The majority of breast augmentations performed in the United States today are done using silicone breast implants. In 2012, they comprised 72% of the total number of breast enlargements whereas saline implants were used in the remaining 28%. In my practice, I use silicone breast implants in nearly 99% of my patients and for great reasons (read below).

It was only back in 2006 when saline implants were used in the vast majority of breast augmentations – 81% to be exact, with silicone used in the remaining 19%. Of course, that wasn’t because women preferred saline implants over the silicone implants.

They don’t.

Instead, the reason is that the FDA issued an edict that severely restricted the usage of silicone implants between 1992 and the end of 2006. Consequently, a high percentage of women who were seeking to undergo a breast augmentation were forced to either accept an implant that wasn’t their preference or not to undergo the breast enlargement at all.

Obviously, reaping the rewards, satisfaction, benefits, etc. of undergoing a breast augmentation with less aesthetically pleasing implants is better than not having the surgery. After all and regardless of implant type, an augmentation mammoplasty is generally associated with a marked improvement in self-esteem, confidence, relationships with others and even in multiple facets of one’s sex life.

Silicone breast implants are aesthetically far superior to the saline breast implants for many reasons. They successfully simulate the feel of normal breast tissue whereas saline ones do not. In fact, saline breast implants very often can be felt quite distinctly and prominently. Particularly in thin skinned individuals and those with implants placed above the muscle (submammary), rippling of them can be both felt and seen through the skin. This is quite rare with silicone implants.

There are several other reasons why silicone breast implants are the gold standard of breast implants. However, many women with saline breast implants can still obtain quite excellent results. The following patient of mine demonstrates this.

Ten years ago, when she was 37 years old, this patient underwent a breast augmentation with saline implants placed in a submuscular pocket. She has had no problems whatsoever in the intervening period of time and has been extremely happy with the outcome including her “D” cup breast size. This includes no issues with rippling, hardness or contour irregularities and no restrictions in the clothes that she wants to wear.

Before breast augmentation with saline implants

Ten years after breast augmentation – frontal view

Before breast augmentation

10 years after breast augmentation

Before breast augmentation

10 years after breast augmentation

My examination confirmed all of this. She has soft and naturally mobile breasts without firmness (capsular contracture) and a nice configuration without any discernible rippling of the implants.

So, even though silicone breast implants can give superior results when used in breast augmentation, many women can still have outstanding results even with saline breast implants.

For more information on breast augmentation surgery including silicone or saline breast implants or for 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

Keloids of the earlobe and the ear in general are very common and do occur in all ethnic groups. They can range in size from fairly small and discrete to large, deforming, painful and attention grabbing. What they all do have in common is their conspicuous location and unwanted presence.

Though some keloids of the ear and earlobe have a very high predilection to recur and are quite challenging to permanently eradicate, most can be treated successfully with a combination of plastic surgery, steroid injections and postoperative monitoring for any signs of regrowth. The surgery typically involves complete removal of the keloid and reconstruction of the defect in order to obtain as normal appearing an ear or earlobe as possible. Concurrent with this, I will injection an effective dosage of steroid medication that serves to suppress the risk of regrowth.

It is then important to keep a watchful eye for any signs of recurrence as this is more likely to happen within the first year and a half after treatment. If identified early, a strategic amount of a steroid medication injected into the area is usually effective in controlling and reversing this keloid regrowth. Unfortunately, many patients do not take this postoperative monitoring part seriously so they do run the risk of the keloid growing back to a size that can be as big or even larger than the original one.

The following patient of mine illustrates a few of these issues. She is a 24 year old female who had a keloid of left ear for many years . It was first treated three years ago with a steroid injection by her physician but there was no follow-up monitoring. Consequently, it re-grew to a far larger size than it was before her treatment. Another physician attempted laser treatments but they were predictably unsuccessful.

A)  Keloid of left ear before surgery

B)  After keloid removal left ear

C)  Keloid before surgery – oblique view

D)  After keloid removal – oblique view

The size of the keloid of the left ear when she saw me in consultation was 2.5 cm, or 1 inch (Fig. A and C). My treatment for her consisted of complete excision of the keloid under local anesthesia, reconstruction of the defect and an immediate steroid injection (Fig B and D). Sutures were removed at one week and she was started on a silicone scar cream at 3 weeks. Monitoring her every one to three months, she has shown not even the slightest evidence of a recurrence.

If you would like more information on the treatment of 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

Gynecomastia, or male breast enlargement, is a common problem that can afflict a significant percentage of adult males depending on age, medical history, and drug, medication and steroid usage. The negative impact on self-esteem, social interactions and behaviors can be quite substantial. Many men avoid certain sports or activities because they are too embarrassed to expose their “feminized” chest to others which exposes them to the risk of ridicule or derogatory comments. Such behaviors and untoward consequences have been documented in several medical studies.

I have seen many men in their 20’s with the most minimal, virtually imperceptible enlargements who are devastated by their “deformities”. They are in great shape, well sculpted and with a low BMI (body mass index) but they are so bothered and obsessed with their nominal “enlargement”.

Now imagine a teen-age boy – hormones raging, confused, relatively emotional (some males actually have that capacity despite what most women think!), insecure, probing their machismo – and with GYNECOMASTIA!

How exactly do you think he feels?

You would be quite right (and immensely understated) if you said “not very good”.

Unfortunately, there has been little previous research on this age group of affected males despite the fact that up to 69% of boys experience gynecomastia during puberty. Thankfully, though, most will have resolution of their enlarged breasts within 1 – 3 years.

A prospective study was performed at Boston’s Children’s Hospital and Harvard Medical School which investigated the psychosocial impact of adolescent gynecomastia. It used a large sample size, control group and valid survey assessments. The outcome was just published this month in the journal of Plastic and Reconstructive Surgery.

While not totally surprising, the findings were quite important and eye-opening including. Self reported social and mental health are notably impacted including reduced self-esteem and social interactions. There was an association with depression, anxiety, adjustment disorders, suicide ideation, disordered eating behaviors and thoughts (though they didn’t exceed the threshold for eating disorders). These boys frequently experienced embarrassment, humiliation, rejection and teasing as a consequence of their gynecomastia. One very interesting and not so intuitive finding was that those adolescents with very minor breast enlargement could be just as severely impacted as those with far more substantial enlargements.

The findings from this comprehensive study as well as from other smaller studies and case reports and from personal observations, all point to gynecomastia being much more than just a cosmetic issue (which is how it has been largely treated in the past). It clearly has a major negative psychosocial impact on those boys who are afflicted with male breast enlargement. Consequently, there needs to be serious consideration for earlier treatments including surgical intervention.

For more information on gynecomastia and male breast reduction surgery or to schedule a complimentary consultation with me, please contact my office at 480-451-3000.

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

For those of you who think that there may be too much plastic surgery in the Scottsdale and Phoenix metropolitan area.

Who disparage the women of Scottsdale stating that their breast augmentations, tummy tucks and liposuction make them appear too superficial and overdone.

Who may feel that cosmetic surgery is just so frivolous and it reflects the shallowness of the individual who has had it…

I now offer you the other alternative for your viewing, er, pleasure:

The sunbathing women of St. Petersburg, Russia
REUTERS/Alexander Demianchuk

Yes, they are 100% natural – pure, unadulterated women. No breast augmentations. No nose jobs. Or tummy tucks. Or anything resembling cosmetic surgery or even cosmetics in general.

Come to think of it, I wonder if they even have teeth? Or any iota of good taste and discretion.

But there they are, in the snow and cold of St. Petersburg, Russia, in early March proudly flaunting their surgically untouched physiques. Even though they are “perhaps” beauty challenged, they do appear to be quite happy and contented.

So, who are we to judge them?

Matter of fact, there may be some inebriated older men “cruising” around who may be whistling at them right now.

Yes, so when it is illustrated this way, the beautification of Scottsdale and Phoenix aided with plastic surgery is not so bad after all, is it? And knowing that plastic surgery does increase the particular individual’s confidence, self-esteem, happiness, satisfaction and so forth – it can be a win-win for everyone.

* * * * *

If you would like information on any plastic surgery procedure that I perform such as breast augmentations, breast reductions or tummy tucks or to schedule a complimentary consultation with me, please call my office at 480-451-3000.

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

Dr. Steven Turkeltaub uses a combination of liposuction and fat injections to level out depressed scars, add fullness to the face, and provide greater volume and improved contours to the body.

Phoenix, AZ – At the Arizona Center for Aesthetic Plastic Surgery, Dr. Steven Turkeltaub’s Phoenix plastic surgery practice, patients are able to use their own fat to provide fullness to other areas of their bodies. With fat transfer (fat injection) procedures, Dr. Turkeltaub can add volume to other areas of the body in order to create smoother, more proportionate or natural contours, provide greater fullness and projection to various areas and even level out depressed scars.

According to Dr. Turkeltaub, an individual’s own fat has almost limitless potential as a filler/volume enhancer to address cosmetic concerns ranging from facial creases and irregular contours resulting from previous liposuction procedures to breast contouring of both a reconstructive and aesthetic nature. At the Arizona Center for Aesthetic Plastic Surgery, he says the common uses for fat injection procedures in the face are to provide greater volume in the cheeks and brows for a more youthful appearance as well as to reduce the size of creases such as around the mouth.

The Phoenix plastic surgeon says fat injections are also commonly used for breast reconstruction and breast revision patients who have very thin breast tissue for any of a number of reasons. Additionally, Dr. Turkeltaub notes some breast reconstruction and breast revision patients end up with irregularities, such as a flattening of the breast as a result of a mastectomy. He adds that reconstructions that also make use of fat transfer technology allow for a more natural-appearing breast than ever before, with smoother and more shapely contours.

Dr. Turkeltaub highlights that the best candidates for fat transfer procedures are patients that possess a fair to moderate amount of excess fat somewhere on their body. The patient must have a sufficient amount of fat to use for the transfer. He adds that extremely thin people are usually not candidates for this procedure as they do not have an adequate amount of fat necessary for proper treatment. In addition, Dr. Turkeltaub says patients should be in good overall health and maintain a wholesome diet and exercise routine.

According to the Phoenix plastic surgeon, fat injections can be performed either under local anesthesia, with or without sedation, or under general anesthesia – depending on the extent of the areas being addressed and other factors. He states that he oftentimes performs fat injection procedures in conjunction with liposuction. During these procedures, the fat is saved, collected, and then injected into the area(s) of the body the patient wants to volumize or have corrected. Rather than disposing of fat after liposuction and then harvesting more at another time for fat injections, Dr. Turkeltaub uses a technique that allows both procedures to be done simultaneously.

Ultimately, Dr. Turkeltaub notes that fat harvesting and injection techniques have improved over the years and results are now more predictable than ever before. In the end, he says some patients are better candidates than others, and who would be an appropriate candidate needs to be determined on a case-by-case basis during a consultation with a board-certified plastic surgeon.

About Steven H. Turkeltaub, MD, PC

Dr. Steven Turkeltaub is a board-certified plastic surgeon who attended Boston University and Boston University School of Medicine for a six-year medical program from which he received his medical degree. He is the author of papers, articles, and textbook chapters on plastic surgery that appear in national magazines and newspapers. Additionally, he is an active member of the American Society of Plastic Surgeons, American Society for Aesthetic Plastic Surgery, and the Arizona Society of Plastic and Reconstructive Surgeons among other prestigious medical organizations. Dr. Turkeltaub is available for interview upon request.

Can aesthetic plastic surgery result in you feeling more confident, happy and satisfied with your life in general?

Be more satisfied with your body?

Are the effects evanescent or do they persist long term?

Can it improve the way you interact with others?

Can it positively affect your sex life?

There has been many articles in the medical literature, some not necessarily rigidly scientific, that largely support the positive benefits that cosmetic plastic surgery has on a person’s confidence, self-esteem, happiness, body image, interpersonal relationships and even sex life. Of course there are multitudes more of similar impressions and anecdotes.

In my post: Can a Breast Augmentation or a Breast Lift Improve My Sex Life? , I noted that following a breast augmentation or a breast lift, 61% of those women reported an increased frequency of sex and 70% had improvement of quality and satisfaction of their sex life. Of course, this study looked at only one anatomic area and sought an answer to a specific question.

A prospective study conducted in Germany and Switzerland that was just published in Clinical Psychological Science, provides sound scientific evidence of the positive psychological benefits of cosmetic plastic surgery in general. In this research, a large group of 544 first time plastic surgery patients was carefully evaluated and compared to a group of 264 people who had desired plastic surgery but elected not to follow through and with another group of 1000 people who never had any interest in such procedures. These latter two groups served as controls to provide a more sound basis for any findings. There were noted to be no differences among the groups in depressiveness and life satisfaction. The plastic surgery patients were assessed prior to surgery and at 3, 6 and 12 months postoperatively and then compared to the other groups.

What were the findings?

Even at twelve months, the patients who underwent cosmetic plastic surgery noted an improved quality of life and sense of well-being, greater satisfaction, happiness and feelings of attractiveness. They had more confidence and self-esteem along with less anxiety – not only of the operated on area but also of their body in general. All this was statistically significant.

The findings from this study clearly show the broad spectrum of positive benefits that plastic surgery can have on the right patient. They should also serve to further dispel the misguided thinking that cosmetic surgery is a superficial and frivolous endeavor.

For information on any plastic surgery procedure that I perform or to schedule your complimentary cosmetic consultation, please contact my office at 480-451-3000.

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

Silicone breast implants have become increasingly popular as the implant of choice for breast augmentation surgery over the last several years. This follows the Federal Drug Administration (FDA) lifting its restrictions on their usage back in 2006. As of last year, data from plastic surgeons revealed that silicone breast implants were used in 72% of the breast augmentation procedures while saline implants were selected only 28% of the time – an almost 3:1 ratio.

In my Scottsdale and Phoenix plastic surgery practice, the numbers are even more dramatic. Nearly 99% (not an exaggeration) of my patients undergoing a breast enlargement or a mastopexy with implants choose silicone implants over the saline implants. The 1% who do elect to go with the saline ones are not selecting them because they think that they feel more natural. They don’t. Instead, the most common reason is an immediate cost issue – the saline implants are less expensive than the silicone ones.

There are many reasons for the accelerating popularity of silicone breast implants for breast augmentation surgery. Probably the most important reason is the naturalness of their feel – like a youthful breast. Saline implants can’t come close to matching this at all. In fact, after holding and feeling the saline implants, most of my patients (and their significant others, when present) state that they feel like water balloons. This is clearly not a ringing endorsement of them.

In over twenty five years of practice, I have never had one patient or a significant other tell me that they preferred the saline implants over the silicone breast implants because they feel more natural. That is an amazing though not surprising 100% consensus.

Of course, there are several other reasons that make the silicone breast implants far superior to the saline ones not only for a breast augmentation or a breast lift with implants but also for breast reconstruction. With the politicization of their usage now in the somewhat distant past and the clarification of their safety following the most comprehensive evaluations of any medical product or device ever, I would expect that silicone implants will become the easy choice for an increasing percentage of women.

For more information on silicone breast implants, 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

You might have seen slick ads or advertorials on TV touting the amazing facial rejuvenating results from simple non-surgical proprietary procedures that sound like they are fairly equivalent to a standard surgical facelift. Great looking, energetic moderators (sales people!) and overly professional appearing physicians enthusiastically hyping the procedures, often using multisyllabic, obscure, impressive sounding terminology that aims to create an aura of authenticity or even scientific substantiation. THEN – there is a cavalcade of the most contrived overly enthusiastic patients who share their effervescent testimonials. We are shown their pre- and postoperative photos capturing what appears to be miraculous photoshopping, uh, I mean transformations.

Did you ever notice that the before photos of these patients quite often show them as angry or unhappy, without make-up, overweight and looking like they hadn’t slept for days? In their after photos, they can’t smile enough, appear thinner, their makeup is exquisitely done, hair is perfect and they exude an almost saintly radiance.

Do I sound a bit cynical?

Well, it’s because non-surgical procedures purporting to rejuvenate the face CAN’T have anywhere near the effectiveness of a properly performed facelift. They may add volume which can affect contour, the duration of which is quite variable. However, they typically don’t tighten, reposition, redrape and remove excess skin – maneuvers that are mandatory for appropriate, predictable and longer lasting facial rejuvenation.

Ever hear of the Vampire Facelift?

It’s a great name that evokes intense, colorful (red!) imagery. It is also a patented procedure that simply involves injecting your own blood that has been processed along with a hyaluronic acid dermal filler (the same material that comprises Juvederm®, Restylane® and Perlane®) into your face, adding volume and affecting contour. No removal of loose, excess skin. Or tightening.

How ‘bout that Stem Cell Facelift?

It sounds almost like a science fiction procedure, one at the vanguard of technology. Anything that mentions stem cells just has to produce miracles. Right?

Not quite!

The procedure involves injections into the face of fat (which is commonly done) which normally has high concentrations of stem cells, except in this procedure, the practitioner often claims to have increased the concentration of these cells. Despite countless anecdotes and “papers” purporting to prove the increased effectiveness of this approach, there are no peer reviewed scientific papers substantiating this. Again, there is no skin tightening, repositioning or removal of excess skin. This stem cell facelift is, in essence, just injections of fat into the face which already is being commonly done as an ancillary procedure of a standard facelift. But with “stem cell” in the name, the practitioner can promote this as an amazing cutting edge treatment and, consequently, charge exorbitant amounts of money.

And get lesser results than from the a traditional facelift.

So buyer beware!

If you need a facelift, then get a facelift – and from a reputable board certified Plastic Surgeon.

Don’t fall for slick marketing hype!

For more information on facial rejuvenation procedures such as a facelift or full face CO2 laser skin resurfacing or to schedule a complimentary consultation with me, please call my office at 480-451-3000.

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

They say that it “pays to be nice” (though I’m not sure who the “they” are).

Yeah, that’s true most of the time but not always. Ever hear the expression that “nice guys finish last” – so who knows?

One thing that is even truer than this is that it “pays to be beautiful”.

Yes, that‘s right. It is called the “beauty premium” and it has been a known fact for a very long time. Multiple scientific studies have also substantiated the important role that attractiveness can have on the success of a person’s career including the earning of substantially more money than those who are not so physically fortunate.

A survey conducted by the now defunct Newsweek back in 2010 revealed that:

• A majority of hiring managers noted that job candidates who were qualified for the job but were unattractive could expect to have a much more difficult time obtaining a job as compared to someone who was more physically appealing.
• In ranking applicant attributes in the order of importance, these hiring managers placed attractiveness ahead of education (experience was number one, confidence two and appearance three).
• These managers generally recommended that job seekers spend just as much money and time making themselves as attractive as possible as they do on creating their optimal resume.
• Attractive women earn 4% more than those women who are not; for handsome men, the corresponding beauty premium is 5%. (This is quite a surprise and not very intuitive in that this effect is both present in men and with an even greater reward.) This difference can add up to over $250,000 over a working career.

All of this is particularly relevant in these challenging economic times. Our present day job market is horrific at best. Good jobs are at a premium and the competition for these positions can often be brutal due to an overabundance of qualified and overqualified applicants. The tie breaking factor may just be your appearance.

Many more people are seeking plastic surgery now not only because they want to look better and feel better about themselves but also because they want to be more competitive in the job market. I have clearly seen this in my plastic surgery practice and this is true for both men and women. What I’m also frequently hearing is that older, far more experienced, qualified and reliable workers are forced have to compete with the younger generation who also may not only be  relatively more attractive (more youthful, for sure) but also less expensive to have on the payroll.

The cosmetic procedures that are sought after are both surgical and non-surgical in nature. The most common non-invasive significant cosmetic procedure are Botox® injections (particularly of the crow’s feet and the frown lines) and facial fillers (Juvederm®, Restylane®, and Radiesse®) to soften facial creases and lines.

The plastic surgery procedures can and do run the full gamut but most commonly include breast augmentation, liposuction, rhinoplasties (nose job) and tummy tucks as well as the anti-aging ones – facelifts, blepharoplasties (cosmetic eyelid surgery), forehead lifts and facial laser skin resurfacing.

So, just perhaps, plastic surgery may allow you not only to obtain the appearance that you have always wanted, provide you with more self-confidence and self-esteem but it also may be a great investment for your future career and financial well-being.

For more information on any plastic surgery procedure that I perform or to schedule your complimentary cosmetic consultation with me, please call my office at 480-451-3000.

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

Mommy makeovers are becoming increasingly popular as more and more women realize that they have wonderful plastic surgery options available for improving the appearance of their bodies following completion of their families. You might have worked diligently to lose most or all of your baby weight, exercised religiously and scrupulously watched your diet BUT: You don’t have the same body that you had before having your child(ren).

Multiple or even just one pregnancy can wreak havoc on even the most careful woman. Even though you might have limited your weight gain during pregnancy, you still may be left with permanently lax and excess abdominal skin that also may bear significant and extensive stretch marks. Your tummy may also protrude despite all the sit-ups, weight lifting and aerobics that you do. There may also be larger or new areas of “gross” fat deposits on your abdomen as well as elsewhere, making an undesirable situation even worse.

And then there are your breasts…

If you are real lucky, maybe they haven’t changed too much. But more than likely, unfortunately, they are not what they used to be. Often, they have become smaller and less firm. Sometimes they actually remain larger but are droopy, irregular, uneven and laden with stretch marks. Their postpartum appearance is dependent on a multitude of factors including genetics, weight gain and fluctuations, bra wearing, history of breast feeding including number children that were breast fed and the duration, smoking and nutrition.

You look in the mirror or at yourself directly and wish that you could have your pre-pregnancy body back. In fact, you may be quite self conscious about your appearance now which can adversely affect your self-esteem, confidence, social interactions and even your relationship with your husband or significant other.

Mommy Makeover to the rescue!

Yes, a Mommy Makeover may significantly and effectively improve the appearance of your body, correcting changes that occurred from your pregnancies and, in some situations, allow parts of you to look even better than they were before having your family.

What exactly constitutes a Mommy Makeover?

A Mommy Makeover isn’t one specific procedure but instead, a combination of procedures appropriate for each specific woman that will correct and improve areas that have not fared well as a result of child bearing and breast feeding (when relevant). Typically, it involves surgery to improve the appearance of the breasts and the abdomen but plastic surgery of other areas can also be performed at the same time, such as liposuction or eyelid surgery, in order to obtain an even more dramatic rejuvenation.

The cosmetic breast surgery may just consist of a breast augmentation if there has been some “deflation” of the breasts but no drooping. When there is also hanging breast tissue, a breast lift with or without breast implants could be performed. In situations where the breasts have enlarged or are just large and droopy, a breast reduction may be the procedure of choice.

Considerations for the abdomen would include a full tummy tuck, mini tummy tuck and liposuction. What would be most appropriate would depend on several factors including the presence, extent and location of the skin laxity and excess fat. Liposuction of other areas can also be done concurrently – such as of the thighs, hips, flanks, back and knees – in order to obtain even greater contouring improvements.

A Mommy Makeover not only allows you to undergo a major and positive transformation in your appearance but it can also do wonders for your self-confidence, psyche and sense of attractiveness.

A definite win-win situation.

For more information on a Mommy Makeover or on any other plastic surgery procedure that I perform or to schedule your complimentary consultation, please call my office at 480-451-3000.

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

For years, we have been awaiting FDA approval (U.S. Food and Drug Administration) of the “gummy bear” silicone breast implants so that they could be offered here as an option for breast augmentation, breast reconstruction and breast revision surgery. The wait is, alas, finally over. Yesterday, on February 20th, 2013 the FDA announced their formal approval for the usage of this implant. Officially, the implant is called the Natrelle® 410 Highly Cohesive Anatomically Shaped Silicone-Filled Breast Implant or the shorter version, the Natrelle® 410.

For more information on this newly approved silicone breast implant, please see “Gummy Bear” Silicone Breast Implants Just Approved by the FDA for Usage on our breast specialty website www.arizonabreast.com.

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

Trying to find relevant and interesting topics in plastic surgery for my blog that may grab your attention can be challenging at times. After all, there are probably only so many times (thousands?) that you can hear about all the liposuction various actresses had and what’s involved with that surgery. Or that so and so actress has so much Botox® injected to annihilate any and all wrinkles that when she pencils in her brows, the point often slips and glides up her frozen forehead to her hairline like someone stumbling with smooth soled shoes on black ice.

Well this time I know that I’ve found something very interesting (particularly if you have measurable levels of testosterone) while surfing a multitude of internet sites. It was sheer serendipity that it my eye caught a glimpse of a more than intriguing title on a web page declaring: “Boob-staring good for men” which also led to another: “Staring at women’s boobs good for men’s health”?

Somehow, I missed this article when it first became public though it might have been because the research was conducted in Europe and so it wasn’t initially translated into English. Only fairly recently was it published in English and, quite notably, in the prestigious New England Journal of Medicine.

This involves a study performed by German researcher, Dr. Karen Weatherby, which discovered the health benefits for men by the simple and natural action of staring at women’s breasts for at least 10 minutes per day. Based on her data, she stated that: “Just 10 minutes of staring at the charms of a well endowed female is roughly equivalent to a 30 minute aerobics workout”.

This 5 year study involved 200 men who were monitored and assessed for multiple parameters including pulse, blood pressure, heart disease, weight and diet. One hundred of these men were told to stare for specific amounts of time daily at firm and shapely “D” cup or larger breasts of younger women, a majority who had undergone breast augmentation surgery. The other hundred men served as controls for scientific purposes, and were prohibited from this “indulgence”.

At the completion of the research, Dr. Weatherby found that those men who stared at voluptuous breasts of women for at least a minimum of ten minutes per day had lower blood pressures, slower pulse rates (indicating greater fitness) and less heart disease than the control group who were not allowed to engage in this ogling. She found that, in addition, there was a statistically significant reduction in the occurrence of heart attacks and strokes. Potentially, this can save and prolong lives though the study was too small in size and not conducted long enough to be able to answer this definitively.

She theorized that the reason for these unexpected health benefits was that: “Sexual excitement gets the heart pumping harder and faster and improves blood circulation just like what a person experiences with intense sports or aerobics.”

So according to this research, it’s actually OK, in an unusual sense, to be a male chauvinist pig. Or a creepy staring weirdo or ogling pervert.

It’s good for your heart health and more!

Though many women may feel very uncomfortable, vulnerable or even threatened by this relatively boorish male behavior, they should consider the important collateral benefits for men who do have a shorter lifespan on average than women.

A little more tolerance from women (if I should say so myself)!

Dr. Weatherby has called for more studies to be conducted by other researchers and with far greater numbers of participants in order to be able to reconfirm her findings and answer other important health questions. Interestingly, she is considering a related study in the future where, instead of men, she will use lesbians so as to see if there is a similar benefit experienced by these women.

*****

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

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

For more information regarding the above study, please click here.

The United States is the plastic surgery capital of the world based on total numbers of plastic surgery procedures being performed according to the International Society of Aesthetic Plastic Surgeons (ISAPS). We account for 17% of the world’s cosmetic surgery procedures and almost 25% of the non-invasive procedures. This is based on a survey of plastic surgeons throughout the world. As would be expected by necessity, much of the data is extrapolated. Furthermore, because non-plastic surgeons were not included in the data, the true number of cases being performed here would be far higher.

Rounding out the top five countries in total number of plastic surgery procedures are Brazil, China, Japan and Mexico. When this data is assessed on a per capita basis (including both surgical and non-invasive cosmetic procedures), the United States ranks only in fourth place, behind South Korea, Greece and Italy.

When evaluated for the total number of plastic surgeons, the United States also ranks number one in the world, accounting for almost 20% of the world’s total. The rest of the top five are Brazil, China, Japan and Mexico – which also parallels the total numbers of procedures being performed in these countries.

What is the top plastic surgery procedure being performed in the world today?

Liposuction, possibly related to an increasingly overweight world population. Breast augmentation was a close second. However, in the United States, breast augmentation was the most popular plastic surgery procedure performed, significantly ahead of liposuction which was number two.

This should be of absolutely no surprise to anyone given our cultural tastes for large breasts and voluptuous cleavage. In fact, we accounted for one fourth of the total number of breast augmentations in the world.

Here’s an interesting question: If the number of breast augmentations done in the Scottsdale and Phoenix area were compared to the totals of all the countries of the world, do you think it would rank in the top ten?

Just wondering!

The third most common plastic surgery procedure done by plastic surgeons in the United States are tummy tucks, followed by eyelid surgery (blepharoplasty) and breast lift (mastopexy). The top two non-surgical procedures are Botox® injections and dermal fillers with hyaluronic acid (Juvederm®, Restylane® and Perlane®).

Yes, America leads the world both in natural and plastic surgery facilitated BEAUTY!

*****

If you would like information on any 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

A tummy tuck, also known as an abdominoplasty, is the very common and effective plastic surgery procedure employed to help rejuvenate the appearance of the abdomen. By tightening the muscles and tissues of the abdominal wall, removing excess skin and fat and contouring the remaining tissues, a flatter, tighter and more shapely abdomen can be obtained. The result can be a dramatic improvement in the appearance which you can be very happy with. Weight loss and targeted exercising can’t, by themselves, lead to this result.

Now there is evidence of another benefit of having a tummy tuck: the possibility of long-term weight loss. An unexpected twofer!

Wouldn’t that be nice!

Whether or not there is a relationship between long-term weight loss and body contouring procedures like tummy tucks and lower body lifts (for massive weight loss or MWL) has been pondered in the past but has not been scientifically investigated. Now, a pilot study conducted in the Los Angeles area and just published in the February 2013 issue of the Plastic and Reconstructive Surgery® journal lends credence this possibility.

This clinical study evaluated 20 women for short and long-term weight loss after having undergone an abdominoplasty. Multiple factors were considered and assessed in order to detect any correlations. After one year, fourteen of the twenty women had maintained a weight loss in excess of the amount of tissue resected in surgery. Their average body mass index (BMI, which is derived from weight and surface area) was around 30 (considered borderline obese) prior to their tummy tucks and decreased to 23 at one year (18.5 to 25 is considered to be normal). Those whose BMI was greater than 24.5 were more likely to lose weight than those less than this number.

There was also a positive correlation between the amount of tissue removed during surgery and long-term weight loss. Those who had more than 4.5 pounds removed were more likely to have this result as compared to those who had less than 4.5 pounds removed. (Of course, the amount of tissue removed at the time of surgery was accounted for in the weight loss calculations.)

Two factors may play a role in this long-term weight loss following tummy tuck surgery. First, it was discovered that three quarters of the women who maintained this lower weight experienced an increased sense of satiety (fullness) either after eating or throughout the day. Therefore, they ate less.

The second factor may be that by removing the fat cells contained in the resected tissue, there could be a reduced stimulatory effect on the appetite centers in the brain. The reason for this is that these fat cells release a variety of hormones which are known to enhance one’s appetite. Fewer fat cells results in lower levels of these hormones which translates into less stimulation of these centers – and less eating, fewer calories.

Ultimately, larger scale studies will need to be performed in order to more definitively corroborate such a positive relationship between tummy tuck surgery and long-term weight loss.

Wouldn’t it be wonderful if we eventually determine that an abdominoplasty is not only great for your appearance but also beneficial for your weight and health?

Abs –solutely!

For more information on a tummy tucks, lower body lifts for massive weight loss or for any other plastic surgery procedure that I perform, please call my office at 480-451-3000. You can also arrange for a complimentary consultation with me as well.

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

Breast implant exchange, which involves the removal of a woman’s present implants and replacing them with new ones, is a commonly performed procedure. This type of breast revision surgery is done for many reasons including:

1) size change – going bigger or rarely, smaller
2) replacing old implants with a new and similar ones
3) breast implant rupture
4) switching the implant type from saline to silicone (going from silicone to saline is very rare)
5) capsular contracture
6) shape/configuration alterations such as going to a higher profile implant (more projection)
7) development of infection (exceedingly rare)

This type of breast revision is usually associated with little or no significant discomfort. Compared to their initial breast implant placement for breast augmentation, this is generally a far easier and more pleasant experience.

The following patient of mine is a typical example of breast implant exchange surgery. She originally underwent breast augmentation surgery 6 years ago, at age 18, with the placement of moderate profile, smooth surfaced saline breast implants base size 240cc that were filled to 240cc on the left and 265cc on the right (Fig A, C and E). These were placed in a submuscular pocket employing an inframammary incision. This translated into a “C” cup bra for her which was exactly what she had wanted. She was very happy with the results.

A) 7 years after breast enlargement with saline implants in submuscular pocket

B) After implant exchange using smooth surfaced silicone implants

C) Before implant exchange – side view

D) After implant exchange – side view

E) Before implant exchange – oblique view

F) After implant exchange – oblique view

Several years later now, she decided that she would like to be somewhat larger and more projecting as well as switch to silicone breast implants. In this intervening period of time, she had experienced absolutely no problems with her breast implants.

This patient the underwent bilateral breast implant exchange with the insertion of ultra-high profile smooth surfaced silicone breast implants, sizes 360cc on the left and 400cc on the right (Fig B, D and F). Virtually no discomfort was experienced postoperatively and she returned to work within a few days. She was very thrilled with the outcome as this was exactly what she had wanted.

If you would like more information on breast revision surgery, breast augmentation, breast implants or for any other plastic surgery procedure that I perform, you can call my office at 480-451-3000. At that time, we would also be happy to schedule you for a complimentary consultation with me.

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

In a previous article, Fat Grafting in Breast Reconstruction: A Major Innovation That Can Lead to Great Results, I reviewed some of the most important innovations in breast reconstruction over the last 25 years with the most recent one being the usage of fat grafting for improvement in contouring. This technique, now commonly used, has provided the means to obtain significantly improved breast reconstruction results in many situations that previously had no practical solution.

Fat grafting, however, isn’t the only relatively new major addition to the plastic surgeon’s breast reconstruction armamentarium that facilitates the potential for aesthetically superior reconstructive results. Probably of even greater importance in the advancement of breast reconstruction has been the introduction and widespread usage of acellular dermal matrices (ADM’s) such as Alloderm® and Strattice® , which are processed, non-cellular and non-antigenic tissue. These products have been somewhat revolutionary for both immediate and delayed breast reconstruction as well for revisions of previously performed breast reconstructions. Among some of their advantages have been to provide for greater predictability and control of implant position, a lowered risk for hardness developing following implant placement (known as capsular contracture) which is a particularly high risk for those who have had radiation treatments for their breast cancer, and even for thickening of very thin tissues which allows for greater support and shaping as well as a reduced risk or extent of rippling or contour irregularities.

With regard to breast implants, there are greater choices related to configuration which were not available twenty or even ten years ago. We now have what are known as high and ultra-high profile silicone breast implants which means that they provide not only greater projection but also do so with less width. In the past, the more limited breast implant choices precluded the ability to obtain more appropriate projection in many women undergoing breast reconstruction.

The following case of mine illustrates all three of these innovations and the effects that can be obtained in breast reconstruction when properly and precisely employed.

This is a 52 year old woman who underwent a right mastectomy and reconstruction elsewhere 12 years previously. This was followed five years later by a revision. On the left breast, she had undergone either a breast lift or reduction in order to obtain closer symmetry between the two sides. She saw me in consultation because she wasn’t satisfied with her results which were problematic both when wearing and when not wearing clothes. No method of padding or using inserts in her bra could camouflage the significant differences between the two sides.

A) Before right breast reconstruction revision and left mastopexy – frontal view

B) After revision of right breast reconstruction and left breast lift – frontal view

C) Before right breast reconstruction revision and left mastopexy – oblique view

D) After revision of right breast reconstruction and left breast lift – oblique view

E) Before right breast reconstruction revision and left mastopexy – side view

F) After revision of right breast reconstruction and left breast lift – side view

As you can see from her photos, there are multiple significant deficiencies including of contour, size and projection as well as substantial asymmetries between the two sides (Fig A, C and E). Her skin on the right was so thin that the underling saline implant could be easily felt. Furthermore, the breast was also quite firm.

How did I address all these issues?

On her right side, I released the deforming, tight scar tissue. Alloderm® was placed for shape, tissue thickening and support. Her saline implant was replaced with a much larger and a very high profile silicone breast implant. Fat injections were then employed to correct the significant contour deficiencies as well to improve the overall shape and projection. For the left side, a mastopexy was performed to better match the shape and projection of the right (Fig B, D and F).

Needless to say, she was extremely happy with her results and no longer has to wear padding in her bra.

If you would like more information on breast reconstruction including the use of fat injections or acellular dermal matrices such as Alloderm® or Strattice® or for any other plastic surgery procedure that I perform, please call my office at 480-451-3000. You can also schedule a consultation at that time.

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

Gynecomastia, enlarged male breasts, is a very common problem that men don’t usually talk about much but one that can be very stressful to bear. Enlarged, often feminized breasts, can present quite a challenge to a guy’s self-esteem, particularly to the machismo of men in their teens, twenties and thirties.

There’s nothing like hyping one’s masculinity in front of others including by flexing those sinewy biceps and showing off the finely sculpted six pack abs – and then accidentally take off ones shirt revealing … “C” cup sized man boobs!

“Wow!”

“Nice breasts you got there, Bob (or whatever the name is)!”

Not a real good scene … particularly if you are that guy.

Fortunately, as I have indicated in multiple previous blogs including most recently, The Success of Male Breast Reduction Surgery for the Treatment of Gynecomastia, treatment of this problem is usually quite straightforward and successful – physically, mentally and emotionally.

The following patient of mine is another quite representative example of a male bothered by his bilateral gynecomastia which is worse on one side. He is 21 year old and has had this problem since puberty – it never resolved, unlike that which occurs in a majority of men (Fig. A, C and E). He felt very self-conscious and, in fact, avoided removing his shirt in public including when engaging in a variety of sports.

A) Gynecomastia – before surgery (frontal view)

B) After liposuction and R. breast tissue excision

C) Gynecomastia – before surgery (oblique view)

D) After liposuction and R. breast tissue excision

E) Gynecomastia – before surgery (side view)

F) After liposuction and R. breast tissue excision

Treatment for him consisted of ultrasonic assisted liposuction of both breasts with direct excision of breast tissue from the right side which was larger (Fig. B, D and F). Following surgery, he was placed in a compressive dressing which was then replaced by a tight fitting elastic garment two days later. He experienced little discomfort from the procedure and which was well treated by a minimal amount of pain medication. By three weeks, he was able to work out and engage in sports without limitations.

If you would like more information on male breast reduction surgery for the treatment of gynecomastia or for 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

Dr. Steven Turkeltaub assists his Phoenix plastic surgery patients in eliminating pockets of fat resistant to diet and exercise

Phoenix, AZ – Dr. Steven H. Turkeltaub, a board-certified plastic surgeon in Phoenix, believes the emphasis on beauty in society can cause appearance to be very important for one’s social life, career advancement, and self-esteem. At the Arizona Center for Aesthetic Plastic Surgery, his private practice, he offers his patients both the standard tumescent liposuction as well as ultrasonic-assisted liposuction to help treat their unwanted, persistent fat and allow them to realize a more sculpted and desirable look.

According to the Phoenix plastic surgeon, the ideal liposuction candidate is a person who is in good overall health and who has localized fat deposits. He says this allows for more dramatic and precise sculpting of various areas of the body. Dr. Turkeltaub also states that even patients who are at or near their ideal body weight may have localized fat deposits that fail to respond to diet and exercise. He strongly emphasizes that liposuction is not a weight loss solution and it should not be used indiscriminately for the widespread removal of fat because this can lead to a variety of significant problems including very serious acute health issues.

The most common areas men seek liposuction for include:

• Abdomen
• Love handles/flanks
• Breasts in male breast reduction
• Neck

For women, the areas they commonly target for liposuction are:

• Abdomen
• Flanks
• Thighs
• Hips
• Knees
• Back
• Neck

Dr. Turkeltaub explains that ultrasonic-assisted liposuction utilizes ultrasound waves to disrupt the fat, allowing for easier and more even fat removal. In some areas, it does provide for an increased margin of safety as compared to traditional liposuction.

Tumescent liposuction involves the injection of a fluid containing both an anesthetic and vasoconstrictor into the targeted fat prior to beginning the liposuction. The advantages of this approach are that it significantly reduces blood loss, reduces bruising and minimizes postoperative discomfort. It is an integral part of ultrasonic-assisted liposuction and can be used with standard liposuction.

At the Arizona Center for Aesthetic Plastic Surgery, liposuction is usually performed under general anesthesia for the comfort of the patient. Unless very large amounts of fat are removed, the procedure is done as an outpatient procedure. Most of Dr. Turkeltaub’s Phoenix plastic surgery patients are physically active within the first 24 to 48 hours. They are instructed to refrain from engaging in sports and other vigorous physical activities for around two and a half weeks. Most of the discernible swelling will resolve by 4 – 6 months. However, it may take up to a year for patients to see the “final,” long-term result.

About Steven H. Turkeltaub, MD, PC

Dr. Steven Turkeltaub is board certified by the American Board of Plastic Surgery. He earned his undergraduate and medical degrees from the Six-Year Medical Program at Boston University and Boston University School of Medicine. He has authored several papers, articles, and textbook chapters on plastic surgery that have appeared nationally in numerous magazines and newspapers. Dr. Turkeltaub is dedicated to providing the Phoenix and Scottsdale communities with a comprehensive span of plastic surgery procedures ranging from breast augmentation to BOTOX® Cosmetic.

He is available for interview upon request.

If you are a woman, you probably have at some point in your life, wished to be supremely beautiful with voluptuous lips like many of the renowned Hollywood actresses and other female celebrities?

A young Goldie Hawn

Right?

An older Goldie Hawn – with lip enlargement

Wrong!

Well, they were somewhat nice before she had a bad lip augmentation

What about these?

Courtney Love – younger and the after lip “enhancement”

Yikes! She should have left them alone!

Here are some more really bad lip enhancement outcomes on a variety of celebrities.

Taylor Armstrong

Lisa Rinna

Jackie Stallone

You would think that just maybe, with all their fame, fortune and connections and access to the self anointed “plastic surgeons of the stars”, these celebrities would have a little better taste in lips and the doctors that they choose to go to!

Nah!!!

Actually, it is not surprising on either account. With random results that I have seen over the years in patients coming from the Hollywood and L.A. area, I have not been very impressed. So much of what we hear is unwarranted hype and not based in reality.

Unfortunately, many patients and even treating physicians subscribe to the “bigger is better” approach. They indiscriminately inject excessive amounts of fillers such as Juvederm® or Restylane® into the lips and in the process, violate and obliterate the important landmarks. The consequences can be quite deforming and strikingly bizarre.

Then again, if your goal is to have your lips simulate the appearance of one of a variety of food items – like sausages, duck bills or even trout lips – then you will have achieved your goal. But they will be dis-taste-ful.

Congratulations!

My philosophy on lip augmentation (or lip enhancement), is to enhance them tastefully so that they will appear as natural as possible and be harmonious with the rest of the face. The important and delicate anatomical landmarks of the lips must be preserved while at the same time, enhancing their natural and ideal curves. This requires a fine understanding of the aesthetics of the lip as well as the ability to skillfully create or recreate such results with the dermal fillers like Juvederm® and Restylane®. Consequently, I perform all the lip enhancements on my patients – I do not delegate this to anyone else.

*****

If you would like to schedule a complimentary consultation with me regarding a possible lip augmentation or even any other plastic surgical procedure that I perform, please call my office at 480-451-3000.

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

A question that I’m asked by virtually every patient of mine seeking a face lift is: “How long will my face lift last?”

When you analyze the words closely, the answer would really depend on what one means by “last” mean? Does it mean when there first are noticeable changes in the results over time? Does it refer to the length of time that it would take the face to look like it otherwise it would have looked had it never been operated on? Or, does it mean the time it would take to get back to the patient looked just before having surgery?

As you can see, depending on the intended meaning of the question, the answers can be quite different. Nevertheless, if we consider things in generalities, then some helpful information can derived.

Another issue that has to be considered in being able to provide a useful and informative answer is the effects of a multitude of variables and factors uniquely associated with each person. More precisely, the results of an identical face lift procedure performed on different people would depend on each person’s chronological as well as physiological age, smoking and drinking history, stress, weight and weight fluctuations, health, presence of certain medical issues such as diabetes, genetics and sun exposure.

One must consider the surgical technique and its performance. Different approaches for face lift surgery can yield varying levels of durability of the results. Furthermore, the skill with which a particular technique is performed can positively or adversely affect the long term outcome.

The best plastic surgery research study performed to date which sought answers to how long a face lift lasts was just published in the December 2012 issue of the Plastic and Reconstructive Journal. Conducted in Great Britain, it evaluated both subjective and objective data on 50 patients 5.5 years postoperatively who had undergone a face lift by the same plastic surgeon. Three different face lift techniques were employed on patients ranging in age from 40 to 62, with an average age of 51 years old.

The analysis of the data indicated that at 5.5 years following a face lift, 76% of patients still appeared younger after their procedure than they did prior to it. It was also discovered, though not too surprising, that there was some variability of aging depending on the area analyzed.

This information is somewhat helpful in ways though it does not provide an accurate answer to a specific person. Empirically, we know that patients who are younger, have better skin elasticity and no medical problems can be expected to have longer lasting results compared to considerably older patients who have poor skin elasticity and multiple medical problems.

What general answer do I give my patients regarding this durability issue?

I tell them to expect that at any point in time after surgery they should still look better than if they had never had it at all. This difference here should be greater shorter term but less significant very long term.

For more information on a face lift or other facial cosmetic procedures like a blepharoplasty or forehead lift, please call my office at 480-451-3000. You can also schedule a complimentary consultation with me at that time.

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