Author: Dr. Edwin C. Pound, III M.D. - Cosmetic Plastic Surgeon - Atlanta, GA
http://www.winpound.com/
I was watching the news last night when I saw a plastic surgeon touting a very expensive looking video imagine machine that could take a picture of a patient's breasts and make a 3D image that could be viewed from any angle. It could also be used to determine how those breasts might look with different sized implants. I guess a lot of patients come to that doctor so they can avail themselves of the latest, greatest technology but, to me, it looked like it was making a simple consultation much more complicated.
I don't have a big office with lots of doctors and employees. There are only four of us here, but we have been here for a LONG time. In fact, we have been in the same office since 1976. That is the mark of a stable office. Patients like it when they come in and see familiar faces. Because I am a small solo practice, I can't afford the fancy, expensive lasers and video imaging equipment that larger offices have. If I want to use something expensive, I use the equipment owned by the hospitals nearby. What I lack in gadgetry, I make up for with patient service.
My father started our practice back in 1961. I used to scrub in with him during surgery while I was in high school on weekends and vacations. I learned a LOT from him, not only about surgery but also about how to treat patients. Above all, he taught me not to just care FOR patients, but to care ABOUT them.
From the moment a patient first sets foot in my office to the moment when they leave for the final time, I treat them as I would a family member. Consultations are done by ME, not my staff. Surgery is done by ME, not stunt doctors or residents. When patients go to sleep for surgery, I am standing by their side. My nurse or I call each patient after their surgery to see how they are doing. If a patient has a question, either before or after surgery, they are encouraged to call my office and I speak to them directly. I also take all of my own call so, if a patient has a concern after surgery, they can call the office and get ME, not someone who is not familiar with them. As I jokingly tell my patients, I go nowhere, I have no life!
I like my patients and I like what I do. If a patient has a problem following surgery, I see it as my problem too. Together, we will work it out. I have seen people come to my office who have had surgery elsewhere. When they had a problem, the doctor suddenly became unavailable, not answering their phone calls or even seeing the patient when they came for their office visits. Instead, they were seen by a nurse or other office staff. In my mind, avoiding a problem does not foster patient trust or endear yourself to your patients. I don't always get perfect results, but my patients know that I will do my best to work with them to achieve the best results possible, and I will not abandon them if they have a problem.
I am very conservative in my medical practice. My philosophy is that the procedures that I learned from my father have been around for a long time because they work. New is not always necessarily better. As I have gotten older, I prefer to let the young guys try out the latest, greatest technology. A lot of it comes and goes each year and I would prefer to let the other guys make the mistakes with it. If it is still around in a year then I will learn about it. That is not to say that I am not up to date on techniques, or that I am not innovative. I am the world's foremost leader in the Trans-Umbilical Breast Augmentation (TUBA) procedure, a technique for inserting saline-filled breast implants, under or above the chest muscle, through a small incision in the navel. Our office also developed a technique for pinning back ears that does not require incisions and can be done under local anesthesia in the office.
I also like to give back to the community. I have been blessed with a skill and each year I try to go to a third world country to operate on kids with cleft lips, cleft palates, and burns. This is very grueling but gratifying work. Some of my patients look at the books in my waiting room from my trips and tell me that they feel very vain getting cosmetic surgery when there are so many reconstructive needs in the world. I simply tell them that it is because of them that I can afford to help take care of those kids.
So I watched the news with the plastic surgeon and his expensive video imaging machine, and I wondered who ultimately pays for that machine. Obviously, it has to be the patient. And, while it might be very cool to see your image in 3D, does it really add THAT much more information than what I can convey to a patient simply by holding up an implant to their chest and seeing how it might look? You can do lots of neat things to a person's image by using a computer, but can it be done as well in real life? At the end of the day, I think most patients would prefer experience over expensive gadgets.
Thursday, June 28, 2012
Lip Augmentation: How to Get Full, Pouty Lips Like Angelina Jolie
Author: Dr. Edwin C. Pound, III M.D. - Cosmetic Plastic Surgeon - Atlanta, GA
Visit Us Online for more information - http://www.winpound.com/
Everyone wants lips like Angelina Jolie. Her full, pouty lips are the dream of every woman. Surprisingly, lips like Angelina's are fairly easy to obtain through injections, implants, or lip roll-out procedures. These procedures may add more volume to the lips as well as help contour the shape for a more aesthetic look. Most of these procedures can be done under local anesthesia in the time it takes for a lunch break.
There are a number of filler materials on the market today that are easily injectable and compatible with a patient's tissues. Most of these come in pre-packaged syringes. Most prominent of these injectables include Restylane and Juvederm. These products can be injected without anesthesia or with numbing cream applied to the lips. Most pre-packaged injectables last for six to nine months before being completely degraded by the patient's body. Risks are generally mild and include swelling and possible bruising. Cold compresses applied to the lips may decrease the likelihood of this happening.
One injectable that should be avoided is silicone. Unfortunately, many unscrupulous doctors still inject liquid silicone into the lips. Silicone is a permanent injectable. While results may look good initially, the silicone may migrate through the tissues or create scar tissue that can result in lumpy, uneven lips over time. This is very difficult to correct.
Another injectable material is fat. Everyone has a little fat they can spare. A small amount of fat can be removed from the abdominal area or hips under local anesthesia and then transferred to the lips. Fat tends to be very fragile material, however. If it does not settle in and develop a good blood supply, much of it will be re-absorbed. Since only 20 – 50% of transferred fat survives, doctors tend to over-correct. This means that the patient may have very large lips until the fat settles and the swelling subsides. Patients may be asked to eat only soft foods that don't require much chewing for several weeks afterwards.
Another source of tissue for implantation is skin from the patient or from a cadaver (Alloderm). Again, the patient's own tissue works best and has less chance of being re-absorbed over time, however, donating enough skin may be difficult unless this is being done in conjunction with another operation. Cadaver skin works well and is treated so as not to be rejected by the patient's tissues. It tends to last for a longer time than injectables, however, it is also more costly.
Most lip implants have not worked well in the past. The original lip implants were made of GorTex material. Scar tissue would tend to form around this foreign material resulting in firmness to the lips that was undesirable. The most recent innovation in lip implants is called PermaLip. This is a very soft silicone rubber implant that can be inserted under local anesthesia in the office. Results with this implant have been very impressive. While PermaLip is a permanent solution to lip fullness, it can also be removed easily if the patient so desires.
While injectables may give the lips more volume, they do little to create a pout to the lip itself. This can be done with a lip roll-out procedure. Most lip roll-out procedures are done in a surgical setting as they require incisions inside the lips to create the desired shape. Secondary touch-up procedures may also be necessary to fine tune the results. These can generally be done under local anesthesia in the office.
Visit Us Online for more information - http://www.winpound.com/
Everyone wants lips like Angelina Jolie. Her full, pouty lips are the dream of every woman. Surprisingly, lips like Angelina's are fairly easy to obtain through injections, implants, or lip roll-out procedures. These procedures may add more volume to the lips as well as help contour the shape for a more aesthetic look. Most of these procedures can be done under local anesthesia in the time it takes for a lunch break.
There are a number of filler materials on the market today that are easily injectable and compatible with a patient's tissues. Most of these come in pre-packaged syringes. Most prominent of these injectables include Restylane and Juvederm. These products can be injected without anesthesia or with numbing cream applied to the lips. Most pre-packaged injectables last for six to nine months before being completely degraded by the patient's body. Risks are generally mild and include swelling and possible bruising. Cold compresses applied to the lips may decrease the likelihood of this happening.
One injectable that should be avoided is silicone. Unfortunately, many unscrupulous doctors still inject liquid silicone into the lips. Silicone is a permanent injectable. While results may look good initially, the silicone may migrate through the tissues or create scar tissue that can result in lumpy, uneven lips over time. This is very difficult to correct.
Another injectable material is fat. Everyone has a little fat they can spare. A small amount of fat can be removed from the abdominal area or hips under local anesthesia and then transferred to the lips. Fat tends to be very fragile material, however. If it does not settle in and develop a good blood supply, much of it will be re-absorbed. Since only 20 – 50% of transferred fat survives, doctors tend to over-correct. This means that the patient may have very large lips until the fat settles and the swelling subsides. Patients may be asked to eat only soft foods that don't require much chewing for several weeks afterwards.
Another source of tissue for implantation is skin from the patient or from a cadaver (Alloderm). Again, the patient's own tissue works best and has less chance of being re-absorbed over time, however, donating enough skin may be difficult unless this is being done in conjunction with another operation. Cadaver skin works well and is treated so as not to be rejected by the patient's tissues. It tends to last for a longer time than injectables, however, it is also more costly.
Most lip implants have not worked well in the past. The original lip implants were made of GorTex material. Scar tissue would tend to form around this foreign material resulting in firmness to the lips that was undesirable. The most recent innovation in lip implants is called PermaLip. This is a very soft silicone rubber implant that can be inserted under local anesthesia in the office. Results with this implant have been very impressive. While PermaLip is a permanent solution to lip fullness, it can also be removed easily if the patient so desires.
While injectables may give the lips more volume, they do little to create a pout to the lip itself. This can be done with a lip roll-out procedure. Most lip roll-out procedures are done in a surgical setting as they require incisions inside the lips to create the desired shape. Secondary touch-up procedures may also be necessary to fine tune the results. These can generally be done under local anesthesia in the office.
Breast Augmentation: The TUBA Approach
**Before and after pics can be viewed below!
Breast augmentation surgery is a means for adding volume to the breast using saline-filled or silicone gel-filled breast implants. Attempts to add volume to the breast using other materials in the past have generally been unsuccessful. The first breast augmentation procedure using silicone gel-filled implants was reported by Drs. Cronin and Gerow in 1964. These implants were inserted through an incision in the fold under the breast. In 1972, a technique for inserting implants through an incision under the areola was described by Dr. Jenny. In 1973, an armpit incision site was described by Dr. Hoehler. These three incision sites have been the primary means for inserting implants over the years.
In 1992, a new technique for inserting saline-filled breast implants through a small incision in the navel was described. The approach was an extension of a technique for inserting implants through a small tunnel while performing abdominoplasty (tummy tuck) surgery first described in 1976. It also benefits from the ability of saline implants to be compressed into a tight cylinder for insertion prior to inflation. Dr. Win Pound in Atlanta, Georgia was the first board-certified plastic surgeon to pioneer this technique.
TECHNIQUE:The incision site in the navel, the tunnels to the breast, and the outline of the breast are marked with a marking pen (Fig. 1). An incision is made in the navel and a long instrument is used to make a tunnel just under the skin up to the breast. The tunnel can be placed above or below the pectoralis major (chest) muscle. The position of the tunnel can be confirmed with an endoscope.
A disposable breast implant sizer can then be rolled into a cigar shape and passed up the tunnel to a position behind the breast (Fig 2). It is inflated with air or saline to help develop the breast pocket. It is also used to check the proposed size and position of the implant that will subsequently be placed.
Additional refinements to the breast implant pocket can be made with a long hook-shaped instrument (Fig. 3). The disposable sizer is then removed and replaced with the final implant which is also rolled into a cigar shape and passed up the tunnel into the pocket. This implant is inflated with saline to the final volume. The fill tube is removed and the incision is closed with dissolvable sutures.
ADVANTAGES OF THE TUBA APPROACH OVER OTHER APPROACHES:
Visit us Online for more information - http://www.winpound.com/
Breast augmentation surgery is a means for adding volume to the breast using saline-filled or silicone gel-filled breast implants. Attempts to add volume to the breast using other materials in the past have generally been unsuccessful. The first breast augmentation procedure using silicone gel-filled implants was reported by Drs. Cronin and Gerow in 1964. These implants were inserted through an incision in the fold under the breast. In 1972, a technique for inserting implants through an incision under the areola was described by Dr. Jenny. In 1973, an armpit incision site was described by Dr. Hoehler. These three incision sites have been the primary means for inserting implants over the years.
In 1992, a new technique for inserting saline-filled breast implants through a small incision in the navel was described. The approach was an extension of a technique for inserting implants through a small tunnel while performing abdominoplasty (tummy tuck) surgery first described in 1976. It also benefits from the ability of saline implants to be compressed into a tight cylinder for insertion prior to inflation. Dr. Win Pound in Atlanta, Georgia was the first board-certified plastic surgeon to pioneer this technique.
TECHNIQUE:The incision site in the navel, the tunnels to the breast, and the outline of the breast are marked with a marking pen (Fig. 1). An incision is made in the navel and a long instrument is used to make a tunnel just under the skin up to the breast. The tunnel can be placed above or below the pectoralis major (chest) muscle. The position of the tunnel can be confirmed with an endoscope.
A disposable breast implant sizer can then be rolled into a cigar shape and passed up the tunnel to a position behind the breast (Fig 2). It is inflated with air or saline to help develop the breast pocket. It is also used to check the proposed size and position of the implant that will subsequently be placed.
Additional refinements to the breast implant pocket can be made with a long hook-shaped instrument (Fig. 3). The disposable sizer is then removed and replaced with the final implant which is also rolled into a cigar shape and passed up the tunnel into the pocket. This implant is inflated with saline to the final volume. The fill tube is removed and the incision is closed with dissolvable sutures.ADVANTAGES OF THE TUBA APPROACH OVER OTHER APPROACHES:
- A single small scar is produced in a remote, hidden location (the navel) rather than scars on the breast or in the armpits.
- Then entire procedure takes less than an hour to perform.
- There is no cutting of tissue in the breast. This results in a faster recovery as well as less risk of damaging sensory nerves to the breast and nipple.
- There is almost no bleeding involved.
- The TUBA approach can only be used with inflatable saline implants. Silicone gel implants can
- not be inserted using this method.
- There is less precision with this approach in developing the breast pocket.
- Future surgeries or difficulties encountered during the initial surgery may need to be addressed through a different incision.
Visit us Online for more information - http://www.winpound.com/
Worried about inverted nipples or protruding nipples?
Inverted nipples and protruding nipples are embarrassing issues for many women. Many of my patients tell me that they cannot find much information about the treatment of these problems. This is a shame because they are actually fairly easy problems to correct.
An inverted nipple is an “innie”. Most nipples will become erect with stimulation, however, a truly inverted nipple will not. These nipples are tethered down by bands which inhibit them from becoming erect. In the case of a truly inverted nipple, the solution is to make a small incision at the base of the nipple and use a knife or a small pair of scissors to cut through these tethering bands. This will release the nipple and allow it to evert. To maintain this eversion and keep the nipple from falling back down, a small dissolvable stitch is placed at the base of the nipple. The tissue at the base of the nipple heals together and prevents a recurrence of the nipple inversion. The procedure does not take very long to perform. The main drawback to this procedure is that the milk ducts are also cut along with the tethering bands. This will, in all likelihood, prevent the patient from being able to breast-feed from the involved breast.
Nipples that are elongated or protruding may also be a problem to patients. The solution to this is to remover a strip of skin around the base of the nipple and then telescope the “cap” of the nipple downward to close the gap. The skin edges can be sewn together using an absorbable suture. The result is a shorter nipple and the scar is virtually invisible.
Written by Dr. Edwin C. Pound - Cosmetic Plastic Surgeon - Atlanta, GA
Visit Our Website - http://www.winpound.com/
An inverted nipple is an “innie”. Most nipples will become erect with stimulation, however, a truly inverted nipple will not. These nipples are tethered down by bands which inhibit them from becoming erect. In the case of a truly inverted nipple, the solution is to make a small incision at the base of the nipple and use a knife or a small pair of scissors to cut through these tethering bands. This will release the nipple and allow it to evert. To maintain this eversion and keep the nipple from falling back down, a small dissolvable stitch is placed at the base of the nipple. The tissue at the base of the nipple heals together and prevents a recurrence of the nipple inversion. The procedure does not take very long to perform. The main drawback to this procedure is that the milk ducts are also cut along with the tethering bands. This will, in all likelihood, prevent the patient from being able to breast-feed from the involved breast.
Nipples that are elongated or protruding may also be a problem to patients. The solution to this is to remover a strip of skin around the base of the nipple and then telescope the “cap” of the nipple downward to close the gap. The skin edges can be sewn together using an absorbable suture. The result is a shorter nipple and the scar is virtually invisible.
Written by Dr. Edwin C. Pound - Cosmetic Plastic Surgeon - Atlanta, GA
Visit Our Website - http://www.winpound.com/
Tuesday, June 19, 2012
The Magic of Botox/Dysport
Botox (onabotulinumtoxinA, Allergan) and Dysport (abobotulinumtoxinA, Medicis) are brand names for the most exciting medication used in medicine today. With no more than a few injections, this magic elixir can alter the way we look, without the down time of surgery and with minimal side effects. It is also much less expensive than surgery. Each year brings new ideas for using this highly adaptable medication.
When the brain sends a message to a muscle in the face causing it to contract, it can create lines and furrows over a prolonged period of time. Botox/Dysport acts by interrupting this message so that it does not reach the muscle. Without being told to contract, the muscle lies dormant until the Botox/Dysport wears off, usually in three to six months following injection. Once it wears off, the muscle once again behaves normally as messages from the brain are again received.
Botox/Dysport has a multitude of uses. In the face, it is typically used to prevent the angry-looking “11” lines between the eyebrows, furrows across the forehead, and “laugh lines” extending from the skin near the outer aspect of the eyes. It can also be used to smooth out fine lines around the edges of the lips. When injected just below the corners of the lips, it can help create an upward curve to these corners. When banding of the muscles below the neck form “turkey gobbler” folds in the neck, Botox/Dysport can help relax these bands and smooth the surface of the neck.
Botox/Dysport can be injected into the armpits to help prevent sweating for up to a year or more. This may be useful in patients with problem sweating that cannot be prevented with applied anti-perspirants. It can also be used to prevent sweating of the palms and feet.
Botox/Dysport can also be injected into the strong masseter muscle (used for chewing) at the corners of the jaw to produce a less masculine, less squared-off look to the jawline. It can also help patients who suffer from grinding their teeth.
Botox/Dysport can be used in the prevention of headaches of every kind. Some doctors even use Botox/Dysport injected into the chest muscle during breast augmentation surgery to help relax the chest muscle and lessen post-operative discomfort.
These are just a few of the many uses for Botox/Dysport. New ideas pop up frequently for this remarkable drug.
Written by Win Pound, M.D.
What to do About Protruding Ears
By the time a person is six years old their ears have achieved adult dimensions. While there are studies that determine what the “ideal” dimensions of an ear should be, these studies are based on averages. Every ear is different. The most common complaint seen in a plastic surgeon's office with regard to ears is that they stick out too far from the patient's head. This can be the result of one of two factors (see diagram): 1. The “bowl” of the ear may be rotated outwards too far from the head, or 2. the “anti-helical rim”, the fold just inside the outer edge of the ear, may be under-developed. Sometimes, both factors may be involved. Both of these are fairly easy problems to correct.
In the patient with an outwardly rotated bowl, a small incision can be made behind the ear where the resulting scar will be well-hidden. With the backside of the bowl exposed, several permanent stitches can be used to pin the cartilage of the bowl to the head. Although this procedure can be done with the patient awake, it is often easier on the patient and the surgeon to use general anesthesia. When the repair is complete, the incision is closed.
In the patient with an under-developed anti-helical fold, the same incision behind the ear can be used to access the backside of the ear cartilage. Again, several permanent sutures can then be used to “pinch” the edges of the cartilage together and hold it in place to create a new, more prominent fold. In our office, we have developed a technique for re-creating the anti-helical fold without the need for an incision behind the ear. Our technique, which is usually done under local anesthesia in an office setting, involves placing three or four well-placed permanent stitches through the cartilage from the front of the ear after first weakening the cartilage with a needle.
In both procedures, it is usually a good idea to over-correct the protrusion slightly as there may be some relaxation of the stitches or tissue over time. Care must be taken not to pull the ears forward as this may break the stitches or cause them to tear through the cartilage. In our office, we recommend wearing a headband around the head and over the ears at night for three months following the surgery. If the sutures were to break after three months have passed, the cartilage has usually re-trained itself to its new configuration and there will be no recurrence of the protruding ears. Other risks, such as bleeding, infection, or feeling the stitches are uncommon and are usually easily treated.
Written by Win Pound, M.D.
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