Archive for September, 2012

Saline versus Gel implants

This is common question I get from patients.  I empower the patient to select what would work best for them by providing a handout detailing the pros and cons of each type of implant.  In a nutshell, gel implants are more natural feeling and in appearance, wrinkle or ripple less, and will not deflate overnight.  They are also restricted to use in those older then 22 y/o.   Saline implants stand out and project more, are firmer to touch, and wrinkle more, in addition to their acute deflation when the shell is torn.  They both will make you fuller and larger.  I prefer gel implant myself but its really up to my patient to choose what will work best for her.

Fillers or Fat?

Fillers such as Restylane, Juvederm, and Sculptra have been heavily advertised as ‘the’ answer for any concavities or wrinkles one may have.  Costs for injecting 1 cc start at $504 and this procedure may require more than one cc and needs to be repeated every 6-10 months to maintain the result. The only real benefit of these products is that you can purchase them off the shelf.

Fat grafting is the alternative to facial fillers.  Most people have some extra fat somewhere and this can be harvested (and produce an improved contour there) and injected into wrinkles and depressions similarly to fillers producing a permanent, lifelong result.  Costs for fat grafting are higher initially but over the course of several filler  sessions, will be more economical in the long run.  In addition, fat grafting may have the benefit of introducing stem cells into the skin, having a beneficial effect in that regard as well.  Finally, much more volume can be grafted producing significant results.

So if you’re looking for a long term result consider fat grafting over dermal and facial fillers.  The long term results and less cost make it well worth it.


How do you know your doctor is qualified?

A patient of mine went to the metropolitan area for an implant procedure I do not do.   I’m sketchy on the details as to why she picked him, perhaps it was his website advertising his expertise in the procedure.  She went with him and unfortunately, developed complications that were poorly managed necessitating that she see a metro plastic surgeon who had to take the implant out.  She spent over $10K to have this put in and eventually taken out, leaving her with massive wounds to care for now.  She found out from her second surgeon that the original surgeon was not a plastic surgeon but instead a gynecologist, now ‘cosmetic surgeon’ who may even be using implants not approved for use in America.  Please do your background searches on your chosen doctors and look for red flags such as what board certification is held, what kind of training does she/he have, what continuing education is pursued, what is his/her experience and complication rate (but doctors are known to fudge on this), and whether the facility used is licensed and accredited.  Knowing this helps reduce your risks for a poor outcome as this patient has learned.

Things Plastic Surgery Cannot Change

As read from, there are 3 things that plastic surgery cannot change.  This includes the width of your shoulders, the distance between your eyes and penis enlargement.  The last category has been dabbled with but in reality, has only created more problems than benefits.  In addition, very disappointed and often very angry patients.

What kind of ‘plastic surgeon’ do you choose?

There are many ‘plastic surgeons’ as well as cosmetic surgeons out there.  How do you decide on whom to choose.  The benefits of a Plastic Surgeon (not a facial plastic or oculoplastic or cosmetic surgeon) are many as they are trained to look at the whole self rather than just parts.  If you have your face rejuvenated but not other areas of your body, you will have disharmonious parts that will clash with each other.  The Plastic Surgeon is trained to look at the whole picture and suggest a plan that would address everything.  Cosmetic Surgeons are comprised of other doctors that have chosen to change their careers and have taken the weekend classes to learn what others have learned over a regimented training program over several years.  So be careful with whom you choose to be your ‘plastic surgeon’.

Do you know your doctor’s history?

When selecting your doctor, its suggested you have a consultation, ask your friends and talk to his/her patients and after doing so, if you ‘clicked’, then proceed.  But do you know your doctor’s track record regarding frequency of complications and infections?  Complications and infections are known risks of surgery but if a prospective doctor has a rate that is double the average, you may be better off avoiding him/her.  Hospitals keep track of statistics like this and those that work in hospitals know.