“No silicone!”

“No implants!”

“No risk!”

But the reality is “No science!”

The existing scientific evidence to support the long-term safety and efficacy of fat grafting the breast is shockingly wanting. While some nicely done studies have been done to support short-term results, the cosmetic surgery community has rushed to implementing this procedure into their practices way before the appropriately designed and completed scientific studies have been done. Many of the existing studies have been done only with laboratory, non-mammalian animal models.

Well-done studies on human subjects are ongoing but it will take years and years to be able to follow these patients long term and establish the legitimacy of the fat transfer breast augmentation. Some of the longer-term studies have been done outside the United States and have yet to be replicated by our own board certified plastic surgery community. Also, the majority of quality studies existing relate to reconstructive breast patients (i.e., breast cancer reconstruction patients) and not to cosmetic elective surgery patients, where the majority of procedures seem to be occurring.

So, what are the risks? Why be concerned?

While many of the early skeptics rightly pointed to the possibility of breast fat injections causing difficult-to-read mammograms, most well done studies show that these concerns are probably unfounded. Radiologists seem to have little difficulty reading mammograms in patients having undergone fat grafting to the breasts.

We do know that fat grafting of the breast has limits and that multiple lengthy surgeries may be required to achieve significant breast enlargement as opposed to a single surgery for breast augmentation with an implant.

The bigger concerns center around whether fat grafting to the breast can possibly be associated with a higher risk of developing breast cancer or even accelerating the growth of a previously undetected breast cancer. Recent rodent model studies seem to prove this to be true, while one international human model study did not show this problem. The concern likely has to do with the ever-popular notion of stem cells.

Stem cells are being recognized as possibly having rejuvenatory properties on human skin. For instance, plastic surgeons who perform fat grafting to the face, as an alternative to a facelift, have noted that the overlying skin seems to look younger and fresher post-operatively. These clinicians are convinced, and may be correct, that stem cells are responsible for this phenomenon. And stem cells have been proven to be in the fat used during fat grafting procedures. So, if these fat grafting procedures are transferring rejuvenatory cells into the areas being grafted, what effect might these same stem cells have on breast tissue which has an extremely high risk of cancerous degeneration already? If a stem cell can “rev up” your skin, will it also “rev up” a breast cancer?

My personal philosophy for fat grafting of the breast is one of patient safety first. Until we have more science to show the long-term safety of this procedure for my Atlanta area plastic surgery patients, I will not offer it or any other poorly understood procedure for a female organ that is already cancer prone. While I do hope that well-done long-term studies show this to be a good and safe option for patients, I do not encourage patients to opt for this procedure at present. Avoid the search for Shangri La. The bite may well be worse that it’s bark!

If you are interested in breast surgery and would like to learn more about a options available for you, contact my Atlanta area practice today to schedule a consultation with me, a Board Certified Plastic Surgeon.

For that reason, Dr. Brian Howard insists that his elective cosmetic surgery and also reconstructive surgery patients stop smoking completely four weeks before surgery and an additional four weeks after plastic surgery. This time period has been scientifically shown in multiple medical studies to lower the patient’s risks to nearly that of a non-smoking patient. Smoking cessation ideally includes not using nicotine substitutes, although this is theoretically better than smoking.

Cigarette and cigar smoke contain over one thousand toxic substances, many of which have been shown to adversely affect healing, blood circulation, surgery complications, infection rates, bad scarring and final overall surgery results. One cigarette has been shown to decrease circulation to the human skin by nearly 40%! Since normal surgery healing is tremendously dependent on normal healthy blood circulation, it becomes apparent why “completely stopping all smoking” means just exactly that and nothing else! Sneaking in that one cigarette during the perioperative 8-week window could possibly doom you to unnecessary risks from your cosmetic surgery procedure, even if you are just having liposuction– risks and results that you, the patient, could potentially be left with for life!

There is not a single study to show that smoking is good for humans. There is not a single study to show that smoking will prolong your life. There is not a single study to show that smoking will in any way improve your surgical results or make your scars better. To maximize your chances of getting the best results with the fewest complications, avoid all types of tobacco-containing products for four weeks before and four weeks after your cosmetic surgery whether you are undergoing breast lift or tummy tuck in Atlanta!

To learn more about cosmetic plastic surgery procedures and other things to avoid when considering undergoing surgery, contact our office today to schedule a consultation.

Tummy Tuck is a procedure most commonly associated with and performed on women following pregnancy.  However, men also have indications for an abdominoplasty, particularly in men who have been able to lose significant amounts of weight following focused diet and exercise or else who have had a “gastric bypass” procedure with subsequent weight loss. These men can be left with large amounts of loose, excess skin on their midsection.  This excess skin can be not only a mental stigma of prior obesity to the patient and therefore psychologically hard to look at, but also lead to chronic rashes, sweating, and hard to hide with one’s clothing.

Men and women who develop this excess skin are potentially good candidates for a tummy tuck surgery. The surgery involves removal of the excess skin, typically in an outpatient setting where the patient is able to go home the same day as the surgery.  Occasionally, a tummy tuck is combined with limited areas of  liposuction or other cosmetic procedures.

Best results occur in healthy, non-smoking patients with strong motivation to get rid of the skin and maintain their results by continued healthy dieting and regular exercise. To learn more about a tummy tuck procedure contact my office today to schedule a time to meet with me.

Fortunately, the advent of non-surgical fillers has opened up new exciting avenues for patients needing small or limited areas of touch up on their nose. Simple injections of biocompatible fillers can be done as bedside office procedures with no anesthesia required (other than local anesthesia). Results from non-surgical rhinoplasty are typically highly predictable and may last over a year. Equally appealing is that the injections can be reversed if the result is not ideal, if hyaluronic acid based fillers were the injected agents.

Dr. Brian Howard in Atlanta, Georgia has established a strong reputation for his expertise in non-surgical rhinoplasty. His practice sees and treats patients from across the Southeastern United States for minor corrections from previous rhinoplasty, previous nose trauma, and even some naturally existing nose deformities. The procedure is typically short and downtime consists of icing the nose for 2-3 days afterward. No additional scars, no general anesthesia, no stitches, and patients can drive themselves to and from the office. He is most impressed with the use of hyaluronic acid based fillers, such as Juvederm and Restylane, although at times he uses Radiesse as well.

To find out whether you are a good candidate for non surgical rhinoplasty contact Dr. Howard’s office to schedule a consultation.

Pain pumps have been under development for several years now and have slowly expanded their use into plastic and reconstructive surgery applications. They work by delivering a continuous flow of local anesthetic directly to the operated area after surgery.  Breast reductions have become an integral part of plastic surgery for those women suffering from the physical and emotional downsides of having breasts too large for their bodies.  Surgical breast reductions often result in life-changing improvements on these large-breasted patients.

By surgically placing a pain pump into the surgical bed at the end of surgery, patients may experience less post-operative pain and therefore have an improved experience with the surgery and the recovery process.  This may also result in the patients having to take less pain medicine during recovery, drugs which commonly cause nausea, vomiting, or dysphoria.

Dr. Howard’s experience and expertise in breast surgery has made him high demand in Atlanta for cosmetic and plastic surgery. If you are interested in learning more about a breast reduction, contact our office today to schedule a consultation.

Many new and effective sun-blocking agents are available over the counter, such as products offered by Obagi®, to help minimize damage to our skin as we enjoy outdoor activities. Although it takes due diligence and a small amount of time, responsible application of these newer sunscreens and sun blocks can help us maintain our youthful skin appearance for years to come. More importantly, it can help to mitigate development of skin cancer.

There are two current types of “sunscreens” although the terminology is debatable – sunscreens and sunblocks.

In general, sunscreens provide chemical protection by absorbing the UV rays as opposed to sunblocks, which deflect the sunrays. The newest and most effective sunscreens contain avobenzone, oxybenzone or octocrylene. They absorb both UVA and UVB effectively.

Sunblocks are “chemical-free” or “organic” sun protective agents. They generally contain zinc oxide and/or titanium dioxide. The skin does not absorb these agents, as opposed to sunscreens, but remain on top of the skin. They work by deflecting the sunrays as opposed to absorbing them. They are effective against both UVA and UVB. Sunblocks are more likely to leave a white film on the skin.

While chemical sunscreens do not leave a white film on the skin, there is some early research to suggest that they may generate harmful free radicals in the skin. Although the exact implication of this continues to be studied, it is worth noting nonetheless.

No matter which type of sun protection you choose, it is most important that you make a choice, period, and apply one of these protective agents. It may be the smartest decision you make with regards to your long-term skin health and youthfulness. Stay protected!

Whether you are interested in prevention or skin rejuventation, we offer medical grade skin care products that can help you maintain healthy looking skin. We also provide treatments such as laser skin resurfacing and chemical peels which can be used to renew the skin by treating signs of aging or damaged skin. Proper prevention and treatments can significant reduce age spots, acne scars, wrinkles around the eyes, and other skin damage visible or not. To learn more about skin rejuvenation, contact my office to schedule a consultation.

Combining surgeries has a lot of appeal to patients. Why not take care of multiple problems, like undergoing a breast lift and tummy tuck, both procedures at once, right? While it is safe and common practice to combine multiple cosmetic procedures in healthy and appropriately selected patients, there are certain combinations that may increase patient risk for serious complications or lead to suboptimal results. It is well known that combining tummy tucks with hysterectomies or other urologic and gynecologic procedures has increased risks to the patient. Some of these risks include blood clot formation and pulmonary embolism. Yet, in healthy patients where extra preventative precautions are exercised to help minimize these risks, it is at times acceptable to perform these combined procedures. It would not be wise to perform these surgery combinations in patients with known health problems that would increase their risks even higher, however.

So then what about tummy tucks after pregnancy?

It is common opinion amongst board-certified plastic surgeons in the United States that performing a tummy tuck immediately after a c-section is not advisable. Risks to the mother are high and outweigh any cosmetic benefits. Additionally, an immediate tummy tuck is likely to have a suboptimal cosmetic result due to the altered state of the tissues of the abdomen with pregnancy. The abdominal skin is stretched and thinned with pregnancy making it difficult to remove the appropriate amount of tissue with an abdominoplasty. It is also much more difficult to repair any muscle damage in this scenario for the same reasons.

For these reasons, it is common sentiment to have the mother wait six months after delivery before consideration of an abdominoplasty. This allows the tissues to return to a natural state and for the significant hormonal changes with pregnancy to normalize as well. The surgeon can be much more precise at this time as to how much tissue to remove and how tight to make the muscle repair when necessary. It is always best to be safe than sorry and I always want my patients to have the best opportunity for the best result with the fewest risks!

To learn more about whether or not a procedure is right for you, contact Dr. Howard’s office to schedule a consultation.

Dr. Howard wants to ensure that patients have done their due diligence on background-checking their doctor and only choosing their surgeon after doing their research. Although deaths from liposuction remain rare, there can be no worse outcome. It appears that the treating physician was not maximally credentialed in this case and leaves the question of whether the patients’ death might have been possibly avoided.

The United States has no controls or restrictions in place on which type of doctor can perform any particular procedure. It is possible that an obstetrician can take out a brain tumor in our country! Although I doubt that would ever take place, the boundaries on who performs cosmetic surgery has been blurred by deceptive advertising and the emergence of valueless board agencies allowing any type of physician to claim board-certification in aesthetic surgery. These physicians will likely have taken a weekend course to do your liposuction! For patients, this is a seemingly impossible task to sort out the differences between board societies recognized by the American Board of Medical Specialties and the myriad of concocted agencies that have emerged. Board Certification by the American Board of Plastic Surgery ensures the patient that they have located is an appropriately trained and educated surgeon.

Liposuction has been one of the top two performed cosmetic surgery procedures for a long time in the United States. Although complications can occur for many reasons even in the best of hands and in the best of circumstances, patients need to make sure they have eliminated as many potential risk factors as possible. Do your homework!

If you are interested in body contouring, contact Dr. Howard’s office today to schedule a consultation. He is not only certified by the American Board of Plastic Surgery, but has received certifiecation from the American Board of Otolaryngology (Head and Neck Surgery) as well. Dr. Howard will discuss your aesthetic goals, give you his expert opinion, and will always put your well-being first.

The current design of breast implants is a significant improvement on the original implant design.  The current silicone implant was introduced in the 1990’s, even before the voluntary silicone moratorium.  Since the FDA re-approved silicone implants in 2006 this implant has become the dominant implant device placed in the United States by an overwhelming margin.  Depending on whether the original Cronin and Gerow implants are considered a true generation of design, the current design is either the third of fourth generation of silicone implant.

Why does that matter?  It doesn’t – just semantics fore the layperson.  What is important is that a new generation of silicone implants exists and has been in limited trial use for the last several years.  A great deal of data has been collected on this new design and the FDA continues to evaluate the data in consideration of its approval.  This new generation has often been referred to as a “gummy bear” implant due to its firmer feel.  It is also known as the highly cohesive gel implant.  Allergan’s version is the “410” line of implants while Mentor’s design is known as the “CPG”.  The silicone polymer in this new design is highly cross-linked which creates more of a solid gel than the existing cohesive gel device.  The actual chemicals within the gel are identical to current designs.

The new generations implant hopes to provide additional options for breast augmentation patients and for breast reconstruction as well.  The primary advantage may be the ability to create more upper pole fullness, as the gel will not collapse with gravity dependence.  There may also be more peace of mind for the patient who worries that a rupture silicone implant may leach into surrounding tissues.  Plastic surgeons look forward to the FDA’s decision on this design.

To learn more about breast enhancement procedures that are currently FDA approved, contact my office today to schedule a consultation.

- Most patients are back to work within several days, and many miss only a day of work.

- Lingering soreness for one to several weeks.

- Need to avoid strenuous activity or exercise for one week.

What are the advantages of SmartLipo?

- Much faster recovery time in Dr. Howard’s hands.

- Very small incisions, no stitches required!

- Much less bruising, swelling and pain in Dr. Howard’s extensive experience.

- Done under local anesthesia in Dr. Howard’s office.

- Minimal scarring

Who are the best candidates for SmartLipo?

- Elimination of stubborn local fat collections.

- Revision liposuction patients.

- Those who cannot afford the downtime of other traditional techniques.

- Even individuals with large single areas of excessive fat.

To learn more about smartlipo and whether or not the procedure is right for you, contact our office today to schedule a consultation.