Thanksgiving 2018

Another Thanksgiving at Yager Esthetics- this is our 22nd! Each year, we have a gathering for staff and family to show our thanks and appreciation for being together as a workplace family. We cook, eat, and relax in the space we normally work to make it feel more like home.

Being thankful is a powerful theme, and I am so thankful on many levels. I would like to use this blog to give a little recognition to those who mean so much to my practice.

Thank you, Anesthesia! Your attention to detail and patient safety and comfort makes what I do a great experience for each patient. I spend a lot of time making sure that surgery goes well, and no matter how perfectly I perform, if the anesthesia is not good the experience is ruined.

Thank you, clinical staff! You make sure I have what I need, and that each patient is well taken care of. You are my eyes and ears and I rely on your good judgment to help care for our patients.

Thank you, office staff! If you do not answer the phones professionally and have the knowledge to make sure that the proper appointments are made, I have no patients to see. Your warm greetings and interactions make each patient feel at home.

Lastly, my patients! You are the reason I work so hard. My mission since 1997 has been to provide a safe and excellent choice for cosmetic plastic surgery for the Hispanic community in Washington Heights and I have never deviated from that goal. It is you who sends me most of my new patients and extends my care through so many generations of so many families. I appreciate each of you.

Happy Thanksgiving.

Halloween 2018

Halloween is about dressing up and pretending to be someone or something other than yourself. Our fantasies can run be somewhat lived out, and the acceptability of masks allows a level of anonymity. This makes for an escape from reality.

As a Board Certified Plastic Surgeon, people often come in to have their fantasies realized, but on a more permanent basis. Reshaping the face, nose, breasts, bodies, and buttocks allows for tremendous physical transformations. These physical changes can lead to a change in confidence level and in attitude and personality.

The danger is when people feel that they can fix life’s problems by simply changing physical appearance. This is very rarely the case. You are still you, only better looking.

The best candidates for cosmetic plastic surgery are those who are happy and confident to start with. The physical upgrades are just the icing on the cake.

Who is the Best Plastic Surgeon?

The ASPS has a code of ethics which prohibits its members from claiming to be the best at anything. We try not to entice patients with false claims, and it would be a very difficult statement to prove. We see “Best Plastic Surgeon” lists in airplane magazines, New York magazine, and even in doctors’ offices mounted on wall plaques. So how do we know who the best is?

In order to become a Board Certified Plastic Surgeon from the American Board of Plastic Surgery, you undergo a rigorous training program followed by a series of comprehensive exams. If you look for the ABPS certificate, you are at least assured of some level of quality. However, I know some genius reconstructive surgeons who can’t do even the simplest of liposuctions.

I have been approached about the list you see in magazines, and am sad to report that they can be bought. Knowing the right PR person or editor can be the key to inclusion as well. I would not want to be a part of that type of list, and if you see my name there do not believe it.

I know many extremely gifted technical surgeons who have no interpersonal skills. Others are poor communicators. Some cannot accept criticism, and yell at and blame their patients for suboptimal results. I know bad surgeons who are geniuses at selling themselves, and even though the results are not perfect, their patients love them.

To me, the best plastic surgeon is the one who makes you feel confident, delivers what he promises, and admits when things are not perfect and stands behind his work. I try to always be the best me I can be, and the best plastic surgeon for my patients.

Double Chin Challenge- Kybella vs. Liposuction

The practice of “lipodissolve”, utilizing a mixture of fat melting chemicals injected into the area of interest, has long been controversial. The lack of regulation and standards of exact mixtures and techniques lead the ASPS to tell its members the practice was not safe. Some surgeons and even lay practitioners in spas swore by it, and Allergan launched the first FDA approved product, Kybella, for the use in the double chin area.

I underwent a training in Kybella, including an online certification as well as a hands-on observed injector training. Some of the photos are impressive, but is this product the end of submental liposuction? Let us compare.

Kybella is a nonsurgical treatment, so there are no stitches or anesthesia risks involved. You are awake and can walk out on your own after a brief observation period. No blood tests or doctor’s visits are needed before. The treatment is about 30 minutes, and consists of multiple tiny injections into the fat cells. You will experience significant swelling, especially over the first week, and can have a burning sensation. The average patient in the studies conducted received a little more than 4 treatments to achieve the results. The average cost of each treatment is currently $2500 in NYC. Therefore, for Kybella, it is a total of about 2 hours-2.5 hours of treatment time over 4-6 months to get the result at an average cost of around $10,000. There is no surgery, and less healthy patients can undergo the procedure.

Liposuction of the double chin is a surgery. I use 3 tiny incisions requiring a single stitch each (behind each earlobe and one under the chin), and testing is required beforehand. You will receive twilight anesthesia, and someone has to take you home. You will get swelling and potentially some more bruising, and we recommend some massage after to help the swelling fade faster. It is a single 30 minute procedure, though you will be in the office a little over an hour. Results can be seen in as little as 2 weeks, though small areas of swelling may persist for a few months. Average cost in NYC is $3500-$4500.

I offer both, and the choice is yours.

Rocktober 2018

Every October I spend at least one blog talking about my passion for music, especially rock music. I find listening to music is inspiring while I perform cosmetic plastic surgery and have finally yielded to music server technology as opposed to individual cd’s in the operating room. Less space, but I do miss the few discs that are not easily found on the servers.

When I perform and write music, I feel invincible, as I am actually adding to the art and beauty in the world, much the same as I feel when I perform surgery. Some people are caffeine addicts, others adrenaline junkies. I am an artist in my soul, and plastic surgery allows me to express that in my area of interest, medicine and science.

I am going to multiple live concerts this month to celebrate. I like venues where you can stand up close to the stage and actually watch the individual artists work. Listening I can do in my car or home. Seeing the sweat, facial expressions, and identifying the special spontaneous moments of creative genius is what the shows are about.

I implore you to see live music at least once this month but not so you can record it and share it on social media. Leave your phone in your pocket and be in the moment, let it soak into your soul. It will change your life.

Why do Breast Implants Leak?

The manufacturers list the chance of a breast implant leaking as about 1% a year. That means the longer the implant is in your body, the higher the possibility of it leaking. For example, at 10 years, the risk is 10%. Some last forever, others leak in the first year.

Why do implants leak? There are two main reasons, and one rare occurrence. The most likely event is called “fold flaw fatigue.” This occurs at the edge of the implant, and is caused by a small folding of the implant due to muscle movement which causes the two edges to rub against each other and over the course of years wears a hole in the implant. The second big cause is a valve malfunction, or some tissue growing into the valve if it is a saline filled implant. It is rarely the result of a car accident or falling on your chest. Even rarer are manufacturer’s defects.

When an implant leaks, there are costs associated with replacing it. You have to realize it is not the fault of the surgeon when an implant leaks. It has nothing to do with technique. You need a surgery with a new implant, anesthesia, supplies and recovery, all of which cost money. Sometimes the manufacturers offer a replacement implant at no charge, and some offer you insurance that you have to buy before surgery to cover this type of occurrence.

When a patient of mine has a leak within the first year, I do not charge to replace it and cover the costs out of my pocket, as even though it is not my fault, I feel badly. After a year, I charge less than if you had the implant done elsewhere and came to me for replacement.

While I hope that none of my patients ever have an implant leak, I know that this is not possible. I put in hundreds every year, and have been in private practice over 21 years. This means I have about 10,000 implants floating around the world. Even though it is unpleasant, I hope that if any of them leak, the patient would return to me so I have the chance of helping them again.

Be the Boss on your Consult, but don’t be Bossy

I am a firm believer that a patient should be a partner in his/her care, especially in cosmetic Plastic Surgery. While a Plastic Surgeon has a great deal more knowledge about the procedure you want, there are options that are simply a matter of taste.

When I speak to a patient about surgery, I always present the facts as I know them, in as unbiased a manner possible, so that the decision is the patient’s to make. Clearly if asked my opinion, or if I have a preference, I will share it with the patient so that we can come to an acceptable decision. I am not a technician who will do whatever is requested, it has to make good medical and esthetic sense.

If you are looking for something that would not make me proud as a Plastic Surgeon to put my name on, I will decline to operate on you. That doesn’t mean you have to be a supermodel with a perfect feature, it just means that the esthetics have to represent an improvement that is worth the risk.

I encourage patients to be the boss, and really let me know what they are looking for. If I do not know because you are shy or embarrassed, you have less of a chance of being happy. There is no shame, just be honest and everything will work out better.

I do not like it when a patient is bossy, telling me what to do and how to do it. I am here to educate and assist you in determining what has the greatest chance of success. If you do not want to listen, maybe you should learn to do it yourself (not a serious suggestion).

Assert your desires, partner with a Plastic Surgeon who will listen, and enjoy the results of a healthy partnership.

The Dangers of BBL

Just this past week, an alert was issued by the American Society of Plastic Surgeons regarding fat transfer to the buttocks, or BBL. After a survey of members and the literature, it was found that the incidence of death from the procedure were about one in three thousand. This is by far the highest for all cosmetic plastic surgery procedures. Clearly, this is very concerning to me, as I have done close to 3,000 myself.

The problems that occurred seem to have come from fat being injected into and below the muscles, and that fat entering the bloodstream causing pulmonary embolus and death. These findings made me feel somewhat better for a few key reasons.

When I do a BBL, I am always above the muscle in the subcutaneous plane. A death has never been reported from the procedure when the fat is above the muscle. The only limits are that you cannot always get as much volume that way, but I would rather have someone complain they are not quite as big as they hoped as opposed to someone dying.

Secondly, I always stay away from the lower inner area of the buttocks where the major blood vessels are. I clearly point this out to my patients before the surgery, so that they know where I won’t fill and why.

These findings show the importance of technique and doctor selection. Many non plastic surgeons are now doing cosmetic procedures thinking it is easy money. The experience, skill and anatomical precision required cannot be taught in a weekend course, online videos, or by spending a few months watching someone and calling it a fellowship. Be safe.

Celebrate America

As we approach the 4th of July, I think we should all remember what an amazing country we live in. Despite your political leanings, America is still truly the land of opportunity. That is why so many immigrants seek us out as a dream place to live.

My family came to the US over 100 years ago, and each generation has worked hard to raise our level of education and financial achievement. I hope my children do the same. If you have an entrepreneurial spirit and drive, the freedoms and opportunities are there if you want them badly enough.

The leaders of our country cannot see eye to eye with every citizen, as we all have our own unique experiences and thoughts. Part of what I love about our America is that everyone has the right to be wrong. We hope we are right much more often than not.

I suggest that we all put politics aside and celebrate the Fourth of July together as a nation, respecting the noble concepts upon which our country was founded, regardless of who is in the White House. It is our house, and a house divided cannot stand.

I support America whoever is President, and root for their success, as it is my success as well. There is no other country in which I would rather live.

Summer in the City 2018

Summertime is upon us again in NYC. That means hot weather, air conditioning, and many teachers and school employees looking for plastic surgery. Having the summer off is one of the amazing perks of being an educator.

The summer is also a less clothed time, and people become more conscious of their bodies and flaws. Fixing them is where I get busy. Liposuction, breast implants, and BBL’s are all way up at this time of year. I always do abdominoplasties and facial rejuvenation, but these procedures tend to be steady all year long.

Summer is also a time to be careful with your skin. Sun block, hats, and careful monitoring of your sun exposed areas is crucial. My brother died of melanoma, so I know this is a very real danger. Check those moles, my friends.

For those of you travelling, remember to make sure it has been at least 3 weeks from your surgery before getting on a plane to reduce the risks of DVT’s. Be safe and beautiful!