In several previous posts including most recently Buyer Beware When It Comes to Selecting A Doctor to Perform Your Plastic Surgery, I have emphatically stressed the importance of seeking a well qualified board certified plastic surgeon for your plastic surgery needs. This is true not only for cosmetic surgery procedures such as breast augmentation, tummy tucks and facelifts but also for non-surgical ones like Botox® and Dysport® injections and dermal fillers such as Juvederm®, Restylane® and Radiesse® to enhance facial volume and address deep creases and wrinkles. (Note: There are many well trained and skilled dermatologists who also offer these injectables.)

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

Despite the tough economic times we are experiencing now, people still want to look good. In fact, with such a severely contracted labor market, a more youthful appearance may actually help you compete for a job more effectively. Besides, you just want to look better.

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

Lip enhancement is a very popular procedure that can transform understated or deflated lips into more youthful, attractive and even alluring ones. Unfortunately, not everyone can realize equal benefits regarding their ultimate results due to basic structural differences of their lips. Women who can expect the best outcomes are those who already have or had anatomically fairly large lips in a vertical dimension. Their lips can be expanded considerably with injectable hyaluronic acids such as Juvederm® or Restylane®, allowing for more latitude in obtaining the desired contour and enhancement. Many just want even more fullness than they were blessed with; others have lost volume as part of the aging process and them to be rejuvenated for a more youthful appearance.

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 a very effective hyaluronic acid dermal filler that I use to treat facial lines and creases, for lip enlargement and to provide volume enhancement and highlighting in strategic areas. It is the only dermal filler of its type that has been approved by the FDA to last up to one year. Most of my patients prefer it over its competitor, Restylane®, and the results seem to be longer lasting.

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

Radiesse® is a long lasting injectable dermal filler that is FDA approved for the correction of moderate to severe folds and wrinkles of the face such as naso-labial folds and marionette lines around the mouth and creases of the forehead. It can also be used to augment the chin, cheeks, brows and effect contour changes of the nose and jaw line as well as fill in contour irregularities, deficits and scars. By increasing soft tissue volume in areas, it can serve to rejuvenate one’s appearance. Another area where it has been employed effectively is in the back of the hands which is useful for individuals with thin, atrophic and aged skin.

What is in Radiesse®? It is composed of calcium hydroxylapatite (CaHA) microspheres suspended in a proprietary biocompatible non-allergenic gel that can easily be injected to obtain the desired results. CaHA is the same material found in your teeth and bones. Not only does it provide volume by its presence but it also stimulates the body to produce collagen (protein) resulting in long lasting results.

The injections generally are not associated with much discomfort and can be performed in the office without the need for nerve blocks. The results are seen immediately and can be quite dramatic. Swelling is fairly minimal and typically subsides within 24 to 36 hours.

How long does Radiesse® last for? The duration of the results does vary depending on a variety of factors but somewhere between twelve to eighteen months is fairly typical which significantly exceeds the results of the hyaluronic acids such as Juvederm™, Restylane® and Perlane®. Touchups will often be needed during this period of time to help maintain the results.

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

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