Juvederm® is the most common injectable that I used for lip enlargement. Because of the discomfort associated with injecting fillers into the lips, I do nerve blocks to anesthetize the lips so that my patients don’t feel anything. The flip side of this is that the nerve blocks can be slightly uncomfortable and the ensuing numbness will persist not just in the lips but in surrounding areas of the face for a few hours. This can make speech, enunciating and eating more difficult until it wears off.

Fortunately, now there is a great solution to this dilemma. Allergan, the manufacturer of Juvederm®, received approval from the U.S. Food and Drug Administration’s (FDA) at the beginning of February to market a new formulation of this product that contains the preservative free local anesthetic lidocaine. It is being marketed as Juvederm® XC and contains a powder form of the anesthetic so that there is no dilution of the concentration of the hyaluronic acid.

I have used this Juvederm® XC on my patients including for lip enlargement without any nerve blocks. My patients unanimously found the injections to be very tolerable and comfortable whereas before without a nerve block, they would have been quite uncomfortable. Not only were they relieved in not needing the initial blocks but they also noted that there were no significant effects on their speech or enunciation.

If you would like more information on Juvederm® XC, Radiesse®, Botox® or any plastic surgery procedure that I perform or to schedule a free consultation with me, you can contact my office at 480-451-3000.

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

Many take elaborate precautions so others may not perceive or notice their defect. They wear wearing bulky, loose fitting clothes so the lack of nipple projection won’t be perceived; avoid taking showers in school in front of other women, and change their clothes only in absolute privacy. It can inhibit them from wanting or making themselves available to date. When it comes to intimacy, the impact and stresses can be almost unbearable.

Fortunately, the solution to this often psychological devastating problem of inverted nipples is quite simple and minor. The procedure involves the release of restraining, shortened ligaments and ducts that are preventing the nipple from protruding out. Surgery, which may take only a half an hour to treat both nipples, can be performed in the office under local anesthesia employing tiny incisions that leave essentially imperceptible scars. Pain and down time are minimal with most patients going back to school or work the next day.

Inverted nipple - before treatment

Inverted nipple surgically treated

If you are interested in obtaining additional information on the treatment of inverted nipples or other cosmetic breast surgery such as a breast augmentation or mastopexy or to schedule a consultation with me, you can contact my office at 480-451-3000.

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

1. size change – usually to increase the implant volume and therefore the breast size; rarely to decrease
2. to modify the breast configuration such as to make them more projecting or less wide
3. to switch from saline to silicone implants; rarely, silicone to saline
4. replace a ruptured breast implant
5. in the course of treating one of a variety of aesthetic breast issues such as drooping or capsular contracture, replacing older implants with newer ones.

The most common reason for implant exchange is that a woman is unhappy with the selected size and wants to be significantly larger. It is fairly infrequent to desire a smaller size and this is often due either to the surgeon placing a far too large implant initially or the patient gaining a considerable amount of weight resulting in a marked enlargement of breast tissue.

In my practice, it is fairly rare for my patients to desire a change their breast implant size and if they do, it is usually years later. Why can I keep this rate extremely low? When evaluating my patients in consultation, I listen carefully to exactly what they want or think they want. I also measure and size them in the office, have them try on a variety of implants, and show them photos of other patients to provide them with a greater understanding and visualization. During surgery, this is fine tuned, as I will employ temporary implants in order to assess the effects of various sizes and configurations.

By offering many different styles of breast implants, I can customize the appearance that would be most appropriate and desirable for my patients. For example, patients who are very narrow and desire significant projection would be best served with higher profile implants whereas women who are broad with a moderate amount of breast tissue present may benefit more from moderate profile implants. Many of the patients that I perform implant exchanges on were done elsewhere and indicated that they were never offered or explained the options.

It is essentially unanimous that women prefer the silicone implants over the saline ones as they feel similar to breast tissue. When switching between fill materials, virtually all go from saline to silicone whereas the opposite is almost never performed due to aesthetic issues.

If you would like more information on silicone or saline breast implants, breast augmentation, breast lifts or 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

What is cellulite? It is an anatomic structural abnormality involving the fat, tissue between globules of fat and the overlying skin which is affected by hormones and genetics. The skin in these areas has lost its elasticity, presenting with a relative laxity and contour irregularities.

Liposuction will remove the underlying fat but will not address the overall intrinsic anatomy of the area nor will it have any effect on the elasticity of the skin. With less fat stretching out the overlying damaged skin, the cellulite will actually worsen in appearance. Therefore, liposuction is not a treatment for cellulite.

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

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

Nevertheless, many individuals who have gauged their earlobes decide at some point in time for any of a number of reasons that this appearance is no longer desired or appropriate. Removal of the gauges will result in the shrinkage of the size of the stretched deformity over a period of several months but there will never be closure of the created defect. The ultimate appearance including the size of the persistent defect, quality of the skin, extent of residual stretching and drooping will be affected by a multitude of factors. Many times this residual deformity can attract just as much attention if not more as having large prominent gauges still in place.

Now what? Fortunately, plastic surgery can be performed on the earlobe to reconstitute a more normal appearance. This reconstruction can be performed under local anesthesia in the office. It involves excising the skin along the margins of the opening and configuring a closure that will yield an acceptable earlobe shape. Discomfort from the procedure is usually fairly mild and often requires no pain medication. Sutures are left in for approximately one week.

If you have questions regarding the treatment for gauged earlobes or other earlobe or ear deformities, would like information on any other plastic surgery procedure that I perform or to schedule a consultation, please call my office at 480-451-3000.

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

With this in mind, a question that my office and I are commonly asked is if liposuction can be used as a weight loss procedure. The typical scenario is that the individual is considerably over their ideal body weight, sometimes 40 to 100 pounds or more, and just can’t lose the weight. They are frustrated and state that diets and exercising have not worked. Some indicate that they would use the results from liposuction to motivate them to be more diligent in dieting and exercising.

Delving further into their particular situations reveals that most are not even remotely adhering to their diets, and instead, are consuming far more calories than they think or want to admit to. Their exercise regimens also are highly inadequate, burning off far fewer calories than they think or hoped for. Thus, there is little or no weight loss.

Liposuction, in these situations and in general, is not and should not be employed as a method for weight loss. Removal of large amounts of fat from the body at one time does increase the risk for significant complications or even death when massive and inappropriate suctioning is performed. It is a widely accepted tenet that taking out 5 liters or less of fat in one surgical session is the prudent choice. This translates into only approximately 11 pounds at the time of surgery with the long term amount being notably less.

When you add up the attendant costs for the surgery including possible time off of work, the surgical risks that one is taking, and the considerably compromised aesthetic outcome, it rarely is a wise choice to use liposuction as a means for weight loss. Instead, I strongly recommend being far more diligent in dieting and exercising in order to lose weight.

If you would like more information on liposuction, tummy tucks, other body contouring or plastic surgery procedures or to schedule a consultation with me, you can contact my office at 480-451-3000.

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

Having been in plastic surgery practice for over 22 years in Scottsdale and Phoenix, Arizona, I have long been involved and dealt with and witnessed the multitude of factors and issues regarding silicone and saline breast implants. Prior to 1992, my patients used silicone implants exclusively and were quite happy. During the period of the moratorium in which all my breast augmentation patients and some of my mastopexy and breast reconstruction patients utilized saline implants, I noted that the aesthetic results and level of satisfaction with the naturalness of outcome were decreased and compromised compared to results with silicone implants.

This sentiment came as no surprise. Why? Silicone breast implants feel very natural and “soft”, like breast tissue, so that when they are in place, it often is very difficult to discern their presence particularly for the non-professional. Saline implants, on the other hand, can often be detected, either by sight, feel or both. This is exacerbated in very thin patients who often have “rippling” seen through their skin. These issues and others such as deflations do detract from their popularity. In patients of mine who have had both types of breast implants, every single one of them preferred and were far more satisfied with the silicone ones.

In the more than 3 year period since the lifting of the moratorium on the usage of silicone breast implants, virtually none of my patients select saline implants for their breast surgery which translates to around 99% silicone usage. For the rare few who do, it is only because of the lower cost of the saline implants.

If you are interested in obtaining additional information on silicone or saline breast implants, breast augmentation, mastopexy or any other plastic surgery procedure that I perform or to schedule a consultation with me, you can contact my office at 480-451-3000.

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

If you are interested in scheduling a consultation with Dr. Steven Turkeltaub, you can contact our office at 480-451-3000.

Arizona Center for Aesthetic Plastic Surgery
Scottsdale and Phoenix, Arizona

What is in Radiesse®? It is composed of calcium hydroxylapatite (CaHA) microspheres suspended in a proprietary biocompatible non-allergenic gel that can easily be injected to obtain the desired results. CaHA is the same material found in your teeth and bones. Not only does it provide volume by its presence but it also stimulates the body to produce collagen (protein) resulting in long lasting results.

The injections generally are not associated with much discomfort and can be performed in the office without the need for nerve blocks. The results are seen immediately and can be quite dramatic. Swelling is fairly minimal and typically subsides within 24 to 36 hours.

How long does Radiesse® last for? The duration of the results does vary depending on a variety of factors but somewhere between twelve to eighteen months is fairly typical which significantly exceeds the results of the hyaluronic acids such as Juvederm™, Restylane® and Perlane®. Touchups will often be needed during this period of time to help maintain the results.

If you would like additional information on Radiesse®, Juvederm™, Botox® or on any plastic surgery procedure or service 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

Several biomedical companies offer this tissue though there are clearly differences in the products, results and risks. AlloDerm® by LifeCell Corp. has been the most studied of these with the results being superior.

In the December issue of Plastic and Reconstructive Surgery (Vol. 124 Number 6), a study from the University of Rochester delineated several advantages of acellular dermis in breast reconstruction. For immediate breast reconstruction using tissue expanders, they noted that the expanders could be filled to far greater amounts when AlloDerm® was employed as compared to a different technique. Postoperative inflations were fewer and completed much sooner and allowed for the insertion of the final breast implant at an earlier date. This translated into an accelerated rate of reconstruction, more predictable and satisfactory results and the potential for a better aesthetic appearance. Best of all, there was no significant difference in complication rates with its usage.

I have been using AlloDerm® in my patients undergoing immediate as well as late breast reconstruction procedures and have found it to be an incredibly invaluable addition. It allows for clearly superior and more predictable results in configuration, positioning and softness and reduces the need for subsequent procedures to further refine the results.

If you would like to obtain additional information on breast reconstruction including the usage of tissue expanders or on any other plastic surgery procedure that I perform or if you want to schedule a consultation with me, you can contact my office at 480-451-3000.

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