News

My Breasts, My Face, My Body

October 22nd, 2007

Monthly column for www.rasaspa.com written by Anne Marie Cummings.

One of New York’s Top Cosmetic Surgeons Fully Informs

I’ve never been one to think I would ever want or need cosmetic surgery. In fact I’ve often viewed it as something like the surreal experience depicted in the movie Brazil where a “surgeon” took a roll of plastic wrap and stretched it around and around an elderly woman’s face and head until it was perfectly molded to his liking. This of course, has nothing to do with cosmetic surgery today, or ever in the history of mankind. Yet I am sure that I am not alone in my ignorance when it comes to the subject of breast implants, liposuction, face lifts and non-surgical treatments that many men and women comfortably receive all over the world.

After speaking with Dr. Beverly Friedlander, my limited and rather childish impressions have been altered. Rated as one of New York’s top cosmetic surgeons, Dr. Friedlander has more than twenty years of experience performing a variety of cosmetic and reconstructive procedures; she has taught me to appreciate today’s options regarding body contouring. In taking a closer look at my own skin, as I inch my way closer to forty, I can see that some day I may even consider a few non-surgical fillers here and there. And who knows what else I may do twenty years from now, since the industry is continually growing and offering easier and more attractive ways to deal with aging. No matter what I do, I can assure you, I will be contacting Dr. Beverly Friedlander. Her attention to detail during our interview gave me the trust I would demand before letting her transform any part of me.

Section One: The Breasts

What do you think makes you one of the top cosmetic surgeons in New York?

I think I’ve been ranked on the basis of skill, outcome, training, compassion, and the fact that I understand the needs of my patients (90% are women).

How do the physical and emotional changes that occur as a result of pregnancy and breast cancer affect your work?

During pregnancy, the body changes extensively and it changes out of necessity. The breasts enlarge during pregnancy to provide nourishment for the newborn child. Once nursing is discontinued, the breast tissue shrinks to some degree, leaving skin that is stretched out, and frequently droopy in appearance. A lift may be needed to tighten the skin, and an implant may be needed to restore the size and shape. As for the abdomen, the skin stretches to accommodate the growing fetus. After birth, some loose skin and loose muscle remains, so we do a procedure called a tummy tuck where excess skin is removed and the muscle is tightened. For breast cancer patients, we can create a new breast, bringing the body back to a “normal” appearance. Surgery is very rewarding, for both the surgeon and the patient, as we are restoring self-image, and, more importantly, self esteem.

The risks of breast implants are?

It’s important to know that all surgery has risks. When I meet with patients I always discuss the risks of the surgery (as it may relate to their personal history), the general risks of implants, and the differences between silicone and saline implants. I cover all the major risks. I would encourage any reader interested in plastic surgery to visit the website of The American Society of Plastic Surgery (http://www.plasticsurgery.org/) and the website of The American Society of Aesthetic Plastic Surgery (http://www.surgery.org/). These sites are not commercially biased, and provide a wealth of information.

You place the breast implant behind the pectoral muscle. What other options are there?

There are two options. The implant may be placed behind the muscle which is the most common position, or in the front of the muscle. Placement of the implant behind the pectoral muscle gives a more natural result. This is the preferred position for mammograms as well. Please explain the differences between saline and silicone implants. Silicone implants are FDA approved and were released to the general market in November, 2006. Silicone is softer and more natural in feel and appearance. In patients with thin skin or minimal amounts of breast tissue, the silicone will create a soft, natural appearance. Saline implants are filled with salt water. They are advantageous in women with breasts which are different in size, as the saline implants can be filled with different amounts of fluid at surgery. Both implants can be used for cancer reconstruction, but there are many other options for post mastectomy reconstruction that should be considered as well.

What causes an implant to rupture? And how is that fixed?

Most often implants rupture spontaneously with no trauma associated. Saline leaks cause a deflation of the implant. Silicone leaks are often silent. Silicone implants that are currently on the market are different from those that were on the market in the 80’s. They contain a thicker gel that tends to stay in position if the shell gives away. The FDA recommends that women with silicone implants get MRI studies to detect a silent leak. Ruptures are not that frequent. Published rupture rates are 4% in 4 years (Inamed Core study). The treatment for a rupture is replacement.

Is a patient who likes extreme sports or activities (even an acrobat in Cirque du Soleil) in more danger of having her implant rupture?

I have patients who have gone scuba diving, sky-diving, you name it, and none of those women have come back to me with ruptures. I don’t think extreme activity is going to pre-dispose a rupture.

Does it feel like something foreign is in the body when you have breast implants?

Silicone feels incredibly natural. Many times, you can’t tell an implant is present. With saline you can sometimes feel a rippling or an irregularity, like water in a balloon. The saline is a little firmer than the silicone.

Why do some women look artificial after cosmetic surgery? Is it because they do it over and over again? (examples: Meg Ryan’s lips, Joan Collins’ face)

Regarding the breasts, an artificial appearance may result if the implants are placed on top of the pectoral muscle or the implants are too large. As far as the artificial appearance you’re referring to with Meg Ryan’s lips, this occurs as a result of repetitive procedures or excessive fill. A lot of the fillers are temporary, so they do need to be maintained.

How often do you deal with individuals with Body Dysmorphic Disorder (BDD)? How can you tell if they have this disorder? And what do you do in these situations?

There’s actually a short questionnaire, the responses to which can be highly suggestive of BDD. Typically, it’s an instinctual feeling I have that a patient may have unrealistic expectations or is nit-picking regarding one specific area of his or her body. What I try to do is identify patients who are realistic in their goals.

Have you ever declined performing surgery on someone? If so, what were the reasons?

Yes, I have declined performing surgery for several reasons. The first is the patient has medical problems. They could be on blood thinners or they’ve had a recent heart attack. Also, I decline smokers for certain procedures such as face lifts. People who smoke don’t heal as well as non-smokers. It’s imperative to check all of a patient’s medical history.

What if a patient smokes marijuana?

There are no studies suggesting that marijuana affects the healing process that I’m aware of.

Section Two: The Face

What happens to the skin as we age?

The skin becomes thinner, loses moisture, and does not regenerate as quickly. It loses elasticity causing wrinkles. Gravity pulls the skin downward leading to deep folds, jowls and neck deformities. One of the ways I restore the facial appearance is by using fillers to plump it up. Fillers such as Restylane, Juvederm, Radiesse, and Sculptra, are examples. Surgical treatment consisting of a face lift is sometimes required to restore a youthful appearance.

When do you know your upper and lower eyelids are ready for eye surgery?

Many patients complain of looking tired or angry. They may have excess skin and or puffiness. This is typically related to genetic factors and aging. Both the upper and lower eyelids are subject to these changes which are easily remedied by surgery. Patients can be ready for eyelid surgery in their thirties or later.

Can people get away with having eyelid surgery and nothing else? Or should they have an entire face lift?

Facial aging frequently starts within the region of the eyes. Fine lines and crow’s feet wrinkles are typically an early sign. Many people will benefit from having eyelid surgery simultaneously with a liquid facelift (using fillers to restore facial balance and harmony.) There are a variety of fillers which I use, depending on the area being treated. As we continue to age, face lifting becomes necessary to tighten the skin and facial muscles. Not every patient requires the same treatment.

The areas of the face that are worked on for a face lift are?

Typically the lower face, that is, the jaw-line and the neck. The upper face is addressed with a brow lift and eyelid surgery and the mid-face (or the folds between the mouth and the nose), is typically addressed with mid-facial techniques or fillers.

What are some of the things women can do to naturally prevent wrinkles from around the eyes and face? I use eye creams but never see a difference.

The benefits of eye creams can be mild for someone with a good genetic background and limited sun exposure. However, changes to the skin around the eyes and on the face become visible once women have reached their thirties. I can’t begin to stress the importance of sun screens and skin care products which stimulate good skin health. It’s important to use creams that have a specific goal in mind such as Retnin-A, which stimulates collagen; Vitamin C, which is an antioxidant and protects against sun damage; and alphahydroxy acids which are exfoliating agents that help cleanse the skin. If specific issues are addressed by the products you use, you should see a difference. You want a product that is going to penetrate into the skin and provide your cells with their specific needs.

Regarding protruding “dumbo ears” – how often do you do the procedure to correct this problem? Who was the youngest person with this problem that you helped?

This is not a common procedure these days. By the age of five, the ears have reached 85% of their growth. The youngest person I’ve performed this type of surgery on, was five. I’ve also operated on patients in their thirties who have always been bothered by their ears but did not have the financial means to take care of them as children.

Section Three: Liposuction

Regarding liposuction? How do patients maintain their new look after surgery?

By maintaining a healthy diet and performing moderate exercise regularly.

Why are certain parts of the body resistant to diet and exercise, such as a pot belly, heavy thighs and heavy arms, for example?

The answer simply is heredity. Patients with isolated deformities resistant to diet and exercise can have excellent results with liposuction.

Have you ever had complications when performing surgery? Have any of your colleagues in the industry?

Complications with plastic surgery are uncommon. Any surgeon who has performed thousands of procedures will have had complications. I think if you screen the patient to make sure they are healthy and have no contraindications to surgery, you can decrease the likelihood of complications.

Section Four: The Future

How do you think cosmetic surgery will grow and improve by the year 2020? What will the positive changes be? What will the negative changes be?

We have already seen an increase in cosmetic surgery in the last decade, and I think more and more people are comfortable having it as a result in part from the media attention. Non-surgical procedures such as fillers and laser have become very popular. Off the top of my head I can’t think of any negative changes.

Is there anything you dislike about your profession?

The one thing that I truly dislike is that there are poorly trained doctors who merely claim that they can perform plastic surgery well. This gives the profession a bad name when you hear about problems regarding plastic surgery. It’s important that patients be certain that the physician they interview is certified by The American Board of Plastic Surgery and has the proper experience necessary to perform a procedure.

To learn more about Dr. Beverly Friedlander, go to www.doctorbev.com or call her office at: (973) 912-9120.

 

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