Use of Ear Cartilage in Rhinoplasty
Posted by: Peter T. Pacik, MD, FACS
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?
Posted by: Peter T. Pacik, MD, FACS
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
Posted by: Peter T. Pacik, MD, FACS
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,
PMID: 686049
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Fake Look with Breast Implants
Posted by: Peter T. Pacik, MD, FACS
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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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.
Options for Chin Enhancement
Posted by: Peter T. Pacik, MD, FACS
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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For confidential personalized information and advice, please call us at 1-800-640-0290 during business hours: Monday through Thursday and Friday 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.