Malcolm Rude, M.D.
Board Certified Plastic Surgeon
Brazos Valley Plastic Surgery

Rice Krispies

Patients often notice a funny feeling under their skin after breasts augmentation. It gives them the sensation of rice krispies under their skin. It should not be a cause for alarm. It is a little air trapped in their tissue. This is reabsorbed by the body and ultimately breathed back out. It has caused some laughter through the years but it should not cause anyone to be concerned.

Botox or Dysport for the lower face

The injection of neurotoxin i.e. Botox or Dysport is most commonly thought of for the upper face. Injecting between the eyes, the forehead, or around the eyes for the crow’s feet are the most common areas for injecting Botox. However, we very commonly inject it elsewhere. Some of the most popular areas are on the lips for “smoker’s lines”. Certainly, not everyone who has these lines is a smoker, which only makes them dislike the lines more. Other popular areas are the corners of the mouth. There is a muscle called the depressor anguli oris. It turns the corners of the mouth down in a frown. By softening the action of this muscle it can help the corners turn up some. I often use it in conjunction with fillers on the corners of the mouth or commissures.

Dysport or Botox can also be injected in the chin for people who have excessive chin dimpling.

The last popular area is on the neck. Dysport injections of the neck can be done to help some of the transverse wrinkles. I usually caution my patients that this is a relatively modest result. It can certainly make a difference but it doesn’t in everyone. It also does not do anything to tighten the skin.

Temple Filling

Over the past few years possibly my favorite area of filling has become the temples.

The reason it is my favorite is because it is the area that I can fill with very little bruising that no one knows what I did but everyone is told that they look much better. As people age, particular by the time they hit their mid to later 40’s, their temples begin to hollow. This adds hollowness to their eyes. It is a very subtle but effective way of improving someone’s eye appearance. It can often make them look less tired.

There are a couple of different options for filler.

The best one often depends on what other areas are being addressed. Two of my favorite are Sculptra and Radiesse. The other nice thing about the temples is that we can simulate what the appearance change will be like by injecting saline. This allows the patient to “try it on”.


Ladies often ask me what can be done for the fine wrinkly skin on their chest.

The skin in this area has often gotten significant sun exposure from V-neck shirts over the years. This results in fine wrinkling of the skin.

We now have two very good options for improving this.

The first is Sculptra. Some of the latest techniques in Sculptra have allowed us to improve this area by filling it in. Sculptra is a bio-stimulating. I explain this to patients by telling them that it is best thought of as collagen seeds. There are tiny micronized particles of the same compound that dissolving sutures are made of. As your body dissolves these particles collagen is laid down. The result is a very soft look. It does take several weeks for the collagen to be grown but it has been a nice way of improving a chest. The skin of the chest is often improved with either a combination of chemical peels or lasers. The chest cannot be peeled as aggressively as the face but it can certainly be improved.

Hand Rejuvenation

A common complaint that patient’s voice is their hands. Ladies will tell me that their hands give away or misrepresent their age. Part of the normal aging process that we don’t particularly like is that our hands lose volume as well as accumulate sun damage. There are things that can easily be done to remedy this. One of our favorite fillers for the back of the hand is Radiesse. It is a minimally invasive treatment with very little discomfort. It helps fill in the back of the hands. The combination treatment that is often paired with this is doing a YAG laser. This is a laser that is excellent at targeting the pigment in the skin. It allows me to remove the dark spots on the back of the hand. The combination of filling the back of the hand in to correct the sunken appearance as well as improving the skin has been a very popular treatment.

Implant Types

There are several different types of breast implants. Implants can be differentiated on a couple of different levels. The first most obvious level is their content. Breast implants can either be filled with saline or silicone. The actual shell of the implant is the same. There are pros and cons of each. Saline implants are a little more affordable. They do however have more a little more wrinkling and rippling which is where the implant is visible through the skin. They also don’t feel quite as nature as silicone. Patients rate their implants in look and feel lower than patients with silicone implants. The saline that I use for the implants is directly from an IV bag. Rupture detection is quite easy with a saline implant because it just goes flat.

Silicone implants are by far the more popular implant. Silicone implants are nothing like the “old” silicone implants that were taken off the market in 1991. That silicone was a lot thinner, closer to the consistency of motor oil. Now, the standard silicone implants are significantly more viscous. They are approximately the thickness of a pudding. The nice part about that, should they rupture, the operation to exchange them, is nothing like the old one. In the old days the silicone would leak into the tissue and it was very challenging to get out. Comparatively, the exchange operating is very simple. From a safety point of view the silicone implants are completely safe. They have been exonerated from what they were accused of in the 90’s.

The newest generation of silicone implants have been coined “gummy bear implants”. The gummy bear or form stable implants are thicker and closer in consistency to a gummy bear. For certain ladies this does pose an advantage. It can maintain the height of the implant accentuating upper pole fullness slightly better. I regularly put in “gummy bear” implants but I try to discuss with the patient if this will actually be an advantage for them based on their dimensions and size goals. This is all done as part of an initial breast augmentation consultation.

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