Dr. Ellenbogen's Plastic Surgery Blog

Plastic surgery abroad: Avoid a botched procedure

Wed, 10/01/2014
Plastic Surgery Abroad
Plastic surgery abroad: Avoid a botched procedure

By Ron Robinson

Whenever I hear that someone has gone abroad to receive plastic surgery of any kind (tummy tucks, breast implantsfacelift, the works) I automatically cringe. Mainly because those people flocked to another country without doing a large amount of research and decided on their surgeon due to the allure of cheaper rates. Cue horror story; a boat of tears; and sadly, some serious health issues and complications.

You think you’re saving money?

Is something as serious as invasive surgery worth risking your life to save a few bucks? You end up spending even more money to fix the damage that has been done. According to one board-certified physician, what he sees go wrong with many facial surgeries either done poorly here in the states or abroad are various complications including scarring (from hiding an incision poorly placed, most commonly seen in Mexico and South America), issues with symmetry (like the use of silicone or plastic for rhinoplasty in Asian countries), nerve weakness, and more.

But probably the most common plastic surgery mishap abroad has to deal with breast implants (one of the most popular plastic surgery procedures). Whether they were not placed properly orindustrial-grade instead of medical-grade silicone was used, the cost of fixing those mistakes can weigh heavy on a person’s wallet and health. Last year, PIP implants from France were found containing lower-grade silicone that could lead to rupture or inflammation. These implants are not FDA-approved and cannot be used in the United States.

What about follow-up care?

According to an Orange County plastic surgeon, people think they are getting a good value for surgery overseas. What people have to keep in mind about plastic surgery is that it isn’t a one day ordeal. There are plenty of post-surgery visits to consider, if you want to heal properly and without infections.

“In my practice, patients are seen one day, one week, one month, and three months after surgery,” he explains. “This allows time for the doctor to assess them and make sure everything is progressing normally. It’s also the time for patients to ask the surgeon questions. This is possible over the phone, but the fact is you get more information when the surgeon is in front of you doing a live assessment.”

Opting for surgery done outside of your country means you won’t be able to follow-up with your surgeon easily, to ask questions, take care of any infections or use your insurance to cover the cost (if at all possible). You’re pretty much left on your own, hoping that nothing goes wrong, or paying more money to fly back and forth to consult with your surgeon. It just doesn’t seem worth it.

DIY is not an option 

Botched plastic surgery doesn’t have to deal with just invasive procedures, but can involve non-invasive as well. One show that is bringing to light the dark side of plastic surgery is the Entertainment Channel’s (E!) new reality show, Botched, which gathers cautionary tales of bad plastic surgery and corrects them.

You’ve heard about the monolid, which many women from Asia wish to fix by having double eyelid surgery, but some are using eyelid tape or odd DIY contraptions Well, one woman on the show had a botched “eye westernization” procedure, then went one step further by purchasing fillers off the black market and administering them into her cheeks herself. If you haven’t seen the episode, you can imagine how concerned the doctors were.

Injecting the body with unknown substances can lead to horrifying results These stories are rampant in the US as well as outside the country, but since regulations and sanitary standards may differ from country to country, it’s best to be extra careful abroad.

Safety first

If you do decide to have plastic surgery abroad, remember that not all foreign surgery procedures are bad. You just have to do your research and ask yourself some simple questions before boarding that plane. Smart Beauty Guide has some great Guidelines for Cosmetic Surgery Abroad that can help you plan for a safe procedure and limit your risks.

Concealers unveiled: Last minute skin fixes

Wed, 10/01/2014
Concealers unveiled: Last minute skin fixes

By Jo-Lynne Shane

There’s a fine line [pun intended] between all of the concealers on the market. How does an everyday person navigate all of the options and get the right fit for their skin issues? The answer can be easy if you know a few tips to decipher the differences between the concealers you find in the drug store or big box beauty product shops. It comes down to consistency or viscosity of the product you’re using. No two concealers are created the same, but the consistency of a concealer can be the trick to covering your skin imperfections.

A few tips to applying concealer: 

1. Apply concealer to your trouble spots AFTER application of foundation, BB cream or other facial makeup. I learned this from a pro. Concealers work better when they have something to adhere to. In other words, it doesn’t stay long if applied to “naked” skin. Once you’ve applied your concealer, set it with loose powder. This method gives you the best chances of having your concealer last longer.

2. Blending concealer to look like it isn’t there is best done with a dab of the finger, not a brush. Keep dabbing until the concealer is properly blended into your skin. Most importantly, if you are putting it on under your eyes, use a very light dabbing technique because that skin is delicate and needs a delicate touch. Your ring finger is the best for under eyes.

3. A concealer brush is the next best thing to your finger and can work wonders. Invest in a good one and it will be your friend for years to come. When using a concealer brush under your eyes be mindful of how delicate this skin is, and use your brushing motion with a lighter touch.

4. Conceal in layers. In other words, don’t cake it on at first. Put a little on dab, see if you need more, and add a little more dabbing again. Layering allows you to use the least amount possible without looking cakey.

Concealer types:

• Thick cake-like concealers – I’ll be honest these are the toughest to use as far as knowing when enough is enough, however these conceal the hardest to conceal. A great example of this is Benefit’s Erase Paste The name gives a pretty good idea that this is a thicker concealer. In this case, a little goes a LONG way. For this concealer, consider using a make up sponge or make up blender to blend it into your skin.

• Liquid concealer – a liquid concealer is what I would deem the quick coverage answer. Essence makes a 16-hour concealer that is not expensive but does the job in a pinch. I keep this in my purse at all times so if I’m running around and notice something I’d like to keep under wraps, I dab a little on and voila! I have coverage in a quick fix. Note: if you have oily skin, these do tend to last a shorter time. Liquid and oily skin are not friendly [in most cases] when it comes to staying power.

• Stick and crayon concealers – this is the in-between concealer and the best choice for all around daily use. I have tried many and find the consistency of the L’Oreal Blendable Crayon Concealer?shade=Fair-Light-N1-2-3 to moisturize and conceal. Think of this as a thicker version of your face makeup. It’s great because it can be easiest to work with and use on all of the facial imperfections you’d like to cover.

• Neutralizing colors – I’m sure you’ve seen the green concealer and thought, Why would I put green on my face? Believe it or not, it is great to conceal the redness associated with acne. Pink concealers are great at hiding those purple under-eye circles on fair skin. If you have olive/yellow-undertones, have no fear, a yellow concealer does wonders for your under-eye issues. Blue concealer is great for overdone tans or sunburns. Purple concealers are great for age spots. The Mehron Pro Color Ring Neutrolizer gives you all of the neutralizing colors in one palate. Use these colors under the concealer to make your concealer truly effective at giving you an even skin tone.

When you get to a point where every over-the-counter concealer you’ve tried just isn’t cutting it, there are more permanent options that will allow you to throw away most of your concealers and have younger looking skin.

• If you can still see the scarring or dark spots on your face despite all of the concealers in your arsenal, try dermabrasion. This will replace your current scar tissue with a new layer of skin that can eradicate or minimize the appearance of scars and uneven skin tones.

• For those of you who have uneven skin, not in color, but in evenness of the surface of your skin, a chemical peel will resurface your skin to a smoother layer. It creates a youthful appearance and evens out the marks or fine lines you are seeing.

• Looking to reduce the sun damage you can’t quite cover with over-the-counter concealers, look into laser skin resurfacing. This treatment is a bit less invasive in that there are lasers used to remove those upper layers of skin.

We all have imperfect skin. The key to looking flawless is knowing the right products to use and how to use them. When all else fails, your surgeon can offer expert advice on the best treatment options for your particular skin concerns.

Be smart about beauty: Get back to the basics

Wed, 10/01/2014
Plastic Surgery, Cosmetic Procedures, Beauty
Be smart about beauty: Get back to the basics

By Mary Cunningham

I sum up “Smart Beauty” in four short phrases because beauty is elemental. It’s basic. It’s less about putting on, and more about exposing the raw materials, artfully.

Self Care

My first beauty basic - do what I can do on my own.

Whether that’s using the beautifying power of a good night's sleep or a diet that’s filled with vegetables and lacking in artificial ingredients, I take personal responsibility for my health and do what I can to reverse the aging process naturally. With a power combo of fitness, hydration, rest and meditation- fine lines and “angry 11’s” be gone!

Another smart beauty biggie: prevention. That means reminding myself to apply moisturizing SPF on both my face and my neck. …and the backs of my hands!

Self Knowledge

Knowing my body and loving it. This starts with being honest with myself about what my best assets are, and learning makeup skills and fashion tricks to let them shine. It’s fun to discover which stylish silhouettes accent the best part of my body and diminish those I don’t feel like flaunting. Same goes for learning how to apply a great concealer and highlighter so that I radiate. If anyone asks, I let them think it’s the meditation and green smoothies at work!

Going deeper, self-knowledge also means knowing the difference between a unique quirk and a blemish that causes me pain- physical or emotional. Working to love my quirks, the fewer pain points I have. There is no magical beauty tonic, but there is a transformative power in loving myself more.

Information Gathering

Then it’s time to gather facts. ALL the facts. I do this before purchasing a $10 cream, let alone proceeding with anything more substantial. For products, I want to know what's inside: are there parabens? Sulfates? Formaldehyde?!

And what about the company behind a product? Do they value my health or do they use trendy marketing claims just to sell product?

If I were to consider something more in-depth, then I need a lot more information. I want expert research on the procedure, the recovery time, and the projected effects on my body in 6 months, and for the next twenty years. What are the surgeon’s certifications? Is he/she an expert in the field? What’s their bedside manner like? Perhaps most importantly, do I trust them?

Having as much information as possible lets me feel confident in my choices. From products to procedures, a savvy consumer is an empowered and sexy consumer.

Attitude and Action

Smart beauty is radiating inner kindness and taking the actions to treat others well. When I was younger, I didn’t quite understand the phrase “beauty is only skin deep and ugly is through and through” because I always understood that beauty is holistic. If I don’t like what’s on the outside, I start by changing what’s on the inside.

Smart beauty isn’t complicated- it’s just being smart about how beautiful we already are.

Body contouring treatments: Friend or foe?

Wed, 10/01/2014





Untitled Document

Body Contouring
Body contouring treatments: Friend or foe?

By C.A. Shenigo

The health and beauty market never seems short of get fit quick treatments, procedures and gadgets, and at no time during the year are we ever more hopeful that they’ll work than now — bikini season.

From rapid weight loss pills to cellulite removing treatments, there’s always a new “next big thing” gunning for your hard earned dollars. And more often than not, those same “miracle” treatments lead consumers down the too-short emotional trail from “hallelujah” to “I’ve been had.”

This may come as a surprise (#sarcasm), but some noninvasive body contouring treatments may exaggerate the effectiveness and results of their products. A recent article in The New York Times focuses its laser beam on one such product called the Lila Strawberry Laser. Recently featured on a Rachael Ray Show segment, the Strawberry is seen being strapped onto a test subject named “Candace,” where low-level laser diode panels do what they do for 20 minutes. The on-air result, according to plastic surgeon and scientific adviser to the company that distributes the device, Dr. David E. Halpern, is an eight inch weight-loss off of her circumference. Eight inches in 20 minutes? *studio audience goes wild.

The product heavies claim that these results are typical. But others say “not so fast.”

While that Strawberry Laser has been cleared by the FDA to “reduce the waistline temporarily (I smell a key word),” it is raising skepticism from medical experts like Dr. Mark L. Jewell, a plastic surgeon in Eugene, Ore., and former president of the American Society for Aesthetic Plastic Surgery. “It defies reasonable thinking that in 20 minutes you could lose eight inches,” the good doctor told the Times, noting that “low-level laser devices are unlikely to result in significant changes since they emit about as much energy as a hand-held laser pointer.”

So why do we keep jumping on the latest slimming gimmick bandwagon? And why do companies keep doling them out?

There is an endless rapt audience of consumers who are looking for get-thin-quick results without the medical risks and recovery time of invasive surgeries that are proven to work. This despite the fact that the prime candidates for such treatments are not people looking to lose 10+ pounds, but instead are those that are already fit and simply want to address a small stubborn area. And the FDA doesn’t require rigorous, long-term scientific research that the products work, but instead vets machines that can prove that their latest and greatest is comparable to devices already on the market. The FDA declines, however, to guarantee any of these machines’ effectiveness.

Which doesn’t mean that all of the treatments and gizmos available on the market today, don’t offer effective benefits. In fact, the number one noninvasive body contouring treatment promises more modest results and seems to have consumers convinced: CoolSculpting.

Developed by physicians at Mass General, CoolSculpting involves clamping a section of fat “about the size of a stick of butter” and “cooling” that area for one to three hours, promising that after 12 weeks, the fat layer of the treated area will diminish by 20+ percent (this from a company financed study). Judging from an increase in the company's net revenue from year to year, the treatment seems to be a popular one.

So keep your eyes peeled and remain skeptical. We’ll be on the lookout for the real “next big thing,” and we’re sure you will be too.


Crafting cheekbones with cosmetic surgery

Wed, 10/01/2014
Cheek Bone
Crafting cheekbones with cosmetic surgery

From chin implants to facelifts, there are a variety of procedures that can alter the appearance of one's face. Individuals looking to add a bit of plumpness or definition to their cheeks may benefit from cheek augmentation or facial fillers, both surgeries that can affect cheek structure.

While some people seek this surgery because they want to add or detract a bit of volume, others may be opting for procedures to resemble Angelina Jolie's Maleficent, according to Time Warner Cable News.

Emulating the magnificent Maleficent

The source reported that a rising number of women are requesting cheekbones similar to Jolie's title character, following the release of the movie in May 2014. While these patients are not seeking the same kind of protruding structure, they have requested higher, more defined cheeks. One patient said she broached the topic with her plastic surgeon, but didn't think the procedure would be possible.

"We were joking that it'd be great to have those cheekbones, and she mentioned that was something I could actually do," she told TWC News.

The woman received facial fillers to add more dimension to her appearance, something her surgeon explained would add a bit of highlight and youth. 

This is not, however, the first time a movie has inspired a plastic surgery craze. Following the release of "The Lord of the Rings," many surgeons reported an increase in the number of patients requesting ear surgeries, hoping to receive ears that were similar to elven characters in the series. 

Options to alter the cheeks

While instances such as these are fairly rare, there are several procedures to consider if you're looking to craft your cheekbones. Cheek implants are the ideal option if you're looking to alter, augment or define your face. This surgery may add volume to the desired area, similar to the Maleficent look - but not nearly as dramatic. Depending on patient desire and the recommendation of a board-certified plastic surgeon, there are several options that can be used to enlarge the area.

Typically, doctors will recommend a filler to plump the cheeks, but depending on the individual circumstance, patients may best benefit from bone grafting or repositioning. 

There are many considerations to make prior to your procedure. Candidates for this operation must understand that since the surgery affects the face, it may lead to damage of the facial nerves or infection of the implant - both of which could cause your surgeon to recommend additional surgery. However, the operation is relatively quick and does not require additional procedures, and may lead to permanent results.

Botulinum Toxin (AKA: BOTOX®, Dysport® or Xeomin®) – When too much of a good thing becomes a reality

Tue, 09/30/2014
Cosmetic Procedures
Botulinum Toxin (AKA: BOTOX®, Dysport® or Xeomin®) – When too much of a good thing becomes a reality

By Kelly Cook

We’re all familiar with the concept of “too much of a good thing” but the pearl behind that wisdom hits especially hard when it happens to your face. Two years ago I began to develop the dreaded “11” between my brows. They were slight, but I am all for spending on prevention rather than investing in restoration, so I opted for Botox along with Juvederm injections. My doctor is very conservative and methodical, so instead of doing it all at once, he did the Botox and then waited 2 weeks to inject the Juvederm. The reason behind this is completely logical and I am surprised that more doctors don’t adhere to this practice. The injectable is not very helpful on its own in this case because the furrowing of my brows is what is causing the “11” creases. If I only had Juvederm injected, not only would the problem persist, but the injectable could actually get squeezed out of position by my repeated furrowing.

The Botox prevents the furrowing and stabilizes the area first and the Juvederm then comes in and does its job of filling in the creases as long as I continue to Botox the area to prevent the facial expression that caused it in the first place. So this two-pronged approach has multiple benefits and long-term results. It all went as well as it sounds. I was so happy with the results that I decided to one-up it. That’s where the problem started.

A year went by and I began to regain the ability to furrow my brow. I was pleased that it lasted a full year so I did not feel as though I was “addicted.” What I had already done and was planning to continue to do felt like a moderate and sensible approach. So, I went in and since I was so pleased with the results the last time, I decided to include my forehead because lines were also developing there. I certainly do not want a permanently crinkled and creased forehead so this made sense. I told my doctor to increase the Botox in the “11” area, as well as add a few units on the forehead and above my eyebrows.

Now, it is always difficult to know where to draw the line when you are in the middle of things. Of course hindsight is 20/20, and in this case hindsight made it clear that too much Botox gave me a constant look of surprise. My brows were arched so severely it was almost comical, (and I only admit and dare say it now because this has fortunately subsided and I am no longer suffering from the trauma) - but I looked like a clown. To make matters worse, I had this done 2 weeks before I went on-air on HSN for the launch of my first handbag collection. This was my way of preparing to look my “best”. Thanks to the magic of makeup, I was able to use a combination of concealer on my upper brow and shadowing on the lower to lessen the arch and look more human/realistic. But in real life, I looked like a freak and the obvious look of being overly Botoxed actually aged me.

So where do you draw the line? The lessons I learned are: Don’t strive for perfection; don’t try to correct everything; take the one thing that bothers you most and fix just that. I have never fully appreciated and understood the wisdom of “a little goes a long way” as much as I do now.

6 solutions for dark under-eye circles

Tue, 09/30/2014
Treatments For Circle Under Eyes
6 solutions for dark under-eye circles

By Brooke Seckel, MD

Many people, both young and old complain of dark circles under the eyes. There are many different causes of dark color of the lower eyelid skin and shadows beneath the lower eyelid. It could even be a combination of different problems, which is why it is important to understand what causes dark circles before figuring out how to correct or remove them from under the eyes.

Here are six reasons why you have dark under-eye circles and their treatment options:

Reason 1: Thin skin -The lower eyelid skin is the thinnest skin on the body. Because eyelid skin is so thin light passes through the skin and the purple color of the eyelid muscle shows through the skin.

Solution: It is impossible to significantly thicken lower eyelid skin, but repeated treatments with the 1540 nonablative fractional erbium laser can cause microscopic new collagen growth in the deeper layers of the eyelid skin to thicken the skin and help remove dark circles under the eyes.

Reason 2: Pigment -Sun exposure can cause additional pigmentation of the lower eyelid skin. Typically this pigment appears on the surface and can appear as freckles, brown spots, or a uniform tan color.

Solution: Microdermabrasion and the bleaching cream Hydroquinone can reduce superficial pigment and should be done before more invasive methods. IPL (Intense Pulsed Light) or Photofacial light treatments are a very effective method to remove dark circles under eyes caused by pigment but can only be done on fair skinned individuals. Darker skin types can be treated with the 1540 non ablative laser to remove pigment. Sunscreen and sunglasses are good preventative measures.

Reason 3: Small blood vessels -Because the eyelid skin is so thin you can actually see tiny veins and blood vessels. In many people there is an abundance of small vessels which actually create additional purplish blue color to the lower eyelid skin.

Solution: IPL is very effective at closing small veins and blood vessels. Reducing the number of small vessels is an effective way to remove dark circles under the eyes caused by the bluish color of the vessels. IPL should not be used on dark skin types.

Reason 4: Depression of the Orbital Bone- Some people have a small depression in the bone of the eye socket near the nose, which causes a shadow beneath the lower eyelid running from the corner of the eyes to the middle of the pupil.

Solution: The best treatment in my opinion is to have lower eyelid surgery, or a blepharoplasty, potentially followed by fat grafting. An alternative is using dermal filler instead of surgery with only small amounts of the dermal filler, Restylane. However, repeated injections through the eyelid skin are not advised.

Reason 5: Lack of eyelid fat –Hollow Eyes-this is caused by lack of normal intraorbital fat inside the eye socket surrounding the eyeball. Because of the lack of fat, the lower eyelid sinks in and creates a shadow or dark circle under the eye or a “hollow eye” look.

Solution: Surgically adding fat beneath the eyelid is the most effective way to remove dark circles under the eyes caused by lack of fat around the eye. Fillers can be used but again, repeated injections into the eyelid deep enough to correct this problem can cause problems.

Reason 6: Aging of the eyelid -As the eyelid ages, normal eyelid fat protrudes out against the lower eyelid. This causes what is typically called eye bags or puffy eyes.

Solution: Blepharoplasty is the more permanent and effective technique to remove dark circles under eyes caused by aging. During surgery excess fat causing eye bags is removed. Some of the fat is placed back into the eye beneath the depression, while excess skin is removed if necessary and the eyelid muscle tightened.

Who Should Remove Dark Circles under the Eyes?

Because of the importance and delicate nature of the eye and eyelids only a very experienced board certified plastic surgeon with experience in eyelid surgery should attempt these sophisticated techniques on the eyelids. Consult a plastic surgeon who is a member of the American Society for Aesthetic Plastic Surgery (ASAPS) and start your search in the Smart Beauty Guide.

Very few Physicians are experienced using laser techniques on the eyelid. Ask your plastic surgeon if they are experienced in removal of dark circles under the eyes and ask to see before and after plastic surgery photos  of patients that the surgeon has treated.

WARNING: Be aware that corneal shields, protective covers for the eye and special techniques to pull the eyelid down against the bone of the eye socket during laser pulses are needed. All treatments must be done with an appropriate physician in attendance in a medical setting.

Revealing the Beauty Within: Dermabrasion and Chemical Peels

Tue, 09/30/2014
Plastic and Cosmetic Surgery Procedures
Revealing the Beauty Within: Dermabrasion and Chemical Peels

By Mary Cunningham

Most of us dream of recapturing the essence of youth and returning to the dewy freshness that's faded with the years due to hours on the beach, long runs in the summer, that pesky smoking habit in college, and exposure to other environmental toxins. Every line tells a story and sometimes we don't want those stories broadcast.

While face, brow and neck lifts can transform a face into a more youthful version of itself, there are other options to enhance the look and feel of our skin-- which is thankfully much less expensive and non-invasive. Awesome.

Dermabrasion, dermplaning, dermblading- are all terms for using a small sharp object or rough surface to remove surface acne scars, fine wrinkles and other skin imperfections.

An alternative, one with which I have a LOT of experience, is any one of a variety of chemical peels (glycolic, salicylic, TCA). Peels can successfully reduce the size of pores and the appearance of wrinkles and scars. There are varying levels of intensity, based on the type and concentration of acid used, and how long it is left on the skin.

In addition to reversing skin damage, both can be used proactively to slow the first signs of aging - which is wonderful.

Yet in both treatments, it is paramount that you trust your skin to professionals because each requires: a) expert evaluation to determine whether your skin type will yield optimal results, and b) precision in execution of the treatment.

In light of the many people performing these treatments, and the potential for lasting skin damage, I want to share a few keys to success:

1) Start by consulting with a board-certified MD- a plastic surgeon specializing in these cosmetic procedures.

2) Inquire about the details.

  • Ask to have a patch tested on a part of your skin, other than your face. Skin tone and sensitivity are determining factors in your overall success. For example, chemical peels can have a bleaching effect, so if you have an olive complexion, make sure you are comfortable with a test section first.
  • Ask how long the full process takes- this is not limited to time in the doctor’s office. Your face will be sensitive, red, extremely sun-sensitive and shedding dead layers for days, and likely weeks (depending on the potency of the acid, for example).
  • With those answers, plan your treatment accordingly- if it’s the middle of summer and you have a beach vacation planned, don’t try to squeeze these treatments in before. Sometime in the fall--or when you’ll be ensconced in shade--is ideal.

3) Follow the directions of the doctor, nurse and your care team.

  • Your skin will be extremely sensitive and you must care for it tenderly in these days and weeks post treatment.
  • Going in the sun at this point could multiply the sun damage because you're working with a new, gentle layer of skin right now.
  • This is not the time to be careless with your skin care. (That may be what landed you in this situation in the first place. Just sayin’.) If you’ve invested the time in research as well as the money, don't stop short after you leave the doctor's office.
  • If there are bandages, tend to them per the doctor's instructions. If there are creams to apply, do so. Make sure that you are not only the ideal patient, but that you are your own personal care-giver.

While we were not all born with the gift of beautiful skin, with just a little time and care plus a lot of expertise, the opportunity for a new, fresh face isn’t just a dream.

6 solutions for dark under-eye circles

Tue, 09/30/2014
Treatments For Circle Under Eyes
6 solutions for dark under-eye circles

By Brooke Seckel, MD

Many people, both young and old complain of dark circles under the eyes. There are many different causes of dark color of the lower eyelid skin and shadows beneath the lower eyelid. It could even be a combination of different problems, which is why it is important to understand what causes dark circles before figuring out how to correct or remove them from under the eyes.

Here are six reasons why you have dark under-eye circles and their treatment options:

Reason 1: Thin skin -The lower eyelid skin is the thinnest skin on the body. Because eyelid skin is so thin light passes through the skin and the purple color of the eyelid muscle shows through the skin.

Solution: It is impossible to significantly thicken lower eyelid skin, but repeated treatments with the 1540 nonablative fractional erbium laser can cause microscopic new collagen growth in the deeper layers of the eyelid skin to thicken the skin and help remove dark circles under the eyes.

Reason 2: Pigment -Sun exposure can cause additional pigmentation of the lower eyelid skin. Typically this pigment appears on the surface and can appear as freckles, brown spots, or a uniform tan color.

Solution: Microdermabrasion and the bleaching cream Hydroquinone can reduce superficial pigment and should be done before more invasive methods. IPL (Intense Pulsed Light) or Photofacial light treatments are a very effective method to remove dark circles under eyes caused by pigment but can only be done on fair skinned individuals. Darker skin types can be treated with the 1540 non ablative laser to remove pigment. Sunscreen and sunglasses are good preventative measures.

Reason 3: Small blood vessels -Because the eyelid skin is so thin you can actually see tiny veins and blood vessels. In many people there is an abundance of small vessels which actually create additional purplish blue color to the lower eyelid skin.

Solution: IPL is very effective at closing small veins and blood vessels. Reducing the number of small vessels is an effective way to remove dark circles under the eyes caused by the bluish color of the vessels. IPL should not be used on dark skin types.

Reason 4: Depression of the Orbital Bone- Some people have a small depression in the bone of the eye socket near the nose, which causes a shadow beneath the lower eyelid running from the corner of the eyes to the middle of the pupil.

Solution: The best treatment in my opinion is to have lower eyelid surgery, or a blepharoplasty, potentially followed by fat grafting. An alternative is using dermal filler instead of surgery with only small amounts of the dermal filler, Restylane. However, repeated injections through the eyelid skin are not advised.

Reason 5: Lack of eyelid fat –Hollow Eyes-this is caused by lack of normal intraorbital fat inside the eye socket surrounding the eyeball. Because of the lack of fat, the lower eyelid sinks in and creates a shadow or dark circle under the eye or a “hollow eye” look.

Solution: Surgically adding fat beneath the eyelid is the most effective way to remove dark circles under the eyes caused by lack of fat around the eye. Fillers can be used but again, repeated injections into the eyelid deep enough to correct this problem can cause problems.

Reason 6: Aging of the eyelid -As the eyelid ages, normal eyelid fat protrudes out against the lower eyelid. This causes what is typically called eye bags or puffy eyes.

Solution: Blepharoplasty is the more permanent and effective technique to remove dark circles under eyes caused by aging. During surgery excess fat causing eye bags is removed. Some of the fat is placed back into the eye beneath the depression, while excess skin is removed if necessary and the eyelid muscle tightened.

Who Should Remove Dark Circles under the Eyes?

Because of the importance and delicate nature of the eye and eyelids only a very experienced board certified plastic surgeon with experience in eyelid surgery should attempt these sophisticated techniques on the eyelids. Consult a plastic surgeon who is a member of the American Society for Aesthetic Plastic Surgery (ASAPS) and start your search in the Smart Beauty Guide.

Very few Physicians are experienced using laser techniques on the eyelid. Ask your plastic surgeon if they are experienced in removal of dark circles under the eyes and ask to see before and after plastic surgery photos  of patients that the surgeon has treated.

WARNING: Be aware that corneal shields, protective covers for the eye and special techniques to pull the eyelid down against the bone of the eye socket during laser pulses are needed. All treatments must be done with an appropriate physician in attendance in a medical setting.

Kim Kardashian Plastic Surgery 2014: After Attack in France and First Stop Reportedly Cosmetic Laser Center

Tue, 09/30/2014

Kim Kardashian Plastic Surgery 2014: Kim Kardashian returned to the United States and her favorite cosmetic surgeon in Beverly Hills for routine beauty maintenance.

According to reports, the Keeping Up With the Kardashians star was seen leaving the Epione Cosmetic Laser Center on Monday.

Kim's favorite cosmetic laser center specializes in botox, juvederm, liposuction, and laser skin resurfacing. Kardashian says has never gotten plastic surgery and credits the 50 pounds she lost, she dropped with a low-carb, ketogenic-style Atkins diet and rigorous daily workouts

Hot on reports that Kylie Jenner got plastic surgery to make her lips look like the lips on Kim Kardashian lip injections, Kim is reportedly doing more work on her own. There have been reports that the star of "Keeping Up With The Kardashians," Kim Kardashian, is ruining her body with plastic surgery in an attempt to get rid of baby bump stretch marks.

This summer, a woman named Claire Leeson made headlines for spending more than $30,000 on plastic surgery to look more like Kim Kardashian. Now it appears Kim Kardashian's 17-year-old sister is looking more like Kanye West's wife. Kylie reportedly wanted to be the sister with the "big lips.".\

In February, Kardashian took to Twitter to say "I'm seeing all these nonsense tabloids claiming I have butt implants-injections. Using pics of me 15lbs skinnier (before I had my baby) comparing me to now! I still have weight to lose. Anyone who has had a baby knows how hard it is to lose weight (especially the last bit of weight) & your body totally changes! Making fun of me pregnant & making fun of me trying to lose weight now shame on you. I'm not perfect but I will never conform to your skinny standards sorry! Not me. And BTW I've lost a lot so far & I'm proud of that! Don't give young girls a complex!" 

Kim told "Nightline" in 2010 I'm totally not against plastic surgery."

Kim has only publicly admitted to having Botox. Kardashian even had a doctor X-ray her butt to prove she didn't go under the knife.

Reality television star Kim Kardashian can't avoid plastic surgery rumors despite having Kanye West for her husband as new gossip claims she had work done to her nose.

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