Many men are sheepish about visiting a Dallas plastic surgeon. The perception, after all, is that plastic surgeons primarily treat women. While it is true that female patients are much more prevalent in my office, more and more men are taking the cosmetic surgery plunge.

What are men getting done? The most popular treatment for men is liposuction. Many areas of the male body which are effectively treated by liposuction.  Liposuction can dramatically reduce the size of the flanks (love handles) which is the most common source of fat deposition in many men.  Even with proper diet and strict exercise, many men have a hard time losing weight in this area.   Liposuction of the flanks, particularly in combination with liposuction of the abdomen, can help contour and slim the entire trunk. Liposuction for men is not just limited to the body, however. These days more and more men are turning to liposuction to rejuvenate their faces and necks. Removing excessive fatty deposits from these areas can help to restore lost definition to facial features and provide the patient with a more youthful and rested appearance.

Without a doubt, the most common site for male liposuction is a male breast reduction. Many men suffer from gynecomastia (enlargement of the male breast). Often times, this can limit clothing options for men and make it uncomfortable for them to remove their shirts in public. Liposuction, particularly in combination with an ultrasound, can be used to reduce the size and volume of male breasts. Liposuction of the male breast is performed through small incisions and scarring is minimal.

Botox® and Dysport injections are also becoming increasingly popular for men. BOTOX® and Dysport injections are a convenient way for men to enhance and rejuvenate their appearance without undergoing surgery. BOTOX® and Dysport treatment temporarily paralyzes the facial muscles that cause the lines and wrinkles associated with aging. Within days of treatment, troublesome frown lines, forehead creases, and crow’s feet begin fade or disappear. Results are evident from 1-7 days after the procedure, and generally last anywhere from 3-6 months. Although results are not nearly as long lasting as surgery, the procedure is quick and associated with virtually no down time. The convenience of BOTOX® and Dysport treatment have made it a popular cosmetic option for men. The procedure generally takes about 15 minutes, which allows even very busy patients to schedule appointments. In addition, the injections cause only minor discomfort; the sensation is often compared to the sting of an ant bite and usually lasts only a few seconds.

If you’d like to learn more, please do not hesitate to contact our office as 214.827.2814

I have been struck by the number of fit mothers that have come to my office looking for liposuction, when most of these women really need a tummy tuck (abdominoplasty).  Many of these women have loose abdominal wall skin, stretch marks, and separation of the abdominal wall muscles.  They have the perception that, because they are close to their ideal body weight, they are not appropriate candidates for a tummy tuck.  Instead, they think that they would be better served by liposuction.

This could not be further from the truth.  The best candidates for an abdominoplasty (tummy tuck) are actually those patients that are close to their ideal body weight.  With a limited amount of liposuction, removal of the loose abdominal wall skin, tightening of the abdominal wall muscles, and reshaping of the belly button, achieving a pre-pregnancy tummy is actually an achievable goal!

Click on above photos to enlarge.

Many other women are far from their ideal body weight and come for abdominoplasty consultation.  Although their results are different from patients that are close to their ideal body weight, these still can experience significant benefit from a tummy tuck.

For examples of pre- and postoperative abdominoplasty photographs, please refer to the photo gallery.  If you would like to schedule a complimentary consultation, contact our Dallas or Plano office at 214-827-2814.

Buttock augmentation is becoming an increasingly popular procedure in the Metroplex. If you want to enlarge or re-shape your buttocks and have discovered that they do not respond to diet or exercise, buttock augmentation may be the solution you’ve been looking for. A buttock augmentation (butt augmentation) or buttock lift (butt lift) contours the buttocks and compensates for low amounts of fat in the area. Women and men who enlarge their bottoms can enjoy a more voluptuous and perky profile. Augmentation most commonly is achieved through injections of the patient’s own body fat (“Brazilian Butt Lift”).

Who is a candidate for buttock augmentation?

Buttock augmentation can enhance the natural curves for patients who are unhappy with the shape of their rear ends. It can also add volume and roundness to a flat or small butt for patients seeking a more balanced body profile. Body-builders may seek buttock augmentation if they are unable to develop gluteal muscles in proportion with the rest of their bodies. Generally, if you are looking for a fuller, curvier butt, buttock augmentation may be for you.

Implants vs. Fat Transfer

The preferred method for performing buttock augmentation is fat transfer, the use of the patient’s own body fat to reshape the butt. Fat injection achieves a more natural result, has a lower risk of infection, and also contours the areas around the buttocks to enhance the overall effect. However, implants may be recommended for patients who have very little body fat to harvest, such as body-builders and naturally thin patients.

Buttock Augmentation with Fat Transfer (”Brazilian Butt Lift”)

Buttock augmentation with fat transfer, also known as the Brazilian Butt Lift in honor of the country in which it was developed, involves two steps. First, the patient’s own fat is collected through liposuction. The most popular areas for liposuction before buttock augmentation are the lower back, waist, flanks (love handles), thighs and stomach. This not only provides the raw material for buttock enhancement, it also contours the areas around the butt for a more dramatic result. The liposuctioned fat is then purified in a special process so that the best fat is ready to be reintroduced to the body.

In the second step, the donor fat is added to the buttocks with hundreds of tiny injections at different depths to ensure an even, attractive augmentation. This method of fat injection lends a shapely contour to the buttocks that lasts a long time. Special attention is given to the upper buttocks so the entire rear looks youthfully and naturally lifted.

Recovery

After buttock augmentation with fat transfer or silicone implants, patients should avoid sitting directly on the buttocks or lying on their backs for two weeks to maximize results. During this time, compression garments are worn to reduce swelling. Patients may experience some pain or discomfort, bruising and swelling after the procedure. Most patients return to work two weeks after their buttock augmentation and are able to resume all normal activities within four weeks. Swelling typically dissipates by the sixth week. Patients are asked to use padding under the buttocks while sitting through the sixth week after surgery.

Side Effects

As with any surgery, there are risks to buttock augmentation with fat transfer. These include infection, bleeding, fat necrosis (hard lumps), reaction to the anesthesia, and damage to nerves or muscles. Occasionally, a repeat operation is necessary to achieve the desired results.

Results

When performed by an experienced surgeon using the proper techniques, buttock augmentation is a highly satisfying and permanent procedure that enhances the profile of the buttocks and surrounding areas for a younger, firmer, curvier look.

Patient Profile

The patient is a 25-year-old woman who was unhappy with her flat buttocks. She underwent gluteal augmentation with her own fat, otherwise known as a Brazilian Butt Lift. This consisted of liposuction from her trunk and thighs, followed by a fat purification process, and then enhancement of the buttocks with her own fat. She is seen 2 months after surgery with fuller buttocks.

It’s been my impression that more and more of my patients are seeking silicone breast implants, which have been FDA-approved since 2006. This impression has been confirmed by recent data published by the American Society of Plastic Surgeons. Breast augmentation remains the number one cosmetic surgical procedure in the United States.  Last year, 289, 328 breast augmentations were performed in the United States, and half of them utilized silicone implants.

This confirms that more and more patients are realizing that silicone implants are softer, more natural devices with an excellent safety profile. Silicone implants also tend to have less problems with visible rippling than saline implants. For patients who have experienced significant changes to the breasts after breastfeeding, pregnancy, weight loss, or breast cancer surgery, augmentation or reconstruction with silicone implants often yields superior cosmetic results.

Silicone implants do have a few negatives. They are more expensive than saline breast implants and require a slightly larger incision for placement. It’s also more difficult to detect an implant rupture and may require an MRI to detect it with certainty. In certain patients, particularly younger woman with some breast tissue, breast augmentation with saline implants may provide nearly as nice a result as surgery with silicone implants.

To learn more about breast augmentation, do not hesitate to contact our office at 214-827-2814. Act now to take advantage of our summer specials on breast augmentation!

This was published on April 2, 2010 on the Los Angeles Times online

By Shari Roan

Cosmetic procedures like Botox, facial fillers and liposuction are big money-makers for physicians. Not surprisingly, doctors other than plastic surgeons and dermatologists also offer cosmetic treatments. According to a new study, nearly 40% of doctors offering liposuction in Southern California had no specific surgical training.

The study, published in the April issue of the journal Plastic and Reconstructive Surgery, examined 1,876 cosmetic practitioners from San Diego to Los Angeles. Only 495 of them were trained in plastic surgery. Primary care physicians made up the fourth-largest group of liposuction providers following plastic surgeons, dermatologists and otolaryngologists.

There is no law to prevent doctors from offering these services, especially in a doctor’s office (doctors need to apply for privileges to perform services in hospitals). Many non-surgeons take a course or participate in some form of limited training to perform liposuction or inject fillers. But such training is not required and is often inadequate, according to the American Society of Plastic Surgeons.

Though providing Botox or facial fillers is unlikely to be dangerous, liposuction can result in serious complications, the authors state. “We feel that the provision of such a potentially hazardous treatment by physicians with no training in surgery poses a genuine threat to the safety of patients.”

Further, the authors state, aesthetic franchises have sprung up that have no association with one particular provider, making it more difficult for patients to know just who is responsible for their care.

“The practices are often named after a geographic location with a cachet of affluence,such as Rodeo Drive, Beverly Hills or La Jolla. In these practices, the practitioners are employees of the owner of the clinical facility, and are pushed to produce revenue. The divorce of the practice from the name of the responsible physician has the potential to have a profound impact on the doctor-patient relationship and how patients select a provider,” the authors state.

Still, the authors say more legislation is not what’s needed, calling government meddling ”a guest who may never leave.” They suggest more effort to educate the public on who is or isn’t qualified to perform various cosmetic procedures.

I vote for whichever method — education, legislation or perhaps both — will protect consumer health and safety regardless of professional turf wars.

Taken from http://today.msnbc.msn.com/id/36101073/ns/today-parenting_and_family (published 3/30/2010)

Experts mull Pros and Cons of letting youths go under knife

by Laura T. Coffey

Teens can be mean. Just ask Jen Selter, Jon Escalante and Hannah Olson.

For years, Selter endured taunts because of her nose size. Kids ridiculed her by saying she looked like a pelican and by calling her “butter face” — code for “She’s hot, but her face!”

Escalante deliberately grew his hair out to hide ears that had branded him with the nickname “Dumbo.” And Olson’s self-confidence flagged as she tolerated “horrifying” name-calling after developing DDD-size breasts as a teen.

In a world where people of all ages increasingly turn to plastic surgery for reasons that are purely cosmetic — and, in some cases, narcissistic — Selter, Escalante and Olson said they opted to go under the knife as teenagers for different reasons. It wasn’t something they did solely because of the relentless name-calling. It also had a whole lot to do with how they felt about themselves on a deeper level.

“My advice to teenagers is don’t have a nose job just ‘cause you’re worried about what other people say or think,” said Selter, who had rhinoplasty done last summer at age 15. “It all has to do with how you feel on the inside. And getting a nose job made me feel good inside and out.”

TODAY Once Jon Escalante had his ears surgically pinned back, he felt confident enough to cut his hair in order to pursue his dream of becoming a firefighter.

Like ‘braces for crooked teeth’?
To be sure, the very notion of doing any kind of plastic surgery on teenagers raises concerns for many parents and health professionals — and there are valid reasons for concern.

“Mom and Dad, please be sure your adolescent or your teen is aware that this is not a coping skill — that every time we feel uncomfortable about ourselves, then we go out and we get surgery,” psychiatrist Charles Sophy told TODAY. “Because that’s how we begin a huge line of problems.”

Reputable cosmetic surgeons with teen patients typically recommend a series of at least four sessions with a therapist before moving forward with any procedures. The point of these sessions is to uncover underlying motives for wanting surgery, as well as to determine the emotional maturity of the patient.

Such precautionary steps are important because demand is on the rise. Although just two percent of all plastic surgeries are performed on teens, the number of teens getting plastic surgery has doubled since 2002, according to the American Society of Plastic Surgeons. Nose reshaping, ear reshaping, acne and acne-scar treatment, breast augmentation and breast reduction are popular procedures among teenage patients.

TODAY Hannah Olson’s breast-reduction surgery gave her relief from pain and made it possible to maintain an active, athletic lifestyle.

Generally speaking, plastic surgeons report that many teens want plastic surgery because they long to fit in with their friends, while many adults pursue plastic surgery because they want to stand out.

But when a teen seeks out plastic surgery to correct a noticeable physical defect or to change a body part that’s caused prolonged psychological distress, that can be a good thing, doctors say.

“It’s no different than kids getting braces for crooked teeth,” said Dr. Sam Rizk, Selter’splasticsurgeon.

Dr. Nancy Snyderman, NBC’s chief medical editor, agreed that plastic surgery can be altogether positive in the right circumstances. In the cases of Selter, Escalante and Olson — all of whom were featured in Friday’s edition of People magazine and interviewed on TODAY on Tuesday — Snyderman thought they made responsible choices when they decided to have plastic surgery done at ages 15, 17 and 19.

“Remember we’re not looking at 10- and 11-year-olds,” Snyderman said. “We’re looking at young adults who were part of the decision-making process, and that plays a big role. … You’re looking at three very appropriate cases for wanting to change things.”

TODAY Jen Selter’s nose job at age 15 made her a more confident and carefree teen.

How young is too young?
Before moving ahead with any kind of plastic surgery, parents and teens are encouraged to remember that surgeries are never risk-free. They should read up about any possible complications and be sure they can handle the risks involved. A real awareness of the risks can prompt parents and children to pursue non-surgical options for changing body image, such as diet and exercise.

Parents and children also should be aware that guidelines do exist for younger patients. Facial plastic surgery generally should not be done on anyone until facial growth is complete. For a female, that happens by about age 14; for a male, it’s about age 15.

The U.S.Foodand Drug Administration will not allow breast augmentation to be done on anyone younger than 18, and most surgeons will refuse to perform liposuction on anyone younger than 17 or 18.

(Generally speaking, it can be wise to choose a surgeon who has experience working with younger patients. Be sure to check the surgeon’s complaint history.)

For their parts, Escalante, Olson and Selter all told TODAY that they have no regrets about their plastic surgeries. Escalante’s decision to have his ears pinned back made him feel good about cutting his hair to pursue his dream of becoming a firefighter. Olson’s breast-reduction surgery gave her relief from pain and made it possible to maintain an active, athletic lifestyle. And Selter’s nose job made her more confident and carefree.

“Jen is so happy now,” said Selter’s mother, Jill Weinstein. “I would say to parents … it’s the greatest gift you could give to your child. What greater gift is confidence and to help them feel happy in who they are?”

This is an interesting conglomeration of facts, published onTBO.com (http://www2.tbo.com/content/2010/mar/17/171510/brief-history-breast-implant) on March 17, 2010

Despite its litigious history, breast implant surgery is the most popular surgical cosmetic procedure in the country.

Here are some events that have kept breast augmentation in the news throughout history:

1890s: The first surgical breast augmentation procedure is performed with paraffin wax injections, resulting in infections and lumps. By the 1920s, the practice is discontinued.

1895: German surgeon Vincenz Czerny is known as “the father of cosmetic breast surgery” for reconstructing a woman’s breast by transferring fatty tissue from the belly and buttock areas into the breast. The procedure isn’t very successful because the body quickly reabsorbs most of the fat, leaving the breast lumpy and lopsided.

1940s: During World War II, Japanese prostitutes have silicone liquid injected into their breasts to appear more voluptuous, causing health problems and death. Even so, the procedure catches on and spreads to the United States before the practice is banned.

1950s: Well-endowed Hollywood icons Marilyn Monroe, Ava Gardner and Lana Turner help make the bombshell’s hourglass shape popular, causing many women to turn to padded bras and augmentation to keep up.

1961: Surgeons Frank Gerow and Thomas Cronin develop the first silicone breast implant with the Dow Corning Corp.

1962: Timmie Jean Lindsey, a 30-year-old mother of six, visits a Houston Hospital to have a pair of floral tattoos removed from her breasts and becomes the first woman to get silicone breast implants.

1965: A surgeon develops the first saline-filled breast implants in France.

1977: A woman wins a $170,000 settlement from Dow Corning for pain and suffering after her breast implants rupture.

1980s: Ralph Nader’s Public Citizen Research Group sends out warnings that silicone breast implants cause cancer.

1992: After reports of women claiming implants are hazardous to their health, the FDA stops the cosmetic use of silicone-gel implants.

2000: The FDA approves saline-filled implants, finding them safe and effective for use in breast augmentation and breast reconstructive surgery.

2004: While being photographed at a party, actress Tara Reid accidentally exposes her scarred breast. She later admits to having botched breast surgery.

2006: The FDA approves silicone breast implants again.

2008: Breast augmentation surgery replaces liposuction as the most popular cosmetic surgery in the United States.

2009: Hungary holds a beauty pageant, “Miss Plastic Hungary,” to highlight the positives of plastic surgery.

2010: A Beverly Hills plastic surgeon says breast implants saved the life of one his patients by helping stop a bullet to her chest.

Sources: beyondniptuck.com; pbs.org; breast-plastic-surgery.org, breastimplantsusa.com and ofc.berkeley.edu

This was published in the Star-Ledger on March 7, 2010

Black-market cosmetic surgeries hospitalize six N.J. women

By Rohan Mascarenhas/The Star-Ledger

March 07, 2010, 9:46PM

NEWARK — Six women from the Essex County area who wanted fuller bottoms ended up in hospitals after receiving buttocks-enhancement injections containing the same material contractors use to caulk bathtubs, officials said.

The women checked into hospitals in the county after their procedures, apparently administered by unlicensed providers, went horribly wrong, state health officials said. The women underwent surgery and were given antibiotics. No arrests have been made.

Different from medical-grade silicone, the substance used in the botched procedures was believed to be a diluted version of nonmedical-grade silicone.

“The same stuff you use to put caulk around the bathtub,” said Steven M. Marcus, executive and medical director of the New Jersey Poison Information and Education System, who learned about the bizarre procedures through a committee he sits on that monitors outbreaks in the metropolitan area.

“What a tragedy,” said Gregory Borah, chief of plastic surgery at Robert Wood Johnson University Hospital in New Brunswick.

Using over-the-counter silicone can cause abscesses that he said resemble “a big zit.”

Borah, also president of the New Jersey Society of Plastic Surgeons, said the botched procedures underscore the need for patients who seek augmentation to have it administered by a licensed professional in a sterile setting.

A plastic surgeon doing buttocks augmentation would make an incision to develop a pocket underneath the muscle and shape the buttocks with inert medical-grade silicone, Borah said. He noted it is a relatively uncommon procedure in most practices and that he has done only two in his 24-year career.

By the time he tells patients of the potential risks — from anesthesia, scarring and silicone shifting when patients sit down — they often change their minds.

Breast and cheek augmentations are the most common procedures, he noted. Borah said buttock augmentation is more popular in some cultures than others.

The state Department of Health and Senior Services did not identify the women or release any details about their ethnicity. It also did not say where the “unlicensed medical provider or providers” performed their procedures.

“Fortunately, these women are being treated and are recovering,” said Tina Tan, the state epidemiologist. “But there is the potential for more serious complications if these infections are not treated early and properly.”

Investigators have not determined if the six cases, which began to be reported in mid-February, are related, but they have stoked concern among officials that such injuries are more common than previously thought.

Health officials issued an alert to state hospitals and doctors about the cases and the potential for more victims.

Marcus said there have been other incidents over the past couple years of providers providing implants of nonmedical-grade silicone, then getting put out of business — only for other shady providers to surface.

“Caveat emptor: Buyer beware,” Marcus said. “If it looks too cheap, there’s probably a reason it’s too cheap.”

By Rohan Mascarenhas and Mike Frassinelli/The Star-Ledger

This story was published in the New York Times, March 11, 2010 (http://www.nytimes.com/2010/03/12/business/media/12wrinkle.html?ref=health)

To Take on Botox, Rival Tries Rebate

By NATASHA SINGER / Published March 11, 2010

Allergan makes Botox Cosmetic, the well-known injectable anti-wrinkle treatment. Medicis markets Dysport, a competing anti-wrinkle shot, in the United States. The Food and Drug Administration has approved both drugs to smooth skin furrows between the eyebrows.

And now Medicis has introduced a new marketing campaign that pits Dysport directly against Botox, essentially issuing a Pepsi challenge for the wrinkle wars. The campaign is even called the Dysport challenge.

Medicis is offering more than rebates on its own product. For customers who feel unsatisfied after trying Dysport, the company is also offering a rebate on a treatment with Allergan’s Botox.

“We are so confident that we are literally willing to bet our money that patients will love their Dysport treatment,” said Jonah Shacknai, the chief executive of Medicis.

The Dysport campaign, which runs through April 30, is thought to be the first time a drug maker has offered a rebate on a competing drug. But it is hardly the first instance of pushing pharmaceuticals with a marketing zeal more typical of consumer products that do not carry a risk of medical side effects.

These days, hoping to inspire patient loyalty, various makers of prescription drugs are promoting giveaways, rebates and discounts. Sepracor, for instance, is offering a seven-day free trial of its popular sleeping pill Lunesta. Merck is running a print ad with a voucher for a free 30-day supply of its Januvia tablets for Type 2 diabetes. Another Merck ad carries a $20 coupon for the allergy and asthma drug Singulair.

But it is vanity medicine — including products like Botox and Dysport — that has been at the forefront of consumer enticement programs. That is because insurance typically does not cover such medical products, meaning consumers must pay for them out of pocket, buying directly from physicians. Volume discounts or rebates for the doctors have also been part of the marketing push.

Some medical ethicists worry that the discounts and deals may prompt doctors and patients to make decisions based on money rather than efficacy and safety. When doctors sell cosmetic medical treatments on which they themselves receive rebates, it poses inherent conflicts of interest, said Dr. Carl Elliott, a professor of bioethics at the University of Minnesota medical school

“It’s like a doctor who has his own drugstore, and he’s writing the prescriptions and selling them,” Dr. Elliott said. “It’s the treatment of medicine as a consumer product that seems a little creepy.”

Neither Botox nor Dysport is entirely risk-free. Both are purified forms of botulinum toxin — a nerve poison produced by the bacteria that can cause botulism. The injections have occasionally resulted in temporary cosmetic problems like droopy eyelids or uneven eyebrows. And such drugs now display federally mandated “black box” warnings on their labels stating that botulinum toxins have been associated with rare but potentially life-threatening health problems.

Mr. Shacknai of Medicis said he understood ethicists’ concerns about the marketing of medications prescribed to treat specific diseases. But Dysport and Restylane, a skin-plumping injection marketed by Medicis, are not disease treatments, he said, but cosmetic products intended to improve the appearance.

“What we are doing with the Dysport challenge and ongoing promotions for Restylane,” he said, “is to make it easier financially for people to try our products after consulting with a physician and determining if it’s right for them.”

The Dysport promotion, running on the product’s Web site and in a few glossy magazines like Us Weekly, offers a $75 rebate check on an initial Dysport treatment for wrinkles between the eyebrows, a procedure that can cost consumers $300 to $500.

The “challenge” comes into play for those who elect to have a second procedure three months later. Satisfied customers can receive a $75 rebate on a follow-up Dysport treatment, while dissatisfied customers who want to switch can receive a $75 rebate on a Botox treatment.

“This is really a novel spin,” said Dr. Kenneth Beer, a dermatologist in West Palm Beach, Fla., who is a paid investigator, consultant and speaker for both Allergan and Medicis. “There are always loyalty or affinity rebates, but they never come in and say, ‘Check out the neighborhood and, if you don’t like it, we’ll pay you to move back.’ ”

The campaign demonstrates the lengths to which a new entrant to the wrinkle-smoother category will go to gain market share from Botox, which enjoyed a virtual monopoly on injectable toxins in the United States until the introduction of Dysport last year.

Botox, a drug that has both cosmetic and medical uses, had worldwide sales last year of about $1.3 billion. Gary Nachman, an analyst at the health care investment bank Leerink Swann, estimated that Dysport could eventually gain a 20 to 25 percent market share in the United States. He described the Dysport rebate effort as a kind of “Hail Mary pass” that could help Medicis get to that point faster.

Last month, Medicis sent out a mass message about the rebate to its physician customers.

“Financially speaking, there’s no reason not to try Dysport,” said the Medicis message. “This offer is so unique that we expect plenty of news coverage. And we have promotional items for use in your office.”

Caroline Van Hove, an Allergan spokeswoman, responded to a reporter’s query with an e-mail message that described the Dysport promotion as a price-cutting exercise meant to cannibalize the market — at the expense of patient education. She wrote that “incentive programs like Medicis’s engage consumers for the wrong reasons, deflecting their attention to bargain shopping versus proper physician dialogue on product benefits/safety.”

Mr. Shacknai of Medicis said the Dysport promotion “understandably would create fear and concern with our competitors” because the rebate could lead to a significant shift in market share.

Drug advertising is often expensive. But given the economics, the Dysport rebate promotion is not sustainable for long, said Ronny Gal, an analyst at the research firm Sanford C. Bernstein & Company.

With a list price to physicians of $475 per vial — enough to treat the eyebrow furrows of perhaps five patients — Dysport brings Medicis about $100 per treatment, he said, so a $75 rebate for each is steep. Moreover, the rebate program effectively repositions Dysport as a value brand, a risky strategy in the luxury sector of vanity medicine, Mr. Gal said.

In any case, critics like Dr. Elliott of Minnesota say this latest wrinkle in the wrinkle wars pushes drug marketing one step further away from evidence-based medicine and deeper into the realm of product promotion.

“I’m not fan of turning medicine into a consumer product,” Dr. Elliot said. “But we are so far into it already that I don’t see the tide turning back.”

Are breast implants permanent?

Breast implants are not permanent devices, but can sometimes last for up to 25 years with no problems.

Can breast implants be removed?

Implants can be removed, but the breast skin and tissue may become stretched over time.  As a result, the breasts may develop redundant skin and a breast lift (mastopexy) may be required after the implant is taken out.

Is breastfeeding possible after breast augmentation?

Breast implants usually do not affect the ability to breastfeed.

Who is eligible to get breast implants?

You are not eligible to get breast implants for cosmetic purposes if you have untreated breast cancer or infection, are under 18 years of age, or are pregnant or nursing.  Silicone implants cannot be placed for cosmetic purposes in patients under 21 years of age.  Breast implants may be placed in younger patients if needed for reconstructive purposes.

Will insurance cover breast augmentation?

Insurance companies do not cover breast implant surgery performed for cosmetic purposes.

What happens if the implant ruptures?

Patients often worry about implant rupture even though it is not a terribly common problem. Within 10 years of surgery, only one in ten implants will rupture.  If a saline implant ruptures, the implant will simply deflate in a few hours and your body will absorb the salt water.  If a silicone implant leaks, it may not become apparent for several years.  For that reason, the FDA recommends that patients get an MRI 3 years after breast augmentation, and then every two years thereafter to assess for rupture.

How will my breasts look and feel after breast augmentation?

Some bruising and swelling occurs right after the procedure, but disappears relatively quickly.   Once the swelling is gone, the breasts feel healthier and firmer. Saline breast implants feel a bit firmer (both inside and outside the body), while silicone gel breast implants are softer and more natural feeling.

Will there be scars?

Although scars are a part of the breast augmentation process, Dr. Jejurikar’s goal is to make the scars as aesthetically pleasing as possible.  Dr. Jejurikar places the incisions around the areola, under the arm, or under the breast. Breast augmentation scars, regardless of where they are located, tend to heal extremely well.

When can I return to work and resume normal activities after breast augmentation?

It will take a few days to return to normal activities, and even then, patients often feel fatigued. It is often possible to return to work within one week after breast augmentation surgery. Strenuous physical activity should be avoided for three weeks following surgery.