“the treatment to erase wrinkles with Botox”
Our clinic is in a small town in Tokyo but with many foreigners here in the town of Hiroo. As mentioned in this homepage, Botox is currently widely used for treatment other than wrinkle, such as slimmer of muscle of jawline, hyperhidrosis of armpits and limbs, migraine, and the like. In our clinic, in particular, there are many patients who use Botox for treating headaches.
Today we will talk about Botox treatment example for wrinkles. The unit used here is discussed based on Botox of Allergan Inc.
Frown lines: wrinkles between the eyebrows are types of vertical wrinkles (also called 11 o’clock signs) that can only be made when expressing difficult expressions, or types that always exist irrespective of facial expressions. In the former case, Botox often works, the effect usually appears within one week after treatment and the effect lasts for 4-5 months. Botox works at the site of the nerve endings, making the muscles paralyzed by not transmitting mediators between the muscle junction and making it less likely to wrinkle.
The target muscle is the muscles running parallel to the eyebrows called the corrugator muscle and the muscles running up and down at the base of the nose called the procerus muscle. Normally 4-6 places slightly above the eyebrows, 1 injection at the root of the nose (to the procerus muscle). The dose is 15 – 20 units. Furthermore, when injecting, the outside of the eyebrow shall be shallow and the inside will be treated deeply. Even if you do not make a difficult expression, if there is always vertical wrinkles between the eyebrows, injected materials such as hyaluronic acid may be better (though extreme caution is required for hyaluronic acid injection at this site). Avoid lying down for about 4 hours after injection, avoiding swimming and other exercise, the effect will appear after 4-5 days. It is said that the peak of the effect appears after two weeks, but we check the result after one week and if necessary, carries out additional touch-up injections for free (the guarantee system one week later ). The cost will be 30,000 yen plus tax when only eyebrows wrinkles.
Wrinkle of the forehead: The transverse wrinkle of the forehead can be made when looking upward, and this is due to the frontalis muscle which is one of the expression muscles, the muscles running above and below the forehead, 90 degrees to the wrinkle lines. Wrinkling of the forehead may also always exist regardless of facial expressions, or it can only be seen when making facial expressions. Botox will be a good application in the latter case, and we will inject a total of 15-20 units to the eight forelocks of the forehead.
The point to pay particular attention to in terms of the procedure is that it is often better not to treat the sideways of the forehead at the part near the outside of the eyebrows. If Botox is effective in this part, the eyebrows will drop. Another problem is that when you open the eyes, sometimes you use forehead muscles (forehead muscles) for some people. If Botox treatment is given to the forehead of this type, eyelids become difficult to open. In order to prevent such problems, block the action of the frontal muscle by putting your fingers above the eyebrows in advance and check how much the patient uses the frontalis muscle to open the eyelids. When the frontalis muscle is heavily involved, avoid botox injection in the lower part of the forehead.
By the way, even with the same botulinum toxin preparation, products made in Europe are more likely to diffuse and seem to be prone to the problems described above. Treatment expenses are 30,000 yen plus tax in case of forehead only, but if you join the frown lines or the crows feet, somewhat cheaper on 50,000 yen in two of these parts. The effect is longer than the eyebrows and often lasts more than 5 months. Like the eyebrows, there is a guarantee system one week later. Another thing to note when injecting Botox on your forehead is that you can change the shape of the eyebrows in the way of injection. This method is also used when you want to fist up the crawl outside the eyebrows. This method is also suitable for patients whose eyelid slack is progressing.
Wrinkles in the corner of the eyes (crows feet) can be made fan-shaped from the outer corner of the eyes when laughing with eyes, there are types that can be upward from the outer corner of the eye, downwards, and upwards and downwards. Also, like wrinkles in other parts, there are deep wrinkles that are made even when you are not smiling with your eyes, and not so obvious types of wrinkles when not laughing. The type that Botox shows effective is the latter type. If you have deep wrinkles even when you are not laughing, hyaluronic acid may be injected into that wrinkle.
The treatment amount depends on the number of wrinkles, but it is about 18-25 units on the left and right. The addition of one more thing in the treatment of Botox to the wrinkle part of the corner of the eye can change the shape of the eyebrows. Sometimes it is possible to lift the outside of the eyebrows slightly upwards by Botox injection to the oculi anterior muscle beneath the outside of the eyebrows (it is not a method that everyone can do).
Wrinkles in the upper lip: Longitudinal wrinkles occurring in the upper lip are common in women over the age of 60, but this is caused by the action of the orbicularis muscles surrounding the mouth. This phenomenon is not seen much in men because there is a beard in this part.
When treating, have the patient pucker the mouth, especially marking the vertical wrinkle which occurs strongly with a pen, then inject 10 to 15 units into 4-5 places. Being careful with Botox’s injection to the lips, when the balance between the left and right collapses, the shape of the lips may change or it may be difficult to pronounce correctly.
Injection to other facial sites: Botox is also used for treating temporomandibular disorder by thinning the face line by injection into the muscle of jawline on the face. In addition, Botox’s injection may show a remarkable effect in the uneven surface like the oranges that can be made to the chin. On the other hand, Botox has no effect on the nasolabial lines or Marionette lines (wrinkles extending obliquely downward from the outside of the mouth). Hyaluronic acid injection is recommended for these sites.
“Side effects and failure cases in Botox wrinkle treatment”
Side effects: Although side effects related to Botox treatment are extremely rare, as a example, the eyelid becomes difficult to open (eyelid ptosis is seen less frequently than 1%. It is a complication especially seen in treatment to the frown lines. Even if this condition happens, it will return to its original state naturally in about 3-6 weeks. However, once this condition has occurred, there is a tendency for the situation to become the same again. The next time to be seen is in the treatment section, but the shape of the eyebrows may change or drop down when treating the forehead.
Those who are taking fish oil, DHA, EPA, aspirin or a pain killer tend to have a bruising tendency. In addition to the above, it is not recommended to egg allergy, those who have suffered facial paralysis in the past, those who are pregnant, breastfeeding, those who are planning to become pregnant within the next 3 months. Botox is also used for the treatment of migraine, but as a very rare complication, it may cause a headache to a healthy person. Also, when you have a cold, you may not be able to treat because your condition may get worse when you do not have physical fitness. Even those who are taking some antibiotics are considered to be cautioned.
Failure cases: Extreme failure example does not occur easily, but as we have mentioned, treatment of facial wrinkles using Botox has been used to paralyze muscle groups called facial muscles to make it more attractive. It is a treatment that expects a good effect, so it would be difficult to produce results that you expect to not understand facial muscles and nerve anatomy well. In the United States, Botox’s treatment is usually performed only by a doctor who has received proper training from a plastic surgeon or a dermatologist.
Surgery called Tummy tuck is a surgery to correct sagging of the abdominal skin and subcutaneous tissue, which is associated with extreme weight loss from postpartum and obesity. Because it is a relatively large-scale operation, it is a treatment to be done after hospitalized.
At the same time as the tummy tuck, there are occasionally those who wish to perform liposuction surgery in the abdomen or correct the drooping of the breasts. However, we do not recommend doing two or more such operations together (compound surgery). The reason is that the risk of complications increases significantly.
It has been reported in the United States that necrosis of the tissues of the abdominal wall is likely to occur when Tummy tuck and liposuction are performed at the same time. In addition, when Tummy tuck and breast surgery are performed together, the operation time also becomes longer, the rate of causing deep vein thrombosis increases, water accumulates subcutaneously also in the site of tummy tuck (seroma), the healing of wounds said to be poor.
If you wish to do some of these surgeries, we recommend that you consider the next operation after a period of recovery from each surgery for safety.
Our clinic director has carried out liposuction of many patients in the United States and Japan for many years. Although liposuction is already recognized such an effective treatment in the United States as an established cosmetic medical technology, but there are reports of serious complications such as fat embolism, abdominal perforation and death besides a mild complication such as unevenness of the skin surface. We do not have experience of such serious complications in our practice, but unfortunately there was report of such a case in Japan very recently.
We have repeatedly explained how to make a safe and effective liposuction for many years by invited lectures and papers at academic meetings, but unfortunately there are many self-proclaiming “cosmetic surgeons” in Japan who are not board-certified in plastic surgery, it can be said that in some cases it may be an extremely dangerous procedure.
First of all, careful counseling is essential for liposuction. Depending on the types of the supplement or prescription medicines, it may become easy to bleed, and it may be impossible to carry out safe liposuction unless these medicine are stopped ahead. Also, in preoperative examinations, especially in the case of abdominal liposuction, it is necessary to determine whether there is an umbilical hernia or scar of past abdominal surgery. Small umbilical hernias may be difficult to find even with a specialist. In our hospital, we are trying not to make a hole around the umbilicus in such a case to improve safety.
Next, during the treatment, it is a technical problem, but in case of a right-handed doctor, how to use the left hand becomes important. It is necessary to perform the treatment while checking with the left hand where the tip of the liposuction tool called cannula is heading.
Finally, close all the holes used for suction and fix it under compression. Also, in case of day surgery, after surgery, we request an escorting person to be accompanied to see the patient’s conditions until next day. If that is impossible, you will be hospitalized at a university hospital and do the procedure there.
By observing the above guidelines, liposuction can be safe and effective even if it is a stomach operation. I think that the expenses are never higher compared with slimming surgery using laser or ultrasound.
Many people know that botulinum toxin preparations (such as Botox injection) are used to treat wrinkles. In the United States, it is widely used for treatments other than wrinkles, but I think that it is mainly used in the eyebrows, foreheads, crow’s feet, and hyperhidrosis of armpits in Japan.
Botox had been used in Japan and the US against the state where the eyebands are twitching more than before but in the United States it gets used for various facial expression wrinkles in the upper half of the face and then jaw muscle (slendering the face), temporomandibular disorder, hyperhidrosis (side arm and limb), and so on.
Details of Botox’s side effects and mechanism of action are described in detail on our website, but serious side effects are rare and representative ones include injection in wrinkles between the brows, it is found below 0.5% that eyelids are difficult to open (ptosis of the eyelids). Also, we can not treat pregnant, nursing or those planning to get pregnant.
Many patients are receiving this treatment because the treatment of wrinkles that can be easily done with a clinic easily and the price is relatively affordable (from 30,000 yen). In our clinic, patients with migraine also receive Botox treatment well (from 20,000 yen).
The method of double eyelid is roughly divided into non-cutting(stich-burial) method and incision method. Among them, we are doing a special 3 point fixation method called DST which is durable for a long time. For details, I think that you would like to see this homepage, but the director of our clinic has been using this method for more than 20 years (including the experiences in the US), for well over 1000 people, not only for many Asian people, but also recently for even Caucasian patients to treat as a non-incision method of eyelid’s slack removal.
There are so many attractive people in single eyelids, so it is not recommended to anyone, but the burial method is safe, it is a method to effectively increase the opening of eyes. I think whether you used the tape or glue, but the opening of eyes looks different by slight eyelid change. In our DST burial method, not only in Tokyo, many patients from oversea come to receive the treatment.
On the other hand, if there is a lot of fat on the upper eyelids or if sagging of the eyelid is conspicuous due to aging, it may be clearer to remove extra skin and eyelid fat by the incision method. In that case we recommend incision method from the beginning.
Currently, our office is located only in Tokyo, but many people are coming from afar. Because it is a treatment that can be safely done even for a stay of about 2 days, please consult us.
Although there are various methods for hair removal, it is generally said that hair removal using “medical laser” is most effective. Laser equipment used in our clinic is a widely used model in the United States and has proven track record of providing safe and effective treatment.
There seems to be various methods depending on the clinic for laser hair removal treatment method, but we are carrying out multi-directional repetition of Crisscross fashion as multi-direction. Even with only one pass in one direction you can expect a certain degree of effect, but it may end with marginalization or insufficient treatment effect. In the Crisscross formula, we will treat it in two or more passes in different directions. The problem with this method is that if the practitioner does not recognize the reaction of the skin of the patient well, there is a possibility that it may become a surface burn in some parts, so only medical staff who received solid training are allowed to perform such treatment.
In the US, we call the plastic surgeon specialist “Board Certified in Plastic Surgery” or “Board Certified Plastic Surgeon”.
The word “Board Certified” has a special resonance, which is used to think that everyone in the United States understands its meaning. It is an idiomatic expression. Even in television and other media, scenes like “Is your doctor board certified?” Are often heard, and it is thought that whether you have this title is the first step to judge whether it is a reliable specialist or not.
By the way, in the US, in the place of postgraduate education, the choice of course is not free, past results and appraisal are greatly concerned. In general, it is said that it is the narrowest gate to go to brain surgery and plastic surgery among surgical systems and surgical systems, and the word “Board certified Plastic Surgeon” has a special sound in such a meaning I think there is.
Many of the surgery in the field of cosmetic plastic surgery are day trips and I think that there are many relatively small scale cases of 1-2 hours. However, sometimes there are cases where you need to be systematically monitered after being hospitalized, with breast reconstruction, massive liposuction, or surgery using free tissue.
As mentioned in this blog before, patients need to stay away from blood thinning agents such as Vitamin E, fish oil, aspirin, etc., and during the surgery we use devices to prevent deep venous thrombosis by intermittently massaging instruments in the lower limbs.
When considering the risk factor of the patient side, factors such as age (65 years old and over), obesity index (30 or more), presence of smoking, presence of other basic diseases (diabetes etc.), etc. become a problem.
In addition, in case of surgical procedures for cosmetic purposes, when considering the balance between risk and benefit, it is required that the risk be lower than when treating disease.
Those things are difficult to understand for the general public, but since it is important to life, if you are planning for big surgery, please consult with your plastic surgeon once again.
About several years after breast augmentation surgery, thick capsules are made around the implant with a considerable probability (up to 25%). This is called capsular contracture of a breast implants, and it is classified in three grades in the United States. Grade 1 has a slight wrinkle feeling when touched, but no visible abnormality; Grade 2 is one with wrinkles emerging on the skin surface, Grade 3 is a painful addition in addition to that, requires a removal operation.
Regarding the removal technique of breast enlargement bag, it is not a easy surgery. Simply removing the bag may result in inadequate results. It is necessary to remove capsules that are in close contact with the surface of the bag at the same time. In particular, capsules on the front of the bag should be removed. Otherwise, the capsule will remain around the entire circumference and become a cyst (Seroma).
Upon removal of the capsule, it may cause considerable bleeding. Therefore, at our office, we do not recommend doing such surgery as an outpatient surgery. Our doctor becomes your doctor, we recommend to operate at university hospital.
People considering about beauty care often think that they are often consulted at private clinics. As a director of our clinic, many of the patients are still seen by us at the outpatient clinic, but there are cases where we recommend doctor’s examination and treatment at an university hospital. It is when you are planning to use a special laser equipment not installed in the clinic or think about a large-scale surgery that would be better if you went to hospitalized.
In the university hospital, being hospitalized and undergoing surgery is actually quite secure and safe. For example, there are more than 20 operating rooms in the university hospital where our director is part-time attending. They do many cases of surgeries which are extremely difficult and surgery for seriously ill patients with weak body. This means that, even in surgery for cosmetic medical care, even if unforeseen circumstances should happen, there is a system that can respond. There are also a number of specialist staff of plastic surgery, many anesthesiologists and nursing staff. In the worst case, you can also arrange a ventilator and blood transfusions. Also, even if the condition gets worse after surgery, medical staff will come soon.
As such, our doctor may recommend care at a university hospital on a case-by-case basis, which seems to be a better choice for patients.
There are various reasons for scars, but as you look at changes in color. There are reddish objects, brown ones, and white linear ones. Although red and brown ones if you can avoid getting ultraviolet rays, they will gradually get better gradually even if conservative treatments are done, but if it does not become so or if it is already white, it is quite difficult to improve with normal treatment I will not.
Our clinic sometimes treats such scars by using a fractional carbon dioxide laser made in the USA in collaboration with a university hospital where doctors are part-time staff, so if you are interested please ask .
For treatment of migraine using botulinum toxin (Botox etc.), it is a subject of insurance treatment in Europe and the United States. If a patient is not abnormal by MRI or CT and a headache expert such as neurological department confirms diagnosis. Then, those people are being treated with peace of mind at almost all specialized medical institutions.
In Japan, it is unauthorized as an insurance treatment, so the doctor’s decision is left to the discretion, but our clinic’s guidelines are similar to those in the West. However, if local treatment is desired with mild migraine, we will also conduct partial treatment on a trial basis, so please consult us. In that case, the treatment cost is from 20,000 yen.
In Japan, there are few patients who desire liposuction even if they say slimming surgery, and if possible, they seem to be interested in partial slimming by laser or injection. Also, even with cases with a lot of fat and non-invasive methods that can hardly be treated, it may be giving the impression that ultrasound or liposuction using internal laser is better.
In the United States where the aesthetic medicine is advanced, there are still many methods of liposuction using old-fashioned hands (more than 250,000 cases per year), and there are not many methods using laser or ultrasound in combination. There may be reasons for this, and may have been written before, but in such a way, many burns (burns) due to the heat of the tip of the equipment have been reported, especially for patients with not much fat It is getting not used. Considering Japanese patients with American standards, there are not many people with a lot of fat, so it is our thoughts of our hospital that it is better not to use these devices.
I have talked about the subject like the title in fact in my book about 14 years ago. Looking back now, there are places where I nod and why.
1. Genetic factors
2. Social and behavioral factors
3. Environmental factors
4. Mental factors
5. Physical factors
In a very brief explanation, 1 is a person who has a gene of longevity and can not do anything about this. Regarding social factor of 2, it refers to a stable family life, friendship, or connection with society. Behaviorally, there are overseas data that people with anger and those with aggressive personality are likely to progress atherosclerosis. Excessive drinking also shortens the life span, so I think it is important to know the appropriate amount.
The mental factor of 4 is to think about measures to prevent aging of brain cells. On my own terms, I feel that 3 and 5 actually affect individuals most.
For 3, a person who does not smoke, for example, by smoking clean air, not approaching places and environments where it is easy to meet accidents, saying that you do not smoke, when you ride a car seat belts, job-related work and exercise It is not recommended, etc.
Regarding the physical factors of 5, it is better to exercise not only thinking about things like aerobic exercise but also enjoying and doing it for a long time. Even in golf, tennis or swimming, I think that I will continue doing things I like. I hope to continue with the fitness using the gym instruments, can I still be old? about it. Those who are not good at exercising, I think whether walking, only walking while shopping.
And regards to eating habits, I often see comments from the experts that people with less calorie intake will live longer, do you all know? This is an experimental result that is confirmed only by a mouse or a small creature. In the history of medicine research, there are many examples that even if I think that a good medicine was found in mouse experiments, it did not work for human beings at all. For humans, I do not yet know whether excessive calorie restriction, high protein diet is really good.
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According to a recent journal of the American Society of Aesthetic Plastic Surgery, complications due to the injection of fat into the buttocks are more common than other procedures, and many are serious. For example, complications leading to fat embolism and death are reported in various places.
This is what we had been proposed several times from the past, but this report is published as a fairly clear numerical value.
At our clinic and hospital, due to the reasons mentioned above, fat injection into the buttocks is not performed except for special cases.
In Japan, there are many people who imagine something special about aesthetic medicine and cosmetic surgery. Many clinics bring patients with flashy advertising, and many patients coming to the clinic come secret. Moreover, it is said that many patients are different from the patients who visit usual medical department, i.e., having conditions such as psychosomatic diseases, neurosis, obsessive compulsive disorder, etc. As for the treatment contents, it is better to restore any problems into more normal looking status so that people can live a normal life after plastic surgery, but it is not a good case if someone is concerned about very small and trivial things. The latter is the scene of Japanese aesthetic medicine care, especially in cosmetic surgery.
On the other hand, there is no independent specialized department called cosmetic surgery in the United States because the plastic surgery also includes cosmetic surgery. In the United States, plastic surgery corrects the shape of the nose and the eyelid’s eyelid due to aging, just like general otolaryngology and ophthalmology, who should be cured as anyone sees it and agree with the treatment. It is common for the whole family to come to the clinic/hospital, and often they come to consult with a couple or parents. The inside of the clinic is also bright, not like being hidden quietly like in Japan.
As a result of doing aesthetic medicine care and plastic surgery in both the United States and Japan, I definitely feel such a difference as mentioned above.
Do you know the word EBM? EBM is an abbreviation for Evidence Based Medicine, which is a concept that has been used for a long time in clinical medicine, including plastic surgery. The details are given to the book, but to put it briefly, it is natural thinking that scientifically accepted treatment method is used according to the result such as clinical trials carried out by a reliable method.
However, this way of thinking has not necessarily been followed in the field of medical treatment for non-insurance covered cosmetic treatments. For example, if we say treatment not dependent on EBM, we cured several patients with this treatment method, for example, this method is a unique treatment developed at our hospital, etc. However, it is not supported by data of harsh clinical trials I will do.
I think that this problem will also be found in the treatment site of beauty care, but unfortunately also in the field of regenerative medicine, (unauthorized) cancer treatment, gene therapy and others. We hope you will be a smart customer and accept only EBM.
According to Huffington news in the USA, in the United States in recent years the number of men who receive Botox treatment has increased considerably. Most patients in our hospital are English speaking patients, but many foreign men are receiving Botox treatment each year. The treatment area is forehead (forehead), eyebrows are central. Unlike women, Botox treatment for wrinkles in the outer corner of the eye may be better for men, if you think carefully.
For details, please see the following:
Although it is rare but when a breast augment implant bag was used in breast augmentation and reconstructive surgery after breast cancer surgery, a special lymphoma subsequently occurred in patients who had a textured type surface roughened type bag inserted. We have stated in the past that there is a slightly higher possibility than general population.
It is reported that this issue is becoming a big social issue in the USA today in the New York Times electronic version of the major newspaper in the USA. For details, please refer to the following site.
We informed previously in the part 1 of this title, but the relevance between the implant (bag) used for breast augmentation and T lymphoma has been reported in Europe and the United States. This phenomenon is likely to happen when holding a breast augmentation bag for more than 10 years in the body, especially on a textured type product whose surface is rough. Actually, this Textured type is a kind of breast enlargement bag that is often used in breast rebuilding after breast cancer.
The textured type was said to have less effect of so-called capsule contracture, which makes it harder for the breast and stiffer than the Smooth type with smooth surface. However, on the other hand, it was also known that bacteria settled in the surface roughness, creating a phenomenon called infected biofilm.
The most important thing is that patients who have this breast enlarged bag in their body once palpated by themselves and feel uncomfortable, we recommend that you consult a specialist and perform MRI examination .
With regard to liposuction of tummy (abdomen), we need to think separately for men and women. In general, abdominal fat of females accumulates outside the abdominal wall (subcutaneous of the stomach), and it is suitable for liposuction. On the other hand, as a man’s stomach is represented by the expression “metabolic belly”, it is often stored inside the abdominal wall, that is, between the intestines and organs (visceral fat), as it is represented by the expression of metabolic belly, There are few parts that can be taken with suction.
There are men who often misunderstand liposuction as weight loss surgery. In the case of men, improvement of dietary habits, exercise, change of stress, and sometimes diet medication may be more effective than liposuction although some men are still qualified for localized liposuction procedures.
The director at our clinic about 12 years ago when he just returned to Japan he had a lecture for a Japanese doctor.
At that time he already mentioned that it may lead to blindness rarely as a US report with hyaluronic acid or other subcutaneous infusions. In particular, special care is required for injection into the areas near eyes, between the eyebrows and the nose root. It is better not to inject such sites as much as possible, and when it is absolutely necessary to avoid excessive injection depth and speed (pressure).
The filler injection might appear an easy procedure but because of rare yet serious complication that my occur, a board-certified plastic surgeon or dermatologist should be doing the procedures.
Liposuction is not a procedure to eliminate obesity, it is an operation that effectively removes locally accumulated fat (lower abdomen etc.). Many people misunderstand this as well as the general public, as well as non-professional physicians.
At the American Society of Plastic Surgery, liposuction is not recommended for people with a BMI index of 30 or more. Such a person must first lose weight with diet therapy. As liposuction for patients with a BMI of 30 or more, the risk of complications (deep venous thrombosis and side effects of anesthesia) also increases, so careful response is required.
If the breast is too large and there are symptoms such as shoulder stiffness, it is common practice to cut out the breast tissue by the method called breast reduction method and then sew the skin again.
However, this method has problems in patients who are planning breast-feeding in the future. Another way that can be considered in such a case is to do a method of first reducing fat-portion of the breast by liposuction and then sewing only the skin of the breast. Feeding breastfeeding is possible with this method.
A facelift is a rejuvenating operation that pulls the slack portion of the face and neck, and excise extra skin etc. Surgery may be a 4-5 hour operation in the case of a full face lift. This operation is generally done in a system where you are hospitalized in a hospital under general anesthesia, but sometimes it is done by local anesthesia as a day surgery outside.
Local anesthesia is not inferior to general anesthesia, and local anesthesia may be safer in some patients. Complications of deep venous thrombosis (so-called economy class syndrome) may occur with long operation surgery. It is said that this is not common in procedures under local anesthesia. The patient is awake and is involuntarily moving his legs.
In Europe and the United States, some patients who have undergone breast augmentation in the past have lymphomas in their breasts and are currently monitoring such cases.
ALCL (Anaplastic Large Cell Lymphoma) is called T cell lymphoma in detail. Unlike the same type of lymphoma that occurs in the whole body, what is associated with breast augmentation is localized to the breast and the prognosis is said to be good. It is a phenomenon only seen in cases using breast enlargement bags, especially on the surface called Textured type more commonly found in grainy breast enlarged bags.
The US FDA has instructed plastic surgeons to inform these patients about such information. In France, there is a debate as to whether to prohibit the use of such breast enlargement bags more seriously. However, since it is a very rare phenomenon at frequent times, it seems that discussion has not been done in Japan either.
Regarding liposuction, our clinic has received various questions from many patients of different nationality.
At this time, we will discuss about slimming surgery using various accompanying devices which are said to be the “latest type” among them. For liposuction, it is famous for its wet method with ordinary cannulas using a tumescent solution that has been widely used in the United States for many years and has established safety. In this method, a local anesthetic or a drug which becomes difficult to bleed is diluted highly, injected so as to inflate the tissue in the target area, and then suctioned. In this method, it is known that bleeding volume is 1% or less of the aspiration volume (very little). Also, depending on the skill of the doctor, it is said that there is little damage to the tissues due to the equipment used, and it is a safe way. In our clinic, using this microcannula method which further evolved this method, effective results with little unevenness are obtained.
Nowadays, in place of the above method, some devices have come up that generate ultrasonic waves and lasers at the tip of the liposuction device. Japanese people are sensitive to new technologies, so treatment using these devices seems to be commonly done in Japan. Then how about in the United States? In the United States, such devices temporarily attracted attention, but it is not being used more often now that it is not used frequently. Why? The biggest problem is the seriousness of complications. Many of these liposuction plus alpha devices emit high energy at the tip, resulting in burns (burns) in the subcutaneous tissue, damage to the nerve, edema due to a delay in the course of healing (water accumulation) etc.
As a result, in the United States and elsewhere, it is true that we have returned to liposuction using a conventional tumescent-based system that does not use lasers or ultrasound.
In our clinic, treatment of migraine is done with botulinum toxin (Botox). This treatment is a treatment method approved by government agencies in Western countries such as the United States, Canada, UK, Australia. Prior to treatment we will check to see if it meets some standards.
First of all, doctors such as neurological department and neurosurgery undergo diagnosis of headaches such as migraine. Then, if possible, receiving image diagnosis such as CT or MRI in the past, it is possible to confirm that there is no abnormality, and so on. At the time of the first visit, if you bring a thing with a history list of medications and a history of treatment up to now, the procedure will be smooth.
For those who are in a season of hay fever or other pollen allergy, although it is unapproved treatment, when improvement is not seen with otolaryngology, taking allergy medicine in ophthalmology, in certain countries a small amount of botulinum toxin is sprayed into the nasal cavity. It has been reported that treatment is effective only by applying to the mucosa.
Most patients are in good condition for a while after being subjected to breast augmentation, but when you want to investigate whether there are problems with breast augmentation bags when it becomes stiff or when you feel a change like a streak (rippling), or that my general symptoms are not good , The best test is MRI study.
Although it costs a little, it is possible to detect bag breakage, leak (leak), degree of capsular contracture, peripheral abnormalities (breast cancer, lymphoma etc.). However, someone with metal in somewhere in the body may not be able to do so so it is necessary to check in advance. There may be cases when you have a tattoo (tattoo) in it.
The American FDA recommends MRI examinations every 3 years for people who have performed breast augmentation, but in reality it seems that there is not one who does so frequently.
Hyaluronic acid and Botox are rejuvenation methods that can be treated easily without reservation, but there are some conditions.
Those who are regularly using vitamin E, fish oil (EPA, DHA, omega 3, etc.), aspirin and other pain medication called NSAIDs have thin blood, so it is easy to get bruised by stabbing the needle, especially hyaluron near the lower eyelid. It is safer to treat it without taking medication for more than a week when considering such an injection.
Regarding Botox, it is said that it is not recommended if you are currently pregnant, or breastfeeding, but it is also said that it is better not to use it even if there is a possibility of pregnancy within the next 3 months from now. In addition, this is for both sexes.
Botulinum toxin such as Botox, and dermal fillers such as Restylane and Juvederm have been used for many years to treat facial wrinkles. Botox is usually used to treat lines between the eyebrows, wrinkles on the forehead, wrinkles in the corner of the eye. The most frequently used filler is the same substance as hyaluronic acid which is also present in healthy skin and its deeper layers, and these hyaluronic acid fillers are usually used in combination with legal and marinet wires and longitudinal wrinkles of the upper lip It is used to correct.
Recently, in the United States, long-lasting hyaluronic acid is used to make the upper part of the cheek plump, and by doing so, the wrinkles of all parts of the face pull to the apex of the bulge It is aiming at the effect of being decreased. This method is called Liquid Facelift in English and is also called a liquid face lift in Japanese, is now a very popular treatment.
Breast augmentation surgery is a wonderful operation that makes a very attractive body line. However, after undergoing this operation, there are things that I have to watch over for years. One is encapsulation or capsule contracture, and the breast implants occurring at a rate of 10-15% are in a state of hardening. If the condition gets worse, it will become a streak that you can understand by touching from the top of the skin, or you can understand it even by just looking at it. When such a condition occurs, it is necessary to remove the implant (breast enlargement bag) and also remove the capsule membrane that is completed.
It will be a larger scale surgery than when breast augment surgery was done for the first time. In general, it will be treated as a hospital admission. On the other hand, if you do not remove the capsule stuck to the breast augmentation bag, you can do with simple surgery if you just need to remove the bag, another complication of water accumulation in the capsule (seroma) also can occurs.
Besides this, damage of the bag (rupture) is said to occur at a probability of about 1% per year per one year. It is difficult to detect this by palpation alone, so image diagnosis such as MRI becomes necessary.
It is said that about 25% of patients who have performed breast implants need to undergo surgery in the future if various other complications are added.
The French government recently warned that it is related to implants used for breast augmentation and specialized lymphomas (undifferentiated large cell lymphoma, Anaplastic large cell lymphoma (abbreviated as ALCL) in English) in breasts became.
Currently it is a very rare tumor and the prognosis is better than the lymphoma that occurs in the whole body so it is not a recommendation for patients who have done breast implants immediately. ALCL is a T cell type tumor called non-Hodgkin’s lymphoma, and there are about 60 cases reported in the world about localized breasts, but it is said that there are more than tens of millions of patients receiving a breast augmentation surgery Because it is so, it is extremely rare.
However, in Europe and the United States there is a system to make information disclosure early and the FDA also keeps monitoring on this subject.
“Fiblast” (Fibroblast) is a human bFGF material developed in Japan and it is approved by the Ministry of Health, Labor and Welfare for use in the treatment of decubitus ulcers (burn ulcers, lower leg ulcers) in the plastic surgery field.
Recently medical institutions of beauty medical care have used this material out of approval. Even in our clinic, patients receiving a subcutaneous injection of this substance at another clinics come and complain “lumps” of the injected sites. It is difficult to remove a lump caused by subcutaneous injection of fibroblasts and removal is difficult even with invasive treatment. I think whether it is better to pay attention to subcutaneous injection of the fibroblast material that is used for non-approval use.
Regarding PRP, the substances derived from your own blood, it is necessary to submit a third category registration on regenerative medicine by the Ministry of Health, Labor and Welfare, and I think that some approved medical institutions can still do such treatment. However, it is recent general opinion that the sustained effect by subcutaneous infusion as said earlier can not be expected.
We are using only Swedish Restylane and Juvederm made in France, which is approved as a subcutaneous infusion in the Ministry of Health, Labor and Welfare. Even if problems arise, there are degradative enzymes, and it is rare to cause permanent lumps and the like.
Many of the tattoo removal is done using laser, but if you do not do some pretreatment (anesthesia) then it will be accompanied by a considerable pain.
In our clinic, pain is relieved by using anesthetic cream or a method of injecting local anesthesia. In the case of anesthesia cream, please think that pain can be reduced in 40-50%. On the other hand, in the case of local anesthesia, it becomes painless. The needle used for local anesthesia uses a very fine needle imported from the United States.
Which anesthetic method is better, you can choose from those two. If you would like to take tattoos but are not good at hurting, please do not hesitate to consult us.
The director of our clinic came to Japan from the United States back in 2005. Just ten years ago I gave a lecture on safe hyaluronic acid therapy etc. to the doctors as a lecturer at a seminar on beauty care procedures such as hyaluronic acid. At that time, there was a report that there was already high risk of injection of hyaluronic acid-containing injections into the surroundings of the eyebrows in the United States.
There are few small arteries that are dominant in the vicinity of the eyebrows, and there is no supply of blood flow from the other side with side chains to each other (the end- artery). When injected material enters such a blood vessel, surrounding tissues die (necrosis). Also, since the artery around the eyebrows is located close to the arteriovenous of the orbit (in the dent of the eye), multiple examples in which the injected substance enters the eye artery for reflux to cause blindness It has been reported.
In the case of hyaluronic acid, there is still an enzyme agent that dissolves it, but there are cases where it can not be saved with other injectables, especially those of semi-permanent type.
The same problem may actually occur not only in the glabellar region but also anywhere in the center of the face. There are several technical key points when injecting subcutaneous infusions such as hyaluronic acid, and for those who do not master it, these risks are even higher.
In general terms, I think that treatment of these subcutaneous infusions should be done by specialists (board-certified dermatologists or plastic surgeons) who are familiar with cosmetic medicine (also attending academic societies) doctors. At our clinic, we explain the possible dangers to patients when treating that part, and we are doing the treatment.
Dr. Kure is the only US board-certified plastic surgeon in Japan.
Regarding the pain accompanying the treatment, we use various methods to alleviate the pain used in the United States, we try to treat less burdensome.
Even when using local anesthesia, for example, special pain medication is used to minimize the pain of the injection itself.
In addition, we use Japanese made ultra fine needle. Even in the case of hyaluronic acid injection, it is also possible to treat with almost painless by using nerve block anesthesia according to your request
About 10 years ago when we began preparing the clinic in Japan, we inofrmed on the safety of subcutaneous infusions such as hyaluronic acid in the US at a lecture meeting for doctors, but at that time I have mentioned the serious complications of blindness and skin necrosis many times.
In the United States some of these complications had already been announced.
Although hyaluronic acid itself is generally a safe dermal filler, it is rarely happened that there are events in which facial blood vessels become clogged due to treatment to the vicinity of the eyebrows and nose.
Although highly skilled technique is required for such injections, hyaluronic acid still has some medicines to dissolve it, but in many cases it can be reduced somehow, because there are no such drugs for permanent type of infusions , It will be a serious consequence when a problem occurs.
In our hospital, we do not use it as injectable material except for hyaluronic acid made from USA or France or autologous fat.
Hyaluronic acid is a type of polysaccharide and its basic chemical structure is the same as that originally found in human skin.
Because the force to attract moisture is strong, even a small amount of treatment may cause expansion effect beyond injection volume.
However, since the nasolabial lines formed after many years are deep subcutaneously deeply contained like a scar, it may be difficult to completely eliminate this with subcutaneous injectables.
Although I look at the situation with injection of about 1 cc usually, it can be said that the nasolabial lines should improve according to the injection volume.
It is extremely rare that unexpected swelling occurs by injecting hyaluronic acid.
In that case there is a possibility of allergic reaction (which is said to be very difficult in theory).
In some cases it may be necessary to inject an enzyme agent that degrades hyaluronic acid.
More commonly seen are “lumps” and “bruises”, but the lump is easy to get out or not in relation to the hardness of hyaluronic acid used and the thinness of the skin at the injection site.
Regarding bruises, if you are taking medications or supplements that have blood-thinning action (Vitamin E, fish oil, aspirin, etc.), those who came to treatment after stopping them for more than one week It is safe.
If that is not the case, I think that big bruises will not happen often.
Before applying hyaluronic acid injection, apply local anesthetic cream to the area to be treated and wait for a while before treatment.
This will relieve pain considerably, but if you prefer treatment that is more painless, block anesthesia may be given.
There is little chance of facial nerve paralysis when injecting Botox into the jaw muscle, but it can occur rarely.
If it happens, the left and right difference of facial expressions will appear. Even if paralysis occurs, it will fully recover in the future.
Since Botox has not confirmed safety during pregnancy and lactation, it can not be used during these periods.
Botox itself is a safe formulation and rarely has side effects, but the side effects caused by the relationship of the injection site include eyelid ptosis (eyelid lowering) and eyebrow ptosis.
It occurs with a probability of 1% or less in the treatment of the eyebrows and forehead, but it surely recovers.
Next, symptoms such as headaches, fatigue, and a common cold are rare as those occurring regardless of the injection site.
In rare cases, facial nerve paralysis may occur due to injection into the jaw muscles.
It costs 3,000 yen + tax for the name of the initial registration fee.
Approximately 1-2 times a month is required to show your progress.
This is because OBAJI is a medicine, so it will not work well without a doctor’s guidance.
It depends on the symptoms.
There are 5 to 6 bottles in Obagi’s kit, but our clinic does not use all of them from the beggening.
First of all, when you look at the condition of your skin, for example, if only spots are a problem, you start with two kinds of medicine that rejuvenates skin called tretinoin and whitening medicine.
In this case tretinoin is 7500 yen plus tax, even if whitening medicine is added, it will settle at the 20,000 yen level.
If you have used OBAGI before, even if you want all the kit, it is about 53000 yen (+ tax) at maximum.
This price depends on the clinic.
Improvement in acne, spots, pores, blemishes, and it has lifting effects and so on.
There is also an effect on the melasma (stain of symmetry on the cheeks).
Instead of cutting it, make a double line with a smaller needle and thread than on the eyelids.
The results of the DST method of double eyelid surgery is durable.
There is also a method to fix with just one thread in a simpler way, but there are times when it can lose the created lines.
Three points are fixed by the DST method.
This DST technique is also used to correct the sagging skin of the Caucasian upper eyelids.
Odaji of a pharmacy is “cosmetics” and “Obagi” sold at a clinic is called “Obazi · ZO” and categorized as “medicine”.
There is no major swelling compared to cutting.
Many people get swollen in 4 or 5 days, but some people take more than 7 days.
(3-4 weeks when cutting off), the shower is OK from the next day, makeup is OK from the 2nd day.
This non-cutting upper blepharoplasty can be used for Caucasian people as well.
There are individual differences in the cycle where hair grows, but it is generally 4-6 weeks.
If you are going to book next time, if you are a type of hair growing up well, you can do it after 4 weeks, otherwise it is fine even after 6 weeks.
Also, if you still have not been able to grow even after 4-5 weeks, you can change your reservation by phone (to postpone later).
Who will perform laser hair depilation treatment? Because I want to treat bikini line, I do not like men …admin : Laser hair removal
At our clinic, after the doctor makes an inquiry (a brief consultation), female nurses who are qualified therapists will be doing the treatment.
It seems that laser hair depilation of estheties often takes 10 or more times to treat, but is there a difference in effect between the equipment in the clinic and the esthetic?admin : Laser hair removal
Our depilation laser is an American-made FDA approved “medical laser hair removal device”.
This device is very effective and powerful, but it can not be used unless it is a medical institution.
On the other hand, what seems to be called a laser in what is used in many esthetic salons, it is often “light therapy equipment”, the output is also weak, and it is more than doubled times (medical laser If it is 5 times, I hear that it is often necessary to have more than 10 times on esthetic equipment.
Also, basically hair removal is a medical practice, so if you interpret it by law, depilation with esthetics will be illegal if there is no supervisor of the doctor there in Japan.
If you already have a sunburn, hair removal is not recommended basically.
This is because pigments in the treated area may spatulate or deposit.
Especially, in the case of the lower limb (knee), it may come out like a zebra pattern.
Basically there are risks in the case of the face, but in the event that it is absolutely necessary, after considering the risk sufficiently, there are also possibilities on consultation with the doctor, so please consult us.
There is no problem with sunburn after depilation treatment, but after treatment, please check that there is no redness or swelling.
However, sunburn needs to be recovered before the next treatment.
In our clinic, we will offer you services to everyone, for the first time we offer two designated body areas (listed on the website) at half price.
Also, since it is possible to recalculate if the density or area of hair drastically decreases after the fourth time, please consult the staff.
Also, if you are going to do extensive treatment at more than three locations at once, there is a special discount system separately (from the third treatment), so please consult us.
Our laser equipment is approved for depilation of all skin types in the US FDA.
The laser beam emits energy by identifying the black or brown hair.
The closer the skin color and hair color is to the skin, the more likely it is burns.
To prevent this, we change the wavelength of the laser (100 ms) or drop the output, but it is still easy to cause burns, so a cautious treatment plan is needed.
I have to treat laser hair depilation once and move to another country, but is it worth getting treatment?admin : Laser hair removal
Laser depilation at our clinic/hospital is an American-made medical laser device, and even one treatment can expect a considerable reduction of hair color.
Hair removal effect requires further treatment due to hair cycle, but please be assured that any laser equipment in other countries will be effective further treatment.
The effects of laser hair depilation vary greatly among individuals and can not be said unconditionally, but in general, dramatic hair loss effects can be expected with 3-4 treatments.
This means that there are 3 phases;
1. hair growing now on the surface
2. There is also hair under the skin
3. There are still hair that is still asleep as saying hair.
Therefore, three or more treatments are needed at intervals of 4-6 weeks to treat hair of all cycles.
After that, from the thinner hair to the hair-growing state, until there is no more complete, there are individual differences, even if it is several times, sometimes many times, hair reduction may not be done more than the hair-growing state.
This is due to factors such as hair color, thickness, strength of hair root.
In either case, I think that if you treat 3-4 times, I think that you will understand the general direction of how effective it is.
I think that laser therapy should be avoided during pregnancy as well as American FDA guidelines, as a general theory.
This is due to the fact that the effect of the laser on the maternal body during pregnancy has not been sufficiently investigated, in addition to changes in physiological phenomena such as increased sensitivity of pain, emotionally unstable, etc.
Is it better for hair to be shaved before treatment for laser hair removal? Should I come un-shaved?admin : Laser hair removal
In our medical laser, we can expect sufficient treatment effect after shaving hair.
Although it may seem to be “that” when there is experience of depilation with esthes etc, many of the instruments of the esthetics are weak in output with “light depilation equipment”, stretching the hair, with hair There are times when you take the method of “baking”.
Medical laser has very high specificity to hair, high output, it can expect sufficient treatment effect even if the hair does not grow, (less hair) and less pain.
However, if you withdraw with wax or hairdressing, you can not treat until you come back to some extent.
When I get a job I must put out tattoos, but I do not have much time (about half a year). I heard that it may take about a year for laser. What should I do?admin : Tattoo Removal
If it is 6 months, I think that it is possible to treat 5 times with the interval of each laser treatment being 6 weeks.
However, if you are not able to remove it after five treatments, as a matter of embarrassment, there is also an option for cutting (ablating) and cutting.
Although it is thought that the skin graft is another option, please consult with a doctor as it becomes a method that remains “permanent scar” even if it is any.
Although our medical laser hair removal equipment has been approved by the Food and Drug Administration (FDA), the FDA uses the expression “Permanent Hair Reduction” for permission, which means that the effect of laser treatment is different depending on the skin quality and the color of the hair.
For example, in the case of Caucasian with dark black hair or Japanese, when enough effect is obtained by 4-6 or more treatments, it is often that you can expect such effects as being almost permanent.
However, with thin hair such as brown hair, there is a possibility that further epilation is difficult from the hair-growing state or it will come back thinner in the future.
In that sense, the expression “permanent hair reduction” is used.
Usually the scab can be taken within a week and a flat surface appears.
Thereafter, a light brown color change may occur in the area where the laser hits.
It gradually becomes less noticeable over a few months.
In rare occasions the treated area may be raised somewhat.
If these changes are noticeable, we may refrain from further treatment.
Before treatment of tattoos, we apply anesthetic cream (included in treatment costs) or injection of local anesthesia (actual cost: 1,000 yen ~).
The use of cream alone can reduce pain, but those who want to treat painlessly have an option of injection of anesthesia.
There are at least four factors related to laser tattoo removal.
Color, thickness, depth, skin strength etc .. Regarding color, if red and black, it is almost always possible to remove almost by repeating the number of times.
On the contrary, green, pink, purple and others are difficult to completely remove.
If it is a tattoo where most of these colors are occupied, it may be realistic to cut out (cut) or shave.
Even with black tattoos, thick pigmented tattoos require more treatment. Laser is destroying the top layer only every time.
For depth, for example, shallow pigments that amateurs put in tends to be easier to remove than dyes that are much deeper.
Finally, although it is the strength of the skin, it is sometimes the case that the laser is irradiated, the skin after the treatment rises unevenly.
Even if you use the laser at discreet power in such a case, there may be marks on the skin.
In actual treatment, we decide comprehensively the above things and decide the optimal treatment plan.
There are several factors such as the thickness and depth of the pigment and the kind of color in the easiness of tattoo removal, in some cases it may be inconspicuous by several treatments, and in rare circumstances the case where it takes longer than 10 times to become thin Yes.
For example, in the case of black and red tattoos about 5 x 5 cm in size, the initial treatment cost will be 30,000 yen, consumption tax will be applied.
If the 2nd and 3rd rounds still remain, the same cost will be incurred, but if the treatment area needs to be reduced when 4 or more treatments are needed, re-measure the area and discount it To go.
In addition, between treatment and treatment generally you need to wait for more than 6 weeks.
For treatment of migraine with botulinum toxin (Botox etc.), it is subject to insurance treatment in Europe and the United States, if a patient has no abnormality with MRI etc, a definite diagnosis by a headache expert such as neurology internal medicine is made. These people are being treated with peace of mind at almost all specialized medical institutions.
In Japan, it is unauthorized as an insurance treatment, so the doctor’s decision is left to the discretion, but our clinic’s guidelines are similar to those in the West. However, if local treatment is desired with mild migraine, we will also conduct partial treatment on a trial basis, so please consult us. In that case, the treatment cost is from 20,000 yen.
Dr. Robert K. Kure opened his practice back in year 2000 in Beverly Hills, CA, then in midtown, New York City 2 years later. He moved to Tokyo, Japan in 2005, and opened the current practice in 2007. This is the 10th anniversary in Tokyo.
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