Oriental Eyelids and Plastic Surgery Answers

Question: I’m a 28 year old Chinese female and dislike my eyelids. My eyelids have always had a flap of skin that hangs down to my lashes. I would like to have the extra skin removed from my lids but am afraid of not looking Chinese to my family. Can you do eyelid plastic surgery and still have a patient look Oriental?

Answer: You ask some very good questions about Oriental eyelids. Please read below and contact me at Orange County Plastic Surgery if you have any further questions concerning this, or any other cosmetic surgery procedure.

First of all, Oriental patients do have different eyelid anatomy than most Caucasian patients. In the typical Oriental type of eyelid patient, the superior palpebral fold (the upper lid fold between the lashes and brow) is absent. This occurs in approximately 50% of Oriental patients and is a genetic feature that is passed on from parents to their children with a dominant gene. The Oriental eyelid without a palpebral fold is often referred to as a “single eyelid”, while an eyelid with a fold is called a “double eyelid”.

Operations designed to construct a superior palpebral fold are becoming more popular in Oriental patients around the globe. This surgery has become commonplace in large cities in the Orient as well as in the United States areas, especially in areas like Orange County containing large Oriental populations. The “single eyelid” occurs because a muscle called the levator palpebrae ends within the substance of the lid, instead of attaching to the top of the cartilage plate in the lid, and is not caused by a skin excess! In such procedures, every attempt is made to create the desired fold but not to alter the general shape of the eye or to destroy the web that many Oriental patients have medially, near the nose. Destroying this epicanthal fold would make a lid look more Caucasian and destroy this important Oriental feature of an eyelid and give the patients and eyelid version of Michael Jackson’s nose – this is to be avoided!

As mentioned, 50% of Orientals lack the palpebral fold, but the other 50% do have such a fold – the Oriental eyelid procedure is designed to create such a fold and still leave the patient looking Oriental. A surgeon doing such surgery should be familiar with the differences between Oriental and Caucasian anatomy. It is possible to get a very good result with this plastic surgery procedure, but as with any cosmetic procedure, it is important to research the options and all potential outcomes. It is also important to communicate with your surgeon about how you would like to look after the surgery and obtain comprehensive pre-procedure and post-procedure information.

If you have any specific questions about the Oriental eyelid, plastic surgery procedure, or any other cosmetic procedure, your best bet would be to see a qualified, board certified plastic surgeon to review your options. A plastic surgeon should be able to work with you to get a result with which you are satisfied!

Dr. Juris Bunkis, MD, FACS of Orange County Plastic Surgery is a Harvard trained, Board Certified Plastic Surgeon and has 30 yrs of surgical expertise. Call OCPS at 949-888-9700, email your questions to info@ocps.com or visit our website for more information.

Eyelids and Brow Lifts, Questions and Answers

Q: My upper lids droop over my eyelashes and I would like to have them fixed. I have seen two plastic surgeons, one who agreed that he could help me with my upper lids, another who told me I’d have to have a brow lift as well. My brows are fine with me and I do not understand why a brow lift would be necessary? Why would a surgeon recommend a procedure I did not ask for?

A: You really should go and have another talk with your plastic surgeons – if one recommended a brow lift, he should have explained why he did so. Rarely would we suggest a procedure about a body part not brought to our attention by a complaint originated by a patient. For example, we would never comment about very large or small breasts if a patient came in to discuss an abdominoplasty (i.e. “tummy tuck”).

The two exceptions I can think of relate to chin implants and brow lifts, but in such a situation, I sure would hope that the patient left the consultation with an understanding of why we are recommending the brow lift or chin implant procedures! Patients with weak chins who come in complaining of a large nose or a droopy neck cannot get a great profile without addressing the weak chin because the chin, nose and neck all contribute to the profile. Likewise, if a patient complains of heavy upper eye lids, we have to analyze the balance between the eyelid and brow position.

As a plastic surgeon, our duty is to lay out the options for a patient and each person has to choose the procedure(s) that will give them their desired results. In a pure upper eye lid blepharoplasty, the thin skin excess of the lids is removed but the distance from the lashes to the brows is not changed. In patients with low brows, removing the thin, excess upper lid skin may not be appreciated unless the thicker tissues just below the brows are raised as well. This is not to say that every low brow must be raised when doing an upper lid procedure, but the patient has to understand that only the thin, upper lid skin excess will be removed, that the thicker brow hooding will be unchanged, and that the distance between the brows and lashes does not change with an isolated blepharoplasty.

If a patient desires a more open – eyed look, this will only be accomplished if a brow lift is added to the eye lid procedure. Not only will the eye area look more open following a brow lift, but during a brow lift, the frown lines between the brows will be minimized because we can remove some of the muscles that cause these frown lines, called the corrugator and procerus muscles. And finally, occasionally I’ll see a patient with hooding caused by low brows who thinks they would like an upper eyelid blepharoplasty, but when I gently elevate the brows, I can see that this patient does not have an excess of thin, upper lid skin, just low malpositioning of the brows and I will recommend to this patient that a brow lift be performed without a lid procedure per say.

A brow lift is a minimally invasive procedure. In the endoscopic brow lift, a few half inch incisions are made behind the hair line, allowing the instruments to be inserted. The tissues are freed from the bone, the muscles sculpted, and the brows raised a few millimeters. The brows are fixed in their new position with a variety of devices. The incisions are rarely perceptible after healing has taken place. Occasionally, a brow lift will be performed as an isolated procedure, but more commonly it will be combined with a minimally invasive midface or thread lift, an eyelid procedure or a standard face lift.

If you have any specific questions about cosmetic procedures, you should see a qualified, board certified plastic surgeon to review your options and have additional questions answered!

Dr. Bunkis,MD, FACS of Orange County Plastic Surgery is a Harvard trained, Board Certified Plastic Surgeon and has 30 yrs of surgical expertise. Call OCPS at 949-888-9700, email your questions to info@ocps.com or visit our website for more information.

Are There Alternatives to Liposuction?

Q: I am a fit 54 year old, have had a face lift and look good for my age, but I have a few fatty deposits over my hips and cellulite that don’t go away with exercise and are driving me crazy. I have heard of nonsurgical fat removal – is there any way, shy of having liposuction, which will remove my cellulite and fatty deposits?

A: First of all, congratulations on being fit at 54 and for caring how you look! General health wise, there is nothing better that you can do for your body than to keep fit and to keep excess weight off!

In order to answer your question, I’d first like to give you some background about fatty deposits and cellulite. We all have fat within our bodies, some fat is necessary, but too many of us have an excess of fat. Our body needs energy to survive, and that energy comes from what we eat or drink. No matter whether you are consuming protein, carbohydrates or fat, the body breaks down the food you take in into tiny molecules. The body uses what it needs to survive, and all of the excess, no matter whether it started as protein, carbohydrates or fat, gets converted by the liver into fat. This fat is transported by the blood to fat cells throughout the body for storage. On days when you do not consume as many calories as are needed for survival, the stored fat gets returned to the liver where it is re-manufactured into usable parts throughout the rest of the body. We all know that fat is stored in different ways and places in different people. Women tend to store their excess fat over the hips, thighs and in the external layer, between the skin and muscles, over the abdominal wall. Men tend to store their excess abdominal fat internally, around the intestines, as well as externally over love handles and the chest.

Cellulite refers to the surface irregularities seen over the thighs, hips, and buttocks of almost all women, and is rarely seen in men. Men and women store fat differently under the skin, men more in horizontal layers with a smooth surface, while women store the fat more in a perpendicular manner, which leads to the objectionable surface lumpiness.

Now that we understand about excess fatty deposits and cellulite, let’s discuss what can be done to improve cellulite or remove unwanted fatty deposits. Let’s start with cellulite. There have been many, many treatments varying from home remedies, commercially available creams and ointments, wraps, garments and machines that have been promoted as providing cures for cellulite. It has also been claimed that caffeine, through its ability to constrict blood vessels, can make your skin appear tighter and improve cellulite.

I well remember when, about 20 years ago, Endermologie® was introduced, received a lot of interest from the press and doctors were lining up to purchase these $150,000 machines. These machines basically used rollers that the company claimed, sent a message to the cells, triggering actions such as fat break down and collagen production. The company claimed that cellulite was removed and inches would come off the treated areas. Multiple treatments were required. After any one treatment, the cellulite did seem to improve, probably from the swelling caused by the localized trauma, but unfortunately, a month later, when it was “time for another treatment”, all the cellulite would be back in its full glory. What patients ended up with was basically an expensive massage! This machine simply did not live up to its claims or patient expectations.

Next came mesotherapy or Lipodissolve®, a “non-surgical alternatives to liposuction”. Mesotherapy involves a series of injections that may melt away unwanted small, localized areas of fat. While the main ingredients used in these injections vary, the chemical cocktail typically includes phosphatidylcholine/deoxycholate (PCDC), multivitamins, alpha lipid acid, enzymes and plant extracts. Phosphatidylcholine is FDA-approved to break down blood fats that may increase risk for heart disease, but it is not approved for injection or any other purpose. Use of this substance to dissolve superficial fat is performed in an off-label manner. During these treatments, your doctor injects the chemical cocktail into the fat layers. The injection is relatively painless, with no need for anesthesia. The medication produces a chemical reaction which dissolves localized areas of fat. Benefits can be seen within three weeks of the treatment but proponents claim that several treatments, four to six weeks apart, are required to produce the optimal result. After a treatment, the patient can return to their usual activities. Approximately 100,000 Lipodissolve® treatments have been performed in the United States and Europe and some papers have been written, showing post treatment improvement, but problems remain, and because of these problems, Kansas and Nebraska, are in the process of enacting legislation to ban Lipodissolve®. ANVISA, the Brazilian version of the FDA, banned the use of phosphatidylcholine-based products for injectable fat removal, and Health Canada, the Canadian FDA, has ordered physicians to stop marketing and administering the products. We know that these injections can liquefy fat, but where the fat goes is anyone’s guess. Harmful deposits in the liver or blood vessels could lead to serious medical problems including fatty plaque and increase the risk of heart attack or stroke. The American Society for Aesthetic Plastic Surgery (ASAPS) has reported that infection, disfiguring masses of inflamed tissue and tissue death can occur after Lipodissolve®. I have seen a number of previously treated patients with indentations in the treated sites. Ignoring the health issues, from a purely aesthetic point of view, the main problem with Lipodissolve® is that the results are unpredictable and that surface irregularities are quite common. Lipodissolve® is still in the experimental stage. Clinical studies in the United States that look at the safety and efficacy of Lipodissolve® are underway. This is a treatment that we would only recommend under special circumstances at this time.

The latest nonsurgical technique which is being touted as a magical cure for cellulite and fatty deposits is Cryolipolysis™, using a machine built by Zeltiq, and promoting a “One hour fat fighting treatment”. This is a new technology with very little published information and their machine is not FDA approved yet. From what I’ve read, probes are placed on the skin that cool the fatty layer to about 5 degrees Celsius, about the temperature in a refrigerator. This damages the fat cells and some will die over the next four months. This procedure does not work on large people, or those with a thick fatty layer because the cold cannot penetrate more than a few cm. But for thin people with very small fatty pockets, it might show some promise. The reason it is not FDA approved yet is because there are questions as to what this cold treatment does to nerves, blood vessels, skin, muscle, etc. long term. I see similar question to those discussed above with the Lipodissolve® – where does the fat go, what are the health risks? I simply do not think that loosing an inch off your hips is worth an earlier heart attack!

To summarize, simply put, nothing tops liposuction when it comes to the removal of unwanted fatty deposits (as long as skin laxity is not an issue – if it is, a skin resection may be indicated).

Liposuction is the only scientifically proven method for safely removing fat cells permanently and is the top overall surgical cosmetic procedure performed in the United States. A variety of different cannuals are now used for liposuction, but all are inserted through tiny, hidden incisions and recovery after the procedure is relatively quick and uncomplicated. If you have any areas that are of concern to you, your best bet would be to come in to discuss your concerns with a board certified plastic surgeon.

Dr. Bunkis, MD, FACS of Orange County Plastic Surgery is a Harvard trained, Board Certified Plastic Surgeon and has 30 yrs of surgical expertise. Call OCPS at 949-888-9700, email your questions to info@ocps.com or visit our website for more information.

Are You Ready For Cosmetic Surgery?

Are you looking for a change in your body? A new shape or a new size? Perhaps, a skin treatment or something to help your body and face look younger? If so, there are a variety of surgical and non-surgical cosmetic procedures that can change the way you look and feel. In 2009, cosmetic surgeons across the United States performed more than 10 million different procedures, according to statistics from the American Society for Aesthetic Plastic Surgery (ASAPS), and that number is expected to skyrocket by 2015.

Cosmetic surgery can be as simple as a Botox injection over the lunch hour or as extensive as a “mommy makeover” to reshape your breasts, belly, thighs, face and more. Some procedures only take a few minutes and involve very little recovery time; some take several hours and involve a longer recovery period. Cosmetic surgery can focus on your face, your ankles, your neck, your stomach – you name it. It can make body parts larger or smaller.

If you are considering having some sort of cosmetic surgical procedure, the following checklist will help you determine if you’re a good candidate:

-Have you done your research? Good candidates for any cosmetic surgery have a good understanding of the procedure itself as well as any pre- or post-surgery expectations. Likewise, research will help you understand potential costs, risks, options and more.

-Have you already tried to change your body through diet and exercise? The best candidates for cosmetic surgery are often people who live a relatively healthy lifestyle and have struggled to change or shape certain areas through exercise or diet in the past.

-Have you set some money aside for cosmetic surgery? Health insurance covers some procedures (breast reduction to help with severe back pain in certain instances, for example), but most procedures are out of pocket. In addition, cosmetic surgery procedures vary in price depending on the area and extent of the surgery.

-Have you talked to a cosmetic surgeon? You should make sure the surgeon you are considering has strong experience in your particular surgery and that he or she also has impressive credentials: education, training, job experience, qualified staff as well as a personality and style you are comfortable with.

-Have you had all of your questions answered? Talk to cosmetic surgeons and friends or others who have had cosmetic procedures performed to get all of your questions answered ahead of time. The more you know, the more you can prepare and enjoy the results of your procedure.

Cosmetic surgery can change your body, your mindset, your outlook, your entire life. Doing some research and studying your options can lead you to the best cosmetic surgeon and the best options for you and your body.

Always be sure to do your homework so you’re sure to be trusting a plastic surgeon with proper training and experience. It’s always a good idea to consult only with plastic surgeons who are certified by the American Board of Plastic Surgery. There are many certifications but American Board Certified Plastic Surgeons are usually the most trusted.

Dr. Leo Lapuerta is a board certified Houston plastic surgeon and the founder of the Plastic Surgery Institute of Southeast Texas. To learn more about cosmetic surgery procedures, look through actual patient photo galleries and watch video testimonials visit www.lookyounger.net.

The Truth About Liposuction

Q: I had a friend years ago that had liposuction on the bottom half of her body. 10 years had passed since I saw her; I could not believe my eyes, her face and arms had gained so much weight I didn’t recognize her! Is it true when you lipo from one part of the body it can deposit to other parts?

A: This is an interesting question and addresses a common misconception. Liposuction is currently the most commonly performed aesthetic surgical procedure in the United States. The concept is relatively simple, analogous to a vacuum cleaner that selectively removes excess fat between the skin and the first layer of muscles – it cannot remove deeper fat, for example that inside your belly around your intestines (the deep fat can only be removed by decreasing caloric intake).

The excess outer fat can be reduced by running a metal tube through the fatty layer, creating empty tunnels, which collapse as the patient heals and gives a patient the desired contour improvement. During the liposuction process, the excess fat is physically removed, collected in large bottles (up to five liters can be safely removed in one sitting), and disposed of as biological waste. This removed fat, therefore, cannot go to other parts of your body! Even the thinnest super model has a thin layer of fat under the skin and, when surgeons perform liposuction, at least a half inch layer of fat is always left between the skin and the muscles. The problem is that removal of the fat does not prevent someone from gaining weight in the future!

The equation is pretty basic – your weight is the result of what you consume minus what you burn off. If you eat roughly what you burn, before or after surgery, your weight will be stable and your fatty layer will remain at the same thickness. If you burn more than you consume, your fatty layers will decrease in thickness. Unfortunately, the converse is also true – if you consume more than you burn, whether or not you have had liposuction, your fatty layers will increase in thickness. This increase in thickness will occur over the part that was liposuctioned as well as over other parts that were never suctioned. We all know some overweight people with massive thighs or arms, large bellies, and very full necks, whether they have had prior liposuction or not. Liposuction is designed to treat stubborn area that do not respond to diet and exercise – liposuction is not a weight loss technique and does not prevent someone from gaining weight in the future!

When considering any surgical procedure, it is important to find a surgeon who you trust and to have all of your questions answered. You should know all the facts about your procedure and be aware of the risks prior to committing to the procedure or entering the operating room. It may also be a good idea to see photographs of your surgeons previous patients and their results.

Dr. Bunkis MD, FACS of Orange County Plastic Surgery is a Harvard trained, Board Certified Plastic Surgeon and has 30 yrs of surgical expertise. Call Orange County Plastic Surgery at 949-888-9700, email your questions to info@ocps.com or visit our website for more information. Serving Irvine, Newport Beach, Mission Viejo, Laguna Beach, Rancho Santa Margarita and surrounding cities.

Who to Believe – My Plastic Surgeon or My Dermatologist?

Q: I am 54 years old and beginning to see signs of aging. I asked my dermatologist for suggestions regarding products and she told me I was “too far gone” and suggested a laser procedure. I saw a plastic surgeon who told me that was nonsense and suggested a face lift instead. I want to look better but don’t know who to believe.

A: I can begin by telling you that both are correct, at least in part, and I am certain that both doctors are giving you advice based on their view points, training and expertise. The problem is that most dermatologists do laser resurfacing and not surgical procedures – they tend to recommend procedures they know how to do, regardless of what is best for the patient. And likewise, many surgeons do not do resurfacing procedures and may suggest a surgical procedure without considering the resurfacing option.

Without a consultation, I will have to answer this question in the most general terms. I will begin by telling you a few words about aging and what we can do about it. Two events happen simultaneously as we age. Surface changes occur from excessive sun damage. You can use sun blocks, hats and sun glasses to minimize sun damage as you get older. A laser treatment will remove these superficial signs of aging, but will not affect the dropping and skin laxity, particularly in the jowl and neck regions, that also occur with time.

These latter changes are the result of heredity and will not be altered by sun blocks or helped with a resurfacing procedure. In order to alter neck and jowl sagging, plastic surgeons pick these layers back up and tighten them as part of any traditional or midface lift procedure. Frequently, brows will be elevated back to where they once were, or baggy eyelids will be addressed at the same operation so as to restore a sense of balance to the final result – for example, very baggy eyelids would detract from an otherwise well done face lift which gave a patient a youthful neck.

Such surgery will not, however, alter sun damage or the quality of your skin. Another very important factor is a patient’s expectations – these have to be met! Some patients want nothing but a total improvement, others are willing to settle for less improvement because they are not bothered by certain features or because they are trying to save money. Your best bet is to find an aesthetic surgeon well versed in both the traditional surgical procedures as well as the various resurfacing procedures (chemical peels, laser resurfacing and dermabrasion) so that you can be presented with all the options and then you can decide which is the best option for you. Though your results may vary from a surgeon’s previous patients, during your consultation, you may ask your plastic surgeon to see photos of patients they have worked on. In this way you can get a better idea of the results of different procedures and decide on what will suit you best.

Dr. Bunkis MD, FACS of Orange County Plastic Surgery is a Harvard trained, Board Certified Plastic Surgeon and has 30 yrs of surgical expertise. Call Orange County Plastic Surgery at 949-888-9700, email your questions to info@ocps.com or visit our website for more information. Serving Irvine, Newport Beach, Mission Viejo, Laguna Beach, Rancho Santa Margarita and surrounding cities.

Looking Beautiful on a Budget – Wrinkle Repairs

Q: I am in my early 50′s and I’m starting to see wrinkles. Many of my friends have gotten facelifts and Botox® injections but I’m terrified of needles and knives! Are there any over the counter products that will tighten my skin?

A: Great question! You will know when you are saggy enough to warrant surgery, but in the meantime, there are many non-surgical treatments that can improve the quality of your skin.

Most of us do not appreciate fine facial wrinkles, hyperpigmentation and tactile roughness. Now you can have smoother, less pigmented skin with the newest FDA approved Tretinoin cream, Refissa®. It is emollient based and does not dry out your skin. This product has become the gold standard medical treatment for photo-damaged skin. It works by stimulating cell turn over and causing the sun damaged outer layers to slough off. Refissa® is the first important step to healthier skin. Always remember sun protection year round!

The next step, now that your skin is healthier, may be one of the many peels offered. There are many peels to choose from. For the purposes of this article we will focus on the Microlaser peel. Microlaser peel, the “week-end” skin peel, treats skin conditions more aggressively than the Refissa® is capable of doing. The Microlaser peel is performed with Sciton’s Erbium laser which uses a computer guided scanner to ensure maximum precision treatment uniformly. You will see improvements in just a few days

What exactly does the Microlaser peel treat?

It is a minimal to full epidermis laser peel that precisely removes the outer most layers of the skin. The procedure is individually tailored to the nature of the problem to be corrected: wrinkles, scars, keratoses, pigmentation problems, overall sun damage.

How often does a Microlaser peel need to be done?

As mentioned above, year round sun protection is a key to healthy skin. The results of any treatment, not just the Microlaser peel, will last longer and be more efficacious if you avoid future sun damage. One Microlaser peel procedure will usually be sufficient for a few months but subsequent treatments may be required. As mentioned earlier treatments are customized to each person. During your consultation we can determine what will be best for you.

What can I expect from the treatment?

Smoother, healthier, more vibrant skin. A blended complexion with a lessening of fine lines.

Is the treatment painful?

When you go into the office, a topical triple anesthetic cream will be applied. This application will make the procedure quite tolerable. Afterwards you can have a surface Oxygen treatment.

What is my aftercare? Do I need to wear any bandages or dressings?

No. Microlaser peel is not like a CO2 laser and requires nothing more than a protective ointment like Aquafor or vaseline. This is used as a barrier while you grow new epithelium(baby cells, new skin). You may also go back to your plastic surgeon’s office for oxygen treatments over the next few days.

As you can see, there are options to a scalpel and needle when making your skin look better! Make sure you discuss your concerns with your plastic surgeon prior to any procedure.

Dr. Bunkis MD, FACS of Orange County Plastic Surgery is a Harvard trained, Board Certified Plastic Surgeon and has 30 yrs of surgical expertise. Call Orange County Plastic Surgery at 949-888-9700, email your questions to info@ocps.com or visit our website for more information. Serving Irvine, Newport Beach, Mission Viejo, Laguna Beach, Rancho Santa Margarita and surrounding cities.