Dr. Filiberto Rodriguez

Hi, the answer to this question depends greatly on your physical examination and how severe the sagging of your eyelids is. However, if you have mild eyelid ptosis (droop), then you may be a candidate for the non-invasive ThermiSmooth Face treatment. This uses controlled, non-invasive tissue heating to promote collagen growth under the skin. It can even treat the delicate skin around the eyes and lips because its cutting-edge temperature controls allow the provider to precisely regulate the amount of energy delivered to the skin. Treatment is pain-free and can be customized for each patient’s needs. ThermiSmooth Face can treat problem areas such as forehead “worry lines,” sagging eyelids, “parenthesis” lines or nasolabial folds around the mouth, crow’s feet, and sagging jowls. It can also help firm crepey skin on the face or neck. Most patients see some benefits from ThermiSmooth Face after the first treatment. Typically three procedures are necessary to achieve optimal results. Collagen production takes time, so you'll look younger with natural results. It may take three to six months to see the full effects of facial treatments.

Since the cost of abdominoplasty surgery varies based on the size of the patient, how many additional areas of liposuction, possible need to extend the excision around the flanks to avoid dog-ears, and possible fat transfer that many patients desire, it is not feasible to give cost estimates blindly. In addition, there are anesthesia and OR fees to consider. It is always best to be seen in person for a consultation. I hope this helps.

Hi,

With regard to the new silicone gel implants, they come with a 10-year warranty that covers both "parts" and some "labor." Meaning that if a crack is identified in the shell of the implant (possibly on mammogram, or other screening studies), then the company will replace the implants bilaterally, and also pay some of the associated OR and anesthesia costs. After 10 years, the implants have a lifetime parts only replacement warranty for any implant defect. It is important for patients to realize that implants don't ever "rupture." The shell merely develops a crack, and the silicone gel does not leak. This 10-year warranty is where the concept that implants have to be replaced after 10 years comes from. This is simply not true. Silicone gel implants have a risk of developing a crack in the shell of 1% per year per implant. So, after 10 years, there is only a 20% risk that one of the implants have a silent "rupture" (2 x 10 = 20). Meaning there is an 80% chance that the implants are perfectly fine. If I started having all my patients come back every 10 years to remove their implants, that would be a lot of unnecessary surgery! Follow the FDA recommendations for screening MRI scans to look for silent implant "rupture," and you should be just fine. Yesterday, I removed an old (more than 30 years old) pair of implants with calcified capsules, and the patient was fine.
Hope this helps....

So, the question posed is: Is it normal to have uneven breasts after augmentation? After breast augmentation I noticed that they are uneven. Is it normal?

An important starting point is, did your surgeon measure in detail all of the natural asymmetries and differences that exist in all women's breasts? Perfect symmetry does not exist on anybody, and natural differences between the left and right sides are perfectly natural on the breasts, and also on the face. That being said, it is normal for breast implants to settle at different rates between the left and right sides during the early post-operative period. If a patient develops Grade 3-4 capsular contracture on one side, then this will definitely distort the breast and cause asymmetry. Finally, if there were significant differences between the left and right sides noted pre-operatively, then different strategies such as different sized implants or more complex augmentation mastopexy with breast reduction and implants should have been discussed.
I hope this helps.

Hi. Thank you for your question.

Unfortunately, it's not so simple to just give quotes for procedures without seeing the patient in consultation first. Breast augmentation may also require a lift if the patient has significant sagging of the breast, and implants alone in this setting results in an unpleasant "Snoopy nose" deformity. It is always best to have a formal consultation with a respected and reputable surgeon specializing in these procedures, and then discuss pricing with their patient care coordinator after the surgeon has outlined the best plan for your individual needs.

Hi,

This is truly a challenging question. Certainly, breast reductions are some of the most gratifying operations I perform, and I have even done these on older women in their 70's who regret having waited so long. In your case, I believe that if you are fully aware of the scarring and the risks that your breasts MAY (not for certain) continue to grow as you continue aging, and especially many years from now once you choose to become pregnant, and as long as your parents are supportive (since you are a minor and need their consent), then I wouldn't have a problem performing breast reduction surgery on someone your age. Especially knowing how much it could help you. All this being said, we would have to ensure that such a patient wouldn't need to lose a lot of weight. The information given gives the height, but not the weight. So, if the BMI is too high, then this would need to be addressed first, before proceeding to breast reduction.

Hi. When properly done, other than the tiny liposuction stab incisions strategically concealed, there should be no scarring from liposuction to the arms, or any area for that matter.

Hi. Thank you for your question. I honestly tell my patients that in my hands, breast reduction is the least painful operation I perform. If there is no liposuction needed to the lateral thorax (side chest/anterior axilla), then breast reduction alone is essentially painless. I hope this helps.

Hi. This is a complicated question. Breast lift surgery can be extremely long-lasting (tens of years), and all my breast lift patients (with or without implants) are extremely happy. The main issue is taking care of your breasts after surgery. Subsequent pregnancies after a breast lift will result in the breasts likely becoming saggy again. Similarly, massive weight gain and weight loss after breast lift surgery will also cause them to likely become saggy again. When young, thin patients come in for breast reduction and breast lift surgery, we have these conversations at great length. Hope this helps.

Hello. I am Dr. Filiberto Rodriguez. In response to your question regarding pain after breast lift surgery, I can honestly say that in my hands, my breast lift patients have zero pain. Now, if they elect to add on breast implants or liposuction, then they tend to feel some tightness (but very little pain) from the implants, and some soreness in the areas of liposuction. I hope this helps answer your question.

Hi. Thank you for your question. A "non-surgical" nose job is the use of dermal filler (like Juvederm) to refine aspects of the nose to enhance the contour and profile of the nose. This must be performed by experienced providers who understand the delicate blood supply of the nose to avoid complications such as vascular occlusion.

Although calf raises help engage the calf-pump mechanism to enhance the upward flow of venous blood in the deep vein system to move out of the legs, there are no exercises that improve existing varicose veins or saphenous vein insufficiency. Diet and exercise, while important for overall health, do not halt the progression of varicose vein disease. Fortunately, modern varicose vein treatments are minimally invasive, provide excellent outcomes, and have very short recovery time. Compression hose worn daily may help slow the progression of varicose veins and provide temporary comfort. Schedule a consultation with a varicose vein specialist for more information.

The short answer is that the varicose veins will not cause any complications during her delivery. Many factors during pregnancy contribute to the development of venous insufficiency and varicose veins, including the hormonal changes, increased blood volume, and the pressure of the baby on the pelvic veins during the third trimester. The good news is that with modern treatment modalities, she can have her varicose veins treated soon after the baby is born. In the interim, she should compression hose for support and comfort.

Great question. There is a lot of confusion regarding laser treatments for varicose veins. For the most part, topical (surface) laser treatments only work for the tiniest of spider veins on the legs or face that are too small for sclerotherapy injections. EndoVenous Laser Ablation (EVLA) is a minimally invasive surgical procedure to treat sapheous vein insufficiency (or reflux). Venous insufficiency is a more serious vein disorder that often underlies visible varicose veins, leg swelling, restless leg syndrome, skin color changes to the lower legs, and ultimately skin breakdown and venous stasis ulcers. Venous insufficiency is diagnosed with ultrasound examination. The EVLA procedure involves carefully inserting the laser fiber into the diseased saphenous vein under ultrasound guidance to essentially "weld" the vein shut with the laser energy. EVLA is typically performed under local anesthesia with oral sedation and is a very safe, outpatient procedure performed in the office setting. Micro-phlebectomy procedures are then performed to gently remove the remaining visible varicose veins. A
formal consultation with a varicose vein specialist with allow your doctor to recommend the optimal treatment plan for your varicose vein disease.

Filiberto Rodriguez. MD, FACS, FAACS, RVT, RPVI

Hello. Thank you for your question.

The good news is that there are treatments to eliminate painful varicose veins. These treatments include EndoVenous Laser Ablation (EVLA) of the saphenous veins, if venous insufficiency is present, followed by micro-phlebectomy procedures to directly remove the painful surface varicose veins, and finally sclerotherapy to eliminate any remaining spider veins. Some of these procedures are covered by most insurance companies. Search on the American College of Phlebology website to find a dedicated varicose vein specialist in your area.

Spider veins are damaged, enlarged, or weakened veins that are visible on the skin. These can develop due to injury and sun exposure, but most often occur due to aging. Although mostly a cosmetic condition, spider veins can cause uncomfortable feelings in the legs. If you are experiencing any discomfort as a result of spider veins or would like to diminish their
appearance, you may be a good candidate for spider vein treatment. Spider veins can be treated using a number of different techniques. Typically, sclerotherapy injections are the most common and effective in the legs, whereas spider veins on the nose or cheeks are better treated with topical lasers. Most importantly, if a patient has larger varicose veins associated with the spider veins, or leg swelling, heaviness, skin discoloration of the lower legs, or restless-leg-syndrome, then an ultrasound exam is needed to exclude the presence of underlying venous insufficiency or reflux. It is a waste of time and money to treat the spider veins without first eliminating the reflux larger varicose veins.

Patients often seek treatment of varicose veins due to their concerns of the unsightly, bulging visible varicose veins or spider veins. Often, these varicose veins are painful in and of themselves.

For patients with symptoms of leg heaviness, leg swelling, restless leg syndrome, or a history of a leg ulcer, the presence of saphenous vein reflux (or venous insufficiency) must be determined. This is accomplished with Duplex Ultrasound Technology.

Surprisingly, even many physicians are unaware that modern treatments for varicose veins exist that can help patients with leg pain, heaviness, and swelling. When doctors do recognize the presence of varicose vein disease they often send their patients to a radiology imaging center or a vascular lab for the ultrasound testing. This is very inconvenient for the patient, and often these non-specialized imaging centers do not perform the ultrasound examination for venous insufficiency correctly, thereby
misdiagnosing patients.

The treatment of varicose vein disease must begin with the saphenous veins if the ultrasound identifies reflux. Eliminating reflux with EndoVenous Laser Treatment (EVLT) is the modern, minimally invasive alternative to historic vein stripping surgery. EVLT treatments are performed in the office setting under local anesthesia. History of hypertension and diabetes usually does not prevent us from proceeding with the EVLT. The procedure consists of inserting a small laser fiber through a needle stick in the skin into the damaged vein under ultrasound guidance. Pulses of laser light are delivered inside the vein, which causes the vein to collapse and seal shut. The procedure is done in-office under local anesthesia with mild oral sedation. Your leg will be wrapped for one day, and you are encouraged to take a 30 minute walk the night after the procedure.

After the EVLT treatments are completed, further treatments focus on the remaining visible and painful varicose veins with MicroPhlebectomy treatments, until finally Sclerotherapy is indicated for any remaining spider veins.

Thank for your question. Unfortunately you cannot treat spider veins or varicose veins on your own. Diet and exercise do not improve varicose veins or spider veins. We often recommend (and insurance requires) that patients use compression stockings (15-20mmHg or 20-30mmHg) daily to help reduce symptoms and progression of the varicose veins. Simple sclerotherapy injections targeting the spider veins are often ineffective unless any underlying venous reflux and varicose vein disease are properly diagnosed with ultrasound and treated. Sclerotherapy for spider veins is considered cosmetic whereas many insurance companies cover treatments for venous insufficiency and varicose veins. Patients should avoid medical spas that only offer sclerotherapy and seek treatment from a surgeon dedicated to varicose vein disease.

F. Rodriguez, MD, FACS, FAACS
RGV Cosmetic Surgery & Vein Care
www.RGVCosmetic.com