Will wrinkle reducers make me look unnatural?

Posted December 6th, 2019 by Social Media and filed in Botox, Facial Injectables, Facial Injections, Skin Tightening, Wrinkle Reduction, Wrinkle Treatment

Aesthetic injecting is both a medical procedure and a form of art.  If you choose someone who is not trained, experienced and careful, it is possible for an undesirable result.  It is very important to not only understand anatomy but also the aging process. A good injector will know how and why the face changes over time as well as where and how much to inject to achieve a natural, youthful look. We all have seen the “overdone” person walking around who cannot move their face due to too much product being used. If you have a quality, experienced injector, it is possible to reduce movement and wrinkles without completely paralyzing the muscle. It is my goal for my patients to leave looking refreshed and with expression.  Sometimes this may mean a couple of visits to build the look over time so that it is a more natural process than a quick fix. 

Don’t be afraid of your result. We will work with you and help you achieve a natural, refreshed look that is not overdone or frozen.  Call today to schedule your complimentary consultation. 248-524-0620. 

Kristen Lotz, PA-C

What is carpal tunnel syndrome and how is it treated?

carpal tunnel

As a plastic surgeon, I have the opportunity to operate on several areas of the body.  Our hands are vital to our everyday life and I enjoy being able to restore their function by performing carpal tunnel and trigger finger surgeries.   The carpal tunnel is a space in the wrist that various tendons and the median nerve pass through in order to reach the hand. The median nerve has several functions, including providing sensation or feeling to the thumb, index, middle, and half of the ring finger as well as providing supply to the muscles at the base of the thumb. Sometimes swelling can occur in this space, which compresses the nerve and can cause symptoms of numbness and weakness in the hand. These symptoms can be permanent if not treated early.  

There are various treatments for carpal tunnel syndrome depending on your symptoms and their duration. The simplest treatment is to wear nighttime splints to help prevent compression on the nerve.  Another potential treatment option is a steroid injection into the carpal tunnel. Lastly, a surgical procedure called a carpal tunnel release, could be considered. 

The surgery takes approximately 15 minutes and is performed as outpatient. The surgery involves making an incision approximately 3 cm long in the palm near the wrist and dividing the ligament of the carpal tunnel, which relieves the pressure on the nerve. You are typically able to use your hand for light activities (such as typing) in a few days and will have near full use of your hand after four weeks. .   As a plastic surgeon I have training in advanced reconstructive techniques, including hand surgery, and focus on suturing techniques that minimize scarring.

This surgery is usually covered by most insurance companies.  Call me today to schedule your consultation at our office located in Troy, Michigan.  248-524-0620. 

Dr. Sarah Elswick 

Plastic, Reconstructive and Aesthetic Surgery

Holiday aesthetic timeline, Look your best this holiday season.

Posted December 3rd, 2019 by Social Media and filed in Dermal Fillers, Facial Injectables, Plastic Surgery Troy MI

You want to look your best with dewy skin that looks refreshed and we want to help you achieve this.  Aesthetic surgery just before an event is not a great idea but great skin care combined with wrinkle relaxation and filler and a little TLC can provide that bright eyed glowing look.

Late November, Early December 4 weeks out

This is the perfect time to get your Aesthetic Injections. Wrinkle relaxers and dermal fillers work on different timelines.  They can be done on the same day or separately depending on your goals. 

  • Wrinkle relaxers such as Botox® and Dysport® do not begin to take effect until 3-5 days after your injection and usually peak in two weeks.  They typically last 3 to 4 months, therefore, it is important to get this done early in the month to ensure the product is active and your wrinkles are smooth before your party.
  • Dermal fillers such as Restylane® and Juvederm®, results are instant. This gives you the look you want to achieve the same day. However, there is a real possibility that you may bruise or experience swelling. Therefore, we recommend at least 2-4 weeks before your big event.  The move time the better. This also allows for time to tweak or make adjustments if desired.

Early to Mid-December 1 to 2 weeks out

A spa facial can give your skin tone and texture that boost it needs to have it glow. Our qualified aestheticians will recommend the treatment that is best for your skin. My recommendation is to NOT start a new skin care regimen or any aggressive treatment this close to the event.

 Some safe options may be. 

  • A deep pore cleansing facial or mild chemical peel would help to eliminate congestion and brighten dull skin. 
  • A dermaplane would remove the dead skin cells and peach fuzz. 
  • An OxyGeno facial to exfoliate, infuse and oxygenate your skin. 

Late December or a few days before your event

Schedule a manicure and pedicure. With a focus on personalized, private care, our nail treatments are designed for you. From long-lasting polishes to relaxing hand and foot massages to comforting paraffin wax treatments, your hand and feet will be pampered and give you some relaxation time during this busy season.  

Put your best self forward with this aesthetic timeline. Selfies and candid snap shots aren’t just for celebrities. You’ll want to look your best at the celebrations and the memories created. Be prepared and your will be “camera ready”.  Call today to schedule your appointments

Aesthetic Injections, Michael J. Schenden MD PC & Aesthetic Injection Practice 248-524-0620

Facials & Nails, Schenden’s Medical Day Spa 248-524-3622

Raquel Merlini, RN & Aesthetician

What are the types of skin cancer and why should a plastic surgeon treat them?

There are numerous types of skin cancer but the most common types include Basal Cell Cancer (usually a pearly bump on the skin with an associated blood vessel), Squamous Cell Cancer (usually has a flaky appearance), and Melanoma (usually a brown/black spot with irregular edges).  These definitions are general and not all encompassing. Most skin cancer is associated with excess sun exposure.

Skin cancer lesions can be identified based on the acronym ABCDE:


Border irregularity 

Color that is not uniform 

Diameter greater than 6 mm

 Evolving or changing  

Skin cancers are usually diagnosed by a primary care physician or dermatologist through a biopsy. In addition you should always do self-check and monitor any suspicious moles.

If your biopsy shows skin cancer, you will usually require excision of the lesion to ensure it has been adequately removed.  Sometimes, you may wish to have a plastic surgeon remove the skin cancer or perform the reconstruction after the cancer has been removed, especially if it is in a cosmetically sensitive location.  Plastic surgeons have training in advanced reconstructive techniques, including skin graft and flaps (or re-arrangement of your own tissues) and focus on suturing techniques that minimize scarring.

Having a cancerous lesion can be scary but the removal of one doesn’t have to be. Dr. Elswick performs skin cancer lesion removal at our office located in Troy, Michigan. She accepts most insurance companies.  Call today to set up your appointment 248-524-0620.  

Dr. Sarah Elswick

Plastic, Reconstructive and Aesthetic Surgery

What is Hyaluronic Acid?

Posted November 6th, 2019 by Social Media and filed in Uncategorized

Hyaluronic Acid is a clear, gel-like substance that is naturally produced in our bodies.   It acts like a sponge holding 1000 times its weight in water. Large amounts are found in our skin, connective tissue (joints) and eyes.  Its main function is to bind water and keep our tissues well hydrated, lubricated and moist. As we age, our bodies produce less HA. So along with the natural aging process and exposure to the elements such as UV rays, smoke and pollution, we have less and less HA in our bodies as we get older.  Less HA in our skin means less moisture and more lines, creases and wrinkles.  

Fortunately, we have access to many over the counter products that contain HA.  We can apply the serums and lotions topically to retain moisture in our skin. It is recommended that we use products that contain at least 1% HA in serums or lotions.  HA is also available to take orally, 100-200mg per day is the recommended dose.  

Here at the office, I have the ability to offer my patients Hyaluronic Acid injected into the dermis of the skin to smooth wrinkles, fill creases, and add overall volume to the face in the areas that we lose volume with age.  Juvederm® and Restylane® are the products that we use most frequently for this. They each have a full line of fillers that are developed for various areas of the face and can last anywhere between 9 months and 2 years. They are very effective in replacing the HA that we have lost with age.  We can use them to fill increases that have become deeper with time or we can use them to create volume in areas that we would like enhanced such as the lips, cheek bones or jawline.  

The great news is that these products are extremely safe as we already produce this molecule in our body.  Allergic reactions are extremely rare. We also have an enzyme that is safely injected to dissolve the HA filler if we do not like the result or have an adverse event.  HA fillers are eventually absorbed safely by the body which is why they only last for a certain amount of time.  

We offer complimentary consultation on all our Aesthetic fillers.  Call today to see if Hyaluronic Acid fillers are the right product you! 248-524-0620

Kristen Lotz, PA-C

Aesthetic Injector

How is fat grafting used in Breast Reconstruction Surgery? 


Fat grafting is a way to transfer fat cells from one part of the body to another part of the body, in this case to the breasts.  The fat is collected via liposuction, processed, and then injected into the desired location. The fat can be harvested from any area with excess or undesirable fat.  Typical locations include the abdomen, flanks or love handles, and inner thighs and knees.


The fat can be utilized in multiple different ways.  First and foremost it is used to smooth out any contour irregularities or asymmetries in the breasts.  Similarly, it can be used to camouflage the edges of the implant or improve the appearance of rippling from the implant.  Fat grafting can also be used to enhance the volume of the breast, either by itself or in combination with an implant. If a large volume of fat is required, multiple fat grafting surgeries may be required.  It is possible to create a breast entirely with fat grafting depending on the amount of fat you have available and the size of breast you desire. Fat grafting can also be utilized to improve contour irregularities associated with lumpectomies.


Fat grafting is done at second stage or revisional procedures, not at the time of mastectomy. Usually fat grafting is performed in conjunction with other procedures so the length of the procedure depends upon what other procedures are being done.  In general, fat grafting takes anywhere from 45 minutes to 1.5 hours.


Dr. Elswick performs fat grafting in breast reconstruction cases as well as cosmetic surgeries. It provides beautiful natural results and is appealing to the individual who wishes to use their own body tissues to rebuild and restore their body. Call today to schedule your consultation.  248-524-0620


Dr. Sarah Elswick

Plastic, Reconstruction and Aesthetic Surgery :


What is Goldilocks Breast Reconstruction?


Traditionally Goldilocks Breast Reconstruction was used to describe a type of breast reconstruction where the skin and fat left after a mastectomy was rearranged in such a way to create a breast.  The tissue from the lateral breast and chest wall can also be recruited to provide additional volume. This technique works well in women with large breasts who want smaller breasts postoperatively and fits the adage of “not too big, not too small, but just right” – Goldilocks and the Three Bears story.


There are multiple applications of Goldilocks Reconstruction:

  • The reconstruction can be performed in the traditional aspect, rearranging the patient’s own tissues to create a new, smaller breast.  If desired, the patient can undergo one or more episodes of fat grafting to enhance the size or shape of the breast.
  • The reconstruction can be performed in combination with a tissue expander and/or implant for women with large, droopy breasts desiring better breast shape with a more youthful and “perky” appearance.
  • The reconstruction can be performed in patients who do not want reconstruction but want to limit or prevent the concavity that can be caused by a mastectomy.


This surgery is done at the same time as the mastectomy.  The surgery usually takes 1.5-2 hours depending on whether you are having single or double mastectomies.  This is in addition to the time it takes to complete the mastectomy. Patients are usually hospitalized for one night after a mastectomy with Goldilocks Reconstruction.


During the consultation I will evaluate your specific case and present all the options that are available to you.  We are committed to helping you close the loop on breast cancer and have confidence to move forward. Call today to schedule your consultation. 248-524-0620.


Dr. Sarah Elswick, MD

Plastic, Reconstructive and Aesthetic Surgery 

Considering facial fillers? Don’t forget your Chin!


Our chin is an area that we don’t often think about when we are talking about aesthetic injections like Botox® and filler but it should be.  As we age the mentalis muscle can become hyperactive creating a dimpled, pebbly, orange peel (peau d’orange) look to the chin. It can also begin to turn the chin downward.  Injecting Botox into the mentalis muscle relaxes the muscle smoothing out the skin on the chin and releasing the chin back upward for a more balanced look to the face.  

Some people just genetically have a “weak chin”.  This is when the lower jaw is either less developed or less projecting compared to the upper jaw.  This creates an unfavorable or unbalanced facial appearance. Injecting dermal fillers can really enhance the chin and change the overall appearance and balance to the face and jawline.  Juvederm Voluma® is a very cohesive filler that creates volume and lasts up to two years. It is a great choice for this area of the face.  

In some cases we cannot create enough volume to balance the appearance of the upper and lower jaw with filler.  For these people, surgery is an option. There are several silicone chin implants that can be permanently placed by Dr. Schenden or Dr. Elswick in our surgical suite.   This surgery is called genioplasty.  

Call to schedule a complimentary consultation with me to see which the right procedure is for you.   248-524-0620

Kristen Lotz, PA-C

Aesthetic Injector

What is direct to implant breast reconstruction surgery?

Knowing your surgery options for breast reconstruction is critical for making the right decision.  This week I want to talk about direct to implant reconstruction. In direct to implant surgery the permanent implant is placed at the time of mastectomy, avoiding the need for a tissue expander.  This surgery is also referred to as “single stage” breast reconstruction. I prefer, however, not use this term due to the fact that many women still require a revisional surgery to optimize breast shape, scars, or symmetry.

Candidates for direct to implant reconstruction include women with small to moderate size breasts that want to have the same breast size or smaller breast size post-operatively.  Large implants can cause strain on the breast skin after the mastectomy which may lead to implant failure. As the reconstructive surgeon I would closely with your breast surgeon to ensure you receive the best treatment available.  The reconstructive

 surgery usually takes 1-1.5 hours depending on whether you are having single or double mastectomies.  


During the consultation I will evaluate your specific case and present all the options that are available to you.  We are committed to helping you close the loop on breast cancer and have confidence to move forward. Call today to schedule your consultation. 248-524-0620.


Dr. Sarah Elswick, MD

Plastic, Reconstructive and Aesthetic Surgery


What’s the new trend in Lip filler? 

In recent years when it comes to Lip filler, the request has been the bigger the better. With every trend comes a bandwagon and then it tempers. Although the volume and style injected has changed, the demand for Lip filler is not slowing down anytime soon.

Patients have been requesting a more natural result and lip injections is still one of the primary filler requests I receive.  My belief is to assess the patients face shape, other features in comparison, and definition as well as a full pout is important to most patients. 

The products I use and technique administered varies for each patient.   Different hyaluronic fillers produce different results. I’ll choose Restylane® if my patient wants more structure or has “smoker lines”.  For the patient that wants a pillowy pout, Juvederm® is my product of choice. 

Lip filler can last anywhere from 9-12 months but by 4-6 months, most of my patients feel they are deflating and require a refill.  Interested in learning more? Call today to schedule your complimentary consultation. 248-524-0620


Raquel Merlini

Registered Nurse and Aesthetician