Dr. Silberblatt
offers a complete range of facial procedures and services.
To learn more about a particular procedure, click on a topic
below:
There are a variety of ways to enhance
the appearance of lips. These range from temporary
non-surgical methods to permanent surgical interventions.
(click image to
enlarge)
Lips can be thin either from birth or get thinner
as we age. A popular temporary way of making them fuller is
to inject bovine or human collagen.
Bovine collagen injections provide a way to
enhance lips with no down time and usually last about three
months. Human collagen injections are twice as expensive and
may last longer. Silicone injections are experimental and
not recommended.
Your own fat can be used to make your lips fuller.
This procedure will yield subtle results and requires a recovery
period of about one to two weeks. Slightly greater fullness
can be obtained by inserting a dermal fat graft from your
own body but that will leave a scar at the donor site. It
also will require a one to two week down time. Either of these
results is permanent. Cadaver allografts for the same purpose
are available but have questionable longevity.
Gortex grafts can also be placed. There is a
higher incidence of infection, knotting and irregularity associated
with this procedure but it gives more fullness than any of
the others when successful.
Another approach would be to place permanent
lip color in much the same way that lipstick is used to make
the lips look fuller. The major disadvantage to this method
is that the roll of the lip may reflect light a little differently
and can give a funny look to the lips.
Sometimes a combination of two or more
of these methods is required to accomplish the desired goal.
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Common complaints about noses include
size discrepancies, humps, bulbous tips, drooping tips, wide
nostrils and crooked noses. Many of these deformities
can be corrected using incisions inside the nose but some
may require a small, almost invisible scar across the columella
(the skin covering the septum). The bones may need to be cut
at their base in order to narrow the nose and a splint is
applied for one week. Packing is usually used for three days.
Cheek bruising is generally moderate to minimal and disappears
after three weeks. Minute amounts of swelling can persist in
the tip for as long as a year.
When asked what his favorite operation
is to perform, Dr. Silberblatt answers:
"The greatest enjoyment I get from
any operation is derived from witnessing my patients’
satisfaction, even exuberance, over the results of their surgery.
In this, all operations are equally gratifying. Technically,
however, there is one operation that I find challenging and
always look forward to tackling: rhinoplasty (nasal surgery).
The first task is to understand my patient’s
concerns and goals. Changes need to be patient
rather than physician dictated. Computer imaging is quite
helpful in facilitating this kind of communication. Rhinoplasty
requires meticulous technique and artistic visage. The use
open methods have allowed me to directly view and accurately
change the shapes of the cartilages. Bone cuts need to be
exact. Scars are usually not visible. At the end of the case,
what you see is generally what will result. Changes often
dramatically alter the appearance of a person. Doing a large
number of surgical corrections on the deformed noses of children
born with a cleft lip (ages 3 months to 18 years) has helped
me perfect my technique for surgery on the adult nose. From
the initial consultation to the final post operative visit,
the communication, planning and achievement of the desired
goals in rhinoplasty combine to make it the one of the most
challenging and rewarding operations in cosmetic surgery that
I perform."
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In the last decade a large variety of
materials has become available to help fill wrinkles and make
facial skin smoother. The list includes bovine collagen,
cadaver collagen, your own fat and expanded PTFE (Gortex).
Bovine collagen lasts three to six months and
costs $200 to $400 for wrinkles around the lips. As much as
5% of the population may be allergic to it so an allergy test
prior to its use is mandatory.
Cadaver collagen is carefully selected and treated
to exclude any viruses or other pathogens and is twice as
expensive as bovine collagen. It appears to last longer than
bovine collagen. Fat can be harvested from a patient's stomach,
hip or flank and injected using meticulous technique into
the face. This technique works better to reduce deeper wrinkles.
Superficial wrinkles will be softened but may not be completely
eliminated. Whatever fat takes appears to be permanent. Costs
vary from $750 to $1500 for areas around the mouth and chin.
Gortex is an inert material that can successfully
fill hollows in the face. Unfortunately, there is chance that
the material can become infected and need to be removed. Costs
for the lips or nasolabial region are about $2000. The material
will last for years but with time can become encapsulated
and partially extrude and/or become deformed.
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Lower eyelid surgery can often help
to get rid of the "tired" or "baggy" appearance
of the lower eyelids. Dr. Silberblatt used to do
this exclusively by removal of the fat around the globe but
recently has adopted the strategy of redistributing the fat.
This has the advantage of filling in the depressed trough
that outlines the course of the edge of the orbit. The result
is a smoother appearance that has no depressed areas.
Removing the extra skin and fat
will not only improve appearance but may also improve peripheral
vision. The baggy lower lids are due to lax skin,
muscle, fat pads and possibly arelaxed canthal tendon. Surgery
can tighten the muscle and tendon and remove the small excess
of skin. Surgery will not smoothen "crinkled" skin
nor will it remove "crows feet." These problems,
however, can be helped, by certain skin treatments (see
Skin Rejuvenation).
Depending on how much needs to be done and what kind of anesthesia
is agreed on, costs can vary from $1500 to $3000. The vast
majority of patients are very pleased with the outcome of
this procedure.
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A neck lift can be an alternative to
a facelift depending on how much extra skin and fat you have.
When there is a little extra skin and fat, some of
the fat can be removed by suction and, through a small, hidden
incision just under the chin. Suturing the superficial muscles
creates a hammock or sling and tightens the neck. When there
is more fat and skin, larger areas of the skin need to be
raised and more extensive tightening needs to be done. If
there is a great deal of extra skin and fat as well as cheek
sagging, a facelift is necessary.
t is important to remember that a neck tuck
alone will not take away jowls and cheek
folds. Also, if your chin is set back, great benefit may be
derived from adding a chin implant in addition to tucking
the neck.
Costs vary from below $1000 for liposuction
of the neck to over $2000 for a complicated neck lift. Facility
fees and anesthesia charges also vary and can add significantly
to the cost.
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Chin enlargements can be done by either
putting in an implant or by cutting and advancing the bone.
Chin implants are simpler and the newest designs are unlikely
to leave any tell tale step offs in contour. Dr.
Silberblatt prefers to use those that are made of a porous
polyethylene which can be easily carved on the table. A small
incision is made inside the mouth just above the point where
the lower lip meets the gum and the soft tissues are raised
off the bone. The implant then fits snugly over the chin.
With time, tissues will grow into the porous surface. Infections
are very rare. Most patients are thrilled with the results.
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Resurfacing of the facial skin using
the CO2 laser is an effective method for removing
facial wrinkles. We now have over five years' experience
and have observed the following in our patients:
1) The vast majority are very happy with their
results.
2) There is some lightening of the skin color when compared
to untreated skin. This could be a problem in individuals
with darker complexions.
3) Occasional brown discolorations can occur in treated areas
but these can be treated with chemicals or repeat spot laser
treatments.
4) Although scarring can result from over treatment, we have
not seen this in our patients.
5) Results seem to hold up for at least five years unless
no further care is given to the skin and it is frequently
exposed to the sun.
The CO2 laser cannot
be used to treat stretch marks on the abdomen.
After surgery, the treated areas will
heal just the way any unroofed blister would. A great deal
of special attention and care must be given to the wound for
the first week and it is usually not advisable to plan any
social activities for that period. For the first three weeks,
sun exposure must be avoided. Costs range from just under
$1000 for small areas to about $3500 for the entire face.
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Botox works by both interfering with
the transmission of nerve impulses to muscle fibers and by
destroying the receptor sites themselves. It is very
effective in temporarily paralyzing muscles, thereby eliminating
the wrinkles produced by those muscles when they contract.
These effects have been used to reduce or eliminate frown
lines, forehead lines, crow’s feet and other facial
wrinkles.
The body, however, will eliminate the Botox
and repair its effects on the muscle in two to eight months.
Thus, the effects are temporary. Also, deep wrinkles that
remain when we rest all the muscles of our face will not disappear
after Botox treatment and may require other methods for removal.
The cost for injection of Botox will vary from between $5
to $15 per unit. Typically, 10 to 25 units are used per area.
Some patients with heavier muscles will require more Botox
for the same effect. Occasionally, patients may have temporary
drooping of an eyelid or blurry vision. These side effects
resolve on their own in about two weeks and there are medicines
that can minimize their effects when they occur.
Don’t be taken in by low cost “Botox
specials.” Ask how many units you are receiving. Make
sure your physician is experienced in its use. Dr.
Silberblatt has been using Botox to reduce facial wrinkling
since 1995.
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Most ears that are prominent have failed to
form the normal cartilage fold near the edge of the ear and
also have a deep, enlarged central portion. Surgery to correct
this involves creating a new fold in the cartilage near the
edge of the ear and rotating or reducing the size of the central
cartilage bowl. The surgery is often done at about the age
of five when the ear achieves about 90% of its growth and
just before children go to kindergarten.
It is not unusual, however for adults who have
hidden their ears with long hair all their life to decide
to have this operation. The surgery can be done under local
or general anesthesia. The incisions are placed behind the
ear and are not visible from in front. Most patients
are very happy with their results. Women begin wearing their
hair up and men cut their hair shorter.
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The wrinkles between your eyes are caused
by an overactive group of three or five muscles of expression.
The most common way of softening or temporarily eliminating
the wrinkles is to paralyze the muscles with Botox. These
injections usually need to be repeated every three months.
Temporary benefit can also be gained by injecting
the wrinkles with collagen. The collagen injections need to
be repeated every three to six months to maintain the correction.
Skin resurfacing with a dermabrader or a CO2 laser
can sometimes be used. Another way to correct the problem
is to remove the muscles. This can be done using an endoscope
through small incisions in the scalp or through upper eyelid
incisions. The endoscopic procedure can be done under local
or general anesthesia and can be used to lift the brows and
correct prominent bones of the forehead at the same time.
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The least expensive way to smoothen
some of the lines around the upper lip is to use Retin A and
alpha hydroxy acids. A moderate level skin peel of
the upper lip with trichloracetic acid can also help. Both
of these modalities are included in the Obagi skin care program.
For deeper lines, resurfacing with a laser or
a dermabrader can help although these lines are more resistant
to removal than others elsewhere on the face. Phenol chemical
peels are very effective but cause the treated skin to be
depigmented. Fat injection into the area can help eradicate
the deeper lines. Collagen injections can temporarily improve
the appearance as well. Strips of Gortex can be used.
Although the results are quite dramatic, there
is an increased possibility that, in the long run, scarring
around the implant could cause it to deform resulting in an
appearance far worse than what was there originally. A combination
of fat injection followed by laser resurfacing seems to work
best for me in treating deeper wrinkles around the mouth as
long as patients understand that the results will be subtle.
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It is possible to remove most unwanted
areas of brown pigmentation in the face through a combination
of skin care and a superficial chemical peel. Our
skin care line includes the option for a superficial Tricholacetic
acid peel that is done under carefully controlled conditions.
This “Blue Peel” (part of the Obagi skin care
line) can be repeated up to four times at one treatment allowing
for reliable and reproducible depth control.
Fine and superficial wrinkling is improved
and it is very effective in the removal of melasma. After
the treatment, the facial skin will turn a brownish gray and
then begin to peel off after three to four days. The face
is completely healed in seven to ten days. If the brown spots
have been present for many years, it may take an additional
treatment to remove them.
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