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Posted by 10.26.14

Even the balmy weather and threats of storms didn’t detract from the excitement as facial plastic surgeon Stephen S. Park, MD, became the new President of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) at the group’s annual Fall meeting in Orlando, Florida.

Representing more than 2,700 facial plastic and reconstructive surgeons throughout the world, the AAFPRS is the world’s largest specialty association for facial plastic surgery. In addition to taking the helm of the AAFPRS for a one-year term, Park remains the director of the Division of Facial Plastic and Reconstructive Surgery at the University of Virginia Medical Center in Charlottesville.

Despite a full dance card at the meeting, Park sat down with Beauty in the Bag to discuss his practice, the direction the specialty is heading, as well as what he believes are the three things that can help put the brakes on aging.

Here’s what we found out:

Tell us about your practice.

It’s about 50% reconstructive including correcting congenital deformities such as microtia, a condition where the external ear is underdeveloped. The rest is aesthetic and includes aging face surgery, facelift, and rhinoplasties. My biggest niche, however, is nasal reconstruction, often following trauma or skin cancer.

How does reconstructive facial plastic surgery differ from cosmetic facial plastic surgery?

The lines are becoming blurred and that’s a good thing for patients. For many years, aesthetic surgery was one bucket and reconstructive surgery was another. As such, surgeons put a focus and expectation into the procedure according to which bucket it was in. The thought was ‘at least your cancer is gone, you can live with the deformity.’ Now, however, the two disciplines or approaches have blended. Skin cancer reconstruction has changed based upon what we know about aesthetics. Cosmetic rhinoplasty too is intimately related to functional nasal surgery. We are pulling tricks and nuances from our aesthetic practices into our reconstructive cases and producing a more cosmetically pleasing outcome after reconstructive surgery.

One of the Academy’s main messages to patients has been to ‘trust your face to a facial plastic surgeon’ because these are the experts who are most qualified. Are today’s patients heeding this call?

I very much think this message is resonating. Today’s patients are so unbelievably sophisticated largely because of technology and social media. They can do a lot of homework before they ever meet you and are making more informed choices about surgeons and procedures. The result is that patients are now asking us the hard questions during consultations.

What doe the future of facial plastic surgery look like to you?

Stem cells and tissue engineering will be big. I genuinely believe that in the lifetime of our younger members, so much of what we do and use today in facial plastic surgery will become obsolete. The big nasal reconstructions will be of historical interest only. In the future, a bright engineer will figure a way to use stem cells from a person and seed a perfect, biodegradable, 3-dimenional scaffold and grow a new nose. It may be first grown in an incubator and later implanted into the patient. Once that gets going, we will also begin to use stem cells mixed with growth factors to make new collagen for more youthful skin. We are on the cusp of a revolution.

Is 50 really the new 30 and if so, what does 50 look like in 2014?

I’m 52 and don’t feel old at all. I am shocked at how youthful and energetic so many people can be today.

What is their secret or yours?

In addition to the obvious, such as not smoking, the three things that make a huge difference are: regular exercise, hydration and moisturization. They say eight cups of water a day, but it is really as much as you can drink throughout our crazy days. I always recommend moisturizers to all patients and a sun block with at an sun protection factor (SPF) of 30 or higher.



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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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