Questions about Surgical and Non-Surgical Procedures

Questions about Liposuction

Who is a candidate for liposuction?
Liposuction is not a weight loss procedure. It is best used for individuals who are active, and of normal body weight. Liposuction is best used for localized fat deposits that are diet and exercise resistant.

"I'm thinking of having a liposuction procedure done on my abdomen, is liposuction safe?"
When liposuction is performed with the tumescent technique, it is very safe.

Will liposuction hurt?
We use conscious sedation and a local anesthetic in the tumescent fluid. This helps makes the procedure almost completely pain-free.

How long is the recovery?
Most patients are back to work in a day or two. Some patients take a little longer. The sites will remain tender and bruised for several weeks. The total healing process takes about four months.

Will the fat come back with weight gain?
Once the fat cells are removed, they are gone; the remaining fat cells can swell or shrink, with weight changes.

Misconceptions about trans-umbilical breast augmentation.

The most common myths concerning trans-umbilical augmentation were summarized and dispelled in an article published in the official journal of the American Society of Plastic Surgery*. The discussion of these myths in this article is paraphrased below:

"It Is Too Difficult to Dissect All the Way Up There."
The pocket is not created by dissection but by expansion. There is no cutting going on behind or in the breast. The creation of the pocket is actually easier than with any other method.

"There Are Too Many Complications."
The originally published study actually showed a lower rate of complications than with other methods. There is far less bleeding than with other methods.

"The Surgeon Cannot Control Bleeding."
One characteristic of the trans-umbilical technique is the remarkable absence of bleeding. There is rarely any bleeding to control, but doing so presents no problem. This can be done by visualizing the implant pocket through an endoscope.

"The Surgeon Cannot Position the Implants Properly."
Because the surgeon sees the exact shape of the breast and position of the implant during the expansion phase, there is no guesswork involved in implant positioning. You see what you are going to get.

"Pushing Implants through the Tube Damages Them."
Careful reading of the original article will show that the implants were never supposed to be pushed through the tube. The original article showed the end of the implant seated within the end of the tube for pushing.

"The Technique Leads to Visible Track Deformities on the Abdomen."
The author has seen no visible track deformity in 7 years of performing this procedure.

"Using the Implant as an Expander Damages It."
This is the most understandable of the misconceptions. In the original article, the implant was itself used as an expander. This put the implants under excessive stress. Therefore, this has not been done since 1992. Instead, a separate expander step has been incorporated into the technique.

"Using the Transumbilical Technique Will Void the Warranty on the Implant."
This is patently untrue. (We at Big Sky Cosmetic Surgery have verified with the implant manufacturer that this technique does not void the warranty.)

"It Is a Blind Technique."
This theoretical objection has no significance in actual practice. Tissue expansion, rhinoplasty, and liposuction are "blind" techniques that are well-accepted, performed frequently, and have a low rate of problems. Moreover, the transumbilical technique is the only one of these "blind" approaches in which the operative site is subsequently inspected with an endoscope, which renders it not really blind.

"The Technique Increases the Risk of Implant Failure."
No. This is untrue in both practice and theory.

"The Technique Is Only Suitable for Prepectoral Placement."
This was, in fact, initially true, but the instrumentation and technique for subpectoral placement have been available for some time. (At Big Sky Cosmetic Surgery we place the implants above and below the muscle depending on the needs of the patient.)

"Removal of the Implant Cannot Be Done through a Transumbilical Incision."
The saline implants are, in fact, easily removed through the navel.

"Disrupting the Abdominal Muscles Causes Excessive Pain."
The abdominal muscles are not disrupted in any way. The entire procedure is performed outside the anterior rectus fascia in the subcutaneous plane. One noteworthy feature of the trans-umbilical procedure is that it is less painful than other methods, and it results in a quicker recovery.

"The Technique Cannot Be Performed If the Patient Has an Umbilical Hernia."
This misconception is understandable insofar as the original article cited "abdominal hernia" as a possible contraindication to transumbilical augmentation. In fact, an umbilical hernia can be repaired at the same time.

"The Implant Must Pass between the Abdominal Organs."
The transumbilical procedure is entirely subcutaneous, and it does not involve the abdominal organs or muscles.

"The Technique Cannot Be Performed If the Patient Has a Navel Ring."
Navel rings have proven no obstacle. Some surgeons prefer the ring to be removed during the procedure and reinserted afterward; others prefer to leave them in place or even use them to aid in elevation.

"Going through the Navel Will Cause Infections."
No surgical procedure can be free of the possibility of infection. Thus far, the author (of the referenced article) has seen no infections with the transumbilical procedure; but has seen them with other methods of augmentation. Anyone familiar with the procedure would understand the reason for considering infection very unlikely. One factor in this is that with the incision so remote from the implant, even a wound infection would be unlikely to reach the implant.

"The Surgeon Cannot Control the Plane of the Implants."
The endoscope is used to verify that the implant is in the proper plane relative to the pectoralis muscle.

"Using a Drain Would Require a Breast Incision Anyway."
Most surgeons performing trans-umbilical augmentations have not used drains. Thin, round drains can lead out via the navel, and no breast scar is required. (At Big Sky Cosmetic Surgery we have not found drains to be necessary.)

"The Technique Is Just a Temporary Gimmick."
Time will tell whether this is true, but there is no apparent reason why this would be true.

*Dowden, R. V. Dispelling the Myths and Misconceptions about Transumbilical Breast Augmentation. Plastic & Reconstructive Surgery. Volume 106(1), July 2000, pp 190-194

Breast Implants Options

Saline vs. Silicone

The implants available in the United States are filled with either saline or with silicone. Silicone has the most natural feel and appearance however it also has a number of significant disadvantages. There is a higher rate of capsular contraction associated with silicone filled implants. The human body forms a capsule around all implanted foreign objects. These capsules may contract around soft breast implants causing distortion, hardness and sometimes chronic pain. Saline filled implants have a lower rate of capsular contraction associated with them.

Silicone implants are all pre-filled whereas some saline implants can be filled once they have been placed in the body. Because of this, silicone filled implants require a significantly larger skin incision and cannot be placed through the umbilicus. Also, the exact size of saline implants can be adjusted after they are placed in the body.

Silicone implants were taken off the market by the Food and Drug Administration (FDA) in 1992 because of concerns that they may cause autoimmune and immunologic diseases. No scientific evidence has ever supported any of these concerns and in December 2006, silicone filled implants were once again made generally available in the United States. They are however still under study by the FDA suggesting that there are still questions regarding their safety.

The silicone implants which are now available have thicker shells than those available prior to the ban in 1992. Some believe that this results in a less natural feel and appearance. The silicone implants cost significantly more than saline. In addition, once the implants are in place, MRIís are required every two years in lieu of mammograms for routine breast cancer screening. MRIís are significantly more expensive than mammograms and thus the added expense of silicone will continue for as long as the patient has the implant.

Saline implants are typically slightly overfilled beyond the manufacturerís recommendations. This is done to minimize the chance that ripples will be visible along the edge of the implant. It also keeps the implant from folding on itself. Folds stress the implant and are felt to be the most common cause of implant rupture. Overfilling makes the implant feel a little firmer but the tradeoff seems reasonable.

Round vs. Contoured
The traditional breast implant has a round base and is thicker in the middle than at the edges. Contoured implants are available. These implants are thicker at the bottom than at the top. The theory is that this implant is more anatomically correct and will result in a more natural breast contour. We are not aware of any long term studies which demonstrate this claim to be true and there is anecdotal evidence that the capsule formation which occurs around all implants causes the anatomic implants to assume a round shape over time. Studies have demonstrated that anatomic implants can rotate and cause a distorted and asymmetric appearance.

Smooth vs. Textured
Breast implant shells are either smooth or textured. Studies have demonstrated that textured silicone filled implants are less likely to form capsular contractures than are smooth silicone filled implants. We are not aware of any studies which have demonstrated a significant difference with saline filled implants. Textured shells are slightly thicker than smooth ones and some believe that this causes them to be more easily felt through the skin.

Questions about Rhinoplasty

What is rhinoplasty?
Rhinoplasty is a cosmetic surgery performed to reshape the nose by reducing or increasing its size, removing a hump, changing the shape of the tip or bridge, or narrowing nostril span.

What are the benefits of rhinoplasty?
Benefits of rhinoplasty can range from improved breathing to enhanced appearance and self-confidence.

What are the risks associated with rhinoplasty?
As with any surgery, a rhinoplasty procedure does carry some risks. Fortunately, complications are rare and usually minor . Nonetheless, complications may include infection and bleeding.

Am I a good candidate for rhinoplasty?
Rhinoplasty is ideal for healthy, psychologically stable men and women who are seeking improvement but not perfection in their facial appearance. Most surgeons also consider age as a factor, preferring young patients who have completed their growth spurt.

Will I be put under general anesthesia?
Depending on the preference of the surgeon and/or the patient, rhinoplasty can be performed under general or local anesthesia.

What does a rhinoplasty procedure involve?
Surgical techniques for reshaping the nose vary. However, a rhinoplasty procedure generally involves the separation of nose skin from its framework of cartilage and bone. This can be done either from an incision inside the nose or through an "open" procedure that requires an external incision in the tissue separating the nostrils. The surgeon then reshapes the nose, replaces the skin over the new framework, and applies a splint to help the nose maintain its shape.

How long does it take to recover from rhinoplasty?
Healing after rhinoplasty is slow and gradual with subtle swelling sometimes persisting for months. However, patients can usually expect to return to work or school within a week or two and to more strenuous activity within two to three weeks.

How long can I expect the results to last?
With the exception of changes associated with aging, results are permanent.

Questions about Leg Vein Treatment (EVLT)

What is the difference between "stripping" and EVLT?
Until recently the removal of varicose veins required the vein to be stripped out of the leg. This usually required hospitalization and meant a longer, painful recovery. The FDA approved endovenous laser treatment (EVLT) as a quick, one-time, minimally invasive therapy that didn't mandate hospitalization and which resulted in little or no downtime after the procedure.

Will I have scars?
With EVLT, the incisions are so small that when they are fully healed, they are very difficult to detect.

How long will my recovery be?
Walking is encouraged immediately following the procedure, and normal activities can be resumed within a few days.

Questions about Otoplasty

My daughter is five and is starting to get teased about her protruding ears. Is it too early for her to have corrective surgery?
At this age, the ears have reached 95% of their adult size and surgery is an appropriate option.

What is the recovery like?
We do the surgery here with sedation and local anesthesia. In very young patients the option of general anesthesia is more appropriate. In these cases, we perform the surgery in the hospital operating room. The patient will wear an ear dressing for one week. After the first week, a head band protecting the ears is worn at night for six weeks. There is tenderness, but the discomfort is easily diminished with pain medication.

Are there visible scars?
The incision is hidden in the crease behind the ear and is very hard to detect even in men with very short hair.

Questions about Face Lifts

What is the difference between a face lift and a mini face lift?
A face lift addresses primarily the neck and jowls. The difference between the face lift and the mini lift refers to the length of the incisions. The mini face lift or short scar incision, is hidden in the front of the ear and runs up the back of the ear. A face lift is for a more aged neck and jowls. The incision is hidden in front of the ear, runs behind the ear and is extended into the hairline. When healed, both are very difficult to detect.

What is the recovery like for a face lift?
For all our facial procedures we recommend a two week healing time. Initially you will have swelling and bruising, by week one, most of the swelling will have subsided and by week two most of the bruising will be gone. If any bruising remains it is easily covered up with makeup. You will want to sleep with your head elevated during your recovery, and any discomfort is managed with medication. You can resume most everyday activities after two days; walks are encouraged at this time. More rigorous activities are not recommended for 3-6 weeks. As with all our facial surgeries, you are offered 5 manual lymphatic drainage massages to help reduce swelling and bruising, as well as 5 curelight treatments to speed your recovery.

Questions about Brow Lifts

"I don't want to be restricted in my activities too long. When can I ride my horse and exercise again?"
As with most of our facial surgeries, a strenuous workout is usually allowed after 3-6 weeks. You can, however, resume most every day activities after two days, and walking is encouraged at this time.

"I don't want scars, how big are they and are they visible?"
Since we do this surgery endoscopically, all incisions are within the hairline, there are usually four, they are small and are not visible. No scalp skin is excised, and the hair does not need to be shaved.

Questions about Eyelid Surgery

"What can I do about my "droopy" eyelids and the "bags" under my eyes?"
Eyelid surgery (blepharoplasty) is one of our most popular procedures. Rejuvenating the eyes can transform one's whole look from tired and heavy to refreshed and relaxed. It is very affordable and patients can usually return to work within a week or two.

What does the procedure involve?
On the upper lid, the doctor makes a very fine incision in the crease of the eyelid. Excess fat and skin are removed and the incision is closed. Once healed, the scars are almost invisible. On the lower lid, there are two different approaches. One is called transconjunctival (through the inside of the lid) where excess fat is either removed, repositioned or both. No skin is removed; there is no scar.

The other approach is best when there is excess skin as well as bags. A very fine incision is made near the lash line. The fat is either removed, or repositioned, and sometimes the cheek muscle is slightly elevated, then the excess skin removed. Stitches are removed after four days.

How long is the recovery time?
Initially there is swelling and bruising, this usually resolves in two to three weeks. Most patients return to work after a week or two, using camouflage make-up to mask any remaining bruises.

Questions about Midface Lifts

"I have never heard of a midface lift, what exactly does it do?"
A midface lift is just that. It address the portion of the face from the lower eyelid through the cheeks. The procedure is explained under surgeries on the services part of our web site. It is especially effective if you have hollowing under the eyes and deep nasal labial folds. Imagine subtly lifting your cheeks up to your lower lids and removing excess skin. This is a midface lift as we perform it.

How is this different from a lower blepharoplasty?
A lower blepharoplasty is best if you have bulges and excess skin under the eye; the midface lift improves hollowing under the eye and sagging of the cheek.

Questions about BOTOX® & Dysport™

"My friends are all excited and talking about their results with BOTOX® Cosmetic or Dysport™. I just can't accept injecting poison in my face-is it really safe?"
These products have a track record safety and have been widely used in the medical community to treat ticks and blepharospasms. These treatments are an easy and effective way to rejuvenate the eye area. Lines between the brows, forehead creases, and crow's feet can disappear with one treatment.

How long does BOTOX® Cosmetic or Dysport™ last?
Results from treatment with BOTOX® Cosmetic or Dysport™ can last for up to 4 months. If you discontinue treatment, the frown lines between your brows gradually will look like they did before treatment.

Questions about Clearlight™

"My teenage son has acne to the point where it's starting to affect his self-esteem. His doctor has him on oral antibiotics and topicals that dry out his skin. His condition has improved, but only slightly. A friend told me about the Clearlight™ treatments that require no antibiotics or harsh topicals. How does this work?"
Using new FDA-approved technology, the Clearlight™ works with blue and red light to kill acne bacteria and reduce the inflammation associated with acne. We are seeing improvement after just two treatments.

Is Clearlight™ safe?
Yes. It contains no UV rays, and your son will wear protective eyewear for the treatment.

How do the treatments work?
The protocol is for two, twenty-minute treatments two times a week for four weeks. This will typically keep the skin clear for six months or more.

Will the acne come back?
Acne is an ongoing condition and will require continued attention. We have a proven, effective skin-care regimen for maintenance, and more light treatments may be called for periodically.

Questions about Prolite™ Facial Rejuvination

"I have heard a lot about Prolite™ photofacials as a treatment for Rosacea, can you tell me more?"
Rosacea is an inherited condition that causes a hypersensitivity of the vascular nature of the skin, primarily the face, neck, and chest. It is very common in people of Scandanavian, Celtic or German descent, and in people with light eyes and fair skin.

Rosacea causes vascular flares (a flushing of the face) when stimulated by certain triggers, such as heat, cold, sun, wind, exercise, stress, and certain foods and/or beverages. It is a progressive condition. You can learn more by visiting

Photofacials (a series of 5 is suggested) diminish the general underlying redness, improve the appearance of Rosacea and help to control vascular flares. The treatments also diminish hyperpigmentation (melasma and "sun spots"), reduce pore size, improve dark circles around the eyes, and reduce fine lines.

Is the photofacial only for Rosacea?
No. Anyone with sun damage, pigment irregularities, acne, scarring, or dull complexions will benefit from a photofacial or Intense Pulsed Light treatment.

We offer a complimentary consultation with our consultant to evaluate your skin and offer suggestions for the best treatment and or skin-care products for your skin. At that time she will also outline the costs for her suggestions. You will be under no obligation.

What results can I expect?
You can expect a gradual decrease in the visibility of your skin's imperfections as your ProLite treatments progress. You will see smoother and more uniform skin, smaller pore size and fading of sun spots. Rosacea, a common vascular problem characterized by overall redness and flushing, will show especially significant improvement.

Questions about Laser Hair Removal

Is laser hair removal permanent?
We use the Coherent Light Shear™ dioxide laser for hair removal. The manufacturer has approval from the FDA to claim permanent hair reduction. Seventy-five to 90 percent of the hair does not grow back in good candidates.

"I've heard the laser only works on dark hair. Why is that?"
The laser light is absorbed by melanin. If the hair is gray or blond, there is little or no melanin to absorb the laser energy.

"I've also heard you can't wax before a treatment. Why?"
The hair must be present in the hair shaft. That is why we ask the patient not tweeze or wax (shaving is okay) for six weeks prior to a treatment.

Questions about Nonsurgical Leg Vein Treatments

What causes leg veins to become apparent?
Spider veins (also known as telangiectasias) and varicose veins (larger diameter blue veins) become visible over time due to many reasons. It is felt that one of the main reasons for leg veins becoming visible is heredity. If your parents have bad spider veins or large varicose veins it is more likely that you will also develop these. Other factors that contribute to the development of visible leg veins include trauma, hormone therapy, pregnancy, and an occupation that requires standing on your feet for long periods of time.

How many treatments are required?
It varies from individual to individual but typically 2-4 treatments are required for the best results. In patients with milder cases, 1-2 will suffice. Larger varicose veins may require more.

Is there any difference in treatment of spider veins as opposed to the large veins?
A stronger solution is used to inject the larger veins. Following treatment, it’s customary for patients to wear compression hose of between 20-40 mm mercury, for at least 2 weeks. Since compression hose can be uncomfortable to wear in hot weather, most of our patients prefer to do this large-vein treatment in the fall or winter months. However, the hose are available in fashionable colors, and our patients don’t object to wearing them – some even find them comfortable. If patients are experiencing pain with larger veins, the hose and sclerotherapy will often diminish it.

Another difference in treatment is that a more extensive evaluation is performed before treating larger veins. This evaluation involves a noninvasive ultrasound to determine the status of the vein network,  to confirm that they are incompetent, and to determine if they are connected to any veins in the deeper system, which may affect the results of treatment.

Are there any side effects to sclerotherapy?
Yes, but they are usually quite minor and include bruising, some brownish discoloration at sites of injection, tiny sores at sites of injection, temporary lumpiness due to coagulation of blood in larger vessels and the development of tiny blood vessels at the injection sites. Most of these side effects resolve over time.

Do I have to limit any activity after the treatment?
We encourage walking but discourage high impact aerobics or heavy weight lifting for 24 hours. For large vein sclerotherapy, heavy exercise is limited for a few days.

Does it hurt?
The sclerosing agents used in our office have very little burning or stinging associated with them. Most patients state that it is painless with only occasional minimal stinging. Patients are pleasantly surprised and say that the procedure was much easier than they anticipated and they tolerate the procedure quite well.

I don't have bulging veins, just lots of visible veins on my legs. What do you do for these?
First, Dr. Hetherington will examine your legs with ultrasound to determine the cause and severity of your condition. Several treatment modalities may be recommended–most frequently, a combination of sclerotheropy and laser.

What is sclerotherapy?
During treatment a sclerosing agent is injected into the veins with a fine needle. For very small veins, the laser is more appropriate.

How does sclerotherapy work?
The solution causes irritation inside the vessel and as the tissue heals the veins shrink.

How many treatments will I need?
Depending on the type, size, and serverity, multiple treatments may be necessary.

Questions about Facial Vein Treatments

Can anything be done to get rid of facial veins?
Yes. We have lasers available that improve the appearance of facial veins. Unfortunately, there are no creams that can get rid of facial veins. However, use of a daily sunscreen may prevent their formation.

How do the lasers get rid of facial veins?
A vascular laser light is the a wavelength preferentially absorbed by hemoglobin in the red blood cells. This action creates heat that causes destruction of the vessel wall and resorption and fading of the facial veins. Surrounding tissue is not affected.

How many treatments does it take?
The number of treatments depends on the severity of the facial veins but generally one treatment will give 50-60% improvement. Second and third treatments are often necessary for maximum improvement, usually separated by 2 months to allow complete fading between treatments.

Does the laser hurt?
Most patients describe the sensation as a rubber band snapping against the skin, or a stinging sensation. It is very tolerable, however, with the laser procedure being quick, any discomfort is short. For those who are very sensitive, a topical anesthetic can be used prior to the procedure.

What will I look like after the laser treatment?
Sometimes there is a little swelling with some crusting or scab formation that may occur. These are usually healed within a week. Most patients who have this laser procedure performed do not need to take off time from their work schedule.

In addition to the veins, my face is generally red especially my cheeks, nose, and chin, will the laser make this better?
No, the laser is very specific, it deals with the actual vein or capillary. Intense pulsed light or Photofacials improve the general underlying redness, texture, and tightness of the skin.

Will the veins come back?
It is possible to have the veins reappear overtime. Good sun protection will help, and touch up treatments may be needed periodically.

Questions about Skin Care Treatments

How is your skin care different than what I can purchase at a spa, salon or department store?
Our skin care is all physician based, designed with prescription ingredients to help you achieve beautiful, healthy, radiant skin. We have systems to correct acne, photo damage, aging, fine lines and wrinkles, sensitive/allergy prone skin and hyperpigrnentation. Our skin care includes extensive follow up and photo documentation to make sure you get results. Beautiful skin, a flawless canvas, is our cornerstone.

Questions about Radiesse™

Does it hurt?
Patient reactions vary, so depending on the area treated, injections may be accompanied by either a topical or injectable anesthetic.

How long with the swelling last?
Everyone reacts differently to injections. You can expect to have mild to moderate swelling the first day. It will lessen each day thereafter and very mild swelling can last for several days. Our anesthetic is formulated to help reduce swelling and bruising during the Radiesse™ injections.

How long will Radiesse™ last?
In facial applications, Radiesse™ should provide a correction that lasts around one to two years (with an occasional touchup). Individual results may vary, affected by age, metabolism, skin type, lifestyle and muscle activity.

How quickly can I return to my normal activities?
Approximately 24 hours following injection of Radiesse, most swelling or redness will have subsided. Some patients return to work immediately following injection, while others may need 24 hours.

Is Radiesse™ permanent?
No. The gel carrier dissipates over a few months allowing for new tissue infiltration. The CaHA particles gradually break down and are metabolized over two to three years. However, due to the reaction of the particles with the body to support collagen growth, when the CaHA particles are dissolved by the body, you will be left with the generated collagen. This new collagen growth will keep the area plumper and your next Radiesse™ treatment will need less product injected with the newly formed collagen growth. Other injectable implants cannot provide this great benefit.

Will Radiesse™ become hard or noticeable to touch?
No, Radiesse™ will remain soft and pliable and will take on the characteristics of the surrounding soft tissue.

Will I need a skin test?
No pre-testing is required due to Radiesse's unique synthetic product formulation and biocompatibility profile.

What is Radiesse™ composed of?
Radiesse™ is composed of synthetic calcium hydroxylapatite (CaHA) microspheres suspended in a gel carrier.

CaHA is a biomaterial with over twenty years of use in orthopedics, neurosurgery, dentistry, and ophthalmology, and is the primary mineral constituent of bone and teeth. The semi-solid nature of Radiesse™ is created by suspending CaHA in a common water based carrier, also used in a large array of products.

Radiesse™ is synthetic CaHA that has similar characteristics to bone and teeth, and is naturally compatible with the body. It has been tested extensively in clinical trials for over seven years now with exceptional safety and efficacy results.

How many treatments will I require?
Some patients may achieve an optimal correction on their first injection. For other patients, variability in the rate of tissue in-growth may require a touch-up to achieve an optimal correction.

Are there any side effects?
There are few reported side effects. However, some common injection-related reactions may occur, such as edema, swelling, pain, itching, discoloration, and tenderness at the injection site.

What if I am taking medication?
Radiesse™ should not be implanted in patients while on an aspirin regimen or while taking other medications that could inhibit the healing process. Please consult your physician for more information.

Can Radiesse™ be injected over other implants?
Radiesse™ should not be implanted in patients with other implants or materials still in place.

Is Radiesse™ approved?
Yes, Radiesse™ is approved for use in U.S., Europe, Canada, and various other countries.

Questions about Restylane®

What is Restylane®?
Restylane® is a safe and natural cosmetic dermal filler that restores volume and fullness to the skin to correct facial wrinkles and folds, such as nasolabial folds.

What is Restylane® made of?
Restylane® is a cosmetic dermal filler made of hyaluronic acid, a natural substance that already exists in the human body. The hyaluronic acid in Restylane® is a crystal-clear gel called NASHA™ or Non-Animal Stabilized Hyaluronic Acid. NASHA is completely biocompatible with human hyaluronic acid.

Restylane® maintains its shape using the body's own moisture. The hyaluronic acid in Restylane® is hydrophilic or "water loving." As hyaluronic acid gradually degrades, each molecule binds to more water and over time, the same volume can be maintained with less hyaluronic acid. This ability of hyaluronic acid to bind to water is what helps provide lasting results.

How is Restylane® different than other hyaluronic acid-based products?
Unlike rooster-derived hyaluronic acids and bovine collagen products, Restylane® is free from animal proteins. This limits any risk of animal-based disease transmissions or development of allergic reactions to animal proteins.*

Is Restylane® safe?
Since 1996, over 3 million Restylane® treatments have been safely administered by dermatologists and plastic surgeons in more than 70 countries. This innovative treatment is now approved in the U.S. for the treatment of facial wrinkles and folds.

Based on clinical studies, Restylane® treatments produce a low occurrence of adverse events. The most commonly reported side effects were temporary redness and swelling at the injection site. These effects typically resolve in less than seven days.

Where can Restylane® be used?
Restylane® has been used in more than 3 million treatments in over 70 countries to correct a variety of wrinkles and to enhance the appearance of the lip border. It is currently approved in the U.S. for the treatment of facial wrinkles and folds, such as nasolabial folds, which are the lines from the nose to the corners of the mouth.

How long does Restylane® last?
Restylane® is proven to deliver long-lasting results. Studies have shown that Restylane® effects generally last for about six months. The unique NASHA technology helps maintain the cosmetic effect until the injected material is nearly gone.

How often should I have Restylane® treatments done?
Follow-up treatments are typically scheduled at six-month intervals. (Individual results may vary.)

What should patients do prior to treatment?
You should take a few precautions before being treated with Restylane®. One week prior to treatment with Restylane®, avoid taking St. John's Wort, high doses of Vitamin E supplements, aspirin, and other non-steroidal anti-inflammatory medications, such as ibuprofen. These agents may increase bruising and bleeding at the injection site. Also, if you have previously suffered from facial cold sores, there is a risk that the needle punctures could contribute to another recurrence. We can provide a prescription for antiviral medication.

How is Restylane® different from Botox® Cosmetic?
Restylane® is a natural, cosmetic filler. Botox is a drug that blocks nerve transmission and relaxes the underlying muscles. Many patients have been very pleased after receiving treatment with both products.

Do the injections hurt?
Restylane® is injected directly into the skin in tiny amounts by an ultrafine needle, resulting in minimal discomfort. The procedure is simple and convenient and results are practically instantaneous. To optimize your comfort during the short procedure, your physician may decide to numb the treatment area.

Questions about Portrait® Skin Regeneration

What makes Portrait® different from other available treatments?
Portrait® is a brand new technology clinically proven to stimulate a natural regenerative process of the skin. It is the first to use plasma energy and represents a dramatic leap forward in the science of beauty. Plasma makes it possible to address the unmet demand for significant improvement to the skin with predictable and manageable recovery time and little to no risk of complications associated with other more aggressive anti-aging treatments.

How does it work?
Portrait® uses plasma energy to produce a unique thermal response at and below the skin's surface. This stimulates significant remodeling of the skin's architecture, replacing old damaged collagen with significant amounts of new collagen and replacing the damaged elastin tissue. This is the key to quality, long-lasting and simultaneous improvements in wrinkling, skin laxity, skin texture, acne scars*, pore size, and surface discoloration. The sun damaged skin is removed and the new collagen significantly improves the appearance of the wrinkles and tightens the lax skin without surgery.
*Not an FDA cleared indication

What is plasma?
The fact is, plasma is all around us. The sun is made of it; it's contained in lightning as well as the aurora borealis. Plasma is a gas in which atoms have been ionized or stripped of electrons. Portrait® delivers plasma energy, a unique thermal energy, without direct contact with the skin through a handpiece. The thermal energy is uniformly absorbed by the skin, creating the right conditions and natural growth factors for new collagen and continuing skin regeneration for a natural, more youthful appearance.

Who makes a good candidate for Portrait®?
Portrait® is ideal for those people who do not want more aggressive treatments but who want the same profound results. Anyone who has lost elasticity or has wrinkles around the eyes and lips should consider Portrait® because it is particularly effective in treating these areas of the face. Most skin types are appropriate for the Portrait® procedure which sets it apart from laser and other light-based treatments. If you have darker skin or are prone to scarring, you should seek the advice of your physician.

    In general good candidates include:
  • Someone with sun-damaged skin who wants to reduce the appearance of wrinkles, improve skin texture, and tighten lax skin
  • Individuals seeking a cleaner and clearer complexion that minimizes enlarged pores
  • Someone considering laser surgery, a chemical peel, face-lift or other cosmetic surgical treatments
  • Individuals seeking to repair photodamage and improve the appearance of age spots and the yellow pallor of solar elastosis

How many treatments does a patient need?
Three treatments are recommended.

What does the procedure feel like and how long does it take?
You may experience a sensation of heat during the brief procedure. Generally, a full face treatment can be completed in 20 to 30 minutes. All treatments require that you apply a topical anesthetic before the procedure.

What kind of improvements can I expect to see?
You will see improvements in skin texture and tone with reduced fine wrinkles. You will see reduced deep wrinkles, and overall tightening. As the changeover to regenerated skin occurs, the overall improvement of skin quality will be quite evident.

How long will the effects last?
The results will be seen almost instantly. Additionally, one of the unique characteristics of Portrait® is that your skin will show continual improvement over time. Patients from clinical studies have reported on-going improvements for as much as a year after treatment.

Is the Portrait® procedure safe?
Nitrogen plasma is a naturally occurring element. Portrait® is very safe and its heating effect is highly localized. It does not involve the kind of intense, potentially damaging light radiation found with laser treatments yet it delivers uniquely improved results.

Can Portrait® be used with other treatments?
Your physician will advise you on the best way to combine treatments such as Botox or dermal fillers. If you have had a chemical peel or other resurfacing procedure within the last 12 months you should discuss the timing of having your Portrait® procedure with your physician.

Questions about Photo Dynamic Therapy

My dermatologist wants me to have my AK’s removed by cryotherapy but I frequently get a white scar after healing. Is PDT as effective as Cryotherapy and is there any scarring? 
Big Sky Cosmetic Surgery strongly urges patients to have regular check-ups with their Dermatologist especially after PDT to confirm that the lesions have been removed.
In a split face study Morton et al.*
 At week 24:   lesion reduction of 89.1% PDT, 86.1 Cryo.
64.8% of the participants preferred PDT, 31.5% preferred cryo.

Another advantage is that the entire face is treated so an overall cosmetic improvement in pigment, texture, and tightness is evident.  

  * Morton A, Campbell S, Gupta G, et al. Intraindividual, right-left comparison of topical methyl aminolaevulinate-photodynamic therapy and cryotherapy in subjects with actinic keratoses: a multicentre, randomized controlled study. Br J Dermatol. 2006;155:1029-1036.  

Are there side effects and or downtime?
Anticipated side effects of Levulan treatment include discomfort, burning, swelling, redness and peeling, especially in any areas of sun damaged skin and pre-cancerous lesions.  All of this should be resolved within ten days.

Patients need to avoid direct sunlight for 48 hours following the treatment due to an extreme increase in photosensitivity. Treatment is contraindicated if you are pregnant.

How many treatments will I need?
This is a case specific question and will be discussed during your consultation but in general the following would apply: Some skin conditions respond with a single treatment.

In the case of sun damage and precancerous lesions, at least two treatments 2 to 4 weeks apart are recommended with improvements visible after each treatment.

In the case of acne, four treatments 2 to 4 weeks apart are suggested with improvement seen after each treatment.

How much improvement can I expect?
You can expect to see improvement with each treatment.  People with severe sun damaged skin, AK’s, sebaceous hyperplasia, poor texture and uneven pigmentation may see excellent results after one treatment.

Active acne can improve dramatically after several treatments with a diminishment in the active lesions and improvement in the discoloration left after the lesions has healed.  The effects of the treatment are very long lasting-typically several years.

Financial Questions

What kind of payment options are available?
We accept Visa, Mastercard, American Express and Discover. We also have financing information available at your request.

CareCredit is a credit card exclusive for healthcare services. With CareCredit, you can get a No Interest* payment plan if paid in full within 6 or 12 months on purchases with your CareCredit card. Interest will be charged to your account from the purchase date if the promotional balance, including optional charges, is not paid in full within 6 or 12 months or if you make a late payment. Minimum monthly payments required. Apply today!

Lodging Options for our Out of Town Patients

The following Bozeman Montana Hotels offer special rates for our patients. Please contact our office for details.

Holiday Inn
5 Baxter Lane
Bozeman, Mt. 59715

Best Western
GranTree Inn
I-90 & North 7th Ave.
Bozeman, Mt. 59715

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Right Angle Communications