A friend had a facelift where the scars were hidden inside of her ears. Some time later I noticed that it looks like her ears are being turned inside out! The scars were hidden in the tragus and now they are sticking out of her ears!

Question from Henderson, NV: A friend had a facelift where the scars were hidden inside of her ears. Some time later I noticed that it looks like her ears are being turned inside out! The scars were hidden in the tragus and now they are sticking out of her ears! This was done by prominent and well-respected Las Vegas female plastic surgeon! Is it better then, to have the scar placement in front of the ears?

Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:  

​Every patient is different and so is the healing process. It is most unusual to hear of a hidden tragal incision creating a deformity. 
​
​Many well accomplished surgeons are placing the facelift incision along the edge of the tragus to hide the prior generations stigmata of a scar in front of the ear and skin color and skin texture contrast of the cheek and ear skin.
​
​When a incision is closed tightly or should there be a swelling concern during the healing phase, the scarring process under the skin in front of the tragus may pull the cartilage out and expose the scar.
​
​I would still recommend this incision for most facelift incisions unless there is another reason not to do it. 
​
​I hope this is helpful! All the best!

Is it ok to conduct open rhinoplasty under local anesthesia?

Question from "is it ok to conduct open rhinoplasty under local anesthesia?": I have had 4 consultations: 7yrs, 7yrs, 10yrs, and 26yrs (experience of each dr.)Two stated iv sedation, one stated general anesthesia. The 26yr doctor stated local. He stated too much risk with iv and general., I guess from experience? He would have me on ambiean, Valium etc.. 1.5 -2hr it will take. The 26yr doctor said i have a on a scale of 1-10 difficulty of doing , would be a 4. The other doctors said difficulty, and it would be an 8. Why would this doctor of 26yrs be so confident he can conduct rhinoplasty under local anesthesia?

Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore: 

Dear "is it ok to conduct open rhinoplasty under local anesthesia?"

Yes, but it may not be your safest option. Rhinoplasty surgery requires skill and finesse, particularly in an area of the body where you breathe. With rhinoplasty under local anesthesia, you will hear (music, conversation), feel (not pain necessarily but pushing, pulling, banging) and may not be properly monitored. Should there be bleeding or active secretions or changes in your heart or breathing vital signs, your surgeon will require the skills to multi-task beyond the talents of a nose surgeon.

Most of my rhinoplasty surgery is performed under General Endotracheal Anesthesia to protect the airway and have a select anesthesia provider provide the best experience and safety for your welfare.

Below is an opinion article from the American Society of Aesthetic Plastic Surgery discussing the virtues and concerns of different anesthetics.

I hope this is helpful. All the best!

Dean Kane, MD, FACS

Local Anesthesia and Plastic Surgery: Marketing or Reality?

December 9, 2014

Local Anesthesia and Plastic Surgery: Marketing or Reality?

• The following article by Heather J. Furnas MD is added to the www.DrDeanKane.com website because it is a timely and important opinion which I would like to make available to any patient interested in Dean Kane, MD, FACS’s services

An increasing number of patients ask to have their surgery done with local anesthesia “because it’s safer.” Guess what? That isn’t always the case.

Plastic surgery procedures tend to have clever names: Mommy Makeover, Insta-Boob, Cinderella Surgery... but the operative (no pun intended) word here is surgery. All of the above-referenced procedures are invasive; in the example of the Mommy Makeover, it can include several procedures to achieve the desired result. That means at some point, your body is cut open so the operation can be performed. The Mayo Clinic has weighed in on the use of general anesthesia, explaining it should be considered if your operation:

• Takes a long time

• Exposes you to a cold environment

• Affects your breathing, such as chest or upper abdominal surgery.

They also state that: “Most healthy people don't have any problems with general anesthesia. Although many people may have mild, temporary symptoms, general anesthesia itself is exceptionally safe, even for the sickest patients. In general, the risk of complications is more closely related to the type of procedure you're undergoing, and your general physical health, than to the anesthesia itself.”

So why aren’t patients asking for it? Two reasons come to mind. The first is the need for additional information about the procedure, including any risks or complications that could potentially arise.

This we can provide.

The second is more disturbing, because it seems to correlate with the increasing number of doctors who aren’t plastic surgeons, but who perform cosmetic surgeries learned at weekend courses taught by other non-plastic surgeons.

This we have to fix.

The main selling point for their practice is that they do plastic surgery “under local anesthesia.”

Love the Local Anesthesia–Too Bad It Was the Wrong Procedure!

The problem with choosing a specific procedure solely because it can be done under local anesthesia is that your surgeon may not be offering you the correct procedure or the safest path to your desired result. Why? Because that doctor may not know how to do it.

If a doctor can only do liposuction under local anesthesia, but you need a tummy tuck, he may tell you liposuction is your only safe option. We see many patients who are unhappy after a non-plastic surgeon left them with loose, lumpy skin. They lost time and money, and they still need a tummy tuck to address their specific concerns.

Mini Tummy Tuck and the Sad-Faced Belly Button

Similarly, many doctors perform “mini tummy tucks” under local anesthesia “because it’s safer,” even on patients who need full tummy tucks under general anesthesia. Those patients consult with us, wondering why their belly button is pulled down and their tummy still bulges. They received the local anesthesia they wanted, but they also received the wrong operation.

Drooping Breasts Don’t Lift Themselves

Patients wanting a breast lift often come to us after a non-plastic surgeon gave them breast implants. The patient had the “safe operation under local anesthesia” because the initial doctor didn’t know how to perform a breast lift. Patients come to us to find out if their breasts can be fixed.

Why Would a Doctor Use Only Local Anesthesia?

If a doctor only promotes local anesthesia, ask yourself these questions:

•Is the doctor a board-certified plastic surgeon who operates in an accredited operating room and has hospital privileges?

• Is he/she fully experienced in all aesthetic procedures of the face and body?

• Does he/she only offer local anesthesia because an anesthesiologist won’t come to an office without an accredited operating room?

• Is it better to have the wrong operation under local anesthesia than the correct one under general anesthesia?

Local anesthesia is cheaper and is generally safe, but it’s not infallible. Even without sedation, fatalities can result from toxic levels of local anesthesia, limiting how much can be safely done.

Do You Want the Best Procedure or the One Done under Local?

All board-certified plastic surgeons are trained to do procedures under general anesthesia as well as local anesthesia with and without sedation. As board-certified plastic surgeons, we won’t offer you the incorrect procedure under the guise of “safety” because we don’t know how to do the correct one.

Protect yourself, and ask questions.

Can Botox help for Bell's Palsy?

Question from Toronto, ON: Hello I have had Bell's palsy since I was young and was wondering if Botox can help with the problems, thank you.

 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:​

So sorry for your Bell's Palsy! I hope you resolve completely. 

Yes, Botox and other options may help but not necessarily in a way you might think. 
1. Using Botox on the active muscles of the weaker side might allow the weaker muscles to contract better unopposed.
2. Using Botox on the normal right side may achieve a more even and symmetrical appearance with that of the affected side.
3. You may also consider fillers to provide volume and lift on the affected side. 
4. Laser and chemical peel tightening may be helpful as well.

In all options, please consult with a well experienced Board Certified Plastic Surgeon, ENT or Neurologist with the art, skills and talent to use these techniques.

I wish you the best! 

I am seeking advice as to the success of an endotine device as opposed to regular sutures. Any thoughts?

Question from Long Island, NY: A doctor whom I have consulted uses: "the endotine midface device instead of non-absorbable sutures in mid-facelifts, lowering the risk of skin irregularities, dimpling and swelling and reducing procedure time. Once implanted, the device holds the lifted tissues in place as they complete the process of reattaching to the cheekbones. The device is then absorbed into the body until it is completely dissolved." What is your opinion?

 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:

​Thanks for this interesting question!  
​
​The Midface Lift is a cheek lift to rejuvenate the aging and sagging soft tissues of the upper cheek and unfold the trough of the nasolabial fold. It is also useful in rejuvenating the tear-trough and the separating cheek-eyelid junction.
​
A Midface Lift can be performed at 2 different tissue levels from a variety of incisions according to the surgeons skill and what tissues are desired to be advanced. 
​
​Eyelid incision: this is a common incision to perform a lower blepharoplasty (eyelid lift) and fill the hollow of the tear-trough and cheek-eyelid junction with the fat chambers of the upper cheek. When this flap of fatty tissues is extended, it will unfold the furrow of the nasolabial fold. I use absorbable sutures along the orbital rim periosteum to suspend these tissues and if required a non-absorbable suture to suspend the corner eyelid if there is concern of pulling or rounding of the eyelid. Endotine, a absorbable device placed through a temple incision can be used to hold these soft tissues in place similarly to sutures.
​
​Sub-periosteal incision: this approach allows elevation of the muscles as well as the fatty soft tissues of the cheek through a temple and/or intraoral incision. It is most commonly held in place with a Endotine device or barbed-thread.
​
​Any suspension device, whether it be sutures, Endotine or barbed thread must last long enough for the normal process of scar to hold the advanced tissues in place until healed. 
​
​It is best to compare this surgeons evaluation of what tissues to lift and what techniques he / she are comfortable performing and recommendations with one or more well experienced, Board Certified Plastic or Facial ENT Surgeons. 
​
​I hope this has helped. All the best. 

I am going for a Tummy Tuck next month. I work as a critical care nurse.

Question from Ontario, ON: Is it realistic for me to believe that I am to return to work two weeks post op?

Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:​
The simple answer is no. Every surgeons tummy tuck is not the same and there are numerous considerations:

1.    Absorbable sutures and skin adhesives are (on average) 50% dissolved at 2 weeks.

2.    ​The scar strength from collagen formation at the incision and under the skin flap is minimal at 2 weeks.

3.    ​Your age and nutrition.

4.    Are you a care-giver for other people in your home or else where?

5.    ​How tight (ie, how much skin will be removed) and how bent over will you be for the healing process.

6.    ​Will your fascial girdle be tightened?

7.    Is there a hernia or diastasis to repair?

8.    ​Will you be adding lipo-contouring?

9.    ​Are you prepared for a complication and how will this affect your timing and recovery?

10.  ​Will your work environment include lifting, bending, pushing, pulling? How about contamination from other personnel or patients?

11.  ​and other issues to consider.

Please review your concerns with your surgeon. Stressing yourself to recover will only prolong the recovery.
​
​All the best!

How soon can I have abdominoplasty after having gastric bypass. Stomach is really flabby.

Question from Alabama, AL: How soon can I have abdominoplasty after having gastric bypass. Stomach is really flabby.

 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:​

Congratulations on your journey to weight loss and "improved" health. Unfortunately, it leaves a lot of skin behind that does not tighten and must be removed. 
​
​It is generally recommended to wait 1 year to lose and stablize your weight prior to beginning the skin reduction process. You will also need to optimize your nutrition to reduce the risk of break-down complications. 

There are various options for tummy recontouring following massive weight loss. 
These options are dependent on your skin laxity and the areas of liposuction contouring you wish or need.

You can consider:

1.    a traditional tummy tuck where the ab muscles are tightened, the sides are liposuction contoured, the excess skin is removed, the mons lifted and a new belly button is created.

2.    a panniculectomy / lipo-sculpting where the large lower roll of tummy skin is removed and the upper tummy and sides and / or back are reduced with liposuction.

3.    a body lift used with patients who have super-skin excess and the tummy, sides and back skin are lifted with or without muscle tightening.

4.    liposuction of the circumferential trunk for body contouring.

Please consider a well experienced, Board Certified Plastic Surgeon to evaluate your needs and consider these options with you.
​
​All the best!

At age 45, I understand a facelift would be best, perhaps augmented with other treatments. What should be done?

Question from Virginia, VA: I am aged 46, and have gained and lost and gained again 25 pounds over the past ten years. I have tried to manage areas of my face with injectables, but ultimately where I once had a very defined bone structure, my lower face has become saggy and more jowly than I would like. In regards to my lower face, what would you recommend? Also, could this area be effectively managed with injectables for a couple of years before doing a more invasive procedure?

 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:​

​It would be helpful to see full face and neck photos but I will review and offer you options.  It will be best for you to review these with a in-person evaluation.

Various options for facelifting, minimally and non-invasive facial enhancements and skin texture improvements are available according to the skin laxity and areas of lift or tightening you wish or need. Both surgical and minimally invasive / non-surgical options are listed below.

Surgical lifts would be likened to pulling the bedspread and or top-sheet of your bed up to the head-board and removing the excess material.

Minimally invasive procedures such as fillers provide volume such as adjusting a pillow under the bedspread. Botox and Dysport act by pulling the top-sheet which drags the bedspread upwardly. If the bedspread (or skin) continues to fall to the foot of the bed despite fillers, Botox or Dysport you will need to consider a facelift.

Non-invasive options such as laser and light therapies, skin tightening products and technologies perform their tightening and smoothening of the skin similar to sending your bedspread to the dry cleaners. A more refreshed, even colored, glowing smoother and tighter spread covers the surface of the bed.

The most popular of thefillers,RestylaneandPerlane, a jelly-like clear skin filler is used to fill lines, wrinkles and folds. Juvederm and its longer lasting "cousin"Juvederm Ultra Plusare similar skin fillers, used to soften and fill the nasolabial ("parentheses") and marionette folds, the brow ("number 11") lines and fill and lift the cheeks and lateral brow or chin.Volumais the longest lasting, up to 2 year duration HA filler. Each one is used to expand or volumize the loss of tissue associated with expression, weathering or aging. All the fillers come with numbing anesthetic!.

Non-surgical facial contouring is possible with fillers such asRadiesse, a bone mineral for the nose or cheeks, jaw and chin as well.

Scuptrais the latest of the injectibles stimulation collagen at different levels of the skin adding volume but primarily firming and adding resistance to the formation of wrinkles, folds and descent.

BotoxandDysporttoo have been found to rebalance excessive facial expression, provide a non-surgical brow lift and lip lift and reshape the nose, as well as reducing wrinkles!

Dr. Obagi's new, second generationZO Skin Healthprograms may be added to personalized chemical peels, light and laser resurfacing and tightening and will, smoothen and even the color of your skin.

IPLand fractionatedlaserssuch asCO2 and erbium and now RF(radiofrequency) are additions to smooth the texture of the skin, tighten and reduce red and brown uneven pigmentation.

If you can pinch more than an inch of skin along the jawline in front of your earlobe, you should consider a surgical option to redrape and remove extra skin. 

You may consider: a traditional face and neck lift, short scar face and / or neck lift.

The recent resurgence of the S-Lift (created in the early 1900's), also called by other names as the Quick-Lift, Lifestyle-Lift, Swift-Lift, Soft-Lift, MACS-Lift and others; are a single modification of the S-lift targeted to elevate sagging lower cheeks jowls and lateral upper neck. The shorter scar, limited undermining and second layer lift achieve the "quicker" procedure but not necessarily the quicker recovery or the improvement you desire.
​
It is my thoughts based on these limited photos that you consider a face and neck lift. Thereafter, the use of skin firming, tightening and filling options to maintain or improve your investment. 

Face lift and / or neck lift or any of the other procedures and their combinations should be discussed following a proper examination by a Board Certified Plastic Surgeon who performs all of these options so you will not receive a biased approach because he or she is limited in their skills.

​I hope this was helpful! All the best!

Hair growth in scalp scars after face lift

Question from Whitby, ON: I have a fairly wide scar on the top of my head, close to the brow and am concerned that hair may not grow back in this area. Does hair tend to re-grow in the scalp area if the skin is scarred? Thank you.

 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:​

​Thanks for this question! It is interesting and affects nearly every patient following a brow, face and neck lift. 
​
There are many options for facelifting, depending on the skin laxity and areas of lift or tightening you wish or need. This type of surgery will leave you with scars hidden or not-so-hidden:

1.    in front of your ears and sideburn, 

2.    ​behind the ears and along the mastoid hairline,

3.    ​along the temple hairline,

4.    ​along the forehead or behind the forehead hairline.

Most facial surgeons are knowledgeable and attempt to hide the scar or make a angulated incision so hair bulbs on one side of the scar will grow through the scar to mask it. 
​
​It is also important that you abstain from activities which will damage the hair along the incision at the time of surgery such as:

1.    ​nicotine / tobacco use

2.    ​any type of hair coloring

​
​For most patients these scars are discrete and negligible but for some, the scar which has no pigment, no oil glands and no hair bulbs will be visible.
​
​There are options to speak with your surgeon regarding these concerns.
​1 non-surgical skin care including: retinoids, pigmentation-evening prescriptives
​2 minimally invasive procedures: IPL, fractionated CO2 or erbium lasers
​3 tattoo (not a favorite of mine along hairless skin due to potential ink color changes but worthwhile if in the scalp)
​4 hair grafting
​5 use of hair growing medications such as: Latisse or RevitaHair to be used soon after the surgery but not useful once the scar has matured
​6 scar revision, ie. surgical removal allowing for a hopeful newer, less obvious scar
​
​Please consult with a well experienced, Board Certified Plastic Surgeon, Facial ENT or Dermatologist with the experience required to treat this problem.
​
​I hope this has been helpful. All the best!

Not sure a Tummy Tuck is for me?

Question from Texas, TX: After 3 kids, my stomach is not the same. When I am standing it looks relatively flat (protrudes a bit) but when I sit, I always have this extra skin that hangs. I am fairly fit and trim but it is always there. I am not sure a TT will improve the appearance of my stomach enough to make surgery worth it. Thank you for your input.

 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:​

​ You look wonderful and appear to have retained much of your pre-mommy contour but unfortunately, those "little kids" have stretched your tissues. These include:

1.    ​stretching the outer skin which folds over your bikini when you sit

2.    ​some thickening of the fat

3.    ​stretching of the inner girdle which keeps you from maintaining a flat, tight tummy. 

​
​There are various options for mommy make-over tummy contouring.
These options are dependent on your skin laxity and the areas of liposuction contouring you wish or need.
​
You can consider: 
1. a traditional tummy tuck where the ab muscles are tightened, the sides are liposuction contoured, the excess skin is removed, the mons lifted and a new belly button is created. 
2. a mini-tummy tuck where the skin below the belly button is removed and mons lifted (noting this will leave your muscle girdle and skin above the umbilicus loose and may limit your tummy tuck options in the future). 
​
​For others reading this reply, they may consider: 
3. a panniculectomy / lipo-sculpting where the large lower roll of tummy skin is removed and the upper tummy and sides and / or back are reduced with liposuction. A similar technique is used for the upper arms called brachioplasty or thighs called thigh-plasty. 
4. a body lift used with patients who have super-skin excess and the tummy, sides and back skin are lifted with or without muscle tightening. 
5. liposuction of the circumfirential trunk for body contouring. 
6. liposuction of partial areas such as the front abdomen with and without muscle etching, love handles, inner and outer thighs, arms, neck; any of which use traditional, syringe and ultrasonic liposculpting. 
​
​And, most recently, the non-surgical reduction of fat using Cool Sculpting. 
​
​If you have fulfilled your desires for more children, I believe you will be best served with a traditional tummy tuck and if needed, some lipo-contouring of the flanks for a improved "hour-glass" contour. 
​
​In any case, please seek the evaluation of a well experienced and Board Certified Plastic Surgeon for their recommendations.
​
​I hope this was helpful! All the best!

Tea Time to Erase Time

Your Are Invited to: Tea Time to Erase Time: A President's Day Event with the Staff of Dr. Dean Kane 

Join Dr. Dean Kane’s staff at the Center for Cosmetic Surgery and Medi-Spa to enjoy tea time, a light lunch and learn about how to erase time with ZO Skin Health by Dr. Obagi, Face Peels, Laser Rejuvenation procedures and non-surgical procedures using injectables like Dysport, Botox, Fillers.
A great afternoon to enjoy a skin care workshop, watch demonstrations of live ZO 3 Step Peels, VI Peels, 24 K Golden Facials and the laser procedures of ClearLift to tighten and firm skin, IPL and Pixel to reduce red, brown and texture issues of your face and touch and feel all the skin products. You will have the ability to interact with the staff and have all your questions answered about your facial concerns.

All who attend will receive 20% off on any future service that is purchased at time of the workshop and 20% off Skin Care products. Enjoy a light lunch and tea service. Receive a special President's Day Gift.

Our Tea Time Event will take place on Monday, Feb 16th from noon to 3:00 at our office location:

1 Reservoir Circle, Suite 201, Pikesville 21208. Free and easy parking.

Must RSVP to 410-602-3322 or email Holly@DrDeanKane.com. We are looking forward to seeing you at our Tea Time to Erase Time Event.

Dr. Dean Kane Q&A – I would like to know if Botox would help in raising the scars (indented)?

Question from South Africa, ZA:  I would like to know if Botox would help in raising the scars (indented)? The scar is quite old. I would like to have it raised to the same level as the rest of my skin on my face. 

 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:​
Botox is a muscle relaxer and works cosmetically to reduce the creases, lines and wrinkles of facial expression. On rare occasion, a scar may tether to a underlying facial muscle and Botox may release the pulling effect but don't rely on this effect for a scar remedy.
​
​The attached photo is not visible so I cannot comment on it. 
​
​Every scar is different. Each person and each body or face site that the skin is cut or punctured will heal with a different quality of scar. 

Some are flat and thin but many are thick and ropey, red or pigmented brown.
Some pull causing a contracture or are lumpy. There are many different treatments depending on the quality of your scar(s) which I will address below.

When it bothers you, we may consider the following options:

1. Waiting for the scar to “mature” i.e. become soft and flat
2. Massaging the scar, using scar creams and silicone sheeting to soften it
3. IPL and vascular laser and light therapies to reduce the redness and ‘ropeyness’
4. Steroid injection to reduce the growth and lumpiness
5. Retinoids, hydroquinone skin therapy to reduce the thickness and pigmentation
​ ​6. Fillers and / or Subcision, a technique to cut the scar loose and fill the separation with filler or fat
7. Surgical removal and revision of the scar. 

A scar is permanent and many times becomes imperceptible. Time, of course will help scars improve.
​
​Please seek the evaluation and opinion of a well experienced Board Certified Plastic Surgeon to provide you your best options.
​
​All the best!

Dr. Dean Kane Q&A – I'm 27 yrs old. What is my best option for lifting/improving my face?

Question from Los Angeles, CA:  Noticed slight descent of face, jawline is no longer sharp as it used to be. Had filler in cheeks before (results have worn off) but am reluctant to continue to see this as the quick fix. Filler does little for the structure and the lower face and jowling. I've researched into a mini/lifestyle lift, ultherapy, Nefertiti lift. I already have fairly good cheekbones but wonder if I'd benefit from small cheek implants too. rather invest in a procedure(s) with lasting effects for a good few years. 

 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:​ 
I do see very minimal laxity causing your cheeks elongating slightly and creating a minimal wave across your nasolabial and marionette folds. 

​I would like to review the options that go through a well experienced and Board Certified Plastic Surgeons mind AND THEN make some recommendations...
​
​Various options for face enhancements including facelift, minimally and non-invasive facial options and skin texture improvements are available according to the skin laxity and areas of lift or tightening you wish or need. Both surgical and minimally invasive / non-surgical options are listed below.

Surgical lifts would be likened to pulling the bedspread and or top-sheet of your bed up to the head-board and removing the excess material.

Minimally invasive procedures such as fillers provide volume such as adjusting a pillow under the bedspread. Botox and Dysport act by pulling the top-sheet which drags the bedspread upwardly. If the bedspread (or skin) continues to fall to the foot of the bed despite fillers, Botox or Dysport you will need to consider a facelift.

Non-invasive options such as laser and light therapies, skin tightening products and technologies perform their tightening and smoothening of the skin similar to sending your bedspread to the dry cleaners. A more refreshed, even colored, glowing smoother and tighter spread covers the surface of the bed.

The most popular of the fillers, Restylane and Perlane, a jelly-like clear skin filler is used to fill lines, wrinkles and folds. Juvederm and its longer lasting "cousin" Juvederm Ultra Plus are similar skin fillers, used to soften and fill the nasolabial ("parentheses") and marionette folds, the brow ("number 11") lines and fill and lift the cheeks and lateral brow or chin.Voluma is the longest lasting, up to 2 year duration HA filler. Each one is used to expand or volumize the loss of tissue associated with expression, weathering or aging. All the fillers come with numbing anesthetic!.

Non-surgical facial contouring is possible with fillers such as Radiesse, a bone mineral for the nose or cheeks, jaw and chin as well.

Scuptra is the latest of the injectibles stimulating collagen at different levels of the skin, adding volume but primarily firming and adding resistance to the formation of wrinkles, folds and descent.

Botox and Dyspor ttoo have been found to rebalance excessive facial expression, provide a non-surgical brow lift and lip lift and reshape the nose, as well as reducing wrinkles!

Dr. Obagi's new, second generation ZO Skin Health programs may be added to personalized chemical peels, light and laser resurfacing and tightening and will, smoothen and even the color of your skin.

IPL and fractionated lasers such as CO2 and erbium and now RF (radiofrequency) are additions to smooth the texture of the skin, tighten and reduce red and brown uneven pigmentation.
​
​As for you, you seemed to enjoy cheek fillers before. Try Voluma as it is a very projecting 2 year filler. Add Juvederm or Perlane to the nasolabial and marionette folds. Sculptra will continuously stimulate firming of the skin for up to 2 years. Zo (Zein Obagi) Skin Health programs with retinoids will exfoliate and stimulate the skin for added external rejuvenation.
​
Any of these procedures and their combinations should be discussed following a proper examination by a Board Certified Plastic Surgeon who performs all of these options so you will not receive a biased approach because he or she is limited in their skills.
​
​All the best!

Dr. Dean Kane Q&A – I am a 35 year old man that is having some issues with some loss of volume around the corner of the mouth area.

Question from Jersey City, NJ:  I am a 35 year old man that is having some issues with some loss of volume around the corner of the mouth area. I noticed this occurred about a year after using a antidepressant for some sleep issues. I have read online that using antidepressants causes people to look older because of the constant relaxation of the facial muscles. I just want to know which procedures would benefit me. I have attached some photos. Your opinions are highly appreciated.


 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:​
I do see mild laxity causing your cheeks to soften, creating a minimal wave across the corners of your mouth and marionette folds. 

I would like to review the options that go through a well experienced and Board Certified Plastic Surgeons mind AND THEN make some recommendations...

Various options for face enhancements including facelift, minimally and non-invasive facial options and skin texture improvements are available according to the skin laxity and areas of lift or tightening you wish or need. Both surgical and minimally invasive / non-surgical options are listed below.

Surgical lifts would be likened to pulling the bedspread and or top-sheet of your bed up to the head-board and removing the excess material.

Minimally invasive procedures such as fillers provide volume such as adjusting a pillow under the bedspread. Botox and Dysport act by pulling the top-sheet which drags the bedspread upwardly. If the bedspread (or skin) continues to fall to the foot of the bed despite fillers, Botox or Dysport you will need to consider a facelift.

Non-invasive options such as laser and light therapies, skin tightening products and technologies perform their tightening and smoothening of the skin similar to sending your bedspread to the dry cleaners. A more refreshed, even colored, glowing smoother and tighter spread covers the surface of the bed.

The most popular of the fillers, Restylane and Perlane, a jelly-like clear skin filler is used to fill lines, wrinkles and folds. Juvederm and its longer lasting "cousin" Juvederm Ultra Plus are similar skin fillers, used to soften and fill the nasolabial ("parentheses") and marionette folds, the brow ("number 11") lines and fill and lift the cheeks and lateral brow or chin.Voluma is the longest lasting, up to 2 year duration HA filler. Each one is used to expand or volumize the loss of tissue associated with expression, weathering or aging. All the fillers come with numbing anesthetic!.

Non-surgical facial contouring is possible with fillers such as Radiesse, a bone mineral for the nose or cheeks, jaw and chin as well.

Scuptra is the latest of the injectibles stimulating collagen at different levels of the skin, adding volume but primarily firming and adding resistance to the formation of wrinkles, folds and descent.

Botox and Dysport too have been found to rebalance excessive facial expression, provide a non-surgical brow lift and lip lift and reshape the nose, as well as reducing wrinkles!

Dr. Obagi's new, second generation ZO Skin Health programs may be added to personalized chemical peels, light and laser resurfacing and tightening and will, smoothen and even the color of your skin.
IPL and fractionated lasers such as CO2 and erbium and now RF (radiofrequency) are additions to smooth the texture of the skin, tighten and reduce red and brown uneven pigmentation.

Focusing on you, try:

1.    1. Voluma as it is a very projecting 2 year filler. Add Juvederm or Perlane to the corners of the mouth and marionette folds. 

2.    2. Sculptra will continuously stimulate firming of the skin for up to 2 years. 

3.    3. ZO (Zein Obagi) Skin Health programs with retinoids will exfoliate and stimulate the skin for added external rejuvenation.

Any of these procedures and their combinations should be discussed following a proper examination by a Board Certified Plastic Surgeon who performs all of these options so you will not receive a biased approach because he or she is limited in their skills.

All the best!