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In my opinion attention to detail is what sets apart a great surgeon from an average one. One of the things I discuss with my patients before performing a facelift is the way their ears look. Ears, like many other parts of the body, succumb to the force of gravity and heavy ear rings. They strech, become saggy, and wrinkly. Here is how we improve the ears...

My practice is in Southern California and a large percentage of my patients have a darker skin complexion. Asian and African American patients with a history of keloids or unsightly scars are often hesitant to have a facelift.

Often I'm asked--in regards to the sagging of the jowels and neck area--if there is a more conservative approach one can take: a solution not requiring "any cutting". Here is the answer...

YES! There is a facelift which is well suited for men. Men are generally more hesitant than women to have a facelift. They often worry about visible scarring extending into scalp or forehead, a pulled look, and a long recovery period. It does not have to be like that. My trademarked Tuliplift, which is performed under mild sedation, addresses all the above concerns. It doesn't give men a pulled or artificial look, recovery is usually 10-4 days, and scars are both limited in length and do not extend into hair bearing scalp.

As many of you know from my other blogs, I am not a great fan of permanent injectable fillers. The body and face will change over time; whereas a permanent filler cannot. This important difference can lead to serous problems, and as such I tend to discourage the use of permanent injectible fillers whenever possible.

Artecol is a filler of this type, which consists of little solid microsheres (PMMA) suspended in a solution containing bovine collagen. It is widely used in Europe and will eventually become available in the United States. Given its popularity, one might assume Artecol poses less risk than other permanent fillers, however that is not the case. Recently, I came across an article in the Archives of Dermatology which exposes some long-term risks associated with Artecol and I'd like to share its substance with you.

Right across the street from my office on Wilshire Blvd. there is a large sign that reads: "Instant facelift. No downtime, no cutting, no surgery. Mesotherapy works."

Having practiced cosmetic surgery and dermatology for over 10 years, I have yet to see any significant or lasting improvement caused by the injection of Vitamins or herbal extract. A recent study by Dr. George J. Hruza published in the December issue of Dermatological Surgery (Dermatol Surg 2006 Dec;32:1467-72) shared this view. The study concludes that injections of Vitamins and herbal extracts do not result in any clinically relevant benefit. Aside from subcutaneous injections of Phosphatidyl choline and deoxycholate for lipolysis, mesotherapy continues to show a lack of clinical efficacy while still subjecting patients to potential risk.

Without a compelling study to the contrary, I am reluctant to endorse Mesotherapy as an effective and safe form of treatment. Perhaps more studies similar to Dr. Hruza's will be available in the future to shed more light on the efficacy of these and other commonly used rejuvenation techniques.