A Plastic Surgeon’s Evolution

October 6th, 2011

The importance of change and evolution with the passage of time in a plastic surgeon’s thinking, concepts and techniques is Darwinian. Those who are amenable to change and adaption will not only survive but also thrive.  Those who continue to practice what they were taught in their residency, or cling to techniques and procedures just because they have done it that way for a number of years will become obsolete at best. The only way a practicing plastic surgeon can avoid making changes is to die or to cease being relevant in our great specialty.

As the years pass, a surgeon has the opportunity to learn from the experience of his own practice, and he or she has the opportunity for shared wisdom from direct contact with colleagues, symposia, books, journals, videos etc.  Every surgeon learns a great deal from his patients, who voice their experiences while under his care.  A plastic surgeon must accommodate the requests and desires of patients, and be adaptable to the influence of trends.  In many instances, patients request smaller procedures with faster healing times, even when they are informed that it is not possible to get the same result that can be achieved with a more extensive procedure.

The experience I have gained from colleagues and patients has helped me evaluate my own surgical techniques and results.  Over the years, I have spent a great deal of time in the late evening hours studying pre and post operative photographs of my patients, critically evaluating the results I have achieved and trying to figure out how to make them better. In doing so I have been able to formulate modifications in my thinking and procedures, which have helped bring about a variety of changes.  For instance, I perform more short incision facelifts today than earlier years.  Also, I perform more imbrication of the underlying foundation than years ago. I still perform SMAS flaps and extended SMAS flaps in patients whose anatomy I feel warrants such.  I am more conservative in fat removal during both upper and lower lid blepharoplasty; coronal forehead browlifts in my practice are rare today. Endoscopic browlifts are more frequent and, in some patients, I use a trampoline browlift with only 4 incisions of approximately 5 milliliters each in length.  Essentially all of my rhinoplasties are performed closed, but I have modified my techniques to where spreader grafts, strut grafts, and suture contouring of the alar cartilages are routine, just as in open rhinoplasties performed by others.

Although somewhat resistant years ago, I have embraced fillers and neurotoxins and I use them to compliment surgical procedures, or to treat patients who do not need a surgical procedure.  I could list all the operations I perform, and note modifications I have made, but that is not the purpose of this editorial. The real purpose is to remind us that a surgeon’s evolution is never finished.  He or she can never rest on their laurels or their recent great results.  We need to constantly evaluate new information, new ideas, and new technology.  While some of it will wind up in the pile labeled, “bad ideas”, a portion of it will become time proven for delivering benefits for surgeons and their patients.  There is little question about the fact that, the science of stem cell biology and autologous fat grafting is producing a paradigm shift in both aesthetic and reconstructive plastic surgery in all areas of the body.

In addition, some of the new non-invasive and minimally invasive procedures for facial rejuvenation and body contouring are showing promising results. Sculpting individual anatomic regions, including the buttocks and genitalia are areas that patients are now requesting to have improved.  A practicing plastic surgeon must have extensive knowledge in treating these areas.

With this in mind, my colleague Dr. Daniel C. Baker and I have organized our 31^st Cutting Edge Aesthetic Surgery Symposium which covers, in a comprehensive fashion, autologous fat grafting and minimally invasive and non-invasive procedures for sculpting the entire body.  Equally important for the practicing surgeon is to have complete knowledge of the spectrum of fillers and neuromodulators, new and old, including choice, safety, longevity and complications. It is necessary to critically examine the most up to date science and clinical applications of all of these “need to know” frontiers.  I think it is appropriate to say that most colleagues regard Dr. Baker and I as “operating surgeons”.  I doubt that even five years ago we would have organized a symposium, which emphasizes the content stressed in the upcoming December 2011 meeting.

Change is good and necessary. A surgeon’s evolution can never be finished.   And to quote Dr. Thomas Biggs, “Youth is the capacity to adapt to change”.  I like getting younger!

Posted in Uncategorized No Comments »

Silicone Gel Breast Implants Deemed Safe and Effective; Long-term Studies Needed

September 7th, 2011

Silicone-gel breast implants will remain on the U.S. market while manufacturers work to boost participation rates in required long-term studies, a Food and Drug Administration official said Thursday, as a spokesperson for the agency stated that the FDA continues to believe currently approved devices are safe and effective, but need better long-term follow-up.

The FDA advisory panel began meetings last week on silicone breast implants to consider ways to improve the effectiveness of the implants’ post-approval safety studies. After being banned for 14 years, the FDA in 2006 re-approved Allergan and Johnson an Johnson’s Mentor silicone gel-filled breast implants for breast reconstructive surgery and for breast enlargement in women aged 22 and older.

Such implants had been banned because of concerns about possible links to systemic diseases, including cancer and lupus, which have never been substantiated with the wealth of data accumulated on the devices over the years. However, when the FDA lifted its ban on silicone implants it did so with conditions stating that breast implants did sometimes cause adverse effects, and were not lifetime devices.  Because of this, they required manufacturers to do studies on the implants’ safety and performance after their approval.

As we already knew, study findings announced earlier this year did not show an increased risk of breast cancer or connective tissue disease, although FDA officials noted that longer studies were needed. The safety findings were based on preliminary data from six ongoing post-approval studies conducted by Allergan and Mentor, the only two companies that make silicone implants for sale to physicians in the United States.

Presently, the FDA recommends that women follow-up regularly with their plastic surgeon, MRIs to detect potential ruptures (probably overkill as MRI’s are expensive and insurance won’t cover them for random checks without cause of possible rupture). Patients should also pay attention to any changes and notify their surgeon if they notice any unusual symptoms such as pain, asymmetry or swelling, and educate themselves on the signs and symptoms of complications.

The FDA said it wants to find ways to improve post-approval safety studies and new approaches to mandate studies for the surveillance of silicone implants. Silicone implants are the most studied medial device in the history of modern medicine, so it will be interesting to see how the FDA will go about this to yield any new or useful information on the very popular medical device that around 400,000 women per year get in the United States. Dr. Aston performs breast augmentation in New York, New York and participates in the post-approval studies for silicone gel-filled breast implants.

Posted in Uncategorized No Comments »

Dr. Sherrell Aston on “What’s in a Face at 50?”

August 3rd, 2011

What’s in a face at 50?  This week’s New York Times asks the question of experts including Dr. Sherrell Aston. As time marches on, we see graying of the temples in men (if they still have their hair), loss of facial fat, and sagging of the skin with deepening of the nasolabial folds or laugh lines, and jowls. As the article points out,

‘The loss of fat in the cheeks is part of a reshaping of the face over time, said Dr. Sherrell J. Aston, the chairman of plastic surgery at the Manhattan Eye, Ear and Throat Hospital and a professor at the New York University School of Medicine. Soft tissue slides down over the cheekbone, producing laugh lines and making the cheekbones look a little flatter. The jaw line seems to widen because of the jowls.

“So what’s happened is, if you think of the face as being an upside-down triangle, with the wide portion running cheekbone to cheekbone across the nose, that’s a youthful person, wider over the cheekbones, and narrow across the jaw line,” Dr. Aston said. “When we’re older, it goes in the other direction, wider over the jaw line, and flatter over cheekbones.”

In some people, the outer corners of the eyebrows begin to droop a bit. As a result, Dr. Aston said, “the person will look less alert, less awake almost, certainly less alert and vigorous.”’

The article focuses on how President Obama has aged, albeit gracefully, since his tenure began, no doubt due to father time, a stressful job, and perhaps cigarette smoking. But the President is not the only powerful figure subject to the pressures of time marching on. As the article mentions, ‘“It’s pretty well known that Wall Street has a lot of very young men in very powerful places, and that many of the middle-aged Wall Street men want to look more youthful and more vigorous, because at 52 or 53 they are concerned about the 35-year-old who is gnawing at their heels,” Dr. Aston said. “We see people in every specialty, whether male or female, saying: ‘I’ve got a lot of young people behind me. I need to stay in the game. I have to look as young as I feel.’ ”

Dr. Sherrell Aston is an internationally known cosmetic plastic surgeon who resides and practices in Manhattan, and has performed thousands of facelifts (many of those on men!).  Access the article here: http://www.nytimes.com/2011/07/31/sunday-review/whats-in-a-face-at-50.html?pagewanted=1&_r=3&sq=plastic%20surgery&st=cse&scp=2

Posted in Uncategorized No Comments »

What to give on Father’s Day? Plastic Surgery!

June 20th, 2011

Can’t figure out what to give your dad on his day? Ever thought about supporting him in that crucial decision to make himself look and feel better as he is aging?  Statistics released recently by the American Society of Plastic Surgeons (ASPS) show that more men are going under the knife. Overall cosmetic plastic surgery procedures in men were up 2 percent in 2010 compared to 2009. However, many male surgical procedures increased significantly such as facelifts rising 14 percent in 2010 while male liposuction increased 7 percent.

2010 ASPS statistics show that men underwent more than 1.1 million cosmetic procedures, both minimally-invasive and surgical. The majority of the male top 10 fastest-growing cosmetic procedures were surgical in contrast to the previous trend of growth in minimally-invasive treatments. The rise may be due to the huge group of baby boomers now “coming of age” and wanting to do something about their appearance.

Here’s the Top Ten Fastest-Growing Male Cosmetic Procedures by percentage increase:

1. Facelift – 14% Increase
2. Ear Surgery (Otoplasty) – 11% Increase
3. Soft Tissue Fillers – 10% Increase
4. Botulinum Toxin Type A – 9% Increase
5. Liposuction – 7% Increase
6. Breast Reduction in Men – 6% Increase
7. Eyelid Surgery – 4% Increase
8. Dermabrasion – 4% Increase
9. Laser Hair Removal – 4% Increase
10. Laser Treatment of Leg Veins – 4% Increase

In this Manhattan cosmetic surgery practice, Dr. Sherrell Aston often performs male cosmetic surgery with the most popular procedures including facelift for balding men and those with full heads of hair, liposuction, rhinoplasty, blepharoplasty or eyelid lift, male breast reduction, and chin augmentation.

Posted in Uncategorized No Comments »

Summer’s Here, And So Is Teenage Rhinoplasty!

June 4th, 2011

The teenage years can be a very difficult time. The body is changing rapidly during this time, and the face develops and matures as well.  Over the course of the teenage years the nose changes shape and enlarges along with the face. Because of these physical changes, many rhinoplasty patients are teenagers who express displeasure with the appearance of their noses.  Teens who are unhappy with their nose often look in the mirror and notice only that feature, making them extremely self-conscious and embarrassed in social settings. They also may even be teased or bullied about this facial feature that deviates from what other kids consider to be “normal”.

Because unhappiness with the appearance of the nose is a common complaint for teenagers, rhinoplasty is a surgical procedure that can modify or change the existing look of the nose to a more aesthetically pleasing one and is a common procedure for teens to undergo.  We find this to be true especially during the summer months after school adjourns.

At what age is rhinoplasty a viable option? This is a common question asked by teens and their parents. The nose, specifically the septum and nasal bones, need to mature prior to any surgical procedure.  Prematurely disturbing this growth center of the septum where it lies in the midface could lead to abnormal development of the face. Therefore, it is essential that a teen’s facial growth is properly evaluated before undergoing the surgery to assure that it is an appropriate time to perform a rhinoplasty. Most teenage girls and boys can undergo the surgery successfully by age 15 or 16. When preparing for surgery, not only are patients evaluated from a physical perspective, but also from a psychological one. Rhinoplasty patients must be mature in their understanding of the benefits and limitations of the procedure and have reasonable expectations; parents must also be understanding and consent to the surgical procedure on behalf of their teen as well.

Rhinoplasty is one of the most challenging and complex plastic surgery procedures. It requires that the surgeon has a keen sense of artistic proportions, advanced surgical skills, and extensive experience with the way various nasal structures and tissues respond to surgical intervention, both immediately and with the passage of time. Dr. Aston has written textbook chapters and lectured on rhinoplasty to plastic surgeons, so for more information on rhinoplasty in this Manhattan practice, please click here.

Posted in Uncategorized No Comments »

The Cutting Edge Aesthetic Surgery Symposium 2011: Advanced Body Sculpting Head-to-Foot: Needle, Laser, Cannula, Knife

May 19th, 2011

Thanks for checking out the blog again! We would like to introduce you to our world-famous Cutting Edge Aesthetic Surgery Symposium 2011: Advanced Body Sculpting Head-to-Foot: Needle, Laser, Cannula, Knife.  This is a state-of -the-art aesthetic surgery symposium like none other, and will take place in New York City on December 1-3, 2011 at the Waldorf Astoria Hotel. This comprehensive course will be given over 3 full days.

The opening session will cover current and future stem cell biology and science with clinical applications.  Surgeons will then discuss their individual harvesting, preparation, and transfer techniques of autologous fat.  The symposium continues with sessions covering individual anatomic regions (from head to foot) treated with non-invasive and minimally invasive techniques and how these may compliment or replace more traditional surgery.  The closing session will address “the changing environment of aesthetic surgery; old versus new technology”.

In addition, on Thursday evening December 1, 2011, we will offer a Video Mini Symposium, and on Friday evening December 2, 2011, the Allergan Academy will present Advancements in Breast Aesthetics. An outstanding faculty of scientists, industry leaders, and plastic surgeons will make this a highly educational, stimulating and controversial meeting to equal or surpass the excitement of the 2010 Cutting Edge Symposium, which was sold out 6 weeks in advance. Please visit our Facebook Page
for this legendary cosmetic surgery meeting and “like” us!  I am pleased to be chairing this meeting along with my well-respected colleagues, Dr. Daniel C. Baker and Dr. Tom Rees.  If you are in the media and would like more information on attending our meeting and the latest hot topics to be discussed, please contact us at 212-249-6111.

Posted in Uncategorized No Comments »

Bikini body in 6 weeks! Plastic Surgery tips by Dr. Sherrell Aston

May 10th, 2011

Dr. Aston is on SiriusXM Radio! Listen in tonight at 6pm EST  on Doctor Radio (Sirius 81 XM 81) for some valuable summertime tips for looking your best!

One of the most important things that can be done in 6 weeks to be on a sensible diet that is low in carbohydrates and high in fruits, vegetables and lean meat.

The number of calories consumed each day should be equal to or less than the number of calories burned. Weight loss only occurs when you burn more calories than you consume.

In addition to the diet, engage daily in an aerobic activity such as: walking, jogging, elliptical trainer or sport of one’s choice. Shedding a few pounds and toning the muscles can help with the overall appearance for anyone.

Exfoliation of the skin to get rid of all the dead cells on the surface and daily moisturizers will help the skin have a better glow. A body lotion that has some retinoids in it can help to increase cell turnover and make the skin look better.

Laser hair removal from the bikini area is self-explanatory. However it may take 2 to 3 weeks and more than 1 session to get the hair loss to the point where one is happy.

Breast augmentation is the number 1 cosmetic procedure in the United States and is, without a question, the best and most straight forward means to make a bikini look good. Breast augmentation surgery requires approximately one and a half hours and one can resume all normal physical activities in 3 weeks.

Sagging breasts can be lifted and large breasts can be reduced, both procedures require more extensive incisions than a breast augmentation but the incisions are hidden within a bikini top.

Liposuction of various areas of the body can produce a change in love handles, tummy, saddle bags, inner thighs, knees and help show off that bikini bottom. Liposuction results are seen immediately but there will be some swelling in the areas for 3 to 4 weeks depending on the amount of liposuction performed. Obvious bruises disappear in 2 to 3 weeks.

Traditional liposuction is still the gold standard for body contouring.

Laser liposuction is a highly advertised procedure that is frequently used but there is no scientific documentation that there is an advantage over traditional liposuction. The stated advantages of skin retraction and tightening with laser liposuction is significantly overstated. Cryolipolysis or freezing of the fat cells without any surgery does work for isolated areas of fat removal such as love handles or a small area on the stomach but is not useful for large areas. The results with cryolipolysis may not be totally obvious for 2 to 3 months following the procedure.

Ultrasound and radio frequency devices for removing fat are producing minimal to a modest degree of results and patient satisfaction. These technologies will likely become more useful with the next generation of devices in the future.

Cellulite cannot be improved appreciably with any method, treatment or device. Constant massaging of the tissues with a number of different devices or even one’s hands can cause enough swelling in the tissues to give a very temporary improvement in the appearance of cellulite. When the swelling disappears, so will the apparent result.

There are a number of procedures that can be performed on the face such as upper and lower eyelid surgery, nasal surgery, short incision facelift, Botox and various kinds of fillers can be used to make one look younger, fresher and more relaxed.

Check it out on the SiriusXM website here.

Posted in Uncategorized No Comments »

Welcome to my Blog

May 6th, 2011

Within this regularly updated feature of my website, I will provide visitors with practice news and specials, as well as information regarding the most recent technological advances and new treatments in plastic surgery.

I believe that patient education and open communication with your doctor are the keys to achieving healthy, aesthetically-pleasing results and patient satisfaction, which is why I strive to provide the highest quality of care for patients of all ages. This is done by combining technical skill and broad experience with cutting-edge technology for impeccable medical and cosmetic results.

I sincerely appreciate you taking the time to visit my new blog. Please check back often to learn about the latest news, updates and additions to the practice and within the field of plastic surgery, and feel free to post comments and/or suggestions on any posts that you find of interest.

Posted in Uncategorized No Comments »