Barbie is 52 years old.

Barbie Who?

Two icons, Barbie and Oscar meet face to face in this to find out who is the superior human composite?
Although she was born and raised in New York, Barbie’s curves have penetrated the West Cost ideal in a magnitude directly proportionally to her unrealistic proportions. And while it is true that acrylonitrile butadiene styrene ages better than collagen, Beverly Hills plastic surgeon, Dr. Timothy Neavin, argues that Barbie is far less from perfect than Mattel and her neighboring East Coasters would have you believe when we compare her to Los Angeles’ proud token, the Oscar.
You may recall that it was a few years ago in New York, Barbie made her Fashion Week catwalk debut in 50 outfits by the country’s top designers. This weekend Los Angeles, California,  tore  it up in celebration of a superior American icon, the Oscar. New York City or Los Angeles? Plastic or gold plated britannium? You decide…
Barbara Millicent Roberts was born on March 9, 1959, as the Barbie doll was launched by Mattel, Inc. under the influence of Ruth Handler. But did you know that Barbie was inspired largely from what some consider a German sex doll? Lilli Bild was her name, and she was marketed to adults in bars and tobacco shops as a gag gift, commonly referred to in brochures as ‘always discreet’ and ‘the star of every bar’.
Barbie attended Willows High School in New York City, and over 50 years later she still hasn’t graduated. And while Barbie has been a powerful player of the toy fashion doll market for nearly fifty years, she has also been a wild child inciting numerous controversies and lawsuits.
For one, the Barbie Doll is 11.5 inches in height. On a 1/6 scale, this represents 5 feet 9 inches with a 36 inch chest, 18 inch waist, and 33 inch hips. Biologically speaking, she would lack the 17 to 22 percent body fat required for menstruation. To achieve her unrealistic weight and body proportions, a young woman would likely have to become anorexic or undergo radical plastic surgery.

Oscar's 84th birthday. Barbie is now in her 50's.

Oscar on the other hand will be celebrated his 84th birthday bash this Sunday, February 22, in Hollywood, California. And he didn’t age a bit.  Oscar (still) stands 2 inches taller than Barbie at 13.5 inches. How can you have osteoporosis when you have no bone? He depicts a knight holding a crusader’s sword standing on a reel of film with five spokes, each representing the original branches of the Academy (actors, writers, directors, producers, and technicians). He is a complex alloy favored for its silvery appearance and smooth surface, consisting of approximately 93% tin, 5% antimony, and 2% copper, all smothered an a rich, gold coat.
Although the origins of Barbie are clear, Oscar’s birth name is somewhat nebulous and has been contested. Some theorize that he was named after Bette Davis’ first husband. Others suggest that he was titled after the Academy’s Executive Secretary’s uncle, Margaret Herrick’s.

Whatever origin you choose to use, make no mistake. Oscar is a true class act. He represents the Academy Award of Merit, and remains one of the most sought out entertainment awards in human history. Stay tuned in this Sunday as Hollywood and the Academy’s gold plated statuette proudly represent the West Coast in real style and elegance. New Yorkers and Barbie lovers of the world stare at their television in envy. This is Los Angeles, California, and it is home to the Oscars.

Yesterday in my Beverly Hills office I saw a young woman who had a breast augmentation followed by two subsequent breast augmentation revision surgeries for capsular contracture years later. Her first capsular contracture developed on the right side not long after her surgery. This was revised (by her report – I didn’t do her prior surgeries) with a capsulectomy and breast implant exchange.  But, years later a capsulsar contracture developed on the LEFT side. This unusual situation inspired me to write about capsular contracture after breast augmentation surgery, since it is a rather frequent finding that many women don’t understand well.
A capsular contracture is the medical term for what many people describe as a hardening of the breast implant. In fact, the breast implant stays soft. The hardening is from the scar tissue that forms around the breast implant. Why does capsular contracture develop?  Here are some of the known risk factors:

Autoimmune disorders: Disease such as lupus or scleroderma may be associated with increased risk of capsular contracture.

Smoking

Radiation therapy (as in radiation treatment for breast cancer)

Severe trauma to the breast (car accident, for example)

Hematoma (for instance if one had an accumulation of blood in the breast pocket after surgery.  Blood is very inflammatory.)

Seroma (a collection of fluid under the skin.  This can occur after breast augmentation surgery)

Bacterial infections (sometimes even subclinical infections may increase risks.  Some believe the periareolar incision, since the dissection is carried through or close to the ducts which may harbor bacteria, may *slightly* increase this risk

Silicone molecules leaching into the pocket surrounding the implant (less likely now with the new generation implants that don’t have the leaking problems that their older cousins had)

Breast implant placement. That is, one be more likely to develop capsular contracture when your implants are placed over your chest muscle (subglandular).

The incidence of capsular contracture occurence is about 3 percent per year.  Depending on the symptoms, it may or may not be beneficial to undergo surgery.  For more information about capsular contracture, go this link.

Dr. Tim Neavin is a Beverly Hills breast augmentation specialsit, with offices in Beverly Hills, Dubai, and Glendora.

This is a most interesting story about breast augmentation and breast implants.  This is a story about a  woman who had breast reconstruction followed by heart surgery.   During a Pilates session she had a small accident. Her breast implant got sucked into her chest next to her lungs.  How could this happen?  Good question.  You’re right if you are thinking that breast implants should stay out of the lungs.  This woman had a double mastectomy (removal of both breasts) for breast cancer, followed by heart surgery which involves opening up the sternum, or breast bone. This weakened the chest wall, and during exercises, the sternum became unstable and the breast implant got swallowed up into her chest with heavy breathing! Now, before you say “what in the world!?”.   I’ll say it. Truth is, this type of complication from breast surgery, namely breast implant surgery, is exceptionally rare. For one, it was the heart surgery not the breast reconstruction surgery that led to this complication. Secondly, this would be nearly impossible with a breast augmentation alone. For a breast augmentation, the surgery stays above the rib cage. So while this breast implant story is interesting, it is rare, which I guess why it is so interesting, right?

You can find the original article here: http://www.medicalnewstoday.com/articles/239370.php.

Beverly Hills breast augmentation specialist Dr. Tim Neavin is Certified by the American Board of Plastic Surgery and has offices in Beverly Hills, Dubai, and Glendora.

There has been speculation that 19 year old superstar Miley Cyrus has had a recent breast augmentation. Tabloids abound are touting that her breasts sprung up two to three cup sizes in the last month, presumably from the addition of breast implants.  However, Miley Cyrus denies having a breast augmentation; But, recent pictures have indeed shown much more volume and breast size and cleavage.  This of course is not the first time tabloids and the press has drooled over the thought of young starlets getting cosmetic surgery.  The prospect of young, famous women in Hollywood going under the knife for larger breasts is a much sexier topic than getting an appendix removed.  Well, for most it is.

I personally reviewed some of the photos that led to the speculation that Miley Cyrus enlarged her breasts. I must say that although there appears to be more cleavage and volume, it is easy to be fooled. There has been a rather shocking advancement in bra and breast support technology which can nowadays convert an A cup into a C cup with the realism that would leave Hollywood CGI programmers envious. Such technological progress has led me and a few fellow Beverly Hills plastic surgeon colleagues (who have asked to remain nameless in this blog) that NASA space engineers are secretly subcontracted with Victoria’s Secret.  And on their days off when they aren’t planning the next mission to Mars, draft elaborate support mechanisms that defy all Newtonian laws to suspend big, beautiful breasts.   The truth is,  on determining whether breasts are truly breasts under clothes, it is virtually impossible to actually appreciate true breast volume without seeing the outline of a nipple. Thus, the photos presented lead simply to pure speculation. Until Miley Cyrus appears in a tabloid wearing an unpadded bathing suite where all  is visible, or a tight shirt without a bra, her breasts will remain a mystery, even to NASA.

It is often a very, very, very safe operation. However, there was a recent article dealing in the New England Journal of Medicine that reported blindness from a plastic surgeon in Korea from injecting fat into the glabella. (The glabella is the area between the eyes.) Often, the glabella is an area that gets sunken in with age and develops creases.

Although the nature of the injection was not described in detail in the journal article, there had been isolated reports over the last several years about this type of complication with injections in this region. For one, I do not inject fat or any volumizing product (injectables such as Juvederm, restylane, Radiesse) into  region primarily because there are a few cases of blindness that have been reported.  This one case in Korea is not the first.   Number two, I do not think fat injections  works that well in this particular region. These areas are better addressed with Botox that relaxes the muscles that cause these frown lines.  And, of note, there are no reported cases of blindness from Botox injections.

Also, significant advancements have been made in fat grafting technique. Almost exclusively the few isolated reports of blindness related to fat grafting were in this region (the glabella) and from the use of high pressure syringes with very small needles. For that reason, I as well as most of my colleagues use low pressure syringes and larger cannulas (not needles). With this technique, I do not believe there were any reports at least in the American literature of this terrible complication. The theory behind these few isolated events of blindness are that the high pressure syringes with a small needle actually allow an injection of either fat or any product (such as Juvederm or Restylane) directly into a vessel associated with the eye.  Abrupt occlusion of this vessel led to the tragic blindness in these cases.  Large cannulas (too large to embolize a small vessel) under lower pressure have proven to be exceptionally safe.  This article reported in New England Journal of Medicine should be a stark reminder that you should choose your plastic surgeon wisely, namely, the one that is familiar with fat grafting procedures and uses the latest technologies to reduce the risk of complication.

Silicone-Saline-Breast-Implants, capsular contracture, and beautiful breasts.

Another frequently asked question about breast augmentation is if the breast implants need to be replaced every 10 or 15 years. The answer to this is no. With breast implants basically, if they are not broke, you do not fix them. That is, there is no need to prophylactically replace breast implants. While it is true that the longer they are in the body, the more complication may develop such as breast implant rupture, capsular contracture, implant rippling, and asymmetry; if these problems have not developed, there is no need to replace implants to prevent them from developing.

Of note, regarding to capsular contracture, every year the rate of a capsular contracture developing is approximately 3%. So over the lifetime of your breast implant, the longer any implant is in your body, the higher the chance that a capsular contracture can develop. Regarding breast implant rippling, it is true that saline breast implant can develop more rippling  than silicone implant, particularly if the implant is placed above the muscle (subglandular), or the implant is under filled. Therefore, if rippling is a problem, the saline breast implants can be replaced for a silicone implant, and placed under the muscle (submuscular) if the saline implants are subglandular. Regarding breast implant rupture or deflation, if a saline breast implant deflates, the saline will be re-absorbed into the body and within days it will be evident that there is a major loss of volume on that side. If a silicone implant ruptures, one may not even know. In fact, there are many “silent ruptures” walking around Beverly Hills and every other city in the world right now. These “silent ruptures” (called “silent” because there are no side effects)  are often detected incidentally on imaging studies for other medically related issues.  These are women who have had silicone breast implant breast augmentation and somehow was identified (again, usually by imaging of the chest or breast for any number of reasons) to have silicone slowly leaking into the capsule of the breast. More often than not, there are no ill side effects. Silicone is one of the most inert substances we use in medicine. In fact, silicone devices are not unique to plastic surgery.  Silicone devices have been used in orthopaedic surgery for decades.  So in summary, as long as the breast implants in your body are not having problems and you are happy with their size and shape, do not waste time and money in breast surgery for removing them and/or replacing them.

Looking up accentuates bags which can be removed with small incisions behind the lid.

A great ways to actually view these bulging bags is to ask the patient to look up. This will accentuate any of the protruding bags in the lower lid. Or, one can gently press in the eyeball and see if any of the fat which constitutes the bag protrudes from the skin.  If yo do these maneuvers and there doesn’t appear to be an bulge in the lower lid, the issue is probably not the “bags”.  It is probably volume loss.   Sometimes, the hollowing out below the rim of the eye with aging can create a shadow making the patient look tired. Thus, there are two very different mechanisms that can generate very similar looking problems.   Not surprising, the two ways to correct this vary significantly. Whereas one can improve the appearance under the eyes by removing fat in a situation where there is a protruding herniation or bag of fat below the lids, the management of a hollowed out lower lid/cheek  involves ADDITION of volume such as fat or Juvederm.   In some cases, the combination of both approaches work when a person has both issues to correct. That is, when there is a hollowing out below the rim of the eye plus a protrusion of the fat in the lower lid, then both removal of fat bags with fat grafting or Juvederm to the depression below the rim may be indicated. If the problem with diagnosis is made incorrectly, then adding products such as fat or Juvederm below the rim may actually accentuate the protrusion of the fat bag.  Best thing to do if you think your eyes make you look tired? See your plastic surgeon that you trust and allow them to do these simple maneuvers and see what the best treatment is for you.

Anatomy of Ear

An old friend interested in plastic surgery called me about prominent his ears. He was interested in surgical correction of his ears, which is called otoplasty. Typically, prominent ears are result of two different things. One is the actual concha which is the major concavity of ear. In certain people, this is prominent and overdeveloped. The other component to prominent ears is the antihelical fold. This is the second fold in the ear. The more folded this is, the less prominent the ear protrudes.  In people with really prominent ears, you often see an effaced antihelical fold where this portion is flat.  That is, there is virtually no second ear fold.   Hence the correction of prominent ears can either be partial resection of the conchal bowl or recreating the antihelical fold, sometimes with a combination of both.  It can be done under local anesthesia in the office setting without the need for going to sleep (general anesthesia).  The result is often dramatic and immediate, with virtually no obvious scars. However, your surgeon will usually “over-correct”  the the ear because you will lose about 25% of the correction in about six months. The procedure typically takes about an hour to an hour and a half and the postoperative course is generally well tolerated with no downtime.

However, there is a point when the skin envelope is too large for the fat deposit, and in this instance,  liposuction can actually make the problem worse. Thus,  a proper  diagnosis is important prior to performing liposuction of the arms. With brachioplasty, the excess skin and fat are both excised.  There are different incision approaches, depending on severity of skin laxity. However, sometimes it is necessary to carry the incision down the arm hidden in the bicipital grove. In other minor cases, the incisions can be hidden as we approach the armpit. In any case, the results can be excellent and restore the patient’s body image regarding the arms, once the proper diagnosis is made along wiht an appropriate treatment plan.  Links to some of my book chapters  with renown plastic surgeon Dennis Hurwitz can be viewed here (brachioplasty) under publications tab.