Breast Augmentation …. in a Nutshell Breast Augmentation recently topped liposuction as the most popular cosmetic surgery. This procedure dramatically changes some women’s’ self esteem. I’ve had patients in tears at their initial consultation who had never let their husbands see them without clothing while the lights were on. After breast augmentation they were proud, confident and comfortable. The choices to be made when having this procedure are

(1) Type of implant (2) location of the incision and (3) location of the implant. Saline implants have a larger incidence of becoming hard over time-one of the major causes of re-operation. They can be put in through a smaller incision than silicone implants. They are cheaper than silicone. When they leak or rupture, which occurs at a rate of 1% per year, you have an obvious deformity and breast asymmetry that women tend to want fixed quickly-a surprise expense no one is happy about. They also have a higher rate of palpable or visible rippling. Silicone implants are softer and feel more natural then saline. If they leak or rupture, you probably won’t be aware of it-the breast retains its shape and size. It requires a larger incision then saline. They become hard “encapsulation” at a higher rate than saline implants. They are more expensive than saline implants. I do the operation under direct vision, with a lighted retractor using loupe magnification-not an endoscope and TV camera. I prefer general anesthetic. The operation is usually done in a surgery center, and the patient goes home the same day. The procedure takes about 1 ½ hours and recovery room about 1 hour. Next day, you may shower and do anything else you may feel like doing except taking aspirin, lifting heavy weights, or doing violent exercise. Return to work anytime you feel up to it which varies greatly from person to person but usually is 3-14 days. My personal preference is to put the implant through an incision under the breast in the fold. I feel that it’s the best place to have a scar as opposed to the areola or armpit. Through this incision I have the greatest amount of control over where the implant is positioned. This is the most important factor that determines a patient’s satisfaction and a good result. The bottom edge of the implants can simultaneously be visualized on both sides so that they are perfectly placed-not too high or too low. Lastly the breast fold incision is directly over the main blood vessels that have to be divided in the operation. This incision gives clear view of them allowing control of bleeding that causes pain, swelling and leads to hardening of the implants. It is not unusual to lose less than a teaspoon of blood in the entire operation.

I prefer to place the implants under the muscle. This location is associated with less breast encapsulation, fewer problems with palpable or visible edges of the implants, and the slope of the upper part of the breast is more natural. A person electing breast augmentation should realize this is usually not a one-time procedure. Published rates of re-operations are in the range of 20% over 5 years. This includes patients choosing to be bigger/smaller and also includes complications such as bleeding, infection, hardening of the breasts, malposition and irregularities of the implants, leakage, rupture and scar revision. Despite these limitations, it’s a great operation with a high satisfaction rate— permanently changing how you feel about your body and the clothes you wear.

Botox — Therapeutic and Aesthetic One should use caution and appreciate that not all the ideas for uses of Botox are good ones. Recently I saw some ads touting botox in the treatment of scars, which makes little sense to me. I also don’t think it’s a good idea to use Botox for sweaty palms, though it will work—pain and expense for short term gain. For this result though there is lots of pain and expense for marginal gain. Here are some neat things you may not know about botox. I have been using it for a long time for a lot of problems, some of which have not been published in the literature. Botox is used to paralyze muscles that cause problems by overactivity. Overactive muscles can cause: (1) frown lines in the forehead (2) “crows feet” around the eyes (3) migraines from tension between the eyebrows (4) down turned mouth from overactive depressor muscles at the corner of the mouth (5) dimples in the cheeks from muscles in the face with abnormal attachments to the skin (6) neckaches and headaches from tension and spasm in the muscles in the neck and back (7) buttocks and leg pain from spasm of the piriformis muscle (8) overactive sweating (9) facial twitches and spasms (10) bands in the neck that stand out (11) drooping of the lateral brow giving a sad look. I have been using Botox for all these indications for a number of years and the gratifying results sometimes cannot be achieved by any other methods. A good friend of mine had a rare syndrome in which a muscle in his buttocks pinched his sciatic nerve. Injecting his point of maximal tenderness improved his pain 70% to 80%. One doctor comes in every three months for botox between her eyebrows for treatment of severe migraines. She reports she gets no headaches if she gets her botox but experiences several severe migraines weekly without it. Many people are afraid of Botox and its potential side effects. I tell my patients, “It’s the safest thing we do,” which is true. Allergic reactions are almost unheard of. Drooping of the eyelids should not occur with proper technique and a properly chosen patient. Botox should not be used in patients who must elevate their eyebrows in order to lift their eyelids. If you paralyze the muscles that raise the eyebrows they can’t compensate for the extra eyelid skin that blocks their vision or the weak muscles that raise the eyelid. Tiny amounts of Botox (micro-botox) can be used around the mouth to soften lip lines but you do risk having a slightly unnatural motion in the area. The procedure itself takes approximately two to five minutes depending on the area and amount used. A topical anesthetic and an ice roller prior to the procedure lessen the amount of discomfort experienced during the injections. A unit of Botox costs between $10 and $15. Typically I like to use about 30 units of Botox for the treatment of frown lines. Botox lasts on average 3-4 months, but some extremely sensitive people get 6-8 months out of it. For most people the deformity or problem being treated diminishes with each treatment because the paralyzed muscle cannot regain its prior strength or size.

SEPTEMBER-SPECIAL BOTOX PRICING—$60 discount

VOLUME I, ISSUE 3, SUMMER 2007

Liposuction is really a great procedure, particularly if you have localized areas of extra fat, out of proportion to the rest of your body. It’s not a treatment for obesity and there are some caveats and limitations. Here are a few key things to keep in mind when considering liposuction (1) Liposuction usually will not tighten or reduce extra skin, but it does not hang and become “floppy” after liposuction (2) If you have cellulite or ripples and dents in the area you want treated, these will probably not be improved (3)6 ½ or 7 pounds is the most we remove in an outpatient surgery center setting (4) Liposuction can be performed at the same time as other procedures and the fat can be used to fill out hollow areas of the face (5) Augmentation of the breasts with transplanted fat is not yet proven safe—studies are ongoing

Liposuction Limitations

Choose To Look & Feel Younger — Check Your Posture Often I see patients who come in for cosmetic surgery consultations,

complaining that they are looking old or tired, and wanting to make a change. On examination their shoulders are slumped and their head is forward. If they maintained better posture with their shoulders back and head erect, they would look 25 years younger and healthy!

Granted, many times there are physical limitations that can’t be overcome but often the “deformity” is a matter of habit, and this a choice. Fixing their posture would be far more powerful than any surgery I could do to make that patient appear more healthy and youthful. Consider whether your posture can be improved, and work on it. Lots cheaper than surgery!

Remember this quote by William Jennings Brian…. “Destiny is no matter of chance, It is a matter of choice: It is not a thing to be waited for,

It is a thing to be achieved” More About Facelifts

DAVID L. RAYFIELD, M.D. DIPLOMATE

AMERICAN BOARD PLASTIC SURGERY AMERICAN BOARD OF SURGERY

CENTRAL PARK EAST 222 NEW ROAD

BLDG 6 LINWOOD, NJ

(609) 601-1000

www.drrayfield.com

DAVID L. RAYFIELD, MD Board Certified Plastic Surgeon

With a discriminating eye for detail and a commitment to

patient satisfaction

Botox Fat Injections Juvederm Liquid Face Lift Radiesse Restylane Sculptra Skin Peels

Abdominoplasty Blepharoplasty

Browlift and Eyelid Breast Augmentation

Breast Reduction Facelift Surgery

Laser Hair Removal Lip Augmentation

Liposuction Mesotherapy

Mini Tummy Tuck Midfacelift Surgery

Neck Lift/Liposuction Photofacial™

Dr. Rayfield’s quarterly newsletter about cosmetic surgery and looking your best

The warm weather has finally arrived and it’s time for shorts and swimsuits! Looking great is important which is why the two most popular procedures are liposuction and breast augmentation. In this newsletter I’ll discuss both these subjects. To set the mood here’s a jersey shore poem, my daughter recently wrote. Enjoy this issue and I’m looking forward to seeing you soon.

“Paradise”

Salt caked a film over her skin; She squinted her eyes shut tight,

Just to feel the sun-toasted wrinkles at her tem-ples

The waves had long ago put her in a trance In which she would be happily trapped for life

They didn’t have rhythm, but a pattern That she never wanted to figure out

There was something about the horizon, too. She felt a soothing kind of fear

Like an ant with endless possibilities An elastic breeze shifted her mind

slightly towards reality and a seagull caught her eye

She followed it as it sifted through the air Over the moving sheets of water

She envied its freedom and Wished she could live there too

Rachael Rayfield

IN OUR NEXT ISSUE OF COSMETIC SURGERY INSIGHTS

Laser Liposuction Mesotherapy

Unfortunately, there are a lot of fears and misconceptions about facelifts brought about largely by the visual impact of TV and melodramatic reports in print about complications and difficult recoveries. Patients seem terrified of this procedure. If you have very little neckline or jaw line or a lot of loose skin present on the neck this surgery shouldn’t be feared! It really is just elevating the skin, removing the extra, tightening some loose muscles and, if needed, removing a little fat.

In reality the usual recovery is easy, minimal discomfort and, if you don’t include the eyes, you can be looking very good in 1 to 2 weeks. If you include your eyes recovery cosmetically takes a little longer.

What does a facelift not do? Fix lines around the mouth, fill in hollow cheeks, fill in grooves in the cheeks, fix circles under the eyes, “bags” on the upper cheeks, lines in the face or the deep line that runs from the nose to the corner of the mouth. These problems we address with fillers and lasers and occasionally fat injections. It is a surgical procedure requiring anesthesia but complications such as bleeding, skin loss or nerve damage are uncommon. The procedure is smaller than a tummy tuck or breast augmentation.

Fear not… ask to see some pictures, visit our website & speak with me.

Make your appointment today to take advantage of our

25% Discount on LASER HAIR REMOVAL Friday, August 17th, 2007