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

Please visit my dedicated breast augmentation web site www.breastimplantslongisland.com .

I have maintained a this plastic surgery web site www.epsteinplasticsurgery.com since 1999. The purpose of my web sites is to provide information to the viewer about the plastic surgical procedures that I perform. A web site without useful information of benefit to patients is nothing more than an advertisement. I have always believed in patient education and involving the patient in the decision making process. In order to do that, there has to be a concerted effort to make available useful educational material on the web site.

Breast augmentation is different than most plastic surgical operations because two foreign bodies are inserted into the body. There are many choices to make regarding this surgery: round or teardrop, smooth or textured, saline or silicone, above the muscle or below the muscle, low-medium-high or extra high profile, incision below the breast or around the nipple or in the armpit or through the navel are just some of the choices to be made.

I have yet to identify a web site as comprehensive as I felt necessary to give the viewer one good resource to use in preparation for making the right choices in breast augmentation surgery.

My new web site, www.breastimplantslongisland.com is dedicated to topics that relate only to breast augmentation surgery. The core of the web site is a tutorial I call “Breast Implants 101” that uses not only descriptive text but also illustrations as well as case material from my breast augmentation practice.

I am very proud of this web site and hope that it will be of value to all who visit.

While doing some grocery shopping tonight (yes, plastic surgeons do grocery shopping – my spouse is a dermatologist so we split the household chores) I saw this month’s Life & Style cover story “Heidi’s New Surgery Disaster.” Being a cosmetic plastic surgeon this naturally piqued my curiosity so I bought the magazine and read it when I got home.

The essence of the article is a story about how Heidi regrets all the surgery she had, about ten or so operations performed at once, at a cost of over $100,000. There is an extensive pictorial showing her multitude of scars, which are portrayed as horrific. I am not writing this blog to defend what was done, but rather to make a few comments on my observations and offer my opinion.

1. No one “needs” cosmetic surgery. Sure, we may see someone with a large hump on their nose and say they “need” to have it fixed, but they really don’t. The purpose of cosmetic surgery, as I see it, is to make a person feel better about the way they look, that is, to make them more comfortable in their own skin. There is other reason to have cosmetic surgery than to make you feel better. Never do it for someone else.

2. Do not let your surgeon “talk” you into having anything done that you are not in agreement with. Heidi discussed having liposuction on her legs, but later expressed remorse that the scars did not justify the results and that her surgeon talked her into it. As her surgeon recently and very unfortunately met a tragic end, we will never know the truth about that.

3. Surgery does not happen without scars. All humans form permanent visible scars when their flesh is wounded. Some scars are less apparent than others. As plastic surgeons, we learn how to plan our incisions, close wounds, perform surgery and handle tissues so as to minimize scarring, but we cannot eliminate it. Some patients will form scars more visible than other patients. As surgeons, we have no control over patients biologic wound healing properties. I inform all of my patients of this fact many times over before surgery is performed.

4. Surgery is stressful. Altering your physical appearance, even for the better is stressful. Combining the two can produce stress as well as emotional ups and downs in the immediate period after surgery. This is all normal, and again, I advise all of my patients about this. I even have a cute little diagram that we give them before surgery to explain this. Some patients undergo two or three procedures in a single sitting. With advances in surgical and anesthetic technique, this is rarely an issue. However, where do you draw the line? I am not sure just what the limit should be, but I do believe that ten procedures at once is probably a bit much.

5. With the exception of Heidi Montag’s breast augmentation, I think that most of her results look good. Maybe not perfect, but plastic surgery is rarely perfect. Let’s face it, our tissues are rarely perfect and the surgeon can only work with what he is given, but that doesn’t mean he can’t still deliver exceptional results. My suspicion is that Heidi was not adequately counseled before her surgery about what to expect in terms of results and scars after the surgery. As far as her breast augmentation, I think that that alone can be the subject of another blog, but suffice it to say that it is ill advised to go from an A or B cup to a G cup. The destruction to the breast tissues is irreversible and uncorrectable. A properly performed augmentation based on the natural characteristics of the breasts yields excellent, natural results with minimal risk of problems, both in the short term as well as the long term.

My advice for those interested in plastic surgery is to not be put off by Heidi’s unusual story. Her story is one of a woman with perhaps unrealistic expectations, a long list of features about her body that she wishes to correct, a surgeon who more than pushed the envelope on what in my humble opinion is reasonable and a lack of appropriate preoperative counseling and preparation.

I recommend those interested in cosmetic surgery to do your research. Spend time on the Internet looking at lots of plastic surgery websites. Learn as much about the procedure that you are interested in. Visit several surgeons. Ask lots of questions. Speak to patients who have had the surgery that you are interested in. IF you personally know people who have undergone the surgery that you wish, visit their doctor as well. An informed patient, as with any other consumer, will in the end be the happiest patient.

To your health & beauty,
Dr. Mark Epstein

Do you take vitamins and herbal supplements on a regular basis? Although there are both anecdotal and scientific reasons to do so, many herbal supplements can interfere with surgical recovery, from increased bleeding to unwanted anesthesia interactions. By telling your plastic surgeon what you take, he or she can tell you what to avoid prior to cosmetic surgery, and ultimately decrease the risks for potentially dangerous side effects!

Many of today’s miracle drugs (penicillin, digoxin, codeine and many others) were derived from plants. Conversely, many plants that are not used as a source for medicines do have potent biologic activity and can produce problems if taken shortly before or after surgery. Here is just a short list, not all-inclusive, of potential problems that can occur from taking some herbal preparations around the time of surgery:

• Ephedra - Possible complications: heart attack and stroke
• Garlic - Possible complications: bleeding during and immediately following surgery
• Ginkgo - Possible complications: bleeding during and immediately following surgery
• Ginseng - Possible complications: bleeding during and immediately following surgery
• Kava - Possible complications: may increase the sedative effect of anesthesia
• Saint John’s Wort - Possible complications: may cause acute rejection of a transplanted organ by interfering with anti-rejection medications; rejection may begin within 24 hours of taking Saint John’s Wort
• Valerian - Possible complications: may increase the sedative effect of anesthesia
• Vitamin E - Possible complications: bleeding during and immediately following surgery

It is imperative that you discuss with your surgeon any herbals or over the counter drugs that you are planning to take around the time of your surgery. Furthermore, it is best to stop all herbal medications, supplements and megadoses of vitamins within a few weeks of your surgery. Write a list of any herbal preparations you take along with the medications you regularly take on a piece of paper and keep this list in your wallet.

To your health and beauty,
Dr. Mark Epstein

For many women, a Mommy Makeover is a logical step to take once they have completed their families. Although there’s no specific definition of what constitutes a Mommy Makeover, in general, they usually involve a tummy tuck and some kind of breast enhancement, which could be a breast augmentation, breast lift or reduction, depending on the woman.

How soon can a woman have a Mommy Makeover?
It is my opinion that a woman needs to stabilize emotionally and physically after childbirth prior to contemplating cosmetic surgery of any kind. If they have extra weight, it is best to lose it as soon as possible; if there are any medical problems resulting from the surgery, these need to be addressed, and if there are any emotional issues, such as postpartum depression, this too needs to be treated and resolved before making such an important decision as cosmetic surgery. It is absolutely normal for any woman who undergoes cosmetic surgery and makes a substantial change in their physical appearance to undergo emotional “ups and downs.” We warn all our cosmetic surgery patients about this well before the date of surgery. Emotional depression is a normal result of the surgery, both physiologically as well as emotionally. Fortunately, as long as there is no underlying depression, it is very short lived.

To answer the question as to when to time a mommy makeover, I would recommend not making any important decisions about surgery until any post-partum depression has lifted. That said, if the depression is a direct result of the changes in your body due to pregnancy that can be easily surgically corrected such as restoring fullness to your breasts or removing excess hanging skin from your abdomen, then in those cases it might be worthwhile to make the decision to make a physical change sooner.

To your health and beauty,
Dr. Mark Epstein

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