Tag Archives: Michael Law

NC Plastic Surgeon Discusses Importance Of Breast Implant Placement

While the issue of ‘over’ or ‘under’ the pectoralis major muscle receives a great deal of attention, even more important than implant position relative to this muscle is implant position vertically and horizontally on the chest wall. In many patients, the inframammary fold needs to be lowered in order to allow the implant to rest at a level that appears natural relative to the position of the nipple and areola, and in order to prevent the appearance of excessive upper pole fullness. In my Raleigh North carolina Plastic Surgery Practice, I regularly place breast implants below the muscle and above the muscle.

In profile, the natural-appearing breast is not convex in the upper pole, and an excessively convex and overly full upper pole is a dead giveaway that an implant sits below the skin. Likewise, if the inframammary fold is lowered too far, the augmented breast will appear ‘bottomed out’, with an excessively full lower pole, an empty upper pole, and a nipple/areola that appears to sit too high on the breast – another situation with a distinctly unnatural appearance.

The horizontal position of breast implants also requires a great deal of attention, both in pre-operative planning and in the operating room. Breast implant pockets that extend too fat laterally will result in augmented breasts with an excessively wide space between them in the cleavage area, and the appearance that the breasts are abnormally far apart. If the pockets do not extend far enough laterally, however, the result is an augmentation with an abnormal ‘side by side’ appearance. As it is the lateral projection of the breasts beyond the lateral limit of the chest wall (in frontal view) that, along with the concavity of the waist profile and the convexity of the hip profile, produces the appearance of an ‘hourglass figure’, careful attention must be paid to ensure that lateral breast projection is adequate and appropriate.

Another consideration is that the implant base diameter must match the existing anatomic limits of the breast preoperatively and the breadth of the anterior chest in general. Obviously, a given implant volume and diameter that works well for a small-framed patient who is 5’2” will be inadequate for a large-framed patient who is 5’10”. Careful evaluation of all of these issues is necessary if the ultimate goal of the surgery is a natural-appearing breast enhancement.

I urge all propective patients to take time, do a lot of research and view many many before and after photographs before selcting a plastic surgeon to perform your breast augmentation. Taking some taime to speak to several former patients who have had the same surgery you are considering can also be helpful.

Via EPR Network
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NC Plastic Surgeon Michael Law MD Compares Dermal Fillers

Juvederm, Restylane, Prevelle Silk, Evolence Raleigh, NC Plastic Surgeon Michael Law MD Compares Dermal Fillers

Restylane and Perlane are naturally-occurring injectable agents used for lip enhancement and to soften facial lines and creases. We have found Restylane, Perlane, Juvederm Ultra, and Juvederm Ultra Plus to be very well tolerated, and have yet to encounter an allergic or inflammatory response to any of these products. According to our Allergan representative, our Raleigh, North Carolina Plastic Surgery Practice is one of the top users of Juvederm in the U.S., but we do still use Restylane and Perlane for some patients and we feel confident in the safety and efficacy of both Restylane and Juvederm products.

Restylane and Juvederm do NOT contain any material that does not naturally occur in soft tissues, such as hydroxyapetite or methylmethacrylate, which can result in granuloma (cyst) formation and chronic inflammation. Be VERY wary of injectable agents that contain materials that do not naturally occur in soft tissues, as the risk of these complications is often minimized to patients.

Restylane or Juvederm injections require just a few minutes to perform. The aesthetic improvement is immediate, and in general we will attempt to slightly overfill the lips and overcorrect lines and folds, so that the desired effect remains once the mild initial swelling subsides (in about 24 hours). The goal is an aesthetic improvement that appears natural.

Most injections of Juvederm Ultra or Juvederm Ultra Plus, Restylane or Perlane can be performed with little or no pain by administration of local anesthesia just prior to the injection. Injection of the lips is usually completely painless, using intra-oral anesthesia that produces total numbness of the lips. For injection of lines and creases on the face, a local anesthetic solution is used that causes vasoconstriction, decreasing the likelihood of bruising following the injection. Our aim is to provide an immediate and beautiful aesthetic enhancement, with little or no discomfort and downtime.

The duration of the improvement varies from patient to patient. Some patients have reported ressults of up to a year with Juvederm Untra Plus. Many patients that enjoy the results of their hyaluronic acid treatments become interested in permanent soft tissue enhancement. For these patients, structural fat grafting, using autologous (the patient’s own) fat. Using specialized instrumentation and technique, structural fat grafting can produce permanent improvements in facial contours.

Prevelle Silk is a new hyaluronic acid dermal filler that can eliminate wrinkles or create fuller lips instantly. Dr. Michael Law www.michaellawmd.com has recently introduced Prevelle Silk into his North Raleigh Plastic Surgery Practice. Prevelle Silk contains lidocaine, a numbing agent that helps minimize discomfort associated with the injection. Prevelle is also unique because it leaves virtually no swelling. People can get an injection in the afternoon and look beautiful just hours later. The cost for Prevele Silk is just $295.00 for a 1 cc injection. results lasts approximately 2-3 months.

I expect that many people who try Prevelle Silk as their first filler will be pleased with the results and may opt for a longer lasting filler like Juvederm, Perlane or Restylane for longer lasting wrinkle reduction or lip plumping in the future. Mentor Corporation, the manufacturer of Prevelle Silk will be introducing other hyaluronic acid based dermal fillers in the near future that promise to have a longer lasting results than Prevelle Silk.

Evolence is a porcine (Pig) derived collagen product used to provide soft tissue augmentation. Although no allergic reactions have been reported with Evolence, there have been several reports of nodule formation in the lips. I am currently not using Evolence in my practice. I feel more comfortable with Juvederm, Restylane or Prevelle Silk for temporary soft tissue augmentation and structural fat grafting for permanent augmentation.

A number of other products are available as soft tissue fillers, but many are as yet inadequately tested, and others have been found in some cases to produce disastrous and permanently disfiguring results, such as injectable silicone. Remember, when considering the injection of a soft tissue filler, be sure that your doctor can explain to you what the substance is, why he or she has chosen it, and what side effects and potential complications can occur. Once again, be very wary of injectable agents that contain materials which do not naturally occur in soft tissues, as the risks of complications can be significant. For more information please call 919 256-0900 or visit www.michaellawmd.com

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