Smoothing out wrinkles to give your face a youthful appearance can be reached without surgery and without scars. Botox (Botulinum toxin type A) is the cosmetic form of bacterium Clostridium botulinum. It is mainly used to treat forehead creases, frown lines and crow’s feet.
Botulinum toxin or “sausage poison” is a substance produced by the bacterium Clostridium botulinum. At first it was used in ophthalmology and neurology. That’s when it was discovered the toxin could be used to diminish wrinkles and stop sweating. The amount of applied substance in cosmetology is 1000 times lower than the toxic dosage. The actual effect of botulinum toxin consists of the blockage of nerve-endings; the muscle is de-nerved and no nerve impulses can affect the area. It is practically “numb,” although over time the muscle does regain its nerve impulses. The effect of botulinum toxin is not permanent.
Prague has many attractive features for those considering botox abroad. Its location in Central Europe is easy to access; its mild climate is conducive to healing and its experienced clinics and botox surgeons ensure you’ll receive the best possible care. Botox Prague costs are often much more affordable than in the UK or with the NHS. For more information about getting to and around the Czech Republic, please visit our handy cosmetic surgery Prague info guide.
Are you a good candidate for wrinkle removal using botulinum toxin?
The two barriers to receiving a botulinum toxin application are pregnancy and lactation. Although most moms probably aren’t too worried about wrinkle removal. If you suffer from any nerve diseases, certain allergies and hemophilia also prevent you from using botox.
Botulinum toxin is an out-patient procedure that takes several minutes. The actual application takes 5-10 minutes. It is performed without anesthesia but the treated area may be cooled with a frozen compress. The solution is applied with a thin needle under the skin in the specific wrinkled area. The most common place to receive botox is the forehead and the area around the base of the nose and around the eyes. An experienced surgeon is able to work in small areas, and to treat even the beginning of wrinkles in the area of the upper lip.
Folowing your botulinum toxin application, you should not lie down for four hours after the procedure. This is so the toxin won’t, for example, get in the eyes and perhaps cause drooping eyelids. The patient should also not wear cosmetics, visit a solarium, receive a massage, etc.
Yes, in rare cases, the botulinum toxin does not have any effect. These patients may have developed antibodies in the past through a small intoxication of the poison. There are also documented cases of antibodies being created by very frequent applications. In these cases, another type of botulinum toxin might work.
The effect of the substance after the first application lasts approximately three months, after the second one around half a year and after the third application approximately 9-12 months. The more the substance is applied the longer the effect lasts. However, the effect of botulinum toxin can’t be guaranteed for more than a year. Many clients return once a year, or even better, learn not to use specific muscles and therefore the period between the treatments is prolonged. Boutulinum toxin application in the same area is not recommended more than twice a year (except in the first year.) In case of very deep wrinkles or defected collagen fibres, total wrinkle removal cannot be expected, but only a wrinkle reduction. Here it is possible to combine the botulinum toxin with a suitable filling material, for example collagen or hyaluron acid.
Uses:
Reduction of laugh wrinkles
Relaxation of frown wrinkles
Reduction of fan wrinkles
Relaxation of an unwanted facial expression (e.g. turned-down corners of the mouth)
Treatment of hyperhidrosis – excessive sweating (axillae, palms, soles and face)
Duration of the effect:
Temporary (3 – 9 months).
Duration of the treatment:
Maximum of 10 minutes.
Botulotoxin A is a substance that relaxes muscles. It has been used in medicine for a number of years now and is the most important component of both BOTOX® and DYSPORT®. A special feature of these substances, which are applied by injection, is that they act directly on the cause of wrinkles, namely muscular activity. When BOTOX® or DYSPORT® is injected into a muscle, it temporarily blocks the nerve impulse that causes muscle contraction. The substance therefore acts more effectively against mimicry wrinkles than skin implants do. In addition, it prevents the formation of new wrinkles. The wrinkles become less apparent or disappear completely. Although BOTOX® and DYSPORT® do not have a permanent effect, the treatment can be repeated without difficulty.
The application of BOTOX® or DYSPORT® is completely painless. The doctor uses a thin injection needle to introduce the substance into the muscle that causes the wrinkle or unwanted facial expression. The injection produces only a slight burning sensation. Immediately after the treatment, the skin is slightly reddish and swollen. These effects disappear after about an hour. You don’t need to take any time off work and can appear in public almost immediately after the treatment.
The results of the treatment appear after three to six days. The skin is visibly relaxed and the wrinkles are shallower. The effect is optimal after fourteen days, and lasts three to four months. The more frequently the treatment is repeated, the longer the effect (from six to nine months.)
What is Esthelis, Restylane, Juvederm, Surgiderm, Teosyal, Matridex, Matridur?
New generation of injection fillers containing hyaluronic acid. It is prepared from bio fermentative hyaluronic acid by patented process. It is a monocomponent formulation – containing only one substance. Unique polydensified cohesive structure of Esthelis consists of cohesive gel, which is easy to administer. The skin is smooth after its application. Esthelis is supplied packaged sterile and ready to use immediately.
Esthelis can be used immediately with no prior skin test. The cohesiveness and elasticity allow treatment without overcorrection. The Esthelis injection is administered by a medical professional, which is trained in such injection fillers application. It takes approximately 30 minutes to perform. The final result is visible in 1 to 2 days. It is stable and long lasting. Its main advantage is the natural structure of the substance, which is own to the body and also degrades in the organism naturally. Therefore there is no risk of allergies and undesirable effects.
Use
Duration of the effect
Temporary (6 – 12 months).
Duration of the treatment
About 30 minutes.
What is Restylane®?
RESTYLANE® is hyaluric acid, which is natural to the body. This substance occurs throughout the body and ensures the hydration and elasticity of the skin. Over time, however, the production of hyaluric acid decreases, wrinkles form and the skin becomes less flexible. RESTYLANE® replaces natural hyaluric acid. It forms cushions under the skin that completely fill the wrinkles and furrows. Three kinds of RESTYLANE® (RESTYLANE®, Restylane Touch® or Restylane Perlane®) are used, depending on the depth of the wrinkles. The products are virtually identical: they differ only in the size of the acid beads. Smaller ones are used for minor wrinkles, and larger ones for deeper furrows and for renewing volume.
The treatment
The doctor applies RESTYLANE® to the skin using a thin needle. The slight burning sensation this causes disappears immediately after the substance has been applied. The skin is desensitized with cream at sensitive places, like the lips.
Results
The result of the treatment– smooth skin and fuller lips – can be seen immediately. Although the skin may be slightly swollen directly after the treatment, the swelling disappears within one or two days. The body completely decomposes RESTYLANE® within six to twelve months, at which point the effect of the treatment disappears. However, the treatment can be repeated without difficulty.
As we age, gravity often takes its toll on our bodies. Sometimes this results in loose and excess skin on our face and neck. Unfortunately when this happens around our eyes, it can make us look old and tired. Sometimes drooping eyelids are not only a cosmetic problem, but a health one, as in many cases excess skin can interfere with one´s vision. Eyelid surgery may offer you a solution.
Eyelid surgery is a cosmetic change of upper and lower eyelids. Blepharoplasty solves mostly ptosis (drooping of eyelid), fat prolapses or combination of both defects. The surgeon removes excess skin and so-called fat bags (prolapses). If necessary he/she removes also some parts of increased oblique eye muscle. The patient can undergo the upper and lower eyelid surgery at the same time. If there are only fat bags in the lower eyelids and it is not necessary to remove excessive skin, the operation can be done from the inner-conjunctival side of the lid. This is called the transconjunctival version of the eyelid surgery.
If you have droopy or baggy lids, medical specialists recommend undergoing eyelid surgery as soon as possible. The results are then much better and will last longer. Usually, eyelid surgery is done for clients older than 35 years of age, but in some cases, it can be done earlier, usually because of a genetic predisposition of the client. In the case of younger clients, operation of the lower eyelids is done mostly from the inner–conjunctival side of the eye.
Eyelid surgery can improve your look, but do not expect people to treat you differently. It is therefore important to consider what your expectations are from eyelid surgery. Eyelid surgery can be done together with face-lift or browlift.
Prague has many attractive features for those considering eyelid surgery abroad. Its location in Central Europe is easy to access; its mild climate is conducive to healing and its experienced clinics and eyelid surgeons ensure you’ll receive the best possible care. Eyelid surgery Prague costs are often much more affordable than in the UK or with the NHS. For more information about getting to and around the Czech Republic, please visit our handy cosmetic surgery Prague info guide.
First, the consultation with the eyelid surgeon is very important. It is necessary to speak openly about the reasons for the operation and to decide if it is desirable to operate on all four eyelids or just the upper or just the lower. The surgeon will explain the operational procedure and the process of anesthesia. Do not be afraid to ask questions, especially if you have any doubts or are unsure about something. You can also get more information in our blepharoplasty forum.
Avoid the use of medications such as Acylpiryn, Aspirin, Alnagon or Mironal before the eyelid surgery, as they can increase bleeding during and after the procedure.
Eyelid surgery can be only done if the patient is in a general state of good health. Your surgeon will define the extent of pre-operational examinations needed.
While making pre-operation preparations, be sure to arrange for someone to drive you home after your eyelid surgery and help out for a few days, if needed.
If you decide to undergo the surgery under local anesthesia, a presurgical internal examination is not necessary. You are sent to eye department, where quality and field of vision will be checked, pressure inside the eye will be measured and your eye will be examined microscopically with slit lamp (all these examinations are part of normal examination at ophthalmologist).
Blepharoplasty is not performed if your lacrimal aparat does not function sufficiently. Functional tests of lacrimation serve for evaluation (e.g. Schirmer’s test: A small piece of paper with high absorbable features is inserted on the edge of lower eyelid, distance of its moistening is read after certain time). Further the surgeon evaluates various eye parameters:
Size of palpebral fissure: It is a separation between central edge of upper eyelid and the edge of lower eyelid. The palpebral fissure is narrowed, if the distance is less than 10 mm.
MRD1: It is a separation between middle of pupil in the straight position and middle of upper eyelid.
MRD2: It is the same distance between pupil and lower eyelid. Both these distances should measure more than 4 mm.
Distance between eye fold and centre of pupil.
Exceptionally the surgeon requests CT to eliminate pathologic processes in the back part of eye socket.
On contrary functional tests of eyelid levator are common. The upper eyelid is turned and the patient is asked to look upwards. If the levator is in function the eyelid should turn back. The second test checks the elevation of eyelid by elimination of frontalis muscle out of function.
Eyelid surgery is usually performed under local anesthesia. However, the surgeon or patient may prefer to use general anesthesia. In case of general anesthesia, you will not be allowed to eat, drink and smoke for about six hours before the operation. If local anesthesia is used, the patient can leave for home after the surgery, however general anesthesia requires the patient to stay in hospital.
Blepharoplasty usually takes about one hour. The incision of the upper lids is made in a place to allow the scar to be hidden in the eye´s natural folds. The incision of the lower lid is made approximately 2mm under the eyelashes along the edge of the eye. On the base of prior measurements and layout, excess skin and fat bags are removed during the treatment. Then the cut is closed with precise stitches. After the operation, the eyes may be covered with pads and slight elastic compression. According to your needs, the surgery is done on the upper and lower lids simultaneously or separately and can be combined with other cosmetic surgeries of the face.
Indications to this procedure are:
Ptosis: It is drooping of upper eyelid, which interferes beyond the border of cornea. Ptosis can be congenital or caused during life. Mostly it is caused by underdevelopment of muscle that raises the eyelid or by damage of innervation of this muscle. Often also so-called pseudoptosis occurs, when the eyelid does not droop but is covered with skin fold. Pseudoptosis can be also caused by facial asymmetry and therefore is resembles look of a patient with ptosis.
Solution: At first we check the function of eyelid levator. The surgeon fixes the eyebrow with index finger. It disables function of frontalis muscle that works as adjoining muscle to eyelid elevation. After that he/she checks the movement of eyelids. If the movement is greater than 10 mm and ptosis is up to 3 mm, it means that the levator is in good condition.
Fasanell-Servat surgery (Müllerectomy) – Solution to moderate ptosis up to 2 mm with functional eyelid levator. The surgeon turns over the eyelid and cuts out part of conjunctiva and tiny adjoining muscle (Muller’s muscle) and it is sewed to levator. It shortens and reduces the ptosis.
Aponeurosis of levator palpebrae superioris (levator muscle of upper eyelid) – Solution to ptosis greater than 2 mm when the levator’s function is preserved. The surgeon folds the tendon of levator on the smooth cartilage that thickens upper lid.
Resection of musculus levator palpebrae (eyelid levator) – Solution to moderate ptosis with non-functional eyelid levator. The surgeon can choose either approach through skin (transcutaneous) or approach through interior of eyelid (transconjunctival). In case of transcutaneous approach the incision is lead in natural skin fold, so that the final scar is minimally visible. After that part of the muscle is lifted and the rested parts are sewed.
Frontalis suspension – Solution to non-functional levator and/or heavy ptosis. The surgeon makes two short incisions above the eyelashes of upper lid and two incisions above eyebrows. He/she creates tunnel between holes on lids and forehead and laces through them thin fascia artificial or own to the body (firm and flexible muscle cover). Patient after this surgery opens and closes eyelid with the help of frontalis muscle. He/she learns to control the eyelid with this method during rehabilitation.
Fat prolapses, dermatochalasis, and increased oblique muscle: The incision on the upper eyelids and therefore even final scar is lead so that it is hidden in the skin fold of the lid. This way the surgeon gets into the subcutis. After removal of fat prolapses he/she gets to the muscle. Reduction of muscle fibres is not performed commonly, only in case the muscle is too big. By cutting the muscle the surgeon penetrates into fibrous septum, which separates the orbit (part of the cranial cavity containing eyeball) from its external part. It also avoids the transfer of infection to the interior of orbit. Cutting this septum can remove fat that prolapses behind the eyeball. Greater effect can be achieved if the surgeon presses slightly on the eyeball. At the end of the surgery the muscles are sutured. The fibrous septum does not have to be sewed. During the procedure after previous measurement and draft excessive skin is removed. The surgeon must be careful not to remove too much skin, the lid won’t close then.
Indications for lower eyelid surgery are similar to upper eyelids. They can be performed in two surgical approaches. By the first one the surgeon leads the 2 mm incision below eyelashes (subciliary approach), by the second approach is the incision lead from the conjunctival side of lid with laser (transconjunctival approach). The process is similar to upper eyelid surgery. The aim is the same to remove extra skin and fat. Covers on cornea and pads into eyelid are often used by the transconjunctival approach to eliminate unpleasant feelings during fat extraction under local anesthesia. Advantage of this procedure is mainly invisible scars. Although they cause more often complications that the eyelid lifts from the eyeball (Ectropion).
Blepharoplasty can be completed with a surgery correcting the width of palpebral fissure, the height of corners of the eye or their stabilization (canthopexy, canthoplasty).
Canthopexy: It is a surgery of outer canthus that fixes it. It completes blepharoplasty and can be done through same incisions. The surgeon fixes the ligament of outer corner to the ligament that covers parietal bone (periosteum).
Canthoplasty: It is a surgery similar to canthopexy and these terms are often mixed. By canthoplasty the ligaments of outer corner are loosened. After that the surgeon transfers the ligament and sutures it to periosteum. It changes also the shape of eyeball. Also this surgery presents additional procedure to blepharoplasty. Bandages and light elastic compressions are inserted after the procedure. There are new processes, when the excessive fat is not removed but it is shaped into desired shape. Through this method it was achieved to prevent often darker circles below the eyes after blepharoplasty. Sometimes carboxytherapy is recommended for visible eye circles. You can find out more in the articles: Carboxytherapy and How to solve bags and circles below eyes.
In some cases blepharoplasty is not recommended. It is especially when your eyes have small amount of tears or if you suffer from eye infection. If the skin is too short or if you have lagophthalmos (the inability to close the eyelids completely).
Before you go home, you will receive detailed instructions about necessary care and also receive some painkillers. It is recommended to keep your head higher than the body while sleeping. For at least a week, you should avoid physical activities which raise your blood pressure as this is undesirable following eyelid surgery. The first few days after the surgery, the lids will be swollen and small bruises may occur, especially in the area of lower lids. There are many agents that help to moderate bruises and swellings and they therefore accelerate the recovery process. Wobenzym is recommended that moderates swellings. The best is to take Wobenzym second or third day after the surgery and three times a day. It is only an additional treatment; the state improves even without it. A similar effect has also ointment Auriderm, which is applied on the eyelids two times a day. It is good to start to apply it already 10 days before the surgery. There are many of such agents; it is good to talk about their usage with the surgeon. Eyes may be more sensitive to light, and it is usually recommended that patients wear sunglasses. Most people are able to read and perform their normal activities within a few days.
The stitches will be removed at the latest ten days after eyelid surgery, depending on the how the lids were sutured. Most swelling disappears during the first couple of days after surgery, if you carefully apply the compresses. Most clients return to work seven or ten days following eyelid surgery.
If you consider undergoing the eyelid surgery you should know about various complications that can be associated with this surgery. One of them is oculo-cardial reflex caused by pressure in the eyeball. It is manifested by reduction of blood pressure and pulse. This state can be very severe, although usually it is only small pressure reduction. Sometimes we can see separation of the wounds after taking out the stitches.
Most severe complication is so-called ectropion. It is a state when the eyelid is turned outwards and/or when the conjunctiva is separated from the eye. The patient has permanent tears and the skin around the eyes is constantly moist and irritated. One has the feeling of foreign element in the eye. The eye is then too sensitive and easily infected. Ectropion appears soon after the surgery as a consequence of the swellings, such ectropion is temporary and it improves with absorbing of the swellings. Permanent ectropion is caused by removal of excessively big part of the skin or by complication of deep scars in the area of muscles and ligament.
Therapy: It is not simple. If ectropion is caused by excessive removal of skin, muscle or fat and it is visible even during the surgery, an immediate transplantation of removed skin is then recommended. If such state is visible after the surgery, a skin transplanted from the back of the ear lobe replaces the removed skin. Within conservative therapy also a pressure massage and suspension of the eyelid are recommended. Sometimes even a surgical method canthopexy is used (fixation of outer eyelid).
Another possible and severe complication is feeling of dry eye.
Therapy: It is treated by conservative way with the help of artificial teardrops.
We often encounter with lagophthalmos. It is manifested by inability to close eyes completely, especially during sleep.
Therapy: Treatment is conservative because in most cases the improvement is reached without medical help. It is important that the eye doesn’t dry up too much. That is why artificial teardrops and eye creams during night are used. Sometimes it is good when the eyelids are covered with moistured plaster. Exceptionally a surgical treatment is performed.
Swellings and hematomas cause ptosis after the surgery. It is healed automatically during several days. Sometimes the levators of the eyelid can be damaged or innervated during the surgery. That causes permanent ptosis.
Therapy: Following therapy is surgical with the help of frontalis suspension, which is mentioned in therapy of congenital ptosis.
Very rare complication present visible scars, where the ligaments are reproduced. If you already have such scar on your body, consult it with your surgeon immediately after first session.
We usually encounter with hyperpigmentation (increased darkening) of treated area.
Therapy: If the hyperpigmentation is too visible it can be corrected with laser, although earliest half a year after the procedure.
Among very frequent complications that are not too severe belong milia. Those are tiny white formations localized in the scars. They are formed by damage and closing of the apertura of tiny glands.
Therapy: Easy treatment, when the milium is punctured with thin needle and the content is pushed out. If milia are formed repeatedly they can be cut off.
Asymmetry of palpebral fissure doesn’t have to be caused by the surgery. If the patient before the surgery was without asymmetry it means probably asymmetric removal of fat prolapses.
Therapy: The state is treated with reoperation.
The state is often complicated with infections that have very slight progress.
Blindness after the surgery is very rare. It is caused by bleeding behind the eyeball. Pressure of effusion of blood causes mortification of the retina. Symptoms of such bleeding are insidious; it is a tension inside the eye, pain and firm eyeball.As we age, gravity often takes its toll on our bodies. Sometimes this results in loose and excess skin on our face and neck. ses the same incisions; the procedure is simpler than the first surgery. Before and after photos of previous patient’s eyelid surgery can be seen here.
Want to minimize the look of ageing on your face? Photo rejuvenation and resurfacing are excellent ways of improving your look by softening wrinkles, pigment stains and other signs of ageing.
Photo rejuvenation is a general name for a variety of procedures. The basic definition is it is a thermal disturbance of the skin’s collagen. The result of this process is an activation of the healing process and the release of substances which influence the regeneration of skin cells. The cell activity is stimulated and thus new collagen fibers are created. Skin strength and elasticity therefore improves. Other skin problems that can be treated using photo rejuvenation includes the disappearance of pigment stains and tiny veins, the filling of small wrinkles and scars and a general improvement in skin quality. Photo rejuvenation is a very gentle treatment and therefore can be combined with a chemical peel, other laser treatments, application of botulinum toxin, skin implants and it’s possible to have photo rejuvenation after surgical treatments.
Resurfacing is a method of skin treatment in which a laser is used to remove the top skin layer. The skin is eliminated using a beam from an Erbium or CO2 laser. The results of resurfacing is a smoothing of wrinkles and small scars, skin lifting and general rejuvenation. Resurfacing is more invasive than photo rejuvenation.
Prague has many attractive features for those considering photo rejuvenation abroad. Its location in Central Europe is easy to access; its mild climate is conducive to healing and its experienced clinics and photo rejuvenation surgeons ensure you’ll receive the best possible care. Photo rejuvenation Prague costs are often much more affordable than in the UK or with the NHS. For more information about getting to and around the Czech Republic, please visit our handy cosmetic surgery Prague info guide.
Photo rejuvenation is a gentle warming of the skin with low doses of light energy. The source of energy can be either intense pulse light (IPL), pulse pigment laser or diode laser. This warming causes stimulation of the cells which produce collagen fibers. The process encourages new development of collagen, smoothes out little wrinkles and stretches the skin. The light energy is partly absorbed in dilated facial veins which causes them to seal and subsequently disappear in a few weeks. Photo rejuvenation can cause an improvement of facial pigment stains as well. The healing process following photo rejuvenation is complete in approximately 7 to 14 days.
This method uses so-called ablative lasers, for example the CO2 laser or the Erbium laser. These lasers cause a gentle evaporation of the skin layer, which leads to skin surface regeneration. This procedure is mainly used to treat scars resulting from smallpox or acne, or to smooth out deeper wrinkles or a rough skin surface. The smoothing of wrinkles around the eyes and upper lip is usually perfect. The procedure can be outpatient; surgeons usually recommend a one day hospitalization with other treatments such as laser bio-stimulation or intense red light, for a faster recovery. The healing process takes two to four weeks, and constant sun protection (sunscreens with high UV filters, 50+) must follow for several months. It is possible to combine this procedure with other surgical procedures under general anesthesia, for example a face-lift.
If you suffer from rough facial skin, wrinkles, acne or smallpox scars or pigment stains, photo rejuvenation or resurfacing may be a good option for you. It is necessary to have realistic expectations and realize that photo rejuvenation does not bring as radical results as other cosmetic treatments, like a face-lift) To see before and after photos of photo rejuvenation Prague please visit our picture gallery.
During the first consultation, the doctor will discuss with you your ideas and expectations for photo rejuvenation surgery. He/she will check the condition and elasticity of your skin. If your wrinkles are too deep and/or the skin too loose, the doctor may recommend a combination of photo rejuvenation and another type of treatment, or a more radical procedure, like a face-lift, to achieve the best possible results. The doctor will provide you with all instructions concerning skin care before and after the treatment.
Photo rejuvenation is performed under local anesthesia, usually in the form of an anesthetic ointment. You can go home right after the procedure. Resurfacing is performed in a so-called analgosedation (controlled sleep) and a one-day hospital stay is usually recommended.
Both treatments are very fast. Immediately after the treatment, the skin is slightly red and oozes (in resurfacing the skin damage is more evident). During this time, it is necessary to provide your skin with some extra TLC, such as the application of cold compresses using sterile water and ointments. A total recovery following photo rejuvenation is usually after 7 to 14 days; in resurfacing the healing process can take 2 to 4 weeks. After both photo rejuvenation and resurfacing it is necessary to protect the treated areas from the sun and to use sunscreen with a high UV filter (50+) for a minimum of 2 months. No other measures are necessary.
The results of resurfacing are excellent. Your skin can look 5 to 10 years younger. If you choose to have photo rejuvenation, you can count on good results in the appearance of your skin’s surface, the disappearance of dilated veins and pigment stains. The impact on deep wrinkles is average. The best result is the smoothing out of wrinkles around the eyes.
To achieve the best results from photo rejuvenation, it is necessary to undergo approximately four treatments in a period of six weeks. The final result can be assessed about 3 months after the end of the treatments.
How long will the effects of photo rejuvenation and resurfacing last?
The effects are long-lasting but do not prevent other signs of skin ageing such as the development of new wrinkles, dilated veins or pigment stains. After some time, you may feel the need to undergo photo rejuvenation or resurfacing again.
Skin rejuvenation that is drooping and aging. This revolutionary method uses plasma flow of ionized nitrogen that regenerates skin from depth but does not damage it. It can remove scars after acne, bags around eyes and other problems. You do not even have to restrict your activities even immediately after the procedure.
Plasma is a fourth state of matter (beside liquid, solid and gas) which is formed by free electrons of atom that form inert gas. Nitrogen is used as a source of gas thanks to its ability to oust oxygen from the surface of he skin. This way we can avoid heating of the skin, burns and creation of scars. Nitrogen is not inflammable, therefore there is no risk of sparkle or explosion.
Plasma causes controlled thermal damage of the upper layer of old skin and stimulates creation of collagen fibers and therefore creation of new skin. There is no direct contact with the skin, however the thermal energy is transported right into the tissues.
Plasma skin regeneration – PRS uses portrait device.
The Portrait device is formed by radiofrequency generator that makes inert nitrogen gas, which is then placed into the adapter with a jet at the end in form of millisecond stream right on the skin. Immediately after the contact with the skin the energy changes into heat that won’t damage the epidermis. Plasma appears as a characteristic heat/flame, which changes in yellow light. The distance between the jet and the skin should be approximately 5 mm, in case of high energy the distance should be 1 cm to prevent creation of border lines. The pulse should flow in one direction not from left to right. The area and depth of the thermal effect depends on the selected energy and the size of adapter. The energy can be selected between 1 – 4 J per pulse. This technology can be used for different selected energies, that is associated with the depth of the treatment.
Peel of the epidermis to heating into depth is possible.
The resurfacing of the skin with the usage of plasma has 4 recommended schemas of treatment:
It is mainly used for facial skin rejuvenation: wrinkle removal and general skin lift, removal of odds and unwanted pigmentation. Also for rejuvenation of skin on the neck, chest and back side of hands. The portrait device can treat also areas around mouth and eyes.
Local anesthesia was used with the combination of anesthetic cream, which was applied on the treated area. At present usage of the cream is sufficient, although its application must have the right timing, i.e. it must be applied only on small areas and stepwise on the others according to already finished treatment.
Care after the procedure of skin regenaration with plasma is minimal in case of usage of low energy. In high energies it is relatively simple. You should avoid sun exposure and apply sensitive cream on the treated spots frequently after the procedure during the healing process of the skin.
In case of usage of low energy the redness of the skin stays 2 – 3 hours. When using high energy redness and rough skin appearance is visible. The healing process takes 5 – 10 days, during this period the old epidermis peels away. It is important for the patient not to peel the skin by her/himself and wait until it separates. Not to intervene in the process of healing.
Redness and itching several days after the procedure is common. Itching can be avoided by application of ice on the treated spots. Creation of scabs can appear in case of usage of high energy. A sensitive lotion is good then. Dark spots on the skin might appear caused by low or high energy, they usually absorb within several weeks or months.
The price ranges from 5000 – 35000,- CZK depending on the size of treated area and the intensity of the procedure.
The treatment of dental caries still represents for years a traumatic process for many patients. The fear from the treatment with dental drill leads the patients to avoid the visit at the dental office till it comes to painful complications caused by not treated decay.
Fortunately the same as in other medicine branches happens even in stomatology, the development and application of new technologies. A revolutionary innovation that shows new way of the treatment is the usage of laser in stomatology.
So called tooth drilling is always followed by factors that cause pain, such as vibrations, pressure, warm, that are part of the classic treatment. Laser works as a touchless device so that these factors are eliminated and this enables minimum pain or even no pain during the dental caries treatment.
Another less pleasant treatment is the removal of dental calculus from the visible part of the tooth as well as the parts of teeth that are hidden from the eyes of attending dentist. The principle of deep subgingival tartar removal is based on reaction with the use of fluorescent ray that first takes a look under the gums and then based on this evaluation the tartar is removed by laser.
Laser finds its use in stomatosurgical procedures there, where earlier served the scalpel as the only one device to solve problems. There it reduces the complications that were often followed by these procedures, such as greater soreness, bleeding or swelling. It represents for example facilitated way of erupting wisdom teeth.
Laser helps even to heal such problems like aphthae and herpes. With laser application the time of healing is shortened, by cessation of the wet wound surface, by liquidation of germs and by removal of small nervous endings in the wound that are the starter of these signs.
First place in the Czech Republic, where this new KEY Laser 1243 is used, is Laurea Clinic.
He did not want to be described as an exceptional specialist. But he convinced me in almost every sentence that he really is one. Doc. MUDr. Jan Měšťák CSc., speaks not only about plastic surgery…
Can you describe your way to plastic surgery? Why have you decided to work especially in this branch?
The way began in my childhood. I wanted to study a special school for hotel services in Mariánské Lázně, but it was not possible, so my parents put me out to apprenticeship at the Institute of Physics belonging to the Academy of Sciences. It was a very small enterprise, where we did many beautiful things in designing development shops. I was able to learn much about fine mechanics, which later proved to be very useful to me. I did blue collar work for five years and got to know many teams. Then I understood that it is not important whether you have a degree or not. There are many bad doctors with degrees and many highly skilled people without qualification. At that time I studied a night-school, practiced dancing and played volleyball almost professionally. I got to know that it is possible to manage many things at the same time and do them quite well. The real way to plastic surgery began with experience from the Clinic of Plastic Surgery at the VinohradyHospital in Prague. The head nurse took me, a future student of medicine running in overalls, in affection and asked me to do small repairs in the ward. There I met children with cleft palates and other defects, talked to them and learned about plastic surgery. It helped me to make the final decision.
You were awarded by a Commemorative Medal for Merit for development of plastic surgery in Slovakia and you are a holder of a Patent of Invention on the field of plastic surgery. Can you tell us something about your success?
One of my many activities is to lead in-service training of doctors for plastic surgery. I organize many training activities, one-day workshops and I am a member of the examining committee for medical attestations. Because my pedagogical activities were and are connected with colleagues from Slovakia, I was awarded by this Commemorative Medal.
As for my patent, I got it from the Ministry of Industry and Development approximately ten years ago together with Dr. Babinec for so called imbibitory gel sticks used in plastic surgery. After implanting this gel into the affected place, the gel absorbs water and its volume increases. In this way it is possible to deal with some aesthetic and post-accidental situations. My contemporary work is similar but with a much wider application in plastic surgery. I have to mention again how grateful I am to have experience on the field of fine mechanics. There are many other examples proving it. Naturally, I work on operational procedures as well.
Is there a branch of plastic surgery you are specialized in?
Generally, plastic surgery means dealing with different congenital or acquired defects, post-traumatic and post-operational situations, reattachments, it means reattaching of limb parts separated by an injury, large defects after removing epithelioma or other tumors, burns or aesthetic defects. At the beginning of my clinical practice I dealt with almost all problems, later I specialized in facial clefts. Nowadays, at the Clinic of Plastic Surgery of the First Faculty of Medicine at the Charles University and University Hospital Na Bulovce, which I lead, one of the main programs is dealing with surgical treatment of breast cancer in case of women, with an immediate or subsequent breast reconstruction after its removal.
It is necessary to mention, that there are women in the population, who have frequent cases of breast cancer in their families, which means a high potential risk for them. We have introduced a program of removing mammary gland and an immediate breast reconstruction. The woman can be at ease, without fear to get breast cancer tomorrow, in a week or in some months. Although this is our priority, we deal with other types of operations as well, for example congenital defects of hands, genitalia, different tumors. I would say there is almost no surgical field, which could work without cooperation with plastic surgery. I tell to young surgeons that this is the base and the aesthetic surgery is just at the end of the whole branch.
You mentioned reconstruction of breast after its removal in case of tumor. I came across a study analyzing the value of this demanding operation in case of an ill woman with a very negative prognosis. What is your experience with women in these types of operations?
For me there is no question. I know from my experience and from the experience of my colleagues that the reconstruction of breast is very important for the woman. I operated one young woman with an advanced stage of breast cancer. Neither the oncologist nor the specialist in breast scan recommended a breast reconstruction. The woman came one day and told me she did not want to live without the breast. I consulted the case with the president of the ethical committee of the Medical Chamber and she recommended a consultation with a psychiatrist. This consultation proved the necessity to do the reconstruction. The woman lived six more years. The six years were important for her. It is interesting how often it is not so important for these women whether the primary operation of breast removing was done properly, they are much more interested in the result of breast reconstruction. The loss of a breast is always a very difficult handicap for a woman, so these operations are more than meaningful for us.
Is it possible, in the wide range of treatments you do, to specify the percentage of aesthetic operations and reconstructive operations?
It is sometimes difficult to find the real border between cosmetic an other defects. Among the cosmetic defects belong for example too large breasts, which represent also a burden for the health of the woman – they cause headache, pain of the backbone, skin problems etc. It is however possible to say that the University Clinic specializes more in the general plastic surgery and the private clinics more in aesthetic surgery. Naturally, cosmetic defects are treated at the University Clinic as well.
What is the influence of media on the concept of beauty?
There is certainly an influence and with an increasing number of departments of plastic surgery, it is possible to deal with problems which were insolvable in the past. In my work, I meet women more frequently, it is possible to say that 94% of my clients are women, mainly because women are more sensitive in the approach to their look. Nowadays, there are however also many men, who are concerned with their looks. Women concentrate mainly on dealing with congenital defects, for example small breasts or large nose, as well as problems caused by the ageing process. Some congenital defect can represent a life-long problem. I met a sixty-eight-year old woman, who had suffered from a strange nose shape since her childhood and asked me no sooner that at this age to operate her. The increase in cosmetic operations is obvious.
Don´t you think that aesthetic operations damage the originality?
You may be right, I as a man would not undergo a cosmetic treatment. There are many people, who are interested in the same sex and that´s why they want to change themselves. This is more frequent in case of men than women. Each person has got a different sensitivity. Some women do not care whether they have lost a breast, for others it is a most crucial issue. The result of an operation must be natural, that is very important. It is incredible, how much can some operations help the women, give them strength, self confidence, improve their marriages. Some originality may get lost, but the identity must remain.
What are the most frequent motives for women who decide to undergo a plastic surgery?
It should be never caused by a man. The woman must want the change herself. I know cases of women who do not want to put off their dresses in a changing room where there are more people, because they feel ashamed of their small breasts. The first period which causes dissatisfaction with own body is the puberty. Later, after the woman gives birth, the body changes naturally and many men criticize openly these changes. The woman loses self-confidence. Sometimes there are women, whose husbands had left them, and they can be helped by the operation. An other motive can be a job, women need to look good.
What does your ideal woman look like?
During my residences abroad, I met beautiful blond women in Scandinavia with blue eyes and when i returned home i saw our Czech women. They were marvelous. So i can´t say. There are women who are not so beautiful but give you the impression to be the most beautiful of all. So i don´t classify. Even during the beauty contest there are many girls which are not interesting for you and there may be one whose beauty can be striking.
In what ways is Czech plastic surgery exceptional, what can it offer to the world?
I have experience with many work places and I know about our positive and negative sides. Important is above all academician Mr. Burian and many of his followers, who brought our plastic surgery to a high standard. I would like to mention Prof. Fára, Karfík, Bařinka and others.
When I consider it all and see your hands, I tell to myself how skilled they must be…
You need to have not only a sure and strong hand but also a lot of experience, which enables us to do our job with good results. As I have mentioned before, during many operations and during my work on the clinic, I use the skills and experiences of a fine mechanic with much gratitude.
In your opinion, what is the base of success?
Success can be individual and collective. Individual success is based on diligence, discipline, strong will, ability to overcome difficulties, anticipation and inventiveness. Here I gained experience on the field of sports, because i belonged to the best junior volleyball players in our country. I know there were some more talented players than me, but they did not have the motivation, determination and will. Unfortunately, because of lack of these qualities, many extraordinary people are not successful in sport or in their jobs. The secret of being successful lies also in the ability to distinguish important things from unimportant, useful from useless. I can compare it to a game of chess, where not the first or second moves are important, but the next. The success of a team depends on its proficiency, quality of human relations and discipline as well. Good interpersonal relations and complying with real and convincing goals are one of the most important motivating aspects of success. In my opinion, the success on the field of plastic surgery really depends on the surgeon´s ability to establish patient´s confidence in the doctor and the results of the operation. My long-time experience confirms this.
Where do you see the limits of plastic surgery and which way should this branch develop in future?
Someone has recently asked me about transplanting skin from the face of one person to another. My ethical opinion is clear. I think if someone met a person with a part of his deceased relative´s face, the emotions would be very strong. Next development of plastic surgery should use rich contemporary experience and develop them further. I always tell to young doctors, they should not attempt to do heroic operations which are connected with a high risk. I see clear limits in sobriety and caution.
Is it possible to say that the limits of plastic surgery are defined more by ethic constraints than by technical possibilities?
Definitely. And it is always necessary to practice medicine regardless of money. For me, money is always only an aid to please other people not myself. Even in the case of plastic surgeons, medicine must be more important than money.
Do you suppose that maybe in 20 years the treatments will be different, because of technical development or different materials?
The hand of the surgeon is always the same. This is the main tool and it does not change. Over the years, there has of course developed a much wider range of available operations. Nowadays we have started to use a robot for operations, but the base, the skill, it remains. I believe that many operational procedures will remain. We will use more microsurgery but I don´t expect crucial changes.
Sometimes we hear that aesthetic surgery is somehow redundant, that it does not „save lives…“. What makes the aesthetic surgeon feel satisfied, apart from reconstructive surgery?
It would be a big mistake to think that removal of cosmetic defects by a plastic surgeon is less important than dealing with some congenital defects. We know very well how important is reconstruction of a breast for a woman after a breast cancer operation. Similar is a natural enlargement of underdeveloped breasts or treatment of a large nose, which makes the person feel ridicule. The biggest reward and delight brings me the happiness and joy of a woman, whose life has changed and improved. Other values, even the material ones, are unimportant for me at the moment.
People, who suffer from excessive sweating, have a big social disadvantage. Excessive sweating is caused by abnormal function of sweat glands. It effects mostly limited skin parts as palms, armpits, soles or lumbar region, groins and nape of neck.
Excessive sweating in some parts of body (focal hyperhydrosis) mostly does not have an immediate cause, there are however several contributing factors as wrong diet, anxiety states, depressions etc.
The botulotoxin treatment can be also used to remove mimic wrinkles (ex. wrinkles on the forehead, between the eyebrows, round eyes etc.)
To reduce excessive sweating, type A botulotoxin (trade names are Botox and Dysport) is applied to the affected area with the help of a very thin needle. A very diluted solution is used for the treatment, a small amount of this solution is applied to the skin of the affected area, approximately one stab in 1 square cm.
The principle of botulotoxin effect consists in preventing to transfer impulses of nerve fibres to the sweat glands.
During the first consultation, discuss your expectations openly with your doctor.
The doctor will probably ask you about your anamnesis and present-day state of health. He/she will also define places for the application of botulotoxin, with the help of special measuring instrument.
The treatment is not severe and does not require anesthesia. It is said that it is less painful than blood taking. Anesthetic ointment can be used in case of people who are extremely sensitive to pain.
Reduction of excessive sweating is done without residential treatment, it means you can go home thereafter.
If the treatment was done on your head, you should not bend the trunk forward of lie down for 4 hours. You should not touch treated places for at least 24 hours, thereafter it is possible to touch them gently and wash them delicately.
What is the result of reduction of excessive sweating with the help of botulotoxin?
The effect of botulotoxin starts to appear gradually in 2-10 days. It almost stops the function of sweat glands. The effect is always individual, it lasts 7-12 months or longer. For longer effect, it is necessary to repeat the whole treatment.
The time and the gravitation cause our skin to get loose, there are more wrinkles, pigment stains and other symptoms of ageing process. Photorejuvenation is an excellent method to gain a considerably younger look.
Photorejuvenation is a collective title for various procedures with similar effects.
The main principle of this method is thermal disturbance of collagen in the skin. The result of thermal disturbance of collagen in the skin is activation of healing process and release of substances, which influence regeneration of skin cells. The cell activity is stimulated and new collagen fibres develop. The skin strenght and elasticity improves.
To other effects of photorejuvenation belongs disappearance of pigment stains and tiny veins, filling of small wrinkles and scars and general improvement of skin quality.
Photorejuvenation is a very gentle treatment, that is why it can be combined with chemical peeling, other laser treatments, application of bulotoxin, skin implants and it is possible to undergo it after operational treatments.
We distinguish two main techniques of photorejuvenation, ablative resurfacing and non-ablative photorejuvenation.
Non-ablative photorejuvenation is a less invasive treatment than ablative resurfacing.
This method uses so called ablative lasers, for ex. Carbon dioxid laser and Erbia laser. These lasers cause gentle evaporation of skin layer, which leads to skin regeneration.
This procedure is used mostly to treat scars after smallpox or acne or to smooth out deeper wrinklesaround eyes and on upper lip.
It is a gentle warming of dermis with low doses of light energy. The source of energy can be either pulse light, pulse pigment laser or diode laser.
This warming causes stimulation of cells which produce collagen fibres. The process encourages new development of collagen, smooths out little wrinkles and the skin stretches out.
The light energy is partly absorbed in dilated facial veins, it causes their sealing and subsequent disappearance after few weeks.
The non-ablative photorejuvenation can cause improvement of facial pigment stains as well.
If you suffer from chappy skin on the face, wrinkles, scars after acne or smallpox or pigment stains, you can be a suitable candidate for photorejuvenation. It is however necessary to have realistic expectations and realize that photorejuvenation does not bring such radical results as treatments of esthetic surgery (ex. face-lift).
During the first consultation, the doctor is going to talk to you about your ideas and expectations. He shall check the condition and elasticity of your skin.
If your wrinkles are too deep and skin too loose, the doctor can recommend a combination of photorejuvenation with an other type of treatment or a more radical procedure, for ex. face lift, to achieve the bestpossible results.
The doctor will provide you with all instructions concerning the skin care before and after the treatment.
The treatment is almost painless, but the doctor can use local anesthesia in a form of a anesthetic ointment.
The treatment is very fast. Immediately after the laser treatment, the skin is slightly red and oozes.During this time, it is necessary to provide your skin with a special care, for ex. application of cold compresses from sterile water and ointments.
The complete healing after laser treatment comes after 7 – 14 days.
It is necessary to protect the treated surfaces against sunshine and use cremes with a high UV screen (40 – 120) for minimum 2 months. No other measures are necessary.
The results of ablative resurfacing are excellent. Your skin can look 5 – 10 years younger.
If you have undergone non-ablative photorejuvenation, you can count on very good results, improvement of the features of skin surface, disappearance of dilated veins and pigment stains. The impact on deep wrinkles is moderate. Best results has the smoothing out of wrinkles around eyes.
To achieve best results of the non-ablative photorejuvenation, it is necessary to undergo approximately four treatments in a period of minimum 6 weeks. The final result can be assessed in ca 3 monthsafter the end of the treatment.
Photorejuvenation has long-term results but does not prevent other ageing of skin, development of new dilated veins or pigment stains. After some time, you may feel the need to undergo photorejuvenation for the second time.
Temporary trend – an effort for perfect body – forces women to pay attention also to parts of their bodies that are mainly fully hidden from the eyes of public. For last few years the plastic surgeons have come up with aesthetic modifications even in the most intimate places – external part of female genitalia.
The female external genitalia consists of vaginal opening, urinary opening and a peak with many sensitive nervous endings – clitoris. This whole part is on sides covered with gentle skin folds of tissue – the inner lips (labia minora) that come together right in the area of clitoris. The female external genitalia is on sides covered with bigger skin folds with fat cushions – the outer lips (labia majora). The outer lips usually cover and close the external genitalia. Sometimes it happens that the labia minora grows into bigger size or length and thus they can protrude between the labia majora. Mostly this overlap is not too big so it doesn‘t cause any discomfort neither aesthetically nor functionally.
If the inner lips protrude too much they can cause discomfort in aesthetic way and also in everyday life. Sometimes it is difficult to fit this abnormally enlarged labis into tight underwear or swimsuit, not even mentioning underwear of “tanga“ type, sometimes it can cause discomfort by sport activities – for example bicycle riding. It can also cause some problems with intimate hygiene and this “defect” can represent also a psychic obstacle during the intercourse. The labiaplasty is then effective with good results. Sometimes the plastic surgeon can meet the request for modification or reduction of outer lips, although these procedures are performed relatively rarely. Sometimes there is even request for hymen reconstruction surgery that can also be performed.
Relatively frequent request for modification or reduction of vagina is although already part of gynecological procedures.
As a necessary condition for the procedure is an adult patient. Another necessity is thorough consultative examination with plastic surgeon when the patient gets not only the examination itself but also detailed instruction how the surgery will be performed and what is to be expected. In most cases the patient can agree on her requirements for size or shape of the operated area with the plastic surgeon. The date of the surgery should be then scheduled so that the patient will be operated shortly after the ended menstruation. The plastic surgeon has to instruct the patient also about the need of right intimate hygiene in the period after the surgery.
The labiaplasty is performed almost always under general anaesthesia, on the operational table in gynecological position. The surgeon measures precisely the direction of surgical incisions before the surgery so that the final scars will not be visible and mainly that they will not make any discomfort to the patient. Great attention should be paid to the area of clitoris so the gentle nerves that give special sensitivity to this area will not be corrupted.
Beside very gentle and careful work it is very necessary to cease the bleeding during the surgery. After the modification very tight and also gentle suturing of surgical wound is necessary. To stitch the wound various types of suturing material are used, sometimes absorbable othertimes nonabsorbable (such sutures have to be removed after the wound is healed). Which suturing material is used depends always on the plastic surgeon and his/her experiences. The surgery takes according to the size of the procedure around one hour and is not especially difficult to the patient. Also soreness after the procedure is normally not big, the patients mention only unpleasant but not that strong burning in this area.
The patients after the labiaplasty usually go home next day after the surgery. It is good to stay calm in the next period for about one week, to avoid long sitting, including long car drive and to have the opportunity of perfect hygiene several times a day. We recommend showering and washing with a soup for intimate hygiene or with good and gentle antiseptic soup after each visit of the toilet and to cover the area with pad.
Although some patients heal better if the wound is left on countrary totally uncovered or “free“. The operated area get relatively often quite swelled, but usually the swelling disappears after several days. It is better if you are regularly checked by your surgeon. In any case you should know that the healing process takes minimum 10 but mostly 14 days, sometimes even more. Smaller swelling can stay even for longer time and the operated place gets its final shape approximately after 6 weeks, after this period the patient can start with her sexual life again.
The labiaplasty brings almost always very satisfactory results to the patients. Of course it very much depends on the experiences of the plastic surgeon, so that he/she is able to avoid possible complications that are nevertheless not too common. It also depends very much on the cooperation and discipline of the patient so that she can fulfill all the recommendation in the period after the surgery.
Some doctors – sexologists – don’t like these surgeries too much, they are afraid of possible reduction of sexual sensation in operated women. The experience of last years, when labiaplasty has been performed here, the opposite has been seen. Women who undertook the surgery mention mostly improved sensation during sexual intercourse. Also that by the surgery their psychic problem of their genitalia appearance is removed contributes to global relaxed and improved experiences in their sexual life.