Look fabulous and 10 years younger for Christmas and New Years without surgery and no one know will know…except you.

I’ve been doing non surgical facelifts and rejuvenating the cheeks, nose, eyes, chin and lips for years…using injectable fillers for wonderful natural looking results that can last up to 2 years with maintenance.

Here’s what I use, how and where I use it and how it works:

• Lips    Nasolabial folds    Hollow cheeks
• Weak jawline     Nose job       Brow lift
• Marionette lines    Crow’s feet     Forehead lines/wrinkles
• Undereye shadows     Backs of hands

JUVEDERM comes in three formulas to plump, fill in and smooth wrinkles.  Injected at varying depths it fills in space beneath the skin instantly to create new shape and erase lines and wrinkles. I use it for:  Crow’s Feet, Cheekbones and Nasolabial folds, and to restore luscious lips by instantly removing smoker’s lines and bleed lines. I restore definition to the jaw line by replacing lost volume in the chin area…and more.  It can even do a quick “nose job” such as hump removal.

BOTOX injected between the brows inhibits the muscles in motion, smoothes out existing lines and subtly “lifts” sagging eyebrows.  Yes, an eyebrow lift without surgery!  Injected around the eyes, Botox relaxes muscles that cause Crow’s feet (Juvederm is then used to fill in and plump up this area.)

RADIESSE is a hyaluronic acid based filler that fills and plumps instantly but keeps working for months to promote your own collagen renewal.  It’s great for Marionette lines and naso labial folds or the backs of your hands.

SCULPTRA is long lasting (up to 2 years) and works by restoring volume also.  Used in the cheek area or for naso labial folds it can restore lost fullness.  It’s used in the midface area primarily to boost collagen production.

Newest studies prove that injectables last longer when used with Botox.

EXPERT INJECTOR…injectables are only as good as the injector!  In fact, using someone who is not specially trained and highly skilled can be damaging.  I am an expert injector as is Nora, my assistant.  When you see Nora, you’ll know we know what we’re doing.

I match the right treatment and product to your specific needs as we create your personalized treatment plan…for your instant facelift.

YOU CAN TRUST YOUR FACE TO THIS PLASTIC SURGEON!

Want to look radiant, refreshed and years younger for the Holidays…don’t wait…let’s get you an instant makeover now.

Happy Holidays!

Dr. Steven Davison

Breast Augmentation requires four important decisions for the surgical plan. Answering the key questions clearly improves communication and helps meet patient expectation.

1 – Size of the Augmentation.

This is key to the patient’s satisfaction. It is a little like Goldilocks this one’s too big, this one’s too small and this one’s just right. Using cup size as a starting point is fine but as everyone’s perception of cup size is different, fraut with pitfalls. A better estimate is to use cc increase. As there are physical parameters such as base width of the breast and skin envelope size, a starting range should be suggested by your surgeon. Trying on sizes in a trial and error session or using state-of-the-art 3D imaging are current ways to establish size. 3D imaging now allows patients to see their own chest with and without clothes after augmentation; it is just short of amazing.

2 – Type of Implant

Silicone versus saline is the question. If you’re under 22 years of age, saline is the only option, yet any older and it’s the patient’s desire. The safety concerns stirred up in the media have had no medical science support. So now it comes down to the pros and cons. Silicone implants are softer, lighter and more natural. Saline implants are more prone to rippling unless overfilled which leads to firmness yet can be placed through smaller incisions. This advantage has been negated by the success of an implantation tool called the Keller Funnel. Type of implant is irrelevant to size unless really large implants are chosen which need a larger access incision.

 3- Placement of Margin

The location of incision is either inframammary (in the fold under the breast), periareolar or around the nipple area, transaxillary via the axilla crease or through the bellybutton.  The axilla and bellybutton offer smaller, more hidden incisions where an inflatable saline device is inserted. This benefit is not so great now that more silicone devices are used. The inframammary incision gives the surgeon the most control, yet can ride up the breast with maturity. Ideally, the periareolar incision can be almost imperceptible when it heals but a poor scar or decreased nipple sensation are potential risks. A larger silicone access incision in the axilla can be cosmetically sensitive to the women doing moderate to high intensity exercise in which the arms are raised. An experienced surgeon should consider anatomy, the size and patient desires before pitching the incision. Beware the surgeon who just uses his or her incision only.

 4 – Position of Implant

The last issue is a subglandular device which is under the breast versus the device which is partially under the muscle. The advantage of under the breast or subglandular implant is more effective in size particularly to address some mild breast ptosis. The disadvantage is the implant may show through the skin. A subglandular device is not for thin-skinned individuals or those without at least 2 cm of breast coverage in the upper pole. The partial subpectoral placement means the upper 2/3 of the implant is under the pectoralis muscle. This has the advantage  to reduce the round edge of devices being obvious. The lower third of the device is still covered by the gland alone. Muscle force and function is not affected. In conclusion, the subglandular position is ideal for a larger breasted patient who wants more fullness to correct mild ptosis. The partial subpectoral device is better for most other patients.

A quite frequent problem involved in the removal of small lesions such as moles, nevi and other lesions is…correct identification.  Correct identification and confirmation of the exact site for these small lesions is paramount.  But often, this is a problem when a patient is referred from a dermatologist and presents in our office.

Identification and Clinical Notes The most common way of locating and identifying the correct site is by asking the patient to identify the site in conjunction with clinic notes.  This method is used to help maximize accuracy in the ID process.  Problem is…this can backfire.

I’ve actually had a patient blow up at me when I asked them to confirm which mole the dermatologist wanted biopsied.  But there is an easy solution to this problem.

Smart Phone’s High Pixel Camera! The Smart Phone’s high pixel camera does not require additional lighting, so you can take a photo in the dermatologist’s office without hassle.  Here are the steps I recommend:

1. Take a photo (or have someone on staff do it)…of the marked lesion.
2. Include a frame of reference – e.g. the nose, right ear, left ear, belly button – something discernible.
3. If the lesion is hard to find, include a ruler located by the lesion so we can measure from the landmark.
4. This prevents hours of anguish caused from having to revisit the dermatologist and from incorrect lesion biopsy mistakes.

Be thankful for modern technology…quite amazing!

Happy Thanksgiving!

Dr. Steven Davison

This decade ushers in droopy brows, volume loss in the lower facial third and deep neck bands from loose, baggy skin. These changes will be much less drastic if you started doing anti aging procedures in your 30’s or 40’s.  But, it’s never too late to start.

The goal is balance.  Each part of the face ages at a different pace. If you can address these changes, as they occur in each area…you can maintain a natural balanced look, which allows the face to continue aging as a whole.  For example:  if you focus only on the eyes and do not include the brows or upper cheeks, you will age with a disjointed look between one facial feature and another.

ANTI AGING OPTIONs – Traditional Facelift Having a facelift in your 50’s and 60’s slows facial aging so you’ll always look at least 10 years younger than you really are.  There are several facelift variations (see previous blog) but the goal is: to restore natural curvatures to your facial features while maintaining the right amount of volume in the right places.  Men and women in this season of their lives opt for facelifts when injectables and other noninvasive treatments fail to work as effectively as they once did. A facelift done at this age lasts for years and may only require minor touch ups such as excess skin removal later in the 70’s.

Blepharoplasty – Corrects hollows, under eye bags and volume loss around the under eye area and sagging, bags and deep grooves of the upper eye area as well as volume replacement.

Browlift is the option of choice when injectables fail to give the needed lift.  Browlift restores the brows back to a more elevated and natural looking, more youthful position.

Necklift removes loose skin and fat, which is always a dead giveaway to your true age. Liposuction is often used to remove excess fat deposits and help sculpt this area.  The results are long lasting and help to restore facial balance.

Many Hollywood celebrities in their 60’s look 40ish. Many admit they have had work done all through the aging process in order to stay looking younger, healthier and more vibrant.  Goldie Hawn, Susan Sarandon & Morgan Fairchild look fabulous…just to name 3 of the many celebs.

Fillers vs. Surgery…this is of course the most common question.  I answer in my next blog.

Helping You Keep Your Best Face Forward,

Dr. Steven Davison

Labiaplasty is a plastic surgery of the external (outer) female genitalia.  The predominate reason women seek this operation is increased size of the labia minora (or inner lips). As fashions become more form fitting, hair patterns more revealing and mean of comparison more common, more women are seeking this operation for cosmetic reasons.  Problems with pain, on sitting or in thigh clothes, toilet habits and sexual discomfort are functional reasons patients seek a surgical solution to elongated labia.

The problem may be exacerbated by age or activity (horse or bike riding) and atrophy of the labia majora (outer lips).  Current grading suggests any length more than 5 cm is abnormal by comparison in size with what is considered anatomically normal. The goals of labiaplasty are a minimally invasive way to reduce the enlarged lips while maintaining the sensation, color, texture and adequate opening of the lips. The edges of the labia have a very unique pigmented, corrugated mucosa skin junction that cannot be replicated.

Different techniques exist from amputation of the excess lip, simple wedge excisions and more complex wedge excisions tailored to remove the excess tissue while preserving the edge.  The technique that works the best is one that is tailored to the patient’s own anatomy, yet wedge technique which I use leaves more normal color, appearance and sensation.

The surgery takes about an hour and can be performed under local, sedation or general anesthetic based on patient comfort.  Recovery is about a week of surgical healing with avoiding heavy exercise and sexual activity for two weeks.  Care is minimal involving sitz baths and antibiotic ointment only.  I utilize layers of absorbable sutures which avoid the need for removal and minimize the risk of dehiscence or the wound falling apart which is the most common of this procedure and is a rare complication.

This is one of plastic surgery’s offerings with which patients are undeniably delighted. Large series report 95-98% of patients if happy or would undergo the operation again, a solid testimonial.

The operation is not difficult, yet requires appreciation of genital esthetics, tissue handling and plastic surgery techniques. Seek help from a surgeon with understanding and experience. Ask about techniques they use to preserve mucosa to skin border to maintain texture, color and sensation especially if you have pigmented skin. The surgeon needs to leave at least 1 cm of labial length to avoid retraction and scarring.  I have seen this type  of problem once when serving as an expert witness for another surgeon and it is hard to fix without complex further surgery.

Price is important in all choices but make sure you are comparing the true expenses.  Is this being offered in an office or operating room, is anesthesia included or is it going to require a number of sensitive injections.

In conclusion, this surgery can be combined with other minor procedures to plump up the outer lips or clitoral hooding to remove excess skin from around the clitoris.

Please visit our website for more information.

Dr. Steven Davison