The Cosmetic Corner…
Answers to Your Questions, by Sonya J. Merriman, M.D.
A collection of questions and answers published originally in The Valdosta Scene, in which Board Certified Plastic Surgeon Dr. Sonya Merriman shares her knowledge of plastic surgery and non-surgical cosmetic enhancements, which are available at her practice, Plastic Surgery Associates of Valdosta.
Dear Dr. M. - I am considering having liposuction on my stomach, but I am still deciding if the cost is worth the benefit. A friend of mine had liposuction a couple of years ago. At first, her results were very noticeable, but over time, she seems to have returned to her pre-surgery size. I realize that the results won’t last forever, but is it normal for the fat to return in such a short period of time?
-looking for the skinny on liposuction
Dear Looking – Liposuction, also known as lipoplasty or suction lipectomy, is the surgical removal of localized or regional excess fatty tissue. There are primarily three different techniques that can be used to perform liposuction. I use tumescent liposuction and use ultrasound-assisted lipoplasty in specific areas that will benefit most from that particular technique. Ultrasound-assisted lipoplasty uses ultrasonic energy to liquify excess fat prior to surgical suctioning. The shape change that occurs as the result of liposuction is permanent. If the problem area was your hips and liposuction was performed to treat the “lipodystrophy”, the shape problem would be permanently corrected. However, if you gain weight, you will most likely create a new “problem area”. Liposuction will not prevent future weight gain. Therefore, weight maintenance is very important following the procedure. Liposuction is not a procedure that will make you skinny. It simply slims and reshapes specific areas of the body. It may take several months for the swelling to completely dissipate following the procedure, but the initial results should continue as long as you maintain your weight and practice a healthy lifestyle. Finally, before you decide if the cost will be worth your reward, you must first determine your commitment level to the lifestyle requirements necessary for long-term improvement. You may call my office to set up a consultation or if you have additional questions.
Dear Dr. M. - Can anything be done for someone who has breasts that are significantly different in size? I am an A cup on one side and C on the other. This makes it very difficult to find swimsuits and bras that fit. Many times, I am forced to use some type of padding to help disguise my condition. Is this common? Can it be surgically remedied?
-Feeling Unbalanced
Dear Feeling Unbalanced – The answer to all three of your questions is YES. First, the condition you describe is called breast asymmetry and it is fairly common. As a matter of fact, most women have slightly different sized breasts. However, in some cases such as yours, the difference in size is more significant and warrants some type of surgical correction. Several factors are used to determine the best possible procedure to balance the breasts. You may want to augment (enlarge) the smaller breast to look like the larger one, or reduce the size of the larger breast to match the smaller one. The decision is really just a matter of your personal preference. You did not mention your age, but it may be important for you to know that there are special considerations when someone is considering surgery before the breast size has stabilized. If a young girl is still growing, the mechanical and emotional aspects of the surgery can be much more complicated. Surgery to correct asymmetry has a 90% success rate in attaining a patient’s desired results. Surgical correction has also been proven to boost self-esteem. If you decide to pursue a surgical procedure to correct the asymmetry, please be sure that you seek an experienced, Board Certified Plastic Surgeon. Good Luck!
Dear Dr. M. - I have always been careful to protect my skin from sun exposure while spending time gardening outdoors. Recently, however, I have noticed slight changes in my facial complexion. I am not resisting my natural aging process, but I’m only 42 and would like to put up a few speed bumps to deter the process. My two concerns are brown spots on my face and fine lines around my mouth and eyes. I do not want to have surgery, but I would like to treat this proactively. What are your suggestions?
-Dirt Digging & Sun Screening
Dear Dirt Digging - Kudos to you for already taking a proactive role by protecting your skin from sun exposure. Both of your concerns, brown spots and fine lines, can be treated with a couple of non-surgical methods. The methods are FotoFacial® and FotoFirm®. The first step (FotoFacial®) is with the Aurora skin rejuvenation laser. This laser uses gentle light and electric energies to restore skin to a more youthful state. Brown spots from sun damage and aging, red blotchiness from spider vessels or rosacea, and rough skin texture will improve over a treatment series. The second step (FotoFirm®) is with the Polaris wrinkle reduction laser, which combines safe and effective levels of laser and radiofrequency energies to remodel the dermal layer of the skin by stimulating new collagen growth, creating a smoother and softer appearance. The lasers combined will result in gradual lightening and improvement of pigmented and vascular imperfections. It can improve textural irregularities in the skin due to loss of collagen in the dermis such as: non-dynamic moderate wrinkles, enlarged pores, superficial acne scarring, rough skin texture, and skin laxity of the face and neck. The sensation often associated with the treatments is described as a “hot pinch” or “snapping” feeling. This sensation usually only lasts for a second. The treatment is very safe for the skin. There will be temporary pinkness in the skin for a very short time, and most people return to work or normal activities immediately after treatment. If you are interested in learning more about these treatments, please contact my office to set up a FotoFacial® consult at no charge.
Dear Dr. M. - My ten year old granddaughter, Hannah, has always had a charming personality, but lately she has become more solitary. My daughter expressed concern that other children at Hannah’s school have been teasing her about her “Dumbo ears”. Although her ears have always protruded somewhat, I have never felt that it was significant. However, the teasing is beginning to affect her personality and it hurts me to see her hurt. Her mother and I have discussed the ear pinning procedure we have seen on television. Would Hannah be too young to have this procedure and what are the risks?
-Hurting for Hannah
Dear Hurting – The ear pinning procedure is called an Otoplasty. It is usually done to set prominent ears back closer to the head or to reduce the size of large ears. For the most part, the surgery can be done on children between the ages of 4 and 14. Ears are almost fully grown by the age 4. Adults are also good candidates for the Otolplasty, as there are no additional risks for older patients. The surgery is generally performed in an outpatient setting. I perform the procedure in my office surgical suite. However, a child must be at least ten years old in accordance with the AAAHC requirements for our operative suite certification. Complications are infrequent and usually minor, but as with any surgical procedure, there are risks associated with surgery and specific complications associated with this procedure. A small percentage of patients may develop a blood clot on the ear. The clot may dissolve naturally or can be drawn out with a needle. Occasionally, patients develop an infection in the cartilage, which can cause scar tissue to form. These infections are usually treated with antibiotics; rarely, surgery may be required to drain the infected area. From an emotional standpoint, I think it is important that you and your daughter evaluate Hannah’s feelings regarding her ears. Do not insist that she have the procedure until she expresses a desire for the change. You can inform her of the surgical option, but let the decision be hers. Children who feel uncomfortable about their ears and want the surgery are usually more cooperative during the process and happier with the outcome. If you would like to set up a consultation with me, please contact my office at 800-880-5391 to set up an appointment.
Dear Dr. M. - Ever since I can remember, I have had enormous breasts. Puberty seemed to hit me with full force and I matured at a much faster rate than my friends of the same age. Now that I am in my twenties, I find it difficult to be taken seriously. Most men are more interested in my breast size than my brain size. I would love to be able to exercise, dance, and just enjoy life in general without always being self-conscious. Friends have told me that I might want to check into breast reduction surgery. Also, they have indicated that most insurance companies cover this procedure. Can you please tell me a little more about the process for determining insurance coverage for the breast reduction procedure?
-Busting out in Berrien County
Dear Busting – The one thing you did not mention are any physical symptoms from the size of your breasts. Insurance companies will not cover this procedure if it is for purely cosmetic reasons that you desire the surgery. Some common medical symptoms of macromastia (larger breasts) are back pain, shoulder pain, neck pain, bra strap indentions on the top of the shoulders and rashes under the inframammary folds. Some insurance companies even use weight and height as criterion in determining medical necessity. Normally, a patient must be 1.5 times or less of her ideal body weight. Other requirements of most insurance companies are photographs, measurements and gram reduction estimates. On your consultation appointment, photographs are taken, clinical breast measurements are taken and the physician estimates the amount of breast tissue (measured in grams) to be excised. It is also helpful to provide any additional documentation you may have. For instance, if you have been treated by a chiropractor for back pain, he or she may write a letter of recommendation for the breast reduction. The length of time it takes to receive the determination from an insurance company varies. However, we generally expect to receive the medical necessity determination within four to six weeks. The procedure is an outpatient procedure and may be scheduled at the hospital or in my AAAHC certified office surgical suite. If you are not approved for medical necessity by your insurance company you may still have the procedure done cosmetically. You may call my office to set up a consultation or if you have additional questions.
Dear Dr. M. - My twenty year high school reunion is this Summer. I have not seen most of my old classmates since graduation. Probably much like everyone else, I am very nervous about seeing my old friends. I have been able to maintain my appearance through the years by taking care of my skin and I am an attractive middle-aged woman, but I wonder if I could improve a couple of things that have started to bother me recently. I have a lot of little lines around my eyes and forehead. Sometimes, I feel that they make me appear older than I actually am. I’ve done some research on BOTOX® and I think I would like to see if I would benefit from a treatment. I’ve also read that BOTOX® has been used to treat excessive sweating. I tend to sweat more heavily when I’m nervous and was wondering if a one time BOTOX® treatment for sweating would help at reunion time?
-Twenty-year Reunion? No Sweat
Dear No Sweat – BOTOX® was approved by the FDA for cosmetic use in 2002. BOTOX® is the only FDA approved treatment for the temporary reduction of the “little lines” you mention in your letter. The treatment lasts up to four months. However, the results vary from person to person. There is no downtime required for the treatments, but the BOTOX® will take three to seven days to become fully effective. BOTOX® reduces the movement of muscles by blocking nerve impulses. The skin surface gradually smoothes out as a result of the decreased muscle movement. The BOTOX® treatments for hyperhidrosis (excessive sweating) work in much the same way. The chemical signals from the nerves that stimulate the sweat glands are blocked resulting in a significant reduction in underarm sweating within four weeks of treatment. As an added incentive for you to give BOTOX® a try, my office participates in the BOTOX® Cosmetic Benefit Program which offers discounts up to $50 on cosmetic BOTOX® treatments. If you are interested in more information or would like to schedule an appointment, please call my office at 229-242-3002.
Dear Dr. M. – Acne at forty-three? Come on! I didn’t have this much acne at fifteen! My breakouts are mostly around my chin and cheek area. They are ugly and painful. Sometimes, I’m left with scars on my face. What’s going on? I thought I had been through puberty already!
-Forty-three with Acne
Dear Forty-three - Unfortunately this is a common problem among women your age. Most of the time, breakouts at your age are due to hormonal changes (pre-menopausal) or stress. Although we cannot stop the hormone changes or the stress in your life, we do offer options to help minimize such occurrences. We offer products and treatments to help you get through this rough patch.
Seeking professional help for this problem is key. A Medical Aesthetician can provide you with the correct evaluation and treatment for your particular skin type. Individuals may have the same “issue”, but may require a very different treatment protocol. One of the first suggestions is to adhere to using certain products formulated for your skin type and condition. There are only a few ingredients found in products that work for acne breakouts. The types of products you may need are retinoids, acids and peroxides. Most over the counter products contain these ingredients. However, they do not have a percentage strong enough to successfully make the difference most people are seeking or in the time frame they demand. At Plastic Surgery Associates, we offer a variety of prescription grade products to help reduce breakouts and minimize the marks left behind after an occurrence. The products we offer have a higher percentage of the necessary ingredients to fight adult acne. With correct application, you will enjoy a more timely and satisfying result.
Certain chemical peels and dermabrasion will help with the skin rejuvenation process. These techniques aid in cell turnover. Peels not only help in cleaning up your breakouts, but also in lightening the marks that the acne leaves behind. For more severe cases, laser treatments may be recommended. The laser combines a specific spectrum of light and gentle radio-frequency energies to decrease proliferation of acne-causing bacteria, and may affect the sebaceous glands from over production of oil. If you are interested in more details, please call our office and set up your free consultation with our Skin Care Specialist, Amanda Parker.
Dear Dr. M. – Recently, I was in a health products store and saw some sunscreen pills. Because I was skeptical, I did not purchase any. However, I am interested in learning more about this new product. Do you recommend using the sunscreen pills? Do they really work? If not, what are your recommendations for protecting your skin from damage and/or cancers?
-Potential Pill Popper
Dear Potential Pill Popper - Currently there are several types of sunscreen pills on the market. Two of which are Heliocare and The Sun Pill. Both are dietary supplements that have a combination of antioxidants and multivitamins. They claim to reduce the amount of skin damage a person gets from the sun. However, there is not enough long-term scientific objective data to support these claims. The label for each of these pills suggests that the pills are merely a supplement to traditional sun protection, such as sunscreen lotions. For these reasons, I would not recommend the use of a sunscreen pill as the sole source of protection from the sun. Over the past three decades, skin cancer diagnoses in women under the age of forty have tripled. It is expected that the number of diagnosed skin cancers this year will surpass one million. Over 90% of skin cancers are caused by the sun. Melanoma, which is a potentially fatal form of skin cancer kills an average of 8,000 people per year. Therefore, it is very important not to limit your sun protection to a pill. Also, remember that an inherent weakness of sunscreens is they are not very photostable. After two hours, the active ingredient is minimized dramatically. Therefore, I recommend that you reapply frequently. If you suspect that you may have a malignant lesion as a result of prolonged sun exposure, you should consult with a Board Certified Dermatologist or Plastic Surgeon.
Dear Dr. M. – I noticed in your local phone book advertisement that your ambulatory surgical center is AAAHC certified. What exactly does that mean and should I only consider AAAHC facilities when considering a surgical procedure?
-Acronym Amateur
Dear Amateur - Almost everyone has heard that they should look for “Board Certification” when seeking a qualified Plastic Surgeon. However, less emphasis has been placed on the certification of Ambulatory Surgical Centers. There are three agencies that certify Ambulatory Surgical Centers, AAAASF, JHACO and AAAHC. We chose AAAHC certification for our ASC, Plastic Surgery Operative Suite, LLC. Accreditation Association for Ambulatory Health Care (AAAHC) certification is not a requirement. However, it is a symbol of an unwavering commitment to provide the highest levels of quality of care to our surgical patients. Our accreditation allows us to provide that extra measure of confidence that the community wants to see in its health care service providers. Accreditation is a voluntary process through which an ambulatory health care organization is able to measure the quality of its services and performance against nationally recognized standards. Also, accreditation may satisfy certain regulatory requirements for licensure or certification. Every three years our facility participates in a rigid inspection by an expert surveyor from AAAHC. I would certainly recommend that you consider an ASC that is AAAHC, JHACO or AAAASF certified when choosing a facility for any outpatient procedure. The certification is generally a testament to the dedication and commitment of an ASC to provide the highest quality of care. If you would like to find out more about AAAHC certification, you may go to their website at www.aaahc.com. Please contact my office if you have any additional questions or would like to set up a consultation appointment.
