The Woodlands Plastic Surgeon®

Male Breast Reduction for Gynecomastia

2013-04-23T08:09:00.000-07:00

According to the American Society of Plastic Surgeons, approximately 65% of male breast disorders is secondary to gynecomastia. Majority of boys would develop some form of gynecomastia during puberty. This normally subsides as boys get older approaching their twenties. Gynecomastia may be secondary to heavy marijuana use or may be due to anabolic steroids usage by weightlifters. Endocrine disorders/tumors, testicular tumors, and several prescription drugs (such as anti-depressants and blood pressure medications) may also cause gynecomastia.

Before & After Photos (1 day after surgery) of Gynecomastia Surgery/Male Breast Reduction performed by Emmanuel De La Cruz MD, PLLC

Humiliation, shame and insecurity are some of the psychological trauma that men with gynecomastia experience. Gynecomastia can be embarassing that it can make men be reluctant from removing their shirts off at the beach. It can also make men who are only a few pounds overweight to look heavier than they really are.

Fortunately, there are a few options of treating gynecomastia in adult men which can range from liposuction to surgical excision. Gynecomastia in children may require a more thorough workup, such as a testicular exam and possibly an ultrasound, to rule out a testicular tumor. I recommend consulting your local plastic surgeon about gynecomastia. One of your Houston plastic surgeons will determine the best procedure to correct gynecomastia that would be appropriate to your body habitus and breast anatomy.

Emmanuel De La Cruz M.D.
www.delacruzplasticsurgery.com/

P.S.

I recommend reading other articles on breast augmentation in this blog.

Date of Update: 4-25-2013

Houston Plastic Surgeon

2013-01-28T09:08:00.006-08:00

Operation Nueva Ecija, Philippines

This January of 2013 we headed to Nueva Ecija in the Philippines. The medical mission had seen over 425 patients PER DAY, and we performed over 22 surgical cases PER DAY despite our limited medical/surgical supplies and one to two available anesthesiologists.

Thank you for your support. Our next mission trip on January 13, 2014 will be Operation Antique!

Emmanuel De La Cruz M.D., PLLC

The Woodlands Plastic Surgeon

2012-11-27T21:57:00.000-08:00

Emmanuel De La Cruz MD, PLLC
Plastic & Reconstructive Surgeon
The Woodlands Plastic Surgeon

Plastic Surgeon in The Woodlands

2012-11-18T18:23:00.003-08:00

Emmanuel De La Cruz MD, PLLC
Plastic & Reconstructive Surgeon
The Woodlands Plastic Surgeon

Plastic Surgeon in The Woodlands

2012-10-02T05:45:00.000-07:00

October 2012 Promotion

Woodlands Plastic Surgeon

Houston Tummy Tuck

2012-05-25T22:44:00.000-07:00

Tummy Tuck, Tummy Tuck, Tummy Tuck.... What Do You Need to Know about Tummy Tuck?

(Photograph courtesy of twentyythreex.tumblr.com)

What is the Perfect Body?

Having an hour-glass figure is considered to be extremely attractive by men throughout human history.

The hour-glass figure is the equivalent of having a 36-inch hips and a 23-inch waist.

The perfect hip-to-waist ratio (hour-glass figure) is the best way to assess women to be fertile. Universally, men find "fertile women" to be attractive.

The "Belly Button" or Umbilicoplasty Involved in a Tummy Tuck

A tummy tuck procedure almost always involves repositioning of your belly button (procedure is called umbilicoplasty.)The only time when the umbilicus is not repositioned is when your plastic surgeon performs a mini-tummy tuck, which has very limited indications (very few are candidates for a mini-tummy tuck.)There are several methods of doing an umbilicoplasty performed by different plastic surgeons.

The Ideal "Belly Button" or Umbilicus

Although the ideal shape of the "belly button" has been debated, studies have shown that in a young thin female, the umbilicus tends to have a small, vertically oriented umbilicus.
As the young attractive woman ages, the hooding of the "belly button" and deepening of the stalk develops.
With weight gain and after pregnancy, the umbilicus widens and deepens resulting to an unattractive "belly button."
A wide umbilicus and the presence of an outward protrusion called an "outie" are considered to be unappealing.
An ideal "belly button" according to studies of young women with an attractive abdomen shows desirable characteristics that is small in size, vertically oriented, and the presence of a superior hood.

Before & After Photos of a Tummy Tuck Procedure with VASER Liposculpture performed by Emmanuel De La Cruz MD, PLLC

Pregnancy and Abdominoplasty

Some of the benefits of abdominoplasty may be reduced or eliminated by pregnancy.

Thus it is wise to postpone the procedure if a pregnancy is anticipated in the near future.

Stay tuned for more information about Tummy Tuck....

Emmanuel De La Cruz MD, PLLC

References:

Craig et al. In search of the ideal female umbilicus. Plastic & Reconstructive Surgery. 105(1) Jan" 389-392, 2000.

El-Sharkawy, etl al. A study of the Aesthetic Patterns of the umbilicus among Egyptians with a ew Technique for Umbilical Reconstruction de Novo.

De La Cruz, et al. The Celtic-Cross Technique for Immediate Umbilical Reconstruction. Journal of Plastic, Aesthetic & Reconstructive Surgery.

Baroudi R. Umbilicoplasty. Clinics of PLastic Surgery. 2 (3) July: 431-48, 1975.

Hodgkinson DJ. Umbilicoplasty: Conversion of a "ouie" to "inneie". Aesthetic Plastic Surgery7(4):221-2, 1983.

The Perfect Breast | Houston Breast Augmentation

2012-05-10T18:48:00.000-07:00

Engineering the Perfect Breasts

In today's society, women are subconsciously bombarded with images of larger breasts overflowing out of low-cut dresses. These images are reflected from magazines, reality TV shows and celebrities with enlarged breasts. Because of our society's infatuation with large breasts, the tendency toward favoring larger breast volume with breast augmentation may result to a deviation from the natural shape of the breasts. When the breast is excessively augmented with breast implants, the tear drop shape of the breast becomes more round which is not harmonious and looks unnatural. But then again, the ideal breast is different for every woman.

Photograph Courtesy of http://celebrity-stuff.popsugar.com

Breast Symmetry
Ideally the perfect breasts would be symmetric. Although this seldom comes to mind, perfect breasts aren't what one would expect. One study showed that breast asymmetry in women is a commonality amongst the population. Nearly 80 % of women have asymmetric breasts. Breast asymmetry is measured by several parameters, such as nipple areolar complex size & position, breast size/breast mound volume, breast/chest wall shape, degree of ptosis (sagging), and inframammary fold location. With this in mind, when one seeks a breast augmentation, any subtle difference of the breast may become more obvious after surgery.

What is the Ideal Breast Shape?

The nipple should be pointed outwards and parallel to the ground.
The upper pole of the breast should be full and not "deflated" as found in a "swooping breast." The upper pole of the breast typically becomes "deflated" with aging, pregnancy or even with significant weight loss as seen in athletic women.
The lower pole of the breast should be fuller than the upper pole of the breast. The lower pole should also have a round shape.
The upper pole should have a slope from the upper chest down to the level of the nipple.

(Photograph Courtesy of MedIndia.net)

Breast Ratio (Photograph Courtesy of dailymail.co.uk)

Ideal Breast Dimension

According to a recent British Study by Dr. Malluci, the proportion of the upper to the lower pole should have a 45:55 ratio
The angulation of the nipple should be pointing upwards at a mean angle of 20° from the nipple meridian

According to the study, the upper pole slope should be linear or slightly concave, and the lower pole should be convex.

With the advent and popularity of larger breasts, like Pamela Anderson in Baywatch, the perception of the perfect and ideal breasts have changed. Mild to moderate fullness of the upper pole will produce a more youthful and more beautiful breasts as seen after a breast augmentation. Excessive upper pole fullness due to an overly-sized breast implant will look unnatural, and thus will have an appearance of a more obvious "boob job."

Before & After Photos of Breast Augmentation using the Dual-Plane Technique performed by Emmanuel De La Cruz MD, PLLC. Natural slope achieved after breast augmentation.

With this in mind, what is the perfect breast? The perception of the perfect breasts may vary from culture to culture and may vary individually. The unnatural appearance of an overly-sized breast augmentation may be perceived as more beautiful. Women who wants a "more natural look" may want the ideal "traditional" perfect breasts with a natural slope. Regardless of what one perceives the perfect breasts to be, you should communicate with your plastic surgeon the ideal breast shape that you would want to achieve after your breast enlargement.

Taylor Swift recent Breast Augmentation? (Photo courtesy of Hollywoodlife.com)

Emmanuel De La Cruz MD, PLLC
Plastic Surgeon in The Woodlands

References:
Malluci, et al. Concepts in Aesthetic breast dimensions: analysis of the ideal breast. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2012 Jan;65(1):8-16. Epub 2011 Aug 24.

Smith et al. Breast volume and anthropomorphic measurements: normal values. Plastic & Reconstructive Surgery. 1986. 78(3):331-335
Stark et al. Breast asymmetry: An objective analysis of posteperative results. European Journal of Plastic Surgery. 1991; 147: 173

Dr. Emmanuel De La Cruz Reviews

2012-04-08T07:11:00.004-07:00

Plastic Surgeon in The Woodlands | Houston Plastic Surgeon | Tomball Plastic Surgeon | The Woodlands Plastic Surgeon

To my patients,

Thank You for your Testimonials!

Emmanuel De La Cruz MD, PLLC

The Woodlands Plastic Surgeon
Visit us at Plastic Surgeon in The Woodlands

Breast Massage after Breast Augmentation

2012-04-02T19:15:00.005-07:00

Breast Massage after Breast Augmentation ~ Houston Breast Augmentation

Purpose of Breast Massage after Breast Augmentation

To keep the implant pocket soft and open, resulting in a natural looking breasts.
Some plastic surgeons believe that breast massage may reduce capsular contracture. However, currently there's no clinical studies showing that it reduces capsular contracture.

Breast Massage (Photograph Courtesy of prplastic.com) Note: The implant stabilizer on the far lower right is not part of the breast massage. Not all patients will require an implant stabilizer.

Breast Implant Massage Recommendations

Breast massage may be started 3 to 5 days after your breast augmentation surgery.
Perform this 3 times per day

Prior to massaging your breasts after breast augmentation, I recommend consulting your plastic surgeon.

Emmanuel De La Cruz MD, PLLC

The Woodlands Plastic Surgeon

The Secret to a Beautiful Lip

2012-03-30T08:38:00.003-07:00

The Secret to a Beautiful Lip

Having fuller lips, like that of Angelina Jolie, have been considered a desirable trait. A study has shown that female models who are selected in the fashion industry, in general, have fuller lips (upper and lower) than ordinary women. Several studies have also shown that men prefer women with thick and prominent lips. Over the past several years, there have been an increasing number of women seeking lip augmentation to achieve that sought after voluptuous lip.

Angelina Jolie's Beautiful Lips (Image from Alex-Scheffer.com)

Features that Decrease the Perceived Age in Women

Big eyes
Short nose
Small chin
Thick lips
Thin eyebrows

With aging, the upper lip undergoes several changes which range from atrophy of the fatty tissue of the lips to thinning and a less pronounced vermilion border. Thus, augmentation of the lip may decrease the perceived age in women desiring a sensual and youthful lip.

Photograph Courtesy of http://celebrity-stuff.popsugar.com

Common Changes in the Aging Upper Lip

Fatty tissue atrophy of the upper lip
Thinning and less pronounced vermilion border
Flattening of the philtrum
Widening of the Cupid's bow
Loss of the natural "pout" of the lip

Ideal Lip (Photograph by Rachael Ashe; Courtesy of Wikimedia Commons)

So what is the secret of a beautiful lip? Nearly every fashion model has full and plump lips. Does having a lip augmentation of one's upper lip sufficient to have that sought after voluptuous lip? Studies have shown that the ideal lip has an upper to lower lip ratio of 1.0 : 1.6. If this ratio is altered, as found in women with excessive augmentation of only the upper lip, the lip may look unnatural. This would not be as attractive as the natural upper lip. The upper lip may predominate the discourse in aged lip, but the lower lip may need augmentation as well due to the development of lip ptosis with aging. Moreover, lower lip augmentation may be needed to maintain the upper to lower lip ratio in order to achieve "natural" and beautiful lips.

Lips of a famous actress after lip augmentation. Overcorrection of the upper lip augmentation resulted in a deviation from the ideal upper to lower lip ratio. Thus, the lips look unnatural.

Reasons Some Women Desire a Lip Augmentation

Desire to have more fullness of the lips
Those with genetically thin lips
Those with poor definition of the vermillion border
Atrophic lips due to advancing age

Non-Surgical & Surgical Options for Lip Augmentation

Implant material, such as Goretex, Alloderm, PTFE, Silicone
Fat grafts
Dermal-fat grafts from patient's own tissue, especially after a facelift procedure
Dermal filler lip injections

Before & After Photos of Lip Augmentation using Dermal Fat Graft by Emmanuel De La Cruz, MD, PLLC

In most cultures, having a full lip is associated with female beauty and youthfulness. Young women may want to achieve sensual lips like that of Angelina Jolie or Jessica Alba. The older and refined woman may want to look younger with fuller and sensual lips. Whatever their reason maybe to obtain the ideal lip, one needs to be aware of the secret of the beautiful lip before one undergoes plastic surgery.

Kara Dioguardi was included in PEOPLE's Most Beautiful List (Photo courtesy of Wikimedia Commons)

So is there a secret to a beautiful face?
Stay tuned....

Emmanuel De La Cruz M.D.
Houston Plastic Surgeon

References:

Anderson, Richard. Alloplastic Lip Enhancement. Aesthetic Surgery Journal. 2001. September, 21: 5: 445-449
Bisson M, Grobbelaar A. The esthetic properties of lips: a comparison of models and nonmodels. Angle Orthod 2004;74:162-166.
Giddon, D. Orthodontic applications of psychological and perceptual studies of facial esthetics. Semin. Orthod. 1995. (1)82-93
Koscinki, K. Facial attractiveness: General patterns of facial preferences. Anthropological Review. 2007. (70):45-79
Lemperle, et al. An Index for Quantitative Assessment of Lip Augmentation. Aesthetic Surgery Journal. 2010. May. 30(3) 301–31
Narsete, et al. Lip Augmentation in Conjunction With Facelift: Preliminary Experience With A New Permanent Implant. Aesthetic Surgery Journal. 2009. September, 29: 5: 356-359
Rohrich, et al. The anatomy and clinical implications of of perioral submuscular fat. Plastic & Reconstructive Surgery. 2009;124:266-271.

Scott, et al. Influence of lips on the perception of malocclusion,
Am. J. Orthod. Dentofacial Orthop. 2006. (130)152-162

Turkkahraman, et al. Facial profile preferences among various layers of Turkish population. Angle Orthod. 2004. (74)640-647

Venous Freeze in The Woodlands

2012-03-25T08:12:00.003-07:00

Venous Freeze in The Woodlands | Houston

Cellulite reduction? Is Venous Freeze the potential solution?

Cellulite Reduction

Venous Freeze has been known to reduce cellulite.

Potential Complications from Venous Freeze

Burning of skin
Recurrence of poor skin tone (no long term studies are currently available.)

Stay tuned for more information....

Emmanuel De La Cruz MD, PLLC

The Woodlands Plastic Surgeon

VASER Liposuction in The Woodlands | Houston

2012-02-25T08:04:00.016-08:00

What is VASER Liposuction?

Ultrasonic liposuction for body contouring began in the late 1980's and early 1990s. The VASER system was developed in the late 1990s to reduce complications, reduce physician fatigue, and allow for faster patient recovery.

So What is the VASER?

VASER stands for Vibration Amplification of Sound Energy
at Resonance
This liposuction system employs mechanical and acoustic forces to emulsify fat within a targeted area, while preserving other
important tissue structures.
- "VASER Lipo utilizes acoustic forces to safely dislodge fat cells while protecting surrounding tissues, ultimately producing a clean, smooth aspirate with excellent cell viability."
The fat deposits emulsified from a VASER system are then removed from the body by aspiration (liposuction.)
The individual fat cells remain intact after emulsification from VASER. Thus, fat collected during the VASER Liposuction may be harvested for autologous fat transfer.

VASER Liposuction by Dr. Emmanuel De La Cruz (Before & After VASER Liposuction 1 Month)

VASER Liposuction by Dr. Emmanuel De La Cruz

What are the potential complications from VASER Liposuction?

Burning of the skin
Contour irregularities (less with the VASER when compared with traditional liposuction.)

ADVANTAGES of VASER Liposuction?

Improved skin retraction according to reports by physician users
"No serious complications reported related to VASER technology in more than 70,000 procedures."
"No complications, burns, contour irregularities or prolonged swelling in a study of 77 patients, no revisions needed in a multi-center pilot study."

New technology in plastic surgery is exciting. VASER Liposuction may improve one's body contour, but not everyone would be a candidate. It is essential to see your plastic surgeon if one would be a candidate for a liposuction, whether it be VASER, Smart Lipo or traditional suction lipectomy. Further procedures, such as a tummy tuck, may be needed to achieve the ideal body that one would want.

Emmanuel De La Cruz MD PLLC

The Woodlands Plastic Surgeon

References:

Jewell, Fodor et al. ibid. pp 137–140; Garcia, Proven Safety of the VASER, ibid, pp 2–3
Jewell, Fodor et al. Clinical application of VASER-assisted lipoplasty, ibid. pp 131–145

Mark Shafer, PhD. Principles of Ultrasound for Body Contouring: The VASER® System.

EB De Souza Pinto, MD, R. Federico MD, et Al. Lipomioplasty with VASER: A New Approach to Body Contouring. In: Innovations in Plastic and Aesthetic Surgery, Editors M. Eisenmann-Klein and C. Neuhann-Lorenz, Springer-Verlag, Berlin, Germany, 2008, p. 433-442.

Onelio Garcia, et al. Comparative Analysis of Blood Loss in SAL and Third-Generation Internal UAL. The American Society for Aesthetic Plastic Surgery, Inc. Volume 28, Number 4, July/August 2008

Prado A, et al. A Prospective, Randomized, Double-Blind, Controlled Clinical Trial Comparing Laser-Assisted Lipoplasty with Suction-Assisted Lipoplasty. Plast. Reconstr. Surg. 118(4):1032–1045, September 15, 2006.

Happy New Year!!! 2012

2011-12-31T16:55:00.000-08:00

Emmanuel De La Cruz MD, PLLC

The Woodlands Plastic Surgeon

Breast Feeding After Breast Implants

2011-12-04T20:43:00.002-08:00

Breast Feeding After Breast Augmentation

There are two main types of implants being used for breast augmentation: silicone gel and saline implants. Neither silicone gel nor saline implants interfere with breast-feeding. Although there have been concerns about passing the silicone into breast milk during breast feeding if the implants were to rupture, studies have shown that silicone molecules are too large to pass into the milk ducts and breast gland tissue. Surprisingly, silicone levels were found to be higher in commercially available infant formulas (4402.5 ng/mL) than those found in women with silicone breast implants (55 ng/mL).

Photograph from Alliedhealthblog

Although there are no guarantees that one would be able to breast-feed whether you undergo breast augmentation or not, the type of incision may affect one's ability to breast-feed. There are few choices for incision location for breast augmentation: periareaolar incision (around the edge of the nipple), inframammary incision (incision underneath the breast), axillary incision (along the arm pit), and periumbilical (around the belly button).

A periareolar incision may interrupt or disturb the lactiferous/milk ducts of the breast. Previous clinical studies have shown that women who had breast surgery through a periareolar incision were five times more likely, when compared to women without breast surgery, to have insufficient milk during breast feeding. A periareolar incision may still be used with minimal damage to the lactiferous/milk ducts depending on the technique used by your surgeon to place the breast implant. A recent study showed that there was no difference (p>0.05) found in the breastfeeding experience between periareolar and inframammary approaches in women with hypoplastic breasts (small breasts) who underwent a breast augmentation. This study, however, showed that the success rate of breast feeding decreases by 25% in women with hypoplastic breast who previously underwent breast augmentation. According to the study, the need to supplement breastfeeding increases by 19% in these women.

Fast Facts on Breast Feeding and Breast Surgery

A Brazilian study has recently shown that the probability that a woman will be able to breastfeed exclusively after breast reduction was 29%; after breast augmentation was 54%; and in women who had no breast surgery was 80%.
The risk of not being able to breast feed in women who had breast reduction is 5 times greater than in women who had no surgery (p=0.002).
The risk of not being able to breast feed in women who had breast augmentation is 2.6 times greater than in women who had no breast surgery (p=0.075).

Although the clinical evidence is not as strong for a physician analyzing this data (not a Level I evidence), there is indeed data to suggest that breast surgery, such as a breast augmentation, may affect one's ability to breastfeed. I recommend discussing your concern and your plans to breast-feed with one of your Houston cosmetic surgeons when you decide to have a breast augmentation procedure (breast implant placement.) The type of incision that your plastic surgeon uses may vary based on individual considerations.

Emmanuel De La Cruz M.D.

Houston Plastic Surgeon

Reference:

Andrade RA, et al. Breastfeeding pattern in the first month of life in women submitted to breast reduction and augmentation. Jornal de Pediatria. 2010 May-Jun;86(3):239-44

Cruz NI and Korchin. Breastfeeding after augmentation mammaplasty with saline implants. Annals of Plastic Surgery. 2010 May; 64(5):530-3
Hurst N. Breastfeeding after breast augmentation. Journal of Human Lactation. 2003 Feb;19(1):70-1

Semple JL, Lugowski SJ, Baines CJ, et al. Breast milk contamination and silicone implants: preliminary results using silicon as a proxy measurement for silicone. Plast Reconstr Surg. 1998 Aug;102(2):528-533.

Date Article Updated: 6/1/2011

Breast Lift with Breast Augmentation

2011-11-18T06:37:00.002-08:00

Breast Lift with Breast Augmentation

Although many women who wanted to have their breasts enlarged prefer larger breasts with minimal scarring, some women want a combination of both a breast lift (mastopexy) and breast augmentation. For the woman seeking a breast augmentation, often the surgical decision process is more complex. Your plastic surgeon will evaluate you whether a breast lift may be necessary or not. If one would need a mastopexy, the degree of ptosis (sagging of the breasts) will determine what kind of breast lift procedure would be necessary. The kind of mastopexy procedure would affect the degree and extent of scarring one would have.
Another question one should ask would be "when should the breast lift be performed?" Should it be performed before or after you undergo breast augmentation? These are questions that one should ask your plastic surgeon before you undergo your breast surgery.

Red Brassiere (Courtesy of Wikimedia Commons)

Fast Facts about Breast Lift with Breast Augmentation

The complication rate of primary breast augmentation (1st time one is having breast augmentation) is approximately 1.7% over a three-year period (Scott Spear's study).
The complication rate of a revision or re-do breast augmentation is ~ 21.6%.
The complication rate of a simultaneous primary breast augmentation with mastopexy (1st time of having breast implant surgery with a breast lift performed at the same time) is approximately 17.4% over a three-year period (Scott Spear's study).
The complication rate of a revision breast augmentation with a breast lift is ~ 23.3%.
Simultaneous breast augmentation/mastopexy (breast augmentation & breast lift done at the same time) has an early revision rate (need to revise the surgery) of approximately 8% in one study.

Potential Complications of a Breast Lift

Wound separation/dehiscence
Partial or total nipple loss
Need for further surgery (Revision)
Undesirable/unattractive scarring
Inadequate ptosis correction (correction of sagging of the breasts) and recurrent ptosis
Breast asymmetry and malposition of the nipple
Loss of nipple sensibility
Infection

Even though a simultaneous breast augmentation/breast lift procedure is an elective operation, this procedure carries a risk that is higher than a simple breast augmentation. Moreover, the risk and type of complications may vary based on the type of mastopexy technique used and performed concurrently with the breast augmentation. Being aware and informed about these potential complications are critical before undergoing this kind of procedure. Your plastic surgeon will determine if you are a good candidate for a simultaneous breast augmentation/mastopexy since not everyone is a candidate to have these procedures done at the same time.

Emmanuel De La Cruz M.D.
Houston Plastic Surgeon

Reference:
Atlanta Breast Symposium 2011
Rancati, et al. Simultaneous augmentation and periareolar mastopexy: selecting the correct implant. Aesthetic Plast Surg. 2010 Feb;34(1):33-9;
Spear et al. Augmentation/Mastopexy: A 3-Year Review of a Single Surgeon’s Practice. Plast. Reconstr. Surg. 118 (Suppl.): 136S, 2006
Spear, Scott. Augmentation/Mastopexy: Surgeon Beware. Plast. Reconstr. Surg. 118 (Suppl.): 136S, 2006

Date updated: 2/10/2011

Potential Complications of Dermal Fillers, such as Restylane & Juvederm

2011-11-10T10:10:00.002-08:00

Dermal Filler Complications (Restylane/Juvederm)

There are several facial filler materials that have been approved by the Food and Drug Administration for use in the United States that have been employed by physicians for the past several years. These dermal fillers are very effective and popular cosmetic treatments for today's anti-aging and facial rejuvenation for aesthetic patients. One of the dermal fillers include hyaluronic acid, which is a ubiquitous carbohydrate polymer normally found as a major component of skin where it is involved in tissue repair. Hyaluronic acid injections temporarily smooth wrinkles by adding volume under the skin, with effects typically lasting for six months. Although they seem to be simple procedures, dermal filler complications may potentially occur.

Woman Getting a Botox Injection: Photo Courtesy of Ambro / FreeDigitalPhotos.net

These complications may include intraarterial embolization of hyaluronic acid (Juvederm & Restylane) which can have disastrous consequences. The dermal filler may be injected accidentally into tiny vessels if not performed properly by a trained medical professional. Intraarterial embolization of hyaluronic acid may lead to superficial to deep necrosis of the skin (premature death of cells and living tissues.) This will then lead to ulceration and severe deformity of the face. Embolization of dermal fillers may also lead to blindness, which is a rare complication.

How common is the facial necrosis complication from a dermal filler injection?

This complication is rare. The incidence of facial necrosis of the skin from a dermal filler injection (Zyderm/Zyplast collagen injection) was reported to be 9 in 10,000 cases. Facial skin necrosis may occur secondary to either intraarterial embolization or external compression of the small vessels of the skin by the dermal filler.

Necrosis of the tip of the nose from dermal filler injection into the nasolabial fold

Complication from a dermal filler injection into the nasolabial fold

How can one treat intra-arterial injection of hyaluronic acid? Progression of the skin necrosis can be further prevented by injection of hyaluronidase (Amphadase) into the area of previous injection site. Thus, ask your provider if they have hyaluronidase in their office just in case a complication may arise.

How can one recognize this complication? One of the first few symptoms of intraarterial embolization of a dermal filler would be sharp pain and erythema (redness). The area of skin involved may vary from the local injection site to areas specifically supplied by the arterial vessel involved. This can be further recognized clinically by a bluish discoloration of the face that may eventually progress to necrosis and/or ulceration of the face.

How can one avoid these potential dermal filler complications? It is very important for the medical provider performing these dermal filler injections to have a solid knowledge of the anatomy of the face to avoid injecting the dermal filler into the tiny vessels where embolization may occur. Moreover, the dermal filler should be injected into the correct plane and not deep enough to penetrate into the vessel. The level of injection is dependent on what one is trying to accomplish whether to improve a tear trough deformity or reduce perioral rhytids (wrinkle lines).

Once this complication occurs, can my provider fix the problem? Once necrosis/ulceration of the face occurs, injection of hyaluronidase into the previous injection site may prevent its progression. Once the necrosis has demarcated, your plastic surgeon may need to perform a plastic surgery procedure, such as debridement of dead tissue and possibly a reconstructive facial procedure. Whether you need a plastic surgery procedure or not is dependent on the severity and location of the ulceration/skin necrosis of the face.

Other Potential Complications of Dermal Fillers

Bruising -for patients with no history of heart attack, stroke or blood clot, it is recommended to discontinue taking aspirin and other medications that can cause bleeding (NSAIDs such as ibuprofen; gingko biloba; ginseng; garlic; fish oils; and Vitamin E.)
Nodule formation (lumps) of the skin - incidence varies, depending on the dermal filler used.
Allergic reaction - rare, especially with hyaluronic acid dermal fillers.

I recommend that one should ask one of your Houston plastic surgeons for these potential complications from injectible dermal fillers, such as Restylane and Juvederm, prior to undergoing such procedures. One should also ask their plastic surgeon that if such complications arise, what can be done to minimize and correct the adverse outcome that can potentially happen. Being able to recognize, prevent and treat these potential complications are essential, even for a minor procedure such as a dermal filler injection.

Emmanuel De La Cruz M.D.

I recommend reading about Botox for dynamic wrinkles.

BOTOX Injection for the Wrinkles Around Your Eyes (Crow’s Feet)

2011-11-07T13:54:00.000-08:00

BOTOX Injection for the Wrinkles Around Your Eyes (Crow’s Feet)

Fast Facts about Botox Treatment and Crow's Feet

Wrinkles around your eyes that are present in motion only are ideal for treatment with BOTOX.
If your Crow's feet (wrinkles around your eyes) are present at rest, they may not eliminated with a BOTOX injection.
If your Crow’s feet wrinkles extend toward your cheekbone, and if this increases with smiling, a BOTOX treatment may cause an incongruous appearance. This can create a “Mickey Mouse” appearance in which one may have a flat area around the eyes that is surrounded by extended lines around the mouth.

Hooding of the Side of the Brows (Lateral Brows)

Hooding of the Lateral Brows

If you have hooding of lateral brows which is usually from the loss of tone and descension of the lateral brow, the wrinkle under the hood will likely remain after a BOTOX injection treatment.

Other plastic surgery procedures, such as endoscopic brow lift or Laser resurfacing may be needed, and BOTOX may likely not remove this particular rhytid (wrinkle).

I recommend asking one of your Woodlands plastic surgeons if you are a good candidate for BOTOX treatment for your Crow's feet. Being an informed patient is critical prior to undergoing any treatment, even a minor procedure such as BOTOX.

Emmanuel De La Cruz M.D.

www.delacruzplasticsurgery.com

P.S. Feel free to read more about BOTOX.

Exercise after Breast Augmentation

2011-10-27T21:54:00.001-07:00

Exercise after Breast Augmentation

There has been several athletic women who undergo breast augmentation, and one of the important questions they typically ask is "when can I go back to the gym and exercise?" One of the key elements is that one must not exercise immediately after any type of procedure, including breast augmentation.

To understand why one would be careful when it comes to working out a few weeks after surgery, one should understand how the body would heal after surgery.

Photograph Courtesy of breastexercises.com

Fast Facts about Wound Healing & Breast Augmentation

Maximum tensile strength of a wound is achieved after approximately 3 months.
Around 3 months, the strength of the wound is approximately 90-95% of the original strength of the wound.

Pectoralis Muscle (Chest wall muscle) Strength after a Breast Implant

For implants placed underneath the muscle, especially total submuscular placement such as found in breast reconstruction for breast cancer patients, it was found that there was a decrease in torque strength of the pectoralis muscle by 20.1% after surgery.

Exercise Recommendations

3rd Week

Stationary bike is appropriate, except for the Spinning Stationary bike.
Minimize any activities that would involve bouncing.

4th Week

Stair stepper would be appropriate since there's minimal "bouncing" involved.
I don't recommend an elliptical machine at this time since some athletic women could be aggressive with this exercise.
One can start leg, thigh and buttock exercises.
For the first 8 weeks, no upper body weight lifting at all. I recommend to only work out the lower extremity.
Working out should be every other day if you're an avid athlete to avoid injury and fatigue.

6th Week

The tensile strength of the wound is approximately 60%.

8th Week

At this time, the tensile strength of the wound from surgery would be approximately 70 to 80%.
I would continue using the stair stepper and still avoid running aggressively that would involve a lot of bouncing.
The elliptical machine can be started as long as there's minimal "bouncing" action. I would stress a forward gliding motion on the elliptical instead of vertical bouncing (more resistance can aid with this). If one start having pain over the chest, I recommend to stop doing this particular exercise.
After eight weeks you can start biceps and triceps exercises with light weights and low repetitions (slowly incorporating these into the workout so as to not injure the weak and healing area.)

12th Week

The tensile strength of the wound is approximately 90-95% at this time.
You can slowly start running on the threadmill.
At 12 weeks you can start a regular workout routine, BUT TAKE IT SLOW. We recommend 35-50% of the weight and reps you were using for upper extremity prior to surgery.

Signs that You Have Workout Too Much

According to some of my athletic patients who have worked out beyond their limits after surgery, one of the signs that you have "worked out too much" is the "feeling of soreness & hardness above the incision."
Pain or soreness over the breast/chest area
Worst scenario: wound breakdown and implant extrusion.

Potential Consequences if One Works Out Beyond Their Limits after a Breast Augmentation

Bottoming out and sagging of the augmented breast.
Early wound complications, such as wound breakdown (can occur during the first several days after surgery.)
Implant extrusion (implant exposure) which is a surgical indication to remove the implant and replace it with a new one.
Re-do surgery may need to be done. Without a cosmetic insurance, this can be very costly!

Resuming exercise after breast augmentation can be particularly challenging. One should ask your plastic surgeon for any advice regarding their exercise protocol after a breast enhancement procedure. If one experiences pain after a particular exercise activity, I recommend to stop performing that certain activity and resume 1-2 weeks later.

Emmanuel De La Cruz MD, PLLC

Houston Breast Augmentation

Brooke Dickinson, DC

Chiropractor at The Woodlands

Former College Football Exercise Trainer

References:
Anglin C, Wyss UP. Arm motion and load analysis of sit-to-stand, stand-to-sit, cane walking and lifting. Clin Biomech (Bristol, Avon). 2000 Jul;15(6):441-8.
de Haan A, Toor A, Hage JJ, et al. Function of the pectoralis major muscle after combined skin-sparing mastectomy and immediate reconstruction by subpectoral implantation of a prosthesis. Ann Plast Surg. 2007 Dec;59(6):605-10.

Monaco JL, Lawrence WT. Acute wound healing: an overview. Clin Plast Surg. 2003;30:1-12.

Woodlands Plastic Surgeon

2011-10-19T14:08:00.000-07:00

Mesotherapy and Liposuction

2011-10-15T15:11:00.000-07:00

Mesotherapy versus Liposuction

What is Mesotherapy?

Mesotherapy involves the injection of medications into the skin and is used as an alternative to liposuction.
Currently, mesotherapy is NOT an effective alternative to liposuction when it comes to reduction of fat in the body.
Mesotherapy is NOT approved by the US Food & Drug Administration (FDA)
In mesotherapy, a variety of medications are injected into the skin mesoderm, which is the layer of fat and connective tissue underneath the skin.
The most common medications injected utilized for lipolysis are phosphatidylcholine and isoproterenol.
Currently, there are no clinical reports demonstrating the effectiveness of mesotherapy in body contouring.

Emmanuel De La Cruz MD, PLLC

Houston Plastic Surgeon

References:

Park et al. Effectiveness of mesotherapy on body contouring. Plastic Reconstructive Surgery. 2008 April; 121(4):179e-185 e

US Food & Drug Administration (FDA)

Pippa Butt Lift

2011-10-05T08:53:00.000-07:00

Pippa Butt Lift

Emmanuel De La Cruz MD, PLLC
Houston Brazilian Butt Lift

Smile Train Cambodia & China

2011-09-26T08:23:00.000-07:00

Smile of the Month: Cambodia & China

Lets help support Smile Train & Operation Smile.

Emmanuel De La Cruz MD, PLLC

Houston Plastic Surgeon

The Woodlands Plastic Surgeon

2011-09-21T09:38:00.002-07:00

My Secret Wives

Like playing the piano, there are two sub-specialties of Plastic surgery that I am passionate about: Aesthetic (Cosmetic) Surgery and Hand Surgery. Mastering the smallest detail in anatomy is one aspect that I love about Aesthetic and Hand Surgery. The meticulous dissection required in a facelift, rhinoplasty and peripheral nerve surgery is exciting as it is related to the mastery of anatomy and innovative plastic surgical techniques. The finesse and creativity involved in both cosmetic and hand surgery, such as creating a new thumb or making someone look 20 years younger, are exhilarating. So what is my secret? Hand and Aesthetic Surgery are my secret wives.

Alaskan fisherman who had an amputation of his thumb from a work-related injury.

New thumb that Joel Solomon M.D. and I reconstructed using thepatient's toe.

Emmanuel De La Cruz M.D.

Woodlands Plastic Surgeon

Longer Eyelashes with Latisse? Is It Safe during Pregnancy?

2011-08-26T08:03:00.000-07:00

Longer Eyelashes with Latisse? Is It Safe during Pregnancy?

Longer eyelashes have been the universal symbol of beauty, especially since a woman's eyes greatly affects her whole appearance. Thicker and longer eyelashes enhance one's beauty, and it's no secret that men find women's eyes as one of the most important features of a beautiful face. Some women would take bold steps to acquire that beautiful, luscious long eye lashes no matter how uncomfortable they may be whether it involves placement of fake eyelashes or application of eyelash extensions.

Longer Eyelashes (Photograph Courtesy of Wikimedia Commons)

What is Latisse?

Latisse, a prostaglandin analog, was previously used as an eyedrop to treat glaucoma. The patients being treated for glaucoma with Latisse were found to have thicker and longer eyelashes. After this discovery, several cosmetic companies started adding this prostaglandin analog to their mascaras illegally and touted them as eyelash-lengthening products. The FDA subsequently banned these companies from the illicit use of this prescription medication in cosmetic products. Allergan, the maker of BOTOX, received FDA approval in 2009 to manufacture Latisse as prescription medication to lengthen eyelashes.

Is Latisse Effective in Lengthening your Eyelashes?

Clinical studies have shown that after 16 weeks of use, there's a 25% increase in eyelash length, and 106% increase in lash fullness.

Improvement of eyelash length can be seen as early as 8 weeks, and may continue to improve up to 16 weeks.

Is it Safe to Use Latisse?

It's safe to use Latisse but there are precautions that need to be taken.
Latisse cannot be use when one is wearing their contact lens since one of the ingredients in Latisse (benzalkonium chloride, a preservative) may be absorbed into the contact lens.
Patients with glaucoma who are already undergoing prostaglandin analog treatment should take extra precaution since Latisse may bring their "eye pressure down" lower.

Is Latisse Safe During Pregnancy?

The use of Latisse has not been tested during pregnancy.
Animal studies have shown an increase in miscarriage if taken in higher doses.
Studies have also shown that bimatoprost (Latisse) was also detectable in breast milk.
Thus, Latisse is not recommended during pregnancy and after pregnancy when one is still breast feeding.

Side Effects of Latisse

Increased brown coloration of the iris of the eye may occur, especially in patients with hazel eyes.
Mild itching of the eyes
Redness of the eyelids
Bloodshot eyes
Brown discloration of the skin where the Latisse is applied.

Emmanuel De La Cruz M.D., PLLC

The Woodlands Plastic Surgeon

Breast Implant Placement: Above or Below the Muscle?

2011-08-16T10:55:00.001-07:00

Where Should One Place their Breast Implants? Above or Under the Muscle?

Implant Pocket Selection

One of the most important decisions prior to a breast augmentation procedure is the selection of the breast implant pocket. The clinical manifestations of this may not be apparent for several years since the effects of the implant on your breast tissue may occur gradually. Sagging of the breast may inexorably worsen, especially after giving birth and with aging.

Different Breast Implant Pocket Selections

Total Submuscular (behind the serratus and pectoralis muscles of the chest)
Partial Submuscular (behind the pectoralis muscle of the chest with its origin from the ribs left intact)
Subglandular (above the pectoralis muscle of the chest)
Dual Plane (partial submuscular and partial subglandular/submammary)

Total Submuscular

Mostly a reconstructive technique
Less commonly performed for a breast augmentation
More painful
More bloody due to the dissection during surgery
The breast implant may have a tendency to rise superiorly

Submuscular Placement of a Breast Implant (Courtesy of Wikimedia Commons & Inamed)

Partial Submuscular (Under the Muscle)

Breast animation and distortion may occur when the pectoral muscles contract.
Lower incidence of capsular contracture.
Risk of double-bubble deformity of the breast.
More painful than a subglandular breast implant placement.
Decreased risk of the palpability of the implant edges
Decreased risk of rippling
It allows for better view during mammography.
It's associated with a longer period of recovery, and more post-operative discomfort.

Subglandular (Over the Muscle)

Subglandular Placement of Breast Implant (Courtesy of Wikimedia Commons & Inamed)

Usually reserved for patients who have a substantial breast tissue or mild degree of ptosis (sagging of the breast.)
May be the ideal choice for patients who are avid bodybuilders.
The benefits of this position is the anatomic placement of the breast implant that is not affected by contraction of your chest wall muscles.
A more natural appearance results with the placement of the implant subglandularly.
There may be an increased risk for capsular contracture
Implant palpability may occur when the soft tissues are very thin. Thus, it is very important that the plastic surgeon assess the soft tissue of the breast before deciding to place the implant subglandularly.
Faster recovery
The cleavage is narrower with this technique.
Larger implants may be able to be placed above the muscle.

There’s a reduced tendency for the breast implant to ride high, and higher risk of seeing ripples (especially with saline breast implants.)

Dual-Plane Placement

Dual Plane Technique (Courtesy of Wikimedia Commons & Inamed)

The breast implant is partially covered by the chest wall muscle.
It allows for a more natural appearance while keeping the benefits of having the muscle cover the implant.
The implant is less palpable and less rippling is observed.
Pectoral muscle contraction may still occur with the dual-plane placement of the implant.
There’s also a reduced tendency for the breast implant to ride high, as well as reduced tendency for the implant to lateralize.
This technique has the benefits of both the subglandular and partial submuscular breast implant placement.
The technique is more complicated than the subglandular and submuscular implant placement.

Being a fully informed patient prior to your breast augmentation procedure is critical. Learning the advantages and disadvantages of the techniques for breast implant placement are important, and this should be discussed with your plastic surgeon.

Emmanuel De La Cruz MD, PLLC

Houston Breast Augmentation

References:

Sherrel Aston's Aesthetic Plastic Surgery 2009.

Hidalgo DA. Breast Augmentation: Choosing the optimal incision, implant, and pocket plane. Plastic & Reconstructive Surgery. 2000; 105 (6): 2202-2216

Takayanagi, et al. Where should the implant be placed? Aesthetic Plastic Surgery. 2004; 28:83-88

Tebbetts JB. Dual plane breast augmentation: Optimizing implant soft tissue relationships in a wide range of breast types. Plastic Reconstructive Surgery. 2001; 107 (5): 1255-1272