Plastic Surgery Advice

recent article in a popular newstand magazine this week on plastic surgery in everyday people. The fundamental premise of the article was that plastic surgery today is done on the ‘average person’, not necessarily the rich and famous. They go on to cite five people who had differing plastic surgery procedures and their stories.

This article was refreshing because they all had positive experiences, which is usually the norm, as opposed to many articles which talk about patient’s problems and complications which is not the norm. But the underlying theme of the article is what is most poignant for me. The large numbers of plastic surgery procedures done today could occur for only one reason….that the everday person in society is now representative of the typical plastic surgery patient. There is only a very small fraction of society that is famous or wealthy. The plastic surgery numbers of today, which total in the millions of procedures (surgical and non-surgical), could not come from that segment of society. In the past twenty years we have seen plastic surgery work its way into the mainstream of society and is much a part of American culture as Starbucks, cell phones, and My Space. The typical plastic surgery patient in my practice is just a normal person from the middle fabric of society, the range goes from the unemployed to a company CEO. Nearly 40% of my patients now use financing for major procedures, reinforcing the concept of the ‘average’ patient having plastic surgery. That number is starting to approach finance numbers for major appliances or other big ticket home items.

You may ask yourself why…..why do such large numbers of people sign up for plastic surgery currently? Is it the marketing hype from surgeons, is it the media convincing us that me must look better and younger through their projected images, or is our society just so vain? Probably all three of these have some responsibility, but there is one bigger reason. The main reason, in my practice experience, is that most plastic surgery procedures simply work and deliver what they purport to do. Breast implants make breast bigger and more shapely, tummy tucks really do flatten stomachs, facelifts do turn back the clock and tighten that jaw and neck line, and noses do get better shapes that look better on one’s face. Yes, plastic surgeons and plastic surgery procedures are not perfect. Every result is not ideal and some patients do experience complications. And yes sometimes plastic surgery procedures are overhyped. But most palstic surgery patients, by far, have good results, are satisfied with what has been done, and would go through the same procedure(s) again. A finding that some refer to as accomplishment feedback. This explains why the returning customer now makes up nearly 1/3 of my plastic surgery oeprations performed every year. Such positive experiences very directly promotes plastic surgery as a satisfied patient is very likely to consider another procedure or tell a friend, who may then go on to have plastic surgery themselves. Every business and profession recognizes the tremendous influence of such word of mouth referrals.

Plastic surgery today is and will continue to be for real people. Its benefits are wide reaching and the ability for all of society to benefit, from the child born with a cleft defect to the middle-aged sales representative who wants to look more refreshed, will continue to be more pervasive. The propagation of plastic surgery has as much to do with its overall effectiveness and high patient satisfaction as it does with marketing and media promotions.

One of the most sought after and easily visible beauty treatments is cosmetic tooth whitening. A great smile with white teeth is one of the most powerful contributors to a pleasing and more youthful face

Until recently, tooth whitening has only been primarily available at a dentist’s office or through over-the-counter dental strips or whitening pens. Many rapid tooth whitening systems have caused pain and sensitivity or the traditional trays and goop methid is both messy and inconvenient to wear. Over ‘the-counter whitening strips, while effective, takes weeks to see any visible results and must be used for a long time to see substantial improvement in tooth color.

A revolutionary approach to tooth whitening is a system that in one hour can increase the color of your teeth from 3 to 8 shades….and is not associated with teeth or gum sensitivity.! Using a special blend of hydrogen peroxide and silicone dioxide with a blue light accelerator, the system oxidizes pigments of your front upper and lower teeth restoring them to a more beautiful whiter color. All without heat, mouth sensitivity, or UV light exposure.Greater whitening improvements are seen with teeth stained by coffee, tea, or in those have are or have smoked in the past. Teeth with tetracycline or other antibiotic stains, teeth speckled with fluoride, or teeth with hereditary discoloration will also show good improvement. Teeth with existing cavities or cracks should not undergo whitening. Teeth with existing dental restorations such as crowns or veneers will not respond to this whitening treatment as it is effective only on natural, live teeth.

As both a physician and dentist, I have been reluctant to bring tooth whitening into my plastic surgery and spa practice. I was always concerned about whether the aestheticians could safely and comfortably provide this oral treatment to patients, an area in which they have no previous experience or training. In addition, I had concerns about creating unpleasant sensitivities of teeth or gums which has been the experience with a lot of patients who have previously had rapid teeth whitening. However, the simplicity and safety of cold light acceleration and its low risk of tooth or gum sensitivity make this new variation of in-office hydrogen peroxide trteatment very appealing. It is a natural fit to any of the currenjt aesthetic treatments that we rountinuely do in the office. It can also be easily combined with other aesthetic treatments whether it be microdermabrasion, Botox, injectable fillers, pulsed light therapies, or laser skin treatments. It is easy to see the dual benefit, for example, of lip injections for size increase and undelying tooth whitening. It can literally be combined with just about any aesthetic or spa treatment. It also helps brings closer the concept of a ‘one-stop’ beauty service location.

I often get asked by new patients if I think they are ready to have plastic surgery. The premise of that question is what they eprceive physically and that is one important issue, But there are important psychological and financial considerations as well.

However, a simple yes to that question is based more than just on the physical issues at hand and patient also need to think about other considerations as well before having any plastic surgery procedure. While many have written about surgery preparedness, I would consider the following the ‘big’ three’ which, in my mind and experience, are the most significant.

First, do some background research on the desired procedures as well as on your doctor(s). The internet may be full of inaccurate and misleading information, but it is also chocked full of a lot of good information about everything in plastic surgery. Become a good student again, do your homework, and be prepared to ask your plastic surgeon good questions. You can’t expect the plastic surgeon to tell you everything in the limited face-to-face time you have.Your plastic surgeon has these conversations all day long, you will have far fewer of them. Take charge of your knowledge and education.

Secondly, can you really afford to have the plastic surgery procedures? I fully realize that in life people afford what they want, not what they need. It is not my job, nor am I capable, of assessing whether this is the best way for you to spend your money. My financial responsibility lies in educating you about which procedures have the best value based on what you are trying to achieve. One of the factors to consider in determining financial feasibility is…how much buffer do you have should complications occur? Yu may have extra expenses or need more time off from work should a complication develop. Leave some financial wiggle room if you are considering elective plastic surgery. This area is one of the most common reasons for ‘dissatisfaction’ from plastic surgery procedures.

Lastly, be prepared to accept the reality that complications from plastic surgery can and do occur. And I don’t mean rarely. While most plastic surgery complications are relatively minor and easily solved in most cases, a few are not. Just like a car accident, for example, you are not exempt from the risks of adverse outcomes. It does not always happen to the ‘other guy’. Most importantly, factor this in psychologically. Recovery from plastic surgery will always take longer than you think in many cases. Getting over the inconvenience of a surgical complication will likewise be more prolonged that all will like.

These three areas of mental and psychological preparedness will serve you well to undergo any plastic surgery procedure…and will go far in making you ready for it.

What is Plastic Surgery?

In recent years developments in science and technology have brought about significant changes to the world in which we live. One such change has been the introduction of plastic surgery into mainstream life, having grown from being the preserve of the rich and famous to being an increasingly accepted option for ordinary people.

Plastic surgery is a special branch of surgery that deals with the medical correction of a person’s form and structure. While plastic surgery deals mainly with aesthetic surgery, there are also several other types of surgery that come under this domain, such as the different fields of surgery to the cranio-facial region, hand surgery, surgery to correct skin damage caused by burns, and some forms of microsurgery.

The History of Plastic Surgery

The word plastic comes from the Greek word plastikos which means “to mold” or “to shape”. So, plastic surgery basically means surgery that brings about a re-shaping of a part of the body. Although plastic surgery is generally regarded as being a recent scientific wonder, in fact its history goes back the time of Sushruta in India around the year 700 BC.

In Rome, plastic surgery existed even in the 1st century BC. However because of the dangers involved with this type of surgery, especially when it involves the face or the head regions, it was not until recently, that plastic surgery became more common for the general population.

Different Procedures involved in Plastic Surgery

Plastic surgery often involves a skin graft, whereby doctors take skin from one part of the body, and then graft it onto the area where it is needed. This can involve a number of steps, including different types of grafting like allografting, where the graft comes from another human, and xenografting, where the graft comes from an animal of a different species.

The Difference Between Plastic Surgery and Cosmetic Surgery

People have a tendency to confuse plastic surgery with cosmetic surgery, but there is actually a difference between the two. Cosmetic surgery is in fact a sub-specialty of plastic surgery, and refers to surgery which is carried out purely for cosmetic purposes. The most common procedures for cosmetic surgery include abdominoplasty (also known as a “tummy tuck”), and blepharoplasty, which is a reshaping of the eyelids. Cosmetic surgery can be useful in helping to minimize scars and wrinkles. In recent years, people have gone to have plastic surgery done in countries where the fees are lower than in their own countries.

The Growing Significance Of Plastic Surgery In Recent Years

In recent years, people worldwide seem to be increasingly aware of their body image, and more people are in search of the perfect body. So plastic surgery offers solutions to people’s problems if they feel that their own body falls short of perfection, and more and more people are sorting out what they feel are their bodily imperfections. In particular, in the field of plastic surgery there has been a tremendous demand for cosmetic surgery and liposuction. In most countries nowadays it is possible to find plastic surgery at quite affordable rates. The affordable rates bring plastic surgery more within the reach of ordinary people, so that plastic surgery is now becoming more common.

While the overall number of male plastic surgery procedures performed in the past decade is up, women still far outnumber male patients by about 10:1 in most parts of the country. While male plastic surgery patients undergo some different procedures than women, their motivations for undergoing face and body changes are also different.

While both men and women undergo plastic surgery to look physically better, you have to dig beyond this obvious level to understand what their true motivations are. The desired physical concerns or desired changes are just a reflection of their unspoken concerns. Generally speaking, most women undergo plastic surgery for internal self-image motivations. They want to fell better about themselves. Correcting a physical flaw is one approach to self-improvement. (and perhaps the easiest?) Whether it is a tummy tuck to look better in clothes or t have their eyes done to look more refreshed, plastic surgery for women is mainly about improving themselves and is not necessarily for others. I hear this over and over…’my husband says I look fine the way I am’…or…’my friends say I look fine’. But yet, women want to have the surgery anyway…because they to effect an internal self-image change. Men, conversely, often undergo plastic surgery because they want things. Whether it be to have more women, sex, money or power…it most always deep down is motivated by a desire for external or more tangible things. As a plastic surgerycorollary to ‘Men are Venus, Women are from Mars’…Women do things for themselves, Men usually do things for somebody else. or other external raesons.

The male plastic surgery patient is also different from the female patient in other ways as well. They often do not prefer to undergo radical procedures that make a drastic change in appearance, have less pain tolerance, follow postoperatve instructions less carefully, do not want a prolonged physical or social recovery, and can be more vocal about the outcome of the surgery. (or they are at least more vocal) Much of this has to do with the general greater impatience of men who want to get to the final result quickly…and usually more discretely. This is why smaller more subtle procedures for men are often better, even if the result is not as significant. Men get no accolades, and certainly little support, in society for suffering through a plastic surgery recovery. And the aging of men is generally better accepted in all societies. Women, conversely, garner more empathy if they are suffering to look more ‘beautiful’. In fact, our society expects them to do so.

The handling of the male plastic surgery patient, I have found, is quite different from a female patient. Because of the male mentality, some plastic surgeons do not enjoy working with men. They often require more time and patience than most female patients. And the demands of the younger male patient are higher than that of an older man. The young male patient, who often is more consumed with his personal appearance, can be quite demanding and is most likely to require more than one surgery to make happy.

Facelifting is an inherent part of plastic surgery and one of the earliest cosmetic procedures performed. But yet to the general public, it still remains largely misunderstood.

The general public’s perception of a facelift….based on TV shows and the internet…is someone after such surgery being bruised from their eyes to their neck and their face wrapped up in a big dressing…like they had been involved in a major accident. And that it will take weeks to even look good enough to go out in public. In fact, this belief is quite inaccurate.

Facelift as the name of the surgery is misleading. It does not really describe what the surgery actually does or what the objectives of the procedure are. More accurately, a facelift should be called a neck-jowl lift, for this is what it actually helps. It is ideal for tightening that neck and lifting those jowls. The original name for a facelift, rhytidectomy, should be more accurately described as a necklilft or cervicoplasty. (reshaping of the neck) However, the name facelift persists and always will as it is embedded in our plastic surgery nomenclature.

Therefore, when you realize that only the neck and jowl are affected by the procedure, many of its misconceptions fade away. In isolation as a stand-alone procedure (which half of my ‘facelift’ patients only have), a facelift causes no bruising or swelling from the nose up. While many facelift patients get their eyes, forehead, nose and other facial procedures done at the same time, this is not a requirement and is only done if one wants the ‘total face’ rejuvenated. I find that after an isolated facelift, one can look pretty good in about a week and can easily be out in public in a few days with a little make-up in the neck area. No swelling occurs around the eyes at all!

One of the great misconceptions about a facelift is what is actually done in the operation. A facelift operation is all about tissue layers and vectors of lifting. The lifting off of the skin from the underlying tissues over the side of the face (to the cheek area) and across the neck through incisions placed in and around the ears is obvious in any diagram of a facelift operation. And movement of loose skin pulled back and over the ears at about a 45 degree angle to the face probably accounts for about 80% – 90% of the result created by a facelift. And often this is the only tissue moved in a facelift. This is the simplest, quickest and safest approach. More recent facelift developments have been to lift up tissue layers deeper than the skin. These deep layer that can be moved independent of the skin, is a special layer of tissue over the muscle. This tissue, known as SMAS, is raised and sutured up in a more vertical direction compared to the direction of the skin pull, closer to 60 degrees usually. Erroneously, the public is under the impression that facial muscles are moved whichi can not be done. On top of the muscle sits the SMAS. There is considerable debate as to whether the ‘deeper’ versions of the facelift produce better long-term results than skin movement only.

The neck-jowl lift, known historically as a facelift, can lift two different layers of sagging facial tissues in two slightly different up and backward directions.

quently I get requests from patients for the desire to transform a round face into a more shapely appearance. One cause of a round face is that the patient is overweight. A full neck, round cheeks, and a lot of subcutaneous fat throughout the face creates a generalized fullness that creates a fat and round face. These patients know full well that they are overweight and some liposuction of the neck and buccal lipectomies may make some difference. But weight loss will probably make the most difference in these cases. And these procedures should not be performed until some weight loss has been achieved.

But the overweight patient is not what usually makes up the ’round face’ patient. Most commonly these are younger patients that are not significantly overweight and are usually closer to being more height and weight porportionate. They may have some mild fullness in the cheeks and neck but often their bony prominences (cheeks, chin, or jaw angles) may be somewhat deficient. The approach to these patients must deal with both hard and soft tissues issues to be effective at improving the face’s angularity and definition.

In addition to the fullness of the cheeks and neck, the next most important consideration in facial shape improvement should look at the chin. Often it may only be midly short in the horizontal dimension but the width of the chin is also important, particularly in the male patient. Chin implants today can provide more projection as well as width in many different sizes. Placed through a small incision under the chin bone, a chin implant can lend more definition and squareness to the lower face from subtle to dramatic results.

Upper facial fullness, more specifically midfacial fullness, can be achieved through cheek implants. Placed into position by incisions inside the mouth under the upper lip, cheek implants can provide good highlights through three-dimensional enhancement of the bone as it wraps around the area below the eye. An amazing aray of cheek and midface implants is available to provide a lot of enhancements around this important facial landmark. When paired cheek implants are combined with a chin implant, an upside down triangle of change is created that directly opposes a more round or oval facial shape.

Jaw angle implants are always a possibility but these are rarely needed in most really round faces. They can produce some lateral facial fullness but this is not usually helpful in ‘de-rounding’ the face in most patients.

The procedures of buccal lipectomies, neck and jowl liposuction, chin and cheel implants make up the usual plastic surgery tools for facial rehaping. Which one or a combination of procedures is most helpful for improving facial definition is best determined by careful computer imaging study during the consultation with your plastic surgeon.

r of men that have undergone cosmetic procedures has grown over recent years. Many men desire cosmetic procedures between their late 30’s and 60’s to appear more youthful and in some cases, because of the impact that cosmetic procedures may have on their career. The following tips can be useful for men considering cosmetic procedures.

1. Facial rejuvenation requires special considerations for men, especially for men that experience sensitivity with shaving. Botox and Hyaluronic Acid Injections produce immediate results and do not require recovery time.

2. Liposuction easily improves flanks and breasts on men that are two of the most difficult places for men to reduce weight in.

3. Liposuction results can be enhanced and maintained through diet and exercise.

4. Neck liposuction, chin enhancement, and brow lifts may be alternatives to facelifts for men.

5. Liposuction can produce an etched appearance for the abdomen and pectoral area.

6. Male Breast Reduction is a commonly requested procedure that is safe, effective and does not require a large recovery time.

7. Nose Reshaping has evolved with advanced techniques that include scarless rhinoplasty.

8. Eye lid surgery may be coupled with or an alternative to a brow lift that will improve the appearance of anger and overhanging fat deposits or skin.

9. Men have thicker skin that is more apt to tighten up after plastic surgery than in women.

10. Hair Transplantation is offered in a variety of techniques. It’s important to research the variations in technique and methodology.

2007 Statistics of Cosmetic Procedures Performed on Men

The American Society of Aesthetic Plastic Surgery produced the following statistics of the most commonly requested cosmetic procedures that men requested in 2007, as follows:

Over 300,000 Botox Over 185,000 Laser Hair Removal Over 85,000 Microdermasion

Nearly 84,000 Hyaluronic Acid (Restylane or Hylaform)

Close to 58,000 Liposuction Over 63,000 Laser Treatment Close to 32,000 Rhinoplasty Over to 32,500 Eye Lid Surgery Over 20,000 Male Breast Reduction Close to 16,500 Hair Transplantation

Appearance is an important aspect of modern life. People today not only want to feel good inside; they also want to look good outside. To achieve this end a lot of men and women elect to undergo plastic surgery procedures each year. The results are often dramatic and permanent, so it is important that the patient knows what to expect and that he or she chooses a plastic surgeon wisely. Patients seeking advice on plastic surgery procedures and referral to a plastic surgeon may turn first to word of mouth from their friends and family who may have already undergone a plastic surgery procedure. The Internet is also a common place to look for a good, qualified plastic surgeon.

oday’s plastic surgery procedures are becoming unusual by traditional standards. Many are relatively minor in scope but they are a reflection of contemporary Anerican societie’s perception of beauty and a decreasing tolerance for physical imperfections

As I step back and look at some of the plastic surgery procedures done today, I realize that some of them may be considered unusual . Certainly, some of them are different than traditional perceptions of plastic surgery. Many are relatively minor procedures that can be performed in the office and probably reflect the trend toward treating smaller concerns. They are the opposite of bariatric plastic surgery, for example, where a new subspecialty of plastic surgery has developed to treat the sequelae of gastric bypass and massive weight loss patients. The emergence of larger plastic surgeries and big procedures doesn’t occur very often but every few decades. But more minor plastic surgery innovations and procedures occurs more frequently. Here is a list of my unusual plastic surgery procedures that have emerged and become popular in the past decade.

Buttock Implants/Fat Injections – The appeal of a larger, more rounded buttocks is certainly a body image of recent note. Whether done by transferring fat from one body part to another or by an implant placed through an incision near the tailbone, the desire for buttock enhancement could not have been envisioned ten or twenty years ago. In reality, there are actually more people in America that would want buttock reduction but there is no good procedure for that problem.

Labioplasty (Labial Reduction) – A protruding or enlarged labia can be both a source of irritation and embarrassment and is becoming an increasingly common procedure. One would never have thought that such a concealed part of the anatomy would create a demand for treatment. A very simple and effective procedure, labial reduction restores the outer appearance of the vagina to a more youthful appearance.

Earlobe Reduction/Enhancement – As woman age and with the lifelong use of ear rings, the ear lobes will frequently get longer. The size of the ar lobe can easily8 be reduced in the office and it is a procedure that I often do at the same time of a facelift. Aging may also make one’s earlobes get quite thin and almost shriveled in appearance in very thin females. Injectable fillers, such as Juvaderm or Radiesse, can give an immediate rejuvenation effect to the earlobes that may last as long as a year.

Eyebrow/Eyelash Transplants – The science of hair transplantation has evolved to the point that single hair (follicle) transplants are now routinuely done in scalp hair restoration. It is quite logical that single follicular transplantation be applied to very small areas such as the eyebrow and even the eye lashes. The alternatives of permanent makeup, colored pencils, and false eyelashes made opting for actual hair tranplants a difficult decision. But some few patients do.

Bellybutton Change (Umbilicoplasty) – While most commonly seen as part of a tummy tuck, more non-tummy tuck patients want their belly button changed. Most commonly, it is to change an outie to an inne belly button. Nipple Reduction/Nipple Enlargement – I have seen it both ways. The concern of large nipples is that they can be very visible through clothes…and at all times. Nipple reduction is actually quite easy although some women may have to exchange a smaller nipple for less feeling in that nipple. Most recently, I have started to some men that want their nipples reduced also! With the opposite concern, niple enlargement is usualy about fixing a nipple which turns inward (inverted nipple) to one that points outward. While not quite as predictable (long-term result) as nipple reduction, the nipple can be released and brought more outward.

Corner of Mouth Lift – The downturning of the corners of one’s mouth with age gives a sad or angry appearance. A simple procedure in which a small amount of skin is removed and the corners lifted up and the mouth line leveled gives a nice and subtle improvement. Such a procedure is a simple office operation or is often done as part of a facelift. This is actually an old procedure that has now been ‘reinvented’ or rediscovered.

There is no predicting what this list may look like in 2018!

sion is a common request that I get from patients who have acquired scars from an accident or from a surgical encounter. Whether it is a scar that has just occurred or one that is years old, they are very concerning for many patients.

Topical scar creams and ointments have little proven success, other than anectodal evidence, that they work. Topical scar treatments do have a role to play in early scars but not in older scars. Only the concept of some form of scar revision has any hope of improvement at this point. Scar revision can consist of a variety of treatments including excision and rearrangement (cutting out and reclosing), laser therapies, and mechanical methods of dermbrasion or sanding. All are not equal, meaning that each has a specific role to play and can be beneficial if used in the right kind of scar.

There are several extremely important points that one needs to understand about scar revision. First and foremost, no method of scar revision can completely erase a scar’s appearance. The skin that the scar has replaced will never be normal…..ever. Scar revision is about improvement, not perfection or complete elimination of the scar. As a plastic surgeon, we are not magicians and have no magical wand. The important question before undergoing scar revision then is….how much improvemennt can be had and is it worth the effort. That is where the value of a consultation with a plastic surgeon is…….ascertaining how much scar improvement may be achieved.

Secondly, there is no single method of scar revision that will work for all scars. Much ballyhoo goes on about the use of lasers, but quite frankly, lasers are not the most common method of treating scars. They may seem like an ‘eraser’ but their use is restricted to treating early or persistent redness of scars and some light skin resurfacing of scars. Both of these laser effects produce mild degrees of improvement but it is not effective for many types sof scar problems. By far, excision and primary closure (cutting the scar out and reclosing it) or excision and tissue rearrangement (cutting the scar out and realigning it through geometric rearrangements such as z- or w-plasties) is most common. Scar excision is probably the most effective method of scar improvement, if the scar problem permits, as it is removing the scar first and creating a fresh wound. Dermabrasion and deeper laser resurfacing may be helpful for wide scars that are raised that do not lend themselves to excision.

Lastly, it takes six months to a year to see the final results of scar revision. I tell patients that scar revision is a process that usually involves takes a step back (to allow healing) in the hope that in the long term you have jumped two steps forward and it looks better. It requires a commitment of time and a leap of faith that the ‘effort’ will be worth the result. Scar revision reaults take time to see improvement often at least 6 months after the procedure.