Walnut Creek Doctors

Are There Special Considerations for Liposuction on Asian Patients? I Scar Easily.

I'm female, 27,5'2'', 120 pound. I'm athletic, but all my life have had fat in my lower abdomen. I'm asian and have skin that scars VERY easily. I was reading on Realself that a doctor suggested VASER lipo since it worked better on asian patients "since they tended to have fibourus fat" What type of Lipo would work best for me? Are there any special considerations for asian patients? I've found someone sites that talk about "asian liposuction"--is there such a thing?

Dear QuestionsinLA:

Thank you for your question. Addressing your tendency to scar, liposuction leaves small scars which tend to heal well. Before surgery, review with your surgeon where the scars will be placed. The bigger problem is pigmentation. The skin around the scars can get darker. Usually this is temporary, but it can be permanent.

I have found that using small, straw-like "ports", protects the skin edges from the rubbing of the liposuction cannula, and leads to scars that heal faster and that are less likely to pigment. I was very skeptical the first time I used them, but after seeing the results, I use them every case.

Addressing brand name liposuction. I hire a carpenter based his skills, not on the brand of hammer he uses. You are paying for the skill, experience and judgement of your plastic surgeon. For the vast majority of patients, the results of tumescent liposuction cannot be improved upon.

The biggest obstacle to a great result in liposuction is loose skin. Lasers, ultrasound, radio-frequency, heat, cold have been around a long time. While some studies show a small, measurable improvement  in skin shrinkage, they will not shrink-wrap loose skin. Additionally, measurable and noticeable are two different things. You need the good judgement of your plastic surgeon to guide you. If truly superior results were available with a specific machine, then every plastic surgeon would be using it.

Beware of the practitioner who makes promises too good to be true, or claims to be the only one in the world who has figured out how to achieve superior results. Plastic surgery societies are open, and we freely share results and experience. I learned about liposuction "ports" from a "competing" plastic surgeon in my local area. Great breakthroughs are accepted quickly and shared. Great marketing is tolerated, because our minds are open to improvement.

Every good plastic surgeon wants every patient to get great results. I want you to have a great result, so find a board certified plastic surgeon in your area, not a machine. And if they haven't tried using ports for liposuction, it would be worth mentioning. 

Joseph Mele, MD

Walnut Creek Plastic Surgeon

Dark Eye Circles All my Life What Can I Do?

I have had dark circles on my eyes my entire life even when I was a child. They cover the whole of my eye and give me a purplish, sick, tired and dreary look. I'm now 24 and nothing seems to help. I tried creams, concealers and injectable fillers, but nothing seems to help. I suspect the issue with these solutions working for some people and not me is due to my circles being more genetic that environmental? What can you suggest for me?

There are many causes for dark circles, in most cases there are shadows under the eyes caused by indentations under the eyes.  Sometimes these are seen in the "tear trough" area, sometimes there are circles under the eyes.

In either case, using fillers such as Restylane or Perlane, may be helpful with dark circles.

Good luck in your search for information!

David Mabrie, MD

Bay Area Facial Plastic Surgeon

Are my Breast Implants Way Too Far Apart? I'm 1 Month PO. (photo)

It's been one month since my breast augmentation procedure. I'm happy with the size and shape, though I would consider going slightly larger. Part of the reason I would consider going larger is in the hope that the gap between my breasts would be minimised. Changing sizes would cost a great deal of money, which I'm hesitant to go through with. Are there any alternatives? Do you think they are too far apart? Any honest advice would be greatly appreciated.

At one month, you do not have your final result; however, your result looks great. There is supposed to be some space between the breasts, and the amount varies from person to person. Most women do not have bulging breast tissue over the sternum without wearing a bra. While plastic surgeons realize that having the breast unnaturally close together is often desirable, there are limits and compromises involved.

If the breasts are naturally far apart, the skin between the breasts is tighter, and tends to push the implants out. Aggressively releasing this skin can lead to symmastia (uni-boob) or inadequate soft tissue covering the implant causing ripples. If you are not familiar with symmastia, just google it and you will see the result, if you do google it notice the position of the nipples too.

The ribs are the foundation which support breast implants, and the rib cage is round. This tends to encourage the implants to move apart also.

The most aesthetic positioning of the breast implants depends on many factors, not the least of which is trying to center the nipple on the breast mound. Breast augmentation simply increases the volume of the breast, and servers to magnify any nipple asymmetry. Breast augmentation alone does not change the position of the nipple, only a breast lift does that. But the implant can be moved around under the skin. Moving your breast implants closer together will result in your nipples appearing farther apart. This is a more masculine position.

The best medial results are seen in women who already have some breast tissue in that area. The breast implants support the breast tissue medially enhance cleavage, but the implant itself is not all the way to the medial edge of the breast.

If you want to maintain your implants centrally, wearing a bra will help. This gives immediate results, and helps prevent the implants from drifting apart. Hopefully, you can be happy with the size, shape and location of your breast implants. You have a nice result. :)

Joseph Mele, MD

Walnut Creek Plastic Surgeon