Austin Texas Board Certified Plastic Surgeon

512-324-2765

Non Surgical Procedures

The Skin and Everything Within

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Introduction

The primary focus of my cosmetic surgery practice is advanced surgical approaches to aesthetic challenges, simple to complex. That is to say that I have spent a considerable amount of time and effort learning, honing, and improving my surgical skills with the goal of delivering the highest levels of safety and satisfaction through cosmetic surgical intervention. With that said, I recognize the important role of non-surgical treatments, such as Botox and fillers, in an overall program of facial rejuvenation. These procedures can function as adjuvants by refining and enhancing surgical results. Botox and fillers can also be very useful in helping patients decide if a procedure is appropriate for them. Many of these temporary non-surgical cosmetic treatments have surgical analogs. This means that there are surgical procedures that replicate the result brought about by the Botox or filler. The difference is that the surgical procedure brings about results that are long-lasting and even permanent. Thus, using a non-surgical approach first, allows prospective surgical patients to “date” the result temporarily before they “marry” it.

I also recognize that many people may want a cosmetic change or improvement in their face but are not ready or prepared to have surgery yet. For patients like this, non-surgical approaches are an important component that allows them to remain engaged with the process of facial rejuvenation until they consider themselves a surgical candidate. Please do not mistake my focus on surgery as a liability in the realm of non-surgical treatments. I use my indepth knowledge of human facial anatomy to design non-surgical treatment approaches that create natural appearing results (no frozen or over filled faces) and customized to the enhance patient’s facial aesthetic assets. Furthermore, my education and experience with non-surgical cosmetic treatments, Botox in particular, link back to the origins of these powerful tools. One of my prior mentors was one of the first, if not the first, medical professionals in the United States to use Botox for cosmetic applications. Additionally, I seeks to use Botox and fillers in innovative ways to bring about maximal results. I do all of my own Botox and fillers injections. Each session involves period of thorough evaluation, discussion of desired results and expectations, planning, and product administration. I reject the prevailing notion that “Botox is Botox” and similar sentiments regarding the administration of fillers. I consider the use of Botox and fillers to a powerful tool, whose use needs to be guided by both artistic and scientific principles. Due to my time-intensive approach regarding non-surgical treatments, I am generally booked out several weeks in advance. I think you will find the results worth the wait. 

Furthermore, as I have collaborative relationships with many dermatologist.  I generally recommend that patients continue their Botox and filler activities with their dermatologists and think of me when they are ready for their surgical procedure. 

Botox

Botox is a neuromodulator that is injected beneath the skin to target underlying muscles of facial expression.  Botox selectively, precisely, and temporarily weakens these muscles to decrease their contraction.  By decreasing the contraction of these muscles, the dynamic wrinkles caused in the overlying skin are reduced.  The most common region for injection of the Botox to reduce wrinkles and lines is the glabella.  The glabella is the anatomic term for the lower part of the forehead that lies between the eyebrows just above the nose.  Many people refer to the lines in this area as “eleven (11) lines.”      

Most providers require 4-5 needle sticks and 20-30 units of Botox in this area to achieve the desired results. Often, I use a “limited needle stick” approach to injecting Botox in this region.  In sense one could think of this as a “Mini” Botox injection.  This advanced technique involved precisely inserting a one of the thinnest medical needles along the length of the target muscle, the corrigator supercilii.  Thus, there is only one needle stick per side for a total of two.  This can be contrasted to the traditional approach in which again generally involves 4-5 needle sticks.  Besides the apparent obvious benefits of less needle sticks and potentially the need for less Botox (and thus less expense per area), additional hypothetical pluses observed in some patients include less swelling, less bruising, and less pain.

Please note until further notice, I will only be able to distribute Botox in increments of 50 to 100 units.  Thus, most patient choose to have a comprehensive treatment plan, focusing on other regions in addition to the glabella. 

Juvaderm

Juvaderm is s dermal filler used by plastic surgeons to add volume to various parts of the face.  It is comprised hyloronate a substance natural found in various tissues in the human body.  Juvaderm is well suited to soften deep folds and lessen wrinkles.  Both young and older women can benefit from Juvaderm when a customized approach is used.  One of the most frequent areas treated by Juvaderm is the nasolabial folds, the linear depressions that separate the cheeks from the upper lip and extend from the lower edges of the nose to corners of the mouth. Smaller wrinkles can also be addressed such as fine lines around the mouth.   Juvaderm also has significant utility in others regions of the face due to its ability to add precise amounts of volume to areas that lack fullness and contour.  These areas include the tear-trough and nasojugal fold among others.   Innovative use of Juvaderm include placement beneath the eyebrows to give a fuller look to the tissue above the eye and into the chin for a subtle augmentation in the case of a weak chin.  The results of Juvaderm can be enjoyed for 6 to 9 months depending on a variety of factors.  In my experience some patients desire Juvaderm for cosmetic challenges that are not likely to respond favorably to fillers (and therefor may be better addressed by surgery).  While fillers are less expensive than surgery, the money spent on them is not a value if the result is not a meaningful and natural one.  I am always honest with patients about whether I think they will benefit from a filler and whether they are truly getting value for their money. 

Combination Wrinkle Therapy

Some wrinkles and lines are the result of muscle contraction.  These are dynamic wrinkles, also known as a dynamic rhytids.  The term dynamic refers to the fact that they are the result of bunching of the skin as a result of the contraction of the underlying facial muscles.  As explained above, Botox is an effective treatment for dynamic wrinkles and lines due to its ability to relax and temporarily weaken the muscle contraction. 

The other category of wrinkles and lines are static rhytids.  Static wrinkles and lines are present in the skin regardless of muscle contraction.  They are static, meaning the do no change appreciably with muscle movements, for the most part they stay the same.  Static wrinkles and lines are present due changes in the architecture of the skin, chiefly in the dermis.  Juvaderm and other fillers are used to soften the appearance of these lines and wrinkles by filling the depression seen in the dermis and surrounding skin tissues.  Juvaderm and other fillers also have significant utility in areas of the face where there are is a defect of soft tissue that results in a less than ideal contour.  In this setting, the filler is being used for subtle soft tissue augmentation.

Combination Wrinkle Therapy refers to the synergistic use of Botox and juvaderm.  Botox addresses the dynamic wrinkles and Juvaderm targets the static wrinkles and areas of soft tissue paucity.  This combined approach is both integrated and balanced and helps achieve natural results.

Dermabrasion

Dermabrasion is a method of skin resurfacing that is generally predictable and well-established.  This technique involves the precise and selective removal of the outer (thus aged) surface of the skin.  The skin tissue that is left behind includes a smoother dermis that is repopulated by new skin epithelial cells.  The result is a smoother and more vibrant appearance to the skin.  This procedure is performed under local anesthesia or general anesthesia when combined with a procedure that requires the patient be fully asleep. The recovery for this procedure can be 5 days of healing during which the treated regions need to be kept protected with ointments.  Following healing the wounds the areas treated can remain red for a limited period of time.  Makeup can be used to camouflage these areas.  The area that I believe is the best treated by dermabrasion  the perioral region.  This includes the structures surrounding the mouth such as the lips, chin, and central cheeks.

Obagi

Obagi Medical is an integrated skin care system designed to provide a customized approach to developing and maintaining healthy radiant skin.

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