October 12, 2011

What should I expect with my filler service?

Cosmetic fillers like Restylane®, Perlane®, Juvederm®, and other hyaluronic acid fillers are an excellent alternative to surgical procedures.  These products are composed of a cross-linked sugar gel that can correct wrinkles, volumize the nasolabial fold and lips, fill acne scars, and improve under-eye dark circles.  Dr. Steinsapir is the inventor of a unique and effective method that specifically addresses under-eye discoloration.  This technique is called the Deepfill™ method.  Facial fillers last about a year and treatments are easily adjusted using hyaluronidase, if necessary.  For many years, Bovine Collagen was the gold standard of fillers, but has now been displaced by Restylane® which is now the filler to which all others are compared.

Like Restylane, Perlane® is intended for volumizing, but it differs from Restylane in that Perlane is intended to provide facial volume in the deep dermis and superficial subcutaneous fat.  Perlane and Restylane are not equivalent products.  It is essential that your doctor places Perlane deeper than Restylane.  When used properly, Perlane is an excellent alternative to volumizing products like Scluptra® and Radiesse® and even fat transfer.  Treatment with Perlane also lasts well over a year.

Where are injections commonly performed?

Hyaluronic acid fillers are office-based services. You may see estheticians and unqualified individuals like medical assistants offering injections illegally in spas and salons under the justification that they have a “medical director.”   No States permit this arrangement.  Unless a doctor is present and performs the service, this type of situation is the illegal practice of medicine.  As with BOTOX®, don’t let an unqualified individual perform your Restylane or Perlane service.

Just like BOTOX, only a licensed medical doctor or a nurse under the direct supervision of a licensed medical doctor can inject hyaluronic acid fillers.  The exact details of the required qualifications vary by State so it’s important to research the individual you wish to perform the injection to ensure he or she is qualified.  However, just because your doctor or nurse is minimally qualified to perform the injection does not necessarily indicate he or she is the ideal choice for the procedure.  As with many other medical procedures, the best results require a certain level of qualification, skill and experience; these concerns are perhaps even more important when considering modifications to your physical appearance.

What’s the typical recovery course and what are the physical restrictions?

Many of Dr. Steinsapir’s patients resume their normal activities just after leaving the office with the exception of no workouts for 24 hours.  Wait a day before going to the gym.  If you don’t bruise, there will be about thirty to forty hours during which you experience minimal swelling.  Many patients, both men and women, can hide this swelling right away with a camouflage makeup that matches their skin color if necessary.  If your lower eyelid skin quality is poor and you often collect a small bag of puffiness under the eye, the doctor may counsel you regarding the need to consider a procedure like a chemical peel or surgery prior to getting regular filler treatments so you don’t experience prolonged recovery after each filler service.  This can be discussed when you have your initial consultation.

What are common complications and how are they addressed?

Most people, about 70 percent, do not experience bruising after a Restylane treatment; the other 30 percent experience some degree of bruising; most of it mild.  But a very few (one or two in a hundred) will develop a black eye.  The black eye can take about two to three weeks to completely resolve, and this is a cosmetic concern without health dangers.  The worst part of this is that many will assume that you were the victim of domestic violence.  Glasses and makeup help to hide the bruise while it is resolving.  Considering that Restylane will last over a year, the recovery process is very mild and comfortable even for these few.

For the few Restylane recipients who experience bruising, the short-lived bruise is worth the long-term results.  It’s a good idea to obtain treatment at least three weeks before big events like vacations.  For the biggest occasions such as your own wedding, Dr. Steinsapir advises have treatment 2 months ahead of the event to be completely certain that your pictures will turn out great.

To minimize your risk of bruising, your doctor will ask you to stop taking certain medications that thin the blood, such as aspirin.  If you are taking anything prescribed by a doctor, Dr. Steinsapir strongly advise that you consult with your prescribing physician before discontinuing the medication.  If your doctor suggests that you continue the medication, this does not mean that you aren’t a good Restylane candidate.  If you are willing to be at a slightly elevated risk for bruising, Restylane can still be effective.  Your regular doctor and your cosmetic specialist can help you decide the best route to take.

The incidence of allergic reaction varies with the products used and should be discussed with the treating physician but the incidence of allergies to these products is very low.

For unwanted highlights or bumps that occasionally occur after an otherwise excellent filler treatment, the enzyme hyaluronidase makes Restylane injections easily adjustable to a more desired aesthetic, and your doctor can even erase the treatment completely if you determine together that this is your best option.  In the event that you experience lumps or unwanted effects from your Restylane treatment, hyaluronidase makes it easy to adjust hyaluronic acid fillers like Restylane, Juvederm and Perlane.  This flexibility created by the ability to adjust a service is one of the most important factors making HA fillers such a popular service.

About Dr. Steinsapir

Dr. Steinsapir is a much sought after oculofacial surgeon.  He is an innovator in minimally invasive cosmetic and reconstructive procedures and has invented new methods for treating with BOTOX, fillers and cutting edge reconstructive eyelid and midface surgery.  He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery, including multiple revised cosmetic eyelid reconstructions.  He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago.  He is multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two-year cosmetic surgery fellowship in Rancho Mirage.  He is widely published and lectures to other surgeons nationally and internationally.  He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA.  His private practice is located in West Los Angeles, immediately serving the Los Angeles and Bevery Hills communities.  Additionally, individuals from all over the country and the world regularly come to Los Angeles for this expert care.

To learn more about Dr. Steinsapir’s specialized Restylane treatments, please contact us today.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

September 9, 2011

I had facial fillers and BOTOX and now I look older

If this happened to you, there is no doubt that you are dissatisfied with your treatment and that it makes you feel old – the exact opposite of the reason you chose to undergo the procedure!  There are many reasons your treatment may not have turned out the way you expected it to, but it is not the fault of the BOTOX or the filler, whether it’s Juvederm®, Perlane®, Restylane®, or any other hyluronic acid filler.  Complications from non-surgical treatments like fillers and BOTOX are almost always the result of your surgeon’s talent.  Choosing a skilled surgeon to perform your injections is important, but once the damage is done, choosing a skilled surgeon to fix the problem is imperative.

The Truth About Treatments

As the effects of your BOTOX treatment begin to wear off after several months―Restylane wears off more slowly―your face will slowly regain the looks it had immediately before your treatment.  Restylane and BOTOX treatments will not make you look worse than your original pre-treatment appearance as they wear off, nor are they supposed to make you look worse when treatment is new.  Provided you did not let someone put silicone oil

in your face and treatment is provided by an experienced injector fillers and botulinum toxin A have few side effects.  But if you aren’t happy with your results, you do have options and it is not necessary to wait more than a year for the filler to wear off.

Options for Fixing BOTOX Treatments

Treatments like BOTOX and Restylane are popular because they are noninvasive treatments that together can smooth wrinkles, relax tense muscles, and fill in hollow areas.  BOTOX and Restylane will not permanently alter your looks.  BOTOX is a naturally-occurring purified protein that relaxes muscles, and Restylane is made from a biodegradable sugar-gel that occurs naturally in the body.  Both of these are eventually broken down and expelled from your body completely.

Generally with the botulinum toxin A products (BOTOX, Dysport, Xeomin), the issue is an unbalanced treatment.   These services typically freeze the forehead.  The treatment results can be improved by having the appropriate counter treatment along the eyebrow using Dr. Steinsapir’s Microdroplet method.  However, if your BOTOX treatment has caused eyelid ptosis, Dr. Steinsapir recommends finding an oculoplastic surgeon to help you with this particular issue.  Oculoplastic surgeons are trained to assess and follow upper eyelid ptosis.  They are familiar and have experience treating upper eyelid ptosis.  A prescription for Iopidine (aproclonidine ophthalmic solution) can be helpful in this circumstance.  This medication is a glaucoma medicine that can elevate the eyelid a couple of millimeters. The drops can also be used to assess the severity of the ptosis and predict the likely time frame for the resolution of ptosis.  Dr. Steinsapir recommends trying the drop twice a day for a week.  If the drop is working to open the eye, then it is likely that the ptosis will resolve in 4-6 weeks.

Options for Fixing Filler Treatments

Dr. Steinsapir often sees individuals frustrated with treatments they received elsewhere.  Surprisingly, many people are not aware that the hyaluronic acid fillers can be adjusted using the enzyme hyaluronidase.  This enzyme is delivered with a small injection during a very comfortable office visit.  Dr. Steinsapir has helped people who put up with unsatisfactory treatments for much longer than they need to. These issues are easily dealt with using the enzyme in one or two visits.  It is the ability to make these adjustments that makes it feasible to provide many of the advanced filler services.  Do you have a hyaluronic acid filler issue that is not responding to hyaluronidase?  Some patients have been told they were injected with hyaluronic acid filler but in fact were treated with silicone oil.  Correction of some of these issues can be challenging and need to be approached on a case by case basis.

Restylane is a long-lasting, but not permanent sugar-gel facial filler that is preferred for improving facial contours due to its natural results, even in sensitive areas like dark circles under the eyes and the lip edge.  Restylane and Perlane offer the ability to modify results when necessary.  This includes treatments that were performed in the past and need fine-tuning.  The ability to adjust a treatment with the enzyme can take a good treatment and make it great.  In some cases, as the body slowly breaks down the material over time, slight irregularities may develop despite the initial quality of the treatment.  Sometimes, the answer is adding filler rather than subtracting volume.  For this reason, it is best to start with a detailed assessment with an expert like Dr. Steinsapir.

About Dr. Steinsapir

Dr. Steinsapir is a much sought after oculofacial surgeon.  He is an innovator in minimally invasive cosmetic and reconstructive procedures and has invented new methods for treating with BOTOX, Fillers and cutting edge reconstructive eyelid and midface surgery.  He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery, including multiple revised cosmetic eyelid reconstructions.  He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago.  He is multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two-year cosmetic surgery fellowship in Rancho Mirage.  He is widely published and lectures to other surgeons nationally and internationally.  He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA.  His private practice is located in West Los Angeles, immediately serving the Los Angeles and Bevery Hills communities.  Additionally, individuals from all over the country and the world regularly come to Los Angeles for his expert care.

To learn more about Dr. Steinsapir’s specialized Restylane treatments, please contact us today.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

August 30, 2011

Feeling Pressure to Look Feminine

With an abundance of fashion magazines like Cosmopolitan, Vogue, and Elle there is a lot of pressure to look a certain way in order to be considered “feminine;” full pouty lips, large eyes, flawless skin, and high, full cheeks are the aesthetic standard these days.  The internet has only become a tool to fuel this obsession with female perfection, but the reality is, makeup and Photoshop go a long way in making starlets and models meet the modern standards of beauty.  Nevertheless, the desire by women to meet the ideal is strong, and it doesn’t always require major surgery to achieve.  More often than not, it’s the little touches that make the big difference and starting small can preserve a more natural look and prevent you from looking like you’ve had major surgery.

Lips

Your lips are one of the first parts of your face to appear aged.  With a loss of volume and an increase of lines around the the mouth makeup has a tendency to exacerbate the problem by feathering.  Full soft lips are not just a sign of beauty, but also a sign of youth.  Fortunately, your lips are one of the simplest fixes without the need for surgery.  Fillers can provide a very natural solution to lips that are thin or losing volume.

With so many fillers available on the market today – Restylane®, Radiesse, Perlane, Juvederm, Artefill, Sculptra, Matridex, and even silicone oil – it can be easy to feel overwhelmed by the options.  However, not all of these fillers should be used as lip fillers under normal circumstances.  Hyaluronic acid fillers like Restylane, Juvederm, and Perlane are much more suitable for lip augmentation than permanent and semi-permanent fillers.  This is because they are much more forgiving, do not tend to lump, and can be simply and easily adjusted with the enzyme hyaluronidase.

Dr. Steinsapir prefers the use of Restylane as the best filler for lip volume deficiencies.  This is because the lips are very sensitive and irregularities can arise.  Fortunately, Restylane doesn’t tend to form bumps, and an experienced physician specialist can skillfully place Restylane for natural looks and long-term benefits.

Under Eye Fill

Dark circles under your eyes, or even a hollowness above your cheekbones is easily improved using a similar method as with the lips.  Dr. Steinsapir also prefers Restylane to reduce the appearance of dark circles because it can be easily adjusted.  Despite what the old wives tales say about dark circles and getting enough rest, persistent dark circles are actually the result of your lower eyelid muscle showing through the delicate and thin skin of your lower lid area.  When there is no subcutaneous fat between the skin and the muscle, the area appears dark and sunken.

The treatment requires a skillful hand but once placed and adjusted, the treatment is completely natural and can’t be detected by others. No wonder this has become the most popular eye dark circles treatment.

It is critical that the injecting physician assess how you do after the treatment because a certain percentage of treatments require an adjustment.  Dr. Steinsapir explains that everyone holds a slightly different amount of water in the tissues and small areas of fullness can spoil an otherwise great result.  For this reason, he encourages his patients to follow up about a week after treatment to assess how the service has settled.

Microdroplet BOTOX® and Dysport®

Of course, forehead wrinkles and brow lines are considered unfeminine, even among the older generations of stars like Diane Keaton, Susan Sarandon, and Jane Fonda.  Despite all of these women being over 60, all their photographs show them with smooth foreheads and full cheeks despite their features showing other signs of aging.  Maintaining a youthful appearance is a large part of looking feminine because it’s these features in women that are signs of femininity.

Unlike standard treatment methods, Microdroplet™ BOTOX® and Dysport create brow lift without forehead paralysis.  Microdroplet™ BOTOX® works with greater precision with your facial muscles.  The care and interest Dr. Steinsapir has shown in inventing this treatment demonstrates his dedication to achieving a beautiful, more youthful appearance without impeding the ability to express emotion.

Standard injection methods tend to freeze the forehead.  The forehead can’t move and the eyebrows drop like stones.  What looks good is a gently lifted eyebrow, no crows feet lines or brow pinch, and a forehead with reduced lines that is still able to move.  Imagine a BOTOX® or Dysport® treatment that allows you to have natural expressions!

Chemical Peel

Flawless skin has always been the ideal for beauty and as we all age, men and women alike, our skin develops flaws and spots that may not have been there when we were young.  But cosmetic products are not marketed to men so there is even more pressure on women to maintain clear, beautiful skin.

There are many types of chemical peels available and they treat many types of concerns, so it can be difficult to figure out which chemical peel is right for you.  But the chemical peel is truly an art form with versatile abilities depending on your needs, so it’s vital to understand that for a successful face peel with profound results, you’ll need an expert in performing facial peels who has extensive treatment experience and understands how to combine science and aesthetic planning for the best results possible.

Chemical peels can effectively treat facial concerns like aging skin, fine wrinkles, dark spots, acne, creases, loss of elasticity in the skin, and other concerns.  This frequently makes the chemical peel an excellent alternative to surgery that removes excess skin for the lower eyelid.  A chemical peel in the eyelid region is a minimally invasive procedure that preserves your natural features while rejuvenating your appearance.

Pigmentation is always an important consideration to any chemical peel.  The range in skin colors and complexions is complex, so this is something to consider with your doctor on an individual basis.  Fortunately there are many people who can and do benefit from chemical peels.  Your doctor can tell you more about skin-types as classified by the Fitzpatrick scale, and let you know what that means for you and your candidacy for a chemical peel.  A chemical peel can also help improve concerns with irregular pigmentation.

About Dr. Steinsapir

Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

March 4, 2011

Micro Needling and the Need for Science-Based Treatments

Micro needling, also called skin needling, is a recent trend in cosmetic treatment marketing that sounds miraculous in promotional media but unfortunately is not backed by science or medicine.  Does it work?  We can’t say for sure without extensive research on micro needling, and it’s important to understand that not everybody responds to a treatment in the same way.  But we can say from simple human experience that most products that sound too good to be true often are, especially when they aren’t supported by science, research findings, or promising new approaches that are grounded in established knowledge.

So what is micro needling?  In this treatment you use numbing cream and a roller to puncture hundreds of tiny holes in your skin.  Some claim that this can cure everything from wrinkles to scars to hair loss to unwanted fat.  These claims remain unproven.  Given the different causes of problems as diverse as too much cellulite and too little hair, it seems strange that one procedure says it can address all this and more.  With medicine doctors typically approach the cause of a problem to effectively address it, which is why Dr. Steinsapir only provides evidence-based treatments.  “Cure-alls” may be cleverly marketed, but most often we find that they don’t make sense, aren’t supported by evidence, may rely on dishonest marketing techniques like camera tricks, and are often expensive without delivering on their promises.

Seeking Proven Treatments for Reliable Results

For reliable results and the most return on your financial and emotional investment, we advise you to find an experienced cosmetic surgeon who can help educate you on scientifically grounded treatment options and customize the best individual treatment plan for your unique situation.  Dr. Steinsapir is highly experienced in providing and perfecting established cosmetic treatments like BOTOX and surgeries like the facelift, while also taking leadership in improving cosmetic treatment options, as demonstrated by his work with carved ePTFE orbital rim implants in the midface lift, chemical peel advances, Restylane for dark circles, and Microdroplet BOTOX.  You cannot know which treatment option is best for you until you consult with a doctor specializing in facial cosmetic procedures.  Whichever treatment route you and your cosmetic surgeon ultimately feel is best for you, it should be custom-designed and based on evidence backed by research.

About Dr. Steinsapir

Dr. Steinsapir is board certified in Ophthalmology and has completed numerous fellowships, including three years of Orbit and Eyelid fellowships at the prestigious Jules Stein Eye Institute at the David Geffen School of Medicine at UCLA and a separate two year cosmetic surgery fellowship under the auspices of the American Board of Cosmetic Surgery.  He is widely respected for his work and has published over thirty scientific papers and eight book chapters.   He is a true innovator, having developed Microdroplet™ BOTOX®, a unique patented method for injecting BOTOX®, Deepfillunder-eye Restylane® treatment to address the dark circle and under-eye hollow for up to a year without the need for retreatment.  Dr. Steinsapir is one of the foremost eyelid surgeons in the world.  He is on staff at the UCLA Hospital and Medical Center where he is an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute.  He is also on staff at Harbor/UCLA Medical Center where he serves as an attending surgeon.  He is in practice in West Los Angeles and is in high demand by discerning individuals from Los Angeles, Beverly Hills, and Southern California.  Many of his patients also come to see him from around the country and the world. Very few doctors offer the level of skill and expertise he brings to cosmetic surgery and aesthetic restorative surgery to address prior unsatisfactory eyelid surgery.  Please contact us today to learn more about evidence-based treatment options with Dr. Steinsapir for proven results.

February 27, 2011

Can I exercise my facial muscle for an improved tone?

Exercise and diet are essential for a healthy lifestyle, but it’s important to recognize their limitations.  Not every condition can be cured by exercise, vitamin supplements or fad diets, especially when the problem is not a result of poor nutrition or inactivity.  We absolutely encourage you to exercise moderately and eat well, but we admit to being skeptical of the arising claim that exercising facial muscles can restore youth and beauty to one’s face.  This is an unproven method, and when one considers that they are likely still using their facial muscles just as much as they were ten years ago, it becomes apparent that their aging looks are unlikely due to facial inactivity.

It’s appealing to believe that we can resolve all of our concerns through exercise, and while research shows that exercise does benefit our health in many ways, it also shows that further medical treatment is required for many conditions.  Just as someone with presbyopia cannot exercise to regain the ability to focus for reading vision, it’s not likely that you’ll be able to reverse the effects of age, time, gravity, and stress by wiggling your face or by having electrical currents stimulate your facial muscle to contract.

There are many types of facial cosmetic surgery and other treatment that can help you obtain the result you need if your doctor determines that you are a suitable candidate.  These range from minimally invasive treatments with little-to-no downtime like BOTOX and undereye Restylane to surgeries like the facelift and plastic eyelid surgery including eyelid reconstruction, which give dramatic yet natural results to individuals with far-reaching concerns.  While it is impossible to know which treatment, if any, is most suitable for you before a private consultation with the best facial cosmetic surgeon for you, you can be confident that there are a wide range of treatments that an expert can custom-tailor to meet your needs.

As a specialist in facial cosmetic treatments, Dr. Steinsapir has treated many individuals who first explored a variety of “natural solutions” for their aesthetic facial concerns.  Frustrated when they saw no results, they eventually consulted with Dr. Steinsapir and opted for proven treatment methods that provide dramatic yet natural results.  This human tendency to pursue unproven treatments is not a fault; it is normal to want to independently resolve a problem using the least invasive and most economical method possible.

Dr. Steinsapir is focused on your personal goals and comfort level.  Dr. Steinsapir always asks you questions about your specific goals, individual situation, and preferences so that he can plan a solution that is aligned what you want, so you can feel comfortable knowing that you are ultimately in control of your treatment plan.  Dr. Steinsapir very much believes in using the least invasive method for accomplishing a particular goal; for example, he does not recommend a forehead lift when a BOTOX treatment for wrinkles will will meet your goals – and he is a leader in his field of minimally invasive solutions.

If you are seeking a proven treatment with an experienced facial plastic surgeon with extensive training in oculofacial plastic surgery, we invite you to a personal consultation with Dr. Steinsapir today.  Dr. Steinsapir is honest, friendly, and can talk to you about customized treatments that give you the results you seek by addressing your specific needs and unique facial features.  Please call us today to schedule a time when you can speak with Dr. Steinsapir.

About Dr. Steinsapir

Dr. Steinsapir is a board certified cosmetic surgeon and oculoplastic surgeon in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology.  Dr. Steinsapir has a private practice and also serves patients at UCLA, where he is an assistant
clinical professor. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert provider of facial cosmetic surgery and eyelid reconstruction, which can be a vital part of your evidence-based treatment plan.

February 9, 2011

I had cheek implants in the past. What are my options for improving my appearance now?

If you have had cheek implants in the past and seek further improvement today, you have many options available to you depending on your present situation and goals in addition to the nature of your prior treatment.  The history of treatment approaches in combination with your medical circumstances and personal goals can shed much light on the best ways to improve the appearance after prior cheek implants.

You may already know that there is not a single type of cheek implant.  Nor do follow-up, refresher, or corrective treatments follow one simple or standard approach.  After all, cheek implants have evolved over the years, going through medical advancements and new approaches as cosmetic surgeons researched the most effective forms of cosmetic facial treatment.  Here are a few kinds of cheek implants styles that have been used or are currently in use and what can be done when issues occur.

The Early Cheek Implants

The cheek implants that were performed in the 1980s and early 1990s tend to follow two basic types: the older style “button” shape implants, or the elliptical shape.  With these cheek implants we see that as time passes after the original surgery, loss of cheek soft-tissue (which tends to happen with age) causes the contour of these implants to stand out.  The result that doctors and recipients of the early cheek implant observe here is prominent mounds of volumes where the implants are.  These appear obvious and stand out even to the untrained eye as disturbingly unnatural.

If you are experiencing this situation, consult with an expert facial cosmetic surgeon who can help you determine your best treatment option.  For some individuals, facial fillers can be used to soften the contour around these implants and obtain a more natural appearance characterized by the fuller and more balanced features associated with youth.  However, the best approach is usually the removal of the original implant and, when necessary, its replacement with an alternative and more natural implant as custom-designed by the best cosmetic surgeon for you.

Cheek Implants beyond the 1990s

Since the 1990s, implants have evolved to a more anatomic shape.  Most implant related issues are the result of oversized implants or implants that have settled in less than ideal fashiion.  Cheek implants fitting this description may require surgical removal and, if indicated, replacement.  Cheek implants like this were often placed through a lower blepharoplasty incision or through an incision in the mouth.  Implant placement can be associated with motor nerve damage to the muscles of facial expression or can compromise the appearance of the lower eyelid.  It’s possible that post-surgical changes associated with the eyelid surgery may need to be revised at the same time the prior cheek implant is removed.  Depending on the nature of the lower eyelid issue and the cheek contour, the old implant may then be replaced.  As many of these situations have unique characteristics, Dr. Steinsapir prefers hand-carving a custom ePTFE implant to replace the old implant.

Revisions to the Submalar Implant

Another style of implant is called a submalar implant, which sits low on the cheek.  While this submalar volume positioned at a low level may have appeared complementary at the time of the surgery, some find that this implant begins to look objectionable as the face ages.  Occasionally this problem is made worse because the original surgeon chose the wrong size of implant, or because the implant may not have settled correctly after surgery.  In these circumstances, the best approach is to remove the original implant, and then replace the volume deficiency with a hand-carved custom orbital rim implant in conjunction with a vertical midface lift.

Improvements with the Best Cosmetic Surgeon

The success of your follow-up improvements to prior a facial cosmetic surgery will be closely tied to your choice of a leading cosmetic surgeon who has specialized expertise in the treatment you need, and the establishment of open and comfortable communication that leads you to both feel confident in your treatment path.   As you seek a cosmetic surgeon whose experience and personality are a good match for your treatment needs, consider how Dr. Steinsapir can help you obtain the outcomes you desire.  Dr. Steinsapir attended medical school at UCLA, studied ophthalmology at The University of Chicago, and completed multiple fellowships in orbital and oculofacial plastic and cosmetic surgery.  Today he is an associate clinical professor of ophthalmology at UCLA’s prestigious Jules Stein Eye Institute, and his private practice in West Los Angeles helps many individuals to obtain the improved aesthetic and natural results they have always wanted.  To learn more about your cosmetic treatment options, contact us today to set up your no-risk consultation with Dr. Steinsapir.

July 16, 2010

Will skin bleachers help my dark circles?

Dark circles under the eyes is a problem that is both common and commonly misunderstood.  Dark undereye circle treatment can help, as long as you get the right treatment.  There are a variety of remedies as well as so-called remedies, so finding a qualified cosmetic doctor to accurately diagnose your problem will be crucial in determining the best treatment route.  In many cases, the best solution is an under eye filler like Restylane or surgery like the midface lift to correct the underlying problems.

Undereye Restylane Before and After Photo

Undereye Restylane Before and After Photo

Diagnosis Is Key to Effective Treatment

Many people wonder if a skin bleacher will improve dark circles.  After all, when they look in the mirror they see too much darkness under the eyes, and the logical solution may seem to be simply lightening the skin in this area.  However, in most cases the problem is not too much skin pigment.  This is why if you put on an opaque foundation makeup, you can disguise the problem to some extent, but your under eye area still looks haggard.

The issue of the dark circle is actually optical.  There is too little subcutaneous fat under the eyes, and the tear trough skin in this area is too thin, compounding the problem.  Light penetrates the skin and is then absorbed by the dark red muscle below the thin skin, which normally would be offset by a healthy layer of fat.  Yes, too little fat can be a bad thing, contrary to what popular diet blurbs may tell you – some fat in the face (but not too much) is desirable in order to give the soft appearance associated with youth and beauty.  You can bleach the skin all you want here, but this will not correct the problem, and instead may give you a strange pigmentation effect.

Treatment to Address the Underlying Problem

What we often see in individuals who present with under eye cosmetic problems is a descent of some of the soft cheek tissue known as the malar fat pad, which hollows out the under eye, contributes to the midface groove, and causes excessive fullness in the nasolabial fold.  Correcting these problems should be considered on an individual basis, but most often the best solution is either a midface lift or under eye Restylane.  These treatments address the fundamental problem of the way light interacts with the tissue here.

Restylane restores a natural fullness to the under eye area while allowing the flexibility needed to give precise treatment that is easily adjusted by your doctor should the results be less than ideal.  The midface lift is an excellent option for those with more severe symptoms, while Restylane can still help those who need surgery for dark circles but may be apprehensive for personal reasons.

Skin Bleachers – When to Use Them, and When Not To

Skin bleachers do have their place in cosmetic treatment.  For example, they can be utilized in combination with a chemical peel.  One such use is treatment with an alpha hydroxyl acid to produce smoother skin that, when combined with skin bleachers, has a synergistic effect of lightening the skin.  If you have a problem with hyperpigmentation, then an expert chemical peeler can skillfully use skin bleachers to enhance your appearance.

Skin bleachers are not appropriate when the fundamental problem is not with the color of the skin.  Effective dark circle treatment usually doesn’t involve skin bleachers, because pigmentation is rarely the problem here; rather, the impact of the descending malar fat pad and  the resulting fat deficit impacts your facial optics, and this is what you need to address.

Seek Expert Treatment

Administering under eye fillers is an art form, as is the midface lift.  When you are seeking a cosmetic under eye filler or surgery, you need a facial cosmetic surgeon with the medical training, clinical expertise, experienced specialization, technical skill, and artistic understanding it takes to yield the best results.  We invite you to consult with Dr. Steinsapir, who is one of the few doctors in the world who makes the treatment of dark circles under the eyes a major emphasis of his practice.  Dr. Steinsapir is multi-fellowship-trained in facial cosmetic procedures, and he emphasizes minimally invasive solutions that are proven to work.  Please contact us today to learn more about the best options for your individual concerns.

May 24, 2010

Skin needling – is it the answer?

Skin needling is often a do-it-yourself treatment wherein you use hundreds of tiny needles to puncture your skin, usually with a roller after a low-strength numbing cream is applied.  This is supposed to increase collagen production in your skin to remove wrinkles, erase scars, eliminate cellulite, and reverese hair loss.  Proponents say that this makes it easier for your skin to absorb lotions like face creams and stimulate healing, allowing your skin to repair itself.  This sounds like a revolutionary treatment, but unfortunately all of these claims are unproven.

Separating Fact from Fiction
Skin needling is marketed very persuasively, and we’re not going to dispute their claims.  There may be some benefits to this treatment, but the concern is that these claims are not supported by scientific data.  When this is the case, it can be very difficult to evaluate treatment claims without extensive training and experience in the practice of medicine.  One should be especially wary of products for sale that claim to cure a wide variety of unrelated conditions or offer results that seem miraculous.  Can skin needling really eliminate your winkles, remove your scars, and reverse your hair loss?  We can’t say no with certainty because there’s always the off-chance that someone somewhere might experience this, but we can confirm that there is no hard evidence to back this up.  A treatment advertised as a great deal isn’t ever a good use of your money if it can’t deliver the results you need.  That’s why it’s crucial to find a trusted cosmetic surgeon who can help you sort through all the smoke and mirrors.  For example, a trustworthy doctor will recognize camera tricks in before and after photos to evaluate the actual results.

Alternative, Proven Treatments

We do not mean to say that new treatments lack validity or promise; in fact, Dr. Steinsapir has been a leading cosmetic surgeon and researcher in finding new, better ways to treat people.  Technology is rapidly changing and improving, but that does not mean we have no good reason to value one new treatment over another; if a solution has a sound scientific foundation and subsequent studies to back it up, it may be considered an emerging field with strong credibility.  Dr. Steinsapir has seen fads come and go, and he has also seen new treatments being researched, developed, and then ultimately become a respected medical practice here to stay.  He has been on the forefront of developing and perfecting treatment methods like the midface lift, Restylane as a facial filler, and the chemical peel – all of which can be great facial cosmetic treatments depending on your needs.  And, as a peer reviewer of major cosmetic surgery and ophthalmology journals, he understands how to interpret raw data from a study in ways that media reporters cannot.

What you need will depend on your goals, your situation, and the severity of your concerns.  Cosmetic surgery and other cosmetic treatments for the face that are established as proven treatments are usually the best options to address problem areas in the face.  A trusted physician will be able to evaluate your condition and develop an individual treatment plan for you – because let’s face it, we all look different!

Choosing a Doctor Who Cares

If you are seeking the best facial plastic surgeon in Los Angeles, we invite you to consider how Dr. Steinsapir can address your needs.  He personally performs all treatments at his practice of cosmetic surgery in Beverly Hills rather than turning you over to an assistant, intern, or nurse, and he furthermore only relies on treatments with sound scientific basis and a proven treatment record – both in medical journals and reflected in the satisfaction of individuals he’s treated.  Call us today to schedule your no-risk consultation to find out how a proven treatment with a leading oculofacial plastic surgeon can save you from the stress and cost of failed fad procedures.  It will make all the difference in your treatment experience.

January 27, 2010

Can I have cosmetic surgery under local anesthesia?

You may be surprised to learn that many procedures like eyelid surgery, liposuction, facelifts, and others can be safely performed under local anesthesia with or without intravenous sedation.  Whenever possible, it’s usually best to choose local anesthesia instead of general anesthesia for several reasons:

1.    Local anesthesia is safer.
While cosmetic procedures today are overall considered extremely safe, it’s noteworthy to point out that in the rare cases of malpractice suits or death, most of these problems involve surgeries performed under general anesthesia.  For example, liposuction’s mortality rate when performed under general anesthesia is estimated to be between one in 40,000 cases to one in 5,000.  The actual figure is probably toward the lower end of that range, which means it’s extremely unlikely that you’ll be so unlucky, especially if you choose an experienced and reputable surgeon.  Then, when we look at the mortality rate for liposuction performed under local anesthesia, we find a mortality rate of only one in 300,000 cases.  The lesson to be gleaned here is that while both methods are very safe, the increased dangers of general anesthesia make safe local anesthesia a better option, so why take a chance?

2.    Local anesthesia enables the doctor and patient to communicate and obtain better results.
When the doctor and patient can communicate during the procedure, there is much to be gained.  If you are having eyelid surgery, for example, your surgeon can have you open and close your eyes so he or she can see exactly how your body is responding to the surgery and you can obtain the most precise results possible.  In cases like liposuction, your doctor will ask you to alert him if you begin to feel any mild discomfort.  This ensures that nearby tissues are not traumatized during the procedure.  If they are, you will be okay, but your recovery time will be longer.  When you are conscious, you can listen to your doctor and tell him or her exactly how you feel, which means your results will be more individualized than they would be if you are “out” under general anesthesia.

3.    Local anesthesia allows for faster recovery.
Fewer drugs means that you are less hung-over after surgery, so you return to normal much faster.  Going back to our liposuction example, the compression garments worn for six weeks after general anesthesia are only needed for five to six days after local anesthesia liposuction.  Since you are able to provide feedback to your doctor during surgery, the liposuction is accomplished with much less trauma which means a much faster recovery.

For these reasons, Dr. Steinsapir performs cosmetic procedures under local anesthesia whenever possible.  Cosmetic surgeries under local anesthesia often cost more than they would under general anesthesia because your doctor needs to spend more time working gently and delicately to ensure your absolute comfort.  The increased doctor-patient time does cost money, but this is also the reason why you heal so quickly and receive detailed treatment, along with fewer complications and health risks.

Which procedures can I have under local anesthesia?

This depends on your unique, individual health status and a personal examination.  Usually, those in good health can safely and comfortably receive most of the treatments we provide under local anesthesia.  Nonsurgical treatments like BOTOX, fillers, the chemical peel, and fotofacial of course are routinely administered under local anesthesia.  Cosmetic surgeries like the endoscopic forehead lift, facelift, midface surgery, liposuction, and eyelid surgeries are best performed under local anesthesia or local with intravenous sedation.  It is especially important to receive eyelid surgery under local anesthesia so your doctor can instruct you to open and close your eyes so that he or she can monitor and adjust the effects of the surgery for optimal results.

When is it best to have surgery under general anesthesia?

Generally procedures that are likely to run more than an hour benefit from sedation.  Body wall surgery including tummy tucks and breast surgery should be performed under general anesthesia.  Procedures that are likely to take more that 4 hours are often best performed under general anesthesia but this is something that should be discussed with the individual surgeon.

How do I find a doctor who will treat me under local anesthesia?

As always, we encourage you to be direct with your doctor.  Simply ask your potential cosmetic surgeon if he or she prefers to work under general or local anesthesia, and what he or she thinks will be best for you.  If your doctor prefers general anesthesia for you, find out why.  Is it because of your unique health situation?  Local anesthesia should be the default answer with general anesthesia functioning as an exception.  Yes, this will require your doctor to spend more time treating you, but in the end you will have peace of mind knowing that you’ll receive the safest care, as well as experience the fastest recovery time and the best results.

Dr. Steinsapir specializes in performing procedures that improve the face and body contours under local anesthesia.  He believes the extra time this requires is well worth the safer, superior results and satisfied recipients.  Dr. Steinsapir emphasizes the importance of minimally-invasive, detail-oriented treatments on a comfortable outpatient basis, while maintaining the expertise and safe resources needed for general anesthesia and inpatient treatment for individuals with unique health needs.  If you have any apprehension about anesthesia, Dr. Steinsapir can answer your questions, offer advice, and create solutions during your individualized consultation.  Contact us today to see how we can help.

January 21, 2010

How often should I get BOTOX and Restylane?

BOTOX and Restylane are both great solutions for those who wish to improve their facial appearance without undergoing surgery or invasive procedures.  We know them both to be safe,  comfortable procedures that are effective but not permanent.  If you are thinking about receiving treatment, you are probably wondering how often you’ll need it.  This is a great question that we will address in a moment, but first, please slow down and realize that you don’t have to decide right now how often you’d like to be treated or even definitively opt for any follow-up treatments.  We will give you some general guidelines, but exactly how often you’ll need treatment depends on individual circumstances and personal preferences.

Microdroplet Botox and undereye Restylane before and after photo

Microdroplet Botox and undereye Restylane before and after photo

Restylane, the preferred undereye filler for delicate areas like the undereye hollow, is long-lasting and typically retains great results for one to two years. BOTOX results generally last about four months and some benefits are still apparent after five months.  These are guidelines, not rules; results will vary based on your individual anatomy, treatment plan, and your own perception.

Ultimately, it’s up to you.

Dr. Steinsapir recommends a simple mirror test to his patients.  No, we don’t mean the one you may have heard of that instructs you to smile and look for lines (some lines, as previously discussed, are both natural and desirable).  This test is as follows: if you don’t notice anything issues in the mirror, then you don’t need further BOTOX or Restylane treatments at this time.  But if what you see starts to bother you – maybe you’re brushing your teeth and notice that you’re less satisfied with your appearance – then it’s time for retreatment.  This means that some patients come in to receive BOTOX treatment every two and a half months, because they don’t want to see a single effect wear off, while others come in merely once a year because they only just noticed an appearance they would like to treat again. We encourage you to find your comfort level and what makes sense for your personal goals.

I want precise guidance in scheduling my next treatment.

Perhaps you’re an actor, model, or just a busy mom; perhaps there’s another reason why you want objective advice about when to receive your next treatment.  Your doctor can help you decide how often you should receive treatment.  Objectively, it will probably be about once every four months for BOTOX, and once every year for Restylane.  Your doctor is a great resource for objective advice.  Your friends and loved ones may prefer to compliment you rather than give you honest feedback when you ask how your treatment is holding up.  If how others perceive you is a very important part of your treatment, discuss this with your doctor.

You can always modify your treatment plan later.

So relax!  If you are anxious about your first consultation or treatment because you worry that you might be “getting into more than you bargained for,” remember that you don’t have to sign away your life at a consultation, and a reputable, ethical practitioner won’t pressure you into signing up for some “blue plate special.”  BOTOX and Restylane are low-risk cosmetic treatments not only because of how rare complications are, but also because the results aren’t permanent.  Yes, they are effective, but you have no reason to worry that these services will “make you age faster.”  Few drugs are as well studied as BOTOX and the hyaluronic acid fillers like Restylane.  You may want to view your first treatment as a trial; if you like it, as most people do, then you can continue with treatments according to your needs as discussed with your physician.  If you don’t, then leave it at that.

A consultation, not a commitment.

It’s always wise to consult with a trustworthy doctor before committing to any treatment plan.  First, you need to find out if the procedure you have in mind is actually appropriate to your needs.  Then you of course must make sure you feel at ease with your potential cosmetic physician.  The reliable yet flexible nature of BOTOX and Restylane make these ideal products for anyone hesitant to make a permanent change, and they are also great for those seeking long-term treatments they can count on.

Dr. Steinsapir believes in natural Restylane and BOTOX results and in providing caring, honest feedback that is tailored toward your needs.  This means that you will never be pressured into more than you need or want.  At your individualized consultation, Dr. Steinsapir will ask about your goals and other personal circumstances to help you come up with the best course of action.  Remember to keep communication open with whomever you choose as your doctor to ensure that your needs are met at the times that are right for you.  Dr. Steinsapir meets with you personally for your consultation and, when you’re ready, personally performs your service, not a nurse or a technician.

Dr. Steinsapir is a leading practitioner of BOTOX and Restylane treatments.  He trained alongside the inventor of BOTOX and has since been helping Los Angeles BOTOX recipients achieve satisfying results.  He invented Microdroplet BOTOX and Deepfill Restylane methods.  Call us today for a consultation to learn how BOTOX and Restylane treatments can meet your needs through an individualized program.

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