Fire and Plastic Surgery

Posted October 22, 2017 in Home, Patient Safety

Fires have devastated wildlife and neighborhoods alike in the San Francisco North Bay Area.

Fires have devastated wildlife and neighborhoods alike in the San Francisco North Bay Area.

The recent Napa Sonoma fires make me think about my experience taking care of burn patients. Burn care was one of the most challenging aspects of my Plastic Surgery Training. I’ve treated burns at every stage, from new injuries to old scars. For most of us, burns are unsightly, but for the patient they are so much more.

I had the privilege of training in two of the best burn centers in Northern California: The University of California Davis Medical Center, Burn Center in Sacramento, California, and the Bothin Burn Center inside Saint Francis Memorial Hospital in San Francisco, California. Both these centers are accredited specifically to provide the specialized care that burn patients require.

University of California Davis Medical Center – Sacramento, CA

The University of California Davis Medical Center in Sacramento, CA. I spent many years here between Medical School, General Surgery training and research in Plastic Surgery.

The University of California Davis Medical Center in Sacramento, CA. I spent many years here between Medical School, General Surgery training and research in Plastic Surgery.

My experience at UCD was during my Medical School and General Surgery training years. This was the first time I saw the consequences of a large burn. He was a 9-year-old black boy. The story was that he had taken a bath and the water was too hot. I expected him to have a burn on his foot or hand from testing the water, but over half his body was scalded. His entire lower half was blistered an peeling, and there were multiple smaller areas of first and second degree burns on his chest and arms where the water has splashed against him. It was unclear if he had jumped into the bathtub and had trouble jumping back out, or if he had help staying in the tub. That was for CPS to sort out.

We had to worry about his injury. The ER doctor quickly taught me the Wallace rule of nines. It added up quickly: 18% for each leg, another 18% for the lower half of his torso and 1% for his genitals. This boy had sustained a 55% total body surface area (TBSA) burn. Then we calculated the amount of IV fluids he needed using a modified Parkland Formula. It seemed like a lot, but the sparse volume collected in his urinary catheter told us he needed it, and more.

Meanwhile, the Plastic Surgeons started addressing his wounds. His beautiful, smooth, and youthful tan skin slid off his legs in sheets, revealing the angry pink dermis. I knew his skin would never be the same, but first he had to survive. Dressings slathered with silver sulfadiazine, a thick white paste of antibiotic, were applied to the exposed dermis. This seemed to ease his pain a little, but he still required a lot of morphine.

Burns are serious injuries. While most burn patients survive, even those with large percentage body area burns, it is not a pleasant trip. Multiple operations, weeks in the hospital and years of therapy are usually required. The pain, the smell and the change in appearance, all take a toll on both the patient and those who care for them.

Saint Francis Memorial Hospital Bothin Burn Center – San Francisco, CA

Saint Francis Memorial Hospital, located at 900 Hyde Street on Nob Hill, contains the Bothin Burn Center, a 16 bed ABA certified burn unit, which contains an operating room dedicated to burn care.

Saint Francis Memorial Hospital, located at 900 Hyde Street on Nob Hill, contains the Bothin Burn Center, a 16 bed ABA certified burn unit, which contains an operating room dedicated to burn care.

As a medical student and General Surgery Resident, my role was more resuscitative and supportive. We dealt with the arrival and stabilization of the patient, but not the healing or recovery. It was at Saint Francis Memorial Hospital, during my Plastic Surgery training, when I found out how long the healing process takes, and other hazards that patients are exposed to when burns are caused by fire rather than hot water.

The first burn patient I took care of at Saint Francis Memorial Hospital had a relatively small TBSA burn, but she had a much more dangerous injury. She was a 70-year-old woman rescued by SFFD from a burning building, I’ll call her Mary. The first problem I encountered was getting to the hospital. The single lane of my one-way street was full of cars which were not moving. I left my car on the sidewalk in front of my apartment, to see what the problem was. It turned out that the burning building, the one my patient was rescued from, was on my block.

I introduced myself to one of the firemen, the one with the biggest shield on his helmet, as he seemed to be in charge. I told him I was the Plastic Surgery Fellow at the Bothin Burn unit and that I needed to get to the hospital, preferably, before the patient. I asked if traffic was likely to be diverted, or if I should start walking and find a cab down on Columbus. He looked a little surprised, spoke a few words into his 2-way radio and said, “We’ll get you there doc.” The road was cleared by diverting traffic down Romolo, a road too steep to walk, never mind drive.

I arrived in the ED just before Mary. She had minor burns on her hands and arms, and was having trouble breathing. The biggest hazard of being in a structure fire is not being burned, it is not being able to breath. Fires consume oxygen and produce carbon monoxide (CO), hot gases and noxious fumes. None of which are good for breathing. Her CO levels were high. An oxygen mask was applied to Mary’s face to try and displace the CO from her red blood cells. Bronchoscopy revealed char in her airway all the way down into her lungs, a clear sign of airway injury from breathing in hot gasses. She was intubated and placed on a ventilator to prevent her airway from swelling shut. She was able to breath on her own, off the ventilator in a week. Her burns were superficial and healed with just dressing changes. She was lucky. Her biggest problem was trying to find another apartment in San Francisco.

Most burn patients were not as lucky. All of them were memorable, but there are too many to list. A few of the more tragic stories include:

  • A trucker driving a gasoline tanker was in an accident. The officer who pulled him out of the cab, melted the soles off his police boots in the process.
  • An electrician who contacted an energized panel. The current travelled down his right arm and out his left foot.
  • A woman who passed out drunk into her fireplace.
  • Too many children who pulled the hot tea pot off the table as their family was enjoying a meal in Chinatown.
  • A young girl who was standing on the other side of the barbecue when her father decided to help the coals along with a cup of gasoline.

Plastic Surgery is not always glamorous.

Napa Sonoma Fires

As I watch the Napa Sonoma Fires, I think about the people I have taken care of with massive burns. I have several friends and families of friends who have lost their homes and everything in them over the last few days. Most left with only their wallets and the clothes on their backs. It is tragic, but they are safe. While I am sad for all those who have lost so much, I am very happy that most were able to escape unharmed.

As of this afternoon, 18 have lost their lives in this firestorm, and 65 people are still unaccounted for. My thoughts and prayers are with them, their families and the thousands of first responders doing their best to protect lives and property at great personal risk.

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Otoplasty SF Bay Area (Ear Pinning)

Posted October 09, 2017 in Ear Shaping (Otoplasty), Home, Videos

Prominent ears can be a source of embarrassment and teasing. Cosmetic Ear Surgery (Otoplasty) includes Ear Pinning to reduce the appearance of prominent ears. Many of my patients are adults who have thought about having the procedure for some time. One of the most common reactions I hear after surgery is, “I wish I had done this sooner.” Otoplasty is a one or two hour procedure that can be performed as an outpatient, and for the right patient, it can make a huge difference.

Otoplasty For Adults

These otoplasty before and after pictures show how prominent ears can be reduced. The entire ear is pinned back. In this case, the upper ear is brought in more than the lower aspect to balance the projection.

These otoplasty before and after pictures show how prominent ears can be reduced. The entire ear is pinned back. In this case, the upper ear is brought in more than the lower aspect to balance the projection.

The gentleman above waited years before having Cosmetic Ear Surgery. He had prominent ears, which are typically more prominent at the top. He also had asymmetry of his ears with differences in shape, prominence and rotation. Each area was addresses and improved with his Otoplasty, making him one happy patient.

Ear Pinning Video

This video segment is from the San Francisco Bay Area’s News Station, KRON 4’s, Body Beautiful with Dr. Joseph Mele. The Otoplasty Video reviews the techniques, recovery and procedure of Otoplasty, and illustrates the results with Otoplasty Before and After Pictures.

Otoplasty Video (Ear Reduction)

Otoplasty For Children

There are two peaks in the age of Otoplasty patients. Young adults are the most common, but a significant number of children undergo Otoplasty also. It is one of the most common cosmetic plastic surgery procedures performed for children in my Walnut Creek Plastic Surgery Clinic, and in general. It is important to wait until at least age 5, for the ear to grow to near its adult size before proceeding.

Prominent ears are something we are born with. Ear pinning or Otoplasty is deferred until age 5, because at 5 -years-old, the ear is 85% of the adult size.

Prominent ears are something we are born with. Ear pinning, or Otoplasty, is deferred until age 5, because at 5 -years-old, the ear is 85% of the adult size.

The patient above has the advantage of long hair to cover her ears; however, her ears gave her trouble when she wanted to wear her hair up. This is a common problem for young athletes in particular. After her ear pinning, she could return to playing sports with confidence.

Otoplasty Recovery

Once healed, the ear does not require any special treatment, and recovery from surgery is just a few weeks. A head dressing is worn for the first week, and then a sweatband is worn at night for a few months, to keep the ears from folding forward while sleeping. Once the initial dressing is removed, no dressing is needed while awake.

Cosmetic Ear Pinning Consultations


If you are considering Otoplasty
for yourself or your child, be certain to consult with a Board Certified Plastic Surgeon in your area for detailed and specific advice. In the greater San Francisco Bay Area, call (925) 943-6353 and schedule a private consultation appointment, tailored to your needs.

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Gynecomastia Reduction SF Bay Area (Male Breast Reduction)

Posted October 02, 2017 in Breast Reduction, Breast Reduction (Men), Home, Liposuction, Videos

Disproportionate development of male breast tissue is called Gynecomastia. It’s also called man boobs, or moobs for short, and Gynecomastia Reduction is a cosmetic plastic surgery procedure which I perform every week.

Gynecomastia Reduction Surgery

The above Gynecomastia reduction surgery before and after photos show what is possible with a combination of liposuction and direct excision for an enlarged male chest.

The above Gynecomastia reduction surgery before and after photos show what is possible with a combination of liposuction and direct excision for a enlarged male breasts.

Asymmetry is more the rule than the exception for Gynecomastia. For the Gynecomastia Reduction patient shown above, the right breast was significantly larger than the left, both areolae where dilated and the breasts appear feminized. In fact, the feminine appearance of the breasts is what gives rise to the term Gynecomastia (feminine breasts).

Gynecomastia Correction was accomplished with a combination of liposuction to debulk the disproportionate fat and direct excision of the glandular tissue located under the nipple. The end result is a masculine chest that conforms to the pectoralis major muscles, a reduction in the size of the areolae and significant improvement in his asymmetry, all with minimal scarring. A short incision is hidden in each axilla (armpit) and around the lower border of the areolae (from 4 to 8 o’clock).

Gynecomastia Reduction Video (Male Breast Reduction)

Puffy Nipples

The start screen for the above Male Breast Reduction Video shows a man with Puffy Nipples. The enlarged and protuberant areolae are due to overdevelopment of the glandular breast tissue located directly behind the nipple. A focused surgical approach was used in this cases to remove the excess tissue and allow the nipple-areolar complex (NAC) to conform with the chest and look masculine.

The above Gynecomastia Reduction Video is from the San Francisco Bay Area’s News Station, KRON 4‘s, Body Beautiful. This segment discussed Gynecomastia Treatment and shows numerous examples of Gynecomastia Before and After Pictures to illustrate what the procedure can do for the properly selected patient, in the hands of an experienced, Board Certified Plastic Surgeon.

Global Gynecomastia

When Gynecomastia is distributed throughout the chest, more must be done. In this case, Liposuction was used to remove the bulk of the disproportionate chest tissue. If a glandular component is present beneath the nipple, this tissue also needs to be removed.

When Gynecomastia is distributed throughout the chest, more must be done. In this case Liposuction was used to remove the bulk of the disproportionate chest tissue. When a glandular component is present beneath the nipple, it is unlikely that liposuction alone will remove it, and this tissue is removed directly.

For more globally distributed Gynecomastia, Liposuction is used. Liposuction has the advantage of a long reach through a small incision. Often the 1/4 – 3/8 inch incision is hidden up in the axilla (armpit). For Pseudogynecomastia, breast enlargement due to fat and not glandular development, Liposuction alone is often enough to contour the chest. When a glandular component is also present, direct excision is also used to avoid creating a puffy nipple.

Gynecomastia Reduction Consultations

Every Gynecomastia Reduction Surgeon should be versed in multiple techniques of Gynecomastia Reduction. Depending on your situation, liposuction, direct excision of the gland, skin reduction or a combination of these may be recommended.

To find out what your options are, call (925) 943-6353 today and schedule a private, personalized consultation in our Walnut Creek Plastic Surgery office. If Gynecomastia is bothering you, learn what treatments are available from an experienced, Board Certified Plastic Surgeon.

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Breast Implant Revision SF Bay Area

Posted September 25, 2017 in Breast Asymmetry, Breast Augmentation, Breast Augmentation Lift, Breast Implant Revision Surgery, Home, Videos

Breast Augmentation with Breast Implants remains the most popular cosmetic plastic surgery. Three to four-hundred-thousand women have Breast Augmentation each year in the US alone. It is the safest and most effective means of enlarging the breasts available, but even FDA approved devices, like Breast Implants, need touch-ups from time-to-time.

Do I Need Breast Implant Revision Surgery?

The following Breast Implant Revision Surgery Video originally aired on the San Francisco Bay Area‘s news Station, KRON 4. It reviews Breast Augmentation Revision Options and describes some of the most common breast augmentation revisions. Multiple before and after pictures are included as examples.

Breast Augmentation Revision Surgery Video

Breast Implant Deflation

The introductory photo for the video above shows deflation of this patient’s left breast implant. For Saline Breast Implants, loss of the breast implant’s shell integrity results in complete deflation and loss of breast augmentation. Replacement of a deflated breast implant can be done with minimal downtime. It is also a good time to consider if your breast implants are the right size, profile or style (saline vs silicone), as there is no better time to replace both implants. In situations like the above, it is extremely helpful if you know what type and size of breast implants you have.

Breast Implant Revision – Bigger

The most common reason for Breast Augmentation Revisions is to go bigger. This is especially common after pregnancy with preexisting breast implants as shown above.

The most common reason for Breast Augmentation Revisions is to go bigger. This is especially common after pregnancy with preexisting breast implants as shown above.

The above Breast Implant Revision Before and After Pictures show two common reasons for revision. The first, and the most common, is to go larger. The second, and often seen after pregnancy with preexisting breast implants, is to correct breast tissue sagging off the breast implants.

This patient has already had a Breast Augmentation Mastopexy, also known as a breast lift, using breast implants for additional volume. The larger the preexisting breast tissue volume, the more likely the breast is to sag. This is true with or without breast implants. She desired larger breasts and a perkier appearance. A larger Breast Implant provides both additional volume and support for her breasts.

Breast Implant Revision – Smaller

The above Breast Augmentation Revision pictures demonstrate the correction of bottoming out.

The above Breast Augmentation Revision pictures demonstrate the correction of bottoming out.

Sometimes, the breast implants are too large to be supported. The before picture, in the above Breast Augmentation Revision Before and After Pictures, demonstrates what happens when breast implants are too large, even with a breast lift. Over time, the Breast Implants have over-stretched the skin of the lower breast and moved down the chest. The previous breast lift (mastopexy) scar is red and irritated, and the nipple is riding high. This patient presented with a desire for correction of the shape of her breasts, and also wanted to be smaller.

The after photo shows the results after the mastopexy was revised and the breast implants were replaced with smaller, lower profile, Breast Implants. The mastopexy scar looks less irritated. The distance between the nipples and the bottom of the breast is reduced to normal. The new breast implants are smaller, but maintain the width of the breast to preserve cleavage.

Breast Implant Revision Surgery Consultations

With the popularity of Breast Implants it is not surprising that Breast Augmentation Revision Surgery has become its own specialty. If you have breast implants which are:

  • too small
  • too large
  • too high
  • too low
  • too close together
  • too far apart
  • too hard
  • deflated or leaking
  • not supporting your breast tissue

then give my San Francisco Bay Area Plastic Surgery Clinic a call at (925) 943-6353. With 20 years of experience, I will give you up-to-date options that are personalized to your unique situation. Previous operative reports and your before and after pictures help, so bring them with you, too.

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Tummy Tuck SF Bay Area News (Abdominoplasty)

Posted September 18, 2017 in Brazilian Butt Lift, Breast Augmentation, Breast Lift (Mastopexy), Butt Lifts, Fat Grafting, Home, Liposuction, Mommy Makeover, Post-Bariatric Surgery (After Weight Loss), Tummy Tuck (Abdominoplasty), Videos

The Tummy Tuck is one of the most requested cosmetic plastic surgery procedures I perform. Whether after childbirth, or weight loss, the procedure removes excess fat and loose skin and tightens the abdominal muscles. On the most recent Body Beautiful on the San Francisco Bay Area’ News Station, KRON 4, I had the opportunity to discuss the latest in Cosmetic Plastic Surgery including Abdominoplasty.

Tummy Tuck Video (Abdominoplasty)

Abdominoplasty Video Presentation

The above Abdominoplasty Video discusses the procedure, its recovery, and I narrate the results for multiple Tummy Tuck Before and After Pictures. Examples of combining Abdominoplasty with Mommy Makeovers and Brazilian Butt Lifts are included, too. More on these next.

Tummy Tuck With Brazilian Butt Lift

Abdominoplasty can be combined with other procedures. The most common add-on is Liposuction. It is used to contour the lateral hip and lower back and reduce the undesirable the muffin top. In some cases, the fat removed with Liposuction is repurposed to augment the buttocks. Also known as the Brazilian Buttocks Lift, the procedure can create, or restore, the fullness to the buttocks and hips. An example is depicted below.

The Above Tummy Tuck before and after pictures show an example of what the combination of Tummy Tuck, Liposuction and Brazilian Buttock Lift can do. In the post operative picture on the right, the abdomen is flatter, the muffin top is missing and the buttocks are fuller and rounder.

The Above Tummy Tuck before and after pictures show an example of what the combination of Tummy Tuck, Liposuction and Brazilian Buttock Lift can do. In the post operative picture on the right, the abdomen is flatter, the muffin top is missing and the buttocks are fuller and rounder.

Abdominoplasty With Breast Augmentation Lift

Tummy Tucks can be combined with Breast Enhancement also. This class of combination cosmetic plastic surgery is termed the Mommy Makeover. The most common combination is Abdominoplasty with Breast Augmentation using Breast Implants. The Mommy Makeover Before and After Pictures shown below illustrate the combination of Breast Augmentation Lift (Periareolar) with a Tummy Tuck.

Mommy Makeovers are a class of cosmetic plastic surgery procedures that enhance both the breasts and the belly. The Mommy Makeover before and after pictures above are an example of what can be accomplished with the combination of Breast Augmentation Lift and Tummy Tuck. As with all plastic surgery, careful patient selection is very important.

Mommy Makeovers are a class of cosmetic plastic surgery procedures that enhance both the breasts and the belly. The Mommy Makeover before and after pictures above are an example of what can be accomplished with the combination of Breast Augmentation Lift and Tummy Tuck. As with all plastic surgery, careful patient selection is very important.

Tummy Tuck Consultations

If you are considering a Tummy Tuck, Brazilian Buttocks Lift or Breast Augmentation, be certain to consult a Board Certified Plastic Surgeon in your area. If you are in the San Francisco Bay Area, call (925) 943-6353 to schedule a convenient, personalized consultation appointment. My office specializes in Cosmetic Plastic Surgery and discretion. Come in and learn more.

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New Body Beautiful From Head to Tummy

Posted September 09, 2017 in Breast Augmentation, Breast Implant Revision Surgery, Breast Reduction, Breast Reduction (Men), Capsular Contracture, Ear Shaping (Otoplasty), Home, Tummy Tuck (Abdominoplasty)

Dr. Mele discusses Cosmetic Plastic Surgery on Body Beautiful - September 12, 2017, at Noon.

Dr. Mele discusses Cosmetic Plastic Surgery on Body Beautiful – September 12, 2017, at Noon.

Hey San Francisco Bay Area. Body Beautiful will be broadcast this Tuesday, September 12, at noon. You may not have noticed, but KRON 4 was acquired by Nexstar. The good news is that they have decided to continue Body Beautiful, so I’ve got new Plastic Surgery News to share with you.

Body Beautiful on KRON 4

KRON 4's Body Beautiful with Vicki Liviakis and yours truly on the San Francisco Bay Area's News Station.

KRON 4’s Body Beautiful with Vicki Liviakis and yours truly on the San Francisco Bay Area’s News Station.

I have been doing Body Beautiful live for the last 10 years. The original show was with host Vicki Liviakis, and we would take viewer calls live, on the air. It certainly added excitement. Since we were on the air live, even the “unusual” questions had to be answered.

The latest version of Body Beautiful with host Janelle Marie.

The latest version of Body Beautiful with host Janelle Marie.

Now Janelle Marie is the host, but the format remains the same. This week’s show was taped last week. Maybe KRON’s new management was a little nervous about an amateur, me, on the air live. But don’t worry, you can still submit questions for the show via email or the contact form here in the margin.

This Week’s Body Beautiful Discussion

This week’s show is dedicated to four Cosmetic Plastic Surgery Procedures:

The links above will take to more detailed information about these procedures.

Body Beautiful Airs Tuesday At Noon

Body Beautiful will be broadcast this Tuesday, September 12, at noon. Be sure to tune in or set your DVR. I you miss it, don’t worry. I will be posting the segments from the show here, and the San Francisco Plastic Surgery Blog and on my YouTube channel.

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Tummy Tucks and Previous Surgery – SF Bay Area

Posted August 26, 2017 in Home, Mommy Makeover, Post-Bariatric Surgery (After Weight Loss), Tummy Tuck (Abdominoplasty)

The Tummy Tuck remains one of the most popular Cosmetic Plastic Surgery procedures. Also called Abdominoplasty, the procedure tightens the abdominal wall and is especially useful after pregnancy or weight loss.

Tummy Tucks After Other Abdominal Surgery

The question of how preexisting abdominal surgery effects Tummy Tuck planning, execution and recovery often arrises. While most the time an Abdominoplasty can be safely performed, there are some incisions that make the procedure dangerous. Today, we will talk about how scar location may change your Tummy Tightening Procedure.

Where Is The Tummy Tuck Scar?

The above Tummy Tuck before and after pictures show where the skin is removed.

The above Tummy Tuck before and after pictures show where the skin is removed.

To understand how previous surgery effects Abdominoplasty, it is important to know the location of the removed skin and the circulation that supplies the remaining skin. As the Tummy Tuck Before and After Pictures above show, the lower abdominal skin is excised to remove the excess from the lower belly, to lift the skin above the pubic region (the FUPA) and to leave a scar which is low enough that it hides below the belt-line. The circulation that keeps the remaining skin alive travels in the superficial circulation of the skin that is located above and lateral (toward the sides). It’s the circulatory pattern of the remaining skin that really determines which, if any, of the surgeries performed prior to the Tummy Tuck are likely to cause problems.

Common Surgeries That Do Not Effect Abdominoplasty

In general, any surgery which leaves a scar within the excised skin is safe. This includes c-section, hernia and low appendectomy scars. Surgeries which leave small scars, such as laparoscopic surgery are safe.

Longer scars in the midline are also safe. Since the blood supply comes from each side independently, an incision that runs up and down the middle is unlikely to cause wound healing problems. Below is an extreme example.

The Fleur-de-Lis Tummy Tuck

The Fleur-de-Lis Tummy Tuck is an unusual Tummy Tuck that includes not only the usual low abdominal skin resection, but also removes skin from the middle of the abdominal wall to tighten side to side.

The Fleur-de-Lis Tummy Tuck is an unusual Tummy Tuck that includes not only the usual low abdominal skin resection, but also removes skin from the middle of the abdominal wall to tighten side to side.

The Fleur-de-Lis Tummy Tuck is used in cases of extreme weight loss, when the upper abdominal skin is loose from side-to-side. In the example above, my patient had a pre-existing midline scar running from the rib cage to the pubic region. Since the scar is in the middle, it is not cutting across the blood supply and is removed with the excess skin.

The previous scar was excised with the loose upper abdominal skin as evidenced by the removal of the excess skin in her underwear, as well as the excess skin located above the underwear. Her clothes fit much better after her surgery, and her mobility is improved thanks to the loss of the excess abdominal skin. The muscle, too, was tightened to further improve the cosmetic results and to provide better muscular support for her abdominal wall.

No More FUPAs

The FUPA (fat upper pubic area) is the excess fullness located above the pubic region and below the excess belly skin. If not addressed at the time of a Tummy Tuck, this excess skin can be a continued source of annoyance and embarrassment.

The FUPA (fat upper pubic area) is the excess fullness located above the pubic region and below the excess belly skin. If not addressed at the time of a Tummy Tuck, this excess skin can be a continued source of annoyance and embarrassment.

The FUPA (fat upper pubic area) can be seen in the Abdominoplasty Before and After Photos above. It is the separate skin fold / bulge seen below the redundant abdominal wall skin and above the pubic region. If a standard Tummy Tuck is performed, the FUPA remains a source of annoyance and embarrassment. These pictures were originally shown on my TV show, Body Beautiful. The before picture did not require censorship, because the FUPA covered the private area.The after picture, on the other hand, had to be covered. The scar from the Tummy Tuck can be seen extending laterally from the sides of the blacked out pubic region.

Common Surgeries That Complicate Abdominoplasty

The most common surgeries that can negatively impact the healing after a Tummy Tuck include the traditional “open” cholecystectomy (gall bladder) and pancreatic or any other upper abdominal surgery performed through a “chevron” incision.

The traditional cholecystectomy scar runs diagonally across the right upper quadrant of the abdomen, parallel to the lower edge of the rib cage. This incision cuts the blood vessels supplying the skin below the scar and can lead to problems with circulation to the sin between the scar and the Abdominoplasty scar. Problems can range from slight redness, to complete skin loss. Options are available to “delay” the skin flap, a smaller operation a few weeks before the Tummy Tuck to improve the circulation to the skin, but sometimes performing the Tummy Tuck may be too risky.

The extreme is the “chevron: incision. This scar extends across the entire upper abdomen from side-to-side, just below the ribs. A traditional Tummy Tuck is usually not advisable after this surgical approach. Instead, a reverse Abdominoplasty may be recommended. The Reverse Abdominoplasty is an abdominal wall tightening procedure which is performed across the top of the abdomen, rather than the across the bottom. In most cases, the skin cannot be tightened as well as with the traditional approach, but in select cases, the improvement is still very good.

Tummy Tuck Consultations

In most cases, previous abdominal surgery is not a contraindication for Abdominoplasty; however, you should discuss your specific situation with a Board Certified Plastic Surgeon, prior to scheduling any elective surgery. If you are in the San Francisco Bay Area call (925) 943-6353 today, to schedule a private consultation tailored to your specific needs.

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2017 Talk Award Winner – Dr. Joseph A. Mele, III, MD, FACS

Posted August 12, 2017 in About Dr. Mele, Home

For the sixth year in a row, Dr. Joseph Mele has won the Talk Award for Excellence in Patient Satisfaction.

For the sixth year in a row, Dr. Joseph Mele has won the Talk Award for Excellence in Patient Satisfaction.

The 2017 Talk Award Winner

The 2017 Talk Award Winners were announced last week, and I am humbled and honored to announce that for the sixth year in a row, my staff and I have been awarded the 2017 Talk Award for Excellence in Patient Satisfaction.

Thank you, to all my patients who have taken the time to post a positive review. After 20+ years in practice, I know how rare that is. This is especially true for Cosmetic Plastic Surgeons, like myself, who practice in Northern California, where results are more often very personal and private, than they are something to be live streamed for the world to see.

Dr. Joseph Mele, your San Francisco Bay Area patient rated, five-star, Cosmetic Plastic Surgeon.

Dr. Joseph Mele, your San Francisco Bay Area patient rated, five-star, Cosmetic Plastic Surgeon.

Talk Awards Selection Process

The Talk Award Committee gathers information from a combination of highly respected, no-cost, online user-review websites, blogs, social networks and business-rating services to measure customer satisfaction. Star ratings from the websites, the number of user reviews, scores from other business-rating services and accolades found through their research establish the basis for ratings. This annual audit provides data for a review process to evaluate and rate its findings.

Based on the results of this review and internal guidelines, the Talk Awards assign their own rating to act as a representation of the data accrued. By combining all online information into one score, consumers and businesses receive a fairer overview of customer feedback without having to spend hours locating all the information. Talk Awards takes the worry and work out of finding the top consumer-rated businesses across the country.

…And Thanks For All The Stars

Thank you for all the positive reviews. I run a very personal practice, and do not actively solicit on-line reviews. Perhaps I should, but I find that word of mouth is still alive and well. A referral from a happy patient is the best five-star review I can receive.

If you are considering Cosmetic Plastic Surgery, information on specific procedures is available on the San Francisco Plastic Surgery Blog via the search box in the “Find a Post” section either in the side column, if you are on a big screen, or lower on the page if using a smaller device. You may also search by category by using the drop down menu under “Search By Category.”

Despite the massive amount of information available on the Internet, there is no substitution for an in-person consultation with a Board Certified Plastic Surgeon. To schedule your personal and private consultation appointment, call (925) 943-6353, today.

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Breast Implant Warranties – SF Bay Area

Posted July 30, 2017 in Breast Augmentation, Breast Implant Revision Surgery, Home

If you have Breast Implants, here's some peace of mind to help you chill this summer.

If you have Breast Implants, here’s some peace of mind to help you chill this summer.

Did you know your Breast Implants come with a manufacturer’s warranty? It’s true. All FDA approved Breast Implants in the US come with a Breast Implant Warranty automatically. The details of coverage have changed throughout the years, but here are the latest details for the summer of 2017.

The Big Three Breast Implant Manufacturers

In the US, there are currently three FDA approved Breast Implant manufacturers:

  • Natrelle® (Allergan)
  • Mentor (Johnson & Johnson)
  • Sientra

Below are the latest details. These have been fairly consistent over the last two decades; however, contact your breast implant’s manufacturer directly for the latest information.

Allergan Natrelle® ConfidencePlus® Warranty

Natrelle breast implants are manufactured by Allergen.

Natrelle breast implants are manufactured by Allergan.

The following applies to Breast Augmentation using Natrelle® breast implants performed on or after November 1, 2014.

Enrollment:

  • For Natrelle® Silicone Gel Breast Implants:
    • Automatic and Free
  • For Natrelle® Saline Breast Implants:
    • Standard Warranty: Automatic and Free
    • ConfidencePlus® Premier: Enroll within 45 days and pay $200

Coverage:

  • Natrelle® Silicone Gel Breast Implant coverage:
    • Lifetime FREE breast implant replacement for rupture
    • 10-year FREE breast implant replacement for grade III or IV capsular contracture
    • 10-year up to $3500 surgery cost assistance for rupture
  • Natrelle® Saline Breast Implant coverage:
    • Standard Natrelle® Saline Breast Implant coverage:
      • Lifetime FREE breast implant replacement for rupture (deflation)
    • Premier Natrelle® Saline Breast Implant coverage:
      • Lifetime FREE breast implant replacement for rupture
      • 10-year up to $2400 surgery cost assistance for rupture

Mentor® MentorPromise Warranty

Mentor breast implants are manufactured by Johnson & Johnson.

Mentor breast implants are manufactured by Johnson & Johnson.

The following applies to Breast Augmentation using Mentor® breast implants performed on or after May 1, 2017.

Enrollment:

  • For Mentor® Silicone Gel Breast Implants:
    • Basic warranty: Automatic and Free
    • Enhanced warranty: Enroll within 45 days and pay $300
  • For Mentor ® Saline Breast Implants:
    • Basic Warranty: Automatic and Free
    • Enhanced warranty: Enroll within 45 days and pay $200

Coverage:

  • Mentor ® Silicone Gel Breast Implant coverage:
    • Basic Mentor® Silicone Gel Breast Implant coverage:
      • Lifetime FREE breast implant replacement for rupture
      • 10-year up to $3500 surgery cost assistance for rupture
    • Enhanced Mentor® Silicone Gel Breast Implant coverage:
      • Lifetime FREE breast implant replacement for rupture
      • 10-year up to $3500 surgery cost assistance for rupture, grade III or IV capsular contracture, double bubble or late seroma
  • Mentor ® Saline Breast Implant coverage:
    • Basic Mentor® Saline Breast Implant coverage:
      • Lifetime FREE breast implant replacement for rupture (deflation)
    • Enhanced Mentor® Saline Breast Implant coverage:
      • Lifetime FREE breast implant replacement for rupture
      • 10-year up to $2400 surgery cost assistance for rupture

Sientra® Warranty

Sientra manufactures only silicone breast implants for use in the US.

Sientra manufactures only silicone breast implants for use in the US.

Sientra® offers the following Breast Implant Warranty on all their breast implants.

Enrollment:

  • For Sientra ® Silicone Gel Breast Implants:
    • Sientra warranty: Automatic and Free

Coverage:

  • For Sientra ® Silicone Gel Breast Implants:
    • Lifetime FREE breast implant replacement for rupture
    • 10-year up to $3600 surgery cost assistance for rupture
    • 5-year FREE breast implant replacement for grade III or IV capsular contracture

Breast Implant Warranty Updates

Breast Implant Manufacturers are constantly updating their warranties. Be certain to check with your Board Certified Plastic Surgeon and your Breast Implant’s manufacturer for the latest details.

If you are considering Breast Augmentation or Breast Implant Revision Surgery, give my San Francisco Bay Area Plastic Surgery Clinic a call today at (925) 943-6353.

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San Francisco Breast 2.0 Enhancement (Augmentation, Lift and Reduction)

Posted July 09, 2017 in Areolar Reduction, Breast Asymmetry, Breast Augmentation, Breast Augmentation Lift, Breast Implant Options, Breast Implant Revision Surgery, Breast Lift (Mastopexy), Breast Reduction, Breast Reduction (Men), Breast Reduction (Women), Capsular Contracture, Home, Inverted Nipples, Nipple Reduction, Tubular Breasts

New Breast Enhancement Content

SanFranciscoBreast.com has been completely updated. This update includes new content, and it is artfully illustrated with new breast enhancement videos and more before and after pictures. In addition, the fresh content is wrapped in a new skin, improving navigation for the small screen and the desktop alike.

New Breast Augmentation Information

The site includes new pages featuring the most requested Breast Enhancement Procedures. For example, the Breast Augmentation Information has been exploded into a dozen detailed pages including:

  • Breast Augmentation
  • Breast Implant Options
  • Breast Augmentation Incisions
  • Breast Implant Placement
  • Today’s Breast Implants
  • History of Breast Implants
  • Breast Implant Warranties
  • Breast Implant Care
  • Breast Augmentation Lift
  • Breast Augmentation Revision
  • An Expanded Breast Augmentation Photo Gallery
  • And Hours of Breast Augmentation Videos

Breast Implant Revision Surgery

The Breast Augmentation Revision Section includes pages devoted to specific problems like:

  • Capsular Contracture
  • Breast Implant Deflation
  • Breast Implant Infection
  • Breast Implant Malposition
  • Breast Implant Removal
  • Breast Implant Rippling
  • Breast Implant Scar Revision
  • Breast Implant Replacement
  • Breast Lifts (Mastopexy)

    The Breast Lift section includes details about five main options for Mastopexy. There are also pages dedicated to the combination of Breast Lift using Breast Implants and Areola Reduction.

    Breast Reduction for Women and Men

    Options for Breast Reduction for Women are also reviewed, as several techniques have evolved during the 20+ years I have been in practice. Breast Reduction for Men, also known as Gynecomastia Reduction, is covered with attention paid to the causes and the most current treatments available.

    Specialty Breast Procedures

    A section on the often overlooked details of Breast Enhancement is also included. San Francisco Breast’s Specialty Breast Pages include:

    • Inverted Nipple Correction
    • Areola Reduction
    • Nipple Reduction
    • Tubular Breasts
    • Poland Syndrome
    • Other Congenital Breast Abnormalities
    • Areola Reconstruction
    • Nipple Reconstruction

    A Plastic Surgery Web Site Dedicated to Breast Enhancement

    I have tried to create an all inclusive Breast Enhancement site designed to provide detailed information about the many Plastic Surgery options available for Breast Enhancement, whether that be Breast Enlargement, Breast Reduction or Breast Reshaping.

    While the San Francisco Breast web site in meant to provide information, it is just a starting point. The Internet cannot take the place of a thoughtful, in-person consultation with a qualified Board Certified Plastic Surgeon. If you would like to schedule a private, personalized consultation appointment call (925) 943-6353 today. My San Francisco Bay Area Plastic Surgery clinic specializes in helping you obtain the best possible results.

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