Forget silicone injections. Like cement and glue buttock injections, liquid silicone injections are illegal, people have died from them. The silicone will not stay in place, irritates the tissues and can never be fully removed. Someone offers you a silicone injection? Run away.

Buttock fat injections are legal but rarely last. Fat is living tissue. It needs oxygen, which means new blood vessels to sustain it after injection into your buttocks. The buttocks don’t have enough blood supply to keep all that fat alive. Result? Most buttock fat injections disappear within months. Internet photos of lovely results are taken early, before this happens, so they are misleading.

That leaves buttock implants. They are the best of three poor choices. These permanent silicone implants are usually put in through a low, unnoticeable incision in the buttock crease. Problem – there are millions of germs here. You have a 25% risk of infection around your implant. Once infected, implants must be removed; it takes weeks to heal from these infections. To minimize infection, you have to stay flat on your stomach ¬for 6 weeks – except for shower and toilet. Few people can do this. But that’s what it takes. Another option – incisions high on your buttocks. Infection is much less likely but the scars are clearly visible.

Knowing what is involved, some people have surgery and great results but most decide it isn’t worth it and head to the gym.

Copyright Feb 2012 E Morgan MD

Traditional blepharoplasty makes an outside incision under the lashes, separates the muscle fibers and voila! Beneath the muscle sits the fat. Bulging fat is trimmed, muscle put back and excess skin removed. But the risk with this operation is that muscle may be damaged or scarred, giving you a saggy lower lid.

So next came the transconjunctival blepharoplasty. It goes from the inside the lower lid, so muscle is not involved. The inside lining of the lower lid lies directly over the fat. It is easily trimmed. But what about loose skin? Peels or lasers tighten it but this takes longer to heal….

Now we have the modern transconjunctival fat removal and pinch blepharoplasty. It combines the best of the two other operations. Excess fat is removed from the inside, excess skin from the outside. I use this approach most of the time because of the speedy healing and low risk.

But all three procedures give lovely results. Choose the surgeon with whom you feel most at ease.

Copyright Feb 2012 E Morgan MD

How common are they? About 15% of implants on average form capsules. They can form soon after surgery or years later. They can be mild (making your breast a little more firm) or severe (causing a hard, distorted painful breast.)

What causes capsules? The current well-researched theory is biofilms. These are single layers of bacteria which live on non-living material. Biofilms on implants cause the irritation needed for capsule formation. So surgeons try hard to avoid bacteria during implant surgery — putting implants under the muscle and using a ‘no touch’ surgical technique.

Biofilms may not be the only cause. Women who sleep hugging one breast tightly are more likely to have capsules on that side. Right handed women seem more likely to get capsules on the right side than the left.

Treatment is difficult. Surgically removing capsules, changing implants and placing implants under the muscle may work. But capsules can still return. Do capsules require treatment? No but women with severe capsules find them hard to live with. The ultimate cure is removing your implants. Most women do not want to do this but it is good to know that you always have this choice.

Copyright Feb 2012 E Morgan MD

A mini-tummy tuck only repairs lower abdominal muscles.
Who needs it? Typically a thin woman who had a big baby carried low in the pelvis. Also people who’ve had lower abdominal surgery.
How is surgery done? A short incision above the pubis lets your surgeon tighten the stretched lower abdominal muscles, up to the navel. Little skin is removed.
Recovery: Repaired muscles hurt for about 3 days. About 2 weeks to feel 100% again.

A regular tummy tuck (abdominoplasty) repairs muscles up to the ribs, plus relocates the navel plus removes stretched skin plus liposuctions the waist.
Who needs it? Women badly damaged by pregnancy, people who lost lots of weight and those who have had major abdominal surgery.
How is surgery done? A long, low incision goes from hip to hip, the navel is cut free and muscle repaired up to the ribs. Lower abdominal skin is removed, a new opening made for the navel is created, the waist is liposuctioned.
Recovery: Muscles hurt for at least 3 days. About 4-6 weeks to feel 100% again.

What if your problem doesn’t fit these two operations?
No problem. Your Board Certified Plastic Surgeon can design a tummy tuck just for you.

Copyright E Morgan Feb 2012

Blood clots and emboli are more common after tummy tucks and liposuction than other cosmetic procedures. They occur about 1.2% of the time, or in 12 patients out of one thousand tummy tucks. Pulmonary emboli occur in 0.8% – or in 8 patients out of one thousand tummy tucks.

The risk is not the same for everyone. Having a lot of liposuction with your tummy tuck may double the risk. Risk rises as surgery gets longer and if you smoke, are obese, use hormones and oral contraceptives, don’t walk around after surgery, have had emboli before or an inherited tendency to get them. If you have multiple risks (e.g. are obese, smoke and have had blood clots before), you should see a hematologist before surgery and your surgeon may recommend blood thinners during surgery.

The good news? Intermittent positive pressure machines (or serial compression devices or SCD) massage the legs throughout surgery, keep blood flowing and decrease the risk dramatically, to 0.28%. I use these devices on all my general anesthesia patients.

So yes, blood clots can happen. They are rare but serious. Fortunately you and your surgeon together can minimize your chance of getting them.

Copyright Feb 2012 E Morgan MD

Both techniques cause little bruising and pain after small to medium liposuctions.

One step liposuction:
SAL – suction assisted lipectomy. Removes fat with machine or syringe suction.
Good for most areas, not tough ones (male chest, back, re-do liposuction).
Liposculpture – SAL using a syringe. Good for the neck, small touch-ups, single areas and if machines unavailable.
Microaire (www.microaire.com) – a vibrating cannula breaks up and suctions out fat . Fast, safe fat removal, works well almost everywhere.

Two step liposuction:
UAL – ultrasound-assisted cannula softens the fat before SAL fat removal. Many surgeons, myself included, tried and didn’t like this technique.
Vaser liposuction (www.vaser.com) – trademark name for newest ultrasonic machine.
Laser liposuction – a laser-emitting cannula softens the fat before SAL fat removal. Good for tough areas like the male chest, difficult re-do liposuction and slight skin tightening.

Two-step machines are heavily advertised as pain-free to create demand for the machines. Despite exaggerated advertising claims, laser liposuction is a good option for some.
Call us or any other Board Certified Plastic Surgeon for a consultation to decide what is best for you.

Copyright Jan 2012 E Morgan MD

Liposuction is a great operation. It changes your body proportions by removing excess fat. In so doing, fat cells are also removed. Fat cannot return if there are no fat cells. So after liposuction, with fewer fat cells in the area, less fat can accumulate in that area.

But liposuction is not magic. If you have liposuction and continue to eat for your before-liposuction size, – you will in time regain that fat. It has to go somewhere. A little will settle in the liposuction area, the rest goes to new areas. Generally these new deposits are up and back. For instance, after tummy liposuction, new fat may settle in your buttocks, upper back or breasts. We cannot yet predict where the fat will go. So you may or may not like the result. If your neck is liposuctioned, the fat removed may be so small that even if it returns, it is unnoticeable.

After liposuction, if you get more exercise and eat less, there won’t be any excess fat to come back. And fat may not always return, even if you change nothing. I have patients who had heavy hips on a slender frame. After hip liposuction, they ate the same but no fat came back. Strange but true!

But for most of us, liposuction changes proportions, not weight. People still love the results!

Copyright Jan 2012 E Morgan MD

Forehead outer brow sags. A lateral brow lift corrects this.
Upper lids skin loosens, fat bulges. For this, an upper lid blepharoplasty.
Lower lids skin also loosens, fat bulges. Transconjunctival blepharoplasty and pinch skin excision correct it.
Hollows under the eyes – fat injections (fat transfers) fill the areas.
Tip of the nose thickens and sags – an open tip rhinoplasty lifts it again.
Ear lobes lengthen – ear lobe reduction corrects them.
Lips get long, thin – there’s the lip lift and lip advancement.
Cheeks sag – malar re-positioning or extended MACS lift puts it back.
Lower face and jaw line – also sag. A MACS or short scar face lift works beautifully.
Heavy cheek folds and jaw line – local liposuction smoothes them.
Mid neck loosens – platysma plication and neck liposuction fixes that.
“Turkey gobbler” neck – the answer, a neck lift.
Skin is thin, mottled, lined – therapeutic skin care and TCA peels work wonders.

And there’s much more to choose from. Each step is small. Together, results are dramatic. You may need a few procedures, or all of them.
Working with your Board Certified Plastic Surgeon you can design your own face lift.
With today’s excellent operations, no one need ever know!

Copyright Jan 2012 E Morgan MD

Many practitioners do cosmetic treatments for money – it is cash at a time when it is harder to make a living in health care. Depending on state law, any licensed MD or DO, plus PAs, NPs, dentists, podiatrists, estheticians and nurses do these injections. But a Board Certified Plastic Surgeon will usually not cost more; you will get better care.

In 5 months, I have seen 5 serious problems with cosmetic injections given by non-specialists:
• A woman bled around here eye after her gynecologist’s nurse injected filler into her eye socket. I called the supervising gynecologist; he knew less about fillers than his nurse.
• A med-spa PA asked me to be her supervisor. I had her show me her anesthetic technique. She inserted a long needle directly at the eye. I declined to supervise her.
• A podiatrist consulted me about 3 serious complications in his cosmetic injection practice: permanent facial scarring, filler blobs near the eye and disfiguring granuloma around the eye. None could be fixed, all were avoidable if he had known what he was doing.

See a Board Certified Plastic Surgeon for cosmetic treatments. It is safer for you.

Of course, all nose operations cause swelling that temporarily makes breathing worse. But you may have a problem such as a septal deviation. (The septum is cartilage inside your nose). Some such deviations are insignificant. Others are so important that a cosmetic rhinoplasty can leave you breathing worse and with a crooked nose as well – unless the deviation is corrected and grafts are placed.

Why? The nose is very complex. Nose surgery is like architectural planning. It takes careful analysis to determine what needs to be done at surgery and how to maintain the support of the nose. What is the proportion of bone to cartilage? Has the nose been broken before? What affect has this had? What about the skin? A thick skin can hide all the effects of a traditional cosmetic rhinoplasty – or the real problem may be the skin itself (a condition called rhinophyma).

A Board Certified plastic surgeon will determine the cause of your breathing trouble, analyze your appearance and plan with you the precise steps needed for your surgery to be the success you both want it to be!

Copyright Jan 2012 E Morgan MD