Aesthetic Medicine

The aging face presents a variety of intriguing challenges. More and more, these challenges are being met with injectable fillers, and an increasing variety of fillers populate the market.

At the outset, fillers were used primarily to address specific consequences of aging such as the deepening of the nasolabial folds, the prejowl sulcus, marionette lines and oral commissures.

While fillers met their objective of ameliorating deficits in specific areas, they increasingly are coming to be seen as having broader applications, including the noninvasive remodeling of the lower two-thirds of the older face.

As we age, the face becomes characterized by sagging skin and volume loss. Because skin laxity can result both from the intrinsic aging process as well as volume loss, a certain subjectivity is inherent in treatment considerations. Aging mechanisms of each specific patient may vary from one to the next. By analyzing the face as a whole, rather than isolated lines or wrinkles, today’s aesthetic physician can execute comprehensive treatment protocols to help return the aging face to the “triangle of beauty.”

One such comprehensive treatment protocol that has been effective in my practice has been the replacement of volume to reduce skin laxity arisen from weakened support. I employ a full face approach involving the use of Radiesse dermal filler to effect facial contouring that encompasses both skin surplus reduction and structural enhancement.

While we need to take a total face approach to recontouring, we can divide the face zones as a way to better understand how the face works and how skin laxity in different zones impacts each the other.

These are:

• the central zone involving the mouth and nose areas (relatively immobile),
• the paramedial zone involving the nasolabial folds and malar fat compartments (highest mobility),
• the lateral zone involving mainly the preauricular fossa (minimal mobility), and
• the zone of the ear concha (anchoring point).

Each zone is treated individual to achieve the best overall results for the whole face.

The lips are an incredibly sensitive part of the human body, and an important characterizing feature that defines and accentuates a woman’s sexuality. Through the lips, love is expressed, communicated and experienced.

It’s no wonder women spend so much time trying to beautify them. Luckily, fillers provide excellent options for accentuating and providing supple and full lips in a natural way. Most physicians use two specific types of hyaluronic acid (HA) fillers, Restylane and Juvederm for lip enhancement.

It all started in early 1980s when Zyderm, a bovine-originated collagen product, was approved by FDA for use as a filler for cosmetic purposes. It was mostly used in the folds and wrinkles of the face but quickly gained notoriety for its predictable and reliable use in the lips.

For 20 years, collagen products grew in popularity and enjoyed a monopoly as the only fillers approved for cosmetic treatments. Downsides to collagen, however, included a 3 percent hypersensitivity reaction rate. Thus, patients had to get skin tests prior to treatment. Even so, upwards of 1 percent of people developed allergic reactions. And patients also had to return every three months for the same results-as the collagen only lasted 12 weeks.

The popularity of collagen injections grew steadily, peaking with more than a million annual injections until 2003. That’s when a new competitor came on the scene with the addition of HA and its FDA approval for the treatment of facial lines and folds.

Restylane, the first HA FDA approved for cosmetic use, was a significant improvement over collagen. HA, a complex carbohydrate and one of the building blocks found in the living layers of the skin, is the same in all people and species; therefore, allergic reactions to the HA are unlikely, negating the need for skin testing.

Additionally, HA is extremely hydrophilic and has a high affinity for water, resulting in a smooth, soft, natural result. The product also lasted significantly longer than collagen with most patients seeing correction of their lips lasting at least six to nine months after injection.

Moreover, HA gained additional popularity when we learned its effects could be immediately reversed if necessary. An enzyme agent, hyaluronidase, injected into the skin will digest the HA gel, reversing the effects of the product within 24 hours. Thus, if a patient was not happy, we could remove the HA the next day.

However, HA is thicker than collagen, causing more pain. And, at first, there was no numbing agent premixed within the gel. Therefore, we would need to numb the mouth with a few strategically placed injections of an anesthetic. Patients appreciated the painless injections of the HA, but many did not like the prolonged numbing sensation of their mouth for one to four hours following.

Today, some practices, including my own, pre-mix the product with lidocaine, creating a filler similar to collagen in that it has minimal pain on injection. Another caveat with the HA treatments: the injections require much more technical skill from the injector in order to get a reliable and attractive result.

In 2006, the second HA was approved for use in the United States, Juvederm, providing some competition to other products. Anecdotally, advocates report that Juvederm provides a smoother injection with more plumping. Juvederm seems to attract more water than Restylane. But for those not wanting as much augmentation, Restylane may be a better choice. Nevertheless, either product will result in a nice improvement when done by an experienced physician or provider.

In the near future, expect to see the emergence and request by patients for permanent filler products. Although controversial, many are used overseas with arguably respectable safety and efficacy reports. (See sidebar on smoker’s lines.)

After Care is important. Following treatment, the lips are numb and usually feel bigger than they actually are. To prevent drying out, patients can use topical ointment such as Vaseline or Aquaphor. Additionally, we may use an anti-bruising Vitamin K cream named Auriderm. This product has been shown to reduce bruising time and severity. Most people take home a tube of it and reapply two times a day for a week if needed. However, with our new methods of injecting a hyaluronic-lidocaine mixture, bruising is unlikely or very minimal.

We also provide an ice pack and recommend that patients apply it to their lips on and off for the next 12 hours. Most people go home that evening and comment that their lips are tender, but not significantly enough to interfere with their routine. Some enjoy the swollen look of their lips and do not use the ice pack at all. They will go out immediately that night with their enhanced lips enjoying their engorged appearance.

We allow lipstick to be placed six hours following the treatment. Most people return to their daily schedule the next morning. Some will comment that their lips feel a bit sore for up to a week. If a bruise occurs, which is more likely for those on blood thinners, cover-up makeup may be necessary. Patients can eat and drink whatever they would like, and they can start kissing within hours after being treated. Most people enjoy the benefits of their enhanced lips for six to nine months.

Occasionally, some people metabolize the product quickly, and it is gone in 12 weeks. Others hardly break it down at all, and it will persist up to three years. Everyone is different, but overall satisfaction from this procedure is high for just about everyone.

Thankfully, today we have relatively safe, effective and affordable options to meet one of the most basic human desires: voluptuous, attractive, fuller lips.

The Duchess of Windsor once said, ‘You can never be too rich or too thin.’ Many Americans are fixated with the thought of being thin, since more than half of American adults are overweight and of that number, about one-quarter are obese. The media offers us a concept about body image that many of us cannot relate to.

We all know that losing weight can prevent heart diseases, stroke type II diabetes, high cholesterol, angina, certain cancers, sleep apnea, osteoarthritis, and back pain. The thinner we are the longer is our reasonably healthy life expectancy. By understanding the many factors that contribute to weight gain such as genetics, psychological components cultural issues, physical activity and individual metabolism, we can individualize a diet plan. Most patients are amazed at how much healthy food they can eat and still lose weight! A successful diet plan is focused on the health benefits but the cosmetic results are amazing.

A great tool to evaluate our weight is the Body Mass Index (BMI) and the higher the BMI the greater the health risks. The National Heart Lung and Blood Institute state that weight loss medications are useful for individuals with a BMI greater than 30 with no risk factors and a BMI greater than 27 for those with risk factors. Calculate your BMI now! Most patients do not have to reach their ideal BMI since it is not always realistic or desirable. Some medications may have side effects so all patients interested in weight loss should talk to Dr. Gerard Cappiello about the benefits and risks of these medications.

At Rinnova, diet programs are available with or without medication and with or without liposuction. Each patient get a complete history and physical examination, electrocardiogram and blood work The patient is then seen in the office weekly for their medication, monitoring, BMI evaluation, urine analysis and appropriate vitamins. When patient has reached a healthy weight and is happy the way he or she looks we begin to calculate the amount of calories needed to maintain the weight. The Rinnova plan has been proven and successful. Come and join the hundreds of patients that have lost the weight and kept it off.

The baby boomer generation may be well into their 50s and 60s, but that doesn’t mean they’re ready to concede their looks just yet. In fact, many “boomers” are determined to maintain their once-youthful appearance.

According to a recent survey by the American Academy of Cosmetic Surgery, anti-aging procedures such as facelifts and blepharoplasty (eyelid lifts) are on the rise. Botox procedures and the use of fillers are also increasing. The bottom line is that baby boomers are aging but they don’t want their looks to do the same.

“The baby boomers are getting older but they still feel young and they want to look that way too,” said AACS President Mark Berman, MD. “With anti-aging procedures, people tend to feel much better about themselves afterward.”

Facelifts rose 44 percent from 2008 to 2009 in procedures by AACS members, totaling 34,455 in 2009. Blepharoplasty procedures went up 42 percent, from 42,602 to 60,507. Similarly, non-invasive anti-aging procedures such as Botox (up 157 percent) and fillers (up 245 percent) rose exponentially.

In procedures performed by AACS members, the average age of facelift patients is 54.1 years. The average age for blepharoplasty is 52.3 years. In addition, the average age of patients receiving Botox is 46.6 and fillers is 46.8.

“I think this might come as a surprise to the public when they see just how many baby boomers are trying to slow down the aging process,” Berman said. “As a surgeon, these numbers aren’t surprising because we see older patients all the time.”

The eyes tell it all. The eyes are the most important gateway to your inner self. But as the years go by and aging process takes its toll, our eyelids begin to droop, giving a tired look to what was once your best facial feature.

Dr. Cappiello has worked in the Tampa Bay area since 1981, and dedicated his practice to creating natural, more youthful, refreshed appearance of the face, eyes and brows using various cosmetic techniques, both non-invasive and minimally surgical.

At Rinnova’s own surgical facility Dr. Cappiello performs minimal incision facelifts, thread lifts (Silhouette lift), brow lifts, laser skin resurfacing with skin tightening, facial dermal fillers, upper and lower eyelid surgeries, Botox, Dysport, and other services with minimal to no downtime.

He can improve bags under the eyes, wrinkles and sagging skin on the decolletage, neck, jaw line, forehead and eyelid droopiness, and rejuvenate tired, aged skin to bring refreshed look to your face.

Some women looking for vaginal rejuvenation surgery say to me, ‘Hang up this picture in the operating room and sculpture me after it’”. All I can say, “Okay, fine.”

I am among the growing number of pioneers in a controversial frontier of plastic surgery: nipping and tucking vaginas. Patients pay thousands of dollars for their “designer vagina,” an aesthetic procedure that includes shortening or plumping up the labia, or vaginal lips, or dehooding the clitoris, tightening, or “rejuvenating” the vagina.

There’s a need for these procedures, and women are driving this.

While doctors have long known how to enhance women’s genitals, demand for vaginal surgery has grown dramatically in recent years because this type of cosmetic surgery can enhance sexual satisfaction.

Women who have had their genitals surgically enhanced say it has transformed their lives. While some patients have genuine health problems, such as incontinence, many also ask their doctors to perform additional procedures while they are on the operating table. Others are solely driven by cosmetic or sexual reasons. Some women may have had an incision to facilitate childbirth or other complications of the childbearing, but “the No. 1” reason women seek genital surgery is to enhance the sex life. The surgery may take you back to before children, and it may be amazing.

Not all procedures are even surgical. The so-called G-shot, a collagen-based injection in the G-spot may amplify orgasms and increase pleasure.

A simple trimming of the labia and tightening the vaginal walls may make a “night and day” difference, both for the woman and her partner.

Pornography’s drift into the mainstream and a growing candour about sexuality often lead to the thorny subject of anatomical comparisons, says Leroy Young, chairman of the American Society of Plastic Surgeons’ emerging trends task force.

“[Women] get a comment from their spouse or boyfriend or whoever that, ‘Gee you don’t look like whoever,’ and a comment about a sensitive area like that, of course, is a huge emotional blow. So I think a lot of the women who pursue that are concerned about issues like, ‘How am I going to be perceived?’”

There is no doubt that vaginal tightening benefits men, but women also want change. They say, ‘Look, I want to enjoy this. I want to have the best sexual experience possible.’

The designer vaginas are created by surgically enhancing the external genitalia, including labia majora and minora, vaginal opening and perineum, which creates a “youthful and aesthetically appealing vulva. Trimming elongated or unequal labia is most common; some women get fat transplants to plump up their outer labia. We can also restore hymens for women, often from the Middle East, who want to appear to be virgins when they get married. To tighten a woman’s vagina, I decrease the vaginal opening by drawing muscles and support tissue together with an absorbable stitch. I can build up the perineum, which is between the vagina and anus.

There is no textbook outlining the ways and means that doctors can beautify the vagina. I get most of my new ideas all of his ideas by listening to women. It makes a tremendous difference for sexual gratification for the women. That’s what the procedure is all about.

More on www.DesigningVaginas.com. Schedule a free consultation now.

Combating the natural aging process and the elements that contributes to speeding up the signs of aging has been a long sought after remedy. Anti-aging products can be found lining store shelves, promising to reverse the effects of aging and spas and cosmetic surgery centers have been offering a wide range of treatments and procedures. The laser collagen procedure utilizes the laser’s ability to penetrate through the skin’s outer layer to stimulate new collagen growth.

Read the rest of this entry »

Traditionally, face lifts were the purview of older men and women experiencing relatively severe wrinkles. However, with the advent of mini lifts and other less invasive surgical procedures, men and women in their early 30’s and 40’s are embracing cosmetic surgery to stave off aging and reduce unwanted and unsightly wrinkles and lines. These mini lifts are considered less extreme and can produce both long lasting improvement and natural results, achieving a reduction in wrinkles without the appearance of having had drastic cosmetic surgery.

A number of factors contribute to early aging and premature wrinkles, including stress, heredity, sun exposure or health and beauty habits. People in their thirties and forties may be especially disheartened to see wrinkles developing at such a young age, especially if they feel helpless to stop it.

While there is no way a cream or topical treatment can get you the results of a genuine surgical face lift, mini lifts and other focused procedures- such as eyelid lift surgery – have been developed and fine tuned to provide visible improvements.

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Dr. Cappiello offers a range of face lift options, which may offer the answer that the younger patients are looking for to address wrinkles. As he explains, “men and women in their 30s and early 40s are definitely concerned with wrinkles and fine lines, but they want a solution that provides a long lasting improvement while keeping the changes subtle and natural.” A mini lift is a great answer as it can “create substantial change without going overboard,” according to Dr. Cappiello.

Patients also hope to have shorter recovery times and great results. This combination of requests requires an experienced surgeon who can provide you with an array of surgical options. For example, for those who want to put off surgery or avoid a face lift all together; laser treatments, Botox and Chemical Peels may also provide a viable alternative to surgery.

While these tools and options can be effective, unfortunately there is no one right facial rejuvenation process for every patient. The decision on the type of procedure, and the appropriate age to undergo cosmetic improvements, is best left to the patient and surgeon.

How can you use surplus tissue from your body to go from a 32 B to a C cup?

It is the cosmetic procedure that sounds like many women’s dream: increase the size of your breasts by up to a cup size, while taking inches off your tummy and thighs.

The operation, carried out under local anesthetic, involves the patient having fat removed during liposuction, mixed with other body cells, including stem cells, and then reinjected into the breasts. Quite common in Europe, still novel in the U.S., but unsurprisingly advocates believe this procedure will revolutionize the plastic surgery industry.

My patients are thrilled with the results, having gone from a 32B to a ‘natural looking’ C-cup.

Alternatives

Having silicone implants is not for everybody. Many women want a bigger chest but most do not want water melons. Some don’t like the idea of something alien in their breasts.

Another option to consider is injections of synthetic filler Macrolane – a procedure known as ‘the boob jab’, which can boost the breasts by a cup size. I have seen several reports of this filler turning lumpy, so there is risk of some long term side effects. Read the rest of this entry »

One of the most difficult-to-accept concepts for our patients  is having cosmetic surgery, totally awake and without pain, even days after the procedure. Most patients are amazed that these procedures can be done safely, effectively, painlessly, with minimal down time, but with truly remarkable benefits.

In reality, tumescent anesthesia is used worldwide and is much safer than general anesthesia. I perform all of my procedures such as liposuction, breast augmentation, breast reduction, tummy tucks and mastopexy under local anesthesia. This method is by far, and without question, the safest way to perform these procedures. The patient is very comfortable and interacts with me and my staff.

The patient is able to communicate how she feels, and even get up to go to the bathroom or have lunch with me and the staff. The most amazing part about tumescent anesthesia is that after surgery the patient is pain-free for up to 48 hours. This means that patients go home without any pain or pain medication. Read the rest of this entry »