So first and foremost if you are reading this and I have kept you waiting, or will keep you waiting, I offer you my sincere apologies. There is more to this blog however. I thought you might find it interesting to know how and why we can get backed up.

—–The cascading arrival time: While we have a good scheduling program all it takes is one late arrival to shift the schedule off kilter by 30 minutes or more. Unfortunately that will happen on average about twice during an office day at anyone of my plastic surgery practices in the Washington DC, Virginia area.

—–The exploding consult: for the average consultation we have a pretty good estimate the time it will take for me to evaluate, explain and go over treatments. However, it is extraordinarily common for a patient to book a consultation about one type of surgery but then also ask about two or three more. At 25- 30 minute per topic the math gets a little scary. Interested in knowing more about that topic, read my past blog “What Goes Together- More Than One Procedure of Plastic Surgery”.

—–The mom /friend phenomena: I love it when a patient brings a friend or family member to the consultation another set of ears and eyes is comforting and helpful. It is extremely common though that the friend or family member becomes the second consult in that room at the same time.

—–I am long winded: yes, it’s true. I love to teach and educate my patients and I don’t want anyone to leave feeling they did not get the best and most informative experience they could. So if one topic becomes 3 or if mom or friend has a question I will always feel compelled to answer it in detail.

I hope this doesn’t scare you off. A busy cosmetic plastic surgery practice is a good thing.

So a few tips: Morning consults are less prone to cascading delays, if you’re interested in many things, or so is your companion, just let us know ahead and we’ll leave more time. Bring a book just in case. Whether it’s breast, body, face, nose, or liposuction I’d love to meet you and I’ll do my best not to keep you waiting.

If you have any more questions about my office or to schedule a consultation please contact me.

These breast implants are not approved for use in the United States and I have never used them in my practice. The concern is only relevant for patients who have had breast augmentation outside the United States.

The only gel breast implants approved for use in the United States are manufactured by American companies and adhere to strict quality and manufacturing requirements.

The FDA requires extensive bio-compatibility testing on all its breast implants as described in their administration’s Summary of Safety and Effectiveness Data. These guidelines have resulted in silicone shells that have been tested and shown to possess excellent strength, resilience and elasticity.

If you have any concerns or questions about what is going on in France please do not hesitate to contact our office. If you had breast augmentation surgery outside the U.S. and would like to remove or replace your gel breast implants just please let us know.

Every month or two, I will see a woman with a double D or more breasts who wants me to do a breast lift and give them gravity defying breasts. Now I can do a breast lift on just about any size breast. The problem is that if I lift a large and heavy breast that breast will go south again quite quickly. Heavy natural breast tissue will always respond to gravity and usually the patient does not want to be smaller (smaller breasts droop less).

So here’s how you create a gravity defying large breast… and please recall I generally do not recommend this to patients, but I hope the concept makes sense. First do an aggressive breast reduction and remove most of the natural breast tissue, the tissue that responds to gravity. Come back a few months later and then put in a large implant. The implant restores the volume and upper fullness and tends to defy gravity more than natural breast tissue.

When I do a breast lift with an implant I will often remove a moderate amount of tissue if the patient agrees for the reasons listed above. If an aggressive reduction is needed at the time of lift and augmentation, it is often safer to stage the two in order to preserve blood supply to the breast.

To make a breast smaller only to make it bigger kind of seems like the death of common sense to me but for some it may be the only option to achieve their goals. This is a very technical and difficult concept to get across for me.

If you want to know what’s right for you, or to set up a consultation then contact me and let’s chat.

Labial tissue comes in all shapes and sizes. Some have more, others less. Common concerns patients share with me include a self consciousness during sexual activity, difficulty wearing certain clothing or swimwear and even discomfort with some athletics.

There are two basic types of Labioplasty and I perform both procedures. I believe both are good as long as the patient’s goals are accomplished. The labia minora is the most commonly reduced.

Straight excision simply cuts away the redundant tissue and leaves a straight narrower labial edge. It is the simplest and removes the most tissue. Some believe that it leaves an unnatural looking edge but I have not found this to be the case.

The other method involves removing a wedge or wedges of tissue which preserves the natural edge of the labia.

Labioplasty can be done under a local or general anesthesia. I am happy to show examples in consultation but I don’t put Labioplasty photos on the web. If you are interested in a Labioplasty then contact me to schedule a consultation.

The most common reason for men to have enlarged breasts is unknown. While a very few patients will have a hormonal abnormality it is quite rare and does not change the surgical solutions.

Rule of thumb: Gynecomastia surgery should be performed after puberty and is best performed at younger ages when the skin is more elastic and likely to shrink up when the tissue underneath is removed.

Types:
1) Long nipple.—far more common in women than men a long nipple can be easily shortened under a local anesthesia.
2) Puffy areola: some men (and even women) have a normal breast contour but the areola is large or puffy as though it is sitting on top. The tissue under the areola can be removed under a local anesthesia.
3)True Gynecomastia- a firm lump of breast tissue is sitting right under the nipple areola area and is visible. It feels like a small egg. This can be removed from an incision around the bottom edge of the areola and can often be done under local.
4) Pseudogynecomastia (fake Gynecomastia)- here the problem is not the glandular breast tissue. It is that the breast is fatty. This is usually treated by liposuction. I tend to use ultrasonic liposuction as I believe it works better in the dense male breast. I usually do this with patients asleep.
5) Combination- Most Gynecomastia treatment is a combination of number 3 and 4 above and will require a combination of liposuction with direct excision.
6) Droopy breasts- In an older male patient or sometimes in a patient that has lost a lot of weight the skin becomes droopy and will not shrink up when the tissue underneath is removed. In this situation I will recommend excising skin as well as long as the patient is ok with the scars.

If you are considering this type of surgery and would like to be evaluated I have offices in Annapolis, Rockville, Maryland and Mclean, Virginia. Feel Free to contact me.

So who is Eve? I could tell you about her amazing credentials and her extensive experience in the field of plastic surgery, but she is so very much more than that to me.

She is a good person, a fine and kind and gentle human being with a soul a mile wide. She is my right arm, my closest and trusted advisor and sounding board. She is the kind of person I am proud to have in my practice and proud to have helping care for my patients. She is a passionate and compassionate mother. I feel very lucky to have her.

But what I think may be unimportant, is what my patients think that counts the most. For those of you who know her you know that it’s all true. She has a gentle touch whether it is with Botox, filers or microdermabrasion. The advice she gives is honest and heartfelt and it has won her the trust of countless patients. She is an artist with fillers. It is a case of the student exceeding the master.

So if you have been considering plastic surgery, fillers or Botox and you would like to meet Eve (and Adam) feel free to contact us!

So why switch to silicone breast implants?

A silicone gel implant is softer than saline, mushier and generally more natural looking. A gel implant softens the transition from the chest wall to the upper portion of the breast.

So who might make the switch?

- If you wanted silicone in the first place but had your breast augmentation surgery back when silicone was not available in Maryland.

- If you are very slender with little breast tissue and wish to look more natural.

- If you have rippling from a saline implant that bothers you. Silicone gel implants can ripple too but they ripple the least.

- If you’re saline breast implants are old and you’ve been considering an exchange anyway.

- If you’ve thought about changing your size.

To find out if switching to silicone is right for you and learn more details just contact us through my web site or e-mail my assistant Pei@washingtonplastics.com for a complimentary consultation at one of my three locations in Annapolis or Rockville, Maryland or in McLean, Virginia.

Just before the summer my son got the urge to have a go Kart as he watched a friend in the neighborhood tool around on one his father had purchased. “I also want to learn to weld” he announced. I was relieved about that. Buying him a go kart would have felt like I was spoiling him (let alone the cost!), but building a go kart seemed like an opportunity to learn about mechanics, engineering and even electricity. Not sure how serious he was, I bought a book about welding on Amazon and mailed it to him while he was in summer camp.

“Did you read the book?” I asked when he returned. “ Every word”, he said. I didn’t really believe it until I started reading the book and asked him questions about it. He seemed to have memorized all 300 pages

Well thank god for Craig’s list. A chop saw, grinder and a welding machine later we are well into this project enjoying not only our accomplishments but our time together. My son welds better than I do, but don’t tell him I said that. Our project together has been my joy. I may post some photos when I’m done, and yes I am being very careful with my hands.

To learn more fun facts about our building progress follow me on facebook or to schedule a consultation feel free to contact me!

If you can’t hold a pencil under the fold then you have what I call “gravity defying breasts”. There are two groups of women who have the gravity defying breasts; those women who have little or no breast tissue at all and teenagers where the skin has not yet relaxed. Any woman with a reasonable amount of natural breast tissues will eventually gain some droop. The skin relaxes over time as we age. Pregnancy, weight gain and weight loss can certainly affect this.

But guess what. I think a little droop is a good thing. It is the sign of a mature, normal, and most importantly a natural looking breast. In heavier breasted women a breast lift or reduction will always regain some droop over time as gravity weighs on the breast that remains. The skin is smarter than the doctor. Skin responds to gravity and relaxes over time (thank goodness or my tummy tuck patients would never stand straight again). In fact in a breast augmentation a little droop tends to look more natural and hide the implant better.

So as you read this please know that I spent my life in trying to improve upon or find a balance in the degree of droop. Too much droop and a breast lift and or reduction may be in your future, a little droop and some volume enhancement in the form of an implant may be the way to go. The key is to find the right balance.

Contact my office with any questions or to schedule a consultation.

While I can’t really change the diameter of the neck, I have liposuctioned liters of abdominal and flank fat from servicemen (and women) at bases all over the Maryland, D.C. and Virginia area.

So why talk about this here? I want you to know you are not alone. Liposuction is far more common than you think in the service. I have treated almost every rank with a great sense of pride.

How much you will shrink depends on how much you carry in the first place. I can never guarantee a waist size but it is not uncommon to lose at least two pants sizes or more. The flanks or love handles tend to make the biggest difference as most men wear their belt below the lower abdominal fullness.

I perform many other surgeries for men including breast reduction, rhinoplasty facelift and others, but thanks to the United States government, flank and abdomen liposuction remains the most popular.

If you are considering liposuction and you are part of our armed forces here in Maryland. Washington D.C. or Virginia you are in good company and I would be happy to evaluate you. Yes, we offer military discounts. So please contact my office for further details.