Which Breast Implant Is Better – Silicone or Saline?

Since the FDA approved the new generation of silicone breast implants 4 years ago, patients have been asking me which is better.  The short answer is that neither is better- they each have different pluses and minuses.  The only one who can answer which one is better for you is you.  After reading my opinion, it is my hope that you will be more informed and ready to make a good decision based on facts, not hype or internet gossip.

Saline filled breast implants have many benefits.  They are less expensive, if they leak in your body, it is only salt water that leaks out which is 100% safe.  Since they have a small valve to fill them and go in your body empty, the opening in your skin is smaller, and you can adjust the volume drop by drop to achieve more flexibility in matching the two sides.  When you are 40, you will get a specialized mammogram, and there is no recommendation to exchange the implants unless a problem should occur.  The negative is that if you have less than a B cup, they do not feel as natural to the touch, even though the appearance is the same.

Silicone gel implants have the advantage of feeling more natural in some cases, and can sometimes provide longer lasting projection in my experience.  If I put a saline and a silicone implant in front of you and had you squeeze them, there is a striking difference in feel.  When they are inside your body, behind breast tissue and muscle, the difference is most often impossible to detect. The patients who benefit most are those with less than a full B cup, and those who want very large implants.  The minuses are a larger incision, the fact that the implants cost more, that they only come in limited sizes and cannot be adjusted drop by drop, and the FDA guidelines for follow up.  They state that an MRI should be done at 3 years, and every 2 years after to check for a leak.  They have also suggested that the implants be changed every 10 years.  While some surgeons disagree with the guidelines, they are obligated to inform you of them.  If they do not, my advice is to seek a different doctor.

So, the decision is yours.  Make sure your doctor answers all of your questions, and that you feel confident and comfortable with him/her.  A board certified plastic surgeon should offer you different options in where to hide the scar, implant styles and shapes, silicone versus  saline, and show you pictures of women who look like you body shape and breast size wise with after photos you love.  Good luck!

Is Smart Lipo smart for you?

For the last year, there has been a lot of hype surrounding Smart Lipo, a laser assisted liposuction technique that has since had other companies produce machines like Slim Lipo among others. The marketing plan of the company is certainly smart, promising direct advertising to the public and referrals to all the doctors who buy the machine from them. Because they sell them all over the country, they can afford a national ad campaign, and it results in patients for anyone who has the machine. The real question is does it offer benefits for you the patient?

As of my writing of the blog today, I am not aware of any convincing long term study that shows improved results over traditional liposuction. I am aware of many cases of skin burns and permanent contour irregularities as a result of inexperienced doctors performing Smart Lipo. Let me explain why.

The company that sells the machine wants to sell as many machines as possible. They will sell to any doctor, regardless of his/her training or certification. That means your ob/gyn, family practitioner, or internist who wants to make money can buy the machine and get the referrals as a Smart Lipo expert. The only training they get is to watch a doctor do it in his office before doing it on their own. Additionally, laser assisted liposuction has a much higher complication rate of burns and fluid collections.

This is not to say that the procedure is bad- the major problems are with the doctors. As in my prior blog entry “Is your cosmetic surgeon a plastic surgeon?”, never assume just because a doctor does cosmetic surgery that he is a board certified plastic surgeon. Ask “Are you certified by the American Board of Plastic Surgery?” if you want to be sure.

In my opinion, Smart Lipo is smart for the doctor, not the patient. You pay more for a riskier procedure that is possibly done by a less well trained physician with no benefit of better results. Just because something is new and well advertised does not make it better. Be a smart consumer and do your homework.

Does Plastic Surgery Leave Scars?

One of the most common questions I get is “Am I going to have a scar after surgery?” The answer is, of course! Every time you cut the skin beyond a certain depth, the body repairs the damage by forming a scar. This is to create strength in the damaged area so as to prevent further injury.

The art of cosmetic plastic surgery is to try and minimize and hide the scar in a way that it is the least visible. In many cases, even the trained eye cannot find the mark. We use many tricks, such as hiding it in natural creases such as the fold of the eyelid or curve of the ear, and using the change in color from dark to light, such as in the edge of the areola in breast augmentation.

The healing process often takes about a year before the scar matures, and it can go through some red and firm stages before the process is complete. I see my patients very often after surgery to insure healing is proceeding in the ideal manner. If the scar looks dark,red, wide, or thick, I can usually recommend medications, tapes, and sometimes injections to improve the final result. If a patient comes back after 6 months or longer, it is often too late to help with these small interventions, and sometimes surgery is needed to correct the scar.

Let me also clear up 2 common misconceptions- lasers and keloids. If you do surgery where you are cutting, a laser is just as likely to leave a scar as a scalpel. It is just a different way to cut. Some lasers can help after a scar is established to help flatten or fade a mark, but do not be fooled into thinking that a laser tummytuck, laser breast lift or laser facial surgery is in any way better than traditional surgery. It is often just hype to sell you a service that is most often no better result wise, and in inexperienced hands can have significantly more complications.

Every ugly or visible scar is not necessarily a keloid. Keloids are a type of abnormal scar that rises off the surface of your skin, and grows beyond the border of the scar onto normal skin. It is often treated with steroid injections and radiation therapy in addition to surgery. They are often resistant to correction.

So, if a plastic surgeon tells you that a surgery in which your skin is cut leaves no scar, be very skeptical. No one can promise you an invisible scar, as even the best surgical technique coupled with perfect patient care afterwards cannot overcome genetics. Do know that the overwhelming majority of scars heal extremely well with time, and this should not deter you from seeking out cosmetic plastic surgery if it is right for you.

Overseas Surgery

Many of my patients have been asking me a lot of questions about the recent incident of an overseas plastic surgeon being arrested for practicing medicine without a license in New York.  I thought it would be helpful to explain why if a surgery is done in another country, it is illegal for a doctor to do even a consult here in New York.  Let me be clear in stating that there is nothing wrong with having surgery overseas, provided you are completely aware of the risks, potential extra costs, and your rights as a patient.

Even if you are the world’s best plastic surgeon, you need to be licensed in the US to practice here.  Practicing means doing a consult, free or not, talking to a patient, evaluating them for surgery, or discussing surgery to be done in another country.  This is practicing medicine without a license, which is punishable by years in prison The laws are in place to protect you the patient, as without a license, the state cannot confirm the training, safety, and expertise of the doctor, and he has not shown himself to be qualified to practice in the US.  It also makes it much more difficult to seek damages for errors in care.

Be aware that if your doctor says he comes to the US often and will treat you when he comes in, that this is against the law.  When the doctor comes here and does injections, minor revisions, liposuction or other touch up procedures, he is also breaking the law and putting your health at risk.  An apartment or a spa or salon is not the appropriate place to treat patients even if you do have a license.

To be a great doctor, especially a great plastic surgeon, you need good judgment. This means being honest with your patients, putting your patients’ interests ahead of your own, and following the rules of safety and good practice.  I live by those words, and so should your doctor.

When considering going overseas for plastic surgery, using the surgical fee as the only factor in making your decision is often a mistake, and in order to make a fair comparison, you need to know what you are getting for your money.  Aside from the cost of travel, staying in another country, loss of time from work, there are serious safety considerations. Below you will find some helpful questions to consider when thinking about overseas surgery.

Any plastic surgeon can have complications, even if they do everything properly.  If this happens to you overseas, what is the emergency plan?  Do you have insurance there if you need to be hospitalized?  Can you even get to a qualified hospital quickly enough?  Can you pay those fees which are often due before they even will put you in an ambulance?  Does the nearby hospital have the medications or equipment needed to save your life?  Can you afford to stay longer, potentially missing work, needing someone to watch your children?  If you have a problem later, can you afford to take off more time, pay your additional flight and hotel so your doctor can help you?  Can you afford the costs of a doctor here to fix the issue, if he will see you at all?

What sort of training did your doctor have?  Does he belong to any national or international societies?  How many years have they been in private practice? Have  they ever had a death in the facility, or transported a patient to the hospital emergently?  Are the implants or other devices they use approved by the FDA  for use in the US?

The best way to stay safe is to be educated.  I hope this helps.

Do your Skin Care Products work?

During my training in Plastic Surgery, we were not allowed to talk to representatives of companies that made products for Plastic Surgery for fear of bias. Because of this, I was determined to find out for myself what worked and what didn’t.

When I opened Yager Esthetics/Estetica, I knew my patients could benefit from more than just surgery. I sought out the best in injectable fillers, like Radiesse which is an organic longlasting material with virtually no down time, and Botox and Dysport for dynamic wrinkles. We added skin treatments like the Silkpeel to our regular dermapeels, and brought in the latest in post-op massage treatments from Colombia.

The other important piece has been truly spectacular skin care products. While I have offered peels and products since 1997, and have seen great results, I wanted a way to prove scientifically that they worked, and wanted to measure the results objectively. With the Visia skin analysis computer, I am finally able to achieve that goal.

The Visia is a computerized photosystem that analyzes your skin in 9 parameters such as sun damage, vascular lesions, wrinkles, and texture, and rates your skin against other patients your age to show where your problem areas are. We then select the proper products for each parameter, and after treatment we can remeasure to see the improvement in actual numbers. We can then continually modify your regimen to achieve the best possible results. Some of the most effective product lines we recommend at this time are Obagi and Skinmedica.

Just because a product feels or smells good doesn’t mean it is repairing damage or preventing the aging changes of your skin. I encourage you to come to the office for a complimentary Visia analysis and consultation with one of our Estheticians so that we can insure the money you spend on your skin is well worth it.