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Our Approach to Cosmetic Enhancement

Overview
My approach to the art and science of cosmetic enhancement is to understand the individual and visualize the desired results in relation to his or her self-image, self-esteem and life experiences. Then, as we jointly discuss the steps, stages and alternatives, I think in terms of progression of choices, beginning with the simple, healthy and minimally invasive. Subsequently, I consider more involved lifestyle and surgical enhancements.

My approach is aimed at harmonizing your self-image with the image you see reflected in the mirror. The process does not stop there. My passion—to help guide you to maintaining your youth, beauty and vigor—continues through inspiring you toward a healthy lifestyle enabling you to maximize the quality of your relationships and activities.

My contribution and my passion are based on synchronizing your inner and outer beauty to facilitate long-lasting inner peace. Arching over this entire process is my credo: “What would I do for my daughter if she were seeking my advice as you are now?”

Choosing Anesthesia
One option is IV sedation. With this an IV is started in the arm and sedatives are gradually given to gently put you off to sleep. After you are relaxed, local injections are used so that the surgery can proceed. Another option is general anesthesia. With this, you are started out with IV sedation then put deeper to sleep, once asleep a breathing tube inserted to control your airway; this is removed before you wake up. At the end of the surgery, local anesthetic is injected and you are woken up.

IV sedation doesn’t put you to sleep as deeply as general anesthesia, and your airway is not protected in the event you drift further to sleep or should you vomit. Because the local is injected slowly as the surgery proceeds; the operation takes quite a bit longer.

First, I must stress that both methods are safe. It is simply a matter of preference. In fact, Dr. Stephens has been using IV sedation for 30 years and prefers that method over general anesthesia. I, however, prefer using an anesthesiologist or certified nurse anesthetist (CRNA) and have done so with great success for 25 years. .Our Arlington facility is not set up for general anesthesia, so we perform those procedures at a nearby outpatient surgery facility.

Breast Implants
Everyone is different and everyone has different needs. Therefore, there is no single procedure that is best for all women, which is why I individualize each consultation. Some women prefer saline because it costs about $1,000 less, it is filled with IV fluid and when it leaks in about 10 years, the saline is quickly but safely absorbed and the implant goes flat. The manufacturer warrants the implant with a replacement forever, but the costs associated with the surgeon and anesthesiologist of about $1,500 are covered for 10 years. There is no down time, as replacement is just opening up the old scar and replacing the implant with a new one. Saline implants are more likely to show ripples.

Silicone is becoming the more popular option because they feel more natural. Silicone implants have a longer history of use and were never taken off the market in Europe where they command about 85% of the market. They are filled with a cohesive silicone gel that sticks together, depending on the amount of molecular cross linking during manufacturing. Less cohesive gels tend to migrate like jelly when the implant finally leaks at about 14 years. To avoid this, manufacturers are now making the gel more cohesive so that the silicone will not move away from the breast when the shell finally leaks. Since they don’t show ripples and feel more natural, they are rapidly coming back into favor in the United States. They can interfere with mammograms, in the event there is a question on a mammogram, an MRI might be required.

Both implants are safe, and both have the same potential complications of infection, leakage, hard scar capsules, stretching/drooping of the breast, loss of sensation, and loss of nursing ability.

Should I have the implants placed under or over the pectoralis muscle?

Ripples are normally covered by overlying tissue by the few women who have sufficient breast tissue or fat that the implant is not likely to show. To help avoid ripples Dr. Robinson usually put the implants under the muscle so there is an extra layer to hide the ripples.

Under the muscle placement might give you a bulging look during certain exercise movements. For weight lifters, this might be a consideration. The function of the pectoralis muscle is not permanently weakened, thus that should not be a concern. Again, placement in relation to the muscle is an individual decision to be made at the time of consultation.

All fillers sting when injected and some individuals may need a local anesthetic to control the pain. All fillers gradually go away over time depending on the person, site of injection, the type of material, or on the amount of cross linking of the material itself. Collagen® lasts about three months and goes in smoothly with little pain. Hylaform® hurts more when injected but lasts about six months. Radiesse® lasts about 10 months, is brand new, and they say it does not hurt more than Hylaform®. All can leave bruises, so one week before the injection, you may want to avoid aspirin, blood thinners, vitamin E, and other supplements, especially ginkgo, garlic and ginseng.

After considering these caveats, it is really a cooperative decision between you and your surgeon as to which product you want depending upon the injection site. Like fine wines, the right one will work for you and all are operator-dependent. They are great for the lips, the fold from the nose, wrinkles on the cheeks, acne scars, and frown lines. None is a substitute for a facelift when that is finally needed.

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