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Monthly Archives: June 2013

First I have to make it clear that I despise the catch phrase “Mommy Makeover”—I’m only using it because I need the keyword. I feel like it’s a name that a male plastic surgeon somewhere thought up and decided was total genius–and for some reason it has been perpetuated in the media. For me, the term “mommy makeover” is like nails on a chalkboard—it conjures up images of the flat-ass suburban housewives of my mother’s generation, walking around in high-waisted mommy jeans with a kid balanced on one hip.

Regardless, whether you call it a “Mommy Makeover” or “Breast and Body Contouring,” after you “finally do it!” and spend your time and money to have your body sculpted and/or your breasts made bigger/smaller/perkier, and you soldier through the recovery, you need to throw out your “fat” clothes. Because if you don’t, you’re still going to feel fat.

It’s a crucial part of the transformation. If you continue to wear ill-fitting, baggy, saggy clothes, you will continue to see your body the way it was before. Once my patients are six weeks out from a body contouring procedure, they are no longer allowed to troll around in oversized jeans and huge hippie tops and complain that they don’t feel any different (you ladies know who you are.)

And don’t fall into the trap of hanging on to old clothes for emotional reasons–although I myself am guilty as charged. I am the first—and last—to admit to being an emotional clothes hoarder. My sister, who is a major professional stylist and the fashion director of Who What Wear, edits my closet on a quarterly basis, but sometimes…I have to sneak things back in.

So what relics do I have, taking up space, hidden from my fashionista sister?

1)   A pair of Gotcha bikini bottoms from 1989, a time in my life when I actually enjoyed wearing a bathing suit in public:

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Now I should probably just have them framed.

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2)   A pair of 1997 Miu Miu cork wedge sandals that were so comfortable that I wore them practically every summer day for the next ten years:

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I have lost count of how many times I’ve had them refurbished by Levon at the European Shoe Repair in Malibu, and then at Arturo’s Shoe Fixx in Beverly Hills. It’s been nearly fifteen years, and they are no longer wearable in public, but I’m thinking about getting the entire shoe rebuilt around the amazing buckle.

1)   And my favorite: A 1997 Nicole Miller dress that kind of resembled the Partridge family bus:

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There is rarely an article of clothing that I fall in love with at first sight. But the minute I saw pictures of that dress plastered on every bus stop billboard across Manhattan, I became obsessed with finding one.

Apparently, I wasn’t the only girl who felt that way, because the Nicole Miller store only only had one left—fortunately in my size (a true “four” from the time before there was such a thing as a “double zero.”)

I wore that dress every chance I got, everywhere I went, often with my prized Miu Miu sandals.…not that I had many places to go, since I was a general surgery resident at the time. Then came the heartbreaking day in 2004 when I over-wore it at a plastic surgery graduation party in a dive bar, and ripped the hem in half.

“It would make a nice shirt,” my sister suggested. “Besides, it’s not really in style anymore.” But I was resistant. There was too much nostalgia wrapped up in that dress—all of my under-thirty adventures. I couldn’t give up on it. Eventually, the tailor at Colony Cleaners of Malibu managed to salvage enough of it to turn it into a very short mini-dress.

But it was bittersweet to wear it as a mini-dress, especially now that my skin was almost ten years older as well and I really shouldn’t have been leaving the house bare-legged without a spray tan.

I only wore it twice. The second time was on a whim, to a fashion event at the Chateau Marmont in 2007. My sister had gotten me on the “list,” but she was out of town, so I was on my own. So there I was, walking around this fabulous little soiree by myself, ignored by all the truly fabulous fashion people around me, yet reminding myself how fabulous it was to be there at all, at a party at one of the private Chateau Marmont bungalows, when an attractive, elegant red-headed woman pointed at me and said, “That dress!”

I went from feeling completely out-of-place to ecstatic. At least someone here appreciated my truly phenomenal style. I proceeded to fill her in on the dress’ entire history: “Oh my God, don’t you love it? It’s a Nicole Miller! I got it in 1997. It was the dress of the year! It was on every bus stop billboard in Manhattan! It wasn’t always this short. It used to be below the knee but it got ripped and I had to have it shortened—“

The Redhead did not seem to find my story charming. Or entertaining. She simply looked at me like I was a complete moron and said, “I’m Nicole Miller.”

At which point I became completely starstruck and began babbling even faster until she cut me off with: “You’ve had that dress since it was new?” as if even she didn’t approve of keeping such a relic. Then she added, “I like what you’ve…uhhh…done with it.”

I’m sure she was flattered, but in general, you probably shouldn’t wait until you run into the actual designer to question why you’re hanging on to something that’s over a decade old, and no longer in style.

Which, in a roundabout way, brings us back to the point. Once you’ve spent the time and money on a lipo, tummy tuck, breast aug/lift/reduction—and your shapely body has been uncovered–you should only wear clothes that fit you.

In the first few weeks, you may have swelling in areas that will keep even your “fat clothes” from fitting. Do not despair! This is a common early complaint. As I tell all of my patients—your body doesn’t know that you did this on purpose. On a cellular level you may as well have a huge third-degree burn. Your body has to heal itself, and the way it does so is by pouring fluid into the space of injury (this is known as third-spacing fluid.) 

Think of your body like a sponge. For at least the first six weeks, you need to wear your compression garment as much as possible to squeeze all that fluid back into your bloodstream. It’s going to take a while—after two weeks you should really start seeing it go down, but it could take up to three months (and sometimes longer) for the healing to be complete. And often times, even after the three-month mark, you may experience fluctuation of the swelling with activity. Once you can tolerate massage, ultrasound and infra-red treatments, try to get them as often as possible to help decrease swelling and expedite healing. I send my patients to the Brighton Institute in Beverly Hills, but most physical therapy centers or chiropractors in your area should also have the equipment.

I know that as the swelling goes down, the issue becomes wearing a cumbersome, uncomfortable garment under your more form-fitting clothes. Our  Lipo Queen™ by Design Veronique® shapewear can be used as a second-stage garment, and is almost invisible under clothes, even your skinny jeans.

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Wait till about six weeks to start shopping. I had to do an intervention on a patient in the office this week—she’s ten days postoperative after a full body lipo and she was just about to order a couture gown in her old size. What was she thinking?!?  I mean, what did she think she paid me for?

But you don’t have to go to Barney’s and spend an outrageous fortune on designer duds crafted by the Olsen Twins. At six weeks just start treating yourself to cute clothes that fit. Go to Old Navy, Target, the Gap. The Gap is really good these days. And I don’t know about you, but those vanity sizes are always good for my demeanor.

For instance:

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This woman is three months postoperative from a full body liposculpture in all of these pictures, but in the one where she’s hiding under a big, baggy sweater, you can’t tell.

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And here she is in yoga pants, which are always flattering. 🙂

This patient is two weeks postoperative, in a baggy shirt vs. a tight tee:IMG_1408

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Even without seeing her face, doesn’t she look younger in the more fitted clothes?

If you’ve finally rid yourself of those stubborn bulges—whether by way of diet and exercise, or a little help from a friend ;)—and you’re wearing clothes that fit the new body that you don’t hate anymore, you will just naturally start living a healthier lifestyle. With more confidence, your sex life could improve. Your workout gear will look cuter and you’ll probably exercise more, get in better shape, and you might find yourself in a productive vicious cycle. Before you know it, you’ll be staving off hypertension and heart disease without even trying!

I rest my case. Meanwhile, although Nicole Miller didn’t seem too enthused about my suggestion to bring back the Partridge Family Bus dress, I haven’t given up hope. I’m still searching the billboards on Sunset Boulevard.

So here’s a shout-out to Nicole Miller and her team: How about a Lipo Queen Limited Edition?!? 😉

XO

LQ

Call it collateral damage. She may not have been wearing a plunging neckline, but after her gorgeous debut on the World War Z London Premiere red carpet—like nothing happened!–the Google phrase “What kind of breast implants does Angelina Jolie have?” has got to be trending.

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And once the word is out, the demand across the world for whatever brand and style they are will probably put them on back order for a year. And the implant companies that weren’t used may even see their stock plummet. For a month or so, until the frenzy subsides.

I’m convinced that the “Angelina Effect” will change breast implant terminology forever. Which is great, because I think we were all getting bored with the same old-same old: the “round implant,” the “gummy bear implant” and the “teardrop-shaped implant.” Now there will be the “Angelina Jolie implant” (which, to clarify, must be one of the former three.)

Why is this so incredibly timely?

There has recently been an exceptionally intense knock-down drag-out war going on between the breast implant companies, as they are more aggressively than ever vying for plastic surgeons’ business.

Up until last year, for decades all we’ve had available in the U.S. were third-generation round silicone gel implants. Remember, these implants that we’ve been using are made of cohesive gel—the silicone is solid enough that it won’t leak out into the breast if the shell is ruptured, but it is still soft and moves (think “Jello®,” not “Gummy Bear”). And we’ve had two breast implant companies to choose from, Allergan and Mentor.

Meanwhile, Allergan has been tantalizing us over the past five years at our plastic surgery meetings with dinner presentations about their 410 implant, the miraculous shaped, form-stable anatomic cohesive-gel (translation: “Gummy Bear Teardrop-Shaped implants”) that was going to change breast augmentation forever. Apparently, it has already changed the rest of the world, but our FDA still wasn’t approving its use in the U.S.

Then last year, out of nowhere, Sientra–the little Brazilian “breast implant company that could”–got their Gummy Bear Teardrop-shaped implant through the FDA first.  (See last year’s post First New Brand of Breast Implants In Over Ten Years FDA-Approved and why this is such a big deal).

…and Allergan’s 410 just became available a few months ago…

And the war is on!

I have to say, the fallout has been tremendous for the plastic surgeons, especially for those of us who attended the annual week-long American Society of Aesthetic Plastic Surgery (ASAPS) meeting in NYC this past April, where the first round of competition took place.

We were wooed with extravagant Manhattan dinner events that could have been straight out of Gossip Girl. Allergan hosted an evening soiree at the glamorous midtown Cipriani’s:

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Not to be outdone, Sientra took a few hundred of us out for a dinner cruise up the Hudson River on a luxurious private yacht from the  Chelsea Piers, complete with an open bar and our own personal après dinner fireworks show along the Manhattan skyline, timed perfectly to the music of Katy Perry onboard.

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The Statue of Liberty was a main focal point of the cruise—I’m pretty sure it was supposed to be a symbol of our liberty to use a new implant, and I’m not kidding.

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To be fair, Allergan also had an open bar. 🙂 And they do have  their own fleet of especially attractive male reps and guys in corporate.

Okay, so now I’m going to get serious. This lengthy post is really meant for those of you who are actually thinking about getting breast implants, and are getting very confused by your research out in Cyberspace: “Allergan 410’s” “teardrop” “gummy bear” “Sientra.” Women are coming into my office asking for implants by names they don’t even understand the meaning of. And it’s going to get even more confusing when you see the new Allergan “Keep Them Guessing campaign popping up in your beauty magazines.

Yes, there’s suddenly so much new stuff out there that it’s even becoming hard for the plastic surgeons to keep track.

So which breast implant is the “best” implant?

Just because something is new and different doesn’t necessarily mean it’s better, or right for you.

I’m going to break down the whole new breast implant mystery as clearly as I can, with answers to the following questions:

1)   Are the new “Gummy Bear” implants less likely to leak than the ones we have been using?

NO. They are all cohesive gel. Again, think “Jello®”:

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Vs. “Gummy Bear”:

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2)  Why was a Gummy Bear  Teardrop-Shaped/anatomic implant invented?  I have friends who have round implants and their breasts look totally natural.

The third generation cohesive gel round implant will conform to and take the shape of your existing breast. The Teardrop-shaped (anatomical) implants were designed for breast reconstruction and breasts with deformities, and when they are used, the breast will take the shape of the implant.

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Ironically, what I have found in my practice is that most of my breast cancer/ reconstruction patients don’t even want a “Teardrop-shaped” implant. Once they see that big round tissue expander blowing up, they get so excited about having Victoria’s Secret-looking breasts that they always pick the high profile implant.

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3) Why are the new teardrop shaped implants made of this new, stiffer “Gummy Bear” stuff?

Because if something is shaped, it has to stay stiff and keep the shape, otherwise it will turn into a weird shape when it moves. If a round implant changes shape, it just stays round. But if a “teardrop-shaped” breast changed shape, who knows what oblong-looking thing it could turn into.

This is also why all shaped implants need to be textured. Think of the textured shell as a sort of “Velcro®” that sticks to the surrounding tissues, keeping it from moving around.

4)   What is the difference between the Sientra teardrop-shaped implant and the Allergan 410?

Besides the fact that each company feels that their product comes in “more optimal” shapes and sizes and that their texturing is better than the other’s, the main difference is that the Allergan 410 is firmer. The advantage of this is that it probably is more effective in shaping a tuberous or tight breast. The disadvantage is that it definitely feels firmer. However, keep in mind that even the Sientra implant feels firmer than the regular round ones we’ve been using.

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Can you really tell that one is firmer than the other when they are inside, under the muscle?

I think it’s different in everyone.

5)   What is the softest implant available and why wouldn’t everyone just want that one?

In my opinion, the round Mentor cohesive gel implant is the softest third generation silicone gel implant out there right now. However, with softness comes increased chances of rippling on the sides, so if you have very little breast tissue or body fat to cover the implant, you may have to make a tradeoff between softness and rippling.

6)   Exactly how hard are these Gummy Bear implants, and how do they compare to the regular round silicone ones?

You should make a consultation with a plastic surgeon who has samples in their office so you can feel for yourself.

7)   My doctor doesn’t want to use the teardrop shaped implants because he said they can “turn.” How often does that happen?

I think that if the teardrop-shaped implants are used in the appropriate circumstance by a plastic surgeon who understands the principles of using them, the incidence of them “turning” is very low.

8)   Who is a good candidate for a teardrop shaped implant?

Someone who is an A or small B cup, with tight skin, who wants a breast augmentation and wants absolutely NO fullness of the upper pole (upper slope) of the breasts

9)   Who is not a good candidate for a teardrop shaped implant, and should stick with a round one?

If you have any sagging of your breasts to start with, or you are getting a redo like a removal and replacement, you are most likely better off with a round implant. To work well, the Gummy Bear Teardrop-Shaped implant has to be placed in a tight skin pocket.

If you don’t want the incision to be underneath at the breast crease (inframammary incision) The Allergan 410 implant is too stiff to place through a periareolar (around the nipple incision) and requires a little bit of a larger incision than the other implant options. Since the Sientra implant is a little less stiff, if you have a big areola, you can sometimes have it placed through a periareolar incision.

But what if I want them to look natural? 

Define natural. 🙂  True “natural” is flat and saggy. Usually when women say “natural” they mean “not big and fake.” If you have breast implants placed that are not too big for your chest wall, they will look natural. The “naturalness” of a breast augmentation has to do with the size of the implant used relative to the amount of space there is to place it. (see post from last year Can you always tell if someone’s breasts are fake?)

10)   Should I get textured or smooth implants?

One message I did get out of our big ASAPS meeting in NYC was that textured implants, once big in the eighties, are now becoming in Vogue again as the studies are showing that they have a decreased rate of capsular contracture (scar tissue around the implant). However, since the textured capsule sticks more to the surrounding tissue, they can have an increased rate of rippling, especially in a very thin woman. Again, another trade-off.

Remember, if you are getting teardrop-shaped implants, the decision is made for you—they are all textured (see #2). So you don’t have to even think about this one.

11) What is the point of a “Gummy Bear” round implant, like the one Sientra makes?

At first I was very gung-ho about this one—it seemed like the solution to almost everyone’s problems. The texturing would decrease the rate of contracture, and the increased stiffness would keep it from rippling, without having to make a commitment to a teardrop-shaped implant if the patient wasn’t a good candidate for one. However, I have learned myself that this one is not the be-all and end-all answer for everyone. I’ve seen some great results and just recently one not-so-great. Again, with these Gummy-Bear implants, no matter what shape they are, the breast skin around them has to be tight. If there is any looseness at all you can get a weird “sandbag” effect when it moves.

I hope that the above FAQ’s were helpful for those of you trying to sort out some honest, unbiased answers.

So back to Angelina…do I know which implants she has? There are rumors filtering down through the Beverly Hills plastic surgery grapevine…But just remember that, no matter how amazing she looks (let’s be honest, she looked pretty amazing to begin with, and she had amazing surgeons at the Pink Lotus Breast Center) don’t automatically assume that whatever amazing implants she has are the right ones for you.

Everyone is different. Angelina Jolie is a thin woman who had bilateral prophylactic nipple-sparing mastectomies. You may be undergoing a procedure for breast cancer, a removal and replacement for previously ruptured implants or capsular contracture, or you may be just be considering a breast augmentation to kick off the summer in a bikini… Regardless, your situation is unique, and your plastic surgeon should be able to discuss the pro’s and con’s of each type of implant, so that you understand the choice that you are making.

Still, having said all that, there’s no denying that from a financial standpoint, when it happens, the identification of the “Angelina Jolie breast implant” brand will unquestionably give that company a “leg up.”

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(sorry couldn’t resist :))

XO

LQ

******ADDENDUM*****

Answer to the question “Which breast implant does Angelina Jolie have?

If you saw some of the press releases about her experience, you may have noticed that somewhere in there it says she had a “shaped implant.” Well, at the time of her procedures, Sientra was the only company who’s teardrop-shaped implants were available for general use. So, there you go.