Aesthetic Medicine

A more youthful version of yourself can easily be accomplished without major surgery! We can restore a more youthful face depending on what we wish to change or restore. The facial rejuvenation is more easily accomplished if we divide the face in three parts: the upper, mid face and lower face.

The upper face can be improved by focusing on the eye brows, upper and lower eye lids and crows feet. The lateral eye brows can be elevated with a simple temporal stitch to give gentle lift and open up the eyes. The upper eye lids can be tightened using an ablative laser or a simple blepharoplasty. The puffy lower eye lids (festoons) can be easily eliminated with a percutaneous laser in 15 minutes without any incisions. The fat under the lower eyelids is addressed with a few bursts of the LipoTherme laser beam. The crow’s feet are greatly reduced or eliminated with the skin tightening LipoTherme laser or the Erbium ablative laser or both.

The middle face is not always treated with a full face lift. I use the laser to tighten the facial tissue from the inside followed by a laser to rejuvenate the skin from the outside. The laser can also remove wrinkles and uneven skin pigmentation. Here we can also use the patients own fat to fill in the larger wrinkles resistant to the laser. The mokers lines are also treated by placing the laser beam directly below the skin of the upper lip. Lip augmentation can also be performed with fat transfer or a lip implant. Silhouette sutures, used in Europe to restore the mid face, are placed in less than an hour with minimal down time. The silhouette sutures can be used in combination with the laser that tightens the skin from the inside and a very small and barely visible mini face lift incision.

The lower face can be rejuvenated with liposuction of the neck, chin jowls with the lipolaser not only to melt away the fat but also to tighten the skin. If wrinkles are very pronounced, a small and barely visible incision is made behind the ear to give a beautiful neck lift.

Some people do require a full face lift, which involves gentle restoration of the upper, mid and lower face. These procedures are performed in our surgery center under local anesthesia and, if needed, under conscious sedation. The patient has minimal down time and a quick recovery. All procedures are tailored to the individual needs of the patient.

With the economic crunch causing people across the country to tighten up their belts, it’s not surprising that at-home treatments are growing in popularity as people try to avoid the additional cost of visiting a physician. While people may accomplish a lower price point, they also run a significant risk of harm to themselves.

Injectables such as Botox, Dysport, and Juvederm, as well as dermatological treatments such as chemical peels require special training for proper use, as several women have found out. More and more horror stories are popping up in the media and through my colleagues.

I hear about paramedics, who think that they can handle giving themselves dermal injections since they use needles daily. They use products that claim to be a facial filler to plump up wrinkles. They inject these products under the eyes and near the mouth. They feel fine at first, but the next morning they wake up with huge bags under the eyes and a large pustule on the cheeks.

This DIY practice is extremely dangerous: a few millimeters off, you can puncture your eyeball or hit a blood vessel, possibly causing blindness.

I hear about people buying dermal filler products from some websites that may look legitimate, but are not authorized to dispense prescription drugs. These websites state that the products they sell are similar to Dysport, Botox and other injectables. Customers are instructed to watch a video and start injecting themselves away.

FYI, both Dysport and Botox carry a black-box label, meaning they have a risk of serious side effects. While the risk is low, there is concern that the toxin can spread and cause severe and even deadly respiratory problems. Both products belong only in the hands of trained professionals. Generic products are not approved by FDA, and may contain harmful substances. Beware of  the illegal sale of prescription drugs online, and please do not inject yourself.

Schedule a free consultation to discuss your needs and the options we can offer. Our charges are very competitive and you will have a peace of mind that the procedure is done correctly and by a physician.

We are happy to announce that we have completed the launch of a new web resource for women – DesigningVagina.com. This new web site is dedicated to the rapidly growing field of vaginal cosmetic surgery and genital enhancement. Given the importance of these issues for the well being and sexual life of our patients we thought that this part of the practice deserves special attention.

Our perceptions regarding cosmetic surgery are changing. Breast augmentation, liposuction, facelift and Botox are household words for many Americans. Vaginal cosmetic corrections and enhancements of the appearance may still be new terms but the role these procedures may play in women’s life cannot be underestimated.

There is nothing to be embarrassed or shy about!

Schedule your free consultation to discuss your options.

Dr. Cappiello specializes in the following procedures, which will improve appearance, self esteem, and enhance your sex life:

• Vaginoplasty (vaginal rejuvenation)
• Labiaplasty Minora (labial reduction)
• Labiaplasty Majora
• Clitoral Hood Reduction
• Hymenoplasty (repair of the hymen or revirginization)
• G-spot Enhancement

Laser technologies are expanding our horizons when it comes to non-invasive, safe and fast treatments of common skin and nail problems. Take toenail fungus for example. About 50% of Americans in the 50-70 year old age group have these thick, yellowish-brown, chipped and foul smelling toe nails.

Have you seen Lamisil TV commercials where ugly blobby creatures open up a human toenail and get into the nail bed? Those guys are a nasty group of fungi called dermatophytes who thrive off keratin, the nail’s protein substance.

Also referred to as Onychomycosis, fungal nail infections affect about 30 million people in the U.S. and can have serious consequences to the elderly, diabetics, and immune compromised individuals. In addition to causing difficulty and pain when walking or running, infections underneath the surface of the nail are often accompanied by a secondary bacterial and/or yeast infection in the nail plate.

All conventional treatment options for Onychomycosis have a maximum of 50% cure rate. That is provided your doctor has done some mechanical and/or chemical therapies and established a very strict regimen for you, which involves a combination of oral medications and prescription topical solutions. All oral drugs have some level of toxicity, and may have serious side effects for your liver.

Over the counter creams have less than 8% efficacy.

At Rinova we have developed a comprehensive course of laser-based treatment of the toenail fungus. The laser beam goes through the nail causing microbial damage and instantly kills the fungi that cause Onychomycosis. The procedure takes 15-20 minutes for ten toes. There is no downtime, and you can do anything you want right after the treatment.

Results are not immediate, as it will take 9-12 months for the new non-infected toenail to grow out. You will have to follow a regimen to prevent the re-infection but oral medication will no longer be part of it.

Any treatment of Onychomycosis is considered aesthetic, and insurance companies do not cover it. The cost will range from $1,100 to $1,300 depending on the severity of the case and includes two treatments, post-laser care kit and follow-up visits. Several financing options, starting at $29.95 per month, are available to fit your needs.

Learn more at www.LaserForToe.com and schedule an appointment online.

In 2002, about ten years after Botox had been widely accepted the world wide, the United States Food and Drug Administration (FDA) approved the first botulinum toxin for the cosmetic reduction of movement related facial wrinkles, Allergan’s Botox Cosmetic.

Since then it has become one of the most popular minimally-invasive cosmetic treatments in the United States with more than 2.8 million procedures performed in 2008 alone.

On April 30, 2009, Dysport (Medicis Pharmaceutical Corp., Scottsdale, AZ) became the second botulinum toxin approved for cosmetic use. The product has been commercially available in Europe since the early 1990’s and is approved for aesthetic use in 27 countries. While worldwide experience is plentiful, physicians in the United States are eagerly putting the neurotoxin to the test.

So what’s the difference between the two products? Both have a central core molecule which serves as the “active” portion of the neurotoxin and both have the same mechanism of action. The main difference is that the two products have a different array of associated “non-active” proteins which are complexed around the active core. All in all, the two products will function nearly identically and have the same duration of action, however there may be some subtle advantages to Dysport. Read the rest of this entry »

Have you heard of the new breast implants that don’t use silicone or saline? In fact there are no implants at all. Your fat is the best replacement for the implant! Moving fat from your undesired areas into the breast sounds perfect. But how does it work, what can patients expect, and is it safe?

Natural breast augmentation is a relatively new procedure in the United States, but it has a long history and very successful following in Europe. There are very few physicians performing this procedure in Tampa Bay area.

I use fat taken from your own body via liposuction to add volume to the breasts. You can be rest assured that the procedure is painless, safe, very effective, and results last very long.

The procedure begins with liposuction. I remove fat where it’s not wanted and contour the body where it is most needed, safely and permanently without the need for invasive surgery. The patients will work with me to decide which area they would like to see reduced, commonly the hips, thighs, stomach, or buttocks, and what areas will need to be re-contoured and to what volume.

One of the greatest gains with the new procedure has been in the fat survival rate which is between 85% to 90%. With the addition of adult stem cells to enhance the fat transfer and breast splinting technology, adipocyte survival rates have shown to be even higher. In fact, when the fat transfer is concentrated with adult stem cells harvested from the patient’s own fat, and is injected into the fat that is already within the breast, the result can equal a permanent increase of 250cc to 500cc in overall breast size equating to a 1 to 2 cup size increase. Read the rest of this entry »

I’ve seen and heard about medical estheticians, medical assistants and even front desk staff administering Botox injections.

It’s not legal, as this story on the prosecution of a medical assistant clearly shows.

Betty Guerra’s months long nightmare is over.

The 45-year-old former medical assistant learned today from her attorney that the 10 felony counts against her on allegations of “unlawful practice of medicine” will be dismissed, she said.

“I always believed things would work out the right way,” she said tearfully. “I cannot be punished for something I didn’t do.”

Guerra’s July arrest sparked controversy over what medical assistants can and cannot do. Specifically, there was confusion over whether they are able to give shots.

Guerra was accused of unlawfully administering cosmetic injections, an act commonly performed by medical assistants throughout Nevada.

The state attorney general’s office did not specifically say charges against Guerra would be dropped but indicated it won’t be pursuing the case.

“The complaint against Betty Guerra submitted to the Attorney General’s Office by the Board of Medical Examiners has been contradicted by the subsequent actions by the Board,” Attorney General Catherine Cortez Masto said in a statement. “Therefore, it is fair for us to conclude that it would be difficult to prosecute this case beyond a reasonable doubt.”

Guerra’s attorney, Jason Weiner, said this evening that the attorney general’s office had sent him a copy of an unfiled motion dismissing the case earlier in the day. He would not be able to provide the Review-Journal with a copy of that motion until Wednesday, he said.

After Guerra’s arrest, physicians became concerned about what duties their medical assistants could perform.

Former medical board director Louis Ling said that upon reading a 30-year-old law, he concluded that the assistants could not give shots. With flu season coming on, he then attempted to draft emergency regulations that would allow them to give flu shots, but not Botox or other cosmetic injections.

However, that effort was shot down when a judge recently ruled that the board, in considering the regulations, had violated the open meeting law.

The board later reversed its position, determining that state law allows medical assistants to administer everything from flu shots to Botox. Medical assistants could give shots as long as they are under the “direct supervision” of a physician. Most health officials and doctors take that to mean the physician is on premises.

Ling resigned on Friday.

Guerra, a mother of three who was a physician in her native Peru, said she has been under incredible stress since her arrest and lost her job because of the publicity surrounding her case.

“It was a nightmare. I could not even sleep or eat all this time, wondering what was going to happen.”

Still, she said she harbors no anger.

“Now, I start all over. But it’s just another experience in my life.”

People with excess fat deposited in various parts of the body and those with loose skin have benefited from laser-assisted lipolysis. Lipotherme laser is appreciated by plastic surgeons and aesthetic doctors who earlier found it arduous to treat areas such as the neck, jowl line, inner arms and inner thighs. The laser has the capability to penetrate stubborn fat deposits without much resistance from fibrous tissues and liquefy the fat for aspiration.

The treatment is painless because the size of the incision made is just about 1 mm unlike traditional liposuction where it was close to 10 mm. Skin tightening is achieved by treating the undersurface of the skin where bands that create cellulite and produce new collagen is broken up.

The patient’s recovery is exceptionally fast, especially because the procedure can be carried out under local anesthesia. Certain invasive procedures such as facelift may not be required if treatment is opted using the laser device. Traditional liposuction can also be combined along with Lipotherme if the necessity arises.

As an added benefit laser treatment initiates the growth of new collagen, the protein that makes up the connective tissue in our skin. A visible skin tightening effect will further improve the liposuction results.

More information about Lipotherme

And there’s rarely a true need for a surgical face lift! We have amazing new technologies that help us achieve remarkable results without the excessive trauma of surgery. These solutions are effective, minimally invasive and affordable. Our three laser modalities (Nd YAG, the Erbium and Lipotherm) can be used for 90% of all popular and highly effective procedures to turn back the clock and make anybody look younger for months if not years.

The non ablative 1064nm YAG laser is used to painlessly remove hair, sunspots, age spots, Rosacea, pigmented lesions, spider veins, treat active acne, and to rejuvenate, plump up and tighten the skin around the eyes, face and neck – all with little or no down time. Using this laser every 4 weeks for 3 to 4 sessions will yield outstanding results.

The Erbium laser is used for laser peels of variable depths. The laser resurfacing removes the aged and abused superficial layers of the skin while stimulating growth of new, younger and healthier skin. The smooth new skin is free of lesions, scars and wrinkles.

The two laser can be used together to provide a Bi-Modal Facial Restoration. The combination of these lasers stimulates epidermal tone and texture while improving collagen remodeling. The new skin is free of all those conditions that age the skin such as sun and age spots, wrinkles and acne scars. The treatment is simple, safe and efficacious.

The Lipotherm laser is used to model the chin, neck, jowls and cheeks by melting the excess fat and tightening the skin in the lower and mid face.

Facial wrinkles appear because as we age we lose our subcutaneous fat which in turn causes marionette lines, pronounced nasolabial folds, smoker’s lines and wrinkles around the eyes. These wrinkles can be eliminated by using injectable dermal fillers such as Radiesse, Restylane, Evolence or your own fat – the best natural filler. These fillers last from 6 months (for Restylane), 18 months (for Radiesse) and the fat transfer can last a year or longer. The beauty of fat transfer is that it is your own, natural, readily available, cheaper and limitless.

These procedures will help your body rejuvenate and repair itself and they are available at Rinnova Med-Surgical and Laser Institute.