Get answers to any questions you may have regarding your procedure(s) by contacting an advisor at Envision Cosmetic Surgery to determine what is right for you. More information cick HERE

FACE & SKIN
blepharoplasty
facelift
rhinoplasty (nose surgery)
otoplasty
obagi
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BREASTS
augmentation
mastopexy (breast lift)
breast reduction
re-augmentation
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BODY
abdominoplasty (tummy tuck)
brachioplasty (arm reduction)
buttock augmentation
gynecomastia
liposuction
vaginoplasty (labiaplasty)
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FAQ
What is the difference between saline and silicon breast implants?
Both saline and silicone implants have a silicone shell. The difference is in what fills the implants. A saline implant is filled with saline solution, the same that is used for IV’s. Thus, if the implant ruptures, the body absorbs the saline and the breast shrinks or deflates. A silicone implant is filled with a silicone gel. The silicone has improved with time. The current silicone is called “cohesive” meaning it holds to itself. If the implant were cut in half, the silicone would simply stay were it is and hold its form. If a silicone implant ruptures, you would likely not know as it would stay in the capsule (scar tissue that forms around all implants).
Both implants have advantages and disadvantages. Saline implants are empty when we put them into position so they can be placed through smaller incisions, usually an inch and a quarter in length. However, saline implants ripple more and do not feel as natural. Silicone implants are filled when we put them in place and therefore need a larger incision, usually an inch and three quarters in length. However, silicone implants ripple less and feel more natural. Both implants will give you a natural appearance although if you have little natural breast tissue, rippling may sometimes be visible.

How do I know if I need a breast lift?
A breast lift, known as a mastopexy, is necessary if your nipple is at or below the crease below your breast. The lower the nipple is in relation to the crease, the more aggressive the lift that is necessary. Minor lifts result in a scar around the areola. Major lifts result in a scar around the areola and a vertical incision from the areola to the crease below the breast. Sometimes a short horizontal scar in the crease below the breast is also necessary.

How is a breast lift performed?
When a breast lift is performed, a small amount of skin around the areola and on the central lower portion of the breast is removed. The nipple and areola are not detached. The tissue is folded to move the nipple up higher on the breast and the sides under the breast are brought together (thus the vertical incision).

What can I do about the wrinkles around my mouth?
Wrinkles around the mouth are a challenging problem. Options include injectable fillers such as Juvederm, chemical peels such as TCA (Trichloro acetic acid) help with fine wrinkles but has a longer recovery time, or surgical dermabrasion which may help with fine and moderate wrinkles but has a longer recovery time still.

How does Botox work?
Botox works by stopping the muscles from moving. It will not make your wrinkles go away immediately. Skin has memory and thus, even though the muscles which create the wrinkles are no longer moving, the wrinkles persist. Over time, months, the skin memory decreases and wrinkles will fade.

How long does Botox last?
Botox lasts about 3-6 months. Everybody metabolizes the protein at a different rate. In addition, every facility injects varying amounts of botox which affects how long it lasts as well. The average duration of effect is 4 months.

What is a botox unit?
Botox is measured in units. A number of units are needed to treat an area. Each areas needs differ to be effectively treated. The area right between your eyebrows will likely need 12 to 15 units. To treat the entire central forehead requires about 18 to 22 units. The “crow feet” (outside of the eyes) require around 6 units per side. A full treatment of the central forehead and crow feet requires about 32 units total.

What is smartlipo and how is it different from traditional liposuction?
Smartlipo is the trade name for a laser developed by Cynosure for laser liposculpture. Traditional liposuction is a two step procedure. First, fluid containing two medications, lidocaine and epinephrine, is injected into the area where the liposuction will be performed. Second, cannulas attached to suction are inserted and fat is removed. The removal is traumatic but effective. Smartlipo is a three step process. First, the fluid is injected into the tissue. Second, the laser is inserted into the same tissues, melting the fat and cauterizing blood vessels. Third, the suction cannulas are inserted to remove the now melted fat. The removal is much less traumatic, which results in less pain, faster recovery, less bruising and less swelling. In addition to these benefits, the heat generated by the laser improves skin contracture over traditional liposuction.

How many treatments are necessary for laser hair removal?
Five to eight treatments are necessary to make a hair bearing area essentially free of hair. Hair grows in cycles. The laser only works on active hair follicles. Not all follicles are active at any one time. The average hair follicle cycle is six weeks which is why your treatments will be spaced out about that far apart. Because all of your hair follicles are not active at the same time it is impossible to kill every follicle.

What is the difference between a mini and standard tummy tuck?
A mini tummy tuck removes a small amount of skin below the belly button. During the procedure two vertical muscles called the rectus abdominus muscles are exposed and sewn back together in the midline from the belly button to the incision line. The belly button is not moved. A standard tummy tuck removes all the skin between the pubic hair and the belly button. An incision is made around the belly button and it is left attached to the muscle layer. The skin above the belly button is freed up to the ribs. While the skin is free, the rectus abdominus muscles are sewn together from the ribs to the pubic area. The skin is pulled down to the pubic area resulting in a low incision that spans from hip to hip. A new opening is created for the belly button and it is sewn into place. A standard tummy tuck allows much more skin to be removed and more shaping and tightening of the abdomen. A mini tummy tuck is appropriate for a select few people. Loose skin on the abdomen makes one a candidate for a standard tummy tuck. 

Botox & Fillers

More and more patients are taking advantage of non-invasive treatments that allow a person to return to their daily activities without downtime. Botox or injectable fillers such as Juvederm, Radiesse or Artefil, give immediate results usually without bruising or swelling or any visible sign. Understanding each product will help you make an educated decision about which product is right for you.

Patients are often confused by the many terms and product names that bombard them from the media and other sources. Adding to the confusion, many of the same substances are being made by different companies and marketed with different brand names. For example, Restylane the first hyaluronic acid (HA) filler, made by Medicis Aesthetics, lasts 4-6 months. Demand for longer lasting products led Medicis Aesthetics to develop a new filler they named Perlane. Still composed of hyaluronic acid, Perlane particles are larger thus it takes the body longer to dissolve and the filler last longer. Now multiple companies make a hyaluronic acid filler; Inamed offers Juvederm, and Mentor offers Puragen and more will follow.

Injectable fillers are made of differing substances that effect how long they last. The hyaluronic acid fillers mentioned previously are the shortest acting. Perlane and Juvederm Ultra Plus, typically last 8 months to one year. Hyaluronic acid fillers are FDA approved for injection into the nasolabial folds (parenthesis lines around the mouth). Hyaluronic acid fillers are soft enough to be used in the lips, although use in the lips is not FDA approved or considered an “off label” use.

Radiesse, another common injectable filler, is made of calcium hydroxyapatite and lasts 18 months to two years. Radiesse received FDA approval for facial wrinkles around the mouth, facial lipoatrophy (facial fat loss from medications or sickness), and even for plumping the vocal cords in cases of chronic hoarseness. Radiesse is not recommended for lip injection even as an off label use. This is a longer acting alternative for facial wrinkle treatment or adding volume when needed.

A recent addition to the filler market is Artefill a permanent filler composed of polymethylmethacrylate (PMMA) and collagen. Although the collagen gets re-absorbed, the PMMA is permanent. This means life-long improvement of those unwanted facial wrinkles is possible. Artefill requires a skin test three weeks prior to injection to determine if you are allergic to the collagen component of the injection.

Botox works differently than fillers; however, in some locations the combination of the two products gives better results than either will individually. Botox works by decreasing muscle movement. Muscle movement is usually responsible for creating many of the wrinkles and creases that tell our age. When the muscles stop moving, the skin memory fades over the course of weeks to months and wrinkles become less apparent or if used preventatively never form. Botox’s effect on the muscles lasts three to six months. After an injection, you will begin to notice less muscle movement after one week. The inability to make scowl lines not only makes you look happier, but seems to actually make you happier.