The most frequent questions around cosmetic surgery

Question: What is the most popular procedure in cosmetic surgery ?

Dr.Aslani:In women breast augmentation and liposuction, in men gynecomastia(male breast reduction),rhinoplasty and liposuction. This only reflects my personal experience though. Different surgeons may have different views regarding that

Dr.Aslani:You can prepare your skin with antiseptic solutions like for instance Hibiclens. You can furthermore treat your skin with moisturising lotions. I am unsure what effect that really has, but this is recommended. I do regard beneficial effects from so-called “scar-ointments” as purely fictional.

Question:Is it true that cosmetic surgery in Spain is more popular than anywhere else in Europe?

Dr.Aslani:Yes, I should think so.

Question:Do you think that the current situation has got an adverse effect on quality in cosmetic surgery , especially in Spain ?

Dr.Aslani:I hope not, but I am very much afraid this may well be the case.

Especially in the cosmetic surgery sector in Spain, we see very aggressive marketing moves from UK companies into the sector. We are seeing more and more petients hooked on unrealistic promises paired with ridicolously low pricing. I am afraid that this will not have any good long term effect neither on the cosmetic surgery sector in Spain, nor in the UK:

Question:Is it true that I can only have my eyelids done twice in a lifetime ?

Dr.Aslani:No, not entirely. You are likely to refer to the lower eyelids. There may be some truth in that regarding them though.Lower eyelid blepharoplasty is considerbly more complicated than upper.

Question:Is a deep peeling a good subtitute for a facelift ?

Dr.Aslani:Absolutely not. The mechanism as well as the indication are completely different. A peeling tackles different problems than a facelift.

The two can be combined, but I suggest to do one after the other and not two at the same time.

Breast augmentation-above or below the muscle ?

There are ongoing debates as to whether it is more advisable to place the implants in breast augmentation on top or below the breast muscle.

As in most cases involving aesthetic surgery, there is no single right answer.
The main reason for subpectoral (under the muscle) placement is as follows:
1. The muscle covers the implant, thus capsular contracture (“breasts that feel hard”) is less common.It has become rare anyway, but the cases that I usually see are breast augmentation on top of the muscle. Another theory is that should capsular contracture occur it may be less obvious to be detected.
2. For the same reason, rippling (wrinkling) of the implant is less apparent.It is never completely evitable though.If patients will normally notice such rippling on the lower pole and side.
3. Mammograms are more accurate.
4. In very small-breasted women, the outline of the implant is less visible.As a rule of thumb, if the thickness of breast tissue is less than 2 inches, submuscular placeement is mandatory.
5. Muscle tissue is well perfused. Perfusion is the best combat tool against infection, the most dreaded risk in breast augmentation .

The argument for subglandular breast augmentation (under the breast tissue) placement is as follows:

1. If any degree of ptosis is present, a subglandular implant lifts the breasts much better.
2. Lower risk of postoperative bleeding is involved.
3. Significantly less postoperative pain occurs.
4.  Breast augmentationcan be performed with intravenous sedation and local anesthesia, which is a safer alternative to general (complete) anesthesia.

There are no precut recipes for te best procedure in breats augmentation, but a lot ofsuitable solutions for different patients.

For more info please visit www.cirumed.es

Dr.Alexander Amir  Aslani, MD, EBOPRAS

Hospital:

Director and Chief Surgeon
Department of Plastic, Aesthetic and Reconstructive Surgery
Hospital Quiron Malaga
Avda.Imperio Argentina, 1
E-29004 Malaga
Spain
www.quiron.es
www.cirumed.es

Cosmetic surgery in Spain…….

….is doubtlessly changing its face.
Patients are being more critical, which is good.

In my practice, I notice that patients seeking cosmetic surgery, which is not the only kind of surgery we do of course, ask more well-informed and detailed questions. Spain does traditionally represent a very high standard of cosmetic surgery, with very large numbers of cosmetic surgery cases done each year, amongst the highest rate in Europe. Numbers are not all in cosmetic surgery, but the are of relevance
However,there is still a lack of regulation.
We still see tourism for cosmetic surgery in Spain especially from the United Kingdom, although I think that in the future this has to reviewed critically. In our clinic we do for instance not accept patients any more who are not willing to involve their GP, just in case.

Cosmetic surgery is elective and is generally undertaken under optimal conditions, nevertheless, there are implications, and even if they rather have the nature of nuisances, they have to be adressed.
Cosmetic surgery in Spain has been a major field of interest for companies engaging in this field and I notice that this sometimes attracts patients which may lack basic understanding for what cosmetic surgery is about: working with living tissue with all its inherent pleasures, but also its complications.

With  companies organising cosmetic surgery travel to Spain,I have increasing concerns that understanding for this seems to get lost.

Cosmetic surgery is not like buying a car.
I still think there is a great role for cosmetic surgery in Spain in the future, especially when, hopefully in 2010, private healthcare providers in Spain will be under mandatory regulation, especially companies providing cosmetic surgery in Spain, and there will be no more space for unregulated commercial companies running without regulation or medical directory, purely guided by commercial targets that have to be met.
The structure that we, Plastic surgeons in private practice in Spain, are hoping for, is to establish regulation which might be very similar to the UK healthcare commission.
Whilst this will add a lot of bureaucracy, it will also create a more controlled working environment for us and put an end to commercial entrepreneurs without medical knowledge embarking on a delicate field that requires strict regulation.

The advertising of such companies can be highly misleading in a way that patients tend to believe that the company management might dispose of decades of experiences in cosmetic surgery, while it fails to clarify that this experience is restricted to selling cosmetic surgery and not to any medical knowedge.
This will bring cosmetic surgery in Spain a new face.

Read more about cosmetiy surgery in Spain here

Dr.Alexander Amir Aslani, MD, EBOPRAS

Hospital:
Director and Chief Surgeon
Department of Plastic, Aesthetic and Reconstructive Surgery
Hospital Quiron Malaga
Avda.Imperio Argentina, 1
E-29004 Malaga
Spain
www.quiron.es

Private practice:
Cirumed Clinic
Avda.Ramon y Cajal 7-4°
E-29601 Marbella/Malaga
Spain
Phone:+34 607 307 515
info@cirumed.es
www.cirumed.es

Breast enlargement FAQ

Breast enlargement: Planning, costs, sense and nonsense, fact and fiction about Plastic surgery´s most popular procedure.

The most frequent questions regarding breast enlargement /breast augmentation by Dr.Alexander Aslani, Director and Chief Consultant Plastic surgeon of Cirumed Clinic Marbella.

Question:What is better in breast augmentation, locating the breast implant on top or behind the breast muscle ?

Dr.Aslani,Marbella: Generally the indication depends on the amount of breast tissue the patient has The less breast tissue, the more favourable it is to go behind the muscle.

Question: Is it possible to do a breast augmentation as a day case ?

Dr.Aslani,Marbella: Yes, this is possible. Requests for that are frequent to save hospital costs for the breast enlargement, be careful with submuscular augmentations who may require substantiative pain relief. In planning a breast augmentation, this has to be taken into account.

Question: What is the most common complication following breast enlargement ?

Dr.Aslani,Marbella: Infection. Occurrence depends very much on the access used. Incidence will be between 2-3 %. This is in the nature of surgery with a foreign body.

Question: Do I have to exchange implants every 10 years ?

Dr.Aslani, Marbella: No. This is outdated. There is no preset implant removal times any more, as long as you haven´t got problems, they can be left in.

Question: What is capsular contracture ?

Dr.Aslani, Marbella: A normal foreign body reaction against the implant. This is only problematic once exceeding a certain degree.

Question: Will a an anatomical implant give me a more natural result ?

Dr.Aslani, Marbella: Generally speaking yes. Beware of emptiness on top though, in the breast that is full in the lower pole and flat on top, it may not be the wisest solution.Different women expect different results from a breast augmentation. Some find the look a little bit to natural afterwards.

Question: What recovery time has to be expected ?

Dr.Aslani,Marbella:This depends very much on where the implant is positioned. Positioning behind the muscle heralds a longer recovery time, which can well take a few days.

To mitigate that, I routinely inject a long acting local anesthetic before finishing the breast enlargement. This anaestetic is naturally injected before the implant is put into position, to avoid accidentally piercing the implant.

This injection does considerably alleviate the pain caused by positioning of the implant behind the muscle.

Question:What is the difference between smooth and textured implants ?

Dr.Aslani:Smooth surface implants are suspected to increase the risk of capsular contracture in breast enlargment, which seems to be much lower with textured implants.

Question:I have heard that should one have breast enlargement, there is a high chance to end with the necessity for an uplift later in life ?

Dr.Aslani:Generally speaking, this is not true. It depends on implant and soft tissue development.In selected cases of breast enlargements, however, that might very well be the case. This is a problem of gravity and not a problem of the implants as such.

Question: Which is incision is best for a breast enlargement ?

Dr.Aslani:The three most common and popular accesses are the armpit, the nipple and the fold underneath. There are differences in preference from the side of the surgeon as well as the patient.

Question: Can I breastfeed after a breast enlargement ?

Dr.Aslani:Generally yes. This will depend a little bit on the incision used for the breast enlargement. If introducing the breast from underneath the fold or from the armpit, there should be no problems with breast feeding, Even the periareolar access (cut from the nipple) should not normally present problems, but there is a potential for it.

Question: How high is the risk of hardening of the implants ?

Dr.Aslani:The breast implantsthemselves do not harden….what you refer to is most likely capsular contracture. Every patient will get capsular contracture at some stage, the question is just to what degree. More than mild degreees can be seen in about 5% of cases, with occurrence of the problem being more common if the breaqst enlargement is carried out with positioning of the breast implants on top of the muscle.

However, occurrence of capsular contracture is still a possibility after breast augmentation, although getting increasingly rare.

Know about it, but don´t worry about it too much generally breast enlargement is an operation with an enormous degree of patient satsfaction, whatever problem occurs, we are here to manage it.

Question: What is the operating time for a breast augmentation ?

Dr.Aslani:Roughly one hour.Again, depends on the case.

Question:If my breasts are very saggy, can I combine a breast uplift with breast implants ?

Dr.Aslani:Yes, breast uplift and implants can of course be combined. However you need to undrestand that this makes the procedure a lot more complex and scarring will be involved, to what degree depends on the case. Nevertheless, my overall experience with combining breast uplifts with implants is very positive. It can be a very rewarding operation.But patients have to be aware that revision rates for breast augmentation with implants are generally afre higher than for breast enlargement alone

Question: Do you use saline breast implants ?

Dr.Aslani: No, i personally don’t. I think that the long term advantages of cohesive gel implants are so overwhelming that in breast augmentation that I do not see any space for saline implants.That is of course y personal opinion.

Question: What is the meaning of high profile vs.low profile implants in breast augmentation?

Dr.Aslani: The profile describes the relation of diameter vs projection of the implants. High profile implants in breast enlargement create a lot of projection. Many women find  the sound of this appealing, however, I feel it tends to look rather fake, the bigger problem is that after the breat enlargement the breast can have a fairly large gap. Low profile implants do not induce a lot of projection, so for most breast I suggest moderate high profile implants, which tend to give the most pleasing results in breast enlargement.

Regarding the texture, smooth and textured breast implants are used in breast augmentation.

I personally do not use smooth surface implants, because the herald a higher risk of capsular contracture.

Question; Is there alternative methods for breast enlargement ?

Dr.Aslani: Well, recently there has been a lot of attention for macrolane, which is basically filling the breast volume with hyaluronic acid. This can be a very attractive option for patients dreading a surgical breast augmentation, however, indications are somewhat limited as well as the possible amount of augmentation. A very spectacular variation is aesthetic breast augmentation with autologious tissue, which can be harvested from the buttock or the abdomen as a so-called”free-flap”. I have had patients showing interests in that because in makes the use of actual breast implants unnecessary, but it is a very extensive operation, and i think the cases where the extensice theatre time and surgical distress for the patient  is justified in relation to the relatively straightforward breast enlargement with breast implants is fairly limited.

Question: Is a fat transplant for breast enlargement feasible ?

Dr.Aslani: Feasible yes, although success rates are very variable.Free fat transplants, so called fat grafts, have a very variable survival rate. Percentage of revascularisation seems to be very variable. if patients are happy to accept the risk of that happening and especially if they want fat removal (liposuction) elsewhere in the body, it may well be an interesting option. However, the results of fat grafting remain difficult to predict and I guess that this is a problem we are not likely to solve short-term.

Question: How long do breast implants afetr a breast augmentation last ?

Dr.Aslani: With the last generation cohesive gel implants, this is very difficult to say. There is no preset timespan for removal/replacement of breast implants any more.

Dr.Alexander Amir  Aslani, MD, EBOPRAS

Hospital:
Chief Surgeon and Head of Department
Department of Plastic, Aesthetic and Reconstructive Surgery
Hospital Quiron Malaga
Avda.Imperio Argentina, 1
E-29004 Malaga
Spain
www.quiron.es

Private practice:
Cirumed Clinic
Avda.Ramon y Cajal 7-4°
E-29601 Marbella/Malaga
Spain
Phone:+34 607 307 515
info@cirumed.es
www.cirumed.es