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The Three P's of Plastic Surgery

It used to be that one would go to a salon simply to get one’s hair and nails done, but these days salons offer all kinds of beauty treatments including cosmetic injectables and even more invasive procedures. The prices can be very cheap, but the results can be catastrophic.
Why is it crucial for consumers to take a second look and ask more questions? Notably, there were dramatic cases out of Miami last year when reports surfaced about illegal cosmetic injections being performed on several women. “Doctors” were accused of injecting these women with substances like mineral oil, super glue, concrete, and Fix-a-Flat. The women reportedly were getting buttock injections in hopes of attaining a healthy “backside”, but they could have lifetime disfigurement as a result.
Earlier this year, in Tyler, Texas, a salon owner was arrested for injecting clients in the breast and buttocks with an unknown substance (likely automotive grade silicone) and closing it with a superglue-type sealant. Why would someone get this done to their body? Perhaps it is the very low cost and the lack of information about what these victims are being injected with.
Please be educated on the three P’s of getting a cosmetic procedure done as safely as possible: Product, Practitioner, and Place.
1. Product – Make sure the product you are getting injected with is an FDA approved product for the particular area you are wanting injected. The FDA has approved certain products for injection into different regions of the face for cosmetic purposes, like Botox, Juvederm, Restylane, Radiesse, and Sculptra. There is no synthetic material that has been approved by the FDA for injection in the breast so that is a red flag itself. Ask what neurotoxin or filler is being used, and even research the product labeling online. If a provider refuses or is unable to tell you what material you are being injected with, do not let that person treat you.
2. Practitioner – Know what type of practitioner to go to like a physician trained to do cosmetic procedures or his/her designee has cosmetic injection training.
3. Place – Don’t get injected in a place that you feel uncomfortable undergoing a procedure in such as a salon, mall, or private home. These are medical procedures and they should be performed in a medical office or medical facility due to its sanitary environment with resources at hand. Often the price may seem too good to pass up, but if you hear of a Groupon ad that’s too good to be true or a salon owner that is offering rock bottom prices on something that is going to be injected in your face or body, let the buyer beware as it be dangerous or even fatal. Even at a Botox “party” or event, a physician must be supervising anyone who is doing these procedures and they must the appropriate credentials.
In other words, do your research, ask questions, and become informed!

This information is brought to you courtesy of Dr. Mark Bishara and The Paragon Plastic Surgery & Med Spa


 

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Is Plastic Surgery the Ultimate Gift

Cameras, jewelry, iPods. These are things we expect to see on the wish lists of our friends and family. But, a face lift? Yep, it seems that cosmetic procedures have found their way into Santa’s sack.
With this trend, though, comes a warning. While giving someone a pricey surgery can be considered kind and loving, it can also come with problematic implications. Because the choice is such a personal one, gifting a plastic surgery procedure can be interpreted as meddling and insulting. If you’re thinking of bestowing a loved one with the gift of physical improvement this year, make sure it will be well-received.
Gift-Giver Beware
It wasn’t so long ago that plastic surgery was a hush-hush topic; something that people did but didn’t discuss. But with its rapid rise in popularity and the openness with which many celebrities discuss the work they’ve had, the stigma has been lifted. And with that lift, we’ve seen the fairly recent phenomenon of giving surgeries as gifts.
Presenting significant others and family members with cosmetic procedures has become increasingly common. And it’s not unusual for people to use the holiday season as an excuse to pay for a loved one’s surgery. This practice, however, can rub some people the wrong way.
Surprise Surgery
When it comes to buying someone else a surgery, the worst mistake is making it a surprise. For example, giving your girlfriend a gift certificate for a breast augmentation can cause offense if she didn’t ask for it. It would be like giving someone a membership for a weight loss program; it sends an obvious message that you’re unhappy with their appearance. What was meant to be a present is actually an insult.
There’s really no right way to offer someone a surgery unexpectedly. If you give a certificate for a specific procedure, it’s very clear that you’re critical of that particular part of their body. And if you give an open-ended certificate to a plastic surgeon’s office, it comes across as a general affront to their entire appearance. You might as well say, “I’d love you more if your body were different.”
The Right Way
Giving the gift of surgery is less problematic when it’s on the patient’s wish list. If someone expressly asks for a surgery, then the gift can be considered extremely generous and thoughtful. If the asker isn’t able to afford the procedure on their own, receiving it as a present can be a dream come true.
Before making a purchase, remember that the choice to have a plastic surgery is a very personal one that should be made without the influence of others’ desires for your appearance.
The best possible scenario goes as follows: You are absolutely certain that someone wants a specific procedure as a gift- and you give them a gift card. In a consultation, the surgeon will be able to fully inform the prospective patient about their options, the risks involved and the expected outcomes, as well as an accurate cost. Only after these preliminary steps, should the gift be considered.
There are certainly more conventional and less awkward gifts than that of a plastic surgery procedure. A present should never result in hurt feelings or compromise of one’s own desires. But, if you’re still thinking about wrapping up a surgery gift certificate, make sure it’s for the right reasons.

This note is brought to you courtesy of Dr. Mark Bishara and The Paragon Plastic Surgery & Med Spa


 

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Minimally Invasive Facial Rejuvenation- by Dr. Mark Bishara, MD

Aside from being the largest organ of the human body, skin is also the only organ continually exposed to the surrounding world, interacting with the environment and reflecting the general health condition and age changes.
How Skin Ages
Understanding the mechanisms by which the skin ages has been increasing significantly, along with considerable progress on the way to prevent and reverse the visible signs of aging. However, there are still several mysterious factors concerning aging process and why we all appear to age differently. Aging of the skin is likely caused by both intrinsic (biologic) ‘intrinsic aging’, and extrinsic aging (environmental) factors ‘extrinsic or photoaging‘; these factors are interconnected and may share a final common pathway. The quality of skin features is greatly affected by aging, as skin ages, it tends to become roughened, lax and wrinkled with some pigmentary changes.
The main feature of photodamaged skin is solar elastosis; with accumulation of elastotic material in the dermis. Meanwhile, photoaged skin shows gradual decrease in collagen content. Additionally, collagen becomes disordered with decreased synthesis and enhanced breakdown. These changes contribute to the skin laxity and wrinkling formation.
Skin Rejuvenation
Besides being an art, facial rejuvenation is a developing science. Patients now routinely present to their physician requesting information on improving the signs of facial aging; it is the physician’s responsibility to select the most appropriate intervention(s) based on the patient’s age, physical needs and concerns, extent and location of volume loss and cosmetic goals. Different therapeutic approaches were used throughout the years to give the face a youthful appearance. However, because each person is unique, there is no one modality that is best for everyone. Therefore, to choose the most appropriate therapy, distinctions must be done between rhytides caused by loss of collagen within the dermis, wrinkles due to volumetric loss of fat, redundant folds created by gravitational pull and those caused by hyperfunctional facial muscles.
For ease of patient education, the treatment options for addressing these changes may be simplified into five categories, often referred to as the ‘5 Rs (Redraping, Resurfacing, Retaining, Relaxing and Refilling) of skin rejuvenation: surgically Redraping and lifting redundant tissue; Resurfacing photoaged skin with ablative or non-ablative technologies whether physical, chemical or mechanical; Retaining with skin care; Relaxing dynamic rhytides that are due to hyperfunctional muscles with neurotoxins and Refilling of diminished subcutaneous tissue by restoring 3D volume.
Ablative and Non-Ablative Procedures
Although ablative modalities remain the gold principle for photodamaged skin rejuvenation, its use is associated with risk of side effects as well as a prolonged and an unpleasant post-treatment ‘downtime’ and recovery period. Thus, interest in ablative treatment has waned considerably while non-ablative modalities as well as fractional skin rejuvenation have become appealing alternative treatments.
New perspectives in non-ablative skin rejuvenation treatments have been established with the development of new technologies and techniques, which are used to rejuvenate skin with minimal downtime and complications. Many different terms have been used to describe these procedures including: subsurface resurfacing, laser toning and minimally invasive skin rejuvenation. These modalities are designed to produce many cosmetic benefits, including improvement of wrinkles, skin laxity and texture.
Beside lasers and various in-office procedures, many topical skin care agents were used for prophylaxis as sun screens and for rejuvenation such as retinoic acid and different anti-oxidants including vitamins C and E, co-enzyme Q10 and green tea.
Choosing the appropriate treatment modality which will be the key to success in skin rejuvenation depends on careful evaluation and determining the patient’s needs, skin type and condition, to frame a treatment plan. Good candidates for minimally invasivetechniques tend to have minimal facial sagging. Patients should understand that skin texture will improve and fine lines will be softened but not eradicated. Cumulative aesthetic benefits will occur gradually and will be less dramatic than those seen with ablative resurfacing. Patients with Fitzpatrick skin type III or less are generally best candidates for different procedures with minimal risk of complications.
Goals of Minimally Invasive Treatments
The goal of most minimally invasive treatments is to induce selective dermal injury which results in wound repair response; while keeping the overlying epidermis intact. In response to the induced dermal injury, the healing process begins to stimulate the fibroblast with deposition and reorientation of collagen bundles. Such modalities for skin rejuvenation could be classified into two types, the first relates to treatment of ectatic vessels, pigmentation and pilosebaceous changes, while the second refers to dermal remodeling with wrinkle reduction and/or skin tightening.
Dr. Mark Bishara, whith office in Mansfield and Southlake, TX- provides a wide range of cosmetic procedures to help patients look and feel their best. These procedures are designed to improve the appearance of the face and body through minimally invasive techniques that provide highly effective results. Many of these procedures can be combined in order to achieve your desired appearance. All of our procedures are performed using the most advanced, state-of-the-art equipment.
At our office we offer many treatments that are ablative as well as non-ablative.  Our Pragon Med Spa offers many laser services- skin tightening, skin resurfacing, as well as peels and microdermarbrasion.  Our office also offers Botox, Juvederm and Radiesse.  The new Juvederm Voluma XC will be coming soon.  Please call our office for more information at (817) 473-2120.
 

 

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What Age is Too Old for Cosmetic Surgery- by Dr. Mark Bishara, MD

According to an opinion piece published in JAMA Dermatology, when considering the appropriate ages for aesthetic procedures, the question isn’t so much “What age is too young” as it is “What age is too old?”

In that edition’s Viewpoint feature, the authors write that deeply-etched facial lines that develop as patients age “are caused by repeated folding of the skin and include lines of facial expression and sleep lines,” and that in young adulthood these lines predict “the unique pattern of facial wrinkling that will be seen without expression years later.”
Regular treatment with a neuromodulator when patients are in their 20s or 30s will minimize etched facial lines by the time they’re in their 40s and 60s. They cite the case of identical 38-year-old twin sisters. One began regular botulinum toxin (Botox) injections in the forehead and glabella when she was 25, while the other got injections in the same areas just twice over seven years. They write that while lines glabella and forehead lines were visible at rest, they were not visible in the regularly treated twin four months after her last treatment.
“This observation suggests that regular treatment with a neurotoxin, beginning in young adulthood, can prevent the development of etched-in lines. So there really is rarely a time that is too early. Perhaps the better question is, ‘When is it too late?’”
CST Trends asked two doctors to give their opinions on the issue concerning when is “too early” to begin aesthetic treatments.
“I basically agree with the opinions of the authors but also understand the biopsychosocial implications that may be argued by those who disagree,” says Joe Niamtu III, D.M.D., a Richmond, Va., specialist in facial cosmetic surgery. “I can guarantee that you will see some negative feedback on this viewpoint article, with the opposition saying that we are creating a society of ‘plastic’ people who can’t deal with the normal process of aging … I can see both sides of the argument.”
Dr. Niamtu says he thinks the real “take-home point” of the article is that while preventive treatment can influence the future appearance of aging, “treating younger patients has positive and negative benefits that reach beyond the needle. There are clearly some patients that would benefit from treatment at a younger age and others who would suffer body-image issues if they did do it or wanted to do it and could not afford it.
“The other very important piece of this discussion is that we could not discuss this topic 20 years ago, as there were basically no fillers, neuromodulators or light- and energy-based therapies,” he adds. “I think that the current discussion will become lost in time because in another 20 years we may have easier and more effective treatments that are more effective and preventive and may be highly used by younger patients.”
Joel Schlessinger, M.D., a dermatologist and cosmetic surgeon in Omaha, Neb., concurs with the viewpoint authors.
“I agree wholeheartedly with the authors,” he says. “Sadly, most people take the opposite viewpoint, waiting until it is too late, as the authors comment, and either missing the opportunity to have a full correction or even any chance to have a significant change. On the other side of the equation, there clearly are individuals with body dysmorphic syndrome, who have no issues at all and undergo multiple surgeries in pursuit of a ‘better’ look. This is something that all dermatologists run into at one point or another.
“Overall, it is best to have a discussion with the individual and prepare a plan of action and an ongoing concept of how to diminish signs of aging over time,” Dr. Schlessinger says. “This approach is highly successful and leads to less intervention in later years and, surprisingly, less expenditure over the years.”

 

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5 Tips For Healthy & Young Looking Skin- from Dr. Mark Bishara, MD

Skin experts say that the best way to keep your skin healthy and looking young is to protect it from the sun and not smoke: and after that, taking care with how you wash, moisturize your skin and shave also help.
According to a British Association of Dermatologists survey carried out last year, many Britons are unaware that sun protection can keep the skin looking younger, believing instead that applying a daily moisturizer, eating a healthy diet, drinking plenty of water and having facial massages will suffice.Not only does exposure to UV increase a person’s risk of skin cancer, it also affects the elastin in the skin, which leads to wrinkles and sun-induced skin ageing such as leatheriness and blotchy pigmentation. Featured below are 5 tips for healthy skin:

Tip #1 for healthy skin: Sun protection

Photograph of lady with sun cream on shoulder in shape of sun
Ensure you protect your skin from the sun to maintain healthy skin

Most of the changes seen in ageing skin are actually “caused by a lifetime of sun exposure”.
To protect yourself from the sun, they advise the following three methods (with maximum protection coming from using all three).

  1. Avoid the sun during high intensity hours: the sun’s rays do the most damage between 10 am and 4 pm, so limit the time you spend outside during this period.
  2. Wear protective clothing: wear long sleeved shirts, long trousers or pants and a hat with a wide brim. Remember that tight woven fabric (eg denim) offers better protection than loosely woven fabrics like knits.
  3. Use sunscreen: go for a broad spectrum sunscreen with an SPF (sun protection factor) higher than 15 and apply generously about 20 minutes before you go out and then every two hours. You will need to apply more frequently if you go in the water or sweat a lot.

Tip #2 for healthy skin: Don’t smoke (and watch the alcohol)

Research shows that smoking alone ages skin. In a study published in the Archives of Dermatology, researchers described how they examined the upper inner arms of smokers and non-smokers aged from 22 to 91 and found that after taking into account age and other variables, the number of packs of cigarettes that the smokers smoked per day was significantly linked to skin ageing. They looked at the skin on the upper inner arms to minimize the influence of sun exposure.
Smoking reduces the skin’s natural elasticity by promoting the breakdown of collagen and also reducing the amount that is produced.
Collagen, a protein that helps skin strength, gradually degrades with age, leading to wrinkles. Smoking causes this to happen sooner and also causes the tiny blood vessels in the skin to tighten, which reduces the amount of oxygen and nutrients that the skin cells receive, which also reduces elasticity and accelerates ageing.
The Mayo Clinic also suggest that exposure to heat from burning cigarettes damages facial skin and that certain smoking behaviours contribute to wrinkles, because of the repetitive facial expressions that smokers make, such as pursing the lips on inhaling and squinting their eyes to keep the smoke out.
Drinking alcohol can make your body and skin dehydrated, leaving the skin looking old and tired. So if you are drinking alcohol drink plenty of water and stick to sensible amounts. Have a non-alcoholic drink like soda water or watery fruit juice in between the alcoholic ones to help your body rehydrate.

Tip #3 for healthy skin: Clean your skin regularly and apply moisturizer

A British Skin Foundation survey published in January 2008 found that an astonishing 50 per cent of people who wear make up in the UK are damaging their skin by not removing make up before they go to bed.
The reasons for not cleansing the skin of make up before going to bed were also revealing in that most people were too tired to take it off, suggesting they were not getting good quality sleep which also affects skin health. A significant proportion also said they had had too much to drink or simply couldn’t be bothered.
Cleansing is an important part of skin care because it removes dirt and bacteria; and the key is to do it gently.
Use warm rather than hot water and limit the time you spend in the bath or shower to 15 minutes or less as too much time in hot water strips oils from your skin.

Face being moisturized
Moisturizing protects the skin from drying and acts as a protective layer for the skin

Also, use mild rather than strong soaps and avoid irritating additives such as perfumes and dyes, especially if you have sensitive skin.
When removing make up take care with the delicate skin around the eyes, and if you use waterproof make up you may need an oil-based product to make sure you get it all off.
When you have finished try to pat your skin dry so some moisture stays on it.
Moisturizing is important because it protects the skin from the weather and from drying up and looking dull. It helps your skin maintain its natural moisture levels too, say the Mayo Clinic experts, because it seals in the water already in the skin or slowly release water into the skin.
If you have dry skin avoid alcohol-based products and if you have oily skin avoid oil-based products (use water-based instead).
Some people with oily skin don’t need moisturizer: if your skin feels tight 20 minutes after bathing, then you probably do.

Tip #4 for healthy skin: Get enough quality sleep

Woman sleeping
Focus on quality sleep to keep your skin looking young and healthy

Sleep is essential for healthy skin. Not enough quality sleep will make your skin look tired and older, especially with bags under your eyes. Poor quality sleep can become a vicious cycle because lack of sleep makes you irritable, anxious and depressed, and that makes it harder to get good sleep.
Make sure you have plenty of physical exercise as this reduces stress and creates a healthy tiredness that helps sleep. Yoga and swimming are also good ways to improve sleep.
Aerobic exercise increases the oxygen circulating in your body which helps the skin stay vibrant and healthy.

Tip #5 for healthy skin: Shave with care

People shave to make their skin smooth and hairless, but this can irritate the skin, especially if it is thin, dry and sensitive.
For a smooth shave the Mayo Clinic experts advise that you shave after a warm bath or shower (or press a warm wet cloth on your skin) to soften the hair, don’t shave dry skin, use a clean, sharp razor, and shave in the direction of hair growth.
Make sure you rinse well afterwards with warm water to remove soap and dead cells.
If your skin is irritated after shaving don’t use an alcohol based lotion even if it feels cool, it will make the irritation worse because it dries the skin out.
Dr. Mark Bishara and The Paragon Plastis Surgery & Med Spa in Mansfield and Southlake, TX offers minimally invasive procedures, and skin care treatments to help keep your skin looking great. These treatments are designed to provide subtle enhancements that can improve your targeted problem areas, while allowing you to return to work and your regular activities the very same day. Dr. Bishara is also proud to offer a wide range of enhancing, minimally invasive procedures such as Botox, Xeomin, Juvederm Ultra Plus XC and Radiesse.  Juvederm Voluma XC will be available soon. We will keep you updated or call our office for more information at (817) 473-2120.
 
 
 
 

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