A good plastic surgeon must be precise, discerning, have a great sense of aesthetics, balance and harmony. In a recent post (Breast Augmentation Fail or When Not to Disclose One’s Assets), I discussed the case of actress AnnaLynne McCord and her less than ideal results from a breast augmentation. Despite the significant asymmetries of projection and shape between the left and right side, she seemed quite determined to flaunt her flawed assets. Because she is beautiful, does great charitable work, and stays out of trouble and the headlines, she gets a pass.

AnnaLynne McCord flaunts her flawed results

Now let’s look at the case of Adriana Lima, the Brazilian born model. She is most well known as a Victoria Secret Angel and as a spokesmodel for Maybelline cosmetics but she also is a supermodel, actress and has graced the covers of countless magazines for more than ten years. Since 2005, she has been ranked in the top five of Forbes’ lists of the 20 highest-earning models in the world.

Looking for some good and interesting material to write about, I came across a recent photo shoot of her in a bikini that was posted online which caught my eye (actually both of them). I thought to myself: “Aha. She’s the one that I’ve been looking for!” Who knew that she was so famous?

Now about breast implants and a more tasteful breast augmentation. Below is a photo of her “aug” natural. Before plastic surgery.

Adriana Lima au natural - before breast implants

Pretty. Has potential. Not much money or fame – yet.

Now, after a very nice breast augmentation.

Adriana Lima, supermodel, after breast augmentation

Her breasts are relatively “natural” in appearance rather than being disproportionately or grotesquely large. In clothes (this is a bit of a stretch!), she has good symmetry, cleavage, projection and her breast implants are situated at the same height on her chest.

Worthy of fame and fortune.

My only gripe has nothing to do with her breast enlargement. It has to do with her emaciated, pseudo-anorexic appearance. Look at those ribs and her extremely skinny body!

If you would like to schedule a complimentary consultation with me or obtain additional information on breast augmentation surgery or on any other plastic surgery procedure that I perform, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Arizona Plastic Surgeon on Boosting Confidence in the New Year

According to the American Society of Plastic Surgeons (ASPS), cosmetic procedures have been on the rise since 2009, with over 13.1 million total procedures performed in the past year. Going into the new year, Dr. Steven Turkeltaub, a board-certified plastic surgeon in Arizona, says if there is some improvement in the economy there will be an increase in aesthetic procedures being performed as more patients will be in a better financial state. Additionally, Dr. Turkeltaub discusses some cosmetic treatments to help patients feel and look younger, despite the economy, during the transition into a new year.

At his Arizona plastic surgery practice, Dr. Steven Turkeltaub says he has seen an increase in cosmetic enhancements during this current holiday season. He notes the holidays have traditionally been a particularly popular time of year for people to undergo aesthetic procedures, and adds that the extended holiday vacations offer an opportune time for many patients to seek both surgical and minimally or non-invasive procedures such as BOTOX® Cosmetic injections that can improve appearance as well as boost self-confidence. “The increase in surgical procedures around the holidays is likely related to people being off from work or having a much lighter schedule at this time of year. They may also have more help at home.”

For patients looking for affordable yet noticeable enhancements, Dr. Turkeltaub says that non-surgical injections and dermal fillers like Juvederm®, Restylane® and Radiesse® and BOTOX in Phoenix provide low-cost alternatives to surgical procedures and can provide immediate and effective results with little to no downtime for recovery. He notes that patients often look for simple procedures during the holidays that will improve their self-confidence during the stressful and often physically-taxing holiday season. “Non-surgical procedures such as BOTOX® injections and facial dermal fillers can affect enough changes for many people to produce noticeable improvements such as looking more youthful and relaxed, less angry and less tired.”

Although minimally invasive procedures can produce effective improvements in a patient’s appearance, Dr. Turkeltaub says they cannot truly substitute for the results and dramatic transformations of surgical enhancements like a facelift or breast augmentation in Phoenix. “Non-surgical procedures can provide improvements, but they are not a true replacement for surgery when it is indicated. Undergoing single and straightforward surgical procedures such as a breast augmentation rather than the performance of multiple ones together at far greater costs can improve one’s appearance without breaking the bank.”

Dr. Turkeltaub states that regardless of whether patients choose a surgical or non-invasive path to attain an improved, rejuvenated appearance and increased confidence, he recommends consulting with an experienced board-certified plastic surgeon before considering any treatment. He adds that through the honed skills of a board-certified surgeon, along with a dedicated staff, patients can experience the benefits of a fresh start to the new year with higher quality cosmetic results.

About Steven H. Turkeltaub, MD, PC

Dr. Steven Turkeltaub completed both his undergraduate degree and his medical degree in the Six-Year Medical Program at Boston University, graduating summa cum laude, where he was also a member of the Phi Beta Kappa scholastic honor society and the Alpha Omega Alpha medical honor society. He trained during a general surgery residency at the University of Miami/Jackson Memorial Hospital in Miami and Northwestern Medical Center in Chicago, in addition to a plastic surgery residency at the University of Massachusetts Medical Center. Dr. Turkeltaub is a member of the American Society of Plastic Surgeons, the Arizona Society of Plastic and Reconstructive Surgeons, the Arizona Medical Association, and several other professional societies. His past appointments include two terms as President of the Maricopa County Plastic Surgeons Society and one as Secretary/Treasurer, as well as Clinical Instructor and Attending Physician in Plastic and Reconstructive Surgery at the University of Massachusetts Medical Center. Dedicated to continued education in plastic surgery, Dr. Turkeltaub has been published in several journals and books and attends many national symposiums each year to keep up with the most effective techniques. He is board-certified by the American Board of Plastic Surgery.

Dr. Turkeltaub’s practice, the Arizona Center for Aesthetic Plastic Surgery, has two locations at 10290 N. 92nd St., Suite 207 in Scottsdale, AZ and 18275 N. 59th Ave., Bldg. E Suite 126 in Glendale, AZ, both reachable at (480) 451-3000. The practice can also be contacted online via the website www.turkeltaub.com, www.arizonabreast.com, or facebook.com/drturkeltaub.

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When it comes to breast reduction surgery, I find that women contemplating this procedure don’t usually place the appearance of the final scar at the top of their list of concerns. This is quite the opposite for those considering a mastopexy (breast lift) where this is a major area of concern.

Why is this the case despite the fact that the incisions, usually anchor shaped, are often identical?

The reason is that women who are seeking breast reduction surgery are doing so because of the annoying and even debilitating effects that their massively enlarged breasts are having on them and their quality of life.  Women seeking a mastopexy are doing so largely for aesthetic reasons.

Does this mean that the appearance of the scars is relatively unimportant?

Of course not!

I am just as diligent and meticulous in the repair of breast reduction incisions as I am with the mastopexy ones (as well as for all incisions for all procedures). These are closed using long acting deep sutures in a multilayered repair that avoids the unnecessary and displeasing rail-road track suture marks in the skin. Skin tapes are applied for additional wound support and security and may be used for a total of two to three weeks. At that point in time, my patients will usually begin applying a topical silicone gel to help the scars heal as ideally and inconspicuously as possible. This is usually continued for several months. For patients at higher risk for developing hypertrophic scars or keloids or showing early evidence of their manifestation, silicone gel sheets are used to aggressively deal with these issues.

Most breast reduction scars heal very well, usually as fine lines, and are quite acceptable. It is rare in my experience to see keloids develop in darker complected women.

Before breast reduction

After breast reduction

Before breast reduction

After breast reduction

If you would like more information on a breast reduction surgery or on any other plastic surgery procedure that I perform or to schedule a consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Too often, liposuction is driven by technology and associated marketing rather than by the training and skill of the medical practitioner. You have seen or heard the frequently slick ads touting the amazing outcomes that can be yours when you have your liposuction using “their” miracle machine. Such may or may not include the following:

SmartLipo™
Slimlipo™
LipoLite™
Etc.™

The most important factor is not the machine. It is the doctor performing the liposuction. No machine can correct for poor technique, lack of experience, improper training and a lack of appreciation and understanding of aesthetics.

Unfortunately, many of those physicians (or clinics) that advertise and use these liposuction machines, can be characterized by one or more of these deficiencies. They may market themselves as cosmetic surgeons (possibly because they took courses, etc.) but, in fact, their primary medical training was in family care, internal medicine, emergency medicine, cardiology and so forth.

You don’t see the word “surgery” attached to any of these. That should also serve as a warning.

There are general surgeons who do use these liposuction machines. However, their training is in areas completely unrelated to liposuction and the aesthetic realm. Another hint: most plastic surgeons first train in general surgery and THEN undergo at minimum of an additional two to three years of specialized training in plastic surgery before opening their practices. It must just be that the additional training and experience is important.

So – who do you want to have performing liposuction on your body?

Thought so!

Make sure that your doctor a plastic surgeon who is board certified by the American Board of Plastic Surgery. I am and have been practicing in the Scottsdale and Phoenix area going on 25 years.

Now, for a little levity, check out this video touting an amazing suction machine.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Drains, which are flexible silicone tubes that are connected to a reservoir known as a bulb, allow for the egress of fluid which could accumulate between the skin-fat layer and the underlying muscle. They have been used in abdominoplasties (tummy tucks) for decades for the purpose of minimizing the incidence of fluid accumulation, known as seromas. Most commonly, two drains are placed for a full tummy tuck whereas only one is used for a mini tummy tuck.

There are some plastic surgeons who don’t use any drains – touting a suturing technique that they feel makes their usage unnecessary. This approach hasn’t convinced most plastic surgeons yet and so it is presently employed by a minority.

The drains are typically placed either in the vicinity of or within the abdominal incision itself and remain in place until 24 hour drainage totals decrease below a particular numeric level. The amount used as the metric does vary among physicians. Many use a number of 20cc or less over a 24 hour period for 1 – 2 days; others consider up to 30cc or even more within a 24 hour time frame. There are even some plastic surgeons who largely ignore the drainage quantity and, instead, use the element of time – removing them after a fixed period such as a few days or at one week.

How long can you expect that the drains will be left in for?

Unfortunately, the duration of time that the drains will remain in place after a tummy tuck is extremely variable among individuals and can’t necessarily be predicted prior to surgery unless, of course, a fixed period of time is used. I use relatively strict criteria before the drain tubes are sequentially removed in my patients and this clearly seems to minimize the risk for the development of a seroma. Most of my patients will have both of their drainage tubes removed by two to three weeks; many in less than a week and a half. It is the very rare patient whose drains remain in place for more than four weeks.

The down side for either taking out the drains too soon or failure of the approach that doesn’t use drains is the undesirable accumulation of fluid deep to the skin (seroma). This problem needs to be treated either by repeated (that is, on multiple occasions) aspirations of the fluid which entails the sticking of a needle into the tissues in order to remove the fluid or even the re-insertion of another drain. On rare occasions, surgery may be required to address what can become a fixed and deforming accumulation of fluid.

For more information on a tummy tuck or on any other plastic surgery procedure that I perform or to schedule a complimentary consultation with me, you can call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Breast ptosis, the medical term for drooping of the breasts, occurs to some degree in a vast majority of women who have at least some breast volume present. This is the inevitable result of a combination of loss of elasticity of the skin of the breast and the stretching of underlying tissue support “fighting” against the unrelenting forces of gravity. The picture is not a very pretty one for the many women who want to regain or obtain that more youthful, firm, voluptuous, alluring shape. Furthermore, there is a negative impact on their self-confidence, sexuality and allure.

What can be done to either recoup or obtain that youthful, perky and sexually attractive shape?

Clearly, a breast lift (mastopexy) with or without implants (breast augmentation) will provide the rejuvenation of the breasts with lifting, recontouring, tightening and even adding volume. This can be facilitated employing incisions that range either from one just around the areola to an anchor shape one that also involves a vertical and horizontal component. Unfortunately, many women are very apprehensive about these incisions which ultimate become “scars” and want to avoid them at all costs.

A question that I am frequently asked and which many women have as also evidenced by myriad postings online is: “Can I just get much bigger implants to avoid having to do a breast lift?”

Often, women either know other women who have pursued this approach or they were told this in consultation with other physicians, many who either didn’t have the experience, sensibility or training regarding this issue or lowered their standards in order to “close the deal” and perform the surgery. It is unfortunate that these physicians, quite often not plastic surgeons, wouldn’t do what was in the best interest of their patients just to make a buck (or lots of bucks).

Personally, I will either do what is right for my patients or won’t perform the surgery. It’s all about principles. Period!

Now, why is placing too large an implant in the breast in order to avoid having to do a breast lift a very bad idea?

Let me explain this briefly. The skin is already thin (or thinner) with decreased elasticity (stretchiness) with breast ptosis. Placing an even larger implant than is ideal will stretch out and thin the skin even more. Added to this, many of these physicians recommend that the best way to counter the drooping breast skin is to directly stretch it out by placing the implants above the muscle. What eventuates is that the breasts descend at a more accelerated pace lower on the chest and abdominal wall. The granny breast caricature (no offense to grandmothers)!

Not a pretty picture!

Ultimately, the only treatment of this would be a complex reconstruction that would require an anchor shaped scar (which may or may not have been originally recommended) and possibly one or two procedures. The skin will be much thinner and less elastic than it would have been had the appropriate procedure been performed initially. The final outcome, after spending at least double or more the amount of money than it would have originally cost, will always be significantly inferior to what it could and should have been. Add to this the extra down time, discomfort, inconvenience, etc. and you should easily conclude that not pursuing the correct procedure was a very poor choice.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

XEOMIN Now Available at Arizona Plastic Surgery Practice

At his center for plastic surgery in Phoenix, Dr. Steven Turkeltaub is now providing a recently released alternative to BOTOX® Cosmetic called XEOMIN® for wrinkle reduction. He states that this new product offers an effective alternative to BOTOX® Cosmetic in helping patients reduce fine lines and enhance the vibrancy and youth of their skin and does so at a more affordable price.

Dr. Steven Turkeltaub, a board-certified plastic surgeon in Phoenix, AZ, has announced that he will be offering XEOMIN® as an option to BOTOX® Cosmetic for the treatment of certain facial wrinkles. Though it has been used in many other countries worldwide since 2005, it was in July of this year that the U.S. Food and Drug Administration approved the usage of XEOMIN® in the United States as a treatment for the reduction of glabellar (frown) lines. Dr. Turkeltaub says that he is excited about the new product, which can serve as an effective and more affordable alternative for BOTOX in Phoenix. He also states that treatment with this product can offer patients a noticeable reduction of facial lines and creases translating into a softer, more rejuvenated and youthful appearance.

Dr. Turkeltaub says the benefits available to patients seeking wrinkle reduction from XEOMIN in Arizona are very similar to those associated with BOTOX® Cosmetic, but with a more affordable price tag. XEOMIN® also requires no freezing or refrigeration until opened which reduces costs as well as the risks for unintended or unidentified impairment of viability.

Dr. Turkeltaub is one of a very limited number of physicians in the Phoenix metropolitan area selected by Merz, the manufacturer of Xeomin®, to offer this product at present. XEOMIN® will officially be available nationwide to physicians in the spring of 2012.

Providing the latest advancements in plastic surgery in Arizona, Dr. Turkeltaub says he hopes that XEOMIN® is just one of numerous additional innovations in cosmetic enhancements and facial rejuvenation that will ultimately become effective realities. As with any medical procedure, Dr. Turkeltaub also says he recommends consulting with an experienced and qualified board certified plastic surgeon before undergoing any treatment.

About Steven H. Turkeltaub, MD, PC

Dr. Steven Turkeltaub graduated from the honors Six-Year Medical Program at Boston University and Boston University School of Medicine, receiving both his Bachelor of Arts and Medical Doctor degrees in six years. He was a member of both Phi Beta Kappa and Alpha Omega Alpha, graduating summa cum laude. Dr. Turkeltaub completed his general surgery residency at the University of Miami/Jackson Memorial Hospital and the Northwestern Medical Center in Chicago. He also trained extensively in plastic surgery at the University of Massachusetts Medical Center. Dr. Turkeltaub subsequently served during an academic appointment as Clinical Instructor and Attending Physician in Plastic and Reconstructive Surgery. He is a member of the American Society of Plastic Surgeons, the Arizona Society of Plastic and Reconstructive Surgeons, the Arizona Medical Association, and several other professional organizations. Dr. Turkeltaub is board certified by the American Board of Plastic Surgery and has been rated and awarded as a Patients’ Choice Physician.

Dr. Turkeltaub’s practice, the Arizona Center for Aesthetic Plastic Surgery, has two locations at 10290 N. 92nd St., Suite 207 in Scottsdale, AZ, and 18275 N. 59th Ave. Bldg. E Suite 126 in Glendale, AZ. Both locations are reachable at (480) 451-3000 or online via turkeltaub.com, arizonabreast.com, or facebook.com/drturkeltaub.

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Male breast reduction surgery for gynecomastia (enlarged male breasts) is one of the more commonly performed procedures in men. The results from surgery can be quite dramatic and rewarding. Despite the perception that men don’t obsess or even focus on their appearance a whole lot, this is not entirely or always true. Many men do care and when it comes to the appearance of their breasts.

The underlying cause of gynecomastia can be the result of enlarged glandular breast tissue, increased fat accumulation or a combination of both. Liposuction is the treatment of choice when there is an excessive amount of fat. It typically involves one relatively small incision (around 1/4” to 3/8”) for each side either along the breast fold or at the bottom part of the areola. They usually heal in an inconspicuous manner.

Glandular breast tissue can’t be removed with liposuction – it needs to be excised directly which is accomplished though an incision placed along the lower half of the areola. By nature, this incision is much longer as compared to the one needed for liposuction alone.

A question that many men have, particularly those that are younger and not hirsute (hairy) is “how obvious or apparent will the scars be?”

When the incisions are meticulously repaired (like they always should be!) and treated with a scar gel postoperatively, the final results are usually fairly thin white lines that are not apparent from any significant distance. Sometimes, they are so inconspicuous to the point of being imperceptible (see photo). Regardless, the overwhelmingly positive results from gynecomastia surgery virtually always outweigh any scar that is a consequence of the procedure.

Scar along the bottom half of the right areola

So, if you or someone you know is considering breast reduction surgery for gynecomastia but concerns about the scars have been a major issue, reconsideration should be in order.

If you would like more information on male breast reduction surgery for gynecomastia or on any other plastic surgery procedure that I perform or to schedule a consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Botox® and the other lesser know botulinum neurotoxin type A agents, Dysport® and Xeomin®, can effectively treat dynamic facial wrinkles such as of the crow’s feet, forehead and the glabella (the so-called “1”s and “11”s). They do so rather predictably and without surgery though these treatments are not meant as a replacement for rejuvenating procedures like face lifts, forehead lifts and blepharoplasties (cosmetic eyelid surgery). The most significant negative associated with the treatment by Botox® and the other products is that they have to be injected through the skin in order to exert their effects. Even though the needles used can be extremely tiny, they are still needle sticks.

Wouldn’t it be nice if there were some way that these neurotoxins can be delivered to the underlying muscles without the need for injections?

Like applying them topically.

Of course! There would be no discomfort whatsoever when administered this way.

To this end, there are several investigational studies some of which have been completed, that have evaluated/are evaluating a topically applied botulinum neurotoxin type A specifically to the crow’s feet area. Preliminary results have been quite promising including one study which showed therapeutic effects that were similar to those obtained with the injectable versions, lasted nearly 4 months and were not associated with any serious adverse treatment issues.

There are a few ongoing studies on this topically administered botulinum neurotoxin type A formulation and more will need to be performed before there will be definitive answers and information that can support its safety and efficacy. It may be several years or longer before this neurotoxin could be approved by the FDA (Federal Drug Administration) and brought to market.

Let’s hope that it will be sooner rather than later.

If you are interested in getting Botox® treatments, information on any plastic surgery procedure or would like to schedule a consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Scars are the result of an injury to the skin, either traumatic in nature such as one caused by an accident or elective like one that is a consequence of surgery. Usually they heal level or nearly level with the surrounding skin though they can be wide. When they heal in a considerably elevated fashion within the area of the injury and are associated with firmness and redness, they are called hypertrophic scars. These types of scars usually develop soon after the injury and may regress over time, sometimes a year or more. Often, they are associated with pain and burning. Though they are frequently confused with keloids, the distinguishing factors are that keloids usually appear months to even years after the injury and extend considerably outside the original scar.

Hypertrophic scar of the right thigh

Some of the common treatments for hypertrophic scars include surgical excision, steroid injections, topical silicone sheets and cryotherapy (cold therapy). A variety of lasers have been also been used in attempts to treat these scars. Because lasers are high tech and have been touted for a multitude of other things, many patients request to have their hypertrophic scars treated using a laser.

Can lasers be employed to effectively and predictably treat hypertrophic scars or is their usage just hype and marketing?

A review of the literature on the usage of lasers in the treatment of hypertrophic scars was conducted and published in the November 2011 issue of The British Journal of Dermatology. It analyzed the data only from non-biased and properly controlled previously published clinical trials that employed a variety of lasers. This amounted to thirteen articles reporting on seven different laser types.

They found that only one of the seven laser types showed any evidence of possible therapeutic benefits. This was a pulsed dye laser (PDL) at the 595 nanometer wave length. In their conclusion, they stated that there was insufficient evidence at present to be able to recommend any laser as an effective treatment for hypertrophic scars though future studies may cause this approach to change.

So there is your answer!

If you would like more information on the treatment of hypertrophic scars, keloids or on any other plastic surgery procedure that I perform or to schedule a consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

While web surfing news and political websites, an intentionally selected salacious photo on the home page of the FOX Nation grabbed my attention. In this Pic of the Day section (it actually has been there several days now and you probably can figure out why!), was a photo of a young actress showing off a large portion of her cleavage in her hot red and red hot keyhole gown (see below).

The title associated with the picture was “AnnaLynne McCord Gets Something Off Her Chest”. The writers might have thought this was a cute phrase as they were referring to her recently acquired cleavage through breast augmentation surgery. Unfortunately, their phrase “Off Her Chest” was the exact opposite of what was done. Actually, the more precise description should have been “AnnaLynne McCord Gets Breast Implants For Her Chest”.

You might have recognized immediately that the photo was indeed of AnnaLynne McCord from “90210” but having never watched “90210”, I didn’t know. It took some googling to discover exactly who she is. What I learned is that she may be more than just another beautiful face (and body) – having some acting talent (though again I wouldn’t know that first hand). She does apparently devote a tremendous amount of her time to charities which is more than most Hollywood narcissists do … and that is an admirable endeavor.

However, she does need to devote a little more time and discretion about the clothes that she selects and some things which I will now discuss.

You may be wondering why I am writing about a voluptuous actress on my plastic surgery website, posting a revealing photo and even tossing in some nice comments about her. Well, here is the reason:

Her breast augmentation results as seen in this and other photos are … well, very unacceptable! And to make matters worse, she is brazenly flaunting what I consider to be a suboptimal outcome. Of course, both the less than ideal results and the ostentatious display of them are not a rare phenomenon in Hollywood.

No matter who my patients are, normal every day women or Hollywood actresses (I do have experience in this department), I would NEVER knowingly accept this inferior result in my own patients.

Yes, there are many women on whom it is impossible to obtain great, ideal or even very satisfactory breast augmentation results for a variety of reasons. However, in AnnaLynne’s situation, based on her photos prior to surgery, this did not appear to be the case.

So what am I seeing in the photo?

There is a striking difference in the shape and projection of the left versus the right breast implant with the left one being less projecting. This is independent of the asymmetrical position of her shoulders. Whether or not they are situated at the same vertical height can’t be ascertained by this one view. However, her revealing dress seems to accentuate the substantial disparity between sides – never a good thing.

My philosophy has always been that a breast augmentation is more than just inserting breast implants and trying to obtain a particular cup size. It is a procedure that MUST be performed with precision and this starts right in my office during the consultation. There is a very comprehensive examination that includes not only an assessment of the size of the breasts but also other issues such as their shape, location on the chest wall, asymmetries, skin tone, etc. Sizing is also done but this doesn’t end in the office. I also evaluate various sizes and styles of breast implants during surgery and will use what will give my patient the best possible results based on what the goals are.

You most likely aren’t an actress and probably will never be a movie star, but I sure want to make sure that the excellence of results from your breast augmentation will be what these famous actresses would have wanted (but didn’t receive) as their outcome.

For more information on breast augmentation or on any other plastic surgery procedure that I perform or to schedule a consultation with me, please contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

If you have been hoping for a reliable yet less expensive alternative to Botox® for the treatment of your frown lines, you are in luck. In August, the United States Food and Drug Administration (FDA) approved the usage of Xeomin® (incobotulinumtoxinA) for a variety of issues including frown lines. Among the information that it examined in order to approve this new product were comparative studies from Europe that evaluated Xeomin® versus Botox®. Manufactured by the pharmaceutical company Merz, it has been used elsewhere in the world since 2005 in over 84,000 people and presently is available in 20 countries.

What is Xeomin®?

Xeomin® is another botulinum toxin A, in the same category as Botox® and Dysport®, which acts by temporarily paralyzing the underlying muscles in order to treat wrinkles. These three products have the same basic toxin particle but their formulations are different. Because Xeomin® doesn’t have a surrounding protein particle as the other two products have, it may have the theoretical advantage of lowering the risk of developing antibodies to the product which can reduce effectiveness. (In reality, this does not really seem to be much of an issue with either Botox® or Dysport®.)  It appears that its effects and characteristics are similar to those of Botox®.

Presently, Xeomin® is being released in very limited quantities until its planned widespread release sometime in 2012. We are honored to have been selected by Merz as one of only a limited number of physicians in the Scottsdale and Phoenix metropolitan area able to offer you this new product. In order to make Xeomin® an attractive alternative to the iconic Botox®, we are offering very attractive discounts that can add up to around 20% or $100 less than Botox® (if you use an average of 50 units).

If you would like more information on Xeomin® or Botox® or would like to schedule a consultation and treatment of your wrinkles with either product, you can call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

A very common question that women have regarding activities following a tummy tuck is: “When can I do everything that I want to do?” This also can be asked as “When will I not have any restrictions of my activities?” Interestingly, if you ask around, you will obtain quite a diversity of recommendations. The answer can be very important as you want uneventful healing and no complications. The guidelines that I have for my patients are based not only on science but also on years of experience as to what truly works and what is safe.

My patients are instructed to begin ambulation immediately following their abdominoplasty for many reasons with the most important one being to try to minimize the risk of blood clots developing in the legs which can then also migrate to the lungs resulting in what is called a pulmonary embolus, a condition that can occasionally be fatal. Usually, you can expect to feel fairly tired and weak for at least a week or more, sometimes even up to several months. This gradually improves with time, much faster in some than others.

You can resume normal, non-strenuous and non-vigorous activities as tolerated. That means casual walking but not running, driving when you feel comfortable and are not on narcotic pain medication and no lifting greater than around 10 – 15 pounds. At around three to four weeks you can walk fast but not run a treadmill and also ride a bicycle, preferably a stationary one.

At eight weeks following your tummy tuck, you are allowed to engage in all your normal activities as tolerated and without restrictions unless otherwise advised. This includes weight lifting, sit-ups, full aerobic exercising, horseback riding and most sports. If you have any questions about certain esoteric or extremely strenuous activities, please ask.

For more information on tummy tuck surgery or on any other plastic surgical procedures that I perform, or to schedule your free consultation with me, please call my office at 480-451-3000. You can request whichever location is more convenient for you – Scottsdale or Glendale.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

The incision that I have preferred for virtually all of the primary breast augmentations that I have performed on my patients over the years has been the inframammary one. There have been several reasons for this including the relatively inconspicuous location and scar healing, a lower risk of the development of capsular contracture (firm scar around the implant making the breast feel hard), better surgical exposure that also allows for greater control and precision for the dissection and what intuitively seemed to me to be an approach with a lower risk of affecting the nipple-areola complex sensation. There was no large study performed that evaluated the possible effect of the incision location on nipple-areola complex (NAC) sensation … until now.

Finally, we seem to have a more definitive answer to this issue.

A large retrospective (evaluating patients who already had surgery) study was performed in Italy that evaluated the possible effect of incision location for breast augmentation on the subsequent sensation of the nipple-areola complex. This involved over 1200 women who had the surgery performed by a single surgeon over a more than 6 year period of time using either an inframammary or a periareolar incision. Variables evaluated included patient age, breast implant size, and implant pocket location (in front of or behind the muscle).

What were the findings?

Implant size had no significant impact on the sensitivity of the nipple-areola complex postoperatively. Neither did the age of the patient nor whether the implant was placed in a submuscular pocket (behind the muscle) or submammary pocket (in front of the muscle). The only factor that had a statistically significant effect on the sensation and discomfort of the NAC was the incision location. The periareolar approach resulted in either a decreased or total loss of sensation in 9.5% of patients versus 3.5% with the inframammary one. This translates into a 2.7 times greater risk for sensory loss with the periareolar incision as compared to the inframammary one. The analysis also revealed that the periareolar incision led to a 3.5 times greater likelihood of experiencing areolar pain.

This study provides even more scientific proof of the superiority of the inframammary incision for breast augmentation surgery.

For more information on breast augmentation surgery or on any other plastic surgery procedure that I perform, or to schedule a consultation with me, you can call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

A study presented at the recent American Society of Plastic Surgeons Annual Meeting suggests that for some patients, liposuction alone or in combination with other fat removal procedures such as a tummy tuck, may have long term beneficial effects on health. Incredibly then, seeking to be more attractive or beautiful through liposuction may be beneficial not only for one’s mental well-being but it may also result in improved physical health.

A study was performed by plastic surgeon Dr. Eric Swanson and colleagues from Kansas which evaluated a variety of parameters that could be measured in the blood, both before and after liposuction. This involved a total of 322 patients over a year period. Among the blood tests performed were those for triglycerides, cholesterol, LDL, HDL and white blood cell count. These were assessed with regard to procedure (liposuction alone versus with a tummy tuck) and the patient’s preoperative weight, BMI (body mass index or weight as relates to height) and lab tests.

Among the findings was that patients who had an elevated preoperative triglyceride level experienced an average 43% reduction in the level following surgery. Furthermore, 62% of these patients ended up with normal triglyceride levels following their liposuction. This effect was more noticeable in those who were not markedly overweight. Patients who started with normal triglyceride levels experienced no significant change following surgery. With regard to health risks, elevated triglyceride levels are associated with type 2 diabetes, stroke, coronary artery disease and peripheral vascular disease.

Another interesting finding was a statistically significant reduction in the white blood cell (WBC) count noted at 3 months following surgery. This is quite noteworthy because previous studies have shown that individuals with higher average WBC counts have a significantly greater risk for coronary heart disease than those with lower levels. There were no significant effects on cholesterol, LDL and HDL levels.

Much more research will need to be performed to substantiate and clarify this relationship of liposuction, fat removal and the ensuing positive metabolic effects. Wouldn’t it be nice to know that not only will you look and feel much better following liposuction but that it is also great for your health.

If you would like more information on liposuction or on any other plastic surgery procedure that I perform or to schedule a consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Arizona Plastic Surgeon Discusses Mommy Makeover Procedure

The latest study from the American Society for Aesthetic Plastic Surgery (ASAPS) shows cosmetic enhancement procedures increased nearly 9% from 2010-2011. Breast augmentation and liposuction were the two most common surgical procedures, while BOTOX® injections and hyaluronic acids (Juvederm® and Restylane®) were the two most popular nonsurgical treatments. Board certified Scottsdale plastic surgeon Dr. Steven Turkeltaub believes this particular increase may be in part linked to the growing trend of mommy makeovers: a combination of procedures designed to address the cosmetic concerns many woman have following pregnancy and childbirth.

After a 2% decrease in overall procedures from 2009-2010, the latest study from the American Society for Aesthetic Plastic Surgery (ASAPS) shows the number of procedures performed rose almost 9% in 2010, to total more than 9.3 million aesthetic enhancement procedures. Breast augmentation and liposuction were the two most popular procedures in 2010, a fact Dr. Steven Turkeltaub, a board certified plastic surgeon in Arizona, partially attributes to the growing trend of mommy makeovers in Scottsdale: the process of combining surgical cosmetic enhancement procedures, as well as nonsurgical procedures, to address the common aesthetic concerns of mothers following pregnancy and childbirth.

At his Scottsdale plastic surgery practice, Dr. Turkeltaub states that he has seen an increase not only in individual surgical procedures such as breast augmentation and liposuction as well as in non-surgical procedures like BOTOX® treatments and dermal fillers (Juvederm®, Restylane® and Radiesse®), but also in the number of female patients who desire multiple surgical procedures in order to create a more comprehensive full-body makeover. Much of this is driven by women wanting to regain their pre-pregnancy appearance to feel and appear more attractive and youthful.

The combination of procedures—such as a breast augmentation with a tummy tuck and liposuction—provides financial and recovery time benefits as well. The total cost of the Scottsdale mommy makeover procedure can be substantially less if the individual procedures are performed at the same time. Furthermore, one operative period results in less total time off work, less outside child care, and requires only one recuperation period rather than two or more.

Dr. Turkeltaub states that it is critically important for a patient contemplating cosmetic surgery, whether it is a single procedure like breast augmentation or liposuction, or a combination of procedures similar to the mommy makeover, to seek care from a board certified plastic surgeon. He adds that the complexity of these procedures, even when performed separately, requires the experience gained and skills developed and refined during intensive, rigorous plastic surgery training prior to the certification process.

About Steven H. Turkeltaub, MD, PC

Dr. Steven Turkeltaub earned his medical degree during a six year medical program at Boston University and the School of Medicine. He then completed a general surgery residency at the University of Miami/Jackson National Memorial Hospital, which was followed by a plastic surgery residency at the University of Massachusetts Medical Center. Dr. Turkeltaub is a member of the American Society of Plastic Surgeons, the Arizona Society of Plastic and Reconstructive Surgeons, and the Arizona Medical Association.

Dr. Turkeltaub has two plastic surgery office locations: the Scottsdale office is located at 10290 N. 92nd St. Suite 207, Scottsdale, AZ 85258; the Glendale office is located at 18275 N. 59th Ave., Bldg. E Suite 126, Glendale, AZ 85308. Consultations for both offices can be made by telephone at (480) 451-3000 or online at turkeltaub.com, arizonabreast.com, and facebook.com/drturkeltaub.

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Many patients who see me in consultation for a breast reduction have already conducted a fair amount of research on the internet about this procedure. One issue that they often have questions and concerns about is the need for and the usage of drains for this surgery. Some have read commentaries by previous breast reduction patients who emphasized the “significant” discomfort associated with these drains. Unfortunately, much of the information that people read is either incorrect, not accurate or doesn’t proportionately represent reality.

For many years, I customarily placed drains in all my breast reduction patients, the purpose of which was to help minimize the risk for accumulation of fluid (seroma) and blood (hematoma). This was the norm for the majority of plastic surgeons. The drains, which are “tubes” that exit through the lower skin incision and serve to drain fluid deep to the skin, were more of a nuisance rather than a source of significant discomfort or severe pain. Regardless, most patients were quite happy to have them removed.

Over the last several years, I have made their usage a rare exception and when they are placed, the decision is made during surgery based on a few factors. Fortunately, I have seen no increased incidence of these two complications with this approach – and my patients are happier that they have to deal with one less issue.

For more information on breast reduction surgery or for any other plastic surgery procedure that I perform, or to schedule a consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Breast augmentation is the number one cosmetic surgical procedure that women undergo. It is also among the top two in overall satisfaction with 94% stating that if they had to do it all over again they would still make the same decision. That is an amazingly high number particularly in light of all the risks and complications that plastic surgeons must discuss with their patients prior to this breast enlargement surgery.

One of these risks in breast augmentation and one which I review in detail with my patients is the occurrence of numbness of the nipples and the breast skin in general. How common is numbness of the nipples? Is it temporary or permanent?

As with many surgical procedures where incisions are made and the skin elevated (lifted), there will be some postoperative numbness, albeit usually transient, and such is the case with breast enlargement surgery. Right after surgery, the skin of both breasts can/will be somewhat numb which is also compounded by the initial swelling. Over a period of a few weeks, most if not all of this will resolve in a majority of women; others can take several months. There is a very small percentage of women who may take a year or more for their sensation to return.

The incidence of permanent loss of sensation of the nipples as identified by several studies is around the 3 – 5% range though in my practice, it is extremely rare. This risk is influenced by many factors including surgical technique, skill of the surgeon, incision location and breast implant size. Incisions placed around the areola have a substantially greater risk of resulting in temporary and permanent numbness than those placed through one situated either in the lower breast crease (inframammary fold) or the armpit (axillary approach). Breast implants that are disproportionately large in relation to the chest wall and starting breast size also elevate the risk.

For more information on breast augmentation surgery in Scottsdale or on any other plastic surgery procedure that I perform or to schedule a free consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

A very common question that many women have following breast reduction surgery is “When can I wear an underwire bra?” Some believe that they can never wear one again whereas others might have heard, were told or read recommendations for various periods of time and are confused about the correct answer.

So what is the real answer?

Believe it or not there is no right or wrong answer. There are no definitive, evidenced based studies in the medical literature which reveal that any specific period of time is better than any other or even if an underwire should be worn at all. As a result, each plastic surgeon may have his/her own protocol involving different amounts of time that seems to work for their patients.

What do I recommend for my patients?

A few days after breast reduction surgery, my patients are placed in a sports type bra for a few weeks. Thereafter, they are instructed to wear a comfortable but supportive bra on a regular basis to help maintain the shape of their breasts for a longer period of time especially against the undesirable and relentless forces of gravity. This can include an underwire bra but doesn’t have to necessarily be one.

Due to normal postoperative healing, the incision along the crease will be inflamed and even tender for a few months and it will be during this period of time that an underwire bra may not be very comfortable to wear. Generally, most patients wait at least 2 – 3 months before being able to wear an underwire bra without any discomfort. This time does vary between patients.

If you would like more information on breast reduction surgery or for any other plastic surgery procedure that I perform or to schedule your complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Aside from the love handles and breasts, an area that many men would like to improve the appearance of is their abdomen. Many note localized areas of fat; others don’t like the generalized protuberance. They are hoping that liposuction will be able to address their concerns.

Men do have fat distribution of their abdomen that is distinctly different from that of women. As a result, this can translate into potentially different recommendations and approaches. Whereas most of the fat of the abdomen in women is situated just deep to the skin where it can be removed utilizing liposuction, a substantial amount of the fat in men is actually located inside the abdomen around the bowel where it is not accessible through liposuction.

I do see many men with protuberant abdomens (beer bellies) hoping that a few hours of liposuction will provide them with fairly flat tummies, though not necessarily with a six-pack. Unfortunately, such is not the case when the majority of their fat is intra-abdominal. The treatment in these situations, at least initially, is considerable weight loss.

Not a candidate for abdominal liposuction. Fat is largely inside the abdomen.

A lot of men do present with either localized or generalized fat deposits of their abdominal wall which can be successfully treated with ultrasonic assisted liposuction resulting in a flatter and more sculpted appearing tummy. This can be combined with liposuction of other areas as well as with other cosmetic procedures.

If you would like more information on liposuction of the abdomen or other areas, or for any other plastic surgery procedure that I perform, please feel free to contact my office at 480-451-3000. My office would also be happy to schedule you for a complimentary consultation with me.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona