Too big, too small, too droopy, too lopsided, too…
Many women are unhappy with their breasts and there are no shortage of opinions about what they can and should do to improve them. In breast augmentation, as in most things related to breasts, the internet is awash in information about this plastic surgery. Some of it good, but much of it misleading and confusing. Deciding what’s right for you is actually a fairly straightforward process once you know what to consider. The decisions that need to be made can be grouped into 3 categories which I like to call the three S’s. Silicone vs. saline, Surgical approach (where the scar is) and Size.
Silicone: It used to be that the decision here was silicone vs. saline, but now, it’s more often what type of silicone. Certainly, some patients still prefer saline, but most patients choose silicone for it’s more natural look and feel. However, not all silicone implants are alike. Newer options include silicone gel of different degrees of cohesivity or whether the gel behaves more like a thick liquid or a soft solid, or a “gummy bear”. The standard gel implant remains the most popular although these have been upgraded over the last 20 years to have better fill, less rippling and more durability. On the other end of the spectrum are the highly cohesive or “gummy bear” implants. In these, the gel is a semi-solid such that if you were to cut the shell around the implant, the gel would not flow out. In the middle are implants that have a thicker gel than the standard implants but are not a semi-solid like the highly cohesive ones. Why does this matter? Different implants will have different rates of potential leaking, different effects on breast shape and potential for visible rippling. The best way to make the decision about which implant is right for you is a thorough discussion with your surgeon.
Surgical approach:
This is how the surgeon makes the implant pocket and where the resulting scar will be. The two most popular approaches today are through the crease underneath the breast and through the armpit using an endoscope. Both approaches allow the surgeon to make a pocket of the right size for the implant, typically with minimal scarring. The other important decision is whether to place the implant above or below the muscle. This is where the exam is so important as some patients will have a definite advantage with having the implant placed above the muscles while other patients may have a better result with the implant below the muscle.
Size:
Perhaps the most important decision of all is what size implant will be selected. This is a decision that should be made by the patient in close consultation with the surgeon. The important factors to consider in breast augmentation are what breast size the patient wants and what their chest and breast will allow. There are 3 ways to approach this decision. The first entails careful measurements of the breast and chest by the surgeon. These dimensions will guide the upper and in some cases lower limits of implant size. A second approach uses implant sizers placed in a bra to give a patient some idea of proportion or how the implants will look relative to their hips and body. Finally, there are programs that allow 3 dimensional imaging to be done with realistic depictions of what different implant sizes will look like when they are placed in the body. The ultimate aim of sizing is to give patients the breast size and proportion that achieves their goals. As with most decisions in plastic surgery, this is best achieved with clear communication between the patient and their surgeon.
Erbium laser resurfacing is a highly effective way to dramatically reduce facial wrinkles, but it does have some significant downtime. As such, some background is helpful to understand who it’s for and why.
Facial wrinkles are an inevitable side effect of aging and many treatments are available to reduce wrinkles including botox, dermal fillers and surgery. For certain types of facial wrinkles, these treatments fall short of achieving a significant and lasting improvement. Examples of such wrinkles would include vertical “smoker’s lines” of the upper and lower lips, criss-cross lines of the cheeks, crepey skin of the eyelids and cobble stone skin texture around the mouth. While some of these types of wrinkles may be improved to some degree by dermal fillers, many people have wrinkles that are too widespread or that don’t respond well to injectable treatments. In these patients, laser resurfacing may present an excellent option.
Why is it called resurfacing? Resurfacing is actually what the body does after the treatment. The laser removes the outer layers of the skin very precisely and then the patient’s skin does the real work of resurfacing or healing over the dermis. The laser doesn’t actually burn the skin, but rather ablates or vaporizes the outer layer with a very rapid laser pulse. Wrinkles, texture irregularities and discoloration are removed along with these outer layers. The patient’s own epidermal cells then emerge from the glands and hair follicles and cover over or “resurface” the deeper skin layers. This produces a dramatic and lasting rejuvenation of the skin.
Sounds great, but what’s the downside? During the first week after treatment the skin is healing and this requires regular skin care and being out of sight. Not unlike the Covid-19 lockdown but with frequent facial washing and reapplication of skin balm. After that first week, the skin has healed, but remains pink for several additional weeks. Given the downtime, many alternatives have been developed including chemical peels, “fractional” lasers, intense pulse light and radiofrequency micro-needling. While these treatments may help improve skin discoloration, skin tone and texture, they usually fall short when it comes to significant wrinkle reduction. This is where erbium laser resurfacing excels. Over the last 20 years, we have found that patients who are good candidates and are properly prepared for the downtime do exceptionally well and are thrilled with the short and long lasting results.
Shortly after Michelle Obama was introduced as our country’s new First Lady in 2009, the images of her attractive and muscular upper arms caused social media to erupt. Women across the country sought to emulate her, and develop arms like hers. Exercise and a proper diet, while a key to good health, do not correct the contour problems of the upper arm. The culprit is excess skin. Loose skin of the upper arms has been a complaint of many women. Genetics and age play a role, as does a history of weight gain, especially if followed by a weight loss. Liposuction, while very effective for spot removal of fat, does nothing to tighten the skin. Exercise, while great for muscle tone, has no effect on the loose skin.
As plastic surgeons we deal with “loose” skin on a daily basis. We are smoothing the neck and jawline of the aging face, taking away bags and heaviness of the eyelids, tightening the tummy after a woman’s last pregnancy, and lifting the breasts when they droop either because of genetics and/or pregnancy and breast feeding. Loose skin is the predominate factor in each of these conditions. “Tightening” the skin is akin to altering a garment that is too large for one’s body. In altering a garment the tailor opens a seam to remove the excess material and contour the material so that it “lies well.” In tailoring one’s body we remove excess skin by excising it, which leaves a scar. This scar is equivalent to a seam. As in tailoring, we want a smooth contour and a flat scar, preferably one that is hidden, just like seams on our clothing. Whether it is a facelift, Brachioplasty, tummy tuck, or breast lift, we can hide the scars well.
Returning to the upper arms, a common operation we do is the arm lift or Brachioplasty, an operation which can make a dramatic improvement of the upper arm contour. We are unable to hide the scar as well as we can with the other operations, so the operation is more of a “trade-off.” That is, the patient can experience a dramatic change in the arm contour but has to accept a scar line that is not as well hidden. Despite this, patients are very pleased with the results.
Not a long operation, it is usually done under general anesthesia, though can be done with sedation and local anesthesia. The recovery is fairly easy. Pain is not usually an issue. Patients can shampoo and shower the next day, drive in two days, and return to light office type work as early as one week.
Napa Solano Plastic Surgery is ready to help you look better and feel better about your body. Contact the professionals at Napa Solano Plastic Surgery for your free consultation and find out if Brachioplasty is the right for you.
Laser hair removal is a popular hair removal alternative to electrolysis, waxing, and shaving. It is not an overnight solution, since it requires multiple sessions; but unlike waxing and electrolysis, it can be an almost permanent change. Here is information on laser hair removal so you can decide if this is the right procedure for you.
1. Well Tolerated
When laser light is absorbed by the hair bulb and follicle it converts to heat energy which destroys the hair bulb halting future hair growth. There is some discomfort during the procedure, but it is usually well tolerated. Some areas are more sensitive than others. Our modern equipment has a cooling mechanism which greatly lesson any unpleasantness.
2. It Takes Several Sessions For Complete Results
This is not an overnight solution. Noticeable results are typically seen after 2 – 3 sessions and patients should expect to see full results in 4 to 6 sessions. Sessions are spaced 4 weeks apart to give the skin time to recover. Long term smaller follow-up treatments are sometimes required.
3. Shave or Trim Before Your Laser Treatment
Hair on the skin surface interferes with the laser treatment. So we have you trim all visible hair before the laser removal session.
4. Avoid Exercise and Sunlight Immediately Afterwards
After laser treatment the skin doesn’t immediately disperse heat. The heat can remain in the skin up to 24 hours after the session, so avoid situations that can cause the skin to be overheated or irritated such as hot sun, saunas or hot showers.
5. Recovery is Rapid and Easy
Other than avoiding trauma and heat on the affected areas, the recovery is fairly easy. The laser hair removal session is a quick process and easily scheduled.
6. Say Goodbye to Painful Waxing
Shaving and repeat waxing is time-consuming and more expensive when compared to permanent hair removal by laser.
Napa Solano Plastic Surgery is pleased to announce a new addition to our team of excellent surgeons, Dr. Brett Snyder. Our patients know that we pride ourselves on providing them with the best surgical hands in the industry and Dr. Snyder is no exception. With more than 25 years of surgical experience, Dr. Snyder brings with him technical expertise and outstanding knowledge of current trends in plastic surgery. His warmth and compassion for his patients make him the perfect fit for NSPS.
Dr. Snyder received his undergraduate and medical degrees from Vanderbilt University. He then completed a combined general/plastic surgery residency at Stanford in1995. He furthered his education by spending one year of surgical training at the world renowned Australian Cranio-facial unit where he gained a deep understanding of the facial structure. Prior to joining Napa Solano Plastic Surgery, Dr. Snyder had a large and thriving cosmetic surgery practice in Ponte Vedra Beach, Florida.
Dr. Snyder has dedicated much of his focus to cosmetic surgery of the face, breast and body but also has extensive experience in breast (post cancer) and facial reconstruction. In addition, he has been an innovator in popular non-invasive treatments such as dermal fillers, botox, and numerous laser treatments.
To Dr. Snyder, cosmetic surgery is more than just changing one’s appearance. He knows how important self-confidence is in a person’s life and has this in mind every time he meets a new patient. He and his patients work together to define achievable goals. His expertise, compassion and warmth have made Dr. Snyder a highly sought after surgeon, with patients traveling from around the country to be in his care.
Apart from his regular surgical practice, Dr. Snyder has traveled extensively overseas to offer his surgical and teaching skills in places where children often cannot receive such high-quality care. He has cared for children in numerous countries including Laos, Thailand, Myanmar, Vietnam as well as Guatemala and Peru. Additionally, Dr Snyder is an avid triathlete, hiker, gardener, skier and world traveler. He is delighted to be back in northern California with his wife, Susan, and their three children.
Finding a “plastic surgeon near me” may be easy but choosing the best sometimes takes more time. Dr. Brett Snyder is an industry leader in cosmetic surgery who makes every patient feel confident and satisfied, from the moment they have their consultation to the time they have fully recovered from their procedure. We are proud to have him join the team at Napa Solano Plastic Surgery and cannot wait for you to meet him.
Every other month Dr. McClure writes a column for the St. Helena Magazine. This article will come out in the May 2020 issue. Instead of focusing on an area of aesthetic surgery, Dr. McClure chose to focus on the COVID 19 outbreak, and how this disease is affecting his colleagues around the world.
As a senior medical student I served on a medical mission to Mexico where we operated on children with facial deformities. This experience inspired me to pursue a career in plastic surgery. Fortunately I was accepted into the plastic surgery training program at Stanford University, a residency that encouraged international humanitarian surgery. I was able to serve on seven trips abroad during my training, and able to continue doing this work when I began private practice in Napa. Since that first trip to Mexico I’ve lead and served on more than 85 missions.
Beyond the gratification that came with operating on children and teaching reconstructive surgery across the globe, came the delight in meeting like minded colleagues from around the world. We developed long term relationships. Many of the these friends were young doctors whom I helped train. Others were volunteers like myself hailing from other countries.
With the COVID 19 outbreak and resulting shelter-in-place, Napa Solano Plastic Surgery had to put our elective surgeries and treatments on hold. Being less busy, I found time to connect with friends of mine from around the world. I wanted to see how they and their families were faring in this unprecedented pandemic.
Working in a different country and making friends with its people can be a blessing and a curse. A blessing is understandable, but why a curse? Once one has made an emotional investment in a country and its people, one suffers when that country experiences a horrific event; be it war, natural disaster, or social disruption. The 17th century poet John Donne expressed this feeling of interconnectedness with everyone in the world in his poem which begins with the line, “No man is an island, entire of itself.”
My dear friend Dr. Jorge Palacios of Guayaquil, Ecuador where the virus has taken a horrible toll, lost two of his fellow surgeons, and his grandchild’s pediatrician. My friend Deogratias and his medical colleagues in Burundi (Central Africa), a country of 12 million with less than a dozen ventilators, await helplessly as the pandemic surge moves south. Dr. Ian Zlotolow who has joined me in Laos, Vietnam, and El Salvador now works in NYC’s borough of the Bronx, where they are experiencing the highest death rates in the US. Dr. Paolo Morselli of northern Italy who worked with me in India and Bhutan, has seen the highest death toll in Europe including more than 100 doctors and even more health care workers. I worry about my Central American and South Asian colleagues, in countries that are not capable of handling a surge. Or colleagues in Brazil (210 million people) where the government is woefully unprepared to fight the outbreak. Great Britain which was also unprepared for the onslaught has lost more than 100 National Health Service workers. Dr. Peter Townsend, an intensivist, who worked with me in Colombia, Laos and Romania is in the thick of this battle.
On a positive note, Dr. Dietmar Scholz from Germany who had joined me in Vietnam and Africa, reports that his country has “flattened the curve.” He has begun doing elective surgery again. My many colleagues in Vietnam are rightfully proud that they have contained the virus with less than five deaths in this country of 95 million! Friends, who were fellow volunteers from Taiwan, Hong Kong, and South Korea, were pleased to report turning the corner on the outbreak with very few deaths.
My experiences abroad have taught me that we are in this battle together. We live in a world in which we need to share responsibility for each other’s well being. As John Donne ends his poem:
