Does Obama look 50?

I shared earlier how I felt that fifty was the new thirty. Baby boomers today are more active, vital and involved with their health and fitness than their parents were.  A great example of this is our very own president.   President Obama is making the headlines not only in the political arena, but also among those of us in the plastic surgery field.   I read an interesting article by the American Society for Aesthetic Plastic Surgery blog that talks  about how the President’s recent 50^th birthday has brought to the forefront what a fifty year old should look like.

They mention the “’holy trinity’ of aging: (1) wrinkles, age spots and other superficial changes exacerbated by too much sun and smoking; (2) loss of facial volume, which highlights under eye bags and, finally, (3) drooping of the eyelids, nose, corners of the mouth and jaw.”

If we consider this trifecta in reference to President Obama we can see that he doesn’t exactly fit the mold.    The biggest reason is the president’s race.   His skin better protects form the harmful UV rays of the sun.  It’s also not only thicker, but oilier too.  A combination that save guards against the proclivity to wrinkle of paler skin.

Also helping the President’s appearances are the balance of exercise as an avid ball player and the healthy diet provided by the presidential chefs.     You can also not discount his cool as a cucumber attitude.   A relaxed personality avoids not only frowns but age lines.     The president is a great example of how we can all feel and look better with age.  After all, remember, 50 is the new 30!

Preventing stitches from popping after surgery.

I love when patients have a lot of questions during their consultations.  I think it’s an important part of the process, and insures the best results for the patient.  A question I’m often asked by patients looking to have a tummy tuck is: In What Percentage of Tummy Tuck Cases Do MR Stitches Pop?

That’s a very good question.   Sure, some sutures may "pop" or break.   But the better question is why did one pop?   Was it poor technique? Was it deficient diet and nutrition?   Or was it a lack in patient compliance with post-operative instructions?   All things being equal, I am always concerned about this possibility.  The major control I have in prevention of this occurring is performing safe surgery techniques, giving appropriate post-operative instructions, and advising the patients to eat properly.  However, I cannot control patients who exercise or exert themselves prematurely compromising their surgical result.

At surgery, I approximate the muscles with interrupted permanent sutures rather than one long running suture.   If the one long running suture breaks then the suture has the potential to unravel.   This could effect the result of the tummy tuck.  I  believe that over time, some of these sutures may not hold as true as they did when they were originally placed.  Scar tissue grows in, among, around the placed sutures.  This increases the strength of the closure.  Certainly, this strength increases with time after the surgery.  The repair is the "weakest" in the early 2-3 weeks after the surgery.   This is one of the reasons my patients are advised to refrain from vigorous activity in the early post-operative period.

There are many tummy tucks done each year.  Few have popped sutures requiring re-operation.  As a double board certified surgeon, I take every possible precaution so that my patients don’t have a “popped” suture as part of their tummy recovery experience. 

Feel free to ask me about tummy tucks or other plastic and cosmetic surgery procedures.

Rhinoplasty : Shaping your nose

A nose job or rhinoplasty (Greek: ῥίς rhis, nose + πλάσσειν plassin, to shape), is a delicate work of art that requires clear communication of desired results and a solid pre-operative strategy to achieve the best results.  Rhinoplasty is an operation that is a sum of its parts.  The various parts of the nose need to be brought to a perfect harmony.  Should tip work be performed, then in all likelihood that the nasal dorsum needs to be recontoured to properly align with the newly created tip.   The width of the nasal bones will probably need attention as well.  Welcome to delicate balance that is Rhinoplasty!

Patients often present with large bulbous tips for rhinoplasty.   Rhinoplasty can change the shape of the nose by removing/adding structural elements.   There is some skin retraction following rhinoplasty.   After all, once a bump is taken down or a tip cartilage removed, where does the extra skin go?

Often, the patient who has a big nasal tip has thick skin.   The rhinoplasty surgery does not really address this issue.   Excess skin/tip width can often reduced by reducing the alar base width which is removing part of the nostril.

We still do not have the ability to decrease large excess and thickness of skin on the nose without causing severe changes to the nose.  There are surgeries to help but it is difficult to control scar formation and further thickening of the skin.

By changing the structure of the nose by altering its cartilaginous or bony framework will make a smaller nose, but still a thick nose.

There are patients where "most" of the work needs to be addressed at the tip.   Those patients require more tip work than others but still often need surgical refinement of their nasal dorsum, nasal bones, etc.

I have been performing Rhinoplasty for more than 20 years.  It is a procedure that you continue to learn to perform better.  If you want to learn more I invite you to leave a comment and contact my office.

Breast Enhancement that fits your Lifestyle

Breast enhancement surgeries are is one of the most sought after cosmetic surgery procedures performed today. I’d like to outline some of the various types of these procedures to help women decide which is best of them.  Ultimately, the goal is for my patients to achieve the shape, volume and size of their breasts that best matches their unique goals and physique.

Breast Implants

Breast implants are used to increase the size and fullness of a woman’s breasts. Breast implants are filled with either silicone gel or a saline solution, and can be found in variety of sizes and textures.  Each offering different aesthetic effects. Typically, implants are inserted into a pocket created beneath the breast or behind the pectoralis muscle. However, the implant may be inserted through the areola, the armpit, the belly button, or at the breast crease for better results for certain patients..

There are many benefits to breast implants.  Most notable, most women report  a greater self-confidence, and happily report that they are able to expand their wardrobes to include styles of clothing that they couldn’t wear before.

Breast Lift

Breast lift surgery (mastopexy) is used to treat breast sagging – the natural loss of elasticity, firmness and shape caused by pregnancy, nursing, excessive weight loss and aging. A breast lift typically consists of the removal of excess skin, tightening the skin and, in some cases; it is combined with breast augmentation in order to restore shape and volume.        

Breast lifts result in “perkier” breasts and a more youthful overall look. Because of this, breast lifts are a popular component of the “Mommy Makeover,” a series of cosmetic procedures that is designed to reverse the effects of childbirth and nursing.

Breast Reduction

Excessively large breasts can cause neck, back and shoulder pain, which can lead to chronic health complications. Breast reduction surgery helps correct this issue by removing fatty tissue, glandular tissue and excess skin so that your breasts better match your frame size and become smaller.          

Breast reduction helps alleviate strain on your neck and back and makes it easier to shop for clothing and exercise. Because of the long-term health benefits of breast reduction, these procedures are sometimes covered by insurance.

If you’d like to find out more and further discuss what breast enhancement procedure fits your lifestyle contact my office or leave a comment!

Fighting Acne and Aging?

At the Skin Care Center at Berman Plastic Surgery, I’m often asked if a single product can fight pimples and attempt to beat wrinkles?

There was an interesting article in a recent issue of The Wall Street Journal about products targeted at adults suffering with acne. I’m sure you have seen a number of products being marketed as having both an anti-aging benefit as helping get rid of acne.

It appears to me that the cosmetics industry realizes that they can broaden the appeal of a single product by targeting both the young and old. Resulting in an interesting dichotomy for their products:  Younger clientele get a cure for their acne, while older clients get the wrinkle prevention they desire..

The article points out that the combination skin care products can contain antibacterial, anti-acne ingredients, such as benzoyl peroxide; as well as salicylic acid, which helps clear the pores. These medicines are tried and true  — they work. Regardless of age, it is clogged pores that cause acne. Think of each acne spot is a mini-infection.

The other components of the dual-mission products are often moisturizers and clarifying cleansers.  The purpose of these is to improve the skin’s appearance, and, hopefully, slow the aging process. Retinol is the most commonly used ingredient in the form of retinoic acid (Retin-A.)

My best advice is that you read the labels, study the components, and then make an educated decision. Most importantly, you do not have to spend a fortune on these products.   More often than not, the higher cost items are paying for brand awareness and other cost accrued by the cosmetic company.  Also remember everyone’s skin is different so it’s best to discuss with you skin professional what products are best for you.

If you have any more questions about skin care, I invite you to check out the Skin Care Center at Berman Plastic Surgery.

50 is the new 30!

I read an article last week in the New York Times about the elderly population wanting and having cosmetic surgery.   In the past, more often than not, we would not perform cosmetic surgery on patients older than 70.  It is a different time now than it was 10 years ago.   I have performed cosmetic surgery on 65, 75 and 80 year olds.   I am doing a facelift this week on a 78 year old woman who is super fit!

 

Baby boomers like me are now getting into their fifties.  They are successful, sophisticated, upwardly mobile and want to continue their youthful life.   We want to age as gracefully and slowly as possible.   We are entering our 50's and we don’t feel old. We accept the maturity of aging but not the biological fact that we are older.  Coming out of our 40’s is like leaving our 20’s, and therefore turning 50 is like turning 30. We understand that we are aging, but feel more like we are entering our 30’s rather than 50’s.   

Baby boomers are more active, vital and involved with their health and fitness than their parents were.   The boomers are cycling, running marathons, taking spin classes, hiring trainers, running  triathalons, swimming, exercising like gym rats....all to keep looking young and fit.  All to turn back the clock and trying to stop father time from marching on.   Think about what my generation is eating: Whole foods, organic meats and vegetables, all believing that these are healthier and better.   How many people my age are Vegans?  Vegetarians?  Fruitarian? Pescatarians? Yes the 60's saw a break from traditional values, yet those that are now 60-70 are not as active in their 50's as those in their 50’s today;  the later baby boomers.  

So....

 

Did I ever think in a million years I would take a spinning class?   I was clearly not the only 50 year old in the class.  There were mostly women ages 25-45.  But a few men like me were in their 50’s.

See the attached photos.  Me, yes me, in a spin class(I loved it!) and a friend of mine who is 51 wearing a “30” jersey.  I think I heard him first say it…“50 is the new 30!” 

What to Ask Before Your Breast Augmentation

So, you are considering a breast augmentation.   What’s next for you now?    The most important thing is to do your research so you know what to expect and select the perfect surgeon for you.   We’d like to suggest some key questions you can ask to help you make the best decisions for the details of your operation.  Often times we clam up when we get to the doctor.   Many patients are often surprised by the choices and considerations they’re faced with when considering a breast augmentation.

Looking at your breasts the way a doctor does can be an emotional event full of new information which may be hard to process, but it is essential that you and your doctor are ‘on the same page’ regarding the type of implant and surgical approach that will be used.

Here are a few questions you should discuss and answer prior to having your breast augmentation procedure:

Saline or silicone?


The two most commonly used types of implants are: saline and silicone. Saline implants are silicone shells that are inserted empty and then filled with sterile saline after they’re placed into your breasts.

Silicone implants are inserted into the breasts in full gel form.  Most patients choose silicon implants since they definitely have a more natural feel. However, if a patient is going to have breast lift in conjunction with, silicone implants are recommended over saline.

What size implant?


This is perhaps the biggest consideration in the minds of most women. Breast size after surgery will be dependent on how big your breast  were prior to surgery and the final volume of the implant that is inserted.

Breast implant volume is measured in CC’s (30cc = 1oz). The most popular implant size is 300cc’s. To give you an idea of what 300cc’s might look like, fill a freezer bag with 10 ounces of water.  Then place that in the lower part of your bra. During your consultation, your plastic surgeon should let you try on actual implants by placing them inside your bra.  We suggest that you two different types of tops (perhaps a blouse and a tank top.) This will help you make a better decision about what the right size is for you.

High profile or low profile?


Although implant volume is very important, the shape of the implant is an equally significant consideration. Most women want to be sure their breast augmentation procedures leaves them looking proportionate. A good proportion is not only determined by the breast implant size, but also by the shape of the implant as compared to the size and shape of her chest wall and torso. The choice of moderate vs. low profile has a lot to do with your anatomical chest frame dimensions. For example, if you have a really narrow chest, the round low profile implants may have too big of a diameter for your chest wall. Therefore, you may need to consider going with the high profile shape, which has a narrower diameter but more projection(taller).

In comparing implants of the same size, a low profile breast implant has a wider, rounder base when viewed from the top. A high profile implant has a smaller base. Therefore, when viewed from the side, the high profile implant has more projection. The high profile gives more projection and more fullness near the top. The choice of implant will also affect the resulting cleavage from the procedure.  These days more women tend to prefer the high profile implants.

Textured or smooth implants?


Some implants have a textured surface while others have a smooth surface. A smooth implant is softer and able to move more freely than a textured implant. The past ten years have send trend favoring smooth implants.

Under or over the muscle?


Breast implants can be placed over the muscle or under the muscle. Below the muscle, as it is commonly referred to, is actually a partial insertion of the top part of the implant under the pectoralis major muscle. The most common medical recommendation is under the muscle because it gives the most natural look and the best long term result. There is however a downside, which is that your recovery may be a couple of days longer since the procedure is more involved to get the implant placed under the muscle

If your surgeon suggests ‘over the muscle’ be sure that he has a very good reason for that choice, as inevitably the result does not hold up well over time. Knowing the location of your implants is important to understanding exactly what the plastic surgeon has planned.

 

Where to have the incision?


Most patients with a preference have based their opinion on the experience of someone they know having had that type of incision and the way that looks. There are several types of breast augmentation incisions used by plastic surgeons including the inframammary incision, the circumareolar incision, the axillary incision and even the TUBA incision. The truth is every type of incision has its pros and cons.  There is not one best incision for all breast augmentations. Every case is individualized based on the patient’s specific choices and objectives.

With or without a breast lift?


If you have sagging breasts and a loss of fullness in the top portion of your breasts, you may benefit from having a breast lift in conjunction with your breast augmentation. Often, with age and particularly after pregnancy, the breast skin is stretched or the nipple begins pointing downward. For those patients, who wish to achieve the fuller appearance with better cleavage, I recommend getting breast augmentation with a breast lift.

If you’re planning a breast augmentation procedure, consider these variants be sure to discuss them with your surgeon. Be sure to try implants on for size.

Implant size and profile, incision placement, and implant types are not things you want to go into blindly! It’s important that you discuss them with your board certified plastic surgeon during your initial consult so that you can get the results and look you want and deserve.