Category: Blog

With the busy holiday season upon us, many of my patients are looking for quick fixes. In previous posts, we talked about dermal fillers to plump up the facial lines as well as using Botox to smooth out the wrinkles on the upper face. My practice is one of the busiest in the city, particularly at this time of year, for injections of my favorite dermal filler, Juvederm. This is made of hyaluronic acid, one of the natural building blocks of the skin, along with collagen. Juvederm voluma xc is a smooth filler that I like to use, especially for the nasolabial folds and the marionette lines in the corners of the mouth. It’s also great to help turn the corners of the mouth upward by adding volume to the lower cheek.

We see many patients in the office for lip enhancement. The majority of patients are interested in smoothing out the vertical upper lip lines as well as adding some volume to the lip because as one age, your lips thin out. Juvederm is a great filler for these areas also. I’ll often inject a small ribbon of Juvederm along the upper lip border, although some patients will need injections into the vertical lift lines themselves.

We are starting to see more patients who are interested in a more permanent enhancement of their lips. For these patients, we offer implants. The quality of implants has changed over the years. We had satisfactory results with Alloderm, which is a cadaver dermal graft, as well as Advanta, which is made up of a Gortex-like material. Lately, we have almost exclusively started using Permasil. This is a great lip implant. It is made from silicone and is shaped like a gummy bear worm. It comes in three different sizes, depending on how full the patient wants their lips to look. The insertion is quite easy through small incisions in the corners of the mouth and to date, we have not had any problems. Our patients have been 100% happy with the results. This is definitely the way to go for patients who like full lips, but don’t like to return yearly for injections.

Many patients seek body contouring surgery for looseness of the abdominal skin, particularly after childbearing or after massive weight loss.

Traditional abdominoplasty, i.e. tummy tuck, involves making an incision horizontally across the top of the pubic region and extending the incision laterally to the hip bones. The skin and fatty tissue are then elevated off the underlying fascia (the glistening white tissue) and muscle. The fascia and muscle are then flattened out with sutures that plicate the tissue. The extra skin is then pulled down and removed and the incision closed. This will flatten out the lower portion of the abdomen below the belly button but does not always flatten out the upper portion. For this problem, I have been working on a solution I call the upper abdominal lift.

I have to give my wife credit for the idea. Through an incision in the inframmary crease, beneath the breasts, I dissect down and grab the tough fascia layer. I then pull it up and suture it with permanent sutures, to the ligamentous tissue over the ribs. I then remove a small ellipse of skin. This flattens out the upper abdomen nicely and the results appear to be lasting. The scar is inconspicuous.

The procedure works great, especially if the patient is having breast surgery (either an augmentation and/or lift) done at the same time as the abdominal surgery.

I just returned from a restful vacation. Not only was I stress-free but I was also allergy free. It did not take long to return to the typical Houston weather and my allergies flared back up. It was back to the over-the-counter antihistamines and decongestants. It still left me with puffiness of the lower eyelids. This is a common symptom of “hayfever”, although most allergies are due to other air contaminants including pollution, mold, cedar, and pollen.

In my practice, I see many patients who desire to have treatment for excess eyelid skin and puffiness. In many older patients, the problem is due to the laxity of the membrane that keeps the fat around the eyeball in its proper place. The eyeball only occupies about half the space of the eye socket. The rest is filled with fat which serves as a shock absorber as well as the muscles that move the eyelids and eyeball. As we get older, the membrane that holds the fat pads in place weakens and the fat “pooches forward”. A surgery called blepharoplasty removes some of the herniated fat and repositions the remainder. Over the course of the last 20 years, the philosophy in regard to eyelids surgery has changed. When I was a resident over 25 years ago, the common practice was to remove the fat that was herniated, but this tended to leave a more sunken look to the eyelids, particularly the lower eyelid. Nowadays, we have learned to conserve and reposition fat rather than remove as much as we used to.

For patients whose puffiness is due to allergies, over-the-counter antihistamines, and decongestants will help. There are also creams available that contained penta peptides. These are proteins made of essential amino acids, that I discussed in a previous broadcast. These penta peptides strengthen the capillaries in the eyelids to prevent fluid from leaking out. They also help promote the removal of the fluid from the eyelid tissue. This also corrects the discoloration that many people have that causes dark circles of the lower eyelids.

A new study reveals that multiple sclerosis (MS) is not caused by a blood vessel disorder. Accordingly, there is no need for MS patients to undergo any surgical procedure that involves opening the veins that connect the spinal cord and brain to the heart.

While surgery is a very appealing quick-fix solution, Dr. Bridget Bagert of Ochsner Clinic Foundation in New Orleans says, “It’s really not the right thing to do if the problem isn’t established as being real.”

MS is an inflammatory disease that involves the deterioration of the fatty myelin sheaths that wrap around the axons of the spinal cord and brain. Damage to this protective coating can slow down the brain’s ability to communicate with the rest of the body.

A few well-publicized studies were made linking MS with blood vessel problems. In 2009, Dr. Paolo Zamboni associated MS with a condition known as chronic cerebrospinal venous insufficiency (CCSVI). His theory was that the veins that carry blood from the spinal cord and brain to the heart have become narrow. As a result, the blood is leaked back to the brain. Dr. Zamboni and his colleagues believed that this can cause inflammation and the eventual muscle problems seen in MS patients.

But Dr. Bagert disputes Dr. Zamboni’s theory. “That really casts a lot of doubt on to whether CCSVI exists at all, let alone whether or not it’s the cause of MS.”

Dr. Ellen Marder, from the University of Texas Southwestern Medical Center in Dallas, also supports Dr. Bagert’s view, “We don’t think (CCSVI) is the cause of multiple sclerosis.”

Blood pressure is a crucial indicator of cardiovascular health, influencing various aspects of our body’s function. Recent studies have highlighted a significant correlation between dips in blood pressure and an increased risk of blood clotting, emphasizing the importance of maintaining stable blood pressure levels for overall well-being. In this comprehensive guide, we delve into the mechanisms behind this phenomenon, explore its implications for health, and discuss preventive measures and treatment options to mitigate these risks effectively.

The Role of Blood Pressure in Circulatory Health

Blood pressure, measured as the force exerted by circulating blood against the walls of arteries, plays a vital role in maintaining adequate blood flow throughout the body. It consists of two primary measurements:

• Systolic Pressure: The higher number, indicating the pressure when the heart contracts and pumps blood into the arteries.
• Diastolic Pressure: The lower number, representing the pressure when the heart relaxes between beats.

Normal blood pressure typically ranges around 120/80 mmHg. Fluctuations in blood pressure, whether sudden drops or spikes, can impact cardiovascular health and predispose individuals to various complications, including blood clot formation.

Understanding Blood Clotting

Blood clotting, or coagulation, is a natural process that prevents excessive bleeding when blood vessels are injured. However, abnormalities in this process can lead to the formation of clots within blood vessels, potentially causing severe health issues such as:

• Deep Vein Thrombosis (DVT): Clots forming in deep veins, commonly in the legs, which can lead to complications if dislodged and travel to the lungs (pulmonary embolism).
• Stroke: Clots blocking blood flow to the brain, often resulting from atrial fibrillation or other heart conditions.
• Heart Attack: Clots obstructing blood flow to the heart muscle, causing damage or failure.

The Link Between Blood Pressure Dips and Blood Clotting

Recent medical research has identified a concerning association between sudden dips in blood pressure and an increased risk of blood clotting. When blood pressure drops significantly, the following mechanisms may contribute to clot formation:

• Impaired Blood Flow: Low blood pressure can slow down circulation, especially in areas prone to stasis, such as veins in the legs or heart chambers.
• Endothelial Dysfunction: Fluctuations in blood pressure can damage the inner lining of blood vessels (endothelium), promoting clot formation.
• Increased Clotting Factors: Low blood pressure can trigger the release of clotting factors, accelerating the formation of abnormal clots.

Implications for Health and Well-being

Understanding the implications of blood pressure dips on clotting risk is crucial for preventing serious health complications. Individuals at higher risk include:

• Those with Hypotension: Individuals with chronically low blood pressure (hypotension) may be more susceptible to clotting events during episodes of further pressure drops.
• Elderly Individuals: Age-related changes in blood vessel elasticity and overall cardiovascular function can increase susceptibility to both hypotension and clotting disorders.
• Patients with Cardiovascular Conditions: Individuals with pre-existing heart conditions, diabetes, or those recovering from surgery are at heightened risk due to compromised cardiovascular stability.

Preventive Measures and Treatment Options

Maintaining stable blood pressure levels is essential for reducing the risk of blood clotting events. Effective preventive measures include:

• Regular Monitoring: Monitoring blood pressure regularly and consulting healthcare providers to adjust medications or lifestyle changes accordingly.
• Hydration: Adequate hydration helps maintain blood volume and circulation, reducing the risk of hypotension-induced clotting.
• Healthy Diet: Consuming a balanced diet low in sodium and saturated fats supports cardiovascular health and blood pressure regulation.
• Physical Activity: Regular exercise improves circulation, muscle tone, and overall cardiovascular function, reducing the likelihood of blood pressure fluctuations.

Conclusion: Taking Control of Your Cardiovascular Health

The relationship between blood pressure dips and blood clotting underscores the importance of proactive health management. By prioritizing regular blood pressure monitoring, adopting a healthy lifestyle, and seeking timely medical intervention when necessary, individuals can mitigate the risks associated with hypotension-induced clotting events. Awareness of these dynamics empowers individuals to make informed decisions about their cardiovascular well-being, ensuring a healthier and more resilient future.

Incorporating these insights into daily life fosters a proactive approach to cardiovascular health, reducing the likelihood of blood clotting complications and promoting overall well-being. Stay informed, stay proactive, and prioritize your cardiovascular health to safeguard against the potential risks posed by blood pressure dips. Your journey to optimal health begins with understanding and addressing the intricate balance between blood pressure regulation and clotting prevention.

Decorative tattoos have been part of the culture for thousands of years. No longer is it limited to military personnel and athletes. We’re seeing many younger patients, especially women, getting exotic tattoos often in multiple locations. It is estimated that in the United States, 25% of women between the ages of 19 and 35 have a tattoo.

Although many choose to have a small tattoo placed on their body in an area that’s easy to cover with clothing, we’re seeing more patients with tattoos on their lower arms and necks. These are obviously difficult places to cover with clothing. The reasons for removing the tattoo include “outgrowing the usefulness or novelty”, “my job prohibits me from having a tattoo that can’t be concealed” or “I’m no longer married to or dating the person whose name is on the tattoo”. The Harris County Medical Society, of which I’m a member, offers a “De-Tag” program for juveniles who are in custody to remove gang tattoos. Members of the Medical Society donate their time and the laser companies donate lasers and technicians to spend a few hours on a Saturday to help these young men and women try to get a new start on life.

A few tattoos can be covered with a heavy concealer, on a temporary basis but most patients want the tattoo removed. Over the years there have been a number of techniques to expunge the dye, including using coarse salt and a sponge to scrub the ink out or abrasion to sandblast the dye, freezing the tissue, and using creams to try to leech out the dye, and the use of radio-frequency needles to create blisters, but these have not been very successful or have left noticeable scars.

With the development of lasers, including Q. switched lasers in particular, physicians are able to target specific colors in the tattoo to selectively fracture the pigment granules so that they can be absorbed with less scarring.

Tattoo removal is a multi-treatment process, even with a simple black tattoo. Because of the multiple colors in many tattoos, it is necessary to use different lasers or filters. The laser light has to be specific to that color so that it is absorbed at a maximum rate. Each of the colors has a different wavelength. A green laser beam such as in the 532 nm range, will be absorbed by red pigment, and a red laser beam will be absorbed by green pigment such as in the alexandrite 755nm laser. The 1064 NdYAG laser light is absorbed by water so it is not color specific although this laser frequency works well on black or dark blue tattoos.

When I see a patient with a single color dark tattoo, I explain, that it will take at least five sessions to treat the area. The goal is to burst the tattoo pigment into small enough pieces that the body will absorb it. Unfortunately, the area where there was a laser is now left lighter in color than the surrounding skin. This is fine for someone who’s fair-skinned but in a darker-skinned individual, this can leave a noticeable remainder of the tattoo that was. I also explained that the tattoo removal generates heat and treatment may end up causing hypertrophic scarring.

Some patients do not want to go through the time and expense of multiple laser treatments and would prefer to have the scar removed surgically. This can be done in a single session with small enough stars that the world could be closed without significant tension. Unfortunately, many patients have large stars that require multiple excisions of small areas of the tattoo until the tattoo is totally removed.