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Ask Dr. Manchester

Removal of Corrigator Muscle

Tuesday, November 8th, 2011

Surgery for the relief of migraine headaches has become one of the most frequent asked about procedures in plastic surgery during the past two years.  Nearly 35 million people suffer from this condition which accounts for a loss of $13 billion dollars annually in gross productivity.   Studies have shown that 18% of women and 6 % of men suffer from this condition.   There are now two methods to treat refractory migraine headaches which have an 85% success rate.

During the past 12 years, endoscopic surgery has became very popular in the U.S.. Plastic surgeons have observed that a large number of  their patients found marked relief in the severity and frequency of  their migraine headaches following endoscopic forehead and temporal surgery .   This finding has been observed in Europe as well.
Botox injections to the forehead and eyebrow areas have been  observed to give the same relief.

It is now felt that the corrigator muscles of the forehead obstruct  blood flow and /or causes tension to the supra-orbital and supra-trochler nerves.  Release of this tension by means of removing the corrigator muscle or paralyzing it provides improvement in 85% of patients.

I have found this percentage to be within our study range.   The current treatment of refractory migrane headaches consist of a course of Botox injections to the forehead and corrigator muscles and observe if relief is obtained.  If relief is obtained for over a month, then the patient is given the option of repeat Botox injections every six months or surgical excision of the corrigator muscle.

Question:

I’ve heard of two approaches for reducing the conchal bowl in the ear: resecting sections of cartilage from this area, and using permanent sutures to pin back the ears. What are the pros and cons of these two techniques and is one better than the other?

Answer:

There is no right or wrong. Both procedures are necessary for the plastic surgeon. The procedure used is determined by the patient’s condition. In the majority of patients, pinning the ear backward is what occurs in the majority of patients. There is that one patient that has a very large conchal bowl and causes the ear to stand out from the head at a right angle. This condition needs the bowl resected but not in pieces just a section of the bowl to reduce its depth.

I am 13 and I want to get a nose job…

Friday, March 25th, 2011

Question:

I’m 13 and I want to get a nose job. Everyone says I need to wait a few more years. Why?

Answer:

The face and its skeleton do not stop growing until about age 16. It was thought that if you operate before 16 the nose might stop growing and not keep up with the facial skeleton. The bottom line is that it MIGHT happen and the risk outweighs any advantage.

Question:

I’m 27 with big ears that I’ve always hated. From everything I read, it sounds like Otoplasty is more commonly performed on children. Is it possible to have your ears corrected as an adult and what does this entail?

Answer:

You will need to wear a head band or dressing for one week after surgery. There is no contraindication to having this surgery performed as an adult. Fifty percent of my patients are adults. The operation is more common in children because it is covered by most insurance carriers even MediCal. Insurance coverage is good up to the age of five.

Question:

I’ve been using Botox for a little over a year now. With my last injection, the results just aren’t the same, they’re not as dramatic. Is it possible that I’ve developed a tolerance? Would switching to Dysport® fix this or would I have a tolerance to that as well?

Answer:

I am not sure you have developed a tolerance but maybe a smaller dose of Botox®. You can try Dysport® and see if it improves your result. The most likely cause for the result you complain about is a week solution of Botox®.

I would like to get cheek implants…

Friday, March 25th, 2011

Question:

I’d like to get cheek implants to fix my flat cheeks. What are my options for the implants? What are they made of?

Answer:

Your options are as follows: fat injections or tissues fillers some of which are permanent (like Artefil). An additional choice is silicone implants that are placed either through the mouth or the lower eyelid skin. I prefer the latter. You need to discuss your options with a surgeon. Which you choose will depend on the cost and time you are willing to take off from work. The quickest result is obtained with injectables. The best result is silicone implants.

Question:

I’d like to get a mini tummy tuck because it sounds like the scars will be smaller.  Is this true?

Answer:

You are being foolish. Get the surgery that you need. See more that one plastic surgeon and learn why you need what you need. The funny part is that the incisions are exactly the same. The difference is that the muscles of your abdomen are repaired if needed and the skin is undermined to the naval or to the rib cage and just below the breasts. If you have excess skin in your upper abdomen (above the belly button) you need a full tummy tuck.
Scaring is determined by your surgeon and your skin color and tendency to heal. Some individuals have a tendency to over heal and thus form very thick scars. Also the type of sutures used determines scar formation. Dissolving sutures have a tendency to cause inflammation and thus over healing. The length of time sutures are in also determines scaring. Bottom line is that all scars can be removed and made better. I personally like to use nylon or prolene sutures in subcuticular fashion and leave them in for one to two months so that the scar cannot spread. These sutures are non reactive and can stay in place for months or years if necessary without tissue reaction. Why get a half result. Ask your surgeons. Remember get two or more opinions. Take the one that makes the most sense not the one you want to hear.

What are gummy bear breast implants?

Friday, March 25th, 2011

Question:

What are “gummy bear” breast implants, and how are they different from saline or silicone?

Answer:

Gummy bear implants are the new silicone implants. The silicone is more cohesive thus giving more stability to the implant. This prevents future implant rupture and rippling that was common in the last generation of implant. In addition, the silicone implant feel more like breast tissue and easier to hide.

 

Question:

Hi. I’m 29 and interested in breast implants. Can you explain what the various options are that are available to me?

Answer:

You have many choices for this surgery. First, do you want silicone or saline implants? I prefer silicone implants because they give a softer more natural feel and appearance. Saline implants should be changed every ten years since they have a tendency to leak after this period of time. After three years, saline implants tend to ripple when a person leans forward.
The implants can be placed under the breast tissue or under the muscles of the chest wall. I prefer under the breast tissue. This method gives a more natural contour to the breast and natural cleavage. Implants that are placed under the pectoralis muscle have a tendency to sit farther apart and distort the cleavage plane. They have a tendency to sit higher and lateral to the normal breast placement. The breast are firmer and may move with arm movement.

Question:

I am 37 years old, and the only “problem area” I have is my lower cheeks. Is it time for me to have a facelift or would fat grafting be enough?

Answer:

I have not had the opportunity to see you so I am going to make assumptions. You did not identify the problem in your lower cheeks. I will assume that it is loose skin that sags. This is the most common complaint from weight loss or aging. Following weight loss the skin of the cheeks loose fat and thus substance and the skin no longer fits the original package it was intended. In some individuals tissue fillers can be used such as fat grafting, Juvéderm® or Sculptra®.

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