Chin implants are not used often enough. They are safe and effective and can dramatically improve the appearance of the face.

The chin is almost as important as the nose in an attractive profile, and so chin implants should often be done together with nose jobs.

I often use a chin implant together with a face and neck lift because it is so helpful in creating a clean right angle under the chin and taking up the lax neck skin.

Before you insert the permanent implant, different sizers are used of different shapes and different projections and that is how one determines which is the ideal implant to create the correct contour for the individual patient.

Chin implants are particularly important in men, who look stronger and more handsome with a bold jaw line.

A chin implant is done under local anesthesia, in the office, and there is about 5 days of down time.

You can achieve a full, pouty upper lip without putting anything into the lip.

This is done with a sub-nasal lip lift where skin is removed just under the nose, and the inconspicuous scar (similar to that for a nose job) is hidden inside and under the nostril.

The lift pulls up and enlarges the visible red part of the upper lip and creates a pouty look.

This is a simple and effective operation done under local anesthesia with three days of down time, and I just don’t understand why it is not done more often.

In most cases your breast implants will last many years.  Any breast implant can leak, and the incidence of leaking is slightly under 1% per year.  That means that in 25 years, you may have a 25% risk of one of your breast implants leaking and needing to be replaced. 

            There is no rigid schedule for implant replacement, and they never need to be replaced as long as they are intact.

            If a saline implant leaks, the breast gradually becomes smaller as the saline gets absorbed, and then you realizes immediately that your breast implant is leaking.  With silicone implants, on the other hand, you don’t necessarily know if the silicone implant is leaking because the silicone is very highly cohesive and it all stays inside the implant pocket in your breast.  Therefore, patients who have silicone implants need to have an MRI of the breasts every three years to make sure that the silicone implants are intact. 

            But the important point to make is that silicone does not cause any disease or medical problem and that therefore a leaking silicone breast implant is not a threat to your health.  It is only a local mechanical problem that is corrected by replacing the implant.

We actually do not use microdermabrasion in our practice.  We prefer a technique called microdermaplaning.  I work with Laurie Lombardi, who is an excellent aesthetician.  She has extensive experience with both microdermabrasion and microdermaplaning and feels that microdermaplaning is both safer and more effective. 

The disadvantage of microdermabrasion is that there is limited control in the depth of penetration.  It is possible to get broken capillaries and pitting of the skin with microdermabrasion, and microdermabrasion is not appropriate for patients with pigmented skin.  The crystals used in microdermabrasion can interfere with good visualization of the appropriate target areas in the skin. 

Microdermaplaning is more technically demanding and has to be performed correctly, but yields better results.  It is appropriate for all patients beginning in the late 20s.  The skin is cleansed and then the microdermaplaning is performed by gliding a dermatome on the skin. Microdermaplaning removes facial hair and speeds up the production of new and healthy cells.  It helps smooth acne scarring and it helps with the absorption of skin care products such as vitamin C serum.   Microdermaplaning does not damage healthy tissue or break capillaries, and it is very effective in removing light surface wrinkling and in improving skin texture.  It also lightens uneven hyperpigmented skin to a more even skin tone.  It leaves the skin glowing.

Microdermaplaning takes less than an hour to perform and there is absolutely no down time.  Microdermaplaning should be followed by good skin care at home, and ideally it should be performed every two or three months.

1. Eat less processed food. A wonderful writer recently wrote “avoid anything that your great-great-grandmother would not recognize as food.” This excludes much of what you find in the supermarket.
2. Moderation. Learn to eat slowly and in small quantities, and learn to love leafy vegetables.
3. Learn to meditate. For many people, this is the most direct path to peace and wisdom.
4. Practice a sport that you enjoy on a regular basis. This is better for the body and the spirit than chasing a target heart rate on the elliptical machine. But any exercise is better than none.
5. Devote time, money and energy to a cause or organization that you believe in. This is a good path to meaning and to getting outside of yourself.
6. Skin care. Find and stick with a simple, inexpensive, effective skin care regimen that actually protects and rejuvenates the skin. These products are out there. You just have to use them regularly.

There are four basic breast reduction techniques and scarless liposuction breast reduction is one of them.  With the other three techniques, excess breast tissue and skin are cut out and liposuction is not primarily used.

A). Liposuction.  If you do not have too much sagging, and if you only want to reduce the size of your breasts by approximately one cup size, then liposuction breast reduction is an excellent choice because there are no scars.  So liposuction is a great approach for carefully selected patients.  If you want to be a lot smaller, or if you have a great deal of sagging, then liposuction breast reduction is not a good option for you, even though there are no scars.

B). Breast reduction with a circular scar around the nipple.  This technique has the advantage of minimal scarring, but is also only useful when there is not too much sagging in the breasts. 

C). Breast reduction with the “lollipop” scar.  This is by far the most common technique that I use in my own practice because it is a minimal scar technique.  It provides great long term shape, and it is useful for almost all breasts. 

D). Breast reduction with an upside down T scar.  This is a technique that involves the most scarring, and I do use it rarely for breasts that are huge or that have a truly extraordinary degree of sagging. 

You may have deep smile lines around the eyes or around the mouth, and the treatment for each is quite different.

Smile lines around the eyes which are also called crow’s feet are very effectively treated with Botox injections.  The Botox relaxes the orbicularis muscle which causes the skin to crease into the smile lines.  When the muscle is relaxed, the surface of the skin becomes smoother.  The results of Botox treatment of the crow’s feet typically last for four months.

Laugh lines or smile lines around the mouth are most effectively treated with injectable fillers.  For superficial lines, we use Restylane, and for deep lines we use Juvederm Ultra Plus.  Both of these products are hyaluronic acid gels but they have different properties.  Restylane is more appropriate for superficial lines, and typically lasts 5 or 6 months.  Juvederm is more extensively cross-linked and is more effective for deep lines and folds, and Juvederm has been shown to last for one year.