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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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FDA Okays Cheek Volume Filler Juvederm Voluma XC- by Dr. Mark Bishara, MD

The US Food and Drug Administration (FDA) has approved Juvéderm Voluma XC(Allergan) to correct age-related volume deficits in the midface in adults aged 21 years and older, the company has announced.

Juvéderm Voluma XC is a gel composed of cross-linked hyaluronic acid suspended in phosphate-buffered saline with 0.3% lidocaine. It is the first dermal filler approved in the United States specifically for deep (subcutaneous and/or supraperiosteal) injection for cheek augmentation to correct age-related volume deficit in the midface.
As reported by Medscape Medical News, the FDA’s General and Plastic Surgery Devices Panel unanimously agreed that Juvéderm Voluma XC is effective and safe and that the benefits outweigh the risks, according to the clinical trial data presented to the panel.
“As people age, the cheek area can lose volume, causing the cheeks to flatten out and the skin to droop and sag,” Derek H. Jones, MD, said in a company news release announcing the approval. Dr. Jones is associate professor of dermatology at the University of California, Los Angeles; founder and medical director of Skin Care and Laser Physicians of Beverly Hills; and clinical investigator in the Juvéderm Voluma XC pivotal study.
In the study, “physicians and patients were able to see instant and visible results, including correction of age-related volume loss in the cheek area and a more youthful appearance to the face,” Dr. Jones said.
JUVEDERM VOLUMA(TM) XC is made with Allergan’s proprietary VYCROSS(TM) technology, an advanced manufacturing process that results in a smooth gel that flows easily and consistently. This unique formulation contributes to the lift capacity to correct volume loss in the cheek area and to the duration of the product.(2,3) Additionally, JUVEDERM VOLUMA(TM) XC contains a small amount of lidocaine which helps to numb the treatment area during the injection procedure. The JUVEDERM VOLUMA(TM) formulation without lidocaine was first introduced in Europe in 2005. JUVEDERM VOLUMA(TM) with lidocaine was first introduced outside the U.S. in 2009. As of August 31, 2013, JUVEDERM VOLUMA(TM) with lidocaine (branded as JUVEDERM VOLUMA(TM) XC in the U.S.) is distributed in 72 countries, including markets in Europe, Latin America, Middle East, Asia Pacific, and Canada. The JUVEDERM(R) family of products, including JUVEDERM(R) Ultra and Ultra Plus, are marketed and sold in 85 countries outside the United States.(4)
The most common adverse effects observed in the clinical trial included temporary injection-site tenderness, swelling, firmness, lumps/bumps, bruising, pain, redness, discoloration, and itching. The adverse effects were predominantly moderate (uncomfortable) in severity and lasted 2 to 4 weeks.
Juvéderm Voluma XC will soon be available at Dr. Mark Bishara’s office.  We will keep everyone updated when the product will be available in both of our Mansfield and Southlake offices.
This news is brought to you courtesy of Dr. Mark Bishara and The Paragon Plastic Surgery & Med Spa


 

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