Celebrity Breast Reductions on the Rise

Celebrity Breast Reductions on the Rise

The breast lift, or mastopexy, and breast reduction are two of the least-discussed cosmetic surgery procedures, but they are two of the most important. My patients, and indeed patients in general, are overwhelmingly satisfied with their results. And, these two operations are among the fastest growing plastic surgery procedures, with the number of procedures performed up 70% in the period 2000-2014 according to the American Society of Plastic Surgeons (ASPS).

Now, as more celebrities discuss their plastic surgery procedures openly, we are seeing public figures also beginning to discuss these breast procedures, including a very recent post by Amber Rose on Instagram, Queen Latifah's interview to People, and even Kris Jenner.

Top 5 Plastic Surgery Trends to Watch in 2017

In elective plastic surgery, there are the mainstays like breast augmentation and abdominoplasty, or tummy tuck, but advantages are being made continuously in surgical technique. Societal trends also evolve over time. In 2017, we will see the continuation of trends from 2016, and the continuing adoption of some new and exciting recently approved treatments.  Below, I lay out some the top 5 trends for 2017 based on what I have seen recently in my practice.

Breast Implants: Round versus Anatomical (Shaped)

Breast augmentation is the most popular plastic surgery treatment and has been for several years. When deciding to undergo this surgery, I discuss with my patients a few of the choices they need to make pre-operatively. In order of importance, the main choices to be made are...

What is abdominal etching?

Plastic surgery isn’t just for women! The image above contains the pre-operative appearance and immediately post-operative result, the patient is still on the operating table, of a recent ‘Abdominal Etching’ procedure I performed. The popularity of this surgery is on the rise, possibly in concert with the continued popularity and advancement liposuction techniques or because the stigma of men undergoing plastic surgeon is declining. The majority of patients who seek this operation are men, but women can benefit as well. When performing this surgery on a female patient, I would seek to create a slightly different result as most women do not want a fully articulated six pack in the same way a man does.

In this operation, I perform targeted small volume liposuction at each of several sites in the abdomen to enhance the appearance and contour of the abdominal muscles. The procedure takes 1-2 hours and recovery time is around 2 days before return to work. The patient should wait approximately a month before vigorous abdominal exercise. This patient of mine looked great on the table after the surgery, and he is going to be very satisfied with his ultimate result.

Abdominal etching exemplifies the fact that liposuction is not a weight loss tool. While a pound of two may be “lost” while undergoing liposuction, it is actually dangerous for patients over a certain weight to have the procedure. Liposuction is appropriately used as a contouring and sculpting tool, not a tool for weight loss.

Abdominal etching is a great procedure for those with stubborn abdominal fat who wish to improve the appearance of their abdominal contours. Great for the beach!

Behind the Scenes: Filming a "Mommy Makeover" Patient Feature

Although I've now been filmed several to many times for various news programs and television shows, I never find it boring or too easy. It's still a challenge to speak fluidly without interjections and to make eye contact with a machine! I always get a few jitters before going on camera. While I am completely at home at the operating table or talking to a patient one on one, film seems a bit more intimidating even though very often the television program interview mirrors questions patients may be asking me in my practice. 

Here, we are filming a new segment on a patient's "Mommy Makeover" procedure. Both myself and the patient were filmed answering questions about the surgery. This patient will undergo two surgeries done at the same time: a breast augmentation to raise breasts deflated after bearing a child and a tummy tuck, or abdominoplasty, to remove the stretched out skin and stubborn pad of fat left over from pregnancy. For the patient, she discussed why she wanted the procedure, her expectations of the surgical outcome, and her biggest "must haves". I then talked about a couple of tricky bits of the surgery particular to this patient and how listening to her desires and questions led me to the approach I will take in the operating room.

I'll let you know when it airs!

Buttock Implants versus Fat Grafting

Buttock augmentation has very quickly become one of the most popular cosmetic surgical procedures performed worldwide, and one of my favorite to perform. Its rising popularity is possibly due to celebrity trends and to evolving societal ideals of beauty. There is something of a question though as to how to best achieve augmentation of the buttocks: the most common approach is the classic “Brazilian Butt Lift”, where fat is removed from the abdomen, flanks, back, or thighs via liposuction and then grafted into each buttocks. It is really two surgeries combined into one; whereas the extracted fat from liposuction would normally be discarded, it is reused in the Brazilian Butt Lift. But, while one of the less popular implants on the market, buttock implants do also exist, and are made by reputable implants companies.

In my professional opinion though, the choice between the two options is relatively simple.  Grafting your own native, natural fat is by far the safest and most reliable choice, and produces a beautiful, natural, and long-lasting result.  

Implants in the buttock area are fraught with complications:  infection, moving or shifting of the implants, and breakdown of the surgical incisions are all commonplace. Fat grafting, on the other hand, risks nearly none of this.  Through tiny (2-3mm) incisions, fat is removed via liposuction from the stomach, waist, and lower back, then transferred to the buttocks and hips. In addition, I believe that the result from buttock implants often looks less natural than that from fat grafting.

Truly sculpture of the body, the Brazilian Butt Lift leaves the patient with an hourglass waistline and beautifully full buttocks and hips - all with tissue that is her own.

Liposuction is a Sculpting Tool

Liposuction is an amazing tool to sculpt the body and eliminate unwanted areas of fat in the trunk, flanks, and stomach, but while it is possible to load a pound or two during the procedure, liposuction, or liposculpture, is not actually a weight loss tool. And, it can be dangerous if performed on a patient who is too overweight.

I performed liposuction on the patient whose before and after images are to the right, and removed approximately 300-400cc from the stomach, another liter from her flanks and lower back combined. This patient was a great candidate for liposuction, because you can see, she had a stubborn pad of fat especially in the lower abdomen pre-operatively that she was unable to get rid of through diet and exercise. Liposuction is a great tool for sculpting and removing that unwanted fat.

AAAASF, the governing body for medical safety of operating rooms, guidelines are that no more than five liters of fat should be removed at any one time. Therefore, the proper advice to anyone especially overweight is that weight loss is required before undergoing liposuction. If enough weight is lost, the patient may want to consider the more dramatic effects of an abdominoplasty, or tummy tuck, surgery. The guidelines for a maximum of five liters removed are as they are, because of the tumescent technique used in liposuction. This technique requires inserting almost the same volume of saline solution into the patient’s abdomen as the volume of fat being removed. The saline solution does two things: 1) reduces friction internally to allow the liposuction cannula to slide more easily and 2) makes little blood vessels constrict reducing bleeding intraoperatively.

This is the best in class technique, and it works really, really well. However, all that saline solution is absorbed by the body and changes the patient’s blood pressure. Too much fat removed means too much saline solution needed, which can put the patient into heart failure. I have seen on social media at least one practitioner, not a board-certified plastic surgeon, performing overly large volume liposuction to the point that his patients would have been better served by not being operated on and being asked to lose weight first.

Be careful who you trust to perform this and any other cosmetic surgery as it is real surgery. In liposuction in particular, your surgeon is acting as your sculptor. Choose a good one! The most common pitfall of liposuction is the lack of creation of smooth lines and contours: leaving irregularities, bumps or divots. It takes a fair amount of experience to create a natural smooth result in all liposuction candidates.

My Botox Brow Lift

In the video to the left, I’m demonstrating my “Botox Brow Lift” on one of my recent patients, which is a very neat little treatment that combats a very common side effect of aging: the brows fall over time contributing to a tired, more severe, appearance. This injection works well for those patients desiring a lift of the brows, especially laterally, but who do not wish to undergo a surgical option such as a brow lift or eyelid lift, depending on the particular issues and patient anatomy.

Injecting Botox in particular positions around the eye raises the brow laterally and gives the patient refreshed, rejuvenated look. The Orbicularis oculi muscle runs in an oval in concentric circles around each of the eyes; it is the muscle that allows you to squint. Due to the shape, some of the muscle fibers are vertical and some are horizontal. If you knock out, using Botox, only the vertical muscle fibers on the lateral side of the eye, the brow will pull upward. It's key that you undergo this treatment with an experienced practitioner, because it is near the eye.

I am very well-versed in this technique as you can see from the video, and I evaluate the patient’s anatomy around the eye similarly to how I would do for a facelift or for upper or lower eyelid surgery. Complications, such as having one brow higher than the other or even a sagging upper eyelid, are possible with the wrong placement of Botox or incorrect amounts. In addition, the shape of the brows is responsible for a significant percentage of our perception of facial character. Visit my social media Instagram post on Renee Zellweger’s poorly done Botox and the affected shape of her brows as an example. Consequently,

I make sure to make subtle changes in the brows with my Botox Brow Lift.

Can I have a Tummy Tuck during my C-Section?

Patients ask me frequently as to whether I can perform an abdominoplasty, or tummy tuck, at the same time as their C-section during the birthing process. It is true that the most common reason that women choose to undergo a tummy tuck is due to irreversible changes after pregnancy. Depending on a variety of factors such as genetics, many women are left with post-pregnancy changes including stretch marks, a stubborn pad of belly fat, excess skin, or excess side fat. These changes will often remain even if the woman is able to return to her pre-pregnancy weight, no small task in and of itself.

While the idea Tummy Tuck combined with a C-section may seem compelling and is technically feasible, it is the general consensus among plastic surgeons that it is not a very good idea. C-section is a significant surgery and is performed under similar conditions as an abdominoplasty, but during pregnancy, all the structures stretch out significantly including the skin, the muscle, and the fascia of the abdominal wall. When everything is so stretched out, I wouldn't be able to tell if I were getting a tight enough pull or not of the structures when performing the tummy tuck and closure. The elasticity of the skin isn't high enough.  

As a result, aesthetic outcomes are unpredictable and substandard and the complication rate is quite high. Problems of a combined C-section plus tummy tuck include unsightly bulges, excess skin, and problems with the belly button. Complication risks are infection and possibly fatal blood clots. Consequently, for both aesthetic and medical reasons, I advice my patients to give it 6 months after delivery before coming to see me! And ideally, if you plan to have more children, it is best to have a tummy tuck after all your children have been born.

Kybella: New FDA-Approved Injectable for Submental, under the Chin, Fat

There are many subtle ways that we judge fitness and weight level, and a pad of fat under the chin is one of the less obvious signs of weight gain. Unfortunately, submental, or under the chin, can also be genetic in nature. In either case, up till now, there was no non-surgical option to eliminate that fat.

Recently, the FDA approved Kybella, a new treatment that melts away under chin fat. The active ingredient is deoxycholic acid, which is a manmade form of a substance your body makes, an enzyme,  that helps to absorb fats and works by destroying, or dissolving,  fat cells where it is injected. Kybella is made by Allergan, the maker of Botox Cosmetic, so I trust its quality. It is being requested more and more by my patients.

I feel that surgery gives the more definitive solution to submental fat, but for those patients who do not wish to undergo surgery or who have a less dramatic issue, Kybella is a great option.Treatment is 1-3 to sessions of injections in my office that each take 5-10mins. I make each set of injections in a fine grid pattern to make sure the injectable is evenly distributed under the chin and therefore evenly removes the fat.

Khloe Khardashian recently became the spokesperson for Kybella in Allergan’s “Live Chin Up” campaign. She was asked in an interview if she thought that the “stigma” of injectables has disappeared. I thought her answer was quite a good one: “I wish injectables were treated more like makeup. I'm allowed to contour my face, I have nose contour and cheek contour on, highlighter on, I'm overdrawing my lips, and nobody really says that's crazy. I don't understand why. I basically put on a mask every day. I just really hope stuff like this becomes treated like makeup.” Botox and Juvederm, and soon Kybella, are extremely popular amongst my patients. I don’t personally see much of a stigma remaining; Khloe is right: it is essentially as common as makeup. Ms. Khardashian is not my patient; she is a public figure.

Come in and visit my office if you'd like to try Kybella!