Cosmetic Surgery

Recently, I received an inquiry from a surgical nurse who saw a feature on “The Doctors” TV show demonstrating the “latest, less invasive” neck lift technique from Beverly Hills that is supposed to be less expensive with faster recovery:

“I am a surgical R.N. and I have seen the procedure on TV, ” The Doctors”. A plastic surgeon is one of the hosts. He practices in L.A. A series of tiny incisions are made under the chin (maybe eight) from ear to ear. An “I guide” (a lighted cannula type device) is weaved in and out of the incisions with a suture shoestring resemblence. It goes under the chin and is pulled tight, just like tying your shoes. Very good results for a less invasive procedure that takes minutes to perform with an experienced surgeon. Less costly and recovery is fast. Everyone wins! Just check on the website “doctorstv.com”, it was on Wednesdays show I think. Wish someone would bring this here! Keep me informed please. I have also seen this on another show, but I didn’t catch the name. I just remember hearing it is fairly new and clever. I will volunteer to be a learning patient if you need. Thanks!”

“Surgical R.N.”(Actual Name Withheld for Privacy)

My reply:

Dear “Surgical R.N.”,

Many thanks for the follow-up note.

I found and reviewed the video of the procedure you mentioned here: http://www.thedoctorstv.com/main/procedure_list/1344.

The Doctors TV link gave me enough information to further research the procedure on the Internet.

There is nothing published about this technique in our respected refereed medical journals, nor has there been a presentation at one of our scientific meetings.
The IGuide technique is a variation on the Thread Lift which was a bit of a hype 5-7 years ago and has fallen out of view, if not into disrepute because it turned out to have too many unsatisfactory results and did not hold up well for most patients.
One problem is that the cost of the special sutures is so high that the procedures cost as much as more conventional techniques.
I also have some questions as to the validity of the technique conceptually, knowing what we know about essential plastic surgical technical principles. For example, experience has shown us that without some actual surgical re-draping of the tissues, suture suspension alone (like the Thread Lift and the similar appearing IGuide) fails to hold up over time (6-12 months).

There have also been problems with skin pleating: if you pull the loose or redundant skin up with a thread and don’t remove/cut-out the excess, where does the extra skin go? I have seen numerous patients who have tried the thread lift and ended up with wrinkles and pleats of the neck and cheek skin.

As a surgical nurse, you have probably seen various surgical techniques come and go, and can appreciate the importance of good medical reports including long-term outcomes that instruct us regarding validity of the procedures, satisfactory results and complication rates.

As a Plastic Surgeon, I would not do a procedure on a patient that I wouldn’t do on my own wife: Besides my doubting the conceptual validity of this technique, in my assessment, the IGuide face- and neck lift and techniques do not yet have the track record to merit one volunteering to be a guinea pig.

“Caveat Emptor!” (Let the buyer beware!)

Having said that, I do not know of anyone in Denver who is trying or offering the IGuide technique, but I am certain someone will be, in the near future, and it will be prominently advertised in our media, offering “more for less.” As I mentioned in my previous e-mail, cosmetic surgery is subject to a lot of marketing hype; The IGuide is a perfect fit for that sort of thing, with a catchy name and a promise of fewer incisions, less invasiveness (Are 8 stab incisions along the jawline better than the 1-inch incision in the crease under the chin of a conventional neck lift?) and as good results.

Thanks again for your inquiry and follow-up note.
Paul C. Zwiebel, M.D., D.M.D.

In my private practice, the most frequent procedure I perform is breast augmentation; I perform well over one hundred procedures of breast enhancement in Denver every year! Women who consult with me about breast enhancement in my Denver practice, which specializes in breast augmentation, uniformly express the concern that they do not want results that look “fake.” This blog is the third in a series in which I talk about what goes into avoiding the “fake look.”

In my previous blogs, I have written about the importance of size and shape in achieving a natural appearance with breast implants. In this blog, I will write about the importance of breast implant position to getting attractive results from breast augmentation.

Most women undergoing breast augmentation will benefit from placing the implant underneath the chest muscle (subpectoral), rather than on top of the muscle (prepectoral) and beneath the breast tissue. This technique produces softer breast contours (see Blog: Breast Implants: Looking Real, Part 2: Shape), and the subpectoral implant position results in significantly fewer capsule contractures, the hardening of the breast from scarring or tightness of the space for the implant.

The implant position must be centered behind the nipple. If the implant is too far to the center, the nipple will appear to point too far to the side. If the implant is placed too high on the chest, the nipple appears to point downward; if the implant is placed too low behind the breast, the nipple will point too high.

Here, symmetry becomes very important: the nipples must point the same way on each side.

Further, if the implants are placed too high on the chest, there will be excessive fullness and roundness to the top of the chest, like an exaggerated push-up bra, creating a fake appearance to the breast enhancement.

A common misconception is that implants will lift or support drooping breasts. This is not the case. If a woman is seeing drooping, a breast lift may be desirable, perhaps adding implants for size and enhanced shape. On the other hand, we commonly place breast implants to correct the deflation of the breast or loss of volume after pregnancy.

Breast augmentation is the most frequent procedure I perform, doing well over one hundred augmentations a year. In my practice in Denver, breast augmentation is frequently discussed with women who uniformly express the concern that they do not want results that look “fake.” In this blog, I’ll talk about what goes into avoiding the “fake look.”

The causes of a fake appearance after breast augmentation relate to size, shape, position and motion.

If the implant size is too big for a woman’s frame, she will have a result that will look disproportionately large and distort a woman’s figure, rather than enhance it. This can cause too much fullness in the upper and lateral chest and create an unnatural appearance, as well as difficulty in getting clothes to fit and drape attractively.

Too larger a breast augmentation can draw too much attention to a woman’s breasts and leave a woman feeling self-conscious rather than attractive.

How, then, to avoid the costly mistake of too large an augmentation, but still get the results you want?

Fitting the implant to the person is a key part of a breast augmentation consultation with an experienced breast implant specialist. Careful consideration of each woman’s goals, as well as her particular physique, are critical to achieving successful results.

In my practice in Denver, breast augmentation consultations begin by discussing your goals: understanding your vision is basic to getting you the result you seek. Each woman’s sense of self, sense of aesthetic balance is personal and unique, particularly in her sense of her own body.

Next we perform an examination which includes measurements that inform us what will fit your particular body, taking into account the size and shape of your breasts and your chest, as well as other important factors like skin tone and elasticity.

Then in our imaging studio, we use our state of the art Axis Three Dimensional Breast Simulator. We’ll digitally capture your own image to simulate images of you with implants of different size (and shape) so you can see what your results can look like, and together we can fine-tune your surgery plan to optimize your results.

Your best assurance for getting great results from breast augmentation come form good communication with your plastic surgeon, careful planning and choosing an experienced breast implant specialist with a reputation for producing natural results.

If you’ve read about breast augmentation, you’ve heard about avoiding “capsule contracture,” the term we use to describe the development of firmness of the breast after breast implants. Denver women should always take the time to understand all aspects of the breast augmentation process.

What is a “capsule” and why is it so important to a successful result to breast augmentation? Is there a “good capsule”? How do you avoid a “bad capsule”? The answers are ones that every women having breast implant should know!

The Pocket: When we perform a Denver breast augmentation, we create a space (also called the “pocket”) for the implant behind the natural breast, oftentimes behind the chest (pectoral) muscle. After surgery, the body recognizes that there is a foreign object, the implant, and that it needs to move. To protect the surrounding raw tissue surfaces of the breast, muscle and ribs, the body creates a lining around the implant. Because the implant is moving in the pocket, the body creates a smooth slick lining that allows motion. This lining is very smooth and white and looks exactly like the lining of a joint called the joint capsule, which helps the motion of the joint. That’s why we also call the lining around the implant a capsule, because it looks just like the joint capsule and it helps with motion.

The Good Capsule: The ideal breast capsule is a thin delicate and supple lining with a pocket large enough to allow the motion of the implant to mimic the motion of the natural breast. The result is a natural flowing breast that moves naturally and feels naturally soft.

The Bad Capsule: If the capsule gets thick or stiff, or if it tightens down around the implant, the result is an implant that feels firm, doesn’t move with the breast, and may have an unnatural shape or position. If there has been inflammation, scarring can add to the stiffness of the capsule (“scar capsule contracture”).

How do you get a “good capsule” and avoid a “bad capsule?”  The answers are in my blog: 5 Really Important Things to Do to Prevent Capsule Contracture!