Category Archives: Skin


Permalink to The Right to Bare Arms

The Right to Bare Arms

The procedure which has had the greatest increase in popularity in the last year has been the arm lift and LipoSculpture, or sculpting of the arms using SmartLipo Triplex. According to statistics from the American Society of plastic surgeons arm lifts have increased approximately 400%. This is mainly attributed to Michelle Obama. The public’s fascination with her arms and how strong muscular and tight they are has led to this increase. For many women there is a genetic tendency to have excess skin or fat in their arms as they get older. In some women this even leads to the bat wing deformity with excess flapping skin. This is especially common when women have lost large amounts of weight.
Fortunately there is a solution. Actually there are two solutions. The first solution for milder cases is liposuction. In the past liposuction was moderately successful however there were problems with skin shrinkage. Nowadays with Smart Lipo this problem can be solved. The SmartLipo TriPlex has three different lasers. The first laser melts the fat the second laser prevents bleeding and the third laser stimulates skin shrinkage. By doing this procedure, which involves one or two small incisions just above the elbow, significant skin shrinkage and fat removal can be accomplished. So instead of just removing fat from the arms, with LipoSculpture, we are able to go in and actually sculpt the arms to make them more defined and sexy.
In women that have more excess skin the next alternative is an arm lift. This is combined with liposuction for better contour of the arm. In addition a section of skin is removed from the elbow to the armpit. The seam is then placed on the in side and posterior aspect of the arm to hide the scar as much as possible in most positions. This is a procedure that is extremely effective for removing the batwing issue. In the past scars were a potential problem because of spreading and poor healing in this area. With the newer barbed, zipper type sutures scarring has been much less of an issue although bad scars are possible in general the scars with these newer sutures are absolutely excellent.
With the SmartLipo TriPlex and the arm lift option, any woman can improve the appearance of her arms significantly. These are quite often problems that cause lack of confidence and cause people to completely hide their arms. Within a matter of hours this can be changed. Arm liposuction and arm lifts are both amazingly effective at what they do. They are both part of a new era of body contouring

Permalink to 10 Things to Know About Cellulaze Cellulite Treatment

10 Things to Know About Cellulaze Cellulite Treatment

News Release on Cellulaze put out by RealSelf:

SEATTLE, WA–(Apr 12, 2012) – Is cellulite about to be zapped into submission? A minimally invasive laser-based treatment known as Cellulaze™, created by Cynosure, Inc., was recently approved by the FDA and is piquing public interest as a new procedure against stubborn fat-dimple deposits. On RealSelf.com alone, the largest website for plastic surgery reviews and information, more than 40,000 people searched for Cellulaze on the site in March 2012, compared to just over 1,000 people one month before.

To help shed light on this new treatment as interest spikes, RealSelf gives the inside scoop on the top 10 Cellulaze questions asked on its site. RealSelf.com is not affiliated with Cellulaze or Cynosure, but is an unbiased website that tells the “real story” behind hundreds of plastic surgery and cosmetic procedures, as reported by patients who have them done, and the board certified doctors who perform them.

1. Does it really work? According to Cellulaze reviews on RealSelf.com, yes. The procedure scores a 100% “Worth It Rating” by reviewers who have undergone the treatment, meaning they would all do it again. One user wrote, “So far I am shocked at how different my thighs look. I really look like a new person!” Dr. Grant Stevens of Marina Del Rey at Marina Plastic Surgery Associates, who is a respected plastic surgeon active on RealSelf.com and early Cellulaze practitioner claimed, “I’ve seen it, I’ve touched it, I’ve examined it. It works. It’s phenomenal.”

2. What does the procedure involve? After numbing the area, a small laser tube is inserted under a patient’s skin. The laser heats up to melt lumpy pockets of fat, then cuts through the fiber bands that pull the skin and cause dimples. The laser then heats the skin to trigger new collagen growth, leading to better elasticity and thickness. The procedure must be performed by a trained practitioner, as Dr. Stevens notes, “It’s technically demanding.”

3. What makes it different from other cellulite “cures?” As posted on the RealSelf.comCellulaze Q&A board by Sacramento plastic surgeon Dr. Andrew Kaczynski, M.D., “Alternative non-invasive cellulite treatments only address the external effects of the skin but don’t address the core biology causing problem areas. Creams and massage are quick fixes with sub-par results. Cellulaze is the first technology that goes directly after the actual biological structures causing cellulite.”

4. What are the expected results? Reviewers on RealSelf.com reported saying goodbye to some cellulite spots almost immediately, and the manufacturer claims results further improve over the following 6-12 months. Dr. Stevens speculates, “I think what’s going to happen over the next year is we’ll hear more and more about doctors doing the treatment combined with liposuction, which actually sucks out some of the fat, for maximum results.”

5. How many treatments do you need? Is it permanent? Scoring points as a “one and done” procedure, Clinical studies have shown one Cellulaze treatment can keep cellulite spots at bay for a year or more.

6. Can I see Cellulaze before and after photos? Un-retouched before and after photos submitted by physicians are found at www.realself.com/cellulaze in the Photos section.

7. Will it hurt, and what is the recovery time? The procedure is performed under local anesthesia, and according to RealSelf.com reviewer NYTennis, she “felt some needles initially and some pinching with the numbing procedure… there was some nippy feeling here and there with the laser.” Another reviewer scored it as a low “1″ on a 1-10 pain scale. In terms of recovery, patients are said to be able to return to normal activities in one or two days, but may experience immediate light bruising and swelling to the treated area, as evidenced by NYTennis’ Cellulaze results picture, which reportedly clears within a week or so.

8. How much does Cellulaze cost? RealSelf.com reviewers reported spending an average of $5,700 per cellulite busting treatment.

9. Who is a good candidate? Cellulaze is said to deliver the best results for people who are not significantly overweight, but who have moderate cellulite on their thighs, buttocks and hips.

10. Where can I find a qualified doctor near me who performs the Cellulaze procedure?Visit www.realself.com/find as a starting place to locate and read reviews of nearby board certified doctors who specialize in cellulite treatments and may offer Cellulaze. (Or just call (916) 925-5522!)

To read more Cellulaze information from the RealSelf community, visit www.realself.com/cellulaze.

About RealSelf
RealSelf is the most visited online community for learning about and sharing information and results for medical-beauty treatments. Dedicated to helping people make suitable and empowered elective decisions, the site features consumer reviews, Worth It ratings, pricing information, and thousands of before and after photographs that collectively tell the ‘real story.’ The site also includes safety information and a Q&A with more than 3,500 board-certified doctors so visitors can interact with qualified experts and make safe decisions. RealSelf covers thousands of topics ranging from cosmetic dermatology to plastic surgery, cosmetic dentistry vision correction and more. www.realself.com.


Permalink to SmartLipo TriPlex: A Better Mousetrap

SmartLipo TriPlex: A Better Mousetrap

The SmartLipo TriPlex is the 5th generation of SmartLipo and is exclusively offered in Northern California by Dr. Andrew Kaczynski at Advanced Concepts in Plastic Surgery.

The SmartLipo TriPlex is the 5th generation of SmartLipo and is exclusively offered in Northern California by Dr. Andrew Kaczynski at Advanced Concepts in Plastic Surgery.

SmartLipo is a brand name for a laser assisted liposuction technology developed and manufactured by Cynosure in Europe. SmartLipo TriPlex is the lastest, 5th generation of the SmartLipo brand. After more than six years of Cynosure trying to sell me the SmartLipo technology, after consideration of all the data, I have determined that the SmartLipo TriPlex is indeed a better mousetrap. I am now the only certified plastic surgeon in Northern California to offer this better and safer SmartLipo TriPlex liposuction technology. Liposculpture with the SmartLipo Triplex has proven to be even more effective, with better results than I had even hoped for! If you are researching SmartLipo or liposuction techniques, make sure you ask any doctor you speak to which generation of SmartLipo they are offering and if their laser lipo technology has a temperature monitor auto shut-off.

I have been performing liposuction since it was invented by Dr. Illouz in the 1980s. During all those years, different Liposuction methods emerged, such as Tumescence, Superficial, Power-assisted, Ultrasonic (VASER) and Laser Liposuction. Initially Laser Liposuction was experimental and not very practical. As the machines got better so did the results. However, it was still time-consuming, potentially dangerous because of burns due to lack of temperature control, and results were not noticeably different from previous, and I believed, safeer methods.

The ideal liposuction treatment would involve the smallest incisions, remove large amounts of fat, have minimal bruising, rapid healing, and would shrink the skin in the areas where fat is removed. It would also be safe and consistent . For years, the method closest to this standard was Ultrasonic Liposuction, or the VASER. At the time, there were many different Laser Liposuction systems such as and they all claimed to be the best. However, they were still time-consuming and had the risk of burning due to the lack of control over the lasers energy. That is, until Cynosure came out with SmartLipo TriPlex.

The current generation of Smart Lipo is the fifth generation of Cynosure’s technology. It provides three different laser wavelengths(1064, 1320 and 1440). This does make the system more complex, but much more effective: One wavelength decreases bruising, one increases fat melting, and one increases skin tightening. The biggest change as far as results are concerned, is the fact that there is significant additional skin shrinkage compared to previous systems. This is especially important in problem areas like arms, neck, inner-thighs, and abdomen.

SmartLipo now also leads to less trauma and faster healing. Equally important is the fact that this system has a temperature guide. In the past, the surgeon had to either feel the skin, or use a temperature gun to check the outside temperature. This new system has an internal temperature control which is an important safeguard to prevent excessive heating and the possibility of thermal damage.

The Smart Lipo Triplex machine is the next big thing in body contouring in terms of fat removal, skin tightening, and safety.


Permalink to Reverse Tummy Tuck

Reverse Tummy Tuck

What is a reverse abdominoplasty? Is it plastic surgery for someone who had second thoughts after their tummy tuck? No. It’s a procedure designed to lift the upper abdominal skin from above instead of from below. Let’s start with a basic abdominoplasty. This is designed to remove the pouch in the lower abdomen of hanging skin. Evaluation of the patient looks at the skin, the fat and the muscle separation.  If all of these are present, the patient needs an abdominoplasty. This consists of making a hip to hip incision, listing all the skin up to the breasts, tightening the muscles vertically like a corset and removing the extra skin. This usually is necessary because of big babies, multiple babies, or several babies, one after the other.

But what if the problem is not loose hanging skin, separated muscle and a blob of fat in your lower abdomen? For some women especially over 40, the problem is loose skin above the belly button. The skin lacks elasticity and just starts to form several rolls. ln the past these patients either had to have a full abdominoplasty with a the lot of pull or couldn’t have anything done.

Sometimes the non-invasive Thermage Skin Tighteing can help tighten up the skin in mild cases.

Now there is a procedure that takes care of that. With the reverse abdominoplasty an incision is made just under the breasts in the fold and across the entire abdomen in a horizontal manner. A small dart is placed in the midline to interrupt the scar for better healing. Then the skin is lifted possibly after some Vaser liposuction. This listing goes down to the belly button. The skin is pulled up just as I’ve seen patients show me on themselves many many times with their hands on their upper abdomen pulling up. “Why can’t it look like this?” The excess is marked and trimmed usually from one to 3 inches.

The underside is sutured with quilting sutures to hold it and prevent excessive tension. Then it is sewn in with special zipper type sutures which achieve barely noticeable scar. The procedure is very comfortable postoperatively and has much less downtime than a full abdominoplasty. lt also does not limit the type of bathing suit afterwards. This is because there is no scar at the hip. With a conventional tummy tuck, even with a selection of the scar curving up or down or straight across this area places limits on future bathing suit styles.

lf you’re a candidate it’s a quick and straightforward procedure to improve upper abdominal rolls and loose skin.


Permalink to Kim Kardashian Fesses to Botox but NOT Breast Augmentation

Kim Kardashian Fesses to Botox but NOT Breast Augmentation

kim-kardashian-plastic-surgery

Kim Kardashian says she has only used Botox

Kim Kardashian, of Keeping Up with the Kardashians, admitted to using Botox, in an interview with ABC News show Nightline. However, she says she has not had a nose job or breast augmentation.

“Trust me honey, if I take this bra off you will tell me I need to get them done. I’m totally not against plastic surgery. … I’ve tried Botox before. That’s the only thing that I’ve done.”

Just the way she says that, I tend to believe her and while a great breast augmentation will look very natural, natural, can look natural as well! ;)

However, Kim Kardashian’s sister, Courtney Kardashian says that she has had breast augmentation and seems to be very proud of it!

“I have had breast implants, but it’s so funny ’cause it’s not a secret, I could care less. It’s so funny because the ‘before’ picture that they [In Touch magazine] showed was after I had my boob job, so I’m like, they should have written ‘before Mason’ and ‘after Mason.’ Like my boobs have like tripled since breastfeeding.”

They go on to say that none of the Kardashians have had nose jobs and from looking at pictures on the Internet, even the “before and after” pictures that argue that she has, I tend to believe they haven’t. So much of what you see in those pictures can be explained by lighting and make-up. Kim Kardashian says that she actually did want to get her nose done but decided against it.

“But what’s funny is about my nose, it’s my biggest insecurity. I always want to get my nose done. … I went to a doctor, I had them take the pictures, he showed me what it would look like and it just didn’t– It– I wouldn’t look the same.”

I agree with Kim Kardashian here, if that is her natural nose, she does not need anything done to perfect it. If anything, there is more risk in changing it and it not looking as nice or as individual as it does naturally. Perfection doesn’t have to be generic, people all look different for a reason, plastic surgery is not about trying to make every face look perfectly the same, it is about enhancing what you do have or fixing issues that bother you. In Kim’s case, I would keep that nose, it looks great on her.


Permalink to Megan Fox Plastic Surgery Mysteries

Megan Fox Plastic Surgery Mysteries

Megan Fox Plastic Surgery Controversy

This time it’s Megan Fox - another, “does she or doesn’t she? Has she or hasn’t she?”  Unlike Heidi Montag’s obvious cosmetic surgeries, Megan Fox has a more refined look.  Megan Fox is a beautiful young woman by anyone’s standards – you don’t have to be a Transformers fan to enjoy that!  But, has she had some “refining”?  The beauty of good plastic surgery is that it is subtle, and it often begs the question, “Did she or didn’t she?”

As a plastic surgeon here in Sacramento, I get questions all the time as to whether I think this starlet or that celebrity has had cosmetic work done. One thing I often say is that pretty much everyone in that line of work has or will have something done to improve their appearance. Because Megan Fox has been in the news a lot lately, combined with the fact that she is one of the most beautiful starlets in Hollywood, I get asked about her a lot! If you look at pictures of Megan Fox on the Internet, you can come to several conclusions fairly quickly.  In my medical opinion, I believe I can spot a few procedures she’s undergone.  The important thing is that if she has undergone these procedures, they were performed very well so kudos to her doctor!

1. Megan Fox most definitely has had breast augmentation with breast implants. That’s fairly obvious even to a non-plastic surgeon, but her enhancement matches the rest of her figure, and it is not over the top literally like Heidi Montag’s breast augmentation.  It enhances her body without distracting from her other features.

2. She has also probably had two rhinoplasties.  The first rhinoplasty looks to be slightly unsuccessful.  There is an inverted V look on her upper nose in several photos that were taken after the bump was removed from her nose. This inverted V comes from the bones not coming together after being fractured. This was corrected the second time around, and further refinement appears to have been done on her nose, especially the tip.

3. Megan Fox likely has regular  Botox injections in her forehead. Even young people have some expression lines, but her forehead is incredibly clear without even a hint of a line. By using Botox at her age, she will avoid lines appearing in the future. She also seems to have had some shaping with advanced Botox techniques to raise a lateral and give her an exotic Angelina Jolie -type look.

4. Megan Fox also appears to have had a very good lip augmentation. Unlike many lip augmentations, Megan Fox’s lips are not over-the-top.  Her lips are definitely fuller, but it still looks relatively natural.

5. There has also been some suggestion of cheek implants, but unless they are very small, she just appears to have gotten older and a little more defined with some weight loss.

So what does this all mean?  It means that plastic surgery has something for everybody: for a middle-aged woman who wants to take in her neck a bit, or a young woman who wants a flatter stomach after having babies… or an aspiring superstar just shy of perfection. Were the changes reasonable?  I think she managed to fine tune her already attractive features and she did so without going way overboard like Heidi Montag. Is she more beautiful?  You can judge for yourself. But generally speaking a straight nose, fuller lips, a curved brow, and fuller breasts are often considered to be more attractive by our culture’s current standards of feminine beauty.


Permalink to Heidi Montag Lessons

Heidi Montag Lessons

Heidi Montag Breast Augmentation

Heidi Montag's Breasts Are Too Big!

Some stories just won’t go away. The Heidi Montag saga seemed like just another fifteen minutes of fame for a desperate starlet. And it makes for a great story: D-list celebrity trying to get an edge with an extreme makeover that will catapult her to stardom… or not.

But now, after the initial stories cataloging her surgeries mini brow lift, nose revision, facial and buttock fat grafts, breast implant revision, ear pinning, neck liposuction, the stories continue. She’s in pain. She’s happy. She’s not happy. She wants bigger implants. She’s going outside the U.S. for implants she can’t buy in the U.S., and the stories just continue on and on, probably fed by her publicist.

Since Heidi Montag and her drama are not going away anytime soon, what can we all learn from this modern-day tale of transformation that will help us in our thinking about plastic surgery?

If you are considering plastic surgery, it is important to be realistic about what you are considering and why.  Number one, if you don’t want to set yourself up for disappointment the only reason you should have plastic surgery is for yourself.  No one should be considering plastic surgery because someone else is telling you to.  Plastic surgery should not be undertaken to get or keep a husband or boyfriend, nor to get a specific job. The procedure, and your new image, should be its own reward. It should give you a positive self-image and give you more confidence. To expect secondary gain is setting yourself up for disappointment. The exception to this rule may be a situation where someone is looking prematurely old and seeks facial surgery for better competitiveness in the job market. Heidi Montag is not prematurely old.

Less is more–rule one: I don’t know exactly how long Heidi’s ten procedures took, but I try to limit my procedures to less than six hours. The medical standard for safe elective surgery is less than six hours. This means that after six hours the risk of medical complications rises. It is also more difficult to recover when you can’t get in a comfortable position because of the pain resulting from your multiple procedures. Performing fewer procedures in two operations makes for two shorter, safer operations with quicker recovery time, as opposed to one long one with a much longer and more uncomfortable recovery.

Less is more–rule two: As you age you should only have the minimum amount of work done to correct the problems. There is no such thing as prophylactic facelifts, although some people claim to do them. I’m okay with the chin and nose changes. But the brow lift and fat grafts actually made her look older boring here and harsher. Nothing can replace the freshness of youth and once it’s gone it’s gone.

Less is more—rule three: And important thing to remember about breast augmentation is that breasts can be too big! The only kind of movie Heidi Montag’s new breasts will get her into is the kind with three X’s, rather than snagging Meghan Fox’s roll in Transformers 3! I’ve put in large implants, even the maximum size, 800cc, but these are cases where the woman could handle them because of her height and the size of her chest. If Heidi wants to go bigger than her current 700cc implants, in order to really see a difference she would need to go to 1000cc which is way too much for anyone, much less a thin woman who is 5’2.

The downside of really big implants: Bigger scars to put them in for silicone implants. Putting in 1000cc  saline implants would be a nightmare. They would come down to her knees in no time.

What goes up must come down. Implants that large would have minimal muscle support. There is no breast lift that would lift them up for any significant length of time. She will have to downsize in order to have a successful breast lift.

Implants that big would make her skin tissues paper thin over time. Wrinkles and ripples would be visible.

Implants that large would actually pull down on her shoulders and neck. They would likely cause severe back pain. Most women who naturally have breasts that size eventually come in for breast reduction.

Just because a surgery can be done, doesn’t necessarily mean it should be done. She’s not yet in the ranks of plastic surgery monsters but if she keeps this up, there is little doubt she will be listed on one of many scary plastic surgery Websites.  Good plastic surgery is designed to makes people look like themselves and doesn’t make you look like a different species. Is she on her way? Only time will tell.


Permalink to Facelift By OBGYN?

Facelift By OBGYN?

With the current wave of “Alice in Wonderland” mania, a recent email from a friend reminded me of a scene in that classic book.  In that scene, Alice is talking to the caterpillar and he keeps asking her, “who are you?” This reminder, in my mind, led to my impressions of a current phenomenon I’ve been seeing and reading about lately regarding the business of plastic surgery. It occurred to me that it seemed apropos to ask any doctor, offering plastic surgery, that very same question. This is because the answer to that question can be very vague.

There is a disturbing trend in medicine where internists, family doctors, gynecologists and other specialists are offering to do plastic surgery procedures as a way of making a little cash, “on the side.”  Dermatologists and E.N.T. (ear, nose & throat) doctors are expanding into areas where they have little or no training.  Because of this, complications are escalating like never before.

I know someone who went in for a yearly checkup and found her internists now owned a roomful of lasers next-door and was promoting their use.  The largest liposuction clinic in my community is run by an internists and an emergency room doctor.  Family practice doctors are opening, “med spas.”   Some E.N.T. doctors are beginning to perform breast augmentation surgery and gynecologists are doing face-lifts. What’s going on?

A recent article in Plastic and Reconstructive Surgery by Matthew Camp, titled Who is Providing Aesthetic Surgery? A detailed examination of the geographic distribution and training backgrounds of cosmetic practitioners in Southern California put some insight into this question.

So what is going on?

Medicine is hard-pressed for fair reimbursement by health insurance companies.  Despite any statements to the contrary, it is likely going to get worse in the future.  More and more doctors will be attempting to supplement their income by offering plastic surgery procedures in which they have little or no training.

Plastic surgery is literally the only cash business left in medicine, especially if you include hair transplants, laser hair removal, varicose veins, and all noninvasive treatments under that umbrella.

Individual magazines devoted to different specialties routinely promote, “boosting your income by adding cosmetic services.”  Medical meetings also promote one-day workshops in different procedures and technologies.

Makers of cosmetic products and devices are actively promoting their goods to non-plastic surgeons as a way of expanding their markets.  Moreover, those that are not intentionally marketing to these doctors are none-the-less bound by law to sell to these doctors if the doctor orders from them.  This is because in California, a medical doctor has a license that entitles him or her to do anything they see medically fit in the office.  He can do brain surgery, heart surgery, or sex changes.  If something goes wrong, let the lawyers sort it out after the fact.  There is no restraint of trade for physicians.  Hospitals monitor doctors and only allow them to have privileges for those procedures in which they have actual training and/or certification.  This is why most of these practitioners who are expanding their offerings work only in their offices where they are completely unsupervised and unregulated.

The economic situation that is leading gynecologists to start offering facelifts is also placing very young plastic surgeons, just out of school, in a difficult situation.  Therefore, they are vulnerable to being scooped up by franchise corporations that have catchy names and usually offer one specialty procedure at what they suggest is a discount price that an established and experienced plastic surgeon cannot compete with. The reality is that in most cases they are at or very near regular market prices for these procedures.  These “McFacelift” shops or “LipoKing” franchises perform procedures with pressure on the doctors and staff to do as many per day and as fast as they possibly can.  To quote from the Camp article, “the development of aesthetic practices with individual providers are considered to be interchangeable and replaceable is becoming ever more prominent.”  This is particularly the case among the “medispas.” The practices are often named after a geographic location with the cachet of affluence such as Rodeo Drive, Beverly Hills or La Jolla.  In these practices, or perhaps better described as “mills,” the practitioners are employees of the corporate owner of the clinical facility and are pushed to produce revenue.  The divorce of the practice from the name of a responsible physician has the potential to have a profound impact on the doctor-patient relationship and how patients select a provider.

Therefore, as the Romans said, “caveat emptor;” Let the buyer beware. This is especially true in California since there is essentially no enforcement by the medical board, which has recently been stripped of most of its funding.  Many complaints and many bodies must pile up before anything will be done.  Any doctor can do virtually anything in his office and will not be stopped until there are large numbers of complaints or he kills or maims a patient.  It is amazing that we require such tight restrictions on many other fields such as airline pilots.  What is happening is the equivalent of allowing someone who knows how to fly a single engine plane to go ahead and sit at the controls of 747, bringing it down for a landing into a major metropolitan area without any training.  Do you want the professional airline pilot with a complete education or someone who had a one-day course in the 747 before he takes your life into his hands? On the flip side, I am a trained plastic surgeon who has had thousands of hours of training and experience in plastic surgery but I have also had some training in many other aspects of medicine.  Legally, I can perform brain surgery and heart transplants in my own operating room, but would I be your best choice if you needed these procedures?  What if I were to offer to do the surgery at a discount?  …Yeah, I didn’t think so.

If you’re considering a plastic surgeon, do what the caterpillar did.  Ask, “who are you?”  “Are you board-certified?”  “Are you board-certified in plastic surgery?”  “How many of these procedures have you done?”  “How long have you been providing this procedure?”  “Do you have hospital privileges?  Or is plastic surgery just another way to boost your income.”  Or, “are you a cosmetic surgeon” which is essentially a meaningless term since there is no recognized Board of cosmetic surgery.

Caveat emptor. Do your homework and trust your gut feelings.  If you feel unsure or apprehensive, regardless of whom the person is, move on.  Plastic surgery is not like having your hair done.  Some people spend more time researching a vacation then researching a plastic surgeon, don’t be one of them.


Permalink to Quill Sutures Better Scars

Quill Sutures Better Scars

When considering a plastic surgery procedure, one has to contemplate the potential positive results as well as the negative. Lets face the facts, all plastic surgery incisions are going to have some kind of scaring after they heal. The question is “how do we minimize this?” At Advanced Concepts in Plastic Surgery in Sacramento, we believe an ounce of prevention is worth a pound of cure.  This applies to a lot of things in life and plastic surgery is definitely one of them.  Particularly in plastic surgery, this notion applies to scars.

In the past, the only thing that could be done for scars was to try and treat them if they healed badly.  There are many different creams, gels and injections which have been developed for this.  Why not try to prevent the problem from the outset?  The new Quill Self-Retaining System (SRS) suture, (which was developed by a plastic surgeon), is the latest advance in suturing and I have absolutely found that its application in plastic surgery clearly leads to better scars.  The Quill sutures have tiny barbs in them that allow for better closure.  They eliminate the need for knots and tighten up the incision like a zipper and then provide for, “controlled tension,” which means that the incision is closed and held closed in a very controlled way.  This method also makes is less likely that the incision may re-open. I have used them in my plastic surgery practice for breast  augmentation surgery, breast lift, tummy tucks and body lifts with excellent results and better scars than ever before.  The introduction of these Quill sutures a few years ago was actually the first major advancement in suture technology since the 1970′s! This is just another example of using new technology to achieve excellent results at Advanced Concepts in Plastic Surgery.


Permalink to Local Anesthesia, General or Sedation for Plastic Surgery?

Local Anesthesia, General or Sedation for Plastic Surgery?

There seems to be a trend of late, judging by what is out on the Web and in advertising, to promote plastic surgery procedures under local anesthesia…  only… nothing else… stone cold sober.  Nothing to make you feel relaxed, to take the edge off, nothing to soften or eliminate the sights, the sounds,  and other physical and emotional reactions to having a plastic surgery procedure performed on your body.

Now, I do perform some plastic surgery procedures using local anesthesia pretty much every week.  A little scar revision, a facial contour in a small area, or a micro-liposuction on the face.  But most of the plastic surgery I perform at Advanced Concepts in Plastic Surgery in Sacramento are performed with sedation or with a general anesthetic.

First of all what is sedation? Sedation is when the patient has an IV and receives sedation medication through it but remains conscious.  There are several different kinds of drugs that put the patient in a particularly happy place.  This means you’re not completely asleep but you are also not aware of what’s going on, you are very comfortable and breathing without the help of a breathing machine.

So why would you not want to be aware of what is being done to you?  I’ll use myself as an example.  Several years ago I had a wisdom tooth erupt.  I guess I’m a late bloomer. I had it removed under local anesthesia only.  The dentist did a great job as I did not feel any pain.  But it was a very unpleasant experience with all the rasping, grinding and pulling.  In addition to that, my mouth and jaw was very sore from staying open.  So, how do you think I would have felt after two or three more just like that?  So let me state the case.  If I have to do that again, I just don’t want to know about it, and I assume my patients would rather not experience that kind of discomfort during their plastic surgery procedure either.

Where does strict local anesthesia work best?  Local anesthesia works in small areas and in a very limited short plastic surgery procedure.  When do you want sedation?  When doing a longer procedure with larger areas where they may still have feeling in spite of the local anesthesia, like scar tissue or when working under the muscle.  When you have a longer procedure it’s difficult to lay in one position for hours.  The local anesthesia may wear off and need to be freshened or it will become uncomfortable.  My goal for all my patients is to have everything as painless as possible on all levels.  When you do it under strict local anesthesia, there is always some amount of pain involved.

Another issue has to do with the regulations of surgery centers.  In California, if you do plastic surgery with sedation or general anesthetic, the facility has to be licensed by an agency that licenses surgery centers.  Currently there are two main ones AAAHC and AAAASF.  I actually do inspections for the latter.  When you pass inspection for unique standards of organization, cleanliness, accountability, and safety that means that your physical plant has been approved, it also means that you have hospital privileges for the procedure being done.  However if the procedures are under straight local anesthesia, you do not need to meet the strict standards of the physical plant or hygiene and safety accountability.

That certainly doesn’t mean that everyone promoting, “local anesthesia only procedures,” is doing it to avoid regulation of shoddy or dangerous conditions, but… let the buyer beware.

What about general anesthesia for plastic surgery procedures?  Even when using lots of local anesthesia some surgeries are very stimulating to the nervous system.  This is because local anesthesia blocks the pain stimulus but not necessarily pressure, pulling or heat.  One of the worst horror stories I’ve heard about local anesthesia revolve around a patient that had a breast augmentation under local anesthesia, with some sedation, and “woke up” in the middle of the procedure and was told to be still,” because we have to finish.”  They felt and  experienced much more than they wanted to.  Sometimes you need what is called muscle relaxation sedation to do what you need to do, i.e., put in a breast implant or suture up the abdominal muscles.  A light general anesthetic is perfect for a breast augmentation, mommy makeover or total facial rejuvenation such as a facelift because it keeps you perfectly comfortable for those longer procedures and often times actually requires less total medication and sedation.

In summary: straight local anesthesia is great for very small procedures. But IV sedation or   general anesthesia are better solutions for making the patient comfortable for many plastic surgery procedures.  My goal for the patients is a painless plastic surgery, and local anesthesia is not the best way to achieve  that in every case.

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  • Andrew Kaczynski, MD

  • Advanced Concepts in Plastic Surgery
  • 77 Cadillac Drive, Suite 170
  • Sacramento, CA, 95825
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  • Granite Bay, CA 95746
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