Dr. Epstein's Blog

Dear Friends:

Unfortunately, we are still without power. We do have the appointment schedule for this week and my staff will be contacting patients. Donna (special kudos to her!) has all our phone lines forwarded to her cell phone and continues to answer all our calls. As soon as power is restored, we will be open the following day. The company that hosts our website lost power as well, but will be open tomorrow, so we will also post updates on our website as of tomorrow.

We understand that the aftermath of this storm has resulted in some terrible losses and presented some formidable challenges for many of you. We hope and pray that all of you get the assistance that you need and find the internal strength necessary to rebuild your lives.

The Epstein-Rafal family and all our dedicated staff

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So you’ve decided to take the first step towards surgical enhancement or rejuvenation. You want to arrange a consultation with a plastic surgeon. How do you begin? How do you make sense of the frequent advertisements and recommendations of others? I would like to give you some guidelines as to how to proceed.

Board Certification – The American Board of Medical Specialties (ABMS) recognizes 2 medical specialties, and the American Board of Plastic Surgery is one of them. All other boards with words “plastic surgery” in its name are not boards recognized by ABMS. Some plastic surgeons, as I am, are certified by more than one (ABMS) board (i.e. general surgery) prior to receiving board certification in plastic surgery.

Specialty – Many physicians and other health care providers are performing cosmetic surgery with varying qualifications. There are weekend courses, preceptorships and other brief ways of “learning” cosmetic surgery. Only a physician trained in an accredited plastic surgery residency is formally trained in cosmetic surgical procedure, so be sure to inquire as to the qualifications of that individual to perform that particular type of procedure.

Recommendations – A recommendation from a friend or relative who has undergone a particular type of procedure can provide invaluable information. If possible, it is always helpful to take advantage of this recommendation. In our office, we often refer perspective patients to speak with our many happy patients.

Internet – Plastic surgery web sites contain a plethora of useful information. Spend time reading the factual content on the site. Is it relevant and useful? Also, good quality before and after color photographs provide a unique opportunity to survey the quality of the surgeons’ work. I am particularly proud of our website and I invite you to visit us at www.epsteinplasticsurgery.com to read the information and to view our before and after photos.

The office and personnel – Is surgery performed in an office-based surgical facility? If so, is the facility accredited? By what organization? We are very proud of the fact that we are accredited by JCAHO, the same organization that provides accreditation to hospitals. How were you treated on the telephone? Were the office personnel friendly, courteous and helpful? Did they make you feel special? Were you greeted properly? Were you made to feel at home? In our office, we pride ourselves on treating patients the way we ourselves want to be treated.

The consultation – Was the surgeon warm and friendly? Did he/she spend adequate time with you? (A breast augmentation consultation in our office usually last at least 30 minutes – 45 minutes). Did the surgeon perform a comprehensive physical examination? Was he/she able to understand your concerns and desires as well as propose and explain an appropriate plan of treatment? Did he/she listen to your questions? Did the surgeon make you comfortable about undergoing cosmetic surgery? Ask if he or she has patients that would be willing to speak with you. Please feel free to have a complimentary consultation at our office. I promise that you will not be disappointed. I am committed to delivering the best cosmetic outcome possible. Furthermore, safety is a prime concern. We pride ourselves on performing cosmetic surgery in a highly individualized fashion with in a warm, caring and nurturing environment. That’s what you deserve, whether you come to my office for your procedure or elsewhere.

I hope this helps you to become a most informed consumer of aesthetic plastic surgery services. Happy New Year! I hope this year brings you and yours abundant health, prosperity and happiness.

To your health & beauty,
Dr. Mark Epstein

While recently visiting Dr. Frank Lista, a colleague of mine in Toronto, he described to me a technique for treating gynecomastia that he described and has been quite successful with. The technique is called the “Pull-through technique”. Here’s the story behind the technique and the reason I have adopted it.

The breast is a combination of glandular tissue and fat, mixed together, and covered by skin. It sits atop the pectoralis major muscle on the chest. In the male breast, if there is excess glandular tissue (which is not removable by liposuction), then there can be excess fullness of the male breast. If the breast is very fatty, it may be amenable to reduction via liposuction, which involves making a very small incision, about ¼ inch in length and using a metal tube attached to a suction source to remove the fat. The problem is when the fat consists of small globules amidst a dense matrix of glandular tissue; the fat is not as accessible for removal by liposuction.

In my experience, when performing liposuction alone for gynecomastia, I have been able to remove some fat, and reduce the breast somewhat, but I was never able to remove the excess glandular tissue, therefore limiting the overall cosmetic result of the procedure.

The classic procedure that has been around for years is an open incision approach (around the areola) with direct excision of the breast tissue. In some cases, this procedure has been complicated by nipple numbness, fluid collections, suboptimal contours and a longer recovery.

Now, there is a new alternative. Using the pull-through technique, a ¼ incision is made on the lower breast near the side of the chest wall. Liposuction is used for initial fat removal. Next, the glandular tissue is grasped with a special instrument and removed in small pieces through the incisions on the side of the chest. The advantages to this procedure are significant. There is removal of both glandular tissue and fat, not just fat. No incision needs to be made around the lower half of the areola. There is no empty space seen after direct excision with the risk of a fluid collection. Risk of hematoma (bleeding after surgery is less. As the tissue is removed gradually in small fragments, the contour of the result can be better controlled during the surgery.

This procedure is suitable for most all patients with gynecomastia from the 16 year old muscular male to the slightly overweight middle aged male. There is little discomfort after surgery. The only requirement is to wear a compression garment (vest) for three weeks after surgery. Patient satisfaction is high and the risk of complications is low.

For years, abdominoplasty has been a very popular procedure for women who desire recontouring their abdomen by excising excess skin and fat. Typically, one or two drainage tubes are placed within the space between the abdominal wall muscles and the overlying skin to remove excess fluid that accumulates after surgery and would prevent the adherence of the skin back down to the muscle. For most women, this would be the worst part of the entire surgical experience. Caring for these tubes, dragging them around, trying to find a place within one’s clothing are often problematic. Now, using a new surgical technique, there is no longer the need for these drainage tubes in most cases. The abdominal skin adheres quicker to the abdominal wall musculature, thus shortening the healing process, and also reducing the chance of later fluid accumulation as well. The entire recovery experience after surgery is dramatically improved and the healing accelerated. The ultimate surgical results are just as good with this technique as using the older methods. Dr. Epstein is proud to offer this new technique to his patients in his Stony Brook office.