With the mid-face, it’s important to understand what’s going on. We can see age-related drooping and a gathering of tissues over the nasolabial fold. This also tends to pull eyelid tissue down resulting in an unmasking of the bony inferior orbital rim. This is an area that we want to pay attention to, which can benefit greatly with fillers. I tend to use Radiesse to augment the mid-face but something thinner like a hyaluronic in the tear trough. Radiesse lasts a year, takes 15 minutes to inject and the patients are happy.

Before, we could only get the same results with a cheek implant. But cheek implants frequently resulted in intraoral exposure and complications. Longer acting fillers work very well.

In the mid-face, you need to be mindful of what plane you’re in. I like the subdermal plane, injecting small amounts, then massaging and feathering it. This is why filler is superior to a solid implant. You have the ability to manipulate it endlessly and soften the effects.

In terms of the plane, I’ve had one serious complication with a filler. I was injecting over the bone, in the supraperiosteal level, and some of the filler tracked into the infraorbial foramen and caused a long-lasting numbness in the cheek and upper lip on that side which took almost a year to resolve. The subdermal plain is very safe. I keep the filler out of the orbit, away from the orbicularis, just in the cheek. I treat the orbital rim tear trough with just a light HA. You’re close to the eye so inject slowly while withdrawing the needle. I prefer using a longer needle—a one inch, 30G—and draw it back along the rim, leaving the filler right on the bone and under the muscle. This is an advanced technique so make sure you know what you’re doing and spend some time learning from someone experienced in this procedure.

Some patients who have a prominent medial compartment of the inferior orbital fat, who would otherwise have a blepharoplasty, can be treated with this technique using a light HA along the rim.

This can provide contour improvement in a non-invasive way. HAs tend to last six months on the inferior orbital rim, but I have seen results last up to a year.

For fine facial lines, a light to medium HA is the best bet. For superficial lines, take your time to fill them carefully. For medium to deep lines, a little Radiesse can provide dramatic improvement without any surgery, which patients appreciate.

Medium to large contour defects, whether in the bone or soft tissue, can be treated with Radiesse. If they’re small and superficial, such as acne scars, I usually go with an HA. You can use, for example, Beloltero and the tip of a half-inch 30G needle, using a subcision technique to get a nice effacement of the scar.

Fillers come into their own in the nasolabial fold. I tend to use calcium hydroxylapatite, or Radiesse. I can layer the product—if they have a well-defined line within the fold itself, I’ll layer the Radiesse deep and then apply an HA superficially.

This can be quite successful—a study investigating the use of Radiesse and HA in combination found that the patients were happier with the combination treatment than one treatment alone.

I mainly use calcium hydroxylapatite in the melolabial fold and prejowl sulcus jaw line, unless the tissues are very thin and then I’ll use an HA. Perioral lines, smoker’s lines or very thin lines can be treated with a very light HA.

Using very small amounts of a neuromodulator into the deep lines around the mouth works well. Large amounts interfere with the smile and ability to speak, so don’t get carried away—use it in very fine, small amounts. Some patients are happy with neuromodulator treatment for the depressor anguli oris, but others aren’t. I’m on the fence about that.

When patients come to your clinic for non-surgical facial procedures, you need to individualize their treatment. Dr. Michael Godin maps out his directions for optimizing results with his filler techniques.

Practitioners need a sound knowledge of the anatomy with a good technique to produce the best results. When considering fillers, will you use hyaluronic acid (HA), a semi-permanent filler or both?

In the forehead area, I don’t tend to use much filler. If I do, it will be a very light HA. As with all injections and particularly in areas where you might be worried about vascularity, you want a slow injection while withdrawing, introducing the material in small amounts. The blood supply of the glabella tends to be axial, meaning that the skin is dependent on one vessel. If you occlude that vessel, you can kill the skin.

The periorbital area of the forehead is where neuromodulators shine. I use them quite aggressively in the corrugator and procerus muscle, and the lateral and superior orbicularis oculi. We have to be judicial in our use in the frontalis—we don’t want to over treat it and drop the brow. We also don’t want to under treat it and leave people with a surprised expression, particularly laterally. When patients come in, and want their glabella treated, I ask them to frown. We see the classic “11″ comprised of vertical lines, with the corrugator pulling in, and we can see how laterally based it is. We want to treat the whole corrugator or we will get some pulling in of the brow.

Some patients are more procerus dominant. They have a more vertical pull and consequently the lines are more horizontal. We would not treat these people with a neuromodulator the same way. We have to individualize treatment. We a natural-looking result with botulinum toxin. I like to see some movement—I don’t want to see the forehead frozen. But it can be very useful in getting rid of deep lines, yet permitting them some motion.

Dr. Michael Godin is pleased to announce the release of his long-awaited textbook, Rhinoplasty: Cases and Techniques. This is a must read for all practicing plastic surgeons and facial plastic surgeons as well as residents and fellows in training. The book is published by and available from Thieme Medical Publishers, Inc., New York.

Rhinoplasty: Cases and Techniques is an extremely collaborative textbook that includes contributions from 35 of the world’s finest surgeons from the United States, Canada, Europe, and South America. In addition to writing most of the chapters in the book, Dr. Godin edited these contributions, organized them, and worked with a medical illustrator to reference each concept with full-color, before-and-after photographs and illustrations.

“This is the first playbook for rhinoplasty,” states Dr. Godin. “Virtually every type and shape of nose that requires repair can be found in the easy-to-use index.” The 69 illustrated case studies are categorized by nasal type and cross-referenced, which enables the surgeon to find the procedure he or she is looking for quickly. Each case contains a detailed analysis, plans, operative sequences, and outcomes that will increase your knowledge of techniques and approaches.

Dr. Michael Godin is a double Board Certified Facial Plastic and Reconstructive Surgeon. He is certified by the American Board of Facial Plastic and Reconstructive Surgery in addition to the American Board of Otolaryngology. Since 1993, Dr. Godin has served as the Director of Facial Plastic and Reconstructive Surgery in the Department of Otolaryngology/Head and Neck Surgery at the Medical College of Virginia. In addition to the current textbook, he has written over 20 published articles on facial plastic surgery and is a sought after expert teacher and lecturer both nationally and internationally. He is also one of only 40 surgeons in the United States who has been selected to participate as a Program Director in the fellowship program of the American Academy of Facial Plastic and Reconstructive Surgery.

Patients wishing to schedule a personal facial rejuvenation or rhinoplasty consultation may contact Dr. Godin’s office at (804) 285-8578 or stop by 410 Libbie Avenue, Richmond, VA 23226. For more information about Dr. Michael Godin or Rhinoplasty: Cases and Techniques, please visit www.drgodin.com.

In this article, Dr. Godin discusses Radiesse’s ability to create structural collagen support and it’s ability to stimulate the skin’s foundation making it a favorable option for facial volumetric lifting and contouring.

Radiesse’s ability to create structural collagen support and stimulate the skin’s foundation makes it [a] favorable option for volumetric lifting and contouring. For Richmond, Virginia-based facial plastic surgeon Michael Godin, MD, FACS, Radiesse is the filler of choice, “I use Radiesse extensively in my practice. Its longevity and lifting capacity make it my go-to filler for facial contouring. I tell patients that Radiesse is the cake and hyaluronic acids—such as Juvederm and Restylane—are the icing. I often use multiple filler types in combination, placing the Radiesse deep to the hyaluronic acid, to provide a foundation.”

According to Dr. Godin, “I see so many patients with sagging in the midface which can begin as early as the 30s and is almost universal by [the age of] 50. As the midface descends, the bony rim of the orbit is exposed and any prominent lower eyelid fat is displayed in sometimes dramatic relief. The sagging tissue gathers just above the nasolabial fold, creating a triangular valley between the lower lid and lower cheek.

Radiesse is the ideal material to correct this deformity. It is a sculptural process—one I enjoy. I prefer to place Radiesse in the subcutaneous plane. I imagine myself layering just beneath the fat. I don’t like to go deeper with it as it can track to the infraorbital nerve in this location and cause problems. After injecting I spend quite a bit of time positioning the Radiesse with my hands—feathering the edges of it for the most natural-looking effect.”

With advanced facial contouring techniques, practitioners are able to produce more facelift-like results to meet patients’ demands for long-lasting, non-surgical treatment options. “Years ago, I would have had to take these patients to the OR under anesthesia, make a cut and dissect through their cheek tissue to the bone, and place a synthetic implant that could move, get infected or become terribly obvious-looking with the passage of time and thinning of tissue,” says Dr. Godin. “With my Radiesse technique, [patients] are in the office for 30 minutes and walk out with great-looking cheeks that will last them a year.”

Lewis, Wendy. “Volume Matters.” MedEsthetics. Vol 7. Number 6. Nov/Dec 2011: 22, 24. Web.

I hope this letter finds you well and enjoying the beautiful fall weather. There are many exciting developments happening in my practice which I want to share with you.

MY BOOK IS PUBLISHED

As I write to you, the first printing of my book: Rhinoplasty: Cases and Techniques is on a container ship making its way from the printer in China to the United States. I received an advance copy at the American Academy of Facial Plastic and Reconstructive Surgery meeting in San Francisco last month where surgeons were already ordering the book. The reception for my work has been overwhelmingly positive and it gives me a real feeling of accomplishment to have completed this project. Hard copies of the book will arrive in mid-December and I intend to put one on display in our reception area.

Next week, I will go to New York to do voice-overs for a series of instructional technique videos filmed in my operating room. Doctors who buy the book will be able to access these tutorials on the internet. All of this is extremely exciting to me. I am grateful to my patients who put their trust in my surgical skills and enabled me to generate case material for the book while performing their procedures.

THE MICRO-MINI LIFT™

Although I am becoming increasingly well known for rhinoplasty, my most popular surgical procedure remains the facelift, which can be of great help in eliminating jowls and improving a falling neck. Through years of work, I have developed a modification of the facelift which I call the Micro-Mini Lift™. This is most appropriate for patients with a small amount of excess skin in the jaw line and/or minor looseness of the neck. The incisions are small and recovery time is usually a week or less. I perform this lift mainly for patients in their forties and early fifties who are beginning to see some loosening of the tissues but are not ready for a larger lift. I believe it is crucial to do the right procedure at the right time for my patients and so the Micro-Mini Lift™ is a great addition to my face and neck lift line up.

BEST COSMETIC SURGEON

I was gratified to again be chosen as one of Richmond’s best cosmetic surgeons by the readers of Style Magazine. The results of the voting were released in this year’s Best of Richmond issue.

NON-INVASIVE PROCEDURES

My non-invasive cosmetic practice continues to grow as patients enjoy looking better with little to no down-time. My expertise in this area has received national and international recognition. This past summer, I once again gave a presentation to doctors at The Royal College of Physicians in London. I participated in an expert panel on rejuvenation of the lower eyelid using filler material and performed a demonstration “Liquid Facelift” using several different types of injectables in a model patient for the benefit of the audience. One of the advantages of performing procedures overseas is that it allows me to use and evaluate new materials that will soon be available in the U.S. In this particular demonstration I used Xeomin® which is the most recent FDA approved alternative to Botox®.

Botox® is tried and true as a relaxer of muscles which cause unsightly wrinkles and furrows and is a mainstay of my injectable practice. Dysport® is very similar to Botox® and is nice to have as an alternative for certain specific situations. For filling wrinkles in the face and improving contours in the cheeks and folds, I use Radiesse®, Juvederm® and Restylane®. Adding youthful volume to the face with these materials is truly a form of sculpture and is one of my favorite things to do.

AESTHETIC SERVICES

I am extremely proud to be able to offer you expert skincare from Anne Hurst, Carole Williams, Annie Cooper, Elle Hudson, and Tricia Boor. Having these five licensed master medical aestheticians together in one practice represents a magnificent concentration of talent. All are extremely skilled and experienced and my job in this aspect of the practice is simply to provide them with the best skincare product lines and equipment available.

Recently, we evaluated two revolutionary new devices for providing skincare and chose one to purchase for the practice. The new addition is the HydraFacial™ MD Touch System. This machine is a natural extension of our already popular Silkpeel™ treatments. In addition to infusing various hydrating, brightening, and clarifying solutions into the skin as the facial is performed, this machine expands our ability to treat common skin conditions such as rosacea and acne. The aestheticians performed a HydraFacial on me and I was amazed at how painless the extraction process (usually not my favorite) was using this new technology. All of our aestheticians received training on the machine and will receive more as soon as it is delivered. We are extremely excited about this new addition to our aesthetics lineup.

EXPANDED MEDICAL SPA

We have again expanded the space in the medical spa by adding a laser room. This is a quiet and private space for the aestheticians to use our state-of-the art Lumenis Lightsheer Duet™ hair removal laser. This laser has proved both popular and effective. Fall/Winter is the best time of year to have this procedure performed as there is less tanning of the skin and the laser can more readily treat the dark hair follicles. Our hair removal laser is faster and less painful than any of the others that I have evaluated. We have learned that to get long-lasting results the hair must be treated in its growth phase. About twenty to thirty percent of hairs are in that stage at any given time. This means that you can expect about four to five treatments with perhaps one or more maintenance treatments given later to get the best effect.

FELLOWSHIP PROGRAM

Our new fellow is Dr. Tom Tournas. Tom is our first international fellow, having graduated medical school from prestigious McGill University in Montreal, Canada. Tom will return to his native land after his fellowship and plans to establish an academic facial plastic surgery practice there. He has assisted me in several hundred injectable procedures and has demonstrated the skill and judgment to do these very well on his own. He has been treating patients on days when I am out of town or not available and has been doing an excellent job. I stand behind his work and recommend him to you without reservation for injectable treatments.

THE INTERNET

We continue to improve our website www.drgodin.com. In addition, we have sent out a few “Beauty Blasts” announcing special events and cost-saving offers in the office. If you would like to be included in these notifications, please give my office a call and my staff will make sure you receive them. Please know that you can opt-out at any time if you don’t want to receive notices of such events.

Finally, we have also established a Facebook page for the practice. To view our new page, simply click on the orange Facebook icon which appears at the bottom of our Web site, to the right of our address.

WHAT DOES IT ALL MEAN?

From all of the above, you can tell that my enthusiasm for what I do, which is helping you to look and feel your best, is higher than ever. I believe that by being a leader in the field of Facial Plastic Surgery and staying on the forefront of academic and practical medicine, I can offer you the most options and highest quality services to maintain and enhance your facial appearance. I hope you have a wonderful holiday season and look forward to seeing you in the future.

Sincerely,

Michael S. Godin, M.D.

Dear Patient,

I hope this letter finds you well. I am writing to update you on what’s new in facial enhancement, facial plastic surgery and my practice.

As I pen this letter, I am preparing to go to Rome for a large international facial plastic surgery conference. As a result of publishing my book last fall, I was asked to present a lecture at the meeting and happily accepted. My surgical textbook Rhinoplasty: Cases and Techniques is selling worldwide and doing quite well. If you are interested in what I have been up to, you can find it on Amazon.com. The positive reception for it has been very gratifying and it has opened many doors. I have also accepted an invitation to be the keynote speaker this November at the International Congress of Plastic Surgery hosted by the Korean Society of Plastic and Reconstructive Surgeons in Seoul, Korea. While I enjoy sharing knowledge with my colleagues and traveling to exotic places, I still plan to spend most of my time at home being with my family and working in my practice.

Speaking of the practice, an exciting new development has taken place. Through many years and hundreds of facelifts, I have refined the basic facelift technique. A new method I have developed is called theMicro Minilift™. It is a real advancement in facial rejuvenation, and for that reason I have trademarked it. This small incision lift hides in the natural contours and valleys around the ear and allows lifting of the jaw line and neck. It is most appropriate for patients with mild to moderate sagging in these areas. I plan to introduce the Micro Minilift™ this September at the American Academy of Facial Plastic and Reconstructive Surgery annual meeting in Washington, D.C. to share this technique with my colleagues, but it is already available to you here in Richmond. Not all patients are good candidates for this lift, but if you are, the incision is smaller and the downtime dramatically reduced, all while achieving a substantial improvement. I will be happy to discuss this with you if you have an interest.

My injectables practice continues to be very popular. For relaxing frown and squint lines, we have not only Botox®, but also Dysport® and the recently FDA approved Xeomin®. For filling facial folds and lines, I use tried and true materials such as Restylane®, Juvederm® and Radiesse®. Many patients have commented on the fact that these procedures seem to hurt less in our office than in others. I attribute this to the fact that we use an extremely strong numbing cream which is compounded in California specifically for this purpose. It is put on several minutes before the treatment and makes getting the injections much more comfortable.

Our licensed master medical aestheticians continue to do wonderful work with the extensive selection of medical-grade skincare lines and treatment options which they offer. If you are not already receiving skincare from Anne, Carole, Annie or Tricia you may be missing out! Please know that they offer a complimentary consultation in which they will examine your skin and make recommendations for the skincare regimen that suits you best. I am grateful to all of them as they continue to add an important dimension to my practice.

Finally, it is getting near the time when I will wish my current fellow-in-training Tom Tournas goodbye and welcome our new fellow to the practice. Tom will be returning to Quebec where he will practice both academic and private facial plastic surgery. He has done an excellent job this year and both I and the patients he has helped are grateful to him. Our new fellow will be Dr. Maher Younes who is coming to train with me from the University of North Carolina, Chapel Hill. Dr. Younes did an extensive post doctoral fellowship at MD Anderson Hospital in Houston, Texas prior to joining the Head and Neck Surgery program at UNC. He brings a wealth of experience to our practice and I am looking forward to working with him.

From the above I think you can see that we have an exciting, thriving and dynamic practice that emphasizes excellent results delivered in a safe manner. I also continue to have a genuine passion for advancing the science and art of facial plastic surgery. As always I am grateful to you, my patient for having the confidence in me to let me help you. I wish you a very pleasant summer and hope that you wear sunscreen enthusiastically. I am here to help you whenever you would like.

Sincerely,

Michael S. Godin, M.D.

The creation of original sculpture is a growing passion of mine. I recently attended a sculpture workshop given for plastic surgeons from around the country. This five-day course was given by professional sculptors in conjunction with the New York Art Students League.

A live model served as the subject for this intensive eight-hour-per-day experience. It was gratifying for me to see her form take shape in the clay and was an extremely enjoyable way to spend my time. By creating beauty out of shapelessness, the surgeon’s eye is trained in a different way. I truly believe it enhances my aesthetic sense and helps me to deliver even better results to my patients.

In my spare time, I enjoy sculpting and accept commissions which I’ll execute pro bono for charities. Should you be involved with a charity event that would benefit from auctioning a commissioned sculpture, please get in touch with me to discuss.

– Dr. Godin

Readers looking for the latest in “must-have” beauty products, anti-aging strategies, and cosmetic enhancements turn to the pages of NewBeauty. Dr. Michael Godin is featured in the Spring/Summer 2013 edition, which is due on newsstands April 2013. The world’s most unique beauty magazine, NewBeauty is the ultimate aesthetic resource for “everything beauty,” covering subjects from advancements in facial fillers to the most luxurious spa treatments to the newest wrinkle-reducing serums and everything in between. NewBeauty’s reach beyond print—to online and retail—cements its reputation as a beauty brand powerhouse among readers, marketers, and medical professionals.

Dr. Godin, a double board-certified Facial Plastic and Reconstructive Surgeon in Richmond, VA, was happy to talk with NewBeauty about his treatment philosophy. “I customize what I do for each individual patient. I take time to really listen to what they would like to achieve. Then I try to give them a range of options from less invasive to more invasive treatments.” For instance, Dr. Godin has developed a modification of a facelift called the Micro-Mini Lift^®, which is minimally invasive and is appropriate for patients with a small amount of excess skin in the jaw line and/or minor looseness of the neck.

Since its launch in January 2005, NewBeauty has fearlessly enabled an open and ongoing line of communication about cosmetic enhancements between consumers, manufacturers, and medical professionals. Let’s face it: More than 12.4 million surgical and nonsurgical cosmetic procedures were performed in 2010—a number that continues to rise each year. With a distribution of approximately 500,000 copies per issue, NewBeauty is available for purchase at 40,000 plus retailers in the United States, including major bookstores like Barnes & Noble, as well as airports, supermarkets and newsstands.