What Is Skin Collagen
Collagen is a natural protein in your body that is found in the deep layer of your skin called the Dermis. The Dermis is the red part of your skin that you see when you scrape your knee and the surface or epithelium is scraped off.
Collagen is the major component of your Dermis. A special type of Collagen called Elastin acts like a rubber band to keep your skin tight. Collagen is crucial to skin health and young looking skin. Collagen supports skin health by:

1. Plumps the skin-prevents skin wrinkles

2. Structural Support-prevents skin damage from trauma (Stretch Marks are caused by rupture of Collagen by stretching of the skin during pregnancy)

3. Helps nourish the skin by supporting blood vessels and the flow of nutrients to the skin

4. Provides elasticity-the ability of the skin to snap back when pulled-keeps the skin from sagging

5. Supports the growth of new skin cells-Epithelium-on the skin surface

Collagen is produced by a cell in the Dermis called the Fibroblast. All modern non-surgical facial rejuvenation and skin rejuvenation methods work by stimulating Fibroblasts in the Dermis to produce new Collagen.

Why Is New Skin Collagen Important for Young Looking Skin

The most profound aging changes in your skin are loss of normal Collagen and Elastin. Over your lifetime you can lose as much as 2/3 of your Collagen and Elastin and your skin can thin by 20%.

The visible effects of Collagen and Elastin loss on your skin are:

1. Wrinkles
2. Dry Skin
3. Thin Skin
4. Dull Looking Skin
5. Sagging or Loose Skin

Effects of Sun and Aging on skin from childhood to adult

New Fibroblasts can be stimulated to produce new Collagen by controlled or mild inflammation. Inflammation is the body’s response to irritation or injury. I say controlled or mild inflammation because repeated severe inflammation-such as many sun burns can result in cell death and destruction of Collagen.

Modern skin rejuvenation methods produce controlled inflammation to stimulate new Fibroblasts to build new Collagen and younger looking skin without causing harmful effects. They are:

1. Topical Retin A- Retin A skin cream has been proven to stimulate the growth of new Collagen in the Dermis.

2. Microdermabrasion- Microdermabrasion not only exfoliates but also produces a mild inflammation which stimulates new Collagen production.

3. Starlux Non-Ablative 1540 Fractional Erbium Laser Treatments-Unlike older CO2 Laser Resurfacing new Non-ablative Fractional Laser treatments do not remove skin and there is no down time. Your skin may be pink but no open wounds, drainage or other visible effects.

Before and after 1540 Non-ablative Laser Treatment

4. Combined Laser Resurfacing- This exciting new laser technique is the most effective Collagen stimulating facial skin rejuvenation technique available today. There is a recovery period or down time of 5-7 days. For a detailed discussion see my blog on Combined Laser Resurfacing.

Before and after Combined Erbium Laser Resurfacing

Our Medical Aestheticians are experts at evaluating your skin and recommending the best program for maintaining young looking skin and repairing sun damaged and aging skin. Call 978-369-4499 or email us to make an appointment. Dr. Doherty and I are always available to help you with your decisions.

Dr. Seckel
Dr. Doherty

What about exfoliation? We all know that dead skin cells make your skin look old and dull. Most of you use an exfoliant as part of your daily skin care protocol and after a Microdermabrasion or Micropeel® you know nothing compares to the freshness and glow of your facial skin that you get after a mechanical exfoliation.

Clarisonic Pro Skin Cleanser and Exfoliator

The Clarisonic Pro® Ultrasonic Skin Cleansing System can achieve both mechanical cleansing and gentle mechanical exfoliation right in the comfort of your own home. In fact, we are now using the Clarisonic Pro® in our practice to cleanse and exfoliate your skin before doing many Medical Aesthetician procedures.

I Listen to People That I Trust

After my Medical Aestheticians told me about the benefits of the Clarisonic Pro® Ultrasonic Skin Cleansing System, the Clarisonic® Representative was called into my office the next week. I tried one their products, the Opal, on my own face and it works! I ordered a supply that day. This is the first time in 30 years that I have not delayed, bargained and studied the literature so I could argue for a steep discount. I saw immediate results on my Crow’s Feet when I used the Clarisonic Opal with Vitamin C Serum. It is not permanent like a laser resurfacing, but it was a pleasant experience.

What Does the Clarisonic Pro® Facial Cleanser and Gentle Exfoliating do?

The Clarisonic Pro® is not a spinning brush that harshly grinds away skin cells. Rather, this device uses a soft brush which gently vibrates ultrasonically to clean debris and dead cells from the skin. Therefore Clarisonic Pro® is a facial skin cleanser that provides mechanical cleansing and can be used even on sensitive skin. According to the company studies, it can even be used on patients with Rosacea.

Most importantly for my patients, adequate mechanical cleansing means that the expensive effective prescription topical skin creams like Vitamin C and Retin A will be able to penetrate better without being blocked by skin debris and dirt.

The benefits of this device will be seen visually in the mirror. Many of the immediate dramatic changes such as wrinkle removal and skin firming are due to swelling from the irritation caused by the treatment. But that is okay. Every little bit of irritation causes inflammation which results in new collagen production which is the goal of Microdermabrasion, Micropeel, Laser Resurfacing, Retin A and every other non-surgical facial rejuvenation technique we use.

Clarisonic Pro® will not replace but will enhance results of Microdermabrasion, Micropeel®, Laser Resurfacing and Topical Retin A, Vitamin C and Tazorac.

Who will benefit from the Clarisonic Pro®?
• Any patient who uses makeup and Sunscreen
• Patients who use Anti-aging Skin Care products-Retin A, Retinol, Vitamin C serum, and Tazorac
• Acne Patients
• Patients with Fine lines and Wrinkles
• Patients with Sun Damaged Skin
• Patients with Excess Pigment
• Patients with Sebaceous Hyperplasia
• Patients with Keratosis Pilaris or “Goose Flesh’
• Anyone who wants Youthful looking Glowing Fresh Youthful Skin

How Should You Use Your Clarisonic Pro®

Resist the temptation to save a few dollars buying the Clarisonic Pro® on the internet and using it without professional direction. You need to know how to use it and what products and treatments will enhance your results. More importantly, if it is going to be effective for anti-aging skin care you must use it as part of a comprehensive, Medically Directed Anti-aging Skin Care Program. We have the medical expertise to direct you into the most effective combination of prescription creams and Medical Aesthetician procedures to give you the best, most effective results. For example, if you are on Retin A or other strong exfoliant, you may need to alternate your Clarisonic Pro® treatments with your topical exfoliant applications to avoid irritation.

This device is only as good as the overall comprehensive Medical Grade Anti-aging Skin care program that is monitored by a Skin Care Specialist and experienced Medical Aesthetician. We are here to help you achieve the young looking skin that you want to have.

Come In for a Consultation and Skin Care Evaluation

We are Board Certified Plastic Surgeons who are experts at providing honest skin care advice. Our Medical Aestheticians are among the most sophisticated , most experienced and best trained in the United States and supervised on site by two Board Certified plastic Surgeons-something you will not find at your average Med Spa. We will give you honest advice based on our best medical knowledge.

Come in to find the best, safest and most effective Facial Rejuvenation Program for your unique individual face. Please call 978-369-4499 to make an appointment. You will receive a free copy of my book Save Your Face and during the month of April 2012 the first 10 Newsletter Subscribers will receive a free Micropeel® to get you started on your path to a beautiful young looking face.

Dr. Seckel
Dr. Doherty
Concord, Massachusetts
Boston, Massachusetts

When Does Skin Aging Start?

Unfortunately skin aging starts when we are very young. Exposure to the sun is very destructive to the skin. Ultraviolet radiation from the sun actually damages skin collagen and starts an inflammatory process that leads to skin damage. Sun damage done during childhood does not actually appear on the skin as aging changes for many years.

Sun burn during childhood will not show up as aging changes until we are in our 30’s and 40’s. The lesson is that sun block, sun glasses and protective clothing and hats should be used on all children starting at a young age, especially if the children are fair skinned.

How Can You Prevent Skin Damage?

In addition to sun damage, smoking, unhealthy lifestyle, and stress can cause aging changes and ruin your young looking skin. The best prevention measures to keep your skin looking young include:

• Sun Protection-Sun block, sun glasses, hats, protective clothing, beach time limited to morning and late afternoon-avoid the hottest part of the day 12-2pm.
• Avoid Skin Damaging Habits-Smoking, excessive alcohol intake, drug abuse all can contribute to skin aging
• Eat Healthy- High Antioxidant Colored Vegetables, lean low fat meat and foods, and complex Carbohydrates are best. Vitamin C and B Complex Vitamins are important for skin health.
• Stress Reduction-Exercise, Yoga, and Meditation are all stress relievers and will help your skin as well as the rest of your body and mind.
• Proper Skin Care- Daily cleansing, exfoliation, and proper, proven effective, topical skin care products and routine professional skin care by an experienced Medical Aesthetician

How Can You Tell Your Facial Skin is damaged?

• Early Facial Skin Damage Changes- Pigment, Brown Spots and Red Spots or visible Blood Vessels in the skin are the earliest signs of significant skin damage and aging changes. Typically these appear in your 20’s but if you are a sun worshiper you may lose your young looking skin in your teens.
• Intermediate Facial Skin Damage Changes- Fine lines and wrinkles, more prominent Brown Spots and Pigment and Red Spots and Blood vessels begin to appear in your 30’s and 40’s if you look for them. Aging or skin damage changes are most noticeable in sun exposed areas. On the face these are typically around the eyes and nose and most noticeable in sun worshippers in the Décolletage. Check your Décolletage if you want a gauge of what is going on in your face and may become evident in the years ahead.
• Advanced Facial Skin Damage- Deep Facial Lines-Nasal Labial Fold, Deep Frown Lines and Crow’s Feet, Jowls, Neck Laxity, loss of volume in the cheek with a hollow look in the mid face, severe Brown Spots, Red Spots and Spider Veins are all signs of very significant skin damage and advanced facial aging. At this point significant intervention is required.

How Does Exfoliation Help Keep Your Face and Décolletage Skin Looking Young?

The most prominent feature of sun damaged, aged skin when you look at it through a microscope is layer upon layer of dry, dead, hard skin cells that form a dry unhealthy appearance to the skin. This is called the “Horney Layer” because of the similarity to the structure of a cow’s horn. Loss of collagen in the deeper skin layer called the Dermis and loss of fat from beneath the skin as well as motion from facial movements such as frowning and smiling also causes folds or wrinkles to develop in this skin layer. These wrinkles are surface irregularities in the skin.

Skin Exfoliation removes this dead skin and the surface irregularities similar to the way imperfections on wood are removed by sanding, but in a much gentler and safe way. Deep skin exfoliation also stimulates the deeper layers of the skin to grow new collagen. After exfoliation, once the dead skin cells are removed, topical creams such as Retin A, Tazarotine, and Vitamin C will penetrated the skin more easily and be more effective.

Before and after Fractional laser skin resurfacing

The benefits of exfoliation are:
• Remove dead, dry, damaged skin to reveal healthy young looking skin cells
• Stimulate the deeper skin layer to produce new collagen to replace collagen lost by sun damage, toxins and aging and restore young looking skin.
• Improve the penetration of Skin Care Products like Retin A, Tazorac, and Vitamin C to prevent skin aging changes
• Prevent blockage of Sebaceous (Oil) Gland openings (Pores) and thus help prevent Acne outbreaks
• Improve and freshen skin appearance to a younger look

How to Exfoliate-the Best Skin Exfoliation Techniques?

Facial skin exfoliation should be an everyday part of your skin care routine if you want young looking skin. There are many simple things you can do at home. However if you are serious about preserving skin health and preventing facial and Décolletage skin damage and aging you need to visit a Professional Experienced Medical Aesthetician who knows how to exfoliate on a routine basis. My recommendation is that a maintenance program should involve your Medical Aesthetician at least every 6 weeks after a good baseline exfoliation and skin care regimen has been initiated. The best exfoliation techniques are:

• Daily Skin Cleansing
• Daily Exfoliation- the Clarisonic is an excellent device that you can use at home
• Daily Use of a Medical Grade Topical Skin Cream exfoliant.
• Microdermabrasion or Micropeel every 6 weeks
• For Moderate Skin Damage and aging changes a Superficial Fractional Ablative Erbium Laser Peel
• For Advanced Skin Damage and Aging Changes a Combined Laser Skin Resurfacing with a combination of 1540 Non ablative Fractional Erbium Laser and 2940 Ablative Fractional Erbium Laser treatments

Come In and See Our Medical Aesthetician to get a Head Start on summer.

We are experts at evaluating and treating skin damage and skin aging and helping you have young looking skin. We are also honest professionals who understand the complex field of non-surgical facial rejuvenation. We will tell you what we see and only recommend treatments that we believe, based on scientific evidence, to work.

We hope you will come in for a visit.To entice you we are offering a free Micropeel to the first 10 Newsletter Subscribers who come in for a consult or skin evaluation in the Month of April and a free copy of Save Your Face to all who visit us for any reason.

Dr Seckel
Dr Doherty
Concord, Massachusetts
Boston, Massachusetts

The correction or reconstruction of Tubular or Tuberous Deformity remains a very challenging issue for most Plastic Surgeons. Older traditional surgical methods often produced unacceptable scarring and often poor results. However more modern techniques have improved results significantly and in many cases this deformity can now be corrected with much less visible scarring.

What is the Tubular or Tuberous Breast Deformity?

Tubular Breast Deformity is an inherited or congenital condition that appears during puberty when glandular development starts. The breast is small with inadequate growth of glandular tissue and what is called a constricted shape. The skin of the breast is constricted or tightened around the developing gland tissue which causes the breast to have a tubular or elongated shape.

In some cases the areola appears unusually large as it appears larger than the diameter of the gland. In some cases when the nipple-areola also fails to develop the nipple-areola can be very small. In some cases this is called Hypoplasia or Agenesis. In many cases there is asymmetry with unevenness and in some cases Tubular Deformity can occur on only one side.

Breast Implants to Correct Tubular Deformity

Fortunately, today many patients with Tubular or Tuberous Deformity can achieve an excellent cosmetic result with simple Augmentation with Implants. This technique requires a Sub glandular Implant rather than the Sub muscular Augmentation and requires a modification of the breast gland. There are constricting bands that hold the gland in a tubular shape and these bands are released surgically from underneath the breast gland. This allows the implant to stretch the overlying gland tissue and skin to a more natural appearing breast shape.

In the photo below the patient had a tubular shaped breast on one side and Agenesis or Hypoplasia on the opposite side. She chose, wisely in my opinion, not to have a nipple-areola enlarging procedure on the left side, as this would have created very visible scarring. The implants do provide some stretching and enlargement of the hypo plastic nipple-areola complex.

Before and after correction Tubular or Tuberous Breast Deformity with Breast Implants Right Oblique View

Before and after correction Tubular or Tuberous Breast Deformity with Breast Implants Right Side View

Before and after correction of Tubular or Tuberous Breast Deformity with Breast Implants Left Oblique View

Before and after correction Tubular or Tuberous Breast Deformity with Breast Implants Left Side View

Soft Tissue Expansion for Tubular Breasts with Ptosis or Sagging

In patients who have Tubular Deformity with significant Ptosis or sagging, a technique called Soft Tissue Expansion of often works well. A small inflatable saline implant is placed beneath the breast and gradually inflated by injecting saline through a small port beneath the skin. Over a few months, the expanding implant gradually stretches the breast and creates a more normal shape. This technique can also increase the size of the nipple-areola complex. When the final breast and shape is achieved the expander is removed and a final implant is placed.

Mastopexy or Lift and Implants

In patients who have Tubular or Tuberous Deformity with a very large Areola or significant asymmetry or uneven breasts a Dermal Mastopexy or Breast Lift is often done to achieve better symmetry.The Mastopexy allows for reduction of the Areola if necessary and lifting of the sagging breast.

In the patient pictured below a lift or Mastopexy and Implant was done on the left side and an implant on the right. The left side was sagging or Ptotic and both breasts were constricted but were not “extreme” forms of Tuberous Deformity. These photos are only 2 weeks after surgery and there is still a scab on the left side which went on to heal very nicely. Notice how the left Areola has been reduced to match the right side.

Before and after Breast Implants and Mastopexy or Breast Lift to correct uneven breasts or breast asymmetry front view

Before and after Breast Implants and Mastopexy or Breast Lift to correct uneven breasts or breast asymmetry side view

Donut Mastopexy

Donut Mastopexy is an operation that excises or removes the tight or constricted skin surrounding the breast done to leave behind a more normal shape. The problem with this operation is that the scarring is terrible. I have never used this procedure and doubt that it is done very often now that newer soft tissue expansion is available for severe cases.

Who Should Do Your Surgery?

You should consult a surgeon who is certified by the American Board of Plastic Surgery and who is experienced in Cosmetic Breast Surgery. Ask the doctor if he has experience treating this deformity and if possible show you the results that he/she has achieved. Good results require an expert who knows how to treat this condition.

Call me at 978-369-4499 for more information or read about Breast Implants on my blog. You may contact me and submit breast photos and I will answer your questions by email. You may want to sign up for our Plastic Surgery Newsletter to learn about new non-surgical and surgical treatments in Plastic Surgery.
Dr. Seckel
Concord, Massachusetts
Boston, Massachusetts

Before and After Photos Silicone Gel Breast Implants 300 ccs

Before and After Photos Silicone Gel Breast Implants 300 ccs

Breast Augmentation with Breast Implants is a very popular and common Plastic Surgery procedure. If you are considering having Breast Implants there are many decisions that you will have to make with the help of advice from your Plastic Surgeon. You will have to choose the size and style of Breast Implant, where you want your incision, and whether you want your Breast Implants placed over the chest muscle (see above Before and After Photo) or under the chest muscle (see Below Before and After Photo.)

Before and After Photos Silicone Gel Breast Implants 325 ccs

Beofre and After Photo Silicone Gel Breast Implants 325 ccs

The major muscle on your chest is called the Pectoralis Muscle and there are two of them, right and left. Breast Implants may be placed beneath the muscle, and this technique is called a Subpectoral or Submuscular Breast Augmentation. If the Implant is placed on top of the Pectoralis Muscles, the procedure is called a Subglandular (beneath the breast gland) Breast Augmentation or Prepectoral Augmentation.

To help you decide whether you want a Subglandular or Submuscular Breast Augmentation let’s discuss some of the advantages and disadvantages of both techniques.

Advantages of Subglandular Breast Implants
• Less discomfort
• Quicker Recovery
• Implant falls to normal position more quickly
• Looks better in sagging breast without need for breast lift

Disadvantages of Subglandular Breast Augmentation

• More visible Implant in thin women with little breast tissue
• Breast may sag more over long time
• Folds or Ripples, especially in Saline Implants, may be more visible
• May have higher incidence of firmness long term

Advantages of Submuscular Breast Augmentation

• More tissue covering Implant-less implant show in thin women with little Breast tissue
• Less prone to firmness over long term
• Ripples in Saline Implants less likely to show
• Daily action of muscle provides Implant Displacement exercises
• Some feel a more natural look

Disadvantages of Submuscular Breast Augmentation

• More discomfort
• Longer Recovery
• May interfere with pushups, weight lifting and other exercise
• Visible motion and distortion of Implant with Pectoralis Muscle contraction
• Holds Implant higher thus will need a Breast Lift if you have sagging Breasts
• Need for revision may be more common

How to Decide Under or Over the Muscle

First, you need to have a consultation with one or two experienced Board Certified Plastic Surgeons who are experienced in Cosmetic Plastic Surgery. Visit the website of the American Society of Aesthetic Plastic Surgeons for a list of Board Certified doctors in your area. Discuss you options thoroughly with the Doctor. There will be specific issues regarding your anatomy, lifestyle, and goals which will swing the decision one way or the other.

Also read as much as you can about Breast Augmentation with Breast Implants so you are well informed. Another good source of information is the website of the American Society of Plastic Surgeons.

You and your surgeon will make the final decision however some general guidelines are:

• If you are very thin, with little Breast Tissue and no Ptosis or sagging, the Submuscular approach may be your best choice.
• If you have had children or lost weight and do not want the scars associated with a Breast Lift, and your surgeon feels that you can avoid a lift, then the Subglandular approach may be better for you.
• If you participate in vigorous physical exercise such as weight lifting and pushups and visible motion of your implants will bother you, then the Subglandular approach may be better for you.
• If you are primarily concerned about avoiding capsular contracture or firmness of your implants the Submuscular approach may be best for you.
• If you must have Saline Implants and are concerned with folds or ripples then the Submuscular approach would be better.
• If you want a quick recovery and are concerned about pain or discomfort the Subglandular approach may be better for you.

What is Most Important?

Both Subglandular and Submuscular Breast Implants can provide Beautiful Results and have done so for hundreds of thousands of women. The key is the experience and skill of your Plastic Surgeon. Your choice of a Plastic Surgeon will be the most important factor in your decision.

See more than one doctor, make sure they are certified by the American Board of Plastic Surgery and that they are an expert in Cosmetic Surgery of the Breast. Try to find friends who have had this surgery and ask them about their surgeon. Be sure you feel confident in and comfortable with the doctor who you choose.

Dr. Seckel
Boston, Massachusetts
Concord, Massachusetts

Before and After Facelift

The good news is that there are many steps that you and your Plastic Surgeon can take to hide your Facelift Scars so that others cannot see them.

Where are Facelift Incisions Placed?

Regardless of the type of Facelift-SMAS, Mini, Lifestyle, Weekend, you name it, there will be incisions and they will involve the skin around your ear to a greater or lesser extent. Below are the incisions used for a classic standard Facelift:

• In the Hairline above and in front of the top of the ear
• The front of the ear
• Behind the ear
• In the Hairline behind the ear
• Under the chin if a Neck Lift is being done

What is the Most Visible Facelift Incision/Scar?

• In front of the ear

Facelift Before and After Photo Showing Visible Facelift Scar in Front of Ear

How can The Facelift Incision in Front of The Ear be Hidden?

The incision and thus the scar in front of the ear can be easily hidden by placing the visible portion of the incision inside the ear canal or opening behind the little lump in front of you rear called the Tragus.

Facelift Before and After Photo Showing Hidden Facelift Scar Inside Ear

Why you may ask is this technique not used more often? My answer is:

• It takes more time-adds maybe 20 minutes to the procedure
• It is a little more difficult for your surgeon
• If not done correctly the size of the Tragus can be reduced
• Some surgeons may not know how to do it
• Patients are unaware of how important this technique is and do not demand it

What Else Can Your Surgeon Do to Hide Facelift Scars?

• Careful beveled incisions in hairline to avoid hair loss
• Avoid extreme tension on sutures when closing incisions
• SMAS or Deep Muscle Tightening before skin closure allows less tension to be placed on skin closure
• Avoid Staple Closure
• Use very fine sutures to close visible, non-hair bearing skin
• Early suture removal-5-7 days for skin, 10-14 days in hair bearing area
• Meticulous surgical technique
• Experienced surgeon
• Avoid infection
• Proper wound care

What Can You Do To Improve Your Facelift Scars?

• Read about Facelift Surgery
• Choose an experienced surgeon Certified by the American Board of Plastic Surgery
• Follow instructions
• Keep your incisions clean and dry
• Begin gentle massage of the incisions after two weeks
• Use topical Scar Guard on incisions that are not in the hair
• Avoid strenuous exercise and stress during your recovery
• Eat healthy-protein and high anti-oxidant containing foods
• Supplemental Vitamin C

What to Do If Your Facelift Scars Get Red

Understand that ALL surgical scars are red to pink for 7 months after any surgery. Most scars are white after two years. However if your scars are red, angry looking, itchy and lumpy or raised starting between 3weeks to 8 weeks after your Facelift you may be developing a Hypertrophic Scar.

If this occurs see your surgeon soon. There are many new therapies that can be done to reduce redness and lumpiness of scars, including:

• IPL or Intermittent Pulsed Light Treatments
• 1540 Non ablative Fractional Erbium Laser Treatments
• Topical Steroid Tape
• Steroid Injection-this should be done conservatively , 6 weeks apart no more than 3 treatments or Steroid related problems can occur

Find a good Plastic Surgeon

The skill of your surgeon is the most important factor in achieving well hidden Facelift Scars. Ask your friends who have had a Facelift about their experience. Word of mouth is still one of the best ways to find a good Plastic Surgeon.

Visit the website of the American Society of Aesthetic Plastic Surgeons for a listing of Board Certified Plastic Surgeons who have experience and interest in Cosmetic Surgery.

Call 978-369-4499 for more information.
Dr. Seckel
Boston, Massachusetts
Concord, Massachusetts

Sculptra Aesthetic® is an injectable product that acts as a Bio Stimulant to help your skin form new collagen.
As you know, fat loss, loss of collagen and the effects of the sun cause aging of the skin and wrinkles. Sculptra Aesthetic® helps your body to produce new collagen to repair aged damaged skin.

Dr. Doherty is having excellent results using Sculptra Aesthetic® and is very excited about this product. See before and after photo of Sculptra Aesthetic® treatment below.

Before and After Photos of Sculptra Biostimulant

Fat transfer is transforming Plastic Surgery. As we age, the Fat in our face atrophies or is lost. Remember how you looked as a teenager with full plump “Apple Cheeks?”

The effect of aging of the face resembles a balloon that loses its air. As air is let out, the balloon looks wrinkled, empty and saggy. In a similar way, when the face loses fat, it appears empty, wrinkled and aged. With less fat in the cheeks, older patient’s facial skin becomes loose and tends to fall or sag.. The same holds true for other regions of the face.

Unlike fillers such as Restylane® or Juvederm® , Fat Harvesting and Transfer utilizes your own fat as a Facial Filler. The benefit is that this technique utilizes your own tissue and provides a permanent correction. In general, we harvest or remove fat from your abdomen, flanks or buttocks. These are areas where patients usually have “some to spare.”

The Fat Harvesting and Transfer Procedure is used for:

• Plumping and Lifting the Cheeks and Nasal Labial Folds
• Plumping the Lips
• Improving the Jawline
• Liquid Facelift
• Rejuvenating the Hands
• Breast Enlargement
• Buttock Enhancement
• Treatment of Capsular Contracture and Irregular Folds in Breast Implants
• Correction of Depressed Scars
• Breast Reconstruction following Mastectomy
• Correction of Skin Damage following Radiation Therapy

As you can see, Fat Harvest and Transfer is a very valuable tool for Plastic Surgery. Fat Transfer, however, can only work well if the Fat Cells survive the Transplant. Our new Adivive Fat Harvesting System is revolutionary and allows us to transfer Fat Cells with a 90% survival rate compared to 50-60% with older techniques. See the Photo below showing the dramatic results of Fat Transfer to the Face.

Before and After Photo of Fat Transfer to the Face

Winter is the best time to have Laser Resurfacing. Winter skin is dry. Wrinkles and pigment are more obvious. Recovery from Laser Resurfacing is much easier in cooler weather.

Laser Resurfacing is unequivocally the best facial rejuvenation technique to remove wrinkles and to improve facial brown spots, as well as damaged and aged skin. In the past, the C02 laser has been the gold standard for laser resurfacing. Traditional CO2 Laser Resurfacing recovery, however, is difficult and has discouraged most patients from having the procedure.

Dr. Doherty and I have worked with Palomar Medical Technologies-a medical laser company with its manufacturing and world headquarters based in Burlington, Ma. Over the past four years, we have both worked with Palomar as they developed two Erbium Lasers: the 2940nm and 1540nm Fractional Erbium Lasers. Facial Resurfacing with these lasers achieves similar wrinkle removal results with about a third of the downtime of a CO2 laser treatment.

The Erbium® is a “Cool” laser and produces less heat than the CO2. Erbium can therefore be used on both dark and light skin types. With Erbium technology, there is less skin injury and recovery to nice new fresh pink skin is about five to seven days instead of the traditional three weeks associated with the CO2 treatments. Also notable is the fact that there are no demarcation lines. This means that there are no areas of loss of pigment and the skin texture and color is uniform throughout the face.

See the photos of results below. For more information on the procedure and a detailed article, click on the blog about Combined Laser Resurfacing.

Before and After Photo Combined Laser Resurfacing

If you are pleased with the appearance of your breasts after augmentation, and you have no medical complication caused by the implants, then there is no reason to remove them.

There is a great deal of confusion about whether stable prostheses have to be removed after 10 years. This is because of the FDA guidelines written a few years ago when they approved the new Silicone Gel Breast Implants. The FDA estimates the “useful life” of these products to be 10 years. Thousands of patients have had similar devices in place for over 40 years and have not had problems. It is important for you to understand that the FDA recommendations were not based on any scientific long-term study as there were no such studies for the new approved devices when these new devices were approved. Thus the FDA recommendations are essentially an estimate of “useful life.”

if you are happy with your result and there is no evidence of rupture or any other problem, I do not recommend removing breast implants unless you no longer wish to have them. Just because they are 10 years old does not mean that you “have” to remove them.

There are situations in which I do recommend removal and, if you desire, exchange to new implants. There are however some serious medical reasons that require removal.

Some of the reasons for removal are listed below:

• Infection-rarely the prosthesis can become infected. I have seen infection once in 30 years and it occurred after a nipple piercing. Infection of an implant can be life threatening and removal is a surgical emergency. Signs of an infection are redness on the skin and fever and if this occurs see your doctor immediately.

• Exposure- if there is a break in the skin and the device is exposed removal is almost always recommended immediately.

• Rupture- if your Silicone Breast Implant ruptures it should be removed according to current guidelines. New ones can be placed back into the breast after removing all possible Silicone. If they are Saline, the device deflates and the saline is reabsorbed by the body safely. However deflation creates an asymmetry and you will most likely want a replacement.

• Capsular contracture-capsular contracture presents as firmness or hardness around the prosthesis. It is caused by scar tissue forming around the device. In severe cases it can cause discomfort. If you are considering re-augmentation, then the surgeon will remove the scar tissue, called a Capsulectomy, so that the new prosthesis will be softer. However, if you have developed capsular contracture there is a 50% chance that it will recur after removal, Capsulectomy and insertion of new prostheses.

• Rippling of Saline Implant-many women are troubled by palpable or visible ripples along the side near the axilla or arm pit. This happens most frequently with Saline prostheses. It is not a medical problem but a cosmetic one. Silicone gel prostheses are less prone to this problem, which is more common in thin women with little glandular tissue.

• Displacement, abnormal position or bottoming out-in some patients the prosthesis can become displaced to the side or sag down on the chest. This is again a cosmetic problem and most women opt revision and replacement.

• Double Bubble-in some cases the device falls below the mammary gland and creates a second “bubble” or fullness below the crease. This is usually repaired and the prostheses replaced.

• Snoopy Deformity-in some cases the prosthesis fails to drop down to a normal position under the mound. This can create a bulge above the nipple which from the side view has the appearance of the cartoon character Snoopy. Revision is usually done.

• You want a larger size.

• You want a smaller size.

• Your breasts have sagged and become smaller after having children, or with age. In most of these cases a breast lift or Mastopexy is done and new prostheses are placed.

• You simply do not want to have them any longer.

How difficult is the removal procedure?

If your breast implants are normal and there are no medical issues then removal is very simple and usually not painful. If you want them out, have them removed. Do not be concerned that you will look deformed or abnormal. You will just look smaller, but if there are no problems with the device such as capsules or rupture, you will look fine.

Capsular contracture or tight scar can require more extensive surgery to remove the scar. Some glandular tissue can be removed in these cases and create visible depressions.

In summary there is no specific time at which your breast implants have to be removed as long as there is no medical reason. Most removals are followed by the insertion of new ones after correction of a cosmetic problem.
If you want or need them removed, don’t worry about how you will look. You will, in most cases, look smaller but normal.

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Dr. Seckel
Boston, Massachusetts
Concord, Massachusetts