A Comprehensive Three-Dimensional Rejuvenation Center

Monthly Archives: May 2016

Why less is more: the trend toward natural looking breast enhancement

Fashion trends change, and so do accepted ideals for body appearance. The influences of Latin culture on American norms have triggered an explosion in the demand for buttock enhancement with fat grafting, which was first popularized in Brazil. Another trend patients are requesting is a more conservative and natural looking breast enhancement. A recent survey in California found that women are not looking for an oversized breast enhancement and desire a more subtle appearance. This is a healthier choice for women to choose.

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Due to the prevalence of evidence-based medicine and FDA demand for data on silicone gel breast implants, findings indicate that revision breast surgeries after a primary augmentation mammoplasty are as high as 25 percent. The main reason for these revisions is capsular contracture, but size change is a factor. Thanks to the work of Dr. John Tebetts, Bill Adams and Dr. Dennis Hammond, the concept of calibrating the correct implant size for a given individual based on breast tissue characteristics allows for customization and has reduced revision rates for surgeons who incorporate these findings into their practices.

The idea of putting the largest possible implant into a women’s breast is fraught with potential complications including excess stretch on the tissues leading to thinning of the breast which may result in increased prominence of rippling of the implant, as well as mal-positioning of the device either laterally or inferiorly. This causes an unsightly aged appearance of the breast. The cost of revision can be high if treatment plans include the need for added soft tissue support utilizing acellular dermal matrices or a silk textile mesh to restore soft tissue support of the implants.

Today is a very exciting time in the field of augmentation mammoplasty, because we surgeons have a wide variety of shapes and sizes and silicone gel consistencies to choose from to provide customized results for our patients.

I strive to deliver a primary augmentation of the breast with a correct implant that is sustainable by the body to provide a long-lasting aesthetic result free of revision until the integrity of the implant has failed.

I think in terms of the height and width and projection of the breast independently and choose styles and shapes to match my patient’s desired outcome. I never want people to say that all my breast augmentations look the same. Just as all faces are unique and different, so are breasts. I want to make an individual’s breast look and feel as attractive as possible with long-lasting results. Proportionate breast enhancement is key to achieving these results.

Furthermore, now fat grafting can be performed simultaneously with implant placement, allowing surgeons to correct volume and shape asymmetries, as well as fill in spaces where an implant cannot be placed, such as the cleavage region and the chest wall/implant interface.

If you’re considering an augmentation mammoplasty, take a look at a three-dimensional analysis imaging of yourself. Then discuss your tissue type and pre-existing breast tissue with your surgeon, who will devise a plan to make a customized result that will look attractive and proportional with your frame. A skilled board-certified plastic surgeon will choose an appropriate implant with or without fat grafting to highlight your own unique figure with long-lasting results.

Renew, Refresh, Restore

Spring is here and what a perfect time to refresh your look for graduation, Father’s Day (yes, men do it also!), weddings, or before that fun vacation! It is time to put yourself first, which is hard for so many of us to do. We schedule our physicals and hair appointments. Why not start making appointments to take care of our skin, slow the aging process, and feel more confident? It’s never too early or too late to start. I see patients of all ages, and I will meet with you individually to ensure our goals and expectations are the same. Patients in their early 30’s might want to prevent deeper lines and wrinkles versus the more mature patient that is working to correct volume loss, soften lines, and have a more youthful appearance.

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We have many options to offer depending on your specific goals. I can offer nonsurgical aesthetic treatments, starting with a thorough assessment which includes speaking with you about your concerns, a physical assessment of your face explaining changes I observe from the aging process, and completing a Vectra 3D image. The Vectra 3D imaging is a great tool to assess volume loss in the face, asymmetry and skin quality. We then use this baseline evaluation as a comparison tool during treatments. I also take traditional photos before treatments. It can be overwhelming to take in all this information, so I like to discuss options and come up with a treatment plan to best fit the patient’s desires and budget.

One of our most popular treatments is to use a neuromuscular blocking toxin such as Botox or Dysport to treat frown lines in between the eyebrow, crow’s feet that develop at the corner of the eyes, and forehead creases and wrinkles.

Dermal fillers can address volume loss in the face, reduce lines, wrinkles, and creases on aging skin, create fuller lips, and give the face a more youthful appearance.

My goal is to always keep the patient “natural” looking and make subtle changes to the face. There are multiple dermal filler options. Most are made of hyaluronic acid, which is produced by our own bodies. I select the product based on location and desired effect. Examples are Juvederm, Voluma, Restylane, Lyft, and Silk. I love Sculptra which is an injectable poly-L-lactic acid.  It promotes collagen growth, which improves volume loss, creases, and softens lines. It is an excellent choice for volume loss in the temple area. The key is a good facial assessment and working with my patient to decide on the most beneficial products.

Now a word about microneedling – It is an excellent investment in addition to a neurotoxin and dermal filler to address the aging face. A treatment can be done every four to six weeks promoting collagen growth and improving skin elasticity with minimal down time. Microneedling can improve the appearance of fine lines, acne scars, surgical scars, and stretch marks.

At The Lucas Center we have a dynamic team with over 100 years of combined experience in medical and aesthetics. We are privileged to be led by Dr. Jay Lucas, a board-certified plastic surgeon, who provides medical supervision of the aesthetic team. If your needs can’t be met through aesthetic treatments and filler agents, Dr. Lucas will be glad to meet with you through an individualized consultation appointment to discuss surgical treatments.

Do you look in the mirror and notice subtle changes on your face and frown? The aging process can sneak up on us. The Lucas Center can help you feel more confident about your skin and overall appearance. Get summer ready!

Step Ahead with The Lucas Center! Give us a call today at 865-218-6210 to schedule your free consultation with me.

Non-invasive Kybella may improve your neckline

Non-invasive aesthetic procedures have come a long way in the last ten years. The American Society of Plastic Surgery’s yearly statistics continue to demonstrate strong demand for procedures such as neuromodulators (Botox and Dysport), and hyaluronic acid filler agents (Juvederm, Voluma, Restalyn). Recently, non-invasive contouring systems that perform the techniques of cryolipolysis, such as Cool Sculpting and radiofrequency skin-tightening Ultherapy, have emerged in the marketplace. Now Allergan has added Kybella to the mix as a non-invasive injectable material to dissolve fat under the chin.

Before and After

Before and After

The key to success with these treatments is consulting a comprehensive center that offers a full array of non-invasive and surgical options, and will direct you to the ideal treatment modality for your unique circumstances. Just as with any medical and surgical procedure, there are appropriate candidates and patients with contraindications.

The most important step to avoid dissatisfaction is to be evaluated by a physician who is properly trained to perform comprehensive evaluation and care for all patients with a particular aesthetic concern.

Board-certified plastic surgeons have the most comprehensive education and background experience to correctly evaluate your anatomy and determine which treatments will yield the best outcomes. The statement “if all you have is a hammer the whole world is a nail” rings true for medical spas and dermatologist offices which only have one option, such as Cool Sculpting or Kybella. Just because a treatment option is non-invasive does not mean it is inexpensive. If you factor in the cost of multiple treatments, it may be as expensive as surgery and still fall short of expectations.

When is Kybella the right choice?

With the current status of the injectable form of deoxycholic acid (Kybella) the ideal candidate must have reasonably tight skin with only mild to moderate adipose excess in the submittal and chin neck angle. The patient should not have a significant mandibular jaw discrepancy with the midface or have a particularly steep mandibular plain angle.

When is Kybella the wrong choice?

Any patient with lax skin of the neck or a significant deflation of the neck related to weight loss with demarcated platysmal bands is not a candidate. Taking away fat in this circumstance only worsens the deformity. Any patient with a deep underbite and a small chin with a very oblique chin-neck angle should also avoid Kybella. Deoxycholic acid is mostly created to dissolve fat but does produce some inflammation with the caustic material to encourage collagen production and skin retraction. Skin excess with an oblique chin neck angle and recessed chin will not yield overwhelming positive results.

Instead of Kybella, the better option is placement of a chin implant (genioplasty) with aggressive liposuction to encourage skin retraction. A middle facial third with significant skin excess and deflation combined with loose-hanging skin with platysmal bands is best treated with a corset platysmaplasty in conjunction with a neck/face lift.

Non-invasive aesthetic procedures can be a wonderful adjunct to helping people age gracefully with limited down time. Kybella in the right situation may improve necks and make people happy with the results.

Avoid being pushed into this option without a thorough three-dimensional analysis of your face to determine if it’s right for you. Nothing is more frustrating than spending a great deal of money and not realizing your desired results. Even with surgery, some deformities may not be able to be corrected. Take advice from a board-certified plastic surgeon to maximize your goals and to feel good in your own skin.