There has been multiple claims that treating the frown lines could affect the mood and treat depression, but the most conclusive evidence comes from a study designed by Dr Kruger from Germany.  In fact he conducted the study with a colleague Dr. Wollmer at the University of Basel Switzerland the town of the famous Roger Federer. The study is scientifically designed with a control (placebo) group and demonstrated an 80% positive response in the treated group versus 20% response in the placebo group. The mechanism through which this beneficial effect is obtained is not clear. It is believed that because of the small dose of botulinum toxin A, it is unlikely that this effect is produced by a direct action on the brain. The improvement in depression has to be a proprioceptive feed back from the treated muscles to the brain. It means that if a person is sad or angry these muscles show the expression of anger or sadness. At the same time the muscles make the central nervous system aware of their state of contraction and tightness through the feedback mechanism called proprioception. Elimination of that muscle contraction with the botulinum toxin treatment could break this vicious cycle and improve the mood. Another possible theory is that by looking less angry or sad, the patient gets a more positive response from other people or from the mirror. We all experience that when we feel good and smile other people smile back at us and this spreads the good mood. I believe this study is very important and should positively impact the use of these locally effective neuromodulators. Let me know if you have experienced improvement in your mood after treatment with Botox or Dysport. Please leave a comment here or on our face book page: Farhad Rafizadeh MD for Better Plastic Surgery. I think this would be a great conversation and would be mutually beneficial. Any questions feel free to call me at 973 2670928.

I did one of these procedures today and I thought it would be good to write about the key parts of the procedure and what needs to be done to obtain predictable results. The operation has been described in detail by many great plastic surgeons and different procedures exist to accomplish the result of setting back the ear and preventing it from protruding. Most frequently there are two anatomic malformations that cause the ears to be prominent. One is the over development of the central ear cartilage called concha. The other is the lack of an adequate fold between that central part and the rest of the ear pavilion.

I believe the operation can be done simply by creating the fold using sutures described by Mustarde and removing the excess cartilage. Both these can be done through an incision behind the ear under local anesthesia. The creation of the fold has been a challenge. The cartilage can break or the fold could be too sharp causing a deformity and look unnatural. In order to avoid these complications I have devised a technique that allows me to control the folding process and make the results more predictable. This is not the place to explain the technical details, but I would be happy to explain all the details during a consultation.

If you or a child in your family suffers from this problem make an appointment for a detailed evaluation and a plan of treatment. By calling 973 2670928.

Despite the simplicity of this procedure I see patients who come to my office with less than perfect results on a weekly basis. I believe that the exact knowledge of the functional anatomy of the facial musculature is essential to achieve perfect results. For the longest time I thought it was a lot less expensive for a patient to go to a beauty salon or a spa and have an itinerary doctor do the injection and that was the reason some people did that instead of going to a board certified plastic surgeon. I was really surprised the other day when one of my patient who had been talked into getting a Botox injection while she was getter a haircut, had paid more than what I charge for the same procedure. She was seeing me because despite the high price she didn’t have the appropriate results.  Why not go to a specialist who is most qualified to do the procedure?

This is a common question from my patients in Morristown, New Jersey, but I think there is quite a bit of controversy around this subject. I was watching a video by one of the leading plastic surgeons attempting to bust some myths about breast augmentation and he mentioned that breast implants do not lift the breasts. Then I looked around on the web and noticed that it seems to be a generally accepted notion that breast implants do not lift the breasts. Through my own experience, I have to admit that I do not agree with the fact that breast implants do not produce a lifting effect on the breast and the areola. I believe that if the ptosis (sagginess) is not excessive and certainly in cases of breast deflation, the kind noticed after pregnancy, breast augmentation definitely produces a lifting effect. I will demonstrate this by posting some of the pictures already on this site. I have better pictures to show potential patients in my office. Some of these pictures could not be posted on the web because I did not have the specific consent from the patients for online viewing. However I do not want to imply that every breast ptosis can be corrected by breast enlargement. Most cases of significant breast ptosis will require an augmentation mastopexy (breast lift), but any effective mastopexy will produce scars on the breast that most patients prefer to avoid. In many cases I have been able to create a pleasing breast shape by augmentation without mastopexy. I often discuss with the patient the possible need for a breast lift in case the augmentation alone did not produce the desired effect. The most common breast lift that I perform is the circumvertical lift, which involves a scar around the areola and one going from the areola to the fold under the breast. These scar normally heal well.

Before photo	After photo
Before and after photos of breast augmentation performed by Dr. Rafizadeh in Morristown, NJ. showing the correction of breast ptosis (sagginess) after breast augmentation.

Before there was textured implants we used an implant covered with a layer of polyurethane. Those days the silicone gel wasn’t really a gel, like Jello. It was more like honey and the implant’s  membrane  was very thin. The gel used to come out of the membrane and cause irritation of the capsule, a phenomenon called gel bleed. The incidence of capsular contraction   (tightening of the layer around the implant) was very high, much higher than today. As it turned out the polyurethane covered implants used to have less incidence of capsular contraction, the breasts stayed softer and more natural. Then we found out that the polyurethane got disintegrated by the body and late contractions developed. These implants are no longer available.
Many different manufacturers were making textured implants, assuming that the textured surface would make the capsular contraction less likely to happen. There were all kinds of textured surfaces. I remember one that looked like a brush and was made by Dow Corning. This implant went off the market along with Dow Corning. The two remaining implant manufacturers Mcghan which is Allergan today and Mentor continued making textured saline implants that I was using.
One texturing resembles sand paper and is called Siltex from Mentor. The other a bit coarser and softer called Biocel by Allergan. Over the years I found out that these textured implants caused rippling and leaked more frequently. There is evidence in the literature that there is less incidence of capsular contraction with the textured surface implants, but in my opinion they do not help the capsular contraction, as matter of fact, I found that the breasts were never as soft as with a soft smooth implant breast augmentation. The textured surface offers one advantage. The implant is less likely to move. This could be good and bad in breast augmentation but it is definitely good in post mastectomy breast reconstruction with expanders and in cases where anatomic or contoured shape implants are used.

Conclusion: I only use textured expanders and switch them to
smooth gel implants at the final stage of breast reconstruction. Almost all my breast augmentations are done with smooth implants. Experience is a great advantage and I am very happy with the choice of implants for my patients. There are many plastic surgeons whom I respect offering textured implants even today, but I feel that there is limited application in my practice, except in a rare situation when the implant position is unstable. As you can see there is a lot of nuances that need to be understood.

Please explore the site, read the breast blogs and after reading all this information call us for a consultation to find out what can work for you.

Both implants are made of a silicone polymer membrane that holds either saline or silicone gel. When I started my practice in 1984 we only used gel filled implants. Very few plastic surgeons used saline filled implants. Then all of a sudden a media frenzy started about the silicone gel implants. It was said that they were dangerous and could cause all kinds of diseases. Every woman with a little joint pain was asked to remove her implants. The lawyers started suing the manufacturers and sometimes the doctors who put these implants in. The FDA disallowed the use of silicone implants for breast augmentations, but allowed it for breast reconstruction. Dow Corning the manufacturer of silicone implants went out of business and we only had saline implants for breast augmentation in the US. In New Jersey, we were doing these procedures with textured saline implants. Texture versu smooth is another subject that I will get into  another day. Initially, there was no science behind these claims. Despite of that several law suites were won by the plaintiffs. Years went by and eventually the science caught up. It was finally proven that the silicone implants were safe and did not cause autoimmune diseases. Finally the FDA allowed the silicone implant for breast augmentation. Now both implants are available and they both work well for breast enhancement, but there are differences and the patients need to make a decision.

These are the differences in a nut shell:

1) The gel implant feels more like the patient’s tissue, therefore is better. The saline implant is a bag filled with salt water and it doesn’t feel quite as natural as the silicone. This difference is definitely more noticeable in patients with very small breasts or after mastectomy when there is very little soft tissue to cover over the implant. In patients with larger breasts it doesn’t make as much of a difference and saline implants are very acceptable.

2)  The FDA has required that every patient who gets the gel implant agree to get an MRI to rule out a rupture every two to three years and the manufacturers have made that a requirement as well. Here again, there is little science behind this requirement and it is controversial if this is really necessary, nevertheless this is the law. MRIs are expensive and some patients don’t like them because they get claustrophobic. This is therefore a major problem with the gel implants.

3)  The gel implants require a larger incision to
insert them, about twice the length necessary for inserting a saline implant.

4)  Gel implants are about twice the price of a saline implant. That makes the operation about four to five hundred dollars more expensive.

5)  The gel implants seem to be more stable and are less likely to drop lower in the long run.

As you can see there are advantages and disadvantages. This is why you need to be examined by an experienced plastic surgeon and decide together what would work best for you. I usually spend an hour discussing theses issues amongst other issues with every patient who comes for a consultation in my office in Morristown, New Jersey. Please explore the site. Go to procedures and read about breast augmentation. See the pictures in the picture gallery and read the pertinent blogs under breast category, then call the office for an informative consultation with me.

In my breast augmentation patients in Morristown New Jersey, I have noticed distinct differences between the Caucasian and oriental patients. These differences are not only anatomical, but psychological and cultural. There are also differences in style and taste. These differences affect the choice of implants as far as dimension, projection and volume.

The oriental patient is more reserved and conservative, only asking for a small change in breast size. Anatomically the oriental breast is wider and has less projection, therefore my implant of choice is a wider base implant that matches the dimensions of the breast and provides less volume and projection. In the Caucasian patients I would normally choose a moderate profile or in some cases a high profile implant.

Understanding these cultural and anatomical differences allows us to achieve better results and happier patients. Please call us with any questions and come for a consultation to find out what works best in your case.

In the last blog I wrote about how important was the harmony and balance in facial rejuvenation in the older patient. By older patient I usually refer to patients in their late sixties or seventies. Here I would like to write about younger patients who are coming with early signs of aging in whom there are several options. If the main problem is active lines, lines caused by a muscle action, the initial treatment is Botox or Dysport. Early nasolabial folds can be treated with fillers like Restylane, Juvederm or Radiesse.

I also see patients who are in their mid thirties and start showing laxity around the sides of their chin and early jowl formation. In these patients we have an interesting choice. Filling in the pre-jowl area is a way to camouflage the jowls. A short scar face lift or an S lift with just the pre-auricular scar and tightening of the deep layers will accomplish a more lasting results that could also be more economical in the long run. Again the natural look is a matter of balance and harmony. An artistic evaluation of the facial features will allow us to do the right amount of fillers, fat grafting and skin tightening to create rejuvenation as well as beautification. Results that would look natural because the surgery is imperceptible.

The two components of facial aging are:

1) Skin laxity and redundancies. For example Jowls, nasolabial folds, marionette lines.

2) Changes in skin texture and fine wrinkles.

The second component is primarily sun related and will require skin resurfacing as primary mode of treatment, even though the wrinkles improve with skin tightening procedures such as face lifting.

The skin resurfacing procedures in general will cause loss of pigmentation and are problematic in patients who are tan or can tan. After resurfacing, on close inspection, the skin will have a different appearance.

In northern New Jersey, specifically in Morristown area my patients want to eliminate the gross sign of aging without changing the character of their skin. My patients want to look natural. They don’t want anyone to know they had surgery. I have talked about the natural look at length. It is buzz word on most web sites. Every one claims to create a natural look, but what makes the so called natural look is the harmony and balance in the facial structures as well lack of visible scares and abnormal textures of the skin. To achieve this harmony and balance, I may have to do more than just a facelift. A combination of procedures like a facelift, brow lift and upper and lower eyelid surgery is occasionally necessary. Restoration of facial volume by fat grafting or fillers like Radiesse is sometimes mandatory to create that harmony and proportion that is so important to achieve the so called natural results. A detailed evaluation of your face is necessary to determine how much surgery or combination of surgical and non-surgical procedures is needed to achieve optimal results.