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.
Thursday, July 15, 2010
Friday, July 9, 2010
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, July 2, 2010
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.
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.
Wednesday, June 30, 2010
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...
Sunday, June 27, 2010
Why, hello there. What are you wearing?
Photo courtesy of jfeliasIt'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, June 25, 2010
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!
Monday, June 21, 2010
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.
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.
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