Morgan Cosmetic Surgery

Is there any new treatment for hard breasts after breast implants?

morgan — Tue, 15 May 2012 15:47:25 +0000

Hard breasts after implants is a condition called capsule formation. The implant itself doesn’t harden. The tissues around it are the problem. Irritated by the implant, tissues thicken and shrink, making the implant feel hard or look misshapen or out of place. Although many women with capsules don’t even know they have them, severe capsules are annoying.

Why do capsules form? Any irritation seems to be the problem. Six years of implant research submitted to the FDA by implant manufacturer Mentor (www.mentor.com) shows that 10% of women with gel breast implants and 8% of those with saline (salt water) implants develop capsules.

Surgery is the usual treatment. But a new study reports on using anti-leukotrienes. Leukotrienes are natural molecules involved in inflammation. They may contribute to capsule formation. Drugs that block leukotrienes include Accolate made by AstroZeneca (which proved too risky to use) and Singulair made by Merck.

A recent study shows that Singulair improves mild capsules around implants. It was a small study, only 19 patients, and retrospective with no controls, so the finding is preliminary.

Still trying Singulair (10 mgm a day for 90 days) is reasonable since your other choices are living with the capsules or having surgery.

As we learn more about capsules, we’ll certainly learn more about preventing them!

I had Botox before and my brows drooped. Is there any way to avoid this?

morgan — Thu, 10 May 2012 13:08:12 +0000

Yes.

There are four likely causes of a droopy brow after Botox.

Brow droop can often be corrected right away with a little Botox in the right place – see 1 and 2 below.

The four likely causes and their treatment:
1. Inner brow droop? Treat with more Botox into the corrugator complex. These are the muscles between the brows that pull the inner brow down.
2. Outer brow droop? Treat with a little Botox into the lateral orbicularis muscle just under the brow. These muscle fibers pull the outer brow down.
3. The whole brow droops – the frontalis muscle was injected too low. You may need to wait for the effect to wear off – to avoid problem #4.
4. The upper lid droops over the pupil. This happens when the Botox is injected too low in the mid-brow, affecting the levator palpebrae, the lid lifting muscle. Iopidine eye drops may help by stimulating accessory lid-lifting muscles.
a. This is the most annoying Botox side effect and the reason that Botox is best placed about inch above the mid brow.

The best treatment is avoidance. If it happens, be sure your doctor adjusts the injection next time! And it helps to have your Botox done by a doctor who knows the anatomy. Best of luck!

How often is it safe to have a face lift?

morgan — Fri, 04 May 2012 19:08:48 +0000

With a good Board Certified Plastic surgeon and no health problems or habits that make surgery risky, you can have a re-do face lift whenever you want. I used to say ‘in five to twenty years’ – but read on!

Face lifts have been done for a hundred years. Anesthesia and surgery have improved so much that what once seemed rare, radical and dangerous is now common, normal and safe.
The result? More touch-up face lifts, better results.

Years ago, a face lift was once in a lifetime. As surgery and anesthesia improved, face lifts became less risky and daring. Women in their 50s and 60s had face lifts and maybe a second one in 5 – 10 years.

Now we know that women under 50 have the best and longest lasting face lift results. I have seen this in my own patients. I did a face lift on a woman of 39. She came back at 59 – with almost no additional aging. She only needed Botox. Why? We can’t explain it yet but the earlier your face lift, the less likely you’ll ever need a second face lift.

Whatever your age, today’s face lift techniques and results are excellent, healing is fast. And second face lifts typically bruise less and heal faster than the first. Just enjoy living in the modern world!

Is sedation safer than general anesthesia?

morgan — Tue, 01 May 2012 19:12:48 +0000

No. Today general anesthesia is safer than intravenous sedation.
Here’s how it goes:

1. Safest – local anesthesia only
2. Next – local anesthesia with light sedation by mouth
3. Next – general anesthesia
4. Least safe – monitored intravenous sedation (often called MAC)

This surprises a lot of people. General anesthesia used to be riskier. Why? Anesthesiologists couldn’t tell easily if the breathing tube was properly placed or if your blood oxygen level was too low.

What changed? Technology. Pulse oximetry checks oxygen levels second by second. Carbon dioxide monitors tell the correct position of the breathing tube. Monitors show all information on one screen. And much more.

Result? General anesthesia is very safe. How safe? So safe that malpractice law suits over anesthesia deaths more commonly arise from intravenous sedation.

Why? Intravenous sedation puts no tube in your throat to deliver oxygen and it relies on you breathing on your own. If you are too sedated to breathe, your blood oxygen falls and a tube is needed – but may take too long to keep you from having complications.

Some people prefer sedation because you are less likely to get nauseated. But we have medicines to reduce nausea these days. And once my patients know the safety difference, most choose general anesthesia. I do too. You are precious. Your safety comes first.

How young should I have a face lift?

morgan — Tue, 24 Apr 2012 14:24:07 +0000

As early as you see the changes that a face lift corrects:
• hollowing eyes
• flatter cheeks
• jowls
• loosening neck

You will need a SMAS-platysma face lift. SMAS stands for sub-musculoaponeurotic system – the tissues that support your face and neck. The SMAS face lift returns the tissues to their youthful position, securing them in place.

The sooner you have the face lift, even for minimal changes, the better. Thirty is not too young. Recent research proves that 12 years after a face lift, results are good but women who had face lifts under age 50? Results are amazing.

Why? When you are young, your tissues are stronger. Your face lift result is more secure. It will last longer, dramatically delaying the return of tell-tale signs of age.

Won’t fillers and Botox give the same result for less money? No. Alas many cosmetic doctors are not surgeons and promise face lift results with fillers. I increasingly see very unhappy patients who have spent in one year as much on fillers as they would for a face lift — with no result.

If you see any of the four signs of aging listed above, please see a Board Certified Plastic Surgeon to discuss a face lift.

Is it safe to save money by doing my breast enlargement with an implant personally brought in to the USA for me by my surgeon?

morgan — Thu, 19 Apr 2012 17:20:08 +0000

No. It is illegal for the surgeon, dangerous for you. Here’s why.

The FDA has approved only three manufacturers of gel and saline cosmetic breast implants for use in the USA. They are
1. Allergan – website for their implants is www.Natrelle.com.
2. Mentor – website for their implants is www.loveyourlook.com.
3. Recently approved Sientra – website is www.Sientra.com.

All three companies are in California. Their breast implant manufacturing sites are Texas, for Mentor, Ireland and Puerto Rico for Allergan (the Ireland plant is being closed, the new one is in Puerto Rico) and Brazil for Sientra.

FDA inspectors visit and approve these manufacturing sites.

The FDA is criticized for moving slowly and being too cautious. Perhaps it does but it is for your safety.
Consider the French implant manufacturer PIP.

PIP’s breast implants were widely used in Europe. The FDA kept them out of the USA, citing poor factory quality. The FDA was more right than it knew. PIP was illegally using industrial grade silicone and bribing people to approve false safety studies. Result –PIP implants can kill you if they rupture. France closed the factory in 2010.

Only have a breast augmentation if you trust the surgeon to use implants sold in the USA and approved by the FDA.

Must I wear my compression garment after liposuction?

morgan — Fri, 13 Apr 2012 18:52:45 +0000

Yes. Let me explain why and when you can switch to Step II garment.

Garments support the liposuction area so that you make less Collagen III, the tough healing protein that seals all the tiny tunnels where liposuction was done. Collagen III provides strength but makes the liposuction area firm and swollen for the first six weeks. Then your body starts to replace it with softer Collagen I.

Result? With the garment, you swelling fades faster.

The Step I garment goes on at surgery. It is snug, strong and has zippers and hooks. You need to wear it for about two weeks. You can remove it to bathe after 4-5 days.

We order our garments from Marena, www.marenagroup.com. They are in Georgia and make first-rate garments with a soft, flexible fabric.

After two weeks, your liposuction is strong and you can switch to a Step II garment, a pull-on. You can use snug biking snorts, vests or leggings for a Step II garment or we can order Step II garments from Marena.

You need to wear a garment, ideally for 6 weeks, and for a minimum of four weeks.

What if you decide you aren’t going to wear a garment? You will hurt longer. You will be swollen longer. In the end, you may not get the good liposuction result we both want you to have.

Can I permanently remove fat cells in the office?

morgan — Tue, 10 Apr 2012 13:10:10 +0000

Yes. Liposuction permanently removes millions of fat cells. Fat cannot return to those areas. Small area liposuction is done in the office, large or multiple areas in an operating room.

An office machine called Coolscupting sold by Zeltiq, chills small areas of fat, killing small numbers of fat cells.

But removing fat cells – with liposuction or chilling – means fat can’t return to that area. Usually the fat returns somewhere, unless you eat less or exercise more.

Exceptions? Some people of normal weight with a small tummy ‘pudge’ or excess fat on the hips have no fat return after liposuction. We don’t know why.

Which is better – liposuction or Coolscupting? I say liposuction. Area for area, for one small area, the cost is the same, one office treatment needed, pain the same. But for large or multiple areas, liposuction costs the same, results are better and it takes one treatment.

I am also cynical about heavily advertised fat-loss machines. None have stood the test of time. Zeltiq made its owners rich; the company went public when the machine was released. Now the stock price is down, Zeltiq is losing money because it is selling fewer machines than predicted. Why? I don’t know. But results may not be permanent as claimed. Try it if you wish but liposuction is still the ‘gold standard’ for fat treatment.

I have developed a lazy eye. It opens, then the eye droops half-shut. Help!

morgan — Thu, 05 Apr 2012 18:10:32 +0000

Your condition, medically, is called eyelid ptosis. Ptosis comes from a Greek word, meaning to fall. Exactly as you describe, the eyelid falls too low. You have acquired ptosis because you weren’t born with it. Here’s what going on and what to do.

There are three muscles that lift the upper lid. The main one is called the levator palpebrae. It is assisted by two side muscles. What you describe is a levator palpebrae problem – the side muscles are strong enough to lift the lid but not strong enough to keep it up. So it drifts down. Chances are, the tendon of your levator muscle is stretched or detached from the upper lid. This can happen with age, injury or some medicines. Surgery will shorten and reattach the tendon so the eylid can move normally again.

Nerve and muscle diseases and tumors can affect the levator too. These problems are not corrected with surgery. Your surgeon will check you for this, and for eye dryness, eye dominance and hidden ptosis of the other lid before surgery.

Who does the surgery? A Board Certified plastic surgeon or ophthalmologist.
Surgery is done in an office operating room or surgery center. Recovery? A few days. To quote a recent patient, “Gee, if I knew it was this easy, I’d have done it years ago.”

I don’t want a scar. Should I demand a plastic surgeon at the Emergency Room?

morgan — Tue, 03 Apr 2012 12:13:33 +0000

No one wants a scar but we plastic surgeons, skilled as we are, are not magicians. We cannot change the nature of healing.

When your skin is cut, you heal with scar. How good a scar depends on many factors. A crucial factor is who did the surgery. When you have an accident, your ‘surgery’ is done before you reach the ER.

Provided you get proper ER care, it may not matter who sutures you.
What is proper care? Numbing of the wound, gentle cleaning with sterile salt water, assessment for deep damage, small sutures, supportive bandaging, plus antiboitics, tetanus shots and pain pills.

You may need a plastic surgeon to suture a complex laceration, or if deep tissues are injured or skin badly damaged. The ER staff will call one for you. You still heal with a scar.

What if you just want a plastic surgeon?
The ER staff can ask the plastic surgeon on call.
What if s/he agrees that you don’t need a plastic surgeon?
Unless you have a plastic surgeon friend who comes as a courtesy, you may have to go without a plastic surgeon, pay a cosmetic surgical fee in advance, or go elsewhere.

My advice? Unless you have reason to doubt them, do what the ER staff and plastic surgeon recommend – then have the plastic surgeon check you in the office in 1-3 days.