Online Health Chat with Dermatologist Christine Poblete-Lopez, MD, and Plastic Surgeon J. Vicente Poblete, MD
Monday, September 22, 2014 - Noon (ET)
Cosmetic surgical and dermatology procedures have increased significantly in the past decade. American Society for Aesthetic Plastic Surgery (ASAPS) statistical data indicates “a 12 percent overall increase in cosmetic procedures performed in the United States in 2013. More than 11 million cosmetic surgical and nonsurgical procedures were performed by board-certified plastic surgeons, dermatologists and otolaryngologists in the United States, totaling more than 12 billion dollars for the first time since the Great Recession began in 2008. Of that total, more than 7 billion was spent on surgical procedures and more than 5 billion was spent on nonsurgical procedures.”
Women compose about 90 percent of the cosmetic procedures compared to 10 percent for men. More people are conducting online research about cosmetic procedures. Advances in technology, less invasive procedures and greater access have contributed to this increase.
When considering cosmetic treatments or plastic surgery to refresh your appearance, you should address many questions and discuss recent trends with a board-certified specialist. From Botox® and chemical peels to tummy tucks and facelifts, cosmetic surgery can help reawaken your natural beauty and improve your confidence and overall outlook. But when deciding if this is right for you, there are many things to consider.
At Cleveland Clinic Cosmetic & Plastic Surgery Center, our highly experienced, board-certified surgeons and specialists offer significant experience in all areas of aesthetic and reconstructive plastic surgery, from surgical to non-surgical procedures.
Join our webchat with dermatologist Christine Poblete-Lopez, MD, and plastic surgeon J. Vicente Poblete, MD, to ask questions about all cosmetic and plastic surgery options, including facial cosmetic surgery, cosmetic injectables, facial resurfacing and rejuvenation, cosmetic and reconstructive breast surgery, body contouring surgery, non-surgical body procedures and hair loss treatment.
About the Speakers
Christine Poblete-Lopez, MD, is Assistant Program Director in the Department of Dermatology, Cleveland Clinic. She completed her medical education at Mount Sinai School of Medicine and completed a residency in dermatology at the Skin & Cancer Foundation in the Philippines, as well as Cleveland Clinic. She also completed a fellowship in dermatologic surgery at Cleveland Clinic. She has specialty interests in cosmetic dermatology, cosmetic injectable fillers, Botox® and laser surgery. Dr. Poblete-Lopez is board-certified by the American Board of Dermatology.
J. Vicente Poblete, MD, graduated from the University of Virginia School of Medicine. He pursued his surgical training with a residency in general surgery at St. Vincent’s Hospital and Medical Center, New York Medical College. He also completed a fellowship in hand surgery at the Columbia Presbyterian Medical Center, as well as a fellowship in facial plastic and reconstructive surgery at the New England Deaconess Hospital-Harvard Medical School, Boston. Dr. Poblete’s special interests include cosmetic and facial plastic and reconstructive surgery. He is board-certified in both general surgery and plastic surgery. He is a member of both the American Society of Aesthetic Plastic Surgery and the American Society of Plastic & Reconstructive Surgeons.
Let’s Chat About Cosmetic Treatments & Procedures.
Moderator: Good afternoon and welcome. Thank you, Drs. Poblete and Poblete-Lopez, for being with us to share your expertise about the treatments and procedures that are available to help people improve their overall appearance.
Let’s go ahead and get started with the questions. . .
Age and Cosmetic Surgery
Sammie: What is the current trend of teenagers seeking cosmetic dermatologic and plastic surgery procedures? Please discuss age appropriateness and the types of procedures.
J._Vicente_Poblete,_MD: Actually, a report from the American Society of Plastic Surgery has noted a decrease in teenage cosmetic surgery these past years. The most commonly requested procedures were otoplasty (ear surgery), nose reshaping and breast reduction. More than a specific age as a cut-off, it is the assessment of physical maturity - whether the part to be operated on has fully developed or not - emotional maturity and expectations that are of prime consideration.
Justine: How old is too old for cosmetic procedures? Are there certain procedures that are just not wise to have done and at what age?
J._Vicente_Poblete,_MD: There is really no specific cut-off age for being considered "too old" for cosmetic surgery. I think it is more of your health condition that should be the primary determinant in deciding fitness for cosmetic surgery. The presence of heart conditions, lung conditions and other co-morbid medical conditions increase the risk of ELECTIVE cosmetic surgery. If these conditions exist, I usually ask for the patient's primary care physician or cardiologist to do am assessment and give us guidance on whether or not the patient is cleared for surgery.
CaitlinB: Should we assume we're connected and able to see everything if we can read what you just wrote or is there another portal that we should connect to?
Moderator: The questions and answers come out as soon as the physicians are finished typing them. There is a delay between them, but yes, if you can see this, you are connected!
Finding a Physician
RSJ192211: How do I find the right cosmetic surgeon? What qualifications do I look for, etc?
J._Vicente_Poblete,_MD: There is merit in this question given the increase in "non-qualified" individuals performing different procedures. It is best to check whether the practitioner is "board-certified" in his/her particular specialty. Just being "board-certified" does not mean much if the specialty is not indicated. Case in point, if one is to undergo a hysterectomy, one would be best guided to seek the services of a physician "board-certified in obstetrics and gynecology.” You would not go to a plastic surgeon to have a hysterectomy, right? The corollary is true. If one were to undergo a plastic surgical procedure, it is best to go to a physician who is "board-certified in plastic surgery." It is a "buyer beware" market today with many individuals advertising themselves as "board-certified" without actually specifying what field of training they are actually board-certified in.
RSJ192211: What questions should a person ask during a consultation?
Christine_Poblete-Lopez,_MD: This would really depend on what you are looking for. I think this is a two-way conversation, and your questions will start to come when the physician asks you what brings you to the office. Use the consultation as an opportunity to learn about products or services that you may be interested in, to assess your comfort level with the physician; and then to collaboratively come up with an action plan to address your needs.
Moderator: On Cosmetic Treatments & Procedures
Learn more about symptoms, causes, diagnostic tests and treatments for cosmetic rejuvenation at:
CaitlinB: Hello. I am a bariatric surgery patient. I lost 131 pounds and now maintain a stable weight of 160 pounds. My surgery was two years ago. I am a 28-year-old female. My only other health concern is IBS. I'm very interested in having a full body lift, as I have a lot of extra skin, including a very ugly apron that makes me feel very self-conscious and makes clothes almost impossible to find. I also have notable loose skin on my upper arms and upper thighs. The following are my questions.
1) In order to take care of these things, approximately what price range am I looking at?
2) What are the results that I can expect?
3) How long is recovery?
4) Can this procedure be done in one surgery or would it be done in various stages?
5) Is liposuction included in the price if it is necessary to obtain optimal results for the surgery? If not, what would the additional cost be? Thank you.
J._Vicente_Poblete,_MD: With the increasing popularity of weight loss surgery comes the increase in body contouring procedures associated with the extra skin that results after the weight loss procedures. Most involve multiple areas and I ask the patients to prioritize the areas so that a proper treatment plan can be tailored for each. Given the different procedures and the different staging plans, it is hard to give a price range on these, and this is best discussed during the consultation process.
Results will vary from individual to individual and with the amount of laxity and residual fat. If liposuction is needed, this can either be done at the same stage or in different stages; this varies from surgeon to surgeon.
casi: I was wondering about breast augmentation; above or below the muscle?
J._Vicente_Poblete,_MD: The decision to place the implant above or below the muscle is a joint decision between the patient and the plastic surgeon. In general, factors to consider would be desire by the patient to have a more natural contour, the position of the breast in relation to the muscle - the pectoral muscle is what we are referring to in this case - the thinness/thickness of the breast soft tissues and its ability to conceal the implant. Note that even with an "under the muscle" placement, the implant is not covered by the pectoral muscle 100 percent since the muscle border stops laterally and generally, the lower-lateral part of the implant will not be covered.
pa2four: Does Cleveland Clinic have any breakthrough procedures in cosmetic surgery that sets them apart from any other cosmetic surgery center?
Christine_Poblete-Lopez,_MD: A combination of ultherapy and fractional ablative laser resurfacing is an excellent non-surgical option for facial rejuvenation.
Ultherapy is a non-invasive, no downtime treatment that tightens your skin with the introduction of high focused ultrasound. The treatment can be done to the full face, neck, focused areas of the face or any combination of the above. There is no break in the skin, although the heat from the ultrasound can be painful (feels like hot pins and needles). There is no downtime. Your skin will feel tender and you may get some yellowish bruising the day after. The heat generated from the ultrasound induces collagen remodeling and skin tightening that is noted over six to nine months, but the results are more sustained. This is best for patients who are not yet facelift candidates.
Fractional ablative laser resurfacing with the Smartskin laser involves the use of a laser that removes microscopic columns of skin and inducing collagen remodeling during the healing process. This essentially strips fractionated areas of the skin to allow for rapid healing. The healing process requires some downtime. Depending on how aggressive the treatment is, this can be anywhere from two to three days to seven to ten days of redness, swelling and looking raw. Because the procedure breaks the skin, the procedure has some risks, such as infection, scarring and dyspigmentation. We prep the skin to minimize the dyspigmentation. We prescribe antibiotics and antivirals to minimize the risk of infection and therefore minimizing the risk of scarring. One can expect a small amount of skin tightening, a lightening of sun spots, an improvement of fine wrinkles and an overall rejuvenation.
Combine this with the ultherapy and you get a "repainting" of the surface skin with the laser and a tightening of lax skin with the ultherapy and you get an overall rejuvenation without having to undergo surgery.
pa2four: I am a small person who was slightly overweight and recently lost 15 pounds. Is there an effective, less expensive way to "rid" the neck of a small amount of fat/sagging? I can't afford liposuction. (Maybe there's a new procedure to "melt" it?)
J._Vicente_Poblete,_MD: Contouring the neck has several issues: amount of fat, limited to the central portion or not, amount of skin laxity, the basic anatomy of the underlying neck structures, the presence or absence of platysmal bands (vertical lines in the middle of the neck that get prominent with animation). If "limited tightening" is desired, ultherapy may be an option. When one talks of "melting fat," there are several options on this - laser treatment, ultrasonic treatment, radiofrequency treatments. The next issue would be - what do you do with the fat that has been melted? What would you do with the skin that may be more lax due to the fat breakdown?
megr: My eyelids are getting very droopy. Could you please explain the procedure to fix this? Also, I have "bags" under my eyes. Is there a procedure to correct this and would these procedures be done at the same time? I do have allergies and have always had slight "bags" under my eyes. Would the "bags" come back since I have allergies? Last, but not least, what are the success and failure rates on these procedures? What complications occur and do occur most often?
J._Vicente_Poblete,_MD: There are two areas here, droopy eyelids and baggy eyes. First, with droopy eyelids, the procedures of choice may be an eyelid surgery to remove excess skin or a brow lift or, in some cases, a combination of both procedures. With "bags under the eyes," there are several approaches to this, but the main principles are fat removal or repositioning, if needed, and excess eyelid skin removal. Both upper and lower lid procedures are effective, but as with any other surgical procedures, there are complications.
megr: Since I have allergies will the "bags" under my eyes come back. This question was not addressed by you in my previous question as was the question as to what are the most common complications.
J._Vicente_Poblete,_MD: Swelling of the lower lids with allergy may recur even after surgery. Regarding complications, there are several and this is best discussed in detail during a consultation. In general, the following have been identified: infection, bleeding, scars, damage to the globe itself and lower lid lag or retraction. Also, upper lid closure may be affected – an inability to completely close the upper lids – as well as lid malpositioning.
maritter: What is the safest, least risk-best benefit outcome method of removing facial sunspots and pigment irregularities?
Christine_Poblete-Lopez,_MD: First and foremost, using a sunblock moisturizer on a daily basis will help minimize the darkening of these sunspots. I stress daily because people often think they should only use sunblock when they are "out in the sun." However, we get some sun exposure on a daily basis, even in our Cleveland weather, because the sun's rays go through clouds and windows and reflect on snow. So, even the walk to the car to and from work and the drive to work expose our skin to the sun.
Secondly, a prescription product called hydroquinone (at a 4 percent concentration) used twice a day will help. Augment this with another prescription product called tretinoin. That combination does well. I usually recommend using this at least three to six months to see the effects.
In terms of procedures, lightly freezing the area with liquid nitrogen (cryotherapy) works well. This doesn't work well with skin of color, as the liquid nitrogen can result in lighter spots in the treated areas. This is the quickest, most economical way to treat the sun spots. Often a second or third treatment may be necessary. Other laser treatments (pigmented laser or resurfacing lasers) may also work, but these are usually more expensive and also require more than one treatment.
LucyintheSkies: There are so many skin care products available and many can be quite expensive. I am currently using an Erno Laszlo skin care regime, but I wonder if it will really tone down my age spots over time? I would rather do this prior to having laser removal. I tried the prescription for Retin A but it really bothered my face.
Christine_Poblete-Lopez,_MD: I'm not exactly sure what the ingredients are in the Erno Laszlo skin care line. However, using products dispensed or recommended by your dermatologist or plastic surgeon, usually prescription products or cosmeceuticals (products dispensed at a physician’s office), tend to have higher concentrations of ingredients that are known to work well. For example, glycolic acid products, hydroquinone, tretinoin (like the one you tried) all work well in managing age spots. But always start with a sunblock on a daily basis. There are many different preparations of tretinoin that are available for different skin types. I would go back to see the physician who prescribed the Retin A and ask for another recommendation. There are more moisturizing versions of Retin A (like Renova®) that you can try. Also realize that these are acids you are using, so start slowly when you use them and you will develop a tolerance for using them. Otherwise, other products like glycolic acids work well for those who cannot tolerate tretinoin.
Gail Ann: You suggest applying sunblock moisturizer daily. Is the sunblock moisturizer still effective when using it under makeup? Thank you for answering my question.
Christine_Poblete-Lopez,_MD: Yes definitely.
LucyintheSkies: If you are using 'over-the-counter' skin products, what should you look for in the product? And is there really a difference between illuminating products versus. wrinkle products versus hydration products versus age-spot products?
Christina Smith, Aesthetician: In anti-aging/wrinkle products, I would look for a Retin A. For age spots, it would be a hydroquinone. For illuminating, it would be a Vitamin C product. For hydration, I would look for a good moisturizer, either a lotion or a cream base. There are so many different products on the market. I would love to have you make an appointment with me and we could chat on what would be the best product for your type of skin and for your concerns.
heffone: What is the downtime for a neck lift? Thank you.
J._Vicente_Poblete,_MD: Downtime from surgery is hard to answer in a general way because everyone has a different interpretation of what is "downtime," no driving, no working out, no social activities, etc. These are general guidelines. 1) I advise patients NOT to drive while they are still taking narcotic pain medications after surgery. 2) Downtime is dependent on what you do on a day-to-day basis. The requirements on someone who is retired are different than those on one who is working and doing heavy labor versus one who is working and does mainly desk job functions - phones, computer, etc. 3) Downtime is different depending on what type of procedure you undergo. The downtime in someone who had a facial procedure would be different from someone who had a body contouring procedure (e.g., tummy tuck). These are valid concerns and these are best addressed during consultation with your board-certified plastic surgeon.
CaitlinB: What is the typical recovery time for body contouring surgery?
J._Vicente_Poblete,_MD: There are different types of body contouring procedures, but generally, I advise patients this way:
1. They should be walking, even for a limited basis, on the day of surgery.
2. No driving while on narcotics.
3. No heavy lifting or trunk-related exercises for the first three weeks, assuming no problems after surgery.
4. Return to work is dependent on what kind of work that person does.
janiceasad: I visited Dr. Foglietti for a first visit for facial plastic surgery. Do all Cleveland Clinic doctors make you spend the night like at the Beachwood location? It really makes the price go up.
J._Vicente_Poblete,_MD: Overnight stays are on a case-by-case basis, and physician-to-physician basis. This is best discussed with the treating physician.
Moderator: I am sorry to say that our time with Cleveland Clinic dermatologist Dr. Christine Poblete-Lopez and plastic surgeon Dr. J. Vincente Poblete is now over. Thank you both for sharing your expertise and time to answer questions today.
Christine_Poblete-Lopez,_MD: Thank you very much for your questions. Remember, using a daily sunblock moisturizer is the first step in delaying the aging process. Even in our Cleveland weather, I would make a habit of using it first thing in the day. That way you know you are covered and protected, whether you are off to work or going shopping or to the grocery. The sun is everywhere. I don't ask my patients to avoid the sun, I just ask them to be sun-smart and protect their skin from the sun. So I would do the same to all of you. Thank you.
J._Vicente_Poblete,_MD: I would like to thank everyone for joining us today. There were a lot of good questions and discussion points. Obviously, cosmetic surgery is very popular these days. If you have any additional questions or concerns, it will help if you visit our website: www.clevelandclinic.org/renewyou. Have a great day everyone and enjoy the fall weather.
To make an appointment with one of Cleveland Clinic’s Cosmetic and Plastic Surgery Center specialists, please call 216.444.6900 or call toll-free at 800.223.2273, ext. 46900. You can also visit us online at clevelandclinic.org/renewyou.
For More Information
On the Cosmetic & Plastic Surgery Center
Cleveland Clinic’s Cosmetic & Plastic Surgery Center provides expertise for both surgical and non-surgical cosmetic procedures, ranging from body contouring to breast procedures to Botox® injections. The Center offers patients access to a range of cosmetic specialists including plastic surgeons, dermatologists, oculoplastic surgeons, head and neck surgeons and aestheticians. Additionally, our surgeons are dedicated to improving patient outcomes through innovative cosmetic surgery advances, including minimally invasive facelift techniques, alternatives to face and necklift surgery, shortscar facelifts, and SmartLipo technology. To see a full listing of our cosmetic services, specialists, locations and before/after patient images, visit clevelandclinic.org/renewyou.
On Skin Care and Cosmetic Surgery
Learn more about skin care and cosmetic surgery:
On Your Health
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A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit eclevelandclinic.org/myConsult.
This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician’s independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians. ©Copyright 1995-2014. The Cleveland Clinic Foundation. All rights reserved.