Plastic Surgery News and Technology with Dr. Kenneth Hughes

Dr. Kenneth Hughes, Harvard-educated, Harvard-trained, board-certified plastic surgeon in Los Angeles, developed this plastic surgery education site to provide plastic surgery news and technology.  Plastic surgery is ever advancing and Dr. Hughes has been at the forefront of pioneering new techniques and new technology in plastic surgery. Dr. Kenneth Benjamin Hughes also provides updates on plastic surgery procedures and the latest in technological advances in plastic surgery. This website will detail these advances and news items through a series of comprehensive and timely articles. Dr. Hughes will regularly update this page with relevant plastic surgery paradigm shifts.

 

Platelet Rich Plasma (PRP) for Hair Loss Treatment

Platelet rich plasma or PRP has been around for decades and has been promoted for various orthopedic conditions, skin rejuvenation, and hair regrowth.  Very few randomized controlled trials have been performed and almost evidence has been anecdotal.  Although by no means rigorous and with a small enrollment of 30 females, a prospective, randomized controlled trial of 30 females diagnosed with the most common type of hair loss received scalp injections of platelet rich plasma or saline for a total of 3 treatments over 3 months.  Blinded photographic assessment indicated that 57% of PRP patients vs. 7% of saline patients improved at week 24 from baseline, which was statistically significant.   Adverse reactions included swelling, redness, and bleeding after injections.

 

Fat Grafting to Reduce Post-mastectomy Radiation Damage

Fat grafting has been utilized for decades in postmastectomy reconstruction to improve contours and fill contour defects.  Many plastic surgeons realize the importance of fat grafting to improving the breast shape and contours following implant reconstruction and autologous tissue transfer.  Many plastic surgeons have also seen the obvious improvements that these techniques of fat grafting have had in their own patient populations.  Patients who receive post-mastectomy radiation therapy can be improved with fat injections to reduce post-radiation tissue damage.

Sixty female patients were randomly assigned to two groups, one with fat grafting and one without fat grafting.  At each surgical operation, biopsies were performed in a specific breast area to evaluate adipose tissue thickness.

This study with 1 year follow-up showed tissue and visual evidence of improved tissue thickness with fat transfer to the breast envelope.

 

Covid-19 News and Updates

 Preparedness Initiative to Combat the Coronavirus in Plastic Surgery Clinic

Dr. Kenneth Hughes takes many precautions to combat the coronavirus and assure that no patient contracts the coronavirus. Any patient seen in the office is seen in a particular exam room that has surfaces that can be readily cleansed with antiviral wipes. All surfaces, door handles, drawer handles, counters, and exam room tables and chairs are vigorously disinfected after each patient encounter. Secondly, the cleaning crew is on-site every day to clean floors, bathrooms, fixtures, equipment, and even ceilings. All surgeries are scheduled apart from follow-ups or consultations so that the surgical patient is the only individual in the surgery center other than the 5 staff members. All staff members are instructed and follow these protocols as well. Masks and gloves are worn with follow-up patients. Any patients who have symptoms or coronavirus or who have been in contact with a person who had flu-like symptoms are asked to stay at home. Any nonurgent patient follow-ups are conducted over the phone or through email to minimize the influx into the office. Finally, consultations can be performed through email or through Skype to minimize exposure as well.

There are many other aspects to this system of protection against coronavirus at Hughes Plastic Surgery. However, protection against the spread of coronavirus involves maintaining clean hands and body surfaces, contact surfaces on which the coronavirus can live, and air portals through which the virus can be transmitted. Finally, his Los Angeles surgery center has an ultra-fast air filtration system, which circulates the room volume 30 times an hour. As a last measure, this same filtration system has UV lighting apparatus which kills viral particles on contact. It is important to realize that all of these components protect not only against coronavirus, but other infections as well. If a patient is looking to have surgery, this surgery center of Dr. Kenneth Hughes in Los Angeles spares no expense.

 

Plastic Surgery Clinics in Korea Shut Down Amid Coronavirus Fears

Dr. Kenneth Hughes is a published expert in regard to the trends in the Korean Plastic Surgery Market. The Korean plastic surgery market has always taken on a large number of plastic surgery tourists, and the recent outbreak of the coronavirus has hit the industry hard. According to the Korea Culture and Tourism Institute, there was a tourism deficit of 1.1 trillion dollars in January alone. The number of not only foreigners seeking plastic surgery but Koreans as well has plummeted in recent months. Plastic surgery insiders said they suffered about a 70% decrease in business since January. Some clinics are afraid to be stigmatized by having served a confirmed coronavirus patient, so many refuse to see foreign patients to avoid that stigma. Some of the patients have rescheduled for a later date, but, in many instances, the number of patients seen is virtually zero. In the US, plastic surgeons have closed offices for about 2 weeks now. Most offices have laid off many of the nurses, scrub technicians, aestheticians, and receptionists during this difficult time. Most offices offer virtual consultations to meet patient demand with the understanding that the surgeries will be scheduled sometime in the future. Non-cosmetic elective surgeries have largely been put on hold such as gallbladder removals, joint replacements, and other surgeries that will not substantially alter a person’s state of health for the worse.

 

Coronavirus and Medicine in the News: Stopping the Spread of the Coronavirus (COVID-19)

1) Wash your hands frequently
2) Maintain social distancing
3) Avoid touching eyes, nose and mouth
4) Wear A Mask

Before putting on a mask, clean hands with soap and water. Cover mouth and nose with mask and make sure there are no gaps between your face and the mask. Avoid touching the mask while using it; if you do, clean your hands with soap and water. Replace the mask with a new one as soon as it is damp and do not re-use single-use masks. To remove the mask: remove it from behind and discard it immediately. Clean hands immediately with soap and water.

 

Coronavirus News Update: CDC recommends Mask Wear in Public and California Governor Mandates Mask Wear in Public

The CDC has recommended cloth mask wear for anyone in public, and Dr. Kenneth Hughes asks everyone who comes into his surgery center to wear a mask as well.  A significant portion of individuals with coronavirus are asymptomatic or have not demonstrated signs of infection. These people can still transmit the virus to others before showing symptoms. This means that the virus can spread between people interacting in close proximity—for example, speaking, coughing, or sneezing—even if those people are not exhibiting symptoms. Therefore, CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission. It is critical to emphasize that maintaining 6-feet social distancing remains important to slowing the spread of the virus. CDC is additionally advising the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others. Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure. The cloth face coverings recommended are not surgical masks or N-95 respirators.

 

Breast Implant Manufacturer in the News:  FDA Recall of Textured Breast Implants

As of July 24, 2019, healthcare providers should no longer use new BIOCELL textured breast implants and tissue expanders. The FDA requested that Allergan recall certain textured breast implants due to the increased risk of BIA-ALCL. The recall includes the following BIOCELL textured breast implant products: Natrelle Saline-Filled breast implants, Natrelle Silicone-Filled breast implants, Natrelle Inspira Silicone-Filled breast implants, Natrelle 410 Highly Cohesive Anatomically Shaped Silicone-Filled breast implants, Natrelle 133 Plus Tissue Expander and Natrelle 133 Tissue Expander with Suture Tabs (see full list below). The risk of BIA-ALCL with Allergan BIOCELL textured implants is approximately six times the risk of BIA-ALCL with textured implants from other manufacturers in the U.S.

The FDA has not recommended removal or replacement of textured breast implants or tissue expanders in asymptomatic patients. However, for patients who have concerns and would like removal of their breast implants, Dr. Kenneth Hughes in Los Angeles will be performing these breast implant removal surgeries and/or breast implant replacement surgeries.

Given the concerns generated among patients who have had the textured implants placed from other practices (Dr. Kenneth Hughes places smooth implants in the vast majority of cases), Dr. Kenneth Hughes is proud to be offering a discount for those interested in removal or removal and replacement. To learn more about this discount opportunity, please call or contact Dr. Hughes’s office in Los Angeles. Textured breast implants are less popular in the U.S. than in other countries. Macro-textured implants (like textured implants of Allergan) are less than 5% of all breast implants sold in the U.S.

 

Full Breast Implant Recall List below:

  • Natrelle Saline breast implant styles 168, 363, 468
  • Natrelle and McGhan 410 breast implant styles LL, LM, LF, LX, ML, MM, MF, MX, FL, FM, FF, FX
  • Natrelle and McGhan 410 Soft Touch breast implant styles LL, LM, LF, LX, ML, MM, MF, MX, FL, FM, FF, FX
  • Natrelle 510 Dual-Gel styles LX, MX, FX
  • Natrelle INSPIRA breast implants, styles TRL, TRLP, TRM, TRF, TRX, TSL, TSLP, TSM, TSF, TSX, TCL, TCLP, TCM, TCF, TCX
  • Natrelle and McGhan Round Gel Implants, styles 110, 110 Soft Touch, 120, 120 Soft Touch
  • Natrelle Komuro breast implants styles KML, KMM, KLL, and KLM
  • Natrelle Ritz Princess breast implant styles RML, RMM, RFL, RFM
  • Natrelle 150 Full Height and Short Height double lumen implants
  • Natrelle 133 tissue expanders with and without suture tabs: styles 133FV, 133MV, 133LV, 133MX, 133SX, 133SV, T-133FV, T-133MV, T-133LV, T-133MX, T-133SX, T-133SV, 133FV-T, 133MV-T, 133LV-T, 133MX-T, 133SX-T, 133SV-T
  • Natrelle 133 Plus tissue expander styles 133P-FV, 133P-MV, 133P-LV, 133P-MX, 133P-SX, 133P-SV, T-133P-FV, T-133P-MV, T-133P-LV, T-133P-MX, T-133P-SX, T-133P-SV, 133P-FV-T

 

Breast Fat Grafting: A New Breast Augmentation Paradigm

Dr. Kenneth Hughes is an expert at all types of breast surgery including breast augmentation, breast augmentation revision, breast implant removal, breast fat grafting and breast fat transfer, and breast lift. During his fellowship at Harvard Medical School, Dr. Hughes performed many complicated breast augmentation revision procedures with referrals to the Beth Israel Deaconess Medical Center from all over the world. Whether a patient wants to remove or replace implants, Dr. Kenneth Hughes provides all of the possible reconstructive options to produce the best possible results for breast surgery.

 

Breast Fat Grafting Before and After Photos

 

 

Good News for the Aging Face: Restoring Facial Volume with Fat Grafting 

Only a few years ago, patients who had unilateral facial atrophy or traumatic defects of the face were frequently moved to the top of the list for free flap transfer. A free tissue transfer or free flap transfer involves taking tissue with its given blood supply and moving it to another area of the body and tying into the blood supply in that area. For instance, a flap of skin, fat, and fascia with its blood vessels would be sewn into the facial blood vessels and the piece of tissue would be manipulated into the facial defect. The volume match was frequently poor and several revisions were required for optimal contour. Sometimes the scarring or the number of visible incision lines was objectionable as well.

Sometimes these free flap options are the best options, but, in many cases, fat grafting has revolutionized the thought process, the paradigm, the expectations, and the results for facial reconstruction. Fat grafting is far more versatile in creating smoother contours as it does not require a large incision to place the tissue. Fat grafts can be placed at multiple depths and in very small aliquots to create a much smoother and cosmetically pleasing appearance. In addition, the free flap transfers have issues of complete failure, require long hospital stays, and sometimes physical therapy and rehabilitation. Also the morbidity of these procedures for the patients is much greater than for fat grafting.

Remember that the donor or harvest site for fat grafting only removes fat from an area, and this liposuction can make the areas of harvest look better. In almost every case of free flap transfer, the donor site has a significant scar and can have significant deformity and morbidity as well. There is really no question that fat grafting, if done appropriately for appropriately selected candidates, can be a powerful tool to treat patients with congenital, developmental, and traumatic facial defects.

 

Bodytite: The Latest for Minimally Invasive Skin Tightening

For decades, the field of plastic and reconstructive surgery has sought an alternative to the larger and longer scars associated with traditional excisional or skin removal surgery. While these surgeries produce dramatic results and achieve smoother contours for patients, the scars can sometimes be objectionable for patients and surgeons alike including Dr. Kenneth Hughes in Los Angeles. At the heart of cosmetic plastic surgery is the belief that as much should be achieved in contour or appearance with the least invasive approach. Various energy devices have been advocated in the past for skin tightening purposes in the hopes of providing this less invasive alternative. While heat is frequently the final common pathway to effect tightening of the tissues, the method of delivery and the efficacy as well as potential side effects incurred have not been optimized. Bodytite has been introduced to the market recently and promises something different with regard to its methodology. Dr. Kenneth Hughes was one of the first plastic surgeons in Los Angeles to offer Bodytite technology. In the past, the energy delivery systems have been monopolar devices – one pole with dispersal of energy from that one point. This had two downsides – energy dissipation with distance and inability to focus energy to improve efficacy of treatment. Bodytite is a bipolar energy delivery device in which the energy is focused between the two poles to concentrate the effect and to effectively measure the temperature achieved. This is critical to both achieving the maximal contraction of tissues without suffering massive burns due to inability to regulate temperature. Thus, efficacy is improved and side effects are minimized, and this means better results for the patients of Dr. Kenneth Hughes in Los Angeles. Dr. Kenneth Hughes is quick to point out that Bodytite does not reproduce the tightness of an excisional procedure or that everyone is an appropriate candidate for Bodytite. Tissue contraction will not reproduce the results of excisional surgery, and patient expectations should be managed accordingly. Bodytite is also not without potential complications. Burns are still an inevitable result of a thermal device in some situations. However, Dr. Kenneth Hughes now performs hundreds of these Bodytite procedures each year on the tummies, arms, thighs, bra rolls, and other areas of skin laxity for patients from around the world. The vast majority of these patients are very happy with the improvement in skin tightness and the minimal scarring. This technology has opened up an avenue of improvement for patients who otherwise would have refused the larger scars of traditional surgery.

Dr. Kenneth Hughes has provided below a few of the before and after pictures of the hundreds of Bodytite surgeries in Los Angeles he has performed.

 

Your Bodytite Questions Answered

Question: Lower inner thigh fat removal and/or loose skin concerns, any suggestions on how to fix this issue?

Answer: BodyTite is capable of producing a 40% contraction in tissues. It can be combined with liposuction to improve contours dramatically. BodyTite rids the body of some fat cells and is less traumatic than traditional liposuction.

Question: Am I a good candidate for BodyTite?

Answer: BodyTite will never produce the degree of tightening involved with a surgical skin removal procedure, which excises skin. Patients who fear invasive surgery, scarring, and long down time, typically opt for BodyTite to determine if the improvements are satisfactory enough to circumvent extensive excisional surgical procedures.

Question: Can BodyTite be a solution for uneven skin caused by liposuction?

Answer: Dr. Kenneth Hughes has utilized several techniques to improve uneven liposuction appearance, but it requires great precision to improve this. You need to find a plastic surgeon who does a lot of revisions. You need to realize that no one will be able to produce complete correction.

Question: How long will it take to see results after Bodytite and what is the recovery for Bodytite like?

Answer: Results can be seen immediately after one treatment and are more evident over three to six months post-treatment. Bruising and swelling can occur post-op. Sedentary activities can be resumed in two to three days and full activity with exercise within two to three weeks.

Question: Will BodyTite (without lipo) of outer thigh, buttocks and under butt help to lift droopy buttocks and smooth dimples and rolls?

Answer: BodyTite does not remove any fat, but it is capable of producing a 40% contraction in tissues. Results can be seen immediately after one treatment and are more evident over three to six months post-treatment.

Question: What are the long-term results like for BodyTite?

Answer: BodyTite is capable of producing a 40% contraction in tissues that is permanent.
 

J-plasma for Skin and Tissue Tightening

J-plasma, unlike Bodytite and Facetite, is a monopolar device that is used to heat the skin and underlying tissues to create tightening. Both use radiofrequency energy to create the heat, but the delivery and dispersal are different. J-plasma is supposed to cause contraction of tissue in less than a tenth of a second. Thus, this delivery requires much less effort on the part of the practitioner and reduces surgical time. The real question is does Renuvion or J plasma produce the results and the degree of contraction of Bodytite and Facetite and does it have a very small risk of burns.

Renuvion’s company website states that

  • The use of the Renuvion/J-Plasma device for Dermal Resurfacing in the US is considered an off-label procedure.
  • The use of the Renuvion/J-Plasma device for Dermal Resurfacing in any territory outside of the EU is considered an off-label procedure unless approved by the corresponding territory registration.
  • Risk associated with the use of Renuvion may include: unintended burns (deep or superficial), pneumothorax, scars, temporary or permanent nerve injury, pain, discomfort, gas buildup resulting in temporary and transient crepitus or pain, infection, hematoma, seroma; asymmetry and/or unacceptable cosmetic result. There may be additional risks associated with the use of other devices along with Renuvion and there may be an increased risk for patients who have undergone prior surgical or aesthetic procedures in the treatment area. As with any procedure, individual results may vary. As with all energy devices there are inherent risks associated with its use, refer to the IFU for further information.

 

Nonsurgical Vaginal Rejuvenation with Votiva: the Newest and Most Effective Technology

Votiva is a nonsurgical vaginal rejuvenation treatment that tightens vulvovaginal tissues and offers a number of benefits to patients. Votiva can address changes from aging and childbirth, including vulvovaginal laxity, dryness, and urinary incontinence. The recommendation from the company, InMode, for Votiva treatment is either one 30 minute session or three 10 minute sessions. The sessions are essentially painfree and do not require numbing treatments. The device itself is a wand that delivers heat through radiofrequency. Patients frequently note a warming sensation and nothing more. Dr. Kenneth Hughes has performed this procedure for patients without complications and with high satisfaction rates. There may be some soreness, and you should abstain from sexual intercourse for three days. Otherwise, you can resume daily activities immediately. Many women notice a difference, particularly a decrease in urinary incontinence or tightness, after the first treatment, but more significant changes come as cells turn over and new collagen is produced. Results continue to improve gradually over a few months. The company recommends a follow-up treatment 6 to 12 months out and then yearly, to maintain results.

Pros

  • Votiva treatments are a nonsurgical, pain-free way to address several symptoms at once.
  • There is very little downtime.

Cons

  • You may not see results immediately. They develop over a few months as your body responds to the treatment.
  • Your body continues to age and change after Votiva treatment, so you may require additional treatments.
  • In addition to internal tightening, the external anatomy including the labia majora and labia minora can be improved as well. The size of each can be reduced in size and tightened.

 

Your Votiva Questions Answered

Question: I am 62 and am considering vaginal rejuvenation. There seems to be different procedures. Would Votiva be best for this?

Answer: Inmode asserts that Votiva improves vaginal laxity, dryness, and stress incontinence. In addition, additional studies are underway for pelvic floor weakness. It is noninvasive and pain-free and only requires one 30 minute session for full benefit. It is done without any kind of anesthesia at all and there is no recovery process.

Question: How long does the Votiva procedure usually take?

Answer: A session usually lasts from 10-30 minutes. It is best that you abstain from intercourse for 72 hours following treatment and avoid hot tubs, pools, and bathtubs for 3 days following a session.

Question: Does Votiva hurt?

Answer: It is noninvasive and pain-free and only requires one 30 minute session for full benefits.

Question: What are the side effects of Votiva?

Answer: Votiva has a temperature sensor built into the hand piece which reads skin surface temperature 1000 times per second, allowing clinicians to acquire skin temperature in real time. The “cut off temperature” feature reduces RF energy automatically when the hand piece senses that the required skin temperature has been reached. Clinical evidence suggests prolonged exposure to temperature above 40°C is advantageous for optimal clinical outcomes.

Question: How much does Votiva cost?

Answer: Usually Votiva can range from $3,000 -$3,500. You will only need one time treatment to feel a difference with stress incontinence and tightening.

Question: Votiva v. Kegels

Answer: Kegels can be effective in treating several conditions (vaginal looseness, prolapse, urinary incontinence) as Votiva does. Performing Kegels daily is required for strengthening and toning the pelvic floor before results are noted anywhere from 4 – 12 weeks.

 

Plastic Surgery Education: “How to Select Your Plastic Surgeon” Video

As detailed in the video, review sites can be somewhat helpful. Realself has maintained the most reasonable review submission and allocation process for plastic surgeons and those procedures performed. Realself is one of the very few sites that is plastic surgery specific and values patient education for plastic surgery. However, recent attempts to help monetize the site with plastic surgeon promotion have somewhat corrupted the once transparent site. At one point, several years ago, doctors were ranked purely on the questions answered on the site and reviews garnered. Thus, the plastic surgeon with the most questions answered and the most positive reviews for a procedure would be ranked the highest for a particular procedure. Since that time, plastic surgeons can pay to be listed as an expert in a certain procedure and one up the true star in a procedure. Dr. Kenneth Hughes provides his expert analysis and routinely reviews procedure information for Realself to assure accuracy and currency as a part of Realself’s medical advisory council. Vitals and Healthgrades are two sites that tend to rank highly on google search results along with yelp.com. Vitals and Healthgrades typically record similar information about the surgeon and the nature of obtaining reviews is largely the same. There is not as much plastic surgery information available on these sites, and plastic surgeons cannot really interact with potential patients. However, there are portals for patient scheduling, which is very nice. Yelp is a review site in the simplest and most generic sense of the word with no specific attention paid to plastic surgery and no plastic surgery procedure information is provided. The reviews have been questioned as legitimate by doctors and businesses alike. Trying to evaluate the credentials and expertise of a plastic surgeon alongside reviews for mold removal and plumbing may not be the best way for a patient to find a plastic surgeon. However, it remains the largest and most influential review site for virtually everything. Doctor is a newer review site similar to vitals and healthgrades, but the site allows photos and videos of plastic surgeons to be posted as well. Doctor also has more information available for each individual plastic surgeon. However, it is not plastic surgeon specific in the doctors that are included on the site. Caredash is very similar to doctor.com with a similar layout, plastic surgeon information, and photo and video galleries. There are two newer sites beautyadvisor and cosmetictown. Beautyadvisor is similar to realself in that there is a lot of plastic surgery information present and plastic surgeons can present photos and videos. The site also has a plastic surgery forum for question and answer. In addition, they allow patients to follow plastic surgeons much like instagram. Cosmetictown provides for plastic surgeon information, articles about procedures, photos and videos, and section for surgeon reviews. Neither of these sites are as popular as realself, but they have potential to be very pure sites for patient education.

 

Black Market Silicone Injections in the News

Dr. Kenneth Hughes, board-certified, Harvard-trained plastic surgeon in Los Angeles, has received hundreds of inquiries from patients all over the US and throughout the world in regard to silicone and biopolymer injection removal. Many times these injections are used to augment the buttocks or hips, but they can be used to augment almost any body part including thighs, calves, lips, breasts, and others. These injections are frequently performed in larger volumes using less than sterile offerings by persons who have no medical or little medical training. It is important to realize that Dr. Kenneth Hughes does not inject these materials and most board certified plastic surgeons would not. In addition to complications such as infection, skin death, fat death (fat necrosis), inflammation, and pain in the areas injected, these injections can and have led to many patient deaths. When Dr. Kenneth Hughes sees patients in his Los Angeles surgery center for evaluation, he always explains the multitude of complications that may occur in the removal of these silicone and biopolymer substances including fluid collections, infection, inadequate removal, fat death, skin death, tissue deformities, and tissue defects. These removal surgeries can provide life-saving grace to those patients who have no other alternatives. However, the best advice Dr. Kenneth Benjamin Hughes can give is to never allow injection of foreign substances, especially in large amounts by persons with little or no surgical training.

 

Facelift News

What is a lower facelift? A lower facelift is a surgical procedure that lifts and tightens the lower third of the face. A lower face and neck lift will improve the jowls, the jawline, and the neck and chin areas. Compared to a full facelift, it’s less invasive with smaller incisions, less scarring, and a quicker recovery. People in their late 40s and 50s who are beginning to see sagging around their mouth and jaw may be good candidates for this procedure.

What happens during lower facelift surgery? Just before your surgery begins, you’ll be given general anesthesia or sedation, so you’ll either be fully asleep or drowsy and relaxed. Your surgeon will make incisions near the front of your ears, extending from the earlobes to the hairline. The length of the incisions and their locations will depend on your surgeon’s technique and your facial anatomy. After making the incisions, your surgeon will pull the skin and fat tissue into a newly lifted position. They may also lift and the underlying muscles, also called the superficial muscular aponeurotic system, for a SMAS facelift that produces longer-lasting results. Your surgeon will suture the tissues into their new position, trimming any excess tissue to eliminate sagging and improve your jawline definition.

What should you expect during lower facelift recovery? A lower facelift is an outpatient surgery, which means you’ll return home the same day with aftercare instructions. You’ll be groggy from the anesthesia, so make sure you have someone there to take you home. During recovery, you might also have some discomfort, redness, sensitivity, bruising, and swelling. Your surgeon may ask you to use light ice compresses to reduce swelling and refrain from vigorous exercise for one to two weeks. It is also common to experience a tightening sensation as your skin adjusts to the changes, as well as a temporary loss of sensation around the incisions. Your surgeon will monitor your recovery and remove your sutures at follow-up appointments starting a week after your surgery.

How long do lower facelift results last? Patients report seeing results within a week, as soon as the swelling starts to go down, with most of the swelling gone in about a month. A lower face and neck lift can dramatically alter neck and jawline for years.

Editor’s note from Dr. Kenneth Hughes:  Dr. Kenneth Hughes performs a special type of short scar lower facelift that involves complete dissection of the face and neck that allows for maximal recruitment and improvement in contours.   In addition, Dr. Kenneth Hughes has created a type of skin tethering technique, which allows for dramatic long-term improvement in the neck, jawline, and jowls.

 

Controversial Plastic Surgeries in the News: Rib Removal Surgery

Dr. Kenneth Hughes was interviewed in 2020 about his views on rib removal to reduce the size of the waist. Rib removal is one of those surgeries that few plastic surgeons will perform due to risk for complications. The goal of rib removal, of course, is to reduce the size of the waist. Frequently, ribs 10, 11 and 12 may be removed. “Pneumothorax, a collapsed lung, is a known risk of rib removal surgeries or rib harvest surgeries, due to the proximity of the rib to the underlying pleura,” said Dr. Kenneth Hughes, Harvard-trained, board-certified plastic surgeon in Los Angeles. Rib removal surgery is not a surgery Dr. Hughes performs nor a surgery he recommends.

 

Your Questions about Plastic Surgery News Answered

Q: What is air sculpt?

A: It is a marketing name for a laser liposuction.  Look at before and after pictures and reviews to select your board certified plastic surgeon rather than select your surgeon based upon the name of the liposuction machine used.

 

Q: What is the difference between liposuction and air sculpt?

A: I would not focus on different liposuction methods or techniques but rather on your selection of surgeon.

 

Q: Am I a candidate for an Airsculpt lipo to get rid of my tummy?

A: Liposuction can produce a major improvement in shape. Dr. Kenneth Hughes would have to examine you to give you a better idea of what to expect about the skin. Find a liposuction expert who performs hundreds of liposuction procedures each year and has great reviews and great before and after pictures.

 

Q: What’s different about Airsculpt laser liposuction than other laser liposuction techniques?

A: Liposuction is surgeon dependent not machine dependent. Look at before and after galleries and find the best surgeon.

 

Q: Was This Lip Injection Done Properly, and How Can I Reduce the Bruising?

A: Bruising is very common after having a filler injected. Give it a full 2 week for the product to settle and the bruising/swelling to heal. If the issue continues or worsens, contact your medical provider for further assistance.

 

Q: Is Hyaluronidase for Boletero Safe and Effective?

A: Give it a full 2-3 weeks for Belotero to settle before trying to remove this product. If you’re completely unhappy, you could have hyaluronidase injected to dissolve the area that was injected but would need a few treatments to see full result.

 

Q: Belotero to eye area?

A: Swelling may persist for 1 to 2 weeks or longer after filler injection. You could return the physician to have the area massaged if the product is either uneven or lumpy. Certain skin areas are more sensitive.

 

Q: Swelling after Belotero?

A: If you are still experiencing swelling after the Hyaluronidase, you may need another injection of Hyaluronidase. Response will be based on how much of the Belotero was injected, method of injection/placement, as well as how much Hyaluronidase was used.

 

Q: Discoloration after injection likely from bruising?

A: The skin of the tear trough area is very thin and has a tendency to bruise more than other areas. If the area bruises, it will be discolored. As the bruise is metabolized, it will change from purple to a more yellowish/green. The discoloration is from the extracellular blood and hemosiderin deposits under the skin (a normal occurrence with bruising).

 

Q: Fluid Pocket and Heavy Bruising 4 Days After Boletero Normal?

A: There is a great deal of bruising and swelling, but this can happen with an injection into that area with any product. Certain medications, activity level, along with anatomy and injection technique are all relevant.

 

Q: Too Soon to Inject Lips Again with Different Product?

A: You could consider another filler like Restylane or Juvederm to the lips at this time.

 

Q:  1.5 Weeks Ago I Had Belotero Around the Eye. Now I Have a Puffy Bag Underneath?

A: I would usually wait 2 weeks before determining if residual product exists. The residual product can be dissolved at that time.

 

Q: Had my Belotero Dissolved. Blue Puffy Bag is Gone, Now Very Flat. How Soon Can I Refill and Which Filler Would Be Best?

A: I would wait a couple of weeks after the filler is dissolved, and then you could try one of a couple of fillers. I use Restylane for this purpose.

 

Q: Am I a good candidate for CoolSculpting?

A:  CoolSculpting is a noninvasive procedure that uses cryolipolysis. Targeted fatty tissue is placed between two cooling panels to freeze fat cells which are eliminated by the body’s natural cleansing process. You can return to work immediately. You may need two or more treatments to see results.

Dr. Kenneth Hughes frequently treats failed coolsculpting patients with liposuction as well as paradoxical adipose hyperplastia caused by coolsculpting.

 

Q: Are there less invasive/less risky alternatives to a tummy tuck for me?

A: Safety should always be the first priority when undergoing any type of surgical procedure. Whether genetic or acquired, patients who are diagnosed with thrombophilia are predisposed to excessive blood clot formation, most often in the legs (deep vein thrombosis). None of the non-invasive or less-invasive techniques would remove the loose skin and address the lax abdominal wall to give a nice, flat youthful contour to the abdomen or create a more youthful belly button and remove the c-section scars.

 

Q: I had my 2nd c-section 7 weeks ago along with a myomectomy. What’s the best nonsurgical option for me?

A: BodyTite is a minimally invasive procedure that shapes, tightens and lifts without a larger scar that would be necessary in excisional procedures like a tummy tuck. Bodytite will create about 40% skin contraction or improvement, but it will not reproduce the tightness of a well executed excisional procedure like a tummy tuck. Patients should not expect this type of result, and Dr. Kenneth Hughes emphasizes this to patients very clearly prior to undertaking Bodytite procedures.

BodyTite uses RF (Radio-Frequency) technology that addresses some of the shortcomings associated with traditional liposuction or surgical body lifts. Bodytite is not liposuction and should not be thought of as such. Liposuction can be combined with Bodytite for best results and frequently is used in combination.

 

Q: What is the differences between Liposuction and Coolsculpting in price for reduction of one area?

A: If you want a real difference in the area, find a liposuction expert and proceed.

 

Q: Good candidate for liposuction or non-invasive alternative for my inner knee fat?

A: Knees are a tricky area, and a physical exam will be necessary to determine if this will result in improvement based upon amount of fat and the skin laxity present. This area is more prone to contour irregularity after liposuction, and as such liposuction should be limited. You also do not want to have an issue with falling skin. Another option might be BodyTite.  Bodytite provides significant skin retraction and without larger scars and long down time.

 

Q: Does cavitation work for moderate fat loss in problem areas?

A: Pursue liposuction with an expert plastic surgeon who gives consistently good results.

 

Q: Would Embrace Scar Therapy silicone sheeting be helpful for areolar reduction incisions?

A: The application of topical silicone gel sheeting has been utilized to either limit the development of abnormal scars or treat them once they have occurred. In that the treatment has limited cost and morbidity, it is a good first line treatment for the prevention or treatment of abnormal scars.

In general, scarring is a product of genetics. Some people are good scar formers, and others are poorer scar formers. Dr. Hughes always minimizes the scars to minimize the likelihood of poor scars. There is no one best therapy for scars. Silicone sheets, Mederma, and Bicorneum are reasonable and popular options.

 

Q: Fractora RF or Profound RF: What is the difference between these two treatments?

A: Profound RF is a needle based energy where the energy is delivered via pins to the skin to improve skin texture, scars, wrinkles. Fractora has radiofrequency with microneedling technology combined in one. Fractora can also be combined with additional energy treatments or injectables to achieve a more extensive full face result. Amount of filler (Juvederm or Restylane) depends on the area of injection, your individual appearance at presentation, and your desired aesthetic. Visible results can be seen immediately with Fractora, but typically after two weeks the most noticeable results appear. Improvements continue up to three months after treatment.

 

Q: 1 day post-op. Is this normal healing for Fractora?

A: Patients experience little discomfort or side effects during healing; however, some mild reddening of the skin and some possible slight swelling can occur. It should disappear in a couple of days.

 

Q: Fractora Vs Microneedling?

A: Based on the information you provided you are a good candidate for Fractora. Fractora will give you immediate results with the same amount of down time as micro-needling.

 

Q: Is radiofrequency treatment with Fractora a solution for tear troughs?

A: The tear trough is the result of a volume deficit so you need to fill it with filler or fat.

 

Q: Can you get Fractora in conjunction with Votiva while on blood thinners?

A: Be sure to provide your health history to your plastic surgeon and anesthesiologist. Normal practice is to suspend the blood thinners prior to surgery and resume them after. Your hematologist will have to clear you for the procedures based upon the reason you have been prescribed the blood thinners.

 

Q: Is Fractora performed by a technician or a doctor?

A: Having a highly qualified/trained medical technician perform Fractora is not unusual. Dr. Kenneth Hughes prefers to perform the procedure himself for best results.

 

Q: Will Fractora help with all these smile lines?
A: Fractora can also be combined with additional energy treatments or injectables to achieve a more extensive full face result. Amount of filler (Juvederm or Restylane) depends on the area of injection, your individual appearance at presentation, and your desired aesthetic.

 

Q: Fractora for Indented Acne Scars and Hyperpigmentation?

A: Fractora bridges the gap between fractional lasers and surgical results. Clinicians can select between variable depths, densities and energy levels for results that were previously only attainable with excisional surgery.

 

Q: Fractora Helping Neck Wrinkles?

A: If you are looking for a non-surgical neck lift, Fractora can gradually improve the skin with practically no down time. The radio frequency improves skin texture by diminishing fine lines and wrinkles and tightening the skin by creating new collagen in the neck.

 

Q: Is nd yag laser hair removal effective with blond hair? If not is there any other type suitable for blondes?

A: Lasers work by detecting contrast in the pigment between your skin and hair color. Best results are achieved with lighter skinned individuals with darker, coarser hair.

 

Q: Can I do laser hair removal on my breast region after a vertical breast lift with saline implants?

A: Laser hair removal after breast lift with saline implants should not be a problem. Laser will not negatively or positively affect the healing of the scars. Ask your plastic surgeon when you can start shaving/waxing/plucking hairs around your breast region but a few months should be adequate.

 

Q: Best laser to use for hair removal?

A:  Dr. Kenneth Hughes’s practice offers Diolaze, a non-invasive procedure, that requires no down time for hair removal. A diode laser beam passes through the skin towards hair follicles. The penetrating energy then heats up the hair root, which in turn prevents future hair growth. This procedure has one of the largest treatment spot sizes with a built-in skin cooling surface which makes treatment more comfortable than other devices. The number of sessions will differ depending on your hair color, hair type, body area, and skin tone. For example, each leg can be treated in about 10 minutes. Best results are noted after four to six treatments. Touch-up sessions may be needed as there is no way to rid the body of hair permanently.

 

Q: Time for one session of laser removal of pubic hair?

A: The number of sessions will differ depending on your hair color, hair type, body area, and skin tone, but each session would probably require 15 minutes. Best results are noted after four to six treatments. Touch-up sessions may be needed as there is no way to rid the body of hair permanently.

 

Q: Way to permanently remove excess hair on face, neck, and chest?

A: Dr. Kenneth Hughes offers Diolaze, a noninvasive procedure, that requires no down time for hair removal. A diode laser beam passes through the skin towards hair follicles. The penetrating energy then heats up the hair root, which in turn prevents future hair growth. This procedure has one of the largest treatment spot sizes with a built-in skin cooling surface which makes treatment more comfortable than other devices. The number of sessions will differ depending on your hair color, hair type, body area, and skin tone. Best results are noted after four to six treatments. Most commonly treated areas include: bikini, legs, arms, chest, back, shoulders, stomach, neck, chin and sideburns. Touch-up sessions may be needed as there is no way to rid the body of hair permanently.

Patients who have dealt with electrolysis, shaving, and waxing over many years are very happy with the results from Diolaze, and the fact that the treatment is virtually painless.

 

 

Q: How will I know when laser has done all it can do for my beard?

A: Laser hair removal typically takes 6 to 8 sessions. Removal works best when hair follicles are in their mature stage, however, at any given time, your hair is in various stages of growth. If you have blond or grey hair, or dark skin, you may consider another appointment to remove the remaining hairs.

If your hair removal treatment occurred two weeks ago, I would have expected the bruises to show up within a few days of the session. Because you indicate that similar bruises on your legs have occurred several times in the past for no obvious reason, I would contact your hair-removal professional and ask if others are experiencing the same side effects. If not, you might want to schedule an appointment with your PCP.

Our practice uses a completely noninvasive procedure called Diolaze which presents nearly no risks to your health other than transient swelling and redness where follicles were treated. You can return to work or other daily activities immediately following a treatment session. It removes hair from the bikini line, back, chest, legs, shoulders, chin, stomach and neck.

 

Q: I have an abnormal EKG. I’m very active, would laser liposuction be a safer procedure for me instead of 360 liposuction?

A: What reason did the cardiologist provide for the abnormal EKG reading? If it is not pathological, then it will not pose a threat. If your cardiologist clears you before surgery and has no reason to believe that you would suffer an anteroseptal infarct during or after the surgery, you should be reassured to proceed with the surgery. Of course, your plastic surgeon must be notified of all of the EKG results and determine the risks.

 

Q: Would you recommend laser liposuction for a 61 yo female who is 4′ 11 with a BMI 0f 38 for upper and bottom abdominal and waist?

A: This is very difficult to evaluate without pictures or an exam.  The results depend very little on the method used and very much on the surgeon selected.

BMI is but one measure of fitness for surgery. However, many plastic surgeons prefer that the BMI be at 30 or below and a stable weight maintained for several months prior to the surgery to lower the risks of complications during and after surgery and to insure maximum results. Different board certified plastic surgeons will have different opinions and comfort levels with regard to the BMI so it is best to ask at your virtual or in-office consultation.

 

Q: How many non invasive body contouring treatments before you can see a difference?

A: Liposuction will create a nice result in one session and in one healing period. The subtle improvements with other noninvasive modalities yield results that do not satisfy many patients.

 

Q: Can I have laser Liposuction after having had traditional Liposuction?

A: Dr. Hughes would recommend a liposuction revision specialist. The type of liposuction matters little.

 

Q: Will Laser Liposuction remove the glandular tissue from Gynecomastia?

A: A combination approach may produce the best result, but an exam is always helpful in this.

 

Q: I am considering laser liposuction for my arms. Is it the right procedure for me?

A: Dr. Kenneth Hughes would have to examine you to determine if liposuction would be of benefit.

 

Q: How good are the results of Laser Liposuction as compared to regular Liposuction? Is down time and cost about the same?

A: The results of liposuction are always dependent upon the surgeon not the machine or method.  Some surgeons will consistently generate smooth, dramatic results, and others will not.

 

Q: How big are Laser Liposuction incisions on the abdomen area?
A: 2 or 3 incisions (less than 5 mm each) are all that are required for liposuction of the abdomen and sides.
Q: How long can I wait before getting capsular contracture surgery?
There is no optimal time to perform a capsulectomy but you probably not want to wait for the capsular contracture to get worse or cause increased pain. If your silicone implant is leaking, remove it as soon as possible.
Q: What is the right course of action to treat my capsular contracture?

Capsular contracture is an incompletely understood entity in which many theories have been postulated but none have been substantiated.Capsular contracture can occur in even the most careful surgeon’s practice, and we do not know everything that is responsible for the occurrence of capsular contracture.

Surgical removal of the scar tissue capsule is the most effective method of capsule correction. The submuscular position is preferred for implant placement. This procedure does not eliminate the probability of the recurrence of encapsulation.  In fact the recurrence rate after anterior and posterior capsulectomy is probably 30%.  To reduce the rate further, form stable silicone implants or gummy bears can be used.  Finally, acellular dermal matrices can reduce the risk as well.

 

Q: Does 2 mm fibrous capsule around breast implants mean I have a capsule contracture?
The severity of encapsulation ranges from mild, characterized by no external visible signs of distress, to extreme, which requires surgical correction.  Capsular contracture is very difficult to evaluate without a physical exam.  If the breasts are soft and pliable, capsular contracture is not likely. If your breast implants are feeling tighter and are looking distorted, you may be experiencing capsular contracture.
Q: 4.5 years post BA – Could this be the start of capsular contracture? And if so is there any way to stop it or slow it down?

Capsular contracture is an incompletely understood entity in which many theories have been postulated but none have been substantiated.  Capsular contracture is very difficult to evaluate without a physical exam.  If the breasts are soft and pliable, capsular contracture is not likely.  Capsular contracture can occur in even the most careful surgeon’s practice, and we do not know everything that is responsible for the occurrence of capsular contracture.  For diagnostic purposes, the sequence in the diagnosis should be mammography, ultrasound, then MRI, if necessary.

 

Q: Nipple piercings and capsular contracture?

Capsular contracture is an incompletely understood entity in which many theories have been postulated but none have been substantiated.  The nipple piercings can be removed prior to surgery and replaced later. Replacement should be coordinated with the plastic surgeon who performs you breast augmentation.

 

Q: Hopefully getting surgery soon, how likely is the capsular contracture ​to come back? Are capsulectomies successful surgeries?
The risk of capsular contracture is less than 3% in the overall breast augmentation population.  However, the recurrence rate after capsulectomy surgery is about 30%.  Further measures such as dermal matrices or form stable implants can further reduce this rate.
Q: Any way to avoid or prevent capsular contracture?

Capsulectomy with placement of acellular dermal matrix and/or gummy bear implants should be considered.

 

Q: Would you suggest smooth silicone or textured implants after capsular contracture revision?

The more form stable implants have a lower incidence of capsular contracture as do capsulectomy procedures with the placement of acellular dermal matrices.

 

Q: Are gummies for reconstructive surgery? I have capsular contracture and one of the surgeons I saw wants to put gummies in me.

Dr. Kenneth Hughes would have to see you in person to make a determination about what may be the best option for you.  There are many possibilities here and there is quite a variable range in price depending upon the implants chosen and the dermal matrix applied.

 

Q: Would you recommend to remove the implants and have the breasts lifted since the capsular contracture can happen again?

Removing breast implants will allow for the successful treatment of capsular contracture, but this may not be the best option in patients with less breast tissue or in patients who have thinned tissues due to the duration of implant placement and the size of implants placed.

 

Q: Capsular Contracture 9 Months Post Op on Left Breast?
There is a small risk to developing capsular contracture in the opposite breast if the implant is exchanged.  However, either alternative is reasonable, particularly if you have a strong desire to get larger implants.
Q: Capsular Contracture Under Pectoralis Muscle?
If you have capsular contracture, this tends to be progressive and massage will probably not have an effect on this.
Q: Had 3 Capsular Contractures and Explant. For Revision Surgery is Alloderm/max or Strattice Better? Which Implant is Best?
The form stable implants in combination with Strattice or explantation with fat grafting would be the two options that Dr. Hughes would offer at this time.
Q: Remove and Replace Implants and Switch to Silicone Implants in Submuscular Position with Breast Lift?
It is reasonable to remove the implants and replace them with a transition to a submuscular plane.  If you want to change the shape of the breasts and lift them that could be considered as well.
Q: Capsular Contracture Management for Breast Implants in the Subglandular Position?
If you have subglandular implants and capsular contracture, you should replace the implants and transition to a submuscular plane.
Q: Capsular Contracture Grade IV and Feeling Unwell?
    In grade IV capsular contracture, the removal of the capsule along with removal of the implant and possibly replacement with a new implant usually does make patients feel much better from a pain standpoint.
Q: Right Side Capsular Contracture and Rupture and Left Side No Problems?
For the right sided rupture and capsular contracture, removal and replacement of the implant with anterior and posterior capsulectomy or a replaning procedure is appropriate through the same incision.  There is no need to make another incision in the inframammary fold unless additional skin from the fold needs to be removed for an implant that has bottomed out.  For the left side, nothing is needed if there is no implant malposition, rupture, or capsular contracture.
Q: Second Capsular Contracture Options?
   If both revisions were placed above the muscle, the option of submuscular placement should be explored.  The addition of the dermal matrices can be used in this, but the shift to a submuscular plane is a reasonable option.
Q: Capsular Contracture Treatment?
For the first capsular contracture, a reasonable option is to perform anterior and posterior capsulectomies with implant exchange under the muscle.   One should also consider gummy bear implants or form stable silicone implants and acellular dermal matrix placement including Alloderm and Strattice options.  These two approaches may be preferred in some patients if the patient has little breast tissue and the camouflage of the muscle enhances the cosmetic result.

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