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Posted by 09.07.14

Aaron Kosins, MD, is a well known rhinoplasty surgeon, but he doesn’t want anyone to be able to pick a “Dr. Aaron Kosins” nose out of a crowd. He’s all about natural looking, subtle enhancements that fit seamlessly with a person’s facial features. “The only people who should know you had surgery on your nose are your closest friends, husband, wife, or family members,” he says.

Rhinoplasty makes up a big chunk of Kosins’ private practice in Newport Beach, Calif, but he also performs body work and some reconstructive cases through his affiliation with the University of California, Irvine. In addition, Dr. Kosins is a member of the prestigious ZO® Skin Health faculty, and preaches the tenets of skin health advanced by Dr. Zein Obagi to Orange County and Beverly Hills residents.

He talked with Beauty in the Bag about all of this and more. Here’s what we learned:

How much of your practice is cosmetic versus reconstructive?

I do 80% cosmetic surgery and around 20% reconstructive including cancer surgery and procedures to repair traumatic injuries.

What is trending among Orange County plastic surgery patients today?

More and more, all kinds of people are looking for some sort of body or facial enhancement. Many are lured by the promise of more for less and they come in asking about non-surgical ways to enhance their body or face with less downtime. There are a lot of misconceptions out there about what certain procedures do and don’t do. For example, liposuction is good for minor contour irregularities, but I see all kinds of complications that occur when doctors treat larger areas over aggressively. Celebrity emulation can be an issue. I always ask patients what they want their new nose or breasts to look like and may have to explain why actress Megan Fox’s nose may look good on her face—but not theirs. Most patients understand.

What is your signature procedure?

Rhinoplasty. I don’t use nasal implants. I only use autologous tissue. The greatest innovation in rhinoplasty has been the ability to reconstruct the nose using our own tissues. I often remove implants and use rib, ear ,or septum grafts to reconstruct the nose.

Does the nose age, and can you treat it?

Yes and yes. A lot of women who have rhinoplasty in their teens start showing irregularities in the dorsum (bridge) with age because their skin thins, so I put a blanket of fascia (the body’s own connective tissue) on the dorsum to keep it smooth.

Is there a such thing as a liquid or filler nose job?

You can’t build structure with fillers. It needs to be replaced every seven to eight months. The nose has a similar blood supply as fingers. It’s tenuous and that means it can be dangerous if the injectables are done by unskilled practitioners. There is a role for fillers for correcting minor hills or valleys in the nose. You get what you pay for. You don’t spend $750 for filler and look like you had a rhinoplasty.

What are some of the important things people should know before choosing a plastic surgeon?

Look at the training. A lot of people say they do plastic surgery who aren’t trained to do it. Do your research. You can’t hide online. Make sure the surgeon specializes in the procedure you are considering. You should also like the person who is operating on you.

What is your go-to skin care product line and why?

Hand’s down, it’s ZO Skin Health and ZO Medical products. It really is the Ferrari of skin care lines. All of the products are created based on evidence and all claims are backed up by science. Many products out there say they will reduce the appearance of wrinkles, but that’s not a scientific claim. Today individuals spend more and more on products, yet their skin looks worse and worse. Imagine if you paid a lot of money for a diet and gained 50 lbs? Dr. Zein Obagi designed his products around the skin health restoration principles and the products work. They do what they are supposed to.

What do you mean by “skin health?”

There was no working definition of skin health before Dr. Obagi. Healthy skin is smooth, even in color, firm and tight, well-hydrated, tolerant, contour rich, and disease free. This definition helps guide the choice of therapies therapies and/or address the efficacy of any skin care regimen.



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Posted by 08.31.14

Audrey Rosinberg, MD, spends a lot of her time debunking myths about varicose and spider veins. For example, many people still believe you can get them from crossing your legs. While she does counsel about prevention, Rosinberg is also an expert at getting rid of them for once and for all. More than just a cosmetic issue, these veins can greatly impair an individual’s quality of life and also cause pain and problems with mobility.

The good news is that treatments are far less invasive than ever before, explains Rosinberg, a vascular surgeon  at Union Square Laser Dermatology in Manhattan. She is board certified in both general and vascular surgery. Rosinberg took some time to chat with Beauty in the Bag about this unique niche.

What causes varicose or spider veins?

There is a strong hereditary component to varicose veins. In addition to genetic predisposition, age, pregnancy, and obesity all contribute to the development of varicose veins. People in occupations that require standing or sitting for long periods of time such as a hairdresser or a surgeon may also be at increased risk from developing varicose veins and would likely benefit from wearing compression stockings on a regular basis. Contrary to popular belief, there is no scientific evidence that crossing one’s legs leads to varicose veins.

Do they occur in men or just women?

Both men and women are affected but there is a higher incidence in women. A large population based study reported the annual incidence of varicose veins to be 2.6% among women and 1.9% among men. Although not clearly defined, the incidence of spider veins is thought to be much higher.

Are vein disorders cosmetic, medical, or both?

Vein disorders can range from cosmetic to serious in nature. Spider veins are nearly always cosmetic in nature and do not pose any serious medical risks. For the vast majority of patients, varicose veins are cosmetic in nature as well. A small percentage of patients will have symptomatic varicose veins with symptoms ranging from pain, tenderness, itching, and bleeding to much more serious complications involving, darkening of the skin with stasis dermatitis and ulcers that are difficult to heal and infections. Phlebitis can also be seen in patients with varicose veins and these clots can then propagate to the deeper veins that can cause deep vein thrombosis and even fatal pulmonary emboli.

 How do vein disorders affect quality of life?

Even cosmetic spider veins and varicose veins can affect a patient’s quality of life. Lower limb varicose vein disease is estimated to be the 7th most common reason for physician referrals in the US. Many women are self-conscious of their legs due to the presence of spider veins and may be embarrassed to wear shorts or skirts in the summer. They may be reluctant to enjoy outdoor summer activities like a day at the beach or the pool. Quality of life scales are used to measure disability due to varicose veins. Chronic venous disease has been shown to impact quality of life due to pain, decreased mobility, and limited activities of daily living. The impact increases with increased disease severity. In these patients, quality of life scores improve dramatically with treatment of the underlying venous reflux and varicose veins.

When is the best season to treat vein disorders?

Fall, winter, and spring are the best times to treat your veins. Whether you have large bulging varicose veins or just a few spider veins, we recommend that compression stockings be worn for two weeks following treatment to maximize the cosmetic outcome. In addition, tanning and sunlight should be avoided for six weeks following the procedure to minimize the chances of skin discoloration. Most people don’t want to wear compression stockings during the hot days of summer. Some bruising and discoloration can result from the treatments and these often take several weeks to fade, which is not ideal during shorts and swimsuit season. The maximal effect of fading of the veins is seen 6-12 weeks after sclerotherapy, so if you want to see the results in time for summer, you really need to start in winter as most people will require several sessions of sclerotherapy to cover all of their veins.

What is the greatest advance in treating varicose veins?

The greatest advance in the treatment of varicose veins is the development of endovascular technology. Varicose veins result from increased pressure in superficial veins due to incompetent valves in the underlying saphenous veins resulting in reverse flow or reflux. To treat the varicose veins effectively, the underlying saphenous veins need to be evaluated with ultrasound and if they are found to be the source of the varicose veins, traditionally, the veins were stripped. This required general anesthesia and caused significant discomfort, bruising, and swelling. If the underlying refluxing saphenous veins are not treated, the increased venous pressure will find other escape paths and new varicose veins will form. With the approval of endovenous thermal ablation techniques in 1999 and 2002, the treatment of varicose veins was revolutionized. Local tumescent anesthesia is administered around the vein and a fiber is then placed inside the vein using a small needle. Energy is used to generate heat and the vein is closed by heating it from the inside. The energy source can either be a laser or radiofrequency. Both work equally well in closing the veins. The entire procedure takes about 20-30 minutes and the patient is ambulating and ready to go home 20 minutes after the procedure is finished. In experienced hands, the procedure is very safe with a low incidence of complications.



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Posted by 08.17.14

Dr. Julian De Silva, an eminent UK facial plastic surgeon, talks to BITB about microsurgery and what it means to be one of London’s go-to face experts.

Educated at the London Teaching Hospital, De Silva studied plastic surgery at the University of California, Los Angeles in 1999 during an international elective. His transatlantic training and subsequent network have served him well, giving him real appeal with his clients and a pipeline into the evolving cosmetic trends and techniques from overseas.

De Silva performed his first facial surgery over 12 years ago, and went on to complete fellowships in facial cosmetic surgery in Los Angeles and facial cosmetic and reconstructive surgery in New York, an oculofacial plastic surgery fellowship in London, as well as the inaugural Darzi Clinic Leadership Fellowship in London. When the Olympics were held in London in 2012, the international organizers selected De Silva to provide clinical care to the competing athletes and coaching staff.

Today, he is known for perfecting procedures that require tiny incisions between 2-3 millimetres. He has also consulted for the UK National Health Service (NHS). It’s no wonder patients seek him out for his “small incision and fast recovery technique” to give natural-looking results.

Here, he tells BITB more about his achievements and his brand of super-surgery.

Tell us a bit about yourself

I am a London-based facial cosmetic surgeon who specializes in the eyes, nose, face, and neck areas only. I am a perfectionist and that’s what patients need—someone who has fastidious attention to detail with the surgical skill to back this up. 15-20% of my work is complex revision surgery on patients who have received treatment elsewhere and are not satisfied with their results so you could say that I am a fixer as well as first port of call for people that want to address a facial complaint. I’ve completed over 1,000 procedures to date but no two cases have been alike. There is no formula for the perfect nose for example and unlike what surgeons believed in the 1980s, one size definitely does not fit all. To get the best possible result for your patient, you really do need to love what you do and approach each and every case with the same enthusiasm and uncompromising care and attention in order to continue to create happy patients.

Why did you choose to specialize in facial plastic surgery?

I pride myself on my attention to detail and I am sure this stems from my training in microsurgery plus I love of arts and am a keen sculptor in my spare time so I think this was the natural direction to take. I like the fact that facial plastic surgery is hugely challenging, not simply from a surgical point of view, but also because of the extraordinary level of trust you must establish with your patient before making it to theatre. It’s a real honor when you are entrusted with somebody’s face. You need an exceptionally well-trained eye in this area—it’s not enough to be good at surgery, you need to have the vision to achieve the desired outcome. My obsession with this specialty has helped me achieve triple memberships in British, European, and American surgical organizations.

What advice would you give to someone considering facial plastic surgery?

If you think that 15-20% of all my patients see me for revision surgery (and that’s just at my clinic) imagine the numbers of people all over the UK that are not happy with their result. It’s so hard to pick the correct surgeon and to communicate what you want when it is effectively an image or idea in the patient’s head—how do you describe what you want to a surgeon? The answer is, find a way! Take photos of you with from all different angles, tear sheets of images that you like from magazines, touch your face to illustrate what you are talking about, and don’t be afraid to cross-question the surgeon to see if they really understand your vision. In fact, don’t be afraid to fire questions at the surgeons you meet because they owe you a response to each and every question you have no matter how silly you think it may be. I would recommend asking what percentage of a surgeon’s cases result in revision surgery, i.e. how often does this surgeon get it right and how often does he or she need to get a patient back on the table for further treatment.

Are there any tips that you would give to a budding facial plastic surgeon wanting to make it big?

Find out what you are good at and what you actually like to do; if you can tick both boxes you can become an expert. I would suggest having a portfolio of case studies for people to look over and keep that up to date so everyone has access to your most recent cases. You are only as good as your last result. It is hugely motivating to have satisfied patients so for that reason it’s best to work out how you are able to make the most people happy that you can.

Tell us why you have the edge on other facial plastic surgeons?

I specialize in a technique that reduces scarring and minimizes downtime and people come to me for that and the fact that I can offer a very natural look. I have treated people in the public eye, show business etc. and they, like everyone else, don’t want to look like they have had work done. It’s the rapport you build with patients that gives you the edge. If you can understand what a prospective patient wants, you are realistic about what you can achieve, and you communicate this clearly then this provides the basis for a happy customer. Manage expectation all along—the best kind of plastic surgery is undetectable and a natural looking improvement. Perfect is a very subjective term and there really is no such thing and therefore no magic formula for perfection. My patients know that they are going to emerge from treatment looking their very best.

Are there any new or unique techniques that you offer?

I have pioneered innovations such as the use of fibrin tissue adhesives and laser research. The techniques I use foster natural looking results, and I am continually bringing in new equipment and innovations to give patients faster recovery times and longer lasting results. The use of endoscopic and key-hole techniques minimizes scarring and the use of other innovations such as tissue glue can result in no need for conventional sutures in some facial procedures. I am always looking to improve patients’ recovery and reduce down time and invest in the latest in high-tech innovations in order to provide patients with these advancements.

How would you describe your style?

My style is a natural looking result and this will depend on the individual—their genetics, age, and ethnicity are all key factors. I don’t have the same approach for any two cases so I’d say that having a style would mean that you tend to follow a formula or prefer a certain kind of look, which just isn’t the case. I am a big believer in creating the best natural looking result possible. I look after all my patients on a personal level, and treat them as though they were my friends or family; this has resulted in patients coming back for more procedures and bringing their friends and family to see me.

How do you think your transatlantic training and connections help your work?

My experience from working in the US had helped me give the very best treatments and procedures to my patients. Having worked in both Los Angeles and New York, I use the most advanced techniques to give patients the results they are looking for. Ninety percent of the skills and surgical techniques that I use on a daily basis are from the US, as they minimize incisions, give faster recovery, and deliver more natural looking results.

What do you love most about your job?

I enjoy the challenge of facial cosmetic surgery; every person requires a different set of my skills, whether blepharoplasty, rhinoplasty, or face and neck lift. The relationship and trust that is built between patient and surgeon is quite amazing and it’s a privilege to be chosen.

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