Today, most patients want facial improvement and a youthful appearance without surgery, discomfort or prolonged swelling and bruising. This can be accomplished with facial fillers (Juvederm, Radiesse).

As we age, the underlying facial soft tissue atrophies and we begin to hallow out. Laugh lines, crow’s feet and other facial wrinkles develop causing us to look older and less vibrant than we feel. Today, natural and biocompatible substances such as hyaluronic acid (Restylane, hylaform), calcium hydroxylapatite (Radiesse) and fat are helping to restore a more youthful appearance for millions of women and men. Research is ongoing, and new products are constantly being developed that further expand the choices available to physicians and patients.

Fillers are used to fill lines, wrinkles and lips. They may also be used to reduce the appearance of scarring caused by acne, chicken pox or injury. We also use them to augment cheeks and chins. One of the ways I am using fillers if for facial shaping. By building up the cheekbones and using hylaform to fill the indent in front of the jowls, disguising it, I can give the face a younger shape.

In my practice, a lot of patients point out to me red spots located on their faces and body. It is important to realize that some of these red areas may be early or actual skin cancer. The most common types of red spots are actinic keratosis (premalignant) and basal cell carcinomas.

It is very difficult for a patient to determine what these lesions represent. Typically, a red lesion that is present for many months, that itches, is scaly and flakes, is of concern. A strong history of sun exposure and a fair skinned individual are at high risk for developing these lesions.

When I see these lesions, a biopsy must be done to determine a diagnosis. In most cases, various anticancer creams can be applied to non-cancerous lesions. If a basal cell cancer is found, a minor surgery or radiation therapy is used to treat these cancers. It is important to realize that these cancers are not life threatening as long as they are caught early and treated. It is my advice that everyone examine their selves regularly and see their doctor for any suspicious lesions.

The cardinal feature observed in a skin lesion that proves to be melanoma is a change observed over a period of months. The time scale of the observed change is important. If a lesion grows so that it doubles its size within 10 days, it is usually an inflammatory (irritant) condition. If the lesion grows slowly that the patient or his relatives are unsure of any change, the lesion is often benign. However, medical advice should be sought regarding a lesion that doubles its size in 3 to 8 months. These symptoms may include growth in the diameter or contour of the mole, a change in color, bleeding, itching, ulceration, or the development of a palpable lymph node.

Growth (increased size) and color change (usually darker) are the symptoms most commonly seen first. They occur in over 70% of early, curable melanomas. Most lesions arise from a pre-existing mole, either on the trunk or leg. Please note that these facts and see your doctor immediately if you see these types of dark lesions.

Some people are born with noses that are quite large. Patients describe to me that their nose is like Pinocchio. What they mean is that their nose has a large bump and projects outward from their face. These people are very self conscious about their nose and would like their nose smaller and more shapely.

As a specialist in nose surgery I have treated hundreds of noses. By removing bone and cartilage from their noses, the nose is reduced in size and becomes much more pleasing and natural. The goal for this surgery is to make their nose fit their face and blend with the other parts of their facial anatomy. This surgery is very successful and allows these patients to develop a new self confidence.

There are multiple methods to improve our facial appearance. Today, we see many TV commercials and magazine ads showing wonderful results of facelifts that are inexpensive and require minimal surgery. I would caution consumers about surgeries that promise these great results. Good surgery requires time, expense and good surgical skill. Remember, it is your face that you are improving. Bad results can occur that may not be correctable. Your financial investment in your face will be worth every dollar you spend. Please do your research well.

By removing breast tissue, weight is removed from the chest relieving most of the woman’s discomfort. This surgery will allow the woman to stand upright, exercise normally and be without constant pain. This surgery creates one of the most immediate and dramatic changes in body image. The breasts become smaller, lighter, firmer, and in better proportion to the rest of the body. Clothing choices are expanded. In most cases, normal nipple sensation and the ability to breast feed will be maintianed.

In my experience, I have found this to be one of my most satisfying surgeries.

Plastic surgery offers a solution for men who are troubled by this embarrassing condition. Through the use of ultrasonic liposuction most cases of gynecomastia can be corrected. The excess skin shrinks and contracts following liposuction leaving a smooth and normal contour to the breast area. Only in severe cases will skin and glandular tissue be required to be removed to create a firmer, flatter, and better contoured male breast.

Cosmetic surgery not only makes us look more youthful, but also makes us feel younger. I constantly hear from my patients that they are looked at differently at work and socially following cosmetic surgery. The psychological aspects of this surgery are very uplifting. As we get older we may feel young, but it is depressing to see our aged appearance in the mirror.

Being an Orange County plastic surgery specialist, I find cosmetic surgery to be extremely rewarding. I thoroughly enjoy seeing the psychological changes in people following all kinds of beautification surgery. The fees for this surgery seem quite reasonable considering a person enjoys the benefits of these procedures every day.

Every day I hear from my patients how they hate their lower abdominal bulge. They mention that following their children, they are unable to eliminate the loose skin and fat that has developed. They see s low abdominal protuberance (pooch) in their clothes and especially in their bathing suits.

As a cosmetic surgical abdominal specialist in North Orange County, I have treated hundreds of patients with these problems. In most cases,  a minor surgical procedure is performed, called a mini abdominoplasty. In this surgery, a small scar is made low in the abdominal area (below the bathing suit line), excess skin is removed and liposuction is done to remove the fat. In some cases, the abdominal wall is also tightened. Women in my practice are thrilled with this procedure, since diet and excessive exercise does not eliminate this problem.

Liposuction is the solution. This is one of the safest procedure I perform. There is a lot of advertisements for some non-invasive procedures to correct this problem. Unfortunately, these other techniques result in minimal improvement. If a patient really wants to correct the bulges, liposuction is the only effective way to obtain excellent results. Be careful of newspaper and magazine articles proposing techniques that are not well studied and tested.

Dr. Robert Wald