My second favorite product is Botox®, which has revolutionized the use of non-invasive modalities for the aging face.  Botox® works by blocking nerve impulses to the injected muscles, which reduces the activity of muscles that can cause wrinkles to form.  It is approved by the FDA for use between the brows.  The results are evident within a week, are subtle, and provide a relatively painless way to “refresh” the upper face without freezing all facial expression.

Next is the Clarisonic Sonic Skin Cleansing System, which uses a sonic frequency of more than 300 movements per second to gently cleanse the face.  I use the products from my own line, Anokha, but Clarisonic enhances the results when used with any skin care system.  After properly cleansing the skin, toner, serums, and lotions can absorb more easily and produce better results.  Within four days of beginning use, my skin was smoother, clearer, and more hydrated.

Finally, the importance of a good sunscreen cannot be overlooked.  I recommend a sunscreen with an SPF of at least 30 for all of my patients, every day, rain or shine.  There are many good sunscreens available, but our current favorite is PCA’s Perfecting Protection SPF 30 which protects the skin from UVA and UVB rays.  This light and easily absorbed sunscreen also contains antioxidants, including milk thistle and caffeine, which can prevent and correct damage from free radicals.  Five melanogenesis inhibitors, bearberry, licorice root extract, kojic acid, mulberry root extract, and lactic lcid are also included in the formula.  These agents help to reduce existing skin discoloration and to prevent future hyperpigmentation.

Fat has become an increasingly popular injectable.  For many of us, it’s in abundance, it’s natural, and it’s soft.  Plastic surgeons do use fat in many parts of the body for both cosmetic and reconstructive purposes, including filling in contour defects after breast reconstruction or liposuction, and to plump deep folds in the face.  The use of your own fat for augmentation of the breast is an attractive idea in theory; take something (fat) from an area where you don’t want it (your hips, thighs, buttocks…), and put it somewhere that you do want it (the breasts).  However, the use of fat for injection for breast augmentation has been a highly controversial topic among plastic surgeons for decades.

This topic is controversial for several reasons.  First, grafting fat to the breast can result in nodules and calcifications in the breasts, which can interfere with breast cancer screening and imaging.  Despite this, there is no data to date which shows a clear interference with the detection of breast cancer.  A second issue concerns the potential for mature fat cells and fat-derived stem cells to favor the growth of breast cancer.  However, this data is also limited, and in fact some studies show that adipose-derived stem cells can actually inhibit the spread of breast cancer.  Some of the known complications associated with fat grafting include infection, cyst formation, fat necrosis, fat resorption, nodule formation, and calcification formation.  The methods that surgeons use for harvesting the fat, preparing it, and injecting it also vary widely.  However, each of these items determines how successful the graft will be in terms of its long-term outcome.

Breast augmentation with implants and fat grafting to the breast for volume enhancement are not equal procedures.  While implants provide a predictable result with a fixed volume, fat grafting may require several procedures with a less than predictable result.  Fat grafting is also more expensive as a result of the need for several procedures.  Of course, implants aren’t perfect either; this is a medical device which is placed in the body for purely elective reasons, and it will not last forever.  Each procedure has its own set of risks and benefits.

At this time I do not offer fat grafting for primary breast augmentation, based upon the current data.  However, I do use it in selected cases for adding volume to small areas following breast reconstruction and tuberous breast procedures.  Nonetheless, the technology is developing rapidly in this field, and numerous studies are being conducted on the benefits of fat grafting.  I look forward to further refinements in this area that will hopefully allow us one day to offer this treatment to all patients.

¹Rosing JH, Wong G, Wong MS, Sahar D, Stevenson TR, Pu LLQ.  Autologous fat grafting for primary breast augmentation: A systematic review.  Aesth Plast Surg 2011; 35: 882-890.

On the other hand, if you want an obvious look (you can probably think of a few women in Hollywood who chose this route), you should let your surgeon know.  What’s the downside of going too large?  Your tissues will be stretched out, and may not be able to sustain the weight of very large implants.  Over time, your breasts may drop.  If you have very large implants removed, your breast tissue may not be able to “rebound” back to its original shape, leaving you with stretched out skin.

For more information, I suggest “The Best Breast”, by Dr. John Tebbetts.  This book was written specifically for patients, and is available at Amazon.  It is an easy and informative read that covers every aspect of breast augmentation surgery from the patient’s point of view.

Over 2 million people are diagnosed with more than 3.5 million skin cancers each year.¹  In addition, there is significant evidence that sunburns increase the risk for melanoma, a potentially fatal form of skin cancer.²  Regardless of the color of your skin, a broad-spectrum (provides protection against both UVA and UVB rays) sunscreen with an SPF of at least 30 should be used every day of the year.

Sunlight has two types of rays which can harm us, ultraviolet A (UVA) and ultraviolet B (UVB) rays.  UVA rays, which can pass through glass and penetrate into the dermis of the skin, suppress the ability of our immune system to protect against the development and spread of skin cancer.  UVA exposure also predisposes us to signs of premature aging, including wrinkling and sun spots.  UVB rays are blocked by glass, but are the primary cause of sunburn.  Exposure to both types of UV rays increases the risk of skin cancer.  Tanning beds and sun lamps also contain UV radiation, and are therefore not recommended.

On days when you will be primarily inside, apply sunscreen to exposed areas, including your face, ears, and hands.  On days when you will be outside, apply sunscreen 15-30 minutes over all areas before heading out.  Coat your skin liberally and rub in the product.  Don’t forget your lips!  Use a lip balm that contains a sunscreen.  Reapply sunscreen every 2 hours, or after swimming or sweating.  No sunscreen protects 100% against UV rays, and using sunscreen does not mean that you can stay out in the sun longer.

There are many excellent sunscreens available.  Our personal favorite is PCA Skin’s Perfecting Protection SPF 30.  Ingredients to look for on the sunscreen label to ensure broad-spectrum UV coverage include: avobenzone, cinoxate, ecamsule,menthyl anthranilate, octyl methoxycinnamate, octyl salicylate, oxybenzone, sulisobenzone, titanium dioxide, and zinc oxide.

¹Rogers, HW, Weinstock, MA, Harris, AR, et al. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol 2010; 146(3):283-287.
²Elwood JM, Jopson J.  Melanoma and sun exposure:  an overview of published studies.  Int J Cancer 1997; 73(2):198-203.

For more information about tuberous breast deformity correction in Manhattan, please contact the office of Dr. Naidu.