Q: Thermage Hands – Will It Tighten Skin?

I have loose skin on the backs of my hands and would like it tightened. Would Thermage work for this?

A. Thermage has limited efficacy for hand skin…

Thermage can help tighten hand skin when there is mild to moderate looseness. If there is significant loss of elasticity, it is unlikely that Thermage can make a significant difference.

Contact a LA County Plastic Surgeon

Q: Fat Transfer Using Inner Knee?

Does taking fat from the inner knee and injecting it into the face mean the fat survives better that fat taken from the abdomen?

A. Generally, Fat Survival Is Mostly Related To The Technique.

Small studies suggested that fat from different body sites might have a different survival pattern.  I do not think we know enough to make a substantial claim.  I like the inner knees as donor site; most women like the contouring effect.


Q: Natural Look After Mid Face Lift And Fat Transfer Swelling?

I have had Cheek implants for 4 years and I have been happy with these. My eyes looked very hollow though and a fat transfer was performed 25 days ago to remedy this. I also had A mid-face lift at the same time.

Right now my cheeks are massive. I am really frightened that they are still so huge after 25 days and I’m beginning to doubt if the result will be natural/normal.

My plastic surgeon has said that the result will be normal but I would really appreciate some other input. Can I expect to look natural in 6-8 weeks?

A. You Would Expect Significant Swelling After The Procedure.

Combination of midface lift and fat transfer can result in the expected post-operative swelling. With previous cheek implant surgery, drainage patterns may be affected and the resulting swelling may take longer to clear.

Your surgeon should be able to determine whether there is any localized fluid collection that is contributing to the swelling. You may also ask your surgeon whether gentle lymphatic massage could help clear the swelling. If there are no unexpected complications, you can expect to see significant reduction in the swelling by week 6.


Q: Liposculpture Vs Liposuction?

How does liposculpture compare to liposuction?

A. No. Liposculpture is the same as liposuction

Liposculpture is just another term for liposuction. It might imply that there will be attention to details but technically, it is the same.

Important factors to achieve a great liposuction results are:

1) Good patient selection. Patients with excess fat deposits and good overlying skin quality are good candidates.

2) Good judgment. Removing the correct amount from the correct area obviously works the best. Overzealous suction, especially in the superficial planes can lead to significant deformity. Doctor must be able to correlate the findings while the patients are standing vs when they are lying down during surgery

3) Good technique. Gentle technique with smaller cannula allows better contouring. It may take a bit longer for the surgeon, but certainly worth it for the patient.

For more information contact Santa Monica Plastic Surgeon Reza Nabavian

Q: Would It Be Safe To Have Four Cosmetic Procedures Done At Once?

I’m considering getting Rhinoplasty (just tip work), Breast implants, an inner thigh lift and Liposuction to the flanks/mid-section. I’d like to save cost and do them all at once. Is this safe and/or possible? I’m a young, healthy woman in my mid 20’s. I have lost weight in the past and have flabby skin on my thighs and deflated breasts that can’t be remedied through exercise.

A. Length of surgery and the type of cases to be combined need to be considered.

In your case, the thigh lift has the highest morbidity in relation to DVT. Combination with liposuction slightly increases that risk. Nose surgery adds to the time. My guess is the entire case would take near 5 hours.

My advice would be to take one of the procedures off the table for now. Maybe do the liposuction another time. If you decide to combine, you will need to stay in a nursing overnight recovery center.


Health Care Reform in the United States

Health Care Reform in the United States        By Dr. Reza Nabavian

Via The Huffington Post

The discourse on the responsibility for health care delivery centers on this question: is access to health care an individual “right” or is it a “privilege”? What is not clarified in this question is from whose perspective is it being asked! In typical fashion, the pundits divide along the liberal vs. conservative way of interpreting any complex problem in our society. Instead of simplifying this issue into another hot topic like social security, abortion, gay marriage or gun rights, I suggest we break it down and analyze it from a higher resolution perspective.

From the point of view of a physician, it is in fact a “privilege” to care for another human being. If you read every single “personal statement” by every student who has ever applied to medical school, the pervasive theme is that of an individual who is intensely motivated to care for fellow human beings. I believe that this is a genuine feeling that helps a student put in the long hours of hard work over the many long years that it takes to become a practicing physician. Why else would these bright individuals enter such difficult and demanding line of work? Their cohorts studying business, law, finance, marketing, management, etc., seem to have found a much smoother and easier path to join the “1%”. So from the standpoint of the health care provider, we have a work force that is smart, motivated and for the most part dedicated to the well being of others.

As a patient, I believe it is also a “privilege” to be cared for by a highly trained and caring physician. So if the “economics” were surgically removed from the equation, these two positions of privilege seem highly cohesive! This synergy is very evident in the dynamics of medical “relief” work. I can speak from my own experience working in Haiti in the aftermath of the recent earthquake. But the reality does involve economics and that bring us to the question of “right” to health care.

We may agree or disagree on whether “free market” is the answer to everything. The fact is some services such as “responding to fire emergency” may not have an intuitive supply-and-demand solution. So is the right to health care similar to the right to “fire intervention” or is it more along the lines of a right to housing, food or transportation. From the perspective of a physician, is there a right to free market competition when it involves the health of an individual? Does a patient have a right to the best medical care despite the ability to pay? It is the question of “right” that provokes strong emotions and reverts the issue back to the fundamental principles of capitalism vs. socialism.

With health care costs around 17% of GDP in the United States, it is time to seriously question the wisdom of “for-profit” insurance system. An insurance company has a conflict of interest with both the patient and the physician. It is time to eliminate it. This is not a question of personal “right” to income, care or choice. It is a question of the structure that mediates the patient-doctor interaction. While the government may be too inefficient to manage the country’s health care system, a non-profit health care administration system may be the solution. There is a successful model for this in Kaiser Permanente health care system. While Kaiser is not the government, it is also not mandated to turn in a profit. It just needs to maximize its efficiency. The efficiency comes from having the highest number of members and participants. Imagine if the entire health care apparatus of the country was a united system operated by health care professionals to deliver the best care with maximum efficiency. The patients would have choice. The providers and the supporting industries would be adequately compensated. The system would be inherently efficient because there would be no impetus to take resources (profit) out of the system.

This is both our “right” and our “privilege.”

Follow Reza Nabavian on Twitter: www.twitter.com/DrRezaNabavian


Dr. Nabavian in SecondAct, “Stop the Clock: Lift and Tighten Without the Knife”

“Stop the Clock: Lift and Tighten Without the Knife”

By Melinda Fulmer

Forget the facelift. In the last five years, a flurry of new noninvasive cosmetic procedures have come along, promising to turn back the clock on aging skin without as much risk and recovery time as surgery.

From fillers to lasers, 83 percent of all cosmetic procedures performed in the offices of cosmetic plastic surgeons in 2010 were nonsurgical, according to the American Society for Aesthetic Plastic Surgery.

Of course, not all of the wrinkle-busting, skin-tightening treatments out there are worth the time and money. And because most require refreshing every few months or years — or look better used in combination with each other — they can be as expensive as surgery in the long run.

Unlike surgical lifts that simply pull the skin or muscles tight, however, these no-scalpel treatments increase the collagen and elastin in the skin, making it feel younger. “Some of these devices are changing the quality of the skin,” says New York City dermatologist Neil Sadick.

SecondAct enlisted the help of Sadick and two of the country’s top plastic surgeons to discuss which nonsurgical procedures are most effective at treating the most common aging-skin complaints.

Here are their picks:

Skin Tightening

While wrinkles get most of the attention when the topic of aging comes up, the lack of elasticity in aging skin is also a big issue. This is where the new crop of radiofrequency (RF) treatments comes in.

Thermage, Titan and Pelleve treatments use hand-held radio frequency energy devices to heat the underlying layers of loose skin, tightening the existing web of collagen and stimulating new growth while keeping the surface cool and intact so there’s no peeling or time off work needed — although the skin may appear a bit red or flushed. These treatments can be performed on the face, abdomen, backs of the hands, and even the knees.

Some improvement is immediately visible as the collagen contracts and will build over the next six months as more is created. The effect can last up to several years, says Dr. Reza Nabavian, clinical assistant professor of surgery at the University of Southern California Division of Plastic Surgery.

While this treatment can’t provide the same dramatic results as a facelift, it can take up some of the slack and improve skin texture. Indeed, some facelift patients use it after surgery to tone and tighten the skin.

There may be a bit of pain involved as the device zaps the energy into your skin. The amount of that discomfort varies with the treatment and method. Some procedures such as Thermage only require one visit and may be more painful, while others such as Titan or Pelleve require three visits using less power and more passes over the area.

New Jersey plastic surgeon Dr. Barry DiBernardo even uses Pelleve to do a nonsurgical eyelift, tightening droopy skin on the upper and lower lids.

A similar treatment that is relatively new, Ulthera, uses ultrasound to heat and tighten the underlying layers of the skin and stimulate new collagen growth. The difference with this treatment is that the device has a screen allowing doctors to see underneath the skin to the places where they should deliver the sound waves.

“If you don’t want a facelift, but need some tightening of the tissue under the jaw line, cheeks or brow,” this could be the treatment for you, DiBernardo says.

There haven’t been a lot of head-to-head studies to identify which of these treatments are the most effective, says Sadick, and different doctors favor different methods and machines. However, most are effective for mild cases of sagging, the doctors say.

Cost: $1,800 to $35,000, depending on the area

Wrinkle Fillers

These injectable substances — some natural, some synthetic — pad the age-related hollowing under the eyes, fill in marionette lines around the mouth, and plump up thinning lips, forehead creases and acne scars.

The most commonly used fillers (Restylane and Juvéderm) are made from a natural protein called hyaluronic acid that lasts for about 6 to 9 months.

“It is perhaps the biggest bang for the buck,” Nabavian says, and provides an immediate effect, unlike some other treatments.

Radiesse, made of calcium-based micro-spheres, is a bit denser and may last longer, Sadick says. It is used mostly to plump up cheeks or in the deeper creases along the mouth. There is a chance of bruising and swelling around the injection site, and in some rare cases patients have developed small bumps or infections under the skin.

Cost: $500 to $600 per syringe

Wrinkle Relaxers

Botox, Dysport and the newly approved Xeomin temporarily reduce wrinkles or expression lines on the forehead, near the eyes and between the eyebrows when injected around these areas.

The effects of these Botulinum Type A toxins usually last for about three to six months, after which time additional injections are necessary to maintain the results. Side effects are rare but could include swelling, bruising, allergic reactions and weak or drooping muscles near the injection site. A topical Botox-like gel is still awaiting FDA approval.

Cost: $400 or more per area

Sun Spot Slayers

Laser treatments are good for patients with excess pigmentation and coarse, leathery skin from decades of unprotected days outdoors. Fractionated or ablative lasers remove the outermost surface of the skin with light energy, allowing brighter, less-pigmented skin to come through.

Some of the most dramatic results come from the more aggressive carbon dioxide lasers such as Fraxel re:pair that vaporize small columns deep within the skin to resurface and tighten skin.

Unlike radiofrequency treatments, fractionated or ablative laser treatments (or ones that destroy the top layer of skin) do require more care and up to a week of downtime as the old skin peels and flakes off to reveal new, more even-toned skin. There is more risk of blistering, hyper-pigmentation or scarring with major treatments such as Fraxel re:pair, but the results are more definitive.

Not all fractionated lasers are as aggressive. A new at-home fractionated laser, Palovia, was rolled out last year to big chains such as Bloomingdale’s. The $500 device claims to zap fine lines and wrinkles around the eyes in 30 days of nightly treatments and should provide a small degree of tightening, Sadick says.

Conversely, nonablative lasers such as Laser Genesis, have no downtime because the skin is not burned, but mainly treat milder complaints such as uneven skin texture, redness and fine wrinkles. These treatments can be done on a lunch hour and require four to six sessions.

Intense Pulsed Light (IPL) Treatments (often called photofacials) also diminish excess pigmentation, tighten pores and stimulate new collagen growth. However, the effects of these treatments are more subtle than with peels or ablative laser treatments, and they happen over time. Nabavian says this should be done three to six times a year, with at least three weeks in between treatments for maximum results.

Cost: $250 to $400 for each IPL or Laser Genesis treatment; $3,000 to $5,000 for Fraxel re:pair

SecondAct contributor Melinda Fulmer writes regularly about issues of health and wealth for publications such as the Los Angeles Times and web portal MSN.


Q: Micro-Liposuction of Jowl Fat?

How does this work? Is the liposuction performed from the inside of the cheek? Also, under what conditions can this procedure be used?

A. Jowl lipoplasty can be performed in conjunction with submental lipo or during a facelift.

Liposuction anywhere above the jaw line must be done only in select cases. If there is a distinct jowl pad with good quality skin over it, then liposuction with small cannula can be done. If the skin has poor quality, then the liposuction can make things worse.

During a facelift or facial fat grafting, the jowl can be also addressed by filling the depressions around the jowl, thereby improving the contour.


Dr. Reza Nabavian in Vanity Fair Video: Healing In Haiti

Healing in Haiti

Rebuilding Haiti by Vanity Fair

Episode 4: Rehabilitation, Click The Link Above To Watch

This month marks the two-year anniversary of the earthquake in Haiti that killed more than 300,000 people and left more than 1,000,000 homeless. Last year, filmmakers Jacques del Conte and Chandra Ratner, along with model Lee Greene, traveled to the ravaged island nation to witness the devastation firsthand, and document the heroic day-to-day efforts of volunteers from Artists for Peace and Justice and others as they fight to help rebuild Haiti.

Q: Fat Transfer For Compound Fracture Scar?

I have a compound fracture scar to the inner part of my lower right leg from an accident that occurred when I was 11 (I am 28 years old). I’ve been able to see a plastic surgeon who advised me that he could take some fat from my stomach and put this into the indented area of the scar. However, he said that there was a risk that the fat could seep through the scar tissue and cause an ulcer (20% chance). I wonder what your views are on this and whether you have performed this procedure yourself and its success rate.

A. Fat grafting may be a good option to correct your scar deformity

The scar deformity has two components:

1-The loss of volume from the area after orthopedic procedures.

2-Scar bands that form in the deep plane and tether the skin.

To properly correct the deformity, it may be necessary to release the tethering and then add the fat grafts. It may take more than one attempt to get good results. Knowing that one can add more fat later, will remove the impetus to put too much fat and risk ulcerations, etc


Q: How to Achieve Cleavage After Breast Feeding and Implants?

I’ve had Breast implants for two years now but I recently had a baby. I only breast fed for one month, so my breasts don’t need a lift. I’m just a little concerned that now they actually don’t look that full anymore. They are not sagging, just not as full as they used to be. And what really bothers me is the separation I have now which makes me look like I don’t have a cleavage, I want an opinion on what are my options to have a cleavage?

A. May be possible to move implants more towards the center of your chest.

Either due to initial placement or changes to capsule or the overlying skin, you may have implants that are placed too lateral on your chest. It may be possible to release and allow more fullness at cleavage.


Q: Pain Level For Breast Augmentation And Tummy Tuck?

Will a tummy tuck and breast augmentation be too much pain to handle?

A. Mostly well tolerated with appropriate pain management.

I would recommend using a pain pump, adequate ongoing and as-needed pain medications. May need assistance with getting in and out of bed for 3-5 days. If you have young children, you will not be able to hold them tight or pick them up for at least 2-4 weeks.


Q: Fat Stored After Liposuction Not Good Anymore?

I had an abdomen Liposuction done a few years ago. The doctor gave me my fat to freeze and I have had it since then in my freezer. The problem is that my lights went out for 2-3 days. I would to like know, is the fat is not good anymore? I want to use it for fat grafting to my buttocks.

A. Say no to stored fat!

First of all, if biologic material such as fat, is to be stored for re-use in the body, it must be maintained with the standards of blood banks. So physicians’ offices or patients’ own would not qualify.

Secondly, intuitively and scientifically, fat that is harvested, traumatized, then stored, is likely not going to be a quality product. Not very difficult to harvest fresh fat at the time of injection.


Q: Shorter But Bigger Nose After Rhinoplasty

I sustained a nose injury and met with a surgeon to have Rhinoplasty. I had photos of this famous model whose features were close to mine except her nose. Anyhow, I wanted her nose. I wanted a smaller, well-defined nose. During surgery, cartilage from my ear was put in my nose. Seven months later, my nose appears larger with no definition. It’s shorter but bigger. Could it be due to too much cartilage, and it failed to shrink as predicted? Does cartilage in the nose shrink over time, and if yes, what is the percentage of shrinkage?

A. Many factors can be contributing to the nasal shape

It would be difficult to provide a helpful answer without photographs, but generally, it sounds like you are not happy with the width of you nose as well as the amount of tip projection.

Cartilage does shrink a bit over time but I doubt it is the main reason for the mismatch here (between your expectations and the results).


Q: What Are the Largest Breast Implants I Should Consider?

I am looking into having a breast augmentation within the next 3 months, but the only potential surgeon I’ve met with so far told me that he would not do the breast augmentation unless I would consider a smaller breast implant size. I was completely shocked by this. My breasts have been extremely small my entire life (AA cups) — I have always had to wear a “training bra” and was teased about this a lot growing up. I want to get DD or larger breast implants. Lots of women get breast implants WAY bigger than DD, so why am I being told my request is unreasonable? How do breast augmentation surgeons decide how big is too big for different people?

A. There are important anatomic considerations for breast implant size

The size of your chest wall, (the dimensions of the boney chest) serves as a starting point to determine what implants may be tolerated. Next, one has to have enough native breast skin that can be stretched to accommodate the implant. If someone has very small breast with minimal skin laxity, it will limit what size implant can be placed under the skin. Other factors such as the amount of existing breast tissue and nipple position also need to be considered.

In general, an inappropriately large sized implant can create a lot of problems for you and your surgeon has the responsibility to inform you properly.


Q: How Effective Are Post-Liposuction Touch-ups?

I had liposuction 6 months ago and up with a few contour irregularities. They look like mogul-type lumps, not dimply like cellulite. My plastic surgeon said he could do a touch-up with a cannula that resembles a cheese grater, but not remove any more fat.
He said this would help smooth the lumps. But he also mentioned that one complication of using this instrument could be damage to the blood supply to the overlying skin. He hasn’t seen this personally, but it does worry me. Is this a good procedure to smooth out lumps, and are the risks to the skin worth it?

A: It is important to know whether the bumps are excess fat or post-liposuction scars.

The bumps you are referring to could be either scar tissue that has formed after liposuction. If that is the case, time and massage should provide some improvement. A persistently hard scar may respond to corticosteroid injection, however, this injection can have its own set of complications such as tissue atrophy and telangiectasias, so not a great choice.
If the bumps are due to under-suctioned fat deposits, then liposuction with a small cannula could be helpful. The closer these deformities are to the actual skin, the less likely it is to achieve excellent correction.
Being prudent about revisional surgery is very smart. In the case evolving scars, time is usually on your side.

Q: Thermage or Blepharoplasty for Sagging Under Eyes?

Will Thermage Fix My Under Eye Sagging Skin, Or Will A Lower Blepharoplasty Work Better?

A: Thermage is not the answer to your problem.

Thermage may work on some areas of the body in some individuals some of the time!! For specific and distinct skin excess, the results may be disappointing. For mildly loose skin or to prevent it, Thermage may be valuable. Lower eyelids can be improved with Fraxel, peels or surgery.

Looking Done is So Last Decade

Looking Done is So Last Decade: The Cultural Shift Towards Age Appropriate Cosmetic Procedures

Looking done is so last decade

Middle aged is no longer synonymous with matronly. The over 40 woman is a force with whom to be reckoned. She is no longer seeking the fountain of youth, but rather seeks to look as good as possible – for her age that is. Women want to look refreshed, healthy and energized. They are less concerned with looking 20 years younger

Instead, women over 40 are wearing their hair longer, sporting bikinis and have more economic power and independence than ever before. And, say these women, why should beauty be intrinsically linked to youth?

In an “age appropriate” movement, plastic surgery too has evolved. “Ironically, older techniques may have removed excess skin to combat aging, but these procedures did nothing to restore youthfulness,” says Clinical Assistant Professor of Plastic Surgery at USC, Dr. Reza Nabavian.

Dr. Nabavian reflects a school of thought that subtlety is best, advocating for minimally invasive and preventative techniques that avoid nipping and tucking where ever possible.

The first defense and treatment of aging, he says, resides in proper skin care. “Signs of aging begin with the condition of the skin itself. Sun damage, environmental factors and overall physical and mental health contribute to the health of the skin.” For younger patients, he suggests treating hyperactive glands and acne using treatments such as glycolics and sunscreens. More mature patients require more intensive agents, such as retinoids and vitamin C to gradually resurface the skin and decrease sunspots and wrinkles.

And where wrinkles stand their ground, Dr. Nabavian advocates the use of Botox, Thermage and fat transfers. Where Botox is concerned, Dr. Nabavian warns that, “Botox is commonly misused and has been known to cause a masked and unnatural appearance. One needs to keep in mind that facial movement is a natural process that needs to be preserved.”

Fat transfers, he says are the most natural and non invasive way of rejuvenating hollow or aging skin. “We can now use a patient’s own fat cells to restore fullness and proportion to the face and body. This procedure enhances the appearance with no use of synthetic fillers, implants and drastic surgery.”

The Academy for Peace and Justice Opens New Wing of Classrooms USC Professor Dr. Reza Nabavian Brings Health and Education to Haiti

The Academy for Peace and Justice Opens New Wing of Classrooms: USC Professor Dr. Reza NabavianBrings Health and Education to Haiti


On Friday, November 18, 2011, Artists for Peace and Justice (APJ) celebrates the opening of a beautiful new wing of classrooms at Haiti’s first free secondary school, The Academy for Peace and Justice.

7th and 8th grades are in action for this academic year, set in the new school building. The next phase of construction of the school will start in the spring.

“This is why we fight for Haiti. We are now educating nearly 800 secondary students,” said APJ board member Dr. Reza Nabavian.

Another APJ board member, Paul Haggis, was in Haiti with the organization to mark this benchmark in the ongoing efforts to rebuild Haiti.

APJ continues to support the medical relief projects at St. Damien hospital.

“We are having a series of donor trips to Haiti over the next few months to attract new support for our ever-expanding projects,” says Dr. Nabavian

No Schools for the Masses

“APJ’s main project is to deliver free education because so many kids have no access to school.” In Haiti, education is not free – and as one of the world’s poorest countries, many Haitians simply can’t afford to educate their children. “We created a free middle and high school for kids in the slums. We are building campuses to provide free education.” The curriculum includes music, art, film, community service and computer, leadership and vocational training. “APJ could take up 200% of my time, if I could give it. There’s just so much need down there.”

“I’ve worked on some high profile people, making them look better. But there is a higher level of personal fulfillment when you realize that what you have learned can make such a huge impact on people that have so much need.”

“I’ve always seen myself as a doctor first and a plastic surgeon second,” says Dr. Reza Nabavian, Los Angeles plastic surgeon and USC professor.

Passion to Rebuild Haiti

Dr. Nabavian’s time is in high demand. As a private practicing plastic surgeon, Dr. Nabavian has some pretty high profile clients. And as the Director of Aesthetic Surgery Education at USC, his expertise is a critical component of the university’s residency program. As if serving on multiple panels and maintaining two full time jobs weren’t enough, Dr Nabavian is on the Artists for Peace and Justice Board of Directors. He shares the board with Paul Haggis, Ben Stiller, Olivia Wilde and Dr. Bob Arnot.

Artists for Peace and Justice is a star studded charity that focuses primarily on providing schools for Haitians and secondarily for delivering medical aid. Since the 2008 earthquake, Dr. Nabavian has gone to Haiti over a dozen times to lend a medical hand, “There are two components to our efforts: general and medical relief. I go there to perform surgeries, support hospitals and rehab centers and to help kids with prosthetics.”