Walking Through Breast Augmentation With Dr. Medalie
When a patient comes in the door and she’s interested in a breast augmentation, she checks in, she goes into the exam room, and we put her in a nice, comfy bathrobe. When I come in we have a general discussion about the procedure. We address questions like:
- What is the nature of the surgery?
- How long does it take?
- What’s the anesthesia like?
- What’s the actual process?
- What are the available options for implants?
Next, I take pictures of the patient from different angles. We take measurements and give her the specifics about what is a good idea in terms of augmentation for her. We go over sizing and the nature of the implants in terms of profile. And then, also importantly, we discuss the different types of implants.
A Candid Conversation About the Risks and Benefits of Your Options for Breast Implants
I think a lot of women come in with the idea that they want silicone gel implants, perhaps because they may have the reputation of being softer, or a little bit more natural in their appearance and feel. I show my patients each of their implant options. I’ll show them a silicone gel implant, a saline implant, and then I will show them the IDEAL IMPLANT® Structured Breast Implants. I just put each type of implant in their hand let them feel the differences for themselves. Then I go over the risks and benefits of each of these implants. This can be a five minute conversation if they’ve done a lot of research, or it could be a 15 or even 30 minute conversation.
Dr. Medalie’s Thoughts on IDEAL IMPLANT® Structured Breast Implants
Then the patient and I have the all-important discussion about which type of implant to choose. I’ve been using IDEAL IMPLANT for about nine months now. I discovered them at the Aesthetics Society meeting last year. At that meeting I thought about how all the FDA data has come back with the six year results and showed that the IDEAL IMPLANT actually has very good numbers compared to the other types of implants.
Proudly Introducing Patients to IDEAL IMPLANT
I decided I wanted to give my patients the opportunity to try the IDEAL IMPLANT. I kept a sample of one in my office and a number of patients would come in for breast augmentation and I would show it to them. We would discuss saline implants, silicone gel implants, and the IDEAL IMPLANT. My first patient who decided to try the IDEAL IMPLANT did it because It has good numbers, and because I told her I had no concerns about it. I gave her the options and I let her decide.
The patient had come in thinking she wanted saline implants because she was a little bit nervous about silicone gel implants. For this patient, there was no comparison when we put the saline implant next to the IDEAL IMPLANT. The IDEAL IMPLANT looked and felt much better than the saline implant. There was much less rippling and a much better feel. She said she wanted to try the IDEAL IMPLANT and so we did it. The surgery went fine and I saw her a little while ago. She had her six month follow-up appointment and she looks great and she’s happy.
IDEAL IMPLANT Puts Patients’ Minds at Ease
Some people come in and are on the fence about silicone gel implants. They’re a little bit nervous about it. They see the IDEAL IMPLANT and go, “Wow! I would definitely do this over saline implants.” They like the fact that it is filled with saline but its internal structure makes it look and feel better than a saline implant. It relieves these patients of that little nagging fear they had in their heads about silicone gel implants.
The LIfe-Expectancy of a Breast Implant
I tell my patients what every plastic surgeon should explain – there is a 100% chance of rupture of your implant at some point in your lifetime if you live to be 102. The patient may live for the next sixty, seventy, or eighty years with this implant, and it’s a manmade object. It’s probably not going to survive. At one point the implant is going to rupture. If it’s a saline-filled implant, you’ll wake up one Sunday morning and go, “Hey look, my left-side is deflated.” It can be a little bit embarrassing but the important thing is that you know right away and your body has safely reabsorbed the saline.
Silicone Gel Implant Vs. IDEAL IMPLANT: What Happens After a Rupture Occurs?
I’ve actually replaced saline implants under local anesthesia with some mild oral sedation in my clinic. I don’t take patients back to the OR for general anesthesia necessarily. Silicone gel implants are much harder to do. When silicone gel implants rupture, it may be a couple months before you notice it. The only way to truly tell whether a silicone gel implant has ruptured is to get a high-definition ultrasound or an MRI. By the time we detect the rupture there could be a change in your breast and I may have to go in and expand the capsule again. I may have to clean out the gel material. Most likely it would require a trip to the OR. It can’t be done in the clinic.
Any good plastic surgeon knows that a silicone gel implant is going to rupture at some point and sometimes it is a hassle to go back in and clean out the implant. Sometimes it is necessary to take out the entire capsule. It’s more involved than just going with the saline or structured implant. When my patients understand these risks, they start leaning away from silicone gel implants.
IDEAL IMPLANT Is Dr. Medalie’s Preferred Choice for Breast Implants
Just the other day a woman came in and said she’d seen on my website that I offered the IDEAL IMPLANT and that’s why she came to see me. I told her if I had to choose an implant, honestly, I would choose IDEAL IMPLANT. Even though I do a lot of silicone gel breast implants, personally, if it were for my family member, I would choose the IDEAL IMPLANT.
There was a recent meta-analysis study in which one of the co-authors at M.D. Anderson was looking at the problems with silicone gel implants. There was the possibility of a link between silicone gel implants and Sjogren Syndrome or a small auto-immune disease. It’s very unclear. The FDA vigorously disputes the link but it’s out there. It’s on the internet. People get nervous about that. Even I would get a little bit nervous about it and so I would go for the IDEAL IMPLANT.
Why IDEAL IMPLANT is the Best Option for Surgeons and Patients
To other plastic surgeons, I would say, “Offer IDEAL IMPLANT. What’s the worst that could happen?” Some surgeons are earlier adopters of new technology and others are not. I tend to be an early adopter because I like trying out new things. I will admit freely that with some new technology I realized there were problems. With the IDEAL IMPLANT I don’t have to worry about that because it’s been around for a number of years and it’s already had its first FDA approval. It’s not the next laser down the block that no one is really trying.
When you look at the IDEAL IMPLANT you can tell that it would be a good choice. If the data shows it has the low rupture rate and that people are satisfied with the operation, why wouldn’t you want to have that as an option for your patients? If a patient says, “I want the IDEAL IMPLANT,” you want to be able to offer it to them.
An Experienced Plastic Surgeon’s View on the Benefits of IDEAL IMPLANT
Some of the benefits of the IDEAL IMPLANT include:
- It is filled with saline, which is, essentially, salt water. Your body will reabsorb it.
- Early identification of rupture – If and when it ruptures you will know it very quickly because you will have a visible partial deflation.
- There is no cause for concern for what happens with rupture as opposed to when a silicone gel implant ruptures, and it sits and it’s undetected for two months, six months, or even a year.
- The IDEAL IMPLANT requires a smaller incision that silicone gel implants because it goes in empty, as opposed to pre-filled, like a silicone gel implant.
How IDEAL IMPLANT Compares to Saline and Silicone Gel Implants
In terms of looks, if you stand in the mirror, it will look the same no matter what type of implant you have. I have no doubt about that. Unless you’re extremely thin, it is hard to tell the difference just by looking at yourself in a mirror or looking at a picture, whether someone has a saline-filled or a silicone gel implant.
- Saline Implants: The feel of a saline implant is what some people are concerned about. The biggest problem with saline implants is that patients are worried about the feel of rippling, especially on the side and below the breast. I think the IDEAL IMPLANT has solved that. It has very small micro-ripples that are almost unnoticeable and then when you put a little bit of tissue over that, essentially, you can’t feel the IDEAL IMPLANT.
- Silicone Gel Implants: These implants are not perfect either because sometimes the silicone gel can fold and you can get a little crease in the shell of the silicone gel implant that actually feels like a hard point. There is no perfect implant in someone who is extremely thin. I would say that from a palpability standpoint, the IDEAL IMPLANT and silicone gel implants are the same. The advantages of IDEAL IMPLANT lie in the fact that it requires a smaller incision and you can detect early rupture and there’s no risk to the salt water filling. It’s just water.
The Ideal Solution for Cleveland Breast Implants
I’m a believer. I like the IDEAL IMPLANT because I think it solves some problems that heretofore were not solved. Saline-filled breast implants are less of a hassle down the road than silicone gel implants. The reason why people objected to saline implants originally was because they didn’t feel as good or look as good – especially on the side and underneath where the breast is thinner. Because it is a structured implant, the IDEAL IMPLANT has solved that problem. I like the name. I think it’s an ideal solution for what has always nagged good plastic surgeons.
Considering breast implants in Cleveland? Contact Dr. Daniel A. Medalie at Cleveland Plastic Surgery today to discuss your options. Simply call 216-393-9924 or visit www.clevelandplasticsurgery.com. Dr. Medalie’s office is located at 25700 Science Park Drive, Landmark Centre, Suite 190, Beachwood, OH 44122. Call today for more information on IDEAL IMPLANT ® Structured Breast Implants. *plastic surgery results may vary*
Posted on: Apr 2 2019
Liposuction is a great way to reduce localized areas of excess adiposity but it is not always the answer!
Ten common misconceptions about liposuction
is one of the most frequently performed cosmetic surgical procedures in the United States and around the world. This is somewhat surprising, considering how many misunderstandings about it persist. Listed below are the ten most common liposuction misconceptions we hear as plastic surgeons, and what the actual facts are.
Liposuction can help you lose weight
The reality is that most patients only lose about two to five pounds in total. The best candidates, in fact, are generally within 30 percent of a healthy weight range and have localized fat pockets they would like to reduce.
Liposuction can treat cellulite
Cellulite is not simply an irregular pocket of fat – it occurs when subcutaneous fat pushes connective tissue bands beneath the skin, causing those characteristic dimples and bumps. Because liposuction is only able to remove soft, fatty tissue (and does not directly affect the skin or other tissues), the fibrous connecting bands causing cellulite are not altered.
Liposuction is not for “older” people
Any patient who is in good health and has had a positive medical examination may safely receive liposuction. A lack of firmness and elasticity (both of which commonly decrease with age) may compromise the skin’s ability to re-drape over newly slimmed, reshaped contours. Poor skin quality is one of the main contraindications to liposuction.
Liposuction is dangerous
While every surgery carries an element of risk, liposuction techniques have become increasingly sophisticated. If performed by an experienced and board-certified plastic surgeon, and if the patient follows all appropriate postsurgical instructions, liposuction can be as safe and successful as any other surgical procedure.
Liposuction will fix lax skin
The appearance of a double chin or a heavy tummy may involve some degree of sagging skin with reduced elasticity, as well as excess fat. In such cases, your surgeon may recommend a skin tightening procedure instead of (or in conjunction with) liposuction, as liposuction alone may result in a deflated appearance.
Fat deposits removed will return after liposuction
Liposuction is “permanent,” in that once the fat cells are suctioned out, they will not grow back. However, there will still be some remaining fat cells that can grow in size and expand the area if one’s calorie intact is excessive. The best way to prevent this is to maintain a healthy diet and exercise regimen.
Liposuction is the “easy way out”
As mentioned earlier, liposuction is not a weight loss method, and maintaining ideal postsurgical results should include a general commitment to a healthy lifestyle. Liposuction (or any other body contouring method, for that matter) is targeted to streamline and contour localized areas – ideally, in someone who is within a healthy weight range.
You can get back to your routine right after liposuction
While relatively safe and frequently performed on an outpatient basis, every surgical procedure entails a recovery period, and liposuction is no exception. The most common after-effects include swelling, bruising, and soreness at and around the treatment areas. While the healing process varies from patient to patient, most should plan to take at least a week off work to rest and recover. It may be four to six weeks before a patient can resume strenuous activity or exercise.
Liposuction is only for women
Men frequently request liposuction – in fact, it was one of the top five most popular cosmetic surgeries American men received this past year, according to ASPS statistics. Common areas for treatment include the abdomen, love handles and chest.
Liposuction is always the answer to belly fat
Liposuction targets only subcutaneous fat – the kind that is located below the skin and above the muscle. An abdomen that protrudes due to fat under the muscle and around the internal organs (known as visceral or intra-abdominal fat) will not be improved with liposuction. Appropriate exercise and diet are the only effective methods to combat visceral fat.
Posted on: Feb 8 2018
This has been in the news recently and may be of interest to my patients.
Does nonsurgical fat removal work?
Each year, over 150,000 people get nonsurgical fat removal
performed – and not just women. Nearly 30,000 of those fat removal patients are men. Nonsurgical fat removal is a less invasive alternative to “regular”liposuction
, but does it work? The answer is more complex than a simple yes or no.
How does it compare to regular liposuction?
Nonsurgical fat removal is also often called “nonsurgical” liposuction, but really, it isn’t liposuction at all. Traditional liposuction is a surgical procedure, involving small incisions in which a tube is inserted into a fatty area. The fat is then “sucked out” through the tube, resulting in the permanent removal of those fat cells. Liposuction can be used on large areas where there are significant fat deposits and may be effective after just one procedure. Since liposuction is a surgery, there is some recovery time with swelling, pain and a risk of infection.
Nonsurgical liposuction can be one of a number of procedures which use lasers, heat, cooling or sound waves to “destroy” fat cells which will the be removed from the body as metabolic products. Nonsurgical liposuction generally has less-to-no recovery time as surgical liposuction but it isn’t effective on large areas of fat. Its use should be limited to small, stubborn areas that remain after an adequate diet and exercise program or to patients who cannot undergo surgery. In order to be fully effective, multiple treatments may be required.
Types of nonsurgical fat reduction
Nonsurgical fat removal is done in the plastic surgeon’s clinic, using one of a number of proprietary or “brand name” procedures. Brand names like Exilis, i-Lipo, Liposonix and Zeltiq or CoolSculpting, each uses a different type of treatment which may be laser- or light-assisted, cryo or freezing therapy, or sound through ultrasound or radiofrequency. Each type works to destroy the cell membranes surrounding fat cells which over time, may appear to “melt” the fat away.
Pros and cons of nonsurgical fat reduction
Pros: Nonsurgical fat reduction is just what it says, nonsurgical. There are no incisions done which means a noninvasive procedure with less recovery time required, less swelling and pain and a greatly reduced chance of post-procedure complications such as infection. It doesn’t usually require a lot of pre-procedure preparation and can often be done during the day with a quick return to normal activities.
Cons: The actual fat reduction takes place over the course of weeks or months and several treatments may be required. Because nonsurgical liposuction is an external treatment, it can be more difficult to target the fat in question. The surgeon may not be able to optimally address the fat in difficult areas or in patients with a good deal of scar tissue. Targeting may also be tricky as the physician cannot immediately “see” where fat destruction has been effective and must wait for additional treatment periods to refine the effects. Nonsurgical fat reduction does not produce immediately dramatic results and is not effective in people who need large sections of fat removed.
The bottom line on nonsurgical fat reduction
Liposuction, under expert guidance, is highly effective, more accurate and can be used in a variety of conditions. Newer ultrasound-assisted procedures have enabled plastic surgeons to be highly accurate in fat removal with a minimum of post-surgical complications. In general, liposuction is considered to be much more effective, but nonsurgical fat removal can be a good alternative for those who simply need a little additional help for some stubborn spots – or can be the only alternative if surgery is not possible. So, yes, nonsurgical fat removal works for the right patient but it does not compare to traditional liposuction. Noninvasive alternatives to fat removal, of course, bring limited results, so it’s important to discuss with your surgeon what the true body contour changes will be, as opposed to expectations from ads. In the end, the search for the Holy Grail of noninvasive body sculpting continues!
Posted on: Dec 15 2017
If you’re a smoker considering cosmetic surgery, your plastic surgeon will likely require you to stop smoking for at least two weeks before your procedure ( I actually sometimes ask my patients to quit for up to 3 months in advance if they are heavy smokers–D. Medalie). A long-term follow-up study finds that many patients receiving these instructions will quit smoking, or at least smoke less, in the years after cosmetic surgery, reports the September issue of Plastic and Reconstructive Surgery®, the official medical journal of theAmerican Society of Plastic Surgeons (ASPS).
“Our results show an association between cosmetic surgery and smoking cessation at long-term follow-up,” said lead author Aaron C. Van Slyke, MD, MSc, of University of British Columbia, Vancouver. “Surgeons who request preoperative smoking cessation may influence patients’ long-term smoking status.”
Many Cosmetic Surgery Patients Quit or Reduce Smoking
The follow-up study included 85 patients who were smokers when evaluated for cosmetic surgery. Like most plastic surgeons, senior author Nicholas J. Carr, MD, required all patients from his cosmetic surgery practice to refrain from smoking for at least two weeks before elective procedures. Those instructions reflect a well-demonstrated increase in wound healing problems and other negative outcomes among smokers after plastic surgery.
Five years after cosmetic surgery, 47 patients responded to a follow-up survey. Most of the patients were women; the average age was 40 years. The most common procedures were tummy tuck (abdominoplasty), breast lift (mastopexy), and facelift. After exclusion of five social smokers, the study included 42 patients who were daily smokers before cosmetic surgery.
In the follow-up survey, about 40 percent of patients said they no longer smoked cigarettes on a daily basis. Nearly one-fourth had not smoked at all since their cosmetic surgery procedure.
Most patients said they had reduced their cigarette use by any amount. Seventy percent agreed that discussing their increased surgical risks with the plastic surgeon influenced their ability to quit or reduce smoking.
However, one-half of patients admitted they did not follow the instructions to refrain from cigarette use before surgery. Nearly one-fourth continued to smoke up to the day of their procedure. Dr. Van Slyke and colleagues did not test to confirm whether patients had stopped smoking.
The complication rate after cosmetic surgery was higher in patients who continued to smoke: 24 percent versus 14 percent. (The difference was not statistically significant.) More serious wound-healing complications occurred in two patients, both of whom did not follow the instructions to stop smoking.
Due to the negative effects of smoking on wound healing, many plastic surgeons are unwilling to perform cosmetic surgery procedures in patients who smoke. Compared to studies in other groups, the new findings suggest that cosmetic surgery patients seem more likely to quit or cut back on smoking at long-term follow-up.
“This is consistent with previous research showing patients who seek to obtain cosmetic surgery are more motivated to sustain positive lifestyle changes,” Dr. Van Slyke said.
The results suggest that patients were more motivated to quit by targeted messaging with specific examples of the negative effects of smoking, rather than by a description of the general health benefits of smoking cessation. The authors conclude, “The dialogue between plastic surgeon and patient during the cosmetic surgery consultation serves as a unique moment to provide targeted smoking cessation counseling that may persist well beyond the surgical interaction.”
Posted on: Nov 8 2017
Dr Medalie is pleased to announce that once again he has been elected one of America’s top doctors. He is proud to serve Cleveland and Ohio as a premier plastic surgeon and will continue to strive for best results for his Cleveland plastic surgery patients.
- Dr. Medalie is one of Americas top doctors
Dr. Medalie of Cleveland Plastic Surgery is happy to announce that he has been selected for the 2013 Best of Cleveland Awards for Plastic Surgeons. He is proud to serve his community and will continue to strive for the optimal outcomes for all of his patients.
Dr. Medalie of Cleveland Plastic Surgery and Metrohealth medical center is pleased to announce that he has been given the “most compassionate doctor” award. Through multiple patient reviews he has been elected to this honor. He is gratified to have received this award and will continue to serve his Cleveland, Ohio patients and patients from all parts of the country with the utmost dedication, expertise and compassion.
It is with great pleasure that I announce my election again to Castle Connolly’s list of top doctors in America. I am proud to perform plastic surgery on my patients from Cleveland, the state of Ohio and all neighboring states. I encourage any interested patients to contact me through this web site for more information about cosmetic and reconstructive plastic surgery.