• People are beginning to plan for the summer: This is the time of year when summer vacation plans are made and people begin to dream about long days on the beach or by the pool. With warm weather comes bathing suits and more revealing clothes. This idea usually motivates people to improve their body. Gyms get busier, and so do plastic surgeon offices. Because it takes several months for the body to completely heal after any cosmetic procedure, I recommend that breast and body contouring be done during this time of year, to ensure the best possible results for the warm summer months.

 

• Recovering from surgery in the cooler months is more comfortable: Routine post-operative care usually involves dressings, bandages, and tight compression garments worn under clothes. In cooler months, this is more comfortable. By the time the warm months come around, it will not be necessary to wear all these extra layers. While I do perform a lot of plastic surgery during warm months, my patients are aware that perspiration may cause some irritation to healing incisions.

 

• A good time of year to dedicate to yourself: The hustle and bustle of the winter holiday season is now over, and people tend to have less social and family commitments this time of year. This makes it a perfect opportunity to dedicate some time to yourself and your recovery.

 

• Anticipated Tax refunds: As we enter tax season, many people are anticipating a tax return. Even a small amount of tax refund may make a huge difference in paying for your plastic surgery. Also, there are many different finance options now available for plastic surgery, and your anticipated tax refund may make financing a good option. Many companies have 0% options for a variable amount of time. Many of my patients are signing up for 3-6 months 0% financing, knowing that the tax refund can be applied to partially or totally pay for the surgery.

 

• Plastic Surgery Discounts: While many surgeons only try to improve business during slow times, many (like myself) see a great opportunity to increase business during this very busy season through special pricing. You will be surprised to find very good discounts for surgical procedures this time of year.

As we enter plastic surgery “busy season”, this may be a good time to look into making the improvements in your body that you have always thought about. The timing is right, contact New York City Plastic Surgeon Dr. Schulman for a consultation.

First, let me dispel the myth that ten plastic surgery procedures cannot be performed in one operation. While I will admit that this is a lot, you must keep in mind the complexity of each procedure. 

From what I understand, her procedures included things like a revision of her nasal tip, fat injections to her cheeks, breast implant exchange, liposuction, etc.  These may seem like complicated procedures to the general public, but as a board certified plastic surgeon I know that these are relatively small, quick procedures.  Each procedures carries minimal anesthetic risk or risk of major port-operative complications – especially when performed on a young and healthy person.  While the media likes to focus on the seemingly large number of procedures, the complexity of each and the required anesthetic time is most important.

To give an example, facial rejuvenation surgery in my practice often includes a facelift, necklift, upper blepharoplasty, lower blepharoplasty, browlift, and chemical peel.  This is common combination of six procedures performed widely by qualified plastic surgeons.  The actual operating time of all these procedures may be less than performing one breast reconstruction.

The point is that the most important thing is the total length of the surgery, not the number of procedures. I have no personal knowledge about how long Heidi’s surgery lasted, and if it was an exceedingly long surgery (in excess of 6 hours), than one may argue that it was “too much” – but the fact that ten procedures were done should not be the sole reason for the uproar.

Many people also point out that Heidi is only 23 years old.  Her young age and good health make her a good surgical candidate for an elective surgery (or ten). She has an extremely low risk of complications.  Also the fact that she is so young does not place her at risk for future complications. Yes, as she ages, it is likely that some of her surgery will need to be redone as her body changes. Her surgeries only affect her appearance, not the function of her body or her overall health.

The real issue is whether or not these surgeries should have been performed at all.  The fact that she desires such radical changes in her appearance at such a young age does raise suspicion about her mental state. Body Dysmorphic Disorder (BDD) is a serious condition that involves a person’s intense dislike of the appearance of his or her own body.  In order to truly have BDD, the person must have the perception of a problem, in the absence of a real problem.

For example, if someone has a crooked nose with a large hump, it is understandable that they may be unhappy with their nose and desire surgery.  However, if a person has no obvious deformity, yet they cannot stand they way the nose looks in the mirror and perceive a crooked, humped nose that is not there, then this is a sign of possible BDD.  Plastic surgeons are always on the lookout for these patients because these patients will never be satisfied with the outcome of a surgery, no matter how successful the operation.  They will always perceive a deformity.

I do not mean to imply that Heidi Montag suffers from BDD.  In fact, it is more likely that she simply has a strong idea about how she wants to appear and happens to have the resources and connections to make it a reality.

My personal opinion is that her surgery was a bit excessive in that it dramatically changed her appearance to the point where she looks like a different person. But, as a plastic surgeon that routinely performs cosmetic surgery, I understand that cosmetic surgery is a matter of taste.  It is our job to perform surgery in a safe and ethical manner, without imposing our own sense of taste on our patients.

Sometimes, though, a surgeon needs to say “no” and not be affected by fame or money. Fortunately for my sense of well-being (and unfortunately for my wallet), I say “no” very often in my practice.  I just seem to sleep better at night.

Here are a few guidelines to help you choose your implant size.

1. Determine your personal preference of size – This is done by looking at magazines and photographs in order to determine “how big” you want to be.  You should find 3 photographs: “just right”, “too big”, and “too small.”  You should bring these photographs with you so that your surgeon will have a sense of what you are looking for.

2. As implants get larger, they also get wider – This concept is important in choosing a size implant that fits your body. If you are very small framed, then large implants may be too close to each other in the center or may protrude off the side of your chest.  Your doctor will measure the width of your chest to determine you “base diameter.” This will help him guide you towards a size that fits your body shape and size.  Breast implants are now available in several different shapes such as low projection and high projection. This gives you added ability to have an implant that fits your body.

3. You may not be able to be as large as want – It is not possible to make a big jump in breast size in all women. This is because there may not be enough tissue (breast and skin) to allow for a very large increase in size. Your doctor will examine you to be sure, but size increases of more than 2 full cup sizes may not be safe.  If you are an A cup, and desire to be a DD, this may not be possible in a single operation. You may have to increase to a full C, than a few years later (after your tissue has stretched out) have the implants increased in size to a DD.

4. Small volume differences may not be noticeable – Most people only notice volume changes of at least 50 cc’s, so if you cannot decide between a 330 cc implant and a 350 cc implant, so not stress because the difference will be difficult to tell once they are placed. When trying different sizes, you should increase and decrease by 50 cc volumes

5. Larger implants are heavier – As an implant gets larger, it also gets heavier. This means that very large implants may result in shoulder and back pain, similar to the complaints of women requesting breast reduction surgery.  Also, heavier implants may increase the likelihood of future breast sagging, or ptosis.

6. Take your time – You should not feel rushed or pressured into choosing your implant size. Your surgeon should allow you time to “try on” the implants and examine yourself in clothing.  It is best to try them with a simple, non-padded, non-push-up bra, and a tight t-shirt.  This will give you the best idea about your post-operative result.  Many surgeons will also allow you to borrow the sample implants so that you can see how you feel about the size of the implants over a few days. I routinely tell my patients to wear the implants for a few days, go out to dinner, visit friends, or wear them to work – this is the best way to determine how you feel about the size.

    

So, implant size is a combination of personal preference and your body’s shape and size. You should have an idea of what size breasts you ultimately want to have, and your doctor should be able to tell you if that size is safe for you.  Many Plastic Surgeons now have the ability to use computer simulations to show you what you will look like with different size implants.  This may be helpful, but there is nothing better than wearing the implants for a few days.

1. Permanent Lip Implants – A large number of men and women request fuller lips.  This has traditionally been done using temporary injectable fillers such as Restylane and Juvaderm. In good hands the results are excellent, but temporary.  The cost varies by geographic region and the specific filler chosen, but starts around $700.  With  patients returning on average of every 6 months (sometimes sooner), it will cost you approximately $1400 per year and $4200 over three years.  Now there is a permanent solution – PermaLip. These are soft silicone, permanent lip implants.  With a cost of $1800 per implant, the cost savings is enormous.  I have had excellent results with this safe and permanent solution for those who desire fuller lips.  The demand was high for this at the end of 2009 and I have no doubt that the popularity will only increase.  On a personal note, this makes me very happy given that I am one of only a few plastic surgeons experienced with this procedure.
2. Earlobe Rejuvenation – Long, thin, sagging earlobes are a tell-tale sign of a person’s age and often neglected. I have noticed in my own practice that earlobes age just like the rest of our face and body.  This is why I offer my patients options for earlobe rejuvenation. This may include “plumping” them with fillers, or shortening them by removing excess skin in a simple in-office procedure.  I anticipate that this inexpensive, simple procedure will continue to gain demand in 2010.
3. Adjustable Breast Implants – Selecting an implant size can be a source of tremendous anxiety for the patient. In fact, the most common reason for re-operation after breast augmentation is to change the size of the implant.  Also, many women have pre-existing breast asymmetry, making implant selection difficult because different size implants are required. Post-operative adjustable saline implants can solve this problem by allowing a physician to change the size of the implant through a tiny access port beneath the skin.  While this is not designed for increasing or decreasing your breast size based on your outfit, it is designed to allow the patient to take their time in deciding the final volume of the implants. It is common for breast implants to appear “too large” immediately after surgery when they are swollen and in a high position. After the swelling goes down in several weeks and months, it is common for the patient to complain that they are now “too small.” Now more saline can be added to the implants resulting in the desired size.  The access ports can then be removed with a simple in-office procedure.
4. Belly button enhancement – Another procedure gaining popularity in my practice is belly button surgery. Men and women come to me and complain about the appearance of their belly button. They may feel that it is “too large” or that they what the “outie” made into an “innie.”  Also, the belly button may have been distorted because of a hernia.  Belly Button Rejuvenation can improve the appearance of your belly button with a short in-office procedure using local anesthesia.  Last year I was quoted in the New York Daily News in reference to Victoria Secret Supermodel Karolina Kurkova’s (lack of a) belly button. After that, belly button revisional surgery has become one of the most requested procedures that I performed in 2009 and from the looks of my upcoming schedule over the next few months, this trend will continue.

Only time will tell if my predictions for 2010 come true. I am certain that they will be among the hottest procedures in my practice during the upcoming year, but national trends are difficult to predict.  I look forward to my December 2010 blog entry when I reflect on my predictions.

There have been several attempts in the past to develop a permanent solution for those who want fuller lips. Silicone has been used because it is permanent, but the silicone move when used in the lips because of constant lip motion. Other materials that have been used include Gortex and Alloderm that is rolled like a cigarette and placed in the lips. The problem is that these materials can look unnatural and cause significant scarring on the inside of the lips making it very difficult to remove the materials in the event of a complication. Because of the well documented problems, physicians have virtually abandoned the use of permanent materials in the lips.

Now there seems to be another option. I have been using PermaLip, a permanent silicone implant for the lips. These implants are solid silicone rubber that is soft and flexible. They are manufactured with tapered ends, making them very natural appearing when placed in the lips. The soft nature of the implant allows them to move naturally with lip motion. Additionally, they do not elicit an inflammatory response, making it easy to remove if necessary. This makes the PermaLip a safe option for permanent lip augmentation. Unlike with injectable fillers, the results are consistent and not soley dependent on the skill of your injector.

The implants are placed in a short in-office procedure requiring only local anesthesia. These is some swelling and bruising after the procedure that may last for one week. However, with a cost of approximately $3000 for both upper and lower lip, this is a cost effective option for women who desire permanently fuller lips.

PermaLip is quickly becoming one of my most requested procedures. I fully expect the demand to continue to increase as people look for cost effective options for looking better.

As we age, we lose collagen and elastin. This is very obvious in areas like the face, neck, breasts, and abdomen.  But these changes occur everywhere in our bodies – even our earlobes!  As we age, our earlobes loose internal support and begin to sag.  There is also loss of fat, making them appear thinner. The net result is thinner and longer earlobes, showing your true age.  When looking for rejuvenation fo the face, it is important not to neglect your ears.

I have been performing earlobe rejuvenation for several years now and the procedure is really gaining in popularity. The “lobe lift” has evolved and is customized for every earlobe.  The procedure may involve the injection of dermal fillers, the removal of excess skin, or a combination of both.

For the treatment of thinning earlobes, I inject popular fillers such as Juvaderm, Restylane, or Perlane into the earlobe. This plumps the earlobe, providing a lift. This is a great option for women who find that their thin earlobes appear more aged that the rest of their face.   This is also very popular with women who have stretched out earring holes and have difficulty wearing earrings. By “plumping” the skin around the piercing, the hole becomes smaller, allowing more earring options.

In long, sagging earlobes, I can remove the excess skin. This is done during a simple in-office procedure that takes about 20 minutes with only local anesthesia.  By removing excess skin, the earlobe is shortened, lifted, and made smaller. The scar is hidden and is almost impossible to see.

This procedure is becoming more popular, both as an isolated procedure and as a critical component of my face and neck lifts. While many people do not come to me complaining of the appearance of their earlobes, I would be negligent if I failed to point it out when evaluating someone’s face.  As a plastic surgeon, I am trained to look at the entire person as a whole. Balance and symmetry is a critical component of a youthful appearance.

Liposuction involves the removal of fat with the help of a suction device through very small incisions.  Any volume of fat can be removed – from large volume to just small amount in the problem areas.  After the fat is removed, the skin will generally tighten to accommodate your now slimmer body.  The amount that your skin can tighten depends on several factors: the amount of fat removed, the area it is removed from, and the quality of your skin. 

Liposuction is used specifically to remove fat and improve the overall shape of your body. When performed on your abdomen, liposuction can result in a tighter upper and lower abdomen and flanks, with very small and hidden incisions. Liposuction will not do much to improve your skin. This means that if you have hanging skin, or pannus, liposuction may make this appear worse. Also, if you have abdominal wall laxity because of loss of muscle tone, liposuction will do nothing to help this. Lastly, if you are complaining of stretch marks, liposuction will not eliminate this and may in fact make it look worse.

A Tummy Tuck in New York, or abdominoplasty, is a larger operation but has a significantly greater impact on the appearance of your abdomen. A Tummy Tuck will remove the excess or hanging skin, remove stretch marks, and remove excess fat.  It also involves tightening of the underlying abdominal muscles that become loose with age, after pregnancy, or changes in weight. Tightening the muscles is the most powerful way of giving you a flatter, tighter abdomen.

Your board certified plastic surgeon will be able to examine you and tell you if liposuction or a tummy tuck is best for you.  Oftentimes, the two are combined in order to give you the best improvement in the contour of your abdomen.  Keep in mind that the recovery from a Tummy Tuck is greater than the necessary recovery from a Tummy Tuck. This may also factor into your decision between these two popular procedures.

 Silicone implants have used for a long time.  In the 1980s and 1990s there was immense controversy surrounding silicone implants. There were accusations that silicone implant carried with them a risk of cancer and auto-immune diseases.  In response, these implants were removed from the market, except for the use in breast reconstruction after mastectomy.  During this time, plastic surgeons began to gather an incredible amount of data about these silicone implants and the patients who have had them implanted.  After 14 years of data collection, the data was analyzed and there was no evidence that any systemic or chronic illnesses can be attributed to silicone implants.  In 2007, the FDA removed the restrictions and silicone implants were again approved for use in cosmetic breast augmentations.

 In my practice, approximately 80% of women select a silicone breast implant.  They find the implant softer, more natural, and without the common “rippling” that can be seen in saline implants.  Also, many patients who previously hassaline implants placed, have returned to have the implants exchanged to silicone.

 The rate of implant rupture and leaking is no different between saline and silicone. The only difference is that a ruptured saline implant is very obvious – the woman will “deflate” within days as the body absorbs the salt water.  Detecting a silicone implant rupture is more difficult. Because silicone is not absorbed by the body, the breast will not “deflate.”  Rather, there may be a slight change in the overall shape and feel of the breast. This change may be so slight that it can go undetected for motnhs. An MRI is needed to absolutely detect a ruptured silicone implant.

 The other difference is that a silicone implant is supplied pre-filled, as opposed to a saline implant which is empty and inflated after it is put in the body.  This means that a larger incision is needed to place a silicone implant. It also makes silicone implants more difficult to place through the underarm and impossible to place through the belly button.

As stated earlier, implant selection is a very personal decision. As a physician, I provide the details of each implant type, giving enough information so that my patient can make an informed decision for herself.

First, let me give my qualifications to answer this question. I have been using Laser Liposuction for several years now and have been involved in several clinical studies to examine the benefits of laser-assisted lipolysis. I am also a luminary for one of the largest laser companies and am given the task of training other physicians about the proper techniques for using this technology.  I am among the most experienced in using this technology so I have a deep understanding of the advantages and limitations.

Laser liposuction has a prominent role in my practice.  I do find that it offers my patients less bruising, less swelling, and a more rapid return to normal activities. Most important is that it has a greater abililty to tighten the skin as compared with traditional liposuction methods. This is because the laser energy causes heating of the underside of the skin. This controlled thermal injury stimulates collagen organization and formation. The result is skin with a thicker dermis and more elasticity – ie. “tighter skin”.

However, there is no magic. Laser liposuction will result in tighter skin than traditional methods but it will not give a tight, smooth abdomen in a person who needs a tummy tuck.  It will not give a sculpted neck and jawline in someone who needs a necklift.  It does allow you to have liposuction in areas that plastic surgeons have traditionally avoided because of the fear of loose skin, such as the neck, upper arms, and inner thighs.

Laser liposuction may allow a more rapid recovery, but it is not the “lunch-time lipo” that has been promoted.  You will still bruise, you will still get swollen, and you will still be sore for a certain amount of time. This obviously will vary according to the amount of liposuction performed and on what area(s).

In summary, laser-assisted lipolysis can offer excellent results when performed correctly. It is commonly used in conjuction with traditional liposuction methods in order to give you an improved contour. I am a huge fan of Laser Liposuction – I use it in my practice and I routinely teach others how to use it.  However, I also make sure to give my patients a realistic idea of the improvements they can obtain. I never “over-sell” this because it will only result in a disappointed patient and an unhappy surgeon.

 Also remember, even though the incisions may be small, this is still a surgical procedure that requires a properly trained physician. Make sure your doctor is a board certified plastic surgeon and experienced with this laser technology. Also make sure this is performed in an accredited facility.