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I have lost a lot of weight in the past year but I still have a belly and love handles…

Q) I have lost a lot of weight in the past year but I still have a belly and love handles. I’d really like to get liposuction and tummy tuck surgery. Is it possible to get both surgeries done right after the other?

A) There are a few factors that depend on the answer. Liposuction works well on love handles and I prefer VASER liposuction because of the quick recovery time. However, because belly fat is not always superficial, liposuction is not always a good option.

During a tummy tuck, liposuction is used to remove fat along with the surgical removal of extra skin from the lower abdomen and the relocation of the belly button. Because they are often done together, you would not need to have them done separately.

I suggest you schedule a consultation with a local board certified plastic surgeon to be examined; you can find one through the ASPS (American Society of Plastic Surgeons) website. During the consultation, you can get advice on how to achieve the results you are looking for.

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Do saline implants look good when they are placed over the muscle?

Q) Do saline implants look good when they are placed over the muscle?

A) The way saline implants look when they are placed over the muscle depends on how much breast tissue and body fat you have. Saline implants have a tendency to wrinkle or ripple so if you do not have enough breast tissue or body fat to cover the implants and hide them, these ripples could be highly visible. In fact, when touched, the wrinkles or ripples might still be felt whether they are placed over or under the muscle. With time, the muscle stretches and the wrinkles or ripples show through or are felt if there is not enough breast tissue or body fat.

This tendency for wrinkles or ripples to occur is one drawback of saline implants—they aren’t as common with silicone gel implants. Nevertheless, I have many patients who love their saline implants and would never change them. Your surgeon should be able to review the pros and cons of both saline and silicone gel implants with you in relation to your unique body structure and personal preferences.

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I weigh 160 pounds, I am five feet seven inches tall with a 25-inch chest…

Q) I weigh 160 pounds, I am five feet seven inches tall with a 25-inch chest, and I am getting breast implants in December. I’d like to add volume and also keep a natural look. I am having trouble deciding between going high profile or moderate plus because a lot of photos show implants in a much higher position, which looks fake. Can breast implants be positioned to look more natural?

A) Different positions, sizes, and dimensions of implants all create different looks. I have many patients who have the same concerns. It is also very common for patients to request naturally positioned implants. I spend time with my patients to find the precise look they desire because there are so many implant varieties that come in many shapes and sizes. I also measure as many times as necessary to give my patients every option. This is an important decision so I suggest you discuss your concerns with your surgeon. It is also important to get an idea of how you will look with the size implant you choose because you will be living with the results for the next ten, 15, or 20 years.

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I have seen three ASPS-certified surgeons for Liposuction consultations…

Q) I have seen three ASPS-certified surgeons for Liposuction consultations. The surgeon’s fee ranged from $3,500 to $6,200, they all had the same anesthesia fee, and the facilities fee varied depending on the hospital used, from $1,500 to $2,470. Price is not an issue; I am merely looking for the best surgeon. However, I would like to discuss the role of price because I preferred the physician with the highest fee. What is your advice on how to approach this discussion?

A) I congratulate you for choosing only ASPS (American Society of Plastic Surgeons) certified plastic surgeons for your liposuction evaluations. I agree that price should not be the only factor in this decision. When comparing price, remember that a plastic surgery procedure isn’t a commodity that’s identical from one provider to the next. The results of liposuction, like those of any procedure, depend on your surgeon’s aesthetic judgment and surgical skill. These obviously differ widely. I always tell my patients that it is not necessarily how much fat I remove that is important, it is how much fat I leave.

Additionally, you’ll want to choose the plastic surgeon and staff with whom you feel the most comfortable. There’s value in knowing that you will be cared for by people who understand your goals, answer your questions, and respond to your concerns.

Always check before and after photos to gain a sense of their work. Some of my patients who are considering a procedure ask to speak with some of my other patients who have already gone through the procedure so they can ask specific questions about the experience. You may want to do the same, as it can help with your decision

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In your opinion, who is the best plastic surgeon in NYC for natural-looking Breast Augmentation surgery?

Q) In your opinion, who is the best plastic surgeon in NYC for natural-looking Breast Augmentation surgery?

A) There are many highly regarded plastic surgeons in New York City. To assure that your plastic surgeon has gone through appropriate training, it is important to find a surgeon certified by the American Board of Plastic Surgery. Whenever you are considering a new plastic surgeon, always ask to see their pre and post-op photos and make sure they provide clear, full answers to all your questions. You should never have the feeling that you are being “sold” on a procedure. In my opinion, the best surgeons are often the ones who tell you what they can’t do for you as well as what they can.

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I have been told that it is dangerous to have surgery in Mexico because they have no ICU…

Q) I have been told that it is dangerous to have surgery in Mexico because they have no ICU, but I’ve been considering getting breast implants at a clinic there. Do all US plastic surgery offices have an ICU or are they only found in hospitals?

A) Generally, it is not the best choice to get plastic surgery outside of the US. It’s not a question of whether or not there’s an intensive care unit (ICU) at the clinic. (Incidentally, in the US, “quad A” certification is the gold standard of patient safety for office-based surgical suites.) There are certain standards of care here in the US that you will not find elsewhere. I’m not sure what they are in a clinic in Mexico.
Studies have shown that complication rates are high among patients who have undergone breast implant surgeries in other countries. Part of the problem is that you won’t be followed by the surgeon who performed your procedure. In the event of complications, the same studies indicate that you’ll have a hard time finding a local plastic surgeon willing to correct them.

To assure that your plastic surgeon has gone through appropriate plastic surgery training, go to an American Society of Plastic Surgeons (ASPS) member. A physician needs at least six years of surgery experience and training, with three of those years specific to plastic surgery, in order to be an active ASPS member. They follow a strict code of ethics and are required to take continuing education courses that include techniques on patient safety. If money is an issue, you may want to consider finding a resident’s clinic at a medical school. The prices there are generally considerably lower.

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Tummy Tuck for my husbands large tummy.

Can my 53-year-old husband have a tummy tuck even if his tummy is very large and protrudes well over his waistband?

The tummy tuck is traditionally a female procedure that is provided after women have given birth. Physiologically during pregnancy the body changes. Men traditionally do not seem to have those same issues. For your husband who has a very large tummy that protrudes over his waistband, there are some procedures that would be more appropriate for him, including perhaps a little bit of weight loss, but there are procedures that can be done. I hope this helps.

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The Little Black Book of Plastic Surgeons

Okay, you’ve been thinking about that cosmetic procedure for a while now. The kids are off at camp and you’ve got some time to yourself. It’s the perfect time to make that little (or big) change and get the face, body, and outlook you’ve always wanted. There are plenty of plastic surgeons in our region, but how do you begin to choose the one who will perform your procedure?

Your first concern should be safety. While there’s no reason to be unduly alarmed, plastic surgery is still surgery and that means there are risks. “In general, plastic surgery is safer than getting in an airplane and safer than driving your own car,” says Dr. Fredric Newman of Darien, CT. But just as you wouldn’t get on a plane without some assurance that there was a licensed pilot at the controls, you shouldn’t walk into a plastic surgeon’s office until you’ve done your homework to make sure you’re in safe hands. To help you do your due diligence, please see “Quizzing Your Doctor”.

Of course, when it comes to plastic surgery, safety isn’t all that counts. To help you get the results you’re after, we asked some of the region’s best-known plastic surgeons to tell us what they do best and why. And before anyone gets the wrong idea, the fact that Dr. X is known for her facelifts doesn’t mean that she’s lousy at everything else. Quite the contrary! Many of the doctors listed here are accomplished at a variety of plastic surgery procedures. But just as Oscar-winning actors get known for a certain breakout role, these doctors have a reputation for being particularly good at certain surgeries. If you’re considering making a date for “a little work,” consider this your little black book.

Dr. Andrew Kleinman
800 Westchester Ave., Suite 512
Rye Brook, 253-0700
Specialty: Breast augmentation

What makes for a good cosmetic result? “Basically you have to go to somebody who has experience selecting the appropriate size and placing the implant,” says Dr. Andrew Kleinman. “If you look at women with implants that have too wide a base, she looks like Betty Boop; too narrow and it looks like she’s got two tennis balls. The base diameter of the implant has to be appropriate for the frame of the patient. Once you have the base diameter correct, you have to evaluate the thickness of the soft tissue and the patient’s overall body shape and type to see how much projection is appropriate. Different implants have different amounts of projection. If you get that part wrong, you’ll never get a great result.” Kleinman says placement is equally important. “Some women want their breasts close together so they have more cleavage in clothing, but if you ignore placement of the nipples, they’re not in the correct position on the breast mound.” Should the implant be under or over muscle? “I place them under the muscle in a majority of patients,” says Kleinman. “There’s less roundness of the implant that way and because it’s covered up, there’s less visibility of wrinkles in the implant and it makes it easier to read mammograms.” If it sounds like he knows his stuff, it’s because he’s been doing this for some time now. “The first implants I placed were in 1979, so I’ve been doing these for over 30 years,” he says. “I worked with the inventor of the breast implant, Frank Gerow. I love doing this procedure because the incidence of problems is extremely low and satisfaction is very high. They’re the happiest patients in the world.”

Average Cost: Breast augmentation is generally between $6,000 and $10,000.

Quizzing Your Doctor

The personable doctor you met for the consultation sounded terrific. He was reassuring and solicitous. His office wall was covered by impressive framed diplomas, his waiting room had a white leather couch you saw in Architectural Digest, and your friend says that all the women in her Zumba class swear by him. That’s all well and good but it isn’t good enough. To make sure you’re in the best possible hands, you have to do some homework.

Dr. Andrew Kleinman, President-elect of the New York State Society of Plastic Surgeons and past President of the Westchester County Medical Society says your first question should be about your doctor’s certification.

“When someone says he’s ‘board certified’, be very careful about which board and ask if it’s recommended by the American Board of Medical Specialties (ABMS),” suggests Dr. Kleinman. “There are a lot of made-up boards. If it’s not recognized by the ABMS, it’s a self-proclaimed board.”

According to Dr. Kleinman, if your doctor purports to be a plastic surgeon, “He or she ought to be a member of The American Board of Plastic Surgery. That’s the only board that’s recognized by the American Board of Medical Specialties to certify plastic surgeons.” If you’re seeing a legitimate facial plastic surgeon, their board certification might be as an otolaryngologist instead. “They take an additional exam where they become certified in facial plastic surgery,” Kleinman explains. “While neither certification guarantees that you’re the best surgeon, they do guarantee a certain level of training and experience.”

Once you’ve checked your doctor’s credentials, visit the New York State Department of Health’s website, www.nydoctorprofile.com, and the website for the Office of Professional Medical Conduct, www.health.state.ny.us/professionals/doctors/conduct to see if your doctor has been disciplined. If so, that’s obviously cause for concern. Next, ask about your surgeon’s hospital affiliation. “If your procedure involves anything more than local anesthetic, it should be done in an accredited facility,” says Kleinman. “Even if you don’t think you want your surgery performed in a hospital, ask your surgeon if he or she would be willing to do it there. If the surgeon is credentialed to operate in a hospital, that’s a good sign; but if not, that means something.” In other words, it might very well mean that no hospital will let that doctor operate in their facility.

Once you’ve checked on your doctor’s basic competence, “You want to make sure that the plastic surgeon has experience in the area that you’re interested in,” says Kleinman. “You want to see ‘before’ and ‘after’ pictures of his or her work.” Should you ask how many similar procedures he or she has performed? “It’s difficult to say whether the number of procedures a doctor has performed is particularly significant. There’s no magic number that guarantees a surgeon knows what he or she is doing. Surgical technique is always changing so if it’s new, the number of procedures performed is going to be low. The bottom line is that reputation and results are more important.”

Dr. Kleinman says he likes to see a surgeon whose expertise includes reconstructive as well as cosmetic work. “I used to work on repairing facial fractures,” he says. “There’s nothing like doing that for learning facial anatomy and a lot of what I learned about cosmetic surgery is built on that foundation.”

Finally, once you think you’ve found the right doctor, Kleinman recommends that you ask your primary care physician about him or her. “You’re not asking your doctor for recommendations so much as what he or she might have heard about that plastic surgeon. There are some surgeons who are very charming and appear very competent but the medical community often hears otherwise.”

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NYS

New York State Society of Plastic Surgeons NEWS

DR. KLEINMAN ELECTED PRESIDENT OF THE NEW YORK STATE SOCIETY OF PLASTIC SURGEONS FOR 2010

Rye Brook Plastic Surgeon to Lead New York State Society of Plastic Surgeons

Albany, NY September 20, 2010- The New York State Society of Plastic Surgeons elected Andrew Kleinman, MD, a Board Certified Plastic Surgeon practicing in Rye Brook, NY as their new President for 2010-11 during its Annual Meeting at the Palm West restaurant, New York City, NY. Dr. Kleinman served as a Past President of the Westchester County Medical Society.

Dr. Kleinman has long been a champion of physicians and patients and has a long record of advocating on their behalf. Dr. Kleinman resides along with his wife Noela in Greenwich, Connecticut.

Other officers elected to serve for 2010-11 were Bruce, Barach, MD, President Elect, Schenectady, Stafford Broumand, MD, Vice President, Manhattan, Bob Goldstein, MD, Secretary, Bronx, Paul Weiss, MD, Treasurer, Manhattan and Scot Glasberg, MD, Member at Large, Manhattan.

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