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Blog MD

Visit Drs. Timothy and Jennifer Janiga’s blog regularly for office and product updates and information about important topics in plastic surgery and dermatology. If you have a question that you would like addressed, please contact us.

Breast Augmentation with a Lift vs Just Breast Augmentation

Many women come for a consultation and are not sure if they need a breast augmentation alone or a breast augmentation with a breast lift (also called a mastopexy augmentation). Most women would prefer to have the augmentation alone and hope that this would give them enough of a lift, but this is not always the case.

These are two completely different surgeries that I will try to differentiate today.

breast augmentation with a lift

Breast augmentation is performed for women who would like an increase in the size of the breast, but are less concerned with lifting the breast. A breast augmentation or boob job procedure is performed by using an incision either under the breast, around the areola, or in the armpit where an implant is inserted through the incision. The volume of the implant does give some lift effect, but this is not its primary purpose.

Breast augmentation with a lift also called mastopexy augmentation is usually necessary in women who are looking for a larger size and a lift in the position of the breast. Many have lost a significant amount of weight, have been pregnant multiple times, or have a natural genetic tendency to have pendulous breast tissue.

A breast lift with augmentation entails more incisions than breast augmentation alone. The anchor incision is the most common type but vertical lifts are also possible, decreasing the number of visible scars. The excess skin is removed and the nipple areolar complex is repositioned to be in a more youthful position. Before closing the tissue, the implant is placed to help with size.

You can see some amazing breast augmentation and breast augmentation with a lift/mastopexy augmentation before and after photos on our website.

It is difficult to know whether you will need a breast lift with augmentation or a breast augmentation alone, come to our Reno plastic surgery office for an evaluation with Dr. Timothy Janiga to see which of these procedures is best for you.

~ Dr. Timothy Janiga

How to Treat Unsightly Blood Vessels on the Face

Blood vessels on the face are a common problem. They occur more commonly in fair skin and sun exposed areas. They can be related to rosacea, medications, or sun exposure, but no matter what causes them, nobody likes them.

There are a few treatments for blood vessels, but before we get to treatments let’s talk a little bit about prevention. The first and foremost line of prevention for blood vessels on the face is sunscreen. Wearing an SPF greater than 35 will help decrease the number of blood vessels that you get over time. When we treat blood vessels on the face we always want to make sure that our patients are using sunscreen consistently afterwards to prevent new ones from coming.

Secondly, there is a B vitamin called niacinamide that you can apply topically. This topical preparation is anti-inflammatory, and we have been applying it in cosmeceutical preparations for many years. My two favorite products with niacinamide in it are the Elta M.D. “Clear” sunscreen and the Skin Medica Redness Relief Calmplex.

Another topical preparation for blood vessels and redness is a new prescription medication called Mirvaso. This medication is by prescription only and you will need to see your doctor, but it is new and available to patients now. This medication is applied to the face each morning and constricts the blood vessels on the skin decreasing their appearance. The great thing about this medication is it works within just an hour or so of application. So far, there is no evidence that this decreases the number of blood vessels that you grow over time but it definitely decreases the appearance of the ones that you have.

Lastly, if you would like a significant decrease in the blood vessels on the face we can treat them with laser. Both of the patients in these photographs were treated with intense pulse light laser for blood vessels.

Laser treatment for blood vessels Blood vessel on chin treatment

As you can see from both comparison photos, immediately after there is some redness in the background from the heat of the laser itself, but the linear blood vessels on the cheeks and nose (first set of photos) and the chin (second set of photos) have completely disappeared.

In most patients we use a combination approach with sunscreen, topical niacinamide, topical Mirvaso, and intense pulse light. Over time, some people will develop blood vessels but this combination approach gives them the best chance of keeping them under control long term.

If you would like us to look at and treat your blood vessels on your face, call our Reno dermatology offices to set up a consultation.

~ Dr. Jennifer Janiga

Vitamins for Healthy Skin, Hair and Nails

Often I get asked by our Reno dermatology patients, “What else can I be doing to improve the appearance of my skin?” These patients are usually already following Dr. Jennifer Janiga’s essential skincare routine, so they’re looking for that next step.


I tell them that one key to having beautiful and healthy skin, hair and nails is to ensure you’re getting the proper amount of key vitamins. What we put on our skin and ingest in our bodies can play a big role in the overall health and appearance of our skin, hair and nails. Below are some of my recommendations for vitamins that can benefit your skin, hair and nails.

Vitamin A:

Vitamin A helps to stimulate collagen, which thickens and exfoliates the skin thereby reducing clogged pores, sun spots and even precancerous lesions.

Vitamin C & E:

Antioxidants, such as Vitamin C and E can help undo or reverse the result of sun damage by enhancing the skin’s ability to repair itself.

Vitamin C is particularly beneficial for two reasons. It acts as an antioxidant, which helps squelch the destructive free radicals and undo the damage caused by UV radiation. Secondly, Vitamin C improves the effectiveness of your daily sunscreen by promoting the collagen synthesis needed to firm up and thicken the skin, thereby mitigating that sun damage which results in thinning, wrinkling and sagging. Finally, the hardworking Vitamin C supplement will improve your hair growth and help avoid the deficiency they can lead to split ends.


Iron is another vitamin that is important for healthy skin, hair and nail growth. A deficiency can cause your hair to be thin and lacking luster. It can also cause your nails to be brittle and break easily.

B Vitamins:

B vitamins also promote healthy skin and it too is important to get the daily-recommended amount. Each of the several B vitamins provides specific benefits.

Thiamine, also called vitamin B1 helps build new cells. Riboflavin, commonly called vitamin B2, works as an antioxidant similar to Vitamin C & E described above. Niacin, vitamin B3, is used to treat acne. Pantothenic acid, vitamin B5 and Pyridoxine, B6, can help to produce healthier skin by reducing inflammation and lessening the redness that results from sun damage. Then there is Biotin, vitamin B7, for healthy cell formation, which promotes the growth of healthy skin, hair and nails. Finally, we have Cobalamin; vitamin B12, which helps iron do its job.

Making sure you get the daily-recommended dose of all these vitamins is an important part of achieving optimal skin health and appearance. If you recognize that you are not following the well-balanced, healthy diet, discuss supplementation for your specific needs with your health care provider.

To set up a consultation with Dr. Jennifer Janiga or me, to discuss which vitamins may benefit your skin, hair or nails, call us any time at 775-398-4600.

~ Melanie, Janiga MDs Physician’s Assistant

Transformation Tuesday: Patient Before & After

For this month’s before & after transformation we chose a patient who had a treatment plan that was customized to her specific needs. As with all of our Reno plastic surgery patients, we evaluate this patient’s needs and requests to create a treatment protocol that fit her needs.

In this patient’s before photo she has a significant amount of laxity in the lower face and neck, requiring a facelift, but one of the things that also really bothered her was her upper lip.

facelift before

Many people will advise filler or fat grafting to this patient’s upper lip, but this case is a more difficult one. This is a perfect example of a woman with a naturally aged and very thin upper lip. No matter how much filler or fat you place in this upper lip you will not get the results you are looking for. You will get that characteristic overfilled duck shape lip that we all dislike.

This patient received an in-office face and neck lift, which had minimal recovery time, and an in-office upper lip lift. An incision was made below the nose and a portion of the skin was removed.

mini facelift after

You can see that this gives her the natural shape of her youthful upper lip back and a beautiful Cupid’s bow shape.  No filler or fat was placed in the lip, the before and after are 6 weeks apart and she has nothing but her natural anatomy.

Come visit our Reno plastic surgery office and have a personalized one-on-one consultation with me.  We can discuss if you need one of our customized procedures including lip lift, in office facelift, earlobe repair, or possibly revisionary surgery from previous operations.

~ Dr. Timothy Janiga

Dr Jennifer Janiga’s Favorite Skincare Products + a Freebie!

When my Reno dermatology patients ask me for the best product to treat wrinkles, I tell them about one of my favorite product combinations for fighting wrinkles … a growth factor + a retinoid. The growth factor builds collagen and promotes cell turnover with the added bonus of essentials antioxidants, while the retinoid increases collagen. This is a one-two punch for anti-aging.

From now through April 15 (tax day) we will be offering our growth factor TNS Essential Serum, bundled with a FREE retinoid. This is a $75 value. 

TNS essential serum is a product you can use twice a day, morning and night. You put on one pump on freshly cleansed skin. It is a combination of growth factor, antioxidants, and peptides. This combination fights the damage you do every day, helps stimulate collagen, and promotes cell turnover. At six months we can see under the microscope on biopsies of the skin, an increase in collagen.

Retinol Cream

Retinoids have been around for more than 30 years. Many studies have shown that they increase collagen, which of course is our favorite effect of this medication. But, the other things that retinoids do is to stimulate cell turnover, decrease pigment in the skin, shrink pores, and naturally exfoliate the skin.

Retinoids are a topical product and are a derivative of vitamin A. The side effects are redness and irritation. Personally, I can only use a retinoid on my dry skin one time per week, but I have patients who can use these products every day. My advice is to apply a retinoid in the evenings on top of the TNS essential serum as often as your skin can tolerate, this can range from 1 to 7 evenings per week.

We know that when it comes to wrinkles and skincare, the right products can go a long way. This combination of a growth factor and retinoid will get your skin looking amazing. Come in to our Reno dermatology office and get our two favorite skincare products for anti-aging the TNS essential serum and get the retinoid (for free!).

~ Dr. Jennifer Janiga

Skincare Tips for the Reno-Tahoe Climate

With over 300 days of sunshine each year and an average temperature of 50 degrees, the Reno area is a great place to live. The opportunities for outdoor activities are boundless and include hiking, biking, and swimming in the warmer months and snowshoeing, skiing and snowboarding in the winter.

Lake Tahoe

Unfortunately, the high desert climate has a downside that can be quite damaging to your skin. The air is very dry, with humidity levels as low as 10% compared to Hawaii for example, where the humidity averages over 70%.

Here are some tips from Janiga MDs Reno Dermatology on how to best protect our skin from the ravages of this sunny, windy and dry environment.

1. Get a humidifier. Since the air is dry both indoors and outdoors, it is a good idea is to get a humidifier for your home. They are simple devices, which use the water from their reservoirs to infuse moisture into the air, which helps to replace that lost moisture in our skin.  They are relatively inexpensive, and come in various sizes, from single room size to whole house units. An added benefit is that the additional moisture also lessens the amount of the annoying static electricity associated with low humidity.

2. Use a good moisturizer. The use of creams, ointments or lotions to hydrate the skin is essential in Reno.  I recommend moisturizing the skin at least once a day.  CeraVe cream and Cetaphil cream are two products I particularly like because they are easily applied and do not leave a greasy feel. It is also a good idea to use a moisturizer immediately after bathing, which helps to lock in the skin’s natural moisture and enhance the effectiveness of whatever cream you are using.

Skincare for dry climates

3. Wear Sunscreen. Facial skin deserves special care. Applying a moisturizer containing sunscreen is an easy two-for-one, which hydrates and protects the skin at the same time.  I suggest a product called Elta MD Facial for daily use and then at night, I recommend Replenix Hydrating night cream, which provides moisture and has the added benefits of anti-aging ingredients.

For the delicate skin around the eyes, one should use a designated eye cream.  Skin Medica has a great product called Eye Repair, which I use for the upper and lower eyelids.

4. Hydrate your Hair, Nails, Lips and more. Everyone has learned that the dryness in the air can also affect our mucous membranes as well as our lips, hair and nails. Using a hydrating shampoo and conditioner can improve the health of the scalp and hair in this climate.

The skin of the lips is especially sensitive to the harsh conditions. Using a lip balm with sunscreen several times a day is a good idea. Elta MD lip balm is an excellent yet inexpensive product for lip protection.

Insofar as your nails are concerned, applying an ointment like Aquaphor on the your nail beds will help keep them healthy and prevent splitting.

5. Adjust Your Lifestyle. Avoid taking long hot showers and baths as the heat and water will dry out your skin. Try to stay in the shade as much as possible and drink plenty of water when you are enjoying your favorite outdoor activities.

Follow these skincare tips for a dry climate like Reno and you’ll be able to enjoy all that beautiful Reno-Tahoe area has to offer, while maintaining your youthful, smooth skin. All of the products I have recommended in this article (that are not at a drugstore) are available for purchase at Janiga MDs South Reno office.

~ Melanie, Janiga MDs Physician’s Assistant

The Most Effective Ways to Treat Wrinkles

Many times patients come in to our Reno dermatology office and drop a large bag of product on the floor while saying “none of this works.” I ask them what they were hoping the products would do, and nine out of 10 people put both hands on their cheeks and lift their face showing a facelift. I remind them that there is no facelift in the jar and try to discuss with them the different options that are available to help with lines on their face.

How to Treat Wrinkles

There are several different forms of wrinkles. They can be fine wrinkles due to smiling, deeper wrinkles over time with aging, and can be worsened by lax skin. Each different type of wrinkle will respond best to a different treatment.

For example, topical products are good for the fine lines and wrinkles. The lines associated with movement can be treated with some of our injectables, as can the deeper wrinkles. That fine textural irregularity can be treated with lasers, and that very lax skin might need surgery to get you the improvement you’re looking for.

Here is more information about what I think are the most effective ways to treat wrinkles.


The topical products that are best for wrinkles include retinoids and growth factor serums. These are the two products that we know of that can build collagen with a topical application. In the laboratory we are able to measure an increase in college and with these two substances.

We have a retinol product and two growth factor serums in the office if you would like to try either of these products. Topical products build collagen overtime and it takes 6 to 12 months to see a difference in those fine lines, pore size, and textur


The injectable products can also be used for wrinkles. For wrinkles associated with movement, Botox and Dysport are the treatments of choice. These are neurotoxins that inhibit muscle movement for 3 to 4 months with each injection.

Other injectables can be used in areas such as the nasolabial fold or the marionette lines (the line from the corner of your mouth down to your chin), the tear trough (the line under your eyes that makes it look like you have bags), and to the midface cheekbone area.  There are a multitude of injectable products that can go into these deeper lines but in general they are called fillers and most people are familiar with them as trade names of Juvéderm, perlane , restylane, and radiesse.


Lasers can be used to resurface the skin improving text from irregularities, fine lines, and smoothing moderate wrinkles also. For resurfacing, we use the ablative and non-ablative ICON laser in our office.


For wrinkles caused by laxity of skin, there is only a small amount that topical products or injectables will do. In most cases if the issue is laxity of skin, a facelift is the treatment of choice. There is an in-office mini facelift version as well as the standard facelift that is done in the operating room.

Most patients have a combination of at least one or two things such as textural regularities and laxity or fine lines and deep nasolabial fold. Each treatment and patient is unique. Come to our Reno Dermatology and Plastic Surgery office for a personal consultation to find out which of these treatments is best for you.

~ Dr. Jennifer Janiga

Two Tummy Transformations by Dr. Timothy Janiga

With my line of work, often seeing is believing. That’s why today we are profiling two of our patients who underwent drastic tummy tuck transformations. These women have very different body types, so you can see how plastic surgery can benefit just about anyone.

Our first transformation comes from a patient with extra skin on the abdomen from having multiple children. The laxity of the skin in this area is very common after the stomach has been stretched multiple times from pregnancy. As you can see this woman would not be able to lose anymore weight or do any more crunches to improve her stomach. Her skin was not able to regain its tightness and elasticity.

A tummy tuck to remove this extra skin was performed allowing her to have a flat stomach once again. The photo shows her stomach before surgery and three months post operation.

Tummy Tuck Before and After

In our second before and after plastic surgery photo features a patient that had about 5 pounds of tissue removed from the abdominal area to give her back a flat and more appealing stomach. Additionally in this patient a small amount of liposuction was performed to improve the contour.

The photo below shows the transformation of the patient’s stomach from before to three months post operation.

Tummy tuck and liposuction before and after

Tummy tuck and sculpting procedures can be performed for women of different sizes, shapes, and anatomy. As you can see from these two examples sometimes only skin needs to be tightened and other times a more extensive procedure with contouring can be done.

Make an appointment at our Reno plastic surgery office and see how I can tailor body procedures specifically to your body type.

~ Dr. Timothy Janiga

Five Budget-Friendly Skincare Tips

Having gorgeous, youthful skin does not have to cost an arm and a leg. Often I have patients at our Reno dermatology office who are surprised to learn that many of our top recommended treatments and products cost much less than they anticipated.

Budget Friendly Skincare

Here is a list of the top five budget-friendly ways you can improve your skin’s appearance:

1. Daily use of sunscreen is the cornerstone of skin care. It not only can undo some of the signs of sun damage, but will also in prevent further damage.  Sun screen is relatively inexpensive and is by far the most budget friendly product one can use to improve the health and appearance of the skin. Of all sunscreens available I particularly love the product called Elta MD Facial. This creamy and hydrating lotion has SPF 30+ which contains zinc, a physical sunblock. The price of a 4ounce container, which should last several months, is only $28.

2. Glycolix Body Lotion. In this dry climate I also recommend the Glycolix Body Lotion for use as a body moisturizer. It can be used once or twice a day and contains alpha-hydroxy-acid glycolic acid, an exfoliator which rids the body of the top dead layer of skin allowing the moisturizing component to penetrate deeper, thus providing more hydration than a moisturizer without an exfoliant. The cost for a 12 ounce bottle of Glycolix is $36.40.

3. Lip protection. We often also forget much needed protection for our lips from the ravages of sun and wind, but this is one of the first areas that can show skin damage. A great value for lip protection is the Elta MD Lip Balm, a hydrating lip balm with SPF 30 and which costs a mere $10 for a .28 ounce container.  I like to apply this product in the morning before putting on lipstick and I reapply it several times a day when outdoors skiing, snowboarding or hiking. This particular product is also water resistant, an obvious benefit.

4. Anti-Aging Night Cream. There are several bedtime products but the one I prefer is Replenix Restorative Night Cream. It feels silky and smooth, has a pleasant light scent and contains a number of anti-aging components, including antioxidants, ceramides, peptides and phyto stem cells. At $66 for a 2 ounce container it may seem somewhat pricey, but is in fact quite budget friendly being as the 2 ounces should last a month or more.

5. Botox. Finally, an affordable injectable anti-wrinkle treatment that will provide the most noticeable improvement in smoothing wrinkles is of course Botox.  It is generally used on the most common wrinkled areas which are around the eyes, also called crow’s feet, between the eyes, and on the forehead. The effects of Botox last from 2 to 6 months and the cost depends on both the area being treated and your personal anatomy.  This is because Botox smoothes wrinkles by relaxing the muscles, therefore the stronger the facial muscles are in the area treated, the more solution is required.

If you’re looking for cost effective ways to improve the appearance of your skin, the above are my picks. If you’re looking for a tailored skincare approach, visit Janiga MDs for a consultation and we can help devise a plant to fit your skin and budget.

~ Melanie, Janiga MDs Physician’s Assistant

Treatment Spotlight: All About Liposuction

Liposuction is one of the most common cosmetic surgery procedures in the United States. Last year more than 200,000 men and women received liposuction in the US. In general, this is a high satisfaction procedure with low downtime.

One of the common misconceptions about liposuction is that you can use liposuction as a means to lose weight. This is incorrect. In fact, the best candidates for liposuction are people who are at or near their ideal weight and have stubborn areas of fat deposits.

For example, women with pear-shaped bodies will have small amounts of fat deposited in the hip area even though they have a flat stomach and very thin arms. In the apple shaped body people may have thinner legs but hold fat deposits in the abdominal or flank areas.   Even though there are fat deposits in specific areas, these

body types are not able to lose more weight, but still have fat deposits in the hip and buttocks area. In order to decrease these deposits liposuction is a realistic and common choice. Other possibilities for liposuction include the arms, around the knee, and the neck.

Something that has been in the media a lot recently is liposuction of the stomach area to make the muscles of the stomach more defined. This is also possible.


Most liposuction procedures need to be done in an outpatient surgical facility, but small areas can be performed in the office under tumescent local anesthesia.  There is usually some bruising and tenderness of the area for 1 to 3 weeks afterwards.

During recovery, you will wear compression garments to keep the swelling down and give you the best results as soon as possible. Most people can return to work in about a week if their job is not strenuous.

If you would like to be evaluated for liposuction procedure at our Reno plastic surgery office, please make an appointment. I would be happy to examine you and let you know if you are a good candidate for this procedure.

~ Dr. Timothy Janiga