PlasticSurgeryPA.com Blog

Fear of Augmentation Mammaplasty

Submitted by Daniel A. Sterling, MD FACS

For a patient, what fear is generally associated with a breast augmentation?

Breast augmentation is a procedure that causes both anxiety and excitement in women undergoing the procedure. The most common fear of breast enlargement is pain. We routinely use pain control catheters to deliver local anesthesia during the post-op period. Augmentation mammaplasty is one of the more commonly performed procedures. and vast amounts of information are readily available about the procedure-omit. It is considered to be safe and the majority of women are happy with their results and achieve an improved sense of self image. We have many patients who are willing to discuss their experience and are happy to speak to prospective breast augmentation patients.

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Waiting period for breast reduction or breast lift after weight loss

Submitted by Daniel A. Sterling, MD FACS

What is the waiting period for breast reduction or breast lift after weight loss?

It is prudent to wait for a period of time when undergoing any procedure after significant weight loss. Once one has reached a weight that is near their target, then it is prudent to wait a short period of time to make sure that no significant swings in weight will occur long term. Once this is done, you can achieve a much better and longer lasting final result since the tissues have reached a stable plateau.

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For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE.

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Augmentation Rhinoplasty

Submitted by Daniel A. Sterling, MD FACS

Is it possible to have augmentation in rhinoplasty?

Several concepts in rhinoplasty need to be understood. The nose can be reduced, altered, or augmented depending on the nasal deformity. When doing an augmentation rhinoplasty there are a number of options including cartilage, bone and artificial materials that can be used for grafting purposes.

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Use of Ear Cartilage in Rhinoplasty

Submitte by Daniel A. Sterling, MD FACS

Possible ear cartilage warping from rhinoplasty?

Ear cartilage can be used for grafting purposes during a rhinoplasty. All cartilage is prone to warping and it is for that reason that certain techniques are employed to prevent this, namely, scoring of the cartilage and secure fixation.

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How Much Fat is Removed in a Breast Reduction?

Submitted by Daniel A. Sterling, MD FACS

Is 200 grams of fat in breast reduction a large amount?

The amount of fat removed in a breast reduction is all relative to the size of the breast to begin with. If a woman is very petite and her breasts are relatively large for her frame, then 200 grams of removed fat may be entirely appropriate and give the desired breast shape. There are some women who have breasts that are so large that ten times that amount is removed from each breast but this is the exception rather than the rule.

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The Lamont Classification Revisited

Vaginismus continues to be under diagnosed by most health care professionals, including gynecologists. In patients who have aversion to GYN exams, inability to have intercourse and give a history of inability to use tampons, vaginismus should be part of the differential diagnosis.

Many of my patients who fail in their ability to have a speculum examination complain that they were told to “just relax” or that it is all in their head. Patients who have a more severe form of vaginismus (Lamont level 3 to 4) are often shunted from therapist to therapist over a course of many years and are unable to make any progress while their relationships are deteriorating. Vaginismus is the most common reason for unconsummated marriages.

Lamont, in 1978 (Ref 1) described four degrees of severity in his proposed classification. In the most severe form of vaginismus he describes the generalized retreat that takes place with the buttocks elevating and withdrawing and adduction of the thighs. My patients, many of whom are self diagnosed, are able to accurately classify themselves by reviewing the Lamont classification, and recording their level of vaginismus in the history they give me. Indeed, some of my patients suggest there should be a Level 5, manifested by sweating, nausea, vomiting, and “going unconscious”. In my practice the more severe cases of vaginismus are treated with Botox injections under anesthesia (Ref 2-4) and these patients show the same withdrawal behavior as the anesthesia is deepened. Attempted intercourse and hitting the “brick wall” they so often refer to is documented by severe vaginal muscular spasm, usually involving the bulbocavernosum, while the patient is deeply sedated.

There is a need for physicians to raise their awareness of vaginismus in treating these patients.

References: Lamont JA. Vaginismus. Am J Obstet Gynecol. 1978 Jul 15;131(6):633-6.

Pacik PT. Botox Treatment for Vaginismus. Plast. and Reconst. Surg. 124:

455e-456e, December 2009

Ghazizadeh, S. and Nikzad, M (2004). Botulinum Toxin in the Treatment of

Refractory Vaginismus. Obstet Gynecol 104, 922-925.

Abbott JA, Jarvis SK, Lyons SD , Thomson A, Vancaille TG. Botulinum toxin type A for chronic pain and pelvic floor spasm in women: a randomized controlled trial. (2006) Obstet Gynecol. 108:915 -923.

PMID: 686049

Contact Us for More Information

For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on Vaginismus for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE.

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Fake Look with Breast Implants

Submitted by Daniel A Sterling, MD, FACS

Possible to get larger breast implants without fake look?

Depending upon your frame it is certainly possible to have large implants placed without looking fake. Typically large implants look fake early on; however, once they descend into the proper position and become more anatomically shaped they become more natural in appearance. Women with larger frames can handle larger breast implants without looking fake. If, however, the implants chosen are disproportionately large to your frame they will look fake going forward.

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Options for Chin Enhancement

Submitted by Daniel A Sterling MD, FACS

Chin implant methods and options?

There are several methods for enhancing the appearance of a chin. The most extensive method is called a genioplasty where the bone or mandible is cut and advanced forward and secured in position with a metal plate and screws. Chin implants, however, are far less involved in terms of procedure and recovery and can be placed either through an incision inside the mouth or a small incision under the chin. Lesser deformities can be corrected with facial fillers; however, this would need to be repeated as they are temporary and only last up to a year or more.

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Implant Replacement or Breast Lift after Capsular Contracture

Submitted by Daniel A Sterling, MD FACS

Breast implant replacement or breast lift after capsular contracture?

The treatment for capsular contracture, depending upon the severity, is either a capsulotomy (opening of the capsule) or complete removal of the capsule (capsulectomy). Once this is done, there is no contraindication to replacing implants or performing a mastopexy with the caveat that there is a slightly increased risk of recurrent capsular contraction. A significant breast lift or mastopexy may be delayed if the entire capsule is removed for vascular protection of the nipple areola complex.

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Breast Implants on Top of the Muscle

Submitted by Daniel A Sterling, MD, FACS

How do saline breast implants look if placed over the muscle?

Breast implants placed over the muscle, also known as subglandular augmentation, is only indicated in a limited number of patients. Body builders and women who pose flexing the upper body musculature request subglandular implants so that there is no distortion of the implants and breast appearance when they flex or lift weights. If there is an adequate amount of breast tissue to cover the implant a saline implant may be indicated over the muscle, however, silicone implants are recommended. Any augmentation over the muscle is associated with a higher risk of capsular contracture; however, it is still relatively low and somewhere in the 10% range.

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Breast Implants after Breast Reduction

Submitted by Daniel A. Sterling, MD, FACS

Breast implants for C cup breasts after reduction?

Infrequently, women will seek breast augmentation after having had a breast reduction. Usually this occurs in women who have had a breast reduction at a young age and have subsequently had children and now have significant deflation of the breasts. Certainly, breast implants can be placed for C cup breasts to provide the fullness, fill the envelope and restore the fullness that was present prior to loss of volume.

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The Use of Struts in Rhinoplasty

Submitted by Daniel A. Sterling, MD, FACS

What is a strut procedure?

A strut is a support structure by definition and is sometimes used during rhinoplasty to provide support. For example, when a patient has a “weak tip with poor support” a columellar strut is placed to restore support to the nasal tip and provide an excellent result to the rhinoplasty.

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Rhinoplasty for bulbous tip

Submitted by Daniel A. Sterling, MD, FACS

Can a nose job correct bulbous tip deformity and look natural?

A rhinoplasty to correct a bulbous tip is one of the most commonly performed procedures. The tip can be refined and reduced to give a very natural appearing tip without any evidence of having had a rhinoplasty in essence.

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THIGH ULTRASONIC LIPOSUCTION

Submitted by Daniel A. Sterling, MD, FACS

Will ultrasonic liposuction work on thighs?

Ultrasonic liposuction is one of the modalities that is used infrequently for very specific indications. In particular, it has been used on very dense fibrous fatty areas such as in the back or male breasts. The fat of the thighs is quite different than those areas and there is no need to use ultrasonic liposuction on the thighs. Standard liposuction works very well on most areas including the thighs.

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Advancing to Dilator # 6, Mr. Big Blue

Patients generally have no difficulty working with the # 4 or # 5 dilators once they return home after being treated with Botox for vaginismus. Advancing to the largest # 6 dilator — jokingly referred to as Mr. Big Blue — may take more effort.

Relaxation is the key to getting comfortable with the #6 dilator. Remember, even if you’re nervous, you won’t hit that “wall”—the Botox took care of that. And while Mr. Big Blue may feel weird at first, or briefly uncomfortable, it won’t be painful; and in fact may eventually be used for arousal.

To help relax with Mr. Big Blue, practicing in a warm bath and using lubricants works wonders.

While soaking, use a silicone based lube, which lasts longer than water-based lubes. (Pjur is a good brand, just avoid those containing additives which can cause a burning sensation.) Though Vaseline is not normally recommended, a small amount won't hurt you. (I recommend cocoa butter, which smells nice too.) Apply the lubricant to the entrance of your vagina and coat the dilator. You can then stay in the bath for about 30 minutes with the dilator in place.

Once you have advanced to the large blue dilator, intercourse is not far away.

For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. You can also visit our website on Vaginismus for more information or use the online contact form to send an inquiry. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE.

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Combined Breast Lift and Augmentation Mammaplasty

Submitted by Daniel A. Sterling, MD FACS

Can a Lollipop breast lift and an breast augmentation be performed in one procedure?

There are many types of breast lifts, also known as mastopexy. A lollipop mastopexy is one of the intermediate procedures for women who do not have a significant amount of breast hang, or ptosis. The combination of breast implants at the same time as a lollipop lift is frequently done and usually results in a very nice outcome.

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Male breast reduction with areola reduction

Submitted by Daniel A. Sterling, MD, FACS

Can a male breast reduction include an areola reduction?

The areola can frequently become enlarged when a breast becomes excessively large. Areola reduction is a standard part of any breast reduction on both male and female patients. If all that is required is liposuction, then the areola can be reduced at the same time.

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