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Category Archives: Ask the Doctor

Ask the Doctor

Ask the Doctor: Does “fat” cause snoring?

Only sort of! New research is coming out that links a fatty liver — a condition that frequently strikes those who are overweight or obese — with sleep apnea. Sleep apnea is characterized by interrupted breathing or snoring during the night, and the severity can range from only a nuisance to deadly.

Studies conducted over the past year have shown that those with fatty livers have a greater than 50% chance of also having sleep apnea. Additionally, the fattier the liver, the more severe the apnea. One theory doctors have is that the loss of oxygen from sleep apnea increases chronic inflammation, worsening the liver.

Although this doesn’t seem like good news, there is a silver lining: Helping one problem tends to help the other. Thus, if you have a fatty liver or sleep apnea, try getting tested — you may have new ways of combating either disease.

Additionally, your sleep apnea might not be related to your liver at all! If this is the case, Dr. Michelle Yagoda is an expert ENT doctor who has treated hundreds of cases of sleep apnea. From allergies to a deviated septum, she will help you fix your breathing problems!

Ask the Doctor, Facial Plastics

Top 8 Reasons to Get a Blepharoplasty

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Blepharoplasty - eye lifts in New York CityEyes: They are the focal point (no pun intended) of your face. You can dress them up with makeup, but if you have serious cosmetic problems in your eye region, you probably look older than you should! Dr. Michelle Yagoda sees all different types of patients who would like to look younger and more refreshed, and, oftentimes, it is all in the eyes! Eyelifts provide permanent and natural solutions to various eye problems and concerns. Think about getting a blepharoplasty – or eye lift – if you…

  1. Want to get rid of bulging fat bags. Dr. Yagoda’s signature Tr-EYE-umph! non-surgical eye lift can temporarily remove fat bags that accumulate under the eyes, but only a surgical blepharoplasty will provide permanent results. Thickened skin and “bags” (pockets of fat) are some of the most common complaints for women in their 30s and 40s. With the tiniest of incisions, the bags will be gone!
  2. Want to tighten your lower lid area and correct tear flow. If you have tear trough depression and a hollow look under your eyes, consider fixing it with non-surgical blepharoplasty. Fillers can be used to eliminate the hollows under the eyes and plump up the tear troughs. Not only will you look refreshed, but volume will be restored in the space between the lower eyelid bags and the upper cheeks, providing symmetry.
  3. Improve your vision. Advancing years often bring reading glasses, uncomfortable dry eyes, and more serious concerns, such as an increased risk of glaucoma, cataracts, and age-related macular degeneration that can make even everyday tasks such as reading and driving next to impossible. Dr. Yagoda will help you decide if your vision can be improved through an eyelift procedure and, if so, what the best one is for you. Eyelifts not only address cosmetic concerns, but they can improve eye health, too.
  4. 4. Improve your overall appearance. It is a well-known fact that the eyes are the first thing most people notice about each other. If you are not happy with how your eyes, eyelids, or under eyes look, you might feel less confident in your daily life. Restore your confidence with a surgical or non-surgical blepharoplasty!
  5.  Want to have a double eyelid. After spending time at the prestigious Otsuka Academy in Tokyo, Japan to operate with the late, expert surgeon Dr. Hidetada Ishii, Dr. Yagoda has perfected the incisionless Asian double eyelid surgery. Hidden, permanent sutures are used to create the upper eyelid crease that many Asian patients desire, and the entire operation is done under local anesthesia in Dr. Yagoda’s office.
  6.  Want to repair skin cancer defects. If you had or have skin cancer around the eye area, any residual defects should be fixed by an expert plastic surgeon. Dr. Yagoda will help determine which surgery is right for you.
  7. Eliminate dark circles. Part of the difficulty in treating dark circles is figuring out their cause! It could be genetics, lifestyle, allergies, sinus problems, or just a good old lack of sleep. Dark circles make people look much more tired (and older) than they really are, and they are very hard to cover up. Both surgical and non-surgical blepharoplasties are options: In the former, surgical eyelid surgery will provide permanent, rejuvenating results, and, in the latter, Dr. Yagoda uses filler to plump up the circles without any downtime.
  8. Want to stay competitive in the workplace. Although this one could be used when talking about any cosmetic surgery, it is especially true for the eyes! Since your eyes are the most important features of your face – and they are what your coworkers and bosses see when they look at you – it is important to feel confident with your eyes and eyelids. If you don’t, that lack of confidence might transfer over to your day-to-day life!
Ask the Doctor, Facial Plastics

Top Seven Reasons to Get a Face or Necklift

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Man Checking His Throat
Having a neck or facelift done will entirely change the way you feel about yourself! If you are not happy with what you see in the mirror, consider visiting Dr. Michelle Yagoda to discuss your cosmetic concerns. Whether it is for the purpose of youthful rejuvenation or a long-awaited fulfillment of a profile change, neck and facelifts are life-changing surgeries (for the better, of course!).

  1. Correct drooping jowls: The skin that sits below the jaw will often sag and droop with age or excessive weight changes (which sometimes go hand in hand). As the skin ages, it loses collagen and elasticity, causing the droopy skin. Although fillers can sometimes be a temporary fix, only surgery will permanently fix jowls. Either facial liposuction (to remove the fat hanging below the jawline) or a facelift will remove the hanging and fat. You will immediately look younger!
  2. Soften nasolabial folds: Nasolabial folds are the wrinkles that run from the sides of your nose to the corners of your mouth. Deepening with age, there is no way to prevent them. Again, although fillers can lessen their appearance, facelifts can correct them permanently. Often cheaper than using fillers every year, you will love the subtle (but great!) results. Oh, and smiling does not cause them, so smile on!
  3. Restore cheek prominence: If you’ve dreamed of having high and sculpted cheekbones, dream no more! It is possible with surgery. Cheek implants can restore a more angular appearance to the face, but it is important to choose implants carefully. They must be in balance with the rest of you: Too thick implants can make the face appear heavy or overweight.
  4. Relieve effects of Bell’s Palsy: Affecting over 30,000 Americans, Bell’s Palsy is a facial disorder that affects facial nerves, causing a temporary or permanent loss of facial muscle movement (on one side). Symptoms include drooping mouth/eyelids, difficulty closing eye, difficulty eating/drinking, and a face that looks “pulled” to one side. Although sometimes symptoms dissipate over time, for many the effects are permanent. Once Dr. Yagoda deems you a good candidate for reparative facial surgery, she will be able to correct the effects of drooping/unevenness due to Bell’s Palsy.
  5. Provide an angular/sculpted neck profile: Surgical necklifts immediately rejuvenate your facial profile. Not only excellent at correcting hanging or excess skin, they can be used to remove fat around the neck as well. With only very small incisions (which are not visible to the average eye), your neck will become smooth, tight, and sculpted.
  6. Eliminate neck lines: Having horizontal or vertical neck lines is a common problem as the skin ages. You’d be surprised how many people complain of having a “crepey” neck! These fine lines and wrinkles are due to a loss of collagen in the skin, and their severity depends on each individual. Peels can be used in conjunction with necklifts to improve the skin’s texture, creating a smooth appearance.
  7. Eliminate double chins/turkey neck: This one is pretty self-explanatory! If you have excess fat around the chin area (or just do not have a prominent chin), then double chins or “turkey necks” are not uncommon. Fortunately, necklifts and neck liposuction offer solutions. Tiny incisions are made in the treatment area, and the extra fat is extracted by the surgeon. When combined with a facelift or surgical necklift, neck liposuction can do so much as create a chin where there wasn’t one!
Ask the Doctor, ENT, Facial Plastics

10 Reasons to Have a Surgical Rhinoplasty

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Considering a rhinoplasty? If you are, you probably have a good reason, whether it is cosmetic or functional. If you are still on the fence about it, read below for Dr. Michelle Yagoda’s expert comments on why her patients choose to have rhinoplasties. There are a lot of them: After twenty years of experience, this list isn’t even totally comprehensive!

  1. Fix a broken nose: After a nasal trauma occurs, the repercussions are not just cosmetic. Oftentimes, functional problems cause nasal airway obstruction and difficulty breathing. Although broken noses and fractures are common, they are not always easy to fix. Nasal bones need to be reset or repositioned, and the septum might need to be straightened. Additionally, the trauma from the broken nose needs to be corrected as well: Blood can become trapped in the soft tissues of the nose, compressing cartilages on the septum or the tip of the nose. Severe compression can cause the cartilage to lose its shape, strength, and even die off!
  2. Raise nose bridge: If you have a low nose bridge, you might just have to blame your genetics! Certain ethnicities and ethnic groups are more prone to low and flat noses, but, luckily, Dr. Yagoda is very proficient in addressing this cosmetic problem. When a patient wants to cosmetically address a low-bridged nose, Dr. Yagoda makes sure their “new nose” will be more balanced with their facial features. Sometimes this can be done with non-surgical rhinoplasty as well! Ever have the problem of your glasses constantly sliding off your face when you look down? This can be fixed!
  3. Lower nose bridge: On the opposite end of the spectrum, those with high-bridged noses want to make sure their nose isn’t the only facial feature they see! Again, due to certain heritages and/or genetics, noses with high bridges cause more than just cosmetic problems. Ever see two high-bridged nosed lovers try to share an intimate moment? It can get awkward!
  4. Narrow the nostrils: Although genetics and ethnicity can cause the nostrils to be wide and flat, nasal trauma can also cause them to flatten and widen. At first glance this may just seem like a cosmetic issue, but, in reality, the nostril size is very important for proper breathing. The triangle shape of the nostril contributes to the nose’s “nasal valve,” which is the “gatekeeper” of the nose. This important gatekeeper either lets enough air in, or, if the valve is compromised or collapsed, limits airflow.
  5. Change your profile: This is pretty self-explanatory! If you are not happy with how you look in the mirror, a rhinoplasty can help. Whether you’d like to change the nose you already have or correct an aging nose (perhaps it is drooping?) always ensure you and your surgeon are on the same page about what you’d like. There is nothing better than looking in the mirror and loving what you see!
  6. Make a nose smaller: Just because a nose is large does not mean it works well! Large noses and nostrils do not necessarily equal large valves, and bigger noses can have the same breathing problems as smaller noses. So, not only will you make your nose more in-line with your other facial features, you will probably breathe better!
  7. Make a nose larger: Those with short or small noses are the result of genetics or, sometimes, medical problems that are not often seen today in the United States. Because nose-lengthening cosmetic surgery entails augmenting tissue and not merely excising it, it’s one of the most challenging procedures in rhinoplasty. As you might imagine, it’s far easier for a facial plastic surgeon to remove an excess of cartilage and bone than it is to add to it. If you’re contemplating this cosmetic procedure, you’ll need the skills of a true rhinoplasty specialist such as Dr. Yagoda!
  8. Fix a breathing problem: Functional rhinoplasties can be done by themselves or in combination with a cosmetic procedure. Almost everyone knows that a deviated septum needs to be corrected, and abnormal turbinate repair is pretty common knowledge, too. However, not many know that the actual position of the nose bones can cause restricted breathing! To fix this, the surgeon needs to move the bones slightly out to allow adequate air passage.
  9. Fix a cleft nose: Cleft noses are genetic defects that occur in-utero. Treatment requires a team approach with multiple staged procedures and a skilled plastic surgeon to correct structural defects and asymmetrical features. Although the process is very long and involved, the positive results are always worth it.
  10. Fix a skin cancer: Skin cancers on the nose get tricky. They are much more complicated than other body cancers because they can be deceiving: What looks like a superficial skin cancer might actually be very deep! These deep skin cancers end up into the planes of fusion of two facial bones, i.e. the nose with cheek, nose with upper lip, or the nose with the eye. As a result, skin growths that appear to be small can cause significant destruction of the cartilage and mucus membrane below it. Although the removal of skin cancer is typically done during a MOHS surgery, oftentimes the repair requires a skilled rhinoplasty surgeon.
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Ask the Doctor: Where should vocal cord surgery be done?

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Swollen Glands and lymph nodes - vocal cord surgery in NYCAnswer: Vocal cord surgery should be done one place and one place only: in a hospital! There are a few reasons for this, and they are all very important.

When you undergo a procedure on your vocal cords at the hospital, you will be under general anesthesia. This is true for any vocal cord surgery/procedure, including biopsies, laser surgery and the removal of nodules and polyps. All of these conditions cause voice problems of varying degrees, and Dr Yagoda will let you know when surgery is necessary.

During general anesthesia for voice box surgery, a breathing tube will be inserted in your throat. This breathing tube is very, very important: Not only does it help you breathe, but it protects your airway!  Otherwise, when the vocal cords are “touched,” they will spontaneously close. This happens because the body assumes that if something touches the vocal cords, it is likely to be heading downward to your lungs.  Vocal cord closure is the body’s automatic mechanism to protect your lungs.  A breathing tube must be in place to keep the airway open so that oxygen can reach your heart and brain. 

In addition, vocal cord surgery should be done in the hospital for another reason.  Hospitals have the necessary equipment for vocal cord microsurgery.  This includes a surgical microscope that will magnify the vocal cords 400x.  In addition, lasers can assist the surgeon is performing precise and bloodless procedures.  

Now, true or false: Must vocal endoscopies be done in the hospital as well?

False! Vocal endoscopies can be done very safely and routinely in a voice specialist’s office. Endoscopies are simple procedures that do not require any manipulation or instrumentation of the vocal cords. In a matter of minutes — and while you are seated and awake — your vocal cords can be visualized. This allows the doctor to diagnose the vocal disorder.  But, remember, any procedure requiring a biopsy, laser or excision must be done in the operating room under general anesthesia.

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Ask the Doctor: Do you accept Care Credit or other financing?

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The decision to get a surgery or procedure done is a big one for both financial and aesthetic reasons. Dr. Michelle Yagoda strives to offer the best to patients regarding both financing and treatments — which includes taking into consideration payment options.

Although cosmetic surgery lines of credit from companies  like Care Credit (GE), Chase Health Advantage (JP Morgan/Chase) and Citi Health Card (Citibank) seem enticing at first glance — as they offer patients immediate access to elective healthcare procedures — patients should fully understand the terms and conditions before signing on.  Governor Cuomo investigated the “predatory behavior” of healthcare lenders back in 2010.  These healthcare finance companies charge extremely high interest rates — especially if the consumer opts and qualifies for an initial interest free loan period.  Specifically, after the interest free period (ranging from 6-24 months), finance charges are in the range of 15-30%, and, if a payment is missed or the balance isn’t fully paid during the promotional period, then finance charges can be assessed retroactively on the entire interest free period as well. As a result, many patients struggle with loan payments, which oftentimes leads to a devastated credit rating.

While some surgeons are enticed by the promise of an increased volume of patients who can afford services, doctors need to understand that the assessed processing fees are significantly higher than those associated with traditional credit cards (as much as 15% higher).  And, for those patients who are not eligible for interest free loans, the physician will be assessed a processing fee of more than double that of a traditional credit card.

So, who is really benefiting from healthcare financing?  The patient?  The doctor? Upon close inspection, it becomes clear that the answer is neither: It is the lender who wins! Since Dr. Yagoda does not want her patients to struggle with loans – nor does she want to participate in a business plan built around taking advantage of people –  she offers a PSA or a Patient Saving Account. This system allows patients to credit/put away money until they have amassed enough to have their surgery or procedure done.  In the end, this ensures that no third-party is involved, no loans are lingering, and the patient will only have to enjoy their wonderful results!

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Can you correct my thin lips?

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Dr. Michelle Yagoda - New York City Facial Plastic SurgeonASK DOCTOR YAGODA

Question: Can you correct my thin lips? I don’t want to have surgery and am leaning more towards an injectable filler and am trying to find the longest lasting filler?

Answer: All FDA approved fillers last about 3-5 months in the lips. I don’t recommend permanent fillers in the lips as they tend to migrate over time and cause lumps and bumps.  Lips can be naturally augmented with Restylane, Perlane, LaViv, and Juvederm.

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Are there any non-surgical options for facial rejuvenation?

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ASK DR. YAGODA

Dr.Michelle YagodaQuestion: I am a 48 year old woman living in Manhattan and am not ready for a facelift just yet. Are there any non surgical options for facial rejuvenation?

Answer: Absolutely!  You can look younger and refreshed with any one (or a combination) of these non-surgical options: 1. Fillers —Restylane, Perlane, LaViv, Juvederm, Radiesse and Sculptura— can soften nasolabial folds, make cheeks more defined, restore hollowed cheeks and under eye areas, and even make the jawline and chin more prominent; 2. Neurotoxins—Botox, Dysport and Xeomin—can erase the angry and worry lines in the brow, and the crows feet around the corners of the eyes; and 3. IPL — Lasers and Chemical Peels can make the skin tone and texture even and tighter while minimizing fine lines and wrinkles, erasing brown spots, and vaporizing broken blood vessels.  If you are not quite ready for a facelift, but willing to do some minimal surgery that will give you amazing and natural results, consider these two alone or in combination:  1. Liposuction under the chin to get rid of turkey gobble and drooping jowls; and 2. i-Guide neck lift to improve the definition and angle of the neck without any tell-tale incisions at all around the ear.