A plea for honesty about cohesive implants-

Posted on July 19, 2010 under Breast, Breast Augmentation

There continues to be confusion surrounding the different types of silicone implants, specifically regarding what is and what is not a “cohesive” or “gummy” implant.  I beleive that some of this confusion is, unfortunately, being caused by other Plastic surgeons who, either through ignorance or intentional misdirection, are misinforming patients.  I have seen a number of breast augmentation consults who have been told by other surgeons in the Denver community that the silicone implants currently approved by the FDA are “gummy” implants and won’t leak if they rupture.  As has been stated elsewhere in this blog, this is simply untrue.  All of the implants approved for first-time augmentation patients are NOT what should be correctly known as “form-stable, cohesive” implants.  If they rupture, they will leak, despite the aggressive marketing campaigns of certain companies that suggest otherwise.  (I am an investigator in the Inamed 410 trial, and so I am allowed to use form-stable, cohesive implants for some types of revision patients.) 

Why the misdiretion?  I can only think that some surgeons simply don’t know what they’re talking about, or are being less than honest in an effort to convince patients of the safety of the current silicone implants.  Either way, it’s inexcusable.  Patients cannot make a fully informed decision unless they know what the real risks and rewards of various choices are.  There is a new website created by several of the country’s foremost experts on breast implants which contains a wealth of information surrounding cohesive implants.  I would anyone interested in the topic to peruse its content, patients and surgeons alike-

Dr. Wolfe

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How fantastic is liposuction?

Posted on July 9, 2010 under Body

Liposuction can create wonderful body transformations. Localized areas of fat excess can be reduced, leaving behind a person’s natural, more attractive body contours undisturbed by these bulges. BUT… as I was reminded this morning during a consultation with a patient that had previous liposuction, it has it’s limitations. A 43 year old woman had lost about 50 pounds leaving her skin a bit more lax than others her age. She had previous liposuction of her tummy and hoped to have more performed in that area. Unfortunately, her prior procedure created an unnatural appearance with some contour waviness and over-flattening of her lower abdomen. Nonetheless, when she grabbed her tummy, she could create a roll of skin and fat, so she reasoned that more liposuction was the answer. I discussed with her that further liposuction would not be advisable because it does not tighten skin and would only worsen any contour irregularities that she already has. In all likelihood, I would probably not have recommended liposuction of her abdomen in the first place.

This is a common scenario that I see daily in consultations: women that get a “muffin top” over their pants and understandably determine that liposuction is the answer to their problem. Unfortunately, when the jeans are released, no localized bulge exists! In these situations, liposuction is not the solution.

So how do you figure out what to do when frustrated with your body contour in the mirror? If you look hard enough, you’ll find the answer you want to hear. The internet will surely provide content that supports any desired conclusion. If you want to hear that liposuction will tighten skin, you’ll find it. If you want to hear that liposuction will carve out a waste, you’ll find it. If you want to hear that liposuction can chisel out six-pack abs, you’ll find it. But if you want to really find out the truth about the benefits of liposuction, it’s all in the pictures. Before and after pictures taken of real patients shows what can truly be achieved. Perform an honest evaluation of your bothersome areas in the mirror and then go online to find pictures of women with similar situations. If you can’t find the results you want, it may not exist. 

Liposuction must be used properly. In my opinion, most bad results or unhappy patients after liposuction are the result of poor patient selection. In other words, usually the problem isn’t a poorly performed procedure, but a poor choice in performing the procedure! I tell everyone that I meet during a consultation that liposuction is the most over-hyped, over-marketed, and over-performed procedure in plastic surgery. But when it’s used correctly on the right person, liposuction can be fantastic.

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On the perception of aging…

Posted on July 7, 2010 under Face, Face Lift, General Plastic Surgery

A patient I recently saw in consultation for a Mini-facelift asked an interesting question: “Do facelift patients have a hard time adjusting to their new, younger appearance?”  Without hesitation, my answer was “No”. As I thought about it, I realized why, and a quick internet search confirmed my suspicion.  A common comment from patients is, ”I’m here for a consult because how I look doesn’t match how I feel.   This study indicates that most people, and baby boomers in particular, feel younger than they look.  In effect, then, a facial rejuvenation procedure actually improves the balance between how patients feel and what they see in the mirror.  It’s always nice when science confirms something I’ve seen for years-

Dr. Wolfe

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Pearl Fusion: The Latest in Lasers

Posted on March 19, 2010 under Face

We all want flawless, youthful skin.  Unfortunately, fine lines, sunspots, and uneven skin tone plague many of us over (and under!) the age of thirty.  While many have tried lotions, potions and lasers to get their glow on, the results are often underwhelming.  In addition, the downtime that some procedures require can be too much to justify when measured against our busy lives.

At the Center for Cosmetic Surgery, we’re always on the lookout for the next best thing, but we proceed with caution when we find a “miracle cure”. After all, every beauty maven knows that if it seems to good to be true, it usually is. The latest skin saver, however, may just be that magic wand we’ve been looking for. The Pearl Fusion treatment by Cutera combines two lasers for an unrivaled result that requires very little downtime while delivering significant improvement in the texture, quality, and pigmentation of the skin.

Pearl Fusion is a marriage of two proven skincare technologies. The traditional Pearl laser addresses upper skin layer problems such as brown spots, uneven skin texture and fine wrinkles. It’s more powerful cousin, the Pearl Fractional laser, penetrates the deeper skin layers to improve more challenging conditions such as creases around the mouth and eyes. Over the long term, patients will notice continued structural improvements in their skin.

Yet the beauty of Pearl Fusion goes far beyond the peaches and cream skin that you’re left with. Think customized treatments that go only as deep as needed, minimal redness and discoloration compared to more traditional lasers, and results in less than a week. What’s more, The Center for Cosmetic Surgery is the only Plastic Surgery practice in Colorado to offer this groundbreaking treatment.

Unlike its predecessors, Pearl Fusion provides a solution for both the superficial epidermal skin layers and the deep dermal layers.  The one-of-a-kind laser treats wrinkles of different complexities, while visibly improving skin texture, pore size and brown pigment. Translation? The skin’s surface appears not only healthier and clearer, the structure of the skin actually improves for six months as the growth of new collagen occurs.  The best part? It is usually a single office visit procedure and healing takes place over 5-7 days.

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Can cosmetic surgery be too acceptable??

Posted on February 3, 2010 under Face Lift, General Plastic Surgery

So I saw an attractive 25-year-old woman yesterday who consulted me because she was convinced she wanted a facelift.  A Mini-facelift, yes, but still a facelift.  On exam, this woman had a lovely facial shape and a well-defined neck.  No massive weight loss, no skin disorders resulting in abnormal facial laxity, no turkey gobbler passed on from her father.  She just thought a small facelift would make her feel prettier.  What’s more, another plastic surgeon in Denver had already agreed to perform a facelift on her.  She was getting a second opinion from me because she liked my before and after photos online.

I explained to her that, in my opinion, she is simply not a reasonable candidate for this type of surgery.  She’s too young and too pretty, and no matter how aggressively I lifted her face, she would see results for maybe a few years.  After that, all she would have is the scars and the lost money she’d spent.  ”Couldn’t I just do it again at that time?”, she asked.  At that rate, she’d be having her fifth facelift by the time she was forty.  That’s insane.

Now I don’t think this woman has body dysmorphia, a condition I am acutely aware of during my consult days.  She has simply bought into the media’s fascination with plastic surgery, and it’s minimization of risk and recovery.  Like many people, she doesn’t appreciate that these are real operations with real risks, recovery, and side-effects.  Heidi Montag had ten procedures at once in an effort to completely change her appearance, and was being touted as a “hero” by her plastic surgeon for her bravery.  In comparison, a small facelift on a 25-year-old seems positively conservative!

I told this young woman that all elective surgery is a fine balance between the potential benefits and the predictable and potential downsides.  In her case, there was no way I could justify the procedure, and told her so.  And you know what?  She left happier than she came in.

Dr. Wolfe

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