Floppy Earlobes?

You may have looked at your grandmother’s or mother’s ears (or heck, even your own) and noticed that they appear larger, especially around the earlobe.  Did you ever wonder what causes this?

  • Noses and ears actually do continue growing during our lifetime, albeit very slowly.  The underlying cartilage framework increases in size, and the overlying skin is subject to the effects of gravity just like the rest of the body.  This can result in larger ears, and even floppy earlobes.
  • Wearing heavy earrings can cause earlobes to stretch out as well.  Not only will the skin stretch, but the piercing hole will become elongated, so that your earrings always appear to be on the verge of falling out.

The good news is that large earlobes are easily treated.  Trimming the earlobes down is a simple procedure that involves numbing the area with local anesthetic, removing excess skin, and reshaping the earlobe with sutures.   If the piercing hole is stretched, this can be repaired at the same time.

original photo from shutterstock.com

original photo from shutterstock.com

If you look at the photo above, the area marked in blue is the skin that is removed. The resulting incision is in the shape of a T.  Reducing large earlobes does leave scars, but the earlobe usually heals very well, and the scars are generally not be noticeable after several months to a year.  Be aware, however, that earlobe reduction can remove an ear piercing, or change its position significantly, so you may need to have your ears re-pierced after they have fully healed.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Liposuction at the Same Time as Abdominoplasty

When I see patients who are unhappy with the appearance of their stomach, I may recommend abdominoplasty (tummy tuck), liposuction, or even a combination of the two.  Doing liposuction at the same time as an abdominoplasty seems logical: the goal of liposuction is to remove excess fat and the goal of abdominoplasty (tummy tuck) is to remove excess skin, so they are complimentary procedures.  But many people don’t realize that doing the two procedures at the same time can actually lead to problems.

During an abdominoplasty, the skin over the abdomen is elevated off the underlying muscles all the way up to the level of the rib cage.  This allows the excess skin to be pulled down and removed. On the figure below (demonstrated an an incredibly fit model, who admittedly need neither lipo or a tummy tuck), the blue outlines the area of skin which is elevated off the underlying muscles.

original image from shutterstock.com

original image from shutterstock.com

Lifting the skin up cuts many of the blood vessels which supply the skin with nutrients, so the blood supply to this skin flap is decreased.  Subsequently performing liposuction in an area with decreased blood supply can cause problems including skin necrosis, where the skin actually dies, leaving an open wound.  Thus liposuction over the central and upper abdomen (the areas marked in red) should be done cautiously and conservatively after an abdominoplasty.  The hips, thighs, and flanks, however, are not at all affected by having an abdominoplasty; performing liposuction on these areas at the same time is safe (areas marked in green).  If you are considering having liposuction and an abdominoplasty at the same time, here are some questions you may want to ask your surgeon:

  1. Do you do liposuction and an abdominoplasty at the same time?
  2. If so, how often do you perform this procedure?
  3. Have you ever had any complications?

To summarize, having an abdominoplasty and liposuction at the same time is possible.  Depending on the areas where liposuction is performed, the combination can lead to a higher complication rate.  If this is something you are considering, be sure that you feel comfortable with your surgeon’s experience level and his or her explanation of how the procedure will be performed, as well as the risks and benefits.

 

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Help for an Ugly Belly Button?

The belly button, or umbilicus, makes an important contribution to an attractive abdomen.  Ideally the umbilicus should be slightly taller than it is wide, with just a small amount of skin hooding over the top. This is the skin that a piercing would go through.

shutterstock.com

shutterstock.com

Weight gain and loss, pregnancy, and previous surgery can all affect the appearance of the umbilicus. The biggest complaint I hear from patients is “My belly button looks sad.”  There are surgical treatments that can help make the belly button more attractive.

The treatment options depend on what is causing the deformity:

  1. Rectus diastasis (stretching of the abdominal muscles).  Rectus diastasis occurs when the rectus muscles spread apart.  This commonly occurs with pregnancy.  In this instance, the belly button often appears shallow, and stretched out.  Fixing this problem requires realignment of the abdominal muscles, as is done with a full abdominoplasty.  Check out my previous post on abdominoplasty for more information.
  2. Scarring from previous surgery is another frequent cause of an unattractive umbilicus.  If you’ve had any sort of laparoscopic surgery (e.g. appendix or gallbladder removal), or if you ever had an umbilical hernia, you will have a scar at the top of your belly button.  The treatment here is excision of the excess skin that overhangs the scar- an umbilicoplasty.
  3. Excess fat will also cause the belly button to look less attractive.  If you are at or close to your ideal weight, liposuction may help spot-reduce fat around the belly button.
  4. Excess skin is another common culprit of an unattractive belly button.  This occurs after significant weight loss and after pregnancy.  The treatment in this case is usually a full abdominoplasty.

And what if your belly button is an “outie”?  Outie belly buttons are actually caused by a small hernia.  The fascia, or tough connective tissue, that covers your abdomen has a small hole in it, allowing intra-abdominal fat to herniate out.  In this case I recommend seeing a general surgeon to repair the hernia.  Fortunately repair is often covered by insurance.

Do you have a belly-button related question?  Or have you ever thought about changing the appearance of your belly button?  We’d love to hear from you!

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Tylenol and Pregnancy – Why the Media Can be Misleading

If you’ve been reading the news over the past couple of weeks, you may have noticed several articles questioning whether Tylenol is safe for pregnant women to take.  This started when the February 24, 2014 issue of JAMA Pediatrics published an article entitled “Acetaminophen Use During Pregnancy, Behavioral Problems, and Hyperkinetic Disorders”.  This was morphed by the media into articles proclaiming:

  • “Children born to women who used the painkiller acetaminophen during pregnancy may have an increased risk of developing behavioral problems like attention-deficit hyperactivity disorder (ADHD), according to new research.” (Fox News)
  • Acetaminophen use in pregnancy may be linked to ADHD (USA Today)
  • “The “safest” drug for relieving aches and pains, lowering fever and treating headaches in pregnancy may not be so safe after all, according to a new report — it may raise the risk of ADHD and similar disorders in their children.” (NBC News)                                           -italics are mine
Photo: Jim Merithew/Wired.com.

Photo: Jim Merithew/Wired.com.

I realize that I am a Plastic Surgeon, and obstetrics is not my area of expertise. But these headlines bring up an important point: thanks to modern media and news sources, we are inundated by medical information on a daily basis.  The way this information is presented is often skewed, erroneous, or sensationalistic, leaving it up to the average consumer to sort through and find the truth.  The recent news stories on Tylenol in pregnancy highlight this fact.  The article published in JAMA did demonstrate a correlation between Tylenol use and ADHD- but basic statistics knowledge tells us that correlation between two things does not  mean that one causes the other.

So what did this study actually show?  It showed that mothers who take Tylenol during pregnancy have children with a higher incidence of behavioral disorders such as ADHD.  Does this mean that taking Tylenol caused the ADHD?  No.  It does not.  And many of the articles that I referred to above were very careful to make this point.  The USA Today article specifically states “Experts say the study does not prove a cause-and-effect relationship and more study is needed.”  Other news sources, however, skew the facts a bit to make for a more interesting story.  For example, the article on NBC News used phrasing that made it seem as if there is a direct cause and effect relationship.  The headline on the article states: “Pain Pill in Pregnancy May Raise Child’s ADHD Risk, Study Finds.” But this is wrong.  This is not what the study found at all.

So how do you navigate your way through such confusing information?  Any pregnant woman reading these news stories is bound to wonder whether she can use Tylenol or not.  And the stories themselves often don’t make it very clear.  So here are my recommendations:

  1. Check with more than one news source, and read the article carefully.  We’ve shown here that the media takes liberties with the way things are phrased, which can drastically change the meaning and implications.  Checking with a couple of different sources can help give you a more accurate picture.
  2. When it comes to your health, don’t make drastic changes to your behavior based on popular media.  Trying to keep up with the latest recommendations in terms of diet, exercise, or even medications is simply not possible.
  3. Ask your doctor.  In the above example, some of the news stories made it sound as if pregnant women should stop taking Tylenol immediately.  But deciding not to take Tylenol because of the results of a single study is a fairly drastic decision.  After all, Tylenol is the only over-the-counter pain medication considered safe in pregnancy.  If you ask your physician his or her recommendations, you will likely get a very different answer.

Have you read a health or medical news article that you found confusing or misleading?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Breast Implants: Silicone vs. Saline

This question is very similar to asking which is better, a nail or a screw?  Think of breast implants as a tool to accomplish a task.  One may be better than another in certain situations, but they’re both simply means to an end.

www.sientra.com

www.sientra.com

Here are the important things to know:

  1. Both silicone and saline implants are safe.  Although silicone implants were removed from the market for several years, multiple studies since then have shown that they are safe to use.  In 2006, they were approved by the FDA for use in women age 22 or older.
  2. Both types of implants have a silicone shell.  Silicone implants are then filled with malleable silicone, whereas saline implants are filled with sterile saltwater.
  3. Both implants have similar risks, including rupture of the implant, formation of scar tissue around the implant (capsular contracture) and infection.  If a saline implant ruptures, the saline is reabsorbed and the implant deflates.  If a silicone implant ruptures, the silicone stays in place, so further tests such as an ultrasound or MRI may be needed to diagnose the rupture.
  4. The implants do feel different.  I personally think that silicone implants feel softer and a bit more natural, but this is something you should decide for yourself.  If you see a plastic surgeon regarding breast augmentation, he or she will have both types of implant available for you to feel.
  5. Saline implants are placed in the breast empty, then filled with saline after they are in place.  Silicone implants are pre-filled.  So saline implants are more adjustable in terms of size- they can be filled to any amount within a specified range, whereas the silicone implants come in 25-30 ml increments.
  6. Silicone implants cost a few hundred dollars more.  The cost difference is small enough that it likely will not affect your decision-making process, but it is something to be aware of.

Given the above information, how do you choose a type of implant?  If you do not feel strongly one way or another, ask your physician for a recommendation.  I tend to use silicone implants more often for augmentation, because they feel very natural.  I also use them in bilateral breast reconstruction for the same reason.  If there is a significant difference in size between two breasts, or if I am doing a unilateral breast reconstruction, I will recommend saline implants to obtain a better size match.

Do you have any questions about saline or silicone breast implants?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.