New York City, NY-  Please read this New York Times article by John Tierney.  It is interesting, useful, and optimistic.

New Year’s resolutions have almost become a joke for things that don’t work.  Well, it turns out that is wrong.  It is true that many people are not going to keep their resolutions (such as losing weight and exercising more) all year long, BUT studies show that you are much more likely to make improvements than someone else who never made a formal resolution.  So they are worth making.  That is the first point.

The second point is that if you managed to stick to your resolutions for the month of January, you have a really good chance of continuing on the good path.

The third point is to focus on your strategy.  Most people try to build up their will power, but it is easy to run out of this kind of energy.  You are more likely to succeed if you set up your life to minimize temptations.  People with the best self-control actually use their will power less often.

Now we have scientific evidence about the role of stem cells in fat transfer.  Stem cells are present in fat and they are very powerful because they can create new tissues, such as collagen and blood vessels.

The fat cells in fat transfer provide the needed volume.  For example, they make the cheek bone area fuller.  But the stems cells that are transferred along with the fat create new collagen and improve the local blood supply.  These properties of stem cells make the results of fat transfer better and longer lasting.

Something that is being commonly done now is breast reduction at the same time as the lumpectomy.  This is called Oncoplastic surgery.  Oncoplastic surgery has a lot of advantages.  Both breasts are lifted and made smaller.  A bigger lumpectomy with wider margins can be done without creating a deformity in the breast with the tumor.  And of course symmetry is excellent.

Also with oncoplasty surgery, the breast reduction is done before radiation and so the blood supply is not a worry.

The continuing accumulated evidence supports the FDA White Paper of May 2011, which confirmed the safety and efficacy of silicone breasts implants.  No association has been found between implants and connective tissue diseases.  It is now possible to stop using MRIs as a screening tool in patients without symptoms.  It is reasonable to expect that silicone implants will remain intact for at least fifteen years.

It is not really age that determine whether you are a good candidate for cosmetic surgery such as breast implants.  It is good health that make breast augmentation safe.  If your weight is normal, and you are physically active, and you have had a normal history and physical, there is no reason why you can not have it.  And of course you should have a mammogram before surgery.

Nipple sparing mastectomy makes the results even better.  Some of these women don’t look like they had mastectomies at all__they look like they had implants.

There is always some scar after breast reconstruction__often short.  But many women tell us that their breasts look better after breast reconstruction.  These women had breasts that were very small or very large or very sagging.  These problems can be fixed with breast reconstruction.

In women the bulges are typically in the thighs, and in men they are in the love handles.  These bulges are genetic and have nothing to do with being overweight.  In fact, these patients may be skinny precisely because they are trying to get rid of the bulges.  But the bulges don’t go away when you lose weight__ they just get smaller.

This is why thin patients are such good candidates for liposuction.  The rest of their body looks just fine, and when liposuction removes the bulges, they are very happy.

Losing weight is extremely hard to many people.  Telling them that they must lose weight before surgery is really telling them they can not have surgery.  And I don’t see why that should be.  Liposuction is to correct bulges and improve shape, and this can be done very effectively even if you are overweight.  Of course, you will still be overweight afterward.  Liposuction is not a weight loss technique, but you will be rid of the bothersome bulges and you will have better shape.

So I think it is perfectly reasonable for someone who is __ say 20% overweight to have liposuction.

New York City, NY-  People can be confused about silicone because silicone means three different things:

1.  Silocone implants (breast and chin implants) are self-constained and extremely safe.  They are very effective and they are approved by the FDA.  I  recommend them without hesitation.  This kind of silicone does not hurt anyone.

2.  The link above is about injecting industrial grade liquid silicone (full of contaminants) into the body (typically breasts and buttocks).  This is very dangerous and foolish and can only be condemned.  Legitimate plastic surgeons do not do this.

3.  The third type of silicone is medical grade liquid silicone.  There are a few doctors who inject it into the face instead of the usual fillers.  When medical grade silicone is injected with superb skill and in tiny amounts, it can be safe.  But I think this is also a bad idea because it is permanent.

Lay people may think this is a good thing,  but remember, the shape of your face changes and you age, and the silicone does not.  A silicone injection that looked good right away can look deformed in ten years.  And liquid silicone is extremely difficult to remove.

That is why most competent plastic surgeons and dermatologists use fillers like Juvederm Ultra Plus that last a long time (9 months to 2-3 years , depending on what part of the face) but are not permanent.

]]> http://www.drberakablog.com/silicone-injections-are-a-really-bad-idea/feed/ 0 http://www.drberakablog.com/non-surgical-treatments-for-the-face/ http://www.drberakablog.com/non-surgical-treatments-for-the-face/#comments Mon, 03 Oct 2011 19:43:12 +0000 admin http://www.drberakablog.com/?p=267 New York City- An article titled “Saving Face” in the October issue of Marie Claire is a useful review of non-surgical treatments for the face.  This is my take:

1.  I have seen very disappointing results with Intense Pulsed Light (IPL) treatments; so I don’t recommend it.

2.  Deep ablative laser resurfacing gives you really dramatic results, but there is one week down time.

3.  We are doing more and more with Botox.  A few units placed about half an inch below the corners of the mouth relax the muscle that pulls down, and __ the corners come up!

4.  Injecting fillers deep (Radiesse is best for this) can lift and reshape the face.  We don’t use cheek bone implants anymore, because the fillers are safer and look more natural (without surgery).

5.  Stay away from fat injections unless you are also having a facelift.  Juvederm does the same thing, lasts more than two years in the tear trough under the eyes, and it is done during an office visit.