Filler vs. Neurotoxin (Botox, Dysport)

A common question that I am faced with is which is better for a patient: fillers or Dysport. This is a little bit of a trick question. These are both simply just tools for facial rejuvenation. They accomplish different things and they have different indications for using them.

Fillers are for filling static wrinkles. One of the most common examples is the fold that goes from the side of your nose towards the corner of your mouth, the nasolabial fold. Fillers can also be used for volumizing the face. One of the signs of aging is a deflated appearance to the face. As people age their face changes from a more round shape to more triangular. Volumizing the face can help rejuvenate the face. A common filler that is used at the time of facelift is fat grafting. It can also be done independently from a facelift. The other use for fillers is for shaping the face. Fillers such as Radiesse have been, aside from its usual indication for the nasolabial folds and other uses around the face, has also been used to conceal nasal defects.

So while fillers are used to fill wrinkles that are there at rest neurotoxins such as Dysport or Botox are used to weaken the muscles that cause winkles. Wrinkles or facial lines are caused by animation of facial muscles. The wrinkles are usually perpendicular to the axis of the muscle. The muscles on your forehead run up and down thus the wrinkles run across the forehead. The wrinkles between your eyebrows are vertical. The muscles called the corrugator supercilii is perpendicular to this inline with the eyebrow.

Dysport is commonly used by me for the forehead, the glabellar (the 11 between the eyebrows), and around the crow’s feet. Another common use of it is around the mouth for softening lipstick lines.

To answer the question of which is better; fillers or neurotoxin, it just depends on whether you are trying to fill in a wrinkle that is there at rest or weaken a wrinkle that is caused by animation.

Tummy Tuck with Labor

I am occasionally asked to perform a tummy tuck at the same time as a lady gives birth. I certainly understand the desire to combine these two procedures. The lure is that “as long as we are there….”.

There are several very serious pitfalls that make this a very unwise decision in my opinion.

The first is the patient’s safety. Mothers at the time of delivery often have issues with blood clotting. They can either clot too easily or clot too much. There are various reasons for this but the reality is that mothers have an exaggerated tendency to bleed or clot. For safety sake combining this with a procedure that has a small but real risk of deep vein thrombosis or blood clots seems particularly unwise. The last thing I want to do is hurt a brand new mother. Pregnant women also have an altered immune system. This in theory could make them more prone to having wound healing problems or infections. A mother with a new born baby may want to breastfeed and would not want to be on antibiotics should that be needed.

The second reason is that you would get a suboptimal result. There are a couple reasons for this. One is that ladies tend to retain water so their tissue is quite edematous at the time of delivery. This is going to restrict how much skin you can get off and limit the success of the operation. Also, mothers should be given a chance to lose some of their baby weight. This will enhance their result that the surgeon can achieve for her.

Next is that the uterus is also swollen and taking up more space than it will after the lady has recovered from pregnancy. This is going to limit on how tight you can get the abdomen.

Overall I think doing a tummy tuck at the same time as delivering a baby is ill-advised. It compromises the safety of the mother while giving her a suboptimal result. 

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How To Choose A Plastic Surgeon

People often shop for a plastic surgeon. It is not uncommon that a patient will interview myself as well as other plastic surgeons trying to make their decision for surgery. There are several things that an educated patient should look for. There is no perfect filter for finding the right doctor. There are several things that one can look for.

1. Is the doctor a board certified plastic surgeon? There are a variety of doctors that try to pass themselves off as cosmetic surgeons that are not properly trained in plastic surgery. An easy place to check is the American Board of Plastic Surgery (www.ABPLSURG.org). Another place is the American Society of Plastic Surgery (www.plasticsurgery.org).
2. Find a plastic surgeon that you communicate well with. Plastic surgeons can perform a lot of procedures and achieve a variety of results.