header

Breast implant infections are less common in an office based setting

Published
on August 31, 2010
. 0 Comments

Infection after breast augmentation can be devastating.  Most commonly, these cannot be treated with antibiotics alone and often require removal of one or both implants.  Unhappy patient.  Unhappy surgeon.

The reported U.S incidence of postoperative infection after breast augmentation is around 2 -2.5%.

There is a trend towards more aggressive bacteria causing these infections.  A recent study in the Plastic and Reconstructive Surgery journal revealed 68% of these infections to be caused my MRSA.  This is a very aggressive bacteria and can be difficult to treat.  In this study, all of the procedures were done in a hospital based operating room.

These numbers seem really high to me.  Particularly given the fact that… knock on wood….I haven’t had a single implant infection in the seven years of my practice.   This is something around 1000 implants without a single infection!

My general strategy involves.

  1. Preoperative antibiotics, given before the surgery
  2. Meticulous prep
  3. Bathing the implants in antibiotics and wiping the skin incision with antibiotics prior to implantation
  4. Limited handling of the implant
  5. Postoperative antibiotics
  6. Performing the procedure in my own office operating room

Having my own certified office based operating room is the key.

As opposed to a hospital operating room, only clean procedures are done in my O.R.   There are no sick or infected patients.  The multi-antibiotic resistant bacteria found in hospitals is not a problem.  There are fewer operating room staff involved and fewer potential sources of contamination.

Other advantages to choosing a certified office based operating room for your breast augmentation include; cost, safety, privacy, and overall patient comfort and experience.

Bookmark and Share
Join the conversation: No comments
Tags: , , .


Keeping your children safe — a plastic surgeon’s perspective.

Published
on July 19, 2010
. 2 Comments

Over the years, I have seen a variety of unusual and unfortunate injuries in the Emergency Department that have required my care as a plastic surgeon.  Boat propeller injury to the legs of a child, non-lethal gunshot wound to the face and bear mauling injuries to name a few.

Over the years, I have also seen patterns of common injuries.

The following is a list of causes for injury that may require a plastic surgeon.  This list is created from my experience.  There are of course many other types of childhood injuries that are notably not listed such as motor vehicle accidents, suffocation, and drowning.

  1. Falls (2.8 million children require medical attention/ year)
    • Preventing falls in children is obviously futile.  Kids fall.
    • Take measures to protect them where you can.
    • Make sure the home playground is adequately padded and safe.
    • Use home safety devices such as stair gates.
    • Avoid sources of tripping such as rugs near a fireplace.
    • Keep heavy objects off the top of unstable furniture.
  2. Dog bite injuries. (800,000 dog bites requiring medical attention/ year)
    • This is the 5th most common reason for a child to visit the Emergency Department.
    • “That dog is usually great with kids”, is what parents often say.
    • Parents should avoid letting their children near dogs that are play fighting, sleeping or while they are eating.
    • Children should be trained to ask the dog owner before touching a dog.
    • Children should not feel comfortable with their face near a dogs mouth.
    • These types of injuries can be severely deforming as the tissue is crushed in addition to being torn.
    • There is a high risk of infection associated with dog bite injuries.
  3. Toy related injuries (165,000 trips to the ER/ year)
    • Riding toys are the number one cause.
    • Unrelated to plastic surgery, 54% of toy related fatalities were from choking.  Of these, balloons were responsible for almost half.
  4. Door injury (45,000 child emergency room visits/ year), 15,000 amputation injuries per year.
    • Car doors, house doors and less commonly elevator doors.
    • The “hinge” side of the door is particularly likely to result in injury.
    • The hinge side of the door has a more forceful “pinch” up to 40 tons per square inch.
    • Keep children from playing with doors.  Teach children it is wrong to slam doors.
    • I have personally seen more than a dozen child finger tip amputation injuries from this type of injury.
  5. Treadmill injuries (about 25,000 injuries/ year)
    • A child, wanting to be with mom who is running on a treadmill, puts his/ her hand on the treadmill.
    • It can be caught between the moving belt and stationary treadmill.
    • This results in a deep burn injury, usually to the fingers.
    • This may require skin grafts or other surgical options to heal.
    • If able, make sure the treadmill faces children who are playing.
    • Better yet, use the treadmill only when children are not nearby.
  6. Lawn mower injury (18,000 children/ year)
    • These are generally severe injuries and completely preventable.
    • Children younger that 12 should never operate a lawn mower, (16 if a riding mower).
    • Children should stay an appropriate distance from the mower, in my opinion not in the yard period.
    • Debris such as rocks can become missiles at short range.
  7. Bathtub burn injury
    • 67% of injuries occur in children 2 years or younger
    • Burns occur most commonly from a parent or sibling adjusting the temperature (turning on the hot or turning off the cold) while the baby is in the tub.
    • Keep the temperature on the hot water heater less than 120 degrees.
    • Check the temperature of the water with the back of the hand.
    • Recheck the temperature after adjustments.
    • Some of these injuries are the result of abuse, I assume anyone reading this would not be such a parent.
  8. Fireworks (7,000 injuries requiring medical attention/ year), over half are children.
    • The injury pattern is commonly a burn, or occasionally blast related injuries.
    • Sparklers cause most of the injuries in children
    • The number of injuries is particularly high considering there are only a few days of the year where fireworks are generally used
  9. Electrical cord bite injury
    • The child bites through the electrical cord insulation
    • Electrocution is the most significant concern
    • Often a severe burn injury occurs at the corner of the mouth
    • This can result in disfigurement and narrowing of the corner of the mouth with healing
    • Surgery and oral splinting are often necessary.

Being the proud father of two beautiful little girls with a boy on the way, I understand the instinct to keep kids safe.   Injuries cannot be completely prevented.  Understanding common causes can help a parent prevent many of these injuries.

Bookmark and Share
Join the conversation: 2 comments
Tags: , , , .


My child has a cut, how do I know if it needs stiches? – A mom’s guide.

Published
on July 18, 2010
. 0 Comments

I get calls from friends and family frequently asking exactly this question.

The 4 cm gash across the nose obviously needs to be repaired.  Get off the computer and calmly take your child to the doctor or E.R.

What about the small cut?  Which of those need to be repaired?

Clean or dirty?

If it is a dirty wound or the object causing the injury was dirty or rusty, a tetanus shot needs to be given if not up to date.  Most children are up to date with school immunization requirements.

Location?

The location of the wound is an important factor.  Contrary to public perception, the reason to close a laceration is not to prevent infection.  If fact, the risk of wound infection is generally increased with closure.  The main reason to close a laceration is for cosmetic benefit.  (Can’t you just see insurance companies determining laceration repair to be an uncovered, cosmetic procedure).  A small 1/4 inch laceration on the leg may not need repair whereas the same laceration on the face likely would.

Depth of laceration?

This is the difficult one to assess with a phone call.  “How deep is it?”, often leads to a puzzled answer.  In general if the wound is gaping open more than a couple of millimeters when the laceration is pulled open then it is through the dermis.  Most lacerations 3 mm or more through the dermis benefit from repair.  In contrary, A 1 inch laceration through the epidermis but not through the dermis will do well without repair.  This is more of a “scrape”.

Clean or ragged?

Most ragged lacerations benefit from some debridement at the time of repair.  The classic injury is a dog bit injury.  Parenthetically, do not let your children near dogs that are play fighting or when they are eating.

Damage to underlying tissue?

This most commonly occurs in the hand.  Even small stabbing lacerations in the hand can cause nerve or tendon injury.  Numbness or lack of motion would be obvious indicators that evaluation would be necessary.

Bookmark and Share
Join the conversation: No comments
Tags: , , , .


Questions to ask your plastic surgeon

Published
on July 17, 2010
. 1 Comment

Choosing the best plastic surgeon for you can be a difficult process.  This is obviously not the type of shopping where finding someone from a phone book will do.  Unfortunately, some still do.

A certain amount of research should be done before you ever consider making the appointment.

  • Ask around.
  • Review physician websites.
  • Review before and after photos.
  • Review non-biased doctor rating websites such as healthgrades.com, vitals.com and a number of other sites.
  • Check into a physicians board certification status at www.ABMS.org.
  • Learn about the procedure(s) you are interested and alternative options.

Now you are ready.  You’ve done your homework and are ready to make the consultation with the plastic surgeon that you feel may be best for you.  Here is a cheat sheet to take with you to your consultation to make sure the important questions get answered.  In your research some of these questions may have already been.

  1. Are you a board certified plastic surgeon?
    • This is probably the most important question to ask.  Board certification signifies; appropriate training, continuing education requirements, and good ethical standing.
    • A plastic surgeon who is not board certified is likely to have a significant reason such as 1) inadequate training, 2) unethical billing or advertising practices or they 3) may just be lazy.  All reasons for concern.
    • It is important to recognize that there are a number of “boards”, but only the American Board of Plastic Surgery certifies plastic surgeons.  I have blogged in the past to help educate patients about the confusing issue of board certification.
  2. How long have you been in practice?
    • Every training program is different.  Some allow plastic surgeons in training a lot of autonomy and independence.  Some do not.  It is usually a good idea to choose a plastic surgeon at least a few years out of training.  Skill and judgment improve with experience.
  3. How many of these procedures have you done?  What percentage of your practice is this procedure?
    • Not every plastic surgeon has the same skill set as another.  Some plastic surgeons may emphasize facial surgery, others body surgery etc…  You want your plastic surgeon to be not only skilled and experienced but particularly skilled and experienced in the procedure that you are interested in.
  4. Can I see before and after photos or testimonials?
    • Ask if all of the before and after photos are the surgeons own work.  If not, run!  There are laser and other medical technology companies who have stock before and after photos that they allow their clients to use.  These are generally the best result ever achieved and is not consistent with what patients should expect for themselves.  This is intentionally misleading and should be cause for concern.
  5. Where is the procedure performed?
    • This can be at a hospital, outpatient surgical center, or office based operating room.  All have an excellent record for safety.  If in the physicians office operating room make sure it is a certified operating room.  Certified operating rooms meet specific safety standards and are reviewed yearly for safety.  Dr. Yates operating room is certified by the AAAASF.
  6. What kind of anesthesia will I have and who will provide the anesthesia?
    • Anesthesia for cosmetic surgery can range from general anesthesia to wide awake with local anesthesia, depending on the surgery performed.  Ask your surgeon about the training of the person administering the anesthesia and confirm with them on the day of surgery.  It is very appropriate for a nurse to provide anesthesia for light sedation.  Make sure anything beyond that is administered by an anesthesiologist or CRNA.
  7. Who is doing the procedure?
    • You have gained trust in your surgeon.  Through your communication he understands your specific goals.  Make sure he is actually the one operating.  This is rarely a problem but can be in large hospital or teaching hospital settings.
  8. What happens if there is a problem requiring revision?
    • Every surgeon has their own revision fee schedule.  These fees can include facility fees, anesthesia fees, and surgeons fees.
    • I do not charge surgeons fees for revisions.  This helps me keenly focus on taking every step possible to avoid these complications.
    • I have my own office operating room and do not charge a facility fee for its use for revisions.
  9. Do you have hospital privileges to do the same procedure at a hospital?
    • Hospitals have stringent criteria regarding training and safety before granting privileges to do a specific procedure.
    • If a physician does a specific procedure in his office but does not have privileges to do the same at a hospital, there is likely a problem.  Most typically, they do not have adequate experience and training in that procedure.

Many of these questions do not get asked because a patient is embarrassed or does not want to be rude.  Ask us these questions!  Those of us who are adequately trained and take the appropriate safety precautions find it refreshing when a patient cares about their own safety enough to ask.   Pass this list on to your friends considering plastic surgery.

Bookmark and Share
Join the conversation: 1 comment
Tags: , , , , , .


Natural breast augmentation

Published
on July 1, 2010
. 0 Comments

“Natural breast augmentation” is becoming a popular term in breast enhancement.  But what does it mean?

Of course, patients interested in breast augmentation would for the most part prefer a natural breast augmentation.  Does this mean the results look “natural” or that the augmentation uses natural tissue without implants?

Natural breast augmentation can mean:

  1. Breast augmentation with structural fat grafting
  2. Breast enhancement pills or creams (worthless in this plastic surgeons opinion)
  3. Breast enlargement with a suction device (Brava device)
  4. A natural appearing result with breast implants.

Of these, fat grafting is currently what most people are referring to when they use the term “natural breast augmentation”.

The idea is simple.  Fat and associated stem cells are harvested from other areas of the body and injected into the breast for augmentation.  Undoubtedly this works, but only to a small degree.   This is controversial and currently very few plastic surgeons offer this type of natural breast augmentation.

There are major problems with this procedure that need to be fully worked out before someone like myself would feel comfortable doing the procedure on a patient.

The most compelling issue is the diagnosis and treatment of breast cancer.   When the fat is injected there is always some of the tissue that does not survive the transfer.  This can lead to “fat necrosis” which could be confused with breast cancer on mammography.  This may lead to “too few” or “too many” biopsies of concerning areas.

Areas of fat necrosis could feel firm, defeating the goal of “natural breast augmentation”

The procedure, at best, results in a modest breast size increase.  In my experience, most patients who desire breast augmentation are looking for a more significant change than “natural breast augmentation” can afford.

Fat grafting is fickle and requires significant knowledge and experience to get it right.

I can not recommend “natural breast augmentation” at this time.  If you choose “natural breast augmentation”, please choose a board certified plastic surgeon who is comfortable with the procedure.  (There are very few).

Bookmark and Share
Join the conversation: No comments
Tags: , , , , , .


A story of Utah kindness

Published
on June 29, 2010
. 0 Comments

A patient presented to me two weeks ago from the east coast.  She is predominantly Spanish speaking and as a result the communication before her visit was lacking.  She had arranged for a consultation with the assistance of her daughter and the translator in the clinic.

We were told she was from the west coast and was interested in a facelift consultation.  In reality, she was from the east coast and was interested in a mommy makeover (breast rejuvenation and a tummy tuck).  She also mistakenly was expecting to have surgery that day.

We were told that her daughter was taking care of her, that she had taken a couple of weeks off work, and was scheduled to fly home in two weeks.  The only way that she would have the recovery time I would require before returning home was to start the process immediately.

Amazingly, everything fell into place for her and we were able to rush things along.  We scheduled breast augmentation that evening and a tummy tuck a couple of days later.  (Emergency breast augmentation is not a common part of my practice, if you are wondering).

We asked to talk with her caretaker before surgery to be sure she was responsible and capable.  When we found that she was not going to be present, we of course had to cancel surgery.

Here’s where it gets interesting.

She called a local church and explained her situation.  They arranged for a caretaker to stay with her for her recovery period.   The individual who volunteered was amazing.   She was a Spanish speaking, extremely nice and responsible lady.  She dropped everything in her own life to care for this complete stranger who she met for the first time just before surgery.  She took her into her home, helped her with food and bathroom, cared for drains and did many things that loved ones find cumbersome after such a surgery.  She took her sight seeing, bringing a wheel chair.  She brought her to all of her clinic appointments.

They are now great friends!

People from Utah are kind and I am proud to practice here.

Bookmark and Share
Join the conversation: No comments
Tags: , .


Multiple plastic surgery procedures – combined or staged?

Published
on June 19, 2010
. 8 Comments

1 + 2 = 5?

Many patients who desire plastic surgery are interested in more than just one procedure.  For example, the massive weight loss and mommy makeover patients often request multiple cosmetic procedures.

Patients who have lost a lot of weight often find that their reward for hard work is loose skin.  These patients often desire a face lift, arm lift (brachioplasty), breast lift/ augmentation, tummy tuck, and thigh lift.

Mothers often find that after pregnancy their breasts droop and deflate and their abdomen is loose with new stretch marks and bulges.

These patients just want their bodies BACK.  This can be viewed as reconstructive as much as cosmetic.

When combining multiple plastic surgery procedures the risks are more than additive.  In other words if the risk of a breast augmentation is a 1 (arbitrary) and the risk of a tummy tuck is a 2, the combined risk is not a 3.  The combined risk is more like a 5.

The most feared complication after any surgery is a DVT (blood clot) going to the lungs (pulmonary embolism).  A large percentage of these patients do not make it to the hospital with the presenting sign being “sudden death”.

Not the kind of thing you want to think about when researching plastic surgery, I know.  It is something that I am scared to death of and take every precaution to reduce this risk as close to zero as I can.  I plan on never seeing this complication in my practice.  (knock on wood…I have never even had a close call).

There are several well known risk factors for DVT

  • Long procedures
  • General anesthesia
  • Genetic mutations (caution for the patient with a bleeding disorder or multiple miscarriages)
  • Liposuction combined with other large procedures
  • Oral contraceptives
  • Patients with cancer

The duration of a procedure is a risk factor for almost every possible complication after plastic surgery, including infection, scarring and anesthetic complications.

This brings me back to the point of this post.  The length of a procedure and type of anesthesia are two very important variables that I have a lot of control over.  When a patient presents desiring multiple cosmetic procedures, I prefer to stage them.  My general rule (and one that keeps my patients out of harms way and allows me to sleep well at night), is that I will usually do in one operation only what can be done under sedation with local anesthesia (without general anesthesia).  There are procedures which have to be done under general anesthesia, but these are the exception.

In the massive weight loss patient, this may mean 4 – 6 operations. Many of these can be done within a few days of each other to allow for one period of recovery.  A common sequence may be:

  1. Facelift (day 0)
  2. Breast lift/ augmentation (day 2)
  3. Arm lift (day 7)
  4. Tummy tuck (day 9)
  5. Inner thigh lift (day 14)
  6. Posterior thigh lift (1-3 months later)

By two weeks, the makeover is nearly complete.  At this point the recovery is much easier and quicker than a large combined procedure.  The risks of each procedure are minimized significantly.

For the mommy makeover patient this may involve two or three operations

  1. Breast augmentation/ lift (day 0)
  2. Tummy tuck (day 2)
  3. Liposuction (can be combined with the other procedures for a couple of small areas or separated)

But what about the costs of staging the procedures, isn’t it a lot more expensive?

The costs can actually be less with a staged approach, if the surgeon has his own operating room and does not charge a facility fee for its use.  Our AAAASF certified outpatient operating room is where most of our cosmetic plastic surgery procedures are performed.  There is not an additional facility fee or the high costs/ risks associated with a several day hospital admission.

How about the pain?

The pain associated with a staged approach is less.  Kind of like getting hit in the stomach 6 times by a child vs. once by an adult.

It is certainly more difficult for the patient, as well as me and my staff, to separate the procedures.  It is definitely worth it in this plastic surgeons opinion.  I am not a surgical risk taker… I don’t do well with even minor complications after elective cosmetic surgery, it tears at me.  It is worth the extra effort to avoid ever dealing with a major complication.

Bookmark and Share
Join the conversation: 8 comments
Tags: , , , .


Smarter liposuction

Published
on June 8, 2010
. 0 Comments

Liposuction is a procedure under constant evolution.

First there were traditional dry techniques developed in the 1970’s.  Fat was simply removed by suction.  This was bloody and frankly barbaric.

The tumescent liposuction technique was invented in the 1980’s by Dr. Klein, a California Dermatologist.  This significantly cut down on bleeding and risks.  Most cases of liposuction could be done without general anesthesia with tumescent techniques.

Further refinements in liposuction techniques have included:

  1. Smaller cannulas – to minimize scarring and prevent contour deformities
  2. Superficial liposuction – small cannulas just beneath the skin to encourage skin shrinkage
  3. Power assisted liposuction
  4. Ultrasound assisted liposuction (Vaser among others)
  5. Laser assisted liposuction (smartlipo)
  6. Water assisted liposuction (Water-jet)

The final three are technology based advancements that melt, loosen or burst fat cells to help suction them.  These (and many more on the horizon) have become increasingly popular in the past few years due to extensive marketing efforts.

There may be some benefits to laser, ultrasound or water assisted liposuction.  Time will be the final judge.

Smartlipo is the current market leader in laser liposuction.    I have told patients that “smarterlipo” is to choose a board certified plastic surgeon and trust his judgment regarding the best treatment option for them.  I have thought that I should trademark the term “smarterlipo” although trademarking a general term to imply uniqueness to what I am doing is not my style.

A few misconceptions about liposuction

  1. Liposuction is almost never done under general anesthesia (advertisements for liposuction “chains” often claim otherwise)
  2. Liposuction does not require weeks to months to recover from (again, cautious with advertising claims to the contrary)
  3. Choosing a plastic surgeon to perform your liposuction is not more expensive (in fact when factoring revisions, much less)
  4. Technology does not make a poorly trained surgeon better – avoid the “cosmetic surgeon”
  5. Liposuction can only tighten loose skin to a slight degree
Bookmark and Share
Join the conversation: No comments
Tags: , , .


What is the best bra after breast augmentation?

Published
on May 7, 2010
. 0 Comments

Finding a good bra after breast augmentation can be challenging.

For the first 6 weeks to 3 months the bra should be comfortable, without underwire, and clasp in the front.  We use a simple post surgical sport bra.    After the first 3 months, patients are excited to get some new, prettier bras.

I recommend wearing a bra nearly all the time, including at night.  This is to prevent the implant from “bottoming out” or falling to the sides.  This is unlikely in many patients, although some patients have less support for the implant internally.  These patients are at higher risk for implant displacement.

Many bras do not fit comfortably after breast augmentation.  Breasts with breast implants are generally a little different shape than natural breasts.  Augmented breasts are generally a little rounder, narrower to the sides at their base, and have more spacing than natural breasts of similar size.

Underwire bras are controversial.  I prefer that patients do not wear underwire for prolonged periods of time.  The issue with underwire with breast implants is that the underwire could displace the implants if worn too early or often.  Often the underwire is improperly shaped to support the augmented breast and is uncomfortable.

One bra,  Le Mystere No. 9, is marketed as the  first bra specifically designed for women with breast implants.  The cup is more rounded, the underwire is narrower to fit the implant ideally and the spacing between the cups is designed a little wider.  This bra manufacturer is in partnership with Mentor, one of the leading implant manufacturers.  The reviews are good.  Cost is around $75.

Le Mystere No. 9 Scarlett Allover Lace Bra

Bookmark and Share
Join the conversation: No comments
Tags: , , .


Survey shows mommy makeover has a high satisfaction rate

Published
on May 3, 2010
. 1 Comment

There was a recent poll by Harris Interactive on behalf of Realself.com looking at trends in cosmetic and plastic surgery.  The study surveyed over 2100 patients aged 18 and over.  The study looked at interest and satisfaction with cosmetic surgery.

Tummy tuck (29%) and liposuction (23%) topped the list of procedures that patients would undergo if finances weren’t an issue.

The realself “worth it” rating index showed the highest satisfaction with a mommy makeover (97%) tummy tuck (85%), vision correction (83%) and breast augmentation (77%).

I have seen a tremendous volume of mommy  makeover, tummy tuck and breast augmentation patients in the past few months.  Partly, this is seasonal.   I think there is more to it.  Happy patients who consider procedures “worth it” talk.

The study looked at procedural costs as well.   The average cost for a tummy tuck was $8,722 and breast augmentation was $6,591.  I am happy to say our costs are significantly less.

Bookmark and Share
Join the conversation: 1 comment
Tags: .


Natural plastic surgery results should be the goal

Published
on May 1, 2010
. 1 Comment

Certainly, every cosmetic surgery patient is looking for a change.  Sometimes, more is not better.  Sometimes more is irreversible and damaging.

I would rather “under-do” 10 facelifts than “over-do” one.   You don’t have to look further than Joan Rivers or Kenny Rogers to understand why.  Facelift results should look like a rested, more youthful version of the patient.  Not like a different person entirely.

I would rather “under-do” 10 rhinoplasties than “over-do” one.   Michael Jackson.

In my opinion the top surgeries that are too frequently over-done are:

  1. Brow lift – No one has ever come to my office asking if I can make them look surprised.   A well executed brow lift usually actually results in only a couple of millimeters of brow elevation.  This can often be accomplished non-surgically with Botox.
  2. Facelift – The skin should not look tight or pulled.  There should still be some lines and wrinkles.  The corner of the mouth should not be pulled.
  3. Blepharoplasty – The upper eyelids should have excess skin when the eyes are open, otherwise they wouldn’t close.
  4. Breast augmentation – Symmetry is beauty.  The circumference around the hips should match that around the breasts.  The contour of the breast should be nearly a straight line without bulging from the collar bone to the nipple.

There are times when being aggressive is beneficial to ultimate outcomes:

  1. Abdominoplasty (tummy tuck) – it is hard to “over-do” a tummy tuck.
  2. Breast reduction – I have seen a few patients who after breast reduction later had breast augmentation (none of my patients, knock on wood).  This is rare.  Most breast reduction patients are just tired of their heavy, large breasts and desire a significant change.
  3. Breast lift – As long as the nipple position is correct and the operation is executed safely, it is nearly impossible to “over-do” the lift.  Generally over-lifted on the table means fantastic results in 6 weeks.   Fabulous results on the table can result in bottoming out over time.

This is not to say that every one of my results are what I would consider “perfectly natural”.  This is, however, my philosophy and goal.

I am fortunate to practice in a fairly conservative area in Utah where many of my patients share these sediments.  This is one of the primary reasons why I practice in Utah instead of, say, Beverly Hills.

Bookmark and Share
Join the conversation: 1 comment
Tags: , , , .


Does lipodissolve work?

Published
on April 21, 2010
. 0 Comments

Lipodissolve is similar to mesotherapy.  This involves injecting a mixture of “fat dissolving” chemicals into the fat.  This is marketed as a noninvasive alternative to liposuction.

Yes,  lipodissolve can work.  The problem is it is very inconsistent.  I have seen a patient with large calves and ankles who swore to me that these doubled in size after lipodissolve.

Yesterday, I saw a patient back for her 3 month tummy tuck followup who had lipodissolve several months previously.  This caused areas of irregular fat which became a larger problem than original issue.

Lipodissolve does work....sometimes too well

Bookmark and Share
Join the conversation: No comments
Tags: , , .


Awake breast augmentation?

Published
on April 12, 2010
. 0 Comments

In the New York Times last week there was an article about awake breast augmentation.  The article is interesting and worth a read.

The cliff note version of the story, for those inclined to short cuts, is basically this:

1) A number of “cosmetic surgeons” are doing large procedures such as breast augmentation in their office operating rooms under local anesthesia and sedation.

2) The training of these “cosmetic surgeons” involves a weekend course

3) The “cosmetic surgeons” state that the procedures are safer because it is done under local anesthesia

4) Some patients are allowed to choose their breast implant size on the table while sedated

5) “awake breast augmentation” is a vague term and the level of sedation may be quite deep.  The article implies that anything other than general anesthesia would be considered “awake”

6) Many (if not all) of these “cosmetic surgeons” are doing these procedures in non-accredited operating rooms.

I find myself particularly well suited to comment on this article as I do all of my breast augmentation operations without general anesthesia in an accredited office operating room.  My general feeling of the article is that they did a reasonable job in helping distinguish the board certified plastic surgeon from the “cosmetic surgeon” in experience and level of training.

The first example in the article is a patient who had breast augmentation under general anesthesia followed by exchange for a larger implant years later under light sedation.  She was able to choose her implant size on the table.  Sounds incredible?

An implant exchange requires little if any sedation and is a painless procedure.  The pocket is already developed.  Many plastic surgeons, including myself, would do the procedure with just local anesthesia if a patient so desired.  Allowing a patient to pick their breast size while sedated is nonsense.  “Here take this …. try to keep your eyes open and head up …. now how large should your breasts be again?”   Some decisions are best left to proper planning.

I have never heard of the “National Society of Cosmetic Surgeons” discussed in the middle of the first page.  This is just one of many “societies” and “boards” fabricated to try to validate someone with inadequate training.  It sounds like this societies members have in common $7,000 and a free weekend.

Safety – There is nothing safe about having breast augmentation performed by someone with inadequate training, no matter the type of anesthesia used.  That being said, I personally prefer sedation for breast augmentation.  I feel it is easier on the patient.  Patients generally wake with less pain and nausea.  Many well qualified plastic surgeons prefer general anesthesia for their own reasons.   What is important is choosing a board certified plastic surgeon and they can discuss what they feel most comfortable with.

Bookmark and Share
Join the conversation: No comments
Tags: , , , .


Why taxi drivers don’t fly planes

Published
on March 7, 2010
. 3 Comments

I once bought the DVD “Spider-man” from a street vendor in New York.  The movie was still in the theaters and although I felt unlikely that this was legit, it was only $5.  To my surprise, the movie was actually on the DVD.  It was a low quality home video obviously taken by a patron of the movie.  The gentleman’s head in the row ahead cut out the bottom third of the screen.  Clearly, “knock-offs” are rarely the same quality as the original.

I should have known better.  The gentleman who sold me the movie kept his movies in a “pack and run” blanket and kept looking nervously over his shoulder.

Unfortunately “knock-off” cosmetic surgeons do not tip their hand as easily.  Years ago, a patient simply had to make sure that their plastic surgeon was board certified to be safe.  I can assure you that this is no longer the case.  There are thousands of physicians doing plastic surgeons who are “board certified” but have no training in plastic surgery.

I received a fax last week from the American Board of Cosmetic Plastic Surgery offering me “certification” by their board.  Their requirements for certification were 1) be a physician, 2) have a pulse, 3) send an application and 4) have $300.  I would receive a beautiful framed certificate to hang proudly in my office.  For an additional $200 I would be given the title Fellow of the American College of Plastic Surgeons.  There is virtually no training prerequisite.  These are meaningless titles.

The largest such board is the American Board of Cosmetic Surgery.  Their website has the audacity of implying that a “cosmetic surgeon” has specialized training above and beyond that of a plastic surgeon.  The criteria to become certified doesn’t have any teeth.  You have to be board certified in basically anything else (dermatology, oral surgery, OB/Gyn, family practice…) and send in an application.  There is actually a little more to it but not much.

Be very careful if your surgeon uses the term “cosmetic surgeon” at all.

There are dozens of cosmetic surgery boards.  There is only ONE board that certifies plastic surgeons.  The American Board of Plastic Surgery.  This is the only board that is recognized by the American Board of Medical Specialties.  The training requirements are strict.  The ethical standards are strict.  The cosmetic surgery training is balanced and complete.

It is downright sneaky how close to the “American Board of Plastic Surgery” some of these boards have come with their names.  An innocent patient when asking about the board status of a cosmetic surgeon could hear “yes, I am certified by the American Board of Cosmetic Plastic Surgery” and think nothing of it.  In fact, the name would imply that they are a sub-specialized plastic surgeon in the field of cosmetic surgery.  Purposely misleading.

It will unfortunately take a high profile death and exposure by mass media (think Oprah) before the general public will understand the difference.

Taxi drivers are excellent drivers.  Their license fortunately doesn’t allow them to fly planes.

Family practice physicians are excellent doctors (my dad is one).  Unfortunately, their license does allow them to do cosmetic surgery.   Some with poor judgement are attempting it.  Scary but true.


Bookmark and Share
Join the conversation: 3 comments
Tags: , , , .


Do breast implants cause stretch marks?

Published
on February 28, 2010
. 0 Comments

I have been asked a number of times if breast implants cause stretch marks.  My response has always been that it is certainly possible but I have never seen it.  I had a patient this week who actually did develop some stretch marks after breast augmentation.

She is in her 20’s and is a light skinned, petite, redhead who is now 4 months out from uncomplicated breast augmentation.  A couple of months ago she started developing a couple of stretch marks on her right breast.  Given her red hair and light skin these are quite pink and visible at this time.  Hopefully they will fade, I fully expect that they will.

Stretch marks are usually associated with elevated hormone levels at the time of skin stretching, which is why there are more common during pregnancy.  This patient interestingly has a long lasting implanted hormone for birth control.  I am certain this contributed to the development of stretch marks in her.

It is certainly not a common complication. I have seen dozens of patients previously with similar hormonal implants who had breast augmentation without stretch marks.

To prevent stretch marks, I would recommend that patients who are taking oral contraceptives or have implanted hormonal implants pay particular attention to skin moisturizers before and after breast augmentation.

Bookmark and Share
Join the conversation: No comments
Tags: .


The painful truth about “painless breast augmentation”

Published
on January 31, 2010
. 0 Comments

I often have patients who ask me if I do “painless breast augmentation”.  The truth is that there is no such thing as painless breast augmentation.  In my opinion, anyone claiming to offer pain free breast augmentation are being purposefully misleading.

I have seen patients for breast augmentation revision who originally had a “painless” breast enhancment who reported to me that the experience was otherwise.

Much of the pain after breast augmentation is due to the stretch of the tissues around and above the breast implants.  Larger implants and placement of the implants beneath the pectoral muscles can increase this pain.

Its not all doom and gloom, however.  There are some excellent “tricks” to help reduce the pain significantly.

  • Gentle tissue handling without tearing
  • Creation of the implant pocket with minimal cautery (burning)
  • The use of local anesthetics at the end of the procedure (pain pump vs long-lasting anesthetics)
  • Avoiding hematoma (bleeding in the implant pocket)
  • Use of conservative breast implant sizes
  • Placement of the implants above the muscle

I would not recommend placing the implants above the muscle for most patients.  There are too many advantages (shape and feel) with placement beneath the muscle.

Generally, using these tricks the pain is minimal to moderate, lasting a couple of days to weeks.  The average patient takes pain medications for 3 days after surgery.  I certainly have patients who report they take no narcotic pain medications at all.  Unfortunately, the converse is also true and I have patients who still need pain medications for 2 weeks after surgery.

Here is my advice to the patient concerned about breast augmentation pain:

  1. Choose a board certified plastic surgeon.  (You just want to do this once)
  2. Go into it expecting pain (I have found that these patients generally do better)
  3. Do seek out a plastic surgeon who is experienced in breast augmentation
  4. Do find a surgeon who places an emphasis on limiting your pain and down-time as much as possible
  5. Avoid any plastic surgeon who would claim “painless breast augmentation”.  What else are they misleading you about?
Bookmark and Share
Join the conversation: No comments
Tags: , , , , , , .


3D breast imaging – excellent option for breast asymmetry.

Published
on January 16, 2010
. 2 Comments

Most women have some degree of asymmetry in their breasts.  An important aspect of any cosmetic or reconstructive procedure is addressing and hopefully correcting asymmetries.

We have now been “live” with 3D imaging for a week and one of the things that I have been most excited about is its ability to measure and compare breast volume.  I have spent the past 12 years perfecting my skills at estimating breast volume and volume discrepancy between the breasts.  In one week, my office staff (with the assistance of the computer) is now better than I am.  Not quite, but you get the idea.

A few examples of the value of this tool:

1)  A patient presents for breast augmentation but the degree of asymmetry is severe.  The 3D imager will calculate her breast volume, breast dimensions and volume discrepancy between the breasts.  We can accurately choose implants of different fill volumes and dimensions for each breast that will best correct this asymmetry.  We can simulate the 3D image with these implants in place.   This truly is a game changer.

"Click" to see image rotate

2) A patient presents for breast reduction.  We can better calculate breast volume differences to help achieve postoperative symmetry.

3) A patient presents for breast reconstruction for breast cancer.  We can get dimension and volume analysis of the normal breast as a “template” for reconstruction.  This can help guide with implant selection to choose the proper implant for an ideal reconstruction.

4) A patient desires breast augmentation but is not sure whether she would benefit from a mastopexy (breast lift).  We can simulate the results with and without a lift.  This can help the patient understand outcomes in a way that is impossible for me to express with words alone.

Bookmark and Share
Join the conversation: 2 comments
Tags: , , , .


Plastic Surgery predictions for 2010

Published
on January 10, 2010
. 1 Comment

1.  The general public will learn that not all doctors doing plastic surgery are plastic surgeons.

There seems to be a growing number of non-plastic surgeons doing plastic surgery procedures.  I am not talking about botox, laser therapy, etc…  I am talking about major operations such as liposuction, breast augmentation, and facelifts.  This is at a critical mass and I think that the bubble is about ready to burst.  I predict there will be a high profile complication that will receive significant press.  This may even result in state or federal laws prohibiting unqualified physicians doing plastic surgery.

2. “Gummy bear” implants will be released in the U.S. but won’t become as popular as expected.

“Gummy bear” implants are used in Europe currently.  These may be approved by the FDA for use in the U.S. near the end of the year.  They are silicone implants with a more solid type of silicone than currently used.  The benefits are 1) shape control and 2) less risk of silicone leak.  The disadvantages are 1) increased cost, 2) firmer, less natural feel,  3) larger scar length and 4) possibility of an unusual breast shape if the shaped implant rotates out of position while healing.  I believe most physicians and patients will continue to prefer the silicone implants currently used.

3.  Cosmetic surgery will regain the popularity it had before the recession.

In my practice I have already seen a significant increase in demand.  I have heard this from colleagues in other parts of the country as well.  Failure of the “botax” cosmetic surgery tax to pass will help as well.

4.  More and more body contouring for weight loss procedures will be done.

Obesity rates continue to rise.  Similarly, dietary weight loss and weight loss surgery is more and more common.  These patients want to look as great as they feel.  Unfortunately, most have a significant amount of unwanted loose skin on the arms, abdomen, thighs, and breasts.

5.  Fat grafting for breast augmentation will gain popularity.

“Why can’t I just take the fat from my butt and put it in the breast?.  It is possible but is still a little controversial.  This is very time consuming (if done right) and can only give modest size increase.  A few new types of liposuction (most notably water assisted liposuction), allow more efficient ways to harvest large volumes of fat for grafting in the breast.

6.  Fewer autologous and more implant breast reconstructions will be performed

Breast reconstruction after mastectomy for breast cancer can involve implants or the patients own tissue (autologous).  A recent survey of female plastic surgeons reported that female plastic surgeons would prefer implant reconstruction if they needed a mastectomy.  Personally, I feel that I can get a better cosmetic result with significantly less risk to the patient with implant reconstruction.  This has always been a problem in patients requiring radiation as there is a high risk of implant hardening or deformity.  New radiation technology that more specifically radiates the breast tissue without radiating the implant will decrease this risk.

Bookmark and Share
Join the conversation: 1 comment
Tags: , .


3D photographic simulation now available.

Published
on January 7, 2010
. 1 Comment

I am proud to announce that we have completed installation of our new 3D imaging photography.  This should be up and running for next weeks consultations.  This equipment creates an unbelievable 3D image that can be rotated and manipulated in a variety of ways.

This produces a very realistic image of postoperative expectations, and is particularly useful for rhinoplasty and breast augmentation.

The software can accurately detect differences in breast size to help with precise correction of asymmetries.

Even more exciting is that a patient can visualize what their breasts would look like with a variety of implant shapes and sizes.  No more guessing.

Bookmark and Share
Join the conversation: 1 comment
Tags: .


Cosmetic tax out, tanning tax in.

Published
on December 19, 2009
. 0 Comments

Good news, it looks as if the cosmetic tax provision will be removed from the Senate health reform bill.  Instead, there will be a 10% tax on indoor tanning services to help pay the high costs associated with the health reform program.

UV exposure and tanning beds have been shown to be directly associated with most cases of skin cancer.  Similar to the tax on cigarettes, a tax on tanning could help to offset some of the medical expenses caused from its use.

I agree that taxing actions that contribute to the costs of health care makes sense.  But where does one draw the line?

Whats next, a Big Mac tax?  Obesity is a significant drain on health care costs, costing Americans billions of dollars yearly.

The good news for tanners is that the tax isn’t scheduled to start until, July 2010.  By then there should be plenty of good old fashioned, tax free sun!

Bookmark and Share
Join the conversation: No comments
Tags: , , .


Will my breast implants pop in a car accident?

Published
on December 17, 2009
. 0 Comments

Patients occasionally ask me about the durability of breast implants.  They are concerned that the implants may pop or fail if they get in an accident or fall.  Although anything is possible, usually a failure occurs in an implant that has been in for a long time and the shell wears out.  An earlier failure can be due to leakage at the fill valve or a “fold flaw” of the implant.  This occurs when the implant folds in its capsule causing a wear point.  This risk can be minimized by overfilling saline implants and creating the appropriate sized pocket relative to the implant.

I found this entertaining video from Mythbusters looking “scientifically” at the strength of breast implants.

Bookmark and Share
Join the conversation: No comments
Tags: , , , , , , , .


Discounted hotel rates for out of town plastic surgery patients

Published
on December 10, 2009
. 0 Comments

For patients considering traveling to Utah for plastic surgery we have made it even more affordable.  Click the out of town travel guide link to find special deals on local Marriott hotels offered only to Dr. Yates patients.

Bookmark and Share
Join the conversation: No comments
Tags: , , , .


Survey reveals that Americans oppose cosmetic surgery tax.

Published
on December 10, 2009
. 0 Comments

A recent survey conducted by the Opinion Research Corporation revealed that respondents oppose the proposed cosmetic surgery tax by a 52%-43% margin.  This number increased when the individuals polled learned that the majority of Americans that will be effected by this tax report a household income between $30,000 to $90,000.  This is a tax largely on women and the middle class.  For details of this study, click here.

Bookmark and Share
Join the conversation: No comments
Tags: , .


“Botax” to take effect January 2010

Published
on December 1, 2009
. 1 Comment

If you are considering cosmetic surgery, you may want to hurry as the costs are about to increase by 5%.  The new health care bill unveiled by the senate last week includes a 5% tax on all cosmetic procedures and surgeries.  This is an effort to help raise the funds required to extend health insurance to uncovered Americans.

Although I am in agreement that more money will need to become available if universal health care is to become a reality (a matter for another discussion), I am not convinced that this will have the desired effect.

I am concerned that there will be significant negative effects from such a tax.

There is already a cosmetic surgery tax in New Jersey, they have seen a significant decline in business as a result.

  • Many of these patients simply cross state lines to New York and other surrounding areas to avoid the tax.  Hopefully, we don’t find an increase in travel out of the United States to avoid these taxes.  This could lead to dangerous consequences
  • Many practices have been hit hard by the down economy and this could be a “third strike” that could force many out of business.

I am certainly happy to do my part and feel extremely lucky to be in the profession that I am in.  However, this tax seems to target moms wanting their bodies back and baby boomers unfairly.  My 2 cents.

Bookmark and Share
Join the conversation: 1 comment


Dr Yates Tummy Tuck Video is number one on Youtube

Published
on November 30, 2009
. 1 Comment

I have had more traffic than expected on my tummy tuck video that is hosted on Youtube.  Trying to figure out why I typed “tummy tuck” on the Youtube search bar and sure enough my video came up number one!

As a side, my blog posts are now interfaced with both Twitter and Facebook.

Bookmark and Share
Join the conversation: 1 comment


New tummy tuck videos on my website

Published
on November 11, 2009
. 2 Comments

Full tummy tuck video

Umbilicoplasty video (how to create the perfect belly button)

Bookmark and Share
Join the conversation: 2 comments
Tags: , , , , , , , .


Before and after photo update

Published
on November 4, 2009
. 0 Comments

I added a few new before and after photos specifically facelift, blepharoplasty and breast augmentation photos to the website.

Due to the popularity of my previous videos, I am going to add a full abdominoplasty video to the website this weekend.  Very suprising to me, currently my mini tummy tuck video ranks #2 for the world for the search for “tummy tuck” on youtube!  I am not sure why or how but I am thrilled.

Bookmark and Share
Join the conversation: No comments
Tags: , .


Water assisted liposuction (Body-Jet). The future of liposuction?

Published
on October 29, 2009
. 2 Comments

I recently attended the American Society of Plastic Surgeons meeting in Seattle.  I attend this meeting yearly to learn about new procedures and technology to keep up to date with my practice.

It seems like every year there are several new alternatives to liposuction or adjuncts to liposuction treatment.   In this post I will discuss a few of these and put my take on what this means for the current and future.

Laser liposuction (particularly smartlipo) is still pretty hot.  A small laser probe burns and destroys the fat and heats the skin.  The claims are that damaging the fat cells prior to their removal makes the suction more efficient and that the heating causes skin tightening.

Dr. Yates take – I think there probably is some skin tightening with the laser lipo.  The question is whether it is significant enough to be of any advantage to the patient and to justify the additional expense and costs to the patient for the technology.  I am still holding out for better data and hopefully a price reduction.

Ultrasound assisted liposuction (Vaser is currently the most popular) – The ultrasound helps to loosen the fat cells prior to their removal.  The Vaser liposuction uses less thermal energy than previous types of ultrasound assisted liposuction.   The claim is that the connective tissue is preserved allowing better skin retraction.  This is in distinct contradiction to what the laser liposuction folks are saying.  They have found improvement of skin retraction from not heating the skin but preserving the natural connective tissue which may be responsible for skin retraction.

Dr. Yates take – There may be something to this.  For me dense areas such as male breast development and the flanks may benefit from the additional “breaking up” of the fat cells prior to their removal.  As far as skin tightening, anatomically this makes some sense to me.  Again, I am waiting for better proof that this is not just a marketing tool.

Water assisted liposuction (Wet-Jet) -  This is probably the most exciting new liposuction modality for me.  A spray of anesthetic fluid is incorporated onto the end of the suction cannula.  The spray of fluid helps to loosen the fat cells prior to removal.  The claim is that the fat can be more efficiently removed and that large areas can be treated more easily and safely.  Much of the local anesthetic is removed as quickly as it is injected allowing for larger volumes of local anesthetic.  They claim that patients recover quicker with less swelling and bruising and with lower pain scores.

Dr. Yates take – I am looking seriously at getting this for my practice.  The theory behind it makes sense and I have heard from a few plastic surgeons using it that they are happy with it.  An additional benefit would be that it is a very easy method of harvesting fat for fat grafting in areas such as the face, buttock and for contour deformities.    I want to know that it is safe and works well before using it on a patient.  I will update my posts when I have new information.

Zerona laser – This is an external, completely non-invasive laser which supposedly penetrates the skin and melts the fat.  The fat is removed by the lymphatics.  The machine looks like an octopus.  The patient lies on a table and the machine does the work.  It is reportedly pain free with no down time.

Dr. Yates take – This would be absolutely the very best thing out there for the patient if it proves to be effective and safe.  The rep for the company told me that they have studies underway and that the results look good.  My concern is that the fat, cholesterol and lipids would potentially lead to early heart disease.  They said that the lipids have been looked at and there was no increase.  They also claim that there are MRI studies that show a reduction of fat.  I will wait for these studies before I comment on them.  My best guess is that the amount of fat removed will proove to be marginal and that several treatments will need to be done each at a significant expense to the patient.   Still exciting stuff, though.

Bookmark and Share
Join the conversation: 2 comments
Tags: , , , , , .


Breast reduction insuance question

Published
on October 11, 2009
. 0 Comments

Patient question

I am xx years old and in pretty good health: exercise regularly, etc. I am 5′8″ tall and weight 162 pounds. I have lived my whole life with too-large breasts and I am tired of the neck and shoulder and back pain and the headaches. I have researched a good deal and you have an excellent reputation. I am in Grand Junction, CO, so would need to drive either to Denver or Salt Lake City to see a surgeon that regularly does reduction mammoplasty. I wear a 36DDD and think a 36C would be about right. My questions are: – Can you arrange to do surgery without an advance visit, or is one necessary? – My insurance requires about 500 grams to be removed. Does it seem likely that I would have this much? (It isn’t clear to me from reviewing before and after photos) – given this information, how long would you estimate II need to be in SLC? – What days do you do surgery? Thank you in advance for whatever information you can provide. Also thank you for what seems to me to be an honest and forthright approach on your website.

Dr. Yates reply

It would not be possible to get an insurance authorization without a consultation.  There are a few criteria that must be met for an authorization for breast reduction.  You may have already reviewed these on my website.

One of the most critical components of this is the volume of breast tissue estimated to be removed.  The cup size alone is not enough for me to accurately estimate — this would require a consultation.  I would guess that your starting cup size of DDD would be large enough at your weight.  We would also need to make sure that I am contracted with your insurance.  Give my office a call next week so that they can look at the insurance information with you to help plan your next step.

Bookmark and Share
Join the conversation: No comments
Tags: , .


Medical tourism – is it safe?

Published
on October 6, 2009
. 1 Comment

Medical TourismMedical tourism is a fairly hot concept right now.  This involves travelling for surgery, often in an exotic location, and often at a significantly reduced price.  The U.S. is not the only country whose citizens  travel abroad for surgery.  In some countries with socialized medicine it may take over a year to get a hip replacement, for example.  People just can’t wait and look elsewhere.

As far as cosmetic surgery is concerned, the cost savings of a procedure is the major push towards medical tourism.

But is medical tourism for plastic surgery safe?

There are several reasons why travelling abroad for plastic surgery may be dangerous.

1)  There are many excellent plastic surgeons in other countries, no doubt.  In the U.S. there are also several bad plastic surgeons as well as physicians untrained in plastic surgery doing these procedures.  Fortunately, finding a good plastic surgeon in the U.S. is not a mystery, as it may be in another country.  Look for board certification (by the American Board of Plastic Surgery) and membership of the American Society of Plastic Surgeons.  There are no untrained physicians in this society.  In another country it may be much more difficult finding a qualified doctor.

2)  The safety standards are significantly more stringent in the U.S. than in most other countries.

3)  The follow up visits may be compromised by difficulty with travel.  A problem may not be recognized.

4)  Language barriers may impair effective communication.  You may not be getting exactly what you think you are.

5)  Long trans-continental flights immediately after surgery can increase the risk of blood clots in the legs.  This is one of the most dangerous post-operative complications that can occur.

6)  Some bacteria uncommon in the U.S. are common in other countries.  Travellers diarrhea and other travel related infections can add significant risk to the procedure.

7)  Revisional surgery is much more complicated than the original surgery and often more costly.  For example, you could find that in saving $2000 for your breast augmentation in Mexico, the cost for revision of a complication exceeds $10,000.

My advice is look at other options locally for cost savings

There may be some areas near your location, within the U.S. where the cost of plastic surgery is relatively cheap.   For example, I have many patients who travel from the west (particularly California, Nevada, Wyoming, and Idaho) to my office in Utah.  It is close enough to avoid long travels and to be able to keep up with the standard follow up schedule.  The cost saving for some of these patients may be 25 – 50%.  Not as cheap as Mexico of course, but still a significant saving.

Cosmetic surgery is elective surgery.  There is no rush.  The results (good or bad) can be permanent.  Do not make a poor decision to travel overseas for plastic surgery, there is just too much to loose.

Bookmark and Share
Join the conversation: 1 comment
Tags: , , , , .


Utah plastic surgeon is top keyword used to find this website

Published
on September 30, 2009
. 1 Comment

The internet is fascinating.  The amount of information that is available to us at the click of a button is amazing.

Ten years ago if a patient was looking for a plastic surgeon they may have looked in the phone book.  How do you pick a good plastic surgeon from a phone book ad?  Look for the prettiest ad?  Just pick the full page ad?

Along came the internet.  Many of the patients that I see in consultation have been to my website prior to their visit.  Here a patient can find additional information about me and the procedures that I perform.  The patient can feel at least somewhat comfortable walking into the consultation.

It is interesting to see how patients find my website.  The most commonly searched keywords include my name in them.  The other most common keywords used to find my website are (in order of popularity) utah plastic surgery, breast reduction photos, breast augmentation photos, mommy makeover cost, utah breast augmentation, mini tummy tuck video, tummy tuck photos, mini abdominoplasty, plastic surgery utah, mini abdominoplasty photos, breast augmentation utah, plastic surgery financing, and utah plastic surgeons.

Many of the next 20 keywords searched are “photos”.   Other than my home page, the pages that are most visited on my website are photos pages.  People love the visual and feel they can gain a lot from the before and after sections of websites.  That is just something you cannot display in a bilboard, newspaper ad, radio, T.V. or a phone book.

Bookmark and Share
Join the conversation: 1 comment
Tags: , , , .


Latisse for eyelash enhancement

Published
on September 22, 2009
. 2 Comments

blepharoplasty imageLatisse was released this year for both lengthening and darkening of deficient eyelashes.  My experience thus far has been very positive.  The patients (inclucing my wife) who have used the product have been very satisfied.  The biggest problem with the product is that it is fairly expensive and when you stop using it the results go away fairly quickly.

The risks of Latisse are minimal but include skin irritation, iris pigmentation and bacterial infections of the eye.  The FDA recently issued a warning to Allergan, the manufacturers of Latisse regarding their failure to adequately express these risks in their advertising.

Latisse cannot be purchased in a physicians office in Utah as it is a prescription medication.  It can only be distributed through the pharmacy.

Bookmark and Share
Join the conversation: 2 comments
Tags: , , , , , , .


Summer vacation

Published
on September 21, 2009
. 0 Comments

I have been on a several week hiatus from blogging.  I know this is a blog about plastic surgery but wanted to share a couple of pictures from my trips.  I was gone for basically 3 1/2 weeks.  By far the longest vacation I have ever taken in my life.  It just worked out that two vacations planned a year in advance were back to back.

I went to Greece with my wife and a couple of friends, without the kids.   We went to Athens, Mykonos and Santorini.  By far my favorite was Santorini, it was just amazingly scenic.  Mykonos was nice but a little too “night life”.  Athens was historic and clean for a big city but not terribly relaxing.

A week later we drove the California and Oregon coast from San Francisco, California to Portland, Oregon. We are big University of Utah football fans and usually try to do at least one good road trip each year.  Three years ago was North Carolina, two years ago was UCLA in the Rose bowl and last year was Michigan and New Orleans for the Sugar bowl.

Bookmark and Share
Join the conversation: No comments


Can I breast feed with breast implants? Is it safe?

Published
on September 1, 2009
. 0 Comments

breast-augmentation-23aThe value of breast feeding for the developing infant is well known. In general, women who consider breast augmentation are of child bearing age, so this comes up fairly frequently. Women are understandably concerned that choosing to have a breast augmentation will affect their ability to breast feed or that it may be dangerous for the child.

The truth is that breast feeding can be affected by breast implants, although unlikely. The inframammary (crease) incision does not involve division of any milk ducts or glandular tissue and these risks can be minimized with this incision choice. The incision around the nipple involves the division of some of the milk glands and is more likely to be a problem. That said, with either incision breast feeding is very likely to be successful with breast implants.

Studies have looked at the risks to the baby with breast feeding with breast implants. This has been aggressively studied and no risks have been identified. I can safely say that it is safe to breast feed with breast implants.

I have found that some women with breast implants choose not to breast feed. I suspect this percentage is higher than that of the general public. My assumption is that there is fear that breast feeding will “ruin” the results. It is true that pregnancy can cause droop of the breasts. This can occur whether on not the patient has had an augmentation. However, there was an interesting study about 3 years ago that determined that pregnancy affected the breasts similarly with or without breast feeding. My experience would suggest otherwise, but an interesting study nonetheless.

Bookmark and Share
Join the conversation: No comments
Tags: , , , , , .


Breast feeding and sensation changes with an incision around the nipple

Published
on August 2, 2009
. 0 Comments

Pt. Query:

Hi there! i’m looking at getting a breast augmentation. I love all of your before and after photos and have seen alot of good reviews online. However, when i called, the soonest they could get me in for a consultation is in three weeks, the busiest doctor i have seen/called so far. I am concerned with how busy you are and am curious how hard it is to get in after the surgery. Also what are you experiences with going through the nipple and sensitivity and breast feeding? thank you for you time!

Dr. Yates Response:

Don’t worry about the followups we are very accommodating.  The scheduling line is not allowed to double book our appointments so that we have some ability to see people that need to be seen.  Call and talk to one of my assistants and I am sure they can get you seen sooner than 3 weeks.  (801) 773-4840 ext 3441.

Regarding the areolar incision, there is a greater likelihood of problems with sensation and breast feeding and if these are an issue at all I would recommend the crease incision.  The percentage of risk is somewhere around 5-10% for sensation and 15% for breast feeding.

Bookmark and Share
Join the conversation: No comments
Tags: , , , , .


Where to place the scar in breast augmentation?

Published
on August 1, 2009
. 1 Comment

breast-augmentation

Patient question:

Hi Dr. Yates, You do great work. What incision you prefer and why? Do you think periareolar incision has a higher chance of loosing nipple sensitivity? I saw most of your example are crease incision. Please also advise the BA fee, saline & silicone. Thank you.

Dr. Yates Reply:

Personally, I think of the three major decisions: 1) type of implant, 2) size of implant, and 3) location of scar, that the scar location is by far the least important.  As I am sure you have read I do not prefer the armpit or belly button incisions for their lack of accuracy, leaving the periareolar and crease incisions.  I used to believe that the periareolar incision had the opportunity to hide better because of the anatomic boundary between nipple and skin that you could hide the scar.  I think the crease is even a better anatomic boundary.  However, If the crease incision starts at the crease it usually ends up a little above it on the breast which is not desired.   It does take some skill and experience to allow the final scar to END UP at the crease.

Yes there is a slightly higher risk of issues with nipple sensitivity and also breast feeding with the periareolar incision.

The cost of breast augmentation in my office is $4100 for saline and $5200 for silicone.   My fee has not changed substantially in 6 years and it will likely increase at the first of the year when I audit my fee schedules.

Bookmark and Share
Join the conversation: 1 comment
Tags: , , , , , , , , , , .


Travelling for plastic surgery

Published
on August 1, 2009
. 0 Comments

Patient Query:

i just have a couple of questions. if i got breast augmentation done in utah how long would i have to stay for? would i have to come back for a check up? and if anything went wrong, such as they didn’t drop of any other complications how do you handle that?  [I am from] hawaii… so its really out of town ha but thats good.  My main concern was not having to come all the way back for the check ups

Dr Yates Response:

Generally I would have you stay in town for a couple of days.  I would see you the day after and the usual f/u schedule is 3 weeks, 3 months, 6 months and 1 year.  The 3 week appt. is the most important.  If there are problems, I may need to see you more frequently although this would be extremely unusual.  Although I always prefer that you keep all of the appointments, in reality many out of town patients email me their update for the 3 month and 6 month visits to save a visit.  (there is not much more than a quick check of scar and implant position for those visits).

Bookmark and Share
Join the conversation: No comments


What is the HCG diet?

Published
on July 31, 2009
. 1 Comment

I have had a few patients ask me recently if I offer the HCG diet.

The answer is no.  At this point it is experimental, unproven and possibly dangerous.

The 500 calorie/ day is too restrictive to be healthy.  Messing with fertility hormones (HCG) makes no sense.  The body has a delicate balance of hormones and adding synthetic hormone has consequences.

We all want an easy way out but the same rules for weight loss apply today as they always have.  The formula is simple and we all know it.  Healthy eating + exercise = weight loss.

Bookmark and Share
Join the conversation: 1 comment


Should I wait until I am done losing weight for a breast reduction?

Published
on July 30, 2009
. 0 Comments

I receive several emails per day from interesting patients with good questions.  I always respond personally to these e-mails.  I have decided to add a new feature to my blog, including some of these questions and answers.  Easy for me because I am answering the question anyway and hopefully helpful to other patients who may have similar questions.

Patient question:

Hello Dr. Yates, I am interested in having breast reduction surgery. But as most probably are, I am very nervous about surgical procedures. I have read over and over again how this surgery works and feel comfortable with the information i have gathered. I have a lot of lower back and neck pain. And I really just want to improve my quality of life. I am currently overweight but am losing weight as I have changed the way I eat, and exercise. What are the chances that as I lose weight, my breasts will become smaller? Would it be better to wait and see after i have lost more weight? I also enjoy running and doing active things, but cannot because my breasts just get in the way. They have been large throughout all my teenage years and have stopped me from doing so many things that I have wanted to do. Please Help! Thank you!

Dr. Yates reply:

Your breasts certainly may get smaller with weight loss, everyone is different.  If your experience is that they fluctuate in size significantly with weight changes then there is a good chance that they will get smaller and you should wait.  For many individuals with large breasts, the size and weight of the breasts keep them from exercising and loosing weight.  This may be a good reason to proceed sooner if you feel you fit into this category.

Bookmark and Share
Join the conversation: No comments
Tags: , .


Botox without needles

Published
on July 30, 2009
. 2 Comments

Unless you have been living in a cave, it should be no supprise that botox is an injectable medication that helps improve certain types of wrinkles.  Other than the cost, one of the most problematic issues for patients is the needle.  Most of us just don’t enjoy getting stuck.

Hope is on the horizon.  There is a new topical non-injectable form of botulinum toxin has shown promise in phase II trials.  The medication is manufactured by Revance Theraputics Inc and involves a “carrier” protien to move the medication through the skin to the site of its effect.

The future of botulinum toxin for treatment of wrinkles, hyperhidrosis (excessive sweating), and possibly (but not proven) for hair loss may be as simple as application of a cream.  However, don’t line up at your plastic surgeon or dermatologists office just yet as it is not yet FDA approved.

Bookmark and Share
Join the conversation: 2 comments
Tags: , .


New silicone breast implant size options now available

Published
on July 23, 2009
. 0 Comments

The Mentor corporation has announced more options in their already excellent selection of memory gel silicone implants.

Silicone MemoryGel Breast Implants

Smooth round memory gel implants by Mentor are my current preferred choice for silicone implants.  I received a fax from the company yesterday that they have manufactured eight new size options.  Two of these are in high profile implants 475 cc and 750 cc.  Four of these are in a moderate plus profile 425 cc, 475 cc, 525 cc, 575 cc, 650 cc and 750 cc.

As opposed to saline implants, silicone implant come pre-filled.  Previously silicone implants came in 25 cc intervals starting at 100 cc to 450 cc in high profile and 400 cc in moderate plus profile.  Above that, the implants came in 50 cc intervals to 700 cc.  This meant that for patients choosing implants above 400 cc they would have to jump up considerably to the next size.  These new implants fill in some of the gaps giving patients and plastic surgeons more options.  Good job Mentor, but what took so long.

Bookmark and Share
Join the conversation: No comments
Tags: , , , , , , .


Can you believe online testimonials?

Published
on July 15, 2009
. 1 Comment

Yesterday, news about the big box face lift company “Lifestyle lift” fraudulent online testimonials led to a $300,000 settlement.  Apparently the company was trying to balance its negative online reviews by asking employees to pose as satisfied customers and writing raving reviews.  For the complete story click here. I don’t have any specific comments about this company.  The only Lifestyle lift surgeon that I know is actually a well trained plastic surgeon.  The purpose of this blog is not to rub it in but rather to discuss online reviews.

Wherever there are anonymous reviews there is the risk of deceit.  In this case apparently some of the reviews posed as individuals with names.

Personally, I have a number of members of my own staff who are happy customers but my ethics would not allow them to post a review of me or my practice.  There is simply too much conflict of interest.  My belief is that doing a good job and trying to make patients happy is all that I can control.  Good reviews should be the reward for a job well done.

On a positive note…I have read some of the reviews of plastic surgeons in Utah and for the most part those with the best reviews I would consider some of the best plastic surgeons.  The same can be said for some of those with poor reviews.

I would like to believe this is an isolated event and is not happening elsewhere.  Hopefully, this settlement will disuade people from tooting their own horn.

Bookmark and Share
Join the conversation: 1 comment
Tags: , , , , , , .


How long do plastic surgery procedures last?

Published
on July 14, 2009
. 1 Comment
squared circles - Clocks by Leo Reynolds

I am often asked how long the results of plastic surgery and cosmetic surgery last.  This is very procedure specific with some procedures only lasting a couple of months while others last a lifetime.  Some procedures give a patient a significant benefit for the rest of their life although the results may be diminished over time.

Procedures with results that generally last a lifetime with little change over time:

  • Rhinoplasty
  • Otoplasty

Procedures with benefits that last a lifetime but changes can be expected over time:

  • Breast augmentation – implants can fail over time requiring replacement (most commonly from 10 – 20 years).
  • Breast reduction – Breasts remain lifted relative to where they would be otherwise but time and gravity do not stop.
  • Breast lift-  see breast reduction
  • Facelift- Face remains improved relative to what it would have been but time and gravity do not stop
  • Liposuction – The fat removed is gone for good but additional weight gain can lead to loss of some of the improvement
  • Tummy tuck – there is generally very little change over time outside of weight gain and pregnancy
  • Eyelid surgery – The aging process doesn’t stop

Procedures that are expected to loose results with time:

  • Botox – about 4-6 months
  • Soft tissue fillers – 6 months to 2 years depending on which filler is used and the location

Other than the procedures that are designed to last only a few months, basically all plastic surgery procedures have very long term results.  Because of this, it is extremely important that patients choose their plastic surgeon very carefully.

Bookmark and Share
Join the conversation: 1 comment
Tags: , , , .


Was Diprivan (Propofol) involved in Michael Jackson’s death?

Published
on July 5, 2009
. 1 Comment

The circumstances of Michael Jackson’s death are not entirely known.  One of the possible causes has been speculated as Diprivan overdose.  Diprivan (Propofol) is a powerful anesthetic that is used by anesthesiologists for anesthesia during operative procedures.  It is referred to as “milk of amnesia”.  With proper monitoring and administration by an anesthesiologist, this is a very safe medication.  In fact, it is one of the medications that I use most frequently for cosmetic surgery in my office operating room.

I find it quite peculiar that Michael Jackson may have overdosed on Diprivan.  There is very little “high” or euphoria associated with this medication.  Most patients wake up feeling well rested and relaxed initially but nearly all of its effect wears off rapidly.  I have never heard of the medication being used as a drug of abuse.

Nonetheless, several bottles of Diprivan were found at his residence prescribed by as many as five unknown doctors.  I hope they loose their licenses to practice medicine as this medication has no buisness being used outside of a medical facility.

Bookmark and Share
Join the conversation: 1 comment
Tags: , .


Is there such a thing as “scarless” cosmetic surgery

Published
on June 28, 2009
. 6 Comments

There is a lot of hype about “scar-less surgery” and unfortunately a lot of misinformation as well.  I will try to clarify scarless surgery a little.

Scarless surgery can be classified as:

  • Fetus surgery – interestingly, fetal surgery does not heal with scarring.  There are a lot of theories about why this is true and something that medical science is trying to understand.  Hopefully someday we will learn the secret and scarless surgery can be a reality.  As I can safely assume that none of my readers fit this category I will move on.
  • Scars that are much shorter than customary for a given procedure.  (But not truly scarless)
    • “scarless breast reduction” involves very small (3-5 mm) incisions for liposuction of the breast.  The scars are very short and well hidden but there ARE scars.
    • “scarless facelift” -  endoscopic facelift through shorter than customary incisions.
  • A non-invasive approach to a procedure.
    • “scarless breast augmentation” with fat grafting
    • “scarless facelifts” with laser skin tightening or fat grafting.
    • “scarless rhinoplasty” – Soft tissue injectable for correction of nasal defects.
  • Incisions through tissue other than the skin.
    • This is hot in general surgery right now.  Weight loss surgery through the stomach endoscopically by the way of the mouth for example
    • No great examples of this in cosmetic surgery.
  • Scars placed away from the operative site
    • another version of “scarless breast augmentation” or TUBA is the placement of breast implants through the navel.  The scar is actually just as long or longer than the standard approaches it is just on the abdomen.  I do not favor this approach for a variety of reasons.  I blogged about it a few weeks ago http://www.yorkyates.com/breast-implant-scars/

Confusion lies in the variety of procedures that have a number of versions of “scarless” surgery.

In my opinion, for the appropriate patient “scarless breast reduction”  and  “scarless facelift” with endoscopic lift or fat grafting have some value.  “Scarless breast augmentation” with fat grafting will likely prove to be a fringe ‘fad’ in plastic surgery.  “scarless breast augmentation” with TUBA is inaccurate and in no way solves the problem with scars in breast augmentation.

Bookmark and Share
Join the conversation: 6 comments
Tags: , , , .


Laser liposuction

Published
on June 26, 2009
. 9 Comments

Laser by mrebert

Laser liposuction is the hot new thing in liposuction, body contouring and fat removal.  It may even be the hottest thing we have ever seen in liposuction.  This only seems to be gaining popularity.  Add a laser to anything in medicine and the average consumer instantly assumes it must be better.  I don’t know how many times I have been asked if I am going to make an incision with a ‘laser’ for a procedure.  An absurd idea!

As a plastic surgeon who considers himself well versed in the world of cosmetic surgery it leaves me scratching my head a little.  How has this gained so much momentum?  Is it that it really does something significant that traditional liposuction can’t, or is this just fabulous marketing?

There are dozens of new fads each year.  About 90% fizzle out as the flaws become exposed and 10% “stick” and are shown to have real value.   This 10% is what most plastic surgeons incorporate into their practice.    There is a small minority who try everything new, try it out on as many patients as they can and jump ship when the problems arise.  Not me!

I reviewed websites and literature of several of the more common laser lipo platforms including smartlipo, slimlipo, Lipotherme, cool lipo, and LipoLite.

These manufacturers claim there are several advantages of laser lipo:

  • “can be performed in an office-based setting while the patient is awake. No longer is it a requirement that patients be put to sleep using general anesthetics nor do they need to be admitted to the hospital for the procedure” – www.smartlipo.com
  • Skin tightening
  • Smoother skin
  • Less downtime
  • Less pain
  • Increased safety
  • Quicker procedures

A little lesson on the difference between laser liposuction and traditional or tumescent liposuction is in order.

  • The steps in traditional liposuction include: 1) sedation, 2) injection of numbing solution (tumescent fluid), 3) Removal of fat through small canullas.
  • The steps in laser liposuction include: 1) sedation, 2) injection of tumescent fluid, 3) laser treatment of fat, 4) Removal of laser treated fat.

The laser damages the fat cells before they are removed.  The heat generated from the laser is reported to cause skin tightening.

I have always been dissatisfied with the amount of skin tightening that can be achieved with traditional liposuction.  The reported benefits of skin tightening with laser liposuction is a very interesting for me.  Of course, training in Missouri I am a “show me” kind of person so I tried it out.

First hand experience with laser lipo!

This week I had a rep. from one of the laser liposuction manufacturers bring a unit for me to demo.  The patient was scheduled for liposuction of the abdomen, upper hips, back, and inner thighs.  We discussed the possibility of laser liposuction of her abdomen to help encourage loose skin to contract.  I REALLY wanted that skin to contract.  If it would have I probably would have been so happy I would have purchased the $90,000 unit on the spot.

Unfortunately the experience was otherwise.

  • Skin tightening? – There was NO early skin tightening.  Time will tell if this occurs later.  (I will update you in a couple of months)
  • Quicker recovery? – Although the claims are made that there is no down-time.  The fine print and discussions with the rep. would suggest otherwise.
  • Pain? – The pain was significantly greater, the patient reported it  felt like it was “burning”.  The areas treated with traditional liposuction were much less painful.
  • Speed of procedure – The addition of the laser adds an extra step which takes a significantly longer time (about double the procedure time)
  • Safety – Liposuction is only as safe as the skill level of the doctor performing the procedure.  If anything laser liposuction is less safe as there is the potential from skin burns from the heat of the laser and more sedation is necessary from the increased pain.

There are a few definite disadvantages to laser liposuction

  • Very few experienced plastic surgeons are using it.  A “cosmetic surgeon” is not the same thing.  (see other posts)
  • It is more expensive.  The machine is expensive, additionally there is $250 of disposable laser equipment on average for each procedure
  • More pain (my first hand experience)
  • Longer procedures (more risk)

Don’t believe the hype

It felt a little like test driving a Ferrari without a motor.  It looked really cool but didn’t really do anything.

Let me repeat.  I really wanted to find that this lived up to all of the claims.  It would be a fantastic tool and would solve the problem of patients with loose skin.

I have no vested reason to “bash” laser liposuction or any of these companies.  I didn’t report which machine I used for a reason.  The gentleman was quite pleasant and honest with me about the shortcomings of laser liposuction.  He said the major reason to use this technology is that with all of the marketing, patients are lining up for the procedure.  My motivation for writing this is only to be the balancing “voice of reason” from someone who is not trying to sell their product.

According to the American Society of Plastic Surgeons, “The only study that has scientifically compared this to standard liposuction has found no differences between these techniques in terms of the results.”

As far as I know, there are no plastic surgeons in Utah doing laser lipo at this time.  Competitively, there is a fortune to be made.

The business man in me would love to do just that.

The responsible doctor in me just won’t allow it.

I will update the progress of my patient in a couple of months.  If there is skin retraction to a significant degree expect my next post to be about the new laser liposuction equipment I have just purchased.  Don’t hold your breath!

Bookmark and Share
Join the conversation: 9 comments
Tags: , , , , , , , .


Dysport may prove to be no cheaper than Botox

Published
on June 17, 2009
. 3 Comments

With the announcement that Dysport received FDA approval a few weeks ago, I have been hoping that the price point would be significantly less.  Botox is around $450 for a 100 Unit vial.  Dysport is around the same price for a 300 Unit vial.  Dysport is around 1/3 the price per unit.  However, Dysport is approximately 1/3 as potent as Botox.  So the cost to the consumer looks like it will be roughly the same.

Bookmark and Share
Join the conversation: 3 comments


Common sense would be a good first step towards health care reform

Published
on June 17, 2009
. 0 Comments

I was watching president Obama talking about the health care “crisis” today and couldn’t help but think of the patient I saw today about breast reduction.

She is hoping that her insurance, PEHP, would pay for it.  She is a deserving patient with significant problems with back and shoulder pain associated with the weight of her breasts and it is reasonable that her insurance should pay for it.

She has a unique type of insurance that pays 50% for surgical procedures.  We discussed going to the Davis Surgical Center (where I do most of my outpatient surgeries) where the total facility cost was going to be around $2500.  Quite reasonable I thought.  Unfortunately, we found out that her insurance did not have a contract with the surgical center and this had to be done at the hospital.  The total facility cost we were quoted was $12,000 at the hospital.  Nearly $10,000 more than the surgical center.

The problem is not with the surgical center.  They bend over backwards to try to get insurance contracts.  The problem is with the insurance companies.  At the surgical center they would pay 50% of the $2500 vs. 50% of the $12,000.  I am no accountant but that seems like a no-brainer.  Somewhere someone is padding their own pockets.

Of course being resourceful, we have decided to instead do the procedure in my office operating room for approximately 1/3 of the total cost at the hospital without her insurance involvement.

Just what the insurance company was hoping for!

Bookmark and Share
Join the conversation: No comments
Tags: , .


Breast augmentation scars

Published
on June 15, 2009
. 2 Comments

Accuracy is the key

There is a lot of discussion at the time of breast augmentation consultation regarding the scar.  In my opinion “where is the best place to hide the scar?” is an important question but an even more important questions is “through which incision is breast augmentation most accurate?”

There are three main incisions for breast augmentation, around the nipple, under the breast crease and in the armpit.  There are two other uncommon incision choices, through the belly button (TUBA) and through an abdominoplasty incision.

Implant pockets must be symmetric

The most important variable that determines the outcome of breast augmentation is the quality of the implant pocket created.  For perfect results, these pockets have to be perfect.  Not just close.

Although no plastic surgeon (including myself I hate to admit) could ever expect to achieve a perfect result every time, the odds are much better through incisions close to the implant pockets.   Those being the crease incision beneath the breast and the incision around the nipple.  The other incisions are great in theory but just not as accurate.

Rather than assessing the pocket size, spacing and symmetry with the surgeons gloved fingertips simultaneously, the pockets are assessed individually with a long instrument.

Imagine the task of simply writing your name.  The armpit incision would be the equivalent of holding the end of a 3 foot long pen.  The belly button incision would be the equivalent of a 10 foot pen in the dark.

Breast incisions are more accurate

The scars around the nipple and under the fold heal very well and are generally not bothersome to patients.  For saline implants, they are about 1″ long, for silicone about 3″.  If they are well placed they hide very well.  I do not charge for scar revisions and can count the number of these scars I have had to revise on one hand!

Bookmark and Share
Join the conversation: 2 comments
Tags: , , , , .


“Branded” facelifts only as good as the surgeon performing the operation

Published
on June 7, 2009
. 1 Comment

facial rejuvenation photo

There are a number of facelift operations that have branded themselves and advertise their brand heavily.  Lifestyle lift and quick lift are two of the more common.  Patients are often looking for surgeons with a “magic procedure” that can improve techniques with decreased downtime.  To be sure, surgeons are looking for this recipe even harder.  In the case of facelifs, although these procedures tout themselves as being better or equivalent results to standard facelift procedures with less expense and downtime, buyer beware.  It should be the surgeon that attracts a patient, not a procedure.  The results of a procedure are only as good as the surgeon behind it.

There is an exellent review of these procedures at  http://www.ocala.com/article/20090604/ZNYT04/906043023?Title=A-Face-From-an-Infomercial

Bookmark and Share
Join the conversation: 1 comment
Tags: , , , , , .