Kimberly,
There are not any permanent fillers available on the market in the U.S. currently that are F.D.A. approved for facial lines. Artefill was available and you may be able to find some around, but the distributor in the U.S. went bankrupt and so it is no longer available. A new distributor may pick up the product in the future. The only other permanent filler available is liquid silicon. It is approved for retinal detachments, but some physicians are using it for facial lines and lip augmentation. I personally do not use silicon and have seen complications from it. There are some who support its use, but there are significant potential long term complications to consider. I do not recommend it. Its just not worth it. Sounds to me like you are on the right track with your current use of Restylane and Juvederm. You could consider Radiesse for the smile lines as it is a little longer acting and may build some permanent collagen, but it is not good for lips. There is a permanent implant available for the lips,but it is relatively new and its longevity and patient satisfaction has yet to be determined. Hope this helps.
Ed Buckingham
SMAS stands for Submuscular Aponeurotic System. The SMAS is a thin fibromuscular sheath that envelopes the muscles of the face and is involved in the bony cutaneous attachments to the skin. It isn’t really of importance except to the facial plastic surgeon as it related to face lifting and other facial operations. To the facial cosmetic surgeon it is probably the most important structure to know about and how it relates to the other structures of the face. The SMAS lies in continuity with the platysma muscle of the neck and is probably the embryonic extension of this layer into the face. It is important because we use the SMAS to tighten the facial skin and reposition the depressed fat pads of the face, ie. jowls and sagging necks. A lower facelift is perfomed in our practice by dissecting under the platysma and SMAS for a varying distance, depending on the patient, and then tightening this layer. This achieves a dramatic and long-lasting result. The skin is then gently trimmed and replaced without any tension so that the lift look natural and the incisions heal invisibly.
Maggie,
Thanks for your question. Absolutely I am board certified. I have a board certification from the American Board of Facial Plastic and Reconstructive Surgery as well as the American Board of Otolaryngology. I specialize exclusively in facial cosmetic and reconstructive surgery. My first five years of residency were specialized in significant surgery of the head and neck including major traumatic and neoplastic sugery. I then performed an additional fellowship in facial plastic and reconstructive surgery. I currently write board questions for the American Board of Facial Plastic and Reconstructive Surgery and administer the Oral Board. My complete qualifications are on the website. Please take some time to review them.
We perform surgery both in the office, at Central Park Surgery Center and at several major hospitals in the area. Office surgery consists of smaller procedures that can be carried out under local anesthesia with or without some oral sedation. Procedures requiring, or as requested by the patient, deeper sedation are performed at Central Park primarily and occasionally at a hospital. When we are at Central Park we use board certified anesthesiologists. Some of the hospitals also utilize nurse anesthetists.
I hope this information has been helpful. Please feel free to call or email with any further questions.
Ed Buckingham
Alison,
Thanks for your question about Fraxel laser. The Fraxel re:store and Fraxel re:pair are really two completely different treatments with the only thing in common is that they are both fractionated, which means that they lay down tiny spots of treatment surrounded by normal skin which speeds healing. The Fraxel re:store is an erbium laser that treats pigmentation, fine liines, wrinkles, some redness, acne scarring and more. It is a series of 4-6 laser treatments done at one month intervals. Each treatment has about 1-2 days of swelling and 4-5 days of a mild redness called erythema which can be covered with makeup immediately. So the social downtime with makeup is about 2 days. The results for pigmentation are great and wrinkle improvement and other concerns is mild to moderate. The Fraxel re:pair is a CO2, carbon dioxide, laser. It is a one time treatment, but has more downtime. The patient’s skin is a little weepy and crusty for 7-10 days and you are required to wear ointment on your skin for this time period. You cannot wear makeup to cover it so the social down-time is more like 7-10 days. It provides nice improvement for wrinkles and pigmentation as well as other skin concerns. So the real difference is the number of treatments and down-time. We would be happy to talk with you more about your specific concerns and answer any other questions you have.
Susan,
Thank you for contacting us. I have to tiptoe around that answer a little bit so forgive me. Ther term “Lifestyle Lift” is trademarked so unless you work for the company or have a contract with them to use that term you are not technically performing a lifestyle lift. Having said that a Lifestyle Lift is not a special secret procedure like some would have you believe. It is just a trademarked term for a limited incision facelift. We do face-lifting procedures with limited incisions all the time. In fact we are different from the corporation “Lifestyle Lift” in that we are most concerned with developing a relationship with you so that we can best determine which type of facelift will benefit you most whether it is a limited incision facelift (also called a mini-lift or S-lift) or a more significant lower face and neck lift. We have many examples of our results on our website. I encourage you to look them over and we would love to answer any further questions or see you in consultation.
