How many units of Botox does it take to reduce a masseter?

Posted on April 6, 2024 by admin

Botox for masseter reduction, or Dysport for masseter reduction, is an excellent procedure to reduce the tension in the jaw, decrease grinding of the teeth, relieve stress in the lower face, and to slim the appearance of the jawline and face. As a neuromodulator, the mechanism of action of Botox and Dysport is to work at the neuromuscular junction to prevent the presynaptic release of acetylcholine, thereby relaxing the muscle by preventing its contraction. As new synapses form within the neuromuscular junction, this effect subsides until eventually full function of the target muscle returns – typically in 3-4 months.

During the time the neuromodulator (Botox or Dysport) is active in the muscle, the muscle becomes relaxed and can not contract with its normal force. The masseter muscle is one of four muscles involved in chewing, and when it becomes relaxed will reduce the intensity of bruxism or teeth grinding and clenching, relieve stress associated with tension in the lower face and bite, and will slim the face by reducing in size and volume.

Does Botox or Dysport permanently reduce the masseter muscle? No, it can not make a permanent change as it will only relax the masseter muscle in a temporary fashion, typically relaxing the muscle for 3-4 months. Once the masseter muscle function returns, the bulk and volume of the muscle will return, typically a total of 4-6 months after the treatment.

How many units of Botox does it take to reduce a masseter?

For most patients undergoing Botox for masseter reduction, 20-30 units per side is a typical range, with 25 units per side being the most common initial dosing.

With Dysport for masseter reduction, a 3:1 conversion for equivalency, which means 60-90 units of Dysport per side, or 75 units per side.

How long does it take for your masseter to shrink after Botox or Dysport?

The muscle will relax and clenching, grinding and stress symptoms will decrease in ~1 week. Once relaxed, the masseter muscle will take 4-6 weeks to visibly shrink in size, and it will continue shrinking and slimming your face for the 3-4 months that Botox or Dysport is active.

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Oligio X Next Generation K-Beauty Skin Tightening

Posted on April 1, 2024 by admin

The aging process of the skin involves an accumulation of extrinsic and intrinsic factors that contribute to increasingly loose, sagging skin with pigmentary dyschromias. Though we have little control over the intrinsic factors (genetic and cellular) that cause our skin to age, the extrinsic factors – such as exposure to sun and its resultant U.V. radiation, and to environmental pollutants and contaminants, are things that we can minimize to maintain the youthful qualities of our skin. With chronological aging, however, even the most steadfast will experience thinning of the collagen and elastin within the dermis, a decrease in the subcutaneous fat under the skin, and thinner, more wrinkle-prone and lax skin.

Radiofrequency energy is formed by oscillation of electrical current in the 20 kHz to 300 GHz range. RF current has been applied in medicine for over 100 years, in applications as diverse as electrosurgery to magnetic-resonance imaging. Previous generation RF-based skin tightening devices such as Thermage delivered RF energy in a way that caused quite a bit of patient discomfort, thus limiting effective energy delivery to the skin and subcutaneous tissue. Oligio X delivers radiofrequency energy at a high frequency (6.78 Mhz) simultaneously with pulses of cooling gas, which allows for impedance matching with the deep skin layers while protecting the epidermis, and minimizing discomfort to the patient. The RF energy will efficiently heat the dermis and subcutaneous tissues to allow for maximal collagen formation and re-organization in safe manner.

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What’s the best treatment for sun spots, hyperpigmentation and solar lentigines?

Posted on March 13, 2024 by admin

Light amplification by stimulated emission of radiation, or laser devices, provide focused energy delivery to precise targets in the skin while minimizing collateral injury. Prior to 2012, Q-switched lasers delivering light energy at nanosecond wavelengths allowed for pulsed energy delivery that could target lesions such as sun spots, hyperpigmentation, melasma, nevus of Ota and other pigmented lesions to maximize destruction and fracture of the melanocytic components creating dyschromias in the skin while minimizing the thermal injury to surrounding normal tissue and skin which could result in post-inflammatory hyperpigmentation. With the advent of even shorter pulse-width lasers, in the order of picoseconds instead of nanoseconds, the ability of deliver higher peak power density comes also with the ability to reduce the amount of photothermal injury due to the reliance of photoacoustic and photomechanical destruction of melanin into smaller particles for absorption by the lymphatic system of the skin.

Since being awarded FDA-approval in 2012 for their 755 nm PicoSure laser, Cynosure has continued to innovate and develop the next generation in pulsed picosecond laser technology with the PicoSure Pro, which captures the short pulse-width technology but with enhanced peak power delivery, allowing for more effective and efficient treatment of hyperpigmentation, age spots, solar lentigines, tattoo pigment removal, and other pigmented lesions.

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What is Asian blepharoplasty? How is Asian blepharoplasty different from a typical upper blepharoplasty or eyelid lift?

Posted on February 20, 2024 by admin

Asian blepharoplasty differs from other types of upper blepharoplasty in that it requires a slightly more complex surgical technique and vastly different aesthetic to create a naturally beautiful result. When upper blepharoplasty or eyelid lift is performed in an aging patient, the procedure will commonly involve removal of excess skin and perhaps removal of excess fat through an incision made along the pre-existing supratarsal crease. The upper eyelid crease, or supratarsal fold, does not need to be reinforced or recreated in most of these patients due to a strong connection between the skin and levator aponeurosis. In many Asian patients, the adhesions between the skin and levator aponeuoris must be reinforced with supratarsal fixation or “anchoring” sutures to create a crisp, defined fold. In cases of multiple folds, asymmetric folds or supratarsal creases that are lower than desired, Asian blepharoplasty is an effective way to modify and enhance the shape and appearance of the upper eyelids.

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What is a spreader graft in Rhinoplasty? What purpose do spreader grafts serve in the nose?

Posted on February 14, 2024 by admin

Spreader grafts were initially described in the ’80s by a rhinoplasty surgeon named Jack Sheen, who used them through an endonasal – or closed, scarless – approach to provide support in patients with short nasal bones, and to reconstruct the middle vault after dorsal hump reduction. Since this initial description and application, the uses of spreader grafts during nose job surgery have been expanded to include correction of internal nasal valve narrowing or collapse, adding additional support to the dorsal septum, straightening deviation of the dorsal septum, widening the middle third of the nose, to lengthen or counter-rotate the nose, and to create continuity of the dorsal aesthetic lines.

Spreader grafts can be carved from straight pieces of cartilage, most typically from that harvested from the septum or the cartilaginous rib. Tapering and chamfering the grafts allows for the optimum nasal contour during rhinoplasty and revision rhinoplasty by reducing any unnecessary bulk, and providing volume only in the locations where it will increase the cross-sectional area of the internal nasal valve, and/or provide necessary support for the nasal framework.

Spreader grafts carved to span the length of the middle vault, while transitioning seamlessly under the nasal bones, and tapered along the dorsal aspect to recreate and improve the dorsal aesthetic lines.

Before and after revision rhinoplasty with rib cartilage and fascia to restore stability and projection of the dorsum while counter-rotating and lengthening the nose with extended spreader grafts.

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What is a deep-plane facelift? How is it different from a SMAS facelift?

Posted on February 14, 2024 by admin

During a traditional SMAS facelift, the skin and subcutaneous tissue is elevated from an incision designed around the ear in a single layer. The layer deep to the skin and subcutaneous fat is the SMAS, or superficial musculo-aponeurotic system, a term coined by plastic surgeons Mitz and Peyronie in the 1970s to describe the anatomic layer investing the muscles of facials expression. For a traditional facelift, the SMAS layer is either plicated (oversewn) or imbricated (a small portion resected and the ends re-approximated) and the skin pulled along the incision to create a lift. This approach would distribute some of the tension of the lift along the SMAS layer, but a significant portion of this force vector would fall on the skin incision line itself.

During a deep-plane facelift, the skin and subcutaneous fat is elevated in one plane, and then as the dissection proceeds anteriorly towards the midline of the face and neck, the dissection descends under the deep-plane (SMAS layer) to create a thicker, more robust flap consisting of skin, subcutaneous fat and SMAS combined. The SMAS is mobilized and secured to provide the lifting for the facelift, with minimal reliance on the skin itself, thus allowing for a tension-free closure of the incisions. This results in a less “pulled” and more natural appearance, more durable, long-lasting results, and reduces the amount of downtime due to bruising and swelling.

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Where are the scars for a deep-plane facelift? How much downtime is there for a facelift?

Posted on February 13, 2024 by admin

The beauty of a well-designed and well-performed deep-plane facelift is that the result is youthful and natural, and the scar is virtually undetectable. The incision is hidden in the temporal hair tuft, along the back of the tragus, and in the crease behind the ear, outlined in red in the figure above. With meticulous, tension-free closure of the incisions, they become difficult to see by two weeks, and fade with each and every week of healing.

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Sutures remain in place for one week, and patients typically feel “restaurant ready” in two weeks.

Before and After deep-plane facelift with Beverly Hills Plastic Surgeon, Dr. Donald B. Yoo, M.D.

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Does scarless rhinoplasty or closed rhinoplasty have any limitations? Why wouldn’t you want a nose job with no scar?

Posted on February 7, 2024 by admin

Closed rhinoplasty or scarless rhinoplasty is an excellent procedure in the properly selected patient. Scarless rhinoplasty involves making incisions only within the nostrils, so that the scars are hidden and difficult to see from the outside. This does make the surgery faster, and swelling typically will be less than a comparable open rhinoplasty procedure. Scarless rhinoplasty and closed rhinoplasty work best in patients with:

  1. near ideal tip support
  2. near ideal tip aesthetics
  3. adequate dorsal height and projection
  4. thin to moderate thickness skin

Closed rhinoplasty and scarless rhinoplasty faces serious limitations in patients with:

  1. weak nasal tip support
  2. wide, bulbous or ptotic nasal tip
  3. lack of projection
  4. lack of dorsal height
  5. very thin, or thick, sebaceous skin

The best candidates for closed rhinoplasty and scarless rhinoplasty are those patients with near ideal tip aesthetics and seeking only a very mild change to the appearance of their nasal tip, but do want to address contours along the nasal dorsum such as a dorsal hump or wide lateral nasal sidewalls. Anything beyond a minor change to the tip of the nose often will be better served through an open rhinoplasty approach.

This beautiful patients underwent a previous scarless rhinoplasty with another surgeon with overall good results, but with some contour irregularities along the nasal tip and a lack of definition along the tip-alar transition. Using unified tip grafts crafted from her septal cartilage and cartilage from her ear I was able to create a smoother nasal tip contour and redefine the tip, ala and nostrils.

With proper incision design and execution, an open rhinoplasty will also leave a “scarless” appearance, with greater refinement and definition of the nasal tip complex.

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Considerations during Asian Rhinoplasty and Asian Nose Job using your own rib cartilage and DCF (diced cartilage fascia)

Posted on February 7, 2024 by admin

Asian rhinoplasty and Asian nose job surgery has enjoyed a surge in popularity as the interest in rhinoplasty surgery more broadly has also increased due to the wider social acceptance and emergence of techniques and surgeons capable of producing predictably beautiful results. While rhinoplasty as a general concept involves reshaping the nose, it’s far too broad a term to accurately reflect the enormous variation in terms of surgical technique and expertise demanded of rhinoplasty surgeons to modify an individual’s anatomy to create the specific aesthetic desired.

For Asian rhinoplasty more precisely, the challenge of creating definition in a setting where the pre-existing nasal framerwork and innate nasal cartilages are weak relative to the thickness and strength of the overlying skin, the rhinoplasty surgeon has the additional challenge of creating form by supplementing and enhancing the structure and integrity of the nose. The 1970s saw a rapid rise in China, Korea and Japan of using silicone implants to augment the nasal dorsum and bridge, and often project and define the the tip of the nose as well. Silicone provided a quick and easy way to add structure, and some degree of definition, to the nose in a way that was well tolerated for years, and sometimes even decades.

As time went on, however, the effects of having a synthetic implant – silicone, Goretex and Medpor – became clear in that they behaved like foreign bodies in the nose, always facing rejection and sometimes even extrusion or ulceration through the skin. For this reason, surgeons have sought out different sources from your own body to provide building blocks for reshaping the nose, including: septal cartilage, ear cartilage, fascia, rib cartilage, and bone.

For the safest, most permanent results, using 100% your own tissue is the best building block. Whether your surgeon uses ear cartilage, septal cartilage or rib cartilage is only one part of the equation for creating a naturally beautiful nose. While some sculptors may be able to turn a block of marble into a flooring tile, an expert sculptor with superlative aesthetics will be able to create Michelangelo’s David. In the same way, seeking a surgeon who uses your own tissue is the bare minimum, requisite first step to achieving successful results, while the more paramount requirement is having the skill and artistry to create the shape that you desire.

See more at:

https://www.youtube.com/drdonyoo

https://www.instagram.com/asianrhinoplasty/

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Who is the best rhinoplasty surgeon in the world? Best Plastic Surgeon in Beverly Hills?

Posted on February 3, 2024 by admin

Any attempt at definitively and objectively determine who is the single best plastic surgeon, or rhinoplasty surgeon for that matter, is an endeavor fraught with subjectivity and destined for failure. Unlike other surgical specialities where outcomes and quality of treatment may be quantified, at least to a certain extent, with indicators such as rates of cure/survival, complication, infection, patient satisfaction, etc. in plastic surgery, relative success and failure is determined by each individual patient and not the collective of patients undergoing surgery by a particular surgeon. In the case of plastic surgery, simply choosing a surgeon who had success creating a wildly popular and sought after nose on a celebrity’s face such as Song Hye Kyo, Angela Baby, or Scarlett Johansson, is not a gaurantee to yield the same beautiful result. As a patient seeking out plastic surgery or rhinoplasty, be exceptionally wary of any surgeon advertising themself, or even self-describing themself on their website search results as “The Best Rhinoplasty Surgeon in Los Angeles” or “The Best Plastic Surgeon in Beverly Hills” as these are titles bestowed unto themselves.

When choosing a plastic surgeon, or rhinoplasty surgeon, the more important question to ask is: Is this the best plastic surgeon in the world for ME? This means the standard recommendations of vetting the doctor’s credential’s, training, reviews and expertise hold true. However, there is a very important distinction and caveat that can only be gleaned by careful review of this surgeon’s previous work, including before and afters and videos of previous patients. Has she/he operated on patients that have anatomy like mine? Has she/he produced beautiful results on other patients that look like me? HOw often does this surgeon perform this specific procedure? Does my rhinoplasty surgeon or plastic surgeon share my same ideals and biases when it comes to aesthetics and do we align in terms of the facets of my appearance I’d like to enhance and which I’d like to simply preserve? These are simply a few of the questions a potential patient should thoroughly consider before finding the “best” plastic surgeon for any kind of procedure.

In the end, the best plastic surgeon and best rhinoplasty surgeon is the surgeon who delivers the naturally beautiful results you are looking for.

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