Q. I have many fine lines on my face, mainly on my cheeks.  These lines make me look much older than I am and it is more and more difficult to cover the lines with makeup.  I do not think I am ready for a facelift.  Is there another option to improve the wrinkles on my cheeks?

A. You did not tell me your age so I cannot gauge whether your wrinkles are premature aging due to environmental damage or changes that would be expected.  When I evaluate someone’s face I am looking at the quality of the skin, i.e. how much damage to the skin has taken place related to sun exposure and how much of the problem is related to sagging of the skin due to the effects of gravity.  Sagging of the skin generally requires a facelift.  It makes sense if the skin is sagging that lifting is the treatment (i.e. facelift).  Environmental damage such as brown spots and fine wrinkles of the cheeks and around the mouth are typically treated with a medically directed skin care program to improve the quality and appearance of the skin.  The fine lines generally will not go away with just a skin care program, instead, they usually require laser resurfacing to achieve maximum improvement of the wrinkles.  The laser that is most commonly used, and the one that we use at the Barber Center for Plastic Surgery, is a fractionated CO2 laser.  This laser is designed to smooth fine lines on the face, primarily the cheeks and around the mouth, by creating a controlled injury to the wrinkled skin which then stimulates new collagen formation thereby filling in the wrinkle.  Recovery from laser resurfacing treatment ranges from as little as a few days to up to 10 days, depending on how much power the laser is set to deliver.  The deeper the wrinkle, the more aggressive the laser must be set in order to achieve the desired results.  The treatments can be done under local anesthesia for more superficial skin wrinkles, or general anesthesia, for more damaged skin with deeper wrinkles.  Sometimes a facelift is also recommended in order to restore more youthfulness to the face, but you should see a board certified plastic surgeon to get a customized treatment plan for you.

Q. How long does it take to see the results of fat removal using Coolsculpting?  I have fat mainly around my midriff and would like to shrink it.  What are the potential risks?

A. Coolsculpting is a game changing technology that freezes fat causing the fat cells to die and then be discarded by the body.  The procedure is outpatient and does not require any drugs or anesthesia.  You may drive yourself to the procedure and drive yourself home.  Each treatment will result in about a 22% reduction of fat cells in the area treated.  Most patients require two treatments per area to get desired results.  The typical patient will start to see improvement in as little as a few weeks, however, it takes 3 months for all of the fat cells to be removed from the treated area.  The fat removal occurs slowly and is done by specialized cells in our body whose job is to remove dead cells.  Since most patients need two treatments per site, we recommend a 4-6 week break between treatments with the final results being judged about 3 months after the second treatment.  As for potential risks or complications, there are relatively few.  There are some patients who are disappointed with the final results, mainly because not enough fat disappeared to satisfy their expectations.  Our experience is that about 90% of patients are satisfied with the results.  Another fairly rare complication is the onset of post treatment pain, most commonly on the abdomen, that occurs about 4-7 days following the treatment.  The pain is described as a burning sensation and is likely due to some cold injury to the cutaneous nerves.  The pain lasts for about a week and is treated with either over the counter medication, like ibuprofen, or a prescription of Neurotin®, if the burning is not relieved by ibuprofen.  Only about 1-2% of patients will experience this complication.  The most important predictor of a successful treatment is the correct selection of a patient; that is, using the Coolsculpting device on patients that can be expected to get a good result.  It is not a weight loss treatment.  It is a method to reduce localized areas of stubborn fat that will not go away with diet or exercise.

————————————–

William Byron Barber II, M.D. has been practicing plastic surgery in Greensboro for 20 years and is certified by the American Board of Plastic Surgery.  He is Chief of Plastic Surgery for Moses Cone Health System, and is an active member of numerous local, regional and national plastic surgery associations.

Visit his website at: www.BarberPlasticSurgery.com or e-mail him at: AskDrBarber@BarberPlasticSurgery.com