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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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Holidays stressing you out? Here’s your prescription!


Here we go againChristmas music is on the radio, the calendar is filling up, traffic is getting noticeably worse and it’s only November!  How are we going to get through another holiday season and maintain our serenity and unflappable grace?  If you’re like me, you want to book a 3 week trip to a remote island.  No, make that 5 weeks.  I’d leave the day after Thanksgiving, someone else would do the dishes, and I’d come back home all tan and relaxed (and skinny from NO HOLIDAY FOOD, because there aren’t any rum balls on remote islands) on New Year’s Day to a clean house and no sign of holiday decor, anywhere.

Now, back to reality.  Sigh.

Not that the holidays are all bad.  I begrudgingly agree that they can be fun, if you have a sane family and some rich friends that throw amazing parties.  Oh, I know, then there’s the whole joy of giving and fellowship and thankfulness part.  And some people even like shopping for gifts!  But for the rest of us, what can you do to minimize the stress?

#1 Take time for yourself:  Say no to at least one holiday party and get a massage or take a bath instead.

#2 Get enough rest:  Be a “sleep scrooge” and don’t let anyone disturb you.  You are insanely beautiful, and you need your beauty sleep.

#3 Eat well:  Not too much, and not “holiday food”, but real, living food that you have to wash in the sink and cut up.  Use the time it takes to meditate on how grateful you are to know how to take care of yourself.  And while you’re at it, drink some pure, filtered water.

#4 Supplement:  We can’t eat well ALL the time, and some well-chosen nutraceuticals can be an essential bio-hack.  I recommend Magnesium (citrate or glycinate) 200 mg twice daily for the calming effect.  Over 325 enzymatic processes in the body require magnesium, and the average person gets about half of what they need!  Leg cramps, anyone?  A powder form like Natural Vitality Natural Calm is a nice way to end the day mixed in warm water before bed.  Second, a high quality B-complex because stress (and coffee, and alcohol…) deplete your stores pretty quickly.  Thirdly, make sure you are not Vitamin D deficient.  It can wreck you!  Take 5000 units of vitamin D3 every day.

#5 Exercise:  Get some joyful movement into your day, whether it’s a yoga class, a walk with a friend, or turning up the music and cleaning house really really well.  I try to schedule my workouts like appointments, but that all goes to hell when I get too busy.  Forgive yourself, and then get busy being active again as soon as possible.  It’s your body, and no one’s gonna love it like you can.



Original post here:

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