What is your opinion on using a board certified surgeon in facial and reconstructive surgery for a facelift?

Dr. Dean Kane Q & A.

Q.  What is your opinion on using a board certified surgeon in facial and reconstructive surgery for a facelift? I have been trying to research information on facelifts. It appears that it would be a good rule of thumb to consult with a board certified surgeon in facial and reconstructive facial surgery, for a facelift. What are your opinions on this, am I correct in this assumption?

A.  ​​​Great question! First I will offer you the party line and then my personal 2 cents.

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Party Line:
​Many health care providers are now performing plastic surgery procedures, but that doesn’t mean they’re all qualified to perform plastic surgery. ASPS Member Surgeons are trained in cosmetic and reconstructive procedures of all types.

Plastic surgery involves many choices. The first and most important choice is selecting an ASPS Member Surgeon you can trust. ASPS Member Surgeons meet rigorous standards:

• Board certification by the American Board of Plastic Surgery® (ABPS) or in Canada by The Royal College of Physicians and Surgeons of Canada®
• Complete at least six years of surgical training following medical school with a minimum of three years of plastic surgery residency training
• Pass comprehensive oral and written exams
• Graduate from an accredited medical school
• Complete continuing medical education, including patient safety each year
• Perform surgery in accredited, state-licensed, or Medicare-certified surgical facilities
• Adheres to a strict Code of Ethic

Do not be confused by other official sounding boards and certifications. The ABPS is recognized by the American Board of Medical Specialties (ABMS), which has approved medical specialty boards since 1934. There is no ABMS recognized certifying board with "cosmetic surgery" in its name.

By choosing a member of the American Society of Plastic Surgeons, you can be assured that you are choosing a qualified, highly trained plastic surgeon who is board-certified by the ABPS or The Royal College of Physicians and Surgeons of Canada.

To make sure your surgeon has these outstanding qualifications, look for the ASPS Member Surgeon Symbol of Excellence or link / contact the American Society of Plastic Surgeons or American Society of Aesthetic Plastic Surgery to locate a highly trained plastic surgeon in your area. 

My 2 cents worth:

There are talented Board Certified Plastic Surgeons and not so talented ones in facelifting or any other sub-specialty.

​There are talented Board Certified Surgeons in other fields such as ENT Facial Surgery and Oral and Maxillofacial Surgery in the FaceLifting sub-specialty.

Explore diligently and search for the best most experienced surgeon you can trust. 

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 wish you the very best!

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Would cool sculpting work for me with 2 treatments? Or is Liposuction necessary?

Dr. Dean Kane Q & A.

Q.  Would cool sculpting work for me with 2 treatments? Or is Liposuction necessary? I am 37 years old and have stubborn arm fat which hasn't been improved with any type of exercise or diet all my life. Otherwise I am happy with my body. I am also nervous about the after effects of lipo. I have read many people saying that years after lipo their metabolism seems to shift and they start gaining weight uncontrollably in weird places. I have maintained a weight with 7 lbs of fluctuation through the last 15 years.

A.  ​​​Thanks for sharing your photos. Although they are limited, you seem thin with mild lipodystrophy (fat) and skin laxity of the upper arms. I can appreciate your frustration!

​It is best to obtain consultation from a well experienced, Board Certified Plastic Surgeon with all skills for a upper arm contouring and lift so you are not biased by their lack of options.
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​Please consider the following:

1. ​CoolSculpting 1 or 2 sessions per arm to reduce the superficial fat and possibly (although no guarantees!) obtain some skin shrinkage around the smaller volume. This is very limited to the areas bulging only.
2. ​LipoContouring which will provide near circumfirential fat reduction and etching of the upper arm muscles. You may obtain some skin shrinkage around the smaller volume but also skin redraping due to the wider contouring.
3. ​A arm(pit) tuck may help in advancing the skin and reducing the skin excess. This option may be performed at the same time as lipocontouring but in your case due to age and exercise may be best 6-12 months later after the lipocontouring has healed and softened. It limits the scar to the armpit but also limits the amount of skin reduction.
4. ​A brachioplasty (arm lift). This incision comes down the inner aspect or back or the arm to remove skin excess but leaves a more visible scar. I would also recommend to do this a year later after lipocontouring.

I hope this has been helpful!

All the best!

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Help with SINGLE frown line, not a number 11. It is 1 inch long. Plastic surgeon said it was a split muscle & should be removed?

Dr. Dean Kane Q & A.

Q.  Help with SINGLE frown line, not a number 11. It is 1 inch long. Plastic surgeon said it was a split muscle & should be removed? I am worried about the side effects of resectioning the muscle, I hear its risky. Will Botox work if I get it every 3 month religiously? And maybe add laser resurfacing? I am 45 and it gets worse every day.

A.  ​​​This is a very common concern for many patients.

​A complex of muscles between the eyebrows expressively pull them together and downward toward the top of the nose. This causes the skin to fold and over time create a increasingly permanent crease as a "11", a single fold or many smaller lines.
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​Botox, when injected properly will reduce the expressive pinching of your eyebrows together and thereby reduce the folding of the skin.  The residual skin creasing, skin thinning and fat loss between causing the furrow will not disappear without further options.

Removing or dividing the muscle will only create a deeper depression due to the muscle volume loss.
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​Options to "fill" the "1" or "11"s.

1. ​Filler do just that, add volume. They may be placed at the level of the bone, muscle, fat layer and skin.​Injectible fillers in this precise region have a higher risk of complications and must be selected carefully and performed by a artful and very experienced injector. Layering the filler(s) may be necessary to achieve the results you wish including: fat, hyaluronic acid gels and radiesse.
2. The dermis and epidermis of the skin are also thinned and you may consider stimulating the renewal of skin cell thickening and repair in this areas as well as fine lines, pigmentation and rougher sun / weather damaged facial skin with retinoids (retinols, Retin-A) and proper skin healthcare.

Consult with and consider your injector carefully! Choose a well experienced, Board Certified Plastic Surgeon, ENT Facial Surgeon or Dermatologist 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!

Does CoolSculpting treat cellulite?

Dr. Dean Kane Q & A.

Q.  Does CoolSculpting treat cellulite? My legs from the top down to my knees have bad cellulite and as I'm loosing weight it is looking worse. What can I do?

A.  ​​​Cellulite is nothing more than a superficial layer of normal fat cells caught beneath the poorly expansive skin. The fat appears bumpy and irregular because it is trapped between a skin ceiling, a tough unyielding fibrous floor and thin fiber walls. Any swelling or reduction in the metabolic fat will inflate or deflate its appearance on the skin. Like a parachute, more or less air will create dimples and pulls on the silk chute. A thicker skin such as those of black, Mediterranean, Asian, Indian and other origins will resist the irregularities on the skin. A thinner northern European skin will more easily show the pucker, dimpling, hollows and bulges.
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​Sometimes, what you consider to be Cellulite may be skin laxity or other dermatologic concerns which are treatable.
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​CoolSculpting is tried and true but limited in fat reduction with some skin contractibility on some patients. It is not found to be consistent or reliable in reducing the superficial fat that creates Cellulite. In fact, there is no reproducible or reliable technology to improve Cellulite. There ARE other alternative medicine and dietary options that may help.
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​Please consult with a well experienced, Board Certified Plastic Surgeon or Dermatologist to evaluate and compare appropriate options for you.

All the best!

Is it better to address skin rejuvenation before or after facelift surgery?

Dr. Dean Kane Q & A.

Q.  Is it better to address skin rejuvenation before or after facelift surgery?

A.  ​​Great question! This is a continuous source of confusion for ALL patients.

​First, you must know all the options under the categories for face, neck, eyelid and forehead enhancements. These include: surgical, injectible, non-invasive laser / peel and skin health.
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Second, you must compare photos of yourself years ago identifying skin laxity, pigmentation, volume changes and expression lines you wish to rejuvenate.
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​Third, obtain well seasoned, Board Certified Plastic Surgeon or Facial ENT evaluations with a diagnosis of your aging features.... NOT a single therapeutic recommendation but a management plan.
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​4th, develop a budget and a timing of what features you wish to improve recognizing you will need 3 weeks to 3 months or longer for recovery.
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​The following will be helpful:
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​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 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.

Sculptra is 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.

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.

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.
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​YOU'RE CORRECT, IT IS CONFUSING!  I advise my patients:

1. that ZO skin health and Sculptra begin and continue to rejuvenate the texture of the skin before and after and surgical and injectible procedures.

​2. If you have a particular social event for which you wish particular enhancements, consider the recovery period and any potential side-effects or complications.

3. Find a trusting well experienced, Board Certified Plastic Surgeon or Facial ENT Surgeon who offers ALL the skills and options you are considering so he or she may offer you a trusting unbiased recommendation.

I know this has been long winded but I hope it has been helpful.

All the best!

Does the CoolSculpting reduce the appearance of stretch marks?

Dr. Dean Kane Q & A.

Q.  Does the CoolSculpting reduce the appearance of stretch marks? I had a baby 13 weeks ago and I only have a pooch left that I had even before I was pregnant. Since I now have stretch marks, I was wondering if this procedure would help with my tummy fat as well as the stretch marks or will the stretch marks still remain? Thank you!

A.  ​​Congratulations! You also look great 3 months following giving birth. Thanks for sharing your photo.
​
​This is a great question not previously asked about stretch marks (cutaneous striae). Stretch marks are due to the stretching of the skin, particularly the dermis with inadequate collagen formation. There is no good or consistent way to replace the collagen of stretch marks with any technique. Skin excision is the primary option to removing striae of the skin.
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​CoolSculpting (CS) is "tried and true". It will reduce limited fat in skin bulges and if multiple sessions are performed, a liposuction and contouring effect may be accomplished. Do not expect CS to shrink skin nor improve stretch marks.
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​I recommend you consult with a well experienced, Board Certified Plastic Surgeon to consider your options.
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​Given the flower tattoo you have, and the possibility of more pregnancies, you may wish to consider CS at this time and a tummy tuck following all your pregnancies. You can have the tattoo re-finished following the tummy tuck.
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​I hope this has helped!

All the best!

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.

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​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.
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​I hope this has been helpful.