January 23rd, 2012
There are three possible reasons for the abdomen to protrude:
1. Excessive abdominal wall fat
This is best addressed by dieting, exercise, and weight loss and/ or abdominal liposuction.
2. Excessive laxity of the abdominal wall
Pregnancy, significant weight loss, and aging loosen the abdominal wall. Full tummy tuck entails permanent sutures used to tighten the weak, protruding abdominal wall in the midline from the rib cage to the pubic region. If a hernia (hole in the abdominal wall) is present, it may also be repaired.
3. Excessive intra-abdominal fat
This is best addressed by dieting, exercise, and weight loss. Plastic surgery will not help.
How can I tell which one is causing my protrusion?
It is best to be evaluated by a board-certified plastic surgeon, although you can certainly get an idea of what is causing your protrusion by answering a few questions and looking carefully at your abdomen.
- Have you lost a significant amount of weight? If so, you probably have excessive laxity of the abdominal wall and may benefit from tummy tuck.
- How many children (if any) do you have? In general, women with more children have more laxity of the abdominal wall. In the absence of children and weight loss, you probably do not have major abdominal wall laxity.
- Can you “pinch more than an inch?” If you can pinch more than an inch of abdominal fat, you may have excessive abdominal wall fat. If you are unable to get rid of this with diet and exercise, then liposuction may be helpful.
- Do you have a hard, round abdomen (“beer gut”)? If so, you probably have excessive intra-abdominal fat. Since the fat is inside the abdominal cavity, plastic surgery will not help.
There are many surgical options for excessive abdominal protrusion. These include liposuction, mini-tummy tuck, extended mini-tummy tuck, and full tummy tuck. Remember that you should be within 5 to 10 pounds of your desired weight before considering cosmetic surgery of the abdomen. If diet and exercise aren’t helping, liposuction or tummy tuck may be worthwhile considerations.
Side view of abdominal wall layers(fat inside tummy, abdominal wall muscle and fat)
Lipo:
Liposuction of abdomen, hips and flanks. Breast augmentation.
Before After
Full tummy:
Full tummy-tuck and breast augmentation
Before After
Full tummy-tuck and breast augmentation
Before After
For more information, including before / after photos, please click here.
To schedule an appointment, please call us at 469-467-0100 or email us at drfriedman@plasticsurgerydallas.com
Ronald M. Friedman, M.D.
Certified, American Board of Plastic Surgery
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas, Texas
www.plasticsurgerydallas.com
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January 13th, 2012
Tummy tuck (abdominoplasty) is an excellent option for many women who have experienced stretched-out, hanging skin, excessive fat, and laxity of the abdominal wall following pregnancy and/or major weight loss. One major downside of the procedure: it hurts. Specifically, cinching in the abdominal wall by 4 or 5 inches can be very uncomfortable.
How do we best control the pain and ease your recovery? Unlike many surgeons in the Plano/Frisco area, I provide a pain pump for all full tummy tuck patients. This looks essentially like two very thin ( a few millimeters) epidural catheters that enter the upper abdomen . Marcaine, a long-acting local anesthetic, is dripped through the catheters onto your abdominal wall for about 72 hours after surgery. Although you will still require oral pain medication, the pain pump significantly reduces the discomfort associated with tummy tuck. In most cases, this means that you can go home a few hours after surgery. In addition, the manufacturer we use, Accufuser, allows a bolus feature; this means that , if you need it, you can push a button to give yourself an extra dose of local anesthetic at home.
Recovering from a tummy tuck is no fun; but a pain pump makes it much more tolerable.
Accufuser pain pump
Tummy tuck and breast augmentation
Before After
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January 6th, 2012
Fiction! I am not sure just how this urban myth got started, though I have a hunch. Both FDA-approved US breast implant manufacturers, Allergan and Mentor, offer a 10-year limited warranty on their products. Although the warranty expires after ten years, the implants do not. (Assuming that you have a 36,000 mile warranty on your car, you probably don’t have to replace your car when you reach 36,000 miles.)
So how long do breast implants last? No one knows for certain, but my best estimate is that most saline implants will last 10 to 15 years, and most silicone gel implants will last a little longer. Remember that implant longevity fits a bell-shaped curve, so some implants may deflate (saline) or rupture (silicone gel) after only a few years, whereas others may last 20 or 30 years. It’s luck of the draw.
The important point is that your breast implants are man-made devices that will probably not last as long as you do. It is likely that you will require replacement of your implants at least once during your lifetime.
Although the manufacturer provides a Limited Warranty on saline breast implants, we automatically provide an extended Platinum-Plus Warranty for all of our primary saline augmentation patients. This means that if you experience a deflation within 10 years of your breast augmentation, your out-of-pocket cost to have me replace your implant will be ZERO (no surgeon fee, no surgical facility fee, no anesthesia fee, no implant fee). I do not know any other plastic surgeon in the Plano, Frisco, McKinney area who purchases the Platinum-Plus warranty for his saline breast augmentation patients. (For women undergoing breast enlargement with silicone gel implants, the manufacturer’s standard warranty is essentially equivalent to the Platinum-Plus warranty. No additional warranty is necessary.)
Bottom line: If you choose to undergo breast augmentation, your implants will not have to be replaced every 10 years. But they will probably have to be replaced at some point. Make sure that you have the best warranty possible.
Deflated right saline implant Intact saline implants
Deflated right saline implant Intact saline implants
For more information, please visit www.plasticsurgerydallas.com
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
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September 27th, 2011
Plastic surgeons and cosmetic surgeons routinely advertise that they can “sculpt” your features: your nose, your tummy, even your breasts. Patients routinely request a “chiseled” jawline. Who would want to have liposuction when you can have liposculpture?
The sad truth, however, is that most surgeons are not actually sculptors. There are no art classes offered in medical school. And if your surgeon, by chance, has a background in drawing or painting, these are 2-D activities which poorly translate into the 3-D world of surgery.
Before After
By contrast, I am fortunate to have extensive experience in wood and marble sculpture. I took shop class in 7th grade when I couldn’t figure out what else to take for an elective—and I fell in love. Soon I was spending 60-hour weeks in my workshop during high school summers. It got really exciting when people started buying my sculptures: first neighbors and eventually strangers. Then I started displaying in shows and galleries.
At some point toward the end of high school, I had to make a decision: pursue art and music (my other major endeavor) or pursue academics. I decided to pursue medicine, in general, and plastic surgery, in particular. Plastic surgery was and continues to be the closest that I can come to doing sculpture for a living—and still be able to make a living. (You’ve heard of starving artists, but you probably haven’t heard of starving plastic surgeons.)
Does this mean that I can sculpt your body? Not really. Surgery is not sculpture because the human form is far less predictable than a block of wood or marble. Unlike any other medium, human tissues are fragile; can become scarred, infected, or bleed; and change contour as they heal.
Does this make my background in sculpture useless? Of course not. Every day I have to make decisions during surgery. While some of these simply require a good tape measure or caliper, others require something more elusive: an artistic eye.
I sincerely believe that my background as a wood and marble sculpture has helped me become a better plastic surgeon.
For more information about breast augmentation–including more photos, please visit www.plasticsurgerydallas.com
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
Posted in Home, Plastic Surgery | No Comments »
September 27th, 2011
In an ideal world, breast augmentation alone would lift sagging breasts. In the real world, it doesn’t. For a discussion of whether you would be better off with implants alone versus implants with a lift, please see our article.
Assuming that you are interested in mastopexy(breast lift) in conjunction with breast enlargement, there are four potential incision choices:
1. Crescent mastopexy
Advantages: Small scar along the upper half of the areola (pigmented tissue surrounding the nipple).
Disadvantages: Minimal degree of lift, may stretch and distort the areola.
Bottom line: I rarely, if ever, recommend this technique.
2. Periareolar (donut) mastopexy
Before After
Periareolar mastopexy with breast implants
Advantages: Small scar around the entire areolar border, may reduce areolar size.
Disadvantages: Mild degree of lift, long-term risk of areolar stretching (especially if an aggressive degree of lifting is attempted).
Bottom line: Useful in carefully selected patients who are interested in lifting the nipple areolae while reducing areolar size.
3. Vertical (lollipop) mastopexy
Before After
Vertical mastopexy with Breast implants
Advantages: reliably lifts most breasts and nipple-areolae, helpful in lifting asymmetric breasts, reliably reduces areolar diameter
Disadvantages: Larger scar (vertical lower breast scar in addition to periareolar scar).
Bottom line: I use this technique for most augmentation mastopexies. In most women, the advantage of improved breast contour outweighs the disadvantage of a vertical scar.
4. Inverted-T (anchor) mastopexy
Before After
Inverted-T mastopexy (without implants)
Advantages: reliably lifts even the saggiest breasts
Disadvantages: Largest scar (horizontal scar in breast crease, vertical lower breast scar, and periareolar scar). Larger risk of delayed wound healing, which can endanger underlying implants.
Bottom line: I use this technique for some breast lifts (without implants) and most breast reductions. Unlike many surgeons, I do not typically use the full anchor incision for simulataneous augmentation and mastopexy.
Here’s a brief summary of my usual recommendations:
Degree of sagging Recommendation
Minimal Breast implants alone
Mild Periareolar (donut)mastopexy or breast implants alone
Moderate Vertical (lollipop) mastopexy
Severe Inverted-T (anchor) mastopexy
There is no perfect technique that suits all women and all breasts. In carefully selected patients, however, the combination of breast augmentation and breast lift may lead to a far better result than either operation performed alone.
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August 25th, 2011
Breast augmentation with simultaneous breastlift is a technically challenging procedure. This is due to the fact that we are simultaneously expanding the breast size with a saline or silicone gel implant while contracting the amount of skin via mastopexy (breast lift). Despite these challenges, in a woman who desires larger and perkier breasts, this combination of procedures achieves what neither procedure can do alone.
The best way to evaluate a surgeon is to view his surgical results. As a specialist in breast and body contouring, I strive to achieve natural and proportionate breast enlargement and mastopexy results.
As you view the photos below, look for
- Increased breast size proportionate to the patient.
- Improved nipple-areolar position.
- Improved fullness of the upper and inner breasts.
- Improvement or resolution of “sagging.”
1. Breast Augmentation with lift, Saline Implants (Patient also had Full-Tummy tuck):
Implant size: 300 cc implants; Incision: Vertical Mastopexy
Estimated size change: 38D to 38 Full D; Height and Weight: 5’4″, 175 lbs
2. Breast Augmentation with lift, Saline Implants:
Implant size: 420 cc implants; Incision: Vertical Mastopexy
Estimated size change: 36C to 36D; Height and Weight: 5’6″, 136 lbs
3. Breast Augmentation with lift, Saline Implants:
Implant size: 330 cc implants; Incision: Periareolar mastopexy
Estimated size change: 34A to Full C; Height and Weight: 5’4″, 125 lbs
4. Breast Augmentation with lift, Silicone gel Implants (Patient also had Full-Tummy tuck):
Implant size: 421 cc implants; Incision: Vertical mastopexy
Estimated size change: 34 small C to 34 Full C; Height and Weight: 5’3″, 106 lbs
5. Breast Augmentation with Silicone gel implants
Implant size: 360 cc implants; Incision: Vertical mastopexy
Estimated size change: 34B to 34 Full C; Height and Weight: 5’4″, 135 lbs
Our breast augmentation with lift patients come from all over Texas (Dallas, Fort Worth, Lubbock, Denton, Wichita Falls, Austin), Oklahoma, Arkansas, and Louisiana.
For blogs that I have written on specific breast enlargement topics, please see:
- Determining breast implant size
- Saline vs. silicone gel
- Safety of silicone gel
- Low, moderate, and high profile implants
- Smooth vs. textured implants
- Implant placement above vs. below muscle
- Capsular contracture
For articles that I have written on specific breast enlargement topics, please see:
- Cost of breast augmentation
- Breast augmentation with vs. without breast lift
For more information about breast augmentation–including more photos, please visit www.plasticsurgerydallas.com
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
Posted in Breast Augmentation, Breast Implants, Home | No Comments »
August 4th, 2011
Ronald M. Friedman, M.D., has been providing cosmetic and reconstructive plastic surgery to the Paris, Texas community since 1996. Dr. Friedman serves as the Director of the West Plano Plastic Surgery Center, located on the campus of Texas Health Presbyterian Hospital of Plano. Less than a two hour drive from Paris, Dr. Friedman specializes in breast augmentation, breast lift, liposuction, tummy tuck, mommy makeovers, and Botox and Restylane injections.
Dr. Friedman has been named a Best Doctor in Dallas by D Magazine for four consecutive years. He was also named a Texas SuperDoctor by Texas Monthly magazine for four consecutive years. For more information about Dr. Friedman, including before and after photos, please visit www.plasticsurgerydallas.com.
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July 19th, 2011
Women who consult me regarding breast augmentation are usually (and justifiably) very concerned about maximizing cleavage with the procedure.
These are the factors that determine the amount of cleavage following breast implant placement:
Figure 1:
Before After
Figure 2:
Before After
1. Your anatomy. Regardless of your breast size, you can probably look at your breasts in the mirror and see whether they are close together (figure 1) or far apart (figure 2). The distance between your breasts before surgery strongly influences the distance between your breasts after surgery.
2. The implant size. In general, larger implants create more cleavage than smaller implants. More specifically, implants with a larger diameter extend closer to the midline than those with a smaller diameter. If cleavage is a major priority, then use the largest implant with which you feel comfortable.
3. Surgical technique. I routinely place first-time breast implants under the pectoralis major muscle for a variety of reasons (see my implant position blog). Having done this operation over 2000 times, I have noticed that the pec major muscle has an outer leaflet (further from the midline) and an inner leaflet (closer to the midline). I frequently divide the outer leaflet to maximize cleavage—while preserving the integrity of the inner leaflet.
Remember that cleavage is just one of several factors that determines the success of your breast augmentation procedure. For more information, please see our other breast augmentation blogs and articles:
- Determining breast implant size
- Saline vs. silicone gel
- Safety of silicone gel
- Low, moderate, and high profile implants
- Smooth vs. textured implants
- Implant placement above vs. below muscle
- Capsular contracture
For articles that I have written on specific breast enlargement topics, please see:
- Cost of breast augmentation
- Breast augmentation with vs. without breast lift
For more information about breast augmentation–including more photos, please visit www.plasticsurgerydallas.com
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
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July 7th, 2011
The average plastic surgeon performs about 30 to 35 breast augmentations annually. I performed 70 breast enlargements—in the first 6 months of 2011. The best way to evaluate a surgeon is to look at his surgical results. As a specialist in breast and body contouring, I strive to achieve natural and proportionate breast enlargement results.
Remember that the single greatest factor determining the appearance of your breasts after augmentation is the appearance of your breasts before augmentation. As you view the photos below, notice that a woman’s breast shape changes very little with augmentation. The primary changes are increased breast size and increased fullness of the upper breasts.
1. Breast Augmentation with Saline Implants:
Implant size: 330 cc implants; Incision: Inframammary fold
Estimated size change: 34B to 34C; Height and Weight: 5’7″, 119 lbs
Before (Front view) After (Front view) Before (Side view) After (Side view)
2. Breast Augmentation with Saline Implants:
Implants: 420 cc implants ; Incision: Inframammary fold
Estimated size change: 36B to 36D Height and Weight: 5’9″, 140 lbs
Before (Front view) After (Front view) Before (Side view) After (Side view)
3. Breast Augmentation with Saline Implants:
Implant size: 330 cc implants; Incision: Inframammary fold
Estimated size change: 34c to 34D; Height and Weight: 5’4″, 122 lbs
Before (Front view) After (Front view) Before (Side view) After (Side view)
4. Breast Augmentation with Saline Implants
Implant size: 360 cc implants; Incision: Inframammary fold
Estimated size change: 34 small B to Full C; Height and Weight: 5’4″, 130 lbs
Before (Front view) After (Front view) Before (Side view) After (Side view)
5. Breast Augmentation with Saline Implants
Implant size: 360 cc implants; Incision: Inframammary fold
Estimated size change: 34B to 34 Full C; Height and Weight: 5’0″, 95 lbs
Before (Front view) After (Front view) Before (Side view) After (Side view)
6. Breast Augmentation with Silicone gel implants
Implant size: 421 cc implants; Incision: Inframammary fold
Estimated size change: 32B to 32C; Height and Weight: 5’5″, 120 lbs
Before (Front view) After (Front view) Before (Side view) After (Side view)
Our breast augmentation patients come from all over Texas (Dallas, Fort Worth, Lubbock, Denton, Wichita Falls, Austin), Oklahoma, Arkansas, and Louisiana.
For blogs that I have written on specific breast enlargement topics, please see:
- Determining breast implant size
- Saline vs. silicone gel
- Safety of silicone gel
- Low, moderate, and high profile implants
- Smooth vs. textured implants
- Implant placement above vs. below muscle
- Capsular contracture
For articles that I have written on specific breast enlargement topics, please see:
- Cost of breast augmentation
- Breast augmentation with vs. without breast lift
For more information about breast augmentation–including more photos, please visit www.plasticsurgerydallas.com
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
Posted in Breast Augmentation, Breast Implants, Home, Plastic Surgery | No Comments »
June 8th, 2011
Although television shows such as The Swan and Extreme Makeovers make cosmetic plastic surgery look exciting and glamorous, this so-called “reality” couldn’t be farther from the truth.
Cosmetic surgery remains popular because it makes people look and feel better. But make no mistake: it is real surgery with real risks and downsides. In my 15 years operating on patients from Dallas, Plano, Frisco, Richardson, McKinney, Carrollton, Irving, Southlake, and Lewisville, I have learned the realities of cosmetic surgery firsthand.
Virtually every surgical procedure is associated with the following negative factors:
1. Scars: Like it or not, any time you cut the skin, your body generates a scar. Part of my job is to make the scar look as inconspicuous as possible—but there’s still a scar. This is a necessary trade-off for the desired improvement in contour.
2. Pain: Surgery hurts. There is no such thing as a painless surgical procedure. You will require pain medicine (from anywhere from a couple days to a couple weeks), and you may wonder what you were thinking the first couple days after surgery. Fortunately, pain is temporary and generally well-controlled by medication. But it is unavoidable.
3. Time off work: You may be tough, but the combination of surgery, anesthesia, and pain medication will result in some time lost from work. If you have a desk job, you will likely be back to work very soon. If your job requires significant lifting, you may have to modify your work activities for several weeks.
4. Time off athletic activities: For most breast and body contouring procedures, you will require 4 to 6 weeks off heavy lifting, pushing, and pulling. (This includes strenuous workouts and lifting your children.) It’s inconvenient but very necessary.
5. Risks: Infection, bleeding, need for further surgery, unsatisfactory cosmetic results (to name a few). The good news: 90 to 95% of patients are happy with their surgical results. The bad news: 5 to 10% are not.
I feel privileged to be able to make a living doing something I really enjoy. But cosmetic surgery is more fun for me than it is for you. Make sure that your plastic surgeon takes the time to thoroughly educate you before you undergo any procedure.
Our cosmetic surgery and plastic surgery patients come from Dallas, Fort Worth, Plano, Frisco, McKinney, Allen, Richardson, Garland, Sherman, Denison, Prosper, Celina, Wichita Falls, Parker, Highland Village, Denton, Arlington, Irving, Southlake, Carrollton, Lewisville, Colleyville, and Trophy Club. For cosmetic surgery before and after photos, please visit www.plasticsurgerydallas.com .
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
Posted in Breast Augmentation, Breast Implants, Earlobe, Face, Home, Nipple Procedures, Plastic Surgery | No Comments »
