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

AnnaLynne McCord flaunts her flawed results

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

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

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

Adriana Lima au natural - before breast implants

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

Now, after a very nice breast augmentation.

Adriana Lima, supermodel, after breast augmentation

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

Worthy of fame and fortune.

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

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

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

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

SmartLipo™
Slimlipo™
LipoLite™
Etc.™

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

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

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

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

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

Thought so!

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

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

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

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

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

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

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

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

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

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

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

Not a pretty picture!

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

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

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

In several previous posts including most recently Buyer Beware When It Comes to Selecting A Doctor to Perform Your Plastic Surgery, I have emphatically stressed the importance of seeking a well qualified board certified plastic surgeon for your plastic surgery needs. This is true not only for cosmetic surgery procedures such as breast augmentation, tummy tucks and facelifts but also for non-surgical ones like Botox® and Dysport® injections and dermal fillers such as Juvederm®, Restylane® and Radiesse® to enhance facial volume and address deep creases and wrinkles. (Note: There are many well trained and skilled dermatologists who also offer these injectables.)

It may seem rather obvious to you as to why you would want to have your cosmetic surgery performed by someone who is well trained and board certified in plastic surgery. Unfortunately, I have seen countless, otherwise intelligent patients over the years who knowingly sought care from poorly “trained” health care providers that often unscrupulously portrayed themselves as either plastic surgeons or an “equivalent” and ended up with either substandard  or even disastrous outcomes.

Even with injectable agents, training, experience as well as ethics matter. There are individuals in virtually every area of the health care industry offering Botox®, Juvederm®, Restylane® and other dermal fillers such as anesthesiologists, obstetricians and gynecologists, internists, family practitioners, nurses, dentists, naturopaths and other “para-professionals”. A weekend course is not enough to provide one with the aesthetic foundation, nuances, skills, experiences, etc. that would be a requisite for safe and appropriate outcomes.

The following patient who I saw exemplifies this problem. (She was very happy to share this experience with others so that they might be able to avoid the situation that she has found herself in.) She was unhappy with some grooves below her lower eyelids (called naso-jugal grooves) that were making her look old. There was no excess skin or fat bags. While living in California, an experienced plastic surgeon skillfully treated them with Restylane® resulting in an excellent outcome.

After moving here, a friend recommended that she use her person who wasn’t a doctor of any kind or even a nurse – but did offer injectable treatments. This provider not only injected the absolutely wrong material but also did it unskillfully and in the wrong location – and precipitated significant bleeding.

Eyelid bags and swelling created by inappropriate and unskilled injection of dermal filler into lower eyelids

Left lower eyelid bag resulting from dermal filler injection

Rights lower eyelid bag resulting from dermal filler injection

A trifecta of incompetence!

This unfortunate patient now has extremely prominent injectable created bags and distortions where there were none before. Making matters worse is that this is not a correctable situation. Hopefully with time, the injected material will dissipate and there will be no permanent long term deformities.

So, the next time that you are considering cosmetic plastic surgery, Botox® for your wrinkles or even treatment of the creases and grooves of your face with dermal fillers, think “Plastic Surgeon”.

If you would like information on any cosmetic plastic surgery procedure that I perform 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

Our very own Dr. Steven Turkeltaub is honored to have been named a recipient of the 2010 Patients’ Choice Award. This accolade is to recognize physicians nation-wide who have made a clear-cut difference in the lives of their patients. The criteria for the Patients’ Choice Award is based on a set of rigid factors, including: bedside manner, doctor-patient interaction time, follow-up care, professionalism of support staff & overall superior patient experience and care. There are a plethora of positive physician reviews submitted by patients online everyday, however very few physicians receive rave patient reviews on a consistent basis. In fact, Dr. Turkeltaub is among only 6% of physicians in the country to receive this distinction

The adage that “you get what you pay for” is very true for a segment of the plastic surgery market. In fact, it can be further modified to state that “you get what you pay for – and less!” What I am referring to is seemingly bargained priced cosmetic surgery that is not being performed by plastic surgeons but instead by those who have had little training and may not have your best interests at heart. These often includes physicians who have not had extensive formal surgical training but instead have taken even just “weekend” courses to learn and earn their way to luxury.

Unfortunately, many patients seeking plastic surgery select their physician based on price or glitzy marketing but neglect to thoroughly investigate their credentials and reputation. I have seen too many patients in consultation who were subjected to considerably substandard cosmetic surgery performed on them often by unscrupulous, greedy and poorly “trained” doctors who deceitfully and dishonestly portrayed themselves as plastic surgeons either overtly or by overwhelming inference.  They may use the term “cosmetic surgeon” as if it is a synonym for a “plastic surgeon” in name and training which it is not. These commonly have included physicians with primary medical training in internal medicine, family practice, gynecology, emergency medicine or general surgery.

The attraction invariably was much lower total prices along with fancy ads. Ironically, many experienced the bait and switch scheme resulting in total expenditures that often far exceeded what they would have paid to have their surgery performed by a reputable, well-trained plastic surgeon. Of course, if you then add in the total costs for corrective surgery (which may never fully reverse the inferior outcome that they were left with) and the final outlay can be multiple times higher.

As a health care consumer, you need to do your homework though it can be daunting and you still can be deceived. Don’t be swayed by marketing, suaveness of the physician or their staff, a luxurious appearing office and low prices as these are often ruses and props used to further deceive you into believing that you will receiving top notch care. It is quite often just the opposite.

Make sure that the doctor that you are considering is residency trained in plastic surgery and board certified or board eligible (this board eligible part can be confusing) by the American Board of Plastic Surgery though this doesn’t guarantee a particular result. It does at least inform you that he or she has received a certain level of training necessary to be able to perform as a competent plastic surgeon.

The often cited and wannabe “American Board of Cosmetic Surgery” is not officially recognized by the American Board of Medical Specialties but is instead somewhat of a marketing deception that uses its official sounding name to confuse the public into believing that their “certified” physicians are the equivalent or better than residency trained and board certified plastic surgeons.

Buyer beware!

As most of you already know, I trained in a plastic surgery residency program in Massachusetts and am a board certified plastic surgery by the American Board of Plastic Surgery which is a recognized board by the American Board of Medical Specialties.

If you would information on any type of plastic surgery that I perform such as breast augmentation surgery, tummy tucks, rhinoplasties and facelifts, you can call my office at 480-451-3000. We would also be happy to schedule a complimentary consultation for you if you so desire.

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

In an article posted on June 21st, I discussed the risks that people take by seeking cosmetic surgery south of the border (Don’t Seek Plastic Surgery South Of The Border). Attempting to save money, too many patients expose themselves to substandard and poorly regulated medical care that results in disappointingly inferior outcomes for the “fortunate”, permanent and irreversible severe scarring and deformities for many or even death for the very unlucky. Expenses for corrective surgery, which doesn’t fully resolve the deformities, can far exceed what the aesthetic procedure would have cost to be performed by a board certified plastic surgeon in the United States.

A variation on this theme involves cosmetic surgery being performed in this country by individuals who are unlicensed, may not even be formally trained or who may be enterprising illegal aliens individuals who exploit their own ethnic community in order to make money. At times, this can be a difficult deception to discern especially for those who are not well educated or at least versed in what to look for or inquire about. These practitioners often lie about their credentials, licensure and experience and may even operate out of a store-front or their home and under the radar.

Such was the case involving two sisters of Mexican descent who were running an illegal cosmetic filler practice in Sylmar, California. Their injection of liquid silicone into the buttocks of a perfectly healthy 22 year old Hispanic female in July lead to her needless death – a horrific but not rare tragedy that can be perpetrated by these illicit operations. The women who performed the injections fled to Mexico.

Deciding where to seek plastic surgery is very important and should be taken seriously – and not just for a breast augmentation, tummy tuck, rhinoplasty or even liposuction – but also for injectables such as Juvederm®, Radiesse® and Botox®. Your decision should be based primarily on qualifications and reputation and then secondarily on price. Though there is never any guarantee of outcome, make sure that the physician that you are considering is either board certified or board eligible by the American Board of Plastic Surgery and is a member of the American Society of Plastic Surgeons (ASPS) which has rigid ethical standards. (I am both board certified by the American Board of Plastic Surgery and am a member of the ASPS.)

If you have any questions regarding my qualification or certifications in plastic surgery or on any cosmetic surgery procedure that I perform 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

A recent report of the death of yet another American seeking cheap cosmetic surgery south of the border illustrates the ultimate price that people are imprudently willing to pay in order to potentially save money. Not everyone who undergoes plastic surgery in Mexico ends up dead or with disastrous results but I have surely seen countless patients over the years who have ended up permanently disfigured and scarred unnecessarily. Adding insult to injury, they often had to spend thousands and thousands of dollars more in attempts to correct their deformities. Many also were emotionally scarred from their experiences.

Is it really worth the risk to travel to a foreign country where rules, regulation and oversight are extremely lax, where the law is generally on the the practitioner’s side and you don’t really know what you are getting? Definitely not! Don’t go to Mexico or similar countries.

Plastic surgery should be taken seriously, whether you are considering a breast augmentation, tummy tuck, liposuction, facelift or any other procedure. This is your body and you do want the best possible results even though there are never any guarantees. Make you decision based on qualifications and reputation, not price, and confirm the information.

Many doctors who perform cosmetic surgery may mislead you into thinking that they are plastic surgeons when they are not. They may even claim to be board certified members of a cosmetic surgery board but this is essentially a marketing ploy to give them the appearance of legitimacy. Be wary.

For most cosmetic plastic surgery procedures, you should make sure that your doctor is either board certified or board eligible by the American Board of Plastic Surgery. Being a member of the American Society of Plastic Surgeons, which has strict ethical standards, is also important. These don’t guarantee an outcome but can surely assist you in making your decision. (I am both board certified by this board and a member of the plastic surgery society.)

If you have any questions regarding plastic surgery qualifications or any cosmetic surgery procedure such as breast enlargement, liposuction, tummy tucks or are interested in scheduling a complimentary consultation with me, please call my office at 480-451-3000.

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

It has been unequivocally clear to me that women prefer general anesthesia rather than a twilight anesthesia when undergoing a breast augmentation procedure. During my more than twenty two years of plastic surgery practice in the Scottsdale, Glendale and Phoenix metropolitan area, countless patients that consulted me for their breast revision surgery have recounted their highly unpleasant and very painful experience of having their breast enlargement performed with only sedation and local anesthesia. Many indicated that they felt wide awake. Even 15 or more years later, they still vividly remembered their horrible experiences – not something the operating doctor should be proud of.

An overwhelming majority of board certified plastic surgeons perform breast augmentations, breast revision surgery and breast lifts using general anesthesia in certified facilities such as outpatient centers and hospitals, using anesthesiologists – doctors whose specialty is providing anesthesia safely and effectively. It is a far more pleasant experience and overwhelmingly safe given everything else being equal.

Furthermore, in most of the situations where the twilight anesthesia (sedation with local anesthesia) is used, it is administered either by the operating doctor, a nurse anesthetist, a standard nurse or even worse, one of the physician’s office employees and is performed in an office. Quite a contrast in terms of safety, quality, standards and experience!

To compound the issue, more than likely the doctor performing the cosmetic breast surgery in these situations is not a board certified plastic surgeon. They may be an obstetrician-gynecologist, general surgeon or even a family practitioner or internist.

Would you really want these individuals who have not undergone long and rigorous training like plastic surgeons do performing your surgery?

I don’t think so!

If you have any questions regarding anesthesia and breast augmentations, breast lifts or breast revisions or on any other plastic surgery procedure that I perform or if you would like 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