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04 Aug What is collagen? What does collagen do?

Collagen is the most abundant protein in the human body and is the substance that holds the whole body together. It is found in the bones, muscles, skin and tendons, where it forms a scaffold to provide strength and structure.

Endogenously produced collagen (i.e. collagen synthesised by the body) plays numerous important roles in health, with the breakdown and depletion of the body’s natural collagen associated with a number of health problems. As such, exogenous (supplemental) collagen is increasingly used for medical and cosmetic purposes, including to help with healing and repair of the body’s tissues.

What is collagen?

Collagen is a hard, insoluble and fibrous protein that makes up one-third of the protein in the human body.  In the majority of collagens, the molecules are packed together to form very similar long thin fibrils.

According to MediLexicon, collagen comprises a family of genetically distinct molecules, all of which have a unique triple helix configuration of three polypeptide subunits known as alpha-chains.

Each chain contains around 1,000 amino acids, and usually features an amino acid sequence consisting of glycine, proline and hydroxyproline.

There are numerous different types of collagen, at least 16 types, but 80-90% of collagens in the body belong to types I, II and III. The collagens in the human body are strong and flexible. Type I collagen fibrils are particularly tensile, and are stronger than steel, gram for gram.

Collagen and the body

Collagen is most commonly found in the skin, bones and connective tissue within the body, providing structural support, strength and a degree of elasticity (in combination with elastin). In particular, collagens can be found in the extracellular matrix – an intricate network of macromolecules that determine the physical properties of body tissues.

In the middle layer of the skin – the dermis – collagen helps form a fibrous network, upon which new cells can grow. Collagen is also required in the replacement and restoration of dead skin cells. Some collagens also function as protective coverings for delicate organs in the body such as the kidneys.

Collagen production naturally declines with age, reducing the structural integrity of the skin and leading to sagging skin, the formation of lines and wrinkles and the weakening of cartilage in joints.

Collagen is secreted by a variety of different cells, but primarily by connective tissue cells. While young, the body consistently produces collagen, but collagen synthesis begins to decline around the age of 40, with a dramatic reduction in synthesis in women after menopause. By the age of 60 there is typically a considerable decline in collagen production.

Medical uses of collagen

Collagen is resorbable (can be broken down and assimilated by the body), is functionally diverse and is naturally occurring. This means that collagen has several different medical applications and can be used with a variety of medical devices. In addition, it can be formed into compacted solids or lattice-like gels when being prepared for use, making it clinically versatile.

Collagen that is used medically can originate from human, bovine, porcine and ovine sources.

Skin fillers

Injections of collagen can improve the contours of the skin and fill out depressions. Collagen can be used cosmetically to remove various lines and wrinkles from the face, as well as scarring (including acne), so long as the scars do not have a sharp edge.

Collagen fillers can originate from human and bovine sources. Use of injected collagen can be restricted in people with severe allergies, and skin tests are typically required before bovine collagen is used.

Collagen is used to fill relatively superficial defects. More extensive defects are usually filled with substances such as fat, silicone or implants.

Wound dressing

Within wound healing, collagen attracts new skin cells to the wound site, promotes healing and provides a platform for the growth of new tissue. Collagen dressings are therefore used in order to aid the healing of certain types of wound, including:

  • Chronic non-healing wounds
  • Exuding wounds
  • Granulating or necrotic wounds
  • Partial and full-thickness wounds
  • Second-degree burns
  • Sites of skin donation and skin grafts.

It is advised that collagen dressings are not used for third-degree burns, wounds covered in dry eschar or with patients who may be sensitive to bovine products.

Guided tissue regeneration

Collagen-based membranes have been used in periodontal and implant therapy to promote the growth of specific types of cell. In oral surgery, barriers can be used to prevent fast-growing cells of the gingival epithelium migrating to a wound in a tooth, preserving space there for tooth cells to potentially regenerate.

The benefit of using collagen-based membranes for this purpose, in addition to collagen’s healing qualities, is that they can be made to be resorbable (the body breaks down the collagen and assimilates the protein over time). This means that patients do not require a second surgical procedure to have the barrier removed.

Vascular prosthetics

Collagen tissue grafts from donors have been used in peripheral nerve regeneration and vascular prostheses, used in arterial reconstruction. Certain prostheses have been found to be thrombogenic – causing coagulation of the blood – but at the same time, compatible with the body of the host.

Treatment of osteoarthritis

Collagen supplements or formulations may be beneficial in the treatment of osteoarthritis. In a number of trials, they have been found to provide some degree of pain reduction. However, in other trials, use of collagen supplements and formulations has not been found to result in any additional benefit.

A 2006 review found that collagen hydrolysate helped to significantly decrease painful symptoms of osteoarthritis while improving joint function. The supplement was well absorbed, led to collagen accumulation in cartilage, and helped to stimulate specialized cells in the joints called chondrocytes to create extracellular matrix.

Skin revitalization

Many products containing collagen, including creams and powders, claim to revitalize the skin. However, despite the marketing of these products as ways to increase the levels of collagen within the body, collagen molecules themselves are too big to be absorbed through the skin.

The benefits of these products, where they exist, are most likely attributable to their moisturizing effects, but they do not strengthen the skin or directly increase collagen concentration in the skin. Such over-the-counter treatments are also not classified as drugs, meaning that there is no requirement for scientific validation of the claims made regarding their efficacy.

Increasing collagen production

The growth of collagen, elastin, and melanin can all be stimulated through laser therapy, involving intense wavelengths of light. This method can be used in the treatment of stretch marks.

Collagen, like all proteins, is made up of amino acids. Of these amino acids, nine are considered essential, i.e. they cannot be synthesized by the body and must be acquired through the diet.

Other nutrients that may support collagen formation include:

  • Proline: found in egg whites, meat, cheese, soy and cabbage
  • Anthocyanidins: found in blackberries, blueberries, cherries and raspberries
  • Vitamin C: found in oranges, strawberries, peppers and broccoli
  • Copper: can be found in shellfish, nuts, red meat and some drinking water
  • Vitamin A: found in animal-derived foods and in plant foods as beta-carotene

What damages collagen?

There are a number of factors that can deplete the levels of collagen found within the body. Avoiding the following could keep the skin healthy for longer:

  • High sugar consumption: a diet high in sugar increases the rate of glycation, a process whereby sugar in the blood attaches to proteins to form new molecules called advanced glycation end products (AGEs). AGEs damage adjacent proteins and can make collagen dry, brittle, and weak.
  • Smoking: many of the chemicals present in tobacco smoke damage both collagen and elastin in the skin. Nicotine also narrows the blood vessels in the outer layers of the skin, which reduces the delivery of nutrients and oxygen to the skin, compromising skin health.
  • Sunlight: Ultraviolet rays in sunlight cause collagen to break down at an increased rate, damaging collagen fibers and inducing the accumulation of abnormal elastin. Abnormal elastin leads to the production of an enzyme that can also break down collagen. This process can lead to the formation of solar scars.
  • Autoimmune disorders: Some autoimmune disorders cause antibodies to target collagen. Mutations to the genes responsible for the coding of collagen alpha-chains can affect the extracellular matrix, leading to a decrease in the amount of collagen secreted, or to the secretion of dysfunctional mutant collagen.

Collagen levels deplete naturally over time and there is no way to prevent this intrinsic aging. However, by taking precautionary measures, it is possible to reduce extrinsic aging and protect collagen, keeping the skin, bones, muscles and joints healthy for longer.

If you are curious about collagen, please contact Sieveking Plastic Surgery in Nashville, Tennessee to schedule a consultation.




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15 Jul Are you a good candidate for Botox Treatment

Botox® Cosmetic (Botulinum toxin) candidates in Nashville, TN?

Smiling, frowning, squinting, and even chewing – basically any facial movement – can eventually lead to one of the most common signs of aging: wrinkles. They can make you appear tired or even angry when you are not. One of the quickest and safest remedies to remove wrinkles is an injection of botulinum toxin type A – Botox.

Botox® Cosmetic (Botulinum toxin) can be combined with other cosmetic skin procedures – such as chemical peels, dermal fillers, or microdermabrasion – to further improve your results. This combination of therapies can even help to prevent the formation of new lines and wrinkles.

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01 Jul Botox – a Minimally Invasive Procedure

What is botulinum toxin type A?

Botulinum toxin (BOTOX) is a purified substance that’s derived from bacteria.  Commonly known types of botulinum toxin type A injections include Botox and Dysport.

Injections of botulinum toxin blocks muscular nerve signals, which then weakens the muscle so it can’t contract. The end result is diminished unwanted facial wrinkles.

Botox injections can be used to help smooth:

  • Crow’s feet
  • Forehead furrows
  • Frown lines
  • Skin bands on the neck

Photos of Botox injection results.

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Contact Dr. Nicholas Sieveking

If you would like more information on BOTOX Cosmetic treatment, or if you would like to schedule a consultation to talk more about your options, please contact Dr. Nicholas Sieveking in Nashville, Tennessee today.

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26 Jun Botox Treatment Questions

Questions to ask my Nashville, TN plastic surgeon about Botox Treatment

Use this checklist as a guide during your botulinum toxin (Botox) consultation:

  • Are you certified by the American Board of Plastic Surgery?
  • Were you specifically trained in the field of plastic surgery?
  • Is the office-based surgical facility accredited by a nationally- or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
  • Am I a good candidate for botulinum toxin?
  • What will be expected of me to get the best results?
  • Who will perform the botulinum toxin injections?
  • Have they been specifically trained in this procedure?
  • Where and how will you perform my procedure or treatment?
  • How long of a recovery period can I expect?
  • What are the risks and possible complications associated with my procedure?
  • How can I expect to look over time?
  • Do you have before-and-after photos I can look at for this procedure
  • What results are reasonable for me?

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24 Jun Cosmetic Surgery is Real Surgery

Cosmetic Surgery is Real Surgery. Do it Right the First Time. Find a Surgeon You Can Trust.

We’ve seen a rise in the number of people traveling abroad to have plastic surgery. The cheaper costs may be tempting, but consider the risks. Download our free white paper on the dangers of medical tourism and get the facts from a trusted source. Plastic surgery is best performed by a qualified board-certified plastic surgeon. Use our free Find a Surgeon tool to find an ASPS Member Surgeon near you.

5 Things You Should Know About Plastic Surgery Tourism

1. Cosmetic surgery is real surgery and has some risks

Every surgery, including cosmetic surgery, has some risks involved. These risks may increase during vacation-related plastic surgery.

2. Vacation-related activities may compromise your health after having a procedure

Cosmetic surgery trips are marketed as vacations, but vacation activities should be avoided after surgery in order to ensure proper healing and reduce the risk of complications.

3. Travel + surgery significantly increases risk of complications

Did you know that long flights or surgery can increase the potential risk of developing pulmonary embolism and blood clots?

4. You may not be legally protected in the U.S.

There are no U.S. laws that protect patients or mandate the training and qualifications of physicians who perform plastic surgery outside the United States. There may be no legal recourse if surgical negligence occurs.

5. Bargain surgery may not be a bargain

Patients can incur additional costs for revision surgeries and complications that may total more than the cost of the initial operation if originally performed in the U.S.

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10 Jun All Botox solutions are not the same – Nashville’s best can help

Botox injections are the most popular cosmetic procedure performed worldwide.

Millions of patients are injected each year with the wrinkle fighting drug – Botox.

Its popularity is attributed to:

  • There is minimal downtime – 15 minutes of bumps from the Botox injection
  • The procedure is highly effective in improving wrinkles
  • Discomfort is usually minimal
  • Side effects are few and rare
  • Cost is fairly reasonably, but depends on how many areas are done
  • The time it takes to get a treatment is less than 10 minutes

All patients will age differently, so what areas need treating for optimal cosmetic results needs to be tailored specifically to each patient.  A cookie cutter approach to every patient will not work.  There are several areas of the face which can be considered advanced:  lips, corners of mouth, neck, gummy smile, under eye, bunny lines, inner eyebrows which require a highly trained and experienced injector, or you will live with a disfiguring facial appearance for 3 months.

The trend is moving away from the frozen, no movement, very obviously treated face to a more natural appearance.  Rather than blasting and overwhelming the forehead with Botox, a technique using very small, precisionly placed aliquots that allows for movement but with diminished wrinkles.  This is a more difficult technique to master.

Shortcuts are often routine in regards to Botox injections.  A majority of practices will draw up syringes of Botox in the morning, or the day before, by a nurse, medical assistant, or office staff.  That means the patient will need to get injected in multiples of what is contained in a syringe, leading to limited customization.  Also, errors in dilution and sterile technique are possible when filling the syringes is not done by the same person that is injecting the Botox.  (Botox comes in a powder form and needs to have saline added to reconstitute it to become an injectable solution.)

Discomfort related to Botox injections can be minimized using various techniques.  Using preserved saline has been shown to result in less pain than using regular saline.  Needle size, speed of injection, and using proper needle placement is also a key factor affecting comfort.  Certain areas require different dilutions to lead to maximal cosmetic benefits.

Touch ups to correct minor imperfections require an advanced injectors experience.  They also need a responsive provider, easily available for a drop in or work in patient.

Getting injected by an unknown provider at someone’s Botox party, is never a good idea, and almost always leads to problems that one has to live with for 3 months.  The “savings” are never worth it.

Although Botox injections are extremely popular, there are many people that are not pleased with their experience.  This is not the norm for the high volume, experienced injector in Nashville, Tennessee.  As explained above, there are many intricacies which can contribute to better results. Hopefully the public will understand that Botox should not be considered a routine cosmetic procedure, and they need to select their providers carefully.

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03 Jun Nashville TN – Sieveking Plastic Surgery can help treat Chronic Migraines with Botox

Treat Chronic Migraines with Botox Injections in Nashville, TN

Botox injections can relieve migraine headache symptoms for up to 3 months.

Did you know that Botox — famous for smoothing out wrinkles on the face — has been approved by the FDA to treat chronic migraine headaches in adults.

The FDA says Botox injections have been shown to be effective in the prevention of migraines, which are debilitating headaches that cause intense pulsing or throbbing pain and affect about 12% of Americans.

“Chronic migraine is one of the most disabling forms of headache,” Russell Katz, MD, of the FDA, says in a news release. “Patients with chronic migraines experience a headache more than 14 days of the month. This condition can greatly affect family, work, and social life, so it is important to have a variety of effective treatment options available.”

Migraine headaches are sometimes called “sick headaches” because they often are accompanied by nausea and sensitivity to light and sound.

Botox to treat chronic migraines is typically given at intervals of about 12 weeks as multiple Botox injections around the head and neck to try to dull future headache symptoms, the FDA says in a statement.

The FDA says it’s important that patients who suffer chronic migraines discuss with their doctors whether Botox is appropriate for them.

Allergan Inc., the maker of Botox, says in a statement that the FDA’s approval applies to people with chronic migraine, which it defines as a “distinct and severe neurological disorder characterized by patients who have a history of migraine and suffer from headaches on 15 or more days per month with headaches lasting four hours a day or longer.”

The company says that when treating chronic migraine, qualified medical specialists administer 31 Botox injections into seven specific head and neck sites.

It says that Botox, when injected at labeled doses in recommended areas, is expected to produce results lasting up to three months depending on the individual patient.

If you would like more information on BOTOX Cosmetic treatment, or if you would like to schedule a consultation to talk more about your options, please contact Dr. Nicholas Sieveking today – Nashville, Tennessee’s number-one Plastic Surgeon.

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29 May 5 Steps to Select the Best Plastic Surgeon

Advice on how to select a great plastic surgeon.

Make sure the surgeon is board-certified

This one, say experts, is a no-brainer. For plastic surgery, you want a doctor who’s certified by the American Board of Plastic Surgery. It’s simple: The American Board of Medical Specialties’ Web site will tell you if a doctor is board-certified in plastic surgery.

Why is it so important to have a board-certified surgeon? Because legally any doctor is permitted to do any procedure — a psychiatrist could do a breast augmentation. If you use a board-certified plastic surgeon, you know he or she has completed three to five years of training in general surgery and a minimum of two to three years of training in plastic surgery, plus they have to take written and oral tests, according to Dr. Jim Stuzin, chairman-elect of the American Board of Plastic Surgery and assistant clinical professor at the University of Miami.

Board-certified plastic surgeons also have to do continuing medical education and take a written test every 10 years.

Check the surgeon’s record

Many state licensing boards, like California’s, list malpractice judgments, plus any disciplinary actions by the board.

Ask if the surgeon has hospital privileges

Even if you’re having a plastic surgery procedure at an outpatient clinic, it’s worth asking where the doctor has hospital privileges, because hospitals do background checks, says Dr. Rod Rohrich, past president of the American Society of Plastic Surgeons. “If they don’t have hospital privileges, that’s a huge red flag,” he says.

Come armed with questions for the doctor

One crucial question for your potential surgeon is how often he or she does the procedure you’re interested in. “If I’m coming to you for a facelift, you’d better do it almost weekly,” says Rohrich, who’s also chairman of the department of plastic surgery at the University of Texas Southwestern Medical Center.

The Arizona Medical Board’s Web site has a list of questions you can print out and bring with you to the doctor’s office. For example, the medical board suggests asking whether the physician will be performing the procedure in its entirety.

Be wary of multiple procedures

“When you bundle procedures, the risk goes up,” says Stuzin, the plastic surgeon in Miami.

The more procedures you have, the more money the doctor makes. Dr. Grant Carlson, a plastic surgeon at Emory University School of Medicine, says an unethical surgeon might suggest a neck lift when someone has come in looking for just for a nose job. “Unfortunately, money is a motivation in some people.”

Perhaps the most valuable advice, Trobaugh says, is to be swayed only by objective information about the surgeon, and not by how the doctor makes you feel. “[Adams] truly sounded like he was going to help me. He seemed like he would be truly concerned about me,” she says.

“And there are no stupid questions when you’re about to alter yourself in some major way.”

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16 May Thermi Laser Treatment, is it worth it? General feedback and reviews from around the country

Thermi Laser – Skin Care Treatment in Nashville, TN

I Like my Photos Again – Plymouth Meeting, PA

For the past year or two, I have hated every picture I’ve been in. My neck/chin looked awful. I have been a patient of Dr. Allan Wulc’s in Philadelphia for years (fillers/Botox) but I wasn’t ready for surgery. He suggested an in office treatment he just started doing called ThermiTight. WOW.   Thank you.

40 Year Old Mom. In Good Shape, but Had Lax Skin in Jowls and Neck. – Scottsdale, AZ

I was given the opportunity to try ThermiTight for my neck and jowls. Wow!!! So far, I am only a little past a month post treatment and my “turkey neck” is almost gone. My jowls are tight against my jaw line now. I am told the 3 month mark is the WOW moment. I can’t imagine it even getting any better.  Its already amazing.

ThermiTight Took 10 Years off my Face & Neck.. – Raleigh, NC

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14 May Cosmetic Procedures to Cure Smile Lines

We all love to smile, but so-called ‘smile lines’, or nasolabial folds, can make us look sad and tired.

What are the best ways to treat smile lines – nasolabial folds?

Nose to mouth lines (also known as the nasolabial fold) run from the outside of the nostril to the corners of the mouth. They appear as we get older, as our cheek fat descends and we lose volume in our faces. These lines naturally look deeper when we smile, but if they stick around when our expression is serious, they can appear to drag our features down. That’s why many people look for a solution to restore a smoother, happier look.

One of the simplest options is to plump out fine lines by injecting them with a temporary hyaluronic dermal filler. If done carefully this fills in the crack and gives a fantastic effect. Less is more here, so look for a doctor who offers you a complimentary follow up appointment as part of your treatment.

Deeper folds are caused when the fat in the cheeks sags down to the nasolabial lines and the skin becomes less elastic with age. The result is that the skin and fat appear to droop around the mouth.

If the folds are more pronounced an alternative approach to injecting directly into the lines, is to use a thicker filler to restore volume to the cheeks. This pulls up the skin over the cheeks, so smile lines soften or disappear. Again, this needs a subtle approach. Do not be tempted by permanent fillers as they are much more likely to cause complications. Results from fillers can last from six months to a year.

For folds with overhanging sagging that fillers can’t fix, or if you want a more permanent solution, a facelift or mid-facelift is a good approach.  This replaces the cheek tissue into its youthful position and tightens loose skin. It will leave scars in the crease where the ear meets the face, behind the ear and into the hairline. But in the hands of a skilled and experienced surgeon can create a beautiful result.


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