Masha Banar, Board Certified Physician Associate
Masha is a Board Certified Physician Associate with over a decade of experience in Plastic and Reconstructive Surgery, Dermatologic Surgery, Dermatopathology, and Hair Transplantation. A graduate of Northeastern University's PA Program, she completed her residency during 5-years at Boston Medical Center's Department of Plastic and Reconstructive Surgery, where she covered hand trauma and surgery emergencies, and plastic and reconstructive surgical cases.
Non-surgical Face Sculpting
Fillers are a safe and temporary alternative to rhinoplasty, chin augmentation, brow lift, or even cervicoplasty (lower face lift). Procedure takes about half an hour, is not painful, has minimal side effects like swelling and bruising for a few days, and is more affordable.
Non-surgical rhinoplasty or nose job.
This quick procedure can make your nose appear more aesthetically pleasing to the eye. Whether it's the projection of nasal tip, overall symmetry of the nose, or smoothing the sharp angles or "bumps"-fillers can temporary alter the shape of your nose and make it look more proportional to the rest of your face.
Non-surgical chin augmentation
Chin that lacks projection can make your face look unpoportional and weak. Men might want to augment the chin for more masculine appearance as well. Fillers are safe alternative to chin augmentation.
Non-surgical face lift
We lose a lot of volume in our face with age. Cheeks deflate and skin drapes itself to create smile lines, marionette lines, and jowles. Replacing volume in the cheeks can literally lift the face and achieve more feminine and young contour of the face. Fillers or fat and stem cell transfer are best alternatives for the face lift.
Non-surgical tear trophs treatment
Do you look tired even after a good night sleep? Do you have bags or depressions under your eyes? You might need blepharoplasty, but if you're not ready for surgery you can try a safe alternative-hyaluronic acid filler. Come in for a consultation to see if this procedure is for you.
Eyelid Surgery
Blepharoplasty (eyelids lift) is surgery to repair droopy eyelids by removing excess skin, muscle and fat.
As you age, your eyelids stretch, and the muscles supporting them weaken. As a result, excess fat may gather above and below your eyelids, causing sagging eyebrows, drooping upper lids and bags under your eyes. Blepharoplasty can reduce make your eyes appear younger and more alert.
An incision is made along the natural fold of the upper eyelid. Then excess skin and some muscle and fat beneath the skin are removed. The incision is closed with tiny stitches that leave a nearly invisible scar.
The incision on the lower lid is made just below the lashes in your eye's natural crease or inside the lower lid. The surgeon removes excess fat, muscle and sagging skin. Stitches follow the lower lid's natural crease.
Blepharoplasty usually takes less than three hours, depending on the amount and location of tissue being removed. Afterward you spend time in a recovery room, you can leave later that day to recuperate at home.
After blepharoplasty a lubricating ointment will be applied to protect your eyes and prevent dryness. The ointment often may cause temporary blurred vision. You may also experience excessive tearing, light sensitivity and double vision just after the surgery. Your incisions will be red and visible at first, and your eyelids may be puffy and feel numb for several days. Swelling and bruising, similar to having "black eyes," will likely last a week or more. Ice packs or cold compresses applied to your eyes can help reduce swelling.
Pain is usually minimal. You may be given a pain reliever, such as acetaminophen, for mild discomfort, but remember to avoid Aspirin, Ibuprofen (Advil, Motrin, others), other NSAIDs and herbal supplements that may increase bleeding. Stitches are usually removed in about five days.
As with any surgery, blepharoplasty carries some risks, such as:
- Bleeding, infection, scarring
- Temporary numbness of the eyelid skin
- Dry, irritated eyes
- Temporary vision changes, such as double vision
- Impaired eyelid function
- A very small risk of blindness due to bleeding behind the eye
Double-eyelid surgery / Asian blepharoplasty
Double-eyelid surgery is the most common cosmetic procedure in China, and East and South Asia. The typical Asian eye is characterized by puffiness and lack of a supratarsal fold in the upper eyelid (single eyelid).
About half of Asian patients posses an upper eyelid with a low but defined eyelid crease and another half have no sign of crease formation. Even when present, Asian crease differs from typical Occidental (Western) crease as it is closer to the eyelashes and is shaped differently.
Why is Asian eyelid so different from non-Asian?
The Asian eyelid that has no crease has the levator muscle (muscle of upper eyelid that opens it) insert either very low (for partial or low creases) or not at all into the skin, so that no crease is visible. The reason that the Asian eyelid appears puffier than the Occidental eye is that the fat (postseptal fat) hangs lower over the eyelid to make the eyelid appear both fatter and the eyelid opening narrower. Creation of the crease moves the fat out of the way and creates the same degree of opening in the eyelid aperture.
Occidental (Western) eyelid. Asian eyelid.
Notice how levator aponeurosis extends into the upper eyelid muscle and skin to create a fold (Left diagram).
How do you create a fold in the upper eyelid?
After the initial skin incision, the orbicularis muscle is encountered and moved out of the way to visualize the orbital septum. The orbital septum holds back the fat pad, and immediately below it lies the levator muscle . The levator is the structure that is fixated to the skin with sutures to create the levator-to-skin crease that is desired. These sutures are removed after one week when the levator to skin fixation is already durably created during the healing process.
Is the surgery safe?
Although any procedure carries some risks, double eyelid surgery is safe.
When can I go back to work?
Most of the patients take a week off from work at which point the swelling goes down significantly.
Fat Transfer / Liquid Facelift
Fat grafting is rapidly becoming one of the most requested procedures for a new generation.
It offers a valuable tool to address the demands for less invasive cosmetic procedures that produce natural, long-lasting results.
With age we lose the fat in our faces. At the same time supporting ligaments of the fat compartments stretch and allow the fat to descend with gravity. These factors contribute to the flatness of the cheeks, deepened tear trophs and nasolabial folds, marionette lines, and jowls.
The latest trend in plastic surgery is replacing lost volume of the face for the lift rather than just pulling the skin upwards.
Fat graft is minimally invasive in office procedure that is usually performed under local anesthetic. Pre-operatively we plan where and how much we would inject and where would we take the fat from (usually flanks, abdomen, and thighs).
On the day of procedure someone should drive you to the office and pick you up. We give medications to control pain and anxiety, and you will not be able to drive by yourself.
Procedure: fat is harvested with micro-cannula attached to 10 cc syringe with applied negative pressure. It is then transferred to the centrifuge to separate it into components. After we get rid of extra fluid fat is gently transferred to smaller syringes and injected in the same fashion as a filler would be, in your face. Procedure takes from one to two hours. You will then spend some time in recovery and room and later will be discharged home.
Injectables
Facial fillers / Radiesse
Radiesse is the best filler for "liquid facelift" and treatment of nasolabial folds in my opinion: it lasts about one year, it gives fantastic support for the skin of the face and has a great cost/benefit ratio compared to some of the other products available. Another benefit is instant result with minimum downtime for those of you who MUST look your BEST in two weeks!
This product is FDA approved and has been on the market for a very long time to prove its safety and longevity. It is made of methyl-carboxy-cellulose gel with calcium hydroxy appatite crystals, which is completely biodegradable and non-reactive (cannot cause allergic reaction).
Treatment takes about 15 minutes and should not hurt at all. I love using this filler to re-create youthful cheek contour and lift the face, and to smooth smile and marionette lines. I also use it to enhance cupid's bow and philtrum columns, which gives the lips definition and support.
Lastly, I use it to augment chin and jaw line, lift the brows, and to change the shape of the nose (augmentation of nasal dorsum and tip, see "non-surgical face sculpting").
A lot of clinicians prefer hyaluronic-based fillers like Restylane and Juvederm because it's much easier to use them, they are dissolvable in case of any mistakes, and they don't last as long as Radiesse. Although I love using Juvederm for lips augmentation and filling of tear trophs (depressions under the eyes), I favor Radiesse for other treatments for the reasons above.
JUV�DERM�
JUV�DERM� is a smooth consistency gel made of hyaluronic acid � a naturally occurring substance in your skin that helps to add volume and hydration. JUV�DERM� injectable gel instantly restores skin's volume and smooth away facial wrinkles and folds.
The new JUV�DERM� XC formulation is enhanced for patient comfort-it has the numbing agent, Lidocaine, mixed in the product. You can now get the smoothness you expect, with the improved comfort you want. JUV�DERM� XC provides smooth and natural looking results and now a more comfortable experience � so everyone will notice but no one will know!
With JUV�DERM� the injection process takes only about 15 minutes and results are immediate. Plus, there�s minimal recovery or downtime. And now with the newest formulation of JUV�DERM�, the effects of Lidocaine take place in seconds, potentially reducing the need for further anesthetic.
This product is best for lips augmentation and fine wrinkles around the mouth.
Botox
Botox is a prescription medication approved by FDA since 2002. Botox is used to treat wrinkles created by movement of muscles by temporarily preventing the muscles from flexing. You can treat glabellar wrinkles ("number 11s" between brows), crow's feet around the eyes, lines on the forehead, or even lift the brows to slightly open up the upper eyelid. Treatment is very quick and safe. Botulinum toxin has been available for several decades and much higher than cosmetic doses are used to treat some medical conditions like muscle spasms, migraines, or hyperhidrosis (excessive sweating).
Risks are minimal and very limited in the hands of experience injector. Although the science and anatomy behind the treatment is relatively simple, it still takes an artistic eye and precise knowledge or anatomic landmarks to create natural looking results.
Results usually last about three months. In my experience, if patient comes in 2-3 times in a row every 3-4 months, muscles get weaker and less product is needed less frequently. Just like with other products, people with very high metabolism who are naturally very thin and/or work out regularly might have results that last less than three months.
Lip Augmentation
If you always wanted to have perfect pouty lips or want to get rid of smoker's lines around the mouth you might consider lips augmentation. It is important to not only look at the volume and proportion of the lips, but their shape--this part is often neglected by many injectors. Cupid's bow is the most attractive part of the mouth and could be enhanced as well. The best temporary filler for the lips is hyaluronic acid (Juvederm, Restylane) and for more permanent results Masha suggests fat graft.
Procedure takes about 20 minutes and is done under local anesthesia (I use both numbing cream and nerve block with Lidocaine-anything to make it less painful!). Bruising and swelling can last a few days and results can last up to one year.
Lipodystrophy Reconstruction
Reconstruction of Facial Lipodystrophy
Patients with human immunodeficiency virus are often affected by lipodystrophy-syndrome of fat redistribution. Fat disappears in the face and accumulates centrally (neck, breasts, abdomen). These are common side effects from highly potent anti-retroviral medications.
Morphological changes related to highly active anti-retroviral therapy are often devastating to the patients and affect their quality of life significantly. There are several reconstructive options available to tackle this disfiguring condition. Please schedule a consultation to discuss which option is best for you.
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| Mild lipoatrophy of the face |
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