A few other surgeons on Cosmetic Surgery Chronicle have emphasized the importance of board certification. But so far no one’s fielded a question that’s a little more challenging to sort out: “How do I know my surgeon really stays current with the latest developments in the field?”

This is difficult to answer because there are so many things that a surgeon has to do to stay up-to-date. I can’t point to one thing and say, “This is the must-have factor.” What I can do is share some ways that I keep myself current so that I can offer proven techniques and technologies for my patients.

How Surgeons Keep Pace with New Developments:

• Read professional journals like the American Journal of Plastic and Reconstructive Surgery and Aesthetic Surgery Journal
• Attend training seminars on new technologies
• Maintain membership and attend conferences for national and international plastic surgery societies like the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery
• Participate in clinical trials for new surgical devices (for instance, I am currently participating in clinical trials for BodyTight™, a traditional liposuction alternative)

A cosmetic surgeon in New Jersey who has recent, frequent involvement in the areas I mentioned and whose areas of study focus on issues that relate directly to your key procedure is much more likely to offer the latest and most effective techniques.

Many people start thinking about traditional face lift surgery between the ages of 40 and 70; before the age of 40, many people don’t want or need a full face lift procedure. A few “maintenance” treatments, however, can sometimes help you to age more gracefully and, in some cases, delay a few of the signs of aging.

If you’re under the age of the 40 and are not ready for surgery, but you’re still interested in rejuvenating your appearance, you may want to consider these treatments:

1. Softening Nasolabial Folds and Glabellar Lines

Most patients over the age of 25 will start to see clear vertical lines appear in the nose-to-mouth area and glabellar lines (vertical lines between your eyebrows). These generally aren’t very dramatic before age 40 or so, but they can still add a few years to your appearance.

My recommendation: For nasolabial folds, usually I’ll use a dermal filler like JUVÉDERM® Injectable Gel or Restylane®. Lines between the eyebrows can be treated with BOTOX® Cosmetic.

2. Correcting Loose Skin

Every so often I’ll see a younger patient who’s had a lot of sun exposure or has experienced dramatic weight fluctuations and is showing some skin laxity.

My recommendation: In an older patient I’ll usually recommend a face lift in New Jersey to trim away that sagging excess skin and smooth things out more permanently, but usually younger patients’ skin is firm enough that it can “bounce back” with a laser treatment alone. The big exception is loose eyelid tissue, which usually will require surgery even if the patient is under the age of 40.

Having the breast volume and cleavage to look great in a bikini or low-cut dress is an important goal for many of my breast augmentation patients. In last week’s post I gave you my first two tips for getting great cleavage from your breast implants procedure near Portland, Oregon; this week I’d like to follow up with my last two.

3 — Avoid fully submuscular placement. Full or partial submuscular placement creates a softer, more gradual curve at the top of the breast, but placing the breast implants entirely below the muscle can “disguise” some of the natural contours that give you a really nice cleavage line. Subglandular placement (above the chest muscle) is popular for creating a very clear, definite cleavage line, but for women with little breast tissue and thinner skin, this approach generally does not offer good-looking results.

Most “submuscular” procedures these days place only the top part of the implant below the muscle, but be sure to talk with your doctor and find out which approach exactly he or she uses.

4 — Follow your surgeon’s postoperative-care instructions to the letter. Excessive internal scarring around the implants (capsular contracture) definitely alters the cleavage line, along with the whole shape of your new breasts. Good plastic surgeons in Portland take plenty of precautions before, during, and after your procedure to help prevent scarring, but if you fail to take proper care of your new breasts afterward, you can undo much of your surgeon’s careful work.

Pull quote: “A good surgeon is meticulous in planning your procedure, and you should devote that same kind of care to your own recovery process.” – Dr. Chung

Community. Although it’s a word that can mean different things to different people, the general concept is of sharing – sharing a locality and, in many cases, much more. Although you should never try to reach some cosmetic “ideal,” it’s natural for your concept of beauty to be influenced by the people and the place around you. It’s why many people choose a local surgeon instead of traveling to visit a big name practice elsewhere. If a surgeon lives and practices in your community, they are more likely to understand your concept of beauty, often better than a surgeon across the state or across the country.

While surgeons and patients in some areas prefer a bolder, more dramatic look, other people in different areas may be looking for something a little more subtle. What most of my cosmetic surgery patients in Fresno and Visalia desire is a natural looking result. Other patients in other areas may prefer something that is more visible or attracts more attention.

A surgeon’s role should be to listen to your goals, make recommendations about procedures that can meet these cosmetic goals, safely perform surgery, and be there to follow-up with your longterm care. A skilled and experienced surgeon will be able to give you the results you want, even if it means stepping outside of what’s “typical” for them. So, although a local surgeon can offer several benefits, a qualified surgeon in any area, as long as they take the time to work with you and establish an understanding relationship, should be able to give you excellent results.

If you’re doing research about plastic surgery online, some of the most useful resources you may find are before and after photo galleries. Written descriptions that accompany cosmetic surgery photos can help you understand what was performed and why, but sometimes these descriptions are overly technical and difficult to understand. I recommend paying close attention to the photos themselves, and educating yourself about what to look for.

If you’re considering facial cosmetic surgery, here’s a brief list of things to consider as you view on-line photo galleries.

Best Practices for Online Photo Galleries

These are the guidelines I share with my staff for taking photos of our Fresno and Visalia plastic surgery patients:

Multiple angles are, in general, a must have. For most facial procedures, there should be a front view and a side view.

The entire face should be photographed (even if, for example, only eyelid surgery was performed). This will show that results are in balance with the rest of the features and that facial harmony is preserved.

The background of both the before and after photo should be the same solid, neutral color.

Lighting should be sufficient and the same in both photographs.

In most instances, patients should have a neutral facial expression.

Makeup and jewelry should not be worn in either photograph.

Hair should be pulled away from the face and tucked behind the ear.

A clear statement that the people depicted are “actual patients” and a disclaimer that “your results may vary” should always be present.

Practical Application

Now, don’t jump to conclusions if not every single one of the photos in the online photo gallery of your cosmetic surgeon follows the rules I’ve mentioned above. What’s more important than getting the lighting “just right” or insisting that patients do not wear makeup is that the photographs are an ac-curate representation of the surgeon’s skill and an indication of the kind of results that can be achieved with each procedure. In other words, the intent of the gallery should be to inform and to educate, not to mislead. If this is the surgeon’s intent in presenting the gallery and if the photos comply with most of these guidelines, then the gallery can be a useful guide in the process of selecting a surgeon and a pro-cedure.

There’s a popular misconception that BOTOX® Cosmetic and DYSPORT® botulinum toxin treatments will freeze your facial expressions completely. This isn’t true, and I’ll explain why.

How BOTOX Really Works

BOTOX, and other cosmetic botulinum toxins like DYSPORT, tightens by relaxing one set of facial muscles, leaving the opposing muscle set free to pull the tissues tight. Over-injection of BOTOX can end up relaxing the facial muscles too much, and could in fact limit facial expressions, but when performed correctly a “frozen” look should not occur.

Still, a lot of patients out there are expecting their New York City or Westchester County BOTOX treatment to freeze their face completely – or are even unhappy if it doesn’t – because they mistakenly think that that means it’s working.

The Results You Really Want

Following a BOTOX treatment, the ideal result is a softening of facial wrinkles for a more natural look. It’s important to keep in mind that botulinum toxins only treat the kinds of wrinkles that are caused by repeated facial muscle movement. For other wrinkles caused by volume loss and skin aging, injectable fillers like JUVÉDERM® Injectable Gel, Restylane®, Radiesse® or Sculptra® are more appropriate and can produce immediate enhancement.

The best way to apply BOTOX is in a mild quantity that will relax the one muscle set just enough to allow tightening, but not enough to block muscle function entirely. If you’re considering BOTOX, I encourage you to “just say no” to a frozen appearance and seek a natural-looking enhancement.

The Technology

Nonsurgical treatments have historically focused heavily on skin care in San Jose, California. With the Accent system, however, nonsurgical treatments have entered a whole new arena: body contouring. Using two different radiofrequencies, and without anesthesia or a single incision, the Accent can achieve improvements in cellulite, excess fat and skin laxity. During treatment, a handheld device delivers radiofrequency energy to deep tissue layers and surface skin to contract connective tissue, drain fat, improve circulation, and encourage collagen growth. The treatments are brief, virtually painless, and have very limited side effects or recovery time.

Get Systematic

With the Accent System, radiofrequency technology is just a piece of the puzzle. In order to ensure positive and long-lasting results, I also suggest a personal trainer for my patients who offers a customized diet and exercise program. It’s important for people to understand that cosmetic surgery can get you only partly there, and to get the long-lasting, transformational results you want, you need to look at your entire lifestyle. This is as true for surgical procedures (such as liposuction or a tummy tuck) as it is with the Accent System.

In 2003, the American Society of Plastic Surgeons (ASPS) agreed to review the content for a new show, the ABC-TV series Extreme Makeover. I was on the review panel, and what my fellow surgeons and I observed and the subsequent developments have opened my eyes to a whole range of concerns raised by this new “reality” phenomenon. Here are some things the public should keep in mind.

ASPS involvement (although controversial at the time) did lead to some positive outcomes from Extreme Makeover. The consulting surgeons encouraged the show to demonstrate some key realities of the plastic surgery field: patient consultation, informed consent, physical and psychological examination, board-certification, postoperative care, and the importance of performing procedures in credentialed facilities.

While Extreme Makeover did, to a large extent, demonstrate these key points, its immense popularity opened the door for a lot of shows that most definitely have glossed over some important realities. These spin-off shows have at times misrepresented the plastic surgery profession and have, even more dangerously, led many people to have unrealistic expectations for their “real life” surgery.

A major concern is that these shows cut the scenes that involve consultation, complications, and recovery. When you cut out that time, you’re not only giving plastic surgery patients the idea that the process is “magical” and immediate; you’re also de-emphasizing all the planning and follow-up that must happen if the patient is going to choose wisely, heal well, and be happy with the result.

Take breast augmentation in New Jersey (breast enlargement) for example – the typical breast augmentation patient I see will need to spend the first 10 days after surgery resting up and avoiding many activities. Most patients won’t see full results for several months. Even the best surgical techniques in the world won’t have you going from “before” to “after” in a matter of days following most surgeries.

Bottom line: Plastic surgery in New Jersey is faster and more comfortable than ever and, with a good surgeon, you have every reason to expect a smooth recovery, but just remember that it is surgery, not magic.

Pull quote: “Appropriate planning and follow-up must happen if the patient is going to choose wisely, heal well, and be happy with the result.” – Dr. D’Amico

When I talk with women about Portland, Oregon breast augmentation, they are usually very excited to be able to wear clothes like bikinis and low-cut dresses without feeling self-conscious about their breast size. And for most of them, nice cleavage is an important part of that goal. This week and next week I want to highlight a few tips for enhancing your cleavage.

1 — Wear a normal bra to your consultation. For many women with small breasts, push-up bras may be “the answer.” These bras are designed to make your breasts look bigger, and to give you better cleavage in the process. But it’s not a good idea to wear one to your consult. A padded bra can limit your ability to evaluate your options with implant sizers or samples because it “adds” to breast volume and alters breast position. Stick with a plain, unpadded bra when you come in for your consultation.

2 — Be sure your surgeon understands how important great cleavage is to you. For most women, there is an “ideal” position for the breasts, where they would look most natural and flattering overall, but depending on the width of your rib cage and the angle of your breasts, that position may not be quite the best for giving you a really beautiful cleavage line. Talking with your surgeon in detail about breast implants in Portland will help you get a better idea of which variables can be adjusted to make sure your cleavage will look just right. For example, you might prefer to have your nipple/areola area “pointing” less directly forward, if it means your breasts can be spaced closer together.

Pull quote: “Having an accurate idea of your options is almost as important as finding a reliable surgeon to perform your procedure.” – Dr. Chung

I see many patients who express interest in one of the variations on the general tummy tuck (abdominoplasty) procedure, such as a “mini tummy tuck.” Although these alternative procedures may be a good option for some people, there’s another tummy tuck procedure I offer at my practice that may work even better than these other alternatives, a procedure that offers many benefits to my patients in Fresno and Visalia: the Avelar tummy tuck. I thought I’d share some of those benefits in this post.

What Is the Avelar Tummy Tuck?

Created in the 1990s by Dr. Juarez M. Avelar, a Brazilian surgeon, the Avelar tummy tuck combines abdominoplasty with tumescent liposuction. The technique requires less cutting, although it still removes the excess skin that is usually addressed during a tummy tuck. Combined with the removal of drooping skin, tumescent liposuction is used to safely and effectively eliminate excess fat.

Why the Avelar Tummy Tuck?

There are several benefits to the Avelar procedure that I have seen with my Fresno and Visalia tummy tuck patients.

The Avelar technique reduces the risk of flap necrosis and other complications.

In some cases, more fat can be removed than with a traditional tummy tuck.

Many patients experience less pain and a faster recovery with the Avelar technique.

Deciding between liposuctionm, mini abdominoplasty, full abdominoplasty or Avelar tummy tuck can be confusing. The only way to truly know what is best for you is to meet with a qualified cosmetic surgeon.