Spider Vein Removal
The best and gold standard treatment for spider veins is laser. Laser vein removal is an easy, fast, and effective way to treat superficial veins Laser therapy has been used in the medicine for more than 30 years. Advances in technology have helped developed many different lasers. The laser uses a focused beam of light. In the treatment of veins, the wavelength of light is targeted to the pigment in the blood. The laser heats up the small vein and destroys it. The laser beam is focused and does not damage the nearby skin tissue. Over a period of four to six weeks, the vein is reabsorbed by the body and disappears.
The laser pierces the skin and penetrates the superficial blood vessel. The heat generated from the laser coagulates the blood inside the vessel causing it to collapse and seal. Over the next few weeks, the vessel will disappear and all the blood will be removed by the body's scavenging cells. The newer laser treatments allow the delivery of a precise dosage of energy to each blood vessel without injuring any nearby structures.
In most cases, only the very small superficial veins are treated with a laser. The majority of individuals do not require any type of anesthesia, but for those who are squeamish or anticipate pain, the physician may apply a topical anesthetic 20 minutes prior to the procedure. Most current day lasers also have a cooling system which prevents the tip of the laser from getting hot.
Many people, especially fair-skinned people in sunny climates, will develop areas of the face as they age where superficial veins and capillaries in the skin become enlarged and highly visible. Because of their typically irregular and spidery appearance, these superficial cutaneous vessels are commonly referred to as 'spider veins'.
The medical term for this phenomenon is 'telangiectasia', which is essentially Greek for 'the stretching out of the very end of a blood vessel'. And that's essentially what 'spider veins' are. They occur most frequently in the central face, particularly on the anterior cheeks and at the base of the nose. Some people develop very prominent spider veins on the dorsum and tip of the nose, where they are difficult to conceal.
Rosacea is a condition of the facial skin where the central face (nose, cheeks, chin, central forehead) gradually turns red and develops numerous fine telangiectasias. These areas easily become flushed, particularly after physical exertion, eating spicy food, or having a glass of wine. Rosacea has traditionally been treated with topical agents and oral antibiotics, however most patients experience improvement only when the medications are in use, with return of rosacea once the treatment is stopped. For many patients, rosacea is fairly resistant to topical and oral medications.
The cause of spider veins and rosacea is not completely understood, and appears to be multi-factorial. Contributing factors may be a genetic predisposition, the chronic use of topical steroid agents, and solar damage to the facial skin that gradually builds up over many years. Rosacea occurs most commonly in warm climates where people get a great deal of year-round sun exposure.
These conditions can perhaps be prevented (in part) by the avoidance of excessive exposure to ultraviolet radiation (the sun, that tanning bed), the avoidance of chronic topical steroid use, and by the daily use of a high-SPF facial sunblock. In some cases, telangiectasias are associated with a systemic autoimmune disorder, such as scleroderma. Once a person develops facial telangiectasias and/or rosacea, these conditions in general do not spontaneously disappear.
So how do I get rid of rosacea, or my facial spider veins, or both?
The ideal treatment for 'spider veins' and rosacea should be easily administered, safe for the patient, reliably effective, should not require an excessive number of treatments, should be non-invasive, and should not have a prolonged recovery period.
Here's the good news: such a vein treatment does exist. A pulsed-dye laser developed specifically for the treatment of cutaneous vascular disorders, can completely eliminate most facial 'spider veins', usually in two to three treatments (large areas of long-standing spider veins may require more treatments), and can reverse the cutaneous manifestations of rosacea as well. In addition, the laser energy pulse delivered by the laser has been modified to limit the development of post-treatment bruising (purpura), a problem associated with older pulsed-dye lasers.
The laser uses light energy of a wavelength that is specifically absorbed by structures which are reddish or purple in color, i.e. capillaries and small arteries and veins. The laser beam incorporates a Dynamic Cooling Device which sprays the skin with a cooling agent immediately before every laser pulse. This advanced technology both protects the skin from thermal energy and reduces the discomfort previously associated with pulsed-dye laser treatment. The laser pulses are generally described by patients as feeling like 'a rubber band snapping against the skin'. No anesthesia (topical or otherwise) is required.
While pulsed-dye laser technology has been available for decades, pulsed-dye laser treatment of rosacea and facial telangiectasia was not frequently performed as the laser energy tended to explode superficial blood vessels, producing facial bruising that may persist for several weeks. The new laser modulates both the peak energy and the duration of the laser pulse in order to coagulate rather than explode dermal blood vessels, which allows treatments to be performed that produce little or no bruising. This advanced technology makes it possible to achieve significant clearance and even complete elimination of facial redness and spider veins with no 'downtime'.
Is Laser therapy a 'cure' for rosacea?
That really depends upon how one defines 'cure'. If by this one means "can you eliminate the facial redness, flushing and spider veins that I walk into your office with?", then the answer is YES - we are able to completely eliminate these findings for many of our patients with a series of laser treatments. However, any individual who has experienced resolution or significant improvement in rosacea following laser treatment is at risk for recurrence of facial redness and flushing if they do not take steps to avoid the primary risk factor: ultraviolet light (sunlight) exposure.
We strongly recommend that our patients 'protect their investment' by using a high-quality, chemical-free sunblock on a daily basis, rain or shine, summer or winter. Hats are also highly recommended in the summer months. Appropriate protection from damaging UV rays can prevent the recurrence of the facial redness and flushing associated with rosacea for most patients.
Breast Reduction
The surgery, which the Food and Drug Administration has called "good medicine", is quickly gaining popularity. In 2005, over 113,000 women had breast reductions, an increase of 11 percent from 2004
Procedure
Doctors almost always perform breast reductions while the patient is under general anesthesia. During pre-operative visits, the doctor and patient may decide on new, usually higher, positions for the areolas and nipples.
For males, excess tissue may simply be removed through a tiny incision in each breast. This leaves minimal scarring.
Patients may take a few weeks for initial recovery, however it may take from six months to a year for the body to completely adjust to the new breast size. Some women may experience discomfort during their initial menstruation following the surgery due to the breasts swelling
Techniques
Inferior pedicle technique
The inferior pedicle technique, sometimes also known as a keyhole or Weiss pattern reduction, involves an anchor-shaped incision which circles the areola. The incision extends downward, following the natural curve of the breast. Excess glandular tissue, fat, and skin is removed. Next, the nipple and areola are moved into their new higher position. A drawback of this technique is sometimes "square" looking breasts, but this is a common option for women with the largest, droopiest breasts.
Vertical scar technique
The vertical scar technique, also known as the SPAIR or short scar breast reduction, is now widely gaining popularity due its minimal scarring and round shape post-surgery. To perform this, a doctor performs what is also known as a "lollipop incision" to the breast, resulting in the least amount of scarring. There are no horizontal incisions, and the scars are less likely to broaden with time, as with the Anchor-shaped technique. This technique keeps its results the best in the long term.The breast is reduced through removal of the lateral and inferior tissues, leaving the upper pole mostly untouched
Liposuction only technique
The liposuction only technique is used for women with breasts that are not quite as large as with the other procedures. For the best outcomes, women who choose this procedure have perkier breasts without a drooping nipple, as the skin itself never moves, but, rather, fat is simply removed from inside of the breast. The result is not as drastic as the other techniques, but it involves a much quicker healing time, less pain, and less money. This is the technique typically used for men.
Free nipple graft technique
The free nipple graft technique, a less common procedure, is now typically used only in the most extreme cases of drooping. In this procedure, the areola and nipple are completely removed for relocation and replaced as a skin graft higher on the breast. In these cases, sensation from the areola area will be lost and it is most likely to impair lactation as compared to the two most popular procedures, although some women have been known to successfully produce some amounts of milk.
Breast Lift
Loss of skin elasticity, gravity and other factors such as weight loss, pregnancy and breast-feeding ultimately affect the shape and firmness of your breasts. Patients who are generally satisfied with the size of their breasts can have a breast lift to raise and firm them, resulting in a more youthful breast contour. Some patients may be unhappy that they have lost a significant amount of breast volume over time. In such cases, implants inserted in conjunction with a breast lift can increase breast size at the same time as the shape and position of the breasts are enhanced.
Results of a Breast Lift
Breast lift surgery will make your breasts firmer and more uplifted. The position of your areolas and nipples will be enhanced, and the size of your areolas will be aesthetically pleasing.
The incisions from your breast lift surgery will heal and fade over time. It is important to realize, however, that the incision lines will be permanently visible. In some instances, they will eventually be only faint lines. Certain individuals may have incision lines that are more noticeable. Fortunately, the incisions for your breast lift are in locations easily concealed by clothing, even low-cut necklines.
How long will the results last?
Unless you gain or lose a significant amount of weight or become pregnant, your new breast shape should remain fairly constant. However, gravity and the effects of aging will eventually alter the size and shape of virtually every woman's breasts. If, after a period of years, you again become dissatisfied with the appearance of your breasts, you may choose to undergo a second breast lift procedure to restore their more youthful contour and appearance.
Maintaining a Relationship with Your Plastic Surgeon
You will return to your plastic surgeon's office for follow-up care at prescribed intervals, at which time your progress will be evaluated. Once the immediate postoperative follow-up is complete, many surgeons encourage their patients to come back for periodic checkups to observe and discuss the long-term results of surgery.
Please remember that the relationship with your plastic surgeon does not end when you leave the operating room. If you have questions or concerns during your recovery, or need additional information at a later time, you should contact your surgeon.
Breast Augmentation
Also known as augmentation mammaplasty, breast augmentation involves using implants to fulfill your desire for fuller breasts or to restore breast volume lost after weight reduction or pregnancy.
The results will be long-lasting
The results of your breast augmentation surgery will be long-lasting. You will find it easier to wear certain styles of clothing and swim wear.
Like many women who have had breast augmentation, you may also have a boost in self confidence.
Implants may need to be replaced or revised
It’s important to know that your breast implants are not permanent and may require replacement during your lifetime. You should expect to have future visits with your plastic surgeon to discuss changes in your breasts.
Over time, your breasts can change due to aging, weight fluctuations, hormonal factors and gravity. If, after a period of years, you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast lift or implant exchange to restore a more youthful contour.