Ask Dr. Barber About Plastic Surgery - November 2008

Q:  I hear  about wrinkle treatments, dermal fillers, BOTOX®,  Restylane®,  Juvederm® and I am confused.  What are these treatments and  how  long do they last?

A: I can understand why you are confused, the public being flooded with advertisements about BOTOX® Cosmetic and fillers such as Juvederm® and Restylane®.  Let me try to explain the difference between fillers and BOTOX® injections.  Restylane® and Juvederm® are injectable filler products that can be used to smooth deep wrinkles or creases in the face.  The material that is being injected is a substance called Hyaluronic acid which is a substance that is found in our skin naturally, but one which tends to diminish as we get older.  This substance attracts and holds water, which allows that area that is being injected to "plump" and therefore soften the crease.  The procedure is usually performed with a topical anesthetic and it takes about 45 minutes to complete.  As for the difference in Juvederm® and Restylane®, they are both hyaluronic acid products, made by competing companies, both of which would like to convince you that their product is universally better.  In my practice, I like to use Juvederm® for the lips because it seems to inject a little easier; however I will often use Restylane® and Juvederm® interchangeably for the laugh lines since I believe that the results are similar.  BOTOX® Cosmetic is the other injection that you have asked about.  This is an injection that is used to relax a muscle that might be causing a wrinkle.  The most common area where BOTOX® Cosmetic is now being used is in the forehead for the transverse lines and in the frown area between the eyebrows.  BOTOX® also works very well for crows feet.  What these areas all have in common is that there is a very small muscle under the skin that is responsible for the wrinkle.  If you can relax the activity of the offending muscle, then the wrinkle will be reduced and in some instances completely disappear.  Unfortunately, none of these products are permanent.  You can expect between 6 and 12 months of improvement from the fillers such as Restylane® and Juvederm®, and about 3-4 months of muscle relaxation from BOTOX® Cosmetic.  As with any cosmetic procedure, it is important that the person who is doing your injection be experienced and knowledgeable about what she is doing.  In my practice, I have a full time nurse injector who is responsible only for performing these injection procedures.  Since this is her full time job, she has a wealth of knowledge about injectables and can deliver a result that our patients find extremely satisfying. 

Q: My stomach is fat and hangs down after having my 3 children.  Do I need a tummy tuck, liposuction  or both?   I also don't like my thighs.  Can I get them liposuctioned at the same time?

A:  It is not unusual to experience stretched skin with some accumulation of fat in the abdominal area after having children.  It is always my first recommendation to try to lose weight and tone up the old fashion way, that is with diet and exercise.  Once you have gotten back close to your pre-pregnancy weight and you are still not happy, then a consultation with a board certified plastic surgeon may be in order.  Excess skin and fat that hangs down in the lower abdomen can be treated very nicely with a tummy tuck, and sometimes with a little liposuction in combination with the tummy tuck.  An abdominoplasty is designed to remove the redundant skin and tighten the abdominal muscles in order to give you a flatter abdomen.  In my practice, I will often recommend that liposuction in the hip or flank (waist area) be done at the same time to give an overall better shape to the abdomen.  Liposuction of the thigh area can be done at the same time in many instances, however, each person must be evaluated individually to assure that it is safe to do this combination of surgery.  Abdominoplasty is a procedure that is done under general anesthesia, takes about three hours to perform and often requires an overnight stay at the outpatient center.  You can expect to be out of work for about 2 weeks, and be restricted from the gym for about 6 weeks.  The pain from the procedure is now much more tolerable with the advent of the pain pump, a small disposable apparatus that you go home with following the surgery. This device automatically delivers a local anesthetic to the abdomen, thereby decreasing the pain and allowing more comfortable movement during the first few days following the surgery.  In summary, it sounds like a tummy tuck is what may help you, but you will need an evaluation with a board certified plastic surgeon to determine exactly what is right for you.    

Ask Dr. Barber About Plastic Surgery - October 2008

Q:  After having 3 children, I am very self-conscious about my breasts.  My body is not what is was before I had my children and I don't like the way my breasts look.  I'm embarrassed to say that it effects almost every aspect of my life.  I'm 33 years old. Can you tell me what type of implants I should have and what is the cost?
A:   Having children certainly can change your breasts.  This is one of the most common complaints that I hear in my practice.  Pregnancy and nursing babies can alter both the shape and size of the breasts. Frequently, a woman can actually lose as much as a full cup size in volume, a condition known as post-partum atrophy, or simply the loss of breast tissue.  Another very common thing that is seen after pregnancy is the breast changing shape, where the upper breast loses its fullness and becomes flat.  In this situation it looks like most of the breast tissue is in the bottom half of the breast.  If during pregnancy the breasts get really large and you nurse your baby for any significant length of time, sagginess of the breast can also occur.  So how are all of these unwanted changes of the breast corrected?  The most important thing is to have the breasts accurately assessed by a board certified plastic surgeon.  Simply putting in a breast implant to restore volume may not always be the right answer.  If, for instance, the breast is droopy, then performing a breast augmentation alone without doing a lift of the breast will not correct the problem.  When I evaluate a woman for her breasts, I will take about 8 different measurements of the breast in addition to evaluating the degree of droopiness.  If there is no significant droopiness of the breast, then a breast augmentation alone will suffice to restore volume and fullness to the breast.  If there is significant degree of droopiness to the breasts, then either a lift alone or in combination with a breast implants is the procedure of choice.  So as you can see by my answer, it is not totally straight forward and for that reason seeing a doctor who is familiar with breast surgery is very important.
Q:    I have heard that it is better to get a facelift when first signs of sagging and wrinkling appear, rather than wait. Is this true?  Will a facelift last longer if I get it earlier?  I just turned 40 and I'm starting to see things I don't like when I look in the mirror.

Ask Dr. Barber About Plastic Surgery - September 2008

Q:  I am debating whether to have liposuction of my thighs.  I am 135 pounds and 5'5" tall.  I do not think that I am overweight but my thighs have a bulge on the outside that just looks terrible.  I have seen liposuction on TV and it looks so painful.  Can you tell me what is really involved in liposuction of the thighs and when I can expect to return to work?

A: Liposuction is a surgical procedure designed to remove unwanted fat from certain areas of the body where fat may accumulate in a disproportionate way compared to the rest of the body.  The area that you are describing in the outer thigh is referred to as the "saddle bag" area and is one of the most common areas where I perform liposuction.  The thighs respond beautifully to liposuction; that is the fat in the saddlebag area is very amenable to removal with few side effects. My technique for the thigh is to use tumescent technique where the fat is first injected with a local anesthetic and then ultrasonic energy is applied to melt the fat which allows more efficient removal of the fat.  The surgery for this area usually takes about 1 to 1 1/2 hours to complete, is typically done under anesthesia, and is an out patient procedure, meaning you will be able to go home within an hour or two after the surgery.  I use two small incisions on the thigh to remove the fat, which are minimally noticeable.  You will need to wear a girdle for about three weeks following the surgery, to help reshape the thigh.  Depending on the job that you perform, you can expect to be able to return to work in less than one week, although you will still be swollen and sometimes a bit bruised.  I usually allow my patients to return to exercise about 3 weeks following the surgery.  It is not uncommon that I will also recommend inner thigh liposuction be done at the same time, since I find that removal of fat in both the outer and inner thighs will result in a thinner thigh than just doing the outside alone. A visit with a board certified plastic surgeon can more specifically answer all of your questions.

Q:  Can you explain to me why it is important for my plastic surgeon to be board certified?

A: Board certification in any specialty, whether you are talking about plastic surgery, internal medicine, pediatrics or whatever, is very important because it indicates that the doctor in question has satisfied rigorous criteria to be able to say that he/she is board certified.  These criteria include graduation from an approved medical school, completion of an approved training program (internship and residency), passing a written examination at the conclusion of training, and in some specialties such as plastic surgery, submitting all of your surgical cases for one year for review by a panel of nationally renowned plastic surgeons to ensure that you are practicing within accepted standards of care.  After review of your cases, an oral examination is given by the panel where the examinee is evaluated for competence, safety, and surgical ability. It is a long process for doctors to achieve board certification and it shows you, the patient, that your doctor has done everything to maximize his ability to practice quality medicine.

Ask Dr. Barber About Plastic Surgery - August 2008

Q: I have had breast implants since 1991.  I don't really have any problems with them, but I wanted to know if I will need to replace them at any point?
 
A: The simple answer to your question is yes.  The harder part to your question is when you need to replace them.  If you have saline or salt water filled implants, then I recommend that you wait until one begins to leak.  How do you know when that happens?  Well you will gradually begin to get smaller on the leaking side.  The loss of volume does not happen fast, it is not like a balloon popping, but instead a very slow leak that can take weeks or even months before you are sure.  If you are worried that it might be leaking, see your plastic surgeon who will be able to help with the diagnosis. Replacing a saline implant is pretty straight forward, a short surgical procedure (less than one hour), where the failed implant is removed and a new one is replaced.  I do recommend that you replace both implants, since the opposite implant may not be far behind the leaking implant.
If you have silicone gel implants, the diagnosis can be a little more difficult.  It is often impossible to tell by physical exam whether the implant is leaking or not.  Sometimes a mammogram with an ultrasound can be very helpful in determining whether there is a failed implant.  The most accurate way to determine if the implant is leaking or has ruptured is to perform an MRI.  Unfortunately, this is expensive, but it will tell you whether it is time to replace your implants or not.  If you have not seen your plastic surgeon recently, then I recommend that you be evaluated to insure that your implants are intact.  If they are leaking, then it is my recommendation that they be exchanged for new implants.
 
Q:   I am 39 years old and have developed a splotchy complexion with many brown spots that seems to get worse in the summer.  I do spend time in the sun, but I have 3 children and it is hard not to be outdoors with them.  Is there anything that can help get my face looking better?
 
A: Although it is impossible to give you an accurate diagnosis without actually examining you, it sounds like you are developing what are called dyschromias or simply put, brown spots.  These are frequently due to repeated sun exposure and unfortunately with continued unprotected sun exposure, they are likely to get worse.  My first recommendation is to use sun screen religiously.  You need to apply it each time you are outside for any extended period of time (that is more than 10 minutes at a time), and you need to reapply it every few hours.  The use of sun screen will keep your existing sun spots from getting any darker and will also hopefully prevent new ones from forming.  Unfortunately sun screen alone will not fade the spots that are already there.  To treat those spots requires a skin care program that uses skin lightener in combination with Retin-A.  This program does require a doctor's prescription so you will need to visit your plastic surgeon or dermatologist to be evaluated and treated.  A good physician directed skin care program can make a world of difference in your skin, both by improving some of the existing damage and in preventing or at least slowing future damage related to aging and environmental exposure.    

Ask Dr. Barber About Plastic Surgery - July 2008

Q:  Will liposuction get rid of cellulite? 
A: Oh if only it were true, that liposuction would erase cellulite, what a dream come true for those who suffer from this pesky problem.  Unfortunately, the short answer to your question is that it will not get rid of cellulite.  In fact, liposuction can actually make it worse in some instances.  In order to understand why liposuction does not predictably improve cellulite, you must first understand what causes cellulite.   Cellulite is a condition in which dimples in the skin are created by fibrous bands that are connected between the undersurface of the skin (the dermis) and deeper underlying tissue.  These bands are shorter than the actual distance between the skin and the deeper connection, and as a result, the thick band pulls the skin inward creating a dimple.  Simply doing liposuction may remove fat, but not typically break up the fibrous bands, thus leaving the patient with a smaller thigh, but still with dimples.  Many techniques have been tried to break these connections, and although some improvement can be made occasionally, in my experience it is not predictable.  Therefore, I tell my patients that I can not improve cellulite with liposuction alone.  Some newer techniques are being advertised combining radio frequency waves that produce heat with deep massage which, when combined, is purported to help reduce cellulite.  This is new technology, and like so many other new technologies in plastic surgery, the actual results may not match the initial claims.  When it comes to newer techniques for the treatment of cellulite, my advice is buyer beware until there is an established track record with these devices.  
 
Q:    I have read about different shaped breast implants.  Can you tell me how to select the right implant for me?
A: There are different shaped implants, usually described as round implants and anatomic implants, also known as teardrop shaped implants.  If you are considering saline (salt water) filled implants, then my recommendation is to stay with the round implant.  There are a couple of reasons why I recommend this.  The first is that all implants that have a shape other than round have a textured or roughened surface.  This type of surface creates friction in the breast implant pocket and makes it less likely that the implant will rotate out of position.  Remember, this implant must be placed such that the thinner part is at the top of the breast and the bigger part of the teardrop is at the bottom.  You certainly do not want the narrower top part of the implant to rotate to the bottom of the implant pocket; this would result in a weird shaped breast.  So the textured surface is important to hold the implant in place. However (and here is where I have a problem with this implant), this textured surface implant has a higher failure rate (leakage) than the smooth implants, as reported in some studies.  When the implant leaks, it must be replaced, and who wants to have to replace the implant more often?  Not my patients.  The second problem I have with the shaped saline implant is that it is not even well documented that a teardrop shaped implant actually will maintain its teardrop shape long term, and may in fact assume a round shape eventually.

Now what about the new anatomic (teardrop) shaped silicone gel implant?   Unfortunately, the newer technology silicone get implants have not been available for the general patient population for a long enough period of time; and therefore there are no large studies to document what the long term results will be for the shaped silicone gel implant.  My personal feeling is that there will likely be some indications in which the shaped silicone implant will be the better choice for some patients.  Still, for my patients who choose silicone implants, I recommend the round smooth cohesive gel implant; it gives a very nice result and frankly, it is just too hard for me to switch from what works to something that does not have as proven track record.  

Ask Dr. Barber About Plastic Surgery - June 2008

Q:  I have had BOTOX and Restylane once to eliminate lines on my face and I love the way it took the wrinkles away from my eyes and removed the lines from the sides of my mouth, but the lines are starting to  come back.  Is it safe to have another injection this summer?

A: Yes it is safe to have additional filler such as Restylane injected again. Typically you can expect Restylane and Juvederm to last about 6-12 months depending on where it has been injected.  It usually lasts longer when injected into the smile lines (naso-labial fold), often lasting up to a year; as opposed to the lips where you can expect to see improvement for about 6 months.  As for the BOTOX ®, it usually lasts about 3-4 months before the muscle activity begins to return.  As a general rule, I do not retreat with BOTOX ® any closer than 3 months following the last treatment.  As for the fillers such as Restylane, there are no problems with retreating at any point from the previous treatment.

Q:  My breast size has always bothered me since I nursed my last child.  One side is larger than the other.  Do I need breast implants or just a breast lift?

A: What you describe is very common, that is asymmetry of your breasts and the changes that frequently occur with child birth and nursing.  Although I am not sure I can give you exact advice regarding your breasts without examining you, I can give you some general advice about what I see almost daily in my practice.  Most women will have breasts which are asymmetric; however, it is really only a problem when it is hard to find bras that fit well or swimsuits that can be comfortably worn.  Mild asymmetries rarely require treatment.  When the breasts are significantly different in shape or size, then the treatment is to address the breast that you are not happy with. For instance, if you have a large breast and a small breast, then I will ask you which breast you like better.  If you like the larger of the two, then the treatment is to increase the size of the smaller one, usually by placing an implant.  If you prefer the smaller one, then a reduction is often the optimal treatment.  This scenario is unfortunately a little too simplistic, since in most cases I see; it requires addressing both breasts in order to get them to the desired size and symmetry.  My best advice for you is to be evaluated by a board certified plastic surgeon and see what procedures may help to restore you breasts to a more youthful look and at the same time equalize their size. 

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.