Silicone is Back

By Anthony Youn, MD

Breast augmentation is one of the most popular plastic surgery procedures today. According to the American Society of Plastic Surgeons, in 2005, 291,000 breast augmentations were performed, up from 187,000 just five years ago. The numbers of women undergoing breast augmentation are expected to rise substantially since the FDA lifted the 14-year ban on silicone gel breast implants in November. Breast augmentation is currently the plastic surgery I perform most often in my practice.

Why were silicone breast implants restricted from use with the general public for so long? The FDA placed a moratorium on these implants after numerous women came forward with what were believed to be arthritis and other diseases from gel implants. Subsequent large scale studies have not proven any connection between silicone gel implants and these “connective tissue diseases.” Because of this, the FDA has now allowed the use of silicone gel breast implants in all healthy, non-pregnant women over the age of 22 who desire these implants either for cosmetic improvement or for breast cancer reconstruction.

What’s the difference between gel implants and saline implants? A lot. Prior to November 17, 2006, the U.S. was the only major industrialized country to ban the use of these implants. Gel implants feel and look much more realistic than saline implants. There is no comparison between the two cosmetically.

Gel implants are softer than saline implants, and therefore feel more like real breast tissue. They are also not as prone to develop visible wrinkling which can occur with saline implants in women with a lack of breast tissue. The newest gel implants, like the MemoryGel implants from the Mentor Corporation, are now considered cohesive. This means that the gel which is inside does not leak out of the implant if there is a tear in the shell. It appears to stay in place.

While this provides the patient with some peace-of-mind, it is important to realize that the FDA recommends an MRI be performed three years after the implantation, and every two years thereafter to make sure there are no tears in the implant’s shell.

While most plastic surgeons and thousands of patients are applauding the FDA’s decision to approve silicone breast implants, many women continue to undergo breast augmentation using saline implants. Although not as realistic as gel implants, saline implants have been used nearly exclusively for the past fourteen years, with overall pleasing results. These implants are less expensive than gel implants (almost half the cost!), have a safety profile second-to-none, and require a smaller incision for placement.

Unlike gel implants, saline implants can be placed via the Transaxillary Endoscopic Breast Augmentation technique for the most hidden scar. Gel implants must be placed through either an incision under the breast or around the areola. In my practice, I’m finding that 2 out of every 3 women who undergo breast augmentation surgery are continuing to choose saline breast implants. Nearly all are extremely happy with their choice.

So where does this leave the patient who is unsure of which implant to use for breast augmentation? The best thing about the availability of gel implants is that women now have a choice on which implants to use. It is important to discuss this choice with your plastic surgeon to determine just which implant is right for you. Make sure to choose a plastic surgeon who is certified by the American Board of Plastic Surgery and has hospital privileges to perform breast augmentation. This way you know your plastic surgeon has been fully trained to perform the surgery you are considering, and hasn’t just completed a weekend course on the procedure. Look at the surgeon’s before-and-after photos, ask questions, and avoid “bargain-basement” cosmetic surgery centers which often hire poorly trained physicians. In plastic surgery as well as life, you often get what you pay for.

Dr. Anthony Youn is a nationally recognized, board-certified plastic surgeon and is a member of the American Society of Plastic Surgeons. He received his medical degree from Michigan State University in 1998 and completed his general surgery and plastic surgery training at the Grand Rapids MERC Plastic Surgery Residency Program. He also completed a fellowship with the Advanced Aesthetic Surgery Fellowship in Beverly Hills, California. He has privileges at William Beaumont Hospital in Troy and Unasource Surgery Center. He’s been featured on E!’s “Dr. 90210”.

Living Longer, Looking Younger

With Anthony Youn, MD

We are living longer. We are living healthier. We are living a more active lifestyle. Each time we turn on the radio or television today, we are reminded of new ways to stay fit, look good, feel good and remain active.

As a result of this country’s overwhelming desire to look and feel as great as possible – for as long as possible – the cosmetic surgery industry has seen record increases in customers. According to www.plasticsurgery.org, invasive procedures are up 38% over the past five years, while non-invasive procedures are up 58%.

Television shows such as The Swan, Extreme Makeover and Dr. 90210 have brought plastic surgery into our living rooms. Not only have these series made procedures less intimidating to the common viewer, they have also shown the incredible results you can experience.

While the television shows take several weeks’ worth of time and are edited it into a 60 minute time slot, the results reflected can be obtained for many people – not just the rich and famous.

So, if you are one of the millions of Americans looking for ways to fight the aging process, what do you need to know?

Some of the most common requested procedures that physicians are hearing pertain to facial plastic surgery. Facelifts, eyelid surgery, and body contouring is becoming more common as people try to look as young and fresh as possible.

Dr. Anthony Youn, a board certified plastic surgeon in Rochester Hills, says the key to successful outcomes begins with realistic expectations.

“When you are looking at anti-aging procedures, it is reasonable to take 10-20 years off your appearance,” says Dr. Youn. “To say you can take more than that off is wrong.”

According to Dr. Youn, the increased exposure to plastic surgery has benefited the industry, because it has led to more advances in minimally invasive surgery procedures. People also realize that surgery is possible for anyone, not just for the wealthy.

“The trend now is the less-invasive techniques. People in general don’t want to look like anyone else, like Jennifer Aniston for example. Many are pretty happy with how they look now. They just want to create a better version of themselves without visible signs of surgery,” says Dr. Youn.

If you decide to pursue plastic surgery, one thing to consider is your motivation. Dr. Youn points out that facial plastic surgery can enhance your life, but cannot make somebody happy.

“People who are in difficult times in their lives, divorced, lost a loved one, or are in other vulnerable situations such as trying to get their spouse back, should not use plastic surgery to make themselves happy,” says Dr. Youn.

Joan Rivers may be the poster-child for facial plastic surgery for many people. However, Dr. Youn explains that new procedures can make someone who is 60, look 45, but a natural 45.

The three dimensional procedures that are used today go beyond the “facial tightening” and focus on volumetric facelifts. These procedures help fill one’s face with fat taken from another part of the body, reprocess it, and place it back into the patient’s face. This procedure helps remove the gaunt look that is one of the first signs of aging.

“Three dimensional plastic surgery looks more realistic and is not just about the tightening and lifting,” says Dr. Youn. “Those who have had numerous lifts in the two dimensional style are the people you can point out in the mall, or on the street. Their results are more unnatural looking.”

When looking for someone to perform some of these highly skilled procedures, it is important to find a physician who is board certified by the American Board of Plastic Surgery. Those who are board certified by this organization have undergone formal training, testing and have a moral code of ethics to abide by.

“Our field has undergone numerous changes. It used to be about making people look younger, now the top plastic surgeons look to use their skills and technology to make people look better, more attractive,” said Dr. Youn.

The procedures that have increased the most since 2000, according to www.plasticsurgery.org include: buttock lifts, tummy tucks, upper arm lifts and breast lifts.

For minimally invasive procedures, the use of Botox is up 388% compared to 2000.

So, how safe is plastic surgery? Well, it is important to remember that it is surgery. And, with any surgery there is risk – even with the most skilled surgeon.

In his practice, Dr. Youn recommends patients visit their primary care physician to make sure they are healthy enough to undergo surgery. This can include checking a patient’s heart condition to make sure they can withstand several hours of surgery.

“Pretesting with a primary care physician is important. Safety is a top priority for a plastic surgeon,” said Dr. Youn. ”The longer a surgery is going to take, the more risk there is for complications, so pre-testing is very important. I have turned people down who want a lot of work done. I’ll put my status as a physician first, and a plastic surgeon, second.”

Patients should not “bargain shop” for a cheaper surgery. This should not be on the top of your list when looking for a plastic surgeon. As with anything we purchase as consumers, “you get what you pay for.”

As Dr. Youn stated, “You don’t regret surgery that you haven’t done. You only regret surgery that you have done. Even if you can save one person from a unnecessary surgery, it is a great thing.

It is important to get the word out. We are trying to educate the community and patients on how to do the research when finding a surgeon. There are the Wal-Marts of plastic surgery, and there are the Guccis’s and Fendi’s of plastic surgery. There are certain things you shouldn’t bargain shop for.”

Dr. Anthony Youn is certified by the American Board of Plastic Surgery and is a member of the American Society of Plastic Surgeons. He received his medical degree from Michigan State University in 1998 and completed his general surgery and plastic surgery training at the Grand Rapids MERC Plastic Surgery Residency Program. He also completed a fellowship with the Advanced Aesthetic Surgery Fellowship in Beverly Hills, California. His hospital affiliations include William Beaumont Hospital of Troy, Crittenton Hospital, and Unasource Surgery Center.