Tag Archives: face

Latest Cosmetic surgery techniques 2014

The American Society of Aesthetic Plastic surgery meeting 2014

latest techniques

I was recently at the annual meeting of the American society for aesthetic plastic surgery (ASAPS) in San Francisco to see the latest cosmetic surgery techniques 2014.

There are about 6500 Board certified plastic surgeons in the US. Of those, only about 2000 are members of the American society for aesthetic surgery (ASAPS). This select group of plastic surgeons are those whose practice is primarily devoted to aesthetic plastic surgery- cosmetic surgery. Plastic surgeons from all over the world go to the meeting to learn the latest techniques in cosmetic surgery.

Fat injections to the face

The concept of fat injections, and by definition almost, stem cells, continues to be widely popular.

Plastic surgeons are increasingly injecting fat into the face for facial rejuvenation during a face lift. The fat seems to stay in the face for some patients and not for others. Cause unknown.

Fat injections into breasts

fat injections into the breast continues to be problematic. A recent study shows that fat injection by itself does not cause breast cancer. But… if you have a breast cancer, the fat injection will make the migration of  the cells faster and increase the chance of metastatic cancer- not good. Specially when 1 out of 9 women in the US is going to get cancer, getting metastatic cancer is a death sentence.

Fat injections into joints

The most exciting reports for fat/stem cell injections come from studies where fat is being injected into knee joints that have suffered injury. The torn cartilage actually seems to heal itself. Studies are being done now to reproduce the early study which cam from Pakistan…

Deep Vein Thrombosis

Deep vein thrombosis or DVT is a cause of pulmonary emboli which is the number one cause of death in cosmetic plastic surgery patients. Several protocols have been identified for dealing with patients at high risk for DVT. These are patients with previous history of DVT, women who are smokers, and women on birth control. Sitting in a particular position for a long time will also increase the risk.

Putting patients on blood thinners before the surgery was widely advocated as the thing to do. It now turns out the the risk of bleeding during the surgery outweighs the risk of actually getting a PE.

Bacteria around breast implants

Bacteria have long been thought of as being contributors to capsular contracture- a condition which occurs for unknown reasons around some breast implants. The bio-film, a film of bacteria that covers the implants was thought to be the main contributor to this “chronic infection”. Now it may be that the bio-film does nothing or may actually protect against the contracture! Essentially, no one knows.

Take home message

I have rarely come back from a medical conference more confused that when I went there. It seems that the science of cosmetic surgery is in a period of flux. What we thought was true, isn’t, and  what was not true is not true or is true.

What was it that former defense secretary Rumsfeld said recently,

“Reports that say there’s — that something hasn’t happened are always interesting to me, because as we know, there are known knowns; there are things that we know that we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns, the ones we don’t know we don’t know.”



Google Glass for plastic surgery

Google Glass the future in surgery

Last week I was at the American society for aesthetic surgery (ASAPS) meeting in San Francisco. The Keynote speaker was the man in charge of Google glass marketing, Ed Sanders, and he proved to be an interesting choice for elucidating the medicine of the future.

Google Glass is essentially an computer hooked up to a pair of glasses. The commands for different actions are given by voice, The glasses have a small screen on the upper right hand side which function as the screen and a camera is also included in the front. You can thus take photos with the glass and store or delete them by voice, surf the web and perform most of the functions that you would do with a normal computer.

Google glass

Google glass for plastic surgery

The applications of google glass to surgery and to cosmetic plastic surgery in particular are particularly exciting.  Mr. Sanders first gave the example of how he uses google glass in his daily life ( he has access to the glasses which currently sell for $6999 on E bay). He told of how his wife watches a game of soccer that their child is playing with the glasses, and relays that info in realtime to her husband who is often traveling. This does not require the cumbersome hand held devices which arguably can do the same ting now. In fact, Mr. Sanders could be watching the game while having a business meeting!

For the cosmetic plastic surgeon, the application of google glass in the operating room is most interesting. In plastic surgery, the surgeon is often the only one who can actually see what is going on  in the operating room. Be it a breast augmentation, face lift surgery or a tummy tuck, the assistants in the operating room usually see nothing and hence cannot be as responsive to the plastic surgeon’s need as in other more “open” surgeries.

The very same small incisions that cosmetic surgery patients want slows the surgery. With Google glass, the surgeon can be relaying the information of what he sees and what he is doing to the whole of the operating team. Paraphrasing the words of Mr. Sanders, Goggle glass gives others your point of view- it gives others your perception. Now we can all see the world through other peoples’ eyes.

Mommy makeover-Breast-Abdomen plastic surgery

Mommy makeover

Mommy surgery before

                                                                                    Mommy surgery after

Cosmetic Plastic surgery of breast and abdomen after childbirth or massive weight loss is often called a Mommy makeover. Recently a patient asked me if in fact it was not a ‘Mummy makeover” since patients are often bandaged up like mummies after this cosmetic surgery duo!


Changes  to body after pregnancy or weight loss

Several distinct but common changes occur to the body after pregnancy or weight gain and loss.

  • Fat Deposits – occur in the flanks, love handles, back and abdomen
  • Loose skin – as a result of stretching of the skin leads to loss of elasticity of skin and its hanging down
  • Breasts become smaller and may also become droopy due to loss of volume and elasticity- in women and men!
  • Arm skin becomes droopy but fat accumulation in the arms may increase
  • Facial  and neck skin may droop giving an older look


Surgery of the abdomen and breasts

Mommy makeovers typically include

Other procedures may include

Mommy makeovers will take between 3.5 to 4.5 hours depending on the type of surgery that needs to be performed. Though some surgeons like to continue to operate on other body areas at the same time, I find that 8 hour cosmetic surgeries are just too much for me. They are also way too much for the patient! I prefer to divide up the surgeries into more reasonable segments, sometimes just by a few days, to allow easier healing for patients.

Recovery from Mommy makeover

After a mommy makeover the recovery will depend on the number and type of procedures performed as well as all the usual reasons for differences in individual healing. Although patients are up and walking the same day as surgery, typically it will take about 10-14 days before patients are back at work. I have had patients return as soon as 3 days after surgery and as long as 14 days.

Here is a link to a patient returning to the office after only 12  hours following mommy surgery;  http://www.youtube.com/watch?v=HCqqri8Yt5M&list=UUGHAP0wTkrkJuRo1yN1CFjg

Full healing though will take about 4 months though their healing is gradual and progressive.

Mommy makeover surgery gives women a new look . A new look for their bodies and a new look on life.

How to stop smoking before plastic surgery

Smoking no good before or after cosmetic surgery


Everybody knows that smoking tobacco products of any type is not good for you.  Rates of smoking in the US have come down but still 30% of the population smokes.

It is important for patients to stop smoking before and after any cosmetic plastic surgery. https://www.tavmd.com/2011/10/26/preparing-for-cosmetic-plastic-surgery/

Most Board certified plastic surgeons will not even perform some surgeries like face lift if patients smoke; we know the disaster that could happen with smokers and facial surgery.

I require my patients to stop smoking for at least 7 days before and 7 days after any cosmetic surgery. The longer the better.

stop smoking








Bad effects of smoking cosmetic surgery

Lung cancer is an obvious cause of smoking. Smoking also damages your skin making you look old. For plastic surgeons though, effects of smoking are much more immediate and important for the results you want.

1. Tar

All tobacco products create tar when burned. That is a dark, gooey material you can squeeze out of filters. It is also what lines your lungs. With cosmetic surgery needing general anesthesia, tar build up makes it more difficult for your lungs to clear normal secretions caused by anesthesia. You end up coughing more, and creating even more secretions. Coughing after plastic surgery increases your blood pressure and the risk of bleeding. It also hurts!

2. Nicotine

The main drug effect of tobacco is due to Nicotine. The high from smoking is due to nicotine. All types of tobacco products including electronic cigarettes have nicotine. Of course chewing tobacco does not give you tar.

This drug causes a number of effects; both a stimulant and a relaxant.

It will increase glucose  and adrenalin in the blood and cause stimulation. It increases brain concentration and memory and decreases appetite and pain. It also increases Dopamine ( a brain neurotransmitter) which is involved in enhancing our brain’s perception of pleasure and relaxation. It make you feel good.  Sounds like the perfect drug to give to patients after surgery! However it also acts a an arterial vasoconstrictor. It cuts down on the blood supply to the skin. In fact, each cigarette will decrease the blood supply to the skin 50% for 10 minutes. Imagine having an elastic band tied around your finger for 10 minutes. Your finger would not be happy! If you have 3 cigarettes that is 30 min etc. … Wounds that do not get blood will not heal and will fall apart with dead skin and tissues. Not good.


How to stop smoking before plastic surgery

Stopping smoking before and after surgery is important . But, how to stop smoking before plastic surgery is a not so easy. Get past the first three days and the rest is a breeze.

The trick to stopping smoking is to substitute the rewards that your brain has come to associate with nicotine. Every time you think of a cigarette, you will need do something else to substitute for the pleasure you had previously from nicotine.

It’s a question of breaking the habit with respect to time of day.
For example smoking  after meals, every time you enter a car, or  when you feel stress.
Substitute nicotine effects. For example, drink a glass of water, go for a walk around the block, eat something sweet like dried fruit, raisins, or chocolate . All of these will increase Dopamine in the brain and make you feel good the way nicotine did. One of the best methods to increase Dopamine is to have more sex.
You will have to do something to get tension release.
Going told turkey without support usually leads to failure.
By the way, if your partner or other people in the house smoke it makes it more difficult for you to quit. Maybe they can quit along with you!

Cosmetic Eyelid surgery news

The Eyes have it

Cosmetic Eyelid surgery, or Blepharoplasty, is a surgical procedure to remove the excess skin and fat from the upper eyelids and lower eyelids. Today I am going to talk about cosmetic eyelid surgery news that I have recently come across.

Here are some blogs about how the procedure is performed





New Information about eyelid surgery

Cosmetic plastic surgeons have known for a while the importance of the eyes in perceptions of looking younger and more rested.

I always tell my facial plastic surgery patients that the first area for cosmetic rejuvenation surgery is the eyelid area.

Eye movements women in red men in blue

When looking at each other, we spend 80% of the time looking at a rectangle that goes form side to side of a face , up to the eyebrows and down top the bottom of the eye socket. The glabella, or area between the eyebrows falls in this area – another reason Botox in this area is so important in making us look better.

New research now shows that there are distinct differences between men and women in how we look at faces.

For any given period of time, men will look at the nose , and two eyes in a slower manner. Men spend more time looking at the nose, then one eye and then the other.

For the same period of time, women will look at the three areas in a more rapid sequence. Women will look at each area for a briefer amount of time but then repeatedly come back to it again.

The implication here is that by looking more often at the same area, there is a more pronounced and deeper imprint of the image on the brain. Maybe that is why women are better than men at remembering faces.

One brain cell per face

Another amazing new discovery is related to how our brains function to remember faces. Research now shows that  we allocate one brain cell or neuron to each face we see. It seems that we do not care how many different photos of the face in various guises there are. Our brain cell is dedicated to that one face and will recognize it despite changes in photo angle, hats, or even age. One neuron per face. Our family, friends, acquaintances, Hollywood actors, TV personalities and politicians  obviously take up a large number of neurons. What a waste of some neurons that I could have spent on better things.

One neuron per person



Brow Lift or Eyelid Lift? Maybe Both

Brow lift with or without eyelid lift


As in any job, cosmetic plastic surgeons often see the same plastic surgery condition again and again.

I have written about brow lifts or forehead lifts in the past.



Brow lift  and eyelid photo

Today I want to tell you about the decision-making process a cosmetic surgeon uses to determine whether a cosmetic surgery patient with excess skin on the upper eyelids needs an eyelid lift, blepharoplasty, a  forehead lift or both.


Eyelid surgery

As we age, our eyelids, like other parts of the face, change due to a number of factors, including:

  1. environmental damage—sun exposure
  2. genetics—thinness of the skin
  3. individual factors —what your anatomy is like


The skin of the eyelids is the thinnest skin of the body, so the effects of aging are often seen there first, manifesting as drooping of the eyelids and herniation of fat from around eyes.

Cosmetic plastic surgery to correct eyelid droop is called a blepharoplasty. Cosmetic plastic surgeons will remove excess skin and fat from the upper and lower eyelids to give you a more youthful look.


Brow/forehead lift

With aging, foreheads will also droop, as brow muscles and skin become lax and allow a downward migration of structures. When the eyebrow is below the bony part of the brow, you have a droopy brow and may be a candidate for a brow lift! Drooping of the brow causes:

  1. lines between eyebrows
  2. horizontal lines across forehead due to over-activity of muscles trying to pull the brows up
  3. appearance of more skin and fullness of upper lids

Brow lifts include:

  • removal of excess skin of the forehead in the center of the brow and in the lateral areas of the brow
  • Elevation and fixation of the forehead muscles in a higher position


Evaluation of a patient for upper eyelid surgery or brow lift

When seeing a patient for facial rejuvenation of the upper facial area, I always start with the eyelids.

  1. I look at excess skin in the upper lids and feel the quality of the skin and see how much skin there is for excision. At the time of blepharoplasty, the excess skin is actually measured to the millimeter to be sure that not too much skin is removed and that the cosmetic patient will be able to close his or her eye!
  2.  I look at any extra fat that may be present around the eyelid. The upper lid has fat in two compartments. The first is along the width of the eyelid and the second in the corner close to the nose. Excess fat is removed during surgery.
  3. I lift up the brow and see how much of a difference that makes to the excess skin of the lids.
  • minimal difference to eyelid skin with brow elevation: there is no need for any brow surgery.
  • great deal less eyelid skin with this maneuver: patient may be a candidate for just a brow lift, as long as the brows are droopy.
  • eyelid skin is improved but not totally gone: cosmetic patient may be a candidate for both a brow lift and an upper eyelid lift.

A complete evaluation of the forehead and eyelid area is imperative for patients considering facial rejuvenation of these areas. It is important for patients to know that in some patients there is a significant contribution to droopiness of upper eyelid skin from a droopy brow, and cosmetic patients will not get the results they want if both areas are not addressed.


Morad Tavallali, M.D., FACS

Lyme Disease, John Kerry and My Face

Lyme disease effects and facial palsy


I was not going to write again about Lyme disease or my recovery from facial palsy, but recent news just begs for comment.

I have written about my facial palsy as a result of Lyme disease in the past. Here are some of those posts.



Lyme disease tick photo

Lyme disease in the news

Since then, the CDC has come out with a new and startling report. The cases of Lyme disease in the US have been seriously underreported. Instead of 30,000 people a year getting Lyme, the number seems to be at least 300,000, and even that is probably an underestimate! Of course, having a larger number of people around the country having a disease decreases the personal sympathy factor, but that’s OK. What is not OK is the huge number of people who are walking about with complaints of fatigue and lack of energy who have been misdiagnosed or not diagnosed at all, let alone treated for Lyme disease.

The greater the awareness, the less chance that patients will develop “chronic” Lyme disease and whatever that may entail.


My facial palsy

I was lucky in a sense that the combination of a rash and my facial palsy led to a high degree of suspicion about Lyme disease, which was confirmed by a blood test. Had I not had the facial palsy, I would have thought the fatigue was just due to getting older, the rash just a sunburn or allergy. The paralysis of my face has improved significantly.  At rest, I look like I always did. When I grin, though, there is still a weakness on my right side. I also cannot sneer on the right, nor wink : not two facial expressions I use anyway. My eye’s tearing on the right has stopped but I still cannot force a closure as tightly as before.

John Kerry before photoJohn Kerry after photo

John Kerry’s palsy?

Today I saw a report that showed that Secretary of State John Kerry looks different than usual. Here are his recent photos, and  yes, he sure does look different! The spokesperson said he was very tired and stressed. Some have said he has had Botox and others that he has developed a… Bell’s palsy. I do not think the poor man has time to potter around his garden and get bitten by a tick, so I doubt the cause is Lyme disease, but still, a facial palsy is no fun. Stress is a well known cause of Bell’s palsy. We are learning now that stress can cause and/or uncover many of the immune-system-modulated reactions that lead to disease.


I shall be scouring the internet to see if I can find a video of him, with facial movement or otherwise. The chubby look could also be a reaction to steroids that he may have been placed on to reduce the effects of the Bell’s palsy.


All of you healthy readers: “For there you go by the grace of god…” Take care of yourselves and learn how to de-stress.


Morad Tavallali, M.D., FACS