Article | Blepharoplasty

  • By Master Account
  • 07 Jul, 2016
AVOIDING PLASTIC EYELIDS
E. Gaylon McCollough, M.D., F.A.C.S., Jim English, M.D.

The goal of a facial plastic surgeon should be to correct the undesirable conditions for which he has been consulted and to avoid leaving his mark on the patient. By embracing the concept that prevention is better than cure, it is generally possible to avoid the “operated-on look” following cosmetic surgery. We describe a number of safeguards we use to preserve natural-looking eyes following lower lid blepharoplasty in men and women. The most common, permanent complication described following conventional lower lid blepharoplasty is the round eye. The condition is readily identified by an increase in scleral show between the limbus and lower lash margin. Closer evaluation will reveal inferomedial displacement of the lateral commissure, increased slope of the lateral third of each eyelid, a flattened, unanimated, pretarsal component, and an unnatural infralash crease produced by the healed incisional scar. These findings are one step short of ectropion; therefore, the methods herein described should help reduce the incidence of this more dreaded and serious complication of blepharoplasty. (Arch Otolaryngol Head Neck Surg 1988; 114:645-648)

A round eye is thought to occur following iatrogenic disruption or weakening of the tarsofascial sling or hammock. A more flaccid “hammock” is unable to resist the inferior and medial pull placed on the lower lid margin by postoperative contracture of the surgically created lower lid flap. Lower lid abnormalities may also occur in the unoperated-on lid as the lateral canthal tendon weakens and becomes more flaccid with age. Regardless of the cause, increased scleral show is generally accompanied by widening of the palpebral fissure and a more obtuse lateral canthal angle.

Many of the aforementioned unnatural postoperative sequelae may be avoided by lowering the conventional lower lid incision to a skin crease approximately 4 mm below the border of the eyelid. This distance usually corresponds to the inferior border of the tarsus. As a direct result of a lowered incision, the pretarsal area is undisturbed. The retained integrity of the skin-orbicularis-tarsal-canthal tendon complex (hammock) is maintained and can better resist the inferomedial pull of any contracting scar and/or excess skin removal.

SKIN FLAP VS SKIN-MUSCLE FLAP
The two principal approaches to removing excessive tissues in the lower lid are the skin flap and the skin-muscle flap. The diagnosis of the problem determines which technique is used in a given patient.
Significant redundancy of lower lid skin is best corrected with a skin flap (Fig 1).
When a skin-flap technique is used, it is felt by some that downward traction on the lower lid during healing may be aggravated by a sheet of contracting scar under the previously undetermined flap on the more mobile lower lid margin.
The “classic” lower lid skin incision, described by Castanares1 and Rees2, is made approximately 1 to 2 mm below the border of the lower lid (Fig 2). An incision this close to the lashes, however, could result in unnecessary disruption of the tarsofascial hammock, particularly if, when exposing lower lid fat, the surgeon removes any pretarsal orbicularis oculi muscle and/or disrupts the integrity of the orbital septum close to its insertion on the inferior border of the cartilaginous tarsal plate (Fig 3).
Despite the amount of skin excised, any contraction of the lower lid flap during healing could produce an unwanted inferior and medial pull on the lid margin postoperatively. These combined vectors often produce blunting of the lateral commissure, an undesired increase in the amount of scleral show, and leave the patient with a more operated-on or unnatural-looking eye (Fig 4). If the pretarsal orbicularis muscle is removed, the pretarsal portion of the lid may be left with an abnormally flattened appearance.
The aforementioned undesirable sequelae can generally be eliminated by placing the lower lid incision along a line corresponding to the inferior border of the tarsus.
Contraction of the sheet of scar, which is thought to occur throughout any undermined area, is not as likely to occur with a skin-muscle flap technique. Still, it remains a factor that the surgeon must consider in planning his operation. We contend that avoiding disruption of the pretarsal hammock composed of skin, orbicularis oculi, the cartilaginous tarsus, and the most superior portion of the horizontal fibers of the orbital septum will tend to resist these contracting forces, providing skin (and/or muscle) removal is not excessive.
Webster 3,4 addressed the problem of inferior displacement of the lid margin via a flap suspension technique and lateral canthopexy. He felt that excision of tissue superior and lateral to the canthus would suspend the lower lid flap to the lateral orbital soft tissue when the wound was closed and would tend to offset any inferomedial pull during healing. Later, he advocated suture plication of an iatrogenically weakened or senescent lateral canthal tendon in an effort to reduce the incidence of postoperative ectropion and/or rounding.
We have attempted to avoid the unwanted sequelae of blepharoplasty. Placing the skin incision farther inferiorly from the lid margin seems to be a key factor in avoiding surgical-appearing eyes.
Depending on the pattern of rhytids in the lower lid, the incision is made approximately 4 mm below the lower lash margin. By design, this leaves behind more of the overlying orbicularis oculi muscle fibers attached to the anterior border of the tarsal plate. Placing the incision through the orbicularis oculi muscle and orbital septum farther from the lid margin leaves more of the septal fibers attached to the inferior border of the tarsus, and better preserves the lower lid hammock connecting the medial and lateral canthal tendons (Fig 5). With more undisturbed tissue between the initial incision and the margin of the eyelid, the amount and dynamic effect of postoperative scarring in the eyelid should be diminished. Furthermore, by leaving more skin (and muscle) superior to the initial incision, an additional safeguard is introduced. If, by chance, the surgeon should remove too much skin during the procedure, the undisturbed skin superior to the original incision may stretch with the passage of time and relieve some downward traction placed on the lower lid.

PREOPERATIVE CONSULTATION
Essential to any cosmetic procedure is the preoperative consultation. During that time the surgeon has an opportunity to examine the patient and look for those conditions that may herald a potential problem postoperatively. The amount of preoperative scleral show, if present, is noted and pointed out to the patient. Photographic documentation of the preoperative state is essential.
The tonicity of the lower lid can be ascertained by the “snap test,” i.e., pulling the lid away from the globe and releasing it quickly. A lid with a good “hammock” will snap back into position. On the other hand, a lid that floats back or remains in an abnormal position will usually require additional surgical maneuvers in order to avoid round eye and/or ectropion. (If a patient tends to have a rather lax lower lid, the surgeon may consider a pentagonal full-thickness wedge resection of the lower lid lateral to the limbus at the time of surgery. Webster 3, 4 has advocated lateral canthal tendon plication as an alternative treatment for hammock flaccidity.)
During the consultation, the surgeon explains to the patient the limitations of surgery and attempts to evoke the patient’s expectations. If pathologic conditions of the eyes are elicited or suspected, and preoperative ophthalmologic consultation should be obtained.
During the initial visit the patient’s eyelid-brow complex is analyzed to ascertain if adjunctive surgical correction might be indicated (in addition to a blepharoplasty).
As a rule of thumb, blepharoplasty tends to improve the sags and bulges, but does not appreciably remove fine rhytids around the eye. If wrinkling is present, a discussion of a postoperative chemical peel for correction of this condition eight to 12 weeks following blepharoplasty should be a part of the preoperative consultation.

OPERATIVE PROCEDURE
With the patient lightly sedated and in a reclined position at about 45o, the intended blepharoplasty skin incisions are outlined with a skin marking pen prior to injection of the local anesthetic. The proposed incision is planned for a skin crease approximately 4 mm below the border of the lash margin. The incision begins a few millimeters lateral to the punctum medially and courses laterally just past a vertical line dropped from the lateral commissure (Fig 6). At this point, the incision curves inferiorly and laterally into a naturally occurring relaxed skin tension line in order to obtain a more aesthetically pleasing scar.
Each lid is then infiltrated with 1% lidocaine (Xylocaine) with 1:100,000 epinephrine for both hemostatic and anesthetic purposes.
If it is to be done in conjunction with a lower lid, the upper lid is corrected first. After the excessive upper lid skin has been removed and the fat pads have been adequately excised, one or two tacking sutures are placed to close the lateral aspect of the upper lid wound.
The previously outlined lower lid skin incision is made with a No. 15 blade, while a surgical assistance offers countertraction medially, inferiorly, and superiorly. The operating surgeon’s hand places countertraction laterally so that the skin incision can be made quickly and precisely. This initial incision is made only through the skin.
A small curved iris scissor is used to spread and penetrate the orbicularis oculi muscle laterally. A more blunted scissor is then used to undermine the entire skin muscle flap.
While ing the orbicularis oculi muscle from the orbital septum, it is wise not to disturb the periosteum overlying the infraorbital rim. Disruption of the periosteum could allow the orbicularis muscle to heal directly to the bone or frayed periosteum during the postoperative period. If this should occur, undue downward traction on the lower lid might produce lid distortions.
Once the undersurface of the orbicularis oculi muscle has been d from the orbital septum, one blade of the scissor is placed in the previously created pocket beneath the muscle. The other blade of the scissor is placed externally along the initial skin incision. The incision through the orbicularis oculi muscle and subcutaneous tissue is completed when the blades of the scissors are approximated on a 45o bias through the full thickness of the flap exiting at the previously made skin incision.
Since the skin-muscle flap is selected in those patients with minimal skin redundancy, the flap is reflected primarily to remove excessive fat (Fig 5). The fat pads can be more accurately identified by making a “nick” in the orbital septum while placing a small amount of digital pressure on the globe. This maneuver causes the excessive fat to bulge through the orbital septum for easy amputation. Prior to excision, the base of the fat stalk is injected with local anesthetic and generously cauterized with bipolar cautery before its removal. Only the portions of fat that exude easily through the defect in the orbital septum are removed.
After each fat “compartment” has been adequately treated, the skin-muscle flap is draped superiorly and laterally. Small vertical cuts are made into the overlapping portions of the skin-muscle flap, dividing the tissue to be removed into three or four segments. This maneuver adds a measure of safety and tends to prevent excess skin removal.
We have discovered that when both the skin and muscle incisions are placed inferior to the tarsus, it is not necessary to remove a strip of muscle from the undersurface of the skin-muscle flap. Once the overlapping skin and muscle have been removed, the wound edges are precisely closed with a 6-0 catgut suture.
In patients with festoons of lower lid skin in which a skin-flap technique is used, the orbicularis oculi muscle is divided with a separate incision 3 or 4 mm inferior to the initial skin incision. The margins of the orbicularis oculi muscle are reapproximated with interrupted 6-0 chromic catgut sutures after fat removal.
When either skin flaps or skin-muscle flaps are selected, the lower incision leaves behind more innervated orbicularis oculi muscle on the anterior aspect of the tarsal plate. In addition, fewer muscle fibers are disturbed laterally, thereby preserving the circumferential contracting mechanism of the orbicularis oculi superior to the blepharoplasty incision.
The surgical scar resulting from the more inferiorly placed incision heals quite nicely, just like the conventional higher placed incision, and is generally quite acceptable (Fig 6).
We believe that prevention is better than cure. If the safeguards herein described are embraced, the incidence of postoperative displacement of the lid margin can be significantly reduced (Fig 7) and, in most cases, ectropion or an unsightly round eye can be avoided.

COMMENT
Rounding of the eye can be a common postoperative sequelae of blepharoplasty. In our experience, relocating the conventional lower lid incision to a more physiologic position has proven beneficial. Leaving the pretarsal soft tissues and the associated “hammock” undisturbed may avoid the “operated-on” or surgical-appearing eye. The scar from the more inferiorly placed lower lid incision is aesthetically acceptable, and, in most cases, can be camouflaged with makeup one week following surgery.

References
1. Castanares S: Blepharoplasty for herniated intraorbital fat: Anatomical basis for a new approach. Plast Reconstr Surg 1951;8:46-58.
2. Rees TD: Surgical procedures, in Aesthetic Plastic Surgery. Philadelphia, WB Saunders Co, 1980, pp 470-524.
3. Webster RC: A flap suspension technique in blepharoplasty on lower lids. J Dermatol Surg Oncol 1978;4:159.
4. Webster RC: Suspending sutures in blepharoplasty. Arch Otolaryngol Head Neck Surg 1979;105:601-604.
By Master Account 01 Dec, 2016

It's that time- Time to look like you FEEL . Fall and Winter are the perfect time to do something for yourself. For the first time ever, Dr. English is offering a complimentary in-office surgical evaluation and (separate) makeup makeover. This limited time offer is for Hot Springs Village and the surrounding area. So if you are a "villager" who wants to look as youthful as you feel, call us today at 501-227-9556 or message us here. 

Listen for us on 92.9 KVRE or see us in the Hot Springs Village Voice or your mailbox.

By Master Account 01 Dec, 2016

Blepharoplasty (Eyelid Lift)

Your eyes are often the first things people notice about you, and are an important part of your overall appearance. Over time, the upper eyelid skin loses its elasticity and stretches, the fat bulges, the eyelid muscles weaken, and the eyelids droop. This condition detracts from your overall appearance and can make you look older or tired. The droopiness can irritate your eyelashes or even touch your glasses. And, in more severe cases, this excess skin may interfere with your field of vision and activities such as driving.

What is Blepharoplasty?
Eyelid surgery, or   Blepharoplasty , is a procedure to remove this excess skin and bulging fat, and to tighten lax muscle of the upper eyelids. Blepharoplasty may restore a more youthful appearance and enhance your vision by the removal of the excessive skin. For an incredibly rejuvenated appearance, this may be just what your looking for.

Who is a Candidate for Blepharoplasty?
The best candidates are those who are healthy and well-motivated with realistic expectations. Some medical conditions may increase the risks in Blepharoplasty such as thyroid disease & patients who do not make sufficient tears to keep their eyes well lubricated.

During your initial consultation with English Plastic & Cosmetic Surgery Center, we will discuss your individual situation and any concerns you may have. After thoroughly discussing your expectations and the limitations of the procedure, an appropriate treatment will be customized just for you. For a consultation please call us at 501-227-9556.

By Master Account 01 Dec, 2016
Injectable wrinkle fillers can give you a more youthful look for a fraction of what a traditional facelift costs. Most will fill lines and wrinkles in less than 30 minutes with results that can last up to 6 months. Injectable wrinkle fillers, unlike BOTOX injections that relax the muscle under a wrinkle, fill the line, crease, or area with one of several different substances. As a result, trouble spots nearly disappear.
Wrinkle fillers can also be used as “volumizers,” plumping and lifting cheeks, jawlines, and temples; filling out thin lips, and plumping sagging hands.

The treatment is fast and easy. But not every wrinkle-filler is right for every type of wrinkle. The least risks and best results come from using the right one correctly. That’s why you should only have fillers injected by a specialist with ongoing, special training.
Here is a breakdown of a few dermal fillers and BOTOX available at the English Surgi-Spa.

Wrinkles
Many wrinkles originate from creases in the skin that are caused by making the same expression over and over. These “frown lines,” “crow’s feet,” and “smile lines” result from the contraction of muscles under the skin. BOTOX® Cosmetic improves these wrinkles by blocking the electrical impulse from reaching the area. As a result, the muscle becomes less active, the skin over the muscle relaxes, and the wrinkle gradually softens and frequently disappears.

BOTOX® Cosmetic injections are used to improve wrinkles between the eyebrows, on the forehead and around the eyes. On occasion, other areas may also be treated with BOTOX® Cosmetic.

Restylane is an injectable filler whose sole purpose is to help provide filling or plumping within the foundational layers of our skin known as dermis which makes up eighty to ninety percent of the skin’s thickness. Why is that necessary? With each decade of life lived, the foundational layers of our skin lose approximately 6% of their thickness. As age, sun exposure, genetics and life style choices slow down the skin’s ability to renew itself, we begin to see and feel our skin’s thickness diminish. This loss initially becomes obvious in the areas around the eyes, the mouth and the hands but its effects are ongoing in other areas as well. As the skin thins with age, wrinkling and the formation of facial lines of expression are not far behind. Restylane smooths away wrinkles and scars, enhances facial contours, and rejuvenates skin. Treatments are tailor-made and the results are instant!

Restylane Lift is a hyaluronic acid, as is Restylane, both of which are capable of the same hydrophilic properties of our own native dermal properties that attract and hold a significant amount of water within the superficial and deep layers of our skin. However, since the molecular weight and particle size of Restylane Lift is larger, it allow us to place it deeper within the confines of the reticular dermis (lower layer of the skin) and adjoining subcutaneous layers (layers just under the skin) without the rapid degradation and/or loss of results as seen when the smaller hyaluronic products are placed in these areas.

Restore fullness to lips
Restylane is also specially designed to create fuller lips. Whether you would like to have softer, fuller lips or just add a touch of volume in the lip border to give a more sculpted look.

Shaping facial contours
Belotero is specially designed to integrate into your skin and mold to your distinct facial contours. By adapting to the individuality of your skin, it softens lines and wrinkles around the nose and mouth for smooth and natural results that are uniquely you. Belotero balance dermal filler has a unique manufacturing process that offers a soft, cohesive gel which is able to fill in your wrinkles for results that are even, smooth and immediate.
Restylane can give you a stronger, more defined chin and improve your profile. By replacing lost natural volume in the skin you can also create fuller cheeks, by lifting the skin over your cheekbones to restore shape to the upper part of your face.
The benefits of a Restylane treatment generally last for several months and can be maintained by repeated treatments once or twice a year.

How long does a Dermal Filler to work?
It’s immediate, but it can take a few days to “settle into” its final shape. It often looks even better after a day or two. Many patients are surprised at how much better they look right after their treatment.

What will I look like right after my filler treatment?
Most patients put their make-up on and go right back to normal activities. If you’ve remembered the no aspirin, Advil, Ibuprofen, Aleve (think ones that start with vowels) rule, then you should have very little bruising after your treatment provided your provider is gentle. A small amount of puffiness or mild swelling for a day or two is normal.

Do I need to come for repeat or maintenance treatments?
Yes. Dermal Fillers require maintenance a couple of times a year depending on which filler, the area injected, and your own particular body chemistry. You should be given an estimate on this at your initial consult.

To find out what’s right for you please call us for a consultation at 501-227-9556.
By Master Account 29 Aug, 2016
Years ago, people seeking cosmetic surgery would bring pictures of celebrities to their doctor — and ask for “Angelina Jolie’s lips,” “Kate Beckinsale’s nose” or “Jennifer Aniston’s arms.”
But now people bring in their selfies — filtered through Instagram.
It’s a huge trend that we’re seeing more and more of.  Selfies are everywhere.  Go to a restaurant and people are stacked up behind the arm of a cell phone posing for a selfie. Instagram is flooded with the selfie crazed photos. It’s being socially engaged and definitely a part of our culture. People are bringing in pictures of themselves taken at a favorite angle or filtered, and saying they want to look like that all the time. The American Academy of Facial Plastic and Reconstructive Surgery says there’s been a 33% bump in procedures driven by self-awareness from social media since 2013.
Just about anyone can look refreshed thanks to Photoshop—which many celebrities admit using in order to always look their best. But real life requires real solutions, and that’s where we come in.
At the English Surgi-Spa we have an arsenal of minimally invasive, lunch-break treatments for under $1,000. The results are outstanding, but friends and family often don’t know that any work was done. Some describe post treatment as looking really well-rested. Wrinkles or fine lines diminished and blemishes visibly improved. No more relying on the Amaro filter to soften those selfies when you have Restylane and Belotero fillers to reduce lines around the mouth and marionettes. And forehead lines or those pesky 11’s between the brows? BOTOX can take care of that. Maybe you need a little lip action? Plump that pucker with a filler, it’s amazing the immediate result it gives! Partnered with an Ultra Jessners Facial Peel and Microdermabrasion treatment and the result is that you look like you, but better. Amazingly better!
We’re taking selfies to a whole new level! To learn what’s right for you contact us today at 501-227-9556.
By Master Account 29 Aug, 2016
CO2 Fractional Laser is a way to clear up damaged skin and rejuvenate the surrounding tissue, allowing for a healthy clear complexion. The way it works is quite fascinating. It is quick and requires little to no downtime. This treatment has given many of our patients new baby smooth, luminous skin again. Glowing testimonials make this a popular non-surgical alternative. Yeah, we’ve come a long way baby!
Are you wondering if this treatment is right for you? Here are a few FAQs to help you decide:

So How Does it Work and What Does it Do?
Fractional CO2 Laser skin resurfacing can improve the appearance, the resiliency and elasticity of your face, neck or anywhere you choose by selectively targeting the superficial layers of skin that contain fine lines or wrinkles, scars and hyperpigmentation. Laser skin resurfacing is now a very safe and common procedure that many people are choosing rather than more invasive surgical procedures. Fractional resurfacing laser treatments can be used to improve the following skin conditions:

o Pigmentation problems (especially brown pigment)
o Age spots, sun spots and sun damage
o Minimum to moderate wrinkles
o Textural irregularities
o Lip lines
o Acne scars
o Surgical scars

How long does a fractional resurfacing procedure take?
Fractional laser resurfacing treatments are generally quick, lasting around 30 minutes to an hour. The length of the procedure depends on how many areas of the face, neck or chest are being treated.

How many fractional laser resurfacing treatments will I need?
Many patients see a significant result and are happy after only 1 treatment. Others may need a series of laser treatments in order to see the best results. Some patients renew their skin tone once a year with a CO2 laser treatment depending on their sun exposure. The exact number of treatments varies and depends on the needs of the patient and factors such as age, skin type, etc.

When will I see the results of the fractional resurfacing treatment?
Visible results from fractional resurfacing laser treatments can vary. There are essentially two stages of results: immediate and progressive. It usually takes one week after your laser treatment your skin to begin to feel smoother, look brighter and for the tone to become more even. Your skin will continue to improve over the next several weeks or months as your beautiful new skin color, tone and texture begins to shine.

How long do the effects of the fractional resurfacing laser last?
The results of the laser treatment are long lasting, but not permanent. The better your take care of your skin and protect it from the sun, the longer the results will last. You might need annual touch-up treatments to keep your skin looking its best.

How much downtime should I expect after a fractional resurfacing treatment?
There is minimal downtime after a fractional resurfacing laser treatment. Right after the procedure your skin will probably appear red and slightly swollen, but this will fade and many patients are able to cover up the redness the next day. Immediately after the treatment, your body naturally starts working by replacing aged tissue with new ones. Within 2-4 days after the procedure, you will notice your skin to be visibly smoother, healthier and younger looking. Results will continue to improve over time. Patients can resume their normal active lifestyle in immediately although your skin’s appearance will appear pink/red similar to a sunburn for the first week or two. This procedure will a luminous natural glow that has been lost as a result of age and sun damage.
By Master Account 29 Aug, 2016
Sexual well-being is important to a happy, well balanced life. In addition to physical pleasure, sex is a gift which strengthens emotional bonds between partners, and adds excitement to life. Time changes many things. As a woman ages, her body changes all over. Childbirth, weight change, and surgery can alter the vagina (birth canal) and labia (inner and outer lips) forever. Through Vaginal Rejuvenation procedures offered at the English Plastic & Cosmetic Surgery Center, Dr. Christy Walker, a board certified gynecologic surgeon and fellow of the American Board of Obstetrics and Gynecology can bring back confidence to intimacy. Dr. Walker is also a fellowship trained cosmetic surgeon and an accredited Associate of the Laser Vaginal Rejuvenation Institute of America. She is proud to be the first physician to offer Laser Vaginal Rejuvenation in Arkansas.

So let’s break the ice and get to the issue at hand. It’s a hard subject for most women to just come right out and discuss so we want to explain the basics about this cosmetic procedure because knowledge is power and you have the power to do what’s right for you. It’s normal to be frustrated with the changes your body goes through over the years. The negative body image that occurs can affect your self-esteem. Vaginal Rejuvenation can improve how we look at our body and can improve self-esteem, which in turn can improve sexual relationships.
The procedure removes the excess tissue from the vagina and it’s supporting structures, to restore the muscle tone and aesthetic qualities. Vaginal Rejuvenation can increase sexual satisfaction, as well as improve some physical issues such as urinary incontinence.
While there are some non-surgical options to Vaginal Rejuvenation, they are not always effective at repairing the lax, stretched tissue that can occur over time. The problem is that muscle tissue that has lost its elasticity can be almost impossible to improve without surgery.
Vaginal Rejuvenation surgery is a 1-2 hour outpatient, office-based procedure performed under anesthesia that restores vaginal muscle tone, strength, and control. This procedure reestablishes the caliper of the vagina to its original size thus restoring sexual gratification for the woman and her partner.

Most patients are able to return to work within 72 hours and resume normal sexual activity within 6 weeks. The growing number of women seeking this surgical option has escalated significantly over the past few years. Now with state of the art solutions women don’t have to suffer in silence any longer, and can enjoy a better sex life as well.
By Master Account 29 Aug, 2016

You may think that a facial is something you should have only as a luxury or every once in a while. The truth is that regular facials are important for your skin and has a positive benefit on both your physical and mental well-being.

Professional versus home facials

With all the information available on the Internet it seems like it’s easy to give yourself a facial at home. However having a professional facial is a monthly must. It gives you the chance to work with a skin care specialist. A skin care specialist can evaluate your skin, point out problem areas and advise you on the best treatment options for improvement. Approach at home facials with caution. Over exfoliating can be detrimental to your skin and actually do more harm than good. Harsh ingredients can cause irritation or sensitivities. We recommend professional facials and at home skin care maintenance.

What is included in a facial?

A facial is more than just a few cucumbers on your eyes and some moisturizing cream on your face. A good facial will include a skin analysis to determine the most efficacious products to use. Cleanse, tone, 20-30 minutes of facial massage to stimulate blood flow followed by a masque and appropriate products applied. Facials paired with Microdermabrasion treatments show optimum results.

Why you need regular facials

Your face is the one area of your body that is almost always exposed to the outside elements including wind, sun, and cold. In order to keep your face looking young and jubilant, you need to take care of your face.  Stimulation and exfoliation is a must when getting a facial. By having a facial every 30 days your skin will show the benefits of youth, vitality with psychological effects of improved self -esteem.

Anti-aging effects

Regular facials can help your over the counter anti-aging products work better. The reason for this is that regular facials help to relax the muscles and tone your face. Facials improve elasticity, soften facial lines and brighten the skin.

Various types of facials

There are various types of facials that you can get. Problematic skin requires deep cleansing, but there are special products for those who have sensitive skin problems. Facial masks will help to unclog your pores and clear up your skin and have anti -aging benefits to it.

How often should I get a facial?

Facials are beneficial at least once every thirty days. You do not want to do them too often because that can have an opposite effect on the skin, but once a month will keep your skin looking its best. Then, when you are at home, or in between facials it is very important to take care of your skin by treating your face, moisturizing it daily and adding a broad spectrum SPF 30 to your daily routine. If you have oily skin make sure to find an oil free moisturizer and sunscreen.

Facials are best thought of as a regular part of your beauty and cleansing routine. Receiving regular professional facials is important for proper care of your face. Maintaining with at home treatments will amplify your results. If you have a busy schedule, some of our patients schedule a facial every 6 weeks just as they do a hair salon appointment. It becomes a part of a healthy routine that your skin needs and deserves.

By Master Account 27 Jul, 2016

There is a story we hear quite often with our patients. The old song and dance about growing up looking forward to spring and summer to slather on the baby oil and fry baby fry. Think about it, just a short time ago being tan was a way of life and the only ads remembered for sun care were the ones with the Coppertone baby and the puppy pulling down her swimsuit to reveal a sunburn. Ouch! Yeah…times have changed.

If we only knew then what we know now there would have been a lot more umbrellas, hats and zinc oxide in our lives. Over the years all that time spent in the sun can seem to creep up on us in the form of brown sunspots, melasma and dull skin on the face, neck, chest as well as arms and hands. In fact it can sometimes take up to 10 years for past sun damage to creep to the surface of our skin.

As the importance of a broad spectrum sunscreen came into the forefront many of us stopped the burning and tanning phase and became sunscreen fanatics, but the damage was already done and we all wish we could erase the history of those baby oil days. Well here’s your chance…the   CO2 Fractional Laser   is a way to clear up the damaged skin and rejuvenate the surrounding tissue, allowing for a healthy clear complexion. The way it works is quite fascinating. Crazy cool modern technology! This treatment has given many of our patients new baby smooth skin again.

Glowing testimonials   make this a popular non-surgical alternative. Yeah, we’ve come a long way baby!

Are you wondering if this treatment is right for you? Here are a few FAQs to help you decide:

So How Does it Work and What Does it Do?

Fractional CO2 Laser skin resurfacing can improve the appearance, the resiliency and elasticity of your face, neck or anywhere you choose by selectively targeting the superficial layers of skin that contain fine lines or wrinkles, scars and hyperpigmentation. Laser skin resurfacing is now a very safe and common procedure that many people are choosing rather than more invasive surgical procedures.

Fractional resurfacing laser treatments can be used to improve the following skin conditions:
o Pigmentation problems (especially brown pigment)
o Age spots, sun spots and sun damage
o Minimum to moderate wrinkles
o Textural irregularities
o Lip lines
o Acne scars
o Surgical scars

How long does a fractional resurfacing procedure take?

Fractional laser resurfacing treatments are generally quick, lasting around 30 minutes to an hour. The length of the procedure depends on how many areas of the face, neck or chest are being treated.

How many fractional laser resurfacing treatments will I need?

Many patients see a significant result and are happy after only 1 treatment. Others may need a series of laser treatments in order to see the best results. Some patients renew their skin tone once a year with a CO2 laser treatment depending on their sun exposure. The exact number of treatments varies and depends on the needs of the patient and factors such as age, skin type, etc.

When will I see the results of the fractional resurfacing treatment?

Visible results from fractional resurfacing laser treatments can vary. There are essentially two stages of results: immediate and progressive. It usually takes one week after your laser treatment your skin to begin to feel smoother, look brighter and for the tone to become more even. Your skin will continue to improve over the next several weeks or months as your beautiful new skin color, tone and texture begins to shine.

How long do the effects of the fractional resurfacing laser last?

The results of the laser treatment are long lasting, but not permanent. The better your take care of your skin and protect it from the sun, the longer the results will last. You might need annual touch-up treatments to keep your skin looking its best.

How much downtime should I expect after a fractional resurfacing treatment?

There is minimal downtime after a fractional resurfacing laser treatment. Right after the procedure your skin will probably appear red and slightly swollen, but this will fade and many patients are able to cover up the redness the next day. Immediately after the treatment, your body naturally starts working by replacing aged tissue with new ones. Within 2-4 days after the procedure, you will notice your skin to be visibly smoother, healthier and younger looking. Results will continue to improve over time. Patients can resume their normal active lifestyle in immediately although your skin’s appearance will appear pink/red similar to a sunburn for the first week or two.

This procedure will a restore a luminous natural glow that has been lost as a result of age and sun damage.

By Master Account 27 Jul, 2016

Dr. English:

I absolutely could not be more pleased! I feel great about the way I look. I wasn’t lacking in self-confidence before the procedure, but I have noticed from comments from others, they say I look better than ever and that I “carry” myself differently. Happier than they’ve ever seen.

Because I’ve had trouble with headaches since the age of 14, I have seen several doctors throughout the years and dealt with office staff. From general practitioners to neurologist, neurosurgeons, ENT’s, allergy doctors, gynecologist, urologist, eye doctors, podiatrists, dentist, and three other plastic surgeons (none of which I chose to have any work by). I have never experienced a more caring, knowledgeable, absolutely wonderful doctor and staff! If a new patient ever needs a reference, please do not hesitate to give them my phone number! Dr. English is so kind and caring and all of the ladies have been so nice, helpful and a complete pleasure to deal with! I would and actually have already been talking about and referring friends and family to you! I could not be more pleased.

Thank you for everything!

~ TL


Dear Dr. English and Staff:

I wanted to let you know that I’m very pleases with the results from my surgery. I was a 55 year old woman requesting improvement to my lower eyelids and lower face. I had heavy bags and hollowness under my eyes. My lower face was sagging and my neck looked older than I felt. Dr. English suggested a lower facelift with a chemical peel around my eyes. After thoroughly researching Dr. English, I made a decision to have my surgery in Little Rock. I live in Northwest Arkansas, but did not find a physician in that area that I was comfortable with.

Recovery was a slight inconvenience, but the results of looking 10-15 years younger were well worth it! I will never forget the recovery process and the exceptional follow up care that I received. Dr. English and his staff were available for questions any time of the day or night. I found him to be very conscientious, compassionate, and sympathetic during my healing process. I look very natural and pretty. People are amazed when they see. Me. I highly recommend Dr. Jim English and the English Plastic & Cosmetic Surgery Center.

~ Linda


I have had three children and developed a complex about my vaginal area. I would not let myself be intimate for years because of my insecurities. After looking online for a doctor that did vaginal reconstruction I found Dr. English. After meeting with him I decided to do the procedure, and all I can say is that it changed my life! I am so happy that I made this decision to do this for myself! I no longer have a complex, but instead I have a new found confidence in myself that has changed me and my life!

~ Tina


I am a 49 year old female, mother of three and have been a patient of English Plastic & cosmetic Surgery Center for several years. I believe in taking care of myself and love trying new things as the world is ever changing. I was watching “The Doctors” one day and the subject was on female sexual enhancement with sparked my attention. A lady and her husband were on the show explaining how much netter both their sexual and intimate experiences were since his wife had the procedure done. I thought, “Hey, men do it and it seems to be a hit, why not enjoy more sexual pleasure too?” This woman and her husband seemed thrilled with the results. With a couple of clicks on the computer, here comes Dr. Jim English to the rescue. In fact, his procedure was much better and more permanent. It is called Fat Augmentation of the Anterior Wall.

After a few weeks of struggling with embarrassment I finally decided to talk with the female staff members and was reassured that I had nothing to be embarrassed about. I was treated with utmost respect and had the procedure done with very little discomfort, with only a few hours of down time.

There are no words to describe the pleasure and intimacy I now have with my husband. This has been by far the best decision I’ve made in regards to my overall feelings of wellbeing. I recommend this procedure to all women. It truly has made my sexual experience as a woman an overwhelmingly joyful one that we should all have. Thank you, Dr. Jim English and thanks to all your staff. You all have made my life experience exceptional.

Sincerely,

~ S.M.


Dr. English:

Since today is possibly my final follow-up visit, I thought it would be the perfect time to write a testimonial. First of all, I want you to know how much I greatly appreciate the service, courtesy and professionalism you and your staff have shown me since I first walked into your office for a consultation. You came highly recommended to me as a FIRST choice by a colleague who had used two other cosmetic surgeons in the Little Rock area.

I consider my breast enhancement surgery a great success! It’s a procedure that I have considered for years. Many times while shopping, I would become frustrated with the way clothing fit me. In January of 2012 I told my husband that I wanted breast enhancement surgery for my 50th   birthday. Because I am a very conservation, frugal and practical person this request was quite a surprise coming from me. I had zero reluctance about having the surgery because I’m a resilient person but my greatest concern was the cost. My husband researched on the internet and found an average cost. Surprisingly, on my first consultation when I received the printout of the cost of the surgery, it was ONLY “fleece” to schedule the surgery.

Once the surgery was scheduled, I never had any fear until the morning of the surgery. When I arrived at your office, I told you that fear had overcome me that morning. You said, “We will take care of that in a minute.” What you did next touched my heart and will always be treasured! You prayed with me! I have had four surgeries over my lifetime and you are the first doctor to ever pray with me. I thank God for you and how you seek His guidance daily. The entire process was easy for me, even the recovery period. The few people that knew that I had the surgery couldn’t believe how quickly I recovered. I absolutely do not have any regrets at all about having the breast enhancement surgery. I am a very HAPPY and much SATISFIED client!

~ JC

By Master Account 27 Jul, 2016

The joy of a new baby is one of the greatest feelings a parent can experience, but it isn’t all toothless smiles and baby kisses. Pregnancy and childbirth take their toll on a woman’s body.  And getting rid of that post pregnancy paunch can be difficult, especially when you consider the challenge of raising a little one. Come on in to English Plastic & Cosmetic Surgery Center and kiss that post baby belly goodbye with liposuction.

Can Liposuction Eliminate a Pregnancy Paunch?

After pregnancy many women are surprised to discover new fat pockets in areas where they’ve never had a problem. This new fat is often resistant to diet and exercise, sticking around no matter what you try. What’s a new mom to do? Liposuction might be the solution you’re seeking. It can sculpt the body after pregnancy, restoring definition, removing undesired fat, and slimming the abdominal area. For some women, a tummy tuck isn’t necessary; liposuction can do the trick and restore your body and your confidence after baby.

Liposuction is a great choice for removing stubborn pregnancy fat. Diet and exercise are still essential, liposuction simply complements your efforts, helping to remove resistant fat deposits and sculpt your body into an attractive and desirable shape. Come in for a consultation and discuss your options. We can help you determine if liposuction will help your meet your post pregnancy body goals.

Can I Manage Liposuction Recovery and a New Baby?

Many new moms worry that they won’t be able to handle the stress of a new baby and recovery from liposuction; surprisingly most people find that liposuction recovery isn’t that difficult. Your specific recovery times will vary depending on the type of liposuction you receive and over which areas. Your surgeon will discuss the specifics of recovery with you before surgery.

Most people experience some bruising and swelling for a couple of weeks after the procedure. Any pain can be managed with pain medications.

Love your post pregnancy body again with liposuction from English Plastic and Cosmetic Surgery Center. Call us today to schedule your consultation.

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