I am pleased to announce the initiation of our new blog, which will allow our patients to stay informed on the latest advances and other news in Facial Plastic Surgery. I will be posting articles and other entries that help to ensure that you are exceedingly well-prepared for any procedure, and keep you updated on new developments and specials here at Cincinnati Facial Plastic Surgery. Importantly, I also encourage each of you to submit anything you might be interested in, including any articles, questions, or comments about recent developments. Having a running dialogue like this is a fantastic and stimulating way to learn more about how to get the best results and the best bang for your buck!

To kick things off, those of you who have been asking about alternatives to Botox will be happy to know that the long-awaited competitor, Reloxin (to be distributed by Medicis, the makers of Restylane and Perlane), is finally under review by the FDA. It's impossible to predict when exactly the review will be completed, but I will let you know as soon as I do. The Botox brand has had a monopoly on this market in the U.S. for years now, and we welcome the prospect of competition in this area to stabilize, or even improve, the affordability for all of our patients.

I also have a backlog of interesting articles I've accumulated over just the past few months. I'll start with this one from the front page of the Enquirer--it's a very well-written article. Please also see my reply to the author, pointing out the benefits of Fat Transfer for a more long-lasting effect of Volume Replacement in the face.

Dr. Donath

Eyelid Lift
Posted May 20, 2010 2:46 PM in Blepharoplasty

A patient came to our office today requesting advice on her upper eyelid and brow region, which she feels gives her an aged appearance more so than any other area of her face. She said she had seen another doctor who had recommended a browlift and was wondering whether this was the best approach for her features. In looking at her, she has a nice, full upper eyelid and brow region, meaning she has not had a great deal of volume loss in this area which is common in most people her age group (mid-60s). She also has a nice shape of the brow hairs, with the inner portion beginning at the bony rim of the brow, arching upward toward the temple, and then descending back down to the bony orbital rim so that the beginning and end of the brow is essentially on a horizontal plane; what frequently occurs is that the outside or temporal side of the brow hairs begin to drop downward toward the cheek with age. That really is not the case with this patient today. She does however have a moderate amount of skin excess of the upper eyelid and I told her this was the main thing that I would recommend that we address. She was relieved that we did not feel that she needed a browlift, as she did not want to disturb her hairline and while I told her that there was a type of browlift which would not move the hairline backward, we again do not feel that she needs this type of browlift either.

The type of discussion above is one that I have had numerous times with patients, where we educate them about the state-of-the-art approach to the upper eyelid and brow region, which is that of maintaining a more full and natural brow such as that of Brooke Shields and other models who do not have high brows at all, but rather have brows as described above. It is important to emphasize the need for not just skin removal from the upper lid, (blepharoplasty), but also to stress the importance of replacing the volume of the upper eyelid and brow region that we all lose with age. Replacement of this volume is best done with fat transfer, also called lipotransfer, and to see examples of fat transfer to the eyelid region, please take a look here.

To see before and after pictures of patients that have had the excess skin removed please click on this link.
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Fat Transfer (Volume Lift SM)
Posted May 18, 2010 7:44 AM in Facial Surgeons

I saw a patient today who is approximately one year out from having malar  implants (cheek implants) placed by another surgeon and was now interested in  improving the transition between the implant and his lower eyelid area. The  primary reason why I do not routinely use hard cheek implants (such as  silastic) is exactly as is the case with this patient today, where the  transition between the borders of the implant and the lower eyelid area can be  abrupt and leave the patient hollowed and even more tired looking than before  the implants were placed; the implants can contribute to the "dark circles"  look under the eyes. This can be easily corrected by filling in the depression  directly above the cheek implant with synthetic fillers such as Restylane, and  can be done in less than an hour in the office and requires only application of  numbing ointment which is very effective. This also provides an immediate  improvement which was very gratifying to the patient today.  There can be  significant bruising associated with this procedure, but this is minimized by  avoiding aspirin, advil, motrin, and any other medicine in the "NSAIDs" class,  as well as vitamin E and fish oil, all of which can thin the blood. Additionally,  we have a V-beam laser which we routinely use to treat bruising so that the  patients can get back to work or social activities much faster. If this patient  had come to me initially for filling of the cheeks, I would have likely  recommended fat transfer for the filling of the cheeks as well as the tear  trough area (the "dark circle area" under the eyes) because I am able to tailor  this to any patient's individual needs, which vary considerably. Using the  patient's own fat is also beneficial because fat is the richest source of stem  cells in the body, and these stem cells seem to improve the quality of the  overlying skin in the months to years after the fat transfer.

For  examples of pre and post procedure pictures ("before and afters") for fat  transfer to the face, please click on this link http://www.cincyfacialplastics.com/Fat_Transfer_01.html.

For  examples of patients who have undergone fillers to the face such as Restylane,  Perlane, Juvederm and Radiesse, please click on this link http://www.cincyfacialplastics.com/Injectable_Fillers_01.html.

Lastly, if you have any questions about any of these procedures, please don't hesitate  to call the office at 513-891-LIFT (5438) or email us at info@cincyfacialplastics.com.
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Facelifts
Posted April 21, 2010 12:40 PM

Today, I saw a patient who asked about the difference between the QuickLift that we perform and other facelifts including the "Lifestyle Lift." The primary difference, I told her, is the vector or direction in which the face is rejuvenated or lifted: Most facelifts pull mostly backwards and somewhat upwards, creating a pulled look which is especially apparent around the corners of the mouth, where the mouth gets a stretched, almost joker-like appearance. We take great care at Cincinnati Facial Plastic Surgery to perform a more refined lift that is directed mostly upward, which is the more natural direction. These results are reflected in the pictures which are seen at this link Cincinnati Facelift Before and After Pictures, where the patients are seen to be naturally rejuvenated and do not have the “pulled” look. The other primary difference is in the planned scars: We are meticulous about where we place the incisions in order to hide the resultant scars in an optimal way. We also bevel the incisions in the region of hair-bearing skin so that hair grows through the scars in order to camouflage them, and we hide them behind the ears. Because of this, we routinely receive compliments from hairdressers as being the best at hiding the scars so it is extremely difficult to tell that someone has had a facelift done. Perhaps in other parts of the country, this is not as important, but for facelifts in Cincinnati and in other somewhat more conservative areas, the patients greatly appreciate this. Lastly, through my training with experts in the area of fat transfer for volume restoration of the face, I am able to provide the most natural rejuvenation of the face, particularly in the area under the eyes, using the patients’ own fat cells (we take them from where you don't want them). This patient today had dark circles under the eyes as a result of the shadow which occurs when we lose fat in this area with age. This natural occurrence is easily corrected by the natural procedure of fat transfer from another part of the body, such as the belly. Placed very carefully, the fat is long lasting and addresses areas of the face which were formerly untouchable by any facelift procedure. To see before and after photos of patients who have had fat transfer to the face in Cincinnati, please click on the following link:

Cincinnati Fat Transfer Before and After Pictures

Revision Rhinoplasty
Posted February 24, 2010 3:30 PM

We performed a revision rhinoplasty (“corrective nose job”) today for a very pleasant woman who had undergone 2 previous nose reshaping surgeries by other surgeons but was left with a distorted nasal tip and dorsum (top part). What we found during the procedure was buckled nasal tip cartilages, a lack of adequate support of the nasal tip, and irregularities of the cartilage that makes up the top part of the nose near the bridge (dorsum). These are fairly common findings in revision nose surgery. Fortunately, she had all of her nasal septal cartilage remaining, which we used to replace some of the tip cartilages and to support the central part of her nasal tip that tended to droop when she smiled. We also shaved down the irregular dorsal cartilage. These techniques should give her a much softer, more pleasant nose that blends more harmoniously with her face. As we discussed with her, usually the result of revision nose reshaping is to make the nose fade away from the viewer’s eye, and instead people will focus on the attractive eyes and other features of the face; frequently patients come to our office with nasal features that are distracting rather than complementary or harmonious and that is what they hope to have resolved. Being able to help these patients provides tremendous satisfaction for us.

To see before and after photos of patients who have undergone nose reshaping surgery, click on the following link:

http://www.cincyfacialplastics.com/Rhinoplasty_01.html