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 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

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”!
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Part I – What three dimensional imaging systems are

I have always enjoyed technology. Since I was a teenager in the early 1970’s, I loved electronics (computing wasn’t even a hobby back then). For my pre-med major in college, I studied Biomedical and Electrical Engineering at Northwestern. It was there that I obtained a strong background in computers and emerging biomedical technologies. During the latter part of my plastic surgical fellowship training, I saw the advantage to know not only how to operate computers and run software programs, but to learn how to develop tem as well. Several of the software applications I developed over ten years ago, are still in use in my practice today.

When I was a surgical resident, I remember visiting a young plastic surgeon that had a computerized imaging system. It consisted of an inexpensive, low resolution video camera, a computer (one of those early PC’s) and a monitor. He took a photo of my face and showed me how the software could change the image. He deftly demonstrated how he could take my nose, remove it from my face and replace it back, this time upside down. Kind of a cool curiosity, but is it worth it? That was about twenty five years ago. Over the years, I have seen a couple of such imaging systems that could take a two dimensional image (two dimensional means a flat image with height and width, but no depth) and manipulate it somewhat. I was pretty unimpressed by what I saw, until recently.

I practice plastic surgery in the same office as dermatologist Dr. Elyse Rafal, who also is my spouse. Dr. Rafal has always been involved in clinical drug trials with various pharmaceutical companies. These studies rely on high quality, consistent, reproducible photographic imaging. Over the thirteen years I know my wife, I cannot remember a single drug study that required imaging that did not have customized photographic equipment developed by Canfield Scientific, in Fairfield, NJ.
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