Latisse can help you grow your own lashes longer, thicker, and darker.  Results are measurable within 8 weeks, and Latisse has become the fastest-growing daily health and beauty treatment as a result!  Dr. Cambre and his staff are Certified Lash Experts.  Ask us about Latisse on your next visit, and receive a special discount when you purchase two treatment kits!

View the Latisse Video

Latisse Before and After Gallery

Cosmetic/Plastic Surgery

On behalf of all plastic surgeons, Dr. Cambre thanks all of you for your activism and vocal opposition which led to the defeat of this unfair proposed tax!

What is Facial resurfacing?

Many factors contribute to the development of facial wrinkles and damage to the skin. Aging, sun exposure, one’s genetic background and lifestyle, and other factors such as nutrition, smoking, and alcohol consumption, all play a role in the way our skin looks, causing it to appear thin, wrinkled, and dried-out. Blotchiness, pigmentation changes, and brown spots may occur as a result of oral contraceptives, pregnancy, or genetic factors. In some patients, a history of acne in adolescence may have left the skin rough and uneven. The aged, damaged appearance of the skin that results from these multiple factors over time can often be improved by skin resurfacing.

A number of techniques have been developed to accomplish the goal of a refreshed appearance of the skin. These include dermabrasion, chemical peel, and laser resurfacing techniques.

Am I A Good Candidate for Skin Resurfacing?

You may be a good candidate for skin resurfacing if you have one or more of the following conditions:

* wrinkled or sun-damaged facial skin which has lost it’s elasticity and firmness
* vertical wrinkles around the mouth, causing your lipstick to “bleed” into these lines
* “crow’s feet” at the corners of the eyes, or a “crinkled” appearance of the eyelid skin
* brown spots or blotchy, irregular skin coloring
* acne or chicken pox scars
* certain types of pre-cancerous rough skin growths
* old, superficial scars from previous injuries or stitches

Patients with these characteristics are candidates for a skin resurfacing procedure, which can be done at any age. Because each patient’s skin condition, genetic background, and risk factor profile is unique, not every technique is applicable in all cases. Patients who are currently taking Accutane”, Retin-A”, or other topical skin treatments, those who have previously had resurfacing procedures, or those with active skin infections involving the areas to be treated may not be good candidates. Generally, treatments which are more superficial will require less time for healing, however the results may not be as long-lasting. In such cases, the procedure may need to be repeated at a later date in order to maintain the same type of result as might be expected from a deeper, more extensive treatment. Dr. Cambre will help you to determine which Skin Resurfacing procedure is right for you.

Are there Alternatives to Skin Resurfacing?

Realistic expectations are important. Not all skin flaws will be removed by skin resurfacing, and the skin will continue to age. Lines which are the result of normal facial muscle activity – smiling, laughing, squinting, etc. – will naturally recur over time. Other measures, such as Injectable Fillers (Collagen, Restylane, Radiance, etc.) or Botox treatments, may be required for heavier lines, or those caused by excessive muscle activity in certain locations on the face. In some cases, excessive laxity of skin cannot possibly be tightened sufficiently by skin resurfacing, and other facial rejuvenation procedures, such as Facelift, Brow Lift, or Blepharoplasty (Eyelid Lift) are necessary, to help you achieve the results you desire.

What should I know about The Risks of Facial Resurfacing?

All skin resurfacing techniques carry some risk of complications, although such complications are infrequent and usually minor. However, because of individual patient variables in existing skin conditions, wound healing characteristics, nutrition, lifestyle, etc., the risks are not always predictable. Minor complications include the development of tiny whiteheads (milia) due to skin irritation during healing. These may require a minor treatment for removal, or the use of an abrasive skin cleanser. The skin may be temporarily more sensitive to drying or cracking, and may require the use of moisturizers. Patients who suffer from cold sores may experience a flare-up of this condition following resurfacing. Some treatments (especially phenol peels) may produce a bleaching effect on the skin, but other types of resurfacing treatments may cause unanticipated color changes or skin blotchiness. Rarely, raised or thickened scars may occur, which may be permanent.

Laser Skin Resurfacing

Of the various techniques for skin resurfacing, the use of the laser for this purpose is the most recent development. Dr. Cambre uses one of the newest lasers, the Ultrapulse carbon dioxide (CO2) laser, to treat sun-damaged skin, facial wrinkles, and scars.

What is a LASER?

The word “laser” is an acronym, which stands for Light Amplification by the Stimulated Emission of Radiation. A surgical laser, such as the CO2 laser, produces a beam of light capable of sequentially removing unwanted tissue, such as scarred, lined, wrinkled, and otherwise imperfect skin. The laser vaporizes skin cells by emitting bursts of high-energy photons (light particles) that are absorbed by water in these cells. Laser light penetrates to a precise depth which can be controlled and adjusted depending upon the chosen energy setting. This makes the procedure safe and predictable, while reducing the risk of scarring or pigmentation problems. Laser skin resurfacing is performed on an outpatient basis under light sedation or general anesthesia. Laser resurfacing may also be combined with other aesthetic surgical procedures. As a result of this treatment, you are left with fresher, firmer, smoother-looking skin.

What Areas Can Be Treated With Laser Resurfacing?

The laser is used to reduce fine wrinkles, acne scars, and other minor skin imperfections, especially around the mouth and eyes. It can improve blotchy, sun-damaged and acne scarred skin, problems that often cause concern to both men and women. The entire face and eyelid areas can be treated, and patients with a variety of complexion types, including darker skin, can also be treated.

What are the Benefits of, and Alternatives to, Laser Resurfacing Treatment?

Laser resurfacing is an alternative to other techniques of Skin Resurfacing such as chemical peel and dermabrasion. The benefits of the laser technique may include less pain and a faster recovery time. There is somewhat less likelihood of bleaching of the skin with the laser technique than with Phenol peels. Patients may also notice improvement in areas of facial pigmentation irregularity. In many cases, there is a mild “tightening” effect on the skin, which is especially useful in the lower eyelid areas.

Before Your Laser Resurfacing

Prior to your laser resurfacing Dr. Cambre will discuss your goals for improvement of the facial skin. The skin is usually pre-treated with Retin-A, Glycolic Acid products, or pigmentation lighteners before surgery, to improve the healing time.

The Laser Resurfacing Procedure

A local anesthetic is given to ensure that you are comfortable throughout the procedure. General anesthesia or sedation is usually advised, to avoid discomfort in areas that may not be completely numbed by the local anesthetic. Dr. Cambre directs the laser beam toward your skin imperfections. The laser quickly and accurately vaporizes the outermost layers of skin with each pass. Each area may be treated more than once in order to achieve optimal tightening and removal of imperfections. Treatment may be directed to specific areas (e.g., around the eyes and/or around the mouth) or to the entire face. If the eyelids are to be treated, special metal shields will be used to protect the corneas. At the completion of the procedure, a light ointment is applied to the treated skin areas, to facilitate healing and to provide comfort.

Your New Look

In most cases, only one treatment session is needed. After approximately a week to ten days, the new skin surface growth will be complete. The initial redness of the skin fades in a few weeks to a light pink, which can be concealed with makeup. The discoloration usually disappears in two to three months. The goal of laser resurfacing is to improve the appearance of the facial skin. Results of the surgery depend on many factors such as your hereditary skin type and quality, your age, sun exposure, and overall health habits. Expectations by the patient must be realistic, and results should be anticipated as improvement rather than total correction of the quality of the skin.

Dr. Cambre will continue to monitor your progress and work with you to arrange a program of healthy lifestyle, skin care, and periodic maintenance procedures to enhance the longevity of your result, and to keep you looking your best following your Laser Resurfacing procedure.

Chemical Peels

Chemical peel is helpful for wrinkles, light acne scarring, and irregular pigmentation such as freckles and age spots. It is meant to diminish imperfections by peeling away the skin’s top layers. Chemical peels vary according to their specific ingredients and their strength. Depth of peeling action may also depend on factors such as how long solutions remain on the skin and whether they are lightly applied, or more heavily or vigorously applied. Pre-cancerous conditions such as keratoses (thick, rough, reddish growths) also respond well to this procedure.

There are several types of chemical peels:

Alpha Hydroxy Acid (AHA) peels are the lightest type of chemical peel. They are derived from purified forms of a number of naturally-occurring biological acids, such as glycolic (apple) and lactic (milk) acids. The concentrations (strengths) of these acids can be varied, and they can be applied at weekly or longer intervals in order to achieve the desired effect.

What Are the Benefits of AHA Peels?

* No anesthesia or sedation is needed. Usually, patients experience only a mild tingling or stinging sensation when the solution is applied.
* Sometimes a single treatment will give skin a healthier, radiant look.
* No downtime–patients can immediately resume normal activities.
* AHA’s can be mixed with a facial cream or wash in milder concentrations as part of a daily skin-care regimen.

Generally, AHA peels may require multiple treatments in order to maintain their beneficial effects.

Tri-Chloro-acetic Acid (TCA) peels are an intermediate-strength chemical peel. TCA generally penetrates to a deeper level than AHA peels, and has a longer-lasting effect.

What Are the Benefits of TCA Peels?

* TCA is especially effective in treating darker-skinned patients.
* TCA can sometimes be used to achieve some effects of a deep peel, depending on the concentration and manner of application. Recovery time is generally shorter than with a deep (phenol) peel.

TCA peels may require pretreatment with AHA or Retin-A creams. Often, repeat treatment may be required in order to maintain the beneficial effects. Deeper TCA peel may require up to 10 days for sloughing and healing of the peeled skin to occur, prior to the use of camouflage cosmetics, or scheduling of social engagements.

Phenol peels are the strongest form of chemical peel. Phenol peeling is reserved for individuals with deep wrinkles from sun exposure or is used to treat skin wrinkling around the lips and chin area, and in sun-damaged, unevenly pigmented, or coarsely wrinkled facial areas.

What Are the Benefits of Phenol Peels?

* Effects of a phenol chemical peel are long lasting, and in some cases are still readily apparent up to 20 years following the procedure. Improvements in the patient’s skin can be quite dramatic.
* Normal work schedule and other activities can be resumed after 1 to 2 weeks.
* Variants in the phenol peel formula can create a milder solution for broader use.

Possible postoperative complications can include scarring, infection or abnormal pigmentation. Phenol tends to have a bleaching effect, and a patient may need to wear make-up to blend treated and untreated areas. While AHA and TCA peels can often be done in the office, Phenol peels are a major procedure that must be done in an outpatient surgery center setting, with EKG monitoring. Phenol cannot be used on the neck or other parts of the patient’s body.

Chemical peels are generally not as effective in treating individuals with dark, oily complexions. Some facial skin disorders do not respond to chemical peeling. Skin pores may appear larger, and the skin may not tan properly in some cases, after a chemical peel. Patients with a previous history of Herpes Zoster or cold sores may be prone to re-activation of the virus. All forms of deep skin peels include the risk of delayed healing and scarring. Before Your Chemical Peel

Dr. Cambre will discuss with you your goals for the chemical peel process. In some cases, Dr. Cambre will choose to perform a small “test” patch of the chemical peel in an inconspicuous area of the forehead or behind the ear, to be certain that the chosen technique is compatible with your skin type, before treating the entire face or target area. Dr. Cambre may also suggest the use of bleaching agents or light peeling treatments in order to enhance your outcome or to speed your recovery after the peel.

The Chemical Peel Procedure

Dr. Cambre will select the best chemical or chemical mix for the individual characteristics of your skin, after fully discussing with you the options and alternatives, and your desires. The chosen solution is applied–using a sponge, cotton pad, cotton swab or brush–to the areas to be treated. This may take only a few minutes for the lighter AHA or TCA peels, and can typically be accomplished without anesthesia. For the deeper Phenol peels, you will usually require general anesthesia, and the procedure will take from one to two hours to complete. After the lighter peels, there is often no need for dressings or ointment to be applied to the skin. For the deeper Phenol peels, Dr. Cambre will typically cover your skin with an occlusive ointment. In the case of severe wrinkles around the mouth and eyes, Dr. Cambre may also apply a tape mask to enhance the penetration of the peel. This mask will be removed in about two days after your peel, under a light anesthetic.

Your New Look After a Facial Resurfacing Chemical Peel

The lighter peels can be accomplished with minimal or no “down-time”. In most cases, there is a slight flaking and mild redness of the skin, which may also seem slightly dryer. The amount of improvement varies and depends upon the initial condition of the patient’s skin. Significant improvement of damaged skin can be achieved, which can produce dramatic results.

Non-Surgical Skin Rejuvenation

A skin rejuvenation program is often used in conjunction with either chemical peels or laser wrinkle removal to reduce the fine wrinkles of the face, to lighten areas of hyperpigmentation, and to produce a softer texture to the skin. The program can be carried out separately or in conjunction with the other surgical facial rejuvenation or skin resurfacing procedures listed here. After a consultation establishment of a treatment plan for your cosmetic needs, Dr. Cambre will recommend skin care products you can use at home on an ongoing basis, to maintain your new look.

We invite you to inquire about laser skin resurfacing, chemical peels, microdermabrasion, and daily home skin care regimens, and hope it can help you achieve smoother, fresher, younger-looking skin.

What are Injectable Fillers?
A variety of materials have been employed over the years in an effort to fill unwanted lines or to plump thin lips. Some of these materials have also been used to treat depressed scars due to chicken pox or other trauma to the skin. A brief summary of these materials is as follows:

COLLAGEN

Collagen is a generic term for the protein matrix which forms the structural protein lattice of connective tissues like the dermis layer of the skin.

ZYDERM 1 and ZYDERM 2 Collagen is bovine-derived collagen used to treat fine to moderate lines, wrinkles, and scars. ZYPLAST Collagen is bovine-derived collagen which is chemically stabilized, to be used in deeper lines and wrinkles and thicker skin areas. These are the original forms of injectable collagen, which have an excellent safety and patient satisfaction record in over 1.5 million patients over the last three decades. Although allergic reactions are rare, skin testing must be done at least four weeks before the initial therapeutic injection in order to insure that there is no allergic response.

COSMODERM Collagen is human-derived collagen used to treat superficial lines. COSMOPLAST Collagen is cross-linked human-derived collagen used to treat deeper lines and wrinkles in thicker-skinned areas. COSMODERM and COSMOPLAST Collagen is grown in the laboratory under carefully-controlled conditions from non-cadaver human dermal fibroblasts, using the same tissue engineering techniques originally developed to create products used to treat burns and other wounds. Because the material is human in origin, skin testing is not required prior to first use.  With the development of longer-lasting and more stable injectable fillers that are less subject to re-absorption, Collagen-based fillers have fallen out of favor and are no longer the first-line treatment.

Allergan will be discontinuing the production of bovine (Zyderm/Zyplast) and human (Cosmoderm/Cosmoplast) collagen products in 2010.

HYALURONIC ACID is a polysaccharide / glycosaminoglycan that is identical in all species and tissue types. It plays an important role in giving volume to the skin, shape to the eyes and elasticity to the joints. There are numerous product lines in the Hyaluronic Acid family from multiple manufacturers, but they share similar characteristics and differ in terms of concentration and/or the inclusion of local anesthetics.

RADIESSE

The injectable material RADIESSE is comprised of 30% Calcium Hydroxylapaptite (CaHA) bio-ceramic particles 25-45µ in diameter, identical in composition to the mineral portion of human bone and teeth, suspended in an 70% aqueous gel carrier (carboxy methylcellulose), making it exceptionally compatible with the human body. Calcium hyroxylapaptite (CaHA) has been used for decades in plastic and reconstructive surgery, orthopedics, otology, otolaryngology, neurosurgery, dentistry, maxillofacial surgery, and urology. Once injected, the gel carrier provides the matrix within which cellular infiltration can occur. RADIESSE is indicated for treatment of deep lines and wrinkles including the nasolabial folds and marionette lines, and can also be used to add volume to the cheek bones and jaw line, as well as the back of the hands.  It is a long-lasting filler that is not indicated for use in the lips.  Over time, the calcium hydroxylapatite is degraded to calcium and phosphate and absorbed by the body.

AUTOLOGOUS FAT

Your own fat, harvested through liposuction, can be re-injected into unwanted lines and areas of soft tissue deficiency. This has the advantage of utilizing your own tissue as a filling material, eliminating the concern of allergic reactions to foreign material. The procedure can make use of a portion of the fat that would otherwise be discarded after a standard liposuction or body contouring procedure, or small amounts of fat for transfer can be harvested from an inconspicuous area as an independent procedure.

How do Injectable Fillers Work?

Botox injection is performed without anesthesia because it is virtually painless. The injections are made using an ultra-fine needle placed directly into the muscles responsible for the unwanted expression lines. The wrinkle-reducing effects are not permanent, and injections may need to be repeated three to four times per year to maintain the improvement. Research has suggested, however, that long-term use of the injections leads to a longer duration of effect, although some patients may develop a tolerance or partial immunity to the effects of Botox over time. Patients over the age of 65 may not experience such dramatic results, and, because each patient is unique, the degree or completeness of results may vary. Botox is only useful in treating expression lines and cannot be used to repair sagging skin caused by aging (see Facelift, Brow Lift, Blepharo plasty).

Are Injectable Fillers Right For Me?

BOTOX is a medically-purified form of a natural bacterial protein (Botulinum Toxin ) which has been known for centuries to produce muscle paralysis. The therapeutic use of Botox is a recent development, beginning in approximately 1980 with the use of the medication to treat certain conditions involving the eye muscles. It was discovered that certain wrinkle lines were temporarily eliminated when the Botox treatment spread to involve the muscles which cause the wrinkles. Many surgeons and dermatologists began treating unwanted lines and wrinkles in their patients by injecting Botox into the tiny facial muscles that create wrinkles, producing a temporary cosmetic paralysis of these muscles, which eliminates the ability of these muscles to contract and produce wrinkles. Botox gained FDA approval for use in the treatment of unwanted wrinkles in the glabella (the frown lines between the eyebrows) in April, 2002. It is also commonly used “off-label” (without FDA approval) to treat “crow’s feet” wrinkles at the corners of the eyes, horizontal forehead wrinkles, tight muscle bands in the neck, and even migraine headaches due to muscle hyperactivity.

The Procedure

In the forehead area, Brow Lift with surgical division of the procerus and corrugator muscles responsible for the unwanted frown lines may provide permanent correction of the unwanted muscular activity producing these frown lines, eliminating or reducing the need for Botox treatments. Similarly, division of the platysma muscle bands in the neck may relieve the appearance of tight cords in the neck which are sometimes effectively treated with Botox. Other molecular variants of Botox are being developed, in the hope of longer duration of effectiveness, or as alternatives for use in treating patients who may develop resistance to the toxin over time.

Alternatives to Injectable Fillers ?

Botulinum Toxin (Botox) works by binding to the nerve endings, preventing the release of the chemical transmitters that activate the muscles. Blockage of these transmitter signals from the nerves to the muscles results in diminished or absent activity in the affected muscles, preventing them from contracting.

The risks of Injectable Fillers

Possible delayed side effects are temporary weakness of nearby muscles; in rare cases, eyelid drooping may occur, or patients may develop headache or flu-like symptoms. Since the wrinkle-reducing muscle paralysis effect of Botox is completely reversible with the passage of time, any side effect is only a temporary condition. Rarely, patients may develop an immunity or tolerance to Botox, and the treatments may become less effective. Dr. Cambre will explain all potential associated risks at the time of your consultation.

Your new look after Injectable Fillers?

As with any other medical and cosmetic surgical procedure, careful patient selection is important. You may be a good candidate for Botox treatment if you have any of the following conditions:

* Moderate to deep vertical or oblique lines between the eyebrows
* Moderate to deep transverse or horizontal lines in the forehead
* Deep “crow’s feet” in the lateral eyelid area
* Certain types of muscle tension headaches caused by spasm of the forehead muscles

Botox treatment may not be appropriate for you if you are pregnant or nursing, if you have certain neuromuscular diseases, or if you are taking certain medications (aspirin or anticoagulants, aminoglycoside antibiotics, quinine, or calcium channel blockers). You should understand that the treatments provide temporary effects, and that Botox is not a substitute for surgical facial and forehead rejuvenation.

Frequently asked questions about Injectable Fillers

The wrinkle-reducing action of Botox on the treated areas requires several days before fully taking effect. Voluntary and involuntary activation of the muscles in the treated areas will gradually diminish and disappear after a few days to a week, and you will notice that muscular activity in the treated areas will gradually return generally within two to three months. To maintain your result, we recommend a repeat treatment at that time. Second and subsequent injections may have a longer duration of effectiveness. Immediately after the injection, patients may experience slight bruising or temporary pain around the injection area that quickly fades. Normal activities can be performed immediately after leaving the office.

Introduction
Facial wrinkles and lines of expression are the result of repetitive folding and creasing of the skin caused by activity of the muscles of facial expression. In many cases, these muscles may become hyperactive, leading to unwanted lines in the forehead area which may make us appear angry, or producing “crow’s feet” at the corners of the eyes, which may make us appear prematurely aged. In some areas, the preferred treatment may involve the use of an injectable filling material (Collagen, Restylane, Radiance, etc.) to plump up the line; in other cases, elimination of the unwanted muscle activity may result in improvement of the unwanted line.

What is BOTOX®

BOTOX® is a medically-purified form of a natural bacterial protein (Botulinum Toxin ) which has been known for centuries to produce muscle paralysis. The therapeutic use of BOTOX® is a recent development, beginning in approximately 1980 with the use of the medication to treat certain conditions involving the eye muscles. It was discovered that certain wrinkle lines were temporarily eliminated when the BOTOX® treatment spread to involve the muscles which cause the wrinkles. Many surgeons and dermatologists began treating unwanted lines and wrinkles in their patients by injecting BOTOX® into the tiny facial muscles that create wrinkles, producing a temporary cosmetic paralysis of these muscles, which eliminates the ability of these muscles to contract and produce wrinkles. BOTOX® gained FDA approval for use in the treatment of unwanted wrinkles in the glabella (the frown lines between the eyebrows) in April, 2002. It is also commonly used “off-label” (without FDA approval) to treat “crow’s feet” wrinkles at the corners of the eyes, horizontal forehead wrinkles, tight muscle bands in the neck, and even migraine headaches due to muscle hyperactivity.

What should I know about the risks of BOTOX®?

Possible delayed side effects are temporary weakness of nearby muscles; in rare cases, eyelid drooping may occur, or patients may develop headache or flu-like symptoms. Since the wrinkle-reducing muscle paralysis effect of BOTOX® is completely reversible with the passage of time, any side effect is only a temporary condition. Rarely, patients may develop an immunity or tolerance to BOTOX®, and the treatments may become less effective. Dr. Cambre will explain all potential associated risks at the time of your consultation.

How does BOTOX® work ?

Botulinum Toxin (BOTOX®) works by binding to the nerve endings, preventing the release of the chemical transmitters that activate the muscles. Blockage of these transmitter signals from the nerves to the muscles results in diminished or absent activity in the affected muscles, preventing them from contracting.

What to expect after your BOTOX® Procedure

The wrinkle-reducing action of BOTOX® on the treated areas requires several days before fully taking effect. Voluntary and involuntary activation of the muscles in the treated areas will gradually diminish and disappear after a few days to a week, and you will notice that muscular activity in the treated areas will gradually return generally within two to three months. To maintain your result, we recommend a repeat treatment at that time. Second and subsequent injections may have a longer duration of effectiveness. Immediately after the injection, patients may experience slight bruising or temporary pain around the injection area that quickly fades. Normal activities can be performed immediately after leaving the office.

Am I a good candidate for BOTOX® Treatment?

As with any other medical and cosmetic surgical procedure, careful patient selection is important. You may be a good candidate for BOTOX® treatment if you have any of the following conditions:

* Moderate to deep vertical or oblique lines between the eyebrows
* Moderate to deep transverse or horizontal lines in the forehead
* Deep “crow’s feet” in the lateral eyelid area
* Certain types of muscle tension headaches caused by spasm of the forehead muscles

BOTOX® treatment may not be appropriate for you if you are pregnant or nursing, if you have certain neuromuscular diseases, or if you are taking certain medications (aspirin or anticoagulants, aminoglycoside antibiotics, quinine, or calcium channel blockers). You should understand that the treatments provide temporary effects, and that BOTOX® is not a substitute for surgical facial and forehead rejuvenation.

Your New Look After BOTOX® Treatment

In combination with a program of regular skin care, our patients find BOTOX® treatments to be an effective way to maintain a youthful facial appearance. By eliminating the facial lines we associate with stress and fatigue, BOTOX® treatment is another secret weapon we can employ to ward off the signs of aging.

Dr. Cambre is committed to helping you to maintain the best possible results of BOTOX® treatment and all other facial rejuvenation and cosmetic surgery procedures, in order to keep you looking your best.

The BOTOX® Procedure

BOTOX® injection is performed without anesthesia because it is virtually painless. The injections are made using an ultra-fine needle placed directly into the muscles responsible for the unwanted expression lines. The wrinkle-reducing effects are not permanent, and injections may need to be repeated three to four times per year to maintain the improvement. Research has suggested, however, that long-term use of the injections leads to a longer duration of effect, although some patients may develop a tolerance or partial immunity to the effects of BOTOX® over time. Patients over the age of 65 may not experience such dramatic results, and, because each patient is unique, the degree or completeness of results may vary. BOTOX® is only useful in treating expression lines and cannot be used to repair sagging skin caused by aging (see Facelift, Brow Lift, Blepharoplasty).

Are there alternatives to BOTOX®?

In the forehead area, Brow Lift with surgical division of the procerus and corrugator muscles responsible for the unwanted frown lines may provide permanent correction of the unwanted muscular activity producing these frown lines, eliminating or reducing the need for BOTOX® treatments. Similarly, division of the platysma muscle bands in the neck may relieve the appearance of tight cords in the neck which are sometimes effectively treated with BOTOX®. Other molecular variants of BOTOX® are being developed, in the hope of longer duration of effectiveness, or as alternatives for use in treating patients who may develop resistance to the toxin over time.

Frequently-Asked Questions About BOTOX®

Q: Can I use BOTOX® to treat the lines around my mouth?
A: No. Generally, BOTOX® is used only to treat muscular activity producing unwanted lines of facial expression. Since the lines around the mouth are a natural result of normal activities, such as talking, smiling, laughing, etc., these muscle actions should not be paralyzed.

Q: Can BOTOX® cure my headaches?
A: Certain types of headaches due to excessive forehead and facial muscle tension may be reduced or relieved by BOTOX® treatment. The exact mechanism of action is unknown.

Q: Will my insurance carrier cover my BOTOX® treatments?
A: Except in rare cases, BOTOX® treatments are generally not covered by insurance without documentation of necessity by your neurologist or internist, and even with such documentation, the treatments are frequently denied as cosmetic in nature. If you wish to seek reimbursement from your carrier, our office will provide you with the necessary documentation.

Q: Can BOTOX® be used in other areas?
A: There is some evidence that BOTOX® treatments may provide temporary relief of hyperhidrosis (excessive sweating) in the palm of the hand or armpit areas. Insurance coverage may apply in these cases, if your primary physician can provide appropriate documentation. Treatment of these areas frequently requires larger quantities of the BOTOX® material than does treatment of unwanted wrinkles in the forehead or crow’s foot areas, and the cost of treatment is therefore greater. BOTOX® may also be used in some cases to treat tight muscular bands or cords in the neck area.

Q: Will my lines get worse if I stop using BOTOX®?
A: No. Your lines will gradually return to their appearance before you began treatment.

What Is Body Lift?

Body lifts are plastic surgery procedures intended to shape and tone the abdomen, buttocks, thighs and breasts.

Body lifts can be used to treat excess skin, cellulite and sagging fatty tissue, meaning the procedure may be performed on people who have sustained massive weight loss after bariatric surgery such as gastric bypass or Lap Band. In addition, these surgeries can help mothers get their pre-pregnancy bodies back.

What Is Abominoplasty?

A flat and trim abdomen is one of the essential features we identify with youthful good health and physical fitness. Flabby, loose skin and a bulging abdomen may make it difficult to wear certain types of clothing items we favor, and may make us self-conscious about revealing our bodies at the beach or in the gym, or even to our spouses or partners.

Abdominoplasty, or “Tummy Tuck,” is designed to firm and smooth your abdomen. Many times, a protruding abdomen is the result of weak abdominal muscles, or repetitive cycles of weight gain followed by weight loss. Occasionally, there is an inherited familial pattern of localized abdominal obesity, while the rest of the body contours are normal. Often, the culprit is pregnancy, which may also cause the skin to lose its elasticity as well as causing the abdominal muscles to weaken and separate. This type of laxity of the abdominal wall generally will not improve solely as a result of greater attention to diet or exercise if the skin and underlying muscles have been overly stretched and weakened, and their resilience has been pushed beyond the point of recovery. Many patients are discouraged by their lack of progress or improvement in their body contours, often in spite of rigorous regimens of diet and exercise, which never seems to translate to visible improvement.

Abdominoplasty corrects the underlying conditions contributing to this problem by removing excess abdominal skin, reducing fat below the skin and tightening the muscles of the abdominal wall, if necessary. Often, old unsightly scars from C-section or appendectomy, and stretch marks of the lower abdomen can be removed as well. The result is a more youthful, firmer and flatter abdominal contour.

Realistic expectations are important. Abdominoplasty is not a substitute for weight loss. In some cases, we recommend enrollment of our patients in a medically-supervised weight management program, and often we recommend our patients to consult with a nutritionist or registered dietitian for initiation and long-term maintenance of healthy eating habits and weight stability.

Am I A Candidate?

Both women and men who have excess fat and loose skin of the abdomen can benefit from Abdominoplasty. Dr. Cambre carefully considers age, obesity and overall health when evaluating a candidate for this procedure. The best candidates are healthy and physically fit patients who have maintained a stable body weight near their ideal goal, with a disciplined program of diet and exercise. You may be a good candidate for Abdominoplasty if you have one or more of the following conditions:

• Excess or sagging abdominal skin
• An abdomen that protrudes and is out of proportion to the rest of your body
• Abdominal muscles that have been separated and weakened by pregnancy or weight gain
• Excess fatty tissue that is concentrated in your abdomen

Smokers, diabetics, and patients with uncontrolled obesity are poor candidates. Women should be relatively certain that they will not become pregnant in the future. For qualified patients, Abdominoplasty can provide a dramatic improvement in physical appearance and general sense of well-being. There is often an increased exercise tolerance, along with an alteration in available styles of dress and clothing, and a motivation to maintain the outward improvement in body shape, with healthier lifestyle and dietary choices.

The Abdominoplasty can sometimes be combined with other procedures, such as hysterectomy or bladder suspension.

Your Consultation

Dr. Cambre will take a complete medical history and conduct a careful examination to evaluate your overall health. Ideally, the Abdominoplasty patient has no health problems, and wishes only to remove an excess deposit of fat or loose abdominal skin. Patients on a personal or medically-supervised weight-loss plan should be relatively close to their target weight before having the operation. Women planning future pregnancies should delay Abdominoplasty, as pregnancy may cause further abdominal stretching.

Photographs will be taken before and after surgery.

Antibiotics will be prescribed at the time of surgery to prevent infection. To minimize the possibility of excess bleeding, you should avoid taking drugs containing aspirin. You may also be advised to shower with an antiseptic soap on the night before or morning of your surgery.

The Procedure

Abdominoplasty is generally carried out in an accredited outpatient surgical facility, or on occasion, in a hospital setting. The procedure is done under general anesthesia. You may be given a sedative medication beforehand so you will feel relaxed. The surgery generally takes 3 to 4 hours, depending on the individual circumstance, and whether other additional procedures are planned in conjunction. Patients usually spend the night of surgery in an aftercare facility; alternatively, patients may be discharged to their own home under the care and supervision of a private-duty nurse or a responsible adult caregiver.

The procedure is most commonly performed by making a gently-curving incision extending for a variable length between both hip bones and above the pubic area, hidden in the bikini line. The length of this incision depends upon the amount of excess skin requiring removal. A second (circular) incision is generally made around the navel (umbilicus). The skin is lifted from the abdominal wall and elevated up to the ribs, revealing the abdominal muscle. Loose, separated muscles are tightened with sutures, and any abdominal hernias are repaired. This results in a firmer abdominal wall and narrower waistline. The skin is re-draped and tightened over the abdomen, the excess skin and fat are trimmed and removed, and the navel is restored to its normal location through a new incision in the abdominal skin. Existing stretch marks in the lower abdomen are often removed in the process, and any remaining stretch marks tend to be flattened and improved. The incisions are then carefully closed with hidden sutures and surgical tape. Temporary suction drains are inserted to eliminate fluid buildup, and firm elastic bandages or a surgical girdle are applied to the area to limit swelling and bruising.

Options and Alternatives

There are several variations of the standard technique of Abdominoplasty, which Dr. Cambre will discuss with you, if appropriate to your condition. These include “mini” or partial Abdominoplasty, in which there is no incision around the umbilicus. This more limited procedure is reserved for patients with minimal loose skin and excess fat deposits located primarily below the umbilicus. For some patients with excessive and lax skin of the flanks and hips in addition to the abdomen, a more extensive procedure such as Belt Lipectomy or Lower Body Lift may be required in order to achieve the best results. Occasionally, Liposuction alone may be used in circumstances where there is good skin elasticity and localized excess fat only. More often, Liposuction (suction lipectomy) is used in conjunction with either mini- or full Abdominoplasty procedures, to remove additional unwanted fat deposits, and to improve the overall contours of the waistline, hips, and thighs.

Risks

Anyone considering surgery should be aware of both the benefits and risks. Fortunately, significant complications from Abdominoplasty are infrequent, and patients are generally gratified with the results.

Potential risks of Abdominoplasty include bleeding, infection, and reactions to anesthesia. There may occasionally be tissue loss and delayed wound healing along portions of the horizontal incision, especially in cases where the procedure has been extensive, or in smokers and diabetic patients. Patients are encouraged to walk as much as possible in the first few days after surgery, to avoid the possibility of pneumonia or of blood clots forming in the leg veins. There may be an accumulation of serum fluid beneath the abdominal skin, requiring prolonged drainage. All scars will be permanent, although they are expected to fade over time. Rarely, the scars will require revision involving a subsequent procedure if they have healed poorly, or additional contour-correction procedures (dog-ear excision or liposuction) may be required to achieve optimal results.

It is not possible to list or anticipate every conceivable complication. However, most risks can be lessened and managed by carefully following the recommendations and instructions provided to you by Dr. Cambre during your consultation. Dr. Cambre will address any of your personal questions or concerns at that time as well.

Recovery

You will awaken gently from anesthesia in the recovery room, usually free of nausea or pain. Mild discomfort is usually well-controlled with pain medication. When you are fully awake, you will be ready for transfer to the aftercare facility, or to your home with a responsible adult caregiver. You will be encouraged to get out of bed for short walks to promote circulation and to facilitate deep breathing. Although you may not be able to stand up completely straight, it is best if you do not lie in bed or sit for long periods of time during the first several days. A mild amount of swelling and bruising is normal. You will also be required to wear a support garment or girdle, to limit swelling and fluid accumulation. You may be instructed to sleep on your back with a pillow under your knees. Dr. Cambre will see you in the office 24-48 hours after surgery. You will be given special instructions for showering and changing your dressings until the drains are removed, generally 7 to 10 days after surgery. Sutures are removed in stages over the period of 5 to 14 days.

The speed of recovery depends on your physical condition prior to surgery; those with stronger abdominal muscles usually recover faster. Straining, bending, and lifting must be avoided, since these activities might cause increased swelling, bleeding, or disruption of the surgical repair. Allow yourself at least 1 to 2 weeks to recuperate before returning to non-strenuous work; sexual activity should be avoided for a minimum of two weeks. Most patients may resume light to moderate exercise 3 to 4 weeks after surgery. You may experience prolonged numbness over portions of the abdominal area, which may persist for several months. The incisions may remain red or pink for many months following surgery before they finally begin to fade. It may take several weeks for all the swelling to subside to the point that the final results of your improved abdominal contour can be appreciated.

Your New Look

Though the recovery period may be somewhat longer than that of other cosmetic procedures, Abdominoplasty provides significant and lasting rewards for a patient previously distressed by a protruding, sagging abdomen. Although the incision lines are permanent, they will fade over time. The incisions generally are well hidden in natural skin folds, and are covered by most common undergarments and swim wear. Unless you gain or lose a significant amount of weight or become pregnant, your abdomen should remain firmer and flatter for many years.

Our patients after Abdominoplasty generally feel more confident about their appearance, both in and out of clothing. As an added benefit, most patients will have a greater variety of choices as to the types and styles of clothing they feel comfortable wearing, following Abdominoplasty. Our patients who follow a proper exercise routine and healthy diet, and who dedicate themselves to maintaining the results we achieve with surgery, will benefit the most from Abdominoplasty.

Frequently Asked Questions

Q: Why are drains necessary?

A: Suction drains are used in combination with external pressure from an elastic abdominal binder or girdle, in order to evacuate the fluid (serum and blood) that commonly accumulates between the abdominal wall and the underside of the tightened abdominal skin and fat after the procedure. By eliminating the fluid build-up, the drains help the skin to re-attach to the abdominal wall.

Q: How long will my drains remain in place?

A: Drains (usually two) will remain in place until the daily volume of drainage decreases to a minimum, generally between 5 days and two weeks.

Q: When can I shower or bathe?

A: You may shower after the first office visit / dressing change, generally within 24-48 hours after surgery. You must not bathe or immerse the incisions or drain sites under water in a bathtub, hot tub, swimming pool, etc. until all drains have been removed and the incisions are completely healed. Dr. Cambre will instruct you when bathing is permitted.

Q: How long do I need to wear the binder or girdle?

A: The binder or girdle is used to diminish the amount of swelling and bruising in the abdominal area, especially after Liposuction in combination with Abdominoplasty. It also prevents accumulation of excess fluid (serum or blood) under the abdominal skin, and helps to maintain the contour of your new abdomen. It should be worn continuously, 24 hours a day, 7 days a week (except while showering) for the first 3-4 weeks. After that time, it can generally be used for support and comfort during the daytime only, for an additional 3 weeks.

Q: When can I resume exercise?

A: Patients are encouraged to begin walking immediately after surgery. You may resume more strenuous walking on a treadmill, or mild upper extremity weight training after 7-10 days. Most patients resume full, unrestricted exercise after approximately 4 weeks.

Q: When can I resume driving?

A: Most patients may resume driving after approximately 48-72 hours. You should not drive if you are taking narcotic pain medication, sedatives, or muscle relaxants.

Q: When can I return to work or normal social activities?

A: Most patients are able to return to work or resume normal social activities after 5 to 10 days. If your work involves sitting for extended periods, you are encouraged to take frequent breaks to stand and walk, in order to promote circulation and deep breathing. You will need to wear loose-fitting clothing which will hide the presence of your drains and abdominal binder or girdle, as long as these are necessary.

Q: What would happen if I become pregnant after Abdominoplasty?

A: Your skin and abdominal wall will stretch to accommodate your pregnancy. However, you may require an additional surgery to regain the improvement, if the skin becomes lax again.

Q: Does insurance ever pay for Abdominoplasty?

A: Abdominoplasty is usually considered a cosmetic procedure; therefore it is not covered by insurance. However, if significant spreading of the abdominal wall muscles or a hernia is present, a portion of the surgicenter and professional fees may be eligible for reimbursement.

Q: Is there a greater risk if I am a smoker?

A: Abdominoplasty patients who smoke have a much higher risk for loss of skin, delayed wound healing, infection, pneumonia, and blood clots in the leg veins which may result in pulmonary embolism and death. It is absolutely essential that you refrain from smoking for three weeks before and three weeks after surgery.

Q: Is there anything that can be done to improve the appearance of the scars?

A: Generally, the scars will fade nicely as time passes, and in many cases, no additional treatments are needed. If the scars become somewhat thick or red, Dr. Cambre may recommend treatment with silicone gel strips or liquid, or possibly laser treatment of the scars to lessen the redness. For this reason, your follow-up visits are important, so that the progress of your wound healing can be monitored.

Abdominoplasty Before & After:

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Thigh lift surgery raises, firms, and tightens the skin of the thighs. Excess skin is removed and the surrounding tissue is repositioned to create a more youthful and pleasing body contour.

Thigh lifts are usually performed on those with large amounts of loose, hanging skin on the thighs. The goal is to return the body to a more normal appearance after loss of skin elasticity due to extreme weight loss or age-related changes.

What is Reconstructive Breast Surgery?

Breast reconstruction offers hope for a woman losing her breast to cancer. Reconstruction can often be performed at the same time as the mastectomy, beginning the process of restoration and healing. Depending on health conditions, however, a mastectomy patient may have to wait before undergoing reconstructive surgery. Whether Breast Reconstruction is done immediately or on a delayed basis, this surgery holds much promise that the post-operative breast can match the natural breast again.

The Beast Reconstruction Surgery Procedure

When reconstructive surgery is performed simultaneously with the mastectomy, Dr. Cambre will discuss your surgical options, as well as the risks and alternatives to each option. This may include the two-stage approach, inserting a tissue expander at the first operation, followed months later by replacement of the expander with a permanent silicone breast implant, or the use of your own tissues to reconstruct the breast mound in one stage. Dr. Cambre will work with your oncologist and general surgeon to ensure the best possible conditions for reconstruction.

Breast reconstruction usually involves more than one operation, and secondary follow up procedures may be performed on an outpatient basis. Follow-up procedures may only require local anesthesia, and often involve reconstruction to recreate the nipple and areola, or scar revisions. Sometimes surgery is performed on the natural breast to match the reconstructed breast; such procedures include Mastopexy (breast lift), Breast Reduction, or Breast Augmentation.

Skin Expander with Breast Implant

This is the simplest of breast reconstructions, with the shortest recovery period. This is the favored procedure for persons who have heath problems or contradictions to surgery that is more extensive.

Breast reconstruction using tissue expanders is performed in two stages. In the first stage, a tissue expander is placed under the skin and muscles of the chest wall at the same operation as the mastectomy procedure (immediate reconstruction). In other circumstances, the expander is placed many months or years after the mastectomy procedure (delayed reconstruction). After healing of the incisions, saline is added on a weekly basis to the expander. As the expander inflates, the skin envelope is gradually stretched and enlarged.

When the skin has been sufficiently stretched, the tissue expander is removed, and is replaced by a permanent breast implant in the second stage procedure. Nipple reconstruction, if desired, is performed as a separate procedure.

Advantages: Simplest surgery and shortest recovery from surgery.

Disadvantages: Multiple trips to the office over several weeks or months to undergo expansion. Capsule formation or poor cosmetic result due to thin skin.

Possible Complications:

• Loss of breast skin requiring removal of implant. If you have undergone radiation or if you are a smoker, this procedure is not advisable as you are at increased risk for skin loss.
• Noticeable outlines of the implant due to capsule formation or thin breast skin
• Hard texture due to capsule formation
• Inadequate symmetry or implant position as compared with the remaining breast

Latissimus Dorsi Myocutaneous Flap

This surgery involves moving the latissimus dorsi muscle and overlying skin from the back, tunneling it to the chest to create a new breast mound. The incision is usually made along the bra line so the scar will be concealed.

Blood transfusions are not usually required. A breast implant is often placed under the flap if necessary to balance a difference in size. Nipple reconstruction is done later.

Advantages: This is a very reliable procedure, which provides good tissue coverage for an implant. The chances of capsule formation around the implant are reduced.

Disadvantages: Scar across the back. There may be decreased strength in the back due to muscle loss (usually minimal). Capsule formation may occur and result in the need for additional surgery.

Possible Complications:

Circulation problems with the flap Formation of capsule around the implant Symptoms from loss of shoulder muscle, such as decreased strength Unsightly scar on the back, not hidden by clothing Collection of fluid (seroma) under incision requiring needle aspiration

Rectus Abdominus Myocutaneous Flap

This is the most complicated type of breast reconstructive procedure, involving about 4 – 5 hours of surgery. The procedure can be done either as a “pedicle” flap, or as a “free” flap. In the pedicle flap operation, one of the rectus abdominus muscles along with its’ blood supply is tunneled along with the overlying skin up to the chest. In the “free” or microsurgical procedure, a portion of the rectus abdominus muscle with its overlying skin is removed from the lower abdomen. The artery and vein are then surgically re-attached under the operating microscope to an artery and vein on the chest wall near the mastectomy site. In both procedures, the breast mound is then created to match the opposite site. A blood transfusion may be required. You may donate your own blood before surgery to be re-infused during the surgery.

Breast implants are not usually required. The tissue is generally adequate to match the size of the opposing breast. If the opposite breast is large or pendulous, it can be decreased in size by a simultaneous Breast Reduction. Patients wishing to have this procedure must stop smoking six weeks prior, and six weeks following surgery. Failure to comply may result in death of the flap. A synthetic mesh is placed over the area of the abdominal wall where the muscle is removed. This strengthens the abdominal wall and minimizes the chance of hernia formation. Nipple reconstruction is done as a second procedure. Some contouring of the new breast mound may be necessary at the same time.

Advantages: This provides the most natural looking breast reconstruction with the added benefit of a “Tummy Tuck”. No implant is needed so capsule formation is not a risk. The scar is easily hidden with clothing.

Disadvantages: There is a risk of herniation of the bowel resulting from moving the rectus abdominus muscle. Abdominal strength is diminished. This is the longest procedure and has the greatest risk for complications, and may require a blood transfusion.

Possible Complications:

Inadequate tissue requiring the use of a breast implant Poor circulation to the flap resulting in tissue loss Weakness or herniation of the abdominal wall Collection of fluid (seroma) under the skin requiring needle aspiration Infection, in particular of the mesh requiring surgery for removal

Nipple Reconstruction

The reconstruction of a nipple adds a very pleasing final touch to the breast. This is a simple outpatient procedure that may be done with local anesthesia. The goal of the surgery is to create a nipple that has the appearance of the nipple of the opposite breast. To reconstruct the nipple, a local flap of skin is usually taken from the breast flap. To reconstruct the areola, skin may be taken from the inner part of the upper thigh or from behind the ear. These areas tend to have a darker pigment, which will provide a better contrast to the breast tissue. As a second procedure, the healed nipple can be tattooed to improve the color match of the opposite breast.

Possible Complications:

• Excessive scarring
• Shrinkage of the projecting part of the nipple
• Infection of the donor site or the newly created nipple
• Blood clot under the nipple, which may result in loss of all or part of the new nipple

FAQ’s

Q: How will I look / feel after the surgery?
A: Reconstruction of the breast following mastectomy is a very rewarding procedure to both the patient and the surgeon. Many women describe a feeling of once again being whole. There are many written materials available regarding breast reconstruction. There are support groups available where one can meet women who have gone through these procedures. Ask us for references, books, and support groups in your area. Take advantage of these invaluable resources.