April 24th, 2012
Chin augmentation has seen a dramatic increase in the number being performed and the number of patients asking about it. Though chin augmentation has been a procedure that has been around for over 30 years, the recent increase in popularity is being related to people looking at their own profile more critically while spending time in front of the computer during web chat activities. With new technologies such as face to face live web chats, real time facial profiles are being displayed and observed by all computer and mobile phone users. The cameras on a computer or phone have a narrow field and do tend to narrow and constrict the face accentuating an already weak chin. When taking a self-portrait photo with a mobile device and/or in the mirror, the face is usually slightly turned to one side, which reveals the profile.
A stronger chin is an attractive feature in the male face, but even in the female face a fuller lower face with more definition has become more en vogue. With people looking at their profile in the computer more and the computer cameras highlighting facial profile deficiencies, the web chat chin has become a common reason to improve the looks of patients young and old through simple procedures such as chin augmentation and/or a neck lift.
Chin augmentation can be performed through multiple modalities with injections and implants being the most common types.
Chin augmentation with injections can be performed in the office under local anesthesia with minimal to no downtime. The injections can be either, calcium-based biostimulators like Radiesse® or collagen-based biostimulators like Sculptra®. To achieve a long lasting chin augmentation with these products, it may require multiple rounds of injections until the final chin profile is achieved. Fat injections have been applied in the lower face, which uses the body’s own fat and is placed deep along the jaw bone. Fat injections require a donor site or another operative site where fat is removed and it can be unpredictable in its longevity in the face.
A chin implant is a solid shaped implant of silicone or porous plastic, which requires a surgery to insert it on the jawbone. Chin implants are made in different shapes and sizes to really be able to individually give the amount of chin augmentation the patient wants. I usually place a chin implant through a small incision under the chin which most patients already have a natural crease. The operation can be performed in about 1 hour and usually patients can go home the same day. A chin implant can be combined with a rhinoplasty in order to improve facial harmony, as well as a neck lift to really improve chin and neck definition. A chin implant combined with a neck lift is a very powerful operation for the male facial profile, and can be applied to the weak, double chin.
Excess neck skin is not addressed with just a chin implant alone, as well chin, and neck liposuction has minimal to no effect on treating excess skin, therefore a neck and/or facelift would more appropriately treat these issues. Male neck skin excess can be treated with a very simple “in-office” procedure called a direct neck excision, which involves removing the central neck skin and reorienting the central neck scar with a zig-zag incision pattern. This direct neck excision is a very powerful and convenient procedure, but has a significant scar burden, which can be appropriate for the male neck skin and the male patient who would tolerate the scar, however not appropriate for the female neck. The female neck and the male with significant neck complaints should really be addressed with a standard neck-lift procedure, even in the 30 something year old female with a full neck that runs in the family. Neck liposuction can be added to these neck lift procedures to help improve the contour of the neck. Stand-alone neck liposuction should only be applied to a minority of patients who just have neck fullness, no associated with excess skin or underlying muscle laxity. Neck liposuction, chin augmentation, and a neck lift or facelift procedure can be all combined for an impressive change in the contour and profile of the lower face. These combination procedures will not change the way you look, they just make you look thinner, more sculpted and younger.
Simple chin augmentation can be performed to directly improve the chin profile to improve your web chat profile and hopefully change your Facebook profile.
March 11th, 2012
Gynecomastia is the enlargement of breast tissue. It can be applied to both male and female breast tissue. Male gynecomastia is a very common condition treated by Dallas plastic surgeon Dr. Trussler, which usually affects adolescent males and can be related to multiple different medical problems and medications. It is most commonly associated with an abnormal, but benign hormone imbalance, which can relate to increasing peripheral hormones from adipose (fat) tissue. At the time of birth, the mother’s hormones do circulate in the newborn, which commonly causes neonatal breast hypertrophy in males, which resolves over the first months of life. During puberty, there are increased amounts of circulating hormones, which can be affected by the peripheral fat and increase the balance of estrogen in the male, which can stimulate the formation of breast tissue. This breast tissue can be located just under the nipple causing an enlargement of the nipples or it can be more general, with the development of fairly large breasts. The male breast tissue is usually firm and nodular glandular tissue with peripheral fatty tissue. This breast enlargement is a source of social embarrassment and poor self-confidence, which alters the participation in athletics and clothing. The treatment of male gynecomastia, first involves identifying and correcting any reversible causes of the problem, which can involve medication changes, and hormone therapy. In cases where there are no identifiable causes of gynecomastia, surgical removal of breast tissue is really the only effective modality of correction in combination with weight loss. Typically an endocrinology evaluation and ratio of the documentation of glandular tissue to fat is needed for identifying whether excision is medically necessary.
Surgical treatment can involve removal of the tissue under the nipple just with simple local anesthesia or chest contouring with liposuction combined with removal of the firm tissue under the nipple to a complete chest reconstruction with repositioning of the nipples. Recovery is variable depending on what is done, though some element of a compressive garment on the chest is recommended for approximately 3 weeks. Patient satisfaction is very high and the treatment of male gynecomastia is very rewarding for not only for the patient, the plastic surgeon as this can dramatically change the life of a young man.
Dr. Trussler will discuss the technique that will give the optimal result in each degree of male gynecomastia. The individualized treatment plan will factor into recovery and any cost incurred with the procedure.
February 13th, 2012
1. Are you board certified in Plastic Surgery?
All specialties can do cosmetic surgery, though plastic surgeons are typically trained in both cosmetic and reconstructive surgery with strict guidelines that must be met in order to complete their board certification. Look for certification by the American Board of Plastic Surgery. Dr. Trussler did complete a full General Surgery residency for which he is board certified by the American Board of Surgery, as well as formal Plastic Surgery training for which, he is certified by the American Board of Plastic Surgery. Dr. Trussler did complete a post-graduate fellowship in aesthetic surgery, which gives him unique and specialized training in this field. He has completed his Maintenance of Certification (MOC) for the American Board of Plastic Surgery and is a Fellow of the American College of Surgeons (FACS).
2. What is your experience with this type surgery?
Ask your plastic surgeon how many of the specified procedures have they performed and if they do you have specialized training or academic interest in the type of surgery. Dr. Trussler does contribute to the scientific advancement of plastic surgery and you will find that his surgical experience is supported by his scientific knowledge of the field.
3. Where will the procedure be performed?
You should ask your board certified plastic surgeon where the procedure will be performed and if it requires an overnight stay. Look for the certification of the operating room facilities, as well as the facilities for overnight stay. Hospital affiliation is important for any patient or procedure that requires a hospital environment for their recovery, or if unforeseen hospital admission is needed after a surgical procedure. Dr. Trussler operates at multiple certified facilities with the capabilities of overnight and hospital stays.
4. What type of anesthesia will be used during the procedure?
There are different types of anesthesia, which are used for different procedures and different age groups. Look for certified facilities with physician directed anesthesia, administered or overseen by board certified anesthesiologists. Dr. Trussler will discuss the type of anesthesia he would typically recommend for the procedure, but anesthesia is administered by a board certified anesthesiologist.
5. What are the risks associated with the procedure?
Every procedure has risks. Dr. Trussler will review the general risks of the specific procedure, which may include bleeding, infection and scars. Short term and long term risks will be discussed. Surgical risk can be decreased through prevention and safety.
6. What is the recovery for the procedure?
Dr. Trussler will review the time needed, if any in the after care facility or hospital. The time off work will be very procedure and work specific. Time to cardiovascular exercise ranges from 2 to 3 weeks and to heavy lifting about 4 to 6 weeks. This is as well outlined in the aftercare instructions you will receive at the time of consultation.
7. Do you have representative before and after photos of the procedure(s) to be performed?
Most plastic surgeons do have representative photos available to review. There may not be a specific patient that matches your body, but look for examples of pre and post-operative photos that are standardized and of good quality. Not every patient gives consent to release their photos for review, but there should be examples of the procedure performed. Dr. Trussler has professional photographers and a photo studio in his office and this will be part of the initial consultation. Imaging can be performed to give a realistic and representative example of your individual post-operative result.
8. Can I get an exact breakdown of the fees for the procedure?
There are multiple procedures with in plastic surgery that are covered by medical insurance, though cosmetic procedures are not. Dr. Trussler’s staff will give you an itemized estimate during your consultation, which will give the fees for anesthesia and the operating room, as well as surgical fee and any cost for implants if needed. Overnight fees can be additional costs, which are worth the extra amount for both safety and comfort while recovering from surgery.
Dr. Trussler does offer financing for surgical procedures, as well as accepts all major credit cards.
9. What kind of after care do you recommend for my procedure?
Aftercare is specific for each procedure and these instructions are provided in written form. Scar care is promoted when the initial healing phase is complete and may range from simple scar massage to nightly silicone sheating. Dr. Trussler does incorporate lymphatic massage into the recovery phase, which is administered by his massage therapist and aestheticians. Maintenance and skin care will be discussed before and after your procedure.
10. How long will the results of this operation last?
Nothing is forever, but what is acceptable is procedure and technique specific. The majority of the time, the small “mini” procedure or injection does not last as long as the more invasive technique, though this should be taken into account with amount of recovery when delineating an individualized plastic surgery plan with Dr. Trussler.
January 24th, 2012
Over projecting or prominent ears are significant congenital ear deformities that are a source of teasing and social embarrassment for a young child. The prominent ear can be present at birth and can be molded at a very early age (younger than 6 weeks) with a simple soft hat or headband. After this time, the external ear develops over the first three years and after that the ear prominence can be fully evaluated. There can be multiple components to the prominent ear, including effacement of the upper fold of the ear, enlargement of the conchal bowl, or a combination of the two. Prominence can be mistaken for cupping or constriction of the ear, which may require a different operation for correction. In order to correct the prominent ear, the cause of the prominence should be identified and usually 2 out of the 4 causes should be addressed in order to give a natural and long lasting correction. The operation can be performed at earliest at the 5th year of age, in between kindergarten and the first grade, but can be performed at any point after this age. Adults seeking otoplasty or ear pinning, can have this done under local anesthesia; however children usually require general anesthesia to alleviate anxiety of the operation. The otoplasty operation usually takes under two hours and is an outpatient operation/procedure. The ear prominence is corrected through an incision in the back of the ear, which enable folding, suturing and reducing the ear prominence. The sutures are internal and usually a simple headband dressing is all that is needed. This is removed in one week and then I ask my patients to sleep in an athletic head-band for 3 weeks. School can be resumed in one week and athletics in 3 weeks after an otoplasty procedure. Scarring is usually minimal and the most common risk is partial recurrence of the prominence. An otoplasty consultation with photographs is an important component to proceeding with an otoplasty, or ear pinning, which can be done in Dr. Trussler’s pediatric or adult offices, in Dallas or Plano, Texas.
January 21st, 2012
What are the different types of buttock augmentation?
Buttock augmentation is becoming a very popular procedure in the United States. There are multiple types of buttock augmentation, which increase the volume and change the shape of the buttock: buttock implants, fat grafting to the buttocks, butt lift with autologous augmentation. Depending on the amount of surrounding tissue the procedure that is right for you and your goals will be selected. Buttock implants are typically solid silicone, which come in variable sizes and shapes, which are inserted through central incisions and placed under the muscle. Fat grafting uses fat harvested from mother regions of the body and is injected above and into the gluteal muscle to provide increased volume and shape. A butt lift uses an upper buttock incision to lift the buttock, tissue that is not removed can be rotated under the lift to provide increase volume to the buttock.
Am I good candidate for a buttock augmentation?
Buttock augmentation should only be done on healthy patients without significant medical problems. Depending on the type of augmentation recommended it would fit your body. Typically the thin patient without any surrounding fatty deposits would be a candidate for buttock implants. Buttock implant selection is limited in the United States and some buttock shapes are not optimal for implants as they usually lay under the muscle and provide upper outer projection. Fat grafting or a Brazilian Butt Lift is appropriate for the patent who does not desire an implant and has good skin tone who has enough surrounding fat to support enough fat for harvest. This can always be combined with an implant to provide shape to the buttock. A butt lift is appropriate for the patient who has lost a significant amount of weight and has excess skin around the buttock. This procedure will elevate the sagging butt but can flatten the buttock if not combined with an autologous buttock augmentation, which uses the tissue which would otherwise be removed to provide projection to the buttock.
Procedure technique
In general most buttock procedures should be performed in under general anesthesia in the operating room with the patient positioned laying on the their stomach. Repositioning during these operations is common secondary for the need to harvest fat from other areas
Buttock implants: general anesthesia with the patient in the prone position. Implants are placed through 1 or 2 incisions in the upper buttock crease. They are placed under the muscle or under the muscle lining or fascia depending on the shape of implant used. Complete coverage of the implant as well as implant position and sterile technique are a must.
Brazilian Butt Lift or Fat grafting to the buttock: fat is harvested from other areas of the patient, but most commonly in the areas around the buttock to help shape and define this region. The fat is then processed and washed depending on the technique used and then re-injected through small incisions into the buttock tissues.
Butt lift can be performed as an individual procedure or as part of a body lift. It is performed through an upper buttock incision extending from hip to hip and elevates the buttock tissue. The excess tissue can be rotated under the buttock skin to increase volume in this area.
January 2nd, 2012
The lower eyelid is a complex structure composed of skin, muscle and fat. The function is to protect the eye and keep the tear film on the globe. It does not have as much mobility as the upper eyelid which does have the most movement during the blink phase, though with squinting and when something is projected towards the eye (ball, fist, tree branch) the lower eyelid and cheek do provide a significant amount of protection. The lower eyelid is likened to a clothesline with a sheet of skin and muscle draped over it. The clothesline is the lash line which is the site of lower eyelash follicles, a stiff strip of collagen called the tarsal plate and moisture glands; this is all suspended by inner and outer eyelid tendons which anchor the lower eyelid to the orbital bone.
The lower eyelid can be reconstructed for congenital defects such as clefts or colobomas, for tumors such as skin cancer, or for scar after a traumatic accident. All layers and structures of the lower eyelid should be repaired individually to maintain function and position of the lower eyelid. If the lower eyelid is maligned or there is scar formation which pulls the eyelid down or away from the globe, dryness and irritation can occur. This is referred to a lower eyelid ectropion. Ectropion can be prevented with proper positioning and support with the first operation, with stretching and scar massage after and proper positioning of the lower eyelid during the reconstruction. Supportive type procedures are called canthopexy, which is the tightening of the outer eyelid tendon, or a canthoplasty which is the tightening and reconstruction of the tendon. A canthoplasty may involve detaching it from the bone and repositioning it to a new position through a drill hole suture. These same principles are applied to the rejuvenation of the lower eyelid which should involve tightening the lower eyelid and repositioning of the lower eyelid and cheek fat (cheek lift or mid face lift), and removal of skin. This will smooth and reshape the lower eyelid giving it a younger, more youthful look. Lower eyelid surgery does have a significant amount of recovery, with at least a two to three week downtime until the eyelid swelling and bruising resolve. With any invasive lower eyelid procedure the muscle of the lower eyelid can become lax and lose muscle tone which resolves over a short period of time. Every patient desires a short recovery but for youthful correction of the lower eyelid an individual approach to each structure is necessary and each patient, cosmetic or reconstructive should have a individual operative plan derived during your eyelid consultation with Dr. Trussler.
August 7th, 2011
Dark circles under the eyes are secondary to shadowing and skin color changes in this area. The shadowing is caused by a natural groove in this area called the tear trough. The tear trough is created by the deep attachment of the skin and muscle to the underlying bone. It functions to segment the movement of the lower eye muscle, but can worsen with age when the cheek fat descends or the septum holding lower eyelid fat in weakens. The skin in this area is as well thin and can have inherent dark pigment or show the dark color muscle underneath. The majority of the lower eyelid darkening is secondary to the tear trough and/or the naso-jugal groove. This can be corrected with skin hydration with an eye cream which helps moisturize and smooth the lower eyelid skin. Volumetric fillers such as hyaluronic acid gels like Juvederm® can help to fill a deep groove and level the skin in this area. This may be the first step in treating the dark circles under the eye and is usually indicated in the young woman who has had darkening throughout her life but has worsened in the late twenties or thirties. It is an in-office procedure with minimal recovery. The most frequent complication is bruising and incomplete correction. It usually requires two treatments for a complete correction of the tear trough and may require one to two syringes of filler per eye. Aftercare involves icing for two days and bruising can be covered with makeup. The downside is that fillers are not permanent and the area requires more volume than you would expect to achieve a noticeable result. Fillers in this area can last over one year and usually require half of the volume on reinjection of the areas.
Fillers should be combined with skin care to maximize the treatment of the dark eye circles. A hydrating moisturizer can be applied to the lower eye in the morning and in the evening as part of the eye care treatment for dark circles. The Neocutis® Biocream based products are easily applied and easily tolerated in this area. Surgical options for dark circles and associated a deep tear trough, include lower eyelid blepharoplasty with fat repositioning and ligament release to fill and tightening the lower eyelid. This requires a general anesthesia and a longer recovery, though the results are long lasting and likely more affordable in the long run as compared to repetitive filler treatment. It is not uncommon to perform lower eyelid blepharoplasty on the young patient for this problem. Male and female plastic surgery patients in their thirties may consider this option for the permanent treatment of lower eyelid dark circles.
A consultation with Dr. Trussler would help formulate a treatment plan for lower eyelid dark circles.
July 6th, 2011
Stand in line at any grocery store and you will either see or be directed towards bad celebrity plastic surgery. Everyone is familiar with the “Joan Rivers Facelift” or the” Kenny Rogers Eyelid Surgery” because they are celebrity faces that are frequently exposed to the public eye and photo documented at different stages of healing. The question persists: Are celebrities prone to plastic surgery mishaps? Or do they select substandard plastic surgeons? Or is this the standard of care in plastic surgery?
In general, the over exposed and frequently photographed celebrity plastic surgery figures tend to cloud the view of the lay public and sets an example of what a patient does not want to look like. When you think that these entertainers are financially sound and can consult with the best, which may translate to the most expensive plastic surgeons in the country; why does it appear that it goes wrong so frequently in this population?
The answer is probably multi-factorial in that the best plastic surgeons are not always the most expensive, but this is lower on the list of etiologies; it is likely more commonly related to the profession and the need for an early return to the camera. On facial procedures, scars are generally hidden with makeup though swelling is not. To limit the downtime and the amount swelling smaller, “mini” type procedures are frequently done. These smaller procedures are less invasive but tend to put more stretch on the skin rather than support the lift on the deeper structures of the face. This makes the lift and tuck prone to early relapse and frequent revisions. With the longer lasting procedures they require more invasive surgery with a longer period of convalescence. In general this is not the case for facelifts in that a well done facelift that supports the repositioned facial soft tissue on the Superficial Musculo-Aponeurotic System (SMAS), the scars are inconspicuous and the recovery is about a week. Mini facelifts, short scar and endoscopic cheek or mid-face lifts all have this recovery as well. Even fat injections tend to cause a significant amount of swelling and bruising, as well as that of a liquid facelift with volumetric fillers or a vampire lift with plasma products. Direct neck excision is a perfect example of a minimally invasive procedure which is easily applied to the celebrity population because of the ease of performing it and the very limited recovery. The downside to this would be long central neck scar, which can be covered with facial hair hence only recommended for males and it does not deliver the same contour as a standard sub-SMAS neck lift.
Eyelid procedures, specifically lower eyelids are really the etiology of the “bad” facelift. Lower eyelid surgery or lower eyelid blepharoplasty can remove excess skin, fatty bags, and a downward slant or puppy dog eyes. Lower eyelid blepharoplasty has numerous approaches and the smaller procedures do have limited recovery though can cause severe deformity. Therefore one would get into problems when a small lower eyelid procedure typically causes a problem with scarring and lower eyelid drooping, and then a revision procedure is performed with the same parameters of small procedure for a quick fix. These quick fixes generally do not correct the problem, but contribute to a continuum of exponential lower eyelid malposition and deformity. During this time the celebrity is in the public eye because of the lack of preparation for repetitive surgeries and paprrazzi photos are taken and a bad eye lift makes it to the cover of US Weekly or TMZ. Really this slippery slope could be avoided with the right operation from the start with the acceptance of some recovery for the optimal result, rather than the small result with the short recovery and the multiple revisions.
How does a plastic surgeon let this happen? They succumb to the enticement of being the plastic surgeon to the stars, however more commonly it backfires to become the plastic surgeon with only one star.
June 21st, 2011
Men’s facial skin is different from that of a female in that it is more vascular and less prone to hormone induced thinning. The increased vascularity or blood flow is secondary to the dense distribution of hair follicles and it is generally thicker. As well there is not the hormone response of thinning seen with women after menopause. Men do not care for their skin as well as women. They are prone to sun damage and do not routinely maintain their skin. There is no need for make-up application and removal, which makes skin care a non-habit. Fortunately, men who shave their lower face get exfoliated routinely through shaving. This unconscious exfoliation is unfortunately followed by the routine of caring for their freshly shaven skin with the application of a skin drying alcohol based aftershave.
Multiple skin care lines directed towards the male patient exist, though the same basic skin care principles exist for both sexes: cleanser, moisturizer which is skin type specific, sunscreen and an exfoliant or retinol containing product. Male formulations maintain these principles, but the male face needs stronger concentrations to achieve active ingredient penetration because it is thicker, though in regions of the face where the hair density is greater a milder formulation may be needed because of over drying after shaving. Males will not tolerate the side-effects of active skin care like redness and peeling however these are rare because of the thickness and depth of penetration needed to cause these side-effects, therefore in combination with the regional effects of shaving, a simple yet moderate strength therapy regimen is recommended.
Male skin care products are centered around shaving and physical activity. They usually are mildly fragranced or unfragranced. Phytomer has a male skin care line for both face and body. The body line is mildly fragranced and has an exfoliating body wash and moisturizer. The facial line has a daily detoxifying cleanser, and an every other day oxygenating exfoliant. The Rasage Perfect shaving mask is thin for close razor to skin interaction and a clean shave. There is an alcohol free soothing aftershave as well as a Hydra-matifying moisturizer with a higher talc component to absorb oil. This male skin care regimen is active and simple with known ingredients that work.
Male skin resurfacing usually requires a strong pretreatment in order to de-keratinize and condition the skin. Men do have a higher ratio of skin cancer and actinic damage, therefore pretreatment can help plane and smooth any precancerous lesions. Serial lower concentration TCA are more common than full strength TCA secondary to a shorter recovery, but the majority of male skin will tolerate a medium depth peel and a repeat treatment in 6 weeks.
In general, men do want to preserve their skin quality and a recommended simple skin care regimen combined with a daily sunscreen can improve skin quality. Male patients will typically consider skin resurfacing in the form of medium depth chemical peels and even neuro-modulators such as Botox. These in-office procedures can be performed easily with little to no downtime. The male facelift is a reliable and predictable operation, and in combination with these aforementioned procedures can take years off a man’s face.
The most difficult aspect of male skin care is a consultation with a physician, but once the discussion is initiated in a plastic surgeons office they can be very compliant with a simple plan. Men can consult in my Dallas or Frisco office for a skin care and facial rejuvenation consultation.
June 19th, 2011
Laser hair removal or selective photothermolysis has just been revolutionized with the LightSheer Duet platform by Lumenis, Ltd. The system has two hand-pieces for different areas: one that is smaller with a cooling shield and a larger one that actually has a vacuum-assist. Both the cooling shield and the vacuum make the laser very comfortable, however the larger spot size makes it faster to cover larger areas with only one pass and with less energy. This larger spot size covers more area which is ideal for the back and legs. The type of laser, the 800nm diode, is not new to laser hair removal and targets melanin which is pigment in the hair bulb. The hair follicle target spares the skin and the fact that the vacuum sucks the skin into the laser it makes it more effective and less injurious to the skin. Historically laser hair reduction treatment has required multiple treatments which after the first few long painful procedures it makes it intolerable for the needed repetitive treatments. The LightSheer has made these repetitive treatments short and painless which keeps patients wanting to complete their laser hair reduction. All areas can be treated with comfort and effectiveness. This is performed by my aesthetician and requires no downtime. Treatments can be spread out over a 4 to 6 week period and approximately 4 to 8 treatments may be required. Darker skin tones should always be careful with laser treatments. Please contact my office or through www.drtrussler.com, either in Dallas or Frisco to make an appointment for laser hair treatments or any other laser treatments needed.
