Grand Rapids Doctors

I Smoked 5 Cigarettes a Week After Rhinoplasty, Did I Damage the Results?

Dear doctors, I just had a closed rhinoplasty done last week, it is beautiful and I'm so happy with it but I smoked 5 cigarettes today. I now have a little blue line at the bottom of my nose and I didn't have it yesterday. I want to cry because I have been given the most beautiful nose. I threw my pack of cigarettes away. I know I shouldn't have done it, and I won't do it anymore. I just want to know what to do. Could it have ruined the results? Please help.

Smoking before or after a Rhinoplasty is not a contraindication  (although it should never be recommended). It is doubtful that you caused damage and I would not worry about it. Other procedures such as Face Lift and Abdominoplasty are associated more commonly with problems if you smoke in the peri operative period. I would still avoid any further smoking (better yet-quit). If the blue persists, I would see your surgeon.

Scott R. Brundage, M.D.

Grand Rapids Plastic Surgeon

Options For Hyperpigmentation of Breast Reduction Scars on Light Skin? (photo)

I had a breast reduction done 6 months ago at 19. I do wish more tissue had been taken, but that's not my main issue. I've had darkened pigmentation around the scars since shortly after surgery, and it has not improved at all in the 6 months after despite using silicone sheeting and BioOil. I have been trying to find other examples of women with a similar problem, but it seems much more common in darker skin. I am Caucasian with fairly light skin. What are my options to deal with this?

As others have stated it will take a year for scars to settle. Something that you may want to try is topical 4% hydroquinone. This is a prescription but also comes mixed with Glycolics to potentiate the effect. It is considered a "skin bleaching cream" but actually just slows the deposition of pigment from the melanocytes (pigment cells in your skin). You will need to use it for 4 months to see if it will help and avoid UV exposure (tanning booth). If this does not help and a year has passed, the scars could be revised but I would forewarn you that the same thing may happen since this is more related to how you heal as opposed to the surgery. If your scar  "blanches" on compression, this is indicative that it is more related to the normal process of inflammation that usually resolves by a year. If this type of situation persists,  then IPL (Intense Pulsed Light) therapy or the use of a pulsed dye laser could help.

Scott R. Brundage, M.D.

Grand Rapids Plastic Surgeon

How Many Cosmetic Procedures Can Be Done at One Time? What Are Things That Affect General Anesthesia?

I'm planning on undergoing a rhinoplasty, otoplasty and two mole removals (most likely via incision), is it safe to do all these under the same general anesthesia. I have a slight fear of going under general anesthesia, due to the hundreds of horror stories that I have come across. This includes patients waking up mid-way through surgery and being unable to speak but hear and feel everything that is going on. I am just wondering what kind of things need to be disclosed and affect general anesthesia i.e Anti-depressants, whether you smoke, herbal supplements?

Thank-you for your question as this is something that comes up often in consultations. Many patients consider having more than one procedure done at a time to limit the time they will need help at home or limit the amount of time they take off from work. The number of procedures that can be performed together is determined by the extent of the procedures, the patient's medical and physical condition and the time spent under anesthesia. Procedures with greater areas of dissection and thus possible fluid or blood loss will stress someone with a compromised physical condition and may be dangerous. General anesthesia lasting longer than 5-6 hours has been shown to greatly increase the risk of infection, blood clots in the lower legs, and patient temperature changes.

The rule in our  accredited surgery center is that surgical procedures performed under general anesthesia must be completed in under 5-6 hours, and each patient's medical condition is assessed carefully, often with input by the patient's doctor and/or our anesthesiologists. 

Douglas Leppink, M.D.

Grand Rapids Plastic Surgeon