February 2010
Update from Baker-Gordon Plastic Surgery Symposium
I just returned from the 44th annual Baker-Gordon Plastic Surgery Symposium in Miami, Florida. The lecturers were from the US as well as South America and Europe, which reveals quite a diverse perspective. This year's theme focused on minimally invasive techniques in plastic surgery. This included some endoscopic assisted approaches to midface lifts as well as endoscopic breast augmentation, through the axilla (armpit). Although these techniques are quite interesting, they are in no way substitutes for traditional "open" techniques of facelifts or breast augmentation. There is a role for these types of procedures, however only in certain select patients. The incisions may be slightly smaller, however, the surgeon does give up some degree of control over the operation and its visualization.
As these techniques improve over time they may become more accepted in the world of plastic surgery, however for now, they are merely additional choices that the surgeon and patient have when considering cosmetic procedures. Be sure your surgeon is comfortable and familiar with his or her specific choice of technique regarding your plastic surgical procedure. Plastic surgery is continually evolving as a field and plastic surgeons must gradually evolve and modify their practices based on outcome studies- not just follow the latest trends.
Best wishes,
Dr. Bruno
Interesting case of the Day: Lower Eyelid surgery with no skin or fat removal
The appearance of dark circles or "bags" under the eyes can be a source of great concern for some patients. This can create a tired or older look which is seen in both men and women. The cause of this appearance is not always due to excess skin or excess fat but rather bulging fat beneath the lower eyelid. Modern plastic surgery techniques will preserve this fat and reposition it such that a natural, youthful lower eyelid/cheek area is established.
Today's patient: 37 year old woman who had noticeable fat bulges beneath her lower eyelids. She had no loose skin in this area. Although she had visible fat bulges of the lower eyelid, this was not considered "excess" fat but rather misplaced fat.
The surgery was performed through an internal incision behind the lower eyelid (transconjunctival approach) which leaves no scars. The bulging fat is preserved and the weakend orbital wall, much like a hernia, is repaired and strenghtened with stitches. By leaving the fat around the eye, this maintains a youthful appearance and avoids the sunken or skeletal look that can result from removing too much fat.
This type of surgery is best done under general aneshesia, but can also be performed under local anesthesia with sedation. There is some swelling for several days, but virtually no visible bruising. The pain is well controlled with oral analgesics. Most patients can return to work in about three days.
Careful evaluation of a patient's unique anatomy will determine the cause of their concern and consequently the best surgical plan for treatment.
Please feel free to contact me with any questions you may have about the appearance and possible treatment options for your lower eyelids.
Best wishes,
Dr. Bruno
October 2009
Interesting Case of the Day: Silicone Breast Augmentation in patient with previous Breast Reduction
Patients will often times request a change in the size and/or shape of their breasts. Sometimes this involves removing breast tissue, lifting breast tissue, inserting a breast implant, or a combination of these procedures. These procedures can be performed simultaneously or can be staged, meaning done at two separate surgeries. The reason for staging procedures is to ensure adequate blood supply and prevent any wound healing complications.
Today's patient: 22 year old woman who underwent a vertical breast reduction one year ago to improve both the size and shape of her breasts. She now desires more fullness of the upper portion of her breasts, which is something that a breast lift or reduction alone can not always achieve. Usually patients will require a breast implant to attain the "fuller" look they desire.
A silicone breast implant was inserted through her previous well healed periareolar incision in a subpectoral (under the muscle) location. The implant was 325cc, high profile style which gave the fullness she was looking for in the upper portion of the breast.
The final outcome is more predictable when this type of surgery is "staged". In this particular patient, due to the degree of sagging of her breasts, to have done a reduction/lift and an implant in one surgery would have been very difficult. The tissues and skin can not always accomodate the tension that an implant (bigger) and a lift (smaller) places on them at one time. This is not to say that a patient can't have breast implants and a lift simultaneously, but each patient needs to be evaluated on an individual basis.
Feel free to contact me with any questions regarding breast implants and breast lifts or reductions.
Best wishes,
Dr. Bruno
October 2009
Interesting Case of the Day: Fat Transfer to Lower Eyelid/Cheek with Lower Blepharoplasty
Patients commonly will complain that they look tired or old, which is usually due to the appearance of their eyes. The eyes are the first area to show signs of aging due to the extremely thin skin in this area combined with overactive muscles (squinting) causing fine lines and wrinkles. Equally important in the aging process is the loss of soft tissue or fat in the eye area which contributes to an older, gaunt look. The eyes can appear sunken in over time as the fat begins to atrophy or shrink with age.
Today's patient: 43 year old man with excess skin of lower eyelids and hollowed out appearance of lower eyelid/cheek junction. The lack of fatty tissue of his lower eyelid area actually contributed more to his premature aging than did the excess lower eyelid skin.
For the lower eyelid surgery (blepharoplasty), a small incision was made just beneath the eyelash line with a conservative removal of lower eyelid skin. Once this was complete, I harvested fat from his lower abdomen which was then treated and injected back into the lower eyelid/cheek area. This serves to create a fuller cheek contour and softens the transition between lower eyelid and cheek, creating a more youthful appearing face.
Most of this fat transferred to the eyelid/cheek area will survive (~90%) due to the robust blood supply of the face. The area will be swollen and bruised for about 10 days, and the pain is well controlled with oral analgesics. Fat transfer is a very safe and well studied technique which can yield dramatic changes to a patient's appearance. Most of the fat will persist for years, compared to other injectables (Juvederm, Restylane, etc) which typically dissolve within 6-9 months.
Feel free to contact the office is you have any questions regarding fat transfers.
Best wishes,
Dr. Bruno
September 2009
Interesting Case of the Day: Breast Augmentation with Tummy Tuck and Liposuction of the Back
Many patients are interested in having more than one surgical procedure performed at the same time, under the same general anesthetic. This is discussed in my blog under "Combination Procedures in Plastic Surgery". Provided the patient is in good general health and the surgery can be completed in a reasonable amount of time, this is quite common and safe.
Today's patient: 30 years old, 5ft tall and 150 pounds. She has had three previous pregnancies and does not plan to have any further children. Her bra size was B/C and she wanted to become a D cup. She had stretch marks and loose skin of her lower abdomen as well as fatty deposits on her sides (flanks) and lower/mid back.
For the breast augmentation, silicone breast implants were used, inserted through a periareolar incision, under the pectoral muscle- 371 and 397 cc (to improve her asymmetry). Liposuction was performed first on her lower back and then on the sides to further accentuate the waistline contour provided by the tummy tuck. The procedure lasted about four hours.
Many would refer to this case as a "mommy makeover", where a woman wants to regain the breast size and abdominal contour she once had before pregnancies. This type of case has become more popular over the last several years and may not seem as "interesting" as the title suggests. However, what is interesting is realizing what kind of dramatic changes can be achieved in one day with plastic surgery. Although not everyone may be a candidate for this type of procedure, many women will in fact be able to experience this degree of improvement in just one day.
Best wishes,
Dr. Bruno
September 2009
Buttock Augmentation
Over the past several years, there has been an increased interest in buttock augmentation or gluteal reshaping. Many patients are looking for a more shapely buttock area, not necessarily just a larger buttock size. An effective technique to achieve this result involves performing a fat transfer, which involves harvesting fat from one area of the body and transferring (injecting) it to another area (such as the buttock).
This is accomplished by performing liposuction of the lower back, abdomen, love handles and occasionally the thighs, in order to harvest the fat while improving the contour in those areas simultaneously. This fat, once removed and strained, is then transferred to the buttock area using a syringe and metal cannula. This surgery is done typically under general anesthesia and takes approximately two to three hours. The goal is to reshape the entire gluteal, lower back and abdominal area while at the same time creating a fuller, more aesthetically appealing buttock area.
Most patients will take about one week off of work during the recovery from a buttock augmentation using fat transfer. One of the most important aspects of recovery is to avoid sitting for approximately two weeks. This is important so as to avoid any pressure on the newly transferred fat cells in the buttock area, which could result in their death and shrinkage. Patients can sleep on their stomachs or on their sides during this time period. They can sit only with the assistance or pillows placed under their thighs so there is minimal to no pressure on their buttock area. Most of the fat cells will survive (~80%) and provide for a long lasting result.
Ideal candidates for buttock augmentation using their own fat are patients who are slightly overweight and therefore have enought fat to be transferred to the desired area (buttock). Patients who are very thin are not good candidates for a fat transfer and may consider silicone buttock implants. However, these implants can shift, develop hard scar tissue and occasionally become infected.
Hope this helps answer some of the questions you may have about buttock (gluteal) augmentation.
Feel free to contact the office for more information regarding buttock augmentation.
Best wishes,
Dr. Bruno
September 2009
Saline vs. Silicone Breast Implants
Patients are always asking about the differences between saline and silicone, which one is better and which one is safer. I will start out by saying that they are both safe and FDA approved. There has never been any study to suggest that either saline or silicone breast implants cause breast cancer or any health problems. In the US, silicone breast implants were restricted from 1992 until 2006 because there was a concern at that time that ruptured silicone implants were causing women to become ill. After approximately 15 years of studying silicone implants and the women who had them, breast implants have been determined safe. There is no scientfice evidence linking silicone implants (even ruptured implants) to any medical illness or disease. Furthermore, the newer generation silicone breast implants have lower rupture rates when compared to saline breast implants. This improved longevity of silicone implants has led to fewer reoperations and revisions.
Last night I attended a presentation on silicone breast implants, in particular, related to the effects of silicone implants in the human body and the cause of scar tissue around implants (capsular contracture). One of the lecturers was a PhD in toxicology who has studied silicone devices (including breast implants) for over 20 years. He gave some interesting facts regarding silicone in general. He explained that we are exposed to significant amounts of silicone in our everyday lives, through the use of toothpaste, hairsprays, deodorants, skin lotions and sunblocks. The amount of silicone that our body absorbs from these products far exceeds the silicone that a patient could ever absorb from a breast implant.
The conclusion is that silicone, whether it's in a breast implant or a sunblock, is safe when exposed to the human body and causes no medical illnesses. There is a lot of scientific evidence to support this, not just for breast implants, but for many other silicone medical devices.
Please feel free to contact me if you have any questions or concerns regarding silicone breast implants.
Best wishes,
Dr. Bruno
August 2009
Combination procedures in plastic surgery
Often times, patients will request more than one procedure to be performed during the same surgery. Whether this includes a facial procedure with a breast augmentation, or a tummy tuck and several areas of liposuction, the combination of procedures is not as important as the patient's overall health and safety.
Firstly, patients should be in good overall health as determined by their primary care physician or internist. This involves a complete history and physical examination with an EKG and additional blood work. Occasionally a patient may even need clearance from a cardiologist. The patient's age is not as important as their level of health. If there are any health concerns, the patient can be referred to a specialist for further investigation prior to surgery. Remember, cosmetic surgery is elective, so there is no rush to undergo these procedures until you have the proper medical clearance.
Secondly, once your good health has been established, the total length of the surgery must be closely considered. For example, a breast augmentation, which takes about one hour, can safely be combined with a tummy tuck, which takes about two hours. That makes for a total of about three hours, which is reasonable for outpatient plastic surgery. In fact, the American Society of Plastic Surgeons (ASPS) has determined six hours to be a guideline or limit of surgery duration for outpatient plastic surgery. If the combined procedures last longer than six hours, it is recommended the patient stay overnight at a hospital or after-care facility to be observed. If a combination surgery is scheduled to be longer than six hours, the surgeon needs to consider staging the procedures and performing them at separate times to ensure patient safety. The longer a surgery is, the higher the risk of deep vein thrombosis (DVT) or blood clots developing in the lower extremities becomes.
Each patient has their own unique anatomy and their own individual needs. I will be happy to discuss the most realistic and safest approach to your surgery if you are considering a combination of procedures.
Best wishes,
Dr. Bruno