R. Merrel Olesen

Cheat Sheet / Updated 03-27-2016

If you’re considering cosmetic surgery, ask detailed questions to find a qualified surgeon and facility for the procedure. When meeting with a cosmetic surgeon, look for red flags that suggest that you should consider a different doctor.

Article / Updated 03-26-2016

Preparation for a skin peel depends mainly on the type of skin you have and will ultimately be decided by your doctor. Fair-skinned people may not need to be treated before peeling. If you have skin of color, however, then you're at increased risk of developing dark spots following your peel. In this case, a pretreatment regimen including glycolic acid, hydroquinone, and Retin-A (retinoic acid) is frequently suggested to help minimize the possibility of postoperative hyperpigmentation, make your peel more uniform, and decrease your downtime. As a general rule, you should follow the pretreatment regimen for three to four weeks. After your treatment, most surgeons will give you prescriptions for antiviral medications and antibiotics. Physicians vary from practice to practice on what topical creams and ointments they prescribe to reduce pain and inflammation. Your physician will determine your specific postpeel regimen. Here's what you should know about your recovery from a peel: You need to be prepared for your appearance more than anything else. You'll look worse than you feel, but your appearance will improve very rapidly in the first week after your procedure. You'll swell to some degree, but swelling will diminish fairly rapidly in the first few days. Having someone around to help with activities such as dressing changes and meal preparations is a good idea. Any discomfort you experience will be short-lived but can be significant for the first few days. You'll see your physician either daily or every other day for the first week to have your wound assessed. You'll probably want transportation to the office for the first few visits. You may be very swollen, and discomfort may interfere with driving ability. Peels can be uncomfortable for a few days, and the peeled area may look unsightly. Some patients want to hide the peeled area. Getting through the pain In general, anyone who undergoes a trichloracetic acid (TCA) peel will have a relatively painless post-treatment course. The injured skin stays on the wound and acts as a dressing. This skin doesn't peel off until the underlying skin is healed. Your skin will feel tight and you will feel like you can't apply enough moisturizer. Pain, however, isn't the major symptom. Laser peels and croton oil peels are deeper than most other peels, and for a few days, you'll experience discomfort from the open wound created by the peel. You'll receive pain medication and detailed dressing instructions to follow until you're healed. You'll also start taking an anti-inflammatory medication before the peel and continue it until you've healed. If pain becomes intolerable, call your doctor's office. Taking it easy After a skin peel, you need to stop all vigorous physical activity. If you're taking any pain medication, you won't be able to drive because the medication may slow your reaction time or make you drowsy. You'll be swollen as well, so if you have trouble opening your eyes, you shouldn't drive. In addition, you should avoid any activity or environment that causes you to sweat because sweating will make your ointment or cream runny and more likely to get into your eyes, causing irritation and blurriness. Laying low or hiding out Moderate and deep skin peels do have associated downtimes. You'll want to hide out for seven to ten days, depending on the depth of the peel, because you'll have excessive peeling during this time or the need to apply heavy coats of petroleum jelly to keep the wound moist. After your wound has completely epithelialized (grown new skin), you can apply coverup makeup and resume normal life activities. Knowing what's normal Deep skin peels, either with the laser or chemicals, require more labor-intensive care than other peels in the first few days. You'll experience irregular healing based upon skin thickness, and the wound won't look good to you. You'll need reassurance from your surgeon that your appearance is normal. Somewhere between two and seven days, you'll probably wonder if it was all worth it. Be reassured, however, that you're experiencing normal healing. Judging the result Deep skin peels, either laser or chemical, take several months to heal. Redness means that your skin is still inflamed and still generating collagen. The final result won't be evident until the redness is gone. The timing of a second peel, if you need one, is up to your doctor. At a minimum, you have to wait until you're completely healed from the previous procedure, which in most cases takes several months. Many doctors wouldn't even consider doing a second peel for six to nine months.

Article / Updated 03-26-2016

You've heard the terms plastic surgery, cosmetic surgery, and reconstructive surgery bandied about, and you're confused. No wonder. You'll see both medical and marketing uses of these terms and when you see them, you need to know what they mean. When you hear the word plastic, you probably think of the modern material that's molded into myriad products — patio chairs, kids' toys, kitchen glasses, and airline knives and forks. The list goes on and on. This plastic isn't what we're talking about. Actually, the word comes from the Greek word "plastikos" or the later Latin word "plasticus," both of which mean "to shape or mold." Plastic surgeons shape or mold your body into new and more pleasing forms. Another form of this word, the suffix -plasty, is used in the names of many plastic surgery procedures. In the mid-1800s, the medical term for nose reshaping came to be rhinoplasty — rhino (for nose) plus plasty (to describe the shaping technique). Other examples include abdominoplasty (reshaping of your abdomen), mammoplasty (changing the shape of your breasts), and blepharoplasty (reshaping of your eyelids). As defined by the American Medical Association, the medical specialty of plastic surgery includes two subcategories of procedures: Cosmetic: Cosmetic surgery is performed to reshape normal structures of the body to improve the patient's appearance and self-esteem. Reconstructive: Reconstructive surgery is performed on abnormal features of the body (usually caused by congenital defects, developmental abnormalities, infection, tumors, or disease). It is generally done to improve function, but may also be done to approximate a normal appearance. Cosmetic surgery improves form, whereas reconstructive surgery improves function. Defining cosmetic surgery The primary purpose of cosmetic surgery is to improve your form, or appearance. In cosmetic surgery (sometimes called aesthetic surgery), you take a normal or near-normal part of the body and alter it to make it look better. For example, a young man with a weak chin line seeks cosmetic surgery to alter his profile. Or a 60-year-old woman with a face that is normal for a 60-year-old decides to get a facelift to improve her appearance. The most common cosmetic surgery procedures are the following: Liposuction Breast surgery Nose reshaping Eyelid lift Tummy tuck Facelift The rate at which these procedures are performed has been growing exponentially for many years. From 1997 to 2003, the number of surgical and non-surgical cosmetic procedures grew from 2.1 million to 8.3 million, according to the American Society for Aesthetic Plastic Surgery. If this keeps up, you won't have a neighbor or coworker who hasn't has something lifted, tightened, augmented, or filled. Cosmetic surgery and cosmetic surgeons are not synonymous. If you or a loved one is considering a cosmetic surgery procedure, you really need to know whether the surgeon you're consulting is trained in plastic surgery. Some doctors, even good ones in other fields, hoping to blur the boundaries of training and experience, run ads calling themselves cosmetic surgeons. This is perfectly legal in many places. They may be wonderful physicians, dermatologists or Ob-Gyns, for example, but they never had specialized training in plastic surgery, never did a residency, and so are not as qualified to give you the best result. Ask, ask, and then ask again to verify that the person who will do the surgery you want is trained in the specialty of plastic surgery or a surgical specialty that includes training in the procedure you want. Understanding reconstructive surgery During reconstructive surgery, the surgeon works with a body part that is not within a range of normal appearance to make it look more normal. Generally disease, deformity, or trauma prompts patients to seek reconstructive surgery. The repair of a cleft lip or reconstruction of breasts after cancer is considered reconstructive surgery, not cosmetic surgery, because the body part that is being improved didn't start out in a range of normal appearance; rather, it's being brought back to a normal appearance or function. Other common reconstructive procedures include facial reconstruction after serious accidents and hand surgery for work-related injuries or degenerative diseases such as arthritis. Blending cosmetic and reconstructive techniques Sometimes the cosmetic and reconstructive techniques are combined in one procedure that improves both appearance and function. An example is a rhino/septoplasty, in which the rhino portion of the surgery shapes the outer nose and the septo portion improves the breathing function of the inner nose.

Article / Updated 03-26-2016

Saline and silicone implants both have advantages, and both types of implants can and do produce excellent breast augmentation results. Because of current FDA restrictions, for most women having breast augmentation, saline implants are the only option. Silicone implants can be used for reconstructive purposes during augmentation procedures — if you have had previous breast reconstruction or a chest wall deformity, if there's a large difference in your breast sizes, or if you also need a breast lift at the same time. Saline implants Before it's placed in a breast, a saline implant essentially feels like a plastic sandwich bag filled with water. It's constructed of an outer shell of several layers of silicone rubber that includes a valve. Saline implants are usually filled to their final size by a disposable tube that runs from a bag of saline to the implant within the breast cavity. When the tube is withdrawn, the valve seals automatically, and a small additional sealing tip attached to the implant is inserted into the top of the valve. Implants come in various sizes ranging from 150cc (cubic centimeters) to approximately 700cc. The smaller sizes, from 150cc to 400cc are available in 25 to 30cc size increments. Above 400cc, the increments are 50cc. Here are some facts about saline implants: Cost: Saline implants are about half as expensive as silicone gel implants. Feel: Saline implants can be somewhat less soft and feel less natural than silicone gel implants. The best results with saline implants, however, are comparable to the best results with silicone gel implants. Volume: Saline implants enable surgeons to microadjust the volume in each implant. When the initial breast size isn't the same on each side, the surgeon can microadjust volume to balance the two sides. Wrinkling: In many augmented breasts, saline implants can be felt at the bottom or along the lower sides as an edge or as slight wrinkles. This effect is normal. Silicone gel implants Silicone gel implants have a shell made of several layers of silicone rubber. In prior generations of silicone implants, the wall or covering of the implants was weaker and more porous. The silicone within the implants was runnier, and small amounts of the silicone would bleed through the implant walls. The silicone now used in gel implants is semi-solid (non-runny and less likely to migrate). Reduced silicone bleed has probably resulted in reduced capsule formation. Here are some other important facts about silicone gel implants: Cost: Silicone gel implants cost about twice as much as saline implants, a problem if the cost of surgery is an issue to you. Feel: Silicone gel implants feel softer and more natural than saline implants. Wrinkling: If capsule formation does occur, silicone gel implants can develop wrinkling. In general, however, silicone implants don't develop the edge wrinkling that is common with saline implants. Volume: No microadjustment in volume of the implants can be made. The implants are completely sealed. From the smallest size available up to 400cc, the implants come in 25 to 30cc size differences. Above 400cc, the different sizes vary by 50cc. This has one small disadvantage in that most breasts normally vary in size, from one side to the other. If size variations can't be corrected in 25 to 50cc increments, some slight asymmetry in breast size will remain. Other implant options Although 85 percent of breast augmentations are performed with smooth round saline implants, some other types of implants are also being used. These are Textured implants have a rough outer covering. In the past ten or more years, when there was a high rate of capsule formation, surgeons felt that texturing the implant surface reduced the incidence of capsule formation. Textured implants are available in round shapes, but are also available in anatomic, or teardrop, shapes. Most plastic surgeons have abandoned textured implants because they are perceived by many to cause increased rippling and a higher incidence of capsules and consequently are much easier to feel than the newest smooth, round saline implants. High-profile implants allow you to have more volume in a narrower base width. Many surgeons use breast measurements to determine the maximum width of breast implant that can be used on a patient without causing distortion. If a small woman with small breasts and a narrow chest wall wishes to be a C or D cup size, the appropriate standard profile implant that fits her frame may not have enough volume to achieve the size she wants.

Article / Updated 03-26-2016

You may have exercised hours each day and watched your calories but still don't look the way you want in your dress or bikini. Or perhaps you just want to be your best and have decided to give yourself a present. You've decided that liposuction may be just what you want. A careful preconsultation evaluation of your own body and the goals you want to reach will make your consultation and decision-making process easier. Considering cultural ideals Liposuction is one of the more popular cosmetic procedures for both men and woman. For many people, the inability to have an attractive, youthful shape creates great stress, particularly for those who have tried to improve their figure through diet and exercise programs. A focal point of discontent for many men and women is the isolated fat deposit. The knowledge that liposuction can reduce those disproportionate localized accumulations of fat and help improve body contour irregularities often brings great relief to many people. Some young women aren't successful socially because they believe that their bodies are not attractive. In a different society or era, women may not have those feelings, but modern society does place a lot of emphasis on shapely bodies. Making those bodies closer to what society perceives as normal occasionally causes social miracles. Sizing up your health and body If you're considering liposuction, you're an ideal candidate if you're healthy, in good physical condition, and have tight, smooth skin (no cellulite or surface waviness). If you don't fit this ideal model and still want to consider liposuction, don't worry. Although the ideal patient can achieve an excellent result, you can achieve a very good or good result if you don't fit the ideal criteria. Dramatic changes can be achieved if you have localized areas of bulging caused by fat under the skin. For example, if you have very large hips and/or large outer thighs but otherwise have a normal shape, you're a good candidate for liposuction. These areas respond extremely well to liposuction, and you can have a normal shape the rest of your life. Liposuction can't help with generalized obesity, intra-abdominal fat, or excess loose skin. Some people with bulging tummies hope that liposuction can help but find out that almost all of the excess fat is "inside" the abdomen, wrapped around the intestines. Liposuction can't help in that instance. People who are moderately overweight can benefit from liposuction, and there are no absolute age limits. However, older patients usually have diminished skin elasticity and therefore may not receive an optimal result. If you have a bleeding disorder or take anticoagulants, you're probably not a good candidate for surgery in general and for liposuction in particular. If you have heart disease, pulmonary disease, or diabetes or are excessively overweight, you'll have a slightly higher chance of complications with all surgery. If your surgeon or her staff asks you for clearance from your physician or cardiologist before surgery, don't be upset. Those requests let your surgeon know that you can withstand the surgery safely. What liposuction can (and can't) do You have dieted and exercised and are stuck with a body that's still slightly too full in several areas. In women, the areas are usually the abdomen, hips, thighs, inner knees, and sometimes the upper arms and back. In men, the areas are usually the abdomen, flanks, and chest or breasts. The other areas of your body are normal, or at least as normal as you can get them. Liposuction can help you solve these problems. After 25 years of liposuction, surgeons have found that additional areas, such as knees, ankles, the face, and areas around the breasts and armpits, can also undergo liposuction with wonderful improvement. If you have localized excess fat essentially anywhere on the body surface (except perhaps the upper and lower eyelids), it can be liposuctioned. Many patients want their backs liposuctioned and end up slightly unhappy that they don't see greater changes. The reason is that the skin on the back is very thick and loose and the thick skin is frequently confused with excess fat. Liposuction of fatty chests or breasts works extremely well on men. The procedure is also a good alternative to breast reduction surgery for men and in some women with very large breasts. Avoiding the magic wand syndrome Your goal for liposuction should be to improve body contour, understanding that it will not change the way your skin looks. Liposuction removes persistent fat not responsive to diet and exercise and establishes more normal proportions between areas of the body. It also improves your appearance both in and out of clothing. You must be aware that the usual goal is improvement, not perfection. Having realistic expectations can make the entire experience much more satisfying and reduce your chances of disappointment. If you start the process with tight, hard skin, you will probably end up the same way, but with better contours. If your skin surface is wavy, dimpled, or wrinkled to start, your contours will improve, but the surface may stay the same. Some patients, in spite of receiving all this information, still believe in some recess of their brain that liposuction will make them perfect. When they realize that surgery hasn't made them perfect, they end up disappointed, even if they have a wonderful result. Matching expectations with reality is why your surgeon gives you so much information before surgery.

Article / Updated 03-26-2016

Only when you are realistic about the real risks of having cosmetic surgery, the costs, and the recovery can you make the best possible decision for yourself. Remember, you're in the driver's seat here, and the choice is yours. You can say "aye" or "nay" to cosmetic surgery. One thing is certain: You'll be the one who has to live with the consequences, whatever you do. Different people have different triggers that turn dissatisfaction into action. At some point, something happens that tilts you over the edge — one way or another. Your decision-making process may lead to one of three conclusions: go forward, stop, or postpone your decision. Understanding your motivations is an important step toward making your final decision. Getting to the heart of your motivations When considering having cosmetic surgery, you want to be sure that your motivations are personal and positive. When you're in control of your life and are a positive and happy person, cosmetic surgery can be a wonderful way to improve some imperfection that is bothering you. You're not looking at cosmetic surgery as a panacea for your problems but as an enhancement of your nice life. If you're thinking about having cosmetic surgery to solve some life crises or heal a sick emotional relationship, think again. The very fact that you are dealing with significant emotional or psychological issues should be a warning flag to you to wait. If you don't have any emotional or relationships issues but are facing significant financial or health issues, then you also want to wait until those issues are resolved. This is a significant personal decision, and you want all your ducks in a row. This decision isn't one in which you simply hope for the best or plunge ahead. Assessing your health Surprisingly, most people who function normally are able to have surgery, but it requires complete honesty, many precautions, and careful planning. A careful medical workup reveals whether cosmetic surgery is safe for you. Some conditions definitely make it too risky to have certain procedures. Understand that you must be candid with your surgeon — you may have health conditions (obesity, for example) or personal habits (such as smoking or drug use) that make surgery impossible. If you want to ignore sound advice and withhold pertinent medical information, you may be able to keep shopping until you find a surgeon who will operate on you, but at what risk? What will be the impact for you and your family should you follow this course and something really unfortunate happens? If your medical and surgical specialists tell you that you're not a safe candidate for surgery, then you need to listen. Checking your finances One very practical reason for deciding to go ahead with the cosmetic surgery that you've been wanting is that you can finally afford it. Cosmetic surgery is rarely covered by insurance, so you have to be prepared to pay for it yourself. If you're like some patients, you prepare in advance and have the total amount of money you need for the procedure in your checking account. Fewer than 50 percent of patients fall into that category. An increasing number of patients are using creative ways to realize their cosmetic surgery dreams. You don't want to be financially irresponsible, but if you find that you can afford it, then you may decide to "go for it." Your desire to have cosmetic surgery can't supersede rational financial planning. Out-of-control finances can do permanent damage to your financial future. Get your financial life in order before you go forward with the surgery. Never forget that healing is optimized when you're calm and stress free. Being in severe financial trouble can cause emotional distress, which can impair healing and recovery. Accepting cosmetic surgery's limits The mirror may reflect something you want to change, but you must be realistic about what's achievable. Ultimately, you need a consultation with a surgeon to determine whether your desires are fully compatible with your body type. The best surgeon can't change your genetic makeup. The happiest patients are those who accept the changes that are achievable and don't expect those that aren't possible. They aren't trying to look like someone else or become someone else — they just want to be the best they can be. Cosmetic surgery doesn't absolve you of the responsibility to eat and exercise responsibly. Liposuction is a good method of changing contours, but it's not a substitute for weight loss. Liposuction is a wonderful procedure for the person who is within normal weight ranges but who can't diet or exercise away certain genetic contours that can be truly troublesome. The single exception is surgery after massive weight loss.

Article / Updated 03-26-2016

Choosing a surgeon is the single most important decision you will make when it comes to cosmetic surgery. Take enormous care going through the selection process, and ask these questions, that a good, dependable surgeon should willingly and openly answer: Are you a board-certified plastic surgeon? (If not, are you board eligible or does your training and certification include the procedure I’m considering?) Board certification by the American Board of Plastic Surgery ensures the highest level of training. Call 866-ASK-ABMS (275-2267) or visit www.abms.org to verify. Do you have privileges to perform my surgical procedure(s) at an accredited hospital? Hospital privileges ensure that other physicians have checked out your doctor for you and determined that he is suitably trained and has demonstrated skill to perform your procedure in their hospital. Are you a member of one or both of the two prestigious societies for plastic surgeons: American Society for Aesthetic Plastic Surgery (ASAPS) and American Society of Plastic Surgeons? These self-governing societies have high standards and do your homework for you regarding your surgeon’s continuing education compliance and facility accreditation. Do you devote a significant portion of your practice to cosmetic surgery? You’re more likely to get the positive surgical result and patient experience you seek when your surgeon focuses on cosmetic surgery. How many times have you performed the procedure I want? How often do you perform it? Do you have before-and-after photos? Generally, the more experience a surgeon has, the more consistent his results. But, you still have to like the results. Before-and-after photos are a great way to find out if you share the surgeon’s aesthetic. What is your patient-education philosophy? You should be a partner in your care. That means you need to find a doctor who is committed to proactive communication and quality educational materials. Will you perform all of my surgery? If anyone else helps you, what will they do? You’re paying for the surgeon to do your surgery — the entire surgery. You should be told who will assist and how. Some procedures, such as breast reduction, require two surgeons, but you’ll be told in advance.

Article / Updated 03-26-2016

Your cosmetic surgery can be performed in a hospital, independent surgery center, or office-based surgery suite. Wherever the surgery is done, make sure it’s a safe, accredited facility, so ask these questions: Is my surgery going to be performed at the hospital or an ambulatory outpatient surgery center? These facilities have to adhere to the highest safety standards. If your surgery will be performed at one of them, you probably don’t need to investigate further. Is my surgery being performed in an office-based surgery suite? If so, you want to know the surgery suite has current accreditation. Ask to see the current license and check out the organization on the Web. What type of anesthesia do you recommend for the procedure(s) I am considering? You need to understand the risks and benefits of each type and why that type is suggested for your particular procedure. What are the qualifications of the person who is providing my anesthesia? Will I be able to meet with my anesthesia provider? Using board-certified MD anesthesiologists or certified registered nurse anesthetists (CRNAs) is recommended.

Article / Updated 03-26-2016

Searching for a cosmetic surgeon is more manageable when you use a clearly defined system to make the choice — consider all options and weigh them cautiously. If you’re consulting with a cosmetic surgeon and any of the following red-flag situations occur, you might want to consider looking for a different surgeon: During an appointment or pre-consult The phone isn’t answered promptly or is answered by a machine. No one takes time for your call; the doctor’s staff is abrupt or downright rude. You don’t receive promised information materials before your consultation. You can’t get your questions answered because the staff isn’t knowledgeable or says “the doctor will tell you everything at consult.” You can’t find out a ballpark fee. How can cost be a secret? You find out you won’t be meeting with the surgeon at your consult. Don’t waste your time. At the consultation You wait too long, which can be a sign that the physician doesn’t respect your time. If this happens, you must decide whether you can add an hour of waiting to every visit. If a physician is running late but apologizes because it’s unusual, then you don’t necessarily need to be concerned. You feel like just a number. Neither the doctor nor his staff is friendly or taking time to get to know you. You feel like you’re known only as the breast aug in Room 3. Your doctor isn’t listening to what bothers you or adds procedures that you’re not sure you want. He’s giving you one-size-fits-all answers when you want a tailor-made surgical plan. The practice can’t show you before-and-after pictures, or if the doctor is in a group, the staff can’t tell which doctor did the surgery pictured. You don’t receive a written fee estimate at consult, or the practice doesn’t have written policies for costs related to secondary surgery. You feel negative energy in the facility. You see examples of disinterest in you by the doctor or staff or notice unrest in their interactions with each other. Staff members contradict the surgeon’s recommendations for you. You feel pressured into scheduling surgery that day. This is a big decision, so you need time for reflection. When making your decision If something about the technique or recovery is sounding too good to be true, it probably is, especially if other surgeons disagree. The practice does nothing to follow up after your consultation — no phone calls, no letters. Do they care? Your gut is telling you no. If something doesn’t feel right, trust your instincts. Second consults may help you feel more comfortable. Or continuing until you find the right surgeon and staff may be the best solution.