A broken nose? Not so!

The well known Beverly Hills board-certified plastic surgeon Stuart Linder, M.D – who blogs as “Dr. Body”– tells about the most common myths that patients ask about. Also commenting is the equally well known Robert Kotler, M.D., a top Beverly Hills board-certified cosmetic plastic surgeon (and a former Dr. 90210 star) who blogs as Dr. Face; he also tells about the myths and beliefs he hears.

Dr. Face is a member of the American Academy of Facial Plastic Surgery and Reconstructive Surgery. Dr. Body holds a membership  in the American Society of Plastic and Reconstructive Surgeons, among many other medical organizations.

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Dr. Face (Dr. Kotler): I don’t know about you but I’ve found a few myths about facial plastic surgery circulating out there. We hear them at the first patient consultation.

Dr. Body (Dr. Linder): Such as?

Dr. Face:  Take rhinoplasty, for instance. The myth seems to be that the nose will be “broken.” Some prospective patients seem to envision the process of correcting any malpositioned nasal bones as crude and barbaric. In reality, the nasal bones are sometimes re-aligned and must first be parted but it’s not as though you take a sledge hammer to the nose. Actually, that realignment is a carefully and delicately controlled repositioning of the nasal bones. In addition, the patient is asleep and we use drugs to control pain and bleeding, if any.

Dr. Body: The most common question like that I get in body surgery is from breast augmentation patients who want to know if it’s really true that breast implants must be replaced every ten years.

Dr. Face: How do you explain it?

Dr. Body: I tell the patient that that any one breast enhancement procedure will probably result in another such operation sometime during the life of the patient. But it’s nothing predictable like when the oil in a car must be changed. And, yes, implants do fail due to wear and tear but I have no way of knowing when that might happen. It might be in 20 months or 20 years. I’ve seen both extremes.

Dr. Face:  After I explain the broken nose myth, I listen carefully to make sure that nose surgery patients understand they will look quite decent by ten days after the operation and very good indeed by two weeks. Some have the misconception they will appear battered and bruised for months, post-op. Nasal surgery super-specialists typically deliver results that look very good only seven days after the procedure.

Dr. Body: I must tell breast enlargement patients one thing they hate to hear.

Dr. Face: The cost of plastic surgery?

Dr. Body: No, that they can’t take a shower for 14 days after getting breast implants. But there is a method to my seeming madness. Water washing into a fresh wound can cause a staph infection which means the entire procedure has to be redone. But patients who take no showers for two weeks after the procedure have an infection rate of 1/10^th of one percent. The usual, common, accepted benchmark is an infection rate of about one percent of patients.

Dr. Face:  Even though nose surgery patients look good after one to two weeks, I have to remind them the nose will be fragile for at least six weeks.

Dr. Body: I almost always put breast implants under the chest muscle so I receive a lot of questions about why that is necessary. (Read more about breast implants placed under the muscle.) Many want to know when they can again exercise and the answer to that is a minimum of three weeks. For tummy tuck patients, it’s more like six to eight weeks.

Dr. Face: Many patients quiz me about training. They often ask about the difference between a general plastic surgeon and facial plastic surgeon.

Dr. Body: What do you say?

Dr. Face: Easy. While a general plastic surgeon performs cosmetic procedures all over the body, the facial plastic surgeon limits his work to the face and neck. Training for that is two years of post-M.D. training in general surgery followed by at least another four years specializing in head and neck surgery and facial plastic surgery. Surgeons who want to be eligible for certification by the American Board of Plastic Surgery must complete a minimum of three years of general surgery and three years of plastic surgery throughout the body. Fellowships, the finishing school of both specialties, can add another one or two years of training.

Dr. Body: Next time, let’s talk about how the media influences the practice of plastic surgery. I know I’ve got some thoughts on it and I’ll bet you do, too.

Dr. Face:  In spades, doctor! In spades!

Plastic surgeon does a breast augmentation

The well known Beverly Hills board-certified plastic surgeon Stuart Linder, M.D – who blogs as “Dr. Body”– tells about the most common questions body patients ask. Also commenting is the equally well known Robert Kotler, M.D., a top Beverly Hills board-certified cosmetic plastic surgeon (and a former Dr. 90210 star) who blogs as Dr. Face and tells the FAQs (frequently asked questions) that facial plastic surgery patients want to know.

Dr. Face is a member of the American Academy of Facial Plastic Surgery and Reconstructive Surgery. Holding a membership, among many others, in the American Society of Plastic and Reconstructive Surgeons is Dr. Body.

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Dr. Face: I don’t know about you but I’ve found a few myths about facial plastic surgery circulating out there. We hear them in the first patient consultation.

Dr. Body: Such as?

Dr. Face:  Take rhinoplasty, for instance. The myth seems to be that the nose will be broken. Some prospective patients seem to envision the process of correcting the nasal bones as crude and barbaric. In reality, the nasal bones are sometimes re-aligned and must first be parted but it’s not like you take a sledge hammer to the nose. Actually, that realignment is a carefully controlled repositioning of the nasal bones. In addition, the patient is asleep and we use drugs to control pain and bleeding, if any.

Dr. Body: The most common question like that I get in body surgery is from breast augmentation patients who want to know if it’s really true that breast implants must be replaced every ten years.

Dr. Face: How do you explain it?

Dr. Body: I tell the patient that that any one breast enhancement procedure will probably result in another such operation sometime during the life of the patient. But it’s nothing predictable like when the oil in a car must be changed. And, yes, implants do fail due to wear and tear but I have no way of knowing when that might happen. It might be in 20 months or 20 years. I’ve seen both extremes.

Dr. Face:  After I explain the broken nose myth, I listen carefully to make sure that nose surgery patients understand they will look quite decent by ten days after the operation and very good indeed by two weeks. Some have the misconception they will appear battered and bruised for months, post-op. Nasal surgery superspecialists typically deliver results that look very good only seven days after the procedure.

Dr. Body: I must tell breast enlargement patients one thing they hate to hear.

Dr. Face: The cost of plastic surgery?

Dr. Body: No, that they can’t take a shower for 14 days after getting breast implants. But there is a method to my seeming madness. Water washing into a fresh wound can cause a staph infection which means the entire procedure has to be redone. But patients who take no showers for two weeks after the procedure have an infection rate of 1/10^th of one percent. The usual, common, accepted benchmark is an infection rate of about one percent.

Dr. Face:  Even though nose surgery patients look good after one to two weeks, I have to remind them the nose will be fragile for at least six weeks.

Dr. Body: I almost always put breast implants under the chest muscle so I receive a lot of questions about why that is necessary. (Read more about breast implants placed under the muscle.) Many want to know when they can again exercise and the answer to that is a minimum of three weeks. For tummy tuck patients, it’s more like six to eight weeks.

Dr. Face: Many patients quiz me about training. They often ask about the difference between a general plastic surgeon and facial plastic surgeon.

Dr. Body: How do you explain it?

Dr. Face: Easy. While a general plastic surgeon performs cosmetic procedures all over the body, the facial plastic surgeon specializes from the neck up. Training for that is two years of post-M.D. training in general surgery followed by at least another four years specializing in head and neck surgery and facial plastic surgery

Dr. Body: Next time, let’s talk about how the media influences the practice of plastic surgery. I know I’ve got some thoughts on it and I’ll bet you do, too.

Dr. Face:  In spades, doctor! In spades!

Infectious agents are always lurking in some corner and watching over a surgeon’s shoulder  for a happy place to land and multiply.

Even in the most experienced of hands that follow all the sterilization guidelines in the cleanest and most sterile of operating rooms, the standard rate for infection everywhere is about one patient per hundred.

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Dr. Face: (Dr. Kotler) Have you been stern lately, doctor?

Dr. Body:  (Dr. Linder) Yes, I had a patient recently to whom I gave an absolutely beautiful breast augmentation that healed nicely. But when she went home, she thought that she – and perhaps others – could see that one breast was a tad larger than the other. And she wanted a redo – she wanted the equivalent of a shot glass worth of silicone (50cc’s) added to the breast implant she perceived as smaller.

Dr. Face:  What did you do?

Dr. Body: I explained the risks that attend any plastic surgery and that such a tiny adjustment was not worth risking a possible infection or other complication and thanks for asking but I could not do the procedure. She went elsewhere, had the surgery, got a terrible infection and had to have one implant removed while that breast healed for six months.

Dr. Face: Plastic surgeons are, by nature, perfectionists but that is a perfect case of what we mean by “reasonable expectations.” Most people, including her significant others, only saw a huge, healthy improvement. But any time the surgeon opens a chest or takes a breast implant out of its sterilized package and exposes it to air, the slight risk of an undesirable complication like infections is present.

Dr. Body: Unfortunately, most rejuvenation surgeons are wont to talk about a negative issue like infection. But the truth is:  infective agents are floating around in the cleanest, most sterile of operating rooms. Also, human skin is alive with all sorts of flora, including bacteria that can get into an open wound. Of course, the surgical area is painted with germ killers but there are super resistant bugs that can survive and start their own colonies.

Dr. Face:  Make that, their own colonies even though every precaution is taken. Implants for the face and body are packed in sterile materials, the implants are soaked in sterile agents after opening and the surgical site of the body or face is irrigated with an antibacterial solution before closing.

Dr. Body: That’s one of the reasons we want to see plastic surgery patients in the morning after the procedure. It’s apparent to us — even before the patients — when an infection is developing so we leap on it as early as possible. Some infections are so powerful, they can digest cartilage. But if the surgical area can go three to six days with no infection, we can be relatively sure we are home free.

Dr. Face: American plastic surgeons and the U.S. medical care system is very concerned about infections and also happens to be very good at tracking down the source.

Dr. Body: I bet you are talking about the case several years ago when the U.S. Centers for Disease Control (CDC) got involved in solving an infection outbreak in New Jersey.

Dr. Face: That’s right. An unusually large number of women were reporting to their doctors with infections in what appeared to be liposuction cases. The CDC interviewed the women and found they all had liposuction in the Dominican Republic at a particular clinic. The source of the infections turned out to be  unsterilized liposuction wands.

Dr. Body: So it’s more important than ever to check your surgeon’s website for information about his or her surgery center. Those facilities marked:

• AAAASF (American Association for Accreditation of Ambulatory Surgical Facilities)
• JACHO, (Joint Commission on Accreditation of Healthcare Organizations)
• AAAHC (Accreditation Association for Ambulatory Health Care)  
• Medicare certified

and will be following all the the standard sterilization procedures known.