Welcome to our November Newsline.

The “liquid facelift”

THE “LIQUID FACELIFT” is a term with huge appeal to today’s cosmetic surgery candidate, with the promise of instantly improving the appearance of lines, wrinkles and sagging skin — without surgery — simply by injecting synthetic fillers or the patient’s own fat.  While these minimally invasive treatments are touted for their ability to “refill” the face’s lost volume, there is often a misconstrued perception by some patients that these dermal fillers can lift the skin and soft tissue.

While controversy exists as to whether changes of midface aging are caused by gravitational migration of the cheek fat, or if it is due to fat atrophy, one study in Plastic and Reconstructive Surgery found gravity to be the primary culprit.  According to the study’s author, John Q. Owsley, M.D., clinical professor, Division of Plastic Surgery, University of California Medical School, San Francisco. “fat atrophy may contribute secondarily in those whose faces become thinner as they age,” but laxity is still the primary culprit.

Restiline Cheeks

That is not to say that there is no place for the use of fillers, but rather to emphasize that they are not a substitute for the surgical correction of laxity.  Certainly, in younger patients fillers may be the preferred form of treatment, and even in older patients they are quite useful, especially in combination with lifting procedures.  In the example shown here, Restylane was used to fill a hollowness in the cheek resulting in a far more natural and attractive appearance.

Like all forms of treatment, fillers are not entirely without risk.  Fat injections can sometimes cause lumpiness and, in rare occasions, severe infection.  Even though it is the patient’s own natural tissue, significant absorption often occurs.  The synthetic fillers are generally found to be quite safe, but of course their effectiveness is limited in time.  While some of the newer fillers seem to last longer, they also seem to be somewhat more prone to complications.

Whether fillers or surgery are the best option for you should be determined not by advertisements but by a thorough consultation with a cosmetic surgeon who is skilled in all forms of facial rejuvenation.  Only by knowing the pros and cons of each can you make the proper decision as to the best form of treatment for you.

Is more extensive dissection worthwhile in facelifting?

 A team headed by researchers at the University of Toronto’s Department of Otolaryngology/Head and Neck Surgery has released results of a study suggesting that deep-plane face-lifts in the mid-face and neck result in outcomes that are clinically and statistically  superior to those of the less extensive, so called mini face-lift.

The researchers reviewed preoperative and postoperative photographs of 25 patients who had undergone a minimal dissection face-lift and 25 patients who had undergone a deep-plane face-lift. The postoperative photographs were taken at least six months after surgery.  According to the study results, the three independent observers rated the patients who underwent a deep-plane face-lift as having significantly better results than those who had the less extensive surgery.

This study supports our contention that the added dissection that is part of the deep plane and biplane facelift techniques makes the added time and effort well worthwhile for the patient.  While the techniques of deep plane and biplane surgery are more complex, in actuality, experience combined with newer surgical technique, allows us to actually accomplish these procedures without a significant increase in recovery time.

Reshaping Buttocks

Fuller buttocks are certainly in vogue.  We are receiving more and more requests for this type of enhancement.  Currently there are two methods of buttock enhancement available.  The first involves the use of silicone implants.  Both gel filled and solid silicone implants have been used.  This technique is seeing increased popularity especially in South America.  Experience in the United States has been slower, probably related to the fact that only solid silicone implants are available in this country.  While several surgeons have demonstrated good results, there is still a rather high rate of complications with the possibility of infection the most serious concern.  Additionally, the recovery period with implants can be prolonged.

Reshaping Buttocks

It is likely that with further experience, this may become a better choice, but for now, we are not offering buttock implants at our Center.

The other option is re-injection of a patient’s own fat into the buttock.  Since the buttock is largely fat, this makes good sense.  The question, of course, is how much of the re-injected fat survives.  This is a concern with any type of fat re-injection.  However, so far, our experience has been quite favorable.  While there is certainly variation in the degree of absorption of fat from patient to patient, we feel that this is a worthwhile procedure, especially in individuals who are already considering liposuction.

A New Home on the Range

Country Retreat

Recently, the Tobins obtained some property in the country.  It is really a beautiful site and came with a recently built home as well as a horse and a donkey.  Of course, like any new acquisition, there was work to be done.  One of the areas of concern was the corral which was badly in need of painting.

A couple of weeks ago, we decided to close the office for a Country Retreatday and have a “voluntary retreat” in the country.  The entire staff, turned out, including our Doberman – Jeta, and we made short order of the job.  Now, when you enter the property, you see a beautiful freshly painted corral.  Although it was hard work, the staff pitched in with enthusiasm confirming the fact that, as we already knew, they are simply the best!

Country Retreat

Sunscreen in winter? 

UV rays can penetrate through clouds and glass.  They cause skin aging and cancer.  They are just as powerful on a dull cloudy day as they are on a bright summer day.  UV rays effect even the deeper layers of the skin, causing loss of collagen and elasticity resulting in sagging and wrinkling

You don’t have to spend an afternoon on the beach to get UV exposure.  Have you ever noticed that someone who spends a lot of time driving has more hyperpigmentation and wrinkles to the left side of their face?  That is most likely because they are receiving more UVA rays from the driver’s side window.

Long story short, sunscreens provide protection from the sun’s harmful rays as well as providing a barrier from pollution and wind.

At the Facial Plastic & Cosmetic Surgical Center, we not only help to reverse the signs of aging but take a proactive approach by carrying an array of medical grade skin care products.  Please call for more information.

That’s it for now.  Thanks for reading and keep letting us know what you would like to see in these newsletters.


Howard A. Tobin, M.D., F. A. C. S.

For general information: askdena@newlook.org or n41gt@newlook.org