BRIDEface/Everything you ever wanted to ask a plastic surgeon

One of our lead makeup artists here at BRIDEface, Penny Curtis, also works at Cincinnati Facial Plastic Surgery for Dr Alex Donath. I recently had the enviable opportunity to pick his brain and ask many of the questions my clients and I frequently discuss in our consultations. I love his honesty and straightforward approach!

Q: I see a fair number of sun-worshipping brides with hyperpigmentation and sunspots. What can she do to minimize this, and typically how many treatments will she need?

A: We see quite a few sun worshipers as well! Fortunately there are several types of treatment that can be used to reduce sun spots. The most efficient way to reduce them is with either a peel, such as a TCA peel, or with our state-of-the-art Fraxel Dual laser. The Fraxel Dual laser can have as little as 2 days’ downtime, while the TCA peel can result in a few days to a week of downtime for sun spots. Also, if the bride only has a few spots, the TCA can be used for just spot peels, and this can mean essentially zero downtime as long as the areas are small! The Fraxel Dual has the additional advantage of improving fine lines, for brides with slightly more sun damage. Another treatment many brides opt for is IPL, or a ‘photofacial.’ As opposed to the other methods above, IPL typically requires 2-3 treatments to get the same results as a single round of the others, but aside from darkening of the sun spots for several days before they flake off, there is really no downtime. One caveat about IPL: you must avoid significant sun exposure for a 1-2 weeks before and 2-3 weeks afterward, to prevent burning or post-treatment darkening of the skin, and this means it isn’t the best treatment for summertime. Lastly, if the bride has several months before the wedding and is looking for a low cost, albeit prolonged alternative, she could use hydroquinone cream–this lightening or “bleaching” cream can lighten the spots but requires patience. So, with multiple treatments available, we are able to find one that’s just right for every bride!

Q. What are you thoughts about younger women (under 35) using Botox as a preventative measure? I seem to be hearing this more and more.

A: Great question, and one we are frequently asked in the office. I typically tell patients that the best bang for their buck is to wait until they see fine lines at rest, in the areas of movement we typically treat with Botox and Dysport, such as between the brows, the forehead, and around the eyes. Age is less of a factor than sun damage, as I see quite a few women in their late 20s and early 30s who have more fine lines than some women in their early 40s who have avoided the sun more or have worn good sunscreen. On the other end of the spectrum, it’s best not to wait too long to begin treatment with Botox or Dysport once you begin seeing fine lines, as they will only deepen with time and then require dermal fillers such as Restylane or Juvederm in addition to Botox or Dysport, to give similar results.

Q. What are some of the best strategies for acne scarring; pitting, dark spots?

A: I have found that the best treatment for acne scarring is a combination of laser resurfacing with our state-of-the-art Total FX laser (fractional CO2 laser), as well as fat grafting beneath the scars just after using a special instrument to break up the attachments of the scar to the deeper tissues (which causes the ‘pitting’ look). Either of these techniques can be done by themselves of course, with reasonably good results, but if there is availability for approximately a week of downtime, the combination will usually give the best results. For just one or two scars, however, we might simply recommend excising them and suturing the edges closed, or even filling the depressions with a dermal filler like Restylane or Juvederm; filling is best for those who have very limited downtime available and/or are getting close to their big day (1-2 weeks).

Q. What are some procedures Mothers of the Bride might have to look fresher and brighter for the wedding?

A: We see a large number of Mothers of the Bride, and it’s always very gratifying to help with this stressful time for them. The number one area I’m asked to refresh is around the eyes, where we perform upper and lower eyelid lifts (blepharoplasty) to greatly improve the tired or aged appearance. I do a large amount of volume restoration in my practice, having been trained by leaders in the field, and so I strongly feel that the most natural way to rejuvenate the eyes is to combine blepharoplasty with fat transfer (or fillers) around the eyes. We do this as part of our VolumeLiftSM,
which prevents the hollowed-out appearance that we see all too often in women (and men) who have had too much skin and volume taken away. Some mothers really only want volume around the eyes and in the cheeks, to help reduce ‘dark circles’ and give more flattering cheekbones, and then we will perform our VolumeLiftSM as a single procedure. With your body’s own fat as the filler or volume restorer, the real advantage is that it is long lasting–compared to synthetic fillers like Restylane and Juvederm which last 9 months to a year, you should get many years of compliments from a well performed fat transfer. In fact, I tell patients that fat is at least a 5-10 times better value than synthetic fillers because of the difference in longevity.

A close second to the eyes in terms of requests for refreshing is the jawline and neck area. Mothers in their 50s and up can usually benefit from either a minilift or a facelift, and the best result really just depends on the degree of aging and sun damage. For as little as a few days of downtime, we can perform a minilift on someone with little excess skin and get a beautiful, lasting result, and for those with a heavier neck and jawline, a more specialized lift is usually going to get the most “Oohs and Ahhs.” But the best thing is that, if done well, people won’t know any surgery was done at all–we routinely have mothers come back after the wedding to tell us how great everyone thought they looked but that all others could guess was that the hair style was changed! It’s truly one of the happiest parts of my job.

As far as nonsurgical treatments, in addition to the treatments mentioned above for sun spots, the Total FX laser is a wonderful treatment for refreshing the skin, removing fine lines and wrinkles more quickly and with longer term results than Botox and fillers. But for those with only a couple of weeks to go before the wedding, Botox or Dysport and fillers like Restylane and Juvederm are wonderful for improving lines, folds and sunken cheeks, and aside from a small chance of bruising and a little swelling, there really is no social downtime.

Q. What can be done for a client who has inherited very dark circles, or has prominent “bags” under her eyes?

A: One of the most surprising things for our patients is the fact that “dark circles” are mostly caused by volume loss under the eyes, not skin pigment! The way to demonstrate this on someone, and something I frequently do in the office, is to shine a light (I use a flashlight) from overhead and look for the shadow (“dark circle”) beneath the eye, in the area called the “tear trough.” If this goes away when you then move the flashlight down in front of them to shine directly at the “dark circle” area, they are a candidate for filling that area. On the other hand, any pigment that you see when the light is shining directly into the area is unlikely to improve with filling, but as I mentioned, this is really the exception rather than the rule.

This volume loss in the “dark circle” area occurs in most people before they actually need a lower eyelift to reduce puffiness, and we can actually treat this area using your body’s own fat, for a long lasting result, or with a synthetic filler like Restylane. I have treated people as young as 27 with this technique, with very high levels of patient satisfaction. For those with a little more puffiness, typically not seen until at least the mid to late forties, our lower eyelift can greatly reduce the tired appearance that this creates, with minimal discomfort and downtime.

Q. Are there any “new” products or procedures that you can share with us?

A: Two of the biggest advances in my practice have been the use of a bruise-busting laser after procedures and the use of fillers that are premixed with numbing medicine. The laser that we use is fantastic for speeding up the clearing of bruising after both surgical and nonsurgical procedures, working in as little as 24 hours to change a dark bruise into a light orange one that is much more easily concealed with makeup. We offer this as part of all of our procedures, and do not charge extra for it. Our patients are much happier when they can shave a few days or more off of their social downtime or time off from work. We combine this laser treatment with several other methods as part of our RapidRecoverySM Technique, which has truly transformed our patients’ post-treatment recovery period.

The other new technique our patients love is the premixed numbing medicine in our fillers. Previously we would have to perform uncomfortable numbing injections before using Restylane, Juvederm, and Radiesse, somewhat like at the dentist’s office, but now we simply apply a special numbing cream (compounded just for us by a pharmacy on the East coast) for a few minutes, then go straight to filling with the lidocaine-mixed fillers, which numb as they go in. I actually was skeptical that this could be more comfortable than the strength of the numbing injections themselves, but my patients have uniformly loved the change–they are more comfortable and it takes less time to do the treatment because there are only half as many injections. And when my patients are happy, I’m happy.
Thanks so much for taking the time to ask these questions and I’d be happy to answer any follow-up questions your readers might have!

Dr. Donath is a double-board certified Facial Plastic Surgeon whose practice is exclusively dedicated to the face and neck areas. His office is located in Kenwood, one block west of Kenwood Towne Centre, at 7763 Montgomery Road. For a complimentary consultation, please call 891-LIFT (5438), or click: Be sure to mention this blog posting for 20% off your first in-office procedure.

August 18, 2011

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