So what is gynecomastia and what is the cause? It is the enlargement of the male chest as a result of breast tissue growth. Yes, it is actual breast tissue, not simply fat. All men have some small amount of breast tissue normally. Hormonal imbalances can cause an increase in the level of estrogen (also normally found in men but in much lower levels than women) to rise, signaling breast tissue to enlarge. The hormonal imbalance can occur from prescription medication such as many anti-depressants, psychiatric medications, and weight loss medicines. It can also occur from anabolic steroid use of chronic marijuana smoking. Interestingly enough, when the offending medication or drug is eliminated, the chest may decrease in size but rarely goes away entirely. Obesity triggers the conversion of testosterone to estrogen and can result in male chest enlargement. A more rare cause of male chest reduction is tumors, such as testicular cancer that can secrete abnormal hormones. Enlargement of both sides is most common, although one may become larger than the other. If there is enlargement of only one side, the possibility of male breast cancer must be considered although it is rare.

If you suffer from male chest enlargement, you should be evaluated by a physician. Your physician will perform a history to determine the possible causes. This will include a detailed history of all drug use, both legal and illegal. Also, a physical exam may help determine whether tumors or cancer is a cause. Your physician will also test your blood for hormone levels and possibly have you seen by an endocrinologist. Approximately 80% of the time, there is no detected cause for this and it is termed “idiopathic” – a fancy medical term for “we have no idea why”.

After treating any underlying medical condition or in the case of “idiopathic gynecomastia”, you may be referred to a plastic surgeon for discussion of the options for correction. Gynecomastia reduction surgery is one of the most common procedures among my male patients.

The treatment will revolve around removing the excess tissue. This may be done with liposuction to suction out the breast tissue and fat. Often, there is a hard lump of breast tissue that is felt under the nipple and areola. This is called the “breast bud” and is very resistant to liposuction. The tissue is just too dense to be removed by suctioning alone and needs to be removed through an incision around the areola. In severe cases, there is excess skin as well as underlying breast tissue. In these cases, reduction usually involves removal of breast tissue with a combination of liposuction and excision, as well as removal of the excess skin.

Gynecomastia is extremely common and a major source of embarrassment, no matter what the age. There are many options for correction. You should see a board certified plastic surgeon to learn about these options. To see some of my before and after gynecomastia pictures Click Here.

To learn more, or to schedule your consultation, contact me or call 212-289-1851.

If a breast implant “bottoms out”, it drops below the normal breast fold. This causes the nipple to turn upward and appear near the top of the breast mound instead of over the center. Also, as the breast implant drops lower, the upper pole of the breast becomes flatter.

The cause of this is usually over aggressive dissection of the breast fold. If the surgeon disrupts the support structures of the normal breast fold, the fold weakens and cannot support the weight of the breast implant. Large and heavy breast implants may make this problem more likely.

Repair of this problem involves reconstructing the breast fold. This can be done with carefully placed internal sutures. Recently, surgeons are now using acellular dermis – either human or pig dermis – to help strengthen these internal sutures and to help support the breast implant in the normal position and prevent it from sliding lower. Keep in mind that these materials provide great results and are recommended, but it can add about $2,000 to the cost of your surgery.

“Bottoming Out” is unfortunately common with breast implants and while we have very good and effective ways of repairing it, it is best not to suffer from this at all. Like everything, the key is prevention. Your surgeon must respect the fold. The breast fold is a normal anatomic structure and care must be taken to not damage it during a breast augmentation. I should mention that it is standard to have to slightly lower the fold to accommodate breast implants, but this needs to be done carefully. Also, very large implants in very thin women should be avoided because of this possible complication.

To learn more about Dr. Schulman and his breast augmentation or to schedule your consultation, contact us or call 212-289-1851.

Both implants are composed of a solid silicone outer shell and it is the “filling” that makes each different. Saline implants are filled with saline salt water. Silicone implants are filled with a cohesive silicone gel. If you cut a silicone gel implant in half, the gel will not ooze out – think of the consistency of the inside of a gummy bear. This is a tremendous improvement over the earlier generations of silicone implants that were composed of liquid silicone oil that would run out freely from a ruptured implant.

Saline implants are packaged unfilled. This means that the empty implant is placed in the breast and the surgeon fills the implant with saline fluid to the desired volume through a small fill tube. There are several advantages to this. Because the empty implant can be rolled up like a cigar, it can be placed through an incision smaller than the incision required for a silicone implant. Another advantage of saline implants is that the surgeon has some latitude in the amount of volume that can be added. The implants can generally hold a 30cc range of fluid. This means that a 300cc implant can be filled to anywhere between 300cc and 330cc. This allows for intra-operative adjustment of volume to help achieve symmetry of the breasts. This has a specific advantage when performing breast augmentation on women with pre-existing breast asymmetries. We can sit the patient up in the operating room and can look at the breasts and fine tune the volumes – maybe add a little to the right or take a little from the left.

Silicone gel implants come pre-filled. This means that the volume is pre-determined and cannot be adjusted in the operating room, therefore the pre-operative examination and implant size selection is paramount. In addition, the pre-filled silicone gel implants require a longer incision to inert. This longer incision means a longer scar. It also means that some incisions location choices may not be an option. For example, it may be impossible to place large silicone gel implants through a peri-areolar (around the nipple) incision in women with very small areolas.

In terms of the look and feel of the implant, no one will dispute that silicone gel implants look and feel more natural. They are soft and feel very similar to natural breast tissue. Saline implants tend to be firmer and may show visible rippling around the edges. There can also be visible folds, especially during movement or bending over. Placing the implants under the muscle can reduce some of this, but a saline implant will never look or feel as natural as a silicone gel implant.

Studies show that the rupture or leak rate of both implants is the same. However, the ability to detect a leak is quite different between the two implant types. When a saline implant leaks, it is obvious. Your breast will be deflated in a few days or weeks depending on the size of the leak. When a silicone gel implant breaks, the gel will not leak out. This means the breast will not change size. Rather, it will change very slightly in shape. These changes can be subtle and an MRI is needed to detect a silicone gel implant rupture. Studies do not show any connection between systemic sickness and a silicone implant rupture. Silicone gel will not get into the blood and travel throughout the body and cause cancer, Lupus, arthritis, or any other illness.

As you can see, there are advantages and disadvantages to each type of breast implant. To learn more about your options for breast augmentation and implant selection, visit a board certified plastic surgeon. Contact us to schedule your appointment with Dr. Schulman, by calling 212-289-1851.

The fastest growing group is my male patients. Nationally, males comprise less than 20% of all cosmetic surgery patients but this number has been increasing dramatically over the past few years. According to the American Society of Aesthetic Plastic Surgeons (ASAPS) the number of males undergoing cosmetic procedures increased 2% from 2009 to 2010, but the increase in specific procedures among men has far outpaced females over the same time period. Below is a list of the fastest growing cosmetic procedures among men, based on the percent increase from 2009 to 2010:

A total of 1.1 million men underwent cosmetic procedures (both surgical and non-surgical) in 2010 and males now comprise about 25% of my patient population in New York City. The most common surgical procedures among men are facelifts, liposuction, and rhinoplasty. The most common non-surgical procedures include Botox, Fillers, and laser vein removal. So why is plastic surgery among males growing faster than any other group? Part of this is the “de-stigmatization” of plastic surgery. It is no longer taboo and is more acceptable – probably the result of a long list of television shows focused on plastic surgery. But this does not explain why men in particular are turning cosmetic surgery. Some claim that it is the aging baby boomer population that is now looking for some relief from advanced years.

My personal opinion is that this is directly related to the changing economy. As the economy took a turn for the worse, the workforce became increasingly competitive. The 50 year old man with 30 years of work experience now finds himself competing with a younger (and cheaper) competitor, and not only in New York City. Older males are looking for every possible advantage to be hired, get that promotion, or keep from getting fired. Despite the idealists that think that looks don’t matter, the fact is that they do. Whether fair or not, studies have shown that better looking males tend to have more success in the workforce. Cosmetic surgery became a way for older men to look younger and more refreshed.

When choosing a doctor for male cosmetic surgery in New York City, make sure to choose a surgeon who has experience with male patients. This is extremely important because surgical techniques vary between men and women. With male patients, it is important to have a balance between improving one’s appearance and retaining the masculine features.

If you are interested in learning more about a procedure or technique, contact my office to schedule a consultation for plastic surgery in New York City.

The lack of moisture in the air dehydrates our skin causing it to crack and lips become chapped. Along with dry skin come wrinkles and fine lines causing people to look older than they are. You must beware that it’s not just the cold air outside that damages our skin but the dry heat inside the house can dehydrate us as well.

Skin Care Tips

1. Place a bowl of water in front of your heater- This will keep moisture in the air while your heater is running and keep your skin from drying out.

2. Lotion up- Whether you are coming in from outside, getting out of the shower or sitting on the couch make sure to always put lotion on. This will help hydrate your skin.

3. Bundle up- Make sure to put on extra layers. Whether you are in the house or leaving the house that extra layer will help your body naturally heat itself, which keeps in moisture.

Lip Care Tips

When thinking about our face one of the most important factors that tend to get over looked is our lips. Most people either go without anything or think that their everyday lipstick helps when in reality it doesn’t. Having chapped lips is like eating a sand salad. It hurts to rub your lips together and does not look appealing.

The best thing we can do for our lips during this time is to lather up. Always have Chap Stick in your purse or pocket to help keep those lips stay luscious and smooth. The best chap sticks will have shea butter or coconut oil in them and Chap Stick Brand moisturizers work wonders as well.

One quick fix tip to help keep those lips moisturized is to exfoliate and lock in moisture. This is done at night after you have washed your face for bed. First take a tsp. of sugar mixed with oil and rub on your lips. The grainy sugar will help remove excess skin on the lips. Then apply a tsp. of honey onto your lips and let sit over night. In the morning you will wake up to moisture locked lips.

Medical Grade Skin

Everyone has their own unique skin so it’s imperative to keep it healthy and happy through daily and nightly skin regimens. Medical grade skin care products, such as the one I am launching this year, have higher quality ingredients then store bought brands, giving your skin the extra love it needs all year long. Additional monthly, quaterly or bi-yearly treatments such as facials, microdermabrasion and chemical peels could also be incorporated to your skin regime.

Individuals looking to maximize a rejuventated appearence by tightening the skin on the face may want to consider Reaction by Viora. People in their 50′s who want to decrease the signs of aging may want to take additional steps to achieve skin rejuventation if demeed appropriate by a plastic surgeon. Additional procedures to help diminish lines and wrinkles include facelift and eyelid surgery. These procedures can also help tighten sagging skin.

For more information on medical grade skin care or skin regimen tips please feel free to contact my office today.

According to a recent article in Time Magazine, individuals with wrinkles are less likely to get hired for a position. Could this be caused by the tired or angry look lines and wrinkles around the eyes and on the forehead can create? Possibly. Imagine you are a business owner and you are hiring someone to represent your company, the first person your clients will often met, are you going to hire someone who looks like they are tired, mad or warn out? Probably not. Some business owners are starting to count age against individuals. They want someone who has experience, but doesn’t show it- literally.

For this reason many individuals in industries such as sales, account management and retail or opting to undergo facial rejuvenating procedures such as Botox, eyelid surgery and Facelift. Women and men are considering it an investment in their career, similar to the way you invest in college. Facials, chemical peels, laser skin resurfacing are treatments to help improve and maintain healthy glowing skin, which people are undergoing on a routine basis. Injectables such as Botox, Restylane and other facial fillers can help improve the signs of aging by decreasing the extent and definition of lines and wrinkles, which are other common procedures being performed. Injectables and facial fillers are non-invasive and typically require quarterly or bi-yearly up keep to sustain and maintain a refreshed appearance.

For individuals seeking further improvements than decreasing the visibility of lines and wrinkles, such as getting ready of sagging skin above the eyelid or sagging skin on the neck or near the jowls often turn to eyelid surgery, facelift, neck lift, or a combination of procedures. Additionally, individuals who are looking for less up keep on a quarterly basis turn to these surgical procedures as the results often last much longer than injectables and facial fillers when weight is properly maintained.

If you are interested in learning more about a procedures of cosmetic plastic surgery, contact my office in New York City today to schedule a consultation.

Resource: http://money.blogs.time.com/2010/12/27/need-work-you-might-want-to-have-a-little-work-done-on-your-face-first/

Just as frequently though, patients request not to look like well known celebrities. This list of celebrity “don’t-wanna-be” changes a few times a year, but here is a list of the most common celebrity no-nos and tips to avoid looking like them.

1.   Madonna’s cheeks – Clearly she has had injectable fillers in her cheeks, but because her cheeks seem to be growing, almost magically, I suspect she has had fat placed in there as well. Fat transfer involves removing fat from one part of the body and placing it in another. The fat that is transferred is a living cell and should theoretically live forever. While this sounds like a great procedure, the problem is that the fat can sometimes take on a life of its own. For example, the fat will still retain the characteristics and behavior of the place it is taken from. So, if fat is taken from a place that easily increases or decreases with weight changes (such as the abdomen), it will also increase or decrease in the face. The result can be mysteriously growing cheeks. While I can’t say for sure that Madonna has had fat transfer to her cheeks, I can say that her cheeks appear too round and too full for her face, a look that my patients specifically want to avoid. Carefully placed filler can give a natural and predictable result.

2.   Lisa Rinna’s Lips – Lisa Rinna has long been know for her full and oddly shaped upper lip. We in the cosmetic world have known all along that this is a tell-tale sign of silicone injections gone bad. But she has adamantly denied having anything injected into her lips for years and years. Finally, she admitted this year to permanent silicone injections and underwent surgery to remove the silicone. Regardless of what was injected, Her lips exhibit the classic characteristics that my patients want to avoid – overly full, asymmetrical, and abnormally shaped. The ideal lip should be fuller in the middle, and less full at the corners. A “pouty” look is also considered very attractive. Stick with temporary fillers like Restylane and Juvaderm for a natural look – and besides, if you don’t like it, it will go away in about 6 months unlike silicone which is forever.

3.  Tara Reid’s abdomen – Tara Reid’s abdomen is the perfect example of what can happen when liposuction is too aggressive. As I always say, with liposuction, it is not what you remove, but what you leave behind. If I were to remove every bit of fat during a liposuction procedure, only a thin layer of skin will remain, resulting in lumps, bumps, and contour irregularities. Careful liposuction with small instruments can help minimize the chance of having an abdomen that looks like hers.

4.  Tori Spelling’s breasts – You may be shocked to hear this, but Tori Spelling has breast implants. And these implants show some serious problems. They are widely spaced and the implants themselves show visible edges and rippling. Some of these problems are likely the result of saline implants placed above the muscle in a woman who is extremely thin. To reduce the likelihood of “spelling breasts”, my patients opt for silicone implants that look and feel more natural and have less chance of having visible edges or rippling. Also, placing the implants under the muscle will add another layer of tissue, camouflaging the implant even more.

5.  Michael Jackson’s Nose – His nose is perhaps the most infamous example of what can go wrong with a rhinoplasty….or seven. Michael Jackson had undergone multiple nose surgeries. Each subsequent surgery can damage the blood supply to the bone and cartilage. This injury to the supporting structure of the nose can cause “collapse” as seen in the later pictures of Michael. I should also mention that Latoya and Janet also likely had multiple nasal surgeries and are exhibiting early signs of structural collapse. Almost all my rhinoplasty patients jokingly tell me in consultation that they don’t want to look like Michael Jackson. The way to avoid this is to not have dramatic changes made and to avoid multiple nasal surgeries.

If you have any other questions, concerns or would like to schedule a consultation with Dr. Schulman please feel free to contact us.

Dr. Schulman discuss the latest system used in body contouring, skin tightening and cellulite reduction.

Pumpkin can be used for more than just carving jackolantern and decoration, when consumed, applied or smelled it can improve your skin, physical and mental health, and your love life too! Due to the many benefits pumpkin has, numerous physicians have included pumpkin to the ingredients of skin care products and as specialty facial scrubs and peels.

Beneficial Ingredients for your Skin!

• Alpha hydroxy acids can assist with the removal of old skin which improves skin complexion and radiance.
• Beta-carotenoids is an antioxidant which can help protect the skin from free-radical damage caused by sun rays, as well as can enhance sunscreen and protect the skin from environmental factors.
• Fatty acids are known to reduce the appearance of fine lines and wrinkles.
• Sodium hyaluronate hydrates the skin which can decrease the appearance of fine lines and wrinkles.
• Vitamin A may increase the softness of your skin as well enhance the youthfulness of your skin by increase the rate at which cells renew.
• Vitamin C boosts collagen production and decrease the breakdown of elastin which can help prevent the signs of aging from being more apparent.

Physical and mental Healthy Benefits of Pumpkin.

• Carotenoids: according to studies conducted by the National Cancer Institute, consumption of certain carotenes, such as alpha-carotene and beta-carotene, can help your body fight off illnesses including types of cancer.
• Zinc and omega-3 fatty acids: Pumpkin Seeds contain zinc and omega-3 fatty acids which may promote bone density and enhance brain skills assocated with thinking
• Pumpkin seed oil: Cooked pumpkin seed oil has been known to help prevent tooth decay and cavities.

Enhance your love life ladies with Pumpkin!
• Pumpkin Pie: The consumption of pumpkin pie can enhance sexual functionality in both men and women.
• Pumpkin scent: The scent of pumpkin spice has been reported to be one of the top-rated aphrodisiacs among men according to studies conducted by the Smell & Taste Treatment and Research Foundation.

So don’t forget to enjoy some pumpkin this fall! Your skin, body, brain and significant other just might thank you!

If you are past the stages of being preventative and need to be proactive with your anti-aging skin regimen, there are non-surgical procedures that can help. These treatments include microdermabrasion, Botox, Dysport, and medical grade skin care products.

To learn more about facial rejuvenating treatments that are right for you, contact my office today to schedule a consultation.

As a society, we tend to focus on the bad outcomes, because this is what sells the magazines. Moreover, “regular” people probably derive some sort of pleasure (albeit twisted) in famous celebrities who always seem to get whatever they want, being the victims of “bad plastic surgery.”

But, the real truth is that there is excellent plastic surgery being performed everyday on celebrities and non-celebrities. Modern techniques for surgery allow for smaller incisions that are better hidden, more rapid recoveries, and more “natural” results. Gone are the days of dramatic surgical changes and barely recognizable post-surgical faces.

Facelifting technique has seen the greatest advancement. The facelifts of the 1980’s with the windswept look, overtight skin, and upturned mouth reminiscent of “The Joker” are no more. Plastic surgeons now “lift” and “reposition” the deep structures of the face (the fat pads and muscles), and very little is done to the skin. In fact, after the underlying structures are repositioned into a youthful position, the skin is simply “redraped” and not pulled tight. You would be surprised at how little skin is actually removed during a facelift when it is done correctly.

I will share a little trick that I do with every one of my pre-operative facelift patients in consultation. To show what you will look like with a very well done (and natural) facelift, lay on your back and look at yourself in a handheld mirror. Impressive, right? This allows gravity to show you where everything should be.

Additionally, non-surgical treatments have evolved as well. Chemical peels should no longer result in that obvious shiney, over-smooth, waxy skin. Injectable fillers can be done conservatively so that they restore volume and fill lines, without making someone look like they have been over-inflated. Botox and Dysport can soften lines and do not have to completely prevent movement. That “frozen look” that people fear is a result of a bad injector, not the injection! Believe it or not, it is possible to eliminate lines on your forehead AND be able to lift your eyebrows!

My point is that there are excellent plastic surgeons that perform surgeries and injections that rejuvenate and improve, without making you look ridiculous and “overdone”. My patients obviously want to look different (ie. better) but they don’t want people to know exactly what they had done. They want someone to ask if they got their hair colored or lost weight, when the truth is that they had their eyes or face done.

Finding the right surgeon is the key. So, as long as there remain bad plastic surgeons (or non-plastic surgeons trying to act like plastic surgeons), the Weeklies will continue to have lots of content for the “bad plastic surgery” section. Nobody wants to read about the good results.

If you are interesed in seeing before and after photos of plastic surgery procedures performed by me, visit his photo gallery, or contact my office to schedule a consultation.