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.

Breast Reconstruction 101 by Dr. Caroline Glicksman is one in a  series of video based information for patients featured on THEplasticsurgerychannel.

What exactly is breast  reconstruction?
Breast cancer is the most common cancer occurring in women, affecting one in eight women in the United States.  Improvements in breast cancer screening have led to an earlier stage at which most cancers are detected.  There are also greater surgical options for women today, and when a mastectomy is needed teamwork between the breast surgeon and the plastic surgeon is the key to a successful outcome.  So what do you need to know if you or a loved one has been diagnosed with breast cancer and is considering breast reconstruction?

First of all, all women considering breast reconstruction should be given the opportunity to learn about their reconstructive options. These may include the use of one’s own tissues to reconstruct the breast, or the use of implants in a single of staged procedures.   A breast reconstruction can be performed immediately, at the time of the mastectomy, or delayed until the patient has completed possible chemotherapy or radiation.

Although reconstructive surgery following mastectomy is a federal law as detailed in Women’s Health and Cancer Rights Act of 1998, individual policies do vary and patients may encounter many difficulties in obtaining reimbursement.

How good can a breast reconstruction look?
The goal of early reconstructive surgeries was achieving a satisfactory result in a bra. Today, breast reconstruction can create breasts that look more like augmentations due to improved oncoplastic coordination, better surgical techniques, and advances in implant technology and design.

Breast Reduction 101 by Dr. Caroline Glicksman is one in a  series of video based information for patients featured on THEplasticsurgerychannel.

What is breast reduction surgery?

Breast reduction surgery:  am I a good candidate,  where are the scars, and will this operation be covered by my health insurance, are the most common questions my patients ask.

First, a breast reduction usually involves the removal of skin and fatty and glandular tissue from the breast to reduce the volume and reshape the breast.

Many patients may have had symptoms for years associated with the heavy weight of their breasts and may have associated problems requiring chiropractic care or physical therapy.  Although the scars of a breast reduction will fade over the years, they are permanent.  In addition, while the majority of younger women should be able to breast feed after breast reduction surgery.

Patients should be close to their ideal weight, free of any illness that would inhibit wound healing or anesthesia, and if over 35 should have had a recent mammogram.

The surgical actual surgical procedure varies depending on the amount of breast tissue to be removed.  Most procedures are done as an out-patient with recovery and full return to normal activities with-in about  2-3 weeks.  The actual amount of tissue removed, the pattern used for skin removal and breast reduction and post-op course all depend on your breast size and the preferences of the plastic surgeon.

Does insurance cover breast reduction?

Finally, the question of insurance reimbursement for this procedure is very complicated.  Individual plans vary, and many surgeons no longer accept what insurance companies will pay for this procedure.  It is best to check with your insurance company and then select your surgeon based on his or her qualifications and experience with  breast  reduction.

What patients should know about breast augmentation in New Jersey

Many women who are considering a breast augmentation in New Jersey begin their search on line and may be confused by the choices of implants that are available today.  Since 2006 both saline filled and silicone filled breast implants have been available to women in the United States.  In general, implant choices include both saline and silicone devices.  But there are also other choices to consider.  Silicone implants are manufactured as both round and shaped devises and they may have either a smooth or textured surface. So first let’s discuss the fill of an implant.  Although saline implants were popular for a really long time, many women and their plastic surgeons were unhappy with the feel of the implants and the rippling that could be felt or seen. They are still an option for many patients, but silicone gel implants are now the most popular implants in most of the world.

What is important for patients to know about implants for breast augmentation?

Silicone Gel implants for breast augmentation can be further divided into two groups:

• First there are the round gel implants. These implants are made slightly underfilled to make them soft and the gel is more cohesive, slightly thicker, than it was in earlier generations implants.  They come with both a smooth and textured surface on the outer shell of the implant, as texturing of the surface was thought to reduce capsular contracture, a tightening of the pocket around the implant.  There are many studies underway to determine if texturing of implants makes a real difference, but for now we do know that texturing may help with maintaining the position of an implant
• The newest generation of Form Stable Highly Cohesive Gel breast implants are nicknamed the “Gummy Bear” implants.  They are also called the Style 410 Silicone gel implant. These implants remain investigational in the United States until their FDA approval.  Gummy bear implants are very different from the round gel implants.  First of all the gel is thicker, or form stable.  This makes the implants just firm enough to resist folds and creases, yet soft enough to still feel like a breast.

Studies over the last 10 years in the US and since 1993 in Europe have shown considerably lower rupture and capsular contracture rates, however, studies are still ongoing until these implants are FDA approved. Finally, many web sites and plastic surgeons are creating “cohesion confusion” and women are often mislead by practices and sites advertising for “gummies” or “highly cohesive implants” that are just round gel devices.  Keep in mind the following when learning about your implant choices:

• Round silicone gel breast implants were FDA approved in 2006 after a 15 year moratorium.  They come with both a smooth and textured surface and should be available at all plastic surgeons’ offices.
• The newest generation of highly cohesive form stable implants, also known as “Gummy Bears” are always shaped, and always textured.  Patients must enroll in a FDA approved clinical trial, agree to a long-term 10 year follow-up, and these implants are only available from plastic surgeons who are approved investigators.

Dr Glicksman has been in practice for 20 years in New Jersey. Breast augmentation is a primary area of  expertise for her and she  has  presented nationally and internationally on this subject as well as published peer reviewed articles on breast augmentation. Remember a better educated breast augmentation New Jersey patient will make safer decisions and achieve longer lasting results.

Plastic Surgery Channel expert Dr. Bruce Van Natta talks about breast lifts / mastopexy in Indianapolis, Indiana.

What exactly is a breast lift/mastopexy?

As a member of The American Society of Plastic Surgeons and The American Society for Aesthetic Plastic Surgery, Bruce W. Van Natta,M.D. has expertise in a variety of cosmetic and reconstructive plastic surgery procedures.

This is a commonly requested procedure that is often misunderstood. Generally when a woman has excess skin around the breast often after pregnancy or weight loss, the breast size has reduced and there is a lot of skin around the area. This can be viewed as a deflation effect in the breast and the treatment for this would be to conduct an operation to remove some of that excess skin. Following pregnancy many women feel that their breast deflate, loose volume and become saggy. Dr Van Natta has been in practice for 20 years in Indianapolis, Indiana. Breast lifts / mastopexy have been one particular area that Dr Van Natta has specialized in his practice.

Who needs a breast lift/ mastopexy?

Dr. Van Natta finds that a lot of times women come in thinking that they need a breast implant or breast lift/ mastopexy when they that would not automatically be the right procedure for them. At times like this, it is important to sit down with the patient and really understand what their goals are in terms of how they want to look and appear without involving names of procedures and technical terms. Sometimes after such consultations, the surgeons can determine that all the patient really wants is a little more fill in the upper part of the breast and this can be achieved easily with an implant. Really taking the time to talk to patients and asking to see before and after pictures can help a surgeon understand what the patient’s goals are and allow them to do the right procedure. Seeking consultation with a board certified plastic surgeon is the 1st important step in patients getting the best outcome with breast lift / mastopexy. Asking questions and also talking to other patients who have use the same surgeon for a breast lift/ mastopexy can be helpful.

Breast augmentation or enlargement is the most common type of cosmetic surgery done in the United States each year.  Plastic surgery channel expert, Dr. Bruce Van Natta states in the year 2010, nearly 300,000 women chose to enlarge the size of their breasts using silicone or saline implants.

Why do Women Choose Breast Augmentation?

There could be various reasons for seeking breast augmentation however most often women are seeking to restore the volume and firmness in their breasts post pregnancy which often leads to a deflation in their tissues. Other women may be trying to enlarge their breast size so as to have fuller breasts to complement their overall shape.

How is Breast Augmentation Done?

Breast augmentation is most commonly done under general anesthesia and the breast implant is placed under the pectorals muscle. Recovery for this type of surgery varies from a day to about a week or two depending on the surgeon’s technique.  Implants may be placed through the armpit, the areola or the breast fold.  The overall  results are excellent; however,  there are  distinct differences in the recovery and reoperations rates depending on the technique.
Due to these reasons, it is very important to find a surgeon who is well qualified and experienced. It is recommended that the patient find a surgeon certified by the American Board of Plastic Surgery. The surgeon one chooses should ideally be very well versed with the breast augmentation procedure and should have performed it numerous times. Another good source of reviews about surgeons and their practices is through talking to friends and acquaintances.
Be sure to check the PSC website for more information about breast augmentation safety and options available.

What non-surgical fat  removal devices are available?:

1. Ultrashape
   Ultrashape is a widely used device for noninvasive cell destruction and skin tightening. It uses high intensity focused  ultrasound or  HIFU  to find and destroy unwanted fat cells, reduce circumference and give a slimmer shape. This device is also not commercially available in the United States.
2. Lyposonix
   This device is not cleared for sale in the United States. It basically is a noninvasive fat reduction device that similarly uses to get rid of targeted fat deposits in certain areas. It is generally a single treatment device where the patient is brought in for about an hour or so. 
3.  Zeltiq
   Only one of these devices is commercially available in the United States right now and that is Zeltiq which is otherwise known as “Cool Sculpting”. This device looks like a laser and has an applicator and attaches to that part of your body that has additional fat. These areas are usually the abdomen and flanks but the device has been used for outer arms and inner thighs. What this device does is that in the course of an hour it chills the fat in the area it is attached to. The fat is chilled to a temperature around freezing point. These  frozen fat cells then dies and goes away over the next 60-90 days and leaves the patient more toned and slim.

What  else should patients know?

All non surgical technology is very  popular and the potential for  non-surgical fat removal is hugely marketable.  Interested patients should be  careful of  the marketing hype and spin done with these technologies by  often  centers or  physicians with no  formal training for body contouring.   Cheaper is not better and  can  be  dangerous.  Make  sure you do  your homework.  Seek a  surgeon who is  Board Certified by the  American Board of Plastic Surgery, and  consult resources such as The Plastic Surgery Channel for  current information.  You  can  even  Ask our Expert Surgeon about non-surgical fat removal directly.

Facial fillers are  one of the most commonly requested procedures in Plastic surgery.  There are different type of fillers including juvederm, restylane and radiesse.  These products provide volume to the face.  We know that a primary component to  facial aging is the loss of volume.  Facial fillers  restore this  volume and in turn  help rejuvenate the face giving a fresher, younger look.  Not  all patients come into their plastic surgeon with the  same complaint.  Some may  say they  have a “tired look” and other may  say they have a “hollow look” to  a certain area of the face such a s the eyes.

Filler  injections are relatively painless and  are easily performed in the office.  Interested patients should look for a  Board Certified Plastic Surgeon to  discuss the  filler that may work best for them

Dr. Keyes is heavily involved in research and studies related to data collection and patient safety. He is double board certified by The American Board of Plastic Surgery and The American Board of Otolaryngology – Head and Neck Surgery. Dr. Keyes is a renowned international lecturer on safety during surgery.

Rhinoplasty is one of the most difficult surgeries to perform in cosmetic surgery. There are some plastic surgeons that specialize in Rhinoplasty more than any other surgery. One thing to make sure when undergoing a Rhinoplasty is to choose a surgeon who does this procedure frequently and is well versed with all the possibilities and techniques in the procedure. The surgeon must have a great deal of skill specific to Rhinoplasty. Rhinoplasty can be life changing surgery as it really does change the appearance of the face dramatically. Having said that, this is exactly why patients must be cautious in choosing the right surgeon since their entire facial appearance is at stake. The look arrived at after the rhinoplasty must have harmony with the rest of the patient’s face. It is therefore very important to understand the credentials of the plastic surgeon before undergoing the surgery.

What are Gummy Bear Breast Implants?

Lots of patients ask her about the difference between different cohesive breast implants and whether all silicone breast implants are cohesive.

Silicone breast implants made a comeback into the American market in 2006 and since then there has been confusion about the two types of implants – the traditional round gel implants and the newer form stable implants. This brings us to the question as to whether all silicone implants are cohesive and what exactly are Gummy Bear Implants. While all silicone implants are cohesive to some degree, there is a difference between the round silicone breast implants that are currently approved and the newer form stable devices that are still considered to be under investigation in this country.

Are Gummy Bear implants really different?

Gummy Bear Implants also called  cohesive gel implants fall within the newest form stable device category which means that they are just stable enough to resist folds and creases but soft enough to feel like a breast. They are considered to be semi firm but pliant nevertheless. The form stable feature refers to the fact that they are expected to retain their shape in every position. So there should be minimal creases, rippling or overlapping when a patient sits, stands or lies down.  In the US, Gummy Bear Implants are always shaped implants.

Dr. Glicksman advises that is a doctor suggests a Gummy Bear Implant, the patient should ask if they would be required to participate in a long term study. The reason for this is that Gummy Bear Implants or Cohesive Gel implants are not approved by the FDA in the United States and the authority requires a long term, large scale study to be conducted under rigorous guidelines before it can approve the same. Until then, these devices can only be made available to patients within the context of such a study. She further suggests doing ones due diligence and homework while considering a breast implant. Choosing a Board certified plastic surgeon is important and the patient should remember to ask the right questions including the exact type of breast implants the surgeon suggests as  well as  there expertise in the procedure including  presentations and publications they have done on breast augmentation.

Dr. Glicksman is a Medical Board Advisory Member of the Plastic Surgery Channel and  an  expert on gummy bear breast implants.