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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 needs.

Surgeons Wu and Lee at work with Plastic Surgery, Modesto

Plastic Surgery Modesto Information & More

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Calvin Lee
, MD  |  Tammy Wu, MD

Plastic Surgery   General Surgery   Leg/Face Veins   Expert Skin Care  Acupuncture

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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 less bruising.

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 administration.

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 are best

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 located).

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 stockings/exercise.

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 advice.

Q:  Do Restylane lip injections always give good results?

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 "always").

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 area.  

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 possiblity?

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 area. 

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 difference?

A:  Restylane vs. Perlane filler injections





We have both products in our office.  We will choose each product based on:

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 common risks?

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 are?

Asked by Chandra on

A: Potential 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 implants.

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.

Good luck!

Tammy Wu, MD - Board Certified Plastic Surgeon in Modesto, CA

Q:  Obagi Nuderm vs. Clenziderm - Which is better?

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

Regarding Cost of OBAGI Nu-derm and Clenziderm

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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