Your Obagi Systems and Product Resource in Miami

More and more people are hearing about, and seeing the effects of Obagi products. As a result, patients are doing research to learn more about their products. Here are some valuable links that will help with your understanding of Obagi products.

• http://www.obagi.com/
• http://www.obagi.com/sites/default/files/useruploads/files/cande_pi.PDF
• http://www.obagiskin.com/

One thing to remember is that it has prescription strength ingredients to ensure its effectiveness. This is a medical grade product that is used to work with your skin on a cellular level. Obagi System and Products are physician dispensed and should be used only under the guidance of your skin care professional. Dr. Sharma carries Obagi products in his Coral Gables offices.

The Condition & Enhance System is the only prescription-strength skin care system that’s proven to collaborate with these procedures to make your overall results even better.

Here are some instructions just to keep in mind while using Obagi Condition and Enhance kit. 

1. Gentle Cleanser-Use AM/PM (normal to dry) or Foaming Gel (normal to oily) Wash, rinse with lukewarm water, avoid rubbing with towel
2. Toner- Use AM/PM (adjusts the pH in your skin)- Put toner on a cotton pad and apply to entire face- Do not rinse
3. Clear- Use AM/PM (topical treatment that 4% of hydroquinone to reduce hyper pigmentation & improves uneven skin tone. Measure 1-2 pea-sized amounts and apply evenly to entire face, extending to hairline and over the ears*Avoid contact with eyes*
4. Exfoderm or Exforferm Forte- promotes new skin cells for a lighter brighter complexion-Use AM only- Measure 1-2 pea-size amounts and apply evenly over entire face, avoiding eyelid area. Massage until completely absorbed
5. Blender- USE PM only- Rx treatment that contains 4% hydroquinone to target hyper pigmented areas of the skin and increase the penetration of the active ingredients of the system. Measure 1/2 gram approximately 1 pea-sized  amount of Blender- Apply around the eye area avoid corners of lips and corners around nose
6. Tretinoin- PM only, Great to use in conjunction with Blender. Start using the Tretinion twice a week at night for now. "Blend" the Tretinoin with the "blender"- pea size.  But if you do use it together avoid the eye area.
7. SPF- super important- use daily- avoid the sun if you can while using this product. Sunfader SPF use daily and/or any other SPF by Obagi.

If you notice your skin is really starting to peel in excess then you need to reduce the use of the Tretinoin.

There are several excellent videos of transformation stories on Obagi’s YouTube Channel, http://www.youtube.com/user/obagimedicalproducts?feature=results_main if you want to see some results for yourself.

Dr. Sharma strongly recommends discussing your skin care needs, especially following any facial plastic surgery procedure, so the final results will meet and exceed your expectations.

If you live in Miami, Coral Gables, Brickell, South Beach or West Palm Beach and are interested in speaking with Dr. Sharma’s offices to purchase or learn more about Obagi Systems and Products, please feel free to contact us at (305) 456-5727. We are located in Coral Gables at 475 Biltmore Way, Suite 308. We look forward to speaking with you and answering any questions you may have about these wonderful and effective skin enhancer products. 

Understanding Plastic Surgery of the Eyelids

There is no facial feature quite as important as your eyes when it comes to expressing your thoughts and emotions. Drooping or overhung upper eyelids and sagging lower lids can happen to anyone. Eyelids are often a tell-tale sign of aging; however, even young people are affected. Chronic allergies can cause eyelids to swell which increases the development of overhanging upper lids or “bags” under your eyes. Your genetics do play a part but too much sun exposure, excess squinting and habitual eye-rubbing can promote sagginess.

The good news is that eyelid problems can be treated very effectively through a procedure called blepharoplasty. This is a relatively simple procedure that removes excess skin, muscle and fatty tissues. Many of Dr. Sharma’s patient’s will combine blepharoplasty with other facial plastic surgery procedures, such as a browlift or facelift. 

If you suffer from sagging upper or lower lids, blepharoplasty will make a dramatic difference and give you a fresher, brighter and more youthful appearance. 

In the image below, Dr. Sharma performed an Upper and Lower Blepharoplasty on this patient along with fat transfer to her cheeks. For the purposes of this article, notice the significant improvement one month after her surgery in the appearance of her eyes.

There is a video of the actual surgical procedure on Dr. Sharma’s YouTube Channel. 

In this image, a patient of Dr. Sharma's underwent Upper & Lower Blepharoplasty
to improve the appearance of her eyes. Notice arrows #1 and #2 on the day of the surgery
and then notice the improvement one month after.

Why Do Your Eyelids Sag or Droop?

Over time, everyone experiences changes in the eyelids. Even blinking can affect your eyes – yes…blinking! – because every time you blink, the skin and muscles of your upper eyelids stretch just a tiny bit. Little elastic fibers in the skin draw back your eyelids back to their natural position. A good example to liken the process to is an elastic band – think about what happens when you stretch it out and snap it back repeatedly. Over time, the skin and muscles of the upper eyelid will get longer. 

This image uses an elastic band to demonstrate the way your eyelids blink.
Your upper eyelids stretch a tiny bit and then drawn back to their natural position
by little elastic fibers.

Think about it, you’ll probably blink billions of times of the course of your lifetime. Eventually, a little fold of skin could develop as the excess skin bulges outward and hangs over the lid. Sometimes, if this gets severe, you may find your field of vision is obscured by the drooping upper lids and if you’re a woman, you might find it hard to apply your makeup if your eyelids droop or sag.

Think about how many times your eyelids blink over the course of a day.
then, think about how many times these tiny elastic fibers stretch over the course
of 30 years.

Often times, people refer to sagging in the lower lids as “bags under the eyes”. Nearly everyone develops some degree of sagging in this area because of age and gravity. Your eyes are surrounded by a protective layer of fatty tissue encased in a membrane that holds it tightly in place. Over time, the membrane will weaken, allowing the fatty tissue to slip downward. Skin and muscle are stretched by the protruding tissue which produces puffy bulges that are impossible to hide with cosmetic products.

One of Dr. Sharma's patients who underwent Upper Blepharoplasty.

The problem seems worse in the morning when you wake up because fluids collect in the fatty tissue while you are lying down. Gravity may draw the fluid away after you get up but if you have a large amount of excess fatty tissue; it will take a long time to clear up. 

How Blepharoplasty is Performed

Incisions in the upper lids are made in the crease above each eye (see Figure 1). Excess muscle, fat and loose skin is then removed and fine sutures are used to close those incisions. The resulting scar will normally fade to a fine line that virtually disappears into the eyelid crease.

Figure 1 - External incisions are hid in the crease of the eye

Figure 2 - Internal incisions are not visible because they are done on the
inside of the lower eyelid.

Eyelid surgery is usually performed under intravenous sedation and local anesthesia. Most people can go home the same day! Dr. Sharma frequently performs eyelid surgery under local anesthesia only. He has performed this procedure under local anesthesia thousands of times!

You may experience some mild swelling or bruising of your eyelids after surgery, but this usually subsides quickly. Dr. Sharma recommends using a cold compress and to keep your head elevated when you lie down to help reduce swelling which will speed the healing process. If you have any discomfort after surgery, it can be controlled quite effectively with mild pain medications. 

Dr. Sharma in surgery performing Upper and Lower Blepharoplasty.

Eyelids heal quite quickly and scars usually are pretty inconspicuous. Women can completely camouflage any remaining marks with eye makeup after they have healed adequately. Most men find that the scars disappear into their natural “smile” lines. 

Sometimes, it may help to wear sunglasses for a few days to cover the swelling and as a reminder not to touch your eyes while they are healing. If you wear contact lenses, you must wait two to three weeks before you can resume wearing them. 

For more information about upper and lower blepharoplasty procedures with Dr. Sharma, please feel free to contact his offices at (305) 456-5727 to schedule your free consultation. 

Why are Botox and Restylane becoming increasing popular among men?

Cosmetic fillers such as Botox and Restylane are becoming increasingly popular among men in their twenties and early thirties. A 2010 report by the American Society of Plastic Surgeons revealed that the fastest growing nonsurgical procedures sought out by men aged 20 to 29 are injections of Botox and soft tissue fillers like Juvederm and Restylane.

These treatments are fairly non-aggressive up, they have little or no downtime and the results are subtle. There are some preventive aspects to fillers as well. By taking care of wrinkles early, it makes it harder for them to reappear later in life. The metrosexual phenomenon has destigmatized many grooming treatments, such as facials and pedicures that rest why lane were once considered strictly by women. Cosmetic procedures such as fillers have tended until recently to remain squarely in the realm of women who hold Botox parties the way women used to host and attend Tupperware parties. So why are young men suddenly opened to wrinkle fillers and Botox? Is it any wonder that guys who really shouldn’t be worrying about looking old are suddenly feeling over the hill,  when they are bombarded by advertising showing young men who look well-rested and have no wrinkle lines?

Here is a schematic of the male face and the various regions where cosmetic enhancement is most viable.

In the image above, we’ve provided a facial planning chart for men. We’ve identified the top 10 areas on a male’s face where cosmetic fillers can improve your appearance. If you’re interested in these procedures, we suggest you take a minute and review the diagram to see which areas require the most attention. This way, your consultation with Dr. Sharma can focus on the areas that you feel require the most attention first.

Although most male-grooming companies have moved well beyond deodorant and shaving cream offering anti-aging products that run the spectrum from face wash to eye creams. However, in today’s world, many guys would rather drop a few hundred dollars on a few quick and relatively painless jabs from a needle to achieve that youthful look. They simply don’t have the time to wait for some magical creams to work.

The results achieved by fillers are going to be pretty subtle, however, but they would certainly effect how you feel about yourself. The confidence such treatments can instill is another benefit of cosmetic fillers.

What is a hyaluronic acid?

According to The American Society of  Plastic Surgeons , hyaluronic acid is a natural substance found in your body. High concentrations can be found in fluid surrounding the eyes and other soft connective tissues. It can also be found in some cartilage, joint fluids, as well as skin tissue. It is extracted and reformulated by scientists in a laboratory and now has become one of the most popular kinds of injectable filler. Hyaluronic acid is not derived from animal sources.


What areas can Restylane treat?
• From the nose to mouth (nasolabial folds)
• between the eyes (glabella)
• lips (to add shape and volume)

If you're a man and you're interested in learning more about cosmetic fillers and how they can improve your appearance, please give my office a call at (305) 456-5727 and I'll be happy to discuss with you which cosmetic filler product is best for you.

Dr. Sharma has appeared on television discussing facial plastic surgery and cosmetic surgery.
He is a Double Board Certified Facial Plastic Surgeon with offices
in Coral Gables and The Palm Beaches.

What is Facial Enhancement using Fat Transfer?

Fat Transfer or fat grafting usually involves harvesting fat from one part of the body, purifying it and then carefully re-injecting it into the area needing attention. Fat injected into areas that require volume enhancement produce safe, long-lasting, and natural appearing results. There is no other field of medicine which demonstrates the degree of innovation that is seen in plastic surgery. The concepts and techniques used are dynamic and constantly seek to improve efficiency, comfort and safety in the interest of the patient.

One of the most significant trends today is the replacement and enhancement of facial volume. It has been shown that a reduction in fullness of the cheek area gives people that “aging” look. This hollow look usually worsens with age but can be present in younger people if they are genetically predisposed.

Hollow cheeks make people look:

1. Older

2. Sad

3. Tired

Restoring this lost volume will make a significant difference by creating a younger, fresh look. The overstretched look which can result from the common facelift may have fewer wrinkles, but does that person really look younger?

Who is a candidate?

Patients that are generally considered a good candidate for fat injection are in good health. If you have any history of abnormal bleeding, or swelling following a procedure then you should mention this during your consultation. If you’re a smoker, then this is something you should definitely disclose as well.

Patients interested in fat transfer do require a thorough consultation. A full history and physical exam will be required before your procedure. Pictures are taken before the procedure and an informed consent form must be obtained. Either local or general anesthesia may be used as every case is specific to the patients’ needs.

Some common side effects of fat transfer:

1. Swelling is the most common side effect and should settle down within several weeks

2. Bruising

3. Numbness

4. Slight asymmetry which should improve as swelling improves

5. Infection

6. Loss of volume

An alternative approach involves a procedure called fat transfer. In this technique, I take excess body fat from the abdomen or inner thigh using liposuction instruments. The fat is then prepared and concentrated under sterile conditions and carefully injected back into the areas of volume deficiency. The result is a permanent enhancement of that area without the risk of allergic reactions or possible complications with implant materials. Not only has fat transfer proven to be an excellent technique for enhancing the cheek area, but it’s also successful in improving jaw line definition (delaying the need for a facelift), improving the appearance of the upper and lower eyelids, and even enhancing temporal deficiencies (the sides of the forehead).

There is some evidence that fat transfer may help with overall skin quality, possibly due to the stem cells within the transferred fat. The discussion of the benefits of stem cells in controversial and I suggest you discuss these issues with your provider – preferably a Double Board Certified Facial Plastic Surgeon like me.

In the image above, I injected fat from the patient’s abdomen to her cheek areas. This patient also had excess skin removed from above and below her eyes (upper and lower blepharoplasty). Notice that two weeks after her surgery, her cheeks are visibly enhanced. Some swelling remains, however, it should subside within another week or two and she will begin to see the final results of her cheek enhancement.

It is a safe, conservative technique which if properly planned and performed gives a long-lasting result indistinguishable from your natural facial contours. To watch me perform fat transfer, please click this link to my YouTube Channel.

To contact my offices please call (305) 456-5727 and I’d be happy to answer any questions you might have about facial volume enhancement.

Why should you trust your face to a Facial Plastic Surgeon?

In today’s world more and more people, both women and men, are seeking ways to maintain a youthful appearance. With so many different procedures available to enhance your cosmetic appearance, the cost of all these procedures can definitely add up. So what does the average person do? They look for affordable rates for procedures through places like GROUPON or they search for the cheapest alternative.

What are your risks by always looking for the cheapest alternative? Often times, quality care is what’s sacrificed in those bargains. This is not to say that there aren’t several reputable clinics and doctors who engage in offering the most competitive price, however, to offer such low prices, something is almost always sacrificed.

The purpose of this blog is to attempt to build value in the person you entrust your face to – the most prominent area on your body by which other people recognize you.

Let’s use dermal fillers for example, and we’ll assume that you’re interested in getting some Restylane. If you subscribe to GROUPON, you’ll see some offers like the one below offering a fifty percent discount. You’ll notice in this particular example, the offer sold out. 

We kept this offer anonymous because the purpose is to show how cost is the driving factor in people’s selection process of where they go to get their treatments. Perhaps the establishment offering this discount is reputable, that’s not the purpose of this blog, the purpose is to attempt to persuade you if you’re thinking of getting treatments – or any procedures done to your face – to entrust your face to Facial Plastic Surgeon.

To illustrate the value of going to facial plastic surgeon, let me draw the analogy of getting your hair cut. Your choices are to go to a place like Supercuts or to a salon where the stylists have some experience cutting and coloring hair. Obviously, the pricing will be different because the attention you receive is different.

The justification can only be trying to save some money. Ok, perhaps trying to save some money on your hair is understandable because it will grow back; however, trying to save some money on procedures involving the injection of a substance into your face is not something that should be considered solely on price.

Going to a proper facial plastic surgeon will probably cost you more money because we understand the value we offer since we are specialists when it comes to your face. We spend years in specialized training learning about facial beauty and facial anatomy as well as how to deliver the best results to each individual. The alternative is to go to a clinic that is allowed to perform procedures simply because they have the minimum requirement to do so. But more important, we spend time with you to make sure the results look natural and will give you that well-rested youthful appearance.

The flip-side can be devastating because obviously the results will show on your face. If you’re considering having a facial enhancement procedure, I suggest that you find a doctor that you’re comfortable with. Find one that will spend time getting to know you and what your cosmetic goals are. If price is an issue, often times, doctors offer financing terms and some are even willing to negotiate if you’re reasonable. 

As a Facial Plastic Surgeon who has performed many revision surgeries and has seen some devastating results to people who went to unreliable doctors, the best advice I can give you is to save money on other things. Set yourself a goal to save money to visit a specialist when it comes to your face.

If you’re interested in a no charge consultation with Dr.Sharma, please contact his offices at (305) 456-5727 to schedule your appointment. 

Secondary Facelifts Explained by a Facial Plastic Surgeon

If you underwent a facelift several years ago and were satisfied with the results but are now starting to notice some degradation, you are a likely candidate for a secondary facelift to restore your youthful appearance.

Secondary facelifts are sometimes referred to as ‘facelift revision surgery’ or ‘reverse facelifts’. They are performed either to restore the results achieved with the original facelift surgery, or to correct a faulty procedure. Even the best facelift can only provide temporary benefits because of the gradual reappearance of the signs of aging. A secondary facelift is a common procedure, performed to regain that natural well-rested youthful appearance.

Here is a link to Dr. Sharma's Official YouTube Channel. In the video below, Dr. Sharma discusses facelifts from his Coral Gables offices. 

Many people choose to do a secondary facelift because the results of their original facelift have faded. A facelift (rhytidectomy) have results that usually last on average for about ten years. Secondary facelifts usually become necessary around this time. Some people might even choose to have a less invasive means of rejuvenating the appearance of their face by the use of dermal fillers.  Dermal fillers can help with reducing the appearance of lines and wrinkles and also reduce the appearance of nasolabial folds (laugh lines). Rhytidectomy eventually becomes the best option for a more permanent treatment.

Second Facelift Procedure

The actual procedure of having a secondary face lift may involve the same area as the first or may even be expanded to improve the appearance of other areas of the face. More than likely there will be some amount of scar tissue in the face from the previous surgery. The scar tissue, if not too extensive, can actually help limit some of the bleeding and scarring. Dr. Sharma will discuss with you your options for treatment and review with you exactly what kind of facelift will be necessary to get the best results.

Risks of a Secondary Facelift

The risks of face lifts include:

• Bleeding

• Bruising

• Infection

• Nerve damage

• Facial asymmetry

• Anesthetic risks

In general, most people enjoy the aesthetic results for 10-15 years before they seek a secondary facelift. Facelifts are one of the most common plastic surgery procedures chosen to be redone because the face continues to highlight the signs of aging more visibly than any other body area and it features our most distinguishing and identifiable physical characteristics.

Most patients are extremely happy with their primary facelift and therefore, when the rejuvenating effect begins to fade they decide to have a secondary facelift to achieve that same level of rejuvenation they originally enjoyed. If you were pleased with the results from your first facelift, there are other considerations that will help you efficiently embark upon your revision facelift process with Dr. Sharma:

• Remind yourself about the specifics of your original facelift surgery. You will want to share the details about this previous procedure that yielded such favorable results for you.

• Know exactly what you're trying to improve with this facelift, and communicate this to Dr. Sharma. Even if you were pleased with your original facelift, you may have different wants or expectations now.

• During the consultation, bring in before and after photos of yourself from the first surgery that way Dr. Sharma can refer to these images while considering your current options to create a more personalized surgical plan for your second facelift.

If you're looking into revision facelift surgery to correct poor results from your first facelift, Dr. Sharma suggests that it is prudent to take certain steps the second time around. He has many years of facelift experience behind him and is able to make personalized suggestions and recommendations for your surgery, however, you should consider these questions and in preparation for your consultation with him:

• Identify what specifically displeased you about your original facelift results, and clearly communicate this during your consultation. 

• Be very specific idea of what you want and share all your thoughts with Dr. Sharma.

If you are interested in speaking with Dr. Sharma about a secondary facelift or facelift revision surgery, please contact his offices at (305) 456-5727 to schedule an appointment for a consultation.

About Dr. Vijay Sharma

Vijay M. Sharma MD, MPH is a Double Board Certified Facial Plastic Surgeon and a co-founding member of The Plastic Surgery Institute of Miami. He exclusively focuses on cosmetic procedures and surgery of the face. This specialization includes the face, neck, nose, eyes and ears. Born and raised in Maryland, Dr. Sharma attended college and medical school at The George Washington University in Washington, DC. He went on to a successful head and neck surgery residency at Tulane University in New Orleans. Dr. Sharma distinguished himself as the Chief Resident of Head and Neck Surgery at the world famous Charity Hospital of New Orleans. He then completed the prestigious Glasgold Fellowship in Facial Plastic and Reconstructive Surgery. Dr. Sharma moved his New York area private practice to Miami and Coral Gables in 2007.

Botox and Dysport Treatments for Men

According to the American Society of Plastic Surgeons www.plasticsurgery.org our society places a high value on looking young and fit. Men of all ages and all walks of life are looking into plastic surgery for cosmetic reasons. Several men have indicated to Dr. Sharma that their goals include a more balanced nose, a rejuvenated face and less lines and wrinkles. 

Billions of dollars are now being spent on cosmetic surgery – up to 90% of it by women. Basically, that means that the other 10% of cosmetic surgeries are performed on men – that’s $100,000,000 a year spent by men on improving unappealing characteristics of their appearance. In today’s world, people consider their looks as key to their self-image and it appears place a high value on their appearance.

More and more men are focusing on improving their looks and the importance of beauty today is far more pervasive than one might think. Consider this; all this spending on plastic surgery and cosmetic surgery procedures comes at a time when almost a fifth of Americans lack basic health care.

Since most literature concerning plastic surgery or cosmetic surgery focuses on women, Dr. Sharma wanted to offer men some valuable information for them to consider if they are contemplating improving their looks. In the diagram below, Dr. Sharma identifies ten (10) areas where men can enhance their facial features. Many of these areas are similar for women, however, usually men have more pronounced wrinkles or folds and thicker skin.

Many men are reluctant to undergo plastic surgery because they are afraid that they’ll no longer have that “distinguished” look. Dr. Sharma is careful to keep your appearance as natural as possible, however, his primary concern is to focus on areas that are a concern to you. As a result, we’re offering this schematic to help you properly identify the areas that are concerning you.

Men are good candidates to receive injectable dermal fillers as well as Botox or Dysport. You won’t often hear too many men discussing their procedures with other men or women but when you stop and think about it for a moment, there is no reason why men cannot use the same products as women to enhance their appearance. One way to start is by trying dermal fillers, otherwise known as a 'liquid facelift' and here are three (3) good reason why:

1. It's a good way to get started and test to see if plastic surgery or cosmetic surgery suits your lifestyle.
2. The effects of dermal injectables generally wear off after four (4) to six (6) months.
3. Dermal fillers are more economical than actual surgical procedures. 

Facial planning guide for men who are considering plastic surgery or cosmetic surgery with Dr. Sharma.

The facial planning chart above is a guide to help you begin identifying areas where you want to see improvement. Dr. Sharma has identified and provided the names of ten (10) areas for you to consider. Additionally, this chart will help you begin your discussion with Dr. Sharma when he asks you, “So, what do you want to improve?” during his consultation with you. 

Often times, plastic surgeons won’t come out and tell you what you should have done because they might mention something you’re not unhappy with and they don’t want to generate any further self-conscience insecurities. Therefore, by identifying these areas for yourself, it will help educate you and streamline your consultation.

If you’re a man and interested in learning more about your options for plastic or cosmetic surgery, please call Dr. Sharma’s Coral Gables offices at (305) 456-5727 and we’ll be glad to answer any questions you might have. 

About Dr. Sharma

Vijay M. Sharma MD, MPH is a Double Board Certified Facial Plastic Surgeon and a co-founding member of The Plastic Surgery Institute of Miami. He exclusively focuses on cosmetic procedures and surgery of the face. This specialization includes the face, neck, nose, eyes and ears. 

Born and raised in Maryland, Dr. Sharma attended college and medical school at The George Washington University in Washington, DC. He went on to a successful head and neck surgery residency at Tulane University in New Orleans. Dr. Sharma distinguished himself as the Chief Resident of Head and Neck Surgery at the world famous Charity Hospital of NewOrleans. He then completed the prestigious Glasgold Fellowship in Facial Plastic and Reconstructive Surgery. Dr. Sharma moved his New York area private practice to Miami and Coral Gables in 2007.