Why your breasts change – observations from the beach

As I lounged on the beach this weekend (with my SPF 50), my eyes wandered to all the breasts around me. It’s ok, because as I tell my wife, it’s all “research” and I assured her it was for my latest blog entry. Breasts can be found in a variety of shapes and sizes. But the point is that the breasts that I observed are likely not the same size and shape that they were five years earlier. Breasts are extremely susceptible to changes – they change with age, weight, pregnancy, and breast feeding. To understand why, we have to examine the physiology of the female breast.


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Not all Plastic Surgery is “Bad Plastic Surgery”

The popular magazines (insert your favorite “Weekly” here) are filled with pictures of celebrities and his or her “bad plastic surgery.” I am even guilty of offering my comments in several of these magazines about what specifically is wrong about the particular celebrity’s look. I have been quoted calling Madonna’s cheeks “bizarre”, Christina Aguilera’s breasts “too big for her body”, and Mickey Rourke’s face “overdone.” (more…)

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Breast Augmentation
New Breast Funnel Improves Breast Augmentation Results

I perform a lot of breast augmentations, especially as we approach the warm summer months. While my results have been excellent, there are a few things that we as plastic surgeons have little control over: the development of capsular contracture, implant rupture, and poor scarring. Of course, we use a variety of techniques to reduce the incidence of these things, but there still remains a large unknown component. (more…)

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Plastic Surgery
New York City Smooth Tuck

Click here to view Dr. Schulman's Smooth Tuck procedure featured on FOX News. There is only one place to get this innovative new abdominal contouring procedure, contact Dr. Schulman today.

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Plastic Surgery
Now Entering the Plastic Surgery “Busy Season”

Every profession has a “busy season”, and we are now entering the busiest time of year for cosmetic surgery. March-May is the time of year when people finally pull the trigger on the plastic surgery that they have been thinking about for years. There are several reasons for this: (more…)

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Breast Augmentation
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.  (more…)

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Breast Implants
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.


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Plastic Surgery
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. (more…)

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Lip Augmentation
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.

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Lobe Lift
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.

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Tummy Tuck vs Liposuction

Many patients are unhappy with the appearance of their abdomen.  They may complain about the extra fat, the loose skin, the lack of tightness, or the presence of stretch marks.  It is important to understand the difference between a Tummy Tuck, or abdominoplasty, and Liposuction in order to decide which is most appropriate. 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.

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Breast Implants
Silicone or Saline – Which is the better breast implant?

Several times each day I am asked the question, “Is silicone or saline a better implant?”  I explain that I cannot say which is “better” because it is impossible to define “better.”  Also, breast implant selection is a very personal decision.   I do tell my patients that silicone implants tend to look more natural and feel more natural.  They then must decide if this constitutes “better” in their mind.  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.

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Laser Liposuction
Laser Liposuction – Is it worth the hype?

One of the “hottest” trends in plastic surgery is Laser Liposuction.  Many physicians promote this new technique as the latest and greatest in body contouring.  They point to smaller incisions, less bruising and swelling, greater skin tightening, and faster recovery. But is this hype justified, or is this just a creative attempt at marketing in a down economy?

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.

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Plastic Surgery
Candidate for Mommy Makeover New York

It is obvious that pregnancy and childbirth has a tremendous effect on a woman’s body.  These changes are the result of the weight fluctuation and hormonal changes that accompany pregnancy. Commonly, women complain of abdominal laxity and stretch marks, increased fat of the lower abdomen, thighs and hips.  Women also complain about the changes in their breasts. Breasts commonly decrease in size and become “droopy”, often accompanied with stretch marks around the nipples. (more…)

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Breast Augmentation
Breast Lift or Breast Implants

I am constantly asked by women whether they should get breast implants or a breast lift.  There seems to be a lot of confusion on the part of women interested in breast surgery.  Understanding the benefits of each procedure will help to eliminate the confusion and help you decide which procedure will best meet your needs. (more…)

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