Cosmetic Surgery

THE ART OF PLASTIC & RECONSTRUCTIVE SURGERY …

Ask Dr. Moon

Obsessed

Dear Dr. Moon, A friend of mine has been obsessing about having plastic surgery lately, and I'm getting a little worried for her. She's been going through a rough divorce, and I think she believes that a breast enhancement will solve all her problems. What can I do to change her mind? - Miranda M.

Dear Miranda,Your question is a great example of just why it's so important that a plastic surgeon thoroughly consult with a patient well before an operation is scheduled. While you certainly have your friend's best interests at heart, only a patient and her doctor can ultimately make the decision to proceed with plastic surgery. You can rest assured, however, that today's physicians are trained to recognize who may, and who may not be a qualified candidate for surgery.

The American Society of Plastic Surgeons identifies five general groups of people who may not be right for plastic surgery: those who are in crisis (which may include your friend, since divorce is a leading crisis factor), those who have unrealistic expectations, those who are impossible to please, those who are obsessed with a minor feature and those who have a mental illness. Not all of these are automatic disqualifiers. In some cases, a physician may simply decline to perform the operation, but in many cases, counseling is recommended. return to top

Inverted

Dear Dr. Moon, It's a little embarrassing to mention, but I have an inverted nipple. I've heard that this can cause real problems with women who are trying to breast-feed. Can cosmetic surgery help? - Shauna L.

Dear Shauna,The surgery itself is relatively straightforward. It is generally performed on an outpatient basis using local anesthesia, and complications are uncommon. There are risks, of course, including the possibility of reinversion, but the vast majority of procedures are performed without incident and with results that are typically very satisfying to patients. The nature of your particular operation will depend on the specific intensity of your inversion. As with many cosmetic conditions, there are varying degrees of severity.

I must caution, however, that a surgeon cannot guarantee that the procedure will restore the ability to breast-feed. For a better sense of what you can expect, you'll want to consult with a qualified surgeon. return to top

Nose Knows

Dear Dr. Moon, I'm not satisfied with my nose and have been considering surgery for a while now, but I have a special concern: I'm black, and I don't want to lose my ethnicity just to get rid of a bump. Am I out of luck? - April K.

Dear April,Far from it. Beauty has nothing to do with race and everything to do with balance and symmetry. If you have some feature that troubles you, aesthetic plastic surgeons can help - whether you're black, white, Asian, Native American or, well, you name it.

Most important is that you and your physician work together to determine just what your goals and expectations are and that you arrive at a result that feels natural and organic for your face. Certain racial characteristics may influence the way your physician performs the procedure. For example, among African Americans, the skin tends to be a little thicker than among whites. But these are technical issues that you need not concern yourself with. Start by choosing an experienced, licensed surgeon with whom you have established a good rapport and be clear and honest in your discussions. That's the surest way to get a satisfactory result without sacrificing an important part of who you are. return to top

Freckles

Dear Dr. Moon, My Irish grandmother always considered my freckles a blessing, but lately I've considered them more of a curse. I hate the idea of looking like Pippi Longstocking. Is there anything that a cosmetic surgeon can do for me? - Lara M.

Dear Lara,Freckles can be a charming feature, but not everybody is so enamored with them. But whether your freckles are hereditary or the result of sun damage, photorejuvenation is the treatment of choice for many plastic surgeons and dermatologists today. It's a process that uses strong pulses of light to pinpoint small lesions- and that's what freckles are- precisely, without causing damage to the surrounding tissue. Unlike other treatments, there is literally no recovery time, so you don't have to hide behind closed doors waiting for redness or swelling to dissipate,

Not only is it approved by the FDA for use on freckles, it's also proven to be effective for conditions including general sun damage, rosacea, birthmarks, age spots, pigmented lesions, acne scarring and other blemishes. What's most important, however, is -not appearance but health, and those with freckles should be on the watch for any that change shape, size or color over time. That could be an indicator of skin cancer or other serious skin conditions and should be examined by your physician. return to top

Which Is Which

Dear Dr. Moon, You see a lot of doctors calling themselves plastic surgeons, some calling themselves cosmetic surgeons and some using both terms. Is there a difference? - Linda L.

Dear Linda,Plastic surgery is a broad term that generally refers to the repair, reconstruction or replacement of physical defects related to a tremendous variety of body parts. What some find confusing is the fact that it's also used to refer to the cosmetic enhancement of these areas, too.

According to the American Board of Plastic Surgery, cosmetic surgery is a subset of plastic surgery that is concerned with techniques designed to improve appearance. Naturally, these are procedures that benefit people interested in looking younger or more vibrant, but they're even more valuable in the treatment of birth defects, trauma and the recovery from disfiguring diseases.

No matter what sort of doctor you choose to visit, however, remember that degrees and certifications should not be the only factors that determine your decision. Just as important is the physician's experience and the confidence you feel in his or her abilities. Make sure to talk with your doctor first, ask as many questions as you like, and don't be afraid to look for someone else if you're not completely comfortable with the relationship. return to top

Self-conscious

Dear Dr. Moon, I have pronounced veins on my face that I'm very self-conscious about. What sorts of treatments are available to help? - Dave B.

Dear Dave,Unsightly facial veins are another concern that cosmetic surgeons hear about on a regular basis. The causes aren't completely known, but we suspect that it's related to a wide range of factors, including heredity, sun damage, aging, hormone therapy and even the use of oral contraceptives.

Until recently, this was a problem that could only be masked with cosmetics. However, new technology makes it possible for dramatic improvement. Laser therapy can literally eliminate facial veins and give your skin a much clearer, healthier appearance.

Lasers are used to precisely target the veins in question, causing minimal damage to the surrounding skin. The concentrated energy of the laser coagulates the vein - essentially, clogging it -- after which it is slowly absorbed into the body. Depending on the size of the vein being targeted, you'll probably need a series of at least two or three treatments to have optimal results, with each treatment spaced about four to six weeks apart. return to top

Split Lobe

Dear Dr. Moon, This might seem silly compared to a lot of what you deal with, but I had an accident (don't ask!) that ripped an earring right through my lobe. Is there anything you can do? - Joan P.

Dear Joan,You might be surprised to find out that split earlobe repair is one of the most frequently asked about reconstructive procedures that cosmetic surgeons encounter. A nice pair of diamond studs may be attractive, but they can cause a lot of problems - everything from elongated holes to full tears.

Fortunately, it's a condition that's readily corrected. Physicians generally use what's called a "Z-plasty" technique, which means that they reconnect the tissue in a zig-zag pattern to restore strength to the lobe and prevent splitting from happening again. In an hour or so, under local anesthesia, your tear will be closed, stitched and ready to heal.

One thing they typically ask, though, is that you wait about six weeks before having it pierced again, and don't be surprised if they insist on doing the piercing themselves so they can be certain to locate the new hole in the strongest part of your lobe. return to top

Bogus Botox

Dear Dr. Moon, I'm interested in Botox, but the recent story about the people who were injured from "bogus Botox" - including a doctor! - has me worried. Should I be? - Sheila M.

Dear Sheila,In a word, no. In fact, just the opposite. The tremendous attention surrounding the case has actually made the administration of Botox a safer practice. That's because doctors, suppliers and patients are all more attuned than ever to the proper use of Botox, and that should help prevent similar accidents from happening in the future.

Allergan, the company that manufactures Botox, has noted that the physician responsible for administering the injections was unlicensed. What's more, an FDA affidavit shows that the drug he injected was not Botox but an unregulated and unapproved form of bulk botulinum toxin. Perhaps most serious of all was that, according to the same affidavit, the patients received massive doses of the substance. Under these circumstances, it's not surprising that something went terribly wrong.

When properly administered, Botox has a track record that's second to none for safety and effectiveness. If you're still interested, the best thing you can do is make sure that you're dealing with a licensed physician, insist on brand-name Botox and make sure your dosage is within the standard range for your needs. return to top

Like Botox

Dear Dr. Moon, A girlfriend recently told me about a cream with an ingredient that worked a lot like Botox. Is there really such a thing? - Patricia H.

Dear Patricia,You're not alone. There are literally millions of women and men, too who are concerned about wrinkling. Fortunately, there is an alternative. It's a substance called Acetyl Hexapeptide, and it works much like the active ingredient in Botox. By reducing the amount of nerve activity transmitted to your facial muscles, Acetyl Hexapeptide can restore a degree of smoothness to wrinkled areas.

In fact, clinical reports indicate that it serves two cosmetic functions simultaneously: lessening the appearance of existing wrinkles and preventing new ones from forming. But be careful when choosing a cosmetic product that you don't confuse Acetyl Hexapeptide with Alpha Hydroxy Acid- also known as AMA. Even though the names might sound related, these are very different substances. return to top

Any Good News

Dear Dr. Moon, My family keeps telling me that I'm not focusing on the right things, but I was recently diagnosed with breast cancer, and what saddens me the most isn't the disease itself but the idea of a mastectomy. Is there any good news that can put my mind at ease? - Alice B.

Dear Alice,I'm pleased to report that there are a number of excellent new surgical options available for women in just your situation. Foremost among these procedures is what surgeons call the "skin-sparing mastectomy with immediate reconstruction." It's an operation that's performed jointly by your cancer surgeon and a cosmetic surgeon. The cancer surgeon is responsible for removing diseased tissue from your breast, leaving most of the skin intact.

The cosmetic surgeon takes over from there, replacing what was removed with healthy tissue from somewhere else on your body - typically the abdomen or back. The final result is typically a very faithful recreation of the original breast, which goes a long way toward preventing the sense of loss and change that so frequently accompanies mastectomies performed without reconstruction. The next time you talk with your oncologist, ask about what surgical options are right for you. With good, current information at your disposal, you'll find it far easier to muster the strength and confidence you'll need to effectively wage the fight of your life. return to top

Drowning In Sweat

Dear Dr. Moon, Is there anything that a doctor can do about sweat? I just moved to South Florida, and I'm drowning here. Antiperspirants don't work. Deodorants don't work. I sweat through every piece of clothing I have, and I don't have to tell you how embarrassing it is. Please tell me you have a fix. - Paul D.

Dear Paul,To someone who's never suffered profuse sweating, your question might sound trivial. But for the nearly eight million Americans who have what doctors refer to as "hyperhidrosis," the problem is real. You can learn more about the subject of excessive sweating from the Web site of the International Hyperhidrosis Society at www.sweathelp.org. As far as treatment is concerned, one increasingly common non-surgical technique is the use of Botox to paralyze sweat glands in the armpits.

It's the latest trend among celebrities who know they're going to make appearances at high-pressure events like the Oscar ceremonies, giving them the confidence to appear in front of millions without fear of dark patches or the potential ruin of some very expensive fashions. A more extreme solution - particularly useful for those with uncontrollably sweaty hands- is a procedure called endoscopic thoracic sympathectomy, or ETS. In this surgery, the nerve bundle that controls the sweat gland is actually destroyed or removed, shutting down the problem right at the source. Don't be shy about talking things over with your doctor. Even if these aren't viable options, there are a number of alternative therapies available, and one may be just "the thing you need to stay dry". return to top

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