The Evolution of Cosmetic Surgery

Boosted by baby boomers doing all they can to maintain their youth, cosmetic surgery is growing in popularity at a rapid pace. Statistics report that over the past five years, cosmetic surgery procedures have grown by almost 300%.

Desired concepts of beauty are constantly changing, due in part to new technology and expert techniques. According to plastic surgeon, Juris Bunkis, M.D., F.A.C.S. of Orange County Plastic Surgery in Rancho Santa Margarita and Dublin, California, the tight, pulled “wind tunnel” look was the signature of a 1970s-era facelift. There was also the scooped nose with a pinched nasal tip, and unnaturally round, hard breasts after breast augmentation surgery.

Such obvious signs of surgery are no longer desirable by most people, and increasingly shunned by patients who wish to turn back the clock in a more natural way, without such tell-tale signs of surgery.

“Facial surgery is not about looking 30 at age 75! No amount of skin and muscle tightening can achieve such an unrealistic goal,” stated Dr. Bunkis. “It’s about looking the best you can, at any age.”

Other factors play a role in relaying a patient’s age such as the quality of the skin, sparkling eyes and the sound of a voice. The goal of facial rejuvenation today is to create as youthful a result as possible while maintaining a balanced and natural, un-operated look.

New Approaches To Facial Surgery

Dr. Bunkis explained that the newer approaches to facial surgery are primarily aimed at the mid facial region. The relatively new midface lift specifically addresses the central facial hollowness that naturally occurs as many people age. By suspending tissue back to its original place, the aging face can then be sculpted tension free to recreate the soft and graceful curves of youth.

“It is absolutely necessary to achieve this balance to arrive at a pleasing surgical result, explained Dr. Bunkis. “My techniques have changed over the last twenty years, and the concept of a pleasing result continues to evolve.”

Compared to the mid 1970’s, when Dr. Bunkis began doing surgery, techniques today utilize shorter and less visible facelift incisions and a greater emphasis has been placed on midface lifts and other techniques which elevate the fallen tissues in a more natural way. Today’s techniques do not raise the sideburn, distort the hairline behind the ears, or leave patients with a horizontal, pulled back look that was so common in years past.

Understanding the Aging Process

A key factor in plastic surgery advances has been a better understanding by plastic surgeons of the nature of the aging process, and the development of techniques that address aging skin tissue. Nevertheless, technical advances still cannot guarantee a perfect result. Patients must start by choosing the right surgeon—one who not only understands their concerns, but one who also has the ability to focus on what the surgery will achieve, as well as the artistic talent to achieve the desired result. With his years of experience and artistic touch, Dr Bunkis brings to his patients a knowledge and expertise in aesthetic surgery that makes him a leader in his field.

Dr. Bunkis’ main objective is to achieve a natural look for each patient, and to allow each patient to look as good as they can for their given age. He evaluates each patient’s concerns, decides how best he can help them, and offers a solution to their problems. This frequently requires a discussion of areas or procedures that the patient may not have previously considered.

“For example, if someone comes in with a complaint about a droopy neck, but does not mention their severely sun damaged skin, I feel it my duty to discuss laser skin resurfacing for completeness sake”, said Dr. Bunkis. He believes that a layperson may not realize that tightening droopy muscles and skin will not affect the skin’s quality. Such a person may wake up after a face lift with a gorgeous jaw line and face contours, but be disappointed because the skin is still blotchy and sun damaged. Not approaching the face as a whole may create an unnatural result and deprive the patient of full benefit of the doctor’s talents.

The ideal facial rejuvenation procedure leaves the patient with a jaw line that matches the rest of the face including eyes, forehead and skin texture. This process, Dr. Bunkis explains, begins with a through consultation.

Facial Rejuvenation Consultation

So what are the consultations like and what suggestions may be made? This depends on each patient’s concerns, desires, and present condition. Dr. Bunkis begins each facial consultation with an explanation of the aging process and discusses generalized skin care, as well as general anti-aging treatments, which may be applicable.

Normal facial aging is a two-prong process. The first prong is genetically determined, such as the formation of the jowls, drooping of the neck or brows, bagginess of the eyes, the degree of chin prominence, or the size of the nose. These features are not under the patient’s control and cannot be changed without surgery. The second prong of the aging process includes skin texture and the general health of our skin, as well as the amount of fat in our necks, and the impact of sun exposure, obesity, smoking and excessive use of alcohol. This latter group is obviously under a patient’s control. Dr. Bunkis attempts to help each patient develop a healthier lifestyle and, along with his aesthetician, discuss sun protection and long-term skin care options.

Different Facelift Approaches

Dr. Bunkis gave examples of different approaches that might be offered to patients of various ages with various degrees of aging: “For a patient in her thirties with a slight neck fullness, a lipo-sculpting procedure may be all that is required to give her a youthful jaw line, as the skin will usually have sufficient elasticity to snap into place. This same approach would not be appropriate for a patient in her forties, as skin and muscle laxity would be expected to persist if the issue is not addressed.

“For such a patient, however, a traditional facelift may not be required yet. Quite possibly an excellent result could be expected by combining the liposuction with a short incision under the chin to tighten the neck muscles. Or we may add to this a midface lift, which can be achieved with a small stab wound in the fold between the cheek and the upper lid and a short incision behind the sideburn—avoiding incisions around the ears. In an older patient, not only would a full facelift be indicated, but also brow lifts, lip enhancements, or skin resurfacing may be added to achieve the optimal result.”

Setting Expectations

Whatever approach is suggested, Dr. Bunkis explains the expected outcome to each patient thoroughly. “I can do this by placing the patient in front of a mirror and lifting their skin, or by using computer imaging. During the consultation, I always relay my philosophy and give each patient a realistic idea of what they can expect to achieve with surgery. This is an art form and the patient deserves to know my vision before we embark on the surgical voyage,” concludes Dr. Bunkis.

Dr. Bunkis practices in South Orange County and in the San Francisco East Bay. A Board Certified Plastic Surgeon specializing in cosmetic surgery of the face and body, Dr. Bunkis has years of unsurpassed surgical expertise. Below are examples of actual patients of Dr. Bunkis that illustrate the various options for facial rejuvenation.

A 35-year-old anesthesiologist patient with a full neck, before and after neck liposculpture, chin implant and rhinoplasty. This same neck contour and sagging could not be corrected as effectively with an isolated liposuction procedure in someone a decade or two older because of the loss of skin elasticity and muscle laxity.

A 48-year-old, weathered female patient who looked significantly older than her stated age, before and two years after (at age 50) following a full-face CO2 laser resurfacing, endoscopic brow lift, facelift, upper and lower eyelid procedures. The neck was liposuctioned as a part of the facelift, but a neck liposuction alone would only have left her with a thinner but saggier neck and not addressed the unusual laxity and sun damage she had.

Dr. Bunkis can be reached by calling (949) 888-9700 or you can write to him at bunkis@ocps.com.

— Janet d M., Coto de Caza, CA

A: Mid-facelifts are relatively new, but we have been doing them for 10–15 years. Both types of facelift procedures are designed to turn back the hands of time, but each addresses different aspects of the aging process. A standard facelift is still the ideal procedure to tighten a loose neck and to help with jowls.

You are correct in saying that the mid-facelifts are relatively new procedures, but they address an age-old problem: drooping and hollowing of the cheek areas below the lower eyelids, which creates a so-called “tear trough” deformity. These mid-facelifts can be done as an isolated procedure to freshen a face in the late 30s or 40s that is showing the earliest signs of aging, or combined with a traditional facelift in an older person, or as an isolated procedure in an older patient who has had a traditional facelift but the mid-face was not addressed.

One of the beauties of a mid-facelift is that it can be done through short incisions that are hidden behind the hair line and through a tiny stab wound in the fold between the cheek and the upper lip, just large enough to let us insert a few very long needles, which heals without a visible scar. The mid-facelift will not alter your jowls or neck laxity, so if these are an issue, a traditional face and neck lift will also have to be performed to achieve optimal rejuvenation.

Facial rejuvenation is at the top of the list of the most common aesthetic surgical procedures performed here at Orange County Plastic Surgery. Most people feel physically and mentally vigorous and energetic long after their appearance has begun to deteriorate due to aging. A face, neck, brow or mid-facelift procedure is designed to provide you with a rejuvenated appearance. The degree of improvement achieved depends on the severity of the initial deformity, the age of the patient, tissue elasticity and the recommended procedure.

Here are a few patients that show the benefits of the mid-face and traditional facelifts:

(Actual patient of Dr. Bunkis) 47-year-old female before and after mid-face thread-lift with lower-lid blepharoplasty, without the need for a traditional face or neck lift.

(Actual patient of Dr. Bunkis) Similarly aged, 47-year-old female with neck laxity and jowls, but not much in the way of mid-face laxity, before and after an endoscopic brow lift and facelift. No need for a mid-face here. Conversely, a mid-facelift would not have addressed the things that bothered her most: jowls and neck laxity.

(Actual patient of Dr. Bunkis) 54-year-old female a year after a traditional facelift done elsewhere, neck still quite tight, but complaining of mid-face and lower eyelid laxity. To address her concerns, a mid-face thread lift was performed by Dr. Bunkis to lift the drooping cheek tissues next to the nasolabial fold, thus removing the oblique trough that forms across the cheek as people age, and giving her a nice and youthful cheek. This procedure also elevates the junction between the eyelid and cheek, allowing us to shorten the eyelid, adding to a more youthful look. The “after” photos, six years later at age 62, show that the improvement has been well maintained.

It is important to seek a surgeon who is well-versed in all of the options, so that a customized plan can be developed for your concerns.

Please feel free to call Dr. Bunkis at Orange County Plastic Surgery (949-888-9700) for a complimentary consultation so that we can lay out all your options for you.

First of all, for those of you who missed it, last week a whole bunch of kind-hearted people helped a 71-year-old Mexican artist get rid of a large skin cancer which had eaten away the center of his face!  The surgery was performed at the Laguna Hills Surgery Center and all services for his surgery were donated by Orange County Plastic Surgery, the Surgery Center, its staff, Dr. Kevin Becker the anesthesiologist and surgery center medical director, and the pathologist, Dr. Allan Rushovich.

With Dr. Rushovich’s help, we were able to determine the extent of the tumor and to remove all of it. This entailed removing what was left of his nose and about half of his right cheek. I was able to close the central defect with a flap from his forehead, rotating it 180 degrees to cover the area that had been occupied by his nose. The flap is 100 % viable and he is making a remarkable recovery.

There were a few days when he was down but as the swelling is starting to go down, Manuel realizes that he will eventually look much better than he did before his cancer was removed. When a flap is rotated 180 degrees like this, a pucker is created at the point where the skin is turned on itself. In this case, the pucker is located just below the right eyebrow medially. This temporary pucker is necessary because it contains the blood supply to the flap and cannot be transected until the flap gains new blood supply from the area in which it was placed. In a month or two he will return to have this pucker resected and he should be ready for more photographs.

This is what Manuel looked like prior to going in for his surgery. The pink are on his right cheek was also tumor and had to be resected.

Thank you to all of you who helped and for the many of you who sent us encouraging words!

Summer is around the corner and we should all be cautious to minimize sun damage to our skin. Excessive exposure to the suns UV rays is the cause of skin cancers.  It has been shown conclusively that skin cancers occur more frequently in areas that enjoy more sunny weather (definitely more common in California, Texas and Florida than in Washington state or Minnesota). It occurs more commonly in fair-skinned people and definitely more common in people who have spent more time in the sun!  But that does not mean that we should avoid the beautiful outdoors we have here in California! Just do whatever you can to protect your skin from exposure.

Sun block should be applied to all exposed skin and a hat should be worn whenever possible to keep excessive rays of sunshine off our face. Get a good sun block that you like. Look at the SPF factor. In general, the higher the SPF factor, the longer the sun block will protect your skin.  A 15 SPF may have to be reapplied every hour to be effective, while a 45 SPF will protect you for four hours. And if you hate the white look, it is possible to get a very effective spray tan before you go outside – and then put sun block over it!  The best place to do this in Orange County is one of the five Unique Tan Bronzing Boutiques. If you have a choice, plan your outdoor activities in the early morning or later in the afternoon instead of mid day when the sun’s rays are most intense.

Manuel had a basal cell carcinoma, by far the most common type of skin cancer.  A basal cell carcinoma will continue to grow and grow, eating the flesh locally but cells from this cancer do not metastasize – if not treated, this tumor can create local havoc but cells do not break away and travel to the brain, lungs, liver or lymph nodes, and they can with the other two skin cancers.  Manuel got into the trouble he did because his cancer was not treated adequately – he had it for 27 years!

In this country, it is possible to see a case like this in some more remote area, but it is very rare because these cancers do not grow quickly and most people would have enough sense to get it treated. The other two types of skin cancers, squamous cell carcinomas and melanomas carry a more serious threat as they can spread to other parts of the body.  Squamous cell carcinomas usually occur in older folks who have been in the sun a lot (for example, older fishermen, golfers or tennis players) but melanoma’s can strike the young as well as the old, and can be very deadly if not caught early.  Melanomas frequently arise from moles. If you have a lot of moles over your body, you should see a dermatologist at least once a year for a total body skin check. Dr. Daniel Di Cesare of Orange Coast Dermatology is an excellent dermatologist and we would recommend him highly. He works our of our Orange County Plastic Surgery office and can be reached at 949-888-8500.

So look beautiful this summer, but be wise. Use sun block, wear a hat and sunglasses, and do see a good dermatologist once a year if you have a lot of moles or if you have had a cancerous or precancerous skin lesion in the past.

Manuel is a 71-year-old, well-respected artist in Rosarito, Mexico. A few years ago, he noticed a growth on the tip of his nose but did not have the money to see a doctor, let alone to have it treated. As the years progressed, the lesion grew and by now, has consumed the bulk of his nose and the right cheek adjacent to the nose.  Manuel and his wife still talk about seeing a doctor when they sell a few paintings, but they have never been able to get ahead enough to afford a doctor.

A little more background about Manuel. He was born in the Yucatan in 1931 and has been painting and drawing since 1957. He attended art school in New Mexico and in California (at the California Institute of the Arts). Manuel obtained his green card and worked in the United States for a number of years, but decided to return to his native Mexico. His green card has since lapsed.

On the 14th of March of this year, Deborah Palermo from Orange County Plastic Surgery, who owns a second home near Rosarito, walked into the Polo’s Gallery and first met Manuel. She was shocked by the advanced stage of skin cancer she saw on Manuel and utterly surprised that no one had stepped up to help him.

Deborah told Manuel that she worked for a plastic surgeon in Orange County, asked if she could take his photograph and offered to help him have his cancer treated. Deborah is the Reception Desk Coordinator at Orange County Plastic Surgery and is an angel for taking it upon herself to help Manuel. Just think of how many thousands of people have seen Manuel, up close and personal, and never thought to ask what the problem was or how they could help!

Upon seeing the photos of Manuel, I concluded that he had a basal cell carcinoma (although that won’t be confirmed until the pathologist analyzes the tissues). Years ago, this type of skin cancer was called a “rodent ulcer” because it looked like a rat had been chewing on the involved part—in this case, poor Manuel’s nose.

I offered our assistance and contacted Dr. Kevin Becker, Medical Director and Head Anesthesiologist at the Laguna Hills Surgery Center to see if the surgery could be performed there. Dr. Becker immediately offered his services but it took him a week to get together with the surgery center brass to get their approval. I’m sure it felt like a month to Dr. Becker because Deborah was hounding him daily, asking if any progress had been made! Dr. Mark Adlard, a well-known family practitioner in Rancho Santa Margarita, offered to do the electrocardiogram and required pre-operative laboratory tests as his donation to this effort. Dr. Becker, the Surgery Center, the preoperative and post-operative nurses, the OR nurse, the scrub tech and the pathologist, Dr. Allan Rushovich of Irvine all volunteered their time and expertise for Manuel’s surgery and recovery.

Dr. Bunkis and Deborah wrote letters to the Mexican Consulate General and the State Department to get Manuel permission to cross the border.  U.S. Immigration had the letters and photos I sent, but insisted that Manuel come in person to the Tijuana office so they could verify his problem. The mayor of Rosarito accompanied Manuel and his wife on this important trip, and this past Wednesday the permission to come into the United States for his medical care was granted. That evening, after putting in a full day of work at Orange County Plastic Surgery, Deborah left for Rosarito and brought Manuel to her home in Orange County. He will be staying with the Palermo family while he is here.

Manuel came into the Orange County Plastic Surgery office on Thursday for his pre-op with myself and our nurse, Tracey Prescott. We were all struck by how delightful Manuel was and, typical of many deformed patients I have seen in third-world countries over the years, how unbothered he seemed by the aesthetic part of his grotesque deformity!  Manuel speaks English quite well—years ago he taught art at a couple of American colleges. He still plays basketball weekly despite an arm deformity from an old untreated fracture (he cannot straighten one arm). He deeply thanked the Americans who were making it possible for him to get rid of his cancer. I just hope I was able to convey the magnitude of surgery he requires to have his cancer removed!

It is Sunday, April 11th as I write this and Manuel’s surgery will be performed tomorrow, on Monday at the Laguna Hills Surgery Center. I know that removing the tumor, if indeed we are able to surround the tumor completely, will leave a gigantic hole and very little of a nose. If at all possible, my goal will be to close the wound with a flap from Manuel’s forehead. The flap, raised from the central forehead and turned 180 degrees, should cover the defect in the nasal area and some cheek flaps will be required to cover the rest. If a forehead flap is used, I’d have to go back about three weeks later to divide the flap pedicle between the eyebrows and to finish insetting the flap. That would be our ideal scenario, but I was very moved when a reporter from Channel 11 FOX news told me that she knew of a prosthetist that will be able to donate a custom nasal prosthesis for Manuel if I do not have enough of his own tissue left to complete the reconstruction. We will definitely keep you updated on this one!

Thank you, Deborah, for initiating this and for all the rest of you who have and will contribute so greatly to help this very poor but very good man!  God bless you all!

Here is a photo of Manuel with his wife in their gallery in Rosarito!  Now that’s true love, as good as I’ve ever seen it!  Say a prayer for Manuel!

Tuesday, April 20th 6:30 PM
Laguna Cliffs Resort and Spa
25135 Park Lantern, Dana Point, CA 92629

Red Hot Speakers on Red Hot Topics:

Lory Kaufman – Fine Fashion Jewelry
Sharm Cressey – Fashion Consultant, The Latest Lingerie
Paul Salazar – Hair Styles for Spring, Summer, Compliment Your Image
Shery Meredith – Owners of Unique Tan, UV Taning Alternative
Gennifer Montoya – Owner of Waves and Beyond Skin Care
Dr. Norman Huefner – Sensational Smiles – Cosmetic Dentistry

From Orange County Plastic Surgery
Anne Floerchinger & Tracy Prescott – Skin Care
Dr. Juris Bunkis – What Plastic Surgery can do for you

See the flyer: Dr. Juris Bunkis – An Evening of Beauty April 20, 2010

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949.888.9700
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A:  This is an interesting question and addresses a common misconception. Liposuction is currently the most commonly performed aesthetic surgical procedure in the United States.

The concept is relatively simple, analogous to a vacuum cleaner that selectively removes excess fat between the skin and the first layer of muscles – it cannot remove deeper fat, for example that inside your belly around your intestines (the deep fat can only be removed by decreasing caloric intake). The excess outer fat can be reduced by running a metal tube through the fatty layer, creating empty tunnels, which collapse as the patient heals and gives a patient the desired contour improvement.

During the liposuction process, the excess fat is physically removed, collected in large bottles (up to five liters can be safely removed in one sitting), and disposed of as biological waste. This removed fat, therefore, cannot go to other parts of your body! Even the thinnest super model has a thin layer of fat under the skin and, when surgeons perform liposuction, at least a half inch layer of fat is always left between the skin and the muscles.

The problem is that removal of the fat does not prevent someone from gaining weight in the future! The equation is pretty basic – your weight is the result of what you consume minus what you burn off. If you eat roughly what you burn, before or after surgery, your weight will be stable and your fatty layer will remain at the same thickness. If you burn more than you consume, your fatty layers will decrease in thickness.

Unfortunately, the converse is also true – if you consume more than you burn, whether or not you have had liposuction, your fatty layers will increase in thickness. This increase in thickness will occur over the part that was liposuctioned as well as over other parts that were never suctioned.  We all know some overweight people with massive thighs or arms, large bellies, and very full necks, whether they have had prior liposuction or not.   Liposuction is designed to treat stubborn areas that do not respond to diet and exercise – liposuction is not a weight loss technique and does not prevent someone from gaining weight in the future!

A good way for me to discuss this further is through photographs and I would like you to look at the accompanying pictures of a 35 year old male who chose to have his abdomen and love handles contoured, all in a procedure that took less than an hour!

Sometimes a very pleasing change over can be achieved with a relatively simple and minimally invasive procedure!  If you have any areas of concern or would like to evaluate your options, please feel free to contact Orange County Plastic Surgery at 949-888-9700.

Actual patient of Dr. Bunkis, before and after a five liter liposuction procedure.

We lived on the hospital grounds and ate local foods, in a relatively Spartan environment. After a breakfast of papaya, beans, eggs and some coffee, we would start seeing patients and deciding who we could help and who we could not – a very difficult experience to say the least! One year, I met a four year old boy who had never walked, with a painful hip and fever. I noticed a mass over the side of his hip and decided to open the area to see what the cause of his problem was – we did not have XRay or laboratory facilities in this town and any specimens had to be sent back to Guatemala City by bus. I was surprised to find a cheesy white material in the joint and did not know what it was – a few days later, we found out that this youngster had TB in his hip joint. There was no way to help him further in Guatemala and I volunteered to take him home with me. He was treated at the Shriner’s Hospital in San Francisco and recovered over a six month period, at which time another team of volunteers brought him back to his village.

We would see patients or operate from about 7 am until 7 pm each day for about ten days straight, and during this time, performed about 150 operations. The bulk of the patients I was were kids with a variety of birth defects or injuries. But in the early 80’s, while civil war raged in Guatemala, it was not unusual to see someone in fatigues come in for treatment of an injury, and we never asked which side they were on! We were there for the kids and neither side saw any advantage in harassing us! As a matter of fact, the government was quite helpful, expediting our trips through customs, providing us with the yellow school bus to bring us to Neuvo Progreso, and giving us armed guards for the journey.
Whenever we could, we did an adult patient as the first one for each trip – adults are more forgiving and we did not want to “test the system” on a malnourished 3 month old! A different group of volunteers went down to this village four times a year but in between, the hospital was run by the real heroes in this story, the nuns from Mexico and Spain, and the padre from Italy, who live there permanently and have given their lives for the local people!

At the end of the ten days of working there, we head back to Guatemala City and fly home, fatigued, usually a few pounds lighter and as content as a person could possibly be! There is nothing more fulfilling than helping those in need!
And before I sign off, I’d also like to mention our registered nurse, Tracey Prescott and some of her escapades abroad to help others. Here in Orange County, Tracey helps patients with pre and post op care, injects fillers and Botox, does laser hair removal and skin resurfacing. But when time allows, she’s off helping other!
Happy Thanksgiving from all of us at Orange County Plastic Surgery!

• The Lip Plumper improves lip volume and fullness while smoothes the appearance of fine lines. The product gently conditions lips, making them smooth and soft. It contains four categories of ingredients:

Plumping Agent:

• Palmitoyl Oligopeptide (Maxi-Lip ™)
• Centella Asiatica Extract (Gotu Kola)

Antioxidant:

• Tocopherol and Camellia Oleifera (Japanese Green Tea) Leaf Extract

Lip Conditioners:

• Beeswax, Allantoin, Dimethicone, Aloe Barbadensis Leaf Extract and Anthemis Nobilis (Chamomile) Flower Extract

Moisturizer (Emollients/Humectants):

• Sorbitan Isostearate, Ethylhexyl Palmitate, Glycerin and Sodium PCA

How does this product work? The mechanism of action includes stimulation of collagen synthesis, stimulation of glycosaminoglycans and maintenance of the newly formed Collagen. This will result in a 30% reduction of furrows (note, not 100% but hey, 30 % isn’t that shabby considering that no surgery or injections are required!). Lip moisture will be increased by as much as 60%! And finally, lip volume will increased by an average of 40%! I think you can see this new product has been so desirable!

The Vivité Daily Firming lotion tones and tightens dimpled “orange peel” skin as no other non surgical procedure before it! It improves skin elasticity and firmness for a smooth, sleek look. It uses an advanced formula which hydrates and moisturizes the skin to keep it soft and smooth. This product likewise contains four classes of ingredients:

Slimming Agents:

• Caffeine
• Isomerized Linoleic Acid (Regu-Shape)

Antioxidant:

• Olea Europaea (Olive) Leaf Extract

Skin Texturizers:

• Glycolic Acid & Ammonium Glycolate (pH 3.8)

Moisturizer (Emollients/Humectants):

• Cyclopentasiloxane/Cyclohexasiloxane, Isohexadecane, Dimethicone, Ceresin, Glycerin, Sericin, and Lecithin

This product works by reducing lipid uptake and accumulation into the adipose tissue, by accelerating the cAMP pathway, and by reducing fluid level between cells. This results in a reduction in the size of the lipid droplets, a reduction in the lipid content of the adipose tissue, a reduction of thigh circumference and a smoother appearance of the skin. In an initial study, six women between the ages of 40 and 61 with mild to moderate cellulite or “orange peel” skin on the thigh applied Vivité Daily Firming Lotion twice a day for 8 weeks. Expert Grader evaluations were made at baseline, 4 and 8 weeks post treatment. Amazingly, five of the six subjects demonstrated a reduction in thigh circumference. The average change over the 8 week period was 0.65 inches. Additionally, favorable changes were observed in the appearance of cellulite, skin dimpling and skin elasticity/tightness with no adverse events being observed during the course of testing. In conclusion, Vivité Daily Firming Lotion is effective at reducing thigh circumference by more than half an inch on average as well as improving the overall appearance and condition of the skin.

If you have any specific questions about these products or any cosmetic procedures, your best bet would be to see a qualified plastic surgeon to review your options. Pease feel free to contact our office at 949-888-9700 to set up an appointment with Dr. Bunkis; you may also check out our web site at www.ocps.com to learn more about our practice.

I am interested in having a facelift but as you know, we are blessed in California in that there is on shortage of plastic surgeons to choose from. I suspect that one of the more important things for a consumer to look at is a surgeon’s background. Could you please tell us something about your background – and any other tips you could give someone looking for a surgeon.
Michael M Dove Canyon, CA

Well, Michael, you are right – in most beautiful, relatively affluent areas, there isn’t a shortage of plastic surgeons, lawyers, contractors, CPA’s and so forth. I think there are three things that separate surgeons that you should consider.

• training and background
• surgical skills
• bedside manner

There is no substitute for a good education, and I would be hesitant to choose a surgeon who has not been well trained, who is not Board Certified by the American Board of Plastic Surgery, and who does not keep up with his or her continuing medical education (this is a life-long process). But even amongst equally trained physicians, you will find wide variation in surgical skills. Ask to see multiple examples of a surgeons work. And finally, all else being equal, there is no point going to a surgeon you do not connect with on a personal level.

I will begin by going over my background. I have made a name for myself as an innovative plastic surgeon who specializes in aesthetic surgery, with a successful practice that has thrived for 30 years. As medical director of Orange County Plastic Surgery (OCPS), I have a 5-Star practice here in South Orange County but also continue to see patients in northern California, where I got my start in plastic surgery. I stay busy through referrals from satisfied patients from around the globe, who frequently cite my caring, attentive approach and expert surgical skills. When you come in to see us, we will make sure that you see many examples of my work – after all, I have done facelifts on five of my employees over the years and what better way to show you what we are capable of?

My philosophy is based upon the concept that a successful result from cosmetic surgery stems from a successful partnership between the patient and the surgeon. Such a partnership is based on professionalism, trust, education, and understanding. I make it a priority to really listen to the patient’s concerns — our goal is to help our patients achieve their aesthetic surgery goals and as a result, feel better about themselves.

I have an impressive academic background, having served as Assistant Clinical Professor of Surgery, Division of Plastic Surgery at the University of California at San Francisco School of Medicine. Upon graduating from the University of Toronto Medical School in 1974, I completed a general surgery residency at the Mary Imogene Bassett Hospital, Columbia University in New York and the Beth Israel Hospital, Harvard University in Boston. This was followed by board certification in general surgery. I subsequently returned to Harvard University to complete my residency in plastic and reconstructive surgery – my professor, Dr. Joseph E. Murray, a very impressive man, was a Nobel Prize Laureate in Medicine. In 1981, I joined the plastic surgery faculty at the University of California at San Francisco School of Medicine and was subsequently appointed Chief of Plastic Surgery at the San Francisco General Hospital. I am a diplomat of the American Board of Plastic Surgery and a fellow of the American College of Surgeons. Dr. Bunkis is a member of the prestigious American Society for Aesthetic Plastic Surgery and the International Society of Aesthetic Plastic Surgery. Surgeons from around the world are frequently seen visiting us at Orange County Plastic Surgery.

Next I will tell you a little about the practice itself. OCPS is a state-of-the-art plastic surgery center offering a comfortable environment and the very latest advances in cosmetic surgery. OCPS specializes in the newest techniques for face and forehead lifts, including the mid-face and short scar face lifts, blepharoplasty (eyelid surgery), rhinoplasty (nasal surgery), liposuction, abdominoplasty (tummy tuck), post weight loss body sculpting (body lifts), breast reduction / uplift through the short scar techniques, and augmentation mammoplasty (breast enlargement). Other treatments include Botox ® and the latest filler injections, laser skin resurfacing and laser hair removal. I also am one of only a handful of plastic surgeons to perform pectoral, buttocks and calf implant surgery.

If your goal is to look younger, OCPS can help. Bringing together the very special talents and surgical expertise of its professional staff, OCPS offers an array of exclusive anti-aging treatments to help you recapture that youthful glow. Services include facial rejuvenation utilizing the latest lasers, mid-face and endoscopic brow lifting techniques, as well as eye lid and nasal surgery. Best of all, the center’s computer imaging system will give you a sneak preview of the expected outcome so you can make an informed decision about your surgical procedure. OCPS has a state-of-the-art laser suite featuring a variety of lasers especially adapted to treat fine lines and wrinkles, spider veins, Rosacea and other pigmented lesions of the face and body.

In addition, Orange County Plastic Surgery offers a full line of skin care including custom-designed skin care, Vi-Peels ®, European facials and specialized skin care treatments.

Are you ready to make some positive improvements to your appearance? Dr. Bunkis and his expert staff can sit down and review your goals and options, and ensure that your aesthetic surgery dreams become a reality.

Distinctions and qualifications:

• 30 years experience
• California’s premiere facial and body rejuvenation centers
• Minimally-invasive and “quick-fix” anti-aging treatments
• Complete aesthetician services
• Convenient south Orange County and San Francisco East Bay locations

If you have any specific questions about cosmetic procedures, your best bet would be to see a qualified plastic surgeon to review your options. Pease feel free to contact our office at 949-888-9700 to set up an appointment with Dr. Bunkis; you may also check out our web site at www.ocps.com to see further examples of similar patients.

Actual patient of Dr. Bunkis: 67 year old male with lax neck, who wished to have it improved to increase his value in the workforce, before and two years after a neck lift and a lower lid blepharoplasty.

We would not be able to tell you which option would suit you best without examining you in person. Having excess skin and fat following multiple pregnancies or non-pregnancy associated weight loss is a common complaint. Abdominal bulging may be due to residual weakness of the underlying muscles following stretching from excess internal fat or a baby. In addition, not all stretched skin returns to its normal tension, and unwanted fatty deposits may accumulate or persist following pregnancy or weight loss. Abdominoplasty (tummy tuck) deals mainly with the excess skin and fat in the front of the belly, and is the appropriate procedure in the vast majority of patients who present following pregnancy and without a history of massive weight loss. A tummy tuck consists of undermining the abdominal wall skin and fat, tightening the muscles, cutting away the extra, lower, anterior abdominal tissues and redraping the remaining skin. Liposuction may be used as an adjunctive tool to help sculpt the fat deposits in the flank or thigh areas. The lower body lift procedure deals with circumferential excess of fat and skin e.g. belly, thigh, and buttock. The posterior trunk, buttocks and thigh skin does not get stretched in an average pregnancy, and this procedure is usually performed on patients who may have lost in excess of a hundred pounds with a diet and exercise program, or following gastric bypass or stapling procedures. It is a more extensive procedure but yields good results in patients with excess skin and fat in these areas.
If you have any specific questions about cosmetic procedures, your best bet would be to see a qualified plastic surgeon to review your options. Pease feel free to contact our office at 949-888-9700 to set up an appointment with Dr. Bunkis; you may also check out our web site at www.ocps.com to see further examples of similar patients.

Actual patient of Dr. Bunkis: Pre & Post Abdominoplasty: 40 year old African American with a prior vertical lower abdominal GYN scar, before and after abdominoplasty with liposuction of the flank areas.

Actual patient of Dr. Bunkis: Pre & Post Lower Body Lift: 29 year old following significant weight loss, before and after belt lipectomy to address the circumfential tissue laxity.