Breast Augmentation

1) Transconjunctival Lower Lid Bleharoplasty (TCB)

TCB is a cool way to remove “fat bags” from the lower eyelid as no incision is required on the skin and there is no weakening of the lower lid as does occur with the usual lower eyelid surgery. In TCB, a laser incision is made inside the lid and right on the fat pad and the fat pad is removed to flatten puffy lower lids. This preserves strength to the lower lid. It is the preferred method to remove fat by many plastic surgeons and is also great for patients with pigmented skin as it doesn’t leave a scar. Schedule a consultation today to learn all of our eyelid surgery options. 

2) Fat transfer Breast Augmentation

This method uses the patient’s own fat harvested from the hips, lower abdomen and thighs to fill the breast. The upside is that its natural and no implants are necessary but the results are highly variable so the size cannot be controlled and the breast can only be enlarged about one half a cup size. Most patients in southern California who are considering breast enhancement want to be at least one to two cup sizes larger.

3) Laser treatment for Wrinkles

Most are familiar with the fact that the laser is used in medicine but the carbon dioxide laser is most frequently used to treat fine to intermediate and sometimes even deep wrinkles of the face. The laser is an amazing tool to get rid of wrinkles, no matter what the cause (most wrinkles occur as the result of the aging process and not from cigarette smoking). In fact,  in most patients, at least 85 to 95 percent of wrinkles can be removed. 

4) Panniculectomy

A pannus refers to the excess skin that hangs down from the tummy over the pubic area. It is usually removed during a tummy tuck but when patients are not candidates for a tummy tuck, they might be able to simply have the hanging excess lower abdominal skin removed with a panniculectomy.

5)  Brachioplasty

This is the medical term used to describe an arm lift. There are different ways to accomplish this task. The most common technique is to remove the skin from the inner arm with the fat underneath it. Another technique is to first suction the fat from the arm and then remove the skin in a single surgery. 

The patient is a 63 year old woman who noted excess upper lid skin folding and some wrinkling of the lower eyelid and adjacent Crow’s foot area. There were no “fat bags” of the lower lid but the patient noted some dryness of her eyes and she used liquid tears in the morning and evening. She had Botox in the past but felt that more recently the Botox was not as effective as it had been. 

The patient had a conservative upper eyelid surgery (upper blepharoplasty) with laser treatment of the lower eyelid and Crow’s area. She was very happy with her cosmetic result and there was no worsening of her dry eyes. She found it much easier to wear makeup and found her makeup lasted longer and fewer applications were required. 

Eyelid Surgery and Patients with Dry Eyes

As we all age, there is a decrease in the amount and quality of tears that lubricate and protect the eye. Upper lid surgery can further decrease the beneficial effect of the tear film if too much skin is removed. Patients with dry eyes can still have upper eyelid surgery (upper blepharoplasty) but it must be performed more conservatively (less skin can be removed). Despite this conservative approach, significant improvement can be achieved and patients can “look a lot better”. 

Eyelid surgery cost is the same with the conservative approach and healing time is also about the same as with conventional upper lid surgery.  

When the laser is used to treat wrinkles within the lower lid, there is also some tightening of the lower lid but this generally is not associated with dryness of the eye. That is important to remember when comparing laser treatment of the lower lid with lower eyelid surgery which can have an effect on lower lid function, especially when it is done with the external or flap technique (lower blepharoplasty). It is rather better to approach the removal of the fat pads from inside the lid when patients have dry eyes and to use the laser to tighten the skin.

In patients that are good candidates for a tummy tuck (abdominoplasty) can drastically improve the look of the abdomen.. It not only can flatten the front and sides of the abdomen but can also restore pre-pregnancy aesthetics and streamlines the bodyAfter a tummy tuck patients can find it easier to work out and also feel they better “fit in” with other younger patients at the gym. 

Costs for tummy tuck depend on the fee of the surgeon, the place the surgery is being performed and the type of surgery necessary. Anesthesia may also be a factor but most tummy tucks are performed under general anesthesia to make this procedure safe and to get the best cosmetic result. 

The commonest type of tummy tuck is referred to as a “standard tummy tuck (standard abdominoplasty). The average patient that has this kind of tummy tuck has had children and has a prominence where the front of the abdomen protrudes and this is usually from the top to the bottom of the tummy. These patients also have skin excess where the skin of the abdomen is loose or folded, especially over its lower part and the skin can hang down over the pubic bone. There may also be skin excess within the upper part of the abdomen. 

Tummy tuck prices are generally the same with a certain geographic area but may vary depending on any additional procedures added to the tummy tuck, such as liposuction of other areas. Tummy tuck near Temecula, CA may be similar around the Temecula area but be less than costs in Beverly Hills, though the same operation is performed and with the same attention to detail and cosmetic result. That is why it behooves patients to shop around and even have procedures out of their residential area should the cost be significantly lower. Some plastic surgeons have packages they offer that include not only the procedure itself but short term lodging near their surgery center both to make surgery safer and more convenient for their patients. 

Mini May Be Better

Some patients may not need to have their entire abdomen treated and have a lesser procedure and these are often referred to as mini-tummy tucks. There are many variations of a mini-tummy tuck but they share in common the fact that they take less time to complete and therefore cost less than a standard tummy tuck. (By the way, most patients refer to a standard tummy tuck as a “full tummy tuck“). Sometimes mini tummy tucks are performed with liposuction as part of the treatment of the front of the tummy and liposuction surgery is much faster than any kind of tummy tuck. The decision to have a specific type of tummy tuck or liposuction is based on the patient’s anatomy and their goals for the treatment. But the tummy is an area where, often, the recommendation of the plastic surgeon is most important to consider, regardless of the price. 

The Dreaded Scar

Not to diminish the fact that a tummy tuck means that there will be a scar about the lower abdomen, patients often focus on the scar but don’t weigh the scar against the improvement they will gain with a tummy tuck because that is the reason the patient is in the doctor’s office in the first place! Patients must consider how badly they wish a tummy tuck versus how bad the scar might be ultimately. And there are things that can be done to treat scars. 

An experienced plastic surgeon can really help patient understand which procedure may be best for them and to give a reasonable expectation about the safety of the surgery and their cosmetic result.

Do you have your own surgery center?

Plastic Surgeons who have their own surgery center wish the most privacy and best care for their patients. When doctors own their own center they are more involved with the care process, not just bopping in to do surgery somewhere and leaving. They work on quality improvement of the center and that means patients are better cared for. 

When patients are cared for by one team that supports one doctor, the team can work better with the plastic surgeon to deliver consistent care at the highest and safest level. 

I know you are board certified but what are you certified to do?

The free enterprise system of the United States allows doctors to set up their own board! These boards may not be recognized by The American Board of Medical Specialties. This Board determines whether a specialty board is legitimate based on many factors including whether a board has core principles not present in other boards. That doesn’t mean that unapproved boards are not of high quality but that patients should evaluate more deeply, unapproved board members training and compare it with the training of other physicians that have been chosen and trained through more conventional programs approved by The American Board of Medical Specialties. 

What is the difference between a plastic surgeon and a facial plastic surgeon?

Plastic surgeons go through a long program of general surgery and then are chosen by other plastic surgeons to enter a two or three year plastic surgery training experience. Facial plastic surgeons go through a long program of ear nose and throat training and then do a one year fellowship in cosmetic surgery of the face. The Board of Facial Plastic Surgery is not approved by The American Board of Medical Specialties because, at its core, it is not different than the field of plastic surgery. 

So it may appear, superficially, that facial plastic surgeons are better trained to do facial cosmetic surgery because the name implies they are more specialized but the opposite may be true. It depends more how much time a physician is spending doing cosmetic surgery of the face and the results they are able to achieve. It therefore is very important for patients who are considering facial plastic surgery to find out more about the physician and especially important to view before and after photos of their previous patients.    

Can Patients really become addicted to plastic surgery?

Basically anyone can become addicted to anything because that’s how we are as people! But generally, and for most patients, doctors limit how much plastic surgery they will let patients have just because they don’t want a “bad rap” in their community. We see “plastic surgery junkies” on TV but for the most part patients are not having surgery to excess. 

Do Plastic Surgeon use plastic?

The word “plastic” in plastic surgery comes from the Greek word plasticos which means “to shape or mold”. The only plastic like materials used in plastic surgery are silicone rubber products used in chin and cheek implants and the shell or balloon outer part of breast implants is made of silicone sheeting.

At what age should I have plastic surgery?

As a general rule, surgery treats problems and problems can occur at any and every age. As long as a patient is healthy, they can have the surgery if it addresses the problem that bothers them. 

Do breast implants cause disease or cancer?

The plastic surgery scientific community knew that breast implants were safe by the 70’s because larger studies had been done to prove they were safe. Despite that, breasts were taken from the market in the late 80’s even though it was well known that implants had a high safety margin. 

Recently, cases of breast implant associated lymphoma have occurred but are exceedingly rare. All of the known cases have occurred in association with textured surface breast implants and almost entirely from one company’s textured implant.