James J. Romano, M.D., FACS
I have been to two different plastic surgeons for a consultation on a brow lift. They agree on the fact that I need a brow lift but they disagree on the procedure. One has suggested an endoscopic brow lift and the other a coronal brow lift. I am 46 and have low eyebrows but not a significant amount of loose skin on my forehead. The coronal lift seems very invasive but I have heard that the endoscopic lift doesn't work as well. What are the statistics?
Your experience is not unusual and often very good plastic surgeons may recommend different techniques that can provide the same or similar results. In terms of your anatomy, one technique may be better suited for you than the other. Your plastic surgeon will consider your features and expectations, as well as the associated risks and benefits. Both endoscopic and open (coronal) lifts address the problem of low eyebrows. Some surgeons prefer the endoscopic approach, while others argue that the endoscopic lift does not seem to elevate high enough or stay quite as long as an open lift. Clinical studies have supported the effectiveness of both techniques. The open lift may be particularly effective in treating horizontal forehead wrinkles. Be aware that either procedure may slightly elevate your forehead and hairline. For most patients, this is not a significant concern.
Are there certain surgeons who specialize in children's procedures? We are thinking of having our son's ears done but want to find someone who is familiar with children's needs and the procedure as well as anesthesia. How do we find a person who specializes in this area?
There is a subspecialty of pediatric plastic surgery in which some fully trained plastic surgeons have taken additional training. You may want to inquire about this. There are also a number of plastic surgeons that have special interest and expertise in treating pediatric patients and their related plastic surgery problems.
On the other hand, I can reassure you that this is a very standard and routine operation performed well by virtually every board-certified ASAPS-Member plastic surgeon. What I would confirm initially is that your plastic surgeon performs this operation and likes to treat children. Then I would meet with the surgeon and find our what type of operation and techniques are recommended and why. Take your son or daughter with you to meet the surgeon, so that you can see how the doctor relates to your child.
I am going to have liposuction on my legs. Is there such a thing as a person with fibrous fat? If so, what are the complications and how would one know they have this type of problem?
This is a very good question and important in the context of leg lipoplasty (liposuction). Many people believe that fat is largely the same throughout the subcutaneous tissue space of our body. There are, however, fibrous bands that criss-cross the fat compartments. These may be denser in one area or another or in certain anatomic situations, such as after infection or after a previous lipoplasty procedure. What it sounds like you are concerned with is the suggestion of "fibrous" fat in the legs. It is generally agreed that the fat in the legs is held more firmly in place and likely has more associated fibrous bands than fat in other parts of the body. You can tell because there is less mobility or "wiggle" to the fat in the legs than in the abdomen, for instance. However you have arrived at this understanding, the real issue here is that lipoplasty of the legs for this reason is very “unforgiving”. I tell my patients that it is the one area of the body that has the highest likelihood of contour irregularities (bumps or dents) after lipoplasty. The thinner and the firmer your legs, the more likely are postsurgical irregularities. Technique and operative planning are extremely important in lipoplasty of the legs. Make sure you discuss the risks thoroughly with your plastic surgeon before proceeding.