Breast Reduction Surgery: The Ultimate Weight Loss and Lifestyle Procedure?

The first thing that I tell patients about breast reduction surgery is that is it a life changing operation. It is relatively rare that you do one thing in a few hours that impacts your world in so many ways. But while most women realize that a breast reduction can make your breasts smaller and lighter, they may not know how many other aspects of your body and world can be affected by this change. And they definitely do not realize to what degree your weight and overall health are usually impacted.

ONE- Proportions

When patients ask me what size their breasts should be, I hesitate to answer. For one, every body is different, and I am a big believer in proportions. A slim woman who is very tall and has wide shoulders may be able to carry a larger size, while a narrower woman with small hips may be better off with smaller breasts. One thing is for sure: they were not handed out evenly, and most of us are on one side or the other of the breast proportion spectrum.

One of the complaints I get from my breast reduction patients preoperatively is that they "can't buy clothing." They might be a size 4 in pants but an 8 in tops, so what happens when they want to buy a dress in one piece? Or, could you imagine, a bathing suit? It becomes almost impossible. What is worse is that wearing something too small on big breasts can look unprofessional or unattractive, so the default usually falls to the larger size- which can then look frumpy. When the rest of your body is small and only the breasts are large, that larger size doesn't fit you right anywhere, and you start looking like you are wearing someone else's clothing. Downsizing to the right one resumes that proportionality, instead of having your entire wardrobe dictated by something that only represents 10% of your entire person.

TWO- Weight

Even if you are not wearing clothing two sizes too big, very large breasts have the effect of making you look heavier than you are. Whether standing still, walking around, or sitting across a table or desk from someone, you will seem heavier than the scale suggests. Bringing that size into range of the rest of you allows the overall impression to be more accurate. In the end, most patients who get a sizeable reduction can look like they lost 20 pounds without having done anything at all. This is similar to the effect of removing a double chin through liposuction. A small patch of fat in the wrong place can suggest something very different about the rest of you, and an oversized top half can be even more extreme.


Whether large or small, breasts that sag suggest older age. Gravity being what it is, the larger the breast, the more likely it is to hang low. When performing a breast reduction, the goal is to minimize size but also maximize lift, which has the side effect of rejuvenating that entire area. Once reduced, the shape of the breast must then be rearranged, and this is the perfect opportunity to create something perky and light. Nipple position is a critical component of the operation, and the nipple is almost always raised back to its ideal aesthetic location. Finally, when moving the nipple, the areolar is generally resized and also reshaped, leaving the door open for a little artistic license and customization. This is where the design aspect comes into play; and in the right hands, it completes the cosmetic renewal. Can you say "mono-kini?"

FOUR- Cleavage

One of the things that is most difficult for people who do not have large breasts to understand is that the larger the breast, the less likely it is for the breast to be in the right place. Large breasts tend to pull on the skin and the ligaments, ending up hanging rather than sitting up in place. The more breast tissue there is, and the heavier it is, the more likely it is to hang down low. As it pulls, the volume that once was in the upper part of the breast falls below the fold, and you can eventually end up with most of the breast on the belly rather than the chest.

When performing a breast reduction, it is important to recognize that the breast tissue has fallen below where it belongs. The goal is not to just remove some tissue and pull the rest up by the skin. Skin has no inherent structure, and it will just fall back down again in time. Plus, if the skin falls after the nipple has been moved, you can get a "bottoming out," where the nipple is up and the breast is down, looking as backwards as it sounds.

For a breast reduction to be successful, the tissue that is left behind must literally be relocated to the upper portion of the trunk, and the cleavage line reclaimed. It may seem counterintuitive but the bigger the reduction, the more likely you are to grow your cleavage line by having the surgery performed. This involves a certain amount of redesigning and a clear 3D perspective on anatomy, but when properly executed, it leads to a remarkable transformation- and often a bra-optional lifestyle to boot.

FIVE- Diets Optional

Most of my breast reduction patients complain that they try everything but cannot lose weight. As you can imagine, if you had two 10 lb. weights around your neck, it would be hard for you to exercise too! For these women, simple things like going for a jog seem prohibitive. I hear stories all the time about women who wear two and three bras at a time while going for a run, because they can't contain their chest in any meaningful way. Getting a breast reduction when you need one can change all of that.

On average, a breast reduction patient in my practice will lose anywhere from ten to twenty pounds in the first six months after surgery. This is because she can actually exercise now. This is also because she can see her body, and the apparent weight loss from the surgery itself gives her a first look at what could be if she keeps that train going. For women who have been struggling with their weight, this can be a first step to a lighter life; but most importantly, it is a springboard to the final benefit: a complete change in lifestyle.

SIX- A New Lifestyle

A few years ago, one of my breast reduction patients told me that when she went home after surgery, her son was shocked to see that "Mommy, you grew!" She obviously had not gotten taller, but she was standing up straight for the first time in years. She was also walking differently, because she now had breasts that were not only proportional and lighter, but more symmetrical. For decades, she had had one much larger than the other, and it pulled her not only down, but to the side. She had the deep shoulder trenches from orthopedic brassieres, dents in her chest from industrial strength underwire, too-big-tops, and a hunched neck that required daily pain medication. Not fun.

After her surgery, this lovely woman suddenly walked tall, straightened out, and started a new workout regimen. She got so much healthier that her early high blood pressure went away and she no longer needed medication. The back pain also resolved and she no longer needed pain medication either. And she was finally able to buy clothing that fit, which meant that she could shop anywhere and benefit from sales. Huge amounts of money saved. It was a total life transformation.


While many plastic surgery patients are happy with their results and feel that it was worth the effort, women who have had breast reduction surgery are among the most satisfied. From weight loss to body rejuvenation to saving tons of money on bras and bikinis, the overall effect is generally transformative in every way. Happy is the woman who can wake up pain-free, go for a jog, and then throw on a summer dress without a bra and get on with her day. This bring new meaning to the concept of women's liberation. Be free, ladies, and thrive.


The High Cost of Free SIicone

These days you can find silicone almost anywhere. It’s in the hot pads we use for cooking, the gel we use for scar healing, and the industrial lubricants that the contractor uses for some of his building projects. Silicone is versatile and ubiquitous, but there is one place where you can find it that it does not belong: hanging out free in the human body.

One of the reasons why silicone has been so widely adopted is that it has long been considered inert, meaning that the body does not react to it. As more and more silicone products were developed, the medical community supported their use with the belief that the human immune system had no reaction to the material, making it safe as an implant product. If the body didn’t react to it, then the rate of inflammation and infection would be low, and therefore problems would rarely occur. Unfortunately, after decades of use, this concept is now being called into question. But even if you assume that there is reactivity to silicone, some forms are more problematic that others.

When we think of silicone for medical use, breast implants are the first thing to come to mind. But there are many other forms that silicone can take, and many other places it can end up. From eyelids to buttocks, in the form of liquid or solid, silicone has been making an appearance in multiple places here and abroad, often with dire consequences. So why is this such a problem? And why are we using so much silicone if it causes us so much trouble? Let’s try to demystify this issue once and for all.

1.      Solid silicone implants

Solid silicone is a block with a specific shape. This type of silicone is used to make things like chin or cheekbone implants. The product remains hard, and is often used to substitute things like bone. Like any foreign body, a scar shell called a capsule forms around it, and this contains the implant and serves as a barrier to the rest of the body.

Because solid silicone has no liquid or gel component, even if the implant cracks, there is nothing in it that can run around the body. This means that removing it is usually pretty easy. Even if it is stuck to the capsule, it can be removed with the capsule shell and this takes everything out in one go. The problem with the solid state is that it is very firm, and this makes it less desirable for areas that are not meant to be solid like rock.

2.      Silicone gel

When you want something semi-solid for softness but that also remains contained fairly easily, gel is the answer. Silicone gel has a relatively solid consistency, but it also has a softness and fluidity that make it ideal for simulating human tissue. The degree of “cohesiveness” in the gel refers to how linked the molecules are, or how solid it feels and how much it holds its shape. At this point, technology allows us to dial up or down on the softness, depending on what we are using the implants for.

Some of the other places that silicone gel can be found is in calf or buttock implants. Often, these implants also have a thin, pliable, solid shell and the gel is used to fill the shape. The solid shell contains all of the product, and a capsule forms around it as usual. The problem with these implants is that, depending on the level of fluidity of the gel, if they burst, the insides come out. Therein lies the main issue.

Once silicone gel is no longer contained within its shell, it is basically free, in full contact with the human tissues. That’s where things get hairy. The gel is sticky, taffy-like even. This makes it incredibly difficult to clean up. It sticks to everything it touches, irritating tissues and causing inflammation. Removing it becomes a huge problem, and this is where the real trouble starts. Most of the time, in order to really get it out, you have to remove the sticky gel, the shell, the capsule, and any tissues that came into contact with it. What a mess. This is one reason why many surgeons in the Unites States do not perform these procedures. When it goes bad, it’s bad, and very hard to cope with.

3.      Liquid silicone

Here is where things get really sticky. Liquid silicone was also long thought to be inert. As a filler material, it offered the option of being clear, malleable, and easy to inject. It also had the property of infiltrating the tissues like gelatin into a sponge, by filling every nook and cranny evenly. This was very tempting to practitioners who were looking for some bulk without having to make an incision and insert a block of construction material. But the same thing that makes liquid silicone so good as a filler material also creates a medical nightmare when things are less than fantastic: it cannot be removed from those tissues.

Imagine wiping up liquid Jell-o with a sponge and then putting that sponge in the fridge and letting the Jell-o set. Now take the sponge out and try to remove the Jell-o from it. It’s totally impossible. This is what happens when liquid silicone is injected into a buttocks. The stuff sets into the fat and muscle, never to be retrievable again. If it has the misfortune of getting inflamed or infected, then the misery has just begun.

Whether or not you believe it is inert, silicone gel is still a foreign body to the human body. It can get covered in bacteria and become infected. If it is not inert, then it can cause an inflammatory response without any infection present, stimulating your immune system to fight it off and attack. When this happens, your body will make a lot of scar tissue, causing tight and painful areas where the battle has taken place. In many cases, these infections and/or inflammations can make the person sick; and they can strike at any time and with any degree of frequency. What is worse is that, not only is there no specific medical treatment for this condition, there is no way to predict how bad it will get nor how often it will get there. This is where the black hole of misery begins.

One area where liquid silicone sometimes makes an appearance if the eyelid. People looking to fill in the divots under their eyes will sometimes get persuaded to go for a permanent solution. While some forms of liquid silicone are approved for human injection, these are intended for use in ophthalmology procedures, not for cosmetics. Injectable medical-grade silicone only comes in these small amounts in the U.S., but it is not made for wrinkle repair. When it sits quietly, all is well; and the results can be terrific. But if it decides to get upset, it too cannot be removed without removing a large piece of that same eyelid. The other thing is that the inflammatory response is usually so great that a different kind of scar tissue forms, called a granuloma. This too must come out for treatment to be complete, because it harbors small amounts of the silicone that the immune cells were not able to destroy. All in all, this can become a true disaster right in the middle of your face.

Whether in small or large amounts, free silicone can unpredictably become a life-long problem. Any tissues taken out in order to take out the problem silicone will ultimately need to be replaced. This means that treatment can be long and require multiple stages or surgeries, and end with disfiguring scars. Patients who get large amounts of free silicone injected, usually in other countries, will find it difficult to get any kind of treatment once seeking care here, because the interventions required are often dramatic and with unpleasant outcomes. The alternative is living with chronic pain and deformity, as the granulomas become hard and lumpy, the opposite of what you wanted for either look or feel.

Consider as well that once the gel gets out of that shell, it essentially becomes the free silicone that no one wanted to inject in the first place, whether or not there is a capsule barrier present. This is the big problem with breast implants, when silent ruptures mean free silicone without the patient even knowing it. What started as a contained soft addition becomes a clumpy mess of gel and granuloma, often with small bits traveling around the chest wall. Removing it becomes an arduous search and destroy mission, one that many surgeons shirk away from performing. While this situation is usually not as bad as the buttock epidemic currently under way, it can be just as miserable for its bearer.



Thousands of people get lured every year into having silicone injected into everything from their buttocks to their labia, often with the promise of lasting results with no surgery and no downtime. It takes very little time, costs very little money, and seems to hold the answer. But if you stop to consider this for a moment, it may occur to you that if this were the real easier and cheaper answer, it would have replaced surgery long ago. It hasn’t. Also consider that most of the time, free silicone injections are occurring in motel rooms rather than credentialed physicians’ offices, and payments are in cash only. This too should set off all of the alarms.

In the end, there is usually a reason why certain things are not done very often. Sometimes it is because they are difficult and require expertise. Other times, and more usually, it is because somewhere along the way the community figured out that it probably wasn’t such a great idea, and people stopped doing it. The best litmus test is this: If a Board Certified plastic surgeon won’t do it, and you rarely see successful before and after stories about it, you probably don’t want to chance it yourself.If it were such a good idea, there would be more of it going around, and you would have at least a handful of friends who could show you how happy they were with their results ten years later; as opposed to the horror stories you find online and in blogs. In aesthetics, as in life, you often get what you pay for; and short cuts often lead you right off the cliff. There is no buying your way out of that freefall, and it’s no


How to Spot a Fake!

Ever consider buying a really expensive handbag, and then realize that you could get something that looks almost exactly the same for a fraction of the price? Ever buy a really expensive handbag on a deep discount only to then realize that it’s not authentic? Well, don’t feel bad. It can be very difficult to spot a fake if you don’t know what you are looking for. That is why they have things like the Goyard Guide to help you figure out if what you are seeing is really real.

The same principle holds true for cosmetic surgery. Before and after shots are sometimes compelling to the point of being mesmerizing, and they often seem nearly impossible. What you might not realize is that many of these pictures are not representative of what that person actually looks like. There are countless photo-taking and Photoshop-ing tricks that can significantly affect how those pictures come out. Even where you stand when you take the picture can make a huge difference in how it represents what you are capturing.

So how to spot a fake? Here is your quick and dirty guide… Then take the SELF-TEST to see if you can spot the fake!

Tip #1: COLOR

Colors can make skin look fresh and bright, dark and dusky, red and angry, or green and sickly. Small changes in “HUE” can suggest well-being or age, depending on which way you skew it. Always look to see that something pink or green that was not supposed to change looks the same on the other side. Take a look at the picture below for example. The eyes are different colors, but they are not supposed to be. In this case, the color difference is more of a light and dark issue than a red/green issue, but the difference in color is a great tip off that the picture is a little skewed.


By far, the most influential aspect of a photograph is the lighting. Bright lights wash out details like fine lines and wrinkles. Brightening a photo with the computer can decrease contrast, or make the colors blend more together, and therefore look more even. Always look at the lighting on the before and the after. If they are not the same, chances are things are misrepresented. In the picture here, the eyes are different colors because the lighting is darker on the left. Darker lighting means deeper folds, more prominent wrinkles, etc... Always look for bright spots and dark spots, and any glare that just washes out the problems. This will be your first clue.


Saturation is the intensity of color in a picture. Basically, it describes how much paint is on the canvas. High saturation can make things look rounder or fuller, more plump. Lower saturation can make things look drab and less vibrant. See here the lips- much plumper on the right. Higher saturation is like putting an extra coat of lipstick on, without even touching the subject.

Tip #4: ANGLE

Do this experiment on yourself: hold your camera up high and take a picture of yourself facing up at it. Now take the same selfie with the camera in your lap and facing down. Totally different right? Not only does the angle change how the light bounces off things, but gravity also either pulls your face back to freshen you up, or forward to make things sag. The angle in which you take the picture can really make things look different. Always consider how the person is standing or holding their head. It can be a game-changer.


Because of the way that photo lenses work, there is an optimal distance at which to stand when taking a picture. Any more or less will change the photo itself, in a way in which zooming in or out will not fix. Without getting too technical, it’s all about the geometry of the light, or the way it bounces off your object and onto the lens. If you take a picture of someone’s breasts while standing close to them, they will look huge. Stand back six feet, and they will shrink up, without anyone doing anything to them at all. The close photo gives things a “fishbowl” appearance, almost like a panoramic view. Standing back lets the different elements in the photo even out and equilibrate. When considering that photo, try to see if any particular element seems a little blown up, or out of proportion. It may be exaggerated.


Back in the day (I will date myself here), before and afters routinely showed the before with someone frowning or serious, and the after shot had a glowing smile. Infomercials are still famous for this, as you watch the before eggs sticking to the pan that no one will ever be able to clean, and the perfect after eggs slide onto a plate with three strawberries and a single sprig of mint. The intention is to suggest that everything was miserable before the treatment, and now we are all just giddy with contentment.

What has happened lately, interestingly enough, is that this has shifted a bit. Because there is such a huge focus on rejuvenation, and therefore wrinkle-reduction, after shots rarely show anyone smiling. Why not? Aren’t they just delirious after their Botox treatment? Well, the answer is that those happy-lines are in fact wrinkles. Showing someone smiling will remove much of the evidence that they had their faces appropriately treated. Smiling can not only bring out your laugh-lines and crow’s feet, it can also reveal your double chin and the bags under your eyes that normally only show in the morning before your coffee. Always take into consideration how the movement of facial muscles may affect how the skin folds around them.


For body shots, posture is everything. Stand in front of a mirror, then turn sideways. slump down your shoulders and hang your neck. Now curl your pelvis under. Ugh. Very “before”.

Now stand up straight, bring your shoulders back, and stick out your butt. Now tighten your abs. That’s better! Now twist at the waist- WOW!

Right there, you just created your own before and after with no surgery at all. Shoulder posture totally changes the way the breasts lay, and overall core positioning can push out your gut or pull it right in. How your legs are placed also has an effect. Stand forward with your shoulders and hips square. Meh. Now rotate just a little to the side and cross your feet in front of you. Very slimming! These are the tricks the stars use for their red carpet looks. These are also perfect before-and-after tips for why one look might look very different from the other.


We all know that the clothes we wear can really change how we look. But they can also change what we think we see. The height of a collar can make a neck seem shorter and more chunky, or taller and slimmer. Low-waisted clothing reveals more of the belly, and it shows the definition of the midline. A higher waist will smudge out that line break between the narrowest part of the waist and the wider hips, and this could obscure the contour. When the before shows a high waist or chunky belt and the after has a streamlined (and sometimes Spanx-ed) profile, this may be part artifact and not all fact.

Tip #9: MAKEUP

Makeup is a very common tool for before and afters. In general, people look better in makeup. You can make or erase shadows, plump lips, brighten eyes, and take away shine. In this photo, the makeup colors look similar but the makeup is used very differently. The eye-shadow on the right brings out the eye and makes it look much bigger. The lipstick on that side goes beyond the lip line, and the color is brighter. This makes the lip much fuller. Shadows on the nose also make it look thinner and make the nostril look smaller. No, really, look closely. They fooled you!!

Tip #10: TONE

Finally, let’s talk tone. Ever notice how sometimes you read an email, and even though you can’t hear the person’s voice, you can feel their tone? Tone is a huge factor in photography. Think of it as the background music of the shot. In this photo, the left side seems sadder than the right, although at first glance the woman appears to be in the same mood. But if you really look at it, you will see that on the right side she is almost, sort of, subtly, smiling. The corner of her mouth is just a little up, the corner of her eye a little lifted, and the muscles in her face just a tad bit animated. She is a little happy. Not enough to tip you off, but just enough to make you feel it. The woman on the left had a bad day. The one on the right is feeling just fine. Almost happy. Definitely confident.

So how do you tell the tone of a photo? Easy. How does it make you feel? That’s your answer.

The verdict: Photos can show us things that are and things we want to show equally. When considering your cosmetic options, be an educated consumer. Surgery on your body is higher stakes than buying that almost-handbag, and the advertisements are more aggressive. Remember that the before and after shots you see are the best that person has to offer, and also represent what they imagine is a great result. Make sure your goals line up with theirs. But more importantly, when looking at those pictures, all designed to make you say “wow,” know how to spot these tricks. An excellent surgeon will doctor her patients, not her photographs.


Why Everyone Needs a Plastic Surgeon on SpeedDial

Life is full of Boo-boos. They happen to everyone all the time. But before you decide to just "butterfly" it and run, consider this: there's probably a plastic surgeon nearby who could patch up that boo-boo and get it looking much much better down the road.

Plastic surgery has come a long way since its inception last century. Wound care technology and surgical techniques, along with breakthrough lotions and potions, now have us in a place where the idea of a scar is a very different thing than it was for our grandparents. What's more, since a scar is not mature for at least one year after injury, there is actually a lot that can be done over a long period of time to ensure the best possible outcome. You just need the right coach.

The idea of a plastic surgeon evokes Botox and breast augmentations- yes, we do those. But what most people do not realize is that we also fix cuts, burns, broken bones in the face, nerve injuries, and hand wounds. We repair bellies, cover open wounds for other surgeons, and shepherd our patients through full body rejuvenation in a way that no other specialty can. 

So whether life hands you a surprise party, the aftermath of pregnancy, or a bump on the head that "came out of nowhere," know this: the boo-boo lady is your lifeline to timely expert care, and your best chance at destroying the evidence of a bad day


You're Not Alone... Why No One's Bra Fits Well

You’ve probably heard the statistics: 80 percent of women are wearing the wrong bra size, and they don’t even know it. But many of these women have been wearing bras every day for decades. How, exactly, could they be so clueless? If you had the wrong size shoe, you would probably know it. So how could something so intimate be so off-base?

The Problem With Sizing

The problem with bra sizing lies less with the wearer than with the sizer. Bras have only been around since the 1930s, when corsets went out of fashion and people started making underwear as we know it today. The original idea of bra sizing focused on how much ptosis, or sagging, a woman’s breasts had. This proved to be minimally useful, so the "A,B,C,D" letters were eventually re-adapted to assess breast volume more than position.

How Traditional Sizing Works

The way that bra sizing works is as follows: The chest wall is measured in circumference just below the breasts. The breasts are then measured in circumference at their peak, and both numbers are recorded. If the difference between the two numbers is one inch, then the cup size is A, if it is two inches, the size is B, and so on. This approach is simple and direct, and seemingly adequate, but ultimately totally inefficient.

The Missing — And Most Important — Measurements

The problem with this approach to bra sizing is that it fails to take into account many things. For one, the most important measurement of any breast is the base diameter, or the width of the breast. As a plastic surgeon, this is the most critical assessment I make on any breast exam during a consultation. The base diameter of the breast sets the stage for any implant-based surgery by letting the surgeon know how much real estate she has to work with. Similarly, the width of the breast should guide what covers the breast. Much as a foot fits into a shoe, width can make or break its success; cup sizing as we know it takes no account of this.

Bra cup sizing also fails to recognize the height of the breast, and more importantly, how low it hangs. If you measure the circumference of the breasts at their peak, but the breasts are sagging to the floor, you are likely to underestimate how much breast really lives there. In some patients, most of the breast tissue lies low on the abdomen rather than on the chest up above. In extreme circumstances, this could mean that more than half of the patients’ breast tissue eludes the cup size measurement entirely, and remains unrepresented. This may be part of the reason why the original cup sizes came with a disclaimer that they were in fact not useful for very large-breasted women.


Now let’s consider gravity, the enemy of perkiness. Most breasts will sag over time, but some will sag more than others. The more a breast sags, the flatter it appears to be. The flatter it is, the less it can project forward away from the body. If you go back to the cup measurements, and you visualize the measuring process, it becomes clear that perky breasts will stick out more than flatter ones. And they could easily measure out to a larger cup size even if the breasts they represent are in fact half the size of the sagging ones.

Finding the Right Bra

It is now becoming clear that bra cup sizing is in fact quite arbitrary. So what about the professional lingerie houses that offer personal sizing? Are they the answer? Yes and no. As long as we have the current system, finding the right size bra will continue to be similar to finding the right size pair of jeans. The sizes will serve as a guideline, but it is only once you identify the perfect brand for you that things will really fit into place. It’s helpful to look for the model a brand uses—does she have similar characteristics to you, in terms of breast width and size?

The reason why lingerie houses may be more successful in fitting you than a regular underwear house is that they have a clear sense of how their items are sized, and they often have a variety of styles that incorporate different widths and projections to compensate for client variability. Still, this option remains a mere Band-Aid to the real problem: bra sizing was created by people who thought of breasts as small, medium, and large, once they were freed of their corset baskets 80 years ago.

Developing a New Bra-Sizing System

As a dedicated cosmetic breast surgeon, I spend a lot of time thinking about breast shape, size, and proportion. I also spend a lot of time consulting with patients, most of whom are never really comfortable in their bras. It is my plan to devise a realistic bra sizing system in the near future, one that can be standardized and represents relevant measurements for each woman. Conceptually, this is not that challenging. The real question is, if this system were developed and proved to be useful, how would anyone get the world’s bra manufacturers to make the switch?

Seek Support Without the Wire

Old habits die hard for a multi-billion dollar industry, but there is hope that if enough women learn how to find the right bra, seeing the difference it could make may incite a revolution; cup size would finally become an antiquated custom. In the meantime, embrace your B, whatever that means, but lose the wire. The only thing worse than the wrong width bra is one with a metal band set to the wrong diameter. Technology offers us revolutionary new materials that can change and conform as needed, and support without the remnants of a corset. Support is possible without metal, and shape is easier with stretch. Until the day that bras are actually made to fit real breasts—and I believe that day is coming—the only chance we have at comfort is adaptability.



ho·me·op·a·thy ˌhōmēˈäpəTHē/

I am not generally that big on lotions and potions. Few things truly work as well as they should, and even fewer come without significant side effects. For scar therapy, you can't argue with the data on silicone and sunblock. But for the other nemesis of cosmetic surgery, unsightly and uncomfortable swelling, there is Arnica.

Arnica is a homeopathic medicine derived from a plant whose mechanism is not well understood. What is well understood is that it has an impressive ability to limit swelling, bruising, and pain after physical stress. Many athletes routinely take it to help ease the burn after a strong workout. Today, Arnica Montana is a mainstay of plastic and aesthetic surgery.

While we are not sure exactly how it does it, Arnica can do many things. It can speed up healing, relieve pain, decrease the pressure and discomfort felt by swelling, limit inflammation, and in fact fight infection. The two chemicals it may work on are called helenalin and dihyrdohelanin- two potent warriors that attack inflammatory cells, bacteria, and even some cancers. There are rare reported side effects from it, and most people do experience a significant benefit from its use. Furthermore, it's cheap, easy to use, and at this point easy to find.

So why doesn't every surgeon use it? Among plastic surgeons, Arnica is a frequent flyer. Because so much of what we do is elective, we have the benefit of presurgical planning. But the medical world is beginning to hear our cry, and fortunately gentle remedies like these are taking hold. Coupled with Bromelain, an enzyme found in pineapple juice that decreases inflammatory prostaglandins, Arnica is indeed becoming very popular in head and neck surgery and some orthopedics. 

Now before you run out there to stock up, remember that ,as a general rule, self medicating is a bad idea. Don't take anything without discussing it with all of your doctors. Many people do not realize that all these over the counter "vitamins" and "herbs" are indeed drugs. They too come from plants, they too can have side effects, they too are not for everyone, and they too can interact with other substances. Keep perspective and keep it simple. And with the right homeopathy on board, you'll also keep it cool.


When Looking Young Starts to Get Old

Every once in a while, as you gaze at one of your favorite celebrities who just really hit the big-time, you start to wonder.... what in the world did she do to herself? She still looks sort of like herself, but somehow things just seem off. Even stranger, you know she is young, and she seems a little less wrinkled, but she also oddly looks a lot more like an older woman than she did a few months ago. How does that happen?

In the wake of an injectables revolution, one must consider the old adage- all things in moderation. Fillers and toxins are fantastic aesthestic tools, and when used properly, can yield tremendous results. But if things get out of hand, they can really backfire. 

For one, some lines are meant to be on your face, and completely removing them makes things look a little strange. For example, nasolabial folds (aka, laugh lines) should be soft and not make you look like a wooden puppet, but if you really flatten that entire upper lip area, you start to look like a doll and not a human. What's more, complete flattening makes the lip look longer, and that looks more masculine. And anything masculine on a woman will start to look old.

There are several areas of the face that have this same limitation when overly smoothed, but this is not the only potential pitfall with injections. At this point, so many people are so overdone that the overdone look has its own stigma. You can spot the look from across a room, and it has the connotation of an older person trying to look young beyond what is possible. The interesting thing about this is that, when a young person starts to look done, she will start to look like the older woman trying to look young, and will then start to look OLD! The more tells there are, the worse this gets, until eventually you just can't tell who is who anymore.

The good thing about most of these methods is that they do wear off, so if you go too far there is usually room for reprisal. But if enough needles have been enough places, scar tissue will form, and this is a one way situation. Patients may not realize that  no cut does not mean no scar- it only means tiny needle shaped ones. A couple of them twice a year won't do much in the long run, but if you've used five syringes in your cheeks every quarter for ten years, there is in fact no turning back. And at that point, sometimes surgery is the better answer after all.

In treating patients with fillers and Botox, I always consider what the natural younger version of them should look like. The intention is to slow time and preserve identity, all the while without letting anyone know that you are doing anything. Beauty extremes seldom succeed, and there is also just so much your skin can handle without fighting back. Be aware that this type of fight generally isn't pretty.


But Will It Leave a Scar? The Top Ten Tips

It happens all the time.. I talk to patients about their surgery, including their scars, I tell them the scars will always be there. And then they ask me: "But I thought I was having plastic surgery?"

Any time you cut through the skin full thickness, you will get a scar as a result. Scarring is your body's way of healing and closing a wound. Scars happen, and nothing can prevent them from happening. BUT, the degree to which they are visible varies widely. Not seeing a scar doesn't mean that there is no scar there. That being said, while scarless surgery does not exist, invisible scars can be a reality.

1. The main factor in scar formation is genetics. If you are someone who scars a lot, then that will often be your fate. If you "heal well," you are already ahead of the game.

2. The second key to good healing is a proper surgical repair using all of the plastic surgery principles of optimal wound healing. This is operator dependent.

3. Optimize nutrition. You scar what you eat. If you have the right stuff going in, you are more likely to do the right things on the outside.

4. Follow instructions. Most patients underestimate how much their instructions can impact how their scars will look in the long run. If you are told to put on cream, use it. If you are recommended to massage, do it. All of these things have an impact; and even if each is a small factor in and of itself, the combined effect and longevity of use can create huge differences.

5. Keep it clean. There are situations in which wetting a wound is a bad idea. But unless you have been told to keep it dry, washing is a good idea. Infection, even on a small scale, can cause a lot of inflammation. Inflammation is the enemy of a good scar.

6. Keep it dry. When it's not being washed, a wound wants to be dry. Excessive wetness, including things like using too much ointment, can create goopy messiness. None of this will help the layers form or the bugs stay away.

7. Avoid the sun.

8. Avoid the sun!

9. Get ahead of problems early. If you think you have a thickening scar like a keloid, or if your scar is itching or burning, go see your surgeon. There are many problems that require early intervention for good treatment, and many interventions that often have success. Get in early for best results.

10. No lotions or potions. As you watch your scar mature and agonize over every change, people around you will have many suggestions for what to put on it. Some will seem reasonable, and others more like strange brews. Bottom line is that if it wasn't recommended by your doctor, it's likely to muck up the pot. Keep it simple.

Scars are unavoidable. Good scars are the goal. 

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But Can You Wear a One-Piece?

When my patients ask me what size they will be after surgery, I struggle with the answer. They want me to use one of the conventional letters (A,B, DD) but these are not exact measurements (read more about why bra sizing makes no sense!). What's more, these letters do not reflect the fact that there is no one size for all.

When assessing what size to make someone, whether bigger or smaller, it's all about proportions and balance. Everything looks different depending on what it is next to. When you make the breasts bigger, the belly looks smaller, and vice versa. That seems pretty intuitive. But what is not always so immediately obvious is the fact that the same size will look different on different people. The exact size breast on a smaller, shorter, narrower woman will appear tiny on someone six feet tall and broad shouldered. The ultimate size has less to do with the bra cup in a vacuum, and everything to do with the overall proportions of the patient. If you're not looking at shoulders, hips, and height, you're not really sizing things up properly.

In terms of clothing size, most women have an overall size. The best candidates for plastic surgery are those who know and maintain their size, but have one element that is off proportion to the rest. For example, someone who has full hips and wears a medium overall but can't fill a B cup bra. That person will always have trouble finding clothing, and spend most of their dress time padding up. Another example is the mom who is a overall size small but has a weak and bulging belly that just can't crumple into a pair of regular jeans. Imbalance.

Imbalances can be obvious or subtle. The best way to know if you are imbalanced is to go one-piece shopping. If you can't buy a one piece or a bikini in a set, you are probably imbalanced. This is not an issue if it doesn't bother you, but if  you're buying three sets of swimwear because nothing works as it should, it may be time to consider your surgical options. In most cases, the target is clear and the goal can be attained. The trick then is not to overshoot; and if you really want to hit a home-run, find a surgeon who can get that "fake out" result for you. If you get to the size you should have had to begin with, no one will question whether or not you came that way. If it fits, it fakes. Just another happy day at the beach. :)


Jawline Liposuction : The Facelift Before The Facelift

Many of my patients have just a little bit of a problem with sagging - especially at the neckline. For most of these patients, it's too soon for a facelift, but it's time to do something.

The feminine jawline is shaped like an egg- oval and smooth. Early jowls will square off the jaw, making it look more rough, wide, and masculine. All of these elements have an aging effect. 

A little liposuction in just the right areas can empty the early jowls, get rid of a double chin, and allow the skin to spring back into a more angled shape on the neck, all in all restoring that youthful look. And all this with a few small incisions that fade over time. 

Recovery and downtime are minimal compared to a facelift, but the results can be dramatic. The skin usually tightens enough for this stage, the jowls disappear for now, and overall it can buy you another ten years. My mantra in my practice is to "make it as simple a road as possible to get to the desired result." In this case, it's often a straight and smooth shot to ten years ago.


If My Belly Is the Problem, Why Does My Back Hurt?

Many people suffer from back pain, and back pain has a huge list of possible causes. But one item on that list that many people don't think of is the other half of their trunk: the belly.

Our bellies are there to do a lot more than just look good in a bathing suit (although that is a great part of it). Our bellies also support our cores, and as a result, they balance out our backs. When I was a kickboxer many moons ago, I remember my trainer used to tell me how important it was to work out my back in order to support my belly. He warned me about doing too many crunches without working on the other side, realizing that if I didn't do a well-rounded job with my workouts I might get thrown off and actually end up injured. He was right- and it turns out it works the other way around too.

So many of us fail to hold our posture, and we work out erratically, forgetting to exercise the "other" muscles that we have. But one key time when this problem really rears its head is after baby-making. Bellies can take a lot of stress, but baby making is as real as it gets. For most moms, by the time you finish, the strength and structure of the abdominal wall is all but lost.

With the muscles off alignment and the tissues all stretched out, even the best of workout efforts are likely to fail. Furthermore, pushing even harder without the right balance can cause an even more extreme stress on your core- and more pain. Rebuilding your belly, whether surgically or non, can sometimes be a huge help in finding that balance and sometimes even in relieving that pain. For some patients, a weak belly can even mean trouble going to the bathroom, since pushing down to get stuff out is another important role that the beautiful belly is supposed to play. Misery.

Your belly wall is actually a bigger part of your overall health than it's made out to be. Ripped abs are sweet, but they are more than just eye candy. A strong and balanced core helps you stand up straight, feel alright, and work that middle the way it's supposed to. Getting a proper assessment can help you figure out what is causing all of that drama- and that's the first step to getting better.


Mommy Rehab?

If you broke your ankle, you would get surgery, wound care, and then 8 months of structured, carefully measured rehab.

If you pulled a muscle, you would be instructed to rest it for at least 6 weeks- how else could it possibly recover?

And yet, after you have children, even several children, even pulled out of you c-section children, there is no prescribed course of rehabilitation. Your mind, your body, your everything is forever different and you can barely recognize any of it. And you are left to your own devices.

Post-partum rehab is a very real, important, totally unexplored field of medicine. What is should look like is physical strength and balance training, belly support, surgical reconstruction if needed, pelvic floor exercises in measured amounts, psychological support, and nutritional counseling. What it looks like now is, "You have issues? What do you expect? You had three kids!"

My mommy mission is to help women start asking the right questions before, during, and after baby-making. I want to help moms recruit the support, information, and professionals that they need to literally get and keep it together. Join us tomorrow at the Motherhood Center, and let's start the conversation.