Tag Archives: Beverly Hills



If we’re taking bets on a woman who is at least partially clothed, without X-ray vision even a plastic surgeon has to admit, “No.” But that doesn’t mean there’s not some help going on. There’s all kinds of smoke and mirrors out there. The bionic push-up bras aside, I’ve had patients go down two cup sizes in the exam room once they remove the Victoria’s Secret water bags. And even though they’re just meant to try on in the office, I swear that my supply of sample “try-on” breast implants has definitely dwindled down over the past few years.

Don’t even try to decipher the ones you see in magazines. Even the implants are photo-shopped—-here’s a lovely video about that from one of my old posts that I highly recommend 🙂

Of course, there are the obvious ones, like the ninety-five pound woman sporting a DD cup, or the one who looks like she has melons pushing up to her chin.

But those are obvious to everyone. So maybe a better question to ask is:

“Why do some breast jobs look fake and others don’t?”

Even here in Beverly Hills, most women seeking breast augmentation—whether it’s a college graduation present or part of their mommy makeover–want to look “natural,”  “in proportion to their body,” and often have it done so “nobody can tell.”

In my experience, the most important variables involved in achieving a natural-appearing breast augmentation with an implant are:

1)    The size of your breasts to begin with.

Especially the width. As a breast implant size increases, so does the base diameter. Your goal may be a D cup, but if your chest wall is too narrow, the implants will not only stick out on the sides and disrupt your natural anatomy, but this is a set-up for unnatural shape, rippling and implant malposition down the road. When I help a patient choose a breast implant, I recommend keeping the base diameter of the implant at about one centimeter narrower than the base of her breast.

2)     Your skin envelope.

Is there room in there for the size implant that you want, or is it going to be so tight that the implant will never drop? Chances are, if you’ve had children and breast fed there will be plenty of room, but not always. Also, skin in darker and Asian women is usually thicker and has more elasticity, so it doesn’t stretch as much for a big implant.

3)     How much breast tissue do you have now?

Can you pinch at least two centimeters of thickness? If so, if you go with a size-appropriate implant, you probably have enough tissue to camouflage the upper border so there won’t be that obvious ledge. Having your implants placed “under the muscle” or sub-pectoral also helps avoid this problem.

4)     What is the distance from your nipple to your inframammary crease (the fold underneath your breast)? This usually depends on whether you have tuberous breasts or not. If the distance is closer to ten than five centimeters, you are more likely to get a natural, tear-drop shape result with a breast implant, as opposed to a round one.

So–again, keeping it G-rated—with all of the above information, can you tell which of the women below has had breast implants?

The answer is, of course, ALL OF THEM (I mean, come on, this is L.A.)

I grew up in New York where everyone got nose jobs, but I’d never even heard of anyone having a “boob job.” You just started every high school summer promising yourself that this was going to be the year, you were just a late bloomer and somehow you were going to show up at school in September with a C cup. And if it didn’t happen, well…the only option was to learn to live with it and develop your personality. Even in Northern California where I went to college, I remember hearing about one girl on campus who was rumored to have had breast implants and it just seemed so unfathomable to me. I mean, how could her parents let her do that, and where would you go to even do such a thing?

Well, I soon found out. And what I also found out was that unless you’re talking about a twenty-one year old girl with perfect natural C-cup breasts, breast implants actually usually look do better than the real thing.

I remember when my plastic surgery chairman at UCSD took his daughter to a Britney Spears concert (yes, this was a long time ago, before she’d even been married the first time or had any kids). They had really bad seats, and although they’d had to watch the show through binoculars,  he did get a good close-up look at Britney in her risqué costume, and he said that she had breast implants. This was when she was a teenager, long before such an accusation was even hinted at in the media, so I asked him how he could know such a thing without seeing her naked and he said, “Because they look too good.”


So since then whenever someone asks me, “Do you think those are fake?” my expert plastic surgeon’s answer is always:

“If they look too good to be real, then they’re probably not.”



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If you haven’t heard about it already, you will.

Of course, the tragedy was documented on the internet within seconds. But at first, in all of the links I came across, I saw that the specifics had been tastefully left out, and it didn’t seem like anyone was trying to “uncover the truth.” It wasn’t on the news, and nobody outside of our “Beverly Hills plastic surgery community” seemed to know about it. I truly thought that this was really going to just come and go, to be left alone for the family and the people involved to deal with without scrutiny. When I turned on the radio on my way to the OR the next morning and heard about Justin Bieber’s arrest for a DUI while drag racing, I was sure that the pop culture machine had moved on.

Until I saw this article that one of my colleagues sent me:

At least the article was objective. It just seems unfortunate to me that the Hollywood Reporter felt a need to delve into such a sad, personal tragedy for viewership. The only thing that makes it even Hollywood Reporter-able was their angle about it involving a big “Celebrity Plastic Surgeon. ” The article even went on to mention celebrities who have been rumored to have been his patients. Was that necessary?

Now that the information is out, I’m sure there will be countless commentaries throughout the media where bored, scandal-hungry, reality-TV thriving Americans will give their opinions as to why it happened. There are already insensitive comments circulating on the internet about the surgeon, Beverly Hills, and plastic surgery in general, insinuating that everyone involved was greedy and crazy and did something wrong. Not to mention the tasteless videos posted on You Tube by onlookers who recorded the whole incident on their phones.

I’ve heard that there is already an article out there entitled, “Woman Jumps off Building Unsatisfied With Her Plastic Surgery.” This is ridiculous. It was the morning after her surgery, and there was no way any rational individual would make a decision at that point about their surgical outcome. She most likely hadn’t even seen herself yet. The surgeon and his work are completely unrelated to this woman’s suicide.

I know that this little blog is not a big enough platform to nip the growing snowball of negative editorials that are going to be written about Beverly Hills plastic surgeons and their patients in the bud. All I ask is that everyone who has a chance to read this, please share it with whomever you can. None of the people involved with this devastating event wanted it to happen. The surgeon is actually the best in our field for what he does, and gives impeccable care to all of his patients. The patient had an excellent team of caregivers. Her running onto the roof and jumping was not “a reaction to the medication given to her” as someone commented below the above recent article link. Why she did it? I don’t know—it’s none of my business.

I guess all I want you to take away from this is that the surgeon and his work and her suicide were most likely COMPLETELY UNRELATED incidents. Try to ignore the sensationalized stories that will undoubtedly pop up on the internet or on talk shows in the weeks to come, and remember that NOBODY has the facts.



This is huge news. I first heard about this new company, Sientra when they sponsored a St. John’s Hospital Plastic Surgery Division dinner meeting about a year ago. The speaker bragged about how their implant line was already going strong in Europe, but I ignored their threats to become FDA-approved in the U.S. I figured the company as a whole was delusional and I actually felt sorry for them for spending so much money on all the free food and alcohol at the four-star restaurant. I mean, it’s nearly impossible to get anything FDA-approved in this country, especially something as invasive as a silicone breast implant. (Which, as I tell my patients should make you feel better about having the ones that are approved.) But Mentor and Allergan have pretty much been the Coke® and Pepsi of breast implants for as long as I can remember. (Actually, Allergan started out as McGhan, then became Inamed and then really pulled ahead when it got taken over by Allergan and the sales reps started bundling our breast implant purchases with free Botox® and Juvederm®.)

So why is this such a big deal?

 Most of the implants from this new company Sientra will probably not be significantly different from the ones already offered by the other two giant manufacturers. (I’ll let everyone know what they feel like in comparison to the others as soon as the company brings by samples, which I imagine will be as soon as all of the plastic surgeons in town open their doors for business on Monday morning.)

But the big story here is that this new company, Sientra has in its available armamentarium, a teardrop-shaped implant comparable to the “gummy bear” one that Allergan and Mentor have been trying to get approved for nearly a decade.

So what is this “Gummy Bear” implant, anyway?

All of the silicone implants that are available today are third generation. They are made of a cohesive gel, which means that if you cut one in half it will just stay the way it is, and the silicone won’t run out all over the place:

Truthfully, their consistency is more like Jell-o® than a Gummy Bear, but it’s the same idea.

The implants that have been nicknamed the “Gummy Bear” implants are the fourth generation silicone, which are made of an even more ”cohesive” gel. This means that not only do they not leak, they barely move(think stiffness of Jell-O® vs. Gummy Bears.) The difference is that they are teardrop-shaped, and to keep their shape they are firmer and don’t move at all, even if you lie down. This is what is known as “form stable.” There has been a lot of hype about how “great” they are–especially by the small number of plastic surgeons who have access to them through the Mentor and Allergan clinical trials.

Except now everyone’s going to be able to get them from Sientra.

But the FDA tends to keep things fair and square. Seven years ago Mentor and Allergan both got approval for silicone implants on the same day. If form-stable Gummy Bear implants by Sientra are getting approval, the same thing will probably happen for Mentor and Allergan by the end of the week.

However, don’t let the supply/demand thing fool you. Just because they’re less accessible doesn’t mean they’re necessarily better for everyone. The way I like to think of it is that instead of the implant taking the shape of the breast, with these “form stable” implants the breast takes the shape of the implant, which is most useful in a case of reconstruction after mastectomy or in a tuberous breast. In fact, these implants were initially intended for breast reconstruction patients, and somehow became another marketing tool for the plastic surgeons who not only have access to them, but get paid to use them and talk about them.

I have personally seen results with these form-stable implants, and while they definitely have advantages in breast reconstruction (both in congenital breast deformities and mastectomy patients) my opinion is that the third-generation ones that feel more like Jell-O® are better for most primary cosmetic procedures, and these are the ones that I would choose for myself. By the way, the form stable implants require a bigger incision in the breast (pretty much always at the inframammary crease) because you can’t manipulate them as much to insert them. (They were obviously developed by a man.) So don’t be upset that you missed out on something if you just got breast implants a few weeks ago and you suddenly hear about this “superior new Gummy Bear implant” fresh on the market.

Regardless, I also predict that along with everyone else in Beverly Hills, I will be getting a call (if not a knock on my door) from the Sientra sales rep on Monday morning. So for all of you considering breast implants, imagine that every plastic surgeon in town is probably going to be getting at least one free pair to try from Sientra, and then Mentor and Allergan are going to have to up the ante, get off their laurels, and give us each at least one complimentary pair. Whether or not your plastic surgeon decides to pass the savings on to you is up to them, but I think it’s a good time to get a breast aug…I’m just saying…;-)

Have a great weekend!



P.S. Here’s a link to one of the newsflashes if anyone is interested:

FDA clears 3rd silicone-gel breast implant for US

Baggy lower eyelids are actually caused by the fat that pouches out from inside the orbit (eye socket). The thin skin and muscle that hold the fat in place loosen as we age. Combined with the gradual loss of the youthful fullness of our faces, these fat pockets become even more prominent. In some of us it’s genetic. At least once a week I’ll have a patient stare at their reflection in the hand mirror and—with that deep sigh of resignation—say: “I’ve had them my whole life, just like my mother/father.”

No matter the cause, under-eye bags can make you look tired and sad when you’re not, and it’s just not a good look for anyone.

In case you’re one of those fortunate few who are too young and/or genetically blessed to even know what I’m talking about, below are some obvious examples contrasting Charlize Therons youthful, flat “lid-cheek” junction with the separation of the lower lid and cheek and the tear trough that occurs as we get older, such as in Donald Sutherland:

So, what are the options for taking care of this less-than-desirable problem? Read More

I just found out about this study being conducted by nationally renowned facial plastic surgeon Dr. John Joseph here in Beverly Hills. If you have deep acne scars that you would like to get rid of, see below:

Has acne left scars on your cheeks? If you have moderate to severe acne scars on your cheeks, you may be eligible to take part in a voluntary research study lasting up to twenty months for the treatment of your acne scars with an FDA-approved dermal filler or placebo. Participants must be at least eighteen years of age, in good health, and have at least four individual scars on the cheeks.

Qualified participants may be compensated for time and travel.

For more information, please contact:

Irma Garcia

Dr. John H. Joseph, M.D.

9400 Brighton Way, Suite 403

Beverly Hills, CA 90210


Have a great weekend!



I just had my first Pellevé™ skin tightening treatment a few days ago and I have to say, I am impressed. The skin around my eyes definitely looks less “crinkly”—no matter how hard I smile!–and there was no downtime at all. Even my husband agreed there was an improvement, and he never notices anything. I take that back. He would probably notice if I got a breast aug.

Christine at Ava MD is really excited about this new laser, and I totally trust her. I have also seen a lot of good reviews about it online. My next treatment is in a month. At that time we are also going to try the Accent™ skin tightening Read More

I get a lot of “curbside consults” from my patients, showing me skin lesions (“moles”) that they “should really get removed someday” and ask if I can do it for them.

The answer is, “Yes, I absolutely can,” and “Yes, I am a plastic surgeon and I can give you the best scar possible,” but that doesn’t mean that the lesion should always necessarily be excised. The two main deciding factors are:

Read More