Breast Cancer

During my training in Plastic Surgery and General Surgery at Columbia Presbyterian Medical Center, I was involved in many cases of breast cancer and the reconstruction of breasts. It was some of the most important and memorable training I had, and I very nearly went into practice for breast reconstruction.

When I was a General Surgery resident, I had a patient with recurrent breast cancer who needed a very big surgery, a radical mastectomy, where we remove not only the breast, but the chest muscles and extensive lymph nodes as well. The surgery went well, and she was free of cancer.

Several years later, when I was Chief Resident in Plastic Surgery, I had the pleasure of performing breast reconstruction on her. She looked and felt whole again, and I was very gratified to know that I helped save her life and restore her form.

I finished training and went into private practice in cosmetic Plastic Surgery here in NYC. One year later, she came to see me and ended up doing a cosmetic facial procedure. Just recently, nearly 20 years after her cancer surgery, she was back for cosmetic services and in perfect health.

While I am a cosmetic plastic surgeon, I salute all of my colleagues who dedicate themselves to the noble battle against breast cancer.


All about Stretch Marks

As a Board Certified Plastic Surgeon in New York City, I am no stranger to patients looking to remove stretch marks. They are those wide, scary marks that start out pink and can turn red or brown depending on your skin type. Eventually they turn silvery white. What might surprise you is that more and more of them are men.
Men get stretch marks for different reasons than women. The most common causes are puberty, rapid weight gain, steroid use, and overaggressive weight lifting especially at younger ages. Women get them from pregnancy, hormonal changes, and weight swings.

Stretch marks are a tear in the deeper layers of the skin caused by a stretching force from the inside out. This leaves the surface of your skin intact, but it is empty underneath making it appear like a run in a stocking. Most often they appear on the stomach, shoulders, and hips and thighs.
How do you erase a stretch mark? That is the trillion dollar question. In short, you can not erase a stretch mark, but you can make it look much better. There is no laser, cream, or peel that will magically eliminate these scars as of yet.

The only way to remove a stretch mark 100% is to remove the skin it is on. In women, a tummy tuck can often accomplish this. In men, if it is the stomach that has the striae after weight loss, this is possible. Yes, I have done tummy tucks on many men. But what about shoulders and legs?

We treat each stretch mark differently. We use some creams to help fade the color, and have had good success with Silkpeel, dermabrasion, and laser in the right patients. Men like it, because it does not involve surgery or time off from work.
So don’t feel alone, ladies. Some men also feel your pain.


How to prevent Wrinkles

Wrinkles are a natural part of the aging process. They can form by the repeated action of the muscles under your skin over time, or the drooping of tissues from changes in weight and gravity. They are not a disease, you will not die from them, and you do not have to do anything about them. Unless they bother you.

Preventing wrinkles is always smart. Avoiding smoking and sun exposure, drinking plenty of water, and treating your skin well by using only water based make up and adequate sun screen are they basics. If you are very expressive with your face, you are more likely to form wrinkles as well. It is often impossible to change this, but being mindful of it helps.

Wrinkle treatments have not changed much, as we still use muscle relaxers and fillers. There are some newer products to use for superficial lines, and the combination of products has been helpful in achieving artful results.

Over the last year and a half, my Nurse Injector has been handling the great majority of these treatments with outstanding results. This has increased the flexibility of scheduling for patients, so thast even if I am in surgery, you can get your treatment.

I encourage you to start the evaluation process early, so we can treat and maintain you before the wrinkles get out of control.


Stop Smoking before Surgery

As a doctor, of course I believe that no one should ever smoke. There is no debate that smoking is harmful to your health and can cause cancer, emphysema, birth defects if you smoke while pregnant, and also trigger asthma.

As a board certified plastic surgeon, specializing in cosmetic plastic surgery, to stop smoking at least 3 weeks prior to your surgery is critical for obtaining the best esthetic results. I find that by explaining the reasons why smoking is harmful makes my patients more willing to quit.

The chemicals in cigarette (and marijuana) smoke can shrink small blood vessels, and lead to poor circulation. Any surgery that tightens skin such as facelift, breast lift, or tummy tuck, damages blood flow to the skin. Normally, healing will still occur due to the small vessels. In smokers, there is less of a reserve, and skin can literally die or fail to heal properly. As you might imagine, have a hole on your face, breast or stomach is not attractive.

Smoke also retards wound healing in general, and can affect scar quality. This is true even with second hand smoke, and I tell my patients whose spouses smoke to stay away from them while they smoke during the healing process.

Smokers also are at a higher risk of anesthesia complications, as they sometimes do not have proper lung function. Anesthesia requires exchange of gases through the lungs, and poor exchange can lead to poor outcomes.

Cosmetic plastic surgery is not life saving or is it ever an emergency. Because of that, at Yager Esthetics we need to reduce your risks as much as possible. Stopping smoking is so important in this process, and we encourage everyone to do so. Be safe and smart- lying to your doctor about not smoking can increase your risks even more, as the tightness of the pull during surgery is different for smokers as well.


Breast Reduction Surgery

Everyone likes to talk about breast implants, and how “bigger is better.” If you talk to a woman who, through simple genetics or after childbirth, has large breasts naturally, they might tell you to be careful what you wish for.

When your breasts weigh too much for your body, they can cause a host of problems- back pain, neck pain, rashes between and underneath the skin folds, grooves in the shoulders from the bra straps, and even numbness of the hands. It can change the style of clothes you feel comfortable wearing, the type of exercises you can do, and even affect your self esteem and intimate relationships.

Fortunately, breast reduction surgery has been done for more than 100 years. While the goal is to relieve the excess weight, modern procedures can often lift and create a much more ideal and youthful shape as well. There are many different techniques, depending on the amount of tissue we need to remove and how low your nipples sit, and we can often minimize scarring.

Many studies have been done to show the significant increase in the quality of life obtained by breast reduction patients, and my experience with many hundreds of patients bears this out as well. And don’t think you are too old for the procedure. As long as you are in good health, breast reduction can be the best decision you have made.


Importance of Massages after Surgery

Although I am extremely well educated (The Johns Hopkins University, Columbia University College of Physicians and Surgeons, Columbia Presbyterian Medical Center), and Board Certified by the American Board of Plastic Surgery, I was taught nothing about post operative massage. The Chairman of Plastic Surgery at Columbia scoffed at the idea, and not a single attending physician offered this therapy to there patients.

When I opened Yager Esthetics in 1997, I naturally did not believe that this therapy was necessary, or even worked. In 1999, I had a patient on whom I performed a liposculpture and removed a significant amount of fat. She came back for her 6 month visit and looked incredible. When I asked what she had done, she told me that she was back home in Colombia, and had lymphatic drainage massage at a local clinic. The skin texture, smoothness, and completely natural look left me amazed even though I had performed nearly 1000 liposuctions by that point.

While little scientific evidence exists in the literature to even look at the effects, I did my research and was stunned by the results. Nearly 100% of my patients who did post operative massage were very satisfied with the improvement.

Not every massage is equal, and you have to be careful to select a well experienced therapist to ensure the best results. Not every spa is appropriate for the immediate post surgical patient, and you need to ask your surgeon if it is ok. Starting early(within a few weeks) makes a huge difference as well. In general, the therapy should be a little uncomfortable if it is effective. Gently touching the skin as in a relaxation massage feels nice, but will not get you the results you need.
In my opinion, post operative massage therapy greatly enhances the results of liposuction, as well as other plastic surgical procedures. I have 3 very tired massage therapists that can attest to this as well.