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Cosmetic Surgery Associates Blog


Posted on: March 24th, 2014 by Rod Zickler No Comments
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#1     How soon can I get my surgery?

Often we are able to schedule surgery dates as early as two weeks after the first consultation.  Of course, assuming that your health will permit this and assuming the dates available are compatible with your schedule.  For people with much longer surgeries where more operating room time is required, it may require a little more lead time.  For people who are waiting insurance prior authorization statements, often there is a 4-6 week lead time through the insurance carrier before we can schedule surgery, so depending on your needs we may be able to get your surgery very quickly.  Please leave yourself enough time if you are thinking about getting a procedure so you are not left doing things in a rush.  This should be a very careful consideration.  Your health is too important to leave to the last minute.


#2     What is the difference between silicone and saline implants?

This is a very deep topic with a great deal of literature and information.  The short answer is that saline implants are filled with the same I.V. fluid that you might receive in the hospital, whereas silicone implants are filled with a silicone gel.  Some of the silicone gel is non-cohesive.  Recently the “gummy bear” implants are now filled with a cohesive gel which should theoretically have less risk of migration if there should be a rupture, leak or deflation of the implant.  In general, saline implants have the disadvantage of perhaps showing rippling or dimpling in thin patients who receive large implants more so than silicone implants would.  Silicone implants have the disadvantage of requiring an MRI scan to check on rupture, leak and deflation.  This is recommended by the manufacturer at every 2-3  years after implantation.  Saline implants tend to be somewhat less expensive on the front end and have much less cost if they need to be removed for rupture or deflation.  Silicone implants are often more expensive at the time of the first surgery, require MRI surveillance and can have more significant problems if thy do rupture requiring a more extensive operation to remove not only the silicone gel but often the scar capsule that contains it.  Silicone implants however are less likely to rupture, leak and deflate than the saline implants.  This is a complicated issue and will be addressed soon in its own page in the web site.


#3     How do I know if I need Botox and fillers or do I need a “real” facelift?

In general, botulinum toxin and the currently available dermal fillers are excellent ways to camouflage and treat fine lines and wrinkles in the face.  Botulinum toxin works by weakening the underlying muscles of animation in your face.  Such lines as the vertical 11’s between the eyebrows are caused by contraction of the corrugator muscles.  By weakening these muscles in people with good elasticity and no fixed lines in the skin you may have complete resolution with botulinum toxin.  However, if this has persisted for a long time and the skin itself becomes redundant or there is significant brow ptosis from the normal aging process and overuse of the corrugators and the forehead skin and frontalis muscles no longer appropriately support the brow in good position, it may be that Botox is not a good solution even for the vertical 11 lines that it is FDA approved for.  It may be that the ideal correction for this problem in someone with brow ptosis and loss of muscle tone in the frontalis muscle and redundant skin of the forehead is an appropriately performed brow lift which is a real surgical procedure.  The surgery is meant to restore normal anatomic relationships and rebalance the position of the brows and in so doing eliminate the vertical 11’s.  Generally surgical procedures are longer lasting in their effects and much more definitive in fixing the problem.  A careful analysis in our office can help you decide which is right for you.  Just like this discussion with the vertical 11’s, many other of the lines and imperfections in the face can be either camouflaged with dermal fillers or restored with surgical procedures such as facelift or autologous fat transfer.  The short answer to our FAQ is that fillers and Botox often camouflage minor problems in youthful skin of good quality, whereas surgical techniques are necessary to restore significant changes in aging or weight loss.  As always, a careful consultation in our office will be your best guideline no matter which therapy you end up choosing.


#4     Do I need my implants replaced after 10 years?

No.  Melissa has heard this question a surprising number of times from women who have been told by other doctors that they should have their implants replaced.  I am not sure where this idea came from, but the answer is “no.”  If you have saline implants the accumulative rupture, leak and deflation rate risk is about 1% for every year you have had your implants so your risk over the next 10 years of having an implant rupture is less than 10%.  That means 90% of women who have implants for 10 years do not have any rupture, leak or deflation.  If you are happy with your implants there is no need to have them routinely replaced just because of a given time interval.  The implants usually fail by a mechanism known as “fold flaw” which is somewhat random in its distribution.  If you are happy with your implants, there is no rippling, dimpling or capsule contracture problems, then leave well enough alone and enjoy them.  With a saline implant, if there is a rupture, leak or a problem with the implant, you will know.  It will be obvious and it wil go flat.  At that point it is reasonable to have your implant replaced.  Different manufacturers at different times have had different warranty policies but probably you will get your implants replaced free of charge if you have either Mentor or Allergan (McGhan) implants.

If you have silicone implants, this is a different matter.  You do not necessarily need them replaced after 10 years.  Their rupture, leak and deflation rate is even lower than for saline implants.  However, the implant manufacturers recommend an MRI three years after your implants and every two years after that to worry about a condition called “silent rupture.”  It is important to know if your silicone implant is ruptured or not before you have symptoms.  This is another topic for discussion.  If you have had an MRI and the implant is intact then, again, there is no need to routine replace your implant just because of a given time interval.  The reason to replace your implant is if you are in some way dissatisfied with the implant or your body scar capsule around it.

If you have any questions about plastic surgery, or  related topics and want them addressed in a future blog post, leave a comment .

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