Valencia Plastic Surgeons

What's the Best Lip Enhancement and Plumping?

What options do I have for lip augmentation?

For patients interested in fuller, more pronounced lips, I would recommend hyaluronic acid (HA) fillers such as Juvederm or Restylane.  I usually perform this in the office under local anesthesia.  The length of time these fillers last is variable, roughly 6-8 months.  These fillers really have minimal side effects and your surgeon can fine tune the result to the look you want.  The result is usually immediate, but as the hyaluronic acid pulls in water, you can detect a slightly fuller look over the next 3-4 days.  If you don't like the result, you have a day or so to massage the HA and dissipate the result.  If massaging does not't get rid of the HA, there is an enzyme called hyaluronidase that can be injected by your surgeon to break down and dissolve the HA.  Patients who desire a more permanent lip augmentation can have autologous fat grafting.  Despite the fact that only about 40-50% percent of the fat is retained after 6 months, the 50% that stays is permanent.  You may need several injections to get the permanent lip augmentation look you want.  I have also used Alloderm in the lips with good long-term results.  If you are interested in lip augmentation, I would always recommend a patient use a temporary filler like Restylane before using something more permanent to ensure the patient likes the appearance of fuller lips.

Best wishes.

Peter Ashjian, MD

Bakersfield Plastic Surgeon

Do Breast Reconstruction Tissue Expanders Cause Pain As They Expand?

It seems like a tissue expander would be painful as it stretches the skin - am I crazy?

One of the most common techniques for breast reconstruction is the use of tissue expanders (with or without a dermal matrix graft e.g. Alloderm).  It is a relatively shorter procedure than autologous reconstruction (e.g. TRAM, DIEP).  In my opinion, implant-based breast reconstruction is a good option for the following patients:

1) Women who already have breast implants,

2) Women who have A-cup or B-cup breasts,

3) Women with minimal breast ptosis (sagging breasts),

4) Women who are having bilateral breast reconstruction,

5) Women who have not had or will likely not be getting radiation therapy as part of their treatment.

Unlike a cosmetic breast augmentation, there is no breast tissue to cover an implant after a mastectomy, therefore tissue expanders/implants are ALWAYS placed beneath the pectoralis major muscle after a mastectomy.  The tissue expander is placed beneath the pectoralis major muscle and beneath the Alloderm (if it is used).  Some volume is placed in the expander at the time of the mastectomy.  The volume depends on the ability of the sub-muscular pocket to accommodate the volume and on the mastectomy skin tension.  During the post-operative period, the tissue expander is filled on a every other week schedule.  Usually the patient does not feel the needle piercing the skin of the mastectomy due to the numbness of the skin after the nerves are cut during a mastectomy.  As the tissue expander is filled, the patient may feel a pressure sensation or discomfort as the expander both stretches the skin and pectoralis major muscle by pushing against the chest wall.  Therefore, most patients feel a mild discomfort during the expansion phase which usually lasts about 2-3 days.  Mild pain medication is enough to help relieve the discomfort.  If you feel significant discomfort, then you must communicate this to your plastic surgeon so the next time the expander is filled, less volume is used.

Peter Ashjian, MD

Bakersfield Plastic Surgeon

Is Abdominal Liposuction the Same As a Tummy Tuck?

Although many plastic surgeons combine some liposuction during the abdominoplasty procedure, this is often limited to the flank regions and/or thighs.   The abdominoplasty procedure is used to address several components of the anterior abdominal region which liposuction does not.  The abdominoplasty -

1) Removes excess skin,

2) Removes excess fat, and

3) Tightens loose abdominal muscles (rectus muscles).

Liposuction only removes excess fat.  Therefore, liposuction relies on skin elasticity to contract once the excess fat is removed.  Although, there are some new types of liposuction techniques (i.e. laser-assisted) which have some component of skin tightening, it is often a modest amount and does not compare to the significant amount of skin that can be removed and tightened with abdominoplasty. Your board-certified plastic surgeon will be able to deternine which type of procedure will be the most appropriate for your specific concerns.

Best wishes.

Peter Ashjian, MD

Bakersfield Plastic Surgeon