Rochester Hills Plastic Surgeon Offers New Web Site Designed to Inform and Create Online Community

Rochester Hills, MI – Rochester Hills plastic surgeon, Joseph E. Mark MD of Plastic Surgery Arts & Spa launches an innovative website designed to educate, connect and inform visitors with the latest advancements in both surgical and non-surgical procedures.

More than a cosmetic surgery office, Plastic Surgery Arts & Spa considers each new patient or client part of its family of thousands. Clients will now be able to use the Web site to connect and communication with the staff and Dr. Mark himself.

plasticsurgeryarts.com provides patients the opportunity to Get To Know Dr. Mark from the comfort of their own homes long before their first visit to Mark’s state-of-the-art surgical facility located in Rochester Hills.

The Web site also features before-and-after photos of many of Dr. Mark’s procedures, a Get To Know Doctor Mark tutorial, and testimonials from patients. Using valuable links to the My Body Network, clients will also have the chance to learn more about procedures performed at many other trusted area offices, and communicate with previous and current patients before receiving treatment.

PlasticSurgeryArts.com launches this week with promotions and drawings each day for visitors. The Endless Beauty Online launch event runs Feb. 22-27 with a grand prize drawing on Saturday, Feb. 27 of a complete makeover at The Spa at Plastic Surgery Arts.

For complete details, visit www.plasticsurgeryarts.com.

New Technology for Cellulite, Skin Tightening Offered in Rochester

Rochester, MI – Plastic Surgery Arts & Spa announces Lipo Shaper, a non-invasive aesthetic device that tightens skin, re-contours the face and body, reduces cellulite (orange peel). This safe treatment works for all skin types and colors, and offers solutions to the inevitable problems of weight gain and aging skin.
 
“Prior to bringing Lipo Shaper into the office we tried the procedure on several patients,” said Tina Polleiner, Facility Director for Joseph E. Mark, MD at Plastic Surgery Arts & Spa. “They loved it so much they brought their husbands in for treatment!”
 
The Lipo Shaper technology is a non-surgical alternative to weight loss and body re-contouring. Tighten lines and sagging skin and remove excess weight without pain and down time. Patients see results from the first treatment and know that each treatment brings better results.
 
• Tighten the jaw line, reduce jowls, re-contours the chin line, and reduce excess tissue under the eyes.
 
• Smooth the orange peel look caused by cellulite, tighten loose skin and re-contours body measurements.
 
• Firm the breast; tighten loose skin under the arms or on the stomach.
 
• A non-surgical alternative for obesity and liposuction treatments.
 
• Excellent for pain relief and increased healing recovery – Sports Medicine – Post Surgical Surgery Free Alternative for Skin Tightening Cellulite (Orange Peel) Face and Body Contouring
 
Plastic Surgery Arts & Spa is located at 1886 West Auburn Road in Rochester Hills. Joseph Mark, M.D., F.A.C.S., is a Board Certified Plastic Surgeon with more than 28 years of practice in the art of plastic surgery. He is dedicated to providing the finest quality of medical care in cosmetic surgery. For more information, call (248) 606-0000 or visit www.plasticsurgeryarts.com.
 

Better Than Botox: Rochester Plastic Surgeon Offers New Procedure

Rochester plastic surgery center announces new treatment to reduce fine lines and wrinkles. Certified plastic surgeon, Dr. Joseph Mark of Plastic Surgery Arts & Spa is one of the only certified surgeons in the Oakland County area offering DYSPORT for the treatment of fine lines.
 
DYSPORT, was recently approved by the US Food and Drug Administration in late April 2009 as a successful treatment of glabellar lines. The treatment is an acetylcholine release inhibitor and a neuromuscular blocking agent.
 
Medicis, the leading independent specialty pharmaceutical company in the United States focusing primarily on the treatment of dermatological and aesthetic conditions has rights to market DYSPORT in the United States for the aesthetic indication (glabellar lines).The company and its products are dedicated to helping patients attain a healthy and youthful appearance and self-image.
 
Plastic Surgery Arts & Spa is currently offering both DYSPORT and Botox ® as treatment to fine lines. More information on DYSPORT, current patients and clinical trials is available by contacting Plastic Surgery Arts & Spa.
 
Plastic Surgery Arts & Spa is located at 1886 West Auburn Road in Rochester Hills. Joseph Mark, M.D., F.A.C.S., is a Board Certified Plastic Surgeon with more than 28 years of practice in the art of plastic surgery. He is dedicated to providing the finest quality of medical care in cosmetic surgery. For more information, call (248) 606-0000 or visit www.plasticsurgeryarts.com.

Ask the Doctor: November 2008

Question: What are the least invasive procedures for breast augmentation?

Answer: Breast augmentation in this day and age should be a minimally invasive surgery. Why would anybody want a large incision on their breast or axilla(armpit)? For the longest time physicians were taught that you needed maximum exposure to all surgeries. The scar was thought of later and the line “it heals pretty well” was always used to tell the patient that the scar was going to be long and obvious.

What patients may not know is that depending on the implant, incisions may be anywhere from about an inch for silicone implants to about one third of an inch for saline implants. Minimally invasive breast augmentation, which is another word for camera-assisted augmentation, is not new. It has been pioneered for about 15 years but what has changed is the relative size of the cameras. They are now down to a quarter of an inch and in fact can go smaller resulting in smaller and smaller incisions. However the limiting step is the actual implants and their respective diameter. The silicone implant can be squeezed through about a one inch incision because they come pre-filled with silicone gel. The saline implant however comes empty and can be squeezed to about one third of an inch and then filled to the desirable volume with saline once inside the breast.

Endoscopic breast augmentation was first used to do the surgery trans-axillary, but it still left about a one to one and a half inch scar. A new procedure called PEBAM uses a miniaturized camera system and surgical tools that allow the trained surgeon to do the surgery with one third of an inch incision. It can also be used to do the surgery through the umbilicus (belly button), placing the implants under the pectoralis muscle.

The less invasive the surgery, the less pain, quicker recovery, and most importantly, the less scarring and visible signs of surgery the patient will experience. These new techniques are usually performed by board certified plastic surgeons who have great experience in the art, form and function of the breast as well being able to handle any complications that may arise.

Typically breast augmentation done with the PEBAM approach allows the patient to resume activities the next day and resume unrestricted activities in a few weeks.

Ayoub Sayeg, MD is a board-certified plastic surgeon currently in private practice in Troy, MI.

If you would like to submit a medical question to Ask the Doctor, please send via email to: askthedoctor@healthandleisureonline.com.

*Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.

Liposuction Goes High Definition

With Bruce Chau, DO

You may also find that your “love handles” never go away despite how many hours you spend on the treadmill each week, or how many abdominal exercises you do. Your desire to have that healthy, chiseled look is not being met despite your efforts to eat right and exercise often.

One of the alternatives more men are seeking today to get rid of this extra fat is high definition liposuction, according to Dr. Bruce Chau, a board certified plastic surgeon.

“This new approach is unique because it is a marriage of three distinct areas; anatomy, artistry and technology,” says Dr. Chau. “It is a framing, and shaping of the body where in some cases, you do not remove all of the fat.”

A South American physician, Dr. Alfred Hoyas, was a medical illustrator who has reviewed the male anatomy over history. In his studies and illustrations, he noticed that today’s man was more chiseled and “bulkier” than men in the 50’s, 60’s and 70’s.

“He looked at the (male) body over the years, and men haven’t changed all that much for what people desire how the body looks,” says Dr. Chau. “The only thing that changed was the bulk of the muscle. If you look at actor Kirk Douglas in the movie “Spartacus,” he was in great shape, but didn’t have that chiseled look like men today seek.”

As a result, Dr. Hoyas began to utilize “high definition liposculpture” that married the three aforementioned areas together, and gave men a more bulky, athletic, chiseled look than in the past.

“In America, we look to make someone thin, take the fat out, and give curvature,” says Dr. Chau. “But in South America, they look to leave a little fat in the right areas to give a better, more realistic shape.”

By leaving a thin layer of fat over the muscle, it helps frame the muscle and appears to give it more size, explains Dr. Chau. Since men continue to lose muscle mass after the age of 30, this high definition liposculpture approach, takes this into consideration and gives men a more muscular look.

“Look at the six-pack,” says Dr. Chau, referring to most men’s desire for a flat, fit-looking stomach. “With high definition liposculpture, you leave a little fat in the ‘hills’ of the six pack and you suck out as much in the ‘valleys.’ This will give it a more chiseled look.”

Utilizing the Vaser-Assisted Liposuction technology, men can get better results, but Dr. Chau explains that not every male will get the results desired. “We look at body mass index (BMI) and try to determine who will get the best results,” he says. “The ideal candidate will have a BMI around 25. If a patient is higher, we suggest he does more exercising and dieting before getting the surgery.”

If a patient is trying to lose weight by working out, eating right, but can’t seem to get “over the hump,” liposuction can help them lose a few inches that may add motivation to the patient to get to their desired goal.

This approach to liposuction is very applicable to women, too, says Dr. Chau. And, he explains, historically, women are more apt to consider these procedures than men.

There are several reasons men tend to seek out plastic surgery less frequently than women, says Dr. Chau. “Men don’t want to get plastic surgery because they are afraid someone is going to say something about their vanity,” he says. “But this is an imaginary fear.”

Secondly, he says that men are more afraid of pain than women, and don’t want to deal with it – even though the pain can be minimal and is aided with medication.

Finally, Dr. Chau says that men do not want to take time off from work just to get cosmetic surgery. “There is less impetus for men to change their appearance because society accepts them if they are little more round, or older looking. Society is more critical of women’s appearance, so they are more willing to take time off to look better,” says Dr. Chau. “It’s a different psychology.”

Dr. Chau admits there was some initial skepticism about Dr. Hoyas’ approach, but that it has more recently become accepted in many plastic surgery circles. “There were five of us from the U.S. who had hands-on training in South America,” says Dr. Chau. “It was a very difficult training, and I performed surgery on four patients. It was not a weekend course where you just watch a video and look at pictures. You actually did the surgeries.”

Plastic surgery for men became more popular over a decade ago when it was believed that men had to look younger to remain competitive in the workforce. Some believe this still remains true today. And, with our desires to continue to look young and healthier into our later years, we can expect to see more men considering liposuction as one of their alternatives.

Bruce Chau, DO, is board certified by the American Osteopathic Board of Surgery in Plastic and Reconstructive Surgery. He is a graduate of Western University, College of Osteopathic Medicine of the Pacific. He completed his General Surgery Residency at Peninsula Hospital Center, NY, and his Plastic and Reconstructive Surgery Residency at the Plastic Surgery Institute, Mercy Hospital Medical Center. He is in private practice in Southfield, and is program director for plastic surgery residency at Michigan State University.

Diagnosis: Breast Cancer – But What About My Breasts?

The odds are that one in nine women will get breast cancer in their lifetime. Those are staggering numbers.

Once a diagnosis of breast cancer is made a whole team of specialists get involved to guide the patient through the treatment choices. What essentially determines your prognosis and treatment is your staging of the disease – the worse (of higher) the staging, the more aggressive the treatment.

There are essentially a combination of treatments ranging from chemotherapy (including hormone blockers), radiation and surgery that can be used. The best determination will depend on age, stage, certain hormone receptors of the disease and family history.

A majority of women will probably not need plastic surgery because the disease, if caught at an early stage, can be treated with lumpectomy and possible radiation and/or chemotherapy. If these treatments are done then a woman preserves her own breasts and the cosmetic result is excellent.

For those whose treatment regimen may include a total mastectomy the question is, “What about my breasts???”

For women who have more advanced disease, the best treatment may be a mastectomy with or without lymph node sampling. At this stage a thorough consultation with a plastic surgeon is required prior to the mastectomy so that reconstruction can be done simultaneously while in the operating room.

The first meeting should include a thorough history and physical exam. A plastic surgeon will consult with his or her colleagues regarding the type of mastectomy, the staging of the disease and whether post operative radiation or chemotherapy may be used. Most importantly, the patient is examined for the risk of surgery and reconstruction. Is she healthy, does she smoke, are there comorbidities? During the interview, the plastic surgeon will ask whether the patient wants to do reconstruction at all or does she want reconstruction with her own tissue or using implants and other materials.

Some patients that get mastectomies at an older age or have severe comorbidities may not be candidates for aggressive reconstruction. If a patient has aggressive disease and requires radiation, then reconstruction may be delayed for a while until her disease is better controlled.

So what are the options?

OPTION 1: Bypass reconstruction and possibly be fitted for an external prosthesis.

OPTION 2: Reconstruction using your own tissue.

This may require we use the muscle and skin from your back, tummy or buttocks. It may be done as a flap with an artery supply that is intact and simply moved or the blood supply is interrupted and reanastomosed under a microscope (free flap). Sometimes an implant may be needed to get proper size.

Reconstruction using your own tissue (autologous) gives the most natural feel and look to the breast but the trade off is another site of surgery including a scar, longer surgery, more prolonged recovery and possible revisions in both the donor site and the mastectomy site. The transferred tissue may need to be trimmed and revised. Once the proper look is achieved a nipple will have to be reconstructed and tattooed. Also the other breast may have to be augmented and/or lifted or reduced to achieve symmetry. If radiation is used post-operatively then autologous reconstruction is delayed for a while.

OPTION 3: Reconstruct with implants.

Usually a tissue expander is placed at the same time as the mastectomy and expanded post operatively to a desired result. Then the patient is brought back in after a couple of months or after chemotherapy and/or radiation and a permanent implant is inserted. The implant may be saline or silicone. The risks and benefits of both implants can be discussed with your doctor. As with any reconstruction the other breast may be augmented and/or lifted or reduced. Finally, a nipple on the reconstructed breast will have to be made and tattooed. In some instances a muscle may be harvested to add to the reconstruction. Lately to reduce the morbidities, Alloderm (cadever dermis) can be used to substitute for the muscle.

Every patient, regardless of staging, age or comorbidities has to make wise and educated decisions both for their treatment as well as their reconstruction. Whether the reconstruction is done during the initial mastectomy or delayed for a time can be dependent on the disease and subsequent treatment. It may be wiser to treat the disease and then reconstruct once the patient has had chemotherapy and/or radiation. The resultant reconstruction will not be affected by these modalities as much.

All surgeries carry risk and a qualified board certified plastic surgeon can discuss the risks, treatments and possible choices in a simple yet thorough matter.

Dr. Ayoub Sayeg is a Board Certified Diplomate, American Board of Plastic Surgery, Cosmetic and Breast Fellowship Trained. He received his medical degree from the University of Toronto and served his general surgery residency at Washington Hospital Center, Washington, D. C. Dr. Sayeg served his plastic surgery residency at Wayne State University in Detroit from 1998 to 2000.

Ask the Doctor: August 2007

Question: My teenager has begun to ask me about plastic surgery. Is this too young of an age? – D.M., Royal Oak

Answer: Dear D.M. – Plastic surgery is much more prevalent in the adult population. Over the last 10 years, teenagers are slowly increasing their numbers in outpatient plastic surgery procedures. The reasons for this are multi-fold.

First, plastic surgery is much more acceptable not only in the adult population but also in the teenage years. It seems all of the young Hollywood stars have had some kind of plastic surgery, making patients feel it is safe, trendy and more importantly, acceptable. Second, complications are very low and recovery time much shorter and less painful. Third, plastic surgery is much more affordable than it used to be.

Teenagers in this day and age are under tremendous pressures to succeed. Those teenage years sometimes define the rest of their lives. Any edge – within reason – can help a teenager compete better, feel more confident, become more physically active and attractiveness can be an asset.

The two most common teenage surgeries are rhinoplasty and breast reductions. The nose stops growing at about the age of 16. Sometimes prominent, deviated or cosmetically unacceptable noses can be fixed at an age where the resultant outcome gives a teenager tremendous self esteem and confidence. So in this one case, a rhinoplasty is acceptable and many teenagers are eager to have the surgery.

Another example is large breasts in teenage girls. Once puberty hits, a young lady may become more self-conscious of her body as it transforms into a woman. With large breasts, they may feel more neck, back or shoulder pain. They may be athletic and now they tire more or are unable to participate in some physical activities. Then a breast reduction done in a minimally invasive way may be the answer. But patients are cautioned that the breast size will increase with weight gain or pregnancy and any surgeries may require revisions in the future.

Obesity has become a major epidemic in the teenage population. In fact a lot of parents try to use plastic surgery as a means of weight loss. This is not the answer.

Obesity brings about many problems for patients. A disproportionate body – whether it is larger breasts in males or females, redundant skin or increased fat in the body may make the patient’s self-esteem suffer. Also, being overweight may decrease physical activity levels which are needed for both weight loss and overall better health.

Unfortunately, plastic surgery is not the answer in these types of patients because the main problem (overweight) has not been treated and you are trying to fix the end results of obesity. In some cases, these patients might do better with bariatric surgeries and once the weight is controlled be eligible for reconstructive surgery.

Teenagers today are not given as much credit as they deserve. When it comes to plastic surgery education, patience and common sense, as well as listening to the complaints they have, are the best ways to deal with teenagers.

Many times, simply waiting until he or she is of legal age to consent to surgery allows the teenager time to mature, grow wiser and be more comfortable with all their decisions. However, some plastic surgery procedures are safely done in the teenage population, and balance should always be the goal.

Ayoub Sayeg, M.D. is a board-certified diplomate of the American Board of Plastic Surgery, Cosmetic and Breast Fellowship trained. He received his medical degree from the University of Toronto and served his general surgery residency at Washington Hospital Center, Washington D.C. Dr. Sayeg served his plastic surgery residency at Wayne State University in Detroit.

If you would like to submit a medical question to “Ask the Doctor”, please email your question to: askthedoc@healthandleisureonline.com

* Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.

Hi-Def Lipo For Women

With Dr. Bruce Chau, DO

When it comes to a woman’s desire for the “perfect body,” each one may have a different opinion about what that may look like. For those women who work diligently trying to lose weight, but cannot quite work the extra fat from certain parts of their body, high-definition liposuction is available.

In a previous issue, we discussed how men can utilize high-definition to get a more athletic, muscular look. The only thing different with women is that they have such a variability of what they like and do not like, according to Dr. Bruce Chau, a board certified plastic surgeon in Southfield.

“All men want to look athletic, but not all women want to have a six pack,” says Dr. Chau. “The technique is like traditional liposuction, but the goal is not to remove all of the fat, but to remove the fat to accentuate certain parts of the anatomy.”

Unlike traditional liposuction, this technique combines artistry, physiology and technology, says Dr. Chau. “We don’t rely solely on the machine. It is a skill, an operator-dependent skill that you have without just relying on the machine. It is more of an artful skill; it’s artistic control over where you are going to take the fat.”

This new technique combines artistry, anatomy and the Vaser-assisted liposuction technology; making it feasible and attainable for women to get better results. It is not new machinery, it is skilled-dependent. “Not everyone is trained in this technique. You need to have many years of experience to do it,” says Dr. Chau.

“Sometimes people don’t realize it does take a long time, it can’t be done always in a hour or two, it takes time to reshape the body. There is no quick fix.”

Dr. Chau says the recovery time depends on how many areas of the body are done. “With women we want to outline a certain silhouette. We can put a little indentation in the spine, the lower back, above the tailbone. Many women want those little dimples and we can shape that,” says Dr. Chau.

He explains that high-definition liposuction gives the physician the flexibility to shape the athletic female versus the soft, shapely female, versus the more full figured female.

“Women are a little different because they have a lot more options because they want to be thinner, athletic or improve silhouette,” says Dr. Chau.

Once again, Dr. Chau says that high-definition liposculpture is not for everyone. “It takes a very motivated patient. It is for people who exercise but cannot get rid of certain areas of fat,” says Dr. Chau. “They must have a certain body mass index and motivation.”

Liposuction is not for everyone, but women can obtain realistic, desirable results when they prepare appropriately.

Bruce Chau, DO, is board certified by the American Osteopathic Board of Surgery in Plastic and Reconstructive Surgery. He is a graduate of Western University, College of Osteopathic Medicine of the Pacific. He completed his General Surgery Residency at Peninsula Hospital Center, NY, and his Plastic and Reconstructive Surgery Residency at the Plastic Surgery Institute, Mercy Hospital Medical Center. He is in private practice in Southfield, and is program director for plastic surgery residency at Michigan State University.

Reshaping You to Fit Your New Body

A growing epidemic in the United States is morbid obesity.

Be it genetic predisposition, poor eating habits, a sedentary lifestyle or post partum weight gain, the US and the world is realizing the medical costs associated with this epidemic. Already, the statistics are staggering. Forty percent of the population is obese and increasing every year.

For the longest time morbid obesity was treated non-surgically. Weight reduction was usually tied to exercise and calorie controlled diets. Medically, physicians were able to help by correcting imbalances in hormone status such as thyroid, estrogen, and cortisol. Anti-obesity

drugs such as phentarmine have also played a role, but their long term side effects are still questionable and cost is a factor. But as obesity skyrocketed, so has diabetes.

About 15 years ago, a surgical option was developed for the very morbidly obese and was reserved for those in life and death situations. Although complications were relatively high, it was the beginning stages to developing the protocols for surgical weight loss procedures that we are accustomed to today.

Weight loss surgeries today consist of either lap bands or gastric bypass. These procedures have proven very successful in extreme weight loss for the morbidly obese and has been maintained over a longer period of time than

most non-surgical entities. In fact, according to the Agency for Healthcare Research and Quality, bariatric surgeries have increased nine-fold between 1998 and 2004 from 13,386 to 121,055. Complication rates have also decreased due to laparascopic techniques.

While significant weight loss may look successful on the outside, it leaves another side that is largely not talked about – excess and sagging skin.

When consulting for bariatric surgery, the potential for body reconstruction should always be addressed. A lot of physicians and patients assume that once the weight loss is done, the patient will go back to their perceived new looks without any corrective surgery. As a plastic surgeon who performs post-bariatric cosmetic surgeries, almost 95% of patients require some reconstructive work approximately one to two years after their surgery.

A lot of patients don’t realize that with morbid obesity the skin, fascia and underlying tissue support system is strained and damaged to the point that it loses its recoil abilities. Very few people will have their skin go back to normal.

Think about pregnancy and how the abdominal skin does not return 100 percent to its pre-pregnancy state. Now, use this same analogy and put it to skin on the entire body for a much longer period of time. You can realize the extent of the damage to the skin and underlying tissue.

Our skin, breasts, and underlying tissues are soft, pliable and somewhat durable. But our bodies were never made strong enough to handle excessive weight over a long period of time.

So where do we start?

In the face, one usually sees the tell tale signs of aging: redundant skin in the face, neck and eyes; fatty deposits in the neck and eyes; early jowling; thinner skin; exaggerated facial lines (nasal labial folds). These are usually taken care of with brow lifts, eyelifts, face and neck lifts and fillers such as fat, Restylane or Radiesse.

Also common after weight loss is hair loss. This can be taken care of medically or sometimes surgically with micro or macro hair graft transplantation.

The chest and breast area usually does not fair well after extreme weight loss. The breast support system is made of skin, connective tissue and ligaments. Unfortunately, these specific tissues don’t hold up well to excess weight over long periods of time. As the weight loss is complete, the breasts tend to lose a lot of their volume, shape and support. They decrease in size and become ptotic (droopy).

Treatment options may include a breast lift, augmentation or oftentimes both. Thanks to newer techniques in minimally invasive surgery (PEBAM, SPAIR) scarring is left to a minimum while the saline or silicone implants can increase the breast’s volume.

The arms also suffer from redundant skin. The skin in the inner aspect of the arm is the thinnest compared to the outer arm. Some of the redundant skin involves the axilla and upper back area. The excessive skin is usually excised and the upper arm reconstructed to give a more natural look. This is known as a brachioplasty.

Liposuction is also used as an adjuvent in certain areas. The scar heals up somewhat well and is located on the inside of the arm extending into the axilla. If the upper back has redundant skin, an upper body lift is considered to get a more cosmetic appearance.

The areas most people complain about is the abdomen and thighs. In the abdominal area, the skin may be loose and overhanging their beltline, there could be some fatty deposits that are not desirable, and the muscles may be weak and need to be tightened. Also, hernias resulting from the gastric bypass may be present. The best way to take care of the abdominal area is either liposuction, abdominoplasty, or both.

In the thighs, the skin becomes redundant and sags both in the inner and outer areas. The buttocks can also lose their volume and sag. An inner and outer thigh lift is usually done in conjunction with a buttock lift. This can involve liposuction to contour the thighs. The abdominoplasty, inner and outer thigh lift, and buttock lifts are collectively known as a lower body lift. The scars are acceptable and usually hidden in creases or the underwear line.

Liposuction alone is not enough to give the body the contouring that is most pleasing. It is an adjunct only. Surgical scars usually take a year to heal and in about 10 percent of patients, revisions may be necessary. Like all surgeries, the risk of complications is greater in the post bariatric population. A thorough medical clearance is advisable, and peri-operative antibiotics and DVT prophylaxis is given.

The big question is how much of this surgery should be performed at a single setting? There is no right answer. However, scientific studies show that the longer in surgery you are, the more at risk you are to suffer afterwards (pneumnia, DVT, Pulmonary emboli, atelactasis, etc.).

The general rule of thumb is usually six hours. My philosophy is to stage the surgeries over a three month period, doing no more then 6-8 hours at a time. Remember, it’s not how fast you get to the finish line. It is getting there in the safest fashion.

In the end, realistic expectations and safe and effective reconstruction by a board certified plastic surgeon can help you get over the stigma and the resultant excess skin left. Leaving behind, a new you!

Ayoub Sayeg, M.D. is a Board Certified Diplomate, American Board of Plastic Surgery, Cosmetic and Breast Fellowship Trained. He received his medical degree from the University of Toronto and served his general surgery residency at Washington Hospital Center, Washington, D. C. Dr. Sayeg served his plastic surgery residency at Wayne State University in Detroit from 1998 to 2000.

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”.

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