203-335-3223

Voted Best & Top Plastic Surgeon in Fairfield County & Connecticut

“I have a much more confident overall attitude about myself and I’m happy to say the experience was definitely a success!” — LD

Jeffrey Rosenthal MD
Board Certified Plastic Surgeon l Former, Chief Plastic Surgery at Bridgeport Hospital

140 Sherman Street, Fairfield, CT 06824
Rosenthal Cosmetic Surgery & Skin Care Center

"Where Art Meets Science"

Articles by Dr. Rosenthal

11 Questions You Should Ask Your Plastic Surgeon

Date Published: Nov 14 2000

www.drkoop.com
Jeffrey S. Rosenthal, M.D., a board-certified plastic surgeon in Fairfield, Conn., advises people shopping for a plastic surgeon to ask the following questions before undergoing any procedure.

What is your certifying board? The American Board of Plastic Surgeons (ABPS) is the only certifying body recognized by the American Medical Association to certify plastic surgeons. You can obtain a referral to a board-certified plastic surgeon by visiting the Web site of the American Society of Plastic Surgeons, or by calling them at 1-888-4-PLASTIC.
What was your residency in? Board-certified plastic surgeons must spend some of their residency in their specialty — plastic surgery.
Do you have privileges at a hospital to perform the same procedure you are about to do in your office? Look for a surgeon who has surgical privileges at a hospital.
What are the benefits of the procedure we are talking about? You can expect the surgery to recontour, rejuvenate or reshape the areas of concern, and to improve your overall appearance. Beware a surgeon who promises miracles. He should encourage realistic expectations.
Are there other procedures or associated services that might enhance my appearance? Some procedures work best when accompanied by complementary procedures. For instance, if you’re having eyelid surgery done, consider also having an eyebrow lift.
Are there potential risks from the surgery? What are the major complications and do they occur frequently? You want your surgeon to discuss the major risks and complications of the procedure you are considering. Some of these might include the potential for bleeding, infection, poor scarring and complications that would be unique to the individual procedure. Although these complications occur infrequently, the surgeon should be aware of them and therefore protect you from their possible occurrence. Your surgeon should tell you what type of anesthesia will be used and give you the rational for the type of sedation you will receive.
Are there regimens I can do prior to surgery to improve my results? You’ll get the best results if you are in good health before surgery. Your physician may advise you to improve your diet, get exercise, refrain from smoking and start a vitamin regimen. He might also warn you to stay away from products that increase bleeding in the days prior to surgery, including aspirin, ibuprofen, vitamin E and certain herbal products.
What should I do after surgery to optimize my results? A few simple steps after the procedure will ensure you get the best results possible for you. Your surgeon will advise you, but his recommendations may include: continue to eat well; restrict all strenuous exercise for a number of weeks to reduce swelling, bruising and the risk of excessive bleeding; and refrain from cigarette smoking for three weeks, if not forever.
How long will it take to heal completely, and will there be visible scars? Your surgeon should be able to prepare you for the recovery period. Results vary from individual to individual, but in general there will be an improvement in your appearance within the first few weeks after surgery. At that time you should expect to look better than before surgery, but you will have residual swelling, which takes between six weeks and six months to diminish. Scars can take up to one year to mature, but they can be placed in shadows or less conspicuous places to minimize their visibility.
When can I resume my normal activities? You will want to rest your body after surgery to give it a chance to heal. To accelerate your healing, avoid strenuous activity for three weeks and follow your surgeon’s instructions. A little makeup goes a long way to cover any residual bruising, and you might be able return to normal work activities within six to 10 days, depending upon the procedure.
Do you have before and after photos or patients I can speak to before surgery?
While results will vary among individuals, and you should not assume your procedure would turn out the same as someone else’s, your surgeon should be willing to provide before and after photos of patients on whom he has performed surgical procedures.

A GUIDE TO BREAST RECONSTRUCTION

Overview
 By Jeffrey S. Rosenthal, M.D.
Written BACUP (England)

Breast Cancer Awareness
Although the major incidence of breast cancer is found in women, there are also a significant number of males who are afflicted with this life-altering problem. We have made enormous strides in the detection and treatment of breast cancer but have yet to offer freedom from this physical and emotional malady.
Self-examination, followed by routine physician evaluation and mammography allow timely recognition, treatment and cure. Your active participation in your own health care is of paramount importance. Therapies have become more effective and easier to tolerate. Deforming surgeries, performed many years ago, have been replaced by simpler yet effective modalities for removing the cancer cells. And for those women who choose a mastectomy there are a host of reconstructive procedures available to reshape this very vital area of the body.

Hope is the common thread that weaves us together, as we fight against and treat breast cancer. The Norma F. Pfriem Breast Care Center, whose symbol is the rose of hope, at Bridgeport Hospital and in Fairfield, is an organization dedicated to quality of life.

It may be ironic to celebrate this month with the enthusiasm normally given to a holiday, but the progress that has been made and will continue to be made in the detection and cure of breast cancer not only gives us all hope for the future, but tears of joy for those women and men who will be able to live normal, productive lives. Wishing health and happiness for the years ahead!

Common Reconstructive Procedures
Your suitability for breast reconstruction will be influenced by a host of factors. The type of tumor, position of the tumor in the breast, and the extent of the cancer will all be important factors in determining the amount of breast tissue left behind after the mastectomy. Operations that spare the chest (pectoralis) muscle, such as simple or modified mastectomies, usually leave behind ample amounts of skin and fat. This allows for an easier reconstruction than those operations that remove this muscle, such as a radical mastectomy.

One of the main decisions to be made about breast reconstruction is whether to start the reconstruction simultaneously with the mastectomy (immediate reconstruction) or to delay the process for days, months, or even years (delayed breast reconstruction).

In attempting to restore the breast to a shape and size compatible with your wishes and to match the opposite breast, surgeons start by considering the simplest procedure and progress to the more complicated ones as necessary. The controlling factors in this decision will be the amount and quality of the tissue left behind and the position and shape of the opposite breast.

Immediate Breast Reconstruction
With immediate reconstruction, the breast is removed and simultaneously reconstructed, or at least the beginnings of reconstruction will be carried out. This is done with either an inflatable medical balloon, which stretches the remaining available tissues, an internal permanent prosthesis (silicone gel or saline-filled implant) or with tissue transfer, which will be discussed later on. The main advantages of this technique, if available for you, are in the economy of time due to the reduction in the overall number of operations and its positive effect on your psychological outlook. The period of mourning and depression often experienced with mastectomy is markedly diminished once the breast restoration has begun. Likewise, the sense of loss associated with the mastectomy is shortened, and in many cases not experienced, as the substitute breast has already taken its place. The ability to get on with your life and potentially reduce the overall number of operations also makes this an attractive alternative. Additional procedures may follow to refine the breast shape, exchange implants, alter the opposite breast to give better symmetry, or to build a nipple and areola. Immediate reconstruction allows the plastic surgeon to work with the general surgeon in designing the best and most appropriately shaped breast at the time of the mastectomy.

As the reconstruction starts immediately after the mastectomy, this adds to the overall operating and anesthesia time. However, it does reduce the total number of operations. At the conclusion of these procedures your surgeons will be concerned not only with the healing of the mastectomy site, but also with the progress of the newly restored breast. Despite being a valuable option, not all women are good candidates for immediate reconstruction. Factors such as the size and extent of your breast cancer as well as your overall general health may make immediate reconstruction impractical.

Delayed Breast Reconstruction
The vast majority of breast reconstruction operations are performed months or even years after the mastectomy. This allows the skin and scar tissue to soften and become more malleable. During this time, a foam rubber external prosthesis may be worn inside your bra, if desired, to simulate the lost breast. Some women start to focus on other areas of life, no longer worrying about the removed breast or its significance and becoming quite comfortable with the external breast prosthesis. Others still do not feel whole, find the external prosthesis bothersome, and wish their breast to be restored.

Unlike immediate reconstruction, a separate operation is planned to restore the breast mound. The procedure chosen will depend upon the quality of remaining chest tissues (skin, fat and muscle). The reconstructive choices are similar to that discussed for immediate reconstruction. Frequently this, too, will be staged, necessitating more than one operation to complete the total process. An advantage of the delay is that is allows the unsure woman time to think about her desire for reconstruction and focus on one procedure, rather than two. The disadvantages lie in having an additional operation apart from the mastectomy and waiting a number of months for the chest tissues to heal prior to the commencement of the restoration.

With reconstruction, these women now pass through another stage in their overall treatment. The sense of bodily loss experienced with the mastectomy is diminished. This change is not just a physical alteration, as the new breast can bring psychological benefits by improving self-esteem body image. Women have reported that within months the reconstructed breast is accepted by the mind as being a natural, integral part of the body.

If you have opted for a delayed breast reconstruction, now is the time to meet with your plastic surgeon to discuss which procedures will give you the best results. Many of these decisions will be based upon your physical examination which will determine the tissues that are available to enhance your new breast. Your expectations and wishes will be discussed and the major complications identified. The probable number of operations needed, recovery time, and the aspects of healing are also important parts of this discussion. This meeting should aim to prepare you for the surgery, both physically and mentally.

Submuscular Permanent Implant
Recreating the breast mound with a prosthesis (implant) is done by using a silicone envelope or bag. This contains gel or saline to give it shape, form and consistency. Implants come in a great many sizes and shapes, from the very small to the very large, to simulate the shape and weight of the removed breast. A specific type is chosen for each individual to produce a new breast and to match the opposite breast, when possible.

During surgery, usually under a general anesthetic, the implant is placed beneath the chest muscles through the old mastectomy scar. This is done to protect the implant by providing additional soft tissue coverage. Quite often there is sufficient skin, fat and muscle left behind after the mastectomy to allow for this. The operation may take a few hours, but the hospital stay is brief, not usually requiring an overnight stay.

A moderate amount of swelling and discoloration of the chest skin may be present for a few weeks. The final shape of the new mound will take some time – up to a year – before it becomes established. Some women have moderate discomfort from the operation for a few days which is usually relieved by pain medication. Generally, daily regimes can be quickly resumed (three weeks), except for the most vigorous athletic, work or household-related activities.

Despite the best intentions of your doctors, complications cannot always be prevented. The most common complications include infection, bleeding, and scarring (capsule formation) around the newly-implanted prosthesis. This latter problem is not really a complication, but actually a natural means by which the body isolates man-made materials from body tissues. All implants cause some capsule formation, but only those that become very hard or pull on the implant and deform it require further surgery. Your doctor’s knowledge and awareness of these potential complications will help to prevent or control them, should they occur.

In situations when there are inadequate amounts of skin and/or muscle to cover the implant, or when the surgeon attempts to match the opposite breast without operating upon it, another technique known as tissue expansion is utilized.

Tissue Expansion
Through an incision in the skin, with delayed reconstruction or at the time of the mastectomy, an empty medical balloon is inserted beneath the chest muscles. A separate valve is attached to this balloon, which is placed beneath the chest skin and left undisturbed for a few weeks. The balloon is gradually inflated on a weekly or bi-weekly basis by passing a thin needle into the valve through which a sterile solution is injected. A mild pressure sensation may be felt during this process but the discomfort is brief and most women find it bearable.

The gradual inflation of the balloon continues until it is over-inflated. This ensures that sufficient skin and muscle are available to match the larger, opposite breast, or allows the placement of a permanent implant in situations that might require the addition of other tissues, as in tissue transfer. Usually, this over-inflated state lasts from four to six months to allow for stretching of the tissues making up the mound before the second stage is attempted. Difficulty in wearing some clothing and certain physical limitations may be experienced during the expansion.

Stage two involves the exchange of the expanded balloon for a permanent prosthesis similar to that described above for a simple submuscular reconstruction. This may be done under either local or general anesthetic. When necessary, the shape of the breast can be altered during this stage or the crease under the breast can be moved or reestablished. As with submuscular reconstruction, the hospital stay is limited. Activity levels are similar, and post-operative discomfort is usually not severe. The final shape of the breast mound will take many months to finish healing.

In some cases, a permanent tissue expander is placed under the chest muscles. This type of implant requires that only the valve is removed (under local or general anesthetic) when the breast has achieved its desired shape and size. The drawbacks in using this prosthesis include the inability of the doctor to further refine the breast after the expansion has taken place either by altering the position of the prosthesis, repositioning the lower breast crease, or by substituting another implant.

For those women who lack sufficient quantities of tissue despite tissue expansion, or those with poor quality tissues left after the mastectomy, healthy and plentiful skin, fat and muscle from other areas of the body can be transferred to the chest (tissue transfer).

Tissue Transfer
Areas of the breast that could not be rebuilt by the previous methods can be filled in and/or recontoured using tissues from the upper back, abdomen or buttocks (tissue transfer).

One of the tissue transfer procedures rotates the back (latissimus dorsi) muscle to the mastectomy site. The muscle carries the overlying fat and skin which is maneuvered into its new position on the upper chest. Still attached to its original blood supply, this blend of tissues can build up the hollows created by some radical mastectomy operations. This enables a prosthesis to be inserted, thus reconstructing the breast mound. The transferred portion of muscle and skin does not leave behind a significant deformity or weakness of the back. It does, however, add a scar to the upper back which some women may object to.

The Transverse Rectus Abdominalflap (TRAM) is a blend of tissues taken from the abdomen or lower portion of the belly. This, too, relies on a blood supply still attached to the muscle. Portions of fat, muscle and skin are transferred to the upper chest leaving behind a long lower abdominal scar. Unlike the other procedures, a prosthesis is not always needed if this tissue transfer method is used, as the lower abdomen usually has more than ample amounts of fat and skin to build the breast mound. But do not be misled–more is not always better, and the fat in this region must be firm. Illnesses such as diabetes or vascular disease, and even having had prior operations on the abdomen, can prevent you from being a suitable candidate for this type of reconstruction.

A third tissue transfer method uses portions of tissue from the buttocks. This tissue is reconnected to the chest blood supply using specialized microvascular techniques. This operation is chosen in only a few selected cases and is by no means the usual method for most reconstructions needing tissue transfer.

All tissue transfer procedures are extensive operations and have a potentially higher complication risk. They are, however, extremely valuable, offering alternative methods of reconstruction, especially when simpler operations cannot be performed.

The Opposite Breast
Even though the breast mound is now restored, the reconstruction is not complete until it resembles the opposite breast. In well-endowed women who have a large or pendulous (droopy) opposite breast, obtaining breast symmetry is more difficult. To achieve a better match with the newly reconstructed breast, the surgeon may reduce the size of the opposite breast, elevate and reshape it (mastopexy), or in some cases insert a prosthesis to enlarge it (augmentation)

Frequently, these operations can be performed in conjunction with either the nipple/areola reconstruction or during further refinements of the breast mound. After these procedures most women have a breast mound of appropriate size and shape and one which matches the opposite breast.

Finally, the breast mound is transformed into a breast with the addition of a nipple and surrounding areola (darkened skin).

Nipple and Areola Reconstruction
Nipple and areola complex reconstruction is begun some months after the breast mound swelling has diminished and the shape of the breast has settled in. Premature placement of the nipple and areola will cause it to be either too high or too low.

Under either general or local anesthetic, the new nipple is outlined on the peak of the breast mound. Using tissues from this area, the nipple is raised and fashioned. A skin graft is then taken from the upper, inner part of the thigh to form the surrounding doughnut, or areola, leaving behind a fairly inconspicuous thigh scar. The operation is usually performed on an out-patient basis and is accompanied by some tenderness in the thigh donor site for a week or two.

The shape and projection of the new nipple and size of the areola are approximated to that of the opposite breast. However, the color of these structures may not be identical to the original. When this is a problem, tattooing of both the nipple and areola may produce more acceptable results. Sometimes simply tattooing the shape of a nipple and areola on the mound will give the illusion of having a completed reconstruction, although authentic projection is lacking. Alternatively, the nipple is rebuilt and the surrounding areola is tattooed without the use of a skin graft.

A less frequently used method is taking part of the nipple from the opposite breast to fashion a nipple for the new breast. However, the other nipple may be too small to be used, and there is a risk that sensation in the existing nipple will be diminished.

The nipple from the original breast containing the tumor can rarely be used on the reconstructed breast. There is concern that some cancer cells will be transferred to the newly formed breast. Besides, with the available technology, nipple and areola formation has been elevated to a refined art.

Often, two operations can be combined so that the nipple and areola are fashioned simultaneously with the remolding of the opposite breast. The newly fashioned nipple and areola transforms the reconstructed breast to appear more like the original. Unfortunately, though, the new nipple and areola will not have the original nipple’s unique sensitivities.

Sometimes a false nipple can be used. These are made of soft plastic and simply adhere to the peak of the new breast. The false nipple will give an authentic projection under your clothes but, again, will not have the original nipple’s sensitivity nor will it be a permanent part of the breast.

Nipple and areola formation is usually regarded as the final step which completes the reconstruction. Many women see this step as an ending to the struggles, physically and psychologically, which began with the initial diagnosis of breast cancer.

Questions For You and Your Plastic Surgeon
1. Does breast reconstruction interfere with other treatments (for example, chemotherapy or radiotherapy)?
Both treatments can start fairly soon after the reconstruction; however, a slight delay may be necessary to allow the surgical wounds to start healing. Neither therapy is made less effective by the breast reconstruction.
Radiotherapy for cancer prior to the breast reconstruction can affect the quality of the remaining skin. This may mean you will need a tissue transfer or tissue expansion operation.


2. Does the breast implant cause cancer?
No. Medical research to date does not indicate that the implant causes cancer.


3. Will a recurrence of breast cancer be hidden after the breast is reconstructed?
Normally, a local recurrence is first seen in the skin of the chest or the scar tissue left behind after the operation. Both of these areas can usually be seen or felt by your doctor during your follow-up examinations. Tissue transfer techniques may be a slight hindrance to physical examinations, as new skin and muscle are brought to the chest. Continued follow-up examinations by your physician will help to detect any changes.


4. Will my reconstructed breast feel normal?
The gel or saline-filled implant matches the breast tissue that has been removed in weight, size, and consistency. The breast may remain soft or become firmer than the day it was restored due to capsule formation. Fat within tissues transferred may atrophy or become thinner causing a change in breast consistency. Keep in mind that breasts normally feel slightly different from side to side and from woman to woman.

The new breast skin will feel normal to the touch, but some areas may feel numb. This is due to the mastectomy which removed or cut many of the nerves leading to the breast. Likewise, the new nipple and areola will look and feel normal to touch, but lack in most sensitivities.


5. Will the new breast look exactly like the one which was removed?
No, it would be almost impossible to exactly copy the removed breast, but in many cases a close match can be obtained.


6. Is the recovery period lengthy or painful after reconstructive surgery?
Depending upon the method used, various physical restrictions may be placed upon you. In general, no strenuous activities can be performed for at least three weeks from the time of the reconstruction to allow for initial healing to take place. Most women notice some stiffness and soreness in the operated areas, which is short-lived and usually relived by mild painkillers and local therapy (e.g., stretching). When combined with the mastectomy, the sub-muscular implant or tissue expansion reconstruction does not cause additional discomfort. Tissue transfer may cause additional discomfort in the donor site.

Any further limitations, as well as individual information on what to expect after the operation, should be fully discussed with your surgeon before the reconstruction.


7. Do I need nipple and areola reconstruction?
The final stages or finishing touches are entirely up to you. Many women are very satisfied to have just the breast mound, while others feel that the nipple/areola transforms the mound into a visual breast. There is no need to make this decision until the breast has settled in.


8. Is it always necessary to alter the opposite breast?
Once again, you are an active participant in the decision to operate upon the other breast. In many instances uplifting, reducing, or enlarging this breast will allow for better symmetry between the two breasts.


9. With immediate reconstruction, is the hospital stay prolonged over that of the mastectomy alone?
The recovery time is usually about the same; however, this will depend upon the type of reconstruction and if there are any associated complications.


10. Is the breast implant easily broken or damaged?
Both the gel and saline-filled implants are surrounded by a strong silicone envelope. Under normal conditions they do not break. In the rare case of the implant leaking, rupturing or deflating, it may be substituted for a new one, usually without affecting the previous results.


11. Does capsule formation around the implant or expander have any effect on the reconstruction?
Every man-made prosthesis is surrounded by scar tissue. This is the body’s way of isolating it. In some cases the scar tissue becomes overabundant causing the implant to feel harder than normal. If firmness or distortion of the breast becomes a problem, then the capsule can be surgically broken.


12. What is the most common type of breast reconstruction?
The placement of an implant below the chest muscles after the mastectomy can give very pleasing results if there are adequate healthy tissues present. Individual selection for this and every other type of restoration procedure is critical. The options available for your particular situation should be thoroughly discussed before the reconstruction takes place.


13. Will I ever view the reconstructed breast as my own?
Studies show that within months of the surgery women begin to assimilate their new breast into their own body image and soon thereafter feel it is their own.


14. Do my expectations about the breast reconstruction play a role in my satisfaction level?
Definitely. Having a realistic idea of what to expect and knowing that the new breast will never be an exact duplicate of the one removed will assist in your satisfaction.


15. Are most women pleased with their results and if given the opportunity would they do it again?
The vast majority say that they would undergo either immediate or delayed reconstruction again. Having the ability to wear normal clothing and not constantly being reminded of the cancer, by a flattened chest, has helped them adjust to the mastectomy.


16. Will I still be able to have a breast reconstruction if I did not consult a plastic surgeon before my mastectomy?
The availability of breast reconstruction does not depend on the length of the interval between the mastectomy and your decision to have reconstruction. It is determined by your health and the quality and amount of tissues remaining after the mastectomy. A discussion with your surgeon beforehand, however, will enable planning of the breast reconstruction and possibly allow for immediate reconstruction.


17. Is breast reconstruction available from the National Health Service?
Yes. If you have had or are going to have a mastectomy as cancer treatment, you are entitled to a free breast reconstruction from the National Health Service. Alternatively, if you prefer, there are surgeons who will do reconstructive surgery privately.
One must be responsible for one’s own well being. I hope that I have assisted you in your quest and that you will continue to seek out those answers that will benefit your recovery.
Jeffrey S. Rosenthal, M.D.
Emeritus, Chief Section Plastic Surgery Bridgeport Hospital
Private Practice-Cosmetic Surgery
Diplomate, American Board of Plastic Surgery
Copyright© 1986 Written BACUP (England)
Modified 2008 Norma F. Pfriem Breast Care Center

(BELL Technique) Brow Elevation Lid Lift Combined Browlift & Blepharoplasty Consultation

from Dr. Rosenthatl

Every patient is important to me. You have entrusted me with your care, and as such I consider you unique. Hearing my patients profess a high degree of satisfaction with the way they look and feel is what drives my office. We look forward to your joining our satisfied family of patients.

Having been in private practice for over 23 years has allowed me to fine tune and think about every aspect of your care. No two surgeries are ever the same, and each must be tailored to match your particular needs. I take great pride in my work and want you, my patient, to be extremely pleased with your results; achieving a content family of patients is the result of carefully planning each step of your journey. Today’s consultation was the starting point. From here, my office staff will work with you to set a date for surgery and preoperative visit that best fits into your schedule.
During the pre-operative visit, you will receive care guidelines outlining what can be done to optimize your results and make you the most comfortable before, during and after surgery. At this time, your prescriptions will also be written for you so you can arrive home after surgery without worrying about how to get your medicines. These prescriptions will be accompanied by guidelines informing you how and when to use these medicines.
During surgery, it is my task to look out for your well being, which I take very seriously. The day of surgery, I will meet you beforehand and be with you as you are being sedated. Once the procedure has started my aim is to do the very best I can for you. I am often asked how long surgery will take; my only answer is as long as I need for both of us to be pleased with the outcome. I never rush through surgery as I wish to be gentle and afford you an optimal outcome. This allows time for only one major surgery per day.
After the end of your surgery, your care has only just begun. As you awaken I will remain close by. Maintaining close contact after the procedure, coupled with personalized and frequent evaluations in my office, will help to ensure optimal results. After all, we both want to be delighted!!

Shape them, pluck them, tease them or tint them–the eyebrows often need more than a camouflage job.

Low lying brows, especially the outer 1/3- 2/3, often require a surgical fix. A unique brow lifting procedure called the BELL Technique (Brow Elevation Lid Lift) is performed with eyelid surgery (Blepharoplasty).

The outer brows are repositioned through the eyelids and sides of the scalp. The combined brow & lid lift creates a lovely separation between the eyelid and eyebrow. A refreshed, awake appearance is the end result. Delay the signs of aging around your eyes by lifting, tightening and smoothing your eyebrows and eyelids all in one operation.

Advantages:
The eyebrow repositioning is performed at the same time as the eyelid reshaping. The outer brow is elevated, creating a lovely separation between the thicker brow skin and thin delicate eyelid tissue. Not only are the brows lifted, but the muscles causing those deep lines and furrows in the forehead are softened, eliminating many of the lines and wrinkles.

Scars are kept to a minimum without the need to remove excessive hair or to scar the top of the scalp. Eyelid and brow scars are well hidden, which is especially beneficial for men or women with receding or thin hairlines.

With this unique procedure the upper face is revitalized. Eyebrows and lids look natural and refreshed. It is safe and associated with minimal discomfort.

The end results restore a natural and healthy appearance.

When is the optimal time for my surgery?
Being in the best shape, mentally, physically and skin wise is desirable. As the rest of our body ages, so does the skin. The elasticity and thickness diminish over time, therefore, having a procedure when there is something relatively small to correct is better than waiting for everything to fall. An earlier lift lasts longer and gives you added years to look and feel your best.

Why have a Browlift & Blepharoplasty?
Often the outer eyebrows droop causing a stern or harsh appearance. The brows fall below the bone causing a hooding of the over the outer eyelids. You will only notice the hooding if you allow your eyebrows to relax. It is common to keep the forehead wrinkled and thus elevate the outer brow skin. So you may not be aware of your eyebrows low lying position.
When the brows are low they must be gently repositioned immediately prior to correcting the extra lid skin and fat. Otherwise the appearance will not be natural and the lid scar will extend onto the thicker temple skin. Only addressing both the brow position and the lids can you be afforded an optimal look. In order to give a natural appearance after surgery, the lids and brows must all be balanced.

Are there any other treatments that will improve my appearance and results?
Definitely! Good skin care and the proper skin care products will get your skin in the best shape before surgery and maintain it afterwards. We have superb skin care aestheticians who will evaluate your skin and recommend the proper care for you.

Where is the surgery performed?
A private Surgical Center in Bridgeport or Bridgeport Hospital

What will I need before surgery?
You may be asked to obtain a medical evaluation by your family physician, and/or an eye exam by either your optometrist or ophthalmologist to ensure that you are in the best possible shape.

Type of Anesthesia:
You are gently put to sleep using general anesthesia so that you will be comfortable throughout the operation. Once asleep, I will place local anesthetic under the skin so that you will feel no discomfort. This will also minimize the amount of medicine you receive during the operation. By putting you to sleep your heart rate, blood pressure and levels of oxygen will be optimized. Rest assured that being asleep for hours is generally very safe, and the 5-5 ½ hours you sleep will be just fine.

Will smoking effect my healing?
Yes- Each cigarette’s effects lasts 12 hours on the blood vessels of the body. Smoking causes the skin to heal poorly and the complications associated with smoking are tremendous. Even second hand smoke during the weeks before after and after surgery will adversely affect your results. Stopping is a must before and after any operation.

How long will the surgery take?
I take my time and like to be meticulous. This means not rushing through your surgery in order to work on another patient. In addition, there are many things that must be done before the operation can even start, including washing and preparing the area, making sure that your body is well cushioned, and placing your legs into special boots in order to compress them during the surgery. Likewise, at the end of surgery I need to clean your face and apply a special dressing. I will also wait around in recovery after the surgery to be certain that all is going well before I leave. The surgery itself lasts between 5- 5 ½ hours.

What can I expect?
The folds of skin and creases in of the upper and lower lids will be smoothed out. Bulging pockets of fat will be softened and re-contoured to yield a refreshed and alert appearance. Your eyes will look much brighter than before. Likewise the low lying eyebrows will be positioned to give a wide awake and natural appearance. Usually, only the outer 1/2 – 2/3 of the brow is altered so that you will not have a frightened or abnormal appearance. The forehead may also be smoothed out so that you will no longer have the need to raise the brows up off your eyelids by wrinkling. The combined procedure will open up your eyes and give you a lovely separation between the brow and lids. Men, too, are benefited by the combined lift; however, the brow position is contoured and tailored specifically for males to leave a masculine and rested look.

Where are the scars?
The scars are well hidden in the upper lid crease and just below the lower eyelashes. Often an invisible scar is placed inside the lower lid to remove unwanted fat. The browlift scars are in the hair bearing temple regions of the face. The scars are a few inches long and have a curve to match the contour of your head.

Do you shave my head?
There is not need to shave the area. A fine strip of hair will be trimmed, but this is usually the area to be removed. So you will lose very little hair.

Can I have a noticeable bald area?
Although the cutting is between the hair follicles to allow growth over the scar, there are occasions where the hair does not grow sufficiently. However, the surrounding hair is usually sufficient to cover the scar.

How long will I wear a bandage?
At the end of surgery I will place paper strips along the upper lid and across the outer lower lids. These will support the lids and keep the tread clean. When you awaken in recovery you will have a cotton pad over the lids for 30 minutes to keep the swelling to a minimum. I will then remove the pads while you eat and drink. Your head will be wrapped with a soft comfortable dressing for 24 hours. You will be instructed to remove it the next day.

Do I clean anything?
The paper strips on the lids are best left alone. You will have clips in the scalp to support the skin and afford a better scar. These clips are washed in the shower with shampoo, cleaned with a q-tip and peroxide and then covered with a very thin layer of antibiotic ointment (Bacitracin). At times you may need to place a gauze pad or sanitary napkin over the clips if there is any oozing. This would be for the first few days, if necessary.

When can I shower?
Usually the day after surgery you can shower; however, it is best to not let the water hit your face. Bathes, hot tubs, and steam rooms are not a good idea for 3 weeks after surgery so as to keep your swelling down. Washing your hair the day after surgery is perfectly fine. But you must either towel dry the area gently or use a hair blower on the cool setting. No heat to the area for 2 weeks.

When can I get my hair colored?
Coloring your hair a week prior to the surgery and 3-4 weeks afterwards is good. If there are any small open areas in the scalp then you might have to wait a bit longer after surgery to recolor.

Will my lids or forehead hurt?
Generally, there is minimal discomfort. You may note snugness where the extra skin was, but there should be very mild or no discomfort. A prescription to help alleviate pain, should it arise, will be given before surgery. Occasionally, there is mild discomfort over the temple area for the first two nights. This is easily relieved with the pain medicines supplied.

When I can resume activities?
It is best to relax for the first 7-10 days. Bruising is variable and usually located around the lids. Seeing your best friends after 10 days is good, but I would wait at least 2 weeks before meeting new acquaintances. After 2 weeks you will look presentable. After 3 weeks you will look much better than before surgery, but you still have another 3-4 weeks for 50% of the swelling to subside. It is not a good idea to exercise or increase your heart rate for 3 weeks from the time of surgery. This will help to diminish your swelling and improve the rate at which you heal.

What can I do to expedite my healing?
We will give you a set of guidelines that tells you what medicines to stay away from and which vitamins to take. Do not allow anyone to smoke in your presence for weeks. Using ice often, rest, maintaining a low salt diet and having a positive attitude all go a long way to assisting your recovery.

When will I see you again?
Depending upon the combination of surgeries, you will re-visit the office within 4-8 days. There will be multiple visits (which are included in your care) to evaluate your progress and support your healing needs.

Are there any additional fees to what was quoted?
Occasionally, the surgery takes a bit longer (as there is never a rush), but you may owe an additional fee for the operating room and anesthesia. However, if future surgery or procedures are necessary then there are additional fees for anesthesia, the operating room and the surgeon.

Conclusion:
My staff and I will strive to take the best care of you. We appreciate your trust and confidence in us and do not take it lightly. My aim is to refresh, smooth out, and brighten your appearance. A natural look is always best; especially one that maintains your personal facial identity. Looking as good on the outside as you feel on the inside is what we will accomplish together.

If you have additional questions we are available to answer them. Thank you for visiting us today.

Jeffrey S. Rosenthal, M.D.

BOTOX THERAPY
See the dramatic results YOU can achieve
with Botox

Dynamic wrinkles are caused by contractions of the delicate underlying facial muscles every time you smile, laugh or frown. The more emotion you show, the deeper these wrinkles and lines are likely to be.
Deep ingrained lines of the face will not be affected by Botox injections only those lines caused by muscular activity will be improved or softened.

The procedure known as cosmetic denervation uses Botox injections to improve the appearance of worry lines, frown lines, laugh lines, crow’s feet and other dynamic wrinkles.

WHAT IS BOTOX THERAPY?
Botox is a purified botulinum toxin and is used to soften facial lines and wrinkles. Botox works well for forehead lines, crow’s feet, and frown lines. Botox is injected into the muscle in these areas and works by weakening the muscle, which in turn lessens the lines of facial expression. Botox relaxes the muscles so they do not contract fully. Botox blocks impulses from the nerve to the tiny facial muscles that are related to expression lines.

ARE BOTOX TREATMENTS SAFE?
Botox injections have been used safely and effectively for over ten years to treat many ophthalmological and neurological disorders. Each year thousands of patients receive Botox treatments for a variety of conditions and it is quickly becoming a popular treatment for reversing the visible signs of aging. Botox treatments for wrinkles and signs of aging have not specifically been approved by the FDA. It is considered an “off the shelf use” of this product and has been used by physicians for this purpose.

WHAT IS THE TREATMENT LIKE?
Cosmetic enervation with Botox is a simple and relatively safe procedure. Using a tiny needle, a very small amount of Botox is injected into several locations on the face. Because the needle is so fine and only a small amount of liquid is used, the pain associated with the injections is minimal. Using a topical anesthetic (Emma cream) will further diminish your discomfort. Most patients compare the sensation to a bug bite. You can resume normal activities immediately but exercise is not recommended for 4-6 hours. You can drive yourself home. Some patients experience a slight bruising at the injection site. This can be covered with make-up. The treated areas will take 5 to 14 days to soften; treatment will last 3 to 6 months.
PRECAUTIONS TO BE FOLLOWED
If any of the following apply to you, you should not receive Botox injections:
- If you have myasthenia gravis
- If you have neuromuscular disease such as muscular sclerosis
- If you have an allergy to human albumin (eggs )or to botulinum toxin
- If you are pregnant or breast feeding
- If you have taken aspirin, Advil or anti-inflammatory medication in the last
two weeks.

WHAT TO DO AFTER BOTOX INJECTIONS
Do not lie down for 4 hours after the treatment
Do not massage the treated muscles for 4 hours, this could possibly cause the Botox to spread to the muscles around the eyes.
Exercise the muscles injected by contracting them 2-3 times every 15 minutes for 1 hour after the treatment, this helps the Botox attaches better to active muscles.

REPEAT BOTOX INJECTIONS
Injections can be repeated every 3 to 6 months. With time some patients will require less frequent treatments as they break the habit of contracting frown lines and other muscles of facial expression. The muscles themselves may weaken from lack of use.
Sometimes an injection does not have sufficient effect and a touch-up is necessary. The Botox effect may take 36 hours to 14 days. Repeat injections are necessary every 3-6 months or sooner in some individuals.

Sometimes the Botox injection is not effective due to the production of antibodies or individual resistance to Botox. Boxtox effect may also decrease in its affectivity over time.

ARE THERE ANY SIDE EFFECTS?
Temporary bruising is the most common side effect. Sometimes an injection does not have sufficient effect and a touch-up is necessary. Occasionally, individuals may be resistant to the Botox injection. Rarely, drooping of the eyebrow or eyelid can occur. Lasting for up to six months, this drooping is may be reversible with an eye drop medication.

Extremely rare double vision has been reported. In some cases, Botox can migrate and cause a temporary weakness of nearby muscles and asymmetry of the face. The risk of any side effect depends on the muscles injected. Dr. Rosenthal will discuss this with you in length before your treatment. Because the effects of Botox are usually reversible, most side effects are temporary, lasting a few weeks to months.

We look forward to assisting you and will be glad to answer any questions relating to Botox injections.
Jeffrey S. Rosenthal, M.D.
Fairfield County, Connecticut

Diet and Beauty Advice From the Experts
Woman’s Magazine asks our Local Professionals….
Jeffrey S. Rosenthal, M.D., Fairfield:

Why is it you just cannot lose those bothersome inches from your hips, thighs and buttocks? Genetics confounds your every attempt, leaving you frustrated and angry. We are not talking about ten, twenty or more pounds equally distributed, which can be managed by a good exercise program and eating style. Enter liposuction, stage right!

Liposuction is a technique that sculpts away fat cells using a thin tube, called a canula, attached to a vacuum device. Under a good surgeon’s hand, it reshapes bulges to gentle curves. Fat cells are whisked away by suction, never to return. Remaining fat cells can get bigger or smaller, like a balloon inflating or deflating, but there are fewer cells to blow up.

So imagine a process that allows you to fit into smaller jeans or wear the same sizes of a two piece bathing suit by altering your contours. It is not a weight reduction method and the final results do take a bit of patience, but the end result is well worth its weight in….!

Dr. Rosenthal is a Board Certified Cosmetic and Reconstructive Plastic Surgeon. 140 Sherman Street, Fairfield, Ct. 06824 – Telephone 203-335-3223

Foggy Brain (or Fuzzy-Brain) following Chemotherapy:
Is It Real or Imagined?

Previously only discussed behind closed doors; chemotherapy’s aftermath of memory problems, fatigue, anger and despair are now out in the open. While chemotherapy affects each and everyone differently, by understanding what is happening during this crucial time in your life, you can establish a sense of control. With the knowledge of the physiological and psychological effects of chemotherapy treatment, you can have more confidence in your self-perceptions and can assist in your recovery. You can call upon your inner resources (and power) during and after your treatments to help heal yourself. Rest assured that this strength is at your fingertips. So, let us explore some of the explanations for what is happening to your body that will enable you to better deal with these confounding alterations in your life and very being.

First and foremost, realize that the stress that your body is under is enormous. In response to this added stress, your body produces cortisol, which is made by small walnut-sized organs above both kidneys called the adrenal glands. Imagine that you are an athlete about to compete in an event. Your heart rate increases, your muscle tone becomes exaggerated, your pupils dilate to let in light as your brain prepares to control all these events and those to come. Well, your adrenal glands are in a race. They are overworked with the stress of worrying, fears of cancer, along with your efforts to control these fears and unknown future events. You may have gone through surgery or are about to have your cancer removed. Constant stress causes your body to be in a heightened state of tension. This heightened state of arousal (tension) exacerbates your existing feelings of discomfort and vulnerability. The extra cortisol also adversely affects insulin utilization, fat, and sugar processing. You may find that getting up in the morning is difficult. You may have no energy to lift your head off the pillow and find that fatigue sets in faster and lasts longer. The adrenal glands’ production of cortisol due to stress is eventually altered. This will further add to your state of depression and create abnormal responses within your brain.

The chemotherapy drugs that you presently take to control any remnants of your breast cancer drastically affect estrogen production. If you are not already menopausal, your body’s hormonal balance will be thrust into a rapid state of change. Normally, the onset of menopause is a measured process that allows your body to gradually adjust to the decrease in estrogen (peri-menopausal). However, breast cancer cells are often dependent upon estrogen and, thus, part of the cure is to diminish this source of supply. With the decrease in ovarian and fat production or blockage of estrogen, comes the onset of a menopause-like state. You may find that your skin has a different texture, your sexual organs are drier, your mood has changed and there are rapid oscillations in the way you feel.

Things that normally were taken in stride now become much greater events in your life, which can, in turn, lead to a state of depression. Likewise, your body naturally produces testosterone that helps to maintain muscle and bone strength and works in conjunction with estrogen for sexual arousal. Prior to this instantaneous menopause, your testosterone levels were balanced by estrogen. Now, however, unopposed testosterone may contribute to your feelings of tension and anxiety, or it can cause you to yield to aggressive tendencies that in the past were more easily suppressed.

The brain has message transmitter hormones that are also in a state of turmoil. Your life has suddenly been altered by the discovery of breast cancer. Of course, you contemplate the worst. Surgery and chemotherapy add additional insults to your body. Your sense of worth, empowerment, and control over your life and destiny have been altered by the simple words that you have cancer. The daily pressures of life, raising and caring for a family, spousal obligations, and work activities have put you in a pressure cooker mode. Pressures, which you normally take in stride, become burdensome. This only compounds your anger, episodic mood swings and anxiety or depression. Coupled with the psychological changes are the physical manifestations that may occur due to the chemotherapy and surgery. Your personal identity is now undergoing a transformation. This is not who you are or who you have been.

Added to this is the insult of memory and learning disruption; i.e., where are my keys? , did I do that errand today? This interference in memory and learning are called cognitive loss. Studies confirm that these alterations in your thinking may indeed be real. It is likely that the burden of having breast cancer and the additional strain of going through treatments compounded by your hormonal imbalance and altered cortisol levels, may contribute to the loss of memory and learning difficulties.

Not only do cognitive alterations exist and impact upon your daily activities, but they have far-reaching effects on your family members, friends and business relationships. Some of the losses in memory and cognitive thought may even last years beyond the end of your treatment. You will be undeniably disturbed by these cognitive losses and may not know how to deal with them. This is especially true if you are told that these memory changes, physical disruptions, and social breakdowns are unique to you and not commonly shared by many women in these circumstances.

But as we know now – this is far from the truth.

We do not have all the answers, nor do we know the exact cause of these alterations. Common sense would tell us that they are attributable to many coexisting factors affecting you.

The first step towards helping yourself is to recognize that there is a problem. An honest and open discussion between you and your physicians (oncologist & surgeon) and counselor regarding your experiences and fears, needs to be brought out into the open so that you can better manage your altered lifestyle. Controlling, minimizing, or mitigating the hormonal, physical, and emotional side effects of chemotherapy is a challenge that should be embraced and understood rather than ignored or denied.

One has to realize that the art of medicine is a healing continuum that embodies learning about the disease process, formulating specific treatment options, and then redirecting these parameters to meet your personal and ever-changing needs. Treatments are far from perfect, but strides made within the past decade for curing breast cancer have been tremendous and are responsible for the continued health of countless women and men.

Treatment options are multidimensional, relying on the control of breast cancer through surgery, chemotherapy gene identification, and radiation therapy. Someday we hope to identify and isolate the genetic causes of cancer. Until such time current treatments reflect the present day state of medical research and are still the most effective that humanity has ever yet known.
The healing of the body through the mind-body connection, given the appropriate environment, is legendary. This restorative process can only occur if attended to with the awareness of the problem and the desire to help oneself. Cancer is the Gordian Knot of our era. How do we cure cancer while maintaining the stability and health of the human body?

Multi-tasking:
Multitasking, or simultaneously performing many tasks at once, may be disruptive to the thoughtful understanding of each task that your brain needs to analyze and formulate answers. Try riding five trains at the same time that are going in different directions. Which destination will you reach when traveling in such a chaotic pattern, and do you really save time? Or is it just a huge expenditure of your brain’s energy? The brain may process these tasks but there is a toll that must be paid. Multiple centers of the brain light up at once when you try to do simultaneous tasks. Remember that the brain is constantly working to maintain your life functions of breathing, circulation, fighting infection, controlling muscle movement, thoughts, vision, hearing and speech to name but a few tasks. Asking your brain to jump through hoops to satisfy your multiple comes at a cost. Multi-tasking boosts stress hormones, which are already zooming upward; wearing down your finely balanced internal system resulting in fatigue, loss of focus, and chaos. How often have you forgotten where you were driving when on the phone? A famous actress noted that she likes to save time by reading a book or watching a movie while having sex.

Emotional imbalance & Counseling:
Emotional upheaval and physical distress will affect your family. Surgery upon the breast may leave you with feelings of sexual inadequacy. It is important that you realize that you are still the same woman within and that your family and friends love you.
Anger, when directed for a reason, is healthy; however, when it is free-floating and unbridled it will eat away at you and increase your overall stress level. Reach into your inner core and find a comfortable place where you can allow your mind to be calm – the place where loved ones exist and where smiles and laughter and good times are in abundance. Extend your hand and its warmth will be met by those that care about and for you.

Your mind has an amazing ability to heal you, if you let it. No one denies that you have the right to feel badly, but wallowing in self-pity does not help your body to heal. What can be done with the feelings of isolation, frustration and anger? Confiding your feelings with a friend or counselor helps. Writing your worries down in a private journal to get them off your mind will often soften the tension and distress. Centers such as the Norma F. Pfriem Breast Care Center will be your advocate; friends await you there to direct you or just lend a hand on a bad day. Likewise, excluding your spouse, significant other, family or friends in the attempt to shelter them, often works in the reverse. Openness allows for greater understanding and compassion. They, too, want to help and may also be feeling frustrated and alone. If you isolate yourself within an impenetrable barrier, those that care about you cannot share their loving warmth. You are counseled to let them into your life to calm the energy imbalances within you.

Exercise:
Jump-start your body with daily exercise. Feelings of well being, due to increased blood and oxygen flowing through your body, are essential and add to your peace of mind. Likewise, exercising daily produces pleasing substances called endorphins, which assist in the regulation of your happiness. The stress created by your body is translated into accelerating levels of cortisol similar to that found in the runner about to start a race. Exercise is a way in which the body can reduce these levels and calm down once again.

Smoking:
Smoking steals much-needed oxygen from your muscles and brain. The 40-plus toxins and nicotine present in cigarette smoke only serve to diminish the oxygen needed to heal you. Nicotine accelerates your heart rate and shrinks down blood vessels throughout your body. This crutch will, in the long run, be more harmful than helpful. Besides robbing your body of blood flow to your internal organs, it permanently alters the quality of your skin and adds additional risks of poor health.

Nutrition:
Your body needs healthy nutritional foods that can sustain it during these added days of stress. There is nothing wrong with the occasional splurge; however, eating a balanced healthy diet will nourish your body and mind. The human body and mind are amazing; however, they need nourishment. The tendency may be to eat out of frustration. And who could blame you. But in the long run eating a diet low in saturated fats and sugars with moderated consumption of alcohol (which is a depressant), will afford you a greater opportunity to heal. Common sense tells us that water (which comprises most of our body), grains, fresh vegetables, unsaturated fats and proteins will replenish the energy source for your brain and motivate your body.

Omega 3 fatty acids are important for the nerves and brain. Fat is a large component of the cells that comprise the nervous system. Take supplements of good quality.
Vitamins such as Zinc and B complex will soothe your mind. Calcium and magnesium will nourish your bones and allow muscles to function properly. Other vitamins should be discussed with your physician prior to starting. During your treatments it is important to ask your oncologist and surgeon which vitamins are acceptable. Likewise, a consultation with a nutritionist knowledgeable about various effects of food and supplements on your treatment will be beneficial. There are numerous books that will augment your understanding of your added nutritional needs, found in bookstores or on the web.

Is chemo-brain real or imagined?
The crux is that normal patterns of forgetfulness occur with the natural aging process. When the emotional intent of the thought and reality of breast cancer is added to the mass of swirling thoughts that the brain has to master minute by minute, it is no wonder that you become overwrought. Family, business and personal obligations, fears of the unknown, and the potential ramifications, estrogen and hormonal imbalance, physical discomfort from surgery or chemotherapy, all contribute to the feeling of having a foggy brain.

You may feel fragile, confounded by the thoughts of illness. The unknown is always worse than actually knowing. Overwhelmed and distraught, your mind has no peace. Constant turmoil precludes clear thoughts. Cancer is a bummer to have. It threatens your very existence. You can overcome these dreaded events that you are going through and come out a stronger and healthier woman. It may be no solace to know that many have traveled the same path, but it does help to understand that your happiness is dependent on your outlook. Living your life, as best as you can, during this difficult time, will help your body and mind. Our cells are renewed each day, giving us the opportunity to grow and become stronger. Healing requires time, positive energy, patience and love of self. Like a paper cut upon your finger, which is initially sore, your healing will require time and soon be a part of your past.

Balance:
Try meditating. This can take various forms. Thinking and repeating to yourself that you are healthy and happy is a self-fulfilling prophecy.

Visualize yourself being well, strong and healthy. Visual imagery has been shown to affect the body in a very positive manner.

Surround yourself with friends who are calm and generally optimistic. Negative individuals give off negative energy. Positive energy buoys us up and recharges us. Would you not be more pleased to be around a person who smiles rather than a frequent frowner?

Laugher is contagious and in all likelihood calms the brain down or relieves it of tension.

Focus on what really matters to you. If you find that you are forgetful, make a list of the things that you need to remember. Busy people have a lot on their minds and need reminders. Daily stresses of living exaggerate everyone’s forgetfulness.

Take a health break when you can. Stop and breathe, take a brief walk, read an enjoyable book or magazine to clear your mind.

Start a log of your journey. Record the good and the not-so-good. Not as a reminder of these events but to alleviate your mind from having to remember them. Air your thoughts in private and with your family, friends and a counselor or therapist who will guide you through this turbulent period.

Some days may be bluer than others but beautiful golden mornings and stunning sunsets await you.

With your loving family and friends on your side you will be able to reach deep within yourself to find a center of calm within what must seem like an endless storm. Take the time you need for your well being. Peace and tranquility emanates from within our central core.

Difficult as it may seem during these life altering times, having a positive approach and surrounding yourself with the warmth of your family and friends will help to overcome the hurdles faced with having breast cancer. Your mind is an amazing organ of growth and healing. Your mind and body are one. Together they have been known to accomplish unparalleled and only dreamt of deeds.

Congratulations! By endeavoring to understand yourself, you have just realized one of these amazing goals. No one will say that what you endure is easy; but with guidance and balance to your life you can and will flourish.

Liposuction or Abdominoplasty? How to Decide?

by Jeffrey Rosenthal, M.D.
Sometimes, patients are confused about exactly which procedures they need to under go in order to take care of a bulging stomach. Many come to me after childbirth and when their families are complete to regain the figure they had before pregnancy.

I remember one patient who told me:
“Choosing clothing in the morning used to be a daily chore. Now, after my contouring surgery, it’s a non-issue. Whatever I pull out, I can wear. What a pleasure, one less thing to think about.”
That patient, Karen, bore great frustration and displeasure about her hips, wide thighs and buttocks that did not fit the upper half of her body. Despite an active exercise program, she could not reduce these bothersome areas. Buying clothing a size larger was necessary to accommodate the discrepancy between her top and bottom. Moreover, her pants were snug in all the wrong places, making her uncomfortable and self conscious.
The answer for Karen? Liposuction.
Liposuction vs. Tummy Tuck
Morgan, too, was disenchanted with her body. After multiple pregnancies, her belly never returned to the flat, toned shape she was used to seeing in the mirror. Nor did sit ups seem to be the answer. Skin draped over her pants, her muscle tone was gone, and she contemplated never wearing a bathing suit in public again.
“Liposuction is ideal for women with localized fat deposits.”
Morgan’s solution lies with a tightening procedure known as abdominoplasty, or more commonly called a “tummy tuck.”
Body contouring is a permanent solution to improving both your shape and body image. Both liposuction and abdominoplasty remove fat from the belly, but that is where the similarities diverge.
Body Contouring
If you are old enough to remember the Special K cereal commercial, you may recall that if you could “pinch an inch” you were told you can lose some weight by diving into their cereal.
Additionally, this ad pitch can be used to determine which areas of the body to contour. Areas of the belly that show localized fat beneath the skin can be removed — forever — using either procedure.
So what’s the difference between liposuction and an abdominoplasty? Why can’t you just suck away the pounds?
Generally, neither procedure is appropriate for very overweight people until they have lost weight and have reached a healthier state. The path we surgeons decide to take is determined not only by the amount of fat present but its location.
Other determining factors are how loose the skin is, how stretched and floppy the overlying skin appears, whether the muscles that support the inner organs are saggy or snug, if there are large areas of unsightly stretch marks, and if the belly button is cute or has been widened.
Local Fat Deposits
Showing these areas of concern to a plastic surgeon may be disconcerting at first because no one likes to bear it all, but the only way to choose the right course of action is through a complete examination.
Liposuction is ideal for those women and men with localized pockets of fat. It is an amazing procedure which sculpts away selective fat deposits previously resistant to diet or exercise. Frequently, these bulging zones are genetically predetermined and easily found somewhere else in the family tree. Those with ideal body weight, who are unable to contour genetically determined areas, benefit greatly from this procedure.
Remove Fat Cells
Don’t despair, help is on the way! Universal areas of concern such as the hips, inner and outer thighs, abdominal area (belly), knees, waist, back, and neck can be contoured with great success. Smoother, shapelier bodies are the end result.

Either general anesthesia or sedation is followed by placing local anesthetics under the skin to numb and soften the areas to be suctioned. Tiny, well-placed, barely visible incisions allow for sculpting using various thin tubes (known as cannulas) attached to a medical vacuum device.
After the procedure, supportive, elastic compression garments are worn for a few weeks to keep the areas snug. Mild discomfort is treated with simple pain medicine and a period of bruising and swelling is tended with cold packs. The difference in your new body is apparent in weeks. Thereafter, your shape continues to improve as the swelling subsides. Since we are born with a finite number of fat cells, once they have been removed they do not return. This allows for a permanent contour improvement.
So, why not just do liposuction?
Again, a careful examination will often be the telling factor. Patients with loose skin, poor muscle tone of the abdomen, or bulging of the belly from protrusion of the inner organs will usually not be good candidates for liposuction because simply removing fat from these areas will not afford optimal shaping.
Mommy Makeover
Although pregnancy brings new life and love to your family, it usually results in stretching of the tummy skin and underlying muscles with accumulation of unwanted fat. The tummy tuck is part of the “mommy makeover” procedure.
“Like a deflated balloon, the stomach of a woman after extensive weight loss or pregnancy is often loose, floppy and wrinkled.”
Think of a deflated balloon that will never again retain its original shape once it has been inflated. Like a balloon, the belly of woman after extensive weight loss or pregnancy is often loose, floppy, and wrinkled. This is especially true of a woman with a narrow pelvis allowing for the front and bottom of the abdomen to enlarge disproportionately.
Muscles that support the front of the abdomen, running vertically from below the ribs to the pubic area (the rectus muscles), are pushed apart and stretched like a rubber band and may be made worse after c-sections. It’s very similar to pulling on an elastic band until it no longer snaps back. The result is what we fondly call a potbelly. The crunch machine will not help much in this situation, nor will dieting and exercise significantly improve these areas. But the tummy tuck can.
An abdominoplasty is a far-reaching procedure that requires you to be asleep under general anesthesia. Extra fat and sagging skin are removed while the underlying loose rectus muscles are tightened.
Hip, Thigh Bulges
Stretch marks along the lower front of the abdomen are also removed as the abdomen is toned and slenderized. The belly button is also contoured to fit your new appearance. Often, liposuction can be added to reduce troublesome bulges of the thighs or hips, as well.
The scar is hidden within underwear and swimsuits along the lower belly and usually around the belly button. There is more discomfort for the first week or two than with liposuction, but then again, muscles and skin have been tightened. Activities after this surgery are limited to prevent swelling or other harmful side effects. You will be pleased to note that this includes such mundane activities as house cleaning and cooking or any activity that would increase your heart rate and blood pressure. During these weeks, you will be wearing an elastic binder to aid in comfort and decrease swelling.
Why have an abdominoplasty? You probably already know the answer. Your body is proportioned once again, posture is corrected and a new wardrobe is attainable! And best of all, the extra lower belly skin is no longer hanging. Although swelling and healing takes a while to disappear, you will note in a few weeks how well you look and feel.
Plastic Surgery: An Art Form
You need to be comfortable with your body and the decisions you make to reshape it. Seek out a board certified plastic surgeon who can explain the various options with you and be one with whom you are at ease.
Remember that plastic surgery is also an art form that brings together both sculpting and science. During your consultation, ask questions and look for honest answers. You should be shown before and after photos of other patients who have had similar procedures. Being realistic in what can be achieved and what you can expect will only heighten your satisfaction and allow you to delight in your new body. It is an amazing adventure which can offer a lifetime of joy.
Just look at the difference in one patient’s stomach:

A 37-year-old patient with two children shows the state of her tummy before her abdominoplasty procedure, right. After three months, the patient shows the results of her tummy tuck, left. Note the great improvement and lack of scarring in her belly button which has actually been surgically moved to a higher position. (Photos, courtesy of Dr. Rosenthal.)
The national average surgeon fee for liposuction in the United States during 2006, the most recent year for which statistics exist, was $2750. The national average surgeon fee for tummy tuck, also during ’06 was $5,063. Be sure and ask your surgeon about other plastic surgery costs like anesthesiologist fee, operating room fee, pre-surgical testing, medications and compression garments, among other possible charges.
About the doctor: Jeffrey S. Rosenthal, M.D. is a board certified plastic surgeon in private practice in Fairfield, Connecticut. Dr. Rosenthal is also an artist and sculptor and Emeritus ,Chief Section of Plastic Surgery at Bridgeport Hospital.

Liposuction or Abdominoplasty (tummy tuck): How to decide.

January 11, 2008

“Choosing clothing in the morning used to be a daily chore. Now, after my contouring surgery, it’s a non-issue. Whatever I pull out, I can wear. What a pleasure, one less thing to think about.”

Karen bore great frustration and displeasure with her hips, wide thighs and buttocks that did not fit the upper half of her body. Despite an active exercise program, she could not contour these bothersome areas. Buying clothing a size larger was necessary to accommodate the discrepancy between top and bottom. Her pants were snug in all the wrong places, making her uncomfortable and self conscious. The answer for Karen? Liposuction.

Morgan, too, was disenchanted with her body. After multiple pregnancies her belly never returned to the flat toned shape she was used to seeing in the mirror. Sit ups did not seem to be the answer. Skin would drape over her pants, her belly muscle tone was gone and she contemplated never wearing a bathing suit in public again. Morgan’s solution lies with a tightening procedure called an abdominoplasty, more commonly known as a “tummy tuck”.

Body contouring is a permanent solution to improving both your shape and body image. These procedures fall within two categories: liposuction and abdominoplasty (or tummy tuck). Both remove fat from the belly area, but that is where the similarities diverge. If you are old enough to remember the Special K cereal commercial, you may recall that if you could “pinch an inch” you were told you can lose some weight by diving into their cereal. This saying can be used to determine which areas of the body to contour. Areas of the belly that show localized fat beneath the skin can be removed- forever- using either procedure. So then, what is the difference between liposuction and an abdominoplasty? Why can’t you just suck away the pounds?

Generally, neither procedure is appropriate for very overweight individuals until they have lost weight and have reached a healthier state. The path we decide to take is determined not only by the amount of fat present but where it is located. Other determining factors are how loose the skin is, how stretched and floppy the overlying skin appears, whether the muscles that support the inner organs are saggy or snug, if there are large areas of unsightly stretch marks and if the belly button is cute or has been widened. Showing these areas of concern to a Plastic Surgeon may be disconcerting at first; as no one likes to bear all, but the only way to choose the right course of action is through an examination.

Liposuction is ideal for those women and men with localized fat deposits. It is an amazing procedure which sculpts away selective fat deposits previously resistant to diet or exercise. Frequently, these bulging zones are genetically predetermined and easily found somewhere else in the family tree. Those with ideal body weight, who are unable to contour genetically determined areas, benefit greatly from this procedure.

For example, athletes who partake in multiple sports (as well as the people that train them) often become frustrated and despondent by their inability to sculpt their bodies despite vigorous exercise. It is difficult to achieve peak performance while feeling self conscious about one’s body image, be it a business meeting, playing tennis with your friends or just being you. There is help on the way! Universal areas of concern such as the hips, inner and outer thighs, abdominal area (belly), knees, waist, back and neck can be contoured with great success. Smoother & shapelier bodies are the end result.

Liposuction is immensely popular due to its ability to permanently remove fat cells. Either general anesthesia or sedation is followed by placing local anesthetics under the skin to numb and soften the areas to be suctioned. Tiny, well-placed, barely visible incisions allow for sculpting using various thin tubes attached to a medical vacuum device (not a Hoover!). Supportive elastic garments are worn for a few weeks after the procedure to keep the areas snug. Mild discomfort is treated with simple pain medicine and a period of bruising and swelling is tended to with cold packs. The difference in your new body is apparent in weeks. Thereafter your shape continues to improve as the swelling subsides. Since we are born with a finite number of fat cells, once they have been removed they do not return. This allows for a permanent contour improvement.

So, why do any other procedure than liposuction? Again, a careful examination will often be the telling factor. Those with loose skin, poor muscle tone of the abdomen or bulging of the belly from protrusion of the inner organs will not usually be good candidates for liposuction because simply removing fat from these areas will not afford optimal shaping. But there is another procedure that lifts, tightens and reshapes these difficult to manage areas of the belly. An abdominoplasty offers the greatest improvement to these problems by tightening and tailoring these structures.

Although pregnancy brings new life and love to your family, it usually results in stretching of the tummy skin and underlying muscles with accumulation of unwanted fat. Think of a deflated balloon that will never again retain its original shape once it has been blown up. Like a balloon, the belly of woman after extensive weight loss or pregnancy is often loose, floppy and wrinkled (prune belly). This is especially true of women with a narrow pelvis, allowing for the front and bottom of the abdomen to enlarge disproportionately. Muscles that support the front of the abdomen, that run from below the ribs to the pubic area (rectus muscles) are pushed apart and stretched like a rubber band and may be made worse after c-sections. This is very similar to pulling upon an elastic band until it no longer snaps back. The result is what we fondly call a pot-belly. The crunch machine will not help much in this situation, nor will dieting and exercise significantly improve these areas. However, a tummy tuck can.

An abdominoplasty is a far-reaching procedure that requires you to be asleep. Extra fat and sagging skin are removed along with tightening the underlying loose muscles from below the ribs to the pubic area. Stretch marks along the lower front of the abdomen are removed as the abdomen is toned and slenderized. The belly button is also contoured to fit your new appearance. Often, liposuction can be added to reduce troublesome bulges of the thighs or hips, as well. The objective is to produce a firmer, flatter and better shaped abdomen which might even put you back in a yellow bikini!

The scar runs along the lower belly and usually around the belly button. There is more discomfort for the first week or two than with liposuction, but then again, muscles and skin are tightened. Activities after this surgery are limited to prevent swelling or other harmful side effects. You will be pleased to note that this includes such mundane activities as house cleaning and cooking or for that matter any activity that would increase your heart rate and blood pressure for a number of weeks. During this time you will be wearing an elastic binder to aide in comfort and decrease swelling.

Why have an abdominoplasty? You probably already know the answer. Your body is proportioned once again, posture is corrected and a new wardrobe is attainable! And most of all the extra lower belly skin is no longer hanging. Although swelling and healing takes a while to disappear, you will note in a few weeks how well you look and feel. It is nice to have your body toned again and to be able to see you’re stocking feet.

Jane, another satisfied abdominoplasty patient said, “After three cesarean sections, sit-ups and weight reduction were of no help in hiding my pot belly. After my tummy tuck, I can now look in the mirror and see my toned, smooth body. My body is proportional again and my posture has never been better. It’s a gift to be able to buy a new wardrobe that looks great on me! The highlight of my experience was to find the body that I thought was lost forever. Tears come to my eyes when I think about how I found myself again.”

There you have it. You need to be comfortable with your body and the decisions you make to reshape it. Seek out a Board Certified Plastic Surgeon who can explain the various options with you and with whom you are ease with. Remember that Plastic Surgery is an art form that brings together both sculpting and science. During your consultation, ask questions and look for honest answers. You should be shown before and after photos of other patients who have had similar procedures. Being realistic in what can be achieved and what you can expect will only heighten your satisfaction, allowing you to delight in your new body. It is an amazing adventure which can offer a lifetime of joy.

Jeffrey S. Rosenthal, M.D.
Board Certified Plastic Surgeon
Private Practice Fairfield Connecticut
International/National Artist & Sculptor
Chief, Section Plastic Surgery at Bridgeport Hospital

Skin Deep
Want a Face-Lift? First, Better Stop Smoking

By ABBY ELLIN
August 14, 2008

LISA MORRISON has always considered herself a pillar of health. She ate only organic food, exercised often and meditated. The only glitch in her otherwise exemplary existence was the pack of Marlboros that she had inhaled daily since age 18.
By the time Ms. Morrison, now 50, went to see Dr. Vincent Giampapa, a board-certified plastic surgeon in Montclair, N.J., she had tried everything to quit for the sake of her health. “Acupuncture, the patch, hypnosis,” she said. “Nothing worked.”
Nothing, that is, until 2007, when Dr. Giampapa told her she would have to toss her beloved cigarettes if she wanted a neck- and eye-lift. “The doctor strongly suggested that if I wanted to heal properly I needed to quit,” Ms. Morrison said. “When you start talking about your face, it becomes motivating.”
Each year, roughly 40 to 45 percent of the 45 million smokers nationwide try to quit, according to Dr. Michael Fiore, the director of the University of Wisconsin Center for Tobacco Research and Intervention, in Madison. Only about 5 percent quit for life.
But these days, the growing number of cosmetic-surgery patients are motivated to quit for other reasons: vanity, and the threat of not being able to get a coveted new face, stomach or pair of breasts.
“When someone hears this from an internist or cardiologist who says it’s really bad for you, it increases your risk of lung cancer, it’s bad for your heart, people tend to blow that off if they’re feeling well,” said Dr. Alan Gold, the president of the American Society for Aesthetic Plastic Surgery. “But if they have a medical problem and are not going for just a routine checkup, they may tend to listen to that advice more.
“With plastic surgery it’s a little bit different. People are desirous of an elective procedure, and that’s their main objective in coming in. It’s something they truly want.”
For the last 5 to 10 years, many plastic and cosmetic surgeons have refused to operate on smokers, especially those seeking a face-lift, tummy tuck, or breast-lift — procedures that require skin to be shifted.
“Nicotine causes the tiny blood vessels in the skin to clamp down or constrict, which reduces blood supply to the skin,” said Dr. Darshan Shah, a plastic surgeon in Bakersfield, Calif. Complications can include poor wound healing, increased risk of infection, longer-lasting bruises, and raised, red scars.
“Twenty-five years ago, it may have been more acceptable for a patient to have undergone surgical procedures while smoking,” said Dr. Patrick McMenamin, the president-elect of the American Academy of Cosmetic Surgery. “Nowadays if a doctor knew a patient was smoking and they did flap surgery,” he said, referring to an operation where shifting skin is required, “many of us would say that’s malpractice.”
Plastic and cosmetic surgeons recommend quitting a minimum of two weeks before and after procedures, though some require longer to be extra safe. (Smokers also run the risk of infection and respiratory complications during anesthesia). For instance, Dr. Jeffrey Rosenthal, the chief of plastic surgery at Bridgeport Hospital in Connecticut, mandates six weeks of smoke-free living before eyelid surgery or breast augmentation, and six months to a year before a tummy tuck.
They also take it upon themselves to devise smoking cessation plans, prescribe drugs like Wellbutrin or Chantix and recommend hypnotists or support groups.
“Why invest so much money in a cosmetic procedure for enhancement if the patient will not participate and do his or her part to help ensure the best outcome possible?” said Dr. Shirley Madhère, a plastic surgeon in Manhattan.
Nancy Irwin, a therapist and clinical hypnotist in Los Angeles, said that plastic surgeons refer 5 to 10 percent of her clientele. “They don’t mind dying for cigarettes,” she said of her patients, but if smoking gets in the way of their breast enhancement, “there’s a problem.”
“They’re putting image before health,” she said.
Plastic surgeons cite a few reasons why now, more than ever, they require patients to kick the habit. In recent years, as the number of operations has skyrocketed — roughly 11.7 million cosmetic surgical and nonsurgical procedures were performed nationwide in 2007, up from 3 million in 1997, according to the American Society for Aesthetic Plastic Surgery — more people (and smokers) are coming through the doors.
Since most plastic surgery is elective, plastic surgeons have time on their side as opposed to, say, a heart surgeon. “You can talk to people about quitting smoking, but you may not have a month’s worth of time before you try to save their life with heart surgery,” said Dr. Roger Friedenthal, a board-certified plastic surgeon in San Francisco who refuses to operate on smokers.
The arsenal of non-nicotine antismoking aids have grown, too. “With the advent of things like Chantix, we have a much higher success rate,” Dr. Shah said. (A caveat: this year, the Food and Drug Administration issued a warning against the drug, claiming it can cause depression and suicidal tendencies in some patients.)
Then there’s the matter of the cosmetic surgeon’s reputation. It can’t help business if a cigarette-loving patient ends up looking like the Bride of Frankenstein.
“I take great pride in my work,” said Dr. Rosenthal of Bridgeport Hospital, who estimates that more than two-thirds of his patients who smoke quit for good. “I want it to look great for you as well as for myself. If they smoke even one cigarette, I run the risk of it not healing. It’s like trying to water your lawn with a crimped hose.”
But all surgeons — and not just plastic or cosmetic — are increasingly urging patients to stop smoking before surgery, be it a face-lift or to repair an anterior cruciate ligament, Dr. Fiore said. It’s not as if cosmetic surgeons are responsible for a major uptick in smoking cessation, he said, adding “this is not a prime driver of quitting in America.”
No doubt some patients lie about kicking the habit. “Some won’t, but will tell you that they have,” said Dr. Scot Glasberg, a board-certified plastic surgeon in Manhattan. “These are all adults, and I’m not going to be the person looking over their shoulders.”
The fact that some plastic surgeons do no more than check the condition of their patient’s skin and smell for nicotine provides a substantial loophole.
Others want proof. Dr. Samir Pancholi, a board-certified cosmetic surgeon in Las Vegas, obtains a urine test; Dr. Madhère asks patients to sign a legal waiver stating whether they have stopped smoking and acknowledging the postoperative risks and potential complications of smoking.
Fear motivated Carolyn Davis, 42, a reformed social smoker in Sacramento, to quit cold turkey before her breast augmentation in 2005. “This was like the first major surgery I’d had as an adult,” she said, “so when my doctor, who I respect, tells me not to smoke and here are some reasons why — then I have to respect that.” (In the four years since surgery, she relapsed for just two days, she said.)
Dr. Pancholi, who is certified by the American Board of Cosmetic Surgery, takes scare tactics a step further. He shows patients graphic postoperative pictures of smokers who didn’t heed his advice to quit. “They see the wound opening up, turning red or black, the edges start coming apart,” he said. “They see the skin graft we use to put it back together.”
Margaret Pyles, 42, a human resources director for youth homes in Bakersfield, first went to Dr. Shah in 2004, looking to have a breast reduction. He told her that she needed to quit a minimum of 30 days before the surgery. A pack-a-day smoker since 16, she couldn’t face battling her addiction yet again.
But once her back pain grew constant, and her abdominal muscles too flabby for her taste, Ms. Pyles went back to Dr. Shah last month for a breast reduction and lift as well as a tummy tuck and liposuction. But not before she quit smoking with the help of Chantix and a hypnotist Dr. Shah recommended.
Both helped her overcome nicotine, she said, but fear really kept her on track. “I was afraid the anesthesia would go wrong, or I’d wake up coughing my head off and split my guts open,” she said. “And I was able to stop.”
Ms. Pyles, who has not lit up again, is thrilled that her desire to turn back the clock may help prolong her life. “I was so focused on wanting the breast reduction more than I wanted the cigarette,” she said.

Teen patients require extra attention to detail
in consent, screening to avoid problems
Expect younger patients to have limited focus, overlook details of risk

Plastic Surgery Practice Advisor – May 2008

Major benefits possible for teen patients
Jeffrey Rosenthal, MD, chief of plastic surgery at Bridgeport
(CT) Hospital, has worked with many teenagers and
young adults and agrees that these patients can be limited in
their ability to focus, their willingness to discuss body image,
and their comprehension of the important issues involved. “I
have to drag information out of them more,” he says. “Some
are very willing to talk about it, but some are quite sensitive
about their body image and not comfortable talking about it
with a stranger. They tend not to be as expressive as adults.
You have to be very concerned with how you approach them,
what you say to them, how you touch them.”
Rosenthal also sends some patients to an adolescent psychologist
before approving the procedure to make sure
they understand the pros and cons of the surgery.
Clearly, some common cosmetic enhancements on young
patients are inappropriate, Rosenthal says. Providing Botox
or fillers for a teenager would be “reprehensible,” he adds.
However, he also notes that some cosmetic improvements
can have a significant positive effect on young people.
“I’ve done rhinoplasty on young men and women
and then had their parents come back and tell me that the
child is more confident, their schoolwork is better, they’re
just radically transformed,” he says. “I’ve also had young
people who had to stop smoking and drinking before surgery,
and then they never started up again. They saw that
they could stop.”

THE LIQUID FACELIFT

If you feel young but your face is telling a different story, then a “Facelift out of a Bottle” using Juvéderm.

By Jeffrey Rosenthal, M.D.

Radiesse and Botox will amaze you. Refresh, lift, tone and brighten your appearance while you maintain your personal identity. Why not look on the outside how you feel on the inside?

Fillers have revolutionized facial contouring with little or no downtime. Juvéderm and Radiesse are synthesized products that plump up, support and reshape the face, lasting from several months to over a year. The results can be so remarkable that Dr. Rosenthal refers to his procedure as “a liquid face lift”. While Juvéderm smoothes out lip lines and restores lost volume around the mouth, Radiesse restores or improves the cheek bones and arch to lift, smooth and contour hollow areas. The combination of Radiesse and Juvéderm is a perfect match for non-surgical facial rejuvenation and enhancement.
Botox is another wonderful non-invasive rejuvenating procedure that is used to create a “pretty” and relaxed upper forehead. Dr. Rosenthal can transform a tense and wrinkled forehead into a smoother and attractive one. He accomplishes this by balancing the many muscles in the upper face rather than leaving you with a frozen appearance. This creates a rested and tension-free appearance.

Be confident and comfortable with yourself. Even though beauty starts from within, let Dr. Rosenthal and his caring staff help you care for the outside.

“What You Should Know About Your Surgery”

Who is not a bit frightened or perhaps very concerned prior to having surgery? Even when the surgery is cosmetic or elective in nature, the threshold for anxiety is imposing. Having some control over the procedure will allay much of your anxiety and contribute to a smooth and enduring outcome.

Look at the surgery as an adventure, into an unknown land, that requires a guide to prevent your getting lost and to assure that the expedition will be advantageous. So let us delve into some of the ways that you can facilitate a positive outcome.

Choosing a surgeon is always the inaugural event, which will make the experience less bumpy. Look for a physician who has the knowledge, experience and skill-set to perform the surgery that you are interested in. But as crucial to whom you pick, this individual must be able to communicate the benefits, potential risks and expected outcome of the procedure and have a plan to make the event as stress-free as possible for you. Communication is paramount in all walks of life, but especially critical in order for you to trust that you will be well taken care of. Once you establish a mutual respect, trust that your surgeon will look after you and let go of your desire to direct the show.
Make a list of questions that you wish to be addressed during the initial meeting and come prepared by researching your surgery in advance on line, will greatly assist you. A word of caution is in order regarding second hand information from friends and their experiences may be influenced by a host of factors which are unrelated to you.

Ok, you have chosen your surgeon, the time and place for surgery but now your participation is even more integral to the successful outcome. Your state of mind influences how your body will deal with the physical part of the surgery. The immune system, that part of the body that fights to prevent infections and helps in the healing, is influenced by your overall health and how positive you are. You can control your outlook, to some degree, by associating with upbeat individuals and through filtering out worrisome thoughts and replacing them with a more optimistic attitude. The mind is a very powerful weapon that will protect and assist you in the healing process.

Let’s now discuss a few of the factors that you have a tremendous ability to affect.

Traveling far distances within a few days of surgery is not the ideal situation. Prolonged sitting causes the blood to pool in your lower legs which may increase the risk of blood clots. Likewise there are host of herbs, vitamins and medicines that either increase or decrease your ability to control bleeding or clotting.

To be on the prudent side you should discuss what medications you are on with your surgeon prior to the surgery. However, in general over the counter herbal products should be discontinued 2 week prior to surgery as they may influence your body chemistry or affect how you tolerate anesthesia. Many of us take baby aspirin daily to assist with circulation. Unless taking under the supervision of a physician, Aspirin, Motrin and Advil like products, vitamin E, fish oils, flax oils and cold remedies containing any of the above must be discontinued 2 weeks before and after surgery. Likewise your glass of nightly wine or spirits should be halted within the same time frame.

A word of caution is in order for those who partake of tobacco use. There are not many habits that are so destructive to the healing process than smoking. Numerous toxins, additives and nicotine bathe each cell of the body causing irreparable harm. The carbon monoxide that is inhaled affects the oxygen content of the blood, a vital component of healing, causing the areas operated upon to fall apart. Your lungs are compromised by the smoke increasing your risk of complications. You would not consider sucking on your car exhaust before or after surgery, so it is necessary to discontinue cigarettes weeks before and after surgery.

A few basics that will make the process smoother for you.

1. Stay away from crowds a few days before surgery to prevent your catching a cold.

2. The night prior to surgery eat a meal that is easy to digest, like pasta.

3. Stay away from salty foods for 2 weeks after surgery to decrease swelling.

4. Wear comfortable and loose fitting clothing to the center where the surgery is to done.

5. Get all of your prescriptions filled in advance of the surgery and learn what order and how often to use them.

6. Have a few bags of frozen peas or corn that you can transfer to baggies. Apply the peas/bags wrapped in a thin towel to the area that was operated upon for 10-15 minutes 4 times a day for a week to keep the swelling down.

7. If you have no pain after surgery, use Tylenol every 6-8 hours for the first 2 days to prevent discomfort. Or use the prescribed pain medicine given to you by your surgeon.

8. Keep the area operated upon elevated, if you can. This will diminish swelling.

9. Minimize your activity for the first week, to keep your blood pressure from rising.
10. Refrain from sports or heart rate elevation for a few weeks after surgery to allow for optimal healing.

11. Have low salt food at home for the week.

12. Books on tape or movies you can enjoy at home will take away from your boredom.

13. Expect bruising, some bleeding and perhaps discomfort for the first weeks after surgery.

14. Be realistic, you will not be able to resume your normal daily routine for days to weeks afterwards. Plan for this.

15. Healing is controlled by you body. Having a positive outlook will assist your body in the mending process.

16. The mind, body and your spirit have to be balanced.

17. Take control of your destiny no one can predict the ultimate outcome of surgery but you can significantly improve upon and influence your fate.

Jeffrey S. Rosenthal, M.D.
Diplomate, American Board of Plastic Surgery
Emeritus, Chief Section Plastic Surgery Bridgeport Hospital
Chairperson, Plastic Surgery for National Book Reviews
Board Member of the Connecticut Society of Plastic Surgery
Private Practice Plastic Surgery, Fairfield, Connecticut

DIET AND BEAUTY ADVICE FROM THE EXPERTS
Woman Magazine asks our local professionals….

Jeffrey S. Rosenthal, M.D., Fairfield:

Why is it you just cannot lose those bothersome inches from your hips, thighs and buttocks? Genetics confounds your every attempt, leaving you frustrated and angry. We are not talking about ten, twenty or more pounds equally distributed, which can be managed by a good exercise program and eating style. Enter liposuction, stage right!

Liposuction is a technique that sculpts away fat cells using a thin tube, called a canula, attached to a vacuum device. Under a good surgeon’s hand, it reshapes bulges to gentle curves. Fat cells are whisked away by suction, never to return. Remaining fat cells can get bigger or smaller, like a balloon inflating or deflating, but there are fewer cells to blow up.

So imagine a process that allows you to fit into smaller jeans or wear the same sizes of a two piece bathing suit by altering your contours. It is not a weight reduction method and the final results do take a bit of patience, but the end result is well worth its weight in….!

Dr. Rosenthal is a Board Certified Cosmetic and Reconstructive Plastic Surgeon. , Fairfield, – Telephone 203-335-3223

Art of Plastic Surgery Fairfield CT