What Makes a Face Beautiful? Part II

The Secret to a Beautiful Face Part II

Is there a Secret to a Beautiful Nose? (Photograph by Angela George from Wikimedia Commons)

Stay tuned....

Emmanuel De La Cruz M.D., PLLC

Royal Wedding 2011 with Prince William and Kate

Royal Wedding of Prince William & Princess Catherine

Congratulations to Prince William and Kate Middleton.

Fast Facts about the Royal Wedding of Prince William and Kate Middleton

• Approximately over 2 billion people (>180 countries) watched the Royal Wedding on television, and approximately 400 million people watched it on YouTube Live.

• Over 750 million people watched Prince Charles and Princess Diana's Royal Wedding.
• The Royal Wedding costs as much as  £50-100 million, which dwarfs the £7.4m price of security at the G20 protests in London in 2009. 
• The estimated cost of Kate Middleton's wedding ring is around 85,000 pounds.
  
• Approximately 2.8 million people in Great Britain and the United States alone had written status updates about the royal wedding in the 24 hours before the service began. 
• Facebook was updated 74 times a second during the wedding service- making William and Kate's big day the 6th biggest web event in history.

For those who were unable to watch their wedding:

Houston Plastic Surgeon 

Recommended article to read:

• The Secret to a Beautiful Face

Lip Augmentation ~Houston Plastic Surgeon

Lip Augmentation:  What is the Best Way to Have a Pouty Lip?

There are several options to have a full lip:

• Dermal filler injection (lip nodules may occur after a filler injection; up to 25% incidence.)
• Lip implant using Goretex or Alloderm
• Dermal Fat Graft
  

Lip Augmentation by Dr. Emmanuel De La Cruz using a Dermal Fat Graft

I recommend reading The Secret to a Beautiful Lip

Emmanuel De La Cruz M.D.

Smile Train April 2011

Smile Train of the Week ~ Cambodia
Smile Train and Operation Smile are two of the non-profit organizations that help children with cleft lip/palate all over the world.   Please visit their facebook website and help support their cause.

Emmanuel De La Cruz M.D.

Lagophthalmos: An Eyelid Surgery Complication

Can't Close Your Eyes after your Eyelid Surgery? 

The inability to completely close one's eyes (lagophthalmos) after an eyelid surgery can be devastating and life-changing.  Difficulty washing one's face can be a problem since soap can get into one's eyes with a lagophthalmos.  Excessive dry eyes are also associated with lagophthalmos, and can be very bothersome.  The condition, lagophthalmos, can occur after a blepharoplasty or eyelid procedure.  In the majority of cases, post-surgical lagophthalmos resolves several days or weeks  after a blepharoplasty procedure. 

Tear by NessaLand (Photograph Courtesy of Wikimedia Commons)

Fast Facts about Lagophthalmos after Blepharoplasty

• Lagophthalmos occuring after eyelid surgery maybe secondary to scarring in one of the layers of the eyelid (middle lamellae) or secondary to excessive skin resection.
• In mild cases, lagophthalmos is mostly temporary and may resolve after intermittent eyelid massage.
• Poor eyelid closure from lagophthalmos may lead to worsening of dry eyes.   This may lead to exposure keratoconjunctivitis (inflammation of the conjunctiva and cornea of the eye).
• If this persists more than 6 months after an eyelid surgery, surgical correction may be required.
• Surgical correction may consist of skin graft placement or lysis of adhesions between the preseptal orbicularis muscle, the orbital septum and levator aponeurosis (different layers of the upper eyelid.)

What Does one need to do if One has Lagophthalmos or Inability to Completely Close the Eyes?

• Artificial tears may need to be applied to one's eyes very frequently.
• Lubricating eye ointments should be applied before bedtime.
• In severe lagophthalmos, a moisture chamber over the eyes (such as Tegaderm) may need to be used during sleep.

Unfortunately, complications may arise after any surgical procedure even with "the best techniques in the best of hands".  Even the most skilled plastic surgeon will encounter surgical complications, such as lagophthalmos, at any time during one's surgical career.  For the surgeon, prevention is the key.  For the patient, education about one's surgery is critical.  One should be aware of the risks and signs of complications of an eyelid surgery, such as infection, lagophthalmos and loss of vision.  I recommend to always ask your plastic surgeon information about your plastic surgery before one undergoes any procedure. 

Emmanuel De La Cruz M.D.

References:

Airiani S, Braunstein R E, Kazim M, Schrier A, Auran J D, Srinivasan B D. Tegaderm transparent dressing (3M) for the treatment of chronic exposure keratopathy. Ophthalmic Plast Reconstr Surg. 2003;19:75–76.

Klapper, et al.  Management of Cosmetic Eyelid Surgery Complications. Semin Plast Surg. 2007 February; 21(1): 80–93.

Wilkins R B, Byrd W A. Complications of blepharoplasty. Ophthal Plast Reconstr Surg. 1985;1:195–198.

Hand Rejuvenation with Fat Transfer (Fat Grafting)

Younger Looking Hands With Fat Transfer?
The hand, as well as the face, is one of the most visible areas of the human body where one can detect aging.  Even with a successful facelift to make one look youthful, one can determine the presence of aging by looking at one's hands.  A youthful hand is not a "fatty hand".  However, aging dissipates the fullness of the dorsal hand which makes the tendons of the hand more visible through the thinner skin of the aged dorsal hand.  With the advent of dermal filler injections to achieve a youthful face, hand rejuvenation using autologous fat and dermal fillers has been gaining popularity among patients who desire to look younger.

The Creation of Adam Hand by Michaelangelo (File courtesy of Wikimedia Commons)

Hand Rejuvenation Options

• Dermal filler injection, such as Radiesse, which is an off-label use and not FDA-approved as of April 2011.
• Autologous Fat graft/transfer 
• Surgical excision of excess skin of the hand
• Laser treatment

Fast Facts about Hand Rejuvenation with Fat Transfer

• Fat is harvested by liposuction (using the Coleman technique) from the abdomen or thighs.
• The fat is then injected onto the dorsum of the hands (back of the hand.)
• Approximately 15-20 mL of fat may be injected into the dorsum of each hand, as described by Sydney Coleman M.D..
• After the procedure, patients will typically experience swelling of the hands.
• All patients in one study recognized improvement in the texture of the hands. 
• Wrinkling of the hands will still occur despite fat grafting.
• No significant tendon problems reported after the procedure according to Coleman's study.

Best Candidates for Hand Rejuvenation with Fat Transfer

• Patients with noticeable loss of fullness of the dorsal part (back of hand) of their hands with apparent thinning of the skin.
• Patients with no history of extensor tendon problems, such as tenosynovitis.
• Patients with intermetacarpal wasting of the hands.

Hand rejuvenation may seem to be a simple procedure whether it is with fat grafting or with a dermal filler injection, such as Radiesse.  However, with the complex anatomy of the hand and with the potential hand complications that can occur, one should be cognizant of who performs these type of procedures.  As a surgeon, I recommend seeing a plastic surgeon to discuss the different options available for hand rejuvenation.

Emmanuel De La Cruz M.D.

Reference:
Bidic, Sean, Daniel Hatef, and Rod Rohrich. Dorsal Hand Anatomy Relevant to Volumetric Rejuvenation. Plastic & Reconstructive Surgery. 2010 July; 126(1): 163-168

Coleman, SR.  Hand rejuvenation with structural fat grafting. Plastic & Reconstructive Surgery. 2002 Dec;110(7):1731-44
Edelson KL. Hand recontouring with calcium hydroxylapatite (Radiesse). Journal of Cosmetic Dermatology. 2009 Mar;8(1):44-51.  

Giunta, et al.  Structural fat grafting for rejuvenation of the dorsum of the hand. Handchir Mikrochir Plast Chir. 2010 Apr;42(2):143-7.