Q. Tell us about yourself and your practice.
A. My two passions are plastic surgery and my family and I am now proud to bring my wife and daughter home to provide my services to the communities of the Gulf Coast as an integral part of the Mobile medical community. In opening my own clinic, The Park Clinic for Cosmetic and Reconstructive Surgery, PC and joining with Dr. Roberta Swain and Dermatology and Dermatologic Surgery of Mobile, PC, creating Mobile Plastic & Reconstructive Surgery and Dermatology, Inc, the goals of myself and my staff are to provide world-class reconstructive and cosmetic care to my patients in a professional, informed, personal, safe, private, and comfortable environment.
Q. Please explain the primary procedures performed by your practice.
i. Breast reconstruction - Clearly, the primary goal in the management of breast cancer is cure of the disease, but treatment should consider the cosmetic outcome if the patient so wishes, as there are important psychological benefits to breast reconstruction for those women who desire breast reconstruction. There are two basic options in breast reconstruction – implants or tissue from other parts of the body.
ii. Other cancer - Cancer and its treatment may lead to skin defects, bone loss, soft tissue defects, absence of structures such as the breast, or asymmetry, among other problems. Reconstruction utilizes similar techniques of grafts, flaps, tissue expansion, and other modifications. Common cancers treated by me include Skin Cancer, Breast Cancer, Hand tumors, and Head and Neck cancer. I perform all aspects of skin cancer management including diagnosis, treatment, reconstruction, and monitoring. However, dermatology assistance is also common, especially removal of the defect by Mohs surgery technique.
iii. Abdominoplasty - An abdominoplasty is a cosmetic operation not covered by insurance aimed at re-contouring the abdominal wall, but muscle tightening also may improve low back discomfort and strength. The operation can be safely performed in an outpatient or office operating room facility with general anesthesia, deep sedation, or epidural block. Incisions are designed to place scars under a preferred underwear or bathing suit pattern. After elevating the abdominal wall and redraping, excess skin and fat are removed and the abdominal muscles are tightened to improve the waist line. Often the vertical abdominal muscles are separated, a "diastasis rectus," and the hourglass narrowing above the hips are lost, both of which can be improved with internal sutures. The existing navel (umbilicus) is preserved and transposed. The procedure takes approximately 2 to 3 hours.
iv. Liposuction - Liposuction uses high pressure suction to remove fat from undesired areas and thick deposits on the body, most commonly from the hips, buttocks, knees, abdomen, thighs, back, upper arms, chin, or neck. Liposuction is not a substitute for weight loss, as the amount of fat that can be safely removed and the ability of the skin to shrink down are limited especially after previous skin expansion with pregnancy and significant weight fluctuations.
v. Thighs - The most common thigh complaints are excess fat or loose skin, which are often incorrectable with diet and exercise. Localized medial or lateral thigh excess, such as "saddlebags," can usually be corrected with thigh liposuction. The medial thigh occasionally requires excisional techniques, usually limited to a scar in the inguinal crease, but down the leg in severe cases. Both excisions and liposuction in the medial thigh should be performed by trained plastic surgeons as there are important vascular, neural, and lympathic structures at risk in this area and the thin, loose skin may not contour well after liposuction. Circumferential adiposity is more difficult to correct. It is possible to liposuction circumferentially but the risks are increased and conservative, serial treatments may be necessary to remove the desired amount of fat in a safe manner.
vi. Arms - Fat deposits and skin laxity in the upper part of the arm and armpit are common, even in the absence of obesity. Moderate fat deposition can be treated with arm liposuction with minimal scarring in the armpit. A brachioplasty, removal of excess skin and fat, may be necessary to rejuvenate arms with excessive, hanging skin, especially after significant weight loss. The scarring may be limited to a transverse scar in the armpit, but typically requires a longitudinal scar down the inner arm. This scar is planned to be masked when the arms are at one’s side but may be visible when the arms are elevated.
vii. Breast augmentation - Breast augmentation, or augmentation mammoplasty, is a surgical technique to increase the size of the breasts. Any woman that desires a larger breast may be a candidate for breast augmentation if she has realistic expectations. There are other techniques to increase the size of the breasts, but the most trusted technique is placement of an implant surgically. There are multiple options that are discussed and decided during a breast augmentation consulation.
viii. Breast lift - Sagging or ptotic breasts occur with age, pregnancy, and weight fluctuations, but can be improved with a breast lift, or mastopexy. In the case of mild ptosis or deflation hypomastia, a breast implant alone may correct the deformity. Moderate ptosis can be corrected by excision of skin in a doughnut fashion around the areola. More severe sag will require a vertical scar or anchor shaped scar below the nipple to tighten the loose breast around the elevated nipple. Preoperative evaluation with physical exam, mammogram, or ultrasound will be performed prior to surgery to rule out cancer and all pregnancies should be completed prior to mastopexy.
ix. Breast Reduction - Large, heavy breasts can cause a number of problems including neck pain, back pain, bra strap grooving, upper extremity nerve compression, rashes, or yeast infections, as well as considerable embarrassment, especially to younger women and teenagers. Women experiencing any of these problems may be candidates for a breast reduction. A breast reduction removes excess tissue and returns the descended nipple/areola to a more normal size and position, producing more comfortable, proportional, and aesthetic breasts.
x. Facelift - A facelift (rhytidectomy) tightens the lower face and neck by removing excess skin and resuspending the support structures of the face to improve the jowls, nasolabial folds, downturned mouth, platysmal bands and lax neck.
xi. Necklift - The neck can be addressed alone or with a facelift. Excessive fat in the neck can be removed with liposuction, but in most instances, a short incision is needed below the chin to remove excess fat and address the muscles of the neck by placating platysmal separation in the midline and transaction of longitudinal bands. With a facelift, tightening of the SMAS and tension behind the ear and along the posterior hairline will rejuvenate the neck. Without a facelift, adjunctive measures to tighten the neck skin, such as ultrasonic treatment or direct skin excision
xii. Nosejob - The nose is the dominant feature of the face and is the most common reason to seek plastic surgery consultation. In a rhinoplasty, the bone and cartilage framework are modified and the skin is redraped. Thin, smooth skin redrapes, but thick, oily skin will limit the final result.
xiii. Browlift - The forehead-brow lift operation can be performed alone, with eyelid surgery, or with a facelift. The forehead-brow lift is an important component of facial rejuvenation procedures in most individuals over the age of 50. The operation is designed to correct sagging eyebrows, to lift heavy brow skin that hoods the upper eyelids, and to correct the deep wrinkles between the eyes and on the forehead. It can also be very beneficial in younger patients who have congenital or early descent of the brows. It may also be an essential component of operations to correct the upper eyelids since a significant portion of upper lid complaints may be due to the heavy brow skin that has descended onto the upper lid, a problem not correctable by operation on the upper lids alone.
If fingers on the forehead gently pulling the eyebrows up corrects the heaviness in the upper lids and provides a more youthful appearance, the patient is likely a candidate for a brow lift. In the glabella (between the eyes) the deep vertical creases are caused by the corrugator muscles and transverse wrinkles are caused by the procerus muscle. The transverse creases in the forehead are caused by the frontalis muscle. Long term activity leads to deep wrinkles that are always present. These muscles can be treated with Botox® but are best addressed by muscle division during the operation.
xiv. Eyelid tuck - The typical complaints of a good candidate for eyelid surgery are heavy or droopy upper lids, bags and puffiness of the lower lids, or excess, wrinkled skin in the lids. A natural consequence of aging, these characteristics can also occur prematurely in younger individuals. The changes with age in both the upper and lower eyelids are a result of excess skin and protrusion of fat but other structures may be involved or even the root of the problem. In younger patients there may be little or no skin redundancy and all lid changes may be due to protrusion of fat due to weakness of the septum or muscle. In addition to the assessment of the skin, muscle, septum, and fat, it is important to appreciate any sagging of the eyebrows as a brow lift may be needed. Blepharoplasty in simplistic terms is directed at removal of the excess skin and fat bags from the upper and/or lower eyelids. Crow’s feet, are not improved by a standard blepharoplasty. If excessive skin impairs the visual field, correction may be considered reconstructive and it may be covered by insurance. Outside of this situation, however, eyelid surgery is considered cosmetic, and is typically not covered by insurance.
xv. Common complaints related to the lip include lips that are too fat, too short, too thin, too long, and too wrinkled. The latter three become more prevalent with age, sun exposure, and cigarette smoking. Lip reduction is a procedure to reduce a prominent or protruding lip. With local anesthesia, intraoral mucosa is removed which shortens and debulks the lip. Lip augmentation includes injectable collagen (Zyplast®), fat, or other fillers (i.e. Restylane®, Juvederm®), surgical placement of permanent or semipermanent implant material (Goretex®, Softform®, Medpor®, Alloderm®), or surgical enhancement including lip advancement and lip lift. In lip advancement, a small strip of skin is removed where the lip meets skin. When this wound is closed, it gently everts the mucosa, providing a shorter, fuller appearing lip. In a lip lift, a small ellipse of skin is removed from the upper lip at the junction with the nose and as the wound is closed, it lifts the lip, shortening it. The corner of the mouth lift is a direct excision of skin above the commissure. Plumping of the lip can also be surgically performed without implants by advancing intraoral tissue.
xvi. Chin - A mild degree of retrogenia, setback chin, or microgenia, deficient chin, can be corrected with placement of a prosthetic chin implant, which is a quick, relatively simple operation that can be done under local anesthesia either through the mouth or below the chin crease. In more severely deficient or weak chins the correction is best accomplished with chin advancement, known as a genioplasty, which involves moving moving the bone to achieve the desired effects. Plates and screws are necessary and a bone graft may be required to add height. A foreign body is avoided but recovery is more significant. A chin that extends too far forward can be corrected by a chin reduction, either burring bone, cutting bone, resecting a wedge of bone, or sliding bone. The soft tissues of the chin may be a source of complaints for patients. A pseudo-deficiency may be due to excess skin or fat surrounding and/or below the chin, a "double chin." Correction of the neck with liposuction or neck lift may correct the appearance of the chin. As the face ages, the chin descends, creating a "droopy chin" or "witch’s chin", but a chin lift can be performed.
xvii. Post weight loss surgery - Obesity is a major health crisis with 32% of Americans classified as obese and 5 % as morbidly obese. Weight loss surgery is the most effective long-term treatment for obesity and approximately 200,000 procedures are performed annually. Unfortunately, the surgery does not take care of all of the problems since markedly stretch skin loses its ability to contract completely. Multiple plastic surgery procedures are necessary to improve hygiene and cosmesis after weight is stable at its new low. The most common procedures include a lower body lift, abdominoplasty, thigh lift, breast surgery, upper arm lift (Brachioplasty), blepharoplasty (eyelids), and face/neck lift. A thorough consultation is necessary to determine the staging of the needed surgeries based on patient desires and safety. With most health insurance plans, these are cosmetic surgeries not covered by insurance. Certain procedures combined with reconstructive procedures such as hernia repair may allow for partial coverage but clear communication is necessary to avoid confusion.
xviii. Minimally invasive procedures – a number of minimally invasive treatments can improve wrinkles and hide aging. This includes botox, fat grafts, hyaluronic acids (juvederm, restylane), sculptra, radiesse, etc. These treatments can be done in the office.
Q. Are you certified by the American Board of Plastic Surgery?
A. Yes
Q. Do you have hospital privileges to perform this surgery?
A. Yes at 5 different hospitals
Q. Where will you perform my surgery?
A. Depending on the type of surgery, I perform my operations either at an ambulatory surgery center for the more private feel or at the hospital when more care is necessary.
Q. What is the difference between Cosmetic and Reconstructive surgery?
A. The end result is usually the same but with different reasons and perspective, maximizing ones appearance, function, and self esteem. The barriers can be fuzzy but in general, cosmetic surgery is not covered by insurance and requires more personal investment.
Q. What benefits does Reconstructive surgery provide?
A. The ability to restore ones function and comfort.
Q. Who is a good candidate for Reconstructive surgery?
A. Anyone who has a problem or defect that is impeding their life.
Q. Does Reconstructive surgery have possible risks and complications?
A. Of course, they are procedure specific and the benefits of an operation must outweigh the risks.
Q. How is a chemical peel performed?
A. Chemical peels are medical procedures that use a variety of chemicals to either lyse or coagulate the skin, leading to rapid exfoliation of the epidermis and superficial dermis. They are designed to treat the changes that occur with genetic and photo-aging, including irregular pigmentation, reduced elastic fibers, fine wrinkling, and slow cellular turnover. The depth of peel is determined by the expectations, budget, and allowable recuperation time.
Superficial peels (Glycolic Acid, Salicylic Acid, Jessner’s solution) are nonablative but remove the top layer of the epidermis and stimulate healing, thickening, and hydration. A superficial peel is appropriate for a patient wishing to correct fine wrinkles and mild degrees of hyperpigmentation.
Medium depth peels (Trichloroacetic acid :TCA) are ablative and reach into the dermis. Depth of treatment is not only dependent on the concentration but on preparation of skin and the number of applications and can be judged by the frosting that occurs during the procedure. With the increased depth of peel comes significant additional improvements in skin elasticity, hydration, tone, and color, but also increased discomfort and risks of scarring, infection, and altered pigmentation.
Deep peels (Phenol / Croton Oil) are ablative and extend into the deep dermis, leading to the deposition of new epidermis and dermis with normal elastic fibers, glycosaminoglycans, and collagen. However, this is a deep, painful burn done only under sedation and the patient needs to be monitored and resuscitation equipment should be available.
Q. What is the recovery time for a chemical peel?
A. Superficial peel – hours to 2 days
Medium depth – 2 weeks
Deep peel – 6 weeks
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