Sunday, October 25, 2009

Facial Rejuvenation:The Importance of Upper & Lower Blepharoplasty




While I enjoy all aspects of Plastic & Reconstructive surgery, facelift surgery is particularly enjoyable to me. I am very fortunate to have a successful facelift practice at such an early point in my career. I am very grateful to have learned from such excellent mentors in Beverly Hills and I give the highest thanks to Dr. Giacobazzi, Dr. Moelleken, Dr. Markowitz, Dr. Perlman, Dr. Lesavoy, & Dr. Leaf for giving me the opportunity to watch and learn from them. They provided me with invaluable knowlege, experience, lessons, and insight.

As I review my results, I understand the importance of rejuvenation of the eyes to create a more youthful appearance to the face. As the face ages, the brow descends and skin accumulates around the upper lid and fat begins to herniate through the lower lids creating a tired appearance to the eye. While I do not encourage procedures during consultations, I often point out to patients who present for facelifts that small, subtle changes to the eye can yield a large difference. In this photograph one notices how effectively an upper blepharoplasty, or upper eyelid, procedure in conjunction with removal of fat from the lower eye can restore a youthful appearance to the face when utilized in conjunction with a facelift.
Brian P. Dickinson, M.D.

Wednesday, October 21, 2009

My Great Mentors in Plastic & Reconstructive Surgery




I am truly grateful to have Plastic & Reconstructive surgery practices in both Orange County and Beverly Hills, California. As another birthday passes, my career advances, I accrue more wisdom, and I give thanks for what I have and what I have attained.

Among the many things I am thankful for, one is the great relationships that I have developed with the outstanding surgeons who trained me and who are truly masters in the field. I look forward to maintaining these relationships in the future. Relationships take time, effort, and energy. I look forward to the benefits that will be gained from the hard work and I look forward to making my mentors proud.

Brian P. Dickinson, M.D.

Breast Augmentation Consultation & Bra Sizing: The Challenges & The Basics


Breast augmentation consultations and procedures may be challenging when trying to determine post-operative bra size. I have found the bra-sizing system designed by Dr. Edward A. Pechter from Valencia, CA to be the most effective method for successful breast procedures.



The breast augmentation consultation can often bring anxiety to the patient as there are many questions to be addressed or discussed. These variables can range from topics pertaining to the patient (medical conditions, height & weight, bra size, pre-operative breast shape); surgeon (preference for above vs. below the muscle, incision choice); or implant (saline vs. silicone, smooth vs. textured, profile).

Determining bra size in breast procedure consultations creates a common frame of reference for the physician and patient to discuss post operative bra size. The first step in the physical examination is observation. In the observation step, both the patient and I stand in front of the mirror and with the same perspective identify any asymmetries between the breasts. Breasts are more often than not asymmetric with either a discrepancy in breast volume, breast fold position, nipple position, shoulder height, and chest wall asymmetry. After this step of the physical examination we proceed to pre-operative bra sizing.

Bra Sizing: The Basics

The size of a bra is determined by two factors: 1) The Band Size & 2) The Cup Size.

1) The Band Size

Step 1. The band size of the bra is relatively a fixed number determined by the circumference of a woman’s chest. This number can be measured with a measuring tape in inches, just beneath the breasts, in the crease where the band of the bra would be placed.
Step 2. Add five to the number of inches determined from this measurement. For example, if the measured number is 27” then if you add the number 5, the result is 32. Therefore the band size of the bra necessary is 32. If the measured number were 28” adding 5 would result in a 33 band. One quickly realizes when bra shopping that there are no odd number band sizes, so one would try on a 32 or 34 band bra to see which fit best. In this scenario, the 32 bra would be worn on the last of three clasps and a 34 bra would be worn on the first of three clasps.

The band size is relatively consistent in women of adult age as the bony ribcage has completed growing. This number will change to a small degree if a woman gains or looses weight around the chest where the band of the bra would normally be placed. The so called “bra fat”.

2) The Cup Size

I have found the “Size Me Up” system designed by Edward Pechter in Valencia, CA to be the best system for determining cup size. In the “Size Me Up” system, the dome of the breast is measured by starting the measurement from where the breast begins on the side of the chest, passing over the nipple and finishing towards the sternum where the breast ends. The resulting measurement is then compared on the “Size Me Up” chart to determine the cup and bra size.

One point I have learned is that the “cup volume” or “measured breast dome” increases depending upon the band width. That is, a “C” cup represents a smaller volume breast for a woman with a small ribcage (i.e.32 band size bra, C-cup) than a woman with a larger ribcage (i.e. 36 band size bra, C-cup).

In my experience, the best manner in which to predict the post-operative cup size is to determine the pre-operative bra size measurements and base diameter of the patient. The post-operative cup size can be predicted by using these measurements with the volume per base diameter of the breast implant.

While the prediction of post-operative cup size is not exact, I find this step to be helpful, as it facilitates a common frame of reference between the patient and surgeon.

Photograph: Revision breast augmentation. Bilateral Capsulectomy, Conversion of total submuscular saline breast augmentation to dual plane silicone breast augmentation.






Tuesday, October 20, 2009

Liposuction: Inner/Outer Thighs, Lower Abdomen






While I enjoy all aspects of my Plastic and Reconstructive Surgery practices in Newport Beach & Beverly Hills, California, I have found that liposuction is often a very powerful tool whether it is used alone or in conjunction with other aesthetic procedures.

I have already commented on the efficacy of liposuction for the "upper arm and bra fat" areas in my previous blog publication. Liposuction is an excellent adjunct to breast augmentation, breast lifts, rhinoplasty, and abdominoplasty.

For example, frequently I have patients who undergo breast augmentation who would also like to have liposuction performed on the localized fat deposits beneath their chin or neck. Or, a woman who wants to have a rhinoplasty or "nosejob" performed and have the fat removed from beneath her chin or neck. These types of combination procedures are very powerful when performed in the same aesthetic region, for example rhinoplasty and neck/chin liposuction as well as breast lift with liposuction of the bra fat.

Above you see before and after results of liposuction of the inner and outer thighs and lower abdomen of a happy patient. I find it to be of paramount importance that liposuction should not be overdone as the natural contour of the body part may become distorted and appear obvious. When in consultation with your plastic surgeon, always inquire about liposuction as an adjunct procedure for the procedure you are about to undergo.

Friday, October 16, 2009

The Fractional CO2 Upper and Lower Blepharoplasty



I have been very impressed with the results of the Fractional CO2 Laser for full facial resurfacing as well as for concentrated efforts on the upper and lower eyelids.

Patients who are excellent candidates for Fractional CO2 Laser include younger patients with fair skin who are not quite yet surgical candidates for either upper or lower blepharoplasty, facelift, or necklift.

Traditionally I have found that female patients in their late thirties and early thirties who do not want aesthetic surgery and who are starting to develop skin laxity do great with these treatments in the areas of the eyelids, jowls, neck, and nasolabial folds.

Often these happy patients will return for their post-procedure appointments and say that their friends all ask, “Did you just get back from vacation?” or “You look so well rested”.

I am very happy with the results I am obtaining with the CO2 Laser and look forward to using it in conjunction with rhytidectomy in the months ahead.

Brian P. Dickinson, M.D.

Wednesday, October 14, 2009

Revision Breast Augmentation in Elite Athlete’s, Fitness Models, & Runway Models




Revision breast augmentation procedures may be challenging for the Plastic & Reconstructive Surgeon as there are many variables to consider. I find these revision breast augmentation operations to be particularly enjoyable as there are often significant anatomic and aesthetic variables to address so that the outcome is successful.

Common variables in “Fitness Models” & “Runway” models include:

1) Prior breast augmentation surgery
2) Implant Malposition (Most Commonly Lateral/Axillary Displacement of Implant)
3) Muscle Contraction Induced Deformity
4) Initial scar placement
5) Capsular contracture
6) Avoiding or minimizing loss of strength
7) Low body fat
8) Desire for early return to exercise

It is important for the Plastic & Reconstructive Surgeon to be aware of dimensions and profiles of implants available to the patient to best camouflage the implant. In the “Fitness Model” and “Runway model” population the variables mentioned above make the margin for error small and the visibility of the implant may be very unforgiving. Appropriate selection of implant based on the base diameter of the patient, soft tissue characteristics of the patient, and implant profile may optimize the outcome. It may require several discussions between the surgeon and patient to make sure that everyone is on the same page with respect to implant size, shape, desired cup size, and realistic expectations.


Thursday, October 8, 2009

Revision Breast Augmentation: Correction of Capsular Contracture & The Double Bubble Deformity




While I enjoy all aspects of Aesthetic Surgery, correction of capsular contracture and revision breast surgery is particularly enjoyable to me. Not only do I enjoy anatomic and aesthetic challenges of these operations, but also the degree of patient satisfaction is high.

This patient had painful capsular contracture and left breast double-bubble deformity. Correction of this asymmetry was done with bilateral "en bloc" capsulectomy, re-set of the inframammary fold, and change of implant profile. I am very thankful to have had such excellent aesthetic surgery training from outstanding mentors in Beverly Hills, Sherman Oaks, Encino, and Valencia. I am truly fortunate.