By Carolynn Grimes
ThePlasticSurgeryChannel.com

Dr. Baxter says there are real benefits for patients:

1. Less reliance on narcotic drugs for pain
2. Less pain in the most critical first three days following surgery

Dr. Brett Snyder, a board certified plastic surgeon says, besides long lasting pain relief, Exparel means an increase in the patient’s comfort and better outcomes. Snyder, a board member of ThePlasticSurgeryChannel.com says, “Using a topical, sustained release local anesthetic will reduce post-operative pain and therefore reduce post-operative narcotics, which will lead to quicker and better results.”

Exparel Receives FDA Approval

Developed by Pacira Pharmaceuticals, Inc., Exparel was approved in October, 2011 by the Food and Drug Administration and recently launched into the market place.  President and CEO of Pacira Pharmaceuticals, Inc., Dave Stack says, “This FDA approval is an important milestone for Pacira, as well as the millions of patients undergoing surgical procedures in the U.S. each year. We are excited to launch Exparel in the United States.”

Dr. Dan Del Vecchio, a board certified plastic surgeon and member of ThePlasticSurgeryChannel.com says Exparel combines Liposome, which is used to deliver chemotherapy and Marcaine which is commonly injected into surgical wounds to reduce pain. “For the past 20-30 years we haven’t made many advantages in post-operative pain management. We treat our patients mostly with narcotics,” says Del Vecchio.  He says, “The problem with narcotics is they can cause side effects.  In young patients narcotics may cause nausea or vomiting, in elderly patients they can cause urinary retention and respiratory depression.” Del Vecchio says, when you look at hospital stays for patients who have received narcotics and have had an adverse side effect, the average increase in a patient’s hospital cost is about 5-thousand dollars.   He says, “not only is it patient safety issue, it’s an economic issue.”

Exparel, a Good Pain Management Option for Plastic Surgery Patients

For plastic surgery patients, Del Vecchio says, “There’s obviously potential to look at our breast augmentation patients, and abdominoplasty patients, these are the patients that have significant pain in the post-operative period.” Controlling pain after surgery is a serious consideration for many people looking into any plastic surgery procedure. Dr. Baxter states, “I think this is a real advantage for patients; if I were going into surgery the idea of not having to experience the pain at least to the same degree would be a very appealing concept.”

By Brett Snyder, MD
and Carolynn Grimes
ThePlasticSurgeryChannel.com

What is a Facelift?

Snyder says, “When we talk about the face, we are generally talking about the area from the chin to the eyebrows. Facelifts as we generally think of them don’t address this area. The traditional facelift is probably better termed lower face and neck lift, because those are the areas that benefit most from the operation.”

Procedures that correct the eyebrows, eyelids and cheeks are usually separate from the traditional facelift procedure and they have their own names such as brow lift and mid facelift. Snyder keeps the terminology simple for his patients and tries to be very specific when explaining how each procedure will help.

Who Would Benefit From a Facelift?

The American Society of Aesthetic Plastic Surgeons (ASAPS), says most patients who are interested in a facelift feel their facial features do not reflect their youthful spirit and energy level. They’re looking for ways to refresh and rejuvenate their appearance.

If you’re seeing signs of aging in your face and would like to do something about it, a facelift might be for you. A facelift can correct some of these common signs of aging…

• Sagging in the middle and lower face
• Creases below the lower eyelids
• Creases along the nose extending to the corner of the mouth
• Look of jowls in the lower face
• Excess skin under the chin and jaw

Dr. Snyder says the lower face and neck lift will improve the appearance of the lower cheeks and jowls, the jawline and the neck. “This will also help the hanging bands in the middle part of the neck,” says Snyder.

However, many people don’t understand why they have to do a facelift if they are just worried about their neck. Snyder says patients are anxious about the facelift portion because they don’t want to turn out like the bad examples they see in magazines. He says, “The neck and the face are connected, they share many of the same structures, and if you’re going to take care of one, then you must also address the other.”

Most importantly, Snyder says, all facelifts are not the same, and a well done facelift will achieve the patient’s goal of a natural, well-rested look with a youthful appearance.

By Robert Grant, MD
and Carolynn Grimes
ThePlasticSurgeryChannel.com

Grant, a leading plastic surgeon in New York says the use of neurotoxins for improvement of facial appearance in the recommended doses has a safety profile and a track record of success that is unparalleled in the aesthetic world.  “When used judiciously, the use of neurotoxins like Botox and Dysport have been a great advance in improving how one looks and feels about themselves,” says Grant.

However, the opposite is true, Grant says, when human growth hormones (HGH) injections are used for cosmetic reasons.  Grant says growth hormones have not been proven safe over the long-term, and without a track record of reliability, he doesn’t recommend their use for cosmetic reasons. “There’s a reason human growth hormones are condemned when used cosmetically by just about every reputable endocrinologist who has studied its use,” says Grant.

What is HGH?

HGH is a hormone that is naturally produced in the pituitary gland in the brain. It stimulates growth, cell reproduction and regeneration, but normally declines after adolescence.  Currently the Food and Drug Administration (FDA) does not endorse the use of HGH as a form of anti-aging treatments. Some of the possible side effects of HGH include:

• high blood pressure
• heart failure
• diabetes
• abnormal bone growth
• hardening of the arteries
• joint/muscle pain or arthritis-like symptoms

If you are someone who is interested in staying younger looking, you are probably better off sticking with the tried and true. Botox has been around for more than two decades and studies indicate that it is safe for cosmetic treatments. Now, there are other brands of neurotoxins on the market that give consumers more choices, including Dysport and Xeomin.

A Healthy Sex Life Increases HGH Production

Grant says if you are still interested in human growth hormones for keeping yourself young looking, he has an alternative suggestion; have more sex! Grant says a recent study from Scotland reports that having a healthy sex life, meaning making love with your partner on average three times a week, can make you look as much as seven years younger. In addition to promoting self-esteem and confidence, sexual activity increases the production of human growth hormone.  Grant says, “There really is no better exercise for the mind and body than a healthy sex life.”

By Lee Thornton MD
and Carolynn Grimes
ThePlasticSurgeryChannel.com

Body contouring around the waistline is very predictable and successful as long as the proper procedure or combination of procedures is selected and tailored to your particular body shape. Dr. Lee Thornton a board certified plastic surgeon says there is some confusion as to when you may need liposuction versus more invasive surgeries such as a mini or a full abdominoplasty.

Thornton says the first step for either procedure is to evaluate the structures that determine the shape in the midsection, from the lower part of the rib cage to just below the waistline. These include the position and condition of the abdominal muscles, and the amount and distribution of the fat in the area. Also the condition, and the amount and quality of the overlying skin is taken into consideration.

When Liposuction May Be Right For You

Thornton says if you happen to have strong muscles that have not been affected by pregnancy, previous surgery or other factors, and the overlying skin is relatively tight with good elasticity, you probably will only need liposuction to get rid of unwanted fat.

When performed in a properly selected patient, Thornton says liposuction is a very safe and reliable procedure. “Liposuction performed by an experienced surgeon will remove unwanted fat, but you must have good muscle tone and the overlying skin must have the ability to tighten after the fat is removed,” says Thornton.

When a Tummy Tuck (Abdominoplasty) May Be Right For You

When there is a significant issue with laxity of the underlying muscles or a significant excess of skin or stretch marks, Thornton says tummy tuck otherwise known as adominoplasty, is probably the way to go.

Mini-Adominoplasty vs. a Full Adominoplasty

A mini adominoplasty takes care of the muscle, skin and fat from the belly button to the pubic area. A full abdonimoplasty addresses the muscle, skin and fat from the rib cage to the pubic area. “If there is a laxity of these muscles you must open the area in order to reshape and tighten the muscular ‘foundation’ of the midsection,” explains Thornton. He says if there is excessive loose skin or skin that has lost its elasticity due to aging or stretch marks, it is essential to surgically remove the skin to achieve the desired result.

Your surgeon may choose to use liposuction or direct surgical removal of fat tissue when performing either of these procedures.  Failure to properly evaluate and address these structures will lead to poor outcomes.  However, when you have a complete evaluation by a board certified plastic surgeon who has experience in this area, you should expect to achieve good and long lasting results.

Cheers,
Dominik (male, 20 years old)

By Dr. Lee Thornton
and Carolynn Grimes
ThePlasticSurgeryChannel.com

For many women, when they lose weight or stop breast feeding, the skin does not shrink back to its original shape. If you would like to re-gain your original breast tissue but aren’t sure which procedure would be best, Dr. Thornton sorts out the differences and explains some of the most common questions women are asking.

How to choose?

It requires the evaluation and expertise of a board certified plastic surgeon with experience in all of those procedures to achieve the best result.

What are breast implants designed to do?

Implants add volume or size to the breast and they can also change the shape of the breast.  Implants can make the breast fuller, by giving it a more rounded appearance, as well as adding fullness to the upper portion of the breast. Losing volume or fullness is a common complaint of many women that comes with age or pregnancy.

Implants come in different sizes and shapes.

Implants come in different sizes and shapes and can be filled with saline or silicone gel. A plastic surgeon can help you choose the right fill and shape of an implant to correct differences in shapes and size of the breast.  In fact, says Thornton, “Most women have some degree of asymmetry naturally.  He says, “If the asymmetry of the breasts are not too great and the breast does not have too much sagging, drooping or excess skin, a breast augmentation alone will be all that is needed.”

Choosing an Implant that’s too big, could mean complications later.

Choices get more complicated Thornton says, when the differences in breast size or shape cannot be corrected with an implant alone.  He says, don’t  pick a breast implant that is too large for your body.  “ The use of an implant that is too large will lead to problems requiring more complications in the future,” says Thornton. Implants, as a general rule, do not keep the breast from sagging and can often make sagging worse when the breast ends up too large for your body.

Some women have enough breast tissue and don’t need an implant

If you already have a breast size that is adequate, you and your surgeon should give serious consideration to performing a breast lift alone.  Thornton says, “There is no way to add an implant to your breast for fullness and not also increase the size of your breast.”

What is a breast lift?

A breast lift, otherwise known as a mastopexy can give long lasting and natural results without the need for an implant.  The mastopexy alone does not give quite the fullness above the nipple long term that you can get with an implant, however the trade off of the lift alone without the implant is often the best choice when your breast is already big enough.

What the experts say…

In Thornton’s experience, he says in most situations it’s not appropriate to remove your natural breast tissue and place an implant to get that “implant” look or fullness up top.  If you have enough beast size naturally, use your own tissue and just have a breast lift.  “I have often seen patients after they have had a combination lift and implants and they feel they are too big and then they begin to sag again,” says Thornton. He says, “The heavier the breast, the more it droops, regardless if there is an implant or not. Implants, as a general rule, do not keep the breast from sagging and can often make sagging worse when the breast ends up too large for your body.”

To summarize, breast implants are normally used for increasing breast size and for relatively minor shape changes, while a breast lift is sometimes needed with an implant to overcome greater amounts of excess skin or sagging and can be used alone to correct sagging when breast size is already adequate.

By Carolynn Grimes
ThePlasticSurgeryChannel.com

Dr. Robert Grant, a board certified plastic surgeon from New York says, “Everyone has a different healing time because of skin type, genetics and overall health.” According to Grant, “Surgeons should take an individual approach with each patient.”

Dr. Lee Thornton agrees and says, educating patients on the steps outlined below and following your doctors instructions to the letter may be the most important thing you can do to prevent scarring.

Five Steps to Better Looking Scars

Step one - minimize tension on the scar and keep pressure over the scar with surgical dressings. Stress on your incision by lifting or bending can put tension on the incision. The stress can pull the scar apart and delay your healing time, sometimes making the scar wider.

Step two – keep your scar clean to prevent infection. It’s important to identify the signs of infection early and visit your doctor immediately. Signs of infection may include, redness surrounding the scar, swelling or inflammation, drainage, or fever.

Step three – make sure your scar stays out of the sun. Minimal exposure to sunlight is extremely important. Sunscreen is an important ingredient to add for those scars on the face and body that may be exposed to the sun.

Step four – this is where the patient can make the biggest difference. Keep the scar hydrated with topical silicone gel or silicone sheets. Silicone has a proven scientific benefits for healing scars.

Step five – monitor your scar closely. You may need a steroid cream or a steroid injection to cut down on inflammation to prevent widening of the scar or a raised red scar.

New Scar Creams Make it Easier for the Patient

Plastic surgeons with The Plastic Surgery Channel say manufacturers are making it easier than ever for the patients by combining sunscreens and steroids with silicone gels and creams. By combining key ingredients into one product, surgeons say patient’s are more successful at treating their scars because there is one less step they have to take.

Dr. John Gross, a board certified plastic surgeon in California says patients with a history of poor healing that typically get keloid or hypertrophic scars may need to get steroid injections. However, Gross points out, the first line of treatment is to use a silicone gel or silicone with a steroid cream included in the gel. He says, if that doesn’t do the trick to reduce inflammation and redness, then a steroid injection may be needed.

Surgeons agree, by taking these five steps and following your doctors orders, patients can expect a much better outcome for their scars.

By Dr. Brian Reagan
and Carolynn Grimes
ThePlasticSurgeryChannel.com

Don’t Be Fooled By Clever Marketing

Reagan says many ads and infomercials such as the mini-facelift use clever marketing techniques and consumers need to know the difference.  “We are talking about your face, and you can’t simply throw away a bad purchase and buy another,” says Reagan.

Dr. Reagan who specializes in facial rejuvenation at his San Diego, California practice is passionate about plastic surgery advertising and has put together a list of Do’s and Don’ts to help consumers figure out what’s marketing hype and what’s credible information.

The Don’ts:

Don’t believe everything you see in commercials— Many ads claim they use techniques that are new and revolutionary.  Reagan says, most often these claims are not true.  He says, the ‘mini-face lift’ is simply a facelift along with a neck lift under local anesthesia while you sit in a chair.  He explains, the ‘quick lift’ is a type of facelift that uses a stitch or two to lift your face in a more vertical direction.  While this means less surgery and less time for the surgeon, the scars are often longer and placed in a more visible spot.

Don’t be swayed by a fancy procedure name.  Sometimes, it’s just that, a fancy marketing name.

Don’t let the price be the determining factor on which doctor you choose to perform your surgery.

Don’t be pressured into paying immediately to reserve your spot.  If you feel pressured, something is not right and you should leave.

Don’t agree to a surgical procedure without consulting with other board certified plastic surgeons. It doesn’t hurt to get a second or even a third opinion.  Make sure they are board certified in their field of practice and members of the American Society of Aesthetic Plastic Surgeons (ASAPS).  A plastic surgeon who is a member of ASAPS has a particular focus on cosmetic surgery.

The Do’s:

Do your homework.  Look into the credentials of your plastic surgeon. Reagan says, “As surgeons, we know the most important decision you will make is who you choose to do your surgery.”  While many doctors claim themselves as cosmetic surgeons, know that a board certified plastic surgeon has done extensive training to develop the skills and judgment to perform your surgery correctly.

Do understand the limitations of a mini-facelift. Many times the mini-facelift is not sufficient for some patients.  If a doctor only performs the mini-facelift, then he is not capable of giving you an honest consultation on what you may need.

Do ask to talk to previous patients.  If the doctor performs great service, his or her patients should be happy to talk.

With any plastic surgery procedure, make sure the doctor you choose is board certified and that you feel comfortable with the consultation.  A board certified plastic surgeon should be able to offer options based on your particular needs to get the best results possible.

By Brett Snyder, MD
and Carolynn Grimes
ThePlasticSurgeryChannel.com

Mastopexy, or what’s frequently called a breast lift, is a popular procedure especially among women who have gone through pregnancy, breast feeding or weight loss.  At a certain stage in many women’s lives, they are left with droopy breasts that an implant alone can’t fix.  Dr. Brett Snyder, a board certified plastic surgeon says many patients who are interested in a breast lift have a lot of concerns about the procedure due to common misconceptions.

Mastopexy Myths

Dr. Snyder says one of the most common myths is the breast nipple is completely removed during a breast lift.  “In reality, the nipple is left attached to the breast and the skin is rearranged to allow the nipple position to be elevated,” says Snyder.  He says, in most cases, nipple sensation is preserved because the nipple is not removed.

Another common misconception is that using a larger breast implant will lift the nipple. Snyder says, “While implants are very useful to restore breast volume, they don’t actually lift the nipple.”  He explains how trying to use a larger implant to lift the nipple either doesn’t correct the problem or can create long term problems for the patient.

Don’t Allow Your Fear of Scaring Determine Your Decision

Scars are another misconception most patients fear.  Either they’ve seen or heard of bad cases or they fear their scars will be unattractive to themselves or to their husband or partner.  Snyder says most patients tell him that they are extremely happy with the end result and the scars healed nicely.  The majority of his patients say the improvement of the breast shape is worth the trade-off of a barely noticeable scar.

Snyder says if you’re considering a breast lift but have put it off because of any of these myths; don’t put it off any longer.  He says your first step should be to visit a board certified plastic surgeon to discuss your concerns and hopefully, some of your fears and apprehensions will be put to rest.