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Pain

Today would have been the 47th birthday of an old friend.  He was a remarkably bright presence, and his smile made the world a better place. I miss him.

I met him when he was starting college at Columbia University and I was starting Medical School there. He had a back issue he had been dealing with, and it seemed odd to me.  I sent him to a Neurologist who found a spinal cord tumor.

He underwent surgery and radiation therapy which stabilized the mass.  He went on to finish his degree, get married, and have children. The one thing he could not control was the pain.

Narcotics, Toradol, spinal stimulators, medical marijuana, and all other attempts were not met with success.  Still, he lived with a smile on his face and was there for all.

Finally, after 25 years of suffering, he ended his life.  He had a party to celebrate the 25 years, it turned out it was just to say goodbye. I was not there.

The point of the story is that pain cannot be ignored or disregarded, be it temporary or chronic.  Take it seriously, and save the medications for when you need them.


When the Hype Exceeds Reality in BBL

I have been a Board Certified Plastic Surgeon for quite some time, being in private practice for more than 20 years. I have been doing fat transfers to the buttocks since before it was called a Brazilian Butt Lift, and continue to perform this procedure more than 150 times a year. I think I get great results, yet I hear some disappointment from patients more than with all other surgeries. Am I just not good at the surgery, or is it something else?

When I compare my results to those seen in the Plastic Surgery journals, I feel they exceed nearly all in effectiveness and fat take. That makes me confident I am doing it well. So why are some people not thrilled? I blame social media.

People watch reality tv, look at photoshopped pictures and posts, and feel that it doesn’t matter what they start with, that a good plastic surgeon can do anything. This is unfortunately not true. The amount of fat you have, the bone and muscular structure, and metabolism are all factors beyond our control. I have miraculous changes walking around who are upset that with white lycra tights, there is a slight difference from side to side, even if they started out horribly asymmetrical.

My choices are to either stop offering the procedure, or to continue to try and educate each patient as to what is possible and what is not. I am not ready to stop. Be realistic and accept a great result. Perfection is sometimes the enemy of happiness.


How Being a Drummer has made me a Better Plastic Surgeon

As some of you may know, I am the drummer in an alt rock band, Used Karmas. If you are interested, you can take a listen on Spotify, and hear our first album. What does this have to do with plastic surgery? Absolutely nothing.

As I have practiced and played the drums more, I have improved. It is no longer just keeping time and fearing a miss hit, it is a sense of rhythm, time, and what is called “the pocket.” Being in the pocket means that you are in rhythm, but you feel the whole song revolve around the time signature you set. This is a musical way of saying you are comfortable with the beat and can dance around it without losing it. It is sort of what happens with a great dancer who is really feeling it.

As I operate, I am in a zone where time, hunger, and the outside world do not exist. I am so focused on the case at hand that I literally do not look at anything but the field I am operating in. I reach my hand out for whatever I need, and it is placed in my palm.

As my drumming has gotten better, I have thought of operating in “the pocket” as a different way to experience surgery. I am still dead focused on what I am doing, but enjoy and feel the rhythm of the operation as if it were a piece of music. Having this time signature in my head has made my favorite thing even more enjoyable.

I guess I dance to the beat of my own drummer. Fortunately for my patients, I have never lost my groove.


Zapatos Baratos Salen Muy Caros

It is said in Spanish that cheap shoes can be costly. This is a phrase that is applied to buying something inexpensively that ends up costing you much more in the long run. Unfortunately, it applies to cosmetic plastic surgery as well.

Being in Washington Heights since 1988, and in my private practice, Yager Esthetics, since 1997, I have seen my share of poorly performed plastic surgery, as well as procedures done by unlicensed people resulting in often irreparable damage.

The procedure that irks me the most is silicone injections. Sometimes, as in the lips or cheeks, it simply results in a disfigured shape. Surgery can sometimes debulk and assist in correction.

Injections in the buttocks are more common. Some patients develop abscesses or infections, others get hard balls, others create a rock hard contour that can be painful and change color. There are cases that I prescribe steroids for comfort, others I inject, and others where I can simply use a liposuction technique to reduce the silicone load. Some, I can offer no help, as the cure is virtually an amputation of the skin and tissue which I do not feel comfortable doing.

I recently had a woman who had silicone injected into her breasts. She had red damaged skin, hard masses, and a disfigured appearance. She was devastated, and it ruined her self esteem and relationships. I was able to perform a partial mastectomy with implant reconstruction and a lift which miraculously even preserved nipple sensation. She was lucky, but it cost her 10 times what the injection did.

Be smart with your health and body. There are places to save money, but plastic surgery is not where I would suggest.


Being a Good Patient Escort

So, you have carefully vetted your Plastic Surgeon, insuring he/she is Board Certified by the American Board of Plastic Surgery, and that he does plenty of the procedure you want with great photos of results you like. He/she is a good fit emotionally and trust wise, and has the experience to make you feel confident. You have gotten great patient recommendations, and are ready to go.

The office looks great, the Operating Facility is accredited, and the staff seems warm and professional. All goes according to schedule on their end, so no problems, right? Um, what about your situation at home or wherever you will be recovering? Who will be helping you?

Oftentimes, people think about things like walking up stairs, or where they can be comfortable sleeping. They make arrangements for child care and coverage at work, and make sure they have the house stocked with the food they will need. What they do not always choose wisely is the escort.

The patient escort has to get you to the office on time, and have the means and abilities to take you home safely and care for you. They will be given all the instructions, as you are just out of anesthesia, and may not remember or be able to do it all on your own.

You need to choose someone smart and capable who can deal with medical situations without panicking, and that can make you feel safe and calm so that your recovery is uneventful. People who annoy you or get under your skin should be avoided. Jealous people who will try to knock you or your decision to have surgery can be toxic as well.

Your patient escort should be positive, supportive, and caring, and want you to look and feel your best. My office and I do everything in our power to take the best care of you, but it is up to you to select the best patient escort.


Beware the Brides of March

While most brides choose June or another warm month to get married, the preparations start much earlier. In some cases, years in advance. What is dangerous is when it is March, and the wedding is less than 3 months away, and the diet and exercise plans are failing.

Sometimes, the brides turn to a plastic surgeon to help the magic moment of their nuptials come off like the fairytale they have imagined since they were 5. Other times, it is the mother of the bride either pushing their daughter into it, or trying to do something for themselves.

The problem is that when a woman comes in a few months before their biggest day ever to date, by the time all the testing and scheduling is completed, there is zero margin for error. Flights have to be safe, dresses have to fit, swelling has to be gone. Heaven forbid a complication occurs and there is no time to revise a result.

I choose my Brides of March carefully, as my reputation depends on my results. Ruining a wedding is something I hope never to do. I must, therefore, insure that expectations are realistic, that the timeline is safely doable, and that the motivations and health of the woman are both sound.

If you are planning a wedding, and part of your happiness depends upon cosmetic plastic surgery, start waaaay in advance, at least 6 months. The stress of getting married is high enough. Let me help you achieve your goal in a relaxed and peaceful way.


Safety Trumps Money

As a Board Certified Plastic Surgeon, I have had the privilege of taking care of the Hispanic community for 20 years in my private practice, Yager Esthetics. I have always considered patient safety my number one concern, and have never done an unnecessary procedure to earn money, or sold a service, product, or procedure that I did not feel was of benefit to the patient.

Additionally, I often have patients who want multiple surgeries, and feel doing it all at once is best. That is not always true. You must consider the health of the patient, additional risks of a combined procedure, as well as the positioning and discomfort during the recovery process. For example, a healthy, normal weight, young person can do an abdominoplasty with liposuction of the flanks. If they wanted fat transfer to the buttocks, this would be separate, as to get the proper result from a fat transfer, you need to sleep on your stomach and not sit for a week. This is impossible to do after a tummy tuck. Sitting on a special pillow is not, in my opinion, the best or safest option.

Some patients have risk factors due to age, weight, or medical history. I always suggest separating procedures for safety concerns, often consulting with the patient’s primary care doctor. These are elective surgeries, and every effort to reduce risks should be made.

One of the hesitations I hear is that separating the procedures is more costly, and this is true. You are paying the operating room fee and anesthesia fees twice. In an effort to keep you safe, I have changed my policy so that if you schedule and pay for your multiple procedures and I decide to separate them, you will pay the same as if it were all done together.

That is what I call putting safety ahead of money.


A Look Back at BBL in 2016

Fat transfer to the buttocks, or Brazilian Butt Lift (BBL) is a major part of my practice at Yager Esthetics. Being the Latin beauty expert, I know a few things about the importance of curves to the female form. After 20 years in private practice, I have learned many important things, and want to share them with you in a report on my BBL cases from 2016.

I did my first BBL before it was even called a Brazilian butt lift. It was 1998, and there was very little information out of the US. I got my information from Luis Toledo, a Mexican Plastic Surgeon, who explained his technique to me. I have further refined my method, and do more every year. It continues to be one of my top 5.

In 2016, I did over 150 fat transfers to the buttocks. I had zero infections, no DVT’s, and one request for additional fat to be placed. These statistics are extremely encouraging, and are a testament not only to my skill, but to my office and our ability to inform and educate each patient as to their expectations and proper care.

Patient selection is very important, as each patient needs to have enough fat that can be removed while not having a negative effect on the body to create the size they desire. Furthermore, they need to have the anatomic structure and space required in the buttocks region to add to. If someone wants more than is possible or safe, I explain the limits, and if that is not what they want, I do not perform the surgery.

In the right patient with the proper expectations, patient satisfaction is extremely high. If this is an area you have been thinking about, there has never been a better time to stop by for a consult or return visit. Yager Esthetics is always out front, but we are also behind you!


Laser Tattoo Removal is here

After years of requests from my patients, I finally have the technology needed for safe tattoo removal in darker skin types. It is so important that I offer only treatments that work for my patients, and do not simply market whatever is new and in the news. The trust that I have built in the Hispanic community over the last 20 years is vitally important, and no amount of money can make up for it.

The technology started 3 years ago, and has improved to the point that I feel it is the gold standard for tattoo removal of all colors on all skin types. It is faster than the old lasers, and requires fewer treatments to clear. It is also less painful.

Not everyone is a good candidate, and older tattoos are easier to remove. If you make a mistake in judgment, you have to wait 3 months to laser it off. Our system has 3 different wavelengths, so even the trickier colors can be treated.

All who perform this treatment have passed a comprehensive laser safety and science program, and received training hands on with a certified company trainer. They have all practiced on actual patients and staff, and only those with the top skills are allowed to perform this service.

I love adding a new tool to our shed, especially one as amazing as this. Call or email us for questions, and to make an appointment. Introductory special pricing will not be available forever, so get rid of that exes name or that poorly drawn picture. No regrets!


Happy 2017

As we begin a new year, it is a helpful starting point to think about what we can do better in 2017. After 20 years at Yager Esthetics, I am constantly listening to my patients in an attempt to deliver what they need. That has lead me to create an expert team of nurses and estheticians to find solutions specific for Hispanic skin, dark spots, laser hair removal and skin tightening with radiofrequency. We continue to treat cellulite and stretch marks with the latest technology, and have found the best scar prevention and treatment procedures and products.

My surgeries continue to become more refined, even after over 2000 abdominoplasties and 5000 plus liposculptures, and thousands and thousands of breast procedures. I always want to think there is more that I can do, and it drives me to be inspired by each case as if it was my first. My BRA procedure, Breast Reduction with Augmentation, has been a revelation. Lift and reduce the breast, and add an implant for fullness.

Our office is well on the way to a paperless operation, utilizing tablets and computers to streamline your experience, and our website redesign will provide a refreshed and more interactive experience. Look for more video and enhanced social media to come.

We have purchased very exciting new technology that will debut this month. You have been asking for these services for a long time, and finally I am excited that the technology exists to do it for our Latin patients. I will not spoil the surprise yet, but I am sure the majority of you will want it.

My pledge for this year is to stop and appreciate each patient and procedure. I am honored to be able to do what I do, and to have made a difference in the care of my community. I am humbled by your support and love. May you all have a healthy and blessed 2017.