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. https://www.themotherhoodcenter.com/classes-and-education/#recover-your-belly