Viewpoints: Controversies in Plastic Surgery

What is the SMAS? The earliest facelifts were single layer procedures that only tightened the skin. Good results were possible but longevity and scar quality were limited by high wound healing tension on the skin. In the 1970’s surgical anatomists described the Superficial MusculoAponeurotic System, or SMAS. This is a dense connective tissue layer in...  read more

Injectables are becoming more and more popular for facial rejuvenation, but there is a limit to what these agents can accomplish. Depending on the patient’s age and the type and severity of their wrinkles and folds, a facelift may be a better alternative. What types of injectables are used for facial rejuvenation? There are two...  read more

New FDA Alert on Breast Implants Due in part to recent social media pressure the FDA has once again called into question the safety of breast implants. The FDA enforced a twelve year moratorium (1994 to 2006) on the use of silicone implants to investigate an alleged association with rare connective tissue disorders. There was...  read more

First, some background. Breast implants are available in both round and tear drop shapes and each type can have either a smooth or rough (textured) outer surface (Figure 1). The material inside the implant, either saline water or silicone gel, have both been proven safe after decades of investigation and are not in question. However,...  read more

Why consider combining procedures? There are scenarios that naturally favor this approach. For example, facial aging typically affects both the eyes and face by a certain age. Treating just one area may produce a disharmonious appearance. Therefore blepharoplasty (eyelid surgery) and facelifts are commonly done at the same time. Similarly, changes in both the breasts...  read more

The vast majority of women have successful breast augmentation surgery and are pleased with their results for decades. However some women are tempted to have a second procedure to make a good result even better. In other instances a problem may exist or develops over time that warrants additional surgery. An important goal is to...  read more

Most individuals are best served by eyelid surgery (blepharoplasty) alone to restore a youthful appearance to the upper eyelids. Browlifts add a layer of complexity to the process, as well as increased operating time and cost. However, browlifts significantly improve results when used in the right situations. Also, the recovery time is about the same...  read more

A complete abdominoplasty, or “tummy tuck”, is a major surgical procedure that removes stretched skin and excess fat, flattens the abdomen by tightening underlying muscles, and improves the overall contour of the waist. It has the toughest recovery of all plastic surgery procedures associated with it and leaves the biggest scars. However, in the right...  read more