San Diego Facial Plastic Surgery

Botox and Dysport have now been competing head to head on the market for several months, and our San Diego patients have reported good results with the new botox competitor. In our practice, we have found that it takes approximately 3 units of Dysport to every 1 unit of Botox to achieve comparable results. Since there are 300 units in a bottle of dysport and 100 units in a bottle of botox, ounce for ounce they are pretty much the same.

For patients it is important to understand that $4/unit for Dysport is the same as $12/unit for botox- simply multiply by 3 to get the equivalent value.


Overall, having two competing products that both work means lower prices and that is what we have seen. Patients should keep their eyes peeled for specials on either product at our San Diego Face medical spa.


Several of my patients who reported that their botox has not been lasting as long as when they first starting using it have switched to dysport, to see if they can get more "bang for the buck." We will keep you posted on these results...

Labels: botox, dysport, dysport san diego, la jolla botox, san diego botox

Active FX and Total FX are two of our most popular San Diego skin rejuvenation procedures. The reasons for this are that these procedures are quick, involve minimal downtime (generally one week at the most) and are effective. Patients achieve often dramatic improvement in wrinkles, loose skin around the cheeks, eyes, and jowls, and acne scars. Despite these great results, it is important for patients to understand that great looking skin requires maintenance. If bad habits resume after your laser skin resurfacing treatment, the brown spots, wrinkles, and crepey skin will also return.

Most of our patients pre-treat their skin with retinol and hydroquinone based products as recommended by our aestheticians. Medical grade products have a higher concentration than regularly found in the drug store, and act to inhibit hyperpigmentation (dark spots) and also allow a deeper, more effective penetration of the laser.

In addition to pre-treatment, we recommend avoiding direct sun exposure and using a high quality sunscreen with UV-a and UV-b protection.

Approximately one to two weeks following Active FX, patients are generally ready to resume their skin care, which at this time can be re-tailored to their current skin condition. The goal at this point is to maintain the result of the laser treatment, and also to build upon that with even more improvement over time. Having a great team of aestheticians and an aesthetic RN allows us partner with our patients for long term great looking skin!

Labels: active fx, laser resurfacing san diego, laser skin resurfacing, medical spa, skin care after laser

While some patients truly have "bags" under their eyes which require surgical removal with a lower eyelid lift or blepharoplasty, others simply have a hollow look below their eyes that makes them look tired or older. This hollow area is called the nasojugal groove, and it forms in people with a certain bone structure predisposition as they age. The aging process results in loss of fat and elasticity, and the skin "sinks" over the bone, creating a shadow or "dark circle." Simply removing fat above the hollow area can sometimes accentuate it- making the eye seem more hollow and old. A better option is to restore volume to this area!

These days, we often use fat grafting to the area beneath the eyes, to permanently restore fullness and lessen the appearance of the nasojugal groove. For patients who don't want the expense or (relatively little) downtime of fat grafting, injectable fillers can be an easy fix.

In either case, it is best to have an experienced surgeon or injector doing these procedures, as the area around the eyes can be prone to bruising or irregularities.

My preferred injectable filler for this area is Restylane. It lasts a long time (up to a year or more)
and has relatively little swelling.

Labels: blepharoplasty, eyelid bags, infraorbital hollow, injectable fillers, lower eye hollow, restylane for lower eyes

"Liquid Facelift" was probably coined in regard to Sculptra, which is a "large volume" injectable filler. Unlike a syringe of restylane or juvederm or even radiesse, sculptra comes in a bottle which generally prodcuces 5-6 syringes of product for injection. While scluptra can target specific lines like the nasolabial folds, it is better known for adding plumping volume to thin, "hollow" faces. By changing these hollow areas (below the cheek bones and in the temple, for example) to more convex or rounded, the face looks naturally more youthful. In some cases, if no volume were added and the skin was simply pulled, these thin faces could look unnatural and "operated."
Indeed, sometimes a "liquid facelift" can be better that a regular facelift for the right candidate!

The principle of liquid facelift can also be applied to fat grafting. This is another way of adding to volume to the face to make it look more youthful. It involves an addtitional procedure- liposuction- but the filler is one's own fat and the supply can be plentiful and relatively inexpensive.


So how long will it last? Sculptra has been known to last 2 years PLUS. Fat, after trasnplantation to the face, is generally permanent after six months, with most patients retaining 40-50% of the fat that is grafted.

In our San Diego practice, a "liquid facelift" is generally topped off with a "Total FX" fractionated skin resurfacing treatment. In this way, the refreshed, volume enhanced face receives a new, smooth layer of skin. The Total FX treatment removes lines, wrinkles, scars, hyperpigmentation, and tightens loose skin. The overall look is amazing, and in many cases rivals a surgical facelift.

When considering a liquid facelift, it is important to consult with a board certified facial plastic surgeon who will examine your face and tell you if you are a good candidate. If you truly need a surgical lift, this may still be the best option, and save you substantial money on fillers. Remember, a "Mini Lift" can be performed with no general anesthesia in about 1-2 hours.

Labels: fat grafting, juvederm, liquid facelift, radiesse, restylane, san diego, sculptra

Many patients have expressed confusion about the differences between Total FX, Active FX, and Deep FX skin resurfacing, so I'd like to clarify a few things.

All these names refer to treatments performed with the same laser- the Ultrapulse CO2 Laser from Lumenis. Active FX is the term coined to refer to a frationated treatment with a 1mm spot size. Active FX allows for quick healing, minimal risk, while still achieving excellent skin contraction and tightening and removal of brown spots and sun damage. Deep FX refers to a fractionated treatment with the 120 micron (smaller) spot size, which penetrates deeper into the skin, enabling treatment of deeper scars, wrinkles and irregularities. Because of the smaller spot size, deep fx is not as effective for superficial brown spots. For that reason "Total FX" combines one pass each with each of these different spot sizes, theoretically providing the best of both worlds.

So what kind of results have we seen?

The look and feel of skin after a Total FX treatment is truly impressive, and our patients have been very satisfied. I believe that for patients with moderate skin laxity and wrinkles- Total FX is a great choice.


I advise patients not to be too concerned about the "name" of the treatment they receive. We customize all laser treatments to the patient: to their desires, their skin quality, and the downtime they want. The best choice will be made after a comprehensive consultation in our office.

Labels: active fx, deep fx, laser resurfacing san diego, san diego laser, total fx

At the recent meeting of the American Academy of Facial Plastic Surgery in San Diego, CA there was some discussion regarding facelifts and smoking.

Conventional wisdom states that nicotine and facelifting are not good partners. This is because nicotine constricts (makes smaller) the blood vessels supplying the skin. During a facelift, the skin is temporarily "lifted" away from the deeper tissues (including the blood supply) so that it can be redraped following tightening of the deeper tissue. In non-smokers and otherwise healthy patients this temporary separation of the skin causes no harm- there is still plenty of collateral blood flow. In smokers, this collateral blood flow is limited, raising the risk of inadequate blood flow to the skin edges.

Inadequate blood flow carries a certain risk for slow healing, and skin complications. A worst case scenario can be prolonged healing and poor scars that require revision.


Most plastic surgeons attempt to reduce this risk for smokers by encouraging them to quit. Generally two weeks of no smoking prior to a lift, and one week after will put patients in a "safe zone" for healing. Occasionally, patients are unable to quit completely prior to surgery and that is where the patient and surgeon need to sit down and have a frank conversation.


Patients who are "light smokers" (less than 1/2 pack per day) can often be safely treated with a "mini facelift." This involves shorter skin flaps, with less stress on the small blood vessels. However, the surgeon should be highly experienced and skilled in face lift procedures to perform this procedure safely and still achieve a good result for the patient. Most importantly, the patient needs to have realistic expectations and understand that they are still at higher risk than a non-smoker for healing complications. If I feel that my patient doesn't accept this, or doesn't understand the risks of smoking, I will not operate. Also, if I feel I cannot safely give the patient what they want- I will not operate. As with all cosmetic surgery, communication between the plastic surgeon and patient is the key to a happy outcome.

Labels: facelift, mini facelift, plastic surgeon, san diego, smoking

Hispanic, Asian, or African American patients who are active candidates for rhinoplasty or just thinking about having a nose job often have a similar complaint: My bridge is too low!

It is important to differentiate those ethnic rhinoplasty patients whose bridge and profile fit their other features and thus appear "natural" from those whose bridges are too low even for ethnicity. These latter patients' appearances can be greatly improved by augmenting or building up the bridge of the nose. Unfortunately, not every nasal surgeon is skilled at building the bridge up in a natural, long lasting, and attractive way. I often see ethnic rhinoplasty patients who have had surgery elsewhere and are not pleased with their bridge augmentation. Reasons range from visible or mobile implants, unnatural shaped implants, to poor bridge/tip proportion. It is very important to match the tip height (or projection) to the bridge height!

Revision rhinoplasty for ethnic patients can be complex due to the need to replace a pre existing implant, which may require dissecting through scar tissue around the implant. However, thick skin generally is a plus for allowing a smooth contour in the nose following the revision.


Silicone implants are a fairly common cause for revision bridge surgery in these patients. Silicone is difficult to sculpt, which can lead to noticable edges under the skin. In addition, it can sometimes form a capsule around itself, preventing the implant from sticking to the underlying bone and cartilage. Finally, silicone may occasionally extrude through thin skin especially if the implant is too long.

Endogenous cartilage from the nasal septum, ear, or rib can be used for bridge augmentation, however I have found gortex to be very useful in this capacity. Gortex tends to adhere nicely to the bone is very easy to sculpt and contour for a natural, long lasting appearance.

Labels: bridge augmentation, ethnic rhinoplasty, nasal bridge implant, nose job, rhinoplasty