Q.I keep hearing about a new treatment called Xeomin. What is it and will I benefit from it?
A. Xeomin is the latest generation neurotoxin approved by the FDA for the temporary
improvement of moderate and severe glabellor lines (frown lines between the
eyebrows). It is a very similar product to Botox Cosmetic. The duration of wrinkle
reduction is usually 3-6 months with onset of action approximately three days.
One difference between Botox and Xeomin may be related to the development of
resistance to treatment over time. Some early reports suggest that patients using
Xeomin over a number of years are less likely to experience resistance to the
product due to antibody formation. At this point, Xeomin is a new product in this
country, but early reports in the Dermatologic literature suggest that it performs
just as well as Botox, but time and experience will tell.
Our office is one of a select few in the Capital District currently offering Xeomin. It
will be made available nationwide in the spring of 2012.
Q.Are there any procedures that can reduce the appearance
of crepe skin- on face & neck area?
A. Crepe skin on the face can be treated in several ways. The least
invasive approach involves skin care with Retina-A, microdermabrasia
and light acid peels. The next level of treatment might
include stronger acid chemical peel (e.g. 35% TCA) and/or CO2
laser resurfacing. These treatment modalities can effectively deal
with deeper wrinkles. There is also Smartlipo (laser-assisted liposuction).
In patients that have both neck fat and loose skin,
this technology can offer significant improvement in tightening
the neck without invasive surgery. Finally, surgical lifting of the
face and neck skin (i.e. facelift) is the most invasive procedure
for facial rejuvenation but can provide dramatic and long lasting
results. Facelifting remains the gold standard for correcting loose
skin of the neck and jawline.
Q.My 19 year old son has recently (within the past 6 months)
developed stretch marks under his arms and most recently
(this past week) noticed the beginnings of one on his bicep.
He has always been physically fit and has exercised consistently
for years. He recently started lifting weights but does
not do “heavy weights”. Is there any treatment for the stretch
marks that are present and how can he avoid more?
A. Strech marks can occur with weight lifting whenever there is a rapid
increase in muscle size leading to skin stretching (stretch marks).
Some of the stretch marks may recede if weight lifting is stopped
or reduced, but often the marks are permanent. Red stretch marks
can be treated with lasers to reduce the color so they will blend in
with the surrounding skin pigment (assuming light skin type).
Q. Can plastic surgery be used in the treatment of
molluscum contaigosum?
A. Molluscum contaigosum is a common benign viral infection
usually involving the skin or mucous membranes and
is generally seen in children. The virus is transmitted from
person to person contact.
Generally Molluscum Contagiosum is a dermatological
problem and the lesions can resolve spontaneously. For lesions
that persist or enlarge, simple liquid nitrogen therapy
is effective, but may take more than one treatment.
Finally, as a last resort, surgical removal can be performed
for lesions resistant to more conservative treatment.
Q. What does an upper arm lift involve and how long is the typical recovery time?
A. Patients who have lost a significant amount of body weight often present with excess skin involving the arms. This is especially true after bariatric (weight loss) surgery where patients typically lose greater than 100 pounds.
Excess skin is removed from the arms and the final scars are placed in the inner aspect of the
upper arm. Depending on the degree of skin excess, the scar sometimes extends down to the
elbow. Most patients are very pleased with the contour improvement after this surgery and
consider the potentially permanent and visible nature of the scars to be a welcome tradeoff.
Finally, scars fade considerably in 6-12 months in most cases.
Q.What treatments are available for Varicose veins/spider veins? How long is the recovery period? Who is a good candidate?
A. Spider veins are a common complaint in patients who typically stand on their feet all day. Over a number of years, these spider veins become more prominent and this prompts patients to seek treatment. Treatment options include selerotherapy (saline injections) or laser treatments (our preferred method). Laser therapy is very effective and requires little to no down time. Multiple treatments, depending on the number of veins, present are required. The most typical treatment locations include the legs and face and the treatments must be done on un-tanned skin. Overall, the best candidates for laser treatment have a fair skin type. In contrast, Varicose veins are large, typically painful, dilated veins that require a vascular surgeon to treat.
Q.I had a lip lift 2 years ago. My scars on my lips feel very hard, tight & firm and I also have nerve (painful) sensation. The scars remain irritated – is there anything I can do to get rid of the sensitivity?
A.Generally speaking, scars on the body are fully mature and maximally healed at one year. If it has been two years and the scars are still bothering you, then an evaluation by a plastic surgeon is indicated. Occasionally, surgical scar revision or steroid injections may be indicated to improve the appearance of the scar and to decrease the firm feel. As far as the painful sensitivity is concerned, this may be a permanent problem. However, a consultation with a neurologist may be appropriate as medications, such as Lyrica, have been known to decrease paraesthesias (painful nerve sensations).
Q.I have deep vertical lines on my upper lip. What can be done for this?
A.Signs of perioral aging such as vertical lines of the upper lip can be treated in a number of ways. Lines in the upper lip can be caused by the action of the underlying muscle. These dynamic wrinkles can be improved with Botox injections to decrease muscular activity. Static wrinkles that are present when the lip is at rest can be treated with CO2 laser resurfacing and/or soft tissue fillers. Example of soft tissue fillers include one’s own fat, collagen and hyaluronic acids. The amount of correction that can be achieved and how long it will last will depend on the patient’s condition at presentation and the techniques used. Restylane, Juvederm, and Radiesse are examples of fillers that are popular currently. They are injected into the skin to fill out wrinkles. The results can last from six months to twelve months. These treatments have minimal down time.
Q.What is the best treatment for someone who has scars resulting from acne?
A.Facial scars that result from acne damage can often be a very distressing problem for patients. Generally speaking, therapy with resurfacing technology (i.e. lasers and/or dermabrasion) in combination with dermal fillers (hyaluronic acid, calcium hydroxylapatite, collagen, etc.) can be very helpful.
Resurfacing with lasers, for example, can help smooth the edges of the scar, reducing their depth and ultimately making them less noticeable. Because acne scarring also leads to volume loss in the skin (typically pitting of the skin is seen) adding a bulking agent can greatly enhance the result of the laser resurfacing.
Q.What are fillers? What does Radiesse do to make you look younger?
A.Dermal fillers have become increasingly popular among patients because they are minimally invasive, require little down time and are highly effective at mitigating the signs of facial aging.
One such filler is Radiesse which received FDA approval for cosmetic applications in 2006, namely treatment of the nasalabial folds. It is a good volumizing agent and also works well in augmenting the cheeks and smoothing the jawline. Radiesse is thought to maintain a good correction for one year or more and some studies also indicate that the product stimulates collagen production by the body. Therefore, the effects of the treatment may have some permanency.
Q.My daughter has a small lump, not really visible, just under her eyebrow on the outer corner. I think it is a dermoid cyst, we’re not sure if it is growing, if so slowly. The doctor said not to worry and to have it removed when she gets a bit older. It worries me, I don’t want it to affect her eye in a negative way. I’ve read online that they are quite common, even often occurring in that very location.
A.Dermoid cysts are benign growths that are commonly seen involving the lateral 1/3 of the brow, the nose and the scalp. In general, they are considered to be rare with an estimated incidence of .002 to .005 % of births. The cysts that involve the corner of the eyebrow generally are confined to the soft tissue of that region and do not extend more deeply to involve bone or intracranial structures.
Dermoid cysts do tend to enlarge over time and can get infected, so surgical removal is generally recommended while the growth is small.
Q.What is the longest lasting correction for frown lines that extend from the corner of the mouth down the chin?
A.To correct contour deficiencies of the face, a variety of injectible soft tissue augmentation agents have emerged. Restylane, Radiesse, and fat are some of the most popular fillers. Restylane lasts 6-12 months and Radiesse 1-2 years. Fat can be permanent, but 50% of it goes away after the initial treatment. Soft tissue fillers also serve as an excellent adjunct to more definitive and long lasting techniques such as a face and neck lift.
Q.What is involved when someone undergoes a neck lift procedure?
A.What type of neck lift surgery you undergo depends on what concerns you have about the appearance of your neck and a careful examination of your anatomy. Loose skin, loose or redundant musculature and excess fat are the common stigmata of an aging neck. Which type of neck lift surgery you undergo will depend on which of these you present with. Patients with good skin quality and only excess fat can undergo liposuction alone. Those with redundant muscle must have surgery to transect or re-sect the muscle. Finally, those with excess skin require an incision along the posterior ear and hairline to remove the excess skin. More times than not, patients present with a combination of problems involving skin, muscle and fat. These patients require a combination of the above techniques to achieve an ideal neck. Often neck lift surgery is combined with other surgeries such as face lifts.
Q.What type of surgery is available for droopy eyelids? My one eye is almost half closed due to this condition?
A.Ptosis, or drooping of the upper eyelid, may occur for several reasons. Most commonly with aging there is weakness or detachment of the muscle that lifts the eyelid. Ptosis should not be confused with excess skin that hangs over the eyelid margin and interferes with vision. As you age, eyelid muscles weaken and the skin loses elasticity. As a result, fat may protrude causing “bags”. If these changes occur prematurely they contribute to an aged and tried appearance. Drooping of the eyelids, excess loose skin and bulging fat can all be corrected with blepharoplasty (eyelid) surgery to rejuvenate one’s appearance. Blepharoplasty may be performed in conjunction with other plastic surgical procedures, such as a brow lift, facelift or skin resurfacing. A complete evaluation is necessary to determine which procedures are indicated.
Q.What are the benefits of a tummy tuck?
A.Most individuals strive for a flat well-toned abdomen
through exercise and diet. However, pregnancy and
significant weight loss can cause the abdomen to sag
and protrude, and these changes are exercise resistant.
A tummy tuck can remove excess skin and fat from
the lower abdomen and repair weak muscles (from
prior pregnancy or surgery) with the end result being a
youthful flat abdomen.
Q.What can be done to treat acne scars? Also, my
pores seem to be getting larger as I age. Can this be treated?
A.Acne scars can be treated with either dermal fillers
(agents that plump up the skin and add volume) or laser resurfacing technology. Laser can remove a thin layer of skin surrounding the scars to make the depressions less noticeable. Often, we employ a combination of both laser and dermal fillers for optimal results.
Q.Are there any new treatments available for wrinkles
around the lips? Is surgery my only alternative or is
there less invasive treatments such as injections?
A.In my experience, a combination of procedures is the
best approach to treating wrinkles around the lips. The
surgeon needs to address the skin textured changes
with laser resurfacing (to smooth the lips). Additionally,
volume restoration to the lip lines (red/white border) with
dermal fillers like juvederm enhances the result greatly.
Finally, the muscle activity around the mouth (pursing
muscle) can be softened with the use of Botox.
All three modalities described above used together
gives an excellent result for perioral rejuvenation.
Q.Since having children, I have some loose skin in the stomach
area. In the past I have been told I would need major surgery to
improve this area. Is this still the case?
A.Until recently, the only procedure that could help with loose skin
in the stomach area was an abdominoplasty (tummy tuck). Since
our practice has acquired the Smartlipo Triplex laser liposuction
system, this is no longer true. Smarlipo allows us to offer liposuction
to patients with loose skin (after childbirth) and achieve excellent
results. Smartlipo also offers great results for the neck area,
allowing some patients to avoid a full face and neck lift. Traditionally
these patients could only be treated with more invasive surgery.
Therefore, we can offer liposuction to patients who, in the past,
were not considered candidates. A consultation is necessary to
determine if Smartlipo could make a difference in your particular
case.
Q.I am 20 years old. I used to have a very plumped looking face. I went through a
rough time recently and seemed to have lost the volume in my face, especially
in my cheeks. Is there anything that can be done?
A.Volume loss is one of the hallmarks of the aging face-uncorrected volume loss can
have effects on the overlying skin which can lead to significant premature wrinkles.
There are many injectable products available used to correct volume loss in the
face. The two most popular agents include Sculptra Aesthetic (poly-l-lactic acid) and
autolagous fat (fat from your own body).
Sculptra Aesthetic is an injectable agent that stimulates new collagen production
which is the basis for the cosmetic volumizing effect. This can last up to two yearsseveral
treatments are required to achieve the desired effect and repeat treatments
are needed to maintain results.
Autolagous fat is also gaining popularity as a volumizing agent. Fat is considered
a permanent filler and has two advantages. First, it restores volume to the face,
improving form and shape. Secondly, because adult fat injections have a regenerative
effect actually improving the appearance of overlying sun-damaged skin.
A consultation with a board certified plastic surgeon is the best initial step in determining
which filler will best meet your needs.
Q.I have a mole on my chin that I would like removed.
Can this be done without leaving a prominent scar?
A.After surgical procedures, the body heals itself by forming
scars. There are plastic surgical techniques that can be
used to help minimize, but not completely eliminate scars
(such as might occur after a mole removal). Scars can look
red initially after the surgery, but usually fade in a period
of six to twelve months. Over the counter scar creams are
also available that can help hasten the healing process.
In general, the face tends to heal very well and unacceptable
scars that occur after minor procedures are rarely a
problem.
Q.I recently had a mole removed off my neck – and
now there is a high red raised scar – I’m very self
conscious. Can this be lessened by plastic surgery?
A.Scars can take up to one year to mature, flatten and
fade. If a scar looks red and raised early after surgery,
conservative treatment measures are indicated. These
include scar cream, silicone gel pressure tape, and intralesional
steroid injection. If after a reasonable period
of conservative treatment, (6 months at least) the scar’s
appearance is unacceptable, then surgical revision can
be undertaken.
Q.Can a TCA chemical peel help with fl at warts on
my face?
A.TCA is typically used in an aesthetic plastic surgery
practice for superficial peeling to treat wrinkles and photoaging
of the skin. Depending on the depth of the “wart”
in the skin, TCA may or may not be effective. Dermatologists,
not plastic surgeons, typically treat warts with
topical agents such as liquid nitrogen and salicylic acid.
For more information, you can contact your local dermatoligist.
Fox & Schingo Plastic Surgery
Dr. Patricia A. Fox, a Board Certifi
ed Plastic Surgeon, has been providing
skillful and compassionate Plastic
Surgery in this community since 1978.
She completed her General Surgery &
Plastic Surgery training at Georgetown
University Hospital and is the co-director
of the Ellis Cleft Palate Clinic. Dr. Fox is
also the medical director of Surgeons for
Underserved Nations, a non-profi t organization
dedicated to providing volunteer
surgical services to such places as the
Dominican Republic, Mexico & China.
Dr. Victor A. Schingo, Jr., is also Board
Certifi ed in plastic surgery. He completed
his Plastic Surgical training at the
University of California, San Francisco,
followed by a fellowship in cosmetic surgery
at New York University and Manhattan
Eye, Ear, Nose, and Throat Hospital
in New York City. Dr. Schingo is
currently the only board certified Plastic
Surgeon in the area who has completed
a cosmetic surgery fellowship and
he has used this experience to provide
quality care in this area over ten years.
This general Information is not intended to provide individual advice. Please make an appointment with a physician to discuss you particular situation and needs.
