best cosmetic surgery surgery in San Jose, Bay Area
Best cosmetic surgeon in San Jose, Bay Area
Recently listed in "San Francisco Magazine 2005"
as one of the Best Plastic Surgeons in the San Francisco Bay Area.


Update on Operative Procedures

FOREHEAD OR BROW LIFT
For the past few years, most procedures of this type have been preformed with the endoscopic method. By making five small incisions in the scalp, the forehead tissue is completely undermined down to behind the brows and cheekbones, removing chunks of depressor muscles. This enables the elevator muscle system to pull the brow upward thus improving saggy brows.

On patients who have a plethora of wrinkles on the forehead, the conventional method of cutting two inches behind the hairline from ear to ear is still the preferred and the most successful method to employ.

FACELIFT
Plastic surgeons have recently been implementing the ingenious technique of double layer lifting. This is not the traditional method of skin lifting, but a newer method that achieves better and longer lasting results and is more effective in improving laugh lines and the jowls.

Although lifting of the skin for this method basically remains the same, new methods of lifting the muscles of the face and platysma muscle systems of the neck are utilized.

There are some modifications of traditional facelift to eliminate undesirable hairline changes in front and the back of the ear.

MID-FACELIFT

This is a newer operation for improving the laxity of the tissue between the lower eyelids and the upper lip. It is also effective for improving the lines between the cheek and the upper lip (nasolabial lines). It can be performed with the facelift of as a separate procedure. The approach is through an incision in the lower eyelid or through a combined approach of temporal area and the inside of the mouth. The procedure may also improve the hollowing of the lower eyelid.

BLEPHAROPLASTY (Cosmetic Eyelid Surgery)
This procedure has undergone many improvements and modification over the past few years. The most recent advance is in the area of lower blepharoplasty. As you may know, this procedure is most often utilized to alleviate puffiness, which is corrected by removal of excess fat in the eye socket through an incision below the lash line or through the inside tissue of the lower eyelids (eliminating the outside scar).

The new concept is that any removal of fatty tissue from orbital regions may cause different levels of enophtalmus (sunken eye), an effect that may worsen as the patient ages. To avert this problem, the excess eye socket fat is not removed; it is partially removed or conservatively removed with the remaining pulled downward and repaired to the bony structures of the eye socket. This not only corrects puffiness by reducing the fatty tissue of the lower eyelid but also abates the depression between the eyelids and cheeks.

An even newer concept perceives puffiness of the lower eyelids as a herniation process that would only require repair of the fascia in front of the socket to improve herniation without manipulation of fatty tissue. This procedure, however, is still in the experimental stages and is not widely accepted at the time.

Asian blepharoplasty, of which I do a great deal, has not yielded any new concepts except that the natural line of the upper eyelid is made approximately 5-6 mms form the upper eyelid lash line rather than the more standard of 8-9 mms. This adjustment results in a more natural appearance and increase in patient satisfaction.

RHINOPLASTY(Cosmetic Nose Surgery)
Although open rhinophasty is not a new operation, it was once used for correction of deformities after the second, third or fourth surgeries, it was uncommon in primary rhinoplasty.

I along with many other plastic surgeons, have been incorporating the techniques of open rhinoplasty into practice for the past few years. In my opinion, this procedure is the best improvement in rhinoplasty, since the results are much more predictable and, best of all, more desirable in certain cases.

LASER SURGERY

In the past few years, laser surgery has become the panacea for many skin problems ranging from sun damage and spider veins to tattoo removal, pigmented lesions and hair removal. The following delves into each of these areas and the pros and cons therein.

LASER RESURFACING
Dermabrasion, chemical peels and other procedures were once the only choices for removing superficial layers of the skin damaged by the sunrays or aging. But today the state-of-the-art use of laser resurfacing has improved the method of resurfacing, although in many cases microdermabrasion and chemical peel can be used. The advantages of laser resurfacing are as follows:
1.
The procedure is much cleaner, without splash of skin material and blood.
2.
The depth of abrasion can be controlled more precisely and properly depending on the thickness and character of the skin on different areas of the face.
These factors could not be controlled as efficiently with chemical peel and posed even more dangers with dermabrasion of thin skin such as that of the eyelids. The major disadvantage of laser resurfacing is that it is a more expensive procedure.
NON-ABLATING (NON ABRADING) LASER TREATMENT
For the last few years, non abrading laser or intense light have been tried, expecting to improve the facial lines and quality of the skin without resurfacing and, as a result, no down time. But recent reports have shown that these types of treatments do not meet most patient expectations.
LASER TREATMENT FOR SPIDER VEINS
The smaller the varicose veins, the more difficult it is to inject them with sclerosing agents. When spider veins are too small for injection, laser works quite will, although sclerotherapy by injection is still the treatment of choice for larger veins.
LASER TREATMENT FOR TATTOO & PIGMENTED LESIONS
Certain pigmented lesions and tattoos can be removed with laser, but patient has to be realistic and understand that tattoo removal many take several procedures, and complete eradication may not be possible.
LASER HAIR REMOVAL
Different types of laser as well as filtered non-laser lights are popular treatments for hair removal. Physicians must be acutely aware of different skin types to properly adjust the treatment to prevent change in skin color and other potential complications. Although this procedure does not remove all the hair permanently, it reduces the number of hair follicles in three or four sessions and make the remaining hair in the area thinner and much less noticeable.
LASER FOR CUTTING & OPERATIVE PROCEDURES
Despite the popularity and success of laser, the American Society of Plastic and Reconstructive Surgeons still recommends that the best way to cut the skin and the tissue is by a sharp, cold surgical blade. Like any other new technology, the laser has been extolled for promotion and marketing purposes but nothing thus far has replace the surgical blade cutting procedure. While there are certainly advantages to laser cutting, including hemostasis, a mayor drawback is tissue destruction during resulting in more inflammation and scarring.
BREAST AUGMENTATION

Gel filled implants are back. In my opinion, and opinion of plastic surgeons, gel filled implants are still the best implants used for augmentation mammoplasty when allowed to be used by the F.D.A.

Gel filled implants are not yet approved for use in patients who undergo the procedure for the first time, unless certain conditions such as breast laxity or chest deformity exist, but they may be used in patients who have certain complications after the use of saline filled or get filled implants.

Gel filled implants of today are more durable that the older ones and are available in either smooth or textured surfaces. They have less potential complications of skin rippling and unnatural feeling on palpation than saline filled implants. Most importantly, the FDA could not prove any health risks from cause by them.

Does it really make a difference using round or teardrop and other so called anatomic shape implants? Scientific studies indicate that it really makes no difference except the anatomic shape implants are more expensive, and have the risk of rotation and misshaping the breasts. These studies were published in the Journals of Aesthetic Surgery and were presented at the Aesthetic Plastic Surgery meetings.

BREAST REDUCTION & LIFT
Recently a method of liposuction of breast tissue has been used in some specific cases of large breast to reduce their size with almost no scarring. This procedure can be tried only in selected cases.
ABDOMINOPLASTY
There is nothing new about this procedure, except lateral tension method, which applies the tension on the outer portion of the abdomen, preventing elevation of the pubic hairline and improves the loose skin of front portion of upper thighs and groins. Also considering the entire trunk as one unit, which means that liposuction of the hip areas, waistline and upper abdomen may be performed at the same time. The result from this method is more uniform and pleasing to the patient.
LIPOSUCTION
There are two techniques that are most successfully utilized by physicians in today’s medical practices. They are:
1.
Tumescent and wet technique. Prior to the beginning of the liposuction procedure, certain amount of fluid is injected into the tissue. This solution contains a small amount of local anesthetic and Epinephrine (constrictor of blood vessels). This procedure improves the pain post operatively and eliminates blood loss during surgery. Today bleed transfusion is almost never used in liposuction.
2.
Use of ultrasonic systems in which a machine generates 2500 vibration per second and is transferred to the suction cannula. The procedure results in melting the fatty tissue before suctioning, decreasing the amount of blood loss and post-operative bruising in selective areas of the body where fatty tissue is firmer and more difficult to suction. Ultrasonic system can also be used in reducing breast size of makes and females, and is more effective in repeat surgeries of liposuction.
MICRODERMABRASION

Microdermabrasion is a technique that offers many benefits of dermabrasion, chemical peel and laser resurfacing in a lesser degree without significant complications. It is effective in treatment of sun-damaged skin, fine wrinkles, age spots, large pores and acne prone individuals. The skin becomes smother, softer and more uniform in color and texture. Microdermabrasion is not effective in deep wrinkles and acne scars, but it works well with fine lines around the eyes, mouth, neck, chest and hands. The most commonly treated areas is skin of the face…For the best results, it may have to be repeated every two weeks for one to two months. Acid peel and other more extensive procedures may augment the results. It can be used on all skin colors.

The procedure takes about 45 minutes and is performed in the office without the need for anesthesia. You may feel like fine sandpaper is being gently rubbed on your skin. No preoperative preparation is required. Following microdermabrasion, you may experience a tightness or sunburn sensation for a day or two. Redness, if any, resolves in a few hours. You may apply moisturizer and make-up after the procedure.

   
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