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.

###

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

Fat injections have been used in the treatment of contour deformities of various areas of the body as well as for rejuvenation, particularly in the face. Referred to also as lipofilling, fat is suctioned from areas of excess deposits, then processed and injected into where it is needed. This technique has been used with increasing frequency to further refine the results of breast reconstruction in order to obtain fuller, more projecting and natural appearing contours. The question that many plastic surgeons and others have regarding this approach is whether or not the injected fat is associated with an increased risk of recurrent breast cancer.

A study published in the Annals of Oncology in May 2011 provides some answers that may be helpful in resolving this issue. The research involved analysis of data on 321 women who had surgery for breast cancer performed in Milan, Italy and who subsequently underwent lipofilling as a component of their breast reconstruction. They were then case matched to 642 women who also underwent surgery for breast cancer but did not have any fat injections as part of their breast reconstruction. Follow-up after the surgery for breast cancer averaged 56 months; for those who underwent lipofilling, this number was 26 months.

What were the results?

It was found that eight women from the lipofilling group and nineteen women from the control group had local recurrences, a difference that was not statistically significant. For recurrences of noninvasive breast cancer, also known as an “in situ” cancer, there were three recurrences in the fat injection group whereas there were none in the control group, a difference that was statistically significant. The researchers felt that this result may have potentially been affected by the very small numbers involved, the relatively shore follow-up time, and the fact that previous research has shown that the control group should have had an average rate of recurrence of over 2 percent for this period of follow-up time yet this particular group yielded none.

Though this study is by no means the definitive answer on the subject of the safety of fat injections for women undergoing breast reconstruction, it surely does provide comforting evidence to those women considering lipofilling as part of their overall reconstruction.

For more information on breast reconstruction surgery including the usage of fat injections or for any other plastic surgery procedure that I perform, or to schedule a consultation with me, please feel free to call my office at 480-451-3000.

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

A labiaplasty, or the plastic surgical reduction and improvement of the labia minora, is the Rodney Dangerfield of cosmetic surgery: “it doesn’t get no respect!” Many people who have heard of the procedure consider it to be a frivolous, incredibly unwarranted one sought out by superficial, self-absorbed women who have too much time on their hands, more money than they know what to do with and are of so little of substance that they even have to critique the anatomy of their private parts. Often, the phrase “Scottsdale women” is used in the same sentence.

Is this perception of a labiaplasty reflective of reality or is there more to the story?

As with any cosmetic procedure, there is a subset of women who obsess about any real or imagined imperfection of a part of their body. With regards to their labia minora, they want designer ones which are what a labiaplasty can offer.

However, a majority of women have real and substantial issues which this procedure can address. For example, large protruding labia minora can be painfully stretched, compressed and irritated during a variety of physical activities, particularly horseback riding and bike riding as well as with sex. This can result in skin breakdown and even chronic infections. Tight and form fitting clothing can elicit similar problems as well as create significant embarrassment by making the anatomic problem fairly evident to the general public. Finally, the considerably enlarged labial size can create a variety of hygienic problems.

When performed correctly, a labiaplasty can successfully address both the cosmetic and functional issues that are associated with atypically large and prominent labia minora. It can alleviate the issues that had been associated with a variety of activities including having sex as well as improve self-esteem.

In later posts, I will cover specifics on the procedure itself including techniques and expectations. If you would like more information on the labiaplasty procedure or for any other plastic surgery procedure that I perform, or to schedule a consultation with me, please feel free to call my office at 480-451-3000.

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

At the time you decided to have your earlobes gauged, it seemed like a great idea. Maybe you just wanted to look different than most everyone else and this was a statement of your individuality. Perhaps it was done as a sign of rebelliousness and disdain for authority. Or, maybe it just made you look cool.

Whatever the reason was then, you probably didn’t consider the long term consequences of your action. Now you may be looking for a respectable job but many businesses won’t hire you because of your “statement” – unless you are applying at Starbucks. If you are considering enlisting in the military – forget it. They straight up won’t take you as long as you are walking around with holes in your earlobes.

What can you do?

Fortunately, gauged earlobes of essentially every possible degree of distortion and stretching can be reconstructed using meticulous plastic surgery techniques that both close the hole and provide a reasonable appearance. The following patient of mine illustrates both a fairly typical initial deformity and the outcome that can be achieved though plastic surgery.

This is a 29 year old male who had gauges in his earlobes for a year and a half and now needed to remove them and have the resulting holes closed (Figures A, C and E).

A.) Gauged right earlobe

B.) Right earlobe after surgery

C.) Gauged left earlobe

D.) Left earlobe after plastic surgery

E.) Gauged left earlobe

F.) Left earlobe after plastic surgery

His reconstruction was performed in the office with just local anesthesia, an approach that he found to be quite comfortable. Employing precise plastic surgical techniques under magnification, the earlobes were able to be reconstituted to an appearance that looked normal again (Figures B, D and F – which are 3 months post surgery). Needless to say, he was extremely happy and grateful with the results.

If you have any questions on the treatment of gauged earlobes 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

A question that is often on the mind of women who are contemplating undergoing a breast augmentation in Scottsdale and are also planning on having children in the future is “will my getting breast implants have an effect on my ability to breast feed?” This actually is a very good question that has a positive answer which I will share with you in one word:

No!!

Let me explain this to you in a little more detail.

When breast implants are inserted for a breast enlargement using either the inframammary (lower breast crease) or transaxillary (armpit) approach, there is no need to disrupt any of the breast tissue whether or not they are placed in front of (submammary) or behind the muscle (submuscular). When a periareolar (around the areola) incision is employed, there is actually a disruption of some of the ducts in the process of creating a pocket for the implants whether or not they are placed above or below the muscle. Even with this approach (where dissection traverses some breast tissue), most of the ducts and their connection to the areola and nipple still remain intact.

Over the years, many of my breast augmentation patients have had children some time after their surgery and I am unaware of anyone who was unable to breast feed. Of course, there are women who do not have breast implants and who are unable to breast feed.

If you would like more information on breast augmentation surgery in Scottsdale or breast implants or for any other plastic surgery procedure that I perform, please feel free to contact 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

Who knew that the harmless but descriptive term “blonde bombshell”, an epithet for a voluptuous, well endowed, drop dead gorgeous blond woman could one day be taken literally?

The same goes for the expression that “she has killer boobs”.

This weaponized breast/bra approach will definitely capture the attention of airport security.

Our world is being threatened by religious forces of evil and hatred that are twisting and perverting scientific, technological, aesthetic and medical advances for destructive purposes. This is not unlike many previous groundbreaking advances such as controlled nuclear fusion and fission that can be employed for peaceful purposes like nuclear power plants or for war and lethal uses as in annihilative nuclear weapons.

Now it seems that even a breast augmentation can be used for nefarious purposes.

What is the world coming to?

What is this all about?

Islamic terrorist groups are seeking to use implantable explosive devices that won’t raise suspicions and are nearly impossible to detect, allowing the terrorist to effectively evade security in order to wreak havoc on airplanes and elsewhere. Breast implants are the ideal readymade device to accomplish these nefarious acts. They are large enough to hold a highly lethal amount of explosives that could predictably blow a plane out of the sky. Pectoral and buttock implants are other possibilities that also would not raise much suspicion.

How can this be done?

The implants, which normally may be filled with saline can instead, be filled with an explosive such as PETN which is stabile until a chemical reaction is initiated. This reaction is simply precipitated by injecting the chemical trigger into the implant at the desired time which is accomplished by puncturing the skin with a sharp device that contains the element. The object can be modified and disguised to appear as a nondescript pen. All the terrorist has to do is just pull out the device and stab himself/herself to initiate the lethal reaction. This can be performed anywhere on the plane: while sitting in a seat, in the restroom or even near the cockpit.

The only good news about this is that if you had an “irrational” fear of flying before, it is at least not so irrational any longer.

Finally, to paraphrase a slogan from the 60′s so as to apply it to breast augmentation surgery: Make love, not war!

For more information on peaceful uses of breast implants or on breast augmentation surgery, please feel free to contact my office at 480-451-3000.

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

Extensive, prolonged sun exposure without skin protection has been associated not only with premature aging of the skin but also with an increased risk of developing a variety of skin cancers, most commonly basal cell carcinoma, squamous cell carcinoma and malignant melanoma. The risks are far higher in those with fair skin than burns and lower in those who are dark complected. Tanning booths have also been identified as a highly efficient short-cut to developing these unwanted problems.

The method of action of the facilitating of accelerated aging and development of skin cancers is through ultraviolet radiation from the sun and tanning booth elements that penetrate through the top layers of the skin. The main culprits are ultraviolet B (UVB) and ultraviolet A (UVA).

The most obvious ways to minimize ultraviolet radiation damage to our skin is to decrease our sun exposure, protect our skin when we are out in the sun and to stay away from tanning booths. Applying effective sunscreens and wearing protective clothing can reduce our exposure to these harmful ultraviolet rays.

There is considerable confusion in determining what is an effective yet safe sunscreen due to the fact that so much of the available information as well as marketing is misleading and inaccurate. For example, the SPF number that is listed for a particular sunscreen applies only to the UVB rays and has no bearing on the protection provided, if any, to the more deeply penetrating and also damaging UVA rays. Unfortunately, there is no similar number or standard that we can use to assess and compare UVA protection levels. Compounding this problem even more is the fact that sunscreens with an identical SPF number do not offer the same level of protection.

Since 1978, the federal government has unsuccessfully attempted to regulate sunscreens with a variety of proposals. It now appears that there may be a more common sense plan that will allow the consumer to be far more informed when trying to decide which brand to buy. Of course, only time will tell if this will be the case. This system will not be implemented until next year.

In essence, there will be a standardization of terminology and claims which also involves the abolishment of the terms “sunblock”, “waterproof” and “sweat-proof”. The term “broad spectrum” can be claimed by those sunscreens that meet the specified criteria. “Water-resistant” can be used but manufacturers will have to specify whether this is for 40 or 80 minutes. Ratings above an SPF of 50 will not be allowed as there is no evidence that any of the products provide this level of protection.

As part of the continuing quest to maintain youthful looking skin as long as possible, we must remember to minimize our sun exposure, refrain from using tanning booths, avoid smoking and effectively use sun protection techniques daily. With the advent of what appears to be a more helpful way of assessing the effectiveness of sunscreens, we may just have more success in preserving our looks.

For more information on skin care, skin care products or even skin cancers or to schedule a consultation, you can call my office at 480-451-3000. We also offer a wide variety of skin care products in office as well as at our online skin care store that may help meet your personal needs.

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

Dr. Turkeltaub on Rise of Tummy Tuck Procedures in Arizona

144,929 tummy tuck procedures were performed in 2010, making it the fourth most popular cosmetic enhancement procedure, according to the latest statistics from the American Society for Aesthetic Plastic Surgery (ASAPS). Dr. Steven H. Turkeltaub, a board-certified plastic surgeon in Arizona, discusses the 13.3% increase compared to 2009, as well as the fact that a majority of Americans now approve of cosmetic enhancement.

More than 9.3 million cosmetic enhancement procedures were performed in 2010, which is a 9% increase from 2009 according to the most recent data from the American Society for Aesthetic Plastic Surgery (ASAPS). One of several reasons for this increase is an even greater acceptance of cosmetic surgery, which has become increasingly mainstream, says board-certified plastic surgeon Dr. Steven Turkeltaub. He adds that a slightly improved economy following a deep recession with pent up demand has played a significant role in this increase as well.

According to the ASAPS study, more than half of all Americans now approve of cosmetic enhancement. The tummy tuck, also called an abdominoplasty, is a popular procedure at Dr. Turkeltaub’s Arizona plastic surgery practice, a fact which is also reflected in the ASAPS report. The abdominoplasty was performed 144,929 times in 2010, which amounts to a 13.3% increase over 2009. Dr. Turkeltaub says one reason for the increase in this particular surgery could be the growing popularity of the mommy makeover procedure. The mommy makeover is a combination of procedures that can include not only a tummy tuck, but also a breast augmentation with or without a breast lift, a breast reduction, liposuction, and a variety of nonsurgical treatments.

Dr. Turkeltaub says Americans simply want to look as young as they feel and a tummy tucks is one of the procedures in the right person that can provide these results. If the economy begins to show more significant improvements, Dr. Turkeltaub says he expects the number of patients seeking a tummy tuck along with other cosmetic plastic surgery procedures to continue to increase substantially.

About Steven H. Turkeltaub, MD, PC

Dr. Steven Turkeltaub earned his medical degree from Boston University and the School of Medicine. He completed his general surgery residency at the University of Miami/Jackson Memorial Hospital and the Northwestern Medical Center, followed by his 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. Continuing medical education is also extremely important to Dr. Turkeltaub because it allows him to stay on the cutting-edge of plastic surgery.

The Arizona Center for Aesthetic Plastic Surgery is located at 10290 N. 92nd St. Ste. 207 in Scottsdale, AZ 85258, and can be reached at (480) 451-3000, or found online at either turkeltaub.com or the Plastic Surgery Arizona – Dr. Steven Turkeltaub Facebook page.

###