Photo Credit: aafprs.org
Thanks to a host of new country music stars and a hit TV drama bearing its name, Nashville, Tenn. is hotter than ever. Country music popped again when Taylor Swift, Carrie Underwood, Brett Eldredge, Tim McGraw and many others hit the scene and it has been on fire ever since. Always a popular genre, this new generation of stars ushered in a whole new crop of country fans and festivals.
Although he’s just a little bit country when it comes to his musical taste, facial plastic surgeon William Russell Ries, MD, is all about Nashville and has established a thriving reconstructive practice in the Music City. A Professor in the Department of Otolaryngology – Head and Neck Surgery and the Odess Chair of Facial Plastic and Reconstructive Surgery at Vanderbilt University in Nashville, Tenn., Dr. Ries is also the American Academy of Facial Plastic and Reconstructive Surgery’s Group Vice President for Public and Regulatory Affairs-elect.
He sat down with Beauty in the Bag to discuss his practice, his hometown, and where he thinks this specialty is headed. Here’s what he had to say:
How much of your practice is reconstructive?
About 80%. Rhinoplasty is the bulk of my practice, I do a lot of rhinoplasty for functional reasons, but there is always a cosmetic component to those as well. This is also true with other facial reconstructive procedures such as skin cancer reconstruction.
What are today’s Nashville denizens looking for when seeking facial plastic surgery?
They are looking for a more youthful look without the appearance of being overdone. Non-surgical therapies are popular among people who aren’t ready for major surgery.
What is your best anti-aging advice?
Always wear sunscreen. It’s also important use a moisturizer and stay hydrated.
What should a person ask a surgeon during a facial plastic surgery consultation?
It’s important to ask how often the surgeon performs the procedure that you are interested in. If someone is doing one a year, he or she might not be the best choice. If the answer is two or three a week, you may want to gravitate toward that person. In general, facial plastic surgeons have a tremendous deal of experience and training performing procedures on the face, head, and neck. This is why the Academy’s motto is ‘trust your face to a facial plastic surgeon’.
Where do you see this specialty headed?
We will hear a lot more about non-surgical techniques for facial rejuvenation including lasers, ultrasound and/or radiofrequency. Tremendous strides are being made in this area, but these modalities won’t replace surgery. We are learning how to manipulate skin and collagen to affect real changes, and we can combine these energy-based devices with fillers and neuromodulators. For bagging and sagging, surgery is still the best option, but some tightening and refreshing is possible with today’s non-surgical procedures. In reconstruction, regenerative medicine–including the use of 3D printing and the growing and manipulating of living tissue–will play a big role in the coming years.
Tell us about your work with facial synkinesis.
This is a condition that refers to an abnormal involuntary facial movement after recovery from a facial paralysis. Voluntary movement of one facial area causes movement of a different facial muscle group. For example, you smile and your eye shuts. Most of these individuals have facial paralysis due to Bell’s palsy, surgery or trauma. Facial physical therapy helps, but we have been successful when we treat the overactive muscles using needle electromyography (EMG) guidance and then inject small amounts of Botox to weaken the overactive muscle. Treatment is repeated four times a year because once the Botox wears off, the muscle tightens back up.
Photo Credit: vipplasticsurgery.com
Everyone who sets foot on the Las Vegas strip tends to see themselves as a Very Imporant Person (VIP), but as many a weekend gambler or tourist soon learns, all that glitters isn’t gold. That said, there are still places in Vegas where VIP actually means something — including VIP Plastic Surgery. Christopher Khorsandi, MD is the chief plastic surgeon at VIP Plastic Surgery in Las Vegas and Los Angeles. He is board certified in plastic surgery, and trained in minimally invasive hand surgery and migraine relief surgery. “No matter if you just walked off the runway, run a family, or are running between jobs, we want our patients to feel like VIPs,” he tells Beauty on the Bag. Dr Khorsandi shared other insights about his practice and what people in Sin City are really looking for when it comes to cosmetic surgery — and some of his answers may surprise you!
Here’s what he had to say:
What is your practice mantra at VIP Plastic Surgery?
We do not have a factory mentality with anything we do. We believe in tailored treatments and an atmosphere that is never rushed or pressured.
Tell us what people in Las Vegas are looking for in terms of cosmetic enhancements. Is bigger still considered better?
Las Vegas is really a major hub for plastic surgery and making things bigger will always be a part of the plastic surgery landscape, but I believe the days of 1,200 cc breast implants and humongous trout pout lips are behind us. What we do hear from nearly all our patients is that they want to be bigger, but at the same time they want to look natural. It almost seems contradictory, but I do believe you can go big and still look good. So how do we accomplish this? We take a tailored approach to implant and filler selection. We use a 3D modeling system called VECTRA 3D to show patients what they will look like with different amounts of volume. That way we get just enough augmentation to satisfy even the most discerning patients. As a result, this creates the highest level of satisfaction in our patients which is reflected in our online reviews.
What is your signature procedure?
I pride myself on my rhinoplasties. I think it’s the top level of plastic surgery and it takes a keen eye and a skilled hand to deliver results. There are many plastic surgeons out there but very few of them excel at rhinoplasty. It’s a surgery of millimeters, and it takes an almost obsessive attention to detail to make it work well.
What are the biggest trends that you are seeing today?
In terms of trends we are seeing increasing numbers of women looking for Brazilian Butt Lifts and gluteal augmentation. I think this trend will continue for a few more years as the techniques have become safer and more predictable. The butt augmentation is like the new breast augmentation. Case in point: Sports Illustrated‘s Swimsuit Issue this year featured three derrieres. Women are embracing the idea that you can have a more shapely backside without having to do thousands of squats in the gym seven days a week. Our first choice for butt augmentation is fat. We tend to use fat for augmentation 8 to 1 in our practice because you get the added benefit of liposuction and body contouring. However, there are implants available for patients with little donor fat available. With the number of patients we are seeing, Butt Lifts are second in line for my signature procedure.
Tell us about migraine relief surgery, and how it is changing the way these debilitating headaches are treated.
Migraine relief surgery is a new field of plastic surgery that has developed in the last decade to address the issue of chronic migraine pain. We know that Botulinum toxin can significantly reduce the frequency and severity of migraine attacks. The mechanism of action is likely the paralysis of small muscles that surround and pinch nerves in the scalp and forehead. Surgery looks to reduce migraine attacks by releasing the muscle from around the nerve and allowing for decompression of the nerve. Studies performed at Harvard University in Boston and other notable institutions have indicated that these techniques have lead to improvement in 90% of patients. It’s a very exciting new field, and we are one of the few practices nationwide offering the treatment.
How would your patients describe you and your bedside manner?
I think they would say that I have a passion for what I do and that I enjoy my job which translates into a positive office environment. It’s a privilege to get to do the work that I do and be able to be part of so many peoples’ life journey. I enjoy the practice and the people. In other fields of medicine there is this need to see high volumes of patients in order to make ends meet. In my practice, I can spend quality time with my patients. It’s like the old days of medicine where your doctor actually knew who you were, and remembered you. Some patients tell me it’s the most interaction that they get to have with a physician. I often get the sideline: “Hey Doctor Khorsandi, can you take a look at something for me?” Or, “I have a family member who is undergoing this type of medical treatment, what do you think?” I think it’s a compliment to the amount of trust we have built with our patients.
Photo Credit: amronmd.com
Beverly Hills dermatologic surgeon David Amron is on a mission. Dubbed a “liposuction expert,” from his enclave in Beverly Hills, Amron performs body contouring procedures with a keen aesthetic eye and superb level of care. Amron is the Founder of Spalding Drive Cosmetic Surgery and Dermatology, as well as Beverly Hills Doctors Surgery Center. He specializes in non-surgical facial rejuvenation and is recognized internationally for his unique approach to artfully sculpting and shaping the body for women and men. As a pioneer in the field, he offers multiple types of body sculpting and fat removal procedures that can be done individually or combined, depending on the patient, for a truly customized experience and outcome. Another thing that stands out about Amron is that he is not the typical “Beverly Hills cosmetic surgeon.” His well heeled international clientele tout his caring beside manner and the special interest he takes in all of his patients, not only the ones you see on the big screen.
Lipedema is an often-misdiagnosed fat storage condition affecting millions of our national and global population. It primarily occurs in the legs, specifically the anterior thighs, knees, and ankles. Often, it will also appear in the upper arms in later stages. It develops the appearance of tree-like, column-like legs, with disproportionate fat storage and a lot of non-pitting edema, or excess swelling. A lot of times there’s a cuff around the ankles in lipedema patients. It’s different from obesity and fat legs. Obesity is being overweight, and fat legs may just be a part of genetic disproportion, but with lipedema, there’s also prominence of swelling, and again, that sort of column-like look to the leg. Commonly there’s a genetic inheritance component to lipedema. It occurs almost exclusively in women, and usually appears after puberty and progressively gets worse. It affects approximately 11 percent of the female population — 17 million women in the U.S. and 370 million women worldwide. For the most part, lipedema is resistant to diet and exercise.
Various medical treatments have been met with limited success, and the only real possible cures are tumescent lymphatic sparing liposuction (which many surgeons are reluctant to perform) and water-assisted liposuction (WAL). There are a number of things that have been done, but nothing with the same results. One of the main treatment therapies is Manual Lymphatic Drainage (MLD). It does seem to significantly help with the swelling that comes with lipedema, however, there’s a lot of maintenance involved, and it doesn’t really seem to make a difference in terms of the disease itself. There are several doctors and healthcare providers around the country who are treating lipedema medically. The medical treatment primarily revolves around the use of medicines such as Cimetidine and supplements such as Selenium, as well as others, to reduce the inflammation and swelling. The role of decongestive therapy also involves MLD, leg elevation, and compression is used to reduce swelling.
Lipedema is a very under-recognized condition, especially in the United States, and I’m one of the few doctors with experience in surgically treating lipedema patients. I want to further advance both the knowledge and awareness of lipedema among the medical community, as well as within the general public. There are many treatment centers in Europe, especially Germany, a country at the forefront of initial research and treatment for lipedema patients. Unfortunately, there are very few treatment centers in the nation, but I’m currently in the process of advancing my practice to treat more and more lipedema patients around the world. I’m also setting up an extensive protocol, both pre- and post-surgically, to treat these patients in a comprehensive fashion. Along with that, I am aligning myself with many medical experts around the country, including Dr. Karen Hebrst, who is a worldwide expert in fat disorders, such as lipedema. We’re working together to establish protocols, and also collaborating on studies among lipedema patients to not only advance therapies, but also to increase awareness, so that possibly one day, lipedema might be more recognized by insurance companies in terms of coverage. Lipedema patients are not only suffering from the aesthetic effects of the disease, which creates emphasis on disproportionate areas, but they also suffer in terms of their lifestyles. As lipedema progresses, patients experience a series of symptoms including: discomfort, pain, numbness, and often immobility. Patients begin to experience a viscous cycle of worsening swelling and pain, such that they can’t properly exercise, which certainly makes the condition worse.
I’ve been an expert in liposuction surgery for the past two decades, and in recent years, there’s absolutely been an exciting area of advancement in regards to noninvasively targeting fat. I’ve been observing this area very carefully, and there are several devices that work well. Some are better than others, but UltraShape is the most specific, noninvasive device that exists, and it represents the next generation of approaching fat non-surgically. It’s much more customized and focused on how it works, versus other, more nonspecific modalities. As a key opinion leader for Syneron, the developer of UltraShape, I’m one of the first few surgeons in the nation to offer the treatment. Before UltraShape was released to other surgeons, I already made the decision to incorporate it into my practice as a great alternative for patients who do not want surgery.
It’s important that patients do their research to select a surgeon they trust — they shouldn’t be quick to make a decision, or fall prey to some price-driven marketing campaign. The patients I see have taken the time to learn and understand the procedure, and they come to me as an expert in the area. I am really here for guidance, and to help patients determine what the best course of action may be, whether it’s surgical or nonsurgical. Patients want a procedure that will deliver the best results, and one that doesn’t involve a lot of recovery time. That’s one of the advantages to some of the noninvasive techniques that are now entering the marketplace. UltraShape is entirely painless and works very, very quickly. In as little as two weeks, patients already start to see improvements in their bodies. In regards to traditional liposuction, when patients understand my approach, which uses local anesthesia as to general anesthesia, they’re often impressed by how little downtime they experience. Patients will leave my office half an hour after their surgeries, and are able to go home and walk around. The next day, patients are usually up and going, and in as little as two days, most are back at work and doing their daily routines, including light exercise.
If patients have reasonable expectations, and are evaluated properly, noninvasive treatments provide a great alternative for someone who wants to avoid surgery. Noninvasive approaches are an area of significant growth in the industry, because now, we have the ability to remove and destroy fat tissue. This area is getting better and better, not only in terms of non-surgically removing fat, but also in terms of tightening up the skin. I use a variety of technologies, and we’re seeing fantastic improvements in cellulite in ways we wouldn’t have seen years ago. I’m currently developing a new approach, Integrative Body Contouring, which provides the patient with a more comprehensive treatment. The approach is now more holistic, and instead of doing a liposuction procedure to simply remove fat, Integrative Body Contouring will address the role of many different facets – how overweight the person is, his or her ability to lose weight, as well as the role of exercise and muscle tone. Additionally, proper hormonal balance is critical, so we’re incorporating anti-aging medicine into the treatment, addressing patients who are hormonally challenged and adding corresponding therapy as part of their overall procedure. I’ve always been a purest in terms of all of the new improvements that have entered the marketplace. I always return to the most important factor, which is the trust a patient places in his or her surgeon. I’m very excited about all of the recent technological advances, but again, the most important factor to me will always be selecting the right doctor.