When considering plastic surgery, it’s natural to focus more on the expected result than on the surgical process. However, to be fully informed, it’s important to learn about the safety of the procedure as well as the expected outcome. Although thousands of people have plastic surgery every year without complications, no surgical procedure is risk-free. To maximize safety, ensure that:
- Your surgeon is adequately trained
- The facility where your surgery will be performed conforms to strict safety standards
- Your surgeon is informed of any medications you are taking and your full medical history, especially if you have had any circulation disorders, heart or lung ailments or problems with blood clots
- The surgical facility will use an anesthesiologist to administer and monitor your anesthesia and your recovery immediately following the procedure
After Breast Augmentation
HOW CAN I DETERMINE IF MY PLASTIC SURGEON’S SURGICAL FACILITY MEETS ACCEPTABLE SAFETY STANDARDS?
The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery have issued a statement to their members that by July 1, 2002 all plastic surgery performed under anesthesia, other than minor local anesthesia and/or minimal oral tranquilization, must be performed in a surgical facility that meets at least one of the following criteria:
- Accredited by a national or state recognized accrediting agency/organization such as the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), Accreditation Association for Ambulatory Health Care (AAAHC), or Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
- Certified to participate in the Medicare program under Title XVIII
- Licensed by the state in which the facility is located
WHY IS IT SO IMPORTANT FOR MY PLASTIC SURGEON TO KNOW DETAILED INFORMATION ABOUT MY PERSONAL AND FAMILY HEALTH HISTORY, EVEN IF I AM ONLY HAVING A SIMPLE COSMETIC PROCEDURE?
There is always risk with any surgical procedure. However, as a patient, you can play an important role in reducing your risk by providing a full and complete health history to your surgeon.
Certain elements of your personal or family health histories may increase your risk of certain complications. This will be reviewed by the doctor prior to the surgery.
HOW CAN I BE SURE THAT THE ANESTHESIA CARE I RECEIVE IN MY PLASTIC SURGEON’S SURGICAL FACILITY IS ADEQUATE?
Anesthesia care in an accredited or licensed facility has reached a level of sophistication that is absolutely comparable to the care received in the hospital. For maximum safety, ASPS recommends that:
- Any planned anesthesia should be administered by an anesthesiologist. Dr. Ronan performs his procedures with a board-certified anesthesiologist on all but the most minor procedures at the surgery center.
Before any type of anesthesia is used, the surgeon and anesthesiologist must take a full medical history. A physical examination and appropriate lab tests may also be performed. Your surgeon needs to know if you have any serious medical problems or have had previous adverse reaction to any other type of anesthesia. Also, you must let the anesthesiologist know about any medications you are taking (including herbal supplements), any known drug allergies, when you last ate and whether you smoke cigarettes, use alcohol or illegal drugs.
You should be assured that you will receive individual monitoring by skilled, licensed personnel before, during and after the procedure. Staff who are familiar with the warning signs of cardiac or respiratory distress and are trained in advanced cardiac life support (ACLS), should be on hand to monitor your procedure and recovery following your surgery.
If you are told that you will be kept overnight at the surgical facility while you recuperate, make sure that the facility is accredited by a recognized agency. In an accredited facility you will receive around-the-clock care and monitoring by two or more skilled and licensed staff members with at least one trained in ACLS. You will also be assured that the facility has the necessary equipment and medications to handle complications that may arise and an emergency plan in case you need to be transferred to the hospital.
WHAT IS IMPORTANT IN CHOOSING A PLASTIC SURGEON?
Most importantly you must feel comfortable with your surgeon. You should also carefully consider where you surgeon wishes to perform your procedure. Make sure your surgeon is qualified to do the procedure you are considering in a local hospital before allowing it to take place in an office based surgery center. Some surgeons operate in office ORs in order to do procedures they have not been credentialed to do in the hospital.
DO YOU OFFER PATIENT REFERRALS/ TESTIMONIALS?
Yes. Please ask for a list of patients if desired.
WHAT IS THE FEE FOR COSMETIC CONSULTATIONS?
Consultations are complimentary.
DO YOU OFFER FINANCING?
Yes, once you have had your consultation, a patient coordinator will help you submit an application, which takes a very short time to complete. You will receive an answer regarding approval very quickly.
WHAT IS PLASTIC SURGERY?
Plastic surgery is named from the Greek word “plastikos” which means “to shape”, based on the surgeon re-shaping the form of the patient’s form through surgery. It has nothing to do with the types of materials used in the surgery itself. In surgery, many different materials may be utilized, depending on the desired results and the type of surgery. Frequently, the surgeon will make use of the patient’s own tissues, including tissues from another location of the body, or by reshaping the existing tissues to achieve a better appearance. Historically, many materials have been used in cosmetic and reconstructive surgery, including ivory, wood, and others. In modern times, hard silicone rubber is a popular material. This should not be confused with the gel silicone which has sparked so much controversy through its use as a filler for breast implants.
IS THERE ANY VISIBLE SCARRING?
Any time a cut or incision is made in the skin, there is a scar left behind as part of the normal healing process. Plastic and Reconstructive Surgeons have received special training and have extensive experience with minimizing the size of these scars, creating the least noticeable appearance of then, and locating them in the least conspicuous areas possible. Often the scars will become undetectable to all but the most careful examination over the course of time. In addition, scars may be hidden in the hair, along a wrinkle, in the mouth, etc. to minimize the visibility of the scar. Other times scars are more visible. The approximate placement and length of the incisions will be discussed before surgery. You can review patients photos with similar incisions.
CAN AN ABDOMINOPLASTY ELIMINATE “STRETCH MARKS” FROM MY PREGNANCY?
If the stretch marks are located in on the lower abdomen (below the belly button) then they can usually be removed in the course of abdominoplasty. Typically, all of the skin from just above the navel to the pubic area is removed. This skin usually contains the stretch marks and well as the less elastic skin. The upper skin which is more elastic, better quality and has fewer or no stretch marks, is stretched across the entire abdomen.
WHAT IS THE ADVANTAGE OF AXILLARY APPROACH FOR BREAST AUGMENTATION?
The axillary approach has several advantages for most patients. First, it does not invade the breast tissues directly, going underneath instead. This means that you have a less chance of permanent numbness. In addition, the pectoralis muscle is not divided which gives a stronger support for the implant over time. Another advantage is that there is no scar left on the skin of the breast. Instead, the scar is located in the armpit in a high wrinkle, which is a much less noticeable location. Typically, the scar is smaller.
HOW MUCH CAN MY BREASTS BE ENLARGED? WHY IS IT LIMITED? HOW BIG SHOULD I GO?
The degree of enlargement is based on the anatomy of the patient’s body more than any other factor. Saline-filled implants require placement underneath the muscle layer of the chest to achieve a natural result in most patients. The implant must be covered by the muscle layer, and this coverage determines the maximum volume of the implant. The width of the patient’s chest, as well as the locations of nerves in the chest and abdomen limit the maximum volume of an implant that can be used, because the total width of the implant must fit underneath the muscle without intruding into the nerve bundles, otherwise numbness of the breast and/or nipples would result. Your surgeon can help you determine the best size of implant for you at the time of your consultation.
Most of my patients desire a full, proportional look. They want something nice but not too obvious. I prefer to create nice looking breasts that fit a patient’s body well rather than very large breasts that are too large for the frame. In fact, I do not have any patients that have told me that I have made them too large.
WHERE CAN I STAY IF I AM COMING FROM OUT OF TOWN?
HYATT house – San Ramon
2323 San Ramon Valley Blvd
San Ramon, CA 94583
Ask for : Julie Thomas Director of Sales* 925-743-1882
*Mention Bishop Ranch for special rates.
WILL I BE ABLE TO BREAST FEED?
Breast augmentation (under the muscle layer) should not affect your ability to breast feed. For sub-glandular augmentation (under the breast tissue, but over the muscle layer), like any other surgery which disturbs the breast tissue itself, there is a risk of losing the ability to breast feed. I do not perform subglandular (over muscle) primary augmentations.
WHY DID MY BREASTS GET SMALL AND DROOPY AFTER PREGNANCY?
A loss of volume, often associated with drooping, is very common after pregnancy and is called post-partum breast involution. Volume loss with a small amount of sagging can be corrected with the breast augmentation surgery. For an excessive degree of sagging, a mastopexy or ‘breast lift’ may be the solution. I typically perform a minimal incision breast lift with augmentations. This means that the lift incision is only a circle around the areola. Severe breast drooping may require an additional incision.
CAN PLASTIC SURGERY CORRECT INVERTED NIPPLES? CAN I ENLARGE OR REDUCE THE SIZE OF MY AREOLA?
With inverted nipples, the problem is that the ducts are too short and tether the nipple. This can be corrected in the office under local anesthesia. The procedure is very and fairly simple. The incision is small and located on the underside of the nipple so that it is difficult to see.
The areola can be reduced in size or enlarged. This may be done as a standalone type of procedure under local anesthesia. Or, it may be done in conjunction with an augmentation, breast reduction or breast lift.
This type of procedure is called a ‘trans-umbilical approach’. I have trained in this procedure and learned it from the surgeon who invented it. My malpractice carrier, the one with the most plastic surgeons, refuses to cover this procedure. They claim that the procedure is associated with much litigation. In addition, the implant manufacturers frown on this technique. I value the opinion of the largest plastic surgery malpractice company and implant manufacturer. It is probably not a good idea to have an augmentation with this technique.
DO IMPLANTS RUPTURE?
Mechanical failure of the mammary implants is possible. The rate of failure is low and should be discussed with your surgeon, including the implant manufacturer’s limited warranty.
DO I HAVE TO HAVE MY IMPLANTS CHANGED AFTER A CERTAIN NUMBER OF YEARS?
No. You do not need to change your implants unless there is a problem. The implants have a warranty on them (5-10 years depending on the manufacturer). If they deflate during the warranty, the manufacturer will give you an implant and pay towards replacement.
WHAT CAN YOU DO TO CORRECT ASYMMETRIES OR DIFFERENCES BETWEEN THE BREASTS?
Nearly everyone I have examined has some asymmetry in their breasts. Sometimes these differences are subtle and other times they are more pronounced. It can be a difference in size, height of the nipple, amount of drooping, height of the breast fold, contour of the ribs, height of the shoulder tips, etc. Many times we can attempt to correct or improve upon the asymmetries. This can be done by lowering a fold, place slightly more saline on one side, etc. Most of the time, there are subtle asymmetries before and after surgery.
DO BREAST IMPLANTS CAUSE YOU TO GET BREAST CANCER?
No. Breast implants do not cause breast, or any other cancer. Studies have shown that women who get breast cancer and have implants have the same outcome as women that get breast cancer and do not have implants. You still should get mammograms as recommended by your physician. Notify your mammographer that you have implants as they will do a few special views to maximize the mammogram.
DO YOU PUT THE IMPLANT UNDER OR OVER THE MUSCLE?
I typically put the implant behind or under the pectoralis major muscle. There are several reasons for this. I believe that it looks much more natural. There is more tissue between the implant and the outside world. There is less chance of complications. There is more support for the implant to protect against drooping. But, most of all, the mammogram is better when the implant is under the muscle.
REGARDING BLEPHAROPLASTY, WHAT METHODS ARE USED? WHAT ABOUT “LASER BLEPHAROPLASTY”? WHAT’S THE DIFFERENCE?
The conventional upper blepharoplasty utilizes a crescent shaped incision located along the upper eyelid fold. Excessive skin and central fatty tissue is removed. The incision is then closed.
There are multiple options for the lower lid. Most lower blepharoplasties are of the conjunctival type. This means that an incision is made on the back side of the eyelid and fatty tissue or the bag is excised. The scar is not seen. If the patient has a minor skin excess or wrinkles, the laser can also be used to tighten the skin or improve/remove wrinkles. Patients with more significant skin excess will need the subciliary approach. An incision is made just below the eyelashes. Fatty tissue or the bags are removed. Skin excess is trimmed and the incision closed.
WILL HAVING BLEPHAROPLASTY AFFECT HOW MY CONTACT LENSES FIT?
Blepharoplasty surgery only works on the skin and muscle of the eyelids area — how your contact lenses fit is based on the shape of your eye itself. Although you won’t be able to wear contact for the first few days after surgery (to allow time for the healing process to begin without disturbance) blepharoplasty surgery will not change how your contact lenses fit or function.
WHY MUST BROWS BE EVALUATED WHEN CONSIDERING UPPER BLEPHAROPLASTY?
The upper eyelid and the brow must always be evaluated together. This is very important.
Let’s consider someone with a low brow. The low brow causes skin to pile up on the upper lid. This weight causes the person to unconsciously lift the brow until this weight is removed. If skin is removed during an upper blepharoplasty, this weight is reduced. This allows the brow elevators to relax and lower the brow until the skin piles up on the lid again and obscures the result of the upper blepharoplasty. This situation can be avoided by recognition of the brow ptosis and treatment through a brow lift or browpexy.
When someone doesn’t have brow drooping, this situation does not occur.
WHAT IS “TUMESCENT” LIPOSUCTION?
The tumescent technique is a liposuction method that can reduce post operative bruising, swelling and pain. Also, blood loss is minimized during tumescent liposuction due to the effects of the local anesthetic which is used. In the tumescent technique, areas of excess fat are injected with a large amount of anesthetic liquid before liposuction is performed. The liquid causes the compartments of fat to become swollen and firm or “tumesced.” The expanded fat compartments allow the liposuction cannula to travel smoothly beneath the skin as the fat is removed. This can give multiple benefits — extra precision for the surgeon, reduced loss of blood for the patient, and extended pain relief after surgery, which can reduce the need for pain medication immediately after surgery.
WHY DO PATIENTS WEAR A COMPRESSION GARMENT AFTER SURGERY?
After liposuction, swelling is expected. A compression garment helps reduce swelling and helps to reshape the tissue. Many patients see little difference or are even larger during the first week after surgery. The following week, patients usually begin to see results. After 2 months, the patient will be at about 80% of the result. Improvement continues until about 6 months after surgery when all of the swelling should be gone. I usually have patients wear their compression garment for 3 weeks, 24/7 and then 3 weeks during sleep.
CAN I STILL GAIN WEIGHT AFTER LIPOSUCTION?
We are born with a certain number of fat cells. During liposuction, fat cells are removed with the surgery. The remaining fat cells get bigger when you get bigger and get smaller when you get smaller. If you maintain your weight, the fat should not come back to the liposuctioned areas. If you put on weight, it will more likely to be distributed more evenly over the body and less likely to go to your ‘trouble zones’.
WILL I STILL HAVE CELLULITE OR RIPPLING AFTER LIPOSUCTION?
The aim and goal of surgery is to improve one’s appearance as it relates to shape and volume. The degree and the magnitude of one’s cellulite and rippling prior to surgery will affect the post-operative outcome. In mild to moderate cases, the cellulite and rippling is usually improved with the surgery. But, no promises can be made regarding cellulite. Liposuction improves the overall shape of the body in addition to making it smaller.
HOW MUCH WILL MY POST-OP APPOINTMENTS COST?
We do not charge for postop visits – you are our patient for life.
HOW LONG WILL MY FACELIFT LAST?
The good news is that your facelift will not fall down at the stroke of midnight on the tenth year! Actually, a facelift (and other procedures) will turn back the clock. You will start aging again from that point forward. You will always look better than if you did not have the procedure in the first place.
WHAT CAN BE DONE FOR A “DOUBLE CHIN”?
In younger individuals with good skin tone, the fat in this area can be removed with gentle liposuction, and this improves the contour of the neckline. When skin tone is poor, it may take a facelift procedure with liposuction to correct the condition.
WHAT CAN BE DONE FOR “FROWN LINES” AND “CROW’S FEET”?
We use our facial muscles for smiling, frowning and other expressions and, over time, prominent lines may be formed in the outer layers of skin. A substance called Botox can be injected into these overactive muscles to cause temporary paralysis (3-4 months) and smooth these problem areas. Botox or Dysport works best for dynamic wrinkles or those wrinkles that are caused be expression or muscle contraction.
AM I READY FOR A FACE-LIFT?
Skin and facial tissue that sag along with aging can give you an appearance of tiredness or anger even when you are feeling happy and energetic. A facelift procedure primarily addresses jowling and neck laxity. With facial rejuvenation, you appear rested, healthy and more youthful. The idea is to look better and/or younger, not different.
If your concern is less about jowling and neck and more about the cheekbone area, then you may be appropriate for a short scar facelift. This is a newer procedure that involves incisions in the hairline and in the mouth which are not typically visible.
WILL I LOOK NATURAL AFTER MY SURGERY?
I choose the techniques that I use to create a natural, non-surgical appearance. Every effort is made to improve your appearance in the most natural view.
HOW IS THE TATTOO REMOVED?
The tattoo is removed using our FDA approved light based machine. It is a safe and effective way to remove all colors in about 3-5 treatments. The energy from the machine is absorbed by the tattoo pigment which breaks into smaller pieces. This smaller pieces of pigment are absorbed by the body (macrophages) and removed.
Others methods include salabrasion, dermabrasion, surgery or other lasers.
HOW MANY TREATMENT SESSIONS WILL THERE BE?
The typical tattoo is removed in about 3-5 treatments. Compare this with 10-20 treatments with other lasers. This is a considerable cost savings.
ARE ALL COLORS REMOVED?
Yes. All colors are removed with our method. Compare this with other lasers that do not remove all colors.
WILL THE TATTOO COMPLETELY DISAPPEAR?
In most cases, nearly all or all of the pigment will be removed. In some patients, there is little sign of a previous tattoo. Many patients are left with skin that is a bit lighter than the surrounding skin. A few patients will have some scarring associated with removal. Strict adherence to our after-care regimen reduces the chance of scarring and minimizes its appearance.
WHAT IS THE AFTER-CARE?
Afterwards, we treat the area with an antibiotic cream, non-stick dressing and pressure for about 7-10 days. Then, we apply a steroid cream and a pressure dressing. This is continued until the next treatment (30 days after first treatment). The process is repeated until the tattoo is gone (usually about 3-5 treatments).
WHAT ARE THE POSSIBLE SIDE EFFECTS?
There is a small risk for infection. Cleansing and the antibiotic cream limit this risk. Hypopigmentation (treated skin is lighter than surrounding area) is likely in most patients. Scarring or hypertrophic scarring is possible. Adherence to the after-care program will limit or lessen scarring.
WHAT IS THE COST?
The cost is based on the size of the tattoo. The cost consists of complete treatment (usually 3-5 treatments) and not individual sessions. The price includes initial dressings and some supplies. Additional dressing may be purchased, if necessary. You will be given a prescription for steroid cream. The total cost is typically lower than the cost of most laser based removal systems and there are fewer treatments necessary.