Tag Archives: PROCEDURE

Buttocks plastic surgery update

Buttocks plastic surgery update

 

buttock shapes

I recently saw a classification for buttock shapes. It turns out there are pear, apple, mandarin and tomato buttock shapes.  Funny but no one told me that during my training. It also appears that the citrus fruit among these, mandarin, is the shape most aspire to: two round balls for buttocks. Buttocks plastic surgery keeps on evolving and its time for a buttocks plastic surgery update!

From a cosmetic plastic surgeon’s perspective, there are three types of buttocks plastic surgery that can be performed: patients want their buttocks larger, smaller or just lifted.

A.

Making buttocks bigger

The options for making buttocks larger are:

1. Silicone implants

In this outpatient cosmetic procedure, a 2-3 inch incision is made between the buttock cheeks and a solid silicone implant is placed under the buttock (gluteus) muscles.

  • Silicone implants used are different from ones used in breast augmentation and are firmer to touch
  • Implant have to be placed higher in buttocks, as you cannot sit on implants for fear of rupture; we all sit on the bone under our buttocks
  • Healing takes about 10 days and full recovery 1-2 months

2. Fat injections – Brazilian buttock lift

  •  Even though the Brazilian buttock lift has “lift” in its name, it’s a plastic surgery procedure that both enlarges and lifts buttocks
  • Liposuction of abdomen and hips is performed, and harvested fat is injected into buttocks
  • I typically inject about 800 cc into each buttock at one surgery for maximum effect
  • This is an outpatient cosmetic surgery requiring 3-4 days for recovery and 1 month for full healing
  • About 30% of  fat injections will naturally disappear, but some will remain permanently; everyone is different

B.

Making the buttocks smaller

There is really only one cosmetic procedure to make buttocks smaller, and that is liposuction. In this procedure, three to four small incisions are made around either cheek and fat is removed, leaving behind a smaller buttock. The cosmetic danger is in removing too much fat and turning a plump cheek into a flat and droopy one—not a good idea.

C.

Lifting the buttocks

There are two options for this cosmetic procedure, buttock lift surgery and, again, Brazilian buttock lift.

Buttock lift surgery

In this surgery, a scar is placed in a crease under the cheeks and the skin is turned in to give a modest lift.

The problem is that the plastic surgeon is trying to push and hold your skin and fat tissues in a high position against gravity’s force; given the weight of skin and fat, gravity wins. The scars are not great from this surgery, and I try hard not to perform it!

Brazilian buttock lift 
As above, fat injection will not only make a buttock larger but will also lift it, in the same way an empty bag is “lifted“ when full. With liposuction I can actually change the shape of the buttocks to to make them larger and lifted or smaller and lifted!

The concept to keep in mind with all these surgeries is that by changing the shape of the skin and fat around an area I can change the apparent shape of the area itself!

The update

I first wrote this blog in 2010. $ years later not much has changed other than…

I now perform a lot more Brazilian buttock lifts than before; it is a routine procedure now.

I do very few silicone implants these days

I have not done a simple lift with cutting of the skin in 4 years! – It is just not a good surgery.

We still do not know how come much fat cells survive in some areas and not in others as well!

Fat injections for breast enlargement

Fat Injections to Breasts

 

I have previously written about fat injections for breast enlargement but new information keeps on coming up and cosmetic plastic surgery patients continue to show interest in this plastic surgery procedure. here are photos from an article in the Aesthetic Surgery Journal of March 2014 by Drs. Spear and

 

Breast augmentation with fat injections  Breast augmentation with fat injections

Breast Enlargement with implants

The traditional methods of breast enlargement by either placement of saline or silicone breast implants under the chest muscles have been performed by board certified plastic surgeons since the late 1960 s.  Breast augmentation surgery has withstood the test of time. The surgery will produce consistent results and has a 98% satisfaction rate amongst patients.

Multiple variations of breast sizes and shapes are possible now that moderate profile implants, moderate -plus sized implants, and high profile implants are available from multiple breast implant manufacturers. These implants satisfy the needs of patients who typically are looking for at least a 2 cup size increase in their breasts.

Breast implants are foreign objects for the body and will form capsules of scar tissue around them which can become problematic at time. The implants can also break or rupture and in general need upkeep.

100% of patients will get a substantial improvement in breast size that is long lasting. Breast surgery with implants takes one hour.

Breast Enlargement wit Fat injections

In order not to have the problems that implants can sometimes cause, fat injection to the breasts has been advanced as an alternative surgery by some plastic surgeons.

Fat is removed by liposuction from one area of the body and injected into the breasts to enlarge them. Breasts are made up of a combination of breast glandular tissues and fat. Breast enlargement with fat injections adds to the fatty tissue already there.

Advantages of breast augmentation with fat injections

  1. Natural tissue and feel of breasts

Disadvantages of breast augmentation with fat injections

  1. Un-predictable loss of  breast volume- some of the fat always dies after a fat transfer. How much will die is unpredictable despite multiple techniques for handling and injection of the fat. Typically the latest study shows that only 30% – 40% of the fat injected remains within 6 months.
  2. Risk of development of breast cancer – The fat that is injected will have stem cells which when in the vicinity of breast tissue could cause breast cancer. This has been shown to occur in animal models. Even the latest plastic surgery article about breast enlargement with fat injections mentions that patients should be counselled about the risk of developing breast cancer!
  3. Small volume of breast enlargement possible.  In general breast augmentation achieved with fat injections only gives one cup enlargement of the breast. Typically about 250 cc fat is injected.  Within a few months after surgery only 30- 40 % of the fat remained. How much of that actually stays long term is unknown.
  4. Longer operative time. Typically surgery took 3 hours for fat injections.
  5. 10% of patients have substantial improvement in breast size, and 50% have a moderate improvement in breast size.

So,

Breast enlargement with fat gives minimal improvement in breast size ,has un-predictable results, of unknown duration, requiring three times longer surgery, and increases the risk of breast cancer.

No thanks- I’ll stick to implants for now.

 

 

 

Hypertrophic scars

Thick scars after plastic surgery- hypertrophic scars

 

One of the topics that I am constantly trying to explain to my cosmetic plastic surgery patients is the occurrence of hypertrophic scars.   A recent study showed that 50% of scars will become hypertrophic after surgery and that the majority will decrease with time. Making patients understand that hypertrophic scars are a condition due to their skin type and reactivity and not due to what their cosmetic plastic surgeon can control is challenging.

Hypertrophic scar Good normal scar

 

 

Causes for Hypertrophic scars

There are many theories as to why Hypertrophic scars occur. The short answer is that no body knows why some patients develop hypertrophic scars or even Keloid scars. Hypertrophic scars are scars that produce extra collagen and become thicker and inflamed.  Keloid scars are the same process but occurring on skin on the outside of the area of trauma and also having even greater collagen deposition.Patients also have itchiness and sometime pain in the scars. The scars occur commonly at injury sites to the skin dermis layer such as occurs with burns or trauma, but also occur along surgical incisions.

Hypertrophic scars are known to be more prevalent in patients with darker skin color. Why? Again no body knows but that fact has allowed people to study the differences between darker and lighter skin and to look for other differences which may also be involved.

It turns out that darker skin individuals have more sebaceous oil glands in their skin than light individuals. That may be one of the causes.

More importantly, it  appears that hypertrophic scars occur more commonly in areas of the body that have higher concentrations of sebaceous glands; the arm pits, around the areola and under the breast, around the umbilicus and the pubic areas. Unfortunately all of these are areas where we plastic surgeons have to put our scars for cosmetic surgery!

Sebaceous glands

If sebaceous gland are in fact a contributor for hypertrophic scars then what are they?

Sebaceous glands are a type of oil gland in our skin that produces sebum- an oily discharge that lubricates the skin and hair .  Each hair follicle has a sebaceous gland attached to it which lubricates the hair. Those of you who have greasy skin have a lot of sebum production. These glands are also the ones involved in causing acne and other skin conditions.

Typically they will get larger and grow with puberty. The sebum also has a bit of an odor which like any oil can become rancid and cause you to become smelly . The sebaceous glands are found in all areas of the body except the soles and palms; these areas do not have hairs.

Demodex mite

… and one other thing, sebum produced by the sebaceous glands is the food source for the Demodex skin mite that lives in the shafts of hair follicles. That’s right we all have millions of insects living off our skin oils and dead cells. These mites normally do not cause much bother but can at times grow in population to cause itching ,irritation,  and redness of skin. All of these are what is seen with hypertrophic scars. They have also been associated with various forms of acne.

Treatment of hypertrophic scars

The treatments available for hypertrophic and keloid scars have had poor results. When we don’t know why something occurs its obviously difficult to find a treatment.

  1. Steroid injections ; Steroids injected into the scars can decrease the swelling, redness and itchiness in some patients. injections are given three times with six week intervals. In many patients it does not work.
  2. 5-Flurouracil ; An old cancer drug that reduces the rate of collagen production. I usually mix this with steroids.
  3. Excision; Cutting out the scar and re-closing  with steroid injections at the same seems to work in some patients- and not in others!
  4. Silicone cream; has been shown to help flatten the scars. I tell patients to use it on all scars.
  5. Pressure; has been shown to help in some cases.
  6. Radiation therapy: an old treatment rarely used today

Treatments and causes for hypertrophic scars are plainly a shot in the dark. Plastic surgery patients need to be aware that scars may become hypertrophic and though in most the hypertrophy will disappear with time, some patients may need other treatments that may or may not help. Its not the surgeon’s fault but it might be the fault of the skin bugs.

 

Plastic surgery causes jealousy

Why plastic surgery causes jealousy in husbands

 

I have written in the past on the psychological effects of plastic surgery and specifically cosmetic plastic surgery.

Over the last few weeks though I have seen two husbands who reminded me  that cosmetic surgery effects the partner of the patient as much as the cosmetic patients themselves.

jealousy

Reasons for jealousy in partners of plastic surgery patients

There are a number of reasons that a plastic surgery patient’s partner may become jealous .

1. Fear of being dumped

The most common reason for being jealous of plastic surgery patients is the fear of the patient’s partner of being dumped. I have had several patient’s husbands ask me just that. ” Doc, how many women get a breast augmentation and then move out and leave their husbands?”

There are obviously some serious problems of self-confidence in these chaps if they feel that the only reason a woman is staying with them is because she has small breasts. Still you would be surprised at the number of men who think like that- and rightfully so!

After a breast augmentation or any cosmetic surgery for that matter, a patient’s self confidence is markedly improved. Patients will stand taller, smile more, be more outgoing etc. That new state of psyche obviously makes people react to the patient differently and, if there were any problems in a relationship to begin with, it just might be enough to push the patient to realize the dud they are with and move on to better things.

2. Fear of partner looking too good

Another set of fears for plastic surgery partners is related to the fear of being dumped but takes the form of possessiveness. Some people are jealous if their partners are attracting too much attention. They fear that if their wife has bigger breasts they will attract too much ogling and that makes them uncomfortable. These are people who are again not confident enough in themselves to allow their partners to wear anything but a sac and cover their heads with a bag.

The subject comes most commonly when discussing sizes for breast implants. All husbands of this type will tell the patients to choose smaller breast implants while the other types of husbands will go for “the bigger the better” size of implants. It is the patient who must make the decision about the size of implants and others point of view is guidance and nothing else!

In summary there are multiple reasons for cosmetic plastic surgery patients’ partners to become jealous of the newly found  self- confidence that their partners achieve after plastic surgery.

The normal, balanced, happy, confident partner is one who supports the decisions of their spouse in cosmetic surgery, is there to be of help during the recovery period and is there to benefit from the improved outlook on life that their spouse has.

By the same token, plastic surgery patients should realize that just changing their bodies through surgery will not solve all of life’s problems and may make relationship issues come to a boil.

Breast enlargement surgery revisions

Breast augmentation revisions

 

Breast enlargement surgery revisions are a tricky topic since its is a mixture of  a number of factors which are all prickly to consider for plastic surgeons and patients. This patient came to me complaining of differences in breast size after surgery elsewhere. The previous  plastic surgeon had placed two implants of markedly different sizes in her. I assume he had his reasons. She was unhappy with the difference in size and in the revision surgery I performed, I placed two implants of the same size for a great result.  However, breast revision surgery can be a tricky surgery due to previous scarring and changes in blood supply and the results can sometimes be worse! A careful analysis of the risk benefits of the cosmetic breast surgery must be performed. Even here the difference may not be noticeable to the untrained eye!

 

Before breast revision surgery

after breast surgery

 

 

 

 

 

Causes for breast augmentation revisions include

  • Technical error by plastic surgeon
  • Poor tissues  and tissue healing of patient
  • Lack of patient following directions post op
  • Complications of surgery
  • Perception of a bad result by patient
  • Perception of a bad result by plastic surgeon
  • perception of results by everybody else
  • Bad luck

Technical errors

Problems arising from technical errors by the surgeon at surgery include

  • rupture of breast implants
  • mal-position of breast implants
  • Inadequate hemostasis leading to bleeding

Poor Tissues

These problems arise from poor genetics on part of  patients.

  • Loose skin /poor elasticity
  • Thin skin / lack of strength
  • Reactive skin / skin which does not heal properly

Poor follow up

Specifically poor follow up of the plastic surgeon’s directions. After breast augmentation massage is essential. Lack of massage can lead to capsular contracture and breast hardening needing a revision surgery.

Complications of Breast surgery

  • Bleeding
  • Infection
  • Nerve damage
  • Implant deflation
  • Scarring
  • These are all known reasons for complications of surgery amongst many others

Perceptions of surgery result

Perceptions of defects ion the surgery results and the reason to change the surgical result with another procedure differ amongst

  • Plastic surgeons- for whom minor defects in the surgical result are acceptable based on the patient’s anatomy and the naturalness of the result
  • Patients – who may have expectations that are not real. Often patients forget that their two breasts are not exactly the same and never will be
  • Friends and family of patients may say something regarding the surgery result which even the patient and plastic surgeon were unaware of .

Bad luck

Sometimes the reason is just bad luck and no known cause can be found and there is no one or anything to blame!

In summary- beware of revisions and listen to your plastic surgeon. Sometimes the risk is just not worth it.

 

 

Mommy makeover-Breast-Abdomen plastic surgery

Mommy makeover

Mommy surgery before

                                                                                    Mommy surgery after

Cosmetic Plastic surgery of breast and abdomen after childbirth or massive weight loss is often called a Mommy makeover. Recently a patient asked me if in fact it was not a ‘Mummy makeover” since patients are often bandaged up like mummies after this cosmetic surgery duo!

 

Changes  to body after pregnancy or weight loss

Several distinct but common changes occur to the body after pregnancy or weight gain and loss.

  • Fat Deposits – occur in the flanks, love handles, back and abdomen
  • Loose skin – as a result of stretching of the skin leads to loss of elasticity of skin and its hanging down
  • Breasts become smaller and may also become droopy due to loss of volume and elasticity- in women and men!
  • Arm skin becomes droopy but fat accumulation in the arms may increase
  • Facial  and neck skin may droop giving an older look

 

Surgery of the abdomen and breasts

Mommy makeovers typically include

Other procedures may include

Mommy makeovers will take between 3.5 to 4.5 hours depending on the type of surgery that needs to be performed. Though some surgeons like to continue to operate on other body areas at the same time, I find that 8 hour cosmetic surgeries are just too much for me. They are also way too much for the patient! I prefer to divide up the surgeries into more reasonable segments, sometimes just by a few days, to allow easier healing for patients.

Recovery from Mommy makeover

After a mommy makeover the recovery will depend on the number and type of procedures performed as well as all the usual reasons for differences in individual healing. Although patients are up and walking the same day as surgery, typically it will take about 10-14 days before patients are back at work. I have had patients return as soon as 3 days after surgery and as long as 14 days.

Here is a link to a patient returning to the office after only 12  hours following mommy surgery;  http://www.youtube.com/watch?v=HCqqri8Yt5M&list=UUGHAP0wTkrkJuRo1yN1CFjg

Full healing though will take about 4 months though their healing is gradual and progressive.

Mommy makeover surgery gives women a new look . A new look for their bodies and a new look on life.

Plastic surgery pain management

New ways  of cosmetic Plastic surgery pain management

Some “discomfort” is an normal and expected part of any plastic surgery procedure.  Plastic surgery pain management is an important part of the recovery from cosmetic surgery procedures. Pain after surgery will change in terms of type of pain and intensity and cosmetic plastic surgeons are trained to hep you get relief from the pain in various ways. here are some previous blogs on pain  found in the pre- and post operative section.

https://www.tavmd.com/2011/03/04/pain-control-after-cosmetic-surgery/

 https://www.tavmd.com/2011/03/08/pain-control-in-plastic-surgery-part-2/

pain

Traditionally, pain management has involved use of  a number of techniques.

  • Medications that control pain;  Drugs for pain control are either

  1. Narcotic medications ( Codeine, Percocet, Vicodin)
  2. Non-narcotic meds like Acetaminophen (Tylenol)
  3. Anti-inflammatory medications that also have pain control (Ibuprofen, Advil).
  • Local treatments for post operative pain

  1. Massage of the area of surgery will improve circulation, decrease swelling and therefore pain.
  2. Hot and Cold therapy will increase circulation and decrease swelling also decreasing pain
  • New findings in plastic surgery pain management

  1.  Music therapy is one of the newer methods to help decrease pain after plastic surgery. It turns out that listening to music which you like can help to decrease pain perception. There is a large body of evidence in control of pain in cancer patients by listening to different types of music or even nature sounds ( like the ones in the spas). The type of music does not seem to matter. If you prefer classical that is fine and if you relax to hard rock that seems to be as efficacious.
  2. Caffeine has recently been found to be useful in pain control. A recent study shows that patients taking Non-narcotic medications like Tylenol or Motrin achieved 5-10% more pain relief by taking 100mg caffeine. That is the amount of caffeine in a cup of coffee. Tea also has caffeine and can achieve the same. So can Coke/Pepsi colas etc. etc. How caffeine works to increase the [pain perception threshold is not fully understood but its stimulation effect on the brain  seems to be part of it.
  3. Under medication has recently been found to be a major cause of lack of pain relief after surgery. A new study has shown that doctors, whether male or female, will tend to under medicate their female patients. Men complaining of pain get medications but women do not! Women complaining of pain are often thought to have a greater psychological component to their pain- which it turns out is not true! So, asking your board certified plastic surgeon for more pain medication is a normal and necessary course if you have been under medicated. Of course too much medication has its own serious and negative consequences, so if the surgeon says no more narcotics, its for your own good!

Using these new findings to help decrease pain after surgery will help you have a smoother post-operative course. Always discuss with your plastic surgeon when and what to take. Even though each technique may only work for 10% reduction of pain, adding them together can give you significant relief!