Why Butt Augmentations (Brazilian Butt lifts) may not be the best way to go..

I came across an article the other day about the popularity of butt lifts.  Is this just a fad?  When will the fad go away (if ever)?  As a woman in her 50’s, I know that most women my age have always been concerned about having a butt that is too big. Why the “big butt” trends now?

A few months ago I asked my nieces about the “J. Lo butt”—they quickly corrected me and said “that is old school”.  I guess it is the Kim-K butt now.  Super-sized!

Remember your mother saying “if all of your friends jump off a bridge, would you too?” It’s idiotic. Unless you are bungee jumping, it probably isn’t a good idea. The concept of doing something everyone else is doing is actually unappealing and disingenuous to me.

Fat transfer to the buttocks actually works very well and can product great results. Statistics show that there has been a huge leap in the number buttocks augmentation (aka Brazilian butt lifts) in the past several years. What many call the Kim K-effect has women seeking a thicker, perkier butt. But with every trend comes danger– this is the jumping off a bridge part.


I think it is important to perform fat injections to the buttocks with a conservative eye and an awareness that what looks good now many not look good five or ten years from now--when the trend for fuller buttocks might not be "in"

So there you have it. The key to doing something everyone else is doing, is doing it in careful moderation. As I read in the article “That way, when you jump off that theoretical bridge, you land on a cushy tush.”

Which Breast implants are the best for you?

Breast augmentation is one most commonly performed cosmetic surgical procedure in America. If you or someone you know is thinking about breast augmentation, it is essential to answer several questions about which type of breast implants are right for you.

Which implants are FDA approved?

There are three manufactures of breast implants that have FDA approval in the United States: Allergan, Mentor, and Sientra. Although there are other brands of breast implants in other countries, the United States has the largest and strictest regulatory process for FDA approval, and only these three companies can legally sell breast implants in the United States. The largest breast implant available in the US is 800 cc.

Silicone or Saline?

Saline implants are FDA approved for anyone over the age of 18. They have a silicone shell and are filled with salt-water. If they accidentally rupture, your body will easily resorb this fluid and the implant will deflate, giving you a “flat tire”.

The advantages of saline implants are that they can be placed through slightly smaller incisions, they can be used in younger women, and they contain salt-water that your body can resorb. In the event of a deflation, you will know within a day that the implant has ruptured.

The disadvantages of saline implants are that they look and feel slightly less natural than silicone implants. Particularly in thin women, saline implants can sometimes be associated with visible or palpable rippling.

Silicone implants are FDA approved in women over the age of 22. The newest generation of implants is filled with form-stable silicone, sometimes referred to as a “gummy bear” implant.  It has a feel similar to a very fresh gummy bear or gumdrop, and could actually be “sliced” without leaking.

The advantages of silicone implants are that they look and feel extremely natural, even in thin women, particularly when they are placed below the pectoralis major muscle. They move more like regular breasts compared to saline implants.  

The disadvantages of silicone implants are that they require slightly larger incisions for placement, as compared to saline implants. It is also harder to detect implant rupture because the silicone is not absorbed like the saline.  The FDA has advised that women with silicone implants undergo MRI surveillance of their implants 3 years the original surgery, and then every 2 years to monitor the integrity of the implants.

If silicone, what kind?

If you opt to have silicone implants, there are a few further choices you must make. Do you want round implants or "tear-drop" (anatomic) implants? And do you want low, medium, or high profile implants? And what about gummy bear implants?

Round or Tear-Drop?

The most common choice of breast implants are round. The main advantage of round implants is that they have no particular radial orientation, so even if they shift or rotate over time, the result will not be noticeable. Round implants are semi-spherical in shape, which is regarded either as an advantage or a disadvantage, depending on the desired look, as they tend to create more fullness on the upper part of the breasts.

The alternative to round implants is anatomic-shaped, or "tear-drop" shaped, implants. The advantage of tear-drop breast implants is that they resemble the actual physiologic shape of a real human breast, with a gently downsloping upper pole and a fuller lower pole (in other words, like the shape of a tear drop). Women who want a very subtle, natural look are sometimes drawn toward this type of implant. The main disadvantage here is that in situations where rotation of the implant occurs over time, a second surgery may be required to correct the implant position.

High or low profile?

Breast implants come in low-profile, regular-profile, or high-profile types. Profile refers to how high the implant sits above your body, with low-profile implants staying the closest, and high-profile implants sticking out the most. Those who want more prominent cleavage or a fuller look should opt for higher profile implants, while those who prefer a more subtle look should opt for lower profile implants.

Regular silicone or gummy bear breast implants?

Although "gummy bear" or highly cohesive breast implants have received a lot of attention-- some of which undoubtedly comes from their catchy nickname-- standard silicone implants remain more popular overall and in my practice.

Gummy bear implants are made with a highly cohesive form of silicone that is form-stable, meaning that even if the implant ruptures, it will not spill or leak. Women with gummy bear implants report that they feel slightly firmer.

Textured or smooth?

There is no universal opinion among plastic surgeons regarding whether textured or smooth implants are superior. There is some data to suggest that the rate of capsular contracture is lower with textured implants.

What size?

The size of the breast implants you choose is one of the decisions that women think about the most.

Before committing to a particular size, discuss your ideal look with your surgeon, "try on" a variety of implants inside your bra, and listen to your surgeon's advice about what size implants your body will safely accommodate. Many patients bring in photos of breasts that they like, but it is not possible to make one woman’s breasts look like another’s!

It is important to remember that not every breast can accommodate every implant. The best size range for your individual anatomy depends on the base width of your breast, your skin pinch thickness at the top and bottom of your breast, your tissue elasticity, and other factors that may be unique to you.

Lastly

When considering breast augmentation, I advise all women to see a board-certified plastic surgeon with verifiable credentials. Ask questions, read about the procedure in advance, have realistic expectations, and choose long-term quality over seductive advertising or cheap prices.

Dr. Bash doesn’t post before and after photos of her patients on the internet. This is for patient privacy, safety, and just makes good sense.  Do you really want your photos out there “forever”? 

What is a Breast Capsular Contracture?

After breast augmentation surgery, the body forms a protective scar lining around the  breast implants called a “capsule.” The body makes the same scar tissue capsule around any foreign object placed in the body-- a heart pacemaker, an artificial hip joint, or a breast implant. Contracture occurs when the scar tissue capsule shrinks and starts squeezing the implant. Since the implant is soft, any pressure will make it feel more firm.

The typical symptoms of capsular contracture are firmness and sometimes discomfort of the breasts. The capsule may involve one or both breasts. Sometimes one breast will look higher than the other side.

If you are experiencing these symptoms, consult with Dr. Bash to evaluate to determine the best course of treatment. Depending on the severity, Dr. Bash may recommend massage of the breast. However, if the breast has been firm for many months, most likely the only remedy is surgical intervention.


For more information on breast augmentation go to the procedure page.

Learn more about Dr. Bash at www.BashMD.com

Breaking Down Your Fears and Myths of General Anesthesia

All too often I hear my patients say “but I’m afraid of general anesthesia”

“But why?” I ask.

“I’m afraid that I won’t wake up”.

If a person believes everything they see on TV shows and moves, I suppose this fear would be justified. But the reality is that general anesthesia is very safe, and even safer than sedation alone.  When a patient has general anesthesia, they are completely asleep and do not feel any pain. The anesthesiologist is right there, breathing for them, giving them oxygen, watching their heart and making sure they are very, very comfortable.  That way, I can do my job by focusing on just the surgery!

When you have “twilight anesthesia” (which can mean many things), the anesthesiologist is not there. The surgeon asks the nurse in the room to give some medication through the IV to the patient to keep them relaxed but hopefully awake enough to breathe on their own. The surgeon has to monitor the patient and give orders to the nurse while performing the surgery. The patient is not completely asleep and should be able to talk to stimulation. Depending on the procedure that is being done, it may take a significant amount of IV pain medication and sedatives to keep the patient calm and comfortable—in most cases, MORE than what would be needed if the patient were completely asleep.

When surgery is performed with a patient under general anesthesia, there are 2 doctors in the room—the surgeon and the anesthesiologist.  Yes, it may cost a little more, but isn’t that worth it?

All of the surgery I (Dr. Bash) do is with a board certified anesthesiologist. When you are asleep, I am your voice. I don’t want anything bad to happen to you. I am right there beside you from the time you go to sleep until you wake up and we go to the recovery room together.

Reality—the risk of not waking up from anesthesia is very, very, very, very small during cosmetic surgery. Be safe.  Request a board certified anesthesiologist.

If you have any other questions or concerns about general anesthesia call Dr. Bash at 602-792-5789.

Putting Your Best Face Forward

The Arizona hot weather has arrived!! We remember to drink more water in the heat, but it is also a good time to think about taking care of our skin. The most important thing you can do for your skin is to protect it from the sun.  You do not need extra time in the sun to make vitamin D—in fact, your risk of getting a melanoma from sun exposure is much higher than ever having a vitamin D deficiency from lack of sun exposure! Sun block should be applied every 2 hours when outside (that includes when you are in your car—the UVA rays, which cause skin cancer, still penetrate through car windows). Sun block that is in makeup or lotions are not present in high enough concentrations to provide adequate protection.  A separate sun block should be used. SPF 50 or higher is recommended.

Other skin care products can also help with aging skin or protecting against the effects of the environment:

·      General moisturizers that have petroleum based ingredients make a waterproof barrier and will help minimize loss of moisture from the skin.

·      HA products such as TEOXANE add water to the skin and hydrate.

·      Products with glycolic help to gently remove the dead skin cell layers, allowing the other ingredients to more easily penetrate the skin.

·      Plant based ingredients such as chamomile help calm and sooth irritated skin. 

·      Other antioxidants, when used regularly can help the skin repair sun damage and prevent some future damage.

Ask Dr. Bash and her staff for recommendations and TEOXANE specials!
Visit www.bashmd.com for more information

New FDA Warning for Facial Fillers

This weekend the FDA posted a new warning for both the manufactures of facial fillers, and for practitioners who inject the products. New labeling will include the following notice:

Warning: One of the risks with using this product is unintentional injection into a blood vessel. The chances of this happening are very small, but if it does happen, the complication scan be serious, and may be permanent. These complications, which have been reported for facial injections, can include vision abnormalities, blinds, stroke, temporary scabs, or permanent scarring of the skin. If you have changes in your vision, signs of a stroke, (including sudden difficulty speaking, numbness or weakness in your face, arms, or legs, difficulty walking, face drooping, severe headaches, dizziness or confusion) white appearance of the skin, or unusual pain during or shortly after treatment, you should notify your health care practitioner immediately."

Dr. Bash does all of her own injections--she does not have her staff injecting, specifically for this reason. Yes, it may cost a little more that at a medispa (and many nurses who do the injections do a wonderful job). BUT--can they recognize and TREAT a complication??

Make sure you know who is doing your injections and what their qualifications are. Who is the medical director? Where are they? What is the medical director's specialty? Can the medical director treat a complication? Be a smart consumer!!

Who is really qualified to inject Botox® and fillers?

Have you ever wondered why prices vary so much on Botox®? Have you ever wondered why your less expensive Botox® didn’t last very long? Neurotoxins such at Botox can only be purchased from the manufacturer or a licensed distributer.  Very inexpensive product can be purchased over the internet from foreign countries (which is illegal) and may be counterfeit.

Prices are usually higher if the plastic surgeon is doing the injections. The board certified plastic surgeon has the most training and expertise to handle any problems that could occur.

In the state of Arizona, the following licensed professionals may inject Botox® or dermal fillers:

• MD
• DO
• Naturopathic physician (NMD)
• Nurse Practitioner (NP)—does not require supervision by a doctor

Per the Arizona Board of Nursing, a licensed RN in Arizona may inject if:

• The can show they have taken a course on injection and have adequate training
• They have immediate access by phone with the supervising MD or DO 
• AND that supervising physician is available in person within 4 hours when requested by the nurse or the patient. 

If you are having injections done in a med spa by someone who is not a physician, always ask who is doing the injections (RN, NP, etc.) and ask about their qualifications. Who is the medical director? What is the medical director’s specialty, and what is their board certification? Does the doctor also do the injections? Can the medical director handle any complications?

Be safe.  Be smart. Ask.