Blog

Thinking about your first Botox consultation?

So you’ve heard about Botox and your friends may be getting it BUT you still have a lot of unanswered questions before you schedule a consultation like “What happens during the consultation?”. So here is my rundown of some common Q&A’s to get everyone caught up.

greeting

Some common questions:

Where should I start learning about Botox?  

Schedule the consultation! It’s complimentary and the best way to assess whether you would benefit from Botox in the first place! I see a large number of patients bothered by something and think that they need Botox, but in fact need something else quite different.  I invite you to explore my Concern Based Menu to research more information on the various options available to you. You may also explore the Botox page.

How long does a Botox consultation last? 

Consultations last 15-20 minutes and you meet with me, personally, to discuss the various options available and come up with a customized plan for you.  I see new Botox patients in both my Southlake and Fort Worth offices.

consult

If I want to have Botox performed, can it be done the same day? 

Yes. Botox can be done at my Southlake and Fort Worth offices on the same day and simply adds around 10 minutes to the length of the consultation.

Is getting Botox painful?

I have performed many, many Botox injections, but would say probably 95% of patients report that the injections were much easier than expected. I use a combination of ice as well as vibration nerve distraction (and good music, of course), to ensure patients are comfortable. Pain during or afterwards is rare.

How will I look after a Botox appointment?

Since effects take 3-5 days to start working, you will be moving your forehead normally when you leave. The effects are gradual. You may notice some small injection site swelling (less than a small pea) that resolves in a couple hours. Most people can go right back to work after their lunchtime touchup.

If I start using Botox, will I need to keep using it? 

The short answer is NO. People that ascribe to Botox prevention, typically maintain use of Botox because they like to avoid deepening of wrinkles on the forehead. However, when the effects of Botox wear off, movement returns to normal.

How long does Botox last? 

Typical results are 2-4 months.

How much does Botox cost? 

Typical Botox prices may range from $320 to $550.

What is the difference between Botox and Dysport?

Please see my earlier blog post on this topic. In short, I tend to use both interchangeably depending on the effect I am trying to achieve. They are both derived from the same original botulinum toxin, but simply purified differently. They are equal in price.

Any other questions? Simply send me an email at jordan@rihanimd.com.

 

Thanks!

JR

Under Eye Rejuvenation with House of Preservation

I’m very excited to be teaming up with some fantastic women with an eye for aesthetics. It is not every day that you can take your fashion/design careers and funnel those energies into blogging about beauty and the art of “age preservation”. But Brittany and Rylie have done just that. Their blog is entitled “House of Preservation” www.houseofpreservation.com and features many current beauty product reviews as well as some treatment reviews. Our focus will be on education of my patients (and their followers), which has always been a top priority for both of us. I hope you enjoy!


Under Eye Rejuvenation with House of Preservation and Jordan Rihani, MD

 

tear trough

Our first video discusses my Facial Plastic Surgery Institute under eye rejuvenation package. This combination of procedures improves the “tired eye” appearance or a prominent “tear trough”. For more information, see the Tired Eyes Page on this website.

Introducing our new Concern Based Website!

I am very excited to launch our new website! I have always thought finding information on which plastic surgery procedure may be the right one for you can be such a long and confusing process. This was at the forefront of my mind when designing my new website.

screen-shot-2016-11-21-at-9-46-02-pm

By clicking on the Concerns menu, you are taken to a graphical representation of the face (desktop version only). This groups many of the common concerns into regions of the face. Common terminology is used for many of these concerns, which then takes you to detailed information about the problem, including links to the various solutions. Alternatively, if you know what you are looking for – simply click the Solutions link which takes you into the various surgical and non-surgical options.

The website is content-rich, just like my old site, in hopes of EDUCATING MY PATIENTS FIRST! It’s pivotal to being an informed consumer, and something I love doing.

 

What’s the difference between Botox and Dysport?

I have received an increasing number of questions about the difference between Botox and Dysport, so I thought it would be good to address the question here. I use both products almost interchangeably.

Are Botox and Dysport both used for the same purpose?

Yes. Both are derived from botulinum toxin and are simply different in their purification methods. Botox is the trade name for the botulinum toxin product made by Allergan (manufacturer of Juvederm, Kybella) and Dysport is the tradename for the botulinum toxin product made by Galderma (manufacturer of Restylane, Sculptra).

Do Botox and Dysport have the same effect?

Yes. Although there is some conflicting data, it is suggested that onset of action of Dysport may be sooner (closer to 3 days than the 5 days for Botox). There is also some data showing increased spread of Dysport compared to Botox. Although clinically, I have not found an obvious difference.

Is the price of Botox different than the price of Dysport?

No. Although the “per unit” price of dysport is lower, in actuality you are using 3 times the amount of product and therefore the price is very similar for both products. For example, I generally recommend 25-40 units of Botox for use in the forehead which would be equivalent to 75-120 units of Dysport.

They are both FDA approved for reducing severity of glabellar lines – Botox originally receiving FDA approval in the 2002 and Dysport in 2009. Botox is also FDA approved for treatment of crow’s feet.

How do I determine whether I use Botox or Dysport? As mentioned, I tend to use the two products interchangeably. If patients request one product or the other, I will use whichever they prefer. If a patient believes they have developed some resistance to one of the products, I will try the other product.

Are there other products similar to Botox and Dysport? Yes, the third FDA approved botulinum toxin product is Xeomin and is manufactured by Merz.

Are there any new products coming out in the near future? There is nothing on the immediate horizon, but there is promise with new longer lasting products. One of those products is undergoing human trials at the moment and may last as long as 6 months, which is very exciting!

Email or call with questions!

-JR

Trends in Facial Volume – Achieving Natural Results

I recently spoke about a topic that has increasing importance in the field of facial plastic surgery and I want to sum up a few of those concepts here.

1. Surgery of the aging face began with removal of extra, loose skin but has made great advances as we learn more about facial aging.

Suzanne Noel, one of the female pioneers of plastic surgery, circa 1918.  Suzanne Noel, one of the female pioneers of plastic surgery, circa 1918.

 

 

 

 

 

 

 

 

 

Since the first facelift was performed in 1901, the surgery has mainly focused on excision of excess skin. With the invention of SMAS and deep plane facelifts in the 1980’s, more emphasis was placed on deeper structures of the face. In the 2000’s, the shift was made to emphasize volume replacement. Some refer to this period as the “Volumetric Period”.

2. Changes below the skin lead to volume loss – including our facial skeleton. 

Skeletal changes in the aging face. Skeletal changes in the aging face.

There is loss of volume of all layers below the skin, including the bone, muscles, and fat which can be quite significant. Imagine the same amount of skin covering both skeletons that are shown. Simply losing that degree of bone volume would result in a large amount of skin and soft tissue sagging.

Replacement of volume at the level of the facial skeleton is first performed to provide a foundation. I am using injectable fillers for the majority of these cases, but facial implants (silicone) are also used for augmentation of the chin, cheeks, and temples.

3. Fat thinning and downward migration occurs

There are significant changes in the fat below the skin. Early changes make fat below the eyes more prominent – as the cheek fat descends. This continues which causes hollowing in the cheeks and prominence of the folds around the nose and mouth.

Replacement of lost fat volume is generally performed with injectable fillers or from fat injections. The ease of use and safety of injectable fillers is partly responsible for their rapidly growing popularity. Fat injections have the benefit of taking the patient’s own fat and allowing large volume replacement.

4. Volume replacement is therefore the answer, right? Not quite…

Not only do we lose volume, but as we also know, we lose skin elasticity which causes loose skin. This leads to wrinkling and sagging of the skin. It is important to address excess skin laxity at the time of volume replacement for the most natural results!

In summary, there is a complex balance in order to obtain natural results. Come in for your complimentary consultation to discuss which options are best for you! Have a great week.

Refer Friends, Earn Points for Injectables, Products and Services

Referring your friends but not feeling appreciated?

We understand! We are making the process super easy with our plastic surgery reward points program. Refer your friends to receive points whenever they purchase products or services. You use those points to apply towards Botox/Dysport, Filler, skin care products, and clinic services. 

What do your friends get? They get 10% off their first purchase and the opportunity to start earning their own rewards points through their referrals. 

We are the only provider featured on this new platform, known as RefpointsMD. You must be an existing patient to start earning referral points, so come by or call the clinic for more details! 

Infographic from RefpointsMD.com

Grand Opening Celebration

Join us for a Grand Opening Celebration next Thursday, July 28th at our Southlake Office. Giveaways, Live Demonstrations (Botox, Venus Freeze, Laser Resurfacing), Hors d’oeuvres, and Cocktails! 521 W Southlake Blvd, Southlake TX 76092. 

Top cosmetic procedures for men

Statistics from the American Society of Plastic Surgeons show overall numbers of plastic surgery procedures are on the rise. Men continue to increase as a proportion of those total numbers. Here are the top facial cosmetic procedures for men (minimally invasive and surgical). 

1. Botox (up 4% from 2014)

Men are increasing using Botox to improve the appearance of crow’s feet and minimize wrinkles in the forehead. (Hence, marketing campaigns coining the term “Bro-tox”) Natural results can be achieved by expert injectors, avoiding the frozen look while still providing a youthful, refreshed appearance. 

2. Laser Hair Removal

Permanently removing unwanted hair can be achieved on the face, ears, and neckline. Men that may be prone to “razor burn” find this to be a quick and easy procedure that saves them from the troublesome irritation as well as time shaving. 

3. Injectable Fillers (up 6% from 2014)

Men are turning more often to fillers to improve volume in the cheeks and tear trough to improve their appearance. This quick, in-the-office procedure can provide a boost with no downtime, which is appealing for men with busy schedules. 

4. Rhinoplasty (Nose Job)

Whether there was a history of trauma or one simply dislikes their nasal appearance, nose surgery tops the list for surgical procedures for men. 

5. Blepharoplasty (Eyelid lift, up 2% from 2014)

Removing hanging skin above the eyes not only provides improvement in appearance, but can provide improvement in vision as well. This quick, in-office procedure takes less than an hour and provides permanent improvement in upper eyelid appearance. 

6. Facelift (up 1% from 2014)

Around 15% of my facelift patients are men that are bothered by excess neck fat or neck sagging. Commonly, men who wear a shirt and tie may notice sagging over the collar. This outpatient surgery has a recovery time of around 1 week and provides permanent improvement in the neck and jawline. 

That wraps up the top procedures, but there is more excitement on the horizon with Kybella, advances in facial resurfacing for skin discoloration, and more! Enjoy your Monday and let me know if you have any questions by sending me an email through my contact form

JR

How young is too young for rhinoplasty (nose job)?

Many parents ask me what the appropriate age may be to consider a rhinoplasty, or nose job, for their children. The reasons for desiring surgery range from a traumatic injury, cleft deformities, or a nasal appearance that is the subject of teasing. I therefore want to explore a few myths and provide some insight into the current thoughts on rhinoplasty in the young patient (less than 18 years old). 

1. Unproven, yet commonly held assumption: Nasal surgery affects facial growth. 

This has no evidence in our medical literature, but has been a commonly held assumption in our field for some time. Previous commentaries (without evidence) have stated that surgery on the septum can affect growth centers of the face. Increasing evidence is now showing no detrimental effects from nasal surgery in younger patients, including a 2014 study published in JAMA Facial Plastic Surgery by Fedok et al reviewing 54 patients with an average age of 12 years.

2. When is surgery indicated in younger patients? 

Image from Fedok et al, corrective nasal surgery in the younger patient.
Image from Fedok et al, corrective nasal surgery in the younger patient.

Trauma: 

Obvious deviations of the nose after trauma can and should be dealt with following the trauma instead of waiting until the patient is 18 years of age. There may be complications from trauma including nasal obstruction, nose bleeds, recurrent sinus infections – which should not be put off. 

Nasal appearance that is outside of our view of normal: 

Noses may have cleft lip deformities (that involve the nose), scarring from previous trauma or surgery, or even pronounced humps or size which can take their emotional toll on someone. Many times it is the child urging the parent for correction of the deformity but sometimes parents seek out opinions on their child’s appearance. Either way, the family should be on the same page about wanting to move forward with surgical correction. 

3. Will the nose continue to change? 

The simple answer is yes. As we age, our skin elasticity continues to change and normal aging occurs. There is no evidence that nasal growth slows as a result of surgery as mentioned above. For more information on the expected post-operative course following rhinoplasty, please see my rhinoplasty page

4. Final thoughts 

Nasal surgery for adolescents should be for functional reasons or for distracting deformities of the nose. These improvements should err on the side of conservative and major work (if needed) may need delay until the patient is older. These decisions should be made during the consultation with the patient and family. This surgery can be quite rewarding for the patient and alleviate years of struggling with their appearance. 

Have a great rest of the week and please send all questions or comments to me through my contact form. 

Understanding Cosmetic Lasers

I will try to keep this short and informative…

Lasers are simply light that is amplified at a certain light wavelength. Think of the spectrum of visible light. We are able to see different colors based on the wavelength of light that is emitted (red corresponds to 650 nm wavelength, for example). 

There are a variety of lasers, each attracts to a certain corresponding color or molecule. You may have heard various names of lasers, but the technology and wavelength is what determines the use of the particular laser

Common uses of lasers (and lasers used): 

1. Vascular lesions, Veins, Hemangiomas (Pulsed Dye Laser, ND:YAG) 

Photo credit: American Academy of Facial Plastic Surgery
Photo credit: American Academy of Facial Plastic Surgery

2. Hair and Tattoo Removal (Diode or ND:YAG)

Photo credit: Kingston Laser
Photo credit: Kingston Laser

3. Fine Wrinkles and Discolorations (Erbium, Carbon Dioxide)

Patients are inundated with brand names and technologies daily – be sure that you are making an informed decision and are given realistic expectations of results. Oftentimes, multiple treatments may be needed for complete resolution of the problem. 

About Fractionated CO2 laser resurfacing. 

One of the most tried-and-true technologies is Carbon Dioxide (CO2) laser technology. The wavelength of carbon dioxide attracts to water – which is present in the surface cells of our bodies. As a result, CO2 lasers are used for controlled, precise removal of the surface cells. This is a great resurfacing tool – for removal of fine wrinkles and discolorations (or sun spots). 

As a way of decreasing down time while still providing results, fractionated laser technology was invented. Think of it as instead of a large column of laser energy, there are hundreds of smaller columns filling that same space, which leaves small spaces of normal tissue in between the resurfaced areas – similar to a checkerboard. 

Fractionated CO2 is one of my methods of facial resurfacing performed in my Southlake office along with Dermabrasion and Chemical Peeling. I am currently using the Phoenix Laser (Fractionated CO2) on the face as well as hands for fine wrinkles and discolorations. Check out the Laser Resurfacing page for more information. 

Please call or email me with any questions or to set up your complimentary resurfacing consultation. 

Best,

Jordan Rihani, MD

drrihani@facialplasticsurgeryinstitute.com

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