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Lappert Plastic Surgery Blog
Breast augmentation without the use of implants has been a goal of plastic surgeons for many years. In any instance where we are trying to improve function or appearance, plastic surgeons nearly always prefer to use the patient’s own tissue to accomplish the desired result. This is because when all is said and done, no matter how well made an implant is, it is a foreign object that has the potential for becoming infected, becoming encapsulated and hard, or being extruded from the body. Even though these are rare occurrences, the preference for living tissue remains. It is also what patients would prefer. I can’t tell you how many times over the past 25 years patients have asked me during breast augmentation consultations, “Dr. Lappert, couldn’t you just suck some of this fat from my thigh, or my tummy and just shoot it into my breast?”
The problem with transplanting living tissue from one place to another, is establishing a blood supply. When we do breast reconstruction for cancer after removal of the breast, the vast majority of our time is spent planning, dissecting, transferring and preserving the blood vessels so the block of tissue that we move will live in it’s new home on the chest. These are big operations. So big, in fact, that to offer such surgery to a healthy woman who is looking for cosmetic improvement would be like swatting flies with a shotgun.
But the idea of just transferring fat cells all by themselves, the way we move skin grafts from one part of the body to another is very attractive because it isn’t big surgery. Surgeons have been playing around with this for over 80 years. The problem is that fat cells tend to be fragile. Much of what was transferred was already beaten to death by the process. The cells were treated roughly, and placed in large globs, preventing most of the cells from obtaining a blood supply from the surrounding tissue. Also, surgeons until recently, didn’t have a good understanding of what was happening to those cells at the microscopic level, and what the surgeon needed to do while placing the grafts so that the cells would have the greatest chance of making a new home for themselves.
An additional problem was the mistaken idea that fat grafts would make mammograms very difficult to read because any fat cells that die tend to leave little calcium deposits, which is what mammographers are looking for as signs of the presence of cancer. Good science, and logical reasoning has put that objection to rest. It turns out that nearly everything we do to breasts (including mammograms) causes little calcium deposits. The fact is that the calcium deposits produced by cancer cells look very different from the deposits caused by trauma to the breast. Best news of all, studies have shown that fat grafted breasts are more transparent to mammography, so cancers are actually easier to detect.
Thanks to the pioneering work of Sidney Coleman and Gino Rigotti (among others), these techniques have improved so much over the past 10 years, that many surgeons (myself included) find themselves doing more and more breast augmentations using the patients own fat. The technique allows us to build shape in very subtle and natural ways that suit the shape of the patient.
Among the many benefits:
1) No implant
2) Natural feel because it is natural stuff
3) Minimally invasive procedure (tiny little puncture wounds instead of surgical scars)
4) The donor site (where you get the fat from) also looks better (e.g. get rid of the muffin top)
5) Local anaesthetic with light sedation, instead of bigger anaesthesia
6) Very quick recovery
Here is an example of breast augmentation without implants. This was accomplished in a single procedure, in my office, under local anaesthesia. The “after” image was taken 6 months after the procedure.
Depending on your basic shape, and your goals, breast augmentation using your own fat may be the right way for you. Do your homework, ask a lot of questions, make sure you are talking to a board certified plastic surgeon who is a member of The American Society of Plastic Surgeons, and see if this is right for you.*
~Patrick W. Lappert, MD
* Individual result vary with any surgical procedure.
When I was a younger man, and in training to be a plastic surgeon, I was taught how to do a facelift. If a patient came into the office, and complained about looking too old there was essentially only one treatment that patient would be offered: a facelift. The only question would be:are we going to lift the brow too, and do we need to treat the eyelids with an “eye-tuck” (blepharoplasty), and are we going to add some treatment to make the skin itself look younger (chemical peel, laser). The basic treatment however was the facelift.
In the earlier days of plastic surgery the thought was that people looked old because they had too much loose skin, so the early facelift was about tightening the skin. By and by, plastic surgeons came to understand that the more important issue was what had happened underneath the skin to make the face look old. We saw that the soft tissue under the skin appeared to have slipped down on the face, as if gravity had pulled things down on the face. In the 1970s plastic surgeons started lifting up the soft tissues under the skin to make the face younger. Over the years, this technique was modified in several ways that particular surgeons thought might make for a more durable result. These operations are still very popular, but in the last few years there has been a huge revolution in how we make faces look younger.
Before I explain to you how we make faces look younger, you have to understand why faces look older. To help you understand this, we will look at two photos of me, taken about 35 years apart.
Besides the utterly depressing loss of hair, I want you to notice several things:
1- Look at the general shape of my face. When I was 24 years old, my face was oval shaped, being very much narrower at the bottom, and fuller at the top. At 59 years old, my face is rounder, being fuller at the bottom and down onto my neck.
2- Notice how I have shadows under my lower eyelids that look like bags, and how the shadow extends across my right cheek, whereas when I was younger,my cheek was entirely smooth from just below my eyelashes right out onto the cheek.
3- Notice the deep lines that extend from the base of my nose, past the corner of my mouth, and down onto my jaw.
4- Notice how the line of my jaw that used to be so visible is now blurred by the fullness in my lower face.
All four of these changes are caused by the same events that accompany aging, namely that some of the fat cells in my face have completely shut down and have virtually disappeared, while others have awakened and become chubby. The fat cells in the upper half of my face have largely disappeared, while the ones along my jaw and down in my neck have plumped up. This is why oval has become round, why my jaw has jowls, why my eyes look tired, and why my mouth looks like a marionette. Think of the cheek as a balloon that has deflated and is now hanging limp across the corner of my mouth.
We call that the “deflation wave”. It is kind of like “the wave” at a football game, when people stand up and sit down as the wave goes along. In this case the fat cells at the top have permanently sat down, and the ones on my jaw and neck have stood up.
Notice how my description of aging has said nothing about “too much skin”. It is all about fat in the wrong place.
Now let’s look at a “No Incision Facelift”. In this nice lady I used laser liposuction to remove the fat from her jaw and neck, and then I used a sophisticated fat grafting technique (using her own fat) to restore the fat to her upper face. No incision, just little punctures hidden under her chin and in the normal creases of her face.
The wonderful thing about this advanced approach is that I do the whole thing in one visit to my office, under local anaesthesia with a very mild sedation, and there is really no recuperation, just one week of being careful about how you sleep, what you eat, and how much you talk.
A very wise surgeon once told me, “Patrick, just because you own a hammer doesn’t mean everything is a nail”. Just because I know how to do a good facelift doesn’t mean everyone needs a facelift. Now I also do minimally invasive techniques that are the perfect approach for many of my patients who neither need, nor want a facelift.*
-Patrick W. Lappert, MD
*Remember that individual results of surgery and other procedures varies.
Using Botox to help people appear younger, more relaxed, and more confident, is a technique that has been around for many years. It is such a popular treatment that Botox has become part of our modern language. Unfortunately this is a medicine that is greatly misunderstood. In situation comedies and feature films, Botox is shown as a drug that turns people’s faces into rigid, numb masks. Let me take a moment to show you that Botox, when used by properly trained practitioners, is a safe and elegant way to take years off your face.
Botox works by interfering with the way nerves talk to muscles. Why would that make a face look younger? There are a number of things that cause our faces to appear older. One of these, particularly in fair-skinned, blue-eyed people, is habitual movement. It turns out that blue and green eyes allow more light into the eye than brown eyes. As a result, blue and green eyed people learn very early to squint in bright light. In fact they learn it so well, that they squint even in subdued light; when they speak, smile, or just think. The problem is that as the years go on, the skin will thin wherever it is being repeatedly flexed by the muscle. This is what a wrinkle is: a line of thin skin caused by habitual movement.
The other thing that happens with this habitual movement is that the muscles doing the squinting get heavier, and more powerful (just like any other muscle that gets a lot of exercise). Over time, this causes the eyebrows to sit lower over the eyes. As this happens, the skin just under the eyebrow rolls down over the eyelid, causing it to hood over. To make matters worse, your brain will feel this skin resting on the eyelids, and want to lift the brow up to stop this. Now the person develops the habit of lifting their brow. This causes the wrinkles on the forehead.
So what started out as a funny little habit of squinting in childhood has become a collection of frown lines, crow’s feet, forehead wrinkles, and hooded eyelids! The face starts to look like a map, and that map is really a diagram of a lifelong tug-of-war between your facial muscles.
This is where Botox becomes a miracle treatment. We use Botox to selectively weaken certain muscles so that the tug of war stops. If we weaken the muscles that squint the eyebrows down, over time the eyebrows will rise to their younger position, the hooding will improve, and the forehead muscles will calm down. After a while the wrinkles soften, the eyes look rested and more open, and the face looks happy and confident. When properly done, Botox does not paralyze the face at all. Instead it simply takes away the habits of movement, while retaining the ability to move. Not a mask, but a younger more confident face.
For most people, Botox is a two to three times per year visit to the Plastic Surgeon. The visit usually takes about fifteen minutes, and you can return to your busy life immediately, without anyone noticing that you have done anything.
Botox is safe and effective, but the person applying it should be very familiar with the anatomy of the face. Check your doctor’s credentials, and find out who in the office is doing the actual injecting. You should also compare price. Ask what they charge per unit. Most treatments use between 25 and 50 units of Botox, and the price in most parts of the country is between $11 and $13 per unit.
Do your homework, and if you decide to try this treatment, be ready to be pleasantly surprised by the results! *
*Remember that individual results of surgery and other procedures like Botox will vary.
Here is a link to the official Botox website, where you can see photos of many different faces before and after Botox.
Everyone is talking about skin cancer; about how to prevent it, how to treat it, who gets it, and who doesn’t, but no one seems to talk about what it is. I think if we explore a few simple ideas, we will fear it less, and also learn where the real breakthrough in treatment is.
Whenever we read about skin cancer, we tend to think about it as something we “get”. It is not unusual to hear a friend say, “Betty was at the doctor’s office and found out that she got skin cancer”. After a while we come to think of skin cancer as something you “get”, like a gravy stain on your favorite necktie. Ooops, skin cancer!
You may be surprised to learn that cancer is a very ordinary part of living in this fallen world of ours. Cancer is a word that describes a process of degeneration that can happen to living cells in which the DNA language of the cell gets garbled, causing the cell to misbehave, sometimes replicating wildly (tumor), sometime wandering off to distant parts of your body and causing trouble (metastasis or spread of cancer). It all begins with some damage to the language library that controls what the cell is normally supposed to do. This degeneration of the DNA happens all the time, and to everybody.Sometimes it is a virus that damages the DNA, sometimes a chemical substance, sometimes radiation.Your body has been producing cancer cells since before you were born!
You may ask, “Well, Dr. Lappert, why aren’t we all dead from cancer?” That is the heart of the issue! The reason why we aren’t all dead from cancer is because we are blessed with an immune system that is constantly rooting out cancer cells and killing them. Doctors call that the “Immune Surveillance System”. We have specialized white blood cells that are constantly sniffing around looking at the surfaces of cells, trying to detect if that cell is making weird proteins that would suggest deranged DNA. If those watchdog cells smell trouble, they will mark that cell for destruction. Other specialized “killer” cells will come along, see the mark, and destroy the cancer cell.
Then why do we get cancer at all? As with all other abilities that we are blessed with, we don’t all have them in equal measure. Some people inherit a tremendous resistance to skin cancers. Other people, particularly later in life when all of our strengths diminish, get skin cancers constantly.
A few years ago, some very clever scientists discovered a molecule that your body uses to communicate between the watchdog cells and the killer cells. It turns out that if you apply that molecule to your skin, your immune response to skin cancer is very greatly amplified. The medicine is called Imiquimod. If you put it on normal skin, nothing happens. If you put it on skin that has even pre-cancer, the skin will redden, and after a period of about 2 months, the cancer is gone!
It hasn’t been proven to work in all cancers, or in all people, but about 93% of the time, it solves the problem.
I’ve been using Imiquimod at Lappert Plastic Surgery for years. It is helpful for making the diagnosis, treating the cancer, or making cancer surgery more effective. I have my patients apply it to any little growth on their skin that is suspicious. If I see it turn red after a week, I have them apply it every evening for a total of one month. If it is still there, after turning red, I will remove it and send it to the lab. If they apply the medicine and there is no reaction, we will watch it. If it is still suspicious looking, we will remove it.
Imiquimod is one of a new class of medicines called Immune Response Modifiers. They are being tested and developed for a whole host of cancers including cervical, lung, and gut cancers. It is one of the most promising areas of cancer care.
If you want to learn more, go to this site:
Lappert Plastic Surgery was the first to introduce Laser Liposuction (SmartLipo) in the Tennessee Valley. Little wonder it remains the most popular body shaping procedure we provide. Our ability to achieve significant improvements in body contour using minimally invasive techniques allows people to get results without having to be away from work or business commitments. Our patients continue to express great satisfaction over their decision to have Smartlipo, and they have been sending their friends to see Dr. Lappert.
Not only do they see a shape improvement, but for our active-duty patients, they also achieve measurable reductions in their “tape”, permitting career advancement.
Liposuction has been around for over 40 years, but it requires significant anaesthesia and “down time” for recovery. With Laser Liposuction (Smartlipo), the cost and risk are greatly reduced, and most patients are able to return to work within a day or two. This reduces the hidden cost of time away from work.
The real advancement in laser liposuction (Smartlipo) is that we use a small laser instrument that destroys the fat cells, turning them into a liquid that can be suctioned out with little to no trauma. That is why we can do amazing lipo procedures in the office under local anaesthetic.
The other great benefit is brought about by the fact that the laser energy that destroys the fat cells also stimulates your body to make collagen in that treated area. As the collagen forms and remodels over a period of several months, the skin gradually tightens down. This effect is not seen with conventional liposuctioning.
The most popular treatment areas are abdomen, waistline, saddlebag/ hips, neck/ jowl area, and arms.
Great results, lower cost, little to no down time!
Call us to schedule your consultation and find out for yourself how Smartlipo at Lappert Plastic Surgery can help you achieve the result you’ve been seeking.
Call 256 772-7123, or click the “call back” button above and we’ll call you!