Lateral Brow Lift Provides Youthful Results

Introducing the lateral brow lift, a quick and easy way to improve the hooding of the eyelid without performing a blepharoplasty (eyelid lift). 

This new procedure is a miniature version of a full brow lift because it focuses on the ouside portion of your eyebrow and can provide lift to an area that tends to show age. The procedure takes about 45 minutes and raises the outside eyebrow. The incision is in the hairline and is about two inches long.

Not only is this procedure effective, it is less costly than a full brow lift. If you would like more information on this procedure now being offered to San Antonio men and women, contact Dr. Robert Young.

It's HOT! How to keep heat from destroying your skin

by Andrea L. Algar

We all know that triple digit heat can make us feel heavy, sweaty, labored, tired and in extreme cases can even make us feel nauseous, light-headed or faint, and even physically sick. But can heat affect our skin?

HUMAN SKIN
Photo Credit: medicineworld.org

Heat affects how we feel and what we do. Exposure to heat also can take a toll and effect unwanted changes in our skin. Considering that skin is our largest organ, and does more than you might realize, it's very important that we take care in our exposure to heat.

We all know that sun exposure is a danger in itself because of the increased risk of bad burns and potential skin cancer. But, we also know that it's difficult to escape the heat in Southern climates and especially here in Texas where we now have temperatures in the triple digits.

In order to fully appreciate why you need to protect your skin, you first need to know the facts about the skin you live in!

Skin is AMAZING - Facts about skin you might not know!

• Skin is the largest and heaviest organ in our body
• The average adult has 8 pounds of skin!
• Skin is 70% water, 25% protein, and usually less than 5% fat
• Skin protects everything inside your body (veins, arteries, blood vessels)
• There are 3 layers in human skin: epidermis, dermis and subcutaneous
• Skin is your body's waterproof covering
• Skin is a barrier to harmful chemicals and germs
• Skin is a shock absorber
• Skin moderates your temperature and helps keep you cool in the heat
• An adult has about 22 square feet of skin (the size of a twin bed or doorway)
• Skin helps you retain water 
• Skin produces nutrients and vitamins
• Skin helps prevent infections
• Skin is the organ primarily responsible for our sensory functions (feel/touch)
• Skin is constantly evolving
• We shed about 40,000 skin cells per minute
• Skin self-lubricates
• Skin renews itself once every 35 days
• Skin holds us together!

You can see how skin is a truly amazing and that it is a most necessary and important part of our bodies. What isn't talked about much is the damage that HEAT can do to our skin. 

Heat can rob skin of vital nutrients, making skin look older. With prolonged exposure, fine lines and wrinkles become more pronounced. With age and continued exposure, sun spots (also called age spots) pop up seemingly overnight. What was once beautiful smooth skin is now marred. It is also much more difficult to keep well hydrated.

Heat can also lead to skin problems such as heat rash. Many people are familiar with heat rash in infants and young children, but it also occurs in adults, with the same annoying bumps and blisters that trap moisture under the skin and can itch, cause peeling, and soreness as they burst open. Heat rash can occur anywhere on the body, but is most often seen on the torso, legs, back and neck areas where perspiration can accumulate and cause rashes. If your skin is prone to breaking out (acne), take extra precautions by washing skin periodically with a gentle cleanser and pat drying. Even those not prone to acne can develop a type of acne common in hot weather called acne mechanica.

To minimize negative effects of heat on your skin:

• Use sunscreen (and use it on your face and body)
• Wear protective clothing including hats and lightweight clothing
• Shower to reduce the risk of heat rash and to help keep your core cool
• Use gentle skin cleansers so your skin isn't dried out or irritated
• Gently exfoliate to release trapped irritants and remove dead skin cells
• Use facial and body moisturizers to lock hydration in following showers
• Hydrate from the inside out! Drink lots of water!
• Alternate water with fruit juices and other nutritious beverages 

Quality Sunscreens Rule!

There are a number of excellent sunscreens in SPF ratings that can help keep your skin safe. I love NeoCutis' Journee Day Cream SPF 30 with PSP growth factors (great for those who don't want to look like they're using a sunscreen). And, fantastic for those who must spend time outdoors is the ViDerm SFP 55 Sunscreen with titanium dioxide and octinoxate that provides oil-free and water resistant 98% protection from UVA and UVB rays at the same time providing EGCG antioxidants as well as vitamins A and E.

As a board certified plastic surgeon, San Antonio's Dr. Robert N. Young suggests you get in the habit of using sunscreens every day. He states, "Remember that even the best sunscreens wear off. If you're spending the day at the pool or beach, they also wash off eventually, even if they are water resistant or waterproof. Reapply sunscreens periodically and use them even on overcast days. As you age, you'll be glad you did. Women I see who have protected their skin from the damage of sun and heat age much better and have fewer complaints about their skin."

Bottom line:  Take care of your skin. Although it is forever changing and renewing itself, the damage that comes from the sun and exposure to heat can last a lifetime!

ABOUT THE AUTHOR:
Andrea Algar is an author who writes on topics that interest her. Over the last 30 years she has written articles on a variety of topics and currently contributes to several blogs on a regular basis.

10 Reasons Not To Get Breast Implants

by Andrea L. Algar

San Antonio Board Certified Plastic Surgeon Dr. Robert Young has taken a look at the Top 10 Reasons to Get Breast Augmentation, but recently he's been asked to take a look at the Top 10 reasons why women might NOT want to get breast implants.

We all can safely assume that the prominent reason women want breast augmentation is to increase the size of their breasts. The reasons they choose do so, however, are as varied as the women who get breast implants. Whether a woman chooses saline breast implants or silicone gel breast implants, and whether they choose round, shaped, textured or smooth has little to do with whether or not they decide to get them in the first place.

What Dr. Young has found is that the reasons women delay or avoid getting breast implants boils down to ten or so most-cited reasons.

Here's our list:

"Afraid what others will think" This is actually more common than you might think. Even those determined to get their breasts enhanced often worry about this. Luckily, most people are very accepting of breast augmentation and in fact most forms of cosmetic surgery. Old stereotypes just don't hold up anymore.

"I'm happy with my breasts"  Undoubtedly there may be women who actually are happy with their breasts just the way they are. Or at least it's their story and they're sticking to it!

"Husband/boyfriend doesn't want me to"  This is also more common than you may think. Even with the progress women have made, they still look to their significant other for support and understanding. It's hard to pursue a procedure when the support is not there, although it begs the question of why he does not support it. Insecurity can rear its ugly head if the partner feels you may become more attractive to other men.

"Health conditions"  Certainly this would seem a very legitimate reason. We advise women with health conditions that pose concern to talk to the primary physician they see for that condition and get medical clearance. If they feel it's okay, then you can rest assured that breast implant surgery should be okay for you. Many women with health conditions such as arthritis,

"I don't have the money"  Finances do play a big role in a woman's decision to get the breast augmentation she's been dreaming about. However, there are many options including patient financing with attractive repayment terms that can help make it affordable to women of all ages. Some get help from friends or family who are willing to help as well.

"I can't get time off of work"  Everyone has concerns these days about taking time off of work. You don't want to jeopardize your job, and you don't necessarily want everyone in the office to know that you're taking the time to get your breasts done. Most women we see take anywhere from a few days to a week or two off of work.

"I'm worried about breast cancer and whether the implants will hide something, or maybe even cause me to get cancer."  Mammography has advanced so much over the last decade, and most experienced technicians know exactly how to deal with them. They've developed techniques that don't require the implant-crushing force that old-time visits used to. They're much more comfortable, and radiologists have learned to read the exams better. Studies have shown that there is no evidence that breast implants cause one to get cancer.

"I don't want to look like a clown and be laughed at. I've heard remarks some people make." This can happen, especially when women select implants that are much too big for their body. We encourage patients to try on a variety of sizes until they find those that feel best for them. You'll know whether you're picking something that's too big or that would make you feel clownish. Just remember, there are no set right-or-wrong answers when it comes to selecting the implants that you like best. Visiting a Board Certified Plastic Surgeon who shows you what various size implants would look like on you is a good step toward a satisfying choice.

"I'm athletic and fear they'll interfere with my workouts/sports"  We've seen runners, weightlifters, body builders, cyclists, swimmers, and many other types of athletes over the years. As long as you adhere to your surgeon's advice following surgery (the recovery period), which does require refraining from physical exercise and strenuous activities, you'll soon be able to return to your routines without harm to you or your implants. For some, it can take as many as 8-12 weeks for return to all of your normal activities.

"It will be costly to replace all my clothes"  Again, much will depend on how much you increase your bust line. Small changes of 1-2 cup sizes often do not require a complete wardrobe change. And, you'll find that you'll look forward to going to the store to purchase your new bras and wardrobe items!

Why would a plastic surgeon discuss why you might not want to get breast augmentation? There are pros and cons to everything in life. We know that women don't usually take breast augmentation surgery lightly, and in fact have probably been thinking about it for many years. Weighing your options is key to your ultimate happiness with breast augmentation. Once you take a close look at each of your objections, trying to think of both the negative and the positive to each, you may find it easier to make decisions you're happy with.

ASPS Report Shows Breast Augmentation Top Procedure - Buttock Enhancement and Neck Lift On The Rise

by Andrea L. Algar

More and more Americans are opting to enhance themselves with plastic surgery and cosmetic procedures. According to a new report from the American Society of Plastic Surgeons (ASPS), cosmetic surgery procedures in 2013 were up 3% from the 2012. 15.1 million procedures were performed.

Not surprisingly, breast augmentations and nose jobs (rhinoplasty) are still the most popular surgical procedures. More surprising is how sharply buttock enhancements have risen.  Almost 10,000 procedures took place in 2013, which represent an increase of 16 percent from the previous year. 

According to Dr. Robert Young, "Breast Augmentation continues to be the number one procedure I do. The Brazilian Butt Lift is also a very popular procedure in my San Antonio Surgery Center. I've noticed a sharp increase in them over the last two years. I think women like it because you're eliminating problematic fatty areas (usually the abdomen, hips or thighs) with liposuction, while adding desired volume to the buttock." Also of interest was that neck lifts also rose sharply with more than 55,000 neck procedures performed last year.

In a press release by the ASPS, President Dr. Robert Murphy said, “The demand for plastic surgery remains strong, with our statistics showing increases in both cosmetic surgical and minimally-invasive procedures… With new devices and products hitting the market each year, there are more options and choices available to consumers wanting to refresh their look or a little nip and tuck."

What does this mean for the average consumer? 

Plastic surgery procedures are far more accepted by society than in decades past. Women talk much more openly about procedures they want or have had. The Internet is alive with forums where patients can share stories, ask questions, and get information. RealSelf.com has emerged as a leader in this. With today's world of competitive work environments, even men are getting into the act. Procedures for men are on the rise, and men are losing the fear of having procedures done to enhance their looks or reverse the signs of aging. 

New products, devices and technologies are coming into the plastic surgery field every year that help to make cosmetic procedures more attractive to men and women. There are more options and choices available for everyone. At the same time, because of this, it's more important than ever to research procedures you are interested in and find qualified professionals. The ASPS, ASAPS and other professional associations recommend seeking services from a Board Certified plastic surgeon who has experience with those procedures.

Mommy Makeovers Are Growing in Popularity But What Exactly Are They?

by Andrea L. Algar

The American Society of Plastic Surgeons recently revealed that a whopping 62% of moms in the United States would like to have plastic surgery to get back their pre-baby figures. While it isn't shocking at all that moms would want this, it is a bit surprising that the number is so high.

Money may keep a healthy number of women from actually having their much-wanted surgery, but the high percentage of women wanting to improve their appearance after having children has people looking at why.

Is "looking good" now seen as being more important to women who have had children? Yes, probably. And there's data to back this up. The same ASPS study found that the average age of women seeking mommy makeovers was lower than it was a decade ago. Interestingly, while the age of potential plastic surgery patients lowers, the average age of mommies has actually risen. A CDC study from 1970 showed that the average age for a first-time mom was 21.4. Between 2000 and 2006, that age went from 24.6 to 25 years old.

While it’s hard to pinpoint why moms are becoming more concerned with their appearance after having children, there's no doubt that it probably has something to do with the fact that plastic surgery has grown in popularity in recent years. The procedures associated with mommy makeovers—breast augmentation, tummy tucks, liposuction, and breast lifts—are more advanced than ever.

There is also the fact that plastic surgery is getting talked about more. The old days of hiding a cosmetic procedure have changed dramatically. Not only do you have women sharing their stories with friends, family and co-workers, they're active on the Internet discussing their experiences, asking questions, and even posting photos of their post-baby bodies in hopes of getting opinions from other women and the doctors who specialize in mommy makeovers.

In San Antonio, there has been a dramatic increase in the number of women who are interested in mommy makeovers. Some know the procedures involved, while others know only the phrase. So what exactly is a mommy makeover? Contrary to what some believe, a mommy makeover can vary according to the mom's needs and can be a combination of any of the following procedures:

• breast lift
• breast augmentation
• breast reduction
• liposuction abdomen
• liposuction hips
• liposuction thighs
• tummy tuck

Patients seek out plastic surgery not only to give them physical results, but also to help them get back their self-confidence and how they felt about their body before children. San Antonio board certified plastic surgeon Dr. Robert Young explains, "I'm seeing more women in their 30's who are looking for mommy makeovers. Pregnancy, hormones, changing body metabolism and childbirth takes a huge toll on the body, especially with subsequent births, and weight gain can stubbornly remain for years after childbirth. Most women become concerned as they notice that their breasts deflate and become saggy, hips and thighs fill out, and stretched stomach muscles cause bulging, excess skin and stretch marks. These can rob women of their self-confidence. Often women cannot bounce back even with better diet and increased exercise."

Facts about Mommy Makeovers:

• Mommy Makeover describes procedures to rejuvenate the breasts and abdomen following childbirth(s).
• The goal of a Mommy Makeover is to try and return the body to its pre-baby state.
• Most women who have had children are good candidates for the procedure if they're in good health and have had all of the children she desires.
• A Mommy Makeover may be done in one or two stages depending on the problem areas being addressed and the number of procedures necessary to accomplish the rejuvenation.
• The type of procedures can vary in a Mommy Makeover.

Many plastic surgeons bundle procedures and give some type of discount on the costs. Some are bundled together such as tummy tuck, breast augmentation. These can be a good value, but you need to make sure that all of the procedures being thrown together are ones that are truly needed. For instance, some may require a breast reduction rather than a breast augmentation. You should be able to customize the "package" of procedures so that they best suit your needs and desires.

Because at least two or more procedures are being bundled together for your Mommy Makeover, you should make sure that your plastic surgeon is experienced providing multiple surgeries. Multiple procedures can increase the risk complications. Sometimes it may be necessary to break the procedures up into separate surgeries. For example, if you would like breast augmentation, but need a breast lift, it is often advisable to first have the breast lift and follow several months later with the breast augmentation.

Make sure you have the appropriate child care and help in the home as well. You'll need someone who can help out in the weeks following your surgery while you heal - something you shouldn't try to cheat on. You could be risking your health and increasing the chance for serious complications if you don't follow your doctor's recommendations concerning activities (including housekeeping, child care, lifting, cooking, working, driving, and even sex). Discuss your needs with your surgeon and get specific advice if you foresee difficulties.

Many Women Can't Live Without Their Spanx - But Is It Dangerous?

They say that history has a way of repeating itself, and this is yet another example of that. It was just a matter of time before someone would find something wrong with Spanx and other shapewear.

What goes around comes around.

PhotoCredit: 2ndSkin.ie

Think back to the 1950's and early 60's when girdles were a daily necessity for so many women. Yes, they helped create the hourglass figure which was so desirable at the time, but they came under scrutiny too, much to the relief of an entire generation or two of women. Corsets were popular before that, and they, too, disappeared after setting fashion trends for decades. "Shapewear" in one form or another have come into fashion and back out of fashion for hundreds, if not thousands of years.

Thanks in great part to the popularity of Oprah and her vocalSpanx, shapewear seemed to become an overnight sensation in our lifetime. But, perhaps for different reasons that girdles died out over fifty years ago, shapewear is now under criticism for causing a host of potential problems for women who wear them on a regular basis. Among the problems reported by physicians across the country:


WHAT SHAPEWEAR DOES       HOW IT AFFECTS YOUR BODY
Compresses your stomach           Can worsen heartburn and acid reflux
Compresses diaphragm                Can cause pain, shallow breathing, nausea, lightheadedness
Compresses intestines                 Can affect your digestive tract causing bloating, gas, pain
Compresses colon                       Symptoms of irritable bowel and/or incontinence
Restricts blood flow                      Can decrease circulation, increase risk of blood clots
                                                   Develop varicose veins, swollen ankles
Compresses nerves                      Can cause tingling, numbness and pain in legs
Cradles muscles                          Can weaken muscles you are no longer using
Traps moisture                             Increased risks of bacterial or yeast infections

Experts advise that you select any type of shapewear with a goal of proper fit. While style is something we always look at, it is far more important to make sure that you select the right type of garment. If you are prone to acid reflux, for example, you want to avoid a garment that sits right under your bra, as it may worsen your symptoms.If you suffer from gastro-intestinal problems, you may want to avoid a waistband garment, and if you have varicose veins, make sure that the legs are not too tight.

Dr. Robert N. Young adds, "If you have large breasts, you may want to avoid shapewear with thin shoulder straps, as it could worsen back, shoulder or neck pain and cause painful grooves.They can provide excellent support, but should fit right so they don't make your problem worse." While shapewear can temporarily smooth your body, they don't offer lasting solutions. If you have problems with shapewear but can't imagine life without it, Dr. Young points out, "You might want to see if liposuction would be helpful for you."

When shopping for Spanx or any type of shapewear, try different brands as they can vary a lot in fit and body styles. Make sure you can wiggle into your garment without a struggle. Remember you will be pulling the garment on and off several times thoughout the day or evening and it should be something you can do easily.

Are the potential dangers of shapewear worth the risk? Some symptoms can become permanent. Varicose veins don't go away on their own and peripheral nerve damage from extended compression can become constant. It may very well be that it is best to avoid wearing shapewear on a daily basis. Save the Spanx for evenings out and special events where you want to look your best, or to wear with a special dress or slacks that require that special touch.

Drop a comment and let us know what your experience with shapewear has been.

ABOUT THE AUTHOR:
Andrea Algar is an author who writes on topics that interest her. Over the last 30 years she has written articles on a variety of topics and currently contributes to several blogs on a regular basis.

Eyelid Surgeries Can Lead To Temporary Dry Eye Symptoms For Some

by Andrea L. Algar

In my experience, any potential side effects, whether from surgery or a medication, can often be more easily tolerated if you know in advance what the potential complications may be. Not only will it avoid an unpleasant surprise, but you may have the opportunity to identify it quickly and get practical advice on how to handle them.

Eyelid Surgery is known
as blepharoplasty

An article which appeared in the October 15, 2012 Archives of Facial Plastic Surgery addressed the fact that following eyelid surgeries many patients experience "dry eye" symptoms.

Dry eye is definitely an irritating thing to develop. I've had it myself, and not from eyelid surgery. It can be extremely uncomfortable.

Some follow up studies show that as many as one fourth of men and women who have blepharoplasty (eyelid) procedures experience some degree of dry eye following their procedure.

Dry eye symptoms can include:

• stinging or burning of the eye
• scratchy sensation in eye
• a sandy or gritty feeling as if something is in the eye
• feeling like someone is "blowing through a straw" in your eye
• excessive "tearing"
• production of mucus in or around your eyes

Symptoms can range from mild to persistent, but not everyone develops these symptoms and there is no definitive test to determine who will and who will not develop symptoms. That said, it seems that some may be more prone to experiencing dry eye with or without eyelid surgery. Women who are menopausal, just starting hormone replacement therapy or going on birth control for the first time, and men or women who have had difficulty wearing contact lenses may be more at risk.

One of the surprising findings of a study which was performed by a Minnesota facial plastic surgeon on 892 patients over a ten year period, was that dry eye was more common in those patients who had both upper and lower lids done at the same time. It also seemed to indicate that the more aggressive the surgical techniques were, the greater risk of dry eye. Disruption of the "blink", which causes the eye surface to lose some of the lubrication provided by one's blink response, seems to be one of the most probable causes.

The good news is that dry eye is fairly easy to treat. Often, symptoms can be helped with eye drops or ointments. It is not usually an indicator of something bad happening, and should not be cause for alarm. If you develop dry eye following an eyelid lift, make sure you discuss it with your physician at your post-op visit. He/she will be able to help advise you on the best treatment for the type of symptoms you're experiencing.

Eyelid lifts average of $3,000 to $4,000 in the San Antonio area, depending on whether you get two lids or all four lids done. According to the  American Academy of Facial Plastic and Reconstructive Surgery, eyelid lifts were the second most popular type of facial plastic surgery after rhinoplasty (nose jobs) in 2011.  Board Certified plastic surgeon, Dr. Robert Young says, "Eyelid surgery is an excellent way to create a more youthful appearance for men and women at the age where they are starting to notice more wrinkles and loose skin around the eyes. It can shave years off one's appearance. Most patients are extremely happy after their eyelid lift procedures. We've always had women request eyelid lifts as they age, but we've seen a noticeable increase in the number of men wanting eyelid lifts in recent years. It's a relatively easy procedure that produces real results."

Should you be overly concerned about dry eye if you're thinking of an eyelid lift? Probably not. But, it is something to know could develop, and if it does, that there are effective treatments for a problem which is usually very short term.

What do you think? Have you ever considered eyelid lift to refresh your face?

REFERENCE:
Archives of Facial Plastic Surgery, October 2012
WebMD - Dry Eyes: Causes and Treatments

Today's Choices In Skin Care Products Can Be Overwhelming...And Potentially Harmful

by Andrea Algar
Contributing Author

It’s hard to resist the lure of beauty product and their promises. We are all in search of the product that will give us youthful, healthy looking skin. So you purchase a product you've heard about, thinking that this will be the solution. Then the next hot product comes along, and it looks even more promising so you purchase that. In fact, you probably shelf the other product before it's had much of a chance to start showing much benefit. Then you end up repeating the cycle again and again. This can be frustrating and expensive!

Psychology experts call this pattern a hedonic treadmill. According to clinical psychologist Richard Raynard, Ph.D., author of books on emotions, “You basically believe the better is just around the corner, despite advances you may have already made.” You derive pleasure from purchases you make, hoping that each new one will bring you more happiness. These goals may or may not be obtainable, but the impulse to satisfy the desire is very strong.This pattern leaves you on a constant and sometimes unsatisfying quest for the perfect product.

Having a makeup counter bursting with beauty products may also encourage you to slather on more than one skin care product at once. Many think that if applying one product is good, then using three or four must be better! This can be a big mistake. Most professional grade products you obtain from a plastic surgeon's office are armed with ingredients more powerful than those you would find over-the-counter in a drug store or even at the counters at expensive retailers. It is best to use these products as instructed by a professional such as your plastic surgeon, aesthetic nurse or esthetician.

“It's harmful to go overboard with skin care products daily because it can cause skin sensitivity,” explains dermatologist Debra Jaliman, MD, the author of Skin Rules: Trade Secrets From a Top New York Dermatologist.

Sometimes when you begin a new skin care regimen, your outer layer of skin can become irritated with redness and peeling. It's usually best to slowly introduce new products into your daily routine, following the instructions for use closely. Also use the products in the morning or at night as directed for best results, and speak to your skin care professional if you have any problems or concerns.

How Adjustable Saline Implants Work

by Robert N. Young, M.D.
Board Certified Plastic Surgeon

The adjustable saline implant was initially used in breast reconstruction to slowly expand the tissue after a mastectomy. It is now sometimes used for breast augmentation. The saline implant that is used has an external valve, the "fill valve", that is positioned under the skin near the incision. We usually put the incision in the armpit, but it can be made around the nipple or in the inframammary fold as well. The implant is filled up to the agreed size at surgery.



Adjustable Breast Implants
shown with fill valves



After the surgery, the patient can decide to adjust the size within about 50cc either up or down. At the office, your physician places a needle through the skin into the "fill valve" and the saline is either injected to increase the size, or withdrawn to reduce the size of the implants. After the patient is happy with the size, the valve is removed in the office under local anesthesia. At that point, no further "adjustments" can be made.

If you've heard about adjustable breast implants and want to know more about them, consider a visit to a Board Certified Plastic Surgeon who can help determine whether they are a good option for you.

You Feel Young, But Your Skin Says Old

by Andrea Algar
Contributing Author

I saw a great little quiz on the Internet today and it prompted me to write on the subject of our aging skin - something all women worry about at some time in their life. If everyone was totally honest, it's something that does concern us when we get older, but don't usually give a moments thought to when we're young and in our prime.

Australian Beach-Goers
PhotoCredit: Malaysianmeanders.blogspot.com

For example, we all know now just how damaging the sun is, and how it can prematurely age our skin no matter how good our genes are. Somehow this doesn't prevent us from rushing to the beach to bask in the sun, or to the tanning salon to freshen up our sun-kissed look! But it's not a very good feeling when you look in the mirror and what is staring back at you doesn't at all resemble the person you feel like inside. If only we knew then...

San Antonio plastic surgeon Dr. Robert N. Young says, "The good news is that there are things you can do to help." With advances in laser treatments for brown spots, and excellent wrinkle relaxers and facial fillers for fine lines and wrinkles, you can take steps to turn back the hands of time (and those sun baked days at the beach)! And, with the use of professional skin care products which include a quality sunscreen you can keep the renewed look fresh.

Take the quiz and see how your skin is holding up...

TAKE THE QUIZ:
Daily Glow - Is Your Skin Aging Faster Than You Are? - Skin Care Quizzes

Correcting A Weak Chin Or Jaw Can Make Dramatic Difference In Face

by Andrea L. Algar

The face is one of the most difficult areas for patients to judge what is needed to look younger. Many automatically revert to the term "face lift", thinking that this age-old procedure is the only thing available to help turn back the hands of time.


Angelina Jolie
Photo Credit: femalefirst.co.uk



But, an experienced board certified plastic surgeon knows that there are many options to consider. Among them are the jaw. A weak jawline can affect the entire presentation of the face. It can make an otherwise normal nose appear too large, a chin too pointed, or the face too long.

Take a look at some of the "most-beautiful" celebrities and you'll note that they all have strong chins and jawlines. There is no doubt that correcting a weak chin or jaw can dramatically improve the entire face. Studies have shown that facial symmetry is an important indicator in determining beauty. A balanced, symmetrical face is chosen as "beautiful" more consistently than those which are not. Angelina Jolie has a notably strong jawline and is an example of good facial symmetry, a major reason she is thought of as one of the world's most beautiful women.

Injectable fillers may be used for small facial areas requiring subtle change, but do not work as well for the large amounts needed for areas like the jawline. Using facial fillers on the jaw can sometimes produce unpredictable results and require repeating the procedure as the product is reabsorbed by your body. The length of time the fillers last depends upon the type of product used, and results will vary with the skill of the injector.

Chin implants can increase projection and create more evenly balanced facial features and they can last a lifetime. Chin and jaw implants look and feel like natural bone structure, and provide a good foundation for face lift if needed on an aging face, or in conjunction with a rhinoplasty to correct the nose. It is a procedure that both men and women can benefit from and the procedure has a relatively short recovery time.

If you've been confused over what procedure would help to balance your facial features, consider consulting with a board certified plastic surgeon in your area. Not all plastic surgeons work on faces, so ask if they do. A surgeon who performs a variety of facial surgeries can help guide you to the procedures that will help you achieve the look you want.

REFERENCE / RESOURCES FOR MORE INFORMATION:
eHOW.com - Face Exercises to Sharpen The Jawline
cbc.ca - Strong jaw lines versus rounded chins
style-makeover-hq.com - Find Your Face Shape
YouTube - It's All About The Jaw! VIDEO

Update: State-of-the-Art 3D Imaging Still Has A Way To Go

by Andrea L. Algar

Dr. Robert Young has always been in the forefront of technologies available to women who want to improve their self-image, their confidence, or their looks with breast enhancement surgery. Dr. Young has performed so many breast augmentation surgeries over the years that he is widely known as the "breast doctor" in San Antonio, Texas, where his office and Outpatient Surgery Center is located. 

Dr. Young recently added a service he thought his patients would like using brand new, state-of-the-art 3D imaging technology. After uploading a few photos, answering a few questions and selecting implant sizes you're interested in, 3D images would be made showing what the implants would look like on your own body. After using the system for several months, however, Dr. Young found that it doesn't quite deliver. The results were disappointing and he decided to discontinue use until the makers could work out the host of problems.

And this isn't the first attempt at utilizing this type of technology. Dr. Young has owned and used imaging software for well over 10 years which "morphs" patient photographs, projecting potential surgery outcomes by manipulating the photo in the office. As Dr. Young describes, "We prefer not to use the morphing techniques because actual outcomes can be quite different than those projected by computer." The computer cannot take into account unique body characteristics that a skilled surgeon knows how to handle and to what extent can or cannot be changed. "Computers cannot deal well with asymmetry or uneven breasts, tubular breasts, wide-spread breasts and other problems we as plastic surgeons are trying to correct for our patients," explains Dr. Young. "I like to rely on what my thirty years of experience have taught me."

The good news is that the methods that Dr. Young been using in his consultations with patients continues to work very well. Since Dr. Young has performed an estimated 8,000 breast augmentations, he has a large collection of before-after photographs which contain a wide variety of body types and breast implant sizes used. This is an excellent way for you to see the quality of his work and how saline or silicone breast implants may look on you.

Dr. Young uses a variety of breast implants including saline and silicone gel implants, in many different sizes, styles and projection heights in order to create the look you desire. There are many different surgical methods available to you as well. Dr. Young is happy to discuss endoscopic, minimal incision methods that leave the smallest scars possible and help you return to your everyday life as quickly as possible. He can address questions about awake surgery, TUBA incisions, adjustable implants, fat injections and many of the more recent trends in breast augmentation surgery.

REFERENCES:
dryoungforever.com - Dr. Robert N. Young, MD, FACS, Board Certified Plastic Surgeon
                                
ABOUT DR. YOUNG

Robert N. Young, founder of Aesthetic Enhancement Cosmetic Surgery & Laser Center, is a Board Certified Plastic Surgeon with over 30 years experience. He has been trained and has extensive experience both as a reconstructive plastic surgeon and a cosmetic plastic surgeon. He has become known as the breast doctor of San Antonio. His San Antonio practice includes a fully accredited outpatient Surgery Center staffed with qualified Registered Nurses, Anesthesiologists and surgical technicians. As a leading plastic surgeon in San Antonio, Texas, Dr. Young is a member of the following professional organizations:

- ABPS Diplomate - Board Certified by The American Board of Plastic Surgery (ABPS)
- Member, American Society for Aesthetic Plastic Surgery (ASAPS)
- Member, American Society of Plastic Surgeons (ASPS)
- Fellow, American College of Surgeons
- Member, Texas Medical Society (TMS)
- Member, San Antonio International Society of Plastic & Reconstructive Surgery (SAISPRS)
- Bexar County Medical Society (BCMS)
- Accreditation by the American Association for Ambulatory Surgical Facilities (AAAASF)

Ultra High Profile Implants Growing in Popularity in San Antonio

by Andrea L. Algar

San Antonio's Dr. Robert N. Young receives a lot of requests from women looking for the newer Ultra High Profile implants. He has been using them since they were introduced last summer, and women have been happy with the results they give.


Mentor, makers of the new
Ultra High Profile Silicone Gel Breast Implants



Because they offer more projection than moderate or even high profile implants, you don't have to go as large with the new ultra high profile implants. In fact, according to the manufacturer Mentor, the new silicone gel Ultra High Profile implants offer the "highest projection with the smallest base". Dr. Young explains, "These new silicone implants are particularly good for small framed women who don't have the chest width to accommodate large implants. I've seen that women who want much larger breasts are really liking the new Ultra High Profile implants. These new implants provide more projection and less width so you don't have to get as large an implant in order to achieve good projection. And, the implants are more full of silicone so they wrinkle less."

There are many new options available for women desiring breast enhancement. Breast Augmentation has evolved to include many options in quality breast implants designed for a wide range of body types, including many different shapes, sizes, projections, materials, methods of insertion and more.

REFERENCE / RESOURCES FOR MORE INFORMATION:
Mentor Corp - Breast Implant Options
LoveYourLook.com - Breast Implant Sizes, Profiles & Textures from Mentor

 

ABOUT DR. YOUNG
Robert N. Young, founder of Aesthetic Enhancement Cosmetic Surgery & Laser Center, is a Board Certified Plastic Surgeon with over 30 years experience. He has been trained and has extensive experience both as a reconstructive plastic surgeon and a cosmetic plastic surgeon. He has become known as the breast doctor of San Antonio. His San Antonio practice includes a fully accredited outpatient Surgery Center staffed with qualified Registered Nurses, Anesthesiologists and surgical technicians. As a leading plastic surgeon in San Antonio, Texas, Dr. Young is a member of the following professional organizations:

 

- ABPS Diplomate - Board Certified by The American Board of Plastic Surgery (ABPS)
- Member, American Society for Aesthetic Plastic Surgery (ASAPS)
- Member, American Society of Plastic Surgeons (ASPS)
- Fellow, American College of Surgeons
- Member, Texas Medical Society (TMS)
- Member, San Antonio International Society of Plastic & Reconstructive Surgery (SAISPRS)
- Bexar County Medical Society (BCMS)
- Accreditation by the American Association for Ambulatory Surgical Facilities (AAAASF)

Can Use Of Aspirin Help Prevent Deadly Melanoma?

by Andrea L. Algar

One of the largest studies of its kind has shown promising findings that regular use of aspirin may lower the risk of developing melanoma. An agressive form of cancer that invades skin cells, many melanomas can turn deadly. Melanoma has been increasing dramatically in prevalence and has become one of the most worrisome cancers because of this. One in 50 will develop melanoma in their lifetime, and the average lifespan for those with advanced melanoma is only one year. It is the fastest growing cancer all around the world.

Melanoma Skin Cancer
Photo Courtesy: Skin Cancer Foundation

Previous studies have not been as large, or as focused. Almost 60,000 caucasian women were studied, primarily because the cancer seems to effect more fair skinned people. According to today's Everyday Health article, "They found that women who took aspirin had a 21 percent lower risk of melanoma compared to those who did not take the drug. And the longer the women used aspirin, the lower their melanoma risk. Those who took aspirin for five or more years had a 30 percent lower chance of developing melanoma than the ones who didn't take it at all. The researchers were able to control for skin cancer risk factors among the women, including variations in skin pigmentation, tanning habits and use of sunscreen."

While this news is promising, daily use of aspirin does carry it's own risks. For many years "baby" doses of aspirin has been recommended for men and women who have cardiovascular disease or are at risk for it. While it cannot be said with certainty that the risk of taking aspirin would outweight the potential benefit, it is an option worth discussing with your physician.

How to Spot Melanoma:

Symptoms of melanoma can vary, and they can develop quickly so it's important to identify them. Not all skin cancers are melanomas. Melanomas are more dangerous because they spread. Melanoma of the skin is called Cutaneous Melanoma and is the most common type. Other types of melanoma can occur in mucous membranes including nose, throat, mouth and are called Mucosal Melanoma. The third type is melanoma of the eye and is called Ocular Melanoma. The Melanoma Research Foundation recommends that you look for the following signs:

 

• A change on the skin. This could be a new spot, or a change in color, shape or size of a current spot.
• A sore that doesn't heal.
• A spot or sore that becomes painful, itchy, tender or bleeds.
• A spot or lump that looks shiny, waxy, smooth or pale.
• A firm red lump that bleeds or appears ulcerated or crusty.
• A flat, red spot that is rough, dry or scaly.

 

As a Board Certified Plastic Surgeon, Dr. Young has identified melanomas on patients with increasing frequency. He states, "If you suspect that you may have a melanoma, you should consult with a dermatologist who is trained to identify and treat skin conditions such as melanoma. It is recommended that men and women have yearly whole body exams which include scalp and the bottoms of the feet since melanomas can occur on just about every part of the human body. As in most types of cancer, treatments are more successful when the cancer is caught early."

 

REFERENCE:

Everyday Health: Melanoma Risk Drops 21 Percent In Women Who Take Aspirin

RESOURCES FOR MORE INFORMATION:
American Cancer Society -  Melanoma Skin Cancer
Mayo Clinic - Melanoma Pictures To Help Identify Skin Cancer (Slide Show)
Melanoma Research Foundation:  What Is Melanoma
Skin Cancer Foundation - Melanoma Information

ABOUT DR. YOUNG:
Dr. Robert N. Young is a Board Certified Plastic Surgeon with over 30 years of experience. His San Antonio practice includes a AAAASF accredited outpatient Surgery Center staffed with qualified Registered Nurses, Anesthesiologists and surgical technicians.

ABOUT THE AUTHOR:
Andrea L. Algar is a contributing author to Dr. Young's blog dealing with issues on cosmetic plastic surgery. She has been working in the medical community for over 30 years, and authors articles on a variety of health, beauty and leisure topics.

Vampire Facelifts Have Many Curious And Others Scared

by Andrea L. Algar
Contributing Author

Just the term "vampire" used with facelift is a scary thought. News of this new technique is getting quite a lot of attention due to the unique marketing name associated with it. But just what is "vampire facelift"?

"Vampire" to most people
Photo Credit: tumblr.com

To best answer that we need to take a look at the reasons that men and women seek out facelifts in the first place. Most commonly, the reasons are aging, sagging skin that we begin to notice as early as our 40's. The problematic wrinkles, bags and sags seem to multiply at alarming rates from there, causing many to start seeking remedies for what they see as false representations of how many men and women feel when they're in their 40's, 50's and even 60's. Recent polls have, in fact, shown that 70 is now seen as the new "middle age"!

But, wrinkles and sagging skin is often accompanied with a loss of fat under the skin, as well as bone and muscle, causing the face to look more aged. With advent of research into stem cells, it has been discovered that plasma from your own body can be enhanced and reintroduced, providing platelets that are rich and rejuvenating, with human growth factors that can repair and rebuild tissue. They've labeled this PRP (platelet rich plasma), which essentially is blood plasma that has been enriched by platelets.

A "vampire facelift" is a fat transfer procedure that combines your own fat, usually obtained by liposuction, and PRP obtained from your own blood.

We already know from years of successful fat transfers, that fat is rich in stem cells. When fat is transferred, these cells take on the characteristics of the cells around them. Fat transfer has been successful when used in the face for many years, however, with the new ability to introduce the PRP along with the fat, it is said that this process stimulates the stem cells to do what they do best, which is to multiply. Multiplying cells means volume to our face. Some research has shown improvement in blood supply and circulation as well.

Fat transfer alone is helpful for many areas of the face including cheeks, temples, forehead, around the eyes, lips, jowls and almost anywhere that there is significant loss of fat. Replacing the volume with fat injection is often a part of a planned facelift, where the facelift can tighten the skin, the fat replacement provides a more youthful, fresh look. The one-two-three punch of the "vampire facelift" could provide much needed volume from the fat, as well as growth factors from PRP and new cells from the stem cells.

Dr. Robert N. Young of San Antonio cautions, "While more hands-on experience with PRP and fat transfer is needed in order to assess longevity and patient satisfaction, it is a procedure worth watching. As we learn more about stem cells and how they can best be utilized, we will undoubtedly improve on these techniques and the outcomes that can be achieved. As with any new procedure, it is often wise to wait until some of the quirks are worked out." While the volume is instant, not all volume is kept with fat transfers, and it can take several months to a year to see the final effects. This could result in patient disappointment if their expectations are not met. Many callers to Dr. Young's practice have expressed disappointment in thread lifts and other "quick fixes" that don't necessarily give the long-term results desired, which is one reason that traditional facelifts and fat injections have remained very popular.

China's Fire Facial Treatments Claim To Fight Wrinkles (VIDEO)

A treatment has emerged from within China that would seem to be a bit too scary for most here in the United States. "Fire Facials" are gaining in popularity there, and are said to stimulate the skin and improve dullness, sagging and wrinkles. But would you be willing to try it?

Setting one's face on fire is not how most people would envision trying to remedy wrinkles. Torture springs to mind quicker than a smooth face. But, in China, the procedure is gaining momentum as a spa treatment called Huǒ liáo is being used on the face, legs and/or other parts of the body.  The procedure involves placing an alcohol-soaked towel and a special "elixir" on the area, then lighting it on fire for a few seconds.

VIDEO WARNING:
This video may be disturbing to watch.




Theoretically, this procedure can work. By "damaging" the surface of the skin, your body fights to heal the wound. When healed the process leaves you with refreshed new skin. Here in the United States, we accomplish the same thing when we perform laser resurfacing, but it is done with much more precision because we can control the depth the laser affects and the amount of exposure, or laser energy, the skin receives. Chemical peels, such as the ViPeel, work in the same manner, yet are gentler and do not have as much down-time as with a full laser resurfacing.

Dr. Robert Young spent seven years as plastic surgeon at the Burn Unit at Brooke Army Medical Center, and later as Chief of Plastic Surgery there. His experience with burn victims is extensive. He explains, "The risk of igniting your face or your body with flammable liquid seems immense. " Leaving the fire too long could permanently damage the skin, leaving horrible scars that may not ever heal. It would seem a huge risk. What do you think?

REFERENCE / RESOURCES FOR MORE INFORMATION:
HuffPost Style - 'Fire Facial' Treatment, AKA Huǒ liáo, Claims to Fight Wrinkles By Setting Face on Fire 

ABOUT DR. YOUNG
Robert N. Young, founder of Aesthetic Enhancement Cosmetic Surgery & Laser Center, is a Board Certified Plastic Surgeon with over 30 years experience. He has been trained and has extensive experience both as a reconstructive plastic surgeon and a cosmetic plastic surgeon. He has been performing successful Brazilian Butt Lift procedures for several years. His San Antonio practice includes a fully accredited outpatient Surgery Center staffed with qualified Registered Nurses, Anesthesiologists and surgical technicians. As a leading plastic surgeon in San Antonio, Texas, Dr. Young is a member of the following professional organizations:

• ABPS Diplomate - Board Certified by The American Board of Plastic Surgery (ABPS)

• Member, American Society for Aesthetic Plastic Surgery (ASAPS)
• Member, American Society of Plastic Surgeons (ASPS)
• Fellow, American College of Surgeons
• Member, Texas Medical Society (TMS)
• Member, San Antonio International Society of Plastic & Reconstructive Surgery (SAISPRS)
• Bexar County Medical Society (BCMS)
• Accreditation by the American Association for Ambulatory Surgical Facilities (AAAASF)

FDA Warns That Most Online Pharmacies Are Fake

Medscape News came out with a disturbing report this past October with medical news that "fake online pharmacies are an emerging health threat, the FDA warns," reads the article intro by Daniel J. DeNoon.


Beware of Fake Online Pharmacies
warns FDA


The FDA cites a recent study by the National Association of Boards of Pharmacy which found that an astounding 97% of the U.S. online pharmacies "violated state or federal laws and/or NABP safety and practice standards." The FDA has immediately acted to warn consumers.

"Buying medicines from rogue online pharmacies can be risky because they make sell fake, expired, contaminated, not approved by FDA, or otherwise unsafe products that are dangerous to patients," FDA Commissioner Margaret Hamburg, MD, said.

The findings showed that many of the on-line pharmacies claiming to be U.S. companies are not. NABP has investigated many of their websites and have shut down many, but others are quickly put in place to replace them.

And, it's said that the sites look legitimate. At about this same time, our Day Spa technician came to me with another story from a patient who claimed to have been able to buy the ViPeel on-line. This peel, along with other prescription skin care products, are sold only to physicians for resale through their offices. It is illegal for people to sell them on the internet. Dr. Robert N. Young states, "Over the years, we've received more and more reports from my patients who have seen these illegal sites selling medical grade and/or prescription items illegally over the internet."

It is scary to think that people would risk their health obtaining items online that may or may not be the real thing. We urge caution in obtaining items you know usually require a prescription or that are sold exclusively through physician offices.

Cosmetic Procedures Grow Worldwide With Differing Favorites

Reports out of Paris by IMCAS show that the European market for cosmetic procedures is continuing to grow, and is expecting at least another 10% increase this year. Breast Augmentation and liposuction continue to be the top surgical procedures, while anti-wrinkle injections and laser treatments are strongest for non-invasive options.


Cosmetic Surgery Popularity Soars


Asia, too, reports strong growth, with demands highest in eyelid surgery and nose surgery. Growth estimates are upwards of 14% for these procedures, perhaps setting the pace for the region of strongest growth in cosmetic and plastic surgery procedures.

In the United States, growth continues despite the sluggish economic recovery. Some speculate that the continued interest in cosmetic procedures is lead by the need to remain competitive in today's tough job market. Whatever the reason, it certainly appears that cosmetic plastic surgery is no longer considered a taboo topic. We've noticed that more and more patients are openly discussing their surgeries with friends, family and acquaintances, and that it's being talked about as a positive, enhancing life experience.

If your're considering a cosmetic procedure, we encourage you to seek out services from a qualified professional who is Board Certified in Plastic Surgery. For more information on what Board Certification means, visit The American Board of Plastic Surgery or the American Board of Medical Specialties.

ABOUT DR. YOUNG

Robert N. Young, MD, FACS - View Dr. Young's Credentials
Dr. Young is a Board Certified Plastic Surgeon with an active practice and Surgical Center in San Antonio, Texas. He has over 30 years experience in plastic surgery, with a specialty in Breast Enhancement surgeries.

Men Are Becoming More Open To Male Cosmetic Surgery Procedures

We've noticed an increase in the number of men who are coming in for consultations with Dr. Young. Liposuction, Eyelid Surgery, Breast Reduction, Calf Implants, Tummy Tuck and even Face Lift are more in demand than ever before. While Dr. Young has always had men desiring rhinoplasty (nose job) and liposuction, the increase in these other procedures has noticeably grown over the past several years.

Why the increase? An article just published by Dr. Robert T. Grant in Medscape News, a publication for physicians, points out that, "Although men do not face the same hormonal changes with aging that women do, the male biological clock still ticks, and over time changes in a man's appearance can lead to a negative self-image, which can take a toll on mental and physical health. Today, men are turning to cosmetic surgery in an effort to help break the cycle of interaction between appearance and negative self-image." In other words, men are caring more about their appearance and have realized that cosmetic surgery procedures can make you feel better about yourself. Something women have known for years!

In an ideal world, we'd be able to slow the aging process down if we achieve a good balance diet, exercise, home life, family life, work life, recreation, management of stress, and our health. But for most of us, this is is a difficult if not impossible task to master throughout the course of life. So instead, we strive to create a balance in our aging with use of diet and exercise when we're in our twenties, skin care products in our thirties, use of wrinkle reducers and facial fillers in our forties, more invasive procedures such as skin tightening, fraxel and laser resurfacing in our fifties, and face lifts in our sixties. While women battle with sagging breasts and flabby tummies, men have to deal with receding hairlines, baggy eyes, excessive love handles and man boobs. Face it, aging is not always easy.

Dr. Robert Young encourages a sensible approach to planning a cosmetic surgery procedure, and understands that men can be a bit intimidated by worries over what others will think, finding a qualified surgeon, and whether it will work for them. Men haven't been as exposed to the experience of cosmetic surgery and don't always have the resources for getting information that women seem to do effortlessly. Most women simply have to ask a friend or co-worker and they're well on their way to getting the names of doctors, websites,  and all the "free advice" they can handle!  Dr. Young encourages men to do their research by checking quality websites for sound information.

Many men are also frightened of "plastic surgery" when they see public figures like Burt Reynolds, Kenny Rogers and Bruce Jenner undergo cosmetic surgery with results that drastically change the person's appearance. Most people feel these are too aggressive and prefer to have a more subtle, natural result. Good communication with your surgeon, realistic expectations, and listening to the advice you receive from your surgeon helps to ensure that you'll receive the results you're looking for.

Cosmetic surgery procedures for men can be a positive, enriching experience. Dr. Robert N. Young of San Antonio is pleased to consult with men about their unique cosmetic surgery wishes. As a Board Certified Plastic Surgeon with 30 years experience, he has helped many men feel better about their changing physical appearance.

RESOURCES FOR MORE INFORMATION:

American Society for Aesthetic Plastic Surgery - Procedure Information
American Society of Plastic Surgeons - Official Website

ABOUT DR. YOUNG

Dr. Robert N. Young, the founder of Aesthetic Enhancement Cosmetic Surgery and Laser Center, has been in private practice for over 20 years. Board Certified by the American Board of Plastic Surgery, Dr. Young has developed an outstanding reputation for excellence in South Central Texas. Dr. Young is one of the most recognized plastic surgeons in San Antonio.

A native of San Antonio, Dr. Young earned his undergraduate degree from the esteemed United States Military Academy at West Point. He served as Platoon Leader, Nike Hercules Missile Site at Homestead AFB, Florida until 1971. Dr. Young completed his medical degree at Tulane Medical School in 1975. Following Internship at Brooke Army Medical Center at Fort Sam Houston, he completed his general surgery residency in 1980 and his fellowship in plastic surgery at William Beaumont Army Medical Center at Fort Bliss  in 1982. He then returned to Fort Sam Houston to serve as a plastic surgeon and consultant to the Burn Unit at Brooke Army Medical Center. There, Dr. Young went on to become the Chief of Plastic Surgery, where he performed all types of major reconstructive procedures, until he retired from the military in 1990. At that time, Dr. Young began his private practice in San Antonio, Texas.

Dr. Young's surgical procedures are performed in his own state-of-the-art Surgical Center, which has been accredited by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). The center provides cost effectiveness for the patient, while allowing total discretion and comfort.