June 25, 2013

In the July issue of Allure magazine, Dr. Caroline Glicksman and I give advice on how to spot overdone breast augmentation. Fortunately, with good surgical planning and technique, this is totally avoidable. It is such a shame that the “poster children” for breast augmentation are anorexically thin women with massive breast implants. They represent but a small percentage of women with breast augmentation. This stereotype creates a pejorative attitude towards breast augmentation in the general public and dissuades many women from having a breast augmentation who would otherwise be inclined to have one. And while natural and beautiful results can be obtained with any implant, the highly cohesive anatomic implants such as the Allergan 410 and the Mentor MemoryShape give even more shape and control when in the right hands.

May 28, 2013

A true zero is so rare in science that claims of its existence always strain credulity. When smart surgeons hear a manufacturer claim something is zero, they conclude that not enough patients were studied, the results weren't accurately reported, or the endpoint was subjective.

"Gel fracture"? In over 1500 gummy bear implants, I've never seen it and many surgeons question whether it is clinically relevant or just an artifact from handling when removing a well-adhered, textured implant. Fracture rates are based upon removed implants, rather than on physical examination, so it may be an artifact of removal.

"Double capsule"? I have seen it, but it exists in normal breasts and is of no significance at all.  

"Zero Rotation"? Unfortunately, that's impossible. Implants must move around inside the body; if no rotations were observed, there are two explanations: the first is that Sientra only studied about two hundred patients with shaped implants in its augmentation study, and that is not a large enough sample to determine a rate of something so infrequent. The second is that, though their implant is teardrop-shaped, it is not shaped enough to either be of benefit when it is in the right position or it is a liability when it is in the wrong position. The more exaggerated the shape, the more critical its positioning needs to be, and the more obvious malposition will be. Having an implant that doesn't make the breast look different when it is malpositioned initially sounds good, but if breast shape is barely changed by implant malposition, then it means that the implant wasn't shaping the breast successfully when it was in the right position. If one wants an implant that can improve and control shape, then it should be expected that shape will suffer if the implant is out of position.

It may sound as if I am opposed to Sientra, I would say the same of Mentor and Allergan if they were to produce an ad like this! 

May 22, 2013

The California Society of Plastic Surgeons holds a conference every year with panels, lectures, presentations, and courses.  The hot topic for the 2013 conference will be gummy bear implants, since the FDA approved them this year. I will be teaching a special 2-hour course entitled, "Technical Mastery of the New Form Stable Breast Implants". I have taught this many times, but every time I do, I gain new insights into gummy bear implants. They say that the teacher learns more than the student, and it is true! Many things need to be done differently with these new implants, but a good breast surgeon will be able to learn and successfully implement this new advancement.

February 20, 2013


The FDA announced today the approval of a next generation breast implant, the Natrelle 410, made by Allergan. Dubbed “the gummy bear” or “cohesive implant,” it offers patients the possibilities of greater durability and a more natural appearance. 
Visit to learn more.
February 4, 2013

Natural-looking, beautiful results are ultimately the goal of any cosmetic procedure. There are a few ways to ensure your facelift is undetectable by the naked eye. Watch my video below to learn the Four Key Points to an inconspicuous facelift.