Questions & Answers
It is not unusual for patients to present to our practice with problems for which cosmetic surgery is an ideal solution, but they hesitate to proceed with a procedure for fear of the tiny risk of a bad outcome. Everyone has a different way of approaching risk, but it is vital that you consider the risk of inaction, and not just the risk of action. The risk of inaction? Let’s say it’s a face lift you are considering. Without the face lift, you are judged (unfairly) to be too tired for that promotion at work, your appearance and diminished feelings of attractiveness interfere with your personal relationships, and you become depressed by the…
Loose eyelid skin can compromise your vision, cause headaches, and make you look older than your years. Blepharoplasty (aka eyelid lift) may eliminate your need to raise your brows to keep your lids open. This helps to minimize forehead creases, and eliminate headaches arising from constant contraction of your forehead muscles. At your consultation, a careful analysis of your forehead function, globe shape and position, eyelid mechanics, and many other factors allow us to make effective recommendations and develop a treatment plan that is right for you.
Our careful analysis of this patient led us to offer a closed technique to reduce the dorsal hump of cartilage and bone, and to use a separate technique (modified Weir excision) to create a more narrow appearance to the nasal base with better nasal tip projection. Not every nose needs to be ‘fixed’, but in this case our patient’s facial appearance was compromised by the extremes of her nasal shape, and she had much to gain from rhinoplasty.
Rhinoplasty (nose reshaping surgery) is one of the most powerful techniques we have for improving your appearance. We use the ‘open tip’ technique when the nasal tip requires multiple maneuvers to achieve the best result. Healing takes a little longer, but by 10 days most patients have little if any bruising and beautiful results can be had by two to three weeks. No nasal fracture was required for this patient. Our key to good results is a careful analysis of the cosmetic problem, and then choosing the techniques that can reliably achieve the appropriate correction.
Beautiful results from breast implant surgery results from excellent surgical technique, but it also relies on informed decisions by our patients. One decision you must make is whether to pursue augmentation through implants or Fat grafting. Fat grafting was not a serious consideration until the past few years, and it still doesn’t have the capabilities of a silicone implant. Still, for someone seeking a modest augmentation (1 cup) and possessing “good??? fat donor sites, and willing to accept unknown risks, and the possibility of lumpiness and inconsistent results, it is a consideration. Much is written about how to make the operation more predictable, but at present it remains that breast implants are…
Beautiful results from breast implant surgery results from excellent surgical technique, but it also relies on informed decisions by our patients. One decision you must make is the choice of implant size. Size is an easy concept, and many patients feel comfortable making decisions on size. Patients often reflect at great length on size, sometimes calling the day before surgery to change implant size Much of the deliberation is unproductive, as the difference between a 300 and 360 cc implant is only a 20% increase in implant size, and probably a 10% increase in overall breast size. Your surgeon should recommend a size at consultation that factors in your chest…
What breast implants are safe?
It is safest to live with small breasts (or no breast if following mastectomy). If you can accept tiny risks of dissatisfaction (about 95% of patients are happy with their decision to get implants), several types of implants are approved for use by the FDA. Saline-filled implants, round smooth silicone gel implants, and structured silicone implants should be considered safest, and textured implants should be avoided unless there is a significant advantage to their use in your case.
Where do breast implants go?
In patients with enough padding (2 cm pinch is general rule), it is preferable to put the implant over muscle. Implants put under muscle are actually only under muscle across the top of the implant, which hides the upper edge of the implant in thin people, but has the negatives of dynamic deformity (breasts get deformed when you contract your pectoral muscle) and the implants tend to sit a little too lateral (not close enough to the center) in some patients.
When should breast implants be replaced?
A saline implant is obvious when it requires replacement, as any leak will result in the breast losing volume. Silicone gel implants (the only silicone-filled implants available since 1999) are not obvious when the shell tears, as the silicone gel remains within the fibrous pocket (capsule) made by your body and volume is preserved. About 20 % of gel implants are found to have a hole at 5 years, MRI over-diagnoses implant holes about 20% of the time, and the presence of a torn implant causes no medical problems in the vast majority of patients. Implant manufacturers will pay for a replacement implant if tear is found (or suspected on MRI). Our advice is to be grateful if your implants are causing you no problems, and leave them alone. If you have hardening, swelling, or mass appearing in an implanted breast, or an illness that defies all explanation, see your plastic surgeon to discuss whether implant replacement is a good idea for you.