I see many variations of patients in my San Francisco Bay Area/Marin County plastic surgery practice that are primarily seeking correction of sagging breasts and often looking for  more youthful and fuller upper breasts.  Often because of pregnancy, breast feeding or simply a weight loss, the breasts begin to look flattened at the upper poles, the cleavage is much less firm and the general volume of the breast itself is greatly reduced.   At the cosmetic surgery consultation, I am often asked if a breast augmentation alone will “fill up” the breast enough to correct the sag.  The answer is sometimes.  Not a very definative answer and here is why.  A minor amount of sag in a small to medium sized breast is often correctable with an implant.  The implant diameter must be appropriately sized in order to achieve a natural cleavage.  If  too small diameter implants are placed, the breasts seem as if they are spaced too far apart.  When the implants are too large, the breasts seem very close and the breasts appear too large for the woman’s chest.  Sometimes,  the best solution is to lift the breast while enlarging it to a naturally full and youthful size again.  The desired outcome of breast augmentation is a larger breast with the nipple at a natural position.  It is not aesthetically pleasing to have a nipple that continues to point downward, even though the breast is fuller. A quick consultation can confirm the appropriate solution to accomplish the desired correction.

Recent years have also brought the advent of implants with moderate to high projection.  These are valuable tools because I often see small chested women that request large breasts.  When a standard moderate implant is used, the diameter of the implant may be too large for the chest.  The patient almost always is desiring projection rather than breasts that fill the entire chest wall.  A high profile implant will have the same amount of fill volume but with a smaller diameter.  Thus, more projection is achieved with a more natural look to the chest wall.

I perform a variety of different breast procedures but always recognize in the surgical planning that the outcome should correlate to the patients lifestyle, athletic choices and desired result.  

I have 2 daughters that are recent college graduates and currently exploring the difficult job market.   I  have had many discussions with both regarding the interview process and the image that is best received by an employer.  Most potential employers would expect an applicant to have a stylish haircut,  neat and well-tended nails,  pressed and freshly laudered clothing, etc.  Should we begin taxing all of these services since they could be construed as unnecessary and a reflection of vanity?  Nope.  The reality of plastic surgery and noninvasive cosmetic procedures is that most people that utilize the different options are like you and I.  They are middle class, responsible with their spending and view these procedures as maintenance.  Of course,  there will always be a few sensational bizarros like Michael Jackson and the Octomom  to tweak  negativity amongst  those that would never do any of these procedures anyway.  Then again, there are many of our politicos that I have noticed move almost nothing on their faces during interviews.

This sort of plastic surgery taxation has been tried in several states unsuccessfully already.  Currently only New Jersey still has a tax on cosmetic surgery and even the legislator that wrote the original bill has recommended canceling it.  Why you ask?  The  amount collected  by the state of New Jersey was 75% off the targeted amount.  Patients were crossing into nearby states to take advantage of nontaxable procedures.  The question of defining what was or was not a cosmetic surgery procedure became blurry.  Several examples of that are:  the woman that had a breast reconstruction requiring breast implants and required revisions,  the massive weight loss patient that required a tummy tuck to remove a large abdominal panice so that she could go on with a normal life and seek employment or the elderly patient with an upper eyelid fold that partially obscured vision.  I would guess that most of us have dealt with an insurance company that has ruled a medical procedure unnecessary.  Imagine the same group of uninformed individuals deciding on taxation.

I do believe that presidential speechwriters do alot of research and are masters of wording, but, and it is a big but, they are not physicians and neither is he.  There are many times that I believe a generic medication can be used, but often a brand named drug is the most recent addition and the most appropriate.  What is the difference?  The brand name is “on patent” for 10 years, the generic is no longer on patent.  Why does the brand name cost more?  Of course, there is profit involved, but also expensive research and development and the process of safety checking and research studies needed to gain approval by the FDA.  I and most of my colleagues understand the importance of making prescriptions financially reasonable for our patients.  Almost daily, my office deals with an insurance company that will not honor a prescription unless it is changed to a less expensive one on the drug formulary.  This is the part of health care that is broken and what does our government do?  Agree with the insurance companies!  There might be more to worry about in my opinion like the salaries of health care company CEO’s that range from a paltry 3 million to 24 million dollars a year.  Maybe if that was regulated too, we could all get the name brand medications!

Welcome to my inaugural blog!  For so many years I have had the privilege of treating wonderful patients from all over the San Francisco Bay Area and beyond.  My challenge has always been keeping up with new and old faces (sorry for the pun!) and making  my patients aware of the latest in interesting cosmetic surgery procedures as well as what is happening in our practice.  I will share with you innovative research and techniques in the plastic surgery community and my opinions regarding their value.  I can most often be found with a medical journal in the evenings and have seen in my years of practice, many variations on almost every procedure.  Some are time tested and true.  Some are hype.  I will share my honest opinions and experiences. 

My Marin County plastic surgery practice provides face, breast and body recontouring procedures as well as non-invasive procedures such as Botox, injectable fillers and Latisse.  Thanks for checking out my blog, more soon!