2011

Do you need to get rid of those lines between your eyes, or filled in around your mouth, and do you like to save money? Allergan, the manufacturer of BOTOX^® Cosmetic and JUVEDERM^® Injectable gel, has developed a great program to reward the patients who use their products.

Just visit https://www.botoxcosmetic.com/alle-program and sign up for the Alle Program. You’ll receive points in your account when you have a treatment from Dr. Koumanis. You can convert these points to coupons and redeem at your next visit.

Board certified Saratoga Springs plastic surgeon Steven Yarinsky, MD, FACS will be among the first to gain exclusive access to XEOMIN^® in the Capital District. Merz Aesthetics on July 21, 2011 announced that the United States (U.S.) Food and Drug Administration (FDA) has approved XEOMIN^® (incobotulinumtoxinA) for the temporary improvement in the appearance of moderate to severe glabellar lines, or frown lines between the eyebrows, in adult patients.

At his Saratoga Springs, NY plastic surgery practice, Dr. Steve Yarinsky is announcing the addition of a new facial rejuvenation procedure known as XEOMIN. He says he is very excited to be able to offer his patients this procedure following the success of the FDA approval process. Dennis Condon, President and Chief Business Officer of Merz Aesthetics, Inc., had this to say about the approval: “The FDA approval of XEOMIN is a significant milestone for Merz Aesthetics and a promising addition to our entire aesthetics franchise. We are confident that XEOMIN will provide patients and physicians with a new option for improving the appearance of glabellar lines.”

“XEOMIN is a promising new option for both patients and physicians and we are encouraged by the response rates seen in the Phase III clinical trials,” said Derek H. Jones, M.D., an investigator for the XEOMIN U.S. study, Clinical Associate Professor of Medicine at the University of California in Los Angeles, Calif., and Director of Skin Care and Laser Physicians in Beverly Hills, Calif.

The approval of XEOMIN is based on the results of two pivotal U.S. clinical trials involving 16 investigational sites and included 547 healthy adult patients. In both studies, XEOMIN significantly improved the appearance of glabellar lines 30 days following the first injection, when compared to placebo. XEOMIN is the only botulinum toxin currently approved in the U.S. that does not require refrigeration prior to reconstitution.

XEOMIN is approved for the temporary improvement in the appearance of glabellar lines in 14 countries in the European Union (EU), including Germany, the United Kingdom, France, Italy and Spain, under the brand name BOCOUTURE^®.

XEOMIN will be available nationwide to physicians in the spring of 2012, but is available now at Saratoga Springs Plastic Surgery, PC. Dr. Yarinsky says XEOMIN differs from BOTOX^® Cosmetic because it lacks proteins that may induce an allergic response that can lessen its effectiveness. “XEOMIN may offer patients a cost effective and longer lasting alternative to BOTOX^® for both cosmetic facial wrinkle reduction and control of excessive underarm perspiration (axillary hyperhidrosis).”

About Steven Yarinsky, MD, FACS

Dr. Steve Yarinsky earned his medical degree from SUNY Upstate Medical Center, Syracuse, and completed his general surgery residency at Ohio State University Hospital. He then completed two years in intensive cosmetic and reconstructive surgery training at the Medical College of Ohio, where he focused on a number of procedures, including breast augmentation, liposuction, and abdominoplasty. Dr. Yarinsky was selected as a Top plastic surgeon by Consumers’ Research Council of America in 2010 and 2011. He is a member of the American Society for Aesthetic Plastic Surgery and the American Society of Plastic Surgeons.

Saratoga Springs Plastic Surgery, PC is located at 7 Wells Street 3rd Floor, Saratoga Springs, NY 12866, and can be reached at (518) 583-4019. The practice can also be found online at www.yarinsky.com.

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Xeomin^® may provide longer lasting wrinkle reduction than Botox^® Cosmetic.

LipoPerfection^® promises speedier recovery and better results.

Breast augmentation is done to increase the size of a woman’s breasts. The procedure is commonly performed on an outpatient basis, in a specialized operating room which may be located at a hospital, surgery center or surgical suite at a plastic surgeon’s office. In November, after over 15 years of scientific research and debate, the Food and Drug Administration (FDA) determined that silicone gel filled breast implants are safe and effective for use in breast augmentation and reconstruction. Women now can choose between saline or gel filled implants for their breast augmentation. There are a few key differences between saline and gel implants.

Saline filled implants have been FDA approved for many years for women over the age of 18 and are filled with sterile saltwater solution from an intravenous bag similar to the fluid that makes up most of the human body. They have a slightly firmer feel than silicone gel. Saline implants have a more flexible fill volume since they are filled at the time of breast augmentation. Different implant surface textures are available: smooth or textured. A woman should speak with her plastic surgeon about which surface type would be best for her. The implants come in shapes to fit different women. Saline implants can be placed through smaller incisions since they are filled at the time of the procedure. Although leaks are uncommon, when saline implants leak, the saline is absorbed by the body and a “flat tire” results. The breast cup size diminishes and an implant replacement is needed. In my experience there is no such thing as a “partial” or “silent” saline implant leak.

The FDA has approved silicone gel implants for women who are at least 22 years old. Gel filled implants have a softer feel and are prefilled at the factory. Different implant volumes, shapes and surface textures are available. Larger incisions are used compared with saline implants, since the gel implant are already filled before they are inserted in the pocket. In contrast to saline filled, the gel filled implants often rupture silently, with the gel contained by the scar capsule that develops around the implant. In this event, there may be no noticeable change in cup size. The FDA recommends that women have breast MRI studies every two years after silicone gel implant placement to detect “silent” leaks. The MRI may or may not be covered by a woman’s health insurance benefits and therefore may be an ongoing out-of-pocket expense that does not apply to women who choose saline filled implants. Ruptured gel filled implants should be replaced. Ask your plastic surgeon about your implant warranty.

There are precautions for women to take when choosing a plastic surgeon to assist them, contraindications to having breast enhancement, and potential complications that should be understood and accepted by women before they have a breast augmentation. All of these issues should be addressed by your plastic surgeon. Your plastic surgeon should help you choose the right size and shape breast implant to fit your figure and make sure that you have realistic expectations of the results that are likely to be achieved.

Some women feel that any plastic surgeon can give them a good result with a breast enhancement. Nothing can be farther from the truth. Breast augmentation is actually a more difficult procedure than it seems when it comes to getting consistently decent results. Rather than price shopping, I advise you to find an experienced board certified plastic surgeon who is a member of the Aesthetic Society who answers all your questions, shows you before and after photos that you like, and whom you feel comfortable communicating with. Then save or finance if needed to pay for your procedure. Many companies offer convenient monthly payments for cosmetic surgery loans. Don’t go cheap when it comes to your cosmetic surgery, since you may truly regret what you paid for.

The emotional effects of breast enhancement can be immensely positive. Women are able to fit the clothing they desire. They become happy with an area of their body that really bothered them psychologically. “Looking and feeling your best” took on new meaning with the results of a study published this year in the Aesthetic Surgery Journal. The article entitled “Better Sex from the Knife? An Intimate Look at the Effects of Cosmetic Surgery of Sexual Practices” showed that there are physical and emotional benefits to cosmetic surgery. “Cosmetic surgery patients overwhelmingly tend to feel better about their body” after their procedure. The majority of women surveyed found that their sex lives and those of their partners were “strikingly enhanced” after their breast or body contouring cosmetic procedure, giving them “a significant quality of life benefit”! The recent FDA approval of gel filled implants has calmed women’s fears of health risks. If you are interested in having breast enhancement I advise you to educate yourself about options, have realistic expectations, and above all, do it for you!

Today’s skilled cosmetic plastic surgeon knows that getting the best results from any cosmetic operation requires a customized surgical plan for each patient. Facelift surgery is particularly challenging, since patients differ widely in their underlying facial structure as well as the extent of their visible aging. According to an article in the The Aesthetic Society (formally the American Society for Aesthetic Plastic Surgery – ASAPS) publication, Aesthetic Surgery Journal, there are at least ten important considerations in designing a great facelift. If patients are aware of the process their plastic surgeon goes through to develop a surgical plan, they can be more active participants in some of these decisions.

A well-designed facelift will take into account factors including:

1. Hairline Position. A small shift in the position of the hairline is considered acceptable and usually is not noticed, but patients starting out with an elevated hairline position may need special techniques to avoid raising it further.
2. Incision Placement. Many patients and their friends judge the success of a facelift on the basis of minimally detectable scars. Where to place incisions depends on factors such as the amount of excess skin and whether the patient has pre-existing creases in front of the ears.
3. Cheek Volume. If the cheek area appears flat because of inadequate bony projection, sometimes the use of fat injections or implants may provide better definition.
4. Fat Pad. In rare instances, a herniated or prominent buccal fat pad, located in the cheek area, may need to be removed or sutured at a deep level.
5. Cheek Folds. Cheek, or “nasolabial” folds are difficult to treat, but a facelift that pulls in a vertical direction will help to restore sagging soft tissue to its natural position in the cheek area. Injection with a soft tissue filler, such as fat, may also be necessary to achieve optimal results.
6. Jaw Line. Jowls are caused by sagging soft tissue that must be elevated. If excess fat is present, it may be removed by suction (lipoplasty).
7. “Trough.” There is a region defined by the angle of the jaw where it interfaces with the neck that is called the ‘trough’. A shallow trough gives the face a rounder look, whereas a deeper trough contributes to a more chiseled look generally associated with youth and attractiveness. When necessary, defatting this area may give it better definition.
8. Chin. The profile of the chin plays an important role in an attractive appearance. An overly prominent chin, “weak” chin, “double chin” or “witch’s chin” all can be addressed with additional procedures performed at the same time as a facelift.
9. Glands. Sometimes the glands located in the neck, underneath the chin, appear prominent and can detract from the neck’s appearance. While most patients find some fullness in this area acceptable, surgical removal or repositioning of the glands is an option, though not without risks.
10. Neck Cords. If neck cords appear prominent from the frontal view, correction may require a small incision underneath the chin, nearly undetectable when healed.

“The very best results in our patients are achieved when we match what facial cosmetic surgery can give them with their realistic expectations.” Our team listens very closely to what you want and suggests positive ways to reach the appearance that you desire. He specializes in giving you “not extreme” just “natural” results.

“Because there are things women need to know about breast implants and augmentation”

Myth 1: “Everyone will know that I have these breast implants.”
Most implants which are obvious to the casual observer are due to avoidable problems: the implants are placed too high, are inappropriately in front of the chest muscle, or are too large for your chest. A carefully planned and performed breast enhancement can give most patients a very lovely, natural appearing result. Be sure to choose an experienced surgeon who will consider your desires while taking into account your height, weight, and your natural breast size, shape, and symmetry. Choosing an appropriate implant shape and size and positioning it correctly are key to achieving a natural looking result. Often, lifting your nipple and areola slightly can greatly enhance your result.

Myth 2: “Implants must be replaced every 5 to 10 years.”
Implants do not need to be replaced unless a problem occurs. Many patients have had implants for 20+ years, which continue to be soft and natural looking. With the saline filled implants currently used for most patients desiring larger breasts, the most common problem is leakage. But less than 1% of our patients have had leaks in 14 years! While implant deflation is not dangerous, the failed implant must be promptly removed and replaced. Interestingly, the most common cause for implant removal and exchange is the patient’s desire to have larger implants! And the most common cause for reoperation is asymmetric implant positioning.

Myth 3: “I will have to change my lifestyle or activities.”
Prior to surgery, we will give you guidelines concerning the time needed off from work, and how soon you may expect to resume your particular sports and hobbies. Once healing has taken place a patient may resume all of her usual activities. Your surgeon will guide you during the initial weeks of healing. Ultimately, you can scuba dive, mountain climb, parachute jump, kick box or anything else that you might desire without worrying about your implants. Breast implant placement may slow times in swimming competition.

Myth 4: “A large enough implant will correct “droopy” breasts.”
If you have droopy breasts, that is, if your nipples are at or below the bottom of your breasts, implants alone will not correct the problem. Implants will increase the size of your breasts, but the nipples will still be too low and your breasts will not look attractive. You will need a lift procedure along with your breast augmentation to achieve a well-shaped breast. The type of lift needed will depend on the amount of drooping present. Your surgeon will discuss the various options with you. Some patients who are satisfied with the size of their breasts, but have lost shape due to pregnancy or weight loss, will find that a lift alone will solve their problem.

Myth 5: “Implants will feel unnaturally firm.”
While augmented breasts will never feel as completely soft as most natural breasts, breast implants are a very good substitute. The key is to prevent, as much as possible, the building up of scar tissue around the implant. While no one has a magic formula to prevent this entirely, there are things that can be done to reduce the chances of having significant encapsulation occur. There are some convincing studies showing that textured saline implants are less likely to develop thick scar capsules than smooth wall implants. Placing the implants under the chest muscle helps to keep them feeling soft, and minimizes visible rippling. Using implants that are not too large and fit comfortably on the chest wall are other factors affecting firmness. It is important to follow your surgeon’s directions to achieve the best possible outcome.