What is Hyaluronic Acid? And Why Do You Want It?

Hyaluronic acid (HA) is a natural substance found in your own body as well as in topical serums and creams. Believe it or not, it is also the primary active ingredient in most injectable fillers used to replace lost volume in the face, for contouring purposes, or to fill in wrinkles and smooth the skin.


Hyaluronic acid is not an acid in the typical sense. It’s not a harsh chemical and it doesn’t strip your skin. In fact, it loves water. HA is a polysaccharide (complex sugar) that can absorb up to 1000 times its own weight in water. Application of HA-containing products leads to increased moisture in the skin which is especially great in dry climates.


In your body, HA is found in several places. It’s located in between skin cells, where it holds water keeping the skin plump and moist. It’s also found in the eyes and in joint spaces, providing lubrication and shock absorption. As we age, the amount of HA in our bodies is diminished. This leads to volume loss, dullness, and a more weathered appearance of the skin.


There are no skin conditions or skin types that cannot benefit from use of HA. In fact, most OTC beauty products that claim to be anti-aging will have at least a small amount of HA in them. Medical grade products, however, will contain higher levels and a higher quality grade of HA. HA serums and creams can be used under sunscreen and other products to humidify the skin and keep it plump and firm, reducing fine lines and wrinkles. Consistent, prolonged use leads to long-term support for the youthful appearance of the skin.


Shah Aesthetic Surgery recently launched Alchemy, our medical grade skin care product line containing HA. Our moisturizer for daytime use contains a high level of hyaluronic acid to increase water content in the skin, firming and plumping up the delicate tissues of the face where our skin needs the most support. Colorado’s semi-arid climate is very drying to the skin so it’s especially important to give it some extra support to keep it moisturized.


You can also find HA in pill form. Long term benefits of taking HA supplements are unknown. It may do you some good and there are no safety concerns, but using HA topically is a more sure fire way to benefit the skin.


As mentioned, HA is also found in injectable fillers such as RestylaneTM, BeloteroTM, JuvedermTM, and VolumaTM. These fillers have very consistent results in replacing lost volume in the face, contouring, filling in wrinkles, and smoothing the skin. HA fillers last between 6 and 24 months depending on which filler is used. At our office in Denver, Dr. Shah is an expert injector for these fillers and in using them is able to achieve significantly improved, natural looking results. Injectable fillers with HA are a very widely used non-surgical cosmetic treatment.


Another use of hyaluronic acid is in the treatment of osteoarthritis. Injections of HA into the joint can help improve shock absorption in joints affected by OA. Injections can also give temporary relief from joint pain, especially when combined with other treatments for OA.

With its many applications, use of hyaluronic acid is an important player in anti-aging both cosmetically and physically. If you are interested in use of HA in skin care or injectable fillers, contact us for more information.

Summer Skin Care – The Basics of Looking Good!

Well here in Denver, Winter is about to be over!  Signs of Spring are all over the place.  I’ll be going up into the mountains for one last hurrah on the slopes with the family.  Summer is the next hurdle for patients of Shah Aesthetic Surgery.  Being a mile up in the air makes for some brutal skin aging.  The air is thinner, colder, and dryer.  The sun is definitely more intense.

People age much faster in my opinion in this alpine desert environment.  There are things you can do about it, so don’t fret!

Here is a list of simple options for great Summer Skin Care:

1. Water – drinking water keeps your skin cells plump and protected.  Summer in Denver means more outdoor activity.  This means more sweating, so keep your water intake high to protect your skin.

2. Sunblock – I am a big advocate for high SPF sunblock.  I personally use a 55 SPF sunblock with UVA/UVB blocking capabilities.  While sunblock in makeup is a good idea, it just really isn’t enough protection up here in Denver since we really get intense sun exposure more than 275 days per year.

3. Vitamin C – this vitamin is really the most important vitamin for making new collagen.  Since is it water soluble 1000-2000mg daily is a safe dose.

4. Exfoliant usage – I am a fan of topical exfoliant serum usage.  Retinols and Vit C/E serums top my list.  I personally prefer Vit C/E because it more gently treats my skin and is safer in sun exposed populations. That being said, Retinols are the superior serum.  Just remember to wear good sunblock and protect your face with a big hat.

5.  Chemical peels – Winter’s cold, dry air has done a number on your skin.  You can recapture some of the ground lost in the war on facial aging by getting a chemical peel.  A chemical peel uses different safe organic acids to gently loosen skin and have it peel off.  This is a more immediate result than the use of exfoliant serums alone.  Depending on the strength of the chemical peel, you can have one as often as on a monthly basis.  Skin looks brighter with a more even texture when you get a chemical peel.  Heck, I even gently peel my own face.  If you see me in person, you’ll realize why I am such a fan.  They are easy to do, easy to recover from, are low risk, and give results!

6.  Eat cleanly – this is a no brainer!  What you put in your body shows in your skin.  Here in Denver, there is no shortage of good food.  I eat both natural and organic as much as I can.  It is expensive, yes, but well worth it when done carefully.  But, even if you shop at a conventional grocery store, you can make healthy choices that will benefit your overall health.  And, everyone knows that Healthy is a lot sexier than Unhealthy!

Now get to it!

Cosmetic surgery performed in an in-office setting

Did you know that many cosmetic surgery procedures can be performed in an in-office setting?

Here in Denver, Colorado, Manish H. Shah, M.D., FACS has perfected the process of performing many cosmetic surgical procedures in an in-office setting.  There are many reasons one might choose to have their cosmetic surgery performed outside of the hospital or surgery center setting.  The following is a list of reasons many of Dr. Shah’s patients have elected to have their procedures performed in his office:

1. They are afraid or anxious about general anesthesia safety issues

2. They are healthy enough for non-monitored procedures (no continous monitoring of heart rate, blood pressure, or oxygen levels) – Level 1 anesthesia (Colorado Board of Medicine)

3.  They feel more comfortable with the idea of having their procedure using only Valium (or similar medication) for sedation/relaxation, and using local anesthesia (like at the dentist’s office.)

4.  They are interested in saving money!! (in-office procedures do not have anesthesiologist fees or facility/equipment fees associated with them)

There are many different procedures that Dr. Shah has performed using only sedation with Valium and local anesthesia here at his cosmetic surgery office in Denver/Englewood, Colorado:

1. Facelift (rhytidectomy)

2. Eyelift (blepharoplasty)

3. Ear pinning (otoplasty)

4. Nasal tip rhinoplasty – primary

5. Revision rhinoplasty

6. Non-surgical rhinoplasty

7. Mini tummy tuck (abdominoplasty)

8. Reverse tummy tuck (reverse abdominoplasty)

9. Small area liposuction

10. Breast lift (mastopexy)

11. Breast implant revision

12. Laser resurfacing of the face, neck, chest, and hands

13. Chin implants

14. Scar revisions of all types

In fact, over 90% of Dr. Shah’s patients will have procedures performed this way.  With a yearly caseload averaging around a 1000 facial and body/breast surgical procedures, this means that many patients have had their procedures this way.

If you are interested in finding out more about your options with regards to cosmetic surgery performed in an in-office setting, please contact Jenny Romano of Shah Aesthetic Surgery in Denver, Colorado at (303) 708-8234.

How is Botox anti-aging?

Here at Shah Aesthetic Surgery in Denver, Colorado, we are huge fans of Botox from Allergan.  Botox is made from a highly purified protein toxin.  When injected in small quantities into facials muscles that cause wrinkles, the muscles weaken temporarily.  In their weakened state, they can’t produce the same amount of wrinkling. Most patients will see results lasting around 3 months.  If a patient is consistent with their Botox usage, those same muscles can atrophy.  This reduces their strength over time and reduces their wrinkling capability.  This usually means that they can lengthen the time period between injections.

When muscles don’t move, the skin wrinkles less making you look younger.  Patients will still need good anti-aging skin care and sunblock to keep the collagen and elastin in the skin as healthy as possible. Regular Botox treatments and medical skin care at Shah Aesthetic Surgery will keep you looking younger!

Summer is over! What about my skin?

Most of us experienced quite a hot summer in 2013. Now that it is over, what are you doing about all that new skin exposure and aging? If you are smart, you are going to try and reverse some of the damage! Here are some tips on how to do just that:

1. Hydrate and Moisturize – It is important to make sure that you are drinking enough water to keep the cells in your skin plump and healthy. Moisturizer, when used properly, serves to seal in this moisture and maximize water retention in the skin.

2. Sunblock – I am a big fan of using full spectrum sunblock. You should make sure you maximize block of UVA and UVB. In most areas of the country, an SPF of 30, should be enough protection. Here is Denver, Colorado, I recommend use of at least an SPF of 50, because of the greater intensity of the sun up at “Mile High” altitudes.

3. Retinols – I LOVE retinols. Retinols are Vitamin A derivates in cream or gel form that you put on your skin every night to regenerate and improve all the layers of your skin. As you get older and experience more skin damage, the epidermis (outer layer) of your skin gets thicker and uneven, while the dermis (inner layer, strength layer) gets thinned out. This leads to older looking skin with wrinkles and volume loss. Retinols (eg. Retin-A) reverse this process. If you love the sun, then avoid retinols, as they make you more sun sensitive. Also, the reversal lasts only as long as you use this product, so make sure to stay in it for the long haul!

4. Skin procedures – To make a bigger dent in the aging your face experienced this Summer, I would recommend looking into non-invasive or minimally invasive skin procedures to remove some of the damage. A common procedure with no downtime is microdermabrasion. This procedure uses crystals or water to pressure exfoliate the top layers of skin. What you get is a polished refreshed look to the skin. This procedure is gentle enough to reperform on a monthly basis. Another procedure that is a particular favorite of mine is the chemical peel. Chemical peels use organic acids like glycolic, salicylic, and TCA to peel of layers of skin to depths greater than microdermabrasion. Typically, patients will need 2-5 days downtime, but the results are typically outstanding. Finally, when patients want the greatest amount of change and downtime is no matter, I recommend the use of fractional laser resurfacing. The gold standard is the use of fractional CO2 laser resurfacing. With this technology, you are basically creating a computer-controlled “sun burn” of the face using laser energy instead of UV radiation.

If you would like to learn more about after Summer skincare, please call Jenny at (303) 708-8234 to make an appointment to speak with me.

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Bullying!! A Good Reason for Plastic Surgery in Kids?

If you are paying any attention to the national media, you know that bullying has become a very common part of growing up.  We are hearing tragic stories of children and teens all over the country taking their lives because they can not live in the shadows of their shame any longer.  We all know that kids can be cruel, but it seems that this has reached epidemic proportions.

In Denver, Colorado, at my plastic and reconstructive surgery practice, I have seen many children and adolescents who complain about being teased and bullied because of the way they look.  Some of the most common complaints are: ears that stick out, a nose that is too big, and bad facial acne.  Other problems have included early development of extremely large breasts, obvious asymmetry of the breasts of girls/teens, and enlargement of breasts (gynecomastia) in boys/teens.

Before one thinks about getting plastic surgery to correct these problems, it is important to make sure that the child and his/her parents are well-educated about the pros and cons of surgery.  If there is any sense that the child might have a psychological issue, then I refer them for psychological evaluation before proceeding forth with surgery.  Fixing a perceived external defect without treating any internal strife is a recipe for disaster.

If, however, the child and parents have healthy motivations, what can be done about these various conditions?

In Denver, Colorado, at Shah Aesthetic Surgery, there are multiple options to handle each concern:

EARS THAT STICK OUT:

The most effective procedure for ears that stick out too much is called an otoplasty or ear pinning operation.  This is a very successful operation in my hands.  Patients seek out our Denver-based clinic for ear improvement.  Children really notice the differences in those around them after about the age of 6 years old.  This is a common time to fix the ears.  If you want more information on otoplasty in Denver, Colorado, I suggest you contact us at drshah@drmanishshah.com.

A NOSE THAT’S TOO BIG:

When a nose appears too big for the face, it can be a target for taunting and bullying.  The most effective procedure for reducing or shaping a nose that doesn’t harmonize with the face is a rhinoplasty or nose reshaping surgery.  As the only Denver, Colorado based member of The Rhinoplasty Society, rhinoplasty or nose reshaping surgery is a common and successful procedure in my hands.  I have seen life changing results and significant improvements in self-esteem after this procedure.  Using very specialized approaches, I am able to reduce and re-apportion the size of the nose to better fit the surrounding facial features.  It can take more than a year to realize the final results, but the wait is usually worth it.  If you would like more information on rhinoplasty or nose reshaping in Denver, Colorado please contact us at drshah@drmanishshah.com.

BAD ACNE

There are a lot of causes for acne.  When we treat acne at our Denver, Colorado plastic surgery practice, we take a multi-faceted approach to the problem.  We work on acne suppression with topical and oral medication along with good skin care and use of chemical peels.  If there are any scars that need to be improved, we used laser, chemical peels and good skin care from companies like SkinMedica to help reduce the visibility of the old scars.  For more information about the care of acne in Denver, Colorado, I would suggest you contact us at drshah@drmanishshah.com.  No one likes to be called “Pizza Face!!”

BEING YOUNG WITH LARGE BREASTS

Being young with large breasts can be a curse.  Not only can it affect athletic activities, it can bring unwanted and salacious attention.  In my Denver, Colorado plastic surgery practice, breast reduction surgery is very helpful in managing this problem.  It is important to note that these patients may need a second breast reduction later in life after breast feeding a baby.  That being said, making breasts smaller so they weigh less and fit better into today’s clothes, is a win-win situation.  If you would like more information on breast reduction surgery in Denver, Colorado, please contact us at drshah@drmanishshah.com.

HAVING BREASTS THAT ARE VERY DIFFERENT IN APPEARANCE

Another problem that children and teens can face is congenital asymmetry of the breasts in girls/teens or gynecomastia in boys/teens.  These kids have a hard time either finding bras, bathing suit tops that fit and look normal to their peers, or they have a hard time taking their shirts off in the locker room and pool areas. For girls/teens, breast enlargement or augmentation surgeries can be performed with or without breast reduction surgeries to even out the breasts in clothes.  For boys, liposuction and/or resection of glandular breast tissue is used to reduce the chest size and create a more masculine looking chest.  For more information about breast reduction or gynecomastia procedures in Denver, Colorado please contact us at drshah@drmanishshah.com.

I hope that this information can help you and your child find some sense of peace in this ever more critical world.

If you would like, please visit us at http://www.drmanishshah.com to see all that we provide to the Greater Denver area, and beyond.

Warmest regards,

Manish H. Shah, MD, FACS

Radiesse is great for adding volume to your face!

Aging is inevitable.  One of the things that you will notice as you get older is that your face starts to lose volume and appears to sag.  There are several reasons for this.  The most common reason is that the skull starts to lose bone after we pass into our 30’s.  Modern cosmetic surgeons, in their attempts to optimize facial rejuvenation, have really embraced volume replacement techniques to provide their patients with a very natural looking rejuvenation.

WHAT CAN YOU DO ABOUT IT?

In Denver, Colorado, a very common method for adding volume back into the aging face is to use a great product known as Radiesse.  Radiesse is an injectible filler that has been shown to provide long-lasting volume.  Radiesse, also known as Calcium Hydroxylapatite, can be used in many places.  It is FDA-approved to be used in nasolabial fold augmentation, vocal cord injection, and radiopaque marking, amongst other uses.  It has been used for the last several years, in off-label ways, to add volume to various areas of the face.

HOW IS IT USED?

In my cosmetic surgery practice, located in Denver, Colorado, I use Radiesse to augment areas such as the cheeks, brow, cheeks, chin, jawline, and chin.  With my specialization in rhinoplasty, or nose reshaping surgery, I prefer to use Radiesse to add height to the dorsum of the nose or fill in defects after nose surgery.

ARE THERE ANY RISKS?

Use of fillers like Radiesse is generally safe!  This fact is one thing that accounts for the popularity of injectible filler usage.  That being said, it is not recommended that Radiesse be used in the lips.  The reason for this is the high probability of lump formation after use in the lips.  Radiesse needs to be massaged after use to prevent irregularities in other parts of the face.

For more information contact:

http://www.drmanishshah.com

or call

(303) 708-8234 to schedule your appointment for Radiesse filler injection, in the Denver, Colorado metro area