Palomar™ Medical has just introduced SLIMLIPO™ a new laser liposuction technology which will revolutionize the way liposuction is done. The word SLIM™ stands for Selective Laser Induced Melting and what is new is the laser wavelength-920 and 920/980 nm- which selectively melts fat-3 times more than SmartLipo™and 5 times more than the 1320nm laser used in the CoolLipo™ device.

In some patients with smaller fat deposits we can melt the fat with the tiny SLIMLIPO™ laser fiber and use no suction to remove the dissolved fat. This means less bruising, less trauma, and quick recovery.

New laser liposuction technology is revolutionizing the way liposuction is done. Benefits of the new laser liposuction technique are

· The laser selectively dissolves fat unlike standard liposuction which can destroy all tissues.

· The laser closes blood vessels=less bleeding, less bruising

· The laser tightens skin=less loose skin after liposuction

· Laser liposuction is less traumatic=quicker recovery

· The laser fiber is tiny= smaller scars

· Smaller areas done under local anesthesia

All laser liposuction machines are not equal. You need to understand the importance of the laser wavelength used to melt fat. Most laser liposuction machines on the market today use a 1064nm or 1320nm laser wavelength. Actually the best wavelength which is most highly absorbed by fat is 920nm, a wavelength patented and owned by Palomar™ Medical in Burlington, Massachusetts.

Palomar has introduced the SLIMLIPO™ Aspire™ Liposuction Unit which is the first 920nm based laser liposuction and is 3 times as selectively absorbed by fat as the 1064nm lasers and 2 times more than the 1320nm-the other commercially available laser liposuction technology. It is also 5 times as selectively absorbed by blood. This means that the SLIMLIPO™ Aspire™ laser liposuction unit dissolves fat and prevents bleeding much more effectively than any other laser liposuction machine available. See the figure below for comparison of the fat melting selectivity of the various laser liposuction units available today-remember, Palomar’s new SLIMLIPO uses the 920nm laser:

For you the patient this translates into:

· Gentler more thorough fat removal

· Less bleeding, less bruising

· Quicker recovery

We also can blend in a 980nm laser wavelength with the Aspire™ which is highly absorbed by the Dermis-the deep layer of your skin which controls skin tightening. For you this translates into:

· Tighter skin after liposuction

· Less risk of revisional surgery after liposuction

I am proud to say that we helped Palomar™ develop this revolutionary new laser and are the first to offer SLIMLIPO™ with the Aspire™ laser liposuction unit in Massachusetts and the Boston area and one of the first practices in the world to have this machine.

If you are considering laser liposuction you really need to know the facts and understand the technology. Once you do the advantages of SLIMLIPO™ with the Aspire™ system are obvious-there is nothing else like it on the market.

For more information on laser liposuction or plastic surgery in general call 978-369-4499 or visit my website.Be sure to sign up for my free email newsletter for information on the latest advances in plastic surgery and non-surgical rejuvenation procedures.

Dr. Seckel

Concord, Massachusetts

Boston, Massachusetts

Liposuction is the most common plastic surgery procedure done in the United States.

Palomar™ Medical has just introduced SLIMLIPO™ a new laser liposuction technology which will revolutionize the way liposuction is done. The word SLIM™ stands for Selective Laser Induced Melting and what is new is the laser wavelength-920 and 920/980 nm- which selectively melts fat-3 times more than SmartLipo™and 5 times more than the 1320nm laser used in the CoolLipo™ device.

In some patients with smaller fat deposits we can melt the fat with the tiny SLIMLIPO™ laser fiber and use no suction to remove the dissolved fat. This means less bruising, less trauma, and quick recovery.

New laser liposuction technology is revolutionizing the way liposuction is done. Benefits of the new laser liposuction technique are

· The laser selectively dissolves fat unlike standard liposuction which can destroy all tissues.

· The laser closes blood vessels=less bleeding, less bruising

· The laser tightens skin=less loose skin after liposuction

· Laser liposuction is less traumatic=quicker recovery

· The laser fiber is tiny= smaller scars

· Smaller areas done under local anesthesia

All laser liposuction machines are not equal. You need to understand the importance of the laser wavelength used to melt fat. Most laser liposuction machines on the market today use a 1064nm or 1320nm laser wavelength. Actually the best wavelength which is most highly absorbed by fat is 920nm, a wavelength patented and owned by Palomar™ Medical in Burlington, Massachusetts.

Palomar has introduced the SLIMLIPO™ Aspire™ Liposuction Unit which is the first 920nm based laser liposuction and is 3 times as selectively absorbed by fat as the 1064nm lasers and 2 times more than the 1320nm-the other commercially available laser liposuction technology. It is also 5 times as selectively absorbed by blood. This means that the SLIMLIPO™ Aspire™ laser liposuction unit dissolves fat and prevents bleeding much more effectively than any other laser liposuction machine available. See the figure below for comparison of the fat melting selectivity of the various laser liposuction units available today-remember, Palomar’s new SLIMLIPO uses the 920nm laser:

For you the patient this translates into:

· Gentler more thorough fat removal

· Less bleeding, less bruising

· Quicker recovery

We also can blend in a 980nm laser wavelength with the Aspire™ which is highly absorbed by the Dermis-the deep layer of your skin which controls skin tightening. For you this translates into:

· Tighter skin after liposuction

· Less risk of revisional surgery after liposuction

I am proud to say that we helped Palomar™ develop this revolutionary new laser and are the first to offer SLIMLIPO™ with the Aspire™ laser liposuction unit in Massachusetts and the Boston area and one of the first practices in the world to have this machine.

If you are considering laser liposuction you really need to know the facts and understand the technology. Once you do the advantages of SLIMLIPO™ with the Aspire™ system are obvious-there is nothing else like it on the market.

For more information on laser liposuction or plastic surgery in general call 978-369-4499 or visit my website.Be sure to sign up for my free email newsletter for information on the latest advances in plastic surgery and non-surgical rejuvenation procedures.

Dr. Seckel

Concord, Massachusetts

Boston, Massachusetts

Experience, artistic sense, and a shared image of your goals for breast augmentation are important factors in achieving a good result. (Contact Dr Seckel)

Most women seeking breast augmentation do so because they feel:

• They have always wanted bigger breasts
• Their breasts have become smaller and less full after pregnancy
• Their breasts have sagged
• They do not like the shape of their breasts
• They want to look better in a bathing suit
• They want to look better in clothes
• They just want fuller more voluptuous breasts
• They want a more feminine looking body
• They just want big breasts

Breast augmentation is one of the most frequently performed plastic surgery operations done in the US today. Overall results are excellent and patient satisfaction and happiness with their new breasts is very high.

With the recent FDA approval of Silicone Gel Breast Implants the options and choices available to you are many. There are also many options for placement of the incision and the implant.

The Breast Augmentation Procedure

What bothers my patients most is the lack of breast fullness and cleavage of their breasts. They just want to have fuller breasts and be able to fill out their bathing suit and look good in today’s fashions.

If your breast is small or is normal size but has no sagging, the breast augmentation procedure is very straightforward and requires little modification.

If you have sagging breasts after weight loss or childbirth, depending on how much the breast has sagged, you may need a dermal mastopexy or breast lift in addition to the breast augmentation.

For most women, however, the breast augmentation procedure can correct the post pregnancy or weight loss breast appearance without the need for a breast lift or mastopexy.

The key issue in making this decision is the position of your nipple. Check the crease in the skin below your breast. This is called the inframammary crease. If the nipple is above this crease then chances are a breast augmentation can be done without a breast lift.

Most often I place the breast implant through an incision in the fold beneath the breast, called the inframammary breast augmentation. This scar normally does not show unless the breast is lifted up. The implant can also be placed through an incision in the armpit called a transaxillary breast augmentation.

If you have had children and your breast has sagged only a small amount I often use a technique called the Transareolar Breast Augmentation. Using this technique I make a very small incision in the areola—the round pink part surrounding the nipple. I then modify the breast gland so that it falls nicely over the implant. If you heal well the scar is hard to notice.

The Transareolar approach does push the nipple up and places the volume of the implant under the nipple and which is where the volume of the normal breast was during pregnancy.

The breast implant can be placed either under the breast gland, called the sub glandular breast augmentation, or under the chest muscle, called the sub muscular breast augmentation. There are advantages and disadvantages to each technique which I will explain to you at the time of your consultation.

Today you have a choice between saline breast implants and silicone gel breast implants. The main difference in the result of breast augmentation with saline breast implants from that with silicone gel breast implants is the feel of the implant. If there are no complications such as hardening of the implant, and the result of the surgery is satisfactory, then a silicone gel breast implant will feel more natural than a saline implant-the silicone gel implant often feels more like breast tissue than does a saline implant.

However, this difference is subtle not dramatic, and there are many people who have saline breast implants in whom I cannot tell the difference between a saline and a silicone gel implant.

There are many factors to consider when making your decision about which type of breast implant to chose. I will give you information about both types of implants at the time of your consultation.

Your Consultation

When we meet I will talk with you and ask you to explain to me the specific goals you hope to achieve with breast augmentation. I will examine you and tell you my findings and recommend the breast augmentation procedure which I believe is best for you.

I will discuss the procedure, your recovery, and expectations and answer your questions. Photos of your breasts will be taken. You will be given an estimate or quote of the cost of the procedure. Financing is available.

Pre OP

The pre operative visit is the time when we will sit down and clearly define your goals. We will discuss what you hope to achieve and what I believe I can achieve with the breast augmentation procedure.

You will also undergo a history and physical exam to make certain that you are healthy and have no medication allergies or contraindications to surgery. An EKG (electrocardiogram) may be done if you have a history of heart problems or have reached a certain age. You will also be given prescriptions for post operative medications.

You also will be asked to read and sign surgical consent forms which outline the risks, potential complications, limitations and expectations of breast augmentation surgery.

The Operation

Breast augmentation is done with you asleep under general anesthesia. Very experienced, superb anesthesiologists will be taking care of you. Safety is our first concern. We use modern, very safe anesthesiology techniques, and take precautions to avoid nausea after surgery.

Breast augmentation scars are usually not noticeable. The scar is usually hidden beneath the breast, in the armpit, or within the pink part of the areola. You will not have visible sutures or suture marks following surgery. I use buried sutures to close your incision. Buried sutures produce less noticeable scars and help avoid the old style “railroad track” suture mark seen when interrupted external sutures are used.

Breast augmentation is done as an outpatient or day surgery. You will go home the same day after surgery. The operation takes about an hour.

After you wake up you will be taken to the recovery room where a nurse will be taking care of you. The nurse monitors you, makes certain you are comfortable and checks your vital signs. You will spend 1-2 hours in recovery. After that, as soon as you are comfortable, able to drink and eat a bland food such as crackers or cookies, and able to go to the bathroom, you will be discharged. The nurse will escort you by wheel chair to your car.

We require that someone bring you to the surgery center and take you home, and that you have someone staying with you the first night after your surgery.

Post op- What to expect

In the recovery room you will be given medications to control any discomfort you are experiencing following your surgery. You also will have medications to take for discomfort at home. You will experience discomfort in the breast area for the first 3-4 days after surgery. If the breast implant is placed under the chest muscle, the discomfort is greater than if the implant is placed under the breast gland.

The day after surgery I will have you start implant displacement exercises. I have you use your hand to massage and move the implant. This technique helps avoid hardening of the implant and actually reduces the length of time you will feel discomfort post operatively.

Most patients are quite comfortable by day 5 post op and some are able to return to work. Generally full recovery takes 2 weeks. I ask you to wait 3 weeks before heavy weight lifting or aggressive work outs.

A Consultation with Dr Seckel

I can tell you a great deal more about breast augmentation and how it would work for you if I see you in person. Call me to set up a consultation or contact me by email. If you would like to email me your questions or photos I can email you my thoughts about which procedure I would most likely recommend for you. For more information on breast augmentation read my blogs about breast augmentation.

I look forward to meeting you. Call 978-369-4499 for an appointment

Dr Seckel

Boston, Massachusetts

Concord, Massachusetts

Eye bags and puffy eyes are caused by a structural problem beneath the eyelid, and eye creams just cannot reach the cause of the eye bag or puffy eye and thus cannot correct eye bags or puffy eyes.

Nearly everyone over 30 begins to notice eye bags, puffy eyes and dark circles under their eyes, Billions of dollars are spent each year on skin creams to remove eye bags, puffy eyes and dark circles under the eyes and plastic surgery, called blepharoplasty which is done to remove eye bags and puffy eyes is the third most common plastic surgery operation done in the United States.

What Causes Eye Bags, Puffy Eyes and Dark Circles under the Eyes?

Eye bags, also called eyelid bags, puffy eyes, tired eyes, and dark circles under the eyes, are caused by protrusion or herniation of the fat which lies beneath the eyelid and which normally is held directly beneath the eyeball. The reason the fat is beneath the eyeball is that it acts as a shock absorber preventing the eyeball from coming into contact with the bone of the eye socket. The eyelid is positioned directly over this supporting fat pad and holds the fat in place directly below the eyeball so that the fat can serve its function.

The problem of eye bags and puffy eyes occurs as we age because as the skin of the eyelid ages it loosens, becomes less elastic, and begins to sag and lose tone. As the eyelid loses tone it cannot hold the fat within the bony orbit or eye socket beneath the eyeball, and the fat pushes forward against the undersurface of the weakened eyelid and creates the eye bag , puffy eye, or eyelid bag.

This pushing forward on the eyelid and creating an eye bag, eyelid bag or puffy eye is technically called fatty orbital herniation, because the fat herniates or protrudes from the bony orbit or eye socket and creates a bulge or eye bag or puffy eye. To herniate means to project through an abnormal opening, like the bulge produced by a hernia on the lower abdomen. Eye bags or puffy eyes are a hernia of the eyelid.

The other eyelid aging sign is called dark circles under the eyes. Technically this is called the arcus deformity and is caused by a tethering of the dark circle skin from underneath the eyelid skin by a structure called the arcus marginalis, which is discussed below. The dark circles under the eyes are essentially a shadow created by the overhanging eye bag or puffy eyelid.

How Are Eye Bags and Puffy Eyes Removed Traditionally?

Eye bag removal has traditionally been done with a plastic surgery operation called a blepharoplasty. During the traditional eye bag surgery the plastic surgeon made an incision on the lower eyelid just beneath the eye lashes, exposed the underlying fat causing the eye bag or puffy eye, and removed the fat and also removed some of the skin which had been stretched into the eye bag. Although the blepharoplasty does remove the eye bag or puffiness, there are several problems with this traditional eye bag or puffy eye surgery.

First, the incision through the eyelid weakens the eyelid skin and muscle which supports the eyelid and holds the eyelid tight against the eyeball. As a result of weakening of the support for the eyelid, the eyelid often turns down or sags after a lower eyelid blepharoplasty. Technically this is called an ectropion or scleral show, but in lay terms it is referred to as the sad eyed look or hound dog eyes. It is a terrible stigma of the old scalpel blepharoplasty operation. The ectropion can also have serious implications for the eye ball itself. When the ectropion is severe, the eyeball can dry out, develop a corneal ulceration, and threaten the eye. Often corrective surgery called a canthoplasty is required.

Because of these serious complications from traditional eye bag and puffy eye surgery new modern blepharoplasty techniques have been developed to remove eye bags and puffy eyes without damaging the support of the eyelid. The newer, more modern blepharoplasty technique is called a transconjunctival blepharoplasty. The conjunctiva is the pink part of the lower eyelid on the inside of the lower eyelid, and during the transconjunctival blepharoplasty the incision is made on the inside of the lower eyelid and the fat exposed and the tissues tightened. The transconjunctival blepharoplasty can be used to remove eye bags and puffy eyes without damaging the outer supporting eyelid muscle and tissues and thus the eyelid support remains in tact and there is little risk of ectropion or hound dog eyes after removal of the eye bags and puffy eyes.

Remove Eye Bags but Avoid Hollow Eyes and Correct dark Circles Under The Eyes!

Another serious drawback to traditional blepharoplasty for eye bags and puffy eyes is that often the surgeon removes too much of the fat that was causing the eye bag. The result of too much fat removal during blepharoplasty is that after removal of the eye bag the patient is left with a hollow eye appearance. This is a very distressing problem for patients, so distressing that many patients choose to have additional surgery to transplant fat back into the eyelid to correct the hollow eye appearance after eye bag and puffy eye removal.

Newer more modern blepharoplasty techniques for eye bag and puffy eye correction do not remove fat but reposition the fat or graft the fat into a better position to create a more youthful eyelid look and remove dark circles under the eyes. When a person has eye bags and puffy eyes there is almost always a dark circle under the eye directly below the eye bag. These dark circles are called the naso-jugal fold or tear trough deformity and is caused by the attachment of a small structure called the arcus marginalis. The arcus marginalis is attached to the bone of the eye socket and is also attached to the underside of the lower eyelid just below the eye bag. The arcus marginalis holds the lid down or tethers the lower eyelid to the bone right at the dark circle, creating the tear trough deformity, so the upper part of the lower eyelid, the eye bag falls over the dark circle or tear trough, and makes the dark circle shadow worse.

Newer more modern blepharoplasty involves a transconjunctival blepharoplasty, which avoids ectropion, followed by release of the arcus marginalis, which releases the dark circle or tear trough deformity. Next, the protruding eyelid fat is not removed, but the bulging fat is placed beneath the dark circle, to plump the dark circle or tear trough, reduce the shadow, reduce the eye bag and puffy eye and avoid the hollow eye.

This is a new technique for removal of eye bags, puffy eyes and dark circles under the eyes and not widely practiced by plastic surgeons yet. As always there will be a 10 year delay between this new medical discovery and the adoption of the technique by the majority of surgeons. That is just the way new technology develops in surgery.

Festoons Can Look Worse After Old Style Blepharoplasty for Eye Bags and Puffy Eyes.

A festoon is often mistaken for an eye bag or puffy eye. In fact a festoon is a puffy swelling on the cheek just below the lower eyelid and is not an eye bag or puffy eye as many people think. The festoon is cheek skin and cannot be removed during a blepharoplasty. It is a puffy swelling at the top of the cheek just below the dark circle under the eye just below the eye bag. he technical term for a festoon is a malar bag.

Most people do not understand what a festoon is and mistakenly believe that the festoons can be corrected by the blepharoplasty for eye bags or puffy eyes. In fact, after a blepharoplasty for eye bags or puffy eyes is done, the festoons can look more prominent and make the face look worse!

For many years there was nothing that could be done to remove festoons, however new technology holds promise that we may soon be able to significantly improve festoons. A lateral eyelid /cheek lift can often remove festoons. New laser skin tightening technology may also soon be used to remove festoons.

The Modern Blepharoplasty for Removal of Eye Bags, Puffy Eyes, and Dark Circles Under The Eyes- Transconjunctival laser arcus marginalis release with preservation and repositioning of orbital fat.

I have used the laser exclusively to perform all of my blepharoplasty operations for the past 12 years, over 2300 cases. The new modern way to remove eye bags and puffy eyes is to use the laser to perform a transconjunctival blepharoplasty with arcus marginalis release to release the dark circles under the eyes and correct the tear trough deformity, and fat grafting to plump the dark circle and prevent the hollow eye look. This technique prevents ectropion, sad eyed look, and hound dog eyes and gives the lower eyelid a very young, smooth look with no eye bags and no change in eyelid shape. The results of my experience are published in the Journal Plastic and Reconstructive Surgery. The benefits of using the laser transconjunctival blepharoplasty with Arcus marginalis release and Fat grafting are:

1. No bleeding
2. Minimal bruising
3. quicker recovery
4. No visible scar on the eyelid
5. no change in the beautiful eyelid shape
6. quicker surgery with less anesthesia time
7. Correct the Tear Trough deformity or dark Circle Under the Eye
8. Avoid Hollow Eyes
9. Remove Eye Bags and Puffy Eyes
10. Excellent Results

Add The Lux2940 Fractional Laser Peel of The Lower Eyelid for Eyelid Wrinkle Removal and Total Eyelid Rejuvenation

All blepharoplasty procedures for eye bags and puffy eyes still do not totally rejuvenate the lower eyelid unless something is done to correct the eyelid wrinkles, brown spots, “crêpe” skin and other eyelid aging skin changes. The new Lux2940 Fractional Laser Peel is a revolutionary new eyelid skin peeling technique that removes eyelid wrinkles, sun damage, and aged skin and creates new fresh youthful looking skin on the eyelid. This new ActiveFX peel can be done at the same time as the blepharoplasty so that true eyelid rejuvenation is possible, removal of eye bags, puffy eyes, dark circles under the eyes, and removal of wrinkles and eyelid skin aging changes.

This is the modern approach to eyelid rejuvenation, Total Laser Eyelid Rejuvenation for removal of eye bags, puffy eyes, dark circles under the eyes, eye wrinkles, and sun damage, all with no change in eyelid shape, no hound dog eyes, no sad eyed look, no hollow eyes, all with the help of the laser and the newest most modern eyelid rejuvenation techniques, the laser and the ActiveFX.

To learn more, contact me or read Save Your Face or follow this link.

Dr. Seckel,

Boston, Massachusetts

Concord, Massachusetts

978-369-4499

Cosmetic Medicine or Medical Aesthetics is a relatively new term which describes an emerging field of medicine in which medical science, medical procedures and medical expertise are utilized by physicians to enhance or beautify people’s outward appearance. Another term used to describe cosmetic medicicine is aesthetic medicine.

Briefly, cosmetic medicine would include:
· Injectables-Botox® and Fillers like Juvederm®, Restylane®, and Radiesse®

· Laser and light therapies

I am sure there are others but the above two categories are certainly the most common. Procedures like liposuction are surgical procedures and I would not include them under the term cosmetic medicine.

Botox®

Botox® is used to lessen the lines of facial expression such as frown lines, worry lines, crows feet, bunny lines and lip lines. Results can be excellent (see photo below of Botox® injection into crow’s feet):

Juvederm®, Restylane®, Radiesse®-Soft Tissue Fillers

The soft tissue fillers like Juvederm® are used to fill deep facial lines and plump the lips. Results can be excellent if injected properly by an experienced professional (see photo below of filler injection into lip):

Laser Treatments

Lasers are used to:

· Remove hair

· Remove pigment and brown spots

· Remove blood vessels from the skin

· Remove wrinkles

Laser procedures are very effective when used by an experienced professional. Effective wrinkle removal requires ablative laser treatments which are done by a physician, and can be very effective (see photo below):

IPL (Intense Pulsed Light-also called photo-facial)

IPL can be used to remove hair, blood vessels, and pigment. IPL can be very effective for removing pigment and sun damage from the face and chest (see photo below before and after IPL treatments to the chest):

Infrared and radiofrequency treatments-Skin Tightening

Infrared and radiofrequency machines like LuxIR Deep and Thermage are used to tighten skin. Generally these machines accomplish about 20% of the tightening that can be achieved using surgical methods (see photo below before and after LuxIR Deep face and neck treatments):

The above cosmetic medicine procedures are the ones most commonly performed and the ones that are effective. There are many others that are widely advertised but which have not been proven to work.

I am sure this field will continue to grow. For more detailed information on non-surgical rejuvenation procedures read Save Your Face or visit my website. You may contact me at 978-369-4499.

Be sure to sign up for my free monthly email newsletter to keep up with new developments in plastic surgery and cosmetic medicine.

Dr. Seckel

Concord, Massachusetts

Boston, Massachusetts

Contact Dr Seckel

However, many people who complain of dark circles under their eyes frequently have a condition more appropriately termed “hollow eyes’ which is a distinct anatomical condition very different from dark circles under the eyes. Recognition of the “hollow eye syndrome” is very important because the technique frequently used to treat “dark circles under the eyes” does not correct the hollow eye look and can actually make the ‘hollow eye syndrome’ worse.

To clearly understand the difference between the varying lower eyelid conditions which many people have and seek treatment for, it is important to understand the difference between “Dark Eyelid Color”, Puffy Lower Eyelids, Dark Circles Under the Eyes, Hollow Eyes, and Festoons:

Dark Eyelid Color- The color of the lower eyelids is darker than the surrounding facial skin on almost every human face. This is a normal condition. The dark lower eyelid color is caused by the fact that the lower eyelid skin is very thin, so thin that you can see through it. The eyelid muscle beneath the lower eyelid skin is a purple color, thus the purple color of the muscle shows through the thin eyelid skin and the lower eyelid looks darker than the surrounding skin. People often complain that the lower eyelid looks blue or purple. The fairer your skin, the thinner your lower eyelid skin and thus the darker your eyelids will appear. In many thin skinned individuals the veins running under the eyelid skin also show through the eyelid skin making the blue color more pronounced. This is a normal condition and cannot be treated. No laser, cream or surgery can correct this. The only solution is a concealer such as Dermablend or Cover mark.

Puffy Lower Eyelids- As we age many people notice that the lower eyelid skin becomes puffy or bulges outward. People often refer to this condition as “bags under the eyes”. Bags under the eyes is caused by a combination of weakness and sagging of the lower eyelid skin and tissues cased by aging changes, and protrusion of fat which lies beneath the lower eyelid skin and underneath the eyeball. Younger healthy lower eyelid skin and tissues normally are taut and prevent the fat from protruding, however with aging and laxity of the lower eyelid skin the fat pushes forward and protrudes, like a hernia. This condition, bags under the eyes or puffy eyelids is technically called fatty orbital herniation, that is a hernia of the fat which is normally contained in the orbit or eye socket. The Plastic Surgery operation called a lower eyelid blepharoplasty often includes removal or repositioning of the protruding fat to lessen the appearance of bags under the eyes.

Dark Circles Under The Eyes- The phrase Dark Circles Under The Eyes refers to a dark depression below the lower eyelid which starts near the corner of the lower eyelid near the nose and runs along the cheek bone below the lower eyelid out towards the ear. Technically this is called the naso-jugal fold, and at advanced stages of facial aging runs into the Tear Trough Deformity, a dark depression that runs out and down the cheek towards the side of the face. The dark circle under the eye or naso-jugal fold is caused by a combination of factors. Most importantly the skin of the dark circle is tethered tightly to the underlying bone of the eye socket, called the orbital rim, by a ligament called the arcus marginalis. Since the skin of the dark circle is tethered to the bone, it cannot sag downward with the lower eyelid and cheek skin as the skin ages and becomes lax. Thus the lower eyelid skin as it sags and is pushed forward and down by the protruding lower eyelid fat, puffs and falls over the tethered dark circle and creates a dark shadow, the Dark Circle Under The Eye. The only truly effective technique to remove Dark Circles Under The Eyes is called the laser blepharoplasty with arcus marginalis release with fat grafting or repositioning. During this procedure, the arcus marginalis is released from inside the lower eyelid and fat is placed beneath the dark circle to plump the dark circle and prevent the arcus marginalis from re-attaching and recreating the Dark Circle Under The Eyes. The laser blepharoplasty is a modern minimally invasive eyelid rejuvenation procedure which allows quicker recovery and less bruising.

Hollow Eyes- Hollow Eye Syndrome describes a condition in which the entire lower eyelid appears “sunken in” and can be a natural or normal human condition or can be caused by trauma or following a lower eyelid blepharoplasty during which too much lower eyelid fat has been removed. The primary cause of the normal Hollow Eye Syndrome is a congenital lack of orbital fat beneath the eyeball that allows the lower eyelid skin and tissue to sink in, or by an eye socket, also called the orbit, which is larger than normal and allows the lower eyelid, fat and tissues to sink in causing the Hollow Eye appearance. Abnormal Hollow Eye Syndrome occurs when too much fat has been removed during a blepharoplasty or when the bone beneath the eyeball has been broken, most commonly by a fist or baseball striking the eye, breaking the floor of the orbital bone and pushing the fat surrounding the eyeball through the break in the bone down into the sinus cavity beneath the bone. To correct the abnormal Hollow Eye Syndrome, either fat must be surgically replaced, or in the case of a fracture, the fat must be pulled back under the eye and the broken bone repaired.
In the case of normal Hollow Eye Syndrome, fat must be surgically replaced to correct the fat deficiency and in some patients, who have an unusually large eye socket because of a deficiency of the bone, an implant to must be placed to make up for the deficiency of the bone of the orbital rim at the top of the cheek bone. This implant is called a tear trough implant.

Festoons- Festoons are puffy skin on the cheeks which lie just below the lower eyelids, at the top of the cheeks and just below the Dark Circles Under The Eyes. Festoons, technically called Malar Bags, are cheek skin, not lower eyelid skin, a very crucial distinction. Their primary importance is that they must be recognized, and you must know that they will not be improved or removed during a blepharoplasty. In fact, a blepharoplasty during which puffy eyelid fat is removed and lax lower eyelid skin is tightened will in fact make the festoons look more prominent and worse. Festoons are poorly understood and difficult to treat. Traditionally the only method was direct surgical excision and removal, however this method usually leaves unacceptable, visible scars on the cheeks. Sometimes a partial face-lift called a cheek lift can improve Festoons. Laser resurfacing can improve them, but the skin color becomes lighter which makes this method risky. Recently newer skin tightening methods using Infrared and Radiofrequency energy hold much promise.

In summary, the normal anatomical variation and the aging changes of the lower eyelids are very complex, and often poorly understood by both patients and many physicians. A proper and clear understanding of lower eyelid and cheek anatomy and the effects of aging on these areas is crucial if proper aesthetic correction of the lower eyelid is to be achieved. Newer eyelid rejuvenation therapy must employ techniques that address the intraorbital fat, the arcus marginalis, and the festoons if pleasing aesthetic results are to be achieved and serious deformity avoided. True Hollow Eye Syndrome requires fat volume replacement and in some cases implant placement to correct bony volume deficiency. It is important to distinguish Hollow Eyes from Dark Circles Under The Eyes because their correction requires decidedly different reconstructive techniques. The recognition of Festoons is very important because standard blepharoplasty eyelid rejuvenation techniques will make Festoons more noticeable. For further information contact me , read Save Your Face or call 978-369-4499.
Brooke R. Seckel, M.D., FACS

Boston, Massachusetts

Concord, Massachusetts

Whether it is fear of surgery or the stigma of having surgery, almost everyone who comes in to my plastic surgery office tells me they want to look younger but they do not want a face lift.

Many new procedures are widely marketed today as a non-surgical face lift, including:

· Thermage™

· Titan™

· Mesotherapy

· Lipodissolve™

· Smartlipo™

· Threadlift™

· Photofacial

· Laser skin tightening

While the advertisements sound great, the reality is that only an expertly performed surgical face lift can achieve the beautiful results shown in the photo above.

Recent technological advances have resulted in new light based skin tightening devices which are being marketed as the non-surgical face lift. While skin tightening technology is impressive, and does work, the results of skin tightening to date hardly qualify as a face lift, non-surgical or otherwise. Skin is tightened but best results are about 20% to 30 % of what a traditional surgical face lift can achieve.

The new skin tightening is called non-ablative to distinguish the new skin tightening technology form the old CO2 laser resurfacing, the Gold Standard for Wrinkle Removal.

To ablate means to surgically remove, and the CO2 laser resurfacing ablated or removed old damaged skin and new skin grew to replace the old. In the process of Laser Resurfacing, heat generated by the laser injured the deeper skin layers and when they healed, with new collagen, the skin was contracted or tightened.

The newer skin tightening technology uses radiofrequency energy or infrared energy to heat the deep layers of the skin to cause contraction and tightening but first cools the skin before the energy is applied to prevent injury and ablation of the superficial skin by the heat energy. Thus the skin is tightened but the surface is not ablated, thus non-ablative skin tightening. There is no down time following non-ablative skin tightening unlike the older CO2 laser resurfacing skin tightening.

Several new skin tightening machines are available. The LuxIRDeep by Palomar, and the Titan by Cutera utilize infrared energy for skin tightening. The Aluma by Lumenis and Thermage utilize infrared energy for skin tightening. Refirme by Syneron uses a combination of light energies with radiofrequency for skin tightening.

All of the machines achieve about similar results when used properly. Generally there is less discomfort with the Infrared skin tightening machines. Complications have been minimal although some serious complications occurred with Thermage skin tightening early on.

In my practice I find that non-ablative skin tightening is most helpful for younger patients who do not have severe aging changes and significant sun damage, people in their 30’s and 40’s who want to correct or tighten early skin sagging along the jaw line or jowl area, neck and cheeks. I use the LuxIR on these larger areas. For skin tightening around the eyelids I use the Aluma which has a smaller treatment head and a suction device that will pull the delicate peri ocular skin into the treatment chamber for skin tightening.

The field of non-ablative skin tightening is in its infancy and will definitely become more effective in the years ahead. The companies are improving their products frequently. For now however the people who benefit most from the skin tightening machines today are younger people who still have thick healthy skin with early aging changes.

There are new sophisticated skin tightening technologies in development and I am working on one with a major laser company, however we are 1-2 years away from an effective, approved product.

The use of the term non-surgical facelift to describe non-ablative skin tightening is an overstatement with technology available for skin tightening today. At best a 30% result is possible when compared to a traditional face lift. Many of the heavily marketed non surgical face lift procedures in the bulleted list above have no scientific basis for their claims.

Be a smart informed consumer. If it sounds too good to be true it usually is. Consult two board certified plastic surgeons if you have concerns about facial aging. To learn more read Save Your Face or contact me.

Dr Seckel

978-369-4499

Concord, Massachusetts

Boston, Masachusetts,

The most popular “Mommy Makeover” typically includes the breast and the abdominal areas. In my practice, I often perform a breast lift and/or breast augmentation to reshape the breasts and a tummy tuck to tighten the tummy. The combination of breast lift and augmentation can restore the breast to a youthful pre-pregnancy shape. (See Photo Below)

Many patients however do not need both procedures and choose only a tummy tuck or breast lift and or breast augmentation.

The results of a mini tummy tuck I call a bikini lift or bikini tummy tuck can be dramatic and the scar can be hidden beneath a bikini or brief underwear. Better, the bulge caused by a C section scar can be removed.(See Photo Below)

The combined breast and tummy “Mommy Makeover” is done in the Hospital Operating Room for your safety. Recovery time is about 10 days to two weeks but you will be up and around after 4-5 days

“Mommy Makeovers” are a very rewarding part of my practice because they can help a new mom “get her body back” and regain her self esteem and confidence. My patients have been uniformly happy and thrilled with the results. For more information please call 978-369-4499.

Be sure to sign up for my monthly free email newsletter to keep up with the latest advances in plastic surgery and non-surgical rejuvenation techniques.

Dr Seckel

Concord, Massachusetts

Boston, Massachusetts

· The laser selectively dissolves fat unlike standard liposuction which can destroy all tissues.

· The laser closes blood vessels=less bleeding, less bruising

· The laser tightens skin=less loose skin after liposuction

· Laser liposuction is less traumatic=quicker recovery

· The laser fiber is tiny= smaller scars

· Smaller areas done under local anesthesia

All laser liposuction machines are not equal. You need to understand the importance of the laser wavelength used to melt fat. Most laser liposuction machines on the market today use a 1064nm or 1308nm laser wavelength. Actually the best wavelength which is most highly absorbed by fat is 920nm, a wavelength patented and owned by Palomar™ Medical in Burlington, Massachusetts.

Palomar has introduced their new Aspire™ Liposuction Unit which is the first 920nm based laser liposuction and is 3 times as selectively absorbed by fat as the 1064nm lasers and 2 times more than the 1308nm-the other commercially available laser liposuction technology. It is also 5 times as selectively absorbed by blood. This means that the Aspire™ laser Liposuction dissolves fat and prevents bleeding much more effectively than any other laser liposuction machine available.

For you the patient this translates into:

· Gentler more thorough fat removal

· Less bleeding, less bruising

· Quicker recovery

We also can blend in a 975nm laser wavelength with the Aspire™ which is highly absorbed by the Dermis-the deep layer of your skin which controls skin tightening. For you this translates into:

· Tighter skin after liposuction

· Less risk of revisional surgery after liposuction

I am proud to say that we helped Palomar™ develop this revolutionary new laser and are the first to offer Aspire™ in Massachusetts and the Boston area.

If you are considering laser liposuction you really need to know the facts and understand the technology. Once you do the advantages of the Aspire™ system are obvious-there is nothing else like it on the market.

For more information on laser liposuction or plastic surgery in general call 978-369-4499 or visit my website.Be sure to sign up for my free email newsletter for information on the latest advances in plastic surgery and non-surgical rejuvenation procedures.

Dr. Seckel

Concord, Massachusetts

Boston, Massachusetts

There is a new laser liposuction device which promises to improve results and advance the concept of laser liposuction as an important body contouring tool.

The new device is a Diode Laser using a combined blended 924/970 NM wavelength which dissolves fat more easily than the current 1064 Yag Laser used in the Smart Lipo Laser liposuction machine.

This is because the 924/970 laser wavelength is much more easily absorbed by fat than the 1064 which is more absorbed by water.

The preferential absorption of the Aspire 924/970 NM Diode Laser into fat makes passage of the laser fiber into and through the fat much easier with less trauma to the tissue. Less trauma means less bleeding and less chance of problems related to forcing the fiber through the fatty tissue as is done with machines using the 1064 wavelength.

Laser liposuction dissolves the fat making it easier to remove with less bleeding and trauma to the tissues. The other promising development is that the laser can also be used to tighten the skin after the fat is removed. If this development works, the laser liposuction technique will help overcome one of the most frequent problems following liposuction that is loose sagging skin over the areas from which fat has been removed.

The Aspire blended 924/970 Diode laser liposuction device is made by Palomar Medical in Burlington Massachusetts.

I am pleased to announce that we are the first plastic surgery practice in the world to have the Aspire Laser Liposuction device which recently received FDA approval. For more information please call 978-369-4499.

Dr Seckel

Concord, Massachusetts

Boston, Massachusetts