BREAST AUGMENTATION: Frequently Asked Questions

Many women choose to have their breasts enlarged to satisfy the desire for a fuller bustline. It is very common for your breasts to not have developed to a size that meets your expectations.  This can create an imbalance in the amount of naturally existing breast tissue relative to the other body measurements such as hip circumference and height.  Some patients may be satisfied with one breast while the other may be significantly smaller.  Breast asymmetry or shape deformities are common in this situation.  A second common scenario occurs with the natural loss of breast volume after significant weight loss, childbearing and aging. The breast often takes on a deflated and sagging appearance, referred to as “ptosis” by plastic surgeons and clothing no longer fits as nicely through the bustline.  Although you may have been happy with your breasts in the past, you may be self-conscious about the way your breasts feel and look now.  Breast augmentation can enhance your breast size and shape, restore your breasts to the more proportional figure, or give you the breasts you have always wanted.
The Aesthetic Surgical Associates work hard to make your consultation as personal as possible.  Dr. Metzinger has developed the section “Frequently Asked Questions” to help you prepare for your consultation.  By preparing yourself in this manner, a large portion of your questions will be answered and when you come into the office, we can discuss your specific desires during the consultation period. This helps us to understand your expectations and determine whether they can be realistically achieved.  The goal of our entire staff is to make your cosmetic surgery experience easy and comfortable, and to provide you with the best results achievable.

Am I a good candidate for breast augmentation?

If you encounter one or more of the following conditions or feelings, you may be a good candidate for breast augmentation:

• you are bothered by feelings that your breasts are too small
• you have difficulty finding clothes that fit well around your bust line
• you experience feelings of self-consciousness when wearing a swimsuit or form-fitting top
• your breasts lost their firmness and became smaller after having children
• the size and shape of your breasts has changed after weight loss
• there is a noticeable size difference between your breasts (one is smaller than the other)

How will my plastic surgeon evaluate me for breast augmentation surgery?

As your personal plastic surgeon Dr. Metzinger wants to understand your expectations and desires for breast augmentation.  We may ask you to fill out some materials to determine whether your expectations can be realistically achieved.  We will have an opportunity to discuss your medical and surgical history during the consultation period and perform a physical examination of your breasts.  We will consider several factors in our decision to perform breast augmentation.  These factors include the size and shape of your breasts, the quality of your skin and placement of your nipples and areolas (pigmented skin around the nipples).  In some cases, when breasts are found to be sagging excessively, a breast lift may be recommended in conjunction with augmentation.  During the consultation period, you will be asked about the desired breast size and appearance that is of importance to you.
You should come to the consultation prepared to discuss your medical and surgical history. This includes information about medical conditions, drug allergies, and medical and/or surgical treatments you may have received in the past.  Knowledge of any personal and familial breast conditions will be helpful.  For instance, you will be asked whether you have a family history of breast cancer and about results of any recent mammograms. It is important for you to provide complete information.

How will my doctor perform my surgery?

Factors related the size and shape of the breasts, skin quality and level of “ptosis” will play a significant role in determining the manner in which your surgeon will perform your breast augmentation.  Personal factors and preferences will help you and your plastic surgeon to determine the appropriate breast size, location of incisions, and whether the implants will be placed on top of or below the pectoralis major muscle.  In general, most of our implants are placed under the pectoralis major muscle, however, in certain cases; the best cosmetic results are achieved with implants placed below the breasts and on top of the pectoralis major muscle. 

What type of implants will be used?

Dr. Metzinger uses both saline and silicone gel breast implants.

On April 10, 1991, the Food and Drug Administration (FDA) asked breast implant manufacturers to submit evidence in a premarket approval (PMA) application that silicone gel-filled breast implants were safe and effective. However, the manufacturers were unable to provide the FDA with this information. Without enough data on safety and effectiveness, the FDA determined that silicone gel-filled breast implants could not be approved for use in the United States. Therefore, silicone gel-filled breast implants were removed from the open market.  In January 8, 2003, the FDA released this statement “Although an FDA advisory panel recommended market approval of Inamed’s silicone gel-filled breast implants in October, rather than accepting that panel’s advice, last night the FDA deferred a decision on Inamed’s implant, pending submission of additional information. Today, the agency also issued a new Guidance Document expanding the data needed from any manufacturers looking to get FDA market approval for such devices.”  In November, 2006 silicone breast implants were FDA approved for use in women 22 years of age and older. The FDA also recommends an MRI after 3 years, then every 2 years to rule out occult rupture.

Where are the incisions placed?

An advantage of saline-filled breast implants is that only a small incision is needed to place the implant in the breast.  Normal saline (medical saltwater) is infused into the implant to obtain the desired size increase.  Often, the incision is less than one inch in length and can be made underneath the breast crease.  In this location, the incision usually heals well and is usually quite inconspicuous.  Another location for the incision is around the lower edge of the areola.  Once the incision is made, the surgeon creates a pocket into which the implant will be inserted, either below or above the pectoralis major muscle and under the breast.  Dr. Metzinger can perform breast augmentation through all the incisions mentioned above.  However, we prefer the inframammary crease incision, which they have found to be highly advantageous.  Your surgeon will work closely with you to establish a surgical plan which best suits your needs.

What happens if I get pregnant or loose weight in the future?

You should inform your surgeon if you are planning to become pregnant or decide to loose a significant amount of weight in the near future.  Your surgeon may recommend that you stabilize your weight prior to undergoing surgery.  If you wish to become pregnant in the future, you should mention this to your surgeon.  Pregnancy is likely to alter breast size in an unpredictable manner and could affect the long-term results of your breast augmentation. There is no evidence that breast implants will affect your pregnancy or your ability to breast-feed.  We are happy to answer any questions that you may have on this matter during the consultation period.

Do breast implants increase my risk for breast cancer? What about mammograms?

Although this has been previously investigated, no scientific evidence has been found to show that breast augmentation increases the risk of breast cancer.  However, the presence of breast implants can make it more difficult to take and interpret mammograms.  For women with increased risk for breast cancer or those having a very strong family history of breast cancer, this may be of special consideration.  Placement of the breast implant under the pectoralis major muscle tends to interfere less with mammography.  However, other factors have to be considered with regard to the ultimate placement of your breast implants. We will discuss this with you in great detail.  In the future, you will need to inform the radiologist performing your mammogram that you have breast implants, so that they can perform this procedure safely and effectively.  All patients who have had breast augmentation should perform breast self-examination on a monthly basis.  A new technology called HALO breast Pap smear is also recommended as an early screening tool.

How do I prepare myself for surgery?

In some cases, your plastic surgeon may recommend a baseline mammogram before surgery and another mammography three months after surgery. This helps to detect any future changes in your breast tissue.  If you smoke, you will be asked to stop smoking in advance of surgery.  Aspirin and other anti-inflammatory drugs which can cause increased bleeding should be avoided at least two weeks before surgery. A full list of other medical and non-medical substances to avoid will be provided to you at our office.  Additional preoperative instructions will also be given to you at that time.  Breast augmentation is usually performed on an outpatient basis either in a hospital, free-standing ambulatory facility or office-based surgical suite.  You should arrange for someone to drive you home after surgery and to stay with you at least the first night following your surgery.  You should obtain all you medial prescriptions before the date of surgery and have those available at home.  You will be given a Postoperative Breast Augmentation Instruction Sheet, which you should keep at home as a reference guide during the postoperative period. 

What happens during surgery?

Intravenous medications are administered for your comfort during the surgical procedure.  Local anesthesia and intravenous sedation are used for patients undergoing breast augmentation to complement general anesthesia. When surgery is completed, you will be taken into a recovery room where you will be closely monitored. Your breasts will be covered by sterile surgical dressings, a surgical bra and a supportive breast band.  You may be permitted to go home after a few hours, unless you and your plastic surgeon have arranged for you to stay in a hospital or surgical facility overnight.

How will I look and feel initially?

Most patients experience some discomfort immediately after surgery.  Your breasts may experience swelling and bruising, but usually this is minimal.  While you can perform some activities at home, vigorous activities should be avoided.  The day after your surgery, you should be up and about.  Any dressings will be removed within several days, and you should wear your supportive bra and breast band at all times.  Your plastic surgeon will probably permit you to shower 24 hours after surgery.  Stitches will be removed five to seven days after surgery.  It is important to follow the guidelines in your Postoperative Breast Augmentation Instruction Sheet at this point.  After breast augmentation surgery, it is often possible to return to work within just a few days or a week, depending on your job. Vigorous activities, especially arm movement, may be restricted for two to three weeks. Sexual activity should be avoided for at least two weeks following surgery. After that, care must be taken to be extremely gentle with your breasts for at least the next month.

What are the risks of Breast Augmentation Surgery?

In 2007, 336,788 women underwent breast augmentation surgery.  Before you undergo breast augmentation surgery, you should understand the risk, benefits and imponderables associated with this type of surgery. The potential complications that are discussed with you during the consultation period include reactions to anesthesia, blood accumulation that may require surgical drainage and infection.  Although rare, infection that does not subside with appropriate treatment may require temporary (usually 3 months) removal of the implant.  Decreased or lost nipple and breast sensation may result from breast augmentation surgery.  Most often this is temporary.  When a breast implant is inserted, a scar capsule forms around it as part of the natural healing process. The capsule may tighten and compress the implant, causing the breast to feel firmer than normal.  This type of capsular contracture can occur to varying degrees.  When it is severe, it causes discomfort, temperature changes and changes in the appearance of the breasts.  More surgery may be required to modify or remove the scar tissue and perhaps remove or replace the implant.  Breast implants are not lifetime devices and cannot be expected to last forever.  If a saline-filled implant ruptures (rate 1% per year), its contents are harmlessly absorbed by the body within hours.  A decrease in the size of the breast is clearly noted.  Rupture can occur as a result of trauma to the chest, but more commonly it occurs spontaneously with no apparent cause.  Surgery will be required to replace ruptured implants.  If you are at an age when mammography should be conducted, it will be important for you to select a radiologist with experience in taking x-rays of augmented breasts.  Special examinations of your breasts such as ultrasound or magnetic resonance imaging (MRI) may be required in some cases.  It is possible that the presence of breast implants could delay early detection of breast cancer.  Additionally, some women have reported problems including certain connective tissue and immune-related diseases.  Women without implants also have these disorders, so the key question is whether breast implants increase the risk of developing the conditions. Several large studies have been completed showing that women with breast implants do not have a significantly increased risk for these diseases.  The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your plastic surgeon or with a staff member in your surgeon's office.   Additionally, during your preoperative visit with your surgeon you will be asked to review and sign a Breast Augmentation Risk Disclosure Sheet which should answer all your questions regarding potential complications and imponderables associated with breast augmentation.

I understand that every surgical procedure has risks, but how will I learn more so that I can make an informed decision?

More information can be obtained from our office and can be picked up at you convenience.  Dr. Metzinger will discuss with you all of the potential risks and benefits of breast augmentation during the in-office consultation in great detail.  Additional information can be obtained from the links below:

• Food and Drug Administration (FDA) Center for Devices and
  Radiologic Health  http://www.fda.gov/cdrh
• The American Society of Plastic Surgeons (ASPS)  http://www.plasticsurgery.org
• The American Society for Aesthetic Plastic Surgery (ASAPS)  http://www.surgery.org

How long will the results of my breast augmentation last?

Except in the event of implant deflation requiring surgical replacement with a new implant, the results of your breast augmentation will be long-lasting.  Gravity and the effects of aging will eventually alter the size and shape of virtually every woman's breasts.  If, after a period of years, you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast "lifting" procedure to restore your breasts more youthful contour.  A capsular contracture can cause serious discomfort and changes in breast contour in your breasts and may require surgery to remove the capsule and replace the implant.
Is it important to maintain a long-term relationship with my plastic surgeon?
You will return to our office for follow-up care at prescribed intervals.  Your surgeon will encourage you to schedule routine mammography at the frequency recommended for your age group.  Please remember that the relationship with your plastic surgeon does not end when you leave the operating room.  If you have questions or concerns during your recovery, or need additional information at a later time, you should contact your surgeon.

ABDOMINOPLASTY: Frequently Asked Questions

What can a tummy tuck do for me?

• A tummy tuck can reduce excess or sagging skin in the tummy area.
• A tummy tuck can tighten a protruding bulge in the lower tummy after pregnancy.
• A tummy tuck can reduce excessive fatty tissue concentrated in your tummy area.
• A tummy tuck can make you more proportionate with the rest of your body.

How will my plastic surgeon evaluate me for a tummy tuck?

As your plastic surgeon, Dr. Metzinger wants to understand your expectations and desires for tummy tuck. We will have an opportunity to discuss your medical history during your plastic surgery consultation and perform a physical examination of your tummy area. Your plastic surgeon will examine your tummy skin, fat and muscles while you are standing and lying down. The tone of your skin and degree of skin looseness in the tummy tuck region will be assessed. We will consider several factors in our decision to perform a tummy tuck on you. These factors include the amount of excess skin and fat distribution. Endoscopic tummy tuck is another technique for minimizing scars and may be useful when patients have only a mild degree of excess muscle laxity.  When you only have a minimal amount of fat and skin excess in the lower parts of your tummy you may be a candidate for a mini tummy tuck. The mini tummy tuck concentrates only on the lower part of the tummy. When more excess tissue develops with pregnancy, a full tummy tuck is the desired procedure. The full tummy tuck concentrates on the upper and lower parts of the tummy. In patients with even more tissue than average, an extended tummy tuck is the desired procedure. The extended tummy tuck serves to tighten the excess tissues in the especially large tummy. All of our tummy tucks will help you re-establish harmony with the rest of your body.  When plastic surgery patients have lost excessive amounts of fat after weight-loss surgery they may need other variations of the tummy tuck, which can include removal of fat pads and extreme excesses of skin from the tummy. The Fleur-de-Lis tummy tuck is one example of these types of plastic surgery procedures. In some cases, the degree of skin excess can extend all the way around the back and is beyond the limits of a tummy tuck. In such cases, we may recommend a more comprehensive plastic surgery procedure, such as the Body Lift, which is a plastic surgery procedure designed to treat the entire trunk area.

Will my insurance help cover the cost of plastic surgery?

Tummy tuck is considered a plastic surgery procedure for the improvement of the tummy appearance, which is generally not covered by most insurance plans. In some cases, a plastic surgery patient may have a hernia associated with their tummy deformity. Other patients wishing to have a hysterectomy along with their tummy tuck may qualify to have this part of their surgery covered by their insurance plan. Many factors determine your eligibility for coverage, including the specific terms of your insurance policy. We will be happy to discuss specific matters with you during the consultation period.  Aesthetic Surgical Associates and Dr. Metzinger DO NOT accept insurance.

Where are the incisions for tummy tuck placed?

A horizontal incision is placed just above the pubic area using plastic surgery techniques. The extent of the tummy tuck incision depends on the amount of skin to be removed. The design of the tummy tuck incision varies according to the structure of your tummy and the style of bathing suit or under garment you prefer. We attempt to keep all tummy tuck incisions within your bathing suit or under garment lines, but this may not always be possible. Individual factors such as amount of excessive skin, stored fat and the condition of your tummy muscles play a critical role in determining the specific plastic surgery technique and tummy tuck incisions used. If there is loose skin above the belly button, the plastic surgeon may make an incision around the belly button. The skin and fat layer is separated from the tummy muscles. To tighten the tummy muscles into a more youthful position, our plastic surgeon brings the muscles together with permanent sutures. The skin of the lower tummy that contains stretch marks is usually completely removed. Any stretch marks remaining above the belly button may be flattened and improved, but you should not expect a dramatic change in their appearance after tummy tuck. As the tummy skin is pulled down to meet the incision of the pubic area, excess tissue is removed. A small opening is made to bring out the belly button. The tummy tuck incisions from the procedure will heal and fade over time. In many instances, tummy tuck incisions eventually fade to become only faint lines. Some individuals may have tummy tuck incisions that are more noticeable. Fortunately, tummy tuck incisions are placed in locations concealed by most bathing suits and undergarments. Your plastic surgeon will work closely with you to establish a plastic surgery plan that will best suit your needs.

What happens if I get pregnant or loose weight after tummy tuck?

You should inform Dr. Metzinger if you plan to become pregnant in the near future. Your plastic surgeon may recommend that you postpone this type of plastic surgery until after pregnancy. There is no evidence that having a tummy tuck can affect your pregnancy. If you get pregnant after your tummy tuck, your tummy may enlarge again in an unpredictable manner and this could affect the long-term results of your tummy tuck. We are happy to answer any questions you may have on this matter during your plastic surgery consultation.

How do I prepare myself for plastic surgery?
If you are a smoker, your plastic surgeon will ask you to stop smoking well in advance of any plastic surgery. Aspirin and other anti-inflammatory drugs which can cause increased bleeding should be avoided at least 2 weeks before plastic surgery. A full list of other medical and non-medical substances to avoid is available at our office. Additional preoperative instructions will also be given to you during your preoperative visit. Tummy tuck is usually performed on an outpatient basis either in a hospital or free-standing plastic surgery facility. You should arrange for someone to drive you home after your surgery and to stay with you at least the first night following your surgery. You should obtain all your prescriptions before the date of your surgery and have those available at home. In certain cases, tummy tuck is performed in conjunction with a medically necessary procedure such as hysterectomy or hernia repair. This will likely require a short hospitalization. You will also be given a Postoperative Tummy Tuck Instruction Sheet, which you should keep at home as a reference guide during the recovery period.

What happens during surgery?

Intravenous medications are administered for your comfort during the plastic surgery procedure. Local anesthesia is used for patients undergoing tummy tuck to complement general anesthesia. A special bladder catheter may be inserted to monitor urine output for most of our plastic surgery cases. When the plastic surgery is completed, you will be taken into a recovery room where you will be closely monitored. Your tummy will be covered by sterile plastic surgery dressings and a plastic surgery garment. You will notice small drain tubes that have been placed within the tummy tissues to help avoid accumulation of fluids. You may also notice the drainage tube that has been placed in your bladder to monitor urine output. Most often, the bladder tube is removed right after your plastic surgery is over, but occasionally we send a patient home with it and remove it the next day. You may be permitted to go home after a few hours, unless you and your plastic surgeon have arranged for you to stay in a hospital or plastic surgical facility overnight.

How will I look and feel initially?

Most plastic surgery patients experience some discomfort immediately after surgery. The next day, you will be encouraged to get out of bed for short walks in order to promote blood circulation. You may not be able to stand up completely after your tummy tuck. We encourage you to get out of bed and sit in a chair during the first few days after your tummy tuck. Straining, bending and lifting heavy objects are to be avoided for six weeks. You may find it more comfortable to sleep with several pillows under your back and a few pillows under your knees. Plastic surgery drains and pain pumps will require special care until they are removed. Depending on the tummy tuck technique used, you may be instructed to wear a support plastic surgery garment for several weeks. Generally, stitches will be removed in stages over a period of approximately one or two weeks. Swelling and bruising after tummy tuck is to be expected. A stool softener or laxative may be required because narcotics can cause constipation. The bruising and much of the swelling will disappear over the next few weeks. However, it may be several months before all swelling subsides and up to one year before you see the final result of your tummy tuck. Numbness over portions of the tummy area is an inevitable result of tummy tuck, but in time it improves. Tummy tuck incisions will be reddish pink in color soon after this type of plastic surgery and can remain this way for many months following surgery. Tummy tuck incisions eventually become more normal in color and fade with time.

When can I resume my normal activities after tummy tuck?

The amount of time it takes for recovery varies greatly between individual plastic surgery patients. Depending on the extent of your tummy tuck and your overall physical condition, you may be able to return to non-strenuous activity from one to three weeks after this type of plastic surgery. You can resume most of your normal activities, including some form of mild exercise, a few weeks after tummy tuck; however, vigorous activities should be avoided. The day after your tummy tuck surgery, you should be up and about. Any plastic surgery dressings will be removed within several days, and you should wear your supportive plastic surgery garment at all times. Your plastic surgeon may permit you to shower 24 hours after tummy tuck surgery, but occasionally you may have to sponge bathe for up to five to seven days. Stitches will be removed ten to fourteen days after tummy tuck surgery. It is important to follow the guidelines in your Postoperative Tummy Tuck Instruction Sheet. You may experience mild, periodic discomfort and swellings for several weeks after your tummy tuck. When the swelling begins to resolve, you may have to get a new postoperative plastic surgery compression garment to contour your body for a full six weeks. Any pain that is severe and not controlled by your pain medication should be reported to your plastic surgeon immediately. You should avoid any sexual activity for a minimum of three weeks, and your plastic surgeon may advise you to wait longer.

What are the risks of Tummy Tuck Surgery?

In 2002, 85,752 patients underwent tummy tuck surgery. This represented a 37% increase in tummy tucks over the previous year. Before you undergo tummy tuck surgery, you should understand the risks, benefits and imponderables associated with this type of plastic surgery. The potential complications that are discussed with you during the plastic surgery consultation include reactions to anesthesia, blood accumulations that may require surgical drainage and infection. Tissue loss along the horizontal incision is a possibility when tummy tuck is performed. When this complication occurs, delays in healing and prolonged recovery may result. Tissue loss during tummy tuck is more common in plastic surgery patients who smoke or have medical conditions such as diabetes and blood vessels disease. Revision plastic surgery may be required in certain instances where tummy tuck incisions healed poorly. Following plastic surgery, fluid may accumulate under the skin as a possible complication of tummy tuck. Removal of this serum is usually painless but may require several extra visits to our plastic surgery office. Another potential complication with tummy tuck is the formation of blood clots in your leg veins. These clots can lead to severe leg swelling, leg pain and can travel to the lung where the clots can cause devastating damage to your heart and lungs. Fortunately, this problem is rare when this type of plastic surgery is performed on healthy patients. We make every attempt to provide our patients with the best available prophylaxis against these kinds of blood clots. You can help to lessen certain risks by following the instructions given to you on the Postoperative Tummy Tuck Instruction Sheet and following any other instructions given by your plastic surgeon.

I understand that every plastic surgery procedure has risks, but how will I learn more so that I can make an informed decision?

The subject of risks and potential complications of tummy tuck surgery will be discussed with you on a very personal basis. Fortunately, significant complications from tummy tuck are not common. Each year, many thousands of people undergo successful aesthetic plastic surgery of the tummy without experiencing any major problems and are pleased with the results. Anyone considering plastic surgery, however, should be aware of both the benefits and risks. More information can be obtained from our office and can be picked up at your convenience. Remember, Dr. Metzinger is happy to discuss with you all of the potential risks and benefits of tummy tuck during your plastic surgery consultation in great detail. Additional information can be obtained from the links below:

• The American Society of Plastic Surgeons (ASPS)
• The American Society for Aesthetic Plastic Surgery (ASAPS) 

How long will the results of my tummy tuck last?

Tummy tuck will reshape and rejuvenate your tummy area. You will likely find it easier to wear certain styles of clothing. Like many patients who have had a tummy tuck, you may have a boost in self-confidence. In general, the results of your tummy tuck will be long-lasting. Unless you gain or lose significant amounts of weight or become pregnant, your tummy should remain firmer and flatter for many years. However, gravity and the effects of aging can eventually alter the shape of your tummy area. After a period of years, you may become dissatisfied with the appearance of your tummy tuck and you may choose to undergo a second plastic surgery procedure to restore a more youthful body contour.

LIPOSUCTION: Frequently Asked Questions

What is Liposuction?
Liposuction is a plastic surgery technique that utilizes a low suction/vacuum device to remove unwanted fatty bulges from the human body. Because the fatty tissue found under the skin is normally very easily removed, the procedure is performed with only a short recovery time and a low level of discomfort. Liposuction revolutionized the treatment of excessive fat tissues, especially those difficult areas that are nearly impossible to improve or remove with diet and exercise alone. Because of its lack of significant scarring and rapid recovery, liposuction has become one of the most popular plastic surgery procedures performed throughout the world. Liposuction is not a substitute for a good diet and exercise regimen and should not be used as a means to lose unwanted pounds.

What is the most volume that can be removed with liposuction at one time?
As a member of the American Society of Plastic Surgeons, Dr. Metzinger is concerned about your safety and satisfaction. The American Society of Plastic Surgeons recommends that no more then 5000 milliliters (5 liters) of fat tissue be removed during a single episode of liposuction performed in an outpatient plastic surgery facility. Removal of greater than 5 liters of fat is possible, but not recommended by our plastic surgery practice. Scientific studies support the fact that removal of more than 5 liters of fat at one time can lead to delays in healing, prolonged swelling, bruising, and other difficulties after liposuction, which can make your experience with plastic surgery less enjoyable. The average liposuction volume removed in our practice is around 3500 milliliters (3.5 liters) of pure fat. Liposuction is used in our plastic surgery practice to remove unwanted fat bulges and improve the overall appearance of the body. Dr. Metzinger super-specializes in liposuction and has a broad experience in using various techniques of liposuction, including Power Assisted Liposuction, Ultrasound Assisted Lipectomy, liposculpture and fat grafting.

What is the Tumescent Liposuction Technique?
The tumescent liposuction technique involves injection of several liters of normal saline (sterile medical salt water) which contains small amounts of adrenaline and anesthetic into the areas where the fat will be removed. The exact amount of pre-liposuction fluid injected varies depending on the total volume to be removed, in general, when more liposuction volume is planned to be taken away, then the more volume of tumescent fluid that is required. This pre-liposuction fluid has three purposes; the anesthetic will help to “numb” the tissues during and after the liposuction procedure minimizing discomfort, the adrenaline with “tighten up” blood vessels minimizing blood loss and bruising with your liposuction procedure, and the extra fluid volume will help “break up” the attachments of the fat cells making it easier to remove the fat volume during your liposuction procedure. The pre-liposuction fluid is injected ten to fifteen minutes prior to the liposuction procedure, after the patient has already been made comfortable by the anesthesia personnel.

What areas are most frequently treated with Liposuction?

Any area of the body in which we are able to store fat, such as, the neck, arms, thighs, legs, ankles, buttocks, tummy, love handles, back, breasts and chest can be treated with liposuction. In women, the most frequently treated areas include the thighs and tummy. In men, the breasts, "love handles" and tummy are treated most frequently with liposuction.

Am I a good candidate for Liposuction?

Almost everyone can be a good plastic surgery candidate for liposuction at some point in his or her lifetime. The best liposuction candidates are individuals who take care of their bodies and follow a good exercise regimen and a reasonable diet. When you have unwanted fat bulges and feel that you have done the best job possible in trying to remove these with exercise and diet, then you may be a good plastic surgery candidate for liposuction. Dr. Metzinger firmly believes that with modern liposuction plastic surgery techniques it is not good enough just to remove the excess volume, but instead to create a situation where the patient has the best opportunity to become a smaller person, that is, to achieve a flatter tummy, a smaller waistline, thigh, or buttock. To achieve this, the individual must have healthy skin that will effectively “shrink” after the volume is taken away. Therefore, individuals with healthy skin usually make the best plastic surgery candidates for liposuction. This group of plastic surgery patients usually includes younger men and women who have not been pregnant or loss significant amounts of weight. However, with ultrasound-assisted liposuction, or power-assisted liposuction some individuals with less than ideal skin conditions can still achieve a wonderful result with liposuction.

Can Liposuction tighten up loose skin?

If there is excess fat in an area and the skin above is healthy, liposuction can tighten the skin and produce a more sculpted and healthy appearance. If, however, the overlying skin is loose, excessive or has stretch marks it may be impossible to achieve a nice tight result with liposuction, even after generous volume removal. In such cases, we may recommend ultrasound liposuction, which can achieve tighter skin when compared to traditional liposuction. In other cases, we may recommend another plastic surgery procedure, which allows for removal of excess skin and tightening (for example, a tummy tuck). In general, most plastic surgery patients who benefit from liposuction are under forty. Most patients over forty will require some plastic surgery procedure that requires surgical skin tightening.

Liposuction seems simple and safe. Are there any risks?

In the hands of a well-trained plastic surgeon, liposuction is very safe and effective. However, no plastic surgeon can deny that there are risks with liposuction and with most plastic surgery procedures. Thankfully, most of the unwanted side effects of liposuction are usually temporary and create no permanent troubles. Swelling and bruising are seen in every plastic surgery patient who undergoes liposuction and is usually gone by two weeks after this procedure. As with other plastic surgery procedures, rare unwanted side effects of liposuction can include infection, bleeding and nerve damage. In addition, skin irregularity or waviness can occur if too much fat is removed with liposuction.

RHINOPLASTY: Frequently Asked Questions

What will my nose look like after Rhinoplasty surgery?

It is my personal philosophy that producing “natural looking” noses after rhinoplasty leads to the most satisfactory results and happiest patients. The “cute” nose of the 1960’s is no longer in demand and while in most cases we can successfully reduce large noses, I believe that a nose which is proportioned to other facial features makes patients the happiest. Excess cartilage and bone in the nose can be reduced using special plastic surgery techniques.  Irregularities and bumps can be removed and crookedness can be straightened and smoothed. Adding tissue grafts to enhance certain features of the nose can also be performed, but good judgment and experience is required to achieve predictable results with these plastic surgery techniques. In modern nasal plastic surgery procedures the trend is to move away from over-reduction of tissue that reduces breathing ability and move towards individualized treatment of each segment of the nose, resulting in a balanced and refined look without compromising function.

How long does Rhinoplasty surgery take?

Rhinoplasty takes from one to five hours depending on the pre-surgery condition of the nose. Nearly all rhinoplasty operations are done at outpatient plastic surgery facilities. Less time does not always equal more efficiency or better results. My personal philosophy is to take the required time necessary during a rhinoplasty to achieve the goals set forth by the patient and plastic surgeon.

Is there a lot of bruising after Rhinoplasty, and how long will it last?

Some bruising and swelling is expected after most Rhinoplasty surgery procedures. In general, bruising after nasal reshaping usually occurs under the eyes and is the direct result of fracturing the nasal bones, in order to reduce the width of the nose. Most plastic surgery patients experience five to seven days of discoloration and swelling around the eyes and upper cheeks. The nose itself will be swollen for anywhere from six weeks to three months or longer, but subtle resolution of the swelling at the nasal tip can take months and up to one year to go away.  If persistent bruising is a problem, we may add Brohmelain to your postoperative medication regimen.  Avoidance of aspirin, ibuprofen and other medications which cause platelet dysfunction minimizes the chances of heavy bruising after rhinoplasty.

I have trouble breathing through my nose. Will my breathing improve after Rhinoplasty?

When the condition described is associated with a deviated or “bent” septum, excessively large turbinates (structures used to filter and clean the air we breathe) and weak or collapsed internal nasal framework, then correction of these offending structures is likely to improve breathing function. Not all airway obstruction results from large or malpositioned anatomic structures. Some airway obstruction is due to physiologic responses elicited by allergies to pollens and other environmental factors. Careful examination is needed before Rhinoplasty surgery to identify the conditions creating nasal obstruction. Some improvement can be achieved in most cases even in those who suffer from seasonal allergies.

I have trouble breathing through my nose. Will my insurance policy pay for Rhinoplasty?

While individual insurance policies vary, in general, functional plastic surgery to improve breathing is considered a covered benefit in many group policies. In this situation, the insurance company may cover the expenses of the operating room, anesthesia and some of the plastic surgery. However, once the “functional” part of the operation is completed, any other plastic surgery performed on the nose is no longer covered by the policy. If additional correction of a cosmetic deformity of the bridge and tip of the nose is performed at the same time, the cost of this part of the plastic surgery procedure needs to be covered by the patient. The Aesthetic Surgical Associates and Dr. Metzinger DO NOT accept any health care insurance.

Will my nose grow after Rhinoplasty surgery?

The nose tends to elongate as we enter the middle years of our life and drooping of the tip of the nose can occur in later years as elasticity disappears from the body. Rhinoplasty as a teenager or young adult will not prevent the effects of aging on the nose. In other words, after Rhinoplasty, the nose continues to grow at a normal rate. However, the final shape achieved with plastic surgery generally lasts a lifetime and the recurrence of bumps and deformities is a rare occurrence.

How important is the plastic surgeon’s experience in Rhinoplasty?

Rhinoplasty is the one plastic surgery procedure in which the surgeon’s knowledge and experience can make the difference between success and failure. Thankfully, my experience in rhinoplasty is quite broad. I first learned nasal reshaping plastic surgery techniques during my Otolaryngology/Head & Neck Surgery residency from two highly respected nasal plastic surgeons. Both of these otolaryngologists are members of the prestigious Rhinoplasty Society. After residency, I did a fellowship in facial plastic and reconstructive surgery and further developed my skills. My adult plastic surgery practice has been mainly cosmetic in nature; however, I have also become skilled in nasal plastic surgery for reconstruction after cancer. As a Plastic Surgery resident at the Johns Hopkins Hospital I was fortunate to perform a large number of nasal plastic surgery procedures on cleft lip/nasal patients. These are some of the most challenging cases, but also served as a tremendous learning experience using various Rhinoplasty techniques. I continued to have good fortunes in rhinoplasty performing nasal plastic surgery on a broad range of patients in private plastic surgery practice. I have now become quite seasoned in rhinoplasty and use special plastic surgery techniques that are highly successful and predictable in treating rhinoplasty patients from all walks of life. I am now an active member of the prestigious Rhinoplasty Society.

BLEPHAROPLASTY: Frequently Asked Questions

What type of plastic surgery is Blepharoplasty?

Blepharoplasty refers to eyelid plastic surgery that is designed to remove the excess fat, skin and soft tissue that becomes noticeable around the eyelids as we age. This plastic surgery procedure is designed to fit the individual needs of our plastic surgery patients. Aging of the eyelids varies significantly from person to person. The development of aging eyelids can occur in the upper and lower eyelids and the need for plastic surgery can occur at any age, but commonly when patients reach their late thirties and forties. This plastic surgery procedure is performed alone or in combination with other plastic surgery procedures, such as, rhinoplasty, facelift, browlift, fat grafting, necklift, chemical peel and liposuction.

Am I a good candidate for eyelid surgery?

If you have puffy eyes or “bags”, you are likely a good candidate for eyelid surgery. Many patients with droopy eyelids have their appearances rejuvenated with eyelid surgery. If you feel that you look “tired” around the eyes and getting rest does not make this go away, then you may be a good candidate for this type of plastic surgery.
The best candidates for blepharoplasty are individuals who are healthy and well motivated. Some medical conditions such as thyroid disease, high blood pressure, dry eyes and cigarette smoking can increase the risks of unwanted side effects from blepharoplasty surgery. All potential plastic surgery patients are asked to see their private medical doctor for a check up before undergoing an eyelid surgery procedure. Eyelid plastic surgery patients are asked to have a check up with their private eye doctor as well, before blepharoplasty.

What are the Goals of eyelid surgery?

It has been said that, “the eyes are the widows to the soul”, and most everyone makes eye contact with dozens to hundreds of people on a daily basis. When your eyes appear tired, swollen or aged, people are likely to treat you the way they see you. A blepharoplasty is a plastic surgery procedure designed to brighten the face by restoring a more youthful appearance to your eyes. In some plastic surgery patients, the procedure will also improve vision by removing the excessive skin of the upper eyelids, which can hang down and interfere with vision. This type of functional plastic surgery may be covered by your insurance company.

Are there incisions or scars from Blepharoplasty procedures?

Dr. Metzinger usually makes incisions using plastic surgery techniques along the natural creases of your upper and lower eyelids, which heal very nicely and usually do not form scars. He removes excess fat, soft tissue and skin and closes the incisions using very fine sutures. The eyelid surgery incisions are made to accomplish the goals of the procedure and are barely visible after several months as they are placed within the normal creases of the upper and lower eyelids. Some patients only need removal of fat and we choose to place our incisions inside the lower eyelids only.

Are the results of eyelid surgery permanent?

We do not expect any plastic surgery result to be “permanent”. However, since the fat around the eyes will not “regrow” after removal, the results of blepharoplasty are usually long lasting. The aging process continues normally after plastic surgery to the eyelids and we expect that plastic surgery patients will require “tuck-up” procedures in the future. Most everyone can enjoy the results of blepharoplasty for ten to fifteen years.

Will insurance cover a plastic surgery procedure, such as, Blepharoplasty?

Some insurance companies will cover blepharoplasty of the upper eyelids only if the excess skin causes blockage of your vision. If your eye doctor can demonstrate that loss of vision or visual restriction is occurring due to heavy eyelids using a special test called the Visual Fields exam, then your insurance company may cover some or all of the costs of this plastic surgery procedure. We recommend that each plastic surgery patient check with his or her insurance company to see if this eyelid surgery procedure is covered under your plan. Aesthetic Surgical Associates and Dr. Metzinger DO NOT accept commercial healthcare insurance.

Will I be bruised after Blepharoplasty?

There will be some bruising that lasts five to fourteen days after blepharoplasty, so you may want to postpone any social engagements during this time. If bruising is prolonged beyond the usual period in your case, our skin care consultant will be glad to demonstrate make-up techniques, which will allow you to return to your usual activities. If persistent bruising is a problem, we may add Brohmelain to your postoperative medication regimen.  As a general rule of thumb, most patients return to work or play by two weeks.  Avoidance of aspirin, ibuprofen and other medications which cause platelet dysfunction minimizes the chances of heavy bruising after blepharoplasty.

At what point are the Blepharoplasty sutures removed?

Dr. Metzinger prefers to removes sutures in five to seven days, unless resorbable (they go away) sutures are used. These do not require removal.

Will the shape of my eye change following Blepharoplasty?

There could be small changes in eyelid shape after blepharoplasty, but these are generally positive as a more attractive shape is restored to the aging eyelids. Skin in the upper and lower eyelids will be tightened during blepharoplasty. Generally, the shape of the eye changes so that it appears more open and less tired after this type of plastic surgery. More dramatic changes, such as, a change in the slant of the eyes, which are sometimes times requested by patients, can be obtained using additional techniques.
Will the fine wrinkles around my eyes go away after Blepharoplasty?
The blepharoplasty procedure will not completely eradicate the wrinkles around the eyes (crow’s feet). There are other plastic surgery procedures designed for these purposes such as chemical peels, lasers, and Botox.

What about my sagging eyebrows and dark circles under my eyes?

The blepharoplasty procedure will not completely eradicate dark circles under the eyes or lift the eyebrows. There are other plastic surgery procedures designed for these purposes such as open, mini, and endoscopic forehead lifts. Dark circles under the eyes can be improved by fat removal, unless the skin there is pigmented. If this is the case, a lightening cream can be prescribed which can improve the situation even more.

What are the risks involved with this plastic surgery procedure?

When performed by a well trained, board certified plastic surgeon, the undesirable effects of plastic surgery are infrequent and minor. All plastic surgery patients will experience some bruising and swelling for a few days after any type of plastic surgery. In addition, a temporary problem with closure of the eyelids can be seen. Some may have temporary blurring of vision, usually due to the ointments applied to the eyelid surgery incisions after the procedure. In rare instances, the lower eyelids may be pulled down causing the inner part of the eyelid to show. If this does not resolve with massage, taping and anti-inflammatory medications, further plastic surgery may be necessary. The theoretical complications of any plastic surgery procedure, such as bleeding, loss of vision, infection, wound disruption and heavy scarring are also possible, but extremely rare. Aesthetic Surgical Associates and Dr. Metzinger require ophthalmology clearance prior to any eyelid surgery or blepharoplasty.

FACELIFT: Frequently Asked Questions

What is a facelift?

A facelift is a plastic surgery procedure intended to remove the visible signs of the natural aging process that is seen on the face. Facial aging is sometimes accelerated due to environmental factors.  Plastic surgery patients generally have facial plastic surgery beginning in their 30’s and 40’s. Genetics can also influence the aging process, and some people find that their physical appearance is much older than their chronological age. A facelift procedure can improve the most visible signs of the aging by eliminating excess fat, tightening the muscles beneath the skin of the neck, and removing excessive and sagging skin. Facial plastic surgery of this type does not “stop” the aging process but merely "sets the clock back." A facelift can smooth the appearance of some wrinkles but is more efficient at reducing the amount of loose skin or excess fatty tissue. A facelift can have very dramatic results depending on the patient, but individuals should be realistic about the results they can achieve through facial plastic surgery.

Who is an ideal plastic surgery candidate for a facelift?

Ideal candidates for facial plastic surgery are individuals who are healthy and well motivated. Some medical conditions such as high blood pressure, dry eyes and cigarette smoking can increase the risks of unwanted side effects from facelift surgery. During the initial facelift plastic surgery consultation, Dr. Metzinger will be able to evaluate if you are a candidate for this plastic surgery procedure. When a person is unhappy with their aged appearance, which may include loose skin, wrinkles, excess fatty tissues, jowls with a loss of definition in the jaw line, or a deep line running from the corner of their nose to the corner of their mouth and under the chin, then this individual may be a good candidate for a facelift and other plastic surgery procedures to rejuvenate the face. A facelift can be done alone or in combination with eyelid surgery, forehead lift, chemical peel, neck lift, rhinoplasty, and liposuction.

Are the results of a facelift permanent?

A facelift can drastically improve the appearance created by the natural aging process, but it does not “stop” the aging process. Plastic surgery for facial aging simply "sets the clock back." We do not expect any plastic surgery result to be “permanent”; however, since the skin and muscles are tightened and the excess fat tissue is permanently removed the results are usually long lasting. The aging process continues normally after plastic surgery of any kind and we expect that plastic surgery patients will require “tuck-up” procedures in the future. Most everyone can enjoy the results of facelift surgery for seven to fifteen years. During those seven to fifteen years after a facelift, the individual develops those signs of aging once again, but will have a more youthful appearance than if they had not had a facelift.

What is the recovery time of a facelift?

Recovery time after a facelift will vary depending on individual factors, but on average is ten to fourteen days of which everyday activities like work must be suspended until swelling and bruising resolves, and one can be presentable again. Most every plastic surgery patient can resume his or her normal activities in two to three weeks after this type of plastic surgery. If prolonged bruising is experienced, our skin care consultant is skilled at camouflage techniques and can help in certain cases. Strenuous activities may not be allowed for 6 to 8 weeks after plastic surgery of the face. Dr. Metzinger will properly instruct each patient based on individual recovery processes and basic guidelines and instructions for the recovery.

Will I have scars from the facelift?

Every plastic surgery procedure which requires the removal of excess skin will also require that incisions be made. Facelift incisions for the most part result in beautiful healing that is barely noticeable to the human eye. In some cases, facelift incisions can become “scars” that are made of thicker collagen tissue. In most cases, the plastic surgeon can control only some of the factors that lead to scar formation. To achieve the desired results, Dr. Metzinger makes only minimal facelift incisions in well-concealed areas to minimize the chances of scar formation. The incisions that are made for a facelift are located within the hairline and in the natural creases in and behind the ear. Some individuals who require more work may have an incision made underneath their chin as part of their facelift. For the most part, these facelift incisions eventually fade and become barely noticeable.

What are the risks of facelift surgery?

Every plastic surgery procedure is associated with certain risks and the ones associated with facelift surgery occur rarely. The most common undesired side effects of facelift surgery are bleeding and fatigue. Other more rare situations include injury to the facial nerve, delayed healing, scarring, numbness, and skin discoloration. Infection is extremely rare during a facelift. If bleeding occurs after a facelift, more plastic surgery may be required to control the situation. Bruising and swelling after facelift are usually temporary conditions, but can last up to six to eight weeks.  During a facelift consultation, Dr. Metzinger will completely evaluate your tissues and medical history in order to assess your individual risks for facelift surgery. High blood pressure and cigarette smoking increase your risk of having problems after facial plastic surgery.

Will I be bruised after facelift surgery?

There will be some bruising that lasts seven to fourteen days after a facelift, so you may want to postpone any social engagements during this time. If bruising is prolonged beyond the usual period in your case, our skin care consultant will be glad to demonstrate make-up techniques, which will allow you to return to your usual activities. If persistent bruising is a problem, we may add Brohmelain to your postoperative medication regimen.  As a general rule of thumb, most facial plastic surgery patients return to work or play by two weeks after facelift.  Avoidance of aspirin, ibuprofen and other medications which cause platelet dysfunction minimizes the chances of heavy bruising after a facelift.

How do I find a qualified facelift surgeon?

It is extremely important to choose a plastic surgeon that is qualified and knowledgeable to perform a facelift. It is best to look for a plastic surgeon that is certified by the American Board of Plastic Surgery and is a member of the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS).
Dr. Metzinger is a diplomat of the American Board of Plastic Surgery, which means he has completed years of extensive surgical training, including the necessary years required to be certified as a specialist in plastic surgery. Dr. Metzinger is also board certified in facial plastic and reconstructive surgery.  Dr. Metzinger is a nationally acclaimed plastic surgeon known for several innovations in plastic surgery. He has received multiple awards for his contributions to plastic surgery of the face, nose, breast and body. Dr. Metzinger is a specialist in plastic surgery who has chosen to super-specialize in performing only those procedures which enhance a person’s physical appearance and well-being. Dr. Metzinger’s goal is simply to be the best provider of aesthetic plastic surgery. He has chosen to combine his years of experience and highly specialized training with the latest technological advances in aesthetic plastic surgery. Facial Plastic and Reconstructive surgery is frequently performed at the Aesthetic Surgical Associates.

What is Sub-Muscular Aponeurotic System (SMAS)?

If you walk into a room full of plastic surgeons, you are likely to hear the term “SMAS.” The SMAS is a layer of extremely strong collagen tissue that is found beneath the skin and covers the facial muscles. Because the SMAS is stronger than skin, when a facelift is performed using this tissue, the results are more impressive and usually long lasting. This "deep layer" approach to facelift is an improvement over earlier skin techniques, but can increase the risk of facial nerve injury.