Top Board Certified Plastic Surgeon NYC
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.
POSTED ON TUESDAY, OCTOBER 19, 2010 AT 11:12 AM by Dr. Darrick Antell
Reconstructive Surgery / Plastic Surgery has evolved quite a bit since the American Society of Plastic Surgeons was first founded in 1931. The field began when doctors/dentists were treating soldiers with facial deformities from WWI. Back then, trench warfare was the norm on the front lines of battle. If one was to stick his head up just a few inches too far above ground level, it was very easy to sustain an injury. Medics scrambled to repair jaws using prosthesis and grafts that would be very crude by today’s standards. Their goal was to enable their patients to breathe, speak and chew again, while literally pioneering the field of medical implants.
As time progressed it became apparent that the final aesthetic result, as well as functionality could be improved with surgery. After key advances scientifically, organizationally and politically, the American Medical Association recognized plastic surgery as an official specialty in 1941. The physicians involved at this point were, most often, dual degree doctors practicing both medicine and dentistry due to the heavy focus on the maxillofacial area. Today it is rare to find a surgeon with this strong of a background, but many of us have found that the extra experience has been invaluable in analyzing and reconstructing the face.
The reconstructive cases I see today are typically those trying to correct difficulties with speech, chewing, breathing or pain. The causes of difficulty can be a misaligned jaw, tissue that is improperly developed or any of a host of issues. Often the solution can involve repositioning the jaw. We make incisions inside the mouth for minimum visibility and cut through either part of or the entire jaw. It is then bolted in place after we have carefully considered where to place it. The procedure has advanced to the point that very little wiring is necessary. It is still, however, very complex and requires familiarity with the subtleties of how your jaw and teeth work together to perform everyday functions as well as consideration of aesthetic appearances. In many cases, the patient can open their mouth right after the surgery. As an added bonus the patient often gets a cosmetic benefit.
For men, strong jaw lines are desirable. If you were to imagine a line from the farthest point on the chin to the farthest point on the nose, the lips should not cross it. Studies have shown that people associate confidence and character with faces that fit this facial profile. I also sometimes point out, anecdotally, that 42 of the CEOs of the top 50 fortune 500 companies fit the description.
Women patients can also benefit cosmetically. In fact, one of our success stories was featured on ABC News
Cleft Lip Repair or Cleft Palate Repair is another procedure that dentist, plastic surgeons are uniquely positioned to perform due to involvement with the mouth and high visibility. I’ve worked with the Operation Smile program and others to perform these procedures for free for the children of Haiti, Ecuador and Mexico so I could go on forever on this topic. If you are interested in hearing more, feel free to message here, Facebookor Twitter.
All in all, a combination of dental and medical background gives the surgeon a type of ‘super specialty’ when it comes to reconstructing the jaw and face and is great training with your hands. I would encourage anyone considering one of these procedures to consult with a dual degree doctor.
For more information on Dr. Antell, New York Plastic Surgeon, and Plastic Surgery in New York, visit the following links.
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POSTED ON TUESDAY, OCTOBER 05, 2010 AT 11:11 AM by Dr. Darrick Antell
Torn Earlobe Repair NYC & Lipoma Removal NYC
Last week when finishing up for the afternoon one of my patients called the office. Her toddler had grabbed hold of her earring and managed to pull it out leaving her with a torn lobe. She said she was headed to the ER at Lennox Hill and since she knew I was on staff there (and just across the street) she asked if I could stop by to check on the repair before I headed home for the day. I think she was a little surprised when I told her to come to my office instead because she said, “I didn’t know your office would handle that.” Its times like these I have to chuckle and remind myself that when most people hear ‘plastic surgeon’ they think of liposuction, rhinoplasty and breast augmentation. The fact is plastic surgery is a practice of applying aesthetic principles to surgical procedures, many of which are performed on parts of the body which are exposed and seen every day (i.e. face, neck and arms).
Lipoma Removal NYC
Like earlobe repair, lipoma removal is a routine procedure in my office. For those unfamiliar with lipoma, it is a tumor composed of fat. The sac that contains the fat is housed in the deepest layer of the skin and, in general, is small (a few centers in diameter). A google search of ‘lipoma,’ however, will show that these growths can also become quite large.
The most common way to remove a lipoma begins by making an incision across the top of the growth like the dotted line above to expose the sac. Unless the growth is so large that blood vessels into the sac have developed, it is typically unattached and can be lifted right out. Sometimes the fat can be eliminated using liposuction with a smaller incision, but that often falls short of removing the sac which can lead to a less than optimal result. Regardless of the method used, the goal is to leave the area looking as though nothing were ever there. In some cases, depressions in the skin are unavoidable but a doctor with aesthetic training has the best background to make sure the result is smooth and continuous.
Torn Earlobe Repair New York
As I said before, earlobe repair is also very common in our office because the damaged site is in a highly visible area. Depending on the nature of the damage I typically start by cutting out the dead tissue around the site of the rip as seen below. From there I stitch the two sides together.
If a piece of the ear is completely missing, rather than just ripped, I can also create a graft from the patient’s skin to fill the gap. The important thing to keep in mind is that the final result looks natural and symmetrical.
There are many other procedures in which the aesthetic appearance is a major factor such as laceration repair and scar revision from tattoo removal or C-section. Every choice, from the type of suture to the stitching style, can affect the outcome. If you would like to hear more about what goes into creating a great final appearance, please don’t hesitate to leave a message here, facebook or twitter.
For more information on Scar Removal in NYC or Earlobe Repair in New York, visit our webiste.
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POSTED ON TUESDAY, SEPTEMBER 21, 2010 AT 6:19 PM by Dr. Darrick Antell
A number of years back I worked with Dan Rather on a piece for the CBS Evening News on plastic surgery.
In the clip we talk about what patients can reasonably expect from a procedure.
I’m mentioning the story now because it addresses one of the major motivations I had for starting my blog. After meeting with patients for more than 23 years it is clear that there are some misconceptions surrounding reconstructive & cosmetic surgery. People often think I have a magic wand that I use to make them look like whatever they want, but I don’t. I believe that if patients are well informed of what we can achieve, not only can we find the best treatment for them, but they will be happier with their results.
Today, I’d like to talk about what kind of results you can expect from a surgery or minimally invasive procedure. For instance, almost every week I do a consultation with a patient that wants to look younger, and there are a number of things I can do for them. A facelift is great for taking up excess skin, Botoxand fillers can smooth wrinkles and folds, and a blepharoplastycan remove the ‘tired’ look from baggy eyes. We are, however, limited by the natural composition of their skin and face. Let’s look at some before and after photos.
The left column contains ‘Before’ photos and the right the ‘After’ photos of twins I’ve operated on who led very different lifestyles. They both look ten years younger after their surgery and have great results, but one will always look older because years of smoking, stress and sunbathing have taken their toll. No procedure that I know of can totally reverse these effects to make her skin quality that of her sisters. Taking another look at the bottom twin, though, we see that she does have far fewer wrinkles around the mouth and neck and several damaging effects have been reversed.
Similarly, there are several patients naturally thick in the abdomen interested in liposuction. We can make their clothes fit better, we can shape their silhouette and reduce love handles, but we cannot turn them into a twig.
The dissatisfied patients that I see are the ones looking for a revision of a primary surgery done at another office because they did not get what they expected. It is a shame because many of them have decent results, but there is a specific quality that they are looking to have revised that was not addressed. That is why when I meet with any patient, most of the consultation is spent learning what exactly it is they would like to correct. That way, I can tell them how a particular procedure will address their concern and we can decide together if, and how they can be accommodated.
If you have questions regarding what can be done for you, don’t hesitate to comment here, or on facebook and twitter.
POSTED ON TUESDAY, SEPTEMBER 07, 2010 AT 11:43 AM by Dr. Darrick Antell
As a surgeon and director of an operating facility I spend more time than your average person worrying about germs and bacteria. I’ve been told that I’m a bit of a perfectionist when it comes to sterilization. That’s why I was thrilled when my youngest daughter came back from summer camp and sneezed into the bend in her arm. Obviously I don’t want her to be sick, but I’ve told her before that if she is going to sneeze or cough the best place is into her arm and not her hands (though it is tough to get children her age to make a habit of it). That way the bacteria making her sick aren’t spread to everything she touches. She later told me that her counselors had named it the “vampire cough.” The idea is that Dracula grabs his cape and covers his face with the bend in his elbow before teleporting. Apparently if they can pretend they are Dracula while doing it, she and her friends can be coaxed into practicing good hygiene.
I had forgotten about that anecdote until earlier this week when I was reading a review for a new facial filler name Selphyl. Nicknamed “The Vampire Facelift,” Selphyl is derived from your own blood and re-injected into your face to fill depressions, wrinkles and folds. The injection is prepared by drawing blood and then isolating the portion of the plasma rich in platelets and then enhancing it with fibrin. Found naturally in your body, they work together to build and maintain the matrix in your skin that keeps it firm and healthy looking as well as stimulate natural collagen production. Selphyl’s popularity may be in part due to the Twilight/True Blood craze, but more likely its appeal is based on the fact that it is biocompatible because it is made from ‘natural’ substances. In addition to being free of acids and toxins this means that there is no need for an allergy test before the procedure and much lower chance of complications.
There are, however, some drawbacks to using your own blood as facial filler. First, you are limited by how much blood you can remove from your body. The Selphyl website says you can harvest about 4 cc of product for each treatment which isn’t enough to add a lot of volume. At that quantity we are probably looking at filling moderate lines and creases of the face. Also, the patient won’t see the full effects until about 3 weeks after the procedure as opposed to the immediate results seen with other fillers. This is because Selphyl stimulates collagen production in your body which takes time to have a visible effect.
Considering Dracula was thousands of years old but still had great skin (a little pale maybe, but still no wrinkles!) I’m beginning to think I have more to learn from him than how to teach my daughter to cough.
While we do not offer Selphyl at our office yet, we do offer a full array of facial fillers. Please don't hesitate to call us at (212)-988-4040 or leave us a message on our blog.