Question 1

What is capsular contracture, what causes it, and how does Dr. Kashan address it?

Accepted Answer

Capsular contracture occurs when the body forms a hard, firm, and painful calcification around a breast implant. This can be caused by contamination during implant placement, the type of incision used, or the implant's location. Dr. Kashan treats it by removing both implants and their surrounding capsules entirely, cleaning the area with a special antibiotic solution, and then either creating a new pocket or reinserting the implant as sterilely as possible. He recommends annual follow-ups to monitor implant health.

Question 2

What is liquid rhinoplasty and what results can be expected?

Accepted Answer

Liquid rhinoplasty is a non-surgical nose job performed by injecting a small amount of filler into the dorsum of the nose to fill divots and sculpt a more defined and aesthetically pleasing shape. It offers instant, natural-looking results without the need for surgery, making it an ideal solution for individuals considering a nose job but preferring to avoid an invasive procedure.

Question 3

Why does Dr. Kashan advise against under-eye fillers?

Accepted Answer

Dr. Kashan strongly advises against under-eye fillers, stating they are not the ideal solution for under-eye hollows or dark circles. He believes that over time, fillers in this area can cause significant issues such as swelling, edema, bluish discoloration, and overall damage to the skin. Furthermore, under-eye fillers carry severe risks including the potential for permanent blindness, worsening or accelerating under-eye bags, and the formation of nodules or allergic reactions, as they are a foreign material.

Question 4

How does Dr. Kashan compare facial fat grafting to traditional fillers for facial volume?

Accepted Answer

Dr. Kashan prefers facial fat grafting over traditional fillers for facial volume, especially for under-eye hollowness and darkening. Fat grafting uses the patient's own fat, purified using a 'tulip system' into nano fat, which offers a 95-100% survival rate, resulting in natural, long-lasting results without lumps or bumps, and improves skin quality long-term. It's an in-office procedure, doesn't require general anesthesia, and carries no risk of allergies or vascular occlusion. While more procedural than quick fillers, which are foreign material and need repeating every 6-12 months, fat grafting has minimal downside, though some fat reabsorption (~5%) and potential for nodules exist. Patients should avoid pressure on grafted areas for 4-6 weeks.

Question 5

When is under-eye blepharoplasty recommended and what does it involve?

Accepted Answer

Under-eye blepharoplasty is indicated for patients with heavy bags or a tired appearance under their eyes. The procedure involves either repositioning or replacing fat, and can also include adding fat grafting to achieve a nice, smooth, youthful contour.

Question 6

What is Dr. Kashan's preferred surgical approach for breast augmentation?

Accepted Answer

Dr. Kashan most commonly uses a dual plane approach for breast augmentation, placing implants underneath the muscle. This technique is preferred to cover implants, avoid rippling, and achieve desirable upper pole volume and cleavage, which he believes looks more natural than above-muscle placement. Going submuscular also lowers the risk of capsular contracture and infection. A critical aspect of this approach is proper muscle release during surgery, which Dr. Kashan carefully tailors to each patient to prevent implants from shifting outwards when muscles are flexed.

Question 7

What does surgical tattoo removal involve and what is the recovery like?

Accepted Answer

Surgical tattoo removal, performed by Dr. Kashan as a full thickness excision, is chosen when patients need quick removal and don't have time for laser treatments. The procedure is done with the patient totally awake and without pain, ensuring all deep pigment is removed. Stitches are used for closure and are typically removed in about a week. The goal is a nice, thin, imperceptible scar that heals beautifully within a few days, becoming virtually invisible in about a month with recommended cream application. Patients can return to work without issues shortly after.

Question 8

What facial rejuvenation procedures does Dr. Kashan offer for the eyes and lips?

Accepted Answer

Dr. Kashan performs upper blepharoplasty to remove excess upper eyelid skin, and lip lifts to restore a Cupid's bow, add upper lip volume, and reduce 'creepiness' on the upper lip, effectively reversing the appearance of the lip by 10-15 years. Lip lift scars are beautifully hidden underneath the nose, and results are subtle yet natural. These procedures, along with facial fat grafting, can be part of a staged facial rejuvenation plan, often performed in-office with local anesthesia for quicker recovery and interim aesthetic improvements.

Question 9

Is tattoo removal painful, and what pain management options are available during the process?

Accepted Answer

Surgical tattoo removal, performed by Dr. Kashan as a full thickness excision, is chosen when patients need quick removal and don't have time for laser treatments. The procedure is done with the patient totally awake and without pain, ensuring all deep pigment is removed. Stitches are used for closure and are typically removed in about a week. The goal is a nice, thin, imperceptible scar that heals beautifully within a few days, becoming virtually invisible in about a month with recommended cream application. Patients can return to work without issues shortly after.

Question 10

What are the early signs of capsular contracture that patients should look out for?

Accepted Answer

Capsular contracture occurs when the body forms a hard, firm, and painful calcification around a breast implant. This can be caused by contamination during implant placement, the type of incision used, or the implant's location. Dr. Kashan treats it by removing both implants and their surrounding capsules entirely, cleaning the area with a special antibiotic solution, and then either creating a new pocket or reinserting the implant as sterilely as possible. He recommends annual follow-ups to monitor implant health.

Question 11

What are the key advantages of facial fat grafting over traditional dermal fillers, especially in terms of longevity and natural results?

Accepted Answer

Dr. Kashan prefers facial fat grafting over traditional fillers for facial volume, especially for under-eye hollowness and darkening. Fat grafting uses the patient's own fat, purified using a 'tulip system' into nano fat, which offers a 95-100% survival rate, resulting in natural, long-lasting results without lumps or bumps, and improves skin quality long-term. It's an in-office procedure, doesn't require general anesthesia, and carries no risk of allergies or vascular occlusion. While more procedural than quick fillers, which are foreign material and need repeating every 6-12 months, fat grafting has minimal downside, though some fat reabsorption (~5%) and potential for nodules exist. Patients should avoid pressure on grafted areas for 4-6 weeks.

Question 12

If under-eye fillers are not recommended, what are the best alternative treatments for under-eye hollows or dark circles?

Accepted Answer

Dr. Kashan prefers facial fat grafting over traditional fillers for facial volume, especially for under-eye hollowness and darkening. Fat grafting uses the patient's own fat, purified using a 'tulip system' into nano fat, which offers a 95-100% survival rate, resulting in natural, long-lasting results without lumps or bumps, and improves skin quality long-term. It's an in-office procedure, doesn't require general anesthesia, and carries no risk of allergies or vascular occlusion. While more procedural than quick fillers, which are foreign material and need repeating every 6-12 months, fat grafting has minimal downside, though some fat reabsorption (~5%) and potential for nodules exist. Patients should avoid pressure on grafted areas for 4-6 weeks.

Question 13

What are the specific long-term risks or complications associated with under-eye fillers that lead to your 'NO'?

Accepted Answer

Dr. Kashan strongly advises against under-eye fillers, stating they are not the ideal solution for under-eye hollows or dark circles. He believes that over time, fillers in this area can cause significant issues such as swelling, edema, bluish discoloration, and overall damage to the skin. Furthermore, under-eye fillers carry severe risks including the potential for permanent blindness, worsening or accelerating under-eye bags, and the formation of nodules or allergic reactions, as they are a foreign material.

Question 14

What does Dr. Kashan say about their techniques?

Accepted Answer

I personally think it ends up being a little too wide on the chest. Usually when you go above the muscle, it looks a little bit more round, not as natural in my opinion. At that size point, I tend to aim more towards a higher profile implant.

Question 15

What does Dr. Kashan say about what they specialize in?

Accepted Answer

The practice performs surgical excision to remove tattoos. All procedures mentioned (upper blepharoplasty, lip lift, facial fat grafting) were performed in the office.

Question 16

What does Dr. Kashan say about consultations?

Accepted Answer

Implant profile and size are determined during a consultation by doing measurements, determining body type, and assessing how much implant the body can handle to achieve a natural or enhanced look.

Dr. David L. Kashan, MD

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