Q&A from Real Self
Modesto Plastic Surgery
This page provides some of the answers posted on
Real Self by Dr. Tammy Wu. Dr.
Tammy Wu is a board certified plastic surgeon practicing in Modesto, California.
These answers are meant to be broad in nature and not specific to any one
patient. Please consult your physician in person for your medical
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Q: What is the best varicose vein removal procedure?
A: Surgery is best for quickest Varicose Vein
results (Microphlebectomy), quicker than sclerotherapy
If the problem is an isolated varicose vein without
underlying greater saphenous or lesser saphenous vein reflux (as diagnosed by
ultrasound), we believe that varicose vein removal (surgery) via
micorphlebectomy the quickest option. For many patients quickest is best
(meaning quickest to show-off-able results)
Microphlebectomy surgery involves making a few small
incisions (after numbing the area) about 1 mm to 2 mm wide above the varicose
vein and withdrawing the vein by hooking it out. The incision is usually so
small that sutures are not needed to close it.
However, everyone has different expectations and
definitions as to what is best.
If quick results is what you are looking for,
surgery with microphlebectomy is best as mentioned above. But this might leave
small 1 mm scars. For many people, these heal very well, and for some, I can't
even find them again unless I look very very closely.
If one has more time and wants a less painful option
(during the procedure), then sclerotherapy injection with foam sclerotherapy is
an option and may consider this the best option for themselves. I have found
that this requires repeated injections and there is are risks of
hyperpigmentation and skin necrosis.
EVLT - endovenous vein laser therapy (Laser
ablation) is used in our office when there is underlying reflux in a deeper
system of veins such as the greater saphenous vein or lesser saphenous vein.
However, we will usually use EVLT in combination with surface varicose vein
sclerotherapy or microphlebectomy.
Just a quick word on stockings (compression
stockings). Stockings are important in the recovery and healing process to keep
the vein flow in the same direction after any of the vein procedures. Among
other benefits, stockings will result in faster healing, better results, and
There are pros and cons to every procedure, please
see your plastic surgeon/vein specialist in person to discuss these in detail
and with pertinent facts that are related to your specific case.
Q: Will I be
able to use the new Latisse eyelash
extension mascara if I wear contacts?
A: LATISSE® for your lashes, not for your contact
lenses (take them out for 15 minutes)
Soft contact lenses may absorb a chemical in LATISSE®
which may unpredictably alter your contacts. However, this doesn't mean you
can't use LATISSE®.
First of all, as the others have said, LATISSE® is
not an extension mascara. LATISSE® is a prostaglandin analog. Exactly how it
works is not known. It may increase the duration of the eyelash growth phase,
which results in longer, thicker, and darker eyelashes.
LATISSE® is a solution treatment for inadequate or
not enough lashes and requires a prescription from a doctor. However, mascara
can be used on your eyelashes in addition to LATISSE®.
According to Allergan, the manufacturers of LATISSE®:
Contact lenses should be removed prior to
application of LATISSE® and may be reinserted 15 minutes following its
I recommend that It is applied at night time before
going to bed. This means that you can usually leave your contacts out until
morning. But if you change your mind and want to go out that night, you should
wait the recommended 15 minutes before putting the contacts back in.
Q: How can I prevent spider veins
A: Preventing Spider Veins: Compressions stockings
Compression stockings (such as Sigvaris or Jobst)
which offer graduated compression (tigher in the feet area, and looser up on the
leg) are the best thing in my opinion for preventing the formation of spider
veins. This is why we carry compression stockings in our office and highly
encourage patients to wear them after their vein procedures in our office.
For prevention of spider veins in the future, I
recommend to my patients to wear compression stockings about 3 times a week.
There's no hard and fast rule to support the optimal amount of time for wearing
stockings per week, but I feel that 1 time a week is better than none, and 3
times a week is better than 1 time a week, etc. I picked 3 times a week,
because it seems "do-able." (even in hot summers in Modesto, CA where I am
After compression stockings, I believe that regular
lower body exercise can help to minimize spider veins.
Even with compression stockings and regular lower
body exercise, we still see patients that need repeated yearly sclerotherapy
injections. If you ask these patients what is the best way to prevent spider
veins, they will say compression stockings, exercising, and once a year (or
every other year) sclerotherapy/laser sessions for the new spider veins.
Everyone is different and have different results from laser/sclerotherapy/compression
Spider veins can be caused by many factors such as:
Many of the above can't be helped.
Please see a doctor in person to get formal medical
Q: Do Restylane lip injections always give
A: The answer is "No" for the question does
Restylane always give good results - but "usually"
Lip injections require a good amount of skill and
experience from your plastic surgeon or injector. I have found that there are
patients with lips that will respond well to fillers, and other patients who end
up looking mediocre after lip augmentation. (The answer is "usually", not
The difference is in how much lip existing lip is
currently showing, and how well defined is the "cupids bow" area of the lip.
There are many different locations and layers to inject to help the lip
augment. For example, if the cupids bow is not well defined, I find that I have
to inject much more superficially to try to create more definition in this
Another challenge - if there is very little red-lip
showing, this inward turn could be due to an overactive muscle and combination
treatment of filler with a small amount of Botox in the muscle around the lips
might give us the look we are trying to achive.
There is never an "always good
results" answer. I would say we can reasonably say that filler usually
gives good results.
As you asked, I also believe that Restylane is a
great choice for lip augmentation (as are some of the Juvederm products).
I would have to see a patient in person and palpate
the muscles around the lip to give a reasonable assessment regarding outcome
results, choice of filler, and the possible need for Botox for lip augmentation.
Q: I have
a vein under my eye that I would like
treated. This is a single larger vein, not
spider veins. Is facial sclerotherapy a
A: Microphlebectomy works best for facial
veins around the eye.
Microphlebectomy surgery involves making a few small
incisions (after numbing the area) about 1 mm wide above the varicose vein and
withdrawing the vein by hooking it out. The incision is usually so small that
sutures are not needed to close it.
There is almost always bruising afterwards in this
We don't like lasers too close to the eye and
sclerotherapy may cause blindness as a risk in this area. Furthermore, the
increase blood flow in this area may diminish the effectiveness of sclerotherapy.
If you had spider veins on the face, I would most
likely recommend a surface laser for vein obliteration.
Please see your doctor in person for a one-on-one
consultation regarding this manner.
Q: Perlane vs. Restylane, what's the
A: Restylane vs. Perlane filler injections
Comes in a "half" syringe (0.4 cc)
Has a slightly smaller needle than Perlane for
injections (thus it might hurt less)
Can be injected more superficially
Works better in the lips in my hands
Is a smaller molecule
Lasts a little bit shorter (4 weeks-6 weeks)
Does not have a "half" syringe
Has a slightly larger needle than Restylane for
injections (thus it might hurt more)
Can be injected deeper - great for deeper
Does work as well for me in the lips
Is a larger molecule
Lasts a little bit longer (4 weeks-6 weeks) than
Costs slightly more than Restylane per syringe.
We have both products in our office. We will choose
each product based on:
Location for filling (for example, around the
eyes, we will usually choose Restylane)
Depth of the folds (deeper ones, we will usually
Note that these answers may change with time as the
manufacturer makes different decisions about the packaging of the products.
Please see your doctor in person for a personalized
answer to your own specific situation.
Q: Breast augmentation - what are some
I am 39 years old, married, mother of 2,
and considering BA (breast augmentation). Very worried about
problems associated with implants. Have read and seen the horror
stories. Started out being excited about bigger boobies...not so
sure now. Want to really know what the risks are and how common they
complications of Breast Augmentation surgery
While breast augmentation
is usually a very gratifying procedure for most women who
choose to have the procedure, this plastic surgery
procedure is not without potential complications.
The complications that are associated with breast augmentation can
be classified into immediate and long-term, as well as those
associated with the surgery itself and those inherent to
The most common potential
immediate complication is hematoma, which
is bleeding into the breast pocket or the wound after closure of
incision. This may occur within 24 to 48 hours following surgery.
However, hematoma may still occur within two weeks of surgery if
there is trauma to the chest. Therefore, one should refrain from
vigorous activities during the first two to four weeks
following surgery to minimize this risk.
Other potential short-term complications
include infection, temporary asymmetry,
temporary altered nipple sensation.
The most common long-term
(beyond the immediate postoperative period of 4 weeks)
potential complication is capsular contracture, or
formation of firm scar around the implant. This contracture may
distort the breast and cause pain
in severe cases. Capsular contracture can be treated with
capsulectomy. Other long-term potential complications
include spontaneous implant rupture, unfavorable external
scarring (of the incision), and asymmetry.
Fortunately, these complications occur
infrequently in the hands of a
well-trained plastic surgeon. I would recommend that you do your
research, and make sure that your plastic surgeon is certified by
the American Board of Plastic Surgery.
Tammy Wu, MD - Board Certified Plastic
Surgeon in Modesto, CA
Q: Obagi Nuderm vs. Clenziderm - Which is
A: OBAGI Nu-Derm and OBAGI Clenziderm have
some similar and some different effects
Both systems will help address acne, but they are
different systems. With the Nu-Derm system you get the added benefits of
hyperpigmentation reduction and anti-aging effects. Clenziderm will mainly just
treat acne. The Clenziderm system does not contain hydroquinone products.
Background info about CLENZIderm from OBAGI
Obagi CLENZIderm is a prescription strength acne
treatment that has a patented, solubilized 5% benzyol peroxide which penetrates
deep in to the follicle to treat acne at its origin. There's a Oily and Dry
skin version of this product (just as with Nu-derm). The manufacturer says that
their benzyol peroxide has better penetration therapeutics than others because
of CLENZIderm's much smaller size.
Background info about Benzoyl Peroxide
Works by killing bacteria and reducing
inflammation in the follicle
Higher strengths doesn't necessary improve
therapeutic benefit. Better penetration may be the key (as in the
Use once or twice per day
May cause skin irritation
May bleach hair or fabrics (ie. your pillow)
Shouldn't be used at the same time with Retin-A
/ tretinoin because benzoyl peroxide inactivates it.
Regarding Cost of OBAGI Nu-derm and
If you are out of a few products in the Nu-derm
system, you can buy the products individually to replenish your system. This
might cost less than buying the whole Clenziderm set - which is a new system.
In our office (Modesto, CA):
The pricing (This post produced on 11/15/09) of
aNu-derm starter set costs about $394, and the pricing of a Clenziderm Starter
Set is $130. We frequently give 10% off on OBAGI skin care products. Tretinoin
costs $73-83 depending on the strength.
To continue on the thought from one of the
paragraphs above on replacing a Nu-derm product. One of the most important
products in the Nu-Derm system that is frequently used up/replaced is the
Nu-Derm Clear which costs $91 for a new replacement bottle.
It is also possible that for certain patients, one
can combine these two systems for desired effects (using Nu-derm at night and
Clenziderm mainly in the morning - not at the same time). Please see your
doctor in person to see what's best for you.
Tammy Wu, MD
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