I am looking into having a breast augmentation within the next 3 months, but the only potential surgeon I’ve met with so far told me that he would not do the breast augmentation unless I would consider a smaller breast implant size. I was completely shocked by this. My breasts have been extremely small my entire life (AA cups) — I have always had to wear a “training bra” and was teased about this a lot growing up. I want to get DD or larger breast implants. Lots of women get breast implants WAY bigger than DD, so why am I being told my request is unreasonable? How do breast augmentation surgeons decide how big is too big for different people?

A. There are important anatomic considerations for breast implant size

The size of your chest wall, (the dimensions of the boney chest) serves as a starting point to determine what implants may be tolerated. Next, one has to have enough native breast skin that can be stretched to accommodate the implant. If someone has very small breast with minimal skin laxity, it will limit what size implant can be placed under the skin. Other factors such as the amount of existing breast tissue and nipple position also need to be considered.

In general, an inappropriately large sized implant can create a lot of problems for you and your surgeon has the responsibility to inform you properly.

I had liposuction 6 months ago and up with a few contour irregularities. They look like mogul-type lumps, not dimply like cellulite. My plastic surgeon said he could do a touch-up with a cannula that resembles a cheese grater, but not remove any more fat.
He said this would help smooth the lumps. But he also mentioned that one complication of using this instrument could be damage to the blood supply to the overlying skin. He hasn’t seen this personally, but it does worry me. Is this a good procedure to smooth out lumps, and are the risks to the skin worth it?

A: It is important to know whether the bumps are excess fat or post-liposuction scars.

The bumps you are referring to could be either scar tissue that has formed after liposuction. If that is the case, time and massage should provide some improvement. A persistently hard scar may respond to corticosteroid injection, however, this injection can have its own set of complications such as tissue atrophy and telangiectasias, so not a great choice.
If the bumps are due to under-suctioned fat deposits, then liposuction with a small cannula could be helpful. The closer these deformities are to the actual skin, the less likely it is to achieve excellent correction.
Being prudent about revisional surgery is very smart. In the case evolving scars, time is usually on your side.

Will Thermage Fix My Under Eye Sagging Skin, Or Will A Lower Blepharoplasty Work Better?

A: Thermage is not the answer to your problem.

Thermage may work on some areas of the body in some individuals some of the time!! For specific and distinct skin excess, the results may be disappointing. For mildly loose skin or to prevent it, Thermage may be valuable. Lower eyelids can be improved with Fraxel, peels or surgery.

Looking Done is So Last Decade: The Cultural Shift Towards Age Appropriate Cosmetic Procedures

Middle aged is no longer synonymous with matronly. The over 40 woman is a force with whom to be reckoned. She is no longer seeking the fountain of youth, but rather seeks to look as good as possible – for her age that is. Women want to look refreshed, healthy and energized. They are less concerned with looking 20 years younger

Instead, women over 40 are wearing their hair longer, sporting bikinis and have more economic power and independence than ever before. And, say these women, why should beauty be intrinsically linked to youth?

In an “age appropriate” movement, plastic surgery too has evolved. “Ironically, older techniques may have removed excess skin to combat aging, but these procedures did nothing to restore youthfulness,” says Clinical Assistant Professor of Plastic Surgery at USC, Dr. Reza Nabavian.

Dr. Nabavian reflects a school of thought that subtlety is best, advocating for minimally invasive and preventative techniques that avoid nipping and tucking where ever possible.

The first defense and treatment of aging, he says, resides in proper skin care. “Signs of aging begin with the condition of the skin itself. Sun damage, environmental factors and overall physical and mental health contribute to the health of the skin.” For younger patients, he suggests treating hyperactive glands and acne using treatments such as glycolics and sunscreens. More mature patients require more intensive agents, such as retinoids and vitamin C to gradually resurface the skin and decrease sunspots and wrinkles.

And where wrinkles stand their ground, Dr. Nabavian advocates the use of Botox, Thermage and fat transfers. Where Botox is concerned, Dr. Nabavian warns that, “Botox is commonly misused and has been known to cause a masked and unnatural appearance. One needs to keep in mind that facial movement is a natural process that needs to be preserved.”

Fat transfers, he says are the most natural and non invasive way of rejuvenating hollow or aging skin. “We can now use a patient’s own fat cells to restore fullness and proportion to the face and body. This procedure enhances the appearance with no use of synthetic fillers, implants and drastic surgery.”

The Academy for Peace and Justice Opens New Wing of Classrooms: USC Professor Dr. Reza NabavianBrings Health and Education to Haiti

On Friday, November 18, 2011, Artists for Peace and Justice (APJ) celebrates the opening of a beautiful new wing of classrooms at Haiti’s first free secondary school, The Academy for Peace and Justice.

7th and 8th grades are in action for this academic year, set in the new school building. The next phase of construction of the school will start in the spring.

“This is why we fight for Haiti. We are now educating nearly 800 secondary students,” said APJ board member Dr. Reza Nabavian.

Another APJ board member, Paul Haggis, was in Haiti with the organization to mark this benchmark in the ongoing efforts to rebuild Haiti.

APJ continues to support the medical relief projects at St. Damien hospital.

“We are having a series of donor trips to Haiti over the next few months to attract new support for our ever-expanding projects,” says Dr. Nabavian

No Schools for the Masses

“APJ’s main project is to deliver free education because so many kids have no access to school.” In Haiti, education is not free – and as one of the world’s poorest countries, many Haitians simply can’t afford to educate their children. “We created a free middle and high school for kids in the slums. We are building campuses to provide free education.” The curriculum includes music, art, film, community service and computer, leadership and vocational training. “APJ could take up 200% of my time, if I could give it. There’s just so much need down there.”

“I’ve worked on some high profile people, making them look better. But there is a higher level of personal fulfillment when you realize that what you have learned can make such a huge impact on people that have so much need.”

“I’ve always seen myself as a doctor first and a plastic surgeon second,” says Dr. Reza Nabavian, Los Angeles plastic surgeon and USC professor.

Passion to Rebuild Haiti

Dr. Nabavian’s time is in high demand. As a private practicing plastic surgeon, Dr. Nabavian has some pretty high profile clients. And as the Director of Aesthetic Surgery Education at USC, his expertise is a critical component of the university’s residency program. As if serving on multiple panels and maintaining two full time jobs weren’t enough, Dr Nabavian is on the Artists for Peace and Justice Board of Directors. He shares the board with Paul Haggis, Ben Stiller, Olivia Wilde and Dr. Bob Arnot.

Artists for Peace and Justice is a star studded charity that focuses primarily on providing schools for Haitians and secondarily for delivering medical aid. Since the 2008 earthquake, Dr. Nabavian has gone to Haiti over a dozen times to lend a medical hand, “There are two components to our efforts: general and medical relief. I go there to perform surgeries, support hospitals and rehab centers and to help kids with prosthetics.”

Stem Cell Face Lifts:
The Future of Plastic Surgery
Dr. Reza Nabavian Studies the Regenerative Effects of Using Stem Cells in Fat Transfers.

Fat transfers are already common procedures in plastic surgery, where fat is extracted from one place in a patient’s body and then injected into another to create natural looking, youthful fullness and to rejuvenate the general appearance of the area.

Yet researchers like Dr. Reza Nabavian, Clinical Assistant Professor of Plastic Surgery at USC’s Keck School of Medicine, are finding that some improvements may be due to the natural presence of stem cells in fat transfers.

“Stem cell research has pointed to the use of stem cells to repair and even to become bone, cartilage, muscle, blood vessels, nerves and skin,” says Dr. Nabavian. “We are conducting studies to understand how stem cells behave in grafted fat tissue.”

Dr. Nabavian is taking part in research at USC where his team isolates stem cells from fat and studies their behavior in living tissue. He is researching a way to deliver a patient’s extracted fat with their own stem cells. These stem cells are harvested from (often unwanted) fat that is removed a patient’s body. These harvested stem cells are then placed back into a portion of that extracted fat. When this stem cell enriched fat is then injected back into the body, the results appear to have remarkable regenerative effects.

“Stem cells may cause a transient release of growth factors that increase the activity of native cells such as fibroblasts, which then increases the production of important skin components.
Specifically, stem cells may be themselves activated in their new niche to become new skin components such as fat, dermis, blood vessels, etc.”

About Fat Transfers:

Fat transfer procedures help rejuvenate and contour the face and prevent or target signs of aging in younger patients. Where older patients are concerned, fat transfers may complement a facelift, as the addition of fat contributes to more natural results.

Fat transfers help contour the body where fat from unwanted areas like the hips or back can be transferred to more desirable areas like the buttocks. Fat transfers are also being used in breast reconstruction and small breast augmentation.
Grafted fat exhibits many of qualities of an ideal filler. It is completely biocompatible and in most patients, available in sufficient quantities. Fat grafts naturally integrate into the host tissues, are removable if necessary, and, by all indications, are potentially permanent.

Because of these characteristics, in the last decade fat grafting has become increasingly popular in aesthetic and reconstructive surgery as a primary or adjunct procedure.

Dr. Nabavian currently advises his patients to avoid fat/stem cells injection to the breasts for the purpose of augmentation.

There are two main concerns that have not been adequately addressed by the proponents of this procedure:

1) It is possible that calcifications may form in the areas of injected fat/stem cells. These may be interpreted as possible breast cancer and may lead to multiple unnecessary biopsies and anxiety. There is also the possibility that growth factors may help promote cancer cells.

2) Most women seeking breast augmentation choose to have volumes of 200-300 cc’s per side. It would be very unlikely to get this augmentation volume efficiently using fat.

Therefore, it is not logical to use a procedure that not only has a questionable safety profile, but also fails to provide adequate augmentation.

Fat/stem cells injection is a great tool for facial rejuvenation and body contouring. It may also be used in breast reconstruction, where the breast tissue is removed and there is no cancer-related concern. But I would advise against using it for primary breast augmentation.

It’s your wedding day, where you’ll take some of the most important pictures of your life. It’s one thing to be a 20 year old blushing bride, where babies seem as sweet as cherry pie. But 20 work years, a divorce and 2 kids later and suddenly the slim white dress and flashing cameras send shivers down your spine.

Second-time brides look for more than routine facials to get camera ready for their big day. Santa Monica Plastic Surgeon and Clinical Assistant Professor of Surgery at USC-Keck School of Medicine, Dr. Reza Nabavian sees many patients who feel the stress of looking fresh down the isle. Below,Dr. Nabavian provides a roundup of procedural and surgical ways of getting camera ready in the months before your wedding.

Procedural Options
Get a head start. It’s hard to wake up one morning and poof! Look better. If you go the procedural route, start researching options and undergoing treatments in the months while you’re picking flowers, hunting dresses and scouting locations.

• Hand Rejuvenation: Wedding photos often focus on the hands to show pictures of the ring and the bouquet. And despite efforts to restore and rejuvenate the face, your hands will always betray you. However, fat injections are a nice way to youthen hollowed and wrinkled skin. Hands also bare brown age marks, which can be removed via laser.

• Laser for Age Marks: Any make up artist will tell you that brown aging spots are a tricky mark to mask. Fortunately, new laser technologies can diminish the look of brown spot before your big day. In addition to hands, the face and chest are often the focus of these treatments.

• IPL Photofacial: Dr. Nabaivian is quick to point out that IPL is a minimally invasive procedure, so you get incremental change over time. “For the busy bride-to-be, that is a plus. But it takes up to 6 procedures, with 3-4 weeks in between, to see desired results.” That means, brides should begin their IPL treatments as far out as they would begin interviewing wedding planners. The benefits of IPL? According to Dr. Nabavian. “It can help with general skin improvement, tone and pore size. For folks with sun spots, IPL is beneficial for more acute change.”

• Sagging Skin: “Thermage is an alternative for women who want a non surgical way to firm loose skin.” says Dr. Nabavian. A single treatment tightens existing collagen and stimulates new collagen growth. Improvements are both immediately visible and continue up to six months to several years, however the procedure works better on patients who start out with mild complaints.

• Fat Injection: Injecting a patients own fat into the skin restores and rejuvenates supple texture to the area. While this is a non surgical option, “this should only be done by an experienced surgeon,” says Dr. Nabavian. “A doctor must have a feel for the layers of skin that he or she is working with.”

Surgical Options
Patients who feel the light of their Golden Years or experience premature aging might seek out the surgical route. “As with anything cosmetic however, do your homework and choose a surgeon who airs on the side of conservative,” says Dr. Nabavian. You might be a bridezilla but you don’t want a surgeon who makes you look like one. 

• Many brides-to-be seek out liposuction for their arms, thighs, belly and/or hips, says Dr. Nabavian. Subtle and safe body sculpting techniques may trim up those areas that, after a certain age, seem impossible to change. For example, “many women look to get liposuction on their arms to allow them to feel comfortable in a strapless or arm-baring dress,” says Dr. Nabavian.

• Nose job: If a woman has ever thought about getting rhinoplasty, her wedding will be the nudge that encourages her to go through with it. “Just be sure that you pick a doctor that champions subtlety,” says Dr. Nabavian. Typically, just the smallest adjustment is all you need for the look you want. Any good surgeon can offer you before and after shots. Avoid over aggressive or inexperienced doctors.

• Fat Injection to buttock: we all remember Pippa and Kate Middleton in their curve hugging wedding gowns. But when a bride doesn’t have youth on her side, Dr. Nabavian finds that many patients seek out body and buttock sculpting in order to feel good in their form fitting attire.

• Brow lift: It’s not uncommon for second time brides to freshen up their look with a brow pick up. Techniques have vastly improved so that recovery time is far less dibilatating. Still, this would be a procedure to pursue at least 3-4 months out of your wedding to allow all swelling and healing to run it’s course.

When it comes to plastic surgery, most would agree that subtlety is best as compared to looking “done.”

Indeed, it’s about graceful accents and tiny tweaks – and anyone will agree that a frozen or pulled face is hardly subtle.  And the dubious use of liposuction to reshape the body isn’t a welcoming procedure to sign up for either.

“Thankfully, we can now use a patient’s own fat cells to restore fullness and proportion to the face and body,” says Dr. Reza Nabavian, Director of Aesthetic Surgery Education at USC where he serves as Clinical Assistant Professor of Plastic Surgery. “Fat transfers use a patient’s own fat cells as a natural and living implant to sculpt and shape the face and body.”

“Fat transferring procedures enhance appearance with no use of synthetic fillers, implants and drastic surgery.” These procedures restore youthful and sensual fullness to the eyes, brows, cheeks, lips, nasolabial folds and chin. Fat transfers can soften wrinkles and crow’s feet, lighten dark circles and decrease pore size.  A patient’s fat can also be used to augment, reshape and lift the buttocks, correct cellulite, dimples and scar deformities and rejuvenate the hands”

“Fat grafting is a natural alternative procedure to filler injection and surgery.” So say goodbye to face scarring and injecting foreign substances like Botox and fillers into your body.

Man Gets Penis Cut Off—And Lives!

Ending a marriage can be messy—you’ve got the lawyers, the divorces papers, the court fees. Next thing you know you’re dividing up you’re possessions. She gets to take the car, the new flat screen . . . your penis.

That’s how it went down for one California couple this past week. On Monday evening, Catherine Kieu Becker, 48, was arrested for cutting off her estranged husband’s penis and tossing it into the garbage disposal.

According to the police reports, after lacing her husband’s dinner with an unknown drug (or poison), Mr. Becker went to lie down, believing something was wrong with the food. While her husband was asleep, Becker tied him to the bed, allegedly waking him by attempting to tug off his clothes.

She then took a knife, cut off his penis, called 911 to inform them of the situation, and then chucked the dismembered member into the garbage disposal.

So what inspired Mrs. Becker to play butcher with her husband’s meat? Not quite sure, though the couple was in the process of sorting through a divorce. Becker was booked into Orange County jail, arrested on numerous charges including aggravated mayhem, false imprisonment, and assault with a deadly weapon.

As for Mr. Becker, emergency relief arrived to the scene in time to rush the husband to the hospital for immediate surgery.

At this point you may be wondering, how could anyone survive that without bleeding to death? We found a brave doctor to speak on the record. (Apparently, “Will you stop treating patients to talk to us about severed penises” isn’t a great interview opener.)

When blood vessels are cut across—and they’re actually severed in a situation like this—they begin to experience extreme spasms, explains Reza Nabavian, M.D., specialist in cosmetic plastic surgery and a Clinical Assistant Professor of Surgery at USC-Keck School of Medicine. That causes the muscles around the vessels to tighten and constrict around the openings in the vessels.

And although not everyone is fortunate enough to have this happen, this may have been the case for the husband considering he made it out alive, Dr. Nabavian speculates.

So what’s up next for Mr. Becker? It depends on if the penis is available to reattach. (How’d you like to be that plumber?) If it is, surgeons will have to act quickly in order to reconstruct the nerve endings, arteries, and veins while piecing the erectile tissue back together.

But if his member is not usable after its trip down the drain, there are other options. “Once the area heals, he’s going to need a complex surgery—using microsurgery to bring some skin and muscle to that area of the body,” says Nabavian. Then a penile prosthetic can be incorporated so he can regain some usage of that area.

According to Nabavian, depending on what happened to the man’s testicular region, sexual functioning may be out of the question. He should be able to urinate, though, since most likely that muscle was not infected in the attack.

In a world where fame is built on infamy, pop culture offers rather disturbing images of the cult of plastic surgery. See the celebrity mongering doctors, the sliced-and-diced-24-year-old-step-and-repeat-princesses, and the wealthy housewives who monstrously balloon and bulge their bodies as a public rite of passage.

But despite this rather morbid snapshot, there is a subtle and ethical side of plastic surgery. The danger of cosmetic procedures, particularly the version portrayed in the media, resides in the retail component of elective surgery, says Dr. Reza Nabavian, M.D., USC Clinical Assistant Professor of Plastic Surgery. “Patients come in and ask for something and pay for a service. In this scenario, patients become like customers.” And medical doctors then become like salesmen.

“As a physician you have to be a doctor first, especially in terms of plastic surgery,” says Nabavian. Doctors should be mindful of smaller procedures that may be a better option for patients. But a doctor, like anybody, has to pay his rent and so may recommend more invasive and expensive procedures to turn a profit.

So what can be done about this?

What we need, says Nabavian, is a public education campaign so that healthy plastic surgery seekers can get safe and comprehensive treatment. “Physicians are somewhat regulated but basically plastic surgery and what doctors prescribe is more or less based on an honor system,” explains Dr. Nabavian. The only way to safely avoid the doctors who are akin to used car salesmen is to do your homework. “Be sure that your doctor is making decisions in the best interest of the patient.”

Dr. Nabavian prescribes asking a lot of questions and doing a lot of research. Educate yourself on the latest technology and be sure to distinguish between fad procedures and procedures that deliver safe and tested results. “Be aware that doctors are often trying to sell you things that you’re not asking for or don’t need.”

Still, patients aren’t the only ones who have to be careful. Doctors must be hyper aware of the psychology and motivation of their patients, says Nabavian. As a professor at USC, Dr. Nabavian teaches young plastic surgeons how to perform safe, effective and ethical cosmetic plastic surgery. And his curriculum has always been hyper focused on ethics.

Dr. Nabavian explains that plastic surgery is often elected based on the perception of patient, and his/her motivation for undergoing any procedure is often hard to discern. “There is so much psychology and human nature that goes into evaluating what exactly a patient needs,” explains Nabavian. The nuance of prescribing procedures then is tied in to many factors. “You must ask, why does this person need this? Is it for them? Is it so that they can be someone else? What exactly do they want?”

Dr. Nabavian says that it’s important to communicate patient goals and to take into account the risks and limitations of surgical procedures. “This type of screening is exactly the kind of thing that makes me successful in my private practice. I try and mirror my own ethical standards and teach residents to develop those skills.”

According to a new survey from the American Academy of Dermatology, 81% of young white women use tanning beds or intentionally tan in the sun, despite repeated health warnings.

Indoor tanning before age 35 raises the risk of melanoma by 75 percent and the World Health Organization added tanning beds to its Group 1 List of cancer causing substances. In spite of the high risks, many teens use tanning beds, easily accessible and without age restrictions, to achieve the “perfect” bronze. Peoople are starting to take notice of the alarming statistics, and 12 states in the U.S. have bills pending that propose age restrictions for using commercial tanning salons. Yet still, more public awareness and education is needed.

There is incontrovertible medical evidence that exposure to Ultraviolet radiation UVA and UVB will result in significantly increased risk of skin cancer.  Additionally, prolonged exposure results in visible signs of aging such as sunspots and wrinkles.  While it is hard to quantify how much exposure is appropriate, the prudent approach would be to limit unprotected exposure to sun.  As in any other vice, such as alcohol, tobacco and fatty food, some folks will get away with it and some folks pay an early price.

A better alternative may be spray/chemical tanning.  This method changes the color of the outer layer of the skin without causeing an actual pigmentation.  It has to be performed in a safe manner so that there is no exposure to the eyes, lungs and mucous membranes. This temporary solution may help address the vanity without significant risk to the sanity!!

Breast implants and and augmented breast shape changes with time.  Sometimes this reflects a change in patient’s own skin and breast tissue as a result of aging and gravity.  In addition, breast appearance may change as a result of formation of scar tissue around the implant. As breast augmentation has become a popular procedure , we have seen  many patients  benefiting from breast implant revision.  These benefits include enhanced cosmetic appearance of the breasts and reduced physical discomfort caused by implant complications.   Some of the implant complications include capsular contraction, implant rupture and leakage, wrinkling of the implant, implant displacement, and infection.  In addition to the physical discomfort caused by the implant complications, the aesthetic appearance of the implant may also be affected.  The capsular contracture and erroneous implant placement may cause the breast look unbalanced, wrinkled, indented and deformed.

Capsular contraction is a result of the tightening of the breast tissue capsule surrounding an implant resulting in firmness or hardening of the breast.  Capsular contracture is classified  by Baker Grades.  Grades III and IV are the most severe.  Grade III  is more firm than normal and looks irregular in shape.  In most cases Grade III requires additional surgery because of  unnatrual appearance.  In Grade IV capsular contracture, the breasts appear to be severely firm and painful with distortion in the shape of the breast.  This complication  requires additional surgery to improve the appearance as well as to alleviate the pain. Breast implant revision surgery can address the distortion in shape by releasing or removing the scar tissue (capsule).  The revision can help recreate the soft and natural shape of the breasts and address implant malposition and visible irregularities. Furthermore, as native breast tissue and skin changes with respect to the implant, patients may require some form of breast lift to fine tune the breast shape and improve the aesthetic appearance of the breasts.  The breast lift can be performed at the same time as revision of the capsule.

There are several types of breast lift that can address the issues:

• If there is only minimal droopiness of the breast, a simple breast lift consist of a lift around the nipple and areola with no scars on the breast.

• More severe breast ptosis (droopiness) may require a more extensive lift.  The scar may extend vertically on the breast and may also extend under the breasts as well.Generally, the scars heal well with time.  Occasionally, scars require treatment with topical creams or lasers to improve texture and pigmentation.

Many women who have had breast augmentation in the past decade have saline implants.  Saline implants are generally more firm and may exhibit more rippling than silicone implants.  Since their FDA approval two years ago, silicone implants have become the more natural choice.  Silicone is closer to natural breast tissue in terms of palpability and touch.  It can also achieve a more natural tear-drop shape. Many women seek  revision of their implants and request a change from saline to silicone implants.

If you are considering a breast augmentation, or a revision of your existing augmentation, contact me for a consultation. I’ll make sure that you have all of the facts you need when making your decision about a cosmetic procedure.

This new procedure claims to fill in wrinkles and to plump up hollow cheeks, using a filler, Selphyl, mixed with the patients own blood. But does it work?

Recently there has been a great deal of talk surrounding a new procedure,  known by most as the “Vampire Facelift”. Stories in The New York Times, on The Doctors, and on CBS news have sparked interest in this new and controversial procedure. Many of my patients come to me for advice on the “latest” procedures that they read about in the papers or see on TV. Throughout my years of practice, I’ve prided myself on my conservative approach which leads to subtle, age appropriate results. I   Fad procedures may come and go, but as cosmetic surgeons we have a responsibility to be doctors first and foremost before we give in to the lure of lucrative retail. Patients must remain extra cautious and vigilant about new fads and procedures which don’t have a clear safety and efficacy record.

In my opinion, this treatment needs to be studied much better before being promoted as such, it has a certain invasiveness and potential for complications are high. And the results may be too modest at best to warrant such risk.In the current environment, patients must be aware that a “doctor” title does not guarantee good advice. And being featured  on television does not promise strong doctor credentials or ethical practice.

This is another clear example that retail and medicine don’t always mix well. Your skin, your wallet, or both could bleed!