Cosmetic Surgery Serving Washington, DC - Dr. Roger J. Oldham Board Certified Plastic Surgeon

Approximately 25 years ago, drawing upon experience gained from post-mastectomy breast reconstruction patients, plastic surgeons began placing the implants behind the pectoralis muscles of the chest for cosmetic breast augmentation.  The technique gained popularity, and is now the most commonly used placement for implants, largely because of two advantages:  1) post augmentation mammograms are more reliable, because less breast tissue is obscured when the implant is positioned behind the muscle; and 2) placement behind the muscle lowers the incidence of capsular contracture, a post-surgical hardening of the tissue around the implant, which can make the breast feel undersirably firm.

Botox, which has been widely used for several years in plastic surgery to minimize deep lines and wrinkles, is now being used to minimize scars.  In a study from the Mayo Clinic, plastic surgeons injected Botox into the skin of the foreheads and upper cheeks of patients following excision and closure of skin lesion sites.  As expected, Botox minimized general movement of the area.  Since the movement of the skin surrounding the surgical site often adversely affects the healing process, they found that the Botox-injected wound sites, which had minimal motion, produced superior scars.

A lot is being written in the lay press about Lipo Dissolve (Mesotherapy) for removal of unwanted fat in the hips, thighs, abdomen and elsewhere.  Various agents are injected into these areas of unwanted fat and this is sometimes done by unlicensed practitioners.  Injecting these solutions are designed to dissolve fat in the subcutaneous layer of the body, but to what degree and with what accompanying side effects, no one knows.  Lipo Dissolve is not a substitute for weight loss or for the more effective procedure of liposuction of larger volumes of fat.  Unfortunately, very little is known about the safety of the solutions and the technique is not endorsed by The American Society of Plastic Surgeons and is not FDA approved.

Both Restylane and Juvederm are frequently mentioned in fashion magazines and the lay press as fillers which can effectively soften folds and wrinkles.  Many people are asking about the differences in the two.  Restylane and Juvederm are both hyaluronic acid products.  Hyaluronic acid is a naturally occurring substance in the body.  Restylane and Juvederm are very similar in composition but there are importance differences which have made Juvederm the treatment of choice for many plastic surgeons.  Juvederm is somewhat more concentrated and is more "cross-linked" which produces a smoother result.  Proponents of Juvederm point out that these differences have distinct advantages including less bruising, milder pinkness and decreased swelling following the injection. 

A recent survey was performed in order to identify the ages of women who are having breast augmentation.  50% of the women were between the ages of 19 and 34; to the surprise of many people, 40% of the women were in the 35-50 age group.

The open rhinoplasty is a relatively new approach to performing nasal cosmetic surgery.  The surgeon makes an incision across the columella (the vertical skin column separating the two nostrils) and elevates the skin from the cartilage of the nasal tip.  The modification to the nasal skeleton (cartilage and bone) is then done under direct vision.  Some surgeons feel that this direct visualization of the underlying structures improves their results.  The open rhinoplasty approach, however, produces increased postoperative swelling and prolongs the receovery time.  Many surgeons are also concerned about creating a permanent scar from the incision across the columella.

Other surgeons prefer the traditional closed rhinoplasty and remain confident that they can see the internal structures very well as they operate through the nostril with specialized instruments and lighting techniques.  

Injection of various "fillers" to eliminate some of the undesirable lines and depressions of the aging process is among the most commonly used non-surgical techniques for cosmetic improvement of the face.  While there are dozens of fillers in use throughout the world, only a few have been approved by the FDA for use in the United States.  The most popular filler in this country is hyaluronic acid (Restyland and Juvederm).  Results usually last 6 to 12 months. The FDA recently approved a permanent injectable filler, Artefil.  The prospect of a permanent result from a filler has obvious appeal.  Because facial structures and tissues change as the face matures, however, many plastic surgeons are hesitant to inject a permanent material.  The placement of the filler that creates a perfect result today may give an unattractive bulge or line as the face ages.  This could result in an uncorrectable aesthetic problem.

The most commonly used incisions for breast augmentation are around the areolar (the pigmented skin around the nipple) and in the crease under the breast.  While most scars are rather conspicuous, there is a lot of variation in the appearance of incision scars from one person to the next.  With breast augmentation, there will always be an incision scar.  An incision line around the areolar is often less noticeable than one in the crease under the breast.  However, the areolar incision line is visible in the upright position as well as in the lying position whereas an incision in the breast crease is hidden in the standing or sitting position.  Other incision locations include the armpit and around the navel.  Many plastic surgeons, however, feel that these incisions are too far from the breast to get an optimal placement of the implants.

FACT:  Basal Cell Carcinomas do, in fact, grow very slowly.  Although it is rare, there are reports of Basal Cell Carcinomas which metastasize.  The greatest concern, however, is that these tumors can reach a very large size if left untreated and can readily invade and destroy underlying tissue including cartilage and bone.

Pain pumps are becoming used quite commonly in plastic surgery especially with abdominoplasty surgery.  Tiny cannulas (tubes) are placed along the muscle-tightening sutures.  This allows the area to be bathed with a long-acting local anesthetic, thereby significantly decreasing the pain.  The cannulas are then painlessly removed three days after the surgery.