Eyelid Crease Surgery for Asians
Q: I've heard about surgery that creates an eyelid crease for Asians. Do you cut the eyelid to create this look?
A: Traditionally, there have been two techniques for creating an eyelid crease for Asian eyes: cutting and non-cutting. The cutting method used to be the only way to create this look until the latter method was developed later. The cutting method has the benefit of creating a permanent crease on the upper eyelid. Unfortunately, this technique sometimes left an unattractive scar on the upper eyelids.
The non-cutting method, or suture method, involves applying thin, non-absorbable stitches to create an eyelid crease. With this method, however, the eyelid crease would sometimes disappear after several months. Along with Minami Clinic in Japan, our clinic recently developed a new method of creating an eyelid crease. This method is similiar to the non-cutting method, but we apply two stitches on one eyelid and perform a special suture-twisting technique.
Using this technique, we have been able to make an eyelid crease that does not disappear. We call this the "Double Sutures and Twisting Method" (DST Method), and we have used this method on more than 1,000 Japanese patients with great success. The operation is relatively painless and swelling is minimal. Usually patients can go back to work the next day.
The doctors original DST technique has been featured in the Aesthetic Surgery Journal.
Upper Lid Depression
Q: What is the most effective way to treat depressions in the upper eyelids?
A: There are a few different ways to treat depressions in upper eyelids. The simplest and most effective way is to inject your own fat into the tissue under the skin of the upper lid. This is called "lipoinjection." The fat is harvested from the donor site (wherever you want), then injected into the upper lid depression. Approximately 60-70% of the fat will be naturally absorbed in a year, but the remainder will usually last for a long time.
Hair Removal with Diode Laser
Q: I'm confused with the ads about laser hair removal. Some people say that you get light or dark spots after this procedure. Are all types of laser hair removal safe? I am Asian and my skin is very dark--is it safe for me to have a laser hair removal procedure?
A: It's been only 4-5 years since the first stage laser hair removal machine became widely available for doctors in the United States. The first generation machine mostly utili zed certain light beams to attack the melanin that contains the hair. The second generation Alexandrite laser more specifically targeted the pigment, but it was not always suitable for dark-skinned patients. Dark-skinned patients were sometimes left with hypo- or hyper-pigmented spots after the laser treatment.
Most recently the FDA approved the use of the Diode laser for hair removal. The Diode laser allows us to target the hair follicles specifically without leaving pigment changes as seen with the Alexandrite laser on dark-skinned patients. It is also less traumatic for Caucasian skin than conventional laser treatments. Our clinics in Beverly Hills and Nagoya are equipped with Diode hair removal lasers.
Facelift
Q: How many different types of facelift methods do you know and which one would you recommend?
A: As you may know, the facelift is one of the most popular surgeries in the U.S., and there are several different methods used to achieve the facelift. Although a facelift can be done by one of the following method:; skin only, limited SMAS, SMAS, extended SMAS, deep plane, and so forth, the gold standard of the facelift is the SMAS method. a surgeon needs to know the anatomy of the soft tissue and nerves of the face in great detail.
After lifting and mobilizing the SMAS, you may or may not need an extended approach to improve the nasolabial lines. The final decision should be made before surgery and be included in the informed consent. The facelift is one of the most time-consuming surgeries and requires a surgeon's expertise. I think it is a safe surgery as long as it is done by a qualified plastic surgeon who has a lot of experience and substantial residency training.
Rhinoplasty (Nasal Reconstruction)
Q: I've heard that "nose surgery" is the most difficult type of plastic surgery. Is that true?
A: You are probably right. The nose is one of the most difficult areas anatomically for reconstructive surgery. There are numerous approaches to improve nasal shape. The use of nasal septal cartilage, ear cartilage, or other implantable materials may improve the shape of the nasal tip or dorsum. You may need to remove excess soft tissue or sometimes it requires fracturing the nasal bone. A thorough consultation and sometimes even a second or third opinion may be helpful in making a final decision.
Chemical Peels, Dermabrasion, and Botox Injections
Q: I have fine wrinkles around my mouth and eyes. What is the best way to get rid of them?
A: There is no one solution to every skin problem, but if you have the right diagnosis of the condition of your skin, we can offer the appropriate treatment. For example, the shallow wrinkles around the mouth are often best treated with a chemical peel or with dermabrasion, but these treatments don't work so well for deep crow's feet around the eyes. Botox is recommended for those areas as well as for frown lines between the brows.
Jaw Angle Reduction
Q: Is it possible to narrow the width of my jaw? If so, please tell me how it is done.
A: Reduction osteotomy (bone cutting) is a relatively common procedure that is performed on those who have a prominent square jaw. This surgery is popular among Asians. The angle of the jaw can be trimmed down by cutting the bone from inside the mouth. The surgery is relatively easy and safe, and creates a softer jaw line.
Breast Augmentation/Revision
Q: I had a breast augmentation 10 years ago with silicone implants but would like to change them with larger saline implants. Can you tell me what kind of procedure that involves?
A: Replacing breast implants can be a difficult procedure. If there is "capsular contracture,"where the tissue around the implant hardens, excision of the capsule is often required. Sometimes a different incision than your initial surgery---underarm, periareolar(nipple) or inframmary (below the breast) incision---is needed.
If you have chronic inflammationof the tissue around the implants, the new implants may need to be placed in a different place (below or above the muscle). In Japan, patients can choose to have alternative implants such as cohesive gel or hydrogel. Coesive gel implants are usually manufactured in France and have a thick silicon gel inside that will not bleed if punctured. The hydrogel implants are made in Germany and consist of hyaluronic acid.
Liposuction
Q: Can you tell me the differences between UAL and PAL liposuction techniques?
A: Liposuction has been performed for more than 15 years and has proved to be a safe and effective procedure for most patients. UAL (Ultrasonic Assisted Liposuction) has been available for some 4-5 years but it is losing its popularity because it tends to burn and cause excessive tissue damage.
The UAL is still useful for certain conditions such as gynecomastia and stiff fibrous tissue. PAL (Power Assisted Liposuction) is a new method that delivers both vibration (oscillation) and suction. It does not burn and appears to be safer than UAL; It can be used for any part of the body and the duration of procedure is shorter than with UAL. The PAL system is currently available at our clinics in Japan and will be available in our Beverly Hills office in the near future.
