Every patient is an individual and any surgical procedure has to be custom designed for that patient.
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Breast Enhancements
Every patient is an individual and any surgical procedure has to be custom designed for that patient. The female breast can be enhanced with:
Breast Augmentation
Breast Augmentation & Lift
Breast Lift (mastopexy)
Breast Reduction
Excess Male Breast Tissue
Information for each procedure is provided below...
Breast Augmentation
The choice of procedure depends on the patient's goals and their anatomy. Breast augmentation is best suited for patients whose breasts are not ptotic (droopy).
When the position of the nipple is below the infra mammary fold, that breast is considered ptotic. The lower the nipple position the more ptotic the breast. In order to create perky breasts a mastopexy (breast lift) may be required. Breast implants push the breast gland forward and fill the breast envelope, but does not raise the nipple position.
How Do You Decide the Right Breast Size For You?
This is completely a personal choice. As a surgeon I am guided by certain aesthetic norms:
1. Breast Implants Increase the patient's Bra Cup size. So if you are a 34 B cup and would like to be a C cup, you would need a 34C cup bra. The "34" number is a measurement of your chest below the breasts.
2. You need to go up in size at least one cup size. If you do not go up at least one cup size you will not notice a significant enlargement.
3. Women's clothing is generally cut for the B - C women. A common complaint is that clothing does not fit properly. Going from an A cup to a DD cup will result in clothing not fitting because you were too small and now you are too big.
4. In my Opinion a Full B cup to a Small D cup is happiness for most women. Clothing fits well. No patient with a C cup wants a smaller breast. In terms of body symmetry; the chest, waist and hips are generally balanced.
5. The right implant size is determined by calculating how much volume it will take to increase your cup size from your present cup size to the size you want to be. So if you are an A cup and would like to be a C cup, that is a two cup increase. Generally speaking, each cup increase requires approximately 200cc (ml) of volume. Implants start at 110cc and go up by 24 cc jumps all the way up to 800 cc.
Breast Augmentation & Lift
There are situations where you will need a breast lift (a mastopexy) and a breast augmentation. This generally occurs when you have a ptotic breast (a breast where the nipple sits below the infra-mammary fold) and you want a larger breast. Implants alone can not raise the nipple and lifts alone do not create a larger breast. The lift will move the nipple into the correct position and tighten up the breast envelope. The implant will make the breast larger and give you more upper pole fulness. When looking at before and after pictures please note the following:
1. The elevated nipple position.
2. Increase breast size and upper pole fulness.
3. The incisions that are around the areola, down to the infra-mammary fold and along the infra-mammary fold. 
Breast Lift
A breast lift is used to raise the nipple position and tighten the breast envelope. The cup size is not changed. Only a small amount of skin is removed.
Breast Reduction
Breast Reduction is used to reduce the size of the breasts. Patients generally request reductions because their breasts are so heavy that they cause neck and back pain, shoulder grooves and heat rash problems below the breast. The incisions for a reduction are similar to those for a lift, but the difference is that the breast gland is removed.
Male Breast Reduction (Gynecomastia)
All Men have breast tissue and on occasion there may be too much tissue. Male Breast Reduction (gynecomastia) is used to reduce the size of the breast. The incisions used depend on the size of the excess breast tissue. Generally the incisions are small and around the areola of the nipple.
Enhancement of the Face & Eyes
Each part of the face has unique opportunities. Each cosmetic surgery is designed to meet specific goals.
Face lifts
A face lift (technically known as rhytidectomy) can't stop the aging process. What it can do is "set back the clock," improving the most visible signs of aging by removing excess fat, tightening underlying muscles, and redraping the skin of your face and neck. A face lift can be done alone, or in conjunction with other procedures such as a forehead lift, eyelid surgery, or nose reshaping.
Blepharoplasty - Cosmetic Surgery of the Eyelids (Upper & Lower Eyelid Lifts)
Eyelid surgery (technically called blepharoplasty) is a procedure to remove fat--usually along with excess skin and muscle from the upper and lower eyelids. Eyelid surgery can correct drooping upper lids and puffy bags below your eyes - features that make you look older and more tired than you feel, and may even interfere with your vision.
Botox
Botox is used to temporarily paralyze facial muscles in order to reduce facial wrinkles. Wrinkles are formed by the action of muscles. If the muscle is paralyzed the wrinkles soften and disappear.
Botox is generally used to treat two areas, the glabellar (frown lines) and the crow’s feet lines of the lateral orbit.
Botox is injected directly into the muscles. The effect takes 48 hours to up to one week to observe. The effect lasts generally three months. Allergic reactions, infections and other complications are rare.
Brow Lift
A forehead lift or "brow lift" is a procedure that restores a more youthful, refreshed look to the area above the eyes. The procedure corrects drooping brows and improves the horizontal lines and furrows that can make a person appear angry, sad or tired.
The face can be enhanced by each of these procedures and by combinations of them. They are independent procedures and do not over lap.
Otoplasty - Cosmetic improvement of prominent Ears
Ear surgery, or otoplasty, is usually done to set prominent ears back closer to the head or to reduce the size of large ears.
Rhinoplasty - Cosmetic improvement of the Nose
Rhinoplasty, or surgery to reshape the nose, is one of the most common of all plastic surgery procedures. Rhinoplasty can reduce or increase the size of your nose. It can change the shape of the tip or the bridge. It can narrow the span of the nostrils, or change the angle between your nose and your upper lip. It may also correct a birth defect, injury, or help relieve some breathing problems.
The abdomen and lower body are enhanced generally with two types of procedures; Suction Assisted Lipectomy and lifts ( tummy tuck, buttocks lifts and inner thigh lift ). It must be emphasized that liposuction and lifts are not a substitute for weight loss. They are both used to contour the body, but the weight that is removed will only stay off as long as the patient eats less and exercises more.
Liposuction
Liposuction is used to contour the body and remove fat. As the bulge is removed the overlying skin retracts. Liposuction does not make wavy skin appear smoother, as a matter of fact it could make it worse. The more fat that is removed from an area being liposuctioned, the greater the chance that irregularities and waviness may develop. The best candidates for Suction Assisted Lipectomy have limited well defined bulges that they would like flattened. The lower abdomen, hip rolls and outer thighs (saddle bags) are classic areas in women.
The Tumescent Technique : There are three basic ways to perform liposuction. The dry technique involves doing liposuction without injecting fluid into the area, which is to be suctioned. The wet technique involves injecting a limited amount of local anesthetic into the area, which is to be suctioned. The tumescent technique involves filling the area to be suctioned with enough dilute local anesthetic to make the skin tense (to swell the skin). Injecting fluid into the area to be suctioned has several benefits. The local anesthetic makes the area numb during the surgery and after for several hours. The epinephrine in the solution causes the small blood vessels to shrink and therefore there would be less blood loss during the procedure. The solution makes the area tense and it is easier to remove the fat.
Lifts - Tummy tuck (abdominoplasty), Inner Thigh Lift and Buttocks Lift
Lifts involve cutting away skin and fat. After significant weight gain and loss the skin and tissue may remain very lose and hang. Liposuction can remove fat but it can not tighten loose skin.
For the abdomen: the tummy tuck removes the skin and fat from the lower third of the abdomen. The rectus abdominis muscles are tightened to help flatten the lower abdomen (These muscles are stretched out during pregnancy and significant weight gain).
For the Inner Thighs the lift involves removing the excess skin of the inner thigh. The incisions may involve both a stocking seam incision (up and down the inner thigh) and a groin incision.
For the buttocks the lift involves removing excess upper buttock, back and hip skin and fat. This tends to lift and tighten the buttocks. It may reduce buttock projection.
