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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.

The Rise of ‘Brotox’: More Men Are Getting Botox Than Ever Before

Continuing our trend for the month of November, we are going to talk today about “Brotox”, or Botox for men.


Brotox is the term that has been coined for Botox in men. Botox is botulinum toxin type A and is a muscle inhibitor that is injected into the muscles in the face to decrease movement along with the lines created by that movement. There are three types of botulinum toxin type A: Botox, Dysport, and Xeomin. Each one has its unique qualities, but all three are able to be used in men.

The American Society of Plastic Surgeons reports that in 2014, more than 410,000 men received Botox, making it the most common non-surgical cosmetic procedure for men last year. It is so common in men that, for the first time, we are starting to receive Botox pamphlets and advertisements with men on the cover.

Interestingly, when giving botulinum toxin type A to men, we find that the facial muscles are much stronger, just like on the rest of the body. Therefore, men require 25 to 50 percent more Botox than their female counterparts. If this fact is overlooked, men will not get good inhibition and may not be satisfied with their procedure. Another important characteristic in a man that cannot be overlooked is the forehead and eyebrow position. In a man, the eyebrows are naturally flatter and don’t arch as much as in a woman. When you perform Botox in a man, you must take care to maintain the flatter eyebrow to prevent a feminized look.

Whether you’re a man or a woman, it’s crucial to find an experienced provider that understands facial anatomy, the difference between men and women, as well as the dosage requirements. Please call our office and make a complementary consultation for Botox or other cosmetic surgical or nonsurgical procedures.

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Breast Reduction for Males – Learn More About Gynecomastia

In November, I am focusing on the cosmetic procedures that are most utilized by men. One of the most common is gynecomastia surgery.


Gynecomastia in men occurs in two main forms. The first is in younger men, where a small amount of breast tissue develops as a result of hormones. This usually does not bring any medical consequences, but becomes cosmetically unacceptable in its appearance. The second type of gynecomastia surgery in men is for excess skin or fatty tissue after weight loss or gain. When performed surgically, both procedures are similar, but the hormonal type of gynecomastia is usually performed on younger patients and is a smaller procedure then the post-weight loss or gain type of gynecomastia surgery.

Most of my gynecomastia patients come in saying that they don’t like the way the chest area looks with their shirt off, and some even have what they consider to be an unacceptable appearance while clothed. The goal of gynecomastia surgery is to remove the excess breast tissue, fat or skin to give the male chest a more masculine appearance.

The procedure takes approximately one to two hours in the operating room depending on how extensive, and the recovery is one to three weeks.

Please call my office to schedule your complimentary consultation if you are interested and cosmetic gynecomastia surgery.

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Growing Popularity in Plastic Surgery for Men – What Are the Trends?

According to a report from the American Society of plastic surgeons, there were 15.6 million cosmetic procedures in 2014. Of these procedures, 1.7 million were surgical and 13.9 million were considered minimally invasive. We talk a lot about cosmetic procedures for women, but for November, we’re going to focus some attention on the other half of the population: men.

The top five cosmetic surgical procedures for men in 2014 were nose reshaping, eyelid surgery, breast reduction, liposuction and facelift. The top five minimally invasive procedures include Botulinum Toxin Type A (Botox, Dysport, or Xeomin), laser hair removal, microdermabrasion, chemical peels and fillers.



From a surgical perspective, nose reshaping or rhinoplasty can be performed in most age groups and is usually a procedure done to improve the overall contour or size of the nose. The width length or a type of dorsal hump can be improved with rhinoplasty. Eyelid surgery candidates are usually a more mature population, who seek help with laxity in the skin on the upper eyelid or bags or laxity on the lower eyelid. Breast reduction in men can be performed after massive weight loss or in men with abnormal tissue called gynecomastia. Liposuction is the fourth most common procedure performed on men. It can be performed on the flanks or abdomen to reduce fat deposits. Rounding out the top five is facelift, which is a similar procedure for men and women, but special care must be taken in men because of their hairline.

For minimally invasive procedures, the overwhelming top spots goes to the botulinum toxin type A with more than 400,000 men receiving this procedure in 2014. Botulinum toxin inhibits muscle movement and is commonly performed to decrease lines in the area between the eyes, the forehead and around the eyes on the sides. Other areas that can be treated include the jaw muscles, which can be prominent in men. Botulism toxin can be used to inhibit some of the muscle contraction in this area, thereby decreasing the thickness of the muscle improving the contour of the face. Laser hair removal is usually performed on the beard area or other areas such as the back where hair is undesirably located. Microdermabrasion and chemical peels are usually performed by an esthetician associated with a plastic surgeon or dermatologist. Rounding out the top five are soft tissue fillers. Men with a desire for improving the lines around the mouth, or giving a lift to the cheek area are interested in soft tissue augmentation such as Juvéderm, Restylane or Voluma.

I’ve included a few before and after pictures specifically for men, but if you would like a consultation for any of these surgical or minimally invasive procedures, please call our office at 775-398-4600 and make an appointment for your complementary consultation.

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Are you a good candidate for breast revision surgery?


There are many reasons to have revisional surgery for the breasts. Having previous breast augmentation, breast lift, breast reduction, or surgical procedure such as breast biopsy or lumpectomy may make you a candidate for a revision.

Breast augmentation revision can be performed for patients who would like a different size implant or a switch between saline and silicone. These procedures can also be performed for someone who may want to switch out a silicone implant for one of the new gummy bear silicone implants. Over time, the concept of ideal breast appearance can change for an individual. As women mature, their bodies change. Additionally, women may decide they want the breast to be smaller or larger. This is the most common reason for breast revision surgery after breast augmentation.

If you have had a previous breast lift, you may choose to have revisional surgery years later. As gravity has a continued effect on the breast itself, some people want to have their breasts lifted again. As women mature, have children, breast feed, have hormone changes and gain or lose weight, the breasts go through significant changes. Additionally, as women go through menopause, the dense breast tissue changes to a less firm fatty tissue adding to the sagginess of the breast. Another reason for revisional surgery after breast lift may be to improve unwanted scarring. With surgery, there is always a scar. At times, we can improve upon the look of a scar by revising it.

Breast reduction is another reason to have revisional breast surgery. There are many cases of women who have had breast reduction and, as the body changes with pregnancy, nursing, or maturing, they may have enlargement of the breasts again. This is usually related to weight gain or loss but may be a natural hormonal change for some women. A revisional breast reduction can also be performed if there is asymmetry in the breast from a previous procedure. If one breast is larger than the other or one is slightly higher, it can be made smaller or lifted higher.

People will also visit us for breast revision surgery after medical procedures that have been done to or around the breast which cause abnormalities in the contour. Revisional breast surgery can be done to improve the contour irregularities after breast biopsy, lumpectomy or from removal of other skin cancers on the breast.

If you have any questions or concerns regarding revisional breast surgery, please contact me, Dr. Timothy Janiga for your complementary cosmetic consultation.

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Atopic Dermatitis in Adults: Causes and Treatment Options


Atopic dermatitis is an inflammatory skin condition characterized by itching, redness and dryness of the skin, sometimes with oozing and thickening of the skin. It is a chronic and common problem that is especially prevalent in dry climates such as in the Reno and Lake Tahoe area. Persistent itching of the skin, also called pruritus, is the predominant characteristic of this burdensome affliction. The principal causes of atopic dermatitis are skin barrier insufficiency and the body overreacting with inflammation. Triggers for atopic dermatitis flare-ups include heat, low humidity, stress, environmental allergies and food allergies, although the latter are less common with adults. In families whose members have allergies or asthma, one or more members is likely to develop atopic dermatitis, and those who do are also more likely to be hypersensitive to fragrances, preservatives, topical antibiotic preparations and to metals such as nickel.

While there are several recognized approaches to the treatment of atopic flares, it is essential to control the itching, restore what is called the skin barrier and reduce or eliminate the known triggers if possible. Unfortunately, due to the compromise of the skin barrier, secondary infections often occur. These infections are generally bacterial, but sometimes viral or fungal. When one is carefully avoiding triggers and appropriately treating the dermatitis but without improvement, it is likely due to a secondary infection which needs to be evaluated and treated medically by a physician.

Patients dealing with this irritating condition have to spend time everyday restoring the skin’s barrier with moisturizing creams and ointments. This should be done during flares and also when the condition is controlled in attempt to prevent flares. We recommend moisturizing at least twice a day with an over the counter cream, two options are CeraVe cream or Cetaphil cream. The first application of moisturizer is best to do just after showering in the morning while the skin is moist. Throughout the day if possible the cream should be applied again and especially to one’s hands after every hand washing. At bedtime an ointment such as Aquaphor is recommended for application from the neck down, then sleep in pajamas with long sleeves and pants to help the ointment absorb into one’s skin.

During a flare, the itching can be treated with antihistamines, many of which do not require a prescription and are conveniently available over the counter. During the day, non-sedating antihistamines such as Allegra, Claritin, and Zytrec are recommended. Patients need to know that the generic equivalents to these well- known medications can work just as well and are generally less expensive. For nighttime use, sedating antihistamines are a good treatment choice as they provide not only a reduction in the itching but are an effective sleep-aid for most patients. While prescription antihistamines are obviously an option also an option, for an over the counter bedtime antihistamine, Benadryl, also known as diphenhydramine, is the most commonly recommended.

The main treatment modality for treating the skin rash are topical anti-inflammatory preparations. For more intense outbreaks – and depending on the area of the body affected – either less or more potent prescription steroids will likely be prescribed. Finally, light therapy, which involves standing in a UVB light box, several times a week, can be helpful as an adjunct for stubborn disease.

Atopic dermatitis can be a challenging and frustrating condition to treat. When skin barrier restoration through moisturizer, topical anti-inflammatory and anti-itch medications do not resolve the skin rash, a daily diary should be kept to help identify one’s individual triggers. The patient should keep careful notes of everything, including foods and drink, exposure to environmental allergens, and stressful events that are or may be related to flares. This track record will assist their dermatology provider in understanding the patient’s triggers to the flares and thereby help in devising a plan to manage if not eliminate them. By way of a simple example, if seasonal pollens are a trigger for one’s atopic dermatitis, it may help to shower before going to bed, and to thoroughly wash the pollen from one’s hair so as to not be exposed to those allergens all night while sleeping.
Medical providers will occasionally refer patients to an allergist to identify specific environmental triggers, and sometimes allergy desensitization treatments are employed to lessen, or hopefully eliminate the body’s reaction to those triggers.

It is well known that stress and anxiety are difficult to manage and their association with atopic dermatitis is sometime a vicious cycle, with causing a flare and the outbreak leading to frustration and more stress. There are many recommended ways to reduce stress, however; regular exercise and plenty of sleep are considered the most important. Patients should discuss with their providers their own particular lifestyles and possible causes of their tension and stress so that their providers can suggest individualized stress management strategies.

In conclusion, atopic dermatitis is a frustrating condition that is usually life-long, with intermittent flares, minor and major, but it is not cause for despair because the outbreaks are decidedly manageable. With the help of your dermatology provider and possibly an allergist, those who are afflicted can lead normal, healthy and comfortable lives.

For more information or to set up a consultation with Dr. Jennifer
Janiga regarding Atopic Dermatitis treatments in our Reno dermatology offices, please send us an email or call 775-398-4600.

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The New FDA-approved Way to Plump up Your Cheeks: Restylane Lyft


There is a new product available that some of you may be reading about called Restylane Lyft. This is a product in the Restylane family of fillers by Galderma. Restylane Lyft is specifically designed to treat mid-face volume loss.

If you are familiar with the Restylane family of products, you know Restylane and Restylane Silk are the thinner of the products, while Perlane was the thicker product. Each of these products is hyaluronic acid derived.

Restylane Lyft is the thicker product, Perlane renamed and used in the cheeks to give a lift. It improves the nasolabial folds in the middle by lifting the cheeks laterally.

Hyaluronic acid fillers are very safe and have been used for more than 10 years to treat lines on the face. Restylane Lyft is now FDA approved for placement in the cheeks to help some of the volume loss in this area and provide a lift to the face, decreasing the prominence of the nasolabial fold. It lasts about one year, and side effects of the injections usually include bruising and swelling, along with some other more rare side effects.

In the studies, people received between two and four syringes to achieve a lift. Each syringe costs between $500 and $700, depending on which thickness you select and how many syringes you purchase.

For a consultation regarding Restylane Lyft, or any other fillers please call 775-398–4600 and make an appointment with Dr. Jennifer Janiga or Melanie Buckley.

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Breast Reconstruction Options Explained

In honor of October, which is Breast Cancer Awareness Month, I thought we would review a little bit about breast cancer reconstruction. My practice is about 30 percent breast cancer reconstruction, and I do most types that are available.


Breast cancer reconstruction is the general term for reconstruction of the breast after cancer. It can come in many forms which we will review here.

First, there can be small abnormalities of the shape of the breast after a Lumpectomy. Lumpectomy is done when there is a small focus of breast cancer that needs to be removed. In this case, the entire breast does not have to be removed. Radiation may or may not follow. Lumpectomy scars can be indented or make the breast appear smaller on one side than the other. We use different techniques to give the breast a more natural shape after surgery. Sometimes an implant is needed, but at times we can take fat from another location on the body and graft the lumpectomy area for a more rounded shape. At times, we need only scar revision after lumpectomy to regain a more natural shape.

Breast reconstruction is commonly done after mastectomy on one or both sides. There are multiple techniques for mastectomy and reconstruction. Let’s first discuss the mastectomy. A mastectomy is when the breast tissue is removed either for an occurrence of breast cancer or for the prevention of breast cancer (in genetically susceptible individuals). The overlying skin is left intact and is called the skin flap, but most of the time the nipple/areolar complex needs to be removed as it contains breast tissue. Once your breast surgeon/general surgeon performs the mastectomy, I will usually come in on the same day and perform part of the reconstruction. Please be aware there are times where we are unable to do reconstruction at the same time; this will be determined by you and your doctors.

With most breast cancer reconstruction, a temporary expander is placed under the skin flaps during surgery. The expander is then gradually inflated with saline over multiple weeks after your surgery to stretch the skin out to allow for a larger permanent implant to be placed later. The expansions are done in the office approximately every two weeks. Once the desired size is reached using the expander, you will return to the operating room and have the expanders removed and permanent implants placed. Some women decide this is where they would like to stop, but other women proceed with grafting and tattooing for nipple areolar reconstruction, and sometimes fat grafting for contouring of the breast.

Sometimes, more involved procedures need to be performed for reconstruction that include a latissimus flap where the latissimus dorsi muscle from the back is moved around toward the front to give more volume or coverage. This is particularly needed after a mastectomy that is accompanied by radiation. Radiated tissue is thinner and, at times, we will need more tissue to help maintain as natural of a reconstruction as possible.

Less commonly, but also possible is a TRAM flap for breast cancer reconstruction. This is where tissue from the abdomen is used instead of the back. Your surgeon will have different reasons based on your anatomy for using each type of procedure.

The government has mandated that breast cancer reconstruction be covered under all health insurance plans. This is been in effect for many years. If you have breast cancer in one breast, insurance companies are also mandated to cover a “matching procedure” on the other side to decrease or increase volume so that the reconstructed and natural breast are as close as humanly possible to each other in their appearance.

If you or a loved one has questions about breast cancer reconstruction please make an appointment with me and your breast surgeon to discuss.

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The Link between Organ Transplants and Melanoma

melanoma-organ transplants

Melanoma accounts for only 2 percent of all skin cancer cases in the United States; however, it is the most serious form and results in the majority of skin cancer deaths. It is the fifth leading cancer in men and the seventh in women and it is estimated that 73,870 new cases of melanoma will be diagnosed in the U.S. in 2015, and that it will kill nearly 10,000 people. The rapid increase in the number of cases and high mortality rate has driven researchers to develop a more comprehensive understanding of the risk factors.

A new study co-authored by Hilary A. Robbins from the Johns Hopkins University Bloomberg School of Medicine in Baltimore, Maryland, suggests that patients who have an organ transplant are, for reasons not yet clear, twice as likely to develop melanoma and are at even greater risk of succumbing to the disease than individuals who have not undergone organ transplantation. The study also revealed the intriguing finding that organ transplant recipients were more likely to be diagnosed with melanoma in its later stages, which contradicts the previously held belief that more instances of melanoma were detected in transplant recipients simply because they were subject to more intensive screening.

The study showed that in fact the greatest increase was not for localized melanomas that are likely to be detected during screening, but rather for regional-stage melanomas that have already begun to spread. One factor considered likely responsible for the increase in the incidence of melanoma among transplant patients is the presence of immunopressive drugs. These drugs are, of course, required treatment for all transplant patients in order to help prevent the body from rejecting the transplanted organ, and patients must take them for their entire lives. Based on this study, we now know that more intensive melanoma screening for organ transplant patients, both before and after surgery, is imperative. Dr. Robbins said, “Closer dermatological monitoring of transplant recipients, particularly within the first 4 years after transplantation, could enable earlier detection of melanoma and help prevent patients from developing metastatic disease.”

In summary, the conclusion reached by the study is that melanoma is not only more common in patients who had received a transplant, but that the risk of mortality is greater because the disease behaves more aggressively in the presence of transplant-related immunosuppressive drugs.

The old adage that “it is better to be safe than sorry,” arguably applies to everyone when it comes to screening for melanoma, but it most definitely applies to transplant patients who should have regular dermatological checkups in order to detect this terrible disease as early as possible.

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The beauty of a mommy makeover


The mommy makeover is one of the most common procedures plastic surgeons – including myself -perform. The mommy makeover is a combination of breast surgery and tummy tuck to restore the shape of the breasts and stomach to their pre-pregnancy states.

The breast surgery can either be a lift, a lift with implants placed or can involve surgery to the nipple areolar complex if needed. Some women only need the breasts repositioned after pregnancy. The milk engorgement, nursing, hormones and changes that occur for the breasts during pregnancy and nursing can make the breasts feel and look flatter and lower than prior to pregnancy. This is also something that naturally happens as we age, so there can be a combination of factors at play. In this case, a breast lift alone may be the only breast surgery needed.

Sometimes, projection of the breast is the major issue and an implant can be placed under the muscle or on top of the muscle to regain some of the projection of the more youthful breast. There are times when both a lift and augmentation are needed to achieve desired result.

One area that we do not talk about as much is the nipple areolar complex. The nipple itself can become elongated from nursing and hormone changes, and the areola itself can look larger once the breast has been stretched with pregnancy or weight gain. The areola itself can be reduced in size, as can the nipple. This can be done in combination with either a breast lift or a breast lift with augmentation, and can be performed alone also.

For the tummy tuck portion of the mommy makeover, there are also a couple of different options. The first is a mini tummy tuck that can be performed through a smaller incision like a C-section scar. This can be performed for women who have had C-sections or for women who have not. This is less invasive than a full tummy tuck, but not everyone is a candidate. A full tummy tuck is a longer incision than the mini tummy tuck incision and can incorporate an old C-section scar and revise it. Both of these surgery options can be performed in women with and without C-sections and both involve removing the excess skin on the abdomen. One area of the tummy tuck that most people are not aware of that I commonly do is a diastasis repair. The diastasis is the longitudinal fibrous tissue of the abdomen that separates the “six pack” of the abdominal muscles, and has commonly been spread by the stretching of the abdomen with pregnancy. When women say they cannot get their waist back after pregnancy, this is usually why. The fibrous tissue between the abdominal muscles has been spread out, and no amount of sit-ups will return the fibrous tissue to its original state. With a tummy tuck, I can go in and repair the diastases, essentially cinching the waste back down to give women back their natural hourglass curve.

The mommy makeover is one of our highest satisfaction procedures. To see what type of breast and abdominal surgery combination is right for you, please come in for your complimentary consultation with Dr. Timothy Janiga.

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What is Otoplasty, and Who is a Good Candidate?


Otoplasty is a procedure performed on children and adults who would like to have their ears lay flatter against their head or who would like the shape of the ear changed. Most people believe otoplasty is only a procedure that pins the ear back to the head, or what’s called “ear pinning.” However, by definition it also includes procedures where the shape of the ear is changed. There are many reasons why people want to change the shape of the ear – including genetic abnormalities – but there can also be cosmetic reasons for the procedure.

When people are exposed to new social situations such as starting a new school, entering a new class, starting a new job or entering college, they may be exposed to a new set of people and feel uncomfortable if their ears do not lay flat against the head or if their ears have an abnormal shape. This is especially common in people with short hair and in those who wear their hair in a ponytail for particular activities. It may not have bothered the person when they were younger, but when these situations arise, ear shape or prominence may begin to bother them.

Otoplasty is performed in children to remove the prominence of the ears or to reshape an abnormally shaped ear the child was born with. With children, this procedure usually needs to be done in the operating room. The downtime after surgery is minimal, but anesthesia can make a child tired for about a week after a procedure.

For adults, both ear pinning and ear reshaping can be performed under local anesthesia in the office in most circumstances. The downtime is minimal, but for more involved cases there can be some discomfort for about a week.

If you or your child is having difficulty with the shape
or prominence of the ears, please call 775-398-4602 to make an appointment to see Dr. Timothy Janiga for a consultation.

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