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“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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“As if you were on fire within, the moon lives in the lining of your skin.”

One of my favorite poets, Pablo Neruda, penned that line in Ode to a Beautiful Nude.

How appropriate for this post!  How can you feed your skin from within so you have that inner luminosity that no amount of expensive serum, sleep, or sex can create, and that poets write about?

In my experience, clean living and clean eating is the cheapest and most effective way – there’s no magic in it, just a lot of attention to detail (and Pinterest posts and reading the beautiful people’s blogs for recipes) and cooking.  Which means cleaning up too, because your dude just eats it and falls asleep.  Mainly because you didn’t train him right from the very beginning.  But back to clean eating – we all strive for that, and should be doing it ALL THE TIME.  But as usual, I have come up with a way to get around it if you happen to slip up once or twice.  Or five times, or all year.  It happens, because we have lives we have to live.  We need solutions!  That’s why I’m here.  I understand you, AND your needs.

As you know, skin suffers from poor nutrition, lack of proper cleansing (inside and out), dry winter air, alcohol, sleepless nights, working too hard…basically, LIVING is bad for your skin.  I’m going to focus on what you can do for your skin nutritionally that really works.  This list serves as an addition – the “extras” – to a high-quality multivitamin and mineral supplement containing at least 10,000 units of Vitamin A, a good spectrum of B-vitamins, and adequate Zinc.  This is your base.  There are several out there that may fit your lifestyle, be it one-a-day, 6 a day, including digestive enzymes to prevent that vitamin burp, or containing supplemental herbs for women’s health.  Pick a great one!

Number 1 on my list is a good MULTI:


What makes skin beautiful?  The structural proteins of skin (collagen, elastin, and keratin) give it firmness and elasticity.  You want the kind of skin that snaps back like a baby’s cheek.  Collagen is the main structural protein of the connective tissue in the body created by epithelial cells and fibroblasts.  The various collagens and the structures they form all serve the same purpose: to help tissues withstand stretching and GRAVITY.

The surface layers of the skin are supported from below by columns of fibers made up mostly of collagen and elastin. This network of fibers forms the molecular sponge known as connective tissue.  The spaces within this sponge are filled with a composition of water, protein complexes, and hyaluronic acid. This jelly-like complex transports essential nutrients from the bloodstream, via the capillaries in your skin. Hyaluronic acid attracts and holds water, which is what plumps your skin so that wrinkles and lines are less visible.

To make collagen, the fibroblasts need amino acids (building blocks of protein) like proline, glycine, and lysine.  They also need certain co-factors including ascorbic acid, or vitamin C.  The thing about vitamin C is that we burn through it really quickly in the stressful world we live in today, and it’s water-soluble, which means what isn’t used in a few hours is excreted in your urine, NOT stored for later use.  Fortunately, it’s easy to get in food and supplement form, and there’s a timed-release option available.  BINGO.

So, Number 2 on my list is Timed-release Vitamin C:

Next is protein.  Amino acids are found in all sources of protein.  Some are more easily digested and absorbed than others, which increases the bioavailability.  In general, animal proteins have a more complete amino acid profile, and plant proteins need to be combined.  Collagen protein is 20 times higher in glycine and proline than other sources (remember the fibroblasts and their needs) and is very well-absorbed, which makes it ideal for boosting collagen production in the body.  It’s derived from gelatin, which as we all know, makes your hair and nails grow.  Take this stuff, 2 Tbsp a day, and you will be amazed.  I am not kidding!  It’s virtually tasteless.  I mix it in my coffee, tea, soup, smoothies, and sometimes in the interest of just gettin’ it done, in some plain hot water.  Two choices, both excellent.

Number 3 on my list is Collagen Peptides:

Since collagen is a very cross-linked molecule with a lot of bonds to make it strong, you need sulfur to help make it.  A good source of sulfur with several other health benefits is MSM, or methylsulfonylmethane. MSM helps make the skin cells more permeable, and therefore more absorbent and receptive to plumping and hydration. The sulfur provided by MSM produces generous quantities of collagen and keratin, both of which are vital for healthy hair, skin and nails. In fact, MSM is often referred to as the ‘beauty mineral’ owing to its ability to add to enhance the thickness and strength of nails as well as hair in a very short span of time.

Number 4 on my list is MSM:

We’ve all heard that Biotin helps your hair and nails grow.  It’s true, but it also helps your skin glow.  Your body needs Biotin to metabolize carbohydrates, fats, and amino acids, the building blocks of protein, which as you know, is integral for building your infrastructure – keratin, collagen, and elastin.  Biotin deficiency is rare because, in general, intestinal bacteria produce biotin in excess of the body’s daily requirements.  However, we all know that the average person’s microbiome may be compromised.  Supplementing with Biotin is safe as long as you avoid daily doses above 5000 mcg (5 mg).  Some people report acne with too much biotin.
Number 5 is Biotin:
Next are the GOOD FATS.  Fat has made it off the black list and is now considered a beauty nutrient.  Good fats are Omega-3’s, avocado, coconut oil, olive oil, grass-fed organic butter or ghee, fatty fish like sardines and wild-caught salmon, and raw organic nuts and seeds.  Personally, I love getting this through diet alone.  If you don’t feel you can, take a high-quality fish or Krill oil or try Udo’s 3-6-9 Blend for a balanced 2:1:1 approach.
Number 6:  Omega-3 and Good Fats
Avofish  Udo

Hyaluronic Acid is a viscous fluid carbohydrate (not one to avoid!!!) that attracts and holds water.  Roughly 50% of the Hyaluronic Acid (HA) in our body is found in the skin. HA and Collagen are vital to maintaining the skin’s layers and structure. It is the collagen that gives the skin its firmness but it is the HA that nourishes and hydrates the collagen.  HA is well absorbed orally when taken on an empty stomach.  As an aside, it is also excellent for joints.  Take 70-100 mg twice a day with other supplements that are absorbed best without food.

Number 7: Hyaluronic Acid


To wrap it up, if you had to pick one, it would be the Multi.  The second one I would get is the Collagen Peptides.  This is of utmost importance if you’re considering an aesthetic procedure or healing from one.  The rest are icing on the cake!

Yours in safe beauty,


Original Post here:


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Post from FunctionalBeautyMD

Skin Care Ingredient Hype: It DOES Matter!

So, you’ve probably noticed there’s a lot in the media about the beauty industry lately regarding the toxicity of ingredients and lack of regulation. There are certain skin care ingredients you should learn to avoid. Should you pay attention?  YES.  Here’s why:

SkinYour skin is constantly regenerating from the basal layer.  As the cell layers mover closer to the surface and away from their blood supply, they become keratinized, metabolically inactive, and eventually slough off.  The outermost 25-30 layers of skin cells, called the stratum corneum, are dead and provide barrier protection:  they keep water in and chemicals and microorganisms out.  By nature, human skin has low permeability. TO PROTECT US.  But what do we do?

We mess with nature.  Using SCIENCE.

Science has allowed us to enhance the skin’s permeability with additives and chemicals, both natural and man-made, to allow for penetration through these protective layers moving substances deep into the biologically active layers of the skin.  Penetration enhancers (also called sorption promoters or accelerants) work by disrupting the “glue” that holds skin cells tightly together, dissolving the keratin, or otherwise “punching holes” in the layers.  Some examples are polyethylene glycol (PEG), PEG-amine, carboxylic acid, urea, propylene glycol, DMSO, liposomes, nanoparticles…  This is good when the molecule that’s getting through is one we want.  But what happens when harmful molecules that exist in the same product get through with it?  And, why are the harmful ones in there, anyway?  Isn’t someone supposed to monitor that?

moleculeGood molecules, or “actives” nourish and promote the health and youthful appearance of your skin.  These are things like Vitamin C, Vitamin E, ferulic acid, niacinamide, copper peptides, and hyaluronic acid, just to name a few.  We want those to get in and do the job!

Then there are the bad guys – parabens, phthalates, bisphenol-A, ethanolamines...the list is looooong.  They are put in to improve the smell, texture, or performance of a product. Poison Some are proven to cause cancer, genetic mutation, reproductive harm or birth defects.  Others are simply irritating or cause eczema, acne or rosacea.  These molecules hitch a ride on the penetration enhancers along with the good guys and WRECK your good intentions.  Did anyone get the photo?  It’s Poison.

Why are these companies allowed to put potentially harmful or PROVEN harmful ingredients in our products?  Because it’s legal in the US.  The European Union bans over 1300 hazardous ingredients from use in cosmetics.  United States?  11.  Yes, I said eleven, y’all.  Until there is better oversight, we have to protect ourselves, and that means arming yourself with knowledge!

Download the EWG Skin Deep app on your phone and use it when shopping:

Our “stratum corneum” does an amazing job of protecting us. If we are going to mess with that, let’s make sure we are doing so carefully, critically, and thoughtfully.  Here’s some help with the data – and don’t forget to take your reading glasses to the store!!!

More reading:

List of acceptable ingredients generally deemed as safe:

The NEVER List:

Whole Foods’ Never List:


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Style A to Z: Holiday Decorating Tips

The Holiday season is upon us, whether we are ready for it or not!


Here are some of my tips for last-minute decorating on a budget, to ensure that your life and home are ready for every family gathering and elegant dinner party!

1. Don’t overlook IKEA- IKEA is a fabulous one-stop-shop destination for all of your holiday decor needs. Introduce some seasonal inspired furnishings to your dining and living spaces, pick up some cozy faux-fur throws, or browse the wide selection of textured and fabulous area rugs to add warmth and holiday charm to your home. With unbeatable prices and wide selections, you are bound to find some pieces you will love!


2. Pull out the Sterling- Nothing says winter like sterling silver! Shimmering and sleek, sterling instantly adds seasonal flare to any space. Be it sconces, candle holders, flatware or otherwise, you shouldn’t underestimate the decorative value of a sturdy sterling piece!

3. Browse the local Dollar Store- It may seem counter intuitive, but you will be pleasantly surprised at the level of quality and selection of decorative items available at the dollar store! You can find awesome glass jars that when filled with decorative Christmas balls, become instant center pieces!

4. Deck the Halls!- Garnish your stair case and mantle with traditional pine boughs for a festive and inexpensive look! Save your own tree-trimmings and check the Pinterest boards for inspiration and techniques for getting the most out of the tinsel!

5. Get Creative!- The Holiday season is just as much about family and friends as it is about expressing yourself! Let your home be an extension of yourself. Deck the halls with all of pieces that make you happy. Consignment shops, antique stores and craft stores can give you inspiration to let your creative side show and can offer some really unique and affordable ways to spice up your winter decor!

Kiss of Couture,
Amy xoxo

Original post here:

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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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