Surgeons are physicians specializing in evaluation and management of problems treated and/or cured by surgery. Cognitive (thinking) and technical (operating) skills are required. To become a surgeon, I graduated at the top of my four year college class, near the top of my four year medical school class, then apprenticed as a surgical resident days, nights, weekends, and holidays in hospitals around the United States for ten years after medical school. Many subjects are mastered, including a foundation of basic sciences such as anatomy (gross and microscopic), biochemistry, physiology (healthy function of the body), pathology (diseases), microbiology (bacteria, fungi, and viruses), pharmacology (drugs), genetics, neurosciences, psychiatry, etc. During my decade of residency, benchmarks were achieved each year to advance to subsequent higher levels of responsibility and independence. We learned about the surgical specialties, saw thousands of patients, and worked with doctors in every area of medicine. Oral and written examinations administered by the American Board of Surgery and the American Board of Plastic Surgery were passed. Training and exams were rigorous and uncompromising, designed to assess cognition (knowledge, reasoning, and judgment), technical skills, and professional ethics. All are critically important for surgery. In practice for over twenty years, I still qualify annually by reporting continuing medical education and occasionally taking maintenance of certification examinations.
Why does this matter? Because quality outcomes can only be delivered in the context of high ethical, scientific, and technical standards. Treatments we recommend should have the highest possible benefit to risk relationship: The most upside and the least downside. Because everyone is different and unique, a treatment that is beneficial for one person may be a disaster for another. To differentiate among patients what is best for one individual, we surgeons must ask questions, i.e. learn about each patient in consultation. We must examine our patients physically to know their anatomy, to understand which treatments may work best and which may not be indicated. Sometimes, we must check additional blood tests, X-rays, or other studies for more information. All that data is analyzed, options for treatment are considered, discussed with patients, and a mutually agreeable treatment plan developed. Every patient should be approached with this stepwise sequence of gathering and verifying information, analyzing the information, prioritizing possible solutions based on the presentation, finalizing a plan, and only then, implementing treatment.
As an aesthetic plastic surgeon, our office fields constant calls for this peel or that product, the latest lunchtime lift, mini-tuck, or new device, diet, or implant. Usually, callers read about it in a magazine, saw a TV show (“The Doctors”), or saw advertising. Media is a business, and media exposure is bought by business. The end game of business is sales. Sales are not necessarily about what’s best for YOU. Sales are about revenue for the manufacturer, producer, and/or marketer of techniques, devices, products, and services. We implement new information and technology in our treatments, but only as appropriate in the upside to downside calculation for each patient.
Nobody comes to us for surgery, people come for results. We specialize in results, not in procedures. Procedures are only means to an end. Often, there are several possible operations that will achieve slightly different results. Results are the solution to a problem. The problem must be properly analyzed first, and treatment solutions follow. Inquiring about solutions, whether a new product or a new procedure, before understanding and analyzing the problem is backwards.
By all means, ask about new treatments and technologies, we’ll answer your questions. As a layperson, you’re not expected to know science, biotechnology, and the human body. But you DO know, more than anyone else can ever know, what bothers you when you look in the mirror or at a photograph of yourself. You know your problem, and in our office, that’s all you need to know. We’ll discuss the rest, and decide with you which solution is the best.
Hands are among our most important body parts, but we rarely think about them. As instruments that accomplish our will, it’s difficult to imagine life without them. Think about all our hands do for us throughout our life.
As children, our hands helped us explore and learn about our big, wide world. They steadied us as we learned to walk, caught us as we fell, helped us get back up, and tied our shoes for the first time. Hands feed us and clean us. Their gestures communicate meaning to others. Hands are our most important tools for lifting, carrying, grasping, and manipulating. Our hands use man-made tools for writing, grooming, driving, sports, making music, building, and for every activity in our daily life. We’ve used them to dry the tears of loved ones. Our hands might have a shiny, metallic ring on them as an exclamation to the world that we’ve found the love of our life. They also might have trembled and shook as we held our children for the first time or as we said good-bye to a loved one for the last time.
Our hands have always been there for us. Our hands and faces represent us to others. Our hands are always on display. A large portion of the grey matter in our brain is devoted to the functioning of our faces and hands. Perhaps that’s why they are the two leading characteristics of our body image and self-esteem.
When it comes to our faces, we are experts with our anti-aging routines-cleansers, toners, masks, scrubs, serums, oils, creams, oh my! But when it comes to our hands? Yeah, not so much. Even if we do have an anti-aging hand-care regimen, we often apply it only once or twice a day and rarely reapply after every hand wash. It’s no wonder that our hands can be a dead giveaway of our age. But that needn’t be the case for these sun-exposed appendages that do so much for us.
Hand rejuvenation therapies have been around for years, and help our hands look younger. As we age, skin and soft tissue on the exposed areas of the hands changes (‘tis a cruel joke that the fat seems to leave our hands and go to our stomachs and thighs). Hands lose fullness of contour, and skin elasticity diminishes. Knuckles may appear more prominent. Veins and tendons may impart a bluish color and bumpy texture. Sun exposure and other influences add tan or brown irregular patches or spots, and the skin becomes loose and wrinkled.
Treatment with a soft tissue filler restores lost volume and improves the appearance of aging hands instantly. Radiesse® is a natural product (Merz Pharmaceuticals) that we’ve used successfully for this application. Radiesse® is FDA approved to use with lidocaine (an anesthetic) to reduce discomfort of the injection. The filler is massaged into place and hands appear softer and smoother.
Radiesse® lasts for about a year, so treatment may need to be repeated. However, it has been found that Radiesse® has some long-term benefits as well as. It can actually stimulate natural collagen production in the treatment sites thus helping the skin’s matrix repair itself over time.
Other hand rejuvenation therapies improve skin surface aging: Our GOLD Rx resolves pigment spots and stimulates collagen production within the skin. Laser treatment or Intense Pulsed Light fades surface pigment, and sunblock should also be applied on top of the hands to protect these sun exposed areas and prevent further aging changes.
Greeting others with our hands is a universal element of humanity. Every culture has a greeting involving hands…a hand shake, a wave, a salute. Hands are always on display and should match the age of our face. In caring for your face and body with your hands, don’t forget the hands themselves!
I am a thirty-eight year old, married, mother of two. I’m five foot three inches tall with size 32A breasts.
While a 32A is technically not completely flat, my breasts are small enough that I’ve never felt like a real woman before. I’ve always felt like a little girl, prepubescent. Society tells us that women have breasts. Am I not a woman then if I don’t have any?
I will say though, that I have a very healthy self-esteem. I’m not perfect, but I’m very happy with my appearance. I’m not tall, but I am very slender. I’ve got small, size six feet that always fit the cute (and usually discounted) display shoes at the department stores. I have a long neck with defined shoulders and upper back which I love
highlighting by wearing my hair in a French twist. And I have a great ass. But my breasts…
All my life people have been commenting on my small, childlike breasts. Why is it a faux-pas to talk about how large a person is, but nothing is off-limits when having public conversations about the smallness of one’s size?
Over the years I’ve had many embarrassing memories about my small breasts.
I remember being high school age when the topic turned to breasts. An acquaintance (and I use that term loosely) felt compelled to announce to the whole group that my boyfriend’s breasts were bigger than mine and of course the group erupted in thunderous laughter. This conversation happened over 20 years ago and to this day my heart still sinks when I think about it. After all, your man is not supposed to have bigger breasts than you. Not wanting to experience that feeling again, I started my search for padded bras.
A few years later came one of my favorite inventions…the Frederick’s of Hollywood, infamous Water Bra. Padded bras never worked for me. There was no jiggle, no softness when you hugged someone. The cups always had a fake shape to them. The Water Bra solved this. Until that is, you decide to get intimate with someone for the first time. The most embarrassing was the first time with my now husband. I had a horrible crush on him for SEVEN years before we finally started dating, so that’s A LOT of build-up. However, and to this day he makes fun of this…the lights were out, we were getting romantic, and he undid my bra, only to hear a loud “thud, thud” as my Water Bra hit the floor. How’s that for romantic? He still calls that my “false advertisement” bra.
After I got married and had my kids, I was not nearly as concerned about my breast size. Were they still small after kids? Yup. And as if possible, a little saggy. But around my early 30s, I stopped caring so much about what other people thought about my breasts and I ditched my Water Bras and my Victoria’s Secret Bombshell Bras. I went to simple shaped cups or on the very rare occasion I could find them, lace cups. Shopping for bras though still had me feeling like a little girl. Especially when the best selection of bras in my size were in Target’s girl department. Have you ever been in the girl’s department of a store and seen the look on another woman’s face when you are looking at clothes and hold them up to yourself to gauge size? I’ve got to say, you don’t feel so hot, sexy or sultry shopping for bras when you get that awkward and sometimes dirty look when the other patrons realize you are indeed shopping for yourself all the while they are shopping for their young daughters.
It wasn’t until a few years ago that I started seriously considering breast augmentation. I wasn’t a “clubbing” 20-something year old wanting attention. I had already had my kids. I have a healthy marriage. I didn’t want “giant jugs” or “melons”. I wanted to be able to buy beautiful and sexy lingerie, and have it fit. I wanted suit
jackets and fitted bodices to not look like the sails of a ship in dead wind. I wanted to feel like a woman.
A few times I almost did it. It’s weird though. It seems that when I don’t have the funds for the procedure, that’s when I’m ready to have it done. But when I do have the funds, I worry about being judged about my decision.
I have friends who have had it done. And I think some of them look good. Others are too big for my personal aesthetic. One I had absolutely no idea that she had them done until she confided in me. That’s how great they looked!
Most of all, though, I worried about what my mom would think. Growing up (as she has breasts just as small as mine), she would tell jokes about herself, such as “I’m a carpenter’s dream! I’m flat as a board!” or “I’m a pirate’s dream! I’m a sunken chest!”. It’s odd that at the same time she was expressing pride at her small girls, she was
inadvertently putting them down. That mentality was passed on to me as well, as I’ve been known to say on occasion that I need a t-shirt that says “In Case of Rape, This Side Up.”
I have always wondered what my mom thinks about breast augmentation. Growing up, she never mentioned it. She did however mention how excited she was when during menopause, the “boob fairy” visited and increased her breasts by a full cup size. I’m fortunate enough that my mother is still with me, so I think I might actually
tackle this scary idea and get up the courage to talk to my mom about breast implants.
One thing for sure that I can tell you is that I am 100% ready to take the plunge to finally be able to wear a plunging neckline. I’m saving up for the procedure and hope you will follow along in my journey as I learn everything I need to know about getting the breasts that I have always dreamed of.
You want the best result, and the best surgeon. How can you tell? Truthfully, the surgeon with the highest standards for his or her own performance reliably holds the highest standards across the board. The best surgeon will have the highest level of training and certification, and will offer you the best care, and likely the best result.
So how can you know? Plastic surgeon or cosmetic surgeon? The differences may surprise you. Because of common misconceptions surrounding cosmetic plastic surgery, you should understand what’s behind the scrubs and the white coat.
Operations that improve the human body are called Plastic Surgery after the Latin plasticus: that may be molded. The two types of plastic surgery are reconstructive surgery, after injuries, and aesthetic (cosmetic) surgery, to improve appearance. Cosmetic surgery is only a part of plastic surgery, but to perform it well, the physician must be fully trained in the entire specialty.
1. All plastic surgeons are cosmetic surgeons but not all cosmetic surgeons are plastic surgeons.
Board Certified Plastic Surgeons have more training and ARE qualified to perform both reconstructive and aesthetic/cosmetic surgery.
A Cosmetic Surgeon is NOT certified to perform plastic/reconstructive surgery.
2. The American Board of Plastic Surgery (ABPS) is the ONLY board approved by the American Board of Medical Specialties (ABMS), which accredits surgical training programs.
Plastic Surgeons ARE certified by the American Board of Plastic Surgery (ABPS).
The American board of Plastic Surgery does NOT acknowledge Cosmetic Surgeons.
3. Don’t all certifying boards have high standards? My surgeon said he’s board certified.
Confirm not only that that your doctor is “Board Certified,” but that he/she is certified by the American Board of Plastic Surgery (ABPS).
Cosmetic Surgeons who claim to be board-certified may have received their certificate from the American Board of Cosmetic Surgery; the American Board of Medical Specialties (ABMS) does NOT recognize this board.
4. Is my surgeon trained to perform my surgery?
After graduating medical school, a Board Certified Plastic Surgeon must be selected among many applicants for residency training in Plastic Surgery. If chosen, the physician learns how to be a surgeon for three to five years, then trains for at least three more years in plastic surgery. Training involves closely supervised continuous evaluation and management of many complex clinical situations, and matures the surgeon personally and professionally. Successful completion of the post-graduate residency years qualifies the surgeon for written and oral examinations administered by the American Board of Plastic Surgery. Surgeons must submit an entire year of his or her surgical accomplishments for the exam. Surgeons are not eligible for the exam until they have been practicing plastic surgery independently for two years or longer.
There are no such requirements for Cosmetic Surgeons. Cosmetic surgeons are doctors who merely decide to perform cosmetic surgery in their practice. The may be certified in any medical specialty such as a gynecology, dermatology, family physician, ear,-nose-throat, etc. Their training may consist of several short weekend courses to a one-year cosmetic surgery fellowship.
5. Why do hospitals and surgery centers only allow doctors certified by the American Board of Plastic Surgery(ABPS) to perform cosmetic procedures?
Because they know the difference! Board Certified Plastic Surgeons CAN perform both reconstructive and aesthetic/cosmetic surgery in hospital or outpatient surgery centers.
Cosmetic Surgeons are NOT privileged for cosmetic surgery at these facilities and are not allowed to perform reconstructive plastic surgery. For this reason, cosmetic surgeons usually perform surgery in office based operating rooms.
6. The American Society of Plastic Surgeons (ASPS) embraces excellence in plastic surgery. Education, research, intellectual exchange and promoting unity are core values.
Only doctors certified by the American Board of Plastic Surgery(ABPS) can become a member of the American Society of Plastic Surgeons (ASPS)
7. The American Society for Aesthetic Plastic Surgery (ASAPS) is an exclusive privilege and requires proven excellence in aesthetic/cosmetic plastic surgery.
- Members MUST be certified by the American Board of Plastic Surgery(ABPS).
- Participate in accredited Continuing Medical Education (CME) programs.
- Document the performance of a significant number and variety of cosmetic surgical cases to demonstrate a wide range of experience
- Be sponsored by two ASAPS-members to ensure that the applicant’s professional reputation meets the high standards required by The Aesthetic Society.
- Abide by ethical standards for professional conduct outlined by the Society’s Bylaws, Code of Ethics, and Conflict of Interest Policy observed by all ASAPS members.
ASAPS does not offer membership to doctors who are trained in specialties other than plastic surgery; therefore Cosmetic Surgeons do NOT meet these requirements.
For cosmetic surgery, your safest choice is a surgeon certified by the American Board of Plastic Surgery who is also a member of the American Society of Plastic Surgeons and/or the American Society of Aesthetic Plastic Surgeons. Quality is the difference.
“Doctor, how long will my surgery take ?”
Before surgery, most ask how long the procedure will last? Behind the question lie mixed emotions. Although the anesthesiologist and I are trusted, you relinquish all control over your face, your body, and your life during a procedure under general anesthesia. Your trust in us is total and complete.
So how safe is general anesthesia? Is a short procedure safer? Given the choice between a shorter face lift or “mini” lift and a longer face lift, should you be afraid of a longer surgery? The answer is, NO, you should NOT be afraid of a longer face lift, YOU SHOULD WANT IT. General anesthesia is VERY SAFE, and longer procedures offer the best, safest, and longest lasting result, generating true value for many years afterward. Consider an analogy: If you hire painters for the exterior of your house and the job lasts six hours vs. twelve or twenty four hours, assuming the same number of workers, the results would be significantly different. Looking in all of the corners, the window panes, around the foundation and gutters, the shorter job will have skipped and missed areas. The coat will not be as thick or durable. Quality always takes time and effort, and higher quality takes more time and effort.
Similarly, not all face lifts are created equal. Our ability to correct aging features has advanced dramatically in recent years. Contemporary face lift offers more natural and beautiful results than ever before. Details of anatomy and technique that improve your result demand from your surgeon extra knowledge, more time to execute successfully, and greater attention to detail. Face lift procedure time is longer, but your result is improved and your procedure is safer. Better outcomes require longer procedures. Advances in anesthesia have allowed this progress without increasing risk or compromising your safety.
If your surgeon plans a “quick lift,” a “lunchtime lift,” a “mini-lift,” or other abbreviated version, you will likely see improvement, but how much will this be and how long will it last compared to the longer version? The answer to this question varies, but in general, you are losing value with the “abridged” or “condensed” version. Often marketed as “new and improved,” quick lift is actually the 1960’s model: cut & pull. Minimal surgery means minimal results. Longer lasting, modern face lift incorporates many advances. Today’s face lift is not just an operation, it is a masterful work of art individualized to reverse aging features by re-positioning sagging tissues into their youthful location and by securing them for a long lasting correction. During the operation, localization of important structures like nerves, vessels, and ligaments adds time, but improves safety of your procedure by preventing complications.
Quick surgery shows in the quality and durability of the result. Quick surgery glosses over details. The surgeon who performs “quick” or “mini” surgery is focused on time and likely on business, NOT on YOU and YOUR RESULT. Quick surgery is never as thorough, careful, or comprehensive as state-of-the-art. If you’re only planning one face lift, for your own sake, DON’T make it a quick one!
A new book by Tamarin Lindenberg entitled “Female Cancer; The Vital Role of Self Perceived Beauty in the Healing Process,” explores the relationship between quality of life of breast cancer survivors and the actual and perceived appearance of their post treatment breasts. Ms. Lindenberg finds that improved appearance of women’s breasts correlates with improved “body confidence, sexuality, and the ability to move forward” after mastectomy with or without chemotherapy, radiation, and other cancer treatments. Her research included women from several areas of the United States. Tamarin, a cancer survivor herself, interviewed many women to understand in more detail the impact that quality of care, most specifically the quality of their breast reconstruction, has upon their self-image and feminine identity.
An important part of Lindenberg’s investigation was her selection of women from various income and ethnic backgrounds, and her collection of the most intimate thoughts and impressions of her female subjects. Although her work continues as Tamarin resumes graduate work following her life changing cancer ordeal, she has already confirmed by revelations from others what she knew from her own experience: The powerful impact of self perceived beauty upon the life of a woman. Ms. Lindenberg has assembled a team of professionals to further help in her work, and is documenting her efforts at CALIEB (Care and Love In Every Blessing).