Dallas Plastic Surgeon: November 2009

Friday, November 20, 2009

US Cosmetic Medical Market Faces New Challenge In Senate Bill

US Cosmetic Medical Market Faces New Challenge In Senate Bill
Wall Street Journal
Phil Haeck, a plastic surgeon in Seattle and incoming president of the American Society of Plastic Surgeons, said his top tax-related concern is ...

Wednesday, November 18, 2009

How to Choose a Liposuction Surgeon

How to Choose a Liposuction Surgeon
24-7PressRelease.com (press release)
What Should I Look For in a Liposuction Surgeon? Although liposuction is a simple concept, it is important you choose a highly qualified, ...

Tuesday, November 17, 2009

Menopause and Your Skin

by Dr. Diane Gibby • M.D., P.A., F.A.C.S

Menopause refers to the physical and psychological changes that occur in women as their “female” hormones (estrogen and progesterone) levels decline and menstruation ceases.

The skin, which helps to produce vitamins, regulate the body’s temperature, and prevents harmful environmental hazards such as ultraviolet light from damaging our internal organs, can be greatly affected.

The dermis is the supportive layer of the skin made up of collagen, elastic fibers (elastin) and hair follicles. Without collagen and elastin, the skin becomes wrinkled, poorly adherent to the body and loses much of its resiliency. Research has shown that estrogen has a direct effect on the thickness and plenitude of both collagen and elastin and with the onset of menopause the amount of collagen decreases by as much as 2 percent per year. Most of us recognize these changes as sagging, wrinkled skin. And because collagen and elastic fibers are a part of the supporting structure of the skin, the alterations weaken the skin making it more prone to injury.

Although the aging process cannot be stopped or reversed, there are many ways of slowing down the changes, which occur to the skin through aging and menopause. Avoiding the harmful rays of the sun and using sun protection can protect the skin. As we age our skin cells grow slower and it takes longer to repair the damage.

A good diet is also an important contributor to resilient skin. Foods rich in Vitamin E and C and selenium can reduce damage done to the skin by serving as antioxidants, which aid in fighting free radicals. Free radicals are dangerous chemicals that can sometimes cause genetic damage when they interfere with cell metabolism. But even if you stay out of
the sun and eat right, chances are your skin will still need some fine-tuning during menopause.

Dry Skin
As you age, your skin’s sebaceous glands produce less of the lubricating oil called sebum, which can lead to dry skin. Low humidity, wind and cold may make the problems worse. Fight back by using a daily moisturizer rich in alpha hydroxy acids to stimulate cell rejuvenation. Certain topical preparations such as Aesthessence, combine many natural elements together in a single formulation to replenish hormone-deprived skin. Gently exfoliating several times a week will help rid the skin of dead, dry cells and allow moisturizers to penetrate deeply.

Wrinkles: Over the years, the connective tissues collagen and elastin gradually lose their strength and elasticity, leading to wrinkles. If your skin is showing some of the ravages of time, consider the following: Prescription creams: Tretinoin (brand name Retin A and Renova) helps slough off dead cells and steps up collagen production, firming the skin and reducing fine wrinkles.

Chemical peels: This procedure can be done in a physician’s office using light sedation. It will improve the deeper wrinkles by removing outer layers of skin. Dermal fillers. Creases from facial expressions—squinting, smiling, frowning—can be plumped up with soft tissue fillers that are either injected or surgically implanted under the skin.

Botox: Injections of Botox can be used to temporarily weaken the underlying muscles that contribute to the development of frown lines between the eyes, crow’s feet, forehead
wrinkles and neck folds. The treatment lasts three to four months.

Laser Surgery: To smooth moderate wrinkles a surgeon uses short, powerful pulses of energy to selectively destroy sun damaged outer and middle layers of skin. Lasers can also be used to remove age spots and to smooth scars.

Cosmetic Surgery: Whether an eye lift or a face lift, cosmetic surgery is the most effective way to improve deep wrinkles and sagging skin. Remember, cosmetic surgery is not intended to make you look 20 again. But rather an excellent way to improve your
appearance by giving a rested, youthful look.

For more information see Dallas plastic surgeon Doctor Diane Gibby at Medical City http://www.drgibby.com

Pregnancy and Your Skin

by Dr. Diane Gibby • M.D., P.A., F.A.C.S

Pregnancy is an exciting time in a woman's life. Most women enjoy being pregnant and are happy with the changes motherhood brings, but are not always prepared for the effects of pregnancy on their skin. Many of pregnancy’s stubborn signature marks can be faded, or even erased, thanks to advances is skin care.

Skin: Many women experience a "glow" during pregnancy but some may develop changes in skin pigmentation, known as melasma (or the “mask of pregnancy”), which is common in the facial area. Studies suggest that up to three in four women may develop these changes which are characterized by a blotchy brown increase in pigment. Since sun exposure can make these areas darker, it is important to a wear sunscreen with a SPF of at least 15. Surface-layer melasma sometimes fade on its own after delivery; when it doesn’t, treatment starts with hydroquinone, a topical bleach, often used in conjunction with skin care products containing Alpha Hydroxy Acids.

Stretch Marks: Up to 90 percent of women develop stretch marks during pregnancy, and there’s not a cream on earth that will keep them from forming (though keeping these areas well-moisturized keeps skin in good condition and just feels good!). That’s because stretching occurs not on the skin’s surface but deep down, causing structural changes to collagen and elastin. Most of these red marks will gradually fade to a silvery white over time. While there are no topical treatments that can successfully remove stretch marks they can be surgically excised in procedures such as a tummy tuck or breast lift.

Spider Veins: These small, dilated blood vessels located close to the surface of the skin are a common imprint of pregnancy that often show up on the face and legs. Some go away following delivery, while others remain. Spider veins on the face can be improved with laser treatments, while small veins on the legs are usually treated with sclerotherapy, which involves the injection of a salt-like solution into the vessel.

Your skin care needs will likely change during pregnancy and during the postpartum period. Hormonal changes can cause previously dry skin to produce oil and otherwise oily skin to feel tight and dry.

For a Highland Park area plastic surgeon please see Doctor Diane Gibby at http://www.drgibby.com

Ear Surgery: What to Expect

by Dr. Diane Gibby • M.D., P.A., F.A.C.S

Otoplasty, or ear surgery, is the only cosmetic procedure that is performed more frequently on children than it is on adults. Because ears are almost fully developed by the age of four, many parents opt to have their child's ears surgically reduced during pre-pubescent or early teen years. Of course ear surgery is also performed on thousands of adult patients a year. However, the cartilage in the ear becomes less pliable with age, which could limit the enhancement capabilities available to the operating surgeon.

Otoplasty is usually performed as an outpatient procedure in a hospital or doctor's surgical facility. For younger patients, general anesthesia is usually administered so that children are asleep throughout surgery, while surgeons may prefer local anesthesia with a sedative for adults and older teens.

The doctor will begin surgery by making an incision along the back of the ear. Depending on the desired results, the surgeon will then reshape the cartilage and remove skin. In some cases pieces of cartilage is trimmed or removed, while other techniques involve the
pinning of cartilage with permanent sutures to pull the ear back closer to the head and make it appear smaller. Regardless of the technique or whether or not cartilage is removed, permanent sutures are used to hold the ear in place. After this, temporary stitches are used to close the incision along the back of the ear. The total surgery will take
between 1 and 2 hours per ear.

Candidates for surgery should be of good health, have no scarring of the ears, and be able to follow post-surgical requirements (this is especially important for younger patients). Most candidates seek improvement of their appearance due to large or asymmetrical ears.

For more information see http://www.drgibby.com

Lifestyle Changes Help Keep That New Look After Liposuction

by Dr. Diane Gibby • M.D., P.A., F.A.C.S

There are many reasons for having a liposuction procedure. For some women, all the exercise and dieting in the world cannot rid them of unwanted fatty deposits commonly found in the thighs, hips and abdomen.

For others, loose skin in the buttocks, thighs or neck are problem areas. Although it is not a substitute for exercise or healthy eating habits, liposuction provides women with the option of removing those excess fatty deposits.

While liposuction can help you obtain the look you want, it is important to maintain that look with proper health, nutrition, and exercise.

Some of the most popular liposuction procedures today are the UAL (UltraSonic Assisted) Liposuction procedure and the Tumescent technique. Each are typically performed on an outpatient basis. The best candidates should be in good health and have realistic
expectations of the procedure. The most frequently treated areas in women include the waistline, abdomen, outer thighs, inner thighs, buttocks, knees, ankles and neckline.

The cosmetic success of liposuction relies on removing inches rather than pounds. Little weight is actually removed, yet dramatic results may be obtained. After the procedure, the patient’s satisfaction with her new look and dedication to maintaining that look are most important.

Following the procedure, home rest is necessary for the first several days, after which a light work schedule may be resumed. The surgeon may recommend wearing a tight- fitting garment, similar to a girdle, after surgery for up to six weeks. These garments help promote healing by reducing swelling and bruising.

Exercise is also encouraged, such as a brisk walk a few days after the procedure. Increased exercise is recommended as the healing process continues as part of an overall healthy lifestyle.

If the patient gains weight after the procedure, the size of the individual fat cells will increase. Too much weight gain may mask the benefits of the liposuction procedure.

Toning and aerobic exercises are also an important part of a good post operative regimen. Patients should strive to maintain or achieve their ideal weight following surgery. This can be accomplished with a healthy, well-balanced diet and exercise.

It is important to remember that liposuction is a surgical procedure. Your body must heal before you see the full benefits. However, within two to three weeks, you should see results with the full effect completely evident within six months to a year after surgery, in some cases.

Before proceeding with liposuction, it is important to thoroughly understand the options available for body contouring surgery, and how as a patient, you can improve and maintain your surgical result with lifestyle changes, if necessary. You should discuss any questions or concerns you have with your doctor before proceeding with any surgical
procedure. The Women’s Center for Plastic and Reconstructive Surgery is one of the few centers in the D/FW Metroplex offering the new UAL procedures for women.

For a DFW area plastic surgeon see Dr. Diane Gibby at http://www.drgibby.com

Facial Rejuvination

by Dr. Diane Gibby • M.D., P.A., F.A.C.S

Aesthetic eyelid surgery is one of the easiest facial cosmetic procedures from which to recover and can be extremely rewarding for patients desiring a more youthful, rested appearance.

Eyes are considered the most expressive feature on our face. Unfortunately, years of laughing, squinting and sun exposure often take their toll on the sensitive skin surrounding the eyes, giving a tired, droopy appearance. An eye lift can be performed on the upper and lower lids simultaneously, depending on the patient's needs. The surgeon makes
incisions in the upper and lower eyelids following the eye's natural creases, and excess fat and skin are removed. The incisions are then closed with fine sutures.

Bruising and swelling may be expected for the first seven to 10 days but makeup such as eyeliner, mascara and concealer can be worn after stitches are removed on the fifth day following surgery.

A brow lift can also help give a rested and relaxed look, by tightening forehead skin, elevating the brows and softening lines between the eyes. It can be done in conjunction with an eye lift for a more dramatic result.

Brow lifts usually require an incision a few inches behind the hairline at the top of the head. Strips of muscles that cause facial features to droop are removed or tightened.
Skin is gently pulled upward; excess skin is removed; and incisions are closed with sutures. Bruising is minimal with this procedure and makeup may be worn prior to the stitches being removed, usually within 10 days of surgery.

Another procedure that can enhance and balance facial features with minimal recovery is a cheek augmentation. This surgery adds definition to the bone structure of the face. The surgeon inserts a soft implant through an incision inside the mouth, to augment the cheekbone area. There is usually very little bruising with this procedure, and the stitches placed inside the mouth dissolve within five to seven days. A liquid diet may be necessary for several days following the procedure, but most patients are up and about the day of surgery.

For a Plano, Texas area plastic surgeon see http://www.drgibby.com

The Benefits of Breast Surgery

by Dr. Diane Gibby • M.D., P.A., F.A.C.S

In America today, there are millions of women who are unhappy with their breasts. Self-conscious because they’re too small. Embarrassed because they’re too big. Or disappointed because the size and shape of their breasts has changed over the years. They may be shrinking, sagging or atrophying. Whatever the problem is, it can often have a serious impact on a woman’s self-esteem.

Surgery of the breast can improve all of these problems. Underdeveloped, small breast can be enlarged, a lot or a little. Oversized, burdensome breasts can be reduced to a smaller, more proportional and comfortable size. Sagging, shrinking breasts can be
lifted and reshaped. Even breasts that have been removed by mastectomy can be reconstructed to restore a natural figure.

Small, underdeveloped breasts or breasts that have become smaller after childbearing can be improved with breast augmentation. This surgery is performed through an incision, either made under the breast just above where it touches the chest, or around the areola (the dark skin surrounding the nipple). After creating the incision, the surgeon makes a pocket either directly under the breast tissue or under the muscle, depending on the surgeon’s judgment and the patient’s physique. An implant is then placed into the pocket and the incision closed. Minimal swelling and some bruising which might occur
immediately following surgery will disappear gradually.

As the years go by, almost every woman notices a gradual change in the size, shape and feel of her breasts. Gravity, pregnancy, breast feeding, weight gain and loss all take their toll. Even if the volume stays the same, the firmness and elasticity are often lost. A breast
lift can reshape and firm sagging breasts. During surgery excess skin is removed from the lower part of the breast. The nipple, areola and underlying breast tissue are lifted up to a new, higher position. Sometimes an implant is used if extra fullness is desired.

Oversized, heavy breast can cause physical and psychological problems. They can be painful, causing backaches, chafing and making it difficult to exercise or perform everyday functions. Then there is the mental burden. Stares and rude comments often cause women to feel embarrassed and extremely self-conscious. These are just a few of the
reasons why women with large breasts choose to have a breast reduction.

This procedure can reduce the size of and reshape large breasts by removing excess skin and underlying tissue. An oversized areola can be made smaller at the same time. Though the procedure is permanent, breasts can still increase in size afterward in the event of weight gain, birth control pills or pregnancy. The surgeon makes incisions
horizontally and vertically following the natural contour of the breast. Excess tissue, fat and skin are removed and then the nipple, areola and underlying tissue are moved to a new higher location. With the nipple in the new position, skin on both sides of the breast is moved down and around the areola and brought together. This firms up and shapes the breast.

Although scars may be long with this procedure, since they are made around and below the nipples, they should not be noticeable even in low-cut clothing.

While women shouldn't let their breasts define them, it can make a difference in how they perceive themselves and can directly affect a woman's self-esteem. Undergoing breast surgery is a very personal choice, and as with any cosmetic procedure, risks and benefits should be considered carefully before proceeding.

For more information see http://www.drgibby.com

Benefiting from Breast Reduction

Benefiting from Breast Reduction
by Dr. Diane Gibby • M.D., P.A., F.A.C.S
Most people would agree that what is inside a person is more important than what is on the outside. Increasingly, however, we're learning that the outside is important too. How you look can have a direct impact on how you feel about yourself. If you are unhappy about some aspect of your appearance, it can make you feel self-conscious, unconfident and unhappy. This especially seems to be the case for women who have overly large, pendulous breasts. Large-breasted women may suffer emotional and social consequences of their breast size, and they often suffer painful physical symptoms. A breast reduction procedure often provides freedom to women who have been plagued by a lifetime of discomfort from bras that never fit properly, painful shoulder muscles, a stooped posture and heat rashes. In addition, it can improve the self-image of women who are embarrassed by their oversized breasts. Reduction surgery also relieves concerns some women may have about accurate mammogram results; studies have shown that it may be more difficult to diagnose a small lump in a woman with very large breasts As we age, the composition of our breasts change. Younger women's breasts consist of 20 to 30 percent fatty tissue, as compared to older women's breasts, which may be up to 70 percent fat, as a result of hormonal changes. So, while a 20-year-old can gain a few pounds without altering the size of her breasts, an older woman may find that gaining weight goes directly to her chest, increasing her bust size. Breast reduction can remove excess fat and breast tissue to provide a more proportionate look. The amount of tissue removed depends on the desired size. Breast reduction may be done as an outpatient procedure or with an overnight stay in the hospital. The surgery takes two-and-a-half to four hours, depending on how much tissue is removed. During the procedure, the surgeon makes an anchor-shaped incision around the areola, which extends down and follows the curve of the crease under the breast. The nipples remain attached to the underlying breast tissue and nerves. The nipple and areola are moved into their new position and skin is pulled around the areola to shape the new breast. If the breasts are very large or pendulous, the nipple and areola may have to be completely removed and grafted into a higher position, resulting in a loss of feeling in the nipple and areola. After surgery, the breasts are wrapped in an elastic bandage or a surgical bra over gauze dressings. A day or two following surgery, the bandages are removed, although a surgical bra is worn for several weeks or until the swelling and bruising subside. Stitches are removed in five to 10 days following surgery. Routine exercise and physical activity can be resumed about four weeks after surgery. Breast reduction allows women increased mobility to play sports, exercise and move more freely than before. It allows women the physical freedom to be more involved with life. The procedure may be covered by insurance if it will alleviate discomfort such as back and neck pain. It may also prove to be medically necessary, if a certain amount of breast tissue is removed. Before proceeding with a breast reduction, it is important to have a thorough understanding of the options available and potential risks associated with surgery. Discuss any questions or concerns you might have with your doctor.

For a Dallas area cosmetic surgeon please see Doctor Diane Gibby at http://www.drgibby.com

Regaining a Firmer Bustline

by Dr. Diane Gibby • M.D., P.A., F.A.C.S

Most women today endeavor to feel and look their best. Many are willing to eat a nutritious diet and maintain a consistent exercise routine so as to reap the health benefits and maintain a youthful appearance. But, the effects of pregnancy, menopause and large
fluctuations in weight associated with hormonal changes. can sometimes cause a women to look older than she feels.

While becoming a mother is a joyous and momentous occasion, it can change your life and your body in many ways. Later in life, women will also experience new changes in their body. These changes leading to menopause can begin as early as age 35.

Sagging or loose breasts are sometimes the result of pregnancy, changes in weight, or due to the natural aging process. The breast lift, or mastopexy, is a procedure that elevates and reshapes the sagging breast.

Breasts are carefully marked in an anchor-shaped form to indicate where the incisions are to be made. The anchor-shaped incision follows the natural contour of the breast, outlines the area where the breast skin will be removed, and defines the new nipple location.

Excess skin is removed and the nipple and areola are moved to a higher position appropriate for the woman’s chest wall proportions. The skin around the areola is brought down to shape the breast.

Stitches are placed around the areola, in a vertical line extending down from the nipple, and along the lower crease of the breast.

Some patients, especially those with small breasts and minimal sagging, may be candidates for less extensive procedures, such as the “doughnut (or concentric) mastopexy,” in which circular incisions are made around the areola, and a doughnut-shaped area of the skin is removed.

A breast augmentation may be performed at the same time as a mastopexy. If an implant is inserted at the time of the breast lift, it will be placed in a pocket directly under the breast tissue or under the muscle of the chest wall.

On the other hand, some women may prefer to have their breasts made smaller, or reduced, at the time of the breast lift. A reduction-mastopexy can be performed through the same operative incisions.

Following surgery, an elastic band or a support bra is worn over gauze dressing. The bra is worn for the patient’s comfort for about three to four weeks.

Before proceeding with a breast lift, it is important to have a thorough understanding of the options available and to discuss any questions or concerns you might have with your doctor. Every patient is unique and her specific needs should be addressed

For more information see Diane Gibby at http://www.drgibby.com

Comparisons of Body Contouring Procedures: Which One Is Best for You?

Comparisons of Body Contouring Procedures:
Which One Is Best for You?

by Dr. Diane Gibby • M.D., P.A., F.A.C.S

While recent media attention may leave one with the feeling that liposuction procedures are simple operations, liposuction remains a surgical procedure that requires serious consideration, pre-operative preparation, with post-operative recommendations that must be followed for a complete and healthy recovery.

It is important to have a good understanding of the different liposuction procedures available when considering body contouring surgery when exercise and diet have lost their “battle with the bulge.” Currently, three of the most popular choices available are
traditional, tumescent and ultrasonic-assisted liposuction.

Traditional liposuction is a surgical procedure designed to remove localized fat pads. A tubular instrument or cannula is inserted through small incisions into the problem area. A suction unit is attached to the outside of the instrument, where the fat is suctioned.

General anesthesia is usually required for this procedure, unless only small areas are suctioned. Recovery time is four to six weeks and requires wearing support garments to reduce swelling. Typically, patients can return to work in three to six days. After several weeks, the patient may resume regular exercise.

Another option is the tumescent technique, which requires local or general anesthesia. With this technique, “numbing” fluid made of sterile saline, mixed with a dilute solution of anesthetic and medication to constrict blood vessels, is injected into the problem area. This shrinks the blood vessels and loosens the fat.

With this procedure, a small incision is made and the fluid and fat are suctioned out by the cannula. This technique allows for a much smaller cannula than used with traditional liposuction, resulting in less blood loss, bruising and less risk of contour irregularities. Most
patients will require three to six days off work, unless only a small area is treated.

Syringe liposuction, often referred to as “syringe liposculpture,” applies the above techniques. However, a hand-held syringe is used to create suction rather than a mechanical suction machine. Proponents of the techniques claim it is less traumatic to the tissues, resulting in less blood loss and better contour. The ideal patient for this procedure would have small areas of localized fat to be removed.

Ultrasonic-assisted liposuction (UAL), yet another option, uses high-frequency sound waves to “melt” fat into an easy-to-extract liquid. Ultrasonic waves are transmitted to the tip of the
specially-designed suction cannula. When the tip contacts the fat cells, they implode, allowing for removal by a low-pressure suction. There is less blood loss with UAL, probably resulting in less bruising and swelling and a faster recovery time.

Patients don’t have to be at their optimum weight for the UAL procedure. In many cases, patients may have twice the amount of fat removed with UAL than traditional liposuction.

The benefit of both tumescent and ultrasonic-assisted liposuction is that the fat cells are “adjusted” or “treated” before they are removed. As a result, more fat can be suctioned and better postoperative results can be achieved.

For more information see http://www.drgibby.com

The Beauty of Botox

by Dr. Diane Gibby • M.D., P.A., F.A.C.S

Whenever we frown, squint or even smile, we gather tissue between our eyebrows into a fold. For many of us, this causes a chronic furrow, producing a frustrated and angry appearence. Now, it's possible to make frown lines, crows feet and forehead creases improve without surgery or scars, by a simple treatment of Botox.

Botox, the trade name for Botulinum Toxin Type A, has been used since the early 1980s for the treatment of strabismus (lazy eye) and blepharospasm (uncontrolled eye blinking) as well as facial spasms. Botox is now being used with success by cosmetic surgeons to help achieve a younger appearance for their patients.

Recently much attention has been given to Botox, because of its ability to paralyze muscles that form wrinkles on the face. Most people are intimidated by the thought of a toxin being injected into their muscles. The truth is that the protein from the toxin, and not the toxin itself, is actually being used. So there is no chance of developing Botulism from the injections.

Botox works by weakening the muscles that control facial expression . Once the resting tone of these muscles are weakened, the pull of the muscles relax and the skin flattens out. This is an entirely different approach than those used previously for treating wrinkles.

In the past, collagen and fat injections have been used to fill in or plump up a wrinkle. These fillers are not as effective as Botox in improving the frown wrinkles on the forehead and between the eyebrows. Researchers have found that the type of lines and wrinkles that respond best to Botox injections are those caused by the muscles--specifically those muscles that are repeatedly over-contracted during facial expressions, such as frowning or squinting. By physiologically weakening the muscles, these wrinkles are removed naturally. This treatment may also be effective for wrinkles in the neck.

Botox injections block the transmission of impulses from the nerve cells to the muscle, which causes a temporary muscle weakening. By selectively interfering with the muscle's ability to contract, existing lines are smoothed out over time and future lines may be prevented. After the procedure, these lines will be improved at rest, and facial movements will no longer create as deep a furrow.

The procedure takes only a few minutes to administer and is performed with the patient in a sitting position. During the injection, which is performed with a tiny needle, the patient is asked to contract the muscle in the area being treated so the physician can determine the proper location for injection.

The patient may feel a small amount of discomfort when the Botox is injected but usually no anesthesia is required. The full effect of the injection is generally not seen for 2 to 7 days, after which a noticeable decrease in facial creases will be seen. The results from this simple procedure are often fairly dramatic. The lack of recovery time adds to the increasing popularity of this procedure.

Botox injections also decrease the patient's ability to frown or squint, which prevents the progressive worsening of these lines over time. Therefore, the method can be considered both corrective and preventative. However, the results are not permanent. Over the next three to five months the Botox gradually looses its potency, eventually restoring the muscle to its original condition. When frown lines begin to appear again, another dose of the Botox is all that is needed to maintain the desired result.

Some physicians have noticed that the duration of muscle "relaxation" is cumulative and lasts longer with each treatment, although there is no scientific data to support this theory.

To date, no systematic complications associated with Botox injections have been documented. As with all biologic products, there is a rare possibility of an allergic reaction. Among the most common side effects are local numbness, swelling, bruising, or a burning sensation during injection. These are usually temporary and typically disappear within a few hours. Currently, there are no known long-term effects of repeated Botox injections.

For a female plastic surgeon in the Dallas area see http://www.drgibby.com

The Beauty of Laser Resurfacing

The Beauty of Laser Resurfacing
by Dr. Diane Gibby • M.D., P.A., F.A.C.S
As more and more baby boomers turn 50, demand has never been greater for new and better ways to improve the appearance of skin laxity, wrinkles and age spots, commonly seen in the aging process. In response to this need, more information on how to stay healthier and live longer has become available, along with new medical procedures and products that allow people to maintain that "youthful glow." We were all born with smooth, baby-soft skin. But as we go through life, our skin is subject to stress, sun-damage, and pollutants which accelerate the natural aging process. These factors often leave skin looking older than it actually is. Although abrasion and chemical peels have offered some hope for patients in the past, there is a newer procedure that is being performed with excellent results. This procedure called Laser Skin Resurfacing or laserbrasion, is a non-invasive procedure performed to resurface and tighten the skin. This process gently removes skin imperfections and dramatically reduces lines and wrinkles while using the most advanced technology available. Now, sun-damaged and aging skin can be removed layer-by-layer, helping protect and stimulate the regeneration of deeper, more healthy skin. Many facial conditions such as fine wrinkling around the eyelids, forehead and mouth can be made smoother with this simple process. Deep laugh and frown lines can be minimized and even the lingering effects of chicken pox or acne scars can be successfully treated with the pulsed CO2 laser Unlike chemical peels, the CO2 laser uses a high energy beam of light to vaporize, or "paint away" scars, lines, wrinkles, and other skin defects. The laser light penetrates to a very precise, controlled depth, making the procedure safe and predictable while reducing the risk of scarring or pigmentation problems. Laser resurfacing is usually done on an outpatient basis at a surgery center or a surgeon's office-based facility. The procedure is most commonly performed under local anesthesia with sedation, especially when it's used to treat localized areas of the face. A patient will be awake but relaxed, and will feel minimal discomfort. For more extensive resurfacing, your surgeon may prefer to use general anesthesia, in which case you'll sleep through the procedure. In the first few days after the procedure, treated skin will appear red and may produce some oozing as new collagen is formed. While healing, the resurfaced skin will be treated with applications of protective creams or ointments. The skin will take about two weeks to heal and may have a pink coloration for 6 - 8 weeks. Makeup can usually be applied within ten to fourteen days, depending on your skins response to the treatment. As with all medical procedures there are risks associated with Laser Skin Resurfacing that can include: burns, scarring, and obvious lightening or darkening of the treated skin. You can reduce your risks by choosing a qualified plastic surgeon who has received special training in laser surgery.

For more information see http://www.drgibby.com

Breast Augmentation: Is it right for you?

by Dr. Diane Gibby • M.D., P.A., F.A.C.S

Breast Augmentation (augmentation mammoplasty) is a surgical procedure to enhance the size and shape of a woman's breast. Women may choose this procedure for several reasons: to enhance their body contour; to correct a reduction in breast size after pregnancy; to balance a difference in breast size; or as a reconstructive technique following breast surgery.

To increase breast size, saline or silicone implants may be used, although the use of silicone implants are under stricter guidelines by the FDA. This procedure is performed either in an office facility, outpatient surgical center or hospital, and may be performed under general, or local anesthesia with IV sedation. The incision necessary for the implant can be made in the crease at the lower breast fold, around the areola, or in the armpit.

Working through the incision, the breast tissue and skin will be lifted to create a pocket either directly behind the breast tissue or underneath the chest wall muscle. Placing the implants behind the chest muscle may reduce the potential for capsular contracture. This placement may also interfere less with breast examination by mammogram than if the implant is directly behind the breast tissue.

The surgery usually takes one to two hours to complete. Stitches are used to close the incisions, and a gauze bandage is applied over the breast. The patient will probably feel tired and sore for a few days following surgery, but should be up and around in 24 to 48 hours.

Stitches are removed in five to seven days, but the swelling in the breasts may take three to five weeks to disappear. A woman should be able to return to work within a few days depending on the level of activity required at her job.

Breast implants do have the potential for complications. These risks include infection (requiring removal of the implant) and capsular contracture (scar tissue), which may develop around the implant, distorting the shape of the breast and potentially causing breast pain. The chance of rupture or deflation of implants is low, but does increase with the age of the implants. Any woman opting to proceed with breast implant surgery should understand revisional surgery might be necessary to treat potential problems associated with implants.

Routine mammograms should be continued after breast augmentation fo women in the appropriate age group. It is also very important that breast self-examinations be done on a monthly basis. These exams may require a little more diligence because the implant must be pushed up and away from the surrounding tissue, so any abnormalities can be detected.

While women shouldn't let their breast size define them, it can make a difference in how they perceive themselves and can directly affect a woman's self-esteem. Having a breast augmentation is a very personal choice, and as with any cosmetic procedure, risks and benefits should be considered carefully before proceeding.

For more information see http://www.drgibby.com

The Wave of the Future: Ultrasonic Liposuction

by Dr. Diane Gibby • M.D., P.A., F.A.C.S

Ultrasonic Assisted Liposuction (UAL) is a revolutionary body-contouring technique, based on the use of ultrasonic energy. Widely used in Europe for years, the UAL procedure has become increasingly popular here in the United States.

UAL uses high-frequency sound waves to "melt" fat into an easy-to-extract liquid. It allows the surgeon to suction larger volumes of fat, minimizing blood loss which may result in less postoperative bruising and swelling and therefore a faster recovery time than traditional liposuction.

For some patients, UAL may be a better option than traditional liposuction. Quite often, patients may have twice the amount of fat removed with UAL than traditional liposuction. In addition, the patient does not have to be at their optimum weight to have this procedure performed.

It is important to note, however, that UAL is not a substitute for dieting and exercise! In the future, UAL will probably become the preferred method of suctioning areas of dense fibrous tissue such as the upper abdomen, back and breasts. Traditional liposuction is often more abrasive than UAL and cannot be used in these areas as easily.

During the procedure, which may be performed as an outpatient, ultrasonic waves are transmitted to the tip of a specially-designed suction cannula. When this tip contacts the fat cells, they implode or explode inwards. The liquefied fat can then be removed by low pressure suction.

As with any major surgery, there are possible complications which may include bleeding, infection, prolonged bruising or numbness, and seroma (collection of fluid under the skin). After the procedure, patients should wear special support garments for four to six weeks to control swelling while the skin regains its proper shape and form. Recovery time varies, but generally, patients are able to return to work in three to five days and exercise may be resumed after several weeks.

Because UAL is so new and the machinery to perform the procedure is expensive, it may be a little more expensive than traditional liposuction (in some cases it may be 25 percent more expensive). UAL will not replace traditional liposuction; rather, it serves as a complement to the liposuction procedures available today. In some cases, it offers more precise and artistic body sculpturing than traditional liposuction.

Before proceeding with the UAL procedure, it is important to have a thorough understanding of the options available for body contouring surgery, and how as a patient, you can improve and maintain your surgical result. You should discuss any questions or concerns you have with your doctor before proceeding with any surgical procedure.

For more information see http://www.drgibby.com

Size Matters: Choose the Perfect Breast Size for Your Body

by Dr. Diane Gibby • M.D., P.A., F.A.C.S

Breast Augmentation is a surgical procedure to enhance the size and shape of a woman's breast. Women may choose this procedure for several reasons: to enhance their body contour; to correct a reduction in breast size after pregnancy; to balance a difference in breast size; or as a reconstructive technique following breast surgery.

Once a woman decides on breast augmentation the next decision is often what size implant to use. This is a very important and personal choice and should be considered carefully. Some women desire a very subtle look while others want a more dramatic contour. Body shape, weight, height, and size of breasts prior to augmentation should also be considered when considering implant size.

Never look at someone else's choice of implant in making your final decision. It's what you start with...plus what you add, superimposed upon the shape of your own body that determines your final results. The same size implant may look completely different on another person. Formulas, standards, and comparisons may work in theory, but it is not uncommon to ask two women with exactly the same size breasts what size they are, and for one to say she is a C cup, while the other is positive she is a D. Breasts size is often "in the eye of the beholder!" Also, bra cup size varies between manufacturers, styles and how you wear your bra.

I suggest that my patients come to the office with photographs of the size breasts they wish to have, as well as pictures of breast sizes that they do not want. This helps eliminate all but a certain range of sizes and also gives me a good visual idea of what my patient's goals are for surgery. When deciding on implant size It is also important to consider that as the implants settle they usually look slightly smaller.

Once breast size has been determined, saline filled implants are used to increase breasts to that desired size. This procedure is performed either in an office facility, outpatient surgical center, or hospital, and may be performed under general, or local anesthesia with IV sedation. The incision necessary for the implant can be made in the crease at the lower breast fold, around the areola, or in the armpit.

Working through the incision, the breast tissue and skin will be lifted to create a pocket either directly behind the breast tissue or underneath the chest wall muscle.

Placing the implants behind the chest muscle may reduce the potential for capsular contracture. This placement may also interfere less with breast examination by mammogram than if the implant is directly behind the breast tissue.

The surgery usually takes one to two hours to complete. Stitches are used to close the incisions, and a gauze bandage is applied over the breast. The patient will probably feel tired and sore for a few days following surgery, but should be up and around in 24 to 48 hours.

Stitches are removed in five to seven days, but the swelling in the breasts may take several weeks to disappear. A woman should be able to return to work within a few days depending on the level of activity required at her job.

For more information see http://www.drgibby.com

Tummy Tuck: When crunches don't work

by Dr. Diane Gibby • M.D., P.A., F.A.C.S

Most people yearn for a flat, trim stomach. Crunches and sit-ups are great for the abdominal muscles, but they often aren't enough to tighten loose muscle and skin. Women in particular have a hard time strengthening these muscles after multiple pregnancies have stretched their abdomen to the limit. Weight loss can also cause loose skin in the abdominal area which may be resistant to toning by exercise.

For many of my patients, the solution has been a surgical procedure known as "abdominoplasty" or tummy tuck which removes excess skin and fat from the abdomen and tightens muscles of the abdominal wall, reducing the appearance of a protruding abdomen. The best candidates for this procedure are women who are in relatively good shape, but who have large fat deposits or loose abdominal skin that has not responded to diet and exercise.

If your loose skin is limited to the area below the umbilicus (belly-button), you may benefit from a less complex procedure called a "partial abdominoplasty," or "mini tuck". This procedure usually requires a smaller incision and less time in surgery and recovery.

If the loose skin extends above the umbilicus, a full abdominoplasty is usually a better option. This surgery is more complex and often requires a longer incision and repositioning of the naval. Although scars are the inevitable results of any surgery, every effort is mades to keep scarring to a minimum. Placing the incision inside the bikini line, for example, helps conceal the scar.

Both procedures are usually accompanied by liposuction to remove fat deposits to achieve more dramatic results.

These procedures are often performed on an outpatient basis, at the Women’s Center for Cosmetic and Plastic Surgery, although some patients may prefer an overnight hospital stay. The type of anesthesia used depends on you and your doctor. I prefer general anesthesia, although local anesthesia combined with sedation is also an option.

Surgery can take anywhere from one hour for the "mini tuck" to four hours for a complete "tummy tuck". Recovery time after these procedures varies from person to person and depends largely on your general health.

For the first few days following surgery, your abdomen will be swollen and tender. Even though you will experience some discomfort, you should start walking as soon as possible to speed the recovery process. The surface stitches will be removed in five to seven days.

Patients having abdominoplasty often experience a feeling of tightness and diminished sensation in the abdomen; both generally subside in the months after surgery.

Some patients return to work in two weeks following surgery, while others take up to four weeks to recover. I am a believer in exercise to help healing; even people who have never exercised before should begin an exercise program to reduce swelling, lower the chance of blood clots, and tone muscles. Vigorous exercise, however, should be put on hold until four weeks following surgery. A supporting girdle may be recommended for optimal healing and contouring.

As with any cosmetic surgery, consult with your plastic surgeon first before considering abdominoplasty. Discuss your goals and expectations. Keep in mind that the desired result is improvement, not perfection.

I have found that abdominoplasty can provide excellent results for patients with weakened abdominal muscles or excess skin. In most cases, the results are long-lasting if a balanced diet and exercise regimen are followed.

For more information see http://www.drgibby.com

Eye Lift: A Refreshing Change

Eye Lift: A Refreshing Change
by Dr. Diane Gibby • M.D., P.A., F.A.C.S
For most of us, aging is a fact of life. As we grow older, the effects of aging become more and more apparent. One of the most obvious places we age is around our eyes. The skin surrounding the eyes is one of the most sensitive parts of the body and is usually the first to show signs of aging. So, while many of us remain young at heart, our eyes may sometimes cause us to look older beyond our years. Bags or wrinkled skin folds over the eyelids, signaling the aging process, can be altered to give you a fresher, younger appearance. "Blepharoplasty," or an eye lift removes excess skin and fat from the upper and lower eyelids resulting in a more youthful appearance. The visual signs of aging are different for every woman. Women with animated faces or who have had a lot of sun exposure may show signs of aging earlier. Women with deep-set eyes, however, tend not to show signs of loose skin as quickly. Women requesting aesthetic eyelid surgery range in age from about 25 years and older, due to the vast differences in how women age around the eyes. Most women are interested in a way to make their eyes appear more youthful and bright. Although this procedure is performed primarily for aesthetic reasons, in some cases loose eyelid skin draping over the upper lids may compromise vision. In these situations, eyelid surgery will improve vision and may be covered by insurance. Whatever the reason for choosing the procedure, aesthetic eyelid surgery may be an answer for women who want to change how they look. Aesthetic eyelid surgery creates a more visually-appealing, rested appearance, free of puffy pouches and droopy eyelid skin. The procedure improves fine lines and wrinkles below the eyelids, but cannot completely remove "crow's feet" or laugh lines. Botox injections can help to soften these lines, as well as the deep wrinkles that may develop between the eyebrows. You should learn as much about the actual procedure as possible. Aesthetic eyelid surgery can be performed on the upper and lower lids simultaneously, depending on the patient's needs. The surgeon makes incisions in the upper and lower eyelids following the eye's natural lines and creases. The underlying fatty tissue and muscle is separated from the skin, and excess fat and skin is removed directly from the open incisions. Eyelid skin is then closed with fine sutures. The procedure lasts approximately one-and-a-half to two hours and can be performed in an outpatient facility. As with all types of surgery, it is extremely important to follow your doctor's post-operative instructions to ensure proper healing. After aesthetic eyelid surgery, a patient will usually be instructed to apply a cool gel pad over the eyes for the first 24 to 48 hours. This helps reduce swelling and bruising. You should also keep your head elevated for several days. Bruising and swelling may be expected for the first seven to 10 days after aesthetic eyelid surgery. The lower lids tend to stay bruised longer than the upper lids. This is a result of gravity, and the procedure usually being more extensive on the lower lids. Since skin around the eyes is thin, the healing time is quick, and scars usually fade in six to eight weeks. Aesthetic eyelid surgery is one of the easiest facial cosmetic procedures from which to recover and can be very rewarding for patients desiring a more youthful appearance. Before you decide on any surgery always be sure to get all of the facts first. Discuss your questions and concerns with your surgeon prior to the surgery. Then, you will be better prepared to make a decision about aesthetic eyelid surgery.

For more information see http://www.drgibby.com

The Science Of Skincare

by Dr. Diane Gibby • M.D., P.A., F.A.C.S

A smooth, clear complexion is one of the most important attributes of physical attractiveness. And the majority of women believe that beautiful skin is important—but not because it makes them feel young or sexy, but because it makes them feel good about themselves. A national survey trying to determine women’s feeling and beliefs about their skin concluded that 96 percent of women are striving for radiant skin.

However, as we get older, maintaining healthy skin and a clear, youthful complexion becomes harder and harder. Especially when it comes to the face. As the most exposed part of your body, your face is vulnerable to the destructive rays of the sun, acne, rashes, allergic reactions, and a whole range of injuries that can leave visible scars. Smoking, yo-yo dieting, nutrition and proper hydration also play pivotal roles in how your skin looks and feels.

As a woman ages, the collagen network that supports her skin can weaken and cause facial lines to form. Collagen gives skin strength and suppleness as well as an inherent ability to retain moisture, so as skin matures it may also become dryer.

The good news is science has made dramatic inroads into skin care formulations. Breakthrough advances are bringing rapid changes to the skin care industry. Women now have many options when it comes to choosing an individual skin care regime. Using moisturizing skin care products that contain exfoliating glycolic acids can help keep the skin looking fresh and decrease the appearance of fine lines. Retin-A is also useful in working to eliminate fine wrinkles, sun damage and age spots by continually sloughing off the outermost, dead layer of skin and increasing collagen production. Retin-A can be even more effective when used in combination with other treatments, such as glycolic acid or bleaching cream.

One of the safest and best choices are products that contain alpha-hydroxy acids (AHAs). Functioning as chemical exfoliators, AHAs help shed older, top-layer skin cells, unclog pores and step up circulation leaving skin with a fresh, glowing appearance.

AHA's can also improve acne. Lotions or cremes that contain AHA's, in addition to salicylic acid, have been known to effectively unclog blackheads and whiteheads.

Another skin care product available today is Renova, released on the market in March 1996. Similar to Retin-A and manufactured by the same company, Renova contains the active ingredient tretinoin. Tretinoin, a Vitamin A derivative, increases dermal thickness by increasing collagen production.

Since Retin-A was generally used for the treatment of acne, Renova has been formulated in an emollient base, with less drying effect. This product, much like Retin-A, can be used to improve fine wrinkles and to reverse some skin changes related to photoaging (sun damage).

In the past, vitamins were not widely used in cosmetics because it was believed they could not penetrate the skin. New formulations have made this possible and as a result, vitamins are now being used extensively in skin care products. Vitamins of particular interest in a
skin care program are Vitamin A, E, C, D and Panthenol (Pro Vitamin B5). Although topical vitamins may have some anti-oxidant properties, they can not replace or substitute for a healthy diet!

Whatever skin care treatment you choose, protecting yourself from harmful UVA and UVB rays emitted by the sun (or tanning booths) is the most important way to take care of your skin. There is no substitute for this type of protection, and of all the options, this is the most
important. Be sure to protect your skin by using a sunscreen with an SPF of 15 or more.

Much like exercise, a personalized skin care program you will use on a consistent basis is important. I recommend Aesthessence, a line of skin care products that combines effective levels of alpha-hydroxy acids to stimulate cell rejuvenation with luxurious botanical
ingredients to moisturize, replenish and clarify the complexion. Different formulations can be used to benefit your unique skin type.

Diane Gibby, M.D., P.A., F.A.C.S Licensed in Texas, Dr. Diane Gibby is board-certified by the American Board of Plastic Surgery (ABPS) and the founder of The Women's Center for Cosmetic and Plastic Surgery. She is a member of the American Society of Plastic Surgeons (ASPS), American Society of Aesthetic Plastic Surgery (ASAPS), American Medical Association (AMA), Texas Society of Plastic Surgeons (TSPS), Dallas County Medical Society (DCMS) and the Board Certified Plastic and Cosmetic Surgeons of Dallas. She is also a Fellow in the American College of Surgeons (F.A.C.S.). Dr. Gibby's office is located at Medical City Dallas, Building C, Suite 820, (972) 566-6323. Individuals interested in brochures or names of qualified plastic surgeons in their area may call the American Society of Plastic and Reconstructive Surgeons at 1-800-635-0635.