The “Mommy Makeover” is a term that plastic surgeons came up with to describe a combination of procedures that rejuvenate the areas on a woman’s body most affected by child birth — the breasts and the tummy. Traditionally, it would include a breast lift either with or without an implant, and a tummy tuck. That is until 1999 when Jennifer Lopez wore that infamous plunging green dress to the Grammy’s and “sparked a tsunami of interest in the derriere” says Dr. Constantino Mendieta of Miami, FL. All of a sudden, women were wanting more shapely buttocks to go with their lifted breasts and tight tummies and the “Mamacita Makeover” was born.

by Katherine Stuart
and Constantino Mendieta, MD

The Mamacita Makeover Adds Shape and Contour to the Buttocks

Pregnancy is a truly beautiful thing, but childbirth can cause a myriad of issues for the mother’s body such as stretch marks, loss of volume in the breasts, drooping breasts, and sagging skin and muscle in the stomach, making them feel both unattractive and self conscious. The traditional Mommy Makeover was designed to restore the breasts and tummy, making the mom feel sexy again. However now, thanks to Ms. Lopez and that dress, the derriere is also on the menu. In the Mamacita Makeover, Dr. Mendieta will address the breast and tummy, yes, but he’ll also remove fat from your hips, thighs or abdomen and use it to shape and contour your butt to make it prettier. Think more Jessica Biel and Pippa Middleton than Kim Kardashian.

It’s about taking a 3 dimensional approach to reshaping the body so that a woman looks just as good walking out of a room as she does walking in. Where Dr. Mendieta puts the volume is going to vary. “Culturally, some people want a very wide lower buttock. Some people want a very narrow buttock. Some people want a taller buttock because it makes their legs look leaner and taller. Others want to have more volume.”  The beauty of the Mamacita Makeover is that Dr. Mendieta can reshape a patient’s backside to suit her individual needs and desires. “What’s fascinating is that every culture has its different nuances as to what they find attractive.” But so does each individual so in his Miami practice, Dr. Mendieta has done it all. “I’m restoring and rejuvenating these mothers self esteem. I’m giving the sexy back.”

The process of rejuvenating the derriere is pretty simple. Dr. Mendieta removes fat from the waist, lower abs and outer legs, which are typically trouble spots for most women, and adds it to the buttocks in very strategic ways.  “Fat has become the liquid gold in plastic surgery. We’re using it to rejuvenate the face, to rejuvenate the hands… and reshape the buttocks.”

Is it Safe to Have All These Procedures Done at Once?

“Safety is our number one concern.” says Dr. Mendieta. All patients must get medical clearance from himself, the anesthesiologist and a third party. If the patient has certain medical conditions or is overweight, Dr. Mendieta will split up the procedures in order to ensure safety. The recovery process is generally about 10-14 days to get back to work, a month to feel normal and 3-6 months to see your final results. It requires patience. You’re going to be swollen. You’re going to have asymmetric healing. One day, your tummy will bloated. The next, it will be flat. This may go on for 3 months and then suddenly, the whole body just shrinks up. For Dr. Mendieta, the Mamacita Makeover is a truly life changing procedure for his patients that he finds incredibly rewarding.  “You do these procedures and it’s transforming. It rejuvenates the soul.”

The post Mamacita Makeover: Lifted Breasts, Flat Tummy and Shapely Derriere appeared first on The Plastic Surgery Channel.

Nose reshaping, also called rhinoplasty can alter a person’s appearance more than any other single operation. Since it is the most prominent facial feature, even small changes can make a big impact. According to the American Society of Plastic Surgeons (ASPS) 2015 statistics show rhinoplasty was the 3rd most popular aesthetic surgery overall. Dr. Stafford Broumand, who practices in Manhattan is a rhinoplasty specialist.

by Isabel Bolt
and Stafford Broumand, MD

According to Dr. Broumand, his approach combines not only surgical technique but a heavy dose of judgment and wisdom. “No one wants an artificial looking nose. Rhinoplasty often gets a less than wonderful reputation because of unnatural and overdone results. A perfect nose is one that fits the face. My patients often comment that they want their new nose to look like it belongs to their face. They don’t want a wax nose stuck there. My goal is to eliminate the possibility that people will notice a “nose job.”

Dr. Broumand hears a host of concerns during consultation and has a keen sense of what can and cannot be achieved. Size, crookedness, profile, irregularities in the bridge, bumps, reducing or enlarging the tip and changing the position of the nostrils are some of the more common complaints he addresses.

A Bit of History – Can One Nose Fit All?

Years ago, in the infancy of cosmetic nasal surgery, some practitioners performed only one (and very radical) type of nasal operation.  An extensive amount of tissue was always removed and the results were considered ”cute” – a tiny, very up tilted (ski slope) nose with a tip that appeared stamped out of an assembly line. Patients had look-alike noses. Dr. Broumand calls this “…a bygone era.” “In the 60’s and 70’s people’s noses wore the trademark of the doctor who performed their surgery. The noses were identical, only the faces changed. Today, there is an emphasis on a natural and individual appearance for the nose.” Dr. Broumand takes pride in tailoring every surgical plan very specifically for each patient.

Subtlety is Essential

It is important to inject some philosophy here – which is every bit as important as the hands performing the operation.  There are some operations in plastic surgery where you want to see substantial differences (like making a breast larger or smaller).  There are other procedures, such as cosmetic nasal surgery, where subtlety is essential.

When Dr. Broumand was a young surgeon, he admits he thought noses were “easy.” “There were 10 major parts to the nose, you take the hump down, and narrow the tip and everything is fine. In fact it’s not that way at all. There are so many subtleties in doing a great nose surgery and in understanding how those subtleties will change with time. That perspective only comes with experience, wisdom, judgment and artistic affinity.”

Dr. Broumand emphasizes a nose should not draw attention to itself, but rather complement other facial features while staying true to a patient’s overall appearance, gender and ethnicity.

The Approach

Dr. Broumand’s practice offers 3D computer imaging where a patient can see their own “before and after. “We use computer imaging extensively to give our patients a sense of what can be accomplished. It provides me with a visual blueprint and puts us on the same page—literally.” Patients quickly see the importance of harmony and balance and how the nose must be in concert with the rest of the face. He also encourages patients to bring in photos of noses they desire to get a general sense of their expectations. But he is very honest in explaining how some of the airbrushed and photo shopped noses are really more fantasy than reality. “We have to talk about what is reasonable.”

There are two techniques used in rhinoplasty–open and closed. The technique chosen is predicated upon the patient’s anatomy and desired changes. It is also a consequence of primary (virgin nose) versus secondary (a revision) nose surgery.

Dr. Broumand prefers to start with the “closed” technique in which incisions are made inside the nostrils and all work performed through the nostrils only.  The incisions are closed with dissolving sutures at the end of the operation.  On occasion when necessary, an “open” technique is utilized.  This requires a small external horizontal incision across the columella (the “little column” between the nostrils) as well as internal incisions. The surgeon can be more aggressive and precise in the “open technique.” Dr. Broumand describes the open technique as akin to lifting the hood of a car to really see what is going on inside. Clear visibility is especially important when making anatomic changes.

At the end of the operation, some packing will be placed in the nostrils and a thermoplastic splint placed on the nose.

Choosing a Surgeon

In nasal surgery, the difference between success and failure is measured in tiny millimeters of tissue removed or changed.  All of this goes towards skilled, artistic judgment. Due to its inherent functional and conceptual complexity, rhinoplasty is widely considered the most difficult procedures in cosmetic surgery. In nasal surgery, revision is even more difficult because it may require replacement of cartilage that was over-zealously removed during the first procedure.  All of this mandates that you carefully choose your surgeon, for the first operation is always the best opportunity to get the best result.  Everything after that is playing “catch up.” As one might expect, subsequent nose reshaping is even more challenging. “You must be vigilant in your selection of a nose surgeon. You are not enhancing a feature—you are changing it. Interview the doctor carefully to be sure you are in experienced hands. Find someone dedicated to the pursuit of perfection so you won’t have to worry about facing a second operation.”

Dr. Broumand encourages all prospective patients to really study a surgeon’s before and after galleries.  “It’s important to look for a surgeon who has done a lot of these. Look at their outcomes. Do the noses all look alike or do they blend in to other features? Talk to other patients to see what the process is like.  Did the patient feel the doctor was on the same page?”

Recovery

If you are considering a rhinoplasty, plan on a two week recovery for the bruising and swelling to subside. Nose surgery involves a feeling of pressure, but surprising little pain. The splint will be removed 5-7 days after surgery.  The nose will look nice when the splint is removed but the residual swelling will take about a month to settle down on the bridge of the nose. Dr. Broumand advises his patients that once the splint is removed, the nose you see at that moment is very close to the final result, however minor swelling ensues and then gradually subsides.  The very minor residual swelling of the tip may take anywhere from 6 – 18 months to totally disappear and reveal the fine sculpting and shaping that has been done.

Ancillary Procedures

The nose is the important central feature of the face and it affects the overall balance and aesthetic appeal of the face from any angle – full face, profile or ¾ views.  Surgery to improve the nose must consider all other facial features so there is a balance and harmony between them. “It is not just the nose in isolation,” says Dr. Broumand. “Lips, chin, jawline–are all involved. Sometimes changing the nose’s length affects the chin. Or, the brow may be more pronounced. These can be augmented with a small chin implant or Botox respectively to create optimum balance.”

Dr. Broumand will evaluate your entire facial structure with a view towards improving not only your nose but its relationship to other portions of the face.  The goal is to blend your nose aesthetically and provide balance and harmony to your facial features.

Form and Function

Contrary to the majority of cosmetic surgeries, the nose offers the additional challenge of being primarily functional. Dr. Broumand explains. “It’s a balancing act. Every part of the nose necessarily influences the other—not only aesthetically but functionally.” The aesthetic component must never compromise the functional aspect. There are structures within the nose, namely the septum and turbinates, which affect the airflow through the nose.  Dr. Broumand will examine the internal structure of your nose at the time of consultation and provide information about possible improvement.  Oftentimes, there is blockage of one or both of the nasal passages which results in decreased airflow.  Surgery to correct these problems can be performed either alone or in combination with cosmetic nasal surgery.  There is no effect on the external appearance of the nose if surgery is performed for functional reasons only.

A Final Word

Dr. Broumand’s keen aesthetic eye, deep understanding of anatomy and remarkable technical proficiency give him the ability to strike the perfect balance between form and function for his patients.

Dr Broumand brings extensive surgical experience and artistic sensitivity into the discussion so that together a final surgical plan will be designed.  He must understand what you are seeking to achieve and you must also understand what is feasible to accomplish. At the end of your consultation, you will have a much clearer idea of what can be achieved so that you can make this very important decision.  What is the goal?  After surgery, people meeting you for the first time will say “Hey, you look great!” If your original nose featured a big hump, hook, broad tip or one just out of proportion there will indeed be a noticeable change–that is why you opted for surgery. But Dr. Broumand says, “…Of course if a big hump, hook, broad tip, or a nose was way out of proportion friends are going to notice. Over time, new people will greet you and simply notice a pleasing profile that fits your face perfectly.”

The post The Perfect Nasal Profile appeared first on The Plastic Surgery Channel.

Three of this country’s leading experts in plastic surgery sat down to discuss one of the most exciting areas in their specialty: fat transfer to the breast. Dr. Daniel Maman of New York, NY, Dr. Richard Zienowicz of Providence, RI and Dr. Stafford Broumand of New York, NY have all been using fat transfer or fat grafting as a component of their breast reconstruction work for years. Only recently, however, has the procedure become popular among their cosmetic patients.

by Katherine Stuart

“It’s the Funnest Thing We Do”

All three now regularly use fat transfer to the breast for their cosmetic patients. “It’s the funnest thing we do.” says Dr. Zienowicz, who describes it as a “win win for women”. The procedure involves performing liposuction to remove fat from an area of the body where you don’t want it – such as the abdomen, buttock, or outer thighs – and putting it where you do want it. One great location is in the breasts, whereby the fat naturally increases the volume. Dr. Zienowicz loves it because, “it allows you to give ultimate symmetry.”

Dr. Broumand agrees, breaking his fat transfer to the breast work into 3 categories. “We can do it for breast reconstruction. We can do it for composite breast reconstruction where we put in an implant and fat to soften the edge of that implant. Or we can do it as a natural breast enhancement,” where the surgeon uses the patient’s own fat to make the breasts bigger. But he’s adamant about the importance of educating the patient as to the pros and cons of fat grafting to the breasts so that their expectations are realistic. “It’s not so simple,” Broumand explains. “It’s a process that we have to explain to the patients who seek us out for this surgery.”

For patients who are young with good skin quality and who are hovering on that line between either a fat transfer or a small implant, Dr. Zienowicz tells them that unless they are prepared for multiple procedures then “an implant always delivers more predictable results than fat grafting.”  However, there are always going to be those patients who will prefer a fat transfer because of the “win win” of removing fat from an unwanted area and/or because it is a natural alternative to breast implants.

Is Fat Transfer to the Breasts Safe?

Although some plastic surgeons have been hesitant to adopt fat grafting into the breast because of concerns about mammography and the ability to monitor changes to the breast, all of our experts agree that this procedure is safe. “Those were early concerns”  says Zienowicz, but “it’s not become a problem whatsoever.” Dr. Broumand was initially worried about what could happen when fat was put into a potential cancer-forming part of the body, but all the evidence has proven that “yes, we can do fat grafting safely.”

Dr. Maman believes that fat grafting to the breast and the coupling of fat with a breast implant is revolutionizing cosmetic breast surgery. One of the real pluses of the procedure is the ability to address asymmetry in a very specific, localized way, and to treat tuberous breast deformities. Breast reconstruction traditionally refers to surgery for patients recovering from breast cancer, but there are patients with other types of breast anomalies or deformities that are considered reconstruction. For instance, young women who come in with a developmental abnormality such as tuberous breast deformity. Now, plastic surgeons can treat these women with just a simple fat transfer to the breast, literally transforming their lives.

New procedures and techniques appear often, some of which seem bright but fade, others become entrenched into the discipline. Fat transfer – whether it be to the breasts, or buttock, or even face and hands – continues to show extreme promise, and appears to become a core procedure when it comes to rebuilding and transforming the lives of patients.

The post Fat Transfer to the Breast is a Win Win appeared first on The Plastic Surgery Channel.

Tummy tuck surgery takes place in two distinct layers of the abdomen. Deep in the abdomen the muscle and fascia layer of the abdominal wall are surgically tightened, providing a firm foundation for a flat stomach.  Superficially, fat and skin are removed in order to tighten and contour the outer abdomen. These two layers that were connected prior to surgery are separated during surgery.  This separation creates a space, a pocket, where fluid tends to collect while the body heals. Unfortunately, these fluid collections, called seromas, slow down the healing process.  

by Anne Meyer
and Grant Stevens, MD

How do you Prevent Seromas?

To aid in recovery, plastic surgeons routinely insert drainage tubes into the space between the two layers during surgery, creating a vacuum pressure that draws the fluid from inside the body to plastic bulbs, or reservoirs outside of the body.  These drains are called Jackson-Pratt drains and they can be a nuisance.  

The Trouble with Drains

Drains make showering and dressing in the early post-surgery period even more difficult.  They add an additional risk of infection to the surgical site.  They must be emptied several times each day and their removal, which normally occurs anywhere from several days to a week or more after surgery, can be uncomfortable.  The tubes commonly exit the body in the pubic region and may result in additional small scars.  

Is There An Alternative to Drains?

Board certified plastic surgeon Dr. Grant Stevens has been doing tummy tucks on patients for over thirty years.  Until recently, he himself utilized drains for every single tummy tuck patient. “In my particular case, I’m the third of three surgeons in my practice, and I’m the oldest one, and it was my younger surgeon colleagues that blazed the trail for drain-less tummy tucks. I watched them do it, and I was the last one to try this drain-less tummy tuck business.  We’ve done a study now of over five hundred patients.  With progressive tension quilting sutures and no drains, our patients had a lower complication rate than the patients with drains,” shares Dr. Stevens.

What are Progressive Tension Sutures?

Progressive tension, or quilting sutures, address the cause of the problem, instead of simply relieving the symptom. Additional sutures are added during surgery to secure the two internal layers to each other.  Once the space is closed there is no longer a pocket for fluid to collect in.  As a result, fluid does not collect.  

“I wouldn’t consider draining them now.  I tack them down with the quilting sutures and we don’t use drains,” Stevens explains.  “You don’t have the hassle, you don’t have the mess, you don’t have the scars, and you don’t have the pain of the drains – taking them out, and leaving them in.  Patients LOVE drain-free tummy tucks.  The whole subject is really exciting because we’ve now proven, without a doubt, that drain-free tummy tucks are better than tummy tucks you drain.”

Most advances in the field of plastic surgery today involve high tech devices.  The beauty of the evolution to a drain-less tummy tuck is that it takes a suturing technique, the foundation of surgery, and provides a new application to improve upon an age old problem.  By incorporating additional sutures at the time of surgery, the hassle of drains can become a thing of the past.

The post Drainless Tummy Tuck: Plastic Surgery Evolves appeared first on The Plastic Surgery Channel.

Bad plastic surgery seems to be the “face” of plastic surgery in the media. We’ve all seen it. The horrors of good surgery gone very bad by way of having too much done. Television series have been born out of these ‘too-much-of-a-good-thing’ nightmares.

One of the fundamental questions that always should be on the minds of patients and plastic surgeons is pretty basic: When do you say, “That’s it, we’re done.”?

by John Hammarley
and The Plastic Surgery Channel

How Things Can Get Out of Hand

It could start innocently, and successfully: one procedure to change one thing. A tummy tuck, for instance, can return a woman’s figure after having kids. Then, other procedures are considered: a breast lift, nose job or something to improve that chin. Especially in the atmosphere where there’s “magic in a bottle” and “lunchtime makeovers,” says Dr. Stafford Broumand, a New York City-base, board certified plastic surgeon. “It takes an experienced surgeon to know when the job at hand is complete. And more is not necessary.”

How much is too much? At what point has someone gone too far? Knowing if there is a problem starts with figuring out why someone wants the surgery in the first place.

If One is Good, Is More Better?

It’s common for people to have two or three procedures done at once, but there have been examples of some practices that “up-sell” procedures and offer financing plans over extended periods of time. Many people are tempted by today’s “airbrushed world” where everyone we see in the media is perfect. Judging and determining what procedures can and can’t be done safely is the responsibility of your surgeon, and the calling card of an expert in the field.

The post When Does ‘Done’ Mean ‘Done’? appeared first on The Plastic Surgery Channel.

Let’s face it. Every woman wants to feel healthy ‘down there’. Vaginal health is critical to confidence, intimacy and an overall feeling of sensuality. There’s no debate that childbirth, aging and menopause takes a toll — tissues can  become loose and dry. Sex can be painful. Exercise can be embarrassing if there are leaks. For too long women have suffered in silence, robbed of being able to experience their full potential. Dr. Jim Namnoum explains a breakthrough procedure, diVa Laser Vaginal Therapy that may deliver the trifecta of results women have been waiting for to achieve good vaginal health after 50.

by Dawn Tongish
and James Namnoum, MD

diVa Has Arrived

Poor vaginal health IS NOT something women must just accept as they age. There are solutions. But up until now, most fixes were surgical, required painkillers and a week off.  There’s a new procedure that offers a safe, effective treatment in less than 20 minutes at your doctor’s office. The diVa Laser Vaginal Therapy, developed by Sciton is the first of its kind, claiming to offer a quick rejuvenation of vaginal tissue to its younger state. It is an attractive offer to many women, who don’t want downtime or anesthesia, but are still searching for long-lasting results. Dr. Jim Namnoum who is a plastic surgeon in Atlanta, Georgia, says the cutting edge technology is sure to be a hit with busy moms and career women, who want results but don’t have a ton of time. “Women want to feel healthy everywhere. The vagina stretches a lot during childbirth and there is dryness and a lot of discomfort during intercourse.” Experts say the laser, diVa works to increase lubrication and improve the firmness of stretched tissue.

Improved Sexual Health

Vaginal dryness can happen at any age, but after 50 and menopause it can become worse. Dr. Namnoum says diva works for women at any age to lessen dryness and improve sexual health and wellness. “If you have experienced dryness after childbirth that can be corrected, so pain can go away and enhancement for both parties can be created.” Namnoum says the laser also works to restore a stretched vagina to a more ‘youthful’ firmness, which will also create a more satisfying sexual experience. “The whole vagina vault gets stiffer and firmer and you can enhance the satisfaction of both partners, by having a more resilient vaginal vault.” A woman can expect to resume normal sexual activities about three days after the procedure.

Feel Like Your Pre-Pregnancy Self

There is nothing more annoying than a slight urine ‘leak’ due to childbirth. Experts say diVa can help to improve muscle tone that may alleviate much of the incontinence issues associated with having children. “There can be just a tiny bit of leakage that happens during exercise, but that’s enough to be really irritating,” says Namnoum. With diVa, there will be improvement of that tissue and the incontinence will be helped. Namnoum adds that these feminine issues can happen at any time in life, when a woman’s estrogen levels are low, like during breastfeeding. He is excited about the opportunity for women to restore a sense of well-being, without a long recovery. “It’s so promising for women that this is available to fix these issues that aren’t so desirable after childbirth. This is a powerful new tool.”

The post Vaginal Rejuvenation, Without Surgery appeared first on The Plastic Surgery Channel.

Dr. Lou Bucky of Philadelphia is an accomplished plastic surgeon who has helped patients achieve their goals and dreams through surgery. Now, with the help of a myriad of new surgical – and, perhaps more importantly, non-surgical – devices, Bucky finds himself in the middle of an evolving plastic surgery a field, a change where surgeons are “becoming experts at understanding how to improve patients’ quality of life.”

 “It’s not just about what makes you look better.” – Dr. Lou Bucky

One such avenue for quality of life improvement is with the MiraDry device. A one-time procedure that utilizes microwave energy without surgery, MiraDry “zaps” the sweat glands beneath the arm pits, ending hyperhidrosis, or a condition that causes excessive sweating.

by Adam McMillon
and Lou Bucky, MD

The Curse of Sweat

The act of sweating is literally a life-saver and helped our species evolve successfully to who we are today. Unfortunately for our glorious modern world, sweating isn’t as necessary anymore, and some of us are further plagued by over-active sweat glands, a condition known as hyperhidrosis.

Surgeons became aware of their patients’ struggle with this condition and found a way through Botox to combat it. “Classically, it was a big breakthrough for years to get Botox to their underarms,” explains Bucky. “The procedure allowed you to sweat less. The only negative was you had to come back regularly to get the treatment.”

Success with a small, never-ending caveat: Botox injections stopped underarm sweating, but every 3-4 months, patients would have to return to have the procedure redone.

MiraDry – A One-Time Wonder

With burgeoning technology and medical research, medical scientists honed in on this overly sweaty niche and developed a new technology called MiraDry. Utilizing the same concept of adding heat to alter bodily tissue, MiraDry targets the actual glands themselves under the arm.

“We were familiar with the impact that underarm sweating had on our patients, and then ultimately a technology was developed called MiraDry,” explains Bucky. MiraDry uses microwave energy – energy we’re familiar with to tighten skin in other areas of plastic surgery – to attack or heat up the sweat glands underneath the arm and allow people to not perspire.”

No More Sweat, No More Odor, No More Deodorant

MiraDry results impress. “Not only are patients not perspiring, they don’t smell either, and the best part is it’s only one treatment,” explains Bucky. “Patients can throw their anti-perspirants away, they can throw their deodorant away. It’s one of the great developments that doesn’t necessarily allow people to look better, but it allows them to get through every day in a much more comfortable way.”

The post A Final Answer to Underarm Sweating appeared first on The Plastic Surgery Channel.

Sientra breast implants is back on the market and available to consumers. Once again, making the implant marketplace a triopoly alongside Mentor and Allergan.

by Carolynn Grimes
The Plastic Surgery Channel

In September of 2015, the European equivalent of the FDA placed a temporary hold on the Silimed CE mark and ultimately on the sale of Silimed breast implants in Europe. Sientra, a U.S. based breast implant company who manufactures their implants in a Brazilian manufacturing plant, was not implicated. However, the company made the voluntary decision to stop selling in the U.S. until the European and Brazilian investigations were completed.

Breast Implant Investigation

Dr. Bruce Van Natta, a plastic surgeon in Indianapolis, Indiana had a special interest in this investigation, like many plastic surgeons across the U.S., he used Sientra implants regularly in his breast surgeries.

“Sientra out of an abundance of caution decided, because this red flag had been raised that they would take the high road, and remove their implants temporarily from the market until an investigation could be done,” says Van Natta.  The “matter” on the outer shell of the implants was found to be microscopic, sterile particles.  “The reality is,” says Van Natta, “you can see particulate matter floating in the air even in the operating room when the light hits just the right way.”

The “matter” on the outer shell of the implants was found to be microscopic, sterile particles.  “The reality is,” says Van Natta, “you can see particulate matter floating in the air in the operating room from cotton gauze and surgical sponges, when the light hits just the right way.”

The investigation was done by an independent third party and after extensive testing and analyses the implants were deemed safe.  “Interestingly, the company also had an independent investigator look at the other two manufacturers and low and behold, they too had particulate matter. This was really a non-issue,” states Van Natta.

Sientra Implants: Safe and Back on the Market

This non-issue has caused significant repercussions not only for Sientra, but for patients, says Dr. Brad Calobrace, a plastic surgeon in Louisville Kentucky.  “I think everybody knew there was some level of particulate matter on implants, that’s just part of all implants.  There was nothing new; there was no unique concerns, and that’s very unfortunate because it always brings implants back into question,” says Calobrace.

The good news, says Calobrace, is these implants are back, they’re safe, and more competition means more choices for women.  “I hold Sientra in high regard for their willingness, just because they had a question that they really knew was ok, to pull the implants off the market, for patient safety.”

The post Sientra Breast Implants are Back! appeared first on The Plastic Surgery Channel.

It’s been one of plastic surgery’s tried and true operations, but the abdominoplasty (or tummy tuck) underwent it’s own major face-lift when liposuction came along. Now, surgeons and their patients have a variety of approaches that can be selected.

by John Hammarley
and Peter Fodor, MD

It’s More than Just One Operation Option

For decades, there was basically just one approach to abdominoplasty, but the advent of liposuction about 20 years ago changed all that.

Now surgeons have several approaches they can use, depending mainly on the degree of correction needed.

First, what tummy tucks can and cannot do. According to the American Society of Plastic Surgeons, a tummy tuck “removes excess fat and skin and, in most cases, restores weakened or separated muscles creating an abdominal profile that is smoother and firmer.” A flat and sculpted mid-section is a dream for many and the goal of just as many folks committed to exercise and weight control. But sometimes these efforts just can’t get the job done. Some people who carry normal weight and proportion still are nagged by an abdomen that either sticks out or is loose and sagging. Some of the biggest culprits are aging, heredity, pregnancy, other surgeries and big swings in weight gain or loss.

Tummy tucks can’t…

take the place of a good diet and weight loss and/or an appropriate exercise program. Technically, the outcomes of a tummy tuck are permanent, but if you slip back into habits that caused the original issue, the best possible result probably won’t last. For this reason, if you’re planning a substantial weight loss or women who may be considering future pregnancies, it may be a good idea to wait on a tummy tuck.

The surgery also can’t fix stretch marks, even though they may disappear or improve if they are located on the areas of excess skin that will be removed.

Variations on a Theme

Dr. Fodor points out that liposuction now provides surgeons and their patients several different approaches to tummy tucks — ranging from minimal to maximum tissue removal, and including complete and partial abdominoplasties, circumferential and floating tummy tucks.

Liposuction can be partnered with an abdominoplasty, making a Lipotuck, which includes body contouring around the hips, thigh and buttocks.

You may have heard of the so-called “mommy makeover.” These surgeries include a combination of liposuction, breast reduction or life and sometimes a hysterectomy.

What is involved?

Abdominoplasties, depending on the extent of the surgery, can take from one to five hours. A partial abdominoplasty (mini-tuck abdominoplasty) can be finished in one to two hours. Dr. Fodor says several tummy tuck techniques can be done without having to reconstruct the umbilicus (belly button), but if it’s needed a surgeon will hide the original umbilicus by suturing it into a new hole created by the surgeon.

Overall, a complete (or full) tummy tuck will include an incision that’s made from hip to hip just above the pubic area. Another incision is made to free the navel from the surrounding skin. The skin is detached from the abdominal wall to reveal the muscles and fascia to be tightened. The muscle fascia wall is tightened with sutures. Surgeons will often employ liposuction to refine the transition zones of the abdominal sculpture. And a dressing and sometimes a compression garment are applied to drain any excess fluid from the site.

The post Tummy Tuck Variations appeared first on The Plastic Surgery Channel.

Yes, it’s as spooky as it sounds. Marketed as a quick way to “rejuvenate” the breasts, the procedure involves injecting platelet-rich plasma (PRP) into the breast. The proprietors of the procedure say the PRP restores youthfulness to the skin, can increase sensation, and even add volume/fill in lacking areas.

Expert breast surgeons are cautious of the claims, considering how much planning and technical production goes into a successful – and beautiful – breast lift. Dr. Christine Hamori of Boston and Dr. Constantino Mendieta of Miami discuss.

by Adam McMillon
and The Plastic Surgery Channel

Can a breast lift be done by injecting blood?

The Vampire Breast Lift gets its name from the PRP, blood plasma that has been enriched with platelets. There have been various interesting and positive results surrounding the use of PRP in different ways to rejuvenate the skin, but to lift a breast?

“That is preposterous to think that if you can inject anything into the breast they’re going to look better, especially blood or PRP… It’s ridiculous,” states Dr. Hamori.

An interesting technical note is the amount of material injected, typically around 5 cubic centimeters (cc’s). Patients looking for volume in a breast lift or augmentation procedure typically begin with an implant of 200cc’s, far more than which is used in the Vampire Breast Lift procedure.

“Just think about it, when you’re putting an implant in you’re putting in 200, 300, 400cc’s,” explains Mendieta. “But they’re just injecting 5cc’s of this material. You’re better off just hitting your breast accidentally on the table and getting it inflamed! It’s crazy.”

The Oscar Goody Bag, or Irresponsible Marketing

As with every ceremony, the Academy Awards has a goody bag built by various companies looking to greatly expand their product. Free gifts in the bag for this past ceremony included a full vacation to Japan, a high-end car for a year’s rental, and… a Vampire Breast Lift!

While perhaps laughed off by the celebrities and crews of Hollywood, the name recognition sticks, and is a problem for consumers who don’t have all of the information. To know that the Oscar goody bag contained a free Vampire Breast Lift means that whatever that is, it must be legitimate if Hollywood actresses are receiving it.

The kind of press is absolutely great marketing, which is why it can be a severe problem for patients looking to change their breasts. “It’s absolutely misleading,” says Dr. Hamori.

Trust an Expert

Instead of always seeking out what is easiest, cheapest, and seemingly “magic”, it’s important for interested plastic surgery patients to practice due diligence when it comes to research and education. Men and women spend years and years of life training to become surgeons and learning together the best ways to achieve the best results, safely. This is what you pay for with not only money, but your time.

“[The Vampire Breast Lift] is the biggest sham you’re ever going to run into in your life,” says Dr. Mendieta. For all of the trouble and dollars spent on the easy route, you may just be delaying great results from board certified plastic surgeon. The most important step in any surgery is thorough consultation with your surgeon, learning the ins and outs of the procedure and what is tuned exactly for your unique situation. It is a very personal, unique experience, which is the bedrock for great results for you.

The post The Vampire Breast Lift appeared first on The Plastic Surgery Channel.

On the surface, it’s a simple question… What is a full C cup? It represents a long-standing challenge for patients and their plastic surgeons as a ‘full C cup’ to one person may be significantly different for another.

by John Hammarley
and The Plastic Surgery Channel

One Person’s “C” May Be Another’s “D”

You’d think since we’ve already taken a solid step into the 21st century, it wouldn’t be a problem agreeing on something as seemingly straightforward as a cup size for a woman’s breast.

Think again. 

“Not a day goes by when someone comes into my office and says ‘I want to have a full C cup’ when we’re talking about breast augmentation,” says William P. Adams Jr., MD, a Dallas plastic surgeon. “The problem is there’s not even a bra that’s a full C cup bra.”

It’s a lot like clothing sizes. Today’s size six in a woman’s dress most likely is a far cry from how big (or small) a size six was just a decade ago. It’s called the same thing, but the actual size can vary by the manufacturer, the generation is was made and who’s describing it.

Who knows?

An estimated 70 percent of women don’t know their proper bra measurements. Without knowing these measurements, it can be very difficult to buy fashionable and well fitting clothes, let alone estimate a different size breast they may like through augmentation.  Many women’s clothing items use bra or cup size measurements to distinguish differences in fit, so these measurements can be extremely important.

Additionally, a woman’s breasts change significantly over time, particularly during and after pregnancy. Weight loss, gain and monthly cycle variations can also have an effect on the size of your breasts. It is advised that you check your bra size once or twice a year or as necessary due to significant weight changes.

“I think there’s no topic greater than this one to find more differences of opinion in between plastic surgeons,” says Constantino Mendieta, MD, a Miami-based plastic surgeon. “You’re not going to find two people who agree on the same answer to this question.”

How to reach a concensus

Dr. Mendieta suggests three ways patients and doctors can come to an agreement on the size of any given breast size. First, measure. “So that your current breast will determine what’s the best implant that your body can accommodate,” he says.  The second way is for the patient to bring in a picture of the size of breast she’d like. A picture may be worth a thousand words as well as being an invaluable guide for both patient and doctor. And the third method would be to use so-called bra ‘sizers.’

Dr. Adams, in his practice, likes to steer women away from fixating on cup sizes and instead utilizes three dimensional imaging. By using this technology, Dr. Adams is able to employ scientific accuracy to show the patient exactly what any certain size implant will look like, instead of estimating with sizers or approximating with a photograph from a magazine.

The post What is a Full C Cup? appeared first on The Plastic Surgery Channel.

The first step of your breast enhancement journey begins with finding a qualified surgeon. In the Midwest, the search for a surgeon may very well lead you to Dr. Craig Colville, a highly respected and sought after plastic surgeon based in Ohio. If you think the logical next step in the journey is scheduling a surgery date, you would be skipping over several important components of the consultation process: Education, Examination and Expectations. Dr. Colville breaks down the three E’s, leading to happy patients at his busy Toledo practice.

by Anne Meyer
and Craig Colville, MD

EDUCATION

“The first thing I tell a patient is we’re going to sit down and we’re going to educate them, so that they understand what the operation is about,” explains Colville. “They’re going to make the choice.  I’m not going to tell them what they should have.  They’ll learn enough to be able to ask for what they want.”  The topics he educates his patients on include implant material selection, implant sizing, implant placement above or below the muscle and incision location options.  The patient education process may extend into multiple visits, and Dr. Colville encourages patients to bring close family members or friends who have concerns about surgery and recovery along with them to learn about the procedure and to ask questions.

EXAMINATION

“The next thing I tell the patient is we’re going to look at them physically,” continues Colville.  “We’re not going to just sit in a consult room and schedule surgery.  We’re going to look at them and look at their body and their breasts.” The examination portion of the consultation involves taking measurements of the chest and breasts as well as taking and studying photos and three dimensional images.  The technology advances in 3D imaging allow Colville’s patients to examine their own bodies from a new and different perspective. “You can put them in front of a mirror or put them in front of their own photograph,” says Colville, “but when they can see their own body rotated around in space, and can see the changes that can take place, it’s amazing.”

EXPECTATIONS

Dr. Colville emphasizes the importance of understanding differences in body proportion and build when discussing a patient’s expectations for the desired outcome.  “That’s why, when people look at pictures, it’s important to also look at the preoperative situation.  Because, if you’re not built like that girl is pre-op, your result will look a little different.”  The implant that looks great on your friend or relative and was  just the right size for them, may not be the right choice for your body type.  

“We want to make sure the patient’s body and their tissues are going to match up with their wishes.  I try to get them to concentrate more on the look, not on exact cup size, not on exact implant size, not an exact dimension of any kind, but a look that they want.  How do they want to look in a dress, how do they want to look in a swimsuit?  It’s really about proportion.”  By taking the time during a consultation to ensure that a patient’s goals are attainable for their unique body and tissues prior to moving forward with surgery, Colville is able to keep his satisfaction rate high.

The post The Three E’s of Augmentation appeared first on The Plastic Surgery Channel.

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Dr. Christine Hamori recently facilitated a round-table discussion with colleagues Dr. Bill Adams and Dr. Constantino Mendieta. The subject? Board Certification. The issue? How patients can discern the difference between credentials that truly matters and those that are just fluff. Dr. Adams believes the distinctions are getting tougher for patients. “Any surgeon can create a good digital marketing site and look really legitimate despite a lack of training in plastic surgery procedures,” he says. Dr. Hamori has seen some websites touting a surgeon’s training, “under a famous European plastic surgeon,” but digging a bit deeper reveals the surgeon is not boarded in plastic surgery but a different specialty altogether. “You can’t blame patients for assuming,” she says. The concensus of all 3 surgeons is that more education is necessary for prospective patients to make the best decision in choosing their surgeon.

by Isabel Bolt
and The Plastic Surgery Channel

Boards: A Tutorial

There are 24 formally recognized medical specialties. The primary function of each American Board of Medical Specialties (ABMS) Member Board is to certify physicians in their primary specialty and sub-specialty areas and to support the professional development of those board certified physicians throughout their career. This is accomplished through a comprehensive process involving educational requirements, professional peer evaluation, examination, and professional development.

There is an American Board of Plastic and Reconstructive Surgery. There is not an American Board of Cosmetic Surgery, yet surgeons who hold a board certification in other areas will perform cosmetic surgery. Dr. Mendieta calls it, “extraordinarily confusing. We have seen general surgeons, gynecologists and even emergency medicine physicians begin to practice plastic surgery. They might be doing those procedures, but they did not take near the time or in-depth training a plastic surgeon took to develop their craft. These doctors trained in a completely different arena, but with some clever marketing can fool people.”

An Elite Specialty

In fact, plastic surgery is one of the most elite, demanding specialties to which a surgeon can aspire. Dr. Mendieta attended medical school for 4 years, did general surgery for 5, spent 3 years in plastic surgery and completed a 1 year fellowship. Drs. Hamori and Adams have similar backgrounds.

Dr. Adams draws the analogy between a surgeon and a pilot. “It gets down to certain regimented training programs that are tried and tested,” he explains. “American Airlines is not going to let a pilot who just got his license a week ago, fly a jumbo jet with a load of people around the world. Similarly, we committed to proven pathways to learn our specialty. Just because a doctor takes a weekend course in breast augmentation or liposuction, doesn’t mean they should be doing it.” Dr. Adams is not exaggerating. There are such weekend courses—and they are well attended by surgeons trying to “expand” their horizons.  Dr. Hamori warns patients that the notion that, “once you are a doctor—you can do anything and everything…is dangerous.”

Look for a Sign

So, what can a patient do to feel secure? Dr. Adams advises patients to look for the icons for ASPS (American Society of Plastic Surgeons) or ASAPS (American Society of Aesthetic Plastic Surgeons) on a surgeon’s website. These societies reliably identify board certified plastic surgeon. Dr. Mendieta is a proponent of thoroughly researching any surgeon you are considering: “Make sure you know who that surgeon is and what they are trained in.”

One of the things all three surgeons emphasized is erring on the side of caution. “You can have problems during surgery even with the best surgeon. You are adding risk to the possibilities of developing complications and they won’t know how to handle it,” counsels Mendieta.

Bottom line: Put yourself in the best hands you can— the hands of a board certified plastic surgeon.

The post The Next Best Question after, “Are you Board Certified?” appeared first on The Plastic Surgery Channel.

Every day in the United States, thousands of patients seek a consultation for a breast augmentation revision. The reasons vary. It might be that the patient’s saline implant has deflated or her silicone implant has ruptured. Perhaps the patient doesn’t like her implant’s shape or size. But a lot of the time, breast augmentation revisions are needed because a patient got older, gained weight, lost weight or had a baby. In short, time took its toll. So, if you are someone who is about to go see a plastic surgeon about a revision, here are some tips to make sure that you don’t wind up a revision, revision, revision patient.

by Katherine Stuart
and Caroline Glicksman, MD

Don’t Repeat the Same Mistakes

Dr. Caroline Glicksman of New Jersey is a breast augmentation expert who lectures both nationally and internationally on how to improve breast augmentations and lower revision rates. In her opinion, the most important thing for a patient to consider during her breast augmentation revision consultation is implant size. A lot of complications that ensue from breast augmentation surgery such as stretching, bottoming out, rippling and having an implant that sits over on the side when you lean back, come from a mismatch between the size of the implant and the patient’s tissues. So, it’s paramount that you think long and hard about whether or not you need such a large implant. “Resizing a patient sometimes takes a little rethinking to get over that need to be so big. Because it’s expensive and you don’t want to keep doing it, and doing it.”

The second thing to consider during your revision consultation is the type of implant. A lot of patients originally went with saline because it was what they could afford or it was all that the surgeon had to offer. But many of the complications that lead a patient to request a revision are due to saline implants. These include wrinkling, visibility of rippling, a hard feeling and a disconnect between the patient’s own breast tissue and the implant itself. Today, there are lots of new options in terms of silicone fill, and shape that didn’t exist the first time around. So, make sure to seek out a plastic surgeon who offers the full range of implant types, saline, cohesive silicone gel, and highly cohesive silicone gel, and shapes.

Last, for women who suffer from their implants being felt and/or seen either due to weight gain, weight loss, pregnancy or age, make sure to ask about the new internal support options. The problem for patients whose implants can be felt and seen is that their tissue has become too thin and can no longer support the implant. In the past, there wasn’t a lot that could be done. But now, there are a number of different options for giving you some kind of internal support. Often described as a mesh, internal bra or scaffold, the surgeon inserts these biologic materials, which are FDA approved, during your revision surgery to give some support at the bottom of the breast and then wraps it around the base of the breast where your tissues are too thin or weak to support the weight of an implant. Over time, usually within the first year, these materials become integrated into your body where they’re eventually replaced by your own tissues. Since both surgeon and patient want an implant that lasts 10+ years, these new internal support options are life changing for those patients with poor skin quality.

By asking these questions and doing your research, you’ll keep yourself from becoming a revision, revision, revision patient. It’s really that simple.

The post How to Avoid Becoming a Breast Augmentation Revision, Revision Patient appeared first on The Plastic Surgery Channel.

We all want to grow old ‘gracefully’, but when fifty rolls around it just seems to get a little tougher. It doesn’t help when you see pictures of Hollywood heartthrobs, like Patrick Dempsey, looking sexier than ever even though he’s hit the big 50 — and starlets like Robin Wright with barely a wrinkle on her creamy complexion as she enters her second half-century. But for the rest of us battling wrinkles, sagging skin, crow’s feet, and jowls, there is hope and help available to make the 50’s and beyond attractive and youthful.

By Dawn Tongish
and The Plastic Surgery Channel

Battling The Signs of Aging

Middle-age arrives, wrinkles and all. That’s when many people begin to realize the years of basking in the sun, smoking, and perhaps consuming a few too many libations have taken a toll on the most important calling card – the FACE! It’s a good time to refresh and consider rejuvenation of the face, when the fifth decade sets in and the changes start to appear. Plastic surgery continues to be an option for men and women who want to fight the signs of aging with a healthy image. According to the American Society for Aesthetic Plastic Surgery (ASAPS), older people are a big chunk of those seeking change through cosmetic surgery  – ages 35-50 made up 45 percent of the nearly 12 million surgical and non-surgical cosmetic procedures performed in early 2014, and those numbers continue to grow.

Less Can Be More

Less can be more when it comes to the right procedure in the over-50 age group. A large swath of baby boomers will reach this milestone soon and are clamoring for a fix that doesn’t require a ton of downtime. “We have to do something to address loss of volume and sinking and sagging skin because those will be the biggest issues in the face over 50,” says Arizona plastic surgeon, Dr Shaun Parson. Parson says skin loses elasticity and gets drier and thinner as we age. He says minimally-invasive procedures are still popular choices because they don’t require much downtime and produce good results in smoothing out fine lines and wrinkles. “I think some of the the new fillers offer really dramatic changes, because they last years. We have never had that before. We have only had fillers that last up to three to six months.”

When Is Surgery The Answer?

It happens after 50. You are walking through the mall and do a double take at the ‘older guy or gal’ in the window’ and then realize, it’s you! It happens to the best of us, even Dr. Clifford Clark. “I remember seeing that old guy and thinking, ‘Who’s that?’ and realizing it was me,” says the Orlando plastic surgeon. Clark says that’s the time to have the ‘talk’ with your plastic surgeon. “I love it when they come to me because then I know they are ready.” He thinks that eventually surgery is inevitable to keep a youthful, refreshed appearance. “As plastic surgeons, we know when the point comes where you are going to get a better result with surgery.” Clark says that fillers and Botox can reach an overload point and can look overdone, heralding surgery to turn back the clock. “Whether it’s eyelid surgery, a brow lift, or a face lift, or a neck lift – we know when it’s a good idea to use these because non-surgical procedures are going to be too much.” Clark says every face is different – some need a facelift by 50 – others can wait until closer to 70. The best advice is don’t try to wing it, start talking to your doctor early.  It’s the right way to put your best face forward after 50!

The post Put Your Best Face Forward After 50 appeared first on The Plastic Surgery Channel.

It seems no feature escapes the aging process, and that includes earlobes.  We can blame heavy earrings or curse heredity, but dangling, elongated, floppy lobes are associated with old age. Dr. Christine Hamori has found that few patients visiting her practice are aware that earlobe reduction is even an option. “As women get into their 40’s and 50’s, drooping earlobes bring their whole face down. Sometimes their piercing hole is almost at the bottom of the lobe. Patients are interested in hearing that there definitely is a pretty simple way of reducing earlobes surgically.”

by Isabel Bolt
and Christine Hamori, MD

“Lobe-plasty”, usually done in conjunction with a facelift, is now gaining popularity as a stand-alone procedure.  “Detached” lobes can be “attached,” prominent lobes can be made smaller and elongated lobes can be shortened– all with the intent of making the earlobes more proportionate to the size of the ear and shape of the face. “It’s a subtle but definite enhancement in appearance,” says Dr. Hamori. “It is amazing how much more youthful the face can look when dangling earlobes are corrected.”

Erase Years in Under an Hour

Earlobe reduction is an office procedure done under local anesthetic. The techniques used will depend upon your specific anatomy. If there is simply extra earlobe tissue, an incision is made along the bottom edge of the earlobe. That soft tissue is removed and repaired. If the lobe is very wide, a wedge-shaped incision may be necessary which creates a thin vertical scar, narrowing and shortening the overall lobe. According to Dr. Hamori, it takes less than an hour and there are no bandages. “You will have dissolving sutures in place and might want to wear a bit of concealer to cover the pinkness. In most cases, stitches will be along the very bottom of the lobe and heal within 2 weeks.” She advises re-piercing 6 weeks post-op.

Dr. Hamori emphasizes that incisions must be carefully placed to minimize any potential scarring. “It’s important that the stitches are carefully done so the scar is smooth and inconspicuous. Make sure you are in the hands of a well-trained, board certified plastic surgeon.” Noticeable scarring is difficult to improve as are overly reduced earlobes. A good surgeon will also strive for symmetry of both the left and right lobes. You don’t want the “correction” to bother you more than your original concern.

Subtle, but Significant

Dr. Hamori finds her post-op “lobe” patients to be delighted. “People want to look trim. Some are wearing their hair shorter as they get older. Some like to put their hair up without feeling self-conscious. It’s one of the little known tips to help women look younger.”

The post Earlobe Reduction: A Quick Fix for “Grandma Ears” appeared first on The Plastic Surgery Channel.

Innovation has always been the name of the game when it comes to medicine. This is certainly true in the field of plastic surgery.  Today, there are almost as many non-surgical options for treating patients as there are surgical. New players like Kybella, Ulthera, Coolsculpting, and Cellfina are radically changing the way that plastic surgeons address aging in both the face and the body. Dr. Laurie Casas of Chicago, IL discusses some of the imaginative ways that surgeons today are combining these non-surgical procedures to deliver truly exemplary results for their patients.

by Katherine Stuart
and Laurie Casas, MD

Cellfina & Ulthera 

Cellfina, the latest darling in the non-surgical arena, is the first FDA approved treatment for cellulite. Clinically proven to deliver long lasting results of up to two years, Cellfina works by treating the underlying connective bands that lie within the fat in our thighs and buttocks. These bands are what actually cause the “dimples” that are the bane of so many women’s existence. Dr. Casas combines Cellfina with Ulthera, a micro focused ultrasound treatment, to specifically address the “banana roll” or laxity that can develop in the posterior thigh from sitting too much. The Cellfina gets rid of the bumps while the Ulthera tightens the skin and underlying muscle. It’s a fast and easy way to improve this trouble spot with no downtime.  Which is really important for patients these days who want to look better, but who don’t want to miss work.

Kybella & Ulthera 

Another one of Dr. Casas’s innovative combinations is Kybella and Ulthera. Kybella is an injectable designed to dissolve the underlying fat beneath the chin. Though often associated with aging, this lump of chin fat can also be genetic and evident in patients as young as 18. In the past, the only treatment options would have been liposuction or a chin implant. Now, Dr. Casas can simply inject the Kybella, wait about 4-6 weeks for the fat to fully dissolve, and then treat the area with Ulthera to promote collagen production and tighten the underlying skin and muscle. Less invasive than liposuction, Dr. Casas also likes the results from this combo more than a chin implant. “Because your skeletal muscle is growing smaller, but your chin implant stays the same size… in 20 or 30 years…. you’ll have issues with a rigid implant.” In addition to the chin area, Dr. Casas also uses this combo to treat underarm fat “off label” (meaning beyond the uses for which it was FDA approved).

Coolsculpting & Ulthera

The Cool Mini is Dr. Casas’s combination of Coolsculpting and Ulthera. Again, this is effective for treating the area under the chin as well as the arms. The Coolsculpting dissolves the fat. Then, 1-2 months later, the patient comes back and is treated with Ulthera for tightening of the skin and muscle in the chin and neck or the back of the upper arm. Great for patients off all ages, this is an ideal option for someone who doesn’t want surgery. In general, men are not as comfortable with surgery as women. But they are as worried about their chin/neck area, often complaining about the folds that hang over their tie. Both the Cool Mini and the Kybella & Ulthera combos are fantastic options for male patients.

As with any non-surgical procedure, the results are going to depend on skin quality. However, assuming that a patient has only moderate laxity in the skin and muscle then these innovative combos are a truly effective option to surgery.

The post Innovative Non-Surgical Combos for the Chin appeared first on The Plastic Surgery Channel.

Most men lead on the go lives, hopping between work and home, juggling career and family. You can imagine, with all the jaunts to the little league games and the occasional night out with the guys, the attempt to stay fit, trim and active has fallen off. Men realize that turning back the clock to the physique of their college years is difficult when middle-age sets in, but the desire to look youthful is still very much alive. That’s how the daddy do-over was born.

By Dawn Tongish
The Plastic Surgery Channel

And Baby Makes… A Fitness Challenge

Many of us know what happens when a baby arrives. There are BIG changes and some of them are physical. There just isn’t time to keep up a slim, fit body. It’s very common for women who are post partum to turn to cosmetic surgery to reshape their body once they are finished giving birth, so why not men? The Mommy Makeover is a well-known overhaul procedure to restore the areas of the body, usually the tummy and breasts most impacted by children. So, what’s the big deal if guys want to look good and feel great in the same middle-age years? As it turns out, men are clamoring for their own ‘re-do’. Similar to the Mommy Makeover, the Daddy Do-Over for men can be a combo of procedures performed in a single surgery. According to the American Society for Aesthetic Plastic Surgery, the top cosmetic surgery procedures in 2013 for men were Eyelid Surgery, Male Breast Reduction and Liposuction. It doesn’t surprise Dr. Richard Zienowicz, a plastic surgeon in Rhode Island, that liposuction is a top choice. “For the man in this late forties or fifties, the love handle area is huge, and that is perfect for liposuction.” Zienowicz says if a man uses liposuction the stored fat will be gone for good. “This really is a good option.”

The “5-Day” Fix

Another popular choice for men who want to wipe away a chronic ‘tired’ look, is eyelid surgery. This surgery removes excess skin from the upper lids or eliminates fat from the lower lids. Zienowicz says Daddy Do-Over patients often seek out this procedure for a well-rested look and he says it is almost instant gratification. “The upper eyelid surgery is amazing. Of all the things we do that is about the most stealthy.” He adds a patient can often go out in public in about a week. “The incisions are invisible, so it’s not unusual to step out in five days,” says Zienowicz.

Why Non-Invasive Treatments Are So Popular

Busy dads often make lousy surgical patients. They don’t want to take the time for follow up appointments. “Men just don’t want downtime,” says Dr. Rod Rohrich, a plastic surgeon in Dallas. Rohrich says men want to know what options are available for non-surgical procedures that are just as effective for restoring a youthful appearance. With the rise of non-invasive and minimally-invasive procedures, men have choices that don’t require the hassle of surgery. “Men are using more Botox and fillers, to soften lines and hide wrinkles and also Kybella to get rid or neck fat. It’s amazing how much that has transformed. ” Rohrich says he has seen a steady increase in the number of men using non-invasive treatments and expects the trend to continue.

It’s time for YOU! Diet and exercise should be part of the plan to get back into ‘pre-baby’ shape, but sometimes it’s not enough – sometimes you need the Daddy Do-Over. Men considering this procedure should always seek the advice of a board-certified plastic surgeon.

The post Why the Daddy Do-Over is a Hot Trend for Men appeared first on The Plastic Surgery Channel.

For the average women who is a bit thick through the waist and hips, liposuction can slim down those areas of the body by removing excess fat deposits and improving body contours and proportion. For that same average woman who has had multiple pregnancies, there may also be loose, bulging skin in the abdominal area. A tummy tuck can flatten and firm the belly by tightening muscles while removing excess skin and fat. Doing either liposuction or a tummy tuck will yield dramatic results. Doing them in combination? Well, that would be the veritable “holy grail” when it comes to rejuvenating the torso, right? “Not quite,” say Drs. Simeon and Holly Wall of the Wall Center for Plastic Surgery in Shreveport, Louisiana.

At the recent meeting of the American Society of Aesthetic Plastic Surgeons (ASAPS), the Walls moderated a panel discussing the most recent advancements in improving the female silhouette. It turns out there is a third step to the combination “lipo”/tummy tuck procedure that makes all the difference and the objective is more about shape than size.

by Isabel Bolt
and Holly Wall, MD and Simeon Wall, Jr., MD

An Evolution in Re-sizing

According to Dr. Holly Wall, years ago, liposuction and tummy tucks were considered “either/or.” “Depending upon the patient…in the evolution of body contouring we used to either do only lipo or only tummy.” The problem with that approach was that in the case of “only lipo,” skin and muscles were not addressed. Conversely, tummy tuck alone would yield an unnaturally flat tummy accompanied by pockets or rolls. “15 years ago,” says Dr. Holly “the combination of liposuction and tummy tuck greatly improved the silhouette.” Dr. Simeon Wall Jr. likens it to “…contouring and shrink wrapping the entire trunk circumferentially.” Both surgeons agree that despite the benefits of combining these procedures, the outcomes were a step below perfection. Liposuction techniques at the time could potentially leave behind a rippled, uneven appearance. Dr. Holly adds a 3 dimensional concern. “If you really shrink wrap…you must think about the hips, thighs and buttocks which could now be totally out of proportion to the reduced torso.”

A Revolution in Reshaping

Several years ago, Dr. Simeon Wall Jr. developed SAFELipo® to address revision liposuction procedures which are primarily performed to correct contour deformities. He soon learned that his unique process could produce dramatic, smooth and natural contours in all his body contouring patients–not just those seeking a revision. SAFELipo® has since been adopted by surgeons worldwide, eager to sidestep the most common complication of lipo. They’ve been able to replicate consistently beautiful results the first time, every time. But that solves for the first intervention–subtracting fat. What about the 3 dimensional concern? According to Dr. Simeon knowing how and where to add fat is the other side of the equation. “Whereas we used to have hip rolls and depressions on the buttock, and maybe a wide saddlebag area….Instead of having to really reduce saddlebag, which may not be the best approach, why not augment the upper part of the buttock (with fat) for a better shape and less wide saddlebags?”

Since SAFELipo® incorporates contour augmentation, redistribution and reduction into a single procedure it is changing the way plastic surgeons are looking at fat. Fat is very fragile to “recycle” and must be meticulously stored and processed for best results. Special canisters designed by Dr. Wall Jr. and colleague, Dr. Dan Del Vecchio purify and optimize fat without damaging it. A technique called Expansion Vibration Lipofilling (EVL), also created by Dr. Wall Jr. is used to inject the collected fat to augment areas for a soft fullness and natural appearance.  “We can augment or reduce little parts of the body for subtle changes in shape that make a dramatic difference.  EVL took many years of research but it changed everything.”

From Rock Carvers to Sculptors

Dr. Simeon describes surgeons at the inception of lipo as “rock carvers.” “We would chop away at hips and saddlebags and waists. We knew how to do small waists. But now shaping hips and making the buttocks and thighs integral…these shapes are prettier and rounder, more youthful and athletic.” Drs. Holly and Simeon Wall have learned in over 100 cases how to add and subtract until the best shapes emerge.  At first some patients are hesitant to add too much volume especially to the buttocks. They don’t want “big wide butts,” says Dr. Simeon. “They don’t understand I’m not talking about Kim Kardashian. More like Cameron Diaz or Jessica Biel. It’s about integrating the buttock shape without making it wider. Now we can make a great butt almost every time.”  Both surgeons mourn the days of “throwing away all that fat…such a missed opportunity.”

Dr. Holly is amazed at all the advances influencing these procedures even after decades. Dr. Simeon agrees. “I think the most important advancement is now we can routinely incorporate more predictable fat grafts and shaping with the tummy tuck and lipo procedures for a truly sculpted outcome.”

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