Dr. Peña Plastic Surgery Blog

Naples, Fort Myers, Bonita Springs, & Estero, Florida

Wednesday, September 30, 2009

Arm Lift Surgery

If you have developed sagging skin in the upper arm region due to lost skin elasticity from aging or massive weight loss, then arm lift surgery might be the ideal treatment to help you achieve a more toned appearance in your upper arms.

During an arm lift, Naples plastic surgeon Dr. Manuel Peña will remove excess skin and fat from your upper arm to create a more toned appearance. It is important to understand that this procedure is ideally suited to candidates who no longer have good skin elasticity. If your skin elasticity is still good, you may benefit more from Vaser assisted liposuction.

The entire procedure can be completed within two to three hours. Dr. Peña will make an incision in your arm near the armpit along the inside of your arm. This will ensure that your scar remains hidden after the surgery is complete.

Dr. Peña uses only the most advanced body sculpting techniques to remove the excess skin and fat from your arms. When this process is complete, he will use Quill sutures to close up the incision site. Quill sutures are absorbable, so you will not have to return to get them removed. After the procedure, you will notice a reduced arm circumference and minimized sagging.

During the recovery process, your arm movements will be restricted while you heal. You will most likely miss one to two weeks of work, depending on your individual circumstances.

To find out if you are a good candidate for an arm lift, please contact our Naples plastic surgery office today to schedule your initial consultation. Dr. Peña serves patients in the Naples and Fort Meyers, Florida area.

posted by Erica at 1:05 PM

Monday, September 28, 2009

Fat Grafts for facial volume

Sculptra can be used to fill a face that is lacking volume. Unfortunately it usually takes about three or four injections over six to twelve weeks to achieve the result that has been proven to 'stick around' for up to three years. The best thing about Sculptra is that it is 'off the shelf' and can be injected when prepared the day before with just an anesthetic cream and ice. The results are gradual and may take up to a month to see. Since the volume is caused by the body reacting to it, everybody gets different volumes per injection. While this is true for fat also because of it's varied take, the desired result can be seen (with a bit extra to allow for some loss) the next day. It is a surgical procedure however and if you have more money than time Sculptra will be a good option. Oh by the way, did I mention that with your own fat cells there are stem cells that can improve the quality of your skin especially in sun damaged or acne scarred skin.

The fat is permanent once the initial three weeks are up. It is living tissue taken from areas that are programmed to grow (abdomen, hips, and thighs). There may be some gradual volume loss from the face as your natural facial fat disappears however.

More immediate 'off the shelf' options are the Hyaluronic Acids, my favorite Juvederm and a recent exciting entry Hydrelle. You see immediate (24 hour results) improvement that stays about one year and probably never returns to the original.

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posted by Manuel M. Pena, M.D. at 2:07 PM

TecnoSurgeons versus Artist/Surgeons

Many years ago I received a csll from a local middle school student wanting to know how she could become a 'laser surgeon'. I laughed and explained to her that the laser was simply one of the many tools we used to accomplish surgical goals. She sounded somewhat disappointed and i never heard from her again. Since that time I have met countless of my patients (new and established) that come in clutching a news article with some new technological advancement. I will gladly take a look and explain why I am or am not currently using that technology. Every year I attend several scientific meetings and try to bring back two procedures or technologies to my practice for evaluation. If I am still using that procedure or technology in one year I consider myself very lucky. There is a helluva lot of hype out there causing poorly trained surgeons to believe that with a magic wand they can become cosmetic surgeons. They have no artistic ability or insight and will simply let a device manufacturer train them. If they are 'well trained', they took a weekend course and took their "Board" online and passed them..


BEWARE of new technology. "All things good were once new, but all new things are not good"

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posted by Manuel M. Pena, M.D. at 7:41 AM

Friday, September 25, 2009

Fillers and Relaxers and PTFE/silicone 'fused' implants

A new system used o harvest large volumes of fat for fat grafting has been introduced. It uses a large sterile container and uses saline to 'cushion' the fat as it is collected (thus the name "Aquavage"). The design also allows ease of cleaning the fat and efficient transfer to the syringes for injection. This is especially useful in larger volume fat grafts such as to the buttocks. The new controversy seems to be if Vaser Assisted liposuction (even at a low 60%) Vaser mode damages the fat cells to a degree that makes them useless as fat grafts.
The Botulinum wars are just starting to heat up with some early competitive pricing by the Dysport camp and some original Botox disciples switching camps! The search for a product that is more effective as a topical agent is closer as the technology to deliver the purified toxin (without the proteins designed to protect in the gut) is perfected. A highly cross linked hyalouronic acid with Lidocaine in it called Hydrelle is coming on strong in the Thick Filler market. We are still waiting for Thin Fillers (for fine lines such as crow's feet and tiny smoker's lines) to make it to the US market. Sculptra has a few more indications and is certainly a good choice if no fat is available of if someone wants a product off the shelf. Too bad no one knows how much volume one is going to get per vial of Sculptra!

Another innovation is the addition PTFE (Goretex) to silicone implants to allow some incorporation or fixation to the implants. This combines the good properties of both while getting rid of the moving/ migrating silicone implant or the 'collapsing/ compressing' Goretex implants. New ideas and new technology. We'll see if they pan out.

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posted by Manuel M. Pena, M.D. at 11:26 AM

Friday, September 18, 2009

Learning about Dysport

Just got to view a detailed web presentation dealing with the science of Bolutinum Toxin type A. The few head to head studies between Botox and Dysport seem to reveal a statistically significant increase in duration of action with Dysport over Botox. Hmmmm? ok. The onset of action seems to be similar and the side effect profile is extremely similar in the larger studies. Therefore my initial hesitancy was because rumors claimed it spread more than Botox thus increasing upper eyelid drooping as a possible side effect. Turns out the numbers are the same. Hmmmm? Why haven't I tried it yet? Well I have enough of both to do my own study and frankly, researchers in this field lie on a regular basis depending on who is funding what. I will have to make my own mind.

The newer studies especially the Dysport studies show higher success with higher doses in those patients with the thicker muscles (men and women with super expressive faces). Remarkably, the complication rate did not increase with the higher dose! This however will prevent me from quoting a 'one price fits all' at least for the glabella.

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posted by Manuel M. Pena, M.D. at 11:49 AM

Weight management update

We are one month into our program. Wow, the results have been impressive. Most of the patients have exceeded their short term goals and are telling everyone about how they did it. Even two patients that went on cruises managed to lose about 1 1/2 lbs in the week. Now, that's tough! We all know that keeping it off will be the hardest part and we use every opportunity to praise the present progress and prepare them for the transition phase and eventual weaning to the Zone Diet/ way of life

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posted by Manuel M. Pena, M.D. at 11:42 AM

Tuesday, September 15, 2009

Hydrelle first look and my experience

Got a chance to try Hydrelle, the latest HA on the market last Friday. It is highly crosslinked (hopefully making it stick around a long time) and has the highest concentration of HA available so far in the US (making it absorb more than 50% of its volume in water thus plumping up the deepest of hollows). The last new twist is that it comes with lidocaine (the injectible anesthetic I often use to numb the areas before injecting the HA's) and this was particularly good because I tried this on myself! I have to admit there was less discomfort than with the previous materials and the swelling was noticeable for about 36 hours. This was probably from all the water being absorbed by the material. No bruising at all but a bit sore for 48 to hard touch. At 4 days I am pleased. Let's see how long it lasts.

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posted by Manuel M. Pena, M.D. at 5:09 AM

weight management and wellness

The patients who have joined our program during the initial 3 weeks have done very well in their quest to shed pounds and get healthy. All but one had elevated cholesterol and most had elevated triglycerides and ldl (bad cholesterol). Some had high blood pressure and one is a type 2 diabetic. I am exited to see their progress as we "follow all the numbers" not just their weight as we approach their goals.

The difficult part will be the transition as we wean them off the program and get them to modify the lifestyle that got them into their present condition of 'unwellness'. I am going to commit my time and my staff's time as well as all the resources we have available to make sure that the individuals that are willing to try will succeed.

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posted by Manuel M. Pena, M.D. at 4:58 AM

Wednesday, September 9, 2009

Lifestyle Lift Busted

Lifestyle Lift the company has been fined by the state of New York for having their employees file bogus "happy patient/customer" testimonials to boost their reputation. Well, I am not suprised. Any company that promises more than it can deliver will need tactics like this to keep the customers coming. If it sounds too good to be true it probably isn't.

I am a pretty fast surgeon and I can't do an "S-Lift" in 1 hour (that is essentislly a Lifestyle lift). I am not in a race .. my only concern is giving you the best surgical outcome with minimum risk and downtime. If you want cosmetic surgery, don't go to McDonald's, ask your physician or ask your friends and visit a plastic surgeon (board certified) who has your best interest in mind and a great reputation to maintain.

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posted by Manuel M. Pena, M.D. at 2:06 PM

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