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

Cosmetic Breast Reduction – You’ve got to Break Some Eggs

2011-12-06T11:37:00.000-08:00

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.

MEN: IMPROVE YOUR FACE VALUE

2011-11-18T13:20:00.000-08:00

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.

AWAKE Breast Augmentation & Other Fantasies

2011-10-31T12:13:00.000-07:00

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.

Louis L. Carter, MD recieved Volunteerism Award

2011-10-28T09:20:00.000-07:00

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.

Innovative Arm Lift Surgery

2011-10-21T10:45:00.000-07:00

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).

Stem Cell Cosmetic Medicine: Buyer Beware

2011-10-19T14:13:00.000-07:00

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.

Cosmetic Sugery: Baby Boomers and Beyond

2011-10-18T10:45:00.000-07:00

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.

Call Today and Reserve Your Place!

2011-10-17T11:51:00.000-07:00

Have you made your reservation for the Beauty Educational Seminar to be held at SpaHBI Monday, November 7th by Dr. Brzezienski? Space is limited! Call Bobby at 423-894-2973 to reserve your place. www.refinedlooks.com

Discover how cosmetic surgery can give you just what you want for the holidays.

2011-10-14T09:47:00.000-07:00

A Beauty Educational Seminar will be held at SpaHBI Monday, November 7th at 6:30 by Dr. Mark Brzezienski. Learn the answers to all of your questions regarding cosmetic surgery, Botox or fillers, and determine which procedures are right for you. Get to know Dr. Brzezienski in a relaxed atmosphere where special attention can be given to your individual inquiries. Space is limited. Call Bobby at 423-894-2973 to reserve your place.

Breast Cancer Awareness

2011-10-12T12:32:00.000-07:00

October is National Breast Cancer Awareness Month. Around our community and country, activities have been planned to promote awareness regarding the early detection and management of breast cancer. As a plastic surgeon, it has been my great privilege to have become involved in breast reconstruction in our community. It is now one of my principle interests. There are many aspects of breast reconstruction that I enjoy. The technical challenge is stimulating, and the results are predictably good. But, far and away, what I have found that always brings me back to breast reconstruction as my favorite surgery are the patients. The women I have had the pleasure to work with are some of the most gracious, tolerant, patient and thankful people I have ever contacted. And particularly this month, I want to say “Thank-you” for inviting me into your lives.

Breast reconstruction can be a confusing choice for patients, especially when one is already confronted with the management of a dangerous disease. There are a myriad of options, and patients really need a reliable guide to help navigate through these personally uncharted waters. To bring the issues to basics, one can have an immediate or a delayed reconstruction. At times, the tumor type dictates that reconstruction should be delayed. Anticipated radiation therapy typically precludes immediate reconstruction. I have also learned that in some patients, immediate reconstruction is just too great a psychological burden. Delayed reconstructions can be performed when the patient is ready, and the cosmetic results are equal to that of an immediate procedure.

There are three types of reconstruction. One type uses all “off-the-shelf” implants. One type employs entirely pieces moved from other areas of the body. A third type uses a combination approach. The best breast reconstruction is patient dependent. I always tell patients that I believe my job is to achieve the best cosmetic result with the least impact on their body. To that end, I have been a great fan of the “off-the-shelf” reconstruction with tissue expansion technique. Here, a flat implant is placed into the mastectomy site and slowly filled postoperatively until the patient is happy with the size. It is then removed, some positional adjustments are made, and a definitive modern silicone implant is placed into the site of the expander. This effort is particularly well received in bilateral cases, where symmetry can be quite close. With one sided mastectomy, often the opposite breast is altered to provide improved aesthetics and symmetry with a breast lift, reduction, or later implant augmentation.

Patients who have had radiation therapy are usually reconstructed about a year after their treatment. I have grown particularly fond of the cosmetic results achieved with a latissimus dorsi and tissue expander technique. Here, a back muscle is swung around to the front through the axilla to provide a healthy environment for the expander. The course then proceeds similar to the "off-the-shelf" expander technique.

There are, of course, several other options with specific applications in my practice. Though no technique is perfect, I have found that the results are very gratifying and serve the patient population well.

Remember Breast Cancer Awareness month, and join the fight to prevent, treat and control breast cancer.

Options When Considering Breast Reconstruction

2011-10-11T07:09:00.000-07:00

October is breast cancer awareness month. It can be confusing for patients confronting the diagnosis of breast cancer to understand the multifaceted approach to breast reconstruction. Attached is an article which reviews the essentials of breast reconstruction in a simple fashion. If you have unanswered questions contact us at 423-756-7134. http://www.refinedlooks.com/Options-breast-reconstruction.htm

CBS News Plastic Surgery Pros Warn Patients About 10 Red Flags

2011-10-04T08:49:00.000-07:00

This video is part of a public awareness campaign to inform potential patients about the red flags they should watch for when considering a plastic surgeon. Click on each number at the top of the video to see each red flag.http://www.cbsnews.com/2300-204_162-10009559.html?tag=page

Denver Meeting Highlights--Mark Brzezienski, MD

2011-10-03T06:29:00.000-07:00

I just got back from Denver and the American Society of Plastic Surgeon's (ASPS) meeting. I was very pleased that the techniques I have employed and developed for cosmetic breast surgery are getting a lot of positive feedback. Of special note is the procedure I nicknamed the SUPREME Mastopexy. Experts across the country are singing the praises of the element of this technique for correcting breast sag over implants.
I was asked to attend the experts' lunch by LIFECELL (the distributors of acellular dermal matrix) where I discussed the manner in which breast reconstruction is performed by my practice, here, in Chattanooga.
I was also intrigued by some reports regarding facial fat injection. The buzz seemed to be that a slow approach to the goal is indicated to avoid cosmetic deformities. That has always been my impression. Facial fat injections can grow and create problems that are difficult to fix. The replacement injectibles like Restylane, Juvederm, and Sculptra were very well received. I attended a workshop with a few new ideas on how to use these reliable fillers.
Of course, the ASPS response to nonsense claims by the "Cosmetic Surgeons" who don't feel that appropriate plastic surgery residency training is necessary before plying their trade with unsuspecting patients was intense. The recent USA TODAY articles and the FOX NEWS reports were frequent topics of conversation. The substandard training, and deceptive advertising techniques practiced by the types of "Cosmetic Surgeons" discussed in the pieces negatively impacts the good work performed by ASPS members who came in plastic and cosmetic surgery by way of standard route overseen by the American Board of Medical Specialties.

Fox News Article

2011-09-29T14:34:00.000-07:00

It seems the news about life-threatening results from unqualified cosmetic surgeons never ends. This is one from Fox News that quotes Dr. Monty Eaves who grew up on Signal Mountain and is immediate past president of the American Society for Aesthetic Plastic Surgery. Dr. Eaves states “Doctors who are not board-certified (plastic surgeons) are one of the biggest dangers in this field.”
http://www.foxnews.com/health/2011/09/26/niptuck-nightmare-dangerous-new-world-cosmetic-surgery/?cmpid=cmty_email_Gigya_Nip%2FTuck_Nightmare%3A_The_Dangerous_New_World_of_Cosmetic_Surgery

Do you know what makes good doctors mad?

2011-09-20T14:01:00.000-07:00

See Roy Exum's Chattanoogan.com article entitled "What Makes Doctors Furious".
http://chattanoogan.com/articles/article_209418.asp

Straight Facts from Dr. Brzezienski

2011-09-19T12:01:00.000-07:00

I was very pleased to read the two day multipage USA lead article on the state of “cosmetic surgery” practitioners in the United States. The in depth approach taken by the author included commentary by American Board of Cosmetic Surgery leadership that really exposed the “man behind the curtain”. I am sure we would all agree that surgical residency training is “not necessary”. You should find training “on your own”… and, then, let your internal ethical compass guide what you should and should not do. That sure sounds like the “Modern Doctor” I want to take care of me and my family. The consumers of the United States are among the most powerful economic engine in the world, and USA Today has certainly “Spoken Truth to Power”.

As noted in the article, this approach to training only exists for cosmetic surgery practice. No one is suggesting that your heart doctor, your pediatrician, your gastroenterologist, your allergist, or your gynecologist, find training outside the infrastructure created by the American Board of Medical Specialists (ABMS) to ensure measurable, reliable training practices across the US. Cosmetic Surgery is isolated in this “Modern Approach”.

The ABMS was established in the first half of the last century to organize the explosion of medical specialties created during that period of medical enlightenment. The principle goal of the ABMS, in simplistic terms, is to protect us from the snake oil salesmen of medicine. It is not a club or an evil empire. It is a mutually agreed upon bureau, outside the Federal Government, that sets the bar for what it means to be a “Board Certified” physician in the US. The ABMS is the BOARD. Of course, now that we have all learned that “Board Certified” is a good thing, that very term has been hijacked (see the ARTICLES section of REFINEDLOOKS.COM for The Hijacking of Board Certification). One simply has to open a company as an LLC, create a “Board-Sounding” name; and certify yourself. It’s that simple, and there is no law to stop it.

When I hear those outside of Plastic Surgery Training discuss it, I am reminded of Mark Twain. He said, “First get your facts straight, then distort them as you need”. If any “cosmetic surgeon” out there wants to know more about the rigors of plastic surgery training then they can apply for our residency. It is three years long, and you better be at the top of your class. We typically have about 25-30 talented, already board eligible general, ENT, OMF, and even orthopedic surgeons interview for two spots on an annual basis.

I spent this past weekend in Nashville with the directors of UT’s state wide medical teaching faculty. Our residency training programs are all well thought through. The candidates, the curriculum, the teaching methodology, the teachers, and the means by which all these concerns are annually assessed are thoughtfully poured over. Those residents who aspire to ABMS certification are trained in programs where the oversight of the teaching is not just vigorous, it is intense. Multiple accrediting agencies continuously review the work of the residency training programs for quality control of the product – the graduated plastic surgeon. If your residency does not meet these stringent requirements, it is closed. The mentorship or fellowship process of training plastic surgeons no longer exists because it did not provide equality of training across the US. Yet it is this type of training atmosphere that the “cosmetic surgeons” ask you, now, to believe is better or more highly specialized. You know, “FIND TRAINING ON YOUR OWN”. (See USA Today) Cosmetic Surgery is not a board certification granted by the ABMS.

So, here’s what the public really needs to know.

The American Board of Plastic Surgery is no “Club”. You cannot get in with just a dues membership, and you do not get to stay forever unless you meet a series of re-evaluation benchmarks over the course of your career.

Ear Nose and Throat surgeons are permitted to be referred to as Facial Plastic Surgeons by nature of their Ear Nose and Throat Residency training. I was trained and board certified in General Surgery before I became a plastic surgeon. In that training, I performed breast surgery, abdominal surgery, thyroid and neck surgery, vascular surgery, and even heart surgery. When was the period in ENT residency where breast examination was mastered? When was the period when abdominal examination was mastered? When was the period when intensive care medicine was mastered (should anything untoward happen during a surgical procedure)? I think I would choose someone like me to do your surgery.

If there is some scientific evidence, some statistic, that indicates that the people I train…those who have been trained as I have… achieve outcomes with higher complication rates, let us bring the data forward. But, when it is brought forward, be sure that it will undergo scrutiny by academic surgeons who do not suffer fools gladly. We find the use of poorly organized self serving, advertising campaigns masquerading as science to be beneath contempt.

There are NO- repeat- NO hospital privileges granted for “Cosmetic Surgery” at any significant health care institution. Hospital privileges are typically granted by ABMS board certification. (For example, OB/GYN, ENT, Plastic Surgery, Internal Medicine…) The plastic surgeons in my practice could, without question, transfer their skills and obtain hospital privileges in Plastic Surgery at any academic medical center in the United States.

Roy Exum’s recent piece on the “Best of What” at Chattanoogan.com outlines our feelings toward the Times Free Press’ Best of the Best advertising event. As I noted, though we receive nomination, the ethics policy of the American Society of Plastic Surgeons and the American College of Surgeons prohibits involvement in these types of media packages. It works well, I suppose, for Best restaurant, but not for Physicians.

The Plastic Surgery Group has been a fixture in the medical landscape of Chattanooga for over 50 years. I, myself, perform almost a thousand surgeries every year, and I’ve been doing it for over 16 years. I can only begin to imagine the number of lives that our practice has touched. I am very proud of the work that my partners do every day, and equally proud of the dedicated young men and women it has been our privilege to train in Plastic Surgery. You can be sure that the Plastic Surgery Group will continue to focus on providing the Chattanooga community with the type of first rate, cutting edge cosmetic and reconstructive surgery that has been the hallmark of my Group’s performance since its inception.

Thanks for reading my thoughts,

M. A. Brzezienski, MS MD FACS

BOTOX

2011-09-09T06:54:00.000-07:00

Botox is used to soften the appearance of wrinkling produced by our facial muscles. The areas in which the treatment is most reliable are throughout the forehead and at the crow's feet area of the eyes. This short procedure is virtually painless and is performed with no anesthesia in our plastic surgery office.

Call us today to set up your consultation! 423-756-7134

Chattanoogan.com Editorial re: Best of the Best Contests

2011-09-06T11:31:00.000-07:00

Roy Exum: Best Of The What?
by Roy Exum
posted September 3, 2011

Roy Exum

For the last several years, the Chattanooga newspaper has found a “Best of the Best” popularity contest is a very lucrative way to make money. The newspaper pushes a full-page “ballot” repeatedly where presumably its readers can nominate everything from “The Best Hamburger” to “The Best Radio Personality” to the “Best Car Dealer.”

Some are so naïve that they vote for the “Best Hair Salon” and “Best Sports Bar” in innocence, but actually the newspaper could care less. It uses the so-called contest to sell many ads, a table-for-10 (for $500) at an awards banquet, and so forth. It’s a sales gimmick – pure and simple - and it’s been a gold mine.

Unfortunately, there are some who abuse the system. A restaurant might have its waitresses laboriously fill out blank ballots between the lunch and dinner crowds. Some scamps, in cut-throat competition based on greed, actually hire different public-relations firms to “stuff the ballot box” and still others work under a misguided notion the bigger the ad they buy the better their chances.

Personally I’ve never paid much attention to the thing, other than to laugh at many of the winners and wonder who on earth picked them. I happen to know who’s got the best of just about anything – this from experience – but if buying a big “vote for me” half-page ad with a color picture tickles somebody’s ego that’s fine by me.

Not long ago a friend of mine got a packet from the newspaper to inform him that his company “has just been selected as a 2011 Best of the Best top three pick!” Enclosed was a form if he was interested in buying advertising (cha-ching!), a form allowing him to buy as many window stickers as he wanted at $3.00 each (cha-ching!), and information on the individual $50 awards-dinner tickets (cha-ching!) with free valet parking.

The trouble is that my friend is a board-certified surgeon and, like virtually every other board-certified physician in Chattanooga, is expressly prohibited from taking part in such folly. It is a clear violation of medical ethics and there is a belief that many other professional persons, whether a lawyer or engineer or dentist or even a hospital, may also be in violation under varying ethical canons.

The American College of Surgeons, in its Bylaws, expressly prohibits its membership from “participating in communications to the public which convey false, untrue, deceptive, or misleading information through statements, testimonials, photographs, graphics, or other means, or which omit material information about which the communication is deceptive.”

While we know the “Best of the Best” is an advertising ploy, I have learned after informally talking to a group of doctors at Erlanger Hospital this week that there is a far-more serious aspect. While there are some very capable and honorable doctors and lawyers who love to see their picture in the newspaper regardless of cost, there is an ominous side.
Believe it or not, there are some less-than-reputable physicians who see the “Best of the Best” as a way to lure patients to their offices despite the fact they may not have hospital privileges nor belong to the professional societies that insist and require strong medical ethics.

Several years ago a local plastic surgeon was the “Best of the Best” winner, but when state medical and law-enforcement authorities began to scrutinize his questionable practice, it is believed he took his own life. Sadly, there are some professionals with questionable standards in Chattanooga today whose are quite similar and would “buy a vote” in a heartbeat.

Sometime last year a doctor based at Erlanger, Mark Brzezienski, who is a noted and well-respected plastic surgeon in Chattanooga, wrote the newspaper a letter of concern about the “Best of the Best” contest. Obviously the letter was never published – are you kidding me? – but allow me to present it because, although it was written in 2010, I believe Dr. Brzezienski hits the mark:

* * *

“Last week I was informed by the Times Free Press that The Plastic Surgery Group has been nominated as one of three ‘Best Plastic Surgeons’ in your recent reader’s poll. We are very grateful to our patients who took the time to complete your survey. However, the enthusiasm we have for our participation in the ‘Best of …’ activities involving our physicians is tempered by our concerns about how these ‘contests’ serve our patient community.

“The TFP has reported on the problematic nature of insurance companies rating of physicians, and how the reputations of even our most-respected doctors in our community can suffer from inaccuracies in flawed ratings data. ‘The Best’ doctors, in my opinion, are that rare breed who combine rigorous intellectual training, technical prowess, and a strong commitment to education and community service.

“From the healthcare services standpoint, I worry about that ‘The Best of ….’ contests may be thinly-veiled advertising campaigns. (Shortly after our nomination I received a call from the TFP regarding a selection of advertising packages that are available for purchase to insure that the community is properly informed.)

“I am not anti-advertising; but when a community newspaper icon, such as the TFP, lends its ‘stamp-of-approval’ to a specific health-care provider by indicating they are ‘The Best,’ loyal readers will surmise that the paper has used its considerable investigative capacity to be certain that the selection measures up to that high standard.

“We have no way of knowing whether or not the people who submitted the votes have any experience with the physicians they selected, if at all. I find that particularly troubling.
From my neck of the woods, I cannot understand why plastic surgery and cosmetic surgery are two separate selection categories. I have had the honor of training about 30 board-certified plastic surgeons in the past 15 years. I can tell you that, without question, they all consider themselves as cosmetic surgeons and rightly so.

“I hope this odd categorical distinction has not sprung from the issues brought forth in your (2010) piece on the ‘Aesthetic Turf Wars’ amongst local surgeons. I fear that it may be that this group of physicians is more likely to purchase competing ad space than other less media-visible medical subspecialties.

“Our community is still reeling from the effects of the practice of the cosmetic surgeon mentioned in your (2010) article. He had significant media presence in our community, and he had been voted “Best Plastic Surgeon” in Chattanooga in another newspaper poll.

“The Plastic Surgery Group recognized the choice of one’s physician/surgeon is a confusing process that requires diligent research. The trust that our patients have in our practice with referral of their friends and family is the greatest compliment that our Group can be paid.

“We are certainly pleased that our patients would go out of their way to nominate us in your ‘Best of …’ contest. However, we have significant trepidations regarding the support of any medical popularity contest when we reflect ‘how and if’ contests of this nature provide beneficial impact on health care in Chattanooga.

For the Plastic Surgery Group,
Mark A. Brzezienski, M.D.

Men and Injectable Fillers

2011-09-02T11:00:00.000-07:00

For most men, time away from work is a significant consideration. The use of injectables can go a long way to improving a wide variety of aesthetic problems without any down time. Consultations are free until September 30, 2011. Call today! 423-756-7134 www.refinedlooks.com

Liposuction for Men

2011-08-31T06:48:00.000-07:00

We often receive calls from men that are concerned about their abdomen and love handles. It seems that despite appropriate diet and dutiful trips to the gym that these sites can be difficult to slim down. Liposuction was designed for just this type of localized management of fatty deposits. Performed under sedation, conservative liposuction in healthy patients requires very little time away from a busy schedule. Call today! 423-756-7134 www.refinedlooks.com

Complimentary Consultations

2011-08-30T05:36:00.000-07:00

We are offering complimentary consultations for the leading cosmetic procedures thru October 1, 2011. Call today and discover what sets The Plastic Surgery Group above the rest. 423-756-7134
www.refinedlooks.com

Men and the use of injectables.

2011-08-29T13:04:00.000-07:00

For most men, time away from work is a significant consideration. The use of injectables can go a long way to improving a wide variety of aesthetic problems without any down time. Call us today at 423-756-7134 for more information.

What is gynecomastia?

2011-08-24T07:33:00.000-07:00

It is the condition of over-developed or abnormally large breasts in men. This condition is common in the male population and can occur in men of any age. Many cases of gynecomastia have no clear cause but certain medications, heredity, and hormone changes can be contributing factors.
Email or call today at 423-756-7134 for more information or to schedule a consultation with one of our surgeons. We look forward to hearing from you!

Limited Time Offer!

2011-08-17T10:33:00.001-07:00

Have you called to schedule your complimentary consultation for a leading cosmetic procedure? Limited Time Offer! Call us today for details. 423-756-7134 www.refinedlooks.com

What are my limitations with facelift surgery and when can I return to my regular routine?

2011-08-16T06:36:00.000-07:00

For the first few days after a facelift, your activities should be significantly restricted and you should rest with your head elevated. As a general rule, you should plan on taking it easy for the first week after surgery. In several days your dressing will be removed and you may be allowed to wash your hair gently but have to be especially careful around your incisions. Most surgeons recommend avoiding any type of strenuous activity for the first 2-3 weeks after surgery. You should limit your exposure to the sun for several months and allow plenty of time for rest, so your body can heal the various incisions. www.refinedlooks.com

Skin Care Limited Time Offer!

2011-08-10T14:21:00.000-07:00

Purchase a Theraderm Skin Renewal System for $130.00 and receive a complimentary Theraderm Peptide Repair Eye Cream ($85.00 value). Call us at 423-756-7134 for more information.

Complimentary Consultations for Leading Cosmetic Procedures

2011-08-09T06:43:00.000-07:00

Limited Time Offer
For a limited time only (August 1st - October 1st) we will offer complimentary consultations for the leading cosmetic procedures. Call today and discover what sets The Plastic Surgery Group above the rest. 423-756-7134

Will my face be numb after a Facelift?

2011-08-05T11:41:00.000-07:00

Some numbness of the skin in the cheek area and neck is quite normal after a Facelift. Feeling will usually return in 1-2 months.

Call us today at 423-756-7134. We are always available to answer your questions.

Mentor's Love Your Look Referral Program

2011-08-03T12:06:00.000-07:00

Mentor's Love Your Look Referral Program rewards you for telling your friends about your breast augmentation experience with Mentor MemoryGel® Implants. You could receive a $50.00 American Express Gift Card if your friend has breast augmentation surgery with Mentor MemoryGel® Implants. Visit www.LoveYourLook.com/ReferAFriend for more information.

We are always happy to answer your questions. Call us today at 423-756-7134. We look forward to hearing from you!

Considering changing your Saline breast implants to Silicone?

2011-08-02T05:06:00.000-07:00

Have you had a breast augmentation using saline breast implants? Mentor is offering a $250.00 American Express gift card for changing your Saline Implants to Mentor Memory Gel Implants. This is a limited time program that runs through August 31, 2011. Call us today for details about Mentor's "Feel The Difference" program. 423-756-7134

How long does the facelift surgery take?

2011-08-01T14:05:00.001-07:00

A facelift usually takes several hours, depending on the extent of the work that is done. The average length of a facelift is between 2 1/2 to 3 1/2 hours.

Limited Time Offer

2011-07-26T12:17:00.001-07:00

For a limited time only (August 1st - October 1st) we will offer complimentary consultations for the leading cosmetic procedures. Call today and discover what sets The Plastic Surgery Group above the rest. 423-756-7134

Will I look "tight" or pulled at the corners of my mouth after face lift surgery?

2011-07-26T06:27:00.001-07:00

The facelift tightens the skin, removes excess fat and tightens underlying muscles in the lower two-thirds of the face and neck, providing a more youthful, fresher appearance. It is not designed to be pulled so tight that it would alter the corners of your mouth.

Will a facelift help the lines around my eyes and forehead?

2011-07-13T14:43:00.000-07:00

The facelift does not alter the appearance of the upper third of the face, in particular the excess skin and lines around the eyes, nor does it help sagging of the brow.

How many years younger will I look with a face lift?

2011-07-12T12:00:00.000-07:00

A facelift cannot stop your face from aging, but it can improve your appearance by "setting the clock back." Factors such as bone structure, heredity, skin texture, sun exposure, smoking history and others all play a role in the extent of improvement one obtains, as well as influencing how long it will last

At what age should I consider a facelift?

2011-07-11T11:04:00.000-07:00

You may be a candidate for a facelift if you are in overall good health and have enough excess skin or sagging in the face and neck to make the operation beneficial. The average facelift patients are in their 40's to 60's, but a facelift can be successfully done on people in their 70's or 80's, as well.

What is a facelift?

2011-07-08T13:35:00.000-07:00

A facelift, also known as rhytidectomy, is a surgical procedure designed to tighten the sagging skin, remove excess fat and tighten underlying muscles in the lower two-thirds of the face and neck, providing a more youthful, fresher appearance.

What is gynecomastia?

2011-07-05T14:42:00.000-07:00

Gynecomastia is the condition of over-developed or abnormally large breasts in men. This condition is common in the male population and can occur in men of any age.

Are there risks with getting a tummy tuck?

2011-06-29T05:46:00.000-07:00

As with any procedure there are risks. However, a tummy tuck is generally a very safe procedure. The uncommon risks include: infection, fluid collections, blood clots, and a few others.www.refinedlooks.com

Can stretch marks be removed with a tummy tuck?

2011-06-28T04:51:00.000-07:00

Depending on the location of the stretch marks they will be removed with a tummy tuck. If the stretch marks are located above the belly button then they will not be removed.

Can liposuction be performed in conjunction with an abdominoplasty(tummy tuck)?

2011-06-27T08:21:00.000-07:00

Yes, if needed liposuction can be safely performed at the time of abdominoplasty. However, this must be judiciously performed to avoid any potential problems.

“Long term complications are likely with silicone breast implants.”

2011-06-24T12:18:00.000-07:00

You may have seen this article in the news or heard about it on TV or through the internet. DON’T PANIC. There has been no new finding regarding silicone breast implants, this is simply an update from the FDA on the status of studies on these implants. And we all know how the media loves to sensationalize certain topics.
To summarize, The FDA has released a statement on silicone breast implants and the ASPS (American Society of Plastic Surgeons) has responded and has been working with the FDA as well. Basically there are 5-10 million women with silicone breast implants worldwide with a 90% satisfaction rate. There has been no evidence to show increased connective tissue disorders, cancer, or reproductive harm. Studies continue to proceed for more long term information but it seems clear that silicone implants are safe and efficacious.
The most common complications include: capsular contracture (scarring), re-operation, rupture, wrinkling, pain, infection, and breast asymmetry. There is no need for routine replacement of your implants unless you develop a problem. It is known that the longer your implants are in place, the more likely there will be a problem such as rupture.
Finally, it is recommended that women with silicone implants receive routine MRI to evaluate the implants at 3 years after surgery and then every 2 years. Also you should notify your surgeon if you notice any changes in your breasts.
If you have any questions or concerns regarding this, please see us for a consultation, call us, or use Facebook and we will be happy to discuss your situation further.

Can men and women have a tummy tuck?

2011-06-24T07:05:00.000-07:00

Yes, a tummy tuck can be performed on men or women.

If we have not answered your question about abdominoplasty ask us! We enjoy hearing from you and are always available to answer questions.

Will future pregnancy affect the results of a tummy tuck?

2011-06-22T06:05:00.000-07:00

Yes, since pregnancy results in stretching of the abdominal skin and muscles, then the abdomen will be affected. Generally one should wait until after pregnancy is not planned to have a tummy tuck.

How much pain is expected after abdominoplasty surgery?

2011-06-21T06:04:00.000-07:00

An abdominoplasty is a somewhat painful procedure but is well tolerated with post-operative oral pain medications and the temporary pain medication pump.

Where are the scars located for an abdominoplasty (tummy tuck)?

2011-06-20T12:14:00.000-07:00

The scars after a tummy tuck are located very low along the abdomen just above the pubic area and around the belly button.

What anesthesia is used during abdominoplasty surgery?

2011-06-17T08:26:00.000-07:00

Abdominoplasty is usually performed under deep sedation or general anesthesia. Also local injections, such as lidocaine, are used and a post-op pain medication pump remians for 2-3 days.

How much time is needed to recover after abdominoplasty?

2011-06-14T05:13:00.000-07:00

The recovery period for an abdominoplasty follows a general course. An abdominal binder is used for 4-6 weeks. The drains are removed after 1-2 weeks. All sutures are absorbable and under the skin, therefore do not have to be removed. The most discomfort is during the first week. Generally you will be back to full activity by 6 weeks.

How permanent are abdominoplasty (tummy tuck) results?

2011-06-13T08:42:00.000-07:00

The results of a tummy tuck are in a sense permanent. However, over time there can be some stretching of the skin or muscles. Also, if one were to gain significant weight then the results of the procedure will be altered.

What is an Abdominoplasty?

2011-06-10T08:40:00.000-07:00

We will begin answering frequently asked questions about Abdominoplasty (tummy tuck) today.
An abdominoplasty (tummy tuck) is a surgical procedure to remove excess skin and fatty tissue from the abdomen. Often the muscles of the abdominal wall are tightened as part of the procedure as well. www.refinedlooks.com

Are there any side effects with the fractional CO2 laser?

2011-06-08T07:53:00.001-07:00

Side effects are rare but possible and include: burns, changes in skin color, and scarring. Also if you have a history of fever blisters or cold sores you should tell your physician at your consultation.

What is the advantage of a fractional CO2 laser over a regular CO2 laser?

2011-06-07T05:34:00.000-07:00

The fractional laser treats only a portion of the outer layer of skin (25%), the remainder of the skin remains intact. This allows for a dramatic result but decreased amount of time needed for healing. In short, a quicker recovery and less redness and swelling.

Can Fraxel laser be combined with other noninvasive facial rejuvenation procedures?

2011-06-06T08:13:00.000-07:00

Can fractional laser treatment be combined with other noninvasive facial rejuvenation procedures? Yes, the laser therapy can be combined with Botox injections and with other injectible fillers such as Restylane or Juvederm.

Does the Fraxel laser treatment hurt?

2011-06-03T07:05:00.000-07:00

The treatment is well tolerated with a topical anesthetic. This may also be combined with local injections for nerve blocks or with a mild intravenous sedation. www.refinedlooks.com

How many Fraxel laser treatments are needed for the best results?

2011-06-01T14:34:00.000-07:00

Usually 3-5 treatments are recommended to obtain the most noticeable and lasting results.

How long do the results last?

2011-05-31T14:00:00.000-07:00

How long do Fraxel Laser results last?

The improvement is both immediate and progressive. Meaning that you notice immediate improvement in skin quality and have a progressive improvement over the next 1-2 months. The duration is variable and depends on the level of treatment and how well you care for your skin after the procedure.

We are pleased to share some patient comments with you!

2011-05-25T07:12:00.000-07:00

I had a breast lift with implants three months ago performed by Dr. Sargent. I am very happy with my results. Thanks to all the staff who helped with the procedure, and thanks to Dr. Sargent for doing such great work!!

Dr. B (Mark Brzezienski) is THE BEST surgeon! I love him and Lacey! It's been a month since my (last) surgery and only he could make a 10 inch incision straight up the abdomen as tiny as a piece of thread! From implants to double mastectomy reconstruction and more, I have always been happy with the outcome! I may live 30 miles from Atlanta, but it worth the 75 mile drive to Chattanooga for "the best"!!

How long does a Fraxel treatment take?

2011-05-25T07:00:00.000-07:00

The treatment procedure takes about 15-30 minutes depending on how many areas are being treated.

What specific problems does the fractional laser treat?

2011-05-23T07:07:00.000-07:00

It is excellent for the treatment of facial aging; such as wrinkles, discolorations, textural irregularities, and photo damaged skin.

What areas of the body is the fractional laser used for?

2011-05-20T09:15:00.000-07:00

The fractional CO2 laser is used to treat areas such as the face, eyelids, neck, upper chest, and hands. It is great for general rejuvenation of the skin.

What is a fractional CO2 laser?

2011-05-18T14:51:00.000-07:00

It is a new type of medical laser that produces multiple minute focused beams of laser energy (like pixels in a digital image) that are delivered to a very specific treatment area.

CanI still have a mammogram after a breast reduction?

2011-05-17T06:13:00.000-07:00

Yes. Depending upon your age and risk factors at the time of surgery you may require a mammogram before surgery. Also, you should have a "baseline" mammogram performed 6-12 months following a breast reduction and routinely thereafter depending on your age and risk factors.

If you have additional questions about breast redcution let us know. We are always happy to answer your questions.

We will begin frequently asked questions about Fractional Laser Facial Treatment tomorrow.

Ladies' Night Out

2011-05-13T12:38:00.000-07:00

Ladies’ Night Out was a big success and we appreciate all of you who stopped by our booth. Dr. Rehm and Dr. Waldrop were happy to answer your questions and had a great time. Thanks to Dr. Rehm’s new nurse, Leslie Johnson, and Teresa Camp, Jamie Rehm and Stacey Waldrop for all their help.

What activity restrictions are there after a breast reduction?

2011-05-11T14:11:00.000-07:00

What activity restrictions are there after a breast reduction? You should expect to have someone available to help with any housework or lifting for the first 1 to 2 weeks. After this time period activity is slowly advanced and you will not be released to full unrestricted activity for about 6 weeks. Your surgeon will advise you regarding your restrictions.

Ladies Night Out

2011-05-11T14:02:00.000-07:00

Meet Dr. Jason Rehm at Ladies Night Out on Signal Mountain Thursday, May 12th from 4:00 - 9:00. Come by our booth and have your questions answered and register for our giveaways. Winners will be announced on our FB page on Friday. Hope to see you there! www.refinedlooks.com

What kind of bra can I wear after breast reduction surgery?

2011-05-09T07:51:00.000-07:00

For the first 2 weeks after surgery a surgical bra is required. After 2 weeks, a snug sports bra or similar bra is recommended. You should not expect to use a bra with an underwire or pushup bra for about 4 to 6 weeks after surgery.

What type of scarring is expected after breast reduction surgery?

2011-05-06T06:28:00.000-07:00

There are several techniques for breast reduction. However, in general incisions are made around the nipple/areola and along the underside of the breast in either a vertical or vertical and horizontal pattern. The scarring that results is very well hidden by natural skin variations and under the breast. The scarring is not visible while wearing clothing or swimwear.

Will nipple sensation change following breast reduction surgery?

2011-05-04T11:45:00.000-07:00

Immediately following surgery most women experience either reduced sensation or hypersensitivity of the nipples. Most often sensation improves or returns to normal over time. The risk of permanent sensory changes is increased with larger reductions.

Does the nipple have to be completely removed during breast reduction surgery?

2011-05-03T07:54:00.000-07:00

The nipple does not have to be removed during breast reduction. Instead incisions are made that allow the attached nipple to be moved with the remaining breast tissue. In very rare instances the nipple may be completely removed and replaced on the breast. Your surgeon will advise if this is necessary in your case.

Are there any sutures or staples to remove after breast recuction surgery?

2011-05-02T12:47:00.000-07:00

No, the incisions made during breast reduction surgery are all closed with absorbable sutures that are placed under the skin and do not have to be removed.

Dr. Jason Rehm to speak at Spa HBI

2011-04-29T12:00:00.001-07:00

Dr. Jason Rehm will speak Monday, May 2nd at SpaHBI. Learn details about the Mommy Makeover and see which procedures are right for you to get your "before baby body" back. Dr. Rehm will discuss everything from Breast Augmentations, Breast Lifts and Tummy Tucks (abdominoplasty) to Facial Fillers and more. Get to know Dr. Rehm while he answers your questions in a relaxed atmosphere. Space is limited. Call Bobby at 423-894-2973 for details.

Can My Breasts Change Size After A Breast Reduction?

2011-04-26T10:22:00.000-07:00

After a breast reduction your breasts will generally remain the same size. However, if you have significant changes in your weight then your breasts may change size.

Learn about Plastic Surgery Benefits at SpaHBI

2011-04-25T09:52:00.000-07:00

Learn about Plastic Surgery Benefits at Spa HBI Thursday, Friday and Saturday, April 28, 29 & 30. Plastic surgery offers many ways to enhance or alter your appearance. If you've ever thought about changing a portion of your body (tummy tuck, breast augmentation, breast lift/reduction, liposuction)or giving your face a new or fresher look (facelift, brow lift, rhinoplasty, cosmetic ear surgery, injectables), an expert from The Plastic Surgery Group will be available to discuss your possibilities and options.

Restorative Facial Fillers at SpaHBI Saturday, April 30th.
Botox, Restylane and Juvaderm treatments with Dr. Jason Rehm and Dr. Jimmy Waldrop.
Call Bobby at 423-894-2973 for a reservation time.

Beauty Educational Seminar at SpaHBI Monday, May 2nd by Dr. Jason Rehm. Learn details about the Mommy Makeover and see which procedures are right for you to get your "before baby body" back. Dr. Rehm will discuss everything from breast augmentation, breast lift and tummy tuck (abdominoplasty) to facial fillers and more. Get to know Dr. Rehm while he answers your questions in a relaxed atmosphere. Space is limited. Call Bobby at 423-894-2973.

Will my breast reduction be covered by my insurance?

2011-04-25T09:46:00.000-07:00

A breast reduction may be covered by insurance if certain criteria as set forth by the insurance company are met. These may include pain, rashes, and difficulty with activities. There is also a requirement regarding the amount of breast tissue to be removed which is variable depending on your height and weight.

We will be answering frequently asked questions about breast reduction this week. If you have a question ask us. We are always happy to answer your questions.

What are the differences in results between silicone gel and saline implants?

2011-04-22T12:12:00.000-07:00

Both silicone and saline implants give excellent results in breast augmentation. But overall, silicone gel implants feel softer and more natural than saline implants. Silicone implants are more expensive due to costs in manufacturing. Ultimately the decision is based upon the preference of the surgeon and patient in any given situation.

2011-04-20T14:25:00.000-07:00

We will have a representative from Allergan at Hairbenders Internationale Thursday, April 21st. He will be able to answer any questions you may have about Botox, Juvaderm Ultra and Ultra Plus. We look forward to seeing you there!

What are the possible breast agumentation incision locations and is one better than the others?

2011-04-20T09:32:00.000-07:00

There are several options for incision location in breast augmentation surgery.

Infra-mammary fold - this incision is located in the fold underneath the breast and is the preferred incision beccause it is well hidden and allows the best access to perform the operation safely and with the most precision.

Peri-areolar - this incision is located just below the nipple at the junction of the areola and breast skin. The scar is more visible and the precision of the operation is less. There is also a risk of inury to the lactation ducts of the breast.

Axillary - this incision is located in the "arm-pit" area and is more difficult to perform and has no advantage over the infra-mammary fold incision.

Umbilical - this incision is made at the belly-button and allows the least precise operation of all. Very few surgeons perform this incision anymore.

Will breast implants affect future pregnancy?

2011-04-18T07:55:00.000-07:00

Breast implants have no affect on future pregnancy. As discussed previously implants may occasionally reduce the ability to successfully breast feed.

Will breast implants affect breast feeding in the future?

2011-04-15T07:00:00.000-07:00

Breast augmentation surgery may result in a slightly lower chance of successful breast feeding. However, the risk is unlikely if the implant is placed beneath the muscle of the chest wall and if the incision is not placed near the nipple.

What is capsular contracture?

2011-04-13T12:38:00.000-07:00

Capsular contracture is the most common complication of breast augmentation surgery. After placement of the implant, the body may form a fibrous capsule around the implant and over time the capsule may become very firm and hard.

How long does it take for the scars to heal and fade after breast augmentation?

2011-04-11T06:29:00.000-07:00

The scars from breast augmentation are quite small and are placed in "hidden" areas, such as underneath the breast. Initially the scars will appear puffy and red; however, as time passes the scar fades, flattens, and softens until it is unnoticeable. The scar will not reach its final appearance for about 9-12 months.

What is the difference between round and contoured implants? Which is best?

2011-04-08T07:19:00.000-07:00

Round implants are simply soft round devices of silicone or saline whereas, contoured implants are specifically shaped (such as a tear-drop shape) and are more firm. Contoured implants have the unique risk of turning in the implant pocket and causing a misshapen breast. Contoured implants also require a larger incision for placement. Round implants are the preferred choice by most surgeons and patients.

When do breast implants need to be replaced or removed?

2011-04-06T11:51:00.000-07:00

There is no set time that implants should be replaced or removed. As long as the implants are intact and satisfactory then they never need to be changed. If an implant ruptures, leaks, develops significant contracture, or if the patient desires replacement with a different size then removal is indicated.

Fabulous Evening at Palate to Palatte

2011-04-04T13:35:00.000-07:00

Palate 2 Palette was spectacular and a huge success. We were delighted all our doctors and lots of friends enjoyed this wonderful evening. Dr. Brzezienski's wife, Jayne, envisoned and created the Living Art studio. Designers from Phoenix and Las Vegas were in the studio creating stunning "balloon" dresses-wearable art! Outside Jayne asked Kelly, owner of Goin to the Dogs in Cleveland, to bring two white standard poodles, one designed with color and the other sculptured. They were a real hit - everyone had to have their picture taken with them! Hair Benders Internationale designers created beautiful "hair" art on our models. Dr. Brzezienski and daughter, Lexie, gave lots of moral support.

Jamie Rehm, Dr. Rehm's wife and owner of Bud Floral Design created a beautiful tropical arrangement for Area 61. Seen strolling among the galleries were Dr. Sargent with wife, Brenda, Dr. Kennedy and wife, Carrie, and many of our residents, staff members and friends.

P2P is an annual event to raise funds for the Craniofacial Foundation of America that supports the Tennessee Craniofacial Center. Dr. Larry Sargent is our group's senior partner and Medical Director of the Center. Many of his patients benefit each year from this event.

When can I start exercising after breast augmentation?

2011-03-30T10:04:00.001-07:00

The first 2 weeks after breast augmentation are the most critical for proper healing and implant position. After 2 weeks you may resume walking exercise and at about 4 weeks you may resume more vigorous activities. Activities such as upper body exercise should be delayed until 6 weeks. Your doctor will advise you on exactly which activities will be appropriate at the given time periods. Proper support of the augmented breast is crucial during the healing process.

Does breast augmentation cause changes in nipple or breast sensitivity?

2011-03-29T06:42:00.000-07:00

Transient changes in sensation may occur for a brief period of time after breast augmentation. These changes are temporary and resolve quickly. Only very rarely can numbness or increased sensation be permanent.

Are there risks with getting very large implants?

2011-03-28T09:51:00.001-07:00

The risks with getting very large implants are virtually the same as getting smaller implants. Very large implants are more likely to show rippling and to bottom out. What does bottoming out mean? In breast augmentation, bottoming out refers to mal-position of the implant in relation to the breast. In this case the implant comes to rest below the lower breast fold resulting in an un-natural appearance. Additional surgery may be required to correct this problem.

Can I still get a mammogram with breast implants?

2011-03-23T05:34:00.000-07:00

The presence of breast implants does not change routine breast cancer surveillance. Breast self exams are still recommended as well as routine mammograms. It is important to tell your mammographer that you have breast implants so that certain maneuvers can be performed at the time of your mammogram.

How long does the surgery for breast augmentation last?

2011-03-22T06:07:00.000-07:00

The surgery for breast augmentation usually takes about one hour. However you will be required to arrive at least one hour prior to your scheduled start time for preparation and will require about one to two hours after surgery for recovery time before going home.

What are the risks with breast augmentation surgery?

2011-03-21T13:09:00.000-07:00

Today we will begin posting Frequently Asked Questions regarding breast augmentation. If you have a specific question email us or call us at 423-756-7134. We are always happy to answer your questions.

What are the risks with breast augmentation surgery?

As with any procedure there are risks associated with breast augmentation. The risks are related to implant device failure and to operative risks. Although the complications are rare they include:

Capsular contracture
Infection
Bleeding/hematoma
Poor scarring
Asymmetry or uneveness
Changes in nipple or breast sensation
Implant rupture, rippling

Your surgeon will discuss all of the risks of surgery with you and answer all of your questions during a consultation.

Liposuction Incision Site

2011-03-18T08:23:00.000-07:00

Friday's question is: Will there be a scar from the liposuction incision site? The scar from liposuction is very small and is placed in a "hidden" area. It is usually less than one centimeter long and is placed in a pre-existing skin crease or at the edge of the belly button. When the incision heals completely in about 9 months is should be unnoticeable.

We will begin discussing Breast Augmentation on Monday. Have a great weekend.

Spring Into Confidence

2011-03-16T07:13:00.000-07:00

HERITAGE HIGHLIGHTS

The Plastic Surgery Group P.C. (PSG) was established in Chattanooga in 1958 with a commitment to high quality, personal patient care and safety. This commitment has resulted in The Plastic Surgery Group setting a standard of excellence in the cosmetic and reconstructive community. The largest private plastic surgery practice in our region, PSG has treated over 275,000 patients since inception 53 years ago.

Dedication to the highest academic standards in physician training led the group to become affiliated with the University of Tennessee-College of Medicine in 1966. In addition to their private practice, each member of the group holds a faculty appointment. To date 81 plastic surgeons have completed residency training with the group and have gone on to successful practices all over the country. The academic requirements for faculty members in a training program are vigorous and ensure patients that they will receive the most current and effective treatments and procedures. The Plastic Surgery Group pioneered numerous “firsts” in the Chattanooga area in cosmetic surgery, craniofacial surgery, hand surgery, and microsurgery. They are recognized as the definitive source for the most qualified and competent surgeons in cosmetic plastic surgery and reconstructive plastic surgery in this region.

Aesthetic Rejuvenation Procedures

Surgeons at PSG perform all aspects of cosmetic surgery. The “hot topics” this spring include breast augmentation, tummy tuck, laser-assisted liposuction, facial rejuvenation and fat grafting. Most of these procedures are performed under monitored anesthesia care as same day surgery. Patients may choose to have their procedure in the PSG fully accredited, comfortable and private facility at or another outpatient surgery center.

Breast augmentation may be performed with silicone (cohesive, memory gel, gummy bear) or saline implants and is customized to each individual patient’s desires. Natural results with small, well-hidden scars and a quick recovery make this a popular cosmetic procedure. Fat grafting is a technique in which excess fatty tissue is removed from one part of the body and transferred to augment another part of the body such as the face, breast, and buttock. Recent surgical advances have refined this technique and resulted in improved outcomes.

Laser-assisted liposuction (Smartlipo) eliminates areas of unwanted fat and tones your problem areas by actually tightening skin.

Facial rejuvenation includes fractional laser facial treatments, filler injections, Botox, blepharoplasty (eyelid surgery), as well as facelifts and neck lifts. Sometimes different signs of aging may require several different approaches used together to achieve rejuvenation of the patient’s look on the whole. “The PSG goal”, according to Mark Brzezienski, MD, “is to achieve a natural aesthetic outcome compatible with the patient’s youthful outlook and confident disposition.”

By some estimates there may be as many as 60,000 doctors in the U.S. performing some type of cosmetic surgery. The fact is that only 6,000 physicians are certified by the American Board of Plastic Surgery, the board officially recognized by the American Board of Medical Specialties to certify doctors in this specialty. When checking your doctor’s credentials, make sure he is certified by the American Board of Plastic Surgery and is a member of the American Society of Plastic Surgeons. When you entrust your face or body to a surgeon, you want to be sure that you are selecting the very best.

RECONSTRUCTIVE PLASTIC SURGERY

Not only does PSG offer all aspects of cosmetic surgery, they are on the leading edge of complex reconstructive surgery as well. Whether it is reconstruction of the head/face, breast, trunk, hand, or lower extremity following trauma or cancer surgery, their surgeons possess the skill and experience to restore appropriate form and function that will allow patients to reclaim their independence and spirit of living.

The Plastic Surgery Group is also home to the Hayes Hand Center and the Craniofacial Foundation of America. They are also intimately involved with the Mary Ellen Locher Breast Cancer Center and with the Erlanger Trauma Center. The board-certified surgeons at PSG are experts in treatment of craniofacial deformities (cleft lip and palate) and facial trauma, all aspects of hand surgery, breast reconstruction, lower extremity reconstruction and microsurgery. Whatever the problem, the physicians at PSG endeavor to create the best possible solution for their patients.

When can I exercise after liposuction surgery?

2011-03-16T05:35:00.000-07:00

When can you begin regular exercise after liposuction surgery? The timing will vary somewhat depending upon the extent of liposuction performed. Generally you may resume your regular plan after about 2-3 weeks.

Liposuction and Compression Garments

2011-03-15T10:18:00.000-07:00

Do you need to wear compression garments or a girdle after liposuction? A compression garment is very helpful following liposuction. It acts to provide comfort, prevent fluid accumulation under the skin, and promotes an even skin tone. We recommend wearing compression for about 4-6 weeks after the procedure.

Will Liposuction Treat Cellulite?

2011-03-14T05:51:00.000-07:00

Good morning! Did you enjoy the beautiful weather this weekend? We will continue this week with our liposuction question and answers. Have we answered your question? You can email your questions or call us at 423-756-7134 or 1-800-634-3334. We look forward to hearing from you!

Today's question is: Will liposuction treat cellulite? Liposuction is not a treatment for cellulite and will do very little to improve this problem. Liposuction is intended to treat localized deposits of fatty tissue.

Next week we will begin discussing the most frequently asked questions about Breast Augmentation.

How does weight gain after liposuction effect the results?

2011-03-11T07:55:00.000-08:00

During liposuction fat cells are removed from the treatment area. However, weight gain after the procedure will adversely affect the results because the remaining fat cells will increase in size. The increase in tissue will not be as significant as would be expected without liposuction. Liposuction should not be used as a treatment of unwanted fatty deposits but also as a stepping stone to a healthier lifestyle.

Runway for Hope a Success

2011-03-09T10:42:00.000-08:00

We had a blast at Runway for Hope, the extraordinary fashion show fundraising event for the Austin Hatcher Foundation. We were proud to be sponsors of this worthy Foundation.

Liposuction and Anesthesia

2011-03-08T13:39:00.000-08:00

What is the anesthesia that is used during liposuction surgery? The anesthesia used in liposuction is usually anesthesia or intravenous sedation. If it's a very small area being treated, then local anesthesia is all that is required. Do you have questions that we have not answered? Email us or call us at 423-756-7134.

How long do liposuction results last?

2011-03-07T13:04:00.000-08:00

We hope you are finding the liposuction questions and answers helpful. Today's question is: How long do liposuction results last or are they permanent? As long as your weight remains stable following liposuction, the results should be permanent. However, weight gain will adversely affect the results. Contact us at 423-756-7134 for more information.

Runway for Hope

2011-03-04T10:33:00.000-08:00

We are proud to be a Platinum Sponsor for Hair Benders Internationale's Runway for Hope. Runway for Hope is a high-fashion runway and hair show event this Saturday evening, March 5, 2011 at the Chattanoogan. This "runway show" will feature international beauty trends but, more importantly, give all proceeds to the Austin Hatcher Foundation for pediatric cancer. Our group supports all the efforts being made in Chattanooga and beyond to support our region's children diagnosed with cancer. When a child has cancer, every member of the family is affected. "Hatch's House" provides a long list of services from marital and financial counseling, neuro-cognitive testing, and educational progamming to emotional counseling for the whole family. We're proud to lend our support to this cause! If you are interested in tickets contact Hair Benders Internationale at 423-894-2973.