An esteemed panel of plastic surgery experts, including Dr. Mark Epstein of Long Island, New York, Dr. Shaun Parson of Scottsdale, Arizona and Dr. Ned Snyder of Austin, Texas, convene to answer one of the most asked questions in plastic surgery.  How do I get rid of this fatty bulge and the cellulite?  Is Liposuction the answer?  This can be very confusing to patients because they often see this one area as one problem and expect one surgical solution to handle it.

by Terrye Tebbets
The Plastic Surgery Channel

The Difference Between Fat and Cellulite

Dr. Epstein breaks down the problem for us, “I think there are really two questions being asked here.  One is about a little bit of fat and the other is about cellulite.”  Fat and cellulite are distinctly different problems in the minds and eyes of a surgeon.  “There are two different layers of fat in the body.  The bumps and the saddle bags that reside in a deep layer of fat can be addressed with liposuction. Then there is cellulite that occurs due to irregularities in the superficial layer and removing fat is not the answer. The bands that are pulling the skin in and causing the dimpling need to be addressed,” says Epstein.

A Promising Option

“We have a new technology, Celfina, that is just becoming available. It is a minimally invasive, using small incisions and done in an office setting,” says Dr. Snyder.  Celfina’s technology allows surgeons a method to disrupt the bands that are pulling on the skin and causing the dimpling. Cellulite, in the past, has been one of the most difficult problems to address for patients in a predictable manner.  Years ago, one of the first tools introduced to the plastic surgery world to address the cellulite problem was a liposuction cannula with a very odd name.  They called it a pickling fork!  Doesn’t sound like a lovely procedure to sign up for, does it?  The end of the cannula was just like it sounds, a forked tip, that surgeons would move through the superficial layer of fat hoping to break up the bands that were causing the dimpling.  Celfina offers a much more precise and predictable way to produce the smooth skin patients are looking for.

Dr. Parson reminds us that surgeons must be honest with patients and paint a reasonable expectation of the result that can be achieved. “If you’re painting a picture of the perfect result when sometimes you can’t deliver a perfect result, I think you’re doing the patient a disservice.”  Dr. Epstein warns, ” You have to have experience to individualize the tool to the patient and the patient’s issues.”  Seeing a board certified plastic surgeon will go a long way in helping you find an expert who truly understands the difference between deep fat and superficial problems and who understands all the options available.

Our experts agree we are just beginning to see the tip of the iceberg in terms of technology and how it can be used to address problems like cellulite.

The post A Procedure to Effectively Battle Cellulite appeared first on The Plastic Surgery Channel.

It turns out that women aren’t the only ones dissatisfied with their chests these days. “One of the things we’ve noticed in our practice is more men coming in just wanting to make themselves look better and feel better.” says Dr. Dustin Reid of Austin, Texas. The chest is one of the areas that bothers men the most with many developing increased breast tissue either at puberty or later in life, making them feel self conscious and keeping them from doing things like going to the swimming pool, waterskiing, or even wearing a t-shirt.  Although hormones, weight fluctuations, genetics and certain drugs like anabolic steroids can all play a part, the exact cause is unknown. But the problem is definitely out of the closet. According to the American Society of Plastic Surgeons, gynecomastia or the male breast reduction is now one of the top 5 most requested procedures for men.

by Katherine Stuart
and Ashley Gordon, MD
and Dustin Reid, MD

Gynecomastia Is Easily Treated 

For most of their patients, Dr. Reid and his colleague Dr. Ashley Gordon treat gynecomastia by simply removing the excess tissue with modern liposuction techniques such as SAFElipo. It’s a simple outpatient procedure. The incisions are easily camouflaged within the armpit. And the patient is back wearing t-shirts in no time. However, there are certain rare cases in which the excess tissue must be excised surgically. This is usually a patient who has lost a massive amount of weight causing the skin to sag and the nipple to fall below the breast crease. This type of case demands a horizontal incision across the chest in order to properly resize and reshape the breast.

With men who develop gynecomastia as teenagers during those formative years where self esteem is developed, it’s extremely important to treat it early. “Because if you wait too long, it can seriously affect their psyche.” says Dr. Reid. Both he and Dr. Gordon have treated men who lived through puberty with gynecomastia and they all wish that they could’ve done something about it earlier.

Pec Implants Are About Shape, Not Volume

Another “hot” procedure for men, according to Dr. Gordon, is pec implants. “Genetically, some men don’t have very well developed pec muscles. They go to the gym and work hard without seeing results.”  For them, pec implants can help to accentuate the muscle, bringing it forward. Different than breast implants, the pec implant is a solid silicone device that comes in a variety of different sizes. It’s less about volume than it is about shape. “It’s all about choosing the right dimensions of the implant for the patient’s actual chest wall and the goals that they have.” says Dr. Gordon. Helping a patient to figure out his goals by looking at pictures is of paramount importance. Some men want an implant that just makes their pec muscle look normal while others already have a bit of pec muscle, but want that Arnold Schwarzenegger body builder look. “All can be done safely, but you need to decide with the patient what their goals are” says Dr. Reid.

The Internet Makes Men Feel More Comfortable

Dr. Gordon believes that the internet is one of the main reasons that more men are seeking out plastic surgery. It allows them to start their research from the privacy of their own home without ever having to talk to anyone about something they might find embarrassing. They can read about other patient’s experiences, and look at before and after photos before actually meeting with a surgeon. Because of this, they tend to come in extremely well educated. Which always makes for a happier patient.

Both gynecomastia and pec implants are very rewarding procedures to perform. “Patients are universally happy with a problem they’ve hated all their life and you can make it go away.” says Dr. Reid.

The post Plastic Surgery Is Not Just For Women appeared first on The Plastic Surgery Channel.

Dr. Constantino Mendieta has a mantra: “The fat you love to hate, is the fat I love to take.” His practice, based in Miami is seeing a sharp increase in a procedure called Fat Grafting. Although it sounds too good to be true, fat grafting, or fat transfer literally takes fat from one area of the body where it is unwanted, and puts it into another area where more volume is desired.

by Isabel Bolt
and Constatino Mendieta, MD

A short history of transferring fat

The first evidence of fat transfer was recorded in the 18^th century, but never became widely accepted until modern liposuction techniques were developed. Complications including infection and the viability of how much fat would “live” through the transfer deemed it unpredictable at best. This began changing when in the early 1990’s Dr. Sydney Coleman, a New York City Plastic Surgeon, began publishing papers describing standardized techniques for fat extraction, processing, and injection. Since that point in time the procedure’s popularity has increased along with a wider variety of clinical applications.

Recent History–The American Society of Aesthetic Plastic Surgeon’s Meeting 2015

The ASAPS meeting held in Montreal, Quebec last May hosted a panel discussion on the evolution of fat grafting, and how surgeons are discovering best practices to produce the most natural looking results. Dr. Mendieta was a panel member. “Fat grafting is a relatively new way to literally sculpt the body and it is revolutionizing plastic surgery. Fat is the ‘liquid gold’ that enables us to reshape, change and augment patients’ body parts in ways diets, exercise and creams simply can’t. A patient’s own body tissue is used, so there is no chance of rejection,” explained Dr. Constantino Mendieta.

Plastic surgeons around the world agree that fat grafting is proving to be a novel technique for body sculpting previously neglected areas including women’s and men’s shoulders, pectorals, legs and stomachs to create definition.

The Fat Grafting Process

The process of fat grafting involves three steps: extraction of the fat from the donor area with liposuction; decanting, centrifugation, and processing of the fat; and finally reinjection of the purified fat into the area needing improvement. Fat is taken from the donor area (stomach, hips, and thighs) using special liposuction techniques with thin cannulas. The fat is either “decanted” or “washed” to separate out the viable adipose fat cells to be used in the graft.

In the first step, fat is extracted from a donor area using liposuction techniques. This is best accomplished by manual methods using thin liposuction cannulas with small holes. Laser or ultrasonic liposuction should not be used for the extraction as it may destroy the fat cells. In the final step, the fat is reinjected in small droplets throughout the subcutaneous tissue of the recipient area. This is to ensure good blood supply to every fat droplet so that the fat graft can survive.

The amount of fat injected is measured in cc’s and ultimately varies according to patient specifics and the area of the body where the processed fat is being injected. 10 cc’s is roughly 2 teaspoons. How much fat is necessary for different areas? In general, 10-100 cc’s might be used for the face, while buttocks can use from 200-1300cc’s in each cheek. Patients must have enough fat to harvest to accomplish their desired result.

Common Areas of Fat Grafting

Simply put, fat can be used anywhere dermal fillers or implants would be used. Dr. Mendieta uses it for facial rejuvenation to restore a more youthful appearance by adding volume to the areas below the eyes or nasolabial folds, the cheeks, nose and even the jawline. The breast can be enhanced by one or two cup sizes using fat. It can also correct breast symmetry, repair radiation damage and correct deformities from lumpectomies or breast reconstruction. The demand for buttock enhancement, also known as a Brazilian Butt Lift is skyrocketing with an 84% increase in the last year. Buttock augmentation can change the size and shape of the buttock while sculpting the hip-waist ratio for a more feminine (or masculine) silhouette. Hand rejuvenation is becoming more popular to not only plump up the volume and padding on the hand, but also improve the texture and appearance of the skin.

According to Dr. Mendieta, fat is really the clay that allows him to “reframe and reshape different body parts.” “What is fascinating is as you age you lose fat from hands, face, breast and buttock and you don’t lose it where you want to lose it from– waist, inner outer leg and love handles. So I am removing fat from where it will never disappear and putting it where you need it. I think fat genetically has a predisposition…and that fat should live forever.”

An Uncommon Area–Men’s Torso

Dr. Mendieta is known for performing something he calls “the Adonis procedure” where he augments a man’s torso–shoulders, chest, abdomen using the man’s extra fat in the love handles or waist. “Not only are we augmenting the butt, hands, and face but now men’s upper bodies.” “Fat clinically takes on properties of where I put it. There’s a lot of flexibility with using fat to contour the overall body shape because fat takes on the physiologic component of whatever it is adjacent to. If you inject fat near bone it takes on the characteristics of bone, and the same applies to muscle. When I put in a muscle, it becomes a bigger muscle. It expands to re-sculpt and contour the chest and shoulders giving a man a nice “V” cut.”

High Demand, Few Experts

It is important to note that extracting fat is a very technique dependent procedure. Applying the fat is the ultimate artistic procedure. Few practitioners are considered experts, so it is critical that a prospective patient choose a plastic surgeon with the experience, training and eye of a sculptor. Demand is high, but the results are definitely not mainstream. Techniques have really improved across a wide range in the industry, but it’s still important for patients to choose a board-certified plastic surgeon with extensive experience in this particular procedure. A conservative approach may involve multiple fat grafting sessions over several months to get the desired results.

The post Embracing Fat for Contour appeared first on The Plastic Surgery Channel.

According to the latest statistics from the American Society of Plastic Surgeons, breast augmentation has been the most popular cosmetic surgical procedure in the United States since 2006 with 286,000 performed in 2014 alone. With more and more women seeking implants at a younger age, one of the most pressing questions for many patients is: If you get breast implants, can you still nurse? The answer is a resounding YES.

by Katherine Stuart
The Plastic Surgery Channel

If You Could Breastfeed Before, You Can Afterwards

The question of whether or not breast implants will impede a patient’s ability to nurse is a common one. Our panel of experts agree that there is not a problem with breast implants and nursing with some caveats. “If you could nurse before, you should be able to nurse after breast augmentation.” says Dr. Laurie Casas of Chicago, IL . But if you’ve never had kids, how do you know if you can nurse? Well, your natural breast tissue can be a pretty good indicator of potential milk production. If you don’t have a lot of glandular tissue to begin with either due to tubular breasts, widely spaced breasts, asymmetric breasts or undeveloped breasts then you’re at a higher risk of not be able to breast feed regardless of whether you have an implant or not.

Other factors to consider are incision and implant placement. It’s rare, but areola incisions can reduce nerve response to the nipple and inhibit milk production. So, if you are planning on having kids, opt for an incision under the breast. And place your implant beneath the muscle. That way the implant won’t be pressing on glandular tissue and potentially impeding your flow of milk.

Surgery Does Produce Scars

Although there is no real interference between a breast implant and the breast tissue, every surgery results in some kind of scarring both internally and externally. Dr. Robert Grant of New York, NY advises his patients who “positively want to nurse” that “they probably should have their children first and think about their implants latter.” Although scarring that would impair a patient’s ability to breastfeed happens rarely, he feels that it is an important part of the consent process for patients to truly understand the risk. “Most of the patients go on to successful nursing no matter what age they had their implants put in.” For Dr. Robert Whitfield of Austin, Texas, it really comes down to age. For patients who are still in their 20’s, “They should probably worry about nursing latter. At that age, they can have their procedure.”

Breast Tissue is the Key

The key for Dr. Casas is does the patient have breast tissue at all? For her pre-pregnancy patients who have zero breast tissue, there’s really no reason to wait. “But my patient who has maybe a beautiful, small B cup breast, that’s the person to counsel. Because there’s breast changes with pregnancy and nursing that will affect the breast size so then the breast implant that was chosen, so carefully, now isn’t he right fit. “

Bottom line: If you still plan on having kids, but want implants then do it. Just consider your risks first.

The post If You Get Implants, Can You Still Nurse? appeared first on The Plastic Surgery Channel.

As women age, they may be concerned with sagging breasts, as well as loss of volume in their bust line. There is a solution in a single surgery, that some believe allows a woman to reduce risk by having only one operation. The procedure combines a breast lift, with a breast augmentation for those wishing to increase size and stop the sag. Doctor Paul Watterson discusses why this duo surgery is so popular and produces dramatic results in some patients. 

by Dawn Tongish
and Paul Watterson, MD

Several factors can take a toll on a woman’s bust; childbirth, breastfeeding, weight loss, weight gain and just the passing of time. Dr. Paul Watterson, who is a board-certified plastic surgeon in Charlotte, North Carolina practicing at Charlotte Plastic Surgery says, over time, the breasts may begin to sag and lose volume. It often prompts women to feel dissatisfied with their body image and uncomfortable with how their clothing fits. “Women want to have some volume back after having children.” He says the goal is to look and feel like they did before childbirth.

“[Patients] aren’t sure how to get their bodies to that point. They don’t know if they need a breast lift or a breast augmentation. It can become a tough decision to make.” – Paul Watterson, MD

Which to Chose – Implant or Lift – or Both

Childbirth can be a grind on a body, so mothers are often excellent candidates for this combo procedure. Breasts often stretch and usually lose some shape after the rigors of giving birth. Pregnancy and breastfeeding can take a toll. The word “sagging” is often the first giveaway that someone is right for the operation. “When I am in a consult with a woman who says my breasts are sagging or when she says I want my breasts lifted, that’s a key word, and probably she needs a breast lift,” says Dr. Watterson. Once the decision is made to have a breast lift, a woman and her doctor can then decide if implants are also appropriate.

Dr. Watterson says using an implant alone isn’t the right course to solve an issue with sagging breast skin. “If you just put an implant, the breast falls off of the breast, and it doesn’t give the result that they are after. When you explain that to a patient they get it, they understand it.”

Seeing is Believing

Patients should be selected carefully for the one-stage procedure, so it is wise for patients to chose a board-certified plastic surgeon familiar in this operation. Doctor Watterson screens patients carefully and says the best technique is to let a woman “see” what she would look like at the end of the procedure using everything from the best imaging devices to a simple mirror. “I have the patient stand in front of a mirror and I show her what she will look like after the lift and then she undertands. I can show her what volume in the breast will do.”

There is no clearer picture. Seeing is believing. “Anything visual is powerful. When they see what they will look like, it’s powerful.”

The post Breast Augmentation/Lift – Does It Work? appeared first on The Plastic Surgery Channel.

The nose does more than just allow us to breathe. It serves as an anchor for our entire face. So, if it’s too big or too small, it can throw off our facial balance. And since perceived beauty is all about balance, the nose can really wreak havoc on some patients self esteem. Which helps explain why rhinoplasty is the second most popular cosmetic surgical procedure in the United States behind breast augmentation. But a lot of patients don’t want the hassle or cost of surgery so is there a non-surgical rhinoplasty? And, more importantly, does it work?

by Katherine Stuart
and The Plastic Surgery Channel

Fillers Are for More than Just Wrinkles These Days

It turns out that the non-surgical rhinoplasty has been around since the early 1900’s when surgeons used liquid paraffin to correct nasal imbalances. Although the corrections proved effective, the paraffin wound up being harmful to the body. As were the silicone fillers of the 1960’s. It’s only recently with the advent of hyaluronic acid fillers such as Juvederm and Restylane that the non-surgical rhinoplasty has become a plausible reality. “It’s not one of the most common things because many of the issues that people have with their nose require surgery, but for small problems, small issues, I think it works very well.” says Dr. Dustin Reid of Austin, Texas.

Though not a substitute for rhinoplasty, fillers can fix little irregularities according to Dr. Richard Baxter of Seattle. “Well if you have a little irregularity, it can be good for that.” While fillers can not reduce the size of the nose, they can augment depressed areas of the nose to lift the angle of the tip and/or smooth out bumps along the bridge. These subtle changes can make the nose look smaller by altering the balance of the face. It’s one of the many ways that surgeons are using fillers for more than just wrinkles these days.

Another way to restore balance, according to Dr. Ashley Gordon of Austin, Texas, is to use fillers on the chin. “One of the places that fillers work really well in conjunction with rhinoplasty is you can do a non-surgical chin augmentation.” Using fillers in the chin area and along the jawline can change the appearance of the nose by restoring balance between the nose and the chin. Assuming that the patient doesn’t need a chin implant, it can work really well.

When deciding whether or not to get a non-surgical rhinoplasty, one of the main things to consider is safety. Because the nose has very little blood supply, surgeons need to be careful about what product they use. The safest are the hyaluronic acid fillers such as Juvederm and Restylane. It’s also important that you see a board certified plastic surgeon who uses fillers often, but who also has a lot of experience doing rhinoplasty surgery and therefore has a firm understanding of anatomy. This is definitely a situation in which a surgeon, not a cosmetic dermatologist, is going to be your best choice for administering the filler.

The post Does Non-Surgical Rhinoplasty Work? appeared first on The Plastic Surgery Channel.

Just a little addition to fat and loose skin to the neck can take a dramatic toll on how youthful one appears, especially when it comes to men. Because men tend to gain fat in their faces, even the smallest amount can make an impact.

The good news is just as easily as that fat can accumulate with age, so too can it be easily removed. Dr. Daniel Maman of New York City is excited about offering a myriad of surgical and non-surgical devices to help men lose that bit of fat under their chin. Dr. Maman is especially proud of their practices ability to offer liposuction under local, a procedure he thinks to be superior to all when it comes to rejuvenating the neck.

by Adam McMillon
and Daniel Maman, MD

A common complaint

We’re noticing our perfections and imperfections more than ever before now that nearly everyone walks around with a high definition camera in our pockets. While it may seem like many are just now noticing the way their neck lifts, the unfortunate truth is it all gets us at some point, especially men.

“The neck and chin area is perhaps the most common reason that we see men seeking treatment,” says Dr. Maman of 740 Park Plastic Surgery. “Men will often complain about a double chin that they see in pictures, that they see in the mirror in the morning when they’re shaving. Another common complaint is fattiness or fullness of the neck.”

Surgery or No Surgery, Is the Choice Obvious?

The explosion of non-surgical treatments in plastic surgery has allowed for some promising options for men looking to tighten up their neck. The CoolSculpting device recently offers a hand piece aimed at “freezing the fat” under the chin, resulting in fat loss with no incisions or downtime. Various manufacturers offer radiofrequency devices that slowly heat the fat which then dissolves, and even one new product, Kybella, is a simple injection that dissolves the fat.

These treatments have a place in Maman’s practice, especially when enticing men on the run who have no time to lose by recovering. Even so, Maman’s liposuction treatment is his go-to choice of technique.

“What we find in our practice offering the full range of treatments is that actually most men are best treated by liposuction,” says Maman. “It’s quite simple, we do it under local anesthesia in the office, it takes about 30-45 minutes and is painless. It’s performed through minuscule incisions that we hide underneath the chin or behind the earlobes.”

Cost and recovery, or what drives men from liposuction

The massive draw to non-surgical treatments is how quick both the procedure and downtime are. For many, the downtime is next to nothing and patients may even be able to return to work. The catch is for results, these treatments must be done multiple times over months, unlike the one-time liposuction procedure.

“When I talk to men about liposuction, they want to know two things: cost and downtime and recovery,” explains Maman. “The truth is when you look at cost and compare the cost of liposuction to many of the non-surgical modalities, liposuction turns out to be the most economical.”

“Downtime after liposuction is actually quite minimal because it’s a relatively small area being treated and the overall volume of the fat being removed is small, yet still impactful. Men can oftentimes go back to work in two days.”

Still, complexity and variety in the treatment options offer surgeons all sorts of treatments for all sorts of people. “By offering all of these treatments,” says Maman, “we are able to choose what’s best and most effective for the patient and also what best correlates to their lifestyle.”

The post Lose the Double Chin and Gain Youth appeared first on The Plastic Surgery Channel.

After undergoing any plastic surgery procedure, you expect to see your surgeon for follow up appointments. Each surgeon varies in their schedule of post-operative appointments.  More than likely, you will have an appointment the week after surgery, again at a month after surgery and finally at several months out. At each visit, your surgeon is checking to see that the initial swelling subsides and that incisions have healed properly without any signs of infection. 

by Anne Meyer
and Caroline Glicksman, MD

Breast Augmentation = Long Term Follow Up

If you’ve had a breast augmentation, your follow-ups should continue well after the early post-operative period and the six month check up. When exactly should your plastic surgeon stop seeing you for follow-up? “I basically never discharge my patients,” responds New Jersey board certified plastic surgeon Dr. Caroline Glicksman.  

The Decade Mentality

“The one thing I think all patients have as a take-away message after breast augmentation, no matter who their physician is, is that they may need to replace their implants in about ten years,” observes Dr. Glicksman.

“The reality is that there is a responsibility between the patient and their physician, for long term follow up.” – Caroline Glicksman, MD

In the past, implants were expected to last about ten years on average before developing a complication which required additional surgery to remove and replace the implant. Advanced science and technology have produced implants with very low 10-year rupture rates. When implants are also sized correctly to fit a patient’s body at the time of surgery, women can get a very long run out of their breast implants..  

In the years following surgery, the body changes even if the implant stays in tact.  As women age they often experience weight gain, weight losses and changes due to childbearing. Eventually menopause will affect every woman’s body, and especially the breasts. The implants that were so perfect for a woman at the time of her surgery, may no longer be appropriate for her body or her lifestyle.

By seeing a patient every year or two, Dr. Glicksman is able to track the changes in her patient’s bodies over time and discuss options for surgery down the road, such as a breast lift or a larger or smaller implant size. “I have patients that are in their late forties and fifties that opt to take them out completely. That phase of their life is over, and they really need to decide if they even want implants anymore,” shares Glicksman. “It comes down to a point where we need to decide if you cannot live without you’re the implants and want to replace them with a newer model, or consider other possible options, like a lift or no replacement at all.”

FDA and MRI’s

Another reason Dr. Glicksman sees her patients at least every two years after they undergo breast augmentation surgery is to monitor the breast implants for any signs of possible silent rupture.  “Current FDA guidelines recommend that patients get MRI’s every two to three years with silicone implants,” Glicksman points out. “We find that a lot of patients either can’t afford that, or just select to not undergo an MRI. It’s nice to have that follow up appointment in the schedule, so that you know that there IS somebody else paying attention to your implants.”

The post Seeing a Patient for the Long Run appeared first on The Plastic Surgery Channel.

Thanks to the internet, women today are better informed than at any other time in history. Which could explain why capsular contracture, something most of us had never heard of 20 years ago, is now the number one concern for those seeking breast implants. “Patients care about safety with the breast implants more than they even care about how the implant looks or feel.” says Dr. Bradley Calobrace of Lexington, KY.

And while capsular contracture is still very much a concern for surgeons and patients alike, the rates have decreased dramatically over the last decade. Why? Well, prevention is the key. Thanks to new techniques such as the use of nipple shields, antibiotic irrigation of the implant pocket and the no touch technique as well as placing the implant under the muscle and the rise in the use of textured implants, occurrence rates for capsular contracture have dropped from 10-15% down to just 2-3%.

by Katherine Stuart
and Brad Calobrace, MD

Capuslar Contracture Is Treatable

Although the percentage of patients today who get capsular contracture is small, it still exists. For those patients, it is important to remember that capsular contracture is treatable. Often without surgery. Dr. Calobrace’s first line of offense is medications such as Singulair and Accolate, anti-inflammatories used for asthma, extra Vitamin E, massage, and ultrasound therapy such as the Aspen Ultrasound which helps to break down the inflammation and stop the capsular contracture cycle. And if that doesn’t work then there is always the surgical option to remove the scar tissue, replace the implant, and change out the pocket if needed as well as repositioning the position from over the muscle to under and vice versa.

It used to be thought that if you contracted capsular contracture once, you were at a higher rate to do so again, but Dr. Calobrace believes “it was because we were inadequately treating it. We didn’t know what we know today.”  In the past, surgeons just treated the capsule. They would put back the same implant. “Today, we treat the whole environment.”

For “breast cripples”, those patients who keep getting capsular contracture again and again and who were often left without hope, surgeons now have the ability to add a biologic/cellular dermal matrix material, basically artificial skin, into the pocket which can take the recurrence rate to almost 0. “In my practice today, doing all the preventative measures that we do, I haven’t seen a capsular contracture in almost two years in any of my patients. That was totally unheard of before. Prevention really does work.” says Dr. Calobrace.

The post The Latest in Preventing and Treating Capsular Contracture appeared first on The Plastic Surgery Channel.

We work and play in a world that is plugged in 24/7. Being accessible around the clock comes with a price for our skin and bodies. You’ve seen people hunched over their handheld devices, with shoulders curled up and thumbs whirling. That poor posture is creating a condition called “tech neck”. It’s caused by the extra straining that is brought on when we try to lean forward to see the screen better. It can leave a digital user, not only in pain, but wrinkled. As, Doctor Lou Bucky discusses the neck is no longer being ignored. There are new options on the horizon to help erase the signs of “tech neck” and so much more.

by Dawn Tongish
and Lou Bucky, MD

There’s a new condition being heaped on the digital world. Users of the world-wide-web are in a world of hurt with headaches and numbness in the arms because of too much straining over the small screen from handheld devices, but there’s another side effect. Portable device users are developing a crease just above the collar bone from repeated use. It’s being called, “tech neck” and it’s making people more aware of that area of their body. “Young and old people are spending so much of their time with their head down or looking at photos of themselves on their devices, that they can’t help but we aware of their neck,” says Doctor Lou Bucky. Dr. Bucky is a board-certified plastic surgeon who practices in Philadelphia, Pennsylvania, says sagging jowls and wrinkled necks are happening to younger people because of the use of digital devices. The neck is no longer forgotten.

“The neck has had a lot of insurgence of attention lately.” – Lou Bucky, MD

Treatment Options – Kybella

The body part that used to be ignored is not longer in the shadows. Consumers are interested in having an attractive neck and that means treating it for “tech neck” and other maladies like moderate to severe fat on the upper neck. Doctor Bucky says there a vast array of solutions for varying cosmetic problems. “There is a wide array of treatments. It used to be the person with a full neck or weak chin would just come in for liposuction and now there are alternatives.”

One option is an injectable substance called Kybella. It is FDA-approved for the treatment of fat. It works by destroying fat cells and can be used to treat a double chin. Experts say it must be used correctly or it can destroy other cells, including skin cells. “Kybella is an injection that melts fat, but it needs to be done a few times.” Dr. Bucky says the perfect patient for Kybella is one who doesn’t mind repeat trips to the doctor’s office.

“The ideal patient is the person, who doesn’t want to go to the operating room, one who feels like they can just have an injection, and doesn’t mind coming back for a few treatment.”

How About – Coolsculpting?

It isn’t new to use Coolsculpting to smooth lines and wrinkles on the body, but a new applicator is allowing consumers to see results on the neck. Zeltiq produced a smaller, more flexible applicator called the Coolsculpting Mini, that can be used to help reduce the fat underneath the chin. Doctor says he is excited about using the new, revolutionary tool to reshape necks. “We have a history of using Coolsculpting for contouring the body. The reality of all of these procedures that are used for contouring the body is that they can now be used for contouring the neck. I think that they go together.”

Doctors don’t usually remove fat from the face to try and maintain a youthful look. The Coolsculpting Mini has FDA clearance. It fits on the neck and there is no need for injections. Each application takes about an hour.

Another Rejuvenation Technique – Intensif RF

The latest rejuvenation technology triggers the skin’s own natural healing process, reducing wrinkles and acne. Intensif RF uses a minimally invasive approach with very little downtime to stimulate effective skin remodeling. This treatment works on the neck area and on deep wrinkles, acne scars and stretch marks. Doctor Bucky says it helps to fill in the blanks. “The missing piece has always been what do we do when we take the volume out. What happens to the skin? Dr. Bucky says laser wasn’t a good option. He says this new option is the best he’s seen.

“We have really embraced this process from EndyMed. It’s about micro needling and a little radio frequency to help tighten the skin.” The skin will continue to improve for an entire year after the treatments. It’s all about knowing the options. “I think if we really become very objective about it, we can identify the the best procedure for the right candidate and have the best outcomes.”

The post The Neck is Getting Noticed appeared first on The Plastic Surgery Channel.

We’ve all heard about the wonders of Botox and how it can take years off your looks, but have you ever heard you should back off Botox as you age? While the benefits of neurotoxins are well documented and have been used in the cosmetic sector for decades, there’s still a time when too much for too long can have an adverse effect.

How long should you continue with injections as the years turn into decades? We talked to board certified plastic surgeons to hear their thoughts on Botox and when LESS really is MORE.

by Carolynn Grimes

Avoid the Artificial

When neurotoxins such as Botox, Dysport and Xeomin are injected, they can safely and effectively erase lines in the forehead, between the brows and at the outer corners of the eyes. Dr. Christine Hamori, a plastic surgeon from the Boston area says as you age, you may want to back off Botox injections to avoid being too smooth and shiny. “You want to be able to animate and look a little bit your age, so it looks natural, not too flat and waxy. That’s really important,” says Hamori.

The shiny or waxy appearance Hamori speaks of is what can happen when your forehead becomes too frozen from too much Botox. Keep in mind, Botox and other similar brands are toxins, and while they’ve been proven safe, the toxins work by paralyzing the muscles. The paralysis keeps you from over animating or frowning, and in turn, reduces wrinkles. But just like any other muscle, the forehead muscles can thin or atrophy when they’re not used over many years. This can be good and bad. Good when you don’t develop permanent lines and wrinkles; bad when there’s overuse and your eyebrows drop down as a result of atrophied muscles. Think about a time when you may have injured an arm or a leg and you weren’t able to use those injured muscles. What happened?  That arm or leg shriveled up and atrophied!

“Repetitive use of neurotoxins needs to be watched.” – Shaun Parson, MD

Dr. Shaun Parson, a plastic surgeon from Scottsdale, Arizona says “Repetitive use of neurotoxins needs to be watched.  I’ve seen people who now aren’t getting good effects [with their neurotoxins] and have heavier brows and we end up doing brow lifts. Would they have eventually had surgery anyway? Maybe, It’s hard to say because everyone ages differently and at a different rate.”

Accept the wrinkle…

So what do we do?  If you’re like many people who love Botox, it’s hard to cut down or do without. Dr. Hamori says you don’t have to stop, just alter the dosing. “Maybe come in a little more frequently but do lower dosing. More dilute and just put the neurotoxin in a couple of spots and not as heavily as you normally would. This way you can have a little bit of motion in your brow.” Hamori says as you get older start accepting a little wrinkle above your brow. It looks more age appropriate anyway!

If you’re concerned about over-doing Botox and you’re striving for a natural look, consider lowering the dosage and go in for more frequent touch-ups. Also keep in mind, Botox must be injected precisely, by an expert. Even though Botox is an extremely common procedure, it’s not a “simple” procedure. When it’s injected poorly the result can be a very unnatural.

The post Backing Off Botox? appeared first on The Plastic Surgery Channel.

The scalpel used to be the only weapon that could win the war against an aging face and neck. For some prospective patients with significant sagging skin that still might be the case. But what about the rest of us who are not ready for a facelift–either literally or figuratively? Dr. Christine Hamori’s Skin Spa is part of her busy surgical practice and dedicated to offering the latest in non-invasive treatments from skin care to lasers—and now ultrasound. Ultherapy® which is the only FDA approved procedure to lift the eyebrows, face and neck without surgery is enjoying increasing popularity. According to Dr. Hamori, Ultherapy® is often her recommendation for patients in their late 40’s, through the 50’s who are not yet candidates for a full face or neck lift, but are interested in tightening up their appearance.

by Isabel Bolt
and Christine Hamori, MD

The Beauty of Sound Energy

Think of sound vs. light. Ultherapy® uses sound energy (ultrasound) which bypasses the surface of the skin to go deeper into skin layers at high, controlled temperatures. This ultrasound stimulates collagen production at the skin’s foundation, without affecting the skin’s surface, lifting the tissues. “It is a modality of heating that actually causes facial shrinking even at the SMAS layer deep beneath the skin to the muscle,” says Dr. Hamori. Ulthera’s secret is collagen regeneration, also known as neocollagenisis, and has been clinically proven and cleared by the FDA. Laser treatments also treat skin, but use light energy which counteracts skin conditions that are more superficial in nature. They do not lift the skin.

Ultrasound has been used by the medical community for over 50 years, and is completely safe. Over 250,000 patients have experienced Ultherapy so you can be confident it has been vetted.

Common Areas Needing a Lift

Ultherapy® addresses the foundational layers of skin targeted during a facelift, but is not a substitute for a facelift if profound sagging of skin is present. At its inception, Ulthera was used for facial rejuvenation, lifting skin in the cheeks, jawline and eyebrow area. Now it is also used for under the chin and the neck to smooth and tighten—tricky areas to treat even with surgery. Recently, the FDA approved its use for décolletage lines and wrinkles on the chest.

No needles, No bruising, No downtime

A full face and neck may take up to 90 minutes, a neck or chest alone as few as 30 minutes. Ulthera® is an in-office treatment. Once the areas to be treated are marked, the ultrasound monitor allows practitioners to see the layers of tissue the energy needs to reach. Gel is applied and a handheld applicator is placed over those targeted areas. Patients often describe the experience as “prickly” or “short stings.” The sensation only lasts as the device emits the energy. Anesthesia is not necessary, but since comfort levels vary from patient to patient, oral medication may be prescribed. Once the session is complete, apart from minor redness or tingling, there are no strong side effects or telltale signs that anything was “done.” Normal activities can be resumed immediately.

Immediate Results?

You may notice a subtle change, but the true results gradually take place as collagen is remodeled from the inside, out. This is dependent upon how quickly an individual naturally regenerates collagen, but the average is usually 2-3 months to see a difference. The vast majority of patients need only one session. As time goes on, the aging process continues so touch ups might be necessary, but results do last because collagen is continually produced. Patients have reported results lasting up to two years.

Getting Started

A one on one consultation with a trained, experienced Ulthera® provider is the first step. After a careful assessment of a patient’s appearance, Dr. Hamori may recommend Ulthera® or perhaps another modality that will be the best fit in addressing concerns. “If the face looks a bit deflated, the brows sag and there is a lack of firmness in the cheeks, medial face, and lower eyelid, Ulthera® is a great tool. It also does a nice job on the neck.”

For all who recoil at the thought of a facelift, this might be the perfect intermediate remedy. Dr. Hamori has first-hand experience with Ulthera®. “I’ve had it done myself and really saw some immediate tightening, then it just continued to improve over the next couple months.”

The post Before a Surgical Facelift is Necessary, Look Into Ultrasound appeared first on The Plastic Surgery Channel.

Otoplasty, a surgical procedure to correct overly large or prominent ears, is on the rise according to the American Academy of Facial Plastic and Reconstructive Surgery. The reason is simple: No one likes to be called Dumbo or Mickey Mouse ears. Not adult men or women and particularly not children. The ridicule can be damaging to their self esteem at a critical time in a child’s development. Otoplasty surgery is an easy, effective way to permanently reshape the ears so that they are more in balance with the rest of the face.

by Katherine Stuart
and Shaun Parson, MD

Overly Large Ears May Lead to Embarrassment and Shame

Although Dumbo was teased about his ears, they did allow him to fly. Sadly, for most kids with overly large or prominent ears, there is just ridicule without any payoff. And it can be devastating. Something Dr. Shaun Parson, MD  of Scottsdale, Arizona has seen first hand. “We have children with very prominent ears who are made fun of, who are very self conscious. They tend to wear their hair down over their ears. They just don’t like the way they look.”  But otoplasty surgery can change all of that. Since our ears are fully developed by the time we are 8, Dr. Parson will typically wait until then to operate. However, otoplasty can also be performed on adults. Many brides request the surgery before their big day and it’s currently one of the top 10 most requested surgeries for men.

While otoplasty surgery is most commonly performed to correct prominent or protruding ears, it can also fix ear asymmetry, deformed ears, reconstruct an external ear missing at birth and repair an ear damaged by traumatic injury or disease. In an easy two hour procedure, the surgeon reshapes the ear using simple suturing techniques. Non-removable, internal sutures are placed on the back of the ear or hidden within the folds of the ear in the front. Since otoplasty is considered a reconstructive as opposed to a cosmetic procedure, it is often even covered by health insurance.

The results, in terms of self esteem, are remarkable. According to Dr. Parson, children who are getting otoplasty are often looking down, embarrassed and self conscious, in their pre-op photos. While after surgery, “they’re almost glowing. They’re so happy to go back out and not be teased anymore.” It can literally be a life changing procedure. “Otoplasty is really one of the reasons that I became a plastic surgeon. I’m able to change the way they feel about themselves and they can go back out in the world and really have their confidence again.”

The post With an Otoplasty, Say Goodbye to Dumbo Ears appeared first on The Plastic Surgery Channel.

Spring may be the season of love and summertime may be vacation time for most of us, but what season do you think is the most popular for a nip, tuck, or a fill? It may depend almost entirely on what part of the country you call home.

by John Hammarley
and The Plastic Surgery Channel

When May Depend on Where

“The busiest season? I would say it’s May, June and July,” says Constantino Medienta, MD, whose plastic surgery practice is in Miami. “Now it doesn’t make sense. They want to get ready for the beach. They want to get ready for sun since school is out. But that’s our busiest season. I haven’t been able to figure it out exactly.”

Conversely, Richard Zienowicz, MD, has his plastic surgery practice in Providence, R.I.

“Over the holidays, there’s a lot of eating that goes on. So that by February people anticipate having to take off all the heavy clothes and get into their beach wear,” Dr. Zienowicz says. “Especially for any vacations even earlier than that, so definitely between February and June in the Northeast, it’s slamming.”

What May Determine When 

Now if you’re going to be happy with in-office, non-invasive approaches such as Botox and dermal fillers, plastic surgeons say it really doesn’t make a difference what season you choose. These types of procedures don’t put you out of commission for important events. Dermal fillers do a great job providing extra  volume to lips, while minimizing the appearance of wrinkles and enhancing contours. And Botox can help smooth out wrinkles, crows feet and frown lines during any part of the year. And these types of minimalist procedures work immediately with zero downtime, so that may help people whose calendars are jam-packed year-round.

If you are considering something more in-depth, what time of year to head to your plastic surgeon may be important. Over the holidays, it may be easier to take time off from work to recover. But you need to be realistic about recovery times when you’re considering having a procedure done during a busy period like Christmas time. Though many surgeries only require a few days before you’re up and running again, it’s probably best to be conservative when you’re estimating your recuperation.

A Great Reason for a Staycation

Though you can recover from a breast augmentation or liposuction over a really nice, long weekend, it’s not unusual for many patients to have some soreness for a few weeks after these procedures. On the other hand, recovering from more invasive procedures, like tummy tucks, can take up to a month. So what may normally seem like effortless tasks could become challenging or even painful when you’re recovering from surgery. The last thing you want is to be restricted by a surgery that was meant to increase your enjoyment of any particular season.

For Dr. Mendieta and his Miami-based practice, he’s actually busy over Christmas.

“You’d think nobody would want to have surgery but it’s some of my busiest time,” Dr. Mendieta says. “so Christmas I guess they see me as Santa Claus. They see me coming down the chimney to recreate the breast or the body or the butt.”

The post Is There a “Perfect Season” for Plastic Surgery? appeared first on The Plastic Surgery Channel.

Modern breast augmentation has evolved in almost every way. The length of procedures, the plan and execution of the procedure themselves, new surgical tools to minimize trauma to the tissue, and above all, implant options. It may seem wild to think about now, but not so long ago surgeons had one implant to use for all breast augmentation cases: the saline implant.

Through rigorous research and design, a myriad of alternative implants have become available in the past few years. And to set the record straight, there is not one “best implant” of the bunch. The growing number of options just means that for the first time in the history of the procedure, surgeons and patients alike have the means to make a choice based on what would best fit and perform on a patient’s unique body.

Dr. Paul Watterson, a board certified plastic surgeon practicing in Charlotte, discusses a few of the new implant options and how – paired with an in-depth consult – they are changing the game when it comes to great results for patients.

by Adam McMillon
and Paul Watterson, MD

From One Option to Many

When you consider all the different body types and sizes of people out there, it’s incredible to imagine that for a long time, surgeons only had one implant design to use. Sure, the saline implant could be filled based on a patient’s desires and size, but that was the only variable in play. To keep pushing the procedure towards even better results, you just need more options to match the level of uniqueness the human body can present with.

“With breast augmentation and with the explosion of the different implants available, it has taken on a whole other level of complexity, but also benefits the patients,” explains Dr. Watterson. “I think back a few years ago we just had saline implants available. Now we have silicone, the more cohesive silicone, and even shaped implants. New sizes and shapes, more variety. It makes for a better procedure for the patient.”

How Does This Help the Patient?

There are many ways a breast augmentation can be performed, just like anything. You can cut corners and only offer one implant, or you can have a lengthy consultation where a surgeon first identifies what the patient is looking for, utilizes 3D imaging or implant sizers to verify that is indeed what they’d like, then choose the correct implant based on those parameters as well as further input from the patient.

That may seem like too much work, but that’s how great results come about. “I sit down with the patient and the important thing for me is to hear what they’re after,” explains Watterson. “Sometimes a photograph helps and we’ll also use the Vectra [3D] imaging system to help them see what they want.”

There is plenty of information on the Internet about different implants and procedure types, but ultimately consulting with a board certified surgeon is the best way to know what you’ll need. Now that more implant options are available than ever before, consults and procedures are that much more refined.

“We don’t expect [patients] to have that kind of knowledge, that’s our job,” says Watterson. “We can then communicate that to them and help them to make this decision.”

The post Complex Breast Aug Planning Improves Results appeared first on The Plastic Surgery Channel.

As we age, our face begins to loose volume. What started as a smooth, plump grape in our early 20’s can begin to look more like a raisin by our 40’s and 50’s. And let’s be honest, no one wants to look like a raisin. So, one of the simplest ways to combat the earliest signs of aging is by re-volumizing the face, either with synthetic fillers or fat grafting. The advantage of the latter is that it is both completely natural, using your body’s own fat, and long lasting.

by Katherine Stuart

There are Advantages to Fat

According to Bruce Van Natta, MD of Indianapolis, Indiana, fat grafting for the face has been “one of the most significant changes” in cosmetic surgery. Synthetic fillers have been around for awhile. They are extremely effective, but they are also all chemical based. Fat grafting, on the other hand, is completely natural, using the body’s own tissue. The procedure is simple. Excess fat is harvested from the outer thighs or abdomen, purified and then injected into the areas of the face that need filling using a microdroplet injection technique. “We’re recycling. We’re taking the body’s own tissue, and… putting it in to fill these areas. I think you can get more finesse, personally, with fat.” says Dr. Van Natta. It also lasts. “The fat is going to stick around.”

“That’s definitely the big advantage… taking something that’s part of you instead of something artificial, ” says Dr. Michael Lee. “Restoring volume as we age is key.”

But is fat grafting as easy as fillers?

The main disadvantage to fat grafting is that it’s a surgical procedure as opposed to fillers. It takes more time to prepare the fat and transfer it to the face than fillers, and it is more costly. For Dr. Brad Bengtson of Grand Rapids, Michigan, it’s not a question of either/or, but rather both/and. What he will commonly do is “layer fillers on top of fat because with fat, the problem is that you can get a lot of volume, but it’s not very specific. It’s a bigger protein or molecule or actual cell than fillers so we use fat to re-volumize the face, and then lay in fillers to the specific lines.”

All of the surgeons agree that it is paramount to see a board certified plastic surgeon with a lot experience in fat grafting for the face as it’s truly an artistic procedure. “It’s also where you put it and where you don’t put it.” says Dr. Bengtson. He likes fat for re-volumizing the lower face, and the temples, but finds it to be “a no go zone for me in the peri-orbital area. I’ve taken out a lot more fat than I’ve put in.” Fat grafting “can be really beautiful in a way that you can’t get with a mid-facelift” says Dr. Van Natta, but whether or not it’s the right choice is really going to depend on the patient and his or her individual needs.

The post Fat Grafting for the Face is Recycling at its Best appeared first on The Plastic Surgery Channel.

Though around since the early 1900’s, plastic surgery is constantly evolving. New products and techniques are introduced annually and it is up to your plastic surgeon to stay on top of it all. Which is why it is so important to select a surgeon who is board certified by the American Society of Aesthetic Plastic Surgery for example. “If you see an ASAPS member, you know that they’ve made aesthetic surgery important. It is what they do.” says Dr. Richard Baxter, MD of Mountlake Terrace, Washington.  Having a surgeon who hasn’t limited his or her training to one or two things, and is more capable of taking a comprehensive approach is a smart move in today’s hyper driven world. Read on for a few more ways in which plastic surgery has changed over the past 20 years.

by Katherine Stuart
and Richard Baxter, MD

What Is The Current State Of The Facelift?

According to Dr. Baxter, facelifts today don’t carry the same stigma that they used to. “I’ve seen more facelifts in my practice…. But there’s also a lot of interest in non-surgical techniques.”  The non-surgical facelift is hands down one of the biggest changes in the last 20 years. And though it has its uses, it’s also important for surgeons to guide patients so that they have realistic expectations as to what can be achieved. Although volume loss, particularly in the mid-face, is one of the earliest manifestations of aging, Dr. Baxter doesn’t believe that “adding volume by itself will postpone the need for a facelift necessarily.”  However, fillers and Botox can allow a patient to maintain a youthful look for a little bit longer, and they’re great for maintaining a patient’s surgical facelift results. “If the skin has sagged and it needs a lift, it needs restoration as well as repositioning.”

New Facelift Techniques Emphasize 3 Dimensions

Twenty years ago, facelifts were all about lifting the skin up. Which often resulted in that overly pulled, artificial look that so many patients fear and want to avoid. Today, plastic surgeons take a 3 dimensions approach to facelifts. According to Dr. Baxter, it’s “thinking about volume restoration, moving the tissues where they need to be to shape the face and then re-draping the skin instead of just pulling the skin.” The result of this new approach is a more youthful, but still very natural looking face. The kind where no one has to know that you had anything done unless you choose to tell them.

Your Looks Really Do Affect Your Self Confidence

One of the more recent trends in plastic surgery is men and women turning to it to boost their self confidence either because they’re changing careers or re-entering the dating world. “That’s really what it’s all about for us is helping people feel better about their looks.” says Dr. Baxter. Numerous studies have been done linking our looks to our self confidence. “How you look really does affect your life.” Feeling good about ourselves makes us more confident which, in turn, makes us perform better in every aspect of life.

The post How Does Plastic Surgery Today Differ From 20 Years Ago? appeared first on The Plastic Surgery Channel.

Gynecomastia – the medical term for breast enlargement – exists as a unique condition that is generally obvious to a physician but may pass as normal for the person afflicted. Men carrying around extra breast tissue since puberty or after massive weightloss may not think that they actually have a condition that can be treated, and might live for years stunted emotionally and physically by the issue

Dr. Maman, a board certified plastic surgeon from New York City, works to educate his patients on gynecomastia, offering hope to those afflicted that it can be helped! While various forms of it exists, various treatments can be offered to counter and achieve a unique path to success.

by Adam McMillon
and Daniel Maman, MD

The Spectrum of Gynecomastia

“Man boobs” is the common name for gynecomastia. Some young boys unfortunately have to bear this issue while going through school, maybe under some scrutiny from more fortunate classmates. Or a man might complete the tough journey of massive weightloss and simply think that the odd shape of their breasts is just a “scar” of their former overweight selves.

“There is a true spectrum of [what that means],” says Maman. “It could be subtle enlargement of the breast tissue that bothers a man when he’s wearing a t shirt or when he goes shirtless at the beach. The other extreme is true breast development in a male. Oftentimes we’ll see that in men who’ve lost significant amounts of weight and have a lot of loose, extra skin.”

What are Treatments Like?

As it is a unique issue, gynecomastia treatments are crafted by surgeons like Maman to be uniquely yours. Based on the consult and state of the condition, a surgical plan will be developed that works to address your gynecomastia, not a standard procedure across the board.

“It can be as simple as subtle liposuction to large amounts of liposuction or, ultimately, the equivalent of a male breast reduction,” explains Maman. “It can be a pretty simple procedure and all cases are ambulatory, meaning they return home the same day. The recovery is short; most men can return to work within 3-5 days from the procedure.”

Shocking Happiness

When the procedure is all said in done, the weight – both physical and mental – of gynecomastia is lifted from patients, offering them a form of happiness that they may not have even realized was possible for them.

“It’s remarkable how happy and how satisfied patients are from our gynecomastia procedures,” shares Maman. “Many men don’t know what their options are and will go quite a long time before seeking treatment. Almost every single time the patient will tells us, ‘I can’t believe I didn’t do this when I was in college. I can’t believe I waited until my mid 40’s to do it.’”

The post Restoring Confidence in Men with Gynecomastia appeared first on The Plastic Surgery Channel.

Dr. Laurie Casas of Chicago, Illinois has seen a lot of advancements in the field of plastic surgery during her 25 years in practice. One of the most exciting, for her, is the non-surgical facelift. Patients “come to us because they don’t want to have surgery.” So the field of non-surgical options just keeps growing and growing. There are injectable fillers, Botox, volumizing agents, RF energy and lasers such as IPL. Are these different technologies a substitute for a surgical facelift? No. But they are a vital and growing part of any surgeon’s long term approach to managing a patient’s facial aging.

by Katherine Stuart
and Laurie Casas, MD

Fillers Are a Temporary Fix

The main difference between fillers and a surgical facelift is that fillers are a temporary fix. They reposition the soft tissue of the skin and the muscle and can produce a little structural change, particularly in the neck. Post treatment, the face will look “swollen” which mimics the plumpness of youth and for awhile, the patient will look and feel fabulous. But within a few months, the soft tissue changes disappear and the patient’s face returns to its pre-treatment look. “If you want to think about a long term approach to managing facial aging, a facelift, neck lift, upper eye lift might be part of your long term plan.” says Dr. Casas.

While a non-surgical approach to facial aging, which includes fillers, Botox, volumizing agents, RF energy and lasers such as IPL, isn’t a substitute for surgery, it is great in conjunction with a facelift or neck lift. “The technology is amazing and it’s just growing. It’s a multimillion dollar business.” According to Dr. Casas, her patients today want to look their best, but they don’t want to look artificial. They want to look as natural as possible. “We have to be sure that we’re treating the skin as well as the deep structures.” The key, for her, is using non-surgical and minimally invasive modalities with timely, but very few surgeries throughout a patient’s lifetime.

A Facelift is Not the End All

Dr. Casas believes that the most important thing as plastic surgeons is “to become internists of facial aging.” When a patient comes into her practice, the goal is to take care of that patient’s skin throughout his or her life. Which means treating whatever current issues exist and then adding modalities such as skin care, lasers, fillers and surgery as needed over time. The rewarding part, for her, is helping her patients through all of life’s ups and downs such as job changes, marriage, childbirth, and death of a parent. So, a facelift is really just one change in a specific period of a patient’s life. It’s not the end all. Muscles will continue to become lax. Fat will continue to atrophy. So the real question is: how to treat a patient over time? A surgeon can’t perform multiple facelifts or multiple eye lifts on the same patient without making the face look unnatural and stretched. “So, you have to be sure that you are maintaining the volume in the face in addition to the underlying structures being repositioned.”

Fat is Our Friend

“If you look at facial aging in a person’s face, it’s really not just loss of fat,  it’s loss of bone as well.” says Dr. Casas. You experience what she calls “bony reabsorption”. The landmarks of the face such as the cheekbones, and jawbone begin to disappear in both height and width. Which causes the soft tissues on top of these bones to also atrophy. This is where Dr. Casas sees a huge help from fillers. Voluma, Sculptra, Restylane, and Juvederm all work by adding volume. It’s really just a question of degree. Which is really where the skill of your surgeon comes into play — knowing exactly which fillers are going to work best in each area of your face to deliver a more youthful, but still natural looking you.

The post Plastic Surgeons are the Internists of Facial Aging appeared first on The Plastic Surgery Channel.

A facelift– it can look incredible or not so good. We’ve all seen celebrities with bad facelifts in the media, but what if it’s you that’s had a bad experience? As you can imagine, it can be emotionally devastating I mean, it’s your face and it’s hard to hide! Maybe the facelift didn’t last as long as you thought, or maybe it was never what you planned on at all.

by Carolynn Grimes
The Plastic Surgery Channel

Revision Facelifts

Dr. Sam Hamra in Dallas, Texas, is a board certified plastic surgeon and specializes is revision facelifts. He even wrote a book about it, called, “The Facelift Letdown”. It’s about the disappointment people feel when their facelift didn’t go as expected.

This is what exactly what happened to Gail when she got her first facelift 15 years ago. We caught up with Gail at Dr. Hamra’s office when she came in for a follow-up on her revision facelift. “The first facelift looked really good for a short time and then it went downhill quickly. Everything had fallen. I looked sour and I looked angry and mad when I really wasn’t,” says Gail. She knows first-hand about the “facelift letdown”. “You just think, how did this happen? The time, the expense, the emotional investment. It was very hard.”

Gail began researching facelifts on line and eventually found herself at Dr. Hamra’s office hoping he could help. Dr. Hamra performed her revision facelift seven years ago and so far, she’s still loving the results.

Know the Buzz Words

“The key is the obligation of the patient. It’s your face and you need to know why you don’t look so good and do your research, says Hamra. Know the buzzwords: pixie ear, hollowed eye, and lateral pull. Once a patient knows what they have, they can interview different surgeons and say, ‘can you fix my pixie ear, my lateral sweep and my hollow eye’?  The surgeon will then know they are an informed patient.”

Dr. Hamra was the first plastic surgeon to document the tell-tale signs of a bad facelift:

• The lateral pull to the side, or the “wind-swept” look.
• The distorted ear that’s pulled down, otherwise known as the “pixie ear”.
• The hollowed eye where too much fat was removed.

Traditional vs. Composite Facelift

These results are sometimes due to a traditional facelift approach of pulling laterally. Dr. Hamra’s approach is called the composite facelift which pulls up, repositioning the entire face. In addition to pulling the face up, the composite facelift also addresses the elements underneath your features – the cheek fat and the lower eyelid muscle are lifted with the skin. “While the cheek fat is preserved and moved up, the excess fat along the jawline giving the ‘jowl’ appearance must be removed,” states Hamra.

With this ground-breaking approach, Hamra says he can reverse the facelift stigma and give patients a natural look. “I was at a party recently and someone said, ‘you have the most beautiful skin’, of course that always make you feel good. And of course I have a little secret as to why it looks good,” laughs Gail. She’s a business professional and wants to stay looking as young as possible to stay relevant in her work. She no longer has “facelift letdown” and no tell-tale signs of a bad face lift.

The post When Your Facelift Lets You Down appeared first on The Plastic Surgery Channel.