TOP 10 MYTHS ABOUT BREAST AUGMENTATION

Breast implants must be changed every ten years?

 

 False. There is no need for breast implants to be replaced every ten years. Breast implants should be replaced or removed when there is a problem with them such as a breast implant rupture or the patient changes her mind for any reason.

 

Saline breast Implants are safer than silicone ones.

False. The saline breast implants became popular due to a moratorium imposed by the FDA years ago when it was thought that silicone breast implants caused various diseases. The US became the main country where saline breast implants were used therefore.

When it was shown that silicone breast implants were NOT associated with any diseases then the rate of saline breast implant went down. Today plastic surgeons in the US prefer silicone breast implants as opposed to saline. Most female patients who have had saline breast implants and changed to silicone ones prefer the natural feeling of the silicone ones.

Saline breast implants can have an advantage in cases of breast asymmetry where different breast implant volumes must be used.

 

Under the muscle is better than over the muscle.

Not always true. The practice of placing breast implants under the pectoralis major muscle is mostly an American preference in breast augmentation. This started when saline breast implants were the main option in the US. Saline breast implants offer a more natural result when placed under the muscle due to extra tissue coverage. Saline implants are harder than silicone ones. In addition Saline implants cause less visible rippling and capsular contracture when placed under the muscle as opposed to over the muscle.

Silicone breast implants have a different biological behavior compared to saline ones. Silicone breast implants are softer and feel soft when placed over the muscle and directly under the breast. Silicone breast implant have a lower rate of capsular contracture and rippling compared to saline ones when placed under the breast itself.

Plastic surgeons in most other countries prefer to use silicone gel implants and place them over the muscle.

Each patient has individual and specific needs.

 

Textured breast implants cause less capsular contracture.

Not true. Textured means that the implant surface is rough. It has a feel like sandpaper. The rough surface causes a mild inflammation and helps the implant to adhere to the tissues. This was thought to decrease capsular contracture.  This has not proven to be the case.

Plastic Surgeons in the US use smooth surface implants preferably. Surgeons in Europe and South America prefer textured implants.

Textured implants provide no advantage against capsular contracture.

 

Breast implants cause cancer.

The information we have up to date does not support such claim.  The year 2012 is the 50Th anniversary since the first breast augmentation. If breast implants caused cancer we would know by now. There has been a recent report that a type of lymphoma was found on the capsule surrounding breast implants in some women with prior breast augmentation. This does not mean that in those people the lymphoma was associated with the presence of the breast implants. More investigation is being undertaken to investigate this issue.   Apart for this very recent report there has never been up to date any proof associating silicone gel or saline-filled breast implants with any cancer in the body. There is simply no cause and effect relationship between breast implants and cancer.  A typical cause and effect relationship is that which exists between smoking and lung cancer.

 

You cannot breast feed after you have a breast augmentation.

Not true. If the surgical incision and approach is under the breast in the inframammary fold and the implant is placed sub muscularly then there typically may not be any problem with future breast-feeding and nipple sensation.

 

I lose breast sensation if I get a breast augmentation.

Not true. If the breast augmentation is done via an inframmamary approach (a small incision about an inch and a quarter underneath the breast fold) then on the contrary women’s breast and nipple sensitivity is heightened. Most enjoy that as an added bonus of the surgery.

 

You need an implant to lift the breasts for a breast lift.

No. The breast lift operation (mastopexy, mastoplasty) has the ability to reshape and mold the breasts giving them a youthful perky look. The whole skill is in the surgical technique of molding. A well-trained plastic surgeon can do that without the need to rely on an implant. Some people do not want implants in their bodies and we must respect that.

 

Darker skinned people are prone to darker, thicker and more visible scars

False. Black, Latin, Indian and southern European patients often believe this to be true. While certain people may have a genetic predisposition to forming keloid or hypertrophic scars, the color of the skin itself does not affect the wound healing process and thus does not affect the eventual look of an incision.

 

Natural Breast Augmentation with fat is better.

While fat transfer techniques continue to advance, in my opinion it is not better than implant-based augmentation. Removing fat with liposuction from different areas of the body and then adding the fat to the breast by injections is indeed a way to enlarge the breasts. However some of that fat will die in the preceding 12 months and may form scar tissue and granulomas. Scar tissue and granuloma will be felt as a breast lump. Can you imagine the scare this patient will have? It will make her seek medical attention, many tests and even breast biopsy in order to rule out that those lumps are not cancer. In addition fat transfer to the breast can cause uneven breast skin contour.

Breast Augmentation & Body Contouring

Breast Augmentation 

Now, the other operation in China that is gaining tremendous popularity is that of the breast augmentation.  What the Chinese prefer when it comes to this operation and many Asians is to do this operation through the armpit so that is a transaxillary breast augmentation.  I talked about that during my trip because I perform the transaxillary breast augmentation with the use of the endoscope for more accurate and precise placement and dissection.  It is of particular note that the Asian populations fear the development of scars and prominent scars that is why they prefer to have that scar in the armpit and not anywhere visibly on the breasts.  It is also of particular mention and note the implant sizes that are the most popular vary from 180 cc to 230 cc.  So, they prefer smaller volume breast augmentation compared to the rest of the world, which I believe is healthy for the long run as well as smaller implants not to stretch the breast too much.

Body contouring operation, particularly operation that we would term mommy makeover, they are just beginning there.

Part of the apprehension has been due to the fact that they are afraid of the lower abdominal scars.  In general, the Asian populations have a slightly incidence to develop hypertrophic scars and keloids in the medical literature.  However, that is the pathological kind of healing.  Normal type of healing is no difference in Asian populations and scarring compared to Western populations, white populations, black populations, or any other human race for that part.

 

 

 

John Anastasatos, MD, FACS

Board Certified Plastic Surgeon in Beverly Hills

Jaw, Cheeks and Lips – Part 3

Mandibular or Jawbone Resection

Once again, there is a distinct anatomic difference between Chinese people and many Asians as opposed to Western people. One of this anatomic distinction is that the face appears to have a square look and a flat look. This has to do with the midface. This is partly due to the anatomy of the mandibular bone also known as the jaw bones. So, a very popular operation in China and also in Korea and other Asian population is an operation where a surgeon carefully and skillfully resects the outer table of the mandibular bone. What does the outer table mean? Essentially, the mandible is composed of two thick cortical areas, one is called the outer table and the other one is called the inner table. The bones are made in such a way for added security and protection. What this means is that the outer table can be carefully and meticulously resected and the inner table if it is left alone it holds the integrity of the whole mandibular structure and the whole facial structure effectively. So, the operation where the surgeon can effectively resect the outer table is very effective operation in making the face appear thinner and give a narrower look and oval-shaped look. This is a very impressive and this is an amazing operation.

The cheeks and the malar prominence.

Once again, the anatomy of many of the Asian populations, particularly Chinese and Korean, is such where the malar prominence may be not as projecting or in another case can be overprojecting. In the case of underprojection, the implants are placed to give prominence. These implants are called cheek implants.
In case of overprojection and/or that contributes to the widening of the face then it can be also a partial bone resection of the outer table of the malar/zygomatic bone.

Lip operation

This operation is more significant than on the face. In most patients, the lips are thin and they will do an operation to raise the white part of the lips so a lip lift operation or simply use fillers to make the lips and especially the upper lip more fuller and central.

John Anastasatos, MD, FACS
Board Certified Plastic Surgeon in Beverly Hills

The Asian nose – Part 2.

This is another one of the most popular operations. Typically, in most Asian
populations, the nose in general appears to be flat and they seek an operation that
will give the nose projection and make it not appear flat.

The operation for this is a fairly simple operation where an implant is used that is being

nicely conforms to the middle of the nose which is called the columella and on top of the
nose which is called the roof or dorsum of the nose. This implant material is either a Porex
material typically produced by company called Medpor and/or it can be a silicone
material and many companies produce silicone nose implants. The operation is
done through a closed rhinoplasty approach and it is an operation that is
expeditious and can be even done under pure local anesthesia if somebody would
like that. The operation has high rate of satisfaction. The most common
complication, short term or long term, can be an infection as these materials that are
artificial, and an artificial material can be infected. It appears that the Porex implant
has a lower rate of infection and also conforms more accurately. Another cause of
reoperation and another complication of this operation is displacement or
misplacement of the implant that can be done at the time of surgery or it can occur
actually over many years because the nose is a dynamic entity and it does grow as
we age.

John Anastasatos, MD, FACS
Board Certified Plastic Surgeon in Beverly Hills

PLASTIC SURGERY IN CHINA AND ASIAN PLASTIC SURGERY PREFERENCES – Part 1.

I recently had the opportunity and the pleasure to be invited by a major hospital Corporation in China. I was the President of the Postpartum Cosmetic Surgery Program that they have initiated. The Hospital Corporation has hospitals in Beijing, Nanjing, and Shanghai so I visited all these hospitals. At those hospitals, I had the opportunity to discuss the newest techniques that I apply to the Asian population in Beverly Hills with the local doctors. I had the opportunity also to meet a lot of patients and discussed what would be the best treatment for them.

In practicing in Los Angeles I am exposed to a large number of ethnic populations. One of those population is Chinese, Korean, and Japanese. Each of this population has a standard of beauty that they seek and there are also anatomic differences compared to Western civilizations. As a surgeon in Beverly Hills that performs many Asian plastic surgery operations, I was able to convey my experience during my visit.

In general, a lot of the plastic surgery in China and other Asian population focuses on the face. Specifically:

1. Asian eyelid surgery.

The Asian eyelids are distinctly different from Western eyelids because they lack an upper crease or an upper eyelid fold. So, Asian populations are interested in having an operation to create an upper eyelid fold that is called the Asian eyelid operation. Specifically, what the surgery does is, it opens up the eyelid and it repositions the levator muscle and its aponeurosis in such a way to create a crease. This crease that most of us have in our upper eyelid is an element of beauty that is perhaps the most popular cosmetic surgery facial operation for Chinese and Asian populations. The upper eyelid operation is an operation that is easily and nicely done under local anesthesia or the patient can elects to have local anesthesia and sedation and also general anesthesia if this is the patient’s preference. The Asian eyelid operation opens up the eyes and this is one of the main reasons why the Chinese people and other Asian seek that kind of surgery. Bigger eyes and wide-opened eyes are an element of beauty. This is an operation with a high satisfaction rate. The most common complication of this operation is asymmetry. Asymmetric crease is the most common complication. In order for that to be corrected, that requires another surgery and that is something that must be explained to the patients.

Stay tuned for Part 2…

John Anastasatos, MD, FACS

Face Lift Part 2.

The neck lift is a very critical part of operation and is often omitted during the facelift.

As my finishing touches I address and lift the lips and the chin in a natural way.

My facelift incisions are well hidden in the hair and inside the ears for the most part. There are some incisions on the back of the ear needed for the neck lift.

Facelift with Fat

The facelift with fat has many good applications for the right patient. It has been noted that the fat can sometimes improve the quality of the skin. I use fat in some of my facelifts but not all. Proper patient selection is the key to success.

Facelift with Stem Cells

Stem cells have been found in fat. So we take the fat with liposuction for one part of the body and we isolate the stem cells. Then we add the stem cells and the fat in the face. How exactly the stem cells function is not yet known.

As a plastic surgeon with integrity I must state that at this point in time we do not know the efficacy and value of adding stem cells to the facelift. Theoretically it makes sense that it works but the scientific truth is that we do not know if it helps and how it helps.

In Europe stem cell applications can be more advanced than the US for regulatory reasons.


John M. Anastasatos, MD, FACS
Board Certified Plastic Surgeon in Beverly Hills

Facelift Part 1.

The facelift or face-lift operation is to me the epitome of cosmetic plastic surgery. Our faces carry and portray our expression. Our faces are who we communicate and express ourselves with the world. Cosmetic surgery therefore on the face is the most significant and must be done in a natural way.

For a natural looking yet effective facelift excellent knowledge of the anatomy is required. Moreover though beyond excellent knowledge and great skill a good “eye” is needed for the beautiful facelift result. The cosmetic plastic surgeon that performs a good facelift not only has the proper training and skill but also has a good aesthetic “eye”.

The good facelift is truly an art form. I personally do not like watching women and men who had facelifts and look pulled and so fake. This plastic look is not good for the face. The face, the eyes, the brows, the lips, the neck must all look natural for the facelift to be called successful.

The proper facelift operation also addresses many features on the face and neck. I begin my operation by addressing the forehead, the brows and the glabella. What I do for the upper third of the face is an endoscopic forehead and brow lift. This is an amazing operation that was developed by my mentor Dr. Luis O. Vasconez. The endoscopic facelift rejuvenates the upper third of the face/ It is an upper face-lift. It open up the eyes in a natural way and people do not look artificial but fresh and rested.

The endoscopic brow lift allows me to lift the nose as well. The nose becomes longer and the tip droopy with time. I also correct the nose with my facelift procedures.

The midface and mid-facelift is the most critical part of the facelift operation. The prominent nasolabial folds, nasojugal folds and jowls all will be corrected with the midfacelift. My secret is that I suspend the soft tissues vertically upward and not sideways. Pulling sideways cause a fake look and plus the results are not so impressive.

I strive for impressive results on my facelifts. Together with the face I address the neck. The neck and face should be best done together for best results. The neck is addresses with platysma band plication, liposuction of the neck and skin tightening.

Stay tuned for Facelift Part 2….

John M. Anastasatos, MD, FACS
Board Certified Plastic Surgeon in Beverly Hills

TREATMENTS FOR THE AGING HANDS

 

I wish I could do something for my aging hands.

YOU CAN! There are treatments to address the elements of the aging hands. Hands are the “tell-tale” parts of the body that are visibly noticed and people do nothing about that. Part has to do with the fact that people do not know of the available treatments. Fat can be added to replace the loss of volume that occurs in the hands over time.  A 35% TCA peel can be applied to the top of the hand, wrist and forearm to help reduce the blemishes and brown spots that occur as a result of years of sun exposure. Repeat treatments can totally eradicate them. For areas that are lighter in color Hydroquinone cream can be used to lighten those areas. I prescribe hydroquinone 6% or 8%. Those strengths must be filled at a compounding pharmacy but work very effectively. If there is significant skin excess of the hands as a result of loss of elasticity skin can be strategically removed with incisions that heal extremely well and tighten the hand. For mild to minimal tightening devices that employ radiofrequency and laser can also be used. Instead of fat fillers commonly used in the face or other parts of the body can be used for the hand as well but they are not as stable in the hand and permanent as fat. The loss of skin thickness and elasticity that occurs in the hand with increasing age cause progressive visibility and prominence of veins of the topside of the hand. Those can be removed easily in the office under some topical anesthesia and without cutting the skin. They can be burned with a simple needle. Another but less popular option for the prominent veins of the hands is injection sclerotehrapy.

 

John M. Anastasatos, MD, FACS
Board Certified Plastic Surgeon in Beverly Hills

DO I have to go to Brazil to get a Brazilian buttock lift?

No. It is done in the US and other parts of the world equally effectively. The Brazilian Butt lift is the technique of performing liposuction in certain parts of the body, harvesting this fat and then injecting it to the buttocks to add volume, enlarge them and lift them. It was popularized in Brazil because that culture appreciates well-shaped buttocks as a very high element of beauty.

I want to have the Brazilian Buttock Lift at the same time as my liposuction surgery.

Probably not if you are thin person. In order for this operation to be effective at least 300cc of pure fat must be inserted in each buttock area. Ideally we like to place over 600cc in each buttock. Please bear in mind that of this fat part of it will die within the first year.

Are there alternatives to the buttock lift with fat?

Yes. Buttock augmentation with implants is an excellent operation. This operation is done through a small 5-8cm incision that is strategically paced in the buttock crease so even if someone wears a G-string it does not show. The implants are inserted trough there. The implants are made of a cohesive silicone gel and their surface can be either textured or smooth. The implant placement can be either under the gluteus maximus muscle or under the skin. I prefer to place the implants under the muscle. Placement under the muscle is more painful but with fewer complications.

Doctor can you take fat from my friend and give me a bigger butt or breasts?

False. This sounds funny but many patients ask me that. I think they know that such does not happen and is more like science fiction. However we may be able to see something like this soon! Tissue from one person gets rejected when implanted to another person. That is why transplant tissues and organs require immunosupression to be able to live in their new host. However there is evidence that stem cells do not elicit an immune response and may therefore be transferred to another host without rejection. Simply described stem cells are natural cells of our bodies that have the capacity to become many different cell types depending on the body’s needs. Much remains to be seen about stem cells but this may be potentially very exciting.

Transplanted fat goes away in time.

Yes some of it will resorb but in good hands most will stay and survive. The beauty of this technique is that the fat that stays there will live forever as its part of the body’s own tissues.

Transplanted fat behaves differently.

We do not know if the fat behaves as it existed in its previous area of harvest or adapts and behaves as part of its new local environment. We know that in some cases it may grow on its own especially in areas with great vascular supply such as the face. The recent find that fat cells can be a good source of blast cells that may cause proliferation of local cell types further adds to these findings.

DO I have to go to Brazil to get a Brazilian buttock lift?

No. It is done in the US and other parts of the world equally effectively. The Brazilian Butt lift is the technique of performing liposuction in certain parts of the body, harvesting this fat and then injecting it to the buttocks to add volume, enlarge them and lift them. It was popularized in Brazil because that culture appreciates well-shaped buttocks as a very high element of beauty.

I want to have the Brazilian Buttock Lift at the same time as my liposuction surgery.

Probably not if you are thin person. In order for this operation to be effective at least 300cc of pure fat must be inserted in each buttock area. Ideally we like to place over 600cc in each buttock. Please bear in mind that of this fat part of it will die within the first year.

Are there alternatives to the buttock lift with fat?

Yes. Buttock augmentation with implants is an excellent operation. This operation is done through a small 5-8cm incision that is strategically paced in the buttock crease so even if someone wears a G-string it does not show. The implants are inserted trough there. The implants are made of a cohesive silicone gel and their surface can be either textured or smooth. The implant placement can be either under the gluteus maximus muscle or under the skin. I prefer to place the implants under the muscle. Placement under the muscle is more painful but with fewer complications.

Doctor can you take fat from my friend and give me a bigger butt or breasts?

False. This sounds funny but many patients ask me that. I think they know that such does not happen and is more like science fiction. However we may be able to see something like this soon! Tissue from one person gets rejected when implanted to another person. That is why transplant tissues and organs require immunosupression to be able to live in their new host. However there is evidence that stem cells do not elicit an immune response and may therefore be transferred to another host without rejection. Simply described stem cells are natural cells of our bodies that have the capacity to become many different cell types depending on the body’s needs. Much remains to be seen about stem cells but this may be potentially very exciting.

Transplanted fat goes away in time.

Yes some of it will resorb but in good hands most will stay and survive. The beauty of this technique is that the fat that stays there will live forever as its part of the body’s own tissues.

Transplanted fat behaves differently.

We do not know if the fat behaves as it existed in its previous area of harvest or adapts and behaves as part of its new local environment. We know that in some cases it may grow on its own especially in areas with great vascular supply such as the face. The recent find that fat cells can be a good source of blast cells that may cause proliferation of local cell types further adds to these findings.

John M. Anastasatos, MD, FACS
Board Certified Plastic Surgeon in Beverly Hills