November Newsletter

Remove Those Summer Sun Spots

Autumn is finally here as temperatures have started to drop and we are getting ready for the holidays. It’s a great time to consider having those procedures done that we don’t normally perform in the summer. This is especially true of CO2 laser skin resurfacing. The summer months are tough on our skin because we develop age spots as well as fine lines and wrinkles. As we age our skin does not hold moisture as it did when we were younger. This all leads to aging of the skin. CO2 laser resurfacing is great for removing that damaged layer of skin on top as well as stimulating collagen growth for healthier thicker skin. We have been having great success using the CO2 laser especially in combination with platelet rich plasma (PRP). PRP, which is using your own concentrated platelets to improve healing, not only shortens the healing time by 50%, but also stimulates faster collagen and blood vessel growth. PRP also stimulates hair growth in thinning hair, especially when used in combination with the micro needling technique. Contact our office to set up your appointment so you can look your best for the holiday season.

Laser Vaginal Rejuvenation

We are also pleased to introduce vaginal rejuvenation for our patients ,using the very best tool on the market. Femtouch CO2 laser vaginal rejuvenation not only thickens the vaginal wall and improves tightening, but also increases blood vessel growth to moisten the vaginal wall. For many of our patients who have stress urinary incontinence, the procedure is a great alternative to bladder suspension surgery in some cases. Many patients require a single five-minute painless treatment, although for those with stress urinary incontinence, up to three treatments spaced one month apart may be necessary. This procedure works great for our patients who can’t take hormone replacement therapy due to a history of breast cancer, but we’re finding that many of our patients who are on hormone replacement therapy like the benefits of vaginal rejuvenation.

Health Tip of the Month

The best foods for chronic pain…

In a recent edition of Bottom-line Personal, a physician in Las Vegas discussed dietary changes that can have an effect on patients with chronic pain. Cherries and other berries are rich in anthocyanin, the chemical that relieves pain better than aspirin. Giving up sugar helps lower the chemical AGE, which triggers massive amounts of inflammation. Switching to olive oil for cooking lowers prostaglandins, a pain causing neurotransmitter. Green tea is great beverage because it contains catechins which are antioxidants to reduce inflammation.

Written by Doctor PerlmanNovember 9, 2016

April Newsletter

Spring is in the air and now is the time to get in shape for the summer!

Skin Care Products in Houston, TX

It’s important remember to keep well hydrated during the hot summer months. Being well hydrated means drinking a lot of fluids as well as keeping your skin hydrated with moisturizers and sunscreens. As we get older, our skin doesn’t retain water as well. In addition we no longer produce as much collagen. These factors contribute to aging of the skin, producing wrinkles, pigmentation changes, and fragile capillaries. At the Advanced Plastic Surgery Centre and Bellezza Skin Care Clinic, we offer state-of-the-art surgical and nonsurgical treatment programs to help your skin look its best. Our in office and at home skincare products are made with the best ingredients at affordable prices. Schedule an appointment with our aestheticians to give your face that youthful glow.

Want to get rid of those few extra inches that exercise doesn’t take away? 

SmartLipo® in Houston, TX

We offer the latest in SmartLipo treatment programs. We use the SmartLipo triplex system, which not only offers the best laser liposuction results but also the safest. The big concern with laser liposuction is that the heat generated could burn the skin and produce scarring. The heat sensor technology in the triplex system automatically senses when the skin is getting too warm and turns off the laser. SmartLipo is great for areas like under the chin, upper arms, medial thigh, love handle and abdomen. It’s done in the office under local with oral sedation and your back to work the next day and back to working out in five days.

Plastic Surgeon in Houston, TX

Check out our specials, which change monthly!

We are grateful for having treated over 10,000 people with a variety of surgical and nonsurgical treatments and consider it a team effort, that involves both the patient, Dr. Perlman, and his staff, to get the best results. That’s why most of our patients are referrals from other patients and we have a five star review rating with the major patient review sites.

Every month were also going to offer a practical tip not necessarily related to medicine.

This month it’s temporary email addresses. If you need a temporary address to fill out a form on the Internet try mailinator.com. It lets you set up an email address which only lasts a few hours and then disappears. It’s great for when you are on a website that asks for your email address, in order to proceed, and you don’t want to give them one of your permanent email addresses.

Best foods for anti-inflammatory benefits: Fruits and berries that contain anthocyanins. Cherries are the number one choice. In addition they contain vitamin C which is a potent antioxidant. Olive oil which contains oleocanthal, inhibits Cox 1 and Cox2 enzymes which promote inflammation. Avoid sugar which causes the body to produce glycation end products (AGE) which triggers inflammation.

Written by Doctor PerlmanApril 6, 2016

March Blog – Getting Ready for Summer

Now is the time to get your body in shape for the summer. Time to start hitting the gym hard, having a healthy diet, drinking a lot of water, and getting proper rest. Now that you’re doing your part, it’s time for us to help you look your best. We offer the latest proven techniques for cosmetic breast surgery, including the “internal brassiere” to help lift your breasts, and breast augmentation using the axillary (underarm) incision, that leaves no scars on the breast. During March, we are offering breast augmentation with gel implants for $5500 complete. That’s a savings with $1000 off the regular price. Breast lifts with the internal brassiere ADM grafts is only $4200, which is a $1500 savings off the regular price. Call 281-655-8200 to schedule your appointment

SmartLipo update

Want to get rid of that little “pooch” under your chin, in your abdomen, or between your thighs? Try SmartLipo. It’s a procedure done in the office under local anesthetic for permanent removal of fat cells. Don’t waste your time on “noninvasive” that removal procedures. SmartLipo takes 1-2 hours and your back to work the next day. Call 281-655-8200 schedule your appointment

Eat, drink, and be healthy

A recent study in Europe showed that alcohol consumption while eating fish raised omega-3 fatty acid levels in the participants. Omega-3 fatty acids are important for lowering triglycerides and decreasing plaque formation in arteries. Wine drinkers had higher levels of omega-3 than beer drinkers, but both had higher levels than not drinkers who ate fish. This only pertains to moderate drinkers. Heavy drinkers had lower levels of omega 3s.

Written by Doctor PerlmanMarch 1, 2016

Topic – Tattoo Removal

Decorative tattoos have been part of 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 a black or dark blue tattoos.

When I see a patient with the 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 . 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.

Written by Doctor PerlmanFebruary 1, 2016

Puffy Eyelids

Eyelid Surgery (Blepharoplasty) in Houston, TXI 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 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 regards to eyelids surgery has changed. When I was a resident over 25 years ago, the common practice was to remove the fat that’s herniated, but this tended to leave a more sunken look to the eyelids, particularly the lower eyelid. Nowadays, we have learned to conserve and repositions 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 which 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 removal of the fluid from the eyelid tissue. This also corrects the discoloration that many people have that causes the dark circles of the lower eyelids.

Written by Doctor PerlmanJanuary 1, 2016

Topic – Tummy Tuck

Tummy Tuck in Houston, TXI am seeing more patients in my practice now, who have a lot of loose abdominal skin, than ever before.  Traditionally, tummy tucks were performed on women , after childbearing age, who had a lot of loose skin.Because of the increased frequency of bariatric surgery i.e. gastric banding and gastric bypass, there are many patients who have lost significant amounts of weight ,and now have loose skin.  In those situations, it is not only the abdomen but also the arms, breasts, thighs, and even the back that are loose .Over the last 10 years, the number of abdominoplasties, performed by board certified plastic surgeons, has increased from 34,000 to approximately 200,000.Women still outnumber men 40:1.

There are different techniques of abdominoplasty and an experienced board certified plastic surgeon knows how to choose the right technique for the patient.  In most cases, the patient not only has loose skin, but also has some excess fat ,particularly in the love handle and lower back area, as well as lower abdomen.  They also have laxity of the abdominal muscles.  All of these problems need to be addressed.  In order to help flatten the abdomen effectively, the fascia directly overlying the rectus muscles is plicated, or sutured together to prevent the abdomen from distending.  In addition liposuctioning is done to a limited degree in the abdomen, as well as love handle and lower back as necessary.

The length of the incision, and tightening of the musculature determines the difference between a “mini tuck” and a standard abdominoplasty.  For the standard abdominoplasty, the muscles are usually tightened from just below the breast bone down to the pubic bone.  For the mini tuck, all the work is done below the belly button or umbilicus.In the standard abdominoplasty, the skin and fat are elevated off the underlying muscle to the level of the ribs.  The hips are then flexed on the operating table and the excess skin pulled down.  An opening is made in this skin flap and the belly button, which is preserved on its stalk, is then pulled up, so that the belly button stays at the same position on the abdominal wall.  In a mini tuck, the skin and fat are only elevated up to the level of the belly button and then the excesses resected.  In an extended abdominoplasty, the incision extends past the hip bone in order to also lift the thigh and the lateral hip at the same time as flattening the belly.

I explain to my patients that the length of the incision is not critical, as long as I can be hidden within the panty line.

Written by Doctor PerlmanDecember 1, 2015

Total FX- The Gold Standard in Facial Resurfacing

Now that summer is almost over, it’s time to start thinking about what we can do to repair the skin damage caused by the summer wind and sun. Although we encourage our patients to moisturize daily, use a good sunscreen, and drink plenty of water, it’s inevitable that our skin sustains continuing oxidation and cellular deterioration caused by free radicals. We know that the sun emits UVA and UVB lightwaves, that cause superficial changes such as hyperpigmentation, blotching, rosacea and acne as well is deep changes evidenced by wrinkles. These changes can also promote the development of skin cancers.

Skin resurfacing involves different treatment methods ,depending on what the problem is ,and how aggressive one wants to be. Some of the resurfacing procedures ,such as superficial chemical peels and microdermabrasion ,can be done to help the more superficial problems, but to treat the deepest wrinkles, one has to resort to laser resurfacing. The Lumenis Total FX system is the most powerful fractional CO2 laser on the market. It allows the physician to penetrate into the deeper layers of the dermis, yet heals in a 3-7 days time frame. The damaged skin is removed and the laser stimulates both collagen growth and new blood vessel formation, to help rejuvenate your skin. The results last 3-5 years. The procedure can be done in the office, under a local anesthetic. There is no pain postoperatively, and the results have been quite dramatic. I’ve also used as treatment for deep acne scars and burn scars with good results.

Written by Doctor PerlmanNovember 1, 2015

Non-surgical facelifts-too good to be true?

Skin Rejuvenation in Houston, TXIn this day and age, we have a “gotta have it yesterday” mentality.  Information is sent around the world in microseconds, packages are shipped overnight, we can even microwave dinner in three minutes.  We’re always on the go, multitasking, working even more than before.We are taking the kids from school, to soccer practice, music lessons, home for dinner, and then we have our regular tennis leagues.

I see many patients who are concerned about facial aging.  They look older than they feel and want to stay youthful and ,in many instances, competitive.  They often look for quick fixes .  When I was a plastic surgery resident 25 years ago, the only treatment methods for the aging face was a facelift, forehead lift and eyelid surgery (blepharoplasty).  Patients were either a candidate or not.  Since that time, our understanding of facial aging has increased dramatically.  We now understand that over one’s lifetime, you can lose as much as 50% of your facial fat.  In addition, the skin becomes lax and the cells are unable to retain water.  This all contributes to the face sagging, with the development of jowls, loose neck skin, prominent nasolabial folds, bags under the eyes, and drooping eyebrows.

Physicians are now not only resecting the loose skin, but also adding volume to the face ,with different types of fillers including fat, hyaluronic acid, and collagen.  In addition, the face lifting procedures have expanded in techniques, to include limited  dissection facelifts, thread lifts,and multi-plane facelifts.  This not only gives the patient many alternatives, but also contributes to the confusion as to what is the best choice.

As I have mentioned before, it’s important to seek a qualified plastic surgeon ,if you are a candidate for a facelift.  There are many practitioners, who are not board-certified plastic surgeons, offering “nonsurgical facelifts” as well as limited facelifts that they advertise will give you the same result as the more traditional surgical facelifts.  Ask them what their qualifications are, if you can see before and after pictures and if you can speak with some of their former patients.  The more traditional facelifts will last 7-10 years.  The limited facelifts and “liquid facelifts” will not give as effective a result, nor will they last nearly as long.  In my practice, I utilize 3-4 different types of face-lifts, depending on the patient’s needs, and I often will complement the facelift procedure with dermal fillers, Botox, and laser resurfacing.Some patients really do not want surgery, even though that may be the best treatment method.  In this situation ,I explain to them alternative treatments and their limitations. There is not a “one-size-fits-all formula” to treat the aging face.

Written by Doctor PerlmanOctober 1, 2015

Photoaging – It’s Something We All Get

Skin Care Products in Houston, TXWe are constantly exposed to the sun throughout our lives. As a baby living in upstate New York, my mom used to dress me up in my snowsuit and “plant me in the snow in the front lawn” on sunny winter days to get some sun and fresh air. We know that there are benefits and adverse effects from sun exposure. We know that sun is a source of vitamin D, although in the northern half of the United States, during the winter, the angle of the sun is such that we don’t get much benefit. During the rest of the year though, the sunlight, and more specifically the UVB rays ,trigger our skin to send vitamin D precursors into our circulation.

UV radiation from the sun is basically in two forms, UVA which has the longer wavelength and UVB, which is a shorter wavelength. The shorter the wavelength the less penetration into the skin. UVB causes most of the visible changes and premalignant and malignant lesions. UVA causes more of the photoaging problems. The UV damage primarily causes molecular damage in the skin, releasing free radicals, which are unstable atoms. These unstable atoms cause cells to disrupt and cause other damage within the DNA of the cells.

What we see in aging skin is pigment changes such as “old age spots”, deep lines and wrinkles, thicker skin and dilated blood vessels. The pigmentation changes are due to overproduction of melanin by the pigment producing cells of our skin. The deep lines and wrinkles and thicker skin are due to accumulation of abnormal elastin fibers and the decrease in collagen production. The broken blood vessels are due to changes in the walls of the capillaries, causing them to permanently dilate. In addition, as we age, our skin cannot retain water as it did when we were younger and dehydrates.

There are many things we can do to help our skin look more rejuvenated. Number one is to drink a lot of water. Drinking four glasses of water a day will help keep us hydrated ,particularly in the summertime. Secondly, use a good sunscreen. Even though sun damage starts when we are children and accumulates during our life, it’s never too late to be proactive in treating our skin. Sunscreen should have UVA blockers as well as UVB blockers. Check the label or ask your skin care specialist if you’re using the right product and make sure that your product is at least an SPF 30.

You should be using a good moisturizer on your skin as well as products that contain vitamin A (retinoids) and vitamin C. Not only do they help accelerate the skin turnover rate and limit melanin production, they also are good antioxidants to help clean up the free radical damage. Bleaching agents that contain hydroquinone to decrease pigment production are also recommended. There have been reports in the literature, that high concentrations of hydroquinone can cause liver damage, so use these products judiciously and only after discussing them with your skin care specialist.

In office treatments include chemical peels, which remove the top layers of skin and promote increased collagen production. Peels such as glycolic acid can remove the top layers but ,for the deeper lines and wrinkles, one needs to use peels that penetrate to the dermis ,such as TCA (trichloroacetic acid) peels.

In our office, we also offer Microdermabrasion ,to mechanically remove the top layer of skin. This is a sandblasting form of skin peeling and is often used in combination with chemical peels.

IPL (Intense pulsed light) is another popular treatment. This is done as a series of light therapy treatments using specific wavelength filters to treat the various problems such as dilated blood vessels, pigmentation changes, and fine wrinkles. There’s no downtime and the results are quite good.

The gold standard for skin resurfacing is the fractional CO2 laser. This is a laser treatment that vaporizes cells and using the fractional method, it allows deeper penetration into the skin with minimal risks of scarring or hyperpigmentation. Recovery time is 3-7 days but the results are quite dramatic.

Have fun this summer, but remember to take care of your skin. Consult your skin specialist, especially if you notice any changes in moles on your skin, such as darkening, increase in size, ulceration, or thickening.

Written by Doctor PerlmanSeptember 1, 2015

Choosing the Right Skincare Products

There are many over the counter products that advertise dramatic results for rejuvenating the skin. Celebrity spokespersons trumpet the benefits of skincare products that turn back the clock, giving the skin healthy youthful glow, removing lines and wrinkles in a matter of days. Americans will spend $5 billion on skincare products and cosmetics this year alone. Some of these products are quite pricey, costing hundreds of dollars for a small jar of product that lasts a month. Because the FDA doesn’t monitor or regulate these products, it’s difficult for the consumer to know how much of the benefit they are.

There are certain ingredients that one should look for in any anti-aging products. The ingredients should address the leading causes for aging of the skin: internal sources such as diet and genetics and external sources such as UV radiation, pollution, wind and smoking. On the cellular level, the damage from free oxygen radicals to cellular DNA, lipid, and proteins affects the integrity of our skin cells including the production of collagen. Since collagen is the main building block of our skin, decreased collagen production will cause noticeable signs of aging such as wrinkling.

Some of the more effective antioxidants occur naturally in the skin including vitamins A., C., and E. Our skin also contains coenzyme Q.-10 which neutralizes free radicals. As we age, our production of these antioxidants decreases. In addition, a diet that is lacking in sufficient amounts of these vitamins also contributes to the aging process.

Vitamin A in its biologically active form is retinoic acid or tretinoin. Vitamin A increases the growth of the epidermis as well as metabolism of fibroblasts and collagen. They also decrease metalloproteinase that degrades collagen . Topical application of vitamin A products improves fine and coarse wrinkling and pigmentation. One of the more common vitamin A products on the market is Retin-A.

The Vitamin B group contains certain subgroups which improve wrinkles such as vitamin B 3 (niacinamide) and DMAE. Gels containing both of these drugs improve wrinkles, pigmentation, yellowing of the skin as well as improve sagging.

Vitamin C is the most plentiful antioxidant in the skin. This biologically active forms include ascorbic acid and alpha hydroxy acid. Skincare products containing vitamin C often include tea based products, which seemed to cause less irritation to the skin. Cellex-C is a common brand but there are many more products on the market that contain this antioxidant vitamin C products have shown to increase blood supply to the skin, increased gene expression of type I collagen and thus improve wrinkling, roughness, skin laxity, and sallowness

Vitamin E is a lipophilic antioxidant. By that I mean that it scavenges free radicals preventing their damaging lipid cell membranes. Products that contain tocopherols and tocotrienols are Vitamin E products. Studies have shown that vitamin E in combination with vitamin C decreases damage to sunburn cells and thus serves more as a protective agent.

Coenzyme Q. 10 and Squalene are also lipophilic antioxidants which decrease with age and a radiation. A synthetic form of coenzyme Q. 10 is idebenone. Alpha lipoic acid is another free radical oxygen scavenger which increases collagen synthesis.

Alpha-hydroxyl acids (AHA) thin out the top layer of skin and speed up the normal process of skin cell exfoliation and regeneration. They can also increase the thickness of the skin and improve the quality of elastic fibers and collagen. Many AHA’s occur naturally in foods. Roman women new the benefits of treating their skin with wine and grapes, which contained tartaric acid, as well as citrus fruits. Ascorbic acid is found in fruits, vegetables Gary products, and tea. Glycolic acid is found in sugarcane and lactic acid in sour milk and tomato juice. Over-the-counter concentrations of AJ’s are quite low but can be beneficial as a home therapy supplement to in office chemical peels which are done with a higher concentration. AJ’s continued to be one of the most effective anti-aging compounds.

Botanicals are finding their way into skincare products for their antioxidant properties some of the more common ones include bioflavonoids and anthocyanins. Both of these have antioxidant and anticancer and anti-inflammatory properties. It is for the anti-inflammatory effects that they are probably most useful when combined with other antiaging ingredients.

Pentapeptides have been linked to increased collagen synthesis. One commercial product from Paris, Matrixyl, has shown to decrease wrinkle depth and volume as well as improve the roughness of the skin even when compared to vitamin C. An eyelid firming gel that we sell in our product line contains pentapeptides to decrease capillary fragility, reduce inflammation, and speed up the metabolism of red blood cells which cause discoloration.

In addition to using the various antiaging products as part of your skincare regimen, it’s important to keep the skin moist. Petrolatum-based products are the most common to maintain the skin barrier to decrease water loss. Glycerin products are key methods, which means that they will actually hydrate the skin rather than decrease water loss. Liposomes also serve a similar function.

In choosing skincare products. Read the label to see if it contains the proper ingredients. Establish a good regiment of gently cleansing your face as well as using toners, anti-aging products and moisturizers.

Written by Doctor PerlmanJuly 31, 2015

Advanced Plastic Surgery Centre

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281-644-0013

8900 Eastloch Drive, Suite 105,
Spring, Texas 77379