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

Plastic & Cosmetic Surgery Skin & Laser Center

July 2017

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.





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.

Dr. Richard Zeff Organizes Surgical Trip to Haiti

Despite Haiti no longer being front page news, the Haitian people continue to face overwhelming health challenges as they try and recover from the catastrophic earthquake that struck their homeland on January 12, 2010. The human loss and suffering has been tragic and is ongoing, which is why we are excited to announce that six of us will be travelling as a surgical team to provide much needed specialized plastic and reconstructive procedures to the victims of the quake. Our travel has been facilitated through The LEAP Foundation (a non-profit 501 (c) (3) organization) which has provided a continued surgical presence since the first relief planes were allowed to land in Haiti. Although LEAP has made the arrangements for this trip, there is a cost associated. Each team is responsible for their expenses of airfare, housing, and transportation in Haiti, as well as the supplies and medications to cover 50 cases for their week.

Like most of you, we have always wanted to help when disasters like this occur but often wonder how much of our contribution actually goes to the suffering. Now we have the opportunity to assure that any donations go directly to the needs of the Haitians. We are donating our time and skills and team members will bring limited personal affects as carry-ons, allowing each of us to check 100 pounds of desperately needed medical equipment.

Here’s how you can help. If you would like to help support us financially (no amount is too small), 100% of donations will be applied towards funding medical equipment and supplies for our team’s trip. Donations can be made directly to the LEAP foundation via their website: www.leap-foundation.org, or via mail to: The Leap Foundation, P.O. Box 7452, Dallas TX 75209. It is important to reference “Dr. Zeff” and “May 23” in the comments or memo section. Checks can also be given to our front office and we will forward them to LEAP.

We are grateful for this opportunity, and want to thank you in advance for your support!

Dr. Richard Zeff’s Team

What Our Patients Are Asking About Breast Enhancement Surgery

1.  How do I choose the right breast implant size?

I’ve found that the absolute best way to select implant size is to try on sizers in the office.  Sizers reproduce the exact shape and feel and when worn under clothing will accurately reflect post op size making size selection very easy.

2.   Breast Implants and Breast Lift after pregnancy? How long after pregnancy should I wait before I can get breast implants and undergo breast lift?

When you are no longer nursing and your breasts stop changing, you can consider breast lift and/or augmentation.

3.    Which breast implant placement gives a more natural appearance? When getting breast implants, what gives a more natural appearance, going under or over the muscle?

I prefer using smooth round implants. My philosophy is that all women already have an inherent breast shape, and they simply want to enhance that shape with larger breasts. Therefore, I don’t use anatomic or shaped implants for cosmetic enlargement.  Because the pectoralis muscle serves as an internal bra, placement under the muscle provides addtional support giving the breasts a perky, but natural look.

4.    Breast implants – How long do they last? When should you replace them?

No one really knows how long they will last. Every patient should expect that they will need to be replaced.  The companies warranty the implants for life. I see no reason to replace the implants at a predetermined time unless there is an issue or problem.

5.    Should I get breast implants if I plan on getting pregnant later? Is it recommended to have breast implants before having a child? How will the breast look after breast feeding?

Getting breast implants prior to pregnancy or breast feeding simply gives a larger starting point.  Whatever pregnancy and breast feeding will do is essentially unaffected except that you will still have the implants when it’s over.

What Our Patients Are Asking About Liposuction

1. What should I ask my doctor during a liposuction consultation?

  • Is there a safe limit to how much can be removed?
  • How well will my skin respond to the procedure?
  • What are reasonable expectations?

2. Is traditional liposuction outdated? With all of the new lipo procedures out there – tumescent, laser-assisted, ultrasound-assisted, and even fat-dissolving injections – is there still a place for traditional liposuction?

Traditional liposuction is still the gold standard.  Most of the newer techniques  are a variation of or an adjunct to traditional liposuction.  Tumescent simply refers to the amount of numbing fluid that is injected prior to the actual liposuction.  Laser and ultrasonic are enhancements that in most cases don’t alter the final result to any significant degree.  Your choice of surgeon is definitely more important than your choice of technique. His or her results should speak for themselves.

3.  Does liposuction in one body area make another get fatter?The Mayo clinic posted the statement that “It’s possible that if you remove fat cells from one area with liposuction, you may gain less weight in that area, but you’ll gain more in another area of your body.” Have you seen this with your patients? Please explain!!

Fat cells don’t move around.  They simply get larger or smaller with your body’s fluctuations.  The distribution or number of fat cells in different areas of your body give you your shape.  By removing fat (cells) from specific areas, we are deliberately altering your shape.  Weight gain following liposuction means that fat cells enlarge according to this new (hopefully better) distribution.