Smoking leads to more complications after surgery.
There is ample evidence proving that smoking tobacco cigarettes increases the risk of complications after plastic surgery. Most plastic surgeons recommend that smoking be stopped four weeks before and four weeks after cosmetic surgery to reduce complications and improve healing. If you are a smoker, this may seem excessive, but even four weeks is a compromise. For example, it takes eight weeks for the immunosuppression that accompanies smoking to substantially resolve.
Since patients and doctors alike want the best results with the lowest risk of complications, stopping smoking before plastic surgery is aligned with the patients’ ultimate goal of being better, faster. In fact, even if you are not considering plastic surgery, not smoking significantly improves your health and decreases the outward signs of aging.
Smoking And General Surgery
Smoking doubles the risks associated with general surgery (operations like hernia repair, appendectomy and gall bladder removal). The glass-half-full way to look at this is that if you smoke, you can cut the risks of surgery in half by stopping smoking four to eight weeks before surgery.
General Surgery Vs. Plastic Surgery
General surgery procedures and plastic surgery procedures are different. Many general surgery procedures are emergencies, so there is little chance to stop smoking before surgery. Additionally, most general surgery operations are performed on internal organs, rather than the skin. Since general surgeons are not usually rearranging the skin, the circulation to the skin is less likely to be disturbed with general surgery procedures. The mastectomy is the most obvious exception to this rule.
Smoking And Plastic Surgery
Smoking increases the complications of plastic surgery by 600%. Plastic Surgery is Skin Surgery, so most procedures involve rearranging skin, tightening skin, stretching skin or removing excess skin. The sentinel procedures for smoking studies in plastic surgery have been Face Lifts, Breast Reductions and Tummy Tucks.
How long does it take for your body to recover from smoking? The above timeline gives just a few examples and includes the average time it takes for the health benefits to be seen.
Face Lifts, Breast Reductions and Tummy Tucks
Face Lifts, Breast Reductions and Tummy Tucks require the formation of skin flaps. Skin flaps are sections of skin that are moved based solely on the blood supply within the skin. These vessels are extremely sensitive to smoking. When smoking, the blood vessels in the skin contract, reducing the blood flow, and the ability of the incision to heal. For these procedures, the risk of wound healing problems is not doubled like in general surgery procedure. It is increased by factor of six. Wound healing problems and skin loss are six times more likely for smokers than for non-smokers.
Is Marijuana Safer Than Tobacco?
The banner on the left was meant to convince voters that marijuana should be legalized. The banner on the right is a joke. Any questions?
No. In many ways, smoking a weed is smoking a weed. Both lead to increased coughing, and for most facial plastic surgery and body work, this causes real problems like bleeding and tearing sutures. It is believed that the high from marijuana is directly related to the damage done to the alveoli. Just like smoking, this leads to an increased heart rate to compensate for the decreased oxygen delivery and lower than normal oxygen concentrations in the blood. Since normal oxygen delivery is better for wound healing, smoking makes healing worse. Marijuana may decrease nausea, and so does tobacco, but there are better and safer meds for the nausea associated with anesthesia. Marijuana also has psychological effects not present with tobacco, which can further interfere with the medications given around the time of surgery.
Is Vaping Safer Than Tobacco?
An actual Lucky Strike advertisement, trying to make is seem like doctors recommend them. Granted, less information about the long term effects of smoking was known then. The message of the ad is that their cigarettes are less irritating than other cigarettes; however, they still make you cough, and coughing leads to additional surgical complications. Less terrible seems to be a redundant theme in smoking advertising, begging the question that it is still terrible.
The long-term effects of inhaling nicotine vapor are unclear. It may be less likely to cause cancer and heart disease, but research is still early. Early in smoking’s history, it was touted as the new health craze. It is good to know the history, so that we don’t repeat it.
While there seem to be fewer noxious chemicals with e-cigarettes, questions remain about exactly what all the substances in e-cigarettes are, and what they do. The American Society of Plastic Surgery has recommended to all its members that e-cigarettes be treated the same as cigarettes until they have been proven safe. Definitive research on the effects of vaporized nicotine on the survival of skin and soft tissue flaps is not currently available. Nicotine is vasoactive, and inhaling nicotine vapor may have similar effects on skin circulation as inhaling the nicotine in cigarettes. When it comes to your appearance and your health, why take unnecessary risks?
What Do Most Plastic Surgeons Recommend?
It may seem like I am being hard on smokers, but these are not theoretical risks. I have seen Tummy Tucks go from perfect to purple after half a cigarette. I have replanted fingers successfully, only to have a patient go home, weeks later, smoke and have his finger turn black and fall off. Smoking caused the blood vessels in the skin to contract to the point of not working. These are preventable injuries, and there is no better medicine than prevention.
Most plastic surgeons recommend stopping smoking four weeks before and after any procedure that involves skin flaps. The most common cosmetic skin flap procedures are Face Lifts, Breast Reductions and Tummy Tucks. The risks of wound healing problems is six times higher in smokers when compared to non-smokers having these types of procedures.
When the incision used is only an access point, i.e. no skin flaps, like Breast Augmentation, your risks are only doubled from smoking. Only doubled. Think about that.
While most plastic surgeons will operate on smokers for non-skin-flap type cosmetic procedures, it is still better to stop at least four weeks before surgery. And if you can stop for four weeks, there is no reason to restart. Only 15% of Californians currently smoke cigarettes. This is an all-time low, but with the recent passage of Proposition 64, we will have to see if the decline in smoking will continue.
The Chin and the Neck are neighbors, so it makes sense that when Plastic Surgery is being considered to enhance one, the other should also be evaluated. This San Francisco Plastic Surgery Blog post considers three patients who presented to my Walnut Creek Plastic Surgery Clinic. Each of them had different problems, but all of them wanted something to improve the profile of their necks.
Neck Liposuction Before and After Pictures
The “full” neck responds well to Neck Liposuction, as long as the skin tone is good. This is demonstrated by the Neck Liposuction Before and After Pictures shown above.
The Full Neck
The ideal Neck Liposuction patient is someone who has disproportionate fat under their chin and good skin tone. The excess fat can be safely and predictably removed with Liposuction, and elastic skin will easily shrink-wrap to the new, tighter profile.
The first patient, whose neck profile is shown in the above Neck Liposuction Before and After Photos, is a good candidate for the procedure. There is excess fat and the skin tone is good enough to show-off the new and improved contour. The definition between the face and neck is enhanced, and the angle of the neck is better defined. What happens when there is not a lot of excess fat, or when there is just too much skin? Read on; the next two examples explain.
Neck Liposuction With A Chin Implant Before and After Pictures
A weak chin can affect the neck profile. When the chin is small, it decreases the definition between the chin and the neck. In the case above, Neck Liposuction was combined with a Chin Implant to maximize the definition and the results.
The Small Chin and the Full Neck
Sometimes, the appearance of the full neck is compounded by a weak chin. With less area, it takes less fat to fill the neck. Liposuction alone would provide some improvement, but would be less effective than it is for someone with a proportionate chin. The Neck Liposuction With Chin Augmentation Before and After Pictures above show what the combination can accomplish.
In the above example, the excess fullness of the neck is removed with Liposuction. The profile is further improved by increasing the projection of the chin with a well proportioned Chin Implant. The “ideal” position of the chin on profile is equal to the projection the lower lip.
Neck Liposuction With A Neck Lift Before and After Pictures
Sometimes there is too much skin for Liposuction to be successful. In the Neck Liposuction with Neck Lift Before and After Pictures shown above, a Neck Lift was used to remove the excess skin, and to reveal the contour created by removing the excess neck fat with neck liposuction.
Neck Liposuction With A Neck Lift
In cases when disproportionate neck fat is combined with excess neck skin, a Neck Lift or Face Lift is used with Neck Liposuction to give the best results. Liposuction alone would leave the neck skin deflated, like a loose sail of skin. By adding a skin lift, the excess is removed, and the skin that remains is tight to the newly sculpted neck profile.
Neck Enhancement Consultations
The secret to excellent Neck Contouring results is a combination of good technique and selecting the procedure that is right for your neck. There are many procedures which can be used to improve the profile of the neck, and searching them all on the Internet can be confusing. Let a qualified and experienced Board Certified Plastic Surgeon be your guide.
If you would like to learn more about what Plastic Surgery can offer you, call (925) 943-6353 today, and schedule a private, personalized consultation appointment in my San Francisco Bay Area Plastic Surgery Clinic.
The Tummy Tuck is the Plastic Surgery workhorse for repairing the abdominal contour after childbirth or weight loss. Abdominoplasty is consistently one of the most frequently performed cosmetic plastic surgery procedures, because it can provide the best, safest and most predictable results possible.
Abdominoplasty on Body Beautiful
I had the opportunity to speak about Tummy Tuck surgery on the San Francisco Bay Area’s News Station, KRON 4’s, Body Beautiful. The following Abdominoplasty Video contains multiple sets of Tummy Tuck Before and After Pictures. Each exemplifies the possibilities available with Abdominoplasty.
Tummy Tuck Video (Abdominoplasty)
Abdominoplasty Consultation Appointments
When considering your Tummy Tuck, be certain to ask how the procedure is performed, what can be improved and what will remain the same. I prefer to keep my Abdominoplasty patients overnight. This allows for a supervised and more comfortable recovery, and assistance with mobility. I find once the initial pain is well controlled, and you are confident in your ability to move about, the recovery goes much smoother.
Be certain to consult a Board Certified Plastic Surgeon in your area who has years of experience with the techniques currently available. If you are in the San Francisco Bay Area and would like to schedule a personalized appointment in my Walnut Creek Plastic Surgery clinic, give me a call today at (925) 943-6353.
Every Mommy Makeover includes enhancement of both the belly and the breasts. The most common combination is Breast Augmentation with a Tummy Tuck (Abdominoplasty). However, other options include:
Breast Implants with Breast Lift
Mini Tummy Tucks
Other Body Enhancements
Brazilian Butt Lift
Lower Body Lift
The combination best for you depends on what you need, tempered by safety and predictability.
Mommy Makeover Video Presentation
The television segment included below is all about Mommy Makeovers and includes many of the most popular variations. The Mommy Makeover Video includes Mommy Makeover Before and After Pictures that illustrate what the procedure has to offer.
The following video segment is from my latest appearance on the San Francisco Bay Area’s New Station, KRON 4. The show gives me the opportunity to talk about the latest Cosmetic Plastic Surgery News.
Mommy Makeover Video
Make Your Mommy Makeover Consultation Appointment
When considering a Mommy Makeover, be certain to find a Board Certified Plastic Surgeon in your area who has years of experience with the techniques currently available. If you are in the San Francisco Bay Area and would like to schedule a personalized appointment in my Walnut Creek Plastic Surgery clinic, give me a call today at (925) 943-6353.
Liposuction remains one of the most popular Cosmetic Plastic Surgery procedures.
Liposuction is Popular
When it comes to controlling the shape of our bodies, American’s put their money where there mouths take them. Collectively, we spend over 2.6 billion on gym memberships and over one billion dollars on Liposuction each year. With over 300,000 Liposuction procedures performed by Board Certified Plastic Surgeons alone. So, what can Liposculpture really do?
Liposculpture Before And After Pictures
First off, Liposculpture and Liposuction are the same thing. Liposculpture emphasizes that the procedure allows for selective removal of fat cells and as a result, sculpting of the body. Liposuction is more objective and emphasizes that the procedure removes fat by vacuuming it out.
The following is a video segment from my latest appearance on the San Francisco Bay Area’s New Station, KRON 4. The show is broadcast live, and gives me the opportunity to talk about the latest that cosmetic plastic surgery has to offer. This television segment is about Liposculpture and includes many Liposuction Before and After Pictures to illustrate what the procedure has to offer. It also includes several complementary treatments for the stubborn neck area.
Liposuction Video Presentation
Liposuction Consultation Appointments
When considering Liposuction, be certain to find a Board Certified Plastic Surgeon in your area who has years of experience with the techniques currently available. If you are in the San Francisco Bay Area and would like to schedule a personalized appointment in my Walnut Creek Plastic Surgery clinic, give me a call today at (925) 943-6353.
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Excellent Breast Enhancement is about obtaining the right size and the right shape. If your breast shape is good, more volume is all that is needed, and Breast Augmentation is usually enough to get the results you are looking for.
However, when breasts are the wrong shape, bigger is not always better. For congenital deformities like Poland’s Syndrome or Tubular Breasts, a Breast Implant alone is often not enough. A Breast Lift is added to reshape the breast mound and relocate the misplaced nipple.
Breast Augmentation With Breast Lift Video (Mastopexy Augmentation)
Below is a segment from my latest KRON 4, Body Beautiful show. Several Breast Augmentation With Breast Lift Before and After Pictures are included and narrated, to help illustrate what Breast Augmentation With Breast Lift has to offer. Examples of both the correction of the typical breast deflation with sagging (breast ptosis) typically seen after pregnancy or weight loss, as well as congenital deformities like Poland’s Syndrome or Tubular Breasts are reviewed.
The splash screen of the video above shows Mastopexy Augmentation used for a woman with tubular breasts and very low nipples. Breast Augmentation alone would give her larger breasts; however, the nipple areola complex would still be puffy and the location of the nipple would remain at the bottom of the breast. A more ideal nipple shape and location was obtained by combining the use of Breast Implants for enhanced volume with a Vertical Breast Lift for a better shape. The result is a happy patient.
Breast Augmentation and Breast Lift Consultations
If you are considering Breast Augmentation or a Breast Lift, be certain to choose an experienced and Board Certified Plastic Surgeon who understands how to address your specific breast anatomy and your goals. In the San Francisco Bay Area call (925) 943-6353, to schedule a personalized and private consultation appointment.
Dr. Joseph Mele appears on the Bay Area’s News Channel, KRON 4’s Body Beautiful this week discussing Breast Augmentation, Breast Lifts, Tummy Tucks, Liposuction and Mommy Makeovers.
Body Beautiful Live Wednesday at noon on KRON 4
San Francisco Bay Area’s News Station, KRON 4, will be airing the latest installment of Body Beautiful this week. The show will be broadcast live, at noon, this Wednesday (Dec 7, 2016) on channel 4, and will include the latest in Cosmetic Plastic Surgery with the emphasis on Body Sculpting.
Liposuction – Sculpting the body by removing disproportionate fat
Abdominoplasty – Using a Tummy Tuck to tighten the abdominal wall and remove excess skin and fat
Mommy Makeover – Combining Breast Enhancement with Abdominal Enhancement to reverse the damage done by pregnancy
So Many Topics; So Little Time
I try to keep the show fast-paced, accurate and informative, but I did not learn about these topics in a half-hour television show. More information is available online by clicking on the links above, but nothing can substitute for an in-person consultation tailored to your specific needs. If you are serious about learning what Cosmetic Plastic Surgery can offer you call my Walnut Creek Plastic Surgery Clinic at (925) 943-6353.
Miami, Florida, seems to be hot bed for Deceptive Plastic Surgery Practices, and is giving good Miami Plastic Surgeons a bad name. The most recent incident to make the national news is a Botched Brazilian Butt Lift at Encore Plastic Surgery. The clinic is linked to a chain that focuses on cheap plastic surgery for medical tourists visiting Florida for a procedure and a vacation.
Fake San Francisco Plastic Surgery
Miami is not unique, however. This year, Carlos Guzmangarza was sentenced to 20 years in prison for performing illegal plastic surgery out of his fake San Francisco, California “plastic surgery” clinic. His Mission District clinic preyed on many Central American immigrants. Allegations include: smoking a cigar during surgery, flushing Liposuction fat down the toilet, sexual assault, the injection of unknown skin fillers and leaving a four inch needle in a patient’s buttocks. Eventually, he was convicted of thirty-three felonies and eight misdemeanors.
Caveat Emptor – Let the Buyer Beware
In most cases, there are clues that everything is not up to the usual standard of care. In the case of Mr. Guzmangarza, not only was he not a Board Certified Plastic Surgeon, he was not a doctor. He did not have a medical license, and that’s something that anyone could check.
Check the Medical License
Notice the medical license is for a “Physician and Surgeon.” California, like all states, does not differentiate.
I am Certified by the American Board of Plastic Surgery. The only ABMS recognized board for Plastic Surgery.
The American Board of Plastic Surgery offers a free, online certification lookup. Click here to see if your doctor is certified by the American Board of Plastic Surgery. Most doctors claiming the title “Plastic Surgeon” are not certified by the American Board of Plastic Surgery. In fact, it is estimated that only one in twelve practitioners practicing plastic surgery are Certified by the American Board of Plastic Surgery. Does your doctor have the best training?
Check For Other Board for Certifications
I am also certified by the American Board of Surgery, because I completed a residency in General Surgery, too.
If your doctor is certified by the American Board of Ophthalmology, they are trained in surgery of the eyes. So if you are having Eyelid Surgery, they should have had the appropriate training. On the other hand, if you are having Liposuction, buyer beware.
If your doctor is certified by the American Board of Otolaryngology, the are trained in ear, nose and throat surgery, so Facial Plastic Surgery is within the scope of their training. If you are having Rhinoplasty, this is an appropriate board for certification. If you are having Breast Augmentation, buyer beware.
Non-Surgical Board Certification
The non-plastic surgery boards listed above are at least surgical boards. Some “cosmetic surgeons” have non-surgical board certifications. Certification by Family Practice and Internal Medicine Boards is not reassuring if you are having a surgical procedure. Proof of additional surgical training should be made available, and it should be years or training, not a weekend course.
Do Your Homework
A well trained, experienced practitioner will be up-front and honest about their training and abilities, but those who are not honest may be even more convincing. You need to do your homework. Use the links above to confirm what you are being told. If it does not fit, do not commit.
It is no secret that the number of Buttocks Augmentations has been growing exponentially in the United States over the last decade. The procedure most responsible for this rise in popularity is the Brazilian Butt Lift.
Brazilian Butt Lift
Tummy Tuck and Brazilian Butt Lift Before and After Pictures: In this case, fat is harvested from the abdomen, back and flanks and is transplanted to create fuller, curvier buttocks.
The Brazilian Butt Lift was pioneered by Brazilian Plastic Surgeon Ivo Pitanguy. It involves three steps.
First, fat is collected via Liposuction, so if you are considering Buttocks Enhancement with Fat Grafting, you need to have a little extra fat to donate.
Second, the fat is cleaned. While many methods exist, decanting, centrifuging and filtering remain the most popular. At the recent American Society of Plastic Surgery Meeting in Los Angeles, all methods were shown to be safe and effective; however, the original decanting method seems to provide the greatest amount of fat take in the buttocks.
Fat in syringes ready for grafting.
Third, the best fat cells are transplanted into the buttocks. The greatest benefit of Fat Grafting to the Buttocks is its ability to not only enlarge, but to reshape the buttocks. Fat can be placed selectively into the areas that need it more. The primary limits to the amount of fat that can be grafted are the amount available, and the blood supply available to support it. Too much fat in one area can lead to less graft take and a greater change of contour irregularities. This is where craftsmanship counts.
Alternatives to Buttocks Fat Grafting
A simple Google search for Buttock Enlargement reveals that there are other ways to get a larger posterior, but are they effective? Other surgical techniques include Buttock Implants and the injection of other substances. The pressure for these types of operations comes from the fact that often, there is not enough fat available for grafting into the buttocks. Unfortunately, the results are not great. Buttocks Implants tend to ride higher that the cosmetic ideal and cannot selectively enhance specific quadrants of the buttocks. Fillers have a long history of disaster associated with them, including infections, granulomas, redness, hardening and even death. There are no FDA approved fillers for the buttocks, and many of the substances used for Buttocks Enlargement, silicone and PMMA, are well known to cause permanent disfigurement, and should be avoided.
Non-surgical alternatives include exercise and creams. Exercise is a very healthy alternative and has many other benefits that fat grafting does not provide. Leg curls, squats and lunges have been proposed as buttocks enhancers. Like muscle building in general, it will work for some, but not many. For women in particular, it is more difficult to build bulky muscle, which is want is needed for any significant enlargement. So while exercise is safe, it is often not effective. Buttocks creams have been available in Brazil for many years. I will not get into the details, but none have received FDA approval for safety or efficacy, so buyer beware.
Buttocks Enhancement Consultation
If you are considering a Brazilian Butt Lift, be certain to seek an experienced Board Certified Plastic Surgeon. It is a highly artistic procedure and is as dependent on technique and craftsmanship as it is on the method selected.
A personal consultation is the best way to learn what the procedure can do for you. Call (925) 943-6353 to speak directly with our San Francisco Bay Area Plastic Surgery staff in the East Bay City of Walnut Creek for your private, confidential appointment.
Last week, I blogged about What to Expect After Breast Augmentation Surgery. Well, several of my proactive patients wanted to know what they could do before surgery to help their recovery. Great question, so today we are talking about how to plan for your Cosmetic Plastic Surgery.
How To Prepare For Cosmetic Plastic Surgery
First and foremost, Cosmetic Surgery is elective. Since you are making the choice to proceed, you should also plan to succeed with a quick and safe recovery. Making a few arrangements and taking a few precautions can really boost the safety and predictability of your procedure.
Timing Is Everything
Very few of us have a plethora of free time. Recovery takes time, and giving yourself adequate time for recovery is very important. For some procedures, doing too much activity will increase swelling and discomfort, for others, it can reverse the progress made with your procedures. Be sure to ask your Board Certified Plastic Surgeon about how much time you will need and what precautions to take, specific to your body and your procedure.
You want to arrange your schedule so that you have the time necessary to take care of yourself. So get your resources organized early, and have your recovery tools ready. Ice packs, prescriptions and a little help from your friends should all be arranged before surgery. With the crack-down on the abuse of prescription drugs, it can take more than one visit to the pharmacy to get pain pills. If you have small children, additional child-care may be very helpful during the days after surgery. Preparing a few days of meals that can be easily warmed up can also help.
Eat A Healthy Diet
Eating healthy is always a good idea, but it is especially important to consume the building blocks your body needs to heal. Balance is important, and more is not better. Supplementing in situations were vital elements of nutrition are lacking can be important, but filling these needs through a healthy diet is always the first choice. In certain situations, like after Bariatric Surgery, certain nutrients may need to be supplemented to make up for the malabsorption these procedures are designed to produce.
Hydration is equally as important. Dehydration contributes to increased nausea after surgery, so stay hydrated before and after surgery. Dehydration after surgery leads to lower blood pressure, decreased circulation and slower healing.
In case you haven’t heard this yet, smoking is bad for you. If you’re a smoker, smoking cessation will improve your results, your recovery and your health in general. For some operations, smoking increases your risk of wound healing problems by 600%, and most Plastic Surgeons will ask you to stop at least four weeks before and after them.
Operations that have a problem with smoking include:
Smoking tobacco is bad, but smoking marijuana may be worse, because unlike cigarettes, pot often it is inhaled completely unfiltered. Even casual pot smoking, now legal in California, will restrict the blood flow to the surgical site, leading to decreased healing, prolonged inflammation and swelling and a reduced result. Marijuana is not the only herb you should avoid before surgery.
Avoid Things That Will Make You Bleed
Certain medications, supplements and herbal remedies are known to increase bleeding. You should review your diet, and everything thing else you take before your surgery. Many herbal remedies seem harmless, but those derived from root and bark often contain salicylates, which will make you bleed just like aspirin can. You can find lists of supplements to avoid on the Internet, like this short List from the Otolaryngologist at Stanford, but the best thing to do it to bring all your medications, herbs and supplements to your pre-op visit for your surgeon to review.
It’s Harder To Hit A Moving Object
Keep moving. The better shape you are in before surgery, the easier it will be to get up and move after surgery, too. Be certain to follow your surgeon’s limitation for activity, but do not become a “couch potato”. Early ambulation has been shown to decrease the risk of problems like pneumonia and blood clots, but it will also make you feel better faster. Humans were not designed to sit around.
Ask Your Surgeon
Be certain to ask your surgeon what you can do to speed your recovery. They can tailor their recommendations to you and your surgery, and help you feel better faster. If you are considering Cosmetic Plastic Surgery in the San Francisco Bay Area, give me a call at (925) 943-6353, and we can go over all the details, together.