A Comprehensive Three-Dimensional Rejuvenation Center

Monthly Archives: April 2015

Botox creates a paradigm shift for facial aging

Botox has certainly become part of our lexicon since the new millennium. When I was in medical school at Penn in the early 1990s, botulinum toxin was only something to be memorized in pathophysiology class as the virulence factor for the Clostridium bacterium that caused botulism. Later on, in residency at the Hospital of the University of Pennsylvania, it was used in the treatment of involuntary muscle contractions and eyelid spasms. At the beginning of my plastic surgery fellowship in 1998, Botox was just beginning to be explored as a novel approach to facial wrinkles. The literature and the applications were still in the infancy when I started practice in 2001.

Fast-forwarding to the present, what would women and yes, men, do without this little protein for facial rejuvenation and the prevention of early aging? What started out as a means to control our “elevens” or “mommy frowns” has now blossomed into a method to actually sculpt the face by applying the knowledge of muscle anatomy to deploy Botox in the right areas to balance opposing muscles of the forehead, mouth, jaw and neck, creating pleasing facial postures.

Having been part of the rise and current use of Botox, I can testify that using this neuromuscular-blocking agent can improve your current appearance with regular use and also prevent or postpone the aging process of your face. Today many clients, particularly women, look at it as yet another maintenance activity like getting your hair and nails done.

Botox can be used to selectively weaken the central brow area to reduce horizontal lines in the forehead. It can also be used on the circular superficial muscle surrounding the eyelids to minimize lateral fine lines around the eyes. Applied properly, Botox can preferentially reduce the lateral eyebrow depressor muscles to allow unopposed lift of the lateral brow by the forehead muscle, weakening the fine lines around the mouth, correcting asymmetries of the mouth, and reducing the banding appearance of a thin neck.

While the results are limited to around three months without reapplication, nothing else can achieve these desired effects as well as prevent the future etching of these lines deeper into your skin.

However, when something becomes commonplace, people begin to feel comfortable with the product to the point that they may oversimplify the treatment process. This comfort level can lead to the misconception that anyone can deliver Botox safely and reliably. For optimal safety and efficacy, Botox should only be purchased from Allergan, the owner and developer of the product. The company will only ship to licensed physician offices.

Some people try to purchase Botox online from out of the country in order to save money, which may or may not be safe or effective. The FDA recently reported that fraudulent Botox packaging was being sold on the Internet. There have been deaths or seriously neurologically impaired events when patients got a different kind of botulinum toxin which was a much stronger concentration and resulted in overdoses.

It’s my professional opinion that no one should receive Botox from an establishment that does not have a medical director who is intricately involved in the day-to-day practice of the office and has a firm command of the anatomy of the face and neck. I am baffled by the concept that dentists are now offering this service to patients as well. Having graduated magna cum laude from dental school prior to going on to medical school, I can emphatically state that dentists are not qualified to participate in these services. Botox is not inexpensive — why purchase it somewhere that might result in substandard results, not to mention nerve damage or death? The quality of the result is directly related to the skill level and knowledge of anatomy of the injector. Be good consumers and check the credentials of your provider. Caveat emptor.

Liberate your body and spirit with a total body lift after weight loss

Body contouring
As a plastic surgeon, I see patients who have lost amazing amounts of weight through bariatric surgery and have used this to champion new lifestyles which can eliminate diabetes, hypertension and sleep apnea. Often these patients can discontinue all medications previously taken under a physician’s care. Unfortunately, post-bariatric surgery patients, who are otherwise healthy and active, find themselves prisoners in their own fortresses of hanging flesh.

People feel better, but they don’t look better because of the excess skin on their faces, arms, breasts, abdomens, flanks, buttocks and thighs. Many bariatric surgeons try to provide surgical rejuvenation procedures themselves, leading to less than desirable outcomes and even unnecessary deaths. Plastic surgeons have additional training and expertise and are uniquely qualified to provide patients with a “get- out-of-jail card” from their excess skin. The important principles of body contouring procedures can only be learned in a plastic and reconstructive surgical residency.

What are the procedures that can help you look and feel better?

A total body lift is usually broken up into three distinct procedures, each one taking 6.5 to 7 hours to perform. These are complex and nuanced procedures that necessitate a tremendous amount of skill to remove and reshape the skin. This operation is a life-changing event, and everyone is universally very happy.

1. Circumferential lower body lift with gluteal augmentation: The first procedure I routinely begin with is the circumferential lower body lift with gluteal augmentation with vascularized flaps from the flank region. Upon completion of this surgery, I can make better aesthetic judgments about the breasts and legs. The lower body lift is actually three separate operations performed at the same time: a tummy tuck and flank-plasty with lateral-thigh repositioning and gluteal augmentation utilizing skin from the muffin top and positioning the tissue into the gluteal region to enhance the buttocks.

Despite the long surgical time and the complex number of procedures performed, I almost always send patients home that night. They actually do much better at home than staying in the hospital. All incisions are closed deeply, so no sutures need to be removed. There are four drains, which stay around a week. We utilize a pain pump with a long acting local anesthetic to block pain response. Everyone gets a blood thinner for five days to prevent clots. It generally takes around two weeks to start feeling better.

2. Upper body lift (bilateral brachioplasty with lateral chest wall reshaping and breast rejuvenation): The next procedure is usually a combined upper arm and lateral chest wall contouring (otherwise known as an extended brachioplasty). This surgery is often blended with a breast lift with or without an implant. The brachioplasty is a one-stage procedure with very few complications, and patients love the results. The breast rejuvenation is almost always a two-stage procedure, because the tissues after weight loss are quite complex. If the residual breast tissue is very thin, it may require an implant to help create shape and volume during the second stage.

3. Medial thigh lift: The final surgery is typically the lateral thigh lift. In most cases, we perform aggressive liposuction in the area of the medial thigh, then resect the loose tissue left after the liposuction. The incision spans from the knee to the groin crease on the inner aspect of the leg. This allows us to transversely tighten the skin in this distribution for a much smoother, firmer look. Patients can resume fairly normal activities in a week. It’s a transformative experience to feel comfortable in shorts, dresses and pants by unburdening yourself of loose, hanging skin.

If you have lost significant weight from bariatric surgery or by other means and are experiencing the difficulties of carrying around excess skin that is adversely affecting your quality of life, please contact me at 865.218.6210 or go online to thelucascenter.com to begin your three dimensional rejuvenation today.

Enhance your confidence and self-esteem with chin-implant surgery

Chin blog
Have you ever looked in the mirror and felt that your lower face or jaw line seemed out of proportion with the rest of your face? Do your lower chin and neck look older than your chronologic age? Compared to others, does your nose appear to be overly prominent despite being otherwise attractive? Have you had braces previously to correct an underbite? If the answer is yes to any of these questions, then you may have an underdeveloped lower jaw and/or chin.

Symmetry matters. Our eyes and brain are trained to recognize symmetry and harmony of the face. If one part is out of alignment, our brain makes a subconscious decision that a face is less attractive. It may sound silly, but people who have corrected chin positions after surgery project more confidence without undergoing drastic changes to the face. In fact, patients who undergo a procedure to provide enhancement to the chin are often asked questions such as, “Did you lose weight?” or “Did you change your hairstyle?” The improvement is so subtle, people are unable to pinpoint exactly what you had done, only that you look better than ever.

Preview your results. During your consultation I’ll analyze your face and also have you undergo a Vectra 3D facial analysis that will allow you to see yourself from all angles and help you understand what I’m seeing. We can simulate very closely what surgery is best for you, and you can decide if you are happy with the results in advance of your procedure (no buyer’s remorse should ever happen).

Chin implant surgery is relatively painless. In most cases there is little pain. Your chin and lips may be temporarily numb after the procedure. You’ll wear a compression garment for a few weeks for two reasons: to control swelling and to enhance a tighter smoother neckline that can provide a more youthful appearance. Your treatment might include liposuction of the chin and upper neck.

If your chin is less prominent with respect to your upper jaw and nose, then a chin implant can provide excellent results. I use an implant material made of a very dense polymer that can be trimmed and adapted to the exact dimensions of your jaw; it’s attached to the bone with two tiny screws. This is vastly better than silicone gel implants that can’t be modified or stabilized and are only placed in a superficial plane around the chin, potentially causing erosion of the bone over time. Because of my background in craniofacial surgery, I’m very comfortable operating on the jaw.

You have options. If your chin is less prominent horizontally and is either too long or too short vertically, then shortening or elongating the bone is possible by cutting the lower part of the jaw and sliding the bone forward. This procedure is a little more involved than the implant surgery, but the recovery time is the same, and it is an outpatient procedure. Both surgeries are performed through a small incision at the bottom of the chin, and the scar is very inconspicuous with time.

Other options include making a more powerful looking lateral jaw line with angle/ body implants. This can be helpful for patients possessing a steep jaw angle with lack of lateral definition to the jaw line. In this situation an implant can be placed through the mouth to enhance the jaw angle and lateral jaw allowing a stronger appearance which males in particular desire.

There are many options for chin enhancement surgery. I look forward to finding the right treatment for your needs. Call 865.218.6210 today or go online to thelucascenter.com to schedule your consultation.

Rebecca Ludwig, Clinical Aesthetician

RebeccaRebecca is our licensed aesthetician. With more than 17 years of experience, Rebecca is passionate about helping our patients optimize the health of their skin and look years younger. Rebecca will work closely with you to design a fully customized regimen to help you reach your skin care goals.

She will also work in close consultation with Dr. Lucas to enhance and promote the longevity of your results following facial rejuvenation surgery (e.g., face lift, brow lift, rhinoplasty, etc.).

Certified in medical aesthetics, Rebecca completed training at the Knoxville Institute of Hair Design, Hair Academy, and lnstitut’ DERMed in Atlanta. She has an advanced Medi Clinical Spa Certification and is an Xtreme Lashes certified Lash Stylist.

Not only will Rebecca work with you to improve your skin, she will help educate you on the best products and services. Her soothing personality and knowledge will give you confidence that you are doing the best thing possible for your skin.

$20 off any services scheduled with Rebecca or any product purchased on April 24th at our open house. Reserve your spot today by calling 865-218-6210 or e-mail at tlc@thelucascenter.com