Fraxel re:pair is the treatment of choice for patient's suffering from acne scarring. Although Fraxel re:store is also effective in a series of treatments, Fraxel re:pair results are far more dramatic. We are seeing marked improvement after a single treatment, although all patients are advised that it may take 2 to 3 treatments for best results. An initial deep re:pair treatment may be followed with another deep treatment 3 to 6 months after the first, or even a Fraxel re:pair Lite treatment. Though not a guarantee of future results, thus far all of our acne scar patients have been very happy and satisfied with their results.

The therapy is illegal in the West, but according to the Thai newspaper The Nation patients are willing to pay between £2,000 to £20,000 in Bangkok to receive the treatment which is claimed to remove facial wrinkles. "Some patients might go into [anaphylactic] shock after receiving several doses of animal stem cells, especially those who have hyper sensitive reactions," warned Dr Tanom Bunaprasert, a medical professor at Bangkok's Chulalongkorn University. Dr Tanom also pointed out that there is no proven medical benefit to the procedure. "The feeling of a younger face is caused by the placebo effect, not stem cells that are injected into their faces," he said. Because the stem cells from an alien organism stimulate an antibody response from the human immune system, doctors say they massively increase the likelihood that the patient would reject a donor organ if they ever require a transplant in the future. Other controversial stem cell therapies are also practised in Thailand. Experimental adult stem cell therapy for failing hearts and for peripheral artery disease caused by diabetes are both available only in Bangkok, and some doctors have questioned whether the procedures are a medical breakthrough or just a scam. Thailand is a popular destination for "medical tourists" seeking often high-quality medical care that may be unavailable or more expensive in other countries. Cosmetic surgery is a particular speciality and is widely advertised. Advertisements claim that a full sex change procedure can be obtained for only around £3000. Dr Tanom also warned against other supposedly stem cell based cosmetic treatments which are widely advertised in print and on the internet. He said that animal stem cell based creams and lotions are of no possible benefit because the stem cells would die long before they are applied to the skin and, besides, stem cells are too large to penetrate the skin and have any effect. Likewise, food products purporting to be beneficially enriched with animal stem cells are a fraud, he said. "Stem cell food has very poor nutritious ingredients," according to Dr Tanom. "You eat numerous stem cells every day for a long time from meat, chicken, fish and pork but you don't know it."

Unfortunately, just yesterday another physician was arrested here in Beverly Hills accused of injecting bogus Botox from a lab (T.R.I.) in Arizona that has distributed ”experimental Botox, not for use in humans" to many unethical practioners. David Hansen, MD of Skinsensation was reported to be involved in allegedly injecting patients with the phony botulism toxin. There have already been indictments against "practioners" in Las Vegas, in Houston, and in Florida for the same offense. In this economic downturn I fear that we will hear about more of these cases. We will also be seeing "discounted" "units" of Botox. Buyer beware, if it sounds too good to be true, it usually is. Not only that, your well being may be at stake. Therefore we must emphasize how important it is to choose your injecting physician most carefully. Choose a board certified physician experienced and trained in one of the cosmetic specialties (facial plastic surgery, plastic surgery, ENT, opthalmoplastic surgery, or dermatology). Sometimes even that is not enough as Dr. Hansen claims to be board certified in dermatology.

Trust, as defined at www.dictionary.com is ...–noun 1. Reliance on the integrity, strength, ability, surety, etc., of a person or thing; confidence. 2. Confident expectation of something; hope. That "Hope" and "confident expectation" not only helped President-Elect Barack Obama to the White House , but also is an essential characteristic to look for and feel when choosing your physician. I actually just finished a Fraxel re:pair (fractionated CO2 laser) of a patient's face and neck. She said that the process was so much easier for her because she trusted me (she's been my patient for 20 years). Over the 23 years of practicing facial plastic and reconstructive surgery, I have found that patient’s procedures and recoveries, and ultimately their results turn out better when they have trust in their treating physician. I can't promise and guarantee your results, but I can promise that I will do the best that can be done, the best that I can do, while keeping you as safe and comfortable as possible. Also I look for a long term relationship with my patients to keep them looking and feeling as youthful and healthy as possible using all of the great tools at our disposal today. I also promise to use only treatments with proven effectiveness, and be a reference source in "making sense" out of all of the new treatments and technologies (separating the "hype" from what really works). The American Academy of Facial Plastic and Reconstructive Surgery has as their slogan, "Trust Your Face to a Facial Plastic Surgeon", the key word being Trust. Be well, and happy, healthy Holidays. Dr. P

Maybe you have been unhappy with your nose for as long as you can remember, or perhaps you are having difficulty breathing; either way, a rhinoplasty or nose reshaping may be an option for you. A rhinoplasty can change many things about your nose, including your nose size (in relation to your face), nose width at the bridge, the size and position of the nostrils, and nose profile (by downsizing visible humps, bumps or depressions on the bridge). A rhinoplasty can also reshape the nasal tip, improve the appearance of large, wide or upturned nostrils and correct nasal asymmetry. From a functional standpoint, a rhinoplasty can correct certain breathing difficulties such as those due to a deviated septum. Rhinoplasty is also an option for certain birth defects or noses that have been injured in car or sports accidents Here's what you need to know now about rhinoplasty. Rhinoplasty Defined A rhinoplasty or nose job is a surgical procedure designed to reshape the nose. It can be done to correct a structural deformity (such as a bump or hook), provide subtle changes to nose size and shape to improve your appearance or to correct a functional problem (such as difficulty breathing due to a deviated septum). The septum is the wall between the two nostrils. Composed of cartilage and bone, it divides the nasal cavity into halves. The ideal nasal septum is straight, separating the left and right sides of the nose into passageways of equal size. In contrast, a deviated septum occurs when the septum is severely shifted away from the midline. In severe cases, a deviated septum may cause difficulty breathing through the nose. Are you a candidate for rhinoplasty? Preparing for Rhinoplasty Your surgeon will likely give you a list of instructions before you undergo a rhinoplasty. In general, there is no eating or drinking after midnight on the evening before. Smoking cessation should occur before rhinoplasty. Your surgeon may be able to provide tools to help you quit. In addition to all the other negative health affects associated with smoking, it severely compromises blood flow to the skin. This means there is less oxygen to aid in wound-healing, and necrosis (death) of skin can occur. Drinking alcohol in the week before rhinoplasty is also discouraged, as alcohol can also impair the healing process. Your surgeon may also discuss discontinuing certain medications in the days or weeks leading up to your rhinoplasty. For example, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can increase the risk of bleeding. While considered natural, certain vitamins and herbal preparations such as Vitamin E, gingko biloba, omega-3 fatty acids and green tea can also increase bleeding risk. Tell your surgeon about everything that you are taking, even if it seems harmless. Never stop taking any medications without first discussing it with your doctor. Some surgeons may prescribe homeopathic therapies before your rhinoplasty, such as arnica (an herb that can minimize bruising). In addition, mega-doses of vitamin C may also help aid clotting and wound healing. Some surgeons also prescribe steroids before a rhinoplasty to decrease the initial swelling. Key Rhinoplasty Statistics In 2007 there were 285,000 rhinoplasty operations performed in the United States, down 7 percent from 2006, according to statistics compiled by the American Society of Plastic Surgeons. Rhinoplasty is one of the top five cosmetic plastic surgery procedures performed each year. Rhinoplasty Risks Infection Bleeding Breathing issues (nasal obstruction) Dissatisfaction with cosmetic results Additional touch-up surgeries Septal perforation. In these cases, there is a small whole in the septum, causing turbulence that results in a whistle when a person speaks or sings. Anesthesia complications Death Types of Rhinoplasty Primary rhinoplasty is a nose-reshaping plastic surgery. Two types of primary rhinoplasty include "open" and "closed": Open Rhinoplasty. For major nose reshaping, the incisions are made in the vertical strip of skin separating the nostrils. This is called the columella. The skin and soft tissue are then elevated off the underlying structures of the nose so the surgeon can see the nasal anatomy. Closed Rhinoplasty. For minor reshaping, many surgeons make incisions within the nose. The skin of the nose is then separated from the bone and cartilage, which form its supporting framework. Once exposed, bone and cartilage can be removed, reshaped, augmented or rearranged to achieve the desired new shape. Secondary Rhinoplasty. Also called revision rhinoplasty, this is performed to correct problems that persist or develop after a previous rhinoplasty. Although the problems may be minor and easily corrected, often the problems are major, which makes the secondary rhinoplasty more difficult. Secondary rhinoplasty can also be done as an open or closed procedure. Filler Rhinoplasty. This involves the use of injectable fillers to fill depressions, smooth out sharp angles or change the angle of the tip of the nose, restoring symmetry and making your nose appear smaller and more attractive. Instead of removing a bump, a surgeon would use an injectable filler to even it out. The results are not permanent. CDC Warns Against Cosmetic Charlatans ATLANTA, May 2008 — The federal Centers for Disease Control and Prevention is warning consumers against undergoing cosmetic surgery by unlicensed providers. Three women in North Carolina developed kidney failure after they received soft-tissue filler injections in their buttocks. The women received the injections from an unlicensed provider, who was arrested and charged with practicing medicine without a license. Click here to read the complete story. Evaluating Your Nose An evaluation with a surgeon is the first step in your decision to undergo rhinoplasty. During this meeting, your chosen surgeon will likely take photographs of your nose at varying angles. He or she will also talk to you about your expectations to make sure that yours are realistic. It may be a good idea to bring photographs of noses that appeal to you, to aid in the dialogue about expectations as well as give the surgeon a better idea of what you want out of your rhinoplasty. In addition, your surgeon can show you photos of other rhinoplasty patients with similar nose shapes, which can help you better understand the likely results. Computer imaging can be used to show how your nose wil look after rhinoplasty. If you are having rhinoplasty, you may also need to consider other facial procedures to achieve balance and proportion. For example, chin augmentation is often performed with rhinoplasty. The Rhinoplasty Procedure Most rhinoplasties are performed on an outpatient basis in a hospital or surgical suite. Exactly how long the procedure takes depends on the type of rhinoplasty that is performed. For example, a primary rhinoplasty normally requires one to three hours in surgery, while a secondary rhinoplasty can take much longer. A filler rhinoplasty can take just 15 minutes. Anesthesia. Your surgeon will likely recommend local anesthesia with some sedation or general anesthesia for your primary rhinoplasty. A secondary rhinoplasty will often involve general anesthesia due to the complexity of the procedure. A filler rhinoplasty requires just local anesthesia. The Incision. Surgery of the nose is performed either using a closed procedure (where incisions are hidden inside the nose), or an open procedure (where an incision is made across the columella). The surgeon then raises the soft tissues that cover the nose through these incisions. This provides access to reshape the structure of the nose. The reshaping. Your surgeon can reduce or augment nasal structures with cartilage grafted from other areas of your body. These pieces of cartilage can come from the septum or occasionally from the ear or the rib cartilage. If the septum is deviated, it is now straightened, and the projections inside the nose are reduced to improve breathing. Closing the incision. Once the underlying structure of the nose is sculpted, the nasal skin and tissue are redraped and the incisions closed. Recovering from Rhinoplasty You will probably be excited, if not anxious, to see your new nose, but patience is key after rhinoplasty. Complete results are not immediate and can take up to one year to be fully evident. You will be unable to breathe through your nose for the first 24 hours, due to nasal packing, which is stuffed up your nose to help reduce swelling and bleeding.There will be some pain that can typically be controlled with pain medicine. Most people who undergo rhinoplasty can stop pain medication after 48 hours. Some people feel nauseated after the surgery. You may experience limited bleeding during the first few days. Your surgeon may also tell you to apply a cold compress to your nose to reduce swelling and to elevate your head for the first 24 hours. It is important to avoid any trauma to the nose during the first week after surgery. Blowing your nose is not permitted after rhinoplasty. This can be tough, as you may feel stuffy. Decongestants may help. You will likely be asked to return in three days so the surgeon can remove the stitches. On day seven, the cast is removed. Your nose will still be swollen, but after two weeks much of the swelling will have decreased. At this point, all nasal packing, splints and other post-surgical dressings should be removed. A splint may be placed over the outer part of your nose to protect your nose as well as help it hold its new shape during the healing process. The surgeon may also place a softer splint inside your nose to prevent scarring inside the nose. By one month, 85 percent of the swelling will have gone down. The remaining swelling may take up to one year. For these reasons, you should wait at least one year before undergoing revision rhinoplasty. Rhinoplasty Cost The cost of cosmetic surgery tends to comprise the surgeon's fee, anesthesia fee and operating room fee. The anesthesia fee ranges from $600 to $1,000, the facility fee ranges from $700 to $1,100 and the rest of the cost is the surgeon's fee. According to the American Society for Aesthetic Plastic Surgery, the national average for plastic surgeon fees for rhinoplasty is $4,277. Secondary rhinoplasty can cost up to three times as much, due to its complexity. A filler rhinoplasty costs a few hundred dollars, but results are not permanent. If you decide you need an additional facial procedure later (such as chin augmentation), the two procedures may be more expensive than if you have them at the same time. [Read more about comprehensive treatment plans.] Insurance does not typically cover the cost of cosmetic procedures, but if the purpose of your rhinoplasty is to improve breathing, it is considered reconstructive and may be covered by insurance. It is a good idea to contact your insurance company beforehand and find out their exact policy. Consult a Qualified Plastic Surgeon Before deciding on rhinoplasty, be sure to discuss treatment options with a board-certified plastic surgeon or a board-certified facial plastic surgeon. Most facial plastic surgeons do their residency training in otolaryngology-head-and-neck surgery, followed by fellowships in facial plastic surgery. Plastic surgeons do their residency training in general surgery followed by a fellowship in plastic surgery, Plastic surgeons should be certified by the American Board of Plastic Surgery. Facial plastic surgeons should be certified by the American Board of Facial Plastic and Reconstructive Surgery. Board certification assures you that your surgeon has had extensive training and is up to date on new technology and techniques. Source: American Society of Plastic Surgery website article on nose surgery. American Academy of Facial Plastic and Reconstructive Surgery website article on rhinoplasty. [page updated October 2008]

Physicians offering bargains on cosmetic injections like Restylane, Juvéderm, or Botox may be offering possibly counterfeit or illegally imported cosmetic injectables, according to the Physicians Coalition for Injectable Safety, an alliance of specialty physician organizations. Bargains on consumer goods and services may be designed to encourage spending in tough economic times, however when related to cosmetic injections like Restylane, Juvederm or Botox, the multi-specialty Physicians Coalition for Injectable Safety warns that discounts raise a red flag. "Bargain prices, deep discounts or purported sales on cosmetic injections are warning signs of potential counterfeit or illegally imported cosmetic injectables, or an injector who is inexperienced or does not specialize in the procedure," cautions facial plastic surgeon and Coalition spokesperson Mary Lynn Moran, MD of Woodside, CA. "Consumers must adopt a buyer-beware approach to offers that seem too good to be true." The group last week issued the warning in the wake of recent FDA hearings on the safety and efficacy of fillers and injectables. And unlike common over-the-counter and prescription medications, cosmetic injectables do not have lower-priced generic alternatives. "Branded cosmetic drugs or devices are sold to physicians at defined prices," said Coalition leader, plastic surgeon Renato Saltz, MD, of Salt Lake City. "There are generic lower-priced brands, no sales for physicians who stock up on injectables, and no bona-fide sources who sell genuine product at lower than market prices; and therefore, there are no deep discounts physicians can pass along to consumers." Some injectable brands do, however, offer post-treatment rebates directly to the consumer. The Coalition issued the warning to consumers, but the news release was also clearly aimed at practitioners. Source: Medical News Today

Facial beauty is all about symmetry, volume, tone, texture, and color. As we age, we lose volume from our faces, especially in the midface area, under the lower eye lids, and in the "marionette" area below the corners of the mouth. Additionally, sun damage causes dyschromia (brown and red spots), and causes changes in tone and texture. As grim as this may sound to those who wish to look (as in the words of Rod Stewart) forever young, there are non-surgical methods of recreating and maintaining volume, tone, texture, and color. These non-surgical techniques include fractional CO2 lasers, fillers, and neuromuscular modulators. A single Fraxel re:pair treatment will improve tone, texture, and color of the skin, as well as restoring some volume to the midface. Fillers such as Juviderm, Restylane, Radiesse, and patients own fat will restore volume. Neuromodulators such as Botox will help eliminate wrinkles caused by excessive muscle movement in the upper third of the face. By using these modalities, facial plastic surgeons now have safe, dependable, and effective non-surgical techniques to restore and maintain youthful faces. These techniques involve the artistic skills of a sculptor combined with the knowledge, discipline, and scientific skills of a cosmetically trained surgeon. Choose your cosmetic physician carefully. Trust your face to a Facial Plastic Surgeon.

All of our hearts have been saddened by the sudden losses incurred by the Marine plane that crashed into the Yoon family home in San Diego. The strength, fortitude, and amazing words of Doug Yun Yoon (father, husband , and son-in-law of the victims) are an inspiration to those who have suffered loss. Our prayers are with you. This tragic accident is a reminder of how important it is to value what we have. To share our love. To be grateful, helpful, and kind. Give hugs and smiles, they are free, even in tough economic times. Say "I love you", and "Thank you" before time runs out and it is too late. Treat others well, and be a blessing onto others. We pray for the surviving Yoon family members as well as praying that the lost family member's souls will be bound to eternal life.

The FDA has approved the use of Latisse, manufactured by Allergan the makers of Botox and Juviderm, for eye lash growth. Latisse is the latest of glaucoma eye drops that have been found to increase eyelash length. Interestingly, the eyelashes will return to their previous normal length when Latisse is discontinued. Latisse joins Lumigan as the latest in having "those long lush lashes". Be well.

Mark Frauenfelder recently wrote a very thought provoking article/blog that cited a recent Europian research study on how actually moving the facial muscles affects the brain (http://www.good.is/?p=13784). The study suggests that Botox is masking our normal response to emotional stimuli. Studies have shown that depression is helped by Botox. Patients take less anti-depressant medicine after their Botox treatments. The facial feedback hypothesis mentioned in the article may explain this finding. Studies and real life are not the same though. Looking at pictures and imitating expressions of happiness and sadness or anger is completely different from real life situations where we are faced with emotional stimuli. When performed properly, patients should still have some movement, and frankly, no one should be able to tell that they have had Botox. The "Botox like" substance was not Botox Cosmetic, FDA approved, manufactured by Allergan. Properly injected, Botox treatments should not completely paralyze the facial muscles as it appears to have been done in this study. There is a psychiatric / mental problem if people "do not respond with appropriate emotional responses to things that are bad for them". Botox has nothing to do with their real life emotional response to significant stimuli. Believe me; I am married to a wonderful woman who is fully capable of feeling and "communicating" all of her "appropriate" emotions and signals, even when her Botox is at its peak effectiveness. ("Yes, those jeans don't make you look fat. darling"). I don't believe that my patients are "questing for perfection"; they just desire to look better, be that less wrinkled as well as less angry looking from the perpetual scowl projecting from their mid brow area. They prefer to look rested, appropriately youthful, and healthy. Let's do a study if feeling good is detrimental to our lives. Lastly, we are all amazed/mouth agape at those "plastic", "done" or "unnaturally frightening" Botoxed patients who can't move a muscle fibre in the upper third of their faces. Blame should be placed on the practioners who have created these Botox "Stepford Wife’s" (or more currently "Desperate Housewife’s"), not on the patients for "questing for perfection". Be well, happy, sad, angry, kind, all when appropriate or inappropriate. Most of all enjoy the beauty of life, and treat others well. Michael A. Persky, MD, FACS

Fraxel re:pair is a fractionated carbon dioxide (CO2) laser that rejuvenates the skin. It can be used at very low settings (Fraxel re:pair Lite) to invigorate the skin, diminish light discolorations, and improve the tone and texture of the skin. It is performed in the office using only numbing cream without any other oral medications or injections. The treatment with this revolutionary laser takes only 15 minutes. After 4 to 5 days of mild redness, patients are able to return to work refreshed. It has been ideal for actresses, actors, television personalities, and politicians who don't have time for the recovery of more aggressive treatments. Having a treatment two weeks before an engagement, speech, or awards show results in a fresh and healthy look whether on high definition camera, film, or in person. It is a fraction of the cost of a full Fraxel re:pair treatment. See you on the red carpet! Dr. P

An old joke about circumsion is that after the procedure the doctor tells everyone, "It won't be long now". The December 1, 2008 e-issue of Plastic Surgery Practice reports that a new use has been found for baby foreskin following circumsion. A radical new antiaging procedure from British biomedical firm Intercytex uses cells derived from circumcised newborn babies. The procedure makes use of Vavelta, a clear liquid in which tiny skin cells, called fibroblasts, are cultured from babies' foreskins donated from hospitals after circumcision. It can apparently rejuvenate and restructure aging and damaged skin by repopulating the lower layers of the skin with millions of healthy young skin cells. These foreskins are treated with enzymes to release the fibroblasts, which are grown in sterile labs. It involves the injection of the liquid into the patient’s face with a fine needle. The expensive procedure takes around 5 minutes and might be useful for hollows and fine lines under the eyes and lines around the mouth. Trials conducted so far have shown that it is safe and the effects are permanent, and that patients with sun-damaged skin, caesarean section scars, burns, or scars seem to respond best. As with all new "permanent" fillers, I will likely wait a few years for all of the "kinks" to be "straigtened out". This puts a whole new take on circumsion jokes of the future....it won't be long now.

Recent reports have implicated fillers with adverse events. Once again, it is most often the person injecting the filler, not the actual filler product that is the problem. In response to the U.S. Food and Drug Administration’s (FDA) recent report of side effects linked to injectable wrinkle fillers, the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) states that wrinkle fillers appear safe when injected properly, in appropriate areas and after a pre-treatment medical history and physical exam performed by a qualified physician. According to the FDA, some injections that resulted in side effects may have been performed by untrained personnel or in settings other than health clinics or doctors' offices. The reports, dating back to 2003, document problems experienced by patients including swelling, allergic reactions and infections. The report says that there is not a clear causal link between the products and the side effects, and does not specify which products were involved. The FDA is planning to consult an advisory panel about amending labeling requirements as well as changing the protocol in the way the products are safety-tested. “Cosmetic fillers have a proven safety record when injected by a properly qualified and trained physician in an appropriate medical setting,” said Dr. Donn R. Chatham, president of the AAFPRS. “While injecting dermal fillers is not surgery, it is still a medical procedure that requires the experience of a physician trained in cosmetic procedures of the face. Today’s highly competitive and marketing-driven world has attracted some who have dubious claims of expertise in injecting these drugs and fillers, and patients may be at risk. Patient safety must be paramount.” The AAFPRS reminds patients and professionals that when a patient requests a facial plastic procedure, and entrusts their face to that physician, that it is in their best interests to seek surgeons who are qualified, trained and experienced in performing those procedures. Board certification signifies that a surgeon has achieved a level of education, training and certification of a high level. And that board certification should be in an appropriate specialty. For more information about injectable cosmetic treatments, appropriate injectors and where to safely access related cosmetic medical procedures, please visit www.injectablesafety.org. The AAFPRS cautions that all procedures have the potential for adverse events and complications. Physicians should have a proper medical history of a prospective patient prior to treatment, and patients should be fully informed and educated about every benefit and risk.

I know that you have heard this before, only to be disappointed with having set your TIVO in vain, but I have been told by pretty high sources that my appearance on EXTRA discussing Fraxel re:pair has been "etched in stone" for Tuesday November 25, 2008 on NBC at 7:00 pm, for what that's worth in "Hollywood". I hope that you and your family have a loving and warm Thanksgiving.

The talented and lovely Ms. Marta Waller had Fraxel re:pair this past summer, and was kind enough to have her experience video documented. You can find the entire 12 episodes of the video documentary on You Tube (http://www.youtube.com/results?search_query=fraxel+repair&search_type=&aq=f). Dr. Persky's appearances on PBS' "American Health Journal", BBC's "Super Botox Me", and KDOC's "OC DayBreak" can also be found on the same You Tube site. Dr. Persky will appear on NBC's EXTRA this Friday, November 7, 2008 at 7 pm. Thanks to Ms. Waller for sharing her Fraxel re:pair adventure with all of us.