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Parrish Cosmetic & Plastic Surgery Center
701 Golf View Dr.
Medford, OR 97504

Toll Free: 800-458-0684

BOTOX® Cosmetic

BOTOX® Cosmetic is a purified botulinum toxin and is used to soften facial lines and wrinkles. It has been safely used by physicians for many years. BOTOX® Cosmetic is most commonly used for forehead lines, crows feet, and frown lines, however it is now being used in other facial areas as well. It has been quite successful in treating facial wrinkles around the mouth and neck bands. BOTOX® Cosmetic is injected into the muscle in these areas and works by weakening the muscle, which in turn lessens the ability of the muscle to contract. Although BOTOX® Cosmetic affects the ability of the muscle to move, it does not impair sensory function. The results can last 4-6 months and repeat treatments are needed for maintenance, however, studies have shown that individuals who have had multiple treatments had results that lasted longer.

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A new injectable used to temporarily improve the look of moderate to severe frown lines between the eyebrows. Though approved in the United States in April 2009, Dysport has a history of use in other countries since 1991. First approved for aesthetic use outside the U.S. in 2001, Dysport has steadily gained in popularity around the world. Today Dysport is marketed and sold for aesthetic use in 36 countries, as of October 2009.

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Non Surgical Facial Rejuvenation

“Restylane® and Perlane®”

In 2003 the first FDA approved non animal based product used for injecting and filling facial lines became available and was called Restylane®. It is used for the treatment of facial wrinkles and folds. It is an injectable substance called hyaluronic acid and no skin testing is needed prior to treatment. The results are immediate and generally last close to a year.

Perlane® is the latest addition to their product line and is different in that the hyaluronic gel particles are larger than those found in Restylane®. The product is expected to last longer and offer more volume and lifting power.

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Radiesse® is an FDA approved dermal filler with a good safety record. It is used to restore volume to smile lines, nasolabial folds, and wrinkles around the nose and mouth. It is made of unique calcium based microspheres suspended in a natural gel that is injected into the skin through a simple, safe and minimally invasive procedure. Results are immediate and typically last a year or longer. The calcium based microspheres form a support system and stimulates the growth of your own collagen. Radiesse® rebuilds your skin’s foundation and restores your youthful look.

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Juvederm and Juvederm Ultra are also commonly used fillers in many ways similar to Restylane® and Perlane®.

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Sculptra® Aesthetic

Sculptra® Aesthetic is not a filler but works by stimulating your own collagen creating smooth, long lasting results. As you age, your body's collagen production decreases, and you may begin to see wrinkles. Sculptra® Aesthetic works to correct shallow to deep facial wrinkles and folds, as it replaces lost collagen, which can help provide a refined, more youthful appearance. Treatment consists of up to 3 separate appointments, scheduled 6 weeks apart.

To learn more about this exciting product you can pick up a complimentary DVD in our office or visit

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Eyelid Surgery

Blepharoplasty (eyelid surgery) is performed to correct the wrinkling and sagging of the eyelid skin and bagging caused by the fat pads of the eyelids. This can occur with aging, or be due to heredity. A blepharoplasty removes the excess fat and wrinkled, drooping skin of the upper eyelids that can make you look constantly tired or sad. It also eliminates bags under your eyes and tightens the lower eyelid skin. The result is a brighter, more alert and rested appearance. This can have a positive effect on the way you feel about yourself.

Some people have eyelid surgery to correct problems that are a result of aging, while others have inherited traits that cause them to seek treatment as early as their 20s or 30s. Aesthetic eyelid surgery can usually correct these problems, although other treatments may also be considered. Smoothing of crow's feet may require laser resurfacing and if the upper eyelid condition is accompanied by sagging of the eyebrows, then a forehead lift may be necessary. Because of individual factors, not everyone will achieve the same results from eyelid surgery. Dr. Parrish will select the surgical technique that will obtain the best outcome for you.

With upper eyelid surgery, an incision is hidden within the natural fold of the upper eyelid and extends slightly beyond the outside corner into the laugh lines or other existing creases. Through this incision, excess skin and fatty tissue are removed. Since the incision follows the natural contour of the upper eyelid, it will be well camouflaged when healed.

For lower eyelid surgery, an incision is usually hidden just below the lower lashes. Through this incision, excess skin, muscle and fat are removed, or fat may be re-distributed to eliminate puffiness or bulges. Other adjustments to correct special problems such as muscle laxity may be performed. As in upper eyelid surgery, the incision is well camouflaged by natural creases.

In some cases, you and your surgeon may decide that the best approach for removing excess fat is through an incision placed inside the lower eyelid. This technique requires no external incision, but it cannot be used to remove excess skin. A laser may sometimes be used in conjunction with this method to tighten the lower eyelid skin.

The surgery takes approximately 2 hours for both upper and lower eyelids, and can be performed under heavy sedation (you are basically asleep) at our accredited surgical center. In most cases, there is very little discomfort associated with this surgery. The incisions are placed so the scars are as inconspicuous as possible. The scars mature over a period of months and can be covered with makeup. It takes several months to achieve the final result. Not every line can be removed since this would make the eyes look unnatural.

Four days after your sutures are removed you may wear makeup, and depending on your line of work, you may be allowed to return to work at this time.

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Ear Surgery (Otoplasty)

Plastic surgery of the ear is most commonly performed to correct the position of ears that protrude significantly from the sides of the head. Such protrusion makes the ears appear to be larger than normal. Overly large ears are a rare condition called macrotia. Protruding ears may occur on one or both sides in varying degrees and are not associated with hearing loss. Even adult dissatisfaction with previous ear surgery is a basis for plastic surgery of the ear.

Correction of protruding ears uses surgical techniques to create or increase the antihelical fold (just inside the rim of the ear) and to reduce enlarged conchal cartilage (the largest and deepest concavity of the external ear). Incisions for otoplasty are generally made on the back surface of the ear. When incisions are necessary on the front of the ear, they are made within its folds to hide them. Internal, non-removable sutures are used to create and secure the newly shaped cartilage in place. External stitches close the incision. Techniques are individualized, taking care not to distort other structures and to avoid an unnatural “pinned back” appearance.

Ear Surgery Medford

Ear surgery offers near immediate results in cases of protruding ears, visible once the dressings that support the new shape of the ear during initial phases of healing are removed. With the ear permanently positioned closer to the head, surgical scars are either hidden behind the ear or well-hidden in the natural creases of the ear.

Treatment of protruding or disfigured ears is possible as early as age 5, when a child's ear cartilage is stable enough for correction.

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Forehead and Brow Lift Surgery

A forehead lift, also known as a brow lift, corrects the sagging or low position of the eyebrows that can cause a permanent tired or sad look.. It softens the creases across the forehead and erases the worried or angry expression that can result from frown lines. The outcome is a more relaxed appearance. This surgery takes about 1-1/2 to 2 hours and is performed under heavy sedation (you are basically asleep). A forehead lift may often be performed at the same time as a facelift, which removes excess skin and tightens muscles in the lower face. Eyelid surgery may be recommended in addition to a forehead lift if there is significant skin overhang in the upper eyelids or puffy bags beneath your eyes.

In most cases, the scars of the incisions are not visible after surgery. They are placed in the scalp, above the ears and hidden within the hair. Through the forehead lift incision, Dr. Parrish can modify or remove parts of the muscles that cause wrinkling and frown lines, and lift your eyebrows to a more pleasing level.

Typically, endoscopic technique is used. The incisions are small and are also inconspicuously placed. The advantage of this technique is that it requires no skin/scalp removal. If your main concern is frown lines between your eyebrows or across the top of your nose, a limited endoscopic procedure to correct these problems can be done. Alternatively, if you are having upper eyelid surgery performed to remove excess skin, it may be possible to treat your frown lines by way of the same upper eyelid incisions.

Most patients take two weeks off from work following a forehead lift. It takes about six months to reach your final result. Not all lines can be removed, but you will look fresher and younger. Since we “turn the clock back”, but can't stop it, you continue to age.

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A facelift is performed to reduce the wrinkling and drooping of the skin of the face and neck. People in their 40s choose to have a facelift to maintain a youthful appearance, while older patients choose to do so for rejuvenation. It will take a few months to obtain your final result. Your result should be natural-looking and make you appear fresher, not mask-like. Not all lines can be removed, but you will look more youthful. Remember, a well performed facelift can be long-lasting, but you will still continue to age.

Facelift incisions are placed to make the scars as inconspicuous as possible. These scars will mature with time. Endoscopic techniques may be used for facelift procedures. Advantages of this technique are much smaller incisions (also inconspicuously placed) and less skin/scalp removal. Everyone has slight asymmetries from side to side, even before surgery.

Facelifts are usually performed at our accredited surgical center. The surgery, which is not painful, is performed under either sedation (you are basically asleep) or general anesthesia. With any surgical procedure, complications, which are uncommon and usually minor, can occur and will be discussed with you at your consultation visit.

A facelift cannot correct conditions such as sagging eyebrows, excess skin and fatty deposits in the upper and lower eyelids, or wrinkles around the mouth. However, a facelift may be performed in conjunction with other procedures that will correct these problem areas.

In the early spring of 2002, Dr. Parrish began performing facelifts using a new technique. This is referred to as the Omega Facelift. It addresses concerns of the jaw and neck line, as does the traditional facelift, however the incisions are less and the results are more dramatic. It can also improve wrinkling in the corners of the mouth. We have many satisfied patients who have undergone this procedure and we have made this technique routine when performing a facelift.

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Endoscopic Facial Rejuvenation

An endoscopic facelift is the medical name for an improved plastic surgical technique that provides facial rejuvenation with minimal scars. Endoscopy is a surgical technique that may prevent the need for long incisions, may allow faster healing, and results in fewer side effects than traditional techniques.

Endoscopic techniques were first developed for use in general surgery, gynecology, and orthopedic surgery, but has found successful applications in plastic and cosmetic surgical procedures.

To perform a traditional brow and facelift, a surgeon made incisions from ear to ear on top of the head, and around the ear to the posterior neck. Endoscopic techniques are now preferred by many surgeons, as it requires fewer, smaller incisions, thereby reducing the amount of scarring. Using a slender, wand-like tube with a fiber-optic camera attached, Dr. Parrish can lift and re-position various areas of the body through use of these smaller incisions. The endoscopic technique generally requires less recovery time and provides more natural-looking results than standard facelift procedures.

Another advantage of endoscopic brow and facelifting is that it allows our surgeons to successfully treat areas that were difficult to improve with traditional facelifting. This generally includes the central third of your face, extending from the center of your brows, to the frown lines and folds adjacent to your nose and mouth (the nasolabial folds). Using the endoscope, the surgeon can lift and re-position the mid-facial tissues at the deep layer (the periosteal layer), just above the cheekbone. For this reason, the procedure is also called an endoscopic subperiosteal facelift. In this way, the whole sagging cheek can be lifted in a more vertical direction, helping smooth the nasolabial fold and enhancing the volume of the upper cheeks, resulting in a more natural, youthful look.

The subperiosteal facelift seems to provide a longer lasting cosmetic result than traditional procedures. With these techniques in the hands of experts, the average years of rejuvenation obtained may be double than that obtained with traditional facelifts.

The younger looks achieved by the subperiosteal facelift occur because the surgeon can work directly under the tissues and muscles that are sagging. The surgeon can tighten these tissues by pulling them upward, outward, or by re-positioning them. (The standard techniques, on the other hand, work only with skin, which is pulled out toward the ear.)

Few complications have been reported after an endoscopic facelift. The surgeon operates under the deep layers of the face, decreasing the risk of nerve damage. Only a few, small incisions may be required; this reduces the risk of infection, scarring, numbness and hair loss. Complications that occur after surgery, such as numbness and hair loss, are temporary and usually are resolved within a few weeks or months.

You may elect to have a partial, semi-complete or complete facelift. This will depend on your aging characteristics and what your desired goals are. For some patients, our surgeons may advise a combination of endoscopic techniques with traditional methods to remove excess and sagging skin.

If your goals are to have your brow raised, to soften the horizontal creases in your forehead, and to erase your frowning lines, the endoscopic technique is recommended. Our surgeons start the surgical process by making 3-5 small incisions (less than 1" in length) in your scalp above the hairline. Next, a fiber-optic tube connected to a microscopic camera is inserted through one of the incisions. The camera relays the image to a video monitor, allowing the surgeon to view the surgical area. Then through the other incisions, the surgeon will place small, surgical instruments under your scalp and forehead and use them to remove the unwanted frowning muscles and to reposition your brow.

The mid-face is similarly addressed through an incision in the scalp at the temporal area and through an intra-oral incision. The entire cheek is lifted off of the bone and lifted upward to reposition sagging in the upper and lower cheek and help re-distribute fullness to the upper cheek and lower eyelid area.

To treat the chin and neck area, incisions are placed under your chin and behind each ear. Through these incisions, your sagging chin is repositioned, the excessive fat from your neck is removed, the loose muscle of the neck is tightened and your entire neck is re-contoured. The results? A slimmer look with a better angle, giving you a more defined neck and a more youthful appearance.

Once the procedure is performed, the surgeon closes the small incisions with sutures or surgical staples, then covers the area(s) with dressings. The dressings may be removed after several days; the sutures and staples, after 5-7 days. In many cases, small surgical posts are used to stabilize the elevated forehead and brow. These posts are removed 5-10 days later.

Endoscopic facial procedures are usually performed at our accredited surgical center. The procedure(s) may take 4-7 hours, and will depend on the procedure(s) performed. You must arrange for a caregiver (a friend or family member) to drive you home. Older patients or those who have had extensive surgery may need more time and/or monitoring to recover. If needed, we can arrange for a Nurse's Aide to come to your home or motel room.

Not all women and men are ideal candidates for endoscopic facelifts. As mentioned above, those with excessive, sagging skin may require a combined technique. (Some patients may feel the youthful change produced by a subperiosteal facelift will be too dramatic for them, and opt for standard techniques.)

Patients with heart disease, uncontrolled high blood pressure, or diabetes may be poor candidates for surgery. As with other types of cosmetic surgery, patients who smoke should stop smoking for several weeks before the surgery.

The majority of the swelling disappears within several weeks and patients may return to most activities within two weeks of surgery. In older patients or patients with heavy faces, the swelling may be prolonged slightly. Although you will usually look and feel great within days of surgery, it may take a few months for the re-positioned tissues to lose all their swelling and for all the areas to heal completely.

Our computer video imaging system can help show you what is realistically possible with facial cosmetic surgery. We are happy to provide this useful tool to you on a complimentary basis.

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Facial Fat Injections

Facial fat injections help decrease frown lines and wrinkles and can be used to add fullness to the lips. This procedure takes approximately 1-1/2 to 2 hours and is performed at our accredited surgical center under local anesthesia with sedation. It can be done as a single procedure or in conjunction with other procedures.

Fat injections are most often used to fill in “sunken” cheeks or laugh lines between the nose and mouth, to correct skin depressions or indentations, to minimize forehead wrinkles, and to increase lip fullness. Repeat treatments of an area may be required. Fat injection involves extracting fat cells from the patient's abdomen, thighs, buttocks or elsewhere and re-injecting the fats cells beneath the facial skin.

After both the donor and recipient sites are cleansed and treated with a local anesthesia, the fat is removed from the donor site through the use of liposuction. The donor site is typically an area where there is excess fat, usually the abdominal area. The fat is then prepared and re-injected to the areas to be treated. At times, an adhesive bandage is applied over the injection site.

“Overfilling” is necessary to allow for fat absorption in the weeks following treatment. When fat is used to fill sunken cheeks or to correct areas on the face other than lines, this over-correction of newly injected fat may temporarily make the face appear abnormally puffed out or swollen.

If a larger area is treated, you may be advised to curtail your activity for a brief time following the procedure. Most patients are able to resume normal activity soon after. You can expect some swelling, bruising or redness in both the donor and recipient sites. The severity of these symptoms will depend upon the size and location of the treated areas. You should stay out of the sun until the redness and bruising subsides - usually about 48 hours. In the meantime, you should use makeup with sunblock protection to help conceal your condition.

The effects of the fat injections vary significantly from patient to patient. Though some patients have reported results lasting a year or more, the majority of patients find that at least half of the injected fullness disappears within 3-6 months. Therefore, repeated injections may be necessary. Dr. Parrish will advise you on how to maintain your results with repeat treatments.

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Facial Implants

Submalar augmentation is a surgical procedure where a silicone implant is inserted in the cheek area to give a more youthful appearance to the face. Through the use of cheek implants, the facial contour is enhanced by elevating and repositioning sagging skin. The procedure takes approximately one hour. The implant is usually inserted by making an incision inside the mouth. Implants are placed in a pocket between the cheek bones and overlying soft tissue. After surgery, a dressing will be applied to minimize discomfort and swelling. The severity and duration of such side effects may vary, especially if another cosmetic procedure was performed at the same time.

Chin augmentation (mentoplasty) can create a more pleasing profile by strengthening the chin. This creates a better balance with the rest of the face. The implant is placed in a pocket between the bone and overlying soft tissue. It is placed through the incision in the mouth. Usually, the chin is taped after surgery to minimize swelling and discomfort. When an intra-oral incision is used, the sutures will dissolve.

This procedure can be performed at our accredited surgical center under local anesthesia with sedation or under general anesthesia and may be performed as a single procedure or in conjunction with other facial cosmetic surgeries. Most people return to work in approximately 1 week.

Remember, with any facial surgery, you may feel and look better in a short period of time. However, it may not be advisable to participate in certain activities - especially activity that may result in the face being jarred or bumped - for several weeks. It's best to check with your plastic surgeon about such matters.

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Laser Resurfacing

In our office we have both carbon dioxide and erbium lasers available for skin resurfacing type procedures.

Our Sciton Profile erbium Laser provides a less invasive treatment with minimal down time and less discomfort post treatment. The erbium laser skin resurfacing helps remove superficial and moderately deep lines and wrinkles. The healing is usually complete within a week. Makeup can be applied at that time. The disadvantage of erbium laser treatments is that often more than one treatment and up to three treatments are required to obtain the optimum results.

Carbon dioxide lasers in general are a deeper treatment and the healing time is slightly longer. Makeup is needed to cover the pinkness for up to a month or so. Carbon dioxide lasers can treat skin with moderate to severe wrinkling. The benefit is that only one treatment is needed to obtain the best results. With both treatments soaks and ointment are used until the healing is complete and sun block is a must.

Both of the above laser treatments require training, skill, and a licensed professional doing the treatments. These treatments are usually perfomed under local anesthesia and often sedation is recommended for the deeper laser treatments.

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Surgery of the Nose

Rhinoplasty helps improve the general cosmetic appearance of the patient by reducing, re-contouring or re-shaping the external nose. Patients should note that there are many irregularities in a normal nose underneath the skin. It is unusual for a nose to be exactly in the center of the face, and for the nostrils to be the same shape and size. These irregularities will persist after corrective surgery.

Some patients are concerned that the nasal change will be so great as to create a subject of discussion among family and friends. In most cases, neither the patient nor the patient's friends and relatives will remember the shape of the nose a few weeks following surgery. Patients are warned that others may not acknowledge a patient's improved appearance, or that these people may disappoint the patient by making an unrestrained comment such as, “I liked your nose better the way it was before”, or “I didn't see anything wrong with your nose.” These remarks may be made by envious “friends” or relatives. Keep in mind that when most people look at others, they look at them in a general sense. So, your changed nose may not be noticed by some people, or your improved appearance may be attributed to other causes.

Rhinoplasty is one of the most common and popular surgeries performed by plastic surgeons today. Although your wishes will be taken into consideration, trust the judgment of your plastic surgeon, as they know what is realistically possible. They will determine facial contour changes, what will suit each face best, and what is practical from a surgical point of view. If the nasal air passages are blocked (deviated septum, etc.), repair can be carried out at the same time with the same anesthetic.

Surgical results cannot be exactly predicted and the healing time will vary from person to person. The skilled plastic surgeon aims for a particular result, and in most cases, the final result is very close. In some instances, a secondary minor procedure may be done, at your surgeon's suggestion (a small, additional fee is charged for this). In general, though , the operation is very reliable and most patients have an uneventful surgery and convalescence, and are very pleased with the results.

The surgery is performed on-site at our center or at the hospital. A local anesthetic with sedation or general anesthesia is used. The surgery takes about two hours. The patient remains in the recovery room until sedation wears off, usually about an hour. If your surgery is done at our center, you would go home after recovery then return to our office the following morning for a check-up.

The incisions for reducing or re-contouring the external nose are made from inside the nose or through a small incision on the columella, the divider between the nostrils. The nasal skin is lifted away from the cartilage and bone, and the excess bony and cartilaginous tissue is removed. The cartilage of the tip of the nose may be altered if necessary. Occasionally, the nose is shortened to adapt to the new contour. Such surgical procedures are necessary to re-form the nose to the desired contour. The excessive skin left by the reduction of the underlying bone and cartilage is elastic and generally re-adapts itself to the framework. This is more rapid and complete in the younger patient.

The eyelids may be discolored and swollen for a period of 7 to 14 days. This depends on the patient's skin type, their age, and their healing ability. At times, the whites of the eyes will be bloodshot, and this may take longer to fade.

Although the major effect of nasal surgery will be noted in approximately 10 days, one may expect additional minor changes to occur over a period of 4 to 12 months. This amount of time is dependent on the patient's age, skin type, and their healing ability. These latter changes are sometimes so gradual that the patient is not aware of them. The older the patient, the longer the residual swelling remains.

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