Recently, there seems to be a “buzz” about the rising number of chin augmentations performed in the United States. I must admit that the Plastic Surgery Group has noticed an increase number of patients who will consider this option as part of an overall approach to facial reshaping, contouring or rejuvenation. Generally, chin enlargement is not done as a stand-alone procedure, without other associated techniques like neck liposuction or nasal reshaping.

Facial rejuvenation has become more popular within the last couple years for many reasons, including the availability of new technologies. Chin augmentations may still lag behind rhinoplasty, facelift and eyelid surgeries, but now patients are aware of what we can offer as part of a more inclusive package.

Whether it is due to their own personal network or the media’s influence, patients are realizing the importance of balance for their face, allowing us, as surgeons, to take a more “global approach” during consultations. Patients tend to have multiple areas of focal concern, especially after they’ve seen a simulated 3D preview of their face before surgery. We use the Vectra 3D advanced imaging technique during consultation to develop a well-thought-out strategy. We then perform a virtual augmentation to let the patient experience a preview of the potential result before making their final decision.

Combination surgeries for a balanced and better end-result are becoming more popular. Some examples would be chin implants with nasal reshaping, or brow lift with eyelid rejuvenation. Chin augmentation is no longer secondary; it is now an integral part of the overall contour.

While recent statistics tout chin augmentation’s increased popularity, many are part of an overall facial rejuvenation, not stand-alone procedures. The actual number of chin augmentations performed remains lower than many other procedures so any relative increase may look statistically like it is outpacing the others. In any case, we, as surgeons, are thrilled to see patients starting to understand our goal of achieving “beauty in balance” and be and become more aware of just how important the lower face and chin contour are a big part of that.

According to the American Society of Plastic Surgeons’ 2011 statistics, more than 1.5 million cosmetic surgical procedures were performed in the U.S. last year. Of that number, 115,902 abdominoplasties, commonly referred to as tummy tucks, were performed. Most of these patients had to endure the discomfort associated with drains used for about a week following the surgery, designed to remove accumulations of fluid that collect under the skin after surgery. There is a better way, however, that is more comfortable without the need for painful drains.

Over the last five years, I’ve developed a specialized technique that offers patients seeking a tummy tuck a more comfortable and safe experience by eliminating the hassle of postoperative drains. Using a revolutionary, new suture technology with tiny barbs along the length of the stitch, and progressive tension technique, I create a “Velcro-like effect,” closing off spaces where fluid (seroma) could collect. It is a new technique based on an old concept that eliminates drains and the pain associated with them without increasing surgical procedure time. I was one of the first surgeons to perform, develop, publish and teach this technique. It is becoming more popular throughout the world since more patients are asking for procedures that are easier to recover from.

Details of the technique are published in several journals including Plastic & Reconstructive Surgery Journal, and Aesthetic Surgery Journal.

The journals tell the medical side of the story. To hear what patients think, watch this video: Mommy Makeovers. You can also look at our before/after photos.

The Plastic Surgery Group is proud to announce that Dr. Valerie J. Ablaza, M.D. was inducted as President of The New Jersey Society of Plastic Surgeons this past weekend at the annual society meeting in Princeton. She is the first female to hold the rank of President of the state society in the modern era.

Dr. Ablaza will spend the year as president working closely with lobbyists and state government officials to support the enactment of policies and legislation that promote patient safety and education. The state society is always working to decrease out-of-pocket costs for patients in terms of insurance reimbursements as well as eliminating other add-on costs related to plastic surgery. New Jersey was the first state to implement a 6% tax on cosmetic procedures in 2004 and this past January, our state society’s tireless efforts led to a roll back of the cosmetic tax.

We look forward to a very busy and productive year for Dr. Ablaza as The New Jersey Society of Plastic Surgeons President.

Even though Botox and the names of many soft tissue fillers have gradually worked their way into everyday conversations, there are many unanswered questions about these regularly used products for cosmetic facial enhancements. One of the most common questions I hear is: “How often should I have this done?” While it may sound like a simple question, the answer is anything but straightforward. People like definitive answers or a formula to guide them, but unfortunately there is no right or wrong answer in this case.

In general, the effect of Botox that weakens muscle movement and therefore softens or eliminates facial wrinkles lasts from as little as three months to upwards of six months or more. Injectable gel-type materials to plump up creases usually persist for six months to more than a year, depending on the area of the face treated. The corrections achieved with both of these products gradually dissipate over time.

It may or may not be surprising that the timing people choose for subsequent treatments with Botox and fillers may not coincide with the expected duration of the product’s effect. In other words, a person may have another session of soft tissue fillers when the previously injected product has not completely disappeared or may return for additional Botox when there is still some wrinkle correction present. Of course, there are people who wait until all the effects of their Botox or fillers have completely worn off before returning for another treatment.

It’s best to avoid the “it looks good” then “it looks bad” cycle if possible. Getting additional Botox injections before the effect of the previous injections have completely worn off maintains a more consistent look without a more noticeable up and down variability. By following this routine, you can avoid “advertising” when you have gotten recent injections. It is no different than filling up the gas tank of your car before the “reserve” indicator lights up.

Deciding on when to return for one of these treatments is similar to the each person’s philosophy for getting manicures and hair coloring treatments. Do you wait until your highlights have grown out two inches or do you get a new treatment when you first begin to see your “roots”? Has your nail polish almost completely flaked off before you schedule your next mani?

From an economic standpoint, the total cost balances out over the course of the year. You can use a smaller amount of Botox and fillers more often or a larger amount of products less often. Some people choose to visit more frequently and use less of the product if they live close by or they may even time their visits as a method of budgeting their resources.

People have different philosophies on when they make a pit stop at the gas station, and they may or may not apply these same principles to how often they stop at their cosmetic surgeon’s office for a “refill”. The way I see it, there’s no reason to drive your car around running on fumes!

When it comes to plastic surgery of the breasts, a lot of the attention these days is focused on enhancement-type surgery. The public is endlessly trying to figure out if this or that Hollywood star has gotten breast implants since their last red carpet appearance. But what about breast reductions? Even though the women having these procedures definitely fly under the radar, their stories are no less important.

There are a number of physical and psychological complaints that bring women into a plastic surgeon’s office for a consultation to reduce their breast size. Most commonly, women suffer from neck, back, and shoulder pain due to the heaviness of large breasts. These women can also have deep grooves on the tops of their shoulders from bra straps and skin irritation beneath the breast area. Disproportionally large breasts are often a source of embarrassment, self-consciousness, unwillingness or inability to exercise, and difficulty with clothing.

Teenage girls with overly large breasts are often introverted and dislike the attention they get from their male classmates. They dread getting changed in the locker room and usually avoid wearing bathing suits in public. Their mothers relate stories of tears and frustration when it comes to shopping for prom dresses.

Breast reduction surgery removes skin and breast tissue together, resulting in smaller breasts, which are also uplifted. It would be difficult and definitely not desirable to reduce the size of large, droopy breasts only to create smaller, droopy breasts! Once your breasts are smaller and lighter after breast reduction, exercise will be easier and more comfortable. Removing excess breast tissue usually leads to reduced neck and back pain as well as relief from moisture and rashes beneath the breasts.

If you are considering breast reduction, it is best to be as close to your ideal body weight for your height as possible. That way, a more accurate estimate can be made of the appropriate amount of tissue to remove that will achieve your desired size. A significant amount of weight loss after the procedure may lead to a breast size that is smaller than you had planned.

Another reason to achieve a certain goal weight prior to breast reduction relates to insurance coverage. One of the many criteria under consideration by insurance companies for precertification is a requirement that you are within 10% of your ideal body weight. The insurance companies believe that women who are outside of this range just need to lose weight and their breasts will become smaller, which in turn will alleviate their pain.

Breast reduction surgery can change one’s life forever. Gone will be the days of feeling top-heavy and always having to wear two sport bras just to exercise. You will finally be able to buy bras off the rack without having to purchase expensive special-order bras. Breast reduction can relieve pain, allow greater freedom with fashion as well as give your self-image a boost.

Some people have considered making changes to their body and face for years, while others make the decision to have cosmetic surgery in a much shorter time frame. It has been said that the average amount of time between first having the idea of surgery and eventually going through with it is fourteen months. In any case, there are specific things that you need to do in preparation for the “big event”. Think of it as getting into the best shape possible for an upcoming race.

It is a good idea to be at or close to your ideal weight prior to having any breast resizing procedure such as a reduction or augmentation, as well as any skin tightening procedure for your face, neck or body. Losing a significant amount of weight after these procedures may change your breast size or shape and may “undo” some of the tightened effect of facelifts, neck lifts and tummy tucks. So if you are serious about losing those annoying ten or fifteen pounds, do it before your surgery!

It is also recommended that you be at a stable weight for several months before having a major cosmetic surgical procedure. In cases of weight loss upwards of fifty pounds, internal mechanisms can be altered, and your body needs time to adjust to the changes in hormone levels and metabolism. The body has essentially been put in a state of malnutrition for a period of time following a large weight loss and the best outcomes after surgery can only be achieved when your body returns to a healthy, well-nourished state.

If you want to win the race, you need to stop smoking for a minimum of two to three weeks prior to surgery. Smoking greatly increases your risks of delayed healing, poor scarring, increased bruising and blood clots. Nicotine causes blood vessels to become narrow, which leads to decreased blood flow and impaired oxygen delivery to tissues. In some cases, smokers can actually lose a portion of skin due to a lower level of oxygen in the operated tissues. The risks can be significantly reduced, but not eliminated, if you refrain from cigarette smoking. “No smoking” includes avoidance of all forms of nicotine that infiltrate the bloodstream such as patches, gum, chewing tobacco, cigars, and pipes. Planning cosmetic surgery is a good opportunity to “kick the habit”.

There are certain foods, medications, and herbal products that act as blood thinners or heart stimulants that should be avoided before having cosmetic surgery. Aspirin, Motrin, and related medications, as well as red wine and garlic can lead to unwanted bleeding and bruising if taken within two weeks of surgery. There are also commonly used herbal supplements that can cause increased heart rate or other unwanted metabolic effects.

You should remain active in the days leading up to surgery to have your best finish. It is a good idea to continue your normal exercise routine even up until the day of surgery. It may be surprising to know that the majority of blood clots causing problems after a surgical procedure develop before the surgery, during sedentary times including long car rides or airline flights.

The finer details of preparing for surgery play a key role in ensuring a smooth road to recovery and crossing the finish line at the front of the pack. When established routines are followed, more predictable outcomes can be expected.

When it comes to making cosmetic changes to your face or body, who really WANTS to have surgery? Nobody! Everyone wants to look younger, improve their body proportions, and tighten sagging body parts without going under the knife, if at all possible. Even when people understand that there is no nonsurgical way for them to achieve their goals, the next question is usually whether it is possible to have a “mini version” of the surgery.

Cosmetic surgeons would love to be able to make all the changes that people want without surgery, but that’s not the reality. Once it has been determined that some type of surgery is indicated to achieve certain cosmetic goals, it’s understandable that people want the procedure that has the least amount of scarring, and the shortest recovery, while also being the least expensive. Unfortunately, that option is not usually the one that gives the best result. It’s no surprise that most people want the best possible result though.

Let’s consider a mini-tummy tuck, which is an abbreviated version of a standard tummy tuck that has a shorter scar and does not involve repositioning the navel. There are only a limited number of people who are good candidates for a mini-tummy tuck including those who only have excess skin and fat below the navel but otherwise have a flat upper abdominal contour. In a mini-tummy tuck, the abdominal skin and fat layer is lifted up only from the top of the pubic hairline to the navel. Then, the tissue flap is stretched downward, the excess skin is trimmed away and the remaining skin flap is sewn into place.

Most women after pregnancy have stretched out their muscle and skin above their navel, as well as the skin and muscle below their navel. People commonly want a mini-tuck when actually their best result would be achieved with a full tummy tuck. They want the “smaller” procedure to avoid a larger, more invasive procedure when, in fact, the outcome of the more complete procedure (full tummy tuck) will be the most satisfying for them and includes repair of the abdominal muscles and improvement in skin excess above the navel.

A similar comparison can be made with mini-facelifts. In contrast to a full face-lift, a mini-facelift takes half the time, has a smaller scar and gives half the result. The best time to perform a mini-facelift is when people have early signs of aging and don’t need the full operation but it is often a disappointing outcome when someone who is a candidate for a full facelift has a mini version of one.

We always want to try to get more for less, whether it’s a bargain at the store or trying to get the same cosmetic changes with less surgery. It is up to the surgeon to counsel people as to the procedure that will fit their problem the best. A mini-type operation can be carried out perfectly well, yet be unsatisfying for the patient. As always, it is important to match the right procedure to the right person if a successful outcome is to be expected. In some cases, doing less is more, but at other times it may not be the right choice.

The nose is a prominent facial feature that cannot be covered by clothing or hair and cannot be altered by make-up. As the nose is one of the most defining characteristics of the face, even a slight alteration can greatly improve one’s appearance. The most common complaints people have regarding their nose include large size, crookedness, a nasal hump, a wide bridge, a droopy or bulbous tip, and excessively flared nostrils. People may also have impaired breathing from a structural abnormality or previous trauma to their nose.

Nose reshaping, or rhinoplasty, can be used to correct a variety of conditions that involve the appearance of the nose and whether it is in proportion to other facial features. Your nose may need to be lengthened, augmented or narrowed to give you your best look. Breathing problems related to a deviated septum or deformities resulting from an injury can be corrected at the same time as procedures to reshape your nose.

The concept of nasal refinement and reshaping has changed dramatically over the past few decades. Previously, the surgery was usually considered a “reduction rhinoplasty,” which decreased the size and projection of the nose. A large amount of cartilage was removed which led to the typical overdone-looking “nose job” of years past. Today, a more limited amount of tissue is removed and the focus is more on repositioning the existing cartilage into a more pleasing shape that leads to a more natural-looking nose. Modern techniques for sewing the cartilage together, molding existing cartilage, and even adding cartilage have resulted in many more options for nasal reshaping.

Since the nose is not usually fully developed before the age of 15 or 16, it is usually recommended that young adults wait until they are at least that age before undergoing cosmetic nasal surgery. For people who are in good health, there is no upper age limit for having nasal reshaping. Gravity and gradual weakening of the supportive structures of your nose that accompanies aging will cause position and shape changes. Your nose can appear longer as the tip droops over time. Thus, it is not unusual to have nasal refinements performed later in life, often in conjunction with eyelid rejuvenation or a facelift. A simple elevation of the nasal tip can result in a younger and more attractive appearance of your nose.

It may be surprising to know that the majority of people request only small changes to their nose rather than dramatic transformations. Instead of erasing all signs of ethnic origins, many people today prefer to preserve some of the character and ethnic qualities of their natural noses while undergoing only subtle refinements. Most commonly, people just want to look like the best versions of themselves.

For people unhappy with the size or shape of their natural nose, rhinoplasty is a welcome solution. This procedure not only improves facial harmony and balance, it can also help people discover newfound confidence in their appearance, which leads to a boost in self-esteem.

Decades ago when cosmetic surgery was less mainstream, it was desired and even expected that dramatic changes would be the end result. It was considered a badge of honor for someone who had undergone a transformation of their face or body to be “noticed” by others. Over the years, we have all seen women in the grocery store and in restaurants with lips that appear swollen and overly large, perky breasts that seem to defy gravity at any age. Without even knowing them, we have silently confirmed their frequent flyer status with the local cosmetic surgeon. Ironically, now that cosmetic surgery is available to people of all walks of life, from A-list actresses to schoolteachers, it has become more popular to make smaller changes and maintain a more natural appearance.

What does “natural” really mean? I think looking natural means that a person’s face or body, after surgery, looks unaltered to someone who doesn’t know what the person looked like before. Of course, family, friends and acquaintances of people who have undergone cosmetic surgery procedures would notice differences immediately and would know that the changes in appearance did not come about naturally.

It may be surprising to hear that people often request that changes from cosmetic surgery be subtle so that no one can tell they had something done. They want to make changes only for themselves and don’t care what other people may think. In fact, they would be perfectly happy if no one noticed that they changed something about their face or body. At first this idea may seem ridiculous. Why would a person undergo a cosmetic procedure that nobody notices? Well, these are usually small imperfections that people don’t like about themselves that others might not see, since an untrained eye may not pick up on subtle deformities or asymmetries.

As an example, nowadays, people want smaller amounts of soft tissue fillers injected into deep facial lines and hollow areas more frequently, rather than having larger amounts injected less often. Instead of making it obvious that you have recently made a trip to the cosmetic surgeon’s office for a “fill”, the idea is to avoid the extremes and to have less drastic changes in one’s appearance when possible.

Now, this rationale of making small, subtle changes in one’s appearance is in sharp contrast to the thought processes of people with body dysmorphic disorder, or BDD, who want repeated surgeries for problems unseen by most others, including their surgeon. People who suffer from BDD have distorted body images and want to change their external appearance in an attempt to fix something on the inside.

Of course there are still people without BDD who ask cosmetic surgeons for the over-the-top look. I have even had people say they want their breasts to be so large that they look fake. When this is done, too much of a good thing can become a bad thing. The most difficult part for patients is knowing when less is actually more.