Nonsurgical Lift Hides Undereye Bags
Facial plastic surgeon L. Mike Nayak, MD, director of facial plastic and reconstructive surgery at Saint Louis University School of Medicine, injects fillers to correct depressions beneath baggy lower eyelids. According to Nayak, patients in their mid-20s to mid-50s are the best candidates for the procedure, depending on how their eyes have aged.

“The nonsurgical eye lift, by filling in the depressions around the lower eyelids, can hide the bags and restore natural contours to the lower eyelids,” Nayak says. “In appropriate patients, the results can equal the results of surgical lower blepharoplasty for several months.”

When patients develop bags in their lower eyelids, they typically also develop depressions under the bags, known as tear troughs. The lower rim of the eye socket can also look hollow beneath the bag. The nonsurgical eye lift restores the contours of the lower eyelid, and hides the bags, by using injectable fillers to build up the sunken skin of the tear trough and lower the orbital rim.

Nayak says he uses non–animal-derived hyaluronic acid as a filler. However, the patient’s own fat may also be used for longer-lasting results.
“Depending on the filler we put in, it will last anywhere from 3 months to 1 or 11¼2 years,” Nayak says. “Different products have different prices and different colors. If I am not confident that the patient is going to get a great result from this procedure, I will start him or her with a 3-month filler to make sure it is going to look good before I inject a 1-year supply of the filler.”

Some risks, notes Nayak, are bruising or swelling, undercorrection or overcorrection, and bumps that can be massaged out.

Are tear troughs preventable? Yes, Nayak says. A sunscreen with UVA and UVB protection is crucial. In addition, Nayak stresses that smoking is very harmful to the skin because it activates enzymes that digest theinjected fillers.

Mayo Clinic Study Finds That Arm Lifts Are Safe
Plastic surgeons at the Mayo Clinic, Rochester, Minn, report that an arm lift (brachioplasty) generally entails low risk. However, minor complications may arise in 25% of the cases. James Knoetgen, III, MD, lead study investigator, and Steven Moran, MD, undertook this research to better understand the complications and outcomes of armlift surgery.

“Arm-lift procedures can produce dramatic results, especially for the massive-weight-loss patient,” says Loren Schechter, MD, a plastic surgeon in Morton Grove, Ill. “The main drawbacks are visible scarring, wound separation, fluid accumulation, and the possibility of sensory-nerve injury. In my practice, patients who have undergone massive weight loss, either surgically or by diet and exercise, are willing to accept the scars. The trade-off is improved appearance and hygiene, and the ability to find appropriate-fitting clothing.”

Arm tissue relaxes and descends with aging and weight loss. The drooping of skin results from a stretching of the anchoring fascial system and the loss of supporting fat. The extra sagging can result in a significant “loose hammock”-like deformity from the axilla to the elbow.

There are different degrees of ptosis (drooping) deformity. Brachioplasty surgery removes the excess tissue and reduces the circumference of the upper arm. The degree of surgical correction depends on the amount of extra skin and how loose the supporting tissue has become. The extra skin is removed via incisions along the inner arm that must be placed where the tissue can be best tightened.
During an arm lift, the plastic surgeon makes a zigzag incision in the upper-arm area, from which excess skin can be excised. Fat can be subsequently extracted with liposuction. When the culprit is only excess fat, the surgery requires only liposuction. In this case, the incision may be smaller. Whereas the patient may be left with a scar after the procedure, most patients report that the scar is well worth the overall aesthetic improvements.

“Preoperative education is important in demonstrating the position of the incisions, as well as the potential for the incisions to spread,” Schechter says. “In addition, light, graded compression wraps in conjunction with closed-suction drains have been helpful in decreasing the incidence of seromas. I have also found about a 10% scar-revision rate in these patients, most frequently to revise a ‘dog-ear.’ In patients whose main problem is lipodystrophy rather than skin redundancy, liposuction with a shorter scar will often suffice.”

In the 40 brachioplasty patients in the Mayo Clinic study, the complications included fluid collection under the skin (four patients), poor scar formation (four), skin infection (three), abscesses under the skin (one), and wound separation (three). Nerve injuries occurred in two patients; prolonged numbness of one forearm and hand occurred in one patient; and pain in one forearm and hand developed in one patient. Furthermore, five patients had parts of their arms revised, four needed changes in their skin appearance, and one needed arm liposuction.
According to Knoetgen, arm lifts provide a functional benefit for some patients in addition to the aesthetic benefits. He explains that in massive-weight-loss patients, an arm lift can help prevent rashes that tend to develop because of excess upper-arm skin that sticks to the skin of the armpit and the chest. An arm lift may also improve the patient’s ability to exercise and make clothes fit better.

The American Society of Plastic Surgeons reports that more than 9,000 arm-lift procedures were performed in 2004. Of these, 4% were performed on males and 96% on females.

Knoetgen attributes the rise of this surgery’s popularity to the growth in weight-loss surgeries such as the gastric bypass because massive weight loss results in large amounts of excess skin. However, he says there is an increasing interest in the procedure from non–massive-weight-loss patients.

Diet, Exercise Are Key to Successful Liposuction
According to the American Society of Plastic Surgeons, liposuction was performed more than 323,000 times in the United States in 2005, making it the most popular plastic surgery procedure. Today, several modalities, such as ultrasound-assisted lipoplasty, tumescent liposuction, and the superwet technique, help plastic surgeons provide patients with more precise results and quicker recovery times.

A study published in the May issue of Plastic and Reconstructive Surgery reports that 80% of the patients who underwent liposuction last year were satisfied with their results and 86% would recommend the procedure to their family or friends. The study also notes that most of the patients who underwent liposuction recognized their role in maintaining and prolonging positive results by eating a healthy diet and exercising.

Patients who adhere to a proper diet after liposuction are twice as likely to lose weight as those who don’t, and they have a 96% better chance of decreasing their clothing size. According to the study, 57% of the patients reported no weight gain after having liposuction; and 46% of these patients reported a weight loss—on average, 5 to 10 pounds in less than 6 months. Of the patients who reported gaining weight, the majority gained between 5 and 10 pounds in the 6 months after surgery.

More than 50% of the female patients reported an average decrease of three dress sizes after liposuction, and 35% said their clothing size did not change. One third of the patients reported exercising more after the procedure, while 58% did not change their exercise regimen. In addition, 44% reported eating a healthier diet, while 53% did not alter their diet.

To be a good candidate for liposuction, a patient must have realistic expectations about what the procedure can do. It is important to understand that liposuction can enhance appearance and self-confidence, but it won’t necessarily provide the patient’s “ideal look.” Therefore, the patient should discuss his or her expectations thoroughly with the surgeon.

Liposuction carries greater risk for individuals with medical problems such as diabetes, significant heart or lung disease, or poor blood circulation; or who have recently had surgery near the area to be contoured.