Tag Archives: Boston
Video

Patient Treatment: Botox

4 Nov

Botox is increasing in popularity amongst professional, straight, male clients, such as this patient. I have many male patients who do a variety of jobs including construction, roofing, psychology, sales, and business owners.
Finding one of these men to be on a Youtube video was easier than I thought!

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Video

Botox 101

4 Nov

An introduction to Botox. What it is and what it isn’t.

Video Blogging… It Starts…

4 Nov

Here’s my first video blog!

Peanut Head: Volume Loss at the Temples

29 Jul

I’d argue the most over looked sign of aging is loss of volume in the temple. As we age, the temples lose fat and begin to narrow, shifting the balance of the face downward. Volume loss here contributes to the appearance of drooping and sagging of the cheeks and eyes (see Structural Changes in the Aging Face for other changes).  It begins as early as in your 20’s. It is most notable in athletes who have very little fat on their bodies, I’ve found especially runners.

As you can see, the area of total volume loss is pretty big when you actually look at it. In order to achieve the youthful contour of the temple, a patient will require a lot of product here. Adding filler to the temple is easy and almost painless, but deciding what filler to use can be difficult, they all have pro’s and con’s.

Juvéderm

This is usually my first choice with patients. For some reason… people tend to be nervous about filling this area! The great thing about Juvéderm is that it’s disolvable. The bad thing about Juvéderm is… you need a lot of it to fill this area, and that can be expensive. I’ve found great results by diluting the product before injection. The patient can see the result immediately. It may not last as long this way, but it is a good starting point. Most people love the result and usually step up to Sculptra when they notice they need a “refill.”


Radiesse

I personally don’t use Radiesse in the temples. It always reminds me of the scene from the Real Housewives of Beverly Hills when Adrienne Malouff’s husband injects Taylor and she has this big bump in her temple and Adrienne goes “is it supposed to look like that?” Although you get more volume with Radiesse, you also have more of a chance for lumps in this area. It’s not as smooth as Juvéderm (which is literally defined as a smooth consistency gel). It’s just not my preference, but for extreme volume lost I can see it being more cost effective.


Sculptra

I personally have had Sculptra injected into my temples. Sculptra is not a filler, but a biostimulator. Over several weeks post injection it promotes collagen production. It may take more than one treatment (usually 1-3 vials 1-3 treatments) to achieve the desired result. This is the longest lasting, and most cost effective product if you consider the longevity, but up front can be expensive. If you are the type of patient who is doing multiple fillers at a time, you should probably step up to Sculptra.


Fat Transfer

Fat injections can also be used in the temples but are only cost effective if a large amount of volume is needed for the entire face. I recommend only allowing a plastic surgeon perform this procedure (although a nurse can do it in Massachusetts). The fat is harvested from another area of the body (usually the lower back) via liposuction and transferred to areas of volume loss in the face (usually not just the temple). There is a lot of swelling and bruising with this treatment and not all the fat will graft (stay alive after transfer). It is also an expensive and invasive procedure. This being said, it can yield great results for patients who really need it.


The Procedure

Numbing cream is applied to the temple. The product selected is mixed with lidocaine and deposited on the bone until achieving desired volume. There is very little pain associated with all injectable products. Bruising isn’t typical; however, there are many vessels in this area, so it can happen. Expected cost depends on the product selected, but expect to use at least 1-2 syringes during time of treatment.

Good luck!

Holiday Wish List

27 Nov

So I was asked to make a list of the things I want for the holidays. I was told to make sure it was not ridiculous. I considered it a challenge to be completely obscure. (Followed by things your girlfriend/wife/daughter/sister might actually want this holiday season.)

  1. My first answer to this was a football helmet full of cottage cheese. If you saw the popular 90’s movie Airheads, you would get this obscure reference. If you haven’t seen it… you should.
  2. A day off. Oh wait… You don’t get those when you have a business. Grrrrr…
  3. New boobs = Need new bras.
  4. Office Space. Actual office space. In the Quincy area. Not the movie Office Space. Although also a great movie with a TON of awesome obscure references. Have you seen my stapler? http://www.youtube.com/watch?feature=player_detailpage&v=pHHZBmF8mk4
  5. New Louboutins. Because I love obnoxious shoes.
  6. A new car. Preferably of the Mercedes variety.
  7. Gay Personal Assistant/Gay Best Friend (GPA/GBA) on payroll. Not only to help me with my business… but sometimes I don’t know which shoes to wear. Also, sometimes he should not wear pants. Because, lets face it, Gay men always have better underwear than straight men.
  8. A dog. Which my assistant will also be taking care of. He told me he will not take care of a pig named “Kosher” or a piranha named “Nemo.” Which I accept, because I’m not sure of the legal status of these animals in the State of Massachusetts.
  9. My significant other to finish law school. Because I have obscure legal questions like “what is the status of having a pig or a piranha for a pet?” and “is ‘I thought speed limits were suggestions’ a viable defense?”
  10. A $10,000 gift card to Starbucks. My CPA, Matt Traiger, told me I have a problem. And I’d like a gift card for gas. I’ll take that in the amount of $25,000. Or I’ll accept stock in Exxon/Mobile.
  11. The Helicopter button in my new Benz. You know, the one you press so your car can fly over 93 when it’s gridlocked. Oh right. That’s EVERYDAY.
  12. An alarm clock that is also capable of removing me from my bed. And putting me in the shower. And cooking. And cleaning. Oh wait… maybe my GPA can do that. Or at least hire people to do that stuff.

I don’t think this stuff is TOO much to ask for.

Ok, but for REAL:

Cool Gifts This Season

Having a hard time finding the perfect gift?  Here’s a few things every female fancies (you can’t go wrong)!

Cute Boutique-y Jewelry? I recommend:

Gift Certificates For:

  • a manicure/pedicure ($15-$50)
  • a facial ($45-$150)
  • her favorite hair salon (be sure not to get just ANY salon)
  • a massage ($60-$100)
  • a day at the spa
  • A nice robe/winter gloves/hat/scarf.  We all wear them… we can always use a new one.
  • This is cool from Target (it said over 3,000 participating spas, but I’m not sure which ones):

  • A Little More Thoughtful:
  • A New Flat Iron (some good names: GHD, CHI, and BaByliss) ($150-$350)
  • Good Shampoo (like my personal favorite, Melu by Davines ~$26.50/bottle http://www.davines.com/en/products/view/dehc-melu-shampoo )

  • a subscription to New Beauty Magazine (www.newbeauty.com) LOVE IT! $9.99/issue
  • NARS Turkish Delight Lip Gloss–looks good on literally everyone (Sephora $22) http://www.narscosmetics.com/color/lips/~/lip-gloss
  • Along the lines of Sephora (which is at every mall) there are some really cool, easy gifts in there.  I love their kits of things like “mascara’s” and “lip glosses.”
  • New Make-up Brushes (check out Sephora again) http://www.sephora.com/makeup-brushes-applicators-makeup
  • Jewelry- but beware– jewelry is a very personalized gift.  Diamonds and pearls are always classy… but is she a diamond girl?  bling bling? or more subtle? like classy pearls?  Does she usually wear gold? or silver?  I once broke up with a guy who bought me aquamarines for an anniversary gift (not because I’m shallow, but because after dating someone for a year, you should know what kind of jewelry that person wears.  I realized it was a dead end relationship.)
  • Lulu Lemon.  For your sporty chick.  (Has anyone seen the commercial where the chick is talking all about why she wears yoga clothes–she bikes, she does yoga, she hits the gym– and then she says “Who am I kidding, I wear Yoga pants because I’m lazy” ahahaha) http://shop.lululemon.com/home.jsp?locale=en_US&sl=US
  • The circle scarf. Very comfy. Very stylish. Check out these deals at Nordstom.com http://shop.nordstrom.com/c/lulu?cm_ven=google&cm_cat=juniors_brand&cm_pla=lulu&cm_ite=lulu%20scarf_b&ef_id=f85OuV1@Z0oAAEZF:20121127045318:s

Just So You Know…

Bags–A crash course

  • Dooney and Bourke (otherwise known as D&B) $$
  • Coach $$$
  • Chanel/Gucci/Burberry/Louis Vuitton $$$$$$$$$

Don’t even think about buying her shoes. — however the book “100 Shoes: the Costume Institute/the Metropolitan Museum of Art” with intro by Sarah Jessica Parker… that’s a great gift!

100 Shoes: The Costume Institute / The Metropolitan Museum of Art

Ask a Chick!

My friend Megan swears by “asking Steph at Nordstrom’s in Natick;” all you need is a size and she can style you up (remember to check the tag of your girls clothes… and also keep in mind every brand is different, confusing and annoying–yea we know!).  If you can’t make it to Natick, that’s ok.  A lot of the high end stores have staff that are MORE than helpful.

Wrap It Up. 

Gifts should come in an exciting box.  So, wrap it up!


Happy Holidays! ~ LK

Will it hurt?

24 Nov

Pain is such an abstract and obscure concept. You can’t really define it. It has so many dimensions. In the hospital, we assess pain on a scale of either facial expression charts or numerically from 0-10. Zero being no pain, and 10 being the worst pain you’ve ever felt in your life. It is an individual experience; the numerical response to a stimulus can differ drastically from person to person. So, whether or not something will hurt is relative.

    Source: http://www.pamz.com

On a Scale of 0-10…

What’s the most painful thing I’ve ever experienced? First, a broken heart. That took a really long time to recover from… and I definitely still have scars! The second most painful thing I’ve ever endured is being in a car accident, which I also still have issues from. I’ve never gone through childbirth, never been divorced, still have both my parents, and never had a kidney stone. So my list has room to change. I’d like to point out that my list does not include Botox, Fillers, or my recent surgery. But that’s what this post is about. Do aesthetic procedures hurt as much as people think they will?

Beauty is Pain

We’ve all endured painful treatments in the name of beauty. Ever tweezed your eyebrows? Waxed your lip? Burned yourself with a curling iron? Stuck an eyelash wand in your eye? Walked more than a street block in stilettos? All painful, but relatable, every day examples of things women do in the name of beauty.

If you asked 100 women the same question, you’d get a 100 different answers. This is because women never have a “yes” or “no” answer. It’s always a story. So here’s a comparison story.

Q: How painful are stilettos?

A: Well, that depends.

  • How big are the stilettos
  • How long are you wearing them for
  • How far will you need to walk in them
  • Who makes them
  • How often do you wear stilettos
  • How often do you wear those particular stilettos (i.e. are they broken in)
  • What condition are your feet in (i.e. do you have any blisters)
  • What size are the stilettos vs. what size are your feet (i.e. does the shoe fit)
  • What are the road conditions for which you will be walking in them (i.e. changes in elevation)
  • What are the weather conditions for which you will be wearing them (i.e. rain or snow, inside or out)
  • Etc, ect, ect.

So, when you ask how badly something will hurt, there are many conditions which will change the outcome. It’s hard to explain the pain factor of beauty. The “Universal Pain Assessment Scale” does not really work when it comes to women and what they’re willing to endure. So… I decided to paint my own comparative scale. Because I love “Paint” (the computer program) and I love making stuff relatable.

The “LK Aesthetic Comparative Assessment Scale”

I’m not going to lie. This took me a long time to create, and it’s pretty scientific (although has no reliability or validity, it is merely my projections). This is how it works. Each treatment is rated in 3 dimensions on a scale of 1-5. Then those 3 numbers are added.

Chemical Peels

Laser Hair Removal


Laser on the Face



Eyeliner Tattoo


Botox


Fillers


Some fillers hurt more than others. The worst is the lips. I used that for the pain scale, but other areas hurt much less.

Tear Troughs    2

Cheeks        2

Marionette Lines    3

Naso-Labial Folds    3

Plastic Surgery

In all fairness… I think surgeries could be subcategorized. I heard liposuction isn’t really that bad. I guess it depends how well you are medicated too. Pain is relative.

I Hope this gave some perspective! Remember, this scale holds no scientific basis.

XOXO. LK.

My Breast Augmentation: Day Before and Day of Surgery

24 Oct

**Disclaimer: I wrote this 2 days post-op and still medicated with narcotics. If anything I say makes no sense… there will be a retraction printed in the future. I just am so excited to write this!!!!

Getting Implants– Entry 1.

October 17: The Day Before

What does one do the day before surgery? I realized I would be out of commission for a good week. In a normal week, there is work and cleaning, and grocery shopping. Preparing for being out for a week, I needed to do extra cleaning, work, and grocery shopping. I had to make sure all my laundry was cleaned and put away. There was food in the refrigerator. My boyfriend tried to convince me I had to make up for a week’s worth of sex (oh boys!). All my meds had to be picked up. I had to pack for my friend’s house… the normal stuff. I also had to get my gel nail polish taken off, my hair extensions fixed, and my eyelash extensions filled (normal? I’m not sure…?).

I got home from work at 11:30, just as Aaron was getting home. I got in the shower, washed my hair, and had my last drink of water (no food or water after midnight). I hadn’t been scared or nervous all day. But I usually do have difficulty sleeping when I’m nervous. Aaron gave me a night-night cocktail (aka Nyquil and ibuprofen) and slept like a baby (not medically prescribed mind you—do not try this at home).

October 18: 5am

Ungodly hour. Normally the only time I make the exception to be awake this early is if:

  1. I’m still up partying from the night before (which hasn’t happened since my UMass Amherst days—I SWEAR……….)
  2. I’m leaving on a plane for Mexico with the Donohue’s (from Donohue’s Bar and Grill in Watertown which is the most fun bar EVER).
  3. I’M GOING TO GET MY BOOBS DONE!!!!

I threw up a zip up sweatshirt (I didn’t want to put on anything that would have to go over the head) and some sweat pants. Don’t forget, it’s difficult to put your arms up over your head post op. Then that age old question hit me. Do I wear underwear? I decided there was probably super special sexy hospital underwear to put on. So I skipped. (They did give me some super sexy briefs at the hospital as I expected.)

Don’t I look hot at 5am?

5:15 AM

I of course forgot to pick up my post op meds (which you should ALWAYS do before surgery). My awesome boyfriend took me to the 24 hour CVS to pick up my vicodin, oxycodone, and antibiotics.

6:00 AM

Caitlyn McGrath arrives in a Ford 950 (whichever the really, really big one is). Cait normally drives a Volkswagen. I’m all like, Cait, why do you have this ginormous vehicle? And she’s all like… Well I didn’t have gas in my car, so I took my boyfriends. So I’d like to give a shout out to Pat from the Sitchiute Fire Department for lending the getaway car. We did have to make a 3 point turn at one point. It was not pretty. (Female Quincy drivers = THE worst).

Are you PSYCHED?!?!” she asked me. I was like, Cait, it’s 5 o’clock in the morning. Please. Stop yelling. (I don’t even think she really was yelling).

Cait is one of the lead medical aestheticians at the office and is in Nursing School, so she got super top secret clearance to be in on my case. Like FBI style. I’m so glad she was there. She knew every doctor/nurse/surgical assistant that walked into my room. And confirmed with me that they were all THE best.

6:15 AM

My nurse Maureen comes in, does my vitals, asks all my medical history questions, and inserts my IV (perfectly on the first try might I add). I signed a bunch of papers and started to get a little nervous, but like that first day of school nervous. That excited, this is going to be awesome kind of nervous.

7:00 AM

The doctor arrived and marked my breasts for the incisions. Then the nice nurse anesthetist came in and gave me something to relax through my IV. I remember being wheeled into the OR room. 5. 4. 3. And see ya later. I was out for the next few hours.

Apparently I woke up at spoke to Caitlyn a little bit, but I definitely don’t remember that.


All bandaged up.


The bandages stay on for about 7 days. You can’t get them wet (i.e. no showering. Iiiiiiick).

2:30 PM

My friend Jen P. came and picked me up and drove me to my other friend Julie’s (when I say this surgery was a TEAM effort, I am not kidding!). Julie is an awesome recovery room nurse and she and I decided it would be best if I stayed with her for the first two days post op. I am SO glad I did.

Even with the meds I was on I was still in a good amount of pain. Julie had to bear hug assist me up off the couch (I couldn’t push up with my arms because it was too painful). She also helped me keep a medication schedule and made sure I got my meds every 3 hours. And last, and most embarrassingly, she helped me pull my pants up when I had to use the bathroom.

5:00 PM

My boyfriend came and brought me beautiful flowers and told me how much he loved me. Awwwwww. He also brought me his fleece because it smells like him and I’m a dork and it helped me sleep.


6:00 PM

The party reallllllyyyyy begins. Kathy Nash (owner of KN MedSpa in Natick) arrives. I am really lucky to have such great friends to take care of me, medicate me, dress me, and help me keep my mind off of the surgery. It is not uncommon to have feelings of being overwhelmed or depressed after surgery. My crew kept a close eye on me to make sure I was mentally and physically stable. Errrrr… baseline…. for me.

  • A Funny Nurse’s Note From the Girls –


Baci, D.O.G. wearing my A sized bra. Awwwww. He looks like such a tuff guy… in a bra.


What! We couldn’t let Baci D.O.G. have all the fun.

A little comparison was in order from old bras to new bras.

October 19

Feeling like a million bucks. Staid on my medication schedule. It’s important to do this for the first day or two post op because you don’t want to get behind with pain. It’s hard to catch up. But I was up walking around once an hour. Feeling pretty good. I know pain worries a lot of people, but at most I felt uncomfortable right before I needed my meds.

Julie took me to Corbu Salon in Cambridge so my friend Devon could wash my hair (felt soooo good!) while Julie got hers highlighted. Thank god for all my friends in the hair industry as well! I mean, I might not have been able to shower for a week, but at least my hair could look good!

My post-op follow up is 10/24. So expect another post about post-operative care shortly!

As of today, I am SO happy. I’ve waited years to do this, and it has been the ONLY thing that has ever bothered me about my body. It’s hard to feel comfortable in your own skin, but whatever helps you do it, then do it. Just don’t go overboard!

xoxo LK

L.A.S.E.R. (Hair Removal)

15 Sep

Light Amplification (by the) Stimulated Emission (of) Radiation

Whenever someone says “laser” it makes me think of that scene from Austin Powers when Dr. Evil wants “sharks with frickin laser beams attached to their heads.” Ha.

Mr. Bigglesworth. HAAAAA. I digress. Anyways, this post isn’t about sharks… it’s about laser. Specifically, about Laser Hair Removal.

I was lucky enough to sit in on a class at Catherine Hinds Institute of Esthetics in Woburn, MA. It was a very informative and interesting class. The teacher was very knowledgeable and interesting. So I’m going to pass on that knowledge to you! Yeah!

First and Foremost…

The most important thing I can tell you about laser hair removal is BE CAREFUL WHERE YOU GO. Laser’s are a class 4 medical device, that, unfortunately, can be used by anyone under current state law (Massachusetts). If you go to a laser factory (i.e. Sleek Medspa, or American Laser Co.) the odds are you are being lasered by someone who has no idea what they are doing. Getting burned is not worth saving $50. I assure you. It’s painful and can leave scarring, and you especially don’t want this on your face.

Next. The second most important thing to ask is “do you have a laser or an IPL?” Many people are offering laser hair removal and it’s actually an IPL (Intense Pulse Light).

What is the difference between IPL and Laser?
A lot.


A Laser is Monochromatic.

Monochromatic: One color, red.

An IPL is Polychromatic.

Polychromatic: Every color in the rainbow. And then some!


A Laser is Collimated.

Collimated: Laser light energy will form a bond and stick together.

Think of a laser pointer.

An IPL is non-Collimated.

The bonds don’t stick together. They kind of spray all over the place. There is no focus to the energy. Think of a flashlight.


A Laser is coherent.

Coherent: The bonds of the laser light all travel together on the same wavelength.


An IPL is non-coherent.

The wavelength of energy is all different and erratic. Some are short and some are long. Some are straight and some are squiggly. It’s chaos I tell you. Chaos.  Yes, I spelled Chaos wrong below.  Shhhh.

What does this mean?!?!?!

A laser is focused energy that is attracted to dark color (hair follicle) and burns and kills the follicle.

An IPL tricks the hair into shock to release the hair follicle, but does not kill it. It will come back! (IPL’s do have a purpose, however, they are great for pigmented lesions! Like hyperpigmentation from the sun).

Pretreatment

  • Do not wear creams or lotions to your appointment.
  • Do not wear deodorant if you’re getting your underarms treated.

Before Your Laser Hair Removal Starts

Before any treatment is started you should fill out a health history. You are NOT a candidate for laser IF:

  • If you have been in the sun in the last two weeks (this INCLUDES a tanning bed). You will get burned by the laser. And don’t even think about lying to the laser tech. You get burned and it’s YOUR fault.
  • You are on photosensitive medications.
  • You have EVER had gold therapy.
  • You have used retinol the night before (on your face, and you’re getting your face lasered).
  • You have Lupus.
  • You are on immunosuppressive drugs.
  • You can’t stay out of the sun. This is IMPERITIVE.
  • Taken Accutane within the last six months.
  • Have an open wound.
  • Are pregnant.

After it has been confirmed that you are a candidate for laser, the tech will choose which laser is the best for your skin. This is based off your skin type.

Alexandrite vs. ND Yag

http://www.alexandrite.net/chapters/chapter7/the-alexandrite-laser.html

http://en.wikipedia.org/wiki/Nd:YAG_laser

Laser’s are named after the gemstone that is used to produce the beam. The two most popular laser’s on the market right now are the Alex and the Yag. What’s the difference?

ALEX

YAG

Multiplex

Gemstone

Alexandrite

NeoDymium Yttrium Aluminum Garnet

Alex and ND YAG

Energy Wavelength

755nm

1064nm

Fires both at same time

Skin Types

I, II, III

I, II, III, IV, V, VI (all)

All

Sun Exposure

None

(at least 4 weeks)

No recent exposure

(5-7 days)

None

(at least 4 weeks)

Attracted to

Melanin only

Melanin deeply

Hemoglobin

Collagen

Melanin deeply and superficially (best for Asian skin)

How Laser Hair Removal Works
Laser hair removal treatment works through a process called selective photothermolysis. The laser energy works it’s way down the stem of the hair to the bottom of the follicle, destroying the cell. The process is selective in the hair through pigment and not the skin around it. Very light colored blonde or white hair cannot have a laser treatment because there is not enough pigment for the laser to select from.

In the diagram below the picture is of a laser, not an IPL. The pulsed red light is referring to the type of firing of the laser. In aesthetics, it fires in a pulse.

During the laser hair removal treatment a cooling system is used to cool the s is usually applied to the skin, this prevents the area being treated from getting too hot or burning under the heat of the laser. There are three main cooling systems:
Cold air

  • Contact cooling
  • Cryogen spray

How Many Treatments Will You Need?

Hair grows in cycles, which is why you can’t kill all the hair in one treatment (although it will reduce the growth for every treatment you have). The face typically takes more treatments than the body.

Body Part

Avg. Number of Treatments

Treatment Interval

Alex

YAG

MultiPlex

Lip

2-4

5-7

3-5

4 weeks

Face

4-6

5-7

4-6

4-6 weeks

Bikini Line

4-5

5-8

4-5

4-6 weeks

Arms

4-5

5-8

4-5

4-6 weeks

Underarms

4-5

5-8

4-5

4-6 weeks

Back

4-6

6-9

4-6

4-8 weeks

Legs

6-8

6-9

4-6

6-8 weeks

**Remember, this is an AVERAGE.

What Does It Feel Like?

The laser pulse is often described as a wave of heat with a sensation of a pinprick. Everyone has a different pain tolerance, and some areas hurt more than others. If it is too painful, the laser tech should have numbing cream on hand.

What Should It Look Like Post Treatment?

There are 3 goals in laser hair removal:

  1. Peri follicular edema (swelling around the hair follicle)
  2. The smell of burning hair
  3. Erythema (redness)

ßperifollicular edema

Redness should subside within 24-48 hours. Within 7-10 days the hair follicle which was killed will be expelled through the cell cycle.

Post Treatment Care

  • Apply aloe or lavender cream to the area for rehydration.
  • If blistering, apply an antibiotic cream.
  • Contact the office if you think you have a burn.
  • Normal skin care regiments can be resumed the day after treatment if there are no signs of being burned.

Laser Hair Removal Side Effects

There are usually few side effects with laser hair removal but you should always check with the person who is giving you the treatment to make sure they are qualified. The side effects which can be experienced in some individuals include pigmentary changes in the skin which include darkened or lightened areas, these changes are usually temporary. Rarely some people experience blisters or burns.

What it should not look like:

The evenly spaced circles are from the head of a laser as it pulses along.

If it’s tracked burns, it’s from an IPL.

Does it work?

Yes!!! LASER Hair Removal works when done correctly (with a LASER and by someone who knows how to use it!). The Boston Globe did a great article over the summer. Check it out. http://www.boston.com/news/health/articles/2010/07/05/are_laser_hair_removal_treatments_effective_and_safe/

XOXO,

Infrared LK

P.S.

Getting Implants– Entry 1

7 Sep

I’ve been working in Plastic Surgery for a few years, and I’ve never been under the knife. I finally made the decision to book a breast augmentation. This is my experience, from a patient point of view.

August 27, 2012

I guess I would consider this day an emotional roller coaster! I had just finished a brachioplasty with the plastic surgeon (as a surgical nurse) when I was called into his office. Long story short, surgery is booked for October 18.

My first reaction was obviously excitement. There may have been a point where I was jumping up and down… and clapping.

Of course, on this day, my mother was meeting my new boyfriend for the first time. Do I tell her? Do I tell my dad? Do I tell my boyfriend’s parents who have probably already read about it on facebook? Honestly, I’ve actually never questioned telling anybody anything I do (although, in hindsight I’ve questioned whether or not it was always appropriate); it was a really odd feeling! I figure, I’m a terrible liar, so I might as well just say it like it is:

“Mom, I’m getting a boob job.”

Things don’t really faze my mother at this point. There was a moment of déjà vu back to the night before my 18th birthday, when I told her I was getting a tattoo.

“How big?” she asked.

“Proportional” I answered. (I gave the wrong answer when I was 18, and I am fortunately not the owner of a GINORMOUS back tattoo, THANK GOD for my mother telling me to make it small!).

“It’s your body, whatever makes you happy.” Aw, mom!

It’s Your Body

Making the decision to undergo plastic surgery should never be anyone’s decision but your own. It should never be for a guy or under peer pressure of a friend. It is a major decision, and as with any surgery, it has risks. I’ve wanted to do this for years, but either I haven’t had the time or I haven’t had the money!

I want to be more proportional. I want my clothes to look good on (or off). And I don’t want to dread bathing suit season!

My reasons for doing this are healthy, and I am very happy with my decision.

August 9,2012 – My Consultation

Choosing size, shape, and style

There are a lot of options to consider when deciding on implants! The first question many ask is: “how big?” expecting an answer in cup size, I guess. But implants don’t come in cup size. They come in cc’s (cubic centimeters). In order to determine the size, shape, and style of implants that are best suitable, there are several things to consider:

  • Symmetry of your breasts
  • The width of your breasts in proportion to the chest wall
  • The characteristics of your breast tissue – how much tissue do you have? How much stretch do you have in your breast tissue?
  • Your goals and expectations for surgery
  • The location of the incision and the implant placement

The Age Old Question: Saline vs. Silicone

Saline

Silicone

Contents

Filled with sterile salt water.

Filled with soft, elastic gel.

May be pre-filled to a predetermined size, or filled at the time of surgery to allow for minor modifications in implant size (good for asymmetrical breasts).

Pre-filled and may require a longer incision for implant placement.

Consistency

Amount of fill affects the shape, firmness, and feel.

Feels and moves like natural tissue.

Risks

scar tissue, breast pain, infection, changes in nipple sensation, implant leakage or rupture.

same as saline.

Rippling

More likely

Less likely

Cost

Less expensive

More expensive

I chose silicone, because it is more natural looking and feeling.

Under the Muscle or Over?


The implant is placed in a pocket either directly behind the breast tissue (right) or underneath the pectoral muscle which is located between the breast tissue and chest wall.

I chose under the muscle.

Incisions, Incisions, Incisions?


An incision can be made either underneath the breast, just above the crease, around the lower edge of the areola or within the armpit.

One of the advantages of a saline-filled implant is that, because it is filled with saltwater after being inserted, only a small incision is needed. Often, an incision of less than one inch is made underneath the breast, just above the crease, where it is usually quite inconspicuous.

Another possible location for the incision is around the lower edge of the areola. A third alternative is to make a small incision within the armpit.

Once the incision is made, the surgeon creates a pocket into which the implant will be inserted, either under or over the muscle as previously discussed.

Smooth or Textured

The surface of the implant can be smooth or contoured. The contoured implants have little bumps on them (like gripping). They are teeny tiny. It’s hard to describe and the pictured don’t really help. But anyways, this keeps the implant exactly where it is placed.


smooth, round

textured, round

I choose textured.

Round or Oval Base

The base of the implant (or the back I guess you would call it when it’s inserted) can come in round or oval.

round

oval base (see how it’s wider)

We are still deciding this one. Leaning towards oval base.

Projection

The amount the implant sticks can be determined by the base to width ratio of the implant.

High Profile Implants

Have more projection per measurement of base diameter than a moderate profile breast implant. An added benefit of the high profile breast augmentation is that in order to create the profile, the side wall of the implant has more height, which may reduce visible rippling. These high profile breast implants will provide more anterior projection (front projection).

Moderate Profile (regular / standard)

These are the standard, creating a ‘normal’ profile. With a full and rounded look, this moderate profile breast implant adds a significant amount of dimension and volume to a woman’s breast. This could create a wider chest appearance, which would benefit those with a narrow chest.

Low Profile Implants

These breast implants have less projection per measurement of base diameter than a moderate profile breast implant.


Example:

200cc High Profile Implant (top in picture) is 9.8cm wide and 9.8cm tall. The projection is 4.9cm

210cc Moderate Profile Implant (bottom in picture) is 10cm wide and 11cm tall. The projection is 3.8cm.

Drawing not to scale. Sorry!

I chose moderate profile, again, because I want the most natural look.

Round or Contoured Implant Projection

Prior to Sientra’s new implant (more on Sientra below) the contoured implant eventually became more round due to the body’s muscle pulling on the silicone gel. The new “gummy bear” implant will keep it’s shape.

round shape

contoured

We are still discussing this as well, but we are probably going with contoured.

Breast Implant Manufacturers

Currently there are 3 companies that manufacture breast implants in the U.S. As of recent, a cohesive silicone gel implant manufactured by Sientra was approved by the FDA (after 8 years of clinical trials). I had heard of this hot new option in New Beauty Magazine (best magazine ever) a year or so ago. They have been nicknamed “gummy bear implants” because, like the candy, the implant has a rubbery consistency that holds its form well over time. This product is the most natural-looking breast shape, and lasts for many years.

The Sientra Implant has the lowest leak rate of all the implants currently approved. Even if the outer shell is ruptured, the silicone gel in the implant remains cohesive and doesn’t migrate to other parts of the body. (I would have tested this theory, but I’m not allowed to cut the implants in half at the office…)

The implant is the most natural looking. Because silicone gel is more cohesive, the risk of shell collapse producing a rippling effect seems to be lower. The implant is also fit to the person’s size and body type.

Less scar tissue
forms with this implant type. Capsular contracture is the medical term for scar tissue buildup and hardening around the implants – a condition that can be painful, and in severe cases, require surgery. The rate of scar tissue buildup appears to be much less with gummy bear implants.

I’ve basically been looking at breasts and reading about breast implants since the middle of August. (Is this what it feels like to think like a man?) Here are some sites I found interesting about Sientra’s new silicone implant (the second two are video’s).

http://www.sientra.com/

http://abcnews.go.com/Health/gummy-bear-breast-implants-future-breast-augmentation-surgery/story?id=16370362#.UEiTF2Hh-pg

http://www.huffingtonpost.com/2012/04/09/gummy-bear-breast-implants_n_1413122.html

My Consultation Sizing


Before

492cc Implant

Before

492cc Implant


Safety during Pregnancy: What You Should and Shouldn’t Include In Your Beauty Regiment

6 Sep

It seems like it’s in the water with co-workers and friends (as evidenced by the three pregnant ladies to the left from Sylvestre Franc). I’ve had a lot of questions about what is and isn’t safe to do when you’re pregnant in regards to skin care products, laser, and injectables. It is understandable that women want to look their best during this time and hormonal changes during pregnancy can sometimes result in acne, unwanted hair growth, melasma and other skin problems. So what is safe to use and what isn’t?

Not surprisingly (to me anyways), there really is not a lot of information on product safety during pregnancy. The FDA rates products on their risks during pregnancy as follows:

Rating Definition

A

Controlled Studies Show No Risk.  Studies in pregnant women show the medication causes no increased risk to the fetus during pregnancy.

B

No Evidence of Risk In Humans.  Studies in pregnant women have not shown increased risk of fetal abnormalities despite adverse findings in animals or in the absence of adequate human studies, animal studies show no increased fetal risk.

C

Risk Cannot Be Ruled Out.  Studies are unavailable and animal studies have shown a risk to the fetus or are also lacking. There is a chance of fetal harm if taken during pregnancy but the potential benefits may outweigh the potential harm.

D

Positive Evidence Of Risk. Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy may outweigh the potential risk such as in life-threatening situations.

X

Contraindicated In Pregnancy. Studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. The use of the product is contraindicated in women who are or may become pregnant.

Skin Care Products

Most skin care products fall into the Class C category; however, some products are recommended by doctors not to be used during pregnancy (although there is not enough evidence for or against them).


Not Recommended:

  • Retinoids
    • In A Practical Guide to Dermatological Drug Use in Pregnancy (Zip, MD, FRCPC) category B topical such as erythromycin, clindamycin, and benzoyl peroxide were recommended over topical tretinoin. This study states reports of congenital malformations in infants whose mothers used tretinoin during the first trimester.
    • This ingredient is found in anti-aging products such as moisturizers, and acne products.
    • Chemically a form of vitamin A, which in high doses can cause birth defects.
    • Oral retinoids, such as isotretinoin (Accutane, an acne treatment), are known to cause birth defects.


  • Beta Hydroxy acids (Salicylic Acid)
    • Ingredients used for their exfoliating and acne-treating properties. They penetrate deep inside the pores and clean out excess oil and dead skin cells that can clog pores and cause acne, blackheads and dull-looking skin.
    • High doses of the acid in its oral form have been shown in studies to cause complications and birth defects.
    • Small amounts applied topically are considered safe (over the counter face wash for example), but peels containing Salicylic Acid are not considered safe when pregnant.

  • Hydroquinone
    • Clinically used for pigmentation for conditions such as melasma, and it is used cosmetically as a skin-whitening agent. Although a large percentage of this topical agent is systemically absorbed, the use during pregnancy does not appear to be associated with increased risk of congenital defects. This finding, however, is based off one study, with a small sample size (so it is recommended to avoid hydroquinone during pregnancy).


Safe

  • Vitamin C, Glycolic acid, and Lactic Acid: derived from fruit and milk sugars, considered nontoxic.

  • Hyaluronic Acid. This is a product your body naturally produces (which means its safe). Because of its molecular size, hyaluronic acid cannot penetrate the skin’s surface, and it is not systemically absorbed.


  • Benzoyl peroxide. Only 5% of topical benzoyl peroxide is absorbed through the skin. It is completely metabolized to benzoic acid within the skin and excreted.

Self-Tanners

Dihydroxyacetone is a color additive that is found in self-tanning products to produce an artificial tan. Color develops following topical application. These products contain dihydroxyacetone in concentrations ranging from 1% to 15%, and when applied topically, systemic levels are minimal (0.5%), and are considered safe to use.

Hair Removal and Bleaching Agents

  • Sodium, calcium, and potassium hydroxide, which are also found in depilatory creams, disassociate into sodium, calcium, potassium, and hydroxide ions, which are all present in the human body. Topical application of these products would not disrupt serum levels and would not be considered a problem for use during pregnancy.
  • Hydrogen peroxide. Hair-bleaching creams contain low concentrations of hydrogen peroxide, making it unlikely to be systemically absorbed. In addition, should it be absorbed, hydrogen peroxide is rapidly metabolized. Therefore, use of these products during pregnancy is not expected to be a concern when done in moderation.
  • Laser has some controversy as to whether or not it’s safe; again, there isn’t a lot of information. Lasers do not penetrate very deep and there is not chemical exchange into the body. One interesting thought from me, (not speaking from personal experience) the body becomes more sensitive during pregnancy, and some laser treatments hurt to begin with. I’m not sure I’d want to get laser under those circumstances!

Botox and Fillers

The safety of Botox injections during pregnancy is unknown (Class C), and while I wouldn’t recommend intentionally getting Botox injections during pregnancy, many women receive injections prior to being pregnant or when they do not know they are pregnant, and have not had any problems. Botox Cosmetic has never traveled systemically, and works only on the muscles into which it has been injected. Therefore, one could presume it is safe to undergo this procedure. But I still don’t recommend it.  Unless you’re planning on having a “Toddler and Tiara” baby.  Then it’s ok.

 

xoxo,

not pregnant LK


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