Upper Airway Resistance Syndrome disturbs sleep patterns, but can be remedied

It may not be your mattress that’s keeping you from having a good night’s sleep. It could be Upper Airway Resistance Syndrome (UARS), according to Jeffrey Raval, MD FACS, located at 250 Steele St., Denver, CO. While sleep apnea has gotten a lot of press in the last few years, UARS is a more recent diagnosis. It’s so new, in fact, that the equipment used in some sleep clinics is not geared up to diagnose the problem the way that an ear-nose-throat surgeon can.

Sleep apnea affects men far more frequently than women. However, older women suffer from UARS than do any other demographic group, says Dr. Raval, an American Board Certified Facial Plastic Surgeon and Ear/Nose/Throat/Head Neck Surgeon. Curiously, UARS is often diagnosed after nasal surgery to correct crookedness or surgery for a deviated septum.

“We have women patients who report back to us that they had spent years of restless, sleepless nights chalking that up to stress, menopause or insomnia. They’ll tell us they never made the connection between breathing well and sleeping well…until after their surgery to correct the nasal obstruction,” Dr. Raval says. Frequently women who suffer UARS have severe nasal airway obstruction. Simple nasal airway reconstructive surgery such as straightening the septum, called a septoplasty, can vastly improve their life by allowing them to sleep throughout the night.

UARS differs from sleep apnea in that many people suffering from sleep apnea are overweight, while those diagnosed with UARS share the opposite condition of a thin face, a small or narrow jaw and a thin neck. When taking his patient’s health histories, Dr. Raval has found that it’s not uncommon among this group of UARS patients to have had orthodontia as a child to correct overcrowded teeth-one of the defining characteristics of the thin face and small or narrow jaw.

Otolaryngologist Steven Park, M.D. released a book in 2008 called “Sleep Interrupted: A Physician Reveals the #1 Reason Why So Many of Us Are Sick and Tired (Jodev Press), on the topic of UARS. His findings in the book are consistent with those Dr. Raval has witnessed among patients who complain of cold hands and feet, low blood pressure, and the inability to sleep on their backs comfortably.
European studies (one study of French women) show that almost half of the women with chronic insomnia and resulting daytime fatigue have UARS-a sleep disorder caused by resistance to air flow through the nasal passages.

Breathing strips (Breathe Right is one such product) do help some patients with UARS. Others see improvement using nasal dilators such as Nozovent or a saline nasal spray. Over-the-counter Claritin can remedy congestion from allergies. When either of those remedies doesn’t solve the problem, an ENT can prescribe a nasal spray containing itraconazole (Sporanox), xylitol, mupirocin (Bactroban) and dexamethasone. In other cases, Dr. Raval has had success prescribing dental devices that push the jaw forward preventing it from blocking the throat opening. And a special nasal mask called a Continuous Positive Airway Pressure (CPAP) can be recommended to deliver air to the airway while preventing the nasal passages from collapsing during sleep.

“A good night’s sleep is one of the best things a person can do to maintain their health,” adds Dr. Raval. “Now that we understand UARS, we have solutions that can help.”

The trend used to be if you had a wrinkle, indentation or a sag in your skin, especially excess skin, pull it taut or take it off. Those procedures were just as invasive as they sound. The newest treatment is a lot easier on the face and the wallet: Simply fill it. Call it recession chic. Then call The Filler Guy, Dr. Jeffrey Raval, an expert on injectable fillers and a facial plastic surgeon.

“We all go from a grape to a raisin as we age,” says Jeffrey Raval, MD, FACS, who practices in Cherry Creek North in Denver, CO. “That’s where the fillers are coming in. Instead of pulling and cutting, the newest approach is to replenish the loss of volume with injections of non-invasive fillers. There are so many filler products on the market today that the friendly competition between manufacturers has led to a reduction in price, a reduction we’re passing along to the patient.”

Competition drives down pricing in any product-technology to housing. Until recently, there were not as many players with products in the cosmetic industry, keeping prices high.

Some of the recent price cuts mean beauty comes at a reduced cost. Radiesse now comes in a larger syringe-up to 1.5 cc from 1.3 cc in size. The larger size syringe is sold to surgeons at the same price as the smaller syringe. The size of a Restylane syringe has doubled, from 1 mm to 2 mm and the price of each syringe sold to doctors only increased 70% vs. 100%. The cost savings on materials (in this case filler materials) allows Dr. Raval to pass that savings along to the patient.

The Filler Guy, Dr. Raval, is the top doc in Denver who specializes in this type of cosmetic enhancement.
He first consults with you to put together a tailored solution based on your desired results and your particular skin’s needs. Your skin is unique to you, explains Dr. Raval, which is why a cookie-cutter treatment just won’t work. It is important to carefully select the right product for your face. The Filler Guy, Dr. Raval, uses multiple types of filler injectables to achieve the most natural rejuvenation treatment possible.

Juvederm is the injectable best for the mid-to-deep dermis of the face. This is the layer that contains nerve endings, sweat and oil glands and blood vessels, so it is a product you would like to have injected by a double-board certified doctor like Dr. Raval instead of at your local spa. Results can last up to one year and it can treat nasolabial folds (also known as parentheses lines or smile lines) in the lower portion of the face. Juvederm is also used to fill the back of the hands, restoring the hands, a dead-giveaway of age, to a younger look.

The benefit in Juvederm is its hyper-tenacity. The product, once injected, tends to draw in water creating a nice plumping effect, explains The Filler Guy, Dr. Raval. “That’s particularly nice for the lips and folds in the face. But we don’t use Juvederm around the eyes because can make eyes look puffy. The eye area is where we use Restylane.”

Restylane restores volume and elasticity to the face. It can be used to treat wrinkles, fill lips, shape cheeks and smooth the glabellar lines between the eyebrows. Pumping up your pout or contouring facial features with filler will not only take years off your face, it will safely be absorbed into your skin the way your body’s natural hyaluronic acid would. It is long lasting, but not permanent.

Perlane is similar to Restylane but gives a patient a more robust correction, says Dr. Raval. Perlane is made up of larger particles which take longer than Restylane to naturally absorb into the skin. Perlane can be implanted to add facial volume to wrinkles and folds in any area of the face as well as to the lips. “Each syringe of Perlane contains a little more correction than does a syringe of Restylane,” notes Dr. Raval. It lasts about the same length of time as Restylane, one year.

Radiesse is the best product for volumizing. “It’s great for treating jaw lines, cheeks and under the cheek,” says The Filler Guy, Dr. Raval. Radiesse stimulates your body’s natural production of collagen so it not only creates a younger you, it prompts your body’s natural collagen-producing function to generate more collagen, enhancing the facial fullness even more. Radiesse is a calcium-based product and the injections require little or no downtime.

Denver’s Filler Doc, The Filler Guy, Dr. Raval is the expert of enhancement. Call Dr. Raval at 303-985-8520 for an appointment.

Once again, news headlines claim that Botox® injections can be lethal. The news reports are not only exaggerated, but inaccurate in that the news stories logged don’t differentiate between injections of BOTOX for medicinal purposes and the injections for cosmetic purposes-a big difference.

“Bottom line, all the reported cases of adverse events using Botox come from injections of BOTOX for medical purposes, not cosmetic,” says Jeff Raval, MD, FACS, American Board certified facial plastic surgeon who is ear/nose/throat board certified too. “The high level of doses of Botox used for medicinal purposes can be too much. For example, there have been cases that doctors injecting Botox in the neck muscle to treat torticollis, abnormal spasms of the neck muscle, have injected too much of the toxin. The patient’s throat can close up and he/she can have trouble breathing.”

But there are no reported incidences of lethal or near-lethal use of Botox for cosmetic treatments, Dr. Raval confirms.

The dangers in Botox use surface in the press every year or so. “There is no truth to the rumor that Botox Cosmetic is dangerous,” adds Dr. Raval.

Are you one of more than 37 million Americans suffering from sinusitis? This common condition restricts the sinuses from draining properly resulting in minor to severe discomfort ranging from headaches to sore throats to constant nasal congestion and facial pain-all because of the pressure. FDA-approved balloon sinuplasty can alleviate the problems, explains Jeffrey Raval, MD FACS, American-Board certified in ear, nose and throat, facial plastic surgery and head and neck surgery.

Dr. Raval regularly performs this procedure, considered to be one of the most revolutionary advances in the practice of ear, nose and throat medicine in the last 15 years. The half-hour surgery performed under general anesthesia is performed through the nostrils and is the least invasive of any type of nose surgery. Known as The Nose Guy among fellow surgeons in Denver, Colorado, Dr. Raval explains that balloon sinuplasty is based on the same principal as balloon angioplasty for the heart. A deflated balloon is guided on a wire catheter up through the nostrils to the source of the blockage and then is inflated just enough to clear the passage, allowing appropriate drainage to occur. Once accomplished, the balloon is deflated and removed.

In the process, the cartilage in the nose is actually spread apart with minimal pain because the bones in the sinus drain are small, soft and malleable. This procedure is an alternative to Function Endoscopic Sinus Surgery (FESS) in which passageways are enlarged through removal of bone and tissue. Instead, says Dr. Raval, balloon sinuplasty eliminates the need to pack the nose with gauze post-op which would be required to stop bleeding following a FESS. Another benefit of balloon sinuplasty is that other treatments can still be given so options are not limited if the patient has a more severe or progressive disease requiring further therapy.

The Food and Drug Administration approved the surgery as a viable solution to sinusitis and because the procedure requires no incisions, no bruising or swelling results. Patients can return to normal activity the next day. Now that’s a breath of fresh air. Consult Dr. Raval to find out if you are a good candidate for this procedure. Balloon sinuplasty may be covered by Medicare or other insurance providers.

Raval Facial Aesthetics is located at 250 Steele St. in Denver, CO. The phone number is 303.381-FACE (3223).

My nose is slightly disproportionate, but not so bad that I need surgery. In fact I don’t think most people can tell my nose is off-kilter unless I’m looking at them straight on and not moving, not even talking. Now that I’m staring into the eyes of my fiancé, I’d like to think he thinks I’m perfect. Is there anything that can be done besides a full-blown nose job?

Clarice—28 years old, Englewood, CO resident engaged to be married in the fall of 2008.

Dr. Raval: Clarice, everyone’s nose is slightly asymmetrical. In cases like yours when a nose isn’t necessarily oversized but is just a little uneven, the newest advancement is simply injecting filler into the smaller side of the nose to plump it up slightly to the same shape as the other side. This works too for small bumps on the bridge of the nose. You just want your nose to look even and not detract from the rest of your face.

The 15 minute nose job uses injectables like Perlane to fill in where needed. Any dents or creases can be eliminated and both sides can be made equal. We numb you up a little prior to treatment with a topical anesthetic ointment and in only 15 minutes, your nose will be ideally balanced. The nice thing about Perlane is that it lasts up to a year and because it’s hyaluronic-based there’s no risk of an allergic reaction.

Call our office for an appointment to see if this isn’t the first option you should consider before weighing a full-blown nose job or rhinoplasty as it’s called in medical terms. Our office number is 303.381.FACE (3223).

Q: I have considered plastic surgery on my nose before, but now at age 27 I broke my nose in a charity powder puff football game. Yes, it was brutal. And not only is it crooked, but I can’t breathe the same. What do I need and what do I tell the Doctor when I go in for a consultation? I want it functional and aesthetically pleasing and I’d like to convey that without saying, “Hey Doc, how ’bout a nose job?”

A: Good question.  Any type of plastic surgery on the nose is generally called rhinoplasty. Granted, this can be discomforting considering the mental image conjured by the word “rhino.” But fret not, rhino means nose and plastic surgery on the nose ranges from full cosmetic reconstruction to noninvasive out-patient procedures to help sinuses.

The new nose guide.

Do you have a humped nose, crooked nose, tension nose, traumatic nose or saddle nose?

Rhinoplasty is for you if…

Form:

You don’t like how your nose looks.  It could be too big, too pointy or have an unwanted bump.  A rhinoplasty can correct it and improve the look of the whole face.

An injury changed your nose and your appearance.  Simply realigning nasal bones that may have been fractured and removing crushed cartilage can correct the nose.  Even if the nose appears twisted or flattened, it can be corrected in approximately two hours.

Function:

You have trouble breathing. A deviated septum can be corrected and nasal passages can be enlarged to ensure breathing with ease.

You suffer from sinusitis. A special type of rhinoplasty called balloon sinuplasty can clear your nasal passages in order to allow sinus drainage.  Headaches, facial pain and congestion are among the symptoms that can be alleviated.

Slightly reshape the nose:

Closed rhinoplasty is the way to go. Incisions are made within the nose and it is slightly rearranged to achieve desired shape. This is done by removing bone and cartilage and then reshaping skin and tissue around the structure. This can typically be performed in 1 to 2 hours

Completely reshape the nose:

An open rhinoplasty is required. The incisions are made on the strip of skin separating the nostrils. Then the bone and tissue is rearranged to the desired shape and the incisions are closed immediately. Following the procedure, an external splint will need to be worn for 6-8 days to ensure proper healing. This procedure takes less than two hours.

Clear sinusitis:

This cutting-edge procedure does not require incisions. A balloon is inserted into the nostrils by using a wire catheter and the balloon is only inflated up to a quarter inch when inside the nasal passages in order to clear them. This is only a 30 minute procedure that typical needs less than 24 hours for full recovery.

Just a handful of years ago, it was unheard of to get online to check out your plastic surgeon before making an appointment. That detail was reserved for coffee klatches or girls night out and even that was affected by regional influences, says Jeffrey R. Raval, M.D., F.A.C.S., triple board certified American Board in head/neck surgery, otolaryngology and facial plastic surgery.

That’s changing today as patients rely on the internet for volumes of information about every subject of interest to them, says Dr. Raval. Google.com or msn.com searches aren’t uncommon as a prospective patient begins to sort out the volumes of information about plastic surgery and other minimally invasive treatments they’ve heard about but not experienced yet.

“We get many hundreds of visitors to our website daily,” says Dr. Raval, who sees patients Monday through Friday and sometimes on Saturdays. “We know from the reports we get monthly that the inquiries are about specific products and treatments. People are searching for these topics by name, sometimes highly specific product names. They may have read about a treatment in a national magazine and then want to find a doctor locally that performs the treatments they’re interested in.”

The New York Times reported in April that roughly 5,700 plastic surgeons are certified with the American Board of Plastic Surgery and that roughly 113 million Americans have used the internet to get healthcare information, according to the 2006 Pew Internet & American Life Project.

Then again patients are very likely to go to the website to review it after they’ve heard from a friend or co-worker that they have been treated in Dr. Raval’s office. “They hear a personal testimonial, look our office up on the internet and then call to make an appointment. Or sometimes they hear a personal testimonial, call information for our phone number and after they’ve made their first appointment will cruise through the website to learn more about us before actually coming in for treatment,” Dr. Raval adds.

To that end, the design of one’s website is significant. Dr. Raval has chosen to run streaming videos of his frequent appearances on local TV channels during which he demonstrates a specific procedure. “Because I watched a video of Dr. Raval online on his website, it was almost as if I had met him previously when I went into his office for the first time,” reports one patient. Videos, especially, give viewers a better perspective of the doctor’s personality and presentation—qualities that are important to assess when selecting a doctor.

Obviously, one of the most motivating experiences to prompt calls for appointments is a personal endorsement. Says Dr. Raval’s receptionist: “We often hear from first-time callers that they are ‘friends with so-and-so’ or that ‘so-and-so referred them.’”

While many patients are talkative about their procedures and the outcome, some patients keep mum and want others to think they’ve got great DNA or luck. Patients in Miami, Florida or Los Angeles, California have historically been far more likely to open up about their plastic surgery and/or non-invasive treatments like BOTOX or Restylane injections, says Dr. Raval. In fact, it’s not unusual for the conversation between complete strangers to revolve around these topics in those areas of the country. In a curious way, you could almost overlay the regions of the country where patients are more inclined to discuss their physical surgical improvements with a weather map. The warmer the weather and the skimpier the clothing, the more patients are likely to reveal that they’ve been “improved.”

Another factor that impacts openness about the topic of plastic surgery (or any topic, for that matter) is cultural. Folks living in the bread-basket of America are known to be conservative and not likely to make fast friends. And sometimes it’s religious. And, of course, income levels have an especially profound impact on the decision to proceed with cosmetic surgery. Since most cosmetic surgery is elective and most insurance carriers won’t pay out on elective treatments, it means that the patient has to have the money to pay for the treatment. Considering that a syringe of the injectable Perlane is about $800, the limits on the credit cards these patients pull out to fund treatment generally are five-figures or six.

Dr. Raval practices in Cherry Creek North, the upscale neighborhood known for its fine spas and high end retail boutiques. It’s not unusual for a patient to pull up to Dr. Raval’s practice in a $60,000 car, wearing a $2500 suit showing off a glowing tan from an $8,000 vacation the week prior. By the same token, Dr. Raval has patients who prioritize their limited funds, making a choice between one luxury or another in order to have plastic surgery.

The tendency to prefer a lot of smaller, less-invasive treatments that don’t require down-time or at the very least require minimal down-time, is an increasing phenomenon, says Dr. Raval who has observed that the bulk of his patients lead highly active lives—with families and high powered jobs. That kind of thinking is directly in line with Dr. Raval’s preference for recommending and performing more frequent, less invasive treatments that allow the patient to enjoy immediate results and satisfaction while not keeping them from being productive otherwise.

The fact is, says Dr. Raval, that it’s the patients who are currently undergoing a treatment or say a series of treatments as in Sciton Laser microdermabrasion who are more inclined to talk up their treatment—in part because they’re so happy with the immediacy of the results, the return to looking younger that they can witness overnight. In some instances, says Dr. Raval, patients share their experience with friends and co-workers because they themselves are so amazed at how far medical technology has come in the last decade. Plus, they enjoy the compliments which typically include mention of them looking rested or young.  “Upon hearing that they look happy or rejuvenated, they’ll often jump in and offer the information about a simple procedure they’ve just had,” Dr. Raval says of the feedback he regularly hears from patients.

“When I get a new car, I tend to notice all the other cars on the road that are the same make and model as mine,” Dr. Raval admits with a chuckle. “When I have just returned from a vacation in a tropical place, I’m more likely to talk about that trip to people I know versus months later. Let’s face it, one of the favorite subjects most people have is themselves, so they tend to talk about what they’re doing and what they’re up to. If I remodel a room in my house, I’m more inclined to talk about the progress while I’m in the middle of it—good or bad—than I am months later after the remodel is complete and my focus has turned to another subject.”

Reach Dr. Jeffrey Raval at 303-744-2300 or visit his website at www.ravalmd.com.

Google Jennifer Aniston and 18,900,000 results pop up in less than 19 seconds, among them teasing headlines like “Aniston and John Mayer caught kissing again” to a report by Fox News in 2007 that Aniston has had a second nose job by Indian plastic surgeon Raj Kanodia, the second one to correct a first surgery for a deviated septum done a dozen years ago. The surgeon is also reportedly the plastic surgery solution to Jessica Simpson and Cameron Diaz, the article by Catherine Donaldson-Evans on the FX website, owned by News Corp. the parent company to FOX News.

Repeat rhinoplasty or nose jobs aren’t uncommon, reports Dr. Jeffrey Raval of Denver, CO, who is known as “The Nose Guy” for his exceptional surgical capabilities in repeat nose jobs. “The issue with a repeat nose surgery is always the scar tissue,” says Dr. Raval, F.A.C.S. and triple board certified facial plastic surgeon with American Board certifications in head and neck surgery, otolaryngology and plastic surgery.

Patients frequently seek out Dr. Raval for their repeat nose job when they’re not happy with the surgery performed by another plastic surgeon. Sometimes these patients come from states away, says Dr. Raval who is not afraid to tell a potential patient who wants unreasonable surgery that they’re not a good candidate for cosmetic surgery.

“I make a point of taking the time to discuss with the patient their concept of what the surgery will do for them,” says Dr. Raval. “If they’re scheduling surgery to please someone else or expect their lives to become altogether different, new and improved because of a surgical procedure, they will not be pleased with the outcome, even when the surgery is flawless.”

No surgical procedure makes everything about one’s life perfect, Dr. Raval adds.

Take, for instance, Jennifer Aniston. Even though she had a first nose surgery, she still ended up divorced from her husband, Brad Pitt. And although she underwent a subsequent corrective nose job to trim the wideness of her nose, she still suffered heartbreak, falling in and out of love. She was incessantly  pursued by the paparazzi. Reports about Jennifer’s every move, whether it was true or not, were widely circulated, particularly when she was expected to be at the same event as her ex, Brad, and his new wife Angelina Jolie.

Nose jobs are done for many reasons, not the least of which is to simply correct the appearance of the nose. Other reasons for nose surgery include restoring breathing function in the case of a patient whose breathing is limited because the inside of the nose is crooked (called a deviated septum). Many patients have noses that are outsized like their parent or other family member, consistent with their DNA of origin. Surgeries to minimize the size of a nose or to correct a bump on the nose are often performed on teens in their mid-teen years.

“The outcome for a teen patient who has been ridiculed or teased because of the size or shape of their nose is almost always highly positive,” says Dr. Raval. “A good nose job eliminates the object of this ridicule and torment. Now if a teen has a big nose and a repulsive attitude or other offensive behavior, chances are nose surgery won’t do a thing to endear others to him/her or to make the teen feel better about him or herself.”

“That would be a case where I would suggest to a parent that the child be seen by a counselor who could help the teen work through his or her emotional issues to better understand what is causing issues in interaction in the first place,” Dr. Raval says.

In his years in practice, Dr. Raval has had many, many patients who’ve had nose jobs tell him that the surgery has improved their lives.

Sometimes patients combine surgery to correct a deviated septum along with surgery to correct the appearance of the nose. When Dr. Raval is minimizing a nose or removing a bump, his overriding concern is that the nose be consistent with the rest of the patient’s facial characteristics. “In the ‘60s patients who came in wanting a nose job might want theirs to be made into a small pixie nose. But those days thankfully ended when the objective of cosmetic surgery became more focused on making a patient look natural as well as beautiful, absent exaggerated change or an over-surgerized noses,” says Dr. Raval.

The decision to opt for a nose job is one that requires a patient to take appropriate time off rigorous activities to recover. Following rhinoplasty, the nose is packed with dressings that must remain in place for several days. Then for about a week to 10 days, the patient is advised to not sniff their nose or blow their nose. Instead they’re instructed to gently dab at any discharge with a tissue. Once the nose has begun to heal, the mucous plug, that at first functions as a sort of protective cover, will naturally dry up and release from the inside walls of the nostrils. Follow-up visits to the doctor will check to confirm that the healing process is going as is expected and the swelling and tenderness that occurs will minimize as the nose heals completely.

“Just because you like the noses the celebrity twins Mary-Kate and Ashley Olsen breathe out of, doesn’t make that same nose ideal for you,” cautions Dr. Raval. “By the same token, it can be tough on a child to have a nose that attracts attention for all the wrong reasons.”

Dr. Raval can be reached at 303-744-2300 or visit his website at www.ravalmd.com

DENVER, CO—One of the standard features of any physician’s office in the last half of the last century as a waiting room.  Yet waiting at all anymore isn’t what patients expect –even when it comes to the results from their treatment.

A lot of that has to with the rejuvenating cosmetic treatments that doctors like Dr. Jeffrey Raval are able to perform that make an immediate improvement—and require no downtime.

At the office of triple board certified Dr. Raval, some of those immediate treatments include the liquid facelift. Using filler materials, like Juvederm and Restylane plus BOTOX, Perlane and Restylane in different combinations, Dr. Raval is able to concoct a customized and immediate facelift of sorts for patients. Within 45 minutes to one hour, the patient leaves the doctor’s office looking years young. In most cases, Dr. Raval, a facial plastic surgeon who concentrates on the head and neck exclusively, doesn’t even have to numb the patient first, saving even more of the patient’s time. (When anesthesia is used on a patient, the patient is required to come early to the appointment to allow the numbing effect to take hold, that’s true even of topical numbing ointments.)

No two people receive exactly the same amount of filler in the same location in the same quantity. But two rules generally apply: BOTOX is used only in the top half of the face including the forehead, between the eyebrows and around the eyes; while fillers are generally used in the lower half of the face.

“It’s the grape to raisin theory,” explains Dr. Raval of the newly popular liquid facelift. “The face starts out on a young person as full and firm. Over time, the face loses its elasticity and its ability to produce collagen. The skin becomes lax and droops and wrinkles and creases begin to form as the jowl or jaw line drops too.

Instead of going under the knife, more patients are opting for non-invasive procedures like fillers and BOTOX to extend the years before a facelift would be the optimum recommendation that Dr. Raval would make.

In a recent liquid facelift performed in 45 minutes or less in the office, Dr. Raval used one syringe of Restylane around the eyes to and in the cheekbone area to plump up the area under the cheekbones that had become sunken. He used one syringe of Radiesse in the lower face along the jaw line to fill in where gravity had begun to pull downward on the face, making the jaw line uneven and aged looking. And he used 45 units of BOTOX around the eyes, forehead and frown area (10 units to the forehead, 10 around the eyes and 15 in the frown area) to smooth away wrinkles. In some cases, Dr. Raval says, these kind of frown wrinkles especially can leave a person looking angry; just a small amount of BOTOX smoothes away the years and the negative expression.

Immediately after a liquid facelift, the patient can reapply makeup and resume routine activities. “No waiting for results and no downtime make this a treatment that renders immediate gratification,” adds Dr. Raval, who has performed hundreds upon hundreds of liquid facelifts since fillers and BOTOX were approved by the FDA.

Patients are scheduled for a recall visit with the doctor two weeks after a liquid facelift at which time Dr. Raval touches up any areas that require more filler or BOTOX.

Dr. Raval finds that the fillers are optimum over a fat transfer which was the superior treatment only years ago. “Fillers have come such a long way in recent years plus they last longer than natural fat transferred from one area of the body to another. There is very little if any discomfort and the results are so impressive that patients leave their appointment looking refreshed and feeling younger.”

It used to be that surgeons removed the fat from around a woman’s eyes when performing a blepharoplasty (eyelid or under-eye surgery). Doctors reasoned that excess fat had to be eliminated in order to tighten the appearance of the eyes.

New techniques have changed all that, according to Jeffrey R. Raval, MD, FACS, triple-board certified facial plastic surgeon who has performed rejuvenating eye surgeries on hundreds of patients—men and women. Instead of removing the fat, Dr. Raval is doing more fat repositioning procedures, building up the wall of fat in the skin under the eyes and adjusting the fat cells in that area. The result is a more youthful appearance rather than the sunken, hollow-eyed look when the fat under the eye is removed.

“The eyes are the first area of the face to show one’s age,” says Dr. Raval. As people age, muscles weaken, skin stretches and fat accumulates around the eyes causing the appearance of fatigue and stress. More than 230,000 people a year undergo eyelid lifts to regain a younger, firmer looking eye area. The procedure can be performed on either the lower or upper eyelids or both and can be combined with other facial procedures.

Upper eyelid surgery is more likely to involve fat removal, explains Dr. Raval. That’s because the upper eyelid tends to droop as we age, and the accumulation of fat above the eyes needs to be reduced slightly to achieve a more sculpted, youthful shape that enhances the brow and makes the upper eyelid visible again.

One complaint that many women have prior to seeking a blepharoplasty is that they go to the effort of putting on eye make-up that no one can see because their eyelids are too puffy.

Patients with exceptionally droopy upper eyelids can find that their vision is impaired. A blepharoplasty to correct that condition is sometimes covered by medical insurance, as it’s not considered simply a cosmetic surgery.

Contact Dr. Jeffrey Raval for a consultation regarding blepharoplasty surgery or fat repositioning by calling 303-744-2300.