Stop By for a Quick Facial Refresher!

In the past couple of years, the world we live in has shifted to a more virtual setting. We worked online. We relied on Zoom and other online platforms to stay connected with friends and family in a way that would be safe for everyone. Even now that the world is reopening to some extent, this shift into online work and other virtual events may continue. People like this option, but may have also found that seeing themselves more frequently has put the spotlight on some of their less-favorite facial characteristics. If you’re in this boat and are contemplating how you can feel great about your appearance, consider some of the quick, minimally-invasive options available at Center for Plastic Surgery in Highlands, NC.

Lunchtime Facelift

For a boost that is immediately gratifying, many of our patients choose Today’s Liquid Lift^TM. As it sounds, this treatment provides significant facial rejuvenation using injectable wrinkle-reducers and volume enhancers instead of surgery. Some of the concerns that can be addressed with this brief, effective treatment include deep creases around the nose and mouth, jowls, crow’s feet, lines between the brows, a descending brow, under eye bags, and more. A liquid facelift is curated specifically for each person to beautifully restore your youthful appearance in a way that looks completely natural.

MicroPeel Treatment

Chemical peel treatments are designed to remove skin cells from either the surface, the epidermis or deeper. The deeper peels can be so strong that they require days or weeks of downtime and special care, Micro peels are designed to work more subtly on just the outer part of the epidermis. Micropeel treatments can be done during your lunch hour or in the middle of a busy week. These treatments use substances like glycolic acid, lactic acid, salicylic acid, or a very light, low concentration of trichloroacetic acid. The results of a micro peel are immediate. These peels lightly exfoliate the epidermis, removing dead skin cells and debris. The acids also lift excess oil from the sebaceous glands, improving acne or similar problems while also decreasing pore size. After a micro peel, the skin looks instantly brighter and rejuvenated with younger, healthier skin cells on the surface.

Microneedling

Where a deep chemical peel or laser rejuvenates the skin by removing the top wrinkled skin allowing it to grow back smooth, microneedling is done to stimulate collagen production to elevate the wrinkles from below. This lunchtime treatment is performed using a topical anesthetic. After cleansing the skin, we apply the anesthetic and let it sit for several minutes until the nerves are somewhat desensitized. Then, the needle-clad handpiece is passed over the skin. As it moves, it creates tiny punctures that extend into the dermis, the support layer of the skin. The punctures close almost immediately and do not tend to cause significant side effects. The skin may appear flushed or red, similar to a sunburn, for a few hours. For many weeks after microneedling, the body continues to make collagen in the treatment area. The result is smoother, softer, firmer skin.

With so many treatment options, it’s easy to feel overwhelmed pretty quickly. Not to worry. You don’t have to know exactly which procedure would be perfect for you. Just schedule a consultation. Doing so puts you in touch with a professional who can explain what each treatment does and what it could do for you. To schedule your consultation with us, call (828) 526-3783.

It is not uncommon for adults to notice an increasing number of spots on the skin as they get older. Because these isolated or clustered discolorations seem to expand exponentially with age, we often refer to them as age spots. They have also been called liver spots (because it was once falsely believed that they were related to liver problems). In truth, most of the discolored patches we see on the skin are caused by sun exposure. For that reason, they are more commonly and accurately referred to as sun spots. Regardless of what we call them, spots on the skin are problematic.  There are two parts to treating these, prevention of new ones and removal of those you already have. We’ll discuss those here. 

Prevention:

Before we attempt to remove existing sun spots, you need to take steps to prevent more from forming. The primary means of prevention is use of sunblock. Since the damage is caused by UVA that is present and the same strength all day every day, and at every latitude. Although there are multiple sunblock ingredients available but the only one that is practical is zinc oxide.  It is a physical sunblock and lasts after application until it is rubbed or washed off. The rest are chemical sunscreens and last only about an hour outdoors or two hours inside.

Treatment of Sun Spots:

The first step in treating sunspots is  evaluation of the spots to make sure they are all benign. After they are confirmed benign and only a cosmetic problem, there are several strategies to lighten them. 

• Interestingly, though sun spots are caused by UV light, one of the best ways to correct them is with light. IPL (Intense Pulsed Light) a laser like device, which we offer in our office, can target the excess melanin in sun spots and break it down into tiny particles. The body can then process and eliminate them, thereby lightening the discoloration. This usually takes several treatments. Because this method is temporary, you will need to repeat it in a year or so
• The other treatment is use of skin care. There are a number of products that can fade the spots but, by far, the most effective is hydroquinone. This is relatively effective when used by itself. However, it becomes exceptionally effective when combined in the Obagi Nu-Derm System. This not only corrects the spots but keeps them from coming back.

Sun spots age the skin. We can help you live without them. Contact our office at  (828) 526-3783 to schedule your appointment for sun spot treatment. 

Microneedling is one of several technologies that markedly rejuvenates the skin and reduces wrinkling.  Here we will discuss those technologies and other things that you can do to improve the quality and appearance of your skin.

Retinol/Retin-A: The cornerstone of skin care to prevent wrinkles has been, for many years, the use of a retinol or tretinoin (Retin-A) after the age of 30.  This is because the skin stops continually making collagen, the substance that thickens the skin, at around 30 years of age.  If the skin is not stimulated to continue the process of collagen production, the dermis, the support layer of the skin, thins and multiple crinkles and wrinkles result.  If you have failed to use these in the past and have developed significant crinkles and wrinkles, then use of the more potent tretinoin is still the mainstay of skin rejuvenation.

Peels & Laser Resurfacing: Once you had developed aged appearing skin, the only treatment that could correct knee wrinkling/crinkling was a leveling peel or laser resurfacing that removed the surface of the skin between the wrinkles to the level of the bottom of the wrinkles and allowed the skin to grow a new surface epithelium over a smoother dermal base.  The problem with this is that, because of limitation of the body’s ability to resurface the skin, they became the procedures with the longest downtime of any of the modern plastic surgical procedures.  Although we could push the body some, the minimum downtime where the skin is somewhat raw and oozing with either of these technologies is about 1 ½ to 2 weeks.

Intradermal Filling: Although fillers have been called “dermal fillers” for many years, until recently no one actually injected the filler in to the dermis, the support layer of the skin.  If they did, frequently a greenish or bluish line would appear when light reflected off the injected filler.  Only in the last 10 years have we had fillers that did not cause this blue line, the Tindal effect.  Belotero Balance® introduced in 2011 was the 1^st.  Juvederm Volbella®, equally as good if not better, was approved in 2016.  These allowed us to actually inject fillers into the dermis elevating the surface of the wrinkle to reduce or eliminate it.  We have also discovered that if the product is placed just at the bottom or under the dermis perpendicular to the wrinkles, it can prevent further wrinkling of the skin and allow the tretinoin to use some of the product to thicken and stiffen the skin.  Other than some mild swelling and occasionally minimal bruising that could be covered with camouflage makeup, there is essentially no down time with this technique.

Microneedling/Fraxel Laser: The one thing that leveling peels and laser did was markedly stimulate the dermis to build significant new collagen at a faster rate than it did with just the use of tretinoin.  The 1^st improvement to markedly improve the rate of the skin’s collagen production was development of the Fraxel Laser, a laser that, instead of removing the surface of the skin, simply poked holes in it.  Since injury to the dermis is the one thing that causes the skin to markedly produce collagen, this significantly turned on the body’s healing processes.  This laser, however, is quite expensive and uncomfortable.  Microneedling was developed to answer these problems.  It does the same thing by using small needles that create holes in the dermis and also turns on the body’s healing processes, markedly stimulating collagen production.

The procedure, done in a physician’s office, uses a device that pushes the needles absolutely perpendicular so that there is only a very minute entry point.  Because of the marked success of this process, “Microneedling” rollers are now being sold for home use.  The problem is that they do not produce uniform holes into the proper depth of the dermis and, instead of entering and leaving absolutely perpendicular, they enter and exit at an angle actually tearing the skin.

No Downtime Skin Rejuvenation: These latter two developments have allowed us to now achieve skin rejuvenation comparable to leveling peels and laser but without the significant downtime.  Our present protocol for rejuvenation of sun damaged, wrinkled, crinkled skin is beginning tretinoin, injection of the wrinkles to reduce as much as we can using Volbella®, and then doing a series of Microneedling procedures.

If you are interested in rejuvenating your skin, call our office at 828-526-3783 to set up a consultation.

If you’ve been planning to have a plastic surgery procedure, you’re probably already looking forward to the outcome of your journey. What you may not have thought very much about is your recovery period. We understand, but, even for minimal procedures, there are things you can do to improve your chance of a good result. Here, we discuss some of the must-haves that can get you through your post-surgical recovery with more ease.

Must-Have #1 – Help

Most people who move beyond their consultation with a plastic surgeon and book a procedure will need some help after surgery. If you’re in the planning stages, do not put off the necessary arrangements. Not doing this can set the tone of your recovery as a stressful one. You should have someone who can drive you home, and do the cooking, cleaning, childcare, and pet care at least for the first day when any stressful activity can increase bruising or other problems. Additionally, you may need someone to help take care of you, depending on your procedure. Remember, everyone needs help now and then. Soon, you will be fully recovered and back to taking care of everyone else.

Must-Have #2 – Home Preparation

Home remedies are items we usually think of keeping on hand to treat minor problems. One of those is ice. Ice packs can be applied for about 20 minutes at a time to soothe swelling and soreness. It is beneficial to have two. This way, one is always ready. Another is a way to raise the head at night if you are having anything in the head or neck done or to raise the hand or foot if that is where you will have the procedure.

Must-Have #3 – Patience

The final must-have that we want to suggest is that you need to have patience as you recover from whatever you have. You may have some swelling and bruising that last for several days or weeks. Usually, these diminish a great deal within the first week after surgery. However, even mild swelling, which can linger for a few weeks, can obstruct the final results you’re so anxious to see. Be patient. Once the swelling has fully resolved, you’ll have years to enjoy your result.

Is this the year you put your cosmetic goals on the front-burner? Call (828) 526-3783 to get the ball rolling.

The idea of using fat from one part of the body to enhance another used to be tossed around in a humorous way. Through innovation in medicine, we can now look at this concept much more seriously. Fat injections, or fat transfer, is now commonly used to restore youthful contours to the aging face. Fat cells can also be injected into the lips to make them fuller, or into deep creases around the nose and mouth. Fat can be used like other fillers, but the results are, essentially, permanent.

What Happens During Treatment

Fat injections require two different processes. First, the skin in the donor and recipient sites is cleansed and treated with local anesthesia. Then, a syringe and cannula (the hollow tube instrument used during liposuction) are used to remove a predetermined amount of fat. This process is slightly different than traditional liposuction and does not typically result in a major change in the appearance of the donor area. After removing fatty tissue, cells are processed to separate the purest fat for injection into the face. The recipient site may be slightly overfilled at the time of treatment to account for natural fat absorption. The entire process can take a few hours.

After Fat Injections

There is very little downtime needed to recover from fat injections. Most patients feel well enough to immediately resume normal activities. However, we do suggest avoiding more strenuous activities and exercise for up to one week. The intensity of effects like redness, swelling, and bruising typically relate to the location and size of the treatment area. Usually, these fade over the course of several days. If a larger volume of fat is extracted, the donor site may be slightly swollen for a few weeks. At about four months post-op, we expect the final results of treatment to be apparent and long-lasting. The renewed facial contouring after fat injections can last a lifetime.

Learn More

Get the full details on fat injections and how they can correct the signs of aging on your face. Call our Highlands, NC office at (828) 526-3783.

Which Filler Works Where?

A filler, by present aesthetic definition, is an injectable substance used to correct wrinkles, folds, or volume loss in the body, particularly the face.  As fillers have evolved, they have replaced early facelifts, redo facelifts, facial implants, and many other surgical procedures such as lower blepharoplasty, peels, and laser resurfacing in many cases.  Their popularity continues to increase.  But, what are these and how do we use them?  Read on to find out.

What are Fillers?

There are many different types available, including fat, collagen, collagen precursors, “collagen generators,” and semipermanent to permanent substances.  Fat is an excellent option and also semipermanent but requires harvesting the fat before it can be injected.  All of the others are products that can be taken off the shelf ready for injection.  Collagen, the first filler developed, is rarely used anymore because its results last at most 6 months and frequently much less.  Collagen generators, such as Sculptra are less often used, since they take a significant time to achieve results that can be achieved by other fillers almost immediately and since many of the other fillers now have a longevity as long these.  Additionally, the collagen precursors have recently been shown to also stimulate collagen, the building block of the support layer of the skin and deeper tissues.  The permanent and semipermanent fillers, (Bellafill®, silicone) though still used, are less so because of difficulty in using without a high problem rate.  The most common fillers used today are collagen precursors, either calcium hydroxyapatite or hyaluronic acid.  The hyaluronic acid fillers, because of their safety record and reversibility if problems arise, are, by far, the most common.  They come in multiple consistencies, each better at correcting specific parts of the face or elsewhere.  There are also many brands of these.  I use the Juvéderm® family of fillers which have the greatest longevity and widest spectrum of product characteristics.

Treatment of the Lips:

Lips generally present 3 different aesthetic problems.  They can be too small congenitally, asymmetric, or lose volume with age.  As they lose volume, the upper lip flattens and loses its normal pout and appears smaller, the skin of the lower lip becomes the most prominent portion rather than the vermillion and wrinkles develop.  Over the years, different surgeries to correct these problems, including implants have been used.  Presently, however, use of a filler generally gives a better, more natural result.  I generally use either Juvéderm® Ultra or Juvéderm® Vollure, depending on the specific need.  Both provide volume filling, though Ultra® provides slightly more fill for the same volume injected.  It lasts approximately 10-12 months in the lip where Vollure® lasts about 18 months or longer.  I use Juvéderm® Volbella for finesse of the shape and for any fine lines remaining after restoring volume.  It also works excellently if only a small amount of correction is needed since it comes in a smaller quantity than the other products.  

Treating Volume Deficiency:

Loss of volume is one of the main problems that occur to the face and body with age.  It is responsible for many of the other problems generally considered signs of aging.  In the face, as volume is lost, the tissues descend forming superior flatness and, inferiorly, folds or creases at the places where the underlying ligaments prevent further descent.  When we first started using fillers, one of the most common areas of injection was along the nasolabial folds, the junctions between the cheek and the lips.  This, however, did nothing for the superior areas that had lost volume and had caused the increased prominence of the nasolabial folds.  Presently, we most commonly treat the nasolabial fold areas by refilling the upper cheeks.  This usually effaces and reduces the folds.  If not, we will revert to filling the fold, but this is now much less common than previously.  We also treated tear troughs, those depressions that appear to be bags in the lower eyelid area by trying to fill the lines.  I discovered many years ago that the most efficient method of doing this is to fill the cheek under the tear trough, thus pushing the tissues back up to their normal position.  This method is now being taught throughout the industry.  Although I previously used Radiesse®, a calcium hydroxyapatite filler for this, I now use Juvéderm® Voluma.  It is placed deep, just on top of the bone, and pushes the tissues up, replacing fat that was lost.  It generally lasts at least 2 years but, in a few cases, has lasted over 4 years.  For the areas where there is no bone to push against, such as in the lateral cheek, both Voluma® and Vollure® can be used more superficially.  Treatment here frequently effaces marionette lines reducing the need to treat them individually. Other areas like the Back of the hand can also be filled to hide the signs of age. 

Treating Lines, Folds, and Wrinkles:

If fine lines and wrinkles are not eliminated by use of Botox® or replacing volume, fillers have also become our best option.  Previously the only thing available was either a leveling peel or laser procedure.  The problem with both of these is that recovery takes at least 10 days to 2 weeks with significant discomfort for that entire time.  Fillers have allowed us to correct the problem almost immediately with minimal down time and no continued discomfort.  Although fillers were originally designed for intradermal use and are still called “dermal fillers,” this is the only time we actually presently place the filler in the dermis, the support layer of the skin.  Volbella®, a relatively thin though strong filler, works excellently when placed in lines and wrinkles.  Unlike many other fillers placed in this location, it rarely causes a blue line (the Tyndall effect).  This elevates and frequently eliminates the wrinkles.  Since the wrinkle is generally caused by loss of thickness of the dermis, I generally, also, crisscross either Volbella® or Vollure® under the area of wrinkles to thicken and stiffen the skin, making it less reactive to the underlying muscle pull.  We then make certain that you are on a good retinol or tretinoin (Retin-A) so the body can use some of the filler to create its own collagen returning the skin to its younger thickness.  By doing this, the most I have had to inject the wrinkles to get them to remain minimal, is twice.

The Option of Fat:

An excellent option for folds and volume replacement is fat.  It can be used anywhere a filler can except intradermally.  However, when placed just below the dermis it can stimulate dermal growth and improvement in the skin because of the inherent stem cells within the fat.

To discuss further the difference between these, the advantages and disadvantages of each, and how they might help you, please call our office in Highlands at 828-526-3783 to schedule an appointment.

Wrinkles around the lips are caused by multiple factors. The first is thinning of the skin and loss of its elasticity. This happens partially with age as the body stops making collagen and elastic tissue continuously at about 30 years of age, and partially from sun exposure. Secondly, the underlying muscle acts to accordion the skin because of the loss of elasticity and the ability to contract without wrinkling. The more you like to talk or use the mouth expressively the more wrinkling you tend to create. Thirdly, the lip loses its subcutaneous support that separates the skin from the muscle. This also increases wrinkling. Once formed, there are a number of things that can be done to eliminate the wrinkles, depending on their severity. 

Skin Care

Occasionally, if the wrinkles are just beginning, all that is needed is what we call Basic Skin Care Plus. This is a good cleanser, an alpha-hydroxyl to remove the dead cells, a pH balancer and a good zinc oxide sunblock Plus effective retinol to add collagen and Obagi®’s ELASTIderm® to add elastic tissue. 

Lip Injection

The normal upper lip has a noticeable pout at the vermillion and defined philtral columns (the vertical lines on either side of the midline). As we age, both are lost and the lip becomes straight rather than concave. Occasionally, significant lines also appear. If this is the case, plumping the lip just back to normal can eliminate the lines and return the lips to a more normal appearance.  

Laser Resurfacing

If the lines are resistant to injection and other treatments or you wish for fast results, the final option is to flatten the lines using a laser. This essentially removes the top layer of the skin, bringing the elevated skin down to the level of the bottom of the wrinkles. In and of itself, this evens the surface of the skin. Additionally, it stimulates collagen production and tightening to further smooth the lip. 

If you have lip wrinkles that you would like gone, call our office in Highlands for an appointment to see what is right for you. Call us at 828-526-3783.

The decision to undergo a plastic or cosmetic surgical procedure is a big one that you likely made with the help and support of a loved one. So, as you ready yourself for surgery, here are a few things to pass along to your point-person and caretaker, the one who will be helping you along this life-changing journey.

The First Night – Your surgical staff will ask you if there is someone at home to stay with you, especially your first night home. If you don’t have a live-in partner, it is essential that you arrange for someone to stay with you. Getting up in the night, feeling dizzy or ill can be especially frightening if you are alone.

The Care and Feeding of You – You may be given restrictions on what you can and cannot eat, depending on your surgical procedure. Staying hydrated and eating healthy will go a long way towards your recovery. You may want to prepare meals in advance and shop for the foods you like, but better yet, let your caretaker prepare your meals. Don’t forget to take inventory of your medications and read the advisory language on the labels. This is important and should be followed, as an upset stomach, unnecessary nausea or vomiting may result from taking your meds on an empty stomach.

• The Kids – If you have small children, arrange for help with child care – whether that is your primary caretaker or a friend. And remember, no heavy lifting!
• Housekeeping 101 – Let your caretaker vacuum. And do the dishes and laundry. Just for a short time while you get back to your old and “new” self!

Call us, today, to learn more about the plastic and cosmetic surgical procedures we offer, and let Dr. Buchanan help you be your best self, every day: (828) 526-3783.

Time flies. Popular maxims such as living your best life and seizing the day ring oh so true.

No matter the time of your life, this may be the perfect time to refresh your image, regardless of your age or gender.

There are many plastic surgery options available today and choosing from them can be confusing at best. You know best what areas of your body and face need improving…and choosing the correct procedure often depends on your age. Dr. Buchanan can help you decide and focus on the goals you have for your surgery.

The Roaring 20’s – Just out of your teens and finally acne-free, you may want to improve the appearance of your skin using minimally invasive procedures and topical treatments. Breast augmentations, liposuction and rhinoplasty (“nose jobs”) are common procedures for young adults.

The Thriving 30’s – You may begin to see your first fine lines and wrinkles. Minimize their appearance with a facial, a chemical peel, laser skin resurfacing or facial fillers. This is also the decade of child-bearing and your body may not be responding to diet and exercise. Consider body contouring options such as liposuction, breast lifts, tummy tucks and “Mommy Makeovers.”

The Fabulous 40’s – You just keep getting better! You may want to consider injectables, brow and eyelid lifts, neck or face lifts. All are excellent compliments to your youthful, active life style. Breast implants and lifts, tummy tucks and liposuction are popular procedures of the “fabulous forty” crowd.

The Fun 50’s – “Fifty is the new forty” and this is your decade. Brow, face, neck and eyelid lifts, laser resurfacing and deep chemical peels are popular procedures for those in this adventurous time of life.

The Savy 60’s – Men and women “of a certain age” are increasingly more likely to have facial plastic surgery procedures during this decade and beyond. If you are in good health, you can still consider a tummy tuck, liposuction and other lift procedures.

Let Dr. Buchanan work his magic – regardless of your age. Call for a consultation, today!

Consider your hands. Think of all the things they have accomplished over the course of your life: The meals prepared, the love given, the dishes washed, the diapers changed, the letters written and the flowers planted. Your hands have worked hard and are one of the first places to show the visible signs of aging. With time, you may begin to see darkened “age spots” or a loss of fatty tissue which makes your hands look bony and perhaps older than your age.

Hand rejuvenation treatments can reverse the visible signs of aging, the effects of sun damage and can help restore your hands to a more youthful appearance – one that matches your youthful, active lifestyle. Various treatments are available and treatment options may be combined to help you achieve the look you desire.

Here are four ways Dr. Buchanan can treat your aging hands at The Center For Plastic Surgery:

Laser Skin Resurfacing – The Ellipse IPL® offers the advantages of intense pulsed light therapy, a proven technology that treats the red and brown areas of sun damage using short bursts of laser light which penetrate and gently remove “age spots.”

Chemical Peel – The Obagi® RADIANCE Blue Peel is a salicylic acid peel that can improve the look, texture and feel of your hands in minutes with no down time. Glycolic fruit acid peels remove the dry, top layer of the skin to reveal healthier, moist skin underneath.

Microdermabrasion – This is a superficial skin polishing that “sands” off the first layer of the skin with tiny crystals. The procedure is non-surgical, non-invasive, fast and easy.

Injectable Fillers – When injected, fillers such as Radiesse and Juvederm injectable gels plump the skin on your hands to give them a more youthful appearance.

As with any cosmetic procedure, it’s important to have realistic expectations and keep in mind that these procedures are designed for improvement, not perfection.

If you would like to know more, call for a consultation with Dr. Buchanan, today, and enjoy younger looking hands – just in time for the Holidays!