Where you should begin when considering Plastic Surgery

Have you considered plastic surgery but were too intimidated to start the process? There are two very important steps to take initially. The first is to choose the right plastic surgeon and the second is to ask the right questions. Anyone with a medical degree and a valid license to practice medicine can call themselves a plastic surgeon. Do you want someone who specializes in hip replacement doing your abdominoplasty or performing your face lift? You need to do your research to ensure a positive outcome.

So how do you make sure the doctor you are interested in is really a plastic surgeon and not just a doctor performing plastic surgeries? Check whether he or she has a plastic surgeon's certification and experience. You can check with the American Board of Plastic Surgery (ABPS) online at Abplsurg to verify their status. It should be a warning sign to look somewhere else if your surgeon is not a member.

What type of training do plastic surgeons certified through ABPS have? How does their training differ from that of non-members? At the bare minimum, they must have completed a 2 or 3 year training program in cosmetic plastic surgery from an approved medical institution. Board certified plastic surgeons are qualified to perform plastic, reconstructive, cosmetic or aesthetic surgery.

Once you have chosen a qualified surgeon, the next step is your first visit to his or her office. During your visit, you most likely will be asked to fill out your medical history for the surgeon to review. He or she will ask you a series of questions, but most of this first visit should be you asking a number of important questions of your own. There are some standard questions you should ask during your first plastic surgery consultation.

This is a comprehensive list of questions to ask your surgeon. How often have you performed this type of plastic surgery procedure? Where will my surgery be performed? Are there any medical tests that need to be performed prior to the procedure, and are they included in the pricing? Approximately how long will my surgery take? What kind of anesthesia will be used? Are there any potential side effects, and if so, how have you dealt with them? What type of pain should I expect and what medications are used to treat it? Are the benefits of this procedure permanent? How long after surgery can I return to work? When can I resume normal activities like exercise, sex, etc.? How many check-ups will I have with the doctor after surgery?

However, there are some instances when plastic surgery can be performed by doctors who are not certified by the American Board of Plastic Surgery. These are typically doctor-specific procedures, such as having eyelid surgery done by an ophthalmologist. You also need to know what will happen if an emergency should occur. Are there resources available to deal with the situation quickly? Cosmetic surgery is a serious elective medical procedure, so doing your research prior to going under the knife only makes sense.

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South Africa Plastic Surgery


Show Your Best Forward - Breast Implants Surgery

Considering a Breast Implants Surgery does not need to be difficult. One only needs to find a board certified surgeon who will hear out your needs and work it out with you.

Initially, you should bring out all your questions regarding the procedure and your objective in wanting one done. The doctor should be able to give you satisfactory answers and also discuss with you any possible risks and complications to a breast augmentation and implant procedure.

S/he should discuss these possibilities: capsular contracture (where the pocket with the bag contracts); symmastia (where the pocket is over-dissected); a hematoma (where blood would collect around the incised area); a rupture of the implants; a seroma (where the implant is surrounded by fluid); necrosis (collapse of the tissue); changes in breast sensation; infection; and dissatisfaction with the results.

Saline Implants

Saline implants are the most popularly used in US breast implant procedure. The bags are filled with saline during the surgery. These are considered safer than silicone implants. If the bags burst inside the body, the saline merely gets absorbed into the body, which does not do any harm.

Silicone Gel Implants

Silicone implants used to have complications in the past, like leakages. Presently, manufacturers have improved on the product with three layers to prevent any leakage. These, however, make the implants a bit firmer, although patients have said that their breasts feel soft and natural to the touch.


Surgeons generally use four types of incision techniques for breast implant plastic surgery. These are:

• Transaxillary: armpit incision
• Areola: nipple or peri-areola incision
• Inframammary fold: crease incision
• TUBA: transumbilical, belly button or navel incision

Doctors and patients favorite is Inframammary incision, where the implant is placed under the muscle. The incision is made in the crease of the breast, so the consequential scarring is not evident.

Breast implant surgeries take about one to two hours, in an outpatient facility under general or local anesthesia.

Cost of Breast Implant Surgery

Breast implant placement costs about $3,400. You would still need to add the costs for the use of the surgical facility, anesthesia, pain medication, medical examinations, post-surgery garments and other miscellaneous expenses.

Post-operative Recovery

Recovery from this procedure is usually seven to ten days. The patients can even go into physical activity, like working out in the gym after three to four weeks. The results are long-term, with revisions to be performed every ten years for changes by age and gravity.

Related Breast Surgeries

Breast enhancement is generally combined with breast implant placement, breast reduction and breast lift. The breast lift reshapes and lifts back the sagging breasts. A breast reduction diminishes oversized breasts.

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South Africa Plastic Surgery


Research Before Your Plastic Surgery Consultation

If you are considering plastic surgery, one of the most important things you need to think about first is to find the right plastic surgeon for the procedure you need or want to have done.

While some decisions are as simple as opening up the Yellow Pages and calling around, finding a plastic surgeon is a much more complex process. Here are some things you should consider before you ever even book a consultation appointment.

Board Certification

You might be surprised to learn that any doctor can perform plastic surgery procedures, whether they are trained in plastic surgery or not. And, because performing these procedures can be a lucrative practice, there are many physicians out there who are enhancing and lifting and tucking who are not board certified to do so.

Any cosmetic surgeon you consider should be board certified in plastic surgery by the American Board of Plastic Surgery. You are advised to only consider having elective procedures performed by one who is certified by this board.

The Accreditation of Their Facilities

It is a common occurrence today for plastic surgeons to perform procedures in their offices or in places referred to as surgery centers. These two options offer the patient a reduced cost while offering the physician a more convenient way to manage their practice.

If you will be having your surgery in a doctor's office or surgery center, make sure that it is accredited. For your own safety, you should only consider having plastic surgery in an accredited facility or local hospital.

Local Hospital Privileges

Even if you will be undergoing your procedure in a doctor's office or surgery center, your physician should have operating room privileges at a local hospital for the procedure you will be having done.

For instance, if you will be having breast enhancement surgery, you should be able to contact a hospital in your local area and confirm that the physician you have chosen has operating room privileges there to perform breast enhancement surgery.

You want to make sure that the doctor you select is able to use a local operating room if they need to for some reason or if there is an unforeseen emergency.

The Plastic Surgeon's Experience

In addition to board certification and hospital privileges, you need to take into consideration the experience of the doctor themselves. If you will be having a tummy tuck, then you want to select a plastic surgeon who has performed as many tummy tucks as possible.

You can usually obtain this information by asking the office staff how many of a specific procedure the plastic surgeon has performed. By considering the experience of the physician, you can ensure that your procedure will be performed by the most skilled hands possible.

By taking into consideration the skills and experience of your plastic surgeon, their hospital privileges, their facility accreditation, and their board certification by the American Board of Plastic Surgery, you can ensure that a plastic surgeon is worthy of scheduling a consultation with for the plastic surgery procedures you are interested in. Your goal is to find a plastic surgeon who can be your partner in reaching your aesthetic goals, and to be worthy of it, she must fulfill all of the above requirements.

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South Africa Plastic Surgery

Plastic Surgeon Cape Town

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Bodies Under Construction

Thinking of Cosmetic Surgery?
Read this first!
By Liane Beam Wansbrough

Three years ago, when a 15-year-old British girl decided to get breast implants for her sixteenth birthday, the story made headlines around the world. Since then, media reports have continued to speculate that cosmetic surgery, once the exclusive domain of wealthy older women, is a trendy new option for any teenager with an adolescent hang-up.

Dr. Darrick Antell, a top New York City plastic surgeon, says he has seen an increase in the number of teenage patients but cautions against calling it a trend. “One of the main reasons for the increase is visibility: today’s teenagers are growing up with parents who have had cosmetic surgery, so they see and hear about it more. The media has also done a good job of making people aware of the procedures available. Another reason is acceptability. In a way, plastic surgery has come out of the closet,” Dr. Antell says.

When details of cosmetic procedures are frequently discussed on talk shows and published in magazines, it’s not surprising that they filter into our consciousness. “Sometimes when I’m out to dinner with my friends, we’ll play a game called ‘What would you have done?’ where we sort of daydream and discuss what we would do if money was no object and the procedures were safe,” says 18-year-old Alison Preiss, an Ontario high school student. While Preiss doesn’t think she could actually go through with a procedure, she says it could go either way. “I could grow up to realize that there are more important things than my nose, or it could really bother me to the point where I decide to have surgery. I suppose it depends on my lifestyle and career choices,” Preiss says.

Suzanne Ma, a 19-year-old Ryerson University student, has considered a double eyelid procedure popular in Asia. “I’m Chinese, and I don’t like my eyes. I don’t have double eyelids, so I feel that my eyes look a lot smaller than they really are. My concerns are not entirely for cosmetic reasons. With my heavy eyelids, my eyelashes don’t grow out properly. Some of them get trapped under the eyelids and it’s very easy for me to get an infection,” Ma says.

As in North America, plastic surgery is booming overseas, especially in wealthier Asian countries like Taiwan and Korea, where it is seen as a way to improve career prospects and self-confidence. In China, women and some men are paying thousands of dollars to have a brutal surgical procedure performed that lengthens their legs so they can fulfill height requirements often used to narrow down the number of job applicants.

Although reasons for cosmetic surgery range from getting a better look to improving job prospects, often the common factor among patients is more than skin deep. “Teenagers who are thinking about having plastic surgery to change the way they look are often addressing issues of self-esteem,” says psychotherapist Dorothy Ratusny.

 “Between the ages of 13 and 19, there’s a lot of emphasis on peers and what others think of you. It’s also a time when things such as not being part of the popular crowd, changes in financial situation and divorce can negatively affect a teenager’s self esteem.”

Cosmetic surgery may have a positive impact if your body image is consistently tied to a negative focus on a particular facial feature or body part. Dr. Antell says, “The classic case is a teenage patient of mine who had reconstructive surgery to correct a significant discrepancy between her upper and lower jaws. When she came into my office for the initial consultation she was constantly looking at the floor. After the surgery, she was looking up and smiling. Now she’s singing in her local school group.” Dr. Antell is careful to point out that there are murky areas. “Liposuction is one of those areas. So is breast augmentation because you’re not really sure that the teenager has stopped growing yet. But there are exceptions, for example, if a patient has breast asymmetry.” Dr. Mitchell Brown, a plastic surgeon at Sunnybrook and Women’s College Health Sciences Centre in Toronto says, “Correcting breast asymmetry, when women develop breasts that are different in terms of shape and size, can be appropriate for teenage girls because it causes a very significant psychological impact on them during their developmental years. 

Doctors are very aware of the psychological drama affecting our lives and it has become a very important factor when evaluating a patient. Dr. Brown says, “The key thing from my perspective is to assess physical, emotional and psychological maturity before treating a patient. I spend a great deal of time with my patients, regardless of their age, to determine that they have thought out their concern carefully and have reasonable goals and expectations.” In other words, cosmetic surgery can improve a patient’s body but it won’t necessarily improve their self-image or guarantee happiness. Dr. Antell says, “I’ve done liposuction on a Sports Illustrated swimsuit model. This is somebody most people would think looked perfect. But she was very insecure. She didn’t see herself the way others did. I can’t give people confidence.”

So, if you’re considering cosmetic surgery you need to ask yourself what you hope to achieve because it’s not going to be the one magic solution that makes everything better. In fact, it may even change you for the worse—just surf the Web and read the thousands of horror stories from people hoping to find peace of mind or happiness by going under the knife.

Dr. Ratusny says, “[Teens] need to be really realistic with the fact that cosmetic surgery may be only one piece of many things that serve to improve aspects of themselves. There may be physical changes but the real change begins with who they are inside.”

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Plastic Surgery Cape Town

Breast Augmentation, Endoscopic Assisted

Clifford P Clark, MD, Assistant Clinical Professor, Department of Surgery, University of South Florida
Contributor Information and Disclosures

Updated: 2003/04/24


The trend in plastic surgery to minimize scarring by remote placement of access incisions is embodied in the transaxillary endoscopic augmentation mammoplasty. The incision is hidden within the axilla, in the first axillary crease, and is generally invisible even with the arm raised. The surgical control gained with the use of the endoscope has resulted in more consistent results, which have renewed enthusiasm for the axillary approach.

History of the Procedure

The transaxillary approach to breast augmentation was described by Troques in 1972 and Hoehler in 1973. Besides the obvious advantage of the hidden incision, this approach facilitated direct access to the subpectoral plane. With this technique, the inframammary crease was altered and the origin of the pectoralis muscle was dissected blindly, accounting for a significantly higher incidence of implant malposition. The limited exposure of the blind technique did not allow complete division of the prepectoral fascia, resulting in the tendency of high-riding implants or the double-bubble appearance of the inframammary crease.

The advent of endoscopic plastic surgery in the 1990s allowed the application of the endoscope to breast surgery. The Emory group reported their experience with endoscopic breast augmentation through an axillary incision in 1993 using a specialized retractor and an air-filled optical cavity (Eaves, 1993). Ho reported a technique that used glycine irrigation to create a liquid-filled optical cavity, although he now also uses a specialized retractor and an air-filled optical cavity. The increased control resulting from direct visualization of the dissection obviated many of the previous downfalls of the blind axillary approach. Howard demonstrated the benefits of the endoscope with the axillary approach by decreasing the incidence of implant malposition from 8.6% to 2% when the endoscope was used.

Endoscopic transaxillary augmentation mammoplasty is now a widely used technique and has withstood the test of time. However, the learning curve is significant, and more straightforward cases should be considered during the initial experience. The axillary approach has limited application in secondary cases.

  Clinical: The importance of the initial consultation cannot be overemphasized. Discuss the 4 possible access incisions with the patient. Present the periareolar, inframammary crease, umbilical, and axillary incisions in a nonbiased manner, and assess the patient's enthusiasm for the axillary incision. Discuss the potential complications of breast augmentation, emphasizing those complications unique to the axillary approach. Discuss implant malposition, axillary hematoma, temporary axillary banding, and lymphadenopathy. Finally, discuss the possible need for an additional inframammary crease incision to treat some complications.

Perform a physical examination. Describe the location of the axillary incision, and draw the position and size of the axillary incision with a surgical marker. Pay particular attention to the distance from the areola to the inframammary crease and the transverse diameter of the breast. Assess the ideal transverse diameter of the breast, with a dimensional approach used to select implant size and direct fold adjustment. The need to lower the inframammary fold 1-2 cm is common; however, more than 3 cm should alert the physician to the presence of a constricted lower pole and the need for parenchyma alteration, which can be more straightforward with another approach. The ideal patient has a distance of 5-6 cm from the areola to the inframammary crease and therefore requires less inferior dissection. 


Indications for endoscopic breast augmentation include the patient's desire for a remote incision and the absence of a well-developed inframammary crease to hide a crease incision below the horizontal visual axis.



Constricted lower pole

A constricted lower pole with a short distance from the inframammary crease to the areola is significantly more difficult and can require radial scoring of the breast parenchyma. The potential exists for inferior implant displacement from overdissection (lowering) of the inframammary crease and superior implant displacement from underdissection of the inframammary crease. In experienced hands, the axillary approach can be used for this type of anatomy; however, use a cautious approach.

Tubular breast

The need for correction of the herniated areola and the scoring of the constricted lower-pole parenchyma makes the periareolar access incision most reasonable for this anatomy.


Pseudoptosis and grade 1 ptosis are possible with this technique, but this anatomy requires the lowering of the inframammary crease to the base of the vertical descent of the breast. This anatomy is not considered ideal for an initial experience and is subject to concerns of overdissection and underdissection of the inframammary crease.

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