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10 QUESTIONS ABOUT COSMETIC SURGERY YOU HAVE ALWAYS WANTED TO KNOW- ANSWERED BY A BOARD- CERTIFIED PLASTIC SURGEON

January 24, 2020

We sat down with Dr. Manish Shah to find out common questions that we have been asked about cosmetic surgery. From all of the different questions that have been sent to us, we have 10 answers that can come in handy for you or someone that is asking you for your knowledge.

ATHLEISURE MAG: How long do breast implants last until they have to be removed and done again?
DR. MANISH SHAH: Although the implants themselves last forever, their structural integrity does not. Over time, the average wear and tear could cause a rupture or leak. In general, saline or silicone implants should be replaced or removed every 10 to 15 years if you notice any changes. A rupture in a saline implant tends to be more noticeable, as the deflation is visible. While that may sound scary, it’s actually quite harmless, as the saline is just absorbed by the body. However, it is not as easy to notice if a silicone implant has ruptured. For this reason, most doctors will recommend an MRI every 2 years for their patients with silicone implants to check for leaks. Implants may need to be removed or replaced for other reasons too, but in general, should last from 10 to 25 years.
 
AM: If I have fat removed through liposuction, will it reappear elsewhere?
DR. MS:
Technically, yes, it is possible for the fat to return, but only if you let it come back. If the patient maintains their weight, the fat will not return or appear somewhere else on your body. A little bit of weight gain is fine, such as 5 to 10 pounds, as long as patients stay close to their “post-lipo weight”. Because fat cells accumulate in an evenly distributed manner, weight gain tends to be more noticeable in areas that are untreated than treated. So, even patients who gained a considerable amount of weight post-lipo look better than they did if they had not undergone surgery.
 
AM: After repeated Botox injections, will facial muscles ever lose the ability to frown?
DR. MS:
Even though one of the side effects of Botox is difficulty smiling or frowning, the effects of Botox wear off in 3 to 4 months. Repeated use of Botox causes the muscles treated to atrophy and thin out. When they "wake" back up they tend to be weaker and less likely to make wrinkle. This is why many consider Botox a great anti-aging treatment. Botox can be administered in a way in which it does not freeze the muscle completely. This is something you would discuss with your injector.
 
Discuss with the injector what your goals are. Some people such as actors need to be able to express themselves. In this case, Botox can be administered so as not to freeze the muscle completely. Others want certain muscles not to move at all. An experienced injector has the knowledge to make adjustments. We also have the ability to combine Botox with other treatments to assist your goals.
 
AM: I thought silicone breast implants can rupture, so why are they still used?
DR. MS:
Both saline and silicone implants can leak. But, it is much harder to tell when a silicone implant has ruptured over a saline implant. Someone with silicone implants may go months or even years without noticing. This is due to the very thick and viscous silicone filling, moving only at very slow rates. It will generally stay within the capsule of breast tissue surrounding your implant, which makes for a simple replacement. Additionally, silicone is the gold standard against which other implantable materials get compared. It is a safe material when used in the human body.
 
AM: Will liposuction eliminate cellulite?
DR. MS:
Although patients used to think liposuction could eliminate cellulite, today doctors are not recommending it for that use. In some cases, liposuction can actually make the cellulite worse by creating more dimples in the skin. While it is true that excess fat can make cellulite worse, it’s not the real cause. Liposuction on the thighs and butt only marginally improve the appearance of cellulite. On the contrary, thin skin in these areas can exacerbate the problem, especially in older women where the skin tends to be less elastic.
 
Doctors have found that ultrasound and laser-assisted liposuction can effectively reduce cellulite because it tightens the skin as it removes fat. But again, these alone will not rid you of cellulite.
 
AM: Will I have to wear my hair over my ears to cover face-lift scars?
DR. MS:
On average, face-lift scars around the ears take about six months to fade and become almost invisible. You probably are going to want to wear your hair down for the first month for recovery purposes. It’s best to choose a hairstyle within this time that will not apply added pressure to the area of incision while still helping to cover up the scar at the same time. Ask your doctor how soon it is safe for you to wear makeup over the scar as a cover up option until they fully fade.

AM: Can my breast implants pop?
DR. MS:
Unfortunately, yes breast implants can “pop”, but it is rare and easily treatable. Both saline and silicone implants have an outer shell that can potentially develop a tear, called a rupture. The rupture could be caused by a variety of things such as normal aging of the implant, trauma caused by a car accident, a needle insertion during a biopsy, or other factors. If you experience any changes in breast shape and size, and increased pain, firmness, and swelling over a period of weeks, these may be signs that your implant has ruptured. Most corrective surgeries include removing both implants and replacing them in the same surgery. Your surgeon might also recommend that you switch to a different type of implant. In any case, discuss with your doctor in detail the best option to avoid risk of rupture in the future.
 
AM: What happens if I’m not happy with my surgical results?
DR. MS:
The first step is to be patient. Some patients look good in as fast as three weeks, others three months, and, for some, the full results aren’t apparent until six months after surgery. You should wait for all the post-surgical swelling and bruising to go away completely before fretting over the end result.
 
With that being said, speak up if you are feeling anxious. At your follow-up appointment, it is perfectly fine to voice to your surgeon that you are feeling disappointed. A good doctor will address your concerns, walk you through the recovery process, and if necessary, talk about the next steps.
 
AM: How soon after my lipo can I have sex?
DR. MS:
After having a procedure like liposuction or a tummy tuck, you will definitely feel some moderate soreness and swelling. It’s normal. When it comes to resuming sexual activity, your personal level of comfort plays a large factor as there is no specific body structure you can damage after liposuction. This means your soreness or the healing process of your incisions may be the only thing stopping you from being intimate. As soon as you feel both physically and emotionally ready, you are safe to resume having sex. For most patients, it takes about a week.  But if we removed excess fat on large areas of your thighs, belly, and/or buttocks, you might have to wait a week to ten days. Before then, your body will be tender and that could make the experience painful.

AM: What is the youngest age you would consider performing a facelift?

DR. MS: When evaluating a patient for facelift surgery, age is only a relative consideration. I've performed facelifts on patients under 40 years of age who lost a lot of weight causing their face to deflate and sag. That being said, most facelift or neck lift procedures are performed on patients between 45-70 years old. If the volume loss can be managed by treatments other than facelift surgery, patients will opt for them. However, once those minimally invasive or noninvasive treatments no longer cut it, a patient can choose to have a facelift. For some patients that may be in their early 40's.

AM: Is there a trendy cosmetic procedure that you feel is a waste of money and time?

DR. MS: The procedure that I find a waste of time and money is Kybella. It is so expensive for patients and has significant social downtime. I can get better results, more quickly with neck liposuction. Also, I am still waiting to see if patients can get decent results with Sculptra injections for buttocks augmentation. For doctors that can't perform surgical procedures, or for patients who want to avoid surgery, these may be their only choices.  

 Read the latest issue of Athleisure Mag.

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PHOTO COURTESY | Joseph Barrientos

PHOTO COURTESY | Joseph Barrientos

DON’T TRY THESE SKIN CARE DEVICES, GADGETS OR TIPS AT HOME WARNS DERMATOPATHOLOGIST

June 27, 2019

Life hacks, DIY tricks, and at home devices that are meant to “mimic the effects of in-office skin care treatments are all the rage right now. They are posted on Instagram, YouTube, and all over the Internet. While some are very constructive and budget-friendly, others are ineffective or downright dangerous. We asked Dr. Gretchen Frieling, who is a Boston area Dermatopathologist, to highlight several highly publicized methods that should bear the warning, “don’t try this at home.”

Dermaplaning - Dermaplaning is a cosmetic procedure that removes the top layers of your skin. The procedure aims to remove fine wrinkles and deep acne scarring, as well as make the skin’s surface look smooth. It uses an exfoliating blade to skim dead skin cells and hair from your face.

The Risks - Anecdotally, the risk of infection, complications, and experiencing pain during home dermaplaning is higher when you do it yourself.  “If you have acne, there is a chance that the blade could nick a pimple,” says Dr. Frieling which means it would take longer to heal. In addition, the tool used for dermaplaning is not a safety razor like what we ladies shave with. The device or tool used to accomplish the dermaplaning on the face is made of a sharp blade with a handle or wand.

At home “Derma-Rollers” for MicroNeedling” Aestheticians and dermatologists use derma rollers on clients to increase elasticity, reduce the appearance of wrinkles, and help with discoloration. Professional treatment can cost anywhere from $100 to $1,200 per session. According to Marketwatch, “A trend report for 2018 from lifestyle site Pinterest says it’s seen a 345% increase in posts for the “derma-roller” over the past year.”  Dr. Frieling is not in favor of using the tools at home because, “the needles aren’t big enough to penetrate the proper holes into the skin, so you’re essentially damaging your face for no reason. And without proper sterilization, derma rollers can harbor harmful bacteria causing infections, breakouts, and can trigger skin conditions such as rosacea, which causes redness and bumps on the face; eczema, itchy inflammation spots; and brown patches on the skin.”

Injecting Botox or other “Black Market” Filler into Your Face - First, even if you were able to get your hands on “real” Botox or filler such as Juvederm or Restylane® it’s almost like putting a firearm in the hands of someone untrained at shooting.  There is no safe way to give yourself Botox. You can’t trust what you’re buying, and even if you could, no amount of YouTube-ing will ever adequately teach you the skills you need to inject it. First, you need to know where to inject the substance. The answer is not to point the needle at the fine lines. After all, you’re relaxing muscles, not filling in wrinkles. Injecting Botox requires an understanding of facial muscles. You need to know which muscles should be relaxed for the desired results and where to target them. Second, you need to know how deeply to insert the needle and how much of the mixed substance you should apply in any given location.

Incorrect injection practices can lead to a host of complications, including eyelid drooping (ptosis), excessive swelling, excessive bruising, and a greater risk of infection. In fact, the infection may become so severe that it becomes a staph infection, an infection that spreads throughout the body and causes a variety of diseases. In any case, recovery will be longer, and the results may not be what you intended.

Lip Plumper Suction Devices - We have Kylie Jenner to thank for these! They are much less expensive than filler in the lips but with a far shorter shelf life. Dr. Frieling’s verdict: “Overuse of suction cup lip plumpers can cause misalignment of the teeth due to the outward pressure of the suction. Devices such as these can also cause swelling and bruising of the lips (and sometimes permanent scarring) when used excessively. The advice is to use these devices sensibly and with caution.”

At home acne extractors - The county has become obsessed with popping pimples thanks in part to the success of the TV show “Dr. Pimple Popper.” Acne extractors sold online, and people are using them at home. But should they?  Picking causes scars or scabs by ripping off the top layer of skin, whereas extracting by a professional pulls out the fluids or solids inside a pimple. It's far more sterile, sanitary, and cleans the pore of extra debris. Why can’t you simply do this yourself? Acne extraction, be it white or black heads, is a ‘don’t try this at home procedure.’ It’s a one-way ticket to scarring, infection and even more breakouts. Only through a professional facial will your skin be prepped and steamed correctly for extractions – by the hands of a trained, licensed esthetician. Skin that has not been adequately prepped for extractions may be resistant, requiring more pressure and manipulation. If used too aggressively, the pressure of the extractor tool can inflame and even bruise the skin. Additionally, a skin care professional is well-practiced in gentle and efficient movements to maximize results while minimizing potential harm.

Cuticle Cutters -Trimming or cutting cuticles during a manicure is purely cosmetic and doesn't benefit the nail in any way. In fact, it's actually harmful to your nails. “The small area of skin is there to protect your nails from infection. When this skin is removed, your nail is left unprotected from bacteria and fungus. Dr. Frieling recommends pushing back the cuticles by applying cuticle remover on each nail.

Chemical Peels - Chemical peels are designed to work by removing part of the top layer of skin to reveal fresher skin for a more youthful appearance. Many products containing low concentrations of acid are sold through beauty retailers and drug stores, and are often safe to use. People also are treated with peels using a higher concentration at medi-spas or doctor’s offices.  When it comes to alpha hydroxy acids or (AHAs) like salicylic and glycolic acids, a concentration of 10 percent or less is safe for home, and more than 30 percent should be reserved for a professional environment, according to a Food and Drug Administration advisory panel. Like many substances, illegal concentrations of chemical peels can be purchased online for substantially less than they would cost in a doctor’s office. But what price do you pay for a “bargain?”  According to Dr. Frieling, “the dangers of experimenting with a medical grade peel at home are numerous and can include: extreme pain in the form of stinging, actual burns to the skin, blistering, scarring, changes in skin color, infection.” What’s more, a skin care professional will determine if you are even a candidate for a chemical peel and possibly rule you out if you have taken the acne medication isotretinoin in the past six months, have a dark complexion, have a personal history of ridged areas caused by an overgrowth of scar tissue (keloids), have abnormal skin pigmentation, have a history of frequent or severe outbreaks of cold sores.

Dr. Frieling says that there are worthwhile “skin care hacks,” DIY recipes for the skin, and some at home devices that are safe and effective. Before buying into the latest Instagram sensation, consult with your doctor first to make sure that you are a good candidate and that what you are considering is safe and effective.

 Read the latest issue of Athleisure Mag.

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In Beauty Tags Dermatologist, Beauty, Skin Care, Dr. Frieling, Chemical Peels, Cuticle Cutters, Acne, Dr Pimple Popper, Lip Plumper, Botox, Black Market, Filler, Face, Derma Rollers, MicroNeeding, Dermaplaning, Dermapathologist
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