Tag Archives: FACS

Unfortunately gravity is unceasing and combined with age and sun related skin loss of elasticity a woman’s tissues surrounding her breast can lead to the breast mound falling lower on the chest. Additionally, the volume inside the breast can diminish with hormonal changes after pregnancy and menopause and with significant weight loss.  All these factors triumphantly combine to give an aged appearance that can be significantly disproportionate to the otherwise youthful feeling of a women. Sound depressing? Sure it does but the artistry and science behind plastic surgery can offset these changes to a woman’s breasts and make them feel good about the skin they are in.

If someone is unhappy with the appearance of their breasts it is helpful for analysis sake to deconstruct the breast into two separate components: the overlying skin brazier, and the volume and its distribution of the breast mound on the chest wall.

The mound itself may have adequate volume but most of the distribution of the volume is in the lower pole of the breast well below the breast fold requiring a bra to perform a heroic task of keeping the breast on the proper location on the chest wall. This situation can be improved by a mastopexy (lift) with creating a lower pole breast flap of tissue transposed under the rest of the breast mound and fixated to a non-mobile portion of the chest wall to provide upper pole fullness. In this situation the skin brazier is loose and has allowed the breast mound to sink inferiorly and requires and generous amount of skin to be removed and repositioned to be coincident with the newly shaped breast mound. For some women this may produce a nice result but particularly individuals who have a very long trunk with a great distance from the breast fold to the collar bone, creating the appearance of low set breasts, the above technique requires another means of providing upper pole fullness. Some women are comfortable with adding an augmentation with a breast implant to enhance shape and form and creating a nice upper pole roundness. Some surgeons are comfortable offering an augmentation at the same time as the mastopexy. Other surgeons would argue, based on data which has shown a 25% revision rate with the combined procedures, would prefer to stage these techniques. I personally like to perform the augmentation mastopexy in a single stage because I would rather have the implant in place to provide shape and volume to the overlying breast mound prior to tailoring the skin envelope of the lift procedure. I find this saves the patient a second general anesthesia, reduces expenses, and can be performed in the office setting with much less cost. Generally, it is only a minor skin re-tailoring to minimally reposition the nipple-areolar complex vertically on the breast mound.

Implants can provide structural shaping and volume enhancement of the breast mound but there are definitely limitations to their effect. Women who have structural limitations to their chest wall anatomy can have difficulty in achieving satisfactory results with implants alone. Individuals with very wide sternums and rapidly sloping chest walls cannot achieve meaningful cleavage with implants alone because the devise cannot be placed on the sternum. Another anatomic limitation eluded to in the above paragraph is the long chest wall with the accentuated length of the breast fold to collar bone giving the illusion of the low set breast. Even an anatomic shaped breast implant which is taller than it is wide still cannot mask this affect. In both of the above situations in which implants are chosen as the enhancer of choice the addition of fat grafting is necessary to create a much enhanced result. The beauty of fat grafting is that it can be placed in any position on the chest or breast. It can be similar to the concept of photo-shopping an image and allows the surgeon to truly sculpt the breast and chest wall to closer reflect an ideal form and helps to hide these difficult anatomic variants with your very own fat.

Other women may prefer to avoid implants all together and in consultation with their surgeon may choose to enhance the shape and volume of the breast mound and chest wall in conjunction with a mastopexy with just fat grafting lone without implants. Just as implants have limitations so does fat grafting. The current art and science of the techniques of autologous fat grafting has a yield of around seventy percent sustainable take of the viable fat implanted into the tissues. This has been reproducible shown over many series of papers presented in the literature. Since fat is a very soft material that cannot resist significant opposing forces of the skin it is difficult to globally enhance a breast mound much larger than a cup to a cup and a half sizes larger in one session. Therefore a women who has a large skin envelope and very limited breast mound volume and desires to have a very full shape should not consider enhancement solely with fat alone. A combined implant with fat grafting provides a much better and stable result. In my experience fat grafting alone is best to sculpt and shape the cleavage and upper poles of the breast and chest wall interface. It can enhance the overall volume by a cup size as well. The other nice advantage of fat grafting for breasts is it allows the removal of unwanted fat volume from places like the flanks, abdomen, and thighs to achieve improved breast shape and sculpting of the body contour.

If you feel self-conscious about the appearance of your breast and feel it is disproportionate to the rest of the body and how you feel about yourself, consult a board certified plastic surgeon in LV Nevada to define your goals and options for rejuvenating your breasts.

Stephen M. Miller, MD, PC, FACS
8435 S Eastern Ave
Las Vegas NV 89123
Phone: (702) 369-1001

http://www.drstephenmiller.com

Twins

Although the birth rate for twins has risen dramatically since 2009 to about 1 in every 38 births, the birth rate for identical twins is significantly more rare: about 1 in every 285 births. The result of a single egg that splits in two, identical twins share more than just their DNA. Emotionally and physically, identical twins can be so alike that people can’t tell them apart. Which can make the job of a plastic surgeon operating on identical twins extremely challenging. Dr. Peter Fodor, an international leader in the field of aesthetic plastic surgery who has operated on a number of identical twins in his Los Angeles, CA practice, shares some of these challenges.

by Katherine Stuart
and Peter Fodor, MD

Almost a No-Win Situation

While all twins gestate together in the same womb, often speaking without words, identical twins go one step further. They share DNA, making them physically the same. This can create a very interesting, but challenging situation for a plastic surgeon. Emotionally, most identical twins adore each other, in Dr. Fodor’s experience, and want to be the same in every respect from voice to dress to what they eat. There’s even a set of twins in Australia who share the same boyfriend. For twins such as this, if a plastic surgeon doesn’t make them exactly the same then he or she has failed. However, there’s also a smaller sub group of identical twins who are extremely competitive and don’t really like each other at all. But they, too, want to look exactly the same post surgery or else their competitiveness will escalate. This can create a bit of a no-win situation. As Dr. Fodor puts it: “Identical twins whether they love each other or don’t like each other quite as much, you better make them look identical after surgery.”

Two Twins at Once

In order to ensure the most successful outcome possible, Dr. Fodor likes to work on both twins. Ideally, assuming the procedures aren’t too long, on the same day. For example, if he’s performing a rhinoplasty, he will do the first twin’s nose, followed by the second twin’s nose, making sure to go through exactly the same steps in exactly the same order. But some procedures have more predictable results than others. A breast augmentation performed with the same size implant will deliver similar results while a nose job can be more difficult partly due to facial asymmetry.

Twins-Rhinoplasty
Rhinoplasty-Twins

Facial Asymmetry is the Norm

Everyone’s face is asymmetrical. If you take a photo of a patient and split it down the middle, the right and left side won’t match up. In fact, Dr. Fodor has a trick mirror in his office that he uses with patients where one side is a regular mirror, and the other is a prism mirror that reverses the right and left sides of the face. Most patients don’t recognize themselves in the prism mirror. “The two sides of the face oftentimes though they look very similar, they’re not identical” says Dr. Fodor. This is true for twins as well.
Twins-and-Rhinoplasty

One Set of Twins. Two Different Surgeons

Another challenge of working on twins is when you only get to work on one because a different surgeon has already worked on the other. It’s allows for the kind of direct comparison that’s hard to capture elsewhere and can be “kind of an ego builder when the twin that you did looks better” or more natural.

Twins and Facial Aging

Aging identical twins are also fascinating since they often don’t age at the same rate due to lifestyle choices. In fact, a 2009 study used identical twins to determine which outside factors contribute most to facial aging. The main culprits were smoking and sun exposure. This definitely comes into play for Dr. Fodor when he’s performing a facelift on identical twins. For him, the most fascinating thing is following up with these patients years down the road and seeing whether or not changes such as stopping smoking will cause them to age at the same rate again.

Needless to say, working on identical twins may be technically challenging, but it’s also a fascinating learning experience for any plastic surgeon.

Peter B Fodor MD, FACS
2080 Century Park East
Suite 1511
Los Angeles, 90067
(310) 203-9818

Plastic surgery for males is a relatively new phenomenon. Historically, men have viewed this venue of services as mostly for women. My father’s generation was not working out in gyms and drinking protein shakes to stay healthy and active in middle age and beyond. Undeniably, the aging baby boomer population refuses to be defined by chronologic age and embraces the concept of wanting to look as good as you feel. With this is mind, why let women have all the resources to age gracefully and look young and vibrant? Men can now maintain a youthful appearance proportionate to our level of health and to our significant others.

What services are available to men?

Skin care: The concept may seem too metrosexual at first glance, but there is a health benefit as well. Sun exposure has a cumulative effect, which damages the outer skin, and dermis making the skin look dry and leathery. Loose, inelastic skin coupled with blotches of dark pigmentation makes the skin appear older than chronologic age would suggest. This is also a set up for skin cancers. Skin care may include skin resurfacing with peels to remove the damaged skin along with micro-needling to induce collagen production and improve skin tightening to provide a much-improved appearance and reduce the potential risks of skin cancers.

The use of Botox, which will weaken the overactive muscles between the brows and around the eyes, can prevent the deep furrows of the skin thus smoothing the appearance. This agent can be employed to hide some of the muscle bands in the neck as well.

Filler agents, such as Voluma, can be easily injected into areas of programed fat atrophy which occurs in aging and results in the cheek falling causing accentuation of the cheek folds and may produce hanging on the jaw line. Voluma, which is a highly crosslinked stiff hyaluronic acid filler, can manage to lift the cheek without making the face look fat.

Rhinoplasty: This is the art and science of the interactions of skin, bone and cartilage of the nose to provide an aesthetically appealing appearance with normal function. Rhinoplasty is a very meticulous surgery with the goal of providing a balanced appearance between the various components of the nose as well as creating harmony with the rest of the face. This surgery can provide a real boost to someone’s appearance and self-esteem.

Gynecomastia: This is a condition in which the male breast increases in size with fibro-glandular tissue mixed with added volume of fat giving it a feminized appearance. Gynecomastia can occur at any age creating self-conscious situations both with and without clothing. Fortunately the correction is very straightforward and very predictable. We recommend the use of ultrasonic energy mixed with traditional liposuction to facilitate fat and fibro-glandular removal of tissue to sculpt the breast back to a masculine appearance. There are occasions when direct excision of tissue directly under the nipple-areolar complex is necessary in addition to the liposuction to achieve the desired results, but the scaring in minimal. Without question a very power surgery that gives wonderful results.

Lipo-sculpturing: Unfortunately diet and exercise can’t cure all problems with the contour of the abdomen and posterior flanks. With metabolism changes, even a meticulous healthy eater with an active lifestyle can still experience abdominal bulges and flank adiposity. For patients with good skin quality without a great deal of skin excess, liposuction can provide a means of sculpting the torso to give a more pleasing shape and enhance confidence with and without clothes. The surgery is generally not that difficult to recover from, and results can be effective.

Eyelid rejuvenation: Do people say you look tired? Do your lids hang over your eyes giving the appearance of sleepiness? Do you have puffy lower eyelids giving you a less vibrant persona? Then you may want to consider eyelid surgery to give you a refreshed look. It’s been said that the eyes are the windows into the soul; so don’t have outdated window treatments. The surgery is mildly uncomfortable with swelling being the biggest issue related to return of feeling comfortable in social situations. Careful consultation with your surgeon is required to avoid complications depending on the anatomy of your eyelids. People will notice the refreshed look after the recovery has taken place.

Neck rejuvenation: A hanging neck with loose skin and excess fat can give the appearance of an aged and out-of-shape individual. It may also project being overweight. Depending on the degree of tissue excess and skin quality, this may be correctable with liposuction alone. However if the skin quality is poor and there is the presence of muscle bands in the neck, a true neck lift will be required. This surgery can take an old-looking neck and transform it to a smooth crisp neckline with well-defined jaw contours. Neck rejuvenation can take years and pounds away from how you look.

In summary, plastic surgery offers men many options to consider feeling good about the skin you’re in. It’s not just for women anymore.

Dr. Kent W. Gabriel, MD
704 W. Nye Lane, Suite 102, Carson City, NV 89703
Telephone: (775) 885-8890

Residents of Las Vegas know all too well the meaning of extreme weather. With thechanging seasons comes dry winter skin, and now that the holidays fast approachingit is time to focus on your skin care regime. Dry climates equal dry skin. Not to mention, dry skin is uncomfortable. It draws out the moisture from your skin leaving you with a less youthful glow, andcan lead you looking older than you really are. It’s easy to ignore daily skin care but when you live in a dry state like Nevada, understanding your skin first is the basis of a good skin care program.

An important part of our mission is sharing our expertise with you. Using the latest VISIA technology, a Skin Spa specialist will take ultra-violet and digital photographs to assist in evaluating your skin. Your face will then be thoroughly cleansed and analyzed for type and condition. To round out your consultation, we will formulate a customized program, and skin care treatments.The medical-grade products we use are available in our retail boutique by prescription so you can maintain the restorative effects at home between treatments.

We carry the following lines:

Obagi® Medical -offers an extensive line of clinically-proven, by-prescription-only skin care systems and products designed to help revitalize, enhance and maintain beautiful skin for life. The following sampling of systems meet the needs of all ages, all skin types.

Éminence Organic Skin Care – body and facial products are a natural approach to skin care. Produced using sustainable farming and green practices in Hungary, Eminence products only use ingredients without harmful chemicals or additives to allow premium results for all skin types. These products are made-up of essential oils and coloring and scents from fruits, vegetables, herbs and teas.

Jane Iredale Mineral Makeup -This is THE Skin Care makeup. Jane was the first to introduce mineral makeup. It is made with minerals and pigments that allow the skin to breathe. Her products provide anti-inflammatory, weight-less coverage, it’s a foundation, powder and concealer all in one. The products will not clog pores, carry a lowallergy risk, contain no talc or parabens or synthetic ingredients and provide sun protection.

Corrective Skin Therapies – Our medically-advanced peels are custom-designed just for you. Using clinically-proven, professional products by BioMedic® and SkinMedica®, we deliver great results when our peels are routinely combined with a prescribed, at-home skin care regime.

In addition to the above, remember to always wear sunscreen. The number one case of premature aging and wrinkles is sun damage. Make better food choices reduce your intake of junk food, Watch foods high in fat and sugars. Hydrate drink up to 8 glasses of water a day.Moisturize its one of the most important things to prevent sagging and dull aging skin. Use oil-based products that retain water on the outer layers of the skin.

Stephen M. Miller, MD, PC, FACS
8435 S Eastern Ave
Las Vegas NV 89123
Phone: (702) 369-1001

Cosmetic Surgery Financing in Today’s Market

As the market for cosmetic surgery and non-surgical procedures grows, patients are always searching for new, innovative ways to pay for their treatments.

WHAT THEY FINANCE
You can wrap up all of your surgery-related costs and cover it with your AHCL loan!
American HealthCare Lending finances treatments, procedures, medications, anesthesia, facility fees, recovery care, surgical garments, travel and lodging, etc.

HOW TO OBTAIN AN AHCL LOAN
It’s easy. Go to www.drstephenmiller.com, click on the AHCL logo and get started with your pre-approval process. Enter your information and our provider number. You’ll receive an email decision upon approval and funding within minutes. Then just select one of the loans offered and verify your personal information. Loans are funded directly to the bank account of the individual listed on the loan.

OTHER PAYMENT OPTIONS TODAY
Dr Stephen Miller still offers traditional payment options such as cash, cashier’s checks, Visa, MasterCard, Discover, American Express and lay-a-way plans. In addition, if you’re interested in opening a heath care-related credit card, we also participate with Care Credit which offers 0% interest rate for 6 and 12 months and 14.9% interest on extended payment options for 24 to 60 months.

Stephen M. Miller, MD, PC, FACS
8435 S Eastern Ave
Las Vegas NV 89123
Phone: (702) 369-1001