Ask Dr. Man – Juvederm

Dear Dr. Man, I’m 42 years old and my mom is 64. My mom just got Juvederm treatments at the plastic surgeon and she looks great. I’ve inherited her wrinkles and am wondering if I can expect similar results, since I’m younger than her. Can you tell me more about Juvederm?

Let me start off by saying that no two people can expect the same results from plastic surgery. Every patient is different, so everyone must expect some difference in results. That being said, when wrinkles, creases and sunken areas of the face begin to appear with aging, the use of facial fillers is usually a good treatment option for most people. Some common fillers are hyaluronic acids, fat, and collagen, just to name a few. Like other hyaluronic acid injectable fillers (e.g. Restylane, Perlane, etc.), Juvederm™ is injected directly into the face for immediate, natural looking results. Juvederm is designed to smooth out facial folds and wrinkles to produce a smoother, more youthful looking appearance for up to six months.
In 2006, the U.S. Food and Drug Administration approved Allergan’s Juvederm as the “next generation of hyaluronic acid dermal fillers.” Juvederm is said to provide longer-lasting, smoother results than its competitors. Hyaluronic acid is a naturally occurring complex sugar found in living organisms that creates structure and elasticity in the skin. With age, the body’s production of hyaluronic acid decreases, and injectable fillers help restore facial volume. Juvederm, however, is unlike other hyaluronic acid fillers in that it consists of a smooth gel containing higher levels of non-animal and cross-linked acid, leading to longer lasting results.
The ideal candidates for Juvederm treatments include individuals with moderate to severe folds and wrinkles around the nose and mouth area. Some of the benefits of Juvederm include:
• Minimized appearance of wrinkles and folds
• Immediate improvement in facial volume and structure
• Minimally invasive treatment with no downtime
• Longer-lasting results
Some patients experience mild, temporary side effects including swelling, bruising, redness, and tenderness; however, most patients tolerate Juvederm very well.
There are plenty of women your age who get this treatment. Talk with a board-certified plastic surgeon to see if Juvederm is the correct procedure for you. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man - Rhinoplasty

Dear Dr. Man, I’m 60 years old and my kids are grown and out of the house. I live in Boca Raton and I’ve been going to the gym and have lost weight and I feel great. However, now that I’ve lost weight, I feel like my nose looks even bigger than before. I’m thinking of getting a nose job, but I’m unsure of what to expect. Can you please give me some information about what a nose job entails? Am I too old to get this surgery?

For many years you have wanted to improve the nose; now you have an opportunity to address the issue once and for all. Surgery to reshape the nose (otherwise known as rhinoplasty) is one of the most common of all plastic surgery procedures. It is common among people of all ages, both men and women. Rhinoplasty can be used to reshape the nose in many ways, depending on the patient’s needs and desires. Some of these ways include reducing the size of the nose, changing the shape of the tip or the bridge, narrowing the span of the nostrils, or even changing the angle between your nose and the upper lip. Rhinoplasty can also help relieve some breathing problems.
The best candidates for rhinoplasty are people who are looking to improve their appearance, are physically healthy, psychologically stable, and realistic in their expectations.
Rhinoplasty can be performed under local with IV sedation or general anesthesia, depending on the extent of the procedure and on what you and your surgeon prefer. Rhinoplasty usually takes an hour or two; however, complicated procedures may take longer. When the surgery is complete, a splint will be applied to help your nose maintain its new shape. Nasal packs or soft plastic splints also may be placed in your nostrils to stabilize the septum, the dividing wall between the air passages.

When rhinoplasty is performed by a qualified plastic surgeon, complications are infrequent and usually minor. You can reduce these risks by carefully following your surgeon's instructions. In the days following surgery, your face may be bruised, but this passes. Each day, your nose will begin to look better. Healing is a gradual process; and some subtle swelling may be present for months after surgery.

Rhinoplasty can do wonders to enhance your appearance and boost your self-confidence. Your age should not be a problem, as long as you are in good health. When meeting with your plastic surgeon, discuss your expectations and realistic options for you.

Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. Dr. Man has a private practice in Boca Raton, FL. www.drman.com

Ask Dr. Man – ECO2

Dear Dr. Man, I’m interested in getting rid of deep wrinkles on my face. Part of it is hereditary, but I also am in the sun a lot, as I am an avid tennis player. Is there any new technology out there to fix my problem? I’d prefer a procedure with as little downtime as possible.

As a matter of fact, there is a new treatment that was recently approved by the FDA for skin resurfacing that provides truly dramatic results for deep wrinkles and scars. This procedure is called ECO2 Fractional Laser Resurfacing.

ECO2 is a state-of-the-art, cutting edge fractional laser skin resurfacing system that dramatically improves deep wrinkles, laxity and sun damaged skin using an advanced state-of-the-art process that delivers thousands of micro fractional laser pulses.

ECO2 gives physicians the ability to administer superior treatment with far better results and patient comfort than traditional CO2 laser systems, thus causing less pain and quicker recovery for patients.

The benefits of this treatment include: superior results, a single treatment, minimal downtime (vs. traditional CO2) and less pain.

A full-face treatment takes about an hour, after a topical anesthetic is applied. A special dressing that decreases swelling, pain and irregularities is applied for two to three days.

After the treatment, you will feel a warm sensation, similar to a deep sunburn. Some swelling and redness may be seen immediately following treatment, but this will subside. The treated area will also appear with a thin crust as the rejuvenation process continues and the old sun damaged, dead skin cells slough off.

Most patients will notice significant improvement after just one treatment. Some patients may undergo a second treatment after three months for even more dramatic results.

ECO2 Is recommended for treatment of the following:
- Deep wrinkles on forehead, face, areas around the eyes and lips.
- Acne scars, surgical scars and burn scars
- Photo damaged skin; uneven skin tone and large pores
- Pigmented lesions; freckles, seborrheic keratoses
-Total skin resurfacing of the face, neck, hands and chest

Dear Dr. Man, I’m 22 and I’m very petite and thin. I weigh 102 and I’m 5’4. I’ve always wanted implants and now that I’ve started to work full time, I can afford them. I want to get D cup implants, but my mother thinks I’m crazy; my boyfriend is all for it. How do I know whether to get silicone and saline implants? I feel like there are so many decisions to make- where do I start?
There are many factors to consider when getting breast implants. When you meet with a board-certified plastic surgeon for a consultation, he or she will be able to talk to you about your various options. In the meantime, I will provide you with some basic information to help you understand the process and considerations when choosing to get breast implants.
There are two main factors to consider when it comes to the size of your implants, namely: the size of the breast in proportion to the size of your body and the characteristics of your breast tissue. Every individual differs in these areas. The ideal breast size should balance with your height and weight measurements. The size also largely depends upon how much natural breast tissue you have. For example, a woman with more breast tissue will need her implants filled with fewer cc’s (volume) in order to get the size she desires. All women are different. While a DD cup may be perfect for one woman, it may look too big on another.

Many women believe that an augmented breast will not sag, which is not true. The tendency of the breast to sag is related to the loss of skin elasticity and how thin the tissue is surrounding the breast. If you choose an implant that is too large, it can actually cause the tissue to stretch and, thus, cause more sagging to occur.
With regards to silicone versus saline, there are benefits and tradeoffs for both. Studies have shown both saline and silicone implants to be safe and effective. Before the FDA banned the use of silicone implants in the U.S. about 13 years ago, over 90% of surgeons preferred silicone over saline. The reason is because silicone implants feel and look more natural, can be more predictable and are considered safe. In 2006, the FDA lifted the ban on silicone breast implants.
Silicone implants have been reported by patients to feel softer and more natural than saline. They also have the ability to naturally adjust as you move. This does not mean, however, that they are the right choice for every woman. Saline implants can feel more firm than natural breast tissue. They have been known to ripple, and this can be felt if the breast tissue covering the implant is insufficient. However, adjustable saline implants can be useful in some women, whose breasts are very asymmetrical, or in women who have had massive weight loss and whose skin has stretched a great deal. Adjustable saline implants also allow the surgeon to fill the implant after surgery, in attempt to achieve the desirable size and fullness the patient is looking for. .
The type and size of the implants that are best for you depends upon what you want and what your breast tissue will allow you to have. I encourage you to discuss all of your options with a board-certified plastic surgeon during your pre-operative consultation.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man – Facial Procedures

Dear Dr. Man, I’m 48 years old, but I have to admit that I think I look older because of my facial features. I know I want plastic surgery, but I have no idea what types of surgery are available besides a facelift. Can you tell me more about my options?

The aging process of the skin varies among individuals. Inevitably, with age, our faces begin to lose the natural collagen and elasticity we are born with. Hormonal changes can also cause loss of moisture and thinning of the skin.

The best care you can give your skin is to protect it from the sun and use proper skin care, preferably a regimen recommended by your doctor. Taking care of your skin is the foundation for preventing the signs of aging, but it is only the beginning. As we age, our skin goes through changes; and even people who follow the strictest skin care regimen eventually show some signs of aging.

Fortunately, there are many treatments and procedures available on the market today. You didn’t mention specifically what signs of aging you have, so let’s talk today about some of the various treatments available to fight the aging process.

The earliest signs of aging generally occur around the eyes and forehead area. Specifically, crow’s feet, frown lines and thinner skin around the eyes are some of the first signs. Non-invasive treatment for these may include Botox™ and/or other filler materials to the affected areas. There are noninvasive resurfacing tools that are now available as well, such as Fraxel Laser, Erbium laser, Portrait Resurfacing, and Medium Peel.

There are also surgical corrections for these conditions, such as the use of suspension lifts to improve contour of portions of the face and neck. These procedures go by many names, such as thread lift, feather lift, barbed suture lift, etc. To help the sagging skin around the eyes, there is a commonly performed procedure known as blepharoplasty, which is used to give the eyes a fresher, less tired look. This usually requires some anesthesia. Check with your surgeon to see if you are a candidate for any of these procedures.

Deeper chemical peels, lasers, and dermabrasion are sometimes recommended for deeper lines and wrinkles. These procedures will most likely call for the use of anesthesia in the form of IV sedation.

New technology is becoming more common and being used more frequently when it comes to skin rejuvenation. Be sure to speak to a board-certified plastic surgeon to determine which procedure is best for you.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man – Body Jet

Dear Dr. Man, I’ve been wanting to get liposuction for a long time, but am worried about the down time and pain involved. I heard about a new procedure called Body Jet that was recently FDA approved. Can you tell me more about it?

I am happy to tell you more. Body Jet, also referred to as Water-Jet Assisted Liposuction, is a superior method of liposuction and may be performed on multiple areas of the body during the same session of surgery, including abdomen, arms, under chin, thighs, buttocks, back and calves. It significantly reduces discomfort or pain during and after the procedure. Recovery is shorter, as patients often return to work and other activities in just a few days.

The Body Jet system is more accurate than tumescent, as it uses a controlled pressure system and special cannula to direct the water in a thin, fan shaped jet. The result is less tissue swelling, thus less discomfort or pain after the procedure. This is accomplished by means of the special cannula and computerized software that allows control of the rate of fluid input and fat output. Because it is more accurate, fat is removed only from fatty compartments without hurting other important structures like nerves and vessels. Thus, fatty tissues are released much more easily, with less tissue swelling.

The procedure is performed under local sedation. It is easily tolerated, allowing smooth patient re-positioning so that multiple sites can be performed at the same time. Because it is more accurate, patients recover much more quickly, with less swelling, bruising or discomfort.

I would recommend Body Jet for people who wish to get rid of extra inches and loose fatty tissue, especially around the tummy, arms, neck, back, thighs, hips and buttocks. Body builders and athletes who want a better shape can also benefit from Body Jet.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Young Lips

Dear Dr. Man, I’m 21 years old and just graduated college. I’ve always wanted full lips, but instead I have thin and narrow lips. I’m happy with every other part of my body except my lips. I really want to get this fixed. When I told my mom and my boyfriend that I want to get this worked on, they told me that only old people get their lips done. Is this true? Also, what can I do to help make my lips fuller and more appealing?

Full lips have always been sought after, regardless of age. A plump pout is considered to be not only a sign of youth, but an icon of sensuality as well. As we age, the lips do lose their plumpness and fullness; however, some women naturally have thin lips. The upper lip in many women can appear thin; and the distance from the tip of the nose to the upper lip lengthens as the lips drop "down,” which can cause a frown-like appearance around the mouth. A lip lift or lip augmentation can increase the volume and fullness of the lips and give a more attractive contour and natural pout.

Lip augmentation can be useful for people who have small, deflated lips, asymmetry, reconstructive needs, dropping or sagging upper lip, lack of color, wrinkling from smoking or aging and other complaints. Lip augmentation is not done only on aging individuals- I see many young patients who desire more sensual and attractive lips.

Lip augmentation uses synthetic or biological products or surgical restructuring to enhance the lips using several different treatment options. A common procedure that we hear a lot about these days is the use of filler materials to give the soft lip tissue more fullness and support. These materials can be injected or implanted into the skin and can include collagen or fat, or new fillers, such as Restylane, Perlane and Juvederm. For lines around the lips, a filler called Cosmoplast works well. Some people go a step further and have a surgical lip lift, which shortens the area between the nose and upper lip, in order to reduce a frown-like appearance.

These procedures are performed in the doctor's office under local or I.V. sedation. After treatment, people usually experience some swelling and bruising. In the case of incisions, sutures are removed after several days. As with all surgery, there are some risks, which you should discuss with your surgeon.

Talk to your plastic surgeon to decide which treatment is right for you.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Botox Parties

Dear Dr. Man, I’m so psyched. For her 40th birthday party, my friend is having a Botox party and treating us all to Botox injections. I’d love to know more about what to expect. Will it hurt? I have a blind date 2 days later- will the shots cause scarring?

Botox Cosmetic has become an extremely popular means of reducing certain facial wrinkles, especially frown lines of the forehead and crows feet around the eyes. Frown lines are the vertical lines caused by contraction of the muscles of the eyebrows. Injecting Botox next to the muscles of the eyebrows and forehead causes the muscles to relax, smoothing out the vertical lines. Botox has become very popular with both men and women, in order to regain a more youthful appearance.

This party you mention does cause me some concern. Botox Cosmetic has become so popular that some people such as your friend are hosting Botox parties, in which several men and women gather together for cocktails and wrinkle-reducing injections. Be advised that the FDA has issued statements warning of the possible hazards of "Botox parties." A Botox injection is a medical procedure that should be performed in a controlled medical environment. I’m assuming your friend’s party will not be at a doctor’s office, so please beware. According to the FDA, administering this treatment during a cocktail party greatly diminishes the gravity of this medical procedure. There is always a risk of adverse reactions or side effects after a Botox injection; so patients need to be in a medical setting that is equipped to handle an emergency situation. In addition, the ingestion of alcohol at or around the time of injection could worsen any bruising at the injection site.

That being said, Botox is an excellent treatment for wrinkles, as long as it is performed safely in the correct environment and by a qualified medical profession. Botox, a therapeutic muscle relaxer, is a by-product of botulinum toxin A (it is not a toxin itself). It acts directly on the nerves of the muscles, preventing the muscles and nerves from receiving electrical impulses. Botox is applied via injections, using a very fine needle. The procedure is relatively painless and takes only several minutes.

Botox has been used safely for over 20 years and was approved by the U.S. Food and Drug Administration for cosmetic use in April 2002. There are minimal side effects, although some complications, such as allergic reactions or swelling, may occur. Patients who are on antibiotics or other drugs should advise their doctor in advance, as these drugs may act to increase or reduce the potency of the injections. The results of Botox last about four to six months, depending on the patient, and should be repeated as necessary. Every patient is different- some experience swelling, while others have no reaction. If you’re concerned about your date, you may want to either postpone the date or postpone the injections.

As a side note, Botox is also used to treat some other medical conditions. It is used to help decrease hyperhydrosis (excess sweating). Botox can also be effective for severe migraine or cluster headaches that don’t respond to other methods of treatment. Talk to your doctor if you have any of these problems, to see if Botox injections are the right course of treatment for you.

In addition to exercising caution with “Botox parties,” please also beware of places that offer “bargain Botox injections,” as they may dilute the concentration of Botox in each injection, which can make the results of the treatment less effective.

Talk to a board-certified plastic surgeon or dermatologist to see if Botox is right for you.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Finding a Plastic Surgeon

Dear Dr. Man, I’m visiting my daughter, her husband and my grandkids here in FL for three week. I’m from Minnesota. I’ve finally decided to take the plunge and have plastic surgery (breast lift and something to get rid of my wrinkles). Down here in Florida, there seem to be a lot of plastic surgeons; however, I would like to have my surgery closer to home so that I don’t have to burden my daughter and her family while I recover. How do I find a good, qualified surgeon in Minnesota? I trust you and your reputation, so any advice you have is most appreciated.

When you decide to have cosmetic surgery, the first and most important step you can take is to find a doctor that is right for you, one that can help you reach your goals. So, where should you begin? In my opinion, the phone book and advertisements are not the best resources for information. Instead, I recommend asking friends, family members, and colleagues you respect. Another good source is your family doctor or other medical professionals. Exercise caution if you choose to use the Internet, and make sure any information you get is from a credible source. Be wary of web sites that provide referral services, which are often paid for by the doctor. Better Internet sources are those of professional organizations, such as the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery.

Once you have a list of doctors to choose from, I suggest calling a few offices and getting answers to the following important questions before deciding on a surgeon.
• Is the surgeon board-certified in plastic surgery? Board certified plastic surgeons are full-time plastic surgeons who are certified by the American Board of Plastic Surgery (ABPS), and who have the surgical skills and judgment to perform a wide range of aesthetic and reconstructive procedures on the total body.
• Is the surgeon a member in good standing of the American Society of Plastic Surgeons, Inc. and the American Society for Aesthetic Plastic Surgery (ASAPS)? These organizations represent board-certified plastic surgeons in the U.S. They can provide a list of board-certified plastic surgeons in your area. For more information about the American Society of Plastic Surgeons, call 888-4-plastic or visit www.plasticsurgery.org; and the American Society for Aesthetic Plastic Surgery, call 215-587-9322 or visit www.surgery.org).
• Is the surgical facility fully equipped and accredited to perform outpatient surgery? Does the surgeon have privileges to perform these same procedures in the hospital? Accrediting organizations that can provide you with more information are: the American Association for Accreditation of Ambulatory Surgery Facilities (888-545-5222 or www.aaasf.org); the Joint Commission on Accreditation of Healthcare Organizations (630-792-5800 or www. jaaacaho.org); and the Accreditation Association for Ambulatory Health Care (847-853-6060 or www.aaahc.org).

Another option you have, which would not burden your daughter and her family, is to have your surgery down here in South Florida, and utilize an after-care recovery center. Some doctors like me offer luxury recovery suites that are monitored 24 hours a day by trained nurses and staff. People come from all over the world to have their plastic surgery done here in South Florida and to recover in our “hotel-like” setting. Whatever you decide, I wish you the best of luck.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Sedations

Dear Dr. Man, I’m having plastic surgery in one month. Originally I was supposed to get a few minor procedures; however, I’ve decided to also get a nose job and breast implants. For my original surgery, my doctor said he would be using twilight sedation. Now that I’m having additional procedures, he said I need to be put under general anesthesia. Can you please explain the difference between the two types of sedation? I’m quite confused. Thanks.

Many cosmetic procedures are performed under twilight sedation. Twilight anesthesia is local anesthesia with the addition of a sedative, such as Valium, given intravenously to relax you. This type of anesthesia is generally chosen for procedures lasting greater than an hour or for a few minor procedures that are being done at the same time in different body areas. It is also used when areas being treated cannot be well anesthetized using local anesthesia. Intravenous sedatives are generally a good addition to the local anesthesia injections given by the plastic surgeon. The combination helps make patients feel comfortable during the procedure.

With twilight sedation, you will be sedated to the point of being asleep, but you will not be unconscious or intubated. Twilight sedation does not provide pain relief to the area being operated on; so local or regional anesthetics may be used as well. Twilight sedation generally involves a shorter recovery and causes less, if any, nausea or vomiting.
In some cases, if the doctor finds that twilight anesthesia does not allow the surgical procedure to be carried out safely and comfortably, the doctor may switch to a general anesthetic.

A general anesthetic provides complete loss of pain sensation and loss of consciousness. It is often used for longer surgical procedures where a substantial amount of tissue manipulation is required. It is also used if multiple smaller procedures are being performed in different areas of the body.

General anesthesia is administered by injection, gas or a combination of both. This causes you to fall into a deep sleep. Your doctor may also use other medications for pain relief and muscle relaxation. Advances in anesthesia have made general anesthesia safer than ever.

No matter which type of anesthesia your doctor uses, be sure to have someone available to pick you up following your surgery, as you should not operate a vehicle. You’ll want to rest after the surgery to let the anesthesia wear off and to let your body heal from the surgery.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Implants

Dear Dr. Man, I’m 22 and I’m very petite and thin. I weigh 102 and I’m 5’4. I’ve always wanted implants and now that I’ve started to work full time, I can afford them. I want to get D cup implants, but my mother thinks I’m crazy; my boyfriend is all for it. How do I know whether to get silicone and saline implants? I feel like there are so many decisions to make- where do I start?

There are many factors to consider when getting breast implants. When you meet with a board-certified plastic surgeon for a consultation, he or she will be able to talk to you about your various options. In the meantime, I will provide you with some basic information to help you understand the process and considerations when choosing to get breast implants.

There are two main factors to consider when it comes to the size of your implants, namely: the size of the breast in proportion to the size of your body and the characteristics of your breast tissue. Every individual differs in these areas. The ideal breast size should balance with your height and weight measurements. The size also largely depends upon how much natural breast tissue you have. For example, a woman with more breast tissue will need her implants filled with fewer cc’s (volume) in order to get the size she desires. All women are different. While a DD cup may be perfect for one woman, it may look too big on another.

Many women believe that an augmented breast will not sag, which is not true. The tendency of the breast to sag is related to the loss of skin elasticity and how thin the tissue is surrounding the breast. If you choose an implant that is too large, it can actually cause the tissue to stretch and, thus, cause more sagging to occur.

With regards to silicone versus saline, there are benefits and tradeoffs for both. Studies have shown both saline and silicone implants to be safe and effective. Before the FDA banned the use of silicone implants in the U.S. about 13 years ago, over 90% of surgeons preferred silicone over saline. The reason is because silicone implants feel and look more natural, can be more predictable and are considered safe. In 2006, the FDA lifted the ban on silicone breast implants.

Silicone implants have been reported by patients to feel softer and more natural than saline. They also have the ability to naturally adjust as you move. This does not mean, however, that they are the right choice for every woman. Saline implants can feel more firm than natural breast tissue. They have been known to ripple, and this can be felt if the breast tissue covering the implant is insufficient. However, adjustable saline implants can be useful in some women, whose breasts are very asymmetrical, or in women who have had massive weight loss and whose skin has stretched a great deal. Adjustable saline implants also allow the surgeon to fill the implant after surgery, in attempt to achieve the desirable size and fullness the patient is looking for.

The type and size of the implants that are best for you depends upon what you want and what your breast tissue will allow you to have. I encourage you to discuss all of your options with a board-certified plastic surgeon during your pre-operative consultation.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Portrait

Dear Dr. Man, My friends are all raving about Portrait. Three of my friends who I play tennis with had Portrait done and they look 10 years younger. I want this done. Please tell me more.

Officially known as Portrait® Plasma Skin Regeneration System (from Rhytec), Portrait reduces and softens the deep lines in the face, proven to deliver true skin regeneration. Results are immediate and long-lasting, with clinical studies showing improvements for as long as a year after treatment. Portrait is FDA-cleared, and is an effective treatment for wrinkles (deep and fine), brown spots, and pigmentations. It also helps improve skin tone and elasticity, in addition to tightening lax and sagging skin. It is approved to treat the face, neck, décolleté, arms and hands.
When most people think of “plasma,” they think of televisions; however, this treatment is very different. Portrait is the first system to employ a highly energized gaseous state known as “plasma” to produce unique controlled thermal energy at and below the skin’s surface. While some treatments lead to improved skin only at the surface, Portrait alters structures below the surface, creating unique conditions for continuing regeneration and improvements in wrinkles, tone, texture and discoloration. It creates a natural response to new skin cell regeneration and collagen growth, similar to a newborn baby’s skin.
Your physician will tailor your treatment depending on your needs and lifestyle. Treatments can vary from one treatment at a higher setting to three treatments at lower settings. Patients are given topical anesthetic cream one hour prior to the treatment; and the treatment itself is usually completed within about 30 minutes. Patients can expect to feel a localized sensation of heat during the treatment.

Following treatment at lower settings, patients can expect to look and feel sunburned for 24 to 48 hours. Within 24 hours after the procedure, they can resume normal activity and wear mineral makeup. Some shedding can occur within the following 3 to 5 days. Following treatment at higher settings, patients can expect to feel a more intense sunburn sensation, with a browning/bronzing to the outer layer of skin. Patients can resume normal activity and wear mineral makeup within 48 to 72 hours. Shedding may occur within the week following treatment. Once shedding has occurred, the redness of the regenerated skin may last up to 2 weeks. This is a much shorter duration compared to CO2 or Erbium Laser treatment.

The benefits of using Portrait can be seen soon after treatment, and patients tend to see progressive improvements over time. Portrait is a safe, non-surgical way to rejuvenate the skin. Combined with Botox and Dermal Fillers, it can provide patients with synergistic benefits that can do wonders for the skin. I believe that Portrait uniquely addresses the growing demand for cosmetic improvement with minimal downtime, and little or no risk of side effects or complications associated with other more aggressive anti-aging treatments.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man - Thigh Lift

Dear Dr. Man, I’m 36 years old. I’m in very good shape, but I can’t seem to get rid of the flab on the inside of my thighs. How do I fix this? Exercise hasn’t helped- I even hired a personal trainer. Do I get liposuction? Will that help?

The skin along the inner thighs generally has less tone and elasticity than the skin along the flanks or the outer thighs. As a result of aging, weight loss and excessive exposure to the sun, the skin of the inner thighs can become thin, loose or hanging.

Even for people with a thick layer of fat along the inner thigh, liposuction alone will not make the skin tighter. What can be done is a procedure known as a thigh lift, which is usually done in combination with some liposuction. The surgeon generally performs liposuction of the inner thigh area first, in order to loosen the overlying skin. Then, an incision is made along the groin crease where the front of the thigh meets the lower abdomen. The incision continues around the upper inner thigh and ends in the crease below the buttock. The skin and tissue underneath are then pulled upward until the skin is taut, and the excess tissue is then trimmed off. A deep layer of stitches is placed in the strong connective tissue of the thigh. Dissolving stitches are then used to close the skin.

After surgery, you can expect to wear a lower body compression garment around the clock for about two weeks, except when showering. You may feel some generalized discomfort along the thigh area, along with a burning sensation along the stitch line in your groin crease at the top of the thigh. You may find it difficult to bend forward or sit in a chair, as this puts the most tension on the stitches. Standing or reclining flat tends to be the most comfortable position for patients the first few days after surgery. You should avoid strenuous activity for three to four weeks following surgery.

The down sides to an inner thigh lift are prolonged recovery and possible visible scars. I would recommend possibly first attempting liposuction alone with some of the newer methods of fat removal. Visit a board-certified plastic surgeon to see if this or another type of surgery is right for you.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Endoscopic Browlift

Dear Dr. Man, I’m finally going in two weeks to the plastic surgeon and getting an endoscopic browlift and some Botox shots. I’ve had Botox in the past, so I’m not concerned about that. However, I’ve never had a browlift. Can you tell me what to expect and how long I can expect the recovery to be?

As we age, it’s very common to develop droopy eyebrows, hooding over eyes, forehead creases and frown lines. A browlift (a.k.a. “forehead lift") is a procedure that restores a more youthful, refreshed look to the area above the eyes. It can help to reduce deep creases, horizontal lines, and furrows in the forehead, while lifting heavy, droopy eyebrows that can create a hooding effect over the eyes and make a person appear angry, sad or tired. A browlift is a minimally invasive procedure often performed in conjunction with a facelift or eyelid surgery; however, it can be done as a standalone procedure.

An endoscopic brow lift is one of the more commonly used techniques. Instead of one long incision from ear to ear (which the traditional browlift uses), this technique requires approximately three to five one-inch incisions. An endoscope (wand with a small camera on the end) is inserted into one of the incisions in order to see the underlying muscles and tissues. Next, the eyebrows are released and secured in a higher position underneath the skin. The frown lines are also decreased by weakening the muscles that cause them.

Many surgeons prefer the endoscopic technique for a brow lift because the scalp incisions are minimized, there is a lower chance of permanent scalp numbness, and the recovery is generally shorter. This technique is also recommended for people with thinner hair.

To reduce swelling after a browlift, you should keep your head elevated. Bandages are removed in a short time, and stitches are removed within a week. You should be able to shower and shampoo your hair within a few days. Some numbness and tightness of the forehead are common after surgery. Your cheeks and eyes may also bruise and swell, but that should not last too long. Most people are up and about within a few days; however, you should rest for at least the first week after surgery. Avoid rigorous physical activity for a couple of weeks after surgery. Most of the visible signs of surgery should fade within the first few weeks.

The position of your brow can have a major impact on facial expression. An elevated and smooth brow can do wonders for restoring a youthful look and a positive facial expression. I’m sure you’ll be pleased with the results.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Injection Holes

Dear Dr. Man, I’m 35 years old and have been getting fillers in my cheeks for a few years now. I’m quite happy with the results. Since I’ve had such good results there, I’m wondering if fillers can help correct the hollows under my eye. I have dark circles, because of my thin, translucent skin. It seems to be getting more obvious as I get older. I’ve heard some negative feedback on people who have used fillers for the under eye area. I do have good skin that heals well, but I don’t want to risk bruising such a prominent area on my face. Thanks in advance for your advice.

The area under your eyes is a somewhat risky area to inject, as it can be prone to bruising and lumps. I’m happy to hear that you have had such success with the injections in your cheeks; however, having success in other thicker areas does not necessarily mean you will not have problems around the eyes.

Every patient is different. In some cases, we need to use fillers if other procedures don’t work; however, there are risks, such as lumps and bruising. The use of hyaluronic acids can usually alleviate these lumps. I suggest you meet with a board-certified plastic surgeon that you trust. Discuss your various options for treatment and concerns you may have. Best of luck.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Vaser Contouring

Dear Dr. Man, I’m a 28 year old man, I work out every day and can’t seem to get six-pack abs. There’s some fat around my mid-section that won’t go away no matter how hard I work out. I saw on television this guy getting Vaser liposculpture. Can you tell me more about this? Also, any other procedures you might recommend? What about body contouring?

Many men, and even women, work out and take care of their health; however, they find they still have extra fat around the middle, tummy or back. Because liposuction removes localized fat that doesn’t respond to diet and exercise, it is one of the best procedures to help men attain their desired body shape.
The Vaser, a new laser liposuction procedure, removes double chins, “spare tires” and “love handles” around the waist, large protruding abdomens and more. These procedures allow the plastic surgeon to be a true sculptor of the human body.
Another popular procedure for men includes body contouring to lift the buttocks, thighs, arms and abdomen; it also helps to reshape the body and remove excess, hanging skin. This procedure is especially useful after weight loss of 50 to 100 pounds or more, and is becoming more common.

If you’re considering plastic surgery, visit a board-certified plastic surgeon for a consultation to help you decide which procedure is right for you

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Perlane Lips

Dear Dr. Man, I want fuller lips. I get collagen injections regularly, but I want something that lasts longer. What about using a longer-term filler, such as Perlane?

Full lips are constantly sought after, for women of all ages; after all, a plump pout is considered to be a sign of youth and sensuality. However, I think long term fillers, at present, are not good options for lips. While I understand your desire for a long-time alternative, I feel that the negatives greatly outweigh the benefits of long-term fillers such as Perlane. Perlane is not made for the lips. It is meant to be injected much deeper into the skin; therefore, it can leave you with a higher chance of lumps in your lips.

There are many excellent alternatives that may suit your needs. As we age, the upper lip, in particular, can appear thin; and the distance from the tip of the nose to the upper lip lengthens as the lips drop "down,” which can cause a frown-like appearance around the mouth. A lip lift or lip augmentation can increase the volume and fullness of the lips and give a more attractive contour and natural pout.
Lip augmentation can be useful for people who have small, deflated lips, asymmetry, reconstructive needs, dropping or sagging upper lip, lack of color, wrinkling from smoking or aging and other complaints.
Lip augmentation uses synthetic or biological products or surgical restructuring to enhance the lips using several different treatment options. A common procedure that we hear a lot about these days is the use of filler materials to give the soft lip tissue more fullness and support. These materials can be injected or implanted into the skin and can include collagen or fat, or other fillers, such as Juvederm. For lines around the lips, a filler called Cosmoplast works well. Some people go a step further and have a surgical lip lift, which shortens the area between the nose and upper lip, in order to reduce a frown-like appearance.
These procedures are performed in the doctor's office under local or I.V. sedation. After treatment, people usually experience some swelling and bruising. In the case of incisions, sutures are removed after several days. As with all surgery, there are some risks, which you should discuss with your surgeon.

Talk to your plastic surgeon to decide which treatment is right for you. You must realize that no one can perform miracles; however, a highly skilled surgeon can transform what you do have into a more balanced look altogether. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Mosaic

Dear Dr. Man, while at my dermatologist, I was complaining about my wrinkles and my acne scars. She was also pointing out that I have a great deal of sun damage on my face. She suggested that I see a plastic surgeon and look into a treatment called Mosaic. Can you tell me more about this treatment?

Mosaic is the first laser to use a new patented process of CCT to remove wrinkles, sun damage and acne scars. FDA-approved, Mosaic is considered the most advanced laser system to date, and it is the first to use a new patented process of Controlled Chaos Technology (CCT) to remove wrinkles, sun damage and acne scars.

Its unique patented CCT computerized delivery system delivers the laser energy in a controlled random "chaos" pattern, which penetrates deeper without thermal damage.

Benefits include: no downtime; immediate results; fewer treatments than other lasers; the ability to see results during the first treatment; no scarring; and the ability to tighten skin and reduce acne scarring.

Mosaic is an advanced aesthetic solution based on the latest in fractional technology. Unlike traditional lasers and light-based technologies that achieve homogenous thermal damage at a particular depth, Mosaic’s exclusive patented techniques work by delivering multiple arrays of randomized microscopic laser beams to the skin.

These beams produce deep, collimated Micro Necrotic Columns (MNCs) that can penetrate as far down to the reticular dermis, while sparing surrounding viable tissues. The outcome produces more natural, more uniform skin regeneration with minimal downtime and dramatic clinical improvements. Most patients are very pleased with the results they see after using Mosaic.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Triactive

Dear Dr. Man, I’m 39 years old and have cellulite around my thighs and butt. I’m pretty thin and athletic. I work out, I eat right, but it doesn’t help. My co-worker mentioned something called Triactive and how it uses a laser and is less invasive than other treatments like lipo. Can you please give me the basics on cellulite and how Triactive can help.

The term cellulite refers to the dimpled appearance of the skin that occurs on hips, thighs and buttocks. This appearance is much more common in women due to the differences in the way fat, muscle, and connective tissue are distributed in men and women’s skin. The American Academy of Dermatology reports that at least 80% of women have cellulite. Currently, more than 45 million women in the U.S between the ages of 20 and 50 suffer from this condition.

The different types of cellulite include: edematous, adipose, interstitial, fibrous or localized adiposity. The causes of cellulite include: genetics, hormonal, vascular, lack of exercise, stress, poor nutrition, digestive disorders and systemic diseases.

Triactive is the only laser FDA approved for cellulite treatment. It is helpful in achieving the following:

- To reduce cellulite, which appears as a “cottage cheese” lumps under the skin
- Pre liposuction: To ease the surgical procedure
- Post-liposuction: To assist with contouring
- Facial Smoothing and Tightening
- Body Smoothing
- Enhancement of microcirculation
- Therapeutic micro massage
- Adipose lymphatic drainage
- Provides noticeable results before and after liposuction, breast augmentation, abdominoplasty and others.

Various parts of the body can be treated with Triactive, including:

- Thighs and buttocks
- Upper arms and neck
- Tightening of the love handles
- Abdomen

Patients who have been treated using Triactive report no pain, and a feeling similar to “having a massage.” Part of this sensation is due to an increase in circulation. Typically the treatment is done in a series of about 10 to 15 treatments to a given area. These can be spaced as closely as three times per week, or once per week.

Your individual results can depend on several factors: The number of areas being treated, your age and general condition and the number of treatments. Typically patients see noticeable improvements after six to eight treatments.

Normally, the series of Triactive treatments can be done annually, with follow-up monthly maintenance treatments. If you have experienced weight reduction, a change in your body fat composition (and need additional tightening) or are have other areas of your body treated, you may want to consider a miniseries of treatments.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Injectable Silicone

Dear Dr. Man, Many years ago (like over a decade ago), my sister went to a plastic surgeon to get silicone injected into her face to make her look younger. I went online to read up about this procedure and I can’t find much about it. I’m wondering why this is the case. If that’s not available, what are some good alternatives? My face is starting to cave in and it definitely shows my age.

Due to age, gravity, and natural daily expressions, the fullness and roundness of the face can weaken and droop downward, making the rounded contours of younger years a faint memory. Also, as we age, the fat and collagen in the face begin to dissipate, which can make the face look more tired and drawn.

The treatment of injectable silicone is no longer approved for cosmetic use in the United States. In fact, the FDA banned its use for wrinkles and facial defects back in 1991. The reason they did this is because injectable silicone has a tendency to harden and migrate, and can cause inflammation and skin necrosis.

There are, however, many other wonderful alternatives that we use as face fillers. Non-invasive use of synthetic filler materials are extremely popular, safe, and very effective. These materials are injected into various parts of the face, and even into the lips for a fuller appearance. A local anesthetic is given, and the injections usually take 30 minutes or less to do. Some of the more popular synthetic fillers used today are Radiesse, Perlane, and Sculptra.

Fillers can offer improvements to the sunken area under the eye. It can also help diminish the appearance of dark circles by reshaping the deep contours that can create shadows in that area. Fillers can also be injected into the lips to help thinning, and can also be placed above the lip to help get rid of the vertical lines caused from smoking or pursing of the lips.

Another filler that is commonly used is Sculptra. It is FDA-approved to treat facial fat loss in HIV patients, but is also used these days off-label for cosmetic improvement, in order to treat deeper facial creases and to create volume in the mid-face, which can be lost with age. Sculptra takes up to three sessions, usually a month apart, to achieve the best results.

I like to use a combination of these fillers in what I call a “liquid face lift.” The combination of these fillers, used on the face, can do wonders to improve the appearance of the face.

Finally, I must tell you about the use of your own body fat as a filler to enhance the face. In fact, this is often considered the golden standard of fillers, since it uses your body’s own materials. This procedure, which can sometimes be done with a local anesthetic, involves taking fat from another area of the body (usually from the belly), and injecting it into the face. The excess fat can even be harvested for future injections.

Discuss these options with a board certified plastic surgeon during your consultation, in order to help decide which treatment is the best choice for your individual needs.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Portrait

Dear Dr. Man, Two weeks from today, I’m getting the Portrait skin treatment done. Can you please tell me what to expect, as far as what it feels like, what kind of results to expect, downtime, etc.?

Portrait® Plasma Skin Regeneration System (from Rhytec) has shown to reducesand softens the deep lines in the face. Results are immediate and long-lasting, with clinical studies showing improvements for as long as a year after treatment. Portrait is FDA-cleared, and is an effective treatment for wrinkles (deep and fine), brown spots, and pigmentations. It also helps improve skin tone and elasticity, in addition to tightening lax and sagging skin. It is approved to treat the face, neck, décolleté, arms, and hands.

When most people think of “plasma,” they think of televisions; however, this treatment is very different. Portrait is the first system to employ a highly energized gaseous state known as “plasma” to produce unique controlled thermal energy at and below the skin’s surface. While some treatments lead to improved skin only at the surface, Portrait alters structures below the surface, creating unique conditions for continuing regeneration and improvements in wrinkles, tone, texture and discoloration. It creates a natural response to new skin cell regeneration and collagen growth, similar to a newborn baby’s skin.

Your physician will tailor your regime depending on your needs and lifestyle. Treatments can vary from one treatment at a higher setting to three treatments at lower settings. Patients are given topical anesthetic cream one hour prior to the treatment; and the treatment itself is usually completed within about 30 minutes. Patients can expect to feel a localized sensation of heat during the treatment.

Following treatment at lower settings, patients can expect to look and feel sunburned for 24 to 48 hours. Within 24 hours after the procedure, they can resume normal activity and wear mineral makeup. Some shedding can occur within the following 3 to 5 days. Following treatment at higher settings, patients can expect to feel a more intense sunburn sensation, with a browning/bronzing to the outer layer of skin. Patients can resume normal activity and wear mineral makeup within 48 to 72 hours. Shedding may occur within the week following treatment. Once shedding has occurred, the redness of the regenerated skin may last up to 2 weeks. This is a much shorter duration compared to CO2 or Erbium Laser treatment.

The benefits of using Portrait can be seen soon after treatment, and patients tend to see progressive improvements over time. Portrait is a safe, non-surgical way to rejuvenate the skin. Combined with Botox and Dermal Fillers, it can provide patients with synergistic benefits that can do wonders for the skin. I believe that Portrait uniquely addresses the growing demand for cosmetic improvement with minimal downtime, and little or no risk of side effects or complications associated with other more aggressive anti-aging treatments.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Teenage Breast Reduction

Dear Dr. Man, I am 16 years old and I have very large breasts. I started developing when I was 11 years old and I am now a DD cup. I’m very thin, so I can’t ever find clothes to fit me since my top is bigger than my bottom. I also have bad shoulder and back pain. It’s difficult for me in gym class or even when I take a run. I want to have a breast reduction but my mom thinks I should wait until after I graduate high school. What do you think? Am I too young or do other girls my age get breast reductions? Please help us settle this.

The issue you are encountering is one that many young women go through. Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight, including back, neck, and shoulder pain. In addition, there may be other physical discomforts, such as bra straps leaving indentations in their shoulders. Large breasts can also make women, especially teenage girls like yourself, feel embarrassed or self-conscious. As you said, it can also be troublesome when trying to find clothes to fit.

Breast reduction, also known as reduction mammoplasty, reduces disproportionate, oversized breasts by removing fat, glandular tissue and skin from the breasts, making them smaller, lighter and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal of the surgery is to give the woman smaller, better-shaped breasts in proportion with the rest of her body.

In most cases, breast reduction isn't performed until a woman's breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort, as in your case.
Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. Luckily, modern surgical methods leave patients with incision lines that are only around the areola and up and down, eliminating the horizontal incision at the bottom of the breasts. These scars should fade with time and are usually covered by a bra or bathing suit. After surgery, the patient is wrapped in an elastic bandage or a surgical bra over gauze dressings. The bandages are removed a day or two after surgery, though the patient continues wearing the surgical bra around the clock for several weeks, until the swelling and bruising subside. Although the patient may be up and about in a day or two, the breasts may still be tender for a couple of weeks. Most women can return to non-strenuous work, school or social activities in about two weeks.

The best candidates for this surgery are women who are mature enough to fully understand the procedure and have realistic expectations about the results. It sounds like you are a mature young lady. I recommend you and your mom speak to a board certified plastic surgeon to help you decide if you are a good candidate for the surgery.

Every patient and every physician has a different view of what is a desirable size and shape for breasts. In your initial consultation, it's important to discuss your expectations frankly with the plastic surgeon, and to listen to his or her opinion.

Breast reduction surgery helps get rid of the physical discomfort of large breasts, the body looks better proportioned and clothes fit better. Chances are that, like most young women, you would be pleased with the results. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Botox

Dear Dr. Man, I’m only 37 but I already have lots of frown lines and some wrinkles. All of my friends have gotten Botox and, until now, I’ve been hesitant to follow suit. Can you give me more info about what Botox is, what kind of results I can expect, etc.? Is it safe?

Botox Cosmetic has become an extremely popular means of reducing certain facial wrinkles, especially frown lines of the forehead and crows feet around the eyes. Frown lines are the vertical lines caused by contraction of the muscles of the eyebrows. Injecting Botox next to the muscles of the eyebrows and forehead causes the muscles to relax, smoothing out the vertical lines. Botox has become very popular with both men and women, in order to regain a more youthful appearance.

Botox, a therapeutic muscle relaxer, is a by-product of botulinum toxin A (it is not a toxin itself). It acts directly on the nerves of the muscles, preventing the muscles and nerves from receiving electrical impulses. Botox is applied via injections, using a very fine needle. The procedure is relatively painless and takes only several minutes.

Botox has been used safely for over 20 years and was approved by the U.S. Food and Drug Administration for cosmetic use in April 2002. There are minimal side effects, although some complications, such as allergic reactions or swelling, may occur. Patients who are on antibiotics or other drugs should advise their doctor in advance, as these drugs may act to increase or reduce the potency of the injections. The results of Botox last about four to six months, depending on the patient, and should be repeated as necessary.

Botox is also used to treat some other medical conditions. It is used to help decrease hyperhydrosis (excess sweating). Botox can also be effective for severe migraine or cluster headaches that don’t respond to other methods of treatment. Talk to your doctor if you have any of these problems, to see if Botox injections are the right course of treatment for you.

Botox Cosmetic has become so popular that some people are even hosting Botox parties, in which several men and women gather together for cocktails and wrinkle-reducing injections. Be advised that the FDA has issued statements warning of the possible hazards of "Botox parties." A Botox injection is a medical procedure that should be performed in a controlled medical environment. According to the FDA, administering this treatment during a cocktail party greatly diminishes the gravity of this medical procedure. There is always a risk of adverse reactions or side effects after a Botox injection; so patients need to be in a medical setting that is equipped to handle an emergency situation. In addition, the ingestion of alcohol at or around the time of injection could worsen any bruising at the injection site.

Also, beware of places that offer “bargain Botox injections,” as they may dilute the concentration of Botox in each injection, which can make the results of the treatment less effective. Talk to a board-certified plastic surgeon or dermatologist to see if Botox is right for you.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Thin Lips

Dear Dr. Man, I’ve always had thin lips, but as I age, my lips are looking even thinner and I just don’t like the appearance of my mouth as a result. My friends have gotten collagen injections in the past. Is that the best treatment?

Full lips have always been sought after, regardless of age. A plump pout is considered to be a sign of youth and an icon of sensuality. However, as we age, the lips can lose their plumpness and fullness. The upper lip, in particular, can appear thin; and the distance from the tip of the nose to the upper lip lengthens as the lips drop "down,” which can cause a frown-like appearance around the mouth. A lip lift or lip augmentation can increase the volume and fullness of the lips and give a more attractive contour and natural pout.
Lip augmentation can be useful for people who have small, deflated lips, asymmetry, reconstructive needs, dropping or sagging upper lip, lack of color, wrinkling from smoking or aging and other complaints.
Lip augmentation uses synthetic or biological products or surgical restructuring to enhance the lips using several different treatment options. A common procedure that we hear a lot about these days is the use of filler materials to give the soft lip tissue more fullness and support. These materials can be injected or implanted into the skin and can include collagen or fat, or new fillers, such as Restylane and Cosmoplast. Some people go a step further and have a surgical lip lift, which shortens the area between the nose and upper lift, in order to reduce a frown-like appearance.
These procedures are performed in the doctor's office under local or I.V. sedation. After treatment, people usually experience some swelling and bruising. In the case of incisions, sutures are removed after several days. As with all surgery, there are some risks, which you should discuss with your surgeon.

Talk to your plastic surgeon to decide which treatment is right for you. You must realize that no one can perform miracles; however, a highly skilled surgeon can transform what you do have into a more balanced look altogether. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Neck Lift

Dear Dr. Man, I’m mortified. I went to visit my daughter and her children in NY last week and my sweet grandchild was playing with the skin on my neck. She innocently said that my neck looks like a turkey. I know she wasn’t being malicious, but she’s right. It is so unsightly and I am most self-conscious about it. What can I do to fix this?

You are not alone! As we age, the muscles and skin of our neck and lower face begins to sag and lose its definition. Jowls may form as muscles loosen and as fat deposits along the jaw line. Fat is also deposited under the chin, causing the neck to become thick and wide. The neck muscles weaken and separate; and bands form, which further weaken the shape and structure of the neck. This causes a "turkey gobbler" effect.

The purpose of a neck lift is to remove loose soft tissue and fat from under the neck by removing fat, tightening muscles and re-draping skin. This helps to improve the neck, jaw line, and cord-like structures in the front of the neck. It even helps to correct a double chin.

Neck lifts are often performed in conjunction with a facelift, though they can be performed alone. Endoscopic techniques are often used to remove excess fat and tighten muscles of the neck. In some cases, endoscopic techniques may be all that is required to remove excess fat from the neck. A neck lift is performed under local I.V. or general anesthesia and usually takes two to three hours. In general, scars from the neck lift are usually short and hidden. Patients are usually back to work in 1-2 weeks. Even though there are no guarantees, patients are usually ecstatic with the results of the surgery.

Keep in mind that sometimes Smartlipo and liposuction are the only treatments you need for a fatty neck. In these cases, there will be no incisions or cuts, except very small cuts that are totally hidden.

Speak with a board-certified plastic surgeon to see if a neck lift is right for you. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Thread Lift

Dear Dr. Man, My sister lives in California and she is considering getting a threadlift. She said it’s like a facelift. Can you give me more information on what this is and how it differs from a regular face lift?

Thread lifts can be an alternative to a face lift for patients who want lifting and tightening of their cheeks, mid-face, jowls or eyebrows, but don't want to undergo major surgery. This procedure uses threads to make the face appear firmer and more lifted. Thread lifts are done under local anesthetic, right at the doctor’s office. During the procedure, the doctor places a special thread below the skin. The thread is used to lift sagging skin and tissue, which is anchored underneath the hairline. The procedure takes about an hour or two. Potential side effects can include bruising and swelling. Recovery can take a few days up to a couple of weeks.

Over the years, thread lifts have seen improved methods that have been recently given FDA approval. In the past, thread lifts have had some problems with sutures rising to the surface and allowing only short-term smoothness; however, now results can last much longer. The results are almost immediate. Many patients report that it gives a natural-looking result.
A thread lift provides many of the benefits of a face lift, with fewer risks and a shorter recovery time. By seeking procedures like thread lifts when the first signs of aging have occurred, patients can take a proactive approach to aging, maintaining a desired appearance before advanced signs are visible.

Like all cosmetic procedures, thread lifts are not for everyone; and patients must have realistic expectations about what it can achieve. Ideal candidates for thread lifts include people who have minimal signs of aging and need just a little lift. If major signs of aging are apparent, then more traditional, surgical options may be the best way to achieve a more youthful appearance.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Suspension Sutures

Dear Dr. Man, My friend got her face done and mentioned that her plastic surgeon used suspension sutures as a part of her surgery. Can you please tell me more about these sutures? How do they work? I’m thinking about getting work done on my face (sagging)- how do I know if my doctor can use these sutures?

Suture suspension is a minimally invasive method where the soft tissue of your face is tightened and elevated using the properties of the suture to enhance and connect the skin. These suture threads are placed underneath the skin in various parts of the face such as the mid face, lower face, neck and sometimes forehead, depending on the work that needs to be done. Suspension sutures are used for repositioning sagging cheeks, lifting sagging eyebrows and adjusting asymmetric brows and face.

Suspension sutures are made from polypropylene threads, a material that has been used inside the human body as a suture material for decades, and are designed with tiny barbs that attach to the subdermal tissue, lifting, suspending and fixating.
Unlike conventional sutures, which are smooth, suspension sutures have tiny barbs or cogs that are spaced evenly apart. Once inserted under the skin, they are fixated in an umbrella-like fashion and with tension, which creates suspension that gently lifts sagging tissues of the brow and face.

The surrounding tissues act to hold the threads in place without the need for visible scars. For the mid-face procedure, the surgeon makes a tiny incision close to the ear, and the threads are advanced along the previously marked contours toward the chin and jaw line. This creates a firm hold on the underlying tissues without causing additional trauma. The barbs do the work of holding, by being fixated to tissue as they are softly contoured into place. Once in position, your body generates new collagen bundles that surround each thread to maintain the lifting effect. The exact placement of the threads will vary from patient to patient.

Procedures using suspension sutures are generally quick.. The length of time will depend on the number of threads used. A typical procedure usually takes about 60 minutes to perform. In most cases, there is minimal discomfort, bruising and swelling. Ice compresses are recommended for the first 24-48 hours. Patients can usually return to work or normal activities in a few days to one week. Usually only one procedure is needed to achieve the desired lifting effect.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Male Plastic Surgery

Dear Dr. Man, I’m a 63 year old recently divorced man. Everyone says I should get out on the dating scene, but I’m quite self-conscious of my appearance. I keep my body in pretty decent shape, but my face looks old. You always hear about women getting plastic surgery- what about men? What kinds of options do I have?

I see many male patients who express a desire to look younger due to dating again or to the competitive nature of their profession. Some men seek plastic surgery in order to get back into the dating scene, to look good for their spouses, or to simply look and feel better about themselves. Whatever the situation, there are many procedures available that are increasing in popularity among men. In fact, did you know that male plastic surgery comprises 15% of all plastic surgery cases in the United States?

The procedures used on men are similar to those used on women; however, there are many differences in the structure of a man’s body. For example, men’s skin tends to be thicker, and the facial area has more hair, which results in a greater blood supply. Therefore, there may be differences in the techniques used when treating men and women.

Some of the most commonly performed surgical procedures on men are nose re-shaping, eyelid surgery, liposuction, and hair transplant, just to name a few. To further enhance their appearance and confidence, men are seeking facelifts as well. The great thing about today’s surgical procedures is that current methods for plastic surgery now have a quicker recovery time, which means less down-time from work.

Non-surgical procedures are also quite common among males. Botox™ injections, skin rejuvenation, and general enhancement to the face with filler materials are just a few of the treatments that are popular among men today.

Speak to your medical doctor for a referral to a plastic surgeon. During your consultation, ask questions and make sure you feel comfortable with the surgeon. Your surgeon can educate you on available treatments, both surgical and non-surgical. You can then make an educated decision regarding your individual needs.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Earlobe Transfer

Dear Dr. Man, I'm getting an earlobe fat transfer next week. I am getting the fat from my abdomen from liposuction. What are the downfalls? Should I have the surgeon "save" some fat in case it does not take well enough?? Can he do that?? Thank you! -Karen

Dear Karen, The use of one’s own body fat is often considered the golden standard of fillers, since it uses your body’s own materials. The procedure you describe can usually be done with a local anesthetic. It involves taking fat from another area of the body (usually from the belly), and injecting it into the face and/or earlobes.

The procedure you described in your email works by plumping the earlobes. Most people are very satisfied with the results, making them look younger and more rejuvenated.

There is always a possibility that your body will absorb most of the injected fat. Therefore, your surgeon should save some fat for future injections. There will probably be a charge associated with re-injecting the fat at a later time. Make sure your surgeon has the equipment to safely store the fat for up to one year following your procedure.

Be sure to choose a board-certified plastic surgeon and discuss all of your treatment options. Best of luck to you.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Breast Reduction

Dear Dr. Man, I want a breast reduction. I’ve lived for 40+ years with extremely large breasts. I’m sick of being a EE. My back and shoulders always hurt. I’m sick of wearing big, ugly bras. I’m ready for a breast reduction. Can you please tell me more about this surgery and what I can expect? Is there scarring?

Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight, including back, neck, and shoulder pain. In addition, there may be other physical discomforts, such as bra straps leaving indentations in their shoulders. Large breasts can also make women feel embarrassed or self-conscious.

Breast reduction, also known as reduction mammoplasty, reduces disproportionate, oversized breasts by removing fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal of the surgery is to give the woman smaller, better-shaped breasts in proportion with the rest of her body. In most cases, breast reduction isn't performed until a woman's breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort.

Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. Luckily, modern surgical methods leave patients with incision lines that are only around the areola and up and down, eliminating the horizontal incision at the bottom of the breasts. These scars should fade with time and are usually covered by a bra or bathing suit. After surgery, you'll be wrapped in an elastic bandage or a surgical bra over gauze dressings. The bandages will be removed a day or two after surgery, though you'll continue wearing the surgical bra around the clock for several weeks, until the swelling and bruising subside. Although you may be up and about in a day or two, your breasts may still be tender occasionally for a couple of weeks. Most women can return to non-strenuous work and social activities in about two weeks.

The best candidates for this surgery are women who are mature enough to fully understand the procedure and have realistic expectations about the results. Every patient and every physician has a different view of what is a desirable size and shape for breasts. In your initial consultation, it's important to discuss your expectations frankly with your plastic surgeon, and to listen to his or her opinion. Breast reduction surgery helps get rid of the physical discomfort of large breasts, the body looks better proportioned, and clothes fit better. Chances are that, like most women, you'll be pleased with the results.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.