Cosmetic Procedures by Indianapolis Monthly

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cosmetic

procedures 88 IM | APRIL 2014

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by Shari Held

Preferred procedures Cosmetic surgeons share their techniques of choice—both surgical and non—for a variety of common problems

It seems like new cosmetic treatments appear almost daily, each claiming to be better than the last. You know how you want to end up looking, but the best means of getting there can be confusing. “Rather than coming in with a onesize-fits-all or I-want-to-do-this approach, it’s more important to make the proper diagnosis,” says Michael Sadove, M.D., of Meridian Plastic Surgeons. “What is the underlying problem? What are my options to address it? What kind of downtime will there be?” To simplify the process, we’ve asked local experts for their recommended cosmetic procedures to remedy several common complaints. Sun or age spots on the face “The best thing from my standpoint is intense pulsed light [IPL] therapy,” says Mark Hamilton, M.D., of Hamilton Facial Plastic Surgery. “It is very low risk and has fairly minimal discomfort and minimal downtime.” This treatment delivers broadband light to the skin’s surface. On average, three sessions are necessary to reduce brown age spots and red spots, and IPL

is the procedure of choice to treat isolated spots for all of our experts. “The second treatment level would be a chemical peel,” says Stephen W. Perkins, M.D., of Meridian Plastic Surgeons. This is a chemical solution applied to the skin that produces a peeling or sloughing reaction. “There are different percentages,” Perkins says. “An aesthetician can do up to 20-percent trichloroacetic acid [TCA] chemical peel, while I do 35 percent. The patient is under anesthesia, and it takes longer to heal, but it definitively removes the brown spots and some of the wrinkles.” If a large area of the face is affected, Sadove recommends a full-face CO2 laser, a treatment that “vaporizes” the damaged layers of skin. “I usually use the laser on the face and then use a chemical peel to taper down to the neck and the decolletage area, so there isn’t any cutoff line when you look at the patient,” Sadove says.

Sagging neck and jowls Several non-surgical alternatives (like Ultherapy, Exilis, and Viora Reaction,

to name a few) are available to tighten facial tissue. Viora Reaction is a Federal Drug Administration–approved device that uses radiofrequency [RF] energy to stimulate new collagen production and reduce the size of fat cells. Different RF treatment modes and handpieces on the Reaction machine target tissue at various depths. One, Viora ReLift, is specifically for contouring the jaw line. “The nice thing about Viora is there’s no downtime with it, and it’s virtually painless,” says Kim Espich, aesthetician and owner of Kurr Aesthetics & Medical Spa. “You do need to be consistent with your treatment when you’re going through the protocol.” Count on from one to eight treatments to achieve effective results. “The problem with all these non-surgical technologies, even though we use them because some patients don’t want to do surgery, is the results are extremely variable from one patient to the next,” Perkins says. For optimal results, cosmetic surgeons agree that nothing beats a surgical facelift (tightening the underlying musculature and jowl tissue, liposuctioning the APRIL 2014 | IM 89

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“You can go to work or drive the kids to soccer practice, but you don’t want to work out when you are trying to heal.” Michael Sadove, M.D., Meridian Plastic Surgeons

When exercise isn’t enough, there are several procedures to help slim down the midsection. 90 IM | APRIL 2014

extra fat, and redraping the skin). “It provides a more dramatic improvement, it’s more consistent, and it will stand up a lot longer,” Hamilton says. Downtime is 10 days to two weeks, although Hamilton says sometimes using mini-lift techniques and fibrin sealants can shorten the healing process. “I actually had a patient go to a job interview on day nine after a mini-lift,” he says. “But most people should count on two weeks.”

Stubborn hip/waist/tummy fat Espich recommends Viora ReFit to tighten skin, as well as reduce fat-cell circumference. “With the handpieces on this machine, we can target both so you aren’t left with sagging skin once you reduce the circumference,” Espich says. Another handpiece helps reduce cellulite by stimulating the circulatory system. By varying the handpieces used, Espich can customize the treatment for each individual. Viora ReFit works by using RF

energy to heat the body’s core temperature to 100.4 degrees. After 10 minutes, your fat cells release triglycerides, the culprits responsible for making fat cells round. There’s no downtime, although you might experience some bruising with the first few treatments, and results will take time to appear, depending on the client. “It’s effective, but you have to be patient and realistic,” Espich says. For Sadove, traditional liposuction (removing excess fatty tissue) remains the gold standard in the treatment of stubborn waist, hip, and tummy fat. For the most effective results, he recommends tumescent liposuction, which uses local or general anesthesia and reduces bleeding and bruising, and ultrasonic liposuction for more fibrous tissues. There’s no real downtime as far as normal daily activities. Though you’ll be sore the next day, you can wear a compression garment to control swelling. “You can go to work or drive the kids to soccer practice, but you don’t want to work out when you are trying to heal,”

Do Your Eyes Need a Lift? Your eyes tell a lot about you: your emotions, alertness and even your age. Heavy eyelids, fine lines and drooping skin can create the unwanted look of fatigue and poor health. Blepharoplasty restores and rejuvenates your overall appearance by creating a natural, well-rested look to your eyelids. Complementary procedures such as fillers, skin peels and Dysport速/Botox速 can enhance the results of eyelid surgery to create a rejuvenated appearance without adding to your recuperation time. To learn more about what blepharoplasty can do for you, schedule a consultation with double board certified facial plastic surgeon Burke Chegar, MD.

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Sadove says. “Increasing your metabolic activity increases swelling and slows down the time it takes to get that result.”

Older-looking hands

Various non-surgical techniques can remove hands’ age spots or prominent veins.

When you decide to roll back the clock, you may look no further than your face. But don’t neglect your hands. They age, too. And when your face and hands don’t match, you look out of balance. For brown spots on the hands, Sadove recommends a laser treatment or a chemical peel. For hands where the soft tissues have atrophied, making the bones prominent, he likes using a hyaluronicacid ﬁller, such as Juvederm, Restylane, or Perlane. “A fat injection in the hands is another option,” Sadove says. “It’s more longlasting.” For prominent veins, Sadove recommends sclerotherapy (injecting chemicals into the veins) or removing the veins through small incisions. “You have to determine which is the greater presenting problem,” Sadove

Enhancing Self Esteem and Appearance His peers have selected him for Best Doctors in America and the Top Docs award by Indianapolis Monthly. Readers of Nuvo magazine voted him “Best Plastic Surgeon”. Colleagues and patients know that expertise makes a difference. Dr. Sadove’s adult practice consists of cosmetic surgery of the face and torso. Facial procedures: • Facelift • Eyelid • Nose reshaping • Laser surgery • Botox/Injectables

Torso procedures: • Breast surgery (enlargement, reduction, lift and reconstruction) • Tummy tucks • Liposuction

Dr. Sadove is dedicated to providing his patients with both the highest level of expertise and unsurpassed personal care. A. Michael Sadove, M.D.

A. Michael Sadove, M.D.

170 West 106th Street • Indianapolis, IN 46290 317-575-0330 • 800-345-1962 • MichaelSadove.com

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says. “Sometimes it’s a combination of all of them.” For a less-expensive option, Espich recommends Glytone by Enerpeel, a chemical-exfoliation peel created specifically to plump tissue and reduce hyperpigmentation in the hands. “It gives an overall rejuvenated look,” she says. “It’s an affordable option, and you’ll see a result after three treatments.”

Deep facial lines With this condition, it’s a matter of how deep they are, how much downtime you can afford, and how long you want the effect to last. Smile lines respond nicely to injectable fillers. “Restylane or Juvederm work very well,” Perkins says. “They are time-proven and last about seven or eight months. Radiesse lasts a year to a year and a half, and Artefill is a much longerlasting filler we’ve been using recently.” For vertical lines around the upper lip and lip border, you’ll need something more invasive. Perkins recommends a

Remedy facial lines with injectable fillers, laser treatments, or dermabrasion.

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Need an eye-opener? Upper or lower blepharoplasty helps tighten skin and reduce puffiness.

You’ve earned your stripes …

laser treatment (about seven to 10 days healing time) or dermabrasion (roughly 10 to 12 days of recovery) to resurface the skin and eliminate deep lines. “In terms of reducing deep wrinkles, I don’t have anything that is more consistent and dramatic as an ablative CO2 laser,” Hamilton says. There are concerns with it, however. Downtime is signiﬁcant—one-and-a-half to two weeks before you can apply makeup—and the skin remains pink for another two to two-and-a-half months, making it necessary to stay out of the sun. Long term, it can lighten the skin. And CO2 laser procedures are an option only for lightskinned people. Espich uses Dermapen, an adjustable microneedling technology that stamps the skin and can be administered via a series of less-aggressive treatments or morevigorous sessions using a topical numbing agent. The technology can be used to treat scarring, texture, pore size, and stretch marks, as well as deep wrinkles. “You don’t have the heat [of a laser] and you don’t have the downtime—if you go really deep you might experience 24 hours

and the chance to start anew.

6 years of waking up with children 12 years of early morning meetings 4 years of nose injuries from high school soccer

day of focusing on yourself

20 years of smiling through tough times

Dr. Taha Shipchandler is your highly skilled expert for advanced facial cosmetic treatments. His personalized treatment options will give you the strength to look and feel your best.

Taha Shipchandler, MD Facial Plastic & Reconstructive Surgery Iuhealth.org/iuhp/facial-plastics

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of redness—but the results are good,” Espich says. “You’ll be hearing a lot more about this in the next couple of years.”

“Often the problem is darkness under the eyes,” Espich says. “Doing some IPL treatments can brighten that area underneath the eye and plump the tissue. For upper-eyelid sagging, you have to get more aggressive. We like to combine different therapies—CO2 laser, Viora Skin Tight, and Botox—to achieve the best effect.” As is typical with laser treatments, you’ll have three or four days where you need to be careful with what you put on your skin, she says. Hamilton uses Viora Reaction to gain subtle tightening in the upper and lower eyelids for people who don’t have the time or desire for surgery. “But if you have a fair amount of extra skin and puffiness in the eyelids, there is still no better way to correct that than surgery,” he says. Upper or lower blepharoplasty removes or tightens extra skin, reduces puffiness, and opens up the eyes. It’s usually done under general anesthesia. Stitches are in for a week, and it’s a week and a half before you can apply makeup, and two weeks before you can get out and about to resume activities. If you have dry eyes, however, you may want to reconsider blepharoplasty. “The surgery makes the dryness worse and that causes the eyes to swell,” Hamilton says. “They’ll feel scratchy. It’s irritating and very noticeable, and in the worst cases it may last for four to six weeks or longer.” Sometimes the upper lid appears droopy because the brow line has shifted south. In that case, Sadove suggests stabilizing the brow to its original position: above the orbital bone for women and at the orbital bone for men. “My preferred way to do that is to make an incision through the eyelid and place a fixation device to set the brow into position,” Sadove says. “There’s also the possibility that there is herniated fat around the eyelids that’s giving that tired, puffy look. It can be removed through the same incision.”

ACTUAL PATIENT

Drooping, tired-looking eyes

REFRESHED LOOK, RENEWED OUTLOOK. Discover how to turn back the hands of time by scheduling a consultation with one of Indianapolis Monthly’s Top Docs.

Dr. Mark Hamilton, MD, FACS DOUBLE BOARD CERTIFIED FACIAL PLASTIC SURGEON

BEFORE

AFTER

Patient received a facelift, blepharoplasty and laser resurfacing.

IU Health North Office | South Office | 800.597.3223 | 317.859.3810 | www.hamiltonfps.com

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by Shari Held

Q&A session 9 important questions to help you in the search for a cosmetic surgeon

If you’re considering plastic sur-

gery, one of the most important decisions is selecting the best cosmetic surgeon. You’ll want to do your homework, schedule consultations with several doctors, and ask pertinent questions. After a consultation, the main one to ask yourself is, did I like that surgeon? “Forget their reputation, forget that everyone in town says this is the person to go to,” says Taha Z. Shipchandler, M.D., a facial plastic surgeon with IU Health Physicians. “None of that matters if you don’t like the doctor. You can get a great surgeon, a great experience, a great office staff, and a great outcome. You just have to look for it.” To get started, here are some questions Shipchandler and Burke Chegar, M.D., of Chegar Facial Plastic Surgery, suggest asking during consultations.

What other types of cosmetic procedures do you perform? “This question will give you more information than the typical ‘How many of these procedures do you do?’” Shipchandler says. “That isn’t easy to verify.” If you want a breast augmentation and the surgeon responds that he mainly performs facelifts and tummy tucks, he isn’t for you, no matter how exemplary his credentials may be. If, however, 85 percent of his practice consists of breast augmentation and he occasionally does some liposuction, that’s a good sign.

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“That’s not necessarily a guarantee of optimal results, but the chances are certainly higher,” Shipchandler says. Are you board-certified, and if so, in what? Dive deep enough to get the information you need. “You want to work with someone who is boarded, examined, and well-trained to manage the issues that go along with your particular type of surgery,” Chegar says.

Can I see some recent patient photographs? “If the physician can’t show you a photograph within the last three months, that’s a red ﬂag,” Shipchandler says. You’ll deﬁnitely want to see other patients’ before-and-after pictures by at least the second visit. They’ll give you a better idea of what your own results might be.

Can I talk to one of your former patients? Most reputable physicians have one or two patients you can call. Shipchandler suggests asking them how comfortable they were with the care they received and how easy it was to talk to and ask questions of the physician.

What are the complications and risks associated with this particular procedure? The best-case scenario may wow you, but you need to understand what could occur in a worst-case situation. “Many risks are low from a patient’s perspective,” Chegar says. “But if it’s a 1-percent risk, all it takes is 100 procedures before you expect to see one. So I address it head-on, because I want to make sure people understand.” Individualize this question by asking if there is anything in your particular case that might lower expectations for optimum results or increase your risks.

Can I see my potential result on a photo-imaging system? Most good ofﬁces can take your photograph and morph it to show you an “after” look. “This helps set goals and realistic expectations and get everyone on the

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same page for a procedure,” Shipchandler says. What will the entire procedure cost? Typically, insurance doesn’t cover cosmetic surgery. Since you’ll likely be the one footing the bill, you’ll want to know all the costs upfront, which certainly is possible, Shipchandler says. “You may not get the answer during that visit, but they should be able to call you back in a few days,” he says. In particular, ask if all follow-up care is included in the cost of surgery. Will you be responsible for additional fees if there’s a problem that necessitates prolonged post-operative care or even a second surgery? “There could be hidden costs that you weren’t expecting,” Chegar says. “If it’s a $10,000 procedure, and all of a sudden you receive a second $10,000 bill because you needed to go back for surgery, that’s a signiﬁcant issue.”

Who will I talk to if there’s a problem or if I have a question: you, your assistant, or one of your partners? Having access to your doctor after the procedure is important. “The one thing that is going to make a patient feel conﬁdent that everything is okay is if they see their surgeon and he looks them in the eye and says it’s ﬁne,” Chegar says.

What’s the typical downtime and recovery time for this procedure? And be sure to ask your physician to deﬁne those terms, or follow up with more speciﬁc questions. “There’s often a difference between downtime in a surgeon’s eyes and downtime in a patient’s eyes,” Chegar says. A surgeon may be focused on your wellbeing, while you want to know how long it will be before you’re able to go out and about after surgery. “I always ask if patients have any important events coming up because some people naturally assume they will look good in a few weeks,” Chegar says. “But once the sutures are out, the bruising and swelling still have to come down.”

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