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The misunderstandings about fillers…

The misunderstandings about fillers…

About every other day I have someone ask me why so and so looks the way she does or why the celebrity of the day has “lips like that”? What they are questioning is the look you can get when you add a lot of filler, such as Restylane® or Juvederm®, to the lips or cheek areas. Usually it’s the lips.

Well, the thing is, it’s not the filler and it’s not the injector, at least not in my office, it’s the patient who is directing this. When we inject filler what you see is what you get right on the spot. Now in the day or two after you may have swelling or bruising that can slightly alter what the real result is, but that is transient. So the point is, when you see someone with really full lips, that you might think are overly plumped, well, they are that way because she wanted them that way. We don’t make that decision for the patient.

When we inject filler we have the patient there with mirror in hand. We treat and then have her take a look. If she likes what she sees we stop. If she wants more, we add more in small amounts until she is pleased. It’s that simple. So don’t be afraid of filler!  Fillers are GREAT products and are actually the treatment that is growing in popularity by the day. If you only want a mild to moderate correction/enhancement that is entirely possible.

Fillers are your friend!

Lee Corbett, MD

Medical Director Corbett Cosmetic Aesthetic Surgery and MediSpa

Scar revisions…are they worth it?

As a Plastic Surgeon I get a lot of requests to check patients to see if they are a candidate for scar revision surgery. A lot of times the answer is a quick, easy “Yes” but not always. And when I tell the patient that I can’t help they are usually fairly unhappy so I want to go over what I, as a plastic surgeon, am thinking when I see a scar.

First, I want to know how old it is. It takes at the very least 6 months to get a good idea of what a scar may turn out like. A lot of times what looks pretty bad at a month or two ends up looking quite good by the 9-12 month point. 1 year is the usual point where I will consider a surgical revision.

Secondly, I want to know the circumstances that left the scar. If the scar resulted from a traumatic laceration I am more willing to consider revision. Traumatic lacerations are usually dirty wounds that involve a crush component to the wound edges. This is not very favorable and can leave a worse scar. If on the other hand, the scar resulted from a surgical procedure I am not quite as willing to take a revision on because the wound was already repaired by a trained surgeon under ideal circumstances.

Third, the location of the scar is important. Any scar over a joint, on the upper back, or the upper mid chest is not going to heal well no matter who sewed the cut up the first time. These areas are just very unfavorable. So location in important.

Your biology is important. If you have a keloid scar or a hypertrophic scar, well these are errors in wound healing that tend to be genetic. There are some things we can try to defeat these problems but unfortunately, especially with keloids, your genes win and the scar returns. Bottom line is some people just don’t heal as well as others and there is nothing I can do to change that.

Finally, if you have a scar and want it completely gone, well that is impossible. It ranks right up there with getting rid of stretch marks. Sounds good but it isn’t gonna happen.

So if you have a scar and your surgeon tells you “I can’t help” there are a lot of good reasons and probably a lot of experiences behind that statement.

Lee Corbett, MD

Medical Director Corbett Cosmetic Aesthetic Surgery and MediSpa

What are fillers and what can they do for me?

Basically, Fillers are injectable treatments that we use to help restore facial volume. If you are in your mid 30’s or above age wise, and you are at a normal weight, you are probably noticing that your face looks a bit thinner each year. A full face is associated with youth. Look at the Victoria Secret supermodels that are plastered everywhere, they are all about 6’0″ tall and 120 lbs but they all have these beautiful round, full faces. That’s because they are all in their teens and 20’s.

So, we use filler to help restore the volume to your face to help you look younger. Now, today’s fillers are an evolution from the Collagen injections of days gone by. The problem with collagen was that some people were allergic to it so you had to skin test them, then wait several days or weeks, then inject, but you had to over inject them because some was going to go away almost immediately so you never really knew what your result would be, and in the end the stuff went away in 3 months or so. And it was expensive. Bad combo.

Today’s most commonly used fillers are made of Hyaluronic Acid (HA). The two most common trade names for these fillers are Juvederm® and Restylane® which you can find in almost any plastic surgeons offices. These are FDA approved products to help fill deeper facial lines and restore facial volume. HA is what is known as a GAG, a gylcosaminoglycan and is already found throughout the body in your connective tissues. So it is already a part of your person and very safe to use. The companies that produce these products all of varying claims of their longevity but what we see is that most people seem to get about 15 to 18 months out of these fillers. The HA fillers are reversible as well so if the patient does not like the result they produce the product can be dissolved. We love them and their popularity amongst our patients and nationally increases every year.

There are more sophiticated fillers like Radiesse and Scuptra. These last much longer, are irreversible and tend to be more expensive. These products are typically used for patients who have had the HA products a couple of times, know they like the results, and want a longer lasting product.

If you have filler questions contact us and schedule a consultation via e mail at [email protected] or 502.721.0330.

Lee Corbett, MD

Medical Director Corbett Cosmetic Aesthetic Surgery and MediSpa.

Post Operative Swelling: When does it go away?

I was on Real Self answering more patient questions today and I am amazed by the number of questions that come in about swelling. Many of these patients have had surgery in the last week or two and are concerned because there is still swelling.

Any time you have surgery, particularly surgery on soft tissues (breasts, tummies, fat) , swelling is an expected normal reaction. There isn’t an operation in plastic surgery where you will see your final results in the first week or two. It just doesn’t work that way. It will usually take at least 4 to 6 weeks for most of the swelling to go away but it can also take between 3 to 6 months depending on what was done. Liposuction for instance will leave you swollen for 3 to 6 months. Now Smart Lipo laser lipo may leave you less swollen than traditional lipo, and you may swell less than your cousin, but everyone swells no matter the technique or the person. That’s just the way the human body heals.

So, if you are reading this and you are swollen post op you are probably healing completely normally. But, and this is the other thing I don’t get, if you are worried, call your doctor! Why turn to the internet for answers? You’ve researched and interviewed your surgeon and ultimately trusted them enough to let them operate on you. Listen to what they have to say.

3 to 6 months. That is normal.

Lee E. Corbett, MD

Board Certified Plastic Surgeon

The 3 P’s of Medi-Spa safety

The idea and a lot of the content of this blog comes directly from the ASPS website blog but it is really informative and so I thought I would copy it and add some additional thoughts. MediSpa treatments are a group of minimally invasive things that usually involve an injection. What we are talking about here are things like Dysport, Botox, Juvederm, Restylane, Perlane, Sculptra, Radiesse, chemical peels and lighter laser/IPL treatments. So what are the 3 P’s? Product, Place, and Practitioner.

Product: Know what product your MediSpa is using. If you haven’t heard of a particular product or heard of it being used in the manner being proposed ask some questions. A great example of this is the Botox and Dysport debate. Botox is used to smooth wrinkles around the eyes and forehead. It is the market leader and everyone knows it by name. Well, Dysport is effectively the same product. But, it is produced by a British company and doesn’t have the same name recognition. So here is an example of something you might not have heard of that is perfectly acceptable. The other end of the spectrum would be something like liquid silicone injections. These are bad. These are the plastic surgery horror stories that you can google. Research your products! Know what is being injected. If it isn’t FDA approved to be injected say “NO!”.

Place: I’ll be the first to admit I have injected close friends with Botox and Dysport in my kitchen. Very close friends. But if you are considering injectables, be it toxins or fillers, be safe with your choice. These are medical procedures. They need to be done in the proper environment. Injectables in hair and nail salons just isn’t a great idea. Honestly the chances of immediate problems with an injection is remote, but if, just if, something unexpected occurs, you want to be in the proper venue. Finally, let me comment on the “Botox Parties”. I know plastic surgeons and derms do these but I disagree. Injecting a group of women in someone’s home when there is alcohol involved just isn’t a great idea.

Practitioner: Who are you letting put that needle in your face?? Are they trained? Who oversees them? You need to know this. In a lot of offices the Plastic Surgeon does all of his own injections. That’s ok. A lot have a nurse or a nurse practitioner do their injections. For instance in my office, I do some toxin injections, but my RN, Lyzah, does most of them. But, before she injected anyone, she was trained by me and then 3 company approved trainers for the products. Then she injected me and all of my staff. Then she injected patients with me literally looking over her shoulder. Now she has injected 1000’s of patients and I have yet to see anyone with a problem. So a properly trained non MD injector is perfectly acceptable. But if you encounter an Aesthetician or LPN or Medical Assistant injector, I would be wary.

Lee E Corbett, MD

Board Certified Plastic Surgeon

Medical Tourism and its’ disadvantages

Medical tourism is gaining popularity. If you are not familiar with the concept it boils down to this. Patients will travel internationally to a destination spot. They will then combine a cosmetic surgery procedure and spend their immediate recovery in this vacation spot. Typically the surgery is much less expensive than in the US and they get to go somewhere tropical. Sounds ideal. However…

The problems with this approach are two fold. First, the training of the surgeon and the quality of the facility where the procedure is performed may not be up to U.S. standards. Plastic Surgeons in the U.S. are overseen by the American Board of Plastic Surgery, American Society of Plastic Surgery, their State Medical Boards, and on the local levels the hospitals and surgery centers credential all of their surgeons. This may be true in other countries but there is no way to know. It is true in every American city.

Secondly, if after you come home, you have a complication it may be very difficult to find a surgeon willing to assume your care. In general, amongst surgeons, the general rule is that you handle your own complications. Plastic surgeons charge global fees that include your surgery and all aftercare. Thus, if you call on a plastic surgeon to handle your complication, you may find that they are less than enthusiastic and may charge you significant fees to assume you care.

Think carefully before you travel for cosmetic surgery.

Lee E. Corbett, MD

Medical Director Corbett Cosmetic Aesthetic Surgery and MediSpa

How does SmartLipo tighten up the skin?

I have the Smart Lipo Triplex laser liposuction machine that I use for almost all of my liposuction cases. I used traditional tumescent lipo for years and my only complaint was my lack of ability to get good skin tightening particularly on the back of the arm, the inner thighs, or tummies on the female patients who had some stretch marks from having babies. Skin tightening on the 40 and 50 something patients can also be a challenge. SmartLipo offers several advantages over standard lipo but skin tightening is a main one. But why?

Smart Lipo, particularly the triplex, uses a blending of two laser beams to create heat just under the skin surface. It has a 3rd laser light that targets and melts your fat cells and this process creates heat too. All of this heat, when properly applied and when taken to the proper levels, serves to heat up the deep surface of your skin, the deep dermis, and this is what causes skin tightening. It basically helps to shrink wrap your skin. It is great for the neck, the back of your arms, the inner thigh area, and lower tummies.

Now, it’s not magic though. It will not tighten up skin that hangs or is covered with stretchmarks and it doesn’t work as well in smokers.

If you want to see if Smart Lipo might work for you please contact our office in Louisville at 502.721.0330

Lee Corbett, MD Medical Director of Corbett Cosmetic Aesthetic Surgery and MediSpa

What do you do when your results aren’t what you thought they would be?

I have recently begun answering questions on the Real Self website for prospective plastic surgery patients and patients who have already had surgery. A fair percentage of the patients who post are doing so because they do not like their results, are unsure of how things are going to turn out, or have had a complication. I am surprised that there are so many patients who are 4 or 5 days out from surgery and already are doubting their surgeons advice. So, I thought I would offer my recommendations on how to handle things if you find yourself in this situation.

First, understand that your surgeon wants you to have a ‘perfect’ result just as much as you do. Personally, my goal is perfection every time I step up to that operating table. Surgeons are an unusual breed. We are super Type A, detail oriented people. My point is your doctor wants great results just like you do. So trust him or her when they tell you things will improve/change. I realize it may seem like they are dismissing your concerns but they aren’t. They’ve just seen this scenario play out literally thousands of times and they are confident this, whatever ‘this’ is, will indeed get better.

Fact: There is no plastic surgery operation in existence where you will see your final result in less than 2-3 months. Soft tissue swells as it heals and so you will not see your final result until that swelling is gone and the tissues normalize.

If you see something you don’t think looks right, ASK YOUR SURGEON! Stay off of the dang internet, don’t call your niece who is a nurse, or the neighbor who knows someone in “whereever-ville”, ask your doctor. He or she knows your particular circumstance better than anyone else.

Now sometimes things don’t turn out as you or your surgeon expected. This can be due to unrealistic expectations on the patients behalf, miscommunication on what you expected from your procedure, or it can be due to the fact that what your surgeon saw in the operating room changed as you healed. In other words, sometimes revisions are necessary. No one likes revisions because they mean more surgery and recovery and costs. But sometimes it becomes the reality and if you are considering surgery you need to be willing to accept this reality. Revision rates are usually quite low with the things we do but they do occur. Your surgeon will be able to tell you early on if this is a possibility.

Complications. There is an old saying in surgery. “The only surgeon who doesn’t experience a complication is the surgeon who doesn’t operate”. This is true. It could be a bleed, or an infection, or a thick scar etc…In these cases trust your surgeon and communicate with them. We train 7 or 8 years to be Plastic Surgeons. I could teach just about anyone how to technically do any operation I do in a week or two. So why do we train for 8 years? Because we have to know how to handle every complication that can possibly occur from an operation. The Chairman of my General Surgery residency had this philosophy: “As a surgeon, you are not qualified to perform an operation until you are expert at every aspect of the pre and post operative care for that particular operation, including any complications.” My point in telling you all of this is if you do have a problem, your surgeon is well trained to help you and get you to where you want to be.

So when in doubt, go see your doctor. I guarantee you your doc would much rather see you lots than have you home worrying, stressed out that things might not be ok.

Lee E. Corbett, MD

Board Certified Plastic Surgeon.

What makes laser liposuction different from traditional liposuction?

With traditional tumescent liposuction the process goes as follows: Very small incisions are used to access the treatment area. Then a saline (salt water) solution is pumped into the area. This process is where the word “tumescent” comes into play, it refers to the infusion of the water into the area. The tumescent fluid does 3 things for us. It causes the fat cells to swell and plump so they are easier to break down, there is lidocaine in it to numb the area, and there is epinephrine in it to constrict the blood vessels. We then wait about 15 minutes to let the epinephrine take effect. Then a hollow tube called a cannula is inserted and moved in a to and fro motion to break up and suction out the fat cells.

Laser Liposuction works a little differently. The incisions used are smaller because of the effects of the laser. 1-2 mm incisions are made and the tumescent water is placed. With the laser we don’t have to wait the 15 minutes because the laser will seal the blood vessels so that saves us some time. So the 1 mm laser wand is inserted and the laser turned on. The laser wand shoots out blended combinations of laser light that target the water in the fat cells and literally melts the fat. So the fat cell is being melted away instead of being physically disrupted as with traditional lipo. The laser also creates heat which is beneficial because it heats the under surface of the skin causing it to tighten more than is possible with standard lipo. The laser also coagulates blood vessels so there tends to be less bruising than we get with standard SAL (suction assisted lipectomy).

Both techniques will result in swelling so that part of your recovery should be the same with each method but most patients report less bruising, pain, and down time with the laser lipo vs standard lipo.

Lee Corbett, MD

Medical Director Corbett Cosmetic Aesthetic Surgery and MediSpa

“Are those real?” How do you spot augmented breasts?

I get this question all the time on a social level, from both men and women, and I certainly hear this during my breast augmentation consultations. What makes an augmented breast look natural vs “fake”? The answer to this question is multifaceted.

The first consideration is size of the implant. The more modest the implant size choice the more natural your look. It’s really that simple. If you choose a really large implant it’s not really likely that you wont look augmented. An implant size that just doesn’t fit your frame is a dead giveaway.

The second point is how much breast tissue do you have to begin with. The more of your own tissue that drapes over the implant the more natural you will look. So this becomes a problem for my more petite patients with an A cup breast. When we put the implant in there is nothing to hide the contours of the implants because there is hardly any tissue on top of it. This is the case where you see the “too round to be true” upper pole of the breast. Now I can help with that by shaping the implant pocket to allow for a more smooth transition of the muscle onto the top of the implant and you can help by choosing a smallish implant. But if you see a breast that looks like there is half a grapefruit behind it, you are looking at an augmented breast.

A large gap between the implants. This may or may not be a sign. A lot of women just have widely spaced breasts. So this can be a natural thing. It can look fake when you have a widely spaced breast and then place a large implant. When the breasts are widely spaced there tends to not be a lot of tissue along the breast bone and you get the ‘half grapefruit’ contour there is the implant is larger.

Movement. Natural breasts move more. Augmented breasts still move because the implants are not attached to you. They float around in their pockets and move with you. The problem again is when you use a larger implant. These have no room to move and tend to always point straight out even when you are laying down. When I place the implants, no matter the size, I make the pocket just the size of the implant so that they will always stay on the front of the chest. I know this doesn’t look as real but my patients love this look and they really, really hate when their implants slide to the side and leave a hallow in the middle of their breasts when they are laying down.

When you look at a breast from the side an un-augmented, mature breast will have more volume below the nipple than above. Now an augmented breast can look this way as well because over time implants assume a tear drop shape with more of the filler (gel or saline) settling to the bottom of the implant. Again, it’s all a question of size. If you choose a larger implant it will give you an unnatural fullness at the top of the breast. Size matters.

I found this question in Allure Magazine and added my own two cents to their answers.

Lee Corbett, MD

www.corbettcosmeticsurgery.com