FacialPlasticSurgeonBlog.com

“SUMMER SECRETS”

What you need to know about protecting you skin in the summer and our summer special offers.

Our evening at the Red Maple Inn was a great success, and we look forward to doing another again soon.  Besides the exquisite cuisine and wine offered by Chef Shari Alexander, we had a lively discussion of the latest in facial rejuvenation and offered a number of video presentations.  It was a thoroughly enjoyable experience.

• Download the details of “The Ultimate Beauty Get a Way” at the Red Maple Inn
• A wonderful weekend of beauty and gourmet treats at the Yankee Magazine 4 star rated Red Maple Inn, Spencer, MA. 
• Experience the culinary skills of renonwned chef and food critic Shari Alexander
• Dr. Bentkover and his aesthetic nurse will be at dinner Saturday night to answer any questions you may have about the latest in Facial Aesthetics.

In Our May News letter

• Move beyond using facial fillers just to fill wrinkles and creases.  You can fill significant areas of lost facial volume or sagging with a deeper filler like Radiesse.  Use a filler to really sculpt and rejuvenate your face.
• Also, featured,  Special Offers and a oppurtunity to have Dinner with Dr. Bentkover and his aesthetic nurese at the Red Maple Inn, Spencer, MA, May 31, 2008

April Face Facts   

Check out our April Face Facts for exciting news….

• A special offer to introduce you to Colorscience Mineral Make-up throughout the month of April
• A very special Day in May, May 1, 2008, for special offers on Restylane and Perlane
• April Face Facts

What exactly do we mean by Facial Rejuvenation?  Is it a facelift or minilift, a facial resurfacing, laser treatments, some facial fillers, skin care products or just Botox®?Well, actually, it can be some of the above, a combination of a few treatments, or all of the above.  At Bentkover Facial Plastic Surgery & Laser Center we take a comprehensive approach to your face.  We will evaluate all the affects of aging on your face and put them in perspective for you.  There is always room for education in the consultation process.  The internet is a wonderful educational tool, but no amount of education from our website or other websites can really tell you what will make you most satisfied with the appearance of your face.  That is the role of a good, old fashioned.  During your consultation, Dr. Bentkover will thoroughly evaluate how factors like the sun, heredity and smoking have affected the aging of your face.  He will often recommend a number of different options to help you achieve your goals; but most importantly, we want to make sure that whatever you choose will make you happy.    When Dr. Bentkover first started in practice almost 30 years ago, the options for facial rejuvenation were much more limited.  When you saw a cosmetic surgeon in those days, the consultation usually focused on surgery; because that was really all that there was to offer.  The main focus at that time was on facelifting, eyelid surgery and brow surgery, procedures still actually in their technical infancy.  The only facial filler available at that time was collagen (FDA approved in 1979), and lasers were rarely used on the face.  Today we can offer you a much more comprehensive approach, from skin care to quick in-office procedures to more sophisticated surgical options.  We have a much better idea about what works and what does not work. That is why your consultation will take about an hour.  Your face ages differently at each of five distinct tissue layers, and Dr. Bentkover will evaluate the aging process in your face at all five of these layers.  He will make suggestions for treatment at all the layers where he thinks the treatment will truly be of benefit.  Basically, he will present you with a smorgasbord of options, and you can pick what you want and what fits your budget.  While he will make suggestions about which treatment or treatments he thinks will most benefit your appearance, the choice is always yours.Throughout our website are numerous articles that cover just about all of the aspects of how to make your face look refreshed and more youthful.  How you look as you age may depend a lot on your genetic code (Yes, you may look like your mom.).  However, everyday we see patients whose major aging issues have been caused by the ravages of excessive sun exposure and smoking.  Making you look more youthful may require some lifestyle changes.  Continuation of smoking and poorly protected time in the sun (or worse, time in tanning booths) will pretty much negate most of what we can do for you.  Pale really is in.  Time to throw away the sun reflector mirrors.  Time to get serious about throwing out the cigarettes.  Make a bonfire with your cigarettes and say good bye to them. If you are willing to make these sacrifices, you will be much happier with the results of any treatments to your face.   Well, enough lecturing.  What can we offer you?It all starts with your skin (the first layer).  Good skin care and skin health are key components to your appearance.  Keeping your pores clean and protecting your skin from the sun is very important.  Our ProCyte® and Neova® skin care lines can help you in this regard.  Younger looking skin has a nice glow.  Replacing dull, tired looking skin with vibrant skin that glows may do quite a lot to improving how you look.  This is called luminescence, and our Obagi® skin care regimens can do quite a bit to restore luminescence, rejuvenating your skin from bottom up and eliminating unwanted facial pigment and brown spots.  Regular deep cleansing facials can also be very important.Wrinkles and deep creases can be treated in the office with fillers and Botox®.  These treatments need to be renewed periodically but give quick, very effective results. The scowl lines between your brows and the crow’s feet lines at the corners of your eyes and lower eyelids can be treated in the office in a few minutes with Botox®.  If the scowl lines are very deep we often treat them also with Radiesse®.  Radiesse® is our favorite filler for deep creases because of its longevity (10-14 months) and cost effectiveness.  Even more commonly, we also use Radiesse® to fill deep cheek-lip grooves (also called nasolabial creases) and to fill the hollows that develop below your eyes as you age, the hollows that can make you look so tired.  We can treat fine lines of the upper lip or give you fuller, younger looking lips with Juvéderm™ or Restylane™.  If you want more permanent improvement in the appearance of fine lines and wrinkles of the face, we can offer you carbon dioxide (CO₂) laser resurfacing or the newer, breakthrough plasma technology of Rhytec Portrait® Skin Regeneration.  Portrait® also removes unwanted pigmentation, tightens and refreshes your skin, often with dramatic results.  It is usually an office treatment and can also be used to tighten the skin between the décolleté.  Treatments with the V-Beam laser and Intense Pulsed Light (IPL) can remove unwanted red lines in your face (telangiectasias, often from Rosacea).  We also use the IPL to treat unwanted pigment of the chest.As you age, you lose fat volume in your face.  This is the second layer that ages significantly.  This loss of volume is what creates hollow areas that might need to be filled (usually with Radiesse®)  The next layer down, (the third layer) often moves “south” in a fairly predictable manner.  This strong fiber-like sheet of tissue under the subcutaneous fat is called the SMAS (subcutaneous muscular aponeurotic system).  It is actually the extension of the platysma muscle (the fan-like muscle of your neck) up on to your face.  It was during Dr. Bentkover’s training with the renowned Dr. Richard Webster in the late 1970’s that Dr. Webster first demonstrated the importance of the SMAS in aging, and therefore, in facelifting.  Now, almost 30 years later, the most effective and longest lasting techniques for facelifting all involve tightening and moving the SMAS.  Procedures under the SMAS (Sub-SMAS or extended sub-SMAS surgery into the “deep plane”) seem to provide the most natural and longest lasting results.  Simply tightening the SMAS without cutting or moving it under local anesthesia does not seem to be as effective or as long lasting a procedure.        A full lower facelift can give you back your jawline and your neckline by rearranging and tightening the SMAS and the platysma muscle.  But now we also have various minilifts that may achieve what you want with a bit less surgery.  A submental platysmaplasty is a minilift of the area of the neck just under the chin (the submental triangle) that takes about 20-30 minutes and can easily be combined with a chin implant to lengthen a naturally short jawline.  A necklift combines the submental platysmaplasty with further tightening of the entire neck through an additional incision hidden in the creases around the ear.  Both procedures can include liposuction (or liposculpture) of fat overlying the platysma.  A necklift takes between 2-3 hours depending on the amount of tightening needed.A cheeklift is a minilift that lifts the SMAS and skin of the cheeks in a vertical direction to tighten the jaw line and the jowls.  It is the upper half of a full lower facelift   A cheeklift takes about 2 hours.A midface lift is a newer minilift that elevates your cheeks and the area under your eyes. As you age, the middle of your face generally descends at about a 45 degree angle. A midface lift elevates this in such a way as to correct the hollows and washed out appearance that can develop in the middle portion of your face.  The procedure takes between 1-2 hours.  In a midface lift, the fourth layer of the five important layers, the coating over the bone (periosteum) is pulled and tightened at about a 45 degree angle.  If you have not already figured it out, a full lower facelift is just a cheeklift plus a necklift.  When adding a midface lift to a full lower facelift, it is called a triplane facelift, because the operation involves elevation of three separate types (or planes) of tissue: skin, muscle/SMAS and periosteum.  This is all explained in detail on our website (www.DrBentkover.com).Any of these procedures can be combined with a brow or forehead lift.  Often this procedure is an endoscopic forehead lift.  They can also be combined with upper and lower blepharoplasty.  These eyelid lifts often involve removal of excess skin from the upper eyelids and rearrangement and/or removal of the fat of the lower eyelids.  Fat transposition and a SOOF lift are variants of the lower lid procedure.  If your chin is short or your cheek bones flat, these can be augmented with implants.  This changes the shape of the architectural framework of your face, the fifth important layer, your underlying bone and cartilage.  As you age, your jawbone can thin.  This can actually make your jowls look worse.  We can also fill this bony deficiency with an implant or Radiesse®.  In addition, rhinoplasty, a passion for Dr. Bentkover, clearly modifies the fifth layer and can sometimes make you look younger. So, what do we mean by Facial Rejuvenation.  Some or all of the above.  Whatever you need and whatever you choose. 

Stuart H. Bentkover, MD FACS

December, 2007

Our December Newsletter

Welcome to my blog.  Every day I see patients who have spent many hours on the web researching procedures only to come to the conclusion that they would benefit from a procedure that is truly the wrong procedure for them.  There is a lot of great information on the web about facial plastic surgery and related procedures; but there is also a lot of misguided information,  and poorly explained information.  I established this blog as a place where we can discuss facial aesthetics openly and without any hype.    I hope through this blog that I can help divert people from misinformation and wrong conclusions about what would benefit them.  You will not agree with everything I have to say, but isn’t that what blogging is all about. 

Thanks for visiting today,

Stuart Bentkover

What is Rhinoplasty?  Rhinoplasty is the art and science of restructuring the nose so that it looks and works better.  It was one of the first facial aesthetic operations and is among those most frequently performed today.  In rhinoplasty, deformities of the nose are corrected by removing, adding, rearranging, or reshaping cartilage and/or bone.  It is the most complex and challenging of the facial operations.  In rhinoplasty, form (appearance, style, the look) is always tied to function (the ability to breathe through the nose).  In every rhinoplasty, the experienced surgeon must make sure that changes in form do not compromise function and vice versa.     

Like to see some of our patient photos?  Click here:  http://drbentkover.com/procedures/rhinoplasty_photos-worcester-boston.shtml   

The objective of most facial resurfacing techniques is to remove wrinkles or scars and rejuvenate your skin.  The earliest techniques involved a mechanical removal of skin layers (dermabrasion) or the application of various chemicals to the skin (chemical peels).  In the mid 1990’s lasers became a popular treatment method.  The most common lasers used were, and still are, the carbon dioxide laser and erbium laser.  Lasers work by delivering a light of a pure, single color (wavelength) to the skin.  The part of the skin targeted by the laser is related to the color of the laser light and the color of the target in the skin.  Each different colored laser beam has a color or range of colors that best absorbs the color of that particular laser.  For the carbon dioxide laser, for example, the primary target of the laser beam is clear water.  Since skin cells are mostly water, the laser targets these cells and vaporizes them away in a very controlled and precise manner.  Fraxel® laser and fractionated carbon dioxide laser technology provide a new means of delivering the laser beam that spares tissue between adjacent areas targeted by the beam.  The primary target is still water.  

Most of the different resurfacing techniques still have appropriate applications today.  The right technology for you depends on the depth of the wrinkles or scars to be treated, how much excess pigment or other signs of sun damage you may have in your skin, and how your skin reacts to light and heat.  Your Facial Plastic Surgeon can often offer you a number of choices or a combination of choices that best fit your needs and your skin type.  Most of these techniques lead to formation of a new epidermis (the most superficial layer of the skin) and a tightening of the dermis (the second layer of the skin) by the formation of new collagen, the basic building block of your skin.  The amount of tightening depends often on the amount of heat delivered to the skin and the precision of the technique.   

Most of us were taught in school that there are three states of matter, solid, liquid, and gas.  Actually, there are four.  The fourth state of matter is plasma, an electrified gas found many places in nature, like the explosions off the sun’s surface, electrical storms, and the Northern Lights (Aurora Borealis).  Some of us even have plasma in our TV sets. 

One of the newest technologies for skin resurfacing is called plasma skin regeneration (the Portrait® procedure from Rhytec corporation).  Instead of using a laser or a chemical to remove and heat the skin, this technology delivers heat to the skin through the careful and controlled application of a plasma gas.  When applied to the skin, the plasma heats the epidermis and dermis.  Over the course of usually 4-7 days, the heated epidermis begins to shed, leaving behind a brand new epidermis.  At the same time, new collagen fibers begin to form and line up perpendicular to the surface of the skin, which is their normal orientation.  New collagen formation can even continue for up to 1 year. 

With the classic, full power, carbon dioxide laser resurfacing (still the standard to which most new resurfacing techniques are compared) the orientation of the new collagen is parallel to the surface of the skin.  This can sometimes lead to a shiny appearance.  Also, the collagen formation period is much shorter.  Generally, a plasma treatment does not penetrate the skin as deeply as a full carbon dioxide laser treatment.  It may not get rid of the very deepest wrinkles as well as the laser, but the down time for overall healing is much shorter.  This can be an important consideration for busy people and is often a primary reason your physician may offer plasma technology.  Also, I  feel that the quality of the skin after a plasma treatment looks more natural and more “rejuvenated” than with a laser treatment.  While deeper laser treatments or chemical peels can sometimes leave the skin very light (hypopigmentation) or too shinny, the plasma treatment usually leaves a very natural and younger looking skin. Plasma skin regeneration is also a very effective and quick way of removing excess brown pigment in your skin from sun damage and some benign and pre cancerous lesions caused by the sun. 

For most skin types treated, plasma skin regeneration is usually done in one treatment.  The Fraxel® laser may have similar affects on the skin but usually requires a series of three to six treatments.  For Mediterranean or South American skin types (patients who never get a sun burn), plasma is often done in three or four treatment sessions using a lower amount of energy than with the single treatment technique. Like most laser resurfacing techniques, it is generally not recommended for Asian or Black skin.  While very controlled, the skin irritation generated by a laser or a plasma gas could cause an increase in pigment in these darker skin types.  This is called post inflammatory hyperpigmentation.

Most plasma treatments can be done in the physician’s office.  Similar to other resurfacing techniques, the type of anesthesia required for a plasma treatment can be as little as a topical anesthetic cream or as much as intravenous sedation or general anesthesia.  The type of anesthesia depends on the size of the area to be treated (e.g. just eye lids vs. the entire face), the amount of energy used, and your personal tolerance for some discomfort.. 

Used by itself, or in combination with other resurfacing techniques, plasma skin regeneration is another, new and exciting technology we can use to rejuvenate your skin.

To view some of my reuslts with plasma skin regeneration, please click here:

http://drbentkover.com/procedures/rhytec_photos-worcester-boston.shtml 

Stuart H. Bentkover, MD FACS