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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Mommy Makeovers – Breast and Belly Rejuvenation

Posted March 04, 2019 in Breast Asymmetry, Breast Augmentation, Breast Augmentation Lift, Breast Implant Revision Surgery, Breast Lift (Mastopexy), Breast Reduction, Breast Reduction (Women), Home, Liposuction, Mommy Makeover, Tummy Tuck (Abdominoplasty)

Mommy Makeovers may include Breast Augmentation, Breast Lifts or Breast Reduction combined with a Tummy Tuck, Mini Tummy Tuck or just Liposuction, depending on the areas that need improvement and the patient’s wishes.

Mommy Makeovers may include Breast Augmentation, Breast Lifts or Breast Reduction combined with a Tummy Tuck, Mini Tummy Tuck or just Liposuction, depending on the areas that need improvement and the patient’s wishes.

There is no denying that breasts and bellies take a hit with pregnancy. Fortunately, there is a solution. Mommy Makeovers rejuvenate both the breasts and the belly, to help restore your pre-pregnancy body.

Mommy Makeover Options

The term Mommy Makeover comes from the frequently requested combination of cosmetic plastic surgery procedures used to restore a woman’s body after childbirth. The most common combination is Breast Augmentation with a Tummy Tuck, but variations are available when indicated.

Mommy Makeover Breast Options

The motivation for having a Mommy Makeover is the desire to restore the breasts and belly to their pre-pregnancy shape. For breast enhancement, the best procedure depends on how the breasts have changed:

  • Smaller Breast may benefit from Breast Augmentation.
  • Larger Breast may benefit from Breast Reduction.
  • Sagging breast may benefit from a Breast Lift.
  • Changes to the nipples and areolae can also be reversed.

Mommy Makeover Before and After Pictures

This Mommy Makeover included Breast Augmentation and a Tummy Tuck, the most common combination for restoring the body after childbirth.

This Mommy Makeover included Breast Augmentation and a Tummy Tuck, the most common combination for restoring the body after childbirth.

Mommy Makeover Belly Options

Just like with the breasts, there options are available for treating the belly, depending on each patient’s needs. While the most common surgery to restore a pre-baby belly is the Tummy Tuck, sometimes a smaller operation is the better choice. Regardless of the procedure used, the best results are obtained when your weight is optimal.

Common scenarios and treatment options include:

  • Loose abdominal skin and muscle laxity are treated with a Tummy Tuck (Abdominoplasty)
  • Loose skin and muscle laxity confined to the lower abdomen may respond to a Mini Tummy Tuck.
  • If the muscle and skin are tight, but disproportionate fat is present, Liposuction might be the best solution.
  • The abdominal fat, which is removed during the Mommy Makeover, is sometimes repurposed to enhance an atrophied bootie. Fat from the abdomen can often be transplanted to the buttocks as part of a Brazilian Buttocks Lift.

This Mommy Makeover combined a Breast Augmentation Lift with a Tummy Tuck and Liposuction.

This Mommy Makeover combined a Breast Augmentation Lift with a Tummy Tuck and Liposuction.

Mommy makeover Consultations

There are many treatment options for Mommy Makeovers, so it is necessary to have an experienced professional to guide your decision making. The Internet can give you an idea of what is possible; however, there is no substitute for an in-person consultation with an experienced Board Certified Plastic Surgeon.

If you have Mommy Makeover questions, call me at (925) 943-6353, and schedule a private consultation appointment. Your options will be discussed and your questions will be answered in a manner specific to your needs.

Coming Soon to a Station Near You

Stay tuned to the Bay Area’s News Station, KRON 4. Later this month, I will be starting my television show Body Beautiful with a segment dedicated exclusively to the Mommy Makeover, and more before and after pictures will be revealed.

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BIA-ALCL Update 2019

Posted February 25, 2019 in Breast Augmentation, Home, Patient Safety

What we know about Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is evolving. We learn more as each new case is identified. Right now, there are just too few cases to know many of the specifics; however, today I will go over the data currently available.

ASPS and ASAPS summary of BIA-ALCL in 2019

ASPS and ASAPS summary of BIA-ALCL in 2019

Much of this information comes from the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS). Thanks to its members voluntarily reporting and collecting information on BIA-ALCL, these US based national plastic surgery organizations have the best database on BIA-ALCL in the world.

What is BIA-ALCL?

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon and treatable type of T-cell lymphoma that can develop around breast implants. BIA-ALCL is not a cancer of the breast tissue itself. It is not breast cancer, but it is found in the breast, around the capsule which surrounds breast implants.

When Does It Present?

The time between breast implant insertion and diagnosis of BIA-ALCL varies greatly. It ranges from 9 months to 27 years, with an average delay in presentation of 9.2 years.

Who Gets BIA-ALCL?

Cases seem to be concentrated in patients who have, or who have had textured breast implants. It seems to be related to the aggressiveness of the texturing and has occurred in patients with both silicone and saline filled breast implants.

Early diagnosis and treatment are key to curing BIA-ALCL. When in doubt; check it out.

When in doubt; check it out. Early diagnosis and treatment are key to curing BIA-ALCL.

After reviewing all available case series, case reports, and registries, BIA-ALCL is more common with textured implants. Textured implants are used less frequently than smooth implants. Textured implants are also used more often for breast reconstruction after breast cancer, because shaped implants are more desirable in this population and texturing is used to reduce breast implant rotation for shaped implants.

To date, no cases of BIA-ALCL have been verified in patients who have had exclusively smooth breast implants. However, it is not possible to exclude the appearance of BIA-ALCL in association with smooth implants at this time. The FDA reports that they are aware of smooth breast implant only cases; however, they warn that this information is “unverified” and potentially “inaccurate.”

The association of BIA‐ALCL and textured implants may be related to the increased surface area of the texturing; however, this has not yet been definitively proven. The variation in surface texturing among breast implant manufacturers may mean there are variable risks for the development of BIA-ALCL.

How Does BIA-ALCL Present?

The majority of patients present years after their initial surgery with one breast gradually increasing in size. The increased size is from fluid, serum, collecting around the breast implant. This collection of fluid is called a seroma. Seromas are normal right after surgery; however these seromas appears later and are thus called a delayed seromas. A few patients have presented with different symptoms such as a mass, skin rash, fever and night sweats, and lymphadenopathy.

How Is The Diagnosis of BIA-ALCL Made?

BIA-ALCL usually presents as increased breast size due to fluid collecting around a textured breast implant.

BIA-ALCL usually presents as increased breast size due to fluid collecting around a textured breast implant.

Diagnosis is based on analysis of the fluid in the seroma. Most commonly, ultrasound‐guided fine needle aspiration of the peri-implant fluid is assessed with immunohistochemistry for CD30-positive large anaplastic T-cell lymphocytes.

How Is BIA-ALCL Worked Up?

PET‐CT is performed following a positive diagnosis. Mammograms are not helpful for evaluating lymphoma, but are important for the evaluation of breast cancer. Often, a multidisciplinary team approach including, when required, an oncological breast surgeon and an oncologist specializing in lymphoma.

How Is BIA-ALCL Treated?

The treatment of BIA-ALCL is evolving. In most cases, cure is obtained by removal of the breast implant and the capsule surrounding it. Incomplete capsular resection has been associated with both recurrence and significantly lower survival. Rarely, patients may present with a mass and have an increased risk of requiring radiotherapy and chemotherapy. Treatment approach should follow international guidelines established by the National Comprehensive Cancer Network (NCCN) for BIA-ALCL, available at nccn.org.

Current treatment recommendation is for bilateral complete capsulectomy and implant removal, as a small number of women have had contralateral disease found incidentally; however, it cannot be stressed enough that the treatment is still evolving, and each patient must be individually evaluated. If you suspect you have BIA-ALCL, do not delay, and contact your plastic surgeon or primary medical doctor immediately.

Summary Statement On BIA-ALCL From The ASPS

I have included below a statement released by the American Society of Plastic Surgeons (ASPS) this week. It summarizes well what we currently know about BIA-ALCL. The ASPS has also published an 2019 online BIA-ALCL summary.

“Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon type of lymphoma that can develop in the scar capsule near saline or silicone breast implants. This disease is currently being investigated as to its relationship with breast implants. The family of ALCL is a rare cancer of the immune system, which can occur anywhere in the body. Based on adverse event reports, the United States Food and Drug Administration (FDA) estimates the total number of cases of BIA-ALCL to be over 450 cases.”

“It has been noted that the majority of BIA-ALCL patients have a history of a textured-surface device. An exact single-number estimate of the risk for both textured and non-textured implants is not possible with the currently available data. Lifetime risk of BIA-ALCL has been estimated at 1:1,000 to 1: 30,000 for women with textured breast implants, and BIA-ALCL risk is currently under investigation. BIA-ALCL usually involves swelling of the breast at an average of 3 to 14 years after the initial breast implant operation. Most cases were cured by removal of the implant and the capsule surrounding the implant; however, rare cases have required chemotherapy and/or radiation therapy for treatment.”

“Patients with breast implants should be followed by a surgeon over time and seek professional care for implant-related symptoms such as pain, lumps, swelling, or asymmetry. Patients should monitor their breast implants with routine breast self-exams and follow standard medical recommendations for imaging (e.g. Mammography, Ultrasound, MRI). Abnormal screening results or implant-related symptoms may result in additional expenses for tests and/or procedures to properly diagnose and treat your condition. Tests and procedures could include but may not be limited to: obtaining breast fluid or tissue for pathology and laboratory evaluation, surgery to remove the scar capsule around the breast implant, implant removal, or implant replacement.”

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Tummy Tucks in the San Francisco Bay Area (Abdominoplasty)

Posted February 18, 2019 in Home, Post-Bariatric Surgery (After Weight Loss), Tummy Tuck (Abdominoplasty)

The Tummy Tuck remains one of the most requested and among my favorite cosmetic plastic surgery procedures. It helps restore a youthful, flat, pre-baby belly, and works after weight loss, too. Unlike bariatric surgery, it is not for weight loss. Abdominoplasty is designed to tighten the abdominal wall, muscles and skin, after weight loss or pregnancy.

Tummy Tuck Before and After Pictures

Tummy Tucks work well for the post baby bump. Diet and exercise are important for recovering abdominal after pregnancy, but sometimes despite your best efforts, loose skin and abdominal wall laxity persist. Abdominoplasty tightens the muscle wall, removes fat and reduces excess skin, all to flatten the belly.

Tummy Tucks work well for the post baby bump. Diet and exercise are important for recovering abdominal tone after pregnancy, but sometimes despite your best efforts, loose skin and abdominal wall laxity persist. Abdominoplasty tightens the muscle wall, removes fat and reduces excess skin, to flatten the belly.

Tummy Tuck Results After Pregnancy

The before picture above shows the typical results after having a baby. The abdomen is stretched out and the baby bump is still present. This patient is healthy and physically fit. Her abdomen is strong and her weight is ideal, but her lower abdomen is bulging. The disproportionate abdominal fullness makes her look out of shape.

The after picture reveals all her hard work. Her Tummy Tuck gave her back a body representative of her fitness level. Her abdomen is flat and tight. Abdominoplasty eliminated the lower abdominal bulge by removing the excess skin and fat and flattened the entire abdominal wall by tightening the rectus and oblique muscles. Now, her clothes fit well. She can appreciate the results of her workouts and just feels better about herself.

Full Abdominoplasty After Weight Loss

Even after the weight loss, the abdomen may appear loose or full. This case shows what a full abdominoplasty, including muscle tightening, can do for a flaccid belly.

Even after the weight loss, the abdomen may appear loose or full. This case shows what a full abdominoplasty, including muscle tightening, can do for a flaccid belly.

Sometimes, even after massive weight loss, abdominal fullness and bulging persist. It’s frustrating. The skin, left damaged after being overstretched, is unable to recoil back to its original form fitting shape. In this case, the muscle wall was also overstretched by intra-abdominal fat caused by weight gain. This allows the abdominal content to push the entire abdominal wall forward. Ironically, the engineering term for this is “plastic deformation,” but we can reverse this appearance with Plastic Surgery. By removing excess skin and fat, and tightening the remaining skin and muscle, the flat belly is restored.

I Only Need A Mini Tummy Tuck

Sometimes a Mini Tummy Tuck is just what the doctor ordered. When the stretching and fullness is confined to the lower abdomen, a mini tummy tuck might just do the trick.

Sometimes a Mini Tummy Tuck is just what the doctor ordered. When the stretching and fullness is confined to the lower abdomen, a mini tummy tuck might just do the trick.

For some patients, the procedure of choice to restore a flat belly is a Mini Tummy Tuck. The Mini Tummy Tuck tightens the lower abdominal wall, and it is a smaller procedure than a full tummy tuck. If you cover the skin below the belly button, and are satisfied with how flat your upper abdominal wall is, a Mini Abdominoplasty might be all you need.

The patient shown above had a great looking upper abdomen before surgery, but the skin on her lower abdomen was loose and jiggled when she walked. The muscles underneath the skin were firm, but bowed outward due to excessive stretching of the lower abdominal muscles during pregnancy. A Mini Tummy Tuck was performed to remove excess skin and disproportionate fat, while tightening the muscles of the lower abdominal wall. The smaller operation provided her a great result with a quicker recovery than a full Abdominoplasty. Not everyone is a candidate for a Mini Tummy Tuck, but it never hurts to ask.

Tummy Tuck Consultations

Tummy Tucks are one of my favorite operations. The results are dramatic, predictable and very rewarding. My patients are delighted with their new and improved bellies. If you are considering a Tummy Tuck or other abdominal rejuvenation call (925) 943-6353 now and schedule a personal consultation appointment.

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Saline Breast Implants – SF Bay Area Breast Aug Surgery

Posted February 11, 2019 in Breast Augmentation, Breast Implant Revision Surgery, Home

All breast Implants create larger breasts. While Silicone Breast Implants are more widely used, Saline Breast Implants still have a role to fill.

All breast Implants create larger breasts. While Silicone Breast Implants are more widely used, Saline Breast Implants still have a role to fill.

Over 90% of today’s Breast Augmentation patients choose Silicone Gel Breast Implants, but Saline Breast Implants still play a role in selected situations. Today, I review the pros and cons of Breast Augmentation with Saline Breast Implants.

Saline Breast Implant Cost Less

Saline Breast Implants cost less than Silicone Breast Implants. Since saline breast implants are easier to manufacture, they cost less. Also, saline breast implants are not pre-filled. The saline is actually inserted during surgery by your surgeon.

Saline Breast Implant Leak Detection

Saline is water with a little salt added to make it as salty as we are, about 0.9% NaCl.

Saline is water with a little salt added to make it as salty as we are, about 0.9% NaCl.

With Saline Breast Implants, leak detection is simple. When they leak, the slightly salty water inside escapes and is quickly absorbed by the body. The result is noticeable deflation, usually occurring overnight. Unlike Silicone Breast Implants, expensive diagnostic imaging, MRI is not needed. Saline Breast Implants are also easier to replace, because only the shell needs to be removed.

Saline Breast Implant Projection

Until recently, Saline Breast Implants provided more projection than silicone breast implants. When saline implants are filled, they become firmer and have more projection. For the same volume, Saline Breast Implants have about 10% more projection. Additionally, Silicone Breast Implants are flat on the back side, while Saline Breast Implants are convex.

Saline Breast Implants are convex on the back, so they give more projection than the flat-backed Silicone Breast Implants for the same volume.

Saline Breast Implants are convex on the back, so they give more projection than the flat-backed Silicone Breast Implants for the same volume.

Saline Breast Implant Incision Size

Saline Breast Implants are inserted empty, so the surgical incision is small. They can be collapsed and then filled after they are inserted by way of a filling tube. On the other hand, Silicone Breast Implants come pre-filled, thus they are bigger and require a larger incision for placement.

Saline Breast Implant Drawbacks

Saline Breast Implants feel firmer, tend to ripple (wrinkle) more and move differently than Silicone Breast Implants. For women going up one cup size, there may be enough native breast tissue to disguise the implant. However, for those going from an A-cup to a D-cup, the implant is more palpable, even when the Breast Implant is placed behind the muscle.

Breast Augmentation Consultation

The difference between Saline and Silicone Breast Implants is just one consideration before Breast Augmentation surgery. While the Internet can provide general information, consulting with an experienced, Board Certified Plastic Surgeon will help you translate which options will work best for you.

If you are in the San Francisco Bay Area, call (925) 943-6353 today, and schedule a private Breast Augmentation Consultation.

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Chin Augmentation with Chin Implants – SF Bay Area

Posted January 21, 2019 in Chin Implants/Augmentation, Facial Augmentation, Home, Videos

A Chin Implant increases projection, provides enhanced facial balance and harmony, and is the most common method of Chin Augmentation

A Chin Implant increases projection, provides enhanced facial balance and harmony, and is the most common method of Chin Augmentation.

Chin Augmentation balances the lower face when the chin is small or weak. The most common technique for Chin Augmentation utilizes a Chin Implant placed on the front surface of the mandible (the lower jaw bone). The Chin Implant supports the soft tissue of the chin, pushing it forward. The result is improved facial harmony by balancing the upper and lower face and better defining the transition between the face and neck.

Chin Augmentation with Chin Implant Video

Chin Augmentation is most commonly used in cases where the front of the chin is located behind the front of the lips when viewed on profile. The following Chin Augmentation Video Presentation shows several examples of Chin Augmentation using Chin Implants. This is the most common procedure used to augment the chin profile, and balance the lower face when the chin is small. This Plastic Surgery Video Presentation is a segment taken from my TV show Body Beautiful, which airs on the San Francisco Bay Area’s News Station, KRON 4.

Chin Augmentation

Chin Augmentation with a Chin Implant is an effective, cosmetic surgery, which can dramatically change your facial profile. Computer imaging can facilitate communication between you and your surgeon as many options exist in the types, sizes and shapes of Chin Implants. Additionally, computer imaging can help visualize the aesthetic nature of the results. Like any surgical procedure, there are risks and benefits which should be discussed with your Board Certified Plastic Surgeon prior to surgery.

Chin Augmentation before and after pictures: Chin Implants can increase chin projection and definition. Before Chin Augmentation, her chin appears flat, is poorly defined and allows the lip and neck to blend into each other. After Chin Augmentation, the Chin Implant provides a defined chin, which clearly separates the lip from the neck. Additionally, the chin's projection now matches the lips' and balances the lower face.

Chin Augmentation before and after pictures: Chin Implants can increase chin projection and definition. Before Chin Augmentation, her chin appears flat, is poorly defined and allows the lip and neck to blend into each other. After Chin Augmentation, the Chin Implant provides a defined chin, which clearly separates the lip from the neck. Additionally, the chin’s projection now matches the lips’ and balances the lower face.

Chin Augmentation vs. Jaw Surgery

Chin Augmentation with a Chin Implant is not jaw surgery. It enhances the apparent size of the jaw, but it does not change the mandible or the way the teeth come together. The implant is applied to the front surface of the bone to provide a cosmetic result. Jaw surgery, also known as Orthognathic Surgery, involves cutting the actual jaw bone.

Sliding Genioplasty

Procedures like the Sliding Genioplasty, cut the mandible and slide the chin piece forward. Metal plates and screws are then used to hold the front of the mandible in the desired position. Since just the front of the mandible is advanced, there is no change in how the teeth come together with this surgery.

Sagittal Split

When malocclusion exists, the teeth do not come together properly. The most common treatment for this is orthodontia. While orthodontia can help one’s bite, it moves the teeth in the jaw, rather than move the jaw and the teeth. In severe cases of malocclusion, jaw surgery may be recommended.

Operations exist to move the upper and lower jaw. One such operation is the Sagittal Split Osteotomy. This corrects retrusion of the mandible, better known as a severe overbite, by moving the entire lower jaw forward. The main goal is to align the teeth, but it has the added benefit of adding projection to the lower jaw and helping with facial harmony. This is a specialized procedure, only performed for specific indications, by specially trained orthognathic surgeons, usually an oral and maxillofacial surgeon in conjunction with an orthodontist.

Cosmetic Chin Surgery

Chin Implants provide stable Chin Augmentation. In the above Chin Implant before and after pictures the patient is smiling. Even with animation, the enhanced projection is maintained and the definition of the neck line is clearly defined. In cases where there is disproportionate fat of the neck, Chin Augmentation can be combined with Neck Liposuction to further enhance your profile.

Chin Implants provide stable Chin Augmentation. In the above Chin Implant before and after pictures the patient is smiling. Even with animation, the enhanced projection is maintained and the definition of the neck line is clearly defined. In cases where there is disproportionate fat of the neck, Chin Augmentation can be combined with Neck Liposuction to further enhance your profile.

When dental occlusion is good, or has been corrected with orthodontia, and the concern is primarily the outward appearance of the chin, jaw surgery is usually not needed. This is where Chin Implants have a niche. At your consultation appointment, the best size, shape and type of chin implant is determined.

Chin augmentation surgery is performed at an accredited outpatient surgery center. During the procedure, an incision is made either inside the lower lip or under the chin for access. A pocket is made and the implant placed in front of the mandible to provide additional projection. Recovery is variable, depending on the type and size of implant, but is normally a few weeks.

Chin Augmentation Consultations

If you are considering Chin Augmentation, there is no substitute for consultation with an experienced, Board Certified Plastic Surgeon. In the San Francisco Bay Area call (925) 943-6353 today, and schedule a private appointment tailored to your specific needs. Computer imaging is available.

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Massive Gynecomastia Reductions – SF Bay Area

Posted January 14, 2019 in Areolar Reduction, Breast Asymmetry, Breast Lift (Mastopexy), Breast Reconstruction, Breast Reduction, Breast Reduction (Men), Daddy Makeover, Home, Post-Bariatric Surgery (After Weight Loss), Tummy Tuck (Abdominoplasty), Videos

Gynecomastia Reduction is one of the most frequently performed cosmetic plastic surgery procedures for men. Over the last 20 years, the number of Gynecomastia Reductions performed has increased 50% – from twenty-thousand in the year 2000 to thirty-thousand procedures last year. However, the examples I am sharing today are not your typical gynecomastia reductions.

Gynecomastia Reduction after Massive Weight Loss is a different operation than the typical gynecomastia reduction. The large amount of excess skin and extremely low nipple position require special attention to detail and appropriate treatment to achieve a great result. This patient had chest skin reduction (a male breast lift), reduction and repositioning of his nipples along with a tummy tuck to restore his physique after impressive weight loss.

Gynecomastia Reduction after Massive Weight Loss is a different operation than the typical gynecomastia reduction. The large amount of excess skin and extremely low nipple position require special attention to detail and appropriate treatment to achieve a great result. This patient had chest skin reduction (a male breast lift), reduction and repositioning of his nipples along with a tummy tuck to restore his physique after impressive weight loss.

Types of Gynecomastia Reductions

Male Breast Reduction techniques vary depending on the amount of tissue that needs to be removed. Small lumps of firm glandular tissue located beneath the nipple/areola complex (NAC) can be excised directly via a small incision around the edge of the areolae. Large reductions may also require liposuction to remove excess fat (aka pseudogynecomastia). Gynecomastia reduction associated with loose skin, or sagging nipples, is more challenging and is the topic of today’s Massive Gynecomastia Reduction Video. This situation is most commonly seen after large weight loss from either Bariatric Surgery or a change in lifestyle resulting in massive weight loss.

Massive Gynecomastia Reduction Video

The following Plastic Surgery Video Presentation shows several methods of Extreme Gynecomastia Reduction. These are common Post-Bariatric Plastic Surgery techniques, but are not the most common methods used for routine Male Breast Reduction. This segment is taken from my TV show Body Beautiful which airs on the San Francisco Bay Area’s News Station, KRON 4.

Post-Bariatric Male Chest Reduction with Tummy Tuck

The goal of Bariatric Surgery is weight loss and the health improvements that come along with it. The improvement, and sometimes the resolution, of diabetes and high blood pressure are frequently seen after weight loss.

On the other hand, massive weight loss also usually leaves behind a large amount of excess skin, and this continues to makes it difficult for patients to feel comfortable. Even with the loss of mass, redundant skin makes finding clothes that are flattering and which fit well difficult.

A massive amount of excess skin is apparent on the trunk of the patient below. His chest is deflated and overhangs laterally, and even in clothes, it looks like he has breasts. His abdominal skin excess is uncomfortable and a nuisance, especially at the belt-line.

Body Lift after massive weight loss including: chest reduction (massive gynecomastia reduction), areolar reduction, breast lift and abdominoplasty (tummy tuck). The early scars are more noticeable in the first several weeks to months after surgery, but will continue to improve and fade during the year or two after surgery.

Body Lift after massive weight loss including: chest reduction (massive gynecomastia reduction), areolar reduction, breast lift and abdominoplasty (tummy tuck). The early scars are more noticeable in the first several weeks to months after surgery, but will continue to improve and fade during the year or two after surgery.

A combination of Gynecomastia Reduction with skin excision and a Tummy Tuck was used to redefine his trunk. The scars beneath his chest are still healing and will fade with time. There is another scar running below the belt-line which allowed for the tightening of his abdominal muscles and removal of his skin laxity. When loose skin extends all the way around the waist, a Lower Body Lift is often the procedure of choice.

Gynecomastia Reduction Revision Surgery

Gynecomastia Reduction Revision Surgery is perhaps the most challenging of all Gynecomastia surgery. In the case below, the patient complained of still having breast fullness after a previous Male Breast Reduction. He had bottoming out of his chest skin resulting in the appearance of breasts in clothing. Paradoxically, he also has severe indentation of his nipples from the previous resection. This can happen when a large amount of breast tissue is removed.

The patient shown below was treated with skin excision and restoration of volume beneath his nipples to smooth his contour both in and out of clothing. Like the patient above, he has scars located beneath the breasts, but these have faded over time.

This patient had gynecomastia surgery prior to presenting to my office. Revision gynecomastia surgery was performed including restoration of volume beneath the nipples (left > right) and resection of the excess skin that remained along the lower chest. His scars have had time to heal and are less noticeable; however, individual results will vary.

This patient had gynecomastia surgery prior to presenting to my office. Revision gynecomastia surgery was performed including restoration of volume beneath the nipples (left > right) and resection of the excess skin that remained along the lower chest. His scars have had time to heal and are less noticeable; however, individual results will vary.

Gynecomastia surgery can be rewarding and build self confidence. Prior to surgery, his sunburn was confined to the open collar area of his chest. After surgery, he was confident in his appearance and went shirtless. The unfortunate result was a burn to his entire chest. He got the sunscreen lecture, but I was also happy that he finally felt comfortable in his own skin.

You have heard it before and will hear it here again on the San Francisco Plastic Surgery Blog. Use of appropriate sun protection is recommended to help prevent skin cancer and premature aging of the skin. In the postoperative period, sun protection is especially important to help prevent the scars from tanning, turning dark and becoming more noticeable.

Breast Reduction for Men Consultations

As mentioned previously, the type of Male Breast Reduction shown above is usually only necessary after massive weight loss. There are exceptions, however, and I have had to perform this surgical variation for men after hormone therapy for prostate cancer and also for a gentleman whose breast enlarged massively with CoolSculpting®. Though rare, Paradoxical Adipose Hyperplasia (PAH) after CoolSculpting® is definitely not cool.

If you count yourself among the 33% of men who continue to have Gynecomastia after puberty, and you would like to learn exactly what treatment options are available for you, call (925) 943-6353 today, to schedule a private consultation appointment. You can also submit your questions via the contact form on this page.

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Liposuction Video – SF Bay Area Plastic Surgery

Posted January 07, 2019 in Home, Liposuction, Videos

As seen in the photo above, disproportionate fat of the sides causes the muffin top, which flows over the top of jeans. Liposuction removes disproportionate fat and flattens the treated area creating a more svelte figure.

As seen in the photo above, disproportionate fat of the sides causes the muffin top, which flows over the top of jeans. Liposuction removes disproportionate fat and flattens the treated area creating a more svelte figure.

Liposuction is used to remove disproportionate fat. It is best for removing bulges caused by fat beneath otherwise firm skin. Popular areas for liposuction include the:

  • Muffin top (waist)
  • Back
  • Abdomen
  • Thighs
  • Male chest
  • Arms
  • Neck

The following Liposuction Video Presentation shows examples of Liposuction of many of the areas mentioned above. A general review of Liposuction, its indications and recovery is also provided along with several before and after pictures.

Liposuction Video Presentation

Liposuction can improve body proportions from head to almost the toes. In this video from KRON 4’s Body Beautiful, San Francisco Bay Area, Board Certified Plastic Surgeon, Dr. Joseph Mele explains and shows examples of his work. Liposuction of the abdomen, thighs, arms and back are narrated with Liposuction Before and After Pictures.

More About Liposuction

While the trunk and thighs are the most common regions for Liposuction, for properly selected patients, liposuction of the arms can provide an aesthetic benefit. When the upper arm is full, and the skin tone is good, Liposuction is used to reduce the girth of the arm, and reveal muscle definition.

Before and after pictures of arm liposuction reveal smaller arms with better muscle definition after liposculpture.

Before and after pictures of arm liposuction reveal smaller arms with better muscle definition after liposculpture.

Liposuction will not significantly shrink the skin, even when a laser or ultrasound is used. If the skin is already loose and hangs off the arm, Brachioplasty (Arm Lift Surgery) should be discussed with your Board Certified Plastic Surgeon.

Gynecomastia Reduction

Next week’s video is about Gynecomastia Reduction (male breast reduction surgery). Not simple Gynecomastia, because there are plenty of “normal” Gynecomastia Reduction Videos on my site already. Next week, I discuss massive gynecomastia, like that seen after massive weight loss. Here is a preview of a more usual case where Liposuction alone, or liposuction with direct excision of the gland, is appropriate.

Liposuction can be used for gynecomastia reduction in selected cases. If the fullness beneath the nipple is fat, liposuction alone may help. If it is glandular tissue, direct excision of the gland is needed.

Liposuction can be used for gynecomastia reduction in selected cases. If the fullness beneath the nipple is fat, liposuction alone may help. If it is glandular tissue, direct excision of the gland is needed.

When the fullness of the male chest is due to fat (pseudogynecomastia), Liposuction alone can often provide adequate reduction. When a collection of firm glandular tissue adds bulk beneath the nipple/areola complex, direct excision of the gland may be necessary. In the above case, the skin is tight, so it will shrink on its own. When the skin is loose, additional surgery is needed, and this is what I will discuss next week, so stay tuned.

Liposuction Consultations

For more information about Liposuction, be sure to visit our Liposuction Page. For personalized information, call (925) 943-6353 for a private consultation appointment. The details of the procedure, treatment options, expected recovery and your goals will be reviewed in detail.

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Breast Reduction Video – Reduction Mammoplasty SF Bay Area

Posted December 31, 2018 in Breast Reduction, Breast Reduction (Women), Home, Videos

The above Breast Reduction Before and After Side View Photos show improvement in breast shape, size and nipple position after Reduction Mammoplasty Surgery.

The above Breast Reduction Before and After Side View Photos show improvement in breast shape, size and nipple position after Reduction Mammoplasty Surgery.

Today, I am posting the latest episode of KRON 4’s Body Beautiful. This video segment continues where the last post left off, discussing Breast Reduction for Women. This new Breast Reduction Video Presentation contains:

  • Information about Reduction Mammoplasty
  • Reduction Mammoplasty Before and After Pictures
  • Descriptions of how Breast Reduction is performed
  • Several options for Breast Reduction
  • Recovery information and tips for after Reduction Mammoplasty
  • Narration of specific examples of Breast Reduction

Breast Reduction Video Presentation

You Are Not Alone

The above Breast Reduction Video is intended to provide general information about the procedure. However, there is no substitute for an in-person consultation with and experienced Board Certified Plastic Surgeon. Years of learning, practice and experience have shaped how I perform Breast Reduction. Many thousands of women have breast reduction surgery annually, but each case is different. Your plastic surgeon is here to guide you through each option and help you achieve the best possible results.

The Best Breast Reduction for You

There are several methods of Breast Reduction which may or may not apply to your specific needs. I tailor my approach to each individual patient, by choosing the option that will achieve the best result in the safest and most predictable manner.

These Breast Reduction before and after pictures demonstrate the amount of reduction and enormous lift possible with the inverted T-technique. You will notice that the breast hangs well below the level of the mole visible anterior to the crook of her elbow in the before photo, while in the after photo, the base of the breast is well above it.

These Breast Reduction before and after pictures demonstrate the amount of reduction and enormous lift possible with the inverted T-technique. You will notice that the breast hangs well below the level of the mole visible anterior to the crook of her elbow in the before photo, while in the after photo, the base of the breast is well above it.

Breast Reduction Consultation Appointments

For your Breast Reduction, you will want an experienced and well qualified Board Certified Plastic Surgeon. Members of the ASAPS (the American Society for Aesthetic Plastic Surgery) are particularly well suited for breast reduction surgery, as they are Board Certified Plastic Surgeons who specialize in Cosmetic Plastic Surgery, including all aspects of Breast Enhancement.

If you are in the greater San Francisco Bay Area and would like to schedule a personalized consultation appointment, call (925) 943-6363 today. Learn what is possible in a safe and private plastic surgery office that specializes in Cosmetic Plastic Surgery.

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Breast Reduction Mammoplasty – SF Bay Area Plastic Surgery

Posted December 17, 2018 in Breast Reduction, Breast Reduction (Women), Home, Post-Bariatric Surgery (After Weight Loss)

Breast Reduction can significantly reduce neck, back and shoulder pain.

Breast Reduction Before and After Photos: Breast Reduction can significantly reduce neck, back and shoulder pain.

Breast Reduction Surgery

Breast Reduction is one of the most rewarding plastic surgery procedures I perform. While the Reduction Mammoplasty is a procedure that often provides aesthetic improvement, it is more commonly performed to reduce the symptoms associated with large breasts.

Reasons For Breast Reduction Surgery

Each patient is different, so Breast Reduction is customized to your specific needs. The most common reasons for Reduction Mammoplasty are:

  • Breast pain
  • Neck pain
  • Back pain
  • Shoulder pain
  • Bra strap shoulder rutting
  • Recurrent rashes under the breasts
  • Inability to perform routine activities of daily living
  • Limitations on physical activity

Often, documentation of these types of symptoms is required for insurance coverage.

<strong>Reduction Mammoplasty Before and After Pictures:</strong> Breast Reduction not only helps reduce the symptoms associated with large breasts but can also increase ones fashion options.

Reduction Mammoplasty Before and After Pictures: Breast Reduction not only helps reduce the symptoms associated with large breasts but can also improve how your clothes fit. The amount of elevation is easy to measure, just look at the position of the breast with respect to elbows in the above pictures.

Will Insurance Cover My Breast Reduction?

Your insurance may cover Breast Reduction. To find out, contact your insurance company directly. You may be required to see your primary doctor for authorization, be required to lose weight, undergo weeks to months of physical therapy, see only a plastic surgeon chosen by your insurance, wait a year and other hurdles. Letters from your primary doctor, physical therapist and chiropractor can help in obtaining prior authorization. Sadly, despite the tremendous amount of relief that comes from the procedure, many insurance companies have begun excluding coverage for Reduction Mammoplasty altogether.

Breast Reduction combines reduction of the breast volume with a breast lift to reduce the torque on the back an  the neck.

Breast Reduction Before and After Photos: Breast Reduction combines reduction of the breast volume with a breast lift to reduce the torque on the back and the neck.

Breast Reduction Consultations

Breast Reduction is one of the most rewarding of all cosmetic plastic surgery procedures because it relieves suffering. You can improve your chances of a good result by seeking an experienced and Board Certified Plastic Surgeon.

To schedule a personal, private, in-person consultation call (925) 943-6353, today. The goals, procedure and expected recovery, specific to your needs, will be reviewed in detail.

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