Plastic Surgery Recovery and RICE Therapy

Posted May 20, 2019 in Home, Patient Safety, Recovery

RICE = Rest Ice Compression Elevation

Over the years, I have posted more than 500 articles about a wide variety of Plastic Surgery Procedures. They are easily accessible and categorized in the side column under the “Search By Category” menu. Each post provides specific information about the procedure; however, this post is dedicated to the recovery process.

Generic Plastic Surgery Recovery

Before getting into the generic recovery rules, I provide the following disclaimer: Every procedure has specific post-operative instructions, and your plastic surgeon will provide you with post-operative instructions paired to the specific methods that they employ during your surgery. We plastic surgeons shape how we do each procedure to each patient based on our experience. I will try to provide some general guidelines. It goes without saying, but I’m going to say it: If you choose an Experienced Board Certified Plastic Surgeon because you trust them and you like the results they achieve, the best course of action is to do things their way.

RICE therapy

Surgery is a form of injury and the common acronym for treating injuries is RICE. RICE stands for:

  • Rest
  • Ice
  • Compression
  • Elevation

All of these can help ease discomfort and speed your recovery, when used appropriately.

Rest

The R in RICE stands for Rest.

The R in RICE stands for Rest.

Rest: Avoiding vigorous activity, heavy lifting and sudden movement helps prevent increased swelling and further injury. Immediately after surgery, rest prevents elevated blood pressure and post-operative bleeding. In the weeks after surgery, movement is good, but rest allows you to heal with increased comfort and a more predictable outcome.

Ice

The I in RICE stands for Ice.

The I in RICE stands for Ice.

Ice: Ice therapy is effective, especially for the first few postoperative days, and it can be continued if it feels good. I recommend using it for 15 minutes and then leaving it off for 45 minutes. Always keep a thin cloth between you and the ice to prevent frostbite. I had a patient fall asleep with ice directly on the skin and it froze causing blisters. He recovered fully, but prevention is the best medicine.

Compression

The C in RICE stands for Compression.

The C in RICE stands for Compression.

Compression: Compression garments are very important to control swelling and keep the skin smooth for many procedures. After procedures like Liposuction, the skin loses support as well as stuffing, so the garment is important for keeping the skin flat and smooth. It should be worn 24/7 for the first two weeks.

Elevation

The E in RICE stands for Elevation.

The E in RICE stands for Elevation.

Elevation: Elevation helps the surgical site drain. During the day this is easy, as our face and body are elevated. At night, laying flat will cause some increased swelling; however, sleep is very important. If you can sleep with the operated body part elevated for a few days, it helps.

Common Sense Recovery Advice

RICE therapy is based upon common sense, and it is a proven treatment. While it provides a grounded framework for comparing treatments, before starting any new therapy, it should be approved by your surgeon. Your surgeon has the most information and the greatest experience with your procedure. It is a good idea to discuss recovery during your initial consultation appointment, because while the surgery may be elective, once the procedure is performed, the recovery becomes mandatory.

If you are in the San Francisco Bay Area and want to learn more about a cosmetic plastic surgery procedure, feel free to use the contact form on this page, check out my main website: DrMele.com or call my office directly at (925) 943-6353, to schedule a personalized consultation appointment today.

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Tummy Tucks (Abdominoplasty) SF Bay Area

Posted May 13, 2019 in Butt Lifts, Home, Tummy Tuck (Abdominoplasty)

Tummy Tuck Before and After (Abdominoplasty)

The Tummy Tuck tightens loose abdominal muscles, removes excess abdominal skin and reduces abdominal fat.

Abdominoplasty is an elective plastic surgery procedure created to restore the appearance of the belly after weight loss and childbirth. Commonly known as a Tummy Tuck, the procedure is extremely effective because it uses a three-step approach to abdominal rejuvenation.

Why Won’t My Belly Flatten?

A common question my patients ask after childbirth or weight loss is, “Why won’t my belly flatten?” Unfortunately, the abdominal skin and muscles can permanently stretch during pregnancy or weight gain.

The abdomen does not always flatten after weight loss. Diet and exercise can increase abdominal muscle tone and reduce abdominal fat; however, they do not remove excess skin and cannot tighten the abdominal muscle sheath.

How Does Abdominoplasty Work?

As mentioned above, the Tummy Tuck is a three-step procedure. It optimally flattens the abdomen by:

  • Tightening the muscle fascia
  • Removing excess abdominal skin
  • Reducing excess abdominal wall fat

Here are the details.

Tightening The Abdominal Muscles

The patient above has very little excess skin and fat; however, her muscles are stretched out of shape. A Tummy Tuck was performed to tighten her abdominal wall, like an internal corset. Also, the available fat she had was used to reshape her buttocks with a Brazilian Butt Lift.

The patient above has very little excess skin and fat; however, her muscles are stretched out of shape. A Tummy Tuck was performed to tighten her abdominal wall, like an internal corset. Also, the available fat she had was used to reshape her buttocks with a Brazilian Butt Lift.

The muscles of the abdominal wall lie beneath the abdominal skin and subcutaneous fat, and superficial to the abdominal organs. With weight gain and pregnancy, the abdominal muscles get stretched out. The muscle fibers still contract and they are strengthened with exercise; however, the case around the muscles (the muscle fascia) remains distended.

As part of the Tummy Tuck, the lax fascia is tightened. It is like applying an internal corset. Since the muscle is the foundation of the abdominal wall, failure to tighten this leaves the abdomen round and poochy. Abdominoplasty is very effective for candidates who are near their ideal body weight. Unfortunately, fat around the organs cannot be removed during a Tummy Tuck, and this internal fat can interfere with the results. For some patients, weight loss is recommended before Abdominoplasty in order to obtain the optimal result.

Removing Excess Abdominal Skin

Tightening the skin removes any skin that folds over. The above Abdominoplasty Before and After Pictures show a small amount of excess skin, but as the muscle is tightened it increases. The pictures in the next section show a large amount of skin excess.

Tightening the skin removes any skin that folds over. The above Abdominoplasty Before and After Pictures show a small amount of excess skin, but as the muscle is tightened it increases. The pictures in the next section show a large amount of skin excess.

Abdominoplasty means abdomen changing, and one of the biggest changes is the removal of redundant skin. When skin is folding over, weight loss and exercise rarely fix it. Moreover, as additional fat is lost, the support for the skin is reduced, and the skin folds over even more.

Tummy Tucks remove excess skin directly via an incision below the belt line. The low placement of the scar helps keep it well hidden. The wider the skin redundancy, the wider the required incision. In cases of extreme weight loss, the redundancy may extend all the way around the body and a lower body lift is performed.

Reducing Excess Abdominal Wall Fat

My patient above has lost a lot of weight. You can see that her muscle laxity is causing the bulge in her upper abdomen, and that excess skin and fat on the lower abdomen are hiding the results of her work-outs. Her Abdominoplasty tightened skin and muscle and removed excess fat which drastically improved the appearance of her belly and her confidence.

My patient above has lost a lot of weight. You can see that her muscle laxity is causing the bulge in her upper abdomen, and that excess skin and fat on the lower abdomen are hiding the results of her work-outs. Her Abdominoplasty tightened skin and muscle and removed excess fat which drastically improved the appearance of her belly and her confidence.

The subcutaneous fat of the abdominal wall tends to be located on the lower half of the belly. This is convenient because when the skin is removed from the lower abdomen, the fat beneath it is also removed.

Fat that extends around the sides and back can also be removed in the same operation with Liposuction. Liposuction of the central abdomen, however, is often delayed a few months to protect the skin’s circulation and to maximize the fat removal.

Tummy Tuck Consultations

For the safest and most predictable Tummy Tuck results you will want an experienced, Board Certified Plastic Surgeon. In the San Francisco Bay Area call (925) 943-6353. My Walnut Creek Plastic Surgery office will schedule a convenient, private and personalized consultation appointment to review all the details of the Abdominoplasty procedure.

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Cosmetic Ear Surgery Video (Otoplasty) in the San Francisco Bay Area

Posted April 29, 2019 in Cauliflower Ear, Ear Pinning, Ear Shaping (Otoplasty), Home, Videos

Otoplasty means ear changing. It encompasses a collection of cosmetic ear procedures designed to restore or create normal anatomy. Otoplasty can also be life changing for those embarrassed by their prominent ears.

Otoplasty means ear changing. It encompasses a collection of cosmetic ear procedures designed to restore or create normal anatomy. Otoplasty can also be life changing for those embarrassed by their prominent ears.

How To Correct Prominent Ears

Ears that stick out can be a source of embarrassment. It is a problem for both children and adults, male and female. This is one reason why the Correction of Prominent Ears is among the top 20 cosmetic plastic surgery procedures performed each year. The two most popular age groups undergoing correction are young children (greater the 5-years-old) and young adults, although it is not unusual to seek Otoplasty as an adult.

If treated at birth, the ear may be able to be reshaped by external splinting. The concept is simple, but splinting needs to be started in the first weeks of life, while the ear’s cartilage is still soft. Splinting not often done, as it is hard to keep the required headgear on for the months required. Even with good compliance, sometimes it is still ineffective.

Otoplasty, ear pinning, reduces the appearance of prominent ears by bringing them closer to the head.

Otoplasty, ear pinning, reduces the appearance of prominent ears by bringing them closer to the head.

On the other hand,Otoplasty, also known as Ear Pinning, is very effective and is the most common cosmetic ear procedure performed in the U.S. In fact, 20 to 30 thousand Otoplasties are performed in the U.S. each year.

Cosmetic Ear Surgery Video (Otoplasty)

Today’s video discusses cosmetic ear surgery also known as Otoplasty. The most common reason for Otoplasty is to reduce the appearance of prominent ears, but there are other reasons for cosmetic ear surgery. Some causes are congenital, while others are acquired.

This Otoplasty Video focuses on two of the most common reasons for the procedure. The first, and most common cause, is congenital: Prominent Ears, while the second reason is acquired: Cauliflower Ears. Prominent ears respond well to reshaping of the natural cartilage with Ear Pinning. Cauliflower ears, on the other hand, require removal of scar tissue caused by trauma.

As always, the patients in the video are included to demonstrate what is possible in selected cases. While educational, this video cannot substitute for an in person consultation with an expert. If you are considering Otoplasty, be certain to seek the guidance of an experienced, Board Certified Plastic Surgeon.

What Causes Prominent Ears?

The most common reason for prominent ears is that they stop developing before forming the final fold that tucks the ears back. Without full development of this fold, the upper half of the ear sticks out from the head rather than tucking back alongside the head. Prominent ears may also be caused by an enlarged concha or a concha which is rotated forward. The concha is the hollow in the center of the ear which catches sound and guides it into the ear canal.

How Old Do I Need To Be To Have Otoplasty?

With Otoplasty, sometimes sooner is better. For children, early intervention can often reduce teasing and bullying.

With Otoplasty, sometimes sooner is better. For children, early intervention can often reduce teasing and bullying.

Otoplasty can be safely performed at age five or older, because the ear achieves 85% of its adult size by age five. It is an outpatient procedure which can be completed under local or general anesthesia. After surgery, a head dressing is required to protect the repair until it has healed sufficiently. After the dressing is removed, often a head band is required at night for the first three months to prevent recurrence.

What Causes Cauliflower Ears?

Cauliflower ear is caused by trauma. Like most medical problems, prevention or early intervention are preferable. Late treatment, as shown in the Cauliflower Ear Before and After Pictured above, can help; however, creating a beautiful ear is very difficult.

Cauliflower ear is caused by trauma. Like most medical problems, prevention or early intervention are preferable. Late treatment, as shown in the Cauliflower Ear Before and After Pictured above, can help; however, creating a beautiful ear is very difficult.

Cauliflower Ears are the result of blunt trauma. They are also known by the sports most likely to cause them: Boxer’s Ears or Wrestler’s Ears. If the ear is hit hard, but the skin is not cut, blood collects under the skin, separating it from the supporting cartilage. If not drained, the blood hardens, and the convex cauliflower shape becomes permanent, replacing the ear’s normal concavity and sometimes affecting hearing. The treatment involves surgical removal of the solid mass of scar left behind. Unfortunately, the skin and cartilage are often damaged, and the ear rarely looks completely normal after correction.

Otoplasty Consultations

If you, or your child, has a problem with the shape of the ears, a Board Certified Plastic Surgeon can usually offer a solution. Be certain to find a plastic surgeon, whom is experienced and comfortable with Otoplasty. In the San Francisco Bay Area, call (925) 943-6353 to schedule a private consultation appointment and learn more about the latest treatment options available for you.

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The Arm Lift (Video) | San Francisco Bay Area

Posted April 22, 2019 in Arm Lift (Brachioplasty), Home, Post-Bariatric Surgery (After Weight Loss), Videos

Brachioplasty removes excess skin and fat creating a tighter, smaller upper arm.

Brachioplasty removes excess skin and fat creating a tighter, smaller upper arm.

Arm Lifts and Brachioplasty

Arm Reduction is a combination of arm fat reduction and arm skin tightening. Both weight loss and liposuction reduce the fat on the upper arms, but neither tightens loose skin. Loose arm skin is a very common problem after bariatric surgery or significant weight loss and can be a source of embarrassment and discomfort for many patients. Arm Lifts or Brachioplasty improve the appearance of the arms by removing fat and tightening excess skin. The result is a slimmer upper arm which fits much better in clothing.

Arm Lift Video (Brachioplasty)

The above Arm Lift Video is from a recent segment of my Body Beautiful television show. The show airs on the San Francisco Bay Area’s News Station, KRON 4. The techniques for Brachioplasty, including scar placement and recovery are reviewed, and many examples of the procedure are illustrated with Arm Lift Before and After Photos.

What Does An Arm Lift Do?

Arm lifts allow for the reduction and tightening of the upper arm, and restore the normal arm proportions after weight loss.

Arm lifts allow for the reduction and tightening of the upper arm, and restore the normal arm proportions after weight loss.

Arm Lifts remove excess skin from the upper arm. The larger the amount of skin, the more dramatic and satisfying the result. The procedure is normally performed under anesthesia, and leaves a scar in the inner part of the arm. A special arm compression garment is worn for several weeks after the procedure to help ensure the best possible result.

Arm Lift Consultations

Arm Lifts are for people who have excessive upper arm skin and who are bothered when their arm does not stop waving when they do.

Arm Lifts are for people who have excessive upper arm skin and who are bothered when their arm does not stop waving when they do.

Arm Lifts are not the most commonly performed cosmetic plastic surgery procedures, so it is important to find an experienced, Board Certified Plastic Surgeon for your Brachioplasty. As a member of the American Society of Bariatric Plastic Surgery, I am dedicated to quality results for my post-weight loss patients. To schedule a private, informative consultation, tailored specifically to your needs, call (925) 943-6353.

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Breast Augmentation With A Breast Lift (Video) – SF Bay Area

Posted April 15, 2019 in Breast Augmentation, Breast Augmentation Lift, Breast Lift (Mastopexy), Home, Tubular Breasts, Videos

Breast Augmentation with Breast Lift (Mastopexy Augmentation) and Tummy Tuck. Breast Enlargement when the breasts are sagging and the nipples are below the inframammary fold requires a Breast Lift to achieve an aesthetic result. The Tummy Tuck further enhances the breasts' proportion by flattening the belly.

Breast Augmentation with Breast Lift (Mastopexy Augmentation) and Tummy Tuck. Breast Enlargement when the breasts are sagging and the nipples are below the inframammary fold requires a Breast Lift to achieve an aesthetic result. The Tummy Tuck further enhances the breasts’ proportion by flattening the belly.

The Components Of Breast Enhancement

Breast Enhancement surgery has two aesthetic components: size and shape. Breast size is increased with Breast Augmentation and reduced with Breast Reduction. Breast shape is adjusted with the Breast Lift. There are many options for adjusting both size and shape, and today’s video is an introduction to the most versatile of all the Cosmetic Breast Enhancement procedures, Mastopexy Augmentation — the combination of Breast Augmentation and Breast Lift procedures.

Breast Augmentation With Breast Lift Video (Mastopexy Augmentation)

This Mastopexy Augmentation Video is from my Body Beautiful television show, originally broadcast on the San Francisco Bay Area’s News Station, KRON 4. It reviews the techniques and options available for different types of Breast Augmentation With Breast Lift.

Indications For A Breast Lift With Augmentation

The majority of Breast Augmentation patients do not need a lift, but here are 5 reasons why your Plastic Surgeon may be recommended adding a Breast Lift (Mastopexy) to Breast Augmentation:

  • Breast sagging (ptosis)
  • Low set nipples
  • Tubular breast deformity
  • Breast asymmetry
  • Disproportionately large areolae

Breast Augmentation Lift – When the breasts are close to the desired size, sometimes a Breast Lift alone is all that is needed to create youthful, perky breasts. If the upper pole is empty, a small implant can be used to  enhance the shape of the breasts by adding fullness to the bust line without over exaggerating the size.

Breast Augmentation Lift – When the breasts are close to the desired size, sometimes a Breast Lift alone is all that is needed to create youthful, perky breasts. If the upper pole is empty, a small implant can be used to enhance the shape of the breasts by adding fullness to the bust line without over exaggerating the size.

Mastopexy Augmentation Consultations

When considering Cosmetic Breast Surgery, be certain to select an experienced and Board Certified Plastic Surgeon. During your Breast Enhancement Consultation, your goals for both size and shape of the breasts should be discussed. If you are happy with the shape of your breasts, and are just looking for more volume, Breast Augmentation alone is likely the procedure of choice. If your size is good, but the shape is bothersome, a Breast Lift may be the best option to achieve your desired breast aesthetic. If your goal is to both augment and rejuvenate your breasts, the combination of Mastopexy Augmentation is often recommended and may be the best choice for you.

To schedule a personal consultation appointment in the San Francisco Bay Area call (925) 943-6353.

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Mommy Makeovers After Children (Video) | SF Bay Area

Posted April 08, 2019 in Breast Augmentation, Breast Lift (Mastopexy), Breast Reduction, Home, Liposuction, Mini Tummy Tuck (Mini Abdominoplasty), Mommy Makeover, Tummy Tuck (Abdominoplasty), Videos

Mommy Makeovers include breast and belly enhancement in one surgery.

Mommy Makeovers include breast and belly enhancement in one surgery.

No matter what shape you are in before childbirth, the postpartum physique is rarely an improvement. Pregnancy can wreak havoc on a woman’s body. Cosmetic Surgery Repairs after having children are done so frequently, there’s a name for it: Mommy Makeover. Today’s video is all about the Mommy Makeover, and its many variations.

Breast Augmentation and Tummy Tuck Video (Mommy Makeover)

This Mommy Makeover Video is from my Body Beautiful television show broadcasted on the San Francisco Bay Area’s News Station, KRON 4. It reviews the techniques and options available for different types of Mommy Makeovers.

What Is A Mommy Makeover?

The Mommy Makeover has two goals: to enhance the shape of the breasts and to flatten the belly. With pregnancy, the breasts enlarge and then often shrink and collapse. Breast Augmentation and Breast Lifting are used to enlarge and lift the breasts. On the other hand, if the breast remain too large after pregnancy, a Breast Reduction can be substituted to improve breast and body proportions. The differences and options for Breast Augmentation and Breast Lifts are discussed further here: Breast Augmentation or Breast Lift?

For the belly, a Tummy Tuck is the workhorse that dramatically improves the appearance of the abdomen by tightening the abdominal muscles and skin, and by removing excess fat. When abdominal laxity is confined to the area below the belly button, a Mini Tummy Tuck may be the procedure of choice to restore a pre-baby toned belly. Lastly, if the skin and muscle tone are good, but disproportionate fat is bothersome, Liposuction alone may be the answer. The differences between the procedures are discussed here: Liposuction or Tummy Tuck?

Mommy Makeover Consultations

If you are considering a Mommy Makeover, or its component cosmetic procedures, Breast Augmentation or Tummy Tuck, be certain to consult with an experienced, Board Certified Plastic Surgeon. In the San Francisco Bay Area, call (925) 943-6353, and schedule a personal and private consultation appointment today.

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BIA-ALCL Special Announcement – April 4, 2019

Posted April 04, 2019 in Breast Augmentation, Home, Patient Safety

Special Announcement Regarding Textured Breast Implants From The ISAPS

As of tomorrow, the use of Textured Breast Implants will be restricted in France.

As of tomorrow, the use of Textured Breast Implants will be restricted in France.

From the ISAPS:

We have been informed today that the French health regulatory authorities (ANSM) have announced the following regulations regarding breast implants, and have summarized the most important information for you. You can read the full text of their announcement here.

As a precautionary step, ANSM decided on April 4, 2019, to withdraw macrotextured breast implants and polyurethane-coated breast implants from the market, as certain macrotextured implants and implants with polyurethane-coated surfaces may be a risk factor for the development of BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma). Given the rarity of the risk to exposure to BIA-ALCL, ANSM does not recommend preventive explantation for women with these implants, due to the very rare risk of serious disease. This decision will go into action on April 5, 2019. The purpose of this precautionary approach is to prohibit the sale, distribution, use, and withdrawal of this type of breast implant in the French market.

The ANSM reiterates its recommendation to use smooth breast implants as the preferred method of cosmetic or reconstructive surgery.

Since 2011, 59 cases of BIA-ALCL have been reported in France, with approximately 400,000 implants implanted annually in the country.

In addition, ANSM would like to reiterate the importance of proper information for women who wish to receive breast implants of all types. The patient and the surgeon should jointly discuss the advantages and disadvantages of the various implants available and alternative techniques in cosmetic surgery or post-breast cancer reconstruction.

An informed consent form containing the identification of the implant surface (smooth, microtextured, etc.), its limited life span, and the possible resulting need for re-intervention and medical care, must be submitted to all women prior to the placement of breast implants.

In the case of functional or physical symptoms in a woman with breast implants (such as abundant periprosthetic effusion, increased volume, pain, inflammation, mass, ulcers, or changes in general condition), particularly in the time since the postoperative phase, the diagnosis BIA-ALCL must be taken into account and ruled out by an analysis of the periprosthetic fluid (CD-30 testing, culture, cytology, and flow cytometry).

For women with breast implants and without clinical signs on the breast, the expert group recommends an annual follow-up examination of the breasts.

The International Society for Aesthetic Plastic Surgery

The International Society for Aesthetic Plastic Surgery

While ISAPS respects the decision reached by ANSM, we would like to point out that this disease BIA-ALCL is rare and, above all, easily treatable with total capsulectomy in early stages or Brentuximab in more advanced cases. Fortunately, compared to the high number of breast implants that are performed on a global scale, there are only few deaths worldwide. We are concerned about the recommendation to only use smooth implants, as we know from evidence-based data that the complication and reoperation rates are higher for smooth implants. Through this decision by ANSM, we plastic surgeons are effectively taken back to the time when there were no anatomical implants. This will affect breast reconstruction outcomes.

We believe that this is the wrong approach and less satisfactory for our patients. It is more important to inform our colleagues, family doctors and gynecologists about the early symptoms of the BIA-ALCL and how to evaluate patients. Patients must also be informed about the possible risks and symptoms of BIA-ALCL at the time of implantation. The information here should be cautious and always show the relation of an extremely rare disease.

We hope that the decision in France will remain on a case-by-case basis and that treatment options using macrotextured implants will not be taken away from our patients and us, as this would be a huge step backwards. Current opinion indicates that macrotextured implants can be safely used when appropriate precautions are taken to mitigate surface biofilm contamination, according to published data.

Image
Kind regards
Dirk Richter, MD,
ISAPS President

The response from the European Association of Societies of Aesthetic Plastic Surgery (EASAPS)

April 4 2019,

Press Release of EASAPS

ANSM (agence national de sécurité du medicament et des produits de santé) stated April 3th, 2019 that macrotextured and surface-coated polyurethane implants from different labels are prohibited in France.

EASAPS opinion is that this is an regrettable decision that is not based on scientific data.
We need evidenced-based and statistically convincing studies for proper patient information on adverse events and the rare disease of ALCL.

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2018 Plastic Surgery Statistics

Posted April 01, 2019 in Home

The ASPS 2018 Plastic Surgery Statistics were released this week, and they are trending up.

The ASPS 2018 Plastic Surgery Statistics were released this week, and they are trending up.

The American Society of Plastic Surgery has released the 2018 National Plastic Surgery Statistics. The Top 10 Cosmetic Plastic Surgery Procedures maintained their order of popularity, with the overall trend being up compared to the previous year. Below, I have listed the most popular procedures and the percentage change from the previous year.

The 2018 Top 5 Cosmetic Procedures reflect the overall upward trend.

The 2018 Top 5 Cosmetic Procedures reflect the overall upward trend.

Top 10 Cosmetic Plastic Surgery Procedures

Here are your top ten Cosmetic Surgeries for 2018:

  1. Breast Augmentation (Augmentation Mammaplasty) – 313,735 up 4% (from 2017)
  2. Liposuction (Liposculpture) – 258,558 up 5%
  3. Nose Reshaping (Rhinoplasty) – 213,780 down 2%
  4. Eyelid Surgery (Blepharoplasty) – 206,529 down 1%
  5. Tummy Tuck (Abdominoplasty ) – 130,081 up 0.25%
  6. Facelift (Rhytidectomy) – 121,531 down 3%
  7. Breast lift (Mastopexy) – 109,638 up 4%
  8. Dermabrasion – 80,697 down 4%
  9. Neck lift – 53,571 up 1%
  10. Breast Reduction (Aesthetic patients only) – 43,591 unchanged

The 2018 Top 5 Minimally Invasive Procedures also show growth.

The 2018 Top 5 Minimally Invasive Procedures also show growth.

The Biggest Gainer and Losers

The top 10 procedures have been pretty consistent through the years, but four procedures stand out for the large percentage changes when compared to last year.

The biggest losers:

  1. Pectoral Implants – 700 down 29%
  2. Buttock Implants – 946 down 28%

I am not a fan of either of these procedures, because in general, the results are not great. Moreover, with advancements in fat grafting to the buttocks, the cosmetic results for Buttocks Augmentation have improved tremendously. Unfortunately, it is still not possible to do fat grafting unless the patient has enough fat to move.

The biggest gainers:

  1. Buttock Augmentation with Fat Grafting – 24,099 up 19%
  2. Hair Transplantation – 23,658 up 18%

Both these procedures owe their rise in popularity to improvement in the technology surrounding them. Fat grafting has evolved from stuffing the buttocks to shaping the buttocks. Gentle handling of the harvested fat, and meticulous care in placing the fat have improved both results and safety. For hair transplantation, improvements in harvesting hairs and minimizing donor site scars have made the procedure more palatable for more men and women.

The 2018 Top 5 Reconstructive Surgeries

The 2018 Top 5 Reconstructive Surgeries

It’s Cosmetic But It’s Still Surgery

It’s important to remember that Cosmetic Surgery is still surgery. Popularity and trends certainly influence behavior, but as a patient, you still need to do your homework. The Internet provides a wealth of information, but the emphasis is too often quantity over quality and new over proven. While it is nice to gather generic information anonymously, Cosmetic Surgery is neither generic nor anonymous. Don’t do it on your own. If you have friends or family who have been through it, ask them. Seek professional advice from experienced, board certified plastic surgeons. The information necessary to make an informed decision should always be specific to your needs.

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Cauliflower Ear Correction

Posted March 25, 2019 in Cauliflower Ear, Ear Shaping (Otoplasty), Home

This cauliflower ear is thick. This ear has the typical appearance of a cauliflower ear. It is thick and irregular. The hematoma has filled the ear up to the rim of the helix and solidified. Plastic surgery was performed to remove the dense scar tissue, and restore the normal topography of the external ear.

This ear has the typical appearance of a cauliflower ear. It is thick and irregular. The hematoma has filled the ear up to the rim of the helix and solidified. Plastic surgery was performed to remove the dense scar tissue, and restore the normal topography of the external ear.

Cauliflower Ear Correction

Cauliflower Ear is a difficult cosmetic deformity caused by a combination of trauma and neglect. Often seen in wrestlers, it is also known as Wrestlers’ Ear. During the injury, the ear skin is pulled away from the cartilage which supports it, causing bleeding under the skin. This collection of blood, known as a hematoma, further lifts the skin off the cartilage giving the typical ballooned appearance. When left untreated, the blood hardens to rock like consistency, making treatment difficult.

The Best Treatment is Prevention

The best treatment for Cauliflower Ear is prevention. Avoiding injury is always preferable to repairing an injury. Unlike when I wrestled, protective headgear is now available. Headgear can protect the ears from injury. MMA fighters do not wear head gear, and many of them end up with cauliflower ears.

The Second Best Treatment is Early Intervention

The second best treatment for Cauliflower Ear is early surgical intervention. When an ear hematoma is treated early, the outcome is much better. Evacuating the blood from between the skin and the cartilage while it is soft, allows the skin to stick back down where is belongs. Often, a conforming bolster dressing is sewn onto the ear to enforce the approximation. Early treatment not only helps keep the ear looking normal, but also prevents the pressure of the hematoma from causing additional injury to the skin and cartilage. Early intervention for Cauliflower Ear can also be considered prevention. Draining the collection of blood while it is soft, prevents it from organizing and becoming hard. Unfortunately, my patient above, did not seek early treatment.

Delayed Treatment for Cauliflower Ear

Cauliflower ear is caused by trauma. Like most medical problems, prevention or early intervention are preferable. Late treatment, as shown in the Cauliflower Ear Before and After Pictured above, can help; however, creating an aesthetically pleasing ear after this type of trauma is very challenging.

Cauliflower ear is caused by trauma. Like most medical problems, prevention or early intervention are preferable. Late treatment, as shown in the Cauliflower Ear Before and After Pictured above, can help; however, creating an aesthetically pleasing ear after this type of trauma is very challenging.

Cauliflower Ears are difficult to restore. The process is hampered by distorted anatomy and rock hard scar, which is often calcified like bone. Staged treatment is often necessary and even though improvement is likely, complete correction is not. Delayed surgical treatment for Cauliflower Ears is much more difficult and frustrating. The organized hematoma is the consistency of cement, the skin is scarred down to it and the cartilage beneath the hematoma often disintegrates from the pressure. This is what happened in the case pictured above. Fortunately, despite the trauma, he did not suffer hearing loss. Often, the swelling fills the ear hole, obstructing the external auditory meatus (ear hole) essentially forming an ear plug. You may have noticed that the ear opening in the after photo is three times larger.

In the before pictures, the interior curves of the ear are completely obscured. The skin is super-glued down to the old hematoma, making further injury more likely. Most of the cartilage of the upper ear was dissolved by the injury, so the helical rim, the curved edge of the ear, had to be reconstructed with skin, without the benefit of normal cartilaginous support. After reconstruction, the hollow of the ear is restored. The helix is clearly defined, and the ear hole is opened to its normal dimensions. The skin covering the ear is thicker than normal due to scarring from the injury, so the subtle folds of the antihelical fold and other ear curves are muted.

Hard Of Hearing

Here, the ear hole, otherwise known as the external auditory meatus, is closed. Cauliflower ear treatment often includes opening an obstructed ear hole, in addition to restoring the normal ear hollow and curves.

Here, the ear hole, otherwise known as the external auditory meatus, is closed. Cauliflower ear treatment often includes opening an obstructed ear hole, in addition to restoring the normal ear hollow and curves.

Sometimes the cauliflower deformity is not isolated to the outer helix of the ear. There are times when the mass extends into the external auditory meatus (the ear hole). When the cauliflower ear deformity extends this far into the ear, it plugs the ear. In fact, it is like having permanent ear plugs. In the above case, scar tissue was removed from inside the external auditory meatus. The changes above are most noticeable at the helical rim and above the ear lobe, with the restoration of the intertragal notch.

Cauliflower Ear Treatment

If you or someone you know has a Cauliflower Ear Deformity, call (925) 943-6353 and schedule a private consultation appointment. The pros and cons of Cauliflower Ear Correction will be thoroughly discussed and a treatment plan developed based on your specific needs.

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Otoplasty (Ear Pinning) for Prominent Ears

Posted March 18, 2019 in Ear Pinning, Ear Shaping (Otoplasty), Home

Otoplasty, ear pinning, reduces the appearance of prominent ears by bringing them closer to the head.

Otoplasty, ear pinning, reduces the appearance of prominent ears by bringing them closer to the head.

Prominent Ears can be a source of embarrassment for many patients; however, we are happy to offer a solution: Otoplasty. It is a common cosmetic plastic surgery procedure that literally means ear changing. By bringing the ears closer to the head, Ear Pinning lets patients enjoy shorter haircuts and/or ponytails, and can be a huge confidence builder for those that worry about their ears sticking out.

Otoplasty Scars

The primary scar for Otoplasty Surgery is in the fold behind the ear. This hidden access allows the ear to be reshaped discreetly. Even the early scars, as shown below, are only visible from behind and only if you have short hair or wear your hair up. Many of my patients with prominent ears keep their hair long to cover them. Long hair can also make recovery easier after Otoplasty, as any postoperative swelling is well hidden.

After Cosmetic Ear Surgery, you’ll have the option of cutting your hair or wearing it up, without the ears protruding. If you live in the East Bay Area, or California’s Central Valley, summers are hot. The option to confidently wear your hair off your ears is a blessing.

Otoplasty scars are hidden in the folds of the ear. The primary scar is behind the ear. The Otoplasty Before and After Photos above show early scars. Even the early scars are well hidden, and as they mature, they become even more discreet.

Otoplasty scars are hidden in the folds of the ear. The primary scar is behind the ear. The Otoplasty Before and After Photos above show early scars. Even the early scars are well hidden, and as they mature, they become even more discreet.

In the above Ear Pinning Before and After Pictures, the ear prominence is reduced in three ways. The top of the ear is folded in, the cup of the ear is reduced and the entire ear is rotated back. The actual height of the ear has not changed, though the ears appear smaller. More details about Ear Pinning can be found on my website’s Otoplasty Page.

How Young Is Too Young For Otoplasty?

Otoplasty is used to reduce the appearance of prominent ears and to improve symmetry. The earliest the procedure is performed is at five years of age.

Otoplasty is used to reduce the appearance of prominent ears and to improve symmetry. The earliest the procedure is performed is at five years of age.

I am often asked by parents, “How young is too young for Otoplasty?” Prominent Ears are usually evident at birth, and are often fixed before adulthood. The ears reach 85% of their adult size by age five, and five years of age is the earliest that Otoplasty is normally performed.

There is evidence that some ear deformities can be corrected by early molding. Headgear is worn, beginning in the first few days of life, and it needs to be worn constantly for months. As you can imagine, this can be difficult to maintain in a baby. The reason early molding works is that the mother’s estrogen crosses the placenta and circulates in the infant.

Estrogen makes cartilage more flexible. In the mother, this facilitates opening the pelvis for delivery. This also softens the cartilage in the infant’s ears. By molding the ear cartilage early, the hope is that as the estrogen levels drop, the ear’s cartilage freezes in this new and improved position. This is likely the reason why splinting later in childhood has not been successful in changing the shape of the ears.

Otoplasty Consultations

Ear pinning can be a very rewarding procedure. If you are considering Otoplasty for yourself or your child, be certain to seek the advice of an experienced, Board Certified Plastic Surgeon. Every ear is different, and several techniques have evolved to treat these differences. If you are in the San Francisco Bay Area, call (925) 943-6353, to schedule a private consultation appointment in my Walnut Creek Plastic Surgery office.

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