Cosmetic Surgery and Skin Care
Raymond Dunn, MD, is the Chief of Plastic and Reconstructive Surgery at UMass Memorial Medical Center and the University of Massachusetts Medical School. In addition to his expertise in reconstructive surgery, Dr. Dunn is the director of the UMass Memorial Cosmetic Surgery Center, where thousands of patients have benefitted from face lifts, body contouring (such as liposuction and abdominoplasty), breast surgery (augmentation, reduction and reconstruction following cancer treatment), and other cosmetic procedures, in addition to skin treatments such as chemical peels and Botox.
Thank you to all who participated in our Cosmetic Surgery "Ask the Expert" session. These were all wonderful questions and we hope you have found the answers informative. Visit: www.ummhealth.org/asktheexpert to learn about upcoming Ask the Expert sessions.
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Physician
Raymond Dunn, MD
Q:
What is the best non surgical treatment for keloid? Do the silicone tape or gel work?
A:
True keloids, which are scars that have grown beyond normal boundaries of healing (like a cauliflower!) will not often respond to simple measures such as silicone tape or gel. These methods are very good for hypertrophic scars, which are wide, red and raised and sometimes occur during normal healing. If it’s not clear whether you have a true keloid or a hypertrophic scar, a plastic surgeon can recommend different options depending on the actual problem.
Q:
Which procedure do you recommend for a female in her late 40s for bags under her eyes, crows feet and sagging under her chin? Less invasive? Recovery time? Longevity? Cost? Thank you.
A:
Options for treatment of the things you have mentioned may range from relatively simple, such as Botox, to more complex such as a facelift or neck lift. We treat all our patients as individuals with very personal goals and views, so a consultation is really the best way to find out your options. But Botox is a wonderful, minimally invasive way to ease those crows feet and minimize any lines around the mouth, which can make some woman appear older than they are. Many of our patients have Botox injections every six months—some more, some less—and we currently have a special offering. Recovery time for Botox is quick, maybe a day or two. Something more extensive, like a face or neck lift, involves making incisions and then tightening and stitching your skin; it’ll take you a week or longer, depending on the specific procedure, to get back to your usual activities, but then we ask you to take it easy. With all of our facial procedures, we stress the importance of sunscreen and pampering your skin. Again, your plastic surgeon can discuss your concerns and your individual goals and explain your options.
Q:
I lost about 130 pounds and need reconstruction of my breasts. Is reconstruction more expensive and painful to recover from compared to just getting breast implants? How long is the average recovery time?
A:
Congratulations on your weight loss! That’s very impressive. Breast lifting procedures often cost about the same as breast enlargement (implants) and the recovery for each of these is relatively short. But the real key, for you, is choosing the right operation. I would strongly recommend consulting with an experienced plastic surgeon who has experience in patients who have had significant weight loss. Our colleagues in the UMass Memorial Weight Center have helped thousands of people lose weight, and so here in the Cosmetic Surgery Center, we have a great deal of experience with helping those patients, too.
Q:
What is the recovery time for a chemical peel?
A:
Recovery from a chemical peel can be minimal (almost none) or moderate (several weeks of skin reddening) depending on the specific type and "depth" of the chemical peel that a patient undergoes. Our next issue of Reflections will detail our skin care procedures, including peels; click here to subscribe. Peels are also described here on our web site.
Q:
Are Botox and Dysport the same thing? What’s the difference?
A:
Botox and Dysport are very slightly different forms of Botulinum toxin but are basically the same. Some practitioners think the effects of Dysport last a little longer, but it is still unclear if this is true. Both are very safe and fairly similar in cost. Botox has a much wider experience in our use and care. In our office, we use Botox and have great confidence in it. In fact, we have a special offering for patients.
Q:
Many years ago I was in a car accident and broke my nose. After a long and, I believe, botched rhinoplasty procedure; my nose is not straight. Recently I noticed I have more difficulty breathing properly through my nose and I am concerned that it may result in obstructive sleep apnea. What do you suggest?
A:
Breathing difficulties like you’ve described can result from internal blockage inside the nose, as well as from other abnormalities in the anatomy of the nose. These blockages can be from a deviated septum (when the thin wall—the nasal septum—that separates your left and right nasal cavities is pushed to one side) or an injury. The only way to know for sure is to have your doctor examine your nose inside and outside. In most cases, it can be improved partially or completely with surgery.
Q:
I have a scar on my upper lip that I 've had for about 10 years. I 've always just kind of ignored it, but I've also been curious about what my options are, if any, for reducing its appearance.
A:
There are several very good options for treating scars that are abnormal, large or in very visible locations. Because it’s been so long since your skin healed, it’s not likely that a procedure like a microdermabrasion or chemical peel would be useful, but surgery could help repair the site and lessen the appearance of the scar. We call is a “scar excision”—where we actually remove the scar tissue and repair the area to minimize its appearance. The specific approach would depend on the severity of the scar; and you can consult with a plastic surgeon to discuss options.
Q:
Can eyelid surgery be done at the same time as other facial procedures? (Specifically cheek implants)
A:
Yes, in most cases you can do eyelid surgery at the same time as other facial procedures, but your surgeon will work with you to decide what’s the best plan for your surgery.
Q:
Is it true that smokers are discouraged from getting cosmetic surgery procedures such as breast augmentation and liposuction? If so, why? How is it different from other surgical procedures? If I quit smoking 3 months ago, how long do you recommend waiting?
A:
Smoking is generally risky for healing almost any kind of surgery, but if a patient has not smoked for 3 months, the risk factors decrease to be almost the same as any other patient; smaller operations such as beast augmentation do not have much higher risk. (Congratulations on quitting!)
Q:
Do you offer anesthesia for chemical peel procedure? During a previous consultation with an out-of-state plastic surgeon, I was told I could not opt for anesthesia with my treatment.
A:
We do offer anesthesia, depending on the type of peel a patient is considering. It might be simply sedation and local anesthetic; in "lighter" peels no anesthesia is generally needed. (I can speak from personal experience, having had several of these done with no anesthesia, here at our Cosmetic Surgery Center!)
Q:
I don’t plan on having another child and am considering a tummy tuck. I have three children, am 35 and in good health. However, I am wondering if I was to get pregnant again in the future, would this reverse the procedure? Would I need another procedure down the road? Is this common concern? I don’t want to wait since the chances of having another are slim.
A:
It is possible to have safe pregnancies after tummy tucks, but the optimum time would be after all pregnancies. There is some chance of stretching skin again if a pregnancy occurs after a tummy tuck is performed.
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