Informative Facts Concerning Our Services

Do you have questions about the surgical procedures, treatments or services that we offer? Below is a list of some frequently asked questions. Please feel free to call our office if you need additional information. We are always pleased to assist you.

BOTOX®

What is Botox?
Botox is the brand name for Botulinum Toxin A, which is a chemical produced by a specific bacteria that can be used to weaken and paralyze the muscle.

How long has Botox been around?
The product has been used by doctors for over 20 years. Originally it was most commonly used by opthamologists to treat children with a “lazy eye.”

Why should I consider Botox?
The procedures can erase the lines between your eyebrows that can often make you look mad even when you are not. It can also soften the smile lines around your eyes, called “crow’s feet.”

How long does the procedure take?
First, I usually apply an anesthetic cream to the area to make the treatment more comfortable. This takes about five minutes. During that time details of the procedures are explained. The actual procedure takes one minute or less!

How long do the effects last?
The effects of Botox usually last about three months. This varies from person to person. There is usually a cumulative effect after several injections, and we often see results last up to six months.

FACELIFT

How long do the effects of a facelift last?
Think of it as a timer you would use for baking. The timer starts when the surgery is complete. The timer advances at different speeds for different people depending on the individual’s age, quality of their skin and the procedure performed. For instance, if you and your twin came in for a consultation, and you decided to have the surgery and your twin decided not to have it, you would always look better from then on. At some point, however, you may need, or want a “tune-up” to get back that original freshness. This usually happens at around seven years, but depending on the individual, it may be a longer or shorter period of time.

When is the best time to have a facelift?
I believe the best time to start is when aspects of your face bother you. Some people want to do little things to prevent aging much like a maintenance program. Others really want to get their “money’s worth.” The average age which I perform a facelift has decreased from the mid-50s to the late-40s. There seems to be some point in our lives when the aging process seems to accelerate. This can be associated with menopause or particularly stressful periods of life.

How long does a facelift take to perform?
Usually between two and a half to four hours, depending on the extent of the facial rejuvenation.

Does it include the neck, forehead and eyes?
Although necklifts are included in about 90% of all facelifts, eyelid rejuvenation and forehead lifts are separate on the “a la carte” basis, since not everyone needs all procedures.

Tell me about the recovery.
We see you frequently afterwards. Daily during the first five days, and then at one week. This allows us to provide you with the best postoperative care, which may include pulse magnetic treatment or ultrasound to minimize swelling and bruising. It also detects any problems, which are easy to treat if caught early. This careful monitoring allows the earliest possible suture removal to minimize telltale signs of surgery such as the visible scars. Our philosophy is that the surgery itself is only part of the service. Most people want to return to their activities as soon as possible. We can provide this by maintaining a hands-on policy immediately after surgery.

When can I resume my activities after a facelift?
Typically you can return to dining out or being seen by friends around 10 to 14 days after a procedure. We encourage brisk walking in four to five days and golf at two to three weeks. Tennis, bike riding and the gym may have to wait six weeks. Hair coloring is permitted after three weeks. A touch up a day or so before surgery may be a good idea.

Is there much pain?
Most patients say that they feel a tight feeling behind the ears for about two to three days after the procedure. The other feeling is tightness around the neck which relaxes in two to three weeks. When browlifts are performed, headaches and a tight feeling around the brow are common for up to 36 hours after the surgery. This feeling usually decreases from the pain medications prescribed. Also, sleeping with your head up on pillows or in a recliner for the first two to three days will minimize facial swelling and this tight feeling.

What are the risks to a facelift?
Bleeding under the skin that has been lifted is the most common risk. This may require a return to the operating room for removal of the blood and stopping the blood vessel that has caused the problem. We use your own blood to make a platelet gel which we use like a two-part epoxy to minimize the possibility of bleeding. Avoiding blood thinners such as vitamin E, aspirin, Ibuprofren, or any products containing these for 10 days before surgery is crucial to minimize problems of this nature. For those patients that have high blood pressure, it is essential that it is well controlled and their nervousness is controlled with the medication provided in the preoperative period. To minimize bruising, we also provide a regimen of homeopathic medications. The second complication is the opposite of bleeding -- lack of circulation to the flap. It is very uncommon and extremely rare in non-smokers and non-diabetics. If it were to occur, it usually occurs below the earlobe and in the area furthest away from the circulation. We have a hyperbaric oxygen chamber which has the dual purpose of improving wound healing and minimizes circulation problems, should they occur. The third and rarest complication is nerve damage. This can occur after a facelift because we are operating on top of the facial expression nerves. Please keep in mind that the patients with the highest risk are those that have had a facelift before since the tissues have been altered. Overall, a facelift is a relatively safe operation with the vast majority of patients being extremely happy.

BREAST REDUCTION

Are breast reductions covered by insurance?
Sometimes, if the amount to be removed exceeds 500 grams, a bit over 1 pound per side and you have symptoms such as grooves in your shoulders and neck and shoulder pain which is often combined with headaches or backaches toward the end of the day. Regardless of symptoms, a breast reduction must be approved by the insurance company preoperatively before they will consider paying for it postoperatively.

How long does it take to perform a breast reduction?
Approximately three hours.

What about the roll of tissue on the sides of the breast going toward the back? Is it fat?
This tissue is a combination of fat and breast tissue which is routinely treated by liposuction during the breast surgery and included in the reduction.

Do I need a mammogram before surgery?
If you have a family history of breast cancer, then I would recommend a mammogram preoperatively at age 35 or older. If no family history is present, then I would recommend a mammogram preoperatively at age 40 or older. You must wait one year after surgery to resume having mammograms.

Will I lose sensation in my nipples?
We measure sensation to the nipples at one year after the breast reduction. About 80% of patients report near normal sensation at that time.

Tell me about the scars.
Although no one really knows until the surgery is performed and the scar is mature, you can get some idea by looking at other scars on your body. We have many methods to minimize the scars postoperatively, but it will always be there to some extent.

BREAST LIFT

Do I need a lift?
Generally, we use the position of the nipple in relation to the inframammary crease or the crease at the base of your breast as a reference point. If the nipple is below this crease (use the old pencil test to see if the nipple is below it) then you will need a lift.

Can I have an implant instead?
Although implants have a lifting affect, the nipple needs to be just a tiny bit above the inframammary crease for an implant-only lift to be really successful.

Can I combine a lift with an augment?
Yes, it usually is recommended to prevent an early recurrence of a flattened appearance on top of the breast.

Where is the implant placed?
Behind the pectoralis muscle, exactly as in augmentation.

Can the breast sag again?
Yes, depending on the quality of the skin and the size of the breast. But retightening usually is very simple and does not require shifting the nipple position again.

What kinds of lifts are there and where are the scars?

• Minimal lift. This usually is combined with an augment where a donut mastopexy or lift is performed removing a donut-shaped area of skin around the nipple and retightening the skin around the nipple arcola area. This leaves a scar just around the circumference of the nipple complex.
• Vertical lift or lollypop scar. This is my favorite. The scar looks like a lollypop and is often combined with an implant in approximately one half of the cases.
• Classic inverted T mastopexy. When you have to do a lot of lifting, sometimes combined with the removal of some of the sagging breast tissue down below, this scar is used. It is an anchor-shaped scar with a component horizontally across the inframammary or breast crease. This is combined with a small to medium implant in about a third of the cases.

What will the scars look like?
Although no one really knows until the surgery is performed and the scar is mature, you can get some ideas by looking at other scars on your body. We have many methods to minimize the scars postoperatively, but it will always be there to some extent.

Can a lift be combined with a reduction?
By definition, a reduction includes a lift. Removal of less than 350 grams are really classified as a lift rather than a reduction. Thus, they are not covered by insurance.

Will my breasts be a perfect match?
No one’s breasts are a perfect match before surgery; therefore do not expect this afterwards. Large differences will be noted and adjusted in volume and nipple position during the surgery. I will make every effort to match the breasts as close as possible.

BREAST AUGMENTATION

What options do I have with regard to incisions and positions of the implant relative to the muscle?

• Incisions include the inframammary (near the crease below the breast)
• Around the areola (at the edge of the colored skin around the nipple)
• In the axilla (armpit)
• Through the belly button (TUBA)
• Placement is behind the pectoralis muscle or behind the breast in front of the pectoralis muscle. Note: TUBA procedures place the implants generally in front of the muscle.

What types of implants are available?

• Textured, or rough, implants versus smooth
• Saline versus silicone-filled

Can I get silicone implants?
The FDA has asked for more information before removing restrictions on silicone implants. Presently, you must fall into several categories. I will be glad to explain these including requiring a lift or having had a problem with saline implants previously. All patients getting the silicone implants must agree to participate in a long-term study. All patients with previous silicone implants can have them replaced with either saline or silicone.

What is an anatomical implant?
These implants were originally designed for breast reconstruction after cancer. They are shaped to somewhat resemble the breast shape and are always textured. They can be saline or silicone. They are sometimes used for breast augmentation.

Are silicone implants safe?
The overwhelming body of scientific knowledge obtained since the “panic of 1992” has shown silicone implants to present no danger to human health. There appears to be no correlation with any diseases including cancer, lupus, rheumatoid arthritis, chronic fatigue syndrome, or loss of libido. This includes when the implants are ruptured. Every country except the US has approved their use once again.

If silicone implants rupture, does the silicone travel throughout my body?
Generally it stays in the “sac” that your body has made around the implants. Occasionally it can be found in the lymph nodes in your armpit much like nicotine can be found in the lymph nodes of those exposed to second-hand smoke. No problems have ever been associated with this.

What is the main difference between saline and silicone?
The feel is the main difference. If you have enough tissue to cover the implant well, saline implants (smooth are my favorite) are perfect. Sometimes you can feel the implants, especially around the sides below the breast. There is never a visual difference.

Do implants rupture?
Yes, usually at the rate of .05% per year. For instance, if I operate on 100 patients this year, one breast implant on average will rupture. Saline implants shrink over a few days, and you excrete the saline through your urine. If a silicone implant ruptures, it usually stays inside its capsule (the body’s own sac) and is often only detected in mammograms or ultrasound of the breast. Occasionally a breast MRI (magnetic resonance imagining) is required to diagnose a rupture.

How long do implants last?
On average, they last 15-20 years.

Besides rupture, what else can happen to implants?
The body’s capsule, or sac, which it makes around the implant can tighten around it and make the breasts feel hard. This is called a capsular contracture. It sometimes requires surgery to relieve it.

How often does the breast get hard?
When the implant is placed below the muscle, the rate has decreased to around 5%.

Can we do anything to prevent capsular contracture?
Yes, I believe that daily massage three to five times a day can decrease the possibility of this happening. By displacing the implant in many directions with these massages, the capsule is kept bigger than the implant. This is crucial to keeping the breast feeling soft and the implant in proper position. There are also some medicines that can be used to reverse the capsular contracture if detected early. Some of the causes of capsular contracture are still unknown, and on very rare occasions they persist despite proactive measures including re-operation.

What else can happen after breast augmentation?
Infections and hematoma are extremely rare and occur at a rate of 1 in 300 patients.

Most of my friends wish they had gone bigger. Why is that?
Six months after surgery, the body image transformation has been complete. They now feel that this has always been their size. Therefore, they wish they would have gone bigger. My recommendation is to communicate well with your doctor. There are wonderful Internet sites to find a “before and after” that reminds you of you. My advise is to go with your initial feelings, and do not try to get your “money’s worth” by going bigger than you want.

How do you like to do breast augmentations?
I prefer at least two visits by the patient. One in which we change your breast shape and size on the computer to match what you have communicated that you are looking for. Expectations and reality meet at these consultations. Asymmetries and limitations are pointed out as well as details of the recovery period. My approach is to perform the surgery under IV sedation through a periareolar incision at the lower edge of the nipple. I then place a smooth, round implant below the muscle.

Can going through the nipple affect my sensation or my ability to breast feed later?
All incision methods can affect sensation. About 1 in 20 nipples experience some decrease in sensation. This often has to do with the size of the implants placed. Almost without exception, breast-feeding is unaffected by breast augmentation.

How much time do I need off from work or school?
Most non-lifting jobs can be resumed on the fourth or fifth day.

When can I get back to the gym?
During the second week after surgery, lower body and limited upper body work can be resumed. Please note you can never do “flies.” Ask me to explain this during our consultation.

Are most patients pleased with augmentation?
Yes, more than 95% are glad they had the operation and would do it again.

LIPOSUCTION

Is liposuction right for me?
If you are out of proportion in a certain area, then liposuction can be used to get you back into “proportion.” If, however, you are significantly overweight and want to use it as a weight reduction plan, then liposuction is not the answer.

Can the fat come back?
At the age of 12, the number of fat cells you will have is set. All localized weight gain represents these cells growing in size in that particular area (e.g., saddlebags, hip rolls, low abdominal pooch area). With liposuction, the fat cells are actually removed or sucked out rather than shrinking them, which is the case when you lose weight. If after liposuction your caloric intake and exercise routine remain the same, the calories will go to those fat cells that were not removed. Thus, they will gain in volume and weight after the liposuction. Sometimes we want this to happen such as in those cases of patients that have small breasts and notice their growth after liposuction to the thighs or hips. The volume can go to the arms, face or back just as easily. Therefore, after liposuction either dietary or exercise changes, or both, must be realized to keep your new shape intact.

Does liposuction have any risks?
The most common risk is small irregularities and asymmetries, which can be touched up easily three to six months afterwards. More serious complication such as infections and scarring are much more rare. The most serious complication after liposuction is blood clots forming in your legs during or shortly after surgery. These can become dislodged and go to the lung where they can cause symptoms ranging from shortness of breath to death. We prevent these by applying leg pumps during surgery and occasionally administering blood thinners such as Heparin around the time of your surgery. Early walking is essential to prevent any problems with your liposuction.