Photo Credit: drmezrow.com
Board certified plastic surgeon Craig Mezrow’s career is impressive. He received a B.S. and M.S. from Emory University in Atlanta, and an M.D. from The Mount Sinai School of Medicine in New York City. He initially entered the field of cardiothoracic surgery, but after a decade, he found his true calling and trained for five years in plastic and reconstructive surgery at the Medical College of Wisconsin. Mezrow went on for additional training in Cosmetic Surgery at the prestigious Manhattan Eye, Ear & Throat Hospital in New York City. He is now in private practice in Bala Cynwyd, located on Philadelphia’s posh Main Line.
Along with breast enhancement, tummy tucks, and liposuction, Mezrow offers a comprehensive nonsurgical menu of BOTOX, fillers, skincare, Intense Pulsed Light (IPL), and lasers. He was one of the first plastic surgeons in the U.S. to offer the UltraShape focused ultrasound device for body shaping, and is also a big proponent of VelaShape to target cellulite and dimples.
He talked to Beauty in the Bag about his love for lasers and light-based devices, the body contouring revolution and where he thinks this field is headed. Here’s what he had to say:
As a board certified plastic surgeon, how and why have you embraced lasers in your practice?
I believe that lasers as well as radiofrequency and ultrasound devices are becoming essential tools in an aesthetic surgical practice. To illustrate this, consider the face and neck lift patient, whom not only has hanging jowls and loose neck skin but also has wrinkles and sun damaged skin. To only perform a face and neck lift without addressing the wrinkles and/or skin dyschromia (pigment discoloration) would be incomplete. Only with a comprehensive approach using light and/or energy-based devices can a complete rejuvenation be achieved. On the other hand, some patients do not wish to have any surgery but instead desire non-invasive treatments to improve their skin color, texture, firming and possibly even reduce regions of excess fat. We now have the ability to address their concerns without employing invasive treatments.
What is new and exciting in the world of body contouring?
Each year, hundreds of the thousands of patients undergo surgical body contouring procedures such as abdominoplasty and/or liposuction. Many desire additional refinements such as reduction of fat deposits without further surgery. For the aforementioned and for those patients who won’t consider surgical modalities, we now have non-invasive treatments. During the last decade, multiple non-invasive fat reduction therapies have been introduced into the United States. Some of these technologies include radiofrequency heating devices such as VelaShape, Venus Freeze, Venus Concept Legacy, and Vanquish. Other devices “freeze” the fat such as Coolsculpting by Zeltiq. Lastly, there are devices that employ ultrasound to destroy fat such as the Liposonix device and the most recently FDA-approved UltraShape device, which is the only non-thermal device in the U.S. market place.
I am very excited about the introduction of UltraShape to the U.S. because this technology uses pulsed, focused ultrasound that is not “cold” or “hot” to selectively destroy fat cells without injuring nerves, blood vessels, muscle, and surrounding tissues. The area to be treated can be individualized, customized, designed to each patients needs. UltraShape is comfortable since it is non-thermal thus not requiring any type of anesthesia. It has no down time, as there is no swelling, bruising, induration, or soreness. With a series of three abdominal treatments performed every other week, a three to six centimeter circumferential reduction can be achieved with visible results as early as two weeks. I also expect to use UltraShape in the near future to treat fatty arms, necks, thighs, etc.
What do you use as your ‘go to’ techniques for turning the clock back?
The most important is the patient’s concerns. After a complete history and examination, we have a discussion about whether the patient desires a combination approach of surgery and nonsurgical modalities or only desires non-invasive treatments. Significant non-invasive rejuvenation and patient satisfaction can be achieved when a combination of treatments are employed using multiple modalities. The treatments may incorporate a combination of lasers, IPL, radiofrequency, and ultrasound devices to achieve aesthetic goals. It would not be uncommon for non-invasive facial and body procedures to be performed on the same day in conjunction with injections of hyaluronic acid-based fillers, polylactic acid and/or botulinum toxins.
Does anything work well for acne scars, stretch marks, and cellulite?
When treating acne scarring, it is imperative to first evaluate the degree of scarring, the patient’s skin type, and the patient’s desires of a single treatment with significant downtime or multiple treatment sessions with little or no downtime. If the patient has a lighter skin type (Fitzpatrick I-III), and accepts downtime, I will perform a single treatment of fractional CO2 laser resurfacing. I have obtained excellent results with Syneron Candela’s CORE CO2 laser. I am very fond of this system because I can perform full ablation and/or fractional ablation with varying settings without changing the hand piece. Full ablation is the complete removal of the skin’s top layers, while fractional ablation involves a controlled wound healing process. The laser places tiny holes or micro channels in the skin which cover a fraction of the total treatment area. This activates the body’s wound healing response, and stimulates the production of new collagen.
For the patients whom do not want significant downtime, I have been extremely pleased with fractional radiofrequency Sublative treatments using Syneron’s Matrix RF. What’s fabulous about this system is the rapid healing, minimal downtime, and the fact that it can be performed on all patient skin types including African American patients. The treatments to improve stretch marks are more complex. It is important to assess if the stretch marks are red, immature scars as compared to lighter, mature scars. While in my opinion, there are currently no reliable treatment options, I have had success using fractional radiofrequency Sublative treatments.
Cellulite continues to be concerning for millions of women. My view is that the technology is improving and hopefully one day, we will have a permanent treatment modality. Syneron’s VelaShape technology has had the longest track record, totaling nearly a decade with four generation of machines to decrease cellulite. Their latest model is the 150 watt VelaShape III, that now has a three treatment regimen protocol. That is reduced from their earlier 20 watt machines requiring sixteen treatments. Another promising newcomer to the marketplace is the Venus Concept Legacy that combines multipolar radiofrequency with electromagnetic energy.
What are your East Coast patients looking for most often and how has that changed in the past decade?
What has changed the most in the aesthetic industry over the last decade is the patient demand, desiring non-invasive, nonsurgical options without downtime for facial rejuvenation and body contouring.
In your view, what is the future of aesthetic surgery?
My opinion of the future of the aesthetic industry is going to be the obvious future demand of non-invasive, nonsurgical, no downtime treatments. I also believe that more physicians are going to incorporate non-surgical modalities with their surgical aesthetic practices.
Photo Credit: aafprs.org
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.
Photo Credit: zoskinhealth.com
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.