Heidi Montag: Sometimes you just have to say “No”

Much has been written recently about Heidi Montag and her “10 plastic surgery procedures in one day.”  I would like to give my thoughts about the many issues that pertain to this “story.”

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.  Read more

How To Choose Your Breast Implant Size

Selecting the size for your new breast implants can be a difficult task.  Many women allow this decision to “stress them out” because they fear making the wrong decision.  I will start out by saying that while the decision is important, it should not be a major source of anxiety.  Many women are too focused on the volume number (or “cc’s”) when the truth is that there is very little noticeable difference between close volumes – only your plastic surgeon (maybe) will be able to tell the difference between a 330 cc implant and a 350 cc implant after it is implanted.  In general, people only notice volume differences of at least 50 cc’s.

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.


Hot Trends in Plastic Surgery for 2010

As we enter a new year and a new decade, I thought it would be appropriate to give my predictions for “Hot Trends” in plastic surgery for 2010. Procedures like non-surgical fat and cellulite reduction will become even more popular, but there are some other, more “unusual” procedures that I predict will become more popular in the upcoming year. Read more

Permanent Lip Implants – A new option for fuller lips

One of the most common procedures performed is lip augmentation. This is generally done through the injection of dermal fillers, such as Juvaderm, Restylane, and Perlane. These fillers provide natural appearing, full lips when performed correctly, but the results are temporary, requiring repeat injections two or three times per year. These treatments are not only painful, but can be costly to maintain. At an average cost of $700 per treatment, maintaining the results can cost upwards of $7,500 over 5 years and a staggering $16,000 over 10 years!

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.

The Lobe Lift

We are all concerned (some same “obsessed”) with looking younger. This is part of the reason why plastic surgery continues to increase in popularity, despite any economic downturn. As a board certified plastic surgeon and Assistant Professor of Plastic Surgery at one of our nation’s top medical schools, I am experienced in every aspect of face and body rejuvenation.  As I continue to look for ways to help people look and feel younger, I noticed an area that is often neglected by people and their plastic surgeons alike – the earlobes.

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.