Élan Institute for Plastic Surgery 2010 East First Street, Suite 270 Santa Ana, CA 92705
March 31st, 2009 Michael A. Jazayeri, M.D.
Mixto is a form of fractional CO2 laser. According to the company information site, www.laseringusa.com , Mixto SX is named for the “mixture” or “mix” of CO2 energy and fractional resurfacing. The SX stands for surgical, since the laser can be utilized to make surgical cuts with little or no bleeding.
The standard CO2 laser is very effective for deep wrinkles and pigmentation of the facial skin. Imagine a person between 50-60 years of age, who has spent majority of their time in sun light. May be they smoke as well. Imagine that thick, leathery skin with deep lines, even when the person is not talking or smiling or raising their eyebrows. That patient’s skin can only be noticeably improved with standard CO2 resurfacing.
Nothing comes without a price! Such resurfacing requires general anesthesia or intravenous sedation, thus increasing the cost and risk of procedure. The patient will have “raw” skin for 7-10 days. The skin may be red or have areas of light or dark pigmentation for months.
For patients who have finer lines and spotty pigmentation of their skin, the fractional laser is a good option.
Fractional resurfacing “skips” areas of skin with each laser zap. Therefore, each zap results in areas of normal skin mixed with areas of treated skin. This results in faster recovery (typically 3-5 days of redness and swelling), less risk of long lasting redness or hyper-pigmentation of the skin, and no need for general anesthesia.
The Mixto laser is a newer generation of fractional lasers. With this laser, one or two treatments are necessary to obtain the desired result, versus 3-5 treatments for the Fraxel laser. The treatments are spaced 3-6 months apart, depending on patient healing.
I have attached a before and after photo to illustrate the effectiveness of the procedure.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon. His office is located centrally in Orange County, in the city of Santa Ana. To schedule a complimentary consultation, please call 714-834-0101.
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March 27th, 2009 Michael A. Jazayeri, M.D.
Fractional laser resurfacing is an exciting new area in laser treatment of the skin. Traditionally, the CO2 laser has been considered the “gold standard” for improvement of wrinkles and pigmentation on the facial skin. There is no question standard CO2 treatment is the most effective for improving deep wrinkles on the face. Unfortunately, such an improvement comes at a cost. The procedure requires general anesthesia or intravenous sedation, thus increasing the cost and risk of the procedure. The face will have a superficial burn (deeper than a bad sun burn) for approximately 7-10 days, and redness or discoloration of the skin may be apparent for months.
There are patients, however, who have finer facial lines and lighter pigmentation. This population is an ideal candidate for the fractional (typically known as Fraxel) laser resurfacing.
As opposed to standard laser where the entire skin is “burned” with each zapping of the machine, the fractional laser “skips” areas. Thus each zap results in areas of normal skin mixed with lasered skin. This allows the healing process to be quicker, with less chance of redness or discoloration. In majority of patients, the need for general or intravenous anesthesia is alleviated.
I prefer the Mixto fractional laser since it requires one to two treatments vs. the current Fraxel lasers which require 3-5 treatments. The treatments are spaced 3-6 months apart, depending on the patient’s healing. I have performed the procedure with topical anesthesia, with no need for general anesthesia.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience. To schedule a complimentary consultation, please call 714-834-0101.
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March 17th, 2009 Michael A. Jazayeri, M.D.
I occasionally have a patient inquire about anatomical or tear-drop shape implants, so I wanted to give my opinion and experience with these implants.
Anatomical implants are flatter on the top and fuller on the bottom. Imagine cutting a tear drop from top to bottom in half. Each half will look like the tear-drop implant.
The thinking behind this design was to give a more “natural” look to the breast, especially in the top half. Too much fullness in the upper part of the breast is un-natural, although some patients prefer that exaggerated look.
The two main problems with the anatomical implants are the risk of rotation and the significant chance of rippling.
All breast implants have a chance of moving and rotating while inside the body. If the implant is round, such rotation is not an issue. However, if the anatomical implant rotates, the shape will be distorted. Additional surgery is required to move the implant in its original position.
To minimize the chance of movement, the surfaces of all anatomical implants are textured. This is a rough surface which is added on the implant shell. The rough surface increases the chance of the implant becoming “stuck” to the breast tissue, and thus reduces the chance of rotation. Unfortunately, this also increases the risk of rippling. As the patient moves, the stuck breast tissue pulls on the breast skin, causing “ripples”. Trust me, it is not attractive! This problem is especially noticeable with patients with thinner skin and muscle.
Given the significantly higher cost of anatomical implants, I do not feel the theoretical advantage of achieving a natural look is worth the potential problems discussed above. For the past ten years, I have used the smooth, round implants with a very high patient satisfaction rate.
Michael A. Jazayeri is a board certified plastic surgeon with over 10 years of experience. To schedule a complimentary consultation, please call 714-834-0101.
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March 16th, 2009 Michael A. Jazayeri, M.D.
Many patients are concerned about pain after surgery. This is especially true for abdominoplasty (tummy tuck) surgery.
To put most of you at ease, I have had many patients who have had C-sections prior to their tummy tuck surgery. All of them have told me the pain of tummy tuck surgery is less than C-section. So if you have had a Caesarian before, you are in luck!
For the rest of us, there is a device which, in my experience, reduces the pain associated with surgery.
This device, called onQ, is a dual (two) pain pump catheter attached to a reservoir. The reservoir is filled with numbing medication (similar to what is used at a dentist office to numb your teeth). The two catheters are placed underneath the skin of the abdomen and secured to the thigh/groin skin with special tape. The catheter slowly releases the numbing medication over a 48-72 hour period. The entire length of the catheter is coated with silver, which has anti-bacterial properties. I have not yet seen any wound infection as a result of this catheter.
Although the catheter does not eliminate the need for oral pain medication, I feel, in most patients, this catheter makes the pain more tolerable, with less need for oral medication. The catheters are very thin and easy to remove. All my patients remove the catheters themselves, avoiding an extra trip to my office.
I have used this catheter for breast augmentation as well. However, the result has been mixed. I, therefore, do not feel the additional cost of the pain pump is justified for breast surgery.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon, practicing in Orange County, California. To schedule a complimentary consultation, please call 714-834-0101.
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March 13th, 2009 Michael A. Jazayeri, M.D.
The surface of breast implants come in two varieties: smooth and textured.
The smooth surface is the covering of the implant which is made of silicone. The inside of the implant contains silicone or can be filled at the time of surgery with saline (salt water).
The textured implant has a textured surface attached to the silicone shell of the implant. As the name implies this implant feel s “rough” to the touch.
The theory behind the textured surface is to minimize the risk of capsular contracture, and reduce the risk of rotation for anatomical implants.
What is capsular contracture? Any non-absorbable foreign body placed inside our body will form a “capsule” around it. Since the body cannot absorb this material, it “ignores” it buy forming a capsule (think of it as a very thin egg shell) around the foreign body. In some instances, this capsule becomes thick and starts to contract. This contracture will cause the breast shape to change and the implant will become tight and deform.
In the laboratory, a textured surface lowers the risk of capsular contracture. However, in the real world, this reduction is not as clear cut. If an implant is to be placed above the muscle (the pectoralis muscle is the muscle which lies underneath the breast tissue), there may be a higher risk of capsular contracture with a smooth surface implant. The risk of contracture is essentially the same if the implant is placed under the muscle. I always place the implant under the muscle, due to better protective covering, less implant palpability, and less interference with future mammography.
The two main issues with textured implant are the higher cost and the increased risk of rippling. Textured implants are more expensive to manufacture. Secondly, the breast and the surrounding tissue will become “stuck” to the textured surface. As the patient and the breast tissue moves, the stuck tissue will pull on the overlying skin, causing “ripples”. Trust me, this is not attractive!
Given the increased cost of the textured implants and the theoretical advantage of reducing capsular contracture, I do not feel their use is more beneficial than smooth surface implants.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon. His office is centrally located in Orange County, in the city of Santa Ana. To schedule a complimentary consultation, please call 714-834-0101.
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March 11th, 2009 Michael A. Jazayeri, M.D.
Many patients are not aware of the hand being one of the main victims of aging. As we age, the hand loses the fat under the skin, which results in tendons and vessels under the skin becoming more pronounced. Sun damage may also cause age spots on the skin, accentuating the aging of the hand.
Fortunately, options are available to rejuvenate the hands. The lost fat can be replaced by commercial fillers present (such as Restylane), or by the patient’s own fat. I prefer the patient’s own fat, since I am replacing what is lost. Furthermore, although usually two to three procedures may be necessary, the remaining fat is permanent after each procedure, eventually resulting in a stable correction.
The procedure can be performed under local anesthesia, similar to going to your dentist. Fat is harvested usually from the abdomen (the area of the skin below the belly button), and then injected into the hand. You should refrain from excessive use of your hands for one week. Some swelling and bruising will be present, which usually is resolved by 7-14 days.
One or two additional touch-up procedures may be necessary until the correction is stable. The touch-up procedures are performed 3-6 months apart, depending on the amount of fat remaining after each procedure.
Any medication which increases the risk of bruising (aspirin, motrin, coumadin, etc.) must be discontinued (unless medically deemed necessary by your physician) two weeks before the surgery.
The aging spots on the hand can be improved by chemical peels or laser (I prefer the Mixto or fractional CO2 lasers). The laser procedure can be done with topical anesthesia.
As we age, we tend to focus on the face. Don’t forget your hands! Next time you see an older person who has had a face lift; look at their hands and judge for yourself.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience. His office is centrally located in Orange County, in the city of Santa Ana.
To schedule a complimentary consultation, please call 714-834-0101.
Posted in Fat Transfer, Hand Rejuvenation | No Comments »
