1.  “You have to have your breast implants changed every ten years.”

     I have absolutely no idea where this came from but it seems that every patient interested in breast augmentation has heard this.  It is NOT true.  Most implants should last 15-20 years before rupturing unless you have very low quality implants (which I think that some surgeons use to get repeat business).  If you are not having a problem with your implants, you do not need to have surgery on them just because they are five or ten years old.

2.  “Breast implants placed on top of the muscle will give you a lift.”

     Breast implants placed on top of the muscle make the sagging that you have more appropriate because larger breasts should droop more than smaller breasts.  In my opinion, they do not really give you a lift; at least not much of one.  In fact, they will probably make you sag more over time because your breasts are now larger and heavier, making the skin stretch.  Breast implants placed under the muscle have support from the muscle and tend to sag less over time.  Implants placed on top of the muscle create a number of problems.  They are easier to feel and see and have a higher risk of rippling; so they tend to look and feel less natural.  They also get in the way more than submuscular (implants under the muscle) implants when doing mammograms so they can interfere more with cancer detection.  Placing the implants on top of the muscle interrupts some of the blood supply to the nipple and areola creating a higher risk of loss of the nipple and/or areola when doing a breast lift in the future.  In addition, implants placed on top of the muscle have a higher risk of developing capsular contractures which causes hardening of the implants as well as painful, misshapen breasts.

The bottom line is: If you need a lift, get a lift but keep your implants under the muscle.

3.  “You must massage your breasts after breast implant surgery to keep them soft.”

     This works in theory, but not in practice.  The idea behind this is that, if you keep the scar capsule around the implant larger that the size of the implant by massaging or manipulating your implants, you can prevent capsular contracture.  I am aware of no study that has even suggested that this is true.  Sadly, I know of surgeons who have used this theory to blame their patients for their own capsular contractures!  “It’s your fault; you didn’t massage them enough.”  Don’t fall for this.  Besides, by putting your implants under the muscle, you effectively massage them every time you move your arms.

4.  “There are treatments that effectively remove cellulite.”

     Think about this one.  If there was a product that effectively removed cellulite, wouldn’t every plastic surgeon in America have it?  You bet they would!  Unfortunately, it doesn’t exist.  Don’t be fooled by statements like, “FDA approved to remove cellulite!”  The FDA does not test products like this for effectiveness.  Their job is to make sure that products don’t harm you.  By being ‘FDA approved’ simply means that you shouldn’t be hurt by the treatment; it does not mean that it will work.  There was a product out like a rolling vacuum that was supposed to remove cellulite years ago but you had to diet, exercise and drink gallons of water a day at the same time.  If your cellulite got better, what do you think did the trick?  You got it, the diet and exercise.  Why do you think so many physicians are trying to get rid their machines now?

5.  “’Quicker’ or ‘Faster’ surgery is better.”

     Let’s think about this one.  Let’s say that you need open heart surgery and have seen two doctors.  One says that he can get you done in less than an hour while the other says that in order to get it done right, it will take three hours.  Who do you go to?

If you’re telling me the first one, God rest your soul!  I can just hear the conversation in the O.R.:

        Nurse: “Doctor, you’ve been in this surgery for over an hour.”

        Doctor: “Time to wrap it up then.”

        Nurse:  “But you’re not finished yet.”

        Doctor:  “Hey, I promised fast not quality.”

    Don’t think that this isn’t far from the truth.  There is a company that owns small surgery facilities and does national advertising for fast surgery.  Their criterion for hiring surgeons is that they can complete their proprietary named surgery in less than two hours.  That’s pretty much it.  Not even a requirement that they be certified by the American Board of Plastic Surgery.  Just get it done fast.

    Do you think that by promising a fast surgery that the surgeon has time to hide the scars, work delicately with your tissues to prevent complications or work diligently to get the best result?  You know darn well that they don’t.

6.  “No down time!”

    This one is pretty simple.  “No down time” almost always means “No results.”

    Even the procedure with the least amount of down time that I can think of, Botox Cosmetic® has at least a little time for the skin to recover from the injections and sometimes you can get a bruise.

7.  “Surgical results from over-the-counter (OTC) skin care products.”

    Sometimes you just have to laugh.  No one really monitors the advertising of these products so they can make any claim they want.  What’s the worst that can happen?  You demand your money back.  Big deal!  How many people actually go through the hassle of arguing with the company to get their $30 back?  It’s just not worth it.  Here’s my favorite:  I saw an advertisement for a skin cream that was guaranteed to work if you used it for three months as directed.  But, you had to request your refund within 30 days!

    Be honest.  You have a cabinet full of products that promised this or that and they just didn’t work.  The fact is that OTC products can only have about half of the concentration of active ingredient as prescription products or those that are purchased in a physician’s office. That equates to about half of the effectiveness.  Most good skin care programs include a combination of products that work together to get the best results.  Our patients have been the happiest with the Obagi® skin care line.

8.  “I am a ‘Board Certified’ plastic surgeon.”

    No laughing at this one.  Regretfully, anyone with “M.D.” or “D.O.” behind their name has the ‘right’ to call themselves a plastic surgeon; even if they have absolutely zero training in plastic surgery.  I kid you not!  Take a look in the phone book under Plastic Surgery.  About 35% of those listed in Columbus are not trained in plastic surgery and are not even eligible to be certified by the American Board of Plastic Surgery.  Only surgeons who are certified by the American Board of Plastic Surgery (ABPS) have had legitimate plastic surgery training and have passed rigorous written and oral examinations in addition to having their practice evaluated prior to taking their exams.

    There is absolutely no substitute of proper training, knowledge, experience and skill.  Make sure that your surgeon has proper certification by the ABPS. THERE ARE NO OTHER LEGITIMATE PLASTIC SURGERY BOARDS!!!!!  If your surgeon is a member of the American Society of Plastic Surgeons, they are properly board certified.  You can check them out at www.plasticsurgery.org to find out for sure. If you are considering cosmetic plastic surgery, you may also want to see if your surgeon is a member of the American Society for Aesthetic Plastic Surgery (ASAPS).  Members of ASAPS are all board certified by ABPS but also specialize in cosmetic plastic surgery.  Their website is www.surgery.org.

    At the very least, make sure that your surgeon is adequately trained!  I see many patients who have surgery by a fake ‘plastic surgeon’ only to have a bad result which can only be partially repaired and they had no idea that their surgeon was not really trained in plastic surgery.  You can’t just read about it in a book and go out and operate on patients; it takes years of training. Do your homework before surgery!

9.  The ‘Expert’ patient.

    The so-called ‘expert’ patient is the one who has had a particular procedure and now feels the he or she is now the world’s expert on that procedure.  This wasn’t a big problem until the development of the internet allowed them to misinform thousands of people at a time in chat rooms, blogs, etc.  The internet can be a good source of information; unfortunately, it can also be a source of bad information.  I’m not sure what motivates these individuals other than they want to be put on a pedestal and praised for their knowledge.  They have no idea what harm they can do.  I spend a lot of time talking with patients and correcting the bad advice they have received from ‘expert’ patient.  Their isolated experience may be very unique and vastly different from what most patients go through.  Beware of these self-absorbed loud-mouths.

10.  “Laser liposuction will shrink and tighten your skin.”

    To be perfectly blunt, this is an absolute lie.  Three days before writing this, I saw a patient with a permanent burn scar on her abdomen caused by laser liposuction which her surgeon told her would tighten her skin.  Well, it’s tight where the scar is but it looks like a second belly button and there’s not much that can be done about it.  I am aware of no good scientific study which suggests that laser liposuction will actually shrink your skin.  I have actually been an evaluator in a study comparing laser liposuction to standard liposuction and there was absolutely no difference between the two!

    There is a very simple reason why this does not work.  First, a little anatomy lesson: There is a layer of fat just under the skin on most areas of the body which contains blood vessels and nerves to keep the skin alive and sensate.  This is called the subcutaneous (sub means ‘under’ and cutaneous means ‘skin’) layer.  When performing any type of liposuction, it is important to leave that layer mostly intact to avoid damage to those vessels and nerves so that the skin over the area treated will stay alive and have sensation. It is also important to keep that ‘buffer’ layer intact to prevent dimpling and rippling of the skin.  In order to get the skin to shrink by applying some sort of energy from underneath, such as with laser liposuction, you have no choice but to destroy that layer resulting in severe damage to the blood vessels and nerves resulting in the scar which the patient above experienced or loss of sensation.  Painful burn scars are one risk of laser liposuction that is not a problem with standard liposuction. Ultrasonic liposuction is another liposuction technique to remove stubborn fat which I have been using for over ten years. It is particularly effective on male breasts, treating areas that have been previously liposuctioned and some other tough areas.  It also is reported to shrink skin, but, for the same reason above, I do not believe that it is actually true.

James D. McMahan, M.D.