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

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

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

Avoiding the dreaded “Trout Pout” – your guide to Natural, Youthful Lips.

We have all seen the unnatural and feared Trout Pouts and Duck Lips that are unfortunately becoming more common as demand for fuller lips increases. I want to share a few principles that I abide by to create natural, youthful (and subtle) improvement in lip volume and appearance. 

Image taken from Rohrich, et al. Plastic & Reconstructive Surgery Journal
Image taken from Rohrich, et al. Plastic & Reconstructive Surgery Journal

1. The Upper Lip-Lower Lip Proportions: 

When looking at the lips, the upper lip should be about 1/3 of the total lip size and the lower lip about 2/3. This trend seems to fluctuate somewhat – these days people are wanting larger upper lips. To achieve natural appearing lips, the upper lip should never be larger than the lower lip. 

 

2. Lengthening of Upper Lip

As we age and skin loses elasticity, the upper lip lengthens which causes less of the red lip to show. There are some simple injection techniques that can allow the upper lip to look shorter, but injections if done incorrectly cause cause worsening of this lengthening because there is too much volume in the upper lip. Lip shortening procedures are also used to lift the red lip to a more youthful position. 

3. Flattening of Cupid’s Bow

A subtle feature, although very important, is the Cupid’s Bow of the upper lip. Flattening of the Cupid’s Bow occurs with aging as the lip lengthens. Injection techniques can be used to improve the appearance of the Cupid’s Bow as well as improve volume of the philtral columns – both features of a youthful upper lip. 

4. Formation of Lipstick Lines

These vertical lines do not just occur in smokers. As patients lose volume in the tissues of the lips, these vertical wrinkles, also known as lipstick lines, occur. I use a combination of Botox as well as fillers to allow normal movement of the upper lip while providing improvement in these pesky lines. 


What you need to know before your lip injections. 

Which fillers do I offer? 

I am currently injecting hyaluronic acid fillers for improvement in lip volume (eg. Juvederm Ultra and Restylane Silk). I also offer collagen and fat for more permanent volume improvement. See my Lip Augmentation page for more information. 

What is the cost and expected down time? 

Depending on which filler is used, most fillers start around $500-600 and go up in price from there. Expect some light bruising. Improvement in lip volume will be evident right away. There is some swelling for a couple of days which decreases over that first week. 

How long do lip injections last? 

In general hyaluronic acid fillers (Juvederm, Restylane) last about 6-12 months. Collagen and fat are more permanent options that can provide improvement for up to 10 years or more, but results may vary. 

For more information see our informational video below. 

Feel free to email me with any questions or comments at drrihani@facialplasticsurgeryinstitute.com

Your Face, Your Story, Your Results: Kay and Basal Cell Carcinoma

My blog series “Your Face, Your Story, Your Results” features patients in their own words as they make the transition through a surgical procedure – whether it be for reconstructive or elective reasons. My goal is to shed insight into the thought process, the emotions, and to encourage conversation and social interaction between patients undergoing plastic surgery. 


Kay is a 49 year old diagnosed with basal cell cancer on her nose in February of 2016.  Here is Kay’s story in her own words. 

The Diagnosis

Basal Cell Cancer on the left nose
Basal Cell Cancer on the left nose

How can a small, slightly raised area (the size of a pencil eraser), on the left side of my nose, lead to facial reconstructive plastic surgery?  I have asked myself that question several times over the past two months.  It all started about a year ago, when I sought input from a dermatologist regarding this area of concern on my nose.  It was initially treated with a freezer burn technique.  Unfortunately, this area of skin grew back and after trying one more non-invasive treatment it was biopsied in early February 2016.  My life was already pretty difficult because I was supporting my close friend, and boss, who had been battling Multiple Myeloma for over two years.  So, when I received the diagnosis of Basal Cell Carcinoma, I was shocked and upset that I now had my own cancer battle to fight.  I had always been alarmed at the number of skin cancer diagnoses each year, but thought I took the necessary precautions to prevent it.   

Following removal of the cancer.
Following removal of the cancer.

Moving forward with a treatment plan, I was scheduled for a consultation with a Mohs surgeon who specializes in the Mohs procedure – a skin cancer cell removal process.  My dermatologist highly recommended Mohs, especially for skin cancer on the face, due to a 98% success rate of cancer cell removal leaving the smallest defect possible.  That was comforting and eased some of the anxiety that was trying to build.  In explaining the Mohs procedure to family and friends, I found myself assuring them that this small area should only take one or two excisions to remove the cancer cells, followed by a few sutures, and I would be on my way.  The reality was that it took 5 passes (4.5 hours) of removing and studying the tissues until the margins were clear.  During the waiting time, between each excision, I was texting my family and friends to keep them updated.  They could tell concern was setting in after the third and fourth excision.  When the Dermatologist reported that the margins were clear, after the fifth excision, I was able to see the defect that the cancer had left.  I remember the shock of looking in the mirror and the disbelief – the feeling of “How can I recover from this?”.  I had a difficult time looking at the raw skin edges and comprehending that it was actually on my face. 

My mind reeled as the Mohs surgeon drew possible options on my face to close the defect.  I had questions rushing through my head, like “does this need to be closed immediately for the best outcome or to prevent infection”?  I was trying to process the shock of how my face looked and felt pressure to make a decision on closing the gap.  As he was explaining my reconstructive options, I took a deep breath and requested to receive a consultation and second opinion from a Facial Plastic Surgeon.

I took a deep breath and requested to receive a consultation…from a Facial Plastic Surgeon…

The Reconstruction

That is what led me to Dr. Rihani’s office. He saw me that same evening and explained my various options, including what his recommendation would be for someone of my age and cosmetic goals.  To be honest, there were financial concerns regarding the surgery and meeting my health insurance deductible.  It was a lot to process within a short period of time.  We came to a decision together to close the defect in the operating room a couple days later.  Dr. Rihani also reassured me that it was okay to leave the defect covered for a few days and not perform an immediate closure.  I was relieved to have all my concerns and questions addressed, to have a reconstructive surgery solution in place that I was comfortable with, and to have a couple of days to process everything I went through that day. 

Finding my New Normal

One day after reconstruction
One day after reconstruction

After the facial reconstructive surgery, I remember feeling relief and ready to move forward into the healing process. The swelling around my eye and nose was extensive and a little scary. I was reassured by Dr. Rihani, when he saw me the day after surgery, that the swelling was normal and that it would get worse before it got better.  As the sutures were removed (a painless process), and as the swelling continued to improve, I began to turn the corner 3-4 weeks after surgery.  At follow up appointments, Dr. Rihani continues to tell me openly and honestly what to expect during the process, and answers all my questions on the transition my facial skin is going through.  There are subtle changes in my appearance that have become my “new normal”, and I continue to improve weekly.  The good news is that I am skin cancer free, and I have the best possible reconstructive outcome due to a talented, caring, and compassionate plastic surgeon.  

6 weeks following reconstruction
6 weeks following reconstruction

Closing thoughts and key points: 

1. It is okay to ask questions and express your concerns. With Dr. Rihani, I was able to take this approach and he did not feel threatened.  We worked through the best possible solution together. 

2. Trust your gut. I was worried about offending the Mohs surgeon doing the Mohs procedure.  But, in the end, I am glad that I sought a second opinion to repair the gap left by the Mohs procedure by consulting with an experienced Facial Plastic Surgeon. 

3. Having a support system is important. My sister, parents, and close friends were instrumental in helping me get through the skin cancer diagnosis and the surgeries that followed. 

Before and After Reconstruction
Before and After Reconstruction

What’s the best SPF for sunscreens? Are we over-emphasizing SPF?

A common question I receive is what is the best SPF for my sunscreen/moisturizer? Let’s break down what SPF (Sun Protection Factor) means and dispel some commonly misunderstood concepts. I also pose the question “are we over-estimating the value of SPF?” 

1. What is SPF? And is a higher SPF better? 

The SPF is simply an equation that relates to how effective something is at blocking UV B radiation (not UV A radiation).

If it typically takes you 10 minutes to burn, SPF will prevent a burn for 15 x 10 minutes or 150 minutes. SPF 30 would be 30 x 10 or 300 minutes, etc. This is because UV B is typically responsible for sun burns as explained below. 

In regards to percent of UV B rays blocked, SPF 15 blocks 93% of UV B, SPF 30 blocks 97%, SPF 50 blocks 98%, etc. So you can see that the scale tends to flatten out, with the benefit of sunscreens over SPF 30 becoming negligible. Don’t forget that these numbers apply at a certain density of application, so if you are not applying enough sun screen, you are not getting the advertised amount of UV B protection. 

2. So are we over-emphasizing SPF? 

Naturally you would think, the higher SPF would be better, right? However the fact is that there is not only UV B radiation, there is also UV A radiation. UV A is deeper penetrating and is known to be the more likely contributor to development of skin cancers and skin aging. The UV B radiation has typically been more popularly addressed because it travels less deep and is responsible for the superficial “sunburns”. 

3. So how do I know how much UV A protection is in my sunscreen? 

Look for words like “UV A/UV B protection” or “Broad Spectrum” on your sunscreens to ensure both UV A and UV B are protected. As of now, there is not a standard UV A rating scale. 

In 2007, the FDA proposed a new 4 star rating system based on UV A protection – which ranges from 0 stars (no UV A protection) to 4 stars (highest UV A protection). See more information from the FDA website here

Also look for products that contain the following ingredients which provide UV A protection: Ecamsule, Avobenzone, Titanium or Zinc dioxide. 

4. Are there non-sunscreen options? 

Don’t forget to simply cover up when you go outside! UPF (Ultraviolet Protection Factor) ratings for clothing can similarly indicate the amount of sun and UV radiation blocked by clothing. Find lightweight clothing and hats that keep you out of the sun’s harmful rays. Don’t forget to apply sunscreen to those hands, ears, and feet. And avoiding the sun between 10 am and 4 pm is best. 

Take away points: 

1. Apply sunscreen 30 minutes before going out. Re-apply sunscreens at least every 2 hours if expecting to be outside. Sunscreens don’t last all day!

2. Generally anything over SPF 30 is not providing additional benefit and can be misleading, since the rating scale does not account for the harmful UV A radiation. 

3. Find broad spectrum, UV A/UV B sunscreen and apply liberally. Most people under-apply their sunscreens. Recommendations for a 5’4″ adult is a golf ball size (1 oz) amount. You could be under-applying and therefore getting less protection than expected!

4. Wear protective clothing and stay out of the sun between 10am and 4pm if possible. 

5. I recommend annual skin examinations for anyone with extensive sun exposure. 

Call or email me with any questions or comments. Have a great weekend!

 

Easy way to get rid of neck fat?

You may be asking is this too good to be true? One of the newest, most asked about procedures I do, is an injectable that dissolves fat – known as Kybella. Kybella is the first FDA approved product of its kind and is having great results in correctly selected patients. We are excited about this easily administered and effective product.

WHAT IS KYBELLA?
Kybella is a product known as deoxycholic acid. This product is not new and not recently discovered. The use of this product is, however, being applied in new and exciting ways. Kybella is an injectable that dissolves submental (chin) fat and allows excretion by the body’s natural excretion mechanisms. The injections are performed in office and typical injection time is less than 10 minutes. Similar derivatives such as ursodeoxycholic acid are used in patients with gall stones to help prevent absorption of cholesterols. Kybella is manufactured and marketed by Allergan, the trusted brand behind Botox and Juvederm. 

WHAT HAPPENS TO THE FAT AND CAN IT RECUR? 

After dissolving the fat, the fat is absorbed and processed by the body in a normal fashion. The fat cells that have been destroyed do not return. If there is weight gain in the future, it is possible that the fat cells that are still alive may enlarge. 

WHAT SHOULD I EXPECT? 
The injection takes less than 10 minutes. Following the injection, there is swelling that resolves gradually over the course of a week. The immediate swelling is due to the Kybella that is present, followed by the gradual absorption of fat and healing of the neck tissues. Typically, 2-3 sessions of Kybella are needed and injections are spaced 6-8 weeks apart. 

WHO IS A CANDIDATE? 

This procedure is great for patients, both men and women, with excess submental fat, but without too much excess skin. The best way to know is come in for a free evaluation! Call 817-529-3232 for more information or to schedule a consultation. 

 

Hormones and Skin Elasticity

When it comes to skin aging, it is helpful to think of two forces at play – external and internal. The external forces include things you can change such as sun and tobacco exposure. The internal are not easily avoided, such as hormonal changes that occur over time. 

Perhaps it may come as a surprise but many women experience a rather sudden change in their overall skin quality and appearance after the onset of menopause.

Some of those changes include: 

1. Skin Dryness – Oil and sweat glands become less responsive to stimulation leading to this unwanted effect

2. Skin Thinning – The deeper layer of skin, or dermis, gradually loses collagen. It is estimated that 2% of collagen is lost every year following onset of menopause. 

3. Hair Thinning – Density and number of hair follicles decrease

Should I consider Hormone Replacement? 

This seems like a logical next step, however you should understand the literature on this topic. There has been evidence for increased risk of stroke, heart attack, and breast cancer in some patients. Discuss this topic with your primary physician or another board certified physician. 

What about my skin care regimen? 

With menopause and skin changes, it is likely that an adjustment will be made to find the best skin care regimen for your skin type. If you have something that works – go with it! But if you are dissatisfied then consider the other “internal” factors at play. 

Use of Retin A (Tretinoin) and Vitamin C

I recommend nearly all patients use tretinoin regularly. This Vitamin A derivative is great for improving overall skin health, skin turnover, and dermal thickness. Additional benefits include decreasing appearance of fine wrinkles and providing brighter healthier appearing skin. Vitamin C serums are another great for adding valuable anti-oxidants to your skin care regimen. See our blog post from last week for more information of Essential Skin Care products. 

Is it time for surgery? 

Whether you think you’re ready for surgery or not, I love talking to patients about their options during a free consultation. I do not think there is one perfect solution for everyone and it depends on where you fall along the continuum of aging. As I say, Aging is a Beautiful Process not a Problem! Let me help you find the right solution. 

Have a great week and feel free to email me with any questions. 

 

Essential Skin Care for 2016

Every good skin care regimen starts with a solid foundation so I want to highlight THREE essential (and simple) concepts of skin care to get you looking and feeling your best in 2016.

1. Microtrauma – This is an important concept that seems counterintuitive, but is great for overall skin health. The idea is to provide trauma on a microscopic level which stimulates skin cells to produce more collagen. Facial brushes, like the simple BufPuf (available through FPSI for $10) or Clarisonic brushes do a great job at doing this. Not only do they exfoliate your skin, but promote thickening of the deeper layers of your skin, or dermis. If you are being too aggressive you may experience some peeling or redness, if so back off for a few days and work back up. 

2. Tretinoin (RetinA, retinol) – This topical medication is derived from Vitamin A and promotes many positive effects in the skin. For people prone to breakouts, this medication is also FDA approved for the treatment of acne. The effects of tretinoin include exfoliation, thinning of the epidermis (top layer of dead skin cells), and thickening of the dermis (deeper layer of skin that contains collagen). This provides most patients with a brighter skin tone as more of the healthier skin can shine through. Side effects may include some skin sensitivity and peeling. If that happens simply back down on your dosage and work up slowly. 

3. Sunscreen and Sun-Avoidance – The best “treatment” is prevention. It is never too late to start wearing sunscreens DAILY. I advise all men and women to be on a daily moisturizer that contains SPF. Many of the dark sun spots (collections of pigmented cells) can be lightened by preventing sun absorption in those areas. Sun damage causes thinning of the skin and wrinkle formation so avoidance is key!

 

 

 

That is a great place to start. For more information call 817-529-3232 or schedule a free consultation and I will be happy to answer any of your questions. Have a great New Year!

 

Blepharoplasty – What to Expect

Dr. Jordan Rihani of the Facial Plastic Surgery Institute reviews the post-operative course for patients undergoing blepharoplasty. 

Facelift – What to Expect

Dr. Jordan Rihani of the Facial Plastic Surgery Institute reviews post operative information for patients undergoing facelift, necklift, and minilift. 

Rhinoplasty – What to Expect

Dr. Jordan Rihani of the Facial Plastic Surgery Institute reviews the post-operative course for patients undergoing cosmetic rhinoplasty or repair of nasal fractures. 

Facial Plastic Surgery Institute Podcast

We welcome you to check out our new podcast, keeping our patients informed about the before and after instructions of various facial plastic procedures performed by Dr. Jordan Rihani. 

Schedule a Consultation
With Dr. Rihani

Call (817) 529-3232 or fill out the form below.

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