Cosmetic Surgery Center, Dallas | Dr. Rai

This space has been looking at ways to rejuvenate the skin and previous blogs have been on May 17 (skin structure), May 21 (BOTOX® Cosmetic), and May 25 (Radiesse).

A chemical peel is a kind of deliberate skin injury but of course it is done carefully and according to your preference. You can choose to have a mild peel, moderate peel, or strong peel, which affect the skin to different depths. There is method behind this apparent madness. When you remove the surface skin cells, the skin responds as if it were injured. The dermis produces new cells and when they rise up to form a new surface layer, they are smoother and tighter than the ones that were removed.

Basically, a chemical peel is like a sunburn. The skin does not peel off immediately. First the skin becomes red, as if you had spent a day at the beach. Then it peels and by the end of a week, you have new skin. This is a great way to treat skin imperfections like:

• Fine lines around the eyes and mouth
• Age spots and freckles
• Mild scarring
• Roughness caused by sun damage or heredity
• The dullness that comes with aging
• Some types of acne

Chemical peels do not treat sagging or severe wrinkles. For that, you might consider laser skin resurfacing or cosmetic surgery such as a facelift, forehead lift, or blepharoplasty (eyelid surgery).

The Chemical Peel Procedure

Dr. Rai can do your chemical peel here as an outpatient procedure. You would first discuss the options and determine whether to have a mild, moderate, or deep peel. If you choose a moderate or strong peel, you may have an anesthetic applied before the peel is done.

The skin is first cleaned and excess oil is removed. The hair and eyes are protected. Then a chemical solution is applied. You feel it as warm and after a short time perhaps a little stinging. During your recovery period, you will need to protect yourself from the sun and depending on the type of peel you had, you might have a bandage over the treated area as protection and to improve the effectiveness of your peel. Dr. Rai will explain how to care for yourself post-procedure and you may have some follow-up visits.

If you would like to know more about methods of skin rejuvenation, and which one would be best for your particular skin, please contact our Dallas/Fort Worth, Texas office today.

On May 17, this space discussed skin structure – the three layers and what they each do. On May 21, we discussed BOTOX® Cosmetic and how it works. Today let’s consider one of the facial fillers called Radiesse®.

As the name implies, facial fillers rejuvenate the skin by filling it with something. Unlike BOTOX® Cosmetic, which is injected past all skin layers and into a specific muscle, facial fillers are injected into the skin’s second layer, the dermis.

The Collagen Matrix

Among many other structures, the dermis contains a network of protein fibers that give support to the skin surface. One type of fiber is collagen and the other is elastin. Together, they give the skin strength and elasticity, but as we age, the body produces less of these proteins.

That weakens the fiber network, creating little gaps in it. The skin sinks into them and now you have some wrinkles or fine lines. Of course, there are other contributing causes for wrinkles, such as sun damage, dryness and tobacco use. No facial filler can change a person’s lifestyle.

But Radiesse® is designed according to the reasoning that if we reinforce the collagen matrix, the skin surface will be smoother. Better yet, if we can stimulate the skin to produce more collagen, the youthful results could last longer.

How Radiesse® Works

Radiesse® consists of a water-based gel with tiny microspheres made of calcium hydroxyapatite (CAHA). Its volume gives immediate results, plumping up the treated area, and as the body gradually absorbs the gel, the microspheres remain and fill gaps in the collagen matrix.

Radiesse® also causes the skin to create more collagen to continue filling gaps. In this way, Radiesse results last significantly longer than results from other fillers – as long as a year or more. That means you need fewer repeat treatments for ongoing results.

Please watch this space for the next part of this series on other dermal fillers and how they work. You can also refer to our page on Facial Fillers for more information.

If you would like to arrange a complimentary consultation with Dr. Rai, please contact our Dallas, Texas office today.

On May 17, this space talked about the skin’s layers and what each one does for us. When you have some understanding of how the skin is structured, you can more easily understand why it starts to look older and how it can be rejuvenated.

In this youth-worshipping age, many people are unhappy when the years start to show on their skin. At The Cosmetic Surgical Center, we have many people coming for procedures like facial fillers and BOTOX® Cosmetic. Both of these can smooth out lines and wrinkles, but they work in completely different ways

Small facial lines are one of the first signs of aging. They may appear first as glabellar (frown) lines or crows’ feet and by age 45 or so, they have increased their repertoire to include nasolabial folds, smile lines, and laugh lines.

Treating Frown Lines

As you can deduce from their names, one of the biggest contributing factors to wrinkles is repeated facial expressions. When we use those same muscles hundreds of times daily, they shape the skin over them. BOTOX® Cosmetic addresses this aspect of facial wrinkles. It works by paralyzing the muscle where it is injected so that it cannot receive messages from the brain telling to contract.

It is not injected into the tiny muscles of the skin’s middle layer, the dermis. It is injected into larger muscles beneath the skin’s subcutaneous tissue. To smooth out frown lines, Dr. Rai injects into the Corrugator supercilii, a diagonal muscle beneath the eyebrows that pulls the forehead skin inward to form glabellar (frown) lines. After such an injection, the Corrugator supercilii cannot contract for three or four months, which keeps the skin above it relaxed. Repeat treatments can extend this so that your frown lines are much less visible.

Treating Forehead lines

BOTOX® Cosmetic is also very effective in smoothing out horizontal forehead lines. It is injected into the Occipitofrontalis muscles that wrinkles the forehead and raises the eyebrows. Now the forehead skin remains relaxed, and again, repeat treatments will gradually discourage this muscle from contracting so often, giving you a more youthful-looking forehead for the longer-term.

BOTOX® Cosmetic is the most popular non-invasive cosmetic surgery procedure and has been for several years. It is a quick and easy procedure and there is no downtime afterwards. It can also be used for crows’ feet, fine lines around the lips and perhaps other wrinkles, depending on the individual case.

Please watch this space next week for how facial fillers work. If you would like to schedule a free consultation with Dr. Rai, please contact our Dallas, Texas office today.

Our skin is our largest organ. It has many functions:

• Insulation (from fat below the skin surface)
• Protection from the elements for body structures
• Minimizing water loss
• Body temperature regulation (through sweat glands and dilation and constriction of its blood vessels)
• Sensation of touch, heat, cold, pain, itch, and pressure (through sensory nerve endings in the skin)
• Production of Vitamin D (through exposure to the sun’s UV radiation)
• Expression of emotions (through blushing, paling and goose bumps. Goosebumps are the tightening of little muscles at the base of each hair. It makes the hair stand up like a bird fluffing up feathers or a porcupine raising its quills.)

We tend to take all of these essential functions for granted and instead focus on what our skin looks like. Much of cosmetic surgery focuses on the skin and on maintaining its youthful appearance with procedures like chemical peels. To get a good idea of how these procedures work, it is best to first understand the skin’s layers.

Two Main Skin Layers

1. Epidermis

The visible skin is an unstable top layer with five sub-layers. It is continually discarding cells and replacing them with new cells that rise up from its lowest sub-layer. This relates to the skin function of protection from the elements. The top layer refreshes itself for continued strength against wind, chemicals, temperature changes, radiation, physical impacts, and the other onslaughts it receives on a daily basis. Also in the epidermis is melanin, a pigment that determines the skin and hair color.

2. The Dermis

The dermis has two layers and holds many structures that enable the skin to perform its many tasks. Here are the sweat glands, oil glands, nerves, blood vessels, tiny muscles, and hair follicles (roots). The dermis also has collagen and elastin fibers that intertwine to support the epidermis and provide elasticity for the skin. When the skin is injected with a facial filler, it is the dermis where those support substances are placed.

Subcutaneous Tissue

Beneath the dermis is a fatty layer with connective tissue, blood vessels, and nerves. The fat here insulates the body and works to regulate the skin and body temperature. Some consider this as a third skin layer and other consider it as separate.

Please watch this space for more on the skin and how we can help you keep yours clear, smooth, and youthful-looking. If you would like to schedule a free consultation with Dr. Rai, please call or email us today. We serve Dallas and Fort Worth, Texas and hope to meet with you soon.

The American Academy of Cosmetic Surgery (AACS) is a not-for-profit organization that provides consumer and professional information and conducts meetings and conferences for cosmetic surgeons and others. Recently they did a large survey of cosmetic surgery procedures done in the U.S.

The survey found that despite the sagging economy, over 17 million procedures were performed in 2009. That is more than has ever been reported before in a single year. The survey included questions about both invasive and non-invasive procedures. Results showed that of the invasive procedures, those most popular over the past years are:

• Abdominoplasty (tummy tuck)
• Rhinoplasty (nose surgery); and
• Blepharoplasty (eyelid surgery).

Dr. Rai at The Cosmetic Surgical Center offers these procedures and has extensive experience with them. Tummy tucks remove sagging skin from the abdomen, along with some fat just beneath the skin, and when your recovery period is over, you will have a slimmer silhouette with the scar hidden in the bikini line.

Rhinoplasty can reshape the nose in virtually any way you would like. You and Dr. Rai can discuss how best to reshape it to give your face better balance. If you have a deviated septum, that can also be corrected in the same procedure. Blepharoplasty removes excess skin and fat from the eyelids to give your eyes a more alert and rested appearance.

With the Boomers’ Help

The AACS noted that it is primarily the baby boomers who are causing the rise of cosmetic surgeries found in their survey.

Economists have commented in the effects of the boomer generation for years. Because it is such a large generation, they have stimulated the economy ever since they were babies. They started by promoting the diaper and baby food industries, then the children’s toys industry, and at each stage of their lives, they have expanded the corresponding industries until now they are promoting cosmetic surgery. As a group, they are unwilling to accept aging and are doing what they can to restore their youthful appearance.

Please call or email our Dallas, Texas office if you would like to have a free cosmetic surgery consultation with Dr. Rai. Our staff is friendly and we are all happy to answer questions.

We hear a lot in the news about BOTOX® Cosmetic and how popular it is, but not so much about the advantages of facial fillers, also called dermal fillers. They do not work the same way as BOTOX® Cosmetic. Instead of temporarily paralyzing the muscle used for frowning, for example, and thus helping to smooth out the frown lines, fillers provide bulk beneath the skin.

Facial fillers work in different ways to plump up the skin. One group of fillers is based on hyaluronic acid, a substance found naturally in the body. It attracts water, bonding to it and holding it to itself.

When used in a filler such as Restylane, Captique, or Hylaform, hyaluronic acid pulls water to the treated skin area. This has the effect of “swelling” the area – giving it a fuller and more youthful look. There is no problem with the body rejecting the filler, as our bodies are familiar with hyaluronic acid.

Another group of fillers uses collagen, another substance found naturally in the body. In youthful skin, collagen, a fibrous protein, occurs in a matrix with elastin, another protein, that gives the skin its elasticity. This matrix supports the skin surface, keeping it smooth. As we age, the body produces less collagen and elastin, so the matrix develops gaps and the skin begins to sink into them – this is one of the causes of wrinkles.

Cosmoderm and Cosmoplast are collagen-based facial fillers that restore strength to the matrix and help to rejuvenate the skin’s appearance.

Yet another approach is taken by fillers that use tiny particles. An example is Radiesse. It uses tiny spheres of calcium hydroxyapatite in a water-based gel. When Dr. Rai injects it beneath the skin surface, the gel immediately plumps up the skin. Over a few days, the body absorbs the gel but then the microspheres take over the job. They fill in gaps in the collagen/elastin matrix and help it keep the skin surface smooth.

Another filler in this group is Sculptra, which uses poly-lactic acid. It forms crystals that add thickness to the skin’s middle layer, the dermis, and also stimulate the skin to produce more new cells.

All filler treatments need to be repeated for long-term benefit. Each individual treatment lasts from about four to 12 or 18 months, depending on which filler is used. Dr. Rai can advise you on which one would do the best job for you.

Please contact our Dallas, Texas office today if you would like to have a free consultation with Dr. Rai.

Having looked at the choices associated with breast augmentation on April 14, the advantages of saline implants on April 30, and the advantages of silicone gel implants on May 3, let’s now consider the downsides of each implant type. If you are considering breast augmentation, it is part of your education and preparation to learn about the disadvantages as well as the advantages of each pre-surgery choice. No implant type is perfect absolutely, but one may be pretty near perfect for you individually.

• There are four choices of incision location for breast augmentation but only three are possible if you choose silicone gel implants. The TUBA approach places an incision in the navel and does an endoscopic procedure to position the implants. This can be done with saline implants which are inserted empty and folded up small, and it gives you no little scars (discreet as they are) on your upper body. If you want silicone implants and do not want any incision done in the navel anyway, this is not a disadvantage.
• In the remote possibility of an implant shell rupture, saline solution will immediately leak out and be absorbed by the body harmlessly; but your breasts will be asymmetrical and you will need to replace that implant as soon as possible. If a silicone implant ruptures, there will be no leak of silicone contents, as it will retain its shape without the shell. However, you will not realize there has been a rupture, perhaps until you go for a mammogram or a breast examination.
• For most people, silicone implants more closely resemble breast tissue than saline implants.
• If, after your breast augmentation, you decide that the implants are too big or too small, saline implants can be easily adjusted but not silicone implants. They are inserted pre-filled and must be replaced.
• Silicone implants are less likely to wrinkle after placement. If you are slender, saline implant wrinkles can show through the skin, looking unnatural.

Both types of implant can obstruct your mammograms unless you have them done by a technician trained in doing X-rays for breasts that have implants.

Both types are susceptible to capsular contraction. The body naturally produces connective tissue around the implant as a kind of immune response. This is not a problem unless that tissue becomes too tight, squeezing the implant and making the breasts feel hard. Dr. Rai can address this problem should it occur.

When done by a properly qualified surgeon with extensive experience, breast augmentation is a very safe and effective cosmetic surgery procedure. Part of having a happy outcome is doing your homework beforehand, so that you know what to expect and how to minimize your chances of any complications. Be sure and follow Dr. Rai’s instructions for pre- and post-operative self-care.

To schedule a free consultation with Dr. Rai, please contact our Dallas and Fort Worth, Texas, office today. We look forward to working with you.

On April 14, 2010, this space considered the choices associated with breast augmentation and on April 30, we looked at the advantages of saline implants. Today we will look at the advantages of silicone gel implants.

Keep in mind that silicone gel implants were restricted by the FDA for 14 years to reconstructive use only. That was in response to a media panic about possible harm should the silicone leak out of a ruptured implant shell.

Fourteen years of intensive research found no links whatsoever between silicone gel and any systemic disease, and it found that all the claims were baseless. In that time, though, many companies worked on making a shell that would not rupture and gel that would not move if the shell did rupture. The result was improved silicone implants being FDA-approved in November 2006.

1. Silicone gel is cohesive – it sticks to itself, unlike saline solution, which is a fluid. It is made from silicon (with no “e”), the second most common element on Earth after oxygen. We all have silicone in our bodies from common household items like hand lotion, dish detergent, laundry detergent, and hairspray. It does no harm. Silicon is found in sand, rock, and crystals. The gel in your implants will keep its shape in the very unlikely event that the shell ruptures.

2. Most people feel that silicone makes for a more realistic-looking breast augmentation. These implants have more of the look and feel of breast tissue. Not being a fluid, the gel does not slosh around during vigorous activity, and does not have a “water balloon” feel.

3. Silicone gel has far less chance of rippling, as can happen more easily with saline implants. In a slim woman, such ripples can show through on the skin. Rippling implants need to be replaced.

4. Silicone gel causes less tissue stretch. Saline implants gradually stretch the breast skin and other soft tissue in the breast, which can cause the implant pocket to expand, the implants to “bottom out”, and the breasts to droop.

5. If you have any chest irregularity like scoliosis, silicone implants drape more smoothly.

The choice between implant types for breast augmentation is really a personal one based on your preferences and lifestyle. Dr. Rai can help you make the decision by giving you more information, but he leaves the choice to you.

To learn more about breast augmentation and how it can best be done for you, please call or email our cosmetic surgery office today. We serve Dallas and Fort Worth in Texas and hope to meet with you soon.