Renaissance Plastic Surgery

As you probably already know, the FDA approved the return of silicone gel implants for general use for cosmetic breast augmentation this past November. Initially there was some reluctance on the part of our patients to consider this option over saline implants, but over the past few months the number of women choosing silicone has steadily increased. It would therefore seem a good time to pause and share my general impressions regarding the differences between silicone and saline.

My overall impression is that silicone implants are a lot nicer than I expected. They are definitely softer with a more natural look and feel than saline. However, to be fair this difference in look and feel becomes less important in patients who start with more breast tissue. For the woman who wants to go from a C to a D cup, she is not likely to notice much of a difference. Silicone implants truly shine in the thin woman with little breast tissue and even less body fat. Saline implants were always less than ideal in this type of patient and now with silicone I can offer patients an option that looks natural, which by the way is still the number one request that I hear: to look natural.

A silicone implant also does not weigh as much as the same volume of saline. The weight difference becomes more of a factor for women choosing a larger volume implant. In larger volume implants, the extra weight of saline may cause more sagging, and in extreme cases could be a source of back or neck pain. I ask patients who want implant volumes greater than 400 cc to consider silicone, although I explain that no one knows the exact volume at which the weight difference becomes important and it will not be the same for all patients.

The last issue is a comparison of risk. The two main long-term risks of breast augmentation are implant leaks and thickening or tightening of the surrounding scar tissue, a condition known as capsular contracture. A saline leak is harmless because the saline is simply salt water than can be absorbed by the body, and the implant can be easily replaced. In the case of silicone, it has a tendency to cling to itself rather than spread and as long as it remains inside the scar capsule there should not be any effects on the surrounding tissue. In all of the research that has been done over several years, there has not been evidence of the silicone spreading to other parts of the body or causing any other side effects. As for capsular contracture, the risk that has been reported thus far is not significantly different for the two types of implant.

To sum up, my own personal experience with silicone gel implants to date has been a very positive one. If that should change in any way, you will be the first to know. My approach at this time is to share with each patient what I believe are the pros and cons of each implant type so that they can make an informed decision. If you are considering breast augmentation, gather this information, consider it carefully with the help of your plastic surgeon, and you will make the decision that is right for you.

Most of the news and excitement about breast surgery was, as expected, the availability of silicone breast implants. As you probably know, the FDA approved the newly designed silicone breast implants for general use for cosmetic breast augmentation last November. The general consensus was that after a short period of hesitation on the part of the patients, more and more women are requesting silicone implants despite the increase in cost when considering breast augmentation.

Many plastic surgeons were also a little hesitant because saline implants had such a high patient satisfaction rate with a very low risk of complications. Thus far the silicone implants have exceeded our expectations and my own experience has been very positive with an extremely happy group of patients. They are clearly softer and their ability to create a more natural shape in women who are thin with little to no breast tissue is unquestionably superior. At this point in time, the complication rate, which includes several years of research on silicone gel implants, is close to that of saline.

The other hot topic was body contouring surgery after massive weight loss, usually defined as greater than 100 pounds. The most common procedures used to treat these patients are tummy tuck (abdominoplasty) and breast lift (mastopexy). This is a challenging group of patients because they have such large amounts of loose and baggy skin and also because many of them have bariatric surgery, such as gastric bypass or banding, which does have some effect on nutrition and wound healing. As the overall experience has grown, techniques have become safer and more effective. As plastic surgeons, we look forward to the opportunity to help this growing patient population restore self esteem through a more positive body image.

The annual meeting of the American Society of Aesthetic Plastic Surgeons ended last week and I wanted to share my thoughts on the state of affairs of plastic surgery. The first thing I learned, through a conversation with my website host, is that my blogs are too long. I tried to be concise but not at the expense of sacrificing information. Apparently I need to try harder. In an effort to "tighten things up", I will divide the body up and today tackle the face.

The Contour Thread LiftTM is losing momentum as an alternative to a face lift. Results have not been long-lasting (often 6 months or less) because the threads used to lift the jowels cut through the tissue. It's called "cheese cutting". Surgeons are now using it more as a tool to help hold up a face lift, which really defeats the original purpose of the threads of avoiding a face lift. What is more promising is the ENDOTINE Ribbon Lift in which a device shaped like a thin ribbon with small prongs is inserted through a tunnel under the skin and used to lift the cheeks and jowels. It is stronger, minimally invasive and over time will dissolve and is replaced by scar tissue, which maintains the lift. Like the Thread Lift there is minimal down time and no scars on the face. I plan to use in my practice.

Lasers are still with us but the CO2 Laser, once the mainstay for the treatment of wrinkles and age spots, has faded into the background because of the long down time and complications. The laser technology that has the most promise is the FraxelTM Laser, which has no down time and significant improvement of wrinkles, age spots and acne scars.

Face Lifts are still with us but not as many are being done. Patients are more interested in less invasive procedures, such as the Ribbon Lift, and non-surgical treatments, especially BotoxTM and RestylaneTM, a skin filler which has almost completely replaced collagen injections.

Overall, facial cosmetic surgery is alive and well but it is changing. The trend is that more people are choosing it and at a younger age but choosing less because they are concerned about risks and down time. It is an opportunity for all of us, as plastic surgeons, to respond to a more educated and sophisticated patient base. At least that is how I see it. Next week: breast and body contouring.