Most patients today are quite knowledgeable about implants. Now that silicone implants are once again approved the majority of our patients request them. They look better and feel more natural, not to mention there are less complications. Gel (silicone) are fully approved by the FDA and all other agencies.
Generally speaking, after a woman has had children the breast not only loose volume but become droopy. In this case just placing a breast implant does not give a pleasing result. Therefore we lift the breast or lift the nipple areola to a more youthful position, which requires a “lollypop” or “T” shaped scar. In the more recent years the majority of surgeons are usually placing an implant as well, not so much for size but for contour. Without the implant the breast may assume a flat or pancake look. This is more surgery than just an implant it takes twice as long in terms of the procedure. The cost is more and of course there is an additional scar. The overall result is very nice and the patients rarely complain about the scars, which tend to fade out within 1 to 1 ½ years.
The breast reduction surgery is similar to the breast lift operation, in that it requires a “T” shaped scar even on occasion a small implant for contour but if the breast is large enough the patient's remaining breast tissue will give a nice rounded contour with out benefit of an implant. Drains are sometimes required for 3 to 4 days. A supportive bra is required postoperatively, and patients are encouraged not to go to the gymnasium or work out for approximately 4 weeks. Complications are very rare, there is some blood loss. The scars are permanent but they are cosmetic. Nipple sensation can be affected although it is a small number of patients that develop this. The rare and tragic fat necrosis can result in loss of tissue from devitalized fat remaining in the breast and even an occasional loss of the nipple, although this is very rare
RECONSTRUCTION AFTER BREAST CANCER:
Unfortunately, we have many patients requesting these procedures. The good news is that survival and reasonably normal lives are now the norm thanks to early detection and intervention. Reconstruction modalities include simple implants, tissue expansion followed by implants, and various flap reconstructions. Nipple and areola reconstruction are preformed with a combination of small flaps and either skin grafts or tattooing.
Gynecomastia is the term for over development of the male breasts. Usually this begins following puberty and is a cause of great concern and unhappiness in adolescent and teenage boys. Many adult males seek attention as well. In my experience, the patients with this disorder are among my happiest patients. These young men avoid the gymnasium, school sports and dating and are routinely embarrassed by this condition. Correction involves removal of offending tissue in combination with liposuction.
The abdominoplasty or “Tummy Tuck” operation is generally for women who have had children and have a sagging belly, with which liposuction would only accentuate the sag of the soft tissue and skin. All of the skin between the naval and the pubic area is removed this area usually includes the stretch marks. The remaining skin above the naval is then pulled down to the pubic area and stretched tight. During the time of exposure, the muscles that have been weakened from childbirth are tightened up which give a flat contour to the belly and does not allow a bulge. The procedure is now done in accompaniment with liposuction of the flanks, to achieve a nice waistline as opposed to a straight contour as in years past. This procedure sometimes requires a drain. The recovery period is usually 7 to 10 days.
RECONSTRUCTION FOLLOWING GASTRIC BYPASS:
These procedures are common in our practice. Following massive weight loss the skin losses its ability to contract, much like the pregnant abdomen after delivery and the skin virtually hangs. The usual procedures include breast lift, lower body lift,which includes the tummy tuck, lateral thighs and buttocks as one procedure. Frequently these patients will return for a “second Stage” that includes breast lift and saggy skin of the arms. Also, face and neck lifts are commonly requested by these patients. Like gynecomastia, the gastric bypass patients are among our happiest patients.
Liposuction is an extremely popular procedure. Patients are advised prior to the surgery that this is not a substitute for weight loss but more for a sculpturing technique. The concept is to remove fat in areas that are storage or depot areas. These are most prevalent in the “saddlebag” or hip area in women, in the abdomen also the inner thighs and in a lot of women in the flank area. It is also very common to do liposuction in the flank area at the same time as the “tummy tuck” procedure, as this gives a much better defined waist line, than just a plain tummy tuck procedure. Liposuction is done through very minimal incisions after first instilling a tumescent fluid, which helps to hemagenize and make the removal of fat smoother and gives pain relief and also returns fluid to the body. Following the liposuction procedure patients are encouraged to wear a compressive garment that smoothes out the area as well as provide comfort for them. The majority of patients are happy with liposuction because both the scars and downtime are minimal.
The meloplasty or facelift is done in the mid 40’s up to the mid 70’s, if the patient is in good health. The drooping relaxed skin is separated from the facial structures. The inner tissue or the ”SMAS” is lifted and fixed to the underside of the bony structures, like the cheekbone. This is done to reduce the jowls and suspend them for a longer period of time. The extra skin is lifted and redundant portions are excised and the scars are very well engineered to hide in the hair and behind the ears. There is very little exposed scar with this procedure. The scar in front of the ear actually curves behind the small protruding portion of the ear called the Tragus. In general the scars are not noticeable with in a brief period of time. Complications with the face lift are rare but can involve some temporary weakness in facial expression on one side around the corners of the mouth and eyebrows. This is rarely permanent and will usually go away. It is from bruising and stretching of the small nerves. Recovery from the facial surgery is quick the face heals very well and after just a few days of bandaging the patient is without bandages, the majority of the swelling and discoloration is gone in the first week and patients can return to an active social life usually within a week.
Blepharoplasty is the correction of “baggy” eyelids. This is a very commonly preformed surgery particularly in the late 30’s, 40’s and 50’s. Men have it as well, although women are the majority of patients. The procedure involves removing of excess skin, usually a small strip of muscle is removed to fix the sulcus, or the crease in the eyelid so that it becomes permanent. The bagginess of the eyelid is from relaxation of the septum that holds the fat around the eye; we all have fat around the eye to protect it as a shock absorber. As we get older it loosens up and we get the tired and baggy look. This fat is removed when this procedure is done. The scars on the eyelids generally heal extremely well. The face is very kind to healing.
Complications are usually minimal a small percentage of people can get some dropping of the lower eyelid. We try to anticipate this and hold it up with a canthopexy, which is an internal stitch from the lower lid up into the eye socket itself, which tends to prevent this problem. Another complication is what is call the dry eye, and it comes from exposure we try to prevent with Visine and other saline type of drops and at night using Lacralube, which is an ointment used to keep the eye moist.
Reshaping of the nose for cosmetic improvement is frequently performed at the same time as correction of the deviated septum to improve breathing. These procedures are requesting by men and women alike, as well as older teenagers. Despite commonly held beliefs the procedure is actually not very painful at all. Frequently, insurance will cover a small portion of the cost if the septum is involved.
For people with prominent ears that stand out, this is the commonly known ear “set back”. These procedures are done frequently as early as age seven as other children are frequently cruel and teasing is common. For small children the surgery is done under general anesthesia but can easily be done on adults under local anesthesia.
Combination Procedures include breast lift and tummy tuck; Breast implants and liposuction; Facelift and tummy tuck etc. There are several advantages in considering more than one procedure at the same time. First, savings both the surgeon and the hospital discount the second procedure. Second, there is one time off of work and not two. The last advantage is that there is one anesthesia exposure only.
My personal rule is not to exceed six hours of surgery at any given time. After this, there is a slight increase in complications and I will not be as artistic at the end of a long day of surgery.
BOTOX AND FILLERS:
Botox and fillers are two totally different means of achieving a more youthful appearance. Botox paralyzes certain muscles of facial expression. Between the eyebrows, horizontal lines of the forehead and the “crows feet” around the eyes.
The fillers do just what the name implies i.e filling in defects and deep lines in the face which tend to occur as we get older. These fillers provide a softening of facial contours resulting in a more youthful appearance. neither of these products are permanent. The Botox affects lasts about 4 to 5 months, and the fillers, depending on which products are used anywhere from 4 to 16 months. The thicker products such as Perlane and Radiesse lasts much longer. Recently, we have begun enhancing cheekbones with Radiesse. And have been really impressed with the results. It has virtually replaced implants and other surgical procedures previously used for this purpose. It is essentially non invasive and far less expensive.
We continue to have our “Botox Day” every month. We purchase the Botox and fillers in bulk and are therefore able to pass on considerable savings to our patients.
We carry the Kinerase Pro+Therapy skin care line. Please call for details and specials.