Updates on Operative Procedures
The field of cosmetic surgery is an
innovative one, especially in the San Jose, San Francisco Bay
Area. Dr. Zandi is on the forefront of
new cosmetic surgery techniques that
improve results while minimizing scars and
down-time. Here are some of the newest
techniques that are pushing the boundaries of cosmetic surgery.
OR BROW LIFT
For the past few years, most brow lifts have been performed
through endoscopic techniques. Less
invasive than conventional techniques, the
endoscope allows the cosmetic surgeon to
make five small incisions in the scalp to
pull forehead tissue behind brows and
cheekbones and remove sections of
depressor muscles. This enables the
elevator muscle system to pull the brow
upward and lift sagging brows.
For patients who have
deep wrinkles on the forehead, the
conventional practice of cutting two
inches behind the hairline from ear to
ear continues to yield good results.
Cosmetic surgeons in
the Bay Area and elsewhere have
recently begun implementing a facelift
technique called double layer lifting.
This new method achieves better,
longer-lasting results and is more
effective than conventional techniques
in improving loose jowls and laugh
lines. In double layer lifting, both the
skin and underlying muscles are
surgically lifted. Although techniques
for lifting the skin remain essentially
the same, new methods of lifting facial
and neck muscles are being used to
achieve improved results.
Doctors have made some modifications to the
traditional facelift to eliminate
undesirable hairline changes in front of and
in back of the ear.
This is a newer operation for improving
lax tissue between the lower
eyelids and the upper lip. It is also
effective for improving lines between
the cheek and the upper lip (nasolabial
lines). A mid-facelift can be performed
with a facelift or as a separate
procedure. The approach can be either
through an incision in the lower eyelid
or through the temporal area and inside the mouth. A
mid-facelift may also
improve hollowing of the lower eyelid.
(Cosmetic Eyelid Surgery)
Cosmetic eyelid surgery has undergone many improvements
and modifications over the past few years.
The most recent advances are in the area
of lower blepharoplasty. As you may know,
this procedure is most often utilized
to alleviate puffiness, which is corrected
by removal of excess fat in the eye socket
through an incision below the lash line
or through the inside tissue of the lower
eyelids (eliminating the outside scar).
new concept is that any removal of fatty
tissue from orbital regions may cause
different levels of enophtalmus (sunken
eye), an effect that may worsen as the
patient ages. To avert this problem,
excess eye socket fat is only
partially or conservatively
removed with the remaining pulled downward
and repaired to the bony structures
of the eye socket. This not only corrects
puffiness by reducing the fatty tissue
of the lower eyelid but also abates
the depression between the eyelids and
even newer concept perceives puffiness
of the lower eyelids as a herniation
process that only requires repair
of the fascia in front of the socket
to improve herniation without
manipulation of fatty tissue. This
procedure, however, is still in the
experimental stages and is not widely
accepted at this time.
cosmetic eyelid surgery, in which Dr.
Zandi has extensive experience, has not yielded any new concepts
except that the natural line of the
upper eyelid is now made approximately 5-6
mms from the upper eyelid lash line
rather than the more standard line of 8-9
mms. This adjustment results in a more
natural appearance and an increase in patient
open rhinoplasty is not a new operation,
it was formerly used to correct deformities
after the second, third or fourth nose surgeries.
It was uncommon in primary rhinoplasty.
Along with many other Bay Area cosmetic
surgeons, I have been incorporating the
of open rhinoplasty into my practice
for the past few years. In my opinion,
open rhinoplasty techniques have
substantially improved the outcome of
nose surgery, achieving more predictable
and often more desirable results.
the past few years, laser surgery has
become the panacea for many skin problems,
ranging from sun damage and spider veins
to pigmented lesions. The following delves
into each of these areas and the pros
and cons therein.
chemical peels and other procedures were
once the only choices for removing
superficial layers of the skin damaged by
the sun or aging. But today
state-of-the-art laser resurfacing has
become the leading resurfacing method. Although in
many cases microdermabrasion and chemical
peel can be used, the advantages of laser
resurfacing are as follows:
procedure is much cleaner, removing
skin material without causing
depth of abrasion can be controlled
more precisely and properly depending
on the thickness and character of
the skin on different areas of the
factors could not be controlled as efficiently
with chemical peels and posed even more
dangers with dermabrasion of thin skin
such as that of the eyelids. The major
disadvantage of laser resurfacing is that
it is a more expensive procedure.
(NON ABRADING) LASER TREATMENT
the last few years, cosmetic surgeons
have tried using non abrading lasers and
intense light to improve facial lines and
skin without resurfacing and downtime. But recent reports
have shown that these types of treatments
do not meet most patient expectations.
TREATMENT FOR SPIDER VEINS
smaller the varicose veins, the more difficult
it is to inject them with sclerosing agents.
When spider veins are too small for injection,
laser works quite well, although sclerotherapy
by injection is still the treatment of
choice for larger veins.
FOR CUTTING & OPERATIVE PROCEDURES
the popularity and success of laser, the
American Society of Plastic and Reconstructive
Surgeons still recommends cutting skin
and tissue with a sharp, cold surgical blade. Like
any other new technology, the laser has
been extolled for promotional and marketing
purposes, but nothing thus far has replaced
the surgical blade cutting procedure.
While there are certainly advantages to
laser cutting, including hemostasis, a
major drawback is tissue destruction during
cosmetic surgery, resulting in more inflammation and scarring.
filled implants are back. In my opinion,
and the opinion of many plastic
surgeons, gel filled implants are still the
best implants for cosmetic breast surgery where
permitted by the F.D.A.
filled implants are not yet approved for
use in patients who undergo the procedure
for the first time unless certain conditions
such as breast laxity or chest deformity
exist, but they may be used in patients
who have had certain complications after
the use of saline filled implants.
Today's gel filled implants are more
durable than older ones and are available
in either smooth or textured surfaces.
Complications such as skin rippling and an
unnatural sensation on palpation are less
common than with saline filled implants.
Most importantly, the FDA has not found
that gel filled implants elevate health
Does using round
or teardrop and other so-called anatomic
shape implants make a difference? Scientific studies indicate
that the only differences are that
the anatomic shape implants are more expensive
and may rotate and misshape the breasts.
These studies were published in the
Journals of Aesthetic Surgery and were
presented at Aesthetic Plastic
REDUCTION & LIFT
a method of liposuction of breast tissue
has been used to reduce the size of
large breasts with
almost no scarring. This procedure can
be tried only in selected cases.
The lateral tension method applies tension
to the outer portion of the abdomen,
preventing elevation of the pubic hairline
and tightening the skin on the front of
the upper thighs and groin. Dr. Zandi
considers the entire torso as one unit,
which means that liposuction of the hip
area, waistline and upper abdomen may be
performed at the same time. The resulting
tummy tuck is more uniform and pleasing to
The two most successful liposuction
techniques used by cosmetic surgeons are:
and wet technique. Prior to the
beginning of the liposuction procedure,
a certain amount of fluid is
injected into the tissue. This
solution contains a small amount
of local anesthetic and
Epinephrine (constrictor of blood
vessels). This procedure improves
post-operative pain and eliminates
blood loss during surgery. Today
blood transfusions are almost never
used in liposuction.
of ultrasonic systems in which a
machine generates 2500 vibrations
per second, which are transferred to
the suction cannula. The procedure
melts the fatty tissue before
suctioning, decreasing the amount of
blood loss and post-operative
bruising in selective areas of the
body where fatty tissue is firmer
and more difficult to suction.
Ultrasonic liposuction can also be used
to reduce male and female breast
and is more effective in repeat
is a technique that offers the benefits
of dermabrasion, chemical peel and laser
resurfacing in a lesser degree without
significant complications. It is effective
treating sun-damaged skin, fine
wrinkles, age spots, large pores and acne. The skin becomes smother,
softer, and more uniform in color and texture. Microdermabrasion,
which can be used on all skin tones, is not effective in
deep wrinkles and acne scars, but it works
well with fine lines around the eyes,
mouth, neck, chest and hands. The most
commonly treated area is the
face. For best results, it may have to
be repeated every two weeks for one to two
months. Acid peel and other more extensive
procedures may augment the results.
The procedure takes about 45 minutes and
is performed in our Bay Area cosmetic
surgery center without the need
for anesthesia. You may feel like fine
sandpaper is being gently rubbed on your
skin. No preoperative preparation is required.
Following microdermabrasion, you may experience
a tightness or sunburn sensation for a
day or two. Redness, if any, resolves
in a few hours. You may apply moisturizer
and make-up after the procedure.