Virtually every year I make a pilgrimage to Miami in the 2nd week of February to attend what I consider to be the finest plastic surgery meeting in the world – The Baker-Gordon Symposium. The annual event is named after Tom Baker, its originator and also the plastic surgeon that popularized the chemical peel in this country.
Forty-six years ago the symposium began when Tom Baker and Howard Gordon, two young plastic surgeons, invited several well-known plastic surgeons to come and speak to other plastic surgeons about their particular areas of interest. It has become a famous event, attended by several hundred every year.
Not only do doctors travel from around the U.S., but many come from around the globe, particularly from the Latin American countries. There are lectures in the morning by invited speakers who then perform live or videotaped surgeries in the afternoon to demonstrate what it was they spoke of in the morning. They must, “Put up or shut up!” The hosts of the symposium keep up a lively conversation with the speakers during lectures, panels, and live surgeries, making it an interactive learning experience. I have my favorite seat in the second row where I sit amongst others who come back to their favorite seats year after year. It makes for wonderful camaraderie as well as for an opportunity to exchange views and ideas with each other during the sessions.
The evenings are spent dining in Miami, enjoying the marvelously illuminated skyscrapers, and walking around in balmy weather with cooling breezes. What a treat for the mind and the senses!
A few highlights from this year’s meeting that may be of interest to my readers:
Non-surgical skin tightening remains in its infancy. If you’re interested in the type of result you get with surgery, dream on! It’s not even close yet!!
Non-surgical fat removal is a bit more promising, but still the significant results that liposuction delivers cannot even be approached by the best of the techniques.
Ultrasonic, Laser, and Radiofrequency assisted liposuction produce heat that leads to fat cell death, inflammation, and more scarring in the area of liposuction that can produce unsightly skin dimpling and irregularities that are challenging to treat. The majority (74%) of plastic surgeons in this country favors traditional (51%) or power assisted (23%) liposuction as opposed to these other modalities.
Buttock Shaping (Gluteal Sculpting in “Doctor Speak”) is enjoying a surge in interest as plastic surgeons recognize that treatment of this oft-neglected area is key to achieving a pleasing surgical result. Fat Sculpting by means of liposuction and fat injection is used most often in Gluteal Sculpting with implants having a role of lesser importance.
There is a lesser degree of capsular contracture with saline as opposed to silicone breast implants. Furthermore, the rate of leakage seems to be about the same with both, but with the leak being obvious with a saline implant but requiring an MRI for detection with a silicone implant.
Fat injection to the breast is beginning to play a more important role in breast augmentation. Although many breast augmentation candidates want a projecting look that can only be achieved with implants, there may still be a role for fat injection in their cases if they are willing to put up with the hassle of using a BRAVA breast suction device that must be worn for several weeks before their operation. If a patient develops intractable capsular contractures, fat injection may soften the contracture or may even take the place of the implant. Furthermore, should the implant be somewhat more visible than the patient desires – especially in thinner patients – fat may be able to soften the look.
On the way home from Miami, I couldn’t help but drop by the Kennedy Space Center for a few “out of this world” shots!
Should you have further questions, please contact my office at (818) 528-6125.
If someone were to ask what has been the greatest advance in plastic surgery in the last 200 years, what would be the answer? Some might suggest liposuction, others the invention of the medical laser, and others injectables like Juvederm and Botox. I would suggest something a bit different!
What do liposuction, laser treatments, and the use of injectables have in common? The answer is the use of anesthesia! Liposuction is done either under sedation, general, or local anesthesia and the solution that is injected into the area of proposed liposuction contains an anesthetic agent. Laser treatment is usually done after the application of a numbing cream or under local, sedation, or general anesthesia. Injectables either contain a local anesthetic agent or the procedure is done under anesthesia of some sort. Were it not for excellent anesthesia, far fewer folks would be willing to undergo a procedure for the sake of appearance!
When did anesthetics originate? They were known in ancient Greek and Roman times, frequently being herbal in origin. Alcoholic drinks were used as well. Nitrous oxide, also known as laughing gas, as well as ether came to the forefront in the mid 1800’s and began to be used to anesthetize patients who were going to have surgery. This type of anesthesia was known as inhalational anesthesia. The patient merely inhaled or breathed the anesthetic gas, fell asleep, and painless surgery was then performed. Since the mid 1800’s, many other agents have been invented, allowing safe and pleasant anesthesia.
The first local anesthetic widely used was cocaine. It was introduced in the mid 1800’s as well, and many others such as Xylocaine have followed.
Morphine, which is found in opium, was first isolated in the early 1800’s and became widely used once the hypodermic needle was introduced in the mid 1800’s. Many other intravenous anesthetic agents have been invented such as Propofol.
I use inhalational, intravenous, and local anesthetic agents in my practice. Sometimes the choice is made by the patient. For instance, a MACS-Lift can be done under local anesthesia, although some patients prefer sedation anesthesia which is done with intravenous Propofol and sometimes a bit of inhalational agent. At other times, the choice is mine, as in breast augmentation that requires the relaxation of the chest muscles by means of intravenous agents for insertion of an implant beneath the muscle.
Regardless of the technique of anesthesia used, it is done safely and pleasantly. The advance of anesthetic techniques over the past 200 years allows for this and certainly has played a major role in the increased popularity of plastic surgery.
Should you desire further information, please contact my office at (818) 528-6125.
I had some facial and neck work done in mid November by Dr. Sanders and was very pleased with the results. Dr Sanders and his staff were extremely helpful in calming any fears and concerns I had. I would recommend him and his skills anyone interesting in these proceedures. The after care following my surgery by nurse Norma and her...
Dr. Sanders is one of the top plastic surgeons in the Los Angeles area. He is board-certified and experienced in a range of cosmetic procedures. For more information or to schedule your free consultation, please call our office at (818) 528-6125.
Where is the best location for a breast augmentation incision? Some plastic surgeons have very definite preferences, but what are the facts in the matter?
There are basically 4 incisions that can be used:
Around the undersurface of the areola – Periareolar incision
Beneath the breast in the fold – Inframammary incision
Through an incision in the armpit – Axillary incision
At the top of the belly button – Umbilical incision
The umbilical incision is limited to saline filled implants since a silicone implant will not fit through the small tunnel that leads up to the breast. Although some surgeons report good results with the umbilical approach, it may be difficult to precisely create the pocket for the implant, producing a disappointing result. In addition, liver and lung injuries have been reported.
The axillary incision has the advantage of avoiding a scar on the breast. I, however, have found this incision to leave a scar that may be quite noticeable with sleeveless clothing such as bathing wear. In addition, it is difficult to position the breast implant in the popular “dual plane location” in which the upper part of the implant is covered by the upper portion of the pectoralis major muscle and the lower part of the implant lies in front of the lower part of the pectoralis major muscle. Many plastic surgeons, including myself, believe that the dual plane location is the optimal position for the implant in most patients, another reason for not using the axillary incision.
The periareolar approach is the most versatile in my hands. It tends to produce a scar that heals very well. The beauty of the periareolar approach is that an incision located at the precise junction of the dark areolar skin and the lighter colored surrounding skin is difficult to see. Of all the incisions, however, this one is associated with the greatest chance of inability to nurse a child after surgery. There may also be a slight increase in the risk of altered nipple sensation compared with the other incisions and perhaps a slightly greater chance of contracture of the scar tissue that surrounds the implant requiring corrective surgery.
The periareolar incision can only be used when the areola is of sufficient diameter to allow for insertion of an implan
t. A saline implant can be inserted in cases of a diameter as small as 1 inch on stretch of the skin, but this may traumatize the areolar skin and produce problematic scarring. A silicone implant requires a diameter of at least 1 ½ inch on stretch of the skin for a small implant. Larger implants require larger diameters to avoid skin injury as well as to avoid implant damage that can predispose to leakage.
The inframammary incision was the original incision used for breast augmentation. If the incision is made precisely in the fold beneath the newly augmented breast, it usually heals inconspicuously, although problematic scarring can occur. If the scar migrates upward from the fold after surgery is completed, it tends to stretch out and be more noticeable. More and more surgeons are using this incision because it avoids the milk ducts that are important for nursing and also avoids the bacteria found in these ducts that may contribute to painful and disfiguring scar contracture. If scar contracture does occur, however, treatment through the inframammary incision may be more difficult.
If a breast lift is going to be done at the same time as the breast augmentation, the implant is usually inserted through the uplift incision.
Ultimately the choice of an incision is one that a patient should make in consultation with her plastic surgeon, but the guidelines listed above may help guide the process.
Should you desire further information, please contact my office for an appointment at (818) 528-6125.
Dr Sanders is a fantastic Dr. He is a man of great integrity. I am so very pleased with my 3 face-lifts and fraxel laser.He has made me very happy and I know many other people share my opinion.I have a loft of respect and admiration for him. The staff is very helpful and nice. I have total confidence in him and trust him 100%. Katarina
Dr. Sanders is one of the top plastic surgeons in the Los Angeles area. He is board-certified and experienced in a range of cosmetic procedures. For more information or to schedule your free consultation, please call our office at (818) 528-6125.
