Sunday, July 31, 2011

How to Choose a Breast Implant Size?

What is the Right Breast Implant Size for You?
When choosing the appropriate breast implant size, it is important to balance your own desires with that of your tissue and body characteristics.   Often, the desired breast implant size is simplified into a bra cup size or volume by both you and your plastic surgeon, and this should be avoided.   An overzealous attempt to achieve the desired cup size or volume without regard to the characteristics of your tissue can lead to an unnatural result that may leave one unsatisfied with your breast augmentation.
Amanda Seyfried (Photgraph Courtesy of Wikimedia Commons & Daniel Åhs Karlsson)

Breast Asymmetry
A majority of women would have some sort of breast asymmetry, which could either be the size of one’s breast, the nipple location or the size of the nipple-areolar complex.  After a breast augmentation, this asymmetry will become more prominent and more noticeable.  Thus, one should be aware of this prior to a breast augmentation.
Can the Asymmetry be Corrected or Minimized?
Your plastic surgeon will determine if one would need a much larger breast implant on one side of your breast to minimize the size discrepancy of one’s breasts. One may need a larger implant on the smaller breast as compared to the other.  This is determined by your plastic surgeon before and also during your plastic surgery.  Your plastic surgeon may use a “sizer”, which could be an implant series of different sizes or an inflatable breast implant that is inflated with saline or air during your surgery to determine the right breast implant size.  This enables your plastic surgeon to minimize the breast size discrepancy  that one previously have by being able to choose the right breast implant before finally placing them during surgery .
Choosing the Correct Breast Implant Size
The desired breast size is determined by multiple factors, such as desired breast size of the patient, breast measurements, and the characteristics of one’s breast and chest wall.  The breast width is one such measurement that a plastic surgeon utilizes to determine the correct implant size.  The selection of the implant is combined with your desired projection which allows your plastic surgeon to choose the appropriate size of breast implant.  Using implant and breast dimensions rather than the desired volume will yield for a more natural result. 

Friday, July 29, 2011

Breast Augmentation ~ Houston | The Woodlands

TOP 5 Things to Know Before Getting a Breast Augmentation

Breast augmentation (breast enlargement) is one of the most common cosmetic procedures performed in the United States. Most patients who undergo a breast augmentation are very satisfied with their results. However, being an informed patient is critical prior to having any surgery. The following facts are important information that all patients should know before having a breast augmentation.
(Courtesy of Wikimedia Commons & Studio Harcourt Paris)

1)Implant lifespan:  Like any other medical device, breast implants can not be guaranteed to last an entire lifetime. Any patient who undergoes breast augmentation should know that at some point in their life, the implants will most likely need to be replaced. This would require further surgery.

2)Need for further surgery:  A recent clinical study had shown that up to 25% of women who had a breast implant may need further surgery within 5 years of the initial surgery.  Another study showed that about 1 in 8 women who received breast implants for augmentation needed another surgery within 5 years.  One should note that the surgical revision rate among different studies, however, varies which ranges from 8% to 25%. 

The need for revision breast augmentation may be due to several reasons.  The most common reason according to a recent study at UCLA was malposition (62%) followed by capsular contracture (hardening of the implant due to surrounding tissues.)  However, a different study showed that the most common indication for revision breast surgery was patient desire for implant size change followed by capsular contracture.  Other reasons for revision breast augmentation include: drooping of the breast, change in breast shape or volume from aging or pregnancy, implant rupture (0.5% at 3 years), and unwanted implant movement.  Regardless of the difference of results from clinical studies, most women with breast implants will most likely need to have further surgery at some point during their lives. 
Kim Kardashian (Courtesy of Wikimedia Commons &
3)MRI and Implant Rupture:  MRI (Magnetic Resonance Imaging) is the study of choice for women with silicone gel breast implants and a history of cancer.  The US Food & Drug Administration recommended regular MRI screening for silicone implant rupture three (3) years after a silicone gel breast augmentation.  The FDA also recommended to repeat the MRI every 2 years subsequent to the initial MRI of the breast.  The evidence for this, however, is lacking.  It is unclear whether the benefits of obtaining an MRI outweigh the risks and potential costs for the patient.  I recommend a shared medical decision making with your plastic surgeon regarding this issue.

4)Breast feeding: Although the ability to breast feed is not guaranteed whether one would have breast augmentation or not, the ability to breast feed may be affected depending on the surgical technique used for breast augmentation . The periareolar incision (nipple approach) may disturb the milk/lactiferous ducts of the breast which may lead to problems with breast feeding.  You should express your concern to your plastic surgeon prior to any breast surgery if you have plans of breast feeding in the future.

5)Alteration of Nipple and Breast Sensation:  The feeling in your nipple and breast may change following breast implant surgery.  The sensation may increase or decrease after a breast implant is placed.  This can range from intense sensitivity or pain, to no feeling at all.  Note that these changes may be temporary or permanent, and may affect ones ability to nurse a baby as well as your sexual response.

Making an informed decision about your surgery is a critical aspect of being happy and satisfied with the results of your breast augmentation.   No article can substitute the valuable information you will receive during your consultation with your plastic surgeon.  I recommend asking one of your Houston plastic surgeons any questions or concerns regarding your surgery prior to undergoing any procedure.

Emmanuel De La Cruz M.D.
Houston Breast Augmentation


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Monday, July 25, 2011

Asian Eyelid Surgery ~ Houston

Asian Eyelid Surgery:  Westernization of the Asian Eyelid?

Beauty has been shaped to a Eurocentric point of view when it comes to the Asian eyelid.  To create that Asian eyelid crease, tape or glue has been used by many Asian women who desire that upper eyelid crease.  There is indeed an obvious influence of the Western culture over several Asian countries, and the overtones of cultural rejection still exist when it comes to discussing Asian blepharoplasty.  But do these women really desire to have a more Occidental look?  In fact, in Asian women who were born without a crease who later desired to have double eyelid surgery, very few sought to look Western.  Interestingly, the double eyelid surgery was first described in the Japanese medical literature in the 1800s long before the Westernization of Japan.  
Asian with an Upper Eyelid Crease (Courtesy of

Fast Facts about The Creaseless Eyelid
  • Approximately half of the Asian population of Chinese descent possess an upper eyelid crease.  
  • Approximately 1/3 of Asians of Korean descent possess an upper eyelid crease.
  • 10% of Asians from the Far East or South East Asia show a natural eyelid crease on one of their eyelids, and the other eyelid creaseless.
  • Some native North & South American lineage possess traits designated to be "Asian." These native Americans may have the heavier "creaseless" upper Asian eyelid and an inner epicanthal fold (a skin fold of the upper eyelid  overlapping the corner of the eye near the nose.) 
The Beautiful Eyelid 

Although the standards of physical beauty may be variable across cultures, the qualities of what constitutes beautiful, especially the upper eyelid, transcends racial boundaries.  Large eyes, a well-defined nose and a smaller chin are standards of beauty in women of various cultures.  An upper eyelid is  considered attractive when it lacks excessive skin and fat.  The presence of an upper eyelid crease is also considered beautiful since it creates the illusion of making the eye appear bigger, which is a universal sign of youth.    This upper eyelid crease also serves as a platform of exposed skin for a more effective application of makeup.

The Epicanthal Fold

The epicanthal fold is the skin fold of the upper eyelid that overlaps the nasal corner of the eye.  In the Asian population, it is present in approximately 40 to 90%, depending on the region in Asia or the study one would read.  There have been numerous procedures developed and described in the medical literature to eliminate the epicanthal fold.  However, most procedures are flawed by creating an unsightly scar in the area of the eye near the nose.  

The Goals of the Double Lid Surgery for the Plastic Surgeon
  • To maintain the natural beauty of the opening of the eye (palpebral fissure).  Being overly aggressive with making the Asian eye appear Western would be a mistake since the new crease that will be created will appear unnatural and look "surgical."
  • To improve the beauty of the eyes by giving an illusion of a larger, more open eye.

    Fast facts about the double eyelid procedure (Excerpt taken from Dr. Magana's article)
    • The prominence of the epicanthal fold is decreased by doing local flaps
    • A lid fold is created by applying parallel sutures that create a new crease which is parallel to the edge of the eye lid
    • In expert hands the procedure takes around an hour
    • There is a "non-incisional" method for Durable Suture Technique (DST). Long term follow up results on this  technique are not yet available.

    Potential complications:
    Before one undergoes any procedure, one should be informed about its potential complications.  It is not uncommon that one would have some asymmetry of the upper lid crease (1-2mm difference) that is created after an Asian double lid surgery.  Scarring may occur as well as disappearance of the upper lid fold.  Moreover, blindness after an eyelid surgery is a very rare complication (1 in 30,000 patients).  Severe pain and a pressure sensation on the eye are common symptoms for an impending visual loss after a blepharoplasty procedure, and one should be aware of these symptoms so that immediate evaluation and treatment can be performed by your plastic surgeon. 


    Emmanuel De La Cruz M.D., PLLC

    Recommended reading:

    Kruavit, Arthi.  Asian Blepharoplasty: An 18 Year Experience in 6215 Patients.  Aesthetic Surgery Journal.  2009; 29; 272
    Mejia, Ergo and Foad Nahai. Visual Loss After Blepharoplasty: Incidence, Management, and Preventive Measures.  Aesthetic Surgery Journal.  January 2011;31(1): 21-29  
    Meronk, Frank. Double eyelid surgery for the Asian eye.
    Park, Jung. Modified Z-epicanthoplasty in the Asian Patient.  Archives of Facial Plastic Surgery. 2000; 2 (1):43-47.

    Thursday, July 21, 2011

    What is SmartLipo Liposuction?

    The Truth behind SmartLipo Liposuction   
    ~ Houston Cosmetic Surgeon

    • SmartLipo is a liposuction method that utilizes a low energy laser (neodynium:yttrium-aluminum garnet laser).  It's extensively promoted as minimally invasive since it can be performed under local anesthesia using small incisions.
    • Due to the size of the cannula (1-2mm), fat extraction is more difficult compared to regular suction-assisted liposuction.  Thus, it is not intended to replace traditional liposuction.
    • Since it is more difficult to extract more fat after lipolysis from Smartlipo, there's a higher likelihood of developing seroma and possibly hematoma if large scale lipolysis is performed.
    • For the treatment of localized lipolysis, such as the removal of fat from the neck, laser lipolysis (Smart Lipo) may be a more effective method than traditional liposuction.
    • SmartLipo is reported to be more effective in removing fat from the knees, chin, neck or face.
    •  A multi-center FDA trial FAILED to show any advantages of SmartLipo over conventional method of liposuction (suction-assisted liposuction.) 
    • A randomized, double-blind clinical trial showed NO major difference in cosmetic result when SmartLipo was compared with the regular suction-assisted liposuction.
    • Less post-operative pain, however, was experienced by patients who underwent the SmartLipo liposuction.
    • Surgical time is longer with the SmartLipo when compared with Suction-assisted liposuction.
    • Higher concentrations of free-fatty acids were found after undergoing the SmartLipo procedure.  The author of the study "alerts to potential hepatic and renal toxicity."
    • Other potential complications include:  infection, hematoma, skin puckering, and sagging.

    Being aware and informed about these different liposuction methods before undergoing such procedures for body contouring is important.  Knowing the advantages and disadvantages of each method make one a better informed patient.  I recommend asking one of your Houston Plastic Surgeons regarding these different liposuction procedures prior to your surgery.

    Mordon, et al.  Histologic evaluation of laser lipolysis: pulsed 1064-nm Nd:YAG laser versus cw 980-nm diode laser. Aesthet Surgery Journal.  2007 May-Jun;27(3):263-8.
    Prado, et al. A prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted lipoplasty with suction-assisted lipoplasty. Plast Reconstr Surg. 2006 Sep 15;118(4):1032-45.
    Sun, et al. Laser lipolysis used to treat localized adiposis: a preliminary report on experience with Asian patients. Aesthetic Plastic Surgery. 2009 Sep;33(5):701-5. Epub 2009 May 30.

    Article Updated on July 21, 2011

    Friday, July 15, 2011

    Breast Lifts and Breast Augmentation ~ Houston Breast Lift

    Although many women who wanted to have their breasts enlarged prefer larger breasts with minimal scarring, some women want a combination of both a breast lift (mastopexy) and breast augmentation.  For the woman seeking a breast augmentation, often the surgical decision process is more complex, especially for those women who previously have given birth or have lost weight.  Your plastic surgeon will evaluate you whether a breast lift  may be necessary or not.  If one would need a mastopexy, the degree of ptosis (sagging of the breasts) will determine what kind of breast lift procedure would be necessary.   The kind of mastopexy procedure would affect the degree and extent of scarring one would have.  
    Another question one should ask would be "when should the breast lift be performed?" Should it be performed before or after you undergo breast augmentation?   These are questions that one should ask your plastic surgeon before you undergo your breast surgery.
    Red Brassiere (Courtesy of Wikimedia Commons)

    Fast Facts about Breast Lift with Breast Augmentation
    • The complication rate of primary breast augmentation (1st time one is having breast augmentation) is approximately 1.7% over a three-year period (Scott Spear's study).
    • The complication rate of a revision or re-do breast augmentation is ~ 21.6%.
    • The complication rate of a simultaneous primary breast augmentation with mastopexy (1st time of having breast implant surgery with a breast lift performed at the same time) is approximately 17.4% over a three-year period (Scott Spear's study).
    • The complication rate of a revision breast augmentation with a breast lift is ~ 23.3%.
    • Simultaneous breast augmentation/mastopexy (breast augmentation & breast lift done at the same time) has an early revision rate (need to revise the surgery) of approximately 8% in one study. 
    • Wound separation/dehiscence
    • Partial or total nipple loss
    • Need for further surgery (Revision)
    • Undesirable/unattractive scarring
    • Inadequate ptosis correction (correction of sagging of the breasts) and recurrent ptosis
    • Breast asymmetry and malposition of the nipple
    • Loss of nipple sensibility
    • Infection

    Even though a simultaneous breast augmentation/breast lift procedure is an elective operation, this procedure carries a risk that is higher than a simple breast augmentation.  Moreover, the risk and type of complications may vary based on the type of mastopexy technique used and performed concurrently with the breast augmentation.  Being aware and informed about these potential complications are critical before undergoing this kind of procedure.  Your plastic surgeon will determine if you are a good candidate for a simultaneous breast augmentation/mastopexy since not everyone is a candidate to have these procedures done at the same time.

      Emmanuel De La Cruz M.D., PLLC

      Atlanta Breast Symposium 2011
      Rancati, et al. Simultaneous augmentation and periareolar mastopexy: selecting the correct implant. Aesthetic Plast Surg. 2010 Feb;34(1):33-9;
      Spear et al. Augmentation/Mastopexy: A 3-Year Review of a Single Surgeon’s Practice.  Plast. Reconstr. Surg. 118 (Suppl.): 136S, 2006
      Spear, Scott. Augmentation/Mastopexy: Surgeon Beware. Plast. Reconstr. Surg. 118 (Suppl.): 136S, 2006

      Saturday, July 9, 2011

      Smile Train July 2011 ~ India

      Smile of the Week ~ India

      Over two hundred thousand children are born with a severe cleft lip and/or palate every year.  With their condition, they are often have the inability to eat, speak, socialize or smile.  In several developing countries, like India and the Philippines, the parents of these children are unable to  afford the surgery that these unfortunate kids desperately need.   Through the non-profit organizations, such as Operation Smile and Smile Train, these international charity provides the free surgeries to children with a severe cleft condition around the world.  Lets help support Operation Smile & Smile Train.  

      Emmanuel De La Cruz MD, PLLC

      Silicone Gel Breast Implant or Saline Breast Implant?