Nip This Tuck That

I wanted to make sure that the word gets out and spreads…. Bioalchamid that has been injected into the face and lips can be removed in a safe and effective manner, IMHO.  In the past several months, in our Beverly Hills Clinic The Palmer Code Institute of Beverly Hills we have had numerous international clients come and request that their Bioalchamid be removed from their face and lips that was injected in Europe and elsewhere.  In each case, the Bioalchamid was successfully removed with minimal surgery.

Francis R Palmer, III, MD

Creator of The Palmer Code (R)

I have had several patients recently from Australia and Europe that flew here, to Beverly Hills, asking me to remove the Bio Alcamid that had been injected.  In one case, the lips were over inflated with the material to the point they look completely deformed.  In another case, the entire mid-face and cheek area was deformed from the material moving lower into the facial tissues.

For the lip Bio Alcamid, incisions were placed just inside the corners of the mouth and the mucosa was elevated off of the lip musculature.  During the dissection, free floating Bio Alcamid was encountered and removed.  Alloderm lip implants were then placed  to create the proper lip volume and proportion, in both upper and lower lips.

In the mid facial case, micro-lipo was performed through a needle nick at the apex of the nasolabial folds and once again free floating material was encountered and removed.  Perlane was  the injected, into the fatty tissue layer, to shape the cheeks in the appropriate aesthetic manner.

Both, of these cases, IMHO represent injections of Bio Alcamid that caused facial distortion and frankly, I was hesitant to take their case because of the uncertainty of being able to remove enough of the Bio Alcamid to make them appear normal again.  I was, as were the patients, thrilled with the amount of Bio Alcamid that I could remove and the overall results.  I did want to share this information with my readers and give you my impression or thoughts on Bio Alcamid. IMHO, I am concerned that Bio Alcamid remains free floating, under the skin and does not become integrated into the tissues as most other fillers.  This may explain why, the injected material was no longer in the place, I imagine the MD injected it and instead feel lower on to the face.  This is a serious issue, IMO and makes the use of Bio Alcamid not reliable.

Dr Francis Palmer

What’s Your Number…the palmer code

Here are some common questions and answers:

Q: I often read that it takes 10 days to recover from a face lift but I don’t know if that includes upper and lower blephs plus browlift, which people often have at the same time. I’d like to know how long to budget in a general way even as you need to add the disclaimer that everyone is different, we all heal at different rates. If it helps I am a 45 woman basically in good health, some asthma and allergies, of Caucaision and African-American descent.   A: I have performed Face Lifts for over 20 years and don’t perform Brow Lifts along with Full Face Lifts because of the area of tissue dissection that required: across the entire forehead, face and neck.  This leaves very little area for blood supply to heal the skin flaps along the lower section of the Face Lift.  I typically will perform the full Face Lift, Neck Lift with or without the Bleharoplasty (eyelid Surgery) and save the Browlift for another time at 6-12 months later.  This is safer than having a problem with healing after the Face Lift where a portion of the skin could die creating an unsightly large scar. Full Face Lift with Neck Lifts require patients stay in the Beverly Hills/Los Angeles area for a minimum of 10 days and the tissues will take 4-6 months for the swelling, lumps and bumps to resolve.  Depending on your particular case…how much tissue dissection, skin removal etc. is performed, the longer your recovery time.  Most patients are able to put on makeup and look at 1 month post-op.   Q:When is the pre operative surgical markings done for a face lift and blepharoplasty. It is before the surgery while you are awake and sitting up or after you are sedated and lying down? A: I have been performing Face Lifts for over 20 years and have taught Face Lift techniques to resident surgeons for quite a few years. The markings associated with a Face Lift could be done either way…with the patient sitting up which is the way I saw plastic and Cosmetic Surgeons do when I was training over 20 some years ago. I have always allowed my Face Lift patients to lay down on the O R table before I do the facial marking as I feel it allows them to relax more. IMO, if the results of a Face Lift are not what you desired, I really doubt the way in which things were marked had any real impact. It’s more important that the true aesthetics of the face are accentuated during any Face Lift technique. The aesthetics of beauty is the topic of my new book “What’s Your Number…the palmer code”. Q: Opinions on Stem Cell Facelift? Is the “stem cell facelift” hype or something worth looking into? I have seen wonderful before and after photos, but I have learned not to always trust them. Thank you for your input. A: Sadly, complete hype. Stem Cell Face Lifts are nothing more exotic than your own fat treated to isolate the naturally occurring stem cells within your fat which is then injected into your face like traditional fat transfer.  Stem Cell Face Lifts may plump up the face but there’s no evidence to support claims that these stem cells will magically rejuvenate your face. Stem Cell Face Lifts can’t:

• tighten the underlying SMAS muscle layer
• tighten or remove excess skin

Q: Would a Surgeon Refuse Me a Temple Lift for Being Too Young?

I am a 20 year old female. I realize that face lifts are intended for much older people, but I think a temple lift could help improve the overall look of my face by giving the outer corners of my eyes a subtle lift and slightly lifting my lower cheeks. I’ve used my fingers to gently elevate the skin in that area and I quite like the way it looks. I don’t think my age should be a big factor in determining whether or not I am a good candidate for this surgery.

A:

At 20 years old it’s unlikely that your eyebrows are low enough in position to warrant any type of Forehead Lift.  I would always reserve the right to change my opinion based on seeing you but in my 20 + years of performing Face and Forehead Lifts, I have not performed a Forehead Lift on anyone under 27 and any type of Face Lift on anyone under 32 years of age.

Q: Face Lift at 40 years old

If I’m in my 40’s, would it be alright to have a Face Lift instead of a filler like Perlane or Restylane? A: Your age is much less of a deciding factor than the signs of aging and the shape of your facial features.  If you have nasolabial folds, jowls and excess loose skin, fillers would be helpful in shaping the face but won’t and can’t remove excess skin or tighten the underlying SMAS muscle.  For that, you would need a Minimum Incision Face Lift or a larger, more invasive traditional Face Lift. Think of fillers like Radiesse, Perlane, Juvederm, Restylane and Sculptra as the least invasive and effective method of reversing facial aging.  Combined Minimum Incision Face Lift along with fillers as the next step and finally fillers with a more involved type Face Lift as the most extreme way to rejuvenate the face and neck.

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Information on Plastic and Cosmetic Surgery topics brought to you by Dr Francis Palmer , world renowned Beverly Hills Plastic and Cosmetic Surgeon voted one of the “world’s best” plastic and cosmetic surgeons.

Today’s news carries a story of Cindy who’s had a record 52 plastic and cosmetic surgeries. I recall media about Cindy, over the years both here and the UK (primarily), where she’s advocated this extreme amount of plastic surgery. Cindy received a stern talking to by Barbara Walters some years back about too much plastic surgery, during one of her US TV appearances and that must be at a point when she had fewer surgeries than the 52 being reported today. Is she a Celebrity because she’s had plastic surgery? It would appear so.

The question isn’t whether it’s right or wrong for her to have this exaggerated number of plastic and cosmetic surgeries ranging from Face Lifts, to Breast Implants, Cheek Implants, Chin Implant, Rhinoplasty and Eyelid Surgery….but rather should this be something that others should emulate? To this, I say a resounding NO! 52 surgeries seems ridiculous, outrageous and highlights some other need that is being met with constantly going under the knife. I’m not convinced that she looks good or better, so I’m not sure what the point of 52 surgeries would have been. From a video on today’s media, she has her hair hiding the front of both ears…what do the scars there look like after multiple Face Lifts and her right side of her mouth seems not to move as well as the left which could indicate nerve damage from one or more of these surgeries.

If we were to use The Palmer Code to calculate her Face Number, would that Number be higher in her before or after photos? ‘m guessing the before pictures would score higher, but you do the calculations yourself and formulate your own opinion. More is not always better and with plastic and cosmetic surgery at the World’s Best level, there is no substitution for sound aesthetic judgment and this would not dictate 52 surgeries, not ever IMHO. The media does consumers a disservice running these pieces with a disclaimer “please don’t try this yourself”.

Dr Francis Palmer
Beverly Hills Plastic and Cosmetic Surgery
“What’s Your Number..the palmer code.”

I thought it would be helpful, for my readers, to include some of the more common Q & A for Face Lifts and Mini Face Lifts or what I call Minimum Incision Face Lifts like our Palmer Celebrity Face Lift.

Question: If I’m in my 40’s, would it be alright to have a Face Lift instead of a filler like Perlane or Restylane?

Answer: Your age is less, of a deciding, factor than the signs of aging and the shape of your facial features. If you have nasolabial folds, jowls and excess loose skin, fillers would be helpful in shaping the face but won’t and can’t remove excess skin nor can anything injected into the face (fillers or your own fat stem cells as recently hyped elsewhere) tighten the skin and underlying SMAS muscle. For that, you would need a Minimum Incision Face Lift or a larger, more invasive traditional Face Lift.
Think of fillers like Radiesse, Perlane, Juvederm, Restylane and Sculptra as the least invasive and effective method of reversing facial aging. Combined Minimum Incision Face Lift along with fillers as the next step and finally fillers with a more involved type of Full Face Lift as the most invasive/effective way to rejuvenate the face and neck. At the end of the day, you’ll have to decide along with the plastic and cosmetic surgeon you choose to do your facial rejuvenation, which of these three options works best in your particular case.

Dr Francis Palmer
Beverly Hills Plastic and Cosmetic Surgery
“What’s Your Number..the palmer code.”

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So, you look in the mirror and see fullness in your upper eyelids making your eyes and face look tired. Now you’re wondering what’s the best way for you to remove this fullness and restore the youthful, attractive look to your eyes. Will a Brow Lift , also called a Forehead Lift or a Blepharoplasty (Eyelift) be required?

Blepharoplasty or Brow Lift how can I tell what’s right for me

Fullness of the upper eyelids come from two places.
• One is the position of the eyebrows. If the eyebrows are low, in position, this adds fullness to the upper eyelids.
• The other factor is true excess upper eyelid fat and skin which honestly, is a bit rare at 31 years old. Now here’s why I believe you can’t get your anser from these photods.

In women, the proper aesthetic shape of the eyebrows and eyes must be determined in person by the plastic and cosmetic surgeon in order to determine which of the above mentioned two factors is causing the upper eyelid fullness in your particular case. I mention this in my new book on the aesthetics of beauty , “What’s Your Number..the palmer code.”.
The surgeon must, IMO, place your eyebrows in the proper aesthetic position and then with you opening and closing your eyes, assess the amount of upper eyelid fullness remaining. There are three possible outcomes all quite revealing:

• When the eyebrows are elevated to the proper position, all the upper eyelid fullness is gone. This means the fullness is due to low eyebrows and the solution is a Brow Lift, not an upper Blepharoplasty which if performed, in this scenario, would actually cause your eyebrows to become lower after the procedure. More on this later.

• When the eyebrows are elevated, some of the upper eyelid fullness remains. This indicates that a Browlift would remove some, but not all of the fullness, the remainer of which could be removed with an upper Blepharoplasty as a combined procedure.

• The eyebrow is already in the proper position and all of the fullness remains, indicating that an upper Blepharoplastyy alone would remove this excess. This is the only scenario, of the three possible, where an upper Blepharoplasty alone is indicated.

Until this simple, but crucial maneuver is performed on you in person, the appropriate procedure can’t be determined. If an upper Blepharoplasty is done when the correct procedure should have been a Brow Lift, to raise the eyebrows, the Blepharoplasty can cause the position of the eyebrows to go even lower after the procedure. Once this happens, the Brow Lift often can’t be performed because there’s simply not enough skin on the upper eyelid to allow the eyes to close properly after the eyebrows have been elevated. This can result in corneal exposure and complications.

Dr Francis Palmer
Beverly Hills Plastic and Cosmetic Surgery
“What’s Your Number..the palmer code.”

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The are so many sources today all claiming to give you information about plastic and cosmetic surgeon including a list of the top, best plastic and cosmetic surgeons that it’s easy to become overwhelmed in your search. How are you supposed to know which source you can trust? Here’s a brief article that I wrote on How to Choose your Plastic and Cosmetic Surgeon that would apply for someone seeking any type of plastic and cosmetic surgery or procedure including Botox, Dysport, Eyelid Surgery, Rhinoplasty, Forehead Lift, Face Lifts, Cheek Implants, Chin Implant, Breast Implants for Augmentation and Enhancement, Lip Augmentation, Perlane, Radiesse, Restylane, Juvederm or Sculptra.

Plastic and Cosmetic Surgery is the art of aesthetically enhancing the physical form. When properly performed, it can dramatically improve one’s appearance, restoring natural and youthful beauty.

A skilled plastic surgeon can help you achieve the look you’ve always desired through a combination of sound aesthetic judgment and surgical expertise that takes years to cull. Quality plastic surgery is “invisible”-it helps you look younger and more attractive, without appearing obvious or artificial. However, aesthetic vision and surgical skill vary among surgeons-so be sure that you are in the hands of a surgeon that is aesthetically gifted, highly competent and extremely well experienced.

Follow these four simple-common sense steps when selecting your plastic and cosmetic surgeon.

#1. First and foremost, listen to the aesthetic judgment of the surgeon. Does it sound like something that would enhance your appearance? Proper beauty aesthetics are easy to comprehend when properly explained. If it sounds reasonable to you, then proceed to step two. If it doesn’t sound right to you…..get another opinion. There is simply no substitute for sound aesthetic judgment! You may wish to read my new book on this subject “What’s Your Number…the palmer code.” **Available at Amazon.com

#2. Ask yourself if the surgeon has the experience to do what he/she is suggesting. Don’t be afraid to ask the surgeon-”how many times have you performed this procedure?” Most important of all-be sure to see real before and after photographs of patients who have undergone the same procedure. Do not settle for computer simulations! The computer will not be altering your looks—-the surgeon will! This is extremely important because, there is no substitute for experience! If you are satisfied, then proceed to step three-if you are not sure, then get another opinion!

#3. Once the first two steps have been met, you can factor in the price. Prior to this you’re not certain which procedure is right for you-therefore the price should be irrelevant. Step three is a point where you can be fairly comfortable with the level of surgical competence and overall satisfaction, so you may want to compare costs. Minor differences in costs may reflect such things as, how much of the finishing stitches does the surgeon do-or does the assistant complete this portion of the procedure. How well are the incisions hidden and how often will you have follow-up visits with the surgeon. There are reasons for price differences-be sure that you understand exactly what you are/are not getting! You may opt to pay the higher price for more personalized care! You can continue on to the fourth and final step.

#4. This is more of an intuitive step than the previous three. Here you may want to factor in variables like the board certification of the surgeon. Does he/she carry an impressive reputation in the community or carry a university teaching affiliation? How do you feel about the surgeon and the office staff? Follow your gut instincts—–they will serve you well!

Dr Francis Palmer
Beverly Hills Plastic and Cosmetic Surgery
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World’s best soft tissue fillers like Radiesse, Perlane, Sculptra, Juvederm, Restylane, Botox and Dysport injections to enhance the lips, treat wrinkles and shape the face.

Whether you’re looking to treat the wrinkles of your forehead, eyes, lips; want to shape your cheeks, chin, jaw line and nose: or you’re looking for lip augmentation or enhancement, these soft tissue fillers can be a quick, easy way to improve your appearance.

Model, not actual patient for educational use only.

Whether you’re right here in Beverly Hills, Los Angeles, Orange Country or out of state or visiting from China, The Middle East, The UK or elsewhere in Europe, these soft tissue fillers and wrinkle treatments can be done as an office visit in 10-15 minutes and you’ll be on your way with a fresh, new look. Radiesse will last about 12 months, Perlane 8-9 months, Sculptra up to 24 months, Juvederm and Restyalne 6-9 months. These treatments are very well tolerated and our patients fly back home all over the world the same or following day whichever they prefer. Be sure to have these soft tissue fillers and wrinkle treatments with an aesthetically qualified and well trained plastic and cosmetic surgeon that understands the aesthetics (beauty) of the face as outlined in my new book on the subject “What’s Your Number…the palmer code” available at Amazon.com Fillers, if placed in the wrong amounts or in the wrong place can make the face appear odd and unattractive. Wrinkle treatments like Botox and Dysport can cause weakness and drooping of the eyebrows, eyelids and lips if placed in the wrong areas. Be sure that you’re getting approved fillers and wrinkle treatment injections and not some low-cost imported product from outside the US as these are not regulated and may not be what they claim.

Dr Francis Palmer
Beverly Hills Plastic and Cosmetic Surgery
“What’s Your Number..the palmer code.”

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World’s Best Rhinoplasty Beverly Hills Style Part Three:

Let’s continue with our series on Rhinoplasty with some specific areas where the nose can be improved. The major anatomical areas of the nose are:

The Nasal Tip:

When people speak about the nose being long or short, in length, they are really describing the angle of rotation of the nasal tip as it meets the upper lip. In long noses, the tip is under rotated from the ideal 105-115 degrees with the later more appropriate for women rather than men. When the tip angle of rotation is 90 degrees or less, the tip is seen as hanging…almost like you could touch it with your tongue. The opposite is also true when the tip is over rotated with and angle greater than 115 degrees giving the nose a short, “pig nose” look.

Rhinoplasty can change the angle of rotation closer to the ideal utilizing various surgical techniques from onlay cartilage tip grafts to trimming the anterior septal angle. If there is an excess of tip cartilage, this cartilage can be re-shaped or reduced to achieve a more streamlined appearance. Tip cartilage shape, symmetry and rotation are the major issues that need to be assessed before a specific and effective Rhinoplasty plan can be formulated.

The upper lateral Cartilages:

The area immediately adjacent and above the nasal tip is referred to as the Supratip and consists of the upper lateral cartilages that combine in the mid line with the superior (upper aspect) of the nasal septum to form the nasal dorsum or bridge. This area can be indented (concave), flat or Convex (stick out) and there can be quite a bit of asymmetry between the two sides of the nose in this area. In addition, the nasal bridge can have a bump, depression or be crooked to one or both sides resulting in an overall C or S nasal shape. The cartilage in this area can be shaped and trimmed for added symmetry and shape. During Rhinoplasty, the nasal bridge can be thinned horizontally and the vertical height can be either reduced or increased to address the specific flaw.

The nasal bones:

The next area of the nose is made up or the right and left nasal bones that join the bony portion, of the nasal septum, in the mid line to create the uppermost area of the nose and nasal bridge. As the cartilage area below it, the nasal bones can be wide, asymmetric, high or low to the face. The bones can be rasped using a nasal rasp to reduce and shape the bone or the bones can be surgically broken and fractured to move their alignment (called osteotomies). There are numerous types and ways to create nasal fractures but I prefer the lateral method where the nasal bones are fractured where they attach to the face. The nasal bones should be splinted for 1 week with a nasal cast and our patients are advised to avoid physical contact that may shift the nasal bones for 1 month post Rhinoplasty. We do not use nasal packing for Rhinoplasty even when the nasal bones are fractured except in cases where deviations in the nasal septum have been removed….in which case a small piece of telfa is placed in each nostril overnight and removed the next day during the first post op Rhinoplasty visit.

The nasal septum (inside the nose and separates right from left nasal cavity):

The nasal septum has little effect on the outside shape of the nose except in extreme cases of septal deviation leading to loss of structural support to the overlying tip, upper lateral cartilages and nasal bones. The most common septal manipulation, in my practice, is the resection of the anterior septal angle to allow rotation of the nasal tip. Next most common manipulation is to remove deviated portions of the septum to improve air flow in the nose. It is normal to have cycling and reduced airflow through one side of the nose alternating to the other side every 90 minutes or so…but becomes a problem when one side of the nasal airway is always reduced or blocked. In these instances a septoplasty to remove the hard cartilage or bone obstruction can increase the airway space. Septoplasty can be carried out alone or as part of a Rhinoplasty.

Dr Francis Palmer
Beverly Hills Plastic and Cosmetic Surgery
“What’s Your Number..the palmer code.”

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Chin Implant for Chin Augmentation: Beverly Hills Style

If you have a weak chin using a Chin Implant for augmentation, of your chin, can balance the entire lower face. Here’s an excerpt from my new book “What’s Your Number…the palmer code, that defines beauty, describing how you can evaluate your chin and profile. “I’m sure it comes as no surprise that broad, squared chins are an ideal shape for men. Women however, appear more attractive with smaller, rounded chins. Regardless of gender, clefts and dimples add to attractiveness.” excerpt from “What’s Your Number…the palmer code.

What's Your Number...the palmer code book

Here’s how you can measure your chin. On profile view, draw an imaginary vertical line downward from your lower lip. A woman’s chin should be 1/4 of an inch behind that line while a man’s chin should approach or slightly exceed the line. If your chin is behind these measurements, you chin is relatively weak for your lower face and you may benefit from Chin Augmentation with a Chin Implant.

The ideal male and female chin shape and size.

**These are photos of models, not patients, and are included for educational purposes only.

The Chin Implants that In have used for almost years years are made of soft silastic and are very well tolerated by the body. I do not like Chin Implants that become part of the bone or the overlying soft tissue as these are difficult or impossible to remove should you ever desire to do so. The Chin Implants come in different sizes from 1 to 4 with 4 being the largest. Typically sizes and 1 and 2 are used. I prefer and believe that Chin Implants should only be placed through a small incision under the chin. This incision placement allows for dissection under and not through the mentalis muscle’s attachment to the chin (this happens with an incision on the inside of the mouth) preventing upward migration, of the Chin Implant, into the mouth as well as ptosis or drooping of the Chin Muscle years after the procedure which is often referred to as “witches chin.” These complications can all be avoided by placing the Chin Implant through an incision under the chin versus an incision on the inside of the mouth.

Chin Implant surgery takes less than 30 minutes and is typically performed under general anesthesia. Swelling is minimal and quickly resolves. Patients can drive home in a couple of days and fly in 1 week following their Chin Augmentation. Either dis-solvable or removable stitches are placed depending on the travel plans of each patient. We do require that all Chin Implant patients sleep on a U-shaped airline style pillow for 1 month following their Chin Implant or feel and touch the implant force-ably with their fingers to avoid any shifting of the implant. Chin Implants, like Cheek Implants are placed under the covering of the bone and are quite stable at 1 month after placement. Normal and even strenuous activity can be resumed after 1 month. Celebrities can use Chin Implants to balance their faces and improve their appearance…so can you.

Dr Francis Palmer
Beverly Hills Plastic and Cosmetic Surgery
“What’s Your Number..the palmer code.”
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