Botox was initially approved by the FDA for treatment of strabismus or an abnormality in the eye muscles in 1989. In 2002 the FDA approved Botox Cosmetic for the temporary improvement in wrinkles between the eyebrows or for treatment of the glabella muscles.

Botox Cosmetic is the most common cosmetic procedure performed in the United States year after year and the same thing stands true in my NJ plastic surgery practice. Every week I inject patients in their glabella, which treats the “11″ lines in between the eyebrows but also off-label in areas like the forehead or crow’s feet. After injection, 2 or 3 days later, these muscles do not move and thus the wrinkles or “angry” lines between the eyebrows are no longer there.

I get many ladies coming in asking for Botox around the nasolabial folds and lip lines. In these areas fillers tend to work better and I discuss things like Juvederm or Radiesse to fill out these lines. Laser resurfacing is an exciting option for lip lines.

I hope this brief discussion helps explain these products better!

The reason for not eating or drinking on the morning of surgery (or being kept NPO) is that any food or liquid in the stomach can be vomited during the start of anesthesia and if aspirated into the lungs can cause severe breathing problems.

The true amount of time needed to wait after eating or drinking is believed to be between 6-8 hours by most anesthesiologists. The patients in my practice are getting elective surgery and it makes sense to take every safety precaution possible.

I have had patients come in who directly disregard the instructions not to eat. They believe that this is an optional instruction and that coffee/milk and a small breakfast won’t matter. The truth is, it does make a difference, and the result of ignoring this instruction is usually postponement of surgery.

The goal of any surgery should be to optimize safety for plastic surgery patients and observing the restriction of not eating before elective surgery should be understood and respected.

I value the reviews that patients write about me and about my practice. One site that we are associated with has a large number of frequent reviews of my NJ plastic surgery practice which I wanted to share.

Other sites such as yelp reviews, yahoo reviews, google places, insiderpages are always growing.

I value the information posted and read it carefully. If you have concerns I wish you would contact me directly at esorokin@delawarevalleyplasticsurgery.com so we can address any issue. If you have the time to post a review, I certainly appreciate it!

The articles describes many patients as wanting to “go underground” during the recovery process and using the holiday season to be able to avoid work, school and friends.

Every year I see patients schedule surgery often in February or March for December of the upcoming year. They know when they will have time off and schedule early for these weeks. I see this in my New Jersey Plastic Surgery practice every year.

I don’t know that this is absolutely necessary especially with rapid recovery procedures such as breast augmentation where I tell patients in my NJ cosmetic breast implant practice to take 3 or 4 days off from work and that this is all that they will need. Even for facial resurfacing procedures such as my fractional Smartskin CO2 laser the recovery is only 5 or 6 days.

Still, I see this phenomenon every year and it is interesting to see it in the Wall Street Journal. In contrast the slow time of year is usually the last week in August or first week in September when kids are home from camp and school is about to start.

The repeal of the tax will be implemented over a 3 year period starting in July 2012. In July the tax will be reduced from 6% to 4%. It will go to 2% from July 2013 to July 2014. It will then goto 0% after July 1, 2014.

NJ implemented this tax in 2004. It quickly failed to raise the revenue that had been hoped. A repeal measure previously failed to pass when Governor Corzine would not sign it into law. It has been said that it cost more to implement and run the tax than was collected.

The law has been very difficult to New Jersey patients. Some patients have chosen to go to neighboring states like New York or Pennsylvania to avoid paying the 6% tax. Other patients who save for years for these procedures have had to save even longer and wait to have surgery or have not been able to afford it altogether due to this extra burden. Many people have called the tax discriminatory against women and the middle class who constitute the majority of plastic surgery patients.

In the end, it will be nice to see this tax go away. The administrative burden alone is a nuisance. While going away in stages of 4% then 2% then ultimately 0 is annoying, it is better than it never going away!

I’d love to hear your comments and posts on this topic!

The entry discusses breast tape, breast gum, and breast enlargement pills. These are some of the things that I hope my New Jersey breast implant patients don’t waste their money on……

Maybe she wants to be a “C.” A small C? A large C? Such a difficult decision….

Many surgeons recommend different ways of deciding what implant to be used. First of all, the most important thing is that the prospective breast implant patient knows what she wants herself. My best recommendation is to look at many sets of breast implant photos. Go online and look at various plastic surgeon websites. Go look at Playboy(C) or a similar magazine. If she doesn’t know what she wants, there is no way the surgeon can deliver a result.

The next important issue is communicating her desires to her surgeon. She needs to not be shy. She needs to tell him or him exactly what she wants. I tell patients in my New Jersey plastic surgery practice to find pictures of breasts that they like. A picture is worth a thousand words and when she shows me what she wants, I have a much better understanding.

The next possibility is things like sizers. Some surgeons’ offices have sets of sizers ladies can put in bras. Some ladies place rice in ziplock bags and place in their bra to determine how much volume they are comfortable with. Weighing the rice can be converted to cc of volume. Some surgeons use computer imaging. I have used computer imaging in my office and found it to be a very artificial, unrealistic portrayal of different sized implants and while it sounds good it didn’t work well for me in my NJ practice. I hated putting the expensive imager in storage but found it misleading. Thus, I have gone back to using sizers in bras as it is a reliable method for me.

The final issue is understanding that different implants look different on different body type frames. A 400cc implant will look very different on a lady that is 5 feet 1 inch tall and 95lbs compared to 5 foot 7 and 150lbs. Thus, when a lady comes in and tells me I put 350cc implants in her friend “Amy” and she wants that size I need to explain to her that the size of the implant is based on her individual chest width, height, weight, and tissue characteristics.

Communication of her desired result is the most important thing I can stress. The potential breast augmentation patient needs to have a good insight into her desired result and to communicate this to her surgeon for a successful outcome.

This is an easy answer for me. Implants belong below the muscle. Occasionally they belong in a dual plane partially under the muscle but it is rare where I would put them above the muscle.

What are the differenceS?

Above the muscle looks more round and fake. Under looks more natural.

Above the muscle feels less natural. Under feels more natural.

Above the muscle does not move with muscle activity while under the muscle they can move. This can look a little weird and weaken strength for a professional athlete. I don’t think this is a huge issue for most people but a consideration for some.

Above the muscle interfere more with mammograms. Under the muscle interfere less.

Above the muscle get more capsular contracture or hardening over time.

Above the muscle ripple more.

Above the muscle might have a slightly easier surgical recovery (by a day or two….)

While this is not an all inclusive list, the majority of these differences point in favor of putting the implant below the muscle. Since breast cancer can impact 1 out of 8 American ladies, the mammography difference is very significant to me.

I place most implants totally submuscular. Occasionally I use a dual plane technique in someone who could benefit from a little bit more “lift” due to the shape of her breasts to start with. If an implant was placed previously above the muscle and I am doing a revision sometimes I will stay in this pocket.

So, it is a confusing issue to some, but easy for me to choose. Most breast implants belong below the muscle in my opinion. If you are considering breast enhancement I would highly suggest meeting with a board certified plastic surgeon to discuss all of your options and get educated in detail.

First of all, I think that while there are many differences between the two devices, it really comes down to three issues when picking your implant.

#1 – First of all, the biggest difference on a daily basis is going to be the way the implants look and feel. In my opinion, silicone gel implants look and feel far more like natural breast tissue. Saline implants tend to feel more like a water balloon, well, because they are filled with water. Even under the muscle with adequate soft tissue coverage, silicone implants feel nicer. Most women getting this surgery want their breasts to feel as nice as possible. Silicone clearly wins on this issue. They also ripple less. If you have ever seen a picture of implant rippling, it isn’t great. Silicone implants do not ripple nearly as much as saline. If you are considering breast enhancement, holding both types of implants is very important. You cannot just read about the differences, but need to feel the implants to make an educated decision. In my Cherry Hill cosmetic surgery practice all prospective breast augmentation patients feel the implants as part of their consultation.

#2 – The second issue is safety. In the early 1990′s the safety of that generation of silicone breast implants became a major issue. This page on my website describes silicone safety however it is a major issue. We did not have access to silicone devices in this country until 2006 when the FDA released the current generation of silicone gel implants for general use. Until then, they were considered experimental. While I am not going to go into detail about the studies performed, the FDA noted that volumes of research showed silicone breast implants to be an overwhelmingly safe device. They were approved for general use and have been used in large numbers since then. I believe that they are safe, as do the majority of plastic surgeons. Most women are able to do a little research and decide for themselves that they are safe. Some ladies want nothing to do with silicone implants due to the stigma still attached to them. While I understand this emotional decision, with a little research most ladies are ok with the safety factor.

#3) Long term detection of leaks. This is a huge issue. The saline implant deflates when a crack occurs in the implant shell. The saline is absorbed and the breast becomes flat. Ladies notice this and thus call their doctor. If it has been 20 or 30 years and their surgeon has retired or they have moved elsewhere, they find a new surgeon. This is a nice feature of saline implants. Simply put, if you have a problem, you know it. With silicone gel implants I tell my NJ breast implant patients that they will likely have no idea that their implant is leaking. Perhaps the breast will change shape or get slightly harder but often there will be no sign of change at all. Because of this the FDA recommendation and the package labeling for the implants states that after silicone breast enhancement, patients get an MRI of the breasts at 3 years and then every 2 years. This is a huge issue. MRI is an expensive test. Insurance companies will likely tell you that this is a cosmetic test and that they will not pay for it. It is inconvenient and time consuming. Some ladies will find the MRI embarrassing. Overall, the MRI is an nuisance and needs to be considered.

In summary, silicone gel breast implants feel better, are safe, but are a nuisance in terms of needing follow up appointments with your surgeon to get expensive MRIs every few years. Whether or not a nicer feeling and more natural appearing breast is worth it to each patient is a personal decision that I can only guide them through.

I hope that this information is useful if you are considering breast enhancement!

There are three operations that plastic surgeons perform on the breast. The most straightforward is placement of a breast implant. If your breasts are perky and small, this is the perfect option. An implant is placed and makes the breasts bigger. We need to decide on saline or silicone implants, but this will be the topic of another day. The other extreme is the lady with very saggy breasts. Often simply due to the way they developed or with weight loss or pregnancy/breast feeding, the nipples hang down and the entire shape of the breast is pointing downward. In this case, surgical option #2 is a breast lift. A breast lift is an operation where excess skin is removed, the tissue is repositioned and tightened, and an rejuvenated slightly smaller breast is the result. Option #3 is a combination of a breast lift and an implant. This is the case where the breast needs to be lifted, but an implant is also needed for volume. It is only safe to combine lifts and implants in some circumstances, which will be a topic for another day.

How do you know which you need? Well, if you love the shape of the breast and nipples point forward and your only complaint is size, then an implant alone will likely solve the problem! Unfortunately, if the breast is starting to sag, an implant alone will not lift the breast to any significant degree. In this case, the implant will give you a bigger saggy breast. That is certainly not an ideal goal, but one that some ladies choose to accept to avoid the scars of a breast lift.
Unfortunately to lift the breast, incisions are needed to remove the excess tissue. Anytime there is an incision there is a permanent scar, and thus it is understandable that in an ideal world we would avoid lifts. This is not reality, and some breasts simply require this procedure. The amount of scarring will depend on how much excess tissue there is and what type of lift will be performed. I will discuss various lifts in the next post.

A simple test to see if you need a lift has been known as the “pencil test.” If your breasts have come down enough that you can place a pencil behind the hanging skin (in between the breast and your abdominal wall/ribcage) and it stays there by itself, you probably need a lift. If the nipple is positioned near or at the level of the breast base crease you likely require a lift.

I see ladies who have gone to other surgeons and received large implants in order to attempt to avoid a lift. They are always upset and always blame their surgeon. This plan does not work. I would highly caution any lady with sagging breasts not to simply get large implants. I hear this from ladies often that “well he said I could probably get away without a lift.” I had a lady come see me recently that I had seen 4 years ago. When I saw her initially I suggested a lift. She went to someone else in the same zip code 08003 as me who told her she would be fine without a lift. He ended up placing 600cc implants in an attempt to mask her droopiness. Now she complain that she has huge droopy breasts. I operated on her a few weeks ago performing a lift and downsizing her implants. She is delighted now that the proper procedure was performed. I worry about that comment because in my opinion a breast cosmetic surgeon should be able to look at a pair of breasts and in 2 seconds tell you what operation is best. I believe that surgeons do this because the lady doesn’t want a lift full well knowing that she will be back to get one. Beware of this.

I hope this explanation helps!