Big Arms are a big deal. I’m not talking about the “big guns” produced by lifting weights. I’m talking about loosing weight, getting in shape and still having big arms due to loose, flabby skin. This is a common problem for anyone who has lost a significant amount of weight. Some people are born with large arms and loose skin, but many of my Arm Lift patients have lost weight through diet and exercise or after bariatric surgery. For them, the larger the weight loss, the bigger the problem.
Arm Lift (Brachioplasty)
Brachioplasty literally means arm changing. The ideal candidate is healthy, with a large amount of loose, redundant upper arm skin. Sometimes called Bat Wings, this skin excess is not amenable to exercise, and further weight loss only exacerbates the problem. There is no skin shrinking ray, so the options are often either an Arm Lift or to live with it.
Arm Lift Video (Brachioplasty)
Below is a recent Body Beautiful segment dedicated to Arm Reduction surgery from the San Francisco Bay Area’s News Station, KRON 4. This Brachioplasty Video answers many of the frequently asked questions about Arm Lifts and reviews the results that some of my patients have received. The information provided is accurate, but cannot be considered medical advice. An in-person consultation with a Board Certified Plastic Surgeon is always recommend prior to choosing a treatment plan.
Arm Lift Before and After Pictures
The above Arm Lift Video includes many Brachioplasty Before and After Pictures. From arm to arm there are differences in appearance, so the Arm Lift is adapted to your unique needs. There is no substitution for an in-person evaluation, but additional Arm Lift Information is available here on the San Francisco Plastic Surgery Blog and on my main web site’s Arm Lift Page.
Arm Lift Consultations
If you want to know more about your options for Arm Reduction, call (925) 943-6353 today and schedule your personalized Arm Lift Consultation. A focused physical examination and medical history are how we start. If you are a candidate, the risks, benefits, procedure, alternatives, limitations and recovery of the Arm Lift are reviewed in detail, so that you can make an informed decision.
Large breasts can be debilitating. The constant heaviness pulls the shoulders down and strains the neck and back muscles, making physical activity difficult. For women who are suffering from chronic neck, back, shoulder and breast pain, Breast Reduction Surgery may be the answer.
Symptoms Of Macromastia
Doctors have a different word for everything, even large breasts. The terms Macromastia and Gigantomastia are used to describe breasts that are disproportionately large and which can cause the following symptoms:
Neck pain – usually the lower neck
Back pain – usually the upper back, but can be lower too
Shoulder pain – from spasms in the muscles needed to support the breasts
Breast pain – aching pain within the breasts themselves
Shoulder rutting – indentations of the shoulders from the bra straps digging in
Recurrent rashes – fungal or bacterial infections in the folds under the breasts
The Cure For Macromastia
Non-surgical interventions, like custom bras, physical therapy and weight loss, are usually the first treatments tried. In fact, many insurance companies require these before even considering authorizing a Reduction Mammoplasty. For women who truly have Gigantomastia, however, non-surgical interventions are rarely effective.
The most effective treatment remains Breast Reduction. By removing a significant amount of weight and by firming up the breasts by tightening the skin, most patients feel relief within minutes of waking up after surgery. When done for the right reasons, the results are dramatic. Multiple Reduction Mammoplasty Before and After Pictures are narrated in the following Breast Reduction Video segment.
Breast Reduction Video (Reduction Mammoplasty)
Below is a recent Body Beautiful segment dedicated to Breast Reduction surgery from the San Francisco Bay Area’s News Station, KRON 4.
Breast Reduction For Men
Usually, Male Breast Reduction involves removing a small amount of breast tissue, Gynecomastia, from beneath the nipple/areola region. Unlike female Breast Reduction, Gynecomastia Reduction rarely requires a reduction in breast skin. An example of male breast reduction with skin reduction is included in this week’s Breast Reduction Video.
Breast Reduction Consultations
The decision to have Breast Reduction is a personal one. More information about the procedure is available through the links in this San Francisco Plastic Surgery Blog post. The best information, however, is only available through an In-person Consultation with a Board Certified Plastic Surgeon.
If you are in the San Francisco Bay Area and would like to schedule a consultation call (925) 943-6353 today.
The Breast Lift (Mastopexy) is one of the most frequently performed Breast Enhancement procedures. It is part of every Breast Reduction and is performed with Breast Augmentation as high as 40% of the time. There are many Breast Lifts to choose from, and I discuss the Breast Lift Basics in this segment from the San Francisco Bay Area’s News Station KRON 4‘s Body Beautiful.
Breast Lift Video (Mastopexy)
Mastopexy literally means “breast fixing”. Unlike Breast Augmentation, it does not change the size of the breast, but the shape. In this segment from Body Beautiful, I discuss the three basic Breast Lifts and review what they can and cannot do. The Breast Lift Video is illustrated with several Breast Lift Before and After Pictures including an example of combining a Breast Lift with Breast Augmentation for a Dramatic Breast Enhancement.
How Does A Breast Lift Work?
Imagine you have a favorite pillow that has gone flat. To restore the pillow’s original firmness, you have two options: You can add more stuffing or make the cover smaller. Adding more stuffing is like Breast Augmentation. During Breast Augmentation the Breast Implant is the additional stuffing that provides volume and some support to the breasts.
A Breast Lift is more like tailoring the breast skin to match the current size. If you are happy with the size of your breasts, but disappointed with the shape, you breasts have deflated or your breasts sag without a bra, a Mastopexy may be the best option. The amount of sagging and the nipple’s location on the breast mound will determine the amount of tailoring necessary and thus the type of breast lift needed.
Breast Lift with Breast Augmentation
A Breast Implant is not usually used during a breast lift; however, it can be added when both sagging and size are issues. The Breast Implant can be used in two ways. The most common way is for Breast Augmentation, where the entire breast is enlarged proportionately. The second way is to balance the upper and lower halves of the breasts. Often, when there is sagging, the lower half of the breast is larger, while the upper pole remains flat. A low profile implant can be used to provide fullness to the upper breast. This can balance the overall shape of the breast without overly enlarging it.
Breast Lift Consultations
To find out what type of Breast Lift is right for you, see a Board Certified Plastic Surgeon. A personalized consultation and a few measurements are all that they need to provide you with your best options. To schedule an appointment in my San Francisco Bay Area Plastic Surgery office located in the East Bay city of Walnut Creek, California, call (925) 943-6353, today.
Dr. Mele and Body Beautiful host Janelle Marie in the KRON 4 Bay Area News studio.
Since my first Body Beautiful appearance in 2007, the goal has remained the same: to explain what Cosmetic Plastic Surgery can and cannot do. The show began in the old KRON 4 Van Ness studios as a live broadcast, giving San Francisco Bay Area plastic surgery curious viewers the ability to call in and have their questions answered on the air.
Body Beautiful – Still Going Strong
The KRON 4 line up has changed through the decade, and so has the Body Beautiful broadcast time. Originally, part of the Medical Mondays lineup, we followed the morning news. As the daytime line up changed, we moved to Wednesday mornings and on occasion, the show was taped and rebroadcast on Saturday mornings.
Dr. Mele discusses Breast Lifts (Mastopexy), Breast Reductions (Reduction Mammoplasty), Arm Lifts (Brachioplasty) and Mini Tummy Tucks (Mini Abdominoplasty) LIVE next Wednesday, June 8, 2016, at noon on the Bay Area's News Station, KRON 4’s Body Beautiful.
This Wednesday Body Beautiful is LIVE
This week’s show is special. We will again be broadcasting LIVE, on Wednesday, June 8, 2016, at noon. It’s a new time, a new show, and it’s from the new KRON 4 studios, but the goal of demystifying Cosmetic Plastic Surgery remains the same. This week’s topics on Body Beautiful are all about Body Shaping:
As usual, the segments from the show will be posted here on the San Francisco Plastic Surgery Blog. Currently, there are 128 Plastic Surgery Videos on the blog, so if you are looking for Cosmetic Plastic Surgery information, you are in the right place. Use the links under Categories to explore the procedures you are interested in learning more about. This blog, as well as my other plastic surgery web sites, are constantly being updated, as new information and options become available. And don’t forget to watch our next live show this Wednesday at noon on KRON 4.
Cosmetic Plastic Surgery Consultations
The Internet is a great place to get information, but there is no filter on it. There is no substitution for an in-person consultation with an experienced and Board Certified Plastic Surgeon. To schedule your personalized and informative, private plastic surgery consultation, call (925) 943-6353, today.
Many suffer from Migraines. Thanks to Allergan, we know that Botox can help, but there may be something safer and cheaper the can help, too.
A lot of my San Francisco Bay Area Plastic Surgery patients suffer from Migraine Headaches, so I looked into the incidence of Migraines and found that according to the Migraine Research Foundation, it is the third most prevalent and the eight most disabling illness in the world. In the U.S., 18% of women, 6% of men and 10% of children suffer from migraines, and I have found this to be true within my own patient population.
Migraines Run In Families
About 80% of Migraine sufferers have a positive family history. It runs in my family. I had a few myself, but I seem to have outgrown them. Thankfully, mine were few and far between, and they seemed to be associated with sleep deprivation. So diet, exercise and regular sleep were enough to keep them to a minimum, but others are not so lucky. Every 10 seconds, someone in the U.S. goes to the emergency room complaining of head pain. While most sufferers experience attacks once or twice a month, more than 4 million people have chronic daily migraine, with at least 15 migraine days per month.
Sleep and Migraines
My observation of an association between Migraines and sleep is not unique. One of the most commonly cited triggering agents happens to be changes in sleep habits. Insufficient sleep, greater than normal sleep, disturbed sleep or alterations to daily bedtime or waking all have been strongly correlated with initiating migraine attacks. Recent research suggests that some migraineurs might be deficient in melatonin production.
A nap can cure a Migraine, but sleep may also be preventative.
According to a well referenced online article by Dr. Mathew Long, Melatonin (a derivative of serotonin) is manufactured in the pineal gland at night, and it functions to regulate the sleep-wake cycle. Furthermore, it has been implicated in migraine pathophysiology due to its anti-inflammatory effects, ability to scavenge free-radicals, inhibition of dopamine and stimulation of nitric oxide synthase. Melatonin also has a role in membrane stabilization. With sleep-related factors featuring so prominently in migraineur’s lives, it makes sense that we examine the relationship between poor sleep hygiene, melatonin synthesis and the tendency to migraine. Research has linked low levels of melatonin in plasma and urine and altered peak time in melatonin levels to a variety of headache types, including migraines.
Sleep and Melatonin
Melatonin has been available as a supplement in the United States since the 1990s and is often used to aid sleep and attenuate jet lag. A study in published in Neurology in 2004 showed promising results in migraine prevention when 3 mg of melatonin was taken 1 hour prior to bedtime. This was confirmed 10 years later when Melatonin was compared head-to-head-to-head with amitriptyline and placebo.
As reported on Medscape, results from a multi-center, randomized, double-blind, placebo-controlled trial showed that 3 mg of melatonin was more effective than placebo and had efficacy similar to that of 25 mg of amitriptyline. Furthermore, it was better tolerated than amitriptyline, with lower rates of daytime sleepiness and no weight gain.
To test the efficacy and tolerability of melatonin and amitriptyline vs placebo for migraine prevention, the investigators recruited 178 men and women who met International Headache Society diagnostic criteria for migraine with and without aura and who had 2 to 8 migraine attacks per month. All patients underwent a 4-week baseline phase during which each participant kept a diary of migraine frequency.Participants were then randomly assigned to receive 3 mg melatonin (n = 60), 25 mg amitriptyline (n = 59), or placebo (n = 59) for 3 months. Medication was taken between 10 and 11 pm daily.
The study’s primary outcome was a reduction in the number of headache days per month. Secondary endpoints included migraine intensity and duration and analgesic use. Tolerability was also measured in all 3 study groups. The mean reduction in headache frequency was 2.7 in the melatonin group, 2.18 in the amitriptyline group, and 1.18 in the placebo group.
Proportion of responders (patients with a higher than 50% improvement in headache frequency, number of migraine headache days) comparing baseline vs last month of treatment.
Although migraine frequency did not differ between the 2 active treatment groups, the proportion of responders was greatest in the melatonin group: 54% vs 39.1% for amitriptyline and 20.4% for placebo. Melatonin was also “very tolerable” and had significantly fewer adverse effects compared with amitriptyline. Daytime sleepiness was the most frequent symptom in all 3 groups but was most pronounced in the amitriptyline group (n = 24). Although patients gained weight in both the amitriptyline (n = 3) and placebo (n = 1) groups, melatonin was associated with weight loss.
Timing of administration and formulation is also important. Ideally, melatonin should be taken between 10 pm and 11 pm to mimic the physiologic peak. In addition, a fast-acting rather than a slow-release formula should be used.
Overall, said Dr. Peres, the study’s findings are promising and warrant further research.
If you suffer from Migraines, Melatonin, a relatively inexpensive and safe over-the-counter supplement may help. I am not recommending you base your treatment on the blog post of a San Francisco Bay Area Plastic Surgeon. You should see a real headache doctor and have the appropriate testing and examinations performed prior to initiating treatment. However, when you see your doctor, if they do not bring up Melatonin, be certain to ask.
Breast feeding is good for babies nutritionally and emotionally. Above is Naomi Jael, from Germany. She caused a viral sensation this week with this snap of her breast feeding her 10-month-old son at a wedding reception, though comments centered more around her public display than the virtues of breast feeding. A more supportive and more comical imitation can be found here.
A common question I get from women considering Breast Augmentation is, “Will Breast Implants interfere with Breastfeeding?” For women who are trying to reclaim their breasts after finishing having children, this is not an issue. However, if you want Breast Augmentation, and want to have children afterward, here are a few things you should know.
Is Silicone Safe For Babies?
Did you know that silicone drops are used to treat infant colic? An article from 1988, Mylicon drops in the treatment of infant colic, dosed 51 colicky infants with 0.3 ml of simethicone with each feeding. Symptoms of colic improved or resolved in 38 infants (78%) after one day and in 44 (86%) after seven days. Simethicone is an anti-foaming agent that relives bloating, and it is still available without a prescription, over-the-counter at your local pharmacy.
Safe enough to use at every feeding and up to 12 times per day. Active ingredient: Simethicone 20 mg in each 0.3ml dose.
Simethicone is a mixture of polydimethylsiloxane (PDMS) and hydrated silica gel. If you have ever taken Gas-X, you have ingested PDMS. What you may not have known is that PDMS is the same type of silicone found inside breast implants. So it is safe for adults, too. So if silicone is in breast milk it’s safe, but can it get out of a breast implant and into the breast milk?
Can Silicone Get Out of Breast Implants And Into Breast Milk?
PDMS is a silicone polymer which can be cross linked to increase its viscosity. This allows it to remain soft, yet resist flow. It is used inside breast implants, and is surrounded by a soft, solid, tear-resistant shell to further isolate it. Current breast implants are made with shells that do not allow the gel to bleed through them, though this was not always the case.
Modern Silicone Gel Breast Implants are filled with highly cohesive gel that does not flow like the oil found in earlier generations of breast implants manufactured before 1994. Implants made before 1985 have very runny filling and a high rate of rupturing.
Older breast implants, manufactured prior to 1994, did allow a small amount of gel to seep through them without a hole in the shell. It is like Helium seeping out of a balloon; however, rather than leaking out over night, it takes years for measurable amounts of silicone to be detected outside the these older breast implants. New breast implants are made with low-gel-bleed shells, which contains the internal gel, and prevents the gel from seeping through the wall. New breast implants also have high-cohesive gel centers, which do not flow like water. In the most recent long term follow-up studies, there have be no cases of the gel migration, which was seen in the older breast implants. So it is unlikely that silicone can get out of the breast implant, never mind into the breast milk.
Is Silicone Found In Breast Milk?
In 1991, before the more impervious breast implant shells were manufactured, a study measuring the amount of silicone found in the breast milk of lactating women with breast implants was published. The scientific sounding title is, “Determination of low levels of silicones in human breast milk by the aqueous silanol functionality test.”
Silicon compounds are widespread in the environment, making measurement of elemental Si in biological systems difficult. The assay was quite laborious and required 10 days to complete and measures PDMS, not elemental Si. The amount of PDMS in the milk of women with implants was not statistically different from that in water blanks or control human milk samples. The milk from women with polydimethylsiloxane breast implants contained 3.62 ppm (parts per million); control milk contained 3.40 ppm; and water contained 2.25 ppm. Moreover, this was in the older breast implants that had gel bleed, and still the levels were not statistically elevated.
Proper Breast Implant Placement Can Help Too
Surgical considerations for decreasing the risk of breast implants interfering with breastfeeding include scar and implant placement. Incisions made around the areola, may cut some of the ducts going to the nipple. I have had many patients with periareolar incisions maintain the ability to breastfeed, because most of the milk gland is between the nipple and the armpit, away from this periareolar incision; however, for patients wanting to breastfeed, I recommend using the inframammary fold (IMF) incision.
The most frequently used Breast Augmentation incisions are the periareaolar incisions and the inframammary incisions as shown above.
Placing the Breast Implant behind the pectoralis muscle can help, too. This provided an additional barrier between the breast implant and the breast gland, and also takes some of the compression off the milk gland. More pressure may trick the breast into thinking it has made enough milk, and turn off production early. Larger implants may also be more likely to decrease the amount of milk produced for the same reason.
Nipple Sensation is Helpful For Breastfeeding
Nipple stimulation is another stimulus for lactation. If you lose nipple sensation after breast augmentation, this may cause a reduction in milk production as it interferes with the normal milk let-down reflex that nipple stimulation causes. Fortunately, decreased nipple sensation is not common after Breast Augmentation.
Normal Breast Are Better For Breastfeeding
What I mean is that if you have normal breasts before Breast Augmentation, you are more likely to be able to breastfeed after Breast Implants are placed. If your breasts did not develop, you are more likely to have problems breastfeeding with or without breast implants. Other risk factors for not being able to breastfeed are: breasts that are spaced far apart, breasts which are tubular in shape or breasts that are significantly asymmetrical. If any of the above describe your pre-implant breasts, it’s possible you don’t have enough of the glandular tissue you’d need to make milk, and one study found that women with these conditions are 25 percent more likely to be unable to breastfeed and 19 percent more likely to need to supplement.
Can I Breastfeed If I Have Breast Implants?
Yes. The current recommendation for women with Breast Implants is to breastfeed. Breast Augmentation is not a contraindication to breastfeeding. While some women will make a smaller quantity of milk, there is no change in the quality of the milk produced.
Breast Augmentation Consultation
If you are currently trying to get pregnant, of plan to have a child in the next year, now is not the time for Breast Augmentation. If you are considering pregnancy somewhere in the future, or if you are done having children then now is a good time to find out what to expect. For a private, personalized Breast Augmentation Consultation call (925) 943-6353 and schedule an appointment. More information is available here on the San Francisco Plastic Surgery Blog, and my other websites, but there is no substitute for an in-person consultation, tailored to your body and your needs.
Downtown Walnut Creek, CA, was closed this weekend, but it was a good thing. The Walnut Festival Association sponsored Art on the Main. Art, food and beverage is usually available along Main Street, but this weekend, the street was open to foot traffic only. Scores of booths with paintings, photography, ceramics, glass, jewelry, wood, textiles, leather and even tie dye, lined the main drag. There was lots to see and lots of sunshine, too.
What Does SPF Stand For?
Freckles are sun damage. Without sun exposure, freckles never appear.
Today in Walnut Creek, SPF could stand for Spring Paintings Festival. When it comes to sunscreen, SPF stands for Sun Protection Factor. It sounds very scientific, maybe even with some math involved, but how is SPF actually calculated? I always imagined sunscreen, meticulously applied to a glass sheet, with UV lasers and collectors measuring the reflection and transmittance of harmful ultraviolet rays. Turns out, it’s much less complicated and accurate.
How Is SPF Calculated?
Soldiers sent off to fight World War II were given sun protection prior to shipping out. Nicknamed “red vet pet,” it was a sticky, unpleasant, solar barrier made from red veterinary petrolatum. When Benjamin Green, an airman and pharmacist, returned home and mixed his red vet pet with cocoa butter and coconut oil on his stove, Coppertone suntan cream was born.
The modern equation for calculating SPF: A(λ) the erythemal action spectrum, E(λ) is the solar irradiance spectrum and MPF(λ) the monochromatic protection factor, all functions of the wavelength λ. However, the original measurements of SPF were not mathematical.
To evaluate the effectiveness and performance of sunscreens, the Coppertone Solar Research Center was established in 1971 in Memphis, TN. Their scientific method involved measuring how long it took pale volunteers to obtain a sunburn, and then slathering them with sunscreen to see how much longer it took. If it took 15 minutes to get a burn without any protection, and 30 minutes with the cream, this was deemed SPF 2. SPF 40, theoretically, would mean 10 hours of protection.
How Often To Apply Sunscreen?
How quickly we burn is highly variable; moreover, the amount of UV light that reaches us depends on many factors, including cloud cover, the time of day and the reflection of UV rays off the ground or water. Swimming and sweating also dilute and remove sunscreen, so a single application, no matter how strong your SPF, is not enough. Application every two hours is recommended, and more frequently if you are swimming or exercising, even if you are using a water resistant brand.
How Much Sunscreen To Apply?
Sunscreen sun on the back under normal and UV light.
In the original tests, 2 milligrams of product were applied to each square centimeter of skin. That’s about a fourth of an 8 oz. bottle of sunscreen per application. This is more than most of us use in a single day at the beach or by the pool. So if you want the protection listed on the bottle, it’s hard to put on too much. The only way to know you’ve applied enough is if you are not burned at the end of the day. The best approach is to methodically apply an even coat of sunscreen 20 minutes before going in the sun. Missed areas will not make themselves known until know much later, after they burn. Sprays can help with even application.
Preventing Sun Damage, Wrinkles and Skin Cancer
This long haul trucker, famously featured in the New England Journal of Medicine, has unilateral dermatoheliosis, which means one sided sun damage to his skin. With the sun shining through the driver’s side window over the years, the left side of his face has received more sun exposure than the right side.
Even before you burn, your skin is accumulating damage. Direct damage occurs to your collagen and elastin fibers, making the skin more leathery, and to the skin cells’ DNA, disrupting your skin’s ability to repair itself and predisposing you to skin cancer. The result is premature wrinkles, irregular pigmentation and a greater chance of skin carcinoma and worse, melanoma.
The San Francisco Bay Area is a great place for outdoor activitie. The best protection would be avoiding the sun altogether, but that’s not realistic for most of us. Limiting the amount of sun exposure, especially midday, helps. Cover-ups, like hats and swim shirts are good. Properly applied water resistant, broad spectrum sunscreen is recommended. With proper reapplication, SPF 15 or greater is recommended for everyone, and SPF 25 or greater if you are prone to skin cancer.
Mommy Makeovers are a combination of cosmetic plastic surgery procedures that enhance, or repair, the breasts and belly. Since both areas take a hit with pregnancy, it is most commonly performed for mommies, but Mommy Makeover procedures are also performed after weight loss. Post Bariatric Surgery patients often have loose skin on their breasts, bellies and other areas, so Mommy Makeovers are performed after weight loss also.
The Mommy Makeover helps by enhancing both the breasts and the belly in a single combination plastic surgery procedure. Above, a Breast Augmentation Lift (Augmentation Mastopexy) is combined with a Tummy Tuck for the optimal result.
The Mommy Makeover is a not a specific operation, but rather a combination of breast and belly enhancement procedures. Each area is evaluated separately and we choose one from column A (breast enhancement) and one from column B (belly enhancement) and the combo plate is termed a Mommy Makeover. The ability to mix and match is what makes the procedure so powerful. The best procedures for each area are combined.
Mommy Makeover – Breast Enhancement
Breast Enhancement is half of the Mommy Makeover. In this case, a Breast Augmentation Mastopexy is performed. A Breast Implant is used to increase the breast volume, while a Breast Lift is used to raise the nipple and reshape the breast. A larger implant without a lift would not make a pretty breast. A larger implant would make larger breasts, too large for this patient’s desires. Additionally, the larger implant would push the nipple lower on the breast.
Breast Enhancement includes many options. The most common are Breast Augmentation and Breast Lifts, though for those women whose breasts do not shrink after pregnancy, Breast Reduction is also a possibility. Below is a list of Breast Enhancement procedures with links to additional information:
The gold standard of Belly Enhancement is the Tummy Tuck. It reduces loose abdominal skin, removes excess belly fat and tightens muscle laxity including rectus diastasis (muscle separation).
Belly Enhancement also includes several options. The classic Mommy Makeover is a Breast Augmentation combined with a Tummy Tuck. The Tummy Tuck (Abdominoplasty) is the work horse. Abdominoplasty can correct loose skin, lax muscle fascia and remove excess fat. It is the only procedure that addresses all three areas over the entire belly. Sometimes, a Tummy Tuck is more than is needed so “smaller” procedures, like Mini Tummy Tucks or Even Liposuction can be substituted for selected patients. Links to more information about the Tummy Tightening Procedures are provided below:
Liposuction can also be added to help with other problem areas like the love handles, muffin top, thighs, arms or chin, too.
Mommy Makeover – Putting It All Together
Choice is good, but sometimes too many choices leads to confusion. The beauty is that you don’t have to decide on your own. An Experienced Board Certified Plastic Surgeon is skilled in all your options, and can explain which procedure best accomplishes your goal. This can help you choose the best procedures, and help you know before committing, if a Mommy Makeover is right for you.
Mommy Makeover Consultations
If you are considering a combination of Cosmetic Plastic Surgery like a Mommy Makeover, call (925) 943-6353 today, and schedule a personalized and private consultation. The best breast and belly procedures will be discussed, and a specific plan created just for your body.
Natural Facial Rejuvenation depends on selecting the best techniques to correct the natural signs of aging. The Neck Lift is usually combined with the Face Lift to maintain facial harmony, as is shown in the before and after pictures shown above.
Plastic Surgeons and Facial Plastic Surgeons alike have for decades debated the benefits of opened and closed approaches for Facial Rejuvenation. Most often, open vs. closed is debated for Rhinoplasty (Cosmetic Nasal Surgery), but at the most recent American Society for Aesthetic Plastic Surgery meeting in Las Vegas, the open vs. closed debate centered around Neck Lifts.
The Annual Aesthetic Meeting attracts thousands of Cosmetic Plastic Surgeons from around the world.
The American Society for Aesthetic Plastic Surgery
The American Society for Aesthetic Plastic Surgery (ASAPS) is over 2600 Plastic Surgeons strong. Most members are from the United States and Canada, but many countries are represented. Only about one-quarter of all American Board of Plastic Surgery certified surgeons have been accepted as ASAPS members. The ASAPS is the largest plastic surgery society dedicated exclusively to the Cosmetic side of Plastic Surgery. Most members, like myself, are also members of the American Society of Plastic Surgeons (ASPS). The ASPS represents both cosmetic and reconstructive plastic surgeons and has over 8000 members. The ASPS represents about 94% of all Board Certified Plastic Surgeons in the United States.
The Las Vegas Plastic Surgery Debates
The nice thing about a society dedicated to just the aesthetic aspects of plastic surgery is that we can focus on Cosmetic Surgery. There are many scientific sessions, expert panels and instructional courses offered over the week long meeting, each dedicated to a specific aspect of what Plastic Surgeons do. Every procedure is covered, often with multiple sessions exploring every aspect of every technique. Since there is often more than one way to do each procedure, lively debates are common, and some of these debates have been going on since long before I started my San Francisco Bay Area Plastic Surgery practice.
The Neck Debate – Open Vs. Closed
One such on going debate explores the various approaches to Neck Rejuvenation. Neck Lifts seem easy enough, but they are one of the more challenging areas to correct. Just about everyone over 40 has tried lifting their neck at least once or twice in the mirror, but making the change long lasting, without distortion, is the challenge. Several Neck Lift techniques exists, but they are usually divided into two main groupings – Closed Neck Lifts and Open Neck Lifts.
Closed Neck Lifts
There is a tremendous amount of crossover between Neck Lifts and Face Lifts, and since the face and neck age together, the Neck Lift and Face Lift are usually combined to maintain facial proportions and harmony. The term Rhytidectomy (literally wrinkle removal) is used for Neck Lifts, Face Lifts and even Brow Lifts.
When the neck has loose skin without platysmal bands, a Closed Neck Lift may be the best option. If disproportionate fat is present, Liposuction can be used to sculpt an even smoother contour.
Closed Neck Lifts are similar to what we do in the mirror. The skin is tightened in the direction of the jaw line, and the excess is removed to hold the smoothed skin in place. This reduces the loose skin under the chin (the waddle or turkey gobbler), reduces jowls and better defines the junction between the face and neck. For closed neck lifts, the skin is opened around the ears like for a Facelift, but the neck is left closed.
Open Neck Lifts
The platysma is a flat muscle that supports the neck skin. Often it is separated in the midline. As we age, we see this separation as Platysmal Bands, the two cords running down the front of the neck. One goal of the Neck Lift is to diminish to appearance of these bands.
Open Neck Lifts do everything a closed neck lift does, but also include an incision under the chin. The opening allows for direct adjustment of the superficial fat and muscles under the chin and down the front of the neck. When platysmal bands are present, the two cords of skin that run from under the chin down the front of the neck, they can be “repaired” through an open technique. Excess fat can also be removed, and we Plastic Surgeons debate how much and from which levels fat removal is most effective, yet still safe and predictable.
Minimally Open Neck Lifts
I add a third class of Neck Lift to my treatment algorithm: the Open-But-Just-A-Little-Bit Neck Lift. This is a combination of a Closed Neck Lift with Liposuction of the neck. It can accomplish much of the fat removal of the open technique through a much smaller incision. When disproportionate fat is present beneath the chin, Liposuction can be a useful adjunct to tightening up the skin. In this case a small incision is made under the chin to allow the fat to be suctioned, but not big enough to look through or repair the platysma muscle.
Most Plastic Surgeons Use Multiple Approaches
In our yearly ASAPS debates, Plastic Surgeons choose techniques and debate the pros and cons, but in reality most of us use multiple techniques. The choice depends on what our patients need. This month I have used techniques from all three categories of Neck Lifts listed above. I choose different techniques for different patients depending on what is broken, and what I have to fix.
How To Choose The Best Neck Lift For Your Neck
If you are considering a Neck Lift, it is helpful to have an idea of what your options are. Some problems respond better to specific techniques. If loose skin is the main problem, a closed technique may be the best. Platysmal bands may respond better to an open technique, while disproportionate fat may respond to liposuction.
The Internet provides lots of information, but trying to choose your own technique is a bit like trying to pick the wrench your plumber is going to use. Get a working knowledge of what is possible and get the help of a professional. Choosing the best Board Certified Plastic Surgeon is much more important than choosing the best technique. Getting multiple opinions can help, but you will likely learn that multiple approaches are possible. Having multiple choices can be a source of confusion, and this is why you need the best Plastic Surgeon.
Neck Lift Consultation
If you are in the greater San Francisco Bay Area, and would like to come into my Walnut Creek, CA, office for a Neck Lift evaluation, give me a call at (925) 943-6353. During your private consultation we will review your expectations and explore your options, so that the best Neck Lift for you can be selected.
When a patient asks me, “Do you think I need a Breast Lift or could I obtain good results with just large Breast Implants?”, I know I have some explaining to do. It’s a common misconception that larger breast implants can lift the breasts. The reality is that Breast Augmentation and Mastopexy (Breast Lift) are two completely different, but complementary procedures.
How To Evaluate Your Breast Enhancement
Optimal Breast Enhancement pays attention to both the size and the shape of the breasts. Above Breast Augmentation with Breast Implants is performed to enhance the size of the breasts and even out the asymmetry (the uncensored before and after pictures are below under “What Is Breast Pseudoptosis?”.
I separate Breast Enhancement into two areas for optimization: the best size and the best shape. Breast Implants are the safest and most predictable means we have to significantly increase breast size, but they do not lift the breasts, ever. Breast Lifts can change the shape of the breast, but they do not change the size of the breasts. Let’s go over each procedure separately, and then talk about the combination of Mastopexy Augmentation.
Breast Augmentation With Breast Implants
Choosing the best size for your breasts is the most subjective, and challenging, aspect of Breast Augmentation. I could spend an entire blog post on How To Chose the Best Breast Implant Size. Clicking on the link under Categories: Breast Implant Options gives you a quick series of San Francisco Plastic Surgery Blog posts that go over the most common options available for Breast Augmentation. The best advice I can give you is to do your homework. Stuff your bra. Try on different clothes. Look at pictures. Review online before and after photos. Whatever it takes for you to know what size is right, do it.
The Ideal Breast Size
Once you have your Ideal Breast Size in mind, you need to explain it to your chosen Board Certified Plastic Surgeon. If you desire smaller breasts, Breast Reduction Surgery is used. Because the volume of the breast is reduced during the Reduction Mammoplasty operation, the breast naturally deflates. A Breast Lift is incorporated into the Breast Reduction to enhance the shape.
Breast Implants enlarge the shape you already have. The Breast Augmentation before and after pictures above show Breast Augmentation without a Breast Lift.
If you desire larger breasts, Breast Augmentation is safest and most predictable option. Breast Implants provide the appropriate boost in volume to enhance your breasts. If you already have a pretty shape, Breast Augmentation is all that is required. Breast Implants provide a proportionate increase in breast dimensions.
The Ideal Breast Shape
When the breast volume is good, but the breast needs a lift, Breast Lifts can help. The Breast Lift (Mastopexy) before and after pictures above show how the breast can be reshaped without adding volume.
The Ideal Breast Shape is independent of size. The ideal breast has the nipple at the front of the breast; the nipple is located on the most forward projecting part of the breast (or slightly higher), and most of the breast tissue is located above the inframammary fold (IMF). The IMF is the junction between the bottom of the breast and the chest wall. When the nipple is located below the level of the IMF this is termed ptosis (true sagging).
Ptosis does not improve with Breast Implants. In fact, large breast implants increase the chance of developing ptosis due to their weight. Implants over 350 cc’s are more likely to require future surgery. Additionally, when the nipple is lower than the IMF, adding more volume to the breast tends to push the nipple down lower on the breast mound. The bigger the Breast Implant, the more weight, and the more the nipple gets pushed down. Not ideal. The best procedure in this case is a Mastopexy Augmentation, or Breast Lift with a Breast Implant.
What Is Breast Pseudoptosis?
Breast Augmentation can help with pseudoptosis and asymmetry. The breasts appear bottomed out before surgery, with most the breast volume located below the nipple and mild pseudoptosis. The Breast Augmentation before and after pictures above show how Asymmetrical Breast Augmentation can correct the shape of the breasts and the size discrepancy. In this case, the right breast was smaller than the left before surgery, so a larger Breast Implants was used on the right.
There is a specific type of Breast Deflation that can occur with weight loss, or after pregnancy, called Pseudoptosis (fake sagging) that responds well to Breast Augmentation alone. Pseudoptosis is likely the source of confusion about Breast Implants fixing sagging breasts. I review the difference between pseudoptosis and true sagging (ptosis) in the post: Do I Need A Breast Lift? (The Pencil Vs. The Pinch Test). With pseudoptosis, the nipple is above the IMF, while the breast tissue is below the IMF. Pseudoptosis is not the same as breast sagging, so it does not require a Breast Lift when Breast Augmentation is performed.
Breast Lift or Big Breast Implants?
The Breast Augmentation Mastopexy before and after pictures above show what is possible when Breast Implants are used with a Breast Lift. Correction of both size and shape is possible.
So, to answer the question, “Breast Lift or Big Breast Implants?” If you are happy with the shape of your breast, and desire a larger cup size, Breast Augmentation with a Breast Implant is likely the best option. On the other hand, if most of your breast is located below the IMF and your nipple is headed south, a Breast Lift is needed to enhance your breast’s shape. A Breast Lift can be used along with a Breast Implant (Mastopexy Augmentation) if the breast needs to be lifted, and additional volume is desired.
Breast Enhancement Consultations
Above, I have tried to simplify the decision tree for Breast Enhancement, but as more details are considered, the plan may need to be customized. If you are unhappy with your breasts’ shape, or you would like to make them a little larger, give me a call at (925) 943-6353, and make a personalized consultation appointment. We can go over all the details and formulate a plan that works best for your specific situation. Need information in Spanish? Click here: Aumento de Senos.