Bra Strap Fat

As I enter my 20th year in private practice plastic surgery, I think back on everything I have learned since finishing my training.  Ninety percent of what I do was not learned in my training.  One area which is not mentioned in any anatomy books or plastic surgery articles is bra strap fat.

Bra strap fat is the roll or bulge that can be seen above and/or below the bra in the back of a woman.  Sometimes it is excess fat, sometimes loose skin, and other times it is simply the creation of wearing a bra that is too small or tight.

Usually, I do not get asked to treat this alone.  With good liposuction of the back, the area will disappear.  It is important to point out to patients before lipo if there may be an excess skin issue with the “BSF” appearance being created.

I have written hear before about women wearing the wrong bra size.  A bra that leaves marks on the skin after being removed does not fit.  Do not be worried about what the numbers say, get the bra that fits.  Stores like Soma, or lingerie departments in Lord and Taylors or Neiman Marcus will be happy to help you understand your size at no cost to you.

Help eliminate BSF, and restore lycra confidence in all women!

I Finished Listening to 1001 Albums I Must Hear Before I Die

As I am in the operating room for 20 hours a week, I have ample opportunity to listen to music.  I had read a book a few years ago, “1001 Albums Yu must hear before You Die.”  It took me a year, but I managed to track them all down.  A year ago, I started listening to them in alphabetical order and just finished last week.

Listening to them could have been done chronologically, to see how music progressed, randomly, or alphabetically.  I chose the abs’s, as that is how I had them arranged anyway.  This order lent itself to a random mix of genres and time periods that left you guessing what was coming next.

I am very open minded about what I listen to, and the process of listening and doing plastic surgery makes me reach new creative heights.  I think of plastic surgery as Jazz, or Social Music as Miles Davis calls it.  There are basic rules that must be followed, but you should explore and innovate where need be to truly create art.

I did not love every cd, but I have a much deeper understanding of music and how it interconnects across genres.  It will definitely help my band, Used Karmas, in the writing of our second album.  I just hope that I don’t have to die since I have heard it all!

June is Busting out all over

It is the end of the first half of the year this month, and I have noticed that June seems to have an increased number of breast procedures. Mainly, it is breast augmentation and breast lifts and a combination of the two.  Breast reductions tend to happen in the fall and winter for some reason.

I theorize that it is due to the warmer weather, when thoughts turn to the beach and more revealing clothing.  Also, teachers, college students, and many other professions have time off over the summer to recover.

As I get ready to start year 20 in private practice cosmetic plastic surgery, I have noticed a trend toward fuller upper breasts.  The number of simple breast lifts that I do has gone down, compensated for by the increase in breast lifts with breast implants at the same time.  The lift fixes the nipple position and shape, while the implant can add the volume to the upper pole of the breast.

What was long considered the normal and natural breast appearance is no longer what most patients want.  While I refuse to make fake looking round balls on a woman’s chest, I do think that the right sized implant can artfully improve the results of most breast lifts.  I use them more for fullness than size.

If you have some time off and have always been curious about your breasts, please come to Yager Esthetics.  There are a host of new implant types and shapes, and the lift techniques have options as well.  Find out why June is busting out all over!

The Ramones and Plastic Surgery

I recently went to the Queens Museum, and was amazed by the special exhibit on the punk rock group, The Ramones. Just four guys from Forest Hills High School who captured a spirit that sparked a great revolution in music.  With a distinctive sound, short lyrics, and a look that changed fashion, The Ramones remain one of the most recognizable groups in rock history.

In some ways, I identify with the group.  When I was finishing my training at Columbia, the path of wisdom for me would have been to join a practice, join an academic institution, or go to a hot bed of plastic surgery like Park Avenue or Beverly Hills.  I had an independent thought.

Opening a beautiful high rent office in Washington Heights, 100 blocks from anywhere, and marketing to the Hispanic community was not just outside the box, it blew up the box.  The more I was told I couldn’t, the more I wanted to make it happen.  No one was going to tell me my instincts were wrong, and if I failed, it would be on my terms.

Now, 19 years later, I am continuing to rock out at Yager Esthetics, creating some of the most compelling work around today.  I err on the side of helping people, no matter the consequences, and 99% of my patients are pleased.

To those on Park Avenue, I wish you the best.  Keep imitating and following the formula.  I will blaze my own trail.  To my Latina friends,  “Gabba gabba, we accept you, we accept you, one of us! “

Make Your Plastic Surgery Fun

As I get ready to start my twentieth year at Yager Esthetics, I think back on all the different patients I have had the pleasure of helping.  Each personality is different, and a good doctor must adjust accordingly.  My interactions with each are professional, but vary in style.

There are the nervous patients who are embarrassed to even mention what they want done.  They are reluctant to be examined, and are more shy about having my female escort see them than myself.  I have to stay calm and soothing, and let them go at their own pace.  I can usually put them at ease enough to give them the information they need.

There are the totally dominated by the husband/boyfriend/family member types.  These patients do not open their mouths, but have others spoken for them while they look down or away.  The key is to make sure that the desire for surgery is their own, not that of the other, and to empower the patient to take control.  Sometimes I have to remove the other person from the room to get this done.

There are the crazy patients who come in two varieties- quirky and dangerous. The quirky ones just have their own view on life, and you need to make sure you are on the same page with the esthetic they are looking for.  They are enjoyable.  The dangerous types have no moral compass, or a skewed idea of what to expect.  I was taught that you can’t argue with crazy, so I try my best to avoid operating on these patients.

The confident patients are the easiest.  They know what they want, take personal responsibility, and are doing the procedure for themselves.  Never an issue.

Lastly, there are the soul vampires- people who feel they own you because they paid for a procedure.  They want 24/7 access to you forever, not just for emergencies.  They take all of life’s problems out on you, and refuse to be happy.

I say, enjoy the process of plastic surgery.  It is happy surgery that you choose to look better.  Let your personality show, be honest and open, and don’t be afraid to laugh at the process.  Remember, we are sticking bags of gel and water in our chests, sucking out fat we refuse to diet away, and trying to fool the world into thinking we are younger by tightening skin or injecting goo and toxins in our faces.  It is ridiculous, but it makes people happy.

Looking Back at First Year Med School

I recently visited Columbia Presbyterian Medical Center and ran into to Fist Year Medical Students.  They had on their short white coats and nametags and were hoping to have permission to examine a patient for their class on Physical Diagnosis.  I immediately flashed back to my experience in the same hospital some 27 years earlier.  It struck me that these guys weren’t even born yet.

I feel privileged to have been admitted to Columbia College of Physicians and Surgeons, and remain proud of graduated AOA and having had the opportunities that led me to this point in my career.  I could not help giving some unsolicited advice to these newbies.

I let them know that while physical diagnosis is important in eliciting symptoms and information, the key to realize is the patient is a person.  They are not feeling well, sometimes fearful, and in a strange environment.  Do not poke and prod them like lab rats.

Make a connection on a human level, show them your equality as beings while eliciting the confidence necessary to have them follow your commands, not as a subordinate but as a peer.  Try to share a little of yourself to put them at ease.

I truly miss the opportunity to teach, and have been inspired to go back to P and S and see how I may be of service. Primum non nocere

Victim of my own Success

When I decided to serve the Hispanic community after my training in Plastic Surgery, I opened up Yager Plastic Surgery in 1997.  I had no business plan or experience, no training in HR or administration, and plenty of school debt.  All that I knew was that I was a good plastic surgeon who could serve a need for Spanish speaking patients in Washington Heights, New York.

As I became more popular, I have expanded the office twice, and rebranded as Yager Esthetics to encompass all of the nonsurgical treatments and spa services we offer.  Fast forward to starting year 20, and I have become busy to the point that there is a wait for surgery and appointments, despite the massive staff I have assembled to keep up with demand.

The good news is that due to my experience, I am able to deliver the highest quality surgical results to more people.  The bad news is that I cannot see everyone at every visit for as long as they might like.  I love my patients, and enjoy talking with them, but have to strike a balance to serve the community as a whole.

This does not mean that I miss anything, or give less care.  I see everything on everyone and ensure the best possible care medically as always.  It is the social part that suffers for some.  This is such a hard balance to strike, and I am still working on it.

Please know that I always give my all, and think that surgically, I have never been better.  I want to make it so people do not have to wait long to see me, but there are only so many hours in a day.  If you need more from me, please tell me.  I am still here for you.  It has never been about the money, only the opportunity to help the Hispanic community.

Income Tax and Plastic Surgery

Today, your taxes are due.  Mine as well.  Nobody seems to enjoy this day unless a refund is due them.  That has unfortunately never happened to me.

Income tax refunds are used by many of my patients for plastic surgery.  A check comes in that you are not expecting, and you start to think of what fun things you can do with it.  After a few years, you plan on it being there.  I have always found this fascinating.

As income tax loan advancements became more popular, the surge in plastic surgery came a bit earlier.  Now in late January to February, the dates are being filled up.  Couple that with the Spring Break holidays, and April is insane.

This is my 19th tax season at Yager Esthetics, and it always keeps me busy.  Earning the money I need to pay my taxes works out well.  In reality, the government is receiving a loan from the people who overpay all year long and then giving it back.  After this, the people give it to me, and I send it back to the government.  The circle of life!

I love it when tax season brings happiness to others.  It is otherwise sad for me.

April Fools

It has become a tradition to pull pranks and practical jokes on people every April 1st.  While some can be funny, others can hurt feelings, be destructive to property, or embarrass some. I want to start a new tradition- April Cool Day.

What is April Cool Day?  It is a day where you go out of your way to find that person who seems to be left out, not fit in, or socially awkward, and say hello to them.  Try to include them in going with the group to lunch, or sharing a table so they are not alone.

All of us have felt vulnerable at some point in time, and could have used a little reassurance that someone in the world was on our side.  Very few of us have the confidence to not care what others think, and human contact and relating to others is an important part of mental and physical health.

What you might find is that those people are actually pretty fun, or can add something to your life.  You might be the spark that enables them to break free of their fear of social situations, or they just might be the one who inspires you to express some inner feelings you were to afraid to release.

Pulling a mean spirited prank on April 1st? Not cool.  You are the April Fool.

When I do not have an Answer

I am an extremely well educated Board Certified Plastic Surgeon.  I have degrees with honor from The Johns Hopkins University and Columbia College of Physicians and Surgeons.  I have a quick mind and an excellent memory, along with 19 years in my private practice career.  Few Plastic Surgeons have ever done as much cosmetic plastic surgery as I have already done in a lifetime.  Good for me.

Despite all of these great credentials, I do not know everything.  There are clinical situations that I handle to the best of my ability, but I am not always correct.  No one is.  As much of an ego blow this can be, I have come to terms with it.  Patients, however, expect perfection.

What I have learned is that if I try my best, yet cannot figure out what to do next, I ask for help from another specialist.  It could be another Plastic Surgeon, or a different specialty, depending on the situation.  There is no shame in sending a patient for another opinion.  I think it shows the utmost respect for patient care.

Patients can be put off by this, and the fear is that they think you don’t know what you are doing.  I try to let them know that it is the exact opposite.  Admitting your limitations takes more courage, and is in the patient’s best interest.

This situation pops up once or twice in a long while, but keeps me grounded.  My only concern is the patient’s well being.  My ego can handle it.