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LA-DOCTOR.COM Physician Member Articles:
BREAST IMPLANTS There are well over 2 million women in the United States with implant-augmented breasts. Despite the unfortunate hysteria over implant safety caused by the FDA, women are again seeking cosmetic breast augmentation, because they enjoy the way the surgery makes them look in clothes and the way that it makes them feel about themselves. We now have over 30 years of experience with breast implants in the U.S. (that’s a lot), and the statistics show that there is no connection between implants and illness or cancer. With implants, whether above- or below the muscle, the woman’s breasts are still “up front”, so they can be examined, mammogrammed, or nursed from, just as they normally would. One of the major reasons that breast implant surgery is so popular is that it is easy to go through. (half of my patients don't even use any pain pills). The surgery can be done under any kind of anesthesia (local, general, or twilight) as an outpatient, and most people go back to office work in 3 or 4 days without difficulty. Well-done breast augmentation requires attention to many factors, including height, weight, shoulder width, width of the hips, length of the torso, span of the ribs and chest, and the amount of natural breast tissue, to name a few. One of the most important details is what the patient wants. After all, the surgery should be done for her benefit, not the surgeon’s. Complications can happen with any surgery, but fortunately are relatively uncommon in breast implant surgery. Bleeding (1%), infection (0.1%), loss of feeling (frequent, but usually temporary), and hardness (3-4%) are the main concerns. Contrary to popular belief, broken silicone implants usually don’t spread around the body – the silicone gel is trapped by a layer of scar and can’t go anywhere. Leaky saline implants go flat (usually overnight, not all at once). Implant replacement is fairly simple – just use the original scar. Current U.S. manufacturers will offer free lifetime replacement for a defective implant. (In 30 years, none of my original patients has ever had a defective implant.) The three most common comments I hear from
nearly every breast implant patient in my practice are (in order): When you go for a consultation, make sure
you feel comfortable with that surgeon. If you don’t feel like you’re on the
same wavelength, try another until you do. That way, you’re more likely to get the
result that you were hoping for. Don’t forget: some breasts are droopy and must be lifted to look good with implants (implants enlarge – they don’t lift), some people just don’t have enough skin to stretch out to a “DD” cup size, and every woman has a different idea of what the ideal breast looks like. FACE LIFTS One of the most common cosmetic surgical procedures requested in the U.S. is the face lift. As we age, the skin loses elasticity. The muscles of the face help stretch the skin and wrinkle it. Sun exposure makes the aging process go faster. The cheeks fall, we develop jowls, and the front of the neck gets slack producing a “double chin”. Here’s a little test that you can do yourself to see if you are ready for a face lift: in front of a mirror, use your hands to pull up your cheeks and neck tightly back toward your ears. (I know you’ve all tried it – so have I). Then, relax your hands slightly and let the skin back down about ¼”. Look at yourself (call this look “A”). Then, let go completely, and see the difference as the skin is completely released (call this look “B”). If the difference between “A” and “B” is worth the week of down time and the price of surgery, then you’re ready. If not, wait a while. Look “A” is an approximation of what you should look like 6 weeks after a well-done face lift. There are several different approaches to face-lifting. There is a trend lately toward trying to do lesser operations with smaller incisions, etc., and people are getting into the mind-set of getting a “face lift” with no down time. These various mini-lifts, endoscopic lifts, upper face lifts, etc., usually do not last as long or give the same results as the traditional face lift. All of us have seen people who have odd swirls of skin and wrinkles when they smile, etc. We’ve also seen people who had a face lift 6 months ago, and it looks like it “fell” or that the surgeon forgot to do the cheeks or neck. Many of these people have had modified- or limited face lift surgery. Certainly, there are times when a more limited procedure is appropriate for a person, but in the average case the traditional lift is generally the best choice. The basic face lift tightens the cheeks, jowls, and neck. If there is extra fat in the jowls, neck, or under the chin, it can be removed during the face lift operation. In most cases, the neck muscles can be tightened, which helps preserve the results of the surgery for a more long-lasting result. For the most part, the scars are hidden within the hair, and are hard to find after they fade. It is important to note that the folds extending down from the nose to the corners of the mouth (nasolabial folds) can be reduced, but not eliminated, by tightening the cheeks with face lift surgery. The mouth and lips are generally not affected by well-done face lift operations. Wrinkles in the face are pulled a little smoother and tighter, but they are not “removed” by pulling the skin tight (this is where lasers are useful). Face lift surgery is generally not painful. In fact, I usually don’t even bother prescribing pain pills, because my patients don’t need them. Most people look presentable in 7-10 days – enough so that they can get out and about. After 2-3 weeks, most of the tell-tale signs of having surgery are completely gone. Most of my patients are back to work in 2 weeks (sometimes less). Well-done facial surgery is very rewarding for both the patient and the surgeon. People often comment that they “want to look on the outside like they feel on the inside,” and face lift surgery helps them achieve that goal. Fortunately, the risk of doing face lifts in good hands is quite small. My advice? If you want to look good with a face lift, don’t expect it overnight – give it a week or two. That’s a small price to pay for a big improvement. EYELID SURGERY
(BLEPHAROPLASTY) & FOREHEAD LIFTS In our youth-oriented society, people don’t want to look old or tired. Puffy lower eyelids can make a person look tired, even when they’ve had a good night’s sleep. If there is too much skin in the lower lids, it can be tightened and improved by removing some of the skin. If there is too much fat under the lower lids causing the lids to bulge or be “baggy”, the extra fat can also be removed. Some younger people may have too much fat without excess skin. In these cases, the fat can be removed from the inside of the eyelid without using stitches. Although eyelid surgery is generally quite safe in well-trained hands, taking out too much skin can give the lower lids a “pulled down” or “hound dog” look which is difficult to correct. The upper lids can have a wrinkled or “heavy” look from either (a) too much skin and/or fat in the upper lid, (b) drooping brows, or (c) both. This is a very important concept. If the cause is drooping brows, removing skin from the upper lids will not correct the problem. Taking out too much skin from the upper lids keeps the eyelids from closing properly when blinking or sleeping, which causes exposure problems. If the problem is drooping brows, the person should have a brow lift, not a blepharoplasty. Just as in any other cosmetic operation, the key to getting good results is in properly analyzing the cause of the problem, then doing the proper operation(s) to fix the problem(s). An interesting aspect of brow lifts is that they make a person look so much younger! Even without a face lift, a brow lift (also called a forehead lift) can take several years off of a person’s facial age. In days past, we used to take a strip of skin across the top of the head to pull the forehead up. These days, we usually do endoscopic surgery, making only 2 small incisions in the hair of the scalp, through which we can do the entire forehead lift. While we’re there, we can also cut the frowning muscles that cause the vertical frown lines between the eyes in the forehead. This prevents the frown lines from getting deeper, and softens the expression. As we age, the skin loses its elasticity. We cannot put the elasticity back. When there is little or no elasticity in the upper lids, the upper lids will wrinkle whenever the eyes are open. (This also applies to the lower lid skin when we are looking down.) It is not possible to make them look baby-smooth again, so we must learn to compromise and accept our limitations, rather than strive for perfection and cause harm by overzealously taking too much skin while trying to “get rid of” all wrinkles. There is usually little or no pain with eyelid surgery, although people who have forehead or brow lifts usually have a “pressure headache” sensation for a couple of days (and may take a couple of pain pills for relief). There may or may not be some bruising with eyelid surgery, but there often are some “black eyes” after doing the brow lift, especially if the frowning muscles are cut. The eyelids are very sensitive to bruising and swelling right after surgery, so I advise my patients to rest as much as possible for the first few days to try to minimize their time “out of circulation”. Eyelid surgery is surprisingly easy to go through. Stitches are out in a week, and most women look presentable in 7-14 days. Men can get the same kinds of improvements, but their skin is thicker, and it takes longer for the swelling to go down and the scars to fade. The preceding articles were kindly
contributed by Bruce M. Ascough, M.D.
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