Double Chin Challenge- Kybella vs. Liposuction

The practice of “lipodissolve”, utilizing a mixture of fat melting chemicals injected into the area of interest, has long been controversial. The lack of regulation and standards of exact mixtures and techniques lead the ASPS to tell its members the practice was not safe. Some surgeons and even lay practitioners in spas swore by it, and Allergan launched the first FDA approved product, Kybella, for the use in the double chin area.

I underwent a training in Kybella, including an online certification as well as a hands-on observed injector training. Some of the photos are impressive, but is this product the end of submental liposuction? Let us compare.

Kybella is a nonsurgical treatment, so there are no stitches or anesthesia risks involved. You are awake and can walk out on your own after a brief observation period. No blood tests or doctor’s visits are needed before. The treatment is about 30 minutes, and consists of multiple tiny injections into the fat cells. You will experience significant swelling, especially over the first week, and can have a burning sensation. The average patient in the studies conducted received a little more than 4 treatments to achieve the results. The average cost of each treatment is currently $2500 in NYC. Therefore, for Kybella, it is a total of about 2 hours-2.5 hours of treatment time over 4-6 months to get the result at an average cost of around $10,000. There is no surgery, and less healthy patients can undergo the procedure.

Liposuction of the double chin is a surgery. I use 3 tiny incisions requiring a single stitch each (behind each earlobe and one under the chin), and testing is required beforehand. You will receive twilight anesthesia, and someone has to take you home. You will get swelling and potentially some more bruising, and we recommend some massage after to help the swelling fade faster. It is a single 30 minute procedure, though you will be in the office a little over an hour. Results can be seen in as little as 2 weeks, though small areas of swelling may persist for a few months. Average cost in NYC is $3500-$4500.

I offer both, and the choice is yours.


Little Things Mean A lot

Every year around the holidays, there is a rush to look better quickly. Office parties, seeing family, and vacations are the main culprits. Surgery is usually not an option, and the primary focus is on the face. So, what can we do to make you look better in a hurry with minimal downtime?

Silk peel is an excellent treatment that can help with skin texture, discoloration and overall glow. In 45 minutes, a nonpainful polishing is accomplished for all skin types. You can return immediately to normal activities.

Exilis, a nonsurgical Radiofrequency skin tightening device, can help with tome and reducing small fat deposits under the skin. While not equal to surgical results, no downtime is needed, and each treatment of 45 minutes leads to improvement. Some redness may exist for the first few hours after the treatment.

Laser hair removal can eliminate the embarrassing facial hairs, or even help with other body areas. Perfect for the holiday season.

Botox and Xeomin can diminish those dynamic wrinkles of the forehead as well as the crows feet. Results begin after a few days, and will last until the Spring in most cases.

Fillers, such as Radiesse, Juvaderm, and Voluma can restore youthful to your lips and cheeks and smile lines. Results are instant, last sometimes over a year. Last minute item that is super. You can also fill the backs of your hands to make them younger as well.

Our skincare is also terrific, and custom tailored programs can be made for you. We treat all skin types, and only offer the most effective products.

Do not forget facials and massage. When you feel good, you look good. Destress in the ySpa.

For last minute gifts, we do have gift cards.

Who would think a Plastic Surgery Center would be the go to holiday destination?


How to be Beautiful at any Age

With a title like that, what person would not want to read what a Board Certified Plastic Surgeon had to say on the matter. What can’t an expert in cosmetic surgery do to make you beautiful? I can start with the skin, and remove dark spots, improve texture, improve elasticity and skin aging. Using Radiofrequency and lasers, skin can be tightened, unwanted hair can be removed.

I can then move on to injectables, and fill in the facial lines that form over time, plump and reshape the lips, and enhance the jawline and diminish circles under the eyes. Neuromodulators, such as Botox, can soften the wrinkles caused by expressions and muscle movements.

If that is not enough, through surgery I can tighten neck bands, lift the cheeks and brow, remove undereye puffiness and upper lid skin excess. I can get rid of a double chin, fix ears that stick out, make your chin stronger, and transform the shape of your nose.

Surely, after all of that, who wouldn’t be beautiful? This is where the definition of true beauty is important. It has nothing to do with the physical that I can change.

    To be beautiful is to be kind to all, to be charitable, to lift someone’s spirit with a smile. It is to look past others imperfections and see only the good. It is to give yourself 100% to whatever you are doing, and to do it with love.

      The truth is plastic surgery makes no difference to a person if they are not happy with who they are on the inside. There are less extreme ways to make yourself look healthier but also, they will make you healthier in the long run. Using anti-aging skin creams like those provided by ‘Beverly Hills MD Skincare‘, can help give you a cosmetic surgery like result without having to go through painful procedures to smooth out the skin. These products may help you to feel happier and more comfortable with yourself in the interim, where you are working on yourself and your internal happiness.

        This blog will make me no money, but it will make the world a richer place for all of us.


Should you do Injectables with a Nurse Injector or a Plastic Surgeon?

As a Board Certified Plastic Surgeon, I like to think I am very well trained. With degrees from Johns Hopkins and Columbia, as well as training at Columbia Presbyterian, not to mention 19 years of practice, few boast better credentials. So why should you consider my Nurse Injector for your Botox and fillers?

The first reason is that she is less expensive than I am. She also has more availability, as I am in surgery for a lot of hours each week. The convenience and cost factors are nice, but is the quality the same?

I did not inject a single patient while in training, as my Department Chairman would not allow any representatives to come and teach us, for fear of product bias. So all of the fancy degrees did not make me a good injector, I learned from the reps and by treating patients. My Nurse Injector took courses and certification programs to learn before ever touching a patient.

I do many things at Yager Esthetics- consults, post operative visits, minor procedures, and cosmetic plastic surgery. My Nurse Injector just injects and does other esthetic treatments, so it is 100% of what she does.

I established Yager Esthetics in 1997. I would not allow anyone to perform a procedure if it would damage my reputation even 1%. You can be assured that I back my Nurse 100%. I trust her with you.

Do not think I do a bad job or that I don’t want to do injectables- it is fun, and I do it well. There are just not enough hours in my day to treat every patient personally, and by having a well trained Nurse Injector, you can save time and money without sacrificing quality.


School is In Session

As next week approaches, school is set to begin.  Parents are rejoicing, and children are crying as another semester gets underway. For me, it is usually a quieter time of year, the end of August and beginning of September, as parents are getting done with summer trips and getting the kids ready for the start of school.

I like to use the brief moments I can take from my practice to learn and implement new ideas and technology.  I look in depth at everything we do, see what patient demands have not been met, and try to fill the gaps.  This has led to our Laser Hair Removal, Skin Tightening, Cellulite Reduction, Dark Spot Treatments, Silk Peels, and Spider Vein services.  All have been great successes, as I must vet every service before offering it to our patients.

Our Non Surgical Facial Rejuvenation has boomed with the addition of Nurse Injectors who truly invest in the art of what they do with seminars and classes to stay abreast of all new options.  The cheek fillers with Voluma have been amazing.

I have started investigating the use of Electromyostimulation with Tummy Tucks to enhance results, and will have my protocol ready for September.  Although I have done over 2000 abdominoplasties already, I always look for ways to achieve even more.

I hope to bring you all useful and worthwhile treatments that truly work, and will continue to make Yager Esthetics THE Plastic Surgery practice for the Latin community.


Lo Imperfecto es el nuevo Perfecto

Puede sonar extraño, pero lo último que trato de lograr en la cirugía plástica cosmética es la perfección. Como residente en formación, nos enseñaron, “El enemigo de lo bueno es lo perfecto.”

¿Qué significa eso?

Nadiees simétrico.Un ojoes más grande, uno inferior, las fosas nasales son diferentes, ninguna mujer tiene2senos que sonexactamente iguales.Curiosamente, nuestroscerebrosestán entrenados paranonotar estos detalles.

Estoyconstantemente sorprendidocuandoseñaloenormesdiferencias alos pacientes, que a menudono tenían ni idea. Todaslas partes del cuerpotienenque estar enarmonía unos con otroscon el fin deparecer natural. Si usted tieneuna caraasimétricacon una narizperfecta,sólo se ve mal.

Una gran cirugía plástica nunca luce como una cirugía. Es el arte de equilibrar las pequeñas cosas que te hacen único, y la mejora de ellos sin perder su carácter. He estado en mi práctica privada en Yager Estética durante 18 años, he realizado más de 5.000 cirugías cosméticas, y todavía tienen que alcanzar la perfección. Tengo, por otra parte, que hice más del 99% de estas personas muy felices. Mi consejo es que siempre sea usted, es lo mejor que puedes ser. Nadie es perfecto.


Imperfect is the New Perfect

It may sound strange, but the last thing I try to achieve in cosmetic plastic surgery is perfection.  As a Resident  in training, we were taught, “The enemy of good is perfect.”  What does that mean?

Nobody is symmetrical.  One eye is bigger, one lower, nostrils are different, no woman has 2 breasts that are exactly alike.  Interestingly, our brains are trained to not notice these details.  I am constantly amazed when I point out tremendous differences to patients, they often had no idea.

All of your body parts have to be in harmony with each other in order to look natural.  If you have an asymmetrical face with a perfect nose, it just looks wrong.  Great plastic surgery never looks like surgery.  It is the art of balancing the little things that make you unique, and enhancing them without losing your character.

I have been in my private practice at Yager Esthetics for 18 years, have performed well over 5000 cosmetic surgeries, and have yet to achieve perfection.  I have, on the other hand, made over 99% of these people quite happy.

My advice is to always be you, but the best you you can be. Nobody’s perfect.


Wrinkle Treatments

Every year around the holidays, patients start thinking about holiday parties and family functions. This means they start worrying about how they look. It is too late for surgery, so they want quick treatments with minimal downtime and good results. The problem is that while it is good to bargain hunt for presents and holiday items, cosmetic procedures need a little more care and caution.

With the changes in insurance reimbursements, many doctors are looking to make more money. Cash up front procedures such as Botox, injectable fillers, and lasers seem like a good idea. Even if they are not trained at all in plastic surgery, most companies will have a nurse or doctor come to the office and train them for a few hours and sell them whatever they wish. I know of Ob-Gyns, Internists, Family Practitioners, Anesthesiologists, Rehab Medicine, and Podiatrists who rebrand themselves and advertise as if they are the experts in the field. Some even do cosmetic surgery!

Another problem is the salon or spa that offers these services with an unlicensed person in the business or an apartment. They claim to be doctors or nurses from other countries, and inject who knows what into unsuspecting people with often disastrous results.
So, how do you avoid these traps? First, make sure you know what specialty your doctor trained in. Ask if they are Board Certified by the American Board of Plastic Surgery. If they give a different board name, it is not the same. You can check going to www.plasticsurgery.org and use the “Find a Physician” tool.
Second, make sure you ask to see the box and syringe of any injectable filler, as it will have the name printed right on it. If they take it out of a large bottle, and it is clear, 99% of the time it is silicone and not what you want injected. Even if it is Botox, ask to see the bottle. It should say Botox and have a purple top. Ask how many units you will be getting so you can make sure they are not watering it down to lower the price.

Lastly, do not let anyone inject you with anything outside a doctor’s office. Make sure it is a licensed physician in the state you are in, or a nurse under his/her direct care. Anything else is illegal.

Wrinkle treatments, when done properly by a trained injector, can be incredibly rewarding and offers a quick beauty boost. Go for it, but just be safe and smart. If it doesn’t feel right, just say no.


How to prevent Wrinkles

Wrinkles are a natural part of the aging process. They can form by the repeated action of the muscles under your skin over time, or the drooping of tissues from changes in weight and gravity. They are not a disease, you will not die from them, and you do not have to do anything about them. Unless they bother you.

Preventing wrinkles is always smart. Avoiding smoking and sun exposure, drinking plenty of water, and treating your skin well by using only water based make up and adequate sun screen are they basics. If you are very expressive with your face, you are more likely to form wrinkles as well. It is often impossible to change this, but being mindful of it helps.

Wrinkle treatments have not changed much, as we still use muscle relaxers and fillers. There are some newer products to use for superficial lines, and the combination of products has been helpful in achieving artful results.

Over the last year and a half, my Nurse Injector has been handling the great majority of these treatments with outstanding results. This has increased the flexibility of scheduling for patients, so thast even if I am in surgery, you can get your treatment.

I encourage you to start the evaluation process early, so we can treat and maintain you before the wrinkles get out of control.


How to prevent Wrinkles

Wrinkles are a natural part of the aging process. They can form by the repeated action of the muscles under your skin over time or the drooping of tissues from changes in weight and gravity. They are not a disease, you will not die from them, and you do not have to do anything about them. Unless they bother you.

Preventing wrinkles is always smart. Avoiding smoking and sun exposure, drinking plenty of water, and treating your skin well by using only water-based makeup and adequate sunscreen are they basics. If you are very expressive with your face, you are more likely to form wrinkles as well. It is often impossible to change this, but being mindful of it helps.

Wrinkle treatments have not changed much, as we still use muscle relaxers and fillers. There are some newer products to use for superficial lines, and the combination of products has helped achieve artful results. Depending on the severity of the wrinkles, treatments can vary. You could also use creams and lotions to help manage any wrinkles that appear. Anybody can use a line smoothing serum to help reduce the appearance of fine lines and wrinkles, making skin look more even. There are various serums on the market but each serum will act differently on different people. It’s also important to find treatments that are suitable for your skin type. You can get treatments designed for oily skin, or dry skin, etc. You may even want to avoid serums and go for something like a nad+ supplement to help work from the inside out.

Taking all of this into consideration, I would encourage you to start the evaluation process early, so we can treat and maintain you before the wrinkles get out of control.