As I sit down to answer the Ask Dr. Barber questions for the May, we are in the throes of a worsening Covid-19 pandemic nationwide. To date, we have not suffered nearly as badly as our fellow citizens in New York, Washington State, or other regional hotspots. I am praying that somehow we are spared the potentially catastrophic events that have befallen some of our fellow citizens. By the time you read this, things will either be better or possibly worse, let’s hope for the former. Somehow, answering questions about plastic surgery today with the fears that we are all struggling with does not seem right, so with my editor’s permission I have decided to freelance a bit. Something of a little historical review of plastic surgery and a story or two.
I am often asked why plastic surgery is called plastic surgery, do we put plastic in people? The answer to that is yes, we do, but that is not the reason the specialty is called plastic surgery. Plastic surgery became a recognized specialty in 1937, long before plastic material was universally incorporated in our everyday lives (although it was first invented in 1907). The actual reason our specialty is called Plastic Surgery is that it named for the Greek word “plasticos” which means malleable, moldable or bendable. In my specialty, we spend a good bit of time figuring out how to mold or move healthy tissues to reconstruct existing defects on one part of the body or another.
Plastic surgery evolved as a specialty as a direct result of the type of injuries that were commonly seen during World War I. This war was known for the battles that took place with the soldiers protected in trenches (trench warfare), where the only part of the body that was not protected was the face and head. As a result, there were many terrible gunshot and blast injuries to the face. There were so many, in fact, that the doctors during the war formed a team of general surgeons who would focus on taking care of facial injuries only. Reconstructing a life altering war injury to the face required precision and patience in order to return the soldier to some semblance of normalcy. After the war was over these surgeons, who had gained so much competency in treating facial injuries, returned to their home countries and eventually formed a new specialty of likeminded surgeons who would specialize in reconstructive plastic surgery. At that time, and really not until the 1950’s, aesthetic surgery did not even exist within the specialty.
Formal training in plastic surgery did not gain much traction until after the surgeons from World War I returned home and began to share with the younger surgeons in training their knowledge and experiences with reconstructive surgery. Formal residency training in the specialty of plastic surgery did not begin at Duke until the mid-1940’s. Before that time, all surgeons were general surgeons, training in all aspects of surgery including orthopedics, neurosurgery, GI surgery, urology, pediatric surgery, plastic surgery, etc. As a general surgeon in those days, you would be called upon to do whatever needed to be done. Some surgeons did choose to focus on one area and would become known as a specialist in that area, say for example, if you liked doing brain surgery and not appendectomies, you could limit your practice to the brain. Thus, the beginning of surgical sub-specialists.
Interestingly, the first chief of plastic surgery at Duke University, where I did my training, was Dr. Randolph Jones. He was appointed as the chief after he finished his general surgery residency at Duke. Imagine that, you complete your training and then apply for a job in the surgery department not knowing in which area you would be assigned. He was assigned to be the first chief of plastic surgery at Duke. Dr. Jones was the chief for only 7 years when, at the young age of 39, he unfortunately met a very untimely yet morbidly interesting demise. Dr. Jones had performed a surgical procedure on a 38-year-old gentleman to correct a complication from a circumcision performed by another surgeon. The surgery apparently did not go as well as the patient had hoped, and he was not happy with his ultimate result. He exacted his revenge on Dr. Jones as the doctor was leaving the Duke Hospital at 5:30 pm on November 18, 1941. The angry patient greeted the doctor, spoke calmly requesting to be seen by Dr. Jones. He agreed to see the patient the next day and the patient accepted the offer and begin to walk away. The assailant suddenly turned back toward the doctor and unloaded 6 bullets from 2 different revolvers into Dr. Jones’s body, killing him instantly. I do not know if it is still true today or not, but when I was a resident at Duke, some 45 years after the shooting, the prevailing wisdom was do not even think about doing that operation. Four years after Dr. Jones death, the second chief of plastic surgery arrived at Duke. Dr. Kenneth Pickrell completed his training in general surgery at Johns Hopkins. In 1944, he arrived at Duke not really knowing for sure in what capacity he would be serving. He served both as chief of neurosurgery and plastic surgery until World War II ended and a fulltime neurosurgeon could fill the position.
I think it is fascinating that that generation of surgeons truly could do it all, and obviously did do it all. Dr. Pickrell, who I never knew, served for 31 years and brought Duke into the modern age of plastic surgery. There have been 7 chiefs since 1934, and I have worked with or known 5 of them. Plastic surgery has changed a lot since its beginnings during World War I, and there are now many subspecialties within the specialty of Plastic Surgery. From the field of plastic surgery has come so many miraculous advancements that have improved the lives of so many people including kidney transplants (first done by Dr. Joe Murray, a plastic surgeon at Harvard and winner of the Nobel prize in medicine), skin grafts, breast reconstruction after mastectomy, limb salvage after IED blast injuries during the Afghan and Iraq War, cleft lip and cleft palate repair, and now face transplants for patients who have suffered devastating facial injuries from trauma or burns. Plastic surgery is more than what we all see on TV and social media. It is surgery performed by dedicated surgeons who look to return people to a more normal state following trauma, congenital deformity or cancer. So, there you have a very brief introduction into the history of plastic surgery. Until next time, stay healthy, observe social distancing and let us all pray for better days ahead.
Q. Is there anything that can be done to improve acne scars on the face. I am in my 30s and had terrible acne as a teenager. The active acne has finally gone away after seeing a dermatologist who was able to get it under control. Unfortunately, I am now left with many scars on both of my cheeks and some on my chin. Makeup does not hide the scars and sometimes seems to make them look worse. I am so embarrassed by my skin and am desperate to find something that will make my face look better.
A. I am sorry that you had to experience so many years with active acne and the unfortunate results: scarring. There are so many options now for the treatment of acne, and although it will not help you, you should keep in mind these options if you ever have children with the same problem. The options include topical antibiotics and Retinoids such as Retin-A®. Oral antibiotics, chemical peels, antibacterial cleansers, and as a last resort Accutane, which is a powerful anti-acne prescription medication are also excellent options. As for your scarring, this a much more difficult problem to fix. First, let me say that there are options that will improve the scars, but unfortunately, there is nothing that will make the scars go away completely. The three modalities for scar treatment of the face are dermabrasion, chemical peels, and fractionated CO2 laser resurfacing. Dermabrasion is essentially sanding the face, but this technique is rarely done anymore. Chemical peels do help but usually are not as aggressive as the laser and often require many peels over a long period of time. I favor using the laser because it is more aggressive in smoothing scars and is also more predictable in the results that can be expected. You should plan on more than one treatment for the scars, as each treatment will give additional improvement. The laser is usually performed with light oral sedation. It takes about a week for the face to heal such that you feel comfortable going back to a normal routine. The risks of laser resurfacing include prolonged redness of the face (looks like a sunburn), creation of new scarring due to the laser (rare), and overall disappointment due to not getting the result that you are seeking. I tell my patients that I can improve their situation in most instances but I will not be able to make your skin perfect. I recommend you see a board-certified plastic surgeon or dermatologist who performs laser on a regular basis.
Q. Twenty years ago I was diagnosed with breast cancer. I was treated with a lumpectomy, radiation therapy to my breast and chemotherapy. At the time, I thought my breasts looked OK after my treatment and I never did any reconstruction. Now, 20 years later, the side that I had the lumpectomy and radiation done is at least a cup size smaller than the unaffected side. It is impossible to find a bra that works, and I hate putting a bathing suit on because it is so noticeable. My question is whether it is too late to fix the small breast and make it look more normal?
A. As long as your health is good, then it is never too late to perform surgery to produce better symmetry of your breasts. You did not state your age, but age really does not matter as long as you are in good health. The description that your breast progressively got smaller over the years following treatment for breast cancer is not that unusual. (Read More)
Q. When I was in my 20’s, I had a breast augmentation with large implants. After the surgery, I was a DD cup bra. Now 15 years and 2 children later, I am 20 pounds heavier than I was in my 20’s and my cup size is an E cup and I am huge. I know I can replace my implants for smaller ones, but I am so worried about what my breasts will look like if I go smaller. Is there any way that I can downsize without looking saggy?
A. Without examining your breasts, it would be impossible to give you a totally accurate answer. Every breast is different in terms of quality of skin elasticity and how much natural breast tissue that is present. I can give you some general information about what you can expect. (Read More)
Q. The back of my hands look very old to me. I have lots of big veins and my hands just look like skin, veins and bones. Is there any way to plump the back of my hands up and make them look younger?
A. As we get older, several things happen to the hands that do make the back of the hand look more skeletal. That means that the veins look big and are therefore more visible, and the bones and tendons look like they are just under the skin surface. This is primarily caused by thinning of the skin and also due to loss of fat under the skin. (Read More)
Q. I take really good care of my facial skin, but my hands seem to give my age away. I have so many brown spots on the back of my hands that I just have not been able to improve. I have tried every over the counter cream that I can find but nothing has worked. I read that there is a laser that can help. Do you know anything about this laser and whether it is a viable option?
A. Yes, there is a laser that is quite successful in lightening the brown spots and in some instances actually getting rid of them completely. The procedure does not require any anesthesia and can be performed in office if the plastic surgeon or dermatologist has the correct laser. The most common laser used for this treatment is the Nd-Yag QS-532 nanometer laser. (Read More)
Q. I am 31 years old with one child. My mother developed breast cancer at age 41 and my older sister was diagnosed with breast cancer at age 37. My mother and my sister were treated with a mastectomy. My ob/gyn doctor recommended I have the BRCA gene mutation test to see if I am at higher risk for breast cancer. I had the blood test and it came back positive for the mutation. After consulting with a genetic counselor, talking to my family doctor and an oncologist, I have decided to have a prophylactic double mastectomy and I would like to have the surgery where the nipple is spared. Here is the problem, I went to see a surgeon who told me that my breasts are too big to have a nipple sparing mastectomy. I wear a DD bra. He said the complication rate is higher in women who have large breasts when preforming a nipple sparing mastectomy. He has suggested a standard mastectomy on both sides. I have seen the results for a nipple sparing mastectomy and a standard mastectomy and I like the results of the nipple sparing mastectomy much better. Is the advice that I have been given correct?
A. First, let me say that I think you were so smart to have the BRCA gene mutation test. I am sorry that the results were positive, but now you can decide what you want to do about your breasts without waiting and wondering what might happen in the future. (Read More)
Q. I would like to do something to my face to make me look younger. I am 60 years old, recently retired and feel great but I see wrinkles and jowls on my cheeks, and loose skin under my chin. What are my options regarding facial rejuvenation, and is there anything other than surgery to tighten my face and reduce my wrinkles?
A. Sorry, but the short answer to your question is that only surgery will lift the loose skin on your cheeks and under your chin. Wrinkles (fine lines) can be treated with laser skin resurfacing, which technically is not surgery since there are no incisions, however, laser is still a procedure with a week or so recovery and can have a short period of being uncomfortable. (Read More)
Q. I recently saw my primary care doctor who did a yearly physical including examining my breasts. He noticed that my breasts were kind of hard and a bit misshapen and he asked me how old my breast implants were. I told him they were more than 30 years old and he looked surprised. He suggested that I see a plastic surgeon to find out about how safe it is to have such old implants. I have had a mammogram every year since I turned 40 and have never been told there is any issue with my implants. Do you agree that I should be evaluated for my implants? I am 63 and had my augmentation in my early 30’s.
A. Let me ask you a question. Are you happy with the look and feel of your breasts? Normal breasts, with or without implants, should be relatively soft and should have a normal breast shape. (Read More)
Q. I have the implant that was recently recalled by the FDA. Do I need to do anything about this or is it safe to keep my implant?
A. If you know that you have the textured Allergan or McGhan silicone gel or saline implant, then yes, you should see the plastic surgeon who placed the implant. The FDA is not recommending the implants be removed; however, you should talk to your doctor and get the latest information on the reason why the implant has been recalled. (Read More)
Q. My son is a college student and is very bothered by his prominent ears. I never knew that he was sensitive about his ears, but he has recently opened up about it. He wears his hair long, so it is not very noticeable. Is my son too old to have ear surgery? I have always been told that this surgery should be performed as a baby.
A. Your son is not too old to have his prominent ears corrected. Although it is more common to perform ear surgery for prominent ears during the preschool years, I have done this surgery on adults as well as teenagers. (Read More)
Q. I have a lot of lines on my face from too much sun when I was younger. I recently went to an aesthetician at a local spa who did 4 chemical peels on my face over a four-month period. I really do not see much improvement in the wrinkles. I do not want surgery but is there anything other than surgery that will help smooth my skin? I am almost 50 years old but my skin wrinkles make me look much older.
A. Sun can have a profoundly negative effect on the skin of the face if you do not protect it with a good sunscreen, consistently applied while outdoors. Genetics also plays an important role in how one ages. Since you cannot affect your genetics, at least for now, the only control you have is protection from the sun’s harmful rays. (Read More)
Q. I have been contemplating having a face lift for several years. I have even had a couple of consultations with a plastic surgeon. I want to have the surgery, but I am afraid that I will not look like myself. I have seen people both locally and on television that truly do not look like the same person. This possibility scares me as I want to look like me, just a little more refreshed. How do I know that I won’t look too different after surgery? What do I need to say to the surgeon to convey what I am looking for?
A. Thank you for your question and it is good that you are thinking about this before surgery and not after surgery. I know the look that you are talking about, and it can be frightening. The people who have undergone overly aggressive facial rejuvenation do not look any younger, they just look different, and sometimes they look strange. (Read More)
Q. I recently completed breast reconstruction on both breasts after bilateral mastectomies for breast cancer. I have breast implants on both sides. I am, for the most part satisfied, however I have a significant dent in the upper part of one of my breasts which is noticeable if I wear a bathing suit. I don’t want to have more surgery if I can help it, so is there anything that can be done for this indentation?
A. Contour irregularities of the breast after breast reconstruction is not uncommon, regardless of the technique used to reconstruct the breast. These deformities can be either an area of hollowness leaving a dent in the breast or an area of excess tissue creating a bulge. (Learn More)
Q. I am 28 years old and had twins about 1 year ago. After delivery, my stomach was a mess, loose skin and stretched muscles. I have been working my buns off for the last 6 months trying to return my tummy to the way it was before pregnancy and it is just not happening. I still have skin that sags around my belly button and I still look like I am 3 months pregnant. My weight is back to what it was before getting pregnant, but I hate my tummy. How can I tighten my skin?
A. Twin pregnancy can be very tough on your tummy because of the stretching that occurs carrying 2 babies. Often the skin stretches beyond its capability of re-tightening, and what is left is loose skin. (Read More)
Q. I have read some recent reports that the FDA is beginning to investigate the safety of breast implants. I have had implants for 7 years and have been happy, but I do not want something in my body that can harm me. Now I am worried and do not know what to do about the implants. Should I have them removed? (Read More)
Q. I recently had an evaluation for Coolsculpting at a spa in the Triad area. I was told that I am a perfect candidate and I could expect great results after one or two treatments. The area that is bothering me is my hip roll. I have not had the treatment yet because I felt a little like I was being given a sales pitch and I am also somewhat skeptical as to whether Coolsculpting really works. Does Coolsculpting work as good as what I am being led to believe?(Read More)
Q. Can you tell me what the latest options are on non-surgical wrinkle reduction? I have fine lines around my mouth, my cheeks and under my eyes. I am only 50 and definitely do not want to have a face lift. I have tried pretty much every cream in the department stores and on the infomercials and my wrinkles are still in the mirror. Please tell me there are some good options.(Read More)
Q. I get injections of Restylane® in my cheek fold about once or twice a year. I have never had any issues other than temporary bruising and swelling, however I read an article recently that talked about blindness that can occur as a result of filler injections to the face. I am now too scared to get injections again. The office where I have received the injections has never mentioned that blindness can occur. Are fillers safe, or do I need to stop doing them? (Read More)
Q. I am totally confused about what kind of skin care would be good for my face. I am a middle-aged woman who has some sun damage from my younger days, but otherwise fairly decent skin quality. My goal is to minimize wrinkle formation and help fade some of the brown spots on my cheeks. Nothing that I have purchased from the cosmetics counter has helped very much and I have spent a small fortune. Is there a skin care program that you recommend for most women? (Read More)
Q. I read about a new saline implant in your Q&A article in this magazine a few years ago called the Ideal Implant. I am interested in a breast augmentation and it sounds like a good alternative to silicone implants. However, at the time I read the article they were very new to the market and I was worried that they had not been in use long enough to know for sure that they are safe. Are you still using these new saline implants and if so, do you think they are good implants? (Read More)
Q. I am almost fifty and have been using both Botox and fillers for my facial wrinkles for almost 8 years. I love the effect as it smooths my forehead lines and the fillers fill in the lines around my mouth. I am just a little concerned that I have been using these injectables for so long and I cannot find any information as to whether it is dangerous to be on these products for a long time. What is your opinion? (Read More)
Q. I desperately want a breast reduction and have even been approved by my insurance company for coverage of the procedure, however, I am so hung up on the potential risks of being put to sleep that I just cannot convince myself to proceed with the surgery. I would like to know your opinion regarding the safety of anesthesia for breast reduction surgery. (Read More)
Q. I have dark circles under my eyes that make me look tired. Is there anything that can be done to lighten my eyelid skin? (Read More)
Q. I had a facelift about two months ago and I can still see my scars in front of my ears. I am worried that they will be permanent. What should I do? (Read More)
Q. I grew up on the coast of North Carolina spending way too much time in the sun. I now have numerous scaly spots on my face and recently had a skin cancer removed. I have read about a cream that can be applied to the face to remove some skin cancers and the scaly spots on the face. Do you know anything about this? The cream is called Efudex. (Read More)
Q. When I was 39 years old (12 years ago), I had breast cancer and had a mastectomy with immediate reconstruction using tissue from my tummy. My reconstructed breast is doing just fine but my problem is that over the last 12 years I have gained some weight and my natural breast is now larger and droopier than it used to be. So unfortunately, my breasts do not match anymore. Is there a way to make them more symmetrical? I am very self-conscious when I put a bathing suit on because the difference is very noticeable. (Read More)
Q. I had a breast augmentation 9 years ago. I have silicone gel implants. One of my breasts is literally as hard as a rock and looks misshapen. I have not been back to a plastic surgeon because I had the surgery in another state. What is going on with this breast, and can it be fixed? (Read More)
Q. I had a breast augmentation last December. My right nipple area is completely numb. My left side is fairly normal. My surgeon said that the numbness will get better, but it has been four months and no change. What is your experience with loss of sensation in that area? (Read More)
Q. I have been keeping up with some of the reports on the association between textured surface silicone implants and the occurrence of breast lymphoma. I have discovered that the implant type that is most associated with this disease is the implant that I have. I am so worried now and wonder if I should have my implants removed? (Read More)
Q. I was recently diagnosed with a malignant melanoma on my shoulder. My husband found it and I unfortunately just watched it for a few months before going to the dermatologist. She biopsied it and ultimately removed it. I was lucky because it was called a superficial melanoma and the only treatment recommended was close follow up for the next five years. I was advised to use sun screen regularly, but I am wondering if there is anything else that I can do and how do I protect my children from this terrible skin cancer? (Read More)
Q. I am a 46-year-old healthy woman who has inherited from my father a neck that has no definition and seems to be full of fat. On a picture of my profile it is hard to tell where my face ends and my neck begins. I have had this neck for about 15 years, but it has gotten worse since I had children and gained some weight. Is there anything that can be done to restore some definition to my neck? (Read More)
Q. About a year ago, I had an upper eyelid lift by a plastic surgeon outside of Greensboro. Everything seemed to have gone well after surgery except that I am still not able to completely close my eyelids together. There is a gap between each upper and lower eyelid when they are supposedly closed. I really cannot see the gap myself, but my husband says it is very noticeable when I am asleep. In addition, my eyes are always dry, and I am constantly having to use drops to moisten them. My plastic surgeon says that it will eventually get better and that there is nothing that needs to be done about the issue. Is there anything that I can do to help this problem? (Read More)
Q. I am contemplating a breast augmentation in the next year or so. I am researching implant options and I remember reading in Kernersville Magazine a year or so ago about a new implant called the Ideal Implant. Can you tell me if you have experience with this implant and if you think it is a good alternative to the silicone gel implant? (Read More)
Q. I had a breast augmentation about 10 years ago. I am older now and having large breasts is not that important to me. I am a long distance runner and the implants just seem to get in the way when I run. I would like to have them removed but I have read online that removing without putting another implant back in will cause distortion of the breasts. Is it true and is it possible to take my implants out? (Read More)
Q. I am in my mid-twenties and I was born with a cleft lip. My lip was repaired when I was a baby and it looks fine to me. However my nose does not look normal and I was wondering if there is anything that can be done to improve its appearance? I have never had any surgery on my nose as far as I know, unless something was done when I was a baby. (Read More)
Q. I am the mother of 4 children and nursed all of them for nearly a year each. I have small breasts but my nipples are too big and honestly just look like they are stretched out. They were not like that before I had children so I think it is related to four years of nursing. Can this be fixed? (Read More)
Q. I had a face lift about 15 years ago and have been very happy. However, my cheeks are again beginning to sag, especially in the jowl area. I am 68 years old and do not think I want to go through another face lift. Is there an alternative to a full face lift to re-tighten my relaxed cheek skin? (Read More)
Q. I have heard that there are some technologies that will tighten the skin of the neck and face so that a face lift can be avoided. Is this true and does it work well? (Read More)
Q. I have heavy upper eyelids with too much skin hanging down. How can I find out if my insurance will pay for an upper eyelid lift? (Read More)
Q. I am contemplating having fat injections in my buttock area. I have seen a surgeon who has scheduled my surgery. However, I recently read some reports about problems with butt lift procedures using fat. Before proceeding, I just want to make sure the procedure is safe. What is your opinion regarding a Brazilian butt lift with fat? (Read More)
Q. I would like to know when I should replace my breast implants. I had an augmentation about 10 years ago in another state. I know that I have saline implants but do not know anything else about them. When should I plan to replace these implants?(Read More)
Q: I had a breast augmentation with silicone implants about 2 years ago. My right side is perfect, but my left side is very hard and does not look natural. My surgery was done in another state and I have moved to the Triad area and do not have a plastic surgeon. What can be done to improve the appearance of my “bad side”? (Read More)
Q: I am 42 years old and have fine lines on my cheeks and around my mouth. I do not have any saggy skin on my face but I do hate the fine wrinkles. I grew up on the coast and abused my skin when I was a teenager. Now it seems that I am paying for this mistake. Is there anything that works to smooth fine lines on the cheeks and around the mouth? (Read More)
Q. Is there any way to get rid of the signs of aging on my upper chest? I have brown spots, red spots, and wrinkles. I confess I do go into the sun a fair amount. (Read More)
Q. I would like to have some filler like Juvederm® injected into my cheek folds that run from my nose to my mouth. These folds have progressively gotten more noticeable as I have aged. I read online that one of the complications of filler to the face is blindness, so I have held off doing the injection. Is this true and if so, is it very common? (Read More)
Q. I recently had the breast cancer gene test and was found to be BRCA2 positive. My mother died of breast cancer at 40 and I am now 36. My mammograms are clear so far but I have been advised to consider removing both of my breasts to protect myself from the disease. What is the best form of reconstruction for double mastectomy if I chose to go this route? (Read More)
Q. I recently moved to the Triad area after living in the Northeast for most of my life. I am interested in having some plastic surgery on my eyes but I do not know how to find the right plastic surgeon since I am relatively new here. Can you give any advice on making sure I pick a good doctor?. (Read More)
Q. A few years ago I had a facelift. Most everything went well except where the facelift scar went into my hair in the temple area. I now have a bald spot about the size of a nickel, but only on one side. It is not that noticeable except when my hair is wet. Is there anything that can be done to get hair to grow back? My plastic surgeon basically told me that it is not noticeable and not to worry about it. (Read More).