Dr Bruce K Smith discusses his BEWISE breast augmentation technique.

Because breast surgery has been one of the most desired types of aesthetic or cosmetic surgeries for
many years, it is not surprising that revisional surgery is commonly requested and sometimes medically
necessary. Breast implants do eventually wear out and need to be replaced. In addition, aging and
pregnancy may drastically change the shape, volume and symmetry of the breasts. Revisional surgery is
a significant part of Dr. Smith’s practice and very few practicing plastic surgeons have the experience
that he has acquired in this challenging area. There are 4 main reason that patients desire revisional
breast surgery.
1. Breast shape or volume change
2. Implant related capsular contracture
3. Implant failure
4. Patients’ dissatisfaction with initial procedure
1. Breast shape or volume changes can occur due to weight gain or loss, pregnancy, aging of
the breast or capsular contracture. After the age of 50, the breast primarily functions as an
organ for fat storage. Increases in the size of the aging breast may motivate women with
breast implants to have the devices removed or reduced in size. With saline implants, the
devices can be deflated with a simple procedure in the office to help patients with decision
making to remove or downsize their implants. Most of the time implant removal or
reduction requires a lift or mastopexy in order to youthfully reshape skin that has been
stretched and droops. Drooping of the breast is referred to as “ptosis.” Ptosis may also
occur in women with breast implants after pregnancy and breast feeding. Many of these
patients desire a mastopexy or lift to reverse the effects of pregnancy.
2. Capsule contracture is the most common late complication after breast implants and while a
great deal of research has been directed toward determining causes and treatments, this
complication still occurs in patients with the incidence increasing by approximately 1% every
year that the implants are in place. Capsular contracture is caused by excessive scar tissue
around the implant that can cause pain, firmness and malposition. Significant and
symptomatic contractures usually require removal of the excessive scar tissue and implant
replacement; often changing the position or “pocket” of the new implant.
3. Implants, like any mechanical or medical device, will eventually wear out and need to be
replaced. While most implant manufacturers replace worn out implants free of charge,
there are other costs not usually covered by insurance for surgery, the facility and
anesthesia. Implants should last at least 10 years and many last over 20. Many patients with
implant failure, use the opportunity to increase or decrease the size of their implants at the
time of replacement.
4. Unfortunately, not all patients are completely satisfied after one surgery on their breasts.
With patient satisfaction as the goal of every plastic surgery procedure; dissatisfaction can
occur related to an early complication, (i.e. infection, hematoma, fluid collection, wound
separation) or a miscommunication between patient and surgeon. Everyone has their own
unique desires and expectations when considering plastic surgery and it is important for
surgeons to have a clear understanding of these perceptions prior to performing surgery.

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Gaspare Tagliacozzi is known as the “father of plastic surgery” for his work in 16th century Italy on reconstructing noses. Apparently there was no shortage of noses requiring “a little work,” back then. While in India certain criminals were tagged in what could be referred to as “offender confirmation surgery,” by cutting off their noses; in Italy it was the common practice of significance-seeking and testosterone-flaunting men to dual with a long narrow sword known as a rapier. Many a nose was cut, or amputated in the process. Whether in India or Italy, no nose was “no bueno,” serving as a “permanent reminder of a temporary (misguided) feeling.” (My apologies to Jimmy Buffet). Jordon Peterson, psychology professor at the University of Toronto, has described the “Matthew- effect” or the Pareto principle where one negative experience can result in a cascade of bad effects resulting in a downward spiral of consequences. In the New Testament, Matthew 25:29 states “For whoever has, will be given more and they will have an abundance,. Whoever does not have, even what they have will be taken from them.” Just for a brief moment try to imagine the consequences of not only being soundly defeated in a test of masculinity and honor, but also having your nose removed in the process. The deformity of the nose, the central feature of the face, has radically changed your overall facial appearance by creating a skeletonized look , like Harry Potter’s adversary Voldemort, as both airways are exposed. It’s not hard to imagine that a series of negative consequences may follow. Your wife or girlfriend may decide she can’t stand to look at you. Your occupation or employment could be lost or diminished. The lost income may result in the loss of your home and less food to eat. Poor nutrition may result in declining health and higher likelihood of illness. Sun Tzu, Chinese general and philosopher who is credited as authoring The Art of War stated that “Victory comes from finding opportunities in problems.” Tagliacozzi, was willing to take a bold step and accept criticism and failure in order to help turn around this spiral of humiliation, depression, and desolation. In a world of sandy necked ostriches, I applaud those who take calculated risks to help others. Those courageous individuals, in turn, are risking a first class seat on the spiral down the Pareto House of Horrors ride. And while I am sure Taglicozzi’s operative schedule was full; I am also sure he dealt with more criticism and ridicule than he deserved for trying to help those in need. Infection, flap loss, separation were not uncommon for his procedure that took the thin skin of the inside of the arm and temporarily attached it to the open wound of the nose: conjoining these two areas for several weeks. In the magic of wound healing, the blood supply to this flap of skin from the arm, would eventually be supplemented and then taken over by the skin around the nose. Over time, the blood supply from the arm could be completely divided and the tissue would survive by blood supplied from the face. The process is much like parents’ financial support of children. At first children are like flaps, completely supported by their parents. Gradually they are able to pay more of their expenses so that parental support becomes less important and eventually children become financially independent. What a beautiful thing this is. But wait, it wasn’t the “beauty” that motivated Taglicozzi, it was the positive psychological effect that motivated him. Just as there is a negative Matthew effect, there can also be a cascade of positive effects that result from a certain event. The verse in Matthew begins by stating that “whoever has, will be given more and they will have an abundance.” With this favorable effect in mind Taglicozzi stated, “We restore, rebuild, and make whole those parts which nature hath given, but which (mis)fortune has taken away. Not so much that it may delight the eye, but that it might buoy up the spirit, and help the mind of the afflicted.”

It is this positive psychological energy that motivated Taglicozzi then and continues to motivate plastic surgeons now.

According to Gallup, spring is the most preferred season of the year. Polls were taken in 1947, 1960 and 2005 and spring was consistently the favorite season, preferred by 34-36% of American questioned. By age group, the preference is more striking for Americans over the age of 65. While 18 to 29 year-olds favor summer, 53% of those over 65 prefer spring. What’s not to love about spring? The whole world comes back to life with longer days, beautiful colors, fresh, clean comfortable temperatures that beg for you to be outside. Unfortunately, Covid19 completely destroyed the excitement that is usually associated with spring this year. It’s ironic that the preferred season of those over 65, brought that particular age group the greatest threat. I am hopeful, however, like the younger Americans, we can all look forward to summer as the spring replacement for renewal and rejuvenation.

For many “renewal” may mean a few days at the beach or in the mountains, a seminar, a book or series or a simple gathering of friends and family without contact isolation restrictions. For others, it may offer an opportunity for an elective plastic surgery procedure that’s been considered for a while. There are many new and interesting procedures to rejuvenate the eyes, face, and body. PlasmaPen is a new procedure now available in the office that can offer exciting skin tightening and rejuvenating results with minimal downtime. Plasma energy is delivered in a series of tiny spots 1 to 2 mm. apart, creating reddish brown dots that fall off in about 5 days leaving smooth, tightened, and rejuvenated skin. Plasma is the same medium of charged atomic particles that in nature creates lightening. The energy passes from a small handpiece to the skin without touching it. The treatment is new, but the early results are very exciting.

The other procedure that is very exciting is offered through the office’s association with a local stem cell company, Celltex. Adipose derived stem cells are specialized cells which have the potential to develop into many different types of cells and provide a wide variety of functions. These cells can differentiate into fat, muscle, bone, and nerve cells. Stephen Hawking , the well known English physicist who passed away in March of 2018 is credited as saying that, “Intelligence is the ability to adapt to change.” If this is true, then these stem cells are the most intelligent cells in the body. These cells can be harvested through a simple procedure in the office or in the operating room at the same time other procedures are being performed. If you suffer from chronic pain, arthritis, neuro-degenerative disorders, or auto immune conditions, I would invite you to consider having stem cells harvested and explore the services offered by this unique company. Celltex is the only company that can expand your personal cell line and offer large numbers of stem cells to be used in treatment without the need for additional harvest procedures. The therapeutic benefits from stem cells is only beginning to be realized.

The summer of 2020 will be a “Summer of Renewal and Rejuvenation,” as we overcome this difficult time of fear and isolation that was created by the Coronavirus pandemic. In medical school, I was always amazed when we studied the history of plagues, epidemics and pandemics in Microbiology: how these incredible events would run their course and then simply go away. Even recent Ebola outbreaks in Africa would devastate villages but then eventually run their course and people would return and resume normal lives. Somehow the recurring cycle of destruction followed by renewal, rebirth and regrowth is programmed in to our lives on earth. This year the coming of spring was clouded, masked and shrouded by fear and forced isolation. We certainly have some “making up” to do for the lost spring of 2020. I hope whatever age you are that this year, summer will be your favorite season.

You won’t be in a position to blow your nose for a couple of weeks. The nose is often considered the focus of the face, so even a minor adjustment can produce a profound effect on someone’s appearance and self-confidence. If you are feeling self-conscious on account of your nose for a number of decades, speak to an experienced plastic surgeon about rhinoplasty and how it is able to help you.

You should discuss what you’d love to achieve and exactly what you don’t like about your nose. It’s possible you’ve been teased about your nose. Most people want to get a nose that’s in harmony with the face. When the nose is wholly numbed, a couple minutes are necessary for the anesthetic and vasoconstrictor (epinephrine) effect to completely do the job. At times, also, the nose wants an additional operation to tweak the last results. Additionally, there are many men and women who have acquired a misshapen nose because of some accident they may have endured from.

Unfortunately, rhinoplasty isn’t a positive experience for everybody. Rhinoplasty is a rather straightforward cosmetic procedure that is done on millions of patients all around the USA annually. To start with, rhinoplasty is among the most frequent surgeries people elect for when they wanted to receive a cosmetic surgery done on their nose.

Lots of people elect for rhinoplasty to modify the appearance of their nose. So it is not difficult to see why it’s the sort of rhinoplasty is preferred. Rhinoplasty is among the most frequent plastic surgery procedures performed in the usa. All things considered, rhinoplasty is among the most frequently performed plastic surgery procedures. Rhinoplasty is consistently among the most requested facial surgeries among patients, as a result of simple fact that the nose is among the most noticeable facial capabilities. Rhinoplasty is among the toughest and most well-known regions of plastic surgery. The most suitable rhinoplasty is likely to make your nose blend with the remainder of your features and make all that’s most attractive about your face stick out.

Broadly speaking, folks start to consider such a plastic surgery since they don’t enjoy the way that they look. Eyelid surgery needs a quick hour or so of surgery which requires small incisions in areas that are simple to hide afterwards. There are several things that you can do in order to reduce to what extent your surgery is likely to cost you. Prior to when you own a cataract surgery, an individual’s eye may be deliberated and then screened to determine just what intra-ocular lens will be placed into your eyeball. The surgery can be carried out purely for cosmetic reasons or to correct an issue with the septum. In some instances revisionary surgery may be critical. The second sort is the elective surgery where if you are not happy about a certain body part then you are going to attempt to correct that.

Possessing the surgery provides you with a feeling of empowerment. Nose surgery is getting an extremely common cosmetic surgery, but there are nonetheless some risks involved. Nose surgery, also referred to as rhinoplasty, is a well-known cosmetic procedure developed for people that want to add balance and symmetry to their facial capabilities.

The surgery can be challenging and it’s therefore important to understand the benefits, risks, and what things to expect after rhinoplasty. The majority of the plastic surgeries even do not need any surgery. If you’re considering undergoing plastic surgery to enhance the look of your nose, it is probable you have spent a wonderful deal time researching the process. Plastic surgery can seamlessly boost the look of their nose and, thus, instill a feeling of self-esteem inside them. Plastic surgery is rapidly turning into a way for individuals to attain the results they need so far as beauty goes. Nose plastic surgery is among the more popular forms of surgery you can get.

The very first point to consider is the length of time it has been since the surgery. Cosmetic surgery is performed on individual who want to boost their outer appearance that might actually be affecting considerable level of self worth. It can also be divided into two categories. It is one of the branches of plastic surgery. It is also possible with the help of fillers. Before deciding if it is exactly what you want or need, it is important to do the proper amount of research on the topic and enough soul searching to feel comfortable with your decision. People today get cosmetic surgery for a number of factors.

Bruce Smith MD

Bruce Smith MD