Unlike many plastic surgeons, Dr. Yan Trokel is getting a lift during the recession. Beauty is supposed to be only skin-deep. But for Dr. Yan Trokel it runs right to the bone. The 39-year-old Manhattan cosmetic surgeon is pushing a new face-hoisting technique–called the Y Lift–that requires no nips, tucks or month long healing time. While traditional face-lifts can involve three to five hours of invasive surgery that results in stitches, swelling and bruising, the Y Lift is performed while the patient is awake and typically takes 30 to 45 minutes. “My patients can fly in, get the procedure done and go out to dinner, to a business meeting–anything they want,” says Trokel. “They look amazing immediately afterwards, and in a day or two they look even better.”

After analyzing a patient’s bone structure, Trokel maps out the face and, with just a dollop of topical pain-numbing ointment, makes a number of small holes in different locations, say, on the forehead or jaw line. He inserts a thin titanium tube loaded with gelatinous filler (a common sugar found throughout the body called hyaluronic acid) into the holes that lifts the tissues and creates a space for the filler, which he often applies directly to the bone. Once cured, the filler becomes the new foundation for the face. By massaging the filler like clay, Trokel can accentuate cheekbones and jaw lines, and even smooth out wrinkles in the neck and around the eyes.

The Y Lift–named for the letter, which Trokel says is the ideal shape of the human face–has become so popular that his calendar is booked solid for the next six months with actors, executives and other physicians from around the world. That backlog may not be recession-proof, but Trokel is faring a lot better than his old-school, skin-snipping competitors. Americans spent $11.8 billion on plastic surgery last year, down 9% from 2007, according to the American Society of Plastic Surgeons. Since 2000 the number of invasive cosmetic surgical procedures, such as cheek implant surgery, chin plastic surgery and forehead lift surgery, is down 3%; meanwhile, the number of minimally or noninvasive procedures–hyaluronic acid treatments (that would be for wrinkles), laser skin-resurfacing and hair removal–leapt 81%. When it comes to vanity operations, patients prefer to pass on the knife if they can.

Born in the Republic of Georgia, Trokel immigrated to the U.S. with his parents in the 1970s. His father set up an art and antiques dealership, but Trokel knew early on he wanted to work on faces. That’s why he went to dental school at Columbia University. “If you really want to understand the face, you have to know how everything works,” he says. “The jaw makes up three-quarters of the face.” Later he attended medical school at the University of Texas, Southwestern Medical Center at Dallas and spent eight years at nearby Parkland Hospital doing everything from cancer resections to facial-deformity reconstructions.

Trokel’s quicker, cleaner approach is based on a fundamental observation. “As people age, they don’t grow extra skin,” he explains. “So we really don’t need to be cutting the excess skin, because there is no such thing.” Over time our facial skin gets thinner, the muscles atrophy and the bone diminishes; that lack of total facial volume results in saggy-looking skin. The Y Lift essentially replenishes the volume. Trokel likens it to making a bed: “You can’t just throw on the duvet. You have to do all the layers to make it look really nice.”

Perfecting his technique after four years, Trokel brought his show to New York in 2006. As word of mouth spread, his 2,000-square-foot office–now with ten other staffers (nurses, technicians and clerical folk)–was soon at full capacity, remodeling 8 to 12 faces a day. With the cost of his assorted procedures running $5,500 to $12,000 apiece, Trokel’s business probably pulls in at least $2 million a year in revenue

A Parking Garage is a building, or part of a building that is designed specifically for the purpose of parking vehicles. Typically there are several floors or levels for parking to take place on.

Parking Garages are designed so that the flow between vehicles can be created using interior ramps, exterior ramps, vehicle lifts or elevators. The actual design of the parking garage depends commonly on where it is located, how many cars it is meant to hold, and what sort of land it is built on. Parking garages that are built on sloping land typically have split-levels. It has been only in the past recent years that many parking garages have been created from independent buildings for that use only, which allows for longer floor spans and accommodations for a greater number of vehicles. Parking garages are also commonly built to serve residential areas like apartment and business complexes, they can be built next to the building they are meant to accompany, below it as in on the first and sometimes second floor of an apartment complex, or often underground to serve as part of the basement of a building.

In the United States the common terms for these structures are Parking Garage, Parking Structure, Parking, Deck and Parkade, the term “parking ramp” is also used, commonly in the upper Midwest, including Wisconsin and Minnesota, but also as far east as Buffalo, and New York, however in the United Kingdom, Hong Kong and Singapore, the term ‘Multi-Story Car Park” is used. Building codes in the United States use the term ‘Open parking structure” relating to a structure designed for storing cars, they are created to have openings in the walls which allow filtering of fresh air in order to disperse car exhaust and fire fumes.

Parking garages that are meant to serve shopping malls are usually built adjacent to a multi-story mall in an attempt to create easier access to various floors of the mall to various floors of the parking garage. The Mall of America in Bloomington, Minnesota for instance, has two large parking garages that are attached to the building at both the eastern and western ends of the mall.

Parking Garages for casinos are built adjacent to the casino. Parking garages for hospitals are usually connected to the hospital. Parking garages for airports are also typically connected to the airport. Parking garages for universities and colleges are built to accommodate growth of student enrollment.

Mixed-use parking structure construction is also becoming more popular, especially where public dollars are allocated. Mixed-use parking garage construction helps generate tax revenue for cities and localities. Instead of parking garage serving a single-purpose, retail and commercial space are incorporated into the structure.

Although the popularity of face lifts has general knowledge of this type of lift fairly common; most people do not have the same type of knowledge when it comes to other types of mechanical bodies. A type of body lift many people benefit from May thigh lift is also known as a leg lift. There are several types of lifts and thigh many reasons a person May require one or more of these procedures.

Types of Thigh Lifts

There are several types of leg lifts, inner thigh, including elevators, lifts and bilateral median thigh lifts. These elevators May also be complemented by body lifts and buttock lifts. Lifts exact requirements vary from person to person.

The inner thigh lift to reduce the amount of skin in the thigh and it strengthens. May this be done with liposuction at the same time? Because this area of the body can be very difficult to cut through diet and exercise, this type of lift can be useful for many people – women in particular. If a person has long been a significant amount of weight is also a good option. This is because, if a person loses a significant amount of weight, in May this person be left with a large amount of excess skin as diet or exercise program can help to eliminate.

The bilateral thigh lift helps to tighten the skin on the outside and front legs. May it be done in addition to other thigh lifts (at the same time) or by itself. With this type of surgery the surgeon makes an incision in which the merits of a person suffering from underwear and removes excess skin and strengthens what is left. This type of surgery is also good for people who cannot cut anything he wants with diet and exercise or if they have lost much weight and excess skin. This type of surgery can be performed with liposuction as well.

A median thigh lift is performed in the upper inner thigh region. May it be done for the same reasons as other thigh lifts (excess skin from weight loss or stubborn weight) or May it be done simply because a person is not like the way upper thigh of his appearance or form.

What to expect

Any person who proposes to raise the thigh should know what to expect before, during and after the procedure. First, to be considered a good candidate for this type of surgery a person must be healthy, and preferably a non-smoker. It may be the healing of a procedure to lift the thigh, but the scar is usually hidden in the underwear line. A person of the doctor in May that advice a patient to get liposuction thigh lift to reduce the amount of fat in a region before lifting. Thigh lifts are usually performed under general anesthesia, most often in the context of a hospital. Anyone considering a thigh lift will probably need someone to drive home after. The time taken off work is usually about two weeks.

For wheelchair users, a common issue is climbing platforms and steps while being seated in the wheelchair. At your home, a concrete ramp made at the entrance of your home is sufficient. But when you want to step inside or outside of your car or when you are in another building, you will have to face some problems. An alternative option is to carry a portable ramp which can be placed at varying heights including steps, along which your wheelchair can be moved upwards and downwards easily.



Wheelchair ramps can be permanent, semi-permanent or portable. Constructing a ramp using concrete is ideal for permanent needs. Special care should be taken on deciding the level of inclination that should be given to these concrete ramps. A steep ramp is difficult to climb and poses the threat of wheelchair being tipped backwards. The accepted inclination level is 1:12 (i.e., for every 1 m height, the length of the ramp should be 12 m).



For portable ramps, the main concerns include the material used for the construction of the ramp, how durable the material is, and how much weight it can bear without deformation. Commonly used materials include aluminum, steel and wood. For apartments and hospitals deciding to put up a wheelchair ramp, the factors to be considered are the different types of wheelchairs with varying width between the wheels and having different weight capacities. The ramp should be able to accommodate both small and big wheelchairs and have a good load bearing capacity.



Specifically designed ramps for vehicle entry are also available. Both permanent and temporary models can be bought. Customized vehicle ramps can be built to suit to the vehicle you are using.



With a number of companies offering a wide range of wheelchair ramps, the best option is to check various ramps to find one which matches with your wheelchair. The lighter the ramp, the easier it is to carry.  The trial and error method of checking different types of ramps will eventually get you the right ramp suited to your needs.

When a person has a face lift, he or she has the procedure in the hospital or in a surgical suite at the doctor’s office. If it is done in the hospital, how long that person has to stay in the hospital after the surgery can depend on several factors. For the individuals who have their procedures done at a doctor’s surgical suite, there is no need to stay in the hospital at all. A surprising number of individuals are having face lifts today and then being sent home that same day, after only a brief time in a recovery room. Whether a person has the procedure in the doctor’s office or in the hospital depends on three things: the preference of the patient, the preference of the doctor and the seriousness of the procedure.



Hospital Surgeries



A face lift that also involves other surgeries along with it will be more serious and take longer to recover from than only the face lift procedure. Due to this, it is much more likely for a person to have that surgery in the hospital and to stay overnight for observation. After the first night, however, the patient would generally be allowed to go home unless he or she has some kind of complication or problem that appears to be developing, or a bad reaction to the general anesthesia. Any kind of reaction, allergy or problem could cause the individual to have to stay longer.



This only makes sense, because the first thing that should be done by any doctor is to ensure the safety of the patient. This is hard to do if the patient is not there to be observed. Even for a complicated face lift mixed with another procedure — such as something done to the eyelids, a rhinoplasty or a chin or cheek implant — a patient will usually only spend one night in the hospital. The next day he or she will go home to continue recuperation.



Doctor’s Office Surgeries



Most face lifts are done in a doctor’s office. Many doctors who perform cosmetic surgery have a surgical suite where they can conduct procedures. This eliminates the need for a patient to go to the hospital and it also lowers the cost, because there are fewer people involved and less equipment. In addition, the doctor does not need to be affiliated with a particular hospital or rent or lease space there for his or her patients that only need a simple face lift procedure.



For a patient who has a face lift – which is usually just the lower 1/3 of the face – in the doctor’s surgical suite, there is no hospital stay at all. These individuals have their procedures, they rest for a little while, and then they go home. Usually, the doctor will want to see them again soon, and they are instructed to call or come in if there are problems, concerns or questions. They recover at home, which saves them a lot of money as opposed to a hospital stay, and many patients feel more comfortable at home in their own beds, as opposed to in a hospital bed all night.



Whichever a patient’s doctor recommends, however, is the way to go.