Dr. Goldstein's Plastic Surgery Blog

What Every Face Needs

2009-05-29T09:42:00.000-07:00

Short of surgery which physically puts our anatomy back where it should be, the aging process should also be treated in terms of skin. We need moisturizers, cleansers, and sun screen on a daily basis; but once in a while we can augment our looks with laser treatments which smooth out our texture , botox treatments which smooth out our frown, laugh lines, and fillers which lessen the deep folds. A unique combination of these procedures helps our face look as young and vital as possible.

Pain Perception

2009-01-22T14:38:00.000-08:00

Pain is both real and perceived. Everyone's response is based on biophysics and emotion. Emotion can of course play a big or small role depending on our psychological state of mind. Nonetheless the majority of our pain is based on very real biophysical and biochemical events. To simplify this event lets pretend that out nerve endings that carry pain sensation to the brain are a gate. Some gates are very easy to swing open with just a light touch or push , and others require pushing with both hands to swing open. Our nerves (gates) vary from person to person; and so nerves require much (gate pushing) or very little (gate touching) stimulation to create the sensation of pain. This is known as the Gate Theory of Pain and explains the differences in reaction to the same pain stimulus from person to person. It is an over simplification to label people as "wimps" or "stoics" and also, many times, unfair.

Laser Treatment of Skin Texture

2008-12-26T12:46:00.000-08:00

The best way to summarize the aging of the skin is to state that our skin texture worsens. Everyone wishes to improve the texture of their skin which includes fine wrinkles, scars, tone and the roughness that appears with time. The texture of our skin can start changing early; it can begin even in our thirties. Now with the advent of the fractional laser the skin can be improved upon in little to no downtime. The fractional component of the laser uses microbeams to treat pinpoint areas of the skin. Instead of treating 100% of the skin surface area, only a fraction (6,8,10%) of the total skin receives a deep laser ablation, allowing for the surrounding non-ablated tissue to "cool down" the area. This technique provides little to no pain during the treatment. The healing process is also quick and the downtime is short. The process works because the treatment stimulates new collagen which plumps up the skin and smooths the texture. This laser can be used on the face, neck, chest and hands. No special preparation is needed other than clean skin that has a numbing cream applied. The procedure takes about half an hour depending on the size of the area. A person may need 1-4 treatments spaced 2-4,6 weeks apart. These treatments can be combined with other laser treatments at the same sitting. People experience mild redness that is treated with moisturizers. Healing occurs in 1-3 days. Most patients can wear make-up in 1-2 days. The laser treatment can be specifically tailored to a person's downtime schedule. If you are looking for smoother, younger skin and rejuvenation then you may be an ideal candidate for this laser.

Laser Treatment of Sun Damaged Skin

2008-12-11T08:24:00.000-08:00

There is a new treatment available in the continued effort to rejuvenate skin. Broadband light is a new innovative technology that can be used to treat sun damaged skin with resultant age spots (brown in color) and red spots of the face, arms, neck and chest. Using the appropriate wavelength filter a wide range of skin conditions can effectively treated. The photothermal energy is directed on vessels that cause redness and on excessive melanin that causes the brown spots. The treatment is tailored to each individual and may require 2-5 sessions to achieve the desired result. The procedure is non-invasive enough so that there is minimal redness and some darkening that resolves in 1-3 days. There is minimal to no discomfort during the treatment and post procedure care involves only the use of a moisturizer and sun screen(which everyone should use anyways). This rejuvenation process is also easily affordable.

Post-Op Domino Effect

2008-11-18T20:07:00.000-08:00

People always wonder why areas of injury or surgery hurt more so many hours after activity has stopped or when they are just plain resting at night and not moving at all. The reason for this all too true phenomenon is the fact that the site of surgery has extra vessels (to provide the cells that will clean up the debris and provide the components of healing) as well as swelling (as a normal response to injury/surgery) in the tissues. As the activity level increases so does the flow of blood which increases swelling even more. Pain is directly proportional to swelling which proportional to activity. Each follows the other with a lag time of 2-4 hours, which explains why most of our pain occurs in the evening while we are resting. We pay for the sins we commit by day, at night.

Not Fade Away

2008-11-10T18:32:00.000-08:00

Some words in our English language have taken on a meaning of their own, not reflecting the original intent, but rather a wish for quality that completely changes the communication . Such a word is "fade". As a plastic surgeon, who cares for as well as creates scars, I explain to patients that their wounds re-model and mature over time and the end result is a scar that has transformed itself from a red, raised, hard appearance to a normal color, flat and soft presentation. This process in effect "fades" the scar, making it less visible, but certainly does not make the scar disappear! The scar is always present but less visible and therefore more acceptable." Fade" does not mean "gone".

The Tom Brady Debacle

2008-10-25T12:51:00.000-07:00

Apparently a great deal of space, ink and blame has been devoted by the media on Tom Brady's knee surgery and resultant complications. The fault finding is aimed at physicians that did their best to help another person. Their well meaning intentions as well as expertise unfortunately did not produce the expected result. This is due to a well known complication: infection, which can occur in any operation under the best of circumstances and under the best of hands. What strikes me as peculiar is that the same type of publicity and public outrage has not been present in response to the unethical, self-serving, selfish behavior of banks, mortgage companies, and investing firms that have brought us to this present economic state. Their primary goals are not to help another person, but rather to help themselves... to our hard earned savings. Lets focus our attention on those who purposefully have hurt us.

We are supposed to be Symmetrical, aren't we?

2008-10-20T19:26:00.000-07:00

To the ancient Greeks, and in some schools of art, symmetry is equivalent to beauty. This maxim however does not truly relate to human beings. We are relatively balanced but on closer examination there are many differences from one side of our body to the other. This refers to our feet, hands, arms, legs, as well as trunk and face. Asymmetry exists not only in length, size, color, location but also in function. No where is this more evident than in the face. Our ears do not match, our eyebrows lift and angle differently, even our eyes on careful inspection differ in roundness and aperture. The same applies to our lips, cheeks, jaws, not to mention function, such as talking where there is some preference to purse lips to one side. This is all good, since its the small differences, the asymmetry, that gives us our individual look and makes us interesting. If we were all completely symmetrical we would be as boring as a store shelf of porcelain dolls. Shakespeare, whose sonnets are some of the best poetry of enduring love, described his lady as being the most beautiful because of a slight imperfection in the form of a mole on one cheek. This imperfection made her facial beauty unique and human. Asymmetry is one of the essences of being human.

A Secret of Plastic Surgeons

2008-10-08T19:42:00.000-07:00

I just saw yet another patient with an open wound and instructions to keep the area dry with clean gauze. I will now reveal to you a long kept secret that will probably expel me from the American Society of Plastic Surgeons. Just Joking. We, as plastic surgeons, have always viewed ourselves as teachers not just technicians, and therefore have been trying to teach our colleagues in other branches of surgery and medicine our experience with healing. We are the ones that are called upon to close wounds that no other service can heal. We arrive and miraculously patients' wounds heal within days. The secret...... none really, just common sense. The internal environment of our body (that is anything below the level of the superficial skin) is moist! Therefore, when trying to heal an open wound keeping the environment moist will provide the normal biologic rapid cascade that leads to contraction and epithelialization better known as a healed wound. Wounds that are kept dry only form a biologic crust that was once live tissue. A layer of live tissue is necrozed (killed) every time an open wound is allowed to dry. Healing is inhibited by a scab of dead tissue that is a wonderful breeding- ground for bacteria. Wounds that are kept moist will practically heal themselves if allowed. So next time a friend gets hurt on vacation..... cleanse the wound with soap and water, apply ointment liberally as often as necessary to moisturize and you too will be hailed as a hero. Psst.. don't tell anyone!

Impusle buy

2008-09-27T12:28:00.000-07:00

I have experienced many occasions where potential patients book surgery on their very first visit with me. While I feel slightly flattered by this event, I feel that a time out is usually worthwhile in order to digest the consultation and brochure information. Almost invariably booking surgery on the initial visit results in postponement or cancellation when the person has had time to take many other factors into consideration such as events, people and other obligations as well as the procedure(s). Impulse buying in other situations has fewer consequences (such as unworn shoes in the closet) but aesthetics are more permanent and require more resolve.

Who is a "Cosmetic Surgeon"?

2008-08-06T03:48:00.000-07:00

Once again another example of bad and unsafe cosmetic surgery presented itself in my office. We, as real plastic surgeons, are asked to "fix" other people's mistakes and, as is the usual case, the patient and plastic surgeon are "behind the eight ball". Results and life would be better if people were educated to seek consultation with a BOARD CERTIFIED PLASTIC SURGEON. This means a surgeon who has specifically trained in plastic surgery programs and has been tested (written and oral exams with presentation of their surgeries) and certified by the AMERICAN BOARD OF PLASTIC SURGERY. This is the only board recognized by the THE NATIONAL BOARD OF MEDICAL SPECIALISTS. Since the "cosmetic surgeon" scene is so confusing for the lay person, I recommend that the only question to ask that will get to the heart of the matter is: Is the surgeon certified by the AMERICAN BOARD OF PLASTIC SURGERY? This is a serious case of public safety not a matter of competition between equally qualified specialists, because they, in reality, are not on par.

Liposuction "Urban legend"

2008-07-16T16:44:00.001-07:00

I have to interrupt my discussion of different laser treatments in order to address a horrible grievance against liposuction. It was made apparent to me that liposuction (liposculture, etc) is "the most dangerous cosmetic procedure" because of several horror stories that have been reported by the media. I agree that liposuction can be very dangerous, but only when used by the wrong hands. People with some minimal surgical training will look at liposuction superficially and think it is an easy procedure. They take weekend courses and start operating on unsuspecting patients. Unless they have had proper and extensive anatomical and surgical experience, these untrained non-board certified money-hungry charlatans will kill you when blindly probing their cannula's through existing hernias, abdomens, diaphragms and lungs because of poor knowledge and even poorer or no pre-op exams. These type of mishaps would not happen if only appropriately trained and certified plastic surgeons were allowed to perform these procedures. Then people would realize the benefits and excellent outcomes from well thought out surgeries.

SkinTyte

2008-06-11T17:36:00.000-07:00

New technology from Sciton makes skin tightening possible. Of course it does not take the place of a face, neck lift or a tummy tuck but it does work for early loose skin. The treatment is derived from thermolysis which heats up the dermal skin while cooling the surface. This provides comfort and safety to the patient. There is no downtime. A series of 2-3 treatments is typical, usually a month apart. It can be combined with other procedures. Full results often require up to 4 months so that collagen can build up and strengthen the skin. Areas that can be treated are face, neck, abdomen, and even arms. No specific after care is needed. You should always use sunscreen though. This is a nice technique if you are not quite ready for more extensive work.

MicroLaser Peel

2008-05-18T15:58:00.000-07:00

The first of many treatments with laser that are available is the microlaser peel. This is perfect for people who are too busy for any significant "downtime". This is an intra-epidermal laser peel or as I rather like to call it: "resurfacing". The laser precisely ablates (removes) a portion of the epidermal skin (outer layer) to smooth out the surface. It is performed with just a topical anesthetic and requires only a normal office visit. The downtime can be predicted by the depth of the peel. Redness lasts usually only 1-2 days. Repeat treatments help deepen the resurfacing process for a smoother, healthier and youthful skin. This treatment is available in the Madison,CT and Providence,RI offices.

Laser Advancements

2008-04-03T19:18:00.000-07:00

I am happy to announce that there are lasers out there that really work with minimal downtime. There are also non-ablative techniques that, of course, have little to no downtime but actually are effective. I personally have had a ten year experience with one company's laser and feel that it has provided good results that were consistently reliable. The number one concern, as always, is safety which this laser has built its reputation on. I therefore recently acquired a new version of the laser which has allowed me to resurface skin more effectively, quickly, painlessly, safely and with little downtime. The laser also has a non-ablative feature in the form of BBL (broad band light) treatment of brown and red spots, hair, acute acne, superficial vessels, and loose skin. There is virtually no downtime with this new advent. I will discuss each treatment modality in the coming blogs and in the procedure portion of this web site.

Mommy Makeover

2008-03-15T14:26:00.000-07:00

A popular new combination of surgeries has hit the late 30's to 50's crowd. Women finished having babies are looking in the mirror and noticing saggy breasts and abdomen. These are areas that naturally age and with the added physical stress of pregnancy can look in need of some rejuvenation to help with uplifting the spirit as well as the body. Breast augmentation and/or lift can now be combined with tummy tucks in most otherwise healthy individuals safely. The combined surgery is performed in 4-6 hrs with an overnight stay. The process saves money as well as takes off years of wear. For more details check with your favorite board certified plastic surgeon.

Medical Clearance for Elective Surgery

2008-03-02T15:27:00.000-08:00

There is a reason why medical histories and exams are obtained at good plastic surgery offices. This is appropriate medical practice where people with significant medical problems are identified and treated and/or prepared so that medical surprises (read... medical emergencies) are avoided as much as possible. Pre-operative blood work and EKGs also help identify potential problems or even prevent serious complications. Recent well-publicized "plastic surgery " related disasters involving high profile people should make every person appreciate the concern and care in their pre-operative evaluation offered by real plastic surgeons.

Planning

2008-02-04T12:10:00.000-08:00

I often come across (happened again today) patients seeing me for the first time and expecting their procedures booked within a limited time period. The usual outcry would go something like this: "I can only do it in the next three weeks, otherwise it will have to wait a year." Well....... why not plan the visit to my office a little more ahead so that self imposed deadlines are not an issue! Good aesthetic procedures cannot be sandwiched. They require planning for good results and patient safety.

Individuality

2008-01-27T09:36:00.000-08:00

Many potential patients compare possible results to other people's outcomes. Unfortunately that is not always the best method to decide on procedures. As an example I have many women wishing to have the same "cup size" as their friend. That will only happen if the two people are exactly the same chest circumference with the same shape, trunk length, body length, weight and tissue firmness. Its best to look inside you to see what you would like to see on the outside. All you need is a mirror.

Urban Legend

2008-01-12T09:49:00.000-08:00

Just a quick note in regard to a vicious rumor that has been spread as truth by lay and medical people alike. There is the mistaken perception that breast implants have to be exchanged after 10 years. Nothing can be further from the truth. If there is nothing wrong with the implants they never have to be touched. 80% of patients never need more surgery after their first procedure. This is one urban legend that serves no worthwhile purpose.

Happy New Year

2008-01-03T16:36:00.000-08:00

Time for resolutions that we would like to fulfill but down deep in our hearts we know we will not. One of the main reasons for this is that we have unreasonable expectations and the first hint of slow or no progress sends us scurrying for a distraction that will make us push aside or, better yet, forget our initial objective. Maybe a realistic goal with the knowledge that results take an unknown amount of time would be more successful. Nothing happens overnight and if someone promises you just that, be very suspect that the only quick event will be the loss of your hard earned money. Plan carefully and you will be more successful and happy.

Liposuction As Incentive

2007-12-25T09:22:00.000-08:00

Liposuction in the best of all possible worlds works best on people who are at or near their ideal weight since it improves contours of the body. Nonetheless I have seen liposuction help people who are visibly overweight as long as it serves as an incentive for weight loss. The person has to be honest with him/herself as to the reality of their determination to lose weight versus fooling themselves. Some people are able to successfully hold the surgery out as a carrot after they lose weight, and others undergo the procedure first no matter how small the improvement as an incentive to go on an exercise and diet program. Either way these approaches work for some people.

Patient Safety and the Media

2007-11-24T09:08:00.000-08:00

I knew as soon as the media explosion of Dr. Jan Adams and Kanye West's mother took place that I would be inundated with phone calls from worried prospective patients. It is very difficult for the lay public to decipher the truth about professionals' credentials especially when the media itself does not care enough to find out important details such as training and true certification. The general feeling is that certification among surgeons is just a "turf battle" between equally qualified professionals. Nothing could be further from the truth. The word "plastic" should be reserved for use by people trained in the field of plastic surgery. It should not be used as a general term describing everybody who wishes to be called a plastic surgeon. The media is to blame for helping propagate the misconception that everybody is a plastic surgeon. This is not so, and IT IS A MATTER OF PUBLIC SAFETY.

Truth in Advertising

2007-11-13T10:09:00.000-08:00

Once again I have recently run into patients seeking more cosmetic and/or corrective cosmetic surgery after having these procedures performed by ENT, Dermatology, Oral Surgery and Ophthamology physicians. Every patient was surprised to learn that their surgeon was not a board certified plastic surgeon. They were board certified alright! Certified in their own field of endeavor. When physicians advertise themselves as cosmetic surgeons they should be truthful about their board certification. It continues to be a matter of patient safety as well as patient satisfaction.

Breast Augmentation III

2007-11-03T12:08:00.001-07:00

There are a variety of incisions for placement of implants. Some make sense, while others are purely a promotion ploy. The oldest incision has been much maligned in favor of newer and therefore presumably more inventive approaches. The axillary incision is good when the scar is good, but some people develope an enlarged scar in this are which becomes very visible in certain clothes. The nipple areola approach is nice at the very beginning, but as the scar matures it becomes lighter in color and in some cases cotracts causing very visible dimpling. The naval incision is at best a long run (and dangerous) for a short slide. I venture to say that this area is very visible in many of today's styles. The infra-mammary (bottom fold) approach allows good visualization for safe surgery, easy access, and excellent scars that are in the fold of the breast. My large following of exotic dancers have this incision and are very satisfied with it. Not all that is old is bad. There are reasons why this classic has withstood the test of time.