Standard Face Lift Clinically known as rhytidectomy, the goal of a facelift is to tighten the face, jowls, chin, and neck by lifting the skin and repositioning the underlying tissue and supportive muscles for an enduring natural look. Dr. Peebles will begin your procedure by making incisions just behind the hairline, around the temples, along the contour of the ear, and behind the earlobe. A small incision may be placed under the chin for neck work. The skin will be separated from the underlying fat and muscle. Excess fat may be removed from the neck and chin area. The underlying skin and muscle tissue are then lifted, repositioned, and tightened with any excess tissue being excised to smooth creases eliminate jawling, and create a naturally youthful contour to the face and neck. Mini-Facelift Less invasive than a standard facelift, patients with a mild degree of jawling and sagging skin are good candidates for this procedure. Depending on the extent of the correction and your personal preference, the procedure may be performed in-office using local anesthesia with sedation rather than in the hospital using general anesthesia. Dr. Peebles will make shorter incisions than those used in the standard facelift typically along the hairline above each ear and/or in the natural creases surrounding the ear. The skin and underlying structural tissues around the cheeks are then lifted and tightened to refine the jawline.

Brow Lift A brow lift, also referred to as a forehead lift addresses the area above the eyes to correct a drooping forehead and any horizontal lines and furrows. A brow lift may be performed at the same time as a facelift, to provide a smoother look to the overall face and commonly includes eyelid surgery (blepharoplasty) to obtain a youthful and harmonious appearance. Plastic surgeons use different techniques for brow lift surgery; which is best depends on your goals, unique anatomy, and the extent of corrections needed to achieve the desired results. Surgical options include: - Endoscopic Brow Lift - Temporal or Limited Incision Brow Lift - Classic or Coronal Brow Lift

Eyelid Surgery Eyelid surgery is a highly individualized procedure that can address sagging skin, smooth wrinkles, eliminate fat deposits, and correct other signs of aging around the upper and lower eyelids. Depending on the extent of the surgery and your preference, eyelid surgery can be performed in the office using a local anesthetic and sedation. - Upper Eyelid Surgery Sagging, wrinkled skin on the upper eyelids can cause the eyes to lack a contoured appearance as well as obscure vision. Upper eyelid surgery effectively addresses this. Dr. Peebles will map out the exact amount of tissue to be removed being careful to accurately measure each eye to ensure symmetry. The surgery typically involves an incision made in the natural crease above the eye after which a precise amount of excess tissue will be removed. Surrounding muscles may be adjusted to make the desired improvements - Lower Eyelid Surgery Lower eyelid surgery can be an excellent solution to correct puffiness caused by herniated fat that collects beneath the eyes. There are a variety of surgical techniques from which Dr. Peebles may choose to improve the lower eyelids. Incisions may be located on the outer edge of the lower eyelid, just beneath the eyelashes or inside the eyelid. Through the incisions, Dr. Peebles will remove or reposition fat to create a smooth, natural contour beneath the eyelid. Depending on the case, excess, sagging skin may be removed or the lower eyelid muscle may be tightened to provide the most natural, effective results. Dr. Peebles will thoroughly explain the alternatives and recommend the approach he believes is best for you.

Neck Lift A neck lift or lower rhytidectomy is a surgical procedure that improves visible signs of aging in the jawline and neck. It can treat excess fat, laxity, or jawling in the lower face; excess fatty deposits under the chin; loose neck skin; muscle banding that has created abnormal contours of the neck. Dr. Peebles may choose either local anesthetic and IV sedation or general anesthesia depending on your preference and the difficulty of the procedure. In consultation with you and based on your goals, he will choose between a traditional neck lift incision or a limited incision neck lift. - The traditional neck lift incision generally begins in the hairline of the sideburn, continuing down and around the ear into the hair at the back of the neck. Fat from the jowls and neck may be reshaped, redistributed, or removed. The skin will be separated from the underlying tissue allowing the tissue to be lifted and repositioned and the thin supportive underlying muscle of the neck, platysma to be tightened. Any excess skin will be removed as it is placed back over the underlying tissue. A separate incision under the chin may be required for liposuction of the area and/or to repair the muscle. - A limited incision neck lift will generally involve incisions around the ear only. These incisions are shorter and the surgery is less invasive. However, the results will be more limited and may be less enduring.

Breast augmentation uses implants or fat transfer to increase breast size, restore volume, achieve a more rounded shape or address asymmetries in breast size.

A breast lift raises the breasts by removing excess skin and tightening the surrounding tissue to create a new breast contour.

A breast reduction removes excess tissue to alleviate the discomfort of excessively large breasts or create a more proportionate and esthetically pleasing appearance.

Breast Implant Removal or Exchange

Breast implant revision can change the size of implants, address capsular contracture, change the composition or style of the implant or replace implants that have ruptured or migrated.

Abdominoplasty (i.e. ‘tummy tuck’) An abdominoplasty removes excess fat and skin in the abdomen as well as restores weakened or separated central abdominal muscles to create a smoother, flatter, and firmer surface. Common reasons for choosing this surgery are to remedy an abdomen that protrudes, is loose, or is sagging due to weight loss or fluctuations, pregnancy, aging, or prior surgery. When considering a tummy tuck, it is important to understand that post-surgery fluctuations in weight can affect the efficacy and longevity of this procedure. Tummy tucks are considered ‘invasive’ procedures and those individuals who are planning to lose significant additional weight or women considering future pregnancies may choose to postpone a ‘tummy tuck’. Tummy tucks performed by Dr. Peebles are performed under general anesthesia. The incision is horizontal and oriented between the pubic hairline and the belly button. Its shape and length are determined by the amount of excess skin. Upon lifting the abdominal skin, any weakened or damaged underlying abdominal muscles will be repaired with permanent sutures. Should it be necessary to remove excess skin in the upper abdomen, a second incision around the navel may be required. The abdominal skin will be pulled down to the incision site with any excess skin trimmed prior to suturing the tightened surface. A new opening for the navel will be created allowing it to pop through to the surface and be sutured into position. There are some patients, particularly after bariatric surgery and massive loss, who also require a vertical excision of skin to maximally improve their abdominal contour.

Thigh Lift A thigh lift reduces and ‘redrapes’ excess skin (and fat) to achieve a smoother and more contoured upper leg. A local anesthetic or general anesthesia will be administered depending on the complexity of the surgery and your personal preference. Depending on your goals, the elasticity of your skin, and the extent of the revision, Dr. Peebles may recommend liposuction as a viable alternative. Inner thigh lift There are several avenues from which Dr. Peebles may choose depending on your goals and the elasticity of your skin. One technique places an incision in the groin, extending downward and wrapping around the back of the thigh. Another technique removes excess skin from the groin down to the knee using an incision along the inseam. If the thigh doesn’t require extensive revision, a minimal incision inner thigh lift with an incision only in the groin area may be performed. Outer thigh lift An outer thigh lift typically involves an incision that begins at the groin, extends around the hip and across the back. Although incisions will be extensive, Dr. Peebles will use advanced techniques to place them where they will be hidden by most clothing and swimsuits.

Liposuction Liposuction removes excess fat deposits from areas of concern and improves the body’s contours and proportions. It can usually be performed concurrently with other aesthetic surgical procedures such as facelift, breast reduction, or abdominoplasty (i.e. ‘tummy tuck’). Target areas include: - Thighs - Hips and buttocks - Abdomen and waist - Upper arms - Back - Inner knee - Chest area - Cheeks, chin, and neck - Calves and ankles It is important to recognize that liposuction is not a modality for weight loss nor is it a replacement for a proper diet, exercise, and healthy lifestyle choices. It is also not an effective treatment for cellulite or loose saggy skin. Prior to performing liposuction, Dr. Peebles will thoroughly discuss your goals and expectations. Immediately prior to your surgery, he will meticulously map out the areas to be treated in order to assure symmetry and a harmonious contour of the areas to be treated. Depending on the complexity of the surgery, light oral sedation or general anesthesia may be administered. Liposuction involves small, inconspicuous incisions. Local anesthesia will be infused into the surgical site through these incisions to reduce bleeding and trauma. Then a thin hollow tube, or cannula, is inserted and Dr. Peebles will use a controlled up and down or back and forth motion to loosen excess fat. Once dislodged, the fat is suctioned out of the body using a surgical vacuum or syringe attached to the cannula.

Breast Surgery for Men Gynecomastia is a condition of overdeveloped or enlarged breasts in men. It is characterized by excess localized fat, excess glandular tissue development, and sometimes excess skin. Gynecomastia can occur at any age and may result from hormonal changes, heredity, obesity, and as a side effect from using certain drugs. There are several procedures to address gynecomastia depending on the extent. Depending on the complexity of the surgery and your personal preference, local anesthesia with IV sedation or general anesthesia may be administered. - Liposuction When gynecomastia presents as excess fatty tissue, liposuction techniques alone may be used. This requires the insertion of a thin hollow tube (i.e ‘cannula’) through several small incisions. Dr. Peebles will then manipulate the cannula to loosen the excess fat, which is then removed from the breast using suction. There are various liposuction techniques that can be used and Dr. Peebles will make recommendations based upon your unique needs. - Excision techniques Excisional techniques are required when gynecomastia involves glandular breast tissue and/or excess skin. Dr. Peebles will do a complete evaluation of the breast to assess its structure and appearance. Based on your unique needs, he will discuss the various excisional options and make a recommendation. - Combination Liposuction and Excision Techniques Under some circumstances, gynecomastia may be best addressed by a combination of liposuction and excision.

Injectables and Fillers provide a more affordable and less invasive alternative to surgical procedures.

Botox (Onabotulinum toxin A) At Phase 4, Botox is our preferred injectable. Of all the botulinum toxins, Botox has been widely investigated and scrutinized by medical researchers and it remains the ‘gold standard’ that injectables of this class are compared to. Its FDA-approved applications are vast and span well beyond cosmetic procedures to treat conditions such as hyperhidrosis, migraine headaches, gastric reflux, urinary incontinence, hand contractures, etc. As a result, we believe it is among the safest alternatives on the market. When Botox is administered to specific muscles in the face, it blocks the nerve signals from activating muscle contractions. By weakening the targeted muscles, the ability to perform wrinkle-producing facial expressions is reduced and fine lines and wrinkles are softened. Botox is an advanced treatment that is relatively comfortable, quick, and can provide tremendous results. Depending on your individual metabolism, treatments are typically needed every three to four months.

Fat Transfer Fat transfer, fat grafting, fat injection are all terms used to describe the process of using excess fat from your own body to augment areas that need more volume. It is a procedure with the potential to produce long-lasting and natural-looking results. Fat extraction is typically done using one of two liposuction techniques in which Dr. Peebles will harvest fat by first inserting a thin tube(‘cannula’) connected to a syringe into a suitable fat ‘donor’ site and gently suction this fat out. The fat is then cleaned and processed for grafting. Specialized cannulas or microcannulas are then used to transfer the fat to those areas requiring augmentation or enhancement. Fat transfer may be a good alternative if you desire: - A more natural approach to adding volume to laugh lines, crow’s feet, and smile lines - Greater volume in your hands - A more enduring filler solution

Juvederm Vollure™ XC and Juvederm® XC These filler gels create a smoother appearance by addressing moderate to severe wrinkles of the face and nasolabial folds. They can also improve depressions that are the result of acne or other skin irritations. Lidocaine in the gel improves the comfort of the injection by reducing sensitivity to pain. The results are clinically proven to last up to 18 months with optimal treatment using maintenance injections at 8 to 9 months to extend the results by replacing any filler that has been metabolized by the body. Juvederm Voluma® XC Developed to target loss of volume in the cheeks, Voluma® XC rebuilds the mid-face by providing a lift to areas that are lax, flattened, or gaunt. It can also be used to augment the chin area of the face. The results are clinically proven to last up to two years with optimal treatment. Juvederm® Ultra XC Whether your lips have thinned over time or you simply want to increase their fullness for aesthetic reasons, Juvederm® Ultra XC temporarily plumps and adds more volume. It is also approved for smoothing and correcting moderate to severe parentheses lines, such as nasolabial folds (smile lines around the nose and mouth. The longevity of Juvederm® Ultra XC can be as much as 12 months with optimal treatment. Juvederm Volbella® XC New to the Juvederm family and thinner than Ultra XC, Volbella® XC was developed for lip augmentation to correct create more subtle firmness and address the fine perioral lines around the mouth. It can last for as long as 12 months with optimal treatment.

RADIESSE® and [RADIESSE® (+) with the added benefit of lidocaine] are used for smoothing moderate to severe facial wrinkles and folds of the lower face such as smile lines, marionette lines, pre-jowl folds, corners of the mouth, and chin wrinkles. RADIESSE® is also used for correcting volume loss in the back of the hands. Once injected, it provides immediate volume and correction and continues to work by stimulating the body to produce its own natural collagen for a long-lasting effect. Treatment longevity differs from person to person and generally lasts 12 to 18 months, however in a clinical study nearly a third of patients continued to show improvement at least 30 months after their last injection.

Restylane® and Restylane-L® Restylane® is a hyaluronic acid gel used to add volume and fullness to the skin to correct moderate to severe facial wrinkles and folds such as the nasolabial folds. It is also indicated for lip augmentation. In a clinical study, 95% of patients continued to see improvement 18 months after treatment. Restylane Lyft Formerly known as Perlane-L, Restylane Lyft is used to treat volume loss and add fullness to the cheeks, mid-face area, and hands. In clinical trials, nearly three-quarters of patients who received injections continued to see improvement 12 months after facial injections and 6 months after injections into the hands. Restylane Silk As we get older, the mouth often betrays our age with thinning lips, lost shape, and an increase in vertical lines above and below the lip. Restylane Silk was designed to provide natural-looking results by using smaller and smoother hyaluronic acid particles than those used in other Restylane products. Restylane Kysse Using the next generation of hyaluronic fillers with its new XpresHAnTM technology that ensures flexible movement and more natural-looking volume proven to last for up to 12 months, Kysse enhances the texture and color of the lips while maintaining a full range of expressions. Restylane® Defyne and Refyne Crafted with Hyaluronic Acid next-generation XpresHAnTM technology, Refyne, and Defyne (for deeper lines) smooth out laugh lines (nasolabial folds and marionette lines) to restore a more youthful appearance without sacrificing your natural facial expressions.

Sculptra® Aesthetic is a longer-lasting filler that provides subtle results while gradually replacing lost collagen—an underlying cause of facial aging over time. Unlike hyaluronic acid fillers, the main component in Sculptra® is poly-L-lactic acid. It produces more gradual yet profound results and is designed for shallow and deep folds and wrinkles. It is a great choice for women who want a more subtle but completely natural-looking transformation to looking rested and younger. In a clinical trial, approximately eighty percent of patients continued to see results 25 months after their last injection.

Skin rejuvenation treatments are non-surgical procedures with little or no downtime that address concerns such as fine lines and wrinkles, skin laxity, uneven skin tone, hyperpigmentation, and damaged capillaries and blood vessels.

Microdermabrasion Microdermabrasion is an exfoliative treatment that buffs away the skin’s outermost layer of dull dead cells to increase its smoothness and luminosity. As an anti-aging therapy, it stimulates cellular turnover, the production of collagen and elastin and can increase the penetration of topical serums. It can easily be incorporated into a full facial treatment. At Phase 4, we use a specialized handpiece that sprays purified microcrystals of salt onto the skin while vacuuming away dead skin cells and spent crystals. It is akin to the process of ‘sand-blasting yet much gentler and safer for even the most delicate skin. If you have any of these concerns, microdermabrasion is a gentle cost-effective treatment with no downtime. - Fine lines, wrinkles, dull appearance, loss of luminosity - Post-inflammatory hyperpigmentation, melasma, or other minor pigmentation problems - Mild scarring resulting from acne or other trauma A team favorite is our customized facial protocol that combines microdermabrasion, therapeutic face masques, ultrasound delivery of serums and the Celluma LED Light Therapy panel to address your skincare concerns.

Chemical Peels Chemical Peels are among the most popular non-invasive cosmetic procedures available to rejuvenate the skin. They can soften fine lines, wrinkles, and acne scars, address uneven pigmentation, increase the skin’s luminosity and smooth textural irregularities of the face, neck, and hands. Chemical Peels are performed at various levels, depending on each patient’s individual goals. - Superficial peels, often referred to as lunchtime peels, are directed toward the outer layers of the epidermis and provide a safe and effective exfoliating treatment for increasing the skin’s luminosity and minimizing the appearance of fine lines, pigmentation abnormalities, and acne scars. Some can be safely incorporated into a traditional facial treatment and combined with microdermabrasion and ‘Celluma’ LED Light Therapy. There is little to no downtime and visible skin peeling is minimal to none. - Medium depth peels penetrate deeper into the dermis, the living layers of the skin, and use more aggressive ingredients at higher levels of concentration. They facilitate the restructuring of the skin’s cellular matrix by stimulating the production of cellular and elastin and increasing the rate of healthy cellular growth. Because the skin will go through a visible peeling process, some patients prefer a downtime of several days, perhaps as long as a week depending on the specific peeling agent. - Deep Peels are the most powerful chemical peels and can produce dramatic and permanent results. They are used to address deep lines, more severe acne scars, and extensive sun damage. Because of their aggressiveness, there is a recovery period of one to two weeks. Given the variation of chemical peels in terms of depth, composition, and results, we recommend a consultation with a member of our skincare team to explore your goals, assess your commitment to downtime, and determine a peel that will safely and effectively address your concerns. Superficial and medium-depth chemical peels are most effective when performed as a series.

‘ProCell’ Micro channeling and Somatic Cell Therapy Developed by a licensed and board-certified dermatologist here in the United States, the ‘ProCell’ micro channeling system improves the appearance of aging and damaged skin by reducing the appearance of fine lines, wrinkles, and acne scarring, addressing uneven skin tone and hyperpigmentation, and increasing skin tone and vitality. It is a highly effective treatment for certain types of baldness and can be used to increase the penetration of topical hair loss serums. If you have any of these concerns, the ‘ProCell’ system is an effective treatment with minimal to no downtime. Typical indications are: - Fine lines, wrinkles, skin laxity, dull appearance, loss of luminosity - Post-inflammatory hyperpigmentation, melasma, or other minor pigmentation problems - Mild scarring resulting from acne or other trauma - Skin damage from the sun, weather, environmental toxins, and smoking - Stretch marks Micro channeling creates minute perforations in the skin which initiate a healing cascade to trigger cells to produce collagen and elastin – the building blocks of healthy, youthful skin. After performing the micro channeling, a certified clinical staff member will apply one of ‘ProCell’s’ proprietary growth serums that are an alternative to platelet-rich plasma and eliminate the need for performing and processing a potentially uncomfortable blood draw. The key ingredients of ‘ProCell’’s growth serums are Somatic CytokinesTM which are ethically derived and replicated from a laboratory culture of human bone marrow mesenchymal somatic cells obtained from medically monitored, healthy young paid volunteers and processed in FDA regulated and compliant facilities. Mesenchymal somatic cells are essential to effective healing. Their number decline with age leading to increased inflammation and longer healing times. Somatic Cytokines™ applied to the skin mimics the effect of having more somatic cells thereby decreasing inflammation and promoting protein synthesis. In addition to Somatic CytokinesTM, ‘Pro-Cell’ growth serums contain: - Hyaluronic acid - Vitamins C, E, B5, and A - Co-enzyme Q10 for increased cellular energy - Ceramide 2 for the repair of the skin’s essential barrier function - Botanical antioxidants Micro channeling is safe for all skin types and can be combined with our ‘Celluma’ LED Light Therapy to increase effectiveness. Its results are cumulative and optimized through a series of monthly treatments. Dr. Peebles and his aesthetic team will work with you to assess your goals and implement a plan that best meets your needs.

Celluma LED Light Therapy

The FDA-cleared ‘Celluma’ is a gentle therapeutic alternative that is designed to improve skin health from the inside out by working at the cellular level to affect change. It delivers low-level LED Light Therapy that has been scientifically demonstrated to stimulate cellular activity where it counts most - within the deepest layers of the skin. ‘Celluma’ LED Light Therapy treatments: - Are low-intensity, non-invasive, and non-ablative - Work without generating thermal heat - Effectively treat inflammatory acne - Increase cellular turnover, improve circulation and the delivery of nutrients to the skin, facilitate the production of collagen and elastin - Address the appearance of fine lines and wrinkles, skin laxity, minor pigmentation problems, and mild scarring - Stimulate lymphatic activity and reduce post-surgical inflammation If you have any of these concerns, ‘Celluma’ is an exceptional, non-invasive treatment with no downtime. - Moderate to severe acne - Mild scarring as a result of past acne breakouts - Skin damage from the sun, weather, environmental toxins, and smoking - Post-inflammatory hyperpigmentation, melasma, or other minor pigmentation problems - Fine lines, wrinkles, skin laxity, dull appearance, loss of luminosity During your session, your skincare therapist will adjust ‘Celluma’s’ proprietary flexibly panel to conform to your face or areas on your body and choose either Red, Blue, Infrared, or a combination of these wavelengths to address your skincare concerns. Sessions are a mere 30 minutes long and can be easily combined with other skincare modalities. An initial series of two to three sessions per week is recommended to maximize your results.

EndyMed Intensif The EndyMed Intensif Radio Frequency(RF) and Microneedle system is an FDA-cleared skin rejuvenation technology designed for both the face and body. It is a minimally invasive therapy that uses collagen induction therapy via micro-needling and focused radio frequency to: - Improve the skin’s texture - Reduce the appearance of fine lines, wrinkles, and minor scarring - Reduce the appearance of cellulite - Tighten the contours of the face, neck, and body The EndyMed instrument is among the most advanced skin rejuvenation therapies on the market. Its sophisticated 3DeepTM technology generates the ideal combination of multiple fields of energy to create optimal and painless remodeling of the skin’s cellular matrix. Using microneedles in harmony with fractional radio-frequency allows the EndyMed to safely deliver thermal energy to trigger the body’s natural healing process and promote the production of collagen and elastin thereby tightening the skin and reducing the appearance of fine lines, wrinkles, and mild scarring. When 3DeepTM thermal energy is directed toward fat deposits, it engages and accelerates the metabolic processing of fat and diminishes the appearance of cellulite. EndyMed treatments performed at Phase 4 include: - Body Contouring – reduce the appearance of cellulite; shape abdomen, thighs, and buttocks - Body Tightening – chest, abdomen, upper arms, thighs, and knees - Facial Tightening – jawline, neck, upper eye hooding, under-eye laxity - Skin Rejuvenation – diminish the appearance of fine lines and wrinkles, mild scarring from acne or trauma, and stretch marks An EndyMed treatment is typically 30 minutes in length. The procedure is generally well tolerated with little discomfort and downtime. Occasionally topical anesthetics are used as needed or desired. Based upon your goals, Dr. Peebles will customize a series of treatments spaced approximately four weeks apart to ensure optimal results.

A facial deeply cleanses pores by exfoliating dead skin cells and extracting blackheads. It includes facial massage and a customized mask to address your skin care concerns.

Massage services include relaxing Swedish and Hot Himalayan Salt Stone, Deep Tissue to alleviate muscular tension, and Lymphatic Drainage to reduce inflammation and eliminate toxins.

Plastic Surgery Glossary | Phase 4 Plastic Surgery

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Glossary

Facial Procedures

Face Lift

Standard Face Lift

Clinically known as rhytidectomy, the goal of a facelift is to tighten the face, jowls, chin, and neck by lifting the skin and repositioning the underlying tissue and supportive muscles for an enduring natural look.

Dr. Peebles will begin your procedure by making incisions just behind the hairline, around the temples, along the contour of the ear, and behind the earlobe. A small incision may be placed under the chin for neck work. The skin will be separated from the underlying fat and muscle. Excess fat may be removed from the neck and chin area. The underlying skin and muscle tissue are then lifted, repositioned, and tightened with any excess tissue being excised to smooth creases eliminate jawling, and create a naturally youthful contour to the face and neck.

Mini-Facelift

Less invasive than a standard facelift, patients with a mild degree of jawling and sagging skin are good candidates for this procedure. Depending on the extent of the correction and your personal preference, the procedure may be performed in-office using local anesthesia with sedation rather than in the hospital using general anesthesia. Dr. Peebles will make shorter incisions than those used in the standard facelift typically along the hairline above each ear and/or in the natural creases surrounding the ear. The skin and underlying structural tissues around the cheeks are then lifted and tightened to refine the jawline.
Brow Lift

Brow Lift

A brow lift, also referred to as a forehead lift addresses the area above the eyes to correct a drooping forehead and any horizontal lines and furrows. A brow lift may be performed at the same time as a facelift, to provide a smoother look to the overall face and commonly includes eyelid surgery (blepharoplasty) to obtain a youthful and harmonious appearance.

Plastic surgeons use different techniques for brow lift surgery; which is best depends on your goals, unique anatomy, and the extent of corrections needed to achieve the desired results. Surgical options include:

- Endoscopic Brow Lift
- Temporal or Limited Incision Brow Lift
- Classic or Coronal Brow Lift
Eyelid Lift

Eyelid Surgery

Eyelid surgery is a highly individualized procedure that can address sagging skin, smooth wrinkles, eliminate fat deposits, and correct other signs of aging around the upper and lower eyelids. Depending on the extent of the surgery and your preference, eyelid surgery can be performed in the office using a local anesthetic and sedation.

- Upper Eyelid Surgery
Sagging, wrinkled skin on the upper eyelids can cause the eyes to lack a contoured appearance as well as obscure vision. Upper eyelid surgery effectively addresses this. Dr. Peebles will map out the exact amount of tissue to be removed being careful to accurately measure each eye to ensure symmetry. The surgery typically involves an incision made in the natural crease above the eye after which a precise amount of excess tissue will be removed. Surrounding muscles may be adjusted to make the desired improvements

- Lower Eyelid Surgery
Lower eyelid surgery can be an excellent solution to correct puffiness caused by herniated fat that collects beneath the eyes. There are a variety of surgical techniques from which Dr. Peebles may choose to improve the lower eyelids. Incisions may be located on the outer edge of the lower eyelid, just beneath the eyelashes or inside the eyelid. Through the incisions, Dr. Peebles will remove or reposition fat to create a smooth, natural contour beneath the eyelid. Depending on the case, excess, sagging skin may be removed or the lower eyelid muscle may be tightened to provide the most natural, effective results. Dr. Peebles will thoroughly explain the alternatives and recommend the approach he believes is best for you.
Neck Lift

Neck Lift

A neck lift or lower rhytidectomy is a surgical procedure that improves visible signs of aging in the jawline and neck. It can treat excess fat, laxity, or jawling in the lower face; excess fatty deposits under the chin; loose neck skin; muscle banding that has created abnormal contours of the neck. Dr. Peebles may choose either local anesthetic and IV sedation or general anesthesia depending on your preference and the difficulty of the procedure. In consultation with you and based on your goals, he will choose between a traditional neck lift incision or a limited incision neck lift.

- The traditional neck lift incision generally begins in the hairline of the sideburn, continuing down and around the ear into the hair at the back of the neck. Fat from the jowls and neck may be reshaped, redistributed, or removed. The skin will be separated from the underlying tissue allowing the tissue to be lifted and repositioned and the thin supportive underlying muscle of the neck, platysma to be tightened. Any excess skin will be removed as it is placed back over the underlying tissue. A separate incision under the chin may be required for liposuction of the area and/or to repair the muscle.

- A limited incision neck lift will generally involve incisions around the ear only. These incisions are shorter and the surgery is less invasive. However, the results will be more limited and may be less enduring.

Breast Enhancements

Breast Augmentation

Breast augmentation uses implants or fat transfer to increase breast size, restore volume, achieve a more rounded shape or address asymmetries in breast size.
Breast Lift

A breast lift raises the breasts by removing excess skin and tightening the surrounding tissue to create a new breast contour.
Breast Reduction

A breast reduction removes excess tissue to alleviate the discomfort of excessively large breasts or create a more proportionate and esthetically pleasing appearance.
Breast Implant Removal or Exchange

Breast implant revision can change the size of implants, address capsular contracture, change the composition or style of the implant or replace implants that have ruptured or migrated.

Body Contouring

Tummy Tuck

Abdominoplasty (i.e. ‘tummy tuck’)

An abdominoplasty removes excess fat and skin in the abdomen as well as restores weakened or separated central abdominal muscles to create a smoother, flatter, and firmer surface. Common reasons for choosing this surgery are to remedy an abdomen that protrudes, is loose, or is sagging due to weight loss or fluctuations, pregnancy, aging, or prior surgery. When considering a tummy tuck, it is important to understand that post-surgery fluctuations in weight can affect the efficacy and longevity of this procedure. Tummy tucks are considered ‘invasive’ procedures and those individuals who are planning to lose significant additional weight or women considering future pregnancies may choose to postpone a ‘tummy tuck’.

Tummy tucks performed by Dr. Peebles are performed under general anesthesia. The incision is horizontal and oriented between the pubic hairline and the belly button. Its shape and length are determined by the amount of excess skin. Upon lifting the abdominal skin, any weakened or damaged underlying abdominal muscles will be repaired with permanent sutures. Should it be necessary to remove excess skin in the upper abdomen, a second incision around the navel may be required. The abdominal skin will be pulled down to the incision site with any excess skin trimmed prior to suturing the tightened surface. A new opening for the navel will be created allowing it to pop through to the surface and be sutured into position. There are some patients, particularly after bariatric surgery and massive loss, who also require a vertical excision of skin to maximally improve their abdominal contour.
Thigh Lift

Thigh Lift

A thigh lift reduces and ‘redrapes’ excess skin (and fat) to achieve a smoother and more contoured upper leg. A local anesthetic or general anesthesia will be administered depending on the complexity of the surgery and your personal preference. Depending on your goals, the elasticity of your skin, and the extent of the revision, Dr. Peebles may recommend liposuction as a viable alternative.

Inner thigh lift

There are several avenues from which Dr. Peebles may choose depending on your goals and the elasticity of your skin. One technique places an incision in the groin, extending downward and wrapping around the back of the thigh. Another technique removes excess skin from the groin down to the knee using an incision along the inseam. If the thigh doesn’t require extensive revision, a minimal incision inner thigh lift with an incision only in the groin area may be performed.

Outer thigh lift

An outer thigh lift typically involves an incision that begins at the groin, extends around the hip and across the back. Although incisions will be extensive, Dr. Peebles will use advanced techniques to place them where they will be hidden by most clothing and swimsuits.
Liposuction

Liposuction

Liposuction removes excess fat deposits from areas of concern and improves the body’s contours and proportions. It can usually be performed concurrently with other aesthetic surgical procedures such as facelift, breast reduction, or abdominoplasty (i.e. ‘tummy tuck’). Target areas include:

- Thighs
- Hips and buttocks
- Abdomen and waist
- Upper arms
- Back
- Inner knee
- Chest area
- Cheeks, chin, and neck
- Calves and ankles

It is important to recognize that liposuction is not a modality for weight loss nor is it a replacement for a proper diet, exercise, and healthy lifestyle choices. It is also not an effective treatment for cellulite or loose saggy skin.

Prior to performing liposuction, Dr. Peebles will thoroughly discuss your goals and expectations. Immediately prior to your surgery, he will meticulously map out the areas to be treated in order to assure symmetry and a harmonious contour of the areas to be treated. Depending on the complexity of the surgery, light oral sedation or general anesthesia may be administered. Liposuction involves small, inconspicuous incisions. Local anesthesia will be infused into the surgical site through these incisions to reduce bleeding and trauma. Then a thin hollow tube, or cannula, is inserted and Dr. Peebles will use a controlled up and down or back and forth motion to loosen excess fat. Once dislodged, the fat is suctioned out of the body using a surgical vacuum or syringe attached to the cannula.
Gynecomastia for Men

Breast Surgery for Men

Gynecomastia is a condition of overdeveloped or enlarged breasts in men. It is characterized by excess localized fat, excess glandular tissue development, and sometimes excess skin. Gynecomastia can occur at any age and may result from hormonal changes, heredity, obesity, and as a side effect from using certain drugs. There are several procedures to address gynecomastia depending on the extent.
Depending on the complexity of the surgery and your personal preference, local anesthesia with IV sedation or general anesthesia may be administered.

- Liposuction
When gynecomastia presents as excess fatty tissue, liposuction techniques alone may be used. This requires the insertion of a thin hollow tube (i.e ‘cannula’) through several small incisions. Dr. Peebles will then manipulate the cannula to loosen the excess fat, which is then removed from the breast using suction. There are various liposuction techniques that can be used and Dr. Peebles will make recommendations based upon your unique needs.

- Excision techniques
Excisional techniques are required when gynecomastia involves glandular breast tissue and/or excess skin. Dr. Peebles will do a complete evaluation of the breast to assess its structure and appearance. Based on your unique needs, he will discuss the various excisional options and make a recommendation.

- Combination Liposuction and Excision Techniques
Under some circumstances, gynecomastia may be best addressed by a combination of liposuction and excision.

Aesthetic Services

Injectable Fillers

Injectables and Fillers provide a more affordable and less invasive alternative to surgical procedures.
Botox

Botox (Onabotulinum toxin A)

At Phase 4, Botox is our preferred injectable. Of all the botulinum toxins, Botox has been widely investigated and scrutinized by medical researchers and it remains the ‘gold standard’ that injectables of this class are compared to. Its FDA-approved applications are vast and span well beyond cosmetic procedures to treat conditions such as hyperhidrosis, migraine headaches, gastric reflux, urinary incontinence, hand contractures, etc. As a result, we believe it is among the safest alternatives on the market.

When Botox is administered to specific muscles in the face, it blocks the nerve signals from activating muscle contractions. By weakening the targeted muscles, the ability to perform wrinkle-producing facial expressions is reduced and fine lines and wrinkles are softened. Botox is an advanced treatment that is relatively comfortable, quick, and can provide tremendous results. Depending on your individual metabolism, treatments are typically needed every three to four months.
Fat Transfer

Fat Transfer

Fat transfer, fat grafting, fat injection are all terms used to describe the process of using excess fat from your own body to augment areas that need more volume. It is a procedure with the potential to produce long-lasting and natural-looking results.

Fat extraction is typically done using one of two liposuction techniques in which Dr. Peebles will harvest fat by first inserting a thin tube(‘cannula’) connected to a syringe into a suitable fat ‘donor’ site and gently suction this fat out. The fat is then cleaned and processed for grafting. Specialized cannulas or microcannulas are then used to transfer the fat to those areas requiring augmentation or enhancement.

Fat transfer may be a good alternative if you desire:
- A more natural approach to adding volume to laugh lines, crow’s feet, and smile lines
- Greater volume in your hands
- A more enduring filler solution
Juvederm

Juvederm Vollure™ XC and Juvederm® XC

These filler gels create a smoother appearance by addressing moderate to severe wrinkles of the face and nasolabial folds. They can also improve depressions that are the result of acne or other skin irritations. Lidocaine in the gel improves the comfort of the injection by reducing sensitivity to pain. The results are clinically proven to last up to 18 months with optimal treatment using maintenance injections at 8 to 9 months to extend the results by replacing any filler that has been metabolized by the body.

Juvederm Voluma® XC
Developed to target loss of volume in the cheeks, Voluma® XC rebuilds the mid-face by providing a lift to areas that are lax, flattened, or gaunt. It can also be used to augment the chin area of the face. The results are clinically proven to last up to two years with optimal treatment.

Juvederm® Ultra XC

Whether your lips have thinned over time or you simply want to increase their fullness for aesthetic reasons, Juvederm® Ultra XC temporarily plumps and adds more volume. It is also approved for smoothing and correcting moderate to severe parentheses lines, such as nasolabial folds (smile lines around the nose and mouth. The longevity of Juvederm® Ultra XC can be as much as 12 months with optimal treatment.

Juvederm Volbella® XC

New to the Juvederm family and thinner than Ultra XC, Volbella® XC was developed for lip augmentation to correct create more subtle firmness and address the fine perioral lines around the mouth. It can last for as long as 12 months with optimal treatment.
Radiesse

RADIESSE® and [RADIESSE® (+) with the added benefit of lidocaine] are used for smoothing moderate to severe facial wrinkles and folds of the lower face such as smile lines, marionette lines, pre-jowl folds, corners of the mouth, and chin wrinkles. RADIESSE® is also used for correcting volume loss in the back of the hands. Once injected, it provides immediate volume and correction and continues to work by stimulating the body to produce its own natural collagen for a long-lasting effect. Treatment longevity differs from person to person and generally lasts 12 to 18 months, however in a clinical study nearly a third of patients continued to show improvement at least 30 months after their last injection.
Restylane

Restylane® and Restylane-L®

Restylane® is a hyaluronic acid gel used to add volume and fullness to the skin to correct moderate to severe facial wrinkles and folds such as the nasolabial folds. It is also indicated for lip augmentation. In a clinical study, 95% of patients continued to see improvement 18 months after treatment.

Restylane Lyft

Formerly known as Perlane-L, Restylane Lyft is used to treat volume loss and add fullness to the cheeks, mid-face area, and hands. In clinical trials, nearly three-quarters of patients who received injections continued to see improvement 12 months after facial injections and 6 months after injections into the hands.

Restylane Silk

As we get older, the mouth often betrays our age with thinning lips, lost shape, and an increase in vertical lines above and below the lip. Restylane Silk was designed to provide natural-looking results by using smaller and smoother hyaluronic acid particles than those used in other Restylane products.

Restylane Kysse

Using the next generation of hyaluronic fillers with its new XpresHAnTM technology that ensures flexible movement and more natural-looking volume proven to last for up to 12 months, Kysse enhances the texture and color of the lips while maintaining a full range of expressions.

Restylane® Defyne and Refyne

Crafted with Hyaluronic Acid next-generation XpresHAnTM technology, Refyne, and Defyne (for deeper lines) smooth out laugh lines (nasolabial folds and marionette lines) to restore a more youthful appearance without sacrificing your natural facial expressions.
Scupltra

Sculptra® Aesthetic is a longer-lasting filler that provides subtle results while gradually replacing lost collagen—an underlying cause of facial aging over time. Unlike hyaluronic acid fillers, the main component in Sculptra® is poly-L-lactic acid. It produces more gradual yet profound results and is designed for shallow and deep folds and wrinkles. It is a great choice for women who want a more subtle but completely natural-looking transformation to looking rested and younger. In a clinical trial, approximately eighty percent of patients continued to see results 25 months after their last injection.
Skin Rejuvenation

Skin rejuvenation treatments are non-surgical procedures with little or no downtime that address concerns such as fine lines and wrinkles, skin laxity, uneven skin tone, hyperpigmentation, and damaged capillaries and blood vessels.
Microdermabrasion

Microdermabrasion

Microdermabrasion is an exfoliative treatment that buffs away the skin’s outermost layer of dull dead cells to increase its smoothness and luminosity. As an anti-aging therapy, it stimulates cellular turnover, the production of collagen and elastin and can increase the penetration of topical serums. It can easily be incorporated into a full facial treatment.

At Phase 4, we use a specialized handpiece that sprays purified microcrystals of salt onto the skin while vacuuming away dead skin cells and spent crystals. It is akin to the process of ‘sand-blasting yet much gentler and safer for even the most delicate skin. If you have any of these concerns, microdermabrasion is a gentle cost-effective treatment with no downtime.

- Fine lines, wrinkles, dull appearance, loss of luminosity
- Post-inflammatory hyperpigmentation, melasma, or other minor pigmentation problems
- Mild scarring resulting from acne or other trauma

A team favorite is our customized facial protocol that combines microdermabrasion, therapeutic face masques, ultrasound delivery of serums and the Celluma LED Light Therapy panel to address your skincare concerns.
Chemical Peel

Chemical Peels

Chemical Peels are among the most popular non-invasive cosmetic procedures available to rejuvenate the skin. They can soften fine lines, wrinkles, and acne scars, address uneven pigmentation, increase the skin’s luminosity and smooth textural irregularities of the face, neck, and hands.

Chemical Peels are performed at various levels, depending on each patient’s individual goals.
- Superficial peels, often referred to as lunchtime peels, are directed toward the outer layers of the epidermis and provide a safe and effective exfoliating treatment for increasing the skin’s luminosity and minimizing the appearance of fine lines, pigmentation abnormalities, and acne scars. Some can be safely incorporated into a traditional facial treatment and combined with microdermabrasion and ‘Celluma’ LED Light Therapy. There is little to no downtime and visible skin peeling is minimal to none.
- Medium depth peels penetrate deeper into the dermis, the living layers of the skin, and use more aggressive ingredients at higher levels of concentration. They facilitate the restructuring of the skin’s cellular matrix by stimulating the production of cellular and elastin and increasing the rate of healthy cellular growth. Because the skin will go through a visible peeling process, some patients prefer a downtime of several days, perhaps as long as a week depending on the specific peeling agent.
- Deep Peels are the most powerful chemical peels and can produce dramatic and permanent results. They are used to address deep lines, more severe acne scars, and extensive sun damage. Because of their aggressiveness, there is a recovery period of one to two weeks.

Given the variation of chemical peels in terms of depth, composition, and results, we recommend a consultation with a member of our skincare team to explore your goals, assess your commitment to downtime, and determine a peel that will safely and effectively address your concerns. Superficial and medium-depth chemical peels are most effective when performed as a series.
Micro-Channeling

‘ProCell’ Micro channeling and Somatic Cell Therapy
Developed by a licensed and board-certified dermatologist here in the United States, the ‘ProCell’ micro channeling system improves the appearance of aging and damaged skin by reducing the appearance of fine lines, wrinkles, and acne scarring, addressing uneven skin tone and hyperpigmentation, and increasing skin tone and vitality. It is a highly effective treatment for certain types of baldness and can be used to increase the penetration of topical hair loss serums.

If you have any of these concerns, the ‘ProCell’ system is an effective treatment with minimal to no downtime. Typical indications are:
- Fine lines, wrinkles, skin laxity, dull appearance, loss of luminosity
- Post-inflammatory hyperpigmentation, melasma, or other minor pigmentation problems
- Mild scarring resulting from acne or other trauma
- Skin damage from the sun, weather, environmental toxins, and smoking
- Stretch marks

Micro channeling creates minute perforations in the skin which initiate a healing cascade to trigger cells to produce collagen and elastin – the building blocks of healthy, youthful skin. After performing the micro channeling, a certified clinical staff member will apply one of ‘ProCell’s’ proprietary growth serums that are an alternative to platelet-rich plasma and eliminate the need for performing and processing a potentially uncomfortable blood draw.

The key ingredients of ‘ProCell’’s growth serums are Somatic CytokinesTM which are ethically derived and replicated from a laboratory culture of human bone marrow mesenchymal somatic cells obtained from medically monitored, healthy young paid volunteers and processed in FDA regulated and compliant facilities. Mesenchymal somatic cells are essential to effective healing. Their number decline with age leading to increased inflammation and longer healing times. Somatic Cytokines™ applied to the skin mimics the effect of having more somatic cells thereby decreasing inflammation and promoting protein synthesis. In addition to Somatic CytokinesTM, ‘Pro-Cell’ growth serums contain:

- Hyaluronic acid
- Vitamins C, E, B5, and A
- Co-enzyme Q10 for increased cellular energy
- Ceramide 2 for the repair of the skin’s essential barrier function
- Botanical antioxidants

Micro channeling is safe for all skin types and can be combined with our ‘Celluma’ LED Light Therapy to increase effectiveness. Its results are cumulative and optimized through a series of monthly treatments. Dr. Peebles and his aesthetic team will work with you to assess your goals and implement a plan that best meets your needs.
Celluma LED Light Therapy

The FDA-cleared ‘Celluma’ is a gentle therapeutic alternative that is designed to improve skin health from the inside out by working at the cellular level to affect change. It delivers low-level LED Light Therapy that has been scientifically demonstrated to stimulate cellular activity where it counts most - within the deepest layers of the skin.

‘Celluma’ LED Light Therapy treatments:
- Are low-intensity, non-invasive, and non-ablative
- Work without generating thermal heat
- Effectively treat inflammatory acne
- Increase cellular turnover, improve circulation and the delivery of nutrients to the skin, facilitate the production of collagen and elastin
- Address the appearance of fine lines and wrinkles, skin laxity, minor pigmentation problems, and mild scarring
- Stimulate lymphatic activity and reduce post-surgical inflammation

If you have any of these concerns, ‘Celluma’ is an exceptional, non-invasive treatment with no downtime.

- Moderate to severe acne
- Mild scarring as a result of past acne breakouts
- Skin damage from the sun, weather, environmental toxins, and smoking
- Post-inflammatory hyperpigmentation, melasma, or other minor pigmentation problems
- Fine lines, wrinkles, skin laxity, dull appearance, loss of luminosity

During your session, your skincare therapist will adjust ‘Celluma’s’ proprietary flexibly panel to conform to your face or areas on your body and choose either Red, Blue, Infrared, or a combination of these wavelengths to address your skincare concerns. Sessions are a mere 30 minutes long and can be easily combined with other skincare modalities. An initial series of two to three sessions per week is recommended to maximize your results.
EndyMed

EndyMed Intensif

The EndyMed Intensif Radio Frequency(RF) and Microneedle system is an FDA-cleared skin rejuvenation technology designed for both the face and body. It is a minimally invasive therapy that uses collagen induction therapy via micro-needling and focused radio frequency to:

- Improve the skin’s texture
- Reduce the appearance of fine lines, wrinkles, and minor scarring
- Reduce the appearance of cellulite
- Tighten the contours of the face, neck, and body

The EndyMed instrument is among the most advanced skin rejuvenation therapies on the market. Its sophisticated 3DeepTM technology generates the ideal combination of multiple fields of energy to create optimal and painless remodeling of the skin’s cellular matrix. Using microneedles in harmony with fractional radio-frequency allows the EndyMed to safely deliver thermal energy to trigger the body’s natural healing process and promote the production of collagen and elastin thereby tightening the skin and reducing the appearance of fine lines, wrinkles, and mild scarring. When 3DeepTM thermal energy is directed toward fat deposits, it engages and accelerates the metabolic processing of fat and diminishes the appearance of cellulite.

EndyMed treatments performed at Phase 4 include:
- Body Contouring – reduce the appearance of cellulite; shape abdomen, thighs, and buttocks
- Body Tightening – chest, abdomen, upper arms, thighs, and knees
- Facial Tightening – jawline, neck, upper eye hooding, under-eye laxity
- Skin Rejuvenation – diminish the appearance of fine lines and wrinkles, mild scarring from acne or trauma, and stretch marks

An EndyMed treatment is typically 30 minutes in length. The procedure is generally well tolerated with little discomfort and downtime. Occasionally topical anesthetics are used as needed or desired. Based upon your goals, Dr. Peebles will customize a series of treatments spaced approximately four weeks apart to ensure optimal results.
Facials

A facial deeply cleanses pores by exfoliating dead skin cells and extracting blackheads. It includes facial massage and a customized mask to address your skin care concerns.
Massage

Massage services include relaxing Swedish and Hot Himalayan Salt Stone, Deep Tissue to alleviate muscular tension, and Lymphatic Drainage to reduce inflammation and eliminate toxins.

615-320-9300

info@phase4plasticsurgery.com

2014 Clifton Avenue
Nashville, TN 37203

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615-320-9300

info@phase4plasticsurgery.com

2014 Clifton Avenue Nashville, TN 37203

2014 Clifton Avenue
Nashville, TN 37203