I am very excited to announce that we were voted The Best of the Brazos in 2013!

What surgical approach for breast augmentation do you use?

Dr Rude:

"There are three common incisions for breast augmentation; the armpit, the areola, and the crease. Generally all the scars are very good. There is not one particular approach that has clearly superior scars. The vast majority of the time the scars from all three approaches are very nice. There are several pros and cons to the different approaches. While an armpit or transaxillary can be done very well it generally has a higher revision rate than through the crease. The areola approach has the disadvantage of having a higher change of changes in nipple sensation. However, the most significant problem with these two approaches is their incidence of capsular contracture. Capsular contracture is where the scar around the implant gets hard. One of the causes of capsular contracture has been discovered to be bacteria trapped within the scar around the implant. This is most likely a manifestation of a biofilm. The areola and the armpit have vastly higher rates of capsular contracture compared to the crease. Some studies have shown a five times higher rate through the nipple and a thirteen times higher rate through the armpit. Capsular contracture can be a very serious complication of breast augmentation. For this reason I choose to do my breast augmentations through the inframammary crease."



Ask Dr. Rude: Blepharoplasty Recovery and Scars

What is the recovery and scars associated with a blepharoplasty?

A blepharoplasty is an eyelid lift. There is upper blepharoplasty for your upper eyelids and lower blepharoplasty for your lower.

The upper blepharoplasty is generally an incision that is placed in your lid crease. Your lid crease is where your eyelid folds when your eye opens. The extra skin is generally cut out above this point. How much fat is reduced depends on the persons eyes. Some people develop very bulging eyes as they grow older and want this reduced so they don’t have such tired appearing eyes. The balance there is that we, as plastic surgeons, don’t want to skeletonize someone’s eyes either. We do have to leave some fat behind in order to improve eyelid aesthetics.

Lower eyelid blepharoplasty can be done in a couple of different ways. I will often do a transconjunctiva approach. This is an incision on the inside of the eyelid, the pink part. This allows me to access the fat pads that give people bulging lower eyelids. It also preserves some of the anatomy that is important for maintaining this structure and integrity of the lower eyelid. I often couple this with a skin pinch on the outside of the eyelid to take up some of the excess skin as needed. Another common lower blepharoplasty incision is to make an incision just underneath the eyelashes and to cut out extra skin as well as get to the fat of the lower eyelids through the same incision. 

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An Interesting Article

For the most part, medical advice delved out by magazines is not of the highest quality. However, I came across an article from Allure magazine that was quite accurate in its' depiction. Read about "The 11 Most Overrated Cosmetic Surgery Procedures"  here.

Lip Enhancement

A common topic that patients ask me about is lip enhancement. They bring in pictures (like the one above), desiring to walk away with similar results.

There is a variety of methods for doing this including fillers (such as Restylane or Juvederm), fat injections, or permanent implants. They all have their own individual pros and cons.

Restylane injections are relatively easy to do and tend to last around 3 to 4 months. At this point, not all the Restylane is necessarily gone however ladies do begin to notice some volume depletion at that point.

Fat injections are a potentially permanent way of augmenting lips. It is a common adjunct to doing a facelift. Fat is aspirated by liposuction from a different part of the body and then injected into the lips. Predictably not all the fat that is injected will survive. The fat that does survive can represent a permanent lip augmentation. I am not a fan of doing fat injections in younger people's lips. If they are at an age where they have weight changes, for instance pregnancy, the fat that you inject particularly if it is from the abdomen will grow as the abdomen grows. This is a better method of augmentation for people who are going to, by their best estimation, be fairly stable in weight.

The third and least popular form of lip enhancement is with permanent implant. Permanent lip implant can certainly look quite nice. In general they run the risks of having palpability of being able to feel the implant. Because this is a highly mobile area that also has a lot of bacteria there are also issues with extrusion and infection. 

Have any questions? Submit them to our website here.

Recommendations and advice are the result of experience and thoughtful, professional judgment. The opinions voiced in this material are for general information only and are not intended to provide specific advice or recommendations for any individual.


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Cellulite 101.

We are commonly asked about cellulite. The appearance of cellulite is caused by a couple different anatomical features.

The first is from loose skin. It's normal to have connections from the skin to the deeper layers. If this skin is too loose, it will hang causing dimpling. This gives the appearance of cellulite as the skin is essentially hanging from that point. The second is that the skin is tethered by too many and/or too short of those fibrous connections from the deeper layers out to the skin with the interposed fat causing bumps in the skin similar to a depressed button on a throw pillow.

The appropriate solutions for these two problems are predictably different.

For loose skin generally the solution is to cut his skin and do a lift. Depending on the body area this works variably well.

For people that do not have extra skin but have too many shortened connections between the skin and the deeper layers, there is a new solution called Cellulaze. This uses a laser to divide the connections that are dimpling the skin. Some liposuction is done to help even out the fat layers between the skin and the deeper layers.  I have very closely researched this technology and do believe that it is modestly effective. The only problem I found was that it is very expensive. We did a survey of various patients, all of which noted that cellulite was a significant problem and that they would be willing to pay to have a for a procedure to fix it. When they were presented with a series of before-and-after's of Cellulaze treatments as well as the price, only 2% said that they would be willing to proceed. Because of this, we have chosen not to offer the service in our office.

Have any questions? Submit them to our website here.

Recommendations and advice are the result of experience and thoughtful, professional judgment. The opinions voiced in this material are for general information only and are not intended to provide specific advice or recommendations for any individual.

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Just An Idea

People sometimes ask me what is the difference between plastic and cosmetic surgery. I ran across an article that I wanted to share with you. It reads:

Because plastic surgery entails a repair or enhancement, almost any procedure has a cosmetic element. But the names are not equivalent. 

"Cosmetic surgery is a very generic term," Rohrich said 

The terms go beyond semantics, however. Board certification in plastic surgery from the American Board of Plastic Surgeons means a physician has completed five years in surgical training at an accredited hospital, with at least two years dedicated to plastic surgery.
Physicians in other disciplines may have some training in plastic surgery; for example, an ophthalmologist may be trained to perform cosmetic procedures around the eyes. However, a medical degree and some form of certification in cosmetic surgery does not equal that level of training. That's why prospective patients need to ask about a physician’s training.

I encourage my staff to advise patients to do their research before scheduling an appointment. Even if they choose not to come to our office, make sure they know that their surgeon has received the highest level of training. As the article states, some surgeons may have cosmetic training (and advertise this), but this does not ensure that they are Plastic Surgeons. The words are often used interchangeably, but they do not mean the same thing. I am a Board Certified Plastic Surgeon and I perform plastic surgery on patients. "Cosmetic surgery" is a grey undefined area.

Finding a Board Certified surgeon is also encouraged. Being "Board Certified" means the individual has completed a training program after going to medical school and they have taken certification examinations to determine their proficiency in a particular specialty of medicine through the ABMS (American Board of Medical Surgery). There is no certification for "cosmetic surgery", but there is for Plastic Surgery. If a surgeon identifies himself as a cosmetic surgeon, I would encourage inquiring further about his specific training.

Furthermore, word of mouth is always helpful when choosing a physician. Ask your friends and do research on the internet, but be sure to take it all in with a grain of salt.

Recommendations and advice are the result of experience and thoughtful, professional judgment. The opinions voiced in this material are for general information only and are not intended to provide specific advice or recommendations for any individual.

Ask Dr. Rude : Liposuction

You can ask us any plastic surgery question you would like. Just fill out this handy tool on our website. Some of the most popular questions will be put on the blog. We will never release your information or identity.

A patient asked:

Is liposuction an effective way to lose weight?

Dr. Rude says:

No it isn't. Liposuction  is good for contouring. I often call it a silhouette procedure. We are trying to give the person a better shape.  The best means of changing someone's weight is through diet and exercise.

Have a question you would like answered? Ask here.

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