AnnaLynne McCord flaunts her flawed results

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

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

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

Adriana Lima au natural - before breast implants

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

Now, after a very nice breast augmentation.

Adriana Lima, supermodel, after breast augmentation

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

Worthy of fame and fortune.

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

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

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

Arizona Plastic Surgeon on Boosting Confidence in the New Year

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

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

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

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

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

About Steven H. Turkeltaub, MD, PC

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

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

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

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

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

Of course not!

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

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

Before breast reduction

After breast reduction

Before breast reduction

After breast reduction

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

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

SmartLipo™
Slimlipo™
LipoLite™
Etc.™

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

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

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

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

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

Thought so!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Not a pretty picture!

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

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

XEOMIN Now Available at Arizona Plastic Surgery Practice

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

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

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

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

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

About Steven H. Turkeltaub, MD, PC

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

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

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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

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