Botox Cosmetic and Dysport are terrific, long-lasting, office-based treatments that erase wrinkles and frown lines in the forehead and upper face. Frown lines in the forehead and wrinkles around the eyes develop from over activity of the underlying facial muscles. Botox Cosmetic and Dysport temporarily relax those muscles and soften or erase the offending wrinkles for up to four months. The injections take effect within three days of treatment.

Beautiful and natural results are the ultimate measure of success in Botox Cosmetic treatments. Injections should eliminate the serious or tired look that comes with wrinkles without causing you to lose expression in your face. By combining clinical knowledge with an artistic vision, your treating physician can give you results that complement your face without compromising your expression.

FREQUENTLY ASKED QUESTIONS REGARDING BOTOX COSMETIC OR DYSPORT

Can I apply makeup after Botox injection? Yes. Botox treatments involve a few injections with a very small needle. Patients can apply makeup and return to work immediately.

Do I see the effect of Botox treatment immediately? No. Botox Cosmetic and Dysport injections take up to three days to take effect.

How painful is the Botox injections? Botox injections are usually tolerated very well. We use topical numbing creams to minimize any discomfort. Some patients prefer cooling of the skin with an ice pack, and some prefer no pre treatments at all.

Can I exercise after a Botox injection? Yes. Physical exercise or facial movement does not impact effectiveness of Botox injections.

I had Botox injection but I don’t see an effect. What could be wrong? In order for Botox treatments to be effective the correct dose of the medication needs to be injected into precise locations in the face. In this case, either too little Botox was used, or Botox was not injected into the correct muscle site. Additional amounts of Botox can be injected to achieve the desired effect.

Can I get Botox to get rid of the lines that form between my nose and the corners of my mouth? Those lines are known as nasolabial folds or melolabial folds. Botox will not be effective for this problem. Injectable fillers such as: Retylane, Juvederm, Scupltra, or Radiesse can help soften these folds.

Does Botox get rid of under arm sweating? Yes. The FDA has approved Botox for treatment of excess under arm sweating. The injection method is different for this indication. In this case, the Botox is injected into the skin, where the sweat glands are located, not into the underlying muscles.

Can I have Botox and filler injections during the same visit? Yes. Botox and filler injections can be complimentary for enhancing your facial features and revitalizing the face. The treatments are often performed simultaneously.

Related procedures:

Botox injections help smooth frown lines and the wrinkle lines around the eyes. Complementary office procedures to help soften lines depressions or folds include filler injections such as Retylane, Juvederm, Scupltra, and Radiesse. Otherwise, more permanent surgical procedures to rejuvenate the face include: blepharoplasty (cosmetic eyelid surgery), fat grafting or fat transfer, and facelift surgery.

A well recognized component of facial aging is loss of fat volume. This loss results in a sunken, hollow appearance to the face, which may be difficult to describe, but is easy to recognize. The face looses its round contours and sharp demarcations develop between different regions of the face. Volume augmentation is a large component of comprehensive facial rejuvenation.

Facial volume restoration can be achieved in several ways. There are many commercially available injectible fillers to augment the face. Products such as Restylane, Juvederm, Scupltra, and Radiesse are now a part of the popular culture lexicon. Although these fillers are easy to administer, they lack permanency. Fat grafting is a permanent technique for restoration of facial volume, and an attractive alternative to the commercially available facial fillers.

Dr. Khosh performs fat grafting in Manhattan, as an office based procedure. Small amounts of fat is gently harvested from the lower body, prepared carefully, and then meticulously injected into appropriately chosen areas of the face. Fat transfer can be used to enhance the appearance of the cheeks, brow, temple, and the orbital regions. Patients notice not only improved facial contours, but also more vibrant and healthier skin. A secondary benefit that has been postulated to be due to growth factors or stem cells present in the fat graft.

Historically, procedures for rejuvenating the face have entailed surgical treatments designed to remove excess fat or skin, and elevate or suspend descending tissues. In the last two decades, great strides have been made in non-surgical facial rejuvenation techniques. These advances were guided by our increasing understanding that facial aging involves not only gravitational descent, but also volume loss, muscular over activity, and skin changes. Non-surgical facial rejuvenation entails the use of injectable fillers, injectable muscle relaxing products, and medical lasers. In younger patients without significant skin sagging, non-surgical facial rejuvenation is an attractive alternative to facelift surgery. In older patients, non-surgical facial rejuvenation may not replace surgery, but it can still have a remarkable effect.

The three main components of non-surgical facial rejuvenation are: injectable muscle relaxers (Botox Cosmetic or Dysport), injectable fillers (Juvederm, Restylane, Radiesse, or Sculptra), and skin resurfacing lasers (Fraxel). Botox Cosmetic and Dysport help erase wrinkles in the forehead and the Crow’s feet. Injectable fillers restore volume to highlight the cheeks, plump the lips, rejuvenate the lower eyelids, and erase the naso-labial folds, the marionette lines, and the jowl folds. Resurfacing lasers restore tone, color, and elasticity to the skin.

revision rhinoplasty

 

How soon can I have revision surgery after a rhinoplasty? The general answer is six months. There are two main reasons for this timing. First, the effects of rhinoplasty take that long to settle. Second, scar tissue from the first operation needs time to mature and soften. Sometimes that timing may need to be moved up or sown depending on the patient and the anatomic findings.

How many times can revision rhinoplasty be repeated? It is best to have as few procedures as possible. Each revision rhinoplasty can induce further skin damage, or scar formation. When revision surgery is delayed, the skin has a chance to heal, and scar tissue softens and thins out. Most patients can tolerate three operations on the nose without significantly increased risk.

My nose is still too big after rhinoplasty; can revision rhinoplasty make my nose smaller? Probably yes, but a physical examination will be necessary. In some patients, skin thickness in the nasal tip limits reduction in size. I use computer imaging to demonstrate likely outcome from revision surgery to the tip.

I had rhinoplasty, and now the tip of my nose looks round and unrefined; can this be fixed? There are two main causes for such development: scar formation and/or poor nasal tip cartilage support. In revision rhinoplasty, both problems can be addressed. Frequently, cartilage grafts will be placed to add definition and support to the nasal tip region.

My nostrils look too big after rhinoplasty; can you fix this problem? Excess nostril show is often due to over rotation of the nasal tip. In revision rhinoplasty, the nasal tip can be rotated down to eliminate unappealing look. Sometimes, reducing the size of nostrils can alleviate such problems.

Rhinoplasty made my nose too small; can my nose be made larger? Revision rhinoplasty is often sought to restore an overly reduced, “operated looking” nose. In these cases we employ cartilage grafts or implants to replace missing structure.

Where do you get cartilage to repair my nose during revision rhinoplasty? The best source of cartilage for revision rhinoplasty is septum cartilage from inside the nose. Unfortunately, due to prior surgery, there may not be adequate cartilage available from inside the nose. Other sources of cartilage include: the ear, cartilage from your rib, or cadaver rib cartilage.

If ear cartilage is used for my revision rhinoplasty, will my ear look different? Will my hearing be affected? We harvest ear cartilage from a totally hidden incision behind the ear. By removing cartilage only from designated areas, the shape of the ear will be undisturbed. Your hearing will not be affected after cartilage removal from the ear.

How do you take cartilage from my rib? We make a small incision over one of the lower ribs, near the midline of the chest. In women, this incision can be hidden under the breast. Once an adequate length of the rib is removed, the incision is closed. Most patients stay in the hospital for one night after this procedure.

I am happy to inform everyone that my facebook page now includes photo albums depicting surgical outcome after cosmetic nasal surgery and cosmetic eyelid surgery. This will make it easier for all my facebook fans to review some of my surgical results.

Sculptra is the only FDA approved injectable filler for general facial augmentation and volumization. Sculptra stimulates the body to replace collagen over time, and restores lost volume and helps to fill depressions or hollowness around the face.

Unlike other facial fillers such as Restylane, Juvederm, and Radiesse, the aesthetic results from Sculptra are not immediately evident. It typically takes several weeks to notice the improvement from Sculptra injections. The enhancement is gradual and subtle. It typically requires two sessions of Sculptra injections to achieve the final desired outcome. Sculptra is longer lasting that other facial fillers, and the results usually last up to two years.

We are offering one session of FREE Sculptra injections to a limited number of patients. Interested patients should contact my assistant Betty at 212-262-0056 ext 209 to schedule a treatment.

During a consultation visit for cosmetic upper eyelid surgery, common questions usually arise. I have summarized some of the more common questions that I answer during a blepharoplasty consult:

Who is a good candidate for upper blepharoplasty?

Patients with relatively good health with redundancy and hooding of the upper eyelid skin, with or without prolapsed fat in the eyelid.

Who is a poor candidate for upper blepharoplasty?

Patients with dry eye conditions, or patients with uncontrolled high blood pressure, or poorly controlled diabetes. Additionally, patients who must take blood thinners are poor candidates for upper blepharoplasty.

What kind of anesthesia is used for upper blepharoplasty?

Upper blepharoplasty can be performed under local anesthesia, deep sedation, or general anesthesia. In general, if blepharoplasty is performed as a stand alone procedure, and the patient is not overly anxious, local anesthesia is recommended.

How is upper blepharoplasty performed?

Excess eyelid skin is marked on the skin. Incisions are designed so that the scar would not be visible once the area has healed. Excess skin and or fat is removed, and the skin edges are closed precisely.

When would a brow lift procedure be recommended for an upper blepharoplasty patient?

If clinical examination shows decent of the eyebrow below the orbital rim, brow lifting will have a significant impact in restoring a youthful appearance to the upper eyelids.

How is the recovery from upper blepharoplasty?

There will be swelling and bruising of the eyelids for about seven to ten days. Pain is moderate and most patients feel quite comfortable with use of Tylenol alone. Applying ice and sleeping in a head elevated position will hasten resolution of the swelling. Patients can shower the day after surgery, and apply makeup once the sutures are removed in four to six days.

Does insurance cover the cost of upper blepharoplasty?

If redundancy of the upper eyelid skin is so severe as to interfere with peripheral vision, some insurance companies will cover the cost of upper blepharoplasty, since the surgery will have a functional impact.

Isabella, a fifty-year-old mother of two saw me last year for a dark spot on her cheek that concerned her. Fair skinned and having spent many a summer tanning by the local pool; I recognized her skin lesion to be new and suspicious on clinical examination. A skin biopsy was performed and it was bad news: Melanoma.

Fortunately for Isabella, it was early melanoma detection and subsequent wide local excision with cosmetic reconstruction was expected to be curative.

I see patients like Isabella on a regular basis and the one common thread in their individual stories are that most are fair skinned and they report extensive sun exposure. The damaging effects of the sun on skin are well documented in medical journals and national media. They start out as discolorations, wrinkles, and loss of skin elasticity, and progress to skin cancers such as Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma. Natural skin pigmentation affords a level of protection to skin and therefore, fair skinned individuals are at greater risk of developing complications from sun exposure. Not surprisingly, smoking appears to amplify the harmful effects of sun exposure on skin.

Public health awareness campaigns such as the May Skin Cancer Awareness Month are having a positive impact on educating the general population on the harmful effects of sun exposure on skin. The important thing to note is that indoor tanning is just as harmful as sun tanning, and should be avoided. Skin protection with sunscreens such as Dermelect Sun Protection Treatments will help reduce the harmful effects of sun on your skin. Remember the key is to reapply sunscreen throughout the day, and use SPF20 or greater. For those of you who spent your formative years tanning, I recommend close evaluation of your skin. If you develop any new skin lesions, especially pigmented lesions that show dark color, irregular borders, and uneven pigmentation, consult with your doctor. Early detection of skin cancers makes subsequent treatment and cure much more effective.

Enjoy May and have a great “sun-protected” summer!

Who is a good candidate for a face lift?

Patients in relatively good health who want improvement of jowls or droopy appearing neck. Those with well-developed jaws, high cheekbones, and elastic skin tend to have better results from surgery.

Who is a poor candidate for face lift?

Patients who require blood thinners, or those with poorly controlled blood pressure or diabetes. Face lift operation should not be performed on those who are active smokers. Significantly over weight patients, and individuals with significant loss of skin elasticity tend to have limited results from a face lift operation.

How long will the results from a face lift last?

A better question would be: How many years will a facelift operation take off from your face? In general, face lift surgery will make you look ten to fifteen years younger.

Where do you make the incisions for the face lift?

The incisions start in front of the root of the ear and extend inside the ear, then reach around the attachment of the earlobe to the face, and finally curve behind the ear. Occasionally the incision behind the ear is extended onto the scalp skin. Once fully healed, the incisions will be unnoticeable. 

What can I expect during recovery from a face lift operation?

Your face will be wrapped with cotton and gauze dressing for one day. Dr. Khosh will remove the dressing after a day and supply you with a special Velcro bandage to be worn for one week. You may shower on the second day after surgery. Most patients do not require narcotic pain medication past the third day. Sutures are removed on the fifth and tenth post-operative days. Bruising and swelling, will last for about fourteen days. You may feel tightness in the neck and numbness around the incisions. It will take many weeks to achieve the final results, but most patients can return to full social and physical activity at three weeks.

How does a chin implant enhance a face lift operation?

It is not uncommon that as a result of aging, there is loss of bone mass from the lower and upper jaws. Volume loss in the lower jaw can exacerbate fullness in the neck. A chin implant adds definition to the jaw and improves the face lift results in the neck.

Do I need a brow lift, if I have a face lift done?

A face lift operation will rejuvenate the mid to lower face, and the neck. People who have descent of the brow will benefit from brow lift to rejuvenate the upper face. The two procedures can be performed during the same operation. During a face lift consultation, Dr. Khosh will examine you and discuss the suitability of a brow lift in your individual case.

The Allergan company has introduced a new injectible facial filler to the market that addresses the main area of concern for most patients: pain during injection. The new formulation of Juvederm has lidocaine (an anesthetic) mixed with the hyaluronic acid (the active molecule that gives the cosmetic benefit).

Hyaluronic acid products are currently the most widely used form of dermal injectibles used for treatment of lines, wrinkles, and depressions in the face. The addition of anesthetic makes filler injections more comfortable. The suffix “XC” indicates xylocaine (lidocaine). Both formulations of Juvederm (Juvederm Ultra, and JuvedermUltra Plus) are available in the XC formulation. Juvederm Ultra and Juvederm Ultra Plus last an average of six and nine months respectively.

Hyaluronic acid products and other dermal fillers can be used for non surgical facial rejuvenation in areas such as the nasolabial folds, frown lines, and depression below the eyes, and marionette lines. These fillers can also be used to augment the cheeks and the jaw, and to camouflage jowls. Dermal fillers can also be used for non surgical rhinoplasty.