Dark Circles Under the Eyes

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Patients with dark circles under their eyes complain that they look tired. The condition is called periorbital hyperpigmentation. Environmental factors that make the condition worse include sunlight exposure, hayfever, lack of sleep, stress, alcohol overuse and smoking.
The condition is classified by appearance as:

• pigmented (brown color)-congenitally darker skin, nevus of Oti or Hori, dermal melanocytosis, side effect of eyedrops, inflammatory induced pigment increase associated with atopic or allergic dermatitis or eyelid rubbing associated with allergies
  
  increased pigmentation from inflammation
• vascular (blue, pink, purple color)-increased blood vessel density
  
  blue color and structural (tear trough) both treated by filler injection
• thin skin making the underlying muscle color visible
  
  thin lower eyelid skin shows muscle under it
• structural (shadows formed by the surface contours such as eyelid bags, eyelid swelling or tear trough visibility associated with aging)
  
  shadows from eyelid bags
• mixture of 2 to 4 of the above classes

structural shadow from malar bags and over pigmented brown lower eyelid skin that is more visible after bags are removed

11 Reasons for Not Having Plastic Surgery

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The primary reason a person may decide against having plastic or cosmetic surgery is not always the price of the procedure and in fact price may have nothing to do with their decision.

1. Cost
In fact the cost of plastic surgery not covered by health insurance is now cheaper corrected for inflation than it has ever been. The problem is that wages of working Americans has not kept up with inflation since the 1970s for a variety of reasons. Additionally, credit card and non-credit card financing options to finance plastic surgery are greater at this time than they have ever been. Click to see available financing options.
2. Lack of connection with the surgeon.
This happens when the surgeon rushes through the consult, gives too many options by “thinking out loud,” doesn’t listen, uses too many technical terms, or doesn’t demonstrate an understanding of your needs. He/she may very well have the best hands in town, but you can’t assess that.

You want a surgeon who doesn't address you from the other side of the room, seems human, is empathetic, can communicate and is interested in you as a person (family, occupation, recreation, aspirations). If you cannot make a connection with your surgeon problems can arise after surgery if you and/or your surgeon are reluctant to speak or meet. You both need to feel comfortable doing so after surgery in order to avert complications and have a smooth recovery. If you cannot do this it is in your best interest to find another surgeon for your surgery or forego surgery altogether.

Improving Calf Definition by Calf Implant Surgery or Fat Grafting

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In a woman the maximal circumference of an aesthetically pleasing leg should be less than one-fifth of her body height and the ideal aesthetic contour of the leg has been defined as relatively flat in the medial upper third of the calf, with a gradual tapering to the ankle. Calf asymmetry is defined as a difference in the maximal circumference greater than 2.0 cm between both calves when standing on tip toes. Asymmetry can be due to surgery, sports activities, nerve injury or obesity. Bodybuilders want larger more well defined calf muscles and most women want slender longer looking legs, especially if they are shorter in height.

Tummy Tuck - Abdominoplasty Complications

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Healthcare including cosmetic surgery today is increasingly data driven. The computer and internet age has allowed the pooling of information or data from multiple sources. These include insurance billings, hospital admissions, medicare billings, medical specialty society online trackers such as the American Society of Plastic Surgeons TOPS, etc. This data is periodically pooled and analyzed for trends over time, incidence of complications, hospital re-admissions, surgeon report cards, malpractice claims won or lost and so on.

Analysis of claims against insurance that covers for major complications of cosmetic surgery from 2008 to 2013 showed that major complications occurred in 4 percent of tummy tucks, compared with 1.4 percent of other types of cosmetic surgery. The most common major complications that were covered were hematomas (collection of blood outside blood vessels that usually present as tense bulges in the skin and deeper tissues such as a wrestler's cauliflower ear), infections, blood clots and lung-related problems. This type of insurance does not cover minor complications and is separate from health insurance, which typically does not cover complications due to non-covered cosmetic surgery. The risk of major complications was 50 percent higher when patients had other cosmetic procedures at the same time as a tummy tuck.

Male, obese and patients aged 55 or older were also at increased risk. The risk was lower if a tummy tuck was performed in an office-based surgical suite rather than in a hospital or surgical center, although that may be due to sicker less healthy patients being more likely to have this surgery in a hospital setting.

Tummy tuck is the sixth most common cosmetic procedure performed in the United States. More than 117,000 were performed in the US in 2014.

Dr. Aaron Stone - Plastic Surgeon Los Angeles
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The Difference Between Abdominoplasty and Panniculectomy
Abdominoplasty Muscle Tightening
 
       

Beauty is in the eye of the beholder - Where You Live

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With modern globalization the most popular films and products are pretty much the same all over the world. Individuals now travel far from home for plastic surgery. That is called medical tourism. At first glance it seems we have reached a global agreement on what beauty consists of. On closer examination we find that is not true.

A survey of 214 Plastic Surgeons from 69 different countries, published in June 2015, revealed that  these surgeons had significantly different preferences for upper breast fullness, areola size in the natural breast, and areola size in the augmented breast based on the country they lived in and their age and independent of their ethnic background. The survey was performed by showing the surgeons computer images that they could make direct adjustments to. Surgeons from India preferred the most full look, while surgeons from France preferred the least upper-breast fullness. Brazilian surgeons preferred the largest areola size, both in natural breasts and in breasts with implants, while German surgeons preferred the smallest areola size. Older surgeons preferred less upper breast fullness and larger areola size.

It turns out it's not just the surgeons. In another study onlinedoctor.superdrug.com commissioned Fractl to investigate perceptions of beauty around the world. Fractl contacted 18 designers (14 women and 4 men) in 18 different countries on 5 different continents and gave them a photo of a woman to Photoshop and retouch to modify haircolor, clothes, shape and form to make her more attractive to citizens of their respective countries.

Body Dysmorphic Disorder - BDD and Plastic Surgery

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Body dysmorphic disorder (BDD) is a syndrome characterized by a strong preoccupation with an imagined defect in a person’s appearance. In cases where the deficit is not imagined and a slight defect is present, the person’s concern is noticeably excessive. Excessive preoccupation with the imagined or minor flaw involves intrusive thoughts about the body part of concern. In addition to daily intrusive thinking, individuals suffering from BDD engage in a variety of compulsive behaviors aimed at alleviating the anxiety caused by the thoughts. Patients with BDD generally engage in thoughts and behaviors related to their perceived deficit for 1 hour or more per day, and that amount has been reported as high as 3 hours per day among adolescents. Symptoms often start in adolescence or early adulthood brought on by remarks made by peers or family members i.e. early bullying and family attachments are significant factors. The average age of onset is 16 to17 years, although it may occur in older adults overly concerned with their aging appearance. Individuals with BDD frequently check their appearance in mirrors to confirm or attempt to conceal the perceived deformity. They may engage in long rituals of grooming, such as repeatedly combing or cutting their hair to make it just so, applying make-up, or picking at their skin. They typically will spend a great amount of time trying to cover up or camouflage the perceived defect employing elaborate clothing rituals. They will seek excessive reassurance from friends, family members, and/or co-workers to elicit placation that the perceived “defect” does in fact exist, or to assure that the flaw is sufficiently concealed. At the extreme they feel anxious around others, avoid social situations, become housebound, only leaving their homes at night to avoid the scrutiny of others. Some drop out of school, avoid job interviews, or do not work in order to avoid public exposure . Patients with BDD have attempted to engage in self-surgery with knives or razor blades to pick at or remove the blemish or with staples to tighten “loose skin". Clearly they see something that others do not see real, imagined or exaggerated.

Plastic Surgery Rehabilitates Criminals

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Between 1953 and the early 1960's Dr. Edward Lewison performed free plastic surgery on inmates of the  Okalla prison in Burnaby, BC Canada. It was renamed Lower Mainland Regional Correctional Centre in 1970. The study involved 450 prisoners and was undertaken with the cooperation of Dr. Guy Richmond, the prison doctor, and Hugh Christie, the warden. Dr. Lewison and a sociologist chose patients on the basis of a  connection between a "bodily defect" and the inmate's behaviour. The idea was that reconstructive surgery that removed deformities would provide such a boost to the prisoners' self-esteem and confidence that they would be motivated to pursue law-abiding lives upon their release from prison. Most of the operations were for congenitally deformed or fractured noses. The rest were for reconstruction of deformed ears, receding chins and removal of facial scars. Almost immediately after surgery, the inmates' behavior improved. "Formerly hostile and incorrigible individuals became polite and gracious in their manner … Among them a keen ambition developed to learn a trade and qualify for transfer to the vocational correctional centre." The studies results were published in the Canadian Medical Association Journal in 1965 citing a 42 per cent recidivism rate for the plastic surgery patients vs. 75 per cent for the general inmate population. Lower Mainland Regional Correctional Centre was closed in 1991. The site is now a park.

Similar studies by different doctors carried out on inmates at Kingston Penitentiary in Kingston, Ont. in the 1960s, in Illinois starting in the 1930s and in Texas in the 1980s had similar results. The theory is still in use today by non-profit organizations in the U.S. which help reformed former gang members to remove facial and body tattoos to help get them out of gangs into jobs. I have been a I volunteer tattoo removal doctor in Los Angeles since the mid-1990s to help get people out of gangs. The patients pay for their treatments by performing volunteer community services and some have gone on to well paying executive or managerial positions. I don't think many people today would support free cosmetic surgery for inmates. In this crazy world some would commit crimes just so they could get the free surgery.

The best way to rehabilitate Two Face back to Harvey Dent would have been Plastic Surgery.

The BBC is currently looking for anyone involved to be in a documentary about the study.

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Lipedema, Lymphedema and Fat Legs

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The 4 main causes for enlarging leg girth or circumference are lipedema (accumulation of fat in the legs), lymphedema (obstruction of lymph flow in the leg), obesity and impaired venous blood circulation (venous stasis). Lymphedema is observed as swelling that usually involves the feet and shows up as impaired flow on lymphangiograms or lymphoscintigraphy . With time the swelling becomes hard and uncompressible and the skin breaks down and becomes infected. Impaired venous circulation is observed as swelling with brown darkening of the skin color, skin break down and inflammation. The blocked veins are visualized by doppler sonography studies using sound waves transmitted through the skin. This blog will focus on lipedema also known as lipoedema in Europe.

The areas of fat concentration tend to be abdominal in aging men, hips and thighs in aging women and buttocks in certain races as those individuals age. The age at which this occurs varies from person to person. Changes in metabolism and fat deposition can also occur more quickly at puberty, after childbirth, gynecologic surgery, with the onset of thyroid disease or menopause. It is easier to lose fat from areas in which your body tends to not concentrate fat. The fat doesn't go to one place and then another as in first, second etc.. It goes all over but more of it is stored in specific areas and it is mobilized from other areas more easily. In some cases the concentration can be dramatic such as very large buttocks with skinny arms and legs, steatopygia, which is more common in certain African tribes.

Ear Pinning - Otoplasty

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Prominent ears can be socially traumatic for children in their early school years.
It is sad that we have non-surgical ways to treat this in infants using the EarWell so they never have to go through this type of bullying yet many parents do not have their babies treated.

The surgical treatment in children or adults involves making an incision behind the ear and placing shaping sutures in the cartilage to create the missing fold that makes the ear stick out. Over the course of a month or two the cartilage reshapes itself to the shape held by the sutures so they are no longer necessary, though we do not usually go back to take them out. Depending on surgeon preference sutures are placed between the cartilage and the side of the head, skin may be removed from behind the ear and/or some ear cartilage is removed to obtain the best longest lasting ear shape.

Before  and After Ear Pinning Otoplasty

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New Break Through Treatment for Keloids

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Keloids are the overgrowth of scar tissue in response to skin injury or irritation. They frequently persist at the site of injury, often recur after surgical removal and overgrow the boundaries of the original wound. They can itch, be painful, restrict movement, interfere with sleep, block a vital function like hearing and cause cosmetic disfigurement with significant psychological effects. The usual treatments of surgery, radiation, cryotherapy and injections can be costly and time consuming. The Division of Bioengineering, School of Chemical and Biomedical Engineering, Nanyang Technological University, in Singapore has just developed a new treatment modality that could make it easier and cheaper to treat this problem. They combined a microneedle transdermal delivery system with medications like 5-fluorouracil that have been used to treat keloids. The system consists of a flexible patch, containing microneedles 0.7 to 0.9mm in length and 1/3 mm in diameter, that is applied to the skin. The microneedles are loaded with the drug, 5-fluoro-uracil (5-FU) in a solid form. The patches are flexible so they can adjust to surface contour. The microneedles penetrate the superficial skin and swell on exposure to tissue moisture opening pores along their surface that release the drug. The release is slow and sustained rather than a sudden release of the drug. The 5-FU concentration in each patch can be varied as needed. Their price points on the product are in the range of 20 cents per patch and their goal is for patients to treat themselves replacing the patch every 12 hours without ever seeing a doctor.

Micro-needle transdermal delivery system patch

So far they have only proven the patch can be applied to pig skin, the medication is delivered over time and the product stops keloid cell proliferation in petri dishes containing such cells.. Trials in human beings have not begin so we are no way near FDA approval. We do not even know what the optimal doseage for these patches should be in different patients.The 5-FU has the potential to leave you with an open wound where the keloid once was. Therefore, I cannot see the FDA allowing a chemotherapy agent like 5-FU to be used by patients without a doctor prescription or supervision.

Scars, Keloids and Hypertrophic scars
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