Considering Large Breast Implants? When can “Big” be “Too Big”?

The stock market has often been compared to hemlines. When skirt hemlines are rising so is the market, and as hem lines fall goes the Dow Jones market index. With the recovery and rise of the stock market since 2008, we have seen hemlines in skirts and shorts as high as they can go. Confidence is on the rise, but not just in hemlines. It seems that the size of breast implants might also be tied to our emergence from the Great Recession.

If we look at our trendsetting West Coast, the high profile breast implant has taken center stage, with common implant volumes of 500cc and more. Mentor has even released a new breast implant, the Ultra High Profile which can put the most volume on the smallest of chests. In the late 90’s, it seemed that a 270cc to 360cc, round, smooth, lower to moderate profile implant, would give wonderful results for almost anyone. With the prosperity of that time came implant inflation with Bay Watch and Pamela Anderson. The following decade resulted in the implant decline of 2000’s with the silicone gel implant moratorium. As the size of implants and interest in them fell back, by 2008 the market came to rest at a new low as well. Now with an increasing interest in higher profile breast implants, we are again at an implant ‘high’ and the worry is that implants and indeed the current markets have gotten a bit ahead of themselves.

High profile breast implants do have an important role in breast augmentation, though there are arguments against them. There are thoughts that they may have a higher risk of complications such as bottoming out, thinning and stretching of the breast, and showing through the breast tissue. Difficulty arises too when considering breast shape and symmetry. In our suburban Chicago practice, we focus on a ‘natural look’, though in some areas this goal may refer to an implant look, or a very full look, a ’higher’ breast look, or even a fake look. There is nothing wrong with a high profile implant if the choice is carefully made, but be careful what you ask for if you are only following the trend. When markets are high, hems are very short, and implants are large, euphoria can be replaced with regret. Caution is key.

Remember that as you consider breast size, think of your investment in good looks over years. Be as big as you want to be, but only as big as you are meant to be. The fit and proportion should last a lifetime. Stay true to yourself, and remember that other peoples choices are just that and trends don’t need to be followed. Implant sizes and dimensions require skill and judgment that we feel only a surgeon should make. What implant you will need for breast augmentation is determined by a careful assessment of your particular breast and chest size, shape, and breast tissue. Even the breast skin envelope and position of the nipple and breast fold will influence your augmentation. Photos of what you like and what you wish for are an excellent tool to help us get your augmentation just right. A picture is worth a thousand words, and far better ones than “natural”.

The stock market is now at a four year high, and implants are bigger than ever. Many large breast implants came out with the last big market correction, and we just might be headed for another fiscal cliff. This is a great time for those considering breast augmentation to choose a safe “buy and hold” approach. Find a look you can enjoy for a lifetime, ups and downs and you will have made a very good investment in yourself, even when the next bubble bursts.

Breast Augmentation: The Shape of Things to Come

Though it seemed that the evolution of the silicone gel breast implant stopped with the silicone implant moratorium in 1992, our office among others, continued clinical trials of implants we hoped will improve the outcome of breast reconstruction. Implants at the time of the moratorium came in a limited variety, round low to moderate profile implants, which do extremely well for augmentation of the breast. Augmentation is in essence enhancement of the natural breast size. Reconstruction of the breast where the breast shape and characteristics have been lost is a different matter. Our work has evolved in studies with the Allergan 153 implant, the Mentor Lumera, and now the Allergan 410, all of which are shaped implants which better mirror the natural breast shape and form. The shaped implants, also called teardrop have a tapered upper edge which can prevent a rounded look and mimic the natural breast profile. Instead of working with the implant diameter and projection alone, the shaped implants allow us to vary the height, width, and the projection independently.

As the new shaped form stable implants from Sientra have reached the market, and both Mentor and Allergan are in the process of FDA approval for their versions, we are likely to hear much more about them and how they will benefit breast augmentation. In our practice, we prefer an implant that is soft and fits and flows within the breast, moving and shifting in shape as the breast naturally moves. The best implant is one that does its job enhancing the breast in a way that cannot be seen or felt, out of mind. Smooth, round, moderate profile implants, either saline or gel will provide the need for most, and it is unlikely that stiffer shaped implants will have a broad appeal. Just our guess, however shaped implants will give us better control when we need it most. The very tight AA breast just might take on a better silhouette when compared to a round implant, and with breast asymmetry we might be able to keep the projection and dimension where we need it. Thin breast tissue and ripples? Again, the shaped implant may be a solution as it will show through less and ripple less than either saline or gel.

Though shaped breast implants will not take the place of current implants in breast augmentation, for those with special challenges, shaped implants will indeed be the shape of things to come.

The Ultimate in Breast Lift

Breast lift is an increasingly attractive option for rejuvenating and restoring a youthful and perky shape lost over pregnancy, or perhaps weight gain and loss. Traditionally, breast lift has been about firming the breast tissue, and lifting the nipple up and onto the front of the breast. At best, a great lift is a ‘no bra needed’ look. The trending or the “ultimate” in breast lift is a combination of lift, and augmentation for the upper fill and roundness we just cannot seem to get through a lift alone.

With volume loss in the breast, and relative skin excess, the nipple can appear low, or for that matter the whole breast can appear to sag lower on the chest. With good support and an upper push, things are not so bad. But sooner or later you must get out of the bra and into a bathing suit. Then again there is the dreaded pencil test. Not the one about cleavage, but the one about the breast that hangs over when you place the pencil in the breast fold underneath. Only a nipple that sits an inch above the fold gets a passing grade.

A good breast lift will move the nipple up to where it belongs, with or without a bra, through an around the nipple approach, or a vertical lift, if the upward move must be greater. Still, the breast may show an upper scoop or a lack of projection above the nipple and the ultimate in breast lift can be had by the addition of an implant, even a small one to fill out the remainder of the breast and firm and round out the breast shape. The majority of those we see who ask about breast lift, favor the look of the lift and implant combined. Even a little fill will do if a fuller cup size isn’t the goal, and the ultimate in breast lift is worth looking into.

Proud member of the ‘Sun Scare’ Industry

While catching up on the pulse of the nation, I just happened to notice that we have been rebranded as part of the ‘Sun Scare’ Industry. Yes, we have been guilty of giving out “misinformation” about the harms and risks of ultraviolet radiation and been active participants in recommending sun blocks and sunscreens to hapless millions at a cost (and our personal benefit?) of billions of dollars. I have also sadly come to learn too that plastic surgeons and other well meaning physicians within this industry are vastly outnumbered, as there are more sun tanning salons in the U.S. than McDonald’s. The tanning industry is no lightweight, and polls have indicated that 90% of those who work within its ranks believe that sunbed exposure causes no health risk! This is something you have to see for yourself, and we suggest www.SunlightScam.com so you too can appreciate where the argument is going.

The tanning industry has rounded up notable endorsements, even from a few physicians who feel that the skin cancer link to sun exposure is a weak one, but they don’t stop there. The key to their defense of the sun is vitamin D. Vitamin D, of course, is an essential vitamin and the lack of it even has its own disease, rickets. Proper bone formation and bone strength relies on vitamin D, even for adults. Our skin becomes a vitamin D factory when exposed to sunlight. And, for all of you lactose intolerant out there, other than your skin, dairy products are the only place you can get it: not meat, vegetables, fruit, or breads. The salon staffs are no longer the agent of photo aging, wrinkles, and skin cancer, but Vitamin D Angels, spreading a warm happy glow and good health. Could it be as well that tanning beds and the vitamin D produced also prevents cancer? You got this right. Some have proposed that vitamin D also prevents cancer of the colon and breast, and the tanning salon is really about cancer prevention. I have to admit I really did not see this one coming.

Unfortunately, the link to cancer prevention and vitamin D is a very weak one. However, the link of sun and ultraviolet exposure is a very strong one. Skin cancer rates are up by 50% according to the National Cancer Institute, especially in young women -- perhaps many of those young women, 28 million visits to tanning salons each year and growing, are in that number. It is a fact that skin cancer kills young women, something the Australian’s have come to know all too well. They believe strongly as a nation the link and risk of sun exposure and ultraviolet exposure. Did you happen to notice the beach volley ball in the recent Olympics? The American team was wearing, well, not too much and was great for ratings; however the Australian team had ‘full cover’ of arms and legs. I may be proud to be American, though I am also proud to be a member of the Sun Scare Industry. Go Australia, you are right on this one.

Mesotherapy at the Day Spa

We received a call today in the office from an individual who was at a spa in downtown Chicago, and underwent a mesotherapy treatment by a “therapist” and she was very alarmed by the severe facial swelling and pain, and a misunderstanding of what she had gotten into. She had called the spa and they could give no advice as the therapist was not available.

First and foremost, mesotherapy is a medical procedure according to the state medical board. The main purpose is to reduce fat and improve cellulite. The process is one of injection of medications and vitamins, sometimes amino acids into the skin to rejuvenate the tissue, and cause lypolysis or the death of fat cells. The concept was popularized in Europe where it is more wildly practiced, and the key agent is phosphatidylcholine, a detergent which causes swelling and inflammation and local fat cell death. It is combined with many agents as I have mentioned into a ‘cocktail’ (they do indeed call it that) which is quite variable from practice to practice, and there are very few studies which confirm the safely or effectiveness. Even the most common ingredient sold under the name lipostabil is not FDA approved and falls within an ‘off label’ use or gray area in medicine. Though the procedure is touted as noninvasive, it is an injection of drugs never the less.

Is mesotherapy safe to reduce fat and cellulite? There simply is not consistent data or a consistent method of treatment, and the American Society of Plastic Surgery does not endorse the treatment and has issued a warning. The fact that an individual in our city was able to receive facial injections in a spa without medical guidance and supervision is alarming. The internet is full of mesotherapy sites, even selling home kits on-line. We wish to reinforce the fact that injection of drugs into the skin is not ‘non-invasive’ and comes with considerable risk Before anyone injects you with anything at the spa, ask to see the doctor for a full explanation of the procedure, the purpose, and the risk so you can make the best decision as to whether mesotherapy is right for you. Be careful out there.

The Medi Spa Crisis; is there is Doctor in the House?

It seems that medispas are everywhere today with hair salons and health clubs offering treatments such as facials, lasers, microdermabrasion and even injections, such as Botox and facial fillers. Of course ‘medi’ suggests medical, and injections certainly fall under services that require skilled, licensed medical care. There is no gray area here. When someone is injecting a medication or medical filler into your face with needles, medical practice is the only way to define it. So, is the medical office where you receive Botox or Juvederm injections the same ‘medical’ office where you exercise or color your hair? According to government regulations it is one and the same. And if the hair salon or health club is where your medical care is provided, is there even a doctor in the house?

Recently in a California hair salon, Posh Hair and Skin Studio, offering Botox and fillers government inspectors arrived to find a nurse practicing without any supervision. She was arrested and is out on bail for medical practice without a license. The doctor with whom she was working was a gynecologist/hair salon operator seeing patients in another location. Yes, he was indeed a co-owner in the hair salon and argued that his nurse had standing orders to administer Botox to his patients. The doctor is unlikely to get off easy on this one, as the government views the hair salon part of his medical corporation and medical offices. How one manages infection control, medical waste, and patient confidentiality at the hair salon is anyone’s guess.

Nurses can be well trained and can become experienced at administering Botox, and even facial fillers. The laws as things stand require that a physician be present and determine by an exam that the treatment as prescribed is right for you. The physician must be available for questions and mishaps, and be responsible to you if problems occur.

A bad hair color or cut is disappointing; however a bad injection can be quite worse. Next time you consider Botox or filler at a day spa or health club, ask yourself, is the environment clean and secure? Is the medication secured and stored according to guidelines? Is there a record of what was done and instructions available to you? Is the person treating you properly licensed? And finally, is there a doctor in the house?

Botox and Juvederm, what is the difference?

With the extreme popularity of both products in our office, Botox and Juvederm, we continually have to sort out confusion between the two, and what each can accomplish. Just today on the Twitter stream the issue was raised. Do you need one, or the other, or will you need both?

In order to set the record straight let’s go back to the basics. Starting with Botox, the medication is a neurotoxin, which sounds a bit scary, though this is indeed how it works. There are now three formulations out there; Botox, Dysport, and now a new one from Merz called Xeomin. They are all formulations of botulinum toxin type A, and studies to date show a very similar result and duration for all three with skilled application. The toxin binds to the end of the motor nerves and stops the connection so the muscle cannot react. Over time, the nerve ends replenish themselves and the muscles again respond to commands to flex and frown. The key here is ‘flex and frown’. Botox, and the like, treat dynamic lines and folds from facial over expression. Wear your worries on your forehead, or smile and squint expressively from the corner of your eyes, Botox is your cure.

Juvederm is quite a different matter, and is one of a group of “fillers” based on hyluronic acid gel. The gel is a chemical which is a normal component of cell membranes, part of the regular stuff in the body and is importantly not a protein. The fact that it is not, prevents any reaction or inflammation which was a dread from collagen injection of days gone by. The hyluronic acid gel is a great plumper because it is hydrophilic, which means it attracts and holds water, and is slowly absorbed and recycled by the surrounding cells. A filler does just that, it plumps and softens lines and folds that are always there or have crept in during the aging process. Smile lines and folds are the first to come to mind.

So, Botox or Juvederm, what is the difference? Wrinkles at rest, Juvederm to fill and contour. Dynamic line or wrinkles with motion, Botox is the cure. Will you need both? Maybe.

Breast Augmentation Revision: Can you Avoid It?

Breast augmentation has been a procedure with very high satisfaction and very low instances of a complication. Still, as we talk to colleagues at meetings and review the published experience, the revision rate after breast augmentation is often alarmingly high. As I look at issues raised on RealSelf.com, which is an open forum of questions and answers about cosmetic surgery, the #1 question that appears is; “What size should I be after breast augmentation?” Indeed, too big or too small is the key motive for many asking about revision after implants.

Clearly everyone will have an opinion as to what breast size is best for you, your friends, spouse or significant other, perhaps even your mother will give you advice on this one. And yes, your surgeon might have just the idea for you and how he might present you on his website as a knockout result. A particular surgeon’s goal might be following a current trend, such as very round and full high profile, and may tell you such things as ‘I always use a gel implant’. But whose choice is it really? The revision after breast augmentation seems to come down to size. The ‘look’ of your breast augmentation might be best left to you. This takes a self exploration as to what look is the real ‘you’ and sticking with your instincts.

Size is not the most important matter in breast augmentation. We feel the most important issue is the look. You will need to explore photos and websites for examples of what you like, and also what you don’t. You may wish to purchase the dream bra you want to wear, pad and fill it out and give it a trial run. When you know the look you need to complete the picture, take all this information with you to a surgeon who will focus his skill toward your goals and not his. Sharing your ideas with others can be like sharing baby names, so unless you trust the source it is best to trust your instincts.

So, can you avoid revision after breast augmentation? If you take the time and do your homework, too big or too small can become just right. And that is the kind of ending both patient and surgeon want each and every time.

The Neck is the Key to a Great Facelift

These are dramatic times for the baby-boomer and their quest for graceful aging. As a group, we have become quite accustomed to looking good and stealing the limelight while we still can. Whether we are on film, aging rockers, or in charge at the office, as a group we just refuse to give up and insist on being as timeless as the music and culture we created.

With sluggish jowls, and loss of the cheek volume, a ‘soft lift’ is great in our late forties and early fifties, to refresh and smooth. The ‘soft lift’ keeps vitality and youth in the cheeks and chin. In our later fifties, bigger problems can emerge, and for some the focus is no longer up front and center. Though we still might call it a facelift, the neck is likely to cause the most distress. Turtlenecks and scarves are not the answer.

It seems that the key to a great facelift is actually in the neck, as the visual focus shifts to the chin and below. Certainly by age sixty, the neck is ‘the’ issue for perhaps half of all looking into a facelift procedure. We could of course call it a neck lift, but a smooth transition into the cheek and upper face is also a must, if we are to get from good to great. But if the neck is right, the rest will follow. We get there with a combination of techniques, reduction and contouring of the fat within the neck and chin, tightening the bands within the neck from below, and lifting the neck upward supported by its own special muscle below, the platysma, or SMAS as it is often called. The healing can be a bit longer, but the efforts are well rewarded.

So for you baby boomers out there, go ahead and stick your necks out, and as Bob Dylan said, may you be ‘forever young’.

UK Cosmetic Surgeons Support Psychological Screening before Cosmetic Surgery

According to new findings, which will be presented this July by the Center of Appearance Research located in Bristol, little is known about the psychological impact of aesthetic surgery, and ability of patients to cope and function long term. Here in the U.S., we might call this ‘long term’ satisfaction with cosmetic surgical procedures. Based on our practice experience, and the hundreds of studies which have considered safety and satisfaction of cosmetic surgery, evidence has clearly demonstrated its success and benefits. We don’t know how the Center of Appearance could have missed all the current published data as it is fairly easy to find. Some individuals have cosmetic surgery for the wrong reasons, and we too have written about this recently, and the careful practice will try to stay ‘patient’ focused and select only those who goals are reachable and meaningful.

In the UK over the last decade, cosmetic surgery has tripled and become a multi billion dollar industry, all of which is in the private sector outside of the national health program, or to quote the sentiment of the article the “unregulated private sector”. Is it really true that UK cosmetic surgeons believe psychological testing vital before cosmetic surgery? We will have to wait and see how the study is received after the July presentation, which might suggest that a well crafted screening process offer a “quick and efficient” guide to alternative care for those who do not measure up. It seems their government is leaning in this direction as the National Confidential Enquiry into Patient Outcome and Death Report was quoted as including “psychological assessment is an important part of any patient’s aesthetic surgery episode and should be routine”.

In the U.S., we may also have to consider what we must share in order to show why we feel that a breast augmentation will enhance our lives, or perhaps that a facelift won’t really land us a better job but really could make us feel better. As a U.S. Cosmetic Surgeon, we hope not. There is something about our independence and free will to settle our own lives that makes us distinctly American. The Edwardian sense of order and protocol may not have left the UK which clearly has been surprised by the tremendous growth in the self improvement cosmetic surgery has to offer. I predict that they will hear back from their subjects what our favorite nanny, Mary Poppins, told her employer George Banks when asked to explain herself about how she was caring for the Bank’s children; “Frankly I never explain myself to anyone”.

Sizing Up Breast Augmentation Revision

Considering the need to revise any cosmetic surgical procedure, we tend to think about complications -- a poor scar, bleeding, perhaps an infection which may have occurred after a procedure, all of which are the ‘real’ risks of a surgical procedure. However, when it comes to breast augmentation it seems that breast size is ‘the’ issue and according to what we read, drives most of the revisions after breast augmentation. Some studies claim that the need for revision after breast augmentation can be as high as 20%, or one out of five. In our own practice, we have been able to get this number down to 1% (we can’t be perfect) and I hope to give you some simple steps how get best out of your breast size.

First and foremost, follow your own instincts. Everyone will have an opinion as to the best breast size for you. Even as you look over pictures of others who have had a breast augmentation, keep in mind that you are looking at other’s choices, and you too should have the say on what is right for you. If ‘everyone’ you see has very full or large breast implants, it doesn’t mean that you too must have them and have that ‘look’, unless of course that is what your goal is. Be true to yourself.

It is the look, and not cup size which will ultimately translate into a great result. When planning augmentation focus on the look that is right for you, how you live, and how you feel inside. Pictures and trial bras are a great way to communicate your ideas. Cup size is relative to the chest size, and will vary by different bra manufacturers. If you fit a full C-cup after augmentation, yet wanted a small D should you be disappointed? If your C-cup is soft and the ‘look’ is you, no one will see you as a particular cup size and you shouldn’t either.

Frequently we hear of patients who are asked to try on breast implants, and are asked then to choose the size they want, say the 320cc or the 360cc. Or, some will tell that their friend has the 420cc implant and they want to have the same one. Breast augmentation by the numbers is a gamble. Unfortunately, you just can’t try on an implant, read the number off the back, and know how it will look and feel after augmentation. If it could only be that easy. And, it should be no surprise that if you use the same implant on two different people, you will get two different results. If we ask patients years later what size implant they are wearing very few will remember, however they will be reminded of how they look every day. It is best to forget about numbers when it comes to breast augmentation.

So if it isn’t about the amount of fill or volume of the implant in the bra, just what do we look for with the trial bra? Again, it is back to basics, the volume as it appears, the upper fill, the cleavage and spacing, projection, how clothing drapes and feels. Next, is a review of photos of the ideal you. You might even be able to find someone just like you before, and close to your goal after if you research well. And don’t forget about photos of what you don’t like. A great surgeon will commit all to memory, and use skill and experience to get you there. The number? I forget them too as we have so many implant choices in size and style. But if the end result or ‘look’ is the ‘you’ that you had dreamt about after breast augmentation, revision becomes our least worry.

Liposuction rebound. Does the fat come back after liposuction?

One of the most frequent questions we are asked about liposuction is whether or not the fat will come back after, or is the procedure permanent. First, and foremost, we know that liposuction is very poor at controlling weight. After all, we are what we eat. But a recent study cited by U.S. News & World Report raised the question as to “where the fat might go, if it indeed comes back after liposuction”?

The source of the recent web stir came from a study just this July published by researchers at the University of Sao Paulo in the Journal of Clinical Endocrinology and Metabolism. They looked at 36 eager volunteers who were heavy though not obese (BMI less than 30) and performed liposuction of two to three pounds of fat. Here is the twist. The individuals were then divided into two groups, one participated in a program of exercise, and the other maintained a more sedentary life. Remarkably for both, the ‘cosmetics’ were good, though we all know that liposuction does indeed ‘work’, and at four months weight was stable and comparable.

So where is the problem? Think of the fat distribution as the ‘whack-a-mole contest’ of body contouring; reduce the fat bump in one place, up pops the fat in another. We have two fat spaces, the fat under the skin, and visceral fat around internal organs. The visceral fat is linked to poor health and an inactive lifestyle, and as you now might have guessed, the Brazilian study showed that after liposuction the couch potato group had an increase in visceral fat where the active group did not. Could you be less healthy after liposuction? The answer is perhaps. We have known for a very long time that visceral fat is more ‘active’ than fat under the skin, and that exercise works to reduce it. The conclusion we draw from the study is that you could be less healthy after liposuction as the fat goes through its whack-a-mole rebalancing act, but exercise after surgery works! No need to starve the moles out of existence, but regular exercise after liposuction will help you not only look the best, but keep you in the best of health. Didn’t we know that all along?

Recent Polls show Breast Implants will improve your Sex Life

As a regular contributor to RealSelf.com, we noted the results of their recent poll concerning breast implants and sexual satisfaction. As expected, women who have completed breast augmentation report a better sex life. What was not so expected was the extent of the gain in sexual awareness and satisfaction. Given the huge number of breast augmentation procedures, over one million in the last three years, fewer people are getting enough rest these days.

The RealSelf.com poll discovered that 70% of women found their sex life improved after breast augmentation. Yes, a whopping seven out of ten found that a fuller breast worth it regarding intimacy and sexual satisfaction. In the poll, 61% reported an increase in the frequency of sex. Is more really better you might ask? Well, 34% reported sex as better after breast augmentation. If you are still not convinced, the intensity and enjoyment of the sex was rated on a scale from one to ten, and 28% of those who responded to the survey reported that sexual pleasure went up 4 points or more on the ten point scale.

Of course, breast implants are not the only means to bedroom bliss, but if you were ever wondering what life might be like after a breast augmentation, the number are really quite revealing. Look for the survey on the RealSelf.com website, where you can find us as well. Ready for any question you might have about cosmetic surgery.

Vampire Fillers are Invading Cosmetic Medicine

Clinical research in plastic surgery has been on the lookout for advancements in facial fillers to add to our compliment in facial rejuvenation. Platelet rich plasma, or PRP, is one such filler which is made from a sample of the patient’s own blood. Early in its investigation, it has become dubbed the ‘vampire filler’. PRP is actually a product developed for orthopedics and approved by the FDA as an injection to promote healing. Use as a facial filler is ‘off-label’, meaning it is not accepted yet as safe and effective as a filler, but can be used in a well informed patient, if a physician’s professional judgment supports the intended use. It appears since Ann Rice reintroduced America to vampires of a romantic sort, and the teen age group followed with the hugely popular Twilight series, it has been love at first bite. Marketing genius combined with branding and trademarks have turned the ‘vampire filler’ into the “vampire face lift”, a name patented in 2010 pushing the interest in PRP fillers to the top of Google searches. Many practices now can offer the Vampire FaceLift just by watching an online tutorial, and paying a monthly licensing fee to use the name. The Vampire FaceLift was demystified to us by a recent report of the story in Plastic Surgery News, our ASPS trade magazine. The procedure is in essence not really a facelift after all, but a combination of an HA filler such as Juvederm, filling around it with a PRP product such as Selphyl to add significant volume to the face. As with fillers we currently use today, volume can provide a short term fix and many patients stay with it until they are ready for facelift surgery to set things straight longer term. As plastic surgeons, we take pride in thorough training, and treatments based on the best medical evidence. We doubt we will ever see the complete end of vampires, though with knowledge and an understanding of just what the vampires are up to, perhaps we can put on a little garlic and protect ourselves from misinformation or a love affair gone wrong.

Maintaining, not regaining: The new paradigm in Facelift

Looking over our patient experience the past several years, the concept of the aging curve has firmly taken hold. Facial aging is a continuum with a gentle upward slope and efforts these days have focused on leveling the aging curve. The traditional facelift candidate used to be an individual with clearly visible signs of aging. Typically, we see laxity in the cheek and jowl, marked by redundant skin and loss of the contour in the neck. Clearly, theses are the hallmarks of facial aging in need of repair. Well before such signs firmly set in, we can see a loss of fullness and volume around the mouth and lip, a flattened cheek, a soft jowl and facial folds. The new paradigm shift in facelift has been maintaining, not regaining, and slowing the upward trend in visible signs of facial aging with earlier intervention. The early maintenance approach is definitely not your mother’s facelift of years ago. Early intervention most often includes individuals in their late forties to early fifties, though for some it makes sense to begin even in the early forties. And maintenance can include fillers and fat replacement, or skin care with peels; however the key is preserving the support in the cheek and jowl. The lift needed to maintain a youthful neck and cheek will address the SMAS, the deeper muscle layer, and in every sense is a real facelift with meaningful and sustained support. Recovery, however, is typically very quick, perhaps a week, and then back to work and social schedules. Maintaining has become the name of the game, and forever young its theme. Holding on to what you have without letting go is an attractive alternative to repair and make over. And an early facelift just may be the way to cheat graceful aging. A woman of an uncertain age or a woman of a certain age, the choice is yours.

The Extraordinary Rise of the Mommy Makeover

It seems that just a year or two ago we spoke often about breast augmentation after pregnancy and for some tummy tuck to contour and tone the abdomen. Yet now there has been an evolution in how we approach the end of childbearing. For the lucky few, such as Brittany Spears, pregnancy and childbirth is a moment off stage and a rise again like a phoenix as if it never happened. (And whoops, she even did it again) But, what about JLo, or Mariah Carey? Did they really have it, the mommy makeover? Like an explosion, the mommy makeover has become a new social trend in restoring and reversing the natural changes which can happen after pregnancy. Media, and the internet, have responded with thousands of references on Google and on Bing. The photo listing on Bing alone will prove to all that we in the U.S. are no longer fearful of baring it all and flaunting our successes, too. Just what exactly a mommy makeover is has no strict definition. The procedures most often combined in restoration of body form after pregnancy are: tummy tuck, breast augmentation with or without a lift, and liposuction. None of these procedures are new, however, what is improving are the techniques that make the combination of procedures safe and the recovery reasonable even for a busy mother. At the core, or heart of the mommy makeover, is where the babies come from, the abdomen, and with the efficiency and increased safety of tummy tuck, the addition of breast rejuvenation, and even some liposuction, are now within reach. After motherhood, women can again have it all in one neat package. Hence, the development of the renewed you, the mommy makeover. We have refined tummy tuck in our practice to suit your office experience with recovery at home. The hospital is the place for labor and delivery, though not for the mommy makeover. Our anesthesia techniques have been lightened, and combined with new local acting anesthetics or blocks to eliminate discomfort. Tummy tuck times have been shortened and the inconvenience of drains has been eliminated, and a rapid return to activity and daily living all have improved the tummy tuck experience, and made possible the addition of breast augmentation or lift, or other procedures to complete the mommy makeover. What is in your mommy makeover, will depend on your specific needs, but the potential of rejuvenation after childbearing has caught hold. With the savings of combined procedures, perhaps a new wardrobe will be a part of your mommy makeover, too.