Archive for the ‘General Plastic Surgery’ Category

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One More Reason to Have Plastic Surgery in the United States

Tuesday, January 24th, 2012

My Phoenix plastic surgery patients sometimes ask me if it is a bad idea to go to other countries to have their procedure performed at a lower cost. In my opinion, surgery is serious business, and bargain hunting should not be one’s priority when it comes to issues of health, surgical quality and safety.

There are certainly some very talented surgeons in Mexico, South America and elsewhere, but the degree of oversight and regulations pales in comparison to the U.S. Surgery is not just about the plastic surgeon – for Scottsdale residents, it is also about the ancillary staff, as well as accreditation, medications and devices used during surgery. In the U.S., very stringent rules and regulations are in place to protect patient safety. The FDA provides important oversight to ensure that medications and products used during surgery have been studied and tested properly.

Recently in the news, there have been reports of concern with a particular type of implant manufactured in France by a now-defunct company called Poly Implants Prothèses (PIP). In 2006, I was involved in a study demonstrating the high deflation rate of saline implants produced by PIP, which was published in Plastic and Reconstructive Surgery, the most prestigious journal for plastic surgeons. In this article, we advised that the deflation rate with these implants was much higher than with saline implants produced by Mentor® and Allergan, the U.S. implant manufacturers.

More recently, it has come to light that the silicone implants produced by this company were made using industrial-grade rather than medical-grade silicone. Of course, this cut the cost on implants significantly, but it also cut major corners on safety. Now, many women are reporting concerns with their implants and tens of thousands of women all over the world may be advised to have these implants removed and exchanged.

Thankfully, because the FDA never approved these implants, the only American women who have to worry are those who travelled abroad for surgery and received PIP silicone implants. Unlike Mentor and Allergan silicone implants, which are considered the most studied medical devices in medical history, PIP implants did not have to undergo rigorous safety screening by the FDA. As a result, patients will have to endure extra surgery to deal with the failure of PIP to produce a quality medical product.

This situation should serve as a warning to patients: Cutting costs up front may end up costing more in the long run. Although surgery in the U.S. is generally more expensive than in other countries, this cost covers more than surgery alone. It covers additional safety and quality and, ultimately for patients, peace of mind.

Scars: What to Expect After Plastic Surgery [Part II: Uncontrollable Factors]

Thursday, January 19th, 2012

Any time an incision is made there will be a permanent scar. As I discussed in Part I of this blog series, when I perform Phoenix area plastic surgery, I take all possible precautions to ensure that scars will heal smoothly. In addition, I advise my patients on what they can do during their recovery process to minimize the appearance of scars. Unfortunately, some factors are outside our control.

First and foremost, genetics is the greatest uncontrollable factor. Everyone scars differently. The same surgeon can perform the same surgery using the same technique on two different patients and get completely different scars. Simply put, some people heal more smoothly, while others have a tendency to form more noticeable scars.

Patients who have a personal or family history of bad scarring should be cautious about surgery. A genetic tendency toward severe scarring can affect not only the external, visible scar tissue but also the internal scar tissue.

Many people of Asian, African, Middle Eastern and Mediterranean descent are more prone to scarring. However, these are general findings, and every individual heals differently regardless of his or her ethnicity. Some Caucasians form thick, red scars while some African-Americans form nearly invisible scars.

Another factor affecting scarring is body location. Certain areas of the body tend to heal with thicker scars. The center of the chest, the shoulders and the back are notorious for bad scars because of the thick, tight skin. This is why surgeons try to avoid incisions in these areas. If, for some reason, an incision must be made in one of these areas, there is a higher risk for thicker or more noticeable scars.

Tension on a wound closure also can contribute to scarring. The more the skin is being pulled, the higher the likelihood that the patient will develop a bad scar. This is one reason why plastic surgery is so challenging; almost everything we do requires tension. Unlike a C-section or an appendectomy, where no skin is removed, breast reductions, tummy tucks and facelifts all require skin removal, which causes more tension to be placed on the wound closure.

To counteract this, plastic surgeons pay a lot of attention to layered closure and fine suturing techniques. One could argue that tension is a controllable factor. However, to a large degree, the surgeon cannot control tension. To achieve the desired result, a certain amount of tightening is required with procedures such as a breast lift or a tummy tuck in the Phoenix area.

Some other causes of scarring also cannot be fully controlled. These include wound infections, problems dissolving internal sutures and other healing challenges. If one of these problems occurs, the patient and surgeon can work together to improve the situation.

I hope I have helped explain one of the most unpredictable and important aspects of plastic surgery. I always do everything I can, both during and after surgery, to minimize scars. Most of my patients heal extremely well and are happy with their results, including their minimal scars. Although some people will develop less than ideal scars despite my best efforts, the majority of such patients are still happy with the overall results of their surgery.

The bottom line is that everyone considering elective surgery must be realistic about the possibility of having more visible scars than they would like and understand that this is a low – but real – risk.

Scars: What to Expect After Plastic Surgery [Part I: Controllable Factors]

Wednesday, January 11th, 2012

As a plastic surgeon in the Scottsdale area, one of the questions I often hear from patients is: “What will my scars look like?”

Obviously, scars will be a concern for patients having extensive surgery, such as a tummy tuck or a breast lift, but patients having less invasive surgery, such as liposuction or breast augmentation, still worry about their scars.

The truth about scars is that there are some aspects the surgeon can control, while other aspects cannot be controlled. Keeping that in mind, the first part of this two-part blog series will discuss the controllable factors, and the second part will discuss the uncontrollable ones.

Controllable factors mostly have to do with surgical technique and postoperative care. During surgery, it is important for the surgeon to be as gentle as possible with the tissues. Rough handling of the skin, overuse of cauterization and imprecise incisions can certainly cause extra scarring. In addition, poor suturing techniques, the types of sutures used and how carefully the sutures are placed can affect scar healing.

When I perform a procedure such as a tummy tuck in the Phoenix area, I am extremely meticulous about how I handle tissue in order to cause the least amount of trauma possible. I also take time during the closure to make sure the tissues and skin line up as cleanly and smoothly as possible. Finally, for all but the smallest surgeries, I do multiple layers of suturing with dissolving, under-the-skin sutures to avoid any stitch marks in the skin. I use longer-lasting deep sutures to take tension off the skin-surface sutures, which reduces the possibility of scar spread.

Controllable factors after surgery include minimizing the risk of infection, scar massage, using ointment in the early period and using silicone sheeting or steroid injections if necessary to flatten scars. For my patients’ follow-up visits after surgery, I always see them personally to evaluate the scars and advise them on what can be done to minimize the visibility of scars.

It’s important to understand that scars fade over time. As you heal, your scars will become less visible.

One final idea I would like to share is that patients can take part in their own healing process to minimize scars. It is very important to follow post-op instructions, including these recommendations:

  • Do not exercise too soon. This can put strain on the tissues.
  • Avoid smoking after surgery. Smoking impairs wound healing.
  • Avoid UV exposure or tanning of scar areas for a full year to minimize scar darkening.
  • Massage your scars for a few minutes each day to help them soften. Products such as Mederma®, which are marketed specifically for reducing scars and stretch marks, are fine, but studies have not shown a huge improvement in long-term scarring. If patients want to use these products, I do not discourage them as long as I know exactly what they are putting on their scars. Some products, such as topical vitamin E, have been shown to cause more harm than good.

In Part 2 of this blog series, I will discuss factors related to scarring that are outside our control.

Is Plastic Surgery Dangerous?

Tuesday, April 12th, 2011

The issue of safety in plastic surgery comes up frequently in the media. News and entertainment shows like nothing better than a high-profile plastic surgery disaster to get viewers glued to their TV sets. Think of how much publicity was given to the case of Donda West (Kanye West’s mother) after her death at the hands of a non-board-certified surgeon. While I feel it is important for my patients to take any surgery seriously, I also believe that the risks of plastic surgery in Phoenix, when performed by a skilled, board-certified plastic surgeon in Phoenix, are very low.

My renewed interest in this topic was piqued by an article I happened to see on msn.com discussing plastic surgery disasters. This was an article which discussed deaths and horrific results from plastic surgery. The stories were all pretty grim, and would understandably make someone very nervous about undergoing a procedure.

As I continued to read about these 20 cases, I quickly noticed a common theme. In only 2 of 20 cases was an actual board-certified plastic surgeon involved! Many of the doctors performing surgery were not properly trained in any form of surgery, and in more than a few cases, the person performing the surgery wasn’t even an actual doctor! In a few cases, the surgeons were performing surgery with their patient under anesthesia, without an anesthesiologist or even a CRNA (nurse anesthetist) present!

Why would people let themselves get into a situation where their very lives would be put at risk? For some of these patients, a rush to get to surgery without properly researching their surgeon was the primary issue. (If you are going to have plastic surgery, make sure that your surgeon is not only “board-certified,” but also confirm that the board they are referring to is the American Board of Plastic Surgery). In other cases, patients were going for the cheapest surgery not realizing that cutting costs usually means cutting corners on skill and safety. (Make sure that your surgery is being performed at a State Accredited Outpatient Surgery Center or hospital, and that you will have a board-certified anesthesiologist performing your surgery).

In retrospect, I felt that this “Plastic Surgery Disasters” article was helpful and eye opening if the truly important points were understood by the readers: Plastic surgery itself is not unsafe, but it certainly can be very dangerous when performed by someone who is not properly qualified and is willing to compromise on your safety. You want your plastic surgeon to have the best skill and training possible. Even if a doctor is really skilled in another specialty, it does not mean that they are properly trained to do plastic surgery procedures. To put this another way, you would not want an “excellent boat captain” to be flying your airplane.

Always do your research when it comes to choosing a plastic surgeon in Phoenix. Make sure the doctor is board certified by the American Board of Plastic Surgery, look at the doctor’s before and after photos, check their training and background, and make sure they do not have any outstanding violations with the medical board. Also, make sure that the surgical facility they use is properly accredited and set up for your type of procedure. If you do these things, your risk of a “plastic surgery disaster” will be extremely low.

Choose Wisely & Avoid Regrets Later

Saturday, January 15th, 2011

How do you plan ahead to make sure you will be happy with your breast augmentation results? Celebrities like Heidi Montag and Lisa Rinna have come forward recently with admissions that they regret some of their plastic surgery choices. Women and men who come to the Scottsdale Center for Plastic Surgery know that I make every effort to communicate realistic expectations and achieve beautiful and natural results the first time. Here are some things to think about now so you won’t have regrets later:

Consider more than just size. This is particularly imperative for women choosing breast augmentation in Phoenix and Scottsdale. Women come to me for a natural result that is in proportion with the rest of their body, and breast implant size is highly influential factor in post-surgical appearance. Lifestyle is another big consideration; if you are an avid runner or bicyclist, you will be best off by avoiding extra-large breast implants.

Get perspective. You may have been unhappy with a certain feature for so long that all you can think about is changing it drastically. For instance, some women with thinner lips want to super-size them. Women with very small breasts sometimes want to go to the opposite extreme as well, and some liposuction patients want every ounce of fat removed from their “trouble spots.” I remind my patients that balance, harmony, and a natural result are the goal. Extreme is never a good word when it comes to plastic surgery.

Think about your motivation. Getting plastic surgery for the wrong reasons is a recipe for disappointment and regrets. Plastic surgery is not a spa treatment, and should be considered carefully while weighing out the pros and cons. Plastic surgery should never be an impulsive decision, and should be seen as a way to enhance your life, not as a quick fix for problems with work, relationships, or self-esteem. I only operate on women and men who have thought carefully about their reasons for surgery, and who have realistic expectations about how surgery can improve their lives.