The Roads to a Yummy-Looking Tummy: A Conversation With Dr. Tommaso Addona

Many FOFs hate their tummies. Can you make it simple for us to understand the options if we want to change the look of our tummies?

OK, I’ll start with the non-surgical option and move up to the most invasive treatments.  I’ll also tell you about the ideal candidates for each procedure.

  • CoolSculpting: This has become a hot new procedure in the last couple of years.  We don’t create any incisions or openings in the skin. Basically, a suction cup device freezes fat and helps us contour small, limited areas of the body.  Love handles are a great indication for this.  Heavy patients aren’t candidates. Non Invasive: Level 0
  • Liposuction & body contouring: This treatment eliminates irritating fat in limited, finite locations, such as the upper belly, love handles and thighs.

It’s not for women who have loose hanging skin anywhere around the belly.  This includes those who had children and lost elasticity in their tummies or those who gained and lost weight and their skin can’t return to its normal form.  The amount of elasticity varies with each of us, but the older we get, the more we lose elasticity.  Invasive: Level 5

  • Mini-tummy tuck, full tummy tuck, and lower body lift: These are your three options if you want to remove loose hanging skin around the belly.
  • You’re a perfect candidate for a mini-tummy tuck, accompanied by liposuction, if you have a limited area of hanging skin, let’s say from the belly button to the pubic region, and some areas of troublesome fat. The procedure takes roughly 1.5 to 2 hours. Invasive: Level 7; this creates a glorified Caesarian section scar.
  • Full tummy tuck: This procedure removes far more skin, repositions the belly button, and tightens the musculature. We work on the six-pack muscles that go straight up and down the belly, from your waist to your rib cage. They may have spread apart and stretched due to childbirth, weight and age, creating a wider mid section and less defined abdomen.

This two-to-three-hour procedure creates a longer horizontal scar on the lower part of the belly than with a mini-tummy tuck.  The scar goes from hip to hip, but is always below the underwear line.  Invasive: Level 8

Please define the belly area for us.

The belly is from below your breasts down to your public area; some women have more fat above the belly button, some below since the way fat is deposited varies from patient to patient.

How do you tell whether a woman needs a full or a mini-tummy tuck?

On exam, we pinch from a patient’s belly button down to her pubic area.  If we can grab the whole amount of skin in one pinch, the patient usually is a good candidate for a full tummy tuck.  But it does vary from woman to woman.

  • Lower body lift (LBL) or body contouring: This is the most involved procedure and encompasses a full tummy tuck from the front and also removes skin from the back to re-contour the upper buttocks.  It is mostly used on patients who have lost a great deal of weight, either through surgery or on their own. Invasive: Level 9.

I’ve heard the term ‘high lateral tension abdominoplasty.’ Is that the same as lower body lift?

There are different names for comparable procedures.  What it’s called depends on where you place the sutures; HLT’s encompass the tummy but also the outer thigh. We smooth out and re-contour that area and place the scar a little higher, but still take into account that more women are wearing lower-riding jeans and underwear than they did 20 years ago.

Many of us have gone away from the name HLT and transitioned to LBL, but the procedure you do varies from patient to patient.

From your perspective, as a young man and a doctor, what do you think is happening to FOF’S in the area of plastic surgery?

The population is acting younger as it’s getting older. You see it in athletes, too.  They’re participating in their sports during their late 30s and early 40s; years ago, they were retired by that time.  Also, people in general are taking better care of themselves and feeling better.  A woman who is in her 40s, 50s and 60s has eaten right, taken good care of herself, exercised, perhaps raised children.  Now she’s come to a point where she’s ready to seek a surgical solution for an area that’s been bothering her and she has the time and resources to take care of it. She’s spent her life taking care of others and now she wants to take care of herself.

I have an 80-year-old patient coming in to have Botox and Scupltra for the first time.  She teaches a sculpting class; she’s dating someone; she’s active in her neighborhood. And she lost some volume in her face and feels she’d like to have Botox and Sculptra.  For the first time in her life, she knows she has options.

Do women also have cosmetic surgery so they can attract more men?

I don’t see that as much in women who are in the 40s, 50s and 60s.  Some women in the 30s, however, say they just ended a relationship and want to do something to help them move forward.

Who will you turn away if she wants surgery?

I don’t do cosmetic procedures on women who smoke, have diabetes, or are cardiac patients. These put you at risk for improper fluid draining, wound healing and other complications.  I wouldn’t recommend an elective procedure without medical clearance.

Is liposuction an answer for losing weight?

No.  First, you should optimize your body mass index if it’s above 30. You’re better off getting it down by exercising and eating right. It also will optimize your outcome when you have surgery.

Do women make mistakes when they choose docs?

Women in general in NY are pretty savvy when it comes to finding physicians and rarely will go with a doctor who isn’t referred or recommended. But if you go to a non-board certified doctor, and there are complications, they can’t manage and help you. Everything might be hunky dory, until there are complications.  It would be equivalent to me performing a neurosurgical procedure.

Many dermatologists work with fillers. Is it better to see a dermatologist or a plastic surgeon for this non-invasive procedure?

Both types of doctors can responsibly inject fillers, but generally, we have greater depth and knowledge of a patient’s anatomy than a dermatologist. If a patient is interested in fillers, but I think she’s best served with a one-time surgical procedure, I will be frank with her. We can offer the whole gamut:  Fillers and surgical procedures.

What would you recommend I say to a woman to convince her to at least have a consultation with you? Let’s say she’s scared of surgery, she doesn’t want to look like Joan Rivers, or she doesn’t have the money.

My aunt is a great example: She’s 55 and at this point she’d like to have some work done, but she has a little fear about surgery. I told her: ‘You don’t commit simply by going in to speak to someone.  It’s just a conversation. If you develop a rapport, that’s great. You’ll get more information, at the very least.’ We also work with plans that help women finance procedures.

Although the taboo of plastic surgery has been removed, I’d never try to convince a patient to have an elective procedure.

Is there a new rule of thumb to follow when you’re considering plastic surgery?

Less is more. Avoid the wind blown approach.

Dr. Tommaso Addona

New York Plastic Surgical Group
999 Franklin Avenue, Suite 400
Garden City, New York 11530

Click here for more locations.

Tel: (516) 504-3014
Fax: (516) 742-4716

Click here to view Dr. Addona’s profile.

The Lowdown On Breast Lifts: A Conversation With Dr. Kaveh Alizadeh

What are the major factors that drive Fab Over Fifty (FOF) women to have cosmetic breast surgery?

One type of woman has been happy with her breasts her whole life. She thinks her breasts fit her body and they look fantastic.  Then she goes through multiple pregnancies or weight gain and loss and she loses the shape she had. A 50-year-old woman will show me an old photo and tell me she wants her breasts to look as good as they used to look.

A second type of woman has always wanted her breasts to look different; Either reduced because she has large breasts she doesn’t like or enhanced because she doesn’t like being flat chested.  But she never had the opportunity to do anything about it. Now her children have gone off college, or she may be divorced and ready to start a new relationship, and she’s ready to pay more attention to herself.

A woman with large breasts also tends to feel the physical effects by the time she’s in her 40s and 50s, which include neck and back strain and skin rash. Like anything over time, your body takes a toll.

You invented a procedure called NaturaBra™. Tell us about it.

The breast lift procedures available to this point made the breasts look good for six months but then the results disappeared. A patient’s skin stretches and the gushy soft stuff inside (tissue) tends to fall.  With nothing to support it, the breast falls right back down.  Breast lifts didn’t last.

When we do a facelift, the foundation is on the bone so it’s tougher and tighter.  There isn’t a tough layer under the breast, so it doesn’t tend to hold itself upright. You need to put something in it that supports it from beneath, but everything proposed was synthetic or made of animal products and other foreign bodies.

NaturaBra™ is a hammock, created by the internal deep layer of the skin, on which the breast tissue sits.  It’s like a sling and it doesn’t sag later on.  This internal support is anchored to the ribs to hold the breast tissue.

How long is that surgery?

It adds a half hour to the lift surgery, so a total of 2.5 hours.

Do other doctors do it?

We train other doctors to do it.

Cost?

It’s approximately $10,000 for everything, including facility, anesthesia and the surgery.

Can NaturaBra™ be combined with a breast reduction or enhancement?

Yes.

What are the factors motivating cosmetic facial surgery?

Changes start to happen around your eyes when you’re in your 30s, around the mouth in your forties, and the neck tends to be an issue when you’re in your 50s.  Years ago, surgery was the only option, so many women waited for issues to accumulate and then they had the big surgery. Now women can take smaller measures when they’re younger, such as lasers and injections.  They can act on the changes in their face as they notice them.

Are we vainer today?

I don’t think so. I view cosmetic surgery (aesthetic medicine) on the same spectrum as reconstructive surgery.  We’re vain whether we have a horrific burn or a cleft lip or you’re a normal fifty-year- old who wants to look the best she can for who she is. If the options we have today were available to your mother, she would have felt the same way. The times we live in dictate how we get to live our lives.  We’re all wired the same genetically. Your mother just didn’t think it was ok to talk about and act on the changes in her face, or that it would be safe to do something.

Today, we know about the importance of dental care and everyone wants to have nice teeth, but no one told your parents about the necessity of caring for their teeth. Your parents didn’t advise you to take care of your skin when you were young, but now you and your kids are religious about using sun block. Education, information and technology give each generation advantages over the previous generation.

What procedures are most popular with FOFs and why?

Breast augmentation is the #1 procedure for all women in the US today, but eyes are the #1 concern for women over 50.  Eye procedures are not seen as invasive or require as much down time as neck surgery or facelifts.

What’s involved in eye surgery?

When a woman had bags under her eyes in the past, we removed the fat from her lower lids, but now we remove excess skin from the top lid and tighten and lift the lower lid. A nice smooth face has a tight and smooth flow from the eyelashes down to the cheeks.  There also should be a smooth transition from the cheeks to lips.

How effective are injections around the eyes versus cosmetic surgery?

Lasers and other non-invasive treatments are trying to effect change. Although they’re good, they’re not as impressive and impactful as surgery. They don’t make a huge difference for long periods of time. Expectations are changing. In the past, you’d have one big treatment later on that you would expect to last seven to 10 years. Now women have little treatments that last a few months. Botox is a good example.  It works great but the effects last only a few months.

After eyes, what do women over 50 care about most when it comes to surgery?

The neck.

Can you do the neck alone?

Most women incorrectly believe that a facelift involves the entire face. Actually, a facelift involves only the lower part of the face and the neck.  Jowls and hanging neck skin bother women most and you can’t fix one without the other. A neck lift and a facelift are intimately interconnected.

Should you do the eyes at the same time?

When it looks really nice on the bottom part of the face, you start thinking what’s going on up there? When one part looks natural and the other doesn’t, we’re wired to see the big difference.

How should we really decide what doctor to use?

There are three important things to consider:

  • The right qualifications and certification. You’d be amazed at how many smart, educated and sophisticated women make mistakes about the surgeon they choose.  They’ll use a surgeon who isn’t certified because he did some Hollywood star or they heard about a surgeon at a party.
  • Multiple consults to gain understanding.  The more you’re in the market, the more you understand it.  As you gain understanding, there’s an intuitive sense whether a procedure makes sense for you. Have a checklist and ask all the doctors the same questions.  Ask all the people the same questions so a pattern will emerge.
  • Feeling connected when you sit down with a doctor. Not as soul mates, but you should feel he or she will be able to take care of you if there’s a problem. If anyone tells you there won’t be pain or problems, you should walk out of the office immediately. A doctor’s staff and nurse must also demonstrate a communal feeling for every patient.

I heard we shouldn’t have voluntary anesthesia after 60 because it causes more brain cells to die. Is that true?

We’re working on the skin and the layers under the skin in plastic surgery, so it’s not life threatening.  We’re not inside the heart or the bowels.

We worried about anesthesia 20 years ago, but we worry about it less now because of current monitoring and techniques.  It’s not as big a scare as people think. Age is not an issue at all with anesthesia. All patients must go to their medical doctors to be cleared. We do workups on every patient; some include stress tests, others do not.

It’s riskier to cross Park Avenue than to have modern anesthesia, especially for someone who is healthy. If, however, a patient has severe heart disease or uncontrolled diabetes, then there’s a higher risk and it would be wise to avoid operating on these patients. If you’re on a blood thinner, for example, it may not make sense to go off the thinner and affect your heart so you can have a facelift.

What kind of surgery do you perform most?

I do breast surgery and eyelid surgery most because my research is in that area, but I have expertise in other areas. Most of my referrals come from friends of other patients and I get recommendations from other doctors, especially for revisional surgery, from obstetricians and gynecologists and internists.

Is it crazy for a 60-year-old to do tummy surgery? Isn’t it very painful?

I insert a pain pump in the tummy that keeps the area numb for the first five days. The patient rarely has to take pain medication. We’re also much less invasive now and the techniques we use relieve the tension on the skin, so scarring is less and the recovery is much faster.

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Dr. Kaveh Alizadeh

New York Plastic Surgical Group
960-A Park Avenue
New York, New York 10028

Click here for more locations.

Tel:  (212) 879-8506
Fax:  (516) 742-4716

Click here to view Dr. Alizadeh’s profile.

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Giving Patients The Once-Over: A Conversation With Dr. Olivia Hutchinson

What do plastic surgeons often overlook before they operate?

They don’t know enough about their patients.

What do you find out about your patients and why is it important?

I think about the patient as a person, and I think this is important in deciding which plastic surgery procedures are indicated and in obtaining the best results. I want to know not just about what part of their appearance they want to change and why, but about the whole patient as an individual, including her lifestyle and daily activities, how she eats and exercises, her family and work environment and stresses, whether she’s in a stable relationship or recently separated or divorced, her current pertinent circumstances, both good and bad.

Surgery is one component of a patient’s life and her mental state can affect her ability to heal properly and to appreciate the results. Surgery releases the hormone cortisol as part the body’s response to a stressful situation, and it’s important that the body returns to normal following the stressful event. Many processes are involved in healing and it is important to optimize patients before surgery so their recovery is smooth and uncomplicated. There are benefits of anti-oxidants in foods and of stress reduction for both combating aging and boosting the immune system to help with healing.

So you interview your patients?

Yes, we have an initial consultation that lasts about an hour, and then a second or third visit depending on patient needs. I think patients appreciate that I take the time with each one of them individually.

Do you ever decide not to operate?

Absolutely. If I feel the patient has unrealistic expectations, or our aesthetic ideals do not match, or there are issues in a patient’s life that make her an unsuitable candidate, then I won’t operate. In some cases medical, psychological and social concerns can be addressed so patients eventually undergo surgery.

Can you give me an example?

I started seeing one patient six months before her surgery. During the second visit, I noticed that something was worrying her. She was very upset and emotional, but not because of her potential surgery. While chatting with her she revealed she was having a problem with her son. They began seeing a therapist I recommended and their relationship steadily improved. If we had not addressed this problem, she would most likely have been unhappy and disappointed with the results of her surgery because the issue with her son would have persisted unresolved.

What procedures are popular today?

For the face, eyelid lifts, fat injections, neck lifts and facelifts. For the body, mommy makeovers, which include breast lift, augmentation or reduction, a tummy tuck and liposuction. I specialize in minimally invasive procedures with limited incisions and short scars.

When is the best time to have mommy makeovers?

A woman should have stable weight and appropriate BMI, and should no longer be lactating. I’ve performed a variety of these procedures on women in their 50’s and 60’s, when their children are grown and they have time to refocus on themselves.

I’ve read that a woman who has liposuction, on her tummy, for example, can expect the fat to show up instead on other parts of her body.

This is a misrepresentation of what happens. Once fat cells are removed by liposuction, they’re permanently removed and the body doesn’t regenerate them. But if a woman gains weight, the existing fat cells that are left in her body will expand with the added fat. So although it may appear like the fat has shifted location in fact fat cells just increase or decrease in size with weight gain or loss.

What are your observations about FOF women and plastic surgery?

FOF women want to look better longer, and are interested in procedures that produce results. Some may be considering a change of lifestyle or a new career, and are looking to improve their appearance. They may feel they look tired, or are bothered by wrinkled skin, or want their external looks to reflect their inner youth. Some may only need a small treatment, such as skin rejuvenation and injections of fat to targeted areas. The nice thing today is that we have a whole slew of techniques and modalities to address a woman’s concerns. These can be mixed and matched to address each person’s particular concerns.

We have a range of laser treatments to tighten skin and reduce wrinkles. Our aesthetician offers photo facials, chemical peels, and in-office laser skin rejuvenation treatments with no downtime. We also offer more extensive treatment with the Fraxel laser, which resurfaces skin, reduces fine lines and wrinkles and acne scarring, and reverses sun damage.

Tell me, honestly, do I look like an old woman? (I figure I might as well get some advice along the way.)

Not at all, you have great skin tone, but you could use some fat injections to add volume to your cheeks and a lift to tighten your neck.

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Dr. Olivia Hutchinson

121A East 83 Street
New York, New York 10028

Tel:  (212) 452-1400
Fax: (212) 421-3435
www.droliviahutchinson.com

Click here to view Dr. Hutchinson’s profile.

A Facelift Without Surgery?! All About Ultherapy, A New, Non-Invasive Procedure.

Tell us about Ultherapy.

Ultherapy utilizes direct ultrasound technology, which first looks at the skin and the layer below it and then delivers small points of heat to the underlying support structures (shrinking the SMAS* muscle), which lifts, tightens and tones the skin.  Visible improvement of the jowls, neck and central face are immediate and improvement continues for two to three months with just a single treatment!  Full results can take up to six months.

Ultherapy is becoming a cornerstone in the non-surgical aspect of my practice for facial rejuvenation and is an adjunct to facial fillers. Ultherapy subtly builds collagen through the body’s own gentle healing response, which further improves overall skin health while tightening the skin.

I will often will recommend Ultherapy before fillers, since it  may reduce the amount of filler a patient  needs, as well as prevent the over-injected, over-filled pillow face.

*SMAS means superficial musculo-aponeurotic system, made up of multiple fibrous extensions that attach through the fat to the epidermal and dermal layers of the skin. These connections cause the three layers of facial skin to act as one and move together. As the skin on our faces ages, there’s a gradual loss of elasticity in the epidermal and SMAS membranes, which contributes as much to the aging face as does the loss of elasticity in the superficial dermal layer.

So Ultherapy is non-invasive, right?

Yes, Ultherapy is non surgical and non invasive.  The FDA approved Ulthera’s patented DeepSEE technology in 2009, which allows us to both see and treat deep below the skin, without surgery. Ultherapy doesn’t use laser or injections, but directly delivers focused ultrasound to deep structures under the skin’s surface.  The results of Ultherapy are superior to radiofrequency, which is the science behind Thermage.

Where on the body, besides the face, can Ultherapy be used?

Ultherapy can be used on the neck, underarms, to treat laxity of the knees and elbows. As the technology evolves, who knows where we will go on the body next!

Is everyone a candidate for Ultherapy?

Patient selection is very important and setting patient expectations is key. If a patient has severe facial laxity, surgery will provide the most dramatic results.  The Ultherapy procedure appeals to men and woman in any decade of life. As patients begin to experience the gradual descent of tissue of the cheek and hint of jowls, Ulthera is the obvious choice. Ultherapy is the most effective technology we now have for patients who prefer non-surgical tightening of the skin.

How long does it take to perform the procedure?

One to two hours.

How do the results compare with those of a surgical facelift?

They differ from patient to patient, but results can range from 30 to 50 percent, with high patient satisfaction. Combining Ultherapy with other procedures further improves the results.

An Ultherapy procedure performed by Dr. Tehrani.

How long do results last?

The effects of Ultherapy are permanent, but since aging continues, patients may decide to have a second treatment in 2 to 3 years.

This sounds almost too-good-to-be-true. Is it?

Yes, it’s true.  Ultherapy results do vary, but I haven’t had an unhappy patient.  Patient selection is key, as are the number of lines (or small points of heat, which are delivered).

How much does Ultherapy cost?

About $3,500 for the brow, full face and neck areas.

Can patients get a light sedation, like we get prior to having a colonoscopy?

Patients are typically pre-treated with a combination of Vicodin and Valium.  We sometimes give IV sedation, supervised by an anesthesiologist, although this is rare. Patients seem to respond well to the cocktail of pain medication and relaxant by mouth. We also provide comfort measures through biofeedback.

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Dr. Kevin Tehrani

30 Central Park South 13A
New York, New York 10019

Tel: (212) 439-9900
www.aristocratps.com

Click here to view Dr. Tehrani’s patient before and after.

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Face The Facts! Choosing The Best Procedure For Your FOFace: A Conversation With Dr. Lawrence Bass

Given the proliferation of facial procedures available today, from fillers to surgery, how does a woman intelligently decide the best treatment(s) for her face and the best doctor to do it?

Yes, the incredible array of procedures is confusing to patients, as well as to doctors who want to perform at a state-of-the-art level. That’s the reason some doctors decide to specialize in only one or two procedures. Often patients will seek out a doctor they heard is the ‘best’ for Botox injections, for example, then go to someone else who they heard is great for another procedure.

Is that a smart move on the patient’s part?

In the short term, that works if all you need is the single treatment.  Over time, as aging advances, you want all parts of your face to look harmonious, cohesive and natural and there’s less chance of that happening when you’re using multiple doctors.

What’s your specialty?

I specialize in facial rejuvenation, everything surgical and non-surgical, not just in one or two procedures.  Over 70 percent of my practice is devoted to rejuvenation. I look at the full face thinking about what is needed now and coordinating for the future.

Please define facial rejuvenation?

Rejuvenation is the process of restoring a patient’s appearance so she looks more youthful and beautiful, but still normal —like herself, just a while back.

At what age should a woman start to rejuvenate her face?

While it will be a little different everyone, changes start to show in most people by the beginning of their forties.  I believe the best strategy is to use the least aggressive options possible at an earlier stage, as issues come up.  Then when they are no longer effective, a bigger intervention can be selected.  I’d rather keep the face looking young than wait until it falls apart and try to pull everything back together.  If you wait until you’re 50 or 60 to get work done on your face, you’ll have to play catch up.

How do you analyze the face to determine what treatments are necessary?

We look at three areas of the face:

  • The skin surface:  Has the sun affected it, for example?  Are there spots, wrinkles, Rosacea? These issues are usually treated with non- surgical, energy-based procedures, such as lasers as well as skin care and skin products.
  • The skin laxity: Surgical lifts remedy loose skin on areas including brows, neck, eyes and face.

Non-surgical tightening includes Ultherapy, which uses sound energy, and Thermage, which uses radio frequency energy to stimulate collagen production in the skin without disturbing the surface of the skin.  This produces a smoothing and tightening of the skin.

Most of the non-surgical lifting technologies are best if used early, to maintain tightness in the face and neck. They are also best when used on a regular basis, unlike surgical lifts, which have a more dramatic result and longevity. Non-surgical treatments shouldn’t be considered a replacement for surgical procedures, but more as preventative treatments to help increase the time before a surgical intervention is required.

  • Volume Loss: Women start to lose facial fat in their thirties, which initially provides a more sculpted look, eliminating the chubby baby face of youth.  But it’s not so nice once they reach forty plus. And when they reach fifty plus, the fat loss starts to accelerate, as do bone and muscle loss.

These changes, subtle at first, make women look haggard. Off-the-shelf fillers, such as Radiesse, can be used to increase the volume in the cheeks, fill in the sunken areas under the cheeks, fill in the depression in front of the jowl  and help build out the angle of the jaw.

Fat injections, which are minimally invasive and don’t require general anesthesia, can take up some loose skin and restore the volume, but they do have a longer period of downtime and swelling than injectable fillers, which only offer minimal, if any, bruising and swelling.

A facial rejuvenation performed by Dr. Lawrence Bass.

What if a 55-year-old woman wants a non-invasive treatment but you think she needs a surgical lift? What do you tell her?

Non-surgical skin tightening is an extremely useful option in facial rejuvenation, but even in a best case scenario, provides only a fraction of the improvement of a surgical facelift.  The facelift remains the gold standard.  And remember, it’s not your grandmother’s facelift.  There have been so many improvements.  It’s safer, with less recovery and better correction than ever before.  A modern facelift provides an exceptionally natural look.

Still, everyone’s life circumstances are different.  Sometimes, a treatment is selected that doesn’t maximize the improvement because the priority is limiting or eliminating recovery time due to work or family obligations or health issues.  Compromise is part of the decision-making in everything we do in life, as long as we make the decision with all the facts –with our eyes open.  I partner with my patients to work through these decisions.

Fat injection or fillers can be used to take up a little skin laxity but trying to fix moderate laxity with fillers will leave you looking like a pumpkin.  Not a good idea.  The issues are different for everyone, but understanding what’s happening to your face overall will help you decide what treatment is wisest.

What do you recommend to a woman who knows she needs a facelift, but can’t afford it?

It is never a happy thing to feel that you can’t get what is medically ideal because of money.  But because aesthetic surgery is paid out of pocket, budget is a reality of aesthetic decision-making.  Sometimes a more limited option, like a mini-facelift, is an excellent alternative to a full procedure.

Still, you only have one face.  Everyone sees it all day, every day. Consider this:  Your face has been aging over the 30 years since you became an adult. Think about how much money you’ve spent on automobiles, on your favorite hobby, or on vacations during this time.  Your one-and-only-face is an incredibly valuable asset.  Saving and budgeting money to preserve or restore it still is only a fraction of what you’ve spent on any of these other things over the time your face has been aging.

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Dr. Lawrence Bass

Bass Plastic Surgery PLLC
568 Park Avenue
New York, New Yorl 10065

Tel: (212) 593-2600
www.drbass.net

Click here to view Dr. Bass’s patient before and afters.

Considering Cosmetic Surgery? Read This.

A screenshot from “Anyone can wear a white coat,” an alarming PSA about plastic surgery, courtesy of the ASPS. Click here to see the complete video.

“In many ways, plastic surgery is still the Wild West in this country. Any physician can legally call him or herself a plastic surgeon. Your family doctor can decide, ‘I think I’ll do facelifts today.’ It’s vital to do your homework to get the best doctor, best procedure and best outcome.”

Dr. Malcolm Roth, plastic surgeon and President of the American Society of Plastic Surgeons

Everyday we get questions from FOFs about plastic and cosmetic surgery. Everything from, “What is the least invasive face lift procedure?” to “Is it safe to have plastic surgery in Mexico?”

This year, we’re partnering with the American Society of Plastic Surgeons (ASPS), a not-for-profit authority on plastic surgery and plastic surgeons—and an organization we trust—to bring you the very best information on this topic.

This week, we interviewed Dr. Malcolm Roth, Chief of Plastic Surgery at Albany Medical Center, and the president of ASPS, who explains exactly how to find the right doctor, and why it can be confusing. “It’s vital for every FOF to do her homework before she chooses a doctor or a procedure,” says Dr. Roth. Our advice: If you’re considering any cosmetic procedure (including injections, lasers or even hair removal) read this first.

Why is it so confusing when it comes to choosing a qualified plastic or cosmetic surgeon?

In this country, any physician can legally call himself a plastic surgeon, even though he may not be board certified in plastic surgery. In most states, he can even advertise that he’s board certified and a cosmetic or plastic surgeon (though he may not be board certified in plastic surgery). So your gynecologist or family doctor can decide, “I think I’ll do facelifts today,” or “I think I’ll do liposuction.” As long as you have an office where you can perform the procedure, you can do what you want to do. There are some exceptions to this rule in a handful of states, but generally speaking, all you need is a facility and a medical license to perform surgery.

Wow. Why would a doctor who is not trained in plastic surgery decide to do it?

It’s difficult surviving in the world today as a physician. Insurance companies are decreasing their payments for procedures and making it more difficult to get paid. It’s easier to say, ‘Why not just do plastic surgery? My patients will pay me cash up front, and it looks easy.’ A cosmetic procedure can sound simple, but, even something like liposuction, in the wrong hands, is very dangerous. We’re hearing more and more about serious problems, and all ASPS members are seeing unhappy patients who need reconstruction, or are even beyond the point of reconstruction, due to surgery performed by unqualified physicians.

What is ASPS and how are its doctors qualified?

We are the largest plastic surgery specialty organization in the world. Our 7,000 cosmetic and reconstructive plastic surgeons are board certified by the American Board of Plastic Surgery. That means they have completed 6 years of surgical training with at least three of those years specifically devoted to plastic surgery. To qualify for ASPS, you must operate only in accredited medical facilities, adhere to a strict code of ethics and fulfill continuing medical education requirements to stay up to date, especially on patient safety. We are a non-profit, and our mission is to advance quality and, most importantly, safety, in plastic surgery.

Why is this important to FOFs?

You know the old expression, if the only tool you have is a hammer, everything looks like a nail? Our surgeons have all the tools in the tool chest. If you’re a family doctor who has taken a weekend course in injectables, you’re going to recommend injectables to your patients, even if there are better options. Our members understand all the options, appropriate facial aesthetics, and most importantly, safety. They know what to do when something goes wrong.

For our society and our members, this isn’t a turf war. This is about trying to make sure patients understand that they have a choice and a responsibility to do their homework.

Okay, so how does an FOF do her “homework?” How do you choose a doctor who is skilled, safe and has the maximum amount of training?

Here are the key questions every woman should ask a plastic surgeon she is considering:

  • Are you board certified by the American Board of Plastic Surgery? Are you a member of ASPS? What is your training in the field of plastic surgery? A certificate on the wall that says a doctor completed a weekend course to learn how to do lipo is not sufficient training.
  • Do you have hospital privileges? That means that a hospital has granted that doctor the right to do a specific surgery in its facility. The hospital credentialing committees look at the doctor’s training, and, if they don’t feel that person meets the standard held by that institution, they won’t allow him to do surgery there. If the doctor says yes, ask, which hospitals? And check with the hospital to make sure.
  • Is your surgery facility accredited by a national or state accrediting agency? Or is it state licensed? If the doctor performs surgery in his or her office, you want to make sure that facility has all the bells and whistles for the rare occasion when something does go wrong. For example, don’t you want to know that there’s a crash cart with all the medication, and all the monitoring devices that can anticipate and prevent something going awry?
  • How many of these procedures have you performed?
  • Am I good candidate for this procedure? What other options are there? Your doctor should be able to help you make a decision based on your budget, your comfort with doing something invasive versus noninvasive, and your anatomical needs. A qualified plastic surgeon has the training to talk to you and perform all of those things.
  • What happens if I have complications? How long a recovery period can I expect and how will you help me through that? Who covers your practice if you’re not around?
  • What happens if I’m not satisfied with the outcome of my surgery? Will I have to pay for it?
  • Do you have before-and-after pictures that I can look through? I suggest this question with the following caution: Today, doctors can use Photoshop and other tools to make their before and after pictures look very different. And I can tell you of instances where I’ve been made aware of people putting images on their website that were not even their own. So don’t let it be your sole determining factor.
  • Can I talk to another one of your patients who has experienced this procedure?

For facelifts, lipo and other surgical procedures, it makes sense to use a plastic surgeon. But what about injectables? Is it okay to go to a dermatologist for that?

Fillers and neurotoxins and other minimally invasive procedures are within the scope of dermatologist training, and it’s certainly reasonable to go to a dermatologist for those things. However, remember that dermatologists are not trained to do the surgical procedures that our members are trained to do. So if your dermatologist offers you filler, that’s probably fine. If, on the other hand, they suggest, “Well, how about I do a facelift?” that’s not in the scope of their training and a better option would be for you to consider an ASPS member surgeon.

Also, a plastic surgeon is going to know every nook and cranny of the face—where the nerves are, and what the ramifications are if you injure a nerve you’re not supposed to. An ASPS member will know how to minimize the risk of injury to vital structures. Injectables aren’t just a “skin procedure,” and it’s valuable to have somebody who has full understanding of the underlying anatomy.

What is the ultimate “red flag” that should send you running from a doctor’s office?

If they’re not trained in plastic surgery, you’ve got to be crazy. Run away. And if they are trained, but you don’t feel like you and the surgeon are connecting… that’s not a good sign. Find someone else. There’s no rush—this is your life you’re talking about.

Visit plasticsurgery.org to start your search for a qualified plastic surgeon in your area.

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Should You Choose A Male Or Female Breast Surgeon? A Conversation With Dr. Tracy Pfeifer

Is there an advantage going to a woman plastic surgeon for breast augmentations or lifts?

I hear from patients every week that they feel more comfortable talking to women doctors than with male surgeons. They say they can more easily express themselves and be understood. We can also identify with them and with the changes in their bodies. For example, some male surgeons think every woman should get implants. In some cases they also tell patients how big they should be.

How does a woman decide whether she should have implants or just a breast lift?

Some women are small and know they need implants to be bigger. But if you’re wearing a C cup, you’re filling it out and you think it looks pretty good, you probably should just have a lift.

Are there many female plastic surgeons?

No, women account for only 10 percent of all plastic surgeons.

Why?

I am sure there are many factors. Traditionally, there’s been a prejudice against women in the world of general surgery. We weren’t considered tough enough to go through the grueling surgery training programs.

How grueling?

I studied general surgery for five years, followed by a two –year residency program in plastic surgery and then a six-month fellowship in breast surgery.

Why did you choose breast surgery as your specialty?

It’s creative and I find it rewarding to deal with so many different patients. We often have interaction afterwards since I see my breast patients for yearly follow-up visits. I also believe in specializing. I don’t do rhinoplasty. However, I do injectables, facelifts, neck lifts and eyelid surgery (blepharoplasty).

What advice do you give FOF women when choosing a plastic surgeon?

Don’t look for reviews on Google and don’t imbue doctors with abilities they don’t have. If your friend had a beautiful facelift by a doctor who is genius at facelifts that doesn’t mean he or she is a genius at performing breast implants. Talk to some of the doctor’s other patients and absolutely ask a surgeon about her background and training. Someone may have trained at an excellent institution for general surgery but has only a mediocre reputation in plastic surgery. Find out also about their breadth of experience. I’m 50, so I have a great deal of experience in breast surgery.

Once we choose a doctor, should we leave everything in her hands, so to speak?

Before your surgery, you should understand exactly what the surgeon intends to do. It’s a little scary when I read online sites, such as www.Realself.com, where doctors answer questions posted by patients. Patients sometimes indicate they’re going into surgery in a few days without any idea what’s going to happen.

Give an example of what can happen if you don’t do enough research on a surgeon or on the procedure you’re about to have.

Let’s say a woman over 60 wears a C cup and has lots of volume, but she’s lost volume in the upper half of her breasts due to gravity. It’s not enough to simply work on the drooping skin because it will start drooping again before too long. A top surgeon will work with the internal tissue so the lift lasts more than a couple of years. Sometimes I insert Strattice (a piece of sterilized pig skin) into the breasts, to reinforce the lift, which can help prolong the longevity of the result. Not all plastic surgeons have experience with advanced breast surgery techniques.

Are many FOF women having work on their breasts?

Breast reductions are quite commons among women who are 60+. They tell me they’ve always wanted smaller breasts, but their father or husbands didn’t want them to do it. The surgery totally changes their lives.

That’s exciting, but many women who’d love to have breast surgery can’t afford to do it. It’s so costly and medical insurance doesn’t pick up the cost.

It is a common misconception that insurance doesn’t cover breast reduction, when, in fact, it does in the majority of cases. We try to accommodate patients who don’t have insurance or whose insurance will not cover the procedure, as well as those who prefer to use a plastic surgeon who doesn’t accept insurance. We will let a patient pay over time. I also like a financing program that Care Credit offers for plastic surgery. The patient can pay off the loan over 12 months without interest.

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Dr. Tracy Pfeifer

969 Madison Avenue
New York, New York 10028

Tel: (212) 860-0670
www.drpfeifer.com

Click here to view Dr. Pfeifer’s patient before and after.

Taking Aim At Cellulite With An Exciting New Laser: A Conversation With Dr. Theodore Diktaban

Cellulite isn’t any girl’s best friend.  What exactly is it?

Connective tissue bands beneath the skin, called fibrous septae, are arranged in a crisscross manner in normal skin.  When they are oriented in a parallel manner from birth, they allow the fat to bulge up against the skin’s thinner surface, creating a rippling, lumpy look. Some septae also harden and contract as women age, which causes more bulging and dimpling by pulling the skin surface inward.

What causes cellulite and is it preventable?

We’re not sure of the exact causes, but they’re believed to be genetic and hormonal.  Cellulite can’t be prevented, but staying thin makes it look less pronounced.  The fat cells get larger or increase in number with grossly overweight people, which cause them to push up against the thin skin.  The skin cannot contain their force. When you lose weight, they shrink, but don’t disappear.

Where is cellulite most likely to appear?

The lower buttocks and back of the thighs are definitely the most common areas. The abdomen, inner thighs, front of the thighs, and even the upper, outer arm can be affected.

How has cellulite been treated?

All treatments up until now have been non-invasive. There were lotions and potions but they didn’t work. Heating and vacuuming or suction massage caused temporary improvement at best.  The reason these external treatments cannot work is because we can’t heat the skin enough to be really effective and the suction isn’t powerful enough to disrupt the fat or divide the fibrous sepate bands. Cellulaze is a one time treatment in contrast to the external devices that require 8 to 12 treatments over a number of weeks, which cause a little bit of swelling, but then they go back to looking the way they were.

Tell us about Cellulaze, the new treatment we’ve been hearing about?

The FDA approved the treatment about five months ago. It’s a minimally invasive, one-time procedure that uses smart lipo laser technology. It works with a 1440 mm wavelength that has the greatest affinity for fat and water. Besides its ability to be fired straight ahead, the laser can be aimed off to the side and directed right down at the fat, up against the skin, as well as sideways at the fibrous septae. This multidirectional laser treatment allows us to finally be able to correct the anatomy that causes cellulite.

How does it work?

We work with a plastic grid with 12 squares, each measuring 2 by 2 inches, and we completely mark out the area affected by cellulite.

We give patients a couple of valiums and painkillers to get them nice and relaxed and then inject a thin layer of liposuction liquid under the skin. Following that, we make a small pinpoint puncture to let the angel hair size laser enter. Each of the squares will receive a calculated amount of energy to the bulging fat, contracted septae and the thin skin.  After the calculations, it’s time to go to work. We aim the red laser sideways to cut the septae; straight down to melt the fat, and then up against the undersurface of the skin to directly tighten and thicken it.  Once all of the laser energy is delivered to the squares, the melted fat and liquid is gently rolled out.  The patient is placed in an elastic garment and then sent home shortly after.

How does the patient feel after the procedure?

Patients should take two days off to relax and let the oozing subside.  The patients can take a shower the day after their treatment and then put the elastic garment back on.

Is there bruising?

Bruising and swelling have been mild.  Some patients are taking one painkiller a day to ease the discomfort. Initially, we were concerned about using the laser close to the skin, but numbness has been minimal.

When can the patient resume normal activity?

Patients can exercise after a couple of weeks, but other than that, they can return to normal activity after a few days rest.

When do the results show?

It takes about six months to see the full effects of the Cellulaze treatment.  The skin also needs to be massaged while it’s contracting.

The cost?

It depends on how many squares we need to work on, but let’s say $4,000 and up.

What are the most common procedures you perform?

Breast augmentation, liposuction (traditional and Smartlipo), Cellulaze and rhinoplasty, otherwise known as nose jobs.

What has been the most challenging surgery you’ve performed?

Microsurgeries on two memorable patients are the most challenging that I’ve experienced. One gentleman, who almost lost his leg in a motorcycle accident, was able to fully walk after a 15-hour operation. I transferred a muscle from his back to cover exposed bone in his leg.

The other case was a young diabetic woman who developed a chronic infected foot wound after cutting it on glass at the beach. I transferred a muscle from her abdomen to restore support and close the large gaping wound. There was a special conclusion for this patient who was perilously close to having an amputation before her microsurgery. She literally came and danced at my wedding later on.

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Dr. Theodore Diktaban

635 Madison Avenue, 4th Floor
New York, New York 10022

Tel: (212) 988-5656
www.drdiktaban.com

Click here to view Dr. Diktaban’s patient praise.

More or less: everything you need to know about cosmetic breast surgery

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What is the main reason that women choose to have breast augmentation or lift surgery?
Women between the ages of 18 and 35 want larger breasts to feel more feminine.  Perky, full but not overly large breasts provide them with the ability to fill out a dress or a bikini, which increases their self-confidence.

Starting in their mid to late 30s, women notice that their once-perky breasts have drooped with age, often times after having children. Their breasts also may lose fullness, as a result of post-pregnancy changes.

Starting in their 50s, women will often notice a change in breast size compared to their younger years.  This is due to age and gravity as well as to changes associated with menopause.  Much of the elasticity has been lost and the breasts don’t have the fullness or bounce they once had.

Are more FOF women having breast surgery? If so, why?
Yes, noticeably more, perhaps in the neighborhood of a 20 percent increase.  Breast enhancement surgery is not just for the rich and famous, actresses or models.  It can benefit women of all backgrounds and at different stages of life.  Competition, the economic downturn and financing plans have made plastic surgery of the breast much more affordable to women of almost all income levels.

How does a woman decide whether she should explore her options?
If a woman would rather have the lights off than on when she is topless, it may be time to consider a consultation with a plastic surgeon.

How do you perform lift surgery?
Breast lifts are performed on women of all ages.  The incision may be made just around the areola, around the areola and down the center of the bottom part of the breast (a “lollipop lift”) or around the areola, down the center and at the infra-mammary crease (where an underwire would sit).  The incisions used will depend on the amount tissue that needs to be lifted and/or removed.

And what happens with implant surgery?
A breast implant can be placed in front of or behind the muscle.  It can be placed through an incision around the areola, under the breast (in the infra-mammary crease), or under the armpit (trans-axillary).  If a breast lift is being performed at the same time, there is no need for any additional incisions beyond those being used for the lift itself.  The surgery is performed on an outpatient basis in an accredited facility.

What are implants made of?
Breast implants have a silicone shell which is filled with sterile salt water (saline) or a silicone gel.  In the United States, three companies manufacture both types of breast implants: Allergan, Mentor (a division of Johnson & Johnson) and Sientra, whose implants recently received FDA approval

What’s the difference?
Silicone gel implants feel, look and behave more like a natural breasts than saline implants.  In general, silicone gel implants also are more durable than saline implants.

What’s happened with the silicone safety issue since 1992, when it was thought leaks from these implants could lead to cancer and they were pulled off the market?
Breast implants are safe and approved by the FDA.  However, saline or silicone gel breast implants can develop leaks.  The odds of rupture are 1 percent per year per implant.  In most cases, it is best to place breast implants under the muscle, which protects and camouflages them better and minimizes any interference with a mammogram.

What if you’re one of the unlucky women?
If a woman has a ruptured breast implant, the implant should be removed promptly.  It may be replaced with a new implant.  If a woman desires, she may use this opportunity to select a new implant type or size compared to the one that ruptured.  To the best of our knowledge, there is a very little chance that a woman’s health will be affected by a leaking implant.


A ruptured saline breast implant.

How can someone tell if her implants are leaking?
The breast will decrease in size if a saline implant has ruptured. It may be more difficult to detect a rupture with a silicone gel implant.  Whether or not a woman has implants, she should perform monthly self breast examinations to detect cancer, as well as have her breasts examined by her doctor at least once a year.  If there is any concern that a silicone gel breast implant has ruptured, a woman should see her plastic surgeon.

How does a woman decide what size implant is ideal for her?
Implant size is a personal choice.  To start, a woman can put on an unpadded bra and a tight T-shirt.  We then insert breast implant sizers to determine what looks and feels best for her. Breast and chest measurements are taken to ensure the implants are within an appropriate range for that patient.

How does a woman decide which surgeon to use?
Make sure the plastic surgeon has completed an accredited plastic surgery residency.  It’s a bonus if he or she has completed additional training, known as a fellowship. Check that the surgeon has hospital privileges for plastic surgery.  If the doctor is operating outside of the hospital, make sure the facility is accredited.  Ask to see before and after photos as well as to speak or meet with patients who have undergone surgery like the one you are considering.

I am a member of the medical staff at Lenox Hill Hospital, Manhattan Eye, Ear & Throat Hospital, and the New York Eye and Ear Infirmary.  I also operate at the Center for Specialty Care as well as in our accredited outpatient surgery center located in our office.  Besides completing a plastic surgery residency, I have completed two fellowships:  one at Georgetown University Hospital in aesthetic and breast plastic surgery, the other affiliated with Stanford in advanced facial plastic surgery.

Is the surgery dangerous?
Plastic surgery that is performed in an accredited facility is generally ve safe.  I work with an experienced team that includes board certified anesthesiologists, which enables me to perform Rapid Recovery Breast Augmentation under intravenous sedation, not general anesthesia.  This means less risk and faster recovery for my patients.  Women walk out of the office a few hours after surgery feeling like they have a little pressure on their chest.

The best question for last.  What is the cost?
The cost for a breast augmentation starts around $5,000.  The cost of the breast lift varies and depends on the amount of work that needs to be done.  A breast lift starts around $7,500.  A breast lift with an augmentation costs around $10,000.

Why is this surgery so costly?
You have to consider all the costs, including the anesthesiologist, the operating room, the implants, the staff, and the surgeon’s fee.

(Editor’s note: A good paint job on a modest size New York apartment costs well over $7,000, so this is pretty good price to give your breasts a fresh new look.)

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Dr. Adam Schaffner

Plastic Surgery Institute
60 East 56th Street, 2nd floor
NYC, NY 10022

Tel:  (212) 688-5882

www.drschaffner.com

Click here to view Dr. Schaffner’s patient before and after.

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Top 6 Plastic Surgery Questions And Answers: A Conversation With Dr. Sharon Giese

What are the best options for a saggy neck and jowls?

Good question, as this is the biggest giveaway of an FOF’s age. Traditionally, FOFs have gotten facelifts as a solution to this problem. However, facelifts can be invasive and have a long recovery time. For the past four years, I’ve been performing a procedure called the “Natural Lift” as a way to avoid or postpone a facelift. I remove a teaspoon of jowl fat and 2 tablespoons of neck fat. It’s a 45-minute procedure, done with local anesthesia and requires minimal recovery time. Consider it the ultimate cheat and prevention for aging.

What are the latest innovations in liposuction? Can you have liposuction anywhere and everywhere?

Yes, you can. This past year two new non-invasive devices have come onto the market that melt fat away when you use them over the skin. They allow you to shrink even the thinnest layers of fat cells in parts of the body that used to be difficult to reach through liposuction cannulas (tools). The device I use is called VASER Shape which feels like a hot stone massage.

What type of implant is better or which do you recommend: Saline or silicone?

I prefer silicone and implant them in my patients 99% of the time. With silicone, the deflation rate is low and they feel more natural. Most women getting augmentation have very little breast tissue and the breast is made up of mostly the implant. In the rare cases where someone with bigger breasts (for example a size B) wanted to go to a size C, then I might use saline.

I’ve heard of a “vampire facelift,” what is this?

Despite its name, the vampire facelift is actually a non-surgical cosmetic procedure, rather than a facelift. It uses the patient’s own blood, which is rich in antioxidants and collagen, to make the skin more radiant. Often times, people combine this treatment with fillers for the ultimate facial rejuvenation. The vampire facelift is the same treatment top athletes such as Tiger Woods have had done to their joints to promote healing and increase vascularity. The way it works is blood is drawn, then the Platelet-Enriched Plasma (PRP) is separated and concentrated. The PRP is essentially tattooed back into the middle layer of the skin to promote radiance. My favorite protocol of this procedure uses the Dermapen. (For more about Dermapen, read below.)

As a teen, I had very bad acne and now I have scars, pitting and large pores. What do I do?

My favorite new device to reverse damage from acne, is the Dermapen. It stimulates collagen in the middle layer of the skin, plumping acne pitting. It’s the only therapy that helps with deep pitting. It can level the top edge of the pit to the bottom. Also, it’s great for fine lines and wrinkles on the upper lip. It can be used on all skin types, is much less expensive than laser devices and does not cause heat damage to the surrounding, healthy skin.

Do you build up resistance to Botox to the point that it stops working?

First of all, there are 3 neuro-modulators on the market today—Botox Cosmetic, Dysport, and Xeomin—each have their own unique properties. You cannot build up a resistance to neuro-modulators. However, the more you use them, the less you need them because you train your face not to make certain movements. For this reason, it’s important to get treatments regularly. I have been using neuro-modulators on myself for 12 years and now I only need to get it done twice a year, whereas when I started I was getting four treatments a year.

Dr. Sharon Giese

114 East 61st Street
New York, New York 10065

Tel:  (212) 421-3400
Fax: (212) 421-3435
www.drsharongiese.com

Click here to view Dr. Giese’s patient before and afters.