Cosmetic Plastic Surgery - San Francisco

Q: What is Average Time for Drains to Stay in After Tummy Tuck?

2011-06-06T10:30:00.001-07:00

A: About 1 week, but depends...

Drains are placed to create a suction effect to remove additional fluid buildup underneath the skin that has been tightened. Drains are placed because we are counting on more fluid to buildup underneath the tissues than the body can absorb. They can be uncomfortable and cumbersome, but are placed for good reasons: the additional fluid that builds up can continue to build or can become infected.

I do not always use drains, but use them based upon an individual basis. I often use "advancing" absorbable tissue/flap sutures or tissue adhesives to avoid placing drains. If I do use drains, I use comfortable, round smooth drains that "slip" right out on removal with minimal discomfort.

There is definitely a lot of patient anxiety surrounding drains, but when well thought out, can be less of a burden than you might think. Sometimes it can be avoided altogether, and in the least, can be minimally burdensome. But most important, let your surgeon make the decision as to whether a drain should or should not be placed.

Q: Yoga Restrictions After Tummy Tuck?

2011-06-06T10:29:00.002-07:00

A: Getting close to full healing, but check with your surgeon first

All tissues require at least 6 weeks of healing time to reach maximal strength so that you can practice your yoga or other strenuous activities. This goes for skin, tendon, muscle, bone, etc. Sometimes, individual healing rates can vary depending on your overall health status. By 4-6 weeks, you are definitely getting close, but check with your surgeon to make sure that your abdomen and fascia have healed to the extent necessary for the additional pressures of yoga. Premature strain on your tissues can lead to complications and reoperation, which of course, you want to avoid!

Q: Who is more qualified to do my liposuction: dermatologic surgeon or plastic surgeon?

2011-06-06T10:29:00.000-07:00

A: Plastic Surgery is a 3-Dimensional Specialty

You have asked a loaded question and from your experience, you can see that there are "turf" battles in medicine and surgery. There is no doubt that your board certified plastic surgeon is more qualified to perform your liposuction. Why? Because we know how to operate on the entire human body, from the skeleton, muscle, fat, skin, and just about everything in between. Plastic surgeons can treat the human body as a 3-dimensional structure and dermatologists treat the skin in 2-dimensions. The plastic surgeon has the technical know-how and experience to build the "house" from the ground up, not just "paint" it. Most importantly, it is the plastic surgeon who will know how to "fix" your issues should there be a problem or complication.

Q: Is it Safe to Have Rhinoplasty in India?

2011-06-06T10:24:00.000-07:00

A: It's not worth the risk....

It's your face and it's your life. Can saving a few thousand dollars be worth that? I think anyone who cares about you and everyone giving you professional advice is telling you that you should have your rhinoplasty done close to home. It does not guarantee a perfect result, but it will increase your chances for a safer procedure with qualified surgeons. There' s a saying about being "penny-wise and pound-foolish." Going to a foreign country to have complicated surgery done is definitely "pound-foolish."

Should I get Laser Liposculpting vs. Body Lift?

2011-06-06T10:23:00.000-07:00

A: Liposuction and Body Lift are not equivalent procedures

It is good that you can ask this question and get a uniform response from a number of board certified plastic surgeons. It is important to remember that Liposuction procedures (Laser or not) are not equivalent to Body Lift/Skin excision procedures. A full evaluation to discuss the pros/cons and the benefits/limitations of each type of procedure will give you the most realistic expectation and best result. Liposuction, whether with Laser or other energy, is for mld to moderate skin laxity, and skin excision procedures (body lift, tummy tuck, etc) are for moderate to severe laxity. A combination of liposuction and skin excision usually gives the best results. Good luck!

How to Get Rid of Varicose Veins

2011-06-06T10:19:00.001-07:00

The Best treatment for varicose vein removal starts with best diagnosis

Varicose veins are almost never formed in isolation; there is most often, a deeper, larger, vein that is "incompetent" that connects to the superficial, visible varicose vein. This incompetent vein is usually the greater or lesser saphenous vein with valves that are not functioning normally. These root cause veins typically give rise to the varicose veins seen on the surface, and thus, to treat the varicose most effectively, the incompetent saphenous vein needs to be diagnosed first with a duplex ultrasound. Once identified, the vein can be treated with laser or radiofrequency (EVLT or VNUS), and the microphlebectomies performed at the same time to remove the varicose veins. This can most often be performed under local anesthesia under 1 hr. To simply treat the varicose veins with sclero/laser without treating the root cause will lead to multiple recurrences and failed treatments. Make sure your physician is using the most cutting edge technologies to effectively treat your veins; the state of the art has moved beyond "vein stripping" and "sclerotherapy."

Most Efficient Procedure Available to Treat Varicose Veins?

2011-06-06T10:17:00.001-07:00

A: Efficient treatments include endovenous ablation with laser and/or radiofrequency, and correct diagnosis

Varicose veins are almost never formed in isolation; there is most often, a deeper, larger, vein that is "incompetent" that connects to the superficial, visible varicose vein. This incompetent vein is usually the greater or lesser saphenous vein with valves that are not functioning normally. These root cause veins typically give rise to the varicose veins seen on the surface, and thus, to treat the varicose most effectively, the incompetent saphenous vein needs to be diagnosed first with a duplex ultrasound. Once identified, the vein can be treated with laser or radiofrequency (EVLT or VNUS), and the microphlebectomies performed at the same time to remove the varicose veins. This can most often be performed under local anesthesia under 1 hr with the patient able to walk right away.

These treatments are highly efficient and effective and far less problematic than the old "vein stripping" techniques of the past.

What Causes Varicose Veins?

2011-06-06T10:16:00.001-07:00

A: There are a multitude of Causes of Varicose Veins--genetic and lifestyle related

Varicose veins are almost never formed in isolation; there is most often, a deeper, larger, vein that is "incompetent" that connects to the superficial, visible varicose vein. This is the "Venous Reflux" disease that you have heard of.

This refluxing vein is usually the greater or lesser saphenous vein with valves that are not functioning normally. These root cause veins typically give rise to the varicose veins seen on the surface, and thus, to treat the varicose most effectively, the incompetent saphenous vein needs to be diagnosed first with a duplex ultrasound. Once identified, the vein can be treated with laser or radiofrequency (EVLT or VNUS), and the microphlebectomies performed at the same time to remove the varicose veins. This can most often be performed under local anesthesia under 1 hr. To simply treat the varicose veins with sclero/laser without treating the root cause will lead to multiple recurrences and failed treatments.

The most common causes of varicose veins is largely genetic with a higher female prevalance. Lifestyle issues with pregnancy, obesity, and work (people who stand on their feet all day), can tip the balance to forming varicose veins.

How Do I Get Rid of Eye Bags?

2011-06-06T10:15:00.001-07:00

A: Treat the causes of the "tired eyes"

There are many reasons for the "tired eyes" look and it is important to understand the anatomy of the area first to decide how best to treat the area. In simple terms, the lower lid has skin, muscle, fat, septum, and the cheek area. A good examination of the area will reveal which or all of these factors are causing the "bags" and the tired look.

If it is minimal, sometimes a filler in the "groove" can smooth out the bags, and can be a "quick fix." In younger patients, removing a moderate amount of fat through an "inside" incision (transconjunctival) can lead to a very natural result. In older patients, there is usually a combination of skin, muscle laxity, weak septum and bulging fat. This condition can be treated with a Lower Lid Blepharoplasty and Fat Transposition that will preserve more of the eyelid architecture for a more natural, long term solution. Make sure your board certified plastic surgeon examines the entire area and explains the pros/cons of the procedure in detail.

Mild Ptosis More Complicated to Fix?

2011-06-06T10:07:00.001-07:00

A: Ptosis is more complicated, but is correctable

It is important first to recognize the condition prior to performing eyelid surgery so that it can be corrected. Levator advancement during the procedure is an effective manuever performed symmetrically to best address the ptosis. A conservative amount of skin excision may also be necessary depending upon the amount of levator advancement to avoid the "fat lid" look. Make sure your surgeon performs Asian eyelid surgery on a consistent basis and understands Asian aesthetics. Good luck!

Slim Lipo Vs. Smart Lipo: Which is Best?

2011-06-06T10:04:00.000-07:00

A: SLIM Lipo is highly effective

Both SLIM and Smart Lipo is a form of laser lipolysis that will help in removing fat and tightening skin. I chose SLIM Lipo for a number of reasons for my patients: #1. Energy (in the form of laser) is helpful in lipoolysis and for skin tightening. This energy is better than having no energy, ie, liposuction alone #2. SLIM lipo has advantages with 2 laser wavelengths, one that is specific for fat and another more for skin tightening #3. SLIM lipo hasa higher tech, flexible tip that is better for Liposculpting and "safer" for corners and curves. Put all of this technology in the skilled hands of a board certified plastic surgeon, and you can get all the advantages that the laser can offer (skin tightening, faster recovery, laser lipolysis, etc) combined with excellent surgical techniques, results, safety.

The right technology in the right hands can provide even better results. The right technology in the wrong hands becomes a marketing gimmick. I recommend that you check the true credentials of the physicians performing "Smart" lipo; oftentimes, they are not plastic surgeons, and many times, they are not even surgeons at all. Developing hand eye coordination and the "touch and feel" for tissues does not happen in a weekend course offered by the laser company. Plastic surgeons train in surgery for 6-8 years, develop extreme technical skills and finesse, and understand 3-Dimensional surgical anatomy. Training alone does not guarantee success, but provides the best foundation and possibility for the best results.

Mini Facelift, MACS Lift, Short Scar Face Lift

2011-02-27T22:35:00.000-08:00

The mini facelift has become a powerful technique for facial rejuvenation. The classic facelift typically involves making an incision in front of and behind the ear. This can allow redraping of the skin around the mid and lower face and neck. The classic facelift techniques of the past have evolved now to give very excellent and natural results with shorter recovery, less incision, and potentially few complications (particularly to the facial nerves below). The “mini” or “minimal access” techniques have evolved from European plastic surgeons and is more in line with the demands of the European patient, who desire a more natural lift that is less exaggerated and has fewer telltales signs of surgical manipulation.

Importantly, all facelifts must address the SMAS (superficial musculo aponeurotic system) layer. This is the strong fascia layer underneath the skin, which is important in pulling and holding the tissues of the face in the vertical direction. This lifting technique is the most powerful way to address the effects of gravity and loss of tissue strength over time. Adressing the SMAS in the appropriate way can improve the 3-dimensional volume of the face as well as the longevity and effectiveness of the lift.

The MACS lift, (Minimal Access Cranial Suspension) is a more accurate term for a mini facelift which combines the lift of the skin and also the SMAS. The vertical lift of the SMAS can improve the jowls and lower mid face significantly. The lost volume of tissue is now raised into a more natural and youthful position around the cheek.

The key advantages of a Mini Facelift or MACS Lift is the shorter recovery period, and the possibility to have a facelift under local anesthesia If desired. The word “mini” can be deceptive in terms of its power and effectiveness. It can be combined with upper and lower eyelid procedures to rejunenate all areas of the face.

I would be happy to discuss this technique in more detail and determine if you are the right candidate for this procedure.

Treatment of the Split Ear Lobe or Ear Lobe Deformity from Ear Rings

2011-01-03T07:01:00.000-08:00

A deformed ear lobe can be the cause of significant stress. The most common cause is the torn lobe from an acute injury where a large ear ring is mistaken for a handle by a baby. The other is the more chronic injury over time, where the lobe becomes torn from heavy ear lobe jewelery or becomes deformed from large, circular jewelery inside the lobe.

Each type of injury creates a different shape to the lobe and the good news is that the lobe can be repaired or reconstructed to appear close to normal. The key difference is that there may be slightly visible scars where the ear was torn or repaired. The overall shape of the lobe depends upon the amount of deformity or "stretch" to the lobe prior to the repair.

The procedure can be performed under local anesthesia and may take 30-45 minutes per lobe to fix. You may return to work immediately afterward. Sutures are removed in 2-3 weeks.

The good news is that there is help available to treat your split or deformed ear lobe! Far too often, I have seen patients significantly distressed about not being able to find the appropriate treatment. Contact your local, board certified plastic surgeon who will be able to treat this condition.

Warning: Hydrelle Complications and Problems. Do not use!

2010-05-01T22:40:00.000-07:00

I am issuing a personal warning about the soft tissue filler, Hydrelle, made by Anika Therapeutics and distributed by Coapt Systems. I was initially excited about this product because I had been waiting for a hyaluronic acid filler with lidocaine. I started injecting this filler in nasolabial folds in February 2010 and luckily, had only injected five individuals. By late March, one of my patients began having bilateral facial swelling, pain, and erythema. I started treating her empirically with antibiotics only to see these issues worsen. These swollen areas became absesses; multiple cultures were negative, both on and off antibiotics. I have subsequently gone on to incise and drain her cheeks both in the operating room and in the office multiple times. I have used hyaluronidase to dissolve as much of the HA as possible but I am still seeing residual in both nasolabial folds.

In the meantime, I have contacted both Anika and Coapt to ask for their assistance in dealing with these complications-- so far, they have responded lethargically and apathetically. I have spoken to several other surgeons who have used Hydrelle. One physician had 4/6 of patients have a severe reaction. A quick search on the Internet will reveal multiple physician and patient complaints about this product. I have filed my complaint with the FDA and have demanded the companies to take this product off the market. To date, they have not done so.

Of the many fillers on the market today, I expected the HA fillers to have the highest safety profile. I have injected hundreds of fillers on patients with Juvederm, Restylane, Radiesse, Artefill and have never seen such a reaction--not even once. 1/5 (20%) speaks very poorly for this product. The other physician with 4/6 (67%) is even worse.

I am uncertain about the type of reaction patients are having with Hydrelle. My patient did not have an allergy to sulfites (typically in red wine), only a distant allergy to penicillin (has taken Keflex without issues). The reaction appears to be dose dependent based on the greater severity on the left nasolabial fold with more product placed into the deeper fold.

I encourage all practioners of Hydrelle to stop using it immediately. Send unused product back and file your clinical findings with the FDA to start an investigation. (please see link below)

https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm

Dr. Naderi in Virginia has significant experience with this as I have found his blog to very helpful. I hope we can assist other physicians to help their patients through this ordeal.

Patients considering facial fillers should stay with Restylane or Juvederm, both with a long and safe track record.

Q: Transumbilical vs Conventional Breast Augmentation?

2009-12-11T08:34:00.001-08:00

What is the difference between transumbilical Breast augmentation and conventional Breast augmentation?

A: It's a different incision with definite limitations
Transumbilical augmentation has been popularized by the idea that the scar and incision is placed in the belly button area and therefore "hidden" from the breast area. Only saline implants can be placed with this method as the "track" from the belly button to the breast has to accomodate a small object (the folded implant) that is then expanded. I have seen some very nice results from this technique, but I have seen some disasters.

First, the belly button is not the "cleanest" area on the body to place an incision and also place a sterile implant through. I have seen some very large scars in this area and the possibility of infection is higher.

Second, the creation of a submuscular pocket --the most important part of placing an implant--is not done in an ideal environment, given the distance of the belly button to the breast area. Again, given the distance, the silicone gel implant (with the most natural feel and appearance) cannot be placed through this incision.

Standard incisions (nipple or inframmary--at the breast crease), allow full access to the breast area for pocket creation, whether below or above the muscle. You can have silicone gel implants or saline implants. The scars area well tolerated, and can really be quite hidden. This is my recommended approach for breast augmentation and most board certified plastic surgeons would likely agree this statement.

The other incison, armpit or axillary, is also a possible approach. Saline and gel implants can be placed, but the maximal gel implant that can be safely placed is around 250cc. 250cc is on the smaller end of the normal request for augmentation and so, most of my patients who have inquired about this approach opt out. They usually want 325-400cc.

So remember, certain approaches like the "TUBA" may sound great, but there are limitations when incisions get further and further away from the actual site of surgery.

Q: Sclerotherapy vs laser vein therapy - which is best?

2009-12-11T08:31:00.001-08:00

A:Most patients have a combination of spider veins, reticular veins, and varicose veins. The reason that patients develop these types of "extra" veins is that there is likely venous reflux of some sort.

What is venous reflux? It means that the veins that usually let blood flow in one direction (back to the heart), are malfunctioning because the valves that allow blood to flow toward the heart, are actually allowing the blood to flow back down to the feet. This causes blood to pool in the veins under pressure and create "varicose veins" and "spider veins."

Therefore, the optimal treatment for the different types of veins that form on your legs depends on the diagnosis or evaluation of the deeper veins (with a duplex ultrasound), to evaluate the health of the deeper veins which give rise to the smaller veins (varicose and spider veins). If this is not done, and the root cause of your veins are not treated appropriately, you are destined to have failure of therapy.

Far too often, I have seen patients have multiple treatments of sclero or laser, etc. If you want to avoid having the same treatment over and over, my advice is to see someone who uses all of the available technology that treat your veins appropriately and effectively.

Laser Liposuction (SLIM lipo versus Smart Lipo)

2009-12-11T07:39:00.000-08:00

About the Technology: There has been a lot of media attention on "fat melting" with lasers. SmartLipo has popularized this with a major marketing campaign. Slim Lipo is the next generation of laser assisted liposuction and reprents the state of art in laser liposuction. SLIM stands for "Specific Laser Induced Melting." The technology is based upon almost a decade of research identify the correct laser wavelength that specifically melts fat. SLIMLipo is 3-5 times more effective in melting and removing fat than Smart Lipo and CoolLipo. Smart Lipo uses a 1064 nm wavelength platform that is non-specific for fat. Smart Lipo simply heats water and increases the temperature until the fat cell bursts. The SlimLipo laser also has a 924/975 combination laser treatment that helps tighten skin during liposuction.

Important Considerations: Just because a physcian uses a laser with liposuction does not mean that s/he is actually qualified to perform liposuction. Remember, the skill and experience of the plastic surgeon is the most important factor in achieving a good result. In fact, many nonsurgeons (family practice, internal medicine, etc) have bought this machine for their practice and have called themselves "lipo experts." Please check for their Board certification in Plastic Surgery (American Board of Plastic Surgery) prior to embarking on a life altering procedure.

Advantages of SLIMLipo: Slim Lipo not only melts the fat but also tightens the collagen fibers and tightens the skin. Slim Lipo uses a thin fiber-optic wand that is flexible and emits a wider area of laser energy to the tissues. SLIMlipo will melt the fat at lower energy levels and is a safer modality than super heating water, which can cause signficant burns. Using Slim Lipo and specficially melting the fat, the fat can easily be suctioned. The SLIM procedure is much less traumatic, less bruising, less swelling and there is considerably less discomfort than traditional liposuction. 95% of my patients undergo the SLIMlipo procedure under local anesthesia. This creates a much safer environment in preventing blood clots and other possible anesthesia complications. I will use the SLIMlipo laser in the operating in conjunction with a larger procedure (Abdominoplasty/Tummy Tuck) to address areas around the hip and waist that need more skin tightening.

The SLIMlipo Laser represents the best that technology has to offer. I encourage you to come see for youself with "Before & After Photos" of the results with the SLIMLipo laser. This is a technology I have chosen as an experienced, board certified plastic surgeon who cares about your safety and excellent results.

www.lifesculpt.com

Post Operative Pain After Breast Augmentation

2009-02-24T10:54:00.000-08:00

Pain after breast augmentation can be considerable. The implant can be placed above the muscle or below the muscle, and most often placement below the muscle causes significant pain from the tissue dissection and stretching of the muscle.

I have found that precise tissue handling and creation of a sub muscular pocket leads to significant decrease in pain in the postoperative period. In addition I used antibiotic irrigation with local anesthetic throughout the procedure to further decrease pain. I also use a High Tech pain patch (Actipatch) that merely sits on the skin that further decreases pain. This has been a proven technology for me and has made a big impact for my patients. I do not use the pain pump around the breast tissue and implant as I am concerned about further tracking of bacteria around the implant which may cause infection or capsular contracture.

Since using this combination of postoperative pain management, my last 10 breast augmentation patients have noted a 2 on a pain scale of (1-10). Prior to this it would range from 2 to 7.

Use of High Tech in Postoperative Swelling and Pain

2008-12-06T20:46:00.000-08:00

Postoperative pain and swelling are common issues after many surgical procedures. Breast augmentation with implants placed under the muscle (pectoralis) can have a painful recovery period. I have been using several modalities for pain management in breast augmentation surgery:

1. Precise surgical technique--atraumatic techniques leads to less tissue damage and less subsequent pain
2. Intraoperative irrigation with anesthetics
3. ActiPatch

Since combining the irrigation with the Actipatch, I have had a dramatic decrease in pain after breast augmentation. This study that is cited lends more scientific credence to the use of Actipatch in the postoperative period.

Leading Plastic Surgeons and Physicians Comment on ActiPatch Breast Augmentation Study

Clinical Study Data a Major Event for the Company - Company Expecting Record Revenues over Coming Quarters

FREDERICK, Md.--(BUSINESS WIRE)--BioElectronics Corp. (Pink Sheets:BIEL), the maker of ActiPatch™, the drug free anti-inflammatory patch, with an embedded battery operated microchip delivering continuous pulse therapy that revolutionizes the way people heal, today released comments by leading plastic surgeons and physicians relative to the recently announced clinical study showing the high efficacy of ActiPatch in reducing post-breast augmentation pain and discomfort. Details of the study can be seen at http://www.exploreplasticsurgery.com/.

Regarding the study, Andrew Whelan, CEO of BioElectronics Corp., commented, “We have received some very positive reactions from leading plastic surgeons and physicians on the recent clinical study on post-breast augmentation pain reduction showing that 73% of studied breast augmentation patients reported less pain and uncomfortably with ActiPatch. We have included a few of these comments below as we believe such excitement is indicative of the positive momentum we are building in the marketplace for the ActiPatch product line. We will be releasing additional data on other clinical studies very soon, which we believe will further advance us toward additional FDA indications for use. We are expecting record revenues over the coming quarters as the momentum behind ActiPatch continues to build. It is clearly an exciting time for all of us at the BioElectronics.”

“ActiPatch demonstrated less pain within the first few days after surgery and provides a simple, low-cost method for delivery of pulsed electromagnetic therapy.” – Barry Eppley, MD, FACS
“Thank you for demonstrating what many of us have already observed anecdotally. I cover call for a number of physicians and clearly receive more calls from other practices than my own. I think ActiPatch is the difference.” - David Whiteman MD, FRCS
"This is very encouraging data from Dr. Eppley and he is to be congratulated for doing the study - This therapy lowers major barriers for patients considering plastic surgery by reducing the long recovery time caused by the swelling, pain, and bruising of the incision and surgical dissection." - Brian M. Kinney MD, FACS, MSME

"I have been using ActiPatch on my patients for a variety of plastic surgery procedures, including breast augmentation, blepharoplasty, and rhinoplasty. The reduction in soft tissue swelling and pain is impressive. It is good to see these studies confirming what I have experienced with my own patient population. Further quantification and validation will be necessary in the future." Charles K. Lee, MD, FACS

“It is exciting to see this very positive clinical data on the use of ActiPatch for breast augmentation recovery. I have been using ActiPatch in my practice for quite some time and found it to be highly effective in reducing pain and speeding recovery.” – Sheena Kong, MD
“I too am impressed and most grateful for the study. These data demonstrate not only the ability of ActiPatch to reduce swelling but offer further confirmation of pain reduction with timely and appropriate application. This is very positive news for ActiPatch and BioElectronics, Corp.” – Lawrence Michaelis, MD, FACS
“Many medical professionals are starting to investigate the use of ActiPatch for the treatment of a variety of conditions, but there has been little clinical data until now. We are also conducting clinical trials and have assembled a team to investigate the use of ActiPatch for the treatment of plantar fasciitis, a condition that affects tens of millions of people throughout the world. We look forward to providing this real world clinical data to our colleagues.” - David G. Genecov, MD, FACS, FAAP

About BioElectronics Corporation
BioElectronics Corporation is the maker of the ActiPatch™. ActiPatch is a drug-free anti-inflammatory patch with an embedded battery operated microchip that delivers weeks of continuous pulsed therapy for about a dollar a day. The unique ActiPatch delivery system, using patented technology, provides a cost-effective patient friendly method to reduce soft tissue pain and swelling. For more information please see http://cts.businesswire.com/ct/CT?id=smartlink&url=http%3A%2F%2Fwww.bioelectronicscorp.com&esheet=5844797&lan=en_US&anchor=www.bioelectronicscorp.com&index=2. For investment relations related information please visit http://www.wallstreetreportonline.com/.

Safe Harbor Statement
This news release contains forward-looking statements related to future growth and earnings opportunities. Such statements are based upon certain assumptions and assessments made by management of both companies In light of current conditions, expected future developments and other factors it believes to be appropriate. Actual results may differ as a result of factors over which the company has no control.