Up until these implants were approved, the most commonly used implants in aesthetic surgery were round. They contained cohesive silicone gel. The newer gummy bear implants contain highly cohesive gel which allows them to be form stable, or to maintain their shape at all times.

There has been a lot of chatter about these implants in blogs and discussion forums because each of the implants—the Natrelle 410 from Allergan and the Silimed line from Sientra—have been available outside of the United States for a number of years. Breast augmentation patients were clamoring for the products because they felt they offered more choice and a superior result. But were they right?

They do offer the consumer more choice. The Natrelle 410 is an anatomically shaped implant, while the Silimed line is available in both a shaped and a traditional round shape. Each is available in a number of sizes and profiles.

But are they better? During the trial period, I was one of the post-operative investigators who examined patients with gummy bear implants. After viewing the results of many augmentations with these implants, I identified the following issues that don’t match well with my ideal aesthetic result: natural in feel and appearance.

• They are much firmer than smooth-walled cohesive gel implants
• The textured or rough outer shell is thicker and easier to feel
• They are less mobile than a natural breast
• They require a larger incision

I have been using the smooth cohesive silicone gel implants with great success since 2006 and do not plan to switch. Because I had first-hand experience with the shaped gummy bear implants during the clinical trials, I was able to make direct comparisons between the results created with smooth cohesive gel implants and those provided by the newly approved textured highly cohesive gel implants. As a result, I realized that I am happier with the results I have seen in my patients than with those obtained from the gummy bear implants. I do think that textured, anatomically shaped highly cohesive gel implants may offer an advantage in reconstructive breast surgery as they recreate the shape of the breast that is lost after cancer surgery.

There are many innovations in my field that have proven to have great value for both patients and plastic surgeons. For example, my patients are very enthusiastic about using 3D imaging to simulate breast augmentation results, and I feel this is a valuable tool in planning aesthetic breast surgery. While I don’t plan to switch to gummy bear implants in my practice, I am happy to say that cohesive gel implants are here to stay and are allowing me to create wonderfully natural results.

There seems to be a great deal of confusion about what facial peels have to offer. Peels are done with a variety of different acids of varying strengths, consequently it is difficult for potential patients to know what results can be expected. I have two licensed aestheticians that provide light glycolic peels in the office. These peels provide excellent skin brightening without the need for sedation or down time. Given in a series, while on a skin care maintenance regimen, excellent improvements can be obtained. These peels do not change pigmentation or wrinkling, but do remove superficial skin cells of the epidermis that can create a dull appearance to the skin.

TCA peels also come in a variety of strengths. I prefer a 30-35% concentration as it affects the deeper layer of the skin called the dermis. In my opinion, this type of peel at theses strengths should be applied by a physician with significant training and experience in skin and wound care. The skin must be prepped with a six week skin care program at home prior to undertaking the peel, so that maximal results can be obtained with minimal risk of healing problems. A recovery time of seven to ten days is required during which significant skin peeling will occur. While the peel itself would be uncomfortable without sedation, the recovery is not painful. Your face will feel tight, but pain is not an issue. Oral antibiotics and medication to prevent fever blisters or cold sores are prescribed.  The skin will remain pink for two to three weeks and sun exposure must be limited during this time.

This peel results in a reduction in brown pigmentation and sun damage as well as softening fine superficial lines. In conjunction with filler treatments, it can also dramatically soften lines around the mouth. Caution must be exercised in dark skinned individuals as excess pigmentation or loss of pigmentation can occur with increased frequency.

Maintaining a skin care regimen at home will insure that the results are preserved. Outdoor activities are not forbidden after the first ten days, but broad spectrum sun block is necessary for protection. The results of these peels generally last twelve to eighteen months. If you are already on one of my skin care programs, call my staff to determine the appropriate steps to take to prepare for a TCA peel. If you haven’t yet taken advantage of the benefits a skin care program can provide, please call on me to help design a program for you. Together we can get your skin in better shape and keep it that way over the long term.

I believe that any breast augmentation should be in proportion to a woman’s body. When I consult with a patient prior to surgery, I evaluate her existing breast size to help determine the appropriate size for her implants. Measuring the width of the natural breast is an important determinant in planning for the surgery, because the existing breast must be able to accommodate the size of the implant under consideration to provide natural-looking results. The thickness of the skin must also be examined to evaluate whether it can successfully cover the implant and prevent rippling.

I also evaluate a woman’s frame when developing a surgical approach for augmentation. To maintain an aesthetically pleasing, balanced silhouette, a tall woman with a broad chest wall will need a larger implant than a thin petite woman, for example. Fortunately breast implants are available in many sizes and profiles, so I am able to recommend the appropriate implant for virtually any body type.

It’s important that the patient and surgeon develop realistic goals for breast augmentation. While many patients are tempted to ask for the largest implants possible, it may be better to view it from a slightly different perspective: Which size implant do I need to achieve my goals? Implants that are too large will look unnatural and may eventually malposition—certainly an undesired effect. There are additional risks with excessively large implants as well, including stretched skin and loss of sensation.

My practice has a wonderful tool for helping choose the appropriate breast implant size—3D imaging. The simulator allows my patients to virtually “try on” different shapes and sizes, and it has proven to be valuable addition to the planning process. I am pleased to be able to offer this for my breast augmentation patients and feel it is a vital step in choosing an appropriate and tasteful implant size.

Careful planning, open communication, and realistic goals all contribute to a successful, natural-looking result from breast enhancement. If you are considering the procedure, please come in for a consultation so we can have a comprehensive discussion about your breast augmentation goals. I am happy to answer any questions you may have.

This is welcome news for patients and surgeons, because it validates the long-held beliefs of plastic surgeons, such as me, who have seen that these surgeries have long-lasting positive effects. Since the research was based on a set of standard assessments, this groundbreaking study sets a scientific baseline for studying such procedures.

The study was based on photographic measurements of fifty patients before and after facelift surgery. The comparative measurements concentrated on the jowl, mouth to chin creases, and neckline angle. Computer software was used to take the measurements from digital photographs. This was an innovative standardized approach that may set the bar for future facial studies. Specifically, the jowl area was noted to maintain eighty percent of the improvements obtained even five years following the procedure.

A fascinating aspect of the study involved human interpretation of the computer analysis. The researchers showed the sets of photographs to a plastic surgeon, a nurse trained in cosmetic procedures, and two lay people; the observations of this group were virtually identical to the changes identified by the computer model.

I suspect this team of researchers’ follow-up study will in fact demonstrate even longer-lasting results, as I have seen in my own patients, but the initial data was limited to the length of the study, which was an average of five and one-half years. For now, we have proof that a facelift can give real and lasting aesthetic improvement. I am pleased that my patients can now choose facial rejuvenation procedures with even greater confidence than before.

If you are confused by the jargon surrounding cosmetic procedures, I welcome the opportunity to help you sort through the terminology.

I begin by making this simple recommendation: Choose a board certified plastic surgeon with experience and proven results, then jointly decide on a plan to achieve your goals.

Each patient must have her own personalized plan for aesthetic enhancement because each individual presents unique circumstances to consider. Partnering with a skilled plastic surgeon can help you fully understand the options you have and identify which approach is best for you.

In consultations with my patients we discuss all areas of concern, and my skills and experience help me recommend the best cosmetic surgery options. Every surgical plan I develop varies to some degree. Through in-depth discussions, my patients and I decide on a targeted approach, free of lingo, with clear expectations.

Shopping on the Internet for a cosmetic procedure and then telling your doctor what you want is putting the cart before the horse. Choose an experienced surgeon who listens and communicates clearly with you. This partnership is the key to surgical success.

Droopy upper eyelids and bags under the eyes don’t do much to convey a person’s inner vitality. Occasionally, the skin or even the muscles in the upper lid have weakened, stretched, and sagged to such a degree that the condition interferes with clear vision. Whether eyelid issues result from the effects of aging or from genetic factors, an eyelid lift (also known as a blepharoplasty) can address these concerns.

To get natural-looking results from eyelid surgery, conservative removal of excess skin and re-positioning of the underlying muscle is generally required. Depending on the patient’s appearance and desires, I might suggest work on the upper lids, the lower lids, or both. I remove excess skin and sometimes fat through well-hidden incisions. My goal as a surgeon is to recreate a rested, youthful appearance, perhaps similar to the look you enjoyed in the past. I never change the shape of the eye as this can make patients look different, not better, to friends and family. Even if the intent is only to improve vision with an eyelid lift, there is usually a positive cosmetic change too.

I perform this procedure with the patient under general anesthesia. Because the surgery is performed in a small area, recovery time from eyelid surgery is relatively short. Naturally, you’ll need to take good care of your eyes in the early post-operative period. Eye drops and ointments will be prescribed and no contact lenses may be worn until specific healing goals have been met, which usually occurs two to three weeks after surgery. I will evaluate your progress with healing at post-operative visits over a six-week period. Within three weeks, exercise and all normal activities can resume.

Eyelid surgery can complement other facial rejuvenation surgery, such as a facelift, which focuses on correcting facial aging in the lower half of the face and neck. Addressing the eyes and the face simultaneously creates a balanced result. When you have a harmonious blend of procedures, it is very difficult to discern that any aesthetic surgery has taken place.

I often emphasize that my surgical objective is to achieve a natural appearance. As you and I consult on your goals, we’ll review all the options and design an approach that works best for your needs.

First of all, no actual vampires are involved; however, there is some bloodletting. This procedure requires a couple of tubes of your own blood to be drawn and then spun in a centrifuge for a few minutes. This process separates the blood into its different components. The plasma portion that contains platelets is drawn into a syringe and injected back into your face. Platelets are cells involved in forming clots to stop bleeding after injury, but they also contain growth factors and proteins that are felt to assist in healing. These growth factors are released after the platelets are injected into the face and are the presumed entities that induce the purported rejuvenative effects.

The good news is no incisions are required and only topical anesthesia is required. The bad news is that nothing is actually lifted, unlike the name of the procedure implies. Additionally, there is not a shred of medical evidence that proves that this procedure has any lasting effects. There are a few starlets that profess the wonders of these treatments, but no scientific studies that show any significant benefit. Even the providers that are offering this procedure report it should be repeated up to three times at intervals of a few weeks, and then maintained every six months. Each treatment is generally around $1200-$1500.

There is no doubt that when the face is injected with almost anything medical, including salt water, mild swelling occurs that softens lines and wrinkles temporarily. When filler agents are injected such as Juvéderm®, there is good scientific evidence that the collagen layer of the skin thickens, making wrinkles less deep. While fat injections are less predictable, and in my opinion rarely aesthetically pleasing, there is some objective data that shows the fat lives and fills in areas of tissue deficit associated with aging.

In contradistinction, there is no such evidence for platelet rich plasma (PRP) injections that are used in Vampire Facelifts. While this fluid has been used to some utility in the orthopedic surgery arena, it is not even FDA approved for injection into the face. It is also true that the majority of providers offering this procedure are not board certified plastic surgeons. Let the buyer beware. If it sounds too good to be true, it probably is.

There are a variety of “less invasive” surgical techniques currently being provided to patients, but slick marketing can lead people down a slippery slope. Who wouldn’t want a shorter scar, shorter anesthesia, shorter recovery and less expensive procedure? But what if the longevity of the result could also be described as short? Or what if it came at the cost of less safety? These minimally invasive and short-scar facelifts are quick and simple for the surgeon, but the shortcuts come at a very high price to the patient in regards to disappointment with the result. Many of these techniques involve tightening the skin only. Skin is a notoriously poor supportive structure as it was designed for protection, not support. Over-tightening skin has created some odd looking individuals! None of us looked stretched or tight when we were young, so there is no reason to believe we would look good now with stretched skin.

Advanced techniques of face lifting provide the most complete, natural, and long-lasting results. These procedures take time, skill, and excellent visualization of the tissues. They involve releasing and properly re-positioning the deeper tissues of the face including connective tissue and muscle, and then gently re-draping the skin without tension. Not all surgeons are created or trained equally. It requires a highly trained, experienced, and adept surgeon to perform this procedure effectively. It is definitely more work, and technically more challenging to do so, but the results are unparalleled.

Specialization in training makes for better results. It is hard to believe, but in Arizona and in many other states, a physician does not have to complete a plastic surgery residency to call themselves a board certified cosmetic surgeon. This huge loophole in scope of practice laws does not bode well for unsuspecting patients. I am board certified by the American Board of Plastic Surgery and a member of the American Society for Aesthetic Plastic Surgeons (ASAPS). I also have obtained a certificate of added qualifications in aesthetic surgery from ASAPS. This society publishes the surgical statistics of their member surgeons, and I perform three to four times more facelifts per year than the average member. This large volume of facelift patients has allowed me to continue to improve my skill. For the first eight years of my practice, I performed head and neck microsurgical reconstruction in cancer patients. These difficult cases provided me with a great deal of experience operating on the deeper tissues of the face and undoubtedly made me a more adept facelift surgeon.

My last bit of advice is to seek a surgeon who insists on safety first. A complete medical exam should be completed prior to elective surgery. Also, operating in a certified surgicenter affiliated with a hospital is key. I have board certified anesthesiologists provide anesthesia for my patients so I can concentrate solely on the surgery. I also keep my patients over one night so that they are closely observed and I can examine them the next morning.

Excellent natural results can be obtained from facial rejuvenation surgery, but do your homework and make sure you select a properly trained and experienced plastic surgeon so that you can enjoy your result for years to come.

My primary concern is for my patients’ safety during plastic surgery. As a board certified plastic surgeon and a member of the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS), I am obligated to perform surgery in an accredited facility. Studies have shown that accredited outpatient surgery centers have excellent safety records, with extremely low rates of serious complications (less than one half of one percent), according to the ASPS.

I perform plastic surgery procedures at the Greenbaum Surgical Specialty Hospital. As an accredited facility, it must meet stringent local, state, and national standards for a comprehensive list of issues, including safety, equipment, sanitation, and personnel. I think it offers the best of both worlds: although Greenbaum was designed primarily for outpatient procedures, it also has 26 private recovery rooms that can be utilized for short stays if necessary.

Among its several areas of specialization, the Greenbaum surgery center excels in all aspects of care related to cosmetic and reconstructive surgery. This facility is part of the larger Scottsdale Healthcare system and is on the campus of Osborn Medical Center, a full-service hospital. It’s also located right across the street from my office. I have been performing surgery at Greenbaum since I opened my practice in Scottsdale because I think it offers the safest environment for my patients.

Although I am not required to use a board-certified anesthesiologist to attend my plastic surgery patients, I insist on it. Anesthesiology is a complex specialty, and board certification assures me that the physician in the operating room with me is exhaustively trained in all aspects of anesthesia during plastic surgery. When I work with another doctor whom I trust, it allows me to focus on the surgery.

Patient safety involves many other factors, too. In fact, it begins with the initial consultation, when you and I discuss your general health and determine whether you are a good candidate for elective surgery. Conducting a comprehensive review of your medical history helps us formulate the most cautious surgical approach possible. So I start focusing on patient’s safety at the original consultation and continue this focus until recovery is complete. In my opinion, cutting corners on safety is not an option.