Posted on December 28, 2009 in Breast, Mommy Makeover / Body post baby, Post Pregnancy Breast, breast reduction
Ah. The chicken and egg dilemma. 
Many women with large breasts are overweight.
Many overweight women have large breasts.
When you are overweight insurance will tell you your breasts are large because you are fat. Lose the weight and your breasts will get smaller. This is true. Especially as you age, breasts get fattier. Even women who when younger had “breasts which did not change with weight,” will see breast size change with weight change when they are older.
So. You are overweight and have large breasts. What to do?
Back to the chicken and egg dilemma…
If you are overweight you need to work out to lose weight. If you have large breasts, it is difficult to do the aforementioned exercise to lose weight because you can’t run, do aerobics, or do anything else which is bouncy. (Who can find a bra? Must you wear two bras?) Yes, yes. It is not impossible. You can work out with less bouncy things like swimming and biking. And yes, you can lose weight by watching what you eat. But it is more difficult.
Why try to lose weight before breast reduction?
The reasons are multiple:
1. Breasts are about proportion to your body. I don’t know what size to make you if I don’t know what size your body will be.
2. A breast reduction lifts the breast. If you lose weight after your reduction you will loosen up your lift. (This is not good. It will make you droop.)
3. If I make your breasts a perfect size and you lose weight, your breasts will get smaller. Again, it is all about proportion to your body.
4. If you are healthier, you will heal better and faster. There are higher surgical risk and complication rates when overweight, especially if your BMI puts you in the obese category.
So. Get working out. Double bra it and get moving. I love breast reductions and lifts. I think they can be life (and back pain) changing surgery.
Posted on December 24, 2009 in interesting & new
Santa came early for us this year.
T’was the night before Christmas (well actually a couple of nights)
And all through the House (of Congress that is)
The doctors and patients lobbied
And the cosmetic surgery tax was doused.
I was hesitant to publish this until I confirmed it from multiple sources. Thank you to all who wrote in and called your representatives. Happy Holidays!
Posted on December 15, 2009 in Face, Skin / Nonsurgical, interesting & new, skin fillers
Volumizing isn’t just for hair anymore.
There was a big shift in plastic surgeon thinking about a decade ago.
Look at the eyelid. We used to remove fat when doing lower eyelid surgery. The thought was remove the bulge, and the eye will look youthful. But the face doesn’t work that way. As you age, you lose facial fat. (Yes yes, you gain it elsewhere where you don’t want it.) As you lose fat in your cheek, you look hollow under the eye, your lower eyelid looks longer, your cheek pad drops, you get lines around your mouth which deepen (stop! stop!) and your face skin slackens. (oy! can you stop already?)
But this is what happens. So fast forward to now- the new generation- no scar, nonsurgical, fill fill fill generation. There is validity to it. I am a surgeon. I love to do surgery. But I saw a patient yesterday who has lost weight. She also exercises more, causing a lower body fat percentage (yes, for those of you with the wee ones, there is hope for us yet to see a gym again.).
She has loose skin.
She would benefit from a facelift. Her skin is loose from age and weight changes. But as I showed her in the mirror, even when I tighten the skin, she is flat. Hollow. The “deflated beach ball.” She needs volume. So instead of rushing to surgery, I recommended she try filler first. To get the result she wants, she must correct the hollowness. She should add volume first (nonsurgical, cheaper, no scar, minimal downtime), and then reevaluate. Adding volume will buy her time, even years, before she wants to do a surgery.
What filler to use?
For first timers, immediate gratification people, and small areas, I like restalyne/perlane or juvederm. For those with higher volume needs who want a longer lasting fill, I like sculptra. Volume doesn’t have to be a overly plump fake look. As with all plastic surgery, when done elegantly and well, it looks seamless. The goal is the “How do you look so good for your age?”, not the “Oh my. did you have a fight with a helium tank?”
So. Pump up the volume. It works.
Posted on December 10, 2009 in Body, scars & scar care, tummy tuck
The belly button.
It has no use after you are born, yet we are quite obsessed about it. Are you an innie? Outie? Many of my young patients pierce it. Many of my moms have one which “winks” after being stretched by babies. Some pregnant women get a small umbilical hernia, so the innie is now an outie.
Egads! When that happens I think you need counseling.
Such a small thing. Such big issues.
Belly button shape after a tummy tuck is a tough thing. I recently fielded a question from a patient who has a slit like belly button after a tummy tuck. That can happen. If your belly button is pulled, it can look stretched.
How can you make a belly button look pretty?
When we do a full tummy tuck, you have a scar going 360 around the belly button. We doctors do all sorts of little tricks to try to tuck the belly button, get it to indent, and hide the scar. I went to a talk once on “aesthetics of the belly button” at our national plastic surgery meeting. (Yes, yes. These are the kind of talks we go to as plastic surgeons.) But belly buttons are important. The belly button shape voted “the best” by the study was slightly hooded on the top and fanned out a little on the bottom.
I try to simulate this. Most of my patients look great. I have patients who’s scars overall are fantastic- hairline, barely visible. If your belly button doesn’t look great, what happened and what can you do?
If your belly button looks too small, it contracted on itself because it is a round scar. I changed the way I inset the belly button to improve this by creating a little advancement flap into the belly button. Also you can try the marble trick to enlarge and round it out.
If your belly button formed a raised scar (keloid or hypertrophic scar) you can try scar creams, massage, silicone gel sheeting, steroid injections, and cutting it out and starting again. In general, I always try to close under little tension. Tension is bad and can lead to raised scars. Keloids though tend to happen more often along the midline. And belly buttons tend to be in the midline.
Funny belly button shape. I find women who are super skinny and have no fat around the belly button are tougher to get pretty belly buttons in because they don’t indent as much, and it is harder to hide the scar. The toughest are women with no indent anymore, where the belly button looks like a shallow saucer. These women are tough as they have blown out their belly button.
But I try. Because what point is having a beautiful flat tummy if you can’t show it off a bit?
Posted on December 2, 2009 in Face, Skin / Nonsurgical, products
Yes, that was not a typo.
I do love skiing, and clearly winter is ski season as well. But as I am a plastic surgeon and not a world famous downhill racer, I am here to tell you winter is prime time, the best time, to improve your skin. Why? Mostly because it is dark, and you aren’t out in the sun, a great thing when trying to get rid of the skin pigmentation caused by the sun.
My favorites for winter:
Retin A products. (Differin, Tazorac, Refissa, Renova) These are not over the counter- they are prescription and not baby safe (sorry for all of you Bay Area moms with the wee ones). The issue with Retin A products is they can make your skin a little red and peely. Not good for summer, but in the winter, AHA! I just tell people I went skiing and got a little windburned (though windburn is likely really a form of sunburn). What does Retin A do? It thickens your dermis (skin) and makes the collagen more organized (which is good). It is tried and true, old old technology which works. Put it on at night. Avoid the sun. If you get too peely, then lower the strength and/or do it every other night.
Peels. TCA, Blue peel. I love it. It is a controlled chemical burn which removes the top layer and a half of your skin.
(Yes, should only be done by a doctor professional. I recently fielded a question from someone who found a kit on the internet to do a home peel. eeek! Some acids are weak- like the fruit acids- so it is difficult to go deep. TCA is not a weak acid, and if you go too deep you will scar and depigment your skin. Bad.) So, back to the TCA. When you go deep enough to do anything for the fine wrinkles and pigment, your skin must resurface. Your skin looks flaky and peely- not red, bleedy, crusty- but you aren’t going to want to be seen by a lot of people as you go through it. The resurfacing process takes 7-10 days. A great lesson to your kids on why they need to put on the sunscreen in our California sun. The skin looks fresh and new after it peels, and you have months before you beat it up again with the sun (and of course, you will now be a big fan of sunscreen daily, yes?). I am a big fan of the peel, and have done it myself. Remember you need a week of downtime and avoid the sun afterwards. Again- walah! Winter is the perfect time. (NOTE: if you are dark skinned, you need to pretreat your skin prior to the peel for a month with Retin A and hydroquinone to insure your pigment will be smooth. Some of my patients get such an improvement from the products, they don’t need to do the peel).
Other good things:
B5 serum- Helps hydrate if you get dry skin.
Antioxidants :C&E. Always good, year round. Skinceutical C E Feurlic and Phloretin CF
Sunscreen: When you do go to the mountains, that windburn is really sunburn. (I know I know. I thought it was just the glow from being in the mountains skiing).
Eyecream: Winter can be drying. Elastiderm helps plump the skin up again.
Hmmm. Think that is about it.
Skin season. It’s on!
