Breast Implants: Consideration #1: How to Find the Right Doctor

Finding the right doctor can be tricky.  By some estimates, there may be as many as 60,000 doctors in the United States who perform some type of cosmetic surgery.  However, there are only 6,000 Board Certified Plastic Surgeons!  Therefore, 90% of cosmetic physicians do not have formal training in plastic surgery.

I have blogged about this topic before:  http://www.pickartplasticsurgeryblog.com/2008/03/10-questions-to.html#more.  At a minimum, you should ask your physician the following questions:

1. Are you certified by the American Board of Plastic Surgery?

2. What training did you have after medical school?  Was it actually plastic surgery?

3. How many breast implant surgeries do you perform each year?

4. What hospitals do you work in?  Where do you admit your patients?

5. If you prefer to operate in your office or ambulatory health care facility, is it accredited?

6. Who administers the anesthesia?  Is this person a Board Certified Anesthesiologist?

7. What do you do if there is a complication?

8. What's your financial policy for complications?

9. Are you academically affiliated?

10. Is the state medical board investigating you for any complaints or malpractice suits?

But sometimes, even the right credentials are not enough....

Pamela Anderson Has the Best (and Worst) Breasts

Paradoxical results from the International Society of Plastic Surgeons:

• When plastic surgery patients are asked, "Which celebrity has the best breasts?" Pamela Anderson tops the list.
• When plastic surgery patients are asked, "Who has the worst breasts?" Pamela Anderson also tops the list.

 

Obviously, some people like "the fake look," and others hate it.  Nobody seems to lack a strong opinion!

The tops of the 2 lists:

    The Best:

1. Pamela Anderson
2. Britney Spears
3. Xuxa (Brazilian singer)
4. Gisele Bundchen

    The Worst:

1. Pamela Anderson
2. Dolly Parton
3. Victoria Beckham

Who Gets Botox and Plastic Surgery? Regular People!

My practice is in Ventura, California--70 miles away from Los Angeles.  However, my high school and college buddies always assume that my patients are more Beverly Hills and less Ventura County.

I repeatedly explain how "normal" are my patients, but I'm not sure that my statements ever get through.  However, now I have some research to back myself up.

The Aesthetic Surgery Education and Research Foundation (ASERF) recently reported what I have always known.  Plastic surgery patients are regular people.  Typical plastic surgery patients tend to be...

• women
• between 41 and 55 years old
• usually married
• with 1-3 children
• almost always employed
• with a household income < $100K

Oh, but those ladies must stuck-up, over-sexed, or crazy--just like on Nip/Tuck.  Wrong...

• Philanthropy and charity tend to be high priorities.
• Exercise and healthy eating are part of their routines.
• Most disdain the "unnatural" look of many Beverly Hills matrons.
• Their typical goals are to look "fresh," "less stressed," "more relaxed," and "rejuvenated."

In fact, most of these patients are comfortable enough with their procedures to talk about them freely...

• Nearly 9 out of 10 openly discuss Botox and injectable treatments.
• 7 out of 10 receive support from the people they have told.

So, let's put to rest the myth that Hollywood and corporate wives are the only plastic surgery patients.  Even if you don't believe me, believe the ASERF demographic data.  It is true that plastic surgery has become mainstream and acceptable for regular women (and men!).

Package Deals in Plastic Surgery: Why They Make Sense

I have increasingly seen advertisements for plastic surgery "packages":

• New mommy makeovers:
  • Breast enhancement
  • Tummy tuck
  • Liposuction

• Surgical facial rejuvenation:
  • Browlift
  • Eyelids
  • Facelift
  • Necklift

• Non-surgical anti-aging:
  • Fotofacial/intense pulsed light lasers
  • Botox or Dysport
  • Fillers (like Juvederm, Restylane, Radiesse, or Sculptra)

My wife has been skeptical.  "Aren't those packages just gimmicks to sell additional services?"

Yes, but that's a good thing.  These bundled procedures do work well together.  Combining services can lead to results that are greater than the sum of their individual parts.

Consider the "new mommy makeover."  All women know that pregnancies and breast feeding cause both the breasts and the abdomen to swell.  In many women, the skin never snaps back to its pre-pregnancy elasticity.  Lifting or augmenting the breasts makes the chest look great.  However, the whole torso is not balanced until the tummy is also flattened and tightened.  So, combining breast enhancement with a tummy tuck does produce the best proportions.

Non-surgical solutions can also be performed concurrently to optimize results.  For example, the "11's" between the eyebrows will usually respond to Botox or Dysport; a 60-80% improvement is typical.  However, for some patients, 60-80% is not good enough; they want 90% erasure of the wrinkle.  So, adding a little bit of filler beneath the relaxed wrinkles (such as with Restylane or Juvederm) can nearly eradicate the 11's.

Fillers can even be used to enhance a surgery.  Everybody knows that a face/neck lift can improve the cheeks, jowls, jaw line, and neckline.  However, the area around the mouth is usually not rejuvenated.  So, I will often recommend Restylane or Juvederm to minimize the "smoker's lines" radiating from the lips.  Combining these fillers with the face/neck lift can produce the most harmonious result.

Gravity is Over-Rated in Facial Aging

At a recent plastic surgery conference in Paris, most physicians admitted that we have been wrong.  Gravity is not the primary cause of facial aging.

Surely, as the face ages, muscles and ligaments do grow more lax.  Therefore, the skin is definitely subjected to the vicissitudes of gravity.

• As we age, the eyebrows do tend to descend--by a few millimeters.
• 3% of aging patients have a downward movement of the corners of the mouth--by 1-2 millimeters.
• In many patients, the upper lip does tend to lengthen.

"Just a few millimeters?  And just 3%?!  Then, why do I look so old?" you might be thinking.

Here are the real reasons why the face ages:

1. volume loss (wasting of fat and osteoporosis of bone)

2. repeated contractions of facial muscles (muscle hyperactivity)

3. skin damage (especially from sun and tobacco)

While the eyes of an observer may perceive significant downward movement in facial structures, objective measurements do not support these common assumptions.  What we are seeing is a combination of cutaneous aging and structural aging that gives the illusion of descent.

Since gravity is not a primary cause of facial aging, should you cancel your lift?  Not necessarily.  Sometimes, a surgical lift does give a great result, even if it is not addressing the issue of aging entirely appropriately.  Plastic surgery is, in truth, as much art as science, and sometimes art does trump science!

However, with this new information, I am going to recommend to my patients in Ventura that they consider...

1. more fillers (especially Sculptra) to increase the facial volume
2. more muscle relaxants (like Botox and Dysport) for over-active muscles
3. more skin care and lasers to minimize skin damage

My Beautiful Mommy: Explaining Your Plastic Surgery to Your Kids

I do feel bad for Dr. Michael Salzhauer.  He is the Board Certified Plastic Surgeon who authored My Beautiful Mommy, the much maligned children's book which explains cosmetic surgery to patients' 4-8-year-olds.  To hear the television pundits, you would think that he was single-handedly responsible for foistering unrealistic body images on our nation's elementary-school kids.

While Dr. Salzhauer probably didn't realize that his book would stir up such a cultural maelstrom, I am glad that the ensuing controversy has created a forum for discussing plastic surgery with the under-10 crowd.  Certainly, grade-school children are concerned when their mothers are gone for a day or two, and then return with bruising and bandages.  Children under 10 are very concrete, and they need to know that their mothers are safe and are making rational choices.  Having an honest conversation with children, both before and after any procedure, is helpful for their understanding.