Is there an effective non-invasive treatment for paradoxical hyperplasia?

Question from London, TX:

I’m suffering from paradoxical hyperplasia after CoolSculpting and would like to know: 1) if invasive therapy is the only solution? (if so, what your recommendation would be) 2) If other types of non-invasive techniques can also be equally effective? (e.g. treatments which use ultrasound technology to melt away the fat such as Liposonix/ultrasound cavitation) 3) if exercise &diet alone can deal with reducing the size of the abdomen? (it doubled in size after the CoolSculpting treatment!) Thanks

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

So sorry this has occurred to you! Paradoxical Hyperplasia following CoolSculpting is uncommon. It is my belief that inflammatory removal of fat cells occurs as well as the proposed apoptosis. This occurs during surgical procedures such as liposuction and tummy tucks as well leaving a firmer, fibrous tissue replacing the lost fat.  ​​I recommend time and deep scar massage initially. Patients who lose weight during the time of focused fat reduction from CoolSculpting do better.

​It may take a year or longer until the changes have settled as any procedure that creates heat or traumatic injury such as ultrasound or radio frequency procedures, liposuction or tummy tuck during the healing process may also add to the lumpy scarring. At that time you may consider these other procedures but only with the evaluation and recommendations of a Board Certified and well experienced Plastic Surgeon.
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​I hope this has helped. All the best!

Dr. Dean Kane

Center from Cosmetic Surgery and Medi-Spa www.DrDeanKane.com

410-602-3322 DeanKane@DrDeanKane.com

Is this a RUDE question to ask your surgeon?

Question from Spartanburg, SC: Docs say that a patient’s face must be carefully evaluated and matched to the “right” surgical technique. IF the PS exclusively does some variation of SMAS lifts should I think he never does the more challenging deep plane for HIS comfort or should I think that NO one showed up for whom a deep plane was the best option?

Answer from Dr. Dean Kane, board certified Plastic Surgeon from Baltimore:                                                                         It is not “rude” to ask the number and styles of facelift or the reasons why a surgeon uses the techniques he or she does for the surgery requested.

​Just as the surgeon should perform a proper evaluation of your past medical, surgical and social history to provide a proper plan to achieve your desires safely, it is in your best interest to find the surgeon whom matches your needs too.
​​Unless there is a specific reason to perform a more complicated procedure, the “twins facelift” study has determined that the difference and duration of various facelifts show nearly no difference.
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​Pick your board certified Plastic Surgeon and Facelift surgeon carefully.
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​All the best!

Dr. Dean Kane Center from Cosmetic Surgery and Medi-Spa www.DrDeanKane.com

410-602-3322 DeanKane@DrDeanKane.com

How long will my QuickLift Last?

Question from Amelia Court House, VA I’m a 52 year old  male who has minimal jowling and very little neck sagging. I just had a QuickLift down, I’m 5 days out. I have minimal swelling and bruising, I’m fair skinned. How long do you think this procedure will last? Any answers appreciated.

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

This is the “age” old, $64 million question each facelift surgeon is asked at consultation; so it is a very good question!

​​The duration of a facelift is dependent on many unique factors:

1. ​ethnic background of the patient including the thickness of the dermis
2. ​prior care and weathering of the skin
3. ​amount of skin elevated and trimmed in the facelift
4. ​added lifts such as the neck, jowl, brow and forehead
5. the skills of the surgeon
6. ​skin rejuvenation procedures and care following facelift
7. ​and others.
8. 
   

In general, the less tissue lifted, the sooner the surrounding tissues will sag and the lifted tissue will relax once again. Rather than create a mis-conception that a quicker lift will heal faster and perform a similar end result to a traditional facelift; the patient and surgeon should identify those aspects of aging and create a surgical / non-surgical plan to manage the patients desire for improvement.
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​The dermis of the skin in patients of northern European heritage tend to be thinner and therefore relax younger than patients of “color” (African, Mediterranean, Hispanic, Asian origins).

​​More weathered or less cared for skin will have less elasticity at the time of facelift and age quicker thereafter.

​​What we can say is that a facelift allows the face to continue the aging process from a younger looking age.

​​Many studies have reviewed this question and the current consensus seems to be that a traditional facelift will “last” 7 to 10 years. Please anticipate less “duration” if you have had less of a facelift.

If you will consider many of the new rejuvenation techniques to continuously stimulate the skin to “anti-age” such as the weekly use of topical retinoids, weekly to monthly use of dermal laser, IPL and fractionated CO2 or erbium lasers, and/or Sculptra therapy; the texture of the skin will improve, firm and tighten. So if you have had a facelift, you can keep it looking younger, longer.

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​I hope this has helped you. All the best!

Dr. Dean Kane

Center from Cosmetic Surgery and Medi-Spa www.DrDeanKane.com

410-602-3322  DeanKane@DrDeanKane.com

Why is it taking so long to heal after facelift?

Question from New Orleans, LA: 30 days post op today. Slow healing, not a smoker! Did everything right then some. Ps not worried, but is there anything I can do to speed up the healing of left ear front? first pic is about 4 days ago. Does not hurt, ooze or burn. Still taking bromelain and vit c and now supplements. Am tired of hiding out. Scabs behind ears still too, left back better than right, but right front better than left. (scab wise) Thank you.Dr. said put nothing on it. I am putting Aquaphor on skin not incision

Dr. Dean Kane, board certified Plastic Surgeon from Baltimore Answers

Thank you for your concern! Healing of a surgical incision is probably the most mis-understood aspect of any surgical education process. In today’s fast paced society, we wish for quicker healing due to less recovery time. Unfortunately, we can optimize the healing process but not make it as fast as you expect or wish for.

The following is a simplified overview for you to consider in your quest for fast healing.

The healing process depends on many factors. The body, whether it is the face, trunk, arms and legs or organs follows a fairly defined process to seal skin and tissue breaks or injury. Short and long incisions, invasive or non-invasive; healing is the same. It is the magnitude of the trauma that prolongs healing according to the bigger or smaller injury. Scar, collagen or fibrosis are all the same name for the mortar that keeps the tissues together with incisions or thickening of the skin which we desire with dermal lasers and medications or injectibles.

Each patient is unique and creates the environment for optimal healing. your heritage, high blood pressure, heart disease, clotting syndromes, diabetes, nicotine use, vascular disease, auto-immune syndromes, nutrition, hydration and prior skin injury are many factors which can prolong healing.

When the skin is lifted off the underlying tissues as they are with a facelift, the incision AND the underlying skin is now devoid of it’s normal supply of circulation. This compounds the factors towards optimal healing and prolongs the process. The “larger” the flap, the more potential lack of circulation. Incisions in hair-bearing areas and certain thicker healing areas will factor into facelift incisions.

In general, in the most optimal case, it takes:
3 to 7 days for circulation to stablize;
7 to14 days for healing cells called fibroblasts to begin to make scar;
3 weeks to develop enough scar strength for return to non-exertional activities of daily living;
3 to 6 weeks for swelling to diminish (although it roller coasters with increased activities until 6 months or longer);
3 months to maximal scar thickening and lumpiness; and
3 to 12 months or longer for the healing to “remodel”, ie thin and stablize to its best.

Your surgeon will guide you in the ways to optimize your healing. Sorry your expectations are not met but nature does not follow our best desires.

I hope this has been helpful! All the best!

Dr. Dean Kane

www.DrDeanKane.com

DeanKane@DrDeanKane.com

Does each vial you get of Sculptra add together producing more collagen or do they not build on each other? Im confused?

Question from Ohio, IL : How does the vials injected weeks apart come together to produce the amount of collagen necessary to give you the results your looking for? Isn’t the first vial of sculptra crystals gone by the time the second vial get injected 6-8 weeks later then so on with the next Vial? Just like to know how it works thanks.

Dr. Dean Kane, board certified Plastic Surgeon from Baltimore Answers

Sculptra is a most interesting product! It is found not to “volumize” or “fill” but to stimulate the production of fibroblast molecules such as collagen, elastin, hyaluronic acid and other glycosaminoglycans in the dermis.
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​The reason for the slow onset of results is that it needs to prime the skin cells, particularly the fibroblast to make the collagen and other products you desire for your results. Each time Sculptra is again injected, it further stimulates these cells to a higher level of production.
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​For the longer onset, you also get longer duration of effects. We have seen improving skin firming and line reduction during the 2 years the product information states. This seems to further endure with other non-surgical stimulatory procedures such as Clear Lift laser, retinoid cream stimulation, deeper chemical peels and the like.
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​Be patient. This product with controlled stimulation has shown remarkable results for a non-surgical approach but is not instantaneous gratification. For that consider injectible fillers.
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​I hope this has helped! All the best!

Dr. Dean Kane

www.DrDeanKane.com

DeanKane@DrDeanKane.com

410-602-3322

How soon can I get Restylane after Kenalog injection?

Question from Madison, CT: I had a Kenalog 40 injection into a raised hypertrophic incision scar which got rid of the all the scar tissue in a week. I have read the Kenalog stays in your tissues for a month. I would like to get some restylane in the area, but do not want the water absorbing properties of restylane to hold the steroid in place for longer than a month. Is it safe to get restylane soon – or is there a way, such as a saline injection, to help flush out the remaining Kenalog beforehand?

Dr. Dean Kane, board certified Plastic Surgeon from Baltimore Answers:  

Kenalog is a suspension of a synthetic steroid used to reduce inflammation. When used under the skin or intralesionally, as you have, it stays localized to the injection area for a prolonged period of time; 40 days per the prescribing information (see reference below). Kenalog is NOT ordinarily used as a water or salt retaining steroid as other glucocorticoids are prescribed.
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​You should have no trouble receiving Restylane or any other HA (hyaluronic acid injectible) outside the area of a Kenalog skin injection.
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​I wish to wait 6 to 12 weeks (42 to 84 days) following injection of kenalog in a hypertrophic skin lesion to allow it to fully work prior to assessing whether a patient requires more kenalog or as you suggest a filler. This will allow you and your injector to determine the extent of atrophy caused by the steroid and the amount, type and placement of filler you will need.
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​Always use the most experienced, board certified plastic surgeon or injector for your skin injection needs.
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​I hope this was helpful! All the best.

Dr. Dean Kane

www.DrDeanKane.com

DeanKane@DrDeanKane.com

410-602-3322

I’m 52 and have hashimotos thyroid. I had Restylane 7 years ago, and would like to do it again. Would it be risky?

Question from Apex, NC : I’ve read some things and I am confused as to weather there is any risks of creating an autoimmune disease. I am in general good Health.

Dr. Dean Kane, board certified Plastic Surgeon from Baltimore Answers:

The human body is remarkable in it’s ability to guard itself against foreign bodies. In the case of Hashimoto’s Thyroiditis, it mistakenly identifies a molecule on the thyroid as foreign and attacks this organ. This can be similar to any and all allergic syndromes whether they are external such as pollen or internal such as auto-immune thyroiditis.

​Restylane and similarly made HA’s (hyaluronic acid fillers) are a molecule made to be bio-identical to human skin HA and therefore this molecule would have no immunogenic reaction in the body. When Restylane and other injectibles are purified for human use, there maybe micro-impurities which stimulate a allergic style response.
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​The cross-reactivity of one molecule stimulating a immunogenic response to another molecule is even more rare.
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​I would recommend you contact your endocrinologist or rheumatologist to see if there is any cross-reactivity between these 2 molecules or any other concerns you should consider.
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​I anticipate the benefits will far outweigh the risks. Good luck.

I hope this was helpful! All the best!

Dr. Dean Kane

www.DrDeanKane.com

DeanKane@DrDeanKane.com

410-602-3322