Plastic and Cosmetic Surgery
New York Plastic Surgeon
Charles K. Loving, Jr., M.D.
Breast Augmentation
The form of the female breast is charged with both significance and sentiment. Of all womanly features, it is perhaps the most representative of feminine beauty and nurturing. Many women feel that the breasts given them by Nature do not fully realize the iconic and aesthetic possibilities of female breasts, and for this reason they seek augmentation. Others may wish to enhance their form so as to emphasize the feminine and/or alluring aspects of their personalities. Still other women may seek breast augmentation as a way of replacing volume lost after pregnancies or of making breasts that are naturally of significantly different sizes a more evenly-matched pair.
Breast Implants are silicone gel implants which are sealed in soft cases of FDA-approved silicone elastomer. The implants come in different sizes, and the decision about which size to use will be made following a consultation with Dr. Loving. Implants also come in different shapes. The most common shapes are round and anatomical. Round implants give the upper breast more overall roundness. Anatomical implants are tear-drop-shaped and give the breasts a full, gently sloping appearance. The implants are placed either directly under the breast tissue or else under the pectoralis muscle. Placement of the implants is important in determining the cleavage between the breasts and the outside curve of breasts. It is important for a patient to fully discuss her wishes concerning breast size and shape with Dr. Loving. She should also carefully consider the doctor's recommendations based on his extensive experience with breast augmentation. The decisions about size, shape and placement of the implants and about which features of the breasts to emphasize will be made with the doctor after a careful evaluation of the patient's other bodily dimensions, such as height, waist and hip size and breast tissue.
Surgery
Women seeking breast augmentation must be in good overall health, as verified by their general practitioner. Breast augmentation is usually performed in the operating facility at Dr. Loving's office under general anesthesia, though local anesthesia may be an option. The procedure takes one to two hours. Incision sites are variable, depending on the patient's anatomy and wishes. They will be decided upon during the consultation with Dr. Loving and will be chosen according to where they will be least visible. Options include in the breast fold under the breast, around the nipple or under the arm. After making an incision, the doctor creates a pocket for the implant, which he then places and fills. The incision is closed with stitches and sometimes surgical tape, both of which are removed after a few days.
Care of the augmented breasts following surgery is usually simple, involving the use of a postoperative or sports bra and protection of the breasts from pressure. The breasts will be sore for several days after the operation, though the pain is usually not severe, and pain medication may be used to control it. Most patients are able to return to work after a few days, though strenuous exercise should be avoided for a few weeks.
Special considerations
Many women are concerned about the effects of breast augmentation on nipple sensitivity, breast feeding and breast cancer. The FDA has published a summary of potential complications called Information for Women Considering Saline-Filled Breast Implants. This summary is available at Dr. Loving's office or by calling 1-800-624-4261. According to this report, changes in breast and nipple sensitivity can increase or decrease after breast augmentation, though breast-feeding is usually not impaired. The summary also states that at this time, following several scientific studies, there is no evidence that women with saline-filled implants are more susceptible to cancer than other women. To help women interested in breast augmentation to decide on size, shape and placement of implants, before and after pictures of augmentations performed by Dr. Loving are available for viewing in his office.
To request more information or to schedule a consultation with Dr. Loving, please call 212-472-0900.
Breast Reduction
In many cultures the ideal female figure has very large breasts, which are often viewed as representations of fertility and caregiving. In day-to-day life, however, many women with large breasts feel encumbered and uncomfortable, rather than idealized. Their very large and usually heavy breasts cause them medical and social difficulties that can complicate normal activities and pursuits. The burdensome weight of the breasts can cause back and neck pain, skeletal deformities and skin irritations caused by chafing and strained bra straps. The most repetitive and basic activities, such as sleeping, exercising and even breathing, can become laborious and even painful as a result of oversized breasts.
Women and teenage girls, may feel that their unusually large breasts overwhelm not just their bodies, but also their personalities. Most women do not want their breasts to be their most obvious feature, and some find that the prominence of their breasts hinders them professionally and stereotypes them socially. Very large breasts inevitably sexualize a woman's self-presentation in ways that are often detrimental to them psychologically and in terms of their careers.
Breast reduction is the surgical procedure performed by Dr. Loving in order to relieve the aforementioned problems and complications of very large breasts. The medical term for this surgery is reduction mammaplasty, wherein Dr. Loving reshapes and dramatically lightens the breasts by removing some of their excess fat, glandular tissue and skin. After the surgery, the breasts are smaller, less weighty and firmer. The areola, which is the darker skin surrounding the nipple, can also be made smaller during the surgery.
Dr. Loving is very experienced in the area of breast surgery, and he understands that breast reduction involves serious aesthetic and emotional considerations by a woman. Breast reduction surgery involves many choices in terms of the amount of the reduction, positioning of the nipples and the final size and shape of the breasts and areolas. Liposuction may also be done under the armpits in order to make the entire torso area proprotional. In some cases, liposuction alone can be used to reduce the size of the breasts. Given these many options, Dr. Loving requires a careful and thorough consultation with a breast reduction patient, so that he can devise for her an individual surgical plan best suited to her needs and desires. Dr. Loving's goal in terms of breast reduction is to give his patient smaller, lighter breasts of the size and shape that are most appropriate for her body and her lifestyle.
Special considerations
Breast reduction is usually performed on women whose breasts are fully developed. In some cases, however, the procedure is done on younger women if the breasts are already so large as to cause serious discomfort. Nipple sensitivity may be decreased or increased as a result of the surgery. Often, this is only temporary, but in some cases, the decrease is permanent. Breast reduction is not recommended for women who intend to breast-feed, though it does not always make breast-feeding impossible. For younger women seeking breast reduction, breast-feeding is an important issue to discuss with Dr. Loving during the consultation.
Surgery
As with all elective surgery, good health is a prerequisite for breast reduction and must be verified by a woman's general practitioner. Dr. Loving may require a pre-surgery mammogram. Breast reduction is usually performed in a hospital under general anesthesia as an inpatient procedure. The surgery itself takes two to four hours. Incision sites vary from patient to patient, and will be fully described prior to the operation. Dr. Loving makes the scars from breast reduction as inconspicuous as possible. They usually fade over time to thin white lines, and they will be hidden by any bikini top.
After surgery, Dr. Loving will wrap the patient's breasts in an elastic bandage or will support them with a surgical bra over gauze dressings. During the first few days after the procedure, the breasts will be very tender. Dr. Loving will prescribe medication to control any pain. The bandages will be removed after a day or two, and the stitches after about a week. The surgical bra, which is much like a sports bra, must be worn day and night for a few weeks so as to support and protect the new size and contours of the breasts. While it may take a few months for the breasts to fully assume their new shape, most women are almost immediately pleased by the relief of so much breast weight and the sense that their bodies are better proportioned and that they look better in clothes. In Dr. Loving's experience, breast reduction-of all other plastic surgery procedures-offers the fastest and most positive results in terms of body image. Before and after pictures of breast reductions performed by Dr. Loving are available for viewing in his office.
To request more information or to schedule a consultation with Dr. Loving, please call 212-472-0900.
Breast Lift
For the woman seeking cosmetic rejuvenation, a breast lift is an option that offers significant benefits. Many women are distressed by the inevitable sagging of breasts that occurs with time and experience. A breast lift, or mastopexy, makes the patient's breasts appear fuller and younger, but uses only her own tissues to achieve this effect. The goal of a breast lift is to raise and reshape the breasts so as to approximate the shape and firmness they had before the impacts of pregnancy, nursing, strenuous exercise and gravity affected their contours.
Breast lifts frequently incorporate a procedure that reduces the size of the areola, the circle of darker skin that surrounds the nipple. The areola often expands with age, and many women want it returned to its former dimensions along with the rest of the breast.
Special Cases
While the potential for mastopexy to reshape the breasts using only existing tissue appeals to many women, others may wish to replace volume they have lost over time or have always wanted. These women may choose to have breast augmentation in conjunction with mastopexy. In these cases, implants are inserted while the breast lift is being performed.
Patients with small breasts or minimal sagging may be able to achieve their desired results with a less extensive procedure than is generally performed. This procedure is called a concentric mastopexy. Concentric mastopexy requires only circular incisions around the areola, where a ring of skin is removed. Concentric mastopexy leaves only minimal scars.
Surgery
A breast lift requires a careful consultation with Dr. Loving, so that the patient can thoroughly explain her medical history and cosmetic desires, while the doctor details the options, possibilities and limitations of the procedure. Dr. Loving understands that the image of the ideal breast varies widely from person to person, and that the patient must therefore clearly express her aesthetic goals.
Mastopexy does not interfere with breast-feeding, and can therefore be performed on women who may have future pregnancies. The procedure leaves the milk ducts and nipples intact. Generally, however, women are advised to wait to have their breasts lifted after having had their last child since the results of the procedure are likely to be significantly undone by the expanding and stretching effects of subsequent pregnancies.
Breast lifts are usually performed in the operating facility at Dr. Loving's office under general anesthesia, though some concentric mastopexies are performed under “twilight” anesthesia. Mastopexy usually takes one and a half to two and a half hours. Incisions are generally made in the shape of a tulip around the areola. Excess skin is removed, the areola and nipple are lifted, and the skin is closed around them, thereby reshaping and firming the breast. After the surgery, the breasts are protected with a bandage or surgical bra. Pain following the operation is usually mild, and can be controlled with the pain medications prescribed by Dr. Loving. As with all surgery, a companion is required to take the patient home after the operation and to be available for assistance overnight. The breasts will be bruised and tender for ten days to two weeks, but most patients feel they can return to public life after a week, being careful to protect the newly-formed breasts from pressure. Stitches are removed after about a week, but a support bra must be worn day and night for about three weeks. The incision marks left by mastopexy are very low on the breasts and are hidden by any bikini top. Before and after pictures of mastopexies performed by Dr. Loving can be viewed in the photographic archives in his office.
To request more information or to schedule a consultation with Dr. Loving, please call 212-472-0900.
Liposuction
Of all cosmetic surgery procedures, liposuction offers the most options to the patient seeking to improve and/or rejuvenate his or her appearance. Liposuction is applicable to many areas of the body, from the face to the ankles. The procedure uses a very small tube to suction excess fat from diet- and exercise-resistant sites on the body. Facial and/or bodily contours are thereby refined, and the result is a fit, youthful and pleasing silhouette. Liposuction can be performed on a very small area, such as a double chin, or on larger features, such as the buttocks or waist. It is appropriate for both men and women and for young as well as mature adults. Results are almost always permanent. The vast majority of patients tolerate liposuction easily and are very pleased with the new, slimmer contours that emerge after the body's adaptation to its new shape are complete. Liposuction's flexibility as a procedure, along with the high levels of aesthetic and emotional gratification that it offers patients, has made it one of the most frequently-performed cosmetic surgeries.
Special Cases
Men In the past few years, liposuction has become popular among men of all ages. For younger men, it offers the possibility of removing the bulges of fat around the waist (“love handles”) that even the most rigorous diet and exercise routines can fail to eliminate. Liposuctioning the abdomen and lower torso can further slim the waist and makes the abdominal muscles appear firmer and more defined.
Gynecomastia, or male breast enlargement, is a fairly common condition in both teenage and adult males. Liposuction is an effective treatment for this condition, as it significantly reduces the enlargement. In addition, Dr. Loving can employ liposuction to a greater or lesser degree in any area if the left and right sides of the chest are asymmetrical.
Many mature men have found liposuction to be a subtle but effective way to rejuvenate their appearance. Youth and vitality can be significantly obscured by the layers of fat that are, for many people, an inevitable result of aging. In men, the fat tends to concentrate under the chin, cheekbones and jaw and around the waist. The fat is often not so much an indication of weight gain as of the redistribution of weight that comes with age and the concurrent shifting of the skin's layers. Imbalances between the left and right sides can become more prominent. The result is often a kind of blurring of facial features and bodily contours that can make patients feel as though they no longer recognize themselves. Through liposuction, Dr. Loving can significantly lessen these effects. Removing a double chin and jowls, for instance, can bring facial features back into focus. The procedure is much less invasive than a facelift but offers many of the same rejuvenating results. Liposuction of the waist not only allows many men to return to the pant and belt sizes of their youth, but can also instigate improvements in their posture, which often worsens with the physical and emotional effects of age-related fat distribution.
Liposuction and Rejuvenation As mentioned in the section above, liposuction is often the best option for men and women who wish to give their features a more youthful aspect. Dr. Loving can fine-tune the procedure according to the individual needs and wants of each patient. He can also liposuction several different areas during the same operation so as to achieve an overall effect of rejuvenation.
Many women are at ease with the surface indications of maturity, such as lines of expression, but are unhappy with the distortions of lineaments and contours that frequently come with age. The majority of women who seek cosmetic rejuvenation are particularly bothered by age-related changes in one or two very specific areas, such as their upper arms, neck or chin. They would like to regain the youthful shapes of those one or two features without making radical changes in their faces and bodies. For them, age-appropriateness is as important as beauty, and liposuction is one of the best ways for them to achieve both goals.
Those women who do wish to address the surfacial signs of aging, may wish to do so via injectables like collagen and/or chemical peels rather than through a facelift. For these women, therefore, liposuction is still the best way to achieve rejuvenating changes in form.
Liposuction and Proportion Liposuction has become the surgical means of choice for adjusting the proportions of areas of the body. Many people, especially women, turn to liposuction in order to achieve an aesthetic sense of balance between their hips and their breasts or their thighs and their waists or their calves and their ankles-or between other areas. Aesthetic ideals and goals vary a great deal between people according to their cultural and individual standards. It is therefore important for each patient to openly and accurately describe his or her desires to Dr. Loving, so that the optimal procedural plan can be designed for each patient.
Surgery
As with all cosmetic surgery, liposuction requires a consultation with the doctor that includes a discussion of the patient's medical history, medications and any medical conditions. The patient's past experiences with weight gain and loss and whether he or she plans to lose or gain weight in the future will also be reviewed. The elasticity of the patient's skin will be evaluated, as will the amount of fat to be removed so as to achieve the best results.
The patient then has professional photographs taken of the areas that will be addressed by the procedure. These photographs further enable the doctor and patient to discuss and plan the procedure.
Liposuction is performed in the doctor's operating facility, and is usually done under a combination of local and “twilight” anesthesia. During the operation, a small, hollow tube is inserted in or near the area being targeted by the procedure. The tube is attached to a vacuum pressure unit, which suctions away the unwanted fat. After the procedure is complete, the tube is removed, and the area is bandaged and covered with a special compression garment that gives the skin support and encourages the new form to develop. Usually, no stitches are required in the sites where the tube was inserted. They close up by themselves, leaving minimal marks that become almost invisible over time. The suctioned areas are bruised and tender for about a week to ten days, depending on how much fat was removed and on the patient's healing tendencies. Pain is usually moderate, and can be controlled by the pain medication prescribed by Dr Loving.
Patients can usually return to work in just a few days, though those who have facial liposuction may want to wait for a week or so, at which time makeup can be used to conceal most remaining signs of bruising. While most patients can perceive a difference in the areas that were liposuctioned after a week or so, the aesthetic benefits of the procedure will become more and more obvious over time as the skin contracts over its new shape and fully reveals its new contours.
To request more information or to schedule a consultation with Dr. Loving, please call 212-472-0900.
Tummy Tuck (Abdominoplasty)
Abdominoplasty, which is more familiarly known as a tummy-tuck, is a surgical procedure that addresses the weakened abdominal muscles and excess skin in the abdominal and pelvic area that can result from large weight loss, multiple pregnancies and aging. In some cases, the skin sags to such an extent that it forms a kind of “apron” over the pelvic area, which can become physically inconvenient and uncomfortable, as well as aesthetically undesirable.
Both men and women are candidates for a tummy-tuck, which removes excess skin and tightens the underlying abdominal muscles. The procedure thereby improves skin elasticity in the area and, for some patients, minimizes the appearance of stretch marks.
Special Cases
A tummy-tuck can be performed on overweight patients. In some instances, the improvements in appearance that result from the procedure strongly encourage patients in their weight-loss efforts. Dieting and exercise can become easier both physically and psychologically once the impediment of excess abdominal fat and skin is removed.
Liposuction is sometimes done in conjunction with a tummy-tuck so as to reduce large fat deposits and achieve the best result. Depending on the patient's needs and wishes, abdominoplasty can be performed only on the area below the navel, or on the entire abdominal area. During the consultation, the patient and Dr. Loving will determine which method is most appropriate and will discuss the incision sites relevant to each procedure.
Surgery
Following the consultation with Dr. Loving, the patient will verify that he or she is in good overall health and will inform the doctor of any medical conditions and all medications that he or she is taking. A modified abdominoplasty is usually performed in Dr. Loving's operating facility under “twilight” anesthesia, and he usually performs full abdominoplasties in a hospital under general anesthesia as an inpatient procedure. After the surgery, the patient will wear a light support garment for a month or so, which helps the abdomen assume its new shape. Stitches are removed in a week. Dr. Loving will prescribe medication to control any pain following the procedure. Most patients return to work after about a week. Before and after pictures of abdominoplasties performed by Dr. Loving are available for viewing in his office.
To request more information or to schedule a consultation with Dr. Loving, please call 212-472-0900.