Cosmetic Dermatology

Cosmetic


What is esthetic eyelid surgery (Blepharoplasty)?
Aging and gravity lead to skin loosening and sagging in the eyebrows, upper and lower eyelids, as well as herniation and pouching of fatty tissue. This results not only in an unpleasant appearance in esthetic terms, but also reduced vision due to the sagging of the upper eyelid. Esthetic eyelid surgery removes the excessive skin, strengthens the membrane in front of the herniated fatty tissue, and / or takes out the excessive fatty tissue. As such, one achieves a pleasant appearance as well as more comfortable vision. The operation leaves a trace along the upper eyelid; however, this trace will be shaped along the natural curve of the eyelid so as to be visible only at a very close distance. As for the lower eyelid, a trace appears just below the eyelashes, but it seems like the continuation of the adjacent natural line on the skin. The eyelid is a part of our body where the lightest of traces will be left after an operation.

Who are eligible for this operation?
Potential candidates are individuals above 30 years of age, who have sagging and pouching in their upper or lower eyelids, and do not have other health issues.

Surgery
The surgery is performed in an hospital’s operating room, under the supervision of an anesthesiologist. Local anesthesia and intravenous sedation are opted for. Depending on the complaints of the patient, surgery may be applied to only the upper lid, lower lid, or both of them at the same time. The operation takes 1-1.5 hours on average, and patients may go home the same day.

After the surgery
The aftermath of the surgery is usually quite comfortable, although there may appear some swelling and bruising around the eyes, as well as dryness, a burning sensation, and blurred vision. Tears may increase, eyes may become sensitive to light for a while. The patients may not be able to fully close their eyes in the first days; however, these are normally expected symptoms that will go away within the first week. The stitches are removed after 3 to 5 days.

Return to normal life
The operation yields positive results; a revision (a second surgical intervention) may be necessary only in very rare cases. Individuals may resume work after three days, and restart using their contact lenses, if any, in one week. Since the new shape of the eyelids will be affected by gravity, it may last a number of years or throughout their lifetime, depending on patients’ constitution.

What is a facelift or facial rejuvenation surgery?
Facelift (rhytidectomy) is a surgical method that removes facial sagging and wrinkles by means of stretching and suspension. However, in recent years, all anti-aging operations on the face have started being categorized as facial rejuvenation.

As individuals get older, as a result of sun rays, daily stress, and other factors (smoking, alcohol, unhealthy eating), the facial skin may sag and wrinkle, and scars and irregularities may appear. An aged face is marked by prominent forehead lines, lower eyebrows, sagging eyelids, pouching and lines under the eyes, deep creases around the mouth and nose, sagging cheeks, invisible chin contours, a fatty neck, and saggy skin. The skin loses its lustre, becomes thin, wrinkly, and spotted with sun scars and other types of moles.

A plastic and esthetic surgery procedure, the facelift operation is also known as rhytidectomy. Facelift and facial rejuvenation operations remove the sagging and irregularities on the forehead, face and neck skin, take away the excess fatty tissue on the cheeks and neck, pull and suspend the facial fascias and fatty tissue on their anatomically correct location, strengthen facial tissues, correct eyelids and perform other complementary interventions (skin exfoliation-peeling, dermal filler, botox, etc.)

Facial rejuvenation operations
– Forehead lift
– Brow lift
– Cheek (central face) lift
– Neck lift
– Liposuction
– Esthetic eyelid surgery (Blepharoplasty)
– Esthetic nose surgery
– Other corrective surgery (removal of skin lesions, dermabrasion etc.)

Facial rejuvenation esthetics
– Dermal fillers
– Fat injection: For lips, cheeks and facial contours
– Synthetic filler material injections: Wrinkles, lips and small irregularities
– Peeling, chemical peeling, mechanical peeling = dermabrasion, laser peeling (laserbrasion)
– Botox: For wrinkles on the skin
– Cosmetic product applications
– Peeling with cream at home, lightening skin tone, activation of skin renewal

Esthetic nose surgery (rhinoplasty) or the nose reconstruction operation is the most common esthetic surgery procedure. An esthetic nose operation may diminish or enlarge your nose, change the shape of your nose or its tip, reduce the width of your nostrils, or change the angle between your nose and upper lip. At the same time, it may correct a congenital or injury-induced deformity or eliminate problems related to breathing.

Esthetic nose surgery can enhance your physical appearance and increase your self-confidence. However, this does not mean that surgery will change your facial appearance into exactly what you had imagined, or that other people will treat you differently after the surgery. Before deciding on a surgery, you need to ask yourself why you want to have an operation and what you expect from the surgery, think about it at length, and discuss all of your questions with your surgeon. The most suitable patients for esthetic nose surgery are those not looking for perfection, but expecting a more pleasant appearance and an improvement.

Complications (unwanted consequences) are rare and often negligible when the esthetic nose surgery is performed by an experienced plastic surgeon. Despite everything, there is always a possibility of complication, such infection, nasal bleeding or reaction against anesthesia. If the open technique is used or if large nostrils need to be reduced, there may remain very small and thin marks on the nasal floor, which are almost invisible.

What is an esthetic breast lift operation? Who are eligible for this operation? Breasts may start to sag for different reasons. The ligaments holding the breast tissue in place may start to loosen in time. Due to weight change, breastfeeding or gravity, there may appear a disharmony between the breast tissue and the surrounding skin membrane. The problem may arise from the breast tissue, skin or both. The result can be a sagging breast that appears almost empty.

What is breast reduction surgery? Who are eligible for this kind of an operation? Although it is generally thought of as a cosmetic operation for enhancing a women’s external appearance, in fact, the esthetic breast reduction operation is reconstructive, and not esthetic surgery. Large and saggy breasts may cause neck and back pain as well as incorrect posture in women. The brassiere may place pressure on arm nerves and lead to numbness. Difficulty in breathing is another possible symptom. The friction between the breast skin and the chest skin may lead to rash and scars below the breasts. Day-to-day physical activity may become hampered.

Furthermore, large breasts may cause problems in choice of clothing, and a woman may experience social and psychological issues when she is not pleased with her appearance. A breast reduction operation gives a natural appearance to the breasts, eliminates the aforementioned problems, and makes life easier for women. Breasts may be large for a variety of reasons. Genetic factors, hormonal change or certain disease may result in large breasts that are not in harmony with a woman’s overall physical appearance. Weight changes, breastfeeding and gravity may further aggravate the problem. Young girls may also experience an augmentation of breast tissue and end up with large breasts as a result.

What is Breast Augmentation Surgery?
For centuries, the breasts have been considered a symbol of feminine beauty. Breast volume is of importance in esthetic measurements such as shoulder or chest width, and waist and hip circumference… Breasts may be small for various structural reasons. Alternatively, one breast may be smaller than the other, resulting in an asymmetrical appearance. Some individuals may genetically lack one breast. The most widespread contemporary method for rendering the two breasts equal or for enhancing their volume is a silicone implant. There were attempts to perform breast augmentation operations with an individual’s own tissue, yet these yielded limited results. For instance, it is possible to obtain some fat tissue from an individual, and then to partially augment the breasts by means of hyaluronic acid or stem cell methods. However, fat filling is not a permanent method. The main substance of a breast implant is the silicone or saline solution, which forms the outer layer of the implant. New generation non-liquid silicone (cohesive gel) has become the most popular implant in our day. Each type of implant presents various advantages and disadvantages. It is necessary for the patient and physician to discuss this issue at length prior to surgery and reach a joint decision as to which product should be employed.

What is a Silicone Breast Implant?
Silicone products are used for various purposes in the cosmetics industry and medical science. A breast implant is a shell shaped like a breast. There exist round implants, as well as anatomic ones shaped like a teardrop. The shell is filled with silicone and the implant has an uneven surface so as to adapt to body tissue. The shell may include different types of filler material. The following breast implants are used today: a. A silicone gel-filled shell covered again with a silicone outer surface. These are manufactured as ready-to-use products in different sizes. In the USA, the Food and Drug Administration has given its approval to these products in November 2006. b. An empty shell, which may then be either gel-filled or saline-filled: During the operation, the shell is filled with saline solution until it reaches the desired volume. In recent years, ready-to-use shells have also been manufactured. c. PVP: In this type, the silicone shell is filled with a chemical substance called PVP (polyvinyl pyrrolidone povidone). It is gel-like and ready for use. The manufacturing company has withdrawn this product from the market. d. Soybean Oil: These are ready-to-use implants, where the silicon shell is filled with soybean oil. They have started being used at a recent date and there is no information on their long-term effects.

Botox, or botulinum toxin is a neurotoxin produced by the bacterium Clostridium botulinum. In Latin, toxin means poison. Naturally, any toxin may become harmful when administered incorrectly or at the wrong doses. Yet it is harmless when used properly, and for therapeutic purposes. As with any medication, Botox has side effects. There may appear a temporary pain lasting a few days after the treatment. Occasionally, in the aftermath of incorrect administrations affecting the nerves that connect to the muscles, there may be temporary strength loss in the arms.

Furthermore, it is not recommended for individuals allergic to this medication, in pregnant women and patients with muscle disorders. It should not be used together with antibiotics and muscle relaxants.

The botox treatment is used for eliminating wrinkles arising from facial gestures, for lifting the brows, and for reducing any facial sagging. It is a short and painless treatment. Botox is injected under the skin by means of small syringes.
Botox is the most common cosmetic method used in the treatment of wrinkles. After the injection, the effect appears in 1 to 10 days and lasts for an average of 3 to 6 months.

In recent years, filler injection is among the major anti-aging and treatment methods for creating volume, ensuring moisturization and eliminating wrinkles arising from acial gestures. Furthermore this is a very effective method in rejuvenating the back of the hand. It is also used for lip augmentation so as to achieve a more attractive appearance. Following dermatological assessment, it is necessary to create a personalized treatment scheme for the patient and to choose the right dermal filler. The dermal filler to be used must be FDA-approved (Food and Drug Administration) and certified.

The dermal filler to be applied comes in different types such as very thin, autologous, synthetic and biological, whose durations can be classified as follows:
Short term (less than 3 months)
Medium term (3-12 months)
Long term (12-24 months)
Very long term (over 24 months)

Hyaluronic Acid
Calcium hydroxylapatite
Polymethyl-methacrylate
It should be injectable with silicone needlepoints or special cannula.

The ideal dermal filler should
Not be allergenic
Be easy to procure and apply
Not be toxic or carcinogenic
Be stable
Be officially approved
Present a natural appearance
Not interfere with biological functions

Dermal filler techniques
Serial puncture technique
Tunneling technique
Fan technique
Crosshatching technique

Medical skin care consists of treatments using dermocosmetic products for reinvigorating the skin, and eliminating fat, blackheads or makeup residue which give the skin a pale appearance.

In medical care, the first stage is conducting a skin anlysis to determine the requirements of the skin.
The skin is cleansed of fat, makeup residue and similar elements so as to create a healty environment for herbal peeling. Dead skin cells are removed so as to prepare the skin for a light peeling treatment employing herbal dermocosmetic products.

Steam therapy helps open up skin pores and softens the skin. Once the blackheads and whiteheads are removed, the skin undergoes deep disinfection by means of high frequency treatment.
Skin care treatments end with a moisturizing and nourishing care mask. If deemed necessary, additional care or treatment methods may be employed during the process, depending on the type of skin.

Another much discussed issue is anti-aging, or preventing the effects of aging, which has recently become a hot topic as individuals attach increasing importance to attaining a beautiful appearance. Our skin starts to age gradually when we are in our 20s. On the faces of our parents, for instance that of our mother, we can partially see our own future, and the aging process of our own skin. We can more or less keep track of our own aging process with questions such as, When did my hair start to go white, when did wrinkles appear on the skin and around the eyes, how deep are my wrinkles?, etc. The idea, “The later I use anti-aging products the better it is” is quite off the mark! It is best to start using skin care products without too much delay, because when our wrinkles become more numerous and deeper, longer and more expensive treatments might become necessary.

Facial lines, expanding pores, sagging and a lacklustre skin are some of the skin problems we experience after the 20s. We tend to think that our skin will always preserve that same spark, but unfortunately start running into problems as years pass by, especially in tranisitional periods. I believe that, around the age of 25, we need to start taking better and more conscientious care of our skin, and avoid using any product right off the shelf without learning about their ingredients and effects, or even testing them at first. Different age groups need to use different cleansing and moisturizing products. We need to pay special attention to the area around the eyes, since that is where the first signs of aging appear, and in remarkable fashion. We need to be mindful of our nutrition and facial gestures. We should opt for natural food and avoid saturated fat, caffeine and fast food. Consuming fish is ideal for obtaining skin-friendly Omega3. Drinking large amounts of water every day is another must. Aside from the age factor, external factors such as excessive makeup, sleeping with makeup on, not using the correct makeup removers, or not cleaning the skin around the eyes properly may also contribute to the creation of wrinkles. Skin creams are effective when the lines are thin, and may postpone the effects of aging. Using antiaging methods at a younger age help us take preventive measures; as such, you should avoid thinking, “The later I use them, the better it is.”

In choosing the right skin care product, what is important is not opting for the most expensive product, but rather identifying the product best suited to our skin type and age. In our mid-20s, the synthesis of the collagen protein found in our skin tends to slow down. As a result, soft wrinkles and thin lines start to appear on our face. This period is dubbed the preliminary aging period. In our 30s, the moisture level of our skin starts to drop, and the thin lines start to become more prominent. Skin dryness causes the skin to appear more lacklustre. We need to apply stronger antiaging treatments to our skin in our 30s. In the 40s, the pace of collagen synthesis in our skin falls sharply. This is when skin care needs to be initiated in earnest. It is the ideal time to start employing effective anti-aging products.
We give priority to antioxidant products, retinol vitamin A, vitamin C, hyaluronic acid, peptids, alpha-hydroxy acid, as well as serums and creams with niacinamide. Dermocosmetic products are especially beneficial. In this vein, the dermocosmetic products suggested by our dermatologists, which do not contain allergenic ingredients and do not have comedogenic effects, are particularly effective.

Peeling is the exfoliation of skin. The human face and body are subjected to dust and dirt throughout the day. As dust and dirt penetrate the skin, the pores are blocked, leading to the formation of acnes and pimples. Furthermore, a layer of dead skin cells appears. Peeling is precisely the technique for preventing these phenomena. Thanks to peeling, the skin gets rid of the dead cells and becomes rejuvenated, and the formation of acnes and pimples is avoided.
Peeling is also used as a treatment method for scarred skins, dry skins, and skins with pimples or wrinkles. As such, the skin restores its lustre. It regains its previous healthy state and is cleansed of comedos and dead cells.
Peeling is not applied only to skins with acne problems. Lighter peeling techiques may be applied to rid the skin of dead cells and grant it a healthier appearance.

Platelet-Rich Plasma (PRP) tubes include a separator gel, which separates the blood in an efficient manner and concentrates as many platelets within the plasma as possible, as well as anti-coagulant material. Moreover PRP treatments are performed with the addition of materials such as CACl, batroxobin or trombin, which are called activators. Nevertheless, recent scientific research has shown that such activators are not necessary; clinical studies extended over a three-month period suggest that there is no difference in terms of therapeutic results. Following an effective PRP treatment, the effects appear in two weeks, become quite prominent by the end of two months, and recovery lasts until the end of the sixth month. A filler effect can also be created by adding CaCI to the plasma generated from PRP, and furthermore, additional CaCI yields more efficient results in the treatment of orthopedic problems. Likewise, there are PRP tubes featuring hyaluronic acid, and as such PRP and filler treatments can be combined.

In effective PRP therapies, prior to the administration of PRP, a dermaroller application (microneedling treatment) is highly recommended in order to accelerate blood circulation and enhance the efficient distribution of the plasma in the affected tissue.

FTC (Fine Thread Contour) therapy is a non-surgical treatment for face lifting, reinvigoration and rejuvenation purposes. Due to gravity and aging, the thin lines that develop on our faces start to get more profound over time, especially due to unhealthy eating habits and frequent weight gain and loss. All this process results not only in the formation of lines in the facial area, but also to the sagging of the cheeks and the chin, giving the face an increasingly oval shape. Looking at older pictures is generally sufficient to realize the transformation of one’s face. Precisely at this point, the FTC – Fine Thread Contour technique is employed to provide solutions to your potential skin problems, as a non-surgical skin rejuvenation treatment, which provides an alternative to esthetic surgery. The treatment is performed under local anesthesia, by the placement under the skin of absorbable threads at a specific thickness. Its effect starts in the first month and last as long as three years. As a comfortable application without any complications, it allows individuals to continue their daily lives as before.

PRP treatment also yields positive results when combined with mesotherapy. It is indicated that the PRP method, 15 days after its administration, should be supported with 4 to 6 weekly sessions of mesotherapy, especiall in hair and anti-aging treatments.

How is the material used in the fibrocell method obtained? First of all a tissue, 2 to 3 mm in diameter, is taken from behind the ear and sent to a laboratory. The fibroblasts obtained from this tiny piece of skin are multiplied within 3 to 6 weeks, and this newly generated material is utilized in the second and third sessions. The production in the laboratory continues after the first application to the skin, and the newly created solutions are employed in the second and third sessions. First of all, the application area is numbed with topical anesthetic creams. At every session, 20 to 40 million cells are introduced to the skin. At the end of three sessions, which generally come in monthly intervals, the therapy is complete. Although the first effects appear comparatively later than in the other methods, the improvement, lustre and reinvigoration becomes more and more apparent from 6 to 24 months, resulting in a visible reduction of wrinkles. The result is a radiant, lively skin with much less wrinkles and sagging.

As years pass by, fat unfortunately starts to accumulate in our cheeks as a natural course of events. With its lipid melting capabilities, Aqualyx® treatment entails the breakdown of excessive fat. Dihydroxycholansäure, a medical device which administers the active ingredient of the lipolysis procedure to break down fat through syringe, has been approved for Europe. The active ingredient penetrates through the membranes of the fat cells and dissolves in fat. Aqualyx® is injected into fat tissue without any pain. It is not necessary to apply anesthesia to the injection areas; however, in very sensitive patients, it is possible to combine Aqualyx® with local anesthesia. The treatment may lead to mild swelling and rash, as well as a slight feeling of pressure. Excessive heat in the form of solarium, sauna, steam baths, etc. and sports must be avoided for three days. Three sessions, with intervals of at least 21 days, take place, and in general, the results start to appear 3 to 4 weeks after the second or third session.