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

In my practice, I find that most consultations for facial aging are driven by a patient’s concern about a particular feature of their face that bothers them. Rarely do they ask me for my opinion as to what is making them look older, nor do they have concerns about large areas. And the fact is, many times what the patient is concerned about is a minor factor in making them look aged or tired, and they are overlooking more significant factors. All the components of the face age simultaneously. Around the eyes, sometimes the uppers or the lowers may look more severely aged than the other. Rarely, however, does the patient appreciate the role played by the brow in the appearance of age in their face.

In order to evaluate the upper eyelids, first you need to assess the brow. If the brow is low, there may be hooding of the brow over the upper eyelid; the patient may think they have an upper eyelid problem. The thing is, you do not want to remove excess brow skin to “tighten the upper eyelid” when the problem is, in fact, the eyebrow. If you do this, then you will just tether the brow down, when if fact it needs to be elevated. I manually elevate the brow to where I think it belongs and then I assess the upper eyelid for excess skin. If there is still excess skin after elevating the brow or fat protruding through the skin, then an upper blepharoplasty is indicated. If the brow doesn’t require elevation, then no browlift is required.

In a consultation for a blepharoplasty in my Stony Point plastic surgery office, the lower eyelid is evaluated independently of the upper eyelid. If there is excess skin, then an external incision just under the lashes is required to remove the excess skin. If there is no excess skin, but there is excess fat protruding through the lower eyelid, then I make an incision just inside the eyelid to approach the fat only. When there are a combination of problems, sometimes I use an approach from both sides. This allows me to preserve the middle muscular layer of the lower eyelid to prevent the development of deformities due to scar contracture later.

I occasionally meet with a patient who has concerns about anesthesia. Sometimes they are concerned about giving up control and being completely asleep without knowing what’s happening. Some of them have heard or read stories about people having bad experiences with anesthesia. I’d like to share with you my outlook on how to choose the right anesthesia for your procedure here in my plastic surgery in Stony Brook, and to review with you the safety features of today’s anesthesia choices.

When deciding what type of anesthesia to employ for cosmetic surgery, I believe it is a mistake to base my decision upon a goal to use the least amount of anesthesia to get the job done. With the current state-of-the-art, modern anesthesia techniques, anesthesia is extremely safe. It is my opinion that it is more important to give you, my patient, the best possible surgical experience in addition to the best surgical result. This necessitates putting you in a “mental and emotional place” that exists without anxiety and no perception of passing time. This requires either sedation or general anesthesia. Sometimes, the line dividing sedation and general is quite vague, so it is almost irrelevant what we call it.

For those concerned about the (albeit rare) mild sore throat that sometimes comes after a surgery, it’s important to know that not all surgeries require that a tube, called an endotracheal tube, be placed down the airway. Often, an LMA (short for laryngeal mask airway) is a better choice. The bottom line for me, as your surgeon, is, “what’s the safest choice for this patient and this procedure?”

For instance, if a patient requires complete muscle relaxation (paralysis) then I can’t just heavily sedate them, because they aren’t able to breathe on their own. The anesthesia machine does that for you. However, if it is OK for the patient to breathe on their own during surgery, then sedation without a breathing tube may be the way to go.

An important consideration when we’re talking about various anesthesia choices is this: one of the nice benefits of sedation and general anesthesia is the amnesia that follows. In other words, you wake from surgery with no recollection of the events you just experienced. It’s like falling asleep for a nap, and when you waken, the procedure is over.

In terms of local anesthesia, I believe that local anesthesia really should be limited to very minor procedures or, in the alternative, procedures done upon very select patients who have absolutely no anxiety and I can obtain an adequate degree of anesthesia in a safe manner.

To your health & beauty,
Dr. Mark Epstein

Part II – How three dimensional imaging is used in my breast augmentation practice

When I see a patient in consultation for breast augmentation, I inquire as to what the patient is looking to achieve. I examine the patient and make recommendations as to what implant I think is best for them. The exact details of how I do this are beyond the scope of this blog, but suffice it to say, I determine what I think is the best implant to fit a particular patient’s tissues. I then have a discussion with the patient about what implant I recommend. The next question is invariably “what will I look like?” I told them that it is very hard for me to answer that question. Due to the nature that the implants conform to the body’s contours, you cannot put an implant in your bra, or a bag of water or rice. In my opinion there really is no way to see how you will look. Maybe you can get a very cursory idea of size, but I caution them that this, too, is highly inaccurate. So it comes down to a matter of trust. The patient just has to trust me that I will take into account the cup size she wishes to be, mindful of the fact that cup size is not a standard volume as “cc’s” are. You don’t buy a container of milk in A, B, C, D, or DD size. You buy a half pint (for your coffee), pint, quart, half gallon or gallon. These all have defined numbers of cc’s in them. For instance, a quart is 948 cc’s. Implants come in cc’s not cup sizes. The actual cup size is the sum total of how much tissue you start with and how many cc’s of implant you add later. The same implant can look very different in three different women.

I have had the opportunity to be the first in Suffolk County, NY to have a computer system capable of three dimensional imaging and surgical simulation. I have since taken the liberty of introducing the system to my breast augmentation patients who have had their surgery performed prior to my having such technology available. I have posed the following question to many of these patients: Prior to your undergoing breast augmentation surgery, did you have any visual image in your mind as to what your surgical result would look like. Having spent a fair amount of time with my patients in consultation prior to surgery, and that included either reviewing photos of similar patients who underwent breast augmentation or having the patients view such patients on my web site, I was very surprised with what they all (and I mean ALL) told me: all of the two dozen or so patients I queried told me that they had absolutely no idea what they were going to look like after surgery. They told me that they just “trusted me”!
(more…)