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)

Mentor Breast Implants - Helpful Information

Some helpful information if you have Mentor Breast Implant or are considering Mentor Breast Implants.

Mentor Homepage

Warranty Information for patients considering Breast Augmentation with Mentor Implants.

Warranty Information for patients who underwent Breast Augmentation with Mentor Implants.

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

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

Safety Facts about Mentor Silicone Breast Implants (pdf booklet)

Myths of Plastic Surgery

Myth 1: Only plastic surgeons can legally perform plastic surgery.

No regulations govern what type of medical practitioner can perform plastic surgery procedures. So the best way to know your surgeon is qualified is to choose an ASPS Member Surgeon.

ASPS Member Surgeons:

• Are certified by the American Board of Plastic Surgery to perform plastic surgery of the face and all areas of the body 
• Have at least six years of surgical training and experience, with a minimum of three years of plastic surgery 
• Operate only in accredited facilities 
• Fulfill continuing medical education requirements 

Myth 2:  Plastic surgery procedures cost the same no matter who performs them or where they are performed.

There are many variables involved in the pricing of plastic surgery procedures - including geographic location, surgeon expertise and demand, and the time and effort your procedure requires. Other factors include the costs of anesthesia, surgical facility fee, labs, and more. Be sure to ask your surgeon about all costs involved.

When choosing a plastic surgeon, remember that the surgeon’s qualifications and experience as well as your comfort with him or her are just as important as the final cost of the surgery. Many plastic surgeons offer patient financing plans.

Learn more about the costs of plastic surgery.

Myth 3:  It is disrespectful to ask your plastic surgeon tough questions.

Asking tough questions is the best way to get to know your surgeon. It gives you the opportunity to learn about their qualifications, experience, and demeanor. Your questions let them know you’ve done your homework, want to be educated about your procedure, and will be an active partner throughout the process.

How to choose your ASPS Member Surgeon.

Myth 4:  It is inappropriate to ask surgeons to speak with their previous patients.
Reputable surgeons will have no problem supplying you with contact information for some of their recent patients. Speaking with patients about their experience and results is an excellent way to learn more about your surgeon.

Read more information on how to plan for a plastic surgery procedure.

Myth 5:  All plastic surgeries are performed in accredited facilities.

Some practitioners perform plastic surgery procedures in nonaccredited facilities. Making sure that your procedure can be performed in an accredited facility will significantly reduce safety risks and increase your comfort level. ASPS Member Surgeons perform surgeries only in accredited facilities.

Myth 6:  Plastic surgeons only perform reconstructive surgery.

Plastic surgery encompasses both cosmetic and reconstructive surgery. ASPS Member Surgeons are trained, experienced, and qualified to perform both cosmetic and reconstructive procedures on the face and all areas of the body. Because many cosmetic procedures are rooted in reconstructive plastic surgery, ASPS Member Surgeons are uniquely qualified to handle your cosmetic needs.

Learn more about cosmetic and reconstructive procedures.

Myth 7:  “Extreme makeovers” are routine in plastic surgery practices.

Contrary to what reality shows portray, extreme makeovers are far from routine or common in plastic surgery. Most patients inquire about one particular area of the body that they would like to improve.

During your consultation, your surgeon will ask you a series of questions to gain an understanding of your goals for plastic surgery and discuss them with you on a realistic basis.

Myth 8:  Science still has not proven the safety of silicone breast implants.

In November 2006, the FDA reversed its 14-year ban on silicone breast implants, allowing patients in the United States access to the same implants that women in 60 countries around the world already have.

You can find a wealth of scientific information on the safety of silicone breast implants at www.breastimplantsafety.org.

Myth 9:  Plastic surgery is only for the rich and famous.

A 2005 study found that almost 60 percent of people who had recently had plastic surgery or were seriously considering plastic surgery had a household income of $30,000–$90,000 a year. In fact, 40 percent of that 60 percent reported an annual income of $60,000 or less. Just 10 percent of respondents reported a household income of more than $90,000.

Learn more about the costs of plastic surgery.

Myth 10:  All board certifications are the same.

Any group of medical professionals can create its own “certification” board. ASPS Member Surgeons are certified by the American Board of Plastic Surgery - a group designated by the American Board of Medical Specialties to oversee credentialing in plastic surgery of the face and all areas of the body. Their certification requires passing rigorous oral and written exams.

Get more information on the qualifications for ASPS Member Surgeons.

History of Breast Implants and Breast Augmentation

Landmarks in this endeavor - timeline style.

1890 - first surgical breast augmentation procedure was performed with paraffin injection.

• This led to infections
• Lump formations in the breast
• By 1920s paraffin injections became out of favor for breast augmentation

1920 - Fat transplants were tried.  Fatty tissue was surgically removed from the belly and buttock areas and trasferred into the breast

• This was unsuccessful because the body would quickly reabsorb most of the fat, leaving the breast lumpy and lopsided.
• By 1940s, this procedure was given up.

1960's - Silicone injections directly into the breast was tried

• Complications of chornic inflammation, infections, and lumps
• These complications caused this form of breast augmentation to fall out of favor.

1950s - Polyvinyl sponges started to be implanted into the breasts for breast augmentation

• Different types of synthetic sponges were also tried
• They were all found to shrink and harden within a year
• Infections occurred.
• There was a possible link between this type of breast augmentation surgery and cancer

1961 - The first silicone breast implant was developed.

1982 - Silicone breast implants were withdrawn due to safety concerns

1988 - Dow Corning, one of the silicone breast implants largest manufacturer settled a class action lawsuit for 3.2 billion for 170,000 women

1992 - Only saline-filled implants have been allowed in the American general market for cosmetic breast augmentation.  Silicone breast implants had been available only to special pateints through FDA approved trials

1995 - Soybean Oil implants introduced

• Considered to be a natural approach to breast augmentation
• 1999 - these breast implants were withdrawn from the market because a they were found to contain a filler that could become toxic in the body as it breaks down.
• This type of breast augmentation surgery was never approved in the U.S.
• an article on Tara Reid's Breast Implants Threaten Her Life - she had soybean implants
• They could also go rancid.

2001 Brava Breast Enhancement and Shaping System was introduced

• Bra-like device sourrounded with silicone that creates a vacuum over the breasts that induce the breast to possibly grow about one cup size.  Must be worn 10 hours a day for several mouths to create a breast augmentation effect.  The idea here is an augmentation method without implants.  Haven't found any satisfied patients using this method of breast enhancement (yet).

2006 - November, the FDA (USA) approves silicone breast implants again

• collection of articles about the reapproval of silicone implants
• After 14 years, silicone breast implants will once be available to women in the United States
• The new implants are the gummy bear style silicone breast implants
• These implants are available locally at Fleming Island Plastic Surgery

Gummy Bear Breast Implants

Allergan/Inamed/McGhan/Natrelle Gummy Bear Breast Implant

What are gummy bear implants?

They are technically called cohesive gel implants.  They are a fairly new type of breast implant with an inner substance similar in quality to a gummy bear.  When cut, it also resembles a gummy bear with a slice through it.  They were designed this way to maintain their shape and integrity if rupture or leakage happens.  The gel doesn't migrate.  This adds a safety factor to these gel implants.  Furthermore, this decreases wrinkling, folds and rippling associated with some saline and other silicone implants.  They also have the look and feel of silicone.  Capsular contraction also seems to be less of a problem.  Gummy bear breast implants have been used outside of the United States for about a decade with positive results.

Downsides to gummy bear breast implants

These breast implants cost significantly more than saline.  The costs can be twice that of certain saline implants and the costs can be more than traditional silicone breast implants.  There's also a slightly larger incision length required.  Gel fracture is a problem caused by a crack in this semi-solid breast implant..

Your Fleming Island & Greater Jacksonville, Florida Source for more information

Dr. William A. Wallace can offer you cohesive silicone gel (gummy bear) implants. Board Certified by the American Board of Plastic Surgeons, the only board recognized to credential plastic surgeons, as well as the American Board of Surgery. 
Dr. Wallace is also a member of the American Society of Plastic Surgeons, the American Society of Aesthetic Plastic Surgery, and a Fellow of the America College of Surgeons. 


Fleming Island Plastic Surgery, in addition to breast augmentation, also offers: liposuction, botox, skin care including: chemical peels, microdermabrasion (diamond), and hyaluronic acid (ie. Juvederm) treatments. 


Visit the Fleming Island Plastic Surgery website today. 
Disclaimer:  Please see your doctor in person for medical information regarding gummy bear implants.

Breast Implant Manufacturers

These corporations are where you can find out more information regarding breast augmentation implants, whether they be silicone, saline, or cohesive gel.

• Mentor Corporation
• Inamed Aesthetics / McGhan / Allergan (makers of Botox)

Information on this webpage regarding breast augmentation, gummy bear breast implants, and breast implant manufacturers is provided by the expertise of the Dr. William A. Wallace, MD FACS of Fleming Island Plastic Surgery. The office number is 904-990-3477 if you have further questions regarding breast implants.