Author: Morgan Cosmetic Surgery

Cosmetic Question:  My doctor told me he thinks I need a peri-areolar lift.  My nipples have come down, but the rest of my breasts looks okay.  What is involved in this procedure?  Do I have to be put to sleep for this?

Cosmetic Answer:
This procedure makes the nipple smaller after it is stretched and has come down – usually after pregnancy, menopause or some weight loss. An incision is made around the wide outer nipple and around the desired size.  Internal sutures are then placed and finally, fine outside sutures are used as needed.  There is no scar in the breast crease and no vertical scar.

If no other breast surgery is being done, a peri-areolar lift can be done in the office with local anesthesia.  Worrying about the surgery is more bothersome than the surgery itself.  To help with this, I recommend some sedation by mouth with a ride home, so you do not find anticipation of surgery stressful.

The surgery takes about 1 ½ hours to do.  Your recovery is likely to be fast.  Sutures come out in 1-2 weeks, no sports for 2 weeks, but walking is fine after 5 days.

Often a peri-areolar lift is done with a breast enlargement – the implant can usually be put in through the areolar incison, if you wish.

The incision around the nipple will be red for some time and may widen, especially if a large breast implant is put in at the same time. Widening is much less likely without an implant.

If all you want is a little lift and no implant, this is an excellent office operation.

Cosmetic Question:  I have had liposuction of my flanks and tummy.  The tummy is fine but I have pain and hard knots on the sides.  What is wrong?

Cosmetic Answer:  These painful knots are common after liposuction of the sides.  It is probably because liposuction here is near bone, nerves and muscle.

• These knots appear to be caused by over-healing with excess collagen.
• They can be treated with dilute steroid injections, mixed with local anesthesia.
• The earlier they are treated the faster the knots respond.
• I emphasize dilute steroid – too much, and in 6 months, skin can be sunken and red.
• Injections no more than once a month – it can take steroid that long to work.
• Most people see improvement in a week.
• One injection may work – but it often needs 3 or more.

Cosmetic Question: I am a tall, slender woman with skinny legs. I had calf implants. My surgeon says they are the popular look. Unfortunately, I have huge, rock-hard bulges at the back of my legs. I get teased that I look like a stork on top and Russian weight lifter on steroids below. Help!

Cosmetic Answer: I am very sorry about this. It sounds as though your plastic surgeon specializes in the hard, bulky implants desired by certain groups, including the professional sports people. He would be unlikely to have the artistic eye for the long, tapered implants needed for a natural look.

You need to first find a Board Certified Plastic Surgeon who does implants in the average woman and man who wants better shaped skinny legs.

When I see calf implant patients, I first want to know the look she or he wants. Then I measure, and then I see what comes closest in the available off-the-shelf implants (custom made implants cost a lot more). The width of your muscle and the length of your leg are important. I show my patients various shapes and sizes available.

I like the Aiache or similar tapered, asymmetric calf implants for women and for most men. They go over the muscle and extend about 2/3 the way down your leg. The average size is 130-170 cc volume in each implant. The implants should be made with super soft silicone. (Durometer is the measurement for silicone softness, but the silicone in calf implants is softer than the standard durometer range.)
There are various manufacturers of calf implants. The ones I use most often are from Allied Biomedical (www.Implantech.com) and Spectrum (www.Spectrum.com)

Once the right implant is selected, (cost ranges from $350-$540 for each of 4 implants), surgery is done to remove the old implants, extend the implant pocket if needed, and put in the new ones. You will need time to recover. Allow yourself 2 weeks – and more if your job requires a lot of walking.

Cosmetic Question:  Is Insta-Breast the best way to decide the right size breast implant for me?

 

Cosmetic Answer:  Insta-Breast is a new way to “test” the size of the implant you are considering. This office procedure infuses sterile salt water into your breasts in the exact volume of the implant you want. You instantly see the result and decide if that is truly the look you have in mind.

 

The result is temporary – your body absorbs the water in 24 hours.

 

What if you absolutely have to fill out a gown as an emergency? Insta-breast can do this also. You can have it done a few hours before a wedding, party or other event – and know that you look the way you want. It is like Cinderella, though – you can look fabulous in the gown you love, but it does disappear by morning!

 

Being a medical procedure, Dr. Morgan offers instant breasts for $1,250.

 

This is the newest but not the standard way to test your implants. The usual way – and free – is to try on sizers. These are sample implants. You put them in your bra. It helps to have a snug T-shirt to see the outline. That allows you to decide the look you have in mind. Then Dr. Morgan, based on her examination, can advise you what kind of implant will come closest to your ideal look.

 

However, some women just can’t make up their mind as to what size is best. They truly get stuck, and so for them, instant breasts is the best way to decide.

Cosmetic Question:  Will having breast implants increase my risk of getting cancer or of a cancer being missed?

 

Cosmetic Answer:  This is a very important question – no woman would want to risk breast cancer in exchange for implants.  In fact, this concern led the FDA to stop the use of silicone gel implants for cosmetic breast  enlargement from 1996 until 2007 – to allow research into this question, among others.

 

Research before, during and after that time showed two consistent findings:

Having implants makes breast cancer much easier to feel and to find on breast examination – by yourself or by your doctor.  The implant pushes the breast forward so small changes can be detected.  This is a huge plus.

 

On the other hand, having implants makes mammograms more difficult to interpret.  This is the minus, but the studies show that the plus and the minus balance each other out.  Breast cancer is detected at the same rate, and at the same stage of development, in women with and without breast implants.

 

What is so important to understand is that a mammograms are not 100% reliable.  You can have a normal mammogram and a breast cancer. So mammograms are useful for screening for cancer, but if you have a new breast lump – even if the mammogram is normal – that lump must be diagnosed.  This usually requires a tissue biopsy.

 

If you have a new breast lump – and your doctor tells you not to worry, the mammogram is normal — you are not ok.  You must see a breast surgeon for diagnosis of the lump.

 

Cosmetic Question:  Why can’t I get silicone lip and buttock injections here in the USA?  It’s easy, it’s permament and it’s done all over South America.

 

Cosmetic Answer:

Injectable silicone for medical use is not approved in the USA because of the problems silicone will cause you a year or so later.  The lip injections look lovely at first – but in time, you will end up with hard, ugly lumps in your lips as your tissues react to the silicone.  Buttock injections?  Read on…..

 

One of the common lip operations I do is removal of unsightly, silicone-hardened lip tissue for women who have had these injections in Columbia and other South American countries.  Unfortunately, once the silicone is injected, it is not possible to get all of it out.  It goes into the muscle as well.  It always takes two procedures to get a good result, because of distortions caused by the remaining silicone.

 

It is much, much smarter to either have fillers like Juvederm in your lip, or fat injections or even V-Y lip advancements instead of silicone injections.

 

As for buttock injections, they are a total disaster – and unfortunately commonly done illegally in the USA.   It is possible to buy “medical grade” liquid silicone online for ten dollars a kilo (quart) – and all sorts of people are willing to illegally inject it into you for money.  You will live with the consequences – a hard, painful, swollen buttock.  It is almost impossible to fix this.  The silicone-injected tissue can be partially removed with surgery, but it will leave your buttocks shrunken and distorted.  If there is a single liquid lump, it may be possible to remove some of it with liposuction.  In the worst cases, the silicone is injected into nerves, causing permanent disability or worse, into blood vessels – killing you.  Liposuction/fat transfers to the buttocks or permanent, soft-solid silicone implants are the only reasonable approach we have today to improve buttock size and shape – except, of course, tons of daily squat exercises.

 

Silicone cosmetic injections in the USA are illegal for reason.  Please avoid them.

 

Call us if we can help. 404.941-3200

 

For more information from Dr. Morgan about cosmetic surgery and treatments, call us for an appointment, search our blog or go to www.realself.com – where Dr. Morgan regularly posts answers.

 

 

 

Cosmetic Question: I am a tall, slender woman with skinny legs. I had calf implants. My surgeon says they are the popular look. But I have huge rock-hard bulges at the back of my leg. I get teased that I look like a stork on top and Russian weight lifter on steroids below. Help!

Cosmetic Answer:

I am very sorry about this. It sounds as though your plastic surgeon specializes in the hard, bulky implants desired by certain groups, including the professional sports people. He would be unlikely to have the artistic eye for the long, tapered implants needed for a natural look.

First, you need to find a Board Certified Plastic Surgeon who does implants in the average woman and man who wants better shaped skinny legs.

When I see calf implant patients, I first want to know the look she or he wants. Then I measure, and next I see what comes closest in the available off-the-shelf implants. The width of your muscle and the length of your leg are important.

(Custom made implants cost a lot more). I show my patients various shapes and sizes available.

I like the Aiache or similarly tapered, asymmetric calf implants for women and for most men. They go over the muscle and extend about 2/3 the way down your leg. The average size is 130-170 cc volume in each implant. The implants should be made with super soft silicone. (Durometer is the measurement for silicone softness but the silicone in calf implants is softer than the standard durometer range.)

There are various manufacturers of calf implants. The ones I use most often are from Allied Biomedical (www.Implantech.com) and Spectrum (www.Spectrum.com)

Once the right implant is selected, (cost ranges from $350 – $540 for each of 4 implants), surgery is done to remove the old implants, extend the implant pocket if needed and replace with the new ones. Yes – you need time to recover. Allow yourself 2 weeks – and more if your job requires a lot of walking.

Call us if we can help. 404.941-3200

For more information from Dr. Morgan about cosmetic surgery and treatments, call us for an appointment, search our blog or go to www.realself.com – where Dr. Morgan regularly posts answers.

Cosmetic Question: What is a stem cell face lift? Where can I get one?

Cosmetic Answer:

You can get one at any reputable plastic surgeon’s office – a stem cell face lift is just facial fat injections. When fat is removed from the body, it contains stem cells.

These are cells that can change into any kind of cell, including skin cells.

The “stem cell face lift” makes the entirely unproven claim that the stem cells in the fat will turn into new skin that in 1- 2 years, tightens your face. This is marketing, not medicine.

What really happens? Fat injections in the face, if they survive, will plump up the face.

Today, we can carefully inject about 25 – 30 ccs of fat into the face. On average, half the fat – about 10 – 15 ccs, will survive. (More in some, none in others. Results are unpredictable.)

The advantage of facial fat injections instead of filler? If you need more than 4 – 6 ccs of filler, the fat injections will cost less and improvement may be permanent.

But the results are from the fat, not the stem cells. But ‘stem cells’ sound like magic. Grow yourself young! It’s a miracle! People can easily be led to pay a lot of money for miracles. If two years later, you don’t have a miracle, that just too bad. Your money is gone.

This false marketing is of great concern to ethical and honest plastic surgeons. We have a hard-earned reputation for honesty and good results, not phony claims.

What to do? Find a Board Certified Plastic Surgeon who does facial fat injections. Yes you will have stem cells injected along with the fat – but your benefit is from the new facial fat.

There is a lot more to discover about stem cells, growth factors and additives to improve fat injection results. So things may change. If so, we’ll tell you about it here!

We offer all cosmetic office and surgical procedures and cosmetic dermatology.

We have offices in Buckhead (Atlanta) and Alpharetta.

We personally answer our phones so it’s easy! Give us a call! 404.941-3200

For more information, search our blogs or go to www.realself.com – where Dr. Morgan regularly posts answers.

Cosmetic Question: I have a question about panniculectomy. I had a gastric by-pass and lost 150 pounds. Now I have tummy skin half-way to my knees. One plastic surgeon said I needed a cosmetic tummy tuck and insurance would not pay. Another plastic surgeon said it was a panniculectomy and insurance would pay. Help!

Cosmetic Answer:

Let me sort out your confusion.

A panniculectomy is an operation that removes excess, over-hanging tummy skin.
A tummy tuck is an operation that removes all excess tummy skin – from the ribs on down – plus removes excess fat and tightens stretched muscle.
If you just want the over-hanging skin gone: you need a panniculectomy.

If you want to look good, with the tummy improved over all – you need a tummy tuck.

A tummy tuck is always a cosmetic operation.

But some insurance will pay for some panniculectomies – the large ones.

The excess, hanging skin (pannus) has to be so large that it causes you medical problems.

For instance, your pannus

Probably makes it hard to urinate.
Probably causes infections in the skin fold and bladder infections and
May make it hard to walk.

These panniculectomies are covered by insurance…but wait, there’s more:

Check your policy. Does your policy specifically exclude panniculectomy or operations to correct effects of weight loss? If so, your insurance will not pay.
But, if it does cover weight loss operations, your surgeon still needs to get approval in advance via a pre-determination report.

So you were confused because both surgeons were partly correct. Your insurance may pay for a panniculectomy. But it will never pay for restoring the rest of your tummy’s appearance.

We offer all cosmetic office and surgical procedures and cosmetic dermatology.

We have offices in Buckhead (Atlanta) and Alpharetta.

We personally answer our phones so it’s easy! Give us a call! 404.941-3200

For more information, search our blogs or go to www.realself.com – where Dr. Morgan regularly posts answers.

Cosmetic Question: What is PRP, and should I have it to make my filler last longer?

Cosmetic Answer: This is an excellent question and a controversial one.

PRP stands for platelet rich plasma. You may have heard it referred to by its trademarked name, the Vampire face lift. Here is what you need to know.

Platelets are tiny blood particles that make our blood clot. They are full of growth factors and cells which make our body heal and grow.

Platelets are found in our plasma, the yellow serum that you see when you scrape your knee. It is the part of the blood that does not have red cells.

PRP concentrates are made by taking a blood sample and spinning it at high speed in a centrifuge. At the end of this violent spinning, the blood has visibly separated into layers. In the yellow plasma layer is a thin white layer. This is the PRP, plasma containing lots of platelets. Out of 30 ccs of blood, there are 2-3 ccs or less of PRP.

There are claims that PRP will improve the results of your filler injections. The vampire face lift combines hyaluronic acid fillers with PRP injections. Is the marketing or does PRP really work? The web sites I have seen look impressive. However, trusting claims can affect your pocket book, because PRP injections cost more than filler, from 50% to 500% more.

And there is no peer-reviewed research showing that this works, although these claims have been made for several years. So… I did a test on myself. I had PRP prepared in the standard manner from my blood and I had 3 sites injected. One with just PRP, one with just filler and one with PRP with filler. I expected the PRP+Filler to look better and last longer. It didn’t.

PRP alone vanished in 2 weeks. Filler alone is still visible 2 months later. PRP + filler lasted only 6 weeks. So, until we have good scientific studies showing if and how PRP improves your filler results, I suggest just having more filler if you want better filler results. Skip the PRP for now.

We offer all cosmetic office and surgical procedures and cosmetic dermatology.
We have offices in Buckhead (Atlanta) and Alpharetta.
We personally answer our phones so it’s easy! Give us a call! 404.941-3200

For more information, search our blogs or go to www.realself.com – where Dr. Morgan regularly posts answers.

Copyright E Morgan August 2014