The Plastic Surgery Group

As summer approaches and clothing becomes more revealing, many women begin to ponder the changes their figure has undergone. Many of these flaws can be corrected with dietary changes and exercise programs; however, aesthetic changes of the breasts are difficult to manage in this fashion. The rise in cosmetic surgeries of the breast seems to confirm this observation.
While most women prior to a pregnancy can see improvements in size and breast shape with implant augmentation, the post pregnancy breast presents several challenges. After children, and especially after breast feeding, the breasts can involute and become ptotic. That means smaller and droopy. Unfortunately, most of these breasts are not well treated with an implant alone.
During consultation, I warn patients about the contention that a larger implant placed above the muscle will tend to correct this problem. I think that there is nothing further form the truth. A large implant placed directly beneath the breast tissue will have a visible ripple shortly after surgery. It will also have a great tendency to droop further because of its weight and the overlying poor breast skin quality. Experts in aesthetic breast surgery refer to this predictable outcome as a Snoopy dog deformity. So, a few months later, you have substituted one flaw for another.
Routine aesthetic surgical treatment for ptotic breasts has been mastopexy (breast lift). This skin tailoring process typically involves anchor shaped scars. These scars do tend to do well, and the surgery can lead to remarkable results. But, many women don't like the idea of having these incisions.
For some women who need a breast lift with their augmentation, a technology called a SAMBA is available. The SAMBA, or simultaneous areolar mastopexy and breast augmentation, requires incisions only around the pigmented portion of the breast. Through this around the areola incision, an implant is placed beneath the chest wall muscle in the usual manner. After this however, the technique changes. Using markings placed before surgery, the excess skin caused by the stretching of the breast during pregnancy is removed. The plan is to both lift the breast gland and reduce the size of the areola. A special GORTEX thread is then woven back and forth from the areola to the surrounding breast tissue. This particular material is remarkable for its strength and pliability. As this stitch is tied, the transformation in the contour of the breast is confirmed. The incision is then closed with absorbable stitches placed beneath the edge of the skin. Paper tapes are placed, and the patient is dressed in a bra. Standard postoperative management of the scars is simple taping.
For those women whose pregnancy has left her with smaller drooping breasts, a SAMBA represents a considerable advancement in aesthetic breast surgery. It produces reliable results in appropriate patients with minimal scar burden. It is performed under a sedation type anesthetic as an outpatient, just like a standard breast augmentation.
If you are considering an active intervention to correct those flaws in your figure, consider a consultation at The Plastic Surgery Group. Cutting edge approaches to body contouring surgery is just one of our centers of expertise.

Choosing to have an aesthetic surgical procedure performed is a very personal act. An integral part of this process is selecting a plastic surgeon. Since most patients have little knowledge of what to consider when making this choice, a brief overview regarding the training and selection of a plastic surgeon is described in this article.

All physicians have attended about four years of medical school. After medical school, most plastic surgeons approach their specialty by completing a residency in general surgery. Typically, this takes about five years. After this training, plastic surgeons then attend a second residency in plastic and reconstructive surgery encompassing an additional two years. Further subspecialization can then be sought in year long fellowships. The "basic training" of a plastic surgeon involves about eleven years.

A plastic surgeon's credentials are developed by completing the above residencies and passing a series of certification examinations. These examinations typically have both written and oral components. In many cases, plastic surgeons have multiple board certifications. One may be board certified in general surgery and plastic surgery, while also holding certificates of added qualificaiton in other subspecialties.

How does one determine if the physician you've chosen is board certified? Most surgeons are very proud of the certifications they have accumulated. Don't be misled by bogus "certifications". The American Board of Medical Specialties governs over 24 specialty boards. But, there are well over 100 self-designated "boards" which are not sanctioned nor approved by the American Board of Medical Specialties. For plastic surgeons, the approved board is the American Board of Plastic Surgery, and none other. If you have questions or have been told otherwise, contact the American Board of Medical Specialities at 1-800-776-CERT. In other words, the question to ask is "Are you Board Certified by the American Board of Plastic Surgeons?"

It is also important to ask for information reqarding the doctor's hospital admitting privileges. Plan carefully and check references. Ask if your surgeon can put you in touch with patients who have had similar procedures performed. Determine if your surgeon is an active member of any professional societies. An example would be membership in The American Society of Plastic Surgeons.

Involvement in the teaching of plastic surgeons indicates a significant commitment to the advancement of the subspecialty. It is safe to assume that these academic plastic surgeons are well informed with regard to advances in their field. Additionally, these physicians routinely undergo stringent review of their qualifications and continuing education as an intrinsic component of maintaining their professorships.

In summary, your choice of surgeon is as personal as your choice of procedure. Find a surgeon with whom you are comfortable and can communicate. Review their qualifications and certifications independently. Make more than one visit for consultation. When you are satisfied that all is in order, trust your surgeon and be secure in the fact that you have made an informed choice.

The decision to undergo facial rejuvenation surgery can involve a variety of choices. The first step is to determine the patient's facial aesthetic concerns. Most people can point immediately to the areas in which they would like to see improvement. There are typically three aspects involved in producing a positive change in one's appearance. These are appropriate facial anatomic positioning, clean skin quality, and youthful facial soft tissue volumes.

As we age, our facial skin and soft tissue becomes less elastic, suffers repeated sun damage and undergoes fat volume loss. Most patients have some combination of these problems that produce the changes which are recognized in the aging face. As most patients understand, facial surgery may be necessary to improve deep facial structure loss. The most common procedures are facelifts and browlifts. Skin quality is managed by many interventions, ranging from topical skin programs to ablative laser surgery. The least familiar of the facial rejuvenation treatments may be the injectable agents. In the past, this branch of care was limited to collagen injections.

Modern injectable filler agents now include hyaluronic acid products such as Restylane which has been very helpful, particularly around the lips and nasolabial folds. Aesthetic facial surgeons have long recongized that loss of facial fat cannot be reliably restored on a long term basis with any off-the-shelf product. This is where Sculptra comes in.

Sculptra is injected into the skin for restoration of the signs of fat loss. It is effective, well tolerated and long-lasting. It is synthetic, compatible with the skin and biodegradable. It is made from a material which has been used in dissolvable suture material and soft tissue implants for years.

Sculptra is injected with local anesthesia below the skin surface in areas which have suffered volume loss. It provides a gradual increase in the thickness of the skin. It will not correct the cuase of fat loss but will substitute for it with increasing skin thickness.

Sculptra works differently than the injectable which preceded it, in that its result is accomplished over time rather than immediately. This allows the body time to respond to the product. Most patients require a series of two to three sessions spread out over about three months. However, also unlike other injectables, it requires a reinjection only about every two years to maintain the correction once maximum improvement has been obtained. Sculptra is indicated for the treatment of lipoatrophy in immunocompromised patients, but is being used off-label for a number of soft tissue augmentation procedures on the face.

Sculptra is injected using a skin ointment anesthesia. As with any injections, there may be minor discomfort. After, some bruising may be anticipated which is self-limited and quickly absorbed with massage and ice pack applicaiton.

So, when considering a facial rejuvenation, it is important to recognize the elements that compose a youthful facial balance. Restoration of the facial positional architectural, skin quality, and volume should all be addressed for each individual to produce an elegant harmony. It is only through this thoughtful consideration that the "operated" look is avoided.

Now that the FDA has approved silicone breast implants for use in the general population, the specifics of their selection need to be defined. We must compare silicone breast implants to the known safety and efficacy record that we have for saline breast implants.

We know that we cannot use our past experience with silicone implants since many practicing plastic surgeons were not practicing before the ban on silicone implants in the early 1990's. Add to that the fact that our current silicone breast implants are so vastly improved over their early counterparts that comparison is useless.

What we do know for certain is that saline breast implants for augmentation have enjoyed a 95% satisfaction rate. That's a record that's hard to beat. The typical risks of saline implants which can lead to disappointment are deflation, contracture, rippling, and contour deformity. The definition of deflation is obvious. Current saline implants carry a 0.4% risk of deflation per year for ten years. Deflation rates after ten years vary, but the implants are not permanent and will deflate in time. Contracture is a hardening in the natural scarring around the implant. This can deform the implant and change its cosmetic appearance. Saline implants have a very acceptable contracture rate. Personal experience leads me to believe that this is around 3%. Rippling is a function of the physics of the implant or its manufacturing process. All saline implants ripple. This can be accentuated by under or overfilling the implant beyond the manufacturer's limits. The ripple can be unnatural appearing, and is the principle reason why saline implants should be placed beneath the pectoralis muscle. Contour deformity constitutes a cosmetic problem with the appearance of the breasts after surgery. These are typically patient and surgeon technique dependent issues and have little to do with the implant per se.

The most significant problem a silicone implant can help with is rippling. Although a silicone implant is not ripple free, it can produce a much more natural result especially with women who have very little or no breast tissue. Whereas silicone implants do not deflate, the monitoring process recommended with MRI is costly and not coverd by health insurance policies. If the implant is ruptured, the breast shape will not deflate like with a saline implant, but replacement is required. Silicone implants require a larger incision for placement to avoid damaging the devise. Contracture rates in the cosmetic population have not been well established for silicone implants. Many surgeons will continue to recommend placement of the implants beneath the pectoralis muscle as this approach has historically produced the lowest contracture rates. Submuscular placement also permits the greatest visulaization of breast tissue with a mammogram.

Then there's the issue of cost. Size for size, silicone implants have more than twice the cost of saline implants. Of course, they are more complex devises. But for many, they perform the same function.

So in summary, saline implants have served the cosmetic breast surgery population well. They are by no means outmoded, though we do anticipate an upsurge in the use of silicone implants. So far, it appears that silicone implants have their greatest advantage in the reconstruction population. They are also particularly helpful in thin patients with very little breast tissue, and in patients who have failed other implants. For more information, see the American Society of Plastics Surgeon's Website (ASPS).

As the iciness of winter melts into glorious spring, our thought naturally embrace this time of renewal. Whether reviving the garden or returning to outdoor sports, we cannot help but feel invigorated.

This may also be the time for a personal reassessment. Do you, in fact, look as refreshed as you feel after your winter dormancy? If your anser is "No" then an eyelift may be the key to a more youthful look without a significant time investment.

The medical term for eyelift is Blepharoplasty. A "Bleph" is a surgical procedure which is designed to improve the aesthetic appearance of both the upper and lower eyelids. These may be addressed individually or together.

As we age, the delicate skin and musculatrue around the eye can develop significant laxity. This can lead to excess skin resting on the eyelashes and lower eyelid bagginess. These problems are exaggerated by chronic sun exposure and sinusitis. The duplicated skin in the upper lids can become so excessive as to obscure one's vision.

Blepharoplasty provides the answer to these problems by returning the architecture of the structures surrounding the eye to their appropriate position---a more youthful one. The techniques of blepharoaplsty are varied, but all techniques will remove some skin, muscle, and to a lesser extent-fat to achieve their goal.

Specifically, an upper lid procedure involves an incision which is made into the eyelid and carried shortly into the crow's foot area. Through this incision, the structures of concern are modified. The incision is then finely closed. In the lower lid, there are options which can be taken depending on the patient's specific problem or desire. An open bleph requires that an incision be made below the lash line extending into the crow's foot area. This approach is particularly helpful in patients with baggy lower lids and permits a redraping of the muscle that supports the lower eyelid. A second approach requires no external incision. Here a judicious amount of fat can be removed from an incision on the inside of the eyelid. A LASER is then used to resurface and tighten the lower lid skin. Your plastic surgeon can explain the advantages of the different techniques to you and apply them to your specific concerns.

Anesthesia for blepharoplasty is typically local with sedation. Blepharoplasty, like all aesthetic surgery, is reserved for those in good health. Postoperatively, depending upon the technique used, I have returned patietins to regular activity in as little as three days. Some swelling and bruising or pinkness may be evident as the healing process advances. All surgical interventions have risks, but thousands of blepharoplasties are performed annually with very satisfying results.

If it's time to shake off the winter blues an eyelift may be the prescription you've been waiting for. Contact your board certified PLASTIC surgeon at The Plastic Surgery Gorup for more information. Free imaging is available with your consultation to give you an idea of what you might expect after surgery.

Labels: The Youthful Face in Three Easy Steps

The Plastic Surgery Group, P.C., in Chattanooga, Tennessee offers the latest skin care procedures, including Juvederm. For more information on the plastic surgery procedures we offer, visit our plastic surgery procedures page or call our plastic surgery staff at (423) 756-7134 or (800) 634-3334. You can also e-mail us your questions and we will be in touch with you shortly.
JUVEDERM Injectable Gel - Optimal Control of Facial Wrinkling

"Injectables" are products that plastic surgeons have been using for years to treat facial wrinking. Over the last several years, the types of injectables available and their applications have gone through an explosive growth period. Fortunately, they have also been refined considerably. In 2007, the reliability and predictability of injection therapy, in trained hands, is at an all time high The history of "Injectables" has been somewhat checkered. Early bovine (cow) collagen products required pre-testing, had short lifetimes, and some significant side effects. Fat injections have had mixed reviews for years because of their complexity and unpredictability of result from patient to patient as well as practitioner to practitioner. The emergence of hyaluronic acid fillers has solved many of the problems of skin reactivity and lumpiness in results. Of these products, JUVEDERM has been especially effective.

Dermal fillers are compounds that can be used to elevate the central depression in a wrinkle. This effectively effaces the wrinkle and eliminates it. Hyaluronic acid is a naturally occuring sugar molecule found in all mammals. It is part of the make up of our connective tissue. It has no cells and is minimally reactive to the surrounding living tissue. It is so effective because it works like a sponge and absorbs water at 1000x its weight. This is the means by which it can increase volume and density of the place in the skin into which it is injected.

JUVADERM has introduced two products. It is supplied in the "Ultra" and "Ultra Plus" types. Advances have been made in our ability to manipulate the hyaluronic acid molecule. By bonding the molecules together, JUVADERM has managed to produce products that can treat both superficial and deeper wrinkles. "Ultra Plus" is also more effective in treating the thicker skin of men. This bonding process has also made JUVADERM more resistant to breakdown by enzymes leading to a longer lasting result. The unique formulation of this new injectable also allows for a smoother consistency, permitting easier and more fluid injection into the treatment site.

So what are the indications for the use of JUVADERM? I think it is an excellent choice for the treatment of facial wrinkling in a wide variety of areas, and in a wide variety of patients. Wrinkling around the mouth including the lips, smoker's lines, nasolabial foldds, and marionette lines are especially responsive to treatment. Scientific studies have indicated that both products maintain at least 1 grade improvement in the appearance of these areas at six months. Although people absorb the product at different rates, over-all its staying power is quite good. Injections would not usually need to be repeated more frequently than every 6 months. JUVADERM can also be helpful with the correction of acne or traumatic scars and lower eyelid bagginess in selected patients.

This type of product expands aesthetic surgery to a population that has virtually no down time or cannot medically tolerate any anesthesia. JUVADERM is typically injected after application of topical anesthesia. If the product is being used to enhance lip fullness, I recommend an anesthetic block like the type your dentist commonly uses. After injection there may be some redness or bruising which is short lived. The results are immediate, but I think that they improve over the course of a week as the product diffuses and attracts water. JUVADERM is rapidly becoming one of our prime weapons in the battle against aging. For further information contact your American Board of Plastic Surgery Certified Certified physician or visit the JUVADERM website.