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NYGPS BlogWelcome to the blog maintained by the New York Group for Plastic Surgery.
Will I gain weight back in other places on my body after liposuction? Can I really have this done on my lunch break? Will my results be instantaneous?
A lot of us find ourselves toying with the above questions in addition to countless others when considering liposuction surgery. So what is the real "skinny" on the liposuction procedure?
Let’s start with the question about results: Liposuction is designed to enhance overall shape and contour by targeting specific "problem" areas. Liposuction is most commonly done along the abdomen, flanks, thighs, and back; it can also be performed effectively on the lower legs, chin/neck line, and arms.
Although results will be instantaneous, there is some post-operative swelling that will subside over the following weeks. We typically recommend that patients wear a surgical compression garment for 2 weeks and then transition to a Spanx-type of garment for an additional month – garment-wearing reduces swelling and helps to ensure the best cosmetic results.
As to whether the fat returns in other body areas, liposuction is an excellent modality to target problem areas but is not a permanent solution to undesirable weight. Patients who have the best liposuction results maintain a healthy lifestyle with proper exercise and eating habits before and after surgery. Liposuction will work to reduce the number of fat cells in a particular area. It is true that if a patient gains weight after surgery, it may gravitate to other areas of the body that did not tend to gain weight before. Maintaining post-surgery weight is key to long-term results.
Liposuction does not typically require much downtime, but a lunch break is definitely pushing it! Liposuction can be performed using local anesthesia to numb only the target area, without actual sedation. However, post-procedure pain and discomfort, while minimal, should be expected. More commonly, liposuction is done under oral or IV sedation, which is generally more comfortable for the patient. The decision as to which anesthesia is best for you will be made by your plastic surgeon based on the number of areas you wish to have treated, the volume of fat that will be removed, and your desire for comfort.
Come in today to meet with one of our board certified plastic surgeons to see if you are a candidate for liposuction!
Many women and men feel self-conscious about the appearance of their skin; some have facial scarring from teenage acne, others have more recently developed brown spots and discoloration on their face or hands from years of accumulated sun exposure. While our board-certified plastic surgeons offer many surgical and non-surgical procedures that can dramatically reduce aging signs by tightening and plumping the skin, another approach is needed to improve the actual surface skin texture…and now we offer it here!
We’ve recently opened Spa Nouvelle at New York Group, a pampering day spa located within our Tarrytown offices, to provide our patients with spa procedures that address specific skin issues or provide a refreshing boost for all skin types. Our highly trained medical aesthetician, Ashlea Hoess, is certified in Advanced Aesthetics and specializes in anti-aging and improving skin tone and firmness; sensitive skin; visible capillaries; melasma (patchy brown discoloration); rosacea (redness) and stage I-IV acne.
Ashlea will customize a spa visit designed to improve the look and feel of your unique skin type, choosing from specialized facials, microdermabrasion or laser therapies proven effective in healing and toning the skin. She’ll use the most advanced technology – plus good old-fashioned hands-on care – to meet your individual needs. Here’s an overview of some of the customized treatments we provide:
Microdermabrasion: We use a hand-held instrument to gently but thoroughly remove the face’s outermost layer, buffing off dead and loose skin cells and stimulating the growth of new, fresh skin. We can eliminate many types of acne scars and dark skin patches (“sun spots”) and reduce fine lines, wrinkles and enlarged pores.
Chemical Peels: We apply a mild chemical solution to your skin, leave it on to for ten minutes, then thoroughly wash it off. The peel is customized to remove uneven pigment, dryness, acne or fine wrinkling. By removing the damaged outermost skin layer, your skin is thoroughly exfoliated and left with a noticeably healthier glow.
Facials: We love giving facials and you’ll love getting one! We analyze your skin carefully and select a facial customized for your skin type and improvements you’re seeking, whether to treat acne or signs of aging or just refresh your skin. We’ll give you a deep hydration and exfoliation that will soothe and plump up your skin and bring out your fresh new skin layers. We offer the latest technology with the ELITE MPX laser photo facial, which works wonders on redness, broken capillaries, hyper pigmentation, sun damage and rosacea.
Laser hair removal: Effective in permanently preventing regrowth of unwanted hair on your face, legs, bikini area, etc.
Come in for a consult with Ashlea to decide which treatment combination is best for your skin type. The result: You’ll look and feel refreshed and better than ever!
This is Dr. Salzberg with insights and perspective for you on the use and safety of silicone breast implants:
There’s been much discussion surrounding use and safety of silicone breast implants over the years, and the information can certainly be confusing! Are they safe? Do they rupture and how can you tell? Do silicone implants increase your risk for autoimmune diseases? Do they need to be replaced at some point? How do they feel? So many questions, and frankly the answers aren't always straightforward.
I would like to take a minute to provide some concise and accurate information so that women feel more confident in the decisions they make when having breast surgery involving the use of implants, whether cosmetic or reconstructive.
Much of the confusion over silicone implant safety stems from when FDA ordered manufacturers to take them off the market in 1992 and required additional research by unbiased plastic surgeons to make sure that leaking silicone implants were not causing autoimmune disorders like lupus, scleroderma, fibromyalgia or rheumatoid arthritis. During this time, breast cancer patients were allowed to receive silicone implants for post-mastectomy reconstructive surgery and research protocols. After 14 years of research, the experts concluded that there was NO causative relationship between ruptured implants and these autoimmune disorders. The use of silicone implants for breast reconstruction and cosmetic purposes was re-instated by the FDA in 2006.
Silicone implants are overall very safe, and in fact have been improved since returning to the market. The outside shell is more stable and less likely to rupture, and the internal silicone is in a more stable form. “Memory gel” implants, as well as “form stable”(also known as “gummy bear”) implants, offer silicone that is more cohesive and less viscous i.e., it will not "run out” of the implant even in the unlikely case of a rupture.
As far as mammography and breast follow-up, radiologists are very accustomed to reading mammograms for women with implants. Many times an additional view of a breast is requested, but surveillance for breast cancer should generally not be a problem with silicone implants. Additionally, many implants are placed behind the pectoralis muscle, so the implant is in a completely different tissue plane that the actual breast tissue. Even when implants are placed sub-glandularly (on top of the pectoralis muscle), they are behind the breast tissue and easily differentiated on mammography.
Silicone implants are also unlikely to rupture. The companies state that it is reasonable to expect to change your implants within 10—12 years, but as long as they remain soft, don't change shape, become hard or cause any discomfort, we leave them alone. In fact, we have lots of patients at our practice that have had the same implants for 20+ years before needing them replaced. Activities of daily living — even kids or dogs jumping on you — won't rupture implants, and they can even take the underwater pressure of scuba diving without damage!
So how do you tell if the implant is ruptured and needs to be replaced? Some women will be made aware when it’s seen on their yearly mammogram. We usually counsel patients on their options and then they decide if they would like them replaced. If the breasts are soft and the patient is not having any symptoms, they do not have to replace their implants. They may simply choose to do so if the patient has had her implants for a while or desires a change in shape or size.
Another scenario is a patient who has had implants for 10+ years and tells us that over the last 6 months or so she’s noticed one breast feels slightly firmer and may sit a little higher than the other. This is an indication that the implant may have ruptured and her body is reacting by tightening the tissue around the implant. Ultrasound and/or MRI can confirm, and if necessary the implants can be replaced in a simple outpatient procedure. There is no reason to have a yearly MRI or any routine testing on your implants - we just recommend you see your surgeon yearly for a quick check up.
What’s the difference between silicone and saline implants? Saline tends to feel firm like a water balloon and is more likely to show contour irregularities like rippling, while silicone feels soft like real breast tissue and is less likely to ripple.
It’s important to have any of your concerns properly addressed by your plastic surgeon when deciding on the use of an implant in breast surgery, but hopefully this gives you some background knowledge and a foundation from which to focus your questions and discussion.
Children are one of the greatest pleasures in life, but pregnancy and breast-feeding can take a toll on your body. Following pregnancy and/or breast-feeding, the breast tissue shrinks, leaving looser skin and a deflated appearance, especially in the upper segment, and the areola can remain larger than desired. Pregnancy can also leave you with excess abdominal skin, undesirable C-Section scars, stretch marks, a weak core and extra fat around the mid-section or "love handle” area. Diet and exercise will help shed the pregnancy weight gain, but unfortunately stretch marks, scars, excess skin, abdominal core weakness and sagging/deflated breasts do not respond to these efforts…So what can you do?
The “mommy make over” commonly refers to a breast lift (mastopexy) and stomach tightening (abdominoplasty.) Often the breast lift is combined with breast augmentation to restore volume while lifting the breast into a better position. Let's take a moment to explore the details of both procedures…
For your breasts: A mastopexy will remove excess skin and tighten and lift the breast, while the augmentation will replace lost volume to restore the upper part of the breasts. Incisions are made in the shape of a lollipop, and thus you will have a scar around the nipple and down vertically in order to achieve the lift. The implant is placed either behind the breast tissue or behind the muscle. The size of the implant needed to fill the skin envelope or create the desired breast size is finalized between the patient and surgeon. In our office, we use a 3-D imaging system to help patients visualize the expected results and assist the patient in deciding on what size implant she desires.
For your abdomen: An abdominoplasty address the three main components of the post pregnancy abdomen. Excess fat around the flank area (“love handles”) is removed with liposuction to help give contour to the waist and hip area. The abdominal wall laxity (loose tone of the belly) and/or separation of the “ab” muscles (rectus diastasis) is repaired using plication – a technique that uses permanent sutures to tighten the fascia (strength layer of the abdomen) and bring the rectus muscles closer together, creating the “six pack/tight” abdomen. Additionally, excess skin and fat below the belly button is removed through an incision that is hip-to-hip but lies low in the pubic region, similar to where a C-section scar would be placed and cannot be seen in a bikini. An incision is made around the belly button as well. The end result is a flat, tight, well-contoured abdomen that no longer contains excess skin or fat. Additionally most of the stretch marks that occur with pregnancy are within the lower abdomen and will be removed with the removal of the tissue below the belly button.
Both procedures can be done as outpatient surgery. Operating room time is approximately 3-1/2 — 4 hours and you will typically go home in a supportive bra and a compressive lower body garment similar to a SPANX. Most patients will require drains (1-2) in the abdomen for a week to help collect any fluid that may accumulate after surgery.
We encourage you to refrain from any strenuous activity or heavy lifting for 2 full weeks. Some patients will feel the need to sleep with their knees propped up or in a reclining position, as the belly is pulled very tight at first. Over the course of the first 10 days, the abdomen will relax and you will begin to stand up straight and sleep how you are most comfortable. After the initial 2 weeks, you are allowed to resume more regular activities and can even begin an exercise routine; we suggest starting with a brisk walk and working up to your normal routine over the course of the first month after surgery. At 4 — 6 weeks after surgery, you can begin abdominal exercises and weightlifting.
A mommy makeover gives women their pre-pregnancy bodies back, helping to restore body image and self-esteem. Although surgery is necessary, most patients tolerate it very well and are back to normal activities in 2 — 3 weeks, feeling wonderful about their restored or enhanced figure!
This is Dr. C. Andrew Salzberg and I am a breast specialist within both reconstructive and cosmetic surgery. Over the years I have seen many types of bras used post-surgery but have come to the conclusion that the American Sports Bra (ASB) is my personal favorite.
The creator of the American Sports Bra is Hilary Lambert and we have worked exclusively together over the last several years to perfect her design, which is ideal for the surgery patient as well as those women who are just looking for a bra that provides excellent support during strenuous exercise. The ASB has been designed with a double layer – internally, an underwire cup that snaps in the front provides shape to the breast and externally, there is a compressive outer shell similar to a standard sports bra but it also fastens in the front. The double layer design provides shape as well as snug support. The front closure allows the post-surgery patient to put it on herself without having to pull if over her head or ask someone for assistance. The American Sports Bra is also available without an underwire with the internal cup layer still present – perfect for patients whose surgeons do not want underwire over an incision or for women who simply hate underwire!
I use this bra exclusively with all my Direct to Implant Breast Reconstruction patients to ensure that there is shape to the breast while the swelling comes down and the implant settles. The compression helps to resolve swelling and allows the patient to feel supported and secure in the initial healing phase. The material is very soft and comfortable, similar to that of Lululemon yoga attire. In addition to my Direct to Implant patients, I recommend this bra be worn by my patients after breast lift, breast augmentation and breast reduction surgery. Patients are fitted at their first post-op appointment right here in our office.
During the years I have recommended this bra to my patients, I have also discovered that they all wear it years after surgery when running or performing other strenuous activities b/c it provides such great support and is also comfortable to wear. Hilary herself is a marathon runner and wanted to design a bra that would offer top-notch support – she was sick of having to wear multiple sports bras while running! Well, she succeeded, as marathon runners everywhere LOVE the American Sports Bra.
Check out the American Sports Bra @ www.americansportsbra.com or visit our office for a personal fitting!
Guest Blogger: Beauty and Fashion Expert DivaDebbi Offers Her Perspective on Breast Reconstruction, and a Night of Style!
Trust is everything...
My name is Debbi O’Shea and I am a long-time patient of the NYGPS. I am also a Personal Shopper at Richards, a specialty store in Greenwich, CT, and write the beauty and fashion blog, http://www.divadebbi.com/
My introduction to the NYGPS was as a breast reconstruction patient. My decision to do an "Angelina," or a prophylactic mastectomy, was made after finding out I was BrCa 1 positive, four years after my breast cancer diagnosis. Believe me, this is not a decision any woman makes easily.
Ultimately, the compassionate care and the beautiful outcome I received made one of the most challenging times in my life completely doable. Dr. Salzberg and his entire staff couldn't have been kinder or more reassuring. I did my surgery 13 years ago, way ahead of the curve and with little support, since prophylactic mastectomy was less common at the time. NYGPS were my cheerleaders and I am incredibly grateful that my breast surgeons, Dr. Roy and Andrew Ashikari, work in tandem with them.
Dr. Salzberg has taught his direct to implant, or "one step," reconstruction method all over the world. Though my surgery came right before this particular procedure was available, his brilliant advance saves women undergoing mastectomy fr om having to go through months of uncomfortable breast expansion and a second surgery wh ere permanent implants are placed. I always encourage friends to call me if they know of someone newly diagnosed.
Yes, trust is everything…
When it came time to address my own anti-aging beauty concerns, the NYGPS was the only place I would consider working with. I am always comfortable feeling like we are collaborating on which non-invasive procedures are right for me, and knowing ahead of time exactly what to expect.
As a beauty blogger, I receive many offers for free services in exchange for blog coverage. I am never tempted to accept them. Why would I incur the risk of looking frozen or unlike myself by unknown hands? Besides with the NYGPS costs are competitive, generally less than NYC and with their new rewards program, loyalty and referral "points" accrue quickly — a win-win for all. I am also excited that they are adding a full-time aesthetician to address additional aging concerns with facials, peels, microdermabrasion and resurfacing lasers.
On Tuesday November 12, the NYGPS is once again joining me at Richards in Greenwich, CT from 6—8 pm for a presentation on looking your best for the Holidays and beyond. We invite you to join us for this fun and informative night of fashion and beauty. The event is complimentary, but reservations are necessary. We would love to see you there! Please feel free to bring a friend: Debbio@mitchellstores.com or 203/622-0551 .
Hello, everyone, this is Dr. Michael Koch -- as Breast Cancer Awareness Month approaches, let’s all do more than talk about it and actively make a difference! I’m excited to be biking in the Young Survival Coalition’s Tour de Pink 3-day East Coast Ride this weekend (September 27—29), and I’m fortunate to be teaming up with a very special young woman: Jamie Pleva-Nickerson, a NYGPS patient who was diagnosed with breast cancer when she was only 29 years old.
Jamie’s breast cancer story actually began when her older sister Tracy was diagnosed at age 32. Tracy was also tested and found positive for a BRCA (BReast CAncer) genetic mutation, which significantly raised her risk of getting breast cancer. (This is the mutation that prompted Angelina Jolie to undergo a preventive mastectomy earlier this year, and it also increases a woman’s risk for ovarian cancer.) The BRCA mutation is inherited from a mother or father, so Jamie took the genetic test when she turned 28 to find out if she shared her sister’s high cancer risk -- unfortunately, she did.
After many discussions, a lot of researching and much soul-searching, Jamie made plans for a preventive mastectomy with Dr. Andrew Ashikari and a simultaneous direct to implant breast reconstruction with my partner Dr. Andrew Salzberg, for her best chance to avoid a breast cancer diagnosis one day. But during pre-surgical breast screening, Jamie was told that she already had cancer. Her new course of action, in addition to the planned mastectomy and breast reconstruction, would include chemotherapy.
Jamie is now a five-year survivor, and offers a supportive shoulder to lean on for other young women with breast cancer. Her big sister Tracy died at 41 years old, and Jamie now rides and raises funds in her memory, and for the many young women in the local area and across the country coping with breast cancer.
I’m an avid cyclist and a gold-level sponsor of the Tour de Pink ride. So when Jamie and I found out about the other's involvement, we eagerly teamed up, along with her husband and friends, and have been holding weekend practices to prepare for the upcoming 3-day event!
Anyone who wishes to support our rides can visit the Tour de Pink East Coast team websites at:
Our faces age due to a combination of biological and environmental factors that can include:
· Sun damage that causes fine lines and brown spots
· Natural loss of collagen over time that results in thinner, looser skin
· Gravity which causes skin to sag around our lower jaw and cheek bones
· Smoking which causes deep and fine lines, particularly around the mouth and lip area
A liquid facelift involves the use of injectable treatments such as Botox or Dysport, and Juvederm or Restalyne, among others, that target specific areas of your face. The results of aging and sun damage can differ greatly for each person. So the combination of different types of rejuvenating treatments, and where and how to administer them, has to be customized for every individual patient.
The ultimate goal with a liquid facelift is a refreshed and younger but still natural look, achieved by eliminating or significantly reducing wrinkles and fine lines; plumping up the underlying tissue beneath the skin to decrease sagging/drooping; and enhancing symmetry. Liquid facelift can address forehead wrinkles, furrow lines between the eyebrows, fine lines around the eyes ("crow’s feet", deep creases between the nose and mouth (nasolabial folds), fine lines around the mouth (“pucker” lines), sagging cheeks, and jowling.
After a liquid facelift you’ll notice a near-immediate difference in your appearance. Additional benefits will appear over the next week or so in some areas of your face, depending on the type of treatment administered.
The benefits of a liquid facelift include:
· Immediate results
· Targets only areas you want to address
· Takes 30-40 minutes (depending on extent of treatment)
· No recovery or "downtime” — go right back to work or out with friends
· Available and suitable for men and women
· Periodic “refreshers” can be done as needed
Call our office and ask about an appointment for a liquid facelift, tailored just for you.
Liposuction is in-office procedure that uses a suction device to remove fat cells from targeted areas of the body, such as the abdomen, buttocks, hips or thighs. Liposuction is very effective at removing deposits of stubborn fat a person can’t shed despite consistent efforts with dieting and exercise.
Liposuction removes many actual fat cells, which don’t grow back or regenerate. However, extra fat taken in as calories has to go somewhere and will settle in areas that may not have had excess fat before, such as the upper arms or legs. But barring extreme weight gain, or even with just a few pounds gained, the body typically retains the improved, more balanced proportions.
The type of liposuction used depends on each patient’s body type and the body area targeted for fat removal, but may include:
· SmartLipo MPX™, which uses a laser to heat fat and make it easier to suction out. The laser also facilitates skin tightening around the contoured areas. Smart lipo is very useful for upper arms, neck and inner thigh, wh ere skin is thin.
· Aqualipo® Liposuction (Body Jet) System, which uses a fine spray to gently loosen fat as it is removed with high-powered suction. This results in less bruising, and helps prevent damage to collected fat when it’s being transferred to enhance areas like the breasts or buttocks with a procedure such as NaturalFill™.
Liposuction is best viewed as an initial phase of body contouring that should be kept up or enhanced by maintaining or losing weight and exercising to hone body tone and musculature. Many patients find a new motivation to staying in better shape – and better health – after their procedure.
Make an appointment for a personalized consultation about which type of liposuction, or other procedure, is best for you.
Simply put, we remove skin, fat and blood vessels — referred to as the “tissue flap” — from an area of the body, typically the abdomen. We immediately transfer the tissue flap to fill up the breast skin, surgically attaching the tissue flap via the blood vessels, so it actually becomes part of the breasts.
Using the body’s tissue offers breasts that look and feel incredibly natural, with the added benefit of excess abdominal fat removal. But the autologous reconstructive surgery is more complex, and the recovery period is typically longer, than with breast implant reconstruction. The decision for each woman generally comes down to her goals for surgery, recovery and aesthetic outcome, and which procedure will best suit her body type. A significant consideration with autologous breast reconstruction is a woman’s smoking habit — smoking constricts the blood vessels needed for successful surgery.
We are trained microsurgeons, and have extensive experience in autologous breast reconstruction, including immediate reconstruction within the same surgery as mastectomy, and with nipple-sparing mastectomy. We welcome your questions and are happy to speak with you about the option of autologous breast reconstruction.
This is Dr. Andrew Salzberg. Patient support and communications is very important to the surgeons and staff at the New York Group for Plastic Surgery. To help reassure family and friends and keep them in the loop as much as possible during surgery, we offer our reconstructive and plastic surgery patients the use of a free digital service called MDConnectME.
Here’s how MDConnectME works: In advance of the surgery date, our patient opts in to receive a digital invitation fr om MDConnectME, asking for a list of cell phone numbers for designated family and friends. This list can include people who will be in the waiting room during surgery, and also those who are nearby, across the country or even around the world.
Right before, during and after the procedure, our surgical staff uses a cell phone or iPad to text real-time updates to the patient’s family and friends. We are not typing new texts, but choosing from an easily accessed, existing list of message options that provide status alerts. So for example, family and friends might receive periodic texts that say: “[Rachel] is being evaluated by anesthesia” or “[Rachel] is going into surgery” or “[Rachel] is in recovery,” and so on.
For a surgery of more than one hour in particular, this method of simple communication can be extremely reassuring. It can allow a husband, wife or parent to leave the waiting room for a meal or a walk without missing an important surgical update. Or, family or loved ones anywhere can be quickly notified to meet up with the surgeon.
The feedback we’ve received has been very positive, with patients happy that their families know wh ere they are in the surgical process. Family members have said they feel more at ease and reassured when they received the updates, and the broader distribution list relieved some of the burden on them to provide multiple updates to concerned family and friends.
What do you think about updates for surgical patients' families? Have there been times you wish you could have been updated?
This is Dr. Michael Koch, plastic and reconstructive surgeon with the New York Group for Plastic Surgery. We receive many questions from women considering breast augmentation, so I’d like to share an overview to help answer some of those questions here. Please also feel free to call for an in-office consultation and we can personalize recommendations just for you:
Breast augmentation, or enlargement, is the most frequently performed cosmetic plastic surgery procedure in the U.S. Some of the reasons women seek augmentation are to:
- Increase breast size and enhance shape
- Restore fullness lost due to childbearing or weight loss
- Achieve more proportionate body shape
- Balance asymmetrical (uneven) breasts
Cosmetic breast augmentation is typically accomplished by inserting an implant into the breast through a small incision. A new way to augment breasts without using implants is a “fat transfer” procedure. Fat is taken from your buttocks or abdomen using liposuction — many women consider this an added benefit! — then processed for immediate insertion into your breasts for augmentation. Another option is to insert implants and also use fat transfer to fill in and further perfect results.
There are two main categories of breast implants — silicone and saline. We recommend silicone for most women because they look and feel more natural than saline, which is a firmer, rounder implant.
The incision for a breast augmentation is very small, about 3—4 cm. The scar is usually very thin and fades with time. However, patients with a history of poor scarring such as keloiding or hyperpigmentation are at risk for similar experiences with their breast augmentation incision.
Most women want breasts that are enhanced but still natural looking, but are initially unsure of the breast size that will help them achieve this goal. Advanced 3D imaging technology enables us to take pictures from different angles and feed them into a computer so a woman can see how her figure will actually look with varying degrees of volume and profiles.
Breast augmentation results can be expected to last indefinitely, though various factors may eventually lead to some drooping. These include:
- Pregnancy and nursing
- Substantial weight gain and/or loss
- Gravity, which pulls the breasts down
This is Dr. Bill Aydin, plastic and reconstructive surgeon with the NYGPS. Hand and finger injuries are among the most common causes for emergency room visits. I’ve operated on many tool-related extremity injuries, including lacerations (deep cuts) that have nearly resulted in the loss of hands and/or fingers.
If a laceration is so deep that it cuts to the bone, we use microsurgery to try to save the hand or fingers and preserve function for the patient. Microsurgery is a very complex, technically demanding surgery that uses specialized tools with microscopes to operate on extremely small parts of the body. When a tendon, nerve, vein, or artery is lacerated, we take a healthy one from another area of the body and graft it to the injury site.
If you are doing summer home repair work with tools, please take the time to prepare properly and put some safety measures in place. Following simple safety rules can help you avoid a serious injury:
· Think through tools and materials you’ll need, and position them strategically in your work area before starting. If you realize midway that you’ve forgotten a tool, carefully and fully disengage from your work to get it — do not lean over or reach up for it.
· Do not use a tool that lacks safety mechanisms or is inappropriate for a specific task. If you’re unsure, check with an expert at the hardware store.
· Alert a family member or neighbor that you’re undertaking a home repair project and ask if they’ll come by to check up on you.
· Keep a phone and first aid supplies nearby, in case. If you’re not at your own home, be sure you know the specific address so emergency dispatch can find you, and be aware of a nearby major medical center.
At some point you may look in the mirror and think: That’s me, but it’s not me. You recognize yourself, of course, but the way you feel inside no longer matches up with how you appear on the outside.
This is Dr. Tae Ho Kim, plastic and reconstructive surgeon with the NYGPS with insights about an injectable filler called Sculptra that can give your face a more youthful appearance by enhancing lost volume, or fullness.
It’s not just wrinkles and lines that age faces, but loss of volume, or fullness. Collagen, a protein substance that makes up the underlying skin’s connective tissue and gives our cheeks fullness and elasticity, provides a youthful appearance. Over the years we produce less collagen; our cheeks sag, which also accentuates folds and lines around the mouth.
Now, the rate of collagen loss is unique to each person, depending on factors like genetics (was your mom or dad one of those people who looked young always?) or damage from the sun or smoking. You may look and feel fantastic as you age, which is wonderful. But if your face appears drawn and drooping, and you’re not real happy with that, injectable fillers in general are great materials for non-surgical enhancements. You clearly want to look good, not swollen, so it’s important to know which filler to use where and why.
For the cheeks, jaw line and sides of the forehead, the facial injectable Sculptra may be the way to improve your facial volume without worrying about the “swollen look.” Sculptra is made from poly-L-lactic acid, which stimulates the tissues under your skin to produce more of your own collagen. Sculptra treatment takes a bit of patience because it typically takes two or three sessions over a few months to complete; the benefit is that your results should last for around two years.
As plastic and reconstructive surgeons at NYGPS, we’re very knowledgeable about facial structure, and very skilled in properly administering Sculptra in the right places to enhance your appearance in a natural-looking way. As Sculptra starts working to stimulate your skin to produce collagen, your face will begin to look fuller and firmer, and therefore more youthful and refreshed.
“A nose which varies from the ideal of straightness to a hook or snub may still be of good shape and agreeable to the eye; but if the excess be very great, all symmetry is lost…”
This is Dr. Tae Ho Kim, plastic and reconstructive surgeon with the NYGPS. The partial quote above by the Greek philosopher Aristotle was actually making a political point, but I’ll take the liberty of applying it to cosmetic surgery today. A person whose nose is not “perfect” according to current standards may still look and feel quite attractive. It’s not the nose in itself, but the symmetry and balance of the face overall that determines what is perceived as aesthetically pleasing. Some people are quite happy with their looks regardless, but for others their nose is a source of upset that they’d like to fix and for them, rhinoplasty may be a good option.
Rhinoplasty is a cosmetic plastic surgery procedure to reshape a person’s nose, otherwise known as a “nose job.” Rhinoplasty is one of the top five most performed cosmetic surgery procedures in the U.S., with about 243,000 done in 2012. But just because it’s done often doesn’t mean it’s easy to do! In fact, the anatomy of the nose is very intricate and complicated.
I have a special interest in rhinoplasty as a natural result of the reconstructive surgery I specialize in to repair the faces of babies and children with congenital facial deformities, such as cleft lip and palate. The idea of fixing these congenital deformities is to restore symmetry and balance to the face, and it’s much the same with rhinoplasty. A nose that is overly large, crooked or bumpy bothers patients seeking rhinoplasty because it results in imbalance, and the nose, along with the eyes and lips, is the most prominent feature of the face.
Patients of all ages seek rhinoplasty, from teens to young adults to people well into their 50’s. It’s best to wait until at least the age of age 14 or 15 before having a rhinoplasty, depending on the size and shape of the nose.
Rhinoplasty is performed either as an open or a closed technique. The main difference is that the open technique requires a small incision in the mid-columella, the bottom part of the nose that divides the right and left nostrils. I prefer using the open method because it enables me to clearly view all the important structures to define the nasal tip and ensure a more complete reshaping.
I would advise someone considering a rhinoplasty to have an evaluation by a plastic surgeon with a great deal of experience in the procedure, as rhinoplasty is a very difficult operation to do well consistently. For my patients, I spend time discussing exactly what he or she likes and dislikes about their nose. I then go over each part of the nose and explain what is aesthetic or not, such as symmetry, width, shape, proper proportions and overall balance with the face.
The type of nose we ultimately shape is based on this detailed assessment, and the goal is to make the nose look attractive but also natural within the person’s face. I also make sure that a patient has a realistic understanding of what is and is not possible. For instance, if a person has a very large nose and wants one that is like Michael Jackson's, I would advise that person against a rhinoplasty.
In my experience, people who have a good result from a rhinoplasty ultimately feel better and more confident about themselves. Finding an experienced plastic surgeon and having a clear understanding of what to expect from surgery and results is key to rhinoplasty success.
I’m Dr. Bill Aydin, board certified plastic surgeon and partner with the New York Group for Plastic Surgery. With the warm weather finally arriving, a common refrain we hear in our offices goes something like this: “I have ‘wings’ under my arms, and I can’t stand the loose skin and fat hanging there!”
The upper arms can be an aesthetically frustrating part of the body. You may try your hardest to tone your arms by weight-lifting and other arm-targeted exercises, but sometimes it helps only minimally or not at all. Or, a substantial weight loss, such as achieved with bariatric surgery, may have left you with an abundance of excess, loose skin on your arms. And for many of us, the “wings” of fat and skin that develop as we get older are simply a result of genetics or a just having a certain body type.
The American Society of Plastic Surgeons (ASPS) recently reported that about 15,500 arm lift plastic surgery procedures were performed in this country in 2012, up by 3 percent from the prior year. The ASPS found that women sought 98 percent of these procedures, and age also had a strong influence, with arm lifts most common among people over the age of 40. ASPS speculates that the rise in arm procedures is in part motivated by fashions and by celebrities showing off their own shapely arms (think Michelle Obama!)
Upper arm slackness is a challenge faced by many women because the skin between the shoulder and elbow is thin and thereby loses its elasticity and starts to hang. It’s a combination of fat and loose skin that creates the under arm "wings." When consistent exercise doesn’t help, plastic surgery can offer options for tighter, toned upper arms.
Many people are candidates for an arm lift using a minimally invasive procedure called Smartlipo, in which a cannula (thin tube) inserted through tiny incisions into the upper arm uses a laser to loosen and “melt” the fat, which is then suctioned out. The laser also helps the skin to maximally retract, or tighten, after the liposuction is complete. The scar from Smartlipo is only a 2-3 mm incision at the elbow for insertion of the cannula and laser. After the procedure, however, it’s important to wear post-op compression arm garments for 6-8 weeks to make sure the skin retracts and the best results are attained.
Alternatively, some patients simply have too much excess under arm skin, either from substantial weight loss or if they are above age 60, and Smartlipo is unlikely to provide optimal results. Instead, they will need direct excision, or removal, of the excess skin along with the fat in a surgical procedure called brachioplasty. The benefit seen with brachioplasty is that the upper arms become quite tight, while the drawback is a scar that extends from the elbow to the axilla, or armpit, on the inside of the arms. However, the scar should fade nicely with time (6 months to a year) if properly cared for with massage and scar care such as certain creams. As with Smartlipo, it’s very important that compression garments be worn after brachioplasty arm lift surgery. Both of these types of arm lift procedures can be done as outpatient surgery in our offices. Smartlipo takes about 1.5 hours, while brachioplasty takes about 2 - 2.5 hrs.
We advocate a diet and exercise plan that keeps your body toned and healthy, but if your upper arms have you self-conscious as the weather heats up and layers come off, we can talk about a procedure that might enable you to proudly bare those arms!
FORCE (Facing Our Risk of Cancer Empowered) Guest Blogger Sue Friedman on NYGPS Support for Hereditary Cancer Resources
About 2.3 million women in the U.S. may be at increased risk for breast and ovarian cancer because of their family history. An estimated 940,000 people in the U.S. carry a BRCA1 or BRCA2 gene mutation, which can be inherited from either mother or father. Women with a mutation in either gene have up to an 85% lifetime risk for breast cancer, and up to a 50% lifetime risk for ovarian cancer.
These women have several options to manage their high risk for breast cancer, including increased surveillance, medications, and prophylactic bilateral mastectomy—the removal of healthy breasts. The decision to move forward with risk-reducing mastectomy, with or without reconstruction, is very personal and can be difficult. Women who are at high risk for breast cancer and who are considering risk-reducing mastectomy usually have time to consult with genetics experts to understand their risk, meet with surgeons to explore their options, and do research to determine which option is right for them.
In my 14 years of working in advocacy, I have seen new advances in mastectomy and reconstruction that have improved cosmetic outcomes, reduced operative and healing time, and reduced discomfort. Research on the safety of nipple- and areola-sparing mastectomy has led to more natural-looking reconstructed breasts and to more high-risk women considering mastectomy for risk-management based on these improved outcomes.
One advance in reconstruction in the last decade is Direct-to-Implant or “One-Step” surgery that was pioneered by Dr. Salzberg at the New York Group for Plastic Surgery. This method allows women who are undergoing reconstruction with implants to forego the discomfort of tissue expansion and complete their reconstruction in one surgery. Dr. Salzberg and his partner, Dr. Koch have performed this “one-step” surgery for hundreds of women from across the country, and have taught the procedure to other surgeons so that more women have access to this procedure. These surgeries enable many high-risk women who would not otherwise have elected a preventive mastectomy to proceed with surgery.
Given the many choices for mastectomy and reconstruction, it makes sense for women to do their research and explore all their options before moving forward with surgery. Depending on their priorities, timeline, and desired outcomes, some women elect to travel to another city or state to have a particular type of surgery or see a particular surgeon. Fortunately there are great resources to help women with their decision making, including the outstanding resource, The Breast Reconstruction Guidebook by Kathy Steligo; the gallery of post-mastectomy photos on the FORCE website; and Show & Tell, the FORCE photo book that features positive and powerful images of post-mastectomy bodies. All these resources provide women with the tools to make the best decision that is right for them.
Dr. Koch and Dr. Salzberg have been an invaluable part of the high-risk breast cancer community for many years, and they share FORCE’s commitment to educating high-risk women about the options of reconstructive breast surgery. FORCE is honoring Dr. Salzberg and Dr. Koch as part of our national “Superheroes” fundraising campaign to support research, education, and advocacy for people with hereditary breast, ovarian, and other cancers.
I am thankful to the New York Group for Plastic Surgery for supporting FORCE in our mission to educate women and improve lives. They are generously kicking off their Heroes campaign with a donation of $2,500. I hope that grateful patients and supporters of Dr. Salzberg and Dr. Koch will consider donating to FORCE in their names by going to the FORCE Superheroes link on this website’s homepage, or going directly to http://www.firstgiving.com/fundraiser/salzberg-koch/heroes.
For more information or support for hereditary cancers,
please visit the FORCE website (http://www.facingourrisk.org/index.php).
Take fat out of your body where you’d don’t want it. Put it back in where you do want it. What a concept! This is Dr. Koch, and I’m going to share information with you about a procedure you may have heard about recently, known as “fat transfer.”
A lot of people know about liposuction, the suctioning of fat from targeted areas of the body like the stomach, thighs or hips. But a newer procedure enables us to preserve and then re-insert your own fat into areas that you’d like to augment or enhance, such as breasts, buttocks or even your face or backs of your hands to replace fat and collagen lost over time.
A “fat transfer procedure” is typically done right in our office’s Operating Room, either under general anesthesia (light sedation similar to the anesthesia you may have had during a colonoscopy) or under local anesthesia with an oral sedative. First, we perform liposuction to extract the fat from areas wh ere you may have excess. The technology we use is called “Aqua lipo” and it’s excellent for fat transfer because it:
· uses high-pressured water streams to gently break up and remove the fat cells so they remain undamaged and pristine, and
· carefully separates the healthy fat from the water used to remove it, so the fat is suitable for transfer back into your body.
Next, within this same surgical procedure, we fill syringes with your preserved fat and inject it into the areas you want to enhance.
There is virtually no scarring associated with this fat transfer procedure. The incisions used to remove and inject the fat are typically 2-3 mm in length and fade to the point that they can be difficult to see within 6 months.
We’ve performed a large number of fat transfers with successful outcomes and very happy patients! We do, however, tell our patients that up to 40—60% of the fat injected can resorb (dissolve) within the first 4 weeks after the procedure. We encourage patients to wear loose clothing over the areas of fat transfer to prevent compressing the healthy fat. This helps minimize the amount of fat resorbed, but some of this resorption is simply a natural part of the healing process. While some patients have less fat loss and no visible aesthetic decrease, others may need a follow-up procedure to add additional fat to areas they want enhanced. The good news is that the amount of fat your body maintains after fat transfer will not decrease any further after the initial first 4 weeks, and will last forever since it’s your own natural tissue.
It would seem logical to inject more fat than desired to make up for the potential loss of fat; however, over-injecting fat can compress it and prevent enough blood supply from reaching the newly transferred tissue. This in turn can lead to fat cell death, which shows as hard nodules or oil cysts within the areas of fat transfer. To prevent this, we carefully inject the fat in fine layers to enhance the area while also allowing proper healing of the transferred fat cells.
Not only is fat transfer an excellent technique used in cosmetic surgery, we also use this technology for medical purposes. For example, women with breast implants after bilateral (double) mastectomy may have issues with asymmetry, or experience contour (shape) irregularities as their breasts se ttle over time. Fat transfer is an effective way to give them a more balanced, symmetrical look. Also, scars from traumatic injury can often have contour irregularities, correctable with fat transfer. Other medical uses for fat transfer include facial asymmetry correction, or padding “boney” prominences such as the heel or coccyx that have lost their native fat pads, from traumatic injury.
Please feel free to ask questions here or visit us for a consult if you’re interested in learning more about a fat transfer procedure.