Ask Dr. K: How Do I Avoid Scarring After Surgery?

My patients are typically very concerned about the amount of scarring that may occur after a procedure, if they have never had one done with me before. As a double-board certified surgeon and with my expertise and post-surgical care regimens combined, we can drastically minimize scarring.

Pre Surgery Planning:

– I design incisions so that the incision mark is less conspicuous.–

– I make sure the incision is closed in multiple layers with the tension being placed on the deeper, stronger layers creating less tension on the skin itself allowing the skin to heal optimally.

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Once the scars are healed, various methods can be used to diminish their appearance. Here are some suggestions I have for scar prevention, management and maintenance:

– Use steri-strip tape on the scar for the first weeks during initial healing.

– After a couple weeks of healing, and your stitches are out, use lift md silicone patches to smoothen, lighten and reduce the scar tissue. The most common and seemingly most effective anti- scarring method is Self-Adhesive Silicon Sheeting . These are small silicone- covered patches that adhere to the skin over and around the scar site. –

– The use of Pre/ Post Surgery Vitamins can play a critical role in preparing your body for surgery, minimize swelling & bruising, and for optimal healing.

– Laser treatments can be used to resurface the area, which decreases and softens scar tissue.

– The use of special creams, lotions or ointments that contain onion extract (Mederma), Retin-A, topical vitamins E and C, Emu Oil and Glycolic Acids as their active ingredients. Although many people use these products, their effectiveness is still unproven.

-If there is still prominent scaring after all these steps, we can inject it with Kenalog.

Rarely, people with prominent keloid scars may decide to undergo radiation therapy. There are no side effects to this and address only cosmetic issues.

– The use of medical tattooing, needles to inject pigment to camouflage and can help reduce the appearance of your scar.

– A viable option is scar revision surgery if prominent scars persist despite conservative topical treatments. This option should be discussed with your surgeon.

What I  to look for before surgery to avoid scarring:

–  Who is more susceptible to scars (darker skin tends to keloid and certain ethnicities may scar more easily) and educate the patient.

– Schedule regular follow ups after surgery to be ready to intervene in case the scarring becomes prominent.

If I have not answered your question, please feel free to let me know, I am here to help.

Lift MD Aesthetics®

436 N. Bedford Dr. Suite 301 Beverly Hills, Ca 90210

310-285-0400

http://www.liftmd.com

Ask Dr. K: The Truths and Myths of Anesthesia

Dear Patients and Friends, 

One of the most important topics I discuss during a consultation is anesthesia. Many misunderstandings exist and I want clear up the truths and myths about the use of anesthesia.

What is anesthesia?

Anesthesia controls pain during surgery. To keep you comfortable and relaxed, medicines are used. Along with anesthesia, close monitoring is used to control breathing, blood pressure, blood flow, and heart rate and rhythm.

What are the different types of anesthesia?

Local anesthesia numbs a small part of the body. You get an injection of the anesthetic directly into the surgical area to block pain. Local anesthesia is used only for minor procedures. Regional anesthesia blocks pain to a larger part of your body. Anesthetic is injected around major nerves or the spinal cord. Major types of regional anesthesia include:

  • Peripheral nerve blocks: An injection of anesthetic near a specific nerve or group of nerves. It blocks pain in the part of the body supplied by the nerve. Nerve blocks are most often used for procedures on the hands, arms, feet, legs or face.
  • Epidural and spinal anesthesia: An injection of anesthetic near the spinal cord and the nerves that connect to it. It blocks pain for an entire region of the body, such as the belly, hips or legs.
  • General anesthesia: Affects the brain as well as the entire body. You may receive it through a vein (intravenously, or IV), or you may breathe it in. With general anesthesia, you do not feel pain during the surgery. It causes you to forget the surgery and the time right after it.

There are several benefits to have anesthesia with regards to cosmetic surgery:

o   With facial or body surgery, anesthesia relaxes, relieves pain and keeps the patient comfortable and still during surgery. Any movements could potentially harm the patient and complicate the surgery, such as contamination of the sterile field or nerve injury.

o   With liposuction, fat is removed more effectively using general anesthesia rather than local technique. Less of the local numbing agent (tumescent) is required resulting in more fat removed. Under general anesthesia, the end result is a more precise contour, and a pleased patient.

o   I perform very few procedures with a paralyzing agent and when I do, it is a very small amount. The paralyzing agent is given for a short duration of the surgery when muscle relaxation is important, such as breast augmentation or tummy tuck.

What determines the type of anesthesia used?

The type of anesthesia used depends on several things:

  • The reason for your surgery and the type of surgery.
  • Your past and current health.
  • The doctor will consider other surgeries you have had and any health problems you may have such as heart disease, lung disease, or diabetes.
  • The results of tests, such as blood tests or an electrocardiogram (EKG).

I am happy to answer any more questions on this topic, or if you would like to talk to me about my anesthesiologists, or meet with them to discuss any further curiosities or concerns, we are happy to accommodate that.

Sincerely,

Dr. K

 

436 N. Bedford Dr. Suite 301 Beverly Hills, Ca 90210

310-285-0400

http://www.liftmd.com

Ask Dr. K: How Do I Know if I Need My Implants Replaced?

Lisa asks, “Dr. K, I have been hearing about ‘explants’ lately? What are explants? How do I know if I need to get my implants removed or replaced?”

Lisa is right, there has been a lot of mention of removing implants lately. Many other of my patients have asked me the same thing so I felt this would be a great question for Ask Dr. K.
An explant is essentially the opposite of implant, in other words, it is the removal of implants. This had been a hot topic lately as reports are being produced stating that implants must be removed for various reason. Let’s set the record straight. I am going to tell you why and when you would need your implants  removed or replaced of at all.
There are 3 main reasons why breast implants would need to be removed.
1) Change of size and shape.
2) Implant leakage or rupture.
3) Capsular contracture.
What is Capsular Contracture?
Capsular Contracture is essentially the hardening of implants which occurs in about 5% of women. Most women experience symptoms about 3 months after the surgery. Several factors may put you at risk.
– Autoimmune disorders
– Smoking
– Radiation Therapy
– Severe trauma to the breast
– Seroma (a collection of fluid under the breast)
– Hematoma
– Bacterial infections
– Silicon modules leaking into the pocket of the surrounding implant.
– Breast implant placement. You may be more likely to develop Capsular Contracture when the implant is placed over your chest muscle (sub-glandular).
Detecting Capsular Contracture.
Warning signs include deformed, misshaped, and painful breasts or breasts that have become harder than when they were put in. There are four levels of Capsular Contracture.
Grade 1: The breast is soft and looks natural.
Grade 2: The breast is slightly firm but looks natural.
Grade 3: The breast is firm and looks abnormal.
Grade 4: The breast is hard, painful and looks abnormal.
Removal or revision of implants, however is not the only treatment for Capsular Contracture. New technologies are being utilized to treat this. See your doctor for remedies and procedures they offer to correct this.
Here are a a few ways to decrease your risk if Capsular Contracture of you feel you may be at risk, however there is no way to predict so be sure to consult your doctor.
– Take a prescription corticosterois drug called Prednisone for two weeks.
– Massage your implants the day after surgery.
– Perform compression exercises in which you squeeze the implant with medium pressure to keep the capsule flexible and loose.
In Summary, there is low chance that you will need your implants removed or replaced. However, if you are experiencing any of the above characteristics or would like to consult a professional to be sure, do so immediately.

436 N. Bedford Dr. Suite 301 Beverly Hills, Ca 90210

310-285-0400

http://www.liftmd.com

Ask Dr. K: What is ALCL?

I have been flooded this week with questions from patients and friends concerning the warning to women at risk of Anaplastic Large Cell Lymphoma (ALCL) from breast implants. On January 26, 2011 the FDA released a safety signal on ALCL in women with breast implants. Although the number of patients who have developed the disease is extremely small, only 34 identified cases out of an estimated 5 to 10 million women with breast implants, I feel it is necessary to to review the recommendations presented by the FDA.

But first, what is ALCL?

1) ALCL is a late onset seroma or fluid collection around the implant, and is very rare and noticeable.

2) The American Society of Plastic Surgeons and the Food and Drug Administration are working together to study those rare cases.

3) Breast implants are the most studied implant in the body and it remains to be seen if there is a connection between the two.

Click HERE for a full report.

If you have breast implants, the FDA urges that there is no need to change your routine medical care and follow up. ALCL is very rare and has only occurred in a very small amount of the millions of women with breast implants. However, the following standard medical recommendations include:

– Monitor your  breast implants. If you notice any changes, contact your health care provider immediately to schedule an appointment.

– Get your routine mammography screening.

– If you have silicone-gel filled implants, see a specialist for periodic MRI’s to detect ruptures as recommended by your health care provider. The FDA-approved product labeling for these said implants states that the first MRI should occur three years after implant surgery, and every two years after that.

– Patients with persistent fluid around their breast implants will have to be tested for ALCL in the future.

If you have more questions or concerns about your breast implants, or feel that you may be at risk, contact your doctor immediately.

436 N. Bedford Dr. Suite 301 Beverly Hills, Ca 90210

310-285-0400

http://www.liftmd.com