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.

Santa Claus and Plastic Surgery

Almost all little children look forward to xmas, a time when good behavior is rewarded with family time and the fulfillment of wishes for presents.  It is a happy holiday, but one in which many lose the true meaning of sacrifice for others, and instead focus on themselves.

Sometimes, cosmetic plastic surgery patients act the same way.  They see their plastic surgeon as a type of Santa Claus, who can magically grant every wish for physical improvement with the wave of a scalpel.  The bandages are like the wrapping paper, which when removed reveals the wonderful gift within.

Many times, patients are thrilled with the results, and understand the work that went into creating them.  All the training and sacrifices made by their doctor to acquire his or her techniques and esthetic eye are evident.  Some, however, like spoiled children, can never be satisfied or have enough.

I always meet with my patients several times before performing a surgery upon them, so that I may review the risks and alternatives of each procedure, and try to give them a realistic idea of what to expect.  Unfortunately, not all patients listen well.

Over 99% of my patients are quite satisfied with their care and results of treatment at Yager Esthetics, but that 1% is what makes my life difficult.  If everything is done well and the results are excellent, and the patient is unhappy, there is very little that can be done.

If plastic surgery is under your tree this year, don’t be naughty.  Listen to your doctor, try to have realistic goals, and all will turn out nice.  Happy Holidays!

Why Does Plastic Surgery Cost More in The U.S.?

When I first opened Yager Esthetics in 1997, I spent a lot of my time answering the question as to why the cost of Plastic Surgery is higher in The United States than overseas, and why the extra money is worth it. Seventeen years and over 5000 surgeries later, it is still the most important question for a patient to ask.

I do not spend my time and energy educating the Hispanic Community about safety and honesty in Plastic Surgery for the sole purpose of making money. I do it to make sure that everyone knows what the risks and benefits are before making a decision as to where and with whom to have elective surgery. I have seen and heard too many horror stories to let my conscience do otherwise.

There are many very talented and qualified Plastic Surgeons in every country. The problem is knowing which is which. In the U.S., you can go to and see if your doctor is Board Certified by The American Board of Plastic Surgery, insuring the highest level of training and education. This type of verification does not exist in most countries, and you have no idea as to what the training of your doctor was.

Where is the procedure taking place? In the U.S., not only hospitals are accredited, but ASPS members are required to operate in only Accredited Ambulatory Surgery Centers, and you can check that accreditation online or by phone. It insures the highest level of safety and emergency equipment as well. In many other countries, operating rooms are unregulated, and you have no idea who is giving anesthesia or caring for you after surgery.

Even if you manage to find a fantastic surgeon who does things well in his well organized center overseas, and you have a complication such as a reaction to anesthesia or an unknown health condition, where is the nearest hospital, how do you get there, and do they have the most advanced technology to save your life? In the U.S., if you have a complication, your doctor is available to see you without having to travel or miss work.

Plastic Surgeons here are also required to have malpractice insurance, follow rigorous and extensive programs for infection control and safety as well as continuing medical education to protect you and your rights, all at their expense. It is important for surgeons to have malpractice insurance, as even some of the most straight-forward surgeries can carry risks, which could potentially turn out to be fatal. If the unthinkable were to happen, and we get faced with a civil action for wrongful death suit from a patient’s family, then we would need to have the relevant protection to help us move forward. Surgery is risky, and so that is why we need to ensure that we have the relevant education, training, and tools in place that can help us to prevent any fatalities from happening. FDA approved materials and products all cost more due to the strict testing needed.

So it is not that U.S. doctors are greedy, or do the same thing for more money. Plastic Surgery is more than just the operation. It is the preoperative testing, the proper training and education of the patient, providing the safest environment and having the systems in place to reduce the risks of the procedures to insure your safety. With all of that, the question should be why is Plastic Surgery overseas cheaper? Also, no your health insurance will not cover cosmetic surgery, that’s for medical emergencies unless you own a personal custom cover policy in which you are paying a lot more for.

Operating on my Employees

At Yager Esthetics, I have over 20 employees, all of whom are women. Like any group of women, some are interested in beauty and appearance. Many of my staff have taken advantage of the products and services we offer for skin care, veins, hair removal, and injectables. A few of them want something more which can only be achieved by surgery.

As a Board Certified Plastic Surgeon who has been doing only cosmetic surgery for the last 17 years in private practice, I am certainly an option. I am honored when someone who works with me selects me as their surgeon, as it means that they respect my work and how I treat patients. If it is not awkward for them, I do not mind operating on my employees.

The staff understand that they will be treated the same, and go through exactly the same steps and process as every other patient I treat. There are no short cuts, and they are expected to follow the same instructions, down to post op appointments on a scheduled basis.

If my employee is not a good candidate for a procedure, or needs to lose weight, the same rules apply as to any new patient. Nothing “extra” or “special” is done for my staff that is not done for everyone seeking surgery. ALL of my patients are important to me, and I only have one level of care- my best.

What Makes Plastic Surgery Results Great?

There are thousands of Plastic Surgeons in the world who do cosmetic surgery. Each one is trained differently, has a different esthetic eye, and experience. The ones who are Board Certified by The American Board of Plastic Surgery meet a certain standard of knowledge, but it does not mean they can achieve great results.
When I go to meetings, I can tell who is an artist and who is a technician in my field. The technicians are the ones who talk about precise measurements and protocols and absolutes, with algorithms for procedures and ratios that must be met. The artists are the ones who talk about balance and proportion and the variations of beauty from patient to patient. I like to think of myself as an artist who respects the traditions of technicians but relies on his own eyes to determine the final results.
To me, I like to achieve dramatic changes in appearance that do not alter the basic character of the person. Everyone should still recognize them after, and be left wondering what is different. If you get the harmony and balance right, even the most drastic improvement appears natural.
Part of it is also to listen to your patient, and communicate well to insure you are both on the same page with regards to goals. I tell my patients they do not have to choose the exact advice I would give as long as what they want is within the boundaries of good taste and normalcy.
How can you tell if your Plastic Surgeon is great? Talk to him/her, feel their personality, and see if the results are what you would want. If they can show you they have achieved what you want before, on a consistent basis, and seem to connect with you, it is probably a good partnership.

The Patient Escort After Plastic Surgery

Whenever a patient undergoes a surgical procedure required sedation, regional, or general anesthesia, they are required to have a patient escort over the age of 18 to leave the office. This has always been the policy of Yager Esthetics, even before we became a AAAASF Accredited Surgery Center. It is amazing that some patients are annoyed at this rule.

The purpose of the patient escort is to have someone who is not altered by the medications that are given with anesthesia, and are not subject to the physical limitations imposed by the surgery so that they may help you arrive home safely. There should also be someone with you for at least the first 24 hours in case something happens and you are unable to call for help. It is common sense.

Going home in a taxi by yourself is never acceptable. If you pass out in the cab, what happens? If you get out of the cab and fall going into your home or building, who can help you? If you become confused or fall asleep from the anesthetic effects, who knows what might happen.

I know that some people live alone, and feel that it is embarrassing to tell someone they need help getting home from cosmetic surgery. It is a private matter, and not everybody has a person that they trust. If this is the case, ask about hiring a nurse or nurse’s aide to take care of you for the first night. They can pick you up and go home with you. Your safety is definitely worth the minor expense.

Is Your Home Ready for a Plastic Surgery Recovery?

Before undergoing cosmetic plastic surgery, my patients need to get ready. They come to Yager Esthetics for a consultation, we discuss what they want to change, and we do a physical evaluation to see if it is possible. We make sure that they are mentally prepared and understand the risks and potential complications, and have reasonable expectations. We make sure they are financially ready and have their financing or payments coordinated. We make sure they are medically ready and have all of their preoperative testing done and a note from their general doctor as needed to ensure safety. But what happens when you get home from your procedure? Is your home ready to receive a Plastic Surgery patient? It doesn’t matter if you choose to have local or even beverly hills plastic surgery recovery is essential and without proper aftercare, problems could arise.

First, you have to fix the social and family issues. Large dogs that jump on you, children who want to be carried, and people who rely on you for day to daycare must be taken care of. Whether it is mom coming to stay with you are sending your kids away, arrangements must be made.

Next, is the house physically ready? If you live in a fifth floor walk up, it is not a good idea to stay there right after an abdominoplasty (tummy tuck). Make sure you have enough pillows, and that your bed is not too high or too low to get in and out of. Make sure it is clean before you come for surgery.

Have you prepared everything you could have? Do you have your medications, has food been cooked according to any restrictions of firmness (for facial surgery), and is someone around to help you especially the first few nights? Remember, the better you plan, the easier the recovery.

Finally, did you fill your house with positive energy? What I mean is that some people are negative about things, or jealous, or resentful. These people need to be removed from the house and replaced with the good attitude supportive friends and family that make your postop period a pleasure.

Picking a Size for your Breast Implants

As a Board Certified Plastic Surgeon in NYC, I do a tremendous number of breast implant surgeries.  I order 50 implants at a time, and put in hundreds every year.  I take pride in trying to select the perfect size and shape to produce a natural and balanced result.  There is an art to it, and I want to give my future patients a few types on how to decide.

Do not pick an implant size and style because you like the way a picture on a doctor’s website looks and that is the implant he/she used. Every woman’s body is a little different in width, height and bone structure.  The same size implant will look very different in a taller or narrower frame.  Also, the amount of breast tissue and the shape and symmetry of your breasts before surgery play an important role in the final result.

Do not say that you want a B or a C, as this is very inaccurate.  If you tried 10 different c cup bras from different manufacturers, each would fit differently.  Cup size is not an exact measure, it is a difference in circumference from your chest wall to the measure around the center of the breast.

Do not tell me your sister had the surgery, and she had 375cc and you want the same.  Your sister may have a very different body shape or breast shape, unless she is your identical TWIN.

So, what should you do?  Seek out a Board Certified Plastic Surgeon, make sure he/she does at least 100 augmentations each year, and that you feel comfortable with him/her.  Have them show you women with similar heights and breast tissue amounts to you, and tell them which after picture looks good to you.  Say to them if you want a little more or less, if you like fullness at the top or a more natural slope, and be specific.  You can also bring photos of what you like and don’t like as a guide.  An experienced surgeon can then look at you and select the perfect size and shape.

To me, bra size doesn’t matter, it is the way your breasts look to you when you look in the mirror. If you are pleased, forget about what the tag in your bra says and enjoy.

Silicone Injections to the Buttocks are Always a Mistake

Let me first start by saying that this is my personal and professional opinion as a Board Certified Plastic Surgeon, and it comes from both my training at Columbia Presbyterian and from my private practice in NYC, Yager Esthetics.  Although I do not know any Board Certified Plastic Surgeons who do the procedure in the US, and to my interpretation of the legal guidelines it is not FDA approved even as an off label use as this type of silicone has no approvals, I am sure it happens.

Despite the increasing number of horror stories reported in the news in both Spanish and English, I was still asked this week by a friend what I thought about her undergoing the silicone injection in a woman’s apartment for $1500 a session.  She had no idea it was illegal or unsafe.

Virtually every week, I get calls from women and men who have had silicone placed in their bodies who are having problems.  Some have open wounds and nasty infections, others have lumps, darkening of the skin, migration of the product to other body areas, redness, heat and pain.  This can happen immediately, or many years later.  In large quantities, I feel that liquid silicone is a ticking time bomb.

I have patients flying in from other countries, Florida, and states up and down the Eastern Seaboard for me to try and remove the silicone, and help them with these often life altering complications.  While I do not enjoy these procedures, I do them because they are necessary and patients do not have many places to turn as most doctors will not even try to help.

I plead with you to not inject silicone in your body.  Let us work to educate our friends and families so that no more deaths and disfigurements come from a lack of awareness.

Great Expectations

When a patient consults with me at Yager Esthetics, they usually come as a result of knowing or seeing a patient of mine who is extremely happy with their result.   I had a woman show me on her phone that in her contacts, I am listed as “Miracle Doctor,” for the transformation she underwent after her procedures.

After 15 years and over 30,000 different patient consults, I have also established what I consider the premier practice in Cosmetic Plastic Surgery in the Hispanic community of the New York region.  The center looks a certain way, the staff is trained just so, even the website and patient education materials show an incredible dedication to detail.

I have also become a frequent resource for the media in Spanish to speak on topics related to my field.  I had a patient see me last week who said “Tiene tanta fama que sale en mi sopa.” (You are so famous that I even see you in my soup).  All of this together means that when patients arrive for their consult, my reputation is such that great expectations are placed on my work.  This is both good and bad.

I am a Board Certified Plastic Surgeon, and I am very confident in the way I operate and manage patients.  My results are generally excellent, and 99% of my patients are extremely pleased with their outcomes.  The overwhelming majority of dissatisfaction comes from patients who expect more than quality plastic surgery can realistically deliver.

I try very hard to give a true picture of the surgical and post operative periods, and to point out the limitations of what I can do.  I even show patients the things on their own bodies that I can not fix.  The problem is when patients think that despite what I say, perfection is guaranteed.

After hearing the wonderful experiences of my former patients, seeing me on television, and going through the consultation and office tour, the bar is set quite high.  I always do my best, and can say I can not recall a single case in which my effort was lacking.  My advice to any patient coming to Yager Esthetics or any other office is to listen carefully to what your doctor says, read all the consent and instruction forms thoroughly,  and be clear in expressing your expectations before electing to have surgery.  If all of this is accomplished, satisfaction is nearly always achieved.