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Will I be able to breast feed after breast augmentation?

Yes. Virtually all patients should be able to breast feed after breast augmentation despite the approach  (transaxillary vs. periareolar, submuscular vs. subglandular). The vast majority of ducts to the nipple are left intact after breast augmentation.

Will I get fat in unusual locations after liposuction?

No. However, this is a complex answer. Your body has a genetic program that directs where fat will be stored. There are definite areas that have a higher priority to store fat. In women, it’s the big 5: the abdomen, hips, outer thigh, inner thigh, and inner knees. In men, it’s the area around the bellybutton, the love handles, and below the chin. Not everyone stores fat equally. I find that after liposuction, patients don’t suddenly develop fat pockets in unusual locations, but may have a greater predisposition to gain fat in areas that already are prone to accumulate fat. There definitely is a hierarchy of where your body stores its fat, and once a person’s problem areas are suctioned, the propensity to gain weight or accumulate fat in those areas is significantly diminished. Remember, billions or trillions of fat cell are removed during liposuction. If that person then maintains a stable weight, he or she will not gain the weight back or gain it in other locations. However, if that person does gain a significant amount of weight, they still do have the ability to gain weight in those problem areas, albeit to a much lesser degree. The most common example is a female patient who has had liposuction of her hips, inner and outer thighs, but also has a tendency to gain weight on the back of her arms which were not suctioned. If this patient then gained weight, she would not notice much weight gain on her hips, inner and outer thighs, but may notice it more on the back of her arms. Generally, if patients stay at a stable weight, they will not gain weight in new areas.

Which is better, placing breast implants on top of the muscle or below?

It depends. I place the implant below the muscle in about 95% of patients. The advantages include a more natural appearing breast, better ability to mammogram the breast, a decrease in capsular contracture, and a decrease in wrinkling or rippling of the implant (especially important with saline implants). The disadvantages include more discomfort after surgery and a banding across the chest when flexing the pectoral muscles.  The advantage to placing the implant on top of the muscle is less post-operative pain and to some a more defined look of the breast (a la Pamela Anderson). The major disadvantages include a higher rate of capsular contracture (the breast turning hard), a higher rate of visible and palpable wrinkling, and to some a “bolt on” or very defined appearance of the breast. Generally, I place the implant submuscular unless the patient is a bodybuilder or desires a very defined look.

When should I start thinking of having a facelift?

When looking in the mirror and your mother is looking back. Just kidding! There is no pat answer to this. It really is a personal decision based on how one is aging and how much it bothers you. One thing is for sure we are all aging. Depending on our genetics, sun exposure, habits (smoking  and/or drinking), and adherence to a “healthy lifestyle” there is a huge difference in the way our faces hold up. Patients have mentioned the following reasons on why they decided on pursuing a facelift: “I can’t wear makeup anymore because it just cakes up”, “I look like my mother”, “I look terrible in pictures”, “my daughter is getting married in 3 months”, “I feel young and energetic, but I look tired”, and “the job market that I compete in is very youth oriented”. Some people have asked me as to whether they should have a facelift before they really need it so the result is not so dramatic. My answer is you need it when you need it and only you can determine that. This decision should be made in the context of knowing a few facts. You only have three facelifts in your life before you start to have the windblown, “gee how come my face doesn’t move” look. Each facelift lasts an average of 7-10 years. Most patients begin shopping for their surgeon in their late 40’s, and the average age that most patients have their first facelift is 52.

Does laser hair removal work?

In a word, yes. However, one needs to understand that it is a process and doesn’t work after one treatment. The laser light is directed specifically at the root of the hair follicle, which is densely packed with melanocytes. The concentrated light creates a thermal injury to the hair bulb. Two things then happen: the hair follicle is shocked and enters a resting phase called telogen where the hair doesn’t grow for a period of 1 to 3 months and the hair follicle atrophies resulting in finer, thinner hair. On average, it takes three sessions to see a major difference and five sessions before the hair becomes significantly thinner. If the hair is very thick and coarse, it may take several additional treatments until it becomes fine. The key phrase is permanent hair reduction. Most patients enjoy the benefits of having significantly less hair, but the biggest benefit is a drastic reduction of ingrown hairs. Overall, the patient satisfaction has been very high.

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