Tag Archives: Dr. Russo

Under Eye Circles and Bags

16 May

Physiology: Broken blood vessels within the lower eyelid. A shadow forms underneath the bag causing the dark circles to appear. As you age, the “bags” (fat pads) can bulge due to gravity, creating an exaggerated space between the skin of the check, and the skin of the eye, over the orbital rim (bone of the eye socket). These dark circles can bring about a chronically fatigued look, or make you appear older than you actually are.

Cause: range from fatigue, vitamin deficiency, hyperpigmentation, allergies, age, and medical conditions. However, heredity is the most common cause for bags under the eye (also, from my patient’s personal experience… I hear children and husbands may also be contributors? It has not been clinically proven however.).

Treatment:

Getting the proper rest and eating the right foods can sometimes help treat and improve dark under eye circles, but if genetic, dark under eye circle will increase if untreated.

Fraxel®, Thermage®, Blue Light Therapy, IPL Photofacial, Dermal Fillers and Chemical Peels (like TCA). Patients with more severe cases of under eye circles, puffiness and loose upper or lower eyelids may want to seek out surgical alternatives including blepheroplasty.

My Best Advice

It is always a good idea to start with the least invasive methods and move on to the most invasive methods. That being said, genetics does play a HUGE role in this, and if your mom or dad has extremely sagging lids, or bulging fat pads, the earlier you do surgery the best result you will have.

Least Invasive to Most Invasive

  1. Hydration: The area of skin under the eye is the thinnest in the body. In a hospital setting, we monitor this area as a sign that a patient could be dehydrated. I can always tell when someone needs fluids just by looking at this clinical sign. Start with drinking water… water is good for your body all around. And… it’s FREE!
  2. Eye Cream: Supply your skin with the nutrients it needs. By depositing certain vitamins and peptides, you can decrease the appearance of dark circles. Before you tell me you’ve tried every cream under the sun… have you read my post on pharmaceutical products? Step 2: Spend wisely.
  3. Noninvasive treatments: Laser stuff. Not my area of expertise, however, I have had IPL on melasma, and it worked great. Laser treatments will help with the discoloration, and may subtly tighten the skin, but they will not fill volume loss. If you have volume loss, see step 5.
  4. Chemical Peels:  Best done in the winter time when you’re not in the sun.  And actually… this is more for fine lines and wrinkles around the eyes than bags and dark circles.  Although it will help the appearance.
  5. Dermal Fillers : (That’s NOT Botox..) A hyaluronic acid of low molecular cross linking like Juvéderm Ultra is most recommended for this area. Thicker fillers, like Radiesse, and biostimulators, like Sculptra, are not recommended for this area. Remember this skin is the thinnest in your body, and thicker products can leave bumps here. Be VERY careful about who you see for this treatment. It is a very advanced procedure that your Dentist or Primary Care probably shouldn’t be performing on you.
  6. Blepheroplasty: Check out my post on Blephs. Observing Surgery: Blepharoplasty.

Dermal Fillers

Dermal Fillers are my area of expertise (Remember photography is also not my thing!!!)

Here’s my Before and After Tear Troughs:


Before: I look tired. And old. Ew. Taken November 2011.


After: As you can see I look more awake and refreshed. Taken February 2011 after I had my tear troughs filled.

I am very happy I did this. Surprisingly, it didn’t hurt at all. The product used was Juvéderm Ultra. It will last about a year. Cost is about $600.

Creams

(The two I like best)

Image Max Eye Cream: This next-generation revolutionary day and night eye crème contains high concentrations of growth-factors derived from plant stem cells to protect skin cells and prevent aging effects caused by free radical damage. Reduces the appearance of fine lines and wrinkles; reduces puffiness and inflammation. Prevents cell aging. Contains grape, alpine edelweiss and apple stem cells for maximum age prevention. Corrective peptide blend for rejuvenation. Retails for about $45

Image Vital C: A scientifically- advanced hydrating, anti-aging eye gel. Contains a blend of nourishing anti-oxidants that reduce the appearance of fine lines and prevent the breakdown of collagen. Vitamin K  (Phytonadion) diminishes dark circles. Restores youthful looking eyes. Retails $31


Observing Surgery: Blepharoplasty

24 Feb

Case Study:

Today I assisted in a blepharoplasty on both the upper and lower lids of a man in his late 50’s. Interesting right? This stuff is not just for women. And before you have any thoughts about it being a gay man you are completely mistaken. This man was a blue-collar, married man.

This patient’s wife, mother, and other relatives had undergone the same procedure. His upper lid was so saggy it impeded his vision tremendously. Genetics plays a large role in how we age, and considering this man had a number of family members who had undergone the procedure, saggy lids clearly ran in his family tree. The women in his family had such great results; the patient was ready to go under the knife. In 3 hours time, he looked about 20 years younger than when he walked in the door, but the most important part for this patient: his vision was improved! He couldn’t believe what a difference it made!


Time:

10:00 am : Patient is given oral sedation and pain medicine. The procedure is done under conscious sedation (patient is awake but comfortable).

11:30 am : Patient has reached adequate level of sedation. Patient is marked on the lids, where the surgeon will be cutting, and local anesthesia is injected into the area.

12:30 pm : The right eye is finished. Top and Bottom lids have been cut and stitched. The patient already states his vision is improved! AND he looks 20 years younger!

1:30 pm : The left eye is finished. Top and Bottom lids have been cut and stitched. The patient is shown his results. The eye is then taped at the sides to kept tension off the sutures.

Stats:

Total time of procedure start to finish: 3 ½ hours

Total time taken off patients face: 20 years

Total cost to patient: $5,250 (Upper only is $3,250 and Lower only is $3,250)

Follow up: The patient will return in 1 week to have the “tension tape” taken off and the non-dissolvable stitches removed (both dissolvable and non-dissolvable are used).

Downtime: About a week of being black and blue, and having the tape on your face. Tape is in though… Tape is the new black! (Just kidding).


(From the ASPS website)

Also known as a “Bleph.” The technical term for eyelid surgery. It improves the appearance of the upper eyelids, lower eyelids, or both by giving a rejuvenated appearance to the surrounding area of the eyes by removing skin and fat. The result gives a more rested and alert appearance.

Almost 200,000 Bleph procedures were performed in 2011, and it remains in the top 5 most popular cosmetic surgery procedures.


Treatable conditions:

  • Upper eyelid surgery can remove excess fatty deposits that appear as puffiness in the upper eyelids.
  • Loose or sagging skin that creates folds or disturbs the natural contour of the upper eyelid, sometimes impairing vision (like in the case study!), can be treated by eyelid lift surgery.
  • Lower eyelid blepharoplasty can remove excess skin and fine wrinkles of the lower eyelid.
  • Bags under the eyes can be corrected by blepharoplasty.
  • Lower eyelid surgery can correct droopiness of the lower eyelids, showing white below the iris (colored portion of the eye).

Is it right for me?

A blepharoplasty procedure is usually performed on adult men and women who have healthy facial tissue and muscles and have realistic goals for improvement of the upper and/or lower eyelids and surrounding area.

You should undergo blepharoplasty surgery for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.

Good candidates for cosmetic eyelid surgery are:

  • Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing
  • Non-smokers
  • Individuals with a positive outlook and specific goals in mind for blepharoplasty
  • Individuals without serious eye conditions

You must tell your doctor if you have any of these medical conditions:

  • Eye disease such as glaucoma, dry eye or a detached retina
  • Thyroid disorders such as Graves’ disease and under or overactive thyroid
  • Cardiovascular disease, high blood pressure or other circulatory disorders or diabetes

Prevention

If sagging lids run in your family, there are things you can do to prevent going under the knife. Botox is used to lift the lid (but it can only lift so much). Ulthera is also being used as an alternative to surgery. But remember, non-invasive and minimally invasive treatments won’t give you the extent of the result surgery will. If you start doing this alternative procedures at a younger age (say mid 30’s) you are more likely to prevent the need for surgery.

The Q-Switch. A Post In Honor of N.

6 Feb

Making mistakes in life happens.  Luckily, most mistakes don’t result in permanent marks on our bodies.  But what about the ones that do?

Tattoo’s are becoming more and more mainstream.  In my opinion, I think they can be a beautiful artistic expression of who you are.

I have a few tattoos.  Yup, it’s true.  A heart on my back from when I was 18.  A Scarlet Begonia on my foot from my DeadHead days (also true), and “A Beautiful Little Fool” in Russian on my ribs (from The Great Gatsby).  Actually, I think this excerpt might be quite appropriate for this post.

“All right… I’m glad it’s a girl. And I hope she’ll be a fool–that’s the best thing a girl can be in this world, a beautiful little fool.”

My Friend N. – A Beautiful Little Fool

A dear and wonderful model friend of mine, N., has a tattoo that she doesn’t exactly love.  Frankie.  The name of an ex-flame on her thigh.  Fortunately for N., I have access to a q-switch.  (She’s gorgeous huh?)

What’s a Q-Switch?

It’s a laser that uses Alexandrite (the gemstone) to break up pigments in the skin.

Getting Rid of ‘Frankie’ – literally and metaphorically

First, I beg of you.  NEVER NEVER NEVER tattoo a name on your body.  Ever.  Unless it’s your dog or your kid…you willlll regrettttt it.  I promised my dad when I was 17 years 11 months and 30 days old that I would never put a name on myself, and it would never be in a place you couldn’t hide.  I’m all about branding… but in terms of marketing, not in terms of inked ownership.

Getting rid of a tattoo is not as easy and quick as the actual tattoo.  Oh no.  It’s painful, can take 8-20 treatments over several months depending on the colors and the age of your body art (pigment changes and becomes embedded in the skin over time, the older the tattoo the harder to treat) and there’s always a chance you will have a little ink left.

Red, yellow, and orange tones respond the best and quickest with the q-switch.  “Frankie” is done in black ink.

How much will tattoo removal cost?  Depends how big the tattoo is and how many sessions you will need.  But you’re not only looking at pain… but you’re looking at some money.  $300+ per session.

In conclusion:

THINK BEFORE YOU INK!

Pictures of the process will be posted as treatments go on!

Thinking about a NoseJob/Breast Aug/Lipo/Tummy Tuck? … Butt Implants?

15 Dec

I go with a lot of my clients to their consultations and watch a lot of procedures with a plastic surgeon.  My wonderful friend called me at 8 this morning to ask me what she should ask at her consult (apparently she forgot I am NOT a morning person).  I jumped out of bed though, because I remembered I had a lists!  I love lists ALMOST as much as I love white boards!

I know Plastic Surgery isn’t for everyone, but I think if you are contemplating it, you should be prepared from the beginning; starting with the right surgeon can make all the difference in the world!

Plastic Surgery:  Making the Best Decision

Brief important plastic surgeon qualifications

Please check out www.plasticsurgery.org to see if your surgeon is ASPS accredited.  If they are ASPS accredited you are in good hands.

Each ASPS member must meet the following:

  • At least five years of surgical training and a minimum of two years of plastic surgery training.
  • Board certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
  • Trained and experienced in all plastic surgery procedures, including breast, body, face and reconstruction.
  • Peer-reviewed for safety and ethical standards prior to attaining the honor of active membership.
  • Only operates in accredited facilities.

When making the choice:

  • Use your head not your heart in making the selection.
  • Bring before and after photos, if possible, to show what you want.
  • Research the doctor, call other patients for recommendations.
  • Get a recommendation from your bariatric surgeon.
  • Meet the doctor and get to know him or her; you trust yourself to his or her care, so you need to feel comfortable with the person.
  • Use the term “reconstructive surgery” with your insurance company, since “plastic surgery” is often considered to be “cosmetic” or “elective” and hence is not covered.

Questions to ask:

1.  Are you an ASPS member surgeon? If he or she answers “yes” you can rest assured that your surgeon is board certified in plastic surgery, has hospital privileges and only performs surgery in accredited facilities.
2.  Are you board certified by the American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada?
3.  Do you have hospital privileges to perform this procedure?   If so, at what hospital? Is the surgical facility accredited?
4.  Am I a good candidate for this procedure?
5.  What will be expected of me to get optimal results?
6.  What are the risks involved with my procedure?
7.  Will I need to take time off work?  If so, how long?

What you should ask about the procedure

8.  What is the simplest and safest surgery to help me achieve my goals?
9.  How is the surgery performed?
10.  What is the expected length of operation?
11.  Are other options available?
12.  What results can I expect, and how long do the typical results last?
13.  Where will scars be located, and how noticeable will they be?

What you should ask about your surgeon’s experience

14.  How many times has the surgeon performed this procedure?
15.  How long has the surgeon been performing this procedure?
16.  How many times per year does the surgeon perform the procedure?
17.  How many patients have required re-operation or touch-ups?
18.  What complications may occur?
19.  How frequently do these complications occur?

What you should ask about logistical matters

20.  What preparation is required the day before and morning of surgery?
21.  Should my regular medications be taken on the morning of surgery?
22.  What time should I arrive at the surgery location?
23.  Should someone drive me?
24.  Should someone wait at the surgery location or come back later?

 

What should you ask about emergency plans

25.  What emergency plan and equipment are in place to provide for my needs in the event of an emergency?
26.  Are the surgeon and staff certified in Advances Cardiac Life Support? (ACLS)?
27.  Does the surgeon have admitting privileges at a local hospital should problems arise during my office surgery? (Call the hospital to confirm)
28.  How would I be transported to this facility?
29.  Has an adverse event ever occurred in the past?

What should you ask about the recovery process

30.  What kind of care will I require?
31.  When will I be able to go home? Is an overnight stay required, or is one available if I prefer?
32.  Who will attend me in the case of an overnight stay?
33.  Will I need someone to drive me home?
34.  If a problem arises after I go home, who answers calls after hours and on weekends?
35.  If I need to be seen after hours, where will this occur?

36.  If I need help in my home, is a private duty nurse available?  At what cost?

37.  Are any special garments, medications, or diets required during the recovery period?
38.  How much pain/swelling/bruising is to be expected? How long are these likely to last?
39.  How long does the entire healing process last?
40.  How many follow-up visits are necessary?
41.  Who performs the skin care/post-operative follow-up/suture removal?
42.  When can I wear makeup?
43.  When may I return to exercise/bathing/driving/normal activities/work?
44.  At what point will I feel comfortable in a social setting?
45.  What if I am dissatisfied with the results or with the degree of changes achieved?
46.  If touch-ups are necessary when would that be performed?

What about fees

47.  Does the cost depend on where my surgery is performed?
48.   Will I need to see another physician prior to surgery for examination or testing because of a preexisting medical condition?

49.  Who pays this cost? Will my regular family doctor suffice?
50.  If a complication causes me to be transported to a hospital or stay overnight, who pays for this additional cost?
51.  If I request multiple procedures, can they be performed at the same time? What are the cost savings?

52.  What options are available for payment?

53.  Does the office accept credit cards?
54.  Is a payment plan available to patients?
55.  What is the refund policy should I change my mind after paying in full?
56.  Is my surgery covered by my insurance plan?

After discussing all of the factors involved with your proposed procedure with the surgeon, you should have a sense of whether or not the surgeon is right to you.  Take note of and consider whether the surgeon:

  • Listen and understand your priorities, opinions, and requests?
  • Communicate concern, compassion, request and honesty?
  • Instill confidence in you?
  • Display confidence in his or her ability to care for you?
  • Seem distracted, or come across as arrogant or curt?
  • Seem patient and willing to spend time to answer all your questions and discuses your concerns?
  • Condescend; talk down or under estimate your intelligence?
  • Make eye contact or continually jot down notes in the chart as you spoke?
  • Display positive body language?
  • Confuse you or offer clear explanations?
  • Appear to be selling you the procedure?
  • Adequately discuss any preexisting medical conditions you might have?
  • Encourage your family to participate in the consultation and decision-making process?

Do you:

  • Feel that you have established forthright communication and a positive rapport with the surgeon?
  • Trust your life to this surgeon?
  • Feel the Surgeon is acting in your best interest?
Remember, Aesthetic Augmentation is no one’s decision but yours. 

Exercise?!?!… but “Nothing replaces traditional…

23 Nov

Liposuction”

A funny quote from the office. I was invited to observe lipoplasty (aka liposuction).  Of course I was psyched!  Before I receive a million hate mails–remember:  the point of my blog is to give information to everyone.  Just because this isn’t  something your interested in doesn’t mean someone else isn’t.  Beauty IS part individual ideals ;). See Beauty Defined.  Also… I tried not to be graphic but still be informative.  I also had the patients permission to write about her experience.  I may add pictures later.

What to expect during the procedure

The patient had baseline vitals and was medicated with xanex and percocet prior to the procedure.  She was marked by the surgeon in a few places on her neck (it was neck lipoplasty).  After the medication took effect, she was laid on the procedure table.  It is a sedated procedure, so the patient was awake and talking throughout.

Local anesthetic was injected before a small incision was made under her chin.  Then a liquid was injected that was a mixture of drugs that separated the skin from the fat, vasoconstricted (to prevent bleeding), and a numbing agent.  The surgeon separated the fascia tissue holding the skin and fat together and used a suction cannula to suck out the fat.  The neck does not contain much fat to suction, only about 100 cc’s was removed.  The patient felt comfortable throughout the procedure.  The procedure took an hour and a half from start to finish.

Sexy Head Bra

Post care instructions are pretty standard.  6 weeks of recovery time.  PLUS EXTRA BONUS:  You get to wear a sexy head bra!  (This keeps fluid from the area, and keeps the skin tight).  Remember, you may require some skin tightening post treatment.  This patient will be doing Ultera in 4-6 months.  Ultera is AWESOME (blog post coming soon)!  It was a great success and the patient is very happy!

Well what about laser? 

(from the American Society of Plastic Surgeons website)

Laser liposuction

Laser liposuction focuses low-energy waves delivered by a thin laser fiber that’s inserted through small incisions. The laser energy is focused on the part of the body where you’d like to have a fatty pocket removed. After the fat is melted, a small cannula is used to suck out the liquefied fat.

Ultrasound assisted liposuction

The fat is dissolved by the ultrasonic waves that are emitted from the end of a cannula that’s inserted through small incisions. Ultrasonic waves delivered through the cannula emulsify or liquefy the fat. After the fat is liquefied, it is then sucked out through a small cannula.

*Note, these are ASSISTED lipoplasties.  So what about regular laser and fat melting?  It’s not that easy my friends.  These procedures are typically performed in locations that don’t offer plastic surgery as an option.  Watch out for good marketing when it comes to these procedures.I have observed some great results from Zerona, but if home care instructions aren’t followed exactly… don’t expect these procedures to work for you.  And remember: 

Nothing Replaces Traditional Liposuction!

 
** For those of you who believe “nothing replaces traditional exercise” remember:  there are a lot of factors to consider when taking plastic surgery into consideration, and it shouldn’t be a thoughtless decision by ANYONE.  Lipoplasty will not keep the fat off forever, only exercise and a good diet will do that.  🙂 
 

Happy Thanksgiving Everyone!

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