Your injury may be one that involves the hand. When people think hand surgery, oftentimes they think orthopedic surgery.  One reason for this thinking is that there are simply more orthopedic surgeons than plastic surgeons. The fact remains, though, that you can do hand surgery from either route. Most orthopedists focus primarily on the bony or skeletal system of the body; this is where they are most comfortable. Orthopedic surgeons may not enjoy the difficult reconstructive challenge of re-plantations and soft tissue reconstruction.

It is in this challenging area where I believe the plastic surgeon has an advantage. Our skill set goes from the purely orthopedic “getting-the-bones-together” processes to revisionary cosmetic procedures such as micro-vascular transplants and toe transplants from the foot to the thumb. It’s not uncommon for us to reattach a forearm severed nearest to the wrist. After the forearm has been reattached, the injury requires skin grafts, tendon transfers, and perhaps nerve transfers. These procedures require the specialized services a plastic surgeon.  We have cared for a number of patients within the last year in which we have had to do all of these things for one person, perhaps not all at once, but over the few months following their original injury.

Because we deal with the most complex plastic surgical cases on a daily basis, we are able to fine tune the skill sets required for  real complex reconstructions makes us even more adept at the cosmetic cases, because a lot of the skill sets are applicable to that. We are not just orthopedic hand surgeons; that’s just one of our specialties within the field of plastic surgery, which is very broad. We are proud of the fact that, as plastic surgeons, we truly operate from head to toe. We operate on all tissue types, from bone all the way to soft tissue.  In that sense, we are not just plastic or cosmetic surgeons.

The reason we refer to these procedures as plastic surgery is because basically we’re asked to either change or mold a body part or an area, either for reconstructive purposes or for cosmetic purposes. When you see the term plastic surgery, it includes everything from cleft lips to burns to hand surgery to complex cancer reconstruction; it’s a very broad field that literally extends from head to toe, including areas of cosmetic surgery, which can include facial surgery, breast surgery (augmentation, reduction, etc.) and body contouring (liposuction, tummy tuck, etc.) Providing the best of both worlds for our patients, we combine our skill sets to provide a comprehensive remedy in response to injuries that affect the bone and the tissue.

Reconstructive surgeons tend to be more aggressive when performing face lift procedures. Due to reconstructive work on cancer patients as well as extensive experience with facial nerves, reconstructive surgeons have a level of skill that allows for less concern about causing damage. Many plastic surgeons choose to perform a basic skin lift to avoid damaging facial nerves, choosing not to address the underlying musculature. Reconstructive surgeons are experienced in working with deeper tissues and muscles to create longer lasting results.

There are many variations of face lifts, and patients desiring a long-lasting result need to inquire about the technique the surgeon will employ. A less complicated surgery will lead to the results lasting a shorter period of time. The most effective surgery is the elevation of the full SMAS, which is a layer of muscle underneath the skin. Although procedures such as this may be more invasive, it has been proven to increase longevity of the results. More bruising and swelling might occur in the first week, but the results of the procedure will last longer than simply placating or removing the skin. It is important for patients to ask their surgeons how aggressive their surgery is going to be, how much they are going to undermine, whether it is going to be skin only, and the expected length of results.

Although it is good to hear from a surgeon that they will be performing a SMAS procedure of some variation, it can still be difficult to gauge the results from a descriptive standpoint. Patient should request the surgeon’s post-operation photographs and photos long term results. Visible results five to seven years post-op is a good predictor of the longevity of the facelift and can give the patient a comprehensible idea of their surgeon’s skills. As in all procedures, more in-depth surgeries produce longer lasting results, and knowing what to expect will ensure that you have chosen the right method as well as the right surgeon.

Every patient is different. Typically, revisions are needed every 10-15 years. Even with deeper-planed face lifting, people still continue to age, and gravity still continues to pull things down. It is not uncommon for patients, especially those with breast operations, to require a lift or new implants. When patients commit to a surgery, it is essential that they understand that it is a lifelong commitment that goes beyond the initial process. Some patients won’t need revisions for an extended length of time, and there are others who require revisions after only five years. This is due to the fact that everyone’s body has a different reaction to foreign material. Although the skill level of the surgeon can be attributed to symmetry and natural results, ultimately revisions are needed regardless.

Aging is not the only factor that must be considered. Implants are a foreign object, and the body treats them as such. In response, the body tries to separate the foreign body with a protective barrier, forming what is called a capsule. Capsules are very common and are found within all types of implants such as indwelling catheters and knee replacements, and often they do not need to be removed. Unfortunately, they can become problematic in breast implants. The nature of a breast implant is soft, and as capsules form within the body, they change the shape and consistency of the breast. Not only does this become a cosmetic deformity, but a tight capsule in the breast can also cause pain. Therefore, revisions are necessary to regain the proper consistency of the implant as well as remove any painful capsules that the body has built in defense.

It is hard to predict how our bodies will react to a foreign substance or when the signs of aging will catch up with us once again. Patients must be well informed that 10-15 years is only an average, and that any procedure is going to require maintenance at one point or another. Even the best plastic surgeons cannot ward off the hands of time.

Cellulite is completely different from cellulose, which is an organic compound that helps make up the cell wall of plants. Cellulose has nothing to do with the human body. Cellulite is deposits of fatty tissue just under the skin that can cause dimpling in the areas of the abdomen and pelvic region because of how it attaches. These dimples can be unsightly, and many women are embarrassed to show those areas in public.

In desperation, people attempting to combat the problem of cellulite have poured money into expensive creams and treatments; there are procedures offered for freezing or even suctioning the outside of the skin.  Unfortunately, suctioning sucked, creams were unreliable and freezing was just painful.  In the end, your skin was still polka dotted with dimples – and you were no closer to that bikini body.

I have been very happy with the laser cellulite removal procedure that I routinely use. Traditional liposuction techniques have had little success in removing the small packets of fatty tissue. The position of cellulite near muscles and connective tissues just below the skin makes them difficult for the suctioning cannula to remove.

I don’t need to go in there and root around, hoping to grab as much of the cellulite as I can. With laser cellulite removal, I create a small incision and use a high temperature laser to actually liquefy the fat and clip the connections, drastically reducing dimpling. Many of the traditional cellulite treatments are also temporary because they don’t actually address the attachments to the skin and the fat directly.

The laser removal process actually changes the shape and reorganizes the tissue so it is much different than before. While the laser cellulite removal process is relatively new, I have long term results that show it is likely a permanent fix. As an added benefit, the heat of the laser actually tightens the loose skin around the treated area.

Often, your skin will shrink to fit your natural contours. Laser cellulite removal is a minimally invasive procedure that can drastically improve your personal body image. While people probably weren’t staring at your dimpled thighs as much as you feared, you’ll be able to go out feeling confident.

In traditional lip suction, a doctor makes an incision and inserts a powerful vacuum device that then rips and tears the fat from your body. Are these the kinds of actions you want to associate with a medical procedure? I don’t think so. When it’s all over, you’re sore and bruised, wondering if all the pain was worth fitting into a size five.

Don’t worry, there is a better way to do it. Laser-based “smart” lipo suction is revolutionizing the procedure. Few plastic surgeons have adopted the technology at this point, but it does mean a better and less invasive procedure for my patients.

In a laser-based lipo suction procedure, a powerful laser heats up and actually liquefies the fat and cellulite. The vacuum cannula then is able to simply suck up the liquefied fat from the area. No ripping and tearing involved, which should hopefully set your mind at ease.

Since the procedure is much less invasive, your body will recover more easily; there will be much less bruising. Laser lip suction is the 21^st Century way of sculpting away that excess fat. The shorter recovery time means you’re up and about much more quickly; with warm weather coming, you can be out on the beach sooner.

When you lose fat from your body too quickly, whether it’s through surgery or dieting, you are often left with excess skin that can be very physically unattractive. With traditional lipo suction procedures, this excess skin is normally cut off, leaving a scar. Using heat to liquefy fat allows us to offer our patients additional benefits as well, because laser-based lipo suction gives you the opportunity to let Mother Nature tighten the skin and avoid additional surgery.

The heat from the laser causes the skin around the liquefied fat to tighten on its own, creating a natural look without the use of surgery or scarring. The extent of the tightening depends on many factors, and sometimes removing excess skin may still be necessary, but the laser can minimize the amount of skin – and therefore the size of the incision and resulting scar – that must be made.

Don’t get me wrong – there are a number of fine cosmetic surgeons – surgeons from whom we receive referrals when our reconstructive skills can help. Skimmers and pretenders, however, are out there, and they often do more damage than good.

The skimmers and pretenders are cosmetic surgeons who have only performed the very basic procedures and are barely able to promote legal operations. They boast proficiency, when in reality they only accept the simplest of cases. It is important that a potential patient be aware of these hazards when looking for a capable surgeon.

Skimmers tend to do a lot of Botox injections, something that is relatively simple but also high in demand; however, the simplicity does not lessen the possible dangers. Skimmers may also perform un-demanding cosmetic surgeries, such as blepharoplasty. This relatively easy surgery includes repairing droopy eyelids by removing excess skin, muscle and fat. Over a six-month period,  a skimmer will have done an incredibly low number of surgeries while still bringing in a substantial sum of money.

Pretenders also concern me greatly. Pretenders are people who are not necessarily trained in plastic surgery, yet they assume that their knowledge in other areas establishes them as equipped to perform the specialized procedures cosmetic and reconstructive surgeons are trained to perform. At this point, it becomes a patient safety issue when those who are not well-trained pretend to be efficient plastic surgeons.

I see the negative effects of such practices when these types of predators finally decide to step over their boundaries. Typically, they are stationed within their comfort zone and only do procedures they are certain they can perform, but eventually, they attempt procedures that they really have no business doing. When they cause more damage, a reconstructive surgeon like me or one of my colleagues must step in to repair damage from procedures that should have never been attempted.

You can protect yourself from skimmers and pretenders. Start by asking questions. Ask your potential doctor what operations he or she has been trained to perform. Also, ask your doctor if there are any procedures that he or she is not capable of performing or has not yet performed.

I do not believe that these skimmers and pretenders are prolific in our field, but they do make a point of being visible, and they detract from our entire industry. Whether you are having surgery for cosmetic reasons or because of accidental disfigurement, birth defect, or post-cancer reconstruction, seek the skills and experience in your surgeon that will ensure a positive experience.

-David Bowie

In general, people do not like change. Women tend to embrace some change, experimenting with various clothing fashions and hair styles. Men, on the other hand, generally don’t like change. They will wear the same clothing regularly, and they may never change their hair style. Men often also give the impression that they are less psychologically sensitive to the effects of aging when compared to women, and men rarely pursue the advantages of cosmetic surgery.  The reality is, however, that as men reach middle age, they will notice other men who dress, look, and are younger. This becomes significant in the business world, as the market place becomes more competitive.

While cosmetic surgery is most often associated with changing a person’s appearance for much the same reason we change clothing or hair styles, the value of cosmetic changes in the hands of a reconstructive surgeon are considerable.  A person may choose a different hair style or clothing style as a way to feel good about his or her self.  A man’s choice to select blepharoplasty, plastic surgery that targets fat around the eyes, making them look younger, or the choice to select liposuction around the abdomen are valid procedures that not only promote a physical change in a person but an emotional change as well. Facelift and liposuction procedures are the most popular for men.  They want to feel good about themselves, and that is okay. Change can be good.  However, there are some changes we cannot anticipate.

I have seen patients who have lost a finger, who have had skin cancer, or who have had an organ removed as a result of cancer. Such patients do not expect these sudden changes, and cosmetic surgery presents an option often overlooked. Given the volume of elective cosmetic procedures, plastic surgery and surgeons find themselves the victim of a cliché, perceived as an answer to those clients who merely seek to change their appearance. Victims of circumstance, clients who have lost a digit or who have been treated for cancer or who have been in an accident, can benefit from the professional talents of the reconstructive surgeon.

For example, somebody who has been in an automobile accident and has gone through a windshield may have a big facial laceration; their face is torn open, and they must have reconstructive surgery. Our experience performing these kinds of reconstructive surgeries allows us to be better at cosmetic procedures as well; we learn where the facial nerve runs, and we see where the parotid gland (a gland responsible for producing saliva is). When we do a facelift we know that if we go too deep in a particular area, we’re going to be right next to a particular nerve.

We are reconstructive surgeons who also do cosmetic surgery, and like the people that find themselves in need of reconstructive surgery unique to their situation, each person that chooses selective cosmetic surgery receives our individual attention because each reconstructive procedure we do is a little different. Men (and women) can comfortably and without shame turn and face the strange changes, whether the changes are necessary or elective.

Plastic surgery incorporates reconstruction in areas such as posttraumatic wounds or damage incurred from cancer, as well as reconstruction of congenital abnormalities. My colleagues and I at Plastic Surgery Institute and the Buncke Clinic have also taken an extra step by studying microsurgery an additional year. This additional year of study has equipped us with skills and techniques that allow us to perform specialized operations to help people disfigured in accidents or recovering from diseases.

Reconstructive surgeons are capable of bringing a vast amount of experience to cosmetic surgery patients. There is a misconception among patients that specialized cosmetic surgeons are more equipped to handle a situation because they perform the same type of cosmetic procedures over and over. But it is our exposure to such a variety of different challenges as reconstructive surgeons that prepare us to offer innovative and efficient techniques to our cosmetic surgery patients.

Each patient I see presents a unique reconstructive challenge, because each reconstructive surgery I perform is unique.

Reconstructive surgeons are highly attuned to handling serious complications that can arise from cosmetic surgeries, like infection or dead tissue, because they are seen all the time in the reconstructive world. When cosmetic procedures, such as face lifts, inflict nerve damage, reconstructive surgeons have specialized training to reattach the nerves and restore motion to paralyzed facial muscles.

People interested in reconstructive or cosmetic surgery have to ask tough questions to find the best surgeon. Find out what kind of operations a surgeon does, and what their typical procedures are. Ask what they don’t do. Don’t be afraid to do your homework to find the right doctor for you.

I believe that anyone thinking about having plastic surgery should consider the benefit of having that procedure performed by a reconstructive surgeon. Reconstructive and cosmetic surgeons can repair lesions formed by cancer, or offer a child born with a disfigurement of the hands or face to have the opportunity to live a near normal life.