Are Seniors at Risk during Cosmetic Surgery?

There has been a continued trend for facelift, or nip and tucks, at a younger age. The idea is one of maintenance, rather than repair for signs of aging. After all, many of us would prefer not to age at all. But for those of us who might have delayed facelift or rejuvenation, is it ever too late, or perhaps are the risks just too high? Certainly all cosmetic surgery contains some risk, though for most the risks can be managed. Facelift can be an option at any age, though it should begin with a careful plan.

For seniors who have some health issues, and almost all will, your primary care physician will be your advocate to get you into the best of shape and provide a ‘medical clearance’ for cosmetic surgery. High blood pressure, even diabetes which is well controlled, may not hold you back as your physician and our office can partner as a team to see the ‘best’ you become the ‘new’ you. We have been able to take steps which shorten the facelift and neck lift procedure, and find that as we age we require less sedation for comfort and care. An overnight friend can be comfort for some, though there is little to do except rest and relax.

As they say, you may never be too old to look your best and facelift or eyelid rejuvenation can still be a safe option. It can start with a simple dream of getting rid of your loose neck skin. Just know you can follow through with a plan for a safe and comfortable procedure.

The Results are now in -- the 5 Top Cosmetic Surgery Procedures for 2011!

And the envelope please . . . the results from the American Society for Aesthetic Plastic Surgery were just released and despite the economy, cosmetic surgery continued to hold its own, and has even grown by 1%. The bottom line is that over 9 million cosmetic procedures were performed in the U.S. last year. Some of the most impressive growth has come from nonsurgical rejuvenation, which made up 82% of the total.

And, the top five cosmetic surgical procedures are: liposuction (325,332 procedures), breast augmentation (316,848 procedures), tummy tuck (149,410 procedures), eyelid surgery (147,540 procedures), and breast lift 127,054 (procedures). Women are still 90% of the total, though there was a small, though significant, increase in men seeking cosmetic procedures. Although breast augmentation and liposuction have been competing neck to neck the past several years, liposuction has again pulled ahead for 2011.

The really big numbers have been in the nonsurgical procedures that we, plastic surgeons, offer. The top five for 2011 are: botulinum, such as, Botox (4,030,318), hyaluronic injectable fillers, such as, Juvederm (1,662,480), laser hair removal (1,452,880), microdermabrasion (794,357), and IPL treatments (726,125).
Perhaps this is your spring to tune up your looks, whether you are ready for nonsurgical skin care, or would like to plunge into liposuction or the breast augmentation you have been waiting for. The aesthetic spa rooms and our private surgical facility are ready and waiting for you!

Breast Augmentation Revision: Is there a second chance for a better Breast Augmentation result?

Of course, the best revision of breast augmentation is none at all, and communication is the key to the dream result, matching the expectation to what you see after your augmentation procedure. Where we see the most trouble is with breast augmentation by the numbers. Many practices will ask those seeking breast implants to try an implant on in a bra, and then read the number of the size they like best. The argument goes that you chose the number, and if too big or too small after augmentation, it was after all your decision. Troubles also come from implants that are just too large for the available skin envelope and breast diameter. Other problems are seen with implants pockets which are not centered in the breast with an implant too high or too low, breast asymmetry, or breast droop or ptosis. Finally, the biggest nemesis of all is capsular contracture with a firm and rounded breast.

Breast augmentation revision can’t solve every problem, though if you have a result that falls way short of the real ‘you’ implant exchange for size can be very satisfying. There are also a variety of techniques to improve the breast implant pocket and implant position to get a better marriage between the implant and natural breast tissue. Breast lift can raise the nipple and keep it up front and center on the breast for the best aesthetic result. And capsular contracture, a difficult and recurring problem might respond to newer techniques with an allograft, a new implant pocket, or even a highly textured and form stable implant, such as the gummy bear.

Remember, communication is the most important step before breast augmentation. In order to get the result you expect, be certain that we know what is expected. The implant size is only a number, one which is easily forgotten, the right look will give you confidence and a look worth remembering.

What a Breast Reduction Can Mean for You.

It seems unfortunate that insurance companies and health plans have a continuing trend of denial of coverage for breast reduction surgery. Our experience over the past 20 years has demonstrated, time and again, the incredible benefit to life and health from a breast reduction. Breast reduction surgery has remained as one of the pleasing procedures for patients, with the highest satisfaction rates of all cosmetic surgical procedures. According to ASPS statistics, there were over 80,000 breast reduction procedures in 2009 despite poor support by the insurance industry.

A recent study and review of all the available data on breast reduction was compiled and published by the plastic surgeons at Emory University in the Journal of Plastic Surgery in 2011. Their work compiled data from breast reduction patients from 1977 to 2010. As we all expected there were significant improvements in musculoskeletal pain, headache, improved sleep patterns, less fatigue, and improved breathing. This alone should impress the insurance industry. The bigger news, however, is that breast reduction also had an impact on improved self esteem, improved sexual function, improved quality of life, decreased anxiety and depression, improved exercise, and a reduction in eating disorders! We, too, had noticed that breast reduction patients tend to lose on average 15 pounds after their reduction. This news just couldn’t be any better!

We do enjoy good support for breast reduction from primary care physicians in our community who recognize the benefit to their patients as well. Even if your insurance plan has turned you down and the benefits seem too good to pass you by, our office can help find a way to make reduction a reality for you.

Number of Patients Seeking a Breast Lift sees a Dramatic Rise.

According to the statistics of the American Society of Plastic Surgery, over the past ten years there has been an increase in the number of breast lift procedures by a whopping 600%. Liposuction which remains the most popular cosmetic procedure has seen the demand fall slightly during this same period. We hope that this is a sign that we are finally addressing weight issues, exercising more, and focusing on body shaping, both in and out of clothing. Certainly body shapers, such as Spanx, have seen explosive sales increases. Plastic surgeons, too, have seen the same effort from patients, hoping to get the best look from the skin they are in as well.

What makes breast lift such an attractive procedure is the flexibility in clothing, such as bathing suits and even camisole tops, which might have been unthinkable without a lift. The freedom from dependence on a bra to hold the breast and nipple up on the chest and relief from the dreaded ‘National Geographic’ look can give an incredible boost to the quality of life. Breast lift can correct a breast which has become thin and flat from weight loss, aging, or pregnancy. Would you dare go braless on a hot summer day? The huge increase in breast lift tells us many might not have before, though after a breast lift there is a whole new world of possibilities.

A New Line of Breast Implants will soon be available from Sientra®.

Every time we have a new breast implant enter the market in the U.S. the news is fairly big for plastic surgeons. We have had two very good choices for most seeking breast augmentation, the Allergan Natrelle®, and the Mentor Memory Gel® implant lines. Worldwide the selection has been all the greater, though now the FDA has released approval for the Silimed® silicone line of breast implants from Sientra®.

We have not seen all the details on the implant series, as the news was just passed on from the American Society of Plastic Surgeons (ASPS). And, we have yet to compare the new implant warranty with the excellent ones from Mentor and Allergan. However, when patient individual needs are concerned, choice is good and the new implants will get our closer “look over” to see where they fit some special needs, such as the Allergan Gummy Bear 410 in our practice. We have had good experiences with the Allergan 410 in selected patients, and we hope too they will become more broadly available and out of the current study restrictions next year.

Yes, Dr. Johnson and the Center for Aesthetic Surgery are on Facebook!

Just when we thought there wasn’t the time for one more thing during the day, we discovered that over 42% of you out there use social media and Facebook for research and exploration into issues concerning cosmetic surgery. So we have made the leap, turned off the television, switched off the radio, and fired up the i-pad. We have created links for Facebook to take you to our website and blog and hopefully to some of the timeliest information in cosmetic surgery today.

Like the rest of you out there, we are caught in the web with links from the American Society of Plastic Surgeons, the American College of Surgeons, Looking Your Best, Realself.com, and many more. We’ll see you on Facebook, and hope we can friend you, and hope you will ‘like’ us!

Time to Shed your Winter Skin: the Season for Microdermabrasion and Facial Peels has Begun.

Over winter with lack of sun and moisture, our skin goes into hibernation, and the outer dry layer begins to build. The winter dryness can lead to the development of fine lines, loss of supple skin tone, and the dry buildup can cause the appearance of age spots and telltale signs of environmental damage.

Spring cleanup is an essential part of maintaining healthy skin, and there is no better way than a program to exfoliate the winter skin as we prepare for warmer weather. Microdermabrasion is an excellent way to combat dryness, and reduce fine lines. Your skin will become more receptive to moisturizers and make-up will flow and blend better. For those with more buildup and blotches, facial peels such as Lactic, Glycolic or TCA will improve skin color and lessen age spots. Beside the blotches, they may also improve under eye circles.

Preparation is the key and we have a program to get you off to good start. Before treatments, you should start with a micro- exfoliating cleanser, and perhaps pigmentation control, followed by a vitamin enrichment of the skin with retinol, Retin-A, to wake up the winter skin.

After your skin is clean and clear, don’t forget the importance of protection. Sun blocks can provide color and physical defense, and sunscreens will allow you fun in the sun while protecting your good looks for years to come. Give us a call for your spring cleaning!

Cosmetic Surgery Horror Stories are on the Rise.

With the changes imposed by the national healthcare transition, it seems that more physicians are making a transition into cosmetic surgery, often with very little training. Under current practice inIllinois, any physician in the state may call themselves a cosmetic surgeon, or open offices featuring cosmetic medicine. We are entering the wild west of cosmetic surgery, where your obstetrician may wish to perform your tummy tuck, or even your dentist may ask if will have Botox with your cleaning. Your last treatment may have been featured on the ‘daily deal’, or perhaps you had a facial filler at a hair salon or house party.
Patients don’t often consider that cosmetic surgery is ‘real’ surgery and can have a false sense of security. In Illinois, we seem to have been spared the worst so far, though the national press has been filling with stories of the ‘uni-boob’ after breast augmentation, death by liposuction, breast implants from hell, and unapproved ‘fillers’ with disastrous results. And nationwide it seems revisionary surgery is on the rise. We, too, have seen an increase in the ‘redo’ consultations or second opinions at our office.

We predict that the trend will continue to grow, and it is time to emphasize that cosmetic surgery is a serious surgery and should be performed safely by a well-qualified, experienced surgeon. The best surgeon for you, whether it is Botox and fillers, or breast enhancement and facelift, is one, board certified by the American Board of Plastic Surgery, and practicing in an accredited office facility. Good standing in the local medical community is also a must, and don’t forget to ask your surgeon if he or she has privileges to perform the same procedures in the local hospital.

So remember, it’s a wild world out there and you will have to do your homework to play it safe. Or, you could just give us a call. I’ve done the hard part for you.

Hope for Capular Contracture after Breast Implants.

Every breast implant used in breast enhancement, augmentation, correction of breast asymmetry, and breast reconstruction will form a natural capsule, a kind of scar over the surface of the implant. For a very few individuals, the capsule will become tight and firm in perhaps two out of a hundred, and the implant will become round, losing its natural softness. The cause is poorly understood, and for most, the contracture happens on just one side. Despite every effort to place the implants cleanly and free of any contaminates, capsules will occur.

Once a capsular contracture has begun, our options have been medical approaches using vitamin E, Singulair™, and implant massage. The success has been poor for most. The surgical options are opening the capsule or removing it altogether, or placing the implant in a new pocket in front of or behind the old one. Surgery is successful about half of the time. Yes, the capsule will eventually return and firm up for half of breast implant wearers. Of course, the implants can be removed, but patients are so pleased with their implants that most will live with the capsule, rather than live without breast implants.

A new idea has emerged with our experience in breast reconstruction. We have trended to more breast preservation and immediate breast reconstruction after mastectomy. Patients with breast reconstruction seem to have the highest rates of a capsule or firm breast implant. However, when we place the implant immediately, and support it with an allograft, the capsular contracture rate has been less than expected. An allograft is a sheet of collagen prepared from a donor that covers and supports the implant and it may prevent the capsule from tightening. Many surgeons are now using allografts ‘off label’ with success to solve problems with capsular contracture giving new hope to those with a firm breast implant. As full studies have not been completed, the proof is yet to come. In time, the allograft may be the tool we have been looking for to solve a very difficult breast implant problem.

Develop a Lifetime of Healthy Skin with Us.

As children, our skin needs very little care -- just cleaning, moisture and, of course, sun protection. But as we age, beginning in our thirties, our skin begins to behave differently. Moisture content starts to diminish, and collagen production begins to slow down. Also, the elastic fibers in the skin begin to give way and are replaced at a slower rate, creating the visible signs of aging.

The concepts of prevention and maintenance must be started at the earliest time possible, to wake the skin and stimulate cellular function and collagen production. In our office, with the help of products from SkinCeuticals, we can start a program of cleaning, toning and moisturizing, and offer sun and environmental protection. As the skin slows its natural cycle of repair, we can also restore those vitamins which can active and restore cell function.

Some of my favorites are: Hydrating B5 Gel to enrich the skin, and vitamin C and E Ferulic to take advantage of the healing effects of vitamin E, and the exfoliating properties of vitamin C. Finally, vitamin A over the long term is the most effective of all to wake up the skin and stimulate cellular function. Retinol from SkinCeuticals is very effective and well tolerated for daily care. And for those who need greater help and have controlled dryness, prescription strength vitamin A preparations such as tretinoin (Retin-A) creams and gels are a proven step.

We know that the majority purchase their skin care products from retail stores, and this is why we have put in place a simple and effective program with SkinCeuticals to see you through your thirties and beyond. Prevention with cleansing and sun protection, and maintenance with hydration, exfoliation and the right concentrations of vitamins, especially vitamin A, can give you a lifetime of skin health.

Breast Reduction Evolves as an Office Based Cosmetic Procedure

On a regular basis our practice sees individuals who have a very large and heavy breasts who are unable to find bras or clothing that will fit both their upper and lower body. Bathing suits are out of the question, back strain is a daily problem, and exercise a challenge. In the past, we had the support of insurance coverage for the physical comfort provided by breast reduction surgery, not to mention the improvement in appearance and self esteem. Yet, we now experience insurance coverage for breast reduction trending lower, with frequent insurance denials, despite appeals. Some insurance plans will not consider breast reduction for any reason, as they pull back under the changes of the new health care plan passed by the government.

Fortunately, the evolution in breast reduction began before the insurance companies stopped including coverage. Over the past eight years, we have adjusted our reduction to involve a smaller scar, eliminated the need for drains, and shortened the recovery time needed. Hospital stays after breast reduction has been eliminated. Breast reduction is now a shorter, safer, outpatient plastic surgical procedure.

Many who are looking forward to breast reduction, and are turned away by insurance have an option to go it alone. Office based surgery is safe and affordable, and with the evolution in reduction techniques, breast reduction is available as an office based procedure. We like office based surgery as the cost is so much lower than hospital settings; safety is assured by our commitment to high standards and accreditation. Of course, this doesn’t include the comfort and patient experience that a private center can provide.

So don’t despair if your insurance has turned you away from a procedure that can have such an impact on the quality of your life. Be free of pain and back strain, wear the clothing you like, and have a look you deserve at our Center for Aesthetic Surgery.

Cosmetic Surgery is Trending to a Younger Age Group: Welcome Generation X.

Review of plastic surgery procedures by the American Society of Aesthetic Plastic Surgeons has revealed a new trend in the demand for cosmetic procedures. According to their 2010 statistics there had been a shift from the Boomers, to Generation X, as the drivers and consumers of cosmetic surgery procedures. The 30 to 45-year-old group, or Generation X, accounted for 43% of all procedures, while the 50 to 65 year olds only 28%!

With shows such as Nip and Tuck, and the ever-present emphasis on beauty as seen in our national magazines and other media, cosmetic surgery is no longer something to be considered in the ‘later’ stage of life, but as a process of continued enhancements to defy the aging curve and maintain youthfulness over time. This major shift has pushed us from restoration of beauty, to one of prevention and maintenance of a youthful and vital look.

Though we will never give up on our Boomers who need our care and attention, numbers indicate that prevention is here to stay. To compare, consider a full SMAS facelift or deep peels at age 60, clearly ‘rejuvenation’, to that of a soft lift or minimal-incision facelift at age 45, for maintenance and prevention.

Preparing for the shift to the nip and tuck generation, we have developed a minimal facelift with a short scar, with a short recovery to match. Eyelid procedures have also been tailored to more subtle changes of aging. Lighter peels and lasers refresh and rejuvenate the skin. And, of course, body contouring has shifted to a mommy makeover to address the wear and tear of pregnancy that our gen-Xers are facing.

The desire to stay young has taken on a whole new strategy, with “preserve and maintain” being the new norm of the next generation. Combined with skin care and other anti-aging programs, plastic surgery is in the mainstream for Generation X.