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Q.

"I have some sagging skin on my face and feel I am beginning to show signs of aging, but I don’t think I am ready for a facelift. Is there any alternative besides skincare that would help me look younger and more refreshed?"



A. While a facelift is the gold standard for facial rejuvenation, many people are not quite to the point of needing or wanting a full facelift. Our office now has new technology call Ultherapy which is an ideal option for people in this situation. Ultherapy is a new type of nonsurgical procedure that uses medical ultrasound for cosmetic improvement of the skin. It delivers low levels of focused heat deep below the surface of the skin to firm, tighten and lift. Your skin’s response to the energy is to stimulate the growth of new collagen. Results include a sleeker, more defined jawline and tighter skin on the neck and under the chin. Ultherapy can also be used on the upper face, especially the forehead to give a lift to the brows. While there is some improvement immediately, you must wait three months to see the full results since it takes the body time for the collagen to grow. Ultherapy has been FDA approved and it involves virtually no downtime. It is necessary to come into the office for a consultation to determine if you would benefit from Ulthera or if you would be a more appropriate candidate for a facelift.



Q.

"What is the best treatment for someone who has scars as a result of acne?"



A. Patients who suffer from acne at a young age can unfortunately be left with visible permanent scarring. Facial acne scarring can be the most problematic area. The gold standard for treating acne scar depressions is with CO2 laser resurfacing. I tell patients to expect at least a 50% improvement with the initial resurfacing procedure, but subsequent treatments may be necessary. Laser resurfacing requires about 7 days for the facial skin to heal and one should expect to have a light “sun-burned” appearance to the facial skin for about 4-8 weeks. This is a procedure best performed during the cold weather season (late fall/winter) so that intense sun exposure can be avoided during the healing phase.



Q.

"Can a chemical peel help dark spots/discoloration on my face? What are my options?"



A. A chemical peel is a skin-resurfacing procedure that is done by applying a chemical solution to the skin to exfoliate the top layers. They are performed for light, medium, or deep resurfacing based on desired outcome. Peels are generally used to treat facial wrinkling and uneven pigmentation (hyperpigmentation) – dark spots. Hyperpigmentation in the form of darker spots of discoloration are primarily caused by years of exposure to UV light from the sun and tanning beds. UV light accelerates the production of melanin in the skin. Areas of the skin that have years of frequent prolonged sun exposure often have spots where melanin is produced in high concentration. Genetic make-up and hormonal factors can also contribute to uneven skin discolorations. A chemical peel can be an effective part of a skin lightening protocol. As the skin is removed, new skin forms. Several treatments may be necessary to obtain a desired result. Along with chemical peels, topical products that aid in the desired result are hydroquinone, kojic acid and retinoids. Daily and repeat applications of SPF are necessary, as well as abstaining from overexposure to the sun & UV rays.



Q.

"I have open pores on my cheeks. I was advised to do lasers. Will this type of treatment work?"



A. Pores tend to be prominent in the oiliest areas of the face. Genetics, age and sun damage all play roles in pore size. The best strategy to reduce the appearance of prominent facial pores is to ensure that they remain unclogged. If they are clogged with excess oil and skin secretions, then the pores will appear larger. Exfoliating treatments (Glycolic Peels, topical vitamin A) along with laser resurfacing may help. Constant skin care is always needed to maintain smaller pore size even with laser treatments.



Q.

"I’ve been thinking about breast augmentation for some time now, but I’m not sure that I’m comfortable with breast implants. Are there any other options?"



A. Fat grafting to the breast is generating widespread interest as a promising minimally invasive therapy for breast augmentation. This is especially true for patients who want only a small to modest change in their breast size and who also have enough donor material (i.e. fat from hips, buttocks, flanks, abdomen, etc). At this time, implant-based (either silicone or saline) surgery remains the gold-standard for breast augmentation for most women; however fat injections are gaining significant popularity and many plastic surgeons are beginning to incorporate breast fat grafting techniques in their practices.



Q.

"I applied Veltin Gel which was prescribed to me for a slight dark scar in between my nose and eye. After applying my skin became darker. I have a slightly medium/dark complexion with sensitive skin. What would my options be to improve the scar?"



A. Veltin Gel is a product that contains Tretinoin (exfoliant) and Clindamycin (topical antibiotic). This is one of many typical medications that are used primarily for treating acne. Tretinoin is a good product to help treat hyperpigmentation (dark scars, melasma) because it increases superficial cell turnover. However, combining Tretinoin with lightening agents such as Azeliaic acid and hydroquinone as well as antioxidants (Vitamin C and Kojic acid) would probably be more effective in lightening the scar.



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.
 

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