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NYGPS Blog

Welcome to the blog maintained by the New York Group for Plastic Surgery.

LazerLift Neck Lift


The New York Group for Plastic Surgery is proud to announce the latest, minimally invasive, non-surgical laser neck lift procedure. The LazerLift system PrecisionTx™, developed by Cynosure, uses a small and precise laser to improve the appearance of the neck, throat and chin. 

This outpatient procedure can be done under local anesthesia with minimal downtime and scarring. The laser removes unwanted fat and tightens the skin, offering a smoother and more youthful contour!

Who should have this treatment?
The best candidates for LazerLift are healthy men and women who have mild to moderate fatty deposits and loose skin of the lower face, jowls and neck.

How does it work?
Typically, one to three small incisions are made under the chin and each earlobe. The area is then anesthetized with fluid containing lidocaine and epinephrine, which limits the pain and blood loss. 

The laser is inserted under the skin which acts to melt and break up fat cells. Thermally controlled laser energy is then delivered to the area to stimulate collagen production in the dermis and tighten the skin. 

A facial compression garment is placed at the end of the procedure which you are asked to wear 24 hours a day for at least 1-2 weeks. The entire procedure takes approximately 45 minutes to 1 hour. You will follow up in the office 1 week later.

How many treatments are required?
One LazerLift treatment is all that’s needed to acquire the desired results! However, it can take approximately 3-6 months to see final results.

Does it hurt?
There is minimal discomfort associated with the procedure.

Side effects?
Since LazerLift surgery is minimally invasive, there are few side effects expected. You may experience soreness, minimal bruising and swelling post-operatively. Most patients are back to their normal routine within 24-48 hours after the procedure.
 
If you are concerned with the excess skin and fat of your neck and chin area, schedule a consultation today with one of our board certified plastic surgeons to find out if the LazerLift PrecisionTx™ laser neck lift is right for you!

How To Avoid Snowblower Injuries


Hudson Valley Hospital Center is asking residents to be careful when using their snowblowers. 

Dr. Ari Mayerfield of the hospital's Hand Center said that each year he sees patients who suffer from a variety of injuries sustained from snowblowers. 

“Due to the improper handling of these machines, patients suffer from fingertip injuries, fractures, lacerations and amputated digits,’’ said Mayerfield, a surgeon who specializes in injuries to the hand and upper extremity. 

Mayerfield works with hand therapists at the hospital’s Center for Rehabilitation to help those injured return to normal function. Mayerfield said he would prefer to see people avoid injuries to start with and that a majority of injuries from snowblowers are caused when people try to clear clogs in the exit chute without turning off the machine, according to a release.  

“When snow becomes clogged in the exit chute of the machine, it causes a jam," he said. "The operator will then inspect the blower, and this is when the majority of injuries occur. The operator's hand will come in contact with the rotating blades while using his/her hand to clear the snow."  

Mayerfield suggested that snowblower users remember the following tips:  
• Turn off the machine
• Wait for a minute to give the blades time to stop rotating
• Keep your hands clear of the exit chute and blades
• Never use your hands to clear the snow - use a stick to clear the clogged chute
• Keep snowblower safety shields in place
• Never allow children to use the snowblower

Nefretiri Butcher, an occupational therapist with the hospital's Hand Center, said even those who use low-tech snow-removing equipment are subject to injuries of the hand and back if they don’t take proper precautions. She suggests that those shoveling snow following these suggestions:  
• Shovel fresh snow: Fresh powdery snow is easier to shovel than the wet, packed-down variety.
• Push the snow as you shovel: It's easier on your back than lifting the snow out of the way.
• Don't pick up too much at once: Use a light shovel (e.g. aluminum). Use a small shovel, or fill only one-fourth or one-half of a large one.
• Lift with your legs bent, not your back. Keep your back straight. By bending and "sitting" into the movement, you'll keep your spine upright and less stressed. Your shoulders, torso and thighs can do the work for you.

By Nathan Bruttell Ossining Daily Voice http://ossining.dailyvoice.com/news/how-avoid-snowblower-injuries

The "Skinny" On Liposuction


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!

Facial Acne Scars? Age or Sun Spots? We Can Help!


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!

The 411 on Silicone Breast Implants


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.

Could I Use a Mommy Makeover?

This is Dr. Michael Koch with an overview of a procedure commonly known as a “mommy makeover.”

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!

Post-Surgery Bra: American Sports Bra

Help! There are so many different sports bras out there and every surgeon seems to have a different opinion regarding which bra is best status post-breast surgery. Not to mention that every time I go in for a bra fitting, I am apparently wearing the wrong size bra with little to no support! How do I decide what is the best option for me??

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 .

Let’s Get Active on Behalf of Breast Cancer Patients!


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: 

http://www.ysctourdepink.org/site/TR/TourdePink/TourdePink-EastCoast?px=1164466&pg=personal&fr_id=1380
Or
http://www.ysctourdepink.org/site/TR/TourdePink/TourdePink-EastCoast?team_id=5030&pg=team&fr_id=1380

Skip Lunch: Get a “Facelift!”


So, we’re all busy. We want quick results in everything, including our appearance. So wouldn't it be nice to freshen up your face and turn back the clock a bit, but without having to undergo a surgical facelift and the associated recovery time? The good news is, immediate facial rejuvenation can be done in an hour or so — without surgery — in the form of a “liquid facelift.”

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.