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25/Jul/2017

The most common aesthetic procedures in the world are filler and botulinum toxin injections. Filler serves the purpose to smoothen deep wrinkles and adding volume to face and body where needed. Botulinum toxin is applied for dynamic wrinkles of the face by paralyzing the underlying muscle temporary. The vast majority of fillers are not permanent, which means that they will be absorbed or metabolized by the body within 3 to 12 months depending on the ingredients and brand. Some fillers, meant for very deep injections to add volume, might stay for up to 18 months. The vast majority of filler patients are pleased with the treatment results and continue to undergo this procedure at appropriate intervals. The filler is available readily and the procedure is quickly performed with little downtime afterward. However, those who seek long-lasting or even permanent results with fillers, can’t be satisfied with the existing products. The best solution for them could be a fat transfer. The technique of injecting fat as body’s own tissue filler is described and already used worldwide for decades. There are sterile single-use kits available, which make the procedure safe and cost effective for patients and practitioners alike. One should know however, that fat cannot be used for very superficial fillings like intradermal injections. Otherwise, there are no restrictions regarding the area and layer of injection. Fat can be applied for facial filling including lips or even body contouring including buttocks and breasts. There is a downside, however. Not all of the harvested and injected fat will survive in the injected area. On average, if done properly, up to 70% of the injected fat cells can stay alive and function as a permanent filler. This fact requires the practitioner to “over-correct” to some extend while injecting and also to advise the patients, that touch up session might be necessary. My approach is, that I recommend patients, who come for the first time for a filler treatment, to decide on ready-made fillers. This way the patients can experience the filling effect on a temporary basis and think of going for a longer lasting solution at the following filler session. If so, I usually propose fat filling to the patient. Getting back to the question in the title: Yes, for those patients, who seek filler treatments on a regular basis, fat might be the best option as a long lasting solution.  

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25/Jul/2017

eye Whenever we meet somebody, the first look is at the eyes. This is the reason, why the orbital/ periorbital region is perceived as the most important part of the face when creating an impression on another person. The human face is divided into different aesthetic units; the periorbital region consists of the upper and lower eyelid, the eye socket, the eyebrows and the upper cheek area. When aging, different parts of this area can age at different speeds. Usually, the upper eyelids will start, dropping and creating some excess skin. Thereafter under eye bags may form and the lower eyelid skin will show wrinkles and laxity. Eventually, eyebrows will drop, worsening the sagging of the upper eyelid skin. When rejuvenating the periorbital region, optimally these signs of aging can be addressed in one and the same procedure. Most commonly upper and lower blepharoplasties or eyelid lifts are performed with or without eyebrow lifts. Although upper eyelid lifts are usually effectively performed, unfortunately, this does often not apply to lower eyelid lifts. In many cases, patients are quite rightly dissatisfied with the results due to insufficient surgical corrections. Utilizing the correct surgical techniques and having sufficient experience, one can achieve truly wonderful and long lasting rejuvenation effects, not only for the lower eyelid as such but also for the entire mid-face area. In the course of the surgery, excess fat from the periorbital area will be removed and used to spread over the bony rim of the eye socket and the muscle is used to lift and suspend the entire mid-face area upwards, reversing signs of time. These changes proved to be long lasting, even after 10 years my patients appear still younger than before the surgery. In conclusion, the periorbital rejuvenation surgery is a rewarding and long lasting improvement of the overall facial appearance and impression, provided that the surgical methods are correctly applied.  For optimal rejuvenation effects, patients need to make sure to choose a surgeon with extensive experience, who is also capable of including the mid face area in the lifting process.

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25/Jul/2017

When I was still living and working in Germany I saw almost every day patients with Carpal Tunnel Syndrome (CTS). Patients with this condition suffer from numbness of the first 3.5 fingers of the hand (thumb, index finger, middle finger and radial side of the ring finger). Sometimes they can’t sleep a full night because the pain in the concerned hand wakes them up mainly in the early morning hours. The underlying cause is an increased pressure on the median nerve, which runs through a tight tunnel when entering the hand on the wrist level. The reasons for this increased pressure can be very different, but Caucasians seem to suffer more frequently from this condition than others. If conservative therapy doesn’t help a surgery is required to release the pressure from the nerve. This is been accomplished by dissecting a ligament called the transverse ligament in the wrist level which builds the “roof” of the carpal tunnel. Nowadays skilled hand surgeons perform this procedure under local anesthesia as an outpatient procedure in a matter of minutes. The success rate is quite high and patients are usually relieved from pain the day after the surgery. However, if numbness was present, this may take up to 12 weeks to fully recover. Look out for those who complain about not sleeping well anymore because they think they slept on their arm and this caused the hand to go numb, maybe they can be helped with a simple hand procedure.

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