Dr. Rohrich: Absolutely not. That is the reason a mini-tummy tuck should be limited to only those patients who do not have extreme skin or fat above the umbilicus as this cannot be altered or significantly changed. A mini-tummy tuck is only good for patients with a high torso, little to no redundant skin above the umbilicus, and have had no children or only one at the most, because it does not tighten abdominal skin above the belly button. A mini tummy tuck does, however reduce the length of the incision and the recovery by one week.

2. Can you do a rectus muscle plication using a mini tummy tuck?

Dr. Rohrich: Of course, you can do a rectus muscle plication (or tightening of the abdominal muscle) of the inferior portion. If you use an endoscope, you can to it above the umbilicus or you can float the umbilicus and do the plication centrally. This procedure should only be done by people that have a long torso with a high umbilicus.

3. Why should you have swelling after a tummy tuck?

Dr. Rohrich: I think it is not uncommon to have some swelling, especially below the belly button for 3 months after tummy tuck. This should subside over time and if it doesn’t you may consider having an external ultrasound or massage in the area in the early post-op period.

4. How long should you have drainage after a tummy tuck?

Dr. Rohrich: It depends. It can be for days or up to 2 weeks in extreme situations. However, in most cases the drainage should end in 3-5 days, or less with current techniques of leaving the deep fatty layer as well as doing quilting or sutures to close the dead space around the drain sites. The key also is to wear compression and to limit physical activity and exercise for 3 weeks after surgery.

1. Why do you put breast implants below the muscle?

Dr. Rohrich: There is very good scientific evidence in the literature to show that breast implants look more natural and feel better if placed below the muscle.  It also does not obscure mammography (both silicone and saline implants) and there is good evidence based data to support that the implants (both silicone and saline) stay softer longer by a significant margin if placed below the muscle.

2. How do you prevent rippling in breast implants?

Dr. Rohrich: The ideal to prevent rippling is to decide pre-operatively what type of implant you need and whether it should be placed above or below the muscle.  The optimal ways to prevent rippling or at least minimize rippling is to place the implant below the muscle, make sure there is adequate breast tissue, and not oversize or under inflate an implant if you are using saline or silicone implants.  Sometimes the use of silicone implant may be better, especially in patient with no breast tissue as well as placement below the pectoralis major muscle.  If you are using saline implants make sure you maximally fill it and not over fill or under fill, as that can cause more scalping or rippling.  If you under fill, it can cause more deflation in saline implants.  Remember, one can almost always feel any implant in the lower outside quadrant of your breast.

3. Why should you under or overfull saline implants?

Dr. Rohrich: One should never underfill a saline implant because that is a higher chance of having a deflation or rupture because of full flow problems.  You should always maximally fill the implant so that it will get less scalping and no rippling in this area, and it will deflate much less.

4. Do you have to replace a ruptured silicone gel implant and why?

Dr. Rohrich: Yes, if there is radiographic evidence or an MRI it should be replaced for several reasons.  Primarily, because long-term the silicone can cause small granulomas or small masses in the breast which can mimic breast tumors that may be similar to breast cancer and can disseminate throughout the breast.  It is optimal to remove the implant with the capsule and attempt to replace with a new implant below the muscle.  All implants need to be considered for removal at 10-15 years, whether the implant is saline or silicone.

5. How long should I wait before I have a ruptured silicone implant replaced or removed?

Dr. Rohrich: Replacement of implants that have ruptured is not an emergent operation, but it is one that should be undertaken within several months from the diagnosis.  Over time silicone implants that have ruptured tend to leak and can cause more scar tissue formed by interaction around the implant.  The procedure requires removing the implants and also the scar tissue around the implant.  Therefore, in most cases, you do need a drain when replacing the implant.  The recovery is brief – about 3-5 days.

6. Should one use high profile or moderate profile implants plus for sagging breasts rather than perform a breast lift?

Dr. Rohrich: In most cases I don’t think that it is prudent to use high profile implant or moderate profile implants (saline or silicone) to correct sagging breasts as this is not the solution.  If you truly have breast ptosis or sagging breasts you should do a breast lift with or without implants.  Obviously, if patients want a lift and more upper fullness they should do a lift with implants (with moderate profile implants) in most cases.

The problem with high profile implants is that they have not been adequately studied and may have much higher incidence of breast tissue and glandular thinning and subsequent long-term rippling effects, whether they are silicone or saline, although this has not be studied extensively.

7. Does the number of cc’s in a breast implant correlate with the breast size?

Dr. Rohrich: It usually does not, because it depends upon the size of breast that you are beginning with.  The resulting cup size does not directly correlate with the implant size.  Just as different size, whether it is a B, C, or D cup varies from patient to patient and from retailer to retailer, there is no way to guarantee that one will have a B, C, or D cup breast after implants.  The goal is to make them proportionate to the patient’s chest wall diameter, amount of breast tissue the patient has and their size and shape.  It is very important not to over augment patients, as they will then have further movement of their breast tissue out to the outside (or lateralization) which will cause distortion and the breast will look too large for the patient’s body and chest wall.

8. How can one breast be hard and the other breast be soft?

Dr. Rohrich: Yes, this can occur since we did not know the real cause of capsular contracture (breast implant hardness).  It is uncommon for capsular contracture to occur, especially with saline implant below the muscle, but is saline implants do get hard they will begin getting hard earlier than later (the first several 3 months) vs. silicone gels, if they get hard, will get hard progressively over time.  One can attempt to do early aggressive breast massage for perhaps 6-8 weeks.  However, if capsule contracture develops then a simply inferior capsulotomy or release of the scar tissue may be all that is needed, especially with saline implants, to restore shape and symmetry.  This is done easily as an outpatient under IV sedation.

9. What is the potential for loss of nipple sensation; numbness on one side and not the other.

Dr. Rohrich: It is not uncommon to have some sensory changes after breast augmentation, especially if there is a larger implant.  Most of the time sensation does return, especially if placed below the muscle, therefore one should wait 3-6 months for the sensation to return.  However, it is acceptable to have some nipple sensation loss with breast augmentation.  The ratio of sensory loss from breast augmentation is 5-10% with the inframammary fold incision being the least (lowest) ratio of nipple sensation loss.

10. How do you make cleavage with breast implants?

Dr. Rohrich: It is somewhat a myth that breast implants will create significant cleavage.  It depends more on the shape of your breasts and the diameter of your breasts pre-operatively as well as the degree of breast augmentation and the amount of breast tissue that you have.  Often, if you have an average chest wall size, there is a better chance for having improved cleavage.  However, it is not a guarantee and just increasing the size does not necessarily increase breast cleavage.  It is actually counter intuitive as with the implant the breast is actually pushed to the side and actually diminishes the cleavage amount one would anticipate.

Question:

Dr. Rohrich: Ethnic rhinoplasty is considered a type of specialty rhinoplasty, like secondary or revision rhinoplasty. When we talk about ethnic rhinoplasty, we are talking about both the differences in the surgical approach to an ethnic nose as well as the way you approach and analyze this type of nose to retain its ethnic origin. It is very important to understand that true ethnic rhinoplasty focuses on preserving ethnic qualities of the nose while reshaping it. A person’s nose is a defining ethnic facial characteristic and it should not be the intention of the surgeon to significantly alter those basic ethnic features. Surgeons must take great care to maintain the patient’s ethnic harmony.

There are several challenges with ethnic rhinoplasty which are not present in a more traditional rhinoplasty and make it a more difficult type of surgery. The skin is usually thicker, which can obscure the underlying structures of the nose and make it more difficult to predict the results. The nasal framework tends to be more delicate, requiring more care and often necessitates the use of cartilage grafts to achieve good results. Darker skin requires more care of the incisions during closure to help minimize scarring. Overall, ethnic rhinoplasty often requires a more complex and elaborate surgery in order to be successful.

If you are seeking a plastic surgeon which has expertise in ethnic rhinoplasty make sure you do your research very well. A true expert in this area has written about it, lectures on this topic, and teaches others how to perform this type of surgery. Look though the doctor’s CV and note any publications and courses he has given on Ethnic Rhinoplasty, which might also be listed as Non-Caucasian Rhinoplasty.

As plastic surgeons, we are focused on getting good results and many will not attempt to perform ethnic rhinoplasty, preferring instead to refer them to a surgeon that regularly performs these difficult procedures. This is why there are not many rhinoplasty surgeons which are highly experienced in ethnic rhinoplasty in the USA.

Question:

Dr. Rohrich: Absolutely. The only skin care agents that truly have a scientific basis are the retinoids, specifically Retin-A. There is a considerable amount of clear, real science which shows that long term use of Retin-A decreases the effects of photo aging, brown spots and increases the dermis.

Normally, our skin turns over every 6 weeks, but use of Retin-A significantly increases this rate to as little as 6 days and in the interim allows you to increase the dermal thickness. Retin-A also enhances the production of collagen in addition to blocking agents that help break down collagen. This reverses some of the aging effects of sun damage.

Perhaps one of the biggest problems we have with retinoids is patient compliance and the early irritation. This is where the guidance of a skin care expert is important, helping you to apply retinoids with a more gradual manner or providing for a mild, more tolerable formulation.

Retin-A is usually prescribed to be used once a day before bed, but some patients may need to start with 2 to 3 applications a week and ease in to daily use.

Dr. Rohrich addresses these 14 myths about facial cosmetic procedures including facelifts, non surgical rhinoplasty, botox, dysport, fillers, skin care, and aging along with the use of cosmetic surgery.

1. MYTH: Everyone ages the same in the face, so the same facelift procedure will work for everyone.

Dr. Rohrich: Not true. Recent groundbreaking work at UT Southwestern on facial fat compartments has shown that we all age differently. This has led to new and more natural ways to customize facelifts for the future. Additionally, the environment clearly plays a role in how we age. There are adverse effects on our skin from the sun, wind and tobacco, among other things.

2. MYTH: Facelifts marketed as in-office procedures – usually taking just one hour with local anesthesia and minimal recovery time – are safe and effective.

Dr. Rohrich: Many patients have been disfigured or experienced complications from procedures like these. If you want long-lasting changes that you’re going to be happy with, it’s better to get a real facelift from a Board-Certified Plastic Surgeon performed in a real operating room under sterile conditions.

3. MYTH: Topical Botox is replacing injectable Botox.

Dr. Rohrich: Not true… yet. Topical application of botulinum toxin A are still in the clinical trial phase. Early indications are that it may work in small areas around the eyes (crows feet) and that it may help make injectable Botox last longer. However, it’s difficult to say it will ever replace injectable Botox, as it doesn’t have the same ability to deliver the toxin to specific muscle areas with pinpoint accuracy.

4. MYTH: Botox is Botox. You can get it for $100 at a hair salon or spa, or pay a lot more to get it from a doctor.

Dr. Rohrich: In Botox, as in life – you get what you pay for! The price of Botox is set by the company (Allergan) that produces it. If you purchase Botox at a severely discounted rate, it’s possible that you’re receiving a very diluted form of Botox or perhaps something that’s not even real Botox at all. What’s more, in salons the product is often injected by people with insufficient training, which can result in problems like asymmetry and droopy eyelids or brows.

5. MYTH: Botox cures migraine headaches, acne and hair loss.

Dr. Rohrich: It’s very effective for both stress and migraine headaches if placed correctly. And there’s preliminary data to show that it does diminish acne and may stall hair loss as well, but more studies are needed. They’re being done now..

6. MYTH: Fillers and Botox are the new non-surgical facelift.

Dr. Rohrich: After a certain age, nothing can produce the results of an actual surgical facelift. However, the proper and skilled combination of Botox and fillers can certainly postpone the appearance of aging in younger patients. Botox can smooth the forehead while lifting and shaping the brows. Fillers can plump up the lips and cheeks and soften the nasolabial folds. The results aren’t permanent, but they require very little downtime..

7. MYTH: The “new” Botox – Dysport – is better and lasts longer.

Dr. Rohrich: The efficacy of Botox and Dysport is about the same. Both injectables are essentially purified forms of botulinum toxin A. Dysport may act somewhat faster and is expected to be about 15 percent cheaper. Dysport is currently being used in Europe and is anticipated to launch soon in the U.S. with FDA approval..

8. MYTH: There are over a dozen FDA-approved fillers on the market. A person should be able to pick the newest one or the one that best fits their budget since they’re all government-approved.

Dr. Rohrich: A practicing Board-Certified plastic surgeon or dermatologist is the most knowledgeable person to determine which fillers to use on the different parts of the face to give you the best results in a cost-efficient manner. A combination of different fillers with different properties is the preferred way for achieving facial rejuvenation. Some fillers are more viscous and don’t migrate as easily; others are more fluid and can plump larger areas. Some cost more because they last longer (like Radiesse, which can last well over a year in comparison to some other hyaluronic acid fillers which act for 6-9 months). Your plastic surgeon should be your guide..

9. MYTH: Permanent fillers are better and everyone should use them.

Dr. Rohrich: Permanent fillers in general have more permanent problems that can’t be removed without disfigurement. And they don’t age well with the patient – so don’t use them. Temporary fillers that last longer – up to 1-2 years – are optimal at this time..

10. MYTH: Stem cells from fat work so well they will replace all facial fillers used today.

Dr. Rohrich: Perhaps in the future, but not now, as we still have to refine how we harvest, grow and stimulate stem cells. But we’ll get there in the next five years!

11. MYTH: You won’t age naturally if you have cosmetic surgery.

Dr. Rohrich: When plastic surgery was in its infancy, surgeons focused on tightening the loose skin of the aging face. With further research done by UT Southwestern plastic surgeons, we now know that an aged appearance is not only caused by loosening skin but by the loss of facial fat. We can naturally rejuvenate the face by techniques that both lift and fill the face. Using these new concepts of fat compartments and fat replacements within the deeper layers, we’ve moved to the next generation of facelift technology.

12. MYTH: Non-surgical rhinoplasty can provide the same results as surgery.

Dr. Rohrich: Not really. Fillers can help make some bumps and depressions go away temporarily – the best ones to use are based on hyaluronic acid – but this solution doesn’t work for significant changes, nor do the results last more than 6-12 months.

13. MYTH: You can remove dark under-eye circles with a cream.

Dr. Rohrich: Unlikely. Under-eye circles can have many causes, including skin pigmentation, shadowing, thin skin and visibility of underlying blood vessels. Different procedures to treat these problems may include the use of Retin-A or bleaching creams, chemical peels or lasers, and potentially surgery to blend the eyelid-cheek junction.

14. MYTH: You can grow thicker, longer eyelashes by applying a liquid gel daily.

Dr. Rohrich: True. The gel is called “Latisse” and its active ingredient was originally developed as a drug to treat glaucoma. When used as directed, you can grow thick, long eyelashes in about 4-6 weeks. There are some side effects to consider, such as it can potentially darken light-colored eyes.

1. Ask if your Surgeon is Board Certified

Ask if your surgeon is certified by the American Board of Plastic Surgery (ABPS). Legally, any surgeon can perform plastic surgery procedures. Choosing a surgeon which has been certified by the ABPS is the best way to ensure your surgeon has had extensive training specifically in plastic surgery. This is the only board which issues certifications based on extremely rigorous criteria including 6 to 9 years of training dedicated to plastic surgery.

2. Ask if your Surgeon has Operating Privileges

Ask if your surgeon has hospital operating privileges to perform your procedure. These privileges are granted to surgeons based on rigorous credentialing by their peers. This is not the case in an office setting, which often have little to no oversight.

3. Ask if Surgery is done in an Accredited Ambulatory Facility

Ask if your surgeon operates in an accredited ambulatory facility. This one is key. Accredited ambulatory facilities have been reviewed and identified as capable of responding to medical emergencies. This is your assurance that the team can take care of the patient if there is a problem and that they will have all the life support capabilities, training, and equipment to respond to life threatening situations.

4. Ask about your Surgeon’s Experience

Ask how often your surgeon performs the procedure. This is not a question of specific numbers, it is about experience and expertise. Find out what your surgeon’s relationship is with the procedure you are seeking. The best surgeons not only perform the procedure regularly, but they also publish in medical journals, they perform research, they engage in teaching and training and offer contributions to the advancement of the procedure.

5. Ask to View Photographs

Ask to see some before and after photos of patients who have had the procedure with your surgeon. Examine these photos carefully. Make sure you are not paying attention to irrelevant factors such as lighting, but to the details of the outcome of the surgery. Every cosmetic surgeon has their own aesthetic sense – their definition of beauty. Make sure you own aesthetic sense matches well with your surgeon’s.

6. Ask about Risks and Complications

Ask about the risks of the procedure as well as the benefits. There is risk to any surgical procedure and you should be fully aware of all the risks before choosing to have your procedure.

7. Ask if the Surgeon uses a Certified Anesthetist

Ask who does the anesthesia. It’s vital that the he or she is a Doctor of Medicine (MD) or a Certified Registered Nurse Anesthetist (CRNA). It’s very important to make sure that the surgeon uses an anesthetist which has been trained and certified by this strict criteria and rigorous training, as it is one of the riskiest aspects of most cosmetic procedures.

8. Ask about your Recovery

Ask about your recovery, especially the first 24 to 48 hours. Ask when you will be able to return to work, when you can return to strenuous activity such as exercise, and how long until you should start to see your final results.

9. Ask for a Second Opinion

Ask for a second opinion and seek a consultation with other Board Certified plastic surgeons. It’s good to receive additional perspectives to help you decide which of many options to take, or to affirm that a specific treatment is appropriate for your specific situation.

10. Ask Real People

Ask for information from real people – family, friends, referrals, and other physicians. Ask for references from other patients which your surgeon has operated on, and talk with these patients about their experience. Do not rely solely on the internet or the media and marketing networks to provide you with information about a procedure. There is a considerable amount of misleading information out there and patients should consider the accuracy of information from dubious and unverified sources.

Question: What is the difference between liposculpture and traditional liposuction?

Dr. Rohrich: Terms like lipostructure and liposculpture are used to distinguish liposuction from 3 dimensional body contouring. It’s not just about fat removal, it’s about reshaping the body by removing (and sometimes adding) the right amounts of fat in the right places.

With liposuction the surgeon is doing just that – suctioning fat only without true 3 dimensional contouring of the entire body silhouette. Considering the overall 3D shape and outcome is truly body sculpting which means you need to perform artistic lipoaspiration while refining the body contours without masculinizing the female silhouette.

This defeminizing of the female shape can be seen frequently and is done by those who do liposuction of a “spot area” like the love handles only. It does not look natural and is a source of great disappointment to patients worldwide. I see many secondary liposuction patients with these problems.

The bottom line is that liposculpting is difficult to do well and requires a very artistic eye and great surgical technique to obtain consistent great results in body contouring for both female and male patients.

Question:

Dr. Rohrich

The overriding aesthetic of today is still that of natural beauty, the so-called “Golden Triangle”. This formula, which is 2500 years old, defines perfect beauty. It was established by intellectuals as a ratio of 1:1.618, known as “phi”.  The ratio applies to a ‘triangle’ of aspects for facial beauty – the width of the mouth to the width of the cheek, the width of the nose to the width of the cheek and the width of the nose to the width of the mouth. It’s one of a youthful, non-operated natural appearance – not looking “wind-swept” or “the hollywood” appearance.

As Plastic Surgeons we are supposed to be in the Face Protection not the Witness Protection Program. Most patients do not want to look like someone else or to look significantly different. People want to look as good as they feel. The wind-swept look of past decades is out.

There should be no surgery tell-tale signs, whether the surgery is a rhinoplasty or a facelift.

As Plastic Surgeons we must always keep in mind the concepts of “Timeless Beauty” by performing age-appropriate plastic surgery so that the patient and their plastic surgery will age well and proportionally with them.

For example, when performing a rhinoplasty on a 50 year old, one should make minimal changes in proportion to the patient’s facial features. Likewise, it would not be wise to give a 50-year-old woman large breast implants that are out of proportion to the rest of her body. We need to avoid the infamous “Cat Woman” and overdone distortions seen in the “Michael Jackson nose”. This simply is not good plastic surgery!

The timeless ideal is an oval face with full eyes and well shaped eyebrows. Innate or unique asymmetries are also beautiful. When we turn the clock back through surgery we must try to preserve these unique asymmetries rather than try to make the face look like someone else’s.

Taken from Dr. Rohrich’s interview in Beyond Beauty by Beyond Black Publishing, London UK.

REALITY: Unfortunately, anyone with a valid medical license can call themselves a plastic surgeon, hang up a shingle and begin treating patients! So plastic surgery has become a “buyer beware” specialty.

2. MYTH: All plastic surgery board certifications are the same.

REALITY: Only the American Board of Plastic Surgery certifies that someone is fully trained in plastic surgery of the face and body. It takes from 6-9 years to achieve this training, and then you must pass a rigorous written and 2-day oral exam.

3. MYTH: Only real plastic surgeons can perform any type of plastic surgery or cosmetic procedures.

REALITY: It may be hard to believe, but anyone with a valid medical license can call themselves a plastic surgeon. The consumer must investigate carefully before he or she goes to see a physician.

4. MYTH: All plastic surgery procedures are done in an accredited operating facility.

REALITY: Unless you are a Board-Certified plastic surgeon by the American Board of Plastic Surgery, you are not required to perform plastic surgery in an accredited facility. That may put you in harm’s way if there’s a problem.

5. MYTH: It’s disrespectful to ask a plastic surgeon tough questions about their experience or expertise, or to ask them to show you some results.

REALITY: Board-Certified Plastic Surgeons prefer informed patients. Knowledge is power, and it’s very important to make the right decisions. It will determine not only your outcome, but your safety as well. In general, an educated patient recovers better because there are no surprises and less anxiety about the procedure.

“Some options require a little recovery time, others take some time to see the desired effects, so now is a good time to be thinking about which procedures are best suited for you,” said Dr. Rod Rohrich, professor and chairman of Plastic Surgery at UT Southwestern.

If you’ve got a month before your occasion, options to consider include:

• Identify some beauty care products containing Retin A to start a new skin care program for life
• Latisse, an eyelash lengthener to improve eyelash length. Takes at least 4 to 6 weeks to see the effects.
• A full face chemical peel can correct skin pigmentation and skin blotches, while refreshing your face and neck. Down time is 5-6  days and the effects should be noticeable in about 10days.

If the countdown is only two weeks away, consider:

• Botox and Dysport for removing crows feet, reshaping the brows, softening frown lines
• Fillers such as Juvederm to plumb up your lips
• Facial fillers such as Radiesse to restore cheekbone highlights, and soften the nasolabial folds and  chin jowls

Often it’s a combination of facial fillers that can produce the best result, Dr. Rohrich noted.

A new injection technique that UT Southwestern Medical Center plastic surgeons are helping pioneer, outlined in a recent issue of the journal Plastic and Reconstructive Surgery, is helping minimize brusing ,swelling and the discomfort as well as  speed up the process for facial injections.  The procedure combines lidocaine with injections of facial fillers to instantly minimize the pain and allows plastic surgeons to begin injection procedures without waiting for traditional anesthesia to take effect.

If you’ve got just a week before the event, consider:

• Photofacial or Intense Pulse Light (IPL) treatments can treat sun spots, small veins, rosacea, and other forms of skin discoloration and refresh the face.
• Facial or body massages

After the party, or even before, consider a massage.

“Massages don’t just feel good, they can help reduce stress that shows up in your face and body ,” Dr. Rohrich noted.

Then, start to think long-term about the way you want to look. Look in the mirror and list the top three things that bother you about your appearance as well as three things you like, Dr. Rohrich advises.

“While there are some effective “quick fixes” available these days, the best strategy is to schedule a consultation so you’re not restricted in your options. You can establish a more comprehensive, long-term strategy that targets your biggest concerns and ensures you’re getting the most out of your beauty budget.”

UT Southwestern Medical Center
Dallas, Texas

The Plastic Surgery Department addressed these issues at UT Southwestern’s first ever Cosmetic Medicine Symposium in Dallas, an event held to educate the general public about the latest and most effective uses of cosmetic medicine and specifically discussed myths about fillers and botox.

1. MYTH: The “new” Botox – Dysport – is better and lasts longer.

REALITY: The efficacy of Botox and Dysport is about the same. Both injectables are essentially purified forms of botulinum toxin A. Dysport may act somewhat faster and is expected to be about 15 percent cheaper. Dysport is currently being used in Europe and is anticipated to launch soon in the U.S. with FDA approval.

2. MYTH: Fillers and Botox are the new non-surgical facelift.

REALITY: After a certain age, nothing can replicate the results of an actual surgical facelift. However, the proper and skilled combination of Botox and fillers can certainly postpone the appearance of aging in younger patients. Botox can smooth the forehead while lifting and shaping the brows. Fillers can plump up the lips and cheeks and soften the nasolabial folds. The results are not permanent, but require very little down-time.

3. MYTH: Permanent fillers are better as they last forever.

REALITY: Permanent fillers cause permanent problems. Longer lasting fillers are good, but permanent substances such as silicone do not age well. Your face changes over time, and permanent fillers can begin to look strange, migrate to the skin surface or cause other long-term problems. Consult with a knowledgeable plastic surgeon to find a filler substance that will age along with you instead of in spite of you.

4. MYTH: Topical Botox is replacing injectable Botox.

REALITY: This is not true… yet. Topical application of botulinum toxin A is still in the clinical trial phase. Early indications are that it may work in small areas around the eyes (crows feet) and that it may help make injectable Botox last longer. However it is difficult to say it will ever replace Botox, as it does not have the same ability to deliver the toxin to specific muscles areas with pinpoint accuracy.

5. MYTH: Facelifts marketed as in-office procedures – usually taking just one hour with local anesthesia and minimal recovery time – are safe and effective.

REALITY: Countless patients have been disfigured or experienced complications from procedures like these. If you want long-lasting changes that you are going to be happy with, it is better to get a real facelift from a legitimate cosmetic surgeon performed in a sterile operating room under general anesthesia. These “lunchtime lifts” may occasionally work for some, but the results are temporary as they don’t do anything to the deeper layers of skin and muscle tissue.

6. MYTH: Botox is Botox. You can get it for $100 at a hair salon or spa, or pay a lot more to get it from a doctor.

REALITY: In Botox as in life – you get what you pay for! The price of Botox is set by the company (Allergan) that produces it. If you purchase Botox at a severely discounted rate, it’s possible that you are receiving a very diluted form of Botox or perhaps something that is not even real Botox at all. What’s more, in salons the product is often injected by people with insufficient training, which can result in problems like asymmetry and droopy eyelids or brows.

7. MYTH: There are over a dozen FDA-approved fillers on the market. Consumers should be able to pick the newest one or the one that best fits their budget since they are all government-approved.

REALITY: A practiced cosmetic surgeon is the most knowledgeable person to determine which fillers to use on the different parts of the face to deliver natural, long-lasting results in a cost-efficient manner. A combination of different fillers with different properties is now the preferred method for achieving facial rejuvenation. Some fillers are more viscous and don’t migrate as easily; others are more fluid and can plump larger areas. Some cost more because they last longer (like Radiesse, which can last well over a year in comparison to some other hyaluronic acid fillers which act for 6-9 months). Your cosmetic surgeon should be your guide.

8. MYTH: There is a true anti-aging cream that will keep you looking younger longer.

REALITY: It’s true! This product does exist and it is called Retin-A. This cream or lotion works by forcing skin cells to turn over faster. With long-term use, it can improve acne and fine wrinkles, smooth the skin and remove age spots.

The other great aging prophylactic is a sunscreen with both UVB and UVA protection. The combined usage of these two lotions, Retin-A and sunscreen, will make a big difference in how fast your skin shows visible signs of aging.

9. MYTH: Fractional laser skin resurfacing tightens the skin non-surgically.

REALITY: Despite a lot of advertising to the contrary, fractional lasers are not skin-tightening devices. However, they can be a good choice to correct sun damage, discoloration, fine lines and even acne scars. A small percentage of patients may achieve some skin tightening, but this is not a predictable benefit. While fractional lasers offer minimal down-time, other types of lasers can offer more visible results. The rule of thumb is: the shorter the recovery time, the less improvement you can expect.

10. MYTH: Laser liposuction is superior to traditional liposuction as it shrinks skin and selectively removes fat.

REALITY: Laser liposuction (an invasive procedure employing a laser-equipped cannula) may be useful for small areas but is not better or safer than traditional liposuction. It does not shrink skin selectively and can cause skin burns if not used properly. It is imperative to choose a board certified surgeon with specialized training when opting for any type of liposuction as there are many unqualified practitioners on the market offering this surgical procedure.

11. MYTH: Mesotherapy is an easy and safe way to spot-reduce fat and lose weight.

REALITY: Mesotherapy is not approved by the FDA. It can be dangerous and very painful and yields little or no results. Also known as “the French method,” mesotherapy uses multiple needle injections to deliver small amounts of herbal and vitamin compounds to the middle layer of the skin. Touted as a minimally invasive procedure that treats everything from cellulite to sagging skin to excess weight, most of mesotherapy’s claims are completely unfounded.

12. MYTH: Non-surgical fat removal will replace traditional liposuction.

REALITY: Yes, there is a new, non-invasive device that uses high frequency ultrasound to break up fat deposits, which the body then absorbs and eliminates through urination. Patients get immediate, permanent spot reduction of fat with no pain, bruising, bleeding or risk of infection. UT Southwestern is leading the clinical trials of this device for FDA approval, and will probably have the first unit in the U.S. available to consumers. It will not replace liposuction: the device is better for small areas and a series of treatments is required for visible results.

13. MYTH: There is a proven way to permanently remove cellulite that really works.

REALITY: To date, all known methods to eliminate cellulite (such as Endermologie and others) are temporary. Cellulite is a byproduct of hormones which govern the distribution of fat storage, and most women have some cellulite regardless of their weight. There is no known long-lasting, proven treatment for cellulite.