(603) 775-7444
137 Portsmouth Avenue Stratham, NH 03885
(603) 775-7444

Plastic & Cosmetic Surgery Skin & Laser Center

January 2018

Facial Fat Transfer: what is it and how can it benefit you?

Fat transfer remains a valuable option for patients desiring a more natural improvement in facial contour and fullness.

Why? 

Fat transfer uses your own tissue as a graft to improve facial volume and contour. Often patients are seeking facial and dermal fillers which provide temporary improvement at a significant cost with side effects such as delayed swelling or an unnatural look. Fat transfer is an alternative that reduces these complications (although it has it’s own risks ). Fat can be transferred into the cheeks, cheek bone area, temples, eyelids, lips and lower face (marionette lines).

How?

Fat is harvested from your abdomen or hips using local anesthetic It is then processed and transferred to small syringes which are used to inject the fat into the desired areas. The procedure can be done under local or general anesthesia depending on patient and surgeon preference.

Fat is transferred as a graft. This means it does not have its own blood supply, and the expectation is that it will develop its own blood supply in order to become permanent. Some of the fat will not survive. Typically patients can expect 40 – 50 percent of the fat to survive the transfer process. Once the fat has taken, the result is permanent. This is in contrast to most dermal fillers which are temporary. In general, fat that does not take simply disappears. Rarely, it can form lumps or calcifications.

Learn More. 

Contact us today and schedule a consultation with Dr. Zeff to determine the best approach to provide natural correction to facial volume loss.

All about lip lines and how to get rid of them.

 

 

 

Lip lines are one of the more common complaints in our practice. Here’s our recommended treatment plan to best get rid of them.

 

 

Successful lip line treatment is multimodal. This means no single treatment will provide the correction desired but rather a series of treatments will be required to obtain the best result. Lip lines are best addressed with (1) Filler, (2) Botox® or Dysport® and (3) Resurfacing.

 

Filler – Volbella® and Restylane Refyne®

 

Wrinkle formation is a complex interaction of structural tissue support and muscle pull on the tissue. Filler addresses issues of structural support. New fillers such as Volbella® and Restylane refyne® are specifically designed to provide this support in areas with significant movement such as the mouth. Filler is placed directly in the lip lines and underneath them to return the support that was present in youth. In our practice we frequently use Volbella® in the aging lip. This product spreads uniformly with low risks of lumps and does not provide excessive volume to the lips. Additionally, the water attracting nature of Volbella® provides an almost internal lip gloss. Volbella® can last up to a year after injection. Patients who are interested filler to the lips should avoid any medication that can increase bleeding risk. Patients should also do this on a day when they do not have any special events planned – lip swelling can last for 48 hours.

 

 

 

Neuromodulator – Botox® or Dysport®

 

Botox® or Dysport® block muscle movement around the mouth. Muscle contraction is the predominant reason for lip lines. Injection around the mouth is difficult and requires experience. Small amounts of neuromodulators are needed to have sufficient effect and reduction in wrinkle formation. Patients fall into two categories with respect to the treatment: love it or hate it. Some patients feel as though it affects the way they speak, making them self conscious. Typically, neuromodulators last approximately 2 to 3 months around the mouth.

 

 

Resurfacing – Microneedling, Ablative Laser, Chemical Peel

 

Resurfacing removes the top layer of skin but more importantly stimulates collagen production in the dermis. This collagen production reduces wrinkles and provides structural support much like filler. Microneedling is the least aggressive while a phenol peel and fractional laser are the most aggressive. More aggressive treatments result in more impressive results but have longer downtime.

 

 

Ultimately, all three treatments, filler, neuromodulator and resurfacing should be used in combination to treat pesky lip lines. Schedule your consultation today to meet with our surgeon to discuss your treatment plan.

Let’s Talk About Facelift

Anyone considering a facelift undoubtedly has many questions as to the nature of the procedure and the associated downtime. Here we hope to address some common questions and concerns.

1. What exactly is a facelift?

The facelift is well recognized as the gold standard of facial rejuvenation. Like many procedures, the term facelift has broad meaning that varies according to a surgeon’s technique and aesthetic. In general terms, a facelift refers to the lifting and tightening of the facial skin and underlying connective tissues and muscles (called the SMAS).  There are many ways of approaching the skin and the SMAS, and each surgeon masters techniques that work best for him/her.

It is important for you to discuss your goals with your surgeon. Some patients desire a more pulled look while others desire a more natural and subtle rejuvenation.  Different techniques can yield the results that you desire.


Before

Before

After

After


2. Can I achieve the same results with filler or Botox?

Botox and filler are great adjuncts in the treatment of facial aging; however, they will not provide the same lift as a facelift nor do they offer the same longevity.

In our practice we focus on a fill and lift technique. We often combine the tightening advantages of a facelift with volumizing effects of fat injection using your own fat tissue. This filling enhances youthful rejuvenation especially of the cheeks (also known as your malar region).

3. How long will my recovery be?

Patients are often surprised by how quickly they recover following a facelift.  We tell our patients to expect to have mild to moderate bruising for one week and mild swelling for up to two weeks.  Most people feel comfortable going out to eat and driving their car at the one-week point, but prefer not to truly socialize until the two-week mark. 

There will be stitches in front of and behind your ears. These stitches are removed in stages with the first set of stitches removed at about one week and the second set at about two weeks.

4. What are the risks of a facelift?

The main risks associated with facelift are injury to a nerve, hematoma or bleeding, difficulties healing, and the possibility of dissatisfaction. 

There are many things you can do to limit your risks. It is important not to take blood thinners such as aspirin prior to your surgery and to make sure you have good control of your blood pressure. Furthermore, smoking has been associated with significant complications in facelift surgery. In our practice, we do not offer this procedure to smokers.

With respect to dissatisfaction, patients must manage expectations and understand that it is impossible to predict how long the results of a facelift will endure. Some patients can expect 10 or more years of consistent lift, while others somewhat less. The longevity is primarily dependent on skin elasticity, which is a function of genetic makeup and environmental exposures.

5. What else can be done at the same time as a facelift to maximize my results?

While a facelift can dramatically improve the laxity of the face and the restoration of youthful shape, it does not necessarily address the texture of the skin itself.  Fine lines and areas of discoloration often require resurfacing procedures. Deep facial resurfacing can address issues of hyper-pigmentation and wrinkles, particularly around the mouth. In addition, rejuvenation of the eyes (blepharoplasty) is also often considered.

To learn more about the facelift and mini-facelift options in our practice, call (603) 775-7444 and schedule your consultation today.

What’s the hype about Volbella?


Volbella is an FDA approved ultra smooth gel filler from Juvéderm that is used to decrease lines and wrinkles on the face.  The smooth formula is injected with fine needles to give the lips a natural look and feel.  Volbella is developed with lidocaine, a local anesthetic, so that treatment is less painful and uncomfortable.  It is primarily used to target the areas around the mouth, such as smoker’s lines and marionette lines, and to shape and plump the lips for increased symmetry and volume. It can be used to reduce the appearance of under eye hollows, also known as tear troughs, by adding volume back to the areas where it may have been lost due to aging.

The procedure typically takes no longer than 10-15 minutes.  Since the swelling and bruising is minimal, there is very little downtime following the treatment. The results of Volbella often last for up to 12 months.  Call our office to schedule an appointment with one of our specialists.


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What Our Patients Are Asking About Facial Enhancement Procedures

What are the best alternatives to a face lift?

Generally, there are no equal substitutes.  Every alternative does something different. A facelift tightens the skin of the face and neck as you might do with your fingers by gently pulling back towards your ears. This takes away excess skin and most wrinkles but doesn’t alter the actual texture of the skin. Injectable fillers can fill out indentations or creases but can’t compete with facelift with regard to tightening or restoring more youthful lines. >BOTOX® Cosmetic simply stops the undesirable creases associated with some facial expressions.

What is the best treatment for under eye wrinkles?

When very subtle, these lines might respond to topical creams. For more severe lines especially when associated with bulging and excess skin, surgical options include blepharoplasty and laser skin resurfacing.

What’s the difference between popular wrinkle fillers? There are so may “wrinkle fillers” like Restylane, Juvederm, etc.  How can I pick the right one?

Restylane and JUVÉDERM are very similar products manufactured by two different companies. It’s generally a question of personal preference. Fillers can differ in how long they last and how effective they are for different areas.  What’s effective for lip enlargement might not be best for a crease.