Is It Important to Wear a Bra With Your Breast Implants?

I repeatedly emphasize to our patients that good bras are important or the breasts will sag. If they wear the bras and have support all the time, particularly for the first year when the scar is forming around the breast implant, often the breasts will be just as perky five years later as when the breast implant is placed. However, especially if the breast implant is a large one, the patient will have unpleasant, unnatural, and unsightly sagging of the breast. Here’s an example where the patient, in spite of all my admonitions, is wearing a very lightweight bra, at only two months after breast implant surgery. We recommended to her that she consider a heavier bra like the Bali Minimizer bra, and as always we told her to continue on her fish oil and Vitamin E indefinitely in order to keep her breasts soft.

Liposuction For Men - Six-Pack Abs

Did you know that you could have sculpted abdominal muscles from your liposuction procedure? There are new options available that can give you a chance to look your best. Dr. Yoho specializes in removing all the possible fat from this “six-pack” area of the abdomen and also injecting a little bit of fat in each square of your “six-pack.” This fat tends to be retained and creates a bulging muscular look. While the recovery takes a little longer than with ordinary liposuction, the results can be stunning. Additionally, we make a special effort to suction the fat from the creases of your abdominal muscles, thus creating more definition. Feel free to schedule a complimentary consultation about this exciting new procedure.

Information About Breast Surgery

We require patients to write out the following so they absolutely understand some of the complications of breast implant surgery: “There will be problems.” “We do not know what problems.” “I will feel the implant.” “I will have rippling.” “They will be unequal or asymmetrical.” “I will need to wear a bra to prevent sagging.” “Sometime in the future I may want or need a breast reduction or lift.”

After the patients write this, we discuss with them all the possible complications of breast surgery. Breast surgery has one of the highest satisfaction rates in our practice, and breast augmentation has been a mainstream procedure in America, with about 10% of women here having breast implants (at least in California). However, there are some problems. In the Allergan® implant study, a re-operation rate of 1 in 3 patients was found after 5 years for silicone implants. It is likely that the saline breast implants have a high re-operation rate also. The biggest problem is capsular contracture, which is a firming or hardening of the implants. This may occur in 5% to 10% of the patients who have breast implants. Fortunately, there are now some medical treatments for capsular contracture including fish oil, which I believe is an anti-inflammatory. We recommend a dose of 4 grams a day. Also, we have a medication called Accolate, which is FDA-approved for asthma. It is not FDA-approved for treatment of other conditions, and so this is an “off-label use of an on-label drug.” Doctors are allowed by law to use drugs that are approved for one disease to treat other conditions. Unfortunately, for Accolate, there have been a few reported instances of liver failure. The chance of liver failure seems to be one in several million per patient. By comparison, every person in America has approximately a one in 8,000 chance of dying in an automobile accident each year. In any case, we want our patients to understand that breast implants are not perfect.

One of the other complications we see, if the patients do not wear good bras, is a “rock in the sock” problem. That is when the skin envelope or the breast itself sags, and the implant sags down with it until you get a very saggy breast with an implant resting at the bottom of it. This can be prevented if a good bra is worn. We recommend wearing a bra at least during the day and, better yet, 24 hours a day for the first 7 to 8 months while the tissues are healing properly. We show our patients that a bra should put pressure on their shoulders and should lift their breasts. This is part of the advice we regularly provide during our complimentary consultation and during the postoperative process as well.


_______________________

Robert Yoho, M.D.

Advances in Breast Augmentation

Belly button breast augmentation or "TUBA" is one of the innovative techniques in breast augmentation surgery that has rendered obsolete many of the surgeries that leave scars on the breast, such as the through-the-areola approach. While some patients need to be treated by the through-the-areola approach because of odd-shaped breasts or other problems, the TUBA approach can put the implant in through the belly button without any scars anywhere near the breasts.

In experienced hands, this technique works wonders for many patients. It seems to have a lower rate of complications, such as capsular contracture, which is firming of the breasts. This complication accounts for the highest of all of the problem rates in breast augmentation surgery.

Dr. Peter Cheski pioneered and invented this technique, and Dr. Yoho learned his technique right from Dr. Cheski, working closely alongside him in his office over the years. Dr. Cheski was at the point where he could perform one of these surgeries in 10 to 15 minutes with virtually no help outside of a scrub tech and a sedation person who watched the monitor. He performed many tens of thousands of these surgeries over the years, and Dr. Cheski is regarded as one of the pioneers in breast augmentation.

Please come in for a look to see whether this procedure is appropriate for you. We love its results, but you must be evaluated before having the procedure.

Sculpting a Six-Pack

Did you know that there are new liposuction techniques that can get you more definition of your abdominal muscles than ever before? These new techniques include special aggressive suction of the fat in between the muscles, which can be done with ordinary liposuction or with other types of liposuction machines. Dr. Yoho’s belief is these new machines don’t yield any significant advantage. However, the real news is that a tiny bit of fat injected into the muscles of the abdominal area makes for greater definition and a much better result. This has to be done carefully and with experience, to ensure that the muscle squares are enhanced and improved. It helps to have good muscle tone before the procedure, but you don’t have to be slender. The liposuction itself can do that.

The Biggest Issue in Breast Implants Part 3: Breast Implantation Issues

Judy in Trinidad

How is capsular contracture or hardening of the breast implants treated?

First, as mentioned in the past essay, we attempt to prevent this by encouraging the consumption of fish oil and Vitamin E. These home remedies are not clearly established to prevent capsules, but there is a lot of circumstantial evidence suggesting that they do.

Second, if you have a capsule, there are various remedies, and one of the things that has been thought to work is a medicine for lung disease called Accolate, or another related medicine called Singulair. These brand-name medicines are commonly used by lung doctors to improve lung functioning in certain kinds of asthmatic and other conditions. They have a very small statistical rate of some serious problem, so be sure to talk to your doctor about these before taking the medicines. In any case, they're expensive and they need to be taken for four to six months in order to be effective. The earlier you catch your capsule, in other words, the softer the breast is before starting the medicine, the better chance you have of correcting the problem with a medication.

We also increase the fish oil to a higher dose, although as stated before, this is not clearly known to be effective. We have seen interesting cases in which a person who stops taking their Vitamin E or fish oil and develops a capsule within a month, but of course, this doesn't prove anything for sure.

Surgery for capsular contracture is problematic, because the chances of the problem coming back are very, very high after most any surgery. The traditional approaches include removal of the capsule, which sometimes is difficult, especially under the muscle, and replacement of the implant in a different plane. This means that if the implant was above the muscle, you put it below the muscle; and if it was below the muscle, you put it above the muscle in the secondary operation. The chances of a return of the hardening of the breast after these surgeries is a disappointing nearly 50 percent.

Unfortunately, the Allergan study, which encompassed many, many thousands of women with breast implants and silicone gel implants, had a secondary operation rate of about one in three after seven years. This means that you must not view these things as a permanent solution to small breasts unless you're lucky.

Judy, my wife, has had her implants for about 15 years and has never had any problem except for a slight firming on one side, so she might be the exception rather than the rule.

Best of luck, and if you get breast implants, be sure you have a good surgeon who will be happy to follow you for any problems afterwards.

The Biggest Issue in Breast Implants Part 2: The Advantages and Disadvantages of Various Breast Implant Techniques

Seattle Port at Night 2

Part 1 covered some of the aspects of above versus below-the-muscle implant placement. One more note about this issue: There was a large-scale study over 20 years ago that showed that with silicone implants that there was a higher capsule or hardening rate with over-the-muscle implants. Subsequent studies have not shown this to be true, so even though this remains as an urban legend, it probably has not been verified. It probably isn't the case.

This brings us to the subject of this essay, hardening or firming of the breast implants or "capsular contracture." Capsular contracture is the most likely complication after breast implantation, and many studies show that rates are about 5 percent or 1 in 20. When capsular contracture occurs, the breast implants become hard and sometimes progressively so, to such an extent that the women can't stand it and want them removed. Most capsules have no significant health impact, but they can be uncomfortable and be cosmetically unacceptable.

The things we try to do to avoid a capsule after the breast implant surgery are threefold.

First, we encourage the use of good-fitting bras (this also helps decrease problems with the implants descending).

Second, we encourage postoperative patients to take fish oil. Fish oil is an anti-inflammatory and we think that it decreases the capsule formation, although this has never been formally studied and may be another urban legend.

Third, Vitamin E at doses of 400/800 International Units a day also helps decrease the chance of a capsule formation.

No one really knows what causes these complications, but certainly if you have some inflammation or an infection or extra blood around the implant, these all typically do increase the risk of capsule formation. But most capsules are of unknown cause, and some women just seem to be capsule-formers. It's possible that the breast ducts which connect with the outside in some women are colonized or infected with bacteria and this may contribute to capsule formation, but this is unclear.

Certainly if you're lactating, your chances of a capsule are much higher, and so for this reason we recommend that you not consider breast implantation for a full three months after having your baby (if you do not breast feed) or after stopping breast-feeding.

The Biggest Issue in Breast Implants: A 3-Part Series

Pasadena's Natural Beauty

 Part 1: By far the most important choice you will make in your pursuit of bigger breasts is whether to put the implant above or below the muscle. The muscle is a wildcard that produces many effects, not all of them good. Understanding all of these options and possibilities is very important. 

We recently took the Sports Illustrated swimwear, swimsuit model edition, and analyzed the problems with the women's breast implants. Many of the under-the-muscle placements had resulted in the implant being pushed out toward the side and down. The girls in the Sports Illustrated photographs were often holding their breasts toward the middle, and many times the implant had dropped or been forced down lower than it might naturally have done so by the muscle action. 

Under-the-muscle implants are supposed to produce a more natural curve in the upper part of the breast area, and perhaps they do for a while. However, eventually most "under the muscle" implants get pushed down so the muscle is no longer really covering them. 

Of course, it's possible and even likely that over-the-muscle implants droop also, unless they're protected by a good-quality bra most of the time. These implants, however, tend to sag straight down. 

Efforts to repair problems like these are relatively hazardous compared to the initial implant surgery. The medical journals are full of reports of nipple areolar area death and a higher infection rate and other problems due to attempts to improve breast implants. 

One particular article I show the patients who want surgery because their breasts have stretched out, and this article shows in living color nipple areolar complex or nipple areolar area skin death and loss of the nipple and areola. 

Even though breast implants have problems, they are still the most popular and the highest satisfaction cosmetic surgery we have. Women who improve their bustline often feel much more confident and are able to perform at a higher level in many ways. 

Fish Oil Is Just Fantastic Stuff, or: Everything You Wanted To Know About Fish Oil but Were Afraid To Ask

Fish oil has been shown in studies to be an excellent anti-inflammatory. It actually has been used for rheumatoid arthritis to decrease inflammation and pain, and it really works as been proved by scientific study. We use it to attempt to decrease breast firmness after breast implantation, which is the most common complication. Capsular contracture or breast firmness occurs in at least 5% of all breast implants and it is a very aggravating problem for both surgeon and patient. It’s our belief that taking fish oil in reasonably large doses, perhaps a teaspoon a day or more of the liquid fish oil (the equivalent of five of those large 1g pills) can be very useful. The best fish oil is refined fish oil which has had the mercury removed. We recommend Nordic Naturals, Carlson, or Eskimo brand fish oil. Nordic Naturals has the biggest reputation, but it may be more expensive. Buy oils online because they are costly. Nordic Naturals is available in several grades. It is important to become knowledgeable about active components in the fish oil and consider buying the more expensive types. We use larger doses at times to combat capsular contracture.

Fish oil is also good for certain kinds of heart problems, and is heavily recommended for people with high triglycerides, which is part of the cholesterol problem. Dr. Yoho takes fish oil every day for an arthritic ankle and so he is certainly an advocate himself.

All About The Total Makeover

Robert Yoho, MD playing with his daughter

Generally, facial procedures are done “all in one.” In other words, facelifts, eyelids, cheek implants, chin implants, noses, and laser resurfacing are often performed at the same time. This has been the traditional approach and is felt to be reasonable by the medical community. 

 However, the “total body makeover” where all this facial work is done and then breasts and liposuction are all performed together we think represents an extreme risk. One of the problems with this involves anesthesia time, which increases the problems with blood clotting and other medical issues related to the anesthesia. Surgeries over a couple of hours to us seem relatively unreasonable, although sometimes our facial surgery or breast lift will extend three hours or a little more.

So beware of the “total makeover.” We think that it’s easier for you and makes more sense to approach these things stepwise, thus getting to know the quality of your surgeon and the quality of the results bit by bit.

GUESS THE IMPLANT VOLUME! (PASADENA / VISALIA COSMETIC SURGERY)

Now these implants are all the SAME number of cc's or exactly the same volume! However, they are different "profiles". The one on the left is a "low profile" implant, while the one in the middle is a "medium profile" implant, and the one on the right is a "high profile" implant. Generally the "high profile" implants ripple less, or "show" through the skin less. We almost exclusively use "high" profile implants; they are more like a natural breast shape and have a pleasing projection quality. The cost to us is somewhat more, but it's worth it to satisfy our patients. The sample from the far left is a little yellow because it's an old specimen. These are all silicone implants with a smooth surface. See DrYoho.com at the following link for more details. Our office services Pasadena, Fresno, Visalia, and Los Angeles Cosmetic Surgery and Breast Augmentation patients.

Why Discount Breast Implants Are a Bad Deal in Los Angeles

This is a cliff known as Tahquitz in the mountains near Palm Springs.

Did you know that implants of different shapes have different costs to the doctor? And did you know that the discount Los Angeles breast implant surgeons generally use only the cheapest breast implants?

Implants made by the two major manufacturers approved for USA use have almost identical shapes. There are three types: flatter (the oldest and cheapest), intermediate, and “high profile.” The high profile implant, for the same volume, has a narrower base diameter and has a bit higher “projection” or distance out from the body when placed under a breast. This is the best implant for most people, but it’s significantly more expensive. In order to visualize this better, the lower or flatter profile implant is shaped more like a Frisbee (not this flat, but you get the idea), while the higher implant looks more like a real breast. The higher profile implants ripple less, a significant consideration especially when saline implants are used.

Now, base diameters must match the patient’s chest. If you have a larger chest, maybe the flatter implant is OK for you to help your cleavage, but for implants over about 350 cc volume, we use almost exclusively the more expensive high profile implants because they look better and the base diameters are usually fine for even a bigger chest. We won’t compromise the result by spending less on the implant. And the wholesale cost of the implant from the manufacturer is a significant part of your breast implant expense.

The Los Angeles breast implant field is an art, because women’s breasts are all different and we have to match your psychological needs for size and shape with both your breast type and the implant choices. We also use different approaches—over versus under the muscle and the different surgical approaches—to try for the best result for you. For example, with relatively large breasts that do not sag, there are many options. Many times, patients like this get the best results with a through-the-armpit approach over the muscle, but under the “fascia” or skin of the muscle. This has many advantages of If you have saggy breasts, many times just an implant will be enough. You may not need a lift, which puts scars on the exterior breast. But some breasts need a lift to get the right result. And if you have very little breast tissue, through the belly button under the muscle may be best. And the “peri-areolar” approach, given careful closure of the incision, gives the best control of the breast pocket and the incision usually almost vanishes. The areolar skin is sort of like lip skin, it hides scars well if the surgeon does his or her job well.

A “one size fits all” approach just won’t give the best results for every person. For example, one surgeon we know only performs his breast implants as over the muscle through the crease at the bottom of the breast. I can’t believe his results are consistently the best. And because his prices are so cheap, I’m sure he’s using only the low profile implants, which aren’t optimal in most cases.

We like silicone implants, but it’s of course your choice if you can’t afford the silicone implants (wholesale cost roughly $2000 to the doctor), or have concerns about silicone. And while we are on the subject, I want to mention the “gummy bear” implant. It’s great marketing, but these implants are hard and unnatural. Too hard for my preference. And they are touted to have a thicker silicone that won’t migrate or run into other tissues if the implant shell ruptures or breaks. I don’t think this is true based on what I have seen when the implants are cut. The silicone in these implants runs and is just as sticky and has characteristics just like the silicone which is used in ordinary implants.

Check out three implants of the same volume, with the three profiles to show the three profiles we use for our Los Angeles / Fresno/ Visalia area patients, here. Remember the high profile implant, the more expensive one, is usually best for implant sizes above 350 cc. You get what you pay for. And you will have a really hard time making decisions about all this complex stuff by yourself, no matter how much reading you do. Try to keep an open mind when you come in for your consultation(s). Choose a surgeon who’s willing to carefully select a size, style, and surgical approach that has the best chance of working, and who is experienced with all four surgical approaches to breast augmentation. And be patient if you don’t get what you want right away. Implants often need to settle into place, and sometimes months of treatment with oral medicines can help this, rather than insisting on an immediate secondary surgery. Much more information is available at DrYoho.com, in particular see this link.

Dr. Yoho has patients come from Glendale, Burbank,

Pasadena, Los Angeles, Encino, Huntington Park, Studio City,

Arcadia, Montrose, Hollywood, La Crescenta, La Canada

Flintridge, Valencia, Monrovia, Eagle Rock, Altadena, San

Marino, Sherman Oaks, Thousand Oaks, North Hollywood,

Long Beach, Beverly Hills, Van Nuys, Santa Monica,

Calabasas, Palmdale, Fresno, Northridge, and Westlake

Village, and Simi Valley to have their “man boobs” or

gynecomastia improved with our special surgical technique.

Our Cosmetic Surgery center in Pasadena, California

specializes primarily in Cosmetic Surgery including

breast augmentation, liposuction, tummy tuck,

cosmetic facelifts, Forehead Lift, Chin and jowl liposuction,

Eyelid Surgery and other body contouring procedures.

The center led by an expert Los Angeles Cosmetic

Surgeon. Dr. Yoho has passed the

boards in Cosmetic Surgery and is dedicated to providing

high quality yet affordable cosmetic surgery options

to his patients and being the best cosmetic surgeon in Los Angeles 

  Glendale, Pasadena, and Beverly Hills.

Cosmetic surgery SEO

Traditional Breast Lifts/reduction versus the new “Vertical Mastopexy/Ice Cream Cone” Breast Lift (with or without implant or reduction)

When you are unhappy with your breasts, there may be three reasons:
1) volume
2) shape
3) positioning

Positioning really refers to how saggy the breasts are. If your only concern is volume, and you don’t have a problem with the shape or positioning or , breast liposuction or an implant may be the best choice. Most patients can achieve a one to two cup size reduction with liposuction, and a 1 to 2 inch nipple elevation with liposuction alone.

If you are concerned with the shape but you generally like the size of your breasts, then the “Ice Cream Cone/Vertical Mastopexy” may be the procedure of choice for you. This procedure can provide a volume reduction if necessary but it’s primary function is to shape the breast and re-position the nipple areolar area. If for some reason after this procedudre, you decide you want a bit more volume, it’s not a problem to place an implant 4 to 6 months later. About 50 per cent of patients choose to put an implant and 50 per cent are happy with the lift only without implant.

Note that the traditional “anchor” scar procedure is generally regarded as not as satisfactory as the vertical mastopexy. This older procedure needs a scar all around the bottom of your breasts plus a scar up the middle plus a scar around the areola as well. It does not hold up as well as the vertical mastopexy, and tends to sag sooner. Also, the newer procedure needs only a scar down the middle of the front of the breast and around the areolae.

Remember whatever choice you make, if you need an implant, it’s always better to do this procedure in two surgeries. This is because if you have the implant put in and reduce the breast as well, the forces on the breast tend to pull the scars apart. When you do the lift first, then put the implant in later, the breast tissues hold up better and there’s less risk of sag and other unsatisfactory results. .

Note: Dr. Yoho does not usually perform the anchor-type scar procedure, the traditional breast lift. However photographs of the other procedure both with and without implants are available at DrYoho.com.

Dr. Yoho's Chapter published in a Breast Augmentation Book

See

(link)
for a large sample of this book. Dr. Yoho's article was about how to alter the implant pocket without going into the implant space. The ideas it contained were originated by Dan Metcalf and Roy Morgan MDs. The technique consists of suturing the skin to the underlying tissues to make a breast implant pocket smaller.

What's the Difference Between a Plastic and Cosmetic Surgeon?

Question:
"What's the difference between a plastic and a cosmetic surgeon?"

Answer:
The best explanation is produced by the American Academy of Cosmetic Surgery. We have reproduced this at DrYoho.com; click here to read more about plastic vs. cosmetic surgeons


Basically, cosmetic surgery is a field of beautification surgery. This includes eyelids, facelifts, breast enhancements including lifts and breast augmentation, and liposuction, among other surgeries. Plastic surgery also includes many other types of surgery, such as hand surgery and complex surgeries cooperating with other surgeons doing reconstruction work. Plastic surgeons typically work closely with other surgeons in hospitals to perform care on sick patients. Some of them also do Los Angeles / Fresno area cosmetic surgery.

If you want to read a comprehensive article about how to choose your surgeon, and understand just how the physician training and experience impacts the performance of various surgeries, refer to this chapter of my book on cosmetic surgery.

This is a pretty complex subject and you need to exercise some judgment and do your homework. Be sure to verify the credentials of your Los Angeles / Fresno area cosmetic surgeon, and research their methods to get a better idea of your options.

Breast Lifts & Reduction in Fresno

Question:
Traditional Breast Lifts/reduction versus the new “Vertical Mastopexy/Ice Cream Cone” Breast Lift (with or without implant or reduction) - what's the difference?

Answer:
When you are unhappy with your breasts, there may be three reasons:

1. volume
2. shape
3. positioning

Positioning really refers to how saggy the breasts are. If your only concern is volume, and you don’t have a problem with the shape or positioning, Fresno, CA breast reduction using liposuction, or a breast implant, may be the best choice. Most patients can achieve a one to two cup size reduction with liposuction, and a 1 to 2 inch nipple elevation with liposuction alone.

If you are concerned with the shape but you generally like the size of your breasts, then the "Ice Cream Cone" / Vertical Mastopexy may be the procedure of choice for you. This procedure can provide a volume reduction if necessary but its primary function is to shape the breast and re-position the nipple-areola area. If for some reason after this procedure, you decide you want a bit more volume, it’s not a problem to place an implant 4 to 6 months later. About 50 per cent of patients choose to put an implant and 50 per cent are happy with the lift only without implant.

Note that the traditional “anchor” scar procedure is generally regarded as not as satisfactory as the vertical mastopexy. This older procedure needs a scar all around the bottom of your breasts plus a scar up the middle, plus a scar around the areola as well. It does not hold up as well as the vertical mastopexy, and tends to sag sooner. Also, the newer procedure needs only a scar down the middle of the front of the breast and around the areolas.

Remember whatever choice you make, if you need a breast augmentation Fresno, it’s always better to do this procedure in two surgeries. This is because if you have the implant put in and reduce the breast as well, the forces on the breast tend to pull the scars apart. When you do the lift first, then put the implant in later, the breast tissues hold up better and there’s less risk of sag and other unsatisfactory results.

Note: I do not not usually perform the anchor-type scar procedure, the traditional breast lift. However you can view my gallery of past breast lift before and after photos to get a better idea of what the vertical mastopexy can achieve.

Cosmetic Surgery Procedures After Pregnancy

Question:
What kind of cosmetic procedures are best for me after a pregnancy?

Answer:
Everyone is an individual and must be evaluated in person; however, many women have deflated and saggy breasts after breastfeeding. Breast augmentation for Fresno-area women can restore the original contours or even create a contour that the patient enjoyed during her breastfeeding days. Many times, no cutting is necessary on the skin of the breast, and the implant can be inserted through the bellybutton without cutting the surface breast tissue to any significant degree or disturbing the nerves to the breast.

Most implants are inserted under the pectoralis muscle. They do well because there is a natural drainage of any slight bleeding into the fat of the abdomen rather than the blood staying in the area around the implant. This bruising on the abdomen rather that around the implant helps decrease the chance of scarring around the implant (capsular contracture). This scarring around the implant can make an implant quite firm and sometimes even painful, but a qualified surgeon will be able to explain what techniques he or she will use to minimize this risk.
For more information, please visit my Los Angeles cosmetic surgery website

Another common procedure performed after pregnancy is liposuction. This procedure is very helpful for women who have exercised enough and have had good enough muscle tone of their abdomen. Skin sagging that occurred after the baby was born can often be improved with liposuction alone if it is not too extreme. The liposuction disrupts the skin tissues underneath the surface, which causes them to contract. As surgeons know, skin contraction occurs in every direction for several weeks after any injury and sometimes for longer. In the case of liposuction the damage is minimal and internal, and the skin is allowed to contract back towards the muscle wall. In the best case, smooth, tighter, natural-looking skin can be produced by liposuction alone.

For those women whose muscle walls do not recover from the stretch of having that extra 20 to 30 pounds of baby and baby support system, muscle wall tightening can be performed. The “ Los Angeles tummy tuck” consists of making an incision from hip to hip and then making a passageway right next to the muscle all the way up to the ribs. In this passageway, the muscle wall is sewn to itself in a sort of pleating process which tightens the muscle. Then the skin is pulled down, extra skin is trimmed away, a new bellybutton is shaped, and the skin is sewn along the lower abdomen. Unfortunately, this method does produce long scars. Also, unless great care is exercised, some of the belly buttons are not very natural-looking. However, a qualified Fresno area cosmetic surgeon should be able to create a result that looks and feels natural.

Another way to tighten the muscle wall - if the skin is not tremendously loose - is to do it through the bellybutton. In this method, a bit of liposuction might be performed on the front of the abdomen, and then a little circular cut is made around the bellybutton. After this, passageways are made in the midline above and below the bellybutton and again the muscle covering is stitched to itself with permanent sutures. This procedure cannot tighten the skin, but the skin often will shrink fairly well later on if the muscle wall is tightened. This avoids the long scar of the tummy tuck, but again care must be taken with the bellybutton or unnatural bellybuttons with scarring right on the surface can result.

Please visit my liposuction Los Angeles website for before and after photos and information about these and other cosmetic surgery procedures.

Common Cosmetic Surgery Questions

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

Answer:
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 www.dryoho.com.



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

Answer:

• 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 www.dryoho.com for before and after photos and procedural information.



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

Answer:
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.



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

Answer:
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.