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madelidowell-blog · 5 years ago

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Since first introduced to the medical community

as a treatment for eye muscle disorders, administering of Botulinum Toxin Type A: Botox and similar neurotoxin injectables, has now become the most popular non-invasive aesthetic medical procedure performed worldwide. However, as physicians strive to make aesthetic medicine procedures more comfortable for their patients, a "cold war" of sorts has emerged regarding the use of topical anesthetic and ice during injectable procedures.

Through a survey of expert practitioners the following "best practices" for the use of topical anesthetic and ice emerges.

The critical factor to minimizing discomfort and bruising is technique. However, based on a patient's tolerance, Buy bocouture 50iu online topical anesthetic can be used to minimize, but not extinguish, the pain associated with subcutaneous injections. Ice is generally considered the best tool to minimize bruising. Other tools in the physician arsenal to minimize pain are size of needle (32 gauge is recommended) and ensure minimal volume is injected (e.g. dilute the Botox at 2.5 cc per bottle =4u/.1 cc). Finally, for a select group of physicians and patients, ice and topical anesthetic completely take a back seat to a "gentle" hand.

Proponents of Ice and Anesthetic

Dr. Mauro C. Romita, Specialist in Aesthetic and Reconstructive Plastic Surgery in New York, shares that "for Botox I typically use iced gel packs which hold the low temperature well and don't melt. Further, "they may be able to be chilled slightly colder than regular ice, but ice is already cold enough."

"If one leaves the cold pack on long enough the tissue chills very well, so much so, that the patient finds the cold intolerable. That's the ideal time to quickly inject the Botox which should only take a few seconds to inject in small volumes. The ice chills the dermis and subcutaneous tissues, which topical anesthetics do not. I use topical BLT anesthetic (benocaine, lidocaine, tetracaine), with cold packs only in a very few patients who are extremely intolerant of any discomfort, as it minimizes the discomfort of the 32 gauge needle at the skin level only. The cold usually does this well enough for 90% of my patients. A minority of patients don't like the feeling of ice packs and just take the Botox 'straight'."

Moreover, "ice compresses put the tiny vessels in spasm and make them harder to injure especially in the glabellar area. Unfortunately, this doesn't apply so much to the veins at the lateral orbicularis."

Finally, Dr. Romita offers this final best practice. "I dilute the Botox at 2.5 cc per bottle =4u/.1 cc so the volume injected is minimal. This helps make it more comfortable."

Dr. Richard Foxx, founder of The Medical and Skin Spa in Indian Wells, also sees the value in the use of topical anesthetic. Dr. Foxx has "adopted the technique of using a topical anesthetic (and giving it enough time to work)" and afterward, begins the pre-injection consultation. "Whether a repeat patient or a new patient, I apply a topical anesthetic and leave it on for about 15 minutes....then begin injecting. I ask the patient to move their muscles and then makes appropriate marks with a white pencil." Furthermore, prior to injecting Dr. Foxx applies a small packet of ice for 15 seconds or so to each area.

Gentle Technique Can take the Place of Anesthetic

Dr. Louis DeLuca, a treatment leader in aesthetic medicine and plastic surgery options in Boca Raton, has found that he has been disappointed with topical anesthetic creams and ice application. "I provide my patients with ample warning before each injection. I touch the area where the injection will be placed and count 1-2-3. Just like the Pediatrician. Nobody likes surprises in the doctor's office. Over the past five years I have had maybe 1 or 2 patients who have requested ice application," attests Dr. DeLuca. "Be gentle with your technique and the patients will have a remarkably comfortable experience."

Furthermore, rather than using ice to minimize bruising, Dr. DeLuca suggests that these tactics work equally well. "Avoid superficial veins (particularly around the eyes...the sentinel vein is a nuisance) as this will lead to excessive bruising. Also, apply direct pressure to the injection sites to minimize post-injection bruising. This absolutely works!"

Dr. Jennifer Linder, Dermatologist, Chief Scientific Officer for PCA Skin and faculty member of the IAPAM, echoes Dr. DeLuca's insights. Dr. Linder finds that "talkesthesia" works well, and she recommends, "keep the patient comfortable and relaxed, tell them before you are going to do any thing, and apply pressure near the needle as a distraction." "I occasionally use ice to vasoconstrict and for anesthesia. If you apply the ice to another area with the assistance of a nurse that can also work well as a distraction. I find most patients do well with cues for relaxed breathing, squeezy balls, tiny gauged needles and 2 cc dilution of Botox. I rarely use topicals for Botox but I always use it for fillers."

In Both Camps

Of course many seasoned physicians find the use of anesthetic and ice is entirely "patient dependent."

For example, Dr. Nathan Mayl, a respected leader in the Fort Lauderdale Plastic Surgery and Cosmetic Medicine field, offers this insight on the companion uses of ice and topical anesthetic.

"I am actually in both camps regarding how to do Botox as well as other spot treatments. I will use both topical and ice for my admittedly "wimpy" patients. They love it. However for the average patient I use ice, but in a special way. We place a single half moon shaped piece of ice into the finger of a glove and hold it in place until the patient says 'cold'. This gives targeted anesthesia and vessel spasm with minimal discomfort (and perhaps less bruising as well)."

Dr. Douglas S. Steinbrech, renowned plastic surgeon in the Manhattan area, concurs. "I like to give my patients a variety of options. Most people prefer ice, while second most common is people requesting anesthetic cream, followed lastly by the "toughies" who don't want anything. Some of my patients have a higher tolerance to the needle and a cold sensitivity to the ice which they don't like. Also, many busy people don't want to wait 20-40 minutes for the anesthetic cream to work."

"I like to use the ice because it is immediate and I find that the topical cream EMLA (Eutectic Mixture of Lidocaine and Prilocaine) takes longer." Moreover, "the ice causes vasoconstriction of small arteries and veins which diminishes the chance of capillary disruption and subsequent bruising."

Dr. Steinbrech also offers this "best practice" to ensure a comfortable experience. Like Dr. Romitra, Dr. Steinbrech finds the "key is small needles. I use 32 gauge, which are tiny," and minimize discomfort significantly.

Dr. Thomas Sterry, a board-certified plastic surgeon in New York City generously shares his expertise. "If I'm using Juvederm or Restylane, I prefer to give the patient a block or to mix the product with local anesthesia. For Botox, you can't do that, and I do want my patients to be as comfortable as possible, so I do have patients who decide to use the BLT topical anesthetic. I give them an ice pack but I really don't know how much it helps. What I've done that I think has helped my patients to minimize the pain they feel during Botox injections is to dilute it with 1 cc, which means that the volume of the injection is much smaller and much more comfortable and that's really my answer to the issue of pain. Years ago when I diluted with 4 cc's, they had four times more product and that much more discomfort.

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whatthekpopofficial · 6 years ago

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Suicide Prevention Awareness: 12 Korean Celebrities Who Tragically Committed Suicide

*Please be aware that this article is a special topic for September, the National Suicide Prevention Awareness Month. While we are making the effort to handle this topic with care, some people may find the topic triggering. Suicide prevention hotlines and resources are listed at the bottom of this article. While this entire month is dedicated to suicide prevention awareness, September 10th in particular marks World Suicide Prevention Day. Regardless of your position or status in life, depression is something that can affect any of us. At times, depression, anxiety, and other issues can make life seem truly unbearable, even driving some people to consider suicide. This is something that can affect anyone around the globe, even famous singers or actors. Due to our love of Korean culture, it's easy to focus on the bright and positive aspects of the entertainment industry, forgetting the challenges and pain that can accompany life in the spotlight. When you add this to the normal demands of being a young person these days, it is easy to understand why some people feel so overwhelmed. In fact, suicide is the leading cause of death among Korean people in their teens, twenties, and thirties. While some advancement is finally being made concerning mental health issues in Korea, there is still a long way to go. In order to bring awareness to the rising number of suicides in Korea and around the world, we wanted to talk about some of the most famous celebrities who have chosen this tragic method of coping with their personal issues. We also want to encourage you that you should reach out for help if you're feeling suicidal or know someone who is. If we can assist in any way at WTK, please let us know. Last year, we lost one of our staff members to suicide. As such, suicide prevention is a topic important to our hearts. For further resources, we would also like to refer you to the radio broadcast we held in honor of SHINee's Jonghyun. The broadcast is divided into different segments, when one segment dealing specifically about what to do when you or a loved one is feeling suicidal. Click here to listen to the broadcast. You can find the different topics and their time stamps in the description of the video. In the meanwhile, let's look back at some of the notable cases of suicide in Korea. We remember these lives and mourn their loss after they succumbed to such a horrible thing. Suicide itself is 100% preventable, and we encourage you to reach our for help today! Park Yong Ha (1977-2010)

If you’re a hardcore drama fan, you will have seen this guy somewhere. Park Yong Ha debuted in 1994 and rose to fame in the early 2000s with Winter Sonata, the famous drama co-starring Bae Young Jun and Choi Ji Woo. He became a hit actor and singer in both Korea and Japan. After the successful drama A Man’s Story and his movie The Scam in 2009, the actor was scheduled to star in Comrades in July 2010. Sadly, however, he didn't make it that far. Speculations still surface as to why a successful and well-known actor like Park Yong Ha would make that choice. Some said he was under too much stress after he started managing his own company, others claimed the news of his father’s malignant cancer was the reason, and some simply cried depression. Whether one or more of these reasons contributed to the decision, no one will ever fully know what went on in the mind of the 33-year-old actor. Lee Eun Joo (1980-2005)

Steadily making a name for herself as an actress, Lee Eun Joo killed herself after leaving a note apologizing to her mother for her decision. The actress appeared in many popular films, including Bungee Jumping of Their Own and The Scarlet Letter. She was young and full of potential. So, why? Was it depression? Was it "insomnia after her nude scenes in The Scarlet Letter" as some people claimed? No one will ever truly know. U;Nee (1981-2007)

This beautiful and promising young woman debuted in 2003 as a dance-pop singer. With her debut album, she instantly become well-received by both fans and critics alike. The young artist was also a rapper and went on to make her acting debut as well. A normally shy person, her label soon wanted her to transition into a more sexy genre of music, pushing her to get plastic surgery and changing her looks. Although it wasn't determined that she suffered from depression until after her death, things she had written on her social media page later came to light that indicated she felt overwhelmed and without purpose. After attending a church service in the morning, she decided to take her own life at the age of 25. Ahn Jae Hwan (1972-2008)

Money issues— including a failed business and debtors storming in— was thought to be the reason behind Ahn Jae Hwan’s death. I watched him in Sunflower, and he was one of the few things I liked about the show. The rising star killed himself by carbon monoxide poisoning while sitting in his car, first leaving an apology note to his newlywed wife. What makes this so sad is that the actor wasn't found for several weeks, leading people to wonder what took his loved ones so long to find him. Kim Jonghyun (1990-2017)

On December 18, 2017, beautiful and talented artist Kim Jonghyun of SHINee made the decision to end his life. A person who had been very public with his long-term struggle with depression, he left behind several texts and notes that gave a glimpse into his mental state at the time. Asking his sister to tell him he did well and explaining to a friend that he just wasn't supposed to have been a celebrity, he talked about his "devouring depression" and feelings of hopelessness. A beautiful soul who had touched countless lives with his music, art, writing, and more, Jonghyun's death was one of the most shocking and high-profile suicides among Korean celebrities. Jeong Da Bin (1980-2007)

Most famous for Rooftop Cat, Jeong Da Bin committed suicide in the bathroom of her boyfriend’s apartment. The boyfriend stated that Jeong Da Bin was depressed because of lack of work, imprisonment of her manager, and cyber attacks on her appearance. With only the boyfriend's words to go on, no one will ever truly know what motivated this lovely young lady to take her life that day in his bathroom. Kim Seok Hyun (1979-2009)

After getting a late start in his career, Kim Seok Hyun played minor roles in few productions on TV. You might recognise his face without being able to recall exactly where you know him from. At the age of 30, he took his life in his own home. Again, all that was left after his suicide were speculations on what led him to take this extreme measure. Many said it was due to depression from lack of work, but the public will never know. Jang Ja Yeon (1982-2009)

Remember the three bullies in Boys Over Flowers? Jang Ja Yeon was one of them. She landed a CF and few other offers because of the popular drama. She was described as a rising star— beautiful and talented. Then, seemingly out of nowhere, she committed suicide in her family's home. It seemed to be a result of depression, but this time, a sponsor scandal was also involved. In other words, it was said she was being sexually abused by the rich investors and executives of her company due to her "slave" contract. The actress left a long letter before her death, naming the culprits and mentioning that they had physically and sexually abused her under the permission of her agent. The reason behind her suicide definitely sounds plausible, but we may never know for sure as the truth never fully came to light. In the end, only the life of a poor young girl was snatched away. Meanwhile, the agent is still alive and prospering. Woo Seung Yeon (1983-2009)

Failed auditions, anxiety, and depression are what led to the tragic suicide of this young star. In fact, she was already receiving treatment for depression. The ironic part is before her suicide, she sent her sister a message that said, "I’m sorry." She uploaded the word "goodbye" to her personal page and changed the background music to a song called ''Sorry." Her family knew she was getting worse and said so. Sadly, it seems that Woo Seung Yeon knew she needed help, but when that help didn’t arrive, she simply gave up. Roh Moo-hyun (1946-2009)

This low-income farmer was inspired to become a human rights laywer who would eventually even serve jail time as he faced against the powerful to fight for the average men. As such, it should come as no surprise that this man would eventually turn his eyes to politics in an attempt to change his world. He eventually was elected and served as the South Korean president between 2003 to 2008 and gained great popularity among the younger generation in particular. Politics aside, it wasn't until he had retired and was living a quiet life that someone brought up some suspicion that he had accepted a bribe in the past. The charge ignited an investigation and brought him into media's scrutiny in what his own party denounced as unfair and politically-motivated. Suffering from poor health already, the former politician decided to take his own life, leaving behind a note saying that he couldn't face the future and asking people to not blame anyone else for his death. Choi Jin Shil (1968-2008)

Choi Jin Shil will always be named as an iconic actress. "There was no other talent like hers," many people have stated. She starred in many films and drama and was called "The Nation’s Actress." However, her personal life was not easy. Her road manager died. She got married, but her husband turned out to be abusive. She filed for divorce and went through a public custody war, losing sponsors as a result. Her friend Ahn Jae Hwan (included earlier on this list) then committed suicide, and she was even accused of being involved in that. Things got really dirty and it was hard to cope with all of this in the public eye, so she opted out of the situation by choosing suicide, leaving behind her two young children. Tragically, her high-profile suicide resulted in a temporary rise in suicides in Korea for the month after her death. Approximately 700 more people killed themselves in that month than in previous times. The entire tragic situation led the South Korean government to take a stronger stance against malicious and libelous comments from netizens since it was found to have been such a factor in Ms. Choi's suicide. Choi Jin Young (1970-2010)

Choi Jin Shil’s younger brother gained interest from producers because of the fame of his sister. He landed a small role or two, but people eventually lost interest in him as an actor. As a result, he fell into severe depression. He unsuccessfully attempted suicide a few times, but less than two years after the death of his sister, he managed to succeed. He did not blame his sister or his family, but constantly being compared to a highly successful sibling is definitely not the easiest way to live. My humble psychological analysis is that Choi Jin Young had lived completely under the dome of his sister. So when she committed suicide, he couldn’t go on and did the same. He even chose the same suicide method as his sister when he ended his own life.

Some readers might be wondering, "What can we do about it? Why are you telling us this?" Simply put, we can all do something. When we have opinions that aren't so nice, we can keep them to ourselves. We can report the malicious comments by other internet users. We can help clean up the negative comments and prevent whatever terrible effect it has on celebrities. After all, they’re people just like us and each one struggles with their own issues that are often compounded by hateful, mean comments. More than anything, just take a stand when you see malicious comments online since those comments can be such an emotional and mental strain on celebrities. While these beloved celebrities succumbed to suicide, many more have been able to beat it! Celebrities like Brian Joo, Lee Sang Min, SHINee's Key, and many more have all admitted to self-harm or suicidal thoughts. In addition, several of our own staff members at WTK are also attempted suicide survivors. If we can make it, so can you! Please know you are not alone. We should understand that depression can affect us all, but suicide is never the answer. No matter how terrible your own situation is, ending your life is not the best way to deal with your problems. If you or a loved one struggles with suicidal thoughts, please get help immediately by calling 1-800-273-8255 or chatting online with a counselor from the National Suicide Prevention Lifeline. For international suicide prevention, please view the list of crisis centers and suicide hotlines in your own country by clicking HERE. If you suspect one of your family members or friends is suicidal, click here to see a list of common signs of suicidal thoughts. You are not alone! Get help today. Let's all work together to stop suicide.

*This article was originally written by author Park Chohwa. Additions have been made by lee1086. Media: As Credited Read the full article

#AhnJaeHwan #ChoiJinShil #globalsuicidepreventionday #kimjonghyun #ParkYongHa #RohMoo-hyun #Shinee #suicidepreventionawareness #u;nee

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complexion-me · 7 years ago

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Interview : Dr Deepak Dugar , Plastic Surgeon

Dr. Deepak Dugar is a renowned Board Certified Surgeon specializing in Rhinoplasty and Facial Rejuvenation. After mastering the science of surgery, Dr. Dugar traveled the world learning the art of surgery from masters of the craft in Paris, London,Monaco, Miami, NYC and Los Angeles. Dr. Dugar is also the only Board Certified Plastic Surgeon in the United States whose entire surgical practice is dedicated to Scarless Nose Surgery.

1) Tell us more about how you became a plastic surgeon.

I have always seen myself as both a craftsman and an artist. I love working with my hands. As an Eagle Ranked Boy Scout, I began working with my hands at a young age through the art of wood working. Whether building a box, a shelf, a name plaque or picnic tables – I truly enjoyed the art of creation. Meticulous craftsmanship balanced with artistic design became a source of fulfillment for me. As I got older, I realized I found immense pleasure in helping people with problems and this desire to help people led me to medicine. Once in medicine, I found a balance in helping people with craftsmanship through Surgery.

2) Why did you decide to pursue a career in plastic surgery?

I want to say that my biggest goal is to give confidence to people who have an insecurity. I look at myself as a medical Tony Robbins. My purpose is to make you forget about and move past any insecurity you may have. We all have insecurities. Sometimes we can conquer it on our own. Sometimes we need a little help. I am here to help you conquer any insecurities so you can continue to live a fulfilled life and conquer the world! Often, I will even tell patients, “your nose looks great and is in perfect balance with your face. Don’t touch it! You don’t need surgery.” This might sound shocking from a nose surgeon, but I believe in integrity and honor over everything. I am not in this for the money. I’m in this for the passion of helping people reclaim the confidence being overshadowed by an insecurity. I look forward to helping people restore their inner faith in their own beauty.

3) Having cosmetic surgery is a growing practice among teens. There is general debate about the appropriateness of cosmetic surgery in teens and whether they truly understand the risks involved. What's your opinion on the topic?

Well first of all, Rhinoplasty is the number 1 surgical procedure performed on patients aged 13-18, and the number 2 surgical procedure performed on patients 18-29. This is no surprise because a nasal deformity can be devastating to the overall balance of the face. Teenage Scarless Rhinoplasty is a sensitive issue and topic and one that involves the family closely. There are two extremely critical factors when considering to operate on a teenager: Nasal maturity and Emotional maturity. Nasal maturity is when the nose has essentially stopped growing and the cartilage and bones are mature enough to withstand the trauma of a rhinoplasty. Usually nasal maturity is achieved by age 15+ for most noses. There are sometimes 17-18 year old noses that are still not mature physically, so it is anatomically specific for each patient individually. I usually will assess a teenager’s nose to identify its nasal maturity. Emotional maturity is even more important. I read people fast and am interviewing patients the entire time to decide if they are mentally and emotional mature enough to understand the consequences of a scarless rhinoplasty. For some teenagers, undergoing a scarless rhinoplasty can be positively life changing – it can end bullying or teasing from their peers, can increase their self-confidence and increase their awareness and motivation in life. Countless times, I have seen young teenagers grow incredible confidence post-operatively due to the insecurities of their nose now gone. Sometimes a nasal deformity can really bring on a significant amount of stress and tension on a person, young or older, and it's important not to demean it or ignore it. A conversation about it is important. One of the most powerful thingsI love to do is ironically empower young teenagers who he truly believes don’t need surgery. I boost their confidence and sometimes hearing it from a Beverly Hills Celebrity Plastic Surgeon is all they need for a kickstart to positive mentality of their beauty. Everyone is truly beautiful and no one needs a scarless rhinoplasty…but if it can help remove insecurity and instill confidence, do it.

4) What do you think makes nose jobs such a sought after procedure?

Beauty is in the refinement of the face - not change. I think nose jobs are so sought after because the smallest of changes can make the most meaningful refinements to a face. It can soften the face so it all blends well and becomes more aesthetically pleasing. If you are considering a rhinoplasty, it's important to know you aren’t alone. There are more than 220,000 rhinoplasty surgeries performed every year in the United States. But unfortunately, over 50,000 of them are revision surgeries, so picking the right surgeon the first time is extremely important. But one truth we never forget is that every nose is unique, and so should be every surgery as well. We do not believe in a “one nose fits all” strategy most surgeons practice based on the mathematically engineered textbook definitions of the “perfect anatomical nose.” We believe rhinoplasty is more art than science, and the art is about balancing your nose to your face.

5) What's the difference between an open rhinoplasty and a closed rhinoplasty?

The technical difference between an open rhinoplasty and closed rhinoplasty is that in open rhinoplasty, there is a use of an external cut along the base of the columella which is used to elevate the entire soft tissue-skin envelope of the nose. This gives superior visualization of the nose and allows easier teaching to students. This is why open rhinoplasty has become the procedure of choice for most surgeons as this is all they were ever taught. Sadly, closed rhinoplasty is a dying field I am trying to revive and continue as it is the superior option for primary (never operated on before) cosmetic noses. The main difference between open and closed rhinoplasty is PHILOSOPHY. Open Rhinoplasty inflicts as much surgery as possible to completely change the nose, whereas closed rhinoplasty performs as little as possible to preserve the character of the nose, while providing the meaningful refinement - all without the risk of a scar at the base of the nose.

Also the healing and downtime is markedly less with closed rhinoplasty. Most of my patients are back to work or school on Day 7 after surgery when the cast comes off.

Actresses, actors, models, entertainers and athletes routinely choose closed scarless rhinoplasty as their method of enhancing their nose and improving their breathing because of its obvious superior advantages over a traditional “open” rhinoplasty. With Scarless Rhinoplasty, we look at the face like a beautiful painting. From time to time, beautiful paintings need to be restored or enhanced. Just as a museum curator would never make a cut down the middle of the painting to make these restorations, neither should a rhinoplasty surgeon inflict a scar in the middle of a face when it is not necessary.

We find that most of our patients desire refinement or enhancement, rather than significant change to their noses. We aim to tweak and subtly enhance the nose, without causing the post-operative “unrecognizable” phenomena when too much has been done to the nose. You will still look like you, just the refined version. We often joke that God did a fabulous job but was just in a little rush – so we are here to help finish finessing the painting.

6) What do you think of non-surgical nose jobs and who's the perfect candidate?

I think these are grossly over utilized and has become even more grossly abused because of social media trends. The only candidates i think that qualify for this are people looking to hide minor asymmetries or mask small bumps. Remember, adding fillers only makes a nose BIGGER - it cannot make a nose smaller. So the proper candidates are actually less than you think. Using safe reversible hyaluronic acid based fillers like Juvederm, we can contour a nose to hide asymmetries or mask bumps when they are subtle and/or if the patient cannot undergo surgery or desires not to. This procedure takes less than 10 minutes in expert hands and for most patients results last 1 year with no appreciable downtime after the procedure.

7) So how would you define beauty?

I believe each person has an individual beauty. My job is NOT to change anyone. I look at every face like a painting. Like a Conservator at The Louvre for fine paintings, my job is only to enhance or maintain. I do not believe in changing. This is the philosophy I take with both noses and injections (botox and fillers). Rhinoplasty should be performed with such subtle enhancement that it could potentially fool the mother’s eye. I believe too much is “done” to noses to make them look fake or “plastic.” My biggest fear is creating a nose that looks “done” so I am always constantly engaging myself in this thought process during a nose surgery. This is also why I only perform CLOSED SCARLESS Rhinoplasty. I believe inflicting a scar in the middle of the face (as most surgeons do with Open Rhinoplasty) is blasphemy. While it is necessary in some noses, most primary rhinoplasty can be performed through a closed, scarless technique.

8) Can you please name some of the most beautiful faces of all time – in your own opinion – existing or dead.

Cindy Crawford, Adriana Lima, Reese Witherspoon, Deepika Paudikone, Blake Lively

9) Lastly, for someone who's trying to avoid getting a facelift what are your top tips?

Lasers, Fillers, and Botox on a consistent basis! People don't realize maintaining your face is just like maintaining your body. Nobody goes to the gym once or twice and expects to have a six-pack consistently.

Credits : www.scarlessnose.com

https://www.instagram.com/deepakdugarmd

#interviews

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