough, I have treated many burns in my life as a plastic surgeon, but this was different. This is a site that most human beings should never have to see, let alone endure. It is devastating to see a once beautiful woman turn into something so horrific. Her neck skin is fused to her chest and breast. Her lower lip is adhered by scar tissue to her chin, which now is a confluence of hard scar that is also adhered to her chest. Where once there were breasts are now nothing but hard thickened scar that have no semblance of anything human. Her womanhood stripped from her in a violent act of cowardice by her husband. I gently put my arms around this woman and assured her that we were going to help her to the best of our capability. Her inferiority complex was palpable. She was an untouchable thrown out of her own world and rejected to fend for herself. This woman was probably clinging to whatever humanity and dignity that still remains in her. Painful and extremely disfuguring scars are all this woman knows and will ever know. My heart was bleeding for this woman. I am her doctor but I am also a fellow human being, who can see right through her suffering eyes. This was the moment that struck me. This was not a congenital deformity I was treating, this was a preventable crime committed by the one person she probably trusted the most, her husband. This woman was a hero to me just because she was alive. I wanted to reach out and touch her heart with my hands, instead all I could offer her was my scalpel and a promise to restore her to some semblance of normal. If I could cut out her pain with my knife blade, I would have offered her that. With my knife blade, I would try to restore her dignity, restore her womanhood, restore her humanity. This untouchable woman touched me in ways too profound even for me to comprehend. As I booked her surgery, I motioned the staff to bring in the next patient. I suddenly realized, this was only my first patient. This was going to be a long day. The American Society of Indian Plastic Surgeons (ASIPS) has dedicated its existence to providing access to plastic surgery to those extremely underserved in rural India.