Lip Lift - Corners of Mouth Lift Surgery for Drooping Corners of Mouth

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The relative positions and shape of the lips and corners of the mouth signify ones age or youthfulness and emotional status (happy, sad, angry). As one ages the upper lip thins, sags and wrinkles. Skin folds or marionette lines appear extending downward from the corners of the mouth and those corners slant downward. The earliest approaches to this area were the surgical facelift and lip lift surgery that removed or repositioned tissue around the mouth specifically removing skin in the area where the lip joins the lip skin (vermilion advancement) or removing skin just beneath the bottom of the nose. The results of doing so however were variable and the scars can be disfiguring. Later came chemical peels and lasers to remove aging wrinkles of the lips. In the 1980s doctors began injecting botox into the muscle that pulls the corner of the mouth downward (the yellow circle in the video below). This gave subtle but temporary results as did injectable fillers in the corners of the mouth. All of the direct surgery to the corners of the mouth that I have seen in the US have had disastrous results with bad scars and/or bizarre appearances with movement.

 Now, from the country that has the most per capita plastic surgery, South Korea, comes the corners of mouth lift. They call it "Smile Lipt" surgery.
In the video it is apparent that when the surgery gives a subtle result it does look good but when done more aggressively makes the patient look like the Joker character from Batman or the main character from Vendetta. Overall the results are better than have been the norm in the US because they appear to focus on the muscles in the corner of the mouth instead of the skin and fat tissue at the corner of the mouth. These skin and fat removal procedures include the “Valentine anguloplasty” after the heart shape of the removed skin at the lip’s edge. That is not to say that muscle surgery alone is better because removal of muscle in this area can create indents.


Patterns of skin removal for lifting drooping corners of the mouth in the West including the valentine anguloplasty and the lentiform excisions. The far right excision pattern includes removal of the marionette line itself and should be reserved for very light skinned patients that have deep marionette lines.

This newly popular surgery has been receiving increasing news coverage.


Face and Neck Lift 1
Face and Neck Lift 2
Aaron Stone MD - Plastic Surgeon Los Angeles
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Xanthelasma, Xanthomas, Eyelid Cholesterol Deposits

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Xanthomas are deposits of fat filled foam or xanthoma cells in the superficial dermal layer of the skin often surrounded by scarring and inflammation. The condition of having them is called xanthelasma. About half of the patients with xanthelasma have a metabolic disorder with increased fat in the blood (Hyperlipoproteinemia type IIa - high blood cholesterol and LDL levels). The fat is transported in a protein capsule so the complex is called a lipoprotein. The treatment for this type of hyperlipoproteinemia is bile acid sequestrants, statins and niacin.

The treatment of xanthomas has been surgical removal of the material with or without overlying skin, laser treatments and chemical peels. The treatment decision tree depends on the size and number of xanthomas and whether they are hard or soft. Hard ones can be uncapped to remove the xanthoma and then the cap of skin is sutured back down. Smaller xanthomas closer to the lower eyelid lashes or upper eyelid creases can be removed with the skin at blepharoplasty. Larger xanthomas needed to be removed in a staged piecemeal fashion. With a 2 or more month interval between surgical excisions.

All xanthelasma patients should have their blood cholesterol and LDL levels checked and treated as needed to prevent recurrence of the xanthomas.

Aaron Stone MD - Plastic Surgeon Los Angeles
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Change the Lines on Your Palms and Change Your Future

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What came first the chicken or the egg and does life's trials and tribulations make the lines or your palms or do the lines predestine your fate? Now in Japan you can change your future by lengthening the life line on your palm or adding money-luck or marriage lines to your palm. Men usually wish to change their business related success lines, such as the fate line（運命線), the money-luck line (金運線) to make profits, and the financial line (財務線) to save what money you make. These three lines, when they come together just right, create what is called the emperor’s line. Women usually request marriage or romance lines on their palms.

An example of the emperor's line.
The procedure takes about 15 minutes and costs about $1000. The surgery is performed with an electric scalpel because lasers and scalpels make inferior lines. Between January 2011 and May 2013, 37 palm plastic surgeries were performed at the Shonan Beauty Clinic in Tokyo, Japan. The clinic briefly advertised the service, but couldn’t keep up with the demand so now it relies solely on word of mouth. Do palm readers ignore man made fate lines?

Aaron Stone MD - Plastic Surgeon Los Angeles
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Teenage Rhinoplasty - Teen Rhinoplasty

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Cosmetic surgery on teens or children is becoming more popular (in 2009 203,000 teens and in 2012 236,000 teens between the ages of 13 and 19 altered their physical appearance) but can be controversial. While adults have appearance altering surgery to stand out or look younger, teens do so to fit in and be more like their average peer.  Not all teens with psychosocial anxiety about a body part have psychological issues, and they should not be dismissed by adults as being too immature to understand their own emotions or automatically be assumed to have primarily psychological problems.

In Australia such surgery is legally restricted. In 2009, breast and nose surgery, liposuction, and Botox on children were banned in Queensland, Australia. Doctors who perform such procedures without medical reason can face up to 2 years in prison. In New South Wales, Australia patients under 18 years of age who are considering cosmetic surgery have undergo a 3-month cooling-off period, followed by consultation with an internist and clinical psychologist before they can have surgery. There are no such regulations in the United States.

Rhinoplasty, nose reshaping surgery, is the most common cosmetic surgery performed on American teens. It is usually performed as same day surgery under general anesthesia. According to the 2010 American Society of Plastic Surgeons report, rhinoplasty made up 45% of all teen plastic surgery procedures. This has been consistent with 44% of teen cosmetic surgeries being rhinoplasty in 2012. Over 30,000 teens a year get nose jobs in the US. The reasons for having the surgery and the specifics of surgery can be much the same as they are for adults:

• Removing a hump on the nose
• Straightening the bridge
• Reshaping the nose's tip
• Increasing or decreasing the size of the nostrils
• Correcting the nose after an injury
• Opening breathing passages
• Making the nose bigger or smaller

But there are additional issues the surgeon has to take into account including:

• is the teenager mature enough and physically old enough to undergo surgery, follow instructions after surgery and wait for complete recovery before judging the result
• are the teenagers motivations for surgery appropriate and are their expectations reasonable
• are the parents supportive and on board

Daily Sunscreen Use Slows The Aging Process

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It has been common knowledge for a number of years that regular sunscreen application prevents skin cancer and the FDA changed the allowed labeling on the counters so they can state this. A study published earlier this month in Annals of Internal Medicine now shows it also slows the aging process.

Researchers at the Queensland Institute of Medical in Australia looked at a group of 900 young and middle-aged, mostly fair skinned men and women under age 55 (to factor out the contribution of genetic aging) that were randomly divided into 2 groups. The first group applied SPF15+ sunscreen to their faces, necks, hands and arms daily. The second group used sunscreen either rarely, or not at all, discretionary sunscreen group. Silicone impressions were taken from the backs of all participants’ hands, at the beginning and then again at the end of the study, 4 1/2 years after it began. Roughly half of the participants worked primarily outdoors, while about four in 10 were regular smokers. The daily sunscreen group showed no detectable increase in skin aging during the course of the study, according to microtopography measures. The visual appearance of aging skin wrinkles from beginning to the end of the study was 24% less in the daily sunscreen group than in the discretionary sunscreen group.

Each group was divided in half again to receive a 30mg beta-carotene supplement or a placebo on a daily basis. The supplement did not affect skin aging in this study. The take home message is that daily sunscreen application can prevent skin cancer, keep you younger looking longer and you are never too young to start applying it. Furthermore, daily sunscreen application does more for you than taking some daily supplements that are believed to be good for your skin.

Suntanning, Tanning, Sunscreens
The Dangers of Sun Exposure
Dr. Aaron Stone - Plastic Surgeon Los Angeles
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Brachioplasty - Upper Arm Lift

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Upper arm fat and skin removal to reduce hanging upper arm skin in obese women was first described in 1930. Cosmetic brachioplasty or upper arm lifts were first described by Argentinian surgeons in 1954 and subsequently became a well established procedure. However, due to the scarring, fluid collections under the skin, nerve damage and wound problems associated with the surgery it was not very popular. According to the American Society of Plastic Surgeons statistics as recently as the year 2000 more than 300 women got upper arm lift procedures in the US. Last year, 2012, the number increased to more than 15,000. 98% of these patients were women, 42% had undergone previous weight loss surgery, 63% were aged 40 to 54 and 33% were over age 55. The total spent on brachioplasties in 2012 was $61 million. What accounts for this 5 fold increase in the number of procedures over 12 years? Some of this is due to the increase in weight loss surgery. Over 200,000 Americans a year undergo some kind of weight-loss surgery, such as gastric bypass.

Malar Bags

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There are 3 separate entities lower eyelid bags, festoons and malar bags.

Lower eyelid bags refers to protruding fat or redundant muscle in the lower eyelid itself above the level of the bone rim under the eye.
Lower Eyelid Bags
Festoons refers to redundant folds of skin with or without muscle in the lower eyelid.

Festoons

Breast Reconstruction with Aeroform Tissue Expander

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It seems like all the latest breast reconstruction techniques like Neopec come from Australia. Now the Australians have come up with a rapid way to expand chest skin after breast cancer mastectomy to allow placement of a breast implant and thereby reconstruct the breast (see my blog Reconstruction After Breast Cancer Surgery). Usually a saline balloon or expander is surgically placed and the surgeon then progressively fills it with salt water that is injected on a weekly basis to stretch the skin. This can take up to 6 months. Now they have devised an expander that contains a cylinder of compressed carbon dioxide gas. The patient controls the release of the gas into the expander with a handheld remote control and slowly expands on a daily basis.

Preliminary data reveal that using the Aeroform Tissue Expander the expansion can be completed in 17 days instead of 6 months. Enrollment in FDA clinical trials have begun in the US and the manufacturer is predicting a 2014 FDA clearance for general use.


Aaron Stone MD - Plastic Surgeon Los Angeles
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Weight Loss After Tummy Tuck - Abdominoplasty

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Obesity is defined as a body mass index (BMI) of 30kg/m2 or greater. By this definition a third of men and a third of women in the US are obese. The prevalence of obesity in this country has doubled since 1980. This is a a major health concern because obestiy increases the risk of many diseases and health conditions, including but not limited to sleep apnea, diabetes mellitus, hypertension, osteoarthritis, dyslipidemia, certain types of cancers, gallbladder disease, stroke, and coronary heart disease. The associated health costs are quite high and have been estimated to be in the range of $75 billion per year. With more severity obesity of body mass indexes of 40kg/m2 or more the condition is considered morbid and weight loss surgery is usually recommended if dieting fails. Weight loss surgery has been proven to reduce the incidence and severity of medical conditions associated with morbid obesity.  The American National Institute of Health guidelines state that bariatric weight loss surgery should be offered to patients with a BMI of 35–40 kg/m² who have obesity related conditions such as diabetes mellitus or obstructive sleep apnea, or in those with a BMI of 40 kg/m² or greater regardless of weight related co-morbidity conditions.


A medical journal article just published revealed on retrospective review that patients maintained weight losses greater than the amount of tissue removed at abdominoplasty/tummy tuck more than a year after the surgery. This amount of maintained weight loss was greater in people who were heavier prior to surgery (24.5kg/m2 or more) and was proportional to the amount of tissue removed at surgery for 4.5 or more pounds of tissue removal. When asked why the weight was lost and the loss maintained these patients responded that they felt full after and between meals so they ate less. In my experience patients lose additional weight because they like and want to maintain their results. That involves lifestyle changes including exercise and eating a healthier diet. Abdominoplasty however should not be performed primarily to lose weight because the complication rates are quite high for patients with BMI over 40kg/m2 and the results are less than optimal with BMI of 35 to 40kg/m2. Nearly every patient I have ever seen who underwent abdominoplasty when morbidly obese (by surgeons other than myself) had complications including disruption of suture lines requiring months to heal. The best results and fewest complications are seen in patients who have stable weights, are not morbidly obese and have good quality skin without stretchmarks.

A Swiss study published in Oct 2012 showed that patients who have abdominoplasty to remove excess skin resulting from weight loss surgery are more likely to keep the weight off after the procedures. These patients regain about a pound a year vs. a 4 pound annual gain for patients who have weight loss surgery without body contouring surgery to remove excess skin. The contouring surgery produces a second wave of elation that helps patients stay on track to lose more weight. The timing is usually 12 to 18 months after the weight loss surgery as the complication rate at that time becomes the same as for those who have never had weight loss surgery.

There is clearly a benefit to abdominoplasty or tummy tuck that goes beyond the initial look achieved by removing excess skin and tightening abdominal muscles. The procedure has a long lasting effect which is different from a facelift whose affect diminishes with time due to the unstoppable aging process.

The obvious weight loss in this patient after abdominoplasty surgery should be maintained.

Abdominoplasty
 Aaron Stone MD - Plastic Surgeon Los Angeles
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Brazilian Butt Lift - Buttock Augmentation Implants and Injections

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Fertility dolls with large hips and buttocks have been found dating back to the pre-dynastic Egyptians of 4000 B.C.

Doll statues and carvings were often placed near a couples bed or on the family altar with suitable offerings that would ask the fertility goddess to work in their favour.

With colonization of Africa in the 1800s women's clothing styles in Europe aimed to accentuate a thin waist with large hips and buttocks. At first this was accomplished by layering clothes on top of each other (petticoats). These could become quite heavy so caged or hooped underskirt frames (crinolines) followed by bustles and then corsets were introduced.