Ask Dr. Man- Scar Issues

Dear Dr, Man, I have some scars that I would really like to get rid of. I have one on my face from an injury I had when I was a kid. I also have a scar on my arm from elbow surgery I had a few years ago. The scar on my arm looks like it’s raised up and the one on my face makes me embarrassed to take pictures. I’ve tried various creams, but nothing seems to work. Is there surgery or other treatments available to get rid of these scars? Signed, Scarred in Boca Raton

Dear Scarred, The good news is that treatment for scars has come a long way in plastic surgery. Today, plastic surgeons have many different tools at their disposal to reduce and treat scars on practically every part of the body through special scar removal techniques.

First, let’s understand what a scar is. A scar is an overgrowth of fibrous tissue and blood vessels that form as a result of an injury, cut or burn. There are many types of scars. Keloids are very thick clusters of scar tissue that appear as red or purple lesions, often growing outside of the injury, cut or incision. This may be what has formed on your arm. Keloids can be difficult to treat and have a tendency to reappear after scar removal treatment.

Hypertrophic scars are similar to keloids and tend to be thick, red and raised, but remain within the boundaries of the original incision or wound. They can often be improved with scar removal methods, such as a simple application of special creams, or injections.

Facial scars, because of their location, are frequently considered a cosmetic problem, whether or not it is hypertrophic. There are several scar removal techniques to make a facial scar less noticeable. Often the procedure involves cutting out the scar and closing it with tiny stitches, leaving a thinner, less noticeable scar. Laser scar removal procedures may also be used, as well as creams.

Burns can also cause scars and can result in a loss of a large area of skin. The resulting scar contracts, causing the edges of the skin to be pulled together. This affects adjacent muscles and tendons and restricts normal movement. Burn scars are usually treated with scar removal surgery, using a skin flap, or graph and tissue expansion.

As mentioned above, there are several ways to treat different scars. One option is surgery, which is often necessary to improve the scar. In this case, the surgeon removes excess scar tissue, and repositions the incision so it heals in a less visible pattern. Scar removal surgery is usually done under local or general anesthesia in the surgeon’s office.

Another treatment option is the use of creams and massages. Special creams are applied directly to the scar, which softens the scar tissue and promotes healing by working on the collagen fibers and realigning them. Massage may also be recommended, especially after breast surgery. This helps to break up the scar tissue.

Scars, especially old scars, may be treated with PhotoDerm, a non-invasive laser-like device that emits an intense flash of light that works directly on the scar by reducing the blood vessels present in the scar tissue.

I recommend speaking to a board-certified plastic surgeon to see which treatment option is right for you. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Abdominoplasty

Last time, I responded to an email from a reader who was interested in learning more about mini-tummy tucks. As I explained, mini-tummy tucks can produce excellent results; however, only a limited number of women (those with firm, flat abdominal muscles with the exception of excess skin and fat only below the navel) are good candidates. A full tummy tuck (abdominoplasty) is usually more satisfying for women because it allows the surgeon to repair the abdominal wall muscles and remove excess skin above the navel as well. In this post, I’d like to discuss a full tummy tuck so you have a point of comparison.

A tummy tuck is a surgical procedure used to remove excess skin and fat from the tummy, to flatten the tummy area and to tighten abdominal muscles. The best candidates for abdominoplasty are people who are in relatively good shape but are bothered by a large fat deposit or loose abdominal skin that won't respond to diet or exercise.

People who elect this procedure most often are women who, after childbearing, have stretched their abdominal muscles and skin beyond the point where they can return to normal. Tummy tucks are also common for men who wish to tighten muscles and remove fat from the middle and lower abdomen. Older patients who often experience weight gain as they age, especially around the abdomen, can also benefit from this procedure. For all patients, men and women alike, a tummy tuck can dramatically reduce a large or protruding abdomen.

If you’re considering a tummy tuck, it is important to know that this procedure requires surgery. It produces a scar, which is hidden in the bikini line. The procedure normally takes about 2-4 hours and is performed under general anesthesia. During surgery, suction lipectomy is done to areas such as flanks and abdomen. An incision the length of which is related to the loose skin is made in the lower abdomen. A narrow tunnel is made in the center of the abdomen, just enough to allow tightening of the loose muscles. A new place is made for the belly button. Finally, the extra loose skin is removed and closure is completed. The result is a firmer tummy and a narrower waistline.



After surgery, the abdomen will be tight and possibly swollen and patients usually experience some discomfort. After surgery, patients wear a light support garment for a few weeks. People are generally back to work within 1-2 weeks of surgery; however, it is recommended that strenuous activity be avoided for about 3-4 weeks.

Abdominoplasty can produce excellent results for patients with weakened abdominal muscles or excess skin. In most cases, the results are long lasting, as long as the patient follows a balanced diet and exercises regularly. If you're realistic in your expectations and prepared for a lengthier recovery period, abdominoplasty may be the answer for you.

For some patients, other treatments, such as liposuction or a mini-tummy tuck (like we discussed last week) may provide an alternative option, eliminating the need for major surgery. I recommend speaking to a board-certified plastic surgeon to see which procedure is right for you. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Mini Tuck

Dear Dr. Man, Ever since I had my baby 3 years ago, I’ve hated the look of my stomach. I work out, but I can’t get rid of parts of my belly. I recently heard about something called a mini-tummy tuck. This greatly interested me because I want a tummy tuck, but I would prefer a less-invasive procedure. Can you please give me more information about a mini-tummy tuck? Thanks, Katee in Boca Raton

Dear Katee, A mini-abdominoplasty, also known as a mini-tummy tuck, In a partial of modified tummy tuck, the incision is often shorter and the navel may not need to be moved. The abdominal skin is lifted up only from the top of the pubic hair line to the navel. The skin flap is then stretched downward, removing the excess tissue, and then the flap is stitched back into place.

Most women after pregnancy have stretched out the muscle and skin above their navel, making many women better candidates for a full abdominoplasty. Many women request a mini-tummy tuck in order to avoid what they perceive to be a more invasive procedure (i.e., a full tummy tuck). However, a full abdominoplasty is usually more satisfying for women because it allows the surgeon to repair the abdominal wall muscles and remove excess skin above the navel as well.

If you’re a good candidate, a tummy tuck is a great procedure to eliminate excess skin and fat, narrow the waistline, get rid of stretch marks on the lower abdomen and improve the appearance of the navel. Sometimes doing less is more; and other times a full procedure is the way to go. In my next post, I’ll discuss the full abdominoplasty procedure in detail, so you’ll have a point of comparison. I recommend speaking to a board-certified plastic surgeon to see which procedure is right for you. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Body Glue

Dear Dr. Man, My sister-in-law keeps bragging about this glue her plastic surgeon used on her to quicken the healing after her facelift. I’m thinking of having some work done and am very interested in anything that shortens the healing time, but I’ve never heard of this before. Can you tell me more about this? Signed, Roberta in Boca Raton

Dear Roberta, Your sister-in-law is most likely referring to something called Body Glue, which is a new technique that provides patients with the latest technology to enhance and shorten the time their body needs to heal itself after cosmetic surgery. By using a small amount of your own blood, the doctor can produce a glue-like gel that, when applied properly, can increase wound healing and decrease the amount of bruising and swelling traditionally associated with various cosmetic surgery procedures.

Body Glue is produced while you are in surgery. The Body Glue process is very simple and pain free. Once you are in the operating room, a small amount of your blood is drawn and processed to release the human growth factors. Since these growth factors are derived from your own blood, there is no chance of transmitted infection or rejection by the body. The blood is then separated into its various components, which concentrates and releases the growth and healing factors, thus producing the glue-like Body Glue gel. It takes only minutes to make the Body Glue gel during your surgery. When your surgery is nearly complete, the Body Glue gel is applied to the area of the surgery. The Body Glue technique can help facilitate the healing process and ensure the best results.

Body Glue works by helping to speed the body's healing process. It does this in several ways, such as: increasing collagen production; improving the growth of new blood vessels; reducing swelling; and improving soft tissue wound healing.

Currently Body Glue is being used on patients undergoing face lifts, brow lifts, neck lifts, breast enlargements, breast reductions and tummy tucks. Body Glue has also proven quite successful in other surgical procedures, such as treating dog bites.

Talk to a board-certified plastic surgeon to see which treatment options are right for you. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Facelift

Dear Dr. Man, I’m 45 years old and I’m in great shape. The problem is that I have the body of a 30 year old but the face of a 50 year old. I have droopy eyebrows and wrinkles on my forehead. I really want to get a facelift, but I never thought people so young get them. Can you please give me more details about a facelift and tell me if I’m too young to get one? Signed, Molly in Boca

Dear Molly, The face of plastic surgery has really changed over the years. It used to be that most people getting facelifts were in their late 50’s or early sixties. Nowadays, we see people coming in earlier (usually in their mid-forties). Since there are less drastic, more minimally-invasive procedures, patients no longer need to wait until aging is extreme.

Today’s facelifts have evolved from years past. They entail more than just lifting and tightening of the skin. There are many excellent procedures out there, depending on each patient’s individual needs.

One procedure is a full facelift, which addresses the mid-face, jowls and neck area. Incisions begin at the temples and go under and beyond the ears, extending laterally into the nape. With a full facelift, the skin and tissue are repositioned and fat is often reduced, repositioned and sometimes added. Then, the skin is redraped and excess skin is removed.

Another procedure is a mid-facelift, which uses similar techniques as a full facelift, but generally does not include work on the neck and jowls. The incisions begin at the temples and go under the ears or begin at the temples and curve back into the hairline just above the ears.

Another alternative for people whose problems lie mainly in the top part of their face is a forehead lift (a.k.a. “brow lift”). A forehead lift can help reduce deep creases, horizontal lines and furrows in the forehead. It can also help lift heavy, droopy eyebrows that can create a hooding effect over the eyes. The procedure helps restore a more youthful, refreshed look to the area above the eyes. It also helps to improve the horizontal lines and furrows that can make a person appear angry, sad or tired. The procedure is done with an endoscope using small incisions.

The best way to decide which procedure is right for you is to visit a board-certified plastic surgeon to discuss your options. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Varicose veins / Port Wine Stains

Dear Dr. Man, I have varicose veins all over my legs and they’ve gotten worse over the years. I’m embarrassed to wear shorts or a skirt. What causes these veins and how can I get rid of them? Signed, Ellena

Dear Ellena, Varicose veins are enlarged vessels, commonly found on the legs and face, which have become weakened and appear as bulges under the skin. Another common problem found on the legs and face are spider veins, which are small, superficial vessels. The exact causes of varicose and spider veins are not known, although heredity plays a large role, as does lifestyle and personal habits, such as standing on your feet for long periods of time.

Today, unsightly veins easily can be treated with new types of lasers using intense pulses of light. PhotoDerm and Vasculight are non-invasive, laser-like systems that safely reduce unsightly blood vessels without injections or surgery. Treatment can be done right in the doctor’s office and can take as little as 15 minutes.

Treatments are customized to your skin type and the size and depth of your veins. The treatment starts with an intense light flash, similar to the flash of a camera, followed by a slight pinch. After treatment, your skin may appear slightly red, which will dissipate after several days. There is no down time and patients usually go right back to work.

Several treatments are required in order to produce the desired results. The treatment is also good for port wine stains, birthmarks and other irregular pigmentations. Side effects may include temporary changes in skin color or blistering.

Dear Dr. Man, I have red birthmarks on my shoulders and my chest. I’d really like to get them removed. Can you tell me more about these marks and what’s involved in removing them? Signed, Betty in Boca Raton

Dear Betty, Red birthmarks, also called "port wine stains", appear at birth and are exhibited by reddish marks caused by an over-abundance of blood vessels. The coloring ranges from pale pink to dark purple. They are most often found on the face, neck and top of the shoulder or chest, although they can appear anywhere on the body.

New treatments using the YAG laser provides relief for most patients. The Vasculight YAG laser is able to penetrate deep into the skin, targeting the red pigment and blood vessels. The laser works by vaporizing the tissues without harming the surrounding area.

Several laser treatments are usually required and a maintenance program may be needed, as these type of birthmarks can reappear.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Teenage Breast Reduction

Dear Dr. Man, My daughter is seventeen and a high school senior. She’s very thin, but has very large breasts- she wears a DD cup, but she’s only a size 4 waist. As a result, she has bad back pain. She also has trouble finding clothes to fit her, since she’s so disproportionate. She wants to get a breast reduction. Can you please tell me more about this surgery and if my daughter is too young to get it? Signed, Concerned Mom in Boca Raton

Dear Concerned Mom, Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight, including back, neck, and shoulder pain. In addition, there may be other physical discomforts, such as bra straps leaving indentations in their shoulders. Large breasts can also make women, especially teenage girls like your daughter, feel embarrassed or self-conscious.

Breast Reduction, also known as reduction mammoplasty, reduces disproportionate, oversized breasts by removing fat, glandular tissue and skin from the breasts, making them smaller, lighter and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal of the surgery is to give the woman smaller, better-shaped breasts in proportion with the rest of her body. In most cases, breast reduction isn't performed until a woman's breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort, as in the case of your daughter.

Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. Luckily, modern surgical methods leave patients with incision lines that are only around the areola and up and down, eliminating the horizontal incision at the bottom of the breasts. These scars should fade with time and are usually covered by a bra or bathing suit. After surgery, the patient is wrapped in an elastic bandage or a surgical bra over gauze dressings. The bandages are removed a day or two after surgery, though the patient continues wearing the surgical bra around the clock for several weeks, until the swelling and bruising subside. Although the patient may be up and about in a day or two, the breasts may still be tender for a couple of weeks. Most women can return to non-strenuous work, school or social activities in about two weeks.

The best candidates for this surgery are women who are mature enough to fully understand the procedure and have realistic expectations about the results. Talk to a board certified plastic surgeon to help you decide if your daughter is a good candidate for the surgery.

Every patient and every physician has a different view of what is a desirable size and shape for breasts. In your initial consultation, it's important to discuss yours and your daughter’s expectations frankly with the plastic surgeon, and to listen to his or her opinion.

Breast Reduction surgery helps get rid of the physical discomfort of large breasts, the body looks better proportioned and clothes fit better. Chances are that, like most women, your daughter will be pleased with the results. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Consultation Questions

Yesterday I addressed a reader’s question of how to find a qualified board-certified plastic surgeon. Once you find a good surgeon with whom you feel comfortable, the next step is to set up an initial consultation. As promised, in this week’s column, I am giving you some advice on what kinds of questions you should ask during your initial consultation with the plastic surgeon. You can use these questions as a guide when composing your own list of questions. Be sure to be specific, and make sure the doctor knows about your goals for the surgery so that he or she can advise you properly.

• Ask about the surgery itself. Where will it be performed and who will perform it? Will it be done in a hospital, outpatient center or doctor’s facility? If the doctor has operating facilities, you will want to make sure the facility is currently licensed and accredited. Ask how long the procedure will take, what type of anesthesia will be used and who will administer the anesthesia.
• Ask what options are available to you with regards to the procedure you are considering. What you may think is the best procedure may not be what the doctor recommends; or, there may be medical reasons that preclude you from having certain types of procedures. Therefore, ask the surgeon what he or she thinks is the best option for you, based on the results you want to achieve.
• Ask the surgeon if you can speak to patients who have had the procedure you are considering. This is an excellent means of learning more about the procedure and finding out if patients were happy with their experience and if their expectations were met.
• Ask what results you can realistically expect and how long these results will last. Will there be any scarring; and, if so, where will the scars be located and how can they be concealed?
• Ask about the risks involved with the surgery. Are there any possible complications? Ask if there will be any pain or discomfort. Inquire about drainage tubes, dressings, bruising and swelling. How long will the recovery time be?
• Ask when you will be able to go back to work and resume your normal activities. Will there be any physical limitations? When can you resume exercise? When can you wear makeup again?
• Ask about costs associated with the surgery, such as fees for the surgeon, the anesthesiologist, the recovery room nurses, the operating room and follow-up visits. Many doctors offer financing options. While most cosmetic surgery today is not covered by insurance, you may still want to ask.

After your consultation, you may discover that you really didn’t connect with the doctor, or that he or she isn’t answering all of your questions to your satisfaction. Whatever the case may be, you want to be sure you choose the right doctor for you. Remember, just because a friend, colleague or acquaintance had a good experience with a doctor does not mean this will be true for you. If you don’t feel 100% comfortable with the doctor, consider consulting with another doctor until you feel comfortable with your choice. Best of luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Finding a Plastic Surgeon

Dear Dr. Man, I enjoy your column and am strongly considering getting some plastic surgery done to make me look younger. My question is, how do I find a reputable plastic surgeon? I’m a snowbird and would like to get my surgery done up North. Also, what kinds of questions can I ask during my visit to make sure it’s the right doctor for me? Thank you, Marcia from Boca Raton, FL and Brooklyn, NY

Dear Eileen, When you decide to have cosmetic surgery, the first and most important step you can take is to find a doctor that is right for you, one that can help you reach your goals.
You can begin your search by asking friends, family members, and colleagues you respect. Another good source is your family doctor or another medical professional. In my opinion, the phone book and advertisements are not the best resources for information. Exercise caution if you choose to use the Internet; and make sure any information you get is from a credible source. Be wary of web sites that provide referral services, which are often paid for by the doctor. Better Internet sources are those of professional organizations, such as the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery.

Once you have a list of doctors from which to choose, I suggest calling a few offices and getting answers to the following important questions before deciding on a surgeon:

· Is the surgeon board-certified in plastic surgery? Board certified plastic surgeons are full-time plastic surgeons who are certified by the American Board of Plastic Surgery (ABPS), and who have the surgical skills and judgment to perform a wide range of aesthetic and reconstructive procedures on the total body.

· Is the surgeon a member in good standing of the American Society of Plastic Surgeons, Inc. and the American Society for Aesthetic Plastic Surgery (ASAPS)? These organizations represent board-certified plastic surgeons in the U.S. They can provide a list of board-certified plastic surgeons in your area. For more information about the American Society of Plastic Surgeons, call 888-4-plastic or visit www.plasticsurgery.org; and the American Society for Aesthetic Plastic Surgery, call 215-587-9322 or visit www.surgery.org).

· Is the surgical facility fully equipped and accredited to perform outpatient surgery? Does the surgeon have privileges to perform these same procedures in the hospital? Accrediting organizations that can provide you with more information are: the American Association for Accreditation of Ambulatory Surgery Facilities (888-545-5222 or www.aaasf.org); the Joint Commission on Accreditation of Healthcare Organizations (630-792-5800 or www. jaaacaho.org); and the Accreditation Association for Ambulatory Health Care (847-853-6060 or www.aaahc.org).

Next week, I will address the remainder of your question by reviewing the items you should ask during your initial consultation with a plastic surgeon. Best of luck to you!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Saline vs. Silicone

Dear Dr. Man, What’s the difference between silicone and saline implants? I’m considering getting implants and I’m not sure how to choose. Signed, Robin in Boca Raton

Dear Robin, Silicone breast implants were first used over 40 years ago, and saline implants were developed a few years later. The main goal of saline implants was to enable the surgeon to place the implant through a smaller incision. Before the FDA banned the use of silicone implants in the United States about 13 years ago, over 90% of surgeons preferred silicone over saline. However, after cases of some silicone implants rupturing, the FDA put a ban on use of silicone implants. Even today, surgeons are somewhat limited in their use of silicone implants.

Silicone implants feel and look more natural, can be more predictable, and are considered safe. They have been reported by patients to feel softer and more natural than saline. They also have the ability to naturally adjust as you move. This does not mean, however, that they are the right choice for every woman.

Adjustable saline implants can be useful in some women, such as those whose breasts are very asymmetrical, or in women who have had massive weight loss and whose skin has stretched a great deal. Adjustable saline implants allow the surgeon to fill the implant after surgery, in attempt to achieve the desirable size and fullness the patient is looking for. Saline implants can feel more firm than natural breast tissue.

Although good results may be obtained with saline implants, compared to silicone gel implants, they are more likely to cause cosmetic problems, such as rippling and wrinkling, resulting in an abnormal shape and feel, particularly in a woman with very little breast tissue.

If you are a woman looking to switch your implants from saline to silicone, I suggest discussing it in length with your surgeon. Some surgeons may recommend that you keep your saline implants if you are happy with their appearance and they have presented no complications.

The type of implant that is best for you depends upon what you want and what your breast tissue will allow you to have. You and your surgeon should weigh the benefits and tradeoffs of both saline and silicone. If you are thinking about breast implants, I encourage you to discuss all of your options with a board-certified plastic surgeon during your pre-operative consultation.

Studies have shown both saline and silicone implants to be safe and effective. An experienced surgeon will help you choose what is best for you.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Thermage

Dear Dr. Man, I read in a fashion magazine recently about a treatment for aging skin- I believe it was called Thermage. I read that it’s kind of like a facelift without the surgery. Can you please give me more details about this and what it entails? Signed, Roberta in Boca Raton

Dear Roberta, Thermage, also called Thermacool, has been featured in several magazines, including Vogue. Called the “non-surgical facelift,” Thermage is a new technologically advanced approach to treating aging skin. It is currently used for treating loosening of the skin around the eyes, forehead, mouth and other areas of the body.

Thermage works by heating the underlying layers of the skin (dermis) with a unique delivery of radio frequency energy, while protecting the skin's top layer (epidermis) with a cooling spray. This is accomplished with advanced safety features that monitor skin temperature and regulate treatments. Thermage causes immediate collagen contraction, followed by new collagen production over a period of time, resulting in a more youthful appearance.

Each time energy is delivered, there is an immediate cool sensation, followed by a brief hot sensation, and again by a cool sensation. Depending on the size of the area treated, the procedure itself may take anywhere from a few minutes to an hour.

One of the major benefits of the procedure is that it does not require any downtime, so you can resume normal activities immediately. Minimal redness is seen in some patients, but it usually disappears shortly after treatment. There is no special care needed after treatment. As a part of good skin care, sunscreen is recommended.

Some patients see results soon after treatment; although in most patients, results appear gradually over 2 to 6 months. Recently completed studies demonstrated continued improvements for at least 6 months after a single treatment session. Thermage is very safe. Although this is a relatively new treatment and a new technology, the number of adverse effects has been small.

It is important to note that while Thermage is an excellent treatment option for many people, it is not a replacement for a facelift or blepharoplasty (eyelid lift). It is important to have realistic expectations when undergoing any treatment. If you’re thinking about Thermage or any other procedure, visit a board-certified plastic surgeon or dermatologist to see what is right for you. Best of luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Botox

Dear Dr. Man, I’m a healthy, active woman, but my wrinkles make me look old. I’m thinking of getting Botox injections to get rid of the wrinkles on my face. My sister recently had Botox injections and she looks great. Can you please give me more information about this? Signed, Young at Heart

Dear Young at Heart, Botox Cosmetic has become a very popular means of reducing certain facial wrinkles, including frown lines of the forehead and crows feet around the eyes. Frown lines are the vertical lines caused by contraction of the muscles of the eyebrows. Injecting Botox next to the muscles of the eyebrows and forehead causes the muscles to relax, smoothing out the vertical lines. Botox has become very popular with both men and women, in order to regain a more youthful appearance.

Botox, a therapeutic muscle relaxer, is a by-product of botulinum toxin A (it is not a toxin itself). It acts directly on the nerves of the muscles, preventing the muscles and nerves from receiving electrical impulses. Botox is applied via injections, using a very fine needle. The procedure is relatively painless and takes only several minutes.

Botox has been used safely for over 20 years and was approved by the U.S. Food and Drug Administration for cosmetic use in April 2002. There are minimal side effects, although some complications, such as allergic reactions or swelling, can occur. Patients who are on antibiotics or other drugs should advise their doctor in advance, as these drugs may act to increase or reduce the potency of the injections. The results of Botox last about four to six months, depending on the patient, and should be repeated as necessary.

Botox is also used to treat some medical conditions. It is used to help decrease hyperhydrosis (excess sweating). Botox can also be effective for severe migraine or cluster headaches that don’t respond to other methods of treatment. Talk to your doctor if you have any of these problems, to see if Botox injections are the right course of treatment for you.

Botox Cosmetic has become so popular that some people are even hosting Botox parties, in which several men and women gather together for cocktails and wrinkle-reducing injections. Be advised that the FDA has issued statements warning of the possible hazards of "Botox parties." A Botox injection is a medical procedure that should be performed in a controlled medical environment. According to the FDA, administering this treatment during a cocktail party greatly diminishes the gravity of this medical procedure. There is always a risk of adverse reactions or side effects after a Botox injection; so patients need to be in a medical setting that is equipped to handle an emergency situation. In addition, the ingestion of alcohol at or around the time of injection could worsen any bruising at the injection site.

Also, beware of places that offer “bargain Botox injections,” as they may dilute the concentration of Botox in each injection, which can make the results of the treatment less effective.

Talk to a board-certified plastic surgeon or dermatologist to see if Botox is right for you. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Smartlipo

Dear Dr. Man, I recently read an article in People magazine about something called Smartlipo. It sounds very good and I’d like more information on this procedure. How does it differ from traditional liposuction? Does it work as well? Signed, Deirdre

Dear Deirdre, Smartlipo is the first and only laser lipolysis system to offer a revolutionary, minimally-invasive procedure for the removal of fat. Using a high-powered laser, Smartlipo is a new laser body sculpting procedure that requires less downtime and fewer side effects than traditional liposuction.

Smartlipo can be a great supplement to traditional liposuction procedures, although it does not replace conventional liposuction. Smartlipo is ideal for treating small areas of the face, neck, arms, breasts, and areas of loose and flabby skin. For most patients, usually only one treatment is required.

If you have areas of fat that do not respond well to diet and exercise, then you may be a candidate for Smartlipo. Ideal candidates are generally in good health, of normal body weight and have realistic expectations for the results.

A very small cannula (tube) containing a laser fiber is inserted into the skin. The cannula is moved back and forth, delivering the laser’s energy directly to the fat cells, causing them to rupture and easily drain away. Because the cannula is smaller than the traditional cannula used for liposuction, Smartlipo is a minimally invasive procedure and can be performed under local anesthesia. The laser causes small blood vessels to coagulate immediately on contact, resulting in less bleeding, swelling and bruising, as well as a quicker recovery time than conventional liposuction. Because general anesthesia is unnecessary, the procedure is very safe.

The session may last from 45 minutes to one hour for each area treated. After the treatment, patients wear a compression garment for several days to several weeks, depending on the body area being treated. Activity may be resumed gradually, but patients should avoid strenuous exercise for about 2 weeks.

Results can be seen in as soon as a week, with continued improvement over several months. The really good news is that Smartlipo provides lasting results. Adults do not create new fat cells; when a person gains weight, existing fat cells expand. The Smartlipo procedure permanently removes fat cells; so, if you do gain weight, most of the fat will be deposited in areas where the procedure was not performed.

Talk to a board-certified plastic surgeon to see if this procedure is right for you. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- New Men Plastic Surgery Proceedures

In Saturday's post, I responded to a reader’s inquiry about plastic surgery for men. I explained that like women, men want trimmer waists and fewer wrinkles. Many also desire more hair. Men are rejuvenating their faces with face, neck and eye lifts, forehead and brow lifts; having lasers and peels to remove the wrinkles and make their skin look younger; resculpting their noses, and undergoing liposuction and tummy tucks. As promised, in this week’s column, I will review the newest procedures that have become extremely popular for men.

The advent of non-ablative lasers and tissue tightening devices such as Thermage offer mini-lifts without surgery. New fillers such as Restylane and Perlane give men more choices to remove lines and wrinkles and fill in deep creases and folds. The Vaser, a new liposuction procedure, removes double chins, “spare tires” and “love handles” around the waist, large protruding abdomens and more. These procedures allow the plastic surgeon to be a true sculptor of the human body.

Many men, and even women, work out and take care of their health; however, they find they still have extra fat around the middle, tummy or back. Because liposuction removes localized fat that doesn’t respond to diet and exercise, it is one of the best procedures to help men attain their desired body shape. Male breasts are another area where liposuction, and sometimes surgical correction, can help to improve the appearance of the chest area and restore self-confidence.

Men are also having pectoral implants to increase the size of their chests, and calf implants to give the legs a more pleasing shape. Another popular procedure includes body contouring to lift the buttocks, thighs, arms and abdomen; it also helps to reshape the body and remove excess, hanging skin. This procedure is especially useful after weight loss of 50 to 100 pounds or more, and is becoming more common.

If you’re considering plastic surgery, visit a board-certified plastic surgeon for a consultation to help you decide which procedure is right for you.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Liposculpture

Dear Dr. Man, I’m 52 years old and my face is starting to show signs of aging. My friend recently got a procedure that injected her own fat into her face. She looks phenomenal. Can you please tell me more about this procedure? Signed, Maura in Boca

Dear Maura, Because of age, gravity, and natural daily expressions, the fullness and roundness of the face can weaken and droop downward, making the rounded contours of younger years a faint memory. Also, as we age, the fat and collagen in the face begin to dissipate, which can make the face look more tired and drawn.

Luckily, there are treatments that can help. Non-invasive use of synthetic injectable filler materials are extremely popular, safe, and very effective. However, use of your own body fat as a filler to enhance the face is often considered the golden standard, since it uses your body’s own materials.

Autologous fat, which is fat harvested from the patient’s own body, offers a unique advantage and has helped to usher in a whole new age of liposculpture. Autologous fat is especially good for facial contouring and enhancement. New advances in harvesting, storing, and injecting the body’s own fat have made liposculpture using the body’s own fat a very desirable option in facial restoration and anti-aging.

Typically, fat is harvested from the hips, stomach, or other areas where it is not needed. This fat is then re-injected into the cheeks, jaw line, lips, brows, or eye lids. It is also used to smooth out deep lines, such as those around the mouth or the deep creases of the nasolabial folds (smile lines). The procedure may need to be repeated in order to build up volume, and to compensate for some of the fat that is absorbed by the body. However, retention of the fat is the usual occurrence; which is what is so great about this technique.

Liposculpture can be very useful for correcting aging of the face and loss of volume in the cheeks, brows, tear trough, nasolabial folds, lips, acne pits and scars, and underneath the jaw line. Injected fat is long-lasting, perhaps a lifetime; although touch-ups in the future can further enhance the results already obtained.

Talk to a board-certified plastic surgeon to see if this procedure is right for you. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Male Plastic Surgery

Dear Dr. Man, I am a 47 year old male, and I’ve always prided myself on my appearance. However, lately I am noticing signs of aging. I am in a competitive work environment, and I am newly single in my personal life; so, needless to say, I want to be at the top of my game and look the best I can. Is it taboo for men to get plastic surgery? Any advice is greatly appreciated. Signed, M.

Dear M., More and more men today are having cosmetic surgery to help them look younger and more attractive. Like their female counterparts, they have discovered the benefits of cosmetic surgery, both personally and professionally. Men are recognizing that wrinkles, frown lines, crow’s feet, droopy eyelids, baldness and double chins can make them look old and tired, and appear less competitive on the job.

Like women, men want trimmer waists and fewer wrinkles. Many also desire more hair. Men are rejuvenating their faces with face, neck and eye lifts, forehead and brow lifts; having lasers and peels to remove the wrinkles and make their skin look younger; resculpting their noses, and undergoing liposuction and tummy tucks. These improvements haven’t stopped at the surgeon’s office. Men are also going to hair salons instead of barber shops, having facials and other skin toning treatments, and even shopping at cosmetic counters.

The number of people having cosmetic surgery is up; and men are a big part of that increase. Many of my patients say they don’t want to keep putting off their dreams and goals. Another reason for the increase is that Baby Boomers have reached the “unfashionable” age of 50. In a society that values youth, 50-year-old executives are competing with younger, fitter and more competitive 30-year-olds, who are often willing to work very hard for less money. I hear from many patients that their baggy eyelids and tired appearance often affect their peers’ perception of their ability to perform their job.

It’s not just busy business executives who are filling waiting rooms. On the home front, men are also finding they want to keep pace with younger-looking wives. For single men, there may be even more pressure to look younger and more attractive. So, to answer your question, it is not at all taboo for men to get plastic surgery. The decision to have plastic surgery is up to each individual. If you’re considering surgery, visit a board certified plastic surgeon to discuss your options and which procedures would be best for you.

Next time, I will review the latest procedures that have become extremely popular for men.

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Reality Shows

Dear Dr. Man, I love those plastic surgery TV shows like Extreme Makeover, Dr. 90210 and the Swan. The results seem miraculous. After seeing the results of the patients on that show, I’m strongly considering getting plastic surgery. Do you think the results are real and can I expect similar results if I get plastic surgery? Signed, Lin in Boca

Dear Lin, As you know, television reality shows that focus on cosmetic surgery have become extremely popular. In fact, these shows have generated major public awareness of plastic and cosmetic surgery. It has been reported that in the year following the debut of ABC’s “Extreme Makeover” the number of plastic surgery procedures in the U.S. increased by nearly 1/3. While we can’t entirely attribute this increase to one television show, it is safe to say that these plastic surgery reality shows have had a significant impact on the rate of people undergoing plastic surgery.

The fact is that people are fascinated by the results they see on these shows. The problem is that many viewers may be too fascinated, to the point where they may make their decision to have plastic surgery based on what they see on the reality shows, rather than actual reality. While these shows can be informative, showing some aspects of what to expect in surgery, many of them tend to underemphasize the fact that these surgeries are actual medical procedures with some risks involved. Often in these shows, patients have multiple drastic surgeries performed, which translate into a prolonged post-operative recovery- these recovery times are often glossed over in the shows.

While these shows can provide some education about different procedures, it is also important to remember that these shows are, for the most part, meant to entertain. Results vary for every individual and you must have realistic expectations and view these shows as entertainment.

These shows might give viewers the impression that these procedures can change their lives and completely transform them. While many procedures can be personally and psychologically beneficial, you must remember that the procedures done on these shows are often unrealistic and extremely aggressive.

For the most part, these shows feature reputable surgeons with years of experience; however, viewers must remember that not all physicians in “real life” are reputable. It is very important to find a board-certified plastic surgeon with whom you feel comfortable and who will provide you with realistic expectations.

Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Gynecomastia

Dear Dr. Man, I have a problem that’s caused me to be self-conscious since I was a teenager. I am a 22-year-old male and I have “man breasts.” Now that I’m out of college, I want to get this fixed so I can build my self-confidence and start dating more. Can you recommend what I need done to fix my problem? Signed, “Mike” in Delray Beach

Dear Mike, The condition you have is rarely talked about, but it's actually quite common, affecting an estimated 40 to 60 percent of men. Gynecomastia is a medical term that comes from the Greek words for "women-like breasts." Though certain drugs and medical problems have been linked with male breast overdevelopment, there is no known cause in the vast majority of cases.

For men like you who feel self-conscious about their appearance, breast-reduction surgery can help. The procedure removes fat and/or glandular tissue from the breasts and, in extreme cases, removes excess skin, resulting in a chest that is flatter, firmer, and better contoured. The best candidates for this surgery have firm, elastic skin that will reshape to the body's new contours. Surgery may be discouraged for obese men, or for overweight men who have not first attempted to correct the problem with exercise or weight loss. In some cases, breast reduction may be performed through less invasive procedures, such as the newer suction lipectomy technique we will discuss in a future column.

The initial consultation with your surgeon is very important. Your surgeon will need a complete medical history and physical exam. First, your surgeon will examine your breasts and check for causes of the gynecomastia. If a medical problem is the suspected cause, you'll be referred to an appropriate specialist. In extreme cases, your plastic surgeon may also recommend a mammogram, or breast x-ray. This will not only rule out the very small possibility of breast cancer, but will reveal the breast's composition. Once your surgeon knows how much fat and glandular tissue is contained within the breasts, he or she can choose a surgical approach to best suit your needs.

Surgery for gynecomastia is most often performed as an outpatient procedure; however, in some cases, or those where other medical conditions present cause for concern, an overnight hospital stay may be recommended. The surgery itself usually takes about an hour and a half to complete, while other procedures may take longer.

Gynecomastia surgery can enhance your appearance and self-confidence. The results of the procedure are significant and permanent. If your expectations are realistic, chances are good that you'll be very satisfied with your new look. Consult with a board-certified plastic surgeon to see if this procedure is right for you. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

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Ask Dr. Man- Brow/Forehead Lift

Dear Dr. Man, I’m fifty-two years old and I’m very unhappy with the way the top of my face looks. My eyebrows are droopy and saggy, and I have lines and creases in my forehead. I want to have plastic surgery to fix it, but I’m not sure what needs to be done. Any advice you can give me is greatly appreciated. Signed, S. in Boca Raton

Dear S., As we age, it’s very common to develop droopy eyebrows, hooding over eyes, forehead creases and frown lines. A forehead lift (a.k.a. "brow lift") is a procedure that restores a more youthful, refreshed look to the area above the eyes. It can help to reduce deep creases, horizontal lines, and furrows in the forehead, while lifting heavy, droopy eyebrows that can create a hooding effect over the eyes and make a person appear angry, sad or tired.

The forehead muscles run vertically down the forehead and attach to the eyebrows and eye sockets. In a forehead lift, the muscles and tissues that cause the furrowing or drooping are repositioned to smooth the forehead, raise the eyebrows and minimize frown lines. Frown lines between the eyes can also be reduced with the use of Botox injections. The results give the face a more alert, rested and youthful appearance.

A forehead lift is generally performed right in the plastic surgeon’s office under general or I.V. sedation. The procedure, which lasts about one to two hours, uses an endoscope, a viewing instrument that allows the procedure to be performed with minimal incisions. During recovery, patients may experience temporary swelling, bruising, or numbness. Patients are usually back to work in several days.

Often patients don't realize how much their sagging forehead contributed to the signs of aging until they see how much younger and more rested they appear after the lift. A forehead lift can produce excellent results by smoothing the forehead skin and giving patients a more animated and youthful appearance. Although a forehead lift does not stop the clock, it can minimize the appearance of aging for years. Consult with a board-certified plastic surgeon to see if this procedure is right for you. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Neck Lift

Dear Dr. Man, I have an embarrassing feature on my body that I really dislike. The skin around my neck is loose and sagging. It’s gotten even worse as I’ve gotten older. PLEASE tell me how to get rid of it. - Anonymous

As we age, the muscles and skin of our neck and lower face begin to sag and lose its definition. Jowls may form as muscles loosen and fat deposits along the jaw line. Fat is also deposited under the chin, causing the neck to become thick and wide. The neck muscles weaken and separate; and bands form, which further weaken the shape and structure of the neck, causing a "turkey gobbler" effect.

It sounds like you might benefit from a procedure called a neck lift. A neck lift helps to remove excess loose skin and fat under the neck by tightening muscles and re-draping skin. This procedure can produce excellent results by improving the neck, jaw line, and cord-like structures in the front of the neck; it is also used to help correct a double chin.

A neck lift is performed under local I.V. or general anesthesia and usually takes two to three hours. While recovering, you may experience some numbness, swelling, or bruising. Recovery takes time and it's important that you're patient with the process. Most people can return to work in about a week.

Neck lifts are often performed in conjunction with a facelift, although they can be performed alone. In addition, endoscopic techniques are often used to remove excess fat and tighten muscles of the neck. In some cases, suction techniques may be all that is required to remove excess fat from the neck.

There are many factors that can contribute to loose and sagging skin in the neck, including aging, genetics, or a major weight loss. Whatever the reason, people young and old undergo neck lift procedures all the time; and they enjoy long-term, natural-looking improvements. I recommend that you visit a board-certified plastic surgeon for a consultation to decide which procedure is right for you. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Breast Reduction

Dear Dr. Man, I’m a twenty year old college student. Ever since I was a teenager, my breasts have always been of concern to me. They’re extremely large and I have a very small body frame. I suffer from back and shoulder pain as a result. My clothes also fit awkwardly since I’m so top-heavy. I’m seriously considering a breast reduction. Can you please tell me more about this surgery? Signed, Mandy in Boca Raton

Dear Mandy, Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight, including back, neck, and shoulder pain. In addition, there may be other physical discomforts, such as bra straps leaving indentations in their shoulders. Large breasts can also make women, especially teenage girls, feel embarrassed or self-conscious.

Breast reduction, also known as reduction mammoplasty, reduces disproportionate, oversized breasts by removing fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal of the surgery is to give the woman smaller, better-shaped breasts in proportion with the rest of her body. In most cases, breast reduction isn't performed until a woman's breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort.

Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. Luckily, modern surgical methods leave patients with incision lines that are only around the areola and up and down, eliminating the horizontal incision at the bottom of the breasts. These scars should fade with time and are usually covered by a bra or bathing suit. After surgery, you'll be wrapped in an elastic bandage or a surgical bra over gauze dressings. The bandages will be removed a day or two after surgery, though you'll continue wearing the surgical bra around the clock for several weeks, until the swelling and bruising subside. Although you may be up and about in a day or two, your breasts may still be tender occasionally for a couple of weeks. Most women can return to non-strenuous work and social activities in about two weeks.

The best candidates for this surgery are women who are mature enough to fully understand the procedure and have realistic expectations about the results. Every patient and every physician has a different view of what is a desirable size and shape for breasts. In your initial consultation, it's important to discuss your expectations frankly with your plastic surgeon, and to listen to his or her opinion. Breast reduction surgery helps get rid of the physical discomfort of large breasts, the body looks better proportioned, and clothes fit better. Chances are that, like most women, you'll be pleased with the results. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Arm Surgery

Dear Dr. Man, I recently lost quite a bit of weight and I consider myself an attractive and in-shape woman; however, I still have flabby upper arms. I go to the gym, but this part of my body does not seem to cooperate. Can you recommend any procedures that can help? Signed, Eleanor in Boca Raton

Dear Eleanor, As we get older, our upper arm skin can become loose and flabby. As you have observed first-hand, it is also very common to have excess skin in this area following a dramatic weight loss. In fact, loose upper arm skin is most often related to weight loss. When people are overweight, they tend to develop heavy upper arms. To accommodate the increased volume of the upper arms, the skin stretches. After weight loss, skin often fails to tighten; and therefore, it sags. The way to improve this problem is through an arm lift, also called brachioplasty. An arm lift is a surgical procedure to remove loose skin and excess fat deposits in the upper arm. An arm lift can help tighten this skin, which can do wonders for self-esteem.

Prior to surgery, the plastic surgeon marks the areas of excess skin to be removed. Once the skin is removed, the wound is stitched together and occasionally a drain is used. The operation is most commonly done as an outpatient, which means you can be home within a few hours. After surgery, bandages are applied. This can be anything from an extensive absorbent bandage with elastic support to a simple dressing with paper tapes (steri-strips). Patients are usually back to work within a week. Exercise can usually be resumed within about 2 weeks.

One of the drawbacks of this surgery is the scarring. Scars will extend from the armpit to the elbow, along the inside of the arm. In general, those with very loose saggy skin are happy to exchange the loose skin for the scars; however, those with a small amount of looseness will probably not want the scars. Some of these people with a small amount of loose skin can benefit from skin tightening effects delivered by radio waves, in treatments such as Thermage or Titan. These methods can be effective by themselves or combined with minimal suction.

In some cases, a plastic surgeon may suggest that liposuction be used in conjunction with an arm lift to remove excess fat in the upper arms. Your plastic surgeon can help evaluate your needs and discuss treatment options. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Ear Surgery

Dear Dr. Man, My son is six years old and his ears stick out. The kids in school make fun of him and he is asking to get his ears fixed. Can you tell me what types of procedures can be done to correct this problem? Is he too young to have surgery? Signed, Lindsay in Boca Raton

Dear Lindsay, Ear surgery, otherwise known as otoplasty, is usually done to set prominent ears back closer to the head or to reduce the size of large ears. For school age children, large, protruding ears can be an embarrassment and the source of much teasing and ridicule from classmates. Luckily, there are procedures available to help. Most operations are performed on children between the ages of 4 and 14, since ears are almost fully grown by age 4. It is also not uncommon for adults to have this surgery. Because of the emotional aspect of having large, protruding ears, it is usually better to have the surgery earlier than later. However, there are generally no additional risks associated with ear surgery on older patients.

Otoplasty is usually performed with local sedation in your plastic surgeon’s office. The procedure, which takes roughly 2-3 hours, requires the surgeon to remove skin and cartilage from the back of the ear. Sutures are placed behind the ear and over the repaired cartilage. Even when only one ear appears to protrude, surgery is usually performed on both ears for a better balance.

Immediately after surgery, the patient's head will be wrapped in a bulky bandage to promote the best molding and healing. Within a few days, the bulky bandages will be replaced by a lighter head dressing similar to a headband. Stitches are either removed or will dissolve in about a week. Scars are well hidden. Patients are usually back to school or work in a week.

Most surgeons recommend that parents stay alert to their child's feelings about protruding ears; don't insist on the surgery until your child wants the change. Children who feel uncomfortable about their ears and want the surgery are generally more cooperative during the process and happier with the outcome.

In the initial meeting, your plastic surgeon will evaluate your child's condition and recommend the most effective technique. He or she will also give you specific instructions on how to prepare for surgery. Most patients, young and old alike, are very pleased with the results of ear surgery. If you've discussed the procedure and your expectations with your surgeon before the operation, chances are you will be quite pleased with the results. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Tummy Tuck

Dear Dr. Man, I have three beautiful children, all of whom were delivered via C-section. I’m a thin person, but I can’t get rid of my belly no matter how much I exercise. I’m seriously considering a tummy tuck. Can you please explain what this entails and what I can expect?

Thanks, Proud Mom in Boca Raton

Dear Proud Mom: A tummy tuck, also known as abdominoplasty, is a surgical procedure used to remove excess skin and fat from the tummy, to flatten the tummy area, and to tighten abdominal muscles. The best candidates for abdominoplasty are people who are in relatively good shape but are bothered by a large fat deposit or loose abdominal skin that won't respond to diet or exercise.

People who elect this procedure most often are women who, after childbearing, have stretched their abdominal muscles and skin beyond the point where they can return to normal. Tummy tucks are also common for men who wish to tighten muscles and remove fat from the middle and lower abdomen. Older patients who often experience weight gain as they age, especially around the abdomen, can also benefit from this procedure. For all patients, men and women alike, a tummy tuck can dramatically reduce a large or protruding abdomen.

If you’re considering a tummy tuck, it is important to know that this procedure requires surgery. It produces a scar, which is hidden in the bikini line. The procedure normally takes about 2-4 hours and is performed under general anesthesia. During surgery, the surgeon makes a long incision from hip to hip, in order to create a skin flap and to reveal the abdominal muscles. The muscles are then tightened, the excess fat is removed, and the belly button is repositioned. Finally, the incisions are stitched, dressings are applied, and a temporary tube may be inserted to drain excess fluid from the surgery site. The result is a firmer tummy and a narrower waistline.

After surgery, the abdomen will be swollen and patients usually experience some discomfort. After surgery, patients wear a light support garment for a few weeks. People are generally back to work within 1-2 weeks of surgery; however, it is recommended that strenuous activity be avoided for about 3-4 weeks.

Abdominoplasty can produce excellent results for patients with weakened abdominal muscles or excess skin. In most cases, the results are long lasting, as long as the patient follows a balanced diet and exercises regularly. If you're realistic in your expectations and prepared for a lengthier recovery period, abdominoplasty may be just the answer for you.

For some patients, other treatments, such as a partial abdominoplasty or liposuction may provide an alternative option, eliminating the need for major surgery. A consultation with a board-certified plastic surgeon can help you decide what procedure is best for you. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Lip Surgery

Dear Dr. Man, I find that as I get older (I’m 45 years old), my lips are looking thinner and I just don’t like the appearance of my mouth as a result. My friends have gotten collagen injections- are there any other treatments available? Signed, Kay in Delray Beach

Dear Kay: Full lips have always been sought after, regardless of age. A plump pout is considered to be a sign of youth and an icon of sensuality. However, as we age, the lips can lose their plumpness and fullness. The upper lip, in particular, can appear thin; and the distance from the tip of the nose to the upper lip lengthens as the lips drop "down,” which can cause a frown-like appearance around the mouth. A lip lift or lip augmentation can increase the volume and fullness of the lips and give a more attractive contour and natural pout.

Lip augmentation can be useful for people who have small, deflated lips, asymmetry, reconstructive needs, dropping or sagging upper lip, lack of color, wrinkling from smoking or aging and other complaints.

Lip augmentation uses synthetic or biological products or surgical restructuring to enhance the lips using several different treatment options. A common procedure that we hear a lot about these days is the use of filler materials to give the soft lip tissue more fullness and support. These materials can be injected or implanted into the skin and can include collagen or fat, or new fillers, such as Restylane and Cosmoplast. Some people go a step further and have a surgical lip lift, which shortens the area between the nose and upper lift, in order to reduce a frown-like appearance.

These procedures are performed in the doctor's office under local or I.V. sedation. After treatment, people usually experience some swelling and bruising. In the case of incisions, sutures are removed after several days. As with all surgery, there are some risks, which you should discuss with your surgeon.

Talk to your plastic surgeon to decide which treatment is right for you. You must realize that no one can perform miracles; however, a highly skilled surgeon can transform what you do have into a more balanced look altogether. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Chin Implants

Dear Dr. Man, I just turned 30 years old; and I consider myself a good-looking person. However, I’ve always hated my chin and, as a result, I hate my profile. I saw a chin implant surgery on television and the results looked amazing. Can you please tell me more about this surgery? Thank you, Paige in Boca Raton

Dear Paige, Chin implant surgery is a common procedure used to bring balance to the facial structure by correcting a weak chin. The chin defines our profile; therefore, chin implant surgery helps to improve the shape, contour, and balance of the face using special implants designed just for the chin. A weak chin can make a normal nose appear larger and an already prominent nose seem even larger; a weak chin may also give the appearance of a fleshy neck. Therefore, chin implants are often done in combination with nose surgery or a facelift.

Your surgeon will select the proper size and shape implant to enhance your appearance. During surgery, the implant is inserted through a small incision underneath the chin. Several stitches are used to close the suture site. Usually the chin is taped after surgery to minimize swelling and discomfort. Sutures in the skin will be removed in five to seven days. If an intra-oral incision (in the mouth) is used, the sutures will dissolve.

After surgery, patients may feel temporary discomfort, with some swelling, bruising, stiffness, or numbness in the affected area. It's normal to experience some temporary difficulty with smiling and talking. Black and blue marks may be visible around the chin and neck. Your plastic surgeon will instruct you about dental hygiene, eating and any restrictions to your activities after surgery.

The results you see on television may often be more dramatic than what you see in real life and no doctor can perform miracles; however, a highly skilled surgeon can transform what you do have into a more balanced look altogether. Chin implant surgery can do wonders to improve the facial structure; and many patients love their new look after surgery.

I recommend that you consult with your plastic surgeon to see if getting a chin implant is the correct decision for you. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Eyelid Surgery

Dear Dr. Man, I’m 55 years young and I have droopy eyelids. My co-worker who is my age just got eyelid surgery and she looks like a million bucks. I’m seriously considering the surgery. Can you please tell me a little more about it? Signed, Shoshana

Dear Shoshana, Eyelid surgery, otherwise known as blepharoplasty, is a popular surgery to help reduce the tired, sad look associated with sagging, droopy eyelids. It also helps reduce puffy look and bags under the eye by removing excess fat.

Droopy eyelids, dark circles and puffy bags under the eyes can give you a tired, puffy appearance, even though you may feel rested and full of energy. Eyelid surgery is a procedure to remove fat - usually along with excess skin and muscle - from the upper and lower eyelids. The surgery can also correct drooping upper lids, which cause a hooding effect and may even interfere with your vision (this condition is known as ptosis of the eyelid). This surgery is also popular among people of ethnic heritage, especially Asians, who are often characterized by an absence of a crease or a fold in the upper eyelid. Eyelid surgery can add this crease to give a more “Western” look, but it does not erase evidence of ethnic or racial heritage.

It is important to understand that eyelid surgery is not a treatment for everything. It will not correct crow's feet or other wrinkles, or lift sagging eyebrows. There are other procedures that are used to treat these conditions. An eye lift can be performed by itself, or combined with other popular cosmetic procedures such as a brow or forehead lift, facelift, cosmetic laser surgery, skin resurfacing, etc. We’ll talk about these other procedures in upcoming columns.

Eyelid surgery is performed in the doctor's operating facility and takes about 1-2 hours. The incisions are well hidden in the natural creases of the upper eyelids and inside the lower lid. Often lasers will be used to make the incisions, so that the excess fatty tissue and skin can be removed. Using the laser, or a peel, your surgeon can also resurface areas of skin under the eyes that may need treatment, such as dark circles or "crepe-paper" skin.

After surgery, patients usually experience some swelling, bruising, and tightness of eyelids. There may also be some numbness, itching and dryness. Temporary light sensitivity may occur. Patients usually can return to work in approximately 3-5 days, and can begin wearing eye makeup in about 5-7 days.

I recommend that you consult with your plastic surgeon to see if eyelid surgery is right for you. Good luck!

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Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.

Ask Dr. Man- Portrait Plasma Skin Regeneration System & Thermage

Sun damage causes the skin to lose its elasticity, and lines and wrinkles appear. After a while, the skin’s texture begins to appear rough, with brown spots and red irregular pigmentations. There are many non-surgical treatments available to help reduce wrinkles and sun damage on the face. Today, I’d like to focus on two new technological advances, namely, Portrait and Thermage.

Portrait (Portrait Plasma Skin Regeneration System) is a new technology proven to deliver true skin regeneration. It reduces and softens the deep lines in the face. Results are immediate and long-lasting, with clinical studies showing improvements for as long as a year after treatment. Portrait is FDA-cleared, and is an effective treatment for wrinkles (deep and fine), brown spots, and pigmentations. It also helps improve skin tone and elasticity, in addition to tightening lax and sagging skin. It is approved to treat the face, neck, décolleté, arms, and hands.

Portrait is the first system to employ a highly energized gaseous state known as “plasma” to produce unique controlled thermal energy at and below the skin’s surface. While some treatments lead to improved skin only at the surface, Portrait alters structures below the surface, creating unique conditions for continuing regeneration and improvements in wrinkles, tone, texture and discoloration. It creates a natural response to new skin cell regeneration and collagen growth, similar to a newborn baby’s skin.

Patients are given topical anesthetic cream one hour prior to the treatment; and the treatment itself is usually completed within about 30 minutes. The benefits of using Portrait can be seen soon after treatment, and patients tend to see progressive improvements over time. Portrait is a safe, non-surgical way to rejuvenate the skin. It involves minimal downtime, and little or no risk of side effects or complications associated with other more aggressive anti-aging treatments.

The Thermage procedure is another non-invasive treatment that has been clinically proven to tighten and gently lift skin to smooth out wrinkles and renew facial contours. The incision-free procedure is fast and easy, and requires no downtime from normal activities. Unlike lasers, the procedure can be performed on patients of all skin types. The device has been cleared by the FDA for the non-invasive treatment of wrinkles.

With each touch to the skin, the device uniformly heats a volume of collagen in the deeper layers of the skin and its underlying tissue, while simultaneously helping to protect the outer layer of the skin with cooling. This deep uniform heating action causes deep structures in your skin to tighten. Over time, new and remodeled collagen is produced to further tighten skin.

The Thermage procedure can take anywhere from twenty minutes to two hours, depending on the size of the treatment area. The Thermage procedure may cause immediate tightening of the collagen structure, with additional tightening over time.

Once again, the method used should depend upon the patient’s desires, as well as the depth of wrinkles and sun damage. Sit down with your doctor and discuss all of your options, in order to decide which treatment is right for you. Good luck!

Email Questions and Comments

Dr. Daniel Man is a board-certified plastic surgeon who has dedicated his life’s work to helping people look younger and improve their appearance through cosmetic surgery. He is a noted author, artist, inventor and educator. Dr. Man has been featured on major television networks, as well as national and local magazines and newspapers for his work as both a plastic surgeon and an artist. He has a successful private practice in Boca Raton, FL. For more information about Dr. Man, visit www.drman.com.