Plastic Surgery Blog


 

Body Contouring - 11/5/2020

By Kristen Aliano Messina, MD

What can be done with excess skin after weight loss? How can post-pregnancy body changes be addressed? Find out more by watching this video!

Body contouring procedures, including abdominoplasty (tummy tuck), liposuction, arm lifts, thigh lifts, and body lifts can be utilized in appropriate patients to address some of these concerns. I am very passionate about these procedures and the life-changing transformations that can be accomplished with them. For more information or to to schedule a complimentary consultation, please call my patient coordinator, Nakai Hatch, at 972-370-7141.

 

Breast Augmentation - 10/28/2020

By Kristen Aliano Messina, MD

Breast augmentation is the most common plastic surgery procedure performed in the United States. Breast augmentation can be performed with implants or with fat grafting. There are two types of implants: saline and silicone. Silicone is approved for cosmetic use in patients 22 and older. Silicone implants look and feel more natural compared to saline implants, but it is harder to detect rupture of silicone implants. The FDA recently released new screening guidelines for silicone implant rupture. Saline implants are less expensive that silicone implants, but it is easier to detect a rupture if one occurs. Implants can be smooth or textured. In my practice, I only use smooth, round implants. A lymphoma called anaplastic large cell lymphoma has been linked to textured implants, which is why I do not use them.

Fat grafting is an alternative for appropriate patients who would like augmentation without a foreign body. Breast fat grafting can often increase the breast by about one cup size. In breast augmentation with fat grafting, fat is removed from the body by liposuction, processed, and then injected into the breasts.

There are risks and benefits to breast augmentation with fat grafting or with implants. I discuss these in detail at the time of the consultation and pre-operative visit.

 

Breast Reduction - 10/16/2020

By Kristen Aliano Messina, MD

Patients with large breasts often experience upper back, neck, and shoulder pain, as well as shoulder grooving and rashes. Many of these individuals often need to wear multiple or specialty bras, and may require pain medication or treatment of the associated pain by a physical therapist or chiropractor. Breast reduction is a procedure that can reduce the size of a patient's breasts, and it often will mitigate many of these symptoms.

Breast reductions are performed in a certified operating room under general anesthesia as a day surgery. The procedure involves removing the excess breast tissue; it also repositions the nipples, giving patients with ptosis (or droppiness) a lift. Scars are made on the breast. Patients who seek breast reductions often do not mind the scars because the improvement of symptoms, and improved body image are often prioritized. As with any procedure that I perform, I encourage scar management and sun protection after surgery.

It is best that patients are weight-stable prior to undergoing breast reduction. This is because if a patient tries to lose weight after the procedure, the size of the breasts may decrease to less than the patient's desired size, and droopiness may reoccur.

I generally see my patients in the office the next day for the first post-operative visit.

 

Hair Restoration - 10/10/2020

By Kristen Aliano Messina, MD

1.2 billion people suffer from hair loss around the world.  Hair loss is a condition that men and women experience.  There are many causes of hair loss.  Some forms of hair loss are amenable to surgical intervention.

Causes of hair loss include stress, thyroid disease, nutrient deficiencies, pregnancy, menopause, autoimmune conditions, scarring from surgery or trauma, and hormonal issues.  The first step in evaluating hair loss is to perform a work-up to understand the underlying cause. Treating the underlying issue is crucial before performing other interventions.  As a plastic surgeon, I collaborate with my dermatology colleagues in working up patients with concerning features in their history or physical exam.

In general, most men who present to me as a plastic surgeon have male-pattern hair loss, indicated by a history of progressive hair loss over time and a family history of hair loss.  These individuals typically do not require any other type of work-up before undergoing intervention to improve hair density.

Medical therapies to improve hair loss include Nutrofol vitamins, Rogaine, and Propecia.  Propecia is a prescription-only medication and blood test monitoring is required.  It is only FDA-approved for use in men.  Make sure to consult with your physician prior to starting any medical therapy for hair loss, including the over-the-counter treatments of Nutrofol and Rogaine.

Platelet-rich plasma (PRP) injections can be utilized to improve hair density.  These procedures are performed in the office in about an hour; multiple treatment sessions are required.  In this procedure, blood is drawn from the patient, spun down in a centrifuge, and the portion of the fluid containing the platelets is injected into areas of concern into the scalp.  Platelets contain chemical mediators that can play a role in rejuvenation.

Hair transplantation is the surgical option for treating hair loss.  In our office, we offer two different hair transplantation systems-Neograft ® and ARTAS ®.  Both are methods of follicular unit extraction (FUE).  In FUE, there is no long, linear scar in the donor site at the back of the head. The hair is harvested in small, follicular units so scarring of the donor site is not easily visible. Neograft ® is a semi-automated system in which the device helps to harvest the follicles; ARTAS is a robotic system in which the robotic arm helps to both extract the follicles and place them in the recipient site.  (The recipient site is the area to which the hair is being moved).  ARTAS provides for robotic precision, and does help to reduce procedure time compared to more manual systems.  ARTAS® is primarily for use for individuals with short, straight hair, while Neograft ® can be used for a much wider array of hair types.

Hair transplantation surgery is performed in the office under local anesthesia.  Unlike surgery performed in an operating room under general anesthesia, patients do not need to fast the night before.  Patients are awake, and can listen to music, movies, and podcasts of their choice during the procedure.  Patients often do not usually need a prolonged period of time away from work.  It takes at least 9 months after the procedure to begin to see the results.

 

Fillers and Kybella (R) - 10/1/2020 

** Photo/diagram in video is for illustrative purposes only, and is not a real patient.

By Kristen Aliano Messina, MD

According to the 2018 statistics published by the American Society of Plastic Surgeons, soft tissue fillers were the second most common cosmetic minimally invasive procedure performed in the United States.  Fillers are injectables that are use to restore or augment volume; they can also be utilized for contouring.  These injectables are commonly used in the face to address volume loss or enhance the appearance of the lips.

There are many different soft tissue fillers on the market.  I primarily use hyaluronic acid (HA)  fillers, including the Juvederm and Restalyne family of products.  I prefer using HA fillers because they can be dissolved, if needed.

While filler injections are relatively safe, there are risks, like any medical procedure.  Risks include bleeding, swelling, bruising, infection, filler migration, asymmetry, and blood vessel blockage by the filler, among others.

A visit to the office for fillers includes a discussion with the patient about his or her concerns and desires, a review of the patient’s medical history, and a pertinent physical exam.  I then review the risks, benefits, alternatives, and expectations of the treatment.  Patients should expect to have some swelling and/or bruising after the procedure.  The swelling will often intensify in the first few days after the procedure before improving.  I counsel patients to give it a full two weeks before evaluating the results.  This two week time period is also important to consider if a patient has an important social engagement or will be having photos taken.

Patients should abstain from the use of aspirin, Vitamin E, fish oil, and non-steroidal anti-inflammatory (NSAID) medications for one week prior to injection.  I also ask patients to wait at least two weeks after undergoing dental cleanings before undergoing filler injections since dental work can release bacteria.  Arnica can be used before and after injection to help improve swelling and bruising.

Another common injectable is Kybella, which dissolves fat.  Kybella is deoxycholic acid and produced by Allergan.  It is approved for the treatment of submental fat.  It has been used off-label for the treatment of love-handles (flanks), thighs, and the pre-axillary area near the breasts.  Kybella involves multiple injections of the area to be treated; each injection site is spaced evenly apart.  Patient usually require more than one treatment; each treatment should be spaced 4-6 weeks apart. Major side effects include bruising and swelling; injury to surrounding structures, including a nerve that runs near the jaw, can occur. 

 

Pre and Post-Operative Care - 9/24/2020

I take pre- and post-operative care very seriously.  In fact, measures taken before and after surgery can potentially reduce the risk of complications and improve the overall outcome for the patient.  Patients must be appropriate candidates for the procedures they seek, and they need to be optimized prior to surgery if they have underlying medical conditions.

Every surgery and every patient is unique, so specific instructions are tailored for each individual.  However, there are some basic guidelines that are helpful for patients to hear. 

For example, I ask that patients undergoing surgery with IV sedation or general anesthesia obtain medical clearance from their primary care physician to ensure that it is safe to proceed with surgery.  If patients do not have a primary care doctor, I can make referrals.

Unless patient must be on a prescribed blood thinner for an underlining medical issue, medications that cause bleeding should be avoided for at least 1 week before surgery.  If it is possible for a patient to stop a blood thinner prescribed for an underlying medical issue, I usually ask the prescribing physician for a note stating that it is alright for the patient to stop the medication.  Blood thinners to generally avoid before surgery include aspirin, ibuprofen, Advil, Aleve, naproxen, Midol, garlic, ginko buloba, Vitamin E, and multivitamins.  A full list of medications to avoid is provided at the pre-operative visit. Tylenol is acceptable to take prior to surgery.

Patients should not eat or drink after midnight the night before surgery.  This is applicable to anyone receiving a procedure in the operating room since that is where IV sedation and general anesthesia is administered.  After undergoing anesthesia, patients are not able to drive, and must have a responsible adult driver available. 

After undergoing general anesthesia, it is important to ambulate and stay hydrated. This helps to prevent blood clots from forming in the legs. Patients can continue to wear compression socks for one week after surgery.  They should be adjusted throughout the day so that there is no skin breakdown.

I prescribe a non-narcotic pain control regimen for after surgery. This includes Tylenol, Celebrex, and gabapentin.  Tramadol, a controlled substance, can be added if needed.

Some procedures require the placement of drains.  If there are drains, patients must keep a log of their drain output. This is important because the log tells us when the drains can be removed, or if there is a problem, such as a hematoma (blood fluid collection) or seroma (body fluid collection).  Drains can be emptied twice per day or when half full.  Drains should always be compressed so that they are on suction.  The color will change from a frank red color to fruit punch color to light pink to yellow.  Drains will be removed once output is <30cc/day for 2 consecutive days.  (This is for each drain).

Cases involving large-volume liposuction, as well as some others, require overnight monitoring.  However, many of the procedures I perform are done on an outpatient basis.  We can also recommend a luxury post-op recovery facility for you to go to if you feel you would benefit.

Please keep in mind that this article is not all-inclusive.  My team and I will go over pre- and post-op instructions at multiple timepoints in your surgical journey with us.  We are also happy to discuss this with your caregiver after surgery.  We know it can be overwhelming, and we are always available to help!

 

What are Neurotoxins? - 9/21/2020

According to the 2018 statistics published by the American Society of Plastic Surgeons, botulinum toxin injections were the most commonly performed cosmetic minimally-invasive procedure. These injections are a non-surgical means of facial rejuvenation. Common botulinum toxin products for injection include Botox, Dysport, Jeuveau, and Xeomin. These injections work by inhibiting the movement of muscles in the face, thereby reducing the appearance of wrinkles.

Common areas from injection include the forehead, crow’s feet, and glabella (the area in between the eyebrows). Patient may also get injected off-label in other areas, including the chin and around the mouth. Injections can be utilized to treat a gummy smile and bruxism (teeth grinding).

While undergoing these injections is relatively safe, there are risks, as with any medical procedure. Risks include bleeding, bruising, swelling, eyelid droop, and asymmetry, among others. Patient should not be pregnant or breastfeeding while undergoing this procedure.

Before undergoing neurotoxin injection, it is advisable that patients avoid aspirin, vitamin E, fish oil, and non-steroidal anti-inflammatory (NSAID) medications for one week prior to the appointment in order to minimize bruising. Arnica can be used before and after the procedure to also alleviate swelling and bruising. Patients should avoid working out for 24 hours after the injections, and should remain upright for 4 hours after the procedure (i.e. no lying down or getting a massage).

The effects of the injections can be seen within 3-4 days, but it can take up to 2 weeks to see the final result. The injections typically last 3-4 months, but this may vary.

Whenever I evaluate a patient for toxin injections, I review the patient’s medical history, perform a pertinent physical exam, and review
the risks, benefits, and alternatives of treatment. I greatly value patient safety.

 

What to Expect During a Surgical Consultation - 9/11/2020

By Kristen Aliano Messina, MD

The surgical consultation is an extremely important visit for a patient seeking surgery. This visit gives the patient the opportunity to meet the team and surgeon, and it gives the patient and physician a chance to establish a relationship and rapport. I believe that good two-way
communication is vital to patient care.

Prior to being seen, I have my patients complete a very thorough medical history form. This enables my team and me to appropriately develop a care plan that is unique and tailored to each patient. It also helps me to understand how risky it might be for a patient to undergo elective surgery and pre-existing conditions that might need to be addressed prior to surgery. This helps with patient safety.

During the appointment, the patient has the opportunity to discuss his or her concerns and desires with me. A pertinent physical exam is performed, and I discuss whether or not the patient would be a suitable candidate for the desired procedure. A plan is formulated. If an
intervention is reasonable, I discuss what the treatment will entail, as well as what the post-operative recovery would be like. I also discuss the risks, benefits, and alternatives of the procedure. In the case of a surgery involving breast implants, I give the patient the chance to examine different types of implants and be sized. Photos are taken for the medical record, and the patient care coordinator discusses scheduling and pricing of surgery. We try to ensure that all questions are answered at the time of consultation, but are, of course, happy to answer questions after the visit has ended.

All patients undergoing surgery with general anesthesia are required to undergo pre-operative clearance approximately 2-2.5 weeks prior to surgery. Patients are generally seen back at 2 weeks (barring some exceptions) before surgery to review the surgical plan, confirm implants if applicable, and go through the informed consent process.

I strive to ensure that my patients feel heard and have a good understanding of the process.

 

What is the Profound? - 9/3/2020

By Kristen Aliano Messina, MD

The Profound is a temperature-controlled radiofrequency/microneedling device produced by Candela.  The device inserts pairs of tiny electrode needles into the skin, and radiofrquency energy is delivered to the skin, heating up the collegen.

It is a non-surgical device for the treatment of facial/neck aging.  It can also be used for the treatment of cellulite. Candela reports that the device can increase elastin 5x in the skin and collagen 2x in the skin.  Collagen and elastin are important molecules in the skin.  As humans age, the elasticity of the skin decreases.  Skin becomes more wrinkled and collagen bundles atrophy.

Profound treatments for both skin tightening and cellulite can be performed in the office under topical and local anesthesia.  In general, patients usually only require one treatment with this device.  There is less downtime with this device compared to surgical options to treat the aging face.  Patients typically see results in approximately 6 months, but this can vary.

As with any procedure, there are risks.  Risks of the procedure include, but are not limited to bleeding at the needle insertion sites, pain, swelling, redness, bruising, pigmentation change, itchiness, and tingling sensations.

Among other conditions, this procedure is not applicable for anyone with a pacemaker, active skin infection, collagen vascular disease, active psoriasis, eczema, and rash in the treatment area, history of keloid and hypertrophic scarring, facial laser resurfacing or deep chemical peels in the last 3 months, any surgical procedure in the past 3 month in the treatment area, and Accutane use in the past 12 months.

For a full discussion of the risks, benefits, and alternatives, as well as suitability for the procedure, consultation is required. 

 

Getting to Know Dr. Aliano Messina - 8/27/2020

Check out Kristen Aliano Messina, M.D.'s biography page on the McGuiness Dermatology website to read more about her education, training, and accomplishments!

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