Articles Provided by Dr. Eisemann of Houston

Plastic Surgery related articles featuring Dr. Eisemann in Houston.
Top Doc
H Texas Magazine

A “Top Doc” five years running, Dr. Michael Eisemann is a board Certifi ed Plastic and Reconstructive Surgeon and a Board Certifi ed Ear, Nose and Throat, Head and Neck Surgeon. Dr. Eisemann believes that plastic surgery is the expression of beauty, balance and proportion, and, therefore, he works to attain a natural, unoperated look. With more than 24 years of experience, Dr. Eisemann has become one of the most trusted and respected plastic surgeons in the Houston area.

At the Eisemann Cosmetic Day Surgery Center, patients are given intravenous sedation and regional anesthesia, which allows Dr. Eisemann to perform many procedures in his offi ce operating facility, avoiding general anesthesia and hospitalization. He is constantly modernizing his center to accommodate the changing needs of his patients. Dr. Eisemann recently added the revolutionary ultrasonic liposuction technology, called Vaser, which removes more fat with less bleeding and a smaller incision than ever before. He utilizes the latest in Intense Pulse Light to treat hyperpigmentation, rosacea and other abnormal vascular skin conditions. Many of his patients have also enjoyed the excellent results of Contour Threads used in face lifts and brow lifts.

Dr. Eisemann formerly served as president of the Houston Society of Plastic Surgeons and is currently a fellow of the American College of Surgeons and the American Society of Plastic and Reconstructive Surgeons. Dr. Eisemann teaches residents and medical students from Baylor College of Medicine, as well as Tulane University students who recently moved to Houston.

Whether you are considering rhinoplasty or breast enhancement, Botox or body contouring, Dr. Eisemann has the experience and training to help you get the results you desire.



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Steps to getting plastic surgery
Michael Eisemann, M.D., F.A.C.S.

When getting plastic surgery done, especially for the first time, it is important to follow a certain path to insure that your procedure goes smoothly. We have put together this simple yet concise list of steps for you to follow.


Step 1 – The Consultation

Scheduling an initial consultation at the Eisemann Cosmetic DaySurgery Center is the first step in having any plastic surgery procedure. This meeting allows for the development of a relationship between the patient and Dr. Eisemann, which is vital for the success of a surgical procedure. During this time the doctor is available to discuss each person's needs and the techniques available to achieve optimal results. The patient develops an understanding of the expected outcome of cosmetic surgery - which is different for each individual - and the physician has an opportunity to determine if the patient has realistic goals and is appropriately motivated for surgery. Video imaging is helpful to allow the patient to view on a split screen a simulated, electronically generated postoperative result, and compare this to the preoperative image.

Step 2 – Financing

Unfortunately, economics often dictate what procedure a patient can or cannot have performed. We have a long-standing relationship with Cosmetic Fee Plan, which can get you financed for virtually any procedure. You can even fill out your application on-line, and one of their agents will contact you with an answer within 24 hours Don’t let economic worries dictate what you can or cannot accomplish, we can help you!

Step 3 – Scheduling Your Surgery

After the initial consultation, scheduling your surgery can be arranged. Each patient receives information and instructions related to the surgery for which they are scheduled. The staff is then available to answer any additional questions and to assist in making necessary arrangements. It is important to note that many procedures will require time to rest and recover, therefore scheduling your surgery during vacation time or a long holiday weekend is often something to take into consideration.

Step 4 – Follow-up Visits

Dr. Eisemann strives to provide the most personal care available and having a follow-up visit is not just recommended, it is required. Dr. Eisemann will examine the procedure’s results just to make sure you are comfortable, safe and happy.

Step 5 – Enjoy the new you

The ultimate goal of any plastic surgery procedure is to make you feel better about yourself. So go out there and enjoy the new you, go to the beach, take a vacation or just show off to your friends. Either way, the new and improved you is dying to be seen, so go out there and do it and enjoy life to its fullest!



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Buttock Implant
Michael Eisemann, M.D., F.A.C.S.

Following the aesthetic trends from South America and Brazil, there is a renewed interest in enhancing the appearance of the buttock. The buttock, like the breast, is most important in defining feminine appearance and sexuality. A flat drooping buttock can be very unattractive, signaling an aged appearance. Young and thin patients can define their figure faults avoiding an androgynous (male shape) appearance.

A wide soft silicone elastic elastomer (not gel) is inserted through a single or double 7 cm incision in the buttock cleft and placed within the gluteus maximum muscle or just beneath the fascia. The implants are round, anatomical, or oval in shape, textured or smooth, depending on the needs of the patient. A drain is removed in one week to reduce the chance of seroma (fluid accumulation) around the implant. Strict observance to post operative instructions is important for a successful outcome. This includes no lying on your back or sitting for two weeks. This is necessary to reduce the chances of wound separation or dehiscence. The new soft silicone anatomic implants, when placed within the muscle usually provides a very natural feel.

The surgery is generally done in the hospital under general anesthesia taking about two hours, and is done as an outpatient surgery. There is postoperative pain that is managed with analgesic medication for 1-2 weeks.



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Short Scar Facelift
Michael Eisemann, M.D., F.A.C.S.

The short-scar facelift has become very popular with the baby boomer generation. In a person's mid to late forties, aging is usually noticeable in the mid-face region while there are fewer signs of aging and excess skin around the jaw line and neck. If you fit this description, you may be an ideal candidate for a short scar facelift.

A short scar facelift is a multi-layer lift where the internal soft tissue structures (the so-called "SMAS" layer and malar fat pad) are adjusted separately from the skin that covers them. It can remove a number of years from the most visible signs of aging and can be performed with other cosmetic surgery procedures (such as liposuction in the region of the neck). The potential results, as with any cosmetic surgery procedure, vary from patient to patient. Your surgeon will be able to give you a more detailed appraisal once he or she has visited with you in person.

The short scar technique is not a cure-all. If you feel concern about wrinkles around your mouth, better alternatives would be a chemical peel, Intense Pulsed Light or dermabrasion.


THE PROCEDURE

In a short scar procedure, all the areas of the face that show signs of aging are repositioned. Your facial structure plays a large part in the exact placement of the incisions as well as your surgeon's strategy in approaching the procedure.

Your surgeon will separate the skin from the fat and muscle below the surface. Fat may be trimmed from around the neck and chin to improve the contour. The underlying muscle and membrane are tightened, the skin is pulled back and any excess is removed. Your surgeon stitches the layers of tissue together and closes the incisions; metal clips may be used on the scalp.

Following surgery, a small, thin tube may be temporarily placed under the skin behind your ear to drain any blood that might collect there. The surgeon may also wrap your head loosely in bandages to minimize bruising and swelling.

COMPARING TYPES OF FACELIFTS

There are actually several modern variations to the standard facelift that can give you a wonderfully natural result and will focus on specific regions of your face.

SMAS versus The Traditional Method

The "high SMAS" (superficial musculo-aponeurotic system) technique uses the deeper tissues (instead of the skin) as a "handle" to work with and reposition facial muscles. The procedure can yield predictable and beautiful results. The 'high SMAS' technique repositions facial fat and can restore a jowled, square face to a more youthful, trapezoid contour.

Short Scar Facelift versus The Traditional Method

The short scar facelift is a minimally invasive lift with an incision half the length of a traditional facelift incision. It is not the best choice for patients with excessive skin around the neck; a traditional approach would give a better result. Scarring in a short scar lift occurs in front of the ear and just behind it. Unlike traditional lifts, the hairline is usually unaffected, allowing women to wear their hair back.

The short scar lift is executed on a deeper plane of the skin and performed with mini-incisions. Skin, fat and muscle are all moved at the same time, giving long-lasting results. Without a brow or eyelift added, a short scar facelift takes between 90 minutes to three hours, which is roughly half the time of a traditional lift.

Mid Facelift versus The Traditional Method

The mid-face lift has been implemented for about 10 years. The fat between the lower eyelid and cheek is blended, filling in the trough or ring beneath the lower eyelid. The advantage of a mid-face lift versus the traditional method is that the area between the upper cheeks and the eyelids also are lifted in the surgery. This gives the patient a more balanced, youthful look. Recovery time is longer (about four weeks versus two weeks for a traditional facelift) and there tends to be more swelling and bruising. Adding a mid-facelift to a standard lower lift increases the operation time by about one hour. For more on mid facelifts, click here .

YOUR FIRST CONSULTATION

It is very important that you feel confident in your surgeon; during your first consultation, he or she will evaluate your face, skin and underlying bone and discuss your ultimate hopes for the surgery. Since each face is unique, so are the potential results in a short-scar facelift. A good surgeon will make sure you have realistic expectations.

Personal medical conditions could cause problems during or after surgery, such as high blood pressure, if your blood has difficulty clotting, or if your body tends to scar excessively. It is very important for your surgeon to know if you smoke or are taking any medications; especially aspirin, Vitamin E, or other drugs or herbal medications that affect clotting.

You'll be given guidelines on eating and drinking and what to avoid. If you smoke, it is very important to stop two weeks before and after surgery. Blood flow to the skin is inhibited by smoking and will slow your face's natural healing process, delaying healing.

It is a good idea to let your hair grow longer (especially if you have a short hairstyle) to help conceal the scars while you heal.


ANESTHESIA

Most short-scar facelifts are performed under local anesthesia, along with a sedative to relax you. Your face will be numb during the surgery, though you may feel some slight tugging. Sometimes general anesthesia is preferable, in which case you'll sleep through the surgery.


AFTER YOUR FACELIFT

Typically you will feel only slight discomfort after surgery, which is easily remedied by pain relievers your surgeon will prescribe for you. Some numbness of your skin is normal and lasts a few weeks. It is best to keep your head elevated and as still as possible for a few days after surgery to help keep the swelling down.

A drainage tube was inserted and it will be removed a day or two after surgery. Bandages are usually removed after one day. For the first few weeks your face will look pale, puffy and bruised but this condition steadily improves, After 6 days nearly all of your stitches are removed, however a few stitches or metal clips may be left in for an additional few days.

It is best to be easy on yourself during the first week of recovery. Your skin will be both tender and numb, so be very gentle to your face and hair. Get plenty of rest. Avoid heavy, strenuous activity (including intimacy with your partner), for at least two weeks (walking and stretching are good). Also avoid alcohol and saunas for several months.

It is not uncommon for patients to become a bit depressed during the first two weeks after surgery due to the swelling and bruising that are a part of the healing process. By your third week, you'll look and feel much better. Most patients are back at work about two weeks after surgery. Special makeup is available that can mask most bruising that remains.


Your new look after your short-scar facelift

Once the swelling and bruising have subsided by 3 weeks most patients are very pleased with the results of the short scar facelift, although for several months the hair may be thin and your skin may feel dry. Scars that are usually hidden within your hairline or the creases in your face and ears, will soften, flatten and lighten. Depending on certain patients, some men may find they need to shave behind the neck and ears, due to the repositioning of skin that grows beard.



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Mastopexy Offers Women A Solution
Michael Eisemann, M.D., F.A.C.S.

Time takes it's toll on a woman's breasts. Factors such as breast-feeding, weight loss and even the inevitability of gravity and age leave many women with body contours that can affect their self-esteem.

Mastopexy (breast lift) removes the excess skin caused by stretching and sagging and re-shapes the breast to look younger. A standard mastopexy takes 1 1/2 hours. Using local intravenous sedation, it is often performed in conjunction with a breast augmentation to provide fullness and breast projection .

Time takes it's toll on a woman's breasts. Factors such as breast-feeding, weight loss and even the inevitability of gravity and age leave many women with body contours that can affect their self-esteem.

Mastopexy (breast lift) removes the excess skin caused by stretching and sagging and re-shapes the breast to look younger. A standard mastopexy takes 1 1/2 hours. Using local intravenous sedation, it is often performed in conjunction with a breast augmentation to provide fullness and breast projection .

It is very important to have realistic expectations toward your result. This is one of the many reasons why you must have a great relationship with your surgeon; you must trust him and the advice he gives you. Your surgeon can tell you from experience what you can hope to achieve.

You should wait on having a mastopexy if you're considering having children. Pregnancy after a mastopexy stretches your skin further, making it thinner. It is very possible you would need another mastopexy. That said, if you do give birth after a mastopexy, it will not affect your ability to breast feed, as the milk ducts are typically untouched by the operation.

There are several standard types of mastopexy. Your surgeon will give you the best option to suit your needs.

Full Mastopexy is performed with an anchor-shaped incision that starts at the base of the areola (the dark circle around your nipple) and extends to the bottom of the breast, meeting the ribcage. The surgeon then cuts out a crescent-shaped piece of skin right above where the breast meets the rib cage. The nipple is not removed but rather transposed to its new position. This operation corrects severe sagging and may result in long scars. The scars do fade in time, but will not disappear completely.

The Crescent Lift removes a crescent-shaped piece of tissue just above the areola and pulls the nipple to a higher position. This is a minor lift for patients who have slight ptosis.

The Benelli Lift is not as invasive and places the scars around the areola. A donut-shaped piece of skin around the areola border is removed and the remaining tissue is attached to the areola. Sometimes a little more tissue is removed above the areola to create more of a lifting effect. Some flattening or loss of breast projection occurs with this technique, especially if an implant is not used.

The Benelli-Lollipop is a Benelli lift combined with a straight incision from under the areola to the crease under the breast. This option is chosen for those who need more than a standard Benelli, but do not need a full anchor mastopexy.

The scars will fade a bit during the first year, and fade more as time goes by. The scars around the areola area fade faster than the scars on the breast skin. Steri-Strips and/or Silicone sheeting is placed on the scars to quicken the fading and flattening of the scars.

Sutures placed under the skin dissolve over several months. Sutures placed through the skin dissolve in one to two weeks. A surgical tape placed over the sutures (or tissue glue) to help protect the wound. You will experience mild swelling, but relatively little pain. You can return to work in 3 to 7 days, providing you do nothing too physical.

You will probably wear a surgical bra over your gauze bandages. This will be worn continuously for about three weeks. If you have non-dissolving stitches, they will then be removed.

You may experience a temporary loss of sensitivity in your nipples and breast skin because of swelling. The numb feeling this creates is normal. Most sensation returns within 1 to 3 months although in rare cases it could take up to a year or more.

Risks factors

There are risks associated with every type of surgery, such as a possible reaction to the anesthesia. A mastopexy leaves a scar that will be visible and it is possible that your nipples and breast skin will lose sensitivity.

Infections can occur, but they are rare. Staph infections can happen because staph lives on your skin along with other bacteria. It is very important to wash your skin for several days before your surgery with an anti-bacterial soap. This will lessen the possibility of introducing bacteria to the incision.

Smokers carry their own risk factors in any type of surgery, such as a slower rate of healing. A rare occurrence in smokers is tissue necrosis, where tissue can be damaged by poor oxygen and blood flow through the nipple and other tissue that needs to be reattached once the lift is accomplished. This condition can be avoided by not smoking for several weeks before surgery. Of course, quitting nicotine permanently is one of the best life choices you can make.



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Implants Above Or Below The Muscle
Michael Eisemann, M.D., F.A.C.S.

One of the first choices you need to discuss with your surgeon is whether you should have your breast implants placed above or below the Pectoralis Major muscles. The Pectoralis Major muscle is a large, triangular muscle that reaches across the chest with one end at the shoulder and one side attached to the chest bone.

Placing the implant "above or below the muscle" is a term misunderstood by many people; in both cases, the implant is behind the mammary glands and the breast tissue. Both approaches have some advantages and disadvantages. Your individual body type, the amount of breast tissue you have and your goals for size and shape will help you and your surgeon determine which position is best for you.

Originally, silicone gel implants were placed above the muscle. Although this worked well in many cases, a significant number of patients, developed capsular contracture, which is a hardening of the scar tissue around the implant.

During the 1970's, breast reconstruction became popular for cancer patients. With no breast tissue to work with, surgeons began placing implants underneath the pectoral muscle. Over time, this procedure proved to lessen the occurrence of capsular contracture. As a result, many surgeons began placing the implant beneath the muscle in most or all of their patients.

The submuscular position (behind the muscle) may have problems of its own. When the pectoral muscle contracts, such as during exercise, the breast changes shape. Another drawback is that the implant, for several months, maintains a high position on the chest wall. It will, however, drop and assume the correct position

Each breast has it's own unique needs. Below is a quick reference guide to give you an idea of what to expect:

If you have very little breast tissue, you will most likely want to "go behind the muscle". With little tissue to cover the implant, the roundness of the implant may be obvious as well as increased visibility of any rippling that occurs. Also, the presence of the implant will be obvious when you touch it. The extra layer of muscle covering the implant will disguise much of the palpable rippling.

If you have some breast tissue (approximately 3 cm or more) you have more choice between above and below the muscle placement. If placed under the muscle, the implant is more likely to move when you perform exercises that use the chest muscles.

If you have very little breast tissue and a droopy breast, a silicone implant would be a good solution. The implant can give a very soft, natural feel and look. Keep in mind the potential for wrinkling and rippling is always a possibility in breast implant surgery.

If you have some breast tissue and a sagging breast , you will probably want to go above the muscle. Even though the breast itself is drooping, the chest muscles are still in their proper position. If you put an implant behind the chest muscle, your breast would still droop but now you would have a breast implant pushing out from the chest wall above the rest of the breast.

If you have a droopy breast with sufficient breast tissue, the implant can be placed in front of the muscle and the tissue should cover the implant nicely. However, you can't fight gravity forever. The additional weight of the implant can create more ptosis (drooping) over time. Wearing a sturdy bra can fight gravity.

Finally, if there is significant ptosis, a breast lift may need to be done along with the breast implant.



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Breast Augmentation Incisions: Pros And Cons
Michael Eisemann, M.D., F.A.C.S.

Knowing you desire an enlargement is only the beginning of your journey. Among the many things to understand is exactly where the implants should be inserted into your body. There are three common entry points, each with it's own set of advantages and downsides.

Periareolar

The Periareolar incision is located on the nipple itself. It is one of the most common procedures in breast augmentation. If you are interested in a mastopexy (breast lift), this incision is the choice most surgeons will recommend. It works well with every type of implant and for both over and under the muscle implant placement.

The Periareolar incision is made around the bottom half of the dark circle of skin surrounding the nipple. The exact incision line is critical for a satisfactory result. For the scar to blend properly it must occur exactly on the edge where the lighter skin meets the darker skin. If the incision heals within the areola area, a "smiley face" can occur from the lighter-colored scar tissue. Surgical tape is placed on the incision and should not be moved, as it reduces the effects of gravity pulling on the skin and aids the scar to heal as a flat, very thin line. A properly healed scar from a well-placed periareolar incision is barely visible.

A potential risk factor is the bacteria found in breast ducts, which can spread germs into the area holding the implants. Many surgeons use a protective sleeve to keep the implants from coming in contact with the breast ducts. This sleeve is not useable if the implant chosen is pre-filled, as with certain saline or gel implants, since they cannot be rolled-up and put in place unfilled.

Inframammary Fold

The inframammary incision is as popular as the periareolar. The implant can be placed or removed above or below the muscle. Since the implants do not pass through the breast ducts, the risk of bacterial infection is greatly reduced. This incision is a favorite among surgeons because it gives the surgeon a great deal of control over the placement of the implant.

The incision is made just above the crease, or inframammary fold, underneath the breast. This helps prevent the scar being seen when in a swimsuit or lingerie. Proper placement is an art-form in itself; the surgeon must estimate where the incision will sit in relation to the crease created by the larger, enhanced breast. A wrong placement higher or lower on the breast will make the incision visible.

Along with giving the surgeon control over implant placement, they also favor this incision for it's use in revision work. Should you need a revision, the original location can be revisited. This means no additional scars that an initial transaxillary incision would require and no additional risk of nipple sensitivity that a periareolar could cause.

A downside to this procedure is if you decide to substantially change the size of the implants after surgery. It is not uncommon after the initial implant procedure for a patient to wish she were bigger or smaller. An implant needs to be centered behind the nipple to look natural. If you decide to go much bigger, the scar will be located higher on the breast. If you go smaller the crease will be raised, exposing the scar in a lower position, possibly in view under a bra or swimsuit.

Transaxillary

The immediate benefit of a transaxillary incision is the lack of scars to the breast. The incision is located in the armpit, where it is only seen when you raise your arm. The scar typically heals well, with maybe a slight discoloration to the skin. Should your scar be fairly noticeable, it will be located in a place where few people will associate it with breast enlargement. The implant can be placed above or below the muscle with this incision.

Though the entry point is away from the breast itself, the procedure can be achieved with or without an endoscope. It is important that your surgeon is very skilled at this incision. If your surgeon does not use an endoscope, the implant can look lopsided.

The downside to the transaxillary incision is in the event of a complication, you will need another surgery and most likely at a different entry point. The transaxillary incision may not be suitable for certain types of corrective surgery. As an example, if you suffer from bottoming out, where your nipple appears too high on the breast due to an implant dropping too low on your chest, an incision on or under the breast would be a better choice.



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What A Mid-Facelift Can Do For You
Michael Eisemann, M.D., F.A.C.S.

With aging, the face takes on many changes; subtle at first, but very apparent as time marches relentlessly on. As the cheeks start their vertical descent, they drag other facial features along for the ride. Jowls appear where fresh, full skin once resided. Lower lids start to sag as do the eyebrows. The neck skin and muscle loosen, erasing the elegant lines and contours of the chin and jaw.

Traditionally, facelifts focused on tightening the skin around the neck and jaw-line. There is a new trend among plastic surgeons to focus on the central part of the face, known as a mid-face lift. The mid-facelift focuses on a triangular area formed between the two corners of the eye and the corner of the mouth. Technically, the mid-facelift is a lower eyelid tuck that is extended to the cheeks. The procedure takes about an hour, approximately one half the time for a classical facelift.

One technique is to vertically lift the malar fat pad (cheek fat) through an incision that is typically used for lower eyelid surgery. It is then suspended in a higher position along with the circular muscle below the eye. This helps fill in the hollow areas of the face caused by age. If the amount of soft tissue of the upper mid-face is full in relation to an emptier lower mid-face and this is accomplished in a flowing and graceful manner, the face will look healthier and younger.

A second technique involves lifting the malar fat pad as part of a three phase facelift- 1) removal and tightening of loose skin, 2) lifting the support layer that consists of muscle and connective tissue to reduce jowling and 3) Freeing the malar fat pad from the underlying bone. Once it is free, a suture is run through the fat pad and underneath a nerve bridge that supplies muscle function to the forehead and upper eyelid. The suture is then pulled toward the temple area where the elevation of the fat pad is then adjusted. The cheeks appear fuller with less jowling and better lower eye contouring.

Mid-face lifts are not only for first time patients. Studies have shown that people who have had previous, traditional facelifts have seen wonderful results using these more modern techniques. Lifting the malar fat pad gave patients a more youthful look while making it possible to correct the "surprised" or "wind tunnel" effects of some traditional facelifts.

Classic eyelid tuck techniques removed fat and smoothed lines and wrinkles, but often resulted in eyes that looked sunken. The mid-facelift also corrects prior eyelid tucks while strengthening the underlying tissue, lifting and smoothing the skin. The fatty tissues of the cheek and lower eyelid are blended, removing the sunken, hollow eye appearance.

Other procedures can enhance the results. The patient's own fat can be transplanted from one area to another (Autologous fat grafting). Lips are commonly augmented to replace fat lost with aging or to create a fuller, softer look. The nose can droop with age and can often be corrected with a 'peri-piriform' implant. The chin can be augmented to improve the jaw contour. Needless to say, a good skin care regimen is important to maintain a healthy, youthful appearance.



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Have You Fought And Lost The Battle Against Acne? You May Be Able To Win The War: Acne Scars Effaced
Michael Eisemann, M.D., F.A.C.S.

For years, the blight of acne scars has plagued millions. Until now, people who suffered from moderate to severe acne could expect to wear their badges of combat from the acne wars on their face. However, thanks to the latest surgical advances, veterans of the war against acne may now claim some victory. Dr. Michael Eisemann, a Houston board-certified plastic surgeon, performs several old and new surgical procedures that often significantly improve acne related scars. Combining the use of dermabrasion, laser resurfacing and the “punch-excision skin-grafting technique”, patients with acne scars can expect at least a 50% improvement to their skin.

Dr. Eisemann defines acne as, “the bacterial colonization of hair follicles and the sweat gland units”. The results of this condition are pimples and in some cases, a severe problem of scarring if not properly treated. The acute acne patient is treated with topical and systemic antibiotics, Retin-A and Acutane. Dr. Eisemann says, “Retin-A inhibits the formation of black heads and comedones (pimples or cysts under the kin) by causing the sloughing of the horny cell layer by rpreventing the cells from sticking together and blocking pores. Retin-A is very effective in treating the earlier stages of acne. However, the development of cystic acne requires Acutane, an orally consumed medication that suppresses the oil content to the sebaceous glands and follicle cell epithelial growth. For patients taking Acutane, it is critical to avoid sun exposure. Hopefully Retin-A and Acutane will control acne effectively enough to prevent visible pockmarks and scarred skin. In some cases, acne scars or blemishes may be inevitable.

Before Dr. Eisemann is ready to surgically restore a patient’s skin, he first decides who is an appropriate candidate. According to Dr. Eisemann, “first and foremost, the patient’s acne condition must be stabilized by a dermatologist. The acne must be in a chronic stage, not active or inflamed, before I even consider surgery. In addition, a patient on Acutane must wait at least one year following treatment before having any form of surgical treatment such as dermabrasion, laser resurfacing or chemical peels which all create a controlled wound. Acutane delays the formation of new skin by delaying reepithelialization. Various medications are used to pre-condition the skin before surgery, such as bleaching agents (hydroquinones) and steroids to prevent post-inflammatory hyperpigmentation and Retin-A to speed reepithelialization in forming a new skin layer. Immediately before the actual procedure, Dr. Eisemann numbs the area with the injection of local anesthetics (Xylocaine) and applies topical EMLA cream.

Depending on the severity of the “skin craters”, Dr. Eisemann will use a progressive combination of three different procedures and says, “Dermabrasion is a leveling form of therapy that uses small chips of diamond attached to a stainless steel wheel. The wheel is rotated by a high speed motor and brushes the upper layer of the skin which includes the intermediate layer of the dermis.” If the doctor does not go through the complete layer of the dermis, one can expect complete healing. Otherwise, going “too deep” can result in scars. “Using dermabrasion is really an art form”, Dr. Eisemann says, “but for deeper skin blemishes I prefer using the ultra-resurfacing laser because controlling the depth is easier and there is always a critical level I want to reach but not exceed.” Ultra short bursts of laser energy are applied to the skin so it is not irreparably burned. A new firm layer of collagen forms in the dermis that tightens the skin making acne scarring less noticeable.

Dr. Eisemann feels that in many cases, more than one procedure may be necessary and says, “Repeat procedures may be safer than trying to ‘go for broke’ the first time. Dermabrasion or lasers are very effective for treating shallow craters, but for deep ‘ice-pick’ scars, neither the laser nor dermabrasion will be effective.” In those instances, Dr. Eisemann says, “the most appropriate treatment entails small punch-excisions and skin-grafting which encompass the ‘ice-pick’ craters going down the subcutaneous tissue. A one to three millimeter skin graft is taken from behind the ear with a sharp punch whose diameter is ½ millimeter larger than the punched out crater removed from the cheek. The doctor then transplants the grafted skin to the recipient cheek skin.”

Whether Dr. Eisemann performs dermabrasion, laser resurfacing or the “punch-excision” grafting technique, the healing time from such procedures is substantial. “These procedures are controlled wounds”, Dr. Eisemann says, “It takes ten to twelve days before the skin re-grows and heals. There are long periods of redness. A camouflage makeup is used to disguise the red areas with a green base makeup. The patient may further add “toners” as color is slowly restored. All of the postoperative camouflage makeup and healing instructions are provided by Dr. Eisemann. After years of long, hard-fought battle against acne, today’s surgical advances have claimed significant victories.



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Houston Health & Fitness Profile on Dr. Michael Eisemann

At a time when everyone from the corner grocery store to multi-national corporations are looking to expand and become less personalized in their approach, Cosmetic and Plastic Surgeon Michael Eisemann, MD maintains a simple philosophy.

“I’m the only doctor that people deal with in my practice. No partners.” Dr. Eisemann says, “I believe there is a level of excellence that ca be achieved through providing a continuity of care. I have a broad-based practice and thanks to my on-site surgical facility, I’m able to do most procedures in-office. I believe by dealing with the same doctor and nurses in a familiar environment it helps to ease any concerns the patient may have.”

In practice since 1977, Dr. Eisemann is board-certified by the American Board of Plastic Surgery and the American Board of Otolaryngology and performs a variety of cosmetic surgical procedures, concentrating on liposuction, breast augmentation, reduction and reconstruction, rhinoplasty and facial procedures.

For his liposuction patients, Dr. Eisemann uses either traditional or ultrasonic techniques to dramatically improve their appearance. Ultrasonic techniques are used to remove fat deposits from hard-to-treat areas such as the back. Dr. Eisemann is also skilled in the use for Endoscopic equipment in breast enlargement procedures.

“I use I.V. sedation in most of my procedures, rather than general aesthesia”, explains Dr. Eisemann, “There are fewer post-operative problems with I.V. sedation. The patient does not have to be hospitalized and I.V. sedation is a more cost-effective method as well.”

Dr. Eisemann is a graduate of Colgate University. He served his residency at Yale University, the John Hopkins Hospital and the Baylor College of Medicine. A past president of the Houston Society of Plastic Surgeons, Dr. Eisemann has been listed in the “Guide to Top Doctors” as one of Texas’ top-rated plastic surgeons.

“Our approach to patient care is to provide services which are high quality, cost effective and convenient. Our highly trained medical staff is sensitive to the individual needs of each patient and provides the personal touch that makes any procedure more comfortable”, says Dr. Eisemann. “I think what makes us unique is our office-based medical facility, which allows us to provide procedures which had been previously performed in the hospital.”

Dr. Eisemann takes special pleasure in producing life-changing results for rhinoplasty patients. He says surgery of the nose requires an uncommon skill and experience.

“Rhinoplasty is a unique surgical procedure because multiple steps are involved, both during the operation and in the healing process. Because you’re dealing with soft tissue, cartilage and bone, extensive experience is needed. A surgeon needs to have performed many surgeries to be able to anticipate what the outcome will be. The surgery can be extremely rewarding when the patient sees their new appearance.”

Dr. Eisemann has noticed the dramatic effect cosmetic surgery has had on many of his patients. The renewed confidence and self-esteem that can be derived through the improvement of an area the patient considers to be a physical flaw can be breath-taking.

“I’ve often thought that plastic surgery can be thought of as a sort of psychological surgery as well. People who’ve improved their appearance often begin to look at life differently. Their new appearance helps them to compete in the workplace better and often improves their relationships as well. The benefits of a surgical procedure frequently go far beyond just the physical corrections that are made in the operating room.”

In order to make the benefits of cosmetic surgery available to as many people as possible, Dr. Eisemann provides several financing options and insurance covers most reconstructive and post-trauma procedures.

An avid golfer and tennis player, Dr. Eisemann says cosmetic surgery has moved into the mainstream of society and is now viewed by many people to be simply another method of improving their life, like taking a night class or changing their hairstyle.



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Face, Neck, And Eyebrow Surgical Enhancement For Males
Michael Eisemann, M.D., F.A.C.S.

When we look angry, tired or sad because of problems in the eyelid, eyebrows or face, we may be giving the wrong impression or communication of our true mood or feelings. We do not look like we feel. Eyebrows are very expressive in this way. Their elevation does not have to engender surprise, but merely an alert, active, energetic and youthful person. Appropriate techniques must be used which demonstrate an understanding of the special regional soft tissue and bony anatomy of the male face. Eyebrow elevation is usually combined with removal of excessive sagging skin and bulging fat of the eyelids. Incisions must be made that are nearly undetectable for the male whose hair is generally shorter than in women and who do not use cosmetics.

In the lower face, a deep supporting layer beneath the skin made of muscle and connective tissue is used to create longer lasting results with less tension on the skin. The tight windblown or mask-like expression of the face seen in the traditional facelift procedures is avoided and scars are finer, softer and hidden in skin creases and within the hairline.

Men, like women, have come to learn that appearance is an important factor in overall appeal. Our Cosmetic DaySurgery Center provides an environment of privacy and confidentiality with the safety and latest technology seen in modern Operating Room theaters. Most surgeries can be performed with local anesthesia and intravenous sedation.

Our nationally certified Operating Room is accredited by the American Association for the Accreditation of Ambulatory Surgical Facilities, Inc. It is not intended as an income center, but as an accommodation to patients seeking excellence and value.



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Intravenous Sedation and Local Anesthesia

We have found that hospitals are often insensitive to the needs of aesthetic surgery patients. Our goal is to perform anesthesia in a safe environment whereby the patient is free of pain and breathing on his/her own. The advantages of intravenous sedation and local anesthesia include the convenience to our patients whose surgery is performed in an office operating room setting, Moreover, there is continuity of care whereby the same personnel see the patient preoperatively, intraoperatively, and postoperatively providing, personalized attention.

We have also noted that patients who return for other surgeries prefer intravenous sedation with regional block over general anesthesia, which requires hospitalization with a longer recovery time as well as a higher incidence of postoperative nausea. We have not seen any cases of deep venous thrombosis or pulmonary embolus. The incidence of infection is lower additionally since there are no hospital-acquired infections.

There is obviously a considerable economic benefit since hospital operating rooms are there fo a profit while the Eisemann Cosmetic Day Surgery Center is not a profit center but exists as an accomodation to patients who prefer intravenous sedation and regional anesthesia. Nearly all head and neck surgeries include facelift, blepharoplasty, and rhinoplasty as well as breast augmentation and breast reduction and abdominoplasty with liposuction can be performed safely and comfortably under intravenous sedation and regional block/local anesthesia



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Effective Acne Treatment

Tender, red, and elevated facial pustules and vesicles are seen with active acne. This can be very psychologically distressing especially to young adults. Without treatment, permanent facial scarring can result. Treatment includes topical and systemic antibiotics including tetracycline derivatives as well as Retin A, Accutane, and vitamin A derivatives. While Accutane has demonstrated excellent results, it must be carefully monitored for serious side effects and can cause teratogenic congenital anomalies (birth defects) in children of pregnant mothers taking this medication.

An exciting new alternative to Accutane is now available at the Eisemann Plastic Surgery Center. This new light based treatment using Intense Pulse Light using Levulan (aminolevulonic acid HC1) has shown 50-75% clearance of the acute acne condition. Several treatment sessions are necessary, 1-3 weeks apart, it is however necessary to avoid direct sunlight and use topical sun block. Other treatment options are available as well, including invasive treatments such as Fraxel, laser treatments, or dermabrasion.



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Abstract from Minimally Invasive Lateral Canthopexy (MILC)

Inherent laxity of the lower eyelid can result in lower eyelid malposition following a lower eyelid blepharoplasty. This can be avoided by a lateral canthopexy technique which involves securing a suspension suture from the lower eyelid to the periosteum canthopexy of the lateral orbital rim at the level of the superior libmus. Techniques vary in the way in which the lateral retinaculum is captured. Jelks et al. described the inferior retinacular lateral canthopexy in which the lateral retinaculum is dissected from above through an upper blepharoplasty incision. Some place a double-armed suture through the lateral retinacular from the lateral extension of a lower blepharoplasty incision and then pass the suture into the upper blepharoplasty dissection, while others advocate canthopexy entirely through the lower lid dissection after skin/muscle flap elevation. Common to all these techniques is careful identification of the lateral retinaculum for suture placement.

The minimally invasive lateral canthopexy (MILC) described by Eisemann is a modification of the Hamra transcanthal canthopexy. In his modification, a C-1 double armed curved 5-0 Prolene suture is passed through at the site of a #18 gauge needle hole placed through the lateral retinaculum and sutured to the lateral orbital wall periosteum.

It is minimally invasive technique that is simple to perform, especially in the hands of a novice blepharoplasty surgeon. An advantage of this technique is absolute assurance of capturing the lateral canthal tendon. Extensive dissection to identify the tendon is not required which limits operative time and postoperative edema. Furthermore, recreation of the lateral retinaculum and canthal angle as in lateral central reconstruction with cantholysis is obviated. In our series of 26 patients, results have been excellent with no complications.



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Michael Eisemann, M.D., F.A.C.S.
Plastic and Reconstructive Surgery
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6550 Fannin Street
Houston, TX 77030
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