Can I have Fraxal and Botox?

Dr. Dean Kane Q & A.

Q. I had Fraxal around the eye area but can I have Botox as well 9 days later when I'm booked in for Botox.

A. ​Botox is a protein than can be denatured and therefore lose its potency with heat. The fractionated CO2 laser penetrates the skin to heat the tissues and can therefore reduce the effects of Botox or like muscle relaxers. Current understanding is that Botox has linked irreversibly to the nerve ending and performed its job within an hour of injection.

​The swelling associated with laser therapies will also increase swelling in the area performed. While I know of no studies to the effect, I can anticipate that the added fluid in the area may dilute the muscle relaxer and possibly cause diffusion effects depending on injector technique.

If you do plan to have both a laser procedure like Fraxel and Botox performed, I prefer they be separated by a day with Botox on the first day followed by laser the next day. ​ Your best results when combining such procedures would be inject Botox and wait for its maximal effects 10-14 days later, then have Laser.

​Please discuss this concern with your injector / laser specialist.

​I wish you well.

Can I get upper lid surgery weeks after Botox on forehead?

Dr. Dean Kane Q & A.

Q.  Can I get upper lid surgery weeks after Botox on forehead? I received Botox on my forehead two weeks ago for the first time and the fact that I can no longer contract my brow up give me a sad look. I don't think my brows droop, I only think that I've always contracted my forehead because of my heavy lids (all my youth also). So if my brows didn't move can I get a blepharoplasty?

A.  ​​Properly injected Botox will reduce the forehead lines, crows feet AND raise the eyebrows into a more youthful arched position. It sounds as if the injection technique you had performed targeted the frontalis muscle causing the brow to drop.

​
​The well experienced eyelid surgeon will lift the eyebrow to its proper height prior to marking and performing the eyelid lift. This said,

1. ​when your brow is arched after Botox, it will be in a better position for marking and a blepharoplasty.
2. ​When your brow and / or eyelid have drooped would be the worst time to perform a eyelid lift as too much eyelid skin may be removed causing you eyelid closing problems.

Please consult with a well experienced, Board Certified Plastic Surgeon or Ophthalmologist who performs both Botox, Browlift and Eyelid lift for your best evaluation and recommendations.
​
​I hope this has been helpful.

I'm having an age spots frozen and then a face lift. How long in between each treatment?

Dr. Dean Kane Q & A.

Q. I am having some age spots frozen/ from my face then 3 weeks later have a neck and lower face lift. Is that enough time between the treatments

A. Congratulations for taking the leap to personal rejuvenation.

​Age spots can be different things to different people and providers. They are pigmented lesions seen mostly in lighter skinned but very sun exposed patients. They maybe lentigos created from the melanocyte or melanin forming cells or a seborrheic keratosis formed from the top layer cells in the skin.
​
​They maybe removed in a variety of ways including:

1. 1. ​liquid nitrogen freezing
2. 2. ​cautery or dessication with a “electric pencil”
3. 3. ​laser
4. ​4. chemical peel.
5. 
   
6. While superficial, they should fully heal so the injury to the underlying skin does not affect circulation or provide a break in the defense of the skin when the face and neck lift are performed.
7. 
   

​I would recommend no less than 3 weeks between dessication of a skin lesion directly on the area of the face and neck lift.

​I hope this is helpful! I wish you the very 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!