Author: Morgan Cosmetic Surgery

Cosmetic Question: I watch the TV channel Bravo. I saw an ad for the ASPS, the American Society of Plastic Surgeons: “What is the difference between a plastic surgeon and a cosmetic surgeon?”

Cosmetic Answer:
Great question. It is very important to understand what is going on in plastic surgery.

Plastic surgeons developed the entire field of cosmetic treatments, starting with face lifts a hundred years ago. Only fully trained plastic surgeons with Board Certification in plastic surgery can belong to the American Society of Plastic Surgeons – or ASPS for short. It is the most prestigious membership for any doctor who does cosmetic work.

Years ago, only plastic surgeons did cosmetic surgery and cosmetic treatments. We have the best training in the field. Three other specialties – ENT, eye surgeons and skin doctors (dermatologist) have some training in cosmetic surgery and other cosmetic treatments.

But cosmetic treatments and surgery are very popular. Lots of other people want ‘in’ – purely to make money.

The problem is, they have little or no training in cosmetic work – ‘training’ may be a weekend lecture course. But these doctors can legally call themselves anything they want – a ‘plastic’ surgeon, a ‘cosmetic surgeon’ or a Board Certified Cosmetic Surgeon – this “Board Certification” is a scam. Any doctor can buy it off the internet.

Cosmetic surgery is not easy to do well and safely. Even the best trained plastic surgeons have complications. Without training or with poor training, people suffer completely avoidable horrible complications and even deaths. This is on the rise in the USA.

We are seeing complications and deaths from cosmetic treatments done by untrained medical doctors – and worse complications and more frequent deaths from treatments done by ‘experts’ who aren’t doctors at all.

You don’t want to pay for cosmetic surgery – and find out your ‘doctor’ has no training, isn’t a medical doctor or is willing to kill you for money.

Here are just a few things I have seen, from non-plastic surgeons doing cosmetic surgery:
– Promotion of expensive, ineffective treatments,
– Unnecessarily painful and unsatisfactory liposuction,
– Death from incompetent liposuction

And that’s cosmetic work done by medical doctors doing cosmetic surgery and treatments without proper training.

I have also seen –
– A podiatrist cause permanent, horrible facial scarring by not knowing how to deal with bleeding he caused when he gave a facial filler injection (podiatrists are trained to work on the foot, not the face),
– A nurse and a PA inject fillers into the tissues of the eye, risking blindness,
– A self-styled ‘therapist’ inject liquid silicone into the buttock, causing permanent hardening of the buttock into a rock like substance,
– Phony Botox and phony filler injected – by various people including a photographer and a hair stylist.

How can you avoid falling into the hands of shady people or untrained doctors?
Some people thoroughly educate themselves about the complex field of medical licensure, Board Certification and residency training and research every doctor they see to assess their qualifications and credentials. That takes a lot of work.

In the alternative, you can make it easy for yourself by only consulting a Board Certified Plastic Surgeon who is a member of the ASPS. When it comes to your looks, your eyes and your lift, the best trained specialists is the best one to see.

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 loose skin under my arm pit. Will an arm lift help me here?

Cosmetic Answer:

It sounds as though you need an axillary (arm pit) lift, not an arm lift. This lift is for women plagued by excess skin in the arm pit area – often after weight loss, but it could also be because that’s just how they developed. It seems to be a more common problem, at least in my practice, in women who form stretch marks very easily. They often have an Indian or Eastern Mediterranean (e.g. Sicilian, Greek, Lebanese) ancestry.

The axillary lift removes all that arm pit excess tissue, using an incision hidden in the axilla (arm pit). If the incision is sutured to the deep, tough fascia in the axilla, one gets a lift of the arm skin as well, but only the skin near this area, not right down the arm.

At times the problem in the axilla is fat as well as skin, so usually liposuction is done with the lift.

It can become quite complex in this area – some women have excess skin down the upper arm, and need a full arm lift (brachioplasty) as well. Others have excess skin along the side of the chest, and need a lateral chest lift as well. And then some women need the entire area treated with liposuction plus an arm, axilla and lateral chest lifts.

This just shows that cosmetic plastic surgery has become so advanced, that we truly can tailor the operation to you – we no longer have just one operation and do it hoping it works for you.

We offer all cosmetic office and surgical procedures plus 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 July 2014

Cosmetic Question: I have a strange large vein running done the side of one lower lid. Can that be fixed?

Cosmetic Answer:

Yes. The lower lid has a complex arcade of veins going through the lower lid muscle. Sometimes a few veins are really large – and look unsightly.

There are 3 ways to treat these prominent veins:

Surgery – this means a small office procedure. A drop of novocaine numbs the skin. A tiny incision is made over it, the vein is then located and tied off with fine absorbing sutures – and then cut in half. This has to be done with magnification – and apart from plastic surgeons and ophthalmologists, few doctors will have fine enough equipment. This is the most effective treatment.
Cautery – the skin is numbed and a tiny needle is put into the vein. The metal end of the needle is touched with a cautery. The current runs into the vein and seals it off. It can be difficult to put in accurately and this approach can burn the skin. In addition, the vein can be sealed off, but then open up again. So it is less certain a treatment than surgery.
Sclerosant – veins in the legs are commonly treated with irritating solutions called sclerosants. The eyes can be treated the same way – by injecting a small amount of sclerosant. This approach in my opinion is too risky – because if the injected sclerosant flows back to the eye it can damage the eye itself.

In general I prefer surgery because it takes more time and effort but it is effective and safe. Cautery is also a reasonable option. However, generally I avoid sclerosants except in unusual circumstances.

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 July 2014

Cosmetic Question: I want larger buttocks but it is too expensive to have plastic surgery. What is wrong with liquid silicone injections? My hair dresser has a friend who will do it for me for under $2,000.

Cosmetic Answer:

People doing these injections insist they are doing nothing wrong. Sadly, that is either their reckless ignorance or – the typical response of any criminal to an accusation of misconduct, “Not my fault”.

The problem is that liquid silicone injections are illegal in the USA for a reason. We went through this in the 1950’s and 1960’s. They look fabulous at first, but they will cause you life-long problems. This is true whether you have them illegally in the US or legally in another country and come back here. Here’s why:

To start, liquid silicone is injected all though your buttock tissues. There is no one clump that can be removed. Next, the liquid silicone irritates all those tissues. Your body responds by hardening around the silicone. Your buttock gets rock hard, and it hurts. It may be inflamed – red, swollen and have draining. Now what to do? The only ‘”cure” is to cut off the buttock… not exactly what anyone wants to do to you.

Instead, you have to have multiple small excisions of particularly irritating areas of silicone.

Unfortunately, that’s not all. Illegal injections are done with industrial grade silicone – it is not pure and it is not sterile. This means you can get allergic reactions and severe infections. Again, the material is impossible to remove.

Now, being liquid, in addition to your buttock being rock hard and stiff and probably painful, inflamed and possibly infected, the liquid silicone doesn’t stay in place. It moves to new places in your body. You not only will have a buttock problem, but problems elsewhere, e.g. in your legs.

If you think having buttock fat transfer or buttock implants is expensive and has risks (and that is true), having silicone liquid injections will be more expensive, riskier and give you a life-long painful, unsightly problem.

The safest thing is to save up and have fat transfers or, if you can take 4-6 weeks off to recover, then soft solid silicone buttock implants are a better option. As we always recommend, see a Board Certified Plastic Surgeon. This is specialty surgery who will provide you with the best results.

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 July 2014

Cosmetic Question: What is the difference between a breast implant capsule and a capsular contracture? How are they treated?

Cosmetic Answer:

The capsule around a breast implant – or any implant – is the body tissue that separates the implant from the rest of your body. It is a thin layer of connective tissue, a normal reaction to any implant.

A capsular contracture means that the capsule is irritated – and has thickened and tightened. Severe irritation leads to calcium deposits in the capsule, so it truly can become rock hard.

Breast implants capsular contracture vary in severity –
Grade I – No capsular contracture. Your breast is soft and feels and looks normal.

Grade II – Your breast has a little firmness, but looks normal.

Grade III – Your breast is firm, its shape has changed and it may hurt.

Grade IV – Your implant is very hard, hurts, is out of place and looks abnormal.

Anything that irritates a breast implant capsule can cause capsular contracture – leaking gel implants, biofilm infection, sleeping position, bleeding around the implant are some causes.

Treatment depends on how bad your problem is – from your perspective. I have seen many women in their 80s, with round, hard, old silicone gel implants who are very happy with them and want nothing done. However, I have also seen women who are very bothered the slightest firmness.

Before having anything done, remember that the risk of a capsular contracture is about 1% for every year you have the implant. Surgery to correct capsular contracture does not always work.

We usually approach capsules this way –

If it does not bother you, do nothing.
If it bothers you but not enough for surgery, then medical treatment with Singular (an asthma medicine), ultrasound and piperidine may help.
If this does not work – a closed capsulotomy may help. Popular in the 1980s, this is a simple, very painful and unpredictable procedure. Your surgeon squeezes your breast until the capsule pops. I will do this on request, because it may damage the implant or only partially release the capsule, making your breast look worse.
If nothing works and you hate the capsular contracture, consider surgery. Here are your options:
Implants are removed with a breast lift to tighten the breast.
Or only implants removed
Or implant removal, capsule removal and breast lift.
If you intend to keep the implants, here is what may be done —
New implants – always
Possibly a new kind of implant, e.g. saline not gel, textured instead of a smooth.
Capsule release (capsulotomy) or removal (capsulectomy) – always
New position for new implant — often.
Acellular dermal material (ADM) to support the implant – often
Fat implants around the implant – for thin skin, visible implant rippling.
Finally, with the increasing use of large volume fat transplants, you can have the implants removed, breast expansion with the Brava system for 2-3 weeks and fat transplants into your existing breasts.

Obviously the cost of treating a capsular contracture goes up as treatment becomes more complex. You will need to have a very detailed discussion with your surgeon to plan exactly what should be done – and remember, with any breast implant, the capsular contracture risk is still 1% a year, even if surgical results are perfect.

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 July 2014

Cosmetic Question: I had an arm lift but the fat came back. I didn’t gain weight. What did the surgeon do wrong?

Cosmetic Answer:

Your surgeon may not have done anything wrong – you may have a condition called Bilateral Symmetric Lipomatosis (BSL, also called Madelung’s Disease).

In BSL, lipomas (fatty tumors) occur in specific body areas and are difficult to remove completely so they typically regrow. The most common areas are the upper back and the arms. In women, the fat does not appear in the neck. There is no test for BSL that can be done before surgery, although surgeons’ familiar with BSL will recognize the possibility that you may have it, if you have fatty tumors in both the upper back and the arms.

A second operation may be worthwhile. At times, the fatty tumor is completely removed and does not return, but it is unpredictable. The arms are more difficult to correct with a second operation than the upper back, because of the fat growing around important nerves and arteries.

BSL occurs in adult men and women, usually of European descent. It was well known in Europe long before it was recognized in the USA, but it is now part of modern medical students’ instruction. The cause is presumably genetic, and there is no outside cause known.

Until you know the diagnosis though, it can be extremely frustrating! Ask your surgeon to research the disease for you or see a plastic surgeon familiar with BSL.

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

We have offices in Buckhead (Atlanta) and Alpharette.

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

Copyright E Morgan July 2014

Cosmetic Question:

I want to have a Mommy Make-Over with a tummy tuck, liposuction, a breast augmentation and a BBL (Brazilian butt lift with fat implants to my butt to increase its size.)

Is it ok to do this all at one time?

Cosmetic Answer:

It is possible. We certainly can do this combination, but we do recommend that you consider having the BBL at a separate time. Let me explain.

First, let’s consider the length of surgery. If you are slim, your tummy tuck with liposuction may take only 3 hours, your breast enlargement takes an hour or less, which leaves lots of time to turn you over for the buttock fat transplants without surgery taking so long that risks increase.

However, if you are over-weight, surgery takes longer, and risks are higher – because of your weight and because longer surgery has higher risks of infection and blood clots. Therefore, safety is a major consideration. Generally, risks rise a lot after 6 hours of anesthesia. If doing the BBL will take surgery past the 6 hour mark, we prefer to postpone the BBL.

Secondly, and equally important, is how you position yourself after surgery. You will need to lie on your back or sit after having a tummy tuck and breast lift, and you cannot lie on your stomach- even being on your side is uncomfortable. During the first week, you sit, lie on a sofa, a bed or a reclining chair, on your back. Why does that matter? It matters because we want the fat transplants in your buttocks to survive – and unfortunately, sitting and lying on your buttock puts pressure on the fat transplants, cutting off oxygen which means they would be less likely to survive. You may not notice at first, but as early as six weeks, the injections may begin fading away.

Why can’t we just inject lots more fat to compensate for this? Research shows that fat transplant survival falls if we inject more than 250 cc of fat in a buttock cheek. The reason is that as we jam more fat into the space, the fat transplants are squeezed together, and they can’t get oxygen, so they then die. If we have put too much fat into one space, the fat can liquefy, forming an oil cyst. Research shows these cysts do not go away – they are permanent and form harmful lumps in the buttocks. This is a common complaint after high volume fat injections for a BBL.

Finally, what about a compromise – having the tummy tuck, liposuction and breast augmentation plus only a 250 cc of fat transplants, but then planning a second round a few months later if the first don’t survive? This is a very good compromise – and one that we are happy to offer.

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

We have offices in Buckhead (Atlanta) and Alpharette.

We always answer our phones. Give us a call! 404.941-3200

For more information from Dr. Morgan about cosmetic surgery and treatments, search our blogs or go to www.realself.com – where Dr. Morgan regularly posts answers.

Copyright E Morgan July 2014

Cosmetic Question: What are UHP breast implants? Are the results natural?

Cosmetic Answer: UHP breast implants or Ultra High Profile breast implants are specifically designed for women with small chests who want much larger implants than their chests would normally accept.

The “profile” of an implant refers to how much gel is in an implant of a specific width. A moderate profile implant has the least gel and projects relatively little. A mid-range has more gel and projects normally, and a high profile implant has even more gel and projects a lot. The ultra high profile implant has the most gel of all.

Here’s how it works: Let us say your chest width is 13 cm wide which is about 5.5 inches wide, and you try on breast implant sizers and you like the look of a 450 cc implant.

A low profile implant, one designed not to project excessively, would be 330 cc for you – if you were a medium B cup, it might take you to about a full C – you want to be larger than that.

A standard or midrange implant for you would be about 400 cc – taking you to a very full C or a D but still a bit small for the look you liked.

A high profile implant – would take you to 465 – that’s what you were looking for. An ultra-high profile would take you to 650 cc – much larger than you want and a very large implant for a 5.5 inch wide chest.

As more gel goes into an implant, as long as the width doesn’t change, the higher implant and the more it goes from round to oblong. The UHP implant is almost oblong in shape, a lot of gel projecting from a small base and not a natural look.

A lot of plastic surgeons, myself included, do not like this look and discourage women from getting UHP implants because they cannot look natural. Also the skin may not be able to stretch enough to accommodate a UHP implant.

I generally recommend that women who want large breasts, but have fairly small chests stay with a high profile implant. Of course every woman has different goals and a different look in mind. For a narrow chested woman who is determined to be very full – and has enough loose skin to accept a UHP implant, it may be her only choice. It is wonderful to have these choices – thanks to the implant manufacturers who have worked for decades to perfect them!