Dr. Kabaker

I just read a story on the ABC News website about a man in Clovis, CA who was impersonating a doctor, and who injected a filler into several patients while working at a spa. These patients thought they were receiving collagen, but the swelling and redness that they developed convinced them otherwise. It turns out that the injector was not a trained provider of cosmetic treatments – in fact, he was not even a physician. He was charismatic enough to convince the spa owner and the patients of his false credentials. Unfortunately, the substance injected was most likely industrial grade silicone, which can lead to permanent disfigurement.

This story highlights the importance of receiving treatments from a well trained and experienced provider, who can prove his or her qualifications. Of course, there are many such providers in the Bay Area, but patients need to be persistent in investigating the backgrounds of their providers. The best providers of quick, non-surgical treatments like injections of fillers are often fully trained in all areas of facial rejuvenation, including more invasive surgical techniques. They should be able to consider all possible treatments before recommending one. Board certification and fellowship training in facial plastic surgery are probably the best indicators of extensive training and experience.

Another point to make from this story involves the cost of non-surgical treatments. Patients occasionally wonder why straightforward procedures, like injections of Botox® or fillers, can be costly. The price of these treatments usually reflects the high cost of the materials to the provider, and this high cost is due to extensive testing that is required to ensure safety. At the Aesthetic Facial Plastic Surgery Medical Clinic, we use only certified products sold to us directly by their manufacturers, and we must pay for that assurance of quality. Injections are not big profit generators for doctors, but that is the “price” we pay to ensure that all of our injectible materials are safe for our patients.

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Tags: Safety Concerns with Injectible Fillers

Fraxel Laser Treatments for Stretch Marks
Posted February 12, 2008 9:18 AM

The Fraxel laser is a new and very effective way to treat a variety of skin complaints, including mild to moderate wrinkles, aging spots, sun spots, melasma, and scars (for more information on the Fraxel, please see the other blog entry and video on our site). Recently, there has been some attention paid to the fact that Fraxel treatments can also be done effectively for stretch marks. For example, a recent article on the “Thatsfit” website reviewed the Fraxel, and other treatments, for stretch marks:

http://www.thatsfit.com/2008/02/04/5-ways-to-erase-and-prevent-stretch-marks/

As you probably know, these visible, wide, blanched marks can result from weight loss and pregnancy, and can be quite bothersome. If you have stretch marks and would like to see them reduced or eliminated, please visit Dr. Hicks for a Fraxel consultation. There is no cost for the consultation, and the treatments themselves are affordable. With Summer approaching, you can take a big step toward a more beautiful appearance!

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ArteFill® – an Effective Permanent Filler
Posted January 23, 2008 9:10 AM

For patients who desire fillers to replace volume in the face, or improve wrinkles and folds, a choice must be made at the start – permanent or temporary. Most often, patients will choose a temporary filler, like Restylane^®, Juvederm^®, Perlane^®, Radiesse^®, or collagen. The arguments in favor of temporary products are understandable, and include:

objection to the placement of any permanent foreign body in the face;
the potential for a foreign body reaction, like scar tissue formation; and
fear that the result will be suboptimal but unchangeable.

The obvious shortcoming of temporary fillers is the need to replace them. Even the longest lasting permanent fillers will remain less than two years, so young patients will need to replace them many times as they age. This process is not only time-consuming, but also costly.

An excellent alternative to temporary fillers is ArteFill^®, a safe and effective product with many uses in the facial aesthetic practice. The permanent component of this soft gel is polymethylmethacralate (PMMA), formed into smooth microscopic spheres. PMMA is a very inert material, and its manufacturing process emphasizes removing impurities, so the risk of excessive scarring (foreign body reaction) is extremely low. The PMMA microspheres are suspended in collagen, and because this collagen is derived from cows, a skin test is required before injection to minimize the risk of an allergic reaction. The injected collagen is absorbed during the months after injection, and the patient’s body deposits native collagen to replace it. So, the lasting effect should be very similar to the appearance immediately after injection.

ArteFill^® can be used to correct many facial abnormalities, such as prominent nasolabial folds (“smile lines”), marionette lines (extending down from the corners of the mouth), lost cheek volume, acne scars, minor contour deformities, depressions of the inner lower eyelid, and many facial wrinkles. The injection process is very similar to other fillers, and is tolerated well by almost all patients. Potential risks are temporary, and include lumpiness at the injection site, swelling, redness, increased sensitivity, and rash or itching. Occasionally, two injection sessions are required to maximize the result.

Any filler must be applied carefully and conservatively, to avoid over-correction and ensure a good result. If used in this manner, ArteFill^® creates impressive and permenent changes that any patient can appreciate. It is an excellent choice for augmentation of the face, and should be considered by anyone who desires a filler injection.

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Surgical Instructions – Facelift
Posted January 22, 2008 8:45 AM

Two Weeks Before Surgery

If you live outside the Oakland area, arrange for accommodations. We can help you arrange for your postoperative care needs.
There are many medications and supplements that must be avoided during the two weeks prior to surgery. These include, but are not limited to, aspirin, ibuprofen, Advil, Motrin, Bufferin, Naprosyn, and large doses of vitamin E. A comprehensive list of these medications and supplements is attached, and is also available on our website (www.drdhicks.com). If you have minor pains or headaches during the two weeks prior to surgery, then Tylenol (acetaminophen) can be used.
There are several medical tests and clearances that need to be completed prior to surgery. These include:

Patients younger than 45 years of age: complete blood count, hepatitis B and C antibodies, and HIV test.
Patients between 45 and 65 years of age: complete blood count, hepatitis B and C antibodies, HIV test, letter of medical clearance from your personal physician (after complete physical exam), and electrocardiogram (EKG).
Patients older than 65 years of age: complete blood count, hepatitis B and C antibodies, HIV test, letter of medical clearance from your personal physician (after complete physical exam), electrocardiogram (EKG), and chest X-ray.

The above blood tests must be completed during the two weeks prior to surgery. The letter of medical clearance, EKG, and chest X-ray must be performed during the three months prior to surgery. If these tests and clearances are not completed and received by our office prior to surgery, then your procedure will not be performed.

Surgical fees must be received by our office two weeks prior to surgery.

One Week Before Surgery

Discontinue smoking.
Do not expose your face to sun.

24 Hours Before Surgery

Confirm your time of surgery with our office.
Shampoo your hair.
Relax and eat well.
Do not drink alcoholic beverages.
Do not eat or drink anything after midnight.

The Day of Surgery

Wash your face well, and do not wear any eye or facial make-up.
You must wear loose, comfortable clothes to the office. A buttoned shirt, slacks, and flat shoes are recommended. Tight clothing will likely be uncomfortable, and high heels will make walking after anesthesia dangerous. In addition, do not wear panty-hose, a pull over top, or contact lenses.
If you wear reading glasses, bring them with you so that consent forms and other instructions can be read. Also bring a case or bag for your glasses.
Leave all valuables at home.
Be ready to give the nursing staff a phone number where you can be reached during the 24 hours after your procedure.
After-care instructions will be given to you and your companion(s) when you are picked up after surgery.

At Home After Surgery

If you experience any sharp pains in your face, or if you notice areas of focal swelling/bruising around the edges of the dressing, call the office immediately.
Do not stand quickly from any seated position. Instead, remain sitting for two minutes before standing.
Do not hesitate to call for assistance with walking, if needed.
Eat small amounts of soft foods, and be sure to keep yourself hydrated by drinking water and juices. Your pain relievers may make you nauseated, and eating large amounts of food, or rich and heavy foods, will make nausea worse.
Cold gauze or ice packs should be placed lightly over the cheeks continuously until around 10:00 P.M. This will help reduce swelling and bruising.
Lie down with your head elevated by 2-3 pillows.
Many patients find it difficult to sleep during the night after surgery. This is often due to lingering effects of anesthesia. Do not be alarmed if you find sleeping difficult.
Tightness of the dressing may be bothersome, but is normal.

The Day After Surgery

You need to return to the office in the morning of the day after surgery. Your dressing will be evaluated; if it is changed, a looser dressing will be placed. This process is not painful, so there is no need to take pain medication prior to your appointment.

Two Days After Surgery

Your dressing will be removed; this is usually done in the office.
You may wash your hair on this day. This needs to be done carefully – you should avoid trauma to the incisions, and prevent excessive water from contacting the incisions. You may wish to have a professional hair stylist perform the washing.

Follow Up Care

Do not smoke.
Keep cold compresses on your cheeks as much as possible for the first three days after surgery.
The morning of the second or third day after surgery will show the most swelling and bruising.
Avoid sudden movement of you head to either side. This will prevent tension on the sutures. Move your shoulders with your head, to avoid turning the neck.
Try to sleep on your back for one week after surgery
Clean your face as needed with a gentle cleanser, and avoid vigorous scrubbing.
Do not use a hot hair drier.
Sutures and staples will be removed one week after surgery. After this, do not place excessive tension on any incisions.
Exercise can be resumed three weeks after surgery.
Alcohol will prolong swelling, and should be avoided for at least two weeks after surgery.
Rest (physical and mental) and adequate nutrition are essential to proper healing. Eat well, and rest as much as possible, during the weeks following surgery.
Numbness, swelling, tingling, discoloration, bumpiness, hardness, crusting, tightness, and redness around the incisions are normal complaints, and will resolve with full healing.
Do not wear heavy earrings for three weeks after surgery.
Avoid sun exposure for 8 weeks after surgery, to prevent excessive swelling and permanent redness of the incisions.
Do not color or bleach your hair for 4 weeks after surgery.
Full healing takes several months, and a final check-up is advisable 3-6 months after surgery.

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Tags: Surgical Instructions – Facelift

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