Columbia Plastic Surgeons

Local Anesthetic w/Oral Sedation - Safe for Upper Eyelid and Lower Facelift Surgery?

Am 55 with skin in very good condition. But have drooping upper lids and banding in neck. To have a lower face lift/platysmaplasty and upper eyelid surgery, doctor has offered me either the option of IV sedation with board certified anes. or was also told I was a candidate for just local with oral sedation, which will save me a substantial amount of money. Is there any reason not to do it this way? Is one form of anesthesia riskier than the other?

I have made a 180 on this issue and now reserve general ( including IV anesthesia) for more difficult patients and procedures, ie laser. It has been the proliferation of injectables that has shown the surgeons and the patients how much can be acomplished with a motivated patient.  I view the safety issue to be the reverse. Even iv sedation carries a higher risk. The primary reason I was slow to change is the worst one most of us use          " because we always have done it this way". Granted the patient must understand their part of increased tolorance just as when receiving Botox or fillers. Cost savings is just an coincidental benefit. As for your surgeon I would go with their advice as to the method they are most comfortable.

J. Smythe Rich, MD

Columbia Plastic Surgeon

Plication with Full Tummy Tuck

I am scheduled for a a TT with flank lipo in April. I am 32 years old. I have lost a total of 60 lbs, and have kept it off since June of 2007. I am 5ft 7" and weigh 165. I see where others have posted that they know how many inches, etc. their abdominal muscles have seperated. I have never been pregnant. Is there a chance that my muscles will not need tightened (stitched) or can being overweight seperate them just as much? Thank you in advance for your professional opinion.

The terms tummy tuck, abdominoplasty, and plication can be misleading. In general the changes to the female abdominal wall from significant weight loss (obtained by diet and exercise) can be similar to those changes subsequent to child bearing +/- significant weight loss. A rectus diastasis ( separation of  the rectus abdominis muscles, usually because of thinned or stretched fascia) is not the only indication for a plication. At times it is helpful to contour and strengthen the abdominal wall after massive weight loss (MWL) in the absence of a significant rectus diastasis, but where stretched or weakened fascia is encountered that envelopes the muscles. Be sure to review with your surgeon what his preoperative plan is and how that might change given what he finds at surgery. 

Richard J. Wassermann, MD, MPH

Columbia Plastic Surgeon

How Long After Donut Lift w/ Implants Do I Need to Wait to Do Revision?

I had a donut lift with implants. I am unhappy with my results. I didn't want implants to begin with but my doc informed me i would have a man's chest if i went with lift alone. I wanted a lollipop lift but he said i wouldn't like the scars. It has been 25 days (3 weeks) since my surgery and Im still not liking them any better. My doc says to give it time. I think they are too big and dont look natural. How long will I have to wait before i can have them taken out and possibly a lollipop lift?

From the photographs and clinical information you submitted, it appears that the third photograph in the sequence is not from the same patient. The first two images correspond to the history.  In general, 3 weeks is too early to consider any sort of revision unless you are attempting to treat a complication such as a delayed hematoma. It sounds like you discussed many options with your surgeon prior to the surgery. At this point, before reconsidering those decisions, I would suggest  allowing at a minimum 3 months, but preferably  6 to 9 months,  for the healing process to mature and the final result evolve. Then you would have much better information on which to base a decision regarding any possible secondary surgery. I hope this is helpful. 

Richard J. Wassermann, MD, MPH

Columbia Plastic Surgeon