Other People’s Plastic Surgery

As a Board Certified Plastic Surgeon in his 22nd year of private practice, I have seen many people who have had prior cosmetic procedures done by other doctors. I am often asked my opinion of the work. I try to avoid this answer at all costs.

One rule I have is to never ask who performed the surgery, as I do not want anything to bias my opinion in either direction. My personal feelings toward a particular doctor, or my prior experience with patients of his/hers, should be left out of the equation.

I also state that it is impossible to judge a result without first seeing the before photos from the surgeon (no offense, but some patients use a before photo that was altered or from many years in the past that do not reflect the true appearance on the day of the surgery). A slightly wider or larger breast on one side may be a horrible error, or a miracle of surgical wizardry to even approach two even sides.

With regard to scar quality, unless it is horribly malpositioned, often the scar depends mainly on the genetics and skin of the patient and the care given after the procedure. An ugly scar does not mean your surgeon did a bad job. When I revise scars, I even tell patients that there is no guarantee it won’t look worse.

I advise patients to look forward, not back. You cannot change the surgery you had, but can try to achieve a better result in the future. I am always happy to have an honest discussion of the options for improving prior surgery, but you need to let go of anger and be positive for a healthy start on getting better.

The Super Bowl of Surgery

Every year, a billion people or so gather to witness the NFL championship game being played by tuning in to the broadcast. It goes beyond mere sport, it has become more of a shared cultural experience that transcends gender, race and religion. Even the interruptions in the action, the commercials, are met with eager anticipation.

What if there were a Super Bowl of Plastic Surgery? The best surgeons going through a season of patients, followed by the highest ranking few having a playoff until the final top 2 remained. It would be the reality show to end all others.

The commercials would be equally interesting, with many industries wanting to cash in on the beauty interested public. Make up, hair care, fashion, nutrition, exercise, as well as luxury goods would kill for the opportunity. Celebrity endorsers would be simple to find.

Imagine the technology that would be employed. Cameras from every angle, graphics on ideal angles and proportion, slo mo replay- it would be amazing. The venue would unfortunately not be large enough for a big audience.

And finally, we could have a panel of judges, enhanced by a phone in vote from the public. There can be world famous plastic surgeons as well as patients who have had a lot of plastic surgery serving to compile the scores. Imagine, the winner would actually be the patient!

Halloween 2018

Halloween is about dressing up and pretending to be someone or something other than yourself. Our fantasies can run be somewhat lived out, and the acceptability of masks allows a level of anonymity. This makes for an escape from reality.

As a Board Certified Plastic Surgeon, people often come in to have their fantasies realized, but on a more permanent basis. Reshaping the face, nose, breasts, bodies, and buttocks allows for tremendous physical transformations. These physical changes can lead to a change in confidence level and in attitude and personality.

The danger is when people feel that they can fix life’s problems by simply changing physical appearance. This is very rarely the case. You are still you, only better looking.

The best candidates for cosmetic plastic surgery are those who are happy and confident to start with. The physical upgrades are just the icing on the cake.

The Dangers of BBL

Just this past week, an alert was issued by the American Society of Plastic Surgeons regarding fat transfer to the buttocks, or BBL. After a survey of members and the literature, it was found that the incidence of death from the procedure were about one in three thousand. This is by far the highest for all cosmetic plastic surgery procedures. Clearly, this is very concerning to me, as I have done close to 3,000 myself.

The problems that occurred seem to have come from fat being injected into and below the muscles, and that fat entering the bloodstream causing pulmonary embolus and death. These findings made me feel somewhat better for a few key reasons.

When I do a BBL, I am always above the muscle in the subcutaneous plane. A death has never been reported from the procedure when the fat is above the muscle. The only limits are that you cannot always get as much volume that way, but I would rather have someone complain they are not quite as big as they hoped as opposed to someone dying.

Secondly, I always stay away from the lower inner area of the buttocks where the major blood vessels are. I clearly point this out to my patients before the surgery, so that they know where I won’t fill and why.

These findings show the importance of technique and doctor selection. Many non plastic surgeons are now doing cosmetic procedures thinking it is easy money. The experience, skill and anatomical precision required cannot be taught in a weekend course, online videos, or by spending a few months watching someone and calling it a fellowship. Be safe.

A Look Back at BBL in 2016

Fat transfer to the buttocks, or Brazilian Butt Lift (BBL) is a major part of my practice at Yager Esthetics. Being the Latin beauty expert, I know a few things about the importance of curves to the female form. After 20 years in private practice, I have learned many important things, and want to share them with you in a report on my BBL cases from 2016.

I did my first BBL before it was even called a Brazilian butt lift. It was 1998, and there was very little information out of the US. I got my information from Luis Toledo, a Mexican Plastic Surgeon, who explained his technique to me. I have further refined my method, and do more every year. It continues to be one of my top 5.

In 2016, I did over 150 fat transfers to the buttocks. I had zero infections, no DVT’s, and one request for additional fat to be placed. These statistics are extremely encouraging, and are a testament not only to my skill, but to my office and our ability to inform and educate each patient as to their expectations and proper care.

Patient selection is very important, as each patient needs to have enough fat that can be removed while not having a negative effect on the body to create the size they desire. Furthermore, they need to have the anatomic structure and space required in the buttocks region to add to. If someone wants more than is possible or safe, I explain the limits, and if that is not what they want, I do not perform the surgery.

In the right patient with the proper expectations, patient satisfaction is extremely high. If this is an area you have been thinking about, there has never been a better time to stop by for a consult or return visit. Yager Esthetics is always out front, but we are also behind you!

Last Blog of 2016

Another year of blogging is now complete. I hope to those who read it, it has provided some valuable information, some amusement, and a little insight into what makes me who I am. Intentionally, and often unintentionally, my personality will leak out in my writing.

Even if no one ever read these pages, it was still worth it to me writing. It is an excellent exercise in thought. Each blog takes me about 10 minutes to complete. I sit down with no topic or notes and then just flow with an idea of the moment. I do no drafts or revisions. I have no editor or assistant. It is often fascinating where my mind decides to go.

2017 will be a year of major changes at Yager Esthetics. Our nonsurgical services are booming, and more technology is on the way. Stay tuned here for what is next. At least 2 will launch in January. Both are long overdue and will be much in demand.

We are going full electronic records and eliminating paper. Get ready for iPads and laptops, as well as a video revamp of the website. Technology cannot be stopped. We will continue to set the bar for plastic surgery in the Hispanic community.

I wish you all a very happy and Healthy 2017. Thank you to all who have supported me over these 20 years, and know I will continue to support you for as long as you will have me.

The Blog Before Christmas

Hard to believe, but this will be my last blog before Christmas. I hope all of you have done your shopping, and are ready to have a wonderful family holiday. I had a great time with my Yager Esthetics family last week at out annual holiday party. We rented a local restaurant, Mamajuanas, and had a fantastic time with great food and drinks.

I am still busy in the operating room, as holidays mean time off from work and school, which translates into time to recover from plastic surgery with family around to help out. A nice way to end the year, but a busier time for me.

I usually will steal long weekends in January, before it gets super crazy, so that I have a little family time and relaxation time. Unfortunately, I am not the kind of person who likes to sit on a beach doing nothing. Vacation for me is all about seeing, doing, and learning. It is often more tiring than work! Have to think about that as a New Year’s resolution. Speaking of resolutions, it’s around this time I begin thinking of what I want to improve about myself for the new year. I haven’t been that good with them in the past – this year I was meant to write a book but the only way that’s going to be finished is if I find a ghostwriter! I’m thinking of keeping it creative again this year but more realistic. Maybe I’ll just try to write more, rather than making a whole book.

I have received so many lovely gifts from patients this year. I tell them that my gift is their happiness, but sometimes they give more. Not necessary, but greatly appreciated. My hope is that each patient feels that I did my best and exceeded their expectations.

This week will be a lot of yspa and injectables like Botox, Xeomin, Radiesse, Voluma and Juvederm, as the office parties and family gatherings bring out the competitive nature of people. I like to theink the Yager Esthetics advantage always gets the edge!

Happy holidays, and thank you for supporting me supporting the Hispanic community.

A December to Remember

It is already the last month of 2016- where did the year go? The older I get, the faster time seems to speed by. Yager Esthetics is charging ahead in our 20th year as the Latina beauty experts. With all of the imitators popping up, we are certainly flattered, but be sure to be safe and do your homework.

December is a funny month, in that we tend to hold a few extra surgery days aside for the “last minute shoppers” of our practice. All of a sudden, people start realizing the holidays are coming, and there is time off from school and work. Gift money comes in, and all of a sudden they want to finally have that cosmetic plastic surgery procedure they have been thinking of.

If that is you, realize that surgery should not be rushed. Testing needs to be done beforehand to insure you are healthy and safe. Implants, girdles, and special order items need to be secured ahead of time, and all of the preop and postop visits need to be coordinated. You need to think about child care, who will pick you up from surgery and care for you, and who will cover you at work.

Of course we offer nonsurgical treatments and injections, such as Botox, fillers, skin tightening, laser hair removal, Silk Peel and skin care, for those who can’t quite get a surgery together. The results are amazing and can get you ready for a holiday party, family gathering, or New Year’s Eve celebration.

If you want this to be your December to remember, be efficient, make an appointment with your general medical doctor for right after your visit with me so testing will not be delayed. Patients aren’t the only ones who take off time around the holidays, doctors do as well. Except for me- I am here to serve you.

The BRA- Thinking Big While Going Smaller

One of my favorite operations in plastic surgery has always been Breast Reduction.  It is the only operation I still do that is not purely cosmetic.  It has been done for over 100 years, though techniques have changed.

I had always been very happy with my results, and still think my traditional breast reduction results compare to any I have seen.  The one thing I did not like, and is a limitation in breast lifts as well, is the lack of fullness in the upper part of the breast to make it seem more full and youthful.

Patients come to me because they have very large and heavy breasts, and want to remove the extra weight, and lift them so they appear more attractive.  What they want to look like is someone who had breast implants.  That’s when I got inspired.

Why not do a breast reduction and put in an implant at the same time? Breast Reduction Augmentation- BRA.  Of course, you need to be very careful technically to insure you preserve sensation and blood supply to the areaola and nipple.

I have performed the BRA about 30 times now, and have been more than thrilled with the results.  Implant selection and care with the size is crucial. I hope to publish my series soon.

So, going smaller does not mean it is necessarily a reduction alone.  Sometimes you need to go back a little farther to move ahead..

7 11- Are Numbers Lucky in Plastic Surgery?

Every week, I operate between two and three days.  Each day, I have to organize the order of the cases based on the type of procedure, the patients’ health, and any preferences each might have.  Being that today is 7/11, 2 numbers considered lucky by some, I thought I would share my insights on case order, day of the week, and Friday the 13th.

I only schedule as many cases as I know I can do with complete concentration and maximal effort.  I will close the date when that number is booked, and everyone else will have to find a different day.  It is not fair to the other patients on that day.  To me, the first patient and the last patient are equally important, and the quality will be the same.

Not everyone can be the first case.  This is basic math.  First priority is always safety, so Diabetics are by necessity first when feasible.  I try to also do small fine motor cases such as eyelids early, as they are quick and recover easily.

I do not like doing big cases last, as recovery can be longer, and I want my staff to stay fresh and allow the patient extra time to be safely discharged.  Heavier patients also need more attention.

I love operating on Friday the 13th.  I experience no difference from any other Friday, and the patients who do not care are usually very rational people, which always helps.

Tuesdays, Thursdays, Fridays- it doesn’t matter to me.  I am as fresh on any of the days, as I take my work seriously and rest appropriately.  I take my responsibility to each patient as a sacred trust which I would never break.

The only lucky numbers in Plastic Surgery are 212-543-1700.  That is my telephone number at Yager Esthetics.