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Andrew A. Jacono, MD FACS - Biography
Author of New York Cosmetic Surgery Blog
 Dr. Andrew Jacono is a Dual Board Certified, Facial Plastic and Reconstructive Surgeon with a thriving practice on Long Island's Gold Coast and in Manhattan. He is Section Head of Facial Plastic and Reconstructive Surgery at North Shore University Hospital Manhasset; Assistant Clinical Professor, Division of Facial Plastic and Reconstructive Surgery at The New York Eye and Ear Infirmary; Assistant Professor, Department of Head and Neck Surgery at the Albert Einstein College of Medicine; Director of The New York Center for Facial Plastic and Laser Surgery in Great Neck, NY; author of the book FACE THE FACTS: The Truth About Facial Plastic Surgery Procedures that DO and Don't Work; and creator of J PAK SYSTEMS™, homeopathic remedies to help optimize healing after aesthetic procedures.
As a leading expert in his field, Dr. Jacono is regularly interviewed about current trends in plastic surgery. He has appeared on ABC's Good Morning America, Inside Edition, MyFox New York, CNN, CNBC, The Morning Show with Mike and Juliet, New York's CW 11 Morning News and Telemundo and has been interviewed on NPR, 1010 Wins and WCBS Radio. His expertise has been featured in national and international print publications including Family Circle, Cosmopolitan UK, Details, Newsweek, US Weekly, and USA Today amongst others. In 2006, Dr. Jacono was elected as one of America's Top Plastic Surgeons by the Consumers Research Council of America. In 2007, Dr. Jacono was elected as one of America's Top Plastic Surgeons by the Consumers Research Council of America and was featured as one of Ten Leaders in Plastic Surgery in Long Island in The New York Times.
January 3, 2008
Did Ashley Tisdale Want a Severe Rhinoplasty, and If Not How Could It Have Been Avoided?
There has been a lot of discussion in the media regarding teen actress and singer Ashley Tisdale's decision to have here nose fixed for a functional breathing problem early in December. When she emerged approximately 3 weeks later, it was difficult to recognize her, similar to the way Jennifer Grey of Dirty Dancing fame emerged after her nasal surgery. It is clear that both of these actresses underwent not just breathing surgery, but an operation called a rhinoplasty (nose job) to alter their appearance. Interestingly, both of these young women were attractive in their own right, and likely wanted only to have minor changes in their nasal shape to better enhance or define their beauty. Interestingly, the extremely small and pinched look of the tip of Ashley Tisdale's nose indicates that a lot of cartilage was removed from it, and this usually causes difficulty breathing; this is the very reason why she embarked on her surgery in the first place.
The unfortunate truth about rhinoplasty is that approximately 7 to 10% of rhinoplasties performed in the United States require revision surgery because the person undergoing the surgery is not satisfied with its look, or because of post-surgery breathing problems. So yes, there is a way to restore Ashley Tisdale's nose to a more natural appearance that does not erase her identity. In her case where the nasal cartilages and bones were overresected (too much removed) this would involve replacing the removed cartilage with cartilage borrowed from other portions of the nose or body like the nasal septum (a piece of cartilage inside the nose) the ears or in very severe cases, unlike Ashley's nose, the rib cartilage. This requires the expertise of a facial plastic and reconstructive surgeon that specializes in both revision cosmetic surgery and reconstructive surgery, and these doctors can be found both through the American Board of Facial Plastic and Reconstructive Surgery or the American Academy of Facial Plastic and Reconstructive Surgery.
So how does the actress or everyday prospective patient prevent this problem when choosing a surgeon? The first step is ensuring your doctor is board certified and specializes only in facial plastic surgery and not a generalist also performing other cosmetic surgery procedures like breast augmentation, liposuction and tummy tucks. Avoid the "jack of all trades." One way of ensuring this is by choosing a doctor board certified by the American Board of Facial Plastic and Reconstructive Surgery as noted above. But this is only the beginning.
When interviewing a doctor for surgery during a consultation, you should be allowed to see hundreds of examples of their work. During your review of these photos, make sure that all the noses do not look the same because that indicates that the doctor has a "cookie cutter" approach to surgery and that your nose will look just like all the others. This is important as each rhinoplasty surgery should be sculpted to balance with other facial features and stature. For example the 6 foot runway model with a long face should not have an overly small and upturned nose because it will look ridiculous.
Additionally, their needs to be an extensive discussion with each patient to arrive at what their concept of beauty is and what their desire is for surgery. If you were Ashley Tisdale and only wanted your bridge slightly refined and wound up with a nose half it's originally size that would be horrible. The best way for a surgeon to arrive at this conclusion is by taking digital pictures of the patient and using digital morphing technology to manipulate the photos so that there is a clear understanding of what a patient wants their nose to look like. This becomes the road map for surgery. This is not a gimmick, and I and a minority of surgeons across the country use this to make sure we are going to deliver what each person wants. Many plastic surgeons will not use this technology as they cannot tailor their operation but give you the "Doctor Smith Nose."
Their needs to be a merging of good techniques, the aesthetic understanding of the surgeon, and the desire of the patient defined by digital morphing to prevent unwanted results. But who knows, maybe Ashley wanted her nose to look that way!
November 16, 2007
Plastic Surgery Should be Safe...Could the Death of Rapper Kanye West's Mother Have Been Prevented?
According to the American Society of Plastic Surgeons, over 11 million procedures were performed on people seeking to improve their appearance, up from 8 million just three years ago. The message is clear that Americans are embracing cosmetic surgery, and that these treatments are becoming more "main stream." With this large number of procedures across the country, and the diverse group of doctors that perform them, the number of patients dying from surgery is an extremely small fraction of one percent. So how does an affluent and educated woman like Donda West, a retired professor and former chairwoman of the Chicago State University English department, die from plastic surgery?
While we do not have all the specifics of the case, the Los Angeles Coroner states that preliminary information indicates West died from "complications of surgery", rumored to having had a tummy tuck and breast reduction. "Complications of Surgery" can mean many things, but the two primary issues are whether she had a complication from anesthesia or a complication from the surgical procedure.
Before we consider whether there was a physician error, the anesthesiologist or the surgeon, the first step in ensuring a safely executed procedure is that the patient is healthy enough to withstand the physical stress of anesthesia and surgery on the heart and pulmonary (lung) systems. This requires a complete medical pre-operative evaluation, performed by an internal medicine doctor (not a surgeon), including complete blood work, an electrocardiogram, and chest X ray. Sometimes more extensive testing is required if a patient has a history of heart problems; a stress test or echocardiogram, etc. Simply put, some people are not good candidates for surgery and one should never have surgery before having a medical clearance. I have patients that are in their 40s that have many significant medical problems and are not candidates for surgery, and others in their 70s who get a face lift after they had a full medical clearance. It has been rumored, but not confirmed, that the surgeon took on the Donda West's case after other surgeons told her it was not safe for her to have surgery.
The next step to a safely executed procedure is choosing the correct surgeon. The surgeon who cared for Donda West is Dr. Jan Adams. Dr. Adams is currently under investigation by the California state medical board, has been the target of malpractice lawsuits and has paid out nearly $500,000 in civil settlements. The board is also investigating whether Adams' license should be revoked or suspended after two alcohol-related driving arrests in the past four years, according to records.
Where do we start when looking for a qualified plastic surgeon? On the internet? In a television show, or a magazine article or a phone book advertisement? A referral from a friend? Cosmetic surgery is more acceptable today than ever before, especially with the media's coverage of Botox and television shows such as Extreme Makeover. Unfortunately people are still secretive, and trying to get information about a good cosmetic surgeon or a good experience with a cosmetic procedure, even from friends, can be difficult.
The reason for caution is that any physician with a medical degree and a license to practice medicine can legally perform plastic surgery in the United States. This is why OB/GYN doctors are performing liposuction, laser skin resurfacing, and Botox in their offices, and dentists are performing rhinoplasties.
Credentials are just the beginning when choosing a plastic surgeon. The public, in my opinion, is confused about this subject and with good reason. In today's competitive environment, in order to attract patients, it has been claimed that there exists only one board that certifies surgeons to perform plastic surgery. This is clearly not the case. There are five different legitimate boards that are either member boards of the American Board of Medical Specialties (ABMS) or equivalent boards. These boards include the American Board of Facial Plastic and Reconstructive Surgery and The American Board of Plastic Surgery.
You should also check your doctor's hospital affiliations. If a physician has privileges to perform surgery at an accredited hospital, this demonstrates that his or her performance and credentials are subject to regular scrutiny. While most plastic surgeons perform surgery only in their office, they do have privileges to perform surgery at a local hospital. If a doctor does not have these privileges, do not use that doctor.
Unfortunately, board certification is only the beginning to choosing your doctor. Board certification in Plastic Surgery or Facial Plastic Surgery means that your doctor has completed his or her residency training, passed rigorous comprehensive written and oral exams, and presented a series of surgical cases. But this does not mean he/she is a skilled surgeon; not all surgeons are created equal. Just as there are certain people who excel in sports due to their unique motor skills, there are a small percentage of surgeons who have the ability to use their hands to sculpt tissue in an aesthetic way. What I am trying to say is that there are good surgeons and there are great surgeons, and to use our sports analogy, your job is to figure out who the pros are versus the minor leaguers.
How do you do this? Ask your friends and your personal physician. Ask to see examples of the surgeon's work, or talk to one or more patients about their surgical experience. Physicians who do the procedure you are interested in regularly, and do good work, will have an abundance of examples. Do not accept statements from your surgeon like . . . "my patients do not want me to show you their pictures" or "my patients are very private." This usually means that there are no examples of their work that they would want you to see. Most of my patients come from word-of-mouth referrals.
Check out the surgeon's office and staff; be sure you will be treated the way you expect and that you feel comfortable there. Be sure the doctor is easy to talk to and is someone with whom you can relate. If you do not get along with your surgeon before surgery, do not expect things to get better after surgery.
In the end sum, you have to be your own best advocate, ensure you overall health first, and do extensive research on your doctor.
Monday, October 15, 2007
Evolence Collagen is The Newest Injectable Filler for Wrinkles and Folds: Promises of Longer Lasting Results But Can It Deliver?
EVOLENCE is a new, collagen-based, soft-tissue filler that quickly and effectively restores shape to facial wrinkles – with benefits lasting for at least 12 months. It is not FDA approved, but is currently available in Europe.
The long-lasting effect of EVOLENCE means that repeat injections may only be needed once a year or less, unlike some other biodegradeable fillers which often need repeating 2–3 times a year. Hyaluronic acid fillers such as Juvederm, Retylane and Perlane usually will require 2 treatments a year to maintain correction. I would be extremely cautious with this new product as most fillers when they first come to market claim they last twice as long as they actually do. For example when the first collagen was launched in the 1980s they said it would last 2 years when it actually lasted 2 months!
The company says that EVOLENCE achieves its long-lasting effects because it is specifically engineered to enhance stability and mimic the properties of natural collagen found in the skin. The filler is produced via the revolutionary Glymatrix™ technology. EVOLENCE is produced in the laboratory by polymerization of porcine (pig)collagen followed by glycation with natural sugar. BECAUSE IT COMES FROM A PIG IT WILL REQUIRE TWO ALLERGY TESTS PRIOR TO BEING ABLE TO USE IT FOR WRINKLE CORRECTION! Many patients also have objections to eating or putting any pig products in their body, so this would also be a potential problem for consumers.
A recent study published in the July 2007 issue of Plastic and Reconstructive Surgery noted EVOLENCE safety in 12 patients, but does not study how long it lasts. The jury is out in my mind until better studies are established in the US.
Posted by Dr Jacono at 10:30 PM
Sunday, September 30, 2007
Andrew A. Jacono, MD, FACS The Newest Fellowship Preceptor for the American Academy of Facial Plastic Surgery and Appointed Chairman of Face to Face
Doctor Jacono was approved to become the next fellowship preceptor to train future specialists for the American Academy of Facial PLastic and Reconstructive Surgery. The Educational and Research Foundation for the American Academy of Facial Plastic and Reconstructive Surgery fellowship program provides postgraduate training in facial plastic surgery. The objectives of the fellowship program are to:
provide an outstanding academic opportunity for the acquisition of specialized knowledge and skills in facial plastic surgery;
develop trained specialists who will contribute to the ongoing development of facial plastic and reconstructive surgery; foster development of facial plastic and reconstructive surgery educators, especially in residency programs; and encourage the development of new skills and knowledge in facial plastic and reconstructive surgery through basic research and clinical trials.
The AAFPRS fellowship program is widely respected by the medical community and represents the finest postgraduate program in the world for the training of facial plastic and reconstructive surgeons. Eligible physicians may apply for 40 positions available each year. Since its beginning in 1969, the program has prepared more than 600 highly specialized experts to be educators and leaders in facial plastic and reconstructive surgery. These individuals and their directors have performed a tremendous service to the AAFPRS and the specialty through the development and dissemination of new procedures, improvement of patient care, refinement of surgical techniques and the promotion of confidence and respect in the specialty.
Doctor Jacono was also named the National Chairman of Face to Face. The American Academy of Facial Plastic Surgery (AAFPRS) Foundation is the first surgical group to take a firm stand and become involved in assisting individuals of domestic violence break the cycle of violence, enhance their self-esteem and rebuild their lives. Many victims of domestic violence receive facial injuries and are not financially able to have these injuries adequately repaired. We offer consultation and surgery, pro-bono, to eligible individuals through FACE TO FACE: The National Domestic Violence Project .
We developed a partnership with the National Coalition Against Domestic Violence (NCADV), which is the umbrella group for the majority of shelters in this country. In addition, the American Medial Association has enthusiastically endorsed our program.
The AAFPRS is a leader in the medical field by helping empower individuals who have been physically abused. The problem of domestic violence is vast. Everyday, the AAFPRS works hand-in-hand with the shelters making sure that the individual is helped emotionally then physically hopefully eliminating the painful memories of the abuse.
We realize that the facial plastic surgery that our doctors perform will not alleviate the emotional scars that these individuals carry at all times. That is why we have partnered with shelters across the country. Healing must occur within before the surgery erases the physical scars.
Posted by Dr Jacono at 6:14 PM
Thursday, August 30, 2007
Expert Revision Facial Plastic Surgeon Andrew A. Jacono, MD, FACS Featured on The Morning Show with Mike and Juliet and Fox 5 News
Dr. Andrew Jacono, founder of the New York Center for Facial Plastic and Laser Surgery, and Section Head of Facial Plastic and Reconstructive Surgery at North Shore University Hospital, is frequently consulted by his colleagues for his expertise in revising and correcting bad plastic surgery results. As an expert in facial cosmetic and reconstructive surgery, he is known to take facial plastic surgery mistakes and turn them into success stories. The most common facial surgery complications relate to either bad eyelid surgery, bad rhinoplasty or bad face lift surgery.
Dr. Jacono was featured on The Mike and Juliet Show and Fox 5 News with his patients who required revision surgery to correct the results of poor plastic surgery performed by another surgeon. The patients featured required revision rhinoplasty and revision eyelid and midface lift surgery.
The links to his television appearances are:
Revision Rhinoplasty involves using your own bodies cartilage and bone for restructuring the nose instead of synthetic implants. Structural cartilage grafts are often required due to collapse of the nasal tip and twisting of the nose from overly aggressive or poorly executed rhinoplasty surgery. Revision rhinoplasty is often performed with cartilage from the nasal septum. When it is not available due to prior surgery, cartilage from the ears or ribs can be used. In the most severe cases calvarial bone from the skull can be harvested and used to re-structure a completely collapsed nose called a "saddle nose."
There are some measures you can take to minimize your risk of having a poor primary surgery. Your surgeon should be Board Certified by the American Board of Facial Plastic and Reconstructive Surgeons (http://www.abfprs.org/). It is important to find out what procedures your doctor specializes in, how many he or she has performed and how recently, and research his or her track record with the state medical board. Try to get a referral to a cosmetic surgeon from a doctor or a friend who has had a procedure similar to one you are considering. Look at before and after photos to see examples of his or her results. Plan to be in your best physical health before having surgery, and agree to follow pre- and post-operative instructions, which are designed to optimize your result. Discuss with your surgeon the anticipated and realistic results. Finally, evaluate your surgeon for the three A’s: affability, approachability, and availability. This will give you an idea of how your surgeon will handle any complications in the unlikely event that one does occur.
Posted by Dr Jacono at 7:01 PM
Sunday, July 29, 2007
Eyelid Lift Surgery Gets a New Twist: Customizing Non-Surgical and Surgical Treatments to Patient's Needs at Any Age
It is said that the eyes are the window to the soul. Each year, one hundred thousand men and woman undergo an eyelid lift (the medical term for this is blepharoplasty) to improve the way they look. Droopy upper eyelids are the results of excess sagging eyelid skin,and can make you look tired, angry or just older. The lower eyelids become puffy and bag develop with age due to prolapse of fat underneath the eyes. There are many different surgical and non-surgical approaches to these problems, and customizing the treatment to the patient's problem is the key to natural looking and beautiful results.
Upper eyelids can be opened up and lifted without surgery with Botox injections. Injecting the muscles that cause the eyebrows to pull down and to droop over the eyes will allow them to lift up and raise the skin of the upper lids. This is a 5 minute treatment that has no downtime, and can be done on a lunch hour or on the way out to meet friends.
Lower eyelid appearance can be improved without surgery as well. Underneath the bags there is usually a deep groove. By injecting the grooves under the bags with fillers such as Juvederm (my personal favorite) or Restylane it camouflages bags and supports them. This is great for those not ready for surgery or with the beginning of bags.
In upper eyelid lift surgery, incisions are placed in the creases of the lids in order to keep the incisions as invisible as possible along these natural folds. The incision is made and the precise amount of excess fat,muscle, and loose skin that are contributing to the problem are removed. It is imperative that it is decided whether the heaviness of the upper eyelids is related to the eyebrows and forehead dropping. This is determined by simply lifting on the eyebrow and seeing if it improves the appearance. If it does, than a browlift is necessary not an eyelid lift.
In Lower Eyelid Lift Surgery, the incision is placed in an inconspicuous location just a few millimeters below the lash line and along the smile creases of the lower eyelid. Again skin, fat and muscle are precisely removed. Extremely fine sutures are then used to meticulously close the incisions, thus minimizing the visibility of any scar.
When it is determined that lower eyelid puffiness (eyelid bags) are solely the result of excess fat, the procedure can be done with an incision inside the eyelid, called a transconjunctival blepharoplasty eye lift, resulting in no external scars.
In some cases of lower eyelid surgery it is necessary not to remove the fat bags under the eyes,but "transpose" or move the fat into deep grooving under the eye. This prevents a "hollowing out" of the lower eyelids that is a tell tale sign of surgery.
Posted by Dr Jacono at 8:53 AM
Friday, July 13, 2007
Surgical and Non Surgical Options for Lip Augmentation
Over the past several decades, there has been a dramatic increase in cosmetic surgery in Western Culture, with an increasing focus on achieving aesthetic ideals and maintaining a youthful appearance. Full lips have become increasingly desirable as they are considered both youthful and beautiful. More over, a trend has been identified toward fuller and more pouty lips in models appearing in magazines over the past century.
As we get older the lips age with the rest of the face, resulting in atrophy of the lips. The lips thin out. Tiny vertical lines appear and the graceful cupid's bow of the upper lip begins to flatten. Others may have been born with thinner lips, and simply want a more defined cupid's bow and greater lip volume to balance the other features of their face.
FACT: According to the American Academy of Facial Plastic and Reconstructive Surgery, lip augmentation using injectable fillers was one of the most commonly facial plastic procedures performed in 2005.
There are two major types of injectable fillers for lip augmentation, those that are permanent and synthetic such as silicone, and those that are temporary and made of a protein or sugar that the body can reabsorb. As permanent filler can be rejected by the body, temporary fillers are a safer bet. These include collagen, which is a protein, and hyaluronic acid, which is a sugar. Hyaluronic acid fillers tend to last longer than collagen (6 months versus 3 months), and the gold standard of hyaluronic acid on the market is Restylane™, but there are different versions coming out on the market including Juvederm™ and Perlane™ which promise to be more stable and last longer.
How these injectable fillers are placed in the lips is as important as the type of material used. The traditional technique currently favored by plastic surgeons and dermatologists worldwide involves injecting the filler into the lip border, which can make the lip look unnatural and overstuffed; a problem that plagues celebrities and socialites from Park Avenue to Beverly Hills. To deliver a more natural-looking result, I created a technique called French Lips™.
French Lips™ is an innovative new lip augmentation technique that uses hyaluronic acid to deliver sexy, pouty lips that look completely natural. This customized technique targets some 15 different anatomic zones of the lip. By injecting the Philtral columns (the two vertical lines above the lips), the center part of the cupid’s bow (to accentuate it’s curvature) and the outer half of the lips, towards the corners (which rolls the lip out ever so slightly), this technique delivers the pouty, sexy lips which have come to define CLASSIC BEAUTY and YOUTH. Lipstick bleed lines and a down turned mouth can also be corrected at the same time.
The cost for a French Lip™ procedure is generally 1,000 dollars and according to our study, it will last about five to six months. The procedure can be performed over lunchtime, and there is essentially no downtime.
For individuals with naturally thin lips seeking a permanent solution, plastic surgeons perform surgical procedures that will require a week or two to recover. These include fat transfers and a technique called V to Y lip augmentation. Fat transfers are performed by liposuctioning some fat from the abdomen or thighs, and transferring the fat with specialized syringes and instruments. These results can last up to 3 years. The V to Y lip advancement surgery procedure delivers permanently voluptuous lips like Angelina Jolie. Using small incisions in the corners of the mouth and the inside of the lips (making them imperceptible) the lip is rolled out from the inside making it permanently pouty and full. My results with this technique were published in the Archives of Facial Plastic Surgery. The cost of these procedures range between $ 4,000 and $8,000. Whether the treatments are injectable or surgical, these procedures can and should be customized to the patients’ desires. The ability of your plastic surgeon will dictate the quality of your results, which is why you should seek a specialist, certified by the American Board of Facial Plastic and Reconstructive Surgery. Those who are certified are listed online at www.abfprs.org.
Posted by Dr Jacono at 5:31 PM
Friday, June 22, 2007
Rare Plastic Surgery Performed on African Teenager to Create an Ear and Reverse Facial Disfigurement
Thanks to probono facial surgery and services donated by Schneider Children's Hospital(SCH), a 17-year-old orphan from Ghana, West Africa is gainingself-confidence and a getting a new start on life. (Photo: http://www.newscom.com/cgi-bin/prnh/20070621/NYTH134A )
Adwoa Frimpomaah was referred to Andrew Jacono, MD, Section Head of Facial Plastic and Reconstructive Surgery at North Shore University Hospital, for surgery toreconstruct a new ear and repair facial scars. She was seriously injured ina pedestrian-car accident in Ghana in 2004 while walking to a nearbyvillage; the driver fled the scene and the accident was never investigated.The collision ripped off half of her scalp on the right side, leaving herwith no hair, massive scars on her right cheek and two-thirds of her rightear destroyed. Her legs were broken and her teeth knocked out. Following the accident, Adwoa spent four months in a Ghanese hospital,but because of the limited availability of medical and surgical care in herhomeland, facial reconstruction was out of the question. In July 2006,Adowa was put in touch with Dr. Jacono by a small American outreach group,Beyond Our Borders, based in St. James, NY and headed by Vic and JeanValente. Dr. Jacono is a participating volunteer surgeon with the nonprofitgroup. Adwoa lives with Mr. and Mrs. Valente, her sponsors. Dr. Jacono and Schneider Children's Hospital (SCH) waived the fees forthe 6 1/2-hour surgery, which took place in December 2006, one day beforeAdwoa's 17th birthday. To reconstruct Adwoa's ear, Dr. Jacono harvested her"floating rib" from her left rib cage and cartilage to create the rim ofher ear. Because of severe trauma to the skin on her scalp, Dr. Jacono performed a complex flap reconstructive procedure to cover the newframework of the ear and used a skin graft from Adwoa's leg to cover thetop part of her ear. Dr. Jacono performed a second surgery in May, whichseparated the flap and created a natural groove behind her ear with anotherskin graft. He also performed a modified face lift to reduce facialscarring. "When Dr. Jacono approached Schneider Children's Hospital about helpingAdwoa after her horrific accident, we did not hesitate to help her," saidPhilip Lanzkowsky, MD, executive director of SCH. "Adwoa had already lostso much; the surgery was something tangible that we could provide to makeher life better. Improving the health and well-being of children is themission of the Children's Hospital and it crosses all geographic andpolitical boundaries." "Although Adwoa's condition did not present any major functionaldisturbances, facial disfigurement is traumatic and psychological scars canlast a lifetime," said Dr. Jacono. "The reconstructive surgery has restoredAdwoa's self-esteem. She is like most teenagers -- very self consciousabout her looks -- and it is a great joy to see her happy again." For more information see www.newyorkfacialplasticsurgery.com or www.northshorelij.com.
Posted by Dr Jacono at 3:00 AM
Tuesday, June 5, 2007
Fraxel Laser II: The State of the Art in Skin Resurfacing
Fraxel laser skin resurfacing is a true breakthrough in laser technology, and it is one of the safest and most effective laser to treat facial wrinkles and aging of the skin (for example forehead lines, lipstick bleed lines, crow's feet and neck wrinkling). Until now, two varieties of laser treatment have been available for cosmetic enhancement-ablative and non-ablative. Ablative, which literally means to vaporize at a very high temperature, are very effective at destroying unwanted tissue but have significant side-effects and require a lengthy healing period. Lasers such as CO2 and Erbium:Yag lasers have an average 2 week recovery time, and have a significant risk of scarring and loss of color of the skin where it turns white. Non-ablative, on the other hand, have very few side-effects and require almost no healing time, but involve numerous treatments over many months to achieve only modest results.
At long last, a laser with the potency of ablative treatments and the gentle safety of non-ablative lasers has won approval from the US Food and Drug Administration to treat a variety of important cosmetic conditions.
Fraxel® Laser Treatment is designed to target aging and damaged skin by creating microscopic "wounds" within the targeted areas well beneath the skin's outermost layer. In this way, Fraxel® Laser treatments trigger the body's own natural production of new collagen and skin cells. And because Fraxel® Laser Treatment combines the impact of ablative lasers with the gentleness of non-ablative lasers, healing occurs so quickly that there is very little downtime for patients. The majority of patients experience a 24 to 48 hour period of a sunburn. The Fraxel II is the second generation of this laser and allows for greater precision, deeper penetration and better results.
After several years of studies and mounting evidence of the Fraxel® Laser's safety and effectiveness, the FDA has cleared this unique new laser to treat Facial Wrinkles, Acne Scars
and Age Spots/Brown Spots. Depending upon the degree of skin changes we are treating, the number of treatments varies from 3 to 6 treatments. With more severe facial wrinkles and aging or deep acne scars, it is often necessary to have 5 or 6 treatments at higher energy settings. It is important to have a qualified specialist to perform these procedures, and a Facial Plastic and Reconstructive Surgeon affiliated with the American Academy of Facial Plastic and Reconstructive Surgery and Board Certified by the American Board of Facial Plastic and Reconstructive Surgery is one to look for. They can be found on the Academy website at www.aafprs.org
Posted by Dr Jacono at 6:27 PM
Thursday, May 31, 2007
Liquid Face Lifts with Perlane, Juvederm, Restylane and Radiesse
Advances in modern medicine allow us to look forward to a greater longevity, and it is a natural extension that technology can now help us look as good as we feel. Although I am a facial plastic and reconstructive surgeon, new technologies and products are available today that provide an alternative to the knife, or at least help us bridge the gap between now and when we are ready to have surgery.
According to the American Academy of Facial Plastic and Reconstructive Surgery’s 2006 Statistics, the number of women undergoing non-surgical cosmetic procedures is up 69% in women and 91% in men since 2000. It seems that today no matter what magazine you pick up, radio show you listen to, or television show you watch, there is regular discussion about the newest and greatest injectable treatments that, over a few minutes, can help rejuvenate the face. What is interesting is not only the types of products available, but how they are being used differently to help lift the face and rejuvenate our appearance.
The two major groups of injectable treatments are fillers, that can fill lines, folds and add volume to a deflating face, and Botox that paralyzes certain muscles in the face helping wrinkles smooth.
Years past the only filler available to us was collagen injection (Zyderm and Zyplast). It came from cows, so it required skin testing to make sure you had no allergy, and the results were short lived, sometimes only 2 to 3 months.
Today there are many more fillers available with better safety and staying power. Hyaluronic acid is a sugar based gel that is injected regularly for folds and wrinkles, comes from a non animal source (it is engineered), and lasts on average 6 months. The two most popular forms available are Restylane™ and Juvederm™. I have been using both in my practice with great results; the difference is that the Juvederm™ is a more stable product that lasts longer, and also is slightly easier to sculpt for the doctor (this means less lumpiness after the treatment). This is the result of it having more crosslinked hyaluronic acid. Perlane is another highly cross linked form og Hyaluronic Acid that was recently FDA approved.
Radiesse™ is another option. It is made up the same mineral substance as our bones (hydroxyapetite) and because of its durable nature lasts longer, sometimes up to 1 year. It is used in the deepest of the facial folds due to its harder nature but cannot be injected in the superficial dermis of the skin as it has a white color and shows through.
Botox is different than fillers as it paralyzes muscles that fold the skin when we animate our face. This can help with crows feet, vertical lines in the forehead (the ones between the eyebrows I call the elevens), and horizontal forehead lines.
The liquid facelift is the result of using these fillers and Botox in an ingenious new way to lift the face. As we age the face loses volume, and droops, almost like a deflated balloon. Instead of surgery to lift the facial tissues, restoring the volume of the face with these fillers supports the face. Where as we used to just inject these fillers into lines and wrinkles like spackle, now we place them differently. For example, injecting a filler like Juvederm™ underneath a droopy eyebrow will support and elevate it. This also works well when injecting the material underneath eyelid bags, making their appearance flatten, or beneath the corner of the mouth/jowl when it sags. Adding volume back to a deflated and droopy cheek will help elevate it, and camouflage the nasolabial folds and marionette lines.
An important part of the liquid facelift is using the properties of Botox simultaneously with fillers. The best analogy to understand how Botox lifts the face is to think of there being a tug-of-war acting on all points of the face, there are muscles that pull things down and muscles that pull things up. If you block the muscles that pull things down, the muscles that pull things up win, elevating that facial structure. An example of this is the Botox browlift, where by blocking the muscles that pull the brow down the brows and eyes open up, a non-surgical browlift. Botox can also be used to relax the muscles of the neck and improve vertical neck bands and sagging.
When fillers and Botox are used in the appropriate combination, the result can approach surgical treatments. The resultant rejuvenated eyelid, brow, cheek and neck appearance is the liquid facelift. The obvious drawback is these treatments need to be repeated twice a year for maintenance. It is, however, a great alternative for those who either do not have the time for recovery, or are not psychologically prepared for surgery. What’s even better it can be done on your lunch hour!
Posted by Dr Jacono at 3:26 PM
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