It may seem rather obvious to you as to why you would want to have your cosmetic surgery performed by someone who is well trained and board certified in plastic surgery. Unfortunately, I have seen countless, otherwise intelligent patients over the years who knowingly sought care from poorly “trained” health care providers that often unscrupulously portrayed themselves as either plastic surgeons or an “equivalent” and ended up with either substandard  or even disastrous outcomes.

Even with injectable agents, training, experience as well as ethics matter. There are individuals in virtually every area of the health care industry offering Botox®, Juvederm®, Restylane® and other dermal fillers such as anesthesiologists, obstetricians and gynecologists, internists, family practitioners, nurses, dentists, naturopaths and other “para-professionals”. A weekend course is not enough to provide one with the aesthetic foundation, nuances, skills, experiences, etc. that would be a requisite for safe and appropriate outcomes.

The following patient who I saw exemplifies this problem. (She was very happy to share this experience with others so that they might be able to avoid the situation that she has found herself in.) She was unhappy with some grooves below her lower eyelids (called naso-jugal grooves) that were making her look old. There was no excess skin or fat bags. While living in California, an experienced plastic surgeon skillfully treated them with Restylane® resulting in an excellent outcome.

After moving here, a friend recommended that she use her person who wasn’t a doctor of any kind or even a nurse – but did offer injectable treatments. This provider not only injected the absolutely wrong material but also did it unskillfully and in the wrong location – and precipitated significant bleeding.

Eyelid bags and swelling created by inappropriate and unskilled injection of dermal filler into lower eyelids

Left lower eyelid bag resulting from dermal filler injection

Rights lower eyelid bag resulting from dermal filler injection

A trifecta of incompetence!

This unfortunate patient now has extremely prominent injectable created bags and distortions where there were none before. Making matters worse is that this is not a correctable situation. Hopefully with time, the injected material will dissipate and there will be no permanent long term deformities.

So, the next time that you are considering cosmetic plastic surgery, Botox® for your wrinkles or even treatment of the creases and grooves of your face with dermal fillers, think “Plastic Surgeon”.

If you would like information on any cosmetic plastic surgery procedure that I perform or to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Are there actually ways that you can improve your looks without emptying your financial reserves?

The answer may be yes. For example, though a facelift, CO2 laser facial skin resurfacing or even eyelid surgery may dramatically rejuvenate your appearance, the price could be too costly for you right now. Though not a substitute, Botox® and facial dermal fillers such as Juvederm® and Restylane® may provide significant enough improvements to make you look and feel better and may even help you better compete for a job. Furthermore, these can be selected at a fraction of the price of more extensive facial rejuvenation. Interestingly, this is exactly the approach that many people have selected during the recession these last few years.

We do offer you a variety of choices in addition to Botox® to help you look better. These include the dermal fillers (skin plumping agents) Juvederm®, Restylane®, Radiesse® and Perlane®. Each one may possess distinct advantages for you depending on multiple factors including the areas that you are considering improving. These dermal fillers can be used to give you more youthful appearing lips, soften the creases around your mouth, fill in depressions at the jowls and various creases or scars on your face, create more prominent cheekbones, and even provide more fullness for sunken in cheeks. Depending on your goals, areas of concerns and financial situation, I can help tailor a strategy that can assist you in obtaining that desirable look which will also fit your budget.

If you are considering Botox® or facial dermal fillers such as Juvederm® and Radiesse®, you would like information on any plastic surgery procedure that I perform or if you would like to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

A variation on this theme involves cosmetic surgery being performed in this country by individuals who are unlicensed, may not even be formally trained or who may be enterprising illegal aliens individuals who exploit their own ethnic community in order to make money. At times, this can be a difficult deception to discern especially for those who are not well educated or at least versed in what to look for or inquire about. These practitioners often lie about their credentials, licensure and experience and may even operate out of a store-front or their home and under the radar.

Such was the case involving two sisters of Mexican descent who were running an illegal cosmetic filler practice in Sylmar, California. Their injection of liquid silicone into the buttocks of a perfectly healthy 22 year old Hispanic female in July lead to her needless death – a horrific but not rare tragedy that can be perpetrated by these illicit operations. The women who performed the injections fled to Mexico.

Deciding where to seek plastic surgery is very important and should be taken seriously – and not just for a breast augmentation, tummy tuck, rhinoplasty or even liposuction – but also for injectables such as Juvederm®, Radiesse® and Botox®. Your decision should be based primarily on qualifications and reputation and then secondarily on price. Though there is never any guarantee of outcome, make sure that the physician that you are considering is either board certified or board eligible by the American Board of Plastic Surgery and is a member of the American Society of Plastic Surgeons (ASPS) which has rigid ethical standards. (I am both board certified by the American Board of Plastic Surgery and am a member of the ASPS.)

If you have any questions regarding my qualification or certifications in plastic surgery or on any cosmetic surgery procedure that I perform or to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Women who have very thin lips with little show of the colored part can also benefit but their anatomy restricts the extent and quality of the potential enlargement. No matter how much filler is injected, they will never have a very full and pouty contour. However, their lips will still be larger, fuller and more visible.

As long as you can appreciate the individual limitations, lip enhancement (enlargement) may be just right for you. Injectable agents like Juvederm® and Restylane® can provide you with a simple and affordable way to transform your understated or small lips into more attractive, alluring ones. With advances in techniques and the recent introduction of Juvederm® XC which contains a local anesthetic, the treatments can be quite comfortable with virtually no downtime.

Lips before treatment

Lips 6 months after treatment with Juvederm(R)

If you would like to obtain more information on lip enhancement, Juvederm®, Restylane® or on any plastic surgery procedure that I perform or to schedule a consultation with me, please contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Juvederm® is the most common injectable that I used for lip enlargement. Because of the discomfort associated with injecting fillers into the lips, I do nerve blocks to anesthetize the lips so that my patients don’t feel anything. The flip side of this is that the nerve blocks can be slightly uncomfortable and the ensuing numbness will persist not just in the lips but in surrounding areas of the face for a few hours. This can make speech, enunciating and eating more difficult until it wears off.

Fortunately, now there is a great solution to this dilemma. Allergan, the manufacturer of Juvederm®, received approval from the U.S. Food and Drug Administration’s (FDA) at the beginning of February to market a new formulation of this product that contains the preservative free local anesthetic lidocaine. It is being marketed as Juvederm® XC and contains a powder form of the anesthetic so that there is no dilution of the concentration of the hyaluronic acid.

I have used this Juvederm® XC on my patients including for lip enlargement without any nerve blocks. My patients unanimously found the injections to be very tolerable and comfortable whereas before without a nerve block, they would have been quite uncomfortable. Not only were they relieved in not needing the initial blocks but they also noted that there were no significant effects on their speech or enunciation.

If you would like more information on Juvederm® XC, Radiesse®, Botox® or any plastic surgery procedure that I perform or to schedule a free consultation with me, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona