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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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

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.

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.

What I will share here is my approach, which is integrated from both plastic surgery and dermatology.

The key to successful facial rejuvenation is no different 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 typical 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 an 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, and 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 muscle anatomy and function is required to selectively thee 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 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 (brow lift, 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 chins, 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 facial 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. Rafa. M.D., a dermatologist (both of us board-certified) as well as Irene Maher, an aesthetician. All of us would love the opportunity to meet with you for a complimentary evaluation to help you decide whether you need Botox, fillers or surgery. It’s our job and our pleasure to assist you in the important task of maintaining a beautiful facial appearance.

To your health & beauty,
Dr. Mark Epstein

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

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.