Plastic Surgery -- What Can It Do for You? -- Shlomo Widder, MD -- Nov. 6, 2002

WebMD Live Events Transcript

Plastic surgery, once the exclusive province of stars and the wealthy, has now become a mainstream choice. Shlomo Widder, MD, answered our member's questions about the latest techniques to lift, tuck, and iron out the wrinkles, sags, and bags.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live, Dr. Widder. We have a lot of questions from our members. Let's get started with them.

Member: I have excess skin from weight loss and stretch marks. What procedures are there for me?

Widder: It depends on the area you have the skin excess in. If it's in the abdomen, then a tummy tuck might be a good procedure. If the skin looseness is in the thighs it can be a thigh lift. If the skin laxity is in the arms, it can be an armplasty or tightening of the skin of the arm. The best thing for you to do is visit a plastic surgeon and discuss your needs individually.

Moderator: What is involved in a tummy tuck? And who is a good candidate?

Widder: The most common candidate is a female who had pregnancies and delivered babies that stretched the skin and the muscles of the abdomen got separated. The tummy tuck is the only procedure that can tighten the skin and muscle and restore the flatness of the abdomen. That procedure can be also suitable for those who have lost weight and consequently the skin loosened up. Many times the muscle is also loose. This is because of loose skin and muscles that diet and exercise doesn't improve.

So these are the most common candidates for this procedure, and it can be done as early as age 18 to 20, which I have done myself. It can even go up to 60 or 70 years old, as long as the individual is healthy. It can be done in a hospital or in surgical center or in office surgeries. It should be in an accredited facility. As long as you get accreditation so you take care of the safety of the patient it can be done in the office. The patient should make sure his or her safety is a concern of the office or the facility, because a tummy tuck is a big operation and the surgery takes about 4 to 4 1/2 hours to do. So you want to do it in a hospital or accredited facility.

The recovery as far as pain and discomfort is two to three days. Return to comfortable motion and light activity is between one to two weeks. To return to normal physical activities like exercise and weight lifting is 6 weeks.

Member: How bad is scarring in these procedures (tummy tuck, armplasty)?

Widder: The scar is something that the patient should accept. It is hidden along the groin and above the pubic bone. It can be hidden by underwear or the bikini. Most of the patients heal nicely with the scar and some develop a keloid.

Member: I'm Korean, 5'1" and weigh 120 pounds; I am very small boned. I appear to be thin from the outside but my weight is unevenly distributed; my arms and upper body are extremely thin and all my weight is in my stomach; it's huge for my body. Would I be a good candidate for liposuction? Or what procedure could help me lose my stomach fat?

Widder: If you are young without history of childbirth and the skin is not loose, you are a good candidate for liposuction as long as there is fat deposit in the area. If you had children or lost weight and the skin is loose, then naturally the preferred surgery is a tummy tuck.

Member: I am 55 and have mild bags under both eyes that started developing around 1992. Now I would like to have them removed. How easy is the procedure and what are its complications?

Widder: Well, every procedure should be taken seriously with the utmost respect to it. There is no easy procedure. The surgery takes about an hour and a half. There is really no pain involved. But if not done correctly, you can have complications. If too much skin is removed the eyelid can be pulled down. There can be a hematoma or blood clot or infection, though the complication rate is low as long as it's done by a competent plastic surgeon. It's less than 2%.

Member: I had one Botox treatment around my eyes (crow's-feet). I am 56 and was not entirely happy with the results. I felt that the paralyzed muscles tended to make my skin sag. Is that normal, and do you recommend Botox rather than a blepharplasty at my age?

Widder: The two procedures are not mutually exclusive. You can do both. The Botox is paralyzing the muscle and the eyelid surgery removes excess skin. So by doing the eyelid surgery, the skin will be nice and tight. However, when you are laughing the wrinkling will return. So the Botox can be done later on or after the surgery, which will give the skin without redundancy or wrinkles and the paralyzed muscle will prevent the skin from wrinkling while smiling or laughing.

Member: I'm a dark-skinned African-American woman with noticeable blemishes left over from teenage acne. I'm interested in dermabrasion, but I'm unsure about it scarring my skin. Is it safe? If so, how many treatments will I need before I see results?

Widder: I am very reluctant to do dermabrasion or laser surgery on African Americans due to the possibility of hypopigmentation and hyperpigmentation, which is excess color or loss of color. And so my recommendation is to have it done with a plastic surgeon or dermatologist with extensive experience with that condition.

Member: What are the latest procedures for treating acne scars?

Widder: There are different procedures. In my mind the laser is procedure of choice for acne scars, but dermabrasion can also be satisfactory as well. Laser is a machine that uses electromagnetic waves and burns the skin. By removing the outer layer of the skin, the skin gets smooth. In addition, the injury causes tightening of the collagen fibers in the dermis, and that gives you tightening of the skin. And so by using the laser, the removal of the outer layer of the skin smoothes it and makes it more uniform and tighter. Dermabrasion has a similar effect, except that it's less consistent unless the surgeon has extensive experience with that technique.

Member: I'm from Singapore. I had protruding ears and went for a surgery to correct them in 2001, but my ears came out again just three months after the surgery when the stitches dissolved. I found out that the doc had only folded back my ears and stitched them together without trimming the cartilage. Did he do the right procedure? I am devastated about how they came out.

Widder: For protruding ear, you do not necessarily need to remove cartilage unless the ear is really protruding extensively, then cartilage removal might be indicated. Although it's rare. In most cases, the technique to achieve permanency of the resetting of the ear is to use non-absorbing sutures. Most likely what happened is that the suture dissolved too early, not allowing time for the scar to be deposited and strengthened. As a result, the ear relapsed. Your condition can be improved by re-doing the procedure and using the correct sutures.

Member: What can be done for a small scar on the face? I had a growth removed and need help with a scar.

Widder: The scar removal is a pretty straightforward procedure. If it's wide or large or elevated, it can be excised preferably along the tension line of the face or smiling lines, so that the scar will blend into the face line. And usually in the face the scars heal very nicely.

Member: My son had heart surgery when he was 8 months old; he is now 9 years old. He is left with chest scars as well as scars from IVs and tubes; will the smaller scars fade? Also, can anything be done for the larger chest scar? He really tries to hide it. Thanks.

Widder: Yes. The scars can be improved by re-excising them in meticulous repair, although the chest bone area is known for keloid or hypotrophic scars. Not everyone develops that condition so it's probably worth trying to revise the scar. I would recommend, though, to do it at a later age when the procedure can be done under local anesthesia rather than putting the patient to sleep due to his young age. Although I have seen young children at age 9 or 10 that were able to tolerate the local anesthesia.

Member: What is the best way, or what is the best product to use, to hide the lines around the mouth?

Widder: The lines around the mouth can be classified to a young person or a more advanced age person. If the lines are very fine, they can be improved by facial care that includes chemical peel and Retin-A. If more pronounced and no skin redundancy, then laser can help significantly. If there is significant redundancy including jowls, then facelift is the best approach.

Member: What are the pros and cons of Botox? How does it take wrinkles away?

Widder: Botox is a drug that is being developed from botulism, which in a large concentration is a poison. However, in cosmetic surgery, the amounts are very, very small. And the drug is paralyzing the muscle. The amounts being used are between 2 1/2 to 4 or 5 units per injection. The most I have injected was 100 units for the forehead and periorbital area. The poisonous amount is about 500 times higher. The side effects of the injection of Botox are local bruising from the injection, and very rarely, droopiness of the upper eyelid, which is resolving within a period of about a month.

Member: I am overweight by 100 pounds. I have acne scars and deep wrinkles (I am 58 years). Should I wait until I lose weight to have a facelift or laser treatment?

Widder: Well, it really depends on the patient and how much he or she is troubled by the facial condition, because if the patient is planning to lose 100 pounds, naturally the skin will get looser. But if the patient is not planning to lose weight and the skin is loose, the patient will benefit from facelift, and there is no reason to delay the procedure.

Member: I had recently gone in for removal and replacement of my breast implants. At the time I went in to surgery I thought they were going over the muscle and when I came out I found out they had gone under the muscle. I am worried that this will make the implants look strange. I also have inverted nipples and wanted to have them fixed to stick out like normal nipples. Am I being impossible? Can you recommend anything to fix my nipples?

Widder: Putting the implants under the muscle is the most common way of doing breast augmentation. That's the only method I use. Results are nice and the implant is hidden behind the muscle so it's not visible and there is no rippling of the skin unless the patient is very thin. By placing the implant under the muscle, the surgeon did the right thing for you. The nipple inversion can be corrected by a plastic surgeon that can perform the procedure under local anesthesia. NO, you are not being impossible. That's why there are plastic surgeons to help people with these problems.

Moderator: Can you tell us about the latest trends in plastic surgery? What new procedures or techniques are on the horizon?

Widder: I don't know if there are really new procedures as of recent, but in the last few years there were new procedures that help with taking care of the face like the endoscopic surgery, which works very nicely for forehead lifts. There are the procedures of fat injection to fill out depressions or obtain a more youthful look. Botox is definitely a recent approval by the FDA for cosmetic surgery. There are new fillers other than fat that are being submitted in the meetings. But one has to be careful with them since there is not enough experience yet with those fillers. I would rather wait for more experience with those new fillers before using them on my patients.

Member: What areas of the body can be sculpted with liposuction? I'm interested in arms, inner leg near knee, and back especially?

Widder: Yes, the areas you mentioned are definitely good areas for liposuction. It is a contouring procedure. It's not a weight reduction procedure. As long as the skin isn't loose and there are fat deposits, the area is a good place to do the liposuction. Other areas are the neck, abdomen, thighs, legs, as long as the skin is elastic. Liposuction is a very wonderful procedure, and it makes patients extremely happy.

Moderator: So if a patient is overweight, they should not expect liposuction to do the work for them?

Widder: That's correct. If they are significantly overweight, other procedures should be done first before these procedures are contemplated. One example is the gastro bypass that is done by a general surgeon. It's a great procedure. I have done tummy tucks on patients who had weight loss after weight reduction surgery (gastric bypass) where they had lost 80, 90 or 100 pounds. Once this is done they stabilize after weight loss. These types of surgeries are wonderful for the self-image and confidence of the patient.

Moderator: How does one choose a plastic surgeon?

Widder: I would look at few criteria that should be considered when one goes to a plastic surgeon. He should be board certified so that he at least has the knowledge. The board certification means the doctor passed written and oral exams that determine he has enough knowledge to practice plastic surgery. That's not enough to assure the patient though that he's a good technician. Look at before and after pictures.

Make sure the surgeon can deliver what is promised. I also recommend having one, two, or three patients that were previously operated on by the surgeon call the prospective patient and tell them about their experience to make sure the surgeon has nice bedside manners and is attentive. If the procedure is to be done in an office facility, make sure it's accredited by one of the accreditation organizations, AAAASF.

Moderator: The American Board of Plastic Surgery is the only Board recognized by the American Board of Medical Specialists to certify plastic surgeons.

Widder: Right. You have to make sure you are going to a surgeon certified by a recognized board. Not all boards claimed by plastic surgeons are recognized boards.

Moderator: What do you think of African Americans getting nose surgery as far as keloids and scarring?

Widder: An African American can do nose surgery. I have not seen keloid on the nose. If you want to go and see an experienced plastic surgeon, I recommend they are board certified in your area. Ask him to show results for African American patients. This is the best way to select a good surgeon.

Moderator: Dr. Widder, we are almost out of time. Do you have any final comments for us today?

Widder: I think that plastic surgery is a wonderful option to have. There is no reason to go through life with being unhappy with the way one looks. All the energy spent camouflaging it is not necessarily the right thing to do. The surgery is safe and predictable. I recommend for anyone to talk to a plastic surgeon and base your decision on the before and after photos as well as the credentials and training of the surgeon.

Moderator: We are out of time. Thanks to Shlomo Widder, MD, for joining us today. To learn more about plastic surgery, be sure to explore all the info here at WebMD, including our message boards and live chats.



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