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Skin Discoloration

Looking to brighten up your skin this winter? One mode of treatment may not be enough. Effective treatment for hyperpigmentation includes clinical procedures combined with a daily skin care regimen at home. Over time, this combination will reduce the appearance of discoloration and minimize its reoccurrence.

Types of hyperpigmentation:

Freckles: genetic condition. Appears anywhere on body, predominately on face.

Melasma: hormonally-induced. Most commonly occurs on face and is generally symmetrical with defined edges. Sometimes called butterfly mask.

Actinic keratoses: occurs on any part of the body where skin has been overexposed to UV and is considered precancerous. May be flat or raised, red or brown in color.

Sun spots/Solar lentigines: Occurs anywhere on body that has been exposed to UV. May be flat and irregular.

Post-inflammatory hyperpigmentation (PIH): Caused by post acne marks.

We provide chemical peels in office. Chemical peels reduce the appearance of fine lines and wrinkles, smooth skin texture and improve the overall tone. A solution is applied to the skin to resurface the outer layer. Over the next week – post treatment, your skin may begin to slough off, revealing a brighter complexion. Chemical peels vary in strength and which one used will be determined by a skin care professional. The number of treatments will vary based on your skin care concerns.

Daily regimens may be long and require continued use, but when compliant, studies show noticeable results within 12 weeks. SkinCeuticals antioxidants provide broad-range environmental protection against UVA/UVB and pollution. Phloretin CF is our antioxidant of choice for hyperpigmentation. Found in the peel of green apples, Phloretin CF inhibits excess melanin production, so it gives you that extra protection alongside your broad spectrum SPF. This treatment is to be used in the morning after cleansing your face.

With SkinCeuticals newest product, Discoloration Defense, you may see results in as little as 2 weeks. This treatment is hydroquinone-free and formulated for hard-to-treat discoloration, including post-acne marks and melasma. Its active ingredients provide a multi-mode mechanism of action to address multiple triggers of hyperpigmentation within the skin. With continued use, Discoloration Defense minimizes the reoccurrence of discoloration. This treatment is to be used in the morning and evening after cleansing and antioxidant.

Topical retinols are recommended to improve visible signs of aging and dark spots. SkinCeuticals Retinol creams utilizes a time-released system which minimizes erythema, commonly associated with retinol use. The soothing, anti-inflammatory cream eliminates the need for additional moisturizer in the evening. This formula will not clog pores and helps prevent formation of whiteheads and blackheads. This treatment is to be used in the evening, after cleansing and before your nighttime antioxidant. You will need to titrate incorporating a retinol into your skincare regime. Start using twice weekly, then progress to more as you become more tolerant to the product. Light peeling/flaking and temporary redness is normal.

It is imperative when beginning an effective discoloration regimen, you use a broad spectrum 30+ SPF. We have sunscreens available for all skin types for daily use.

The non-surgical rhinoplasty; what are the possibilities?

Noses occupy a prominent position on the human face. Many normal anatomic and ethnic variations exist and, depending upon proportionality (e.g. width, length, projection, etc.), the rest of the face can accentuate nasal variations. In some individuals, these variations can and do detract from the overall aesthetics of the face. The key to any surgical or non-surgical intervention by a plastic surgeon is a carefully performed detailed facial analysis. Once analyzed, a surgical or non-surgical approach involving the nose and interplay of the middle and lower third of the human face both in terms of bony structure and soft tissues such as fat pads, muscle of the lips and mouth and chin can greatly enhance the appearance of the nose.

A common nasal variation that many Middle Eastern and Asian descendants have, which they commonly want corrected, is a prominent nasal dorsal hump which slides down an inclined plain to a projecting nasal tip referred as the “poly beak” deformity. Often this is paired with a prominent caudal (lower) septum that plunges downward giving the appearance of a large view of the side nostril. The nasal tip can be further pushed downward during smiling animation if the person has a paired muscle that spans the lower portion of the nose and inserts into the circular muscle of the lips/mouth. Any time the person animates a smile it further pulls the lip upward and the tip of the nose downward. If the lower facial third is diminutive with respect to the middle facial third, such as people with an underbite, the nose in these cases rises to a more prominent position with the overall face. Without question a definitive surgical open septo-rhinoplasty for nasal deformities would provide the best results and, if the individual has the above-mentioned dental-skeletal relationship, adding a chin procedure such as a genioplasty or, if indicated, a chin implant would add harmony with the lower facial third to provide a superior result.

Alternatively, if surgery is not an option, non-surgical approaches can be employed to reduce the appearance of the anatomic variations that might displease the individual. Once again taking a very global detailed facial analysis is imperative to achieving the best results. Primiarily, if a patient presents with the animation deformity of the nasal tip when smiling leading to further lack of nasal tip projection, planned neurotoxin injections such as BOTOX or Dysport can be placed into the depressor muscle under the lip to prevent this action from occurring. If the patient has a retruded chin as we have specified previously, we can enhance the projection with a filler agent such as Radiesse which has the greatest “G prime” number meaning it resists deformity better than any other filler agent. Radiesse can be injected just above the bone on the chin’s tissue to enhance the furthest projection point of the chin creating a more balanced lower facial third making the nose appear less prominent. With respect to the nose itself we can add a hyaluronic acid filler agent such as Juvederm Voluma to the dorsum of the nose to soften the appearance of the nasal hump in conjunction with additional volume added to the nasal tip minimizing the “hook nose” shape. If the plunging caudal (lower) septum gives a greater view of the inside of the nose from a lateral view then adding a filler agent in the nasal mucosa above the lower lateral cartilage may act like a alar strut graft and push the inferior alar rim downward to reduce visualization of the inside of the nose.

If patients have had previous trauma to the dorsum of the nose or have an anatomic variant such as a ski slope deformity, added volume deep to the dorsum and below the skin can build this area up obscuring the underlying deformity. One important point to make is that non-surgical approaches cannot provide a subtraction affect which is needed in a bulbous nasal tip but can provide added volume in other areas such as the chin to balance out the enlargement of a nose.

Bottom line: never chose a provider to perform non-surgical approaches to the nose if they are not already an experienced rhinoplastic surgeon because filler agents are not in-expensive and it takes years of experience to be able to properly analyze and treat noses for optimal results, therefore – invest wisely.

State of the art lipo-abdominoplasty

Many women, after childbearing or significant weight loss, find themselves less than satisfied with their abdominal contour. They may have joined a gym, hired a personal trainer, engaged in cross-fit or boot camp and despite all the blood, sweat and tears still have sagging skin and loose abdominal tissue resulting in bulging of the tummy area. Often the flank areas “muffin top” and the mons pubis and perineum (or genital area) can also cause issues that detract from a sleek look with current athletic leisure wear. Fortunately, board certified plastic surgeons who remain engaged and committed to the continuous evolution of our craft have good options to improve the contour of the abdomen and surrounding areas.

Abdominoplasties have been around for many decades but refinements in techniques have led to better aesthetic outcomes:

  1. Liposuction of the epigastrium (upper central region of abdomen): reduces the skin thickness and can lead to a less bulky appearance when combined with tissue resection of excess loose skin.
  2. Resection of the upper abdominal skin flap sub-fascial fat plan: which can reduce the metabolic load of the flap by eliminating the poorly vascularized fat plain while diminishing the overall thickness of the skin.
  3. Discontinuous undermining of the abdominal skin flap off the costal (rib) margin: to allow further inferior repositioning of the skin flap to lower the final incisional scar to hide better in undergarments and or bathing suits.
  4. Progressive tension suture plication technique of the upper abdominal skin flap: to aide in the obliteration of dead space to reduce and or eliminates the amount of time that drains are necessary and to further sculpt the underlying abdominal shape.
  5. Fascial plication of the inferior edge of the upper skin flap to the lower abdominal wall to prevent scar migration superiorly.
  6. Resuspension, lipocontouring, and reshaping of the mons pubis to provide a sleeker appearance in leggings and yoga pants.
  7. A vertical narrow appearing belly button.
  8. Contouring the flanks with liposuction simultaneously with the abdominoplasty for more circumferential rejuvenation.

 

Just as fashion changes occur so must the plastic surgeon respond to effectively provide aesthetic outcomes that provide body contours that complement the new overlying clothing. The above-mentioned refinements can produce superior results compared to traditional abdominoplasties. If you would like to initiate a consult to see if you are a candidate for abdominoplasty please contact The Lucas Center, Plastic Surgery in Knoxville TN at thelucascenter.com, or 865-218-6210.

Gluteal enhancement and lift with expanded volume lipofilling

Based on the most recent data from the 2018 American Society of Plastic Surgery statistics: buttock augmentation and lift continues to increase in popularity. Some of the enticement that draws prospective patients to seek this operation is the fact that areas of unwanted fat distribution such as excess flanks, bra line fat, abdomen, and thigh tissue excess can be lipo-contoured to give improved body shape while being the donor site to provide needed fat to be placed into the buttock to correct volume and aesthetic form to the gluteal region. This is one example of robbing Peter to pay Paul that benefits both.

Many varied techniques exist to perform this operation but clearly the best approach that provides excellent outcomes and safety is the expanded volume lipofilling technique described by Drs. Wall and DelVecchio and I have incorporated their methods into my practice. The approach allows for efficient application of fat with an oscillating cannula and an expanded tip which actually creates an enlarged space while simultaneously layering the area with fat. The gravest risk associated with this procedure is being unfamiliar with the anatomy and losing reference of the tip of the cannula and injecting the gluteus muscle with a small diameter tip which can cannulate rather large veins which are confluent with a venous network which ultimately returns to the heart and lungs. A large bolus of fat can act just like an emboli of blood clot and can result in death. Several cases in South America and in the state of Florida have resulted with this outcome. Understanding the human anatomy is very important to prevent this outcome as well as using large cannulas that are two big to enter the venous system and always pointing the tips toward the skin. The process starts by filling areas of deficiencies laterally and superiorly followed by inferiorly to achieve an attractive buttock.

The results are very satisfying for both the patients as well as myself because we create pleasing hour-glass figures by eliminating unwanted contours of the upper and mid- back and sculpting the flanks to get rid of the muffin tops and enhance the aesthetic curves of the back as it sweeps to the buttock. If this sounds like it could apply to you and you wish to have a consult to perform body sculpting with buttock enhancement please contact my office either by thelucascenter.com , or 865-218-6210 to schedule an appointment.

Brows that WOW – Microblading

On the cutting edge of aesthetic services, The Lucas Center is now offering Microblading.  Microblading is a semi-permanent eyebrow tattoo for those who wish to create or enhance their natural eyebrows. This procedure allows you to fill and redefine the eyebrows creating results with a natural appearance. Unlike permanent cosmetics, Microblading is performed by manually depositing pigment into the upper layer of the dermis. These micro-strokes mimic the appearance of real hair, lasting up to 2 years.

Microblading is performed in two sessions 4-6 weeks apart to achieve a full eyebrow appearance. A touchup every year is recommended to keep eyebrows looking fresh and crisp.  Eyebrow shape and size are customized to individual client preference.  Color options are available for desired aesthetic results. 

This procedure is ideal for those who want a natural look without daily maintenance.  For the comfort of our clients at The Lucas Center, we offer a local anesthetic administered by our RN/Aesthetician at no additional charge.

Call The Lucas Center to schedule your procedure today!

Breast enhancement with implants and fat grafting utilizing lipofilling technique

Style and personal preferences continue to evolve in breast enhancement trends. Women are requesting a more natural, proportionate breast enhancement compared to the 1990’s Bay Watch appearance. This reflects both style changes and is better aligned with outcome data by both The American Society of Plastic Surgery and the American Society of Aesthetic Plastic Surgery, which denotes smaller revision rates for patients who chose implants offered to them by surgeons who base the choices from a tissue based diagnostic analysis. Women today want long term results which will provide “perky” uplifted breasts proportionate with their frame and will not bottom out overtime from excessively large implants. This lends itself to other trends seen in popular magazines such as the “free the nipple campaign,” and evening gowns with side breast exposure which looks much better with a breast well confined to the anterior chest wall. This profile provides an attractive lateral breast silhouette compared to an overly protruding lateral bulging breast from excessive breast volume or excessive implant size.

I have incorporated an amalgamation of several analyses from leading authors for determining the best implant options for my patients. However, I strongly focus not only on the soft tissue but the underlying skeleton as well. Just as an architect or a civil engineer has to factor the underlying topography of a building site so should a plastic surgeon in the final treatment plan for their patients. The shape and width of the sternum (breast bone) and the shape and slope of the underlying rib cage as it merges with the axillary region has significant impact on how successful a breast enhancement will appear. Imagine if you would a wide breast bone separating the two breast will not allow a tight cleavage appearance no matter how large of an implant is placed. Rapidly sloping rib cages from the sternum to the axilla will result in the overlying breast laying divergent from one another and the larger the enhancement with an implant the more divergent the nipples will become. Also long torsos often times will result in a long distance from the breast fold to the collar bone giving an appearance of a low set breasts. And the situation of a narrow chest wall with a long torso often times, in my opinion, mandates a shaped implant (taller in height than in width) with a highly cohesive anatomic gel compared to a responsive gel to provide an appearance that the breast begins higher on the chest wall. In my clinical experience, roughly forty percent of all the women who seek breast augmentations either have a skeletal configuration issue or a breast soft tissue issue such as a constricted breast deformity that may result in less than satisfactory results with an implant alone. This is why a very thorough physical exam combined with the patient being able to see themselves in a three dimensional imaging system (VECTRA) will allow them to understand why they cannot achieve a result that their best friend may have with a given implant due to individual anatomic variations.

Why Fat Grafting?

The evolution of large volume fat grafting with the expanded volume lipofilling technique to the breasts has been a paradigm shift in how I deliver care to my patients. Fat grafting has proven to be an integral component of an augmentation procedure with implants by helping to overcome some of the anatomic limitations stated above that women may exhibit which can greatly diminish the outcome of these procedures. It has elevated my results additionally by softening the outline of the implants superiorly and helping to avoid the pleating appearance which may occur with even silicone gel placed in the sub-glandular plain. Certainly a controversial topic in any plastic surgery forum on breast augmentation is which anatomic plain is superior for placement of implants. However, my current view, as well as many other highly respected plastic surgeons is: if it is at all possible avoid the downsides of the muscle by placing the implant under the gland. This can reduce animation deformities and the continuous strain of the muscle contracting overtop of the implant increasing the likelihood of the devise from being displaced inferior-laterally overtime. Also, for the constricted breast deformity where the anatomic fold is too high and the lower pole of the breast is tight with less breast volume present, the plan of action is to score the breast tissue underneath and lower the fold to allow the limited breast volume to unfold around the lower pole of the implant to avoid a double bubble effect. Unquestionably, the use of added fat volume to fill this space to further cover the lower implant will, at the same time, result in superior outcomes. I also think that the soft tissue/ implant ratio, if unfavorable, may also lead to an increase risk of capsule contracture outside of the normal biofilm/inflammatory mediated model. I also utilize fat grafting in many of my mastopexies (breast lifts) when performed with or without an implant or in the event that some women wish to permanently remove their implants and wish a breast lift only. Fat grafting can be a wonderful means of adding upper pole volume without the implant. Some women choose to enhance their breasts with fat grafting alone. I first discuss with them that, in my opinion, a combination technique is best but the fat grafting technique alone can yield a modest increase in cup size. Generally, breast volume is stable at around four months post surgery with around 30-40% of the initial fat grafting volume lost due to lack of vascularization. Unfortunately, the best outcome with this approach is right after surgery with all of the fat grafting present combined with natural swollen tissue.

What is expanded volume lipofilling.

Dr. Sydney Coleman was the first plastic surgeon to strongly pursue fat grafting in many areas of the face, hands, and breast. He initially was viewed as a pariah in the industry but his persistence has led to a wide spread acceptance of the concept of fat grafting. He initially used very small cannulas with limited volume application and placed in many different plains to ensure the fat graft take with a blood supply. Fast forward to today, critical thinkers such as Drs. Simeon Wall and Dan DelVecchio have risen to the needs of large volume fat grafting to the buttock and breast and have created a technique of simultaneously expanding the volume of the recipient site (i.e. breast tissue and overlying skin) while back filling this enlarged space with fat in a very expeditious method utilizing PAL (Power Assisted liposculpting) headpiece with an expanded basket cannula. Essentially, the vibrating headpiece is connected to a hydrostatic pump that moves fat from the harvested reservoir retrograde through the cannula and dispenses the fat in a very laminar pattern similar to shaking tiny mustard seeds from a hand onto the ground. This very much avoids clumping which can lead to fat necrosis nodules. The vibrating motion of the basket cannulas expands the volume of the space thus reducing hydrostatic forces on the newly placed fat cells allowing for a greater volume to be placed without strangling the cells under undo force. Additionally, this process rapidly speeds the placement process compared to pushing single aliquots of fat being injected via a syringe thus reducing expensive operative time for the patient. I generally agree with the technique of fat harvesting into a large canister with fat separation from the aqueous component with decanting methods only for the buttock, but with the breast containing a more limited space particularly with an implant underneath, I prefer to clean the fat and more thoroughly remove the excess aqueous fluid with a single use devise called Revolve by Allergan. Therefore, I can be assured all volume injected is viable fat and not excess fluid as well.

In conclusion, successful and extraordinary results in augmentation mammoplasty can be achieved but requires three dimensional thinking, of not just the breast, but the surrounding skeletal and soft tissues of the chest wall. Implant decisions are not just based on volume alone but on the distribution of volume in various implants and may require a shaped implant to achieve a superior result of a round devise. The use of fat grafting to enhance areas of soft tissue deficiencies surrounding implants or to place volume outside of where an implant cannot be placed such as the decollate can lead to superior results not previously available with implants alone utilizing sculpting techniques with fat. Lastly, the newly acquired techniques of expanded volume lipofilling are creating more efficient and larger successful volumes of fat administered with this methodology.

If you are interested in a thorough three dimensional analysis for an ideal breast enhancement tailored to your specific needs please contact The Lucas Center, Plastic Surgery,Knoxville, Tennessee at thelucascenter.com or 865 218 6210.

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