Although breast implants have been around in one form or another since the 1960’s, only two silicone-based implants have made the U.S. Food and Drug Administration’s (FDA) short list of approved devices. But women looking to enhance their figures now have a third option available to them. The FDA recently released a statement announcing the conditional approval of a silicone gel-filled breast implant by Sientra, Inc.

The approval is based on clinical trials conducted over three years with 1,788 participants. The results of these studies fell in line with other breast implants already on the market. However, the approval from the FDA is based on additional studies that will measure the long-term effects or complications that may arise from using the product.

William Maisel, deputy director for science at the FDA’s Center for Devices and Radiological Health stated that the data indicates there was reasonable assurance of safety and effectiveness but that women should still endeavor to fully understand the risks associated with breast implants before undergoing a breast augmentation procedure. But the real question is how eager are plastic surgeons to try out these new implants?

“It’s always nice to have more options and for there to be competition between businesses so they strive to provide the best products possible. The two primary breast implant companies today are Allergan and Mentor. Both of them have excellent products that have been tested over many years,” comments Fort Lauderdale Plastic Surgeon Dr. Paul Wigoda, “With any new implant I personally would wait a few years to see how it performs before I’d use it on a patient. If these new implants are found to be better in some way than what the other companies offer, then it certainly would be something I’d consider using. At this time I don’t know of any reason to change from the implants I currently use.”

While it is always nice to play with a shiny new toy when you first get it, sometimes it’s good to stick with the tried and true for awhile. If you are thinking about breast augmentation surgery, talk to an experienced plastic surgeon like Dr. Paul Wigoda about the many options currently available to you.

After spending a good portion of her young adulthood wrangling with addiction and legal ails, Lindsey Lohan is ready for a new life. To kick off her not so maiden voyage into a sober lifestyle, Lohan hangs up her party-girl ways and dons a new face, literally.

There is no denying that Lohan has had work done. A simple comparison between photos of her today vs. just a few years ago shows that she’s had her lips done and may be using filler to make her cheeks look fuller. While it’s not surprising that an actress would have cosmetic procedures to freshen up her looks, it’s surprising to see someone so young diving into the world of Botox and dermal fillers.

But Lohan is far from alone in her youthful quest to stop time at age 25. While people 35 to 50 years still get the majority of cosmetic procedures, the generation below them (age 19 to 34) account for a whopping 20% of treatments. Rhinoplasty and breast augmentation are the most common procedures performed on people in this age group. The question of the day is is this trend of 25 year olds trying to look 19 again feasible?

“There is no question that Botox and fillers can improve a person’s appearance and make then appear more youthful,” says Fort Lauderadle plastic surgeon Dr. Wigoda, “However, the procedures need to be performed on patients who are good candidates. Trying to make a 25 year old look younger with these procedures is silly. In fact, I would agree with the other surgeons and state that Lindsay looks less natural and older.”

With the stigma of cosmetic procedures fast dropping away, due in part to reality television showcasing young debutantes getting treatments, the trend shows no signs of abating. Indeed, more and more twenty year olds are getting in the chair for Botox and dermal fillers. Although the temporary nature of these treatments means there are little to no medical downsides to getting them, they need to be maintained, which can represent a significant financial investment. Additionally, these minor treatments are sort of like gateway drugs in that they can lead to a Heidi Montag-esque quest for perfection.

Dr. Wigoda offers this advice to plastic surgeons treating young patients. “Just because you can do a procedure, does not mean you should. It’s important for a surgeon to evaluate a person’s face to see what treatment may or may not be appropriate. While breast augmentation or a rhinoplasty may be appropriate for a 25 year old, Botox or fillers may not.”

Dear Doctor Wigoda,

I would first like to thank you for all that you have done. In October 2009, we met as strangers in the ER of Broward General’s trauma unit where I was rushed in as a trauma patient from a hospital that couldn’t handle my case. I was adamant about receiving the best surgeon at the hospital and was told that you would be coming on call in a few hours. The entire staff at Broward General held you in such high regard, and now I know why.

I arrived with a fractured cheek, a lacerated eyelid that had been torn from my face, a nose that was broken and mangled, and severe road rash covering my arms and face. I was ejected from my vehicle and dragged down I-595 approximately 30 yards. I was a complete mess.

I am a commercial pilot and my eyes are everything. You not only repaired my face and lacerations, but restored all normal function as well. Despite my numerous questions and the early hour you were called in, you had a huge smile on your face and turned my personal tragedy into a triumph of surgical professionalism.

In the days and months that followed, I regained the face that I recognized from before the accident, and I am still soaring through the sky thanks to you. My scarring is minimal, despite what the first initial hospital had predicted. I am so blessed and grateful that you were my surgeon. In the years that have followed, you have taken care of many of the people I care the most about in my life.

Whether it has been a breast augmentation, face lift, eye lid rejuvenation, or a nose job, you have surpassed everyone’s expectations and made a huge difference in their lives. Now, two years after meeting you, I have come to you again. This time for elective plastic surgery. I had a large mass in my chest (gynecomastia) and it was distorting my physique, very uncomfortable and awkward. After changing my diet, extensive exercise, and trying everything possible, I knew you could fix me up.

I came in to see you, and like you had done two years ago in the hospital, you greeted me with a big smile. You were full of options and understanding. You navigated around my demanding work schedule, and administered the best treatment available. I left my surgery with immediate satisfaction! I was in minimal pain, and up and about in record time. I am now looking forward to returning to the gym, beach and getting back to being myself again.

You are more than a physician, I think of you as my friend. You are honest, kind, professional, and the example of what a physician should be. Thank you for always being there, and doing everything with so much class. You are the best in the business!

Sincerely,

Darren

Suzanne traveled to Japan to take part in an experimental procedure to preserve her breasts after a mastectomy. The doctors removed fat, blood and stem cells via a small needle from Ms. Somers’ navel and put it through a centrifuge to separate the blood from the other needed “by-products.”  The surgeons then injected the stem cells along with the fat to create a new symmetrical breast for Suzanne.  In her own words, “It is me!” This method is a natural form of reconstruction without the use of implants or foreign materials that the body may reject.

In Breaking Through, Suzanne’s talk show, she recently discussed the opportunity for stem cell facelifts, stating that she recently banked her own stem cells for future use. “As we age, we age in the lower 3rd first and we are able to inject your own stem cells to rejuvenate your own skin. This is the future and so much better than ‘that look.’”

A joint task force of the two leading plastic surgery associations, the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) both hold their stance that there is great potential for stem cells in aesthetic surgery but at this point in time, more research and actual data are required before they should be used in every day procedures. They are quoted as saying “…the scientific evidence and other data are very limited in terms of assessing the safety or efficacy of stem cell therapies in aesthetic medicine.”

The task force is led by J. Peter Rubin, MD, plastic surgeon and noted expert on fat-derived stem cells who stated:

“There are encouraging data from laboratory and clinical studies to suggest that the use of adult stem cells is a very promising field,” said Dr. Rubin, “but as our comprehensive review of the current scientific literature shows, the data available today do not substantiate the marketing claims being made to patients seeking aesthetic surgery and aesthetic medical treatments.”

“Injecting fat into the face is nothing new.” says Dr. Paul Wigoda, “If the procedure is done correctly, about 50% of the fat will usually survive.”  As we age, portions of the face deflate partially due to fat loss, therefore, facial fat injections will assist with rejuvenation. It is important to note that should the individual gain weight, the fat will expand.

Stem cell research has been going on for a few years in hopes of being able to treat a variety of diseases and that will occur but not until 5-10 years from now.  According to Dr. Wigoda,

• “There is absolutely no proof at this time that injecting stem cells anywhere is of any use for cosmetic enhancement. In my opinion, this is a gimmick as “stem cells” is the latest buzz word, similar to what “laser” was a few years ago.
• You could add the word “laser” to any procedure, and people would think it was a magical procedure. To market this as the latest and best thing out there is deceptive in my opinion.
• It seems to me that surgeons are constantly looking for gimmicks to differentiate themselves from their competitors.
• Patients should always be wary of anything that is labeled as the “new best thing out there. The hype often precedes the research which, unfortunately in many cases, shows that the treatment did not have nearly the benefit that was claimed.”

Researchers Dr. Tom S Liu and John Q. Owsley of the California Pacific Medical Center analyzed patient satisfaction ratings and photographs of plastic surgery patients in three age groups: Under 50, 50 to 60, and over 60 years of age. They found that people 50 years or younger maintained their youthful appearance longer and were happier with their results, which was backed up by the patient’s self-reported satisfaction during short and long-term follow up appointments.

Patients over 60 were less likely to maintain and were more dissatisfied with their results. While they looked younger than their peers, people in this age group experienced regression in five areas more quickly. This is likely due to the fact that people over 60 have already incurred significant facial aging that impacts the results they obtain from the surgery. The middle group, 50 to 60, experienced intermediate results.

While some plastic surgeons steer people 50 or younger away from face lifts to other cosmetic procedures, a maintenance facelift may be the best procedure for them after all and the researchers encourage plastic surgeons to offer maintenance face lifts to people in this group. In addition to looking younger longer, the signs of aging in people under 50 tend to be mild. This means a facelift will not change their appearance as dramatically as it does in patients that are older, which is great for people that prefer their transition look as natural as possible.

For more information on how plastic surgery can improve your appearance, contact South Florida plastic surgeon Dr. Wigoda by phone or email.

“People need to educate themselves on the difference between cosmetic procedures such as tummy tucks versus liposuction,” said Dr. Wigoda, plastic surgeon and Chief of Plastic Surgery at Broward General Hospital.

Liposuction and tummy tucks are procedures performed to contour the body. While they both involve removing excess fat, they accomplish different things.

Liposuction

Liposuction, also known as lipoplasty, is a surgical procedure that involves making small incisions where the fat is to be removed using thin, hollow tubes called cannulas to suction the fat out. Typically, the area is anesthetized using a combination of lidocaine and epinephrine. The person may elect for local or general anesthesia. There are different types of liposuction including ultrasonic, laser assisted, power assisted, and traditional suction assisted. Which one is used often depends on the surgeon’s preference and experience.

Liposuction surgery may be considered to treat areas of excess fat in the stomach, buttocks, hips, love handles, saddlebags, thighs, calves, ankles, breasts (including male breast enlargement), back, arms and neck. Liposuction is equally effective in both men and women.

Good candidates for liposuction

• If you have areas of fat deposits that are out of proportion with the rest of your body and do not go away with diet and exercise –sometimes referred to as “diet resistant fat”
• Areas with minimal amounts of excess skin (Liposuction removes fat not skin) and good skin elasticity

Tummy Tucks

Abdominoplasty will enhance your body contour by making your abdomen firmer and flatter. You may find that you feel more comfortable in your clothing and are more confident about your appearance

Good candidates for Tummy Tucks

If you have

• If you have excess or sagging abdominal skin
• A protruding abdomen that protrudes out of proportion to the rest of your body
• Abdominal muscles that have been separated and weakened
• Excess fatty tissue that is concentrated in your abdomen

In this procedure, a long incision is made in the lower abdomen, just above the pubic area. The abdominal muscles are tightened, excess fat is removed, and excess skin is trimmed away. Tummy tucks, also called abdominoplasty, are great for men and women who have loose sagging abdominal skin, weak abdominal muscles, and excess fact that has settled under the skin around the stomach.

While you can achieve dramatic changes in your appearance, including a change in your dress or pants size, you won’t necessarily lose a significant amount of weight using these methods. If you are looking to lose weight, then it is best to follow a healthy diet routine of diet and exercise.

Tummy tucks and liposuction can be regarded as complementary procedures that, combined with other healthy lifestyle choices, can help you look and feel your best.

In brief:

Tummy Tuck vs Liposuction

• Though both tummy tuck and liposuction are surgical procedures to get rid of excess fat, tummy tucks also address problems with loose skin and muscles.

• Liposuction may be less painful and has a shorter recovery time but will not be the ideal procedure if the primary problem is loose skin and/or loose muscles.

• Liposuction is, in some cases, better for younger patients as the results tend to be better when the skin is firm and elastic while tummy tuck can be suitable for patients of all ages

• Tummy tuck is preferred when there is loose skin or muscles, while for persons who have concentrated areas of excess fat, liposuction is more appropriate.

One of the first places to begin is with family and friends: who can they recommend? What were their outcomes? Take a moment to speak with your current medical professionals. Who can they suggest and why?

Eight Tips to Finding Dr. Right for Plastic Surgery

1. Know the lingo
Doctors can now become weekend “certified” in many different types of procedures and have created their own terms which are NOT recognized by the American Board of Medical Specialties. Many doctors understand that cosmetic surgery is big business, big dollars and want market share. “Cosmetic Surgeon” and “Anti-Aging Specialist” are two terms that have been coined by the industry, yet are unrecognized by the ABMS. You might even notice your  OB-GYN is now doing Botox.

2. Advertising does not buy credentials
In most cases, a good doctor does not need to have major advertise campaigns on billboards or radio stations– it is word of mouth that drives their business. That is not to say a doctor should not let his potential patients know about his awesome track record through testimonials and sharing his expertise with the media as a means to educate the public. Paid print media does not make a doctor qualified.

3.  Get different opinions
Meet with several doctors to discuss your plan and your options. It can be overwhelming but knowledge is power.

4. Stay away from the online forums
Often times the patient reviews are not actual or authentic. Many times doctors write the testimonials under assumed screen names. Be wary. Legitimate testimonials can typically be found on Google reviews, YouTube, Yelp, etc.

5. Be realistic about the recovery
Some doctors will downplay the recovery time. Know what to expect in real terms. You may be able to go back to work in just a few days, but will you want to? Today’s recovery time in many cases can be much easier and quicker when in the right care, but keep in mind surgery is surgery so have realistic expectations.

6. Review online and offline images
Keep in mind that some doctors have a fine-tuned finesse with Photoshop. If all of the after pictures look more like Joan Rivers, then run. Look at the details, carefully and with a critical eye. Does the surgeon over-operate or under-operate. Be careful and don’t just assume that the photos have not been retouched. None of Dr. Paul Wigoda’s pictures are enhanced or use Photoshop.

7. Your weight
When thinking about a facelift for example, many doctors will not want to perform the procedure on an obese person as there is only so much that can be lifted or tightened. These results will impact the surgeon’s reputation and if it does not look perfect, it is not a positive reflection on their skills. In addition, they are also concerned about the heart health and wouldn’t want to lose a patient on the table. Take care of your weight before you begin seeking surgical opinions.

8. Scheduling
Make your appointment and get started with your journey towards plastic surgery or cosmetic surgery or non-surgical cosmetic services such as Botox or fillers.

Dr. Paul Wigoda is Chief of Plastic Surgery at Broward General Hospital and has a private practice offering plastic and reconstructive surgery in Fort Lauderdale, Florida.

Note: Parts of this article originated in Departures Magazine January 2012 issue.

Also known as “puffy nipples”, gynecomastia is a condition characterized by excess localized fat and/or glandular tissue development in the chest that is not related to obesity. Although it affects three out of four teenage boys, the condition typically goes away as they mature. But for those few men who are unable to shake the problem, gynecomastia can be a source of unending embarrassment and bad locker-room jokes. But instead of suffering in silence, healthy men can snip the problem away with a simple plastic surgery.

“Gynecomastia surgery is fairly common for men of all ages,” says South Florida plastic surgeon Dr. Paul Wigoda, “The ages of patients I see who request to have their chests made smaller ranges from teenagers to men in their sixties.”

More and more men are viewing plastic surgery as a viable option for improving their overall appearance. The American Society of Plastic Surgeons reported on the trend earlier this year. About 1.1 million cosmetic procedures were performed on men in 2011, which represented a 2% increase over 2010.

Gynecomastia is a fairly simple procedure, but traditional suction-assisted liposuction is often not adequate. Most patients, however, can be successfully treated with ultrasonic liposuction, which uses sound waves to loosen and liquefy fat in the chest area for easy removal. In some cases, glandular tissue may need to be cut out. In situations like these, an incision is made on the lower half of the areola and the excess tissue is removed. The scar left behind is generally barely visible.

Even men with breasts that are large and ptotic can be treated. This usually requires the removal of excess skin, so greater scarring may occur. Gynecomastia can be performed with local anesthesia and sedation, or general anesthesia depending on the situation.

“Most patients do not have significant pain afterward and can resume normal non-strenuous activities in a few days,” says Dr. Wigoda. “I typically recommend waiting four weeks before exercising.”

Before getting gynecomastia sugery, it is important that you approach the procedure with the right frame of mind. You should do it for yourself, and not to fit someone else’s beauty ideal. Set realistic expectations about what you will look like after the surgery. You should also be physically healthy and at a normal weight, and your breast development should have reached a stable state.

If your breasts are out of proportion to the rest of your chest or you are embarrassed to take your shirt off in public, then gynecomastia surgery may be the answer to your problem. Stop by Dr. Wigoda’s website to see how this experienced South Florida plastic surgeon can help you.

“I encourage all my patients to quit smoking before surgery,” said Dr. Wigoda who pioneered the technique painless breast implants.

For decades the Surgeon General has warned that smoking can cause health complications. Yet the Center for Disease Control reports that 19% of Americans over the age of 18 smoke. Not only is smoking unhealthy in general and can lead to diseases like lung cancer, it can cause serious complications during and after plastic surgery.

First, smokers have a higher risk of developing respiratory complications, like pneumonia, with any surgery that requires general anesthesia. Second, there are many cosmetic procedures – such as facelifts, breast reductions or lifts, and tummy tucks – where large areas of skin and fat are undermined (separated from the tissue below) to tighten the skin. Blood flow to the skin decreases during these procedures. If the skin does not receive the minimum amount of blood flow needed to be healthy and survive the surgery, the skin dies and the person ends up with an unsightly wound.

In people with healthy blood circulation, this isn’t a problem. However, smoking inhibits the circulation of blood because nicotine is a vasoconstrictor. It causes blood vessels to constrict (close). This constriction further reduces blood to flow to the areas that are trying to heal. As a result, the skin or other tissue – including fat, nipples, and areolas – can die.

Dr. Wigoda specializes in breast implant surgery and breast reconstruction surgery and says, “In my practice, I ask all patients who smoke to quit at least one month prior to their surgery if they are having a procedure that involves undermining skin. Although there is less risk with breast augmentation or liposuction procedures, I still encourage all of my patients to quit smoking because of the damage it does to the body.”

Patients who smoke age quicker, their skin is less healthy, and they lose elasticity faster – all of which makes them look older than they are. Most Americans only think lung cancer or emphysema is the primary risks of smoking. The reality is that smoking affects the entire body, including all organs, because it affects all the blood vessels. This is why smokers are more likely to have heart attacks and strokes.

To look your best, feel your best, and increase your chances of having a great outcome from cosmetic surgery, give up the unhealthy habit of smoking.

On the surface, it may seem like there is very little difference. Cosmetic surgery is focused on surgical procedures that enhance a person’s appearance. Reconstructive surgery specializes in correcting body abnormities caused by trauma, disease, birth defects, and other problems. While most plastic surgeons have the training needed to do both reconstructive and cosmetic surgery, no cosmetic surgeon is fully trained in reconstructive surgery, and often, not even fully trained in cosmetic surgery.

Training for cosmetic surgeons consists of:

* Four years of college

* Four years of medical school

* Training in a specific medical discipline such as dermatology

* Certification through the appropriate medical board for their discipline

There currently are no specialized residency training programs for cosmetic surgery. The only specialty that includes cosmetic surgery as part of the residency training is plastic surgery. In spite of this, any doctor can perform any type of cosmetic procedure. You could very well get an ophthalmologist performing breast augmentations.

Training for plastic surgeons consists of:

* Four years of college

* Four years of medical school

* 3-7 years of surgical residency

* 2-3 years of plastic surgery residency

* Certification through the American Board of Plastic Surgery

When it comes to getting cosmetic surgery, plastic surgeons are clearly the best trained. The bulk of a plastic surgeon’s experience comes from treating patients with disfiguring injuries. Unlike doctors trained in other disciplines, they are more likely to have experience performing cosmetic surgery on all parts of the body, and they learn under the direction of more experienced surgical staff, over a two to three year period.

Plastic surgeons also have the knowledge and experience needed to reduce scaring. It is a well-known fact that cosmetic procedures, like face lifts, leave scars. A well-trained plastic surgeon, however, can hide scars or minimize their appearance so you can feel confident in your new look.

Dr. Paul Wigoda, MD is a certified member of the American Board of Plastic Surgery who specializes in plastic and reconstructive surgery. He is the Chief of Plastic Surgery at Broward General where he frequently does life saving surgical procedures. He has hospital privileges at three area hospitals. In 8 years of having his own accredited surgery center, he has never had to transfer a patient to the hospital. However, if there is a problem during your procedure, he has the ability to make sure you get the best care necessary.

With any type of surgery, it is extremely important to choose a board certified physician who attended an accredited medical school residency and very importantly, trained thoroughly in the type of surgery you are having. A weekend course does not qualify. Meet them, carefully review their credentials, ask for testimonials, speak to your friends, and gather all of the information on your procedure to make an informed decision. Cosmetic surgery may be elective, but your health and well-being is not.