One of the most common questions we get is what breast implant size is needed to achieve a certain cup size. Real Self, the website where people can ask questions of plastic surgeons, has a question on that almost daily. The problem is, there is no simple answer because the cup size system of bra sizing is just not very scientific. It's an indirect measurement of the breasts, inherited from more modest times. The modern bra dates to about 1914, though the oroginal design was intended to flatten the breasts as the "flapper" style was in. The inventor of the bra, Mary Phelps Jacob, sold the idea to the Warner Bros. Corset Company for $1500. In the 1930's, when a more voluptuous figure was in fashion, Warner Brothers introduced the familiar A-D cup system. They reportedly made millions on their original investment.
Breast implants, now the most popular cosmetic surgical procedure, come in a variety of dimensions and sizes, but cup size is a combination of chest size, breast size, and shape. For that reason, there is no single implant size that correlates to a given cup size. I always recommend that the desired cup size should be a starting point, and so we have patients use a bra of that size and try samples tucked into the bra. In the end it's best to pick what just looks right.
Monday, August 31, 2009
Tuesday, August 25, 2009
skin tightening with liposuction
We all know that liposuction is for recontouring areas of localized fat that doesn't respond to diet and exercise, and tummy tucks and the like are needed where the skin is loose (among other things.) But a lot of people fall in between; there isn't enough loose skin to justify a procedure like a tummy tuck which leaves a scar and has a longer recovery, but it isn't elastic enough to snap back after fat removal with lipo either. Helping these patients achive a smoother contour and some skin tightening has been one of the biggest challenges in cosmetic surgery in recent years.
If you believe all the hype from the various marketing claims for laser-assisted lipo (all of those brand names that sound so slick) then you might assume the problem has been licked. I even had a pitch a couple of weeks ago that one of the laser lipo devices could replace tummy tucks! A good deal of skepticism is called for here, but progress is being made. There are some reports proving that using the laser will tighten skin more than happens with lipo alone.
About time I say, because two years ago I proved that you can do this with immediate post-lipo Thermage. I will have the opportunity to present it at the Hot Topics" session at the American Society of Plastic Surgeons meeting in October. But the bottom line here is that none of these technologies do enough to replace tummy tucks, though they do have a place. We can expect all of them to continue to improve. The important thing is to be able to prove the claims and not inflate expectations ahead of what the technology can deliver.
If you believe all the hype from the various marketing claims for laser-assisted lipo (all of those brand names that sound so slick) then you might assume the problem has been licked. I even had a pitch a couple of weeks ago that one of the laser lipo devices could replace tummy tucks! A good deal of skepticism is called for here, but progress is being made. There are some reports proving that using the laser will tighten skin more than happens with lipo alone.
About time I say, because two years ago I proved that you can do this with immediate post-lipo Thermage. I will have the opportunity to present it at the Hot Topics" session at the American Society of Plastic Surgeons meeting in October. But the bottom line here is that none of these technologies do enough to replace tummy tucks, though they do have a place. We can expect all of them to continue to improve. The important thing is to be able to prove the claims and not inflate expectations ahead of what the technology can deliver.
Monday, August 17, 2009
Where does innovation come from?
I just finished reading a book called Art and Physics (yes I am that nerdy) the premise of which is that major developments in modern art have anticipated breakthroughs in physics. It is a bit of a far-fetched idea, but the author (a surgeon) makes a good case. Ultimately it comes down to integration of right brain thinking (spatial, artistic, intuitive) with left brain thinking (logical, mathematical). Albert Einstein recognized that his breakthroughs arrived through the door on the right side of the brain when he said "Invention is not the product of logical thought, even though the product is tied to a logical structure."
I finished the book on a flight back from a meeting with the people at Lifecell, the company that makes a graft material called Alloderm (and a new one called Strattice.) I started using Alloderm about 10 years ago for certain problems that are associated with breast implants, such as rippling and malposition. It turned out to be very successful and so I published the techniques. A lot of very smart people started working with the idea, and now it is becoming a standard technique with breast reconstruction. It turns out that Alloderm is regenerative tissue, meaning that it actually replaces missing tissue. The field of regenerative medicine is in its infancy but the potential is extremely exciting.
The original idea was not a logical one, but one that arrived by seeing the problem globally. It was a right brain thing.
I finished the book on a flight back from a meeting with the people at Lifecell, the company that makes a graft material called Alloderm (and a new one called Strattice.) I started using Alloderm about 10 years ago for certain problems that are associated with breast implants, such as rippling and malposition. It turned out to be very successful and so I published the techniques. A lot of very smart people started working with the idea, and now it is becoming a standard technique with breast reconstruction. It turns out that Alloderm is regenerative tissue, meaning that it actually replaces missing tissue. The field of regenerative medicine is in its infancy but the potential is extremely exciting.
The original idea was not a logical one, but one that arrived by seeing the problem globally. It was a right brain thing.
Tuesday, August 11, 2009
Julia Child's anti-aging strategy
The success of the new movie "Julia and Julia" has gotten me thinking about putting up my own certificate from the Cordon Bleu cooking school in Paris, where Julia Child trained. It's true! Even though it was only one day, they still give you a certificate. It would look good on the wall with all of my other certificates (I wonder if anyone would notice).
Seriously though, the good news about the movie is that it has rekindled an interest in cooking, and a healthy way of living that Julia Child personified. The trend in recent years has been more toward fast food, processed almost beyond recognition and certainly beyond any real nutritional value. It's hard to believe that only recently margarine loaded with trans-fats was offerred as a healthier alternative to butter. We need to get back to what author Michael Pollan calls "real food"--things your grandmother would recognize. Anti-aging is of course more than Botox, skin creams, and a few nips and tucks (though they have their place); it's about whole foods in the diet. This includes fruits and/or vegetables with every meal, whole grains, that sort of thing. It just isn't that complicated. The hard part is finding foods not laced with high-fructose corn syrup and the like. Here's a simple rule: if it has artificial coloring added, then that means the good nutrients were removed and so it's probably not something to waste calories on.
Seriously though, the good news about the movie is that it has rekindled an interest in cooking, and a healthy way of living that Julia Child personified. The trend in recent years has been more toward fast food, processed almost beyond recognition and certainly beyond any real nutritional value. It's hard to believe that only recently margarine loaded with trans-fats was offerred as a healthier alternative to butter. We need to get back to what author Michael Pollan calls "real food"--things your grandmother would recognize. Anti-aging is of course more than Botox, skin creams, and a few nips and tucks (though they have their place); it's about whole foods in the diet. This includes fruits and/or vegetables with every meal, whole grains, that sort of thing. It just isn't that complicated. The hard part is finding foods not laced with high-fructose corn syrup and the like. Here's a simple rule: if it has artificial coloring added, then that means the good nutrients were removed and so it's probably not something to waste calories on.
Monday, August 3, 2009
Shedding some light on tanning beds and skin cancer
Think it’s a good idea to hit the tanning salon for some color before your vacation? Think again. A new report from the World Health Organization found that the ultraviolet-A (UVA) light in tanning beds, initially thought to be safe as compared to UVB, increases the risk of skin cancer markedly. An analysis of 20 separate studies concluded that the use of tanning beds before the age of 30 was found to increase the risk of skin cancer by 75%. Tanning beds are now considered to be a class I carcinogen, meaning that they move up from a “likely cause” to a “definite cause” of skin cancer.
This shouldn’t have caught anyone by surprise, as it has been known for some time that UVA is associated with premature aging of the skin, and cancer is one of the manifestations of the damage that occurs to skin cells from ultraviolet radiation. My suggestion is to use the spray tans if you must have some color, and get your natural sunlight exposure in the morning or late afternoon.
This shouldn’t have caught anyone by surprise, as it has been known for some time that UVA is associated with premature aging of the skin, and cancer is one of the manifestations of the damage that occurs to skin cells from ultraviolet radiation. My suggestion is to use the spray tans if you must have some color, and get your natural sunlight exposure in the morning or late afternoon.
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