All bodies are not created equal.  For most of us, stubborn fatty deposits attach themselves to our hips, circle around our bellies, cling to our thighs, and even appear on our arms, backs, and chins. You’ve likely identified problem areas of your own that persist despite your diet and exercise efforts. If you’ve ever considered liposuction and thought it was too drastic, you may want to consider a new procedure that is transforming the body-sculpting patient experience.

It’s called VASER LipoSelection®.  These days, patients are turning to this advanced procedure to combat their “trouble spots”, especially those that may be genetic “gifts” or are seemingly resistant to the hours spent at the gym.  By delivering consistent results with minimal pain and down time, VASER LipoSelection is becoming the new standard of care for body contouring.

The key to the VASER LipoSelection difference is tissue selectivity, provided by a patented device called the VASER® System. Simply put, traditional liposuction procedures are limited by their inability to differentiate between the bad (excess fat) and the good (nerves, blood vessels, connective tissues, etc.). While traditional procedures do remove fat, a considerable amount of damage can be done to other important tissues. This can cause bleeding, bruising, and swelling, and lead to a longer recovery.  In addition, damaged collagen and connective tissues can compromise the final shape, leaving behind lumps and bumps where uneven amounts of fat have been removed.  Ultrasound energy employed by the VASER System ruptures fat cells on contact, while minimally disturbing important tissues vital to optimal recovery and consistent results.

Only VASER technology provides the tissue selective LipoSelection procedure, which targets fatty deposits while minimally disturbing the rest of the tissue matrix. As a result, VASER LipoSelection patients consistently report low to minimal pain, bruising, swelling, and down time. Physicians report consistent, predictable results and an enhanced ability to sculpt and contour a patient’s physique. Most patients are able to return to their normal activities in a matter of days. u

For more extensive information about the VASER system, please visit our web site at: www.epsteinplasticsurgery.com.

Mark D. Epstein, M.D., F.A.C.S.

Center for Aesthetic Surgery

2500 Route 347, Building 22A, Stony Brook • 631.689.1100

www.epsteinplasticsurgery.com

On November 17, 2006, the FDA approved the use of silicone breast implants for breast augmentation and reconstruction. All breast implants have a solid silicone shell. Saline implants are filled with saline (salt water) and silicone implants are filled with silicone gel. Up until recently, only saline implants were available for general use in breast augmentation.

Silicone gel implants were used for many years in this country, as well as in many countries around the world, until 1991 when the FDA enacted a moratorium on their use, pending the results of several studies designed to examine the safety of the device.

Based on the research collected in the US and the practical experience gained outside of the US for the past 25 years in over 60 countries, where both silicone and saline have been available to women and 90% of the markets prefer silicone, women generally find silicone breast implants to look and feel more natural than saline implants.  

The safety of silicone-filled breast implants is supported by extensive pre-clinical device testing, their use in approximately 1,000,000 women worldwide and nearly a decade of U.S. clinical experience involving more than 80,000 women. 

Women in the United States now have the same options that women in other countries have had for so many years. As a skilled and dual board certified plastic surgeon I now can provide my patients with the newest option in breast aesthetics that provides women with the most natural look that is proportionate and individualized to their body types and aesthetic goals.

There are several myths about silicone gel breast implants which need to be dispelled.

Myth #1: “In general, silicone products are not safe for use in the body”. Fact: For many years, silicone has been used in numerous medical devices including pacemakers, artificial joints, and even baby pacifiers.

Myth #2: “Silicone implants rupture due to normal activities or mammography. Fact: It is unlikely that silicone implants would rupture following routine physical activity or mammograms. Today’s breast implants have a thicker shell and an additional barrier layer that makes them stronger. They can withstand more than 25 times the force of a normal mammogram without failure. Breast implants, both saline and silicone are not lifetime devices. It is possible that they may fail at some point in a woman’s lifetime and may require replacement.

Myth #3:  “Silicone gel implants cause cancer or diseases like rheumatoid arthritis and lupus”. Fact: Silicone breast implants are among the most extensively studies medical devices in history, with thousands of published reports supporting their use. There has been no proven connection between silicone implants and cancer or other diseases.

Myth #4: “Silicone breast implants can adversely affect a mother’s milk and interfere with breast feeding. Fact: Studies found no evidence of elevated silicone in mother’s milk or any other substance harmful to infants. All mothers with silicone breast implants are encouraged to breast feed.

Myth #5:  “Breast augmentation surgery often results in unnatural and disproportionate results”. Fact: Through proper pre- surgical planning, assessing not only the dimensions of the woman’s chest, but also her tissue dynamics, breast augmentation usually provides a result that is in line with a woman’s expectation of surgery.

The FDA’s decision confirms that silicone gel-filled breast implants are a safe and effective option for women seeking breast implant surgery. Now, with the FDA approval of Silicone-Filled Breast Implants, I am able to offer a broader range of options to all of my patients, many of whom desire to rejuvenate their breasts after child bearing, or enjoy a fuller shape for which nature has otherwise denied them.

Dr. Mark Epstein is a dual board certified plastic surgeon specializing in breast augmentation, with a special focus on improving the patient experience before and after surgery  u

Mark D. Epstein, M.D., F.A.C.S.

Center for Aesthetic Surgery

2500 Route 347, Building 22A, Stony Brook • 631.689.1100

www.epsteinplasticsurgery.com

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? Plastic surgery has now become extremely popular and mainstream. How do you make sense of the frequent advertisements and recommendations of others? I would like to give the reader some guidelines as to how to proceed.

Board certification – The American Board of Medical Specialties (ABMS) recognizes 24 medical specialties, and the American Board of Plastic Surgery is one of them. All other boards with the 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 training 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 surgery of the face, breast, body and extremities. If you choose a non-plastic surgeon for a cosmetic surgical procedure, 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 surgeon’s work. I am particularly proud of our website and I invite you to visit us at www.epsteinplasticsurgery.com.

The office and personnel – Is surgery performed in an office based surgical facility? 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 lasts at least 30 - 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 within a warm, caring and nurturing environment.

Mark D. Epstein, M.D., F.A.C.S.

Center for Aesthetic Surgery

2500 Route 347, Building 22A, Stony Brook • 631.689.1100

www.epsteinplasticsurgery.com

Recent technological advances in the performance of body contouring procedures have resulted in significant improvements in the quality of results, shortened recovery time and dramatically diminished post-operative discomfort as well as improving patient safety.

Liposuction has been around for over twenty years. Although this technique can produce good results, there have been significant improvements.

VASER LipoSelection is quickly becoming the new standard of care for body contouring. The key to the VASER LipoSelection difference is tissue selectivity. Simply put, traditional liposuction procedures are limited by their inability to differentiate between the bad (excess fat) and the good (nerves, blood vessels, connective tissues, etc.). While traditional procedures do remove fat, a considerable amount of damage can be done to other important tissues. This can cause bleeding, bruising, and swelling, and lead to a longer recovery. In addition, damaged collagen and connective tissues can compromise the final shape, leaving behind lumps and bumps where uneven amounts of fat have been removed. Advanced ultrasound energy employed by the VASER System ruptures fat cells on contact, while conserving important tissues vital to optimal recovery and consistent results. Only VASER technology provides the tissue selective LipoSelection procedure, which, targets fatty deposits while minimally disturbing other important tissues. As a result, our VASER LipoSelection patients consistently report minimal pain and bruising, and quick recovery times.

Advances in breast augmentation surgery have resulted in more natural looking breasts and, with the availability of silicone gel filled breast implants, a more natural “feel” as well. Post-operative pain is rapidly becoming a thing of the past as well. Our patients can put their hands high above their heads before leaving our surgical facility. The vast majority of our patients require no medication for discomfort other than ibuprofen (Motrin). Many breast augmentation patients report going out shopping, dinner, etc the same day as their surgery!

Nowadays, more patients are opting to combine breast augmentation with other aesthetic surgical procedures at the same time. With advances in surgical and anesthetic techniques, this can be done safely, often in an office-based surgical setting.

For additional information on breast augmentation, including an extensive photographic gallery, please visit our website at www.epsteinplasticsurgery.com. u

Mark D. Epstein, M.D., F.A.C.S.

Center for Aesthetic Surgery

2500 Route 347, Building 22A, Stony Brook • 631.689.1100

www.epsteinplasticsurgery.com

In my busy aesthetic surgical practice, I see many patients desiring to rejuvenate their facial appearance, but they are not sure as to what they need. They ask me if they should get Botox or fillers which is less invasive than surgery, or go with surgery for a more long-lasting result. What I will share here is my approach, which is integrated from both plastic surgery and dermatology.

The key to a successful facial rejuvenation is no different that that for any medical problem; accurate assessment or diagnosis of the problem followed by correct treatment. I have defined six key areas to assess.

1. Skin quality – Years of chronic sun exposure as well as environmental and genetic factors can induce fine lines and wrinkles, pigment changes, loss of elasticity and overall complexion problems. Here the treatment is to address the skin with topical agents. Botox, fillers and surgery have really no role here. Our aesthetician can refresh the facial skin using various types of peels and other topical agents. This does require compliance, but the reward is fresher, more radiant and youthful skin. Think of it not as a short term treatment to fix a problem, but rather as ongoing maintenance just as is proper diet and exercise.

2. Dynamic lines – These are wrinkles produced in the skin as a direct result of the contraction of underlying facial muscles. Examples include horizontal forehead lines, vertical glabellar (the area of the lower forehead between the eyebrows) lines, crows-feet (the area just outside the eyes) and vertical lip lines. Treatment requires the muscles to be relaxed. Botox is the best way to achieve this. Thorough understanding of facial muscle anatomy and function is required to selectively relax these muscles to give a more youthful appearance without producing a mask-like or surprised appearance.

3. Static lines – These are lines produced not by facial muscles but by a combination of loss of facial fat with aging and also stretching of skin and sagging due to gravity over time. Examples of these lines include the nasolabial folds (the oblique lines between the cheeks and the upper lip extending all the way down from the nose to the corners of the mouth) and the marionette (puppet) lines, which are extensions of the nasolabial folds further down the face. Although surgery can be helpful here, a very popular and effective way to treat these lines is to restore the lost volume to the face. This is done with fillers. Examples of fillers include Collagen, Restylane, Juvederm, Perlane and Radiesse. The longevity of the result varies among the different types of fillers used. For a more complete discussion of Botox and fillers, please visit www.epsteinplasticsurgery.com.

4. Loss of facial volume – As we age, even as a small child, there is loss of fat under the skin which can become pronounced when we are in adulthood. The cheeks hollow and a “tear-trough”may develop under the eyes at the junction of the lower eyelids and cheeks. Fillers work very nicely here, but surgery can improve these areas as well.

5. Sagging of facial structures – Gravity, loss of facial skin and muscle tone result in the descent of important facial features such as the eyebrows, malar area (the prominent part of the cheeks under the eyes) and the development of jowls. In this case surgery is usually the best option (browlift, facelift) although Botox can do a nice job of elevating the tail of the eyebrow and fillers can sometimes reduce the depression between the jowls and chin, giving the “illusion” of a smoother, more unified jaw line.

6. Redundant skin – Loss of skin elasticity and gravity as well as genetic factors weigh heavily on the development of redundant or excess skin. This develops over the entire face. During surgery, the skin is re-draped over the deeper facial structures permitting removal of the excess skin. Although Botox and fillers have no role in correcting redundant skin, they may be useful adjuncts after surgery to restore lost facial volume and correct wrinkle lines due to facial muscle activity

Our practice offers the services of myself, a plastic surgeon, as well as that of Elyse S. Rafal, M.D., a dermatologist (both of us board-certfied) as well as Irene Maher, an aesthetician. All of us would love the opportunity to meet with you for a complimentary evaluation.

Mark D. Epstein, M.D., F.A.C.S.

Center for Aesthetic Surgery

2500 Route 347, Building 22A, Stony Brook • 631.689.1100

www.epsteinplasticsurgery.com

Traditionally, breast augmentation is associated with a considerable amount of pain and downtime, but this no longer needs to be the case. Many surgeons promise a “natural” looking breast, but do they all deliver this?

In 2004, I wanted to perform a better breast augmentation. I wanted predictable, natural results. I wanted a quick recovery with less discomfort for my patients. After changing nearly every aspect of the way I approach the patient and perform the surgery, I can state that we have achieved those goals. Based on a study of our 2007 breast augmentation surgeries, 92% of patients take nothing stronger than over-the-counter medication (i.e. Tylenol and Advil) after surgery. 100% of our patients could raise their arms high above their heads before leaving the recovery room. 86% of our patients return to normal activities (except for heavy exercise) 24 hours after surgery! Many have even gone out to dinner, the movies and shopping (including bra shopping) the same day as surgery.

By the way, the dressing is a small steri-strip bandage. No gauze, tape, wraps, binders or special bras are required, nor desired.