Dr. George S. Lee

The “Eyes” of March

Our eyes are one of the first features people notice when meeting us. Eyes are a prominent facial feature.  It is the surrounding skin, muscle, fat, and hair rather than the eyes themselves that convey emotion. They really are the windows to our soul. What do your eyes say about you? Are you tired or well-rested? Are you happy or sad? They even can reflect our overall health status. Prominent, bulbous eyes can be indicative of systemic disease. Many factors impact the appearance of our eyes and surrounding tissue. Of course, as we age the skin around the eyes becomes more lax and can sag. The tissue of the upper eyelids begins to sag and can obstruct our field of vision and make us look tired and angry. The skin becomes even thinner and dark circles appear. Stress and fatigue produce the bags under our eyes. Age, loss of moisture to the skin, smoking, sun exposure and hereditary factors all contribute to wrinkles, deep lines and puffiness around the eyes. The aging process can cause unwanted changes in expression, causing us to look fatigued and older than we really are.

What can be done to refresh and brighten these tired-looking eyes? I am happy to say today we have many options to give us beautiful, youthful, and refreshed eyes. Many of these treatments are non-surgical with virtually no downtime.

Wrinkles/Crow’s Feet

Periorbital Laser Skin Resurfacing

Over the years, technology has evolved to help patients look and feel better about their damaged skin by improving the skin texture, wrinkles, acne scars, and imperfections.

Dr. George Lee utilizes the advanced Starlux 500 system from Palomar; offering a less invasive alternative replacing traditional, very painful CO2 lasers fraught with potential postoperative sequelae. This includes prolonged recovery, redness, scarring, and possible lines of demarcation of treated and untreated skin. With advances in fractionated laser technology, one will get all of the benefits of a CO2 laser, but with minimal down time. Fractionated laser treatment can be ablative and non-ablative.

“Fractional” laser technology delivers light in patterns of small microbeams, basically “pixels” of laser energy similar to the pixels of the computer screen you use. The very narrow beams heat the dermis in tiny columns, stimulating collagen remodeling as well as affecting the epidermis. Because only part of the skin is treated, the outer layer is not vaporized or only partially vaporized and the skin is not left raw which greatly reduces down time as compared to traditional CO2 lasers.

The benefits of fractional laser treatments become more evident over weeks to months after treatment. Typically, for the ablative skin resurfacing one treatment is only required, but a series of at least four to six treatment sessions is necessary for non-ablative skin resurfacing.

Botox Cosmetic

Facial expressions are created by the use of facial muscles. With repetitive movement of these muscles, wrinkles, called dynamic wrinkles, can appear. Around the eyes these wrinkles are more commonly referred to as “crow’s feet”. Botox Cosmetic is a purified protein produced the Botulinum bacteria. When used in small doses prepared for professional use, it can treat these dynamic wrinkles. It works by weakening the muscles responsible for facial expression, without detracting from these expressions, therefore treating the associated wrinkles. Botox Cosmetic is a temporary treatment. Follow up treatments are recommended every 4-6 months.

Sagging/Drooping Eyelids and Eyebrows

Blepharoplasty

Our eyelids begin to “sag” as we age. This is because we blink 10,000 times over the course of a day and the skin and muscles of the upper eyelid stretch with each blink. Over time the elastic fibers, which cause the skin to recoil, stretch to the point they are unable to return to their normal position. The skin then begins to bulge outward and can hang over our lid or lie on our eyelashes. This can lead to sight problems as the excess skin obscures our field of vision. The “bags” under our eyes develop as we age. Gravity contributes to this as well as weakening of a protective membrane surrounding the eye. This membrane serves to hold the fatty tissue around the eye; however, if it weakens it can allow the fatty tissue to protrude downward, creating the look of “bags”.

Blepharoplasty is a relatively simple procedure that removes excess skin, muscle, and fatty tissue from the upper and lower eyelids. A small incision is made in the upper and/or lower eyelids to remove the excess tissue. The incision is closed with sutures and because the skin of the eyelids heal extremely well the scars are typically not noticeable. Blepharoplasty is routinely performed on an outpatient basis with patients returning to normal activity within a week.

Brow Lift

The eyebrows are important features to our face that conveys emotion. By framing the eye, they enhance the expression of our eyes. Eyebrows that sag are an early sign of aging and if the brow overshadows the eyes it can make us appear tired, sad, or even angry. Heavy eyebrows can be a result of the aging process over time or even hereditary. The drooping brow, like drooping eyelids, can affect our vision. A high, arched eyebrow conveys a rested, more alert, and youthful appearance.

A brow lift is a procedure that lifts and smooths the eyebrow and the entire forehead area. A variety of techniques can be utilized based on the nature of the problem, gender, degree of correction, age, and even how we wear our hair. Surgical options consist of an indirect brow lift, coronal lift, direct eyebrow lift, mid-forehead lift, or endoscopic brow lift. Dr. Lee will you help make the decision on the best approach after a personal consultation. Most patients are able to resume their normal routine approximately two weeks following the procedure. As with the blepharoplasty, the brow lift can be performed on an outpatient basis and can also be combined with a blepharoplasty.

 

                              

Blepharoplasty and Brow Lift – Before           Blepharoplasty and Brow Lift – After

                             

Blepharoplasty and Brow Lift – Before           Blepharoplasty and Brow Lift – After

                              

Brow Lift – Before                                               Brow Lift – After

                       

Periorbital Resurfacing – Before                    Periorbital Resurfacing – After

Provided courtesy of David Kent, MD and reprinted with permission of Palomar Medical Technologies, Inc.

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Oral Lesions – Why They Should Be Examined

Lumps and bumps in the mouth can not only be annoying, they can indicate a more troublesome problem.  While most lesions are benign, it is important to have them fully examined by your dental health provider.  Some lesions are painful, bleed after brushing or flossing, and even unsightly.  However, many lesions are painless and only identified during a routine oral exam.

What are benign oral lesions?  

Not all oral lesions are cancerous.  Some causes of irritation and masses in the oral cavity include:

  • Candidiasis (Thrush)
  • Aphthae Ulcers (Canker Sores)
  • Herpes (Cold Sores)
  • Mucocele
  • Geographic Tongue
  • Hairy Tongue
  • Fibroma
  • Papilloma

How do I manager a benign oral lesion?

If your healthcare provider determines that your oral lesion is benign and does not require treatment, these are some things you can do to decrease the discomfort in your mouth.  If the lesions do become bothersome (painful, itchy or overly-sensitive), there are some ways to ease discomfort: brushing with a soft toothbrush (to minimize irritation), flossing, and avoiding acidic or spicy foods and beverages which have been known to cause flare-ups.  Managing stress is also helpful, and a topical steroid may be prescribed for more severe outbreaks.

Other causes of oral lesions.

The greatest concern with lesions is they may resemble more serious conditions, particularly oral cancer.  Oral cancer may appear as a white or red lesion, lump or ulcer. It is usually small and painless at first, but can grow and spread quickly. Many oral cancers are discovered during routine dental examinations.  The only way to be certain that it is a benign condition is to perform a biopsy on some of the affected tissue.

Known risk factors for oral cancer.

  • Tobacco Use
  • Alcohol Use
  • Human Papilloma Virus (HPV)
  • Pre-cancerous Conditions
  • Previous Cancer
  • Family History of Squamous Cell Carcinoma (SCC)

If you notice a lesion, painful or not, in your mouth; it is important to have it evaluated promptly by your oral healthcare provider.  Quick identification and treatment is imperative for a better change at a good outcome with cancerous lesions.

oralcancer_self-exam

Download the FREE book, What You Need To Know About Oral Cancer, provided by the National Cancer Institute, here – Oral Cancer Guide.

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6 Things You Need to Know About Your Dental Insurance

When you think about insurance, you think about full coverage.  There are a lot of things to consider when it comes to insurance coverage, and all insurance plans are not created equal.  We purchase insurance to safeguard ourselves against unforeseen, large expenses.  Dental insurance provides a limited benefit for dental services. It is important to understand the unique differences of dental insurance when attempting to utilize its benefits.  Here are 6 things you need to know about your dental insurance.

  1. Most insurance companies offer a variety of dental benefit plans with different features. Each plan a dental insurance company has is different.  Even if you and a friend use the same insurance company that does not guarantee that you will have the same plan or coverage.  If your plan is through your employer, the benefits have been determined by your employer in order to contain costs.  One plan may allow an x-ray every year while another only covers it once every 5 years.  Coverage or lack of coverage is not related to the medically necessity of the service.  Just because it is not covered does not mean you do not need it.
  2. Your dentist may not “participate” in your dental plans network. An office needs to be “contracted” with your insurance plan to be in network.  Being contracted is commonly referred to as being a “participating” or “preferred” provider. It really only means that the office has agreed to accepting a reduced fee from the insurance company and also must agree to the rules that the insurance company has created.  These rules are not always based on accepted clinical standards of care, but instead on the ways to minimize the insurance company’s expenses.  If the office is not contracted, they are considered out-of-network.  Some plans have very generous out-of-network benefits, some have limited, and some have none.  Sometimes is is more advantageous to use an out of network provider when the insurance plan restricts the procedures an in-network provider is allowed to perform on its members.  Stepping outside the insurance company’s network of “preferred” or “participating” providers allows for more freedom for you and your doctor to determine the best course of treatment for you.  It is important to consider more than your doctor’s network status with your plan when decided on treatment.
  1. There are two types of deductibles – Individual and Family. The amount a patient must pay “out of pocket” before insurance reimbursement begins is the deductible.  An example of an individual deductible is $50, family is $150.  If the family deductible is met (3 people in the family meeting the $50 individual deductible), then the deductible for all of the dependents on that plan has been met.  There are different levels of deductible depending on the provider’s network status.  Some visits and procedures are not subject to the deductible, meaning that payment by the insurer is immediately available for those services.   
  2. Dental benefits are calculated within a “benefit period”. Your plan could be based off of a calendar year (January-December), or a fiscal year (October-September).  Your annual maximum will be calculated based on the procedures completed during these times.  The annual maximum for dental insurance is much less than a medical insurance, which now since the implementation of the ACA is unlimited.  Annual benefits typically range from $1000 to $2000 for the year.  This means that the most your insurance will pay out in a calendar or fiscal year is that amount, leaving you responsible for all additional costs of treatment.  Dental maximums have not increased since they first appeared in the 1970s.
  3. Percent of coverage depends on the type of procedure needed. Preventative, restorative, basic and major all have different percentages of coverage.  They are not all covered equally.  Oral Surgery may have its own category or fit into major.  It all depends on the plan.  Many times Preventative is covered at 100% while restorative is at 50%, basic at 80%, and major at 50%, for example.  Again, the amount of coverage is plan specific. 
  4. Prior approval required or pre determination suggested. Your insurance may require an approval by their dental reviewer prior to services being rendered.  It is always helpful to submit a pre determination to get a better idea of coverage on expensive procedures, if possible.  By doing this, you will see the percent of coverage before beginning the procedure.  While it is not a guarantee of payment, obtaining a pre determination of benefits helps you to make an informed decision about any possible benefits your plan may extend for your procedure.  Some plans require a prior approval for certain procedures or if your age falls outside the accepted range for the procedure.  For example, some plans only cover extraction of wisdom teeth between the age of 15 and 30 years.  If you are 35, the plan requires your chart to be reviewed by a dental reviewer to determine if the plan will cover the procedure.  If the service is performed without the prior approval, the insurance company will deny the claim for payment.
  5. It is our hope that these 6 items will help explain dental insurance benefits.  Please feel free to ask any questions you may have concerning dental insurance coverage during your consultation appointment.

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My Teenager Is Missing A Tooth – What Now?

shutterstock_105548261.jpgThere are many reasons for a teenager to have missing teeth. Some teens lose a tooth (or teeth) from playing or being involved in an accident.  Teeth may be extracted due to decay, and sometimes teeth are congenitally missing, meaning the teen was born without the tooth or teeth.

When replacing a tooth for a teenager, timing is everything.  Dental implants are considered the best option for replacing a missing tooth.  As the jaw grows the implant will not move with the jawbone as they are imbedded in the jaw.Permanent restoration of a missing tooth in a teenager needs to wait until the jaw has completely developed.  Premature implant placement could cause a misalignment with adjacent teeth.  Boys usually have complete jaw growth by the early 20’s and girls by their late teens.

While waiting for the jaw to fully develop, it is important to maintain the bone health at the site of the missing tooth.  Bone grafts are used to preserve the integrity of the existing bone and stimulate new bone growth that will allow for a solid foundation when it is time to place the implant. Read the rest of this entry »

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Panoramic X-ray – Why you need one

Why is a current panoramic x-ray important?

Pano.pngWhen coming to our office for a dental procedure, it is very important for us to have a current x-ray.  Current x-rays (also known as radiographs), are essential for accurate diagnosis.  It is important for our doctors to see all areas of the face and jaws that are adjacent to surgical areas.  Due to changes that can occur in the face or jaw, it is important that our doctors have a new x-ray to view for quality care.  The acceptable age of the x-ray is dependent on what you are being evaluated for.  For routine extraction of wisdom teeth that are not currently causing any problems, our surgeons will utilize an e-ray that was taken within the past year.  However, if you are being evaluated for a cyst in your jaw bone, a more current x-ray is required.  Our surgeons are able to use past x-rays to compare to newer images to see changes overtime.  Surgery cannot be planned without a current image.  If you were to visit an orthopedic surgeon for knee surgery that doctor would need a current x-ray.  He or she cannot recommend surgery with an x-ray that is 2 years old.  It is the same for oral surgery.  Unfortunately, most dental plans limit the frequency that an x-ray is covered to once over 3 to 5 years. Read the rest of this entry »

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What to Expect at Your Consultation Appointment

If you have been referred to our office by your doctor or dentist, you are probably wondering about the care you will receive in our office. At Cumberland Surgical Arts we understand that there can be some apprehension when being referred to an oral surgeon, so we do everything we can to make your appointment with our office go smoothly. Continue reading to find out what to expect at your consultation appointment!

Scheduling Your Appointment

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Upon calling the office to set up your consultation appointment, whether you’re referring office does this or you call in on your own, we will be more than happy to work with your availability and schedule your appointment when it is convenient for you. We will need all of the patient’s information (Name, Date of Birth, SSN, Insurance, Etc.) when making the appointment, so make sure you have all of that information on hand. Since we see patients for a variety of conditions that can be filed under both medical and dental insurance, please provide us with all of your insurance information. Two days prior to your appointment, your insurance will be verified and you will be made aware of any co-pays that may be associated with your appointment at this time, as a courtesy to you. Read the rest of this entry »

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Get to Know Your Doctor: Q&A with Dr. Lee

Dr. George Lee

Choosing the right dental implant center means more than finding a place that offers the latest technology. It means finding a place with highly-trained dental surgeons and a support staff that puts patients first. As the Medical Director of Cumberland Surgical Arts, Dr. George S. Lee creates a safe and caring environment for patients.

George S. Lee, MD, DDS attended Dental School at Northwestern University in Chicago, Illinois and completed Medical School at Vanderbilt University School of Medicine in Nashville, Tennessee. At Vanderbilt, he also completed his internship in General Surgery and Residency in Oral and Maxillofacial surgery, and served as Chief Resident. Dr. Lee went on to complete a Cosmetic Surgery Fellowship in Dallas, Texas at Willow Bend Cosmetic Surgery Center, affiliated with the University of Texas Southwestern at Dallas.

Dr. Lee serves as a member of the American Academy of Cosmetic surgery, American Academy of Facial Plastic and Reconstructive surgery, American Association of Oral and Maxillofacial Surgeons, American Medical Association, and Tennessee Dental Association. He is the Past President of the 8th District Dental Society. Read the rest of this entry »

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Get to Know Your Doctor: Q&A with Dr. DeFelice

Dr. Matthew DeFelice

Going through dental implant surgery is a life-changing experience. Before going through surgery, patients want to know that they can trust their surgeon to provide them with the best care available. Matthew A. DeFelice, DDS is one of those surgeons.

A graduate of the University of Missouri – Kansas City School of Dentistry, Dr. DeFelice completed his Oral and Maxillofacial Surgery residency at Boston University Medical Center in 2000. As a leader in his profession, he serves as a Diplomate of the American Board of Oral and Maxillofacial Surgery, as well as The National Board of Dental Anesthesia. Dr. DeFelice is also a member of numerous professional organizations, including the American Dental Association and the Tennessee Dental Association.

To help potential patients get to know him better, Dr. DeFelice took the time to answer a few questions. During the interview, he shares his reasons for becoming a dental surgeon and emphasizes that dental implants are the right choice for most patients who need tooth replacement.  Read the rest of this entry »

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How E-cigarettes Affect the Health of Your Mouth

e-cigarette-use-and-impact-1.jpgAs of 2015, there were 2,750,000 e-cigarette smokers in the United States. People may turn to e-cigarettes as a healthier alternative to traditional cigarettes or as means of quitting smoking. But what are the overall health effects of e-cigarettes?

Some of the adverse health effects of regular cigarettes may be avoided with e-cigarettes, as they do not contain tobacco. No smoke is generated, so second-hand smoke is not a problem. Instead, e-cigarettes release a mist. For this reason, e-cigarettes can be used in public places.

E-cigarettes work by using a battery to heat a vaping solution, which contains a combination of nicotine, propylene glycol, glycerin, and flavorings. Inhaling activates the heat. Once the solution is heated, it is released as an aerosol and can be inhaled. Because e-cigarettes don’t burn, they don’t create many of the cancer-causing chemicals generated by tobacco cigarettes. E-cigarettes also don’t cause cigarette-breath, plaque, or yellow teeth.

In spite of the growing popularity of e-cigarettes, there are still a lot of questions about the effect they have on health. While e-cigarettes are generally believed to create fewer health risks than regular cigarettes, they can still cause oral health problems. Read the rest of this entry »

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Fall Sports Season Is Mouthguard Season

mouthguard-football.jpgAs summer turns to fall, football season kicks off. Whether participating in an off-the-cuff touch football game or playing on a school team, you need to protect yourself against mouth injuries. Football is a contact sport, and the impact from a tackle can damage your mouth and jaw. Even with the protection of the cage on a helmet, you can clench your teeth and damage them.

Sports Are a Major Cause of Mouth Injuries

According to WebMD, 40% of dental injuries in adolescents and adults happen while playing sports.

A fall or an elbow to the face can chip, crack, or break a tooth. The soft tissue inside the mouth can get cut or bruised. Teeth can be dislodged and loosened or knocked out entirely if a strong pass hits you in the face. The roots of teeth may fracture as well. A blow to the chin or a fall that causes the upper and lower jaw to be driven together can even cause a concussion.

Fortunately, many of these mouth injuries are preventable by using a mouthguard, a device that covers the teeth. A range of mouthguards are available for protecting your teeth and jaw. Learning more about the features of mouthguard options will help you make the right decision about how to protect yourself or your child while playing sports. Read the rest of this entry »

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