The Blog Has Relocated to our New Practice Website

We've relocated the blog to our new practice website. Please follow us at our new location. If there are topics you'd like to learn about please email your ideas to info@weberfacialplasticsurgery.com and we'll get to work on generating new content.

Sincerely,

Stephen Weber MD, FACS
Weber Facial Plastic Surgery, PC

We've relocated and are seeing patients at our new Lone Tree office!

Weber Facial Plastic Surgery has relocated and is open for business! Give us a call at (303) 792-2224 to schedule your next appointment.

9695 S. Yosemite Street, Suite 359
Lone Tree, CO 80124
(303) 792-2224
weberfacialplasticsurgery.com

Check out our Addy for more information and turn by turn directions to the new office.

See you soon!

Steve

Stephen Weber, M.D., F.A.C.S.

Are Blood Clots a Common Problem in Plastic Surgery Patients?

Recent media accounts regarding Hillary Clinton's blood clot have prompted several of our patients to ask what the real risk is of blood clots after Facial Plastic Surgery procedures. 

The good news is that the risk is low for healthy people without any underlying clotting conditions. There exists a perfect storm of factors referred to as Virchow's Triad. The triad includes pooling of blood in the legs, existence of a hypercoagulable state (more clotting) and injury to the inner blood vessel wall. 

Patients undergoing Facial Plastic Surgery procedures can minimize the risk by revealing any underlying blood clotting problems in themselves or family members. Further, depending upon the level of risk of blood clots (referred to as deep venous thrombosis), many maneuvers can be performed to prevent clot formation. These options include minimizing operative time, placing compressive stockings on the lower legs and using sequential compression devices to prevent pooling of blood in the legs. In more extreme cases, patients can be treated with short-term blood thinning medications to further reduce the risk. 

We are vigilant in identifying warning signs such as swelling, discomfort or pain the calf muscles following surgery. However, in our typically healthy population of patients, the risk of deep venous thrombosis is low.

Stephen Weber, MD, FACS
Lone Tree Facial Plastic Surgeon

Buyer Beware - "Illicit Botox Sparks Alert"

Illicit Botox Sparks Alert reads a recent headline in the Wall Street Journal. In the current case, physicians purchasing illicit Botox from outside the US likely received counterfeit medications. It is unclear whether the vials contain Botox and if they do whether the drug is provided at safe concentrations. 

Only MDs in the United States are allowed to purchase Botox from its manufacturer, Allergan. There are illegal arrangements where nurses, estheticians or those with even less training  obtain Botox from an absentee physician and then perform unsupervised injections. This practice is unsafe, unethical and unfortunate. This is, however, increasing in frequency as poorly trained "practitioners" or "injectors" swarm the field of cosmetic medicine and, in some tragic cases, plastic surgery.

Like many ethical issues, these practices result from financial pressure. An ethical physician would never put his or her patients at risk to make a profit. However, there are those physicians and other providers who have decided that offering cut rate injectable treatments (Botox, Dysport, Juvederm, Restylane, Perlane) is the path to a tidy sum. For very good reasons, legitimate FDA-approved drugs are not cheap (hence the higher cost of being treated by a reputable Plastic Surgeon or Dermatologist). 

When the $8 per unit Botox provider realizes that they lose money on every unit injected, there is tremendous pressure to reduce costs. This can sometimes involve overly diluting the medication such that patients receive fewer units of Botox than they paid for. Alternatively, medications can be purchased from foreign companies in India, China and Canada, to name a few. In some cases, there is no active medication in the purchased product. In other, more dangerous cases, there is excessive or non-medical grade product masquerading as an FDA-approved, safe medication. 

I am reminded of a case in which research grade Botulinum toxin was reconstituted and injected by a chiropractor. He injected himself, his (soon to be ex-) girlfriend and another couple. All four survived but wound up in the hospital for prolonged periods due to a ludicrous overdose of the drug. This type of complication is a "never event" and does not occur when Botox is purchased from its manufacturer in the US. 

The take home message is that there is an increasing number of unscrupulous providers entering the practice of cosmetic medicine. There will always be those that look to make a quick buck rather than building relationships and providing exceptional, long-term care to their patients. Warning signs include:

1. non-core physicians (those other than Facial Plastic Surgeons, Plastic Surgeons and Dermatologists) offering cosmetic services. Many among us have seen ads for injectable treatments at their internal medicine or OB-GYN office. A patient of mine was actually offered Botox by his gastroenterologist! 
2. non-physician "injectors" with no physician affiliation are suspect. To reiterate, they cannot legally buy the product they're offering to inject at bargain basement prices. Thus, you must ask where the product came from. 
3. prices that are too good to be true. In fact, they are. 

It is important to note, that fixing bad Botox is much more expensive than having it done right the first time. There is no substitute for exceptional training and experience.

If you would like to discuss Botox or other injectable treatments with a board-certified Facial Plastic Surgeon in the Denver area, schedule a consultation.

Stephen Weber, M.D., F.A.C.S.
Lone Tree, Colorado

What Can Be Done About Aging Hands?

My patients spend countless hours researching the best preventative and maintenance regimens for care of their facial skin. They return like clockwork for chemical peels, Botox and filler treatments. They perform exhaustive online research to evaluate surgical options for facial rejuvenation. Together, we make decisions on what treatments to pursue to achieve their goals. 

The one issue that is often falls through the cracks is aging of the hands. Second only to our face, the appearance of the hands is a dead giveaway of a person's age and the amount of sun damage they've experienced. Most importantly, if we don't address the hands, there is a discordance in the appearance of the face and hands that is noticeable.

So what options are available to rejuvenate and "spruce up" the appearance of hand aging? 

We perform an increasing number of filler treatments to the back of the hands and laser resurfacing of the hands to fill, tighten and rejuvenate the hands. Two syringes of a dermal filler such as Radiesse can be used to fill the back of the hands with several painless injections. The filler is then smoothed and massaged into the valleys between the tendons of the back of the hand to turn back the clock and plump the hands. These results last for over 12 months.

Once the hands have been filled and plumped we perform laser resurfacing to tighten the skin, eliminate irregular pigmentation and eliminate wrinkles in the hands. With the addition of topical numbing cream, this treatment is painless.

Before - Radiesse Hand Rejuvenation

After - Radiesse Hand Rejuvenation

This combination of treatments is safe and effective for both women and men. The treatments have a very high satisfaction rate and represent the icing on the cake that complements all of the effort we put forth to care for our faces.

Schedule a consultation today to learn more!

Stephen Weber, MD, FACS

Dr. Stephen Weber becomes Fellow of the American College of Surgeons

I am really excited to announce that I've been granted Fellow status in the American College of Surgeons. The college has a very rigorous screening process during which they extensively evaluate a candidate's education, training, professional background and competence in their area of specialization. Fellows must be board-certified in their practice specialty and embody strict ethical and professional principles in order to receive the F.A.C.S. designation. Most importantly, this distinction is one more indicator to our patients that they will be well cared for by an ethical and highly experienced Facial Plastic Surgeon.

Stephen Weber, M.D., F.A.C.S.

We've Just Rolled Out a New Website

We've just rolled out a new www.lonetreefacial.com . Please check it out and let me know what you think!

- Stephen Weber, M.D.

Guest on Lisa Linder's Our Community Radio Program / MileHiRadio Denver

This week I had the pleasure of being a guest on Lisa Linder's Our Community Radio Program. I had a great time with Lisa and her daughter Noel. 

We spent an hour talking about facial plastic surgery and all of the cosmetic and reconstructive surgery that I perform in my practice in Lone Tree, Colorado.

We also discussed my past and future humanitarian mission work. We spent alot of time discussing our recent surgical mission with Outreach Africa. We traveled this year to Tanzania and operated on 59 people and saw over 300 in the clinic over a two week period. You can also find photos of the trip on my Facebook page.

I hope you'll take a listen to the interview!

Transconjunctival vs. Transcutaneous Blepharoplasty: What Does All This Mean and Which is Right for You?

First off, what is a blepharoplasty?

Blepharoplasty, or an eyelid "lift", is one of the most common facial plastic surgery procedures performed worldwide. Both the upper and lower eyelids can be "lifted" but I'll focus on the lowers in this post. Lower blepharoplasty most often involves removing a "bag" or bulge of fat from the lower eyelid and, in some cases, removing extra skin from the lower eyelid as well. 

Before transcutaneous lower blepharoplasty.

After transcutaneous lower blepharoplasty.

What are the alternatives to lower blepharoplasty?

The options are few. However, lower eyelid bags can be camouflaged (not removed but covered up) with injectable filler such as Juvederm or Restylane. This should last somewhere between 6-12 months and must be repeated to maintain the effect. Extra lower eyelid skin can also be treated with CO2 laser resurfacing to tighten rather than remove the extra skin. This is a long-lasting result but is less robust than surgically removing that crepey skin.

What is the difference between a transconjunctival and transcutaneous blepharoplasty?

Transconjunctival means "through the conjunctiva" or pink tissue on the back of the eyelid. Transconjunctival blepharoplasty involves a small incision hidden on the backside of the lower eyelid. The fat pockets are visualized and the fat is either conservatively removed or rearranged to eliminate the bag. The incision heals very nicely and should not cause any problems with lower eyelid position if performed by an experienced plastic surgeon. This approach does not remove or tighten the lower eyelid skin. To achieve this a small amount of skin is removed via a separate skin incision under the eyelashes ("skin pinch") or the lower eyelid skin can be resurfaced with the CO2 laser at the same time.

Transcutaneous means "through the skin." Transcutaneous blepharoplasty is performed through a single incision just below the eyelashes. This same incision can be used to remove the lower eyelid bag and tighten the lower eyelid skin. For this reason, it is much more straight-forward to perform the transcutaneous approach. Many patients are concerned about the appearance of an incision in this location. I can tell you it heals very, very well. In fact, I've had several patients ask why I didn't make the incision in this area at their one week post-surgery appointment. I did.... They just couldn't see it, even one week after surgery.

So which is better?

These two approaches to blepharoplasty are just tools. If performed properly in an appropriately selected patient, they are both highly effective. A consultation is required to discuss the option, surgical or non-surgical, that is most appropriate for you.

To schedule a consultation you can reach my office at (303) 788-6632 or email info@lonetreefacial.com .

Your Anesthesia Options

I am often asked what type of anesthesia will be required for Facial Plastic Surgery.

The most appropriate option depends upon the surgery being performed and the underlying health of the patient. I've listed below the options that I frequently employ and a discussion of their pros and cons.

Local Anesthesia

Local anesthesia involves the infiltration of a numbing solution (Lidocaine and Marcaine) that includes some epinephrine (adrenaline) to constrict blood vessels and minimize bleeding. The area is numbed nearly instantaneously. You do feel a "pinch" or "bee sting" but the area that is infiltrated will remain numb during surgery and for three to five hours afterward. Local anesthesia can be combined with oral sedation (Xanax, Ativan, Valium) to provide relief for anxious patients.

This option is most appropriate for small soft tissue procedures:

• Upper Blepharoplasty
• Mole Removal
• Scar Revision
• Skin Cancer Reconstruction
• Earlobe Repair
• Laceration Repair

IV Sedation (Twilight Anesthesia, Monitored Anesthesia Care, MAC)

IV sedation uses safe doses of common intravenous medications to provide procedural sedation. Medications used include Versed and Fentanyl among others. This is often combined with local anesthesia to provide local relief of discomfort and minimize bleeding during the procedure. IV sedation allows a patient to "sleep" through the procedure without the need for a breathing tube in their airway. 

IV sedation is effective for nearly all facial plastic surgery procedures including:

• Facelift
• Necklift
• Browlift
• Upper and Lower Blepharoplasty
• Rhinoplasty
• Cheek Implants
• Chin Implant
• Liposuction
• Otoplasty
• Deep Laser Resurfacing

General Anesthesia

General anesthesia is what most people think of when they refer to "being under" or "being asleep." General anesthesia results in loss of consciousness that requires a breathing tube to be placed to assist the patient in breathing. When performing face or neck surgery, general anesthesia is only required for cases such as reconstruction of severe nasal defects where it is expected that some blood might enter the airway. In these cases, we need a breathing tube in place to protect the airway and maintain breathing. 

While many facilities will perform general anesthesia for Facial Plastic Surgery, this is not required as IV sedation is safe and effective in most cases. 

For further information about your options, call (303) 788-6632 or email info@lonetreefacial.com .

What can be done about my torn, stretched or "gauged" earlobes?

I am always surprised when I encounter a patient in the office who was unaware that torn, stretched or gauged earlobes can be repaired with a straight-forward office procedure.

Patient 1 - Typical stretched
ear piercing.

Heavy earrings tend to stretch the earlobe and widen the piercing. After years of wearing these baubles, women will typically present with a stretched piercing and very droopy earlobes. The stretched piercing will typically not retain small earrings and they will either fall out or point toward the floor!

Patient 2 - Torn earlobe.

Many women will at one point catch an earring on their clothing or a pillow causing the earlobe to tear. The normal healing process will frequently leave a notch in that torn earlobe that will never heal without surgery. 











Likewise, "gauging" the earlobes can result in earlobes that elongate with a large healed hole in the middle of the earlobe. The lobe will never shrink and the hole will not close properly without surgery. Of note, the popularity of earlobe repair among males has surged since the military will not allow men with gauged earlobes to enlist. In cases like these, a thirty minute office procedure enables these young men to enlist and pursue a military career.

Patient 1 - After earlobe repair.

As I've already alluded to, the only option for repair of stretched, torn or gauged earlobes are surgical in nature. However, the procedure is a quick in office procedure that can be performed in the office on the lunch hour. There is no "downtime." The edges of the torn or stretched earlobe are freshened and the tear is then meticulously closed with dissolving sutures. The gauged earlobe presents a special case since the margin of the gauged piercing is typically very delicate. Thus, gauged earlobes are slightly more complex to repair but can still be fixed with a straight-forward office procedure. 

Patient 2 - After earlobe repair.

The incisions heal very nicely and rarely objectionable. Patients with darker skin can form keloid scars but if you did not keloid from the piercing the chances are very good that you will not keloid following the repair (see Patient 2 at right). Infection is very rare after this procedure. Your new earlobe can be pierced in the office three to four weeks after the procedure.

For more information or to schedule repair of your torn, stretched or gauged earlobe call us at (303) 788-6632 or email info@lonetreefacial.com . 

What's the difference between a browlift and a blepharoplasty? Which do you need?

This is a very frequent question in my practice. Maybe my patient saw something on TV or spoke with a friend but they're convinced that they need a specific procedure to rejuvenate their face. This is incredibly common when talking about the eyes and upper face and there is alot of confusion out there.

What is a browlift?

Women tend to have refined, arched eyebrows which sit above the bony rim of the eye socket. Men, on the other hand, tend to have flat eyebrows with minimal arch and their brows tend to sit right on top of the framework of the eye socket. The browlift procedure is designed to lift and reshape the eyebrows. 

Does the browlift procedure differ in women vs. men?

The procedure is technically the same. However, I aim for a refined, arched brow in women and a flatter, less elevated brow in men to maintain the natural cues of a feminine or masculine face. One major mistake for men seeking brow or eyelid surgery is undergoing a procedure with a plastic surgeon who does not frequently operate on men. The result is often a feminized appearance that clashes with the rest of the man's masculine appearance.

What is a blepharoplasty?

Both upper and lower blepharoplasty are frequently performed. This is the most common procedure performed in my practice for women and men. 

An upper blepharoplasty is performed to remove extra skin from the upper eyelid, a small strip of muscle and occasionally a pocket of fat near the nose. This recreates the natural eyelid crease and "opens" the eyes making a person look more rested and more youthful.

Lower blepharoplasty most often involves removing fat that forms a "bag" or a bulge in the lower eyelid. This is typically performed with an incision hidden on the back of the eyelid. In patients with extra skin in the lower eyelid, a small incision is placed below the eyelashes to remove the extra skin.

So which do I need?

Drooping eyebrows AND extra upper eyelid
skin require both a blepharoplasty and browlift.

• If your eyebrows are drooping AND there is extra skin in the upper eyelid when the brow is lifted to its natural position, you need a browlift AND a blepharoplasty.

Drooping eyebrows but NO extra upper eyelid
skin require a browlift only. 

• If your eyebrows droop but there is no extra skin in the upper eyelid when the brow is lifted to its natural position, you need a browlift only. 

Eyebrows in good position but extra upper
eyelid skin require a blepharoplasty. 

• If your eyebrows are in good position but your upper eyelids are full, you need an upper blepharoplasty.

How can I learn more?

Setup a complimentary consultation with me to discuss browlift, blepharoplasty or any aspect of facial rejuvenation surgery. You can reach my office at (303) 788-6632. For your convenience, I have office hours on Wednesday evenings and Saturdays available.

Dr. Stephen Weber Becomes Diplomate of American Board of Facial Plastic & Reconstructive Surgery

The American Board of Facial Plastic & Reconstructive Surgery recently certified me as a "Diplomate" of the  board. This connotes board certification in the highly-competitive field of Facial Plastic & Reconstructive Surgery. At Lone Tree Facial Plastic & Cosmetic Surgery Center we seek to uphold the rigorous standards of the ABFPRS and provide cutting-edge, safe, ethical care to our patients. Both Dr. Schaler and I maintain double board certification in Facial Plastic & Reconstructive Surgery and Otolaryngology and Head & Neck Surgery.

"The ABFPRS credential signifies that your surgeon:   

1. Has completed an approved residency after medical school in one of two surgical specialties focusing on facial plastic surgery (otolaryngology-head and neck surgery or plastic surgery);
2. Is double boarded, having earned prior certification in one of those specialties through the American Board of Medical Specialties or the Royal College of Physicians and Surgeons in Canada;
3. Has successfully completed a two-day examination;
4. Has submitted for peer-review an acceptable record of at least two years’ clinical experience, including operative reports of a minimum 100 facial plastic surgeries;
5. Operates in an accredited facility; and
6. Holds proper licensure and subscribes to the ABFPRS Code of Ethics."

- From the ABFPRS website (11/2/11)