5 Steps You Can Take if You’re Afraid of General Anesthesia

cosmetic surgery New York We’ve met many patients in our New York plastic surgery consulting room who have an intense fear of general anesthesia (GA). Whether the concerns relate to worry about not waking up, fear of being aware of pain but paralyzed, or concern about side effects—or all three—sometimes patients put off having a procedure because of it.

In our view, it’s unfortunate when prospective patients allow this fear to be a reason to delay or opt out of plastic surgery. In our New York practice, we’ve treated thousands of patients over three decades, so we know GA is safe. But we understand that for some people, “going under” is not easy.

If you’re one of these hesitant patients, here are some suggestions.

1) Choose IV sedation.

We have chosen to use IV sedation, also called “twilight sedation,” for the majority of our New York plastic surgery patients. We made this decision for patient comfort, as IV sedation eliminates general anesthesia side effects patients can suffer: nausea, headache, chills, confusion and more. It’s easier for fearful patients to tolerate as well, as drugs are administered gradually and gently through an IV rather than a mask.

IV sedation requires extremely close coordination in the operating room by a doctor-anesthesiologist duo who knows each other well. Most practices don’t have this. Our team has worked hand in hand for 30 years, and we are proud to offer the benefits of safe IV sedation to almost all our patients.

2) Get information.

Perhaps you can’t come work with us or find another practice that offers IV sedation. Or maybe you are one of our patients but you need an extensive procedure that will require GA instead of twilight sedation. Research can help calm any anxiety you may have. You can visit sites from the Mayo Clinic, the Cleveland Clinic and similar health authorities for reassurance about the safety of GA. You’ll discover that risks of plastic surgery relate to the procedure itself and to your overall health much more than they do to anesthesia.

3) Talk to others.

Chances are you know someone who has had GA—ask them about the experience. You may find they had a headache or grogginess afterward, or another side effect, but they should be short-lived. You will at least be reassured about the process when you learn they went to sleep quickly and woke up seemingly a short time later, having been unaware of any discomfort during the procedure.

4) Learn from your surgeon.

Tell your surgeon about any reservations you might have about GA. You doctor should be happy to tell you about what to expect from the anesthesia process, which drugs and techniques they use and their history with patients. He or she should also listen to you and take your concerns seriously, and help you put some worries to rest. For instance, if you’ve experienced nausea after surgery in the past, for example, your team can administer medication that will help.

5) Find out about the anesthesiologist.

Not all professionals who administer anesthesia have the same training. In some cosmetic surgery practices, GA is given by a nurse anesthetist or an anesthesiologist assistant. In our plastic surgery practice in New York, IV sedation is administered by our M.D. anesthesiologist. He meets with each patient prior to surgery and stays with them the entire time, monitoring them very closely. As a fully trained and accredited medical doctor, he is a critical partner in everything we do and ready for any eventuality.

Our exceptional surgical team is one reason patients are at ease in working with us, and IV sedation is a key part of the experience. When you realize you’ll drift off to sleep peacefully, have your vital signs and anesthesia levels watched very carefully and wake up quickly with no memory at all of surgery, it makes choosing to move forward easier. You may be surprised to find out that many of our patients say that “going to sleep” was the best part of their experience!

Want to find out more about IV sedation for plastic surgery in New York? Fill out our short contact form and we’ll be in touch.

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Pandemic Influences on New York Cosmetic Surgery Trends

New York cosmetic surgery It goes without saying that the worldwide pandemic has impacted everything we do. Here in New York, our cosmetic surgery practice closed down completely for three months as we maintained strict safety precautions and waited to find out if local health organizations needed our services or equipment.

Now that things are opening up, we’re just about back to business as usual. We thought you might be interested in hearing a little about where the industry stands as the pandemic (crossing our fingers) seems to be on the wane, and what we’re seeing on the New York cosmetic surgery front.

One of the professional societies we belong to, the American Society of Plastic Surgeons (ASPS), recently issued a press release that talks about the strange times we’ve been through. Noting that the number of procedures across the industry fell last year, they pointed out that the decrease generally matched the period plastic surgeons weren’t operating. That makes sense.

The Influence of Zoom

New in pandemic times is the mark Zoom has made. Rhinoplasty, or nose surgery, headed the ASPS’s list of top procedures for the first time in a long time. What’s more, three out of the top five popular surgeries focused squarely on the face: nose surgery, eyelid surgery and facelifts.

Prior to the pandemic, we noticed that selfies and Skype had some impact on people seeking facial cosmetic surgery in New York with us, but the almost ubiquitous use of Zoom has taken the trend to new heights. Eyelid surgery, or blepharoplasty, has always been a leading procedure we perform, and we see that continuing into the future.

Life at Home

The ASPS made mention of the fact that as people work completely or partly at home these days, they have more time available for post-procedure recovery. Downtime is sometimes an obstacle for men and women who would like to have surgical treatment, and pandemic has made it less of an issue for significant numbers of people.

In fact, this particular period when the pandemic is almost, but not quite, in the rear-view mirror, there seems to be a bit of a pent-up demand for cosmetic surgery. In a survey of women who had had cosmetic surgery or minimally-invasive procedures, the ASPS found 35% planned to spend more on them in the future than before the pandemic.

Living in the Moment

Finally, having been through a tough time seems to be prompting many to seize opportunities to have the best life they can. In surveying women, the ASPS found 11% more said they were interested in plastic surgery than before the pandemic. The figure was more than twice that high among women who had already undergone a cosmetic procedure.

In our offices here in New York, cosmetic surgery inquiries are in step with that finding, and also in line with our specialties. We have led the way in gynecomastia surgery for men for decades, and interest in banishing man boobs is certainly very healthy these days. The virus may be serving as just the little nudge some guys need to get in here and get there moobs taken care of for once and for all.

We are also pleased to be performing many gender affirming surgeries. Consultations for female to male top surgery and male to female top surgery are on the rise for us and have been for some time. Patients feel comfortable working with us due to our expertise in male and female breast surgery and our sensitivity to people with gender dysphoria. The word is out in this community, and we’re proud to serve them.

We would be very happy to work with you too! Give us a call at 212-570-6080 today.

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The Challenge of Tuberous Breasts

tuberous breasts New York Tuberous breasts are a challenge all around—for women (and occasionally men) who have them and for plastic surgeons as well. If you have the condition or know someone who does, here’s an overview that may enhance your understanding.

What Are Tuberous Breasts?

For a thorough discussion of the condition, you may want to skim this article from The Aesthetic Surgery Journal. It’s technical in nature, but you can see photos of real patients with tuberous breasts and read the authors’ surgical approach to cosmetic improvement.

Like the authors, we’ve heard several different names used to describe tuberous breasts in our New York cosmetic surgery practice. The condition is also called “tubular breasts,” “Snoopy breasts” and other descriptive terms, as well as names that try to explain its cause such as “constricted breasts.”

In short, breasts grow to resemble small tubers because tissue at the base is constricted. The tight tissue prevents the breast from growing horizontally and vertically in a normal fashion, pushing what tissue does form outward and downward. In doing so, areolas frequently become overly large. In medical circles, tuberous breasts are considered a deformity, because it’s an “alteration in or distortion of the natural form of a part, organ or the entire body.”

From a Woman’s Perspective

Many women with tuberous breasts suffer embarrassment and self-esteem challenges. More than other non-life-threatening conditions, such as webbed fingers or deformities of the outer ear, breasts that appear atypical can undermine a young woman’s body image and sense of self at a formative time of life and beyond. Here’s a sample of comments real patients have made about their feelings:

• I feel disgusting and really unconfident.
• My tuberous breasts have bothered me my entire life.
• It is a very dewomanizing condition.

We have consulted with dozens of women with tuberous breasts in our New York practice over the years. Some decide to have surgery, some don’t, and we applaud every patient who makes a well-considered decision for herself. What’s distressing is when people take a stance that allows for no happy future.

A few women feel they would like their breasts corrected—yes, that’s how plastic surgeons view the procedure—but feel guilty about longing for surgery because they’ve internalized that it is a completely vain and “unnecessary” choice. Worse, some women feel the need to dictate to others that choosing surgery is some kind of affront to feminism or cop out to the pressures of modern society.

It’s great when people accept themselves just as they are. But it’s also empowering to make a change that will free you from a burden. As one woman we read about put it:

Children have their ears pinned back, people have “unsightly” moles removed and no one seems to bat an eyelid because it makes them feel better and improves their self-esteem.

No one should be made to feel judged for electing to change something that is truly in the way of their satisfaction with life.

Treating Tuberous Breasts in New York

As we mentioned, we have seen may cases of tuberous breasts in our New York practice. Breast surgery for women and men is one of our specialties, and we have perfected our approach to the condition over time. Here are the basics of the procedure for most patients.

In many cases, tuberous breasts are small and not very droopy. We often remove a doughnut of skin around the areolas, shrinking them if necessary. We leave the dermis, or layer underneath the surface, intact as that’s where the vital blood supply is located. We make a small incision in the dermis on the underside of the breast and loosen the upper layers of tissue down to the IMF, or intra-mammary fold, elevating gland tissue off the chest muscle and its outer layer of fascia. Then, we make radial incisions under the gland and through the constricting tissue so breast gland can splay out over the chest wall as it does in most breasts. Finally, we often place a small implant to give the breasts a little more volume and keep the natural tissue from re-firming up via scarring.

This is a technically challenging operation! But as you might imagine, we derive great satisfaction from performing it for a woman who has suffered because of her appearance. To see a patient’s face light up when bandages come off is a joyful occasion.

If you are not sure if surgery is right for you, consider visiting us in New York for a tuberous breast consultation. You will find our staff to be compassionate, knowledgeable and professional. Contrary to what some people say about plastic surgery practices, we do not push a procedure on anyone. Our goal is to educate and assist our patients in making good decisions for their lives.

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It Seemed Like a Good Idea at the Time…

New York breast surgery If you search online for things that seem like a good idea but really aren’t, you’ll find people talking about dating a co-worker or ordering a second pitcher of margaritas on a Sunday evening. Our favorite true-life story comes from a friend whose son decided it would be fun to roll bowling balls down a steep hill toward a neighbor’s house.

When we’re talking with a patient about breast surgery in New York—breast reduction, breast lift or even breast augmentation procedures—we understand when they’re interested in learning about so-called “doughnut” incisions around the areolas. We talked with a female to male (FTM) transgender patient about the option just this morning—hiding scars in the border between breast skin and the areolas seemed like a good idea to him. It wasn’t.

Doughnut, or peri-areolar, incisions (with areolar skin removal) do work well in limited cases. There are two factors that must be in place: a strategy for protecting the nutrient supply to the nipple to prevent necrosis, and working with smaller sized breasts whose volume won’t cause the scar to spread as it heals. The fact, is, however, patients who are good candidates are limited in number.

Better Approaches for New York Breast Surgery

In cosmetic surgery, peri-areolar incisions are sometimes used in a procedure called a “doughnut mastopexy” (mastopexy meaning breast lift). When breasts sag with time, areolas often spread and patients want them reduced in size. The thinking is to cut a ring of skin from the areola and tighten up the breast by suturing breast skin to the smaller areola.

Unfortunately, unless the breasts are quite small, they put too much strain on the incisions. Patients tend to end up with wide scars and puckering, and it’s not unusual for the areolas to stretch out again. Some cosmetic surgeons still offer the doughnut mastopexy option—we almost never do.

Our New York FTM breast surgery patient was not a good candidate for doughnut incisions because he wanted all tissue removed from his droopy breasts—in effect, a double mastectomy. In cases like this one where there’ll be leftover skin, the best approach is usually larger incisions that allow us to effectively address gland and fat tissue and remove skin. Then, the nipple needs to be moved carefully higher on the breast in a normal position. More scarring, yes, but the scars do fade in time. And the result is more predictable and natural.

This multi-incision/nipple graft technique is useful for other patients looking for surgery for large droopy breasts. We have used it with great success for guys with good sized man boobs, women with very large and/or very saggy breasts and female and male weight loss patients.

For many women seeking breast reduction and breast lift surgery in New York with us, we can use an incision partway around the areola and down toward the breast fold, the so-called “lollipop” incision, or down to the breast fold and underneath in an “inverted T” or “anchor” incision. This is a good compromise approach, preserving nipple integrity while allowing us to remove excess breast tissue and skin as needed, lifting the breast through incisions mostly hidden underneath.

A quick word about men with gynecomastia and wide areolas. We most often recommend removing excess tissue and allowing the areolas to shrink on their own. Many patients are surprised at how, when gland and fat are removed and the breasts become more normal in size, areolas follow suit.

Some Doughnuts are OK

We don’t mean to suggest that all areolar incisions are bad. Indeed, we use them at least weekly for guys with man boobs—usually at the base of the areola to pop out gland tissue. And we use them for women seeking breast augmentation in New York, when they choose modest sized implants placed over the muscle. Advantages do indeed include scars that are almost invisible, but note that we are not removing a circular ring of tissue around the areola in these operations.

There is one time when excising a doughnut of skin can be a good way to go. We do this on occasion for patients with tuberous breasts. It’s technically challenging, and a topic for next time!

Don’t worry if you’re confused about the right breast surgery. Contact us in New York and we will be happy to arrange a personal consultation. Together we can work out the best strategy for getting the results you’re looking for.

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The Irony of Liposuction’s Popularity

New York liposuction There may be no procedure that requires more skill and experience to perform beautifully than liposuction. Ironically, since this cosmetic surgery option is so well-known and desirable these days, patients sometimes think it’s ok to go to just about any doctor or clinic for the procedure.

What’s more, given the popularity of liposuction, many doctors who aren’t board certified in plastic surgery (dermatologists, gynecologists and others) have gotten into the game, sometimes with an array of fancy equipment. And patients often don’t realize the risks of choosing such a provider.

You need to work with a surgeon who is board certified in plastic surgery, who has deep experience with liposuction and who is accomplished with the cannula. Look for a practice like ours in New York, where liposuction is a tried and true specialty. Here’s why:

• Trained plastic surgeons know the whole body.

Board certified plastic surgeons are trained in the anatomy of the whole body, not just one part like the skin or the reproductive system, and they know how structures work together. A good example we’ve used in the past is the back of the thigh where it meets the rear end. Seasoned plastic surgeons will know not to remove too much fat from the upper thigh or the buttocks may sag.

• Experienced cosmetic surgeons understand male and female differences.

Not only do men tend to seek body contouring for different areas than women do, male tissue is often denser than in females. This is a good area you might probe with a prospective cosmetic surgeon, “What’s your experience with male vs. female fat tissue? Do you approach liposuction differently for men than for women?” Read more about this and find out about our approach on our New York liposuction page.

• Those who are skilled with the cannula know what sculpting means.

When a doctor is adept at liposuction, he or she knows what it means to sculpt tissue under the skin. The goal is to eliminate fat pockets, while leaving a thin, even layer of fat just under the skin. That means skin will lie flat after healing, with none of the hills and valleys that are a sign of an inexperienced provider. It also means the skin won’t adhere to muscle underneath, creating a pucker.

• The ability to recognize the stopping point is the “art” of liposuction.

Choose a board certified plastic surgeon who will help make the right decisions for your physique. You may long for the tiny, nipped in waist that’s popular for women right now, but while the cannula can banish belly pooches, it can’t re-engineer your shape. Similarly, if you’re a bigger guy hoping for a slimmer torso, liposuction can address love handles and perhaps extra fat around your upper chest. But a skilled doctor will know how to keep proportions in mind and not cause an unnatural, lopsided result. Look for a liposuction specialist who will be honest with you about these aspects of the procedure.

Avoid Liposuction Revision

Here’s one more reason to avoid working with someone who perhaps has just taken weekend courses in liposuction: do-overs are challenging. We perform many liposuction revision operations in New York each year and we can usually make a poor result look much better. But due to the formation of scar tissue and possible uneven fat tissue, it’s preferable to get liposuction right the first time.

We know you can sign up for liposuction just about anywhere today. But we still believe that getting a terrific outcome is worth traveling for. If you’d like to have liposuction in New York with us, we’d be delighted. Send us a message today!

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10 Tips for Calming Jitters Before Cosmetic Surgery

plastic surgery New York It’s probably more normal than not to be nervous prior to plastic surgery. Our New York patients often say they feel a mix of excitement and anxiety leading up to the big day.

We may have fewer jittery patients than some practices since we have so many years of experience for and we’re not pushy by nature. In addition, the fact that we use twilight sedation instead of general anesthesia in most cases helps many patients feel at ease.

But everyone is different, and we sometimes work with people who are very anxious about their upcoming plastic surgery in New York. If that’s you, here are 10 tips for handling a case of the nerves before your procedure.

1) Let us know how you’re doing.

There’s no shame at all in having anxiety; the thing we regret is when patients don’t tell us. If you’re struggling, we can arrange a time to chat online or by phone, or even refer you to a former patient to talk with. There are ways we can help.

2) Review information.

Reading over all the information we give you, including possible risks and complications and their rates of occurrence, should help. Remind yourself that the risk of a minor complication is low, and the possibility of a major problem is extremely remote. And remember that we’ve been operating for more than three decades and we know our job very well.

3) Watch your online time.

One caveat about reviewing information—don’t spend too much time on the internet. There are cosmetic surgery horror stories just as there are with almost any medical topic, and if you run into them, they could cause the opposite of the desired effect!

4) Prepare your kitchen and bathroom.

When you come back home after surgery, the last thing you want is a sink full of dirty dishes and a bathroom that looks a little dingy. Give these areas some attention before your procedure, and ensure the refrigerator, cupboards and medicine cabinets have what you may need, including prescription medication.

5) Make sure your home is ready to welcome you back.

It’s a good idea to put clean sheets on the bed and have plenty of fluffy pillows around to help you rest easily. You might want to have books, magazines and movies handy, and perhaps some music or podcasts ready for listening. Consider splurging on a flower arrangement for your kitchen counter or bedroom, or some other way to help you feel pampered for a few days.

6) Occupy your mind.

The day before surgery, find ways to distract yourself from focusing on any worries you may have. Watch an absorbing movie, dive into a mystery novel or call an old friend and catch up. You won’t be dodging an issue, you’ll be keeping yourself from engaging in thoughts that don’t help.

7) Use relaxation techniques.

If we know one of our New York plastic surgery patients has sleep challenges, we often advise them to try various relaxation techniques. Breathing exercises and meditation are two practices that really do help. We suggest getting started well before the day of surgery to get into the swing of a new routine. You can watch videos on YouTube—there are many to choose from. And here’s a “how to” article that can help plastic surgery patients from the New York Times.

8) Listen to music.

“Music is effective for relaxation and stress management.” So says an article from the University of Nevada, Reno. Read more here, including a list of suggested pieces. You’ll find one that appeals to you.

9) Have a support system.

You’ll need someone to pick you up and take you home after initial recovery in our surgery center, so why not have that person on call in case you need support over the next few days? Or find someone else you trust who can drop by to see how you’re doing, fix a meal if needed and help with pet care. Even if you think you’ll be fine no matter what, having someone you can call just in case is a good idea, especially if you live alone.

10) Get professional help.

If you know you have a tendency to be anxious, it might make sense to schedule a few counseling sessions prior to having cosmetic surgery. Or you might choose to visit a meditation center—there are several to choose from in our city and some offer drop in classes. Therapeutic massage is another option for feeling relaxed.

If you’re planning plastic surgery with us in New York and you notice your stress level increasing as the date draws near, give us a call at 212-570-6080. We will be very happy to talk with you and see if we can help with a strategy for easing your mind.

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A Jaw Dropping Trend in Cosmetic Surgery

cosmetic surgery New York Sometimes it seems that trends we’re spotting in our New York cosmetic surgery practice happen completely at random, but that’s not really the case. Oftentimes a celebrity in the current spotlight prompts a stampede for a particular procedure—such as the amazing popularity of lip enhancement courtesy of Angelina Jolie.

These days, we’re noticing a sudden focus on the jaw and chin. We don’t believe it’s due to the look of a famous person so much, though. What Allure Magazine suggests makes sense to us; these days, “everyone is so hyperaware of every angle when we’re taking so many more images of ourselves.” Whether we’re posting something on Facebook or Instagram, or whether we’re spending more time on Zoom and Skype, we’re seeing our own images more often than we used to. And we’re becoming more aware of the role the lines of the lower face play in attractiveness.

Here are some ways to get an appealing, youthful look for your lower face. If you’re not sure whether one of these techniques would be appropriate for you, book a consultation with us at our New York cosmetic surgery practice. We’ll give you our honest input.

Filler for your Jaw Line

Fillers are becoming more and more useful for non-invasive appearance tweaks as cosmetic surgeons gain increasing experience with them, including which one works best for which application. We can use a filler to increase the angle of your jawline, or to sharpen the contours if aging facial tissues have begun to descend. Fillers are also a great way to get a sense of what you might look like with some attention to your lower face before you consider a surgical option.

Facelift Surgery

You may not realize it, but a traditional facelift delivers most of its impact to the lower face. Lower cheek skin is lifted, and the jaw line regains young looking angles. Even the neck benefits as skin is elevated and wrinkles smoothed. Facelifts can usually be combined with other procedures, like a neck lift or perhaps Kybella injections to banish a fat pad under the chin.

Neck Lift

If your neck is the biggest contributor to an aging appearance, consider a neck lift. We make a tiny incision under the chin and use it to remove excess fat tissue, tighten ropy bands of muscle and elevate skin as needed. On its own, the procedure involves a relatively quick recovery and minimal discomfort. And you can combine it with a variety of other measures to boost your appearance—Botox, fillers or even eyelid surgery.

Kybella

Though Kybella is a relatively new option in the world of facial aesthetics, our New York cosmetic surgery patients tend to be aware of new developments and ask us about this injectable. If a double chin or pudgy neck is your main issue, and you have decent skin quality, you might be a good candidate to try Kybella. The tiny, targeted injections will dissolve fat cells over a period of a few weeks and the body will cleanse them from your system.

Chin Enhancement

Chin enhancement is not the most common procedure New York cosmetic surgery patients request, but for the right candidate it can make a world of difference. If you have an underdeveloped chin that bothers you, it’s a good bet you know just what we mean. Millimeters of change can transform your face. Your chin can be enhanced with filler, which should provide good improvement but will not last forever. Another option is for us to insert a small implant—an operation which offers more dramatic and stable change.

So Many Options!

The jaw line is an important contributor to everyone’s appearance. Basic angles are key to good looks, and sharpness is a mark of youth. This area of the face used to be a bit of an afterthought—but no more!

There are so many approaches for tuning up the jaw; one or two will surely fit your needs. Call us at 212-570-6080 and arrange a consultation. We’ll examine you and review the entire menu, then you can choose what’s best.

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The Impact of Breast Asymmetry and Surgery

cosmetic surgery New York Have you heard these comments?

Oh, the difference really isn’t that great.

No one notices except you.

Bodies really aren’t perfectly symmetrical. You probably already know that. Your eyes may be positioned slightly unevenly on your face. One of your feet is probably a little larger than the other. We find ourselves pointing this out to patients seeking perfection in our New York cosmetic surgery practice quite often!

But if you’re a woman with breasts that are dramatically different in size, the asymmetry may not be so easy to shrug off. You may not feel able to wear clothes that enhance your figure, and you might even avoid activities like swimming that require revealing attire. You may not be comfortable having intimate relationships. The ways uneven breasts can affect your life may surprise others, but not you.

Last year, a study affirmed “negative effects on emotional well-being and self-image” for some women with breasts that are of different size, shape or position. The research also identified mental health improvements after breast surgery. Read on to learn more.

The Study

A doctor and colleagues from Boston Children’s Hospital published findings from a study of young women with breast asymmetry in Plastic and Reconstructive Surgery, the journal of the American Society of Plastic Surgeons (ASPS) a few months ago. They studied 45 females with a difference of about two cup sizes between their breasts (not due to breast cancer). The women averaged 18 years of age.

The research highlighted something we know about men, women and transgender individuals whose breasts cause them concern: quality of life can be lower than it should be. As an aside, that’s why we have treated ever growing numbers of people seeking cosmetic surgery in New York for breast issues. We know how breast dissatisfaction can affect people and we very much enjoy solving this problem for our patients. Over the years, our reputation for expertise in breast surgery for all kinds of people has grown.

The Boston Children’s study showed that:

At follow-up 3.5 years later after surgery, the women had significant improvements in self-esteem, social functioning, and emotional roles, as well as in overall mental health.

The researchers also found that patients “returned to a level of functioning commensurate with their peers” after surgery.

More Details

The research team reported their experiences treating 45 women with marked breast asymmetry over a period of 10 years. The majority of the subjects had what’s called “hypoplastic” breast asymmetry, meaning underdevelopment of one or both sides. About 30% had “macromastia,” or extremely large breasts, on one side. Some of the patients had been diagnosed with “tuberous breasts”—breasts with a narrow base circumference that forces tissues to grow in a constricted manner. Other women had no diagnosis for their condition.

The plastic surgeons tailored the procedures they performed to the needs of each woman. Breast augmentation was done on one or both sides for 28 patients. For 14 other women, breast reduction was performed on one side, sometimes with treatment of some type for the other side. Three patients had a different combination of breast surgery. The doctors followed up with the 45 women three and a half years after surgery and discovered the mental health gains noted above.

Your Path

We join these plastic surgeons in noting that surgery isn’t the right answer for every woman, even for those with major differences between their breasts. The researchers stated that some people are reassured by simply understanding that their condition is not uncommon. Others are content to use prostheses to even out their appearance.

But if you have a size difference that’s troubling—asymmetry that impacts your life choices and self-esteem—be assured that surgery can provide a safe, straightforward fix. We urge you to choose a board certified plastic surgeon to evaluate your condition and develop a treatment strategy that makes sense. And the more complex your case is, the more experience you should seek out.

If we can help, we’d be delighted. Give our New York cosmetic surgery offices a call at 212-570-6808 and let’s get started.

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Cosmetic Surgeons and BDD

New York cosmetic surgery One of the profound challenges in our industry is body dysmorphic disorder, or BDD. According to the Mayo Clinic, BDD is a mental health disorder that causes patients to obsess about one or more perceived flaws in their appearance. Patients often seek out repeated cosmetic procedures in an effort to “fix” the problem.

The challenge for everyone involved is that it’s unlikely people will be satisfied after treatment. Like most plastic surgeons, we have treated New York cosmetic surgery patients with BDD and only discovered the issue after surgery. The fact is, it’s pretty difficult to spot in the consulting room for a couple of reasons:

• These patients do not own up to having BDD. Men and women with the condition often truly want treatment, therefore they present themselves as rational, thoughtful people. True, a patient may admit to an extreme view now and then (“my nose has ruined every facet of my life”), but this is rare.

• There’s no way to “see” the disorder. Unlike patients with anorexia nervosa, a condition that also causes people to have a distorted self-image, there are no real external signs of BDD.

What the Experts Say About BDD

An article from Dialogues in Clinical Neuroscience available through the National Institutes of Health estimates that the rate of occurrence of BDD in the general population is between .7 and 2.4%. The researchers suggest that the published numbers may be lower than they should be, however, due to the fact that individuals are ashamed to admit to the disorder. Alarmingly, those who seek treatment from dermatologists and cosmetic surgeons are found to have BDD at much higher rates.

Plastic surgery professionals are concerned about this. No one in our cosmetic surgery practice in New York wants to treat a BDD sufferer, not because we lack compassion but because we know surgery or even non-invasive procedures won’t help. If anything, we worry that by inadvertently accepting a BDD patient we might prolong the cycle of dissatisfaction.

One of the plastic surgery organizations we belong to, the American Society of Plastic Surgeons (ASPS), agrees that BDD is a contra-indication for surgery. The ASPS urges its members to get educated about the disorder and comfortable with discussing body image in consultations.

Getting Educated

Since prospective patients with BDD may be adept at hiding the condition, it’s up to us in the industry to keep BDD in the forefront of our thinking. Resources for doctors include:

• A Cosmetic Surgery Screening Scale (COPS) published by a British scientist and available in PDF form upon request

• In-depth questionnaires published in the Aesthetic Surgery Journal by the University of Oxford

There’s plenty of other information online, it just takes a quick search to find many reputable sources.

Practical Matters

We recognize that it’s probably not desirable to administer extensive questionnaires to men and women interested in cosmetic treatment. It’s time-consuming for the patient, impersonal and may come across as unwelcoming. In addition, anyone who’s savvy enough to present themselves well in consultation will know the “right” answers to supply on such an evaluation. We don’t give our New York cosmetic surgery patients a grilling like this.

A good alternative is to have a set of questions in mind to pose to new patients as appropriate. Another U.K.-based publication called Aesthetics offered a list of five questions that could easily be incorporated in one-on-one discussions:

• Do you worry a lot about the way you look and wish you could think about it less?

• What specific concerns do you have about your appearance?

• On a typical day, how many hours is your appearance on your mind? (More than 1 hour a day is considered excessive).

• What effect does it have on your life?

• Does it make it hard to do your work or be with friends?

It might also make sense to come up with a question or two for most patients, with a second list for those a cosmetic surgeon might be concerned about.

The Horizon

More research is being performed on BDD every year. We’re alert for news in our New York cosmetic surgery practice and we heard something encouraging recently: BDD patients can and do recover from the disorder. It may take a while, but apparently treatment combinations including medication and cognitive behavioral therapy are promising.

Not cosmetic surgery.

Talking Turkey–for Cosmetic Surgery

New York cosmetic surgery You probably think we’re against traveling for cosmetic surgery—not true! We are in favor of flying to another city or country if patients do so to work with the plastic surgeon of their choice. We have several patients each year who come to New York for cosmetic surgery with us, and we take every measure possible to ensure their comfort and safety.

We’re not wild about the idea of men and women traveling to get a cheaper price. You can get surgery in other countries less expensively for a reason—the tradeoffs usually undermine your safety. In developing countries in particular, standards for physician credentials, procedure limits, clinic safety measures and follow up care are generally much different than here in the U.S.

We’ve written in the past about risks of booking procedures in countries like the Dominican Republic. People from New York seeking cosmetic surgery tend to choose locations in the Caribbean or Latin America if they’re looking to save a few bucks. Patients from the United Kingdom favor other destinations, and Turkey is an emerging popular choice.

What We Hear About Turkey

There are enough red flags highlighted in media stories to make us worried about patients considering a trip to Turkey. A few of them are touched on in a recent article in The Guardian discussing Brazilian Butt Lift (BBL) surgery:

Surgeons take more risks.

• Risks may not translate into good results. A UK doctor interviewed for the piece notes that she regularly sees patients who are unhappy with their BBL performed in Turkey. Surgeons are willing to insert larger volumes of fat than makes sense, according to the British doctor. Since much of it is not destined to survive, patients end up with misshapen buttocks.

• Credentials can be difficult to evaluate. Web sites are not always helpful, links don’t work and so on. Some Turkish cosmetic surgeons are board certified in Europe or the U.S., but those who aren’t may or may not have the training and experience patients might assume they do.

BBL surgery can be especially dangerous if the provider is inexperienced. When inserting fat into the buttocks, the doctor has to keep the instruments above the gluteal muscles. Failing to do so can allow fat to enter the bloodstream and cause fatal clots. The article in The Guardian mentioned the case of a woman from the U.K. who died from this complication a couple years ago after surgery in Turkey. She’s not the only one.

And the BBL is not the only procedure causing life threatening issues in Turkey. Another issue of The Guardian related the case of a woman who went into cardiac arrest during rhinoplasty surgery in Istanbul. At the time of writing last year, the patient was still in intensive care months later. Other British publications have written about mommy makeovers, eyelid surgeries, liposuction and breast augmentations gone wrong in Turkey.

Additional Considerations

Credentials and risk-taking behavior of cosmetic surgeons in Turkey are just some of the issues. Compared with operations performed in qualified cosmetic surgery clinics in New York, procedures in Turkey may look quite different. Patients have reported surgeries moving forward with no consultation, medical staff in street clothes and a frequent lack of aftercare. When post-op problems arise, it’s not unusual for a Turkish clinic to be suddenly very difficult to get in touch with.

U.K. vs. U.S. Patients

When patients return to the U.K. with complications after cosmetic surgery abroad, National Health Service doctors care for them as needed. An article in The Sun a couple years ago stated that Turkey is “the worst country in the world for botched operations.” It costs the NHS tens of millions of pounds each year to care for patients who have returned from another country. (If patients opt for private care, the price tag can be hefty, as it was for a woman featured in a BBC story recently.)

In the U.S., there’s an additional challenge for returning patients: without a national health organization it can be difficult to find a plastic surgeon to take your case. It’s not that reconstructive surgeons are hard to find in New York, it’s that cosmetic surgery performed after a botched procedure is very tricky. It can be next to impossible to create normal looking results, and many plastic surgeons are very hesitant to even try, even when a patient can foot the bill after already paying for a procedure abroad.

Our View

If you’re fortunate, you may indeed save money on cosmetic surgery in Turkey, the Dominican Republic or another developing country. But understand that you’re rolling the dice, and losers may pay with their looks, their health or even their life. Consider working with us for cosmetic surgery in New York instead. Your peace of mind is priceless!

Photo by Anna Shvets from Pexels

New York Plastic Surgeon

Dr. Elliot W. Jacobs