Phone : 864.214.5232

All posts by Shawn Birchenough

“What’s the Difference Between BOTOX and Filler?”

As well-known and ubiquitous as these products are in the popular press and in my office, there is still a lot of confusion from patients over which injectable to use, when, and where. So here’s a primer!

Botox (and other botulinum toxins like Dysport and Xeomin) works by INHIBITING MUSCLE action.

So, if the wrinkles in between your eye brows (the glabella) or in your forehead or the “crows feet” area are caused by the action of a muscle, then you can decrease the repeated skin creasing by injecting Botox into the muscle. Over about 5-7 days the muscle loses ability to contract, allowing the skin to flatten out and not be so creased. It usually lasts only about 3-5 months before the muscle gets back to full strength and you have to inject it all over again.

However, (and here’s the kicker) the muscle can’t be one that is used for critical facial expressions like smiling or closing your eyes. That’s the reason I avoid injecting Botox around the mouth, cheeks, or into the eyelids – you really need those muscles to work properly to maintain normal facial expressions and functions.

FILLERS (including the hyaluronic acids – Juvederm, Voluma, Restylane, Belotero – and other products like Sculptra and Radiesse) do just that – they FILL! Unlike Botox, the effect is immediately noticeable. They are gels that are injected under the the skin (not into the muscle) to fill in creases, increase volume, and make deeper grooves more shallow. Common places for fillers are in the hollows under the inside part of the lower eyelids (nasojugal grooves), the folds next the nose between the cheeks and lips (nasolabial folds), and the deeper grooves that can form from the corners of the mouth down to the chin (marionette lines).

Fillers can also add volume to the lips and cheeks when used in the right amounts and in the anatomic locations. Just puffing up the lip is easy but looks unnatural. I tend to restore lip symmetry and refine the borders of the lip through very small, precise injections of filler. Very fine lines on the upper lip are difficult to smooth out because of the gel quality of fillers.

So, now that you know the basics, you can come on in to get your injectables! For more information on BOTOX, please visit the skin services section of our website.

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Can You Liposuction “This”?

Patients frequently ask about liposuction and whether it is appropriate for “THIS” – as they grab a certain part of their body they aren’t so happy with – jowls, under chin or neck, bra line on the side of their chest, their love handles, their lower abdomen, their inner thighs, etc.

My answer is always a little tongue-in-cheek “I can liposuction just about anything with fat in it, but should I?”

The appeal of liposuction over other methods such as excision of skin and fat is known: less invasive surgery, less downtime, smaller scars, less costly, etc.

The factors that go into being able to do liposuction successfully are many, but one of the most important factors is the overlying skin tone and elasticity. Because liposuction by definition removes fat (and affects tightening of the skin in varying amounts), it is the skin that then has to contract to provide a good contour and look after the appropriate amount of fat is removed.


Take the patients shown as examples:

Patient 1            Picture2


Patient 1 (on left) has a moderate amount of fat in her lower abdomen and flanks, with very good skin tone, texture and elasticity. There are no stretch marks or loose skin. If I remove fat from her, I can trust that her skin will tighten up afterwards (usually reaching it’s final tightness after about 3 months.) She’s a very good candidate for liposuction!


Patient 2 (on right) also with a moderate amount of fat, on the other hand, has much looser, inelastic skin in the lower abdomen. She has significant stretch marks, and some of the loose, thin skin is already starting to overhang. While I could do liposuction on her, she would be very disappointed because her skin will be even more loose and floppy! A much better procedure for her would be an abdominoplasty (tummy-tuck) to remove that extra, loose skin along with the underlying fat. However, a long scar and recovery time would be needed.


Read more about liposuction and abdominoplasty by visiting and and then come in for a consultation to discuss it further! SB

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“Can I Get an Upper Eyelid Lift in the Office?”

Many patients would prefer to have and upper eyelid lift (or blepharoplasty) in the office – for convenience, comfort, and cost reasons. This is a great procedure to do if you are looking to improve the “tired” look or wish to remove excessive skin and fat above the eyes. Women tell me that it is time for this surgery when they have to pull up the extra skin with their other hand just to put on eye shadow! That’s where a “upper bleph” can help.

In the office, we make the patient comfortable with pain medication and something to keep them calm, though the patient is awake during the entire procedure. Lidocaine injection is used to completely numb the skin prior to the surgery. The skin and fat is removed and sutures are placed. Typically, patients will have about 3-5 days of swelling and some minimal bruising. Makeup can be applied after that point. The stitches come out at about 5-7 days, and then scar management continues after that.

This is a terrific surgery for improving the overall aesthetics of the eyes. Please see some of my images below.

Before - Front View


After - Front View


For more information about upper eyelid lift procedures, please visit

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Chemical Peel vs Dermabrasion?

“True dermabrasion” (as I’ll call it) is going to go deeper than a chemical peel, but your recovery is going to be longer with dermabrasion. That is, more swelling, more minor bleeding, and longer recovery. That is, if true dermabrasion is done.

Many places (including other doctors, and non-medical offices/spas and even at-home kits!) are only doing “micro-dermabrasion”. This is a very superficial treatment of the upper skin layers, with a very light “sanding” of the thicker outer skin layers. This type of treatment is more analogous to the results from a chemical peel than “true dermabrasion”. While micro-dermabrasion can help with skin texture, and stimulate some collagen thickening, the results typically are much less noticeable than true dermabrasion or laser resurfacing (see below). And like many non-invasive facial treatments, they need to be repeated at regular intervals.

Confused with terminology yet?

While true dermabrasion is still used for a small variety of conditions, most plastic surgeons have replaced “true dermabrasion” with laser resurfacing, like fractionated laser treatment. Again, laser treatments can be tuned for different depths of treatments and different colors of light for different effects, with varying level of “social downtime.” This relates to the number of days that the patient will not want to go out in public because of minor bleeding, crusting, swelling, or redness.

As will nearly everything we do in plastic surgery, there is an upside and a downside to varying the levels of treatment. And nearly always, more/deeper/longer treatment results in an improved appearance and result, but comes at the cost of more downtime.

It all depends on what results you are looking for, how much you want to spend, and how much recovery time you have!

The best thing to do is discuss the details of your goals in a plastic surgery consultation.

Read more about all of the non-invasive facial skin care options at

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Breast changes after breastfeeding


I remember my mom taking me along with her to La Leche League meetings when I was a toddler. So I’m a big proponent of breast feedings.

However, this columnist has a good point about changes to her body, and the emotional impact these have.

I have this discussion with my patients frequently – and we can come up with plans to help reverse some of those changes!

Breastfeeding Ruined My Body – Harpers Bazaar



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Benefit of “Gummy Bear” Implants Over Regular Implants?

Over the past several years, breast implant companies have introduced additional types of silicone with their newer silicone implants. (There are now over 500 different implants that plastic surgeons can choose from!)

While traditional silicone implants are still available and used frequently, the new gummy bear, or more technically – “highly cohesive”- implants are being favored for some patients because of their characteristics.

Highly cohesive refers to the chemical structure and the number of chemical bonds within the silicone material, making these implants a little more firm and able to hold their structure (and hence the breast tissue, like an internal scaffold) in a better position, longer.

Long term studies are being conducted to assess whether these implants last longer than traditional silicone implants.

This type of silicone has also made it possible to create “anatomic” or “teardrop” shaped breast implants. These are more natural in shape than the traditional round implants. While not better or worse, they are different!

So, the term “gummy bear” has been applied to a lot of different implants and probably not always used correctly. You should know that there are a large variety of implant shapes, textures, material types now available.

With so many choices, the best advice is to speak with Dr. Birchenough in consultation about which implant best fit your needs and desires in breast surgery!

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When are people most Happy?

I came across a Huffington Post story the other day that talked about what ages and life stages people felt most happy.

Do you feel that the older you get, the less you are held back by the little negativities in life? I know I certainly do. True- I am firmly planted in my forties- but I feel a newfound confidence creeping in! Now don’t get me wrong, aging isn’t an easy thing to do gracefully (or is it? I am too busy fighting it tooth and nail!) Perhaps it’s because I take on things that would have held me back earlier in my life… and I am not afraid to jump in and work on areas of my body and health that made my feel bad about myself in my thirties. Wrinkles? See ya! Creases in my forehead? Good bye! Age spots from too much sun at the beach? Well my dear that’s what the lovely south beach laser treatment is all about- get rid of what makes you self-conscious and get on with all that life has to offer!

There is something about work, home and social life that takes on the sort of ease nowadays that was missing in the crazy years of having my kids in middle school while I was busy outside the house climbing the ‘career ladder’. I think I am beginning to understand that happiness is a choice- and I am so very grateful for health, opportunity and of course all of my family and friends.

Do you appreciate all that you are and all that you have a little bit more these days? Do you think age makes us more aware and grateful? I would love to hear what you think!

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Holiday Refresh-Skin Care Peels

Well, it’s the time of year to put your best face forward. Clark, Rusty, Uncle Eddie and the rest of the Griswolds will be visiting soon!  (Am I dating myself with this quite funny movie?)
So what do you do to freshen up your look, without having a lot of social downtime?
Skin Care Peels (Chemical Peels, if you will….), that’s what!  Dr. Birchenough and his staff have 2 effective treatment lines (VisaoMD and Glo Therapeutics) that will get your skin refreshed and get you back to decorating, trimming the tree or make the roast, all while entertaining your guests (the invited ones, and all the others!!)



VisaoMD Skin Care PeelsCombinations of Vitamin A and C extracts, along with glycolic acid, collagen, enzymes, peptides, and hydrating serums can make a big difference to the overall tone, texture and health of your facial skin
 What Can You Expect?
Superficial peels (BRILLIANCE PEELS )are usually done without anesthesia and allow an immediate return to normal daily activities. Fine lines and mild sun-damage are usually treated. The exfoliation process will help promote new outer-layer growth. Typically, the skin may be pink and lightly peeling for a few days after the peel (and sun avoidance is mandatory!), but the results are obvious within a week!
 Medium depth peels (PRESTIGE PEELS) may require some oral relaxing medications prior to the peel, due to the deeper level of penetration. Healing takes longer, up to 5 or 7 days, with more redness, peeling and flaking of the outer non-viable skin layers. However, the moderate wrinkles and worse sun-damage and pigmentation dark areas will be more fully treated. Sun avoidance is, again, mandatory to optimize results and minimize the side effects.





Glo-Therapeutics® – Customizable Skin Care Peel MIXOLOGY!

Dr. Birchenough and his staff will customize a chemical peel for you, personally, through the Glo-Therapeutics line. Chemical exfoliation promotes cellular turnover with the exclusive Glo Complex, letting  you “Heal while you Peel!” A unique combination of Spin Trap, Carnosine, Alma and Niacinamide, added to TCA, Jessners or Glycolic Acid, and we can individualize your treatment. These extracts help preventing free-radical damage and support the skin structure. Come in to discuss what mix we can serve up for!


Hope to see you soon, SB.

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What are you giving yourself this year?

In the late nineties a department store in Canada (Zellers) aired a television commercial that pretty much summed up how we can get lost in Christmas preparations. It’s a great thing to consider as we make our way into the holiday season.

So tell me- before you start making your grocery lists or inviting friends and family over for a great holiday gathering- what are you giving yourself for the holidays this year? The gift of family is a very important one, but what have you done to ensure you spend quality time enjoying their company? Moreover, aside from the hostess gifts or presents eventually stowed under the tree- what is it that you can give yourself this year that will make the coming months happier and more fulfilling?

Take some time over the next few weeks and consider making a list of things you can do for yourself. Set some time aside to start that book you’ve been putting off. Ditch twenty minutes of shopping time and go for a brisk walk. Take some time for coffee or a glass of wine with friends you wish you saw more of. Visit a health coach, fitness pro, beauty bar professional or even (dare I say it?) a cosmetic surgeon to start talking about how you can look and feel your best for the holidays.

Whatever it is you choose to do with the time you make for yourself- enjoy it- revel in it… and make it the first of many such times you schedule yourself into your busy calendar. Remember- when you feel fulfilled and happy friends and family will be happier too…

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Shiny Happy Woman

Open House Event

We are hosting an open house event Friday, December 5, 2014 from 9:00 AM to 3:00 PM at Village Hospital at Pelham Office.

Get ready for the holidays with special pricing and beauty offers!

Come in and meet with Dr. Birchenough.

RSVP Amber at 864.849.9330.

For more information, please check out the event details featured in Town magazine right here.

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