25 years of sun damage in 1 picture

Think you're immune to the effects of sun damage?
Hardly.

Now more than ever the damaging effects of ultraviolet radiation are well described.

The effects of 28 years of sun damage through Ultraviolet (UV) radiation, are readily seen in this picture originally published by the New England Journal of Medicine. The image is of a 69 year old man who had been a delivery truck driver for 28 years, with the effects of sun damage seen of his left, the side closest to the driver's side window.

The only thing that damages your skin more than the sun's UV rays, is smoking AND the sun's UV rays!

At Fleming Island Plastic Surgery we offer several restorative options to help reduce the effects of sun damage, as well as prevent further injury.

Contact our esthetician, Susan, for your consultation and full evaluation.

Or meet with Dr. Wallace to discuss facial rejuvenation procedures.

www.904plasticsurgery.com

904.990.FIPS (3477)

Overfilled Saline Breast Implants

There is a lot of talk on the internet today about patients receiving OVERFILLED SALINE IMPLANTS. And by overfilled they mean approximately TWICE the recommended volume. Saline (and silicone) implants come in a myriad of sizes and profiles in order to give each patient an individualized result suited for her body and desired outcome. Saline implants are received empty, and filled with injectable saline to a recommended volume. Each saline implant has a fill range with a minimum and maximum recommended volume.

Why is overfilling a saline implant a bad idea?

Implant identifier and measured volume of saline

Same implant in image above, 
filled to 2.5x the recommended projection

Many reasons, in no particular order:

1.   It VOIDS the warranty. Implant manufacturers stand behind their product, and current warranties allow for full cost of a replacement implant should one fail (procedural costs may not be included). However, this warranty is voided should the surgeon fill the implant with more saline than recommended by the manufacturer.

2.   It makes the implant hard. HARD. This has many implications. First, they don’t feel right. Breasts shouldn’t be hard. Second, they can cause pressure on the skin which could result in skin loss and infection in extreme circumstances. Third, they can case skeletal deformities. Your ribcage is alive and constantly remodeling. The pressure caused by a very firm, overfilled saline implant can, over time, create a concave ribcage.

3.   It DISTORTS the shape of the implant. A saline implant when filled correctly has an oval appearance. An overfilled saline implant takes on a round shape, resulting in a very artificial look (and feel! See item #2)

4.   It can cause your Areolae to STRETCH to large proportions. The areolae (the dark skin around the nipple) is less elastic than the breast skin, and resultantly stretches more easily than the skin of the breast in an augmentation. When strained by an overfilled saline implant, patients can be left with areolae over 3 inches wide.

Overfilled saline implants & stretched areolae (left),
exchanged for silicone with an areolar reduction & vertical lift (right)

5.   It is NOT a substitute for a lift. Some surgeons will advocate putting in larger and larger implants to avoid getting a breast lift, which can result in a larger result than a patient desired or anticipated. There is no such thing as an “INTERNAL LIFT”, it just means "overfilled saline implants".

6.   It is MUCH harder (and much more expensive to the patient in the long run) to correct in a revision than getting it right the first time. I have performed many revisions of breast augmentations of patients with overfilled saline implants. None of them was ever straight forward, several of them required some additional procedures to achieve the desired result.

7.   It costs MORE. Some surgeons may charge thousands less than others in the same community. While it seems a bargain, BEWARE. Believe the cliché: if something seems too good to be true it probably is. Saving money in the short term to get an undesirable result may ultimately cost thousands more in the long run to get restorative plastic surgery

Always make sure your surgeon lists the actual fill volume on the implant information card provided to you. Make sure your surgery is performed at an accredited surgery center. Make sure your surgeon is board certified by the American Board of Plastic Surgery. Meet with several plastic surgeons before making your decision, make sure you are comfortable with your surgeon, and get an idea of the price involved with the surgery. If someone is charging thousands of dollars less than the rest of the community, ask yourself why.

Believe the cliché: if something seems too good to be true it probably is. Saving money in the short term to get an undesirable result may ultimately cost thousands more in the long run to get restorative plastic surgery.

Dr. William A. Wallace of Fleming Island Plastic Surgery is double board certified in Plastic Surgery by the American Board of Plastic Surgery and in General Surgery by the American Board of Surgeons. Dr. Wallace is a Fellow of the American College of Surgeons, a Member of the American Society of Plastic Surgeons, and the American Society of Aesthetic Plastic Surgery.

Dr. Wallace is a respected expert in Revisional Breast Augmentation and Augmentation Mastopexy, having given talks nationwide on the subjects to plastic surgeons, community physicians, and patients.

Contact Fleming Island Plastic Surgery to schedule your FREE consultation today: 

Call: 

904-990-FIPS (3477)

Email: 

info@904plasticsurgery.com

(Pictures are of actual patients and implants, and used with expressed written permission)

Why Does Gravity Always Win?

This question is a little vague so I'll try to hit all the angles. 

•First, Gravity always wins because gravity is always in effect. 

The process of aging has been discussed by many accomplished Plastic surgeons, mostly in regard to facial aging. 
Two schools of thought have predominated:
•The face ages because the skin sags/stretches because of... gravity, or rather, a loss of elasticity.
•The face ages because the underlying fat/soft tissues "deflate"

Personally, I believe it is a combination of the two. 
As the skin ages (all skin, not just facial) its elasticity diminishes. It doesn't snap back the way it used to. 
As people age, they often lose weight in their faces (do a google search on older celebrities).
This loss of fat, with a decrease in elasticity, can cause a premature aging of the face, and neck.

Now, apply this to the rest of the body. 
•Breasts: lose volume after pregnancy and menopause, lose elasticity with age (particularly larger breasts, due to gravity!) and resultantly sag. 
•Abdomen: lose volume after massive weight loss, lose elasticity due to multiple pregnancies or massive weight loss, and resultantly sag. 
•Arms, Thighs, Butt... 

What can be done?
For most of the body, if sagging is the problem, the only option is removal of sagging skin. The loss of elasticity of the skin cannot be restored. 
Exeptions to this rule include: the breasts and the face.
•for mild to moderate sagging, breast augmentation with silicone or saline implants may restore a more youthful fullness without having to remove skin.
•for some areas in the face, fillers can restore some areas of sagging or deflation.
•for the butt, sometimes fat injection or implants can be used to fill out an otherwise flattened posterior. 

Post Bariatric Body Contouring - What Is Covered?

Multipart question... 

Gastric bypass has become a very popular option for weight loss in morbidly obese people, increasing in popularity exponentially. Some studies have reported that the procedure is 700% more popular than 10 years ago. 
As the popularity of gastric bypass increased, so too did plastic surgery after weight loss. 7 years ago, 1 in 4 people sought out plastic surgery after weight loss. Now that number is closer to 3 in 4.
The "dirty little secret" of weight loss surgery, is that while you will lose a tremendous amount of weight, you will not lose skin. The skin is worn out. Inelastic. It won't snap back to its original shape. It must be removed.

Taking into account the increase in people getting gastric bypass, and with that the increase in people seeking plastic surgery after weight loss, insurance companies began placing tighter restrictions on what it took to qualify for a covered procedure.
These days, most insurance companies will only pay for a panniculectomy (I'll explain later), and/or a breast reduction.
In addition, patients must meet criteria, commonly:
100 pound or more weight loss
1 year out from gastric bypass surgery
6 months at a stable weight
increasingly they are requiring medical complaints associated with the skin condition:
-rash unsuccessfully treated by another physician.
-back or neck pain
-an abdominal hernia present

Breast Reduction:
the amount of tissue to be removed is often determined by insurance companies using a formula called a "Body Surface Area" (BSA). There are several different ways to calculate this depending on the formula used, but they all are based on your height and weight.
Unfortunately, most people who have had massive weight loss through surgery have DEFLATED, sagging breasts, not large enough to qualify for a covered procedure by insurance. 
often, weight loss patients benefit more from a breast lift, a breast augmentation, or a combination of a lift and augmentation. 

I like to discuss Abdominal body contouring in terms of buying a car. General motors (when I started practicing anyway) had 3 price levels of cars: 
Entry level: Pontiac
Midrange: Buick
Luxury: Cadillac

In abdominal body contouring:
Entry level: Panniculectomy
Midrange: Abdominoplasty
Luxury: Circumferential Belt Lift

In the analogy: they are all cars. They will all get you from point A to point B. The difference is how good they look and the extra features as the price goes up.
Insurance will pay for the Pontiac.
A panniculectomy is the removal of the apron of skin that hangs down over your lap. No tightening of skin up to the ribs, no tightening of muscle, no relocation of the belly-button. In fact, if the belly-button is located within the apron of skin, it is removed in this procedure. 

This is an overview obviously. 

Techniques In Fat Injection

Fat injections, or fat transfer, to the face and other areas of the body have increased in popularity in recent years, but it is hardly a new technique.

Fat transfers have been described in medical journals since as early as 1893 for the correction of deep scars.

Modern techniques in fat transfer through fat injections were developed by Plastic Surgeons. With the development of liposuction in the 1980s Plastic Surgeons now had access to an abundant supply of fat they could now use to reintroduce into the same patient to improve cosmetic problems. The earliest use of liposuctioned fat in cosmetic procedures was 1984 by Plastic Surgeon Dr. Yves-Gérard Illouz of France.

With refinements in technique, fat grafting has become the procedure of choice for an array of cosmetic problems, including facial scarring, lip augmentation, and facial wrinkles (such as several otherwise difficult-to-address areas such as the nasolabial fold and forehead furrows). It also remains an excellent way to improve the contoura of deep or depressed scars.

Fat transfer can be a permanent solution for patients that regularly receive hyaluronic acid injections (Juvederm or Restylene).

In some instances, fat injection can be a faster, more affordable alternative to a traditional facelift, to correct lines of aging. Patients with excess skin in the jowl or neck areas may not be good candidates for fat grafting alone.

Is fat grafting right for you? Maybe. The best way to determine if you would benefit from a fat injection procedure is to schedule an appointment with a Board Certified Plastic Surgeon, the only Board recognized by the American Board of Medical Specialties to perform Cosmetic Surgery.

William A. Wallace, MD FACS of Fleming Island Plastic Surgery is both Board Certified by the American Board of Plastic Surgery AND by the American Board of Surgery. He is a Member of the American Society of Plastic Surgeons, the American Society of Aesthetic Plastic Surgery, and a Fellow of the American College of Surgeons.

For more information, please review the Fleming Island Plastic Surgery website.

Breast Implants and Lymphoma? A Closer Look

The Food and Drug Administration (FDA) on Jan. 26 issued a communication to inform health care practitioners and the public about a possible association between breast implants and anaplastic large cell lymphoma (ALCL). 


Although ALCL is extremely rare, the FDA believes that women with breast implants may have a very small but increased risk of developing the condition. ASPS has been actively engaged with the FDA on this matter and is collaborating with the Agency to develop a centralized registry to collect more information on existing case reports and any new cases that may be identified.


Noting that the FDA is aware of between 34 and 60 case reports of ALCL among as many as 10 million women with breast implants worldwide (based on a review of scientific literature from January 1997 through May 2010), FDA Deputy Center Director for Science, Center for Devices and Radiological Health Bill Maisel, MD, emphasized during a media teleconference that ALCL is quite rare.


This represents a 0.000003 - 0.000006% chance of developing ALCL after getting breast implants. 


Some comments from The American Society of Plastic Surgeons (ASPS) President Phil Haeck, MD regarding this announcement:

"Breast implants are the most studied device in the history of medicine."  

"Both the FDA and ASPS believe that implants are safe and effective, and there is no reason to change what we're doing now." 

"A woman with breast implants has about the same chance of being hit by lightning as she does coming down with this condition."

The ASPS and the FDA recommend that women with breast implants should continue their normal routine in medical care and follow-up, specifically regular self-examination and mammography when appropriate. Women with breast implants should watch for changes in their breasts such as pain and swelling, and contact their plastic surgeon if they have questions. 

The FDA has provided the following documents on its website:
FDA Medical Device Safety Communication: Reports of Anaplastic Large Cell Lymphoma (ALCL) in Women with Breast Implants
Anaplastic Large Cell Lymphoma (ALCL) in Women with Breast Implants: Preliminary FDA Findings & Analyses

Call our office today for any further questions you may have regarding this FDA announcement, or any other questions you may have regarding Breast Augmentation or other Cometic Procedures. (904) 990-3477. 

Natrelle Breast Implants - Helpful Information

Some helpful information if you have Natrelle (previously under the brands Allergan, or McGhan) Breast Implants or are considering Natrelle Breast Implants.

Natrelle Homepage

Breast Augmentation Pre-Consultation Kit with rebate options.

Warranty Information for patients who have had, or are considering Breast Augmentation with Natrelle Implants.

Warranty Enrollment Information for patients who underwent Breast Augmentation with Natrelle Implants.

Safety Information regarding Natrelle Silicone Breast Implants
- For Breast Augmentation
- For Breast Reconstruction

Helpful Facts about Natrelle Silicone Breast Implants (pdf booklet)