Facial Plastic Surgery
- Brow Lift
- Neck Lift
- Blepharoplasty (Eyelid Lift)
- Otoplasty (Ear Pinning)
- Botox and Fillers
Craniofacial differences are more than simple cosmetic differences in the nose, ears, and other features. They include a vast spectrum of disorders that can affect breathing, vision, speech, and of course, appearance. Dr. Panossian has trained at the most respected institutions in the world for craniofacial surgery and facial plastic surgery. His background allows him to incorporate techniques from other subspecialties to not only treat patients with complex craniofacial issues but for those who want to enhance their looks.
When looking into enhancing your facial appearance, it is important to understand that there are many layers to the human face. This requires that your facial plastic surgeon has an understanding of what to manipulate surgically in order to get the results you’re looking for. Similar to building a house, it’s important fix the foundation before putting up the roof. This is often overlooked by most patients and even plastic surgeons.
Another important point is that changing one aspect of your face may unmask another problem area. For example, if you don’t like the appearance of your nose, it is important to take a step back and really define the problem. Is it simply the nose? Or, is it your profile that you dislike? There is a big difference. Dr. Panossian will help you articulate what you’re most interested in achieving so that you are ultimately happy with your transformation. He will spend a large amount of time with you so that you understand your surgical options thoroughly.
Finally, facial aging is inescapable. Everyone will eventually fall victim to it. Whether you grow old gracefully or wish to fight it every step of the way, there are excellent and safe facial plastic surgery options available these days. The study of how the face ages is equal parts science and art. We know common areas that are susceptible to the effects of aging and can predict how someone will age, but there are strong individual differences that cannot be treated in a “cookie-cutter” fashion. Dr. Panossian is obsessive about achieving a youthful face without going over the top. He uses not only the latest facial plastic surgery techniques, but he will employ simpler solutions when appropriate. So, don’t wait, call our office today to schedule your consultation.
What is a facelift?
A facelift is a procedure designed to restore the youthfulness of the face that has suffered the effects of aging and gravity. It typically addresses the area beneath the lower eyelids down to the jawline. By removing excess skin and tightening the underlying muscle layers, a facelift can take years off an aging face. That’s it!
The real difficulty comes from how to achieve these results. This can vary extensively from surgeon to surgeon and with experience. It is important to discuss the goals of a facelift procedure ahead of time and understand the limitations and expectations. Often a facelift is combined with other procedures including a browlift, necklift, eyelid surgery, chin implantation or laser resurfacing. The surgical plan is highly individualized to each patient and to his or her goals.
How is a facelift performed?
There are several variations to a facelift. These can include regular facelift, short-scar technique, and mini facelift. The goal of each of these options is similar in the pursuit of a more youthful appearing face. However, the degree to which each of these options can remedy the specific degree of facial aging can be quite substantial. Generally, the more severe the signs of aging, the longer the scar will be and the closer it will approximate a traditional facelift. A well-done facelift can take 10 or more years off of an aging face. Your consultation with Dr. Panossian will highlight the differences between the various styles of facelift procedure and assess your candidacy for each.
What is the recovery?
Following a facelift procedure, the head will be wrapped loosely with bulky bandages to minimize bruising and swelling. Patients are given prescriptions for antibiotics and pain medication routinely. A small thin tube may sometimes be used along the incision behind the ear to drain excess fluid that might accumulate under the skin. This tube is typically removed the following day after surgery and the dressings changed. Recovery may sometimes take longer when combined with additional procedures such as those mentioned above. There is an option for overnight monitoring in a post-surgical facility for those undergoing more extensive procedures simultaneously.
Swelling typically improves over 1 to 2 weeks. Bruising is not always present, but it will also improve during the same time period. Activity is restricted during the first 4 to 6 weeks to light walking and stationary activities. Heavy lifting, contact sports, aerobic exercises, and sex are to be avoided during this time. Most patients elect to take 7-14 days off from work. During this time, make up can be used to mask any bruising.
What are the risks and complications?
Facelift complications are relatively rare when performed by a qualified and experienced plastic surgeon. However, individuals may vary substantially in terms of health status and genetic predisposition, potentially making them more susceptible to unfavorable results.
These complications can include hematoma (blood collection under the skin), injury to the facial nerve, infection, and adverse reaction to anesthesia. Smokers and individuals with uncontrolled diabetes sometimes demonstrate issues with poor wound healing.
To minimize your risk, pay close attention to Dr. Panossian’s instructions before and after surgery. Dr. Panossian’s staff is available at all times to clarify any pre- or postoperative instructions that you may have been given. Please refer to the Pre- and Postoperative General Instructions for further details.
What is a brow lift?
As we age, one of the problems that the human face encounters is descent of the forehead and brow. A brow lift (or forehead lift) will resuspend the forehead in a more youthful position such that the eyebrow is elevated once again. Another advantage of a brow lift is to diminish the horizontal lines and wrinkles that typically give a person an angry, tired, or sad look.
The procedure itself is relatively straightforward and is often combined with other facial procedures such as facelift, eyelid surgery, neck lift, chin or cheek augmentation, or laser resurfacing. It is important to obtain a highly focused consultation with the plastic surgeon to understand and individualize the results to each patient’s goals.
How is a brow lift performed?
Various techniques for lifting the brow currently exist. Frequently, this will include an endoscopic approach, where a small thin camera is used through several small scalp incisions to visualize the area of the forehead. The muscles and tissues underneath the skin are then manipulated and elevated to the desired position where they are anchored. An alternative technique will achieve the same type of elevation through a slightly longer incision within the hair bearing scalp but under direct vision. Each of these approaches has its advantages. In some cases, the frown muscles may need to be excised in order to create a more uniform lifting of the brow. This is similar to having “permanent Botox” for the lines that occur between the eyes. Dr. Panossian can explain these differences in greater detail during your consultation and direct you to the technique that is right for you.
What is the recovery?
Following surgery, the head is wrapped with loose bulky dressings to minimize bruising and swelling. Infrequently, a small thin tube may be used to release some of the underlying fluid accumulation. This is typically taken out within 24 hours in the doctor’s office. At this point, patients are allowed to shower with shampoo and water. Care is taken not to rub on the forehead or the areas of the incisions within the scalp. Much of the general activity restrictions and return to work instructions are similar to having had a facelift (hyperlink), including avoidance of strenuous activities, exercise, and heavy lifting. Most patients return to work 7 to 14 days following surgery. Pain medication is prescribed ahead of time. Antibiotics may also be used occasionally. Makeup is allowed to conceal any bruising, if it persists. The incisions themselves may sometimes be numb or maintain increased sensitivity for several weeks.
What are the risks and complications?
In men, the eyebrow typically sits at the level of the lowest part of the forehead bone above the eyes. In women, the eyebrow tends to curve upwards slightly above this bone. One of the complications of a brow lift is related to overcorrection, giving an unusual surprised appearance to a woman or a feminizing appearance to a man. An experienced plastic surgeon recognizes this possibility and will pay special attention to positioning the brow at the time of surgery.
Additional risks include the possibility of blood accumulating underneath the skin (hematoma), infection, widened scar, nerve injury to muscles that move the eyebrows and wrinkle the forehead, and mild hair loss along the incisions. Additionally, there may be a need to abandon an endoscopic approach and switch to an open incision technique in rare cases.
All of these complications are infrequent and can be further minimized by paying close attention to Dr. Panossian’s pre- and postoperative instructions.
One of the telltale signs of aging is loss of definition of the neck and the appearance of the much-despised “turkey gobble” or the “double chin.” This happens to varying degrees to nearly everyone. The superficial muscles of the neck loosen over time and fat deposition increases in this region. The end result is a blunting of the angle between the chin and neck and loss of definition of the jawline. One of the most gratifying procedures for both men and women is to surgically restore this angle (called the cervicomental angle) which instantly and subtly re-creates a very youthful appearance. A neck lift can be performed alone or in combination with other facial procedures such as a facelift, brow lift, eyelid surgery, or chin or cheek augmentation. In some instances, liposuction of the neck can be combined as well to improve definition.
How is a neck lift performed?
The overall goal of a neck lift is to tighten the central muscles of the neck (called platysmal bands) and resuspend the hammock of the neck, thereby re-creating the lost angle between the chin and neck. In order to accomplish this, an incision is placed along the border of the hair bearing scalp behind the ears. This incision is continuous with that of a facelift, if performed together. Excess skin is taken out using this incision and the edges of these superficial neck muscles are tightened simultaneously. A separate incision is sometimes placed underneath the chin in order to bring together the two vertical neck bands which are characteristic of the aging neck. Liposuction can be performed through these incisions as well without the need for additional counterincisions.
In some individuals, there may be a soft tissue prominence underneath the jaw which represents the drooping salivary glands. If present, these glands will need to be resuspended during this procedure in order to restore the natural jawline. Sometimes, these glands may be excised completely, if the drooping is severe.
Slight variations of this general technique can be performed as necessary on specific patients. Dr. Panossian will individualize the technique, if it is indicated and if it is consistent with patient goals.
What is the recovery?
Following a neck lift, a bulky supportive dressing or an elastic facial garment will be applied to minimize bruising and swelling. A small thin tube may be used to temporarily drain any fluid collections underneath the skin. This is typically removed the following day in the doctor’s office. Patients are then allowed to shower. Care is taken not to rub aggressively over the neck or the incisions for up to two weeks. Patients are advised to avoid strenuous activities including sports, exercise, and heavy lifting for a period of 4 to 6 weeks. Most patients typically return to work in 10 to 14 days. Makeup may be used as necessary to conceal any residual bruising.
What are the risks and complications?
The risks of a neck lift include bleeding, infection, difficulties with anesthesia, and unfavorable scarring. In addition, some patients may complain of a sensation of tightness in the neck that is temporary. It is rare to cause difficulties with swallowing or breathing following a neck lift. Also, in rare circumstances, there may be over- or undercorrection. It is imperative for patients to follow Dr. Panossian’s pre- and postoperative instructions in order to avoid complications. His staff is available at all times to answer questions.
What is a rhinoplasty?
The nose is often referred to as the keystone of the face. It’s prominent location on the face makes it a point of focus for others and an important feature of social interactions. A rhinoplasty (also known as a “nose job”) is one of the most common and most difficult plastic surgical procedures to perform. Subtle changes in the nose can produce quite drastic changes in overall appearance. The reason for this is that the nose is comprised of an intricate cartilaginous framework which can easily be damaged or warped. Subtle manipulations of these structures require a trained eye and can potentially result in certain irreversible changes. However, when performed correctly, the results are life-changing.
There is a high level of variability among noses. Specifically, differences exist between male and female, older and younger patients, and among different ethnicities. The plastic surgeon must identify these key differences and keep them in line with patient goals. Also, noses are rarely 100% symmetric. There can be differences in size of the nostrils, appearance of the nasal sidewalls, or differences that are appreciated only in different views. The plastic surgeon will need to identify these differences for the patient and devise a highly surgical plan.
A rhinoplasty can also improve one’s nasal airway and, thus, improve breathing. It is, therefore, important for the plastic surgeon to understand that the nose is a delicate organ in addition to a cosmetic focal point. This aspect is often overlooked by many plastic surgeons.
How is a rhinoplasty performed?
Two basic techniques exist for placement of incisions for a rhinoplasty–open vs closed. In the open technique, an incision is placed along the columella (or, the thin segment of skinunderneath the nasal tip that meets the upper lip). This incision is then extended into the nostril and carried along the nostril walls towards the tip of the nose. This technique can give excellent exposure of the very delicate cartilage structures that will need to be manipulated in rhinoplasty surgery. Septal work may also be performed through this incision to correct a deviated septum.
A closed technique does not utilize the columellar incision as in the open technique; therefore, it avoids visible scars. Instead, strategic incisions are placed within the nostrils and positioned such that the cartilage framework can be manipulated without extensive dissection. Similar quality rhinoplasty procedures can be performed with both techniques. The closed technique is believed to be slightly more difficult due to decreased visibility. However, certain advantages do exist in appropriately selected patients aside from an invisible scar. Dr. Panossian utilizes both techniques in his practice and will tailor the approach to the specific goals of each patient.
At times, it may be necessary to perform narrowing of the nasal bridge by osteotomies (or, breaking of the nasal bones). This maneuver is not required in all patients and must not be utilize universally. It can also lead to the characteristic bruising that occurs underneath the eyes following a rhinoplasty. The incisions for these osteotomies are typically placed inside the nose.As mentioned before, if a deviated septum exists, this is also repaired at the time of rhinoplasty through an internal incision. There are many decisions that a skilled rhinoplasty surgeon must make preoperatively and during surgery.
What is the recovery?
A rhinoplasty is usually a same-day outpatient procedure. The surgery could last from 2 to 6 hours depending on the complexity of the case. The nose will feel congested initially and there may be some discomfort from swelling.
Dressings include an external plastic splint anchored with tape to the skin in addition to an internal nasal packing and splints. The nasal packing will be removed the following day, and the splints will be taken off 1 to 2 weeks after surgery. There may be a small amount of bleeding from the nostrils for several days following the procedure. The stuffiness may last several weeks, and swelling can be alleviated with cold compresses.
Swelling and bruising typically subside in 2 weeks. However, a small amount of swelling and/or unnoticeable irregularities may persist for several months. Activities to avoid during the first 6 weeks include blowing the nose, heavy lifting, aggressive exercise, or contact sports.
Most patients typically return to work in 1 to 2 weeks. A small amount of makeup may be used to conceal any residual bruising.
What are the risks and complications?
When performed by a board-certified plastic surgeon with extensive experience, complications are rare and usually minor. Although any surgical procedure carries an inherent risk of infection, bleeding, or an unfavorable reaction to anesthesia, close adherence to pre- and postoperative instructions will minimize their occurrence. Difficulty with breathing following surgery is usually temporary.
In less than 5% of individuals, a secondary procedure may be required to improve minor deformities that can appear after surgery. These cases are unpredictable and may be inevitable even among the most experienced rhinoplasty surgeons.
Blepharoplasty (Eyelid Lift)
What is an eyelid lift (blepharoplasty)?
An eyelid lift (blepharoplasty) is a great way to restore youthfulness to droopy or baggy eyes. The eyes are often a centerpoint for one’s perception of energy or mood to others. When people appear “tired” or “angry,” it is often in reference to the excessive skin of the upper eyelid causing drooping or bagginess under the eyes. These are the results of aging and genetics. An eyelid lift (blepharoplasty) will address the upper and/or the lower eyelids to reverse these signs.
How is an eyelid lift (blepharoplasty) performed?
A blepharoplasty addresses either the upper or lower eyelids with separate goals in mind. In the upper eyelid, excessive skin is usually cut out along with a small amount of fat. Sometimes, fat may be injected into the upper eyelid in the case of someone with a gaunt appearance or deep eye sockets. The incision is hidden imperceptibly in a natural crease along the upper eyelids. If the muscle involved in upper eyelid elevation is weak or the eyelid itself is droopy, additional work can be performed on this mechanism simultaneously without the need for additional surgery.
An Asian blepharoplasty is performed in a similar fashion in order to re-create an upper eyelid crease. This crease is frequently absent in Asian cultures. This procedure, although simple, does require precision and attention to detail in order to avoid obliterating one’s ethnic features.
A lower blepharoplasty will address the bags underneath the eyes. Specifically, the goal is to remove the excess fat underneath the lower eyelids which is the result of gravity and herniation of fat surrounding the eye itself. Many times, the goal may not be to completely excise this fat but to re-drape it over the lower portion of the orbital bone. By doing this, one can eliminate the unfavorable transition between the lower eyelid bag and the cheek. The incision is placed through the inner lining of the lower eyelid (transconjunctival) or directly underneath the lower eyelid lashes and can extend sometimes into the natural crow’s feet wrinkles. The muscle of the lower eyelid may also be tightened during this time, further reinforcing the lift aspect of the surgery.
Both the upper and lower blepharoplasty procedures can be combined with other facial procedures such as a facelift, brow lift, or neck lift. The end result is total facial rejuvenation.
What is the recovery?
An eyelid lift takes between one and three hours to perform depending on whether upper and lower eyelids are performed together. It is most often an outpatient procedure. Pain is usually minimal and can be controlled quite well with oral medication. Eyes are usually not bandaged but may be lubricated with ointment. Artificial tears or eyedrops may also be recommended to relieve dryness, burning, or itching. Light sensitivity, watery eyes, and slight blurring or double vision may occur for several days to weeks following surgery. The head is kept elevated for several days and cold compresses can be used to control swelling and bruising, if present. Stitches are removed in the first week following surgery.
Strenuous activities and heavy lifting are usually avoided for up to three weeks. However, most patients feel ready to return to work between 7 and 10 days following surgery. At that point, use of makeup is allowed to conceal any bruising, if present. Use of sunglasses is encouraged for protection and for light sensitivity issues.
What are the risks and complications?
Complications from blepharoplasty procedures are infrequent when performed by a board-certified plastic surgeon. Minor complications such as double or blurred vision last only a few days. Additional complications may be related to the presence of a pimple or whitehead along the incision where the stitches were placed. This can be treated very simply in the office with a very fine needle.
More severe complications can include difficulty in closing the eyes. Depending upon the overcorrection, this may need to be repaired with secondary surgery. A related problem is the pulling down of the lower eyelids (or, ectropion). This can follow lower eyelid surgery and may sometimes require additional corrective surgery. Some degree of mild ectropion may occur following lower blepharoplasty and will usually resolve with prolonged taping of the eyelid.
In order to avoid these issues, Dr. Panossian requires strict adherence to pre- and postoperative instructions. Additional instructions are provided under the Pre-and Postoperative General Instructions tab. Dr. Panossian and his staff are available at all times to address emergencies or to clarify any pre- or postoperative instructions.
Otoplasty (Ear Pinning)
What is ear pinning (otoplasty)?
Prominent ears can be a point of self-consciousness or dissatisfaction that can easily be corrected. Hairstyles are often modified to cover the ears in these situations. Ear Pinning (or, Otoplasty) involves decreasing the projection of the ears or their overall size in order to provide a more cosmetically pleasing style.
Two reasons exist for a large or over projecting ear: 1) lack of deep outer fold, or 2) over abundance of cartilage in the cup of the ear. The otoplasty surgeon must correctly identify the reason for the prominence and address it accordingly.
How is ear pinning (otoplasty) performed?
Ear Pinning (Otoplasty) is performed usually with a hidden incision behind the ear. Through this incision, the ear cartilage is manipulated and weakened precisely in order to create a deeper fold. The fold is then held together with sutures in its new shape. Occasionally, the excessive cartilage in the bowl or cup of the ear will also be partially excised in order to decrease the prominence. This procedure is generally repeated for both ears in order to retain symmetry. The incision is then closed with sutures and dressings applied. The surgery is done on an outpatient basis and takes between 1.5 and 3 hours to complete.
What is the recovery?
Ear Pinning (Otoplasty) is frequently performed on both children and adults. Immediately following surgery, bulky dressings will cover both ears. There may be throbbing and discomfort over the ears for the first few days. Pain medication will be prescribed to help with this. The dressings will then be taken down one week following surgery and a lighter, removable headband-type dressing will be applied. Normal bathing may begin with care not to rub the ears aggressively. Stitches are usually dissolvable and will disappear on their own in a week.
What are the risks and complications?
Most individuals are thrilled by the outcome of their Ear Pinning (Otoplasty). Nonetheless, perfection is not always achievable. In some cases, slight asymmetry may occur during the postoperative period. This is usually subtle and does not require correction.
Usual postoperative restrictions apply. Patients are required to avoid heavy lifting, contact sports, or aggressive exercise for 4 to 6 weeks.
Additionally, as with any surgery, Ear Pinning (Otoplasty) carries a risk of bleeding, infection, or adverse anesthetic reactions. Adherence to Dr. Panossian’s pre-and postoperative instructions will limit your chance of having these problems.
In the event of a small blood collection underneath the skin (hematoma), a small needle can be used to draw out the blood collection in the office. A cartilage infection may be treated with a course of antibiotics. Sometimes, a small surgical procedure is required to drain an infection or hematoma.
Dr. Panossian’s staff is available at all times to handle your questions regarding operative instructions and postoperative care. Do not hesitate to contact the office in the event of an emergency or for clarification.
Botox and Fillers
What is Botox?
Botox is a drug created from a bacterial neurotoxin called botulinum. In small doses, Botox can cause paralysis in spastic or overactive muscles. It has gained popularity over the last two decades in the cosmetic world for the treatment of wrinkles.
Facial wrinkling occurs for several reasons in addition to aging. Loss of skin elasticity and sun damage can hasten the formation of wrinkles in addition to a person’s genetics. Smoking and other lifestyle choices can also speed up this process.
Wrinkles can be static or dynamic. Static wrinkles are those that are present even when the face is relaxed. Dynamic wrinkles are wrinkles that appear with various facial expressions, but go away when the face relaxes. Botox is highly effective in preventing wrinkles from setting in, but typically does not eliminate static or deep wrinkles. For static wrinkles, fillers are used. Botox typically lasts an average of 3 months and will require repeat treatments when desired.
Aside from treating wrinkles, Dr. Panossian performs Botox injections in cases of facial asymmetry. Specifically, individuals who suffer from facial paralysis or have recovered incompletely from facial paralysis (Bell’s palsy) will occasionally require intervention for asymmetric facial movement. In addition, some patients may develop unwanted facial twitching (synkinesis) while recovering from facial paralysis. This twitching can be relentless and possibly permanent. Botox injection, placed precisely into specific muscle groups, can balance the face and relieve involuntary twitching.
Dr. Panossian also performs Botox injection into palms, feet, and armpits in people suffering from excessive sweating, or hyperhidrosis. This is a very effective treatment for sweating and, for many people, life changing.
There are alternatives to Botox. These include Dysport and Xeomin. Consult with Dr. Panossian regarding the best option for you.
What are fillers?
Fillers are a general category of injectable medications that are designed to increase volume in specific parts of the face. They are gelatinous in consistency and are based on naturally occurring skin proteins such as collagen and hyaluronic acid. Volume is increased by drawing fluid into injected areas. The typical problems treated with fillers are deep wrinkles and other areas lacking fullness. Some commonly used fillers are Juvederm, Restylane, Perlane, Radiesse, and Sculptra. Newer generation of fillers typically last up to 12 months.
There are other substances that serve as fillers. The most popular of these options is using one’s own fat (fat injection or fat grafting). By suctioning fat from the abdominal region and purifying it, fat injection can achieve similar results to other fillers. Although fat injection is considered a permanent type of filler, there are advantages and disadvantages is that the effect can be permanent.
When should I use Botox?
Botox is used most frequently when facial wrinkling increases. Once the effect wears off in approximately 3 months, you can then repeat the treatment indefinitely. There is a growing trend to begin Botox treatments when patients are in their 20’s and 30’s as a preventative measure. This may or may not be a good strategy for you. Your consultation with Dr. Panossian will go over the pros and cons of this approach and tailor the best option for you.
When should I use fillers?
Fillers are used when deep wrinkles set in or the effects of aging and gravity have unmasked volume deficiencies in the face. Permanent wrinkles such as those occurring in the forehead, laugh lines, and crow’s feet are common areas. Even smaller wrinkles such as those occurring between the eyes or around the lips can be filled. Fillers are also helpful for enhancing certain facial features by increasing their volume. These areas can include the lips or cheekbone areas.
Everyone’s genetics are different. Younger patients typically prefer volume enhancement, and older patients may also want to correct deep wrinkles. There is no specific age range to begin treatment. This is a personal choice, but many seek Dr. Panossian’s evaluation and recommendations to guide them in their decision.
What are some risks of Botox?
It’s important to note that Botox injection is extremely safe in experienced hands. Even so, there are some potential risks that should be noted. Being a paralytic agent, Botox will paralyze any muscle with which it comes into contact. This can include adjacent muscles that are not necessarily the intended targets. One example of this is the possibility of a droopy upper eyelid from injection or migration of Botox from forehead injections. Another example is sagging of the lower eyelids or smile with aggressive injections into crow’s feet or laugh lines. The unintended effect is temporary and will allow for function to return as the effect of Botox diminishes.
Bruising may occur if a blood vessel beneath the skin is pierced. This problem typically occurs in the setting of recent use of non-steroidal anti-inflammatory medications such as Advil, ibuprofen, Motrin, Naprosyn, and aspirin. As a general rule, these medications must be discontinued 10-14 days prior to injection to avoid this potential problem.
In rare instances, Botox injections may not fully have the effect one desires. There are several reasons why this may occur including inadequate amount of product injected. Some individuals may also metabolize Botox more quickly resulting in a shorter duration of effect than the average 3 months. And rarely, a vial of the product may contain inactive or denatured Botox. Dr. Panossian is committed to rectifying these issues so that you may have the anticipated result.
What are some risks of fillers?
Several issues can occur with injection of facial fillers. These mostly have to do with contour problems. Uneven injection of material may cause lumpiness in treated areas. Overcorrection is rare but may occur as well. Bruising can occur if blood thinning agents (eg, aspirin, Motrin, Advil, ibuprofen) have been used within 10-14 days of treatment. Allergic reactions are known to also occur very rarely. If you have had an allergic reaction to a specific filler, please bring it to Dr. Panossian’s attention at the time of your consultation.
What is Dr. Panossian’s technique for injection of Botox and fillers?
Injection of Botox and facial fillers is a treatment that should be considered an artistic endeavor that carries some risk. This should not be taken lightly. Dr. Panossian does not believe in handing off this procedure to other staff members to perform. He performs all injections with an eye for artistry and a deep knowledge of facial anatomy. This is as vital to the safety and comfort of his patients as well as for the final results.
Dr. Panossian is an advocate of a conservative approach to the administration of Botox and facial fillers. While other physicians in the cosmetic world may elect to use large quantities of these products, Dr. Panossian believes in injecting only as much as necessary for achieving the intended results. This not only limits complications but makes these treatments more affordable for patients. For Botox injections, he administers a baseline amount of product and re-evaluates the effect in 2 weeks. If necessary, he will perform additional smaller quantity injections at the second visit. The approach to filler injection is different. Single syringes are used at any one session and meticulously injected into problem areas. The success of fillers rests on the experience and knowledge of the person performing the injections. It is important to vary the depth and direction of injections to avoid over- or undercorrection. Dr. Panossian’s passion and extensive experience in this area stands out. Trust your face only to the best!