The future is fat! Having just come back from the ASPS (American Society of Plastic Surgeons), meeting in Toronto last weekend fat is the rage. Fat grafting to the face and body helps restore your youthful appearance and has changed how I think about facelifting. Yesterday I used the waterjet which is a fantastic new machine to harvest fat more easily and gently and re-inject into a young woman’s hands. Hands are a great area for fat grafting as we all get older and the veins start to show more and this can show your age. Smooth full hands are a sign of youth. It is one of the areas I am asked frequently about. The waterjet pumps water into areas to help remove the fat in a more gentle way so that more will last or what we say “take” to the grafted areas. Usual areas of fat grafting is the face or hands or areas of liposuction that need refining. The website is www.humanmed.com if you are interested in the technology.
One of the main operations that I perform in Beverly Hills at the Lasky Clinic is revision breast surgery. As we all know, breast augmentation surgery is one of the most popular surgeries that we perform. It is not without its inherent risks however.
A capsular contracture is scar tissue that builds around an implant and can happen early in the healing process, (3 months), or happen years later. Many patients come to my practice seeking information about a possible revision. Capsular contracture is the condition that causes constriction of the breast and can at times be very painful. If it is what we call a Grade 4 capsular contracture, (one that is the most extreme), the plan is to re-operate and remove the scar tissue and replace the implant with a new implant. I can never guarantee however that the scar tissue will not just reform. We try and give patients advice on massaging the implant which I do feel helps keep a pocket open and may help prevent a re-encapsulation. Medications such as Vitamin E orally, 1000mg per day have been suggested to help prevent re encapsulation. Also, an anti allergy medication Singular has been helpful per some plastic surgeons experience.
Will insurance cover my surgery?
There are times that insurance will reimburse for a capsulectomy, (removal of hard scar tissue), if the patient has pain. Anything that is deemed reconstructive would be billable to insurance. There is no guarantee they will pay anything for the surgery so we send documentation to your insurance company to see if it is covered. Anything cosmetic.…such as replacing the implant and the implants themselves is the responsibility of the patient, as the insurance companies do not pay for cosmetic procedures.
Why should I go to you Dr. Cohen rather than any other surgeon?
You should always go to a surgeon who is Board Certified by the American Board of Plastic Surgery. I have been in practice 10 years in the Beverly Hills area and strive to take very good care of all of my patients. Yours safety is our greatest concern. I have been fortunate to have been elected Chief of the Division of Plastic Surgery at Cedars Sinai. Breast surgery is my passion and I do many breast reductions, lifts and many revisions of other breast surgeries that have not been performed well.
Isn’t a breast augmentation an “easy surgery” that anyone can do?
No. Every surgery is unique. It frustrates me to see young woman who go to doctors who charge less and are trying to get a deal. Remember you get what you pay for. Once the incision is made in the wrong place I can’t make it go away. I have seen woman here in town who have had the nipple incision placed in the incorrect place!
What other breast revision surgeries have you been doing lately?
I fix breasts that have rippling, breasts that are hard with scar tissue. Breast that are made too big that need to be smaller and also lots of patients just want them out!
If I get them out what will I look like?
Hard to say how they will look. Some patients will have extra skin and extra breast tissue. Most patients when I remove them they will replace with a smaller implant. Some will need a lift and some will not. It all depends on the tissues and the quality of the skin and breast tissue.
*The Vitalize Peel from SkinMedica brings the benefits of Retinoic Acid, Alpha/Beta Hydroxy Acids with Resorcinol to provide a strong, but gentle formulation suitable for all skin types and colors. Even after one peel you will notice improvement in your skin’s texture and tone, lessening of fine lines, and a healthier more youthful appearance. The Vitalize Peel is physician strength and has been clinically proven to help skin problems such as age spots, melasma, acne and fine lines. Dramatic results are achieved after a series of peels. Your peel will be scheduled every 3 to 4 weeks with minimal down time.
Special Offer only $125.00 ($200.00 value)
**$50.00 off of botox or dysport with your peel treatment
Space is limited so please call 310-598-1466 310-598-1466 or contact us today to schedule your appointment for May 6th and 7th
Andrew Cohen, MD
201 South Lasky Drive
Beverly Hills, Ca 90212
310.659.8771
www.andrewcohenmd.com
*The Vitalize Peel from SkinMedica brings the benefits of Retinoic Acid, Alpha/Beta Hydroxy Acids with Resorcinol to provide a strong, but gentle formulation suitable for all skin types and colors. Even after one peel you will notice improvement in your skin’s texture and tone, lessening of fine lines, and a healthier more youthful appearance. The Vitalize Peel is physician strength and has been clinically proven to help skin problems such as age spots, melasma, acne and fine lines. Dramatic results are achieved after a series of peels. Your peel will be scheduled every 3 to 4 weeks with minimal down time.
Special Offer Only $125.00 ($200.00 value)
***Bring a Friend and Both of You Get $50.00 Off of Botox or Dysport
Please call to schedule your appointment for
February 4th or 5th
Space is limited
Andrew Cohen, MD
201 South Lasky Drive
Beverly Hills, Ca 90212
310.659.8771
General anesthesia worries many patients. Many patients come to see me in the office and want only local and NOT general anesthesia when i know that if they are asleep they will have a better result. Many doctors do liposuction “awake” under “local” with no anesthesia.
Lots of smaller operations can effectively be done with just local anesthesia. That is when you are fully awake and i inject local anesthesia into the area being operating on. This is how i do moles, skin tags, laceration repairs on children, smaller lacerations on the hand, face or body. Fast acting local is used called lidocaine with epinephrine. This will last for around 2-4 hours in the area.
Local with sedation is more for larger operations. Many times i can do small liposuction areas with this type of anesthesia. Liposculpture of small areas like the neck or arms can effectively be done this way in the operating room. The patient is still monitored and an RN helps to monitor the patients vitals. We use an IV and give a patient Versed and sometimes Demerol or Fentynl for the pain and relaxation.
Larger operations that i perform like body contouring, tummy tucks, breast augmentations or lifts require full anesthesia. I am fortunate to work in an office with a fully accredited operating room with Board Certified Anesthesiologists. The patients are safely put under anesthesia with state of the art monitors and anesthesiologists.
Facelifts are done using a specialized technique. We use sedation with propofol. Our patients are not intubated and given a lot of narcotics. Just enough to make them comfortable and relaxed so that the surgeon can perform the surgery. It is a technique that has been used for over 15 years at the Lasky Clinic and has been well established and recognized as safe and effective.
If you are a man and have extra tissue in your chest , removing the tissue is the best option if done correctly and by a Board Certified Plastic Surgeon.
Many younger men I see as well as older men have breast tissue. Some have extra skin as well. Medications and genetics and weight gain all contribute to the problem of gynecomastia which is male breast tissue. If you are unable to lose weight and still have tissue in the chest area, you may be a candidate for cosmetic surgery to remove the tissue.
The best option is surgical excision of the tissue with liposuction. The surgeon will make the patient comfortable in the operating room with local or general anesthesia. We infiltrate the area with local anesthesia which helps with bleeding and pain. We then suction the area with small liposuction cannulas. Then a small incision is made at the areola site to go in and remove the tissue directly. Drains are left in and a surgical garment is worn for 1-2 months. If the nipple is hanging then there are times skin needs to be removed to tailor and shape the chest. It all depends on how elastic the skin is and the position of the nipple is.
The surgery lasts 2-3 hours and the recovery is usually around 1-2 weeks. Most patients return to work after a few days.
Remember to:
1. Always go to a Board Certified Plastic Surgeon who has a lot of experience in body contouring.
2. Check his pictures and make sure you see lots of results.
FAQs
1. Can this be done awake?
While it is nice to be awake with smaller procedures, having sedation or anesthesia is imperative for excision of gynecomastia. Most of my patients want to be comfortable during their surgery and having anesthesia allow less pain and less bleeding. This will also mean less post operative bruising.
2. Will insurance cover the cost?
Unfortunately, most insurance plans have not reimbursed the cost of excision of male gynecomastia. Most of the time they will not cover this as it is deemed cosmetic. You will have to call your insurance company and ask them if this is a covered procedure.
The CPT code is 19300, and the ICD-9 code is 611.1. Your insurance company will ask for these codes.
3. Will I have drains?
Two small drains are required after the surgery. These will be removed 3-5 days post op. They help prevent any retained fluid.
4. Do I really need to wear a compression garment and for how long?
Compression garments are imperative. These help push down on the skin and help you get a more even appearance to the chest wall. Patients will have them on for 3-6 weeks.
5. Can I go home after surgery?
This is an outpatient procedure and you may go home after the surgery. Some of my out of town patients stay at an aftercare facility here in town for one night. Depends on where you live and if someone is watching you the first night. Your post op visit with me will be on post op day one or two.
Congratulations to our very own Beverly Hills Cosmetic Plastic Surgeon, Dr. Andrew T. Cohen, for being recently featured in the news for his remarkable ability to restore contour and generate natural-looking results for his female patients after pregnancy with the mommy makeover procedure.
The challenges that new mothers face when working to regain their pre-pregnancy figures after childbirth are numerous. Often times, there are unsightly regions on the body that are resistant to rigorous exercise and/or disciplined dieting. Dr. Andrew T. Cohen has given many mothers a solution to this anguish by rebuilding their self confidence through performing the Mommy Makeover Procedure in his Beverly Hills plastic cosmetic surgery practice. The Mommy Makeover is an aesthetic enhancement option that is becoming one of the more popular requests at Dr. Cohen’s office. Click here to read more.
Do you have questions about removing unwanted fat from your body?
Have you been reading about laser liposculpture?
Today I will be using the latest in laser liposuction technology the SmoothLipo by the company Eleme. This has recently been approved by the FDA for liposuction. This is a laser that uses a unique combination of 980nm and continuous wave output to provide the ability to quickly and safely deliver the energy required to heat the targeted fat to the proper temperature. The results are consistent and repeatable and is said to provide optimal skin tightening. SmoothLipo target localized fat deposits using a carefully selected 980nm wavelength. The 980nm absorption profile allows for faster more homogenous heating of targeted areas producing a more uniform result. Continuous wave laser energy uniformly raises the temperature of the treatment area to 45-55 degress C, high enough to cause irreversible thermal death to the fat cells. This process is efficient and effective and continues well after the aspiration.
I will be making a video blog for my patients to see this laser liposculpture in action. I feel there may be some advantages to this new technology but patients need to realize that the results of surgery depend on the surgeon NOT a machine. Going to a Board Certified Plastic Surgeon is the best way to ensure that you will have an optimal result. You are paying for the surgeon’s skill and experience…. not a machine to give you the best results.
“Finally, after years of people telling me I looked tired, and seeing it myself when I looked in the mirror, I decided to look into cosmetic surgery for my eyelids. Dr. Cohen explained the benefits, what the procedure would involve and what to expect during the recovery and post surgery. My consultation with him gave me such confidence in him as a surgeon and such a comfort level in him as a person, that I made the decision to go for it. I’m so happy that I made that decision.
The future is fat! Having just come back from the ASPS (American Society of Plastic Surgeons), meeting in Toronto last weekend fat is the rage. Fat grafting to the face and body helps restore your youthful appearance and has changed how I think about facelifting. Yesterday I used the waterjet which is a fantastic new machine to harvest fat more easily and gently and re-inject into a young woman’s hands. Hands are a great area for fat grafting as we all get older and the veins start to show more and this can show your age. Smooth full hands are a sign of youth. It is one of the areas I am asked frequently about. The waterjet pumps water into areas to help remove the fat in a more gentle way so that more will last or what we say “take” to the grafted areas. Usual areas of fat grafting is the face or hands or areas of liposuction that need refining. The website is www.humanmed.com if you are interested in the technology.
A capsular contracture is scar tissue that builds around an implant and can happen early in the healing process, (3 months), or happen years later. Many patients come to my practice seeking information about a possible revision. Capsular contracture is the condition that causes constriction of the breast and can at times be very painful. If it is what we call a Grade 4 capsular contracture, (one that is the most extreme), the plan is to re-operate and remove the scar tissue and replace the implant with a new implant. I can never guarantee however that the scar tissue will not just reform. We try and give patients advice on massaging the implant which I do feel helps keep a pocket open and may help prevent a re-encapsulation. Medications such as Vitamin E orally, 1000mg per day have been suggested to help prevent re encapsulation. Also, an anti allergy medication Singular has been helpful per some plastic surgeons experience.
