Medical Tourism (Cheap cosmetic surgery?)

Many patients are tempted to travel to distant places to obtain cosmetic surgery at a discounted price. The lure of less costly surgery will often cloud good judgement.  I have spoken with patients who were aware of a center’s poor health record and stated that they were willing to take a chance as long as they were able to have the potential results they desired. A study published this month in the Plastic and Reconstructive Surgery Journal from Montefiore Hospital in the Bronx reported on 42 patients having surgery outside the country over a 3 year period.  Almost half of the patients had severe complications. Many of the patients were poor candidates for surgery. Most of the patients had friends or family members that had successful cosmetic surgery overseas. The average cost of treating the complications was $18,000 a person.

There have been recent deaths in south Florida at discounted cosmetic surgery centers.  These centers change locations and the name of the center to try to stay ahead of the authorities. Discounted cosmetic surgery usually means cutting corners on safety. Patients develop complications and are brought to the emergency room for treatment of these problems. Many times the operating surgeon does not have hospital privileges to care for their patients.  If your doctor does not have privileges at a local hospital in may be a red flag.

Patients need to have follow-up care after surgery to obtain the best results. If you travel a large distance for surgery you have to factor in the travel time and costs to return to your surgeon for follow-up care. If you have a complication you often will need to take time off of work to travel to be treated.  These hidden costs need to be factored in when considering travel for surgery.

What can you do in order to protect yourself from making a costly mistake?  Do your homework! A recommendation from the internet is not how I would select my surgeon.  Speak to your family doctor and ask them who they would choose. Speak to the nurses in the operating room and the emergency room and ask their recommendations.  Check with the Board of Medicine to see if  your doctor is board certified and if they have had sanctions against them.

Thread lift versus facelift

Many cosmetic procedures are advertised as a cure for the aging process. New procedures are developed every year. Many procedures are abandoned shortly after introduction because patient expectations are not met. Over the years there have been new developments in suture material and surgery. Some of these techniques are added to the armamentarium of Plastic Surgeons and other fall by the wayside. Non-surgical facelifts using laser devices, ultra sound, and microwaves are currently available. These devices give modest temporary improvements to your appearance. Fillers and Botox can add fullness and soften wrinkles of the face but for patients that need skin and soft tissues repositioned, these techniques fall far short. The use of suture to lift the face without surgery has been tried over the last decade or so. Most of these procedures are used by non-surgeons since they cannot offer patient conventional surgery. Most of the suture techniques are no longer used because the suture costs as much as surgery and the results with suture lifts usually last only a few months. Before and after photos are usually shown a few days to a few weeks after surgery, be sure to see long term results before proceeding with suture lifts.

The popular web site RealSelf (https://www.realself.com/Thread-lift/reviews) shows a patient satisfaction rate of 54% for thread lifts. Surgical facelifts have a satisfaction rate of over 90%.The recovery from a facelift is a lot longer than a suture lift. However, the results are longer lasting and many of the procedures today have shorter recovery times as compared to 10 years ago. Be sure your cosmetic doctor can offer you all of the options for facial rejuvenation, not just a few. 

Most plastic surgeons spend 7 years in surgical residency training after medical school before they start to practice plastic surgery. Physicians that are not plastic surgeons spend a few days learning a new technique before they offer it to their patients.  Ask questions of your surgeon; being informed is your best policy when it comes to cosmetic procedures. For more information or to schedule a consultation with Dr. Rosato call our office at 772-562-5859, or visit our website www.rosatoplasticsurgery.com and be sure to like us on Facebook, https://www.facebook.com/TheRosatoPlasticSurgeryCenter/

Breast implant myths and useful information

Implants and breast cancer

Breast implants do not cause breast cancer. The breast implant is placed under the breast tissue and often under the chest muscle as well. Women with breast implants do have the same chance of getting breast cancer as women that do not have implants. In many studies of women with breast implants, breast cancers are found at an early stage as compared to women without implants. The earlier a breast cancer is found the better the cure rate. A small group of women have a gene that predisposes them to breast cancer.  Women can get their genes tested to see if they have this gene.  Angelina Jolie had the breast cancer gene and she decided to have her breast tissue removed and replaced with implants to reduce her risk of cancer.

Implants and Mammogram

Mammograms are recommended with breast implants. The usual mammogram has two views of the breast. If you have breast implants a third view is done to visualize the breast completely.  Using the three view technique allows doctors to exam 95% of the breast. Women with breast implants often have their cancers diagnosed at an early stage. This is probably due to an increased awareness of the breast in women with implants.

Breast augmentation and pregnancy

With pregnancy the breast will get larger, and usually the areola will enlarge as well. Some or all of these changes will reverse after pregnancy and breast feeding is completed.  After breast augmentation, the breast is enlarged and the areola also may get wider. How your breast will react to an augmentation depends on your skin qualities.  Some women can develop stretch marks after augmentation just as you can develop stretch marks after pregnancy or weight gain. Implants do not interfere with breast feeding. You can breast feed if you have implants.  If you have implants and then get pregnant the shape of the breast may change and you may require additional surgery to restore your shape. However, most patients after having a baby do not require additional surgery.

When is the best time to have a breast augmentation?

There is no ideal time to have a breast augmentation.  It is important to wait until the breast is fully developed before augmentation.  If you are losing weight and your breast is getting smaller your final size is most predictable if your weight is stable.  So it would be better to wait until your weight is stable before augmentation.  Saline implants are available to women 18 years old and older. Silicone implants are available to women 22 years old and older.

Do I have to exchange my implants every ten years?

No, this is a common misconception that arises from the implant company warranty.

Most implants do not last forever and you may require additional surgery to modify or replace the implant. The implant company has a warranty that will replace your implant if it leaks at any time. The company will also pay a fee toward the cost of surgery to replace your implant if it leaks within the first 10 years.  Dr. Rosato recommends you get a check-up at any time you feel your breast augmentation has changed in shape or softness. Older silicone implants (not cohesive gel) can have a problem with silicone leaking and gel moving into the breast tissue and lymph nodes.  We recommend a check up to access the status of these older implants

Can I dive or fly after breast augmentation?

Once your surgery has healed you can dive and fly at any time.  The pressure of diving does not impact your implant at all. However, cold or hot temperatures will be transferred to the implants. So your implants will heat up in a hot tub and get cold on deep dives. Once your surgery has healed your restriction on activity are without limits.

Can squeezing the implants cause them to burst?

No, any pressure that feels ok on the breast will not damage the implants. However trauma from an auto accident or a severe fall may injure the implants. It is best to be checked if you have any concerns after an incident.

Saline or silicone which is better, safer?

Today’s silicone implants are made with cohesive gel. The gel has the properties similar to a gummy bear candy. The gel is soft and stays connected. This is in contrast to the older gel implants that had gel that was very fluid. Saline and silicone implants have the same plastic outer shell. The shell is a solid silicone plastic that holds the saline or cohesive silicone gel. If a saline implant leaks the saline is absorbed into the body and the breast flattens out and the implant requires replacement. If a cohesive gel implants leaks the gel tends to stay together and usually no change is seen or felt in the breast. It is recommended that all implants be replaced if it is found to be leaking. If there is a question as to whether or not the gel implants are leaking then a MRI can be used to access the implants status. 

Short Scar Facelift

Before

after

It's not your mother face lift

The traditional face lift required scars into the forehead hair and into the hairline behind the ear. Some patients would look "over done" and have a pulled appearance. The introduction of modern equipment and specialized sutures has limited the scar for the modern face lift. The benefits of a shorter scar include not changing the hairline and leaving a natural appearance to the ears. The disadvantage of the short scar is that a heavy neck is not totally corrected and a more traditional face lift may be better suited for patients with heavier necks. The sort scar face lift surgery is done under a twilight anesthesia similar to a colonoscopy and recovery is rapid. The surgery usually last a few hours and patients are home and alert by dinner.  

Most patients have minimal discomfort and use pain medication for a few days while some patients do not require any pain medication at all. The majority of patients return to work in a week or so with very minor bruising and swelling. All  surgeries have potential risks and complications but the shorter operating time and smaller incision limits these potential problems. 

Most patients want to look refreshed and rested not plastic or pulled too tight. If this is the appearance that you are looking for then possibly the short scar face lift is for you. Call for an appointment
772-52-58859.

Ralph M Rosato, MD is board certified by the American Board of Plastic Surgery. He trained at the Cleveland Clinic in Cleveland Ohio, He is past president of the Florida Society of Plastic Surgeons, and the Indian River County Medical Society. He is a member of both national and international plastic surgery societies. 

Dr. Rosato introduced the short scar face lift to his practice in 2006. He presented his work in the summer 2013 at the Cleveland Clinic Foundation Plastic Surgery alumni meeting in Cleveland Ohio.

The Rosato Plastic Surgery Center ( http://www.rosatoplasticsurgery.com )  is a state licensed  ambulatory surgery center,  devoted solely to plastic surgery. It was established in 1998 and has a perfect record of compliance. Anesthesia is provided by board certified anesthesia. The staff is very knowledgeable and experienced. Learn more about facial surgery at http://www.rosatoplasticsurgery.com/facial.html

How to choose a plastic surgeron

Most patients know that they should select a surgeon that is Board Certified by the American Board of Plastic Surgery. The surgeon should also be on staff at the local hospital to make sure they have passed peer review and can care for you in the rare instance that you need to be hospitalized following surgery.

You should ask your primary physician who they would choose for a plastic surgeon. Ask the nursing staff in the operating room at the hospital who is the best Doc to see. You can also review the malpractice history of the physician on line.

What not to do is to select your surgeon based solely on their web site.  While a web site is a good place to start your search many claims and accolades that are placed on the web site are selected for their content. In other words bad reviews are not included on a doctor’s web site. Some claims and awards are bought for a price and some magazine articles are paid advertisements.

Be wary of physicians that claim perfect results and no complications.  Every surgeons has some complications, the best physicians recognize these complications early on and act to prevent long term problems. Waiting to see if things get better may not be the best strategy. I have cared for many patients that have had infections treated with antibiotics over a prolonged period of time when what was need was prompt surgery to limit problems.

Is there a lot of turnover in the doctor’s staff?  While staff members come and go the over-all attitude of the staff should be positive and usually is an indication of the harmony in the office.  We all know the difference between a staff that has it all together and a staff that is in chaos.

Finally you should go with your gut feelings. If you are at ease with your surgeon and have confidence in them then your attitude will be positive and lead to a successful outcome.

Call to arms!

The skin of the upper arms can become very loose and hangs when the arms are lifted. This skin has many nick names and none are flattering. The skin is referred to as bat wings in the US and in the UK they are called bingo wings. The cause of this loose skin is limited exercise and weight gain.

Many patients can firm this area with weight loss and exercise. For those that cannot do it by improving their fitness there are plastic surgery procedures that can help. Liposuction can remove excess fat and surgery can remove skin. The procedure is called a brachioplasty or arm lift.

It is done as an out-patient in an hour or two. Recovery is rapid and consists or wrapping the arms to support the new shape for a few weeks. The more loose skin you have the longer your scar will be.  Excess fat requires liposuction alone if the skin has good tone. If there is a small amount of loose skin then removal of skin in the armpit may be required.  Full bat wings require a long scar from elbow to armpit.

Here is a before and after patient.

The Rosato Plastic Surgery Center is having a call to “arms”. For more information or to schedule a consultation call the Rosato Plastic Surgery Center at 772-562-5859.

Gummy bear implants, what's the difference?

Breast augmentation is one of the most common cosmetic procedures performed in the U.S. and worldwide. In 1992 silicone implants were placed on hold in this country and the majority of physicians used saline implants for breast augmentation. However, the remainder of the world still used silicone implants.

After extensive research the FDA approved the unrestricted use of silicone implants in 2006. Today silicone implants are made with fourth generation cohesive gel. The gel is similar to the consistency of a gummy bear candy. The gel is very cohesive and when cut in half the new implants maintain their shape and the gel does not leak out. Older silicone implants had gel that would leak into the tissues if the implant was broken. The cohesive gel implants have been available in Europe for many years and I have been using them here in Vero Beach with great success.

Many patients with saline implants will exhibit wrinkles in the upper part of the breast or have a shape that is too round for a natural breast shape.  These patients are opting for implant replacement with silicone implants. Silicone implants come in a round shape like saline implants and are also available in teardrop shaped sizes.

Saline implants can be placed through a small incision because the implants are placed into the breast empty. The saline is added after the implants are placed into the body. If a saline implant leaks the saline is absorbed into the body and the breast loses it fullness. When an implant leaks it requires replacement, which is a simple procedure as long as it is done relatively soon after deflation.

An MRI can be used to access the status of silicone implants if a leak is suspected.  A special device developed in central Florida called the "Keller funnel" (www.kellerfunnel.com) helps place silicone implants into the breast and minimize potential infection.

The surgery usually last about an hour and most patients return to work within a week. Surgery should be done in a certified operating room for your safety. Anesthesia is required and usually a twilight technique is used. At the Rosato Plastic Surgery Center anesthesia is directed by a board certified anesthesiologists. The RPSC is a licensed ambulatory surgery center inspected by the state of Florida and the Agency for Health Care Administration.

Call the Rosato Plastic Surgery Center for more information, 772-562-5859, or visit our web site, www.rosatoplasticsurgery.com, or like us on facebook.   Special pricing is available to patients that reference this story.