Historically, nipple-areola complex reconstruction has been considered a secondary procedure to the more important breast mound reconstruction. To optimize positioning of the nipple, surgeons generally recommend waiting until complete settling of the reconstructed breast before performing nipple reconstruction. However, when nipple reconstruction is delayed for months to years, final reconstruction is often never completed, as patients often opt to minimize their exposure to further surgical procedures. Most recently, some have advocated immediate nipple reconstruction in free TRAM flap reconstructions to minimize operative procedures and to achieve earlier completion of the breast reconstruction.
Nipple reconstruction techniques have evolved significantly over the years. From simple tattooing to the more technologically advanced, although rarely available, tissue engineering. Dr.Fisher uses techniques, which provide long-lasting, satisfactory reconstruction with minimal morbidity. While not recommended in breast augmentation, this procedure is inevitable in certain types of reconstructive surgery. (viz. our previous article)
Nipple-areola reconstruction represents the completion of the breast restorative process and has significant psychological implications for women who undergo mastectomy. Nipple size, position, projection, and color are determining factors in the aesthetic symmetry of the reconstruction, qualifying an otherwise nondescript flesh mound as the new breast. Complete nipple-areola reconstruction with tattoo can visually draw attention away from the scars on the reconstructed breast mound. In addition, autologous flap breast reconstruction following skin-sparing mastectomy can usually be designed so that the entire flap skin paddle, along with the scar, is tattooed as an areola.
The benefit of nipple-areola reconstruction is supported by the findings of a retrospective psychological survey comparing the level of satisfaction of women who underwent breast reconstruction with or without nipple-areola reconstruction; a highly significant correlation was seen between level of satisfaction and presence of the nipple-areola complex. Artists and anatomists consider the nipple-areola complex an essential and defining component of the breast aesthetic unit, and the physical characteristics of the nipple gain importance as the breast mound decreases in size. Reconstruction of position, size, shape, and color of the native nipple-areola complex currently are attainable goals; functional restoration of erectile ability and erogenous sensation can be restored by Dr.Fisher.
Pursuant to our internal research conducted from January 1, 2010 to January 1, 2011, out of 512 patients who chose to answer our questionnaire, over 400 came upon their friends’ recommendations. All the respondents looked up our website prior to visiting us. 170 came for a major procedure, 186 for a minor surgery. Almost one half of the patients stated that they prefered complete anesthesia, while the other half did not have any preference in this regard. More than 360 patients have stated that they will “definitely recommend” Dr.Fisher’s services to their friends. The rest simply stated that they would recommend us, without qualifications. All the patients regarded our staff as professional and kind, in all cases (that is 100 per-cent !) answering the patients’ questions; but at the same time gave more weight to the doctor’s attitude and experience. 92% of the respondents stated that being able to trust Dr.Fisher was the most important reason for their coming to us, sometimes repeatedly, for advice and help. 85% stated that they did not find anyone within 25 miles with equal experience and skill. 63% of responding patients came to us because we had “very competitive prices.” Of course no-one would want to associate the adjective “cheap” with anything that they might receive in/on/for the benefit of their body. The body is just as important as the mind, and no-one wants to be ”cheap” when their body/mind is concerned. Thus, we purposefully and intentionally completely omitted this word from our questionnaire.
Patients have the option of having injectable fillers like Juvederm or Restylane to replace volume in the area between the lower eyelid and the cheek to replace the fat from this area that has moved or sunk with age. As newer, longer lasting fillers become available, non-surgical alternatives to blepharoplasty are now possible. Non-surgical blepharoplasty takes about ten minutes, is relatively painless, and causes little to no bruising. The effects of non-surgical blepharoplasty can last around 18 months. After the procedure it is common to have swelling or bumpiness below the eye. They quickly recede and cause little or no pain.
Your eyes are the window to your Soul. What do other people think? You look into their eyes… They look back. A person with drooping eyelids, wrinkled, permanently tired hangdog haggered look in his eyes will not be able to communicate the Joy of his or her Soul. Indeed, there will be no joy. Do people think you are angry or tired when really you are not? Do you look older than you feel? If so, treating the eye area may be your answer.
Dr.Fisher always recommends topical products that are sold at Cosmetic Surgery and Laser Center, Cerritos www.CosmeticSurgeryandLaserCenter.com but only plastic surgery can give you a large-scale, long-lasting new lease on life! You can compare how natural and perfect the results are. The Happiness that we have seen in our patients truly cannot be purchased with money.
Eyelid surgery (blepharoplasty) can correct hollows around the eyes, loose skin, and fine lines and wrinkles. Unlike many other surgeons, who are as yet trying to achieve a natural, “non-pulled” look, Dr. Gregory Fisher has brought this art to perfection. He truly reshapes both the upper and lower eyelid as well as relocates the excess tissue that surrounds the eyeslids. The result is not only obvious and apparent, but also underlying – added strength in the surrounding muscles and tendons.
Blepharoplasty is typically performed to remove excess eyelid skin that causes loss of peripheral vision by blocking a person’s line of sight, causing difficulty with daily activities such as driving and reading. Upper eyelid blepharoplasty can be done both to improve one’s vision or for cosmetic purposes. Lower eyelid blepharoplasty is always done for cosmetic reasons, since it improves the physical appearance of the eyes by removing the “eye bags” and reduces the wrinkling of the skin in the area.
Many patients are worried excessively about complications. “The only complications I have had,” Dr.Fisher says, “have always been the result of the patient’s not following my instructions. After the surgery, most patients will experience bruising and swelling that lasts about seven to ten days. There is no reason to worry. Patients sometimes call me in the middle of the night, only to find out that they are experiencing a natural healing process. Naturally, after blepharoplasty, patients should have ample time to rest their eyes and should avoid wearing eye makeup and contact lenses during the recovery period.”
”Sometimes,” Dr.Fisher continues, complications may arise from the patient’s concealment of his or her condition. It is very important to disclose any prior surgeries to us, hospitalizations, and, in connection with blepharoplasty any headaches, eye surgeries etc. Patients sometimes do not think that a prior eye surgery they had 2 years ago can have any detrimental effects. Well, it can. In such cases, if you want perfect result, you have to provide your full medical history. It is too late for me to get in touch with your ophthalmologist after the problems arise…”
“One of my patients intentionally did not disclose her eye surgery. Two days after a successful procedure, excessive bleeding occurred, which resulted in abnormal folding of the eyelid skin. It took another surgery to correct the defect. Subsequent healing took five months instead of five days. We are surgeons – doctors, artists in many ways – we are not omnipotent and omniscient. The more open the patient is and the more they confide in me with respect to their past medical history, the better the result will be in the end. A simple breach of the post-operative instructions, such as bending over to put on an item of clothing or – as was the case in one of my patients – to catheterize herself – can ruin a perfect surgical result. It is sad, but it happens.”
That is why we inform you on this blog what you may not be fully aware of, and which will save you a lot of time and money. Only patients who obey the instructions of Dr.Fisher and disclose all their prior medical history can expect a perfect result.
In today’s hurried world, you should find some time for yourself and make yourself happy. One of the most obvious choices can be by improving your visage. An experienced, skilled plastic surgeon, such as Dr.Fisher, can take 15-20 years off your face overnight, as if it were the doing of a swift magic wand, not a gentle hand of a mere mortal.
Patients are often surprised how plastic surgery can improve their face – eradicate wrinkles, spots, lines… all those unpleasant signs of aging; and since the outer self molds the inner self equally well as it is often the case the other way round, plastic surgery can add to your mental composure and well being.
Out there, we sometimes see people who did not exercise their choice of a plastic surgeon wisely, and consequently ended up with an equally profound obverse effect: their skin is pulled too tight, unnaturally, ungracefully, or they may even have physical deformities and problems. That is what happens when you do not use your best judgment with respect to your inner satisfaction, but your best judgment with regard to economic concerns. Our advice? If you cannot afford to invest into your well-being and happiness, cannot save a few bucks here, a few bucks there… forget it! Do not give yourself pains. Do not go for the second best – because that might cause just as poor a result as the last – you never know – especially when you have the best one waiting for you.
Dr.Fisher will personally explain to you where the Hollywood starlets – or even erstwhile starlets who, now in their 40s, 50s and 60s, have undergone artful cosmetic procedures to maintain the image of youth – defaulted. Surgery is art – much more than a little nip-and-tuck here and there!
Why, you can see yourself when a facelift goes wrong how even people’s characters alter… Such unfortunate patients will never extol any plastic surgeon. Therefore, ask for the best, look at satisfaction.
During an interview at the 2009 meeting of the American Society of Plastic Surgeons, Dr.Fisher explained the most common pitfalls of facial plastic surgery, and shared some little-known trade secrets for avoiding them.
“During the typical facelift operation, the patient’s ears are subjected to a lot of tension, which causes some drooping of the ear canal,” Dr.Fisher noted. “As the surgeon adjusts the patient’s facial skin and muscle during the face lift, the altered ear drops down, producing extra skin to deal with and dispose of. Patching the patient back up from this usually means producing the ‘pulled’ look. Signs of surgery are conspicuous, as well. If they have a lot more skin to remove, the incision is longer,” he adds emphatically, “and if it’s longer, it is visible.” Shaking his head, Dr.Fisher continues: “We have to do two things: The ear is little higher and there’s more volume. We still do the muscle work, but is there less or more skin? There’s less. And if there’s less skin, the incision is shorter and can be hidden inside the ear.”
Dr.Fisher’s result? A perfectly natural facelift, which will not alter your natural characteristics, will emphasize the beauty of your face, and whose surgical evidence is well concealed. Again: look in the mirror. You deserve better. Why not the best?!
“Can the scars from previous my operation be eliminated by a new surgery?” (Fiona B., Montebello)
Perhaps surprisingly, yes. Scars in the abdominal area (and this also applies to stretch marks) can be entirely eliminated by a skilled surgeon. I have done hundreds, if not thousands of operations where the substantial reason the patient expressed for the surgery was that she, in many cases he, wanted to improve the results of a previous surgery.
Usually, the main objective is to be economical while remaining efficient and equally esthetic. This means finding a fair proportion between maximum gain and maximum loss, so to speak. If there is still excess or mal-distributed fat in the area or perhaps lax or over-hanging skin, the main objective is to eradicate those. This objective must be viewed in proportion to the overall bodytype and size of the patient. Sometimes, even a master surgeon, such as myself, finds it almost impossible to remove entirely evidence of an improperly performed surgical procedure.
The tummy tuck operation itself may also be done in such a way as to remove scars or stretch marks. However, the higher the position of the scar, the more difficult it is to deal with it. It is also generally known that scars heal worse in smokers, not to mention people who use drugs. Scars interfere with the blood supply to the skin in general and sometimes may severely complicate a subsequent or reparative tummy tuck. There is no rule of thumb on this issue here.
Every reparative operation is a compromise of esthetic and pragmatic nature. A personal consultation is absolutely necessary. Unfortunately, many people look at cost of the surgery rather than the skills of the surgeon. In most cases, saving $500 or $1,000 in the short run, will cost you ten times that much in the long run. It is sad but – true.
In the 1980s, Replicon implants were the most popular. Replicon is an anatomically shaped, polyurethane coated, silicone gel-filled implant. Many surgeons felt that the initial results were very beautiful, but short-lived, because the polyurethane, which was bonded to the surface of the shell helped to maintain the anatomic shape of the implant, eventually deteriorated, and once it was absorbed off of the shell, the remaining thin and pliable shell could not hold the silicone gel in place, and so its shape was lost. Further, gravity forced the gel to the bottom of the shell, collapsing the upper breast, and expanding the lower breast. Folds developed in the collapsed upper pole. The shell was very thin, and with time, the shell weakened along those folds, and eventually could break, allowing the relatively liquid-like contents of the implant to leak outside of the shell. In addition to the effects of gravity, the forces of the breast acted upon the implant, deforming its initial anatomical shape. The implant accommodated to the shape of the breast, rather than the breast taking on the shape of the implant.
Dr.Fisher was directly involved in a long and tedious process – far beyond the scope of this article, or this site, to describe in detail – which involved experimentation with diverse silicone gel fillers. Silicone can be made in virtually any firmness, from a liquid lubricant to almost a rock-hard solid. The aim was achieved in making the filler more stable and avoiding collapse of the shell. Further, the modern cohesive shell can be formed into a particular shape and maintain it.
In the past, shape was of only moderate importance, because the forces of the body and of gravity would shape the implant. However, the modern cohesive filler allows for various ratios of width, height, and projection.
The FDA moratorium on silicone gel filled breast implants in 1992 also contributed to increase in competitiveness and invention in this area. The type of implants that were available before the ban are available today as part of an “adjunct study,” which is open to patients with congenital deformities or having a revision for particular reasons.
What distinguishes the modern cohesive implants is that the silicone gel is firmer, essentially a soft solid. If a cohesive implant is cut in half, there is no gross movement of gel, and the implant maintains its shape. The way these are made is that the company uses more “crosslinker” in the making of the implant. The ingredients are the same, but with more crosslinker added, it makes the gel firmer.
Cohesive breast implants implies form stability, or form retention. That means that in any position, the implant maintains its shape. That is an important distinction, because it means that the shell should not fold, and that it will maintain a particular shape. All breast implants are “cohesive” to a different extent. More cohesive are not necessarily better. The bottom line here is the desirability of shape and firmness, which must be in proportion to the body’s natural qualities.
Many people suffer from protruding or malformed ears, which may have exposed them to ridicule during childhood, severely lowering their self-esteem. Otoplasty, or ear pinning surgery, can effectively eliminate these imperfections and create more aesthetically pleasing ears for the patient.
People with large, malformed or misshaped ears choose to undergo ear pinning surgery. If you have prominent protruding ears, noticeably protruding from the head, if you suffer from the “lop ear” when the tip of your ear appears to fold downward and forward, similar to some dog ears, or if you have cupped ears (disproportionately small), or possibly “shell ears” with the absence of natural ear folds and creases, and no curve in the outer ear rim, you may be the right candidate for otoplasty.
Adults and children alike can receive otoplasty, but the operation is mostly performed on children between 4 to 14 years of age. Although rare, Dr.Fisher performed this surgery many times. “At the age of four,” Dr.Fisher states, “the human ear is nearly fully grown. This is the perfect age for otoplasty.”
Many followers of our site and Dr.Fisher’s blog and website, www.drfisher.com, are full well aware that Dr.Fisher is one of the United States’ foremost experts in reparative surgery and surgery of the hand (carpal tunnel syndrome). He established Marie-Louise Cleft Palate Foundation, and helped many children and adults regain their self-esteem by operating on bodyparts as diverse as you can only imagine – from ears and noses, to feet and genitalia. With his Columbia University background in psychology and physiology, he is also a foremost expert to address when you have any psycho-somatic disorder, such as “outstanding” ears.
How does he perform otoplasty? For adults and older children, the use of local anesthesia and sedatives during the operation is preferable. For young children, however, general anesthesia is recommended. The typical time frame for ear pinning surgery is between 2 to 3 hours. If a particular case is complicated, the operation may take longer.
“It is very easy – if you know how to do it,” says Dr.Fisher with his proverbial good humor and large, welcoming smile. “First, we must expose the ear cartilage by making an incision behind the ear. Then the cartilage must be carved and bent backward, closer to the head. If necessary, superfluous cartilage should be removed, just as we do in nose-shaping. Finally, we apply a few permanent stitches to keep the new shape in place.”
To ensure proper healing and molding of the ear after ear pinning surgery, Dr.Fisher uses a bulky bandage around the head of the patient. There may be some aching and throbbing for a few days, which can be relieved and minimized by very effective medication. Dr.Fisher uses self-absorbing stitches, so there is usually no need for a post-op visit for stitch removal. Normal physical activities can be resumed after approximately four to five weeks.
Brachioplasty, also known as an arm lift, is a surgical procedure to remove skin and fat from the upper arm, reducing skin redundancy, be it from fatty tissue, skin, losing weight or muscle.
Aging, fluctuations in weight, simple forces of gravity… all contribute to the loss of skin elasticity and tone.
Brachioplasty, arm lift or arm tuck, can, and often is, coupled with liposuction. When the excess skin is detached, the remaining skin is stretched and stitched back into place. The surgery often lasts for 2-3 hours, and the patients can be sent home on the same day.
Our patients have the advantage of a special arrangement we have with Sheraton Hotel, so even if Dr.Fisher has some prior surgery and the patient is taken into the OR in the afternoon, they can rest comfortably, accompanied by our staff, and transition into a wholesome uninterrupted sleep. Healing time after the surgery will vary between individuals. Dr.Fisher will ask you to avoid engaging in strenuous activities such as lifting heavy objects.
Who are ideal candidates for brachioplasty? Those who have lost weight after a massive surgery (e.g. bariatric surgery or “stomach stapling”), who exceeded their tanning, or even people who find that aging process inflicted unwanted and undesirable effects on their bodies. If a patient has predominantly excess of fatty tissue (all over the body) then liposuction must be performed first (or alongside with brachioplasty). Naturally, people who have some counterindication, such as multiple infections of the sweat glands (Hidradenitis Suppurativa) must be treated appropriately first. In cases of radical mastectomy (extensive breast cancer surgery) swelling of the arms is normal and an added aesthetic procedure may neither achieve the desired effects and/or cause unnecessary complications.
Before deciding on getting an arm lift, one must reflect on the scars that will be permanently found on the side of his or her arms. Depending on the length of the incision, the scar could extend from just within the armpit area or down to the elbow. Although Dr.Fisher has already hidden these scars at the inner side of the arm, its appearance varies from one patient to the other and you should consult with Dr.Fisher on the issue in detail. What matters here is the extent of the procedure. Minimal skin excess may be treated with an incision in the armpit alone. Moderate laxity is treated with an incision from the armpit to the elbow. Most patients fall into this category. More severe cases are rare and may require extension of the incision past the elbow onto the forearm. Dr.Fisher performed dozens of incisions of all three types and has unparalleled experience in the area.
Finally, if you are planning or anticipate a significant loss of weight in the future, it is probably best to postpone your arm lift until after this has occurred to optimize your results.
Following arm lift surgery, many patients experience an immediate improvement in their self-esteem and discover a greater self-confidence. In addition, many also find greater access to different clothing styles and fashions and are less self-conscious at the gym, around the pool, or at the beach.
In Los Angeles, we have summer virtually all year round and many bikini-loving beachcombers love to reveal their physical assets. Weight loss and toning is not all diet and exercise. From the breasts and buttocks to the waist and arms… your whole body is “suctionable,” as Dr.Fisher says. “What an ugly word,” he adds. “It is one of those flash-in-the-pan expressions I commented on in my last interview for Facebook and U-Tube. One should not be susceptible to new-fangled terms in science or art, terms that drive the banner of some lowest common denominator – spaghetti universe, Twiggi body… and such. ‘Suctionable’ seems to be one such term. It is, though, very descriptive. It says what we do in helping people feel better about themselves: we separate the chaff from the grain, so to speak. You see, it does not have to be on the beach – it can be in the privacy of your own home, while you are stepping out of the shower looking at yourself in your bathroom mirror. No-one can see you then – only you. However, how you look is how you feel, and that reflects and bears on your self-esteem when you are fully clothed among other people.”
Dr.Fisher wrote a whole book on the subject, aptly titled “Body Image.” He is currently preparing a second edition. He would welcome any reflections on liposuction that his former patients may have.
For those who have not yet had any cosmetic surgery done and are contemplating getting rid of love handles, hip rolls, muffin tops or whatever other part of your body, which you do not like, “suctionable,” albeit ugly-sounding, is a very descriptive term: we can simply “suck it off.” For example, “abdominal etching” involves the removal of excess fat in between the abdominal muscles, and in doing so creates indentations that give the appearance of a defined stomach. You may have seen this on some of our models on Facebook (all product of Dr. Gregory Fisher’s work). Think six-pack abs? Why not?
Now, as you are, touch yourself on the abdomen. You are sitting? Stand up, lean backward. Now, touch yourself on the abdomen. Can you feel the “sixpack” hiding below? A good surgeon-sculptor, such as Dr.Fisher, can touch you exactly the same way in the operating room, while you are under anaesthesia. He can follow your muscles, and feel where the indentations are. Then, he can suction off the exact amount of fat needed for your muscles to stand out. Of course, you do have to exercise a little and not be a total couch potato. “Abdominal etching” is an option only for individuals in whom total body fat is less than 18 percent. However, it is just as successful, if not more, as a stringent diet and hard exercise, much harder than you would have to exert without ab etching.