Robert Silich MD | New York Plastic Surgery Blog

Q: Is there scarring in Microsuction?

A: Not at all. You can barely see it. We make a small incision underneath the chin that’s the size of a staple. Most people interesting enough, tend to have a little scar under the chin from falling as a child, and we can use that. If somebody is very squeamish about making an incision underneath their chin, we can make 2 small incisions behind the earlobe and the instrument we use (a cannula) will then reach behind the ear to underneath the chin. But usually just under the chin, no one will see it

Q: Is a limited incision face-lift a procedure that’s permanent like a normal face-lift?

A: Yes, it is permanent. This procedure really started to become popular in the last 10 years. We are just starting to see these patients now 10 years after surgery with virtually about the same results that you would get from a full face-lift. Some people argue that a limited incision face-lift will keep you going for a good 7-10 years whereas the more classic face-lift can take you to 15 years but I think that the trade off between the incisions and the length of operative time (longer for the classic face lift), is probably not worth it for the time difference.

Q: Does the hair grow back in a brow lift?
The hair does grow back but based on the concept of the brow lift procedure itself, the hairline usually moves farther posteriorly. Most of the time this is the desired result and is aesthetically pleasing and the basis for the procedure. The ideal candidate therefore for a traditional brow lift procedure is usually someone who has either an average or lower than average hairline.

There are also some modifications to the incisions in brow lift surgery that allow for less than ideal candidates to still undergo brow lift surgery. These are direct hairline incisions; eyebrow border incisions and of course endoscopic brow lift surgery.

Q: Is there a risk of nerve damage with a neck-lift?
Nerve damage with a neck-lift is usually very limited. The most commonly injured nerve is a sensory nerve that supplies the area of the earlobe. This nerve is called the ‘great auricular nerve’, which lies along the border of the sternocleidomastoid muscle which helps turn the head from side to side. This is a nerve that is very rarely cut or injured but it does get bruised and can cause some temporary numbness along the earlobe. This can last for a few days or even up to a couple of months. The feeling almost always returns and most people don’t even notice it.

Q: After a face-lift, will someone be able to have a natural-looking smile?
Yes, of course. In fact ultimately, the smile should not change at all. Something that can change the smile would be swelling or bruising around certain nerves of the face. Having said that, the smile can look uneven for the first or even several weeks after surgery, if not longer. The nerves that affect the smile very rarely get injured directly but are so sensitive that even a small amount of indirect swelling or inflammation around the nerves can cause a weakness after surgery

After face-lift surgery, very often people will have a little bit of an uneven smile. They may not even notice it, but the surgeon usually would be able to evaluate this. The inflammation and swelling ultimately subsides and the smile returns to baseline.This period is the time for patience and reassurance from your surgeon and a conservative approach.

Dr. Robert Silich was invited to appear on the Neil Cavuto Show on the Fox Cable News Network channel yesterday to speak about an Argentinean doctor who was recently released from prison for perpetrating a plastic surgery scam on some of Hollywood's elite.

Priscilla Presley and other celebrities had gone to Dr. Daniel Serrano around 2003 and began receiving what he claimed were miracle injections that worked better than Botox. In fact, Serrano was injecting industrial, low-grade silicone similar to what's used to lubricate auto parts in Argentina into her face.

The injections by Serrano (who was not a licensed physician in the U.S.) allegedly caused several complications including facial paralysis and infections in some of the patients he injected.

Dr. Silich had this to say: “Unfortunately it is an all too common scenario. People to do more research looking at a home or buying a computer than they would for looking into a doctor. I wish I could say that this is an exception to the rule, but it's really not, it happens all too frequently and unfortunately it happens with the kind of people that you think it would never happen with."

Q: What material is used to enhance the shape and size of a woman’s breasts during augmentation mammoplasty?
A: Augmentation mammoplasty basically is increasing the size of the breasts by using breast implant devices. It can correct not only small breasts but it can also correct a certain degree of ptosis which is breast sagging. There are 3 levels of ptosis: first, second and third degree. A breast implant alone usually is able to correct very mild first to second degree ptosis without having to do a formal breast lift which has more scarring. The two materials that are used in breast augmentation are saline (salt water) and silicone gel implants. In 1993 silicone implants were taken off the market by the FDA and have actually been further studied since then and now have re-emerged back on the market for general use and augmentation. They have always been used for congenital deformities and for breast cancer reconstruction but they were taken off the market for cosmetic augmentations for a period of about 14 years.

Q: What changes to the diet or lifestyle do you have to make to maintain liposuction appearance after the procedure?
A: The main thing about liposuction is that though you need not be in great shape, you certainly should not be obese before you have liposuction surgery. Liposuction is really a procedure for problems at specific body areas on people who are normally around the right weight but they have certain distributions of fat that are not aesthetically pleasing to them.

The same thing goes for losing too much weight before hand. You shouldn’t go to your plastic surgeon after you have lost a lot of weight and say, “Oh look at these extra love handles I have.”

As far as lifestyle changes go, liposuction usually jumpstarts people into a better exercise and a diet regimen. Diet is very important afterwards. There are some patients who think that they can eat anything now because of the concept of having a finite number of fat cells (once they are gone the fats cells really are gone forever). However if you do overeat, you can develop something called lipodystrophy or lipodystrophic areas. This refers to a condition whereby someone will then gain weight in other areas disproportion to where they had the liposuction performed.

Having said that, there is a current study out which is fascinating. Plastic surgeons from The Netherlands recently showed that women who have had liposuction done in their abdomen and lower extremities are finding a half cup to one cup size increase in their breasts. Nobody really fully understands why. One theory is that there are circulating fat cells during liposuction that stimulate fat stem cells to then propagate and increase fat stem cells in the breast tissue. But so far no one is really sure what the cause is.

Many people will tend to say, “Oh you know my hips look great, my stomach looks great but now the fat went somewhere else. Now the fat is in my arms or underneath my chin.” Then you find out that they have just been eating a lot more and exercising less, and that that is the true cause of the extra fat appearance.

Q: What are the advantages and disadvantages of a chemical peel?
A: The advantages are that it is a quick outpatient procedure with very minimal discomfort afterwards and very minimal post-operative care. The downside is that the results can be subtle and you probably have to have the procedure performed more than once. You must also be very vigilant about not going in the sun afterwards, so a chemical peel is usually not something that we tend to do a lot of during the summertime. It is usually saved more for the winter months.

A quick answer to that is NO. Everybody is born with a finite number of fat cells. This applies also to liposuction and all other methods of removing fat, particularly in the eye. When you gain weight and you have extra fat, what’s really going on is that the existing fat cells that you are born with are just swelling, they are not multiplying. Once you remove that area, they are not going to grow back. With eyelids in particular, a plastic surgeon has to be very conservative with fat removal because you don’t want a patient to have a very sunken, hallowed eye look.

To come back later and remove a little bit of extra skin down the road is fine. But usually you only need to have fat removed from your eyes, just once. There has actually been a movement lately in eyelid surgery to actually put that fat back into the eyelid particularly in the lower eyelid to fill-in some of those “hallows”.