Much like its identifiable skyline, Dallas is a city known for the beautiful people who call it home. While the Dallas Look can certainly be imitated, it’s yet to be duplicated. Perhaps this is because the Dallas Look is a recognition we refuse to take lightly. In order to preserve and protect our coveted image, we keep our calendars filled with appointments for the latest beauty enhancements, and we spare no expense on face and body rejuvenation. The costs and downtime for each endeavor are worth it once we’re noticed for all of the right reasons. Cosmetic surgeons and dentists and the experts at the hottest medical spas are ready to join forces with you in the battle against aging. If part of your New Year’s resolution is to give your appearance a boost, then this guide to Image in 2009 is the perfect place to begin. After all, Dallas has a reputation to protect.

 

FACE

 

Fractional CO2 Laser Skin Resurfacing. As our skin ages, it gives way to brown spots, texture irregularity, wrinkles, and laxity. In recent years there have been a growing number of aesthetic procedures to treat the skin. “While traditional CO2 resurfacing has been the gold standard for facial resurfacing and wrinkle reduction, the revolutionary technology of Fractional CO2, with its excellent results and much lower downtime and risks, is rapidly becoming the leader in the field of laser resurfacing techniques,” says Dr. Benjamin Basshichis, a double board certified plastic surgeon in Dallas. “With fractionated CO2, I can provide my patients the unparalleled rejuvenating results of CO2 laser with just a week of downtime. It’s a truly revolutionary addition to my practice.”


 With the Fractional CO2, Dr. Bassichis offers state-of-the-art technology for treating moderate to severe wrinkles, age spots, brown spots, acne scarring, and other facial irregularities. The fractional scientific approach utilizes the body’s natural healing response in a unique way. This innovative technology allows the high-energy beams of laser light to form a grid pattern of tiny laser wounds evenly spaced across the skin. With fractional laser treatments, only a fraction of the skin’s surface is treated by the laser, leaving small islands of untreated skin making the healing process faster and enabling patients to return to normal activities much sooner. In fact, 60 to 80 percent of the skin surface remains untreated. However, with the grid treatment pattern, the heat energy of the laser is able to uniformly heat the collagen layer beneath the skin surface. This is the essence of why this Fractional CO2 technology is so effective–the treatment is fractionated at the skin surface to promote good healing, but has all the power of CO2 underneath to give great results.


This breakthrough in science and technology allows patients to take advantage of the incredible results from traditional CO2 laser resurfacing while greatly minimizing the risks and downtime of traditional CO2 lasers. Within a week there is minimal evidence of having undergone the fractional CO2 procedure outside of having new, tighter appearing, fresh skin that continues to improve over the next several months with formation of new underlying collagen. Fractional CO2 benefits include softening and smoothing lines around mouth and eyes, reduction of wrinkles and deeper frown lines, and restoring skin to a healthy, youthful-looking stage, among others. The results of fractional CO2 laser treatment are long-term and, with proper sun protection, can persist for many years. As well, there is early clinical evidence that suggests that CO2 laser therapy can minimize risk of future development of skin cancers by helping to clear up precancerous lesions caused by excess sun exposure.


Based on your clinical needs, Dr. Bassichis can vary the power of the laser to customize your treatment from a more superficial peel to a deeper resurfacing. Most patients return to their normal routine within the week with make-up. Dr. Bassichis will prescribe a healing regimen to optimize your safe recovery from Fractionated CO2, and maximize your results.

 

 Cosmetic eyelid surgery, blepharoplasty, can improve the appearance of the eyelids, restoring firmness to the area surrounding the eyes to achieve a more rested and rejuvenated appearance. Blepharoplasty can correct loose or sagging skin of the upper eyelid, as well as excess fatty deposits that appear as puffiness, bags under the eyes, droopiness of the lower eyelids, excess skin, and fine wrinkles of the lower eyelids. New procedures cause less bruising and downtime.


Dr. Sandy Sule, a double board certified facial plastic surgeon in Dallas specializing in surgery of the face and neck, says the objective of eyelid surgery should always be to create a natural look. When procedures of the eye are overdone, you risk looking older post surgery. “When it comes to the eyes, you don’t want to be too aggressive with surgery,” Dr. Sule says. “You want to do just enough to look rejuvenated and refreshed. Eyelid surgery is one of the most common types of plastic surgery because it’s one of the first areas where people start to notice signs of aging. I have more patients opting for the surgery in their mid to late 30s as more of a preventive measure. The change won’t be as drastic when you start earlier.”


Although blepharoplasty can be performed as a procedure by itself, Dr. Sule often helps his patients decide whether any additional procedures would enhance the successful outcome of their eyelid surgery, such as a simultaneous forehead lift to correct a drooping brow and smooth the forehead, or skin resurfacing to remove wrinkles in the eye area.


 It’s best to avoid overdoing eyelid surgery as poor results can actually make you look older than you did prior to surgery. By removing too much of the fat around the eyes, the eye sockets can appear hollowed, which can make you look even older. Ideally, most surgeons like to reposition the fat pads around the eyes where there are deficiencies, not completely remove them. For optimal results you want to retain some youthful volume for a natural, refreshed look.

 

 Injectable fillers. Injectable fillers such as Restylane, Perlane, collagen, Juvederm, Sculptra, Hylaform, Artefill, Radiesse, and fat transfer are quick, non-invasive ways to rejuvenate your appearance. Injectibles can plump thin lips, enhance shallow contours, soften facial creases and wrinkles, and improve the appearance of recessed scars. A pharmaceutical filler substance or your own fat is injected below the skin surface to fill hollow areas and creases, or plump the lips and back of the hands. “As we age, our faces begin to show the effects of gravity, sun exposure, and years of facial muscle movement, such as smiling and chewing,” Dr. Bassichis says. “This aging process also leads to loss of fullness in the face seen as a loss of cheek fullness, the appearance of sagging lower cheeks and lips, the thinning of lips, and the appearance of hollows in the temples. When the facial volume that keeps our skin looking youthful and plumped-up diminishes over time, the laugh lines, smile lines, facial creases, and hollowness remain.”


 Botox is a non-surgical, injectable, physician-administered aesthetic treatment for moderate to severe frown lines. It works by reducing the contractions of the muscles that cause those persistent frown lines that have developed over time. In most cases, it’s a simple, 10-minute process. Within just days after the injection, you’ll see noticeable improvement in the moderate to severe frown lines between the brows that can last up to four months. Board-certified plastic surgeon Dr. Steven J. White with USA Plastic Surgery calls Botox “magic in a bottle.” He has perfected his approach over time so that it is quick, easy, and virtually painless. He uses very small amounts of a more concentrated Botox which he carefully injects in selected muscles to relax them. With his understanding of facial anatomy from his advanced training in ENT and plastic surgery, he knows exactly which muscles to target to minimize the chance of paralyzing the wrong muscles which could cause a droopy eyelid or an abnormal smile. Dr. White does all the injections himself (rather than delegating them to a nurse) so that he can be sure he targets the right muscles to get the best results. “One of the best things about Botox is that you can not only erase wrinkles once they appear, but you can actually prevent wrinkles from appearing if you start early enough before they form permanent creases in the skin,” Dr. White says. “For most patients, this occurs in the 30s or late 20s and becomes more evident by the time they reach 40 or 50.”


 In the injectable realm, there are a multitude of new fillers on the market and more to come,” says Dr. Peter Malouf, a board certified plastic surgeon with the Center for Skin & Cosmetic Dermatology. “Although an ideal filler still doesn’t exist, there are many good ones available. It’s important to seek out a board certified dermatologist with years of experience and artistic ability. Such physicians will set themselves apart by offering a tailored approach which is safe and effective, along with the expertise to provide for a truly artistic approach to more complex results, such as facial contouring, resulting in a more natural look in a safe environment.”


 Dr. Malouf says to look for silicone filler to make its comeback as the ideal permanent filler. “Also, keep and eye out for fillers used for body augmentation in the office for breasts, buttocks, and other areas of the body.Pending the controversy surrounding stem cell research, there may be applications for fillers in this area.”

 

 Rhinoplasty. The “nose job” as it is often called, can reduce or increase the size of the nose, change the shape of its tip or bridge, narrow the span of the nostrils, or change the angle between the nose and the upper lip. During the surgery, the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape before the skin is re-draped over the new framework. Procedures have improved in recent years, allowing surgeons to reshape the actual structure of the nose without removing the cartilage at the expense of its support. Nasal surgery can also benefit those who suffer from severe allergies and breathing difficulties.
 Rhinoplasty is generally considered to be the most difficult operation in plastic surgery. Dr. White says sculpting the nose is a ‘game of millimeters’ which requires precise techniques and a thorough understanding of the complicated anatomy. “The goal of rhinoplasty is to reshape the nose to achieve a look that appears natural and in balance with the patient’s other facial features,” he says. “Careful attention should be taken to avoid over-resection causing a pinched, collapsed, or ‘done’ look, which are the most common reasons patients are referred to me for rhinoplasty.”

 

 Otoplasty/Ear Surgery. Otoplasty, or ear re-shaping, is often referred to as simply ‘pinning the ears back.’ However, it should involve so much more to achieve the most natural appearing ears. Dr. White believes otoplasty is one of the most artistic of all plastic surgery procedures. He uses a series of specific techniques to re-shape the ears to avoid sharp ridges and re-position them to achieve the most natural look. “It’s amazing what a difference it can make in a person’s appearance and self-esteem,” he says.


 Prominent ears are very common, affecting approximately one in every 700 people. However, they are usually hidden by half the population since most women with prominent ears learn at an early age how to style their hair to cover their ears. This is why more otoplasty patients are men since they have very few options to hide their ears.  Otoplasty can be a challenging procedure for the surgeon, yet it is a remarkably easy recovery for the patient as it’s virtually painless and the stitches are dissolvable. “The best part is that the results are immediate,” Dr. White says. “Seeing the change in how the patients feel about themselves after surgery is truly incredible.”

 

 Facelift and Necklift. Still considered the most effective way of turning back the clock, a facelift can improve visible signs of aging in the face and neck, such as sagging in the midface, deep creases below the lower eyelids and between the nose and mouth, loss of muscle tone in the lower face that may create jowls, and loose skin and excess fatty deposits under the chin and jaw. The facelift provides a more youthful, rested appearance with uplifted contours and improved tone in facial skin.


 Dr. Sule specializes in face and neck lifts. He says the procedures have come a long way since the 1980s when patients who opted for a facelift came away with more of a windswept look than a youthful appearance. “I tell my patients that they are essentially on the conveyor belt of life,” Dr. Sule says. “It’s going to keep moving, but we can slow down the appearance of the progression by taking you back seven to 10 years with a facelift as long as we do it in a way that gives you a natural looking result.”


 Improved less invasive facelift techniques have resulted in less bruising, swelling, and downtime for patients. For the most part, the techniques involve how the surgeon sutures the skin and muscles as well as improved liposuction techniques. Also, scars can be hidden in the hair line and behind the ears. “The results of a facelift are permanent, but you might need a touch up 10 to 15 years down the road,” says Dr. Sule. “Much like eyelid surgery, facelifts are easier to recover from and have less drastic results in those who opt to have them earlier in life, say in their 40s rather than in their 60s.”

 

BODY

 

Breast augmentation involves using implants to fulfill a patient’s desire for fuller breasts or to restore breast volume lost after weight reduction or pregnancy. Placement of implants beneath the chest wall muscle or directly behind breast tissue using pre-filled implants or implants filled during surgery creates the desired volume. Dr. White with USA Plastic Surgery offers the latest advance in breast augmentation with the “Optimized, Rapid Recovery” breast augmentation. He developed this seven-step program over the course of a decade to optimize every step of the process while focusing on a rapid recovery. He specializes in achieving results which appear natural without the “stuck-on” look. By using specialized instruments and precise techniques to avoid bruising and minimize pain, his patients enjoy a remarkably quick and easy recovery. Typically, they have no bruising at all and are only taking Tylenol for pain on the day after surgery. According to Dr. White, the two most important factors in breast augmentation involve first, how the pocket is made under the muscle for the implant, and second, how the surgeon matches the implant to the patient’s body and their desired breast size. “Now that women have the choice of saline or silicone, breast augmentation has once again become extremely popular in Dallas,” Dr. White says. “Patient education is very important. Spending time with the patient during the consultation prior to surgery is critical so that the surgeon can understand what the patient hopes to achieve and can educate the patient about her choices and teaching them what to expect.”

 

 Liposuction slims and reshapes specific areas of the body by removing excess fat deposits, improving your body contours and proportion, and ultimately enhancing your self-image.  Body sculpting with liposuction has continued to grow in popularity in recent years, making it the most common cosmetic surgical procedure for both men and women.


 Dr. White’s frequently performs circumferential body liposuction for greater fat removal and therefore better body sculpting while using very small diameter cannulas (hollow instruments for fat suction) for smoother contours. Specially designed, custom-made cannulas allow him to create a more natural look with less chance of unevenness. A tumescent (super wet) technique is also used to minimize blood loss and allow larger volumes of fat to be removed more safely. Recovery is faster and most patients are able to return to work after several days.


 Success in liposuction is mainly determined by the amount of fat removed, the smoothness of the skin overlying the area after liposuction, and the improvement in overall body shape and contour.

 Tummy Tuck. Also known as abdominoplasty, a tummy tuck involves the surgical removal of excess abdominal fat and skin and includes tightening of the abdominal wall where muscles have weakened. A full tummy tuck requires a horizontal incision in the area below the pubic hairline. Incision size is largely dependent on the amount of excess skin to be removed. Where correction is isolated to the area below the navel, a limited or mini tummy tuck with a shorter incision at the pubic bone may be recommended. “A tummy tuck is a fantastic operation — when it is done well,” says Dr. White. “Spectacular results may be achieved with beautifully sculpted tummies, natural navels, and fine-line scars that can be well hidden by a bikini. Most patients are excited to discover that they drop at least two dress sizes after surgery. Extraordinary results require specialized techniques as well as a commitment by the surgeon to take the time necessary to get the very best result for every patient.” Dr. White stresses the importance of surgeons carefully screening patients for underlying medical conditions that may affect their surgery. For added safety, he  prefers to operate in an accredited operating room on the hospital campus with a doctor (anesthesiologist)—not a nurse (CRNA)—doing the anesthesia. “Special effort should be taken to predict and prevent potential complications,” he says. “Comprehensive patient education is essential so patients will know what to expect at every step in the process.”

 

 Male Breast Reduction. Male breast enlargement, or gynecomastia, is surprisingly common, yet rarely discussed. Fortunately, most cases respond well to liposuction which removes excess fat and glandular tissue to improve the chest contour.


 Dr. White has developed specialized instruments and techniques for liposuction of the male breast which allow him to produce impressive results.  He considers cosmetic surgery for gynecomastia as one of the most rewarding procedures for men because of the big impact it can have on a man’s self-esteem and self-confidence.

 

COSMETIC DENTISTRY Q&A

 

Q. What is the most effective way to improve my smile?


A. “Veneers will make the biggest difference in your smile. Porcelain laminate veneers have quickly changed smiles for thousands of people. A porcelain veneer is a thin wafer of porcelain that can change the shape, size, and color of the teeth. Therefore, veneers are a great aesthetic alternative to orthodontic care and braces. Veneers have the ability change the color and shape of teeth instantly. They can also make subtle changes in the facial structure, creating a more youthful appearance. Remember, a beautiful smile leaves a lasting impression and is your best calling card. A bright, white smile is a sign of health, youth, beauty, confidence, and success.”  – Dr. Kenneth Hamlett

 

Q. I feel like I’m too old for traditional metal braces. Are there other more discreet methods available to straighten my teeth?


A. “The Invisalign system has improved through the years, and now we can treat cases we couldn’t treat before. Invisalign can now close spaces between the front teeth, straighten overly crowded teeth, and even correct someone’s bite. Invisalign is a great alternative for adults because it’s aesthetically pleasing and is really low maintenance. Lingual braces, which are placed behind the teeth, are another good option for anyone who wants to straighten the teeth but doesn’t want the look of traditional metal braces. Even traditional braces have had tremendous technological advances that shorten treatment time, improve comfort, and are available as clear braces, another popular option for adults and older teens. We’re now also offering Invisalign Teen, that offers the under 18 year olds the Invisalign option which until very recently was only limited to adults.” – Dr. Joshika Kanabar, Walnut Central Orthodontics

 

Q. Other dentists have told me I’m not a good candidate for veneers because my existing teeth are too dark? I want to improve my smile. Do I have other options?


 A. Actually, veneers are an excellent option if you have dark teeth. The key to a beautiful, natural-looking result is the right material and right cosmetic dentist. This is a very common concern, especially among our Baby Boomer population. You don’t have to live with dark teeth or a smile you’re not happy with. To improve your smile with veneers, the first step is to be extremely careful when selecting a cosmetic dentist because not all veneer materials and techniques are the same. A more experienced dentist will have the knowledge, finesse, and artistic skills to apply veneers to darker teeth and get natural-looking, aesthetically pleasing results.” – Dr. Lee Fitzgerald