Monday, February 5, 2007

Common Cosmetic Surgery Questions

What procedures are new in Los Angeles / Fresno area cosmetic surgery?

Two procedures are now gaining popularity and we will have to wait and see just how popular they become. The first is revision of the bellybutton as a sole procedure. This can be done by removing a little bit of skin around the belly button and then carefully stitching inside the bellybutton in order to hide the scar. This produces tightening. It is an excellent procedure as a stand-alone bellybutton improvement surgery, or can be done after a Los Angeles liposuction or tummy tuck procedure.

The second set of procedures, which are becoming more common are nipple revision procedures for women.

  • Some women have large, droopy nipples, but these can be revised surgically at my Los Angeles / Fresno area cosmetic surgery practice. In my opinion, the best way to revise these is to carefully remove a cuff of skin from the base of the nipple. This pulls the nipple up and makes it perkier while still preserving nipple sensation.

    Older methods such as cutting off the top of the nipple can often produce attractive results, but have more chance of significant problems and of course entail a much longer healing process.

  • Inverted or "sucked-in"nipples can bother women for a lifetime. The revision can be done by pulling the nipple tissues outward after the area has been injected with local anesthetic. After the nipple is pulled outward, a small incision is made in the side of the nipple and the fibrous bands, which held the nipple down toward the inside of the breast are cut, and the incision is stitched. After this, no special care is needed. Bruising is typical immediately after surgery, but this should go away within 1 to 3 weeks. This procedure be performed at the same time as a Fresno-area breast augmentation cosmetic surgery and greatly enhances the results for those women who have inverted nipples.
For more information on nipple and belly button cosmetic surgery, please visit

What Fresno cosmetic surgery procedures may be "wrong" for most patients?

  • Thigh lifts are often problematic, and generally unacceptable for younger patients. This procedure causes scarring, and sometimes the scar will pull in unnatural fashion on the area around the private parts of a woman. Additionally, the scar tends to migrate or move down the leg as the tissues mature. While there are ways to help prevent or correct each of these problems, overall this is not generally a good procedure in younger women.

    Typical exceptions include individuals who have lost massive amounts of weight. At my cosmetic surgery practice near Fresno I offer liposuction in this area, and in many cases the skin will shrink adequately afterward. In an older woman with exceedingly loose skin, occasionally a thigh lift is an acceptable alternative, but only if the patient understands the potential problems.

    Additionally, thigh-lifts place the scar in a moist area that is somewhat difficult to keep clean, so infections are probably more frequent in this area than for other types of surgery in other areas. When an infection happens, the scars become even more spread than is ordinarily the case with case with body surgery. For all these reasons, thigh-lifts are not popular with the cosmetic surgery community and not all surgeons perform these procedures.

  • Another procedure that is performed by only a few is artificial pectoral implants in males (in the breast area). There are some hard silicone implants that are designed for placement underneath the muscle to simulate a body builder’s chest, but these implants sometimes are mobile, and you can often feel the edges of them, creating a very unnatural result. While it may be possible that someone somewhere is doing a good quality pectoral implant and getting results that are acceptable, I do not know of any.

  • Calf implants are another procedure that is not performed very often and that, in my opinion has unacceptable healing times and a questionable risk-to-benefit ratio. The hard plastic implant (polymerized silicone) is placed through a slit in the back of the knee into the area underneath the muscles of the calf. The patients have to walk around on their tiptoes for weeks to months in order to get the muscle tissue to stretch out around the implant, and this is very uncomfortable. The incision is not insignificant in this area and frequently will spread, producing a scar that may often be unacceptable.

So remember, when you are thinking about cosmetic surgery, you do not have to get "everything on the menu" - just as when you go to a good restaurant, you should not try to eat everything that is there. There are procedures that are appropriate for your particular body and those that are not, and you should consult with your surgeon about what is most reasonable.

For more information, read "Doctor, What Else Do I Need?"
If you are considering cosmetic surgery and live in the Los Angeles / Pasadena area, please visit for before and after photos and procedural information.

What kinds of cosmetic surgery procedures produce the most lawsuits against surgeons?

The answer to this question reflects several factors. First, it can reflect the kind of patients and the perfectionism of the patients who are interested in each procedure. Second, it may represent the difficulty of performing a given procedure well. Third, it may reflect the complication rate of the procedure. If the procedure has many complications, possibly there might be more lawsuits.
  • The number-one litigation or lawsuit risk for the cosmetic surgeon is nose surgery. This procedure represents less than 10% of the cosmetic surgery cases performed and about 1/3 of the lawsuits. Nose-improvement surgery is highly specialized and complex and probably should be performed by surgeons with ear, nose, and throat (facial plastic) background or maxillofacial background only, unless the cosmetic surgeon takes a lot of time to learn the procedure “hands-on” from a reputable training facility.

    The standard joke among cosmetic surgeons is that you should pay the first 100 patients for performing their nose surgery and after that, the patients can pay you. Nose surgery’s healing process is different than any other >Fresno area cosmetic surgery, and it may take a full year for the final result to be seen. A nose that might look good at 3 months might not look good in a year. Experience is everything, or almost everything. An experienced nose surgeon who has the artistic feel for whether what he is doing can produce beautiful changes and a nose that does not look “done.” There is nothing worse than a bad nose job and problems are so obvious right in the middle of a person’s face.

    Liposuction cosmetic surgery in Fresno, on the other hand, has relatively few lawsuits, only about 3% of the total lawsuits against cosmetic surgeons, although it must be about 1/3 to 1/2 of all the surgeries done. However, the problems with liposuction when they occur, are sometimes severe and might require hospitalization.

  • Breast reconstruction, especially when an implant is placed at the same time, requires a great deal of experience, and nipple loss is a possibility with some of the surgeries. This is obviously problematic. These cases have a disproportionately higher litigation rate. Ordinary breast augmentation, however, has one of the highest satisfaction rates in cosmetic surgery and has some problems, but no more than the average cosmetic surgery.

The most important message to take home from all this is if you want your nose done, get it with the most experienced surgeon, and choose your surgeon wisely in any case. Look at this plastic surgeon qualifications checklist for further information about how to choose your surgeon.

I have dark skin. How can cosmetic surgery help my scars?

At my Fresno area cosmetic surgery office I see many patients with dark skin: Filipinos, Hispanics, African Americans and others. These skin types do not do well with aggressive peeling procedures because these can lighten or darken the skin, sometimes for lengthy periods or even permanently. However, with special treatment, this skin types can respond beautifully to our skin care programs.

The first step in treatment of a person with irregular pigment problems of their face is generally to use bleaching agents. We often include Retin-A® for better penetration to lighten their entire complexion. After a month or so of this, frequently, light treatments with slightly destructive methods such as electrical burning may be indicated for problem areas. Then, the patient might be instructed to use the bleaching and penetrating agents some more or they may be allowed to back off and use only a mild treatment regimen and allow their pigment to return to the skin.

Acne scars and wrinkles are particularly difficult to treat in these skin types. The peeling procedures and the deeper laser procedures are just not appropriate for darker skins because of pigment change. The good news is that wrinkles are not usually as much of a problem as in light complexions where the sun exposure has to some extent aged the skin. Darker skins are just protected better from the sun because of the natural pigment.

We can effectively treat dark skinned patients who have even darker areas due to their acne. Acne can be treated with a variety of prescription and over-the-counter medications and there is a cure for it called Accutane®, which generally results in long-term improvement or complete cure of acne.

After these treatments are used, the bleaching creams and the smoothing creams can be employed to produce a complexion that is even and attractive. For some patients in Fresno, more intensive cosmetic surgery may be appropriate, but in general a carefully chosen regimen of laser resurfacing and/or other nonsurgical skin treatments is sufficient. The ultimate goal for complexion treatments of any kind is to produce a smooth even-colored look without the color irregularities that are present with some kinds of skin growths and/or skin irritations such as acne. We will individualize our approach to your skin type by evaluating you carefully and using our best judgment about what would help the most.