Dr. George Sanders

Typically you add volume. This can be done by injecting things or by adding implants. Currently my favorite is PermaLip which is a permanent silastic implant – it’s very natural, well-tolerated, easily removed, and not associated with loss of feeling or undue firmness.

If structural support was required or an addition of volume required, these would be the graft materials of choice.

If your brows are at the level of the supraorbital rim or below. The supraorbital rim is the bony prominence located above the upper eyelid.

It is a breast lift that removes a “donut” of skin from around the areola and then pulls the remaining skin down to the areola with a permanent internal stitch that both tightens and lifts the breast skin, lifts the areola up, and decreases the areolar diameter.

“Dual Plane” refers to placing a breast implant beneath the upper part of the pectoralis muscle and in front of the lower part of the muscle. It allows the lower part of the implant to fill out the lower part of the breast and gives a more natural look and it is a far less painful operation.

Capsular contracture is not completely understood. It is apparently caused in some cases by a small amount of bacteria that become attached to the outer part of a breast implant in what is called a “biofilm.”  These bacteria stimulate an inflammatory reaction in the scar tissue that surrounds the implant, causing it to contract. In other cases, blood in contact with the implant can lead to contracture. X-Ray therapy can also cause contracture. Avoiding capsular contracture is done by minimizing any bacterial contamination of the implant by careful surgical technique and avoiding blood collections around the implant. Placing the implant behind the muscle also helps as does postoperative massage of the implant.

Microliposuction refers to 2 to 3 millimeter diameter cannulas that remove the fat. It can be used in virtually all cases and is free of some of the risks associated with laser and ultrasonic techniques. Microliposuction is done in conjunction with injection of a large amount of local anesthetic solution to minimize bleeding and maximize fat removal.

I use pain pumps in tummy tucks. This is a device that pumps in local anesthetic where the abdominal muscles have been tightened. It markedly reduces pain after surgery and is removed several days later much as one takes out an IV – painless and quick.

Drainless tummy tucks are those done without resorting to a drain after surgery. Usually a drain is required to remove blood and fluid from beneath the skin. If one sutures the skin down to the underlying muscle, this may allow one to get away without a drain. This allows for a more comfortable recovery.

Usually with fat. Implants have too many complications in that area for me to use them.

There are inner and outer thigh lifts and there are several types of each of those. Typically an inner thigh lift requires a scar in the crease between the upper thigh and the perineum or a scar running down the inner thigh to the knee. The latter is reserved for more extreme cases of inner thigh drooping.  An outer thigh lift typically requires a scar that runs from the low abdomen to the mid-back and that is hidden by undergarments.

They run from the underarm region to the elbow. If only a limited lift is required, the scar may be totally confined to the armpit.

The best answer is that, "It depends!" For most patients, a properly done submuscular dual plane placement of a silicone gel implant gives the most natural result. If a patient has large breasts or a great deal of fatty tissue, either in front or behind the muscle looks about the same since the implant is "hidden" by the tissue. If the patient is a body builder, preference may need to be given to an implant placement in front of the muscle to avoid the unattractive movement of the implant that may occur with pectoralis major muscle contraction. If the patient is extremely thin, it may be better to avoid the dual plane position since unnatural rippling of the muscle may occur in the lower part of the breast.

In general I prefer to place the implants behind, as opposed to in front of, the muscle since there is less rippling of the implant that can be seen or felt, there is a more natural slope to the upper part of the breast, mammographic interpretation is better, and there is a lesser chance of capsular contracture (hardness) of the implant. The dual plane position refers to the implant being behind the muscle in the upper 2/3 of the breast and in front of the muscle in the lower 1/3. This position has a number of advantages over the "completely behind the muscle" position such as a lesser chance of forming a "double bubble", less implant movement with muscle contraction, and less discomfort after surgery.

Although a consultation with a board-certified plastic surgeon is required for a proper answer to your question, here are a few general thoughts. You may wish to consider silicone implants as they have some advantages over saline. The average cost depends on many factors, but something in the neighborhood of $8,100 for new silicone implants plus an additional $1,500 - 2,500 for a breast lift, depending on the type of lift needed. For saline implants, subtract $500 from the price.

Although I have used many techniques throughout my career, my favorite is the MACS-Lift because of its low risk and superb results. If a patient needs a greater degree of improvement in the neck than a basic MACS-Lift allows, I can modify the procedure to accomplish their desired result. For those patients needing additional lifting of the cheeks, an Extended MACS-Lift procedure can be the solution.

Not only are the implants far sturdier and less prone to leakage, but we also have a much better understanding of how to minimize complications from surgery.