Tennessee Cosmetic Surgery | The Plastic Surgery Group P.C.

There is no argument that women who suffer significant neck and back pain because of the weight of their breasts benefit from a surgical breast reduction. The varying techniques available to plastic surgeons in the performance of the operation, however, can produce a wide range of results.

The principle purpose of breast reduction is to solve the three problems that plague the overly large breast. First, the design of the surgery must decrease breast volume. This is readily accomplished by any one of a number of techniques. It is in the management of the other two problems where most of the post operative dissatisfaction with breast reduction results lies. The nipple areolar complex must be reduced and moved to a cosmetically ideal location, and the loose and fatty tissue beneath the armpit must be eliminated. The breast’s base is narrowed and rounded with thoughtful attention to each of these preoperative flaws.

The chief cosmetic complaints after breast reduction include inadequate volume reduction, and the persistence of the fat roll along the side of the chest. This problem is typically caused by a misunderstanding of classic breast aesthetics and under-treatment during the operation.

At a recent meeting of the American Society of Plastic Surgeons, I was impressed to hear discussion about a return to focus on surgical techniques that produce this youthful athletic breast. The pendulum is swinging away from techniques that are consumed with the effort to minimize scar length while sacrificing adequate shape. It has always been my contention that, as the old proverb says,”In order to make an omelet, you have to break some eggs.” My approach to breast reduction employs techniques which derive from such diverse disciplines as tailoring, sculpture, and plastic surgery. The breast is dis-assembled and then reassembled in an orderly process that creates an idealized shape and size.

From sculpture, we borrow the concept of removal of the excess while maintaining the volume that will compose the corrected form. Great sculptors can actually demonstrate their subjects emerging from solid rock. The description of this process should be sketched out during the consultation. The patient should become familiar with how much tissue will be removed and from where it is being excised.

From tailoring comes the control of the skin envelope of the breast. This is, perhaps, the most important part of the intervention. It is this process that controls the ultimate shape of the breast, lifts the nipple areolar complex, and avoids the dreaded “batwing”. The greatest tailors make their craft appear effortless and create garments that can transform the bodies of those who wear them.

Finally, from plastic surgery comes the depth of training required to combine these concepts into a living sculptural surgical technique. Not all breast reductions are the same; but with the ideas I have outlined firmly in mind, your breast reduction should be a safe and ultimately satisfying experience.

Face It. Life is Competitive. Last month’s Plastic Surgery News focused on the increase in the number of men having plastic surgery. According to the American Society of Aesthetic Plastic Surgeons (ASAPS), the number of surgical and non-surgical procedures performed on men has increased 290% over the past decade. ASPS President, Phil Haeck, MD, states “You can’t go to the gym and work off your wrinkles.” From Botox injections to facelifts, 21st century men attach no stigma to having cosmetic surgery. They want to look as good as they feel and stay competitive.

Typically, male clients do not want a dramatic change particularly in terms of facial aesthetics. They do not want to look “over done” and prefer, simply, a more youthful appearance. One popular procedure is cosmetic eyelid surgery. Done appropriately, this procedure is designed to remove fatty lower lid bags and the skin that rests on the upper eyelash. Botox injections are very effective at softening wrinkling in the upper face and raising the eyebrow a bit without looking artificial. Wrinkle corrections now come in a wide variety and can be used to create an instant result. Restylane, Juvederm and Sculptra are just three of the products available to fill in furrows and restore youthful volume.

A little bodywork goes a long way. Even men in excellent physical shape may have stubborn love handles, abdominal fat and male breasts. Conventional liposuction or laser-assisted SmartLipo helps sculpt the body into a more pleasing shape or removes the stubborn bulges that don’t respond well to proper diet and exercise. SmartLipo is minimally invasive and offers little to no downtime following a procedure. Sculpting with SmartLipo will reveal the muscles that many men work hard at the gym to strengthen.

Male breast reduction, or gynecomastia, can be accomplished by liposuction or excision, depending on whether the excess is caused by too much fatty tissue or glandular and skin issues. Plastic surgeons are very experienced with both techniques.

A youthful nose goes a long way in improving appearance. The nose ages also. A nasal reshaping may require no bone work at all making it a rapid recovery procedure with a great cosmetic result. Facelifts too, are specialized in men. Men mostly focus on a strong sharp jawline. The plastic surgeon must alter his techniques so as not to produce a feminizing result.

As the statistics indicate, cosmetic surgery is not for woman only. Safer anesthetic methods and a large selection of procedures allow men to tailor their cosmetic surgery to their lifestyle, budget, and the extent of change they want to achieve.

Cosmetic surgery fantasies. Example: the “lunch time miracle procedure with no downtime that does not require any anesthesia and makes you look ten years younger, immediately”. Patients who believe this type of statement are going to be very disappointed. Prospective patients routinely call our office to ask if our physicians perform various procedures they’ve seen advertised on the internet or heard about in a chat room. Recently, a patient called us about AWAKE breast augmentation. She had read about the procedure in a New York Times article. After reading the article myself, I felt compelled to try to provide some education to my patients about the frenzy of marketing that surrounds the repackaging of cosmetic surgery.
“REPACKAGING” means the creation of another name for a cosmetic surgery that is already being done so that it can be remarketed as a fresh idea --- a cutting edge procedure. For example, the New York Times article discusses performing breast augmentation under local anesthesia alone so that the patient can help select the implant that they like best during surgery. The practitioners of this technique indicate that it gives the patient greater autonomy (a bigger voice in the procedure) and is safer than general anesthesia.
As a plastic surgeon who has performed hundreds of breast augmentations under sedation, I find this repackaging of a safe, reliable technique simply irresponsible. The type of sedation used in our practice allows the patient to breathe on their own while they rest comfortably during their controlled, safe procedure. Decisions regarding breast size should be made prior to surgery by way of a thoughtful consultation with the patient. Handing patients implants and asking them to select the size they feel is appropriate is akin to your plumber asking you to select the equipment you think he needs for your job. As it turns out, the practitioners of this AWAKE technique are not Board Certified Plastic Surgeons, but have come to cosmetic surgery by way of Ob-Gyn, or even family medicine. One such “Cosmetic Surgeon” offers a two day $7,000 course in his breast augmentation technique. Two days—wow. The plastic surgery residents currently studying with us will spend about 8 years in training.
The truth is that these operations may or may not be cheaper but definitely not safer without an anesthetist or anesthesiologist present. Cut rate fees attract patients to this group of practitioners whose greatest talent may be salesmanship. To paraphrase one of the doctors who performs AWAKE breast augmentation, “It is more safe,… Patients can scream and, you know,… I can’t be putting my needle there”. You should know that local anesthesia cases can be performed in a doctor’s office and, thus, avoid oversight of his safety practices by surgical accrediting agencies and major hospitals. In many cases, the physician performing the case in his office does not have the credentials to perform the case in a major hospital that must answer to the State for the privileges they grant their surgeons. If your surgeon does not have hospital privileges to perform the procedure you desire, you need to look for another doctor. Additionally, most of these AWAKE technique surgeons give their patients oral sedatives prior to surgery. No physician should rely on a sedated patient to make appropriate, reliable decisions about implant size or anything else.
Repackaging is not limited to breast surgery. Facial volume injection techniques have taken on a media life of their own. “Vampire” facelifts, liquid facelifts, and Stem Cell facelifts are just a few marketing terms. Remember that there is no Stem Cell facelift anything that has been scientifically proven and accepted. Most of these interventions are fat injections or some sort of blood plasma injection. SCULPTRA injections have been referred to as a liquid facelift, but SCULPTRA -although it works well- only provides volume.
Be mindful of the minefield of cosmetic surgery repackaging and over-marketing. Educate yourself. Visit Academic websites and not chat rooms where the conversation can be dominated by less than reputable people. Look for Cosmetic surgeons who are certified by the American Board of Plastic Surgery. Your Cosmetic Surgery should be a positive memorable experience.

We are so proud to announce that Louis L. Carter, MD, FACS received the Volunteerism Award from the American College of Surgeons on Tuesday, October 25th, 2011 in San Francisco, CA. Dr. Carter's relationship with our group began in 1987 when her returned to the U.S. to further develop his skills in hand surgery under the guidance of Cauley Hayes, MD. He practiced with us for almost 10 years before returning to full-time missionary work. The Volunteerism Award is very prestigious and a well-deserved honor for Dr. Carter's selfless efforts providing care to medically underserved individuals. Dr. Carter continues to have a presence in our practice during his time home from the mission field and contributes greatly to our faculty's mission of teaching.

Fluctuations in weight can produce an upper arm cosmetic deformity that presents as sagging skin and is particularly visible when wearing short sleeve shirts. This problem is frequently seen after bariatric surgery as weight loss shrinks the fatty volume of the arm. Known as “Brachioplasty”, a cosmetic arm lift is a surgical intervention that is designed to further decrease the volume of the arm while it tightens and enhances the arm’s underlying shape.
This procedure is performed through an incision in the arm which is placed such that it is beyond view either from the front or back. New innovations in cosmetic arm surgery involve its combination with breast lift surgery and LASER assisted liposuction.
Part of the usual appearance of the arms, breasts, and chest after substantial weight loss develops from a relaxation of the ligaments that hold our skin envelope in place. This leads to a loose skin appearance that proceeds from the elbow to the axilla and upper back, and then to the breasts. An innovative combined arm and breast lift has been developed which takes advantage of the extra tissue available in the upper arms and chest using them to tighten and enhance the breasts. The operation begins in the upper arm where excess skin and fat are removed. The procedure then crosses the axilla and mobilizes the excess skin and fat lying along the side of the chest. A modified breast lift is then performed and the excess skin and fat along the side of the chest is used as a living breast implant to enhance the size and shape of the newly lifted breast. This body contouring operation thereby improves the post weight loss contour of the entire torso in one operation.
For less significant arm changes, a combination of LASER assisted “SMART” liposuction and surgical contouring can be employed. The principle of LASER liposuction is to improve the standard liposuction process by melting the extra fat and heating the overlying skin. Using a computer guidance system, the carefully treated skin is tightened over the reduced fatty layer. Occasionally, LASER liposuction alone is sufficient to produce an effective cosmetic improvement.
Arm lift techniques are performed under anesthesia specialist monitored deep sedation as an out patient surgery in our practice. Good health is a prerequisite for elective cosmetic surgery. Post operative management may include the use of compressive garments, scar management, and exercise restrictions dependent upon the specifics of the surgical technique. However, the great majority of patients return to pre-surgical activities after a month.
Brachioplasty techniques have been proven to provide permanent, reliable results in the hands of expert plastic surgeons. For more information about Brachioplasty and body contouring surgery visit us at our Website Refinedlooks.com, or search the principle source for board certified cosmetic plastic surgeons at the American Society of Aesthetic Plastic Surgeons (ASAPS).

It seems like every time I pick up a magazine or turn on my computer I am confronted by an advertisement describing how “stem cells” are being used to treat a host of illnesses. I have even recently seen a television infomercial reporting the benefits of a “stem cell” cream! How ridiculous. If scientific breakthroughs of this enormity were true, they would be all over the major news channels interviewing nationally and internationally recognized physicians and scientists as well as be a part of the best scientific journals. The reason you see them in unattractive ads and infomercials locally is because they are paid for by unscrupulous physicians, and the publications that present them want the advertising dollars.
Just as I was considering how I was going to provide the public with education regarding the real scientific use of stem cells, my spring copy of AESTHETIC SOCIETY NEWS arrived. Clearly, I am not the only Plastic Surgeon who finds the whole “stem cell” media blitz disturbing. Felmont Eaves III MD, a Chattanooga native, and the President of the American Society for Aesthetic Plastic Surgery, implores plastic surgeons and patients alike to demand better evidence for advertising and marketing claims.
In Dr. Eaves article, he discusses the thousands of publications from around the world that were examined for scientific evidence of valid results from “stem cell” therapy in cosmetic surgery. At present, little evidence exists to indicate “stem cell” treatments for cosmetic surgery are safe and effective.
As a teaching plastic surgeon, it is my job to train my residents to understand whether scientific evidence is valid or not. Currently, the marketing of “stem cell” therapies has gone far beyond meaningful scientific evidence. More well designed experimentation is necessary to gauge the effectiveness of stem cell treatment in cosmetic surgery. At present, there is no study of cosmetic surgical “stem cell” treatments that would hold up to an evaluation by a real scientist.
If a technique is not appropriately tested, it may not only be ineffective, but it could be harmful. Devastating side effects could result from the use of “stem cell” therapy that has not been studied appropriately. The FDA regulates some types of cell therapy and the devices created to collect the cells. The device that separates stems cells from fat cells after liposuction, for example, is a research tool only and is not approved for human use.
I think that Dr. Eaves’ strongest comment however reads,”…the emotional abuse of patients by enticing them with unsubstantiated claims not only harms and deceives patients, but also potentially tarnishes the reputation of plastic surgery and of stem cell therapies themselves.”
I am enthusiastic about the good that “stem cell” therapy can bring to medicine. However, I continue to be very concerned with the claims certain physicians make right here in Chattanooga regarding their use of “stem cells” in various cosmetic interventions.
Buyer beware! As always, a conversation with a physician certified by the American Board of Plastic Surgery is your best guard against costly, unsatisfactory and potentially damaging results. For more information visit the ASPS and ASAPS websites.

At 85, a retired army general’s wife was still in the thick of things. She enjoyed excellent health, and a vigorous lifestyle. She, however, was not at all happy with what she saw in the mirror. There seemed to exist a stark contrast between her self perception and her aged appearance. Her cousin, a well respected, retired plastic surgeon suggested that she might be a candidate for a facelift. After careful review of her physical health, she safely underwent a three hour modified face and neck lift. She was very pleased to regain a “look” that was more consistent with how she felt about herself.

The American Society of Aesthetic Plastic Surgeons has reported that in 2010 at least 84,685 procedures among patients older that 65 were reported by its members. That is a 21% increase from the preceding year. Cosmetic surgery among septuagenarians and octogenarians is on a steady rise as baby boomers pass the age of 65.

Cosmetic surgery should be limited to those who are in good health, but there is not necessarily a theoretical age cut off. It may be better to consider physiologic age then chronologic age. People who have good genetics, and have protected their health with exercise and good lifestyle habits may enjoy an active life well into their nineties. Recent studies published in the Journal of Plastic and Reconstructive Surgery report that the risks of surgery in an appropriately screened population over 65 are no greater than those of younger patients. Cleveland Clinic research has indicated that there is no difference in complications of facelift operations in patients whose average age was 70 and patients whose average age was 57.6.

As our healthy population ages, more people continue to work or even look for second careers. Moreover, the stereotype of the socially isolated, stay-at-home elderly is being exploded. This is the era of the AARP. Spend just a few minutes watching the television and you will see this demographic in action. Baby Boomers and Beyond are vital, engaged; and, as the VIAGRA ads indicate, want to be sexually attractive throughout their Golden Years.

Cosmetic surgical interventions range from eyelift to body contouring and breast augmentation. Injection therapies can even be tailored to meet the expectations of patients with more fragile medical histories. The key to success is safety first. In all studies of elective surgery in the aging population, health problems like diabetes, heart and lung disease, and anticoagulants like warfarin and PLAVIX pose significant questions with regard to the reasonable risk of the procedure.

Look for sound advice from a well respected surgeon. A recent two day multipage special section on “Cosmetic” surgery appeared in the newspaper USA Today. It warned its readers to be wary of the undertrained physician who masquerades as a plastic surgeon to gain the trust of unsuspecting patients. Be educated. If nothing else, seek several opinions about your proposed surgery before acting. Engage you primary care physician in your plan. The best cosmetic plastic surgeons will want your Doctor to be “in the loop” regarding any future surgical intervention. Your cosmetic surgery experience should be both safe and satisfying. Put yourself in reliable hands and enjoy your refreshed REFINED LOOK.