The Best of Silicon Valley

Go Duet! Thank you to everyone who nominated us for the "Best Plastic Surgeon in Silicon Valley 2010" - what an honor.

Vote for us here!

Bab(i)es, Botox, Brouhaha

Probably too young for Botox... Photo courtesy of Maggie Smith

We saw last month the first inkling of the young Glee star admitting to using Botox, now fleshed out into a broader story in this week's NY Times article. Does this represent the early days of a growing trend: cosmetic procedures and surgeries for teenagers becoming commonplace? I think it's interesting how casually some folks are reacting to the news, even comparing it to teens who wish for and receive rhinoplasty (and that's a whole other can of worms...).

And over here, the actress Teri Hatcher (of Lois and Clark and Desperate Housewives television fame) apparently tired of the criticism that she had too much Botox and plastic surgery, posted photos of herself grimacing delightfully in her bathroom mirror.

Botox: it's not for everyone.

News, news

Like I've admitted previously, I am entranced by news/stories/articles/books about beauty and its perception. This series of special pieces in Newsweek about that exactly makes for some fascinating reading.

It's not just the ugly Americans

A flurry of plastic surgery and beauty-related news from foreign lands lately:

Is Taiwan Asia's next one-stop plastic surgery shop? Who knew? I just visit for the food...

Indian students flock to plastic surgery to get ahead. I think this happens here in the US as well, but people tend not to be so frank about it (and we're not just talking about the citizens of Hollywood, either).

Vaseline skin-lightening app stirs debate. Now this isn't a new phenomenon in Asia; many East Asian women are quite fastidious about sun avoidance and a number of creams/lotions/potions/treatments promise to lighten or brighten are directly marketed at them. But the app seemed to take it one step too far.

Plastic surgery bits and pieces: roundup

Wow - just when I was starting to get worried that celebrities had given up on plastic surgery...

Experts: Lindsay Lohan Got Filler in Her Lips Before Jail. Not exactly a peer-reviewed journal, but fascinating nonetheless. Was it Restylane? Or Juvederm? The world holds its breath...

Teenage singer Charice gets Botox for 'Glee' debut. I admit, I really have no idea who this young Filipina is (am I showing my age?), but I hear that Glee is quite a popular show. I understand one wants to make a good impression, but why did this beautiful 18 year old think she needed Botox???

Vampire facelifts: Cosmetic surgery's crazy new trend. Ditto for the whole Twilight phenomenon. But the plastic surgeon's responses in this Salon interview are pretty entertaining.

Don't rule out plastic surgeons yet. That's right. No dinosaurs here.

And finally, I leave you with this heartwarming story that has nothing to do with plastic surgery (but yes, there is still some surgery involved).

News bits and pieces in the plastic surgery world

Not too much going on out there, save for the usual celebrity plastic surgery speculations and denials. Maybe everyone's on summer holiday.

Cosmetic surgery, Hollywood style. From the LA Times online, putting the blame on TV/mass media for the current plastic surgery "craze". Make of it what you will.

12 ridiculous plastic surgeries. A rather entertaining slideshow of "crazy" plastic surgery-type procedures. There are some valid procedures in the mix here; I'll leave it up to you to figure out which ones. And over here, some snarky OC commentary.

The new face of surgery. Not everything in plastic surgery is nip/tuck. This sounds like a great development for victims of facial trauma everywhere.

Frenchwomen's secrets to aging well and 10 ways to age like a Frenchwoman. My favorite bit from this NY Times Style section article is the quote from a Paris plastic surgeon: the point of plastic surgery in France is “to keep the natural beauty and charm of each individual woman, not to fit some current ideal of beauty.” My thoughts exactly - and that's how Dr. Weintraub and I approach every patient at Duet Plastic Surgery.

Friday Figure Fix: Next installment, coming up

Never fear, Friday Figure Fix will be here... Give me a little time to work on the next "boob"-related topic. I think what we'll tackle next is the challenge of making breasts that are too big (headaches, neck strain, back pain, shoulder grooving, social discomfort) more manageable.

Friday Figure Fix: Making them bigger, part 3

This week's Friday Figure Fix wraps up "Breast Augs 101" for all you rabid MPL fans out there. We covered some common questions, the technical aspects (and more), and today we'll discuss some of the complications of breast augmentation. With this kind of surgery, in a skilled plastic surgeon's hands, complications are fortunately uncommon; but they do happen. This week's post is not necessarily to scare anyone off, but to be realistic, provide you with as balanced a picture as possible, and help you become a better informed consumer.

To begin with, breast augmentation (as I keep harping) is still surgery, so all the common risks inherent to surgery apply: bleeding, infection, scarring, need for revision, etc. Some of these standard surgical risks do merit a deeper discussion in the case of breast implants.

Bleeding. We'll include hematomas and seromas in this part of the discussion. But first, some bleeding is expected; we are talking about putting surgical steel to the skin and parts beneath, right? Surgeons, and especially plastic surgeons, have a love/hate relationship with bleeding. On the one hand, bleeding is good - it reassures you that the tissue you're working with is alive; on the other hand, bleeding is bad - blood belongs on the inside, not where you're working...

Anyhow, when we're dealing with breast implant surgery, the rate of bleeding complications is fairly low; we're generally working in an easily identifiable layer where a lot of pesky blood vessels are not typically encountered. So hematomas (collections of fresh or clotted blood) and seromas (collections of clear fluid created by the body) do happen after breast augmentations, but rarely. A few surgeons place drains (tubes to help evacuate fluid from the body) to prevent hematomas and seromas from developing after breast augmentations, but most (including us at Duet) usually don't.


Infection. A lot of times in surgery, wound infections can be dealt with in a fairly straightforward matter; throw some antibiotics at the problem, and things get better. In plastic surgery when we're dealing with implants, we take any hint of infection much more seriously. Because if those implants become infected, surgery often needs to be performed urgently to remove them. If that happens, the body has to be allowed to heal - for several weeks to months - before you can put implants in again.


Asymmetry. Most women are not perfectly matched to begin with. One breast is often larger than the other, and sometimes the alignment of the nipples/areola can be off. Although plastic surgeons do their best to achieve symmetry, if you started out uneven you might still see some of that after a simple breast augmentation surgery. Sometimes the difference seems more exaggerated, because the size of the implants.


Scarring. Again, all surgery causes scarring. As we discussed a few weeks ago, there are ways to disguise the incisional scars necessary to place the implants in the right place. Rarely, those scars can become unsightly, itchy, or even painful. Some of that is caused by surgical technique, but a lot of it depends on your genetics and personal history (some folks, unfortunately, are just prone to scar worse than others).

Capsular contracture. This is a particular kind of scarring specific to implants. Whenever something foreign is placed in the human body, the body reacts by forming a capsule, or scar, around the non-self matter. It's sort of like oysters creating a pearl around an irritating grain of sand.

Sometimes the body overreacts to the foreign body, however, and capsular contracture can develop. The scar capsule that naturally forms around the breast implant is usually soft, pliable, and unnoticed by the patient. When it becomes a problem, that capsule becomes hard, contracted, distorted, and in the worst case, painful. This requires additional surgery to remove the capsule and sometimes even the implant.


Need for revision/replacement. Unfortunately, breast implants are not lifetime devices. On average, a woman who gets breast augmentation can expect to have some sort of surgery every 10 years. Surgery may be needed to remove scar capsule, as mentioned above, or replace the implant, which can leak, rupture, or deflate. This is not to say that surgery should be scheduled regularly, like a yearly physical or oil change. I've seen some women need their implants replaced within a few months, and others (who had the very first implants, in the 1960s) who have never had a problem.

But once you have breast implants, you do need to be vigilant about your breasts - self exams, mammograms, and just an awareness of what normal looks and feels like for your breasts. If you have saline-filled implants, it's relatively easy to know if the implant is leaking (you'll notice that one boob is smaller than the other, because the leaking saline is simply absorbed by your body). It's a little tougher to tell with the silicone-gel filled implants, since the cohesive gel doesn't run, so regular screening MRIs to look for leaks and ruptures are necessary.

And of course, while the vast majority of patients are very happy with the results of their breast augmentation surgery, a few women wish they had gone bigger, smaller, or not at all. Revisional surgery - to upsize, downsize, or remove the implants - can be performed.


More questions? Feel free to email me - AngelineLimMD [at] DuetPlasticSurgery [dot] com.

If only...

Photo by Juergen Teller for NYMag

... everyone was as awesome as Dame Helen Mirren.

We've talked a little bit before on this blog about appreciating all sorts and shapes of bodies. I developed a little bit of a girl crush on Helen Mirren a few months ago, when these pictures of her surfaced on the interwebs. She looked totally great in her swimsuit and knew it. You have to admire that kind of attitude, and besides, she is a pretty good actor.

I bring this up because saucy girl that she is, Dame Mirren is oh so glorious in new photos. Plastic surgery or not, I can only hope to look so good when I crawl into my 60s...

Why, hello there. What are you wearing?

Photo courtesy of jfelias

It's a hot day in Silicon Valley today - right now it's sunny, cloudless, and the weatherman is predicting a high in the 80's. In the Midwest, where my parents still live, they're sweltering in the 90s with high humidity. Just thinking about the heat makes you want to wear as few clothes as possible, right?

So before you jump into the pool, run off to the beach, or even hop into the car for a nice drive with the A/C blasting, remember this: The sun is our skin's enemy.

Want to look good now and later? Protect yourself from the sun (that means no tanning booths either - there is no such thing as a "safe" tan). You'll save yourself from premature aging, wrinkles, and skin cancer; all things plastic surgery can help take care of, but wouldn't you rather not?

Simple stuff: wear as much clothing as you can bear (long sleeves, pants - I know, it's hot in the middle of summer), a wide-brimmed hat, avoid the sun when you can, and slather on the sunscreen regularly. You can even go the extra mile and imitate some of the fair-skinned ladies I've seen in the Bay Area - a full face-covering visor and arm length gloves or "warmers".

Some light summer reading to inspire you:

UVA Reform: It's Not PDQ. The lengths that some folks will go to obtain the best sun protection.

SPF inflation in the sunscreen aisle. An explanation of what's really out there in SPF.

Clothing with UV protection built in. A different kind of style for summer.

"Natural" sunscreen: Better for you? Good question, answered by the LA Times.

Avoid getting burned by sunscreen purchases. Just putting it on isn't enough; you have to put on enough and reapply regularly.

Friday Figure Fix: Making them bigger, part 2

So the quest continues, to make the mysteries of boob jobs and breast augmentation a bit less mysterious for all. We've addressed a few common questions (Saline vs silicone? Round vs anatomic?) and started in on the technicalities of this surgery - time now to wrap up Breast Aug 101.

Last week's Friday Figure Fix focused on the types of incisions available for placing breast implants. Now, let's delve a layer or two deeper and investigate where exactly those implants go.

It's fairly self-explanatory, right? Breast implants go in the area of the breast. But where, exactly? As plastic surgeons, we like to place implants in a well-protected area - more layers of defense against the outside world and a little padding to help camouflage the man-made construct. The luxury of extra coverage is not always available (like in breast reconstruction for breast cancer survivors, which is another topic entirely in itself), so we like to take advantage of that good tissue in breast augmentation surgery.



In the academic journals, some plastic surgeons like to split hairs when they describe the location/technique for breast implants (you'll occasionally run across terms like "subfascial" or "dual-plane"), but when discussing the future home for your breast implants, it pretty much boils down to two locations, as seen in my illustration above.

1. Submuscular (or subpectoral). Here we're talking about placing the breast implant underneath the chest muscle - the pectoralis major, specifically. Why do that? Again, the muscle provides another hearty layer of protection between the implant and all the bugs that roam about the outside world. Some people believe that the extra muscle layer helps blunt the slope of the breast, to give a "more natural" and "less implant-y" look.

There have also been some studies that show a decreased incidence of capsular contracture (hard and sometimes painful scarring around the implant) when breast implants are placed beneath the muscle. There is also speculation that breast function (e.g. sensation, breast feeding potential) is disturbed less with this technique, since there is less surgical manipulation of the breast tissue.

2. Subglandular. If you have enough breast tissue or subcutaneous fat to disguise the implant, subglandular placement (putting the breast implant underneath the breast - which is the gland we're talking about) is an option. Some folks prefer this placement because it looks "more natural" (Isn't that what we said about technique #1? Go figure.). Recovery time tends to be a little quicker, since you're not really messing with the muscle - much less soreness and crampy muscle pain.


So that's pretty much the ins and outs of the technical aspects of breast augmentation - all the key decision points you should hit in the consultation with your plastic surgeon. But wait, you say - all we did so far was gloss over the rosy bits of boob jobs - let's be realistic here - can't things go wrong?

Glad you asked. We'll discuss what can go wrong with breast implants/boob jobs/breast augmentation on the next installation of the Friday Figure Fix!

Plastic surgery bits and pieces: roundup

Some items that have come across my desk recently:

Optimism not linked to higher surgery satisfaction. Whatever happened to the power of positive thinking? Although this facial plastic surgeon's study didn't find any connection, anecdotally, looking at all the patients I've had the privilege of taking care of throughout my career, the ones with good attitudes seemed to bounce back more quickly and do better after their operations.

Forget Botox. Floss your teeth. Well, I wouldn't throw out the Botox just yet, but I have to agree that dental hygiene is pretty important. Not just for your health, but yes, for your looks. All those folks on shows like Extreme Makeover? Some of the dental restorations were absolutely transformative - I was impressed by what a difference a beautiful smile made. I think the lesson here is to take care of yourself; otherwise, all the plastic surgery in the world won't matter.

Joan Rivers talks about plastic surgery... I have to admit, I was a big fan of her catty comments on the red carpet. It's also refreshing to hear a celebrity talk openly about plastic surgery, whether you personally appreciate the results or not.

Cougar cosmetic surgery on the rise... Perhaps a tabloid is not exactly a reference you'd include in the footnotes for your highbrow academic medical paper, but this little bit is interesting, nonetheless. Best part of the piece? The photo/caption: that's no physician performing a cosmetic procedure; that's the anesthesiologist intubating the patient. Nice work, guys.

How the other half heals. Not everything in my world is about plastic surgery - I'm always fascinated by the stories and thoughts of other physicians (right now, I'm working on finishing Atul Gawande's latest book, The Checklist Manifesto), and Teri Reynolds' piece is exceptionally articulate and thoughtful, if you get a chance to pick up this month's issue of Harper's.

Friday Figure Fix: Making them bigger, part 1

Photo courtesy of preciouskhyatt, flickr.com

Last week we answered a couple frequently wondered questions regarding boob jobs, or more clinically speaking, breast augmentation. Now let's tackle some more technical aspects of what it takes to make smaller breasts bigger.

Breast augmentation, is of course, surgery. This may seem self-explanatory, but I really can't emphasize this point enough. You shouldn't be able to walk into a doctor's office for the first time and on the same day walk out with bigger boobs. Cosmetic surgery though it is, breast augmentation still requires a careful history-taking and physical examination by a skilled surgeon long before anything goes up a cup size or two.

Questions (like these) should be asked and answered. Another key point is the placement of the incision or scar. There are several options these days, as you can see in my illustration below.


1. Transaxillary. This is the "armpit scar" - a small incision is made in one of the creases of the armpit, and a tunnel is made to the breast area to allow for placement of the implant. Sometimes a small video camera is used to help see the creation of the pocket where the implant will live; sometimes not.

Some patients and surgeons like this approach because it does not leave any scars on the breast. Instead, you have your scar in a fairly inconspicuous location (hopefully, no one's looking that closely in your armpits).

The downside of the transaxillary technique is that it is a remote approach to the breast; some surgeons feel that fine control over placement of the implant is not as precise. Also, if you need a revision for any reason after a transaxillary breast augmentation, it is very difficult to use the same incision - which means that you might end up with a scar on your breast anyway.

2. Periareolar. A lot of folks commonly refer to this incision as the one that "goes around the nipple", which isn't quite accurate. The incision is made skirting the underside of the areola, the pigmented area around the nipple. Many patients prefer this scar, because they think that it will be well hidden in that area of color change. Many surgeons prefer this approach because it offers direct access to the breast for the implant placement.

Personally, I'm not a big fan of the periareolar incision. I think that the scar is often more obvious when placed around the areola - it often heals to become either lighter or darker than the surrounding breast skin or the areola. Also, the border of the areola is very indistinct if you look at it closely. It's neither a straight line or perfect circle; our incisions are either lines or arcs, which makes it easy to spot from across the room.

One more downside to the periareolar incision: because you're cutting through breast tissue so close to the nipple, you run a slightly higher risk of interfering with sensation and breastfeeding potential.

3. Inframammary. This incision is hidden beneath the breast, just above the bra-line. Patients like it because a well-placed scar ensures that no one sees evidence of their surgery, unless they're peering underneath their breasts with a flashlight and magnifying glass. Surgeons like it because it offers great access to the space where the implants go.

Personally, the inframammary approach is my favorite, for the abovementioned reasons.

4. Transumbilical. This technique was developed and championed more recently, as plastic surgeons attempted to find a "more perfect" approach for breast augmentation. You may have seen it on those reality TV shows or marketed as the "TUBA" technique. The incision is placed in the belly button, which is a great place to hide scars. Unfortunately, you face similar limitations as the transaxillary technique and are tunneling implants quite a distance; this approach never lived up to expectations, and I don't know of any respected plastic surgeons who routinely perform breast augmentations this way.


Next week, we'll take a closer look at where those implants actually go. More questions? Email them to me at AngelineLimMD [at] DuetPlasticSurgery [dot] com.

Kind of a big deal...

Remember this? I was reminded of the whole "Math class is tough" Barbie debacle when I saw this piece by the New York Times' science columnist today, which revisits the hoopla over women in science spurred by comments from then-president of Harvard, Larry Summers.

I won't pretend to understand all of the obstacles and hardships endured by women who have fought their way to the top of academic math and science, but as a woman in surgery - and a female plastic surgeon, nonetheless - I can sympathize.

Let's face it, medicine used to be a boys' club. Growing up, my pediatrician was a lovely older man, and when the time came to choose a gynecologist, there were only men to choose from in my hometown.

But again, medicine used to be a boys' club. Now over half of all medical students are women, and the majority of pediatricians and OB/GYNs practicing today are women. In my surgical intern class at Stanford, six out of twenty-three of us were female, which was fairly impressive to me at that time.

The specialty of surgery, however, remains male-dominated. Why? Is it because men are better surgeons? I would have to disagree with that. Men tend to have bigger egos and greater hunger for power? As much as some may want to believe women are the fairer sex, no to that thought too.

Want to hear my personal theory (and that's all I claim for it - pure opinion, based only on my own experience and reality, no studies, no evidence to back it up)?

Surgery is tough. Any stubborn human being can put his or her head down, put the blinders on, and the nose to the grindstone for five, six, seven (or more) grueling years of residency. But women, as tough as we need to and can be, have an additional biological burden to bear; like it or not, our prime years are spent in surgical scrubs, sleeping in questionably clean beds in dingy call rooms, running around the hospital ward trying to answer to a dozen different bosses, staying on our clog-clad feet for marathon operations. A lot of women (and frankly, men, too) decide that this isn't worth it or that this life (temporary as it may be, if you can optimistically call five years temporary) isn't fair to their families.

I never thought about those harsh social and reproductive realities as a medical student trying to decide what kind of doctor to become. I liked surgery; I loved plastic surgery; and that was that. Maybe my naivete helped me endure. Being on the far side of those years, I can look back without regrets now.

Those years are exactly what make me unique; there aren't that many female plastic surgeons out there (kudos to Stanford for being at the forefront of training women in plastic surgery; perhaps a subject to explore in another post sometime).

And that is what makes my work relationship with Dr. Weintraub so special. Where else in the Peninsula/South Bay/San Jose area can you find a team of female plastic surgeons working together? That's right: Duet Plastic Surgery. We're kind of a big deal.

Friday Figure Fix: Sometimes bigger is better

In contrast to some of the previous topics handled here in the Friday Figure Fix, breasts (or as some might say more casually, boobs, bewbs, boobies, and my personal favorite, "the girls") elicit a stunning variety of feelings and opinions.

For example, if you have a tummy issue, I can pretty much guess that you have a little more tummy than you would like and you want it gone. Whereas with breasts, it could really be anything: too small, too big, too uneven, too droopy, a combination of any of these, or too much like a girl's (for my guy friends out there, you are not forgotten here at this plastic surgery blog!).

So let's tackle one breast-related Figure Fix at a time; we'll start with "too small".

Now before anyone out there gets too huffy, yes, breasts are beautiful (we discussed that last time), and yes, size is relative. But let's just imagine that you are a smart, well-adjusted woman who has always felt that she's a bit on the small side for her own figure or a smart, well-adjusted woman who used to be a little bigger (weight loss, pregnancy/nursing, etc) and misses them. You've tried it all: the rolled up sock or wad of tissues in the bra, the "chicken cutlet" gel inserts, the push-up/wonder/water/miracle bras. You've had a friend or two who had "her boobs done" and now you want to know the facts about breast augmentation as they pertain to you.

Lucky you, this blog has the answers to your questions coming right up.

Basics first...

• Can anyone have breast augmentation?

Not exactly. Like I hinted at above, you have to be savvy enough to understand what you're undertaking when you sign the consent form for surgery. You also have to be of age to consent (sorry, all you hopeful 16-year-olds out there, you're just going to have to wait). And, at least for me, you have to be a reasonable person with reasonable expectations.

Of course, if you look around hard enough, you'll find someone who's willing to be a bit more lax in their regard and restrictions. But is that what you really want in your surgeon, someone who prefers the fuzzy side of ethical?

• Is a "boob job" real surgery?

Uh, yeah. By "real surgery", you mean it involves a knife and blood? Yes. There's no magic in making boobs bigger. There will be some pain and soreness afterward. Sorry.

• Who should I see to have this surgery done?

If it were me, I would look for a couple key qualifications: 1) a surgeon, 2) a plastic and reconstructive surgeon.

Generally speaking (and there are always exceptions), plastic surgeons who have completed 5-7 years of specialized surgical training are well qualified to perform breast augmentation (versus other doctors or medical professionals, who may not even be surgeons but claim competence after completing a weekend-type course).

See also answer to question #1, last sentence of second paragraph.

• What exactly are these implants that are going to be stuffed into my chest?

All breast implants approved for use in the United States today are made of the same silicone shell; the major difference that's discussed is what fills those shells. They can be filled with saline (salt water solution, similar to the balance of fluid already in your body) or silicone gel (a squishier non-native substance, whose appearance helped earn the nickname, the "gummy bear"implant).


Photos courtesy of allergan.com

One's saline-filled, the other's silicone-gel filled. Can you tell the difference? Yeah, not so much by looking at a picture - but feeling the implants gives you the obvious answer. The saline-filled one is pretty similar to a water balloon, whereas the silicone-gel filled one is like one of those stress reliever balls you squeeze in your fist. Some say the silicone-gel filled implant mimics the consistency of the human breast more closely.

There are also other, more minor differences in implants. The shape of the implant can be round or what is termed "anatomic".

As you can see in my lovely illustration, the implants when viewed flat on from above look fairly similar in shape (round, or close to round). When the implants are placed on a flat surface and viewed from the side, you can see more of a difference. But when you hold up the implants as if in the position they will assume in an upright woman, the difference between the round and "anatomic" implants are fairly negligible - both resemble the natural breast pretty closely, due to gravity.

The implant shell can also feel different on the outside, which may or may not affect how the body heals around the implant. Some surgeons will only use smooth-surfaced implants, while others swear by "textured" implants.


The plastic surgical literature doesn't really have much evidence to say that one is "better" than the other, not in hard numbers from clinical trials. So deciding "smooth vs textured" is generally up to the surgeon and you.

• Is this stuff guaranteed?

Well, yes and no. Within a certain time frame, most implant manufacturers will replace implants at no cost if their labs determine that the cause of the implant "failure" is if there was something inherently faulty with the implant itself. Depending on the situation, your surgeon may also waive his/her fee. But that might still leave you responsible for any additional OR and anesthesia fees.

Generally speaking, though, if you wish you had gone bigger (or smaller) after the fact, you might be stuck with paying for the entire surgery all over again.


Other questions? Stay tuned for further Friday Figure Fix installments, or email me at angelinelimmd [at] duetplasticsurgery [dot] com.

Just for men: the latest in faking it

From the Sculptees website

Sometimes this blog can seem overly female-centric; but come on, I'm a female plastic surgeon. This blog is about plastic surgery, and the vast majority of plastic surgery patients are women.

But guys, this post is for you. We first heard about these innovative man-garments a little while back, but the NY Times Style section is hitting it up again.

Enjoy your Memorial Day weekend without fear!

Friday Figure Fix: Boobs, boobs, boobs!

Photo courtesy of m_bartosch

Momentous day here:

1. Finally, a long-promised Friday Figure Fix post! And you thought I was just stringing you along.
2. According to Google, this is my 100th post. Amazing.

So, as you can tell from the title of this entry, there's nothing subtle about the subject matter. Everyone loves boobs, right?

Forgive my cavalier attitude, but as a female plastic surgeon who takes the matter very seriously and personally, sometimes you need to lighten things up a bit.

In previous Friday Figure Fix posts, we've covered just about every other major body part and "flaw", and now with Memorial Day Weekend fast on our heels, we can almost call it summer. You already know how to deal with the other anxiety-inducing bits unveiled by bikini season, now we have to face "the girls".

Breasts are remarkable appendages. We're mammals, so we've all got them, both men and women. In women, of course, the parts tend to be a little better developed - mammary glands, which serve an incredible function - producing milk for little ones. And of course, there is the aesthetic and sexual function of breasts.

Some women feel that their breasts are too small for their frame; others find that they are burdened by overly large breasts - headaches, neck and back pain, shoulder grooving from bra straps, skin irritation and rashes. And nearly every woman has been frustrated by the impossibility of finding a proper fitting bra.

Some women (and men, too) are born without a breast; others are forced by the diagnosis of cancer to have one or both removed.

Over a lifetime, breasts undergo quite a few changes; there is the joy of puberty, cyclical variations with menstruation, ups and downs with weight oscillations, growth during pregnancy, explosive engorgement with nursing, the stretch marks, droopiness, and deflation following child rearing, and the inevitable pull of gravity with aging.

Regardless of what you were born with, there is beauty within. Even after a lifetime of changes, many women are wholly appreciative of what they have; they have their fans as well.

But many women miss what they had before - or what they never had; besides, this is a plastic surgery blog, so we're going to discuss what to do with those boobs in the next few Friday Figure Fix posts.

Friday...

And you loyal followers thought maybe, just maybe, there would be another installment today... No such luck in the MPL world. It's not over yet, though, I promise. I have more facts, thoughts, and wild opinions to share with all of you, don't you worry...

A My Plastics Life Public Service Announcement

When I saw this article in the NY Times yesterday, it made me think of the presentation I give for the HealthTrust of Santa Clara to eager high school students about what I do as a plastic surgeon.

Sure, my life in plastic surgery is all about boobs and Botox - or some would think... I use the class period to reveal a little bit more about the wide, wonderful world of plastic and reconstructive surgery. The NY Times article talks a bit about the spills that professional cyclists endure, and part of my presentation describes dealing with the medical consequences of those accidents. In a few words: lots of stitches, metal plates and screws.

So the one thing I beg the students to remember from my talk? If you ride a bicycle, you need to wear a helmet. I can save your face, but first, the helmet has to save your life.

One student complained, But I had a friend who was wearing a helmet when he got into an accident, and the stupid thing cracked!

Exactly. Better the helmet than your head.

A day (or two, or three, or four) without the internet

Wow. Four and a half days involuntarily deprived of internet access makes you a discombobulated technological cripple. No email, no Google, no news, no way to print out directions to Mother's Day brunch, and most horrifyingly of all, no blogging...

Lucky for us, today AT+T figured out that our woes were the result of a malfunction at the central office and they "just needed to turn the switch on". That took four-plus days to figure out?

Despite our Luddite-like hiatus, the world of plastic surgery still managed to spin on its axis. And although I sometimes fear that my continued posting on this subject puts this blog dangerously close to transforming into a hateful plastic surgical rant, I have to believe that it's all about information and education. So enjoy, more frightening news, this time from our neighbors and colleagues on the east coast.

Friday, but not a Figure Fix exactly: Your moment of zen

A California poppy on top of Windy Hill

Sorry guys, you're going to have to be patient with me about this Friday Figure Fix thing. The column is slowly cooking in my head, and it will emerge fully formed at some point.

In the meantime, I was reading a new book called Drive, by Daniel Pink. It's interesting, a pop-business-culture examination of what motivates people. He opens one of the middle chapters with a snippet of poetry I've never come across before, but really enjoyed:

You need not see what someone is doing
to know if it is his vocation,

you have only to watch his eyes:
a cook mixing a sauce, a surgeon

making a primary incision,
a clerk completing a bill of lading,

wear the same rapt expression, forgetting
themselves in a function.

How beautiful it is,
that eye-on-the-object look.

- W.H. Auden

I love discovering beautiful things in unexpected places.

As plain as...

Photo courtesy of djcodrin

The latest issue of Elle landed in my mailbox a few weeks ago; buried deep in the back of the magazine, under the "BEAUTY: PSYCHOLOGY" section were a pair of articles about rhinoplasty.

The first one, titled "Pieces of You", discusses the author's regret later in adulthood regarding her surgery; she felt she had lost a vital connection to her father, whose proud nose she had inherited and chose to alter as a teenager.

The second article, "Mother, Mirror", takes a different point of view; this author tells how she came to terms with the unique shape of her nose, despite everyone else's unsolicited opinions and advice.

Plastic surgery, clearly, isn't for everyone. The CNN article briefly delves into some of the limitations of age; it raises the question of whether or not rhinoplasty (or any cosmetic surgery, for that matter) is an appropriate "graduation gift" for a teenager.

Even beyond the age issue, I think the decision to change the shape of your nose is one of the most difficult, for both the patient and the surgeon. The nose is such a key architectural element of your face, and it often carries a lot of cultural weight. Much of your nose's shape and structure is related to race and heredity. Some people want to keep some of those ethnic or familial nuances when they have their rhinoplasty; others are committed to eliminate all traces in order to obtain their concept of the ideal nose.

There is no right or wrong; it's a very personal decision and one that you have to live with for the rest of your life. It's as plain as the nose on your face.

Hold on - lush lashes for anyone?

Photo courtesy of djcodrin

The New York Times Style section has another interesting piece today, this time focusing on the explosive popularity of Latisse. For those of you who have somehow missed the Allergan-funded media extravaganza featuring Brooke Shields, Latisse is a medication that increases the length and thickness of eyelashes. As the article points out, Latisse is a prescription-only drug, but consumers and apparently physicians are finding ways around that stipulation.

As with a lot of medical discoveries, Latisse's usefulness for the "lash-challenged" was somewhat serendipitous. The drug, bimatoprost, was originally used and marketed by Allergan as a glaucoma medication; eye doctors noticed that their patients were growing longer, lusher lashes on the treated eye. Allergan moved to capitalize on that discovery, which now grosses them over $70 million a year.

The thing is, because Latisse is so "easy" and the perception is that it's "just" a cosmetic enhancement, it seems that not everyone is exercising the proper amount of caution with its dispensation and use. As with any prescription medication, not everyone is a suitable candidate, and there are benefits, risks, and known side effects with the use of Latisse.

Just as with all the other non-invasive cosmetic procedures, like Botox/Dysport and dermal fillers like Juvederm and Restylane, a qualified and experienced physician should do a full history and physical before determining if you are right for the procedure/medication.

This is what Dr. Weintraub and I do at Duet; call us conservative, but you are not just our client, you are our patient. We want you to look good and feel good, and I think that a little good old-fashioned doctoring helps achieve that. Even with something as "simple" and fabulous as Latisse.

Friday, but not a Figure Fix post...

My apologies, dearest readers, but there is a lot going on behind the scenes at My Plastics Life right now. So in lieu of another insightful, thought-provoking Friday Figure Fix (I promise, one will be forthcoming), here's a roundup of all things vaguely plastic surgery-related I have been catching up on from the past week:

• Yes, another article decrying the downturn in plastic surgery (but not all hope is lost!).
• Somehow, I don't think the U.S. government is going to be following Brazil's innovative lead here. But can you imagine?
• I'm all about looking good at any age, but this is slightly horrifying. Don't girls know how naturally beautiful they are?
• A good thing? Or TMI? I admit, I refuse to join Facebook, for a variety of reasons.
  
• It's a two way street: absolutely.
• Summer's coming, finally. Are you stocked up on sunscreen and wide brimmed hats?
  

Not quitting my day job

Screenshot from www.retroland.com. Not the title-winning shot, clearly.

It's definitely my inner geek crying out, but I sought out and loved the documentary, The King of Kong, which traces one pretty regular man's quest to be the best in one of the most famous games of arcadeland. There's something so fascinating about humans and their obsessions - and how scarily good people can get at something when they devote hours upon hours of their lives.

So a little cheer for this plastic surgeon, who saw the movie, and thought, I can do that. And did.

The best part? He's gotten two referrals out of the media attention following his claim on the championship.

Me? I admit I'm more of a pinball kind of girl, and I'm nowhere near approaching 10,000 hours of play. Something to shoot for, I guess. In the meantime, back to the grind at good ol' Duet...

Nothing says "thinking of you" like...

... your old breast implants. Thanks, Sharon and Ozzy, for sharing.

Friday Figure Fix: Mental break

Okay, I need a little more time to create something fabulous for the Friday Figure Fix column. Give me a week, and in the meantime, enjoy this beautiful view of the Bay Area from an overlook at the Montebello Open Space Preserve. I love living here!

Friday Figure Fix: No miracles here

In what seems like an endless series of "caveat emptor" posts over here at My Plastics Life, now a new tidbit of information on what's really going on out there, this time from the FDA.

We've talked so many times before about how there is nothing magical about how to fix your figure, and something seems too good to be true, it probably is. In the world of medicine - and more specifically, plastic surgery - quick fixes can lead to disappointing, and sometimes even dangerous, results.

In this case, the latest culprit is "Lipodissolve". Who needs surgery when you can get fast results with injections that simply melt the fat away? Life, unfortunately, is not that easy , and it seems that a lot of patients were harmed for believing these practitioners' touts.

Caveat emptor, part three

Photo courtesy of Graeme Weatherston

Seriously, how many times can we talk about this?

In today's Style section of the New York Times, there is a very interesting article discussing a very disturbing trend in cosmetic surgery: the awake breast augmentation. As the article points out, most of the practitioners of this procedure aren't plastic surgeons (or even surgeons) and aren't performing the surgery in an accredited facility.

The supposed benefits to doing a major surgery while the patient is awake? It's cheaper, for one (you don't have to pay for the anesthesiologist); and the practitioners claim that it allows the patient to have "of the moment" input into their bust size.

Maybe I'm a very conservative plastic surgeon, but those reasons seem pretty weak. I like having an anesthesiologist with me during surgery. Breast augmentation is a serious and delicate operation. Since I trained for years to learn all the details of how to perform surgery, I like to focus on what I'm good at and leave the anesthesiology part to the guys and gals who spent their years learning all the ins and outs of anesthesia. Makes sense, not just for my comfort, but especially for my patient's comfort.

As for the patient input claim? I'm definitely a patient advocate in this matter - I do my utmost to communicate openly and often with my patients about what their hopes and expectations are in terms of breast size, shape, and feel - and this should be done well before the operation. By the time the surgery starts, we're all on the same page, and my patients trust me to use my surgical skill and judgment to deliver the look they want. I personally think it's problematic if you don't have that sense of trust before going under the knife and you have to rely on last minute input from your "awake" patient who is actually fairly altered from the narcotics and barbiturates given for the procedure. If you can't drive a car or sign a legal document while on those kinds of meds, you certainly can't give an informed opinion on how big you want your boobs to be.

But that's just what this cranky female plastic surgeon thinks (although, from the comments in the article, it's what other well-known and respected plastic surgeons are saying too...).

I guess we shouldn't be surprised...

It pains me a little to be returning to this subject, because I don't want to seem like I'm enthusiastic or even the least bit encouraging. But yes, Heidi Montag seems to be dragging out her latest stint in the plastic surgery gossip headlines - this time talking about "back scoop" surgery (at least this is mildly relevant to recent posts on this blog).

I feel slightly bad for her - and perhaps shame on her surgeon for this - how can you have a surgery without really knowing what it's about?

Caveat emptor, again

Finally, a little research to back up what I've been on my soapbox about for so long.

So there you go, ladies and gentlemen. The fine scientists at Loma Linda have established that yes, there are an awful lot of folks out there practicing "cosmetic surgery" with no surgical background. Depending on your savvy and comfort level, maybe that's okay for some of the less invasive procedures like Botox and dermal fillers, but you probably want to do a little extra research on the physician you choose for your liposuction...

Friday Figure Fix: Back to back, part two

86F at the Artists' Palette in Death Valley in March. A bit warmer than Palo Alto these days.

Now that cold, dreary weather has crept back on us in the Bay Area, it seems a bit wrong to be talking about how plastic surgery can help get you ready for swimsuit season, does it not? Oh well. The real spring will be arriving soon, with bright and sunny days that seamlessly meld into the sweltering, minimally-clad days of summer. Right?

And so we trudge onward, divesting the deepest secrets to a sexy back, courtesy of your favorite female plastic surgeon... Last week we talked about the main trouble areas associated with the oft-neglected but all-important back. Today, let's talk about fixes.

For overall definition and touch ups, liposuction remains a great solution. We've talked about lipo before, and the same theories apply to its use on the back. You should be close to your ideal weight to get the best results, and if you do have just a few nagging problem areas, liposuction can help trim down some of the fat collections so that your back looks smoother and more in proportion with the rest of your figure.

If we're looking more at rolls of skin and fat (like the ones that hang over the bra, or prevent you from finding a well-fitting bra/swimsuit), we might be veering more into the world of surgical excision. Sort of like a mini-tummy tuck, but on your back, the procedure entails removing that overhang of excess skin and fat. The trade-off for the cunningly named "back roll excision", of course, is a scar. Depending on where the targeted roll is, sometimes that scar can be very well hidden in the area that a bra would cover.

The global pursuit of beauty

I thought this piece in the New York Times' photography, video, and visual journalism blog was especially well-done, with stunning and thought-provoking photos. It reminds us that the pursuit of beauty is so wide-ranging, not just in geography and population, but also in what individual segments of society deem acceptable and not. Where do you draw the line between medical necessity/maintenance of health and hygiene/adaptation to social and cultural norms/preening/cosmetic surgery/obsession/psychiatric disorder? It's more difficult than it seems.

Friday Figure Fix: Back to back

And we're back... so let's talk about backs, perhaps one of the more neglected body parts because it's not something that you necessarily stare at every day, but everyone else sees it an awful lot.

The back really deserves more attention than it gets in the cosmetic world. After all, we are fast approaching halter/tube top/bikini season, and if you want to look good, look good all around, right?

Medically and surgically speaking, the back is both relatively plain (not much to interact with on that side, really) and surprisingly fascinating. The skin is thickest on the back, and the fat that lies beneath the skin has a different quality from elsewhere on the body - it's a bit thicker, denser, and stringier.

If anyone ever has a complaint about the appearance of their back, it's usually related to excess weight that results in undesirable rolls (which have actually been scientifically documented and classified by one of Dr. Weintraub's mentors in New York, Dr. Berish Strauch). Everything that can get a bit thick on the front side often continues around to the back.

So ladies, I'm sorry to inform you, but that extra stuff under your arms that makes it difficult to get a good bra to fit? That's not breast; that's a roll of skin and fat that hangs laterally and continues along the bra line of the back.

Same story with the dreaded "muffin top" - the paunchy bits that hang over your jeans in front and above your hips - that stuff goes all the way back, too.

These "back rolls" are especially dramatic in our massive weight loss patients, where the skin envelope that was once filled with fat now just lie empty, with folds and flaps of unelastic skin layering the back. It's not just a cosmetic issue in these cases; often times these flaps and folds harbor rashes and infections.

Sometimes, however, patients looking for an aesthetic fix for their backs don't have such dramatic problems. Frequently, it's just a matter of having a little extra, unwanted thickness here or there.

I'll be back next week to talk about some cosmetic surgical solutions.

Perspective: thinking about training

Wildflowers at Long Ridge OSP, heralding the long-awaited arrival of spring in the Bay Area

Today, the New York Times website posted an opinion piece that scurries around the belabored topic of resident physicians, work hours during training, and sleep deprivation. If you scroll through the hundreds of comments, you can see that it's still quite a touchy subject for many.

Including me. Although my plastic surgical residency now seems like a lifetime ago (there's nothing like rediscovering the pleasures of a "normal" life), it really wasn't. I'm not sure what the popular conception of the training required for plastic surgery is, but I assure you, it's not a bunch of folks sitting around sipping lattes, taking occasional breaks to inject Botox or do a quick boob job.

I started residency when talk of the mythical 80-hour work week was swirling about; but that's all it was, the stuff of dreams and fantasy, especially to a bunch of overworked, underslept surgical interns and residents who thought it was more of a cruel joke. One hundred- or 120-hour work weeks were not uncommon. I was routinely on call every other night or every third night - these became thirty, thirty-six hour stints in the hospital - do the math, and you realize you've hit 80 hours before mid-week.

I remember one of my general surgery chief residents dispensing advice to the newbies. Doug told us the three things key to surviving internship. When you finally make it home, eat first, then shower. If you go to sleep first, that just means you will go back to work hungry and stinky. And always put the car in park when you come to a red light.

Was it miserable? Well, yes - you're tired, you're hungry, you're working hard, you're not working hard enough, you're on your feet, you're getting yelled at - you're in survival mode. But there's a degree of martyrdom that colors your thoughts (it's 9 am, the time when normal people are just trickling in to work, and I've been at it for 5 hours already, and so many more to go), your spirits are lifted by the joy of actually helping people, and your awesome colleagues in the trenches with you are funny, encouraging, and ultimately save you.

And by the time I finished my training, the 80-hour work week was in full force. Did that mean that when the clock hit 80, the scalpel was removed from my hand and I was sent home? Perhaps for some of the newer trainees, yes, something like that. But some weeks I worked a more humane 60 hour week, and others clocked closer to 100 - but I had already learned to stop counting at 80.

A lot of my peers had the same mathematical dysfunction. Maybe we were the last of the old school, maybe we were already inured to the pain of the endless workday as it quietly merged into night. As surgeons, you just can't quit mid-case. As physicians, you just can't leave your patients. As professionals, you have pride; you want to follow through, you want to make sure that your patients get the best care possible, you want to see what happens.

It's hard to say what is right for the future of medical training, having been on both sides of the work hour debate. And as wonderful and impossibly precious as time and life seem now, outside of residency, I still get to experience medical training, but from another perspective - as the ever-waiting spouse.

My husband is still in the thick of his surgical training. Somehow he too has developed the inability to count beyond 80. It's tough to watch someone you love endure this. Maybe in some ways a resident's life is a little better these days; most months I do get to see my husband every day, if sometimes only for an hour as he shovels some food in and gets his exhausted body ready for another woefully inadequate amount of sleep.

But that's what we tolerate, because we aspire to be the greatest surgeons we can become and because we love what we do.

Friday Figure Fix: Loving lipo, part two

I got so carried away with mythbusting and truthtelling the past two weeks that I neglected to cover the basics about liposuction! You'll forgive me, of course, as I use my awesome Adobe Illustrator diagrams to show you the magic behind the lipo curtain...

So now that we're all on the same page about what is true about lipo and what is just nasty rumor, what exactly are you getting when you sign up for liposuction?

Liposuction is pretty much what the word says - sucking fat. Over most of the body, we have two layers of fat - one is relatively thin and superficial (right beneath the skin), and the other is just below it and more substantial in thickness. When plastic surgeons perform liposuction, we're generally aiming for the deeper layer, for a variety of reasons.


Small incisions are made in the skin, usually well under half an inch. This allows for insertion of the liposuction instrument. By using a metal cannula (a tube of varying diameters) attached to a suction machine, we plastic surgeons remove fat in a planned and controlled fashion. If you've ever watched any of those shows on the Discovery Channel that show liposuction being done, you may have noticed that it can seem like a very brutish procedure.

But if not for the care and strategy behind the technique (and for us plastic surgeons, there definitely is a lot of thought behind the muscle and sweat), the operation could go very badly. How badly? Best case scenario (of bad cases): a little irregularity or lumpiness. Worst case scenario: the metal cannula ends up in the wrong space (like lung or bowel), causing significant organ damage. There is also a lot of physiology behind good liposuction technique; fluids are a critical component of this operation, and they need to be balanced precisely to ensure a safe, successful surgery. Good reasons to choose your surgeon carefully!

When done carefully and correctly, the cannula removes tunnels of fat, creating a swiss cheese-like appearance in the fat that remains, which collapses and heals to give you a slimmer, flatter contour.

Liposuction can be performed under a local anesthetic, with or without some sedation, or under a full general anesthetic, depending on the volume of fat to be removed. It is so important to find a well-trained, experienced plastic surgeon (and an anesthesiologist comfortable taking care of liposuction patients), because as you all surely remember: liposuction is still surgery.

Like I've implied, liposuction is not a terribly sexy procedure, especially during the recovery. Because of the fluid shifts, patients are quite swollen and need to wear compression garments around the clock. Immediately postop, you do get a glimpse of what your new shape will be, and many patients are thrilled by how they look a few days later after the swelling has peaked. But stubborn extra fluid tends to obscure a lot of the fine contouring, and the dramatic final results won't be apparent for up to six months to a year after surgery, once all that swelling has finally resolved.

But if you continue to take care of yourself (a healthy diet and exercise regimen that help you maintain a stable weight), the results will be worthwhile and lasting.

Um, the sky is falling?

Yesterday's rainbow, stretching out over the South Bay.

There seem to be an awful lot of Chicken Littles running about these days, squawking about the demise of plastic surgery. I saw a few articles (here and here), drawing from statistics released from the ASAPS, pointing to the ongoing downward trend in elective cosmetic surgery.

Let's face it - last year was a terrible year for everyone, even us plastic surgeons in the Bay Area. But I disagree that this spells the end of plastic surgery; I still think that there is a lot of interest in cosmetic procedures (hence the noted uptick in less invasive - and cheaper - interventions like Botox and fillers) combined with increasingly pent-up demand. We're just all waiting for the economy to turn.

Are you listening, Washington? Make it happen!

Breast cancer awareness: how YOU can help

Photo courtesy of Peter Bruce

Now, I'm not one for shameless plugs, but this is a special exception, and I think you'll understand why.

The "b for a cure" project is something I became involved with based on the sheer charm and conviction of its founder, Peter Bruce, a professional photographer who lives in San Francisco with his lovely wife, two daughters, and giant (but friendly) dog. He began this project to raise awareness for breast cancer, a cause near and dear to any woman's heart, especially this plastic surgeon's.

As a female plastic surgeon, I have been involved in the journeys of so many women diagnosed with breast cancer, from the initial cancer operation to the reconstructive breast surgery to the post-treatment recovery period. Breast cancer is somehow simultaneously heartbreaking and inspirational, and it remains a cause in need of our continued support.

Peter's project allows ordinary (and extraordinary - you know who you are) women to express that solidarity - whether by helping to garner attention for the project, purchasing the book (expected to be released later in 2010), or even becoming a model (emphasizing the idea that all breasts are beautiful) - I encourage you to visit his website to learn more.

Friday Figure Fix: Loving lipo

So last week we did a little debunking of liposuction myths that refuse to die. Which I know was all old news to you, my dear readers, because you are a smart and appropriately skeptical bunch. But for those of us who are new to the wonderful world of plastic surgery, let's discuss what lipo can actually do for you.

1. Lipo is great for contouring.

If you're reasonably close to your ideal body weight and are stuck staring at stubborn problem areas that absolutely won't budge, no matter how carefully you watch your diet or rigorously train, liposuction is a fabulous technique.

A lot of us women are blessed with womanly figures, but sometimes the proportion can be a bit off, often in the areas of those child-bearing hips and cursed saddlebags. Liposuction can help reduce some of those bulges, so that your overall proportions seem more reasonable:


With lipo, which is a little like sculpting a block of marble (except your plastic surgeon is removing bits of fat, not chunks of stone, with an aesthetic eye), you still retain your womanly curves, but in a refined manner.

And, of course, lipo is not just for women. Plenty of men are looking for a discreet little touch up for their love handles and whatnot.

2. Lipo is versatile.

Where there is fat, there is possibility... Common areas treatable by liposuction include the area under the chin/neck, arms, breasts, back, belly, hips, thighs, and sometimes even around the knees and ankles. Pretty much anywhere.

3. Lipo is that great final touch.

A lot of times in our practice, Dr. Weintraub and I combine liposuction with another procedure - most frequently the tummy tuck. It just allows us to really smooth out the contour of the trunk and waist, so that there are smooth transitions between the chest and the newly tightened belly. This concept of using lipo to supplement another surgical procedure works well; a touch of lipo with a facelift, arm lift, thigh lift is fairly commonly done - with great results.

Nip/Tuck no more?

I must admit, I haven't watched any episodes of Nip/Tuck recently (the bizarre plot twists got beyond my personal tolerance level sometime after Season Two, and my husband and I discovered the freedom that comes with living a cable-free life), but I am somewhat sad to hear that the series is coming to an end this year.

Like I've mentioned in this blog before, I admired the show for bringing the surgical special effects to a whole new level of realism (although no nurse has - or ever will - tie my mask on for me). And, of course, the rocky, drama-filled partnership of Dr. Christian Troy and Dr. Sean McNamara will always remind me how lucky I am to have a wonderful, functional relationship with my partner at Duet Plastic Surgery, Dr. Jennifer Weintraub.

Friday Figure Fix: Learning about lipo

You'll forgive me the facetious bit culled from the wire earlier this week. Sometimes stories like that are just too good to pass up in this line of work.

So let's get down to business, and talk about liposuction (or, lipo for short). As a real, live female plastic surgeon, I'd like to clear up a few misconceptions about this very popular procedure.

1. Lipo will help me melt the pounds away.

Sorry, nope - lipo is not a substitute for weight loss.

There are a lot of surgical procedures out there these days that are designed to help overweight or obese patients lose weight. Liposuction is NOT one of them. If you've been downing the Double-Doubles with fries and a shake regularly, thinking that a little plastic surgery can take care of that one day, you are incorrect.

Liposuction is a fabulous tool in the plastic surgical armamentarium, but it is designed for body contouring in a person who is at, or pretty close to, their ideal weight. Why is that? For one, the results are much better and much more appreciated. More importantly, it's safer for the patient. Speaking of safety...

2. Lipo isn't really surgery.

True liposuction absolutely, positively is real surgery. Every day, there is always some gimmicky new product appearing that promises "lipo" but with no scars, no surgery, no pain, no downtime (you know what they say about things that sound too good to be true...); sometimes they use flashy words like "laser" or phrases like "melt the fat away". These gimmicks are NOT liposuction.

Real liposuction is a tried and true method of body contouring that has been utilized by plastic surgeons for decades. It involves making a small incision in the skin (= surgery), inserting a long metal tube into the fatty layer beneath the skin (= surgery), and sucking out the fat in an informed and controlled manner (= surgery). There may or may not be additional technology involved (e.g. power-assisted lipo and ultrasound-assisted lipo). The surgery may be performed while the patient is awake (but anesthetized so that they are comfortable) or asleep. The procedure may be done in an office setting or in the operating room. This brings us to our next debunkable lipo myth...

3. Anyone can do lipo.

Well, sure. But really?

If I were looking for someone to do a surgical procedure on me, I would check first to make sure they have a valid medical license. You would be surprised.

Then I would check to see what kind of training they have had - they may be an M.D., but did they do their residency in pathology, or do they have a surgical background (because of what we learned in #2)?

And finally, call it a personal bias, but I would also want a plastic surgeon to do my liposuction. Why? Because our years of training include everything you've ever wanted to know about liposuction - how to do it, how to do it well, what complications can occur and how to take care of them. Your plastic surgeon is not just some bearer of a certificate from a weekend course. Our extensive training has taught us to deal with the entire body - "the skin and all its contents" as some like to say; we understand how everything in the body relates to each other, which is important when it's your health and your body.

So right, anyone can do lipo. But why would you want them to?