Top Board Certified Plastic Surgeon NYC
POSTED ON FRIDAY, MAY 13, 2011 AT 9:30 AM by Dr. Darrick Antell
One of the most common goals in aesthetic surgery is a smooth and slim abdomen. Liposuction, abdominoplasty and a body lift can all be used to achieve a desirable result, but you get the best result by addressing issues with your anatomy specifically. Typically, patients are concerned with fat distribution, loose muscle tissue and excess skin. Let me walk you through a few representative examples and what we can do to treat those patients.
Uneven fat distribution is the easiest condition to recognize. In general, these patients have tried diet and exercise but due to heredity predisposition there are some pockets of fat that remain in undesirable areas. We use liposuction in these cases because it removes small to moderate amounts of fat. Some patients have tried injectable fat dissolvers such as Lipodissolve in an attempt to remove these deposits. As I explained in a recent interview with ABC news the main concern with non-surgical fat removal is that we do not know where it will go. This could have profound effects on one’s body if the fat dissolves into the blood and overloads an organ such as the liver. If there are complications as a result this “low cost” alternative, it could wind up being quite expensive.
Loose muscle tissue is another very common condition. Externally this can look like a fat deposit, but it is actually caused by loose muscles or tendons in the abdomen. Typically, loose muscle is associated with a pregnancy that has pulled the rectus abdominus (responsible for the ‘six pack’) from its original position but there are a range of reasons for the displacement. In these cases I often suggest an abdominoplasty or “tummy tuck” to correct the protrusion by restoring the original position of the muscles. This is similar to correcting a hernia.
Some patients only require removal of excess skin in what we call a body lift. This is especially the case when the patient has recently lost a large amount of weight or aging and gravity have caused the skin to sag. This procedure is similar to a face lift or neck lift where a portion of the skin is removed in order to advance the remaining tissue. As an added bonus, c-section scars and stretch marks can often be minimized through careful selection of the site of skin removal.
A combination of procedures can also be performed if the patient feels they have more than one characteristic they would like to improve. Liposuction, abdominoplasty and body lifts are frequently combined to flatten the abdomen, but they can also complement a breast augmentation or breast lift to restore mothers to their pre-pregnancy state.
If you think you would be a good candidate for liposuction, an abdominoplasty or body lift give our office a call at (212)-988-4040 or leave us a message here, on facebook or twitter to set up a complementary consultation.
POSTED ON TUESDAY, FEBRUARY 01, 2011 AT 2:55 PM by Dr. Darrick Antell
One of the easiest ways to shave years off one’s appearance is through an eyelid lift called a blepharoplasty. In this procedure I remove excess skin that causes sagginess and bags around the eye, helping to eliminate the ‘tired’ look that many people develop due to weakening ligaments holding fat in place and loss of skin elasticity.
The reason that a blepharoplasty is so effective is that there are many aspects of the procedure that we can customize to one’s specific anatomy. The first is that we can perform the lift on the top, bottom or both lids. Let’s take a look at an example.
The patient above had an upper and lower lid blepharoplasty to address issues both above and below his eyes. As you can see in the before photo, the patient had developed a ‘hood’ above his eyes that was eliminated with his surgery. In the after photos the skin no longer hangs down below his eye lashes and instead has a nice looking crease as it did in his younger days.
We were also able to rejuvenate the area below the eye. Though part of the bags are cut off in the before photo you can distinctly see their outline in the area near the eye. We removed these signs of aging first by removing the fatty deposits from below the eye and then removing the excess skin with a lifting technique.
The final aspect of a blepharoplasty is where the incision is placed. In the lower lids, I prefer the transconjunctival approach (behind the lower eyelid) because it does not leave a scar on the skin, does not require stitching that has to be removed later and gives me excellent access to the fat deposits below the eyelid for removal.
I like this before and after photo because it demonstrates all of the different aspects of blepharoplasty surgery. Clearly excess skin on the upper eyelid manifests itself differently than on the lower lid. Add to that the effect of fatty deposits and you begin to see how unique each case is.
If you think a blepharoplasty might be right for you leave a message here, on Facebook or Twitter or call our office at 212-988-4040.
For more information on Eyelid Surgery in New York City and Dr. Antell, please visit the following links.
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POSTED ON WEDNESDAY, DECEMBER 15, 2010 AT 10:32 AM by Dr. Darrick Antell
When seeking a reconstructive or cosmetic procedure the typical protocol is to have the patient in for a consultation. During that initial meeting I am listening to the patient’s surgical goals and assessing their anatomy so we can explore all of the options open to them. We then set a surgery date and a schedule for post-operative care. This is typically not difficult for my patients who live in and around New York City. In my capacity as a medical consultant in Plastic Surgery to the United Nations, however, I see a number of international patients to whom travel can become burdensome.
In an effort to accommodate our long distance patients our office has embraced the use of E-mail and Skype to perform ‘virtual consultations.’ Since reconstructive / cosmetic surgery is primarily a visual practice we can use photos and video chat sessions to evaluate if and how the patient can be treated. If they decide to proceed with surgery they can arrive the day before their procedure for the requisite in person consultation, and stay in the area for a few days during their recovery, which cuts their time away from home in half. In some cases a virtual consultation can even save a patient the trip when they are not a good candidate for surgery.
Virtual consultations have made it easier to do follow-up care for out of town patients as well. I prefer to have the patient examined in person five to seven days post operatively. After that, however, long term virtual checkups are a viable option to limit the number of trips an out of town patient must make. Furthermore, some readers may be familiar with the volunteer work I performed in Ecuador, Mexico and Haiti repairing cleft palates and other maladies of the jaw (for more information see http://www.antell-md.com). Many of these patients are unlikely to buy a ticket to visit my office, so the web offers them access to healthcare that they may not have otherwise had.
If you feel like a virtual consultation may be right for you, please contact my office at (212)-988-4040 or leave a message on this site, Facebook or Twitter.
For more information on Dr. Antell and his Plastic Surgery and Reconstructive Surgery practice in New York, visit the following links.
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POSTED ON FRIDAY, DECEMBER 03, 2010 AT 10:59 AM by Dr. Darrick Antell
I know I’ve said it before, but BOTOX ® really is the new aspirin. In early October Allergan (makers of BOTOX®) announced that the FDA approved BOTOX ® for use in treating chronic migraine patients (defined as 15 or more migraine days a month). Many patients are eager to try a new treatment because in addition to pain they typically experience dizziness, nausea, vomiting, sensitivity to light and noise, and sometimes even vomiting. Now that the drug is approved, Allergan is free to market BOTOX as a treatment for migraines (even though it has been used off label for this purpose since 1992), leading some analysts to predict that its therapeutic use will eclipse the cosmetic. Of course, this will also depend on whether insurance companies will cover the treatment.
Just for some background, BOTOX ® is produced by purifying proteins from the bacteria that causes botulism (an illness mainly characterized by paralysis). The cause of some migraines is thought to be pressure on nerves in the neck and head from muscle use. BOTOX ® is used to treat migraines by injecting the frowning muscles found in the forehead, chewing muscles in the temple and others in the neck and shoulders. This leads to relaxation of the muscles, as well as a decreased muscle volume, relieving pressure on the nerve. As an added bonus these patients will have fewer wrinkles. The treatment will wear off and need to be re-administered approximately every 3 to 6 months.
It is yet to be seen whether BOTOX ® treatments will be covered by insurance companies for this approved use, so a recurring out of pocket treatment may be cost prohibitive for some patients. For those seeking an alternative, muscle pressure may also be relieved surgically. Nerves in the forehead run through a tight ring of muscular tissue that can be released via an incision hidden behind the hairline or in an upper eyelid crease to decrease pressure on the nerve (this is actually similar to the procedure performed in the wrist to treat carpal tunnel syndrome). In recent studies the treatment was successful in about 92% of the cases (35% reported elimination of the pain, 57% experienced significant reduction in headache episodes).
If you would like to hear more about either of these procedures you can check out www.MigraineSolutionsNYC.com or drop me a message on Facebookor Twitter.
POSTED ON MONDAY, NOVEMBER 22, 2010 AT 4:08 PM by Dr. Darrick Antell
When discussing surgery of the breast, one of the most common questions asked is “will I still be able to breast feed?” The short answer is yes, so long as mammary tissue is retained and left attached to the nipple you should still be able to attempt to breastfeed. That being said there are some women with large breasts that make very little milk and some with small breasts that make a lot of milk. There are many factors involved and some subtleties to each procedure that should be mentioned.
Breast cancer patients may undergo a mastectomy in which the breast is removed. Subsequently, these patients may undergo a breast reconstruction which may include breast implants. These patients will lose the ability to breast feed because they no longer have mammary tissue, not because of the implant (see discussion of implants below).
Patients undergoing a breast lift (mastopexy) retain the ability to attempt breastfeeding, but face certain risks. During the surgery an incision is made along the crease underneath the breast, around the areola, and vertically between the areola and the base of the breast.
When the excess skin has been removed, the areola is repositioned to complement the new shape of the breast before the incision is closed. During mastopexy the veins, arteries, lymph vessels, nerves and the milk duct remain attached to the nipple in order to ensure functioning in the future. While loss of sensation due to the incision is a risk, my office experiences a very low complication rate.
Breast reduction patients also maintain the ability to attempt breastfeeding, because tissue is typically removed from the side leaving the central functioning tissue intact, and attached to the nipple.
Breast augmentation, in and of itself, does not cause one to loose the ability to breast feed. Tissue is not being removed and the implant should not interfere with the gland. Some women with implants, however, do report having trouble breast feeding. In my experience these are typically women that began with very little breast tissue and would have had trouble breast feeding regardless of the breast augmentation.
Having implants has no affect on your ability to become pregnant. While your breasts will experience normal change with pregnancy and ageing, the implanted portion of the breast will remain the same, with or without pregnancy. I’ve had patients who chose implants after their initial pregnancy, as they liked the feel of the larger breasts while they were nursing and wanted to maintain the fullness. As an example, one of my patients had breast implants after her first two children, then had three more children and breast fed all 5 of them (3 of which were after the implants were inserted).
If you would like to discuss this further, please don’t hesitate to contact us here, facebook, twitter, or call for a consultation (212)-988-4040.