Answers, Organized by Procedure
Select a category, then tap any question to expand the answer. For anything not covered here, Dr. Wigoda’s team is a call away.
In order to become a board certified plastic surgeon, a surgeon must train and graduate from an accredited plastic surgery residency and pass the oral and written boards for plastic surgery. Any physician can claim to be a “cosmetic surgeon”. That terminology is deceptive as it does not require any training. The board certification in “cosmetic surgery” has minimal requirements and can be obtained by practically any type of doctor.
If you are considering plastic surgery, make sure you see a surgeon that is “Board Certified in Plastic Surgery” and not a “board certified cosmetic surgeon”. Membership in the American Society for Plastic Surgeons is only given to board certified or board eligible plastic surgeons. If your surgeon is a member of this society, aka ASPS, that is a credential you want your surgeon to have.
The specific method chosen for your breast augmentation will be determined by your anatomy, Dr. Wigoda’s preferences, and your desired results. The incision is small and is usually made in one of three locations: underneath the breast just above the crease; around the lower edge of the areola; or within the armpit.
Once the incision is made, Dr. Wigoda creates a pocket into which the implanted is inserted. This pocket is made either directly behind the breast tissue or beneath the pectoral muscle located below the breast tissue and above the chest wall.
Anatomic teardrop-shaped implants are available and may be optimal in certain patients, depending on their anatomy and the look they desire. In addition, both saline-filled and silicone gel-filled implants are available. To learn more about saline vs. silicone implants, click here to watch Dr. Wigoda’s educational video on breast implants.
Women who would like to enlarge their breasts to improve the overall balance and proportions of their bodies are ideal candidates. Women may wish to “fill out” their clothes better. Commonly, women may feel that their breasts have gotten smaller after pregnancy and would like to return to their pre-pregnancy size. Lastly, some women are very asymmetric in size and would like to be more even.
Dr. Wigoda generally performs breast augmentation in 60 to 75 minutes.
Dr. Wigoda performs this procedure under general anesthesia with a board-certified anesthesiologist present at all times during the procedure. This procedure is performed in a fully equipped and accredited operating room. You will be placed on the operating room table in a supine position (on your back). After the anesthetic is given, your skin will be cleaned with a disinfectant and sterile drapes will be placed over you. An intravenous antibiotic is administered. Dr. Wigoda will make an incision, create the pocket (space) for the implant, place the implant, fill it with saline (unless using a silicone gel implant), and suture the incision closed. Only a minimal amount of blood is lost. Blood transfusions are not required. After the surgery, you will go to a recovery room until you are fully awake and comfortable. You will be discharged home. Someone else will need to drive you home. You will be given pain pills, a steroid pack for swelling, muscle relaxants, and antibiotics. Dr. Wigoda will typically want to see you back within 1 to 2 days for a quick check and then at one week after surgery for suture removal. Dr. Wigoda will continue to see you periodically over the next 3 months. You will follow-up with Dr. Wigoda on a yearly basis.
Women who are at very high risk for breast cancer based on their own past history or their family history should be discouraged from BA.
Women who are not willing to take a chance on losing some of their nipple sensation or their ability to breastfeed.
Women with significant ptosis (sagging of the breast)- see breast lift/mastopexy 4) Women who have had radiation to their chest for cancer.
There are many potential risks with this procedure but overall, they are not common. In addition, there is only a very small risk of a serious complication. Complications include capsular contracture, rupture of implants, asymmetry of the breast mound, asymmetry of nipple/areola, loss of all or a portion of nipple sensation, loss of or decreased ability to breastfeed, wide scar, extrusion of the implant, palpable implant, the malpositioned implant (too high or too low), numbness on breast, upper arm numbness with the axillary approach, infected implant requiring removal, pneumothorax (collapsed lung), rotated anatomic implant, skin rippling, pain, nipple hypersensitivity
There have been countless studies that have researched this very topic and the answer has been no. There has never been a proven link between breast implants and cancer.
Breast implants will obscure some breast tissue on mammograms. Special views have to be taken to try to see as much tissue as possible. You should let your mammographer know that you have implants so that they can take these special views. Studies have found, however, that women with implants who develop cancer are not diagnosed any later than women without implants.
Breast augmentation may affect your ability to breastfeed. Many women with implants, however, have successfully breastfed. There is no risk to your child with breastfeeding if you have saline or silicone gel breast implants.
Implants primarily come in two shapes, round or anatomic. The anatomic implants are teardrop-shaped. They are similar to the shape of a breast with more projection inferiorly and less superiorly. Round implants are perfectly round. Some surgeons feel more comfortable with one type over the other and will almost universally use one type. Other surgeons will vary the shape of the implant based on their perception of the needs and goals of the individual patient. With anatomic implants, there is less room for error when dissecting the pocket where the implant will lie. The surgeon must be more precise. If the pocket is made too large, the implant may rotate. While it is O.K. for a round implant to rotate, it is not for an anatomic. The shape of the implant used is frequently at the discretion of the surgeon. There is no universal opinion on whether one shape is better than the other. There are also variations in projection with round implants (“high profile”, “mid-profile”, etc)
Yes, there are many sizes. The size of the implant used will depend on how much breast tissue is present and the goals of the patient and surgeon. The majority of women undergoing breast augmentation would like their breasts to be fuller while not having the appearance of being obviously augmented. There is a limit to how large an implant can be and the breast still has a natural appearance. It is possible to place very large implants in almost any patient but at the cost of having breasts that do not appear natural. It is important that patients discuss their desires with respect to size very carefully with their surgeon. The easiest way to communicate to your surgeon regarding this issue is to show him/her photos of topless women, showing women who in your opinion are too large, just right, and too small. If your goal is for a natural look, one key variable in deciding on the size of the implant is the width of your chest. Look for women in the photos that have a similar chest size (not breast size) to you. Remember, however, that your breasts are different from anyone else’s. They will be different in size, shape, feel, elasticity, nipple/areola size, and position, distance from each other, symmetry, etc. The photos are simply to allow for better communication. Do not expect that your breast will look exactly like someone else’s no matter how similar you might think you are to them.
Implants may be placed in one of two locations. They may be placed above the pectoralis muscle, deep to the breast tissue (“subglandular”) or under the pectoralis muscle just above the chest wall/ribs (“subpectoral”). Women who have a moderate amount of breast tissue are candidates for a subglandular placement. The majority of women, however, do not have sufficient breast tissue and are better off with a subpectoral placed implant. In order to place the implant deep into the muscle, the lower portion of the muscle is sometimes partially cut during surgery. The advantages of a subpectoral placed implant are a decreased rate of capsular contracture and a decreased incidence of implant wrinkling. In addition, less breast tissue is obscured on a mammogram.
There are generally three different incisions that can be made for the placement of a breast implant. Implants can be placed above or below the pectoralis muscle from any of these incisions. The three options are 1) below the breast in the fold (“inframammary”); 2) around the lower half of the areola (“periareolar”); 3) In the armpit (“transaxillary”). Some patients may be better candidates for using one incision over the other but most patients are good candidates for at least two if not all three of the incisions. The patient should decide where they would prefer to have their scar. The good news is that in the vast majority of cases the scars heal well and eventually, will be minimally noticeable. The most common incision used at the present time is the inframammary. With the patient sitting straight up or standing, the scar is often not visible as it is blocked from view by the breast. It is more noticeable when the patient lies down. The periareolar scar, if placed correctly, heals very nicely and is often difficult to find even by a trained eye! In order to use this incision, the areola has to be a minimum size (Usually 3.4-4.0 centimeters across). The transaxillary approach has become more popular with the introduction of endoscopic surgery. The disadvantages to this access site are that for women who enjoy wearing sleeveless shirts during exercise (ie, during aerobics, lifting weights, etc) or bathing suits during the warm months, the scar will be noticeable initially when they raise their arms. Finally, all patients must realize that if their breast implants need to be removed for capsular contracture in the future, most surgeons will do this through an inframammary incision as this is the best way to remove the capsule that has formed around the implant. If their original implants were placed through a different incision, they will now have scars in two locations.
The incision regardless of location is usually 3.5-4.5 centimeters long. The incisions usually heal very nicely and may be difficult to detect after 6 months. Because silicone gel implants are pre-filled, the incision used to insert them may be larger than a similar size saline implant.
Implants may be smooth or have a textured surface. The textured implant surface feels almost like sandpaper. The textured surface has been shown to decrease capsular contracture. In addition, it minimizes the amount of movement of the implant. This is a particular advantage if one is having implants replaced. One disadvantage of texturing is an increased incidence of wrinkling of the implants and a slightly higher deflation rate. The textured surface is not palpable through the skin.
There are a few different breast implant manufacturers in the USA. The cost, warranties and rupture rates vary for each brand. Dr. Wigoda will explain the different options and will make recommendations to you regarding the best brand for you.
Dr. Wigoda does not place drains in straightforward (first time) breast augmentations. Dr. Wigoda may place one drain in each breast implant pocket if he is removing and replacing an implant and there is a risk of fluid accumulation. (like when removing a hard capsule) The fluid will drain into a collection device that can easily be emptied. The drains will usually be removed 1 to 3 days after surgery. Drains are placed and removed at the discretion of the surgeon. Removal of the drains is not painful.
You will first have a consultation with Dr. Wigoda to discuss your particular case. Once you have decided to proceed with the surgery and have scheduled a date, you will return for a second visit at which time Dr. Wigoda will review the surgery with you, photos will be taken, consent forms will be signed, and further instructions and prescriptions will be provided. Full payment is made prior to surgery (or financing is arranged). You will have lab tests drawn and an electrocardiogram done by your primary care physician (or we will recommend where to do this) one to two weeks prior to the surgery.
You will arrive at the office surgery center. You will not have eaten or drank anything since midnight the night before. You will be checked in and your vital signs will be taken. You will put on a gown. An intravenous line will be started. Dr. Wigoda will mark your breasts with a marker. You may be given a sedative in your I.V. to help you relax before you are taken back to the operating room.
Bandages will be placed and your chest will be wrapped in an ace bandage. You will recover for 1 to 2 hours in the recovery room. You will then be driven home by a friend or family member. Your activities will be limited for the first few days. It is advisable that you not drive for at least 3 to 5 days after surgery. As the pain and swelling decrease, you will be able to resume normal activities. Dr. Wigoda will allow you to resume strenuous exercise with your arms after 4 to 6 weeks. You may be able to resume exercise with your legs (walking, jogging, bicycling, etc) slightly sooner.
After surgery, it is expected that the breasts will have a moderate amount of swelling. Most of the swelling will resolve over 2 to 4 weeks. The breasts will appear slightly larger than they will ultimately be because of this swelling. Both breasts may have some bruising although it is generally mild and resolves over 1 to 2 weeks. The amount of pain post-operatively is very patient dependent. Some patients will experience mild discomfort, particularly with raising the arms and with increased activity. It is unusual to have significant pain. The vast majority of patients report the pain as tolerable. Some patients have reported difficulty getting comfortable when going to sleep for the first 1 to 2 weeks. Patients may also experience hypersensitivity of their nipples. For the most part, all of the pain and discomfort resolves completely with time, generally 2 to 4 weeks.
For sedentary work with minimal physical activity, you can expect to go back after 3 days. For moderate activity, it will take about 7-10 days to be comfortable. For manual type labor with heavy lifting, you will need to wait 2 to 3 weeks. It will take 3 to 7 days to be able to drive safely, depending on your pain tolerance, how much pain medication you are taking (if any), and whether you drive an automatic or manual transmission automobile.
Dr. Wigoda will remove the sutures after approximately 7 days.
You may want to wait for at least one to two weeks until your incisions are well on their way toward healing. Early sexual activity may prolong your soreness and discomfort.
It will take 3 to 4 weeks for most of the swelling to resolve and probably 3 months for all of it to resolve. After this, you should have a reasonably good idea of what the final look will be. Your breasts may still be a little firmer than they will ultimately be, however. It often takes months before the breasts and the implants feel very soft and natural. It also takes about 3 months on average for the implants to drop to their final position if they are placed under the muscle.
Dr. Wigoda was fortunate to train with the pioneer of a new technique for breast augmentation in Dallas. The technique he learned and uses causes minimal bleeding, minimal swelling and bruising, and minimal pain. The vast majority of patients are quite surprised afterward at how little discomfort they have and how quickly they return to normal activity. Most patients return to work within a few days. Most patients have no or very minimal bruising. Patients are instructed to raise their arms straight up on the evening of surgery. Often times, patients report that their friends (who had surgery elsewhere) suffered for a month or more with significant pain, were not allowed to raise their arms, had significant bruising, etc. This is not the case with the technique used by Dr. Wigoda. Finally, with Dr. Wigoda’s technique for skin closure, scars are typically minimal and are often difficult to see once they have fully matured.
The specific method chosen for your breast augmentation with lift will be determined by your anatomy, Dr. Wigoda’s preferences, and your desired results. Dr. Wigoda will give you an idea of where you can expect the final scars to be during your consultation. Once the incision is made, Dr. Wigoda creates a pocket into which the implant is inserted. This pocket is made either directly behind the breast tissue or beneath the pectoral muscle located below the breast tissue and above the chest wall. Dr. Wigoda will then perform the lift. Generally speaking, only excess skin is removed, leaving all of the breast tissue intact. The breast is lifted and reshaped. For most patients, nipple sensitivity and the ability to breastfeed remain intact.
However, with augmentation alone, or in combination with a lift, the possibility of a loss of sensation and/or loss of ability to breastfeed, does exist. Anatomic teardrop-shaped implants are available and may be optimal in certain patients, depending on their anatomy and the look they desire. On average, it takes approximately one hour for Dr. Wigoda to perform a breast augmentation. If a lift is needed, the total surgical time may increase to between 2.5 to 4 hours.
Dr. Wigoda performs Breast Augmentation using a special technique that he has developed over his more than 16 years in practice where there is significantly reduced pain and a quicker recovery. The reduction in pain also occurs when having a lift. In other words, there is typically little to no increase in pain when having a lift in addition to the augmentation. To learn more visit Painlessbreastimplants.com.
The specific method chosen for your breast lift will be determined by your anatomy, Dr. Wigoda’s preferences, and your desired results. The most common method of breast lift involves three incisions. One incision is made around the areola. Another runs vertically from the bottom edge of the areola to the crease underneath the breast. The third is a horizontal incision beneath the breast that follows the natural curve of the breast crease. After the surgeon has removed the excess breast skin and shaped the remaining breast tissue, the nipple and the areola are shifted to a higher position.
The areola can also be reduced in size. Skin that was formerly located above the areola is brought down and together to reshape the breast. Breasts that are not sagging significantly can be lifted with smaller incisions, leaving smaller and fewer scars. For frequently asked questions about this procedure click here
A patient with grade 1, 2, or 3 ptosis who wishes to reposition her NAC and breast tissue to a more youthful position may be a candidate for the procedure.
Women who smoke, have a high risk of breast cancer (scars may make reading mammograms difficult) or are unwilling to accept scars on their breast, a potential decrease in nipple sensation or the ability to breastfeed should not have this procedure. Also, women with very large breasts who only want a lift will ultimately be disappointed because of a high rate of recurrence unless a breast reduction is performed.
The risks include unattractive scars, loss of nipple sensation, numbness on the breast skin, asymmetry, inability to breastfeed, loss of nipple, and most commonly, recurrence of ptosis. The factors which caused the problem initially, (aging skin, heavy mound, pregnancy, etc,) may be present after surgery so that the recurrence of ptosis is very possible if not likely.
The options for a breast lift are dependent on the position of the nipple and the goals of the patient and surgeon. With significant ptosis, many incisions will have to be made which will leave a scar around the nipple, from the nipple to the breast fold, and along the breast fold. In a patient with less ptosis, the size of the scars can be reduced because less skin is removed. An additional option is to place a breast implant below the pectoralis (chest wall) muscle which simultaneously enlarges and lifts the breast. This may be done at the same time as the lift or 6 to 12 months later depending on the particular circumstances.
Most surgeons, including Dr. Wigoda, will use general anesthesia.
The scars are usually visible but may heal so that they are not very noticeable. The scars may extend around the areola, down to the breast crease, and under the breast. The scars will typically lighten over one year.
This is an important point to discuss with Dr. Wigoda. You can be made larger with an implant, left the same size, or made smaller.
After surgery, it is expected that the breasts will have a moderate amount of swelling. This swelling will resolve over 2 to 4 weeks. The swelling and pain may worsen for a short period during the first menstrual period after surgery. The breasts will appear slightly larger than they will ultimately be because of this swelling. The scars will also appear darker initially. Both breasts will have some bruising although it is generally mild and resolves over 1 to 2 weeks. The vast majority of patients report the pain as very tolerable. For the most part, all of the pain and discomfort resolves completely with time, generally 2 to 4 weeks.
Yes. There will be some scar formation on the inside of your breast. A mammogram done after surgery will very likely look different than one before surgery. You should obtain a mammogram approximately 1 year after surgery for a new baseline. Afterward, the frequency of mammograms will depend on your age.
Because for the most part, the connections between your breast tissue, breast ducts, and nipple do not interfere with a lift, your ability to breastfeed should not be affected.
Unfortunately, as you age, your skin ages and loses its elasticity. Because of this, the weight of your breasts will cause the breast ptosis to recur to some extent. The exact amount the breast will “drop” and the amount of time it will take for this to occur is very patient dependent. It will vary with age, skin quality, and size of breasts.
Dr. Wigoda may place one drain in each breast, depending on the technique used. The fluid will drain into a collection device that can easily be emptied. The drains will usually be removed 1 to 3 days after surgery. Drains are placed and removed at the discretion of the surgeon. Removal of the drains is not painful.
You will first have a consultation with Dr. Wigoda to discuss your particular case. Once you have decided to proceed with the surgery and have scheduled a date, you will return for a second visit at which time Dr. Wigoda will review the surgery with you, photos will be taken, consent forms will be signed, and further instructions and prescriptions will be provided. Full payment is made before surgery (or financing is arranged). You will have lab tests drawn and an electrocardiogram performed by your primary care physician (or we will recommend where to do this) one to two weeks before the surgery.
You will arrive at the office surgery center. You will not have eaten or drunk anything since midnight the night before. You will be checked in and your vital signs will be taken. You will put on a gown. An intravenous line will be started. Dr. Wigoda will mark your breasts with a marker. You may be given a sedative in your I.V. to help you relax before you are taken back to the operating room.
Bandages will be placed and your chest will be wrapped in an ace bandage. You will recover for 1 to 2 hours in the recovery room. You will then be driven home by a friend or family member. Your activities will be limited for the first few days. It is advisable that you not drive for at least 3 to 5 days after surgery. As the pain and swelling decrease, you will be able to resume normal activities. Dr. Wigoda will allow you to resume strenuous exercise with your arms after 4 to 6 weeks. You may be able to resume exercise with your legs (walking, jogging, bicycling, etc) slightly sooner.
For sedentary work with minimal physical activity, you can expect to go back after 3 days. For moderate activity, it will take about 7-10 days to be comfortable. For manual type labor with heavy lifting, you will need to wait 2 to 3 weeks. It will take 3 to 7 days to be able to drive safely, depending on your pain tolerance, how much pain medication you are taking (if any), and whether you drive an automatic or manual transmission automobile.
Dr. Wigoda will remove the sutures after approximately 7 days.
You may want to wait for at least one to two weeks until your incisions are well on their way toward healing. Early sexual activity may prolong your soreness and discomfort.
It will take 3 to 4 weeks for most of the swelling to resolve and probably 3 months for all of it to resolve. After this, you should have a reasonably good idea of what the final look will be. Your breasts may still be a little firmer than they will ultimately be, however. It often takes months before the breasts feel very soft and natural.
The specific method chosen for your breast reduction will be determined by your anatomy, Dr. Wigoda’s preferences, and your desired results. The most common method uses a three-part incision. One incision is made around the areola. Another runs vertically from the bottom edge of the areola to the crease underneath the breast. The third part is a horizontal incision beneath the breast, which follows the natural curve of the breast crease. After the surgeon has removed the excess breast tissue, fat and skin, the nipple and areola are shifted to a higher position. The areola, which is usually larger than ideal, is reduced in size.
Skin that was formerly located above the nipple is brought down and together to reshape the breast. Liposuction may be used to improve the contour, especially on the sides of the breasts. The nipples and areolas usually remain attached to their underlying tissue as they are moved to their higher position, allowing one’s sensation to be maintained. For frequently asked questions about this procedure click here
Women who have a breast size which they feel is out of proportion to their body habitus and have symptoms caused by the weight of their breasts may be candidates for this procedure. These symptoms include neck pain, back pain, bra strap grooving, and intertrigo (skin chafing/rashes in the crease below breast). Insurance companies vary in their minimum requirements to cover this procedure. Your physician will most likely have to send information to your insurance company regarding your breast measurements, bra size, body weight, symptoms, as well as photos of your breasts in order to get approval. Some carriers require a minimum amount of breast tissue to be removed from each breast. This can be in the range of 350-500 grams. Obese women may be denied coverage for this procedure unless they lose a substantial amount of weight. In addition, insurance companies may insist on a trial of conservative therapy before allowing the surgery. These conservative treatments, which may include exercise, physical therapy, etc., are not likely to work if the weight of the breasts is the true source of the problem. An additional indication is in younger women (teenagers) who are teased because of their large breasts and suffer emotional distress. Many otherwise normal teenagers may avoid sports or exercise because of embarrassment. Some women may not have significant discomfort but have difficulty fitting into and buying clothes and may desire a breast reduction for this reason.
There are certainly patients who are at higher risk of having complications after this type of surgery. This includes smokers and patients with multiple medical problems including diabetes mellitus and autoimmune diseases. Patients who are unwilling to risk losing nipple sensation and/or the ability to breastfeed or a patient unwilling to accept scarring on the breast should not have this procedure.
Patients who have undergone breast reduction are some of the happiest patients in plastic surgeons’ practice. They are relieved not to have to carry the extra weight, their back and neck pain usually improve or completely resolve, they can fit into clothes more easily, it is easier and more enjoyable to exercise, and they feel less self-conscious.
This is an important point to discuss with Dr. Wigoda. If you are having symptoms from the weight of your breasts, you will obviously want enough removed to alleviate your discomfort. However, you ultimately want to have a breast size that fits your body. Some patients will come in saying “just take them off” because they are so tired of the discomfort. However, it is a mistake to make you completely flat-chested as this will look unattractive and in the end, you will not be happy.
If your nipple and areola are removed and replaced as a skin graft you will not be able to breastfeed. If you have a “standard” reduction, you may be able to breastfeed but it is impossible to predict this. In other words, there is a chance you will not be able to breastfeed.
There have been multiple techniques described in the literature for breast reduction. One key decision your surgeon will make is whether he will be able to keep the nipple and areola complex (NAC) attached to the breast tissue or if the NAC must be removed during the procedure and then replaced as a skin graft. The former technique will allow for the best chance of preserving nipple sensation and the ability to breastfeed. If the NAC must be placed as a skin graft, essentially all sensation will be lost as will the ability to breastfeed. The key factor in making this decision is the distance from the nipple to the crease below your breast (inframammary fold). If you are on the border between the two options, the surgeon may make the decision during surgery. With regard to the specific technique used, there are multiple options for the surgeon to choose from. Certainly, some techniques are used much more frequently than others. The most important factor is what the surgeon is most used to and comfortable with. The most common in use in the U.S. today is most likely the “inferior pedicle-Wise pattern” technique. This is a safe and reliable technique that preserves nipple sensation and viability. The scars which result from this technique will be around the areola, extending from the areola to the inframammary fold, and then along the inframammary fold, similar to the shape of an anchor or inverted T. Techniques which were developed to leave smaller scars are appropriate for only a select group of patients, are difficult to perform, and are more likely to need revisions. One other option is to use a liposuction cannula to remove the breast tissue. The advantage here is minimal scarring. However, no excess skin is removed and the amount of breast tissue that can be removed is limited. In a small percentage of patients, this may be a reasonable technique which will give satisfactory results.
Risks include loss of nipple, loss of a portion of breast skin, wide scar, loss of nipple sensation, asymmetric breasts, unattractive appearing breasts, continued neck and/or back pain, inability to breastfeed, hematoma, and numbness on the breast skin.
Dr. Wigoda will use general anesthesia.
In the past, it was not unheard of for patients to require blood transfusions during or after a breast reduction because of the significant amount of blood loss. With current techniques, including infiltration of local anesthetic with epinephrine or tumescent infiltration of the breast tissue, transfusions should very rarely be required. Blood loss ranges from 100cc to 500cc.
The procedure takes from 2.5 to 5 hours depending on the volume of breast tissue being removed.
After surgery, most patients are admitted for an overnight stay. Dr. Wigoda may place you in a surgical bra. Most patients will experience some discomfort but very few complaints of significant amounts of pain. A moderate amount of swelling and bruising is normal. This will last 1 to 2 weeks. You will be allowed to slowly increase your activity over the next 2 to 4 weeks. After approximately 4 weeks you should be back to normal activity.
The scars for this procedure are visible but do fade in color over the first year. The scars extend around the areola, down to the breast crease, and under the breast.
After surgery, it is expected that the breasts will have a moderate amount of swelling. This swelling will resolve over 2 to 4 weeks. The swelling and pain may worsen for a short period of time during the first menstrual period after surgery. The breasts will appear slightly larger than they will ultimately be because of this swelling. The scars will also appear darker initially. Both breasts will have some bruising although it is generally mild and resolves over 1 to 2 weeks. The vast majority of patients report the pain as very tolerable. For the most part, all of the pain and discomfort resolves completely with time, generally 2 to 4 weeks. The scars lighten over the next year.
Yes. Because breast tissue has been removed and there will be some scar formation on the inside of your breast, a mammogram done after surgery will definitely look different than one before surgery. You should obtain a mammogram approximately 1 year after surgery for a new baseline. Afterward, the frequency of mammograms will depend on your age.
Dr. Wigoda typically places one drain in each breast. The fluid will drain into a collection device that can easily be emptied. The drains will usually be removed 1 to 3 days after surgery. Drains are placed and removed at the discretion of the surgeon. Removal of the drains is not painful.
You will first have a consultation with Dr. Wigoda to discuss your particular case. Once you have decided to proceed with the surgery and have scheduled a date, you will return for a second visit at which time Dr. Wigoda will review the surgery with you, photos will be taken, consent forms will be signed, and further instructions and prescriptions will be provided. Full payment is made prior to surgery (or financing is arranged or authorization is obtained from the insurance company). You will have lab tests drawn and an electrocardiogram done by your primary care physician or at the hospital one to two weeks prior to the surgery.
You will arrive at the office surgery center or the hospital. You will not have eaten or had drank anything since midnight the night before. You will be checked in and your vital signs will be taken. You will put on a gown. An intravenous line will be started. Dr. Wigoda will mark your breasts with a marker. You may be given a sedative in your I.V. to help you relax before you are taken back to the operating room.
For sedentary work with minimal physical activity, you can expect to go back after 7 days. For moderate activity, it will take about 10-14 days to be comfortable. For manual type labor with heavy lifting, you will need to wait 2 to 3 weeks. It will take 7 days to be able to drive safely, depending on your pain tolerance, how much pain medication you are taking (if any), and whether you drive an automatic or manual transmission automobile.
Dr. Wigoda will remove the sutures after approximately 7 days.
You may want to wait for at least one to two weeks until your incisions are well on their way toward healing. Early sexual activity may prolong your soreness and discomfort.
It will take 3 to 4 weeks for most of the swelling to resolve and probably 3 months for all of it to resolve. After this, you should have a reasonably good idea of what the final look will be. Your breasts may still be a little firmer than they will ultimately be, however. It often takes months before the breasts feel very soft and natural.
Gynecomastia is an effective procedure that works best if you are experiencing swollen breast gland tissue, breast tenderness, pain, and swelling. Candidates for Gynecomastia in the Fort Lauderdale and Miami area include:
Liposuction is performed on adults of all ages. The typical patient is a male or female between the ages of 20 and 50. Patients who have areas on their body with an excess of fat, somewhat out of proportion to the rest of the body, are good candidates. People who are significantly overweight are not good candidates for liposuction. Most patients are healthy and exercise regularly but cannot lose fat in certain areas of their body regardless of how much they exercise. In men, the most common areas are the abdomen and “love handles”.
In women, the inner and outer thighs, including the “saddlebags”, are very common areas to have treated. People of almost any age may undergo liposuction; however, patients with good skin elasticity will achieve the smoothest contour after the fat is removed. You may be a good candidate for liposuction if you desire fat removal or contouring in any of the following areas:
To perform liposuction, one or more small incisions are made near the area to be suctioned. Whenever possible, incisions are placed within natural folds or contour lines of the skin. The fatty areas are injected with fluid containing lidocaine and epinephrine. This anesthetizes the area to be treated and minimizes blood loss. Dr. Wigoda then places a slim, hollow tube called a cannula through the incision so that its tip penetrates the underlying fat. The cannula is then connected by flexible tubing to a suction pump. Dr. Wigoda then moves the cannula back and forth through the fat, which is vacuumed into the tube. The surgery can be performed under sedation with the patient awake but sleepy, or under general anesthesia.
Ultrasound-assisted liposuction is also available. The ultrasound causes fat cells to burst, essentially making the fat melt away. Ultrasound is an excellent technique to use in certain patients. Ultrasound-assisted liposuction is a relatively new device that allows the procedure to be performed more quickly and with less trauma to the tissues. This results in a faster recovery with less pain and bruising. The cannula essentially glides through the fat with minimal effort, allowing Dr. Wigoda to remove more fat in less time and with less injury to the tissues. For frequently asked questions about this procedure click here Watch Dr. Wigoda’s video on liposuction tips for more information.
Patients who are obese or require a large amount of weight loss are not good candidates. Those with significant medical problems and heavy smokers are also not good candidates. Smokers should stop smoking at least 2 to 4 weeks before this or any other surgery.
Liposuction can be redone in areas if not enough fat was removed, or if there is a significant weight gain and the remaining fat cells have grown significantly.
Liposuction is an excellent treatment method for gynecomastia, a condition where a male’s breasts grow out of proportion to the remainder of the body. Excellent results can be achieved. Ultrasound liposuction is often used because the male breast tissue can be rather fibrous and hard. Using the ultrasound makes it easier to break up the tissue to remove it.
It generally takes one to three months for all of the swellings to be gone to be able to see the final contour.
As long as your diet is maintained, the results will last forever. Obviously, your body will still go through the normal changes with age.
The fat cells that are removed are gone forever and will not be replaced. Areas that are not liposuctioned will have the same number of cells as always. Any remaining fat cells in the body, whether in the areas that where liposuctioned or in other areas, can and will get bigger only if a significant amount of weight is gained. The body does not make new fat cells somewhere else to make up for the ones that were removed.
The most common complications of liposuction include contour deformities from taking out too much or too little fat, asymmetry, rippling of the skin, developing a fluid collection (seroma), and noticeable scars. Liposuction is real surgery and serious complications like fluid overload and even death can result. A risk of ultrasound liposuction is burning on the skin.
It is very important to go to a plastic surgeon who has experience with liposuction and who trained at a reputable medical center. There are physicians of many different specialties who have started to do liposuction in the last few years even though they were not formally trained in the technique. This includes some dermatologists, gynecologists, general surgeons, and even internal medicine doctors. The potential dangers of liposuction are very real and the procedure should not be taken lightly simply because it is so common. A weekend training course does not provide enough training for a physician to be competent in the technique.
The procedure can be performed either under general anesthesia or local anesthesia with sedation. Which one is used depends on the surgeon and patient preference. If a large volume of fat is to be removed, general anesthesia is the safer way to go.
Generally speaking, the actual technique of moving the cannula back and forth is not very different from one doctor to another. What does vary is the judgment and experience of the surgeon, who has to decide how much fat to remove and where to remove it. There are different machines that can be used. Some surgeons use standard liposuction equipment while others use power assisted liposuction to help break up the fat before it is suctioned. Dr. Wigoda typically uses power assisted liposuction (PAL).
PAL is particularly useful in areas that are more fibrous, like the back or in male breasts, or in patients who are having liposuction done a second time, who will have more scarring on the inside. Generally speaking, the surgery is less labor-intensive for the surgeon because the PAL helps to break up the fat. Dr. Wigoda feels that he can often remove more fat with the PAL than with standard liposuction.
The fluid that is injected contains lidocaine, an anesthetic, and epinephrine, a vasoconstrictor. The use of this solution decreases the amount of blood loss from the procedure to the point that it is minimal. The lidocaine is needed if the procedure is done under local anesthesia with sedation. It also will help to reduce the pain after surgery to some degree.
The location of the incisions will vary depending on what area is to be liposuctioned. Generally, for each area, one or two incisions are made and they are placed in a spot where they will not be very noticeable.
Tumescent is a term used to describe a technique used where a large amount of fluid is injected into the area to be suctioned and minimal sedation is required or used. The anesthesia comes from the lidocaine in the solution.
Incisions for standard liposuction measure about 5 millimeters. Those for internal ultrasound are closer to 8 to 10 millimeters. They are generally placed in spots where they will be hidden but occasionally they will be visible, particularly in areas like the back.
The procedure can take anywhere from 30 minutes to 6 hours depending on how much fat is taken and how many areas are suctioned.
The volume of fat to be removed can vary significantly from one patient to another. It can range from only a few hundred cc’s (a can of coke is about 450cc) to many liters (even up to 10 liters or 10,000cc). The average amount removed is in the range of 1500 to 3000 cc. Very large liposuction procedures should be done in a hospital with an overnight stay for monitoring.
Fat can be used as a filler and injected either into contour defects (like in the legs) or more commonly, injected into the face. This is done to rejuvenate the face where the fat in the cheek has atrophied or descended. It can also be injected into the lips to “plump” up the lips. Any fat that is to be reinjected needs to be suctioned manually with a special cannula and treated gently by the surgeon if it is to survive.
Generally, much more fat is injected than is needed to fill a defect because only a small portion will survive. This will range from none to 50% of what is injected.
While it is technically possible and is done on occasion in other countries, injecting fat into a woman’s breasts is not a good idea. In the vast majority of cases, it will not last. It can also become calcified (hard) and cause changes in a mammogram that would make it difficult to tell whether the cancer was growing or if it was just necrotic and calcified fat.
You will first have a consultation with Dr. Wigoda to discuss your particular case. Once you have decided to proceed with the surgery and have scheduled a date, you will return for a second visit at which time Dr. Wigoda will review the surgery with you, photos will be taken, consent forms will be signed, and further instructions and prescriptions will be provided. Full payment is made prior to surgery (or financing is arranged). You will have lab tests drawn and an electrocardiogram performed by your primary care physician (or we will recommend where to do this) one to two weeks prior to the surgery.
You will arrive at the office surgery center. You will not have eaten or drunk anything since midnight the night before. You will be checked in and your vital signs will be taken. You will put on a gown. An intravenous line will be started. Dr. Wigoda will mark the areas to be treated with a marker. You may be given a sedative in your I.V. to help you relax before you are taken back to the operating room.
Dressings and a garment or binder are applied. You will recover for 1 to 2 hours in the recovery room. You will then be driven home by a friend or family member. Your activities will be slightly limited for the first few days. It is possible to have some fluid leak out of the incisions for the first 48 hours. It is advisable that you not drive for at least 1 to 2 days after surgery. As the pain and swelling decrease, you will be able to resume normal activities. Dr. Wigoda will allow you to resume strenuous exercise after 3 to 4 weeks.
After surgery, it is expected that the areas treated will have a moderate amount of swelling. Most of the swelling will resolve over 2 to 4 weeks. There is typically some bruising that resolves over 1 to 3 weeks. The amount of pain post-operatively is very patient dependent. Some patients will experience mild discomfort. It is unusual to have significant pain. The vast majority of patients report the pain as tolerable. For the most part, all of the pain and discomfort resolves completely with time, generally 2 to 4 weeks.
For sedentary work with minimal physical activity, you can expect to go back after 1 to 3 days. For moderate activity, it will take about 3 to 5 days to be comfortable. It will take 1 to 3 days to be able to drive safely, depending on your pain tolerance and how much pain medication you are taking (if any).
Dr. Wigoda will remove the sutures after approximately 7 days.
You may want to wait for at least one to two weeks until the soreness diminishes sufficiently. Early sexual activity may prolong your soreness and discomfort.imal bruising.
Generally, a horizontal incision is placed just within or above the pubic area. The length of the incision depends largely on the amount of skin that needs to be removed. For women, the incision is kept within swimsuit lines, when it is possible. Working through this incision, Dr. Wigoda may tighten the underlying muscles by pulling them together and suturing them in place. Any excess skin from the lower abdomen is trimmed away. Typically, an incision is made around the navel and a new, more attractive navel is designed. For frequently asked questions about this procedure click here
The procedure is performed on men and women who have excess skin and fat in the lower abdomen, and/or laxity of their abdominal muscles. It is often performed on patients who have lost a considerable amount of weight and now have a “pannus” hanging from their belly. Patients need to be generally healthy and off any nicotine products for at least 2 to 4 weeks. The procedure is also a good way to get rid of stretch marks along the lower abdomen if there is excess skin to remove.
Abdominoplasty is considered major surgery. It is also usually an elective cosmetic procedure. Patients should be relatively healthy and cannot smoke for 2 to 4 weeks before surgery. Patients who do not fit these minimum criteria are not good candidates. Furthermore, anyone who has had clots in the veins of their legs (DVT’s) in the past is at increased risk of developing these clots again. Patients who only have excess fat may be better off with liposuction. Finally, this is not a treatment for obesity or weight loss. Obese patients are not good candidates.
Risks include asymmetry, dehiscence (opening) of the incision site, necrosis (death) of the belly button, unattractive appearance, deep vein thrombosis (clots), fluid collection (seroma), wide scar, skin necrosis, and infection.
For smaller patients with only a small amount of excess tissue, a “mini-abdominoplasty” can be performed. The operation is essentially the same except that the incision is shorter. A long transverse incision is made, the skin and fatty tissue are elevated off of the abdominal wall, the excess tissue is excised, the abdominal wall is tightened with sutures, and the incision is closed. A new opening for the belly button is made and the belly button sewn in place.
General anesthesia is almost always used.
An incision is made around the belly button, and across the lower aspect of the abdomen.
The scar is very long, usually extending across most of the lower abdomen. The scar is noticeable but is covered with clothing. The incision can be designed so that the scar is well hidden in most bikinis.
The surgery generally takes 2 to 4 hours
Most of the swelling and bruising will be gone after 1 month at which time you will have a pretty good idea of what the final result is.
Yes. Generally, at least 2 drains are placed into the wound. These come out in the pubic region. The fluid collects into a container. The drains may stain in for 1 to 4 weeks depending on the amount of drainage.
If there is a significant amount of excess tissue around the entire abdomen, the only way to remove this is to extend the incision onto the back. A longer scar results, but this is preferable over leaving the excess behind. This should be discussed with Dr. Wigoda before the surgery.
The surgery can be performed as an outpatient procedure. Pain is controlled with medication as well as with a pain pump that the patient goes home with. You will get out of bed the day after surgery and with assistance, begin to walk very slowly. You will need to walk with your waist flexed so as not to pull on the incision site. Over the next 1 to 2 weeks you will begin to straighten out as you walk.
There is a moderate amount of bruising and swelling. The pain can be somewhat higher than for other cosmetic procedures but is tolerable with good pain medication. The new pain pump has reduced the amount of pain significantly. It usually remains in place for 4 to 5 days.
You will have bandages over the incision sites that will need to be changed by Dr. Wigoda during the first week.
There are stitches that will be removed after 7 to 10 days.
Assuming your weight is kept relatively stable, the results are permanent. Obviously your body will go through normal changes with age.
No. It is OK to get pregnant from a safety standpoint. However, your abdominal muscles may once again become lax. You may also find that you have excess skin once again and can also develop stretch marks. If you plan on getting pregnant, it is probably best to wait until you are finished having children before having the surgery.
The belly button can die if it does not get enough blood supply. If this occurs, the necrotic tissue must be removed and the open would be allowed to heal. A new belly button will then have to be reconstructed. Unfortunately, it is unlikely to look as good as the real thing. Luckily, this is a rare complication.
The skin can die as well if it loses its blood supply. This happens most commonly at the center of the incision, below the belly button. If this occurs, the open wound is allowed to heal. This will take weeks to months. A wide scar will result which can be revised once it is completely healed. This is more likely to happen in smokers.
This is not all that unusual. The fluid will need to be drained using a syringe and needle. Sometimes, this has to be done 2 or 3 times before it disappears. This is done in the office with local anesthesia. There is minimal discomfort with this procedure.
You will first have a consultation with Dr. Wigoda to discuss your particular case. Once you have decided to proceed with the surgery and have scheduled a date, you will return for a second visit at which time Dr. Wigoda will review the surgery with you, photos will be taken, consent forms will be signed, and further instructions and prescriptions will be provided. Full payment is made prior to surgery (or financing is arranged). You will have lab tests drawn and an electrocardiogram performed by your primary care physician (or we will recommend where to do this) one to two weeks prior to the surgery.
You will arrive at the office surgery center. You will not have eaten or drunk anything since midnight the night before. You will be checked in and your vital signs will be taken. You will put on a gown. An intravenous line will be started. Dr. Wigoda will mark your abdomen with a marker. You may be given a sedative in your I.V. to help you relax before you are taken back to the operating room.
Bandages and dressings will be placed. You will recover for 1 to 2 hours in the recovery room. You will then be driven home by a friend or family member. Your activities will be limited for the first few days. It is advisable that you not drive for at least 5 to 7 days after surgery. As the pain and swelling decrease, you will be able to resume normal activities. Dr. Wigoda will allow you to resume light exercise after 4 to 6 weeks.
For sedentary work with minimal physical activity, you can expect to go back after 7 to 10 days. For moderate activity, it will take about 10-14 days to be comfortable. For manual type labor with heavy lifting, you will need to wait 3 or more weeks. It will take 10 or more days to be able to drive safely, depending on your pain tolerance and how much pain medication you are taking (if any).
You may want to wait for at least one to two weeks until your incisions are well on their way toward healing. Early sexual activity may prolong your soreness and discomfort.
Many men and women are self-conscious about sagging skin on their arms, as it can off-set their overall appearance. Sagging arm skin is typical in people who have undergone dramatic weight loss. This problem is more common in women, as they find it more difficult to get rid of excess fat in the upper arm area, even with rigorous exercise. The upper arm skin can become loose and flabby with age as well.
Although it can be difficult to reduce excess fat and skin along the arms, a board-certified surgeon like Dr. Wigoda can perform a Brachioplasty, or arm lift procedure, to help reduce the excess skin that droops below the arms. Arm lift procedures are implemented to remove loose skin and/or excess fat from the upper arm. Patients can choose between two different kinds of arm lift surgeries at our South Florida cosmetic center: a full arm lift or a limited incision arm lift.
“Vaginal rejuvenation” covers several different procedures. Vaginal Rejuvenation procedures are designed with a woman’s confidence and sexual satisfaction in mind. The two primary procedures that can be performed either alone or in combination are Labiaplasty and Vaginoplasty, both of which board-certified surgeon Dr. Wigoda specializes in. Explore the differences between vaginoplasty and labiaplasty below.
How long does the Vaginoplasty procedure take? Each of the procedures normally takes an hour to one and a half hours. The combined procedures take 2 to 3 hours.
The goal of labiaplasty is to improve the appearance of the labia and reduce its size. Women want a more youthful appearance of the labia minora, which includes reducing excess tissue and having a tight, non-droopy appearance. Patients want a clean and symmetric appearance.
The goal of the procedure is to tighten the muscles of the vagina to increase the tone and improve sensitivity. The goal is to enhance sexual pleasure and satisfaction.
The excess tissue over and around the clitoris, also called the prepuce, can be reduced. This can not only improve the appearance but will better expose the clitoris for enhanced sensation.
The procedures are performed under general anesthesia where the patient does not feel any pain. A local anesthetic is injected at the time of surgery so that the patient wakes up with no or very little discomfort. Once the anesthetic wears off, there may be some discomfort for which pain medication is prescribed. These procedures do not usually cause a lot of pain. There is some discomfort but it is not unbearable. Most patients may take minimal pain medication for a few days then stop.
Most patients can return to work in seven days, depending upon the type of physical activity required by the job.
You will resume most everyday activities within a week or so but it will be approximately 6 weeks before you can start exercising.
You can resume sexual activity in six weeks if you have completely healed.
Some patients complain of itching of the labia. This is a sign of healing and is not anything to be concerned with.
With any type of surgery, bleeding and infection are possible. However, they are not at all common. While women are concerned about decreased sensation, this usually does not happen. Discomfort with sex is possible but also is not at all typical. Poor healing is possible and in some cases may require a revision procedure, but again, it is not common.
If you are fully healed, you should not have pain with sexual activity. With vaginoplasty, it is recommended that patients use a lubricant the first few times they have sex.
Dissolvable sutures are used exclusively. No staples or glue is used. The sutures will dissolve on their own and will fall out. If a suture remains after the incisions have healed and the suture causes irritation, it can be easily removed.
The labia majora may be too small or atrophied or maybe too prominent. The can be made fuller with fat grafting. They can also be made smaller with excision of excess tissue. This can be done at the same time as the other procedures.
Yes, you can combine vaginal rejuvenation with other procedures including breast augmentation, abdominoplasty, liposuction, and facial rejuvenation. It is common for patients to combine procedures to minimize their “downtime”.
Both men and women may be candidates for a facelift. Patients may request a facelift beginning in their forties up to their eighties. In general, patients want to have a facelift to look younger. That is certainly nothing to be ashamed of. Patients often tell me they feel young, healthy, and energetic but look much older. They may feel or even be told that they look tired, angry, or displeased when in fact they feel energetic and happy. It is becoming more common that men will see me because they are concerned about job security. While on the one hand, they are being as productive as ever, on the other, they appear old, and possibly, less productive as compared to their younger colleagues. While age discrimination is illegal, unfortunately, it is common. Also, men in their late forties or fifties who lose their job and are looking for a new one, often find it is much harder than they expected. Unfortunately, but realistically, part of the reason may be their age or aged appearance. If a man feels comfortable with the idea of having a facelift and feels it may help his career, there is nothing wrong with going ahead with it. Age discrimination certainly occurs with women as well, and the same holds for them. A facelift can make you look younger, fresher, and more energetic. Your self-confidence may be boosted. However, a facelift is not going to solve significant personal or interpersonal problems. It will not save a marriage or other relationship, it will not improve your sex life, it will not guarantee you that raise, promotion, or job you’ve been waiting for, and it will not treat other health problems in your life. If you are considering a facelift, think about your true motives and whether a facelift is an answer. Be honest with your surgeon so that he may advise you with your decision.
A facelift is a lengthy and complex procedure. It also demands relatively healthy skin if serious complications are to be avoided. Because of this, patients with any significant medical problems including heart, lung, or kidney disease, vascular disease, diabetes mellitus, or autoimmune diseases should in the majority of cases, not have this procedure performed. There are a few rare skin disorders where facelifts should also be avoided. These include progeria, Werner’s syndrome, and Ehlers-Danlos syndrome. Smokers, no matter how few cigarettes they smoke, should not have a facelift performed unless they completely abstain from cigarettes both before and after surgery. The length of time to abstain will vary depending on the surgeon but will be at least two weeks before and two weeks after surgery. A nicotine patch is just as harmful as a cigarette and cannot substitute for abstinence. A smoker who wishes to have a facelift must be honest with themselves and their surgeon or horrible complications can result including loss of a large portion of the skin on the face requiring reconstructive surgery. Finally, patients with unrealistic expectations should avoid this procedure. As discussed above, a facelift is not the answer to major problems occurring in your life. Also, while it may make you look younger and refreshed, you will not look like a teenager. Besides, it will not make you more beautiful or attractive than you ever were. It simply reverses some of the changes that have occurred because of aging. The only way to know if you are being realistic is to talk honestly and openly with your surgeon. You do not want to go through the expense, pain, and risk of surgery only to find that you did not achieve your goal.
You will consult with Dr. Wigoda and discuss exactly what your face bothers you. Even if it is a minor problem, mention it beforehand. Dr. Wigoda will explain the options, discuss exactly what he plans on doing and what you should expect after surgery. Dr. Wigoda will take photographs of your face and may review your photographs with you to make sure you are both in agreement with the goals of the surgery. You may consider letting your hair grow long to help hide the scars while you heal.
The most common significant complication of a facelift is a hematoma – a collection of blood under your skin that develops from a bleeding vessel. It occurs in 1-5% of facelifts. Dr. Wigoda will try to keep your blood pressure low during and after surgery to try to prevent this from happening. He will also try to keep you relaxed and comfortable. If you do get a hematoma you may have to go back to the operating room to remove the blood collection. The most dreaded complication of a facelift is an injury to the facial nerve. This nerve stimulates all of the muscles in your face which allow you to make facial expressions: smiling, frowning, kissing, etc. The most common injury is to a branch of the nerve which allows you to smile. The majority of the time, nerve injury is temporary. It may take anywhere from a few days to a year for the nerve to recover depending on the extent of the injury. If the nerve is cut, the injury will likely be permanent. Luckily, this complication is rare and usually resolves with time. Other potential complications with this procedure are uncommon but can include infection, loss of skin, unattractive scars, asymmetry, pulling the earlobe down, and deep scar formation. Dr. Wigoda has developed his facelift procedure whereby he remains fairly distant from the facial nerve with minimal risk of causing injury to it.
Dr. Wigoda uses general anesthesia for this procedure. You will be completely asleep and not feel anything. Some surgeons are comfortable doing the procedure under local anesthesia with sedation. There may be some discomfort when the surgeon injects the local anesthetic and it may be difficult to lay still for many hours at a time.
Incisions are generally made starting approximately 1 inch above your ear, going down in front of your ear, around to the back of your ear, and then into your hair. The incision in front of the ear is often partly hidden by placing it behind the tragus. (The cartilage “bump” in front of the ear opening). The incision behind the ear is sometimes continued along the hairline in cases where a lot of skin is removed from the lower face and neck. These incisions are made on both sides of the face. Often, an additional incision is made under the chin to tighten the muscles in the neck and remove some of the fat in the neck. All of these incisions will leave scars. However, if placed well, they are often difficult to see.
Each surgeon uses his technique; the one he is most comfortable with. However, there are basic principles and philosophies which are followed. The surgeon needs to decide what the “problem areas” are and how he will improve them. All surgeons will remove some extra skin and tighten the remaining skin. What varies, is what, if anything is done to the deeper structures. The primary deep structure which the surgeon will address is called the SMAS (SubMuscular Aponeurotic System) This is a fascial layer under the skin. Today, most surgeons will tighten the SMAS with the belief that this gives a better and longer-lasting result. Even though more structures are being pulled, the patient is left with a less “pulled look” (which nobody wants). In previous years, when only the skin was pulled, surgeons would put a lot of tension on it, worried that the skin was going to stretch back some. Now, since the deeper structures are pulled as well, the skin does not have to be pulled as much. The “pulled look” is avoided and the patient looks better. Surgeons who claim they can get you back to work in a few days or a week may be telling the truth, but you may have to come back every year or two to get redone because the technique does not produce long-lasting results.
A facelift will take anywhere from 2 to 6 hours depending on how much is done and the surgeon’s experience. A faster facelift is not necessarily a better one.
Depending on the technique used, you may have swelling and bruising for as little as two weeks or up to a few months. Most of the swelling, regardless of technique, will resolve in the first month. For the techniques in which the goal is to obtain a long-lasting result, where the deeper structures are manipulated, the swelling will last longer. Therefore it may take anywhere from one month to six months to see the final result.
Yes. Dr. Wigoda will place one or two drains. The drains come out in the hair behind the ears. The drains are usually removed after 24 to 48 hours.
You will go to the recovery room for 1 to 2 hours. Your vital signs will be monitored. Once you are stable you will be taken home (or to a hotel) by your friend or family member. You will want to stay relaxed and primarily in bed for the first few days. You will need to keep your head elevated and relatively still. You do not want to use any pillows directly behind your head for a few days (that flex your head down onto your chest). You should, however, begin to start walking, eating, and using the restroom the day after surgery. Your dressing and drains will be removed after 1 or 2 days. Your activity can slowly increase each day but it will take up to 2 weeks before you start to feel like your old self again. You should avoid any strenuous activity for 4 weeks.
There may be some bruising, primarily in the neck region. The bruising will usually last 2 weeks but becomes less noticeable each day after surgery. The majority of swelling will be in the face. The swelling will last anywhere from 3 weeks to 3 months depending on the technique used. The majority of the swelling, however, will be gone by 3 to 4 weeks. There may be some pain after surgery, but this is usually controlled with pain pills. By the third day, you may not need anything stronger than Tylenol. You should expect that your face will feel and look very different at first. Your facial features will be distorted or masked by the swelling and your face will feel stiff. You will find that you get tired quickly. Try not to get upset or anxious as all of these changes are expected and will resolve in a short period. Lastly, you may experience some itching around your incision sites. This is not unusual and can be treated with medication. This too will go away after a short period.
You should plan on being off work for at least 2 weeks. If your work is strenuous, you will need more time off. After 2 weeks, it may still be obvious that you had surgery (depending on what was done). If you don’t want anyone to know you had surgery, or you at least want all the bruising and swelling gone before going back to work, ask Dr. Wigoda what the average time for this to occur is in his patients.
Dr. Wigoda will change your dressings during the first week after surgery. In the second week, most patients no longer require dressings.
This depends on what is done, on the patient’s skin and tissue quality, age, habits (sun exposure and smoking), and overall health. When the deeper structures are tightened, the results are longer lasting. In my opinion, this is what the goal should be for the vast majority of patients. Everyone will continue to age, but will always look younger than had they not had the procedure.
You will first have a consultation with Dr. Wigoda to discuss your particular case. Once you have decided to proceed with the surgery and have scheduled a date, you will return for a second visit at which time Dr. Wigoda will review the surgery with you, photos will be taken, consent forms will be signed, and further instructions and prescriptions will be provided. Full payment is made before surgery (or financing is arranged). You will have lab tests drawn and an electrocardiogram performed by your primary care physician (or we will recommend where to do this) one to two weeks before the surgery. Medical clearance may be needed.
You will arrive at the office surgery center. You will not have eaten or drunk anything since midnight the night before. You will be checked in and your vital signs will be taken. You will put on a gown. An intravenous line will be started. Dr. Wigoda will mark your face with a marker. You may be given a sedative in your I.V. to help you relax before you are taken back to the operating room.
Dr. Wigoda will remove the sutures after approximately 7 days.
You may want to wait at least two weeks until your incisions are well on their way toward healing. Early sexual activity may prolong your soreness and discomfort.
Dr. Wigoda was fortunate to train with many pioneers of facelift procedures in Dallas. He has combined the best aspects of each technique to create his facelift procedure. The technique he uses causes minimal pain, has natural results, and is long-lasting. The vast majority of patients are quite surprised afterward at how little discomfort they have and how quickly they return to normal activity. Most patients have minimal bruising. Finally, with Dr. Wigoda’s technique for skin closure, scars are typically minimal and are often difficult to see once they have fully matured.
The technique chosen for your surgery depends on your features, Dr. Wigoda’s preferences, and your desired results. One common method is the coronal incision technique. Using this technique, an incision is made across the top of the scalp, beginning above the ears and concealed within the hair. Sometimes the incision may be placed at the front of the hairline. The incision is designed to be inconspicuous when healed. Working through this incision, Dr. Wigoda can modify or remove parts of the muscles that cause wrinkling and frown lines, remove excess skin, and lift your eyebrows to a more pleasing level. A new technique performed by Dr. Wigoda is the endoscopic browlift.
Three to five small incisions are made behind the hairline. A camera and specially designed instruments are used to raise the brow and weaken the muscles that cause wrinkling and frown lines. the recovery period is quicker, the risk of scalp numbness and hair loss is reduced, and the results are excellent. You may be a good candidate for a forehead lift if you have any of the following types of conditions:
For frequently asked questions about this procedure click here
Both women and men are candidates. Most commonly, the procedure is performed on those over the age of 40. Very frequently, a patient presents for a facelift or a blepharoplasty (eyelid surgery) with the complaint of looking tired, sad, or angry when they are not. Coworkers may make comments to them regarding how tired they look. Friends may think they are angry at them when they are not. Without realizing it, the cause of this tired or angry appearance is not the eyelids or the face, but the brow. If the brow is low toward the middle of the forehead, it gives an angry appearance. If it is low toward the outside, it gives a tired look. This can be dramatically improved by simply lifting the brow. The second group of patients is those who do not particularly look angry or tired but are simply aging and appear older than they would like. They often present to the surgeon for a facelift or eyelid surgery. Because brow lifts are only recently becoming popular, they have not thought about a brow lift or possibly even heard of it. Most patients who are candidates for a facelift and/or eyelid surgery will benefit from a brow lift. In fact, if a patient has a facelift and blepharoplasty but not a brow lift, their face may appear somewhat out of harmony with a youthful lower face and an aged forehead. Finally, the third group of patients who would benefit from a brow lift is those who have very prominent wrinkles in the forehead. These may be either the transverse or the vertical wrinkles. These can be significantly reduced by cutting the muscles which cause them.
There are not many contraindications to a brow lift. Some patients may be better candidates for one type over the other, ie, open versus endoscopic. Patients with significant health problems or those who are smokers and are unwilling to quit should not have this procedure.
The primary risks associated with this procedure are numbness of the forehead skin and scalp, loss of hair near the incisions, the descent of the brow to its original position, asymmetry of the eyebrows, asymmetry of the wrinkle lines, lateral displacement of the eyebrows, an elevated and unnatural appearing hairline (with open technique), and inability to raise the brow or wrinkle the forehead. Many of these complications are temporary or can be corrected with additional surgery. The overall risk of developing a significant complication is small.
You will consult with Dr. Wigoda and discuss exactly bothers you about your brow. Even if it is a minor problem, mention it beforehand. Dr. Wigoda will explain the options, discuss exactly what he plans on doing and what you should expect after surgery. Dr. Wigoda will take photographs of your face and may review your photographs with you to make sure you are both in agreement with the goals of the surgery. You may consider letting your hair grow long to help hide the scars while you heal.
You will need to avoid aspirin and aspirin-containing products for 2 weeks before surgery. Also, completely quit smoking at least two weeks before surgery. You should avoid getting a suntan as well. If you use skin rejuvenation creams like Retin-A or Renova, stop using these 1-2 weeks before surgery.
Dr. Wigoda uses general anesthesia for this procedure. You will be completely asleep and not feel anything.
Although many techniques have been used in the past, there are basically two techniques that I feel are safe and work well. These are the open “classic” technique and the endoscopic technique. With the open technique, an incision is made across the top of the head, from the top of one ear to the other. The scalp and forehead skin is then lifted and pulled back. The excess skin is then removed and the incision closed. This procedure can raise your hairline between 1 and 2 centimeters. If your hairline is high already, there are alternative incisions (‘hairline incision”) that can be used. Using the endoscope, three to five small incisions are made just behind the hairline. The endoscope is simply a tube with a camera attached to it that allows the surgeon to see inside the body without making a large incision. With the endoscope in one incision and an instrument in another incision, the scalp and forehead skin is lifted off of the bone. Sutures are then placed from the undersurface of the skin down to the bone to raise and hold the brow. The small incisions are closed. No extra skin is removed. With either technique, the muscles which cause the wrinkles in the forehead can be totally or partially cut to minimize the wrinkles. Other techniques involved making incisions in the forehead skin just above the brow and cutting this skin out to pull the brow up. In general, these leave unattractive and visible scars and should be avoided.
In the open approach, the incision is rather long, extending from one ear to the other, going over the top of the head. With the endoscopic technique, the incisions are generally about 1.5 to 3 centimeters in length. Because all of the incisions are hidden by the hair, they are usually not noticeable at all. Men who are bald or balding can still have this procedure done with the endoscope as the small incisions can be hidden relatively well, even if there is no hair to hide them.
It is not uncommon to place a drain in the forehead during the surgery. This is often removed after one day.
The brow lift will take one to two hours. Often it is done in conjunction with other procedures like blepharoplasty or facelift.
There will be some swelling in the forehead and scalp region. This will resolve in a few weeks. After one month you should be able to see the final results.
You will go to the recovery room for 1 to 2 hours. Your vital signs will be monitored. Once you are stable you will be taken home (or to a hotel) by your friend or family member. You will want to stay relaxed and primarily in bed for the first few days. You will need to keep your head elevated and relatively still You should, however, begin to start walking, eating, and using the restroom the day after surgery. Your dressing and drains will be removed after 1 or 2 days. Your activity can slowly increase each day but it will take up to 2 weeks before you start to feel like your old self again. You should avoid any strenuous activity for 4 weeks.
There will be a small amount of bruising in the forehead region and possibly even around the eyes and in the cheeks. The bruising will usually last 2 weeks but becomes less noticeable each day after surgery. There will be some pain after surgery, but this is usually controlled with pain pills. By the third day, you may not need anything stronger than Tylenol. Lastly, you may experience some itching around your incision sites. This is not unusual and can be treated with medication. This too will go away after a short time period.
The brow should remain elevated and the wrinkles in the forehead should appear less prominent for many years. The aging process obviously does not stop but the overall improvement in appearance may last a lifetime.
You should plan on being off work for at least 2 weeks. If your work is strenuous, you will need more time off. After 2 weeks, it may still be obvious that you had surgery (depending on what was done). If you don’t want anyone to know you had surgery, or you at least want all the bruising and swelling gone before going back to work, ask Dr. Wigoda what the average time for this to occur is in his patients.
Dr. Wigoda will change your dressings during the first week after surgery. In the second week, most patients no longer require dressings.
You will first have a consultation with Dr. Wigoda to discuss your particular case. Once you have decided to proceed with the surgery and have scheduled a date, you will return for a second visit at which time Dr. Wigoda will review the surgery with you, photos will be taken, consent forms will be signed, and further instructions and prescriptions will be provided. Full payment is made prior to surgery (or financing is arranged). You will have lab tests drawn and an electrocardiogram performed by your primary care physician (or we will recommend where to do this) one to two weeks prior to the surgery. Medical clearance may be needed.
You will arrive at the office surgery center. You will not have eaten or drunk anything since midnight the night before. You will be checked in and your vital signs will be taken. You will put on a gown. An intravenous line will be started. Dr. Wigoda will mark your face and scalp with a marker. You may be given a sedative in your I.V. to help you relax before you are taken back to the operating room.
Dr. Wigoda will remove the sutures and or staples after approximately 7 to 10 days.
You may want to wait at least two weeks until your incisions are well on their way toward healing. Early sexual activity may prolong your soreness and discomfort.
Dr. Wigoda was fortunate to train with many pioneers of facelift procedures in Dallas. He has combined the best aspects of each technique to create his own browlift procedure. The technique he uses causes minimal pain, has natural results, and is long-lasting. The vast majority of patients are quite surprised afterward at how little discomfort they have and how quickly they return to normal activity. Most patients have minimal bruising.
You may be a good candidate for rhinoplasty if you have any of the following conditions:
The technique used for your surgery depends not only on Dr. Wigoda’s preferences but also on your desired results. Alterations may be made to increase or decrease the nasal bridge, reduce the size or width of the nose, narrow the nostrils, reshape the tip, or change the angle between the nose and the upper lip.
Rhinoplasty is performed on men and women of almost all ages. It is a common procedure for teenagers, those in their ’20s to ’40s, as well as for those in their 50’s or 60’s who are unhappy with the way their nose has changed as they aged. As long as there are realistic expectations, most people who are unhappy with the appearance of their nose and can specify what really bothers them, are candidates.
As long as the person is in good health and does not smoke for at least 2 weeks before the surgery, there are no major contraindications to the procedure. It is very important, though, to understand the goals of the procedure, and have realistic expectations.
The surgery can take anywhere from 30 minutes to 3 hours depending on the technique used and the complexity of the case. The average time is 2 ½ hours.
The nose can swell considerably after surgery. It takes approximately 1 month for 80% of the swelling to go down. It may take 6 months to 1 year for all the swelling to be gone and to see the final result.
Dr. Wigoda does not use packing but rather a splint inside and outside the nose.
If the nasal bones are broken, there will be a fair amount of swelling and bruising around the nose and eyes. The bruising will take 1 to 2 weeks to disappear. The majority of the swelling will be gone in 1 month. There is some discomfort for the first 3 to 5 days that is alleviated with pain pills.
The technique is generally divided into a “closed” or an “open” technique. The closed technique was by far the more common way to do it up until the last few years when the open technique has gained more popularity. In the closed technique, incisions are made inside the nose and the bone and cartilages are partially removed and/or reshaped. In the open technique, the same internal incisions are made but a small incision is also made on the skin of the bottom of the nose (columella). This allows the skin to be lifted off the nose and allows the surgeon to see the cartilage and bone much better. Many surgeons feel that they can be more precise in doing the procedure this way. The incision on the columella heals very well and leaves a very small scar that is difficult to see. Dr. Wigoda uses the open technique in the majority of cases.
They are made on the inside of the nostrils and, if using the open technique, on the columella (the skin separating the two nostrils).
In the majority of cases, patients have a wide nasal base. By fracturing the nasal bones, the width of the nose can be reduced. While the bones do not have to be broken, reducing the width of the nose will often make the nose more attractive.
The incisions on the inside of the nose are not visible. The incision on the outside leaves a very fine scar that is difficult to see once it has healed. It measures only about 4 to 5 millimeters.
Risks include a worsened appearance, scar deformity, asymmetry, worsened breathing, hole (defect) in the septum, and prolonged bleeding. These are all relatively rare.
The surgery is usually done under general anesthesia.
Dr. Wigoda will remove the bandages after 7 days.
If the rhinoplasty is done with the open technique, the sutures come out at 7 days. Sutures placed in the inside of the nose are absorbable and will fall out after a few weeks.
You will see Dr. Wigoda after 7 days to remove the dressing, and then periodically to make sure you are progressing as you should.
The results essentially last a lifetime. As you age, however, the nose will change in shape to some degree.
Dr. Wigoda will ideally want to see you after 6 months, 1 year, and 2 years to check your progress.
You will first have a consultation with Dr. Wigoda to discuss your particular case. Once you have decided to proceed with the surgery and have scheduled a date, you will return for a second visit at which time Dr. Wigoda will review the surgery with you, photos will be taken, consent forms will be signed, and further instructions and prescriptions will be provided. Full payment is made prior to surgery (or financing is arranged). You will have lab tests drawn and an electrocardiogram performed by your primary care physician (or we will recommend where to do this) one to two weeks prior to the surgery. Medical clearance may be needed.
You will arrive at the office surgery center. You will not have eaten or drunk anything since midnight the night before. You will be checked in and your vital signs will be taken. You will put on a gown. An intravenous line will be started. Dr. Wigoda will mark your nose with a marker. You may be given a sedative in your I.V. to help you relax before you are taken back to the operating room.
Bandages will be placed on your nose. You will recover for 1 to 2 hours in the recovery room. You will then be driven home by a friend or family member. Your activities will be limited for the first few days. It is advisable that you not drive for at least 3 to 5 days after surgery. You will be seen 7 days after surgery for removal of the splints and sutures. As the pain and swelling decrease, you will be able to resume normal activities. Dr. Wigoda will allow you to resume strenuous exercise after 4 to 6 weeks.
You may want to wait at least two weeks until you are well on your way toward healing. Early sexual activity may prolong your soreness and discomfort.
Dr. Wigoda was fortunate to train with many pioneers of rhinoplasty procedures in Dallas. He has combined the best aspects of each technique to create his own rhinoplasty procedure. The technique he uses causes minimal pain and has natural results.
Otoplasty is usually performed as an outpatient procedure, either in the hospital or our South Florida cosmetic center. The surgery is performed under general anesthesia or local anesthesia with intravenous sedation. The procedure usually takes between two and three hours if both ears are operated on. With cutting-edge technology and expert hands, our surgeon performs a combination of procedures to create a natural fold with little to no indication of minor scarring.
Whether through birth or injury, ear defects can be improved through an ear surgery procedure known as otoplasty. The operation treats macrotia (overly large ears), protruding ears, and even corrects prior surgical work for a more natural, balanced appearance to the ears and face. Our qualified surgeon creates a seamless experience by reshaping, moving, and augmenting the external ear for a long-lasting transformation. Post-surgical results have shown to have a great impact on self-esteem, boosting confidence, and awarding comfort to those who otherwise felt bothered by their protruding or disfigured ears.
Children are able to undergo the surgery after the ages of four or five, but should not feel insisted unless they want the change. In many instances, children who are teased about their misshapen ears develop a highly insecure mentality, leading to poor adaptation in school and social settings. If a child feels uncomfortable about their ears and is ready for modification, they are generally more cooperative during the process and happier with the outcome. Adults are able to receive treatment as well.
Recovery is made as effortless as possible with the proper care. After the operation, the head is wrapped in a protective bandage. Medication can be taken to relieve any slight discomfort and within a few days, the bandages can be replaced with a lightweight headband to be worn while sleeping, in order to prepare for the removal of stitches within a week. Any rigorous activity in which the ear might be bent should be avoided for a month or so. Most adults can go back to work about five days after surgery.
Children can go back to school after seven days or so, and must be cautious about playground activity. Our team at Dr. Wigoda’s South Florida cosmetic center ensures a comprehensive surgery for results that last a lifetime. Remove the self-conscious mindset associated with you or your child’s ears for a positive outlook on an appearance that gives you the confidence you’ve earned.
The procedure takes only a few minutes, anesthetics are not required. The injection is made into the muscle with a very fine needle. Dr. Wigoda will determine the muscle(s) in need of treatment and administer the one to three injections necessary.
A very fine needle is used for the one to three injections that are usually given per muscle. Some patients report minor and temporary discomfort from treatment, although pain is alleviated within a few minutes.
Usually, you will see the effects of BOTOX® within three days. The maximum benefit is reached in one to two weeks.
The results you will see from a single treatment of BOTOX® will normally be sustained for approximately three to six months. You will notice a gradual fading of its effects. At this point, you will return for your next treatment. Over time with multiple treatments, the muscles are trained to relax, and the lines and wrinkles appear less severe than when you first began Botox treatment.
BOTOX® should not be used during pregnancy, if you are nursing, or if you are taking certain medications. Botox does not treat all wrinkles. A consultation with Dr. Wigoda prior to scheduling your procedure is recommended.
Treatment with BOTOX® can typically be repeated indefinitely. It has been used for over 10 years worldwide. Acceptable safety in long-term treatment has been established.
The most common side effect is temporary bruising of the treated area. Headaches within the first 24 to 48 hours can occur but are not common. A minute percentage of patients can experience eye drooping, but that resolves itself within 3 weeks. This happens if patients rub the treated area within 12 hours after injection or lay down for an extended period after the injection has been administered.
There are different types of Juvederm injectable gel fillers you can choose from. JUVEDERM VOLUMA XC is an injectable gel for deep injection in the cheek area to correct age-related volume loss. JUVEDERM XC is for the correction of facial tissue from moderate to severe facial wrinkles and folds. JUVEDERM Ultra XC and JUVEDERM VOLBELLA XC are for lip augmentations. Juvederm is an FDA-approved dermal filler that will improve the elasticity of your skin through a gel implant that includes hyaluronic acid, a natural complex sugar that promotes a smooth, supple appearance.
Restylane is a clear gel formulation of hyaluronic acid that acts like your body’s own naturally produced hyaluronic acid. Clinical studies show that patients who were injected with Restylane for the treatment of facial folds achieved an optimal cosmetic result. These results were sustained for a longer period of time than collagen. It can be used on smile lines, marionette lines, and the corners of the mouth. Restylane and Restylane Silk are FDA-approved for fuller and more defined lips.
Radiesse is made of calcium hydroxyapatite microspheres in a gel form. Once it’s injected it provides immediate volume and correction and continues to work by stimulating the body to produce its own natural collagen. Over time, the gel is absorbed, and the body can metabolize the calcium hydroxyapatite microspheres, which allows for your own natural collagen to take its place. It immediately fills the volume lost in your skin and allows for the production of your own natural collagen, which can last up to a year or more.
Botox is a therapeutic, muscle-relaxing agent that works at motor nerve endings (nerves that leads to muscles). It is made from a neurotoxin called botulinum, which is produced by the bacterium called Clostridium botulinum, an organism found in the natural environment where it is largely inactive and non-toxic. By paralyzing and stopping the nerves in the muscles, Botox is used to reduce fine lines and wrinkles. Patients can also utilize Botox for treating excessive sweating disorders and migraines. You can read more about Botox here.
Oftentimes, women and men seek different means to look and feel refreshed, rejuvenated, and youthful – without aggressive surgical procedures. With the right combination of diet and lifestyle, there are great benefits to PRP treatments for people of all ages.
PRP is becoming one of the most sought after and effective means of plastic surgery and corrective cosmetics, and it’s not just limited to PRP for facial rejuvenation. Growth factors found in your own blood, specifically platelets, are revolutionizing sexual arousal with the PRP for women’s sexual health, as well as PRP for men’s sexual health. This type of treatment is also making strides in the fight to reverse hair loss. Because PRP is derived from your blood and stimulates your own stem cell response, there is very little risk in undergoing the treatment.
The PRP for facial rejuvenation is a custom-designed procedure building on long-known plastic surgery techniques and adding in the newly established technology of PRP (platelet-rich plasma) and stem cells. Dermal fillers like Juvéderm, which contain the natural compound hyaluronic acid, and the new PRP techniques are combined with Dr. Wigoda’s plastic surgery expertise to give you a new lease on your skin. Younger, softer, and more beautiful skin that beams your inner confidence is the result – and that’s the promise of the PRP for facial rejuvenation at our South Florida cosmetic center.
For transgender males to female patients, breast augmentation is an option to create larger, more feminine breasts. Hormone therapy is often the first treatment option but the results are variable and may be limited in comparison to what can be achieved with implants. Breast augmentation with implants is a reliable way to enlarge and feminize the breast and helps to improve self- image and gender dysphoria.
Dr. Wigoda is well known for his painless breast implant technique and uses the same technique for transgender females. Other feminizing procedures including rhinoplasty, facial procedures, and liposuction can be done at the same time as the breast augmentation. The preparation, surgical procedure, and recovery are similar for all women. For more information on breast augmentation, please visit our “painless breast implants” page
DING is the most common form of FTM Top Surgery. Generally speaking, it is the most effective and reliable option for the majority of patients. The procedure includes horizontal incisions in the region of the breast fold which results in two scars just below the pectoral muscles. The scars can extend laterally along the chest wall in patients who have excessive skin in this area. The procedure includes removal of the nipples and areola from the breast, resizing of the nipple and or areola if needed, and grafting the nipple and areola at the appropriate anatomic location.
Liposuction of the chest, lateral chest and even the upper back region may be done as part of the procedure to achieve the best result. Patients considering this procedure should take into account the length of the scars and the likely loss of nipple sensation with the nipple grafts.
Patients who have smaller breasts may choose to have either a Periareolar or Keyhole Mastectomy. The Keyhole Mastectomy is performed in patients who have no excess skin, through a small incision at the outer edge of the areola. A complete sub-cutaneous mastectomy is performed through this incision. Liposuction of the chest may also be done as part of the procedure. If there is a small amount of excess skin then a complete peri-areolar incision is made. A small circle of skin is excised. A subcutaneous mastectomy is performed. The outer edge of the skin is closed with a purse-string suture to the newly down-sized areola.
Potential issues with these procedures include not being able to tighten the skin as much as with the DING procedure, pleating or bunching of the scar around the areola with a possible need for future scar revision, and loss of the nipple if it does not retain enough blood flow. The nipple position cannot be controlled or changed by Dr. Wigoda. There may be limits regarding whether the nipple or areola can be reduced in size at the same time. Numbness of the nipple is also possible. The primary benefit is less visible scars.
There are other less common procedures for Top Surgery. The Inverted-T is designed to preserve nipple sensation. The procedure requires saving breast tissue to keep the areola and nipple vascularized. The benefit of the procedure is that there is no grafting of the nipple and there is a greater possibility but no guarantee that sensation will be preserved. The disadvantage is a vertical scar from the nipple to the lower scar, a potentially larger breast since some breast tissue must be preserved, and the inability to place the nipple exactly where you would like. The buttonhole procedure is essentially the same as the Inverted-T without the vertical scar. Neither of these procedures is likely to be the optimal procedure for most patients.
The resulting scars after these procedures are certainly a topic that needs to be and will be discussed with Dr. Wigoda. With that being said, the majority of patients are much happier after surgery than before surgery, regardless of the scars. Dr. Wigoda will make every attempt to create the shortest possible scars while providing the best possible contour. For the DING procedure, the scars will end up along the region of the breast fold and may extend laterally along the lateral chest, depending on the patient’s anatomy.
At the completion of the procedure, the incisions will be sutured as a thin line. Patients will be encouraged to use scar treatments to optimize the result. However, everyone heals differently. The width, color, and thickness of the scar will vary from one person to another depending on their own genetics along with their compliance with using scar products, avoiding the sun, and following post-operative instructions. It will take one to two years for the scar to mature and to see what the final scar will look like.
Patients who have had FTM top surgery done elsewhere may wish to have a revision of their chest. Some patients may not have had the optimal procedure done for them or the procedure they had was not done well. Dr. Wigoda is willing to evaluate these patients to see if their results can be improved. In some cases, it may be a minor correction that can be done under local anesthesia but in others, it may be more involved and require general anesthesia.
Many patients will request to have Body Masculinization Surgery procedures done during the same surgery as the FTM Top Surgery. Most patients will be candidates to combine these procedures in one setting. The benefits include one recovery period, one trip if the patient lives out of the area, and some savings in the cost of the combined surgeries as compared to costs if done separately. The most common procedure includes Power Assisted Liposuction to masculinize the body. Areas that may be of concern include the back, abdomen, hips, flanks, buttocks, and inner/outer thighs.
For patients with excess skin in the lower abdomen, a tummy tuck (abdominoplasty) can also be considered. The cost of the liposuction will vary depending on the number of areas and the amount of fat that needs to be removed
Dr. Wigoda accepts cash, credit card, or medical financing. He does not accept insurance, Medicaid, or Medicare. After surgery, if you wish to submit a claim to your insurance we can provide you will a letter and a copy of the operative report. The cost of the surgery will vary depending on exactly what procedure will be done and how long the procedure may take. If you complete our virtual consult with photos, we can give you an estimate via email. The surgery will usually be performed in our outpatient surgery center. Dr. Wigoda does have privileges at local hospitals where the surgery can be performed if the patient prefers a hospital setting or overnight hospital stay (this is not common or necessary but is available).
For patients who live locally: For an in-office consultation, the easiest way to schedule is to simply call the office at 954-463-7088. The consultation is free. If you would like to do a virtual consult before coming to the office that is perfectly fine. Please fill out the virtual consult form and submit photos. Dr. Wigoda will evaluate the information and reach out to you himself.
For out of town patients: It is best to start with our virtual consult form (link to virtual consult). Please fill this out and include photos. Dr. Wigoda will email you back with his thoughts and opinion and will be happy to answer any questions.
Patients will be provided with prescriptions and detailed instructions for their recovery after surgery. Patients will generally need to return to the office the day after surgery to be checked and have the dressing changed. For local patients, there will be multiple follow up visits over the next few weeks. For out of town patients, it is ideal that they stay in town for at least one week. Dr. Wigoda encourages patients to stay at the New Beginnings Retreat (http://newbeginningstlc.org/) where the staff is very experienced in taking care of FTM patients.
They will provide transportation to the office. Dr. Wigoda has extensive experience in “painless surgery” techniques. For most patients, there is minimal pain and discomfort. Patients are restricted from exercising, heavy, lifting, and swimming for at least four weeks. Patients are able to raise their arms immediately after surgery.
Complications are not common but are possible with any surgical procedure. For FTM top surgery these include bleeding, infection, nipple complications (loss of all or part of the nipple, loss of sensation, hypersensitivity, and loss of pigment), contour deformity, and unattractive scarring.
A private consultation is the best way to get answers specific to you.
