Is Lip Filler Right for Me?

Full lips are a marker of youth and beauty. As we age, however, our lips tend to become thinner and flatter. Mount Sinai’s Facial Plastic and Reconstructive Surgery team offers both temporary and permanent solutions to help you achieve natural-looking, voluminous lips.

“The lips are an important part of our body—they are an area of sensuality and communication. When someone looks at you, they tend to be drawn to the eyes and the lips,” says Noah B. Sands, MD, who is a Facial Plastic and Reconstructive Surgery physician at Mount Sinai. “Our goal is to work with patients to help them find the right enhancement option and achieve their goals.”

What are lip enhancements?

The lips may look different from the rest of the body, but they are actually a thinner, more delicate type of skin. The same way skin wrinkles over time, the lips slowly lose their pillowy appearance as they produce less collagen. Lip enhancements are cosmetic procedures that augment the shape of the lips and the goal is to:

  • Plump up thin or flat lips
  • Redefine and enhance lip shape
  • Reduce vertical wrinkle lines that develop above the lip
  • Restore balance between asymmetrical lips
What enhancement procedures are available to patients?

The most common procedure is a temporary cosmetic injectable. These dermal fillers are gel-like substances that are injected into the lips to create volume. Juvéderm and Restylane, two common brands of dermal fillers, are generally well tolerated by patients because they are made of hyaluronic acid—a naturally occurring substance in the body. The effects of this procedure lasts for about one year.

If you are seeking a permanent solution, a plastic or silicone implant can be used to plump up the lips. A less popular implant choice, is a fat implant. This permanent option involves taking tissue from the belly or thigh and injecting it into the lip. Keep in mind that fat implants are typically not a standalone procedure. They are generally used when a patient is augmenting other areas of the face such as volumizing the cheeks or filling in wrinkles under the eyes.

If your goal is to define your lip shape, a lip lift is an appropriate option. This technique is used to emphasize the border of the lip, giving it a tighter and more defined shape. Additionally, lip reductions are available for patients who would like to de-emphasize their lips.

How do I know which lip enhancement is best for me?

Your surgeon should work closely with you to select the procedure that best meets your needs. However, when patients are unsure, Dr. Sands advises them to be conservative.

“Patients tend to have a fairly strong reaction to lip enhancements at first,” he explains. “I often advise to start with a temporary filler so they get a sense of what the modification will look like and then decide if they want something permanent.”

One of the benefits of fillers is that they are temporary and changeable. If patients are not satisfied with the result, it can be tweaked or even reversed entirely in the same visit. The filler can also be inserted gradually over several appointments.

“There is a misconception that fillers look ‘done’ or will cause a duck lip appearance,” says Dr. Sands. “If the filler is applied and balanced right, it will look like an inconspicuous, natural enhancement.”

When biological materials are used, Dr. Sands says lip enhancements tend to have a more natural look. Lip implants, which use synthetic material, often appear less natural and the texture of the lip itself may also feel different.

There are limits, however, to what fillers can do. “Sometimes patients have asymmetries that can be corrected with fillers but they cannot reshape the lip,” says Dr. Sands. “The lips will also only tolerate so much filler product without looking unnatural.”

How long will it take for the procedure to heal?

Many patients who come to Dr. Sands have had Botox or fillers in other areas of the face. But the lips, he warns, may feel a little different. Since the lips are a very vascular area of the body, they tend to bruise more.

“The results are immediate, but it generally takes a week for the swelling to settle,” says Dr. Sands. “Patients can return to work that day but it is best to schedule the procedure for a time where they do not have a lot of meetings, and at least one week before a major event.”

I’m Young and Healthy. Why Should I Get the COVID-19 Vaccine?

States are moving quickly to enable more people to be eligible for the COVID-19 vaccines. In New York, for example, those 16 and older are now eligible. But many young adults may believe they do not need to get vaccinated.

In this Q&A, Michelle Cespedes, MD, MS, an infectious disease specialist at Mount Sinai who has treated many patients with COVID-19, explains that young people should get the vaccine to limit the spread of the disease, especially new variants; to avoid potential long-term complications for themselves; and to protect others, especially older family members, relatives, and friends. Dr. Cespedes is also an Associate Professor of Medicine at the Icahn School of Medicine at Mount Sinai.

Should young people worry about becoming infected with COVID-19?

This is a question I hear often these days. A lot of people think that because they’re young, they probably won’t get COVID-19. And even if they do, the reasoning goes, they won’t get a bad case. There are data that suggest younger people might not get as sick with the coronavirus as older people. They might be less likely to need hospitalization. But that doesn’t mean young people can’t get COVID-19 and potentially spread it on to other family members. This is especially important to remember when you think about visiting family members around the holidays. We saw that huge spike in cases last year right after Thanksgiving and Christmas. We’d like to avoid a repeat of that.

Is it true that if I get a mild case of COVID-19, it’s nothing to be concerned about?

It is true that young people might not get as sick as the elderly. But that doesn’t mean COVID-19 has no effect on you. Even people who had a mild case may experience long-term effects. Evidence suggests that COVID-19, like any other virus that causes inflammation, can affect the lungs, the nerves to the brain, and even the brain itself. For instance, the loss of taste or smell suggests inflammation in the nerves that control the ability to taste or smell.

Another common side effect is what we call brain fog, which is not a distinct medical or scientific term used regularly by medical professionals. Brain fog describes a collection of symptoms related to changes in thinking and memory. Patients who have had COVID-19 sometimes report that their thinking is sluggish or not sharp, often with poor memory, recall, or attention span. It can be best described as the sense that “I came into this room for something, but I can’t remember what.” While brain fog won’t land you in the hospital, it can last for many months.

Additionally, according to a study conducted by researchers at the Icahn School of Medicine at Mount Sinai and the Naval Medical Research Center, past COVID-19 infection does not fully protect young people against reinfection. The study found that reinfection was quite common amount young healthy adults, making it even more important for them to get vaccinated in order to prevent reinfection, boost their immune responses, and reduce transmission.

How does my getting the vaccine help other people?

When you get vaccinated, it means you likely cannot get the virus, which means it won’t make you sick—and you won’t pass it onto anyone else. In addition to protecting yourself, the vaccine also helps the larger community. If there are fewer targets for the virus to jump to, fewer people will get sick. And that means there will be less chance for more virulent variants to develop. Getting the vaccine is an act of love for your friends and family and the larger community.

 

If you would like to get a COVID-19 vaccine, contact your state or local health department for scheduling.

New York State       New York City

New Jersey               Connecticut

Are Video Calls Straining My Vocal Cords?

Unless you are a performer or your job requires you to talk a lot, you probably do not give much thought to your vocal health. However, vocal cord damage is more common than you may think as it affects as many as nine percent of adults nationwide. And, experts say the increase in video and phone chatting during the COVID-19 pandemic will only make matters worse.

Sarah Brown, MS, CCC-SLP, a speech-language pathologist at the Grabscheid Voice and Swallowing Center of Mount Sinai, has seen a marked increase in the number of patients with vocal strain or fatigue over the past six months.

“People tend to speak louder on video or phone calls when they think they can’t be heard well. Over time, this can set someone up for a vocal injury,” she explains. “On the other side of the coin, elderly patients who are not talking as much during the pandemic, are losing vocal stamina.”

To help patients prevent vocal cord injury, Ms. Brown explains how the injury occurs and provides tips for proper ‘vocal hygiene.’

What causes injury to the vocal cords?

The vocal cords are two bands of elastic muscle tissue located in your larynx, or voice box, that join together to form a V-shape. These cords, which are about the length of your thumbnail, are constantly at work—they come together and vibrate when you speak and open up each time you breathe.

Like other parts of the body, your vocal cords are prone to wear and tear. The area that is most susceptible to damage is the outer layer of the vocal fold, called the epithelial layer or the muscosa of the vocal fold. When the cords rub together too hard, or for too long, the tissue becomes damaged. The most common vocal cord injury is a benign mucosal lesion—a callus-like growth also referred to as nodule, polyp, or cyst.

Who is at risk of vocal cord injury?

While anyone can injure their vocal cords, it is more common in certain careers.

“Vocal damage can occur anytime you take your voice past the realistic limits of what it can do,” explains Ms. Brown. “It is like when you repetitively lift weights or wear uncomfortable shoes and then develop a callus on your skin.”

Ms. Brown treats many performers, news anchors, teachers, and lawyers who sing or talk all day at work. She also sees a lot of parents with big families and young people who yell or raise their voice often.

How do you prevent vocal cord injury?

If you are at risk of vocal strain, Ms. Brown recommends that you establish adequate ‘vocal hygiene’ by abiding by the following:

  • Use an efficient speaking voice. Adequate breath support allows for your voice to resonate well. Try to avoid excessive glottal fry, also known as vocal fry, especially when projecting.
  • Stay hydrated. Vocalists have a phrase, “sing wet and pee pale.” Drink two to four liters of water each day for optimal vocal health. As a result, urine should be light and odor-free.
  • Limit substances. Do not smoke cigarettes and limit alcohol use as both can dry out the vocal cords, increasing your risk for vocal injury. Excessive amounts of coffee, and other caffeinated beverages, can also lead to vocal dryness. If you are a multi-cup-a-day coffee drinker, make sure you compensate by drinking extra water.
  • Exercise regularly: Cardio and strength training helps maintain stamina. Don’t hold your breath when lifting! Use proper breathing techniques when hoisting weights.
  • Stop behaviors that increase vocal strain. Avoid excessive yelling, screaming, or talking; beware of noisy environments such as bars and restaurants; and limit throat clearing and coughing.
  • Warm up and cool down. Learn exercises to safely start and stop prolonged vocal use such as resonant humming, lip trills, and straw phonation.
  • Take breaks. During peak vocal demand, take six vocal naps—a 15 to 30 minute period of vocal rest—throughout the day.
  • Use appropriate audio set up for video calls. A combination of headphones and microphone will ensure that you can hear yourself and your speaking partner clearly so that you don’t speak excessively loud.

For more vocal health information from Ms. Brown, follow her on TikTok @vocalhealth and Instagram @vocalhealthskb. If you would like to see a medical professional regarding vocal strain or fatigue, make an appointment with the Grabscheid Voice and Swallowing Center of Mount Sinai by calling 212-241-9410.

An Interdisciplinary Approach to Voice Therapy

Every patient is different. Unlike many other practices, Mount Sinai Health System laryngologists and speech pathologists work collaboratively to evaluate patients and develop an individualized treatment plan for vocal cord injury.

“Since much of what causes vocal cord injury is behavioral, it is important to include medical, surgical, and rehabilitative perspectives,” explains Sarah Brown, MS, CCC-SLP, a speech-language pathologist at the Grabscheid Voice and Swallowing Center of Mount Sinai.

To assess the condition of your vocal cords, Mount Sinai uses videostroboscopy—a cutting-edge procedure that allows the care team to visualize the vocal cords in great detail. Similar to when your doctor uses a tongue depressor to see the back of your throat, a tiny instrument with a small camera is placed into the mouth. The laryngologist may also use a different technique using a flexible camera through the nose.

Voice Therapy: A Non-Surgical Approach to Care

Most patients benefit from voice therapy before pursuing surgical options. In some cases, voice therapy can eliminate or reduce the extent of surgery needed. Mount Sinai specializes in minimally invasive procedures. These include in-office laser and microlaryngoscopy, which uses high-energy beams of light to remove lesions under local anesthesia in the office.

During one-on-one treatment sessions, speech pathologists teach exercises that balance resonance, improve airflow, and enhance vocal technique. The goal of voice therapy, Ms. Brown explains, is for patients to learn to speak or sing in a new way that protects their vocal cords. The exercises allow patients to feel more confident in their conversational or singing voice.

Mount Sinai Voice Therapy Techniques 

Semi-occluded vocal tract exercises (lip trills, straw phonation, cup bubbles), which help manage airflow and resonance by teaching patients how to properly close their vocal folds without over-squeezing them.

Resonant hums/resonant voice therapy, which increases voice comfort by using gentle humming focused on vibrations in the lips and nose rather than the throat.

Flow phonation, which focuses on maintaining vocal balance through airflow using exercises such as saying “whoooooo” and watching a tissue blow in front of you.

Reducing muscular tension, in which patients are guided through laryngeal massage as well as tongue, shoulder, and neck stretches.

For more vocal health information from Ms. Brown, follow her on TikTok @vocalhealth and Instagram @vocalhealthskb. If you would like to see a medical professional regarding vocal strain or fatigue, make an appointment with the Grabscheid Voice and Swallowing Center of Mount Sinai by calling 212-241-9410.

Prevalence and the Understanding of Autism Spectrum Disorder Are on the Rise

The Seaver Center for Autism Research and Treatment at the Icahn School of Medicine at Mount Sinai is advancing the understanding of autism spectrum disorder.

Autism spectrum disorder (ASD) is increasing in prevalence, but so are options for evaluation and therapies, said Paige Siper, PhD, Chief Psychologist for the Seaver Autism Center for Research and Treatment, and Michelle Gorenstein, PsyD, Director of Outreach for the Seaver Center. “The interesting and exciting part about the work that we do is that we get to see toddlers through adults, and I think that is something very unique about this field,” said Dr. Siper, Assistant Professor of Psychiatry, Icahn School of Medicine at Mount Sinai. The virtual talk can be viewed here.

Paige Siper, PhD, Chief Psychologist of the Seaver Center

“Autism Spectrum Disorder Across the Lifespan” was hosted by the Mount Sinai Office for Diversity and Inclusion. It was part of a series featuring speakers from around the Mount Sinai Health System as well as the community to raise awareness and promote an inclusive and equitable health care environment for people with disabilities.

Dr. Gorenstein, Assistant Professor of Psychiatry, Icahn School of Medicine, said that an important tool in the field is Applied Behavioral Analysis, a class of interventions based on principles of operant learning theory—that is, providing positive reinforcement for observable behavior, like asking for a push on a playground swing, or making a choice. Another therapy, Relationship Development Intervention, is a family-based method that builds social and emotional skills. And there are a variety of therapies to treat conditions that can accompany ASD, such as anxiety, ADHD, or epilepsy.

Michelle Gorenstein, PsyD, Director of Outreach for the Seaver Center

ASD is characterized by difficulty with social communication, as well as the presence of repetitive behaviors or restricted interests.  ASD is primarily a genetic disorder but can also be influenced by environmental factors. Dr. Siper said multiple studies have shown that vaccines do not cause ASD, dispelling a common myth.

One in 54 children in the United States are diagnosed with ASD, and boys are four times more likely than girls to receive the diagnosis. ASD can be identified in children as early as age 18 months, which makes early intervention very important in improving social, communication, motor, and daily living skills.  “Early intervention can change outcomes,” Dr. Siper said. “It’s the opposite of watch and wait.”

The Seaver Center is dedicated to caring for people of all ages with ASD, furthering research into risk factors and drug development, and leading clinical trials. “One of the unique things about our Center is that it really does translate the basic sciences to the clinic,” Dr. Siper said. For more information, visit the Seaver Center site.

Additional disabilities-related resources are available on the Mount Sinai Office for Diversity and Inclusion site.

Mount Sinai Researchers Report Significant Secondhand Marijuana Smoke Exposure In New York City Apartments

Mount Sinai researchers have raised concerns about significant exposure to marijuana secondhand smoke in New York City apartments.

Data from a new study suggesting nearly one third of families smell marijuana smoke when their children are present raises concerns about the potential impact of legalized marijuana on vulnerable populations, particularly children, according to the researchers.

The researchers described their findings in a study published recently in Academic Pediatrics.  The study looked at secondhand smoke and thirdhand smoke—the particles from secondhand smoke that settle on furniture, carpets, and clothing—in multi-unit households, typically apartment buildings.

The lead author of the study is Lodoe Sangmo, a fourth year medical student at the Icahn School of Medicine at Mount Sinai who will graduate in May with Distinction in Research. Karen Wilson, MD, MPH, the Debra and Leon Black Division Chief of General Pediatrics at Icahn Mount Sinai, is the senior author on the study and an international expert on secondhand and thirdhand smoke exposure—what researchers call “incursions.” Dr. Wilson led an investigation in 2018 that found high levels of marijuana metabolite tetrahydrocannabinol carboxylic acid in the urine of young children whose parents also smoked tobacco. That study was published in Pediatrics.

Karen Wilson, MD, MPH

Researchers say the new study of families living in multi-unit housing in New York City builds on these earlier findings, suggesting that regulators take a close look at the impact on children when considering marijuana legalization.

“As we move towards the legalization of recreational marijuana in New York State, this study serves as a warning that our most vulnerable patient populations who live in multi-use housing will likely experience much higher levels of smoke incursions unless we are intentional about regulating exposure, particularly among children,” says Dr. Wilson, who is also Vice Chair for Clinical and Translational Research for the Jack and Lucy Clark Department of Pediatrics at Icahn Mount Sinai. Dr. Wilson notes that while most states with legal marijuana use restrict its use in public indoor and outdoor spaces, they do not have any restrictions on combustible marijuana use in the presence of children.

For their study, the researchers surveyed parents at four pediatric practices in the Mount Sinai Health System, collecting a total of 382 surveys between September 2018 and December 2019.

Parents were asked, “Do you ever smell marijuana smoke in your room/apartment/ condominium coming from another apartment, when you are with your child?”  and “Do you ever smell marijuana smoke in common areas such as the hallway or stairwell, when you are with your child?”

Almost one third (30.6 percent) of participants reported both secondhand and thirdhand smoke, while 47.9 percent had neither incursion, with the remaining 21 percent reporting one or the other incursion.

Participants who identified as non-Hispanic black or Hispanic were more likely to report smelling secondhand smoke than non-Hispanic white participants, a finding that is consistent with disparities in secondhand smoke exposure, caused in part by unequal access and enforcement of comprehensive smoke-free policies within multi-unit housing, according to the researchers.

“In light of these findings, we hope to see the expansion of current policies that solely restrict tobacco smoke to include restrictions on marijuana smoke in order to mitigate disparities and protect vulnerable populations exposed to dual smoke exposure,” says Dr. Wilson.

The study was funded by the Children’s Center Foundation Board of Directors of the Mount Sinai Kravis Children’s Hospital at Icahn Mount Sinai.

According to Dr. Wilson, who chairs the American Academy of Pediatrics Tobacco Consortium, while many states have moved ahead with legalization efforts, research on the effects of secondhand marijuana smoke is still in its infancy.

“We do know that prenatal exposure to marijuana smoke affects brain development and behavior but we don’t know about post-natal impacts, nor about the long-term health effects. We know much more about the detrimental effects of tobacco smoke on children’s health,” says Dr. Wilson. “Studies have linked even low levels of cotinine, a biological marker of secondhand tobacco smoke, with decreased scores on cognitive testing, and asthma. Theoretically, that could suggest that low levels of marijuana could potentially be damaging to the brains and lungs of children.”

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