Ask Dr. Barber

baberpicby Dr. William Byron Barber II, M.D. 

Q.  I am a healthy middle age woman who takes good care of my skin, but unfortunately I have many “smile lines” (wrinkles) on both cheeks.  They are present even when I am not smiling and much worse when I do smile.  They look like parallel wrinkles on my cheeks.  I have been told that there is not much that can be done for them, is that true?


A.  The lines that form around the mouth and on the cheeks have always been a tough problem to correct without surgery.  A facelift, of course, will improve the lines by stretching the skin, but even with surgery the lines that are often described as smile lines will not completely go away.  Chemical peels and laser also have been shown to help, but neither of these modalities will eradicate the lines completely.  There is a treatment that has recently shown some promise in improving the lines of the cheeks without surgery.  This technique involves reconstituting a hyaluronic acid product such as Juvederm® with a local anesthetic (lidocaine) to make the active ingredient in Juvederm® (hyaluronic acid) less concentrated and less viscous.  This change in viscosity allows the filler to flow easier through a very small needle that is injected directly into the wrinkle.  The diluted filler is injected directly into the line until it is flat.  The results have at this point been pretty remarkable, with results lasting up to a year in some patients.  There is some thought that the filler stimulates the patient’s own collagen in the wrinkle and gives longer lasting results than would ordinarily be expected from the filler alone.  This treatment is available at some offices, but as yet, not universally available.  It is just as safe as standard treatment with fillers, the filler is simply being diluted to allow the material to flow into small facial lines.  This treatment has also been shown to give longer lasting results when injecting the deep lines of the forehead.


Q.  I have had two consultations with plastic surgeons for breast augmentation and have been advised to use saline implants by one surgeon and silicone by the other.  I am confused about which type of implant is right for me. 


A.  First of all, you should have asked each surgeon why he (she) made the recommendation for using saline or silicone implants.  He should be able to explain his thought process.  There are several reasons why one implant may be recommended over another, and unfortunately, sometimes the reason is as simple as the surgeon likes a particular implant better.  This is not always the best reason to chose a particular implant.  There has to be some scientific thought process why one implant is advised over another.  For example, in my practice, I will advise a patient on a particular implant based on how much natural breast tissue she has.  Determining how much breast tissue is present is a simple calculation performed by gently pinching the breast with calipers to measure the thickness of the breast tissue.  If there is more than 4 centimeters of breast tissue, then it really does not matter which implant you choose because in my experience, the results with silicone or saline will be equivalent.  If on the other hand, there is less than 4 centimeters of natural breast tissue, you are probably a better candidate for silicone gel implants.  The reason for this is that saline implants can sometimes form ripples that are visible through the skin if the breast is very small and does not cover the implant well.  Of course a patient can choose whichever implant she wishes, but you should be advised about how to make a well informed decision.


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

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