April 30th, 2013 | by Robert Cohen
In Dr. Randquist’s practice, the implants he uses are not only textured, but the majority of them are also anatomically shaped. What this means is that the upper part of the implant is thinner, and the implant gets thicker towards the bottom, imitating the shape of a natural breast from a side view.
There are some advantages and disadvantages to anatomical implants. First of all, these implants have an orientation. As opposed to a round implant, which looks the same from all sides, the anatomical implants have a top and a bottom, so they need to be oriented properly. In the past, many plastic surgeons heard stories about implants shifting or rotating, requiring revision surgery. As I learned from Dr. Randquist, who has placed more than 4,000 pairs of textured anatomical implants, this is a very rare problem with proper pocket dissection.
Another issue with anatomical implants is the shape. Many American patients like a fuller look in the upper breast, whereas many European women like a softer look in the upper breast. What is right for the majority of Swedish women may not be right for the majority of American women. Furthermore, these implants may not be appropriate for patients who present for revision surgery (where there is already a dissected pocket that may be too large) or for women who need implants and a lift. As a result, I feel that the anatomical implants will be a good option for my primary patients seeking a very natural look with limited upper breast fullness, but I anticipate continuing to use many round implants as well.
The benefit of my experience with Dr. Randquist was to broaden my options in providing my patients the best possible results. Will I be using only textured anatomical implants for breast augmentation in Phoenix and Scottsdale? No. But I do feel that these implants will become a much more routine option for American patients, and any surgeon who does not keep these as a part of their surgical choices is limiting possibilities for patients. As surgeons, changing how we think about problems and expanding our skill sets can be a lot of effort at first, but this is ultimately how we grow and provide our patients with the best and most updated surgical options possible.
Tags: breast augmentation phoenix, breast augmentation scottsdale
Posted in Breast Augmentation, Breast Implants, Breast Shaping No Comments »
April 17th, 2013 | by Robert Cohen
As an aesthetic surgery fellow, I had the opportunity in 2004-2005 to work with an implant company called Silimed, which made a very high-quality textured cohesive silicone gel implant. Working with Dr. Grant Stevens (one of the principle investigators on the FDA approved Silimed implant study) in Marina Del Rey, CA, I had the opportunity to place hundreds of these implants and I was very impressed. As a result, I was very excited when Silimed was finally FDA approved in the U.S., and opened to the American market via the company Sientra. The implants made by Sientra are often called “gummy bear implants” in the news, a term that Dr. Stevens coined.
There were many things I liked about Sientra implants during my fellowship. The implants had a soft feel, but were a highly cohesive gel. The shells (outer parts) of the implants were durable but soft, and were not prone to rippling or palpability through the skin. The texturing was also not excessively aggressive, nor was it too weak, which allowed the implants to stay where I put them during surgery and lowered the incidence of capsular contracture.
When working in Stockholm with Dr. Randquist, I was impressed with his long-term results. In the cases he showed, the textured implants stayed in a stable position over many years and maintained a natural appearance. For the five of us visiting Dr. Randquist, I believe this was an eye-opening experience. As Americans, all of us were primarily using smooth, round implants, and the argument presented by Dr. Randquist for using textured implants, as mentioned above, was fairly convincing.
Since my return home, I have shifted towards using more Sientra textured implants. I believe these new implants will offer long-term advantages for many breast augmentation patients. At my Scottsdale practice, I still using Mentor smooth round implants as well, because in some patients, the shape of the Sientra moderate profile implant is too projected, and the shape of the Sientra low profile implant is too flat. I have been getting great results over the years with Mentor implants, and I am not completely switching over, but it is nice to have more options available now to get the best overall results for my patients.
Tags: breast augmentation scottsdale
Posted in Breast Implants, General Plastic Surgery No Comments »
April 10th, 2013 | by Robert Cohen
As a background, there has been a large split in which implants are used in the U.S. versus Europe. Most of the difference can be attributed to the false concern in the early 1990s that silicone might cause autoimmune disorders. Thankfully, after massive medical studies, it was conclusively shown that silicone implants do not cause these disorders. Unfortunately, once the legal system was involved, it took about 15 years before silicone implants were again released for first-time breast augmentations.
During this period of time, plastic surgeons in the U.S. were forced to use saline implants, which have an inferior appearance and feel when compared to silicone breast implants. Phoenix and Scottsdale plastic surgery patients often reported that these round saline implants with smooth surface shells (implant bags) had a propensity to look and feel less natural than real breast tissue. The textured saline implants felt even less natural and were prone to rupturing prematurely.
I was very thankful when the FDA finally lifted the ban in 2006, after overwhelming evidence supported the safety of silicone implants. Silicone implants were always used in Europe, and were also allowed in the U.S. during this time for breast reconstruction, breast lift surgery, and implant replacement surgery. It never made sense to me why first time patients were deprived of these superior quality implants. The newer silicone implants themselves were vastly improved over older versions in the sense that the gel was cohesive (as opposed to liquid) and the shells were much stronger and resistant to rupture.
In any case, I was thrilled to once again be able to use silicone implants in my primary breast augmentation patients. Like the majority of surgeons in the U.S., I had used smooth, round saline implants. Naturally, most of us transitioned to smooth, round silicone implants. These implants generally gave me excellent results, but in certain cases they could shift positions over time. This was common in patients with rounded ribcages, where the implants occasionally migrated laterally (to the sides) when the patients were lying on their backs. This could be a frustrating experience, but I was not particularly interested in trying textured implants as I had been told during my residency that they were more prone to rupture and could be felt more through the skin. This was outdated information that I would soon overcome.
Tags: breast implants phoenix, breast implants scottsdale, phoenix plastic surgery, scottsdale plastic surgery
Posted in Breast Augmentation, Breast Implants No Comments »
April 5th, 2013 | by Robert Cohen
I was recently one of five plastic surgeons nationwide to be invited to participate in a unique surgical experience. I was flown to Stockholm, Sweden to spend time with Dr. Charles Randquist, one of the premier plastic surgeons in Europe. Dr. Randquist has likely placed more textured anatomical implants than any other surgeon alive. Since, like most American surgeons, my experience as a plastic surgeon in Scottsdale was primarily with smooth, round implants, I was eager to watch him perform surgery and to see what kind of results he achieved with these implants.
Stockholm was a beautiful city, and Dr. Randquist had an extremely impressive facility and staff. The entire trip was enjoyable from a cultural perspective as well. His patients were particularly kind and generous in allowing the small group of surgeons to watch their procedures and follow-ups. Although any of these aspects of my trip would make for an interesting blog topic, I feel that the most pertinent information from my experience relates to new implant technology that is now becoming available in the US. As a result, my “Stockholm blog series” will focus on the implants we studied at length in Sweden, and how these implants can potentially benefit my breast augmentation patients in Scottsdale.
Tags: breast augmentation scottsdale, plastic surgeon scottsdale
Posted in Breast Augmentation, General Plastic Surgery No Comments »
November 21st, 2012 | by Robert Cohen
Women aren’t the only ones seeking plastic surgery in Phoenix. During the past several years, more men have been scheduling consultations with me to find out how plastic surgery can improve their personal and professional images.
Although there are a number of procedures that can be beneficial for men, I find that liposuction is one of the most popular because it can be used to address 3 common concerns of my male patients: gynecomastia, love handles and a double chin.
- Gynecomastia: This is a medical condition which results in overdeveloped breasts in men. Many of my patients who have gynecomastia are embarrassed because their chests appear feminine. They may feel forced to avoid certain clothing, activities or social situations because of their “man boobs.” Liposuction can be useful when exercise and diet fail to sculpt a flat, firm chest. I use power-assisted liposuction during male breast reduction surgery to remove excess fatty tissue. This results in a more masculine look and improved confidence.
- Love Handles: Men tend to store additional weight in the abdominal area, especially in the flanks (also known as love handles). Liposuction can create a slimmer, more athletic look by removing this stubborn fat. As long as healthful diet and exercise routines are maintained, the results are long-lasting.
- Double Chin: another area where men tend to store extra fat is under the chin. This can create a double chin and weaken the prominence of the jawline. During chin liposuction, I use very tiny incisions to remove fat and create a more defined jawline. In some cases, chin implants can also be used to create a stronger profile.
Tags: plastic surgery phoenix
Posted in Body Contouring, Liposuction No Comments »