Blog

“Instant” Neck Lift Without Surgery Superior results with minimally invasive technology*

As advances are made in minimally invasive facial rejuvenation technologies, cosmetic/plastic surgeons are getting closer to obtaining surgical like results without a scalpel.

At the present there is not a single non-surgical or minimally invasive modality that seems to get the results people were looking for in a non-surgical neck lift until now! As a board-certified plastic surgeon with years of experience in cosmetic surgery, I felt the same way.  I wanted to be able to offer my patients, who desired a non-surgical neck lift superior results. To accomplish this goal I combine micro-liposuction, internal injectable radiofrequency (ThermiTight™), and barbed absorbable suspension sutures to create an almost instant result that improves with time and typically last several years.*

I call this procedure The “Instant” Neck Lift”.*  Patients are excited to learn that this procedure:

  • Is performed under local anesthesia.
  • Takes less than an hour to complete.*
  • The patient goes home with a compressive dressing which is removed the next morning and then they wear it at bedtime only for approximately 2-3 weeks.*
  • Bruising is minimal because we use only blunt needles.
  • Normal activities can be resumed almost immediately with the exception of heavy exercise that may affect the effectiveness of the barbed sutures.*

Insertion of Barbed Absorbable Sutures

While the results are immediate (micro-liposuction fat removal plus the immediate suspension and tightening of skin along the jawline with the barbed absorbable sutures), the internal radiofrequency heating starts up process of shrinking or as I like to say shrink wrapping the skin of the neck.*  

Results

This process takes up to a year and serial photograph showed the neck looking better and better over this period of time.*

            

           Before                                      After

Individual results may vary.

This was taken 3 1/2 weeks later because the procedure was performed 2 days prior to Hurricane Irma and immediate follow up was impossible.*

Listen to an interview with the patient concerning this procedure.

Peña Plastic Surgery - Cosmetic Surgery for Naples, Fort Myers, FL

If you’re interested in finding out if you are a candidate for this procedure, please call my office at 239-348-7362. Peña Plastic Surgery in Naples since 1990.

*Individual results may vary.  Consult with Dr. Peña to see if you are a candidate.

 

FACTS ABOUT BREAST IMPLANTS, RUPTURE AND RELATED ILLNESS

Peña Plastic Surgery - Cosmetic Surgery for Naples, Fort Myers, FL
Individual results may vary.

More than 300,000 women and teenagers underwent breast implant augmentation surgeries in 2017 (ASPS 2018). In addition, approximately 106,000 women underwent breast implant surgery for reconstruction after mastectomy.  A concern of some women who have had breast implants and women interested in breast augmentation is the possible rupture of the implant. I advise my patients that rupture is an important consideration and a serious but not a common complication of breast implants. The longer you have a breast implant, the greater the chance of implant rupture.

 

WHAT IS A BREAST IMPLANT RUPTURE & BREAST IMPLANT RELATED ILLNESS?

What is a rupture? A breast implant rupture is a tear or hole in the outer shell of the breast implant. If you have saline implants you won’t have to wait long to get your answer.  Usually the change in size as the saltwater bag deflates is rather quick.  It may take a few days and in some cases the valve is the culprit and sometimes only a partial deflation is noted.  Usually it will feel looser and often you will get a crinkly sensation. There is no need for alarm as it is just saltwater that your body will be shedding.

More stressful and more recently confusing are the individuals that believe they have a ruptured silicone implant. Silicone gel is thicker than saline, so when a silicone gel-filled implant ruptures, the gel may remain in the shell or in the scar tissue that forms around the implant (intracapsular rupture).

The concern is fueled by the 1992 implant scare where the FDA called for a stop on the use of silicone gel until safety concerns could be evaluated.  It turns out that the silicone implant manufacturers failed to produce evidence of their safety when there were approved in the1960’s.

There was great concern that these were causing problems anywhere from autoimmune diseases such as Lupus, rheumatoid arthritis, and fibromyalgia, as well as the possibility of them causing many other symptoms such as loss of libido, loss of hair, GI disturbances and even the possibility of cancer.

From 1992, to 1997 a large number of retrospective and prospective studies were made involving huge numbers of women that have received implants.  Statistically, NO correlations were made between the implants and these diseases and symptoms. However, it should be noted that on an individual basis, a foreign body of any type is possible to affect a person’s well-being. If you believe this to be the case, whether or not you believe them to be ruptured, I advise you to consult your physician and surgeon.

WHAT TO DO ABOUT A RUPTURED IMPLANT

Peña Plastic Surgery - Cosmetic Surgery for Naples, Fort Myers, FL
Individual results may vary.

My recommendation in these cases is to call your plastic surgeon and get an evaluation as soon as possible.  While there is no health issue you do not want to let the capsule shrink up too much because it will make the replacement a little bit harder.  This is simply because the capsule or the room in which the implant has lived will need to be re-enlarge so that the implant was replaced can be filled to full capacity.  This is often a good time to change sizes or even consider silicone implant.

Now back to what to do with the possible ruptured implant…Sometimes a ruptured silicone implant will cause the body to create a capsular contracture.  This simply means that the capsule, the space where the implant resides is now contracting and tightening making the breast firm.  A long-term capsular contracture can also contribute to increase incidence of implant rupture as the continuous pressure on the implant can affect the shell or the bag of the implant.  Diagnosis can be done with an MRI of the breast and most recently with 3-D ultrasound.  They both have false positives and false negatives, but they have given us a tool to peek inside the breast and get an idea of the implant status.

Okay let say that we find a ruptured implant with free silicone inside the pocket!  what is the implication?  First of all, there is no capsular contracture, then the simple removal of the implant and the material and replacement is indicated.  When the implant rupture is caused by significant trauma the capsule can be torn and the free silicone can leave the confines space.  It is usually walled off by the body and can mimic a breast mass that will require biopsy and pathological examination.  In these cases, removal of all the material including the capsule will be necessary.

Sometimes the silicone will be felt and a lymph node in the armpit.  The lymphatic system which makes up the series of lymph nodes is simply cleaning up the silicone.  Silicone in the lymph node by itself does not appear to be a problem.  After the removal of the ruptured implant and material.  A decision should be made on whether a replacement implant is desired or whether options such as breast lifts, fat grafts, or simply leaving the breast alone should be all entertained.

When I was training in 1988, we believed the implant manufacturers reports that these implants should last forever. Not so. I tell my patients to expect between 15 and 20 years of implant life.  This does not mean that all implants rupture. Rupture after this point make it 15 or 20 years.  I am simply giving patients the average time period based on my experience.  Probably around 10 years after implantation one should consider a 3-D ultrasound or an MRI to ascertain that the implants are intact.

Usually the implant manufacturers have a warranty on the implants for 10 years.  They will actually replace it now for the life of the patient, but they will help pay for the operation just for the first 10 years.  A few are switching from saline to silicone, the manufacturers will pay the cost of the saline implants and pay you the difference.  Still not a bad deal since they will often do it for the opposite side that is not ruptured as well.

I hope this has shed some light on your questions.  If you have any concerns that were not addressed, please call my office for consultation.

Is There a Danger in Having Cosmetic Surgery If I Feel a Cold Coming On?

You are already to go with a cosmetic surgery procedure, had your consultation, gotten the necessary medical clearances, and have arranged for your pre- and post-operative care. You are eager to proceed but feel like you might be catching a cold. Should you postpone? Should you advise your cosmetic surgeon? Surprisingly this is a very common question I hear from my patients, “I have surgery in four days and I feel a cold coming on!” I get this call several times a month.

My general answer is, “when caught about 4-5 days before surgery, we can proceed with surgery in around 80 percent of cases.” There are steps you can take if you feel a cold coming on. Below is what I advise my cosmetic surgery patients:

    1. Colds are caused by viruses therefore traditional antibiotics will not help you.
    2. Colds are dealt with by your body’s own immune system so we can boost it!
    3. I recommend starting an over-the-counter immune boosting supplement called “WELLNESS FORMULA” some are called WELLNESS BLEND. Available at Whole Foods and Health food stores 4-6 capsules a 4 times a day. This blend has a combination of most immune boosters.
    4. Vitamin C also help. Use high does 3-6 grams (3000-6000 mgs), with lots of water.
    5. Only if the sore throat gets really bad or phlegm turns green or if I prescribe antibiotics, will we have to postpone surgery.
    6. Muscle aches indicate a Flu syndrome and you need to get on a prescription of Tamiflu. Preferably during the first 12-24 hours.

Be sure to talk to your cosmetic surgeon. Hope this helps get you to your scheduled surgery!

If you have any questions or are interested in learning more, please contact my office.

New Concerns about Breasts Implants are Mostly Old Ones

Breast Implant Specialist

Recent concerns about safety issues surrounding breasts implants are primarily trying to reignite issues that pretty much had been resolved in the late 1990s after the 1992, so called, ” Breast Implant Scare”.

What Is ALCL And How Is It Associated With Breast Implants?

However, there i one new concern that has come forward that merits a discussion. This concern is ALCL or anaplastic large cell lymphoma1. This is rare type of non-Hodgkin’s lymphoma that has been associated with breast implant augmentation. This rare type of cancer has primarily been associated with highly textured implants (rough surfaced) which are believed to cause a chronic irritation. In some women, who are genetically susceptible the chronic irritation can occur along with the presence of certain bacteria has recently been implicated. Please be advised that ALCL is a cancer of the immune system, not a type of breast cancer.

These ALCL cases – which I have NEVER seen one after performing over two thousand breast augmentations-. present with an accumulation of fluid around an implant. The diagnoses are made by sending samples of the tissue and fluid for pathological examination. The treatment which is usually curative is removal of the “capsule” around the implant.

According to patient safety guidelines from the American Society of Plastic Surgeons, “the current lifetime risk of BIA-ALCL (BIA, Breast Implant Associated) is estimated to be 1:3817 – 1:30,000 women with textured implants based upon current confirmed cases and textured implant sales data over the past two decades”. Only 16 people worldwide have died from breast implant associated ALCL! As you can compare this number of cases to the total number of augmentations and reconstructions ALCL is EXTREMELY RARE. When caught early, BIA-ALCL is usually curable.

However, this does not mean we can take it lightly however. First of all, highly textured implants are rarely used in augmentation in the US and one manufacturer (Allergan) voluntarily removed them altogether from the European Market.

History and Safety of Breast Implants

For my breast augmentation/implant patients, I personally used smooth implants in over 98 percent of my cases. I did see a patient that had been reconstructed elsewhere with a textured implant and had recurrent collections of fluid around the implants. The biopsy of the capsule and the fluid submitted were both negative for ALCL. 

Concerns about “Breast Implant Related Disease” encompasses most of the concerns that were investigated in the 1992-1999 period that ultimately resulted in a lift of the ban of using silicone implants by the FDA in 2007. While statistically these concerns were not proven to be associated, many individuals still worried that their implants were causing some of their illnesses or at least the symptoms.

These included Auto-Immune illnesses such as Lupus, Rheumatoid Arthritis, Fibromyalgia, and other chronic maladies of unknown origin. Some that were explanted in the early 90’s got improvement of the symptoms. These improvements were also often correlated with the administration of steroids that are by themselves a treatment for the Autoimmune Diseases. There were, however, cases that improved without the use of steroids but the majority saw little or no improvement with explanation.

We did learn a lot about Implants in this period of research and introspection!

Do Implants Last  Forever?

No! implants have a finite life regardless if they are saline or silicon. On average around 15- 20 years. I have seen some rupture at one two years and some perfect at thirty years.

Why Do Some Breasts Get Hard After Augmentation or Reconstruction?

The body makes a “room” for implants when they are inserted and this is lined with special cells. As long as this “room” or “CAPSULE” is bigger than the implant then the breast feels soft. Sometimes an event (could be inflammation/infection of breasts during breast feeding) can trigger scar tissue to form and tighten around the implant causing a “CAPSULAR CONTRACTURE”.

These can also occur gradually, years after the implant was placed without any known “event”. Studies over the last ten years have implicated bacteria in their cause. Not enough bacteria to cause an infection but enough to irritate the body. The bacteria form a barrier around the implant to protect themselves and this is called a BIOFILM.

Treatment includes removal of this scarred capsule with its BIOFILM and a change to a new implant. We often change the “site” from above the muscle placement to below the muscle or vice versa. Recurrence of the Capsular Contracture is always a possibility and can range from 20-60 percent depending on the number of times this has occurred. (Note: The treatment of recurrent Contracture is beyond this blog).

I hope this shed some light on current thoughts and concerns about Breast implants/ augmentation. Bottom line over 90 percent of individuals that have a breast augmentation are glad they had it done.

If you have any questions or are interested in learning more about breast augmentation breast lift and/or breast asymmetry, please contact my office.

1Anaplastic large cell lymphoma (ALCL) is a rare type of non-Hodgkin lymphoma (NHL), and one of the subtypes of T cell lymphoma. ALCL comprises about one percent of all NHLs and approximately 16 percent of all T cell lymphomas. (Source: Lymphoma Research Foundation)

That Fighting Spirit

The young Maya woman was pregnant and had walked four hours over the mountains of Guatemala with her husband and child.

After Dr. Manuel Pena (’81) and his mission team had repaired her child’s cleft lip, through her husband, who could speak Spanish, she asked softly, “Now, can you fix mine?”

With her husband standing next to her and watching, Pena gently numbed her lip, opting out of general anesthesia due to her pregnancy, and performed the repair.

The next day, the family began the long climb back up 9,000-plus feet to their mountain home. “I thought, I’m never going to see them again,” says Pena. “But at the end of seven days, they were back so I could take out their stitches. I thought, this is incredible. This is why I was put here.”

The mountains of Guatemala might have seemed a far cry from the norm for Pena, a Naples, Florida-based plastic surgeon who specializes in aesthetics. But not if you know Pena’s background and childhood. He grew up just across the Caribbean Sea, on the island of Cuba.

A young Pena (left) soon after moving to the United States A young Pena (left) soon after moving to the United States
While those early years before the rise of Fidel Castro were ones of luxury – Pena was the son of the head of trauma surgery at the hospital in Camaguey, one of the island’s largest provinces – it changed “seemingly overnight,” he recalls. Gone were the cook and the nanny. Gone were the properties, even the family home that had been owned by Penas for over 300 years.

The noose was growing tighter in Cuba. Young Manuel remembers waiting in line with his mother for a ration book that would allow the family to buy basic staples like bread, eggs, sugar or meat as the country’s rich resources were being spent on weapons and elsewhere. Out of fear for their family’s safety, his parents sent Manuel’s sister, then 11, with her godparents to the United States.

The rest of the family fled soon after. “My father and mother and I left Cuba in September of 1964,” says Pena, flying to Mexico where they waited three months for a visa. Then 7, Pena remembers his father taking him to the local pool to swim every day, not knowing that his father wanted him to practice in case they would need to swim the Rio Grande. “He didn’t know how deep it was,” says Pena. “But it didn’t come to that.”

The Penas would land in Miami where the family was reunited. But then came the hard work of rebuilding their lives. His father began the process of being recertified as a physician to work in the United States. And his mother, who had never had to cook or take care of a home and had instead spent her days drawing and playing tennis or canasta, used one of her hobbies to keep the family afloat: sewing.
“She was making shift dresses for $1.50 apiece,” says Pena. “It was a sweat shop, but that’s what kept us going.”

It was a tough mountain to climb, but “we were together, we were free and the world was there for the taking,” says Pena.

With the help of friends and the local Boys Club (predecessor to today’s Boys & Girls Clubs), Pena mastered English. After some time in Alabama, the family moved to Milledgeville, Georgia, where his father – now recertified – worked for Central State Mental Hospital and where a large population of Cuban physicians lived. Pena had started working too – even at that young age recognizing the sacrifice his parents had made to ensure their children had a better life.

After majoring in chemistry and biochemistry at the University of Georgia, Pena joined the first-year class at MCG, part of a large UGA contingent at Georgia’s public medical school. There was still that college feeling: keggers every Friday night at the cafeteria and raucous homecoming parades (Pena was head of MCG’s Entertainment Committee), but very quickly, he found his life’s work.

The first week of medical school, Pena sat in on a talk by Dr. Kenna Given, who had just been named section chief of plastic surgery. The lecture ranged over everything from congenital defects and trauma to microsurgery and aesthetics. “I didn’t know one field could be that broad,” says Pena. “So after the lecture, I followed him back to his office and said, ‘I want to do this. Will you be my clinical advisor?’ And he said, ‘Sure, I just took over so I don’t know exactly how this works, but we’ll figure it out together.’”

Pena with his parents at his 1981 MCG graduationPena with his parents at his 1981 MCG graduation
After graduation, Pena completed an internship in New Orleans at Charity Hospital, Tulane University, followed by a general surgery residency at Jackson Memorial Hospital, University of Miami (where he met his wife, Regina) and a plastic surgery residency at the Medical College of Georgia. He also began to start a family, which would grow to two daughters and two sons. Next came fellowships focusing on congenital defects, facial reconstruction and cosmetic surgery at the University of Miami and the Manhattan Eye, Ear and Throat Hospital, an affiliate of New York University.

Pena went home to Florida after his training, choosing Naples as the location for his private practice in 1990 after a chance vacation there and a friend who shared that there was a need for a plastic surgery practice in the area. Life was good, and Pena had already begun giving back to the Boys & Girls Club, which had been so instrumental to him as a new immigrant struggling to learn English. Then Guatemala came calling, thanks to another physician friend who encouraged Pena to clear his schedule and join him for an upcoming mission trip, after the original plastic surgeon had to back out. “I went and couldn’t stop,” says Pena.

Since 1997, Pena has completed nine mission trips, providing major surgical care for more than 250 patients. Along with countries in South America, he has traveled to Jamaica, and Uganda and Burkina Faso in Africa. Back home, he has hosted regular fundraisers such as crawfish boils to raise funds to cover all the equipment and supplies needed. (The boils are ongoing and are now benefiting the Boys & Girls Club of Collier County.)

It’s a need that hits close to home for Pena, who will never forget leaving Cuba, the sacrifice of his parents and the helping hands of so many who have brought him to where he is today. “There’s a great old Chinese proverb. It’s better to light one candle than to curse the darkness. You do just a little bit. That’s all you can do. You can’t fix the world, but if something comes up and you can fix it, you do it.”

The Pena family—Manny, Pena, Regina, Savannah Rose, Athens and Monica—during a trip back to Cuba in 2006The Pena family—Manny, Pena, Regina, Savannah Rose, Athens and Monica—during a trip back to Cuba in 2006.

Originally published: http://magazines.augusta.edu/