Wednesday, September 16, 2009

Cellulite - Cottage Cheese Thighs

Please tweet and retweet



Cellulite (Gynoid lipodystrophy in medical jargon) is the only word we have to describe the uneven pitted surface or dimpling of the skin commonly seen on the thighs of women. The appearance often is described to resemble the surface of an orange peel or that of cottage cheese. The term cellulite was first used by Alquin and Pavot in France to describe this condition. It is common in women, rarely seen in men and begins at various ages depending on body habitus, genetic makeup, etc. Most middle aged women have it. The remainder thinks they have it. As sure as a woman will grow breasts after puberty, she will get dimples and lumps on her skin. Cellulite affects only the buttocks, thighs and legs to about four inches above the knees. I see many patients requesting correction of their cellulite and an equal number of proposed treatments. These include aminophylline wraps, liposuction, liposuction with forked metal tubes to cut fascial strands to the skin and combinations of liposuction with lasers. None are truly effective.


Monday, August 3, 2009

Scars, Keloids and Hypertrophic Scars

Please tweet and retweet



This blog covers skin scars only but does not include burn scars or scars related to breast implants.

Virtually everyone who lives long enough will have a skin scar from elective surgery or an injury. There has been a barrage of cosmetic surgery procedure modifications to decrease total incision length in the hope of creating less scarring. The healing of these disruptions in the skin surface follows a specific process. After the injury or cut there is bleeding. Once this stops an inflammatory process starts to get the cells needed for healing into the wound. New blood vessels grow into the area bringing in the energy needed to complete the healing process. You see this as a red color of the scar and the skin immediately next to the scar that blanches white with finger pressure. Within a week or two the healing is sufficiently strong that the wound should not reopen and any sutures that were placed can be removed. Even though the wound is healed it then must mature over the next 6 to 9 months depending on the type of injury, affected body part, age of individual etc. before the redness goes away and the increased blood flow is no longer needed. Once the scar has fully matured it usually does not blanch with finger pressure. Any problems in this process such as an infection, failure to suture a wound closed, certain vitamin deficiencies etc. prolong the healing time and in doing so result in worse more visible scarring. The skin of younger individuals makes strong repairs and tends to over heal, resulting in larger, thicker scars than on older skin. Skin over the jawbone is tighter than skin on the cheek and will tend to increase a scar's prominence. All scars are more amenable to treatment early in their life span before they mature. It is easier to prevent a bad scar from forming by control/manipulation in the early phases of wound healing than to treat one that has already formed.


Tuesday, June 9, 2009

Injectable Fillers - Collagen, Restylane et al

Please tweet and retweet



The first injectable filler available in the United States was Zyderm I. It was approved by the FDA in 1981 for injection into skin folds and wrinkles related to the aging process or depressed skin scars. Zyderm II followed in 1983 and Zyplast in 1985. They were all basically collagen derived from cow hide. Each form was designed for injection at a different depth within the skin. The chemical composition of each differed slightly so they lasted for a variable number of months, usually 2 to 3 months. Aside from their temporary effect the other major drawback to their use was the need for skin testing. A small amount was injected under the skin and if the patient did not react to the material they could go ahead with a full treatment some weeks after the skin test. If the full treatment was given to someone who was sensitive/allergic severe allergic reactions could result including the loss of the skin over the injection site.



Thursday, April 30, 2009

Facelift, Midfacelift and Neck Lift 2

Please tweet and retweet



To make things easier I first give the prospective facelift patient a mirror for them to point out areas of concern. That way I can be assured to address these in my overall assessment. I then use a top down approach to evaluate the frontal hairline (high, low or average), brow drooping, presence or absence of forehead wrinkles and crows' feet at the outer corners of the eyes, temple wasting or concavity, aging changes of the eyelids (bags, drooping-ligament laxity, excess skin, nasojugal groove depth), nasolabial fold (laugh line) depth, amount of excess cheek skin, cheek surface contour and bone visibility, presence of vertical skin folds just in front of the ear, marionette line depth, severity of jowls, upper lip height and upper incisor show, neck fat, excess skin and muscle banding and finally the patient's overall health condition. Since a large portion of these patient's are elderly with multiple medical problems on multiple medications an Internist is frequently involved to ensure a safe operation with a smooth recovery.
facial aging



Monday, April 27, 2009

Facelift, Midfacelift and Neck Lift 1

Please tweet and retweet



Facelift surgery to treat the aging face started in the early 1900s. At first this only involved removing some skin in front of the ear and under the chin. Striving for greater improvement the surgeons started to cut just under the skin via these incisions to release it from underlying attachments and allow the removal of greater amounts of skin. This flattened the laugh lines (skin fold between the outer edges of the nose & outer corners of the mouth) and marionette lines and that was good enough. That was how it was done for the first half of the 20th century. Progress in the surgical technique was hampered by societal taboos. No doctor would admit he or she did the surgery and no patient would state they had had the surgery.



Monday, March 30, 2009

Lip Augmentation - How to make the lips fuller or bigger

Please tweet and retweet



Lips express emotion, sensuality, and vitality.  As far back as 69 to 30BC Cleopatra used crushed beetles and ants along with red clay, henna, iodine and seaweed to create a red ink-like substance to apply to her lips. Nowadays we have lipstick to make the lips look more prominent.
youthful lips
In the commonly accepted youthful attractive female lips there is a distinct bow shape to the outline of the upper lip, prominent columns of skin are present between the nose and edge of the upper lip with a curving slope lip skin surface, in repose the lower few millimeters of the upper incisors are visible, the upper lip has a greater fullness centrally near the midline of the body and near the outer corners which turn up slightly while the lower lip has more fullness just to either side of the midline.



Monday, March 2, 2009

Negative Pressure Wound Therapy

Please tweet and retweet


Since the beginning of Plastic Surgery as a modern specialty, around World War I, Plastic Surgeons have been consulted to close wounds. In these cases the wound edges could not just be pulled together and sutured because of tissue deficiencies. At that time Plastic Surgeons would raise tubes of tissue (fat and skin) and slowly after multiple operations advance those tubes into the wounds in order to achieve closure.



Thursday, February 19, 2009

Abdominoplasty, thigh buttock lift and belt lipectomy

Please tweet and retweet



Abdominoplasty - Tummy Tuck


Thigh Buttock Lift - Belt Lipectomy (mostly for patients after massive weight loss or bariatric surgery, gastric bypass etc.)


Abdominoplasty for excess skin and fat and loose muscle
Abdominoplasty for excess skin
Abdominoplasty after weight loss
Belt lipectomy 1
Belt lipectomy 2

Dr. Stone's Twitter
blogarama - the blog directory Listed in LS Blogs the Blog Directory and Blog Search Engine


Monday, February 2, 2009

Facial Proportions - Facial Analysis in Cosmetic Surgery

Please tweet and retweet



Faces that are considered youthful and attractive in general have certain proportions and relationships in common. These fall into 3 categories.
  • The first is equivalent size where 2 different anatomical structures have the same size.
  • The second is proportional size where one structure is a specific fraction size of another.
  • The third is positional angle relationships between 2 structures.

The optimal values for the first 2 categories are the same for both sexes. The third category can be altered to achieve a more masculine or feminine look. In assessing a patient for facial surgery Plastic Surgeons must keep these proportions in mind in the process of deciding what specific operative procedures would benefit the patient. This also allows the surgeon to custom tailor the procedure for each patient. No 2 patients should have the exact same procedure unless maybe they are identical twins. This is especially important when the margin of error is small such as a rhinoplasty where the margin of error is a millimeter or less.




Friday, January 2, 2009

The Implications of Herbal Medications on Plastic Surgery

Please tweet and retweet


A majority of otherwise healthy individuals currently are regularly taking herbal medications. This may be with multivitamins and or the usual heart or blood pressure etc medications. I myself regularly take glucoseamine and multivitamins. Although many associate these herbs with being more natural with less side effects than pharmaceutically manufactured prescription medications that is not actually true. Especially in the high doses frequently taken these herbs can thin the blood preventing clotting, prevent healing after surgery, have dangerous interactions with medications given at surgery etc. I have personally had to cancel surgery in the middle of an operation because of bleeding that could not be stopped because the patient took goldenseal or high doses of vitamin E within a few days of surgery without telling me. Vitamin E especially in high doses dramatically thins the blood.

Here is a list of commonly used herbal medications and their associated problems:



facebook comment box