Ask
Dr. Barber About Plastic Surgery - May 2008
Q: How do I know what sunscreen is the best to buy? Is there anything I can do to remove or correct sun damage on my face and body?
A:Summer is fast approaching and many of us will be heading to the pool, lake, mountains or beach. We are an outdoor society and Americans do love the sun. Although a little sun each day is healthy, sustained sun exposure to the point of sunburn or dark tanning can have unwanted effects years down the road. This includes pigment irregularities, skin cancers, and accelerated aging of the skin. Most skin care experts do agree that sun screen is important to help protect our skin, especially in the summer months when we tend to spend more time being exposed. There are many different sunscreens on the market, and I believe that you should use one that protects against both UVA and UVB rays. Protection against UVA rays is relatively new and you should look at the brand you have to see if it covers both A an B ultraviolet rays. The sun screens that do protect from both do tend to be a little more expensive. As for which sun protective factor (SPF) number to choose, I believe that a higher number is better than a lower number. Remember, the higher the number, the longer it will protect without re-application. Also, the fairer skin that you have the better it is to use a higher number because if you are not good at remembering to reapply every few hours, you will at least be protected for a longer time. I recommend a sunscreen with an SPF of 35 or higher. As for brand names verses store name brands, both are good. You don't have to spend a fortune on sunscreens to be protected. For some people, sensitivity to sunscreens will make it necessary to use ones that are available through their plastic surgeon or dermatologist. Have a great summer, but remember to use your sunscreen, and that includes your young children. Teach them now, so it becomes a habit for all time.
Q: Is it safe to have liposuction on my tummy and thighs at the same time? I do not like the way I look in a bathing suit and cannot stand the thought of going through another summer.
A:Liposuction is one of the most commonly performed surgical procedures in plastic surgery. The abdomen and thighs are the two most common areas on the body that are treated with liposuction. It is not unusual that a woman will have unwanted fat in both areas and will want both areas treated at the same time. In most instances, assuming that you are very healthy, doing liposuction on both the tummy and the thighs is very safe. There are different types of liposuction these days, including ultrasound assisted, power assisted, laser assisted, and tumescent liposuction. I will evaluate each person individually to determine which of these methods will work best. The surgery is an outpatient procedure, will take about 2 to 3 hours to complete the tummy and thighs (inner and outer), and you can expect to be back to work in about one week. I usually allow you to return to the gym in about 3 weeks. Remember that it takes about 6 months for all the swelling to resolve, so don't expect to look perfect a few weeks after the surgery. There are risks associated with liposuction including asymmetry, surface irregularities on the skin (dimples or wrinkles), bruising and temporary numbness. Not everyone is a candidate for liposuction and you should see a board certified plastic surgeon for an individual evaluation of your problem areas.
Ask
Dr. Barber About Plastic Surgery - April 2008
Q:
No matter how much weight I lose, I still have a a huge bulge in my stomach that hangs over. I don't like it because there are so many clothes I cannot wear. Is there anything you can do to help me?
A:
Excess skin and fat in the lower abdomen is a common occurrence in women who have had multiple children or in women who may be overweight. My recommendation in all patients who are overweight is to make every attempt to achieve a healthier weight. This recommended weight may not necessarily be your pre-pregnancy weight or may not be what the standard weight tables recommend, but is a weight that is as close as you can get to normal. Once you have reached a healthy weight, and you still have this overhang, one option is a tummy tuck. This surgical procedure will remove most of the excess skin and fat, and in addition, a muscle tightening procedure will often be performed. Occasionally, liposuction of the hips and flanks will be added in order to bring these areas into a more balanced relationship with you new flat stomach. The surgery is performed under general anesthesia, takes about 2 to 3 hours to complete, and is often done as an outpatient. Recovery typically takes about 2 to 3 weeks to be able to return to work, and about 6 weeks before you can do lifting and return to the gym. As with any surgical procedure, there are potential risks associated with a tummy tuck and you should discuss these risks with a board certified plastic surgeon. In my practice, tummy tucks are a commonly performed surgery, resulting in a flatter and tighter abdomen, allowing you to wear clothing that before tummy tuck, was nearly impossible.
Q:
I am 55 years old and had a breast augmentation about 22 years ago with silicone gel implants. My implants now are extremely hard and do not have a natural shape to them anymore. I am embarrassed to hug anyone because I am so self conscious of how hard may breasts are. I am not even sure I want my implants anymore. Can you tell me what is going on and if there is anything that can be done to fix this problem? Is is possible just to take my implants out and leave them out or will that leave me with deformed breasts?
A:
The description of your breasts is a classic example of what is called capsular contracture of the breasts. This process occurs because of a membrane (capsule) forms around the breast implant, as a kind of protective covering of the implant. This begins to happen almost immediately following placement of the implants In a small percentage of women, this capsule progressively tightens around the implant, resulting in a breast which can feel like you have a baseball in it rather than a soft silicone implant. The example that I like to use to explain what is happening is to imagine putting a water balloon into a sock and then begin twisting the sock above the balloon. Soon, the sock tightens around the balloon such that balloon becomes very hard due to the tight sock around it. In capsular contracture, the capsule is like the sock. The implant is as soft as the day it was placed, but the capsule has gotten tight and left you with a hard feeling breast and in your case a distorted breast also. The treatment for your problem is to remove your breast implants along with the capsule. Why remove the implant and not just the capsule? In my experience, silicone get implants that are as old as yours have a high incidence of leaking or rupture and for that reason should be replaced, if that is what you want. It is, however, your decision whether to place new implants or not. In my experience with explanting many women with old or leaking silicone gel implants, if you decide to leave the implants out, you will simply be left with smaller and perhaps droopier breasts, but not ugly breasts. Of course if you decide to replace the implants, you new breasts will be softer and have a much more normal shape. The next question of course is whether the contracture will come back and the answer is that over time it is possible that it will. You should seek an individual evaluation for you situation and have a board certified plastic surgeon outline a plan for correcting your breasts.
Ask
Dr. Barber About Plastic Surgery - Feb.
2008 - PDF
Q:
I am interested in having a tummy tuck. I am a mother of four young children
and have to coordinate someone to help me when I recuperate. How much down
time will I have?
A:
One of the most common questions I get in my practice is whether I can return
a woman’s tummy to the way it was before she had children. As any woman knows
who has had one or more children, there are many changes that take place with
pregnancy, including what happens to your tummy. These changes include development
of a lower abdominal pouch, laxity of skin, stretching of the abdominal muscles,
and stretch marks. These changes don’t happen to all women, and often there
is some family tendency to these things happening. Although a tummy tuck will
never return your abdomen to exactly the way it was before child birth, the procedure
can make a very significant improvement in most of the above listed problems.
A tummy tuck, known as an abdominoplasty, is a surgical procedure that is typically
done under general anesthesia; that is you are completely asleep. The procedure
will usually take about three hours to perform, and can often be done as an outpatient.
The goal in a tummy tuck is to tighten the abdominal muscles, remove the excess
skin and fat in the lower portion of the abdomen, and in doing so remove most
of the stretch marks, at least the ones that are below the belly button. Recovery
from this surgery takes about two to three weeks before you can return to driving
and work. Lifting (and this includes children) should be limited for the first
month or so after the surgery. You will need someone to help you for the first
week or ten days following this surgery, especially with the child care responsibilities.
Q:
I am 42 years old and underwent a breast augmentation when I was thirty. My breasts
have become firmer over the last few years and are not the same shape as they
were when I first had the surgery. Is this anything that I should do?
A:
I am not sure whether you have silicone or saline (salt water) implants,
but if they were placed 12 years ago, they were more likely than not saline implants.
Since you did not mention that they were getting smaller, I can assume that they
are not leaking. However, what you describe sounds like you have developed a capsular
contracture which is the medical term for firmness that occurs around an implant.
When this occurs, it can also affect the shape of the implant. You should see
a board certified plastic surgeon to evaluated your implants. If the degree of
firmness is significant, then a surgical procedure might be necessary to correct
the problem. You should certainly have a mammogram to evaluate not only your breast
but also the condition of the implant. One thing you probably already know, but
I will say it again, no implants will last forever and eventually all will need
to be removed and replaced. Usually I recommend waiting until the saline implants
begin to leak (since saline is a very benign liquid that the body tolerates without
any problem). However, with silicone gel implants, I recommend that you monitor
the integrity of the implant with a periodic MRI. This of course is expensive
and therefore another option would be to undergo a planned exchange of the silicone
implants every 10 to 15 years. This is not a recommendation by anyone such as
the FDA or our plastic surgery society; it is simply a consideration that I discuss
with all patients who have silicone gel implants and is based on my experience
with removing many broken and intact implants, and knowing that it is a much simpler
surgery to change implants before they have an opportunity to leak. This opinion
may change in the future as new data becomes available regarding longevity of
the newer technology silicone gel implants. Regardless, the best advice I can
give you is to follow-up with your plastic surgeon and let him/her examine you
and make appropriate recommendations.
Ask
Dr. Barber About Plastic Surgery - Jan.
2008 - PDF
Q:
I am interested in laser skin resurfacing procedures. I have acne scars, very
large pores and rosacea. Is this the best treatment for my problem?
A:
Laser treatments to the skin of the face can make significant improvements in
the appearance of your face, but this treatment is not for everyone. The different
problems that you describe are treated with different lasers and will have to
be performed at different sittings. If I were treating your acne scars, rosacea,
and large pores, I might start you on a cream based skin care program for several
months to see what kind of results can be achieved with this simpler and less
expensive regimen. If the problems persist, then laser can make a nice improvement
in many cases. Rosacea can be treated quite simply, and typically, enough of the
redness can be removed in one or two treatments that patients are very happy.
Rosacea is one of the easier and more successful treatments with the laser. Acne
scarring and large pores of the skin are more difficult to treat, and depending
on the depth of the scars, laser may or may not be able to achieve complete smoothing
of the skin. There are some gentle lasers (Fraxel or Pro-Fractional) which can
improve the skin with less downtime, but at the cost of having to be treated on
multiple occasions. A more aggressive laser such as the CO2 laser can improve
the skin with a single treatment, but the downtime is longer and the amount of
redness of the skin is something that can last months. A one-on-one evaluation
from a board certified plastic surgeon can help you formulate a plan for trying
to achieve the skin that you want.
Q:
I am 18 years old and my breasts are very different. I have one that is large
and one that is small. I am so embarrassed that I will not put on a bathing suit
and hate trying on clothes. My breasts have not changed in several years so I
am afraid that I am stuck with this problem. Is there anything that can be done
to help me?
A:
Breast asymmetry is present in almost every woman. Fortunately, the amount of
asymmetry is such that it is subtle and not noticed by anyone other than the woman.
That being said, there are a small percentage of women who develop very different
appearing breasts, sometimes it can be shape differences, sometimes size differences
and sometime both. As in your situation, this can affect a woman's self-esteem
and social interactions. There is help for your problem. When I examine a woman
with a significant difference in her breasts, I usually want to know which of
the two breasts she prefers. Sometimes the patient prefers the smaller of the
two, sometimes the larger, and most commonly, she likes neither. The strategy
for trying to achieve symmetry is to make whatever change is necessary to achieve
the symmetry. This often involves putting an implant in on the smaller side, sometimes
reducing or lifting the larger side, and sometimes making adjustments to the nipple
area to even out the size of the nipple areola complex. In almost all instances
of significant breast asymmetry, surgery can improve the appearance to the point
that wearing a bathing suit is something that you now look forward to rather than
avoiding.
William Byron Barber II is
regarded as one of the most prominent plastic surgeons in his field and has recently
been selected one of America’s Top Surgeons. He has been practicing plastic
surgery in Greensboro for 15 years and is board certified by the American Board
of Plastic Surgery. He is presently Chief of Plastic Surgery at Moses Cone Hospital
System and is an active member of numerous local, regional and national plastic
surgery organizations. Dr. Barber hosts free monthly seminars in his office. To
make a reservation, please call Barber Center for Plastic Surgery at 336.275.3430.
The office is located at 1591 Yanceyville Street, Suite 100 in Greensboro. Their
website is www.barberplasticsurgery.com To ask Dr. Barber a question for this
column, please email him at drbarber@barberplasticsurgery.com About Dr. Barber
Dr. Barber has been featured in New Beauty Magazine and was selected as one of
America’s Top Plastic Surgeons of 2006.
