Archive for December, 2011

Breast Implants in Chattanooga Tennessee
Before undergoing breast augmentation surgery, it is important to choose the consistency of your breast implants wisely. All implants are not created equally and thus serve different aesthetic purposes. For optimal results, patients should weigh the pros and cons of saline and silicone breast implants.

Saline Breast Implants

Saline, a silicone based shell with a saltwater solution filling, is the most common implant used for breast augmentation. Their firmness is often criticized as being too indiscreet, but some women choose them for that very reason.

Saline implants are particularly ideal for women that possess a significant amount of excess breast tissue. Because the implants are filled during the procedure, the volume can be adjusted so that the excess skin smoothly covers the implant, allowing for optimal fullness and shape. This also allows the surgeon to make a smaller incision, resulting in a smaller scar.

Although saline implants are more affordable than silicone implants, saline implants have a few disadvantages such as a less natural or harder feel and increased potential for rippling. The appearance of rippling is most common in women who lack the tissue needed to support the implant.

Silicone Breast Implants

Silicone implants, a shell of flexible silicone filled with a firm gel, mimic the tissue of a real breast. They are ideal for thin or small breasted women with thin, chest skin. Once deemed as unsafe, silicone gel implants were reintroduced to the market with the approval of the FDA in November of 2006. Since then, silicone implants have grown in popularity and remain supported by the FDA as a safe and effective device when used as intended.

Silicone implants provide a more natural look and feel than saline implants. Although silicone implants are more natural looking than saline and less likely to ripple, they still present some disadvantages like the need for a larger incision and a higher cost than saline. Silicone implant leaks are also harder to detect than saline implants, but are highly rare if used as intended.

For patient safety, it is important to understand that breast implants, whether saline or silicone , are not lifetime devices and must be replaced according to manufacturer ‘s guidelines (typically every ten years). Both saline and silicone implants come in a variety of shapes and sizes which you can view and feel during your consultation with your cosmetic or plastic surgeon.

Whether you choose saline implants or silicone implants, it is important to review the advantages and disadvantages of both devices with your Board Certified Cosmetic Surgeon.

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liquid facelift in Chattanooga, TennesseeAlthough the skin appears tighter after facelifts, balance and youthfulness can be lacking due to volume loss. The goal of volume replacement is to help patients look more like they did 10-15 years ago, not to make them look like someone else. The term “liquid facelift” refers to treatments that can be performed using injectable therapies that require little or no downtime.

Neuromodulators work on the underlying muscles by relaxing them [Botox, Dysport, Xeomin], softening wrinkles [facial fillers] or appearing to lift a certain area of the face. Other therapies add volume [facial fillers, fat transfer].

As the face ages, it loses volume. This causes shifts in the youthful contours and prominent landmarks of the face. Loss of facial fat, muscle, bone and reduced skin elascity leads to folds, lines, jowls and wrinkles – the dreaded signs of age. Facelifts work to return facial structures to the original positions by shifting muscular structures, removing excess skin and re-drape of the skin to carry a more youthful contoured position. However, facelifts carry increased cost, downtime and surgical interventions. Many 40-50 year olds are looking for facial rejuvenation to tide them over until their facial aging mandates a formal surgical procedure.

Tissue Filler Injectables

Tissue fillers are another group of injectables used for liquid facelifts. The most commonly used are Restylane, Perlane, Juvederm and Radiesse. Not all products can be used just anywhere on the face. Depending on the patient’s appearance and the treatment location, one or a combination of these products can be used to reduce the appearance of wrinkles and provide plumping of various facial structures. Hollowing under the eyes, mid face droop, hollow temples and chin sag can dramatically improve with volume. Cheeks can be enhanced to return that heart-shaped, youthful face and to lift the nasolabial folds. Nasolabial folds and marionette lines can be treated with tissue fillers as an adjunct to mid face surgical lift procedures.

Sculptra and Selphyl exist in a category called collagen stimulators. They can be used to add volume to most areas of the face. Each work by stimulating the body’s natural collagen, which helps smooth out the lines and wrinkles. Selphyl uses platelet-rich plasma to trick the body to generate more collagen.


Neuromodulators relax dynamic muscles that create wrinkles as they contract. Areas that can be treated with Botox include crow’s feet. frown lines, forehead lines, neck lines and chin dimpling. Botox can elongate the appearance of the chin and elevate the corners of the lips, enhancing the patient’s smile. A small amount injected in the lip border reduces the appearance of lip lines and can help the lips appear more plump.

Botox injection is the most popular nonsurgical cosmetic procedure today. Improvement of the wrinkles may last up to four to six months. Until recently, Botox was the only botulinum toxin A preparation with a cosmetic indication. Dysport, the first competitor with similar indications was approved in April 2009. Xeomin has now entered the market with lower unit price than that of Botox and Dysport.

Facial balance can be returned using a combination of the products discussed- with little downtime and without major, invasive surgery. Facial injection is an art form and you must choose your artist well. Review before and after photographs and make sure you have appropriate expectations for non-surgical facial enhancement before you present for facial review. Make sure that your aesthetic ideal matches that of your cosmetic surgeon injection artist.

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Melasma is an acquired hyperpigmentation of sunexposed skin areas, or in plain English, “dull brown spots.” It presents as symmetric hyperpigmented spots which can be separated or bunched together along the cheeks, nose, the upper lip, the chin and the forehead, and can occasionally occur in other sun-exposed locations. Melasma spots are dark, irregular brown-toblack patches that gradually, over time, may develop into mask-like patterns.

What Causes Melasma?

The exact cause of melasma is uncertain. In many cases, there is a direct relationship with female hormonal activity because melasma occurs with pregnancy and with the use of oral birth control pills. Other factors related to melasma include “sun” sensitizing medications, mild ovarian or thyroid dysfunction, and certain cosmetics.

Yet the most important factor in the development of melasma is exposure to sunlight. Without the strict avoidance of sunlight, potentially successful treatments of melasma are doomed to fail. Tanning bed exposure has increased the incidence of melasma in the United States. Melasma, though distressing, is a benign process.

Melasma is rare before puberty and most commonly occurs in women during their reproductive years. Although it can affect anyone, melasma is particularly common in women, especially pregnant women and those who are taking oral contraceptives or hormone replacement therapy (HRT) medications. It is much more common in women than in men; in fact, women are affected in 90 percent of cases. When men are affected, the clinical presentation is identical. Melasma does not cause any other symptoms beyond the cosmetic discoloration. However, the facial discoloration can be devastating.

Persons of any race can be affected by melasma, however, it is much more common in people of darker skin types than in lighter skin types, and it may be more common in light brown skin types from areas of the world with intense sun exposure. Melasma is also prevalent in men and women of Native American descent (on the forearms) and in men and women of German/Russian Jewish descent (on the face).

Melasma is usually diagnosed by a physician visually or with assistance of a Wood’s lamp (black lamp). Under the Wood’s lamp, excess melanin pigments in the epidermis can be identified. Some melanin deposits are superficial in the skin while others may be deep in the dermis. The deeper the pigment deposits, the more difficult it is to treat. The discoloration of melasma usually disappears spontaneously over a period of several months after giving birth or stopping the oral contraceptives or hormone replacement therapy.

Melasma Treatment

Treatments to hasten the fading of the discolored patches include; topical depigmentation creams, acid peels, and laser skin resurfacing. Depigmentation creams such as hyproquinone (HQ) can be used directly on the dark spots. HQ is a chemical that inhibits a specific enzyme involved in the production of melanin pigments. Acids ointments are used to increase skin cell turn-over, pushing the brown discolorations to the surface so rapidly that it results in pigment fading. Other acid treatments are thought to decrease the activity of melanocytes or pigment cells.

When topical treat-ments fail, most patients proceed with facial peels using alpha hydroxy acids or chemical peels with glycolic acid. Yet, some of the most dramatic changes in melasma spots have been attained with laser skin resurfacing treatments. In all of these treatments, the effects are gradual and a strict avoidance of sunlight is required before, during and after completion of therapy. The use of broad-spectrum sunscreens with physical blockers such as titanium dioxide and zinc dioxide is preferred over that with other chemical blockers. This is because UV-A, UV-B and visible lights are all capable of stimulating pigment production. Say goodbye to the tan beds! Last, but not least, cosmetic makeup can be used to reduce the appearance of melasma. Melasma, though annoying, has no known relationship to skin malignancy.

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Mini Facelift in Chattanooga, Tennessee

This patient is shown before and after having a Mini facelift in conjunction with a blepharoplasty (eyelid lift) performed by Dr. White.

Degradation of skin elasticity, deflation of facial volume and descent or falling of facial structures are an unfortunate effect of aging. The traditional facelift addresses each of these issues, but with a price: down time and expense. Many men and women 40 to 65+ who don’t wish to look their true calendar age consider facelift procedures to erase sagging jowl s and that loose, draping, wrinkled skin under the chin.

The office-based mini facelift is a mid-range mini surgical facelift to address the mid to lower face. The post operative effect provides a more natural appearance with limited down time when compared to other formal facelift procedures. Most “traditional” facelifts are performed with general anesthesia and involve multiple weeks of downtime and a long incision beginning at the upper temple and extending behind the hairline on either side of the face to the nape. The minimal incision mini facelift, which has been performed since the late 1990s, is the basis for the officebased mini facelift. The mini facelift proves an overall lift to the lower region of the face and upper neck, offering significant age diminishing effects with minimal downtime and lasting results.

Mini Facelift: The Solution for Saggy Jowls and Neck

The mini facelift is designed for men and women who want to stay ahead of the “Ds” of the aging process: Degradation, Deflation, Descent. As we age, most individuals lose elasticity in their skin and develop varying degrees of descent along the jaw line and beneath the chin. The mini facelift not only tightens skin, it is designed to suspend the underlying structures of the lower face and upper neck. This suspension of the lower face offers the benefit of a more youthful appearance without the wind blown look of a formal facelift. This “turn back of time” from the mini facelift will last until the normal aging process resumes for the individual. Lifestyle choices, heredity, bone structure, skin type and sun exposure all play a part in determining how long the mini facelift surgical results will last for each individual.

Mini Facelift: The Procedure

The mini facelift is an outpatient procedure that usually takes one to two hours to perform, depending on age of the patient and the degree of facial correction desired. Oral pre medications are given to help relax the patient, local block is used for the skin. A small, relaxed S-shaped incision is made beginning along the sideburn, extending along the front of the ear, around the earlobe and up to the hair line back from the ear toward the nape of the neck. Great attention is given to the placement of the incision line to provide an inconspicuous scar after healing. Short skin flaps are created with meticulous care. The underlying connective tissues and facial musculatures are gently lifted and tightened using a simple suture technique. The sutures are anchored to dense tissue around the facial bones to suspend the sagging facial tissues. This suspension enhances the appearance of the jaw line andupper neck. The leftover redundant skin is then tailored to match. The incision is carefully closed using plastic surgery techniques designed to reduce tension and minimize any visible scarring.

In some cases, a small incision will also be made under the chin to remove excess tissues; this tuck with liposuction of the neck and jowl area may be performed in conjunction with the mini facelift for optional aesthetic results in the neck region.

Unlike the conventional facelift that may result in a “pulled back” appearance, the mini facelift offers very natural-looking results. Patients enjoy an overall firming of the lower facial area, noticeable jaw line definition and a more elegant neckline. Generally, the results obtained with the mini facelift are predictable and quite dramatic, sometimes erasing five, ten, even fifteen years from one’s appearance.

Board Certified Cosmetic Surgeon Dr. White is considered an expert at the mini facelift. Call 423-648-4011 to schedule your mini facelift consultation.

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Laser resurfacing uses heat induced by laser light to destroy and remove (vaporize) the upper layers of the skin. This causes new skin to grow. It is typically used to remove or improve the appearance of wrinkles shallow scars (from acne, surgery or trauma) and other skin defects. The laser sends out brief pulses of high-energy light that are absorbed by water and certain substances in the skin called chromophores. The light is changed into heat energy, and the heat then vaporizes thin sections of skin, layer by layer. As the wounded area heals, new skin grows to replace the damaged skin that was removed during the laser treatment.

Fractionated CO2 Laser

The CO2 (carbon dioxide) laser is the most common type of laser used for resurfacing. Fractionated lasers are also used frequently and are growing in popularity because they do a similar job, but penetrate less deeply and therefore heal more quickly with little or no down time. Laser resurfacing is usually very precise and causes little damage to the surrounding skin and tissue. It is done most often on the face, but it may be done on skin in other areas of the body like the chest, back and hands.

The areas to be treated by laser resurfacing are cleaned and marked with a pen. A nerve block with a local anesthetic is usually used to numb the area before treatment. You may also be given a sedative or anti-anxiety medication. If your entire face is going to be treated, you may need stronger anesthesia (in some cases, general anesthesia), pain relievers or sedation.

Laser Resurfacing: The Procedure

You may be given goggles to wear to prevent eye damage by the laser. The laser is passed over the skin, sending out pulses. Each pulse lasts less than a millisecond. Between passes with the laser, the skin may be cooled. The number of passes required depends on how large the area is and what type of skin is being treated as well as the type laser used for the treatment. Thin skin around the eyes, for instance, requires very few passes with the laser. Thicker skin or skin with more severe lesions requires a greater number of passes. The pulses from the laser may sting or burn slightly, or you may feel a snapping sensation against your skin. Laser resurfacing is usually done in a doctor’s office or out-patient surgery center.

Conditions Improved by Laser Resurfacing

Laser resurfacing may be used to remove or improve the appearance of:

• Wrinkles

• Superficial scars caused by acne, surgery or trauma that are not growing or getting thicker

• Color (pigment) changes or defects in the skin, such as liver spots (lentigines), port-wine stains or coffee spots. (Any growth that could be malignant should be evaluatedusing a biopsy before laser resurfacing is done.)

In general, laser resurfacing tends to have good results with fairly low risks. Wrinkles caused by aging and long-term sun exposure, such as those around the eyes and mouth, respond well to laser resurfacing. The long-term results for these types of wrinkles are unknown, and you should keep in mind that new wrinkles will probably appear as your skin continues to age. Wrinkles caused by repeated movement and muscle use (such as those on the forehead or along the sides of the nose) may be improved but not eliminated. They often come back months or years after treatment because the muscles continue to perform the activities that caused the wrinkles before treatment.

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