Are you a Mommy Makeover Candidate?
Posted September 16, 2011 4:57 PM
If you’ve had kids, then you have probably noticed changes in your body including saggy breasts, a stretched out tummy, and random excess fat deposits that are resistant to diet and exercise. A plastic surgeon can help you regain your pre-pregnancy body with a Mommy Makeover, which is a catch-all phrase for breast and tummy surgery. As bathing suit styles have changed, we are making a lower incision on the abdomen. Our patients appreciate a very low incision that can be hidden. We maintain as short a scar as possible. Additionally, the belly button has a minimal incision. This is a special unique procedure that keeps the incision hidden in the belly button to create an “inny” as part of the tummy tuck. Liposculpture is an adjunct to perfect the result and restore the youthful pre-baby body.
Breast augmentation post pregnancy is also individualized as some patients need just volume, and some will need repositioning of the nipple areolar complex. We perform hundreds of breast augmentation surgeries a year. A submuscular implant with silicone gel or saline has been our standard.
After discussing your goals and expectations, we will customize your Mommy Makeover based on the procedures you choose. This is one of our most popular procedures, because patients tell their friends that the Mommy Makeover is both physically and emotionally beneficial. For more information about a Mommy Makeover, please contact the Lasky Clinic at (310) 277-4572.
by Andrew T. Cohen, M.D., FACS
Add Comment |
Permalink
Selecting a Plastic Surgeon - Surgical Training
Posted April 21, 2011 6:01 PM
An American Society for Aesthetic Plastic Surgery (ASAPS) report recently predicted the demand for cosmetic procedures will increase among consumers as the economy rebounds and the number of baby boomers grows.
Given this anticipated upswing that foresees no end in sight, the need for highly skilled plastic surgeons will become even more critical as individuals will seek to entrust their care only to those whose expert reputations precede them.
As a result, people who understand the best cosmetic surgery is that which couples safety with good outcomes will hold their surgeons to the most stringent of standards.
As the old adage goes, who can you trust? When it comes to your plastic surgeon, take confidence in knowing the American Society of Plastic Surgeons (ASPS) has developed a careful and thorough list of the training the physician in whose hands you place your beauty should have to best ensure optimal results.
Undoubtedly, your surgeon should:
- possess, at minimum, six years of surgical training and practice, at least three of which should be specifically in cosmetic surgery;
- demonstrate knowledge in all plastic surgery procedures of the face and body as evidence of a thorough understanding of human anatomy and surgical aesthetics;
- practice only in an accredited medical facility;
- maintain the highest of ethics and standards to guarantee patients' safety; and
- be certified by The American Board of Plastic Surgery (ABPS).
You can further determine if a plastic surgeon possesses the training necessary to meet your goals by seeking reliable sources. This includes not only speaking with past patients with whom your physician may be able to put you in contact, but also conducting an Internet search on the doctor you have selected.
And be certain not to forget one of the most valuable resources at your disposal—yourself! Gather information about your doctor's academic and professional training by asking good and necessary questions during your consultation so you can be as comfortable as possible with the decision you make.
Leslie H. Stevens, MD FACS
Add Comment |
Permalink
It is the new year and the future is fat!
Posted February 22, 2011 4:37 PM in Fat Transfer
It is the new year and the future is fat! Fat grafting to the face and body helps restore your youthful appearance and has changed how I think about facelifting.
Yesterday I used the waterjet which is a fantastic new machine to harvest fat more easily and gently and re-inject into a young woman’s hands.
Hands are a great area for fat grafting as we all get older and the veins start to show more and this can show your age. Smooth full hands are a sign of youth. It is one of the areas I am asked frequently about.
The waterjet pumps water into areas to help remove the fat in a more gentle way so that more will last or what we say “take” to the grafted areas.
Usual areas of fat grafting are the face or hands, or areas of liposuction that need refining. The website is www.humanmed.com if you are interested in the technology. We have been extremely busy at the Lasky Clinic with fat grafting and fat harvesting using the waterjet. Our take and survival of the fat is much better than traditional methods.
Andrew Cohen, M.D., FACS- www.andrewcohenmd.com Board Certified Plastic Surgeon.
Add Comment |
Permalink
Tags:
Fat Transfer
Current Thinking on Lower Eyelids
Posted January 20, 2011 11:18 AM
Over the years the approach to rejuvenate the lower eyelids has gone through many changes. Prior to the mid 1980’s the accepted gold standard of treatment was to remove as much fat, skin and “excess” muscle as possible. These techniques were championed by virtually every reputable surgeon at that time and results from such procedures were published in all of the most highly regarded textbooks. As these results are now revisited in 2011 it is simply astonishing what used to be regarded as a “good result”! Careful attention to those older results shows retraction of the lower lid margin with too much white or the eye exposed and rounding of the lid. There is hollowing around the eyes and eversion of the lashes as well as changes in the angle between the upper and lower lids. Not only are these prior “great results” unattractive, they actually make the person look older!
The trend subsequently moved away from removing skin and muscle, and surgeons began to remove fat from inside the eyelid without the creation of a visible scar. This technique called “transconjunctival lower lid blepharoplasty” was an improvement because less retraction and scarring occurred but it still left patients looking hollowed out. The removal of fat without simultaneous tightening of the skin left the lid skin looking “deflated” and crepey with more lines. The hollow created a shadow in certain lighting that left patients looking tired and older. In order to address these issues some surgeons began taking just a “pinch” of skin without much dissection or using various machines (such as radiofrequency or lasers) to tighten the skin. While these approaches often improved results they occasionally made no significant difference or created some subtle retraction or pigment changes that were unwelcome.
In the late 1990’s some of us began to critically analyze the results of our tried and true techniques. It was apparent that we were not doing a great job at rejuvenating the lower eyelid area so a new approach developed that involved repositioning the fat from inside the orbit to the hollow area beneath the rim. Moving the fat and redistributing it from where there is too much to where there is not enough allows for evening the contours to get rid of the shadows that make people look tired. This technique for rejuvenating the lower eyelid area also maintains the volume under the skin and thus prevents any increased laxity from developing. I do this from an incision inside the eyelid so there is no visible incision. This method of fat repositioning is different from fat transfer, which involves moving fat taken from another part of the body to the under eye area. Fat transfer requires that the fat grafts obtain a new blood supply in their new locale and often times the fat just reabsorbs or takes unevenly, resulting in lumps and bumps.
While patients do sometimes stay bruised for two weeks, this procedure provides for the most natural looking and rejuvenative results that I have yet seen in the past 18 years. While I do not do this on every single patient, most of the lower lids are handled in this fashion. As an alternative to this procedure I may suggest using Restylane to fill in the hollows. While this is a non-surgical procedure and much less costly than surgery the results are not as profound because the bulge of fat still remains…we just inject around it to make it appear flat. Additionally, patients can be bruised for two weeks from injections in this area since the skin is very thin and the tissue is very vascular.
Results of lower eyelid blepharoplasty with fat repositioning can be seen on the website.
Dr. Andrew Frankel
Add Comment |
Permalink
A few words about facelifts
Posted November 16, 2010 10:22 AM in Face Lift
This is my first attempt at writing one of these Blogs and I’ve decided to relay a few of my experiences and thoughts regarding facelifts. When a person is young and feeling good about themselves the idea of having a facelift is the farthest thing from their mind. In fact I believe that most young people actually have disdain for the entire concept and can’t empathize at all with a parent or other older figure in their life that has decided to go under the knife. Ahh…but time eventually catches up with everyone and despite a healthy lifestyle, diet, and exercise many of those same people will eventually wind up across from me in a consultation. I’ve had numerous persons break down and cry to me about how they can’t believe they are actually in front of a surgeon considering a facelift; it was just something they said they would never do. I find it interesting that most people wanting facelifts are generally attractive people who have always been considered good looking and younger than their actual age. When one thinks about this it makes sense however, because these people have been validated about their appearances for their entire lives and, like it or not, it’s an important part of their self image. When signs of aging appear and they no longer receive those compliments that they’ve grown so accustomed to, it can be devastating. This is particularly true for individuals that have relied heavily on their appearances to define themselves.
Let me be clear about something: No one needs a facelift. It’s done in order to make someone feel better about themselves. Therefore the question of when a person should have surgery has very little to do with what they look like, but rather how they feel. At social gatherings I’ll often be backed into a corner by one or two women who have their hands up to their cheeks thrusting them backwards towards their ears in that universal facelift sign asking, ‘Am I ready yet”?...and my standard reply is that they will be ready when the desire to improve their appearance outweighs their fear of doing so. It is best to time surgery before the skin has lost too much of its elasticity and when the person is within 10-15 pounds of their ideal weight. It is also crucial that they are not smoking, as this can cause significant scarring. There are different philosophies about the timing of a lift: Some people wait until everything is virtually hanging to the floor (like a bloodhound) and do everything at once, adamant that they’ll never do surgery again. Others wish to do surgery when they are just beginning to show signs of aging so that they don’t look much different afterwards and can ‘get away with it’ more readily. These people may end up having surgery several times to ‘maintain’. Some people feel that they will get more value out of a facelift when they are younger and more socially active as opposed to when they are a few years older. There are also a few milestone events, such as class reunions and weddings that are powerful incentives for people to undergo surgery. While a recent divorce may incentivize someone to reinvent themselves, this may also be a time of emotional instability and not necessarily a good one for having surgery.
Once the decision has been made to have a facelift and any other procedures that will help rejuvenate the face such as eyelid surgery, brow lifts, etc…then it should be timed to fit into the patient’s calendar. It usually takes two to three weeks to look good enough for “threatening social interactions”. While most patients should look better than they did before the operation within 3-4 weeks, it generally takes about six months before things look optimal. Sometimes laser treatments can be done to make the bruising and redness diminish more quickly but otherwise there is very little to move things forward except the passage of time. I allow patients to return to mild exercise, such as walking on a treadmill, the very first week after surgery. I have them refrain from heavy exertion or any type of inversion, such as yoga or Pilates, for three weeks. The pain is usually quite tolerable with most people discontinuing their need for pain pills by the third or fourth day. Many people feel a bit depressed sometime in the second week after surgery because their energy levels are low due to the high requirements of the healing process. This tends to pass after a few days and is replaced by very positive feelings about the way things are looking. Some firmness in the tissues of the lower face and neck are typical for three months until the swelling resolves and things become more pliable.
There is no denying that there are some awful looking facelift results out there. I can’t tell you how often I hear someone tell me “I can always tell a facelift and I’d never have one because they always look so weird”. Unfortunately this belies the fact that good facelifts are natural looking and therefore do not call attention to themselves. Hence, only the bad ones are recognized; which is a shame. It is the goal of most of my patients that the surgery “cleans things up” and makes them look less tired yet doesn’t change the essence of who they are. With careful planning and proper execution this is achievable. The first emotion that most patients have once they’ve come through the operation is purely relief. As the days pass this turns into appreciation and finally a real excitement as they regain a sense of self confidence. Having a facelift is a stressful ordeal for most patients and it is flattering that people entrust me with something that is so significant for them. It is extremely satisfying for me to take a person through this process and deliver such a unique gift to them. The human connection is a gift to me….
After all, the shortest distance between two people is a smile.
Andrew S. Frankel M.D. FACS
Add Comment |
Permalink
Revision Rhinoplasty
Posted November 15, 2010 5:46 PM in Rhinoplasty
Revision rhinoplasty refers to a procedure done to correct a deformity or breathing problem resulting from a previous rhinoplasty surgery. In general, revision rhinoplasty is reported to occur at a rate of about 5%-18%. It is important to remember that problems leading to revision surgery can result in any patient and any surgeon - regardless of experience or training.
Although the deformities for which patients seek revision may occur in any patient and with any surgeon, the risk or rate of needing revision rhinoplasty is certainly noted to be higher in the hands of inexperienced surgeons.
In medical literature, the reasons for a patient seeking revision rhinoplasty are given as the following:
Poor surgical technique - In the case of a surgery that was preformed by an inexperienced or occasional rhinoplasty surgeon, over reduction of the bridge and tip structures are among the most commonly encountered defects.
Generally, a major revision needs to be done in this setting involving grafting (movement of cartilage from other areas to strengthen or rebuild skeletal nasal structures weakened or removed by preceding operations). Many of these changes are covered up by swelling during the initial months, but eventually as the healing process continues, and swelling subsides - deformities that may have previously gone unnoticed begin to appear.
Poor surgical planning or judgment - This can result from inexperience, being rushed, surgical complications or variations such as bleeding, or excessive swelling during the surgery. Many of these deformities are easier to correct and generally involve tweaking or adjusting the skeletal nasal structures
Airway problems – Although some cosmetic operations can result in nasal airway changes, many of my patients seeking revision rhinoplasty have airway problems that were left untreated during the first operation. The most common airway problem resulting from rhinoplasty is collapse or narrowing of the lower third of the bridge or nasal valve area. Generally, this complication can be avoided by steps taken to maintain an appropriate amount of width and strength in the cartilages responsible for holding the nose open during inspiration. Consequently, there are cosmetic problems that can be avoided using these same techniques.
Pursuit of perfection - There are a subset of people who, after a rhinoplasty with "acceptable" results, or in some people's eyes good results, will look for perfection. This type of revision rhinoplasty should be very carefully considered with very frank discussions about the pros and cons of undergoing revision for minor changes. In some cases, the push for better results may lead you down the road to worse. These types of revisions should only be considered with experienced surgeons with whom your sense of aesthetic taste is a good match. This can only be determined with detailed and frank conversations using visual aids such as the three dimensional morphing technology used at Lasky Clinic.
In summary, though detailed classification of postoperative deformities have been published in the past, the truth is that all patients are different. All previously operated noses are different, and all will need a combination of different reconstructive techniques to improve upon their results.
When choosing a surgeon for a revision rhinoplasty, the important considerations are your trust for the surgeon, the surgeon's experience with revision surgery and, most importantly, establishment of realistic goals for both the patient and the surgeon.
Behrooz Torkian, MD
Facial and Nasal Plastic Surgery
Lasky Clinic, Beverly Hills
Add Comment |
Permalink
Trampoline Platysmaplasty
Posted November 15, 2010 5:46 PM in Neck Lift
Trampoline Platysmaplasty
In the sub specialty of aesthetic plastic surgery, surgeons are continuously striving to give a patient the maximal result while minimizing the incision length and down time.
An area where a dramatic advancement has been made is in the neck. A new procedure and device has just received FDA approval. The procedure is called a Trampoline Platysmaplasty (TPP), and the device is called the iGiude.
There are several groups of patients that would benefit from the use of this device and the TPP:
- The patient with visible muscle bands in the anterior part of the neck under the chin that still has relatively good elasticity of the skin.
- The patient with an obtuse angle of the jaw particularly on profile, that lacks definition of the jaw line from the chin to ear lobe.
- The patient that would typically be a better candidate for a traditional face or neck lift because of extra skin in the neck, and is willing to have a slightly less optimal result in exchange for a not as invasive a procedure with a shortened recovery period.
The surgeon makes several tiny incisions under the chin and along the jaw line to pass a soft non-palpable suture under the skin. No stitches are required for the incisions and they heal within 24 to 48 hours without a detectable scar. Imagine this suture technique as if you were lacing a sneaker and when the laces are pulled the underlying muscle and overlying skin is re contoured to give the patient a more chiseled and defined jaw line smoothing out the muscle bands as it tightens.
Liposuction of the neck can be performed at the same time in patients with excess fat.
Since the surgery is minimally invasive, there is very little swelling and bruising and the recovery is short, only two to three days.
It is possible to do the surgery under a local anesthetic, obviating the need for an anesthesiologist.
The TPP is truly a giant leap forward on the road to maximizing results with minimal pain, swelling, and recovery.
Leslie H. Stevens, MD FACS
Add Comment |
Permalink
Breast Revision Surgery
Posted November 15, 2010 5:45 PM in Breast Augmentation
One of the main operations that I perform in Beverly Hills at the Lasky Clinic is revision breast surgery. As we all know, breast augmentation surgery is one of the most popular surgeries that we perform. It is not without its inherent risks however.
Dr. Cohen….why are my breasts hard?
A capsular contracture is scar tissue that builds around an implant and can happen early in the healing process, (3 months), or happen years later. Many patients come to my practice seeking information about a possible revision. Capsular contracture is the condition that causes constriction of the breast and can at times be very painful. If it is what we call a Grade 4 capsular contracture, ( one that is the most extreme) , the plan is to reoperate and remove the scar tissue and replace the implant with a new implant. I can never guarantee however that the scar tissue will not just reform. We try and give patients advice on massaging the implant which I do feel helps keep a pocket open and may help prevent a re-encapsulation. Medications such as Vitamin E orally, 1000mg per day have been suggested to help prevent re-encapsulation. Also, an anti allergy medication Singular has been helpful per some plastic surgeons experience.
Will insurance cover my surgery?
There are times that insurance will reimburse for a capsulectomy, (removal of hard scar tissue), if the patient has pain. Anything that is deemed reconstructive would be billable to insurance. There is no guarantee they will pay anything for the surgery so we send documentation to your insurance company to see if it is covered. Anything cosmetic.. such as replacing the implant and the implants themselves is the responsibility of the patient, as the insurance companies do not pay for cosmetic procedures.
Why should I go to you Dr. Cohen rather than any other surgeon?
You should always go to a surgeon who is Board Certified by the American Board of Plastic Surgery. I have been in practice 10 years in the Beverly Hills area and strive to take very good care of all of my patients. Yours safety is our greatest concern. I have been fortunate to have been elected Chief of the Division of Plastic Surgery at Cedars Sinai. Breast surgery is my passion and I do many breast reductions, lifts and many revisions of other breast surgeries that have not been performed well.
Isn’t a breast augmentation an “easy surgery” that anyone can do?
No. Every surgery is unique. It frustrates me to see young woman who go to doctors who charge less and are trying to get a deal. Remember you get what you pay for. Once the incision is made in the wrong place I can’t make it go away. I have seen woman here in town that have had the nipple incision placed in the incorrect location!
What other breast revision surgeries have you been doing lately?
I fix breasts that have rippling, breasts that are hard with scar tissue. Breast that are made too big that need to be smaller and also lots of patients just want them out!
If I get them out what will I look like?
Hard to say how they will look. Some patients will have extra skin and extra breast tissue. Most patients when I remove them they will replace with a smaller implant. Some will need a lift and some will not. It all depends on the tissues and the quality of the skin and breast tissue.
Andrew Cohen, M.D.
Add Comment |
Permalink
Beverly Hills, California Breast Augmentation Surgeon Andrew Cohen, MD
Posted November 15, 2010 5:45 PM in Breast Augmentation
After more than a decade of controversy, the U.S. Food and Drug Administration gave approval for silicone breast implants to be used in breast reconstruction and breast augmentation procedures. Two years after the landmark decision, Dr. Andrew T. Cohen offers his views on silicone implants and how patients are responding to them.
(Vocus) February 18, 2009 -- In 2006, 14 years after pulling silicone breast implants from the market for further study, the FDA issued formal approval for their use in breast reconstruction surgeries for patients of any age and breast enlargement procedures for patients age 22 and older. During the absence of silicone breast implants, saline implants became the norm for breast augmentation surgery. However, since they have returned to the market, one prominent plastic cosmetic surgeon in Beverly Hills, California, says the ratio between patients choosing silicone breast implants to saline is now about 50-50.
“Silicone is softer and more natural… I advise to do a more natural implant. Although I do feel that saline is still a good product for someone looking for an augmentation.” Dr. Andrew T. Cohen says he generally tells patients that silicone breast implants are lighter and feel more natural than saline implants. Although saline implants typically require a smaller incision, and problems such as leaks from the implant are easier to detect than with silicone, the silicone implants typically have lower instances of leaking. Dr. Cohen believes silicone implants are “very safe. I have done hundreds with great success.”
In addition to providing first-time patients with silicone breast implants, Dr. Cohen also performs revision breast augmentation surgery for women who have saline implants and would like to switch to silicone. Dr. Cohen says these patients generally tell him they are more satisfied with the silicone implants.
Since the resurgence of silicone breast implants two years ago, many doctors say that it has given patients more plastic surgery options, and allows them to choose for themselves whether silicone or saline implants will be better for their ultimate goals. Practicing at the Lasky Clinic, Dr. Cohen says his Beverly Hills breast augmentation patients are given detailed information on both options at their initial consultation, and he addresses all of their concerns beforehand to make sure they are making the most informed decision possible. Dr. Cohen says he puts a high premium on giving quality care in a safe, confidential environment, and that safety is his highest priority.
Andrew T. Cohen, MD is board-certified by the American Society of Plastic Surgery and a Diplomate with the American Board of Plastic Surgery. Individuals who would like more information on breast implants in Beverly Hills, California can contact Dr. Cohen at 201 South Lasky Drive, Beverly Hills, CA 90212 – (310) 659-8771, or through his website at www.drandrewcohen.com.
Add Comment |
Permalink
Laser Lipolysis Liposuction Technology by SmoothLipo Beverly Hills Los Angeles CA
Posted November 15, 2010 5:44 PM in Body Contouring
- Do you want to have laser liposculpture?
- Do you have questions about removing unwanted fat from your body?
- Have you been reading about laser liposculpture?
Today I will be using the latest in laser liposuction technology the SmoothLipo by the company Eleme. This has recently been approved by the FDA for liposuction. This is a laser that uses a unique combination of 980nm and continuous wave output to provide the ability to quickly and safely deliver the energy required to heat the targeted fat to the proper temperature. The results are consistent and repeatable and is said to provide optimal skin tightening. SmoothLipo target localized fat deposits using a carefully selected 980nm wavelength. The 980nm absorption profile allows for faster more homogenous heating of targeted areas producing a more uniform result. Continuous wave laser energy uniformly raises the temperature of the treatment area to 45-55 degress C, high enough to cause irreversible thermal death to the fat cells. This process is efficient and effective and continues well after the aspiration.
I will be making a video blog for my patients to see this laser liposculpture in action. I feel there may be some advantages to this new technology but patients need to realize that the results of surgery depend on the surgeon NOT a machine. Going to a Board Certified Plastic Surgeon is the best way to ensure that you will have an optimal result. You are paying for the surgeon’s skill and experience…. not a machine to give you the best results.
Andrew Cohen, M.D., FACS
Add Comment |
Permalink